Physical Therapy Commons^™

Greater Number Of Weekly Stairs Climbed Is Associated With Lower Low Back Pain Prevalence Among Female But Not Male Physical Therapists, Amy H. Amabile, Sharon L. Larson, Lisa T. Hoglund, John P. Guarnieri, Maureen Mcdonald, Madeline R. Reich

Department of Physical Therapy Faculty Papers

INTRODUCTION: Certain cardiovascular health benefits of stair climbing are now widely accepted, but no prior studies have as yet been found linking the quantity of stairs climbed to low back pain (LBP) morbidity. Low back pain is a common musculoskeletal impairment, and research has begun to show an association between LBP and gluteus maximus (GM) weakness. With stair climbing being the activity which most activates GM, the aim of the present research was to assess the relationship between stair ambulation and LBP prevalence. The hypothesis of this cross-sectional study was that individuals with LBP would report a significantly lower numbers …

Efficacy Of Externally Paced Training On Pain In Tendinopathy: A Systematic Review And Meta Analysis, Dylan Carmody, Alyssa Conanan, Daniel Moeller, Sarah Khoblall, Christopher Keating

Department of Physical Therapy Faculty Papers

Tendinopathy is a common condition with treatments focused on local tissue adaptations. Externally paced loading programs are designed to cue (visually, auditorily, or temporally) a person as to when to perform an exercise repetition during a set of repetitions. Externally paced loading programs propose central and peripheral changes with tendinopathy but conclusions regarding their efficacy on pain outcomes remain limited. Our review seeks to explore the efficacy of externally paced loading as a method to reduce self-reported pain in tendinopathic conditions. An electronic database search was conducted of PubMed, SPORTDiscus, Scopus, and CINAHL databases. A total of 2,104 studies were …

Manual Therapy And Exercise For The Management Of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report, Zach Mayo, Christopher Keating

Department of Physical Therapy Faculty Papers

This case describes the clinical decision-making behind the conservative clinical management of an individual presenting with chronic neck pain with myriad neuromuscular comorbidities. The focus of this case report is to support the safe utilization of manual therapy and describe the tolerable prescription of strength and endurance exercise in a patient with numerous complications to improve self-efficacy. A 22-year-old female college student presented with a chief complaint of chronic, non-specific neck pain with comorbid Chiari malformation, migraines, upper cervical spinal fusion, Ehlers-Danlos syndrome (EDS), and postural orthostatic tachycardia syndrome (POTS) to an outpatient physical therapy clinic for evaluation and treatment. …

Survey Of Confidence And Knowledge To Manage Patellofemoral Pain In Readers Versus Nonreaders Of The Physical Therapy Clinical Practice Guideline, Richard W. Willy, Lisa T. Hoglund, Neal R. Glaviano, Lori A. Bolgla, David M. Bazett-Jones

Department of Physical Therapy Faculty Papers

Objectives: To compare beliefs of physical therapists (PTs) who read the clinical practice guideline (CPG) for the management of individuals with patellofemoral pain (PFP) to those who have not read the CPG.

Design: Cross-sectional study.

Setting: Online survey.

Participants: 494 currently licensed/registered PTs or physiotherapists.

Main Outcome Measures: Respondents answered Likert-based or open-ended questions regarding the diagnosis, prognosis, risk factors, and management of individuals with PFP, as well as confidence for managing individuals with PFP, especially the ability to identify beneficial and non-beneficial interventions. We dichotomized responses into participants who read (READERS) and did not read (NonREADERS) the CPG.

Results: …

Front-Loading Of Anatomy Content Has No Effect On Long-Term Anatomy Knowledge Retention Among Physical Therapy Students: A Prospective Cohort Study., Amy H. Amabile, Kim Nixon-Cave, Larry J. Georgetti, Ashley C. Sims

Department of Physical Therapy Faculty Papers

BACKGROUND: Information learned over a longer period of time has been shown to result in better long-term knowledge retention than information learned over a shorter period of time. In order to address multiple curricular goals, the timing and spacing of anatomy content within the Doctor of Physical Therapy (DPT) program at our institution recently changed from a very spaced to a very compressed format. The purpose of the present study was to assess differences in anatomy knowledge retention that might have been impacted by this change. The research hypothesis was that students receiving spaced instruction would have significantly better anatomy …

Participation In An Advanced Anatomy Capstone Project Facilitates Student Involvement In The Development Of An Instructional Tool For Novel Dissection, Larry J. Georgetti, Ashley C. Sims, Aaron Focht, Jamie Elcock, Kim Nixon-Cave, Amy Amabile

Department of Physical Therapy Faculty Papers

Introduction. Student-driven design of instructional tools within basic sciences curricula in general, and in anatomy in particular,has been shown to be both a positive educational experience for the student developers and a viable way to create quality materials for future courses. We present here a description of a student collaboration arising from participation in an advanced anatomy capstone research project, resulting in the creation of a new dissection protocol for the thoracolumbar junction dorsal primary rami and their branches.

Materials and Methods. This project was initiated by two third-year doctor of physical therapy (DPT)students and involved participation from faculty and …

Physiological Factors Of Female Runners With And Without Stress Fracture Histories: A Pilot Study., Therese E Johnston, Colleen Dempsey, Frances Gilman, Ryan Tomlinson, Ann-Katrin Jacketti, Jeremy Close

Department of Physical Therapy Faculty Papers

BACKGROUND: Female runners are at increased risk of stress fractures (SFs) compared with men. Literature is lacking with regard to best practice for preventing and treating SFs in women. The purpose of the study was to compare physiological measures and running-related factors between women of various ages and running abilities with and without a history of running-related SFs.

HYPOTHESIS: Women with and without SF histories will differ with regard to medical and menstrual history, bone health, body composition, nutrition, and running history.

STUDY DESIGN: Prospective cohort study.

LEVEL OF EVIDENCE: Level 2.

METHODS: A total of 20 female runners with …

Perceptions Of Risk For Stress Fractures: A Qualitative Study Of Female Runners With And Without Stress Fracture Histories., Therese E Johnston, Jeremy Close, Phil Jamora, Susan F Wainwright

Department of Physical Therapy Faculty Papers

OBJECTIVES: To gain insight into perceived factors related to bone health and stress fracture (SF) prevention for female runners and to understand their experiences within the medical community.

DESIGN: Cohort qualitative study.

SETTING: University health system.

PARTICIPANTS: Forty female runners, 20 who had SF histories and 20 age-and-running-distance matched women without SF.

MAIN OUTCOME MEASURES: Women participated in audiotaped qualitative semi-structured interviews. For women with a SF history, questions sought their perspectives on factors that they felt contributed to SF, experiences with the medical community, and changes made post SF. For women without a SF history, questions sought perspectives on …

A Case Of Thoracic Spondylosis Deformans And Multilevel Instrumented Spinal Fusion In An 84-Year-Old Male., Amy H Amabile, J Raymond Shea, Vishal Desai, Lisa T Hoglund, Jamie N Elcock, Anthony Lombardo, Matthew C Schiffino

Department of Physical Therapy Faculty Papers

Spondylosis deformans is a type of spinal claw osteophytosis which can be found on the anterolateral vertebral bodies of any region, and which consists of protrusions of intervertebral disc tissue covered by a bony shell. We report here a case of thoracic spondylosis deformans and multilevel instrumented fusion found during routine dissection of a cadaver. Theories of the etiology of this condition are reviewed in general, and with respect to this specific case and the potential interaction of the presenting comorbidities. The clinical implications of these osteophytes, including musculoskeletal and visceral sequelae, are also discussed.

Inspiration For The Future: The Role Of Inspiratory Muscle Training In Cystic Fibrosis., Ren-Jay Shei, Robert L Dekerlegand, Kelly A Mackintosh, John D Lowman, Melitta A Mcnarry

Department of Physical Therapy Faculty Papers

Cystic fibrosis (CF) is an inherited, multi-system, life-limiting disease characterized by a progressive decline in lung function, which accounts for the majority of CF-related morbidity and mortality. Inspiratory muscle training (IMT) has been proposed as a rehabilitative strategy to treat respiratory impairments associated with CF. However, despite evidence of therapeutic benefits in healthy and other clinical populations, the routine application of IMT in CF can neither be supported nor refuted due to the paucity of methodologically rigorous research. Specifically, the interpretation of available studies regarding the efficacy of IMT in CF is hampered by methodological threats to internal and external …

Risk Factors For The Elevation Of Psychosocial Barriers In The Recovery Of Lumbar Pathology, Christopher Keating, Cameron Hui, Gerard Smith, Tingting Zhan

Department of Physical Therapy Faculty Papers

Background/Purpose: The prevalence of low back pain (LBP) continues to rise and an appreciation for a biopsychosocial approach, which takes in multiple facets of a patient presentation, may significantly impact this increase. To the best our knowledge, there are no studies evaluating the relationship between the STarTBack Screening Tool (SBT) and the access point the patient enters the health system. Our hypothesis is that patients that access care through the medical model will exhibit greater psychosocial risk.

Methods: A retrospective analysis of 1404 cases of LBP utilizing past medical history, demographic information, and SBT data. A linear regression model to …

The Validity, Reliability, Measurement Error, And Minimum Detectable Change Of The 30‐Second Fast‐Paced Walk Test In Persons With Knee Osteoarthritis: A Novel Test Of Short‐Distance Walking Ability, Lisa T. Hoglund, Phd, Erik Folkins, Dpt, Laura Pontiggia, Phd, Michael W. Knapp, Dpt

Department of Physical Therapy Faculty Papers

Objective

To develop and establish the reliability, validity, measurement error, and minimum detectable change of a novel 30‐second fast‐paced walk test (30SFW) in persons with knee osteoarthritis (OA) that is easy to administer and can quantify walking performance in persons of all abilities.

Methods

Twenty females with symptomatic knee OA (mean age [SD] 58.30 [8.05] years) and 20 age‐ and sex‐matched asymptomatic controls (57.25 [8.71] years) participated in the study. Participants completed questionnaires of demographic and clinical data, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36‐item Short Form Health Survey (SF‐36) followed by 30SFW performance. Participants returned …

Trunk Motion Visual Feedback During Walking Improves Dynamic Balance In Older Adults: Assessor Blinded Randomized Controlled Trial., Eric Anson, Lei Ma, Tippawan Meetam, Elizabeth Thompson, Roshita Rathore, Victoria Dean, John Jeka

Department of Physical Therapy Faculty Papers

BACKGROUND: Virtual reality and augmented feedback have become more prevalent as training methods to improve balance. Few reports exist on the benefits of providing trunk motion visual feedback (VFB) during treadmill walking, and most of those reports only describe within session changes.

RESEARCH QUESTION: To determine whether trunk motion VFB treadmill walking would improve over-ground balance for older adults with self-reported balance problems.

METHODS: 40 adults (75.8 years (SD 6.5)) with self-reported balance difficulties or a history of falling were randomized to a control or experimental group. Everyone walked on a treadmill at a comfortable speed 3×/week for 4 weeks …

A 6-Week Hip Muscle Strengthening And Lumbopelvic-Hip Core Stabilization Program To Improve Pain, Function, And Quality Of Life In Persons With Patellofemoral Osteoarthritis: A Feasibility Pilot Study., Lisa T. Hoglund, Laura Pontiggia, John D. Kelly

Department of Physical Therapy Faculty Papers

Background: Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA.

Methods: Ten females with PFJ …

Atrophy Of Gluteus Maximus Among Women With A History Of Chronic Low Back Pain., Amy H. Amabile, John H. Bolte, Saskia D. Richter

Department of Physical Therapy Faculty Papers

BACKGROUND: Although the relationship between low back pain (LBP) and the size of certain trunk muscles has been extensively studied, the relationship between gluteus maximus (GM) size and LBP has been only minimally examined. Determining whether such a relationship exists would help improve our understanding of the etiology of LBP, and possibly provide a rationale for the use of therapeutic exercise interventions targeting GM with LBP patients. The objective of this study was to compare gluteus maximus cross-sectional area in individuals with chronic LBP, and in a group of individuals without LBP. Our hypothesis was that individuals with LBP would …

Locomotor Adaptation Is Influenced By The Interaction Between Perturbation And Baseline Asymmetry After Stroke., Christine M. Tyrell, Erin Helm, Darcy S. Reisman

Department of Physical Therapy Faculty Papers

Stroke survivors without cerebellar involvement retain the ability to adapt to the split-belt treadmill; however it has been suggested that their rate of adaptation may be slowed compared to those who are neurologically intact. Depending on limb placement, the split-belt treadmill can be configured to either exaggerate baseline asymmetry, or reduce it, which may affect the behavior of adaptation or de-adaptation. The objectives of this study were to characterize the rate and magnitude of locomotor (de)adaptation in chronic stroke survivors compared to healthy matched subjects, and to evaluate whether exaggeration or reduction of baseline asymmetry impact the responses. Seventeen stroke …

Increased Serum And Musculotendinous Fibrogenic Proteins Following Persistent Low-Grade Inflammation In A Rat Model Of Long-Term Upper Extremity Overuse., Helen G L Gao, Paul W Fisher, Alex G Lambi, Christine K Wade, Ann E Barr-Gillespie, Steven N Popoff, Mary F Barbe

Department of Physical Therapy Faculty Papers

We examined the relationship between grip strength declines and muscle-tendon responses induced by long-term performance of a high-repetition, low-force (HRLF) reaching task in rats. We hypothesized that grip strength declines would correlate with inflammation, fibrosis and degradation in flexor digitorum muscles and tendons. Grip strength declined after training, and further in weeks 18 and 24, in reach limbs of HRLF rats. Flexor digitorum tissues of reach limbs showed low-grade increases in inflammatory cytokines: IL-1β after training and in week 18, IL-1α in week 18, TNF-α and IL-6 after training and in week 24, and IL-10 in week 24, with greater …

The Graded Redefined Assessment Of Strength Sensibility And Prehension: Reliability And Validity., Sukhvinder Kalsi-Ryan, Dorcas Beaton, Armin Curt, Susan Duff, Milos R Popovic, Claudia Rudhe, Michael G Fehlings, Mary C Verrier

Department of Physical Therapy Faculty Papers

Abstract With the advent of new interventions targeted at both acute and chronic spinal cord injury (SCI), it is critical that techniques and protocols are developed that reliably evaluate changes in upper limb impairment/function. The Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) protocol, which includes five subtests, is a quantitative clinical upper limb impairment measure designed for use in acute and chronic cervical SCI. The objectives of this study were to: (1) establish the inter-rater and test-retest reliability, and (2) establish the construct and concurrent validity with the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI), …

Aging Contributes To Inflammation In Upper Extremity Tendons And Declines In Forelimb Agility In A Rat Model Of Upper Extremity Overuse., David M Kietrys, Ann E Barr-Gillespie, Mamta Amin, Christine K Wade, Steve N Popoff, Mary F Barbe

Department of Physical Therapy Faculty Papers

We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF) handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and …

Clinical Care Plan: Interdisciplinary Course (Ccpic), Marcia Levinson, Pt, Phd, Mft, Amy M Egras, Pharm.D, Bcps, E. Adel Herge, Otd, Otr/L, Kathryn Shaffer, Rn, Msn

Department of Physical Therapy Faculty Papers

Background/Rationale:

Interprofessional collaborative practice significantly improves patient outcomes, reduces mortality and enhances quality-of-life.

Person-focused care demands collaboration among professions in a team approach to address multiple issues including illness, prevention, and health promotion activities.

Key elements of successful implementation of interprofessional education supported by Clinical Care Plan, Interprofessional Course (CCPIC):

-Increasing knowledge of the roles, responsibilities, and competencies of multiple health professions.

-Collaborating in teams

-Recognizing the patient as the expert

-Communicating effectively

Course Statistics:

-176 students from various disciplines completed course (2008-2011).

Disciplines include:

-Medicine, Nursing, Occupational Therapy, Physical Therapy, Pharmacy

Aging Enhances Serum Cytokine Response But Not Task-Induced Grip Strength Declines In A Rat Model Of Work-Related Musculoskeletal Disorders., Dong L Xin, Michelle Y Harris, Christine K Wade, Mamta Amin, Ann E Barr, Mary F Barbe

Department of Physical Therapy Faculty Papers

BACKGROUND: We previously reported early tissue injury, increased serum and tissue inflammatory cytokines and decreased grip in young rats performing a moderate demand repetitive task. The tissue cytokine response was transient, the serum response and decreased grip were still evident by 8 weeks. Thus, here, we examined their levels at 12 weeks in young rats. Since aging is known to enhance serum cytokine levels, we also examined aged rats.

METHODS: Aged and young rats, 14 mo and 2.5 mo of age at onset, respectfully, were trained 15 min/day for 4 weeks, and then performed a high repetition, low force (HRLF) …

A Clincial Outcomes Commentary On "A Longitudinal Study Of Outcome Measures For Children Receiving Early Intervention Services", Marcia Levinson, Pt, Phd, Mft, Rosaleen Creedon Gnoffo, Pt, Ms, Dpt, Pcs

Department of Physical Therapy Faculty Papers

Pediatric physical therapy, especially in early intervention (EI), focuses on children’s function in natural environments and within daily routines. Valid and reliable tests measuring the ICF participation component are important to consider if we are to align our treatment focus and goals to our measures of progress. This article demonstrates that the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skill scaled scores are sensitive to change in children receiving EI with and without motor involvement.

Trial And Error Versus Errorless Learning Of Functional Skills In Patients With Acute Stroke, Julie Mount, Samuel R. Pierce, Janet Parker, Rebecca Diegidio, Russell Woessner, Lenore Spiegel

Department of Physical Therapy Faculty Papers

Objective: To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments.

Design: Randomized crossover.

Setting: Rehabilitation hospital.

Participants: 33 adult subjects following an acute stroke.

Intervention: Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner. Tasks were taught using errorless learning or trial and error learning. Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam.

Main Outcome Measures: Days until subject was able to …

Movement Patterns Used By The Elderly When Getting Out Of Bed, Julie Mount, Leslie Kresge, Gabrielle Klaus, Lynn Mann, Caitlin Palomba

Department of Physical Therapy Faculty Papers

Background and Purpose. Getting out of bed is difficult for 27.6% of people over 65. The purpose of this study is to describe movement patterns used by older adults for rising from bed.

Subjects. 42 healthy subjects between the ages of 65 and 90.

Methods. Subjects were videotaped performing 5 trials of getting out of bed. Movement patterns were categorized for each body part.

Results. A number of movement patterns occurred that were not reported in younger people. The most frequent movement patterns used were: “roll off” (38.3%) for the trunk, “double push” (34.7%) for the far arm, “multi-push” (36.0%) …

Effects Of Dorsiflexor Endurance Exercises On Foot Drop Secondary To Multiple Sclerosis: A Pilot Study, Julie Mount, Stan Dacko

Department of Physical Therapy Faculty Papers

PURPOSE: This is a pilot study to determine if endurance exercises for dorsiflexors will improve walking for people with foot drop secondary to MS, and if improvement in muscle endurance for persons with MS can be predicted based on the amount of central fatigue (CF) in the muscle.

SUBJECTS: Five individuals with foot drop secondary to MS and five age-matched controls.

METHODS: The intervention was 4 sets of 10 isometric contractions, at 60% of MVC, 3X/week, 8 weeks. Pretests-posttests included a dorsiflexor endurance test with superimposed electrical stimulation to measure CF, and a gait assessment including measurement of dorsiflexion at …

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite)., Cornelis J T Van Uden, Marcus P Besser

Department of Physical Therapy Faculty Papers

BACKGROUND: The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite). METHODS: Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle. RESULTS: Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite®), Cornelius J.T. Van Uden, Marcus P. Besser

Department of Physical Therapy Faculty Papers

Background
The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite®).

Methods
Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite® system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle.

Results
Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Investigation Of The Optimal Load-Bearing Characteristics Of Patellar Tendon Bearing (Ptb) Prostheses, Rahamim Seliktar, Theerasakdi Vachranukunkiet, Marcus P. Besser, Denise Kuenzig, A. Esquenazi

Department of Physical Therapy Faculty Papers

The long-term goal of the research team is to automate the construction of lower limb prostheses using computer integrated manufacturing (CIM) techniques.

Investigation Of The Optimal Load-Bearing Characteristics Of Patellar Tendon Bearing (Ptb) Prostheses, Rahamim Seliktar, Theerasakdi Vachranukunkiet, Marcus P. Besser, Denise Kuenzig, A. Esquenazi

Department of Physical Therapy Faculty Papers

The long term goal of the research team is to automate the construction of the lower limb prostheses using Computer Integrated Manufacturing (CIM) techniques.