Background Adherence to exercise interventions is often suboptimal, despite numerous studies documenting barriers and facilitators. Usability may be a critical yet underexplored determinant of adherence. This study aimed to develop and assess the psychometric properties of the Intervention Usability Scale for Exercise (IUSE). Methods Item generation and content validation involved cognitive interviews and feedback from eight exercise intervention stakeholders and ten target users from the general public. Subsequently, 526 target users from University, Qualtrics and Prolific participant panels assessed exercise programs through an online survey. Dimensionality was assessed using Principal Component Analysis (PCA), Exploratory Factor Analysis (EFA), and bifactor models. Item reduction was conducted through Item Response Theory (IRT) graded response models, assessing discriminability, item information levels/patterns and differential item functioning. Test-retest reliability was assessed using Pearson’s r. Subsequently, short vs. original scale versions were compared. Finally, evidence of criterion, convergent, and discriminant validity was assessed. Results Thirty-six items were initially included, with 16 removed due to low test-retest reliability and factor loadings (r < 0.50). A 3-factor structure emerged from EFA, PCA, and bifactor models: Value, Ease, and Social. Iterative IRT evaluation led to 12 item removals, resulting in 8 final items across three subscales. Validity analyses indicated good convergent (e.g., r = 0.79 with Intervention Appropriateness Measure, r = 0.65 with Intervention Usability Scale), criterion (e.g., r = 0.71 with Net Promoter Score and 0.75 with intention measures), and discriminant validity (r = 0.42 with External Motivation), along with satisfactory internal consistency (Cronbach's alpha: 0.79-0.84). Conclusions The IUSE scale demonstrated promising psychometric properties. Application of the scale with collection of actual uptake/adherence data is needed to assess predictive validity.

Abstract Background Previous cross-sectional studies report an association between psychological distress and severity of pain and symptoms in patients with longstanding non-arthritic hip and groin pain (LHGP). However, there is a lack of longitudinal studies exploring changes in psychological distress over time, and whether these changes relate to changes in pain and symptoms in LGHP patients. This study aimed to assess any changes in patient-reported psychological distress in patients with LHGP from the time of referral to orthopedic care to a follow-up three years later. An additional aim was to explore the relationship between changes in psychological distress and changes in patient-reported pain and symptoms from baseline to the three-year follow-up. Methods Eighty-one patients who had previously participated in a cross-sectional study were invited for follow-up three years after their referral for orthopedic care due to LHGP. The Kessler Psychological Distress Scale (K-10) was used to assess psychological distress, and the subscales for pain and symptoms in the Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess pain and symptoms. The Wilcoxon signed-rank test was used for comparisons of K-10 scores from baseline to follow-up, and Spearman’s rank order correlation was used to examine the association between changes in K-10 scores and changes in HAGOS scores. Results Forty-five (56%) patients participated in the follow-up. No significant group-level change in the K-10 total score was found from baseline to the three-year follow-up (median change 0.0, IQR − 4.25; 4.25, p = 0.792). Significant improvements in the HAGOS subscales for pain (mean change 14.3, 95%CI 7.8;20.8) and symptoms (16.4, 95%CI 8.9;24.0) were reported ( p < 0.001). A moderate association was observed between changes in the K-10 total score and changes in the HAGOS subscale for pain (r s =-0.436, p = 0.004) and symptoms (r s =-0.431, p = 0.005) from baseline to the three-year follow-up. Conclusions Despite no significant group-level change in psychological distress, reductions in psychological distress were moderately associated with improvements in pain and symptom scores. The relationship between psychological distress and hip and groin pain and symptoms highlights the importance of considering both physical and psychological factors in patient management.

INTRODUCTION:People with longstanding hip and groin pain (LHGP) are often referred to orthopaedic care. Physical therapist-led interventions are recommended in consensus statements as the first line of treatment, but it is unknown if structured interventions are more effective than usual care. The aim of this trial is to evaluate the effectiveness of a structured physical therapist-led treatment model (HIPSTER) compared with usual care on hip-related quality of life at 4 months for people with LHGP referred to orthopaedic care. METHODS AND ANALYSIS:This is a preregistered (clinicaltrials.gov, NCT05853640) study protocol for a double-blinded two-armed pragmatic randomised controlled trial. Patients with LHGP (n=122), referred to the Department of Orthopaedics at a university hospital in Sweden, will be randomised into the HIPSTER model or usual care. The HIPSTER model is a 16-week structured, individualised progressive treatment using exercise therapy and patient education. Usual care consists of a recommendation to contact a physical therapist in primary care. Both groups will undergo standard examinations and a surgical consultation at the Department of Orthopaedics. The primary outcome will be the mean group change in the International Hip Outcome Tool from baseline to 4 months, according to intention-to-treat principles. Secondary outcomes include patient-reported outcomes (such as perceived improvement, psychological factors and physical activity), physical impairment tests and radiographic measures. Additional time points will be 1, 2 and 5 years after baseline. Subgroups of patients will complete semistructured interviews and report additional data on psychosocial variables to provide more information on patient experience as well as determinants of adherence. ETHICS AND DISSEMINATION:The Swedish Ethical Review Authority approved this study (Dnr 202205023-01). The results of this study will be published, regardless of results, in scientific journals and as plain language summaries for participants. TRIAL REGISTRATION NUMBER:NCT05853640.

Sport-related concussion (SRC) is a common and complex injury in athletic populations. Linear head acceleration (LHA) and rotational head acceleration (RHA) are key biomechanical factors believed to contribute to SRC, each through distinct mechanisms. Evaluating head impact magnitudes across different sports, athlete populations, and measurement methods is essential for advancing SRC injury prevention and risk assessment. We aimed to examine linear and rotational head acceleration magnitudes associated with SRC impacts in athletes participating in team sports across all ages and both sexes. We conducted a systematic review and meta-analysis adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases (MEDLINE, Scopus, SPORTDiscus) until 4 September, 2024, and the literature search was updated on the 10 November, 2025. Observational and experimental studies reporting peak LHA and/or RHA during SRC impacts in team sport athletes were included. Data were extracted on study characteristics, instrumentation, and head impact magnitudes. The risk of bias was assessed using the National Institutes of Health Quality Assessment Tool, and the certainty of the evidence was evaluated using GRADE. Random-effects meta-analyses were conducted to compare SRC and non-concussive impacts, and subgroup analyses were performed by sport type, age group, sex, session type, and instrumentation type, reporting standardized mean difference and mean difference. Between-group differences were assessed using Qb statistics, and heterogeneity was evaluated using the I2 statistics. Sensitivity and publication bias analyses were also performed. Data from 30 articles representing 3262 athletes (12

OBJECTIVES:To evaluate the test-retest reliability of a novel laboratory-based protocol for inducing and measuring head acceleration in multiple directions under anticipated and unanticipated conditions. DESIGN:Laboratory-based test-retest reliability study. METHODS:Thirty physically active adults (50% female) completed standardized head perturbations using a custom-built apparatus. Perturbations were applied in flexion, extension, lateral flexion, and rotation under both anticipated (cervical muscle pre-activation) and unanticipated (no cervical pre-activation) conditions across two sessions conducted within one week. Peak linear head acceleration (g) and rotational head acceleration (rad/s2) were recorded using a motion capture system. Reliability was assessed using intraclass correlation coefficients (ICC3,1), standard error of measurement (SEM%), and Bland-Altman plots. RESULTS:For anticipated perturbations, both linear head acceleration and rotational head acceleration demonstrated good to excellent test-retest reliability (intraclass correlation coefficient 0.75-0.90), with SEM% ranging from 3.52% to 8.54%. For unanticipated perturbations, reliability was within the moderate to good range (intraclass correlation coefficient 0.72-0.85), with SEM% ranging from 3.99% to 11.72%. Bland-Altman plots indicated no systematic differences between sessions and no evidence of heteroscedasticity. CONCLUSIONS:Linear and rotational head acceleration showed moderate to excellent reliability across multiple directions and anticipatory conditions, supporting the utility of this laboratory protocol for head impact biomechanics research. Unanticipated perturbations and rotational accelerations were more variable, likely reflecting the complexity of reflexive and asymmetric neuromuscular responses. Together, these findings provide a methodological foundation for future studies on head impact biomechanics and cervical neuromuscular function.

OBJECTIVES:To compare head acceleration between blind football players and non-disabled football players, and between anticipated and unanticipated conditions in blind football players. DESIGN:Laboratory-based exploratory study. METHODS:Participants were ten football players (five blind football, five non-disabled; 80% female). Standardized head perturbations were applied in flexion, extension, lateral flexion, and rotation using a custom-built apparatus, under both anticipated and unanticipated conditions. Peak linear (g) and angular (rad/s2) head accelerations were measured. RESULTS:Between-group comparisons did not reveal statistically significant differences; however, a descriptive pattern was observed for peak angular acceleration during rotational perturbations, with blind football players demonstrating higher values in both anticipated (44.75 ± 4.38 vs. 38.09 ± 7.20 rad/s2; p 0.12) and unanticipated (48.0 ± 4.8 vs. 40.9 ± 5.5 rad/s2; p 0.06) conditions. In blind football group, unanticipated perturbations produced higher accelerations than anticipated, with the largest descriptive differences observed in lateral flexion for both peak linear (0.25 ± 0.03 vs. 0.21 ± 0.03 g; p 0.00) and angular accelerations (21.73 ± 4.71 vs. 18.36 ± 6.45 rad/s2; p 0.24). CONCLUSIONS:Descriptively higher peak angular acceleration during rotational trials was observed in blind football compared to non-disabled football players, alongside consistently higher head accelerations in unanticipated than anticipated conditions. While the observed patterns suggest that anticipatory control may influence head acceleration responses, adequately powered studies are needed to confirm the observed directional trends in angular head acceleration between blind football and non-disabled football players and clarify their implications for sport-related concussion prevention strategies in blind football.

OBJECTIVE: To evaluate a 3-month post-hip arthroscopy rehabilitation program within a randomized controlled trial comparing hip arthroscopy to sham surgery for femoroacetabular impingement syndrome (HIP ARThroscopy International [HIPARTI] trial) by describing exercise adherence, type, and pain; 6-month changes in International Hip Outcome Tool-33 (iHOT-33); and physical impairments and functional performance. DESIGN: Exploratory cohort study nested in a pilot randomized controlled trial. METHODS: Participants aged 18 to 50 years with femoroacetabular impingement syndrome completed a 3-month, physical therapist-led, postsurgical rehabilitation program, self-reporting rehabilitation adherence and pain levels on the visual analog scale using weekly training diaries. Baseline to 6-month changes in quality of life (iHOT-33), physical impairment (hip strength, range of motion [ROM]), and functional performance (single-leg hop, side bridge endurance) were reported as mean (standard deviation). RESULTS: Twenty-nine people (37% female, 29.9 ± 7.9 years) participated. Hip extension, abduction, and functional exercises were performed most often. Exercise adherence analysis was limited by underreporting. Training diary data adequate to assess adherence were available for 20 participants (69%). Among those with available data, 16 (80%) met the predefined adherence target of ≥2 sessions per week, and average pain remained acceptable (<2 visual analog scale); iHOT-33 (+18.6 ± 22.5; 95% confidence interval: 10.2, 27.0) and hip flexion ROM (+6°; 95% confidence interval: 2.14, 9.60) improved significantly. Hip extension, adduction, external and internal rotation strength improvements exceeded the minimal detectable change, although they were not significant. CONCLUSION: Adherence was generally high among participants with available data, though limited by underreporting. Hip-related quality of life (iHOT-33) improved despite limited changes in physical impairments, and no improvement in functional performance. J Orthop Sports Phys Ther 2026;56(7):456-464. Epub 23 April 2026. doi:10.2519/jospt.2026.13775.

BACKGROUND: Neuromuscular exercise is commonly used in knee injury prevention programs and in rehabilitation following knee injury, and can also be used to address functional impairments is middle-aged and older individuals with knee and hip osteoarthritis (OA). CLINICAL QUESTION: What is neuromuscular exercise for OA? Why should clinicians use it? And how? Nine themes of common questions from exercise therapists new to neuromuscular exercise are addressed. KEY RESULTS: Neuromuscular exercise aims to improve sensorimotor control and obtain joint stability. Exercises are mainly performed in weight-bearing positions, involving multiple joints and muscle groups, to resemble activities of daily life using commonly available and inexpensive equipment. Neuromuscular exercise should be adapted to the individual and is preferably delivered under the supervision of a trained and experienced exercise therapist. Neuromuscular exercise is safe in terms of serious adverse events and pain flares, and associated with a positive change in pain, function and quality of life like other types of exercise for OA. CLINICAL APPLICATION: Neuromuscular exercise can be used as an alternative to, or in addition to, aerobic exercise and strength training in individuals with hip and knee OA. J Orthop Sports Phys Ther 2025;55(8):1-9. Epub 18 June 2025. doi:10.2519/jospt.2025.13041.

OBJECTIVE:To synthesise evidence related to the dissemination and implementation (D&I) of injury prevention interventions for female, woman and/or girl (female/woman/girl) athletes. DESIGN:Scoping review. DATA SOURCES:MEDLINE, APA PsycInfo, Cochrane Databases for Systematic Review, Cochrane Central Register for Controlled Trials Registry, EMBASE, CINAHL, SPORTDiscus, ERIC, ProQuest Dissertation and Theses Global. ELIGIBILITY:Primary research including ≥25% female/woman/girl athletes of any age or people working with them (eg, coaches), participating in sports competition and/or performance, were eligible. Papers reporting D&I outcomes (eg, coach knowledge, adoption and maintenance) related to an injury prevention intervention and/or a factor (eg, coach beliefs) associated with D&I outcomes were included. RESULTS:220 papers with 419 494 participants (96 790 athletes (49% female/woman/girl), 277 923 coaches (59% working with females/women/girls) and 44 781 others) across 81 sports were included. 89% of the papers were from Europe, Oceania and North America. Papers included amateur (n=175), sub-elite (n=10), elite (n=63) and Para sport (n=2) athletes. Interventions were training strategies (n=113), personal protective equipment (PPE, n=41), policy/rules/laws (n=5) or other (n=61, eg, multimodal). There were >650 D&I outcomes; adoption was the most common, followed by athlete and coach perceptions and attitudes about injury prevention. Key facilitators of D&I were previous injury experience, higher competition levels and positive perceptions and attitudes. CONCLUSION:Most studies on D&I of injury prevention interventions for female/woman/girl athletes were descriptive and related to athletes and coaches. Engaging people across the socio-ecological system (eg, parents, health professionals and administrators) and prioritising under-represented regions, populations and D&I-focused trials may enhance D&I outcomes and ultimately reduce injury risk in female/woman/girl athletes.

Background: The primary aim was to assess psychological distress in patients with longstanding hip and groin pain (LHGP) and compare them with healthy controls. The secondary aim was to explore the association between psychological distress and symptom duration, self-reported pain and symptoms in patients with LHGP. Methods: Seventy-two patients with LHGP and sixty-three controls were included. The Kessler Psychological Distress Scale (K10) was used to assess psychological distress and the Copenhagen Hip and Groin Outcome Score (HAGOS) subscale for pain and symptoms to assess hip and groin pain and symptoms. The Mann–Whitney U test was used for between-group comparisons, and the Spearman's rank-order correlation to examine the association between the K10 and HAGOS. Results: There was no difference in psychological distress between patients with LHGP and controls (p ​= ​0.060) on the K10 total score. More individuals were categorized as having “high or very high” psychological distress in the LHGP group (45 ​%) compared to the control group (26 ​%) (p ​= ​0.035). There was no difference between patients with 3–12 months and >12 months symptom duration for the K10 (p ​= ​0.232). There was a moderate association between more psychological distress and worse self-reported pain (p ​= ​0.003) and symptoms (p ​< ​0.001). Conclusions: In this exploratory study, no difference was observed between patients and controls on the K10 total score; however, more patients with LHGP were categorized as having high or very high levels of psychological distress compared to controls. Among patients, symptom duration did not influence psychological distress, but a moderate association was found between more distress, greater pain, and more severe symptoms.

Purpose (the aim of the study): To compare individual and clinical characteristics of individuals with knee OA, with or without prior knee surgery.

Objective: To describe the SHIELD cohort in terms of symptoms indicative of early knee osteoarthritis (OA) and to investigate associations between patient characteristics (demographics, activity/injury-related) and these symptoms at 1 (cross-sectional) and 3 years (longitudinal) post anterior cruciate ligament reconstruction (ACLR). Method: 106 participants (50 % women, mean [SD] age 25 [5] years) were included. Symptoms indicative of early knee OA were evaluated by the Knee injury and Osteoarthritis Outcome Score (KOOS) subscale pain, KOOS subscale pain <= 72 (KOOSpain <= 72), and <= 85 on two out of four KOOS subscales (pain, symptoms, activity of daily living, quality of life) (modified Luyten). Results: Mean (SD) KOOS pain scores were 83.2 (15.7) and 87.3 (12.7) at 1 and 3 years, respectively. At 1 year and 3 years post ACLR, 18/101 (18 %) and 14/86 (16 %) participants met the KOOSpain <= 72 criterion, whereas 83/101 (82 %) and 67/86 (78 %) met the modified Luyten criterion. 7/15 (47 %) (KOOSpain <= 72) and 59/70 (84 %) (modified Luyten) classified as having knee OA symptoms 1 year post ACLR were still classified as having OA symptoms after 3 years. Lower activity level at 1 year was the sole variable consistently associated with all three outcomes 3 years post ACLR. Conclusion: The proportion of participants fulfilling existing classification criteria for symptoms indicative of early OA after ACLR is highly dependent on the criteria applied and different criteria seem to capture varying aspects of early OA symptoms. Future studies will reveal if these symptoms will persist long-term or just reflect more transient issues.

Injury prevention programmes can reduce injuries in youth team sports, including handball. However, real-world effectiveness and impact of such programmes are limited due to poor implementation. To address this in Swedish youth handball, the ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball’ (I-PROTECT) programme was co-created with end-users, including coaches. Despite tailoring the programme and its strategies to the context and needs of end-users, weekly adherence and programme fidelity remain low. Understanding coaches’ experiences of I-PROTECT may provide insights to revise existing and inform new strategies to support the implementation of injury prevention training in youth handball. The aim of this qualitative study was to explore coaches’ perceptions of the implementation and usability of I-PROTECT. Six coaches (two women), purposively recruited, participated in a 1.5-hour online workshop, including two group activities. They provided feedback on using I-PROTECT and identified challenges and driving conditions for its implementation. Data were collected via an online whiteboard, and audio and video were recorded and transcribed verbatim. The data were analysed using reflexive thematic analysis, guided by self-determination theory (SDT). Three themes were developed: (1) Navigating choices and chores, (2) Learning by doing and (3) Sharing is caring. Coaches responded positively to I-PROTECT and suggested strategies to enhance motivation for using injury prevention training, primarily focusing on app improvements, education and organisational support. Strategies that support coaches’ autonomy, competence and relatedness could be applied in future studies to support the implementation of injury prevention training in youth sports.

OBJECTIVES: To reach agreement among experts on visual assessments of postural orientation errors (POEs) during the single-leg squat (SLS), and to use expert agreement assessments as ground truth for machine learning (ML) models to evaluate their ability to classify POEs. DESIGN: Methodological study with mixed-methods design. METHODS: POEs of the lower extremity and trunk were assessed from videos and scored as good, fair, or poor. Three experts visually assessed each repetition for each POE independently and then reached agreement. ML models, one for each POE, were trained to assess POEs, using supervised learning on a subset of videos from the agreement assessment (n = 48). The remaining 99 videos were used to compare the prediction of ML models with the agreement scores (criterion validity), using quadratic weighted kappa (Ƙ), Spearman's correlation coefficient (r s ), and accuracy. RESULTS: Machine learning models for the POEs knee medial to foot position (KMFP), femur medial to shank, and femoral valgus showed strong association/substantial agreement with expert agreement scores (r s = 0.566-0.702, Ƙ = 0.58-0.7). Machine learning models for the POEs pelvis and trunk showed moderate association/fair agreement with expert agreement scores (Ƙ = 0.28-0.4, r s = 0.324-0.432), and the POE foot pronation showed no association/agreement (Ƙ = −0.042, r s = −0.05). ML models predicted the expert agreement score in 53% to 78% of the cases. CONCLUSION: Using ML models as a fast and comprehensive assessment of POEs during the SLS shows promising results, the ML models for the POEs KMFP, femur medial to shank, and femoral valgus indicating good validity. Training on larger datasets and/or modifications to some ML models may lead to improvements in model performance. JOSPT Methods 2025;1(1):17-29. Epub 25 November 2024. doi:10.2519/josptmethods.2024.0086

BACKGROUND:There is limited knowledge on whether prior knee surgery impacts the clinical profile and treatment outcomes for individuals with knee osteoarthritis (OA). OBJECTIVES:The study aimed to (i) compare individual and clinical characteristics, and (ii) evaluate whether outcomes of first-line treatment differ between individuals with prior knee surgery and those without. METHODS:This study used data from the Swedish Osteoarthritis Register to compare individuals with and without prior knee surgery. Independent t-tests and chi-square tests analyzed characteristics, while linear and logistic regressions assessed group differences at the 3-month follow-up. RESULTS:Of the 94 116 individuals included, 15 637 (17 %) had prior knee surgery. At baseline, those with prior knee surgery were more likely to be male (48 % vs. 29 %), younger (mean age 63 vs. 67 years), and meet physical activity recommendations (69 % vs. 66 %). At the 3-month follow-up, individuals with prior knee surgery had higher odds of expressing willingness to undergo surgery (OR 1.50 [95 % CI, 1.40 to 1.60]), experiencing walking difficulties (OR 1.24 [95 % CI, 1.19 to 1.30]), and to reaching the recommended level of physical activity (OR 1.21 [95 % CI, 1.14 to 1.27]). CONCLUSION:The findings suggest that individuals with knee OA and a history of prior knee surgery may represent a specific clinical phenotype, characterized by a younger age, male sex, and higher levels of physical activity when entering first-line treatment. Despite positive treatment responses in both groups, individuals with a history of surgery more often reported ongoing clinical features at the 3-month follow-up.