Predictors of Functional Disability in Patients Undergoing Anterior Cruciate Ligament Reconstruction

Purpose: The primary purpose of this study was to identify the patient-centric factors that contribute to functional disability in patients undergoing ACL reconstruction, in an effort to help guide patient selection, counseling, and optimal timing of surgery. Methods: All patients undergoing ACL reconstruction by two fellowship-trained sports medicine surgeons from July 2017 to September 2018 were included.Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores for physical function (PROMIS-PF), pain interference (PROMIS-PI), and depression (PROMIS-D) were recorded, as were patient demographic data. The correlation between psychosocial, demographic, and functional outcomes was then analyzed. Results: There were 145 patients (mean age 27 ± 11, 92 males) included in this review. There was a wide range of PROMIS-PF scores (23.2-61.7), PROMIS-PI scores (38.7-78.4), and PROMIS-D scores (34.2-78.1). Preoperative PROMIS-PF scores were negatively correlated with PROMIS-PI (p \u3c0.001), PROMIS-D (p \u3c0.001), and BMI (p = 0.024). Patients who attended physical therapy reported higher preoperative PROMIS-PF scores (p = 0.050), and patients with concomitant meniscal tears on MRI reported lower PROMIS-PF scores (p = 0.044). There was no association found between PROMIS-PF scores and age, sex, smoking status, or median household income. Conclusion: This study demonstrated that depression and pain, measured by PROMIS-D and PROMIS-PI, respectively, were correlated with decreased functional outcomes, measured by PROMIS-PF, in patients undergoing ACL reconstruction. Increased BMI and the presence of meniscal tears negatively influenced functional outcomes. Patients who attended physical therapy before surgery reported increased functional outcomes. PROMIS-PF scores varied widely in patients undergoing ACL reconstruction, and some patients with high scores may be less likely to improve following surgery. Our results lend to a greater understanding of the patient factors that influence PROMIS scores and suggest weight reduction and physical therapy as interventions to improve preoperative function.https://scholarlycommons.henryford.com/merf2019clinres/1019/thumbnail.jp

Preoperative PROMIS Scores Predict Postoperative Improvements Following Rotator Cuff Repair

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has emerged as a valid and efficient means of collecting patient outcomes in patients with rotator cuff tear. The purpose of this study was to examine the role of pre-operative PROMIS computer adaptive test (CAT) scores in predicting post-operative PROMIS CAT scores as well as likelihood of achieving minimal clinically important difference (MCID) following rotator cuff repair. We hypothesize that pre-operative PROMIS CAT scores will directly impact both post-operative PROMIS CAT scores and likelihood of achieving MCID.Methods: Patients undergoing arthroscopic rotator cuff repair by one of three fellowship-trained surgeons were identified over a 12-month period. Only patients that completed pre-operative and 6-month post-operative PROMIS CAT assessments were included in this cohort. PROMIS CAT forms for upper extremity physical function (PROMIS-U), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. MCID was calculated according to the distribution methodology, and receiver operating characteristics (ROC) were utilized to determine if pre-operative scores were predictive of post-operative outcomes. Preoperative cutoffs were used to predict which patients would likely meet MCID using 95% specificity. Results: A total of 80 patients met our inclusion criteria. PROMIS-UE, PROMIS-PI and PROMIS-D improved 6 months after surgery (p\u3c0.001). 76% of patients met MCID for PROMIS-UE, while 89% met MCID for PROMIS-PI, and 54% met MCID for PROMIS-D. Preoperative PROMIS scores were predictive of post-operative outcomes based on ROC analysis which demonstrated significant area under the curve (AUC) of .725 (p=0.003), .757 (p=0.013), and .789 (p\u3c0.001) for PROMIS-UE, PROMIS-PI, and PROMIS-D, respectively. Individuals with PROMIS-UE scores below 24.95 and PROMIS-PI scores above 65.65 yielded a 100% probability of achieving MCID, while a cutoff of 56.45 for PROMIS-D yielded a 91% probability of achieving MCID with 95% specificity. Conclusion: Patients undergoing arthroscopic rotator cuff repair experience significant improvements in upper extremity physical function, pain interference and depression as measured by PROMIS CAT domains. In particular, patients presenting with PROMIS upper extremity scores of \u3c24.95 are especially likely to achieve MCID.https://scholarlycommons.henryford.com/merf2019clinres/1053/thumbnail.jp

Brief Intervention for Truant Youth Sexual Risk Behavior and Alcohol Use: A Parallel Process Growth Model Analysis

Truant youths frequently experience family problems, emotional/psychological issues, substance misuse, and delinquency. They are likely engaging in alcohol use and sexual risk behavior at a higher rate than the general youth population. Early intervention services would benefit them, their families, and society. We present interim findings from an ongoing, National Institute on Drug Abuse-funded, experimental, brief intervention (BI) study involving truant youths and their parent/guardians. Baseline, 3-, 6-, and 12-month follow-up data were analyzed to determine whether alcohol use and sexual risk behaviors were longitudinally related, to examine the effects of the BI on alcohol use and sexual risk behaviors, to identify subgroups of youths involved in alcohol use and sexual risk behaviors, and to assess the impact of the BI on these subgroups. Results indicated alcohol use and sexual risk were longitudinally related. Limited treatment effects were observed for alcohol use. Implications for future research and service delivery are considered. © 2014 Copyright Taylor & Francis Group, LLC

Brief Intervention for Truant Youth Sexual Risk Behavior and Marijuana Use

Substance use and sexual risk behaviors are common among adolescents, but research has focused attention on alcohol use. Much less is known about the relationship of marijuana use and sexual risk behavior among high-risk, especially truant, youths. We report interim findings from a NIDA-funded experimental, brief intervention (BI) study involving truant youths and their parents/guardians. Longitudinal data were analyzed to study (1) the relationships between the youths\u27 marijuana use and sexual risk behavior and (2) the effects of a substance use BI on their marijuana use and sexual risk behavior. A growth model analysis for parallel processes was conducted to study relationships between marijuana use and sexual risk behavior, and to assess the overall BI effect on linear and quadratic trends in subgroups of youth differing in their sexual risk behavior and marijuana use. Implications of the results for future research and service delivery are considered. © 2014 Copyright Taylor & Francis Group, LLC

Emotional Psychological and Related Problems Among Truant Youths: An Exploratory Latent Class Analysis

Latent class analysis was conducted on the psychosocial problems experienced by truant youths. Data were obtained from baseline interviews completed on 131 youths and their parents/guardians involved in a NIDA-funded, Brief Intervention Project. Results identified two classes of youths: Class 1(n=9) - youths with low levels of delinquency, mental health and substance abuse issues; and Class 2(n=37) - youths with high levels of these problems. Comparison of these two classes on their urine analysis test results and parent/guardian reports of traumatic events found significant (p\u3c.05) differences between them that were consistent with their problem group classification. Our results have important implications for research and practice

Brief Intervention for Truant Youth Sexual Risk Behavior and Marijuana Use

Substance use and sexual risk behaviors are common among adolescents, but research has focused attention on alcohol use. Much less is known about the relationship of marijuana use and sexual risk behavior among high-risk, especially truant, youths. We report interim findings from a NIDA-funded experimental, brief intervention (BI) study involving truant youths and their parents/guardians. Longitudinal data were analyzed to study (1) the relationships between the youths\u27 marijuana use and sexual risk behavior and (2) the effects of a substance use BI on their marijuana use and sexual risk behavior. A growth model analysis for parallel processes was conducted to study relationships between marijuana use and sexual risk behavior, and to assess the overall BI effect on linear and quadratic trends in subgroups of youth differing in their sexual risk behavior and marijuana use. Implications of the results for future research and service delivery are considered. © 2014 Copyright Taylor & Francis Group, LLC

The Effect of the Crow Hop on Elbow Stress During an Interval Throwing Program

BACKGROUND: Postoperative rehabilitation protocols after ulnar collateral ligament (UCL) reconstruction typically involve a structured interval throwing program. In an effort to minimize torque placed on the UCL, athletes are often instructed to throw with a crow hop, even at short throwing distances. However, the effect of the crow hop on medial elbow stress is unknown. PURPOSE/HYPOTHESIS: The purpose was to determine whether elbow stress differs with and without a crow hop across the throwing distances of a typical interval throwing program. We hypothesized that crow hop throws would generate lower torque on the elbow than standing throws at each distance of the interval throwing program. STUDY DESIGN: Controlled laboratory study. METHODS: Healthy high school and collegiate pitchers and position players were recruited from the surrounding area. Each player was outfitted with a wearable athletic sleeve and device that recorded elbow torque (Newton-meters), arm slot (degrees), arm speed (revolutions per minute), and shoulder rotation (degrees). Ball velocity (miles per hour) was measured using a radar gun. Players were instructed to perform 3 crow hop throws and 3 standing throws at distances of 30, 45, 60, 90, 120, 150, and 180 feet. A repeated measures analysis of variance was used to compare ball velocity, elbow torque, arm slot, arm speed, and shoulder rotation between crow hop and standing throws at each throwing distance. RESULTS: Twenty athletes participated in this study (average age, 17.8 years; range, 15-25 years). The average medial elbow torque increased at each distance for both crow hop and standing throws at distances of 30, 45, 60, and 90 feet (P \u3c .05), after which there were no significant increases in elbow torque (P \u3e .05). The average torque was higher for crow hop throws than standing throws at distances of 30 feet (13.9 N·m vs 12.0 N·m; P = .002), 45 feet (21.8 N·m vs 19.3 N·m; P = .005), and 60 feet (28.0 N·m vs 24.5 N·m; P = .02). CONCLUSION: Crow hop throws generated greater medial elbow torque than standing throws at distances up to 60 feet; however, there were no differences in elbow torque at distances greater than 60 feet between the 2 throw types. For both crow hop and standing throws, elbow stress increased at each distance interval up to 90 feet before plateauing at distances greater than 90 feet. The crow hop throwing technique does not reduce medial elbow stress during a simulated interval throwing program, and it may actually increase torque at shorter throwing distances. CLINICAL RELEVANCE: The results of our study indicate that it would be prudent for players to initially perform standing throws at shorter distances and only later be allowed to employ a natural crow hop at greater distances to minimize torque placed on the medial elbow during UCL rehabilitation protocols

Optimization principles of dendritic structure

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