Medicine and Health Sciences Commons^™

Cardiorespiratory Fitness Is Inversely Associated With Clustering Of Metabolic Syndrome Risk Factors: The Ball State Adult Fitness Program Longitudinal Lifestyle Study, Elizabeth Kelley, Mary T. Imboden, Matthew P. Harber, Holmes Finch, Leonard A. Kaminsky, Mitchell H. Whaley

Faculty Publications - Department of Kinesiology

Objective: The focus of this study was the association between the metabolic syndrome (MetSyn) and cardiorespiratory fitness (CRF) defined as maximal oxygen uptake (VO2max). Although previous research has shown a relationship between MetSyn and CRF, most studies are based on less objective measures of CRF and different cardiometabolic risk factor thresholds from earlier guidelines.

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 …

Validation Of Accelerometer-Based Energy Expenditure Prediction Models In Structured And Simulated Free-Living Settings, Alexander H. K. Montoye, Scott A. Conger, Christopher P. Connolly, Mary T. Imboden, M. Benjamin Nelson, Josh M. Bock, Leonard A. Kaminsky

Faculty Publications - Department of Kinesiology

This study compared accuracy of energy expenditure (EE) prediction models from accelerometer data collected in structured and simulated free-living settings. Twenty-four adults (mean age 45.8 years, 50% female) performed two sessions of 11 to 21 activities, wearing four ActiGraph GT9X Link activity monitors (right hip, ankle, both wrists) and a metabolic analyzer (EE criterion). Visit 1 (V1) involved structured, 5-min activities dictated by researchers; Visit 2 (V2) allowed participants activity choice and duration (simulated free-living). EE prediction models were developed incorporating data from one setting (V1/V2; V2/V2) or both settings (V1V2/V2). The V1V2/V2 method had the lowest root mean square …

Longitudinal Analyses Of The Sexual And Reproductive Health Knowledge And Parent-Adolescent Communication Of At-Risk Adolescents, Courage Chikomborero Mudzongo

Faculty Publications - Doctor of Psychology (PsyD) Program

Despite declining rates, unintended adolescent pregnancy remains a considerable public health challenge in the United States (Hamilton, Martin, & Osterman, 2015). Unintended pregnancy leads to a host of negative outcomes not only for adolescents, but also for their children who are more likely to get trapped in a cycle of poverty that is difficult to break (Rew & Wong, 2006). Factors such as poverty are difficult to address; nonetheless, sexual reproductive health (SRH) knowledge and parent-adolescent communication (PAC) have been identified as important tools for prevention, and potentially modifiable (Swenson et al., 2009; 2010). The goal of the current study …

Reference Standards For Lean Mass Measures Using Ge Dual Energy X-Ray Absorptiometry In Caucasian Adults, Mary T. Imboden, Ann M. Swartz, Holmes W. Finch, Matthew P. Harber, Leonard A. Kaminsky

Faculty Publications - Department of Kinesiology

Body composition assessments commonly focus predominantly on fat mass, however lean mass (LM) measurements also provide useful information regarding clinical and nutritional status. LM measurements help predict health outcomes and diagnose sarcopenia, which has been associated with frailty. Dual energy x-ray absorptiometry (DXA) is an established technique used in clinical and research settings to assess body composition including total and regional LM. Currently, there are no reference values available that were derived from GE-Healthcare DXA systems directly for US adults for LM, LM index (LMI), percent LM (% LM), and appendicular lean mass index (ALMI) and it is known that …

Reference Standards For Body Fat Measure Using Ge Dual Energy X-Ray Absorptiometry In Caucasian Adults, Mary T. Imboden, Whitney A. Welch, Ann M. Swartz, Alexander H. K. Montoye, Holmes W. Finch, Matthew P. Harber, Leonard A. Kaminsky

Faculty Publications - Department of Kinesiology

Background Dual energy x-ray absorptiometry (DXA) is an established technique for the measurement of body composition. Reference values for these variables, particularly those related to fat mass, are necessary for interpretation and accurate classification of those at risk for obesityrelated health complications and in need of lifestyle modifications (diet, physical activity, etc.). Currently, there are no reference values available for GE-Healthcare DXA systems and it is known that whole-body and regional fat mass measures differ by DXA manufacturer.

Objective To develop reference values by age and sex for DXA-derived fat mass measurements with GE-Healthcare systems.

Methods A de-identified sample of …

Conflict-Handling Styles Demonstrated By Nursing Students In Response To Microethical Dilemmas, Lorretta Krautscheid, Carissa M. Luebbering, Beth A. Krautscheid

Faculty Publications - College of Nursing

Undergraduate nursing students have reported feeling ill-prepared to handle the conflict that accompanies the routine exposure to microethical dilemmas. Microethical dilemmas, as first defined by Worthley (1997), are routine questionable practices that have the potential to compromise quality patient care, negatively impact workplace culture, and initiate moral distress. Nurse educators employ a variety of strategies to support students’ ability to effectively manage conflict; however, little is known about how students authentically respond to ethical dilemmas. The purpose of this pilot study was to describe the frequency of conflict-handling styles demonstrated by undergraduate nursing students who encountered microethical dilemmas embedded within …

Moral Distress And Associated Factors Among Baccalaureate Nursing Students: A Multisite Descriptive Study, Lorretta Krautscheid,, Deborah A. Demeester, Valorie Orton, Austin Smith, Conor Livingston, Susan M. Mclennon

Faculty Publications - College of Nursing

Moral distress and its associated negative consequences among postlicensure nurses have been extensively discussed in the literature. Moral distress is defined as knowing the ethically correct action one should take but feeling constrained from acting on one’s convictions because of internal and external constraints (Epstein & Delgado, 2010; Hamric, 2014; Jameton, 1984; McCarthy & Gastmans, 2015; Musto, Rodney, & Vanderheide, 2015). The focus in much of the reviewed literature is on measuring and describing moral distress, moral residue (lingering feelings associated with moral distress), and subsequent deleterious consequences (frustration, apathy, compassion

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 …

The Art Of Compassion: Educating Nurses For The World (Chapter In Awaken The Stars: Reflections On What We Really Teach), Lorretta Krautscheid

Faculty Publications - College of Nursing

Excerpt: "A unique and perhaps subtle difference exists between educating the best nurses in the world and educating the best nurses for the world. There is a distinction between the two that is at the heart of what makes caring for someone in their time of need an incredible vocation. Think upon a time when you experienced the knowledge, skills, and care of a nurse! think each of us can identify or recall nurses who were proficient and effective coordinators of care. They were nurses who were professionals in the world, protecting and promoting health and safety for ind ividuals, …

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 …

Human Liver Sinusoid On A Chip For Hepatitis B Virus Replication Study, Young Bok (Abraham) Kang, Siddhartha Rawat, Nicholas Duchemin, Michael Bouchard, Moses Noh

Faculty Publications - Biomedical, Mechanical, and Civil Engineering

We have developed a miniature human liver (liver-sinusoid-on-a-chip) model using a dual microchannel separated by a porous membrane. Primary human hepatocytes and immortalized bovine aortic endothelial cells were co-cultured on opposite sides of a microporous membrane in a dual microchannel with continuous perfusion. Primary human hepatocytes in this system retained their polygonal morphology for up to 26 days, while hepatocytes cultured in the absence of bovine aortic endothelial cells lost their morphology within a week. In order to demonstrate the utility of our human-liver-sinusoid-on-a-chip, human hepatocytes in this system were directly infected by Hepatitis B Virus (HBV). Expression of the …

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 …

Reference Values For Body Fat Percentage Obtained From Dual Energy X-Ray Absorptiometry In Adults, Mary T. Imboden, Whitney A. Welch, Ann M. Swartz, Alexander H.K. Montoye, Holmes W. Finch, Matthew P. Harber, Leonard A. Kaminsky

Faculty Publications - Department of Kinesiology

Background: Dual energy x-ray absorptiometry (DXA) is an established technique for the measurement of body composition. Reference values for these variables, particularly those related to fat mass, are necessary for interpretation and accurate classification of those at risk for obesity-related health complications and in need of lifestyle modifications (diet, physical activity, etc.). Currently, there are no reference values available for GE-Healthcare DXA systems and it is known that whole-body and regional fat mass measures differ by DXA manufacturer.

Objective: To develop reference values by age and sex for DXA-derived fat mass measurements with GE-Healthcare systems.

Methods: A de-identified sample of …

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 …

A Spatial Analysis Of Physician Assistant Programs, J. Glenn Forister, Curt Stilp

Faculty Publications - College of Medical Science

Purpose: The Accreditation Review Commission on Education for the Physician Assistant projects a total of 273 accredited programs by the summer of 2020. Over the past 10 years, the number of Central Application Service for Physician Assistants (CASPA) applicants per seat has increased by 53%. However, no studies have addressed the current geographic relationship of applicants to programs and program growth. The purpose of this study was to describe the geospatial patterns and relationships of physician assistant (PA) programs and CASPA applicants.

Methods: Program directory information for established (n = 159), satellite (n = 18), and new PA programs (n …

Learning By Doing: The Md-Pa Interprofessional Education Rural Rotation, Ryan Palmer, Curt Stilp

Faculty Publications - College of Medical Science

While much investment has gone into developing interprofessional education (IPE) curriculum for healthcare professional students, many of these efforts have focused on classroom rather than clinical environments. Implementing robust IPE experiences into clinical training is often complicated by obstacles such as differing rotating schedules and differing curricular requirements. The Combined Medical-Physician Assistant Student Rural Rotation (Med-PARR) at the Oregon Health and Science University takes a practical approach to these challenges. Med-PARR students participate in focused IPE activities that overlay, or 'float', on top of each trainee's profession-specific curricular requirements. Through critical reflection, goal setting, and a community-based project, students get …

Critical-Thinking Skills Of First-Year Athletic Training Students Enrolled In Professional Programs, Dana K. Bates

Faculty Publications - Department of Kinesiology

Context: The Examination of Professional Degree Level document presented to the National Athletic Trainers’ Association Board of Directors states that research in athletic training education has not investigated differences in the critical-thinking skills of professional athletic training students.

Objective: Investigate the differences in critical thinking and other demographic variables across first-year athletic training students enrolled in professional bachelor’s- and master’s-degree programs.

Design: Quantitative study.

Setting: District 10 athletic training programs.

Patients or Other Participants: Students (N ¼ 40) enrolled within their first 6 months of a professional athletic training program were asked to complete the California Critical Thinking Skills Test …