Medicine and Health Sciences Commons^™

The Role Of Balance And Neck Strength In Youth Concussion, Chris Koch, Jenny Neudorfer, Peter Heuberger, Tel Winegar, Calvin Lee, Jarrett Fegel

Student-Faculty Research - College of Physical Therapy

Concussion: A concussion is a trauma-induced alteration in mental status that may or may not involve loss of consciousness; this can include a direct blow to the head or a blow to the body resulting in the head and brain moving quickly back and forth (1).

Current Screen: Current concussion screen consists of: symptom checklist, cognitive assessment known as Sport Concussion Assessment Tool (SCAT), and Balance Errors Scoring System (BESS) (2).

Purpose: The purpose of this study is to determine an assessment to screen an individual’s risk of sustaining a sport-related concussion.

Hypothesis: We hypothesized the SCAT 4, BESS, Four …

Can Foot Exercises Alter Foot Posture, Strength, And Walking Foot Pressure Patterns In People With Severe Flat Foot?, Jeff Houck, Lacey Seidl, Austin Montgomery, Joshua Keefer, Miranda Walker

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Muscle training muscle control for barefoot running (i.e. doming seated[DS] and standing[DSt]) and post foot and ankle injury (i.e. seated plantar flexion and inversion[SPFI]) are common. Although studies demonstrated improvement in foot posture (validated foot posture index [FPI]) immediately following a 4-week exercise program this was not assessed in people with flatfoot. Also, more rigorous assessment of foot function is lacking (i.e. foot posture, strength, and plantar pressure during walking). There is clearly a need for more rigorous clinical data on the effect of foot exercises. The purpose of this pilot study was to assess the immediate effect of …

Clinical Utilization Of Patient Reported Outcome (Promis) Scores For Surgical Reconstruction Of Posterior Tibialis Tendon Dysfunction, Michael Anderson, Jeff Houck, Adolph Flemister, Judith Baumhauer, John Ketz, Benedict Digiovanni, David Ciufo, Irvin Oh

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Previous studies have demonstrated that preoperative Patient Reported Outcome Instrumentation System (PROMIS) scores effectively predict improvement in foot and ankle surgery. Adult acquired flatfoot deformity (AAFD) and Posterior Tibialis Tendon Dysfunction (PTTD) are a common surgical problem, but it is unclear if the specific thresholds for the physical function (PF), pain interference (PI) and depression published previously for all foot and ankle surgeries apply to a specific diagnosis. Furthermore, the interplay of PROMIS scores and clinical variables has not been evaluated. The purpose of this study was: 1) to investigate the change in PROMIS scales and radiographic measurements from …

Generalizability And Validation Of Promis Scores To Predict Surgical Success In Foot And Ankle Patients: A Tale Of Two Academic Centers, Judith Baumhauer, Michael Anderson, Charles Saltzman, Man Hung, Florian Nickisch, Alexej Barg, Timothy Beals, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Patient-reported outcomes are advancing clinical care by improving patient satisfaction and engagement. A recent publication reported preoperative PROMIS scores to be highly predictive in selecting patients who would and would not benefit from foot and ankle (F/A) surgery. Although this publication used the data from 5 fellowship trained foot and ankle surgeons at one institution, the generalizability to other patient populations and geographic areas is unknown. This validation study assesses the pre-operative PROMIS physical function (PF) and pain interference (PI) t-scores as a predictor of post-operative success from a separate geographic area.

Comparison Of Patient Reported Outcomes Using Promis In Patients With Shoulder Pain, Benjamin Strong, Raymond James Kennedy, Joseph Christopher Schaffer, Jon Hedgecock, Jeff Houck, Michael D. Maloney, Ilya Voloshin

Faculty Publications - College of Physical Therapy

Objectives: Compare a disease specific questionnaire (American Shoulder and Elbow Surgeons [ASES]) and a multidimensional global health scale (Patient reported outcome measurement system [PROMIS]) across a variety of shoulder conditions

When Are The Patients Satisfied With Their Outcome? Correlation Of Promis Values With Patient Acceptable Symptom State (Pass) Scores In Foot And Ankle Patients, Michael Anderson, Judith Baumhauer, Adolph Flemister, John Ketz, Irvin Oh, Benedict Digiovani, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: PROMIS values are being adopted due to ease of use and influence on clinical decision making. Studies support the use of PROMIS physical function (PF), pain interference (PI), and Depression (D) for pre-surgical decision making. Patient Acceptable Symptom State (PASS) is a validated outcome measure commonly used in other areas of medicine and surgery that captures when patient’s symptoms reach a daily acceptable level. Knowing what PROMIS scores are associated with a patient’s PASS(Yes)/(No) rating would further enhance the use of PROMIS scales. The purpose of this study: 1) association of PROMIS scales with a PASS rating, 2) threshold …

The Road To Recovery For Bunion Surgery: Data Analytic Plots To Target Patient Progress, Ashlee Macdonald, Jeff Houck, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Patient reported outcomes (PROs) can provide information on individual patient’s progress throughout a treatment course and additionally, with common surgeries, powerful numbers can be generated to provide data analytic curves to provide a recovery road map for patients and surgeons. Those who deviate negatively from the predicted path may have a complication and early intervention can be initiated. Those who deviate positively have the potential to need less physical therapy, early return to sports or work. Hallux valgus (HV) is a common condition of the foot with 4.4 million patients seeking care yearly and surgery is equally common. The …

Reading The Future: Predicting Who Will Benefit From Bunion Surgery, Ashlee Macdonald, Jeff Houck, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Hallux valgus is a common condition of the foot with 4.4 million patients seeking care yearly for this condition. A previous study suggested specific pre-operative cut-off scores based on Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and depression (D) values could predict post-operative outcomes in foot and ankle surgery. Though hallux valgus correction, among other procedures, were identified as one of the most common surgeries in the previous study, specific conditions were not considered separately. The purpose of this study was to evaluate the validity of applying a published comprehensive pre-surgical PROMIS profile …

Injury In D Iii Volleyball Players Is Associated With Preseason Jump And Hop Measures, Jason Brumitt, Alma Mattocks, Phil Lentz, Jeremy Loew

Faculty Publications - College of Physical Therapy

Collegiate volleyball (VB) players are at risk for sports injuries. Reported time-loss injury rates for female Division III (D III) collegiate VB players range from 4.0 to 5.4 injuries per 1000 athletic exposures (AEs). Identifying risk factors in this population may help coaches to reduce injury rates via targeted training programs. The purpose of this prospective cohort study was to determine the ability of 2 functional performance tests (FPTs) [the standing long jump (SLJ) and/or the single-leg hop (SLH) for distance] to identify female D III VB players who may be at an increased risk for a non-contact time-loss lower …

High Prevalence Of Nontraumatic Shoulder Pain In A Regional Sample Of Female High School Volleyball Athletes, Kayt E. Frisch

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

Background: Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants.

Purpose: To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated …

Are Preseason Functional And Biomechanical Measures Associated With Lower Quadrant Injury Risk In Division Iii Athletes?, Natalie Ellis, Jordan Petersen, Jordon Reyes, Victor Wilson, Cj Zita

Student-Faculty Research - College of Physical Therapy

A recent trend in sports medicine research is to determine risk of injury during sport based on preseason functional performance test (FPT) measures.

Equivocal findings associated with prior studies may leave PTs with uncertainty as to which FPT, or combination of FPTs, can best identify athletes who have a greater risk for injury.

Previous studies have utilized "low-tech" FPT measures: standing long jump (SLJ), single-leg hop (SLH), lower extremity functional test (LEFT), and the Y-balance test (YBT) (1,3,4).

These "low-tech" options may not be able to identify potential deficits that could be collected with "high-tech" measures (e.g., DVJ measures collected …

Developing An Auditory And Visual Cross-Modal Continuous Performance Task For Evaluating Concussion, Chris Koch, Taylor Charbonnier, Kristin Dissinger, Steven Egeberg, Matthew Johnson, Lindsey Levanen, Matthew Scott

Student-Faculty Research - College of Physical Therapy

Neurocognitive tests like the SCAT3 and ImPACT have become standard concussion assessment tools. Although these tests have adequate sensitivity, specificity, and reliability, they are unimodal in nature. Consequently, the tests do not fully assess the range of processing that can be affected by concussion (Thompson, 2012). Therefore, we developed a cross-modal continuous performance task to examine cognitive processing post-concussion. Forty-three middle school school lacrosse players, college students, and physical therapy graduate students participated in the study. Twelve of these participants had been previously diagnosed with a concussion. Participants completed a symptom checklist from SCAT3 along with other demographic information (e.g., …

Stroke Survivor And Physical Therapist Perceptions Of Community-Based Exercise In Northwest Oregon: A Qualitative Pilot Study, Angela Grenier, Megan Hofstede, Matthew Hornback, Sara Mason, Breanne Myers, David Sjelin, Cindy Zablotny

Student-Faculty Research - College of Physical Therapy

Upon discharge from formal rehabilitation programs, individuals with chronic stroke are often constrained by physical limitations, leading to a diminished quality of life, participation restrictions, and an increased risk of further disability. (Rose et al, 2013) Community-based exercise (CBE) programs specific to individuals post-stroke may offer a mechanism to ameliorate these sequelae. (Pang et al, 2005) Current evidence supports the efficacy of CBEs in improving health-related outcomes, quality of life, and social participation post-stroke. (Lau et al, 2016)

The aim of this region-specific study is to explore current physical therapy practice in educating and preparing stroke survivors for CBE, from …

Influence Of 4-Week Exercise Program On Clinical And Biomechanical Measures Of Foot Function, Lacey Seidl, Josh Keefer, Miranda Walker, Austin Montgomery, Jeff Houck

Student-Faculty Research - College of Physical Therapy

The significance of foot muscle function associated with flat feet is unclear. It is reported that flat feet have significantly decreased lateral forefoot pressure during ambulation with increased midfoot contact area and increased pressure under the big toe. There are passive mechanisms in the foot that support the arch during static standing, but cannot produce energy for dynamic activity. The two most plausible explanations for energy generation of the midfoot for dynamic activity are muscle contributions or recoil of stretched soft tissue (i.e. plantar fascia and other ligaments) or a combination. No studies to date evaluate the ability of foot …

Sit-To-Stand Symmetry In Individuals With Hip Pathology, Andrew J. Meszaros, Stephen Block, Jake Edwards, Brittany Jones, Elizabeth Keeler, Christina Ridley, Ashley Yates

Student-Faculty Research - College of Physical Therapy

Why study hip fracture?

• Hip fractures occur in approximately 300,000 individuals over 65 years of age and is on the rise

• 53.3% of those who fall, fall again • 50% loss of function in involved lower extremity post fracture

• 25% increased mortality rate 1 year post hip fracture

An asymmetry in force production has been found to exist between fractured/non- fractured sides during a sit-to-stand task post hip fracture, despite having adequate

capacity to perform the task symmetrically.

Houck 2011 found the asymmetry is a result of weakness in the fractured lower extremity.

Briere 2013 found the …

Promis Physical Function Scale Bookmarking And Validation, Luke Skerjanec, Amanda Tamanaha, Alex Wegner, Zane Wise, Jeff Houck

Student-Faculty Research - College of Physical Therapy

• Quick, valid and responsive outcome measure are critical for physical therapists

• The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) is a universal, 124 item, computer adapted system (CAT) that evaluates various health domains including physical function without a ceiling or floor effect.

• PROMIS demonstrates good convergent validity with the Health Assessment Questionnaire Disability Index (HAQ-DI) and Short-form 36 (SF-36) physical function subscale1 and also with ‘gold standard' International Knee Documentation Committee (IKDC) scale. PROMIS score can also predict poor outcomes at various follow-up lengths ranging from 3-52 weeks2.

• The modified physical performance test (mPPT) is …

Morphological Changes In Achilles Tendon Thickness Following An 8-Week Heavy Load Eccentric Exercise Program, W. Howe, B. Telfer, J. Leung, M. Suzuki, C. Young, Tyler Cuddeford

Student-Faculty Research - College of Physical Therapy

• Achilles Tendinopathy (AT) is an overuse injury characterized by pain, focal tenderness, and intratendinous imaging changes.

• Current protocols for treating mid-portion AT are not effective, likely due to not providing sufficient load to the tendon.

• Alfredson’s eccentric protocol, which utilizes high repetition with low load, reduces pain with mid-portion AT in 60.3% of individuals (Van der Plas, 2011)

• Research indicates that heavier loading of the Achilles tendon yields superior results to high repetition with low load (Stevens, 2014)

• Tendons have demonstrated plasticity in their ability to adapt to heavy resistance training. Combined with knowledge that …

What Does A Promis T-Score Mean For Physical Function?, Jeff Houck, Zane Wise, Amanda Tamanaha, Judith Baumhauer, Luke Skerjanec, Alexandra Wegner, Chris Dasilva, Michael Bass

Faculty Publications - College of Physical Therapy

Introduction/Purpose: The use of patient-reported outcomes (PRO) continues to expand beyond research to involve standard of care assessments. Although the PROMIS physical function (PF) is normalized to a T-score it is unclear how to interpret and apply this information in the daily care of patients. The T-score is abstract and unanchored to patient abilities impairing its clinical utility when shared with the patient. Patient questions are concrete such as “when will I be able to run again after this procedure?” The purpose of this research was to link PROMIS PF T-scores with physical function activities and provide a visual map …