Physical Therapy Commons^™

Low Prevalence Of Patellar Tendon Abnormality And Low Incidence Of Patellar Tendinopathy In Female Collegiate Volleyball Players, Marcey Keefer Hutchison, Christopher Patterson, Tyler Cuddeford, Robert Dudley, Eric Sorenson, Jason Brumitt

Faculty Publications - College of Physical Therapy

The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence …

Does Physical Therapy Produce Value For Post-Operative And/Or Non-Operative Foot And Ankle Patients?, Jeff Houck, Christopher Neville, Kostantinos Vasalos, Chad Condidorio, Kathleen Fear, Judith F. Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Healthcare is at a unique time in history where patient reported outcomes have become important in assessing value and subsequent reimbursement with pay-4-performance initiatives. It is unclear whether physical function, pain and depressive symptoms can assist providers determine if additional physical therapy may improve care for foot and ankle patients considering post-op and/or non-operative care. The purpose of this research was to examine symptom severity (PROMIS PF, PI, and Dep) after surgery or with non-operative care at the start of formal physical therapy to determine if this symptom severity presentation and/or change in symptoms over time are predictors of …

Preseason Y Balance Test Scores Are Not Associated With Noncontact Time-Loss Lower Quadrant Injury In Male Collegiate Basketball Players, Jason Brumitt, Kyle Nelson, Duane Duey, Matthew Jeppson, Luke Hammer

Faculty Publications - College of Physical Therapy

The Y-Balance Test-Lower Quarter has shown promise as a screening tool for identifying athletes at risk of injury. Subsequent studies, utilizing heterogeneous populations or different operational definitions of injury, have presented equivocal findings. Therefore, studies evaluating the efficacy of the Y-Balance Test to discriminate injury risk in a homogeneous population is warranted. One-hundred sixty-nine male (mean age 19.9 + 1.5 y) collegiate basketball players were recruited during 2 consecutive seasons (2016–2017/2017–2018). Athletes completed the Y-Balance testing protocol at the start of each preseason. Athletic trainers tracked noncontact time-loss lower quadrant injuries over the course of the season. Receiver operator characteristic …

Promis Pain Interference Is Superior Vs Numeric Pain Rating Scale For Pain Assessment In Foot And Ankle Patients, David N. Bernstein, Meghan Kelly, Jeff Houck, John P. Ketz, Samuel Flemister, Benedict F. Digiovanni, Judith F. Baumhauer, Irvin Oh

Faculty Publications - College of Physical Therapy

Background: The Numeric Pain Rating Scale (NPRS) is a popular method to assess pain. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been suggested to be more accurate in measuring pain. This study aimed to compare NPRS and PROMIS Pain Interference (PI) scores in a population of foot and ankle patients to determine which method demonstrated a stronger correlation with preoperative and postoperative function, as measured by PROMIS Physical Function (PF).

Methods: Prospective PROMIS PF and PI and NPRS data were obtained for 8 common elective foot and ankle surgical procedures. Data were collected preoperatively and postoperatively at a …

Preoperative Promis Scores Predict Postoperative Promis Score Improvement For Patients Undergoing Hand Surgery, David N. Bernstein, Jeff Houck, Ronald M. Gonzalez, Danielle M. Wilbur, Richard J. Miller, David J. Mitten, Warren C. Hammert

Faculty Publications - College of Physical Therapy

Background: Patient-Reported Outcomes Measurement Information System (PROMIS) can be used alongside preoperative patient characteristics to set postsurgery expectations. This study aimed to analyze whether preoperative scores can predict significant postoperative PROMIS score improvement. Methods: Patients undergoing hand and wrist surgery with initial and greater than 6-month follow-up PROMIS scores were assigned to derivation or validation cohorts, separating trauma and nontrauma conditions. Receiver operating characteristic curves were calculated for the derivation cohort to determine whether preoperative PROMIS scores could predict postoperative PROMIS score improvement utilizing minimal clinically important difference principles. Results: In the nontrauma sample, patients with baseline Physical Function (PF) …

Can Foot Exercises And Barefoot Weight Bearing Improve Foot Function In Participants With Flat Feet?, Marcey Keefer Hutchison, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: Unexplored in individuals with flatfoot (FF) is the potential of foot specific exercise and barefoot weightbearing (BWB) to improve foot function. The purposes of this study were

A. To evaluate whether exercise and BWB alter foot muscle structure in participants with FF

B. To evaluate whether exercise and BWB alters foot and ankle function in participants with FF

C. To compare foot muscle structure and foot and ankle function between participants with FF to controls with neutral foot posture prior to exercise.

Methods: Twenty participants with FF and 12 participants with neutral foot posture participated. Participants with …

Preseason Lower Extremity Functional Test Scores Are Not Associated With Lower Quadrant Injury - A Validation Study With Normative Data On 395 Division Iii Athletes, Jason Brumitt, Victor Wilson, Natalie Ellis, Jordan Petersen, Christopher John Zita, Jordan Reyes

Faculty Publications - College of Physical Therapy

Background: Preseason performance on the lower extremity functional test (LEFT), a timed series of agility drills, has been previously reported to be associated with future risk of lower quadrant (LQ = low back and lower extremities) injury in Division III (D III) athletes.Validation studies are warranted to confirm or refute initial findings.

Hypothesis/Purpose: The primary purpose of this study was to examine the ability of the LEFT to discriminate injury occurrence in D III athletes, in order to validate or refute prior findings. It was hypothesized that female and male D III athletes slower at completion of the LEFT would …

Preseason Functional Test Scores Are Associated With Future Sports Injury In Female Collegiate Athletes, Jason Brumitt, Bryan C. Heiderscheit, Robert C. Manske, Paul E. Niemuth, Alma Mattocks, Mitchell J. Rauh

Faculty Publications - College of Physical Therapy

Brumitt, J, Heiderscheit, B, Manske, R, Niemuth, PE, Mattocks, A, and Rauh, MJ. Preseason functional test scores are associated with future sports injury in female collegiate athletes. J Strength Cond Res 32(6): 1692–1701, 2018—Recent prospective cohort studies have reported preseason functional performance test (FPT) measures and associations with future risk of injury; however, the findings associated with these studies have been equivocal. The purpose of this study was to determine the ability of a battery of FPTs as a preseason screening tool to identify female Division III (D III) collegiate athletes who may be at risk for a noncontact time-loss …

Determining Success Or Failure After Foot And Ankle Surgery Using Patient Acceptable Symptom State (Pass) And Patient Reported Outcome Information System (Promis), Michael R. Anderson, Judith F. Baumhauer, Benedict F. Digiovanni, Sam Flemister, John P. Ketz, Irvin Oh, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery.

Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = …

Can Patient Reported Outcomes Guide Therapy Needs In Foot And Ankle Patients?, Jeff Houck, Jillian Santer, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: The patient acceptable symptom state (PASS) is a validated question establishing if patients activity and symptoms are at a satisfactory low level for pain and function. Surprisingly, ~20% of foot and ankle patients at their initial visit present for care with an acceptable symptom state (i.e. PASS yes). These patients are important to identify to prevent over treatment and avoid excessive cost. It is also unclear what health domains (Pain Interference (PI), Physical Function (PF), or Depression (Dep)) influence a patients judgement of their PASS state (i.e. why they are seeking treatment). The purpose of this analysis is to …

Preseason Functional Performance Test Measures Are Associated With Injury In Female College Volleyball Players, Jason Brumitt, Alma Mattocks, Jeremy Loew, Phil Lentz

Faculty Publications - College of Physical Therapy

Context: Preseason functional performance test measures have been associated with noncontact time-loss injury in some athletic populations. However, findings have been equivocal with many studies consisting of heterogeneous populations. Objective: To determine if preseason standing long jump and/or single-leg hop test scores are associated with a noncontact time-loss injury to the lower quadrant (LQ = low back or lower-extremities) in female Division III college volleyball (VB) players. Design: Prospective cohort study. Setting: National Collegiate Athletic Association Division III female VB teams. Patients: A total of 82 female college VB players (age = 18.9 [1.0] y). Main Outcome Measures: Standing long …

Validation And Generalizability Of Preoperative Promis Scores To Predict Postoperative Success In Foot And Ankle Patients, Michael R. Anderson, Jeff Houck, Charles L. Saltzman, Man Hung, Florian Nickisch, Alexej Barg, Timothy Beals, Judith F. Baumhauer

Faculty Publications - College of Physical Therapy

Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population.

Methods: Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and …

Midfoot Power During Walking And Stair Ascent In Healthy Adults, Frank Diliberto, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Intrinsic foot muscles have the capacity to attenuate and reverse arch deformation under loaded conditions. This function is proposed to be an important component in generating the midfoot power and stability requisite for gastroc-soleus muscle action at the ankle during forward propulsion. Synergistic activation of intrinsic foot muscles is proposed to function as a ‘foot core’ during weightbearing activity that is analogous to the function of the smaller muscles at the spine. If this theory were sound, midfoot power would be expected to increase, potentially in proportion to ankle power, as the muscular demand of a task increases. The …

Can Understanding Provider Expectations Improve Provider Adoption Of Patient Reported Outcomes?, Jeff Houck, Jillian Santer, Kostantinos Vasalos, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: New instruments like the Patient Reported Outcome Information System (PROMIS) minimize the burden to patients and providers addressing significant barriers to adoption. Despite these advances provider adoption remains lackluster. Models of technology adoption suggest adoption is more likely to occur when PRO’s directly improve patient care (performance expectancy) and it’s easy to implement (effort expectancy). Problems with effort expectancy are dealt with by training and improving logistics (i.e. eHR presentation, alerts), where performance expectancy is addressed through research (i.e. validation of thresholds). The purposes of this study were to: 1) evaluate the proportion of orthopedic rehabilitation providers who use …

Subtle Cavus Deformities: Is Isolated Lateral Ankle Ligament Reconstruction Enough For Improved Patient-Reported Outcomes?, Ashlee Macdonald, Meghan Kelly, Jeff Houck, Judith Baumhauer, Irvin Oh, Adolph Flemister, John Ketz

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Lateral ankle ligament injuries are common conditions accounting for 25% of musculoskeletal injuries. Prior reports have found increased risk of failed lateral ankle reconstruction in those with a subtle cavus deformity, and therefore, correcting the deformity is often advocated. However, other studies have been unable to identify subtle cavus deformity as a clear risk factor for recurrent injury. The purpose of this study was to 1) compare PROMIS physical function (PF), pain interference (PI), and depression scores in patients with subtle cavus deformities to those without deformity who underwent lateral ankle ligament reconstruction, 2) compare PROMIS scores in allograft …

Does Identifying Provider Expectations Improve Adoption Of Patient Reported Outcomes?, Jeff Houck, Jillian Santer, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: New instruments like the Patient Reported Outcome Information System (PROMIS) minimize the burden to patients and providers addressing significant barriers to adoption. Despite these advances provider adoption remains lackluster. Models of technology adoption suggest adoption is more likely to occur when PRO’s directly improve patient care (performance expectancy) and it’s easy to implement (effort expectancy). Problems with effort expectancy are dealt with by training and improving logistics (i.e. eHR presentation, alerts), where performance expectancy is addressed through research (i.e. validation of thresholds). The purposes of this study were to: 1) evaluate the proportion of orthopedic rehabilitation providers who use …

Can Foot Exercises And Going Barefoot Improve Function, Muscle Size, Foot Pressure During Walking And Qualitative Reports Of Function In People With Flat Foot?, Marcey Keefer Hutchison, Robin Dorociak, Alison Modafferi, Shanna Howland, Angela Foster, Jean Jarbath, Brenden Thompson, Tyler Whited, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Specific exercises to train foot muscles 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. Exercise programs specifically for the foot claim improvement in foot posture (foot posture index [FPI]) and foot strength. However, rigorous assessment of foot function as a result of exercise is lacking (i.e. foot posture, strength, and plantar pressure). Further, no studies specifically address patients with flat foot. The purpose of this case series study was to assess the immediate effects of an 8-week foot exercise and barefoot weight bearing program on …

Can Women Live With More Symptoms Than Men?: Defining Gender Differences In The Patient Acceptable Symptom State (Pass) In Orthopaedic Foot And Ankle Surgery, Judith Baumhauer, Adolph Flemister, Irvin Oh, Benedict Digiovanni, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Over the last few years an increasing focus has been directed to define cut-off points for important health improvement. Minimal clinically important difference (MCID) values have traditionally been used to determine if a statistical change translates to a clinical improvement to the patient. Although MCID is helpful, it may be even more important to identify if the current treatment is adequate or that the patient has achieved an acceptable symptom state (symptoms minimal enough to live with). The purpose of this study was to determine if gender influenced patient reported outcomes (patient acceptable symptom state (PASS) and PROMIS Physical …

Ability Of Patient-Reported Outcomes To Characterize Patient Acceptable Symptom State (Pass) After Attending A Primary Care Physical Therapist And Medical Doctor Collaborative Service: A Cross-Sectional Study, Jeff Houck, Daniel Kang, Tyler Cuddeford, Sarah Rahkola

Faculty Publications - College of Physical Therapy

Objectives: To determine if the Patient-Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, self-efficacy, and global rating of normal function (GRNF) scales are able to accurately characterize a patient’s acceptable symptom state (PASS).

Design: A cross-sectional analysis, using receiver operator curves and chi-square analysis to explore criteria to determine thresholds (80% and 95% sensitivity/specificity) for PASS that are applicable to PROMIS and GRNF scales.

Setting: Phone survey after primary care. Participants: Patients (NZ94) attending primary care for musculoskeletal problems. Interventions: Not applicable. Main Outcomes Measures: Accuracy and proportion of patients classified as PASS Yes or No.

Results: Receiver …

Comparison Of Jump And Hop Test Measures Between Naia And Division Iii Male Collegiate Basketball Players, Jason Brumitt, Amy Engilis, Alma Mattocks, Natalie Ellis, Jordon Reyes

Faculty Publications - College of Physical Therapy

Purpose: To report normative data for two functional performance tests (FPTs) (the standing long jump [SLJ] and the single-leg hop [SLH]) in a population of male collegiate basketball players and to identify differences in measures between athletes based on level of competition, starter status, and position.

Methods: Eighty-six male collegiate basketball players from six teams were recruited for this study. Each athlete performed three SLJs and three SLHs (bilaterally).

Results: Mean (± SD) FPT measures (normalized to height) for all basketball players were: SLJ = 1.0 ± 0.1, right SLH = 0.84 ± 0.1, and left SLH = 0.85 ± …

Asymmetry After Hip Fracture: A Multi-Factorial Problem, Andrew J. Meszaros, Cindy Zablotny, Paul A. Shew, Bret Reordan

Faculty Publications - College of Physical Therapy

Background and Purpose: Sit-to-stand (STS) and static standing mechanics are related to fall risk and function after hip fracture. Often, these patients avoid weight bearing on the fracture side after rehabilitation. The purpose of this study was to use a novel clinically-relevant protocol to examine standing and STS vertical ground reaction force (vGRF) in light of perceptual measures of loading symmetry and muscle torque production in this population. Methods: A person post hip fracture performed 3 different STS conditions and 2 simple load-matching tasks. Motion, force plate, and perceptual data on weight distribution and load were collected. Findings: Standing and …

What Maximum Ankle Torque Is Appropriate For Training Patients With Non-Insertional Achilles Tendinopathy?, Tyler Cuddeford, Jeff Houck, Derek Palmer, Jason Beilstein, Jordan Visser

Faculty Publications - College of Physical Therapy

Background and Purpose: The capacity of the Achilles tendon during a 1-repetition eccentric maximum contraction is largely unknown. This study examined the maximum ankle torque during a concentric/ eccentric heel raise/lowering task and while running in healthy individuals and participants with chronic Achilles tendinopathy. These findings were applied to a 10-week training program for a patient with chronic Achilles tendinopathy.

Methods: A total of 13 subjects (9 healthy and 4 with Achilles tendinopathy) participated in this study. Subjects were asked to perform a maximum eccentric contraction wearing a weighted vest while collecting 3-dimensional biomechanical variables. Subjects also ran along an …

A Study Of Outcomes Following Collaborative Medical Doctor/Physical Therapist Primary Care Service For Musculoskeletal Problems, Daniel Kang, Sarah Rahkola, Catherine Vandehaar, Andrea Mulligan, Kevin Morikawa, Amador Marcano, Tyler Cuddeford, Jeff Houck

Faculty Publications - College of Physical Therapy

Background and Purpose: Collaborative medical doctor/physical therapist primary care services are not described in the literature. The 2 purposes of this observational study were to describe a collaborative medical doctor/physical therapist primary care service, and to describe simple, one question, outcomes including patient acceptable symptom state (PASS), global rating of normal function (GRNF), and success of treatment (SOT) at intake, 1 to 7 days, and 45 to 60 days follow-up. Methods: Patients were seen for 1 to 2 visits and typically received exercise, hands on treatment, ie, manual therapy, and education. Medical doctor/physical therapist collaborative encounters and provider training are …

Identifying Foot And Ankle Patients At Risk To Fall Based On Patient Reported Outcomes Assessments, Judith Baumhauer, Jack Teitel, Allison Mciyntyre, David Mitten, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Each year approximately 30-40% of people over the age of 65 fall. Approximately one half of these falls result in an injury with the estimated annual direct medical costs of $30 billion. Pain, mobility issues, neuropathy and post- operative weight bearing limitations make foot and ankle patients particularly vulnerable to falls. Current approaches to determine at risk patients are cumbersome and time consuming requiring performance testing and “hands on” clinical assessment. The efficiency of obtaining PRO, such as PROMIS, in the clinical arena has been well documented. The purpose of this study is determine if patient reported outcomes (PROMIS) …

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 …

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 …

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 …

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 …

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

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.