Cost Outcomes of Physical Therapist Providers Compared to Primary Care Providers in the Treatment of Musculoskeletal Patients in a Military Treatment Facility: A Retrospective Chart Review”

Purpose: The purpose of this study was to compare the cost of physical therapist (PT) management of patients with musculoskeletal (MSK) disorders to management by traditional primary care managers (PCMs); medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods: This is a retrospective study of electronic medical records using an exploratory, non-experimental, cross-sectional, and quantitative design method. The records of patients with MSK disorders were assessed at an Air Force military medical clinic for 18 months from January 2016 through June 2017. Results: PT management of MSK patients resulted in a significantly lower rate of imaging studies, NSAIDS, and cost of care when compared to MDs, DOs, PAs, or ARNPs. Patients with MSK disorders managed by PTs had no significant difference in return-to-work rate when compared to MDs, DOs, PAs, or ARNPs. Conclusions:The military model of physical therapy direct access care has been shown to be cost effective when compared to care provided by traditional primary care managers

Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia

STUDY DESIGN: Descriptive, cross-sectional. OBJECTIVES: To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. BACKGROUND: There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. METHODS: Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (SIP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. RESULTS: The SIP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The SIP group had weaker lower trapezius strength (mean difference, -9.0 N; 95% confidence interval [CI]: -13.5, -4.4) and wrist extensor strength (-12.7 N; 95% CI: -24.4, -1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the SIP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). CONCLUSION: In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest

Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals

# Background Mechanical percussion devices have become popular among sports medicine professionals. These devices provide a similar effect as manual percussion or tapotement used in therapeutic massage. To date, there are few published studies or evidence-based guidelines for these devices. There is a need to understand what professionals believe about this technology and how they use these devices in clinical practice. # Purpose To survey and document the knowledge, clinical application methods, and use of mechanical percussion devices among healthcare professionals in the United States. # Design Cross-sectional survey study. # Methods A 25 question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. # Results Four hundred twenty-five professionals completed the survey. Most professionals (92%, n=391) used devices from two manufacturers: Hyperice® and Theragun®. Seventy-seven percent directed clients to manufacturer and generic websites (n=329) to purchase devices. Most respondents used a medium and low device speed setting for pre- and post-exercise (62%, n=185), pain modulation (59%, n=253), and myofascial mobility (52%, n=222). A large proportion of respondents preferred a total treatment time between 30 seconds and three minutes (36-48%, n=153-204) or three to five minutes (18-22%, n=76-93). Most respondents (54-69%, n=229-293) believed that mechanical percussion increases local blood flow, modulates pain, enhances myofascial mobility, and reduces myofascial restrictions. Most respondents (72%, n=305) were influenced by other colleagues to use these devices. Sixty-six percent used patient reported outcomes (n=280) to document treatment efficacy. Live instruction was the most common mode of education (79%, n=334). # Conclusion These results are a starting point for future research and provide insight into how professionals use mechanical percussion devices. This survey also highlights the existing gap between research and practice. Future research should examine the efficacy of this technology and determine consensus-based guidelines. # Level of Evidence

The Efficacy and Treatment Fidelity of Kinesiology Taping in Conjunction With Conservative Treatment Interventions Among Individuals With Shoulder Pain: A Systematic Review with Meta-Analysis

# Purpose Kinesiology taping is a common intervention used to treat individuals with shoulder pain. While there have been several studies published to date evaluating the effectiveness of this intervention, a systematic review with meta-analysis synthesizing the collective effectiveness of kinesiology taping is not available. Therefore, the purpose of this study was to perform a systematic review with meta-analysis investigating the efficacy and treatment fidelity of kinesiology taping (KT) in combination with conservative interventions for shoulder pain. # Methods Databases (PubMed, EMBASE, SportDiscus, CINAHL) of studies published in English meeting criteria were searched to October 2019. Methodologic quality was assessed utilizing the Modified Downs and Black checklist. Treatment fidelity was evaluated using a modified fidelity tool. Random effects meta-analyses were performed when an outcome (disability, pain, range of motion (ROM)) was reported by two or more studies. Overall effect size (pooled random effects) was estimated for studies with acceptable clinical homogeneity. # Results When KT was used with conservative treatments, meta-analysis revealed large effect sizes for improvements in disability (standard mean difference (SMD) = -1.35; 95% CI, -2.09 to -0.60) and ROM (SMD = 0.96; 95% CI, 0.60-1.33) with no significant effects for pain. The average Modified Downs & Black score for bias was 11.5 ± 3.9. Of 10 retained studies, only two had good treatment fidelity. # Conclusions Adding KT to interventions performed in clinical settings appears to demonstrate efficacy regarding disability and ROM when compared to conservative interventions alone. However, despite reasonably good methodologic quality, fidelity was lacking in a majority of studies. Because of its impact on the implementation of evidence-based practice, lower fidelity should be considered when interpreting results

Shoulder joint and muscle characteristics in the recreational weight training population

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy]

Hip Osteoarthrosis

https://nsuworks.nova.edu/hpd_pt_facbooks/1001/thumbnail.jp

The Interrater Reliability of the Load and Shift Test for Anterior Shoulder Instability: A Technical Report

Background: Shoulder disorders affect up to 67% of the adult population at some point in their lifetime. The shoulder complex ranks third, trailing low back and neck pain, in musculoskeletal disorders for which individuals seek physical rehabilitation. The assessment of shoulder stability is an integral component of the patient examination, as it may assist the clinician in making a diagnosis, measuring improvement or deterioration, and determining functional impairments. Reliable tests and measurements are therefore essential to both the clinician and researcher desiring to objectively monitor disease progression, outcomes, and mobility impairments. Many of the currently used clinical tests for anterior instability are documented based on a dichotomous outcome, thus do not provide a means of quantifying or ranking the degree of anterior translation associated with the instability. The load and shift test has been described in textbooks and research investigations as a method to quantify (rank) anterior shoulder instability and/or translation at the glenohumeral joint. This test is attractive clinically, as it requires no special equipment or space, thus may be utilized in multiple settings and without cost; however, few studies have investigated the interrater reliability of this test. Purpose: The purpose of this investigation was to determine the interrater reliability of the seated load and shift test using a 4-level grading criteria. Method: Two investigators performed the load and shift test on the non-dominant shoulder of 29 asymptomatic female participants in a repeated measures intrasession design. Each investigator was blinded to the results and the order of testing was counterbalanced to minimize potential bias. Results: Results indicated good interrater reliability with an Intraclass Correlation Coefficient (2, 1) (95% CI) = 0.80 (0.61, 0.90). Conclusion: The load and shift test appears to be a reliable clinical test for detecting and quantifying anterior translation of the glenohumeral joint when using the grading criteria outlined in this investigation. Shoulder translation when excessive is associated with shoulder instability, thus this test may prove valuable as a measurement of anterior instability. Recommendations: Future investigations are needed to determine the reliability and validity of this test among a symptomatic population and including a male cohort

Addressing Hamstring Flexibility in Athletes With Lower Back Pain: A Discussion of Commonly Prescribed Stretching Exercises

summary: Methods used to achieve hamstring flexibility may require modification in the athlete with discogenic lower back pain. Maintaining a natural lumbar lordosis with an anterior pelvic tilt during stretching facilitates the most efficient flexibility gains and protects the intervertebral disc from undue stress