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Aim: To explore factors associated with one-year mortality risk after hip fracture among very old adults (85 +) in Northern Sweden.

Methods: This cohort study includes data derived from Umeå 85 + /Gerontological Regional Database (GERDA), encompassing a representative sample of those aged 85, 90 and ≥ 95 years in Northern Sweden. Data were assessed during home visits and interviews conducted between 2000 and 2017. Associations of baseline characteristics with hip fracture during a follow-up period of 5 years and one-year mortality were analyzed using Cox proportional hazards regression.

Results: Of 1,277 participants, 184 (14.4%) sustained a hip fracture during follow-up, of whom 47.8% died within 1 year of the fracture. Among those with hip fracture, 65% were women. Increased 1-year mortality risk was associated with the presence of depressive disorders (hazard ratio, HR 2.55, 95% confidence interval 95%CI, 1.32–4.93), history of stroke (HR 2.34, 95%CI 1.17–4.66) and subtrochanteric fractures (HR 4.40, 95%CI 1.73–11.21). Conversely, obesity (HR 0.26, 95%CI 0.10–0.67) was associated with reduced mortality risk.

Conclusion: Nearly half of all very old adults sustaining a hip fracture die within 1 year. Depressive disorders, history of stroke and subtrochanteric fractures were identified as significant predictors of increased mortality, whereas obesity appeared to mitigate mortality risk. These findings underscore the need for targeted interventions to manage these risk factors in hip fracture patients very old adults.

Teachers and coaches are key figures in promoting and sustaining injury-preventive behaviors among youth athletes. Although previous studies have demonstrated the effectiveness of injury prevention interventions in floorball, little is known about how these practices are implemented in elite floorball high schools. This study explored how teachers in school sports at Swedish certified elite floorball high schools integrate injury prevention into everyday coaching, focusing on their experiences and strategies. Semi-structured interviews with 15 teachers across Sweden were analyzed using qualitative content analysis to identify themes and underlying categories. Our analysis resulted in one overarching theme: "Facilitating students' development to become their own best coach," reflecting teachers' efforts to strengthen autonomy and competence through progression in injury-preventive training. Three sub-themes captured this process: navigating challenges and opportunities in the school-context, promoting students' own learning and sense of responsibility, and leading with intentionality. Teachers varied exercises, used open communication, and encouraged responsibility, while managing a major challenge—helping students balance total load from school training, club training, and academic stress. Findings highlight injury prevention as an inherent part of the school sport context and underscore the need for coordinated efforts among teachers, team coaches, and sport federations to manage athlete load effectively. These insights offer practical implications for coaching practice and contribute to critical reflection on how pedagogical strategies can support both performance and well-being.

Background: The tibialis posterior muscle has an important role both in stabilizing the foot and in inversion, plantar flexion, and adduction of the foot. Impaired function can lead to tibialis posterior dysfunction. A clinical test that can objectively measure tibialis posterior strength is warranted.

Objectives: The aim of this study was to investigate the interrater, test-retest, and intersession reliability of a test designed to measure tibialis posterior strength with a hand-held dynamometer.

Design: Interrater, between-day test-retest and intersession reliability.

Setting: University laboratory.

Participants: The participants comprised 20 healthy individuals (mean age 28.8 years, n = 10 women) without foot problems.

Method: A test was designed to test tibialis posterior strength with a hand-held dynamometer (HHD). The test was performed on two occasions 5–15 days apart and was carried out by two raters. The intraclass correlation coefficient (ICC), 95 % confidence interval, standard error of measurement (SEM), and minimal detectable change were calculated.

Results: Interrater reliability was good on both occasions (ICC: 0.769, 0.794), test-retest reliability was moderate for both raters (ICC: 0.671, 0.672), and intersession reliability was excellent (ICC: 0.934–0.967). However, the confidence interval had a large variation (-0.027–0.986) and the SEM was relatively high (2.356–3.863 N).

Conclusions: This test seems to be reliable, but has some limitations. The results suggest that the current version of the test could be used to compare strength between feet, but that further development of the test is needed to achieve increased interrater and test-retest reliability.

BACKGROUND: Femoral neck fractures (FNF) are a severe and common injury that affect older adults physically, psychologically, and socially. Variation in the trajectory of recovery remains underexplored. This study was conducted to investigate older adults' recovery experiences during the first year after FNF.

METHOD: This longitudinal interview-based study was conducted with 13 participants aged ≥75 years with FNF who were admitted to the orthopedics wards of two hospitals in Sweden. Semi-structured interviews were conducted with participants at 1, 4, and 12 months after fracture. Reflexive thematic analysis of the interview transcripts was performed.

RESULTS: Participants described their recovery after FNF as a complex and non-linear journey. Four interrelated themes were identified as key aspects influencing recovery during the first year after FNF: engagement in daily activities, fear of falling, family members' bridging of the support gap, and striving for independence. Recovery was represented as a fluctuating personal experience that evolves over time.

CONCLUSION: Recovery after FNF extends beyond physical healing, encompassing emotional adjustment and social reintegration. The understanding of recovery as an evolving and individualized process highlights the need for follow-up and rehabilitation strategies that address not only functional outcomes, but also patients' confidence, motivation, and support in daily life.

Background and purpose — There is limited data on the functional outcome after hallux valgus (HV) surgery. Our study aims to assess 1-year postoperative patient-reported outcomes (PROMs) after a chevron osteotomy (CO) for 3 severity levels, the number of additional surgical interventions during the index procedure, and the association between the presence or absence of internal fixation and PROMs.

Methods — This is a prospective cohort from the Swedish register for foot and ankle surgery (Swefoot), including patients treated with primary CO between 2014 and 2021. HV deformities were classified into 3 severity grades. Pre-operative demographic data, additional surgical procedures, and PROMs (Self-reported Foot and Ankle Score [SEFAS] and the EuroQol 5-dimensional 3-level scale [EQ-5D-3L]) were collected both pre-and 1 year post-surgery.

Results — The study included 2,259 HV feet (2,123 patients, mean age 55 (range 15–90) years, 83% women) The mean SEFAS score increased by 11 (95% confidence interval [CI] 9.8–11.8) points from the pre-surgery assessment to the 1-year post-surgery follow-up for the mild HV group, by 9 (CI 9.0–10.0) for the moderate, and by 9 (CI 7.5–9.8) for the severe group. EQ-5D-3L also improved in all 3 groups. For all 3 HV grades, patients treated with fixation demonstrated no statistically significant improvements in SEFAS scores compared with those without fixation.

Conclusion — Distal chevron osteotomy improved 1-year patient-reported outcomes across all grades of hallux valgus. Improvements were observed both with and without internal fixation. In more severe cases, additional procedures such as Akin osteotomy and distal soft tissue release were more commonly performed.

Background: More knowledge about floorball goalkeepers’ game movements and biomechanical demands is warranted. Therefore, the aim of this study was to observe type and frequency of female floorball goalkeepers’ movements during a game.

Methods: Twelve female goalkeepers (mean age 22 years) were included. An observational study design using video recording was used to explore goalkeepers’ movements during a game. Three different positions were reported in minutes, percent of playing time, and the number of times the goalkeepers performed different movements.

Results: The results revealed that of total playing time, goalkeepers were playing on their knees 31% (± 10%) of the time, in quadruped position 1.3% (± 1.9%) and 67% (± 11%) they played standing. Five movements were performed more frequently; short side movements, pull, stand up, small rotation with legs, and longer ball covers at the goalpost. A large variation in movement was seen regarding how many and what type of movements each goalkeeper performed during the game.

Conclusion: Floorball goalkeepers perform a high number of movements and spend a substantial amount of the match time on their knees. There is no existing research on how these game aspects may impact load as well as physical needs, emphasizing the need for further research. Knowledge from the study lays the groundwork for further studies and may be used when developing future preventive training programme and rehabilitation.

Objective: The purposes of the study were to examine injury incidence among students engaged in elite sports during their first year of study, and to explore factors associated with injury in this population.

Methods: Two surveys were carried out one year apart. A total of 243 students responded to the initial baseline survey; 111 also responded to a follow-up survey. The surveys addressed injury events and characteristics, sports participation, experienced stress, relaxation, control during leisure time, and study pace.

Results: Prior to commencing their studies, 51% of the athletes had experienced an injury; 54% experienced an injury during their first year of study. A previous injury increased the odds of a new injury (OR = 3.174, p < 0.01). Athletes sustaining an overuse injury prior to studies had higher risk for sustaining a new overuse injury during the first year of studies (OR = 4.312, p < 0.001), while sustaining an acute injury prior to studies did not significantly increase the risk for sustaining a new acute injury. Sex, type of sport, and study pace were not associated with increased odds of injury.

Conclusion: A concerning 54% injury incidence was found during the first year of study. A previous injury increased the likelihood of sustaining a new injury. The findings suggest that injury-prevention methods should be focused particularly on students who have been injured in the year before they begin their studies.

Background: Hallux valgus (HV) is a common condition associated with pain, functional limitations, and reduced health-related quality of life. Population-level data on 2-year results of surgical treatment remain limited. The aim of this study was to evaluate patient-reported outcome measures (PROMs) before surgery, and 1- and 2-year follow-up in patients registered in the Swedish quality registry for foot and ankle surgery (“Swefoot”) who underwent surgery for HV. Further, the relation between PROMs and HV severity, BMI, and smoking habits was explored.

Methods: Seven hundred sixty-five feet from 742 patients (median age 58, 87% women) who underwent primary surgery for HV were included. Data on demographics, comorbidities, HV severity, surgical procedures, and PROMs were extracted. PROMs included the Self-Reported Foot and Ankle score (SEFAS), EuroQol 5-dimensional, 3-level (EQ-5D), and satisfaction regarding surgery, appearance, shoe wear, and pain.

Results: At both 1- and 2-year follow-ups, approximately 80% of responding patients reported satisfaction with the surgical outcome (80.4% and 81.0%, respectively). Patients reported significant improvements in SEFAS scores: mean increase of 10 points (95% CI 9.1-10.4) at 1 year and 11 points (95% CI 9.8-11.2) at 2 years compared to baseline. Health-related quality of life also improved significantly; EQ-5D VAS was improved with 7 (95% CI 5-8) after 1 year and EQ-5D index was improved with 0.19 (95% CI 0.17-0.21). The EQ-5D VAS and index did not change significantly between the 1- and 2-year follow-ups. Significant improvements were also reported in satisfaction with appearance, shoe wear, and pain. Regardless of HV grade, the patients had similar improvement in SEFAS. Overweight/obese patients experienced similar improvements as underweight/normal BMI ones. Smokers showed significantly less improvement in SEFAS.

Conclusion: This population-based study using the Swefoot registry data demonstrates that patients surgically treated for HV reported significant improvements in PROMs from before surgery to 1 and 2 years after surgery.

Level of Evidence: Level II, prognostic study.

Background: Tendon injuries are common in athletes and in the general population and require extensive rehabilitation. Current conservative treatment often includes different high-load resistance training (HLRT) modalities. However, certain populations may not tolerate HLRT well. Blood flow restriction training (BFRT) incorporates low load while achieving hypertrophy and strength adaptations comparable to HLRT. However, the effects of BFRT on healthy and pathological tendons are unknown. The aims of this scoping review were therefore to summarize the reported impact of BRFT: (1) on tendon adaptation in healthy individuals, and (2) in tendon rehabilitation after injury.

Methods: A scoping review based on PRISMA guidelines was performed. A systematic literature search in the electronic databases PubMed, SPORTDiscus and CINAHL was performed in May 2024. This review includes peer-reviewed articles investigating the effects of BFRT on healthy tendons and in tendon rehabilitation. Methodological quality was assessed using the Downs and Black scale and JBI Critical Appraisal Checklist.

Results: 19 studies with varied design, population, investigated tendon, intervention design and outcome measures were eligible. Ten studies were randomized controlled trials (RCT), one study was a clinical controlled trial, three studies were feasibility studies and five were case reports. The reviewed studies included 351 healthy subjects and 122 individuals with tendon-related disorders (101 subjects with tendinopathy and 21 subjects with tendon ruptures). Tendons investigated were Achilles (n = 6), patellar (n = 6), hamstring (n = 1), gluteal (n = 1), biceps brachii distal (n = 1), tendons of the rotator cuff (n = 2) and lateral elbow extensors (n = 2). In the nine studies on healthy individuals, the effects of BFRT showed contradictory results regarding tendon-related outcomes. However, changes in outcome measures did not differ significantly from HLRT conditions or low-load resistance training (LLRT) conditions. The studies on tendon rehabilitation also showed contradictory results regarding tendon-related outcomes, although several studies do report decreased pain, increased strength, enhanced performance and improved self-reported diagnosis-specific function.

Conclusions: The present scoping review shows contradictory results regarding tendon-related outcomes although studies point to increasing tendon function after rehabilitation. BFRT may be a viable option to incorporate into training regimes aimed at inducing tendon adaptation. Further in-depth research is warranted. Clinical trial number: This is a review and therefore is Clinical trial number: Not applicable. However, the review has been preregistered at www.osf.io (DOI https://doi.org/10.17605/OSF.IO/PYV43) stated in the method section.

Thigh muscle weakness prevails following anterior cruciate ligament (ACL) injury, as usually evaluated by peak concentric quadriceps strength. Assessment throughout the range of motion (ROM), and for antagonists may provide more comprehensive information. We evaluated angle-specific torque profiles and ratios of isokinetic thigh muscle strength in 70 individuals 23 ± 2 years post-ACL injury (44males, 46.9 ± 5.4 years); 33 treated with ACL-reconstruction (ACL-R), and 37 treated only with physiotherapy (ACL-PT), and 33 controls. Quadriceps and hamstrings torques for concentric/eccentric contractions (90°/s) and ratios between hamstrings/quadriceps strength (HQ) were compared between and within groups using inferential functional data methods. The injured ACL-R leg had lower concentric and eccentric quadriceps strength compared to non-injured leg throughout the ROM, and lower concentric (interval 70–79°) and eccentric (64–67°) quadriceps strength compared to controls. The injured ACL-PT leg showed lower eccentric quadriceps strength (53–77°) than non-injured leg and lower concentric (41–79°) and eccentric (52–81°) quadriceps and eccentric hamstrings (30–77°) strength than controls. There were no group differences for HQ-ratios. The injured ACL-R leg had higher HQ-ratio (34–37°) than non-injured leg. Angle-specific torque profiles revealed strength deficits, masked if using only peak values, and seem valuable for ACL-injury rehabilitation.