Prescription Of Physical Therapy Research Articles

Physical medicine for coincidence of cancer and inflammatory rheumatic disease : What speaks in favour and what to consider?

The coincidence of an inflammatory rheumatic and a malignant disease causes aphysical, cognitive and psychological reduction in performance. The prescription of physical therapy is therefore essential to address safety issues associated with both diseases, as well as side effects associated with antirheumatic and antineoplastic therapy that can impact the treatment. It is important to perform arisk assessment prior to physical therapy to identify potential safety issues and to determine baseline physical and functional status. In this review article descriptive information and the current literature on the safety of physical therapy interventions for people with rheumatic and malignant disease are highlighted, taking the disease process, treatment side effects and associated precautions and contraindications into account.

Comparative Analysis of Ventilatory Responses during Stress Tests in Patients with Chronic Pain: Implications for Therapeutic Interventions.

Understanding the differences in ventilatory responses during exercise between patients with fibromyalgia and those with other chronic pain disorders is crucial for developing effective therapeutic interventions, especially in exercise to identify the better physical therapy prescription. Both populations face unique challenges that impact their ability to engage in physical activity; yet, the underlying physiological responses can vary significantly. In this context, the methodology of this study entailed conducting a comparative analysis of the ventilatory response during exercise in patients with fibromyalgia and those with other chronic pain disorders. The experimental protocol included a total of 31 participants (n = 13 diagnosed with fibromyalgia and n = 18 diagnosed with other chronic pain conditions). All participants completed a stress test, where the ventilatory parameters were measured in three stages (i.e., resting, incremental exercise, and recovery). The results revealed significant differences (p<0.05) in ventilatory responses between both groups. Patients with fibromyalgia exhibited reduced time for the aerobic threshold and a higher respiratory frequency in the anaerobic threshold compared to those with other chronic pain disorders. Furthermore, fibromyalgia patients demonstrated higher values in the ventilatory coefficient during the test and in the recovery stage. In conclusion, these differences underscore the need for tailored exercise programs that specifically address the unique ventilatory challenges faced by fibromyalgia patients to improve their physical function and overall quality of life.

Risk Factors for Loss to Follow Up in Pediatric Supracondylar Humerus Fractures

BackgroundThis study seeks to analyze risk factors associated with loss to follow-up (LTF) after pin pull in pediatric patients with operatively treated supracondylar humerus fractures (SCHF). MethodsA retrospective cohort study of patients under 18 years with operative SCHF from 2010-2020 was conducted. Factors of interest included LTF, age, race, language, distance to the hospital, Gartland fracture type, and Social Deprivation Index (SDI) by ZIP code. Univariate logistic regression was performed for each independent variable and significant variables were additionally analyzed with multivariate logistic regression analysis (MVLR). Results698 patients were included in the study. LTF was 27.8% (194/698). There was a significant difference in LTF between White and non-White (21.5% vs. 31.8%, p=0.003) patients. LTF patients had higher mean Social Deprivation Index (SDI) scores by ZIP code (59.8 vs. 45.7, p<0.0001). When comparing the most deprived to the least deprived quartile, the Odds Ratio for LTF was 3.34 (95% CI 2.12-5.27). The patients lost to follow up were also younger (mean age of 6.9 years old versus 7.8 years old; p=0.0004). After MVLR, higher SDI and younger age remained significant. ConclusionHigher social deprivation scores and younger age were associated with LTF in surgically treated pediatric SCHFs at this institution. Level of Evidencelevel III Key Concepts(1)Patients with higher Social Deprivation Index scores by zip code and younger age have higher rates of loss to follow-up after pin pull for operatively managed supracondylar humerus fractures(2)Patients that were lost to follow-up had lower rates of physical therapy prescriptions compared to patients that were not lost to follow-up(3)No differences in complications were seen in the loss to follow-up group compared to the group that follow-up

Demographic and Diagnostic Factors in Physical Therapy Attendance.

Introduction Physical therapy (PT) is an effective nonoperative treatment for various orthopedic diagnoses. However, patients may have many reasons to dismiss PT, including favoringanother intervention for their injury, time constraints, transportation, and cost. This dismissal of PT may contribute to inadequate patient compliance. This study aimed to elucidate patient compliance with a basic PT prescription and whether PT led to subjective injury improvement. Methods This is a retrospective study of patients observed in Stony Brook Orthopedic clinics from 08/01/2022 to 12/23/2022. Patients prescribed PT received a phone call six weeks after the PT prescription. The primary outcome was patient attendance at PT. Secondary outcomes were subjective; symptomatic improvement was listed asbetter, worse, or the same. Chi-square testing was used to compare outcomes. Results A total of 100 patients were enrolled in the study. Patients prescribed PT following surgery were more likely to attend compared to patients prescribed PT as a primary treatment (P value=0.027). The association between attendance at PT and a change in subjective symptoms (better, worse, same) was not significant. Patients' age, sex, and chronicity of injury were not significant factors in PT attendance. Of the 40 patients who did not attend PT, 14 cited time constraints, 11 utilized self-directed treatment, three cited insurance, two cited transportation, and 10 cited other reasons. Conclusions Overall, postoperative patients were more likely to attend PT compared to patients prescribed PT as a primary treatment. Factors such as age, sex, and chronicity of injury did not affect whether a patient attended PT. Of the patients enrolled, 71% stated subjective improvement in symptoms, but there was no association between symptoms and PT attendance. This study highlights the characteristics of those patient factors that may influence PT compliance and underscores the importance of further research into the population most likely to attend and benefit from PT.

Evaluation of a collaborative ambulatory orthopedic care program for patients with hip and knee osteoarthritis: a comparative observational cohort study

BackgroundIn 2014, the novel orthopedic care program was established by the AOK health insurance fund in southern Germany to improve ambulatory care for patients with musculoskeletal disorders. The program offers extended consultation times, structured collaboration between general practitioners and specialists, as well as a renewed focus on guideline-recommended therapies and patient empowerment. The aim of this study was to assess the impact of the program on health service utilization in patients with hip and knee osteoarthritis (OA).MethodsThis retrospective cohort study, which is based on claims data, evaluated health service utilization in patients with hip and knee OA from 2014 to 2017. The intervention group comprised OA patients enrolled in collaborative ambulatory orthopedic care, and the control group received usual care. The outcomes were participation in exercise interventions, prescription of physical therapy, OA-related hospitalization, and endoprosthetic surgery rates. Generalized linear regression models were used to analyze the effect of the intervention.ResultsClaims data for 24,170 patients were analyzed. Data for the 23,042 patients in the intervention group were compared with data for the 1,128 patients in the control group. Participation in exercise interventions (Odds Ratio (OR): 1.781; 95% Confidence Interval (CI): 1.230–2.577; p = 0.0022), and overall prescriptions of physical therapy (Rate Ratio (RR): 1.126; 95% CI: 1.025–1.236; p = 0.0128) were significantly higher in the intervention group. The intervention group had a significantly lower risk of OA -related hospitalization (OR: 0.375; 95% CI: 0.290–0.485; p < 0.0001). Endoprosthetic surgery of the knee was performed in 53.8% of hospitalized patients in the intervention group vs. 57.5% in the control group; 27.7% of hospitalized patients underwent endoprosthetic surgery of the hip in the intervention group versus 37.0% in the control group.ConclusionsIn patients with hip and knee OA, collaborative ambulatory orthopedic care is associated with a lower risk of OA-related hospitalization, higher participation in exercise interventions, and more frequently prescribed physical therapy.

An Evidence-based Physical Therapy Prescription for Adults With X-linked Hypophosphatemia.

ContextX-linked hypophosphatemia (XLH) is a rare and progressive metabolic phosphate-wasting disorder characterized by lifelong musculoskeletal comorbidities. Despite considerable physical disability, there are currently no disease-specific physical therapy (PT) recommendations for XLH designed to improve engagement and confidence in performing activities of daily living (ADL).ObjectiveThe objective of this patient-centered study was to develop an evidence-based PT program to address gaps in the management of adult XLH without imposing unintended harm.MethodsCreation of the program was informed by a prior controlled clinical study to evaluate the physical and functional effect of XLH on adulthood, and guided by the physical presentation of participants, subjective data and patient goals acquired at intake, and by performance on multiple active range of motion (ROM) movements from the standing position. A weekly standardized interview process was used to assess progression of physical and functional abilities, gains and concerns, and to obtain timely feedback to inform future exercise modifications. Outcomes were evaluated using validated functional tools and subjective data obtained throughout the study.ResultsA remote 12-week PT program was created based on collected data. Open and closed kinetic-chain exercises were developed and implemented. Functional improvements were documented, and weekly surveys indicated improved abilities and confidence to engage in ADL. Minimal improvements were observed in active upper and lower extremity ROM, reflective of substantial bony restrictions characteristic of XLH.ConclusionThis study represents the first disease-specific PT recommendations for XLH to mitigate the unique physical challenges of the adult disorder that can be modified to adapt to the current progression status of the adult disorder.

Sociodemographics and clinical data of patients undergoing physiotherapy treatment in a Hospital in the interior of the state

To characterize the sociodemographic and clinical characteristics of patients over 18 years of age and both genders admitted to a hospital of low and medium complexity in the central region of the state, as well as to recognize the presence of deleterious habits and the prescription of physical therapy. According to the literature, there is a scarcity of studies that address the proposed design and theme, with interference in the planning and quality of the treatment provided. This is a quantitative, cross-sectional study, conducted retrospectively and descriptively. Through the analysis of medical records of the inpatient unit of patients with physiotherapy prescriptions, the collection was performed from January to October 2020. A total of 328 medical records were verified, with a predominance of women patients (54.6%), white (80.2%), elderly (76.2%), mostly smokers (35.4%), from and residents of the west (22.9%) and north (15.8%) regions of the city. The diseases of cardiovascular (n=374), pneumological (n=45), neurological (n=180), and endocrine (n=157) origin stood out, as for the reason and time of hospitalization, respectively, it was pneumonia (29.3%), in a period of up to 14 days (85.1%). Physiotherapy prescriptions predominated once a day, mostly motor (n=202). The sociodemographic and clinical aspects of the patients contribute to a performance based on the quality of care provided, planning, Assistance, and actions aimed at the specificity and effectiveness of interventions.

Current practice of physical therapists in outpatient stroke rehabilitation: a cross-sectional survey in Baden-Württemberg and Thuringia / Arbeitsweise von Physiotherapeut*innen in der ambulanten Schlaganfallrehabilitation: eine Querschnittsumfrage in Baden-Württemberg und Thüringen

Abstract Objective Guidelines recommend task-oriented training and the use of standardized assessments to improve stroke-related mobility deficits. However, the German outpatient physical therapy prescription catalogue does not include these recommendations resulting in a possible gap between guideline recommendations and clinical practice. Therefore, the purpose of this study was to describe physical therapy practice patterns of stroke-related mobility deficits in the outpatient setting exemplified by the states Baden-Württemberg and Thuringia. Methods Using an online survey, physical therapists treating people with stroke in outpatient settings in Baden-Württemberg and Thuringia were recruited. The questionnaire was developed using a multi-step procedure. Using a case vignette and open-ended questions, preferred evaluation and treatment methods were assessed. Data were analyzed using content analysis and descriptive statistics. Results Data from 63 physical therapists were included in the analysis. Answers to the open questions showed a wide range of different citations. Of 186 citations on evaluation methods, 28 (15,1 %) were classified as “standardized assessments”, while 158 citations (84,9 %) were classified as “basic physical therapy evaluation (non-standardized)”. Standardized assessments were cited by 25% of participants. Of 182 citations on treatment methods, 69 (35,2%) were classified as “traditional therapies”. These traditional therapies were cited by 81 % of participants. Task-oriented training was not cited. Discussion Despite the small sample size our data confirm the insufficient guideline use in German physical therapy and contribute results on practice patterns in outpatient stroke settings. These results will be used to initiate theory-based implementation strategies aiming to optimize physical therapy for people with stroke.

Factors Associated with Survey Non-Response in a Cross-Sectional Survey of Persons with an Axial Spondyloarthritis or Osteoarthritis Claims Diagnosis.

Non-response in surveys can lead to bias, which is often difficult to investigate. The aim of this analysis was to compare factors available from claims data associated with survey non-response and to compare them among two samples. A stratified sample of 4471 persons with a diagnosis of axial spondyloarthritis (axSpA) and a sample of 8995 persons with an osteoarthritis (OA) diagnosis from a German statutory health insurance were randomly selected and sent a postal survey. The association of age, sex, medical prescriptions, specialist physician contact, influenza vaccination, hospitalization, and Elixhauser comorbidity index with the survey response was assessed. Multiple logistic regression models were used with response as the outcome. A total of 47% of the axSpA sample and 40% of the OA sample responded to the survey. In both samples, the response was highest in the 70–79-year-olds. Women in all age groups responded more often, except for the 70–79-year-olds. Rheumatologist/orthopedist contact, physical therapy prescription, and influenza vaccination were more frequent among responders. In the logistic regression models, rheumatologist/orthopedist treatment, influenza vaccination, and physical therapy were associated with a higher odds ratio for response in both samples. The prescription of biologic drugs was associated with higher response in axSpA. A high Elixhauser comorbidity index and opioid use were not relevantly associated with response. Being reimbursed for long-term care was associated with lower response—this was only significant in the OA sample. The number of quarters with a diagnosis in the survey year was associated with higher response. Similar factors were associated with non-response in the two samples. The results can help other investigators to plan sample sizes of their surveys in similar settings.

Large Variability of Frequency and Type of Physical Therapy in Patients in the German Network for Systemic Sclerosis.

To determine the type and frequency of physical therapy (PT) prescribed by physicians for patients in the registry of the German Network for Systemic Sclerosis. The data for 4,252 patients were analyzed using descriptive statistics, chi-square tests, and odds ratios (ORs). Overall, 37.4% of patients (1,590 of 4,252) received PT at the end of a yearly follow-up. The most frequently used type of PT was lymphatic drainage (n = 1,061, 36.8%), followed by exercise therapy (n = 1,047, 36.3%) and heat therapy (n = 689, 23.9%). More than three-fourths of treated patients (82%) received 1 or 2 different forms of PT simultaneously. The prescription of PT was associated with the extent of skin fibrosis as measured by the modified Rodnan skin thickness score (<10 [41.8% of patients], 11-20 [55.8% of patients], and >21 [63.9% of patients]; P < 0.001). Patients with musculoskeletal involvement (e.g., arthritis, muscle weakness, joint contractures, tendon friction rubs) had a higher chance of receiving PT than patients without these symptoms, with corresponding ORs ranging from 1.96 (95% confidence interval [95% CI] 1.69-2.28) for joint contractures to 3.83 (95% CI 2.89-5.08) for arthritis. When comparing the type of PT prescription across the initial and all follow-up visits from 2003 to 2017, significant alterations with a decreasing frequency of patients receiving PT could be observed (P = 0.001). To our knowledge, this is the first study reporting the use of PT in patients with systemic sclerosis (SSc) in a large cohort. Although SSc is characterized by considerable disability and restriction of motion, <40% of patients received PT.

PERFIL EPIDEMIOLÓGICO E ATUAÇÃO FISIOTERÁPICA EM PACIENTES HOSPITALIZADOS– ANÁLISE RESTROSPECTIVA

The prevalence of chronic degenerative diseases and life expectancy has increased, which is associated with the higher number of hospitalizations among the elderly. In this sense, physical therapy is an alternative treatment in this population and has several rehabilitation alternatives in order to favor the patient's functionality. The objective of this study was to characterize the profile of hospitalized patients and to point out the physiotherapeutic techniques used. This study is retrospective, with an analysis of records with physical therapy prescription of a public hospital in the period from 2015 to 2017. It was observed that the majority of the patients are men, elderly, with hypertension or more than one risk factor, smokers/ex-smokers, alcoholics, with normal BMI, mean hospital stay of 8 to 19 days and diagnosis in specialty oncology. The most used techniques are exercises breathing, diaphragmatic reeducation, active mobilization and walking. The most frequently used techniques depend on the active participation of the patient, which allows us to conclude the importance of the physiotherapist in hospital units, given their incentive profile to promote activities that can reestablish the patients' functionality

Physical therapy and deep brain stimulation in Parkinson\u2019s Disease: protocol for a pilot randomized controlled trial

BackgroundSubthalamic nucleus deep brain stimulation (STN-DBS) reduces tremor, muscle stiffness, and bradykinesia in people with Parkinson’s Disease (PD). Walking speed, known to be reduced in PD, typically improves after surgery; however, other important aspects of gait may not improve. Furthermore, balance may worsen and falls may increase after STN-DBS. Thus, interventions to improve balance and gait could reduce morbidity and improve quality of life following STN-DBS. Physical therapy (PT) effectively improves balance and gait in people with PD, but studies on the effects of PT have not been extended to those treated with STN-DBS. As such, the efficacy, safety, and feasibility of PT in this population remain to be determined. The purpose of this pilot study is to address these unmet needs. We hypothesize that PT designed to target balance and gait impairment will be effective, safe, and feasible in this population.Methods/designParticipants with PD treated with STN-DBS will be randomly assigned to either a PT or control group. Participants assigned to PT will complete an 8-week, twice-weekly PT program consisting of exercises designed to improve balance and gait. Control group participants will receive the current standard of care following STN-DBS, which does not include prescription of PT. The primary aim is to assess preliminary efficacy of PT on balance (Balance Evaluation Systems Test). A secondary aim is to assess efficacy of PT on gait (GAITRite instrumented walkway). Participants will be assessed OFF medication/OFF stimulation and ON medication/ON stimulation at baseline and at 8 and 12 weeks after baseline. Adverse events will be measured over the duration of the study, and adherence to PT will be measured to determine feasibility.DiscussionTo our knowledge, this will be the first study to explore the preliminary efficacy, safety, and feasibility of PT for individuals with PD with STN-DBS. If the study suggests potential efficacy, then this would justify larger trials to test effectiveness and safety of PT for those with PD with STN-DBS.Trial registrationNCT03181282 (clinicaltrials.gov). Registered on 7 June 2017.

Stagnant Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain in the United States 1997-2010.

A cross-sectional observational study utilizing the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010. The aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States. Despite guidelines recommending PT for the initial management of low back pain (LBP), national PT referral rates remain low. Race, ethnicity, age, payer type, and PT referral rates were collected for patients aged 16 to 90 years who were visiting their PCPs. Associations among demographic variables and PT referral were determined using logistic regression. Between 1997 and 2010, we estimated 170 million visits for LBP leading to 17.1 million PT referrals. Average proportion of PCP visits associated with PT referrals remained stable at about 10.1% [odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96-1.04)], despite our prior finding of increasing number of visits associated with opioid prescriptions in the same timeframe.Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33-0.69) and Medicare (OR 0.50, 95% CI 0.35-0.72). Furthermore, visits not associated with PT referrals were more likely to be associated with opioid prescriptions (OR 1.69, 95% CI 1.22-2.35). Although therapies delivered by PTs are promoted as a first-line treatment for LBP, PT referral rates remain low. There also exist disparately lower referral rates in populations with more restrictive health plans and simultaneous opioid prescription. Our findings provide a broad overview to PT prescription trend and isolate concerning associations requiring further explorations. 3.

A Demonstration of Physician-Generated Health Care Costs in an Initial Orthopaedic Visit

Background: The cost of health care in the United States continues to grow faster than any other sector of the economy. A small portion of the health care costs is attributed to physician reimbursement, but orthopaedic surgeons have an abundance of costly diagnostic and therapeutic modalities for patient care. Providers must be aware of the health care costs they generate in their practice in order to become stewards of cost control. Identifying the costs associated with an ambulatory orthopaedic practice is an important foundation in understanding and controlling the costs that the practice generates. Questions: What is the average cost of an initial encounter with an orthopaedic surgeon? What are the most costly elements in a management plan? How can we financially optimize resource utilization? Methods: We conducted a retrospective review of the records of 23 orthopaedic surgeons that span the main orthopaedic subspecialties at an urban academic medical center. All physician-generated orders were obtained and valuated by their cost to the institution’s health care management organization. Results: A total patient of 822 encounters were reviewed with a total cost of $403,235 (an average of $490 per patient). The most prevalent order was an x-ray (68.1% of patients). The majority of the financial burden was from physical therapy prescriptions (43.1% of total costs). The most expensive diagnostic modalities were advanced imaging studies, particularly magnetic resonance imaging and computed tomography (20.8% of costs). Conclusion: This health care burden exposé is not designed to discourage technology utilization. The authors aim to encourage stewardship through judicious use of diagnostic and therapeutic modalities. Most common musculoskeletal conditions presenting for evaluation can be appropriately diagnosed with a thorough history and physical examination followed by initial non-operative management. Diagnostic workups are only necessary during an initial visit when the initial evaluation suggests life or limb threatening conditions that need to be identified in an expeditious fashion. Diagnostic imaging may become necessary during future visits if the patient has not responded to the initial management and the patient is ready to undergo a surgical intervention based on the imaging. Obtaining imaging to identify a surgical lesion is an unnecessary expense if the patient is not ready to undergo surgery. Understanding the cost of clinical decisions can promote adherence to evidence-based diagnostic indications to more efficiently use health care funds.

Utilization of Physical Therapy Services in Germany from 2004 until 2014: Analysis of Statutory Health Insurance Data

Background: Both at the national and international levels, direct access for patients to physical therapy services is currently under debate. Direct access for patients seeking physical therapy care might reduce waiting time and costs, and thus be of benefit for patients and health insurance companies. To critically evaluate this situation, reliable and valid data are needed, but currently lacking. The aim of this study is to evaluate the health care situation for physical therapy services included in the catalogue of remedies from 2004 up to 2014 in Germany. Methods: To obtain information regarding physical therapy services included in the catalogue of remedies, the freely available "Heilmittel-Informations-System (GKV-HIS)" was used. Data from the regional Associations of Statutory Health Insurance Physicians as well as data from federal reports were extracted for the years from 2004 up to 2014. Results: Prescription of physical therapy increased continuously from 2004 and 2014. In 2004, 155 677 860 and in 2014, 254 695 514 physical therapies were prescribed (increase of 61%). The highest number of physical therapies was prescribed in Saxony for all years, whereas in North Rhine-Westphalia and Hessen the lowest number per 1 000 GKV insured persons. Gross sales from physical therapy services differed between federal states and were the highest in Saxony (2004: 59.8; 2009: 54.6, 2014: 76.7) and Baden-Wuerttemberg (2004: 60.0; 2009: 57.6; 2014: 68.0). Discussion: The results of this study show utilization of physical therapy services as defined in the catalogue of remedies in Germany to be heterogeneous. However, causal relationship cannot be identified on the basis of the analyzed data highlighting the need for further research. Criteria for structural-, process- and outcome-quality are needed to be able to evaluate the quality of physical therapy services. To ensure the quality of physical therapy services, interprofessional and patient relevant research is needed.

Aerobic capacities and exercise tolerance in neuromuscular diseases: A descriptive study

IntroductionUp until now, there has been little description of the test exercises carried out in patients with neuromuscular diseases. However, prescription of physical therapy by exercise requires rigorous individualized assessment of the patient's physical endurance parameters. ObjectiveTo describe exercise tolerance and external limitation factors in a sample group of adult patients suffering from neuromuscular diseases. Materials and methodsA descriptive retrospective study of exercise tests realized at the Reims university hospital for patients divided into three groups according to their pathologies: CMT hereditary neuropathies, muscular dystrophies, metabolic myopathies. ResultsForty-four (44) tests were analyzed. Cessation was occasioned on 63.6% of the cases by muscular symptomatology, with no possibility of maintaining the cycling frequency in 29.5% of the overall population. Insufficient lung volume recruitment was involved in 61.4% of the patients, final oxygen pulse (VO2/heart rate) was 80% lower than the theoretical pulse in 50% of the patients, and there existed an early first ventilatory threshold in 54.5% of the cases. Peripheral deconditioning was highly severe in 18% of the population and significantly greater in the subjects suffering from dystrophies (VT1 at 31% of the maximum theoretical O2, P<0.001). DiscussionThe main limitation factor in exercise tests is peripheral. Ventilatory and cardiovascular limitations can nonetheless be added on; while they are absent when the patient is at rest, they are unmasked in effort situations. Exercise tests could be of great interest in screening and managing the relevant pathologies. Multicenter studies on homogeneous populations could facilitate definition of the procedures specific to exercise tests for patients suffuring from neuromuscular diseases.

Groin Injury - Running

HISTORY: A 16-year-old male sustained a groin injury while running at full exertion. He heard and felt a 'pop' in his right groin and could not continue to run secondary to pain. The pain was described as 10 on a scale of 0 to 10 and located in the proximal inner thigh region. Flexion at the hip and adduction of the leg worsened the pain. The patient denied any associated low back or knee pain. The patient was seen in the ED the next day where X-rays were taken. The next evaluation was 1 week later in an outpatient orthopedic / sports medicine clinic. PHYSICAL EXAMINATION: Examination 1 week after the injury of the right hip revealed tenderness to palpation in the mid inner thigh. Active hip flexion was intact with moderate discomfort. Resisted hip flexion and adduction as well as passive hip extension and leg abduction reproduced pain. There was no significant ecchymosis or palpable defect at the area of injury. Active range of motion at the hip was decreased secondary to pain. The low back and knee exams were normal. DIFFERENTIAL DIAGNOSIS: Adductor injury Hip flexor injury Iliopsoas injury Apophyseal injury Apophyseal avulsion fracture Labral tear TEST AND RESULTS: Hip radiographs: _ 1 cm fragment avulsed from the lesser trochanter of the femur with 3 cm proximal retraction MRI of the right hip and pelvis: _ no injuries to tendons or ligaments of the region _ no other bony injuries other than avulsion FINAL/WORKING DIAGNOSIS: Avulsion fracture of the lesser trochanter of the femur TREATMENT AND OUTCOMES: 1. Weight bearing as tolerated with use of crutches as needed 2. Follow up at 3 weeks post injury revealed improvement in pain, range of motion, and strength 3. Follow up 6 weeks post injury planned with possible physical therapy prescription 4. Management ongoing

Effectiveness Of Aquatic Therapy Versus Land Therapy In Athletes With Lower Extremity Injuries

Aquatic therapy is one of the many options for the rehabilitation of lower extremity injuries in athletes. However, the literature comparing the effects of aquatic and land therapy combined in athletes is scarce. PURPOSE: The purpose of this investigation was to determine if a combined aquatic and land therapy program was more effective than land therapy alone in improving lower extremity power and agility of injured athletes. It was hypothesized that athletes participating from the combined program would exhibit greater power and agility measures than those in the land program after four weeks. METHODS: Nine athletes were randomly assigned to land (n=5) and the combined (n=4) therapy rehabilitation programs. Physical therapy prescription was individualized to meet specific needs of the athlete and their injury. Treatment was offered three times per week for approximately 60 - 75 minutes each day. The follow-up measures were at four weeks after the beginning of therapy and included assessment of power, hopping and running agility. A maximal vertical jump was used to measure lower extremity power and jumping performance. Dynamic stability during hopping and pivoting activities was measured by using a figure eight hop task. A zigzag run task was used to measure running agility. Symmetry indexes between the noninjured and injured limb were calculated for the vertical jump and figure-eight tasks. Mann-Whitney U-test was used to compare differences between groups after the intervention for each of the variables. RESULTS: Statistically significant differences were found for both vertical jump measures (p<.03), with the group receiving the combined therapy exhibiting better outcomes at four weeks compared to the land therapy group. No statistically significant differences for the figure eight and zigzag run results were found. CONCLUSIONS: Aquatic therapy combined with land therapy helped improve lower extremity power and symmetry between both legs in young athletes after four week intervention. However, the results showed no differences in running, cutting, pivoting and agility for those elite athletes participating in either intervention. Perhaps the demands of these tasks or small sample size could have affected the results. Nevertheless, studies with bigger sample size are needed before conclusions can be drawn.

Ambulatory monitoring of activity levels of individuals in the sub-acute stage following stroke: a case series

BackgroundThere is an important need to better understand the activities of individual patients with stroke outside of structured therapy since this activity is likely to have a profound influence on recovery. A case-study approach was used to examine the activity levels and associated physiological load of patients with stroke throughout a day.MethodsActivities and physiologic measures were recorded during a continuous 8 hour period from 4 individuals in the sub-acute stage following stroke (ranging from 49 to 80 years old; 4 to 8 weeks post-stroke) in an in-patient rehabilitation hospital.ResultsBoth heart rate (p = 0.0207) and ventilation rate (p < 0.0001) increased as intensity of activity increased. Results revealed individual differences in physiological response to daily activities, and large ranges in physiological response measures during 'moderately' and 'highly' therapeutic activities.ConclusionActivity levels of individuals with stroke during the day were generally low, though task-related changes in physiologic measures were observed. Large variability in the physiological response to even the activities deemed to be greatest intensity suggests that inclusion of such extended measurement of physiologic measures may improve understanding of physiological profile that could guide elements of the physical therapy prescription.

Poster 69: Brachial plexopathy in patient undergoing surgical repair of rotator cuff rupture: a case report

Setting: Tertiary care university hospital. Patient: A 45-year-old athletic male. Case Description: The patient had difficulty in overhead abduction of arm and complained of pain, which on radiographic investigation was found to be secondary to partial tear of rotator cuff tendons. The patient underwent a trial of physical therapy for 2 months but did not find any improvement. He decided to undergo surgical intervention. A brachial plexus block was planned for the anesthesia. After several attempts, a successful plexus block was given and the patient underwent repair and was discharged postoperatively using a sling. He started developing numbness and tingling over the entire arm, including hands and fingers, within days after surgery. After 2 weeks, he was also found to have limited range of motion (ROM) at the shoulder joint. 4 weeks after his clinical symptoms appeared during postoperative rehabilitation, physiatrists conducted on electromyographic study and magnetic resonance imaging (MRI). The electromyographic results showed upper trunk plexopathy and the MRI showed inflammation the around the upper trunk. Assessment/Results: The patient was treated aggressively with pain medications, and physical therapy (PT) exercises, but after 9 months of therapy he still had weakness in all the rotator cuff muscles and limited ROM. Discussion: Physiatrists often assume care for patients after orthopedic procedures and they should be aware of the complications that surgical interventions can cause. Although brachial plexopathy was not a complication of the surgery per se, it probably occurred secondary to the difficult brachial plexus block. A high degree of suspicion in this case helped the physiatrists to do the necessary tests and to find out the cause. When appropriately diagnosed PT prescriptions can be tailored to address this problem with appropriate expectations of clinical outcome. Conclusion: Brachial plexopathy may develop as a complication due to anesthesia in the patients undergoing rotator cuff repair.