Medical Specialties Commons^™

Prevalence Of Asymptomatic Gonorrhea And Chlamydia Infections Among Ryan White Hiv Population Visiting A Center City Hiv Clinic, Sarah Stuccio, Rakhshanda Akram, Lisa A. Spacek

Phase 1

Introduction: Sexually transmitted infections (STIs) are a major public health problem. Two factors make their diagnosis challenging: frequent asymptomatic presentation and lack of screening, especially at extragenital sites. Additionally, STIs including gonorrhea (GC) and chlamydia (CT) have been shown to increase the risk of sexual HIV transmission. Information about the prevalence, as well as predictors of test positivity, of GC and CT infections can stress the importance of universal screening.

Methods: We carried out a retrospective analysis of the STI screening of patients who attended the Ryan White HIV clinic at Jefferson between 2016 and 2018. The primary …

Zero Tolerance – Mitigating The Opioid Epidemic Amongst Minimally Invasive Urologic Patients, Daniella Wong, Thenappan Chandrasekar, Md, Costas Lallas, Md

Phase 1

Introduction: Opioids are routinely prescribed following minimally invasive surgery (MIS), yet the majority of medication remains unused. However, the literature is lacking evidence for non-narcotic analgesia in MIS urologic procedures. The purpose of this study is to evaluate the efficacy of a non-narcotic postoperative pain management regimen in reducing opioid use following MIS urologic procedures.

Methods: In this prospective study, 51 MIS urologic patients were recruited over two months. Patients in the first month cohort (P1) were managed with the established pain management standard-of-care, while patients in the second month (P2) followed a non-narcotic postoperative pain management protocol that …

Development Of Vaccine Preferences In Parents Of Newborns, Ramon Ruiz, Neera Goyal

Phase 1

Introduction: The resurgence in cases of vaccine-preventable childhood diseases in the U.S. may be associated with increasing rates of vaccine hesitancy. Although previous research has sought to identify attributes of non-vaccinating parents, the timing in which parents make such vaccination decisions has yet to be explored. Our goal is to identify when first-time parents develop their vaccination preferences: before, after, or during pregnancy.

Methods: A cross sectional survey was conducted using a convenience sample of 73 first time parents at Thomas Jefferson University Hospital. Survey questions addressed timing of vaccination decisions and projected compliance with vaccine schedules. Eligibility for …

Survivorship, Complications, And Outcomes Following Distal Femoral Replacement Using Megaprosthesis, Keenan Sobol, John Strony, Timothy Tan, Md, Scot Brown, Md

Phase 1

Introduction: Distal femoral bone loss is often managed with a combination of modular prostheses, structural and non-structural allografts, and metal augmentation. However, when bone loss of the distal femur is severe, the viability of these methods can be limited.In the setting of severe bone loss, endoprosthetic reconstruction (EPR) with a megaprosthesis has become increasingly popular for both malignant and non-neoplastic indications. The primary aim of this study was to determine the short-term prosthesis survivorship, as well as complications, for patients who presented with non-neoplastic disease indications for megaprosthesis distal femoral replacement (DFR) at a single institution. The secondary aim was …

Selective Serotonin Reuptake Inhibitors Are Associated With Increased Bleeding Related Complications Following Primary Total Hip And Total Knee Arthroplasty, Kyle Plusch, John Stammers, Mbbs, Frcs, Alexus M. Cooper, Chi Xu, Md, Paul Kitei, Md, Javad Parvizi, Md, Frcs, Jess H. Lonner, Md

Phase 1

Introduction: Approximately 10-22% of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are diagnosed with depression. Pre-operative depression is associated with poorer patient reported outcomes, costs and increased complications. Selective serotonin-reuptake inhibitors (SSRIs) are first-line treatment for depression due to their efficacy and low side effect profile. There are conflicting studies regarding SSRI-related bleeding complications. This study compares the rate of bleeding-related complications in THA and TKA patients taking SSRI’s to a control group of non-SSRI users.

Methods: A retrospective single institution study of 16,407 primary THA and TKA’s from 2008 to 2018 was performed. Patients with …

Static V. Expandable Tlif Cage Outcomes, Harrison Pajovich, Ryan Nachwalter, Lohit Velagapudi, Joseph Zarowin, Alexander R. Vaccaro, Md, Phd

Phase 1

Static cages were introduced in the 1990s as a solution to degenerative spondylolisthesis, recurrent disc herniation and spinal stenosis. As this procedure was popularized, a new class of expandable Transforaminal Lumbar Interbody Fusion devices was introduced to further improve outcomes that will be studied in this project. It will be explored how expandable cages compare to static cages in TLIF procedures in patient-reported outcomes, complications and restoration of appropriate lumbar lordosis. We conducted a retrospective cohort review comparing those who received expandable and static cages. Eligible patients received TLIF procedure at the Rothman Institute, were ≥18 years of age and …

The Effect Of Perceived Physician Opinion On Breastfeeding In Women With Opioid Use Disorder Who Are Receiving Medication-Assisted Treatment, Lacey Murray, Meghan Gannon, Phd, Vanessa Short, Phd, Mph

Phase 1

Women who receive medication-assisted treatment (MAT) for opioid use disorder (OUD) are less likely to breastfeed than the general population despite the many possible benefits to the newborn. The ongoing study examines the effect of perceived physician opinion on the outcome of breastfeeding in women receiving MAT for OUD. Women who were receiving MAT for OUD at Thomas Jefferson University’s Family Center were given a survey during their third trimester (n=45), and at 1 month postpartum (n=33) to gather information on the perceived opinion of their physicians on how they should feed their baby and the importance of those opinions. …

Cardiac Risk Factors Predicting 30/90 Day Readmission Rates In Lumbar Decompression Surgeries, Blake Nourie, Kevin Xiao, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Assessment Of The Composition And Biologic Activity Of Platelet Rich Plasma And Its Relationship To Clinical Outcomes In Patients With Knee Osteoarthritis, Daniel Nemirov, Bijan Dehghani, Habib Zahir, Xiaoning Yuan, Christine Kim, Reyna Bhandhari, Patrick Fava, Yurii Chinenov, Joseph Nguyen, Laura Donlin, Brian Halpern, Scott Rodeo, Miguel Otero

Phase 1

Recent studies suggest positive clinical outcomes associated with platelet-rich-plasma (PRP) administration to treat knee osteoarthritis (OA). However, the results remain inconclusive in part because of the high variability in PRP preparations and the limited information regarding the relevant biologically active components of PRP. We hypothesize that the variability in clinical response is driven by the heterogeneous composition of PRP. In this study we evaluated the composition and biological activity of PRP and further correlated our findings to clinical outcomes in patients receiving intra-articular injections for knee OA. After IRB approval and patient consent, we enrolled 51 patients (mean age: 57.9 …

Patient And Renal Outcomes Of Posttransplant Lymphoproliferative Disorder Following Solid Organ Transplantations - A Single Center Experience, Kashka Mallari, Goni Katz-Greenberg, Maria Martinez Cantarin

Phase 1

Introduction: Post-transplant Proliferative Disorder (PTLD) is a significant complication after solid organ transplantation (SOT). Major risk factors that contribute to the development of PTLD include Epstein-Barr Virus (EBV) infection and degree of immunosuppression. Despite novel therapies, the 5-year survival rate of PTLD only improved from 40% to 50% over the years. The reported 5-year survival rate of PTLD also remains significantly lower compared to around 90% in other malignancies such as breast and colon cancer. In our center, we hypothesize better transplant outcomes compared to those reported in preceding literatures.

Methods: We retrospectively reviewed the electronic medical records of …

In Vivo T Cell Genetic Engineering With Melanoma-Specific Tcr And Car, Toby Mathew, Vitali Alexeev

Phase 1

Introduction: Adoptive cell transfer (ACT) using T cells genetically engineered to express tumor-specific T cell receptors (TCR) and Chimeric Antigen receptors (CAR) have demonstrated high remission rates in patients with advanced cancers. Targeting of metastatic melanoma with TCR-modified recombinant T cells showed clinically significant response in the majority of patients. However, due to certain drawbacks, this powerful strategy is not yet available for broad clinical application. We propose that in vivo genetic engineering approach may allow overcoming several drawbacks associated ACT and could convert it into generic and cost-effective modality to bring recombinant T cell therapies to general patient …

The Presence Of Gc-C In Extracellular Vesicles Secreted By Colorectal Cancer Cells, Alexandre Martinez, Adam E. Snook

Phase 1

Background: Guanylyl Cyclase C (GC-C) is a membrane-bound protein found on intestinal epithelial cells involved in the activation of CFTR. This protein has previously been involved in the development of colorectal cancer.

Extracellular vesicles (EVs) are bilayered vesicles of varying size (30 to 1,000 + nm in diameter) that believed to be secreted by all cells in the human body. In the past decade, EVs have garnered attention due to their impact in the field of oncology, where they have been shown to potentially serve as biomarkers for various cancers.

In this study, we looked at the EVs secreted …

Ahmed Vs Baerveldt Glaucoma Drainage Device In Uveitic Glaucoma, Zoe Mcwatters, Sapna Sinha, Md, Allen Ganjei, Marlene Moster, Md, Michael Pro, Md, Elizabeth Dale, Md, Daniel Lee, Md, Jonathan S. Myers, Md, L. J. Katz, Md, Scott Fudemberg, Md, Anand Mantravadi, Md, Natasha Kolomeyer, Md, Reza Razeghniejad, Md

Phase 1

Introduction: Uveitis is an inflammatory eye disorder which may elevate intraocular pressure (IOP), causing sight-threatening glaucoma. Treatment of refractory uveitic glaucoma involves implantation of a glaucoma drainage device (GDD). Uveitic glaucoma has been a minority diagnosis in prior studies comparing the valved Ahmed GDD and non-valved Baerveldt GDD. Here we compare the safety and efficacy of the Ahmed and Baerveldt GDD in uveitic glaucoma.

Methods: This retrospective comparative study was conducted on patients with uveitic glaucoma (≥14 years old) who underwent Ahmed or Baerveldt GDD implantation between 2006–2018 with a minimum follow-up of 3 months. Success was defined as …

Down Regulation With Luteal Gnrh Agonist Therapy In Euploid Embryo Transfers Does Not Impact Pregnancy Rates, Isabelle Levin, Keri Bergin, Md, Dmitry Gounko, Joseph Lee, Alan Copperman, Md

Phase 1

Introduction : Gonadotropin-releasing hormone (GnRH) agonists have been used during assisted reproductive technology (ART) treatment for pituitary suppression and stimulation. Currently, clinical opinion is divided about whether GnRH agonist therapy improves pregnancy rates when used for luteal down-regulation in a frozen euploid embryo transfer (FET). This study evaluated the clinical utility of GnRH agonist down-regulation in single, euploid FET cycles.

Methods : A retrospective analysis was performed, using data from patients who underwent a single, euploid FET cycle from 2012 to 2019. Patients were segregated into two cohorts: Group A: single, euploid FET with down-regulation using GnRH agonist; Group B: …

Statistics Of Tumor Micro-Environment, Brenton Maisel, Inna Chervoneva

Phase 1

Introduction: Immune cells play a prominent role in keeping tumors suppressed, but how the distribution of these immune cells within a tumor’s microenvironment remains poorly understood. The long-term goal of this project is to study how statistical spatial distributions of different immune cells is associated with clinical outcome. The first objective is developing an algorithm for identifying different types of immune cells.

Methods: The data motivating this project includes spatial localization information (x-y coordinates) and expression levels of immune cell CD markers quantified by immunofluorescence immunohistochemistry (IF-IHC) in ~1,500 cases of invasive breast cancer. Using expression levels of CD markers …

Marked Circadian Variation In Number And Type Of Hyperacute Strokes During The 24 Hour Day-Night Cycle, Eeman Khorramian, Sidney Starkman, Nerses Sanossian, David Liebeskind, Gilda Avila, Samuel Stratton, Marc Eckstein, Frank Pratt, Latisha Sharma, Lucas Restrepo, Miguel Valdes-Sueiras, May Kim-Tenser, Pablo Villablanca, Robin Conwit, Scott Hamilton, Jeffrey L. Saver, Fast-Mag Trial Investigators And Coordinators

Phase 1

Introduction: Circadian variations in stroke onset provide critical information for the allocation of pre-hospital and hospital resources in clinical care. Confining analysis to patients with defined onset in waking and clearly distinguished ischemic and hemorrhagic stroke subtypes, would substantial benefit our understanding of stroke etiology.

Methods: We analyzed patients enrolled in the NIH FAST-MAG phase 3 trial of field-initiated neuroprotective agents in patients with hyperacute stroke within 2h of onset. Onset times were analyzed in 1h time blocks throughout the 24h day-night cycle. Patient demographic and clinical features, medical history, imaging characteristics, and stroke deficit severity were correlated with …

Spectrum Of Renal Biopsy Findings In Trident Cohort, Casey Jackson, Shira Blady, Shatakshee Chatarjee, Phd, Matthew Palmer, Md, Phd, Katalin Susztak, Md, Phd

Phase 1

Introduction: Diabetic kidney disease is the most common cause of chronic end stage renal failure in the USA. Kidney biopsy is the gold standard diagnostic criteria; however, it is an invasive procedure; not everyone undergoes diagnostic biopsy. The relationship between histological and clinical parameters and prognosis in DKD is incompletely understood. TRIDENT, (Transformative research in diabetic nephropathy) plans to enroll 400 diabetic subjects undergoing clinically indicated renal biopsies and performs multi-omics characterization of subjects to identify pathways associated with kidney function decline. Genetic studies indicated that podocytes influence albuminuria and diabetic kidney disease development. We seek to understand whether …

Evaluating The Migration Rates In Percutaneous Spinal Cord Stimulation Trials, William Hirsch, Nikolaos Mouchtouris, Md, Ashwini Sharan Md

Phase 1

Introduction: Spinal cord stimulation (SCS) provides symptom reduction in patients with chronic low back pain. The most common complication in SCS is percutaneous lead migration from initial placement site. It is our goal to determine whether using skin anchors during trial implantation reduces SCS trial lead migration rates compared to historical controls.

Methods: 197 patients who underwent SCS trial placement at Thomas Jefferson University Hospital between 2015 and 2018 were considered for this study. Complete data including device impedance measurements and pre and post trial x-rays was collected on 12 historical control patients and 19 patients with leads secured using …

The Use Of Cementless Components Does Not Significantly Increase Procedural Costs In Total Knee Arthroplasty, Samantha Harrer, Michael Yayac, Md, William J. Hozack, Md, Javad Parvizi, Md, Frcs, P. Maxwell Courtney, Md

Phase 1

Introduction: Modern cementless total knee arthroplasty (TKA) designs have shown promising early clinical success; however, concerns exist regarding the higher cost of the cementless implants. The purpose of this study is to evaluate the total facility cost of cementless vs traditional cemented TKA along with the effect of cementless fixation on short-term outcomes.

Methods: We reviewed a consecutive series of patients between 2015 and 2017 who underwent either cementless or cemented primary TKA. Itemized facility costs were calculated for every procedure using a time-driven activity-based costing algorithm. Controlling for demographic variables and medical comorbidities, we performed a multivariate analysis …

Nighttime Melatonin Administration And Insulin Sensitivity, Albert Mchugh, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Previous studies have shown melatonin effects on insulin sensitivity, but with conflicting results. The inconsistency between these studies may be due to differences in melatonin dosage and subject age. Low melatonin dosages, generally <5 mg, have been used in prior research. We studied the effect of melatonin 9 mg for 6 weeks on insulin resistance, peripheral microvascular function, and sleep in non-diabetic, non-hypertensive middle-aged and geriatric patients.

Methods: Subjects with a history of hypertension or diabetes were excluded from the study. The geriatric cohort included 5 subjects 60-80 years old while the younger cohort was comprised of 14 subjects age 27-45 years old. Fifteen subjects were randomized to the melatonin treatment group and took 9 mg of controlled-release melatonin by mouth 30 minutes before bedtime for 6 weeks; the four subjects in …

Investigation Of The Superman Stretch On Posterior Capsule Range Of Motion, Brian Gibbs, Christopher M. Aland, Md, Joshua Hornstein, Md

Phase 1

Introduction: Shoulder pain is a common clinical entity affecting all age groups and can frequently be attributed to pathological internal impingement. A primary contributing factor to labrum tears and internal impingement is posterior capsule tightness. In order to improve range of motion (R.O.M.), prior studies have demonstrated that stretching is an important tool for increasing R.O.M. at many joints. We hypothesized that the superman stretch would lead to greater increases in IR than the traditional sleeper stretch.

Methods: A level II, prospective study in collegiate-level athletes from The College of New Jersey (TCNJ) was performed. Shoulder internal rotation (IR), shoulder …

Identifying The Prevalence Of Underdiagnosed Obstructive Sleep Apnea (Osa) In The Primary Care Population Via Targeted Screening Measures, Risa Goldberg, Alyssa Givens, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Obstructive sleep apnea (OSA) is a condition with detrimental health consequences, yet over 75% of OSA cases remain undiagnosed in the United States. This study aimed to determine the efficacy of using targeted screening measures to determine the prevalence of undiagnosed OSA in a primary care population.

Methods: This prospective pilot study utilized a primary care population from Thomas Jefferson University’s family medicine department. Participants were selected using three risk criteria for OSA from STOP-BANG identifiable from their EMR records (BMI >35, age over 50, and hypertension). After screening out patients previously diagnosed with OSA, patients were called and …

Characterizing Patch Test Findings In African American Acd Patients, Vaibhav Garg, Bruce Brod, Anthony Gaspari

Phase 1

Introduction: Allergic Contact Dermatitis (ACD) in African Americans has not been well studied, and there is little information related to differences in patterns of ACD between African Americans and Caucasians. This paper aims to investigate relative differences in patterns of sensitization in African American ACD patients.

Methods: This study is a retrospective descriptive study. Data of ACD patients patch tested from 2009-2019 by Dr. Gaspari and Dr. Brod at TJUH and HUP/UPHS were reviewed. Patch test findings for African American and Caucasian patients were compared. Outcomes such as positive allergens, strength, clinical relevance, patient occupation, and personal product use …

The Effects Of Total Intravenous Versus Inhalational Anesthesia On Fluid Balance For Patients Undergoing Pancreaticoduodenectomy, Jaime Eberle-Singh, David Maguire, Md, Harish Lavu, Md

Phase 1

Introduction: Pancreaticoduodenectomy (PD), the most common surgical treatment for pancreatic cancer, is a complex procedure with a morbidity of 45-60%. Recent studies indicate that intraoperative use of total intravenous anesthesia (TIVA) may reduce post-operative complications for PD patients, when compared to inhalational anesthesia (INHA). We hypothesized that patients who receive TIVA may have a more favorable fluid balance, which is known to reduce postoperative complications in PD patients.

Methods: We carried out a retrospective analysis of patients who underwent PD at Thomas Jefferson University Hospital and were administered TIVA or INHA during surgery between April 2017 and January 2019. …

Impact Of In-House Specialty Pharmacy On Access To Novel Androgen Axis Inhibitors In Men With Advanced Prostate Cancer, Anna Driscoll, Nathan Handley, Md, Mba, Adam Binder, Siobhan Henry, W. Kevin Kelly, Do

Phase 1

Introduction: Novel androgen axis inhibitors are standard of care treatments in advanced prostate cancer. The billed amounts for these medications are often very high, which may create significant financial toxicity for patients and lead to delays in treatment. Our institution implemented an in-house specialty pharmacy in 2014, that provides these medications and evaluates copay assistance options for all patients. We evaluated the program’s impact on out of pocket cost (OOP) and turnaround time (TAT).

Methods: We reviewed available internal specialty pharmacy records to identify prescriptions for abiraterone or enzalutamide filled between 1/1/17 and 12/31/18. Payments were stratified by primary payment …

Mechanical Thrombectomy In Acute Ischemic Stroke Patients Greater Than 90 Years Of Age Experience In 26 Patients In A Large Tertiary Care Center: Outcome Comparison With Younger Patients, Nicholas Elmer, Ahmad Sweid, Md, Joshua H. Weinberg, Vivian Xu, Kavya Shivashankar, Tyler D. Alexander, Ms, Jane Khalife, Md, Michael R. Gooch, Md, Nabeel Herial, Md, Nohra Chalouhi, Md, Pascal Jabbour, Md, Robert H. Rosenwasswer Md, Stavropoula Tjoumakaris, Md

Phase 1

Introduction: Several independent randomized control trials have shown the superior efficacy of mechanical thrombectomy for acute ischemic stroke (AIS). However, the elderly has been underrepresented or excluded in these trials. In this study, we investigated the feasibility and safety of mechanical thrombectomy in patients with AIS aged 90 years or greater.

Methods: A retrospective review of patients age 90 years or older presenting with AIS who underwent mechanical thrombectomy between 2010 and 2018.

Results: Of total 453 patients with AIS, 5.74 % (26) were aged 90 or older, and 69.32 % (314) ranged from 60-89 years of age. Of …

Motivational Interviewing For Cpap Adherence, Grayton Downing, Caitlin Green, Cynthia Cheng, Md, Phd

Phase 1

Introduction: Untreated obstructive sleep apnea (OSA) leads to negative health outcomes. Yet, compliance rates for continuous positive airway pressure (CPAP), the gold standard of treatment, range from 30-60%. This study examines how motivational interviewing (MI), a goal-oriented form of psychotherapy, increases CPAP adherence. We hypothesize that MI increases CPAP compliance when incorporated into CPAP follow-up care.

Methods: We developed and trained our staff with a novel MI training protocol consisting of MI background readings and videos, CPAP technician shadowing, and MI role-play for certification. For the clinical trial, newly diagnosed OSA patients from Jefferson’s sleep center will be randomized …

Avoiding Antiplatelet Reversal In Non-Operative Intracranial Hemorrhages: Functional Outcomes Of Guideline-Based Practice, Angelo D'Antonio-Bertagnolli, Lyena Birkenstock, Ariya Mobaraki, Christine Hammer, Md, Syed O. Shah, Md, Jack Jallo, Md, Phd, Courtney Pendleton, Md

Phase 1

Introduction: Intracranial hemorrhage (ICH) is a common, life-threatening neurological pathology in aging patients, many of whom take antiplatelet medications with potential to worsen the hemorrhage. In the event of ICH, Thomas Jefferson University Hospital (TJUH) follows a protocol modeling the 2016 Neurocritical Care Society (NCS) joint guidelines for antiplatelet medication reversal. We analyzed pre- and post-NCS guideline data from TJUH for outcomes of non-operative ICH patients in order to tease out the potential benefits of this protocol.

Methods: This retrospective cohort study took place from January 2016 – Jan. 2018 at a tertiary care center: TJUH. Patients included were …

Plasma Exosome Mir-155-5p As An Independent Prognostic Risk Factor For Mycosis Fungoides, Adam Cohen-Nowak, Neda Nikbakht

Phase 1

Introduction: Mycosis Fungoides (MF) is a rare non-Hodgkin Lymphoma with variable progression that comprises half of all cutaneous T-cell lymphomas (CTCLs). Previous studies have shown higher expression of the micro-RNA miR-155-5p isolated from biopsies of MF tumors compared to early-stage lesions and healthy skin, illustrating the potential for miR-155-5p to serve as a prognostic indicator. Small extracellular vesicles (30-150 nm) called exosomes are known to play a role in cancer signaling and progression by carrying micro-RNAs. However, no studies have measured circulating exosomal miR-155-5p in the blood of patients with MF. We hypothesize that miR-155-5p is expressed higher in …

Comparison Of Home Therapy Vs Formal Outpatient Physical Therapy In Post-Operative Management Of Two-Incision Distal Bicep Tendon Repair, Joseph Botros, John Horneff Iii, Md, Thomas Harper, Brent Page

Phase 1

Background: Distal bicep tendon tears are a relatively uncommon injury, affecting 1.2/ 100,000 persons per year; they can also cause substantial loss in supination and flexion strength. The most common treatment is a double incision distal bicep tendon repair, which involves surgical reinsertion of the bicep tendon onto the radial tuberosity. Following surgery, physicians have traditionally recommended the patient undergo 5-12 weeks of formal outpatient physical therapy. This can be a significant cost and time burden to the patient. Therefore, some physicians have instead opted for home physical therapy, in which the patient is given instructions on exercises to complete …