Medicine and Health Sciences Commons^™

Thrust Joint Manipulation To The Cervical Spine In Participants With A Primary Complaint Of Temporomandibular Disorder (Tmd): A Randomized Clinical Trial, Breanna C. Reynolds

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this …

Cognitive Load Theory Principles Applied To Simulation Instructional Design For Novice Health Professional Learners, Susan M. Grieve

Department of Physical Therapy Student Theses, Dissertations and Capstones

While the body of evidence supporting the use of simulation-based learning in the education of health professionals is growing, howor why simulation-based learning works is not yet understood. There is a clear need for evidence, grounded in contemporary educational theory, to clarify the features of simulation instructional design that optimize learning outcomes and efficiency in health care professional students.

Cognitive Load Theory (CLT) is a theoretical framework focused on a learner’s working memory capacity. One principle of CLT is example based learning. While this principle has been applied in both traditional classroom and laboratory settings, and has shown positive …

Trigger Point Dry Needling, Manual Therapy And Exercise Versus Manual Therapy And Exercise For The Management Of Achilles Tendinopathy: A Feasibility Study, Alex Michael Koszalinski

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: The effect of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy are unknown. Objectives: To determine the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to exercise in a patient population with Achilles tendinopathy. Methods: This single-factor, pretest-posttest control group design included 22 subjects between the ages of 24 and 65 years with Achilles tendinopathy. Subjects were randomly assigned to either a control group (MT+Ex) or experimental group (TDN+MT+Ex). Subjects in both groups completed 8 physical therapy treatment sessions over 4 weeks. The intervention for the TDN+MT+Ex group …

Effects Of Generic Group-Based Versus Personalized Individual-Based Exercise Programs On Balance, Gait, And Functional Performance Of Older Adults With Mild Balance Dysfunction And Living In Residential Care Facilities - A Randomized Controlled Trial, Varatharajan Lingam

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background and Purpose: To investigate the effect of an individualized exercise program versus a generic group-based exercise program on balance, gait, and functional performance of older adults categorized as having mild balance dysfunction and living in residential care facilities. Methods: Single blind randomized control design. One hundred-twenty residents fulfilled screening criteria for mild balance dysfunction based on the BioSwayTM balance and the Multi-Directional Reach Test (MDRT) primary outcome measures. Secondary assessment was completed using the Modified Physical Performance Test (PPT), hand-held dynamometer (lower-limb muscle strength testing), and gait speed analysis. Sixty subjects received individualized treatment from physical therapists (8 weeks). …

Effectiveness Of A Manual Therapy Approach In Treatment Of Patients With Lumbar Spinal Stenosis, Haitham Ramadan

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: The use of manual therapy for the management of lumbar spinal stenosis (LSS) has not been adequately systematically reviewed in an attempt to determine its effectiveness on patients with LSS. The lack of evidence in support ofcommonly used conservative interventions continues to result in a lack of clarity regarding what interventions should be used to manage patients with LSS. Objective: To use a randomized comparative trial to compare the functional clinical outcomes achieved by patients with LSS receiving two different physical therapy interventions. Methods: In this randomized controlled trial, a total of40 participants diagnosed with LSS were randomized into …

Influence Of A Post-­Graduate Physical Therapy Residency Program On Clinical Reasoning, Professional Development, And Career Advancement In Nairobi, Kenya, Shala Cunningham

Department of Physical Therapy Student Theses, Dissertations and Capstones

Problem Statement

Residency programs that emphasize clinical reasoning and manual therapy can provide a means to optimize the outcomes of physical therapy without the need for or access to expensive equipment. The residency format of continuing education could allow physical therapists in developing countries access to specialty training and ongoing mentorship. However, there are limited studies that investigate the influence of residency training on the progression of clinical reasoning, professional development, and career advancement.

Purpose

The purpose of this study was threefold. The first objective was to describe the outcome of a post-graduate orthopaedic manual therapy residency program on development …

Effect Of Individual Height And Testing Methods On Outcome Of The Forward Functional Reach Test, Jill Elaine Heitzman

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: With falls a leading cause of injuries among those over age 65, early recognition of risk is imperative to reduce rising rates. The Forward Functional Reach test (FFRT) (Duncan et al., 1990) is frequently used to identify fall risk, however, the variability in cut values found in the research may be related to height and reach strategies.

Purpose: The purpose of this study was to determine if FFRT is affected by an individual’s height and if bilateral reach to height ratio could more accurately identify fall risk.

Methods: Sixty-six participants (60 and older) were recruited from a senior center …

Use Of A Telerehabilitation Delivery System For Fall Risk Screening, Robert W. Nithman

Department of Physical Therapy Student Theses, Dissertations and Capstones

Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older …

Predictors Of Shoulder Injuries In Female Collegiate Swimmers, Eric Lee Lippincott

Department of Physical Therapy Student Theses, Dissertations and Capstones

Competitive swimmers frequently injure their shoulders. The risk factors for shoulder injuries in competitive swimmers have not been clearly identified. The primary purposes of this study were to describe the characteristics of female collegiate swimmers at the onset of a swim season, identify the risk factors of shoulder injury in female collegiate swimmers, characterize the swim volume of female collegiate swimmers, and determine if swim volume is a predictor of shoulder injury.

A prospective longitudinal cohort multi-center design was utilized. Female collegiate swimmers [n=53, mean age=19.3+/– 1.2] from four NCAA Division II universities were recruited to participate in this study. …

Diagnostic Musculoskeletal Imaging: How Physical Therapists Utilize Imaging In Clinical Decision-Making, Hilmir Agustsson

Department of Physical Therapy Student Theses, Dissertations and Capstones

This qualitative study describes how physical therapist experts in musculoskeletal disorders evaluate and interpret imaging studies and how they employ imaging in clinical decision-making. The informants are physical therapists who are certified orthopedic clinical specialists (OCS) and/or fellows of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). The study employed web conferencing to display patient cases, record screen-capture videos, and to conduct interviews. Informants were observed and their activity video-captured as they evaluated imaging studies and, afterwards, interviews were employed to explore the processes they utilized to evaluate and interpret the images and to discuss imaging-related clinical decision-making, including …

Relationship Between Rehabilitative Ultrasound Imaging And The Modified Prone Straight Leg Raise Test To Identify Multifidus Weakness, Mitchell T. Maione

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Low back pain (LBP) is often associated with lumbar spinal instability (LSI). The multifidus muscle is considered a stabilizer of the spine and has been studied extensively with Rehabilitative Ultrasound Imaging (RUSI). There may be a relationshipbetween clinical signs of LSI, decreased cross-sectional area (CSA) of the multifidus and weakness. Having the ability to detect multifidus weakness without the use of RUSI may serve to be invaluable to the clinician in detecting multifidus weakness.Purpose: To investigate the relationship between the modified prone straight leg raise test (MPSLR) and CSA of the multifidusmuscle as measured by RUSI and to investigate …

Physical Therapists’ Beliefs About Preparation To Work In Special Care Nurseries And Neonatal Intensive Care Units, Joyce Lammers

Department of Physical Therapy Student Theses, Dissertations and Capstones

BACKGROUND: Physical therapists (PTs) may care for full-term or premature newborns in all levels of hospital nurseries. There is some endorsement in the published physical therapy literature for restricting practice in the nursery setting to only those PTs with specialized training.1-4 PURPOSE: The purpose of this study was to understand the experiences of becoming and being a physical therapist in a special care nursery (SCN) or neonatal intensive care unit (NICU) from the therapists’ perspective. METHODS: The participants were physical therapists who have practiced in a SCN or NICU in the United States. A phenomenological approach was used and data …

Shoulder Symptom Irritability: Development And Testing Of A New Construct, Stephen Michael Kareha

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Physical therapists regularly make decisions regarding intervention intensity based upon pathoanatomy and symptom irritability, but the reliability and validity of classifying patients by symptom irritability are unknown. Purpose: Examine the reliability and construct validity of the shoulder symptom irritability classification (SSIC) system for the purposes of determining an appropriate treatment intensity. Design: Prospective repeated-measures cross-sectional single-blinded design. Methods: 101 consecutive subjects with primary complaints of shoulder pain were assessed by a pair of blinded raters. Raters recorded the SSIC level and selected the appropriate intervention intensities for the subjects. Data Analysis: Prevalence-adjusted, bias-adjusted Kappa for ordinal scales (PABAK-OS) and …

Impact Of An Exercise Program On Stress, Fatigue, And Quality Of Life For Individuals Living With Primary Immunodeficiency Disease, Kerri Sowers

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: There are over 300 Primary Immunodeficiency diseases (PID) that are a result of a genetic or idiopathic dysfunction of any aspect of the immune system. These conditions result in a higher frequency of infections, autoimmune conditions, or malignancies. Moderate intensity exercise is thought to help the immune system, while high intensity exercise may have a negative impact on immune function. The impact of exercise on individuals with an impaired immune system due to PID is not yet understood. Purpose: The purpose of this study was to investigate whether a low to moderate intensity exercise program would have an effect …

Effects Of Functional Electrical Stimulation Cycling Versus Cycling Only On Walking Performance And Quality Of Life In Individuals With Multiple Sclerosis: A Randomized, Clinical Pilot Study, Lori Hochman

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Functional Electrical Stimulation (FES) stimulates peripheral nerves via electrical current to evoke muscle contractions and when combined with lower extremity cycling (LE), creates patterned leg movements. Previous studies demonstrated FES cycling is safe and effective in the spinal cord injury and stroke populations with improvements seen in walking speed, muscle mass, and bone density. Few studies have applied FES cycling to a neurodegenerative disorder, such as multiple sclerosis (MS). The aim of this study is to assess the effect of an 8-week training program using FES cycling, compared to Cycling Only, in people with MS (PWMS). Methods: Using a …

Immediate Effects Of A Seated Versus Supine Upper Thoracic Spine Thrust Manipulation Compared To Sham Manipulation In Individuals With Subacromial Pain Syndrome – A Randomized Clinical Trial, Jason Keith Grimes

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Individuals with Subacromial Pain Syndrome (SPS) often present with a variety of contributing factors. It is possible that a subgroup exists within SPS that has primary impairments of scapular mobility and/or muscle strength. In an attempt to better identify scapular contributions in SPS, the Scapular Assistance Test (SAT) and Scapula Reposition Test (SRT) have been described. Additionally, thoracic spine thrust manipulation has been shown to be effective for shoulder pain. Problem Statement: It is currently unknown whether or not there are impairments in scapulothoracic muscle force generation or scapular mobility in individuals with SPS who have positive results on …

Iliotibial Band Length And Patellofemoral Pain Syndrome: Relationship Between Two Measurement Techniques, Duane Michael Scotti

Department of Physical Therapy Student Theses, Dissertations and Capstones

Purpose: To determine the relationship between iliotibial band (ITB) length and the presence of patellofemoral pain syndrome (PFPS), compare the difference in ITB length between the painful knee and the non-painful knee in subjects with unilateral PFPS, determine the test-retest reliability, standard error of measurement, and minimal detectable change (MDC) of the Ober test and modified Thomas test, and explore the relationship between the Ober test and the modified Thomas test in measuring ITB length. Subjects: Forty-eight subjects were recruited (PFPS group n=24, control group n=24) from three different outpatient physical therapy clinics. Methods: The Ober test and modified Thomas …

Cost Of Physical Therapists Serving As A Musculoskeletal Providers Compared To Family Practice Providers In A Military Treatment Facility, Troy Edward Mcgill

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background. Physical therapists (PTs) in the U.S. military practice direct access and can order limited prescription medications, imaging studies. Military PTs function as autonomous primary care managers (PCMs) for patients with musculoskeletal (MSK) disorders. Objective. The study compared cost of PT management of patients with MSK disorders to management by traditional PCMs; medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods. The researcher used a retrospective study of electronic medical records, using an exploratory, non-experimental, cross-sectional, and quantitative design method. Results. At an Air Force military medical clinic during an 18-month …

Educational Program Attributes And Faculty Teaching Behaviors As Predictors Of National Physical Therapy Examination Success, Natonya Frazier-Early

Department of Physical Therapy Student Theses, Dissertations and Capstones

Purpose: To determine the differences between PT program NPTE 3-year ultimate pass rates (3YUPR) based on program length and faculty scholarship. To explore relationships between 3YUPR and quality faculty behaviors. Subjects: A total of 112 CAPTE accredited PT educational programs in the United States and Puerto Rico during 2013. Method: A quantitative design method was used to retrospectively test differences between program and faculty traits and student NPTE 3YUPR using data from the Commission on Accreditation in Physical Therapy Education (CAPTE), PT Annual Accreditation Reports (AAR) and Federation of State Boards of Physical Therapy (FSBPT) score reports. A self-generated faculty …

Efficacy Of Kinesio Taping As An Adjunct Intervention To Traditional Physical Therapy In The Treatment Of Nonspecific Acute Low Back Pain: A Prospective Randomized Controlled Trial, Hossameldien Elkholy

Department of Physical Therapy Student Theses, Dissertations and Capstones

The Efficacy of Kinesio Taping as an Adjunct Intervention to Traditional Physical Therapy in the Treatment of Nonspecific Acute Low Back Pain: A Prospective Randomized Controlled Trial Background: Acute low back pain (LBP) is a significant health problem worldwide and is one of the leading causes of disability. Objective: The purpose of this study was to examine the effect of Kinesio Taping (KT) on disability, fear-avoidance beliefs, and pain intensity in patients with acute, nonspecific LBP. Research Design and Methods: A prospective, randomized controlled study of consecutive patients referred to physical therapy with a primary complaint of LBP. Seventy-eight patients …

Dry Needling Of Myofascial Trigger Points: Quantification Of The Biomechanical Response Using A Myotonometer., Joseph P. Kelly

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Biomechanical stiffness has been linked to risk of injury and found to be a measureable characteristic in musculoskeletal disorders. Specific identification of stiffness may clarify who is most likely to benefit from the trigger point dry needling (TDN). The purpose of this study is to investigate the reliability and concurrent validity of the MyotonPRO® to the criterion of shear wave ultrasound elastography for the measurement of biomechanical stiffness in the infraspinatus, erector spinae, and gastrocnemius of healthy subjects over increasing muscle contraction. Second purpose is to investigate the biomechanical effects of TDN to latent myofascial trigger points (MTrPs) in …

Gait Analysis Following Total Knee Arthroplasty During Inpatient Rehabilitation: Can Findings Predict Los, Ambulation Device, And Discharge Disposition?, Janet Anne Herbold

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Growth in the number of procedures performed annually in the United States is expected to increase steadily. Post-operative rehabilitation settings vary and include both institutional and community based physical therapy (PT) services. Despite access to PT, deficits in gait often persist for months and even years after surgery. Slow gait speed, asymmetrical walking patterns, and prolonged time in double-limb support following the TKA often lead to the need for an assistive device for walking and prolong the rehabilitation phase. Purpose: The purpose of this study is …

Sub-Clinical Neck Symptoms, Disability, Posture, And Muscle Function In Computer Users, And The Effect Of Education Versus Education And Deep Cervical Flexor Exercise, Donna Lynne Skelly

Department of Physical Therapy Student Theses, Dissertations and Capstones

Purpose: 1, to determine effect of education and exercise on neck pain, disability, cervical posture and muscle function in office workers with sub-clinical neck symptoms; 2, to determine differences in forward head posture in preferred and standardized posture, and 3, to explore the influence of time on work posture in a sub-group of office workers. Subjects: Sixty-six office workers with sub-clinical neck symptoms who utilize computers at least 4 hours per day participated. A sub-group of 27 were videotaped to assess posture over a workday. Methods: Videotaping was performed 15 minutes of the first and last hour of the workday …

Validation Of A Pressure Pain Threshold Scale In Patients Diagnosed With Myofascial Pain Syndrome And Fibromyalgia, Scott William Cheatham

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Palpation is an examination technique used to diagnose and treat myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there is no validated technique for classifying the results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this dissertation was to validate a PPTS in patients diagnosed with MPS and FM. Design and Methods: An observational study. Participants who met the inclusion criteria were placed into three equal groups: MPS, FM, and control. All participants underwent one, two-part testing sessions using the American College of …

Effect Of Stance Symmetry On Perturbation-Induced Protective Stepping In Persons Poststroke And Controls, Katherine M. Martinez

Department of Physical Therapy Student Theses, Dissertations and Capstones

Problem Statement: Stepping is a common strategy after a perturbation. Stroke survivors display a predilection for stepping with non-paretic leg. Insight into induced stepping between stroke survivors and age-matched control may guide our understanding for reactive postural control training post stroke. Purpose: To investigate the difference in perturbation-induced stepping between chronic stroke survivors and age-matched controls at three phases of the stepping response: preparation, execution, and landing and association with clinical outcome measures. Procedure: Twenty-one community-dwelling chronic stroke survivors (mean age 59y/o ±13yrs) and 17 age- and gender-matched controls (mean age 54.4y/o ±17yrs) completed this study. Clinical measures of gait, …

Humeral Retrotorsion In Developing Children And Its Relationship To Throwing Sports, Elliot M. Greenberg

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Baseball players exhibit a more posteriorly oriented humeral head or humeral retrotorsion (HRT) in the dominant arm, likely representing an adaptive response to the stress of throwing. This adaptation is thought to occur while skeletally immature, however there is limited research detailing how throwing while young influences the development HRT. In addition, it is currently unclear how this changing osseous orientation influences shoulder motion within young athletes. Purpose: To determine the influence of throwing and age on the development of asymmetry in HRT and shoulder range of motion (ROM); and analyze the relationship between HRT and ROM. Study Design: …

Investigation Of Relationships Between Physical Characteristics Of Recreational Runners And Lower Extremity Injuries, Steven Marc Jackson

Department of Physical Therapy Student Theses, Dissertations and Capstones

Purpose: The purpose of this study was to investigate the relationship between anthropometric measurements, proximal and distal lower extremity muscle performance, core muscle endurance, lower extremity flexibility, and neuromuscular control with the incidence of injury in recreational runners over one season. Also, when a relationship was established, we sought to evaluate the predictive validity for any of the variables being investigated for risk of injury in this population. Study Design: Prospective cohort Methods: Anthropometric measurements, proximal and distal isometric lower extremity muscle performance, isometric core muscle endurance, lower extremity flexibility and neuromuscular control were measured in 75 recreational runners prior …

Achieving Competence: Clinical Instructors' Perspective, Kimberly W. Coleman-Ferreira

Department of Physical Therapy Student Theses, Dissertations and Capstones

Purpose: The profession of physical therapy uses physical therapist clinical instructors to educate students in the clinical education portion of the curriculum. The requirements to become a clinical instructor are minimal and non- specific regarding formal training and development. A variety of educational opportunities is available to clinical instructors, but the evidence in the physical therapy literature is conflicting regarding the effectiveness of these programs. Additionally, no previous research regarding the meaning of competence, nor the pathway to achieving competence as a clinical instructor was found. Therefore, the purpose of this study was to describe the experience of achieving competence …

Effective Mentoring In Physical Therapy : Approaches For Residency Training, Anne E. O'Donnell

Department of Physical Therapy Student Theses, Dissertations and Capstones

PURPOSE: This study aimed to investigate how physical therapy mentors instill clinical judgment and competence during residency training. The researcher investigated effective mentoring behaviors and techniques in physical therapy residency training. SUBJECTS: Participants included physical therapy residency faculty, physical therapy residents currently enrolled in U.S. residency programs credentialed by the American Physical Therapy Association (APTA), and resident graduates (ie, within the past 2 years) from APTA programs. METHOD: A quantitative survey design was used to gain information about effective mentoring behaviors and techniques of physical therapy residency faculty who foster clinical expertise in physical therapy residents. Two online surveys were …