School of Physical Therapy

Permanent URI for this collectionhttps://hdl.handle.net/11274/8849

Browse

Now showing 1 - 20 of 97

A comparison of overall function between postpartum women with and without diastasis rectus abdominis (DRA)
(May 2023) Celso, Jennifer E 1975-; Wang-Price, Sharon; Weber, Mark; Brizzolara, Kelli
Purpose: The primary purpose of this study was to examine whether the Inventory of Functional Status after Childbirth (IFSAC) questionnaire could identify deficiencies in overall function of postpartum women with diastasis rectus abdominis (DRA). Specifically, the IFSAC scores were compared between postpartum women with and without DRA. The secondary purpose of the study was to determine the reliability and construct validity of a self-palpation assessment of inter-rectus distance (IRD) via telehealth instruction for diagnosing DRA. Methods: Twenty-one women, 610 weeks after vaginal delivery, completed the study. All participants completed the IFSAC questionnaire before a telehealth visit and an in-person visit for DRA diagnosis. To determine the within-session intrarater reliability of the telehealth-instructed self-palpation assessment of IRD for DRA diagnosis, each participant completed the self-palpation assessment twice during the telehealth visit. To determine the between-day intrarater reliability of the self-palpation method for DRA diagnosis, each participant completed another self-palpation assessment during the in-person visit. During the in-person visit, DRA diagnoses made by ultrasonographic assessment of IRD were used to determine the construct validity of the self-palpation method. Each participant was assigned to the DRA group or no DRA group using the DRA diagnosis made by ultrasonography. Results: Although participants with DRA (n = 10) reported a slightly lower total IFSCA score (median = 3.28) than those without DRA (n = 6; median = 3.46), there were no statistically significant differences in scores between the two groups (p = 0.635). The reliability analysis showed a moderate-to-substantial agreement of DRA diagnosis for both the within-session intrarater reliability and between-day intrarater reliability with k = 0.76 and k = 0.50, respectively. For construct validity, there was no or poor (k = -0.290.36) agreement between the self-palpation assessment via telehealth and ultrasound assessments for DRA diagnosis. Conclusion: The results indicates that the IFSAC questionnaire may not be an adequate outcome measure to determine functional levels for postpartum women with DRA. Although telehealth-instructed self-palpation assessment for DRA diagnosis is reliable, this method does not appear to be valid. This suggests that DRA diagnosis for postpartum women should be assessed in-person by qualified clinicians.
A mixed method analysis of the role of balance outcome measures in therapist decision-making and patient outcomes
(10/30/2020) Lyon, Marissa F; GLEESON, PEGGY B
The purpose of these three studies was to assess the impact of using outcome measures on physical therapists' decision-making and patient functional outcomes. Three hundred thirty-seven physical therapists completed an online survey focused on their use of outcome measures and their relationship with decision-making for patients with acquired brain injury. Physical therapists reported that the use of outcome measures frequently impacted decision-making in estimating prognosis, identifying a patient's risk for adverse events, setting goals, communicating, educating, making discharge decisions, and selecting treatment interventions. Twenty-three physical therapists participated in semi-structured interviews focused on outcome measures' impact on decision-making and patient outcomes. Therapists indicated that outcome measures played a large role in clinical decisions, and a majority reported they believed there was a relationship between outcome measures and patient outcomes. Finally, eight physical therapists (PTs) and physical therapist assistants (PTAs) participated in a knowledge translation intervention focused on outcome measures. Patients treated by these therapists demonstrated significantly better ambulation ability and participated in significantly fewer minutes of physical therapy compared to patients treated by six PTs and PTAs who did not participate in an educational intervention.
A mixed methods analysis of empowerment and satisfaction in parents of children with disabilities receiving outpatient rehabilitation
(2022-12-01T06:00:00.000Z) Bressler, May; Thompson, Mary; Medley, Ann; Poskey, Gail; Simpkins, Susan
The purpose of this study was to examine the perspectives of parents of children with disabilities on family-centered care, family empowerment, and satisfaction of care in North Texas outpatient clinics using an explanatory sequential mixed methods design. In the quantitative phase, parents (a) rated the extent of family-centered care provided by their child’s service provider using the Measure of Processes of Care (MPOC-20), (b) completed the Family Empowerment Scale as a measure of their perceptions of their empowerment levels, and (c) assessed their overall satisfaction with services using the Client Satisfaction Questionnaire (CSQ-8). Three separate multiple regressions examined if any of the five domains of the MPOC-20 predicted empowerment at the family level, empowerment at the service system level, and satisfaction of care. Using maximum variation sampling, a subset of the subjects was selected to participate in the qualitative phase where semi-structured interviews were conducted to explore specific behaviors of service providers that contribute to empowerment and satisfaction of care. Survey response rate was 35.6%. Quantitative data analysis found family-level empowerment was predicted by two factors: providing general and specific information. Similarly, service system level empowerment was predicted by providing general and specific information, with the addition of coordinated and comprehensive care. Satisfaction of care was predicted by two factors: providing specific information and respectful and supportive care. Qualitative interviews revealed service providers offering knowledge, skills, resources, and emotional support to mothers appear to be a catalyst for the process of empowerment. Satisfaction of care was impacted by three factors relating to (a) child, (b) structure including the setting and environment, and (c) service provider (connection, communication, commitment). Service providers offering mothers individualized knowledge of their children and activities, and providing emotional support were the common behaviors that led to both empowerment and satisfaction of care. Service providers need to effectively communicate individualized knowledge of the child and activities and have adequate interpersonal skills to create a supportive environment for mothers. Pediatric health care organizations can utilize this information to advance a family-centered environment by tackling any identified system level barriers to providing family-centered care.
Acute stroke rehabilitation outcomes with supported treadmill ambulation training
(2001-05) Filho, Inacio Teixeira da Cunha; Protas, Elizabeth
Objective. To investigate gait, exercise, and functional outcomes with supported treadmill ambulation training (STAT) associated with regular rehabilitation in acute stroke survivors. Design. Randomized, controlled, pilot study. Setting. Rehabilitation Medicine Service, the Veterans Affairs Medical Center, Houston, Texas. Subjects. Seven acute stroke survivors assigned to regular intervention group (RI) and 6 patients assigned to STAT intervention. Methods. Regular intervention consisted of 3 hours daily of physical therapy, kinesiotherapy, and occupational therapy. STAT group received regular rehabilitation with STAT substituted for usual gait training. Participants were tested at baseline, treated for an average of 3 weeks and re-tested upon discharge. The ANCOVA procedure was utilized for differences between the two approaches. Main outcome measures. (1) Gait parameters: Functional Ambulation Category (FAC) scale, gait speed (GS), walk distance (WD), gait energy expenditure (GEE), gait energy cost (GEC); (2) criterion-limited oxygen consumption (clVO2) obtained with the bike protocol, total workload and time pedaling the cycle ergometer; and (3) Measure of functional locomotion (FIM-L). Results. The small sample size did not generate enough power to detect significant differences in any gait parameter variables between the two groups. However, medium to large effect sizes of 0.7 and 1.16 standard deviation units for GEC and WD, respectively, were observed. Criterion-limited VO2 was statistically higher with the STAT intervention (11.34 ± 0.88 vs 8.32 ± 0.88 ml/kg/min, p = 0.039). Highest workload and time pedaling the cycle ergometer were not statistically different between the two groups: 62.50 ± 26.22 watts for STAT versus 41.67 ± 12.91 watts for regular (p = 0.27); and 338.33 ± 31.21 seconds versus 162.00 ± 66.27 seconds (p = 0.13), for STAT and regular group, respectively. FIM-L scores were not different between the two groups after intervention. Conclusions. This study demonstrated the adequacy of the gait parameters and the exercise protocol in evaluating performance with acute stroke survivors. STAT is a safe, feasible and promising intervention for acute stroke survivors, that can be utilized to provide gait training for this population. Future studies with larger sample sizes are warranted for statistical relevance.
An integrated model of functional status and socioeconomic factors affecting hospital length of stay and 30-day readmission risk in individuals with heart failure
(11/22/2021) Tran, Vinh Q; Lin, Suh-Jen
Background: Acute management of heart failure (HF) is a high-cost enterprise. Cost-effective management of acute HF hinges upon hospital outcomes such as length of stay (LOS) and 30-day readmission (30dRA) rate. Literature has produced regression models that predict these hospital outcomes; however, existing models use a limited scope of traditional medical predictors resulting in weak predictive ability. Functional status (FS) and socioeconomic factors (SEFs) have been found to predict various hospital outcomes in patients with HF; however, existing model performance is limited in its scope. Therefore, a modernized, holistic approach through the integration of FS and SEFs into existing medical predictor based regression models may better predict LOS and 30dRA rate in HF. Purpose: To determine the predictive utility of a model utilizing FS, SEFs, and traditional medical variables on hospital LOS and 30-day re-admission rate (30dRA) in individuals with HF. Methods: Secondary data for 2016 to 2020 calendar years was gathered from a Trauma Level I, safety-net hospital. Hospital admissions with a primary diagnosis of HF were included. Subjects under 18 years old at admission and death during hospitalization were excluded. A total of 2204 medical records were analyzed using hierarchical linear regression on log-transformed LOS data and 1953 records were analyzed using logistic regression on 30dRA data. Results: A LOS model utilizing FS, SEFs, and traditional medical factors was found to be significant (r2 = .207, adjusted r2 = .204, F(8, 2195) = 71.579, p < .001). A 30dRA model utilizing SEFs and traditional medical factors was found to be significant (χ2(10) = 43.185, df = 10, p < .001). Within the 30dRA model, FS was found to be not statistically significant (OR: .996, 95% CI [.985 to 1.007], p = .449). Conclusion: A model utilizing FS, SEFs, and traditional medical factors can predict hospital LOS. FS appears to be less contributory to a 30dRA model compared to SEFs and traditional medical factors.
An investigation of trunk control in infants and toddlers with down syndrome
(8/8/2019) Flores, Megan; Mitchell, Katy, Ph. D.
Infants and toddlers with Down syndrome (DS) display gross motor developmental delays and decreased trunk control. Trunk control is a precursor to upright gross motor skills, but this relationship has not been fully explored in infants and toddlers with DS. The Gross Motor Function Measure (GMFM) is a reliable and valid measure of motor skills for children with DS. The Segmental Assessment of Trunk Control (SATCo) shows promise as a simple measure that can be employed by a physical therapist to measure segmental changes in trunk control, but it has not been studied in this population. The purposes of this study were: 1) to examine the reliability of the SATCo 2) to explore the relationship of the SATCo with the GMFM, and 3) to explore the impact of a dynamic standing device (Upsee) on trunk control and motor skills in infants and toddlers with DS. Eighteen children with DS, ages six to 24 months, were tested once on the GMFM and twice on the SATCo by two different physical therapists. SATCo scores among live and video recorded sessions were compared between three raters. The SATCo and GMFM were compared using Spearman’s rho correlation and linear regression. A subset of six children with DS participated in a A1BA2 withdrawal/reversal single-case experimental design study to explore the impact of a dynamic standing device home program on trunk control and gross motor skills in infants and toddlers with DS. Interrater reliability of the SATCo was moderate to good and intrarater reliability was good to excellent. The SATCo showed a good to excellent significant correlation with the GMFM and was a significant predictor of total GMFM scores in infants and toddlers with DS. After six weeks of using the dynamic standing device as a home program, three children had significant increases in GMFM scores and three children did not show significant changes. SATCo scores did not change significantly in any of the children and no adverse effects were reported. For infants and toddlers with DS, the SATCo is a reliable and valid tool and a home program using a dynamic standing device may improve gross motor skills.
Assessment of fall risk in community-dwelling older persons
(2011-05) Chen, Shu-Shi; Olson, Sharon; Gleeson, Peggy; Mitchell, Katy, Ph. D.
This three-study project was developed in collaboration with a local senior services agency to investigate fall risk in community-dwelling elders. The purpose of Study One was to investigate relationships among medication, dementia, and falls in community-dwelling elders with polypharmacy receiving home healthcare services from the agency. Medical information of 147 clients specifically their medication, diagnoses of dementia, and records of recent falls were obtained from clinical records. Chi-square tests were used to compare the use of psychotropic drugs between elders with and without dementia. A logistic regression was performed to test the hypothesis that psychotropic drugs and dementia predicted falls in this population. No significant differences were found in any type of psychotropic drug use between elders with and without dementia. Neither psychotropic drugs nor dementia predicted falls in this population. The purpose of Study Two was to determine the psychometric properties of the agency's Fall Risk Screening Form (FRSF). Content validity was evaluated on the basis of relevance, clarity and ease of use, and completeness of each item on the FRSF, as rated by 5 experts using a content response form. Rater consistency was evaluated by percentage agreement between two raters using the FRSF to assess 5 clients' fall risk. In a retrospective study of 100 clients' records, an ordinal coefficient alpha was used to assess the FRSF's internal consistency, and a Spearman's correlation was used to examine convergent validity between the FRSF and the Fall Risk Assessment Form (FRAF). Results showed that it was reasonable to use the FRSF for fall risk assessment, but there is room for improvement. The purpose of Study Three was to gather information on the procedures of fall risk screening, which involves collaboration between agency components and outreach workers. A semi-structured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. Results indicate that integrating 8 fall-risk categories to a universal form improves the completeness of the form used in different agency components. However, to increase the utility of the fall risk screening, integrating service plans with each screening procedure needs to be developed.
Assessment of stress and burnout in physical therapist clinical instructors
(August 2023) Pontiff, Ryan 1988-; Mitchell, Katy; Gleeson, Peggy; Patel, Rupal
ABSTRACT RYAN PONTIFF ASSESSMENT OF STRESS AND BURNOUT IN PHYSICAL THERAPIST CLINICAL INSTRUCTORS AUGUST 2023 Clinical education is a critical component of a student physical therapist’s (SPT’s) journey to becoming a physical therapist (PT). Clinicians who are willing to be clinical instructors (CIs) are needed to educate and mentor the SPT on affective, cognitive, and psychomotor skills, however the role of CI is typically filled voluntarily. The increase in workload related to the SPT has the potential to increase the perceived stress and burnout of the CI. The purpose of this project was to assess the stress and burnout of CIs and to explore factors related to clinical education which CIs feel influenced their stress and burnout. The first study utilized a cross-sectional approach. The second study utilized qualitative, one-on-one interviews while the third study used a pre- post- study design. The results of Study 1 revealed PT CIs to have moderate stress and burnout levels. Study 2 revealed the following themes: (1) Clinical education positively influences the PT CI, (2) Clinical education influences PT CI stress and burnout, (3) PT CI burnout as an influencer of accepting an SPT, (4) The SPT’s influence on PT CI stress and burnout, (5) The influence of the SPT’s education level on a PT CI’s willingness to accept a student, and (6) The influence of the challenging SPT experience on supervising future SPTs Study 3 findings revealed that there was no significant difference in a PT CI’s stress and burnout between pre- and post- supervising an SPT, however for those with high levels of burnout, SPT mentorship resulted in a statistically significant reduction in burnout. Results of the dissertation provide data to support the presence of stress and burnout in PT CIs, however the perceived stress and burnout may not result in lasting effects. Further studies are needed to identify ways to support PT CIs, reduce their increased workload, and perceived stress and burnout related to clinical education.
Association between lumbar extremes of motion and musculoskeletal injury of the low back and hip in adult women
(2011-08) Borman, Nicole Patrice; Trudelle-Jackson, Elaine; Thompson, Mary E., 1958-
The purpose of this study was to quantify the association between baseline measurements of lumbar extremes of motion, body mass index, self-reported histories of physical activity, and stiffness for musculoskeletal injuries of the low back and hip among women of different ages and racial groups. Participants in the WIN study at the Cooper Institute in Dallas, TX completed Web-based questionnaires on demographics, orthopedic history of symptoms, injuries, and weekly minutes of moderate and/or vigorous physical activity. Data from self-reported orthopedic history of 911 women were analyzed along with measures of lumbar spine motion. The self-reported data consisted of age, race, physical activity level, history of stiffness, and history of musculoskeletal injury (MSI). Four-hundred and sixty-three (50.8%) of 911 women reported having a history of MSI of the low back and hip. Univariate logistic regression models suggest that lumbar flexion in the middle or third quintile (OR = 0.66, 95% CI = [0.44 to .99], p = .05) and history of stiffness (OR = 5.99, 95% CI = [4.5 to 8.0], p = .001) relate to increased likelihood of MSI. Further analysis using multivariate logistic regression revealed that although the women in the third quintile for lumbar flexion were still less likely to report an MSI (OR = 0.68, 95% CI = [0.43 to 1.1], p = .11), it did not reach statistical significance. However, women with reported history of stiffness in the low back and hip at baseline had increased likelihood of MSI regardless of baseline quintile of lumbar motion. Further, the multivariate logistic regression model for MSI controlling for lumbar flexion and extension motion, race, age, body mass index, and physical activity demonstrated that women with history of stiffness (OR = 6.2, 95% CI = [4.6 to 8.3], p = .001) have increased likelihood of MSI of the low back and hip. Women with self-reported history of stiffness at baseline are 6 times more likely to report MSI of the low back and hip. Therapeutic interventions to address low back and hip stiffness early may aid in decreasing MSI of these regions for other women with comparable characteristics.
Barriers to treatment for women aged 18 to 45 with urinary incontinence
(2010-05) Gregoire, Linda Marie; Thompson, Mary E., 1958-; Lovelace-Chandler, Venita
The purposes of this study were to explore the challenges faced by women aged 18 to 45 with urinary incontinence (UI) and to determine why they do not seek treatment. A qualitative approach was used to describe life experiences of young women suffering with UI. Five participants completed individual interviews. Their transcripts were coded and sorted using qualitative software. Commonalities were found among the participants and revealed several barriers to treatment for young women with UI: self management, negative views of medication or surgery, symptoms not perceived as severe, acceptance of symptoms, difficulty disclosing symptoms to their physician, and physicians not asking about UI problems. Even when UI negatively impacted their quality of life, young women were reluctant to seek treatment. The data obtained from this study can serve as a "voice" for these women and provide physical therapists with information to expand clinical programs and better serve this population.
Beyond incredible: The Paralympic road to Rio - an ethnographic study
(8/9/2018) Walters, Sheri; Thompson, Mary E., 1958-
The primary purpose of this ethnographic study was to understand the culture of the U.S. Paralympic Track and Field team from the 2015 World Championships through the 2016 Rio Paralympic Games. Secondary purposes included examination of the influence of sport in the lives of those involved in elite adaptive sport, greater examination of barriers and facilitators to participation for those involved in elite sport, issues related to and relevant to healthcare providers and coaches, and the psychosocial effects of the International Paralympic Committee Classification System within Paralympic track and field. Subjects were observed and select participants interviewed after being identified through purposeful snowball sampling. Observation notes, transcribed semi-structured interviews, social media posts, and media coverage were analyzed using theoretical frameworks to guide analyses. Feminist theory guided the ethnographic data analysis related to sport socialization. Self-determination theory was used to analyze the data relevant to healthcare providers and coaches in two separate phenomenological studies. Morgan’s practice community was used to theoretically frame the phenomenological study of classification. Rigor was established through triangulation, member checking, peer debriefing, and maintenance of a clear audit trail. Through data analysis, common themes related to the power of sport included a variety of health benefits, and increased participation in society. Barriers to participation included lack of awareness, cost, comorbidities, classification, and “doping.” Facilitators included family, sponsorships, others involved in sport, and fun. Negative aspects included injuries, illnesses, and transportation issues. Prominent negative aspects require staff to assist in managing those negative consequences, to educate athletes of the potential risk, and to allow athlete autonomy. Common themes that emerged related to socialization into and via sport included aspects related to shared training environments, traveling experiences, humor, and integration into able-bodied training environments and events. The athletes used sport and humor as a form of resistance against disablism leading to a sense of empowerment. Themes related to the role of healthcare providers included the introduction of patients to sport, athletes’ perceptions of their healthcare providers as facilitator or barrier, and the roles of a healthcare provider. Providers could play a variety of roles, including serving as a researcher, coach, classifier, or working with athletes as a team medical provider. Providers reported experiences within the Paralympic movement that were personally and professionally rewarding. Prominent themes related to coaching included coaching philosophy, development, and challenges. Another theme was the influence of working with this population in the coaches’ lives. Paralympic coaches appear to have adopted an autonomy-supportive-style of coaching, thus empowering their athletes. Coaches report difficulty finding quality adaptive sport coaching education and resources, relying on peer mentorship as a primary mode of gaining knowledge and experience. Adaptive sport athletes often have difficulty finding a program or coach, prompting discussion of integrating athletes with disabilities into able-bodied training groups. Coaches find rewards and meaning in their athletes and their work experiences with this population. Classification issues involving ambulatory sprinters and wheelchair racers produced themes related to psychosocial and potential ethical issues, leading to suggestions for improvement. Lack of transparency and inconsistencies by Paralympic officials and classifiers led to mistrust of the classification system. Potential opportunities for improvement include increased athlete involvement, transparent communication of factors involved in policy decisions, and examination of specific impairments and performance enhancing technology. This qualitative study gave a voice to a population that previously had been rarely heard. In giving these participants the opportunity to tell their story, the participants likely felt empowered in being heard, and we learned what factors were associated with these athletes getting and staying involved with Paralympic sport, including some of the challenges and catalysts to achieving and maintaining elite sport status. We also gained insight into the perspective of the team’s coaches, the team’s healthcare providers, and some national and international classifiers.
Biomechanical evaluation of landing maneuvers in soccer players with an anterior cruciate ligament reconstruction
(5/30/2017) Alanazi, Ahmad; Mitchell, Katy, Ph. D.; Roddey, Toni S.; Ortiz, Alexis, Ph. D.
This dissertation is composed of 3 studies. The first study included the following purposes 1) to evaluate within-session reliability of kinematics and kinetics during 2 landing tasks to determine the number of trials needed to achieve acceptable reliability, 2) to determine between-session reliability of kinematics, kinetics, and F-Scan system during the 2 landing maneuvers performed by healthy soccer players, 3) to evaluate the validity (concurrent validity) of the F-Scan system in relation to a platform system as a criterion reference during both landing maneuvers. The results indicated that F-Scan and 3D motion analysis systems are reliable during planned and unplanned landing maneuvers in healthy soccer players. Additionally, both landings can be used as functional tasks to assess lower extremity performance in this population if 4 trials of each landing are used in order to achieve good trial-to-trial reliability. Moreover, the F-Scan system is a valid instrument to measure ground reaction forces during planned and unplanned landing maneuvers. The second study aimed to compare kinematics, kinetics, and neuromuscular performance between soccer players with an ACLR and healthy non-injured soccer players during planned and unplanned landing maneuvers. The results showed that unplanned landing demonstrated greater injury predisposing factors compared with planned landing by exhibiting a stiff landing technique characterized by decreased hip and knee flexion angles. Generally, soccer players with ACLR showed nearly similar landing mechanics and neuromuscular strategies to healthy non-injured soccer players during both planned and unplanned landing maneuvers. However, soccer players with ACLR appear to utilize a protective landing strategy by decreasing activation of the gastrocnemius muscle, when averaged across both landing tasks. The purpose of the third study was to evaluate the effect of fatigue on landing biomechanics during an unplanned landing task in soccer players following ACLR compared with healthy non-injured soccer players. The results indicted that fatigue caused changes in landing biomechanics; however, these changes were not significantly different when the groups were compared. These results indicate that having an ACLR (at least 1 year post-surgery) does not appear to lead to sustained changes in landing biomechanics induced by fatigue.
Burnout and well-being in physical therapist students
(8/27/2021) Smith, Allison Marie; Ellison, Jennifer
Burnout, a negative psychological response to chronic work stress, has become an increasingly popular topic of discussion in recent years as health care providers and students are pushed to capacity with increasing expectations and decreasing resources. While there is an abundance of research on burnout in physicians and nurses, the literature on burnout in physical therapists (PTs) is far more limited, with minimal research including PT students. Burnout has many negative consequences for the person, their employer or school, and their patients. Burnout follows a developmental process that might begin during students’ academic studies and continues as they transition into the workforce, making burnout an important subject to investigate in students to mitigate or prevent its effects later in life. Assessing burnout in PT students is an important first step toward taking action to prevent and address burnout and improve their well-being. It is also important to determine what factors may influence the development of burnout or which factors may protect against the development of burnout. The purpose of the three studies was to assess the reliability and validity of the Oldenburg Burnout Inventory for Students (OLBI-S), determine the levels of burnout in PT students, investigate individual and environmental factors that may influence the development of burnout, and assess students’ perceptions of burnout and well-being while they are enrolled in a Doctor of Physical Therapy (DPT) program. Test-retest reliability of the OLBI-S and convergent validity of the OLBI-S with the MBI General Survey for Students (MBI-GSS) was assessed in DPT students. Results indicated that the OLBI-S has excellent reliability and good validity. Next, a cross-sectional study utilizing the OLBI-S as well as several other outcome measures was conducted to determine if there is a difference in burnout scores among students in different years of a DPT program, to determine cut-off scores that would be used to group students into burnout categories, and to determine which demographic, individual, and environmental factors may influence the development of burnout. There was not a significant difference in burnout scores when comparing students across years in a DPT program and cut-off scores for burnout groups were established for DPT students. Results indicated that perceived stress, level of resilience, satisfaction with the level of support from faculty, and satisfaction with the overall learning environment at DPT school may influence the development of burnout in DPT students. A final study explored DPT students’ perceptions of factors that promote or impede well-being during their DPT program as well as to explore the students’ definition of burnout. This study utilized a qualitative research design using individual interviews and coding of student responses to questions to assess DPT student perceptions on burnout and well-being. Findings indicated that DPT students experienced burnout as a combination of exhaustion, disengagement, and chronic overload. Factors that negatively affected well-being while in DPT school included unmanageable stress, an excessive workload, and time pressures. Factors that positively affected well-being while in DPT school included prioritizing time, support, and self-awareness.
Changes in gait speed, gastrocnemius strength, and center of pressure for individuals living with Parkinson's disease
(5/31/2018) Shearin, Staci; Medley, Ann; Swank, Chad; Trudelle-Jackson, Elaine; Querry, Ross
Background: Parkinson’s disease (PD) is a progressive disease that impacts the ability to walk in individuals with PD. Changes in gait abilities can lead to falls, changes in independence, and decreased quality of life. The purpose of this study was to create two regression analyses to investigate the relationship of six factors with gait velocity and then gait endurance (the respective gait factor was included in the regression analysis). A secondary and tertiary purpose was to examine the relationship of changes in center of pressure data, gastrocnemius strength, and gait speed with those living with PD and their healthy peers. Participants: This study included a sample of convenience of 65 individuals with PD and 25 community dwelling adults. Methods: Data collected included 6 Minute Walk Test (6MWT) (gait endurance), Montreal Cognitive Assessment (cognition), Calf Raise Test (gastrocnemius strength), Four Square Step Test (balance), Fatigue Severity Scale (fatigue), Movement Disorders Society – United Parkinson’s Disease Rating Scale Motor Subscale (disease severity), Age, and 10 Meter Walk (10MWT) (gait speed) in addition to Zeno Mat single support center of pressure distance (SS COP). Results and D Discussion: For individuals with PD there was a significant prediction model for both gait speed and gait endurance. The 6MWT was the only significant predictor variable for the 10MWT, (F=21.01, p<.001, adjusted r2=.70). Both the 10MWT and heel raises were predictors for the 6MWT, (F=22.14, p<.001, adjusted r2=.71). Using Analysis of Variance, a statistically significant difference (p<.05) was found in 10MWT speed and SS COP distance between those with moderate PD impairment and those without PD as well as low PD impairment. Using Analysis of Variance, s statistically significant difference (p<.05) was found in average heel raises between those without PD, low PD impairment, and moderate PD impairment. Conclusions: This study highlights the impact of gastrocnemius strength in individuals living with PD. This may help to shift focus onto the gastrocnemius clinically to allow a more comprehensive assessment and treatment. Finally, the Zeno Mat may provide a clinical tool to assess changes in SS COP % in individuals with PD.
Comparison of an eccentric exercise intervention to a concentric exercise intervention in adults with subacromial impingement syndrome
(2014-05) Blume, Christiana Lynne; Wang-Price, Sharon; Trudelle-Jackson, Elaine; Ortiz, Alexis, Ph. D.
Research has demonstrated moderate evidence for exercise in the treatment of subacromial impingement syndrome (SAIS). This evidence has primarily addressed traditional concentric – eccentric resistance training with a lack of rationale for selection of contraction type, dosage, or progression of resistance. Recent literature has suggested that patients with tendinopathies respond well to eccentric training although few studies have investigated eccentric training effects on rotator cuff tendinopathy. The primary purpose of this study was to compare the effectiveness of an eccentric progressive resistance exercise (PRE) intervention to a concentric PRE intervention in adults with SAIS. The outcome measures, assessed by examiners blinded to intervention group, included the disabilities of the arm, shoulder, and hand (DASH) functional outcome score, pain-free shoulder elevation active range of motion (AROM), and pain-free shoulder abduction and external rotation strength. A secondary purpose was to determine if five or eight weeks of intervention was adequate to achieve significant changes in the shoulder outcome measures. A third purpose was to examine the correlations between the DASH and the physical measures of shoulder AROM and strength. The study was a prospective, randomized, clinical trial using a two-way, mixed design, with intervention group as the between- subjects factor and time as the within-subjects factor. Four 2x3 mixed-model, analyses of variance (ANOVA) with repeated measures were used to analyze the data from the outcome measures (α = 0.0125). Pearson correlation coefficients were calculated to describe the relationships between the DASH and the AROM and strength measurements. There were no significant interactions of treatment group by time for any of the outcome measures. Post-hoc analyses revealed a significant main effect of time on all outcome measures for all participants. The DASH scores had significant negative correlations with scaption AROM at all three time points and with both strength measurements at week five. The findings of this study indicate that supervised PRE for scapular and rotator cuff muscles performed twice a week for eight weeks may be beneficial in restoring function in patients with SAIS. These findings were true for both concentric and eccentric PRE programs.
A comparison of bone mineral density to the isokinetic strength of the back, abdominal, quadriceps, and hamstring muscle groups in African American and Caucasian sedentary females
(1998-08) Currie, William
A comparison of clinical outcomes between early physical therapy intervention and usual care in individuals following anterior cervical fusion
(2012-12-30) McFarland, Carol; Wang-Price, Sharon; Medley, Ann; Roddey, Toni S.
Early physical therapy (PT) intervention with emphasis on spinal stabilization has been shown to benefit individuals undergoing lumbar spinal surgery. Further, training cervical spine stabilizers (deep cervical flexors and cervical multifidus) has been shown to be effective in reducing neck pain, restoring cervical spinal function and mobility in many types of cervical spine dysfunction. However, the training of stabilizers has not been studied in individuals undergoing cervical spinal surgery, even though these individuals often have problems with residual pain and weakness after the surgery. The purpose of this study was to compare clinical outcomes between an early physical therapy intervention including training of stabilizers and usual care in patients who have undergone Anterior Cervical Fusion (ACF) surgery. The clinical outcomes included: 1) pain level using the numeric pain rating scale (NPRS), 2) patient's perceived disability associated with neck pain as determined by Neck Disability Index (NDI), 3) Deep cervical flexor (DCF) strength, and 4) DCF endurance. This study was a double-blinded randomized clinical trial with a two-factor (2x2) research design. The four clinical outcomes measurements were collected before surgery for baseline, then at 6-week postoperative visits with the surgeon. In addition, at 6 weeks after surgery, the Global Rate ofChange (GROC) was a fifth outcome measure to determine the patient's perception of overall improvement as a result of surgery. The study also examined the relationships among the patient's perceived disability due to pain, DCF strength, and DCF endurance. Additionally, test-retest reliability of the craniocervical flexion (CCF) test of DCFs in surgical patients was determined in the post operative condition. A 2x2 MANOV A was performed to identify interactions between group and time frame. Thirty participants were randomly assigned to early PT intervention or usual care groups, and 29 of these completed 6 week post-operative testing. There were no significant interactions with group by time frame. Results showed significant improvements of all outcome measures by time frame only. Concordance correlation coefficient (pc) calculations on eight participants who completed between day testing showed excellent reliability for CCF-S (0.82) and good reliability for CCF-E (0.70). Pearson correlations showed significant relationships between DCF strength and DCF endurance in all cases, and between NDI and DCF strength and endurance before surgery and with overall data. This study showed that over a 6 week period there is no difference between an early PT intervention and usual care in improving pain and function after ACF surgery. However both groups showed significant improvement from before ACF surgery to 6 weeks post.
Comparison to hand therapy and placebo in the treatment of thumb carpometacarpal osteoarthritis
(2012-08-30) Merritt, Melissa; Roddey, Toni S.; Roddey, Toni; Olson, Sharon; Costello, Charles
The purpose of this study was to compare the effect of hand therapy intervention to a placebo control group over a 4-week treatment period for participants with thumb carpometacarpal (CMC) osteoarthritis. Although hand therapy is recommended treatment for thumb CMC osteoarthritis, there is insufficient high quality evidence, particularly placebo and non-splint RCT's, to support hand therapy intervention (orthoses, therapeutic exercise, and joint protection techniques) for treatment of patients suffering with the symptoms of thumb CMC osteoarthritis. Thirty-five thumbs from 26 participants, 25 female and 1 male, (9 with bilateral involvement) were included after it was determined the participants had a positive grind test. The participants were randomly assigned to two groups: the treatment group, N = 17, were fitted with two orthoses (a neoprene Hely Weber Contoller and a rigid orthoplastic custom orthosis), taught therapeutic exercises and shown joint protection techniques. The control group, N = 18, was given sham cream to lightly apply to the thumb CMC joint. Trained testers, who were blinded to the participants' assignment group, administered the Australian Canadian Hand Osteoarthritis Index (AUSCAN), the lateral pinch strength measurement and accessed the participants' pain while pinching using the VAS scale. The AUSCAN was used as the primary outcome measure. The participants were accessed prior to treatment and 4 weeks later. The between subjects effect of the treatment group and the control group for the post-test AU SCAN post-test scores were statistically significant (p = 0.016) and the within subjects effect for the pretest AUSCAN and post-test AU SCAN scores of the treatment group were significant (p = 0.0001). The within subjects effect for the pretest VAS pain and post-test VAS pain scores was significant for the treatment group (p = 0.0001 ). The pinch strength test was not found to be significantly different between the treatment and the control group.
A computer programmed physical therapy student clinical evaluation form
(1980-12-31) Youens, Edith K.; Cramer, Barbara; Rozier, Carolyn; Pittman, Mildred
Concurrent validity of the use of the Dartfish application to assess motor strategy use in adults
(5/30/2017) Criminger, Christina; Swank, Chad; Medley, Ann; Thompson, Mary E.
Background: Motor strategy use changes with age, resulting in decreased balance and therefore an increased risk for falls. The importance of motor strategy activation in fall prevention is highlighted in current literature; however, physical therapists do not routinely examine motor strategy activation in clinical practice. There is limited available literature on how to objectively measure motor strategy use within a clinical setting given time and financial resource constraints. However, the use of the smart devices such as an iPad in clinical practice may provide a way to address this problem, and thus two studies were carried out. The purpose of the first study was to investigate the concurrent validity of the Dartfish ProSuite 7.0 software, which has been shown to be comparable to three-dimensional systems, and the Dartfish Express application (app) on an iPad 2 as a tool to measure start and stop ankle position during forward and backward ankle strategy activation. This affordable app has the potential to be used by clinicians in the clinic to objectively assess motor strategy use. The purpose of the second study was to investigate motor strategy use during an anticipatory stepping correction in an older adult sample compared with a younger adult sample using an iPad 2 and the Dartfish Express app. Comparisons of start and stop ankle position following forward and backward motor vi strategy activation and the time from initiation to completion of a stepping strategy were examined. Participants: 30 young adults (M= 26.5 ± 4.5 years) and 30 older adults (M= 72.6 ± 4.0 years). Methods: A two-camera set up was used for study one: an iPad 2 and Sony camera lens at equal heights. A one-camera setup with an iPad 2 was used for study two. In both studies, markers were placed on bony prominences on participants’ left side. Participants were read modified Mini-BESTest instructions for forward and backward compensatory stepping corrections. The Dartfish app and ProSuite software was used to measure the ankle start position (degrees) prior to initiation of an ankle strategy, stop position (degrees) immediately following the completion of ankle strategy use, and the time (seconds) it took to initiate and complete a compensatory step. Results and discussion: In study one, Pearson’s product moment correlation coefficient statistic showed an excellent relationship (r >0.75) between the Dartfish ProSuite 7.0 software and the Dartfish Express app on an iPad 2 for all four positions. Thus, the app’s use is appropriate to assess anticipatory motor strategies. Dependent t-test was used to compare means between the two devices. No significant differences were found between forward stop/start and backwards start/stop positions between devices. Therefore, only the iPad 2 and the Dartfish Express app were used in study two. For the second study, independent t-tests were used to compare the difference in ankle start and stop positions between the older and younger adults. A statistically significant difference vii was found in the forward ankle stop position (p= 0.01) that could be indicative of a more reserved anticipatory postural response from older adults. The reserved anticipatory postural response could be a result of increased fear of falling, decreased confidence in the participant’s ability to regain his or her balance beyond that point, or bias from previous experiences in loss of balance episodes. No other significant differences were found. Independent t-tests were also used to compare differences between forward and backward mean-time from initiation to completion of a stepping reaction; no significant differences were noted between older and younger adults. Conclusions: Overall, findings of these studies support the use of the Dartfish Express app as a tool to measure motor strategies and reinforce the importance of clinically assessing motor strategies. Further investigations should evaluate the reliability of the Dartfish Express app, as one considers the use of the app as a primary outcome tool for an intervention targeting motor strategy training.

Browse

Browsing School of Physical Therapy by Title