School of Physical Therapy
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Item Comparing gait biomechanics and function in children with bilateral spastic cerebral palsy when wearing OSKAR AFO-footwear combination versus standard AFO-footwear combination: An exploratory study(2024-05) Pierce, Teresa Long 1960-; Alyssa LaForme Fiss; Hui-Ting Goh; Martin Rosario; Mark GeilA majority of ambulatory children with cerebral palsy (CP) wear ankle foot orthoses (AFOs) when walking. Current literature recommends a segmental approach to orthotic prescriptions that optimizes foot, ankle, and lower leg alignment to achieve optimal kinetics and kinematics during stance and gait. However, there is little evidence to support this approach. The purpose of this exploratory study was to compare gait biomechanics and function in children with spastic CP when wearing ankle foot orthoses-footwear combinations (AFOFCs) fabricated using the Optimal Segment Kinematic and Alignment Approach to Rehabilitation, or OSKAR, versus standard AFOFCs. Ten participants, ages 7 to 13 years, from local pediatric clinics in a large suburban area participated in the study. Each participant wore both types of orthoses in a randomized order and biomechanical data was collected with three-dimensional gait analysis. Function was assessed for each condition using the Pediatric Balance Scale (PBS), Standardized Walking Obstacle Course (SWOC), and the Six-Minute Walk Test (6MWT). Satisfaction with the different orthoses was evaluated with the Orthotic and Prosthetic User Survey (OPUS). Peak knee extension improved in eight of ten participants; however, values were not significantly different between the two orthotic conditions. Participants with a hyperextended gait pattern exhibited peak knee extension values closer to typical in the OSKAR condition compared to participants with crouch gait. Pediatric Balance Scale scores were significantly higher when wearing the OSKAR AFOFCs but all other functional scores (SWOC, 6MWT) were comparable between conditions. Although not statistically significant, mean participant satisfaction scores on the OPUS were slightly higher in the OSKAR condition. Generalizations of study results are limited due to the small sample size and future studies with more participants are needed to evaluate the effectiveness of OSKAR AFOFCs. When examining gait variables, grouping participants based on gait pattern could provide more useful information. Findings from this exploratory study suggest that functional balance may be improved when wearing AFOFCs designed using the OSKAR method.Item The effect of transcranial direct current stimulation plus pain neuroscience education in patients with chronic low back pain and high pain catastrophizing – a pilot randomized controlled trial(2024-05) Alcon, Cory A 1991-; Wang-Price, Sharon; Goh, Hui-Ting; Brizzolara, KelliThe primary purpose of this study was to assess the feasibility of a large double-blinded, randomized controlled trial (RCT), investigating the effects of combined active tDCS plus PNE (tDCS + PNE) to those of sham tDCS + PNE in patients with chronic low back pain (CLBP) and high pain catastrophizing. The secondary purpose was to examine the effect sizes between the two interventions and the effect sizes before and after each intervention in patients with CLBP and high pain catastrophizing. Twenty participants, 10 in each group, with CLBP and high pain catastrophizing were recruited and randomly allocated into the active tDCS + PNE or sham tDCS + PNE groups. All participants received five sessions of their assigned interventions over a 2 week period. Outcomes measures were assessed at baseline and following completion of the study, including the Numeric Pain Rating Scale (NPRS), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), pressure pain thresholds (PPTs), Stroop Color and Word Test (SCWT), and Comprehensive Trailing Making Test – Second Edition (CTMT2). The study was determined to be feasible if (1) the 2-week attrition rate is less than 20%, (2) no adverse responses are reported, (3) at least 75% of patients complete follow-up assessment data, and (4) the time required by study personnel falls under 20% of the principal investigator’s (PI’s) full-time faculty workload. Effect sizes were calculated within each group and between the two groups. All participants completed the required intervention sessions and follow-up assessment. No adverse responses were reported, and 18.8% of the PI’s workload was required to complete the study. The active tDCS + PNE group demonstrated greater effect sizes in all outcome measures except the CTMT2 – Set Shifting test. The between-group effect sizes favored the active tDCS + PNE group with effect sizes ranging from 0.11–1.24. The results of this study suggest an RCT comparing the effects of active tDCS + PNE versus sham tDCS + PNE in patients with CLBP and high pain catastrophizing is feasible. In addition, active tDCS + PNE appeared to produce larger effect sizes than sham tDCS + PNE.Item The effects of dry needling on muscle blood flow of the infraspinatus in individuals with shoulder pain(2024-05) Brown, Jace 1989-; Wang-Price, Sharon; Weber, Mark; Brizzolara, Kelli; Kearns, GaryThe presence of myofascial trigger points (MTrPs) has been associated with the chronicity of shoulder pain. In the past decade, dry needling (DN) has been used in physical therapy practice to treat MTrPs with favorable outcomes. Impaired blood flow has been proposed as an underlying pathophysiologic mechanism of MTrP in patients with shoulder-neck pain. To date, although DN has been shown to change blood flow in healthy individuals, no studies have examined whether DN would change blood flow in individuals with shoulder pathology. The primary purpose of this study was to evaluate the effects of DN on the blood flow of the infraspinatus muscle in individuals with shoulder pain. The secondary purpose of this study was to examine the effects of DN on sensitivity to pressure of the infraspinatus muscle and shoulder range of motion (ROM) in individuals with shoulder pain. This study utilized a sham-controlled design. Forty individuals with nonspecific shoulder pain and the presence of at least one MTrP in the infraspinatus muscle were randomly assigned to a real DN group or a sham DN group. Outcome measures, including blood flow parameters, pressure pain threshold (PPT), and ROMs of shoulder internal rotation and external rotation, were collected before and immediately after a single session of DN. Blood flow parameters included peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and pulsatile index (PI). The ANOVA results showed that the real DN group had a significant decrease in PSV and increases in ROMs of shoulder internal and external rotation after DN, but no significant differences in other outcome measures between the two DN groups. The results indicated that participants who received real DN exhibited a significant reduction in PSV, indicative of an improvement in blood flow to the infraspinatus. Reduced blood flow after DN suggests that DN may have vasodilation effects, leading to relief of capillary compression. DN also may affect muscle relaxation, thus contributing to motion improvement. These results may provide clinicians with further evidence for the use of DN for individuals with shoulder pain.Item The influence of therapeutic exercise on subsequent occurrence of lower extremity musculoskeletal dysfunction within one year of a low back pain diagnosis in the military health system(2024-05) Foster, Kaitlyn Sue 1994-; Wang-Price, Sharon; Brizzolara, Kelli; Weber, Mark; Daniel RhonThe primary purpose of this study was to determine the impact of receiving therapeutic exercise (TE) to manage low back pain (LBP), adjusted for demographic factors, on the time-to-occurrence of subsequent lower extremity (LE) dysfunction within 1 year of LBP diagnosis in beneficiaries of the Military Health System (MHS). The secondary purpose was to examine the impact of the number of TE sessions adjusted for associated demographic factors on the time-to-occurrence of subsequent LE dysfunction within 1 year of LBP diagnosis in the beneficiaries who received TE. In this secondary analysis, a total of 452,668 individuals diagnosed with LBP in the MHS between January 2015 and December 2019 were identified to be eligible participants who were followed for 1 year during which a hip, knee, or ankle/foot dysfunction occurred. Participants were placed into one of two groups: those receiving TE or those not receiving TE. Cox proportional hazards regression models were used to examine the utilization of TE and the number of TE sessions adjusted for demographic factors of interest on the time-to-occurrence of subsequent hip, knee, and ankle injury, respectively. Patients who received TE demonstrated a significantly decreased risk in time-to-occurrence for subsequent LE injuries that decreased further with each additional appointment, in the year following LBP diagnosis. In addition, several demographic factors significantly increased the risk of subsequent hip, knee, or ankle/foot injury including age, being on active duty, seeking care in the emergency room or urgent care, and being in the Army, whereas other factors such as being in the navy, being in the Coast Guard, or being an officer significantly reduced the risk of time-to-occurrence of LE dysfunction in the year following LBP diagnosis. In conclusion, individuals who did not receive TE for their LBP had an increased risk of subsequent LE injury or dysfunction in the year following the episode of LBP. Further, in individuals who did receive TE, the risk of subsequent LE dysfunction significantly decreased with each additional session. The results of the study can inform decisions related to treatment and return to work and sport after LBP.Item The effect of focus of attention on motor performance and learning during a sit to stand task in individuals post acute stroke(2024-05) Hyatt, Ashley Watamura 1982-; Goh, Hui-Ting; Bowden, Mark; Medley, Ann; Rosario-Canales, MartinIndividuals post stroke have reduced ability to stand up with symmetrical weight bearing, while maintaining a midline trunk position. The reduction in the ability to stand up can affect their independence, fall risk, and quality of life. Rehabilitation and the type of instruction provided can impact these outcomes. Multiple studies completed in the healthy adult and sports populations have suggested that focusing on a target or outcome, an external focus, can lead to more success in performance and learning of a motor skill than focusing on body movement, an internal focus of attention. The purpose of this study was to explore the effects of focus of attention on motor performance and learning of sit to stand in individuals post-acute stroke. This randomized cross over study included 13 participants who had a stroke less than 6 months prior and could stand and walk without physical assistance. Individuals were provided internal or external focus instruction and feedback during 4 progressively more challenging sets of sit to stands. Task performance was quantified using force through the affected lower extremity and trunk position during the sit to stand transitions. Motor learning was assessed by a retention test 5 minutes and 1 hour after training, as well as a transfer test by the exploring the effects on gait kinematics. Results of the study suggested there was no effect of focus of attention on the increased use of the paretic lower extremity during sit to stand or gait, but when individuals post-acute stroke were in the external focus condition, they had decreased trunk movement throughout training. All individuals showed improvement of the use of the affected lower extremity and increased unaffected step length, and gait velocity, regardless of which focus of attention was provided. Manipulation check revealed that participants adopted internal focus during practice despite the instructions. This study suggests that individuals post stroke may respond differently than healthy adults to attentional focus cues, especially during sit to stand, but the external focus may impact quality of movement during training. Further studies should explore what factors post stroke can affect their response to focus of attention.Item Validation of the military concussion readiness inventory-dizziness and balance(2024-05) Frank, Amanda 1991-; Weber, Mark; Fiss, Alysa LaForme; Medley, Ann; Hoppes, CarrieThe purpose of this study was to provide initial validation of the Military Concussion Readiness Inventory-Dizziness and Balance (MCRI-DB), the first military-specific patient self-report outcome measure to quantify dizziness and balance symptomology. Using retrospective data analysis, data was extracted from the Traumatic Brain Injury (TBI) Survey Portal, a repository of clinical outcome measures from U.S. military beneficiaries who receive care within the Defense Intrepid Network for TBI and Brain Health. The sample was randomly split into two groups for analysis. An exploratory factor analysis (EFA) with item reduction was completed on the MCRI-DB. Confirmatory factor analysis (CFA) was completed on the modified MCRI-DB. Finally, the modified MCRI-DB was tested for criterion-related validity against the Dizziness Handicap Inventory (DHI) and Neurobehavioral Symptom Inventory (NSI). Data from 553 service members was extracted from the TBI Survey Portal (Mean age = 37 +/- 8 yrs.; Males = 491, Females = 62; Army = 514). EFA was performed using Sample 1 data, starting with component extraction. One component was retained after parallel analysis and scree plot visualization. After determining the number of factors to retain, an iterative item reduction process began, with subsequent EFA after each of the seven rounds of item elimination. This process reduced the MCRI-DB from 68 items to 25 items. A follow-up CFA of the 25-item MCRI-DB was then completed using Sample 2 data, resulting in an acceptable model fit. Internal consistency for the 25-item MCRI-DB was good, Cronbach’s 𝛼 = 0.95. The 25-item MCRI-DB demonstrated strong correlation to the DHI (r = 0.77, p < 0.001) and NSI (n = 0.67, p < 0.001). Factor analysis and item reduction processes led to the creation of the 25-item MCRI-DB, demonstrating a streamlined survey process, reduced respondent burden, and improved data quality. The scale's one-factor solution aligns with recent literature on similar measures, boosting confidence in its ability to represent the construct of dizziness in military service members with a history of traumatic brain injury (TBI). The 25-item MCRI-DB may serve as an alternative self-reported dizziness outcome measure for military personnel. The MCRI-DB contains items that will aid in return-to-duty decision-making after mTBI.Item Factor analysis of children's attitude inventory toward physical education(1995-05) Atkins, Susan; Sherrill, Claudine; French, Ron; Goode, SinahThe purpose of this study was to examine selected psychometric properties of the Children's Attitude Inventory Toward Physical Education (Sherrill & Toulmin, 1977) and to recommend changes, if needed. Subjects ($N=322$) in Grades 4 and 5, were administered the 50-item Children's Attitude Inventory Toward Physical Education (CAIPE), followed by retest of 80 students 7 days after the initial administration. Most subjects responded positively to all CAIPE items. Independent t tests indicated no significant difference between genders or grades. Test-retest reliability using intraclass correlation for the CAIPE was $R=.87$. A principal factor analysis with oblique and varimax rotations revealed 29 items which loaded at.40 or greater. CAIPE is a reliable and global measure of Grade 4 and 5 children's expressed attitudes toward physical education but, revisions are needed to assure construct validity and permit multidimensional scoring of six specific constructs; Outcomes, Negative Affect, Positive Affect, Personal Values, Teacher Attitude/Fun, and Never It.Item Functional predictors of frailty and kidney disease burden in patients with end-stage renal disease receiving dialysis(December 2023) Ward, Rick 1965-; Mary Thompson, PT, PhD; Elaine Jackson, PT, PhD; Kelli Brizzolara, PT, PhDBackground: Frailty is a complex syndrome involving failure of multiple body systems leading to adverse patient outcomes. In patients who receive dialysis, the prevalence of frailty can be as high as 73%, even among younger older adults, with frailty increasing as kidney disease progresses. Despite the high prevalence of frailty, systematic identification of frailty in patients with chronic kidney disease and end-stage renal disease is not standard practice. There is limited research on optimal strategies available to perform these assessments. The literature shows a link between physical well-being and the burden of kidney disease among patients with end-stage renal disease. The goal of this study was to determine functional predictors of frailty and kidney disease burden among patients with chronic kidney disease receiving dialysis. Methods: Twenty-eight patients receiving dialysis at the Wise Health System dialysis center in Decatur, Texas consented to participate in the study. The study analyzed number of falls in the past year, Timed Up and Go time, and 30-second sit to stand repetitions as predictors of (a) frailty score and (b) Kidney Disease Quality of Life burden of kidney disease subscale score. For each research question, linear regression analysis was performed. Results: The overall model predicting frailty score from the predictor variables was significant and accounted for 78.4% of the variance. Timed Up and Go time and 30-second sit to stand repetitions were significant predictors of frailty score. The overall model predicting burden of kidney disease was significant when number of falls in the past year was analyzed independently, accounting for 21.7% of the variance. Discussion and Conclusion: The results of this study provide evidence for the use of Timed Up and Go time and 30-second sit to stand repetitions as assessment tools predicting the physical domain of frailty. The number of falls in the past year contributes to the psychological and social domains of frailty. Individuals with end-stage renal disease receiving dialysis are underserved in physical therapy practice. Preventative strategies are essential as a one-point increase in frailty score correlates to an 87% increase in mortality in this vulnerable population.Item Assessment of stress and burnout in physical therapist clinical instructors(August 2023) Pontiff, Ryan 1988-; Mitchell, Katy; Gleeson, Peggy; Patel, RupalABSTRACT 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.Item Stabilization exercises for patients with low back pain(2006-05) Ali, Tarek; Hanten, William; Gleeson, Peggy; Olson, SharonBackground and purpose. The purpose of this study was to evaluate the effect of stabilization exercises in reducing pain and disability and increasing physical performance of patients with nonspecific low back pain (LBP). Subjects. Forty volunteer participants with nonspecific low back pain for less than 24 months completed the program. Methods. The first (control, n=20) group received a traditional program only (modalities, stretching, and strengthening exercises). The second (experimental, n=20) group received stabilization exercises in addition to the traditional program. Both groups received three visits a week for four weeks. Outcome was based on pain intensity measured by the numerical rating scale, disability measured by the Roland-Morris Scale, and physical performance measured by the timed up-and-go test before and after intervention. Three separate analyses of co-variance, with the pretest scores as the covariates, were performed to determine whether there was a difference between the two groups on the post-test scores. Results. There were no statistically significant differences in reduction of pain intensity (F1,37=0.96, P=0.3325) or increase of physical performance (F1,37=1.286, P=0.264) between both groups. However, there was a statistically significant difference between the groups in disability score reduction (as measured by the Roland Morris Scale) in favor of the experimental group (F1,37=7.73, P=0.0085). Discussion and conclusion. Patients perceived that their functional disability decreased while their actual physical performance as measured by the timed up-and-go test did not change. In this study, stabilization exercises were of some value for patients with nonspecific LBP.Item Is the upper quarter Y-Balance test a useful measure to determine upper limb loading response in female competitive gymnasts after upper extremity injury?(August 2023) Gomez, Christina; Brewer, Wayne; Wang-Price, Sharon; Bickley, ChristinaGymnastics requires an athlete to weight-bear through each upper extremity (UE) in various positions. These unique sport requirements should be considered by clinicians when rehabilitating a gymnast after UE injury. There is currently no reliable and valid clinical test for female gymnasts, though the Upper Quarter Y-Balance test (YBT-UQ) may best recreate the sport’s demands. It requires an individual to maintain a plank position while one arm pushes a marker in three directions. The purpose of this project was to explore the YBT-UQ’s test–retest reliability, convergent validity, and predictive ability for female competitive gymnastics. Gymnasts were recruited using nonprobability sampling methods, and included if they participated in women’s competitive artistic gymnastics. Based on UE pain during gymnastics, participants were placed into either the Pain or No Pain group. All participants were asked to perform the YBT-UQ. For study one, follow-up testing was performed one week later. In the No Pain group, statistical analysis revealed good to excellent test–retest reliability of YBT-UQ composite scores. For the Pain group, test–retest reliability was acceptable to good. For studies two and three, the participants performed the YBT-UQ and a handstand on a portable pressure mat. As a handstand is a foundational gymnastics skill, it was chosen to identify a gymnast’s ability to weight-bear through each UE. The pressure mat system provided real-time data during the handstand. Limb symmetry index (LSI), a measure that compares performance between extremities, was calculated using YBT-UQ composite scores and two pressure measurements, peak pressure and time-to-peak pressure. Statistical analysis of the relationship between LSI of YBT-UQ and LSI of peak pressure revealed no significant correlation between the two variables for any group. Similar results were found for time-to-peak measurements. Analysis of the predictive ability of LSI of YBT-UQ scores indicated that this variable did not predict LSI for either peak pressure or time-to-peak pressure. The YBT-UQ, when used in isolation, does not appear to depict a female gymnast’s ability to perform sport tasks. Clinicians should consider implementing this test in combination with other outcome measures to determine a gymnast’s readiness to return to sport.Item Investigating the relationship between hip joint kinematics and patient-reported measures during squatting tasks & reliability of clinical methods of squatting assessment in females with acetabular dysplasia(August 2023) LaCross, Jennifer Ann 1988-; Brizzolara, Kelli; Thompson, Mary; Lewis, Cara; Weber, MarkBackground: Acetabular dysplasia (AD), a classification of non-arthritic hip pain, commonly affects females and leads to long-term morbidity if untreated. Purposes: To investigate hip kinematics during squatting tasks in females with AD, explore relationships between kinematics and patient-reported outcome measures, and analyze feasibility and reliability of methods for assessing squat performance. Methods: To assess kinematic variability and relationships between variables, 23 females with AD and 28 controls participated. Three-dimensional kinematic data was collected in one session using motion capture. Participants completed outcomes related to pain, hip-specific function, and activity level. Independent t-tests were used to examine differences in maximal hip adduction between groups. A within-subject repeated measures ANOVA was used to investigate hip adduction differences across multiple positions by task. Spearman rank-ordered correlation coefficients were used to evaluate the relationship between maximal hip adduction and each outcome measure. To assess feasibility and reliability of two-dimensional video analysis, 8 females with AD participated. Small knee bend and deep squat performances from the Hip and Lower Limb Movement Screen were recorded and then scored by two investigators. Feasibility was investigated in domains of process and science. Inter-rater reliability was assessed by comparing two raters’ scores using Cohen’s kappa (κ). Results: There were no significant differences between groups in the amount of maximal hip adduction measured during a single (p = .52) or double-leg (p = .35) squat. The amount of adduction did differ significantly across positions during both tasks in females with AD. No significant relationships were found between outcome scores and maximal hip adduction on a single (p =.06 to .70) or double-leg (p =.48 to .85) squat. Two-dimensional video analysis was feasible for this population. Inter-rater reliability was higher for assessing a single-leg (κ = .33 to 1.00) than for a double-leg (κ = .25 to .75) squat. Conclusion: Variability in hip kinematics observed in females with AD suggests that focusing on functional performance may be better than a single kinematic factor when working with this population. While two-dimensional video analysis of both tasks was feasible, assessing a single-leg squat during evaluation is recommended to save time and minimize symptom-provoking activities.Item Treatment adherence: Predictive factors and the relationship with treatment outcomes in patients with low back pain(May 2023) Watson, Seth 1989-; Weber, Mark; Brizzolara, Kelli; Jackson, ElaineLow back pain (LBP) is a significant health problem that is ranked as the leading cause of global disability. LBP affects approximately 80% of the population leading to an estimated $300 billion in direct and indirect costs in the United States alone. Unfortunately, this problem continues to grow with minimal change in the rate of years lost to disability over the past decade. In response to this growing problem, multiple major international guidelines have been developed to improve the provision of evidence-based medicine for patients with LBP. According to these guidelines, one of the first steps for managing this condition is physical therapy. While effective for many musculoskeletal conditions, including LBP, many patients do not experience clinically meaningful improvements in LBP following physical therapy. This has led to increased focus on identifying factors associated with outcomes in patients receiving physical therapy for LBP. One of the factors that has been demonstrated to influence patient outcomes is treatment adherence. While treatment adherence is a prerequisite for positive outcomes, there is a paucity of evidence for how treatment adherence influences outcomes in patients with LBP. In addition, there is limited understanding of what modifiable and non-modifiable factors influence treatment adherence in this population. The collective purpose of the three studies in this dissertation was to identify relevant barriers to adherence while showing how adherence relates to outcomes in patients with LBP. The first study is a retrospective analysis that demonstrates that high patient costs per visit, the presence of an opioid prescription, and symptom duration less than one month predicts non-adherence to treatment. This study led to the development of the second study, which is a prospective analysis that shows that high levels of psychological distress negatively influence treatment adherence. The final study prospectively analyzed 236 participants and demonstrates that higher levels of home exercise program compliance predict improved functional outcomes in patients with LBP. The results of this dissertation support the importance of identifying and addressing the modifiable risk factors for non-adherence to treatment, which may allow clinicians to improve the likelihood that their patients will experience significant improvement in LBP.Item 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, KelliPurpose: 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, 610 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 = -0.290.36) 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.Item Neural correlates of balance performance in chronic stroke: A repetitive transcranial magnetic stimulation study(May 2023) Parikh, Vyoma 1987-; Goh, Hui-Ting; Medley, Ann; Thomas, JodiPurpose: The primary motor cortex (M1) and the cerebellum are both crucial for balance control and can be viable targets for non-invasive brain stimulation aiming to improve balance performance. However, the optimal stimulation target for balance improvement in individuals post stroke has yet to be determined. The purpose of this study was to determine the role of two neural loci (M1 and cerebellum) in modulating balance performance in individuals with chronic stroke using repetitive transcranial magnetic stimulation (rTMS). Methods: Sixteen individuals with chronic stroke (81% male; mean age = 58.1 ± 10 years; chronicity mean = 63.1 ± 41.6 months) participated in the study. A single session of 5Hz rTMS was applied to M1 and the cerebellum in a cross-over randomized manner with a washout period of approximately seven days. Before and after each rTMS session, single pulse transcranial magnetic stimulation (TMS) was used to measure the motor evoked potential (MEP) amplitude of the affected lower limb muscles to quantify corticospinal excitability. The Limits of Stability (LOS) time, LOS overall sway angle, and the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) sway index were used to assess anticipatory and reactive balance control respectively, before and after each rTMS session. Repeated measures ANOVA and Spearman’s correlation analysis were performed. Results: M1 rTMS improved the LOS overall sway angle to a greater extent compared to cerebellar rTMS (p < .001), whereas LOS time was not affected by stimulation target. Sway iv index on the mCTSIB was mediated by stimulation target, proprioception, vision, and time (p = .006). There was no significant effect of rTMS application on mCTSIB sway index under the eyes open conditions. Under eyes closed conditions, M1 rTMS resulted in a significantly improved sway index on the firm surface condition (p = .002), whereas cerebellar rTMS improved sway index on the foam surface condition (p = .001). There was a weak non- significant correlation between change in corticospinal excitability after rTMS and change in balance performance. Conclusion: Both M1 and the cerebellum are viable targets for rTMS and have unique roles in mediating balance performance in individuals with stroke. This information could assist with the development of targeted non-invasive brain stimulation to enhance balance recovery after stroke.Item Use of Y-Balance test performance to predict musculoskeletal complaints in adolescent dancers(May 2023) Stoddard, Carissa Anne 1985-; Wang-Price, Sharon; Weber, Mark; Fiss, Alysa LaFormePurposes: The purpose of the study was to determine whether Y-Balance Test (YBT)™ performance could predict occurrences of moderate-to-severe lower extremity musculoskeletal complaints among adolescent dancers over a single dance season (approximately 3 months). Time-to-occurrence of musculoskeletal complaints also was compared between dancers who had high and low YBT™ performance. Methods: Fifty-five adolescent dancers were recruited for the study, and 49 qualified participants completed the study. The YBT™ scores were collected at the beginning of the study, and an injury surveillance questionnaire, the Oslo Sports Trauma Research Center Questionnaire for Overuse Injury - Updated version 2 (OSTRC-O2), was administered at baseline and every other week for three months. An OSTRC-O2 score of 39 or higher from any of the follow-up OSTRC-O2 questionnaires was considered as an occurrence of moderate-to-severe musculoskeletal complaint. A binary logistic regression was used to determine whether YBT™ scores could predict occurrence of moderate-to-severe musculoskeletal complaints. A Kaplan-Meier survival analysis was performed to determine time-to-occurrence of moderate-to-severe musculoskeletal complaints for the participants who had high and low YBT™ scores. Results: The regression analysis showed an odd ratio of 0.049 (p = 0.236, 90% confidence interval = 0.869, 1.035) using YBT™ performance to predict occurrences of moderate-to-severe musculoskeletal complaints. Although the participants who had low YBT™ scores appeared to develop moderate-to-severe musculoskeletal complaints sooner than those who had high YBT™ scores, the difference was not statistically significant (p = 0.671). Conclusion: The results of this study suggest that YBT™ performance is not predictive of lower extremity musculoskeletal complaints in adolescent dancers over a 3-month season. Although it was not statistically significant, adolescent dancers with a low YBT™ score appeared to be more likely to develop a moderate-to-severe musculoskeletal complaint earlier in the season compared to those with a higher YBT™ score. In addition, the occurrence and severity of musculoskeletal complaints was highest during the first month of the dance season and then gradually decreased as the season progressed, indicating a time interval during which young dancers were at risk of injury.Item Social determinants of health and social vulnerability: How individual and community factors influence physical therapy patient outcomes in a public hospital system(May 2023) Butcher, Allison Hall 1994-; Brewer, Wayne; Patel, Rupal; Brizzolara, Kelli; Marchetti, GregorySocial determinants of health (SDOH) and social vulnerability play a significant role in determining health outcomes. SDOH can affect up to 80% of health outcomes, making them the single strongest predictor of health and wellness. The social vulnerability index (SVI), while initially established to measure public health preparedness, is often negatively correlated with health outcomes. Studies are lacking to quantify relationships between SDOH, SVI, and musculoskeletal outcomes in physical therapy patients. The purposes of the three studies were to establish the test-retest reliability and concurrent validity of the Health Leads Screening Tool (HLST), examine the relationship between community vulnerability and orthopedic physical therapy patient outcomes, and determine which individual factors are predictive of orthopedic physical therapy patient outcomes in a public hospital system. Test-retest reliability of the HLST and concurrent validity of the HLST with the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) were assessed in physical therapy patients. The HLST had excellent test-retest reliability in all nine domains and moderate concurrent validity in six of the nine domains. Next, a retrospective study examined if SVI predicted physical therapy outcomes when dichotomized into success and failure groups based on the Focus on Therapeutic Outcomes (FOTO) survey. SVI was a significant predictor of outcomes in patients with upper quarter diagnoses. In this group, patients in the second-fourth quartiles of SVI were 2.5 times more likely to be classified as failure compared to those in the first quartile. The number of visits that a patient attended was also a significant predictor of outcomes. Every additional visit that a patient attended increased their odds of success by 10%. A final study examined the role of individual factors in predicting physical therapy baseline levels of function, discharge levels of function, and amount of improvement during a plan of care (all measured via FOTO). Self-rated health and SVI explained 12.5% of the variation in baseline levels of function, while social needs, baseline scores, self-rated health, and SVI explained 31% of the variation in the amount of improvement and 62% of the variation in discharge scores.Item Elasticity measures of lower leg muscles attributed to foot arch classifications: A comparison to dynamic balance across groups with and without ligamentous injury(December 2022) Kempfert, David J; Mitchell, Katy; Brewer, Wayne; Bickley, ChristinaPurpose: The purpose of this study was to examine differences, correlations, and predictive relationships between the elasticity of lower leg muscles, categories of arch height and mobility, and dynamic single-leg standing balance among participant groups of healthy, chronic ankle instability (CAI), and anterior cruciate ligament repair (ACLr). Participants: One hundred fifty (109 healthy, 24 CAI, 17 ACLr) recreationally active adults participated in this cross-sectional study. Procedures: Elasticity of the tibialis anterior (TAm), tibialis posterior (TPm), peroneal longus (PLm), and peroneal brevis (PBm) was measured with shear wave elastography (SWE) in non-weight-bearing (NWB) and weight-bearing (WB). The Arch Height Index was used to categorize arch height (low, neutral, high) and mobility (mobile, neutral, rigid). Dynamic balance (DB) was measured with the Y-Balance Test. ANOVAs, with Bonferroni corrections, were utilized to examine differences between and within the variables. Pearson correlations were utilized to calculate the relationship among variables. Linear and multinomial logistic regressions were utilized to determine the predictive relationship between variables. Results: Differences: For healthy participants, the results of this study revealed elasticity of multiple muscles are significantly different between/within positions of NWB/WB. A high arch had greater muscle elasticity than a low arch in NWB/WB. A significant interaction revealed elasticity of the TPm in NWB was less in a mobile arch versus a rigid arch. When comparing participant groups, there was a significant main effect for muscle elasticity and group in NWB/WB. The TPm had the greatest elasticity regardless of group. The ACLr group had the least elasticity regardless of muscle. Relationships: No relationship was found between DB and muscle elasticity in NWB/WB for healthy, CAI, or ACLr groups. Predictions: Arch height/mobility categories significantly predicted elasticity of the PLm, PBm, and TPm in NWB/WB. No variables were found to differentiate CAI from the healthy group; however, DB, elasticity of the TAm, TPm, and PBm in NWB/WB individually differentiated ACLr from the healthy group. Conclusion: This is the first study to utilize SWE to establish muscle elasticity by arch height and arch mobility categories across groups—healthy, CAI, and ACLr. These findings may be used as a comparison for future studies.