BACKGROUND: Clinical investigation of shoulder injuries commonly utilizes visual evaluation of scapular movement to determine if abnormal or asymmetrical movements are related to the injury. To date, the intrarater reliability and diagnostic accuracy of visual evaluation of scapular movement among physical therapists are not known. PURPOSE: The aims of this study were to determine the clinical reliability and diagnostic accuracy of physical therapists visual evaluation of scapulohumeral movements when used to diagnose shoulder impairment. STUDY DESIGN: University based laboratory and an internet based survey. METHODS: Thirty-three physical therapists and 12 patient participants participated in this study. Reliability was measured as percent agreement and using the free marginal kappa statistic (κ) and Cronbach's alpha (α) for interrater and intrarater reliability respectively. Diagnostic accuracy variables such as sensitivity, specificity, likelihood ratios were calculated from contingency table analysis. RESULTS: Visual evaluation yielded the following (95% CI): diagnostic accuracy 49.5%, specificity 60% (56 - 64), and sensitivity 35% (29 - 41), positive and negative likelihood ratios were 0.87 (0.66 - 1.14) and 1.09 (0.92 - 1.27) respectively. Percent agreements of evaluation findings between sessions for static and dynamic symmetry were 69% and 68%, respectively. The alpha statistics for static and dynamic symmetry were both 0.51. Percentage agreement in determining the injured shoulder was 59%, with an alpha statistic of 0.35. CONCLUSION: Visual evaluation of scapular movements, without additional clinical information, demonstrated a poor to fair reliability and poor to fair diagnostic accuracy. CLINICAL RELEVANCE: The clinical utility of the use of isolated visual scapular evaluation is cautioned. More reliable and valid objective measures are needed for diagnosing shoulder impairment. LEVEL OF EVIDENCE: 2b, Exploratory cohort study.

Background and objectives: Research on in utero opioid exposure impacts has focused on Neonatal Opioid Withdrawal Syndrome (NOWS). However, possible impacts on fetal growth and newborn wellbeing have emerged, with inconsistencies likely driven by methodological issues. Our goal was to compare birth outcomes between newborns with prenatal opioid exposure and a matched control group. Methods: Participants were identified via manual review of electronic medical records of all deliveries over five years within a regional health system (6 delivery hospitals across 2 states). From over 18,000 births, 300 with prenatal opioid exposure and 300 control newborns matched on exposure, medical, and background factors were included. Additional factors were statistically controlled. Outcomes included pregnancy/delivery complications, newborn size, and newborn health complications. Results: Compared to biochemically verified controls, exposed newborns had higher rates of fetal growth restriction, weighed less, had decreased length and head circumference, and had higher rates of respiratory distress, sepsis, and jaundice. No significant differences in gestational length, Apgar scores, or neonatal hypoglycemia were found. Adjusted regression analyses revealed that compared to controls, those exposed had an average 150 g decrease in birth weight, a two-fold increased risk for IUGR (OR = 2.09), a nearly three-fold (OR = 2.80) increased risk for jaundice, a more than seven-fold (OR = 7.40) increased risk for respiratory distress, and a thirty-fold (OR = 30.47) increased risk for sepsis. Conclusions: Results suggest significant pregnancy and newborn outcomes beyond NOWS following pregnancy opioid use, informing clinical screening and treatment decisions to enhance health and wellbeing in pregnancy, during the neonatal period, and beyond.

Um die Effektivität der Sporttherapie insbesondere im Rahmen der medizinischen Trainingstherapie zu erhöhen, müssen nach Sportverletzungen wie die vordere Kreuzbandruptur besondere Anforderungen an die Therapie gesetzt werden. Gründe sind die vom Kostenträger determinierte Rehabilitationszeit und eine anzustrebende komplikationslose sportliche Aktivität nach der Rehabilitation des Sportlers. Eine mögliche Alternative stellen offene kinetische Systeme dar. Diesen wird jedoch eine zu hohe Beanspruchung für das frische Transplantat unterstellt. Ziel war es, die Wirkung des offenen und des geschlossenen Systems im rehabilitativen Krafttraining an Patienten nach VKP zu untersuchen. Dazu wurden 34 Patienten (Alter 30 ± 9,9 Jahre, Gewicht 75,9 ± 13,2 kg, Größe 178,5 ± 5,5 cm) in eine randomisiert zweischenklige Trainingsstudie unter realen klinischen Bedingungen eingeschlossen (N=17 je Gruppe). Zur Überprüfung der Wirkung der Trainingstherapie wurden ein Isokinet (120°/s), Lachmanntest mittels Rolimeter sowie manuelle Umfangsmessungen jeweils vor und am Ende der Rehabilitation eingesetzt. Die Ergebnisse zeigten signifikanten Kraftzunahmen der Knie-Extensoren und Flexoren (p<0,05) in beiden Gruppen. Zwischen beiden Gruppen lagen keine signifikanten Unterschiede im Ausmaß der Entwicklung der Kraftfähigkeiten vor (p>0,05). Die vorderen Schubladen blieben bei beiden Trainingsgruppen unverändert (p>0,05). Die Befunde zeigen, dass möglicherweise das offene kinetische System im rehabilitativen Krafttraining eine sinnvolle Ergänzung darstellen kann. / To increase the effectiveness of sports therapy particularly in the context of medical training therapy, must be put in the treatment of sports injuries such as anterior cruciate ligament special requirements. Reasons are the cost of carrier-determined rehabilitation time and a desirable complication-free sporting activity for the rehabilitation of the athlete. A possible alternative are open kinetic systems but it is deemed too high a load for the fresh graft assumed. The aim, the effect of the open and the closed system was examined in the rehabilitative strength training in patients after retail price. These were 34 patients (age 30 ± 9.9 years, weight 75.9 ± 13.2 kg, 178.5 ± 5.5 cm size) were enrolled in a randomized study with two groups under real clinical conditions. To check the effects of exercise therapy were used with an isokinetic (120 ° / s), Lachmann test using Rolimeter and manual volume measurements before and at the end of rehabilitation. The results showed significant increases in strength of knee extensors and flexors (p <0.05) in both groups. Between two groups were not significantly different in the degree of development of strength abilities before (p> 0.05). The laxity of LCA remained unchanged in both training groups (p> 0.05). The findings show that potentially, the open kinetic system in rehabilitative strength training be a useful addition.

This text is a complete team-based and project-based learning course focused on the application of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) to unique groups of program clients and patients. It is designed to engage undergraduate students in exploration of the different facets of the ICF, in how the ICF differs from medical and social models because of these facets, and how each applies to, and ensures, an awareness of all of the ways in which health affects and is affected by peoples’ characteristics and environments. The text includes readings, digital links, readiness assurance elements, and guidelines for individual and team deliverables, but can also be used as a stand-alone text to provide a rich constructivist approach to understanding the structure of the ICF and how to use it for problem solving and decision-making with a patient/client population. It is the author’s intention that the text be used as suits the instructor, and modified to fit the pre-professional or paraprofessional healthcare students being taught, so while case study examples for rehabilitation are include, the text will lend itself to any patient or client group. / https://dc.etsu.edu/etsu-oer/1008/thumbnail.jpg

Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences for students by partnering with the College of Pharmacy, the College of Clinical and Rehabilitative Health Sciences, and the local public housing authority. Select faculty from each college met and developed a plan to form student teams from all three colleges to conduct in-home comprehensive medical and nutrition assessments and medication chart reviews of high-risk older adults. Following the in-home visit, students and faculty discuss the assessment findings at planned interprofessional meetings. Students present their findings from each discipline's perspective and collaboratively set health priorities and develop intervention strategies and an inclusive follow-up plan. Excerpts from students' reflective narratives discussing the impact of the interprofessional service-learning experiences are shared.

Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences for students by partnering with the College of Pharmacy, the College of Clinical and Rehabilitative Health Sciences, and the local public housing authority. Select faculty from each college met and developed a plan to form student teams from all three colleges to conduct in-home comprehensive medical and nutrition assessments and medication chart reviews of high-risk older adults. Following the in-home visit, students and faculty discuss the assessment findings at planned interprofessional meetings. Students present their findings from each discipline's perspective and collaboratively set health priorities and develop intervention strategies and an inclusive follow-up plan. Excerpts from students' reflective narratives discussing the impact of the interprofessional service-learning experiences are shared.

Introduction: Identifying patients at risk for chronic musculoskeletal pain can inform evaluation and treatment decisions. The ability of physical therapists to assess patients’ risk for chronic pain without use of validated tools has been questioned. The Ӧrebro Musculoskeletal Pain Questionnaire (OMPQ) is used to determine risk for chronic pain. Methods: The aim of this pragmatic study was to prospectively quantify the agreement between physical therapists’ assessment of patients’ risk for chronic symptoms compared to the OMPQ. Patients were asked to complete the OMPQ during the initial visit. Physical therapists, blinded to OMPQ risk classification, carried out their usual patient assessment procedures. The physical therapists rated patients as either high or low risk for chronic pain based on their clinical assessment. Agreement between therapist and OMPQ was determined using Cohen’s Kappa (κ) and screening accuracy compared clinician risk to the OMPQ risk classification (reference standard) by way of contingency table analysis. Results: Ninety-six (96) patients’ risk classifications and 15 corresponding physical therapists’ risk estimates were available for analysis. The OMPQ identified a 47% prevalence for high risk of chronic pain. Agreement (κ and 95% confidence interval) between physical therapist rating and OMPQ was slight, κ = 0.272 (0.033–0.421), p = .026. Therapists’ sensitivity and specificity (95% CI) for determining risk classifications were 60.0% (44.3–74.3) and 62.8% (48.1–75.6), respectively. The positive and negative likelihood ratios (95% CI) were 1.61 (1.05–2.47) and 0.64 (0.42–0.97). Discussion: The use of validated self-report questionnaires are recommended to supplement clinician prognosis for patients at risk of chronic musculoskeletal pain.

Introduction: Entry-level physical therapist education on pain has been described as lacking. Calls have been made to include pain science courses to address this knowledge gap. Methods: Physical therapist students’ pain knowledge and attitudes were measured using the revised Neurophysiology of Pain Questionnaire (rNPQ) and Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), respectively. Univariate ANOVAs, with post hoc pairwise comparison and effect sizes, were used to measure these aspects over time. Results: Pain knowledge and clinician beliefs were significantly different (p < 0.001) at various curricular timepoints. rNPQ scores increased from 1st to 2nd year (effect size: 1.10), remained similar between years 2 and 3, and improved following the pain course (effect size: 1.25). Biomedical beliefs were similar during years 1, 2 and 3, and declined following the pain course (effect size: 1.56). Conversely, psychosocial belief scores increased from 1st to 2nd year (effect size: 0.82), remained similar between years 2 and 3, and increased following the pain course (effect size: 1.08). Discussion/Conclusions: Physical therapist education, without a dedicated pain science course, may be insufficiently preparing students to treat patients in pain. Educators should consider adopting a dedicated pain science course or substantially bolstering embedded curricular pain content to promote best practice in pain treatment.

Objectives: To determine the beliefs and describe the health care experiences of patients with complex regional pain syndrome. Methods: A survey tool for patients with complex regional pain syndrome was designed for this study. The survey tool collected self-reported measures associated with pain, disability, health care experiences, education, beliefs, and treatments. Results: Thirty-one patients attending physical therapy for complex regional pain syndrome (mean age 40.48; female n = 20) completed the survey. Patients with presented with high levels of pain and disability and reported various changes associated with altered neuroplasticity such as confused body part recognition, left/right discrimination, neglect, and spreading pain. The patients’ experiences with diagnostic testing and interventions are not in line with the current pain science research and/or evidence-based practice. Overall, patients are ill-informed, confused, and receive conflicting information. Discussion: The suffering associated with complex regional pain syndrome is real, as told by patients. This suffering coincides with a lack of consensus by health care providers and conflicting information on complex regional pain syndrome. Overall, patient experiences show health care providers are not up to date with the current best-evidence regarding complex regional pain syndrome.

Background: Left/right judgment (LRJ) measurement is a potential way to identify dysfunction in cortical body maps, and to measure improvement related to corresponding treatments. Few studies have explored the reliability of various methods for LRJ measurement. Objectives: To determine measurement reliability of LRJ utilizing two methods: card-based (CB) and tablet-based (TB). Establish minimal detectable difference (MDD) for accuracy and reaction time for both assessments. Methods: Testing was done over two different days. Session 1 consisted of testing LRJ utilizing CB assessment with photos of left and right hands over two trial periods. The TB format was also tested over two trial periods. Session 2 tested with the CB assessment for two trial periods. 40 images were used in the basic upright position for both CB and TB formats. Results: Fifty participants (N = 50; female = 35) with an average age of 24.3 (range 19–35) were studied. ICC (2,k) for reaction time for both methods were >0.84. The MDD for reaction time was between 0.19 and 0.49 s for various test points for both methods. Combined left and right accuracy ICC (2,k) for both methods were >0.51, with MDD between 5 and 14%. Conclusions: This study examined the reliability and MDD for the LRJ measurement for card and tablet-based assessments. Generally, LRJ reaction time had good reliability, while accuracy had moderate reliability and varied between testing methods.