School of Physical Therapy

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    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, PhD
    Background: 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.
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    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.
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    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, Christina
    Gymnastics 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.
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    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, Mark
    Background: 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.
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    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, Elaine
    Low 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.
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    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.
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    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, Jodi
    Purpose: 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.
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    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 LaForme
    Purposes: 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.
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    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, Gregory
    Social 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.
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    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, Christina
    Purpose: 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.
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    Examining physical activity and the relationship between physical activity, gross motor development, and segmental trunk control in preterm and full-term infants
    (2022-12-01T06:00:00.000Z) Silveira, Jessica; Jackson, Elaine; Thomas, Jodi; Poskey, Gail
    Preterm infants demonstrate decreased gross motor ability as compared to full-term infants. Previous studies have hypothesized that preterm infants may receive fewer opportunities to practice gross motor skills due to parental perception of vulnerability. The purposes of this study were to determine if preterm infants are given similar opportunities to be physically active as compared to full-term infants and examine if physical activity is related to motor development. Twenty-four full-term infants and 13 preterm infants completed the AIMS, SATCo, Daily Activities of Infants Scale (DAIS), and parent-reported physical activity questionnaires. The relationship between physical activity, segmental trunk control, and gross motor ability was also investigated using multiple regression, with term group, physical activity, and segmental trunk control serving as predictor variables for gross motor ability. There was no significant difference in physical activity between preterm and full-term infants. Segmental trunk control was a significant predictor of gross motor ability, while term group and physical activity were not significant predictors. This study found that majority of infants are not achieving the World Health Organization physical activity guidelines for infants, with many infants spending greater than one hour at a time in restrictive equipment. Preterm infants and full-term infants appeared to receive similar opportunities to practice gross motor skills and term group and physical activity were not significantly related to gross motor ability. Segmental trunk control was a significant predictor of gross motor ability and appears to be an important factor when addressing gross motor development in infants.
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    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.
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    The contributing factors and effects of breastfeeding position-related pain: A mixed methods study
    (2022-12-01T06:00:00.000Z) Wagner, Amy; Thompson, Mary; Breastfeeding; Pain; Brizzolara, Kelli; Da Silva, Carolyn
    Background and Purpose: Breastfeeding has multiple health benefits for both children and mothers. Breastfeeding position-related pain (BPRP) has been established as prevalent in countries outside the United States and affects multiple body regions, including the back, neck, and shoulders. Pain is one of the reasons mothers terminate breastfeeding. The purpose of this study was to describe factors related to BPRP in postpartum mothers, the impact of BPRP on quality of life, and to develop a theory to summarize the findings. Methods: This convergent mixed methods study design surveyed 471 mothers and 83 healthcare providers. Quantitative data were collected and statistically analyzed. Open-ended responses were analyzed using thematic analysis, while qualitative methods ensured rigor, including the use of an audit trail, memo-writing, triangulation of methods and data sources, and reflexivity by the principal investigator. Quantitative and qualitative data were integrated. Results: Mothers reported the most intense pain in the upper back, breast, neck, and shoulders. Seated positions were found to be more painful than recumbent or semirecumbent positions. Pain was negatively correlated with breastfeeding self-efficacy. Pain appeared early in the postpartum period. Minutes breastfeeding per day were predictive of average body pain with breastfeeding. Healthcare providers used a variety of strategies to help mothers mitigate BPRP. These strategies included positioning, exercise, and posture reeducation. The qualitative results revealed an overall theme of support. Themes of internal factors, external factors, and temporal factors related to BPRP fit a bioecological model. Future areas of research included the need for intervention studies, understanding pain with pumping, returning to work, developing measurement tools for BPRP, biomechanical studies of breastfeeding positions, and communication issues between mothers and healthcare providers. Discussion and Conclusion: Pain is prevalent among breastfeeding mothers and appears to be multifactorial. This pain may impact a mother’s ability to reach her breastfeeding goals. Due to variability in BPRP, a person-centered approach by healthcare providers is warranted. Early intervention by healthcare providers using a multidisciplinary approach appears important. More research is needed to investigate BPRP, so that breastfeeding mothers will be able to breastfeed with reduced pain, enhanced comfort, and increased success.
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    Exploration of physical performance, surgical decision-making, and clinical screening for individuals with low back pain
    (2022-03-03) Harris, Sean; Gleeson, Peggy B
    The prevalence of low back pain (LBP) has been steadily increasing in the United States, with current lifetime rates between 80-90%. As a result, LBP is currently the second leading cause of disability in the nation and leading cause of workdays missed. With annual direct and indirect costs estimated between $300-600 billion in the United States alone, there is a growing demand for treatment for individuals with LBP and associated symptoms. Most urgently, there is a need for adequate identification and triage of individuals who would benefit from lumbar surgery, as this population contributes highest to direct and indirect treatment costs. Clinical research evaluating the diagnosis and management of patients with LBP has not kept pace with the growing costs, resulting in a severe lack of high-quality evidence to identify optimal screening, assessment, and treatment. The purpose of the subsequent studies was to aid in the surgical screening process for individuals with LBP by exploring the decision-making of spine physicians and identifying surgical screening tools to help improve efficiency of this process in the future. To this end, a novel screening tool, the functional lumbar index (FLI) was developed by incorporating several commonly utilized physical performance tests into one scoring system. The FLI was validated as an effective tool for identifying individuals who failed conservative management for their LBP using a Poisson regression. Next, five physicians with a high-volume clinical practice of individuals with LBP were interviewed to discuss their individual opinions behind the surgical decision-making process. This data was used to develop the following themes: importance of diagnostic imaging, need for functional assessment, impact of neurologic status, and non-musculoskeletal considerations. The final study prospectively analyzed 50 individuals pre-selected for either surgery (n=25) or conservative care (n=25) on which objective data would best predict pre-determined grouping. Multiple logistic regression analysis was used to identify that the FLI and neurologic status were both significant predictors of pre-determined surgical grouping.
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    The impact of COVID-19 on DPT student and faculty experiences: A grounded theory study
    (2022-04-29) Davis, Lara Elizabeth; Weber, Mark
    The COVID-19 pandemic significantly changed the way that physical therapists provide care to patients, as well as the way physical therapy students and faculty learn and teach, respectively, in Doctor of Physical Therapy (DPT) programs. Students and faculty quickly changed their teaching and learning methods when the curriculum was abruptly switched from all in-person instruction to all-online. The purpose of this study was to develop a grounded theory surrounding how the COVID-19 pandemic and its associated challenges impacted students and faculty in a single DPT program, including their experiences, expectations, relationships, and interactions. Participants were recruited via email and word of mouth. This study included participants from Texas Woman’s University’s (TWU) School of Physical Therapy at both the Dallas and Houston campuses. Participants included twenty-six students (23 female; 3 male) and ten faculty (8 female, 2 male). Ten of the students were in their second year, and sixteen of the students were in their third year of PT school at the time of data collection. Six student focus groups of 3-5 participants and ten individual faculty participants were conducted via interviews held on Zoom. Each participant answered questions from a semi-structured interview guide surrounding how COVID-19 impacted their experiences as students and faculty in a DPT program. Results of this study surrounding the grounded theory of Resilience in Students and Faculty during COVID-19 contained three major categories: Prioritizing Mental and Physical Health, Adaptation of Teaching and Learning Styles, and Enhanced Non-academic Expectations Between Students and Faculty. The results of the study suggest the need for measuring and developing shared resilience in DPT students and faculty in order to create a positive program environment and experience.
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    Measurement of shoulder range of motion, video analysis of pitching, and comparison of shoulder treatments in high-school baseball pitchers with and without shoulder pain
    (2022-04-01) Arthur, Andrew; Mitchell, Katy
    Purpose: The purpose of this study was to evaluate shoulder range of motion, throwing biomechanical differences, and treatment protocols for high school baseball pitchers with and without the presence of throwing-related shoulder pain. Participants: Eighty participants were assessed for shoulder range of motion, 78 for baseball pitching biomechanics, and 38 completed a two-week treatment protocol. Methods: The participants with signed informed consent that met criteria were taken through passive shoulder range of motion measurements for internal and external rotation in the 90/90 position, and video analysis of throwing to measure maximum external rotation, trunk rotation timing, and trunk flexion. The participants reporting the presence of throwing-related shoulder pain were placed in one of four treatment protocols: 1. Self-stretching, 2. Posterior mobilization of the shoulder and manual stretching by a physical therapist, 3. The same treatment as protocol two with the addition of three throwing drills, 4. Only the three throwing drills. Data analysis was performed with SPSS statistical software version 25. A point-biserial correlation and independent samples t-test were run to determine if a relationship existed between shoulder range of motion and the presence of throwing-related shoulder pain. An independent samples t-test was run to determine if there was a difference in throwing mechanics between participants with and without the presence of throwing-related shoulder pain. A split-plot ANOVA was run to determine within subject differences for pre and post measurements and between subject differences for the four treatment groups. Results: This study found that participants reporting the presence of throwing-related shoulder pain had less internal rotation in the 90/90 position. This study also found no differences in baseball pitching biomechanics between high school baseball pitchers with and without the presence of throwing-related shoulder pain. The results of the treatment protocols showed improvement of GIRD, no change in pitching biomechanics, and reduction of pain level in protocols 1-4. Conclusion: GIRD was found in a group of high school baseball pitchers with throwing-related shoulder pain. Treatment with self-stretches and manual therapy showed significant improvement in GIRD and shoulder pain level.
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    Hand range of motion, strength, dexterity, and pain as predictors of hand functional performance
    (2002-12) Mitchell, Ann Elizabeth Burkard; Smith, Sue
    Purposes of this study were to determine (a) thresholds for the resources of range of motion (ROM), strength, dexterity, and pain in specific functional task performance in persons with diseased or injured hands using Nonlinear Causal Resource Analysis; (b) resources limiting performance; and (c) whether changes in resources would predict changes in performance. Twenty-one subjects were measured for hand ROM, grip and pinch strength, dexterity, pain, and self-reported performance of meal preparation and feeding, toileting, and dressing and grooming. Data were used to model resources required for performance and predict levels of performance. Twelve subjects were retested on the same variables, and the model developed initially was tested. Thresholds of performance and limiting resources were identified, and levels of task performance were predicted. In conclusion, results of this study suggest that this model may help clinicians identify limiting resources and predict task performance in individual patients with varied hand dysfunctions.
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    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.