Patient-Specific Functional Scale Research Articles

Is there an association between changes in pain or function with changes in scapular dyskinesis: A prospective cohort study

ObjectiveTo assess the association between changes in pain or function with changes in scapular dyskinesis in participants with subacromial shoulder pain. MethodForty-four participants with subacromial shoulder pain were assessed at baseline and 8 weeks later. The outcome measures included ‘pain at rest’ and ‘pain during movement’ using Numeric Pain Rating Scale (NPRS), shoulder function using Patient Specific Functional Scale (PSFS), and observation of scapular movement pattern using the scapular dyskinesis test. Robust paired t-tests were used to compare scores between baseline and follow-up. Repeated measures correlation coefficient was used to assess the association between changes in pain or function with changes in scapular dyskinesis scores. ResultsA fair association was found between improvement in function and improvement in scapular dyskinesis (correlation coefficient = −0.4, 95% CI: −0.6 to −0.1). No associations were found between changes in ‘pain at rest’ (correlation coefficient = −0.1, 95% CI: −0.2 to 0.2) or ‘pain during movement’ (correlation coefficient = 0.28, 95% CI: 0.0 to 0.5) with changes in scapular dyskinesis. ConclusionOur findings showed improvement in function is associated with improvement in scapular dyskinesis scores. Future studies should explore whether there is causal effect between improvement in scapular dyskinesis and function.

The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons—Elbow form capture aspects of functioning that are important to patients with elbow injuries

Study DesignThis is a cross-sectional study. IntroductionThe Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons–elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice. Purpose of the StudyTo use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e. MethodsOne hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement. ResultsA total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475–driving (35%) and D440–fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%. DiscussionThis study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section (‘d’ categories) of the ICF, this validated that these PROMs measure this conceptual domain. ConclusionThe PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.

Content validity and responsiveness of the Patient-Specific Functional Scale in patients with Dupuytren's disease

IntroductionPatient-reported outcome measures have become the standard tool for reflecting the patient's perspective on their treatment outcome for a wide variety of hand conditions. The Patient-Specific Functional Scale (PSFS), is an individualized questionnaire that enables patients to specify those activities with which they have difficulty in daily life. Purpose of the StudyThis study aims to determine the content validity and responsiveness of the PSFS compared with the Michigan Hand Questionnaire (MHQ) in patients with Dupuytren's disease. Study DesignMulticentre inception cohort. MethodsPatients with Dupuytren's disease being treated with percutaneous needle aponeurotomy, limited fasciectomy, or skin graft were selected from a database with routine outcome measurements in usual care. To assess content validity of the PSFS, the activities specified by patients were classified into the International Classification of Function core set for hand conditions. The standardized response mean is calculated for the pre- and post-change scores of the PSFS to evaluate responsiveness. ResultsThree hundred and eight patients were analyzed before and three months after treatment. Content validity of the PSFS was appropriate because 95% of all items could be classified into the International Classification of Function activities and participation domain. The standardized response mean of the PSFS was 1.0 (95% confidence interval, 0.86-1.2), which was substantially larger than the standardized response mean of the MHQ score 0.58 (95% confidence interval, 0.42-0.74). DiscussionThe PSFS is a content-valid questionnaire which may be more responsive to change than a fixed-item instrument such as the MHQ in patients with Dupuytren's disease. ConclusionsThe PSFS is a valuable tool to set therapy goals and evaluate the progress over time in patients with Dupuytren's disease.

Evaluation of treatment outcome using the patient specific functional scale in knee osteoarthritis patients undergoing multidisciplinary rehabilitation

Purpose: Outcomes of multidisciplinary rehabilitation for patients with knee osteoarthritis (OA) within multidisciplinary settings are often evaluated with disease-specific tools measuring pain and physical functioning. The Patient Specific Functional Scale (PSFS) might capture activity limitations not otherwise captured by standard tools measuring pain and physical functioning. Therefore, the first objective was to make an inventory of which activities are commonly reported as treatment aims by knee OA patients undergoing patient-specific multidisciplinary rehabilitation and to categorize these activities into broader taxonomic domains using the International Classification of Functioning, Disability, and Health (ICF).

AN EXPLORATORY CASE SERIES ANALYSIS OF THE USE OF PRIMAL REFLEX RELEASE TECHNIQUE™ TO IMPROVE SIGNS AND SYMPTOMS OF HAMSTRING STRAIN

Hamstring strain (HS), a common condition found among the injured physically active population, is often treated with rest, stretching, and modalities. Primal Reflex Release Technique™ (PRRT™) is a manual therapy technique used to treat pain caused by over-stimulation of the body's primal reflexes. The purpose of this case series was to explore the immediate effects of PRRT™ for treating hamstring strains. A multi-site case series approach was used to report on the treatment of six patients with HS using PRRT™. The Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS) and range of motion (ROM) measurements were collected, as well as evaluation of symmetry of the sacroiliac joints, reported as sacroiliac dysfunction(SJD). Primal Reflex Release Technique™ (PRRT™) was an effective treatment for subjects with HS. Subjects reported a significant decrease in pain on the NPRS, averaging five points over the course of the treatment (95% CI of 3.374, 6.626). Functional measures on the PSFS were significantly improved following treatment (post-treatment mean = 7.8 ± 1.84, pre-treatment mean = 4.8 ± .97, p < .001; CI: -2.1, -3.9). The mean change on the Passive Knee Extension Test (PKE) (mean = 8.20 ° ± 3.96 °) and ASLR (mean = 10.333 ° ± 8.98 °) indicated statistically significant improvements of post-treatment ROM (mean change = 8.20 ° ± 3.96 °, p = .01). The presence of SJD was observed in all subjects prior to treatment and resolved in all subjects when reassessed after treatment. In this case series, the use of PRRT™ resulted in decreased pain, increased function, and increased range of motion, as well as resolved SJD. The Primal Reflex Release Technique™ may be useful in decreasing symptoms of HS acutely, but long-term effects are unknown at this time. Clinicians should consider using a treatment which targets the autonomic nervous system when addressing pain associated with HS. Level 4 - case series.

Cryotherapy With Mobilization Versus Cryotherapy With Mobilization Reinforced With Home Stretching Exercises in Treatment of Chronic Neck Pain: A Randomized Trial

ObjectivesThe purpose of this study was to compare the effectiveness of cryotherapy with mobilization (CM) vs cryotherapy with mobilization reinforced with home stretching exercises (CMS) on pain and disability. MethodA randomized clinical trial with 2-arm parallel design, concealed allocation, assessor blinding, and intention to-treat analysis. Sixty participants were in 2 groups. Group 1 included cryotherapy with mobilization twice per week for 5 weeks. Group 2 included cryotherapy with mobilization plus home stretching exercises 5 times per week for 5 weeks. The evaluations were at baseline and 2 days posttreatment for the numeric pain rating scale, neck disability index, patient-specific functional scale, and global rating of change. ResultsThe CM and CMS decreased neck pain and disability (P = .000). The statistical significance between the groups’ differences favored the CM in the numeric pain rating scale, patient-specific functional scale, global rating of change (P = .000), and neck disability index (P = .004). ConclusionCryotherapy with mobilization for subjects in this study was more effective in decreasing disability and neck pain than CMS.

Cross-Cultural Adaptation and Validation of the Nepali Version of the Pelvic Girdle Questionnaire

ObjectiveThe purpose of this study was to translate, cross-culturally adapt, and assess the reliability and validity of the Pelvic Girdle Questionnaire (PGQ) in pregnant Nepalese women. MethodsThe cross-cultural adaptation process was conducted according to the Guillemin guidelines. Reliability and validity were assessed using cross-sectional design. The participants responded to questionnaires of sociodemographics, the Nepali version of the PGQ, the Oswestry Disability Index, the Patient-Specific Functional Scale, the 5-item version of the Edinburgh Depression Scale, and the Numerical Pain Rating Scale. The internal consistency was assessed with Cronbach's alpha. The test–retest reliability was calculated using the intraclass correlation coefficient and smallest detectable change. Construct validity was assessed by testing 9 a priori hypotheses that examine correlations between the PGQ activity and symptom subscales, and also among the PGQ subscales and Oswestry Disability Index, Numerical Pain Rating Scale, Patient-Specific Functional Scale, and 5-item version of the Edinburgh Depression Scale. Spearman and Pearson's correlation were used to assess the correlations. ResultsA sample of 111 pregnant women were included in the study. The Cronbach's alpha for the Nepali version of the total PGQ was good (α = 0.83), and the test–retest reliability was acceptable (ICC2.1, 0.72) with a measurement error of SDC95% 18.6 points. Seven of the 9 hypotheses found support, which confirms acceptable construct validity of the Nepali PGQ. ConclusionThe Nepali version of the PGQ is a reliable and valid tool for assessing pelvic girdle pain in pregnant Nepalese women.

Discriminant Analysis of the Patient-Specific Functional Scale in Discerning Between Loss of Physical Function Categories in Community-Dwelling Older Adults

Previous research indicates that the Patient-Specific Functional Scale (PSFS) is a reliable and valid measure of loss of physical function in community-dwelling older adults. However, the ability of the PSFS to classify community-dwelling older adults into categories of loss of physical function has not been investigated. The purpose of this study was to investigate the ability of the PSFS to discern between different categories of physical function loss in community-dwelling older adults. Thirty-one community-dwelling older adults (mean age = 81.1 years; SD = 8.3) completed a set of physical function questionnaires: the PSFS, the Lower Extremity Functional Scale (LEFS), and the Activities-specific Balance Confidence (ABC) scale. Study participants also completed the Short Physical Performance Battery (SPPB). Scores on the PSFS, LEFS, ABC scale, and SPPB were divided into loss of physical function categories (mild, moderate, severe, and very severe). Discriminant analysis was used to determine the ability of the PSFS to discern between the different categories of loss of physical function. The canonical correlation between the eigenvalues and classifications for the LEFS, ABC scale, and SPPB was 0.85 (P &lt; .001), 0.72 (P &lt; .001), and 0.40 (P = .18), respectively. The findings of this investigation indicate that the PSFS has predictive ability to classify community-dwelling older adults into categories of loss of physical function, based on LEFS and ABC scale classifications, which could be important for purposes such as evaluation, screening, and measuring clinically important differences in loss of physical function.

The Search for a Functional Outcome Measure for Physical Therapy in Specialist Palliative Care: An Ongoing Journey

A perspective article on the field testing of outcome measures and functional assessment tools by physical therapists working in specialist palliative care. Palliative care physical therapy is an evolving field, and there is a pressing need to evaluate interventions. The authors are members of a specialist palliative care physical therapy team in Ireland who evaluated their service by conducting several research and quality improvement activities. This involved trialing the use of a number of outcome measures, including functional, global, patient-specific, and quality-of-life scales. The following tools were piloted: the Edmonton Functional Assessment Tool, Second Version; an adjusted version of the Functional Independence Measure, Timed Up and Go test; Five Times Sit to Stand test; a self-devised Mobility Measure; distress thermometer; Patient-Specific Functional Scale; and EORTC-QLC C30. This article outlines the journey toward finding the most clinically useful outcome measure to use with palliative care patients. All the tools that were trialed had disadvantages, and many were not suitable for use on sizeable cohorts in our palliative care population. The team concluded that a functional outcome measure was the measure most suitable for measuring the effect of physical therapy interventions and that there was a need to devise a new functional measure specifically for palliative care. The next stage is to use pragmatic clinician input in devising a clinically useful tool in collaboration with research-based content experts to ensure acceptable psychometric properties. It is hoped that this approach will advance the evidence for physical therapy in specialist and general palliative care.

An initiative to improve equity, timeliness and access to District Health Board-funded physiotherapy in Canterbury, Christchurch, New Zealand.

Background and context General practice teams frequently request orthopaedic and musculoskeletal physiotherapy. In the Canterbury District Health Board (DHB) region, before November 2018, the criteria for DHB-funded physiotherapy were unclear. Wait times were many months. Care was provided on hospital sites. Limited data were available about the service. Assessment of problem A clinical project group including private and DHB hospital physiotherapists and general practitioners was established. Patients requiring orthopaedic and musculoskeletal physiotherapy who had certain criteria were seen by physiotherapists in contracted private clinics in the community instead of by physiotherapists in hospital departments. Patients received up to NZ$300 (excluding GST) of care. A claiming process was established that required the physiotherapy clinics to provide data on patient outcomes. Results In the first 12 months of the programme, 1229 requests were accepted. Patients waited an average of 11.1 days for their first appointment. There was an average Patient Specific Functional Scale increase of 3.7 after treatment. Strategies for improvement A change environment was critical for this community-based, geographically distributed model to succeed. It was supported by key clinicians and funders with sufficient authority to make changes as required. It required ongoing clinical oversight and operational support. Lessons DHB orthopaedic and musculoskeletal physiotherapy can be moved from hospital sites to a community-based, distributed service in a timely, effective and equitable fashion. There was a prompt time to treatment. Data collection was improved by tracking 'before' and 'after' measures.

Descriptive Analysis of an Interdisciplinary Musculoskeletal Program.

Interdisciplinary musculoskeletal programs address comorbidities confounding musculoskeletal conditions and serve as an alternative to the single provider model. Descriptive analysis of an interdisciplinary musculoskeletal program. Retrospective descriptive analysis of patients enrolled in an interdisciplinary musculoskeletal program. Retrospective subanalysis: cohort of patients enrolled in interdisciplinary program with low back pain compared to historical cohort of patients in a single provider clinic. Academic interdisciplinary musculoskeletal health program. Patients referred to program with at least one follow-up visit over a 2-year period. Interdisciplinary musculoskeletal program involving physiatry, pain anesthesia, nutrition, psychology, rheumatology, sleep medicine, nursing, and physical therapy. Patient Specific Functional Scale (PSFS), Oswestry Low Back Disability Index (ODI), number of magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, opioid prescriptions; Press Ganey scores. One hundred and seventy-three patients were enrolled and had at least one follow-up visit. Twenty-four percent of patients with any musculoskeletal complaint demonstrated clinically significant improvements in total PSFS. Mean improvement in PSFS was + 0.864 (SD 1.94), which was a statistically significant improvement (P = .0005), but not clinically significant. Magnetic resonance imaging was ordered for 5% of patients, and no computed tomography scans were ordered. Six percent of patients received opioid prescriptions. Press Ganey scores: 96% responded favorably in regard to physician communication quality, 86% of patients responded favorably for access to care, and 78% responded favorably for care coordination. 27.8% of patients with low back pain in the interdisciplinary program achieved a significant decrease in their ODI, compared to 26.6% in the single provider clinic (P = .87). Interdisciplinary musculoskeletal programs are a promising model to improve the functioning of patients with musculoskeletal pain and decrease downstream utilization. These programs may be more appropriate for patients at higher risk of developing chronic pain.

Validity and reliability of telephone administration of the patient-specific functional scale for the assessment of recovery from snakebite envenomation.

ObjectivesAlthough more than 1.8 million people survive snakebite envenomation each year, their recovery is understudied. Obtaining long-term follow-up is challenging in both high- and low-resource settings. The Patient-Specific Functional Scale (PSFS) is an easily administered, well-accepted patient-reported outcome that is validated for assessing limb recovery from snakebite envenomation. We studied whether the PSFS is valid and reliable when administered by telephone.MethodsThis is a secondary analysis of data from a randomized clinical trial. We analyzed the results of PSFS collected in-person on days 3, 7, 14, 21, and 28 and by telephone on days 10, 17, and 24. We assessed the following scale psychometric properties: (a) content validity (ceiling and floor effects), (b) internal structure and consistency (Cronbach’s alpha), and (c) temporal and external validity using Intraclass Correlation Coefficient (ICC). Temporal stability was assessed using Spearman’s correlation coefficient and agreement between adjacent in-person and telephonic assessments with Cohen’s kappa. Bland Altman analysis was used to assess differential bias in low and high score results.ResultsData from 74 patients were available for analysis. Floor effects were seen in the early post-injury time points (median: 3 (IQR: 0, 5) at 3 days post-enrollment) and ceiling effects in the late time points (median: 9 (IQR: 8, 10). Internal consistency was good to excellent with both in-person (Cronbach α: 0.91 (95%CI 0.88, 0.95)) and telephone administration (0.81 (0.73, 0.89). Temporal stability was also good (ICC: 0.83 (0.72, 0.89) in-person, 0.80 (0.68, 0.88) telephone). A strong linear correlation was found between in-person and telephone administration (Spearman’s ρ: 0.83 (CI: 0.78, 0.84), consistency was assessed as excellent (Cohen’s κ 0.81 (CI: 0.78, 0.84), and Bland Altman analysis showed no systematic bias.ConclusionsTelephone administration of the PSFS provides valid, reliable, and consistent data for the assessment of recovery from snakebite envenomation.

Implementation of a Hospital-Based Orthopaedic Physical Therapy Residency Program: A Case Report Describing Clinical Outcomes, Productivity, and Perceived Benefits

Background and Purpose. Currently, there are 264 credentialed physical therapy residencies across the United States. Most residency programs take a limited number of residents per year, thus the opportunity for the projected 10,721 physical therapy students graduating in 2019 was relatively small. One of the challenges to developing a new physical therapy residency is convincing the host institution that it will be beneficial in the long-term. The purpose of this case report was to describe the effect of implementing a hospital-based orthopaedic physical therapy residency program on clinical outcomes, productivity, and the perceived benefits of the residency program by staff physical therapists and hospital administrators. Case Description. The Patient-Specific Functional Scale (PSFS) was used to assess treatment outcomes for 2 years before the start of the residency program (2007–2008) and for each of the 4 years after the inauguration of the first resident (2009–2012). A total of 3,717 patient outcome scores were used in the analysis. Productivity, measured in “patient visits” and zip code data, representing the service area, was also collected. In addition, staff physical therapists and administrators completed a survey to determine their perceived benefits of the residency program. Outcomes. There was a steady improvement in clinical outcomes from 2007 to 2012. In 2007, the average change in the PSFS was 3.81 and in 2012, 4 years after the start of the residency program, the average change in PSFS increased 37% to 5.21. The number of patient visits increased to 60,983 (+17,071), and patients were travelling from outside the service area (41 additional zip codes) to receive treatment at the hospital from staff physical therapists with specialized training. Survey results indicate that both staff physical therapists and hospital administrators had a very positive view of the impact of the residency program on job satisfaction, professional development, staff retention, and success of the department. Discussion and Conclusion. The results of this study suggest that hospital-based orthopaedic physical therapy residency programs have the potential to improve clinical outcomes, increase productivity, and create a “culture of excellence.” It provides some justification for hospitals and other physical therapy facilities to invest in residency training.

Psychosomatic therapy for patients frequently attending primary care with medically unexplained symptoms, the CORPUS trial: study protocol for a randomised controlled trial

BackgroundMedically unexplained symptoms (MUS) are highly prevalent and pose a burden both on patients and on health care. In a pilot study psychosomatic therapy delivered by specialised therapists for patients with MUS showed promising results with regard to patient’s acceptability, feasibility and effects on symptoms. The aim of this study is to establish whether psychosomatic therapy by specialised psychosomatic exercise therapists is cost- effective in decreasing symptoms and improving functioning in patients who frequently consult their general practitioner (GP) with MUS.MethodsA randomised effectiveness trial with an economic evaluation in primary care with 158 patients aged 18 years and older who are frequently consulting their GP with MUS. Patients will be assigned to psychosomatic therapy in addition to usual care or usual care only. Psychosomatic therapy is a multi-component and tailored intervention, aiming to empower patients by applying psycho-education, relaxation techniques, mindfulness, cognitive approaches and/or graded activity. Patients assigned to the psychosomatic therapy receive 6 to 12 sessions of psychosomatic therapy, of 30–45 min each, delivered by a specialised exercise or physical therapist.Primary outcome measure is patient-specific functioning and disability, measured with the Patient-Specific Functional Scale (PSFS). Secondary outcome measures are symptom severity, consultation frequency and referrals to secondary care, patient satisfaction, quality of life and costs. Assessments will be carried out at baseline, and after 4 and 12 months.An economic evaluation alongside the trial will be conducted from a societal perspective, with quality-adjusted life years (QALYs) as outcome measure. Furthermore, a mixed-methods process evaluation will be conducted.DiscussionWe expect that psychosomatic therapy in primary care for patients who frequently attend the GP for MUS will improve symptoms and daily functioning and disability, while reducing consultation frequency and referrals to secondary care. We expect that the psychosomatic therapy provides value for money for patients with MUS.Trial registrationNetherlands Trial Register, ID: NL7157 (NTR7356). Registered 13 July 2018.

Platelet rich plasma injection for acute Achilles tendon rupture: PATH-2 randomised, placebo controlled, superiority trial

ObjectiveTo determine whether an injection of platelet rich plasma improves outcomes after acute Achilles tendon rupture.DesignRandomised, placebo controlled, two arm, parallel group, participant and assessor masked, superiority trial.SettingSecondary care trauma...

Effect of Neural Mobilization on Nerve-Related Neck and Arm Pain: A Randomized Controlled Trial.

Purpose: Neural mobilization (NM) is often used to treat nerve-related conditions, and its use is reasonable with nerve-related neck and arm pain (NNAP). The aims of this study were to establish the effect of NM on the pain, function, and quality of life (QOL) of patients with NNAP and to establish whether high catastrophizing and neuropathic pain influence treatment outcomes. Method: A randomized controlled trial compared a usual-care (UC; n=26) group, who received cervical and thoracic mobilization, exercises, and advice, with an intervention (UCNM; n=60) group, who received the same treatment but with the addition of NM. Soft tissue mobilization along the tract of the nerve was used as the NM technique. The primary outcomes were pain intensity (rated on the Numerical Pain Rating Scale), function (Patient-Specific Functional Scale), and QOL (EuroQol-5D) at 3 weeks, 6 weeks, 6 months, and 12 months. The secondary outcomes were the presence of neuropathic pain (using the Neuropathic Diagnostic Questionnaire) and catastrophizing (Pain Catastrophising Scale). Results: Both groups improved in terms of pain, function, and QOL over the 12-month period (p<0.05). No between-groups differences were found at 12 months, but the UCNM group had significantly less pain at 6 months (p=0.03). Patients who still presented with neuropathic pain (p<0.001) and high pain catastrophizing (p=0.02) at 6- and 12-mo follow-ups had more pain. Conclusions: Both groups had similar improvements in function and QOL at 12-month follow-up. The UCNM group had significantly less pain at 6-month follow-up and a lower mean pain rating at 12-month follow-up, although the difference between groups was not significant. Neuropathic pain is common among this population and, where it persisted, patients had more pain and functional limitations at 12-mo follow-up.

The effect of extension assist orthosis with pneumatic bladders on pain and function for patients with early knee osteoarthritis.

There are few non-invasive treatment options to slow the progression of osteoarthritis (OA). Recently, a novel knee unloader brace with knee extension assist has become commercially available. Therefore, the purpose of this study was to evaluate the preliminary effectiveness of using a novel unloader brace with extension assist to improve pain and functional outcomes for patients with knee OA. Thirty subjects (17 control group, 13 brace group) completed baseline and 6-week follow up testing with no brace. Patients were randomized into a Brace or No Brace group after baseline testing. Functional tests [timed up and go (TUG), stair climbing test (SCT) and six-minute walk (6MW)], self-reported measures [Knee Outcome Survey (KOS), pain, Patient Specific Functional Scale (PSFS)] and isometric knee extension strength were assessed. Repeated measure ANOVAs were used to identify differences in group and time. Pearson correlation coefficients were calculated for both average number of steps in the brace and exercises compliance compared to change in clinical scores for each group. There was a significant interaction effect for "worst pain" (P=0.002), the brace group improved from a 7.3/10 to 4.7/10 at follow-up (P=0.006) while the control group had no change. There was an effect of time for the SCT (P=0.02), "best knee pain" (P=0.050), and knee extension range of motion (ROM) (P=0.041). There were no significant correlations between exercise compliance and change in outcomes, but when the groups were collapsed there was a significant correlation between compliance and change in knee extension ROM (r=0.526; P=0.025). The extension assist pneumatic unloader brace group demonstrated a significant and important reduction in the "worst knee pain". This may indicate that wearing the brace was able to reduce painful flares. Both groups improved over time for the SCT, "best knee pain", and knee extension ROM, which can be attributed to the stretching protocol. This unloader brace is a promising non-invasive treatment option for patients with knee OA when combined with a stretching program.

Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment.

Few data exist to understand the recovery phase of pit viper envenomation. A recently published placebo-controlled clinical trial affords this opportunity. The purpose of this study is to examine the time course of recovery from copperhead snake (Agkistrodon contortrix) envenomation patients managed with and without the use of antivenom, stratified by age, sex, anatomic site of envenomation, initial severity of envenomation, and geographic region. This is a post-hocsubgroup analysis of data from a multi-center double-blinded clinical trial of Fab antivenom (FabAV) vs. placebo. Outcomes were the Patient-Specific Functional Scale (PSFS) score at 3, 7, 10, and 14days after envenomation. Least-squares mean PSFS score curves were calculated for each subgroup, and repeated measures ANOVA was used to estimate between-group comparisons. Seventy-two subjects were included, of whom 44 received FabAV. Malesdemonstrated better overall recovery thanfemales (model predicted PSFS score 6.18 vs 4.99; difference 1.19; 95% CI 0.12 to 2.25; p = 0.029). No sex difference was found in response to FabAV. Overall recovery and effect of FabAV were similar in adult vs adolescent patients, patients with upper vs lower extremity envenomation, and patients with initially mild vs moderate envenomation signs. Analysis by geographic location was not successful due to ANOVA mode instability. Male victims of copperhead snake envenomation demonstrate slightly better recovery than females, but response to Fab antivenom overall is similar across all subgroups studied.

A central nervous system-focused treatment approach for people with frozen shoulder: protocol for a randomized clinical trial

BackgroundFrozen shoulder (FS) is a musculoskeletal condition of poorly understood etiology that results in shoulder pain and large mobility deficits. Despite some physical therapy interventions, such as joint mobilization and exercise, having shown therapeutic benefit, a definitive treatment does not currently exist. The aim of this study will be to compare the effectiveness of a central nervous system (CNS)-directed treatment program versus a standard medical and physical therapy care program on outcomes in participants with FS.Methods/designThe study is a two-group, randomized clinical trial with blinding of participants and assessors. Participants will be recruited via referrals from orthopedic surgeons and physical therapists, community-based advertisements, private care practices and hospitals. Participants will be randomized to receive either a CNS-focused treatment program or standard medical and physical therapy care. The Shoulder Pain And Disability Index (SPADI) will be the primary outcome, while the Numeric Pain Rating Scale (NPRS), shoulder range of movement (ROM), The Patient Specific Functional Scale, two-point discrimination threshold and laterality judgement accuracy will be the secondary outcomes. Assessment will occur at baseline, at the end of the treatment program (week 10), and at 3 and 6 months’ follow-up.DiscussionPreliminary data suggest that treatments that target CNS function are a promising approach to the treatment of people with shoulder pain including patients with FS. In the context of modest effects from most available physical therapy treatments for FS, this CNS-focused approach may lead to improved clinical outcomes. The trial should determine if the CNS-directed program is more effective than traditional interventions at reducing pain intensity and improving function in a FS cohort and will follow up participants for 6 months, providing important information on the persistence of any treatment effects.Trial registrationNCT03320200. Registered on October 25, 2017.

Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings

Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, andM-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.