Detecting Artificial Intelligence-Generated Personal Statements in Professional Physical Therapist Education Program Applications: A Lexical Analysis

OBJECTIVE

The objective of this study was to compare the lexical sophistication of personal statements submitted by professional physical therapist education program applicants with those generated by OpenAI's Chat Generative Pretrained Transformer (ChatGPT).

METHODS

Personal statements from 152 applicants and 20 generated by ChatGPT were collected, all in response to a standardized prompt. These statements were coded numerically, then analyzed with recurrence quantification analyses (RQAs). RQA indices including recurrence, determinism, max line, mean line, and entropy were compared with t-tests. A receiver operating characteristic curve analysis was used to examine discriminative validity of RQA indices to distinguish between ChatGPT and human-generated personal statements.

RESULTS

ChatGPT-generated personal statements exhibited higher recurrence, determinism, mean line, and entropy values than did human-generated personal statements. The strongest discriminator was a 13.04% determinism rate, which differentiated ChatGPT from human-generated writing samples with 70% sensitivity and 91.4% specificity (positive likelihood ratio = 8.14). Personal statements with determinism rates exceeding 13% were 8 times more likely to have been ChatGPT than human generated.

CONCLUSION

Although RQA can distinguish artificial intelligence (AI)-generated text from human-generated text, it is not absolute. Thus, AI introduces additional challenges to the authenticity and utility of personal statements. Admissions committees along with organizations providing guidelines in professional physical therapist education program admissions should reevaluate the role of personal statements in applications.

IMPACT

As AI-driven chatbots like ChatGPT complicate the evaluation of personal statements, RQA emerges as a potential tool for admissions committees to detect AI-generated statements.

Acute effects of an isometric neck warm-up programme on neck performance characteristics and ultrasound-based morphology

OBJECTIVE

Athletic performance can be enhanced immediately after an isometric warm-up, a phenomenon termed post-activation performance enhancement (PAPE). While isometric warm-ups can improve lower extremity sprint and jump performance, neck-specific isometric warm-ups need development and validation for mild traumatic brain disorders and neck pain. This study examined acute effects of isometric warm-ups on neck performance and morphology.

METHODS

Arm 1: Twenty-six adults (13 M:13F) completed neck performance testing before and after a 10-minute neck isometric warm-up or stationary bike (sham) between two visits. Testing included visual-motor reaction time, peak force, rate of force development, force steadiness, and force replication/proprioception measured by a 6-axis load cell. An inclinometer assessed range-of-motion. Paired t-tests and two-way ANOVA examined effects of neck/bike warm-up and interaction effects, respectively. Arm 2: 24 adults (11 M:13F) completed ultrasound scans of cervical muscles: before 20-minute rest (sham), and before/after a 5-min neck isometric warm-up. Longus colli cross-sectional area and sternocleidomastoid/upper trapezius thickness and stiffness, and cervical extensors thickness was assessed. One-way ANOVA compared morphological values at sham, before, and after warm-up. Significance was set at p < 0.05.

RESULTS

Isometric neck warm-up increased rate of force development in flexion (p = 0.022), extension (p = 0.001-0.003), right lateral flexion (p = 0.004-0.032), left lateral flexion (p = 0.005-0.014), while peak force improved only in left lateral flexion (p = 0.032). Lateral flexion range-of-motion increased after neck warm-up (p = 0.003-0.026). Similarly, longus colli cross-sectional area (p = 0.016) and sternocleidomastoid thickness (p = 0.004) increased.

CONCLUSIONS

Increased neck performance characteristics and morphology are likely due to PAPE effects of isometric neck warm-up. For coaches and athletes, simple isometric contractions could be added to existing warm-ups to reduce prevalence, incidence, and severity of mild traumatic brain injuries and neck pain.

Recurrence quantification analysis of isokinetic strength tests: A comparison of the anterior cruciate ligament reconstructed and the uninjured limb

BACKGROUND

Despite widespread use of return to sport testing following anterior cruciate ligament reconstruction, studies suggest inadequacy in current testing criteria, such as limb symmetry index calculations, to determine athletes' readiness to return to play. Recurrence quantification analysis, an emerging non-linear data analysis tool, may reveal subtle neuromuscular differences between the injured and uninjured limb that are not captured by traditional testing. We hypothesized that isokinetic torque curve data of the injured limb would demonstrate lower determinism and entropy as compared to the uninjured limb.

METHODS

102 patients (44 M, 58F, 10 ± 1 months post-anterior cruciate ligament reconstruction) underwent isokinetic quadriceps strength testing using a HumacNorm dynamometer. Patients completed maximum effort knee extension and flexion at 60°/sec. Data were post-processed with a MATLAB CRQA Graphical User Interface and determinism and entropy values were extracted. Paired-sample t-tests (α = 0.05) were used to compare data from the injured and uninjured limb.

FINDINGS

Determinism and entropy values in the torque curves were lower in the injured limb than the uninjured limb (p < 0.001). Our findings indicate there is less predictability and complexity present in the torque signals of injured limbs.

INTERPRETATION

Recurrence quantification analysis can be used to assess neuromuscular differences between limbs in patients who have undergone anterior cruciate ligament reconstruction. Our findings offer further evidence that there are changes to the neuromuscular system which persist following reconstruction. Further investigation is needed to establish thresholds of determinism and entropy values needed for safe return to sport and to evaluate the utility of recurrence quantification analysis as a return to sport criterion.

Machine Learning in Admissions?: Use of Chi-Square Automatic Interaction Detection (CHAID) to Predict Matriculants to Physical Therapy School

PURPOSE

Machine learning algorithms provide methods by which patterns in admissions data may be discovered that predict admissions yields in education programs. We used a chi-square automatic interaction detection (CHAID) analysis to examine characteristics that predict applicants most likely to matriculate into a physical therapy program after being admitted.

METHODS

Data from applicants admitted to our physical therapy program from the 2015-2016 through 2021-2022 admissions cycles were evaluated (n=413). Variables included applicants' ages, grade point averages, graduate record examination (GRE) scores, admissions and behavioral interview scores, sex/gender, race/ethnicity, home state classification, undergraduate major classification, institutional classification, socioeconomic status, and first generation to college status. A CHAID algorithm identified which variables predicted matriculation after being admitted.

RESULTS

Overall, 47.2% of admitted applicants matriculated. The CHAID algorithm generated a 3-level model with 5 terminal nodes that classified matriculants with 64.9% accuracy. Applicants more likely to matriculate than to decline an admission offer included in-state applicants and White/Caucasian border-state/out-of-state applicants with GPAs below 3.65.

DISCUSSION

While findings are program-specific, the CHAID analysis provides a tool to analyze admissions data that admissions committees may use to analyze their admissions processes and outcomes.

Recurrence Quantification Analysis of Personal Statements from Applicants to a Physical Therapy Doctoral Program: A Cross-Sectional Analysis

PURPOSE

We examined lexical sophistication of written personal statements from physical therapy applicants to determine whether recurrence quantification analysis (RQA) indices distinguish higher- versus lower-scored candidates and correlate with other admissions variables.

METHODS

Written personal statements were extracted from 152 applications, coded numerically, and analyzed with RQA. Along with other RQA indices, determinism-representing predictability of words and phrases-was quantified. A receiver operating characteristic (ROC) curve analysis was used to examine discriminative validity of RQA indices to distinguish between top-10 and bottom-10 candidates. Correlation coefficients between RQA indices and other admissions variables (grade point averages, standardized exam, behavioral interview, and cumulative admissions scores) were also examined.

RESULTS

Determinism in personal statements was lower in top-scored (mean 7.38%) than bottom-scored candidates (mean 11.29%, p = 0.015), differentiated between them with 70% sensitivity (95% CI 34.8%-93.3%) and 100% specificity (95% CI 69.2%-100%), and correlated negatively with candidates' behavioral interview scores (r = -0.168, p = 0.039).

DISCUSSION

The greater expressive lexical sophistication characterized by lower determinism in personal statements provides information about candidates' writing proficiency as a component of their communication abilities that may not otherwise be assessed in traditional admissions variables.

Responsiveness of a Balance Assessment Using a Mobile Application

BACKGROUND

Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app.

HYPOTHESIS

The K-D Balance app will demonstrate acceptable responsiveness for balance assessment.

STUDY DESIGN

Repeated-measures study.

LEVEL OF EVIDENCE

Level 5.

METHODS

A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC).

RESULTS

The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58.

CONCLUSION

The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app.

CLINICAL RELEVANCE

Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles

CONTEXT

Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)-based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited.

OBJECTIVE

To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg).

MAIN OUTCOME MEASURE(S)

The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability.

RESULTS

Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715-0.890) except for SCM SWE stiffness (ICC = 0.554).

CONCLUSIONS

The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.

Qualitative and quantitative evaluation of an interprofessional workshop between physical therapy and medical students

Interprofessional education (IPE) is an important component of medical education, preparing students for the collaboration necessary for high-quality patient care. This study aimed to compare IPE readiness in pre-qualification physical therapy (PT) and medical (MD) students before and after an interprofessional workshop and identify factors influencing the workshop's perceived educational value. In two consecutive years, students were surveyed with the Readiness for Interprofessional Learning Scale (RIPLS) following a four-hour, case-based workshop. During the second year, students were also surveyed before the workshop and answered open-ended questions about its educational value. PT and MD students had similar mean pre-workshop RIPLS scores (83.0, SD 5.3 vs. 80.7, SD 7.9; p = .27), but post-workshop scores were higher among PT students (86.3, SD 6.5 vs. 80.3, SD 8.8; p < .001). Qualitative thematic analysis of responses to open-ended questions revealed students valued IPE within the workshop. However, MD students in particular identified improvement opportunities in workshop delivery, timing, and content. These factors undermined the perceived educational value for MD students and may have contributed to their lower post-workshop RIPLS scores. This study suggests that a brief workshop can improve readiness for IPE among pre-professional students and highlights the importance of content, delivery, and timing to IPE success.

The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report

Background and Purpose: Although the principles of neural plasticity for stroke rehabilitation are well established, specific intervention plans for patients with ataxia following a lacunar infarct are not well described. The purpose of this case report is to describe the intervention program for a patient with ataxic hemiparesis based on principles of motor learning and neural plasticity. Case Description: An 83-year-old, socially active male presented to the emergency department with right-sided upper extremity weakness and ataxia. The patient's acute hospital course included 4 days in a stoke unit, followed by 13 days in inpatient rehabilitation. Intervention: A 3-phase graded mobility and coordination plan was used during inpatient rehabilitation. Interventions included function-based training with repeated ambulation, coordination activities for the upper and lower extremities, and strengthening to help the patient achieve his goal of walking "without gait deviations." The concepts of motor learning and neural plasticity were utilized for timing and feedback on patient errors when implementing this novel program. Outcomes: The patient's level of assistance for mobility and activities of daily living improved from minimal assistance to modified independence without use of an assistive device. The Dynamic Gait Index score improved from 16/24 to 20/24 suggesting a decreased fall risk. Discussion: This case report describes a novel intervention strategy for a patient with ataxia following a lacunar stroke. The application of the principles of neural plasticity and motor learning was the foundation for a function-based plan of care.

A Comparison of Various Cervical Muscle Strength Testing Methods Using a Handheld Dynamometer

BACKGROUND:

Cervical muscle strength, proposed as a modifiable risk factor in concussions, can be assessed using various methods. The purpose of this study was to compare the reliability and force outputs of 3 methods that use handheld dynamometry (HHD) for assessing cervical muscle strength.

HYPOTHESIS:

All 3 testing methods are reliable, and force outputs are significantly different between methods.

STUDY DESIGN:

Repeated-measures reliability.

LEVEL OF EVIDENCE:

Level 5.

METHODS:

The study used a convenience sample of 30 participants. HHD "make tests" for cervical extension, flexion, and right and left side bending were performed using lying push tests, sitting push tests, and sitting pull tests. A sole examiner performed all tests. Two testing sessions were conducted 1 week apart. Analysis included intraclass correlation coefficients (ICCs), repeated-measures analyses of variance (α = 0.05) with post hoc Bonferroni tests, and minimal detectable change (MDC) calculations.

RESULTS:

All testing methods were reliable; the lying push test had the greatest point estimate values (ICC, 0.89-0.95). Significant differences in force were found between the 3 testing methods. The MDC was most sensitive for the lying push method.

CONCLUSION:

Of the 3 cervical muscle testing methods investigated, the lying position with a push test had the largest ICC according to the point estimate and the most sensitive MDC. Force values between the 3 methods were significantly different, which suggests that consistent testing methods should be used.

CLINICAL RELEVANCE:

Results from this study support the clinical use of an HHD "make test" in a lying position for assessing cervical muscle strength. The test is reliable and more sensitive to change compared with tests in a seated position.

Influence of Body Position on Shoulder and Trunk Muscle Activation During Resisted Isometric Shoulder External Rotation

Background:

External rotation (ER) strengthening of the shoulder is an integral component of rehabilitative and preventative programs for overhead athletes. A variety of shoulder ER strengthening exercises are reported, including those intended to integrate the core musculature. The purpose of this study was to examine ER torque and electromyographic (EMG) activation of shoulder and trunk muscles while performing resisted isometric shoulder ER in 3 positions (standing, side lying, and side plank).

Hypothesis:

Significantly greater force and shoulder muscle activation would be generated while side lying given the inherent stability of the position, and greater trunk muscle activation would be generated in the less stable plank position.

Study Design:

Quasi-experimental repeated-measures study.

Level of Evidence:

Level 5.

Methods:

A convenience sample of 25 healthy overhead recreational athletes (9 men, 16 women) participated in this study. EMG electrodes were placed on the infraspinatus, posterior deltoid, middle trapezius, multifidi, internal obliques, and external obliques. EMG signals were normalized to a maximal isometric contraction. Participants performed resisted isometric ER in standing, side-lying, and side plank positions. Results were analyzed using a repeated-measures analysis of variance with post hoc Bonferroni corrections (α = 0.05).

Results:

There was no significant difference in ER torque between positions (α = 0.05). A significant difference in EMG activity of shoulder and trunk musculature between positions was found in 7 of the 8 muscles monitored. Significantly greater EMG activity in the infraspinatus, middle trapezius, and the nondominant external and internal obliques was found in the side plank position as compared with standing and side lying.

Conclusion:

While there was no difference in ER torque between the 3 exercise positions, EMG activity of the shoulder and trunk muscles was dependent on body position.

Clinical Relevance:

If a clinician is seeking to integrate trunk muscle activation while performing shoulder ER strengthening, the side plank position is preferred as compared with standing or side lying.

ELECTROMYOGRAPHY OF THE HIP AND THIGH MUSCLES DURING TWO VARIATIONS OF THE LUNGE EXERCISE: A CROSS-SECTIONAL STUDY

BACKGROUND

The lunge is a closed kinetic chain exercise that athletes frequently use as part of training and rehabilitative programs. While typically performed on a stable surface, modifications include the use of balance platforms to create an unstable surface and suspension equipment. Suspension training exercises are theorized to be higher demand exercises and may be considered a progression from exercises on stable surfaces. Comparison of muscle recruitment between the suspended lunge and the standard lunge has not been reported.

HYPOTHESIS AND PURPOSE

The purpose was to compare differences in muscle recruitment between a standard lunge and a suspended lunge. We hypothesized that hip and thigh muscle recruitment with a suspended lunge would be greater than a standard lunge due to less inherent support with the suspended lunge exercise.

STUDY DESIGN

Analytic, observational cross-sectional study design.

METHODS

Thirty healthy participants (15 male and 15 female) voluntarily participated in this study. Electromyographic (EMG) muscle recruitment was measured in five hip and thigh muscles while performing a standard and suspended lunge. EMG was expressed as a percentage of EMG with a maximal voluntary isometric contraction (MVIC).

RESULTS

Recruitment was significantly greater in the suspended lunge condition compared to the standard lunge for the hamstrings (p < .001), gluteus medius (p < .001), gluteus maximus (p<.001), and adductor longus (p < .001). There was no significant difference in rectus femoris recruitment between conditions (p = .154).

CONCLUSION

Based on EMG findings, the suspended lunge is a more demanding exercise for hip muscles, compared to the standard lunge.

LEVEL OF EVIDENCE

Level 3 Mechanism-based reasoning intervention study trial.

CLINICAL RELEVANCE

The results of this study can assist clinicians in designing and progressing lower extremity exercise programs. With greater muscle recruitment, the suspended lunge is a more demanding exercise for hip muscles and can be considered a progression of the standard lunge as part of an exercise program.

WHAT IS KNOWN ABOUT THE SUBJECT?

Muscle recruitment associated with the lunge exercise, variations of the lunge, and similar exercises has been reported. The use of suspension training exercise equipment has been reported for upper extremity exercises however not for the lower extremity.

WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?

Results of this study provide novel EMG information related to the lunge exercise using suspension training exercise equipment. Clinicians can use this information designing lower extremity exercise programs.

Does fair play reduce concussions? A prospective, comparative analysis of competitive youth hockey tournaments

Background/aim

To determine if Boys Bantam and Peewee and Girls U14 sustain fewer concussions, head hits, ‘other injuries’ and penalties in hockey tournaments governed by intensified fair play (IFP) than non-intensified fair play (NIFP).

Methods

A prospective comparison of IFP, a behaviour modification programme that promotes sportsmanship, versus control (non-intensified, NIFP) effects on numbers of diagnosed concussions, head hits without diagnosed concussion (HHWDC), ‘other injuries’, number of penalties and fair play points (FPPs). 1514 players, ages 11–14 years, in 6 IFP (N=950) and 5 NIFP (N=564) tournaments were studied.

Results

Two diagnosed concussions, four HHWDC, and six ‘other injuries’ occurred in IFP tournaments compared to one concussion, eight HHWDC and five ‘other injuries’ in NIFP. There were significantly fewer HHWDC in IFP than NIFP (p=0.018). However, diagnosed concussions, ‘other injuries’, penalties and FPPs did not differ significantly between conditions. In IFP, a minority of teams forfeited the majority of FPPs. Most diagnosed concussions, HHWDC, and other injuries occurred to Bantam B players and usually in penalised teams that forfeited their FPPs.

Conclusions

In response to significant differences in HHWDC between IFP and NIFP tournaments, the following considerations are encouraged: mandatory implementation of fair play in regular season and tournaments, empowering tournament directors to not accept heavily penalised teams, and introducing ‘no body checking’ in Bantam.

Long-term effect of a short interprofessional education interaction between medical and physical therapy students

Medicine is increasingly focused on team-based practice as interprofessional cooperation leads to better patient care. Thus, it is necessary to teach teamwork and collaboration with other health care professionals in undergraduate medical education to ensure that trainees entering the workforce are prepared to work in teams. Gross anatomy provides an opportunity to expose students to interprofessional education (IPE) early in their training. The purpose of this study is to describe an IPE experience and report if the experience has lasting influence on the participating students. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was administered to first year medical (MD) and physical therapy (PT) students at Mayo Medical School and Mayo School of Health Sciences. Results demonstrated an openness on the part of the students to IPE. Interprofessional education experiences were incorporated into gross anatomy courses in both medical and PT curricula. The IPE experiences included a social event, peer-teaching, and collaborative clinical problem-solving sessions. These sessions enhanced gross anatomy education by reinforcing previous material and providing the opportunity to work on clinical cases from the perspective of two healthcare disciplines. After course completion, students again completed the RIPLS. Finally, one year after course completion, students were asked to provide feedback on their experience. The post-curricular RIPLS, similar to the pre-curricular RIPLS, illustrated openness to IPE from both MD and PT students. There were however, significant differences in MD and PT perceptions of roles and responsibilities. One-year follow-up indicated long-term retention of lessons learned during IPE.

Reliability and accuracy of a goniometer mobile device application for video measurement of the functional movement screen deep squat test

BACKGROUND/PURPOSE

The squat is a fundamental movement of many athletic and daily activities. Methods to clinically assess the squat maneuver range from simple observation to the use of sophisticated equipment. The purpose of this study was to examine the reliability of Coach's Eye (TechSmith Corp), a 2-dimensional (2D) motion analysis mobile device application (app), for assessing maximal sagittal plane hip, knee, and ankle motion during a functional movement screen deep squat, and to compare range of motion values generated by it to those from a Vicon (Vicon Motion Systems Ltd) 3-dimensional (3D) motion analysis system.

METHODS

Twenty-six healthy subjects performed three functional movement screen deep squats recorded simultaneously by both the app (on an iPad [Apple Inc]) and the 3D motion analysis system. Joint angle data were calculated with Vicon Nexus software (Vicon Motion Systems Ltd). The app video was analyzed frame by frame to determine, and freeze on the screen, the deepest position of the squat. With a capacitive stylus reference lines were then drawn on the iPad screen to determine joint angles. Procedures were repeated with approximately 48 hours between sessions.

RESULTS

Test-retest intrarater reliability (ICC3,1) for the app at the hip, knee, and ankle was 0.98, 0.98, and 0.79, respectively. Minimum detectable change was hip 6°, knee 6°, and ankle 7°. Hip joint angles measured with the 2D app exceeded measurements obtained with the 3D motion analysis system by approximately 40°. Differences at the knee and ankle were of lower magnitude, with mean differences of 5° and 3°, respectively. Bland-Altman analysis demonstrated a systematic bias in the hip range-of-motion measurement. No such bias was demonstrated at the knee or ankle.

CONCLUSIONS

The 2D app demonstrated excellent reliability and appeared to be a responsive means to assess for clinical change, with minimum detectable change values ranging from 6° to 7°. These results also suggest that the 2D app may be used as an alternative to a sophisticated 3D motion analysis system for assessing sagittal plane knee and ankle motion; however, it does not appear to be a comparable alternative for assessing hip motion.

LEVEL OF EVIDENCE

3.

Management of a patient with patellofemoral pain syndrome using neuromuscular training in decreasing medial collapse: a case report

BACKGROUND AND PURPOSE

Medial collapse has been reported to increase patellofemoral stresses. This case describes the examination and treatment of a patient with patellofemoral pain syndrome (PFPS), displaying medial collapse during functional activities. The purpose of this case is twofold: (1) to describe a clinical movement pattern assessment using a 2-dimensional (2D) assessment; and (2) to describe a clinical neuromuscular training program focused on optimal movement patterns.

CASE DESCRIPTION

A 19-year-old female diagnosed with PFPS. Initially, the patient exhibited medial collapse. A treatment approach focused on optimization of functional movement patterns to correct medial collapse through visual input and neuromuscular training was implemented. Interventions focused on correction of faulty movement patterns.

OUTCOMES

After four sessions over 3 weeks, the patient reported cessation of pain and displayed an improved movement pattern without medial collapse during functional activities. Discussion and evidence-based recommendations: The clinical assessment of medial collapse utilized was novel, and a successful outcome with minimal visits was achieved for a patient with PFPS. Further research to establish the reliability and validity of the 2D evaluation method of medial collapse and optimum alignment training for patients with PFPS is necessary.

Use of individual feedback during human gross anatomy course for enhancing professional behaviors in doctor of physical therapy students

Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high-quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy education and before the first significant clinical internship could be enhanced in a semester course in gross human anatomy using individual formative feedback. During the human anatomy course, 28 first-year physical therapy students completed six biweekly, anonymous self- and peer assessment surveys that targeted ten professional behaviors important to physical therapists. All professional behaviors were assessed using a five-point Likert scale. Feedback reports occurred at week eight (mid-semester) and week 16 (end-of-semester) and comprised the direct intervention components of this study. At the midpoint of the semester, professional behavior scores and narrative comments from weeks two, four, and six were compiled and shared with each student by one of three faculty members in a feedback session. Students then submitted biweekly self-and peer professional behavior assessments (weeks 10, 12, and 14) for the remainder of the human anatomy course. Differences between preintervention and postintervention scores for each of the ten professional behaviors were compared using the Wilcoxon signed-ranks test. Upon receiving mid-semester individual feedback, students demonstrated significant improvement in each of the ten professional behaviors. Results from this study indicated a gross anatomy laboratory dissection experience during the first academic semester provided an effective opportunity for teaching and assessing professional behaviors of doctoral students in physical therapy.

Reliability of the dial test using a handheld inclinometer

PURPOSE

The primary purpose of this study was to investigate the intra-tester and inter-tester reliability of the dial test using a handheld digital inclinometer. Additionally, we examined the responsiveness of the test, and side-to-side differences for meaningful comparison.

MATERIALS/METHODS

Twenty-four healthy subjects (22.5 ± 2.8 years) participated in the study. The dial test was performed on both knees at 30° and 90° of knee flexion with the subject supine. While maintaining a neutral position of the ankle, an inclinometer was positioned parallel to the medial border of the foot to quantify external rotation of the tibia. Two examiners performed the dial test in a blinded manner. The minimal detectable change across repeated measures and side-to-side difference was calculated.

RESULTS

Intra-tester reliability for examiner 1 (E1) was 0.83 at 30° knee flexion and 0.89 at 90° knee flexion. Reliability values for examiner 2 (E2) were 0.86 at 30° and 0.87 at 90° knee flexion. Inter-tester reliability was 0.74 at 30° and 0.83 at 90°. The minimal detectable change (MDC) for E1 at 30° was ±9.4° and ±7.4° at 90°. For E2, the MDC value was ±9.1° at 30° and ±8.3° at 90°. Ninety-five percent limits of agreement for side-to-side difference was 16.1° and 11.3° ° for E1 at 30° and 90° and for E2 13.9° at 30° and 14.1° at 90°.

CONCLUSIONS

This instrumented dial test using a handheld digital inclinometer to measure external rotation can be performed with acceptable reliability in the clinical setting. A difference of 10° between two measurements on the same knee suggests that a meaningful change has occurred. For right to left comparison, differences greater than 15° suggest clinical significance.

LEVEL OF EVIDENCE

III.

Skating crossovers on a motorized flywheel: a preliminary experimental design to test effect on speed and on crossovers

Ice hockey requires frequent skater crossovers to execute turns. Our investigation aimed to determine the effectiveness of training crossovers on a motorized, polyethylene high-resistance flywheel. We hypothesized that high school hockey players training on the flywheel would perform as well as their peers training on ice. Participants were 23 male high-school hockey players (age 15-19 years). The study used an experimental prospective design to compare players who trained for 9 sessions on the 22-foot flywheel with players who trained for 9 sessions on a similarly sized on-ice circle. Both groups were compared with control subjects who were randomly selected from the same participant pool as those training on ice. All players were tested before and after their 3-week training regimens, and control subjects were asked to not practice crossovers between testing. Group 1 trained in a hockey training facility housing the flywheel, and group 2 trained in the ice hockey arena where testing occurred. Primary outcome measures tested in both directions were: (a) speed (time in seconds) required to skate crossovers for 3 laps of a marked face-off circle, (b) cadence of skating crossovers on the similarly sized circles, and (c) a repeat interval speed test, which measures anaerobic power. No significant changes were found between groups in on-ice testing before and after training. Among the group 1 players, 7 of 8 believed they benefited from flywheel training. Group 2 players, who trained on ice, did not improve performance significantly over group 1 players. Despite the fact that no significant on-ice changes in performance were observed in objective measures, players who trained on the flywheel subjectively reported that the flywheel is an effective cost-effective alternative to training on ice. This is a relevant finding when placed in context with limited availability of on-ice training.

Pilates for breast cancer survivors

Pilates has been advocated for rehabilitation of breast cancer survivors despite little scientific evidence. The authors of this article have examined the feasibility of a Pilates program in postmastectomy breast cancer survivors and the impact on physical and psychological parameters. Fifteen breast cancer survivors were recruited in a one-arm study of 12 weeks of Pilates exercises. The authors assessed recruitment, adherence, and attrition, and measured changes in shoulder and neck range of motion, posture, height, arm volume, quality of life, mood, and body image from pre- to postintervention. Of 26 eligible patients, 15 enrolled, 13 completed the study, and 10 performed more than 50% of the recommended sessions. Statistically significant improvements emerged for shoulder abduction and internal rotation on the affected side, neck rotation toward the unaffected side, and neck flexion. The affected side arm volume and the interlimb volume discrepancy increased. Significant improvements were reported in quality of life, mood, and body image. The improvements in physical and psychological outcomes are promising and deserve further evaluation in a randomized, controlled study. The increase in affected arm volume also warrants additional investigation.

Learning of musculoskeletal ligament stress testing in a gross anatomy laboratory

Human anatomy in physical therapy programs is a basic science course serving as a foundation for subsequent clinical courses. Integration of anatomy with a clinical emphasis throughout a curriculum provides opportunities for reinforcement of previously learned material. Considering the human cadaver laboratory as a fixed cost to our program, we sought opportunities to add value to the resource via vertical integration into a clinical skills course taught later in the curriculum. We designed an opportunity for second-year physical therapy students to revisit the human anatomy laboratory to study select clinical musculoskeletal tests and the associated anatomy in a clinically relevant context. Students performed select orthopedic ligament test on human cadavers, then incised specific structures and repeated the tests. Students were able to feel and visualize the function of pertinent anatomy associated with the clinical tests. Ninety-five percent of respondents reported that the ligament stress testing experience enhanced their understanding of orthopedic clinical tests with 91% reporting an enhanced understanding of anatomy related to specific clinical tests. Likewise, the experience was perceived as enjoyable and valuable with 86% of respondents reporting the experience as enjoyable and 100% responding the experience should continue as part of the curriculum.

A functional model of the digital extensor mechanism: demonstrating biomechanics with hair bands

The action of muscles about joints can be explained through analysis of their spatial relationship. A functional model of these relationships can be valuable in learning and understanding the muscular action about a joint. A model can be particularly helpful when examining complex actions across multiple joints such as in the digital extensor mechanism of the hand. A functional model using two hair bands representing the components of the digital extensor mechanism is described. Through superimposition of the model over one's digit, the combined actions of metacarpophalangeal joint flexion and interphalangeal joint extension are clearly demonstrated. The model provides a conceptual demonstration to enhance understanding of this unique combination of muscle actions about multiple joints.

Interprofessional education in gross anatomy: experience with first-year medical and physical therapy students at Mayo Clinic

Interprofessional education (IPE) in clinical practice is believed to improve outcomes in health care delivery. Integrating teaching and learning objectives through cross discipline student interaction in basic sciences has the potential to initiate interprofessional collaboration at the early stages of health care education. Student attitudes and effectiveness of IPE in the context of a combined gross anatomy course for first-year students in Doctor of Physical Therapy (DPT) and Doctor of Medicine (MD) degrees curricula were evaluated. Integrated teams of MD and DPT students participated in part of the gross anatomy dissection course at Mayo Medical School. A survey was administered to 42 MD and 28 DPT students that assessed their attitudes toward IPE and cooperation among health care professionals. Pre- and post-experience surveys were evaluated. Positive comments were related to opportunities for developing a better understanding of the nature and scope of each other's programs, encouraging teamwork and communication, mutual respect, and reducing the perceptual divide between disciplines. Ninety-two percent of the students agreed that interprofessional learning would help them in becoming a more effective member of the health care team. This initial experience with IPE in gross anatomy provides a basis for continued development of interdisciplinary educational strategies.

Retrospective analysis of the behavioral interview and other preadmission variables to predict licensure examination outcomes in physical therapy

Evidence supporting the use of personal interviews in admissions decisions for health professions programs is conflicting. This retrospective study was intended to (1) quantify interrater reliability for assessing performance on a particular type of structured interview, the behavioral interview, and (2) examine the ability of multiple preadmission variables, including performance on the behavioral interview, to predict first-time performance on the national physical therapy licensing examination (NPTE). Data from 89 interviewees during the 2006-07 admissions cycle were used to examine inter-rater reliability. Data from 141 students who graduated from 2001 to 2005 were used to examine predictive validity of multiple preadmission variables on NPTE performance, including undergraduate cumulative grade point average (GPA), preprofessional science GPA, performance on the Graduate Record Examination (GRE) (including its analytical, quantitative, and verbal subscales), and performance on the behavioral interview. Inter-rater reliability for assessing interview performance was quantified with an intraclass correlation coefficient (ICC1,1). Receiver operating characteristic (ROC) curves and associated validity indices were used to analyze variables that distinguished graduates who did and did not pass the NPTE on their first attempt (alpha = 0.05). The ICC1,1 for assessing interview performance was 0.749. Performance on the verbal subscale of the GRE (ROC curve area = 0.734, p = 0.007) and behavioral interview (ROC curve area = 0.685, p = 0.034) were statistically significant predictors of NPTE performance. This study provides evidence supporting the contributions of the behavioral interview and verbal subscale of the GRE to predict NPTE performance and assist admissions decisions.

The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain

Reference values for standing lumbar curvature (SLC) obtained via noninvasive methods are not well established in persons without current low back pain. The effect of gender is considered to have a significant effect on SLC with women having more lumbar lordosis than men. The effect of age and degree of obesity are not considered to have a statistically significant effect on SLC. The purpose of this study was to test the assumption that measurements of SLC in healthy adults obtained by a flexible curve will differ between genders, whereas the SLC will not differ across categories of age and body mass index (BMI). Two hundred thirty-five volunteers (119 men and 116 women) whose ages ranged between 20 and 79 years participated in the study. Subjects were almost exclusively White and from the Midwest. Measurements of the SLC were obtained by a flexible curve. The curve's shape was transferred to poster board, and the value of SLC was quantified by a previously described technique. A three-way analysis of variance (alpha = 0.05) was used to examine the main effects of gender, age, and BMI on SLC. The effect of gender (F1,199 = 21.4, p < 0.0001) and the effect of age (F5,199 = 2.8, p < 0.017) were statistically significant. The effect of BMI (F2,199 = 1.8, p = 0.176) was not significant. Women (mean, 49.5 degrees +/-10.7 degrees ) demonstrated about 6.5 degrees more SLC than their male (mean, 43.0 degrees +/-10.7 degrees ) counterparts. For age, the only significant difference was between the 20 to 29- and 50 to 59-year-old age categories. This study provides physical therapists with typical values of SLC in men and women without current low back pain.

Influence of Lever Arm and Stabilization on Measures of Hip Abduction and Adduction Torque Obtained by Hand-Held Dynamometry

OBJECTIVE

To examine the reliability of clinical techniques for testing hip abductor and adductor muscle performance.

DESIGN

Repeated measures.

SETTING

Academic laboratory.

PARTICIPANTS

A sample of 21 healthy subjects (12 men, 9 women) between 22 and 31 years of age.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Reliability of repeated measures was estimated by calculating intraclass correlation coefficients. Torque production capability was calculated by multiplying force output obtained with a hand-held dynamometer by the length of the resistance lever arm.

RESULTS

The reliability of abduction testing was greatest in the long-lever condition. Adduction test reliability was greatest in the long-lever condition with bench stabilization. The maximal hip abduction torque tested in the long-lever position was significantly greater (t(20)=9.21, P<.001) than that in the short-lever position. The maximal hip adduction torque occurred using a long lever for resistance application and a bench to stabilize the nontest leg (F(1,20)=15.64, P=.001).

CONCLUSIONS

Muscle performance testing of hip abductors and adductors with a hand-held dynamometer can be performed with good to excellent intratester and intertester reliability. Hip abduction testing is best performed with a long lever. Hip adduction is best performed with a long lever and a bench to stabilize the nontest extremity.

Abdominal muscle performance as measured by the double leg-lowering test

OBJECTIVE

To describe abdominal muscle performance as measured by the double leg-lowering test (DLLT) in healthy subjects.

DESIGN

Repeated measures.

SETTING

Academic laboratory.

PARTICIPANTS

A sample of 100 healthy volunteers (50 men, 50 women; age range, 18-29 y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Repeat measurements of the DLLT to determine reliability and performance standards and to identify variables that predict performance.

RESULTS

The intraclass correlation coefficient (ICC 3,1) for repeated measures of the DLLT was .98. The mean value +/- standard error of the mean for abdominal performance for men was 15.4 degrees +/-2.3 degrees from a horizontal reference, and for women it was 36.9 degrees +/-3.4 degrees . A significant difference was found between men and women on performance of the DLLT (t 98 = -5.3, P < .001). A linear regression model found sex (t = -3.2, P = .002) and age (t = -4.6, P < .001) to be significant predictors of performance on the DLLT.

CONCLUSIONS

The DLLT has excellent intratester reliability. We also found a sex difference in the performance of the DLLT.

The influence of gender and age on hamstring muscle length in healthy adults

STUDY DESIGN

Cross-sectional descriptive study.

OBJECTIVES

To examine the factors of gender and age, stratified by 10-year increments, on hamstring muscle length (HML) as measured by passive straight-leg raise (PSLR) and popliteal angle (PA).

BACKGROUND

Differences in HML between men and women have not been examined for a large group of healthy adults over a wide range of ages. The usefulness of these data is to provide some typical values of HML for future reference.

METHODS AND MEASURES

Two hundred fourteen adults (108 women, 106 men; age range, 20-79 years) with no known history of hip or knee joint disease and no history of recent hamstring strain participated in the study. PSLR (trunk-thigh angle) and PA (thigh-leg angle) were estimated with a goniometer. A 2-way analysis of variance (ANOVA) was used to analyze the effects of 2 independent variables (gender and age) on 2 dependent variables (PSLR and PA). Statistical significance was established at alpha<.05.

RESULTS

HML differed significantly (P<.001) between genders for both methods of measurement, with females demonstrating greater flexibility than their male counterparts. The difference between genders was 8 degrees for PSLR and 11 degrees for PA. HML was not influenced by age.

CONCLUSIONS

This study provides physical therapists with typical values of HML in healthy men and women.

Measuring standing hindfoot alignment: Reliability of goniometric and visual measurements

OBJECTIVE

To examine the reliability of a functional weight-bearing measure of hindfoot alignment, the standing tibiocalcaneal angle (STCA), and to compare the relative reliabilities of goniometrically and visually estimated STCAs.

DESIGN

Prospective blinded comparison.

SETTING

Sports medicine center.

PARTICIPANTS

Eighteen asymptomatic volunteer subjects (10 men, 8 women; age range, 22-41y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Two experienced examiners completed 2 blinded goniometric STCA and 2 blinded visual STCA measurements on each subject's right and left ankles in random order.

RESULTS

Quantitative visual and goniometric STCAs were similar (visual mean range, 5.61 degrees -6.50 degrees valgus vs goniometric mean range, 5.50 degrees -6.94 degrees valgus), and both measurements exhibited good to excellent intrarater reliabilities (intraclass correlation coefficient [ICC] range, .80-.94; 95% prediction limits, 1.51 degrees -2.06 degrees ). Interrater ICCs were only fair for both measurement methods (.50-.75; 95% prediction limits, 2.2 degrees -4.1 degrees ). In terms of relative reliability, the visual STCA and goniometric STCA exhibited good to excellent agreement (ICC range, .64-.95).

CONCLUSIONS

The STCA as described herein exhibited acceptable intrarater reliability for clinical use but may not be acceptably reliable between experienced examiners. The visual and goniometric STCA measurements were quantitatively similar and exhibited similar reliability. Using either method, changes of up to 2 degrees over time may be attributable to measurement error. Clinicians may consider using either STCA measurement in evaluating patients with lower-limb injuries or during screening of high-risk populations.

The effect of static stretching of the calf muscle-tendon unit on active ankle dorsiflexion range of motion

STUDY DESIGN

Masked randomized trial.

OBJECTIVE

To examine the effects of a 6-week program of static stretching of the calf muscle-tendon unit (MTU) on active ankle dorsiflexion range of motion (ADFROM) in healthy subjects.

BACKGROUND

Static stretching of the calf MTU is often prescribed to increase flexibility in patients with shortened connective tissues or to maintain ADFROM in healthy individuals. Presently, physical therapists lack specific information on the optimal dosage of calf MTU stretching necessary to produce improvement in ADFROM.

METHODS AND MEASURES

One hundred one adults (63 women, 38 men; mean age +/- SD, 40.0 +/- 10.9 years; range, 21-59) with no visual evidence of gait impairment due to lower-extremity dysfunction participated in the study. Active ADFROM was measured with a universal goniometer. Participants were randomly assigned to group 1, no stretch controls (n = 24), or to 1 of 3 experimental groups carrying out a 6-week program of standing wall stretches once per day: individuals in group 2 stretched for 30 seconds (n = 26); individuals in group 3 stretched for 1 minute (n = 24); individuals in group 4 stretched for 2 minutes (n = 27).

RESULTS

After 6 weeks, the results of an analysis of variance found no effect of treatment on active ADFROM.

CONCLUSION

The results of this study show that a 6-week program of once-per-day static stretching for up to 2 minutes is not sufficient to increase active ADFROM in healthy subjects.

Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology

OBJECTIVE

To determine indications for the use of postmastectomy radiotherapy (PMRT) for patients with invasive breast cancer with involved axillary lymph nodes or locally advanced disease who receive systemic therapy. These guidelines are intended for use in the care of patients outside of clinical trials.

POTENTIAL INTERVENTION

The benefits and risks of PMRT in such patients, as well as subgroups of these patients, were considered. The details of the PMRT technique were also evaluated.

OUTCOMES

The outcomes considered included freedom from local-regional recurrence, survival (disease-free and overall), and long-term toxicity.

EVIDENCE

An expert multidisciplinary panel reviewed pertinent information from the published literature through July 2000; certain investigators were contacted for more recent and, in some cases, unpublished information. A computerized search was performed of MEDLINE data; directed searches based on the bibliographies of primary articles were also performed.

VALUES

Levels of evidence and guideline grades were assigned by the Panel using standard criteria. A "recommendation" was made when level I or II evidence was available and there was consensus as to its meaning. A "suggestion" was made based on level III, IV, or V evidence and there was consensus as to its meaning. Areas of clinical importance were pointed out where guidelines could not be formulated due to insufficient evidence or lack of consensus.

RECOMMENDATIONS

The recommendations, suggestions, and expert opinions of the Panel are described in this article.

VALIDATION

Seven outside reviewers, the American Society of Clinical Oncology (ASCO) Health Services Research Committee members, and the ASCO Board of Directors reviewed this document.

A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis

OBJECTIVE

To determine whether low-intensity laser irradiation, a widespread but controversial physical therapy agent, is an effective treatment of plantar fasciitis.

DESIGN

A randomized, double-blinded, placebo-controlled clinical study.

SETTING

A sports medicine clinic.

SUBJECTS

Thirty-two otherwise healthy individuals with plantar fasciitis of more than 1 month's duration.

INTERVENTION

Dummy or active irradiation with a 30 mW .83 microm GaAlAs continuous-wave infrared (IR) diode laser three times a week for 4 weeks.

MEASUREMENTS

Morning pain, pain with toe walking, tenderness to palpation, windlass test response, medication consumption, and orthotic use were evaluated immediately before the study, as well as at the midpoint and end of treatment. Subjects were also evaluated at a follow-up 1 month after their last treatment.

RESULTS

No significant differences were found between the groups in any of the outcome measures either during treatment or at the 1-month follow-up. Treatment, however, was well tolerated and side effects were minimal.

CONCLUSIONS

Low-intensity IR laser therapy appears safe but, at least within the parameters of this study, is not beneficial in the treatment of plantar fasciitis.

Problems with India ink skin markings

India ink skin markings allow consistently reproducible radiation field setups. The authors report a case in which a facial tattoo was applied with an injection, resulting in permanent "black eyes." The vaccination technique has not been associated with this complication.

Sonographic patterns in trophoblastic diseases

A range of sonographic patterns in patients with hydatidiform moles can be appreciated with gray scale ultrasonography, which more readily reveals areas of internal hemorrhagic degeneration and fetal growth within a molar mass. Sonography may be used to evaluate patients suspected of having recurrent or invasive trophoblastic disease; a focus of invasive trophoblastic tumor can be identified as a cluster of high-amplitude echoes within the myometrium, which is frequently associated with echo-free areas of hemorrhage. The enlargement or regression of theca lutein cysts associated with these disease processes can also be monitored.