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Pandya J, Puentedura EJ, Koppenhaver S, Cleland J. Dry Needling Versus Manual Therapy for Patients With Mechanical Neck Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:1-12. [PMID: 38284367 DOI: 10.2519/jospt.2024.12091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE: To compare the short- and intermediate-term effects of dry needling to manual therapy on pain, disability, function, and patient-perceived improvement in patients with mechanical neck pain. DESIGN: A single (therapist) blinded randomized controlled trial. METHODS: Seventy-eight patients (mean ± SD age, 50.74 ± 13.81) were randomly assigned to one of the 2 groups: (1) dry needling and therapeutic exercises (DN + Exercises) and (2) manual therapy and therapeutic exercises (MT + Exercises). Both groups received 7 treatment sessions over a maximum of 6 weeks. Outcome measures, collected at baseline, 2 weeks, discharge (7th treatment session), and 3 months after discharge, were as follows: Neck Disability Index (NDI), numeric pain-rating scale (NPRS), Patient-Specific Functional Scale (PSFS), global rating of change (GROC), Fear-Avoidance Belief Questionnaire (FABQ), and Deep Neck Flexor Endurance Test (DNFET). Data were analyzed with mixed-model analysis of covariance (ANCOVA), using pretest scores as covariates, and a Mann-Whitney U test for GROC scores. RESULTS: The ANCOVA revealed significant group-by-time interaction for all variables. Significant between-group differences, favoring MT + Exercises, were observed at all 3 time points on the NDI (2 weeks: F1,446 = 172.68, P≤.001, [Formula: see text] = .27; discharge: F1,446 = 254.15, P≤.001, [Formula: see text] = .36; and 3 months: F1,446 = 339.40, P≤.001, [Formula: see text] = .43). Results for the MT + Exercises group exceeded recommended minimal clinically important difference for all variables, at all follow-up points. CONCLUSION: MT + Exercises was more effective, both in the short term and intermediate term, than DN + Exercises in reducing pain, disability, and improving function in patients with mechanical neck pain. J Orthop Sports Phys Ther 2024;54(4):1-12. Epub 29 January 2024. doi:10.2519/jospt.2024.12091.
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Alnwick GM, Clewley D, Beuning B, Koppenhaver S. Improvements after dry needling for craniofacial pain in a patient with chronic rhinosinusitis: a case report. Physiother Theory Pract 2023; 39:2740-2749. [PMID: 35659189 DOI: 10.1080/09593985.2022.2085218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Typically treated medically, chronic rhinosinusitis (CRS) is a prevalent condition characterized by multiple craniofacial symptoms, some of which may respond favorably to dry needling intervention. OBJECTIVE To describe the outcomes of a patient presenting with craniofacial pain and symptoms consistent with a diagnosis of CRS who was treated with dry needling. Case Description: A 41-year-old male, self-referred to physical therapy with a diagnosis of CRS, with a 20-year history of signs and symptoms associated with CRS, including craniofacial pain and headaches. The patient had been treated with multiple medication regimens over this time, including antihistamines, anti-inflammatories, decongestants, leukotriene inhibitors, and antibiotics; all of which provided only short-term relief. On initial examination, the patient was tender to palpation in multiple muscles of the head, neck, and face. Intervention consisted of dry needling to these muscular tender points once or twice weekly over 2 months. OUTCOMES After 2 months of dry needling, the patient demonstrated clinically meaningful improvements in pain and quality of life, which included a decrease in both medication usage and the frequency of sinus infections. CONCLUSION Although CRS is generally managed medically, we observed areas of muscular tenderness in this case, which were effectively managed with dry needling. Rehabilitative providers may consider screening CRS patients for muscular impairments that may be modifiable with dry needling. Further research should be performed to determine whether dry needling has a role in the management of CRS.
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Affiliation(s)
| | - Derek Clewley
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery Duke University School of Medicine, Durham, NC, USA
| | - Brett Beuning
- Physical Therapy Department, Robbins College of Health and Human Services, Baylor University, Waco, TX, USA
| | - Shane Koppenhaver
- Physical Therapy Department, Robbins College of Health and Human Services, Baylor University, Waco, TX, USA
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Proulx L, Brizzolara K, Thompson M, Wang-Price S, Rodriguez P, Koppenhaver S. Women with Chronic Pelvic Pain Demonstrate Increased Lumbopelvic Muscle Stiffness Compared to Asymptomatic Controls. J Womens Health (Larchmt) 2023; 32:239-247. [PMID: 36450120 DOI: 10.1089/jwh.2022.0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Although lumbopelvic muscle stiffness is commonly clinically assessed in women with chronic pelvic pain (CPP), it has not been objectively quantified in this population, and its association with other pain-related impairments has not yet been established. Objective: To compare superficial lumbopelvic muscle stiffness in women with and without CPP. In addition, pressure pain threshold (PPT) was compared between groups and the associations between muscle stiffness and PPT were assessed in women with CPP. Study Design: Case-control. Methods: Muscle stiffness and PPT of 11 lumbopelvic muscles were assessed in 149 women with CPP and 48 asymptomatic women. Subjective outcome measures, including pelvic floor function, health history, and psychosocial outcomes, were collected before muscle stiffness and PPT measurements. Analysis of covariance was used to compare muscle stiffness differences between groups, and independent t-tests were used to compare PPT between groups. Associations between measurements of PPT and muscle stiffness were calculated using correlation analysis. Results: Five of the 11 muscles measured were significantly stiffer in women with CPP than those without CPP (p < 0.05). PPT was significantly decreased in all muscles measured in women with CPP; however, there was not a significant association between muscle stiffness and PPT in women with CPP. Conclusion: The study identified the abdominal lumbopelvic muscles that have increased stiffness in women with CPP compared to asymptomatic women. In addition, muscle stiffness and PPT are two distinct impairments within this population. The results suggest that women with CPP have peripheral muscle impairments, which may be addressed without intravaginal or intrarectal intervention. Clinical Trial Registration: NCT04851730.
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Affiliation(s)
- Laurel Proulx
- School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, Denver, Colorado, USA
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McGowen JM, Heileson JL, Forsse J, Koppenhaver S. Association Of Muscle Biomechanical Properties With Army Combat Fitness Test Performance In ROTC Cadets. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000881896.38421.5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gagnon K, Bachman T, Beuning B, Koppenhaver S, Unverzagt C, Feda J, Gantt C, Young B. Doctor of Physical Therapy Education in a Hybrid Learning Environment: A Case Report. Phys Ther 2022; 102:6604585. [PMID: 35689811 DOI: 10.1093/ptj/pzac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/03/2021] [Accepted: 05/27/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this case report is to describe the implementation and report early outcomes of a 2-year (6-trimester), hybrid doctor of physical therapy (DPT) program. METHODS The case report describes management of (1) academic affairs, (2) student affairs, (3) faculty affairs, and (4) institutional affairs for an accredited, fully hybrid, 2-year DPT program. In the hybrid program, students from across the country participate in synchronous and asynchronous online learning and travel to campus twice per trimester for immersive blocks of in-person laboratory instruction. The case report describes how the program structures the hybrid learning environment and reports outcomes from the first 2 graduated cohorts. RESULTS Program outcomes assessment revealed that 97% to 98% of students/graduates reported being somewhat or very satisfied with the 2-year hybrid DPT program at the end of DPT year 1, at graduation, and at 1 year after graduation. Clinical instructors reported that 84% of students were prepared or well-prepared for clinical education. At 1 year after graduation, 20% of graduates were enrolled in or had completed residency, National Physical Therapy Examination (NPTE) pass rate was 97%, and employment rate was 99%. CONCLUSION Hybrid DPT education is feasible and may provide opportunities for more flexible and accessible delivery of DPT education. Outcomes of this case report suggest high student satisfaction, increased student/graduate diversity, and graduate outcomes comparable with national averages as reported in the Commission on Accreditation in Physical Therapy Education aggregate data. IMPACT This case report provides early evidence that hybrid DPT education-a type of blended learning that uses both face-to-face and online instructional strategies-is feasible, with student satisfaction and student/graduate outcomes comparable with national averages. Hybrid education may provide educators, programs, and institutions the flexibility to innovate in ways that address some of the immediate and long-term challenges facing physical therapist professional education while maintaining standards of excellence.
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Affiliation(s)
- Kendra Gagnon
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Teresa Bachman
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Brett Beuning
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Shane Koppenhaver
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Casey Unverzagt
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Jessica Feda
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Christy Gantt
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
| | - Brian Young
- Baylor University, Department of Physical Therapy, Waco, Texas, United States
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Koppenhaver S, Gaffney E, Oates A, Eberle L, Young B, Hebert J, Proulx L, Shinohara M. Lumbar muscle stiffness is different in individuals with low back pain than asymptomatic controls and is associated with pain and disability, but not common physical examination findings. Musculoskelet Sci Pract 2020; 45:102078. [PMID: 31704551 DOI: 10.1016/j.msksp.2019.102078] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lumbar muscle dysfunction is commonly implicated in low back pain (LBP). Shear-wave elastography (SWE) uses ultrasound technology to quantify absolute soft tissue stiffness (shear modulus), thereby allowing for estimation of individual muscle contraction and function. OBJECTIVES To compare resting and contracted stiffness of lumbar spine musculature in individuals with and without LBP using SWE. A secondary aim was to explore for relationships between common self-report and physical examination measures and resting and contracted muscle stiffness in individuals with LBP. DESIGN Cross-sectional. METHODS Shear modulus of the lumbar musculature was measured in 60 participants with LBP and 60 asymptomatic controls (120 total) using SWE. The lumbar erector spinae were imaged at rest only, while the lumbar multifidus was imaged at rest and during contraction. Before imaging, participants with LBP underwent a standardized clinical examination including a brief history, self-report questionnaires, and a physical examination. Lumbar muscle shear modulus was compared between participants with LBP and asymptomatic controls using ANCOVA. Potential associations between shear modulus and selected self-report and physical examination measures were assessed using correlation analysis. RESULTS Stiffness of the erector spinae and lumbar multifidus at rest (but not during contraction) was greater in participants with LBP than in asymptomatic controls (p < 0.05). Many of the self-report measures, but none of the physical examination findings were associated with muscle stiffness. CONCLUSION Resting lumbar muscle stiffness is greater in individuals with LBP than asymptomatic controls and is associated with self-reported pain and disability, but not physical exam findings.
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Affiliation(s)
- Shane Koppenhaver
- Baylor University Doctoral Program in Physical Therapy, Waco, TX, USA.
| | - Emily Gaffney
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Amber Oates
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Laura Eberle
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Brian Young
- Baylor University Doctoral Program in Physical Therapy, Waco, TX, USA
| | - Jeffrey Hebert
- University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Minoru Shinohara
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
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Ball AM, Finnegan M, Koppenhaver S, Freres W, Dommerholt J, Mayoral Del Moral O, Bron C, Moore R, Ball EE, Gaffney EE. The relative risk to the femoral nerve as a function of patient positioning: potential implications for trigger point dry needling of the iliacus muscle. J Man Manip Ther 2019; 27:162-171. [PMID: 30935326 DOI: 10.1080/10669817.2019.1568699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objectives: Prudent dry needling techniques are commonly practiced with the intent to avoid large neurovascular structures, thereby minimizing potential excessive bleeding and neural injury. Patient position is one factor thought to affect the size of the safe zone during dry needling of some muscles. This study aimed to compare the size of the needle safe zone of the iliacus muscle during two different patient positions using ultrasound imaging. Methods: The distance from the anterior inferior iliac spine (AIIS) to the posterior pole of the femoral nerve was measured in 25 healthy participants (11 male, 14 female, mean age = 40) in both supine and sidelying positions using a Chison Eco1 musculoskeletal ultrasound unit. The average distance was calculated for each position and a two-tailed, paired t-test (α < 0.05) was used to examine the difference between positions. Results: The mean distance from the AIIS to the posterior pole of the femoral nerve was statistically greater with participants in the sidelying position (mean[SD] = 35.7 [6.2] mm) than in the supine position (mean[SD] = 32.1 [7.3] mm, p < .001). Discussion: Although more study is needed, these results suggest that patient positioning is one of several potential variables that should be considered in the optimization of patient safety/relative risk when performing trigger point dry needling. Level of Evidence: Level 4 (Pre-Post Test).
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Affiliation(s)
- Andrew M Ball
- a Atrium Health , Carolinas Rehabilitation , Charlotte , NC , USA.,b NxtGen Institute of Physical Therapy , Atlanta , GA , USA.,c Myopain Seminars , Bethesda , MD , USA
| | - Michelle Finnegan
- c Myopain Seminars , Bethesda , MD , USA.,d ProMove PT Pain Specialists , Bethesda , MD , USA
| | - Shane Koppenhaver
- e Department of Physical Therapy , Baylor University , Dallas , TX , USA.,f Department of Physical Therapy , South College , Knoxville , TN , USA
| | - Will Freres
- a Atrium Health , Carolinas Rehabilitation , Charlotte , NC , USA.,c Myopain Seminars , Bethesda , MD , USA
| | - Jan Dommerholt
- c Myopain Seminars , Bethesda , MD , USA.,d ProMove PT Pain Specialists , Bethesda , MD , USA
| | - Orlando Mayoral Del Moral
- g Hospital Provincial de Toledo , Physical Therapy Unit , Toledo , Spain.,h Orlando Mayoral Clinica de fisiotherapia , Madrid , Spain.,i Seminarios Travell y Simons® , Toledo , Spain
| | - Carel Bron
- j Physical therapy practice for disorders of neck, shoulder and upper extremity , Groningen , Netherlands
| | - Randy Moore
- k MSK Masters , Cincinnati , OH , USA.,l General Musculoskeletal Imaging, Inc , Cincinnati , OH , USA
| | - Erin E Ball
- c Myopain Seminars , Bethesda , MD , USA.,m Novant Health , Charlotte , NC , USA
| | - Emily E Gaffney
- n USA MEDDAC Guthrie Ambulatory Health Care Clinic , Fort Drum , NY , USA
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Clewley D, Rhon D, Flynn T, Koppenhaver S, Cook C. Health seeking behavior as a predictor of healthcare utilization in a population of patients with spinal pain. PLoS One 2018; 13:e0201348. [PMID: 30067844 PMCID: PMC6070259 DOI: 10.1371/journal.pone.0201348] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/13/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The global burden of low back pain is growing rapidly, accompanied by increasing rates of associated healthcare utilization. Health seeking behavior (HSB) has been suggested as a mediator of healthcare utilization. The aims of this study were to: 1) develop a proxy HSB measure based on healthcare consumption patterns prior to initial consultation for spinal pain, and 2) examine associations between the proxy HSB measure and future healthcare utilization in a population of patients with spine disorders. METHODS A cohort of 1,691 patients seeking care for spinal pain at a single military hospital were included. Cluster analyses were performed for the identification of a proxy HSB measure. Logistic regression was used to identify the predictive capacity of HSB on eight different general and spine-related high healthcare utilization (upper 25%) outcomes variables. RESULTS The strongest proxy measure of HSB was prior primary care provider visits. In unadjusted models, HSB predicted healthcare utilization across all eight general and spine-related outcome variables. After adjusting for covariates, HSB still predicted general and spine-related healthcare utilization for most variables including total medical visits (OR = 2.48, 95%CI 1.09,3.11), total medical costs (OR = 2.72, 95%CI 2.16,3.41), and low back pain-specific costs (OR = 1.31, 95%CI 1.00,1.70). CONCLUSION Health seeking behavior prior to initial consultation for spine pain was related to healthcare utilization after consultation for spine pain. HSB may be an important variable to consider when developing an individualized care plan and considering the prognosis of a patient.
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Affiliation(s)
- Derek Clewley
- Rocky Mountain University of Health Professions, Provo, Utah, United States of America
- Duke University School of Medicine, Department of Orthopaedics, Division of Physical Therapy, Durham, North Carolina, United States of America
| | - Dan Rhon
- Center for the Intrepid, San Antonio, Texas, United States of America
- Baylor University, Doctor of Physical Therapy Program, Waco, Texas, United States of America
| | - Timothy Flynn
- South College, School of Physical Therapy, Knoxville, Tennessee, United States of America
| | - Shane Koppenhaver
- Baylor University, Doctor of Physical Therapy Program, Waco, Texas, United States of America
| | - Chad Cook
- Duke University School of Medicine, Department of Orthopaedics, Division of Physical Therapy, Durham, North Carolina, United States of America
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Sutlive TG, Golden A, King K, Morris WB, Morrison JE, Moore JH, Koppenhaver S. SHORT-TERM EFFECTS OF TRIGGER POINT DRY NEEDLING ON PAIN AND DISABILITY IN SUBJECTS WITH PATELLOFEMORAL PAIN SYNDROME. Int J Sports Phys Ther 2018; 13:462-473. [PMID: 30038832 PMCID: PMC6044598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is a prevalent knee disorder. A novel yet increasingly popular treatment for PFPS is trigger point dry needling (DN). PURPOSE The purpose of this study was to determine if DN is more effective at reducing pain and disability than a sham treatment in individuals with PFPS. STUDY DESIGN Randomized trial. MATERIALS/METHODS Sixty military health care beneficiaries (36 males) with a clinical diagnosis of PFPS were recruited and completed the study. Subjects underwent a standardized clinical examination and were randomized into a DN or sham treatment group. DN treatment consisted of insertion of an acupuncture-like needle into six sites in the quadriceps femoris muscles of the symptomatic lower extremity based on a palpation examination. The sham grouped received a simulated treatment with a sharp object and needle guide tube without puncturing the skin. Self-reports of pain, disability, and overall status were collected before treatment, immediately after treatment and at 72 hours. Data were analyzed with separate 2x2 repeated measures analysis of variance, with independent variables being Group (DN vs. sham) and Time (pre-treatment vs. immediately post-treatment, and pre-treatment vs. 72 hours). The hypothesis of interest in each case was the Group*Time interaction. The alpha-level was set a priori to .05 using 2-tailed tests. RESULTS Both groups exhibited a clinically meaningful reduction in pain based on numeric pain rating scale scores immediately post-treatment and at 72 hours, but there was no statistically significant difference between groups (p = 0.219, 0.310). There was no significant difference between groups for any other outcome measures. CONCLUSION These data suggest that DN treatment is not more effective than a sham DN treatment at reducing short-term pain and disability in individuals with PFPS when used as an isolated treatment approach. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Thomas G. Sutlive
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
| | - Andrew Golden
- Mendoza Physical Therapy Clinic, Fort Bliss, TX, USA
| | - Kristin King
- Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - William B. Morris
- Physical Therapy Clinic, Weed Army Community Hospital, Fort Irwin, CA, USA
| | - John E. Morrison
- Physical Therapy Clinic, Blanchfield Army Community Hospital, Fort Campbell, KY, USA
| | - Josef H. Moore
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
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Koppenhaver S, Kniss J, Lilley D, Oates M, Fernández-de-las-Peñas C, Maher R, Croy T, Shinohara M. Reliability of ultrasound shear-wave elastography in assessing low back musculature elasticity in asymptomatic individuals. J Electromyogr Kinesiol 2018; 39:49-57. [DOI: 10.1016/j.jelekin.2018.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
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Clewley D, Rhon D, Flynn T, Koppenhaver S, Cook C. Physical therapists familiarity and beliefs about health services utilization and health seeking behaviour. Braz J Phys Ther 2018; 22:336-343. [PMID: 29503116 DOI: 10.1016/j.bjpt.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Physical therapists' familiarity, perceptions, and beliefs about health services utilization and health seeking behaviour have not been previously assessed. OBJECTIVES The purposes of this study were to identify physical therapists' characteristics related to familiarity of health services utilization and health seeking behaviour, and to assess what health seeking behaviour factors providers felt were related to health services utilization. METHODS We administered a survey based on the Andersen behavioural model of health services utilization to physical therapists using social media campaigns and email between March and June of 2017. In addition to descriptive statistics, we performed binomial logistic regression analysis. We asked respondents to rate familiarity with health services utilization and health seeking behaviour and collected additional characteristic variables. RESULTS Physical therapists are more familiar with health services utilization than health seeking behaviour. Those who are familiar with either construct tend to be those who assess for health services utilization, use health services utilization for a prognosis, and believe that health seeking behaviour is measurable. Physical therapists rated need and enabling factors as having more influence on health services utilization than predisposing and health belief factors. CONCLUSION Physical therapists are generally familiar with health services utilization and health seeking behaviour; however, there appears to be a disconnect between what is familiar, what is perceived to be important, and what can be assessed for both health services utilization and health seeking behaviour.
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Affiliation(s)
- Derek Clewley
- Rocky Mountain University of Health Professions, Provo, United States; Duke University, Division of Physical Therapy, Department of Orthopaedics, Durham, United States.
| | - Dan Rhon
- Center for the Intrepid, San Antonio, United States; Baylor Doctoral Physical Therapy Program, Waco, United States
| | - Tim Flynn
- South College, Department of Physical Therapy, Knoxville, United States
| | | | - Chad Cook
- Duke University, Duke Clinical Research Institute, Division of Physical Therapy, Department of Orthopaedics, Durham, United States
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Albin S, Van Boerum D, Morgan J, Koppenhaver S. Timing of Supervised Physical Therapy after Hindfoot Fractures. Foot & Ankle Orthopaedics 2017. [DOI: 10.1177/2473011417s000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Category: Ankle, Hindfoot Introduction/Purpose: Fractures to the hindfoot, including the talus and calcaneus, have devastating long-term functional outcomes. To date, no randomized trials have been done assessing the best time to initiate physical therapy after surgical fixation of these fractures. The purpose of this study is to assess whether initiating a supervised physical therapy program including therapeutic exercise and manual therapy two weeks post-operatively (EARLY) versus seven weeks post-operatively (LATE) in patients following surgical fixation for these fractures results in differences in clinical outcomes. The secondary purpose of this study is to assess what factors predict outcomes after these hindfoot fractures. Methods: Fifty patients between the ages of 18-70 years having undergone an open reduction internal fixation (ORIF) of the calcaneus or talus were recruited to participate from two foot and ankle fellowship-trained orthopedic surgeons. Subjects were randomly assigned to initiate formal physical therapy starting within 2 weeks post-operatively (EARLY) (n=26) or 8 weeks post-operatively (LATE) (n=24). Treatment for both groups consisted of impairment based manual therapy and therapeutic exercise. The lower extremity functional scale (LEFS), the American Orthopeadic Foot and Ankle Society (AOFAS) hindfoot scale, range of motion (ROM), pain and girth measurements to assess swelling were the outcome measures for this study. Subjects in both groups were seen for a total of 10 visits. All subjects underwent follow-up assessments at 3 months, 6 months, and 12 months post-operatively. Between-group differences were analyzed using ANCOVAs with baseline scores as covariates. Regression was used to assess factors predicting patients’ self-reported outcomes. Results: Results demonstrated no significant differences between the groups at any time point (3, 6 or 12 months) for the LEFS (p=0.637) or the AOFAS (p=0.634). No significant differences existed between the two groups for active ROM (p=0.106) or swelling (p=0.389). Subjects in both groups demonstrated improved AOFAS scores from baseline to one year follow-up by 26 points (p=0.00); however, most of the change occurred within the first 6 months post-operatively with only a 1.722 (95% CI -3.63 to 7.08) change between 6 to 12 month follow-up visits. Baseline anxiety (as measured by the Beck Anxiety Questionnaire) significantly predicted LEFS scores at both the 6 month and 12 month follow-up periods (r= -0.55, p=0.0015 and r= -0.53, p=0.007). Conclusion: This study did not demonstrate that initiating early supervised physical therapy (within 2 weeks after surgical fixation) improves self-reported outcomes for patients after surgical fixation of a hindfoot fracture as assessed by the LEFS, the AOFAS hindfoot scores, or clinical outcomes such as ROM or swelling compared to patients initiating a formal physical therapy program seven weeks after surgery. Although, many these patients typically have less than ideal clinical outcomes, it is possible that addressing other factors such as anxiety may help improve long-term outcomes.
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Mason JS, Crowell M, Dolbeer J, Morris J, Terry A, Koppenhaver S, Goss DL. THE EFFECTIVENESS OF DRY NEEDLING AND STRETCHING VS. STRETCHING ALONE ON HAMSTRING FLEXIBILITY IN PATIENTS WITH KNEE PAIN: A RANDOMIZED CONTROLLED TRIAL. Int J Sports Phys Ther 2016; 11:672-683. [PMID: 27757280 PMCID: PMC5046961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Recently, dry needling has emerged as a popular treatment for muscular pain and impairments. While there are numerous studies detailing the benefits of dry needling for pain, few studies exist examining the effects on soft tissue mobility. PURPOSE The purpose of this study was to determine if the addition of hamstring dry needling to a standard stretching program results in greater improvements in hamstring flexibility compared to sham dry needling and stretching in subjects with atraumatic knee pain. Additionally, squat range of motion, knee pain, and the Lower Extremity Functional Scale were compared between the two groups. STUDY DESIGN Double blinded randomized controlled trial. METHODS Thirty-nine subjects were randomized to receive either dry needling (n = 20) or sham (n = 19) dry needling in addition to hamstring stretching, to all detected hamstring trigger points on two visits. All dependent variables were measured at baseline, immediately post intervention, and 1, 3, and 7 days after the initial treatment. Each subject also performed hamstring stretching three times daily for one week. RESULTS Significant improvements in hamstring range of motion and all other dependent variables were observed across time regardless of treatment group. However, the lack of significant time by group interactions indicated the improvements were not different between dry needling and sham dry needling groups. CONCLUSIONS The results of the current randomized controlled trial suggest that two sessions of dry needling did not improve hamstring range of motion or other knee pain-related impairments more than sham dry needling in a young active population with atraumatic knee pain. LEVEL OF EVIDENCE Therapy, Level 2.
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Affiliation(s)
| | - Michael Crowell
- Baylor University-Keller Army Community Hospital, Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
| | - Jeffery Dolbeer
- Baylor University-Keller Army Community Hospital, Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
| | - Jamie Morris
- San Antonio Military Medical Center, Joint Base San Antonio, TX, USA
| | | | - Shane Koppenhaver
- US Army Baylor University Doctoral Physical Therapy Program, Fort Sam Houston, TX, USA
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Thelen M, Koppenhaver S. PERFORMANCE OPTIMIZATION AND INJURY PREVENTION STRATEGIES FOR THE ARMY PHYSICAL FITNESS TEST: TECHNIQUE MATTERS. Int J Sports Phys Ther 2015; 10:391-401. [PMID: 26075155 PMCID: PMC4458927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
UNLABELLED The Army Physical Fitness Test (APFT) is a biannual training requirement for all soldiers. The Army has made significant overall fitness gains by developing functional and comprehensive Physical Readiness Training (PRT) programs, but more emphasis on individualized physical fitness test taking technique is warranted in order to optimize performance. The purpose of this clinical commentary is to provide clinicians with several examples of APFT performance enhancement techniques that can potentially be applied not only in the Army, but throughout the military and in the sports community where general fitness assessments are routinely administered. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Mark Thelen
- U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Shane Koppenhaver
- U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
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Koppenhaver S, Harris D, Harris A, O’Connor E, Dummar M, Croy T, Walker M, Flynn T. The reliability of rehabilitative ultrasound imaging in the measurement of infraspinatus muscle function in the symptomatic and asymptomatic shoulders of patients with unilateral shoulder impingement syndrome. Int J Sports Phys Ther 2015; 10:128-135. [PMID: 25883861 PMCID: PMC4387720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Rehabilitative ultrasound Imaging (RUSI) is increasingly used in the management of musculoskeletal conditions as it provides an objective measure of muscle function while being less invasive than needle electromyography. While research has documented the ability to reliably measure trunk muscles in patients with back pain, no study to date has used RUSI to quantify infraspinatus muscle function in patients with shoulder impingement syndrome (SIS). HYPOTHESIS/PURPOSE The purpose of this study was to examine the intra-rater and inter-rater reliability of measuring infraspinatus muscle thickness with RUSI and to compare such measures during resting versus contracted muscle states and in the symptomatic versus asymptomatic shoulders in patients with SIS. STUDY DESIGN Cross-sectional, measurement study. METHODS Fifty-two participants with unilateral SIS underwent a standard baseline examination to include RUSI of the infraspinatus muscle bilaterally. Images were acquired at rest and during a submaximal isometric contraction, by two novice examiners. The isometric contraction was elicited by having prone participants externally rotate their shoulder from a position of 90° abduction into a dynamometer and hold a static force of 20 mmHg (approximately 20-30% maximal voluntary contraction). Images were captured using a standardized placement of the transducer placed just inferior to the spine of the scapula along the medial scapular border and measured off-line using Image J software (V1.38t, National Institutes of Health, Bethesda, Maryland). RESULTS Estimates (ICCs) for thickness measurements ranged between 0.96 and 0.98 for intra-rater reliability and between 0.87 and 0.92 for inter-rater reliability. Reliability was substantially lower (ICC = 0.43 to 0.79) for calculations of percent thickness change. The infraspinatus muscle was significantly thicker when contracted (19.1mm) than during rest (16.2mm) in both shoulders (p < 0.001). There was also a statistically significant interaction between contraction state and shoulder (p = 0.026), indicating that the change in thickness that occurred during contraction was significantly smaller in the symptomatic shoulder than in the asymptomatic shoulder. CONCLUSION RUSI measurements of infraspinatus muscle thickness appear to be highly reliable, both within the same examiner and between different examiners, in patients with SIS. Moreover, such measurements were different in rested and contracted states of the infraspinatus, as well as, between the symptomatic and asymptomatic shoulders of patients with unilateral SIS. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Shane Koppenhaver
- U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Danny Harris
- Physical Therapy Student During Study, U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Amanda Harris
- Physical Therapy Student During Study, U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Erin O’Connor
- Physical Therapy Student During Study, U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Max Dummar
- Physical Therapy Student During Study, U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Theodore Croy
- U.S. Army‐Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA
| | - Michael Walker
- South College Doctor of Physical Therapy Program, Knoxville, TN, USA
| | - Tim Flynn
- South College Doctor of Physical Therapy Program, Knoxville, TN, USA
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Hebert J, Koppenhaver S, Fritz J, Parent E. Clinical Prediction for Success of Interventions for Managing Low Back Pain. Clin Sports Med 2008; 27:463-79, ix-x. [DOI: 10.1016/j.csm.2008.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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