Have data from transgender women after GAS been included in the studies?
Surgeries undergone as part of GAS:
-Gives testosterone levels much lower than the reference values for cisgender women and much more stable than all other groups
- permanent and irreversible trauma to the muscular area (psoas, etc.) which generates losses of strength, mobility and flexibility
What am I missing? The authors measured the number of steps taken by participants for only three days then they followed them for years to see who had better outcomes? Did the participants promise to keep the same level of activity until they died? Is it accurate to assume one’s level of activity will always be the same?
This meta-analysis undertaken by Currier et al. is welcomed to help further understanding of resistance-based training regimen for strength and hypertrophy. Currier et al. identified that future work to identify the optimal protocol and dose for specific exercise prescriptions is needed. While this recommendation is uncontentious, they could have perhaps gone further. The literature is flooded with different types of studies which incorporate strength-related protocols and is reflected in the number of records excluded in this study. For future studies and - where applicable - existing studies should use a harmonized data collection approach which is common in areas of medicine, for example when attempting to characterize infectious diseases (). Ensuring that categorical variables such as age, sex, ethnicity, somatotype, exercise experience, and other appropriate biological parameters are all collected in a standardized way, with datasets made available for reuse could lead to better stratification of data, thus resulting in better insights for future analyses and meta-analyses like the one undertaken by Currier et al.
On behalf of all authors, I would like to express our gratitude for the attention given to our work and for providing a thorough response.
We agree that the ICIQ-FLUTs tool has been identified as a reliable instrument for evaluating lower urinary tract symptoms (LUTS); however, our objective extended beyond solely assessing LUTS. We aimed to incorporate a comprehensive range of symptoms, encompassing pelvic organ prolapse, anal incontinence, and pelvic pain.
Additional and complete information regarding the rationale behind this decision can be found in the Supplementary file 3.
Then, we sought the expertise of panellists in rating each symptom for potential inclusion in the tool.
I am open to further discuss. Thank you again.
Regards,
Silvia
Well done on putting together this paper. Massive undertaking to complete a systematic review of 950 included studies.
I have researched the area of exercise and cardiac rehabilitation for TIA and minor stroke patients. I was therefore keen to know if you included these papers in your review as it wasn’t clear from the supplemental papers I reviewed? For example,
Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord. 2017 Dec 12;17(1):290. doi: 10.1186/s12872-017-0717-9. PMID: 29233087; PMCID: PMC5727948.
Heron N, Kee F, Mant J, Cupples ME, Donnelly M. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. Br J Gen Pract. 2019 Sep 26;69(687):e706-e714. doi: 10.3399/bjgp19X705509. PMID: 31501165; PMCID: PMC6733604.
Heron N. Cardiac rehabilitation for the transient ischaemic attack (TIA) and stroke population? Using the Medical Research Council (MRC) guidelines for developing complex health service interventions to develop home-based cardiac rehabilitation for TIA and 'minor' stroke patients. Br J Sports Med. 2019 Jul;53(13):839-840. doi: 10.1136/bjsports-2018-099593. Epub 2018 Sep 4. PMID: 30181325; PMCID: PMC6585273.
These papers show the benefit of physical activity and ex...
Well done on putting together this paper. Massive undertaking to complete a systematic review of 950 included studies.
I have researched the area of exercise and cardiac rehabilitation for TIA and minor stroke patients. I was therefore keen to know if you included these papers in your review as it wasn’t clear from the supplemental papers I reviewed? For example,
Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord. 2017 Dec 12;17(1):290. doi: 10.1186/s12872-017-0717-9. PMID: 29233087; PMCID: PMC5727948.
Heron N, Kee F, Mant J, Cupples ME, Donnelly M. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. Br J Gen Pract. 2019 Sep 26;69(687):e706-e714. doi: 10.3399/bjgp19X705509. PMID: 31501165; PMCID: PMC6733604.
Heron N. Cardiac rehabilitation for the transient ischaemic attack (TIA) and stroke population? Using the Medical Research Council (MRC) guidelines for developing complex health service interventions to develop home-based cardiac rehabilitation for TIA and 'minor' stroke patients. Br J Sports Med. 2019 Jul;53(13):839-840. doi: 10.1136/bjsports-2018-099593. Epub 2018 Sep 4. PMID: 30181325; PMCID: PMC6585273.
These papers show the benefit of physical activity and exercise for this group of cardiovascular patients (included within a cardiac rehabilitation model) and would add real benefit to your outcomes and findings.
I read with interest your PFD -SENTINEL paper and thank you for putting together this consensus process.
As practising sport medicine physicians, we have an interest in lower urinary tract symptoms (LUTs), including incontinence, within our athletic population, both males and females. LUTs, as part of pelvic floor dysfunction, are reportedly common in the general population (2) and vary with the age of the population surveyed – with one recent survey estimating a prevalence of over 70% in those over the age of 70 years olds (3). LUTs is a group of various symptoms related to urination and can include leaking urine, sudden and frequent urges to pass urine, having a weak urine stream or a feeling that you have not completely emptied your bladder. LUTS, and particularly Urinary Incontinence (UI), are considered to be a female health problem that is inevitable and the result of life and health events such as pregnancy, childbirth, and menopause (Casey, E. & Temme, K. 2017). The issue of LUTs is less well understood in male athletes although it has been reported to be present in approximately 15% of athletes surveyed in one study (1). The acceptance of these symptoms, particularly within female athletes, often leads to under reporting or poor engagement with health care practitioners to assess and manage the condition (Anderson & Anderson 2011, Almousa & Bandin Van Loon, 2019, Rodríguez-López, E.S., et al. 2020). The impact of LUT...
I read with interest your PFD -SENTINEL paper and thank you for putting together this consensus process.
As practising sport medicine physicians, we have an interest in lower urinary tract symptoms (LUTs), including incontinence, within our athletic population, both males and females. LUTs, as part of pelvic floor dysfunction, are reportedly common in the general population (2) and vary with the age of the population surveyed – with one recent survey estimating a prevalence of over 70% in those over the age of 70 years olds (3). LUTs is a group of various symptoms related to urination and can include leaking urine, sudden and frequent urges to pass urine, having a weak urine stream or a feeling that you have not completely emptied your bladder. LUTS, and particularly Urinary Incontinence (UI), are considered to be a female health problem that is inevitable and the result of life and health events such as pregnancy, childbirth, and menopause (Casey, E. & Temme, K. 2017). The issue of LUTs is less well understood in male athletes although it has been reported to be present in approximately 15% of athletes surveyed in one study (1). The acceptance of these symptoms, particularly within female athletes, often leads to under reporting or poor engagement with health care practitioners to assess and manage the condition (Anderson & Anderson 2011, Almousa & Bandin Van Loon, 2019, Rodríguez-López, E.S., et al. 2020). The impact of LUTs on quality of life, physical and mental health has been acknowledged in recent years (Almousa & Bandin Van Loon, 2019, Rodríguez-López, E.S., et al. 2020, Whitney et al, 2021) and has brought about a drive to understand the risks and drivers behind its onset as well as optimal diagnosis and management interventions (Bo, K. 2004, Casey, E. & Temme, K. 2017, Bo et al., 2017). National Institute of Clinical Excellence (NICE) Guidance has recommended that the assessment and diagnosis of UI occurs through use of good history taking, clinical examination and the inclusion of validated patient reported outcome measures (PROMS) (NICE, 2019). The International Consultation on Incontinence Questionnaires (ICIQ) was developed to provide a PROM with high quality standardised assessment of urinary, bowel and vaginal symptoms (Uren, A., et al . 2020) which have been utilised in clinical practice for the last 22 years. The ICIQ FLUTS is a modular questionnaire that was developed and validated in a controlled matched study with a female population attending for urodynamic assessment due to UI (Jackson, S., et al. 2006, Uren, A., et al. 2020). It enables assessment of lower urinary tract symptoms and their impact on quality of life. It consists of 12 items taking around 4-5minutes to complete and has had validity, reliability and responsiveness established (Brooks, S.et al. 2004, Jackson, S., et al. 2006, Uren, A., et al. 2020). The ICIQ-FLUTs has been adapted for use in the athletic population (AFLUTs) and my question is therefore whether you considered using the ICIQ-FLUTs questionnaire in your study and/or including it within your pelvic floor dysfunction questionnaire?
Thanks for your time and happy to discuss further.
Kind regards,
Neil
References
(1) Rodríguez-López ES, Calvo-Moreno SO, Basas-García Á, Gutierrez-Ortega F, Guodemar-Pérez J, Acevedo-Gómez MB. Prevalence of urinary incontinence among elite athletes of both sexes. J Sci Med Sport. 2021 Apr;24(4):338-344. doi: 10.1016/j.jsams.2020.09.017. Epub 2020 Oct 1. PMID: 33041208.
(2) (LUTS)%20include%20vari
47 / 50
ous%20symptoms%20involving%20urination,can%27t%20empty%20your%20bladder. Accessed on 17/05/2023 at 14.45
(3) Przydacz M, Gasowski J, Grodzicki T, Chlosta P. Lower Urinary Tract Symptoms and Overactive Bladder in a Large Cohort of Older Poles-A Representative Tele-Survey. J Clin Med. 2023 Apr 13;12(8):2859. doi: 10.3390/jcm12082859. PMID: 37109196; PMCID: PMC10142045.
(4) accessed on 18/05/23 at 11.30
(5) Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992 Nov;148(5):1549-57; discussion 1564. doi: 10.1016/s0022-5347(17)36966-5. PMID: 1279218.
(6)
Sania Almousa & Alda Bandin Van Loon (2019) The prevalence of urinary incontinence in nulliparous female sportswomen: A systematic review, Journal of Sports Sciences, 37:14, 1663-1672, DOI: 10.1080/02640414.2019.1585312
J.C. Andersen, PhD, ATC, PT, SCS; and Beth Andersen, MS, PT, ATC Screening for Urinary Incontinence in Female Athletes Athletic Training & Sports Health Care | Vol. 3 No. 5 2011
Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med. 2020 Apr;54(7):372-389. doi: 10.1136/bjsports-2019-101969. Epub 2020 Feb 18. PMID: 32071062; PMCID: PMC7146946.
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Bernard, Stéphanie PT, MSc1,2; Pellichero, Alice MSc, OT1,2; McLean, Linda PT, PhD3; Moffet, Hélène PT, PhD1,2 Responsiveness of Health-Related Quality of Life Patient-Reported Outcome Measures in Women Receiving Conservative Treatment for Urinary Incontinence: A Systematic Review, Journal of Women's Health Physical Therapy: April/June 2021 - Volume 45 - Issue 2 - p 57-67
doi: 10.1097/JWH.0000000000000196
Bø K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 2004;34(7):451-64. doi: 10.2165/00007256-200434070-00004. PMID: 15233598.
Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, Bortolini M, Dumoulin C, Gomes M, McClurg D, Meijlink J, Shelly E, Trabuco E, Walker C, Wells A. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017 Feb;28(2):191-213. doi: 10.1007/s00192-016-3123-4. Epub 2016 Dec 5. PMID: 27921161.
Brookes, S., Donovan, J., Wright, M., Jackson, S., Abrams, P. A scored form of the Bristol Lower Urinary Tract Symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am.J.Obstet.Gynecol. 2004; 191(1): 73-82
Carvalhais A, Natal Jorge R, Bø K. Performing high-level sport is strongly asso- ciated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med 2018; 52(24):1586–1590. .
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Casey EK, Temme K. Pelvic floor muscle function and urinary incontinence in the female athlete. Phys Sportsmed. 2017 Nov;45(4):399-407. doi: 10.1080/00913847.2017.1372677. Epub 2017 Sep 5. PMID: 28845723.
Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport. 2006 May;9(1-2):3-9; discussion 10. doi: 10.1016/j.jsams.2006.02.009. Epub 2006 Apr 17. PMID: 16616614.
Harris, P., R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde, Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81.
Harris, P, R Taylor, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]
Jackson, S., Donovan, J., Brookes, S., Eckford, S., Swithinbank, L., and Abrams, P. (1996). The Bristol female lower urinary tract symptoms questionnaire: development and psychometric testing. British Journal of Urology 77, 805–812.
Ljungqvist A, Jenoure PJ, Engebretsen L, Alonso JM, Bahr R, Clough AF, de Bondt G, Dvorak J, Maloley R, Matheson G, Meeuwisse W, Meijboom EJ, Mountjoy M, Pelliccia A, Schwellnus M, Sprumont D, Schamasch P, Gauthier JB, Dubi C. The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes, March 2009. Clin J Sport Med. 2009 Sep;19(5):347-65. doi: 10.1097/JSM.0b013e3181b7332c. PMID: 19741306.
Orchard JW, Meeuwisse W, Derman W, et al. Sport Medicine Diagnostic Coding System (SMDSC) and the Orchard Sports Injury and Illness Classification System (OSIICS): revised 2020 consensus versions [published online ahead of print, 2020 Feb 29]. Br J Sports Med. 2020;bjsports-2019-101921. doi:10.1136/bjsports-2019-101921
OSIICS version 13.5 was released on 8 July 2021 on this website and includes new codes for Female athlete, psychology and cardiology diagnoses in particular.
Accessed on 25/11/2021
Rebullido TR, Stracciolini A. Pelvic Floor Dysfunction in Female Athletes: Is Relative Energy Deficiency in Sport a Risk Factor? Curr Sports Med Rep. 2019 Jul;18(7):255-257. doi: 10.1249/JSR.0000000000000615. PMID: 31283625.
Rodríguez-López ES, Calvo-Moreno SO, Basas-García Á, Gutierrez-Ortega F, Guodemar-Pérez J, Acevedo-Gómez MB. Prevalence of urinary incontinence among elite athletes of both sexes. J Sci Med Sport. 2021 Apr;24(4):338-344. doi: 10.1016/j.jsams.2020.09.017. Epub 2020 Oct 1. PMID: 33041208.
Thank you for your interest in the Sports Concussion Office Assessment Tools, the SCOAT6 and Child SCOAT6. These tools were developed to guide clinicians internationally, using evidence-based components.1 The evidence shows that concussion in children, adolescents and adults affects multiple clinical domains, and the office assessment must address the clinically relevant domains, which will be different in each concussed individual. Using the symptom scales, and interview with the patient, the clinician can identify which clinical domains are endorsed. This guides the clinician towards the appropriate components of the Child SCOAT6 / SCOAT6. Incorporated into the tools are Green “recommended” sections and Orange “optional” sections, to assist the time-challenged clinician in focusing on the most relevant modalities.2,3
Developing the Office tools was a balancing act that primarily considered producing a thorough, multimodal assessment tool but one that was also easy to use and not too lengthy. For instance, we could not ignore research supporting the value of the VOMS but opted for the recently validated modified VOMS which is a validated briefer version.4,5
The scientifically derived clinical reality is that the office assessment of concussed athletes requires a multimodal assessment. Trying to perform a proper multimodal assessment in a 10-minute time period is neither appropriate nor realistic. The concu...
Thank you for your interest in the Sports Concussion Office Assessment Tools, the SCOAT6 and Child SCOAT6. These tools were developed to guide clinicians internationally, using evidence-based components.1 The evidence shows that concussion in children, adolescents and adults affects multiple clinical domains, and the office assessment must address the clinically relevant domains, which will be different in each concussed individual. Using the symptom scales, and interview with the patient, the clinician can identify which clinical domains are endorsed. This guides the clinician towards the appropriate components of the Child SCOAT6 / SCOAT6. Incorporated into the tools are Green “recommended” sections and Orange “optional” sections, to assist the time-challenged clinician in focusing on the most relevant modalities.2,3
Developing the Office tools was a balancing act that primarily considered producing a thorough, multimodal assessment tool but one that was also easy to use and not too lengthy. For instance, we could not ignore research supporting the value of the VOMS but opted for the recently validated modified VOMS which is a validated briefer version.4,5
The scientifically derived clinical reality is that the office assessment of concussed athletes requires a multimodal assessment. Trying to perform a proper multimodal assessment in a 10-minute time period is neither appropriate nor realistic. The concussion diagnostic screen, the SCAT6/Child SCAT6, used within the first 72 hours post-concussion and up to a week, is designed to take 10-15 minutes to implement. The more comprehensive SCOAT6/Child SCOAT6 requires longer appointments with a single clinician, or alternatively, the assessment may be performed by multiple HCPs over several sessions, such as the physiotherapist performing the balance and VOMS assessment. We maintain that a multisystem evaluation remains the most appropriate in the setting of SRC but appreciate real-life clinical scenarios. The tools were developed as the gold standard. It would be more reasonable for health administrations to provide resources to enable practitioners sufficient time to complete the assessment with the tool, rather than compromise the tool to accommodate under-resourced GP practices in some countries. We acknowledge restraints on time, resources and expertise across a range of HCPs and referred to this in the Systematic Review and accompanying editorials introducing the tools.6,7
We are currently endeavouring to develop an electronic version of the SCOAT6 tools which should assist the HCP conducting the assessment and simplify recording of the results.
Finally, as with the SCAT6, the SCOAT6 and Child SCOAT6 contain individually validated elements, but require validation as a combined tool in different clinical and cultural settings and these findings are likely to help evolve the tool in future versions. These changes may include abbreviating any aspects that are found to be redundant.
1. Patricios JS, Schneider GM, van Ierssel J, et al. Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool 6 (SCOAT6) Br J Sports Med 2023;57:651-667.
2. Child SCOAT6 Br J Sports Med 2023;57:672-688
3. Sport Concussion Office Assessment Tool 6 (SCOAT6). Br J Sports Med 2023;57:651-667.
4. Ferris LM, Kontos AP, Eagle SR, et al. Predictive accuracy of the sport concussion assessment tool 3 and vestibular/ocular-motor screening, individually and in combination: a national collegiate athletic association-department of defence concussion assessment, research and education Consortium analysis. Am J Sports Med 2021;49:1040–8.
5. Ferris LM, Kontos AP, Eagle SR, et al. Optimizing VOMS for identifying acute concussion in collegiate athletes: findings from the NCAA-DoD care consortium. Vision Res 2022;200:108081.
6. Patricios JS, Davis GA, Ahmed OH, et al. Introducing the Sport Concussion Office Assessment Tool 6 (SCOAT6). Br J Sports Med 2023;57:648–650
7. Davis, GA, Patricios, JS, Purcell, L et al. (2023). Introducing the Child Sport Concussion Office Assessment Tool 6 (Child SCOAT6). Br J Sports Med 2023. 57. 668-671. 10.1136/bjsports-2023-106858.
Great work on putting together the child SCOAT6 and this is a really helpful piece for the office sport medicine doctors. However, what about the community healthcare teams, eg General Practitioners, GPs, what tool should they be using? Particularly bearing in mind the time constraints of community health contacts, eg GP consults in the UK are most often limited to 10 minutes. What can we expect non-specialist sport medicine doctors to do to help make the concussion diagnosis and therefore initiate appropriate management promptly? Should we be making a childSCATgp?
More patients will be attending primary and community care facilities with concussion as the general knowledge around the diagnosis increases and with new policies and procedures identifying community resources to make the concussion diagnosis and management . Indeed, within the UK, there has recently been grassroots concussion protocols released and they advise that all concussions should be diagnosed by a healthcare practitioner. This will cause a number of patients, both children and adults. to present to community practitioners seeking a diagnosis and we therefore need a community tool to diagnose and manage concussions for the non-specialist healthcare practitioners. Time for a consensus meeting to discuss community, non-specialist concussion diagnosis and management?
Have data from transgender women after GAS been included in the studies?
Surgeries undergone as part of GAS:
-Gives testosterone levels much lower than the reference values for cisgender women and much more stable than all other groups
- permanent and irreversible trauma to the muscular area (psoas, etc.) which generates losses of strength, mobility and flexibility
What am I missing? The authors measured the number of steps taken by participants for only three days then they followed them for years to see who had better outcomes? Did the participants promise to keep the same level of activity until they died? Is it accurate to assume one’s level of activity will always be the same?
International CONsensus (//cqcsw.com/content/54/8/442)
What does ICON stand for? I could not find the meaning of the abbreviation in the text?
This meta-analysis undertaken by Currier et al. is welcomed to help further understanding of resistance-based training regimen for strength and hypertrophy. Currier et al. identified that future work to identify the optimal protocol and dose for specific exercise prescriptions is needed. While this recommendation is uncontentious, they could have perhaps gone further. The literature is flooded with different types of studies which incorporate strength-related protocols and is reflected in the number of records excluded in this study. For future studies and - where applicable - existing studies should use a harmonized data collection approach which is common in areas of medicine, for example when attempting to characterize infectious diseases (). Ensuring that categorical variables such as age, sex, ethnicity, somatotype, exercise experience, and other appropriate biological parameters are all collected in a standardized way, with datasets made available for reuse could lead to better stratification of data, thus resulting in better insights for future analyses and meta-analyses like the one undertaken by Currier et al.
On behalf of all authors, I would like to express our gratitude for the attention given to our work and for providing a thorough response.
We agree that the ICIQ-FLUTs tool has been identified as a reliable instrument for evaluating lower urinary tract symptoms (LUTS); however, our objective extended beyond solely assessing LUTS. We aimed to incorporate a comprehensive range of symptoms, encompassing pelvic organ prolapse, anal incontinence, and pelvic pain.
Additional and complete information regarding the rationale behind this decision can be found in the Supplementary file 3.
Then, we sought the expertise of panellists in rating each symptom for potential inclusion in the tool.
I am open to further discuss. Thank you again.
Regards,
Silvia
Dear Authors,
Well done on putting together this paper. Massive undertaking to complete a systematic review of 950 included studies.
I have researched the area of exercise and cardiac rehabilitation for TIA and minor stroke patients. I was therefore keen to know if you included these papers in your review as it wasn’t clear from the supplemental papers I reviewed? For example,
Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord. 2017 Dec 12;17(1):290. doi: 10.1186/s12872-017-0717-9. PMID: 29233087; PMCID: PMC5727948.
Heron N, Kee F, Mant J, Cupples ME, Donnelly M. Rehabilitation of patients after transient ischaemic attack or minor stroke: pilot feasibility randomised trial of a home-based prevention programme. Br J Gen Pract. 2019 Sep 26;69(687):e706-e714. doi: 10.3399/bjgp19X705509. PMID: 31501165; PMCID: PMC6733604.
Heron N. Cardiac rehabilitation for the transient ischaemic attack (TIA) and stroke population? Using the Medical Research Council (MRC) guidelines for developing complex health service interventions to develop home-based cardiac rehabilitation for TIA and 'minor' stroke patients. Br J Sports Med. 2019 Jul;53(13):839-840. doi: 10.1136/bjsports-2018-099593. Epub 2018 Sep 4. PMID: 30181325; PMCID: PMC6585273.
These papers show the benefit of physical activity and ex...
Show MoreDear Giagio et Al,
I read with interest your PFD -SENTINEL paper and thank you for putting together this consensus process.
As practising sport medicine physicians, we have an interest in lower urinary tract symptoms (LUTs), including incontinence, within our athletic population, both males and females. LUTs, as part of pelvic floor dysfunction, are reportedly common in the general population (2) and vary with the age of the population surveyed – with one recent survey estimating a prevalence of over 70% in those over the age of 70 years olds (3). LUTs is a group of various symptoms related to urination and can include leaking urine, sudden and frequent urges to pass urine, having a weak urine stream or a feeling that you have not completely emptied your bladder. LUTS, and particularly Urinary Incontinence (UI), are considered to be a female health problem that is inevitable and the result of life and health events such as pregnancy, childbirth, and menopause (Casey, E. & Temme, K. 2017). The issue of LUTs is less well understood in male athletes although it has been reported to be present in approximately 15% of athletes surveyed in one study (1). The acceptance of these symptoms, particularly within female athletes, often leads to under reporting or poor engagement with health care practitioners to assess and manage the condition (Anderson & Anderson 2011, Almousa & Bandin Van Loon, 2019, Rodríguez-López, E.S., et al. 2020). The impact of LUT...
Show MoreResponse: Who should undertake the SCOAT6?
Thank you for your interest in the Sports Concussion Office Assessment Tools, the SCOAT6 and Child SCOAT6. These tools were developed to guide clinicians internationally, using evidence-based components.1 The evidence shows that concussion in children, adolescents and adults affects multiple clinical domains, and the office assessment must address the clinically relevant domains, which will be different in each concussed individual. Using the symptom scales, and interview with the patient, the clinician can identify which clinical domains are endorsed. This guides the clinician towards the appropriate components of the Child SCOAT6 / SCOAT6. Incorporated into the tools are Green “recommended” sections and Orange “optional” sections, to assist the time-challenged clinician in focusing on the most relevant modalities.2,3
Developing the Office tools was a balancing act that primarily considered producing a thorough, multimodal assessment tool but one that was also easy to use and not too lengthy. For instance, we could not ignore research supporting the value of the VOMS but opted for the recently validated modified VOMS which is a validated briefer version.4,5
The scientifically derived clinical reality is that the office assessment of concussed athletes requires a multimodal assessment. Trying to perform a proper multimodal assessment in a 10-minute time period is neither appropriate nor realistic. The concu...
Show MoreDear Authors,
Great work on putting together the child SCOAT6 and this is a really helpful piece for the office sport medicine doctors. However, what about the community healthcare teams, eg General Practitioners, GPs, what tool should they be using? Particularly bearing in mind the time constraints of community health contacts, eg GP consults in the UK are most often limited to 10 minutes. What can we expect non-specialist sport medicine doctors to do to help make the concussion diagnosis and therefore initiate appropriate management promptly? Should we be making a childSCATgp?
More patients will be attending primary and community care facilities with concussion as the general knowledge around the diagnosis increases and with new policies and procedures identifying community resources to make the concussion diagnosis and management . Indeed, within the UK, there has recently been grassroots concussion protocols released and they advise that all concussions should be diagnosed by a healthcare practitioner. This will cause a number of patients, both children and adults. to present to community practitioners seeking a diagnosis and we therefore need a community tool to diagnose and manage concussions for the non-specialist healthcare practitioners. Time for a consensus meeting to discuss community, non-specialist concussion diagnosis and management?
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