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Background The Timed Up and Go (TUG) test is quick and easy tests to assess patients’ functional mobility. However, its reliability in individuals with knee osteoarthritis (OA) has not been well established. The aims of this study were to determine the reliability and minimal detectable change of the TUG test in individuals with doubtful to moderate (Grade 1–3) knee OA. Methods Sixty-five subjects (25 male, 40 female), aged 45–70 years, with knee OA participated. Inter-rater reliability was assessed using two observers at different times of the same day in an alternating order. Intra-rater reliability was assessed on two consecutive visits with a 2-day interval. The standard error of measurement (SEM) and the minimum detectable change (MDC) were calculated to determine statistically meaningful changes. Results Intra-rater and inter-rater reliability were 0.97 (95 % confidence interval [CI], 0.95 – 0.98) and 0.96 (95 % confidence interval [CI], 0.94 – 0.97), respectively. The MDC, based on measurements by a single rater and between raters, was 1.10 and 1.14 seconds, respectively. Conclusions The TUG is a reliable test with adequate MDC for clinical use in individuals with doubtful to moderate knee OA.

This randomized clinical trial evaluated the impact of immediate weight-bearing as tolerated on spatiotemporal gait parameters and fall risk in patients undergoing postoperative rehabilitation for tibial plateau fractures. A total of 106 patients who had undergone open reduction and internal fixation (ORIF) for Schatzker I-IV tibial plateau fractures were recruited, with 39 meeting the inclusion criteria and 10 lost to follow-up. Patients were randomly assigned to a non-weight-bearing group (NWB), following a 6-week non-weight-bearing rehabilitation protocol, or a weight-bearing group (WB), allowed immediate weight-bearing. Both groups received the same therapeutic exercise program. Gait parameters were assessed three months post-surgery, including step length, stride length, single stance time, double stance time, step time, stride time, velocity, cadence, stride width, and gait and balance scores from Tinetti Performance Oriented Mobility Assessment (POMA). Of the 29 patients who completed the study, significant differences in favor of the WB group were observed for affected limb step length (p = 0.010), sound limb step length (p = 0.013), stride length (p = 0.010), affected single limb stance time (p = 0.001), sound single limb stance time (p = 0.007), velocity (p = 0.021), and POMA scores for balance (p = 0.021) and gait (p = 0.002). Immediate weight-bearing as tolerated after ORIF for Schatzker I-IV tibial plateau fractures resulted in improved spatiotemporal gait parameters and reduced fall risk.

To date, no clinical test provides specific objective information on the integrity of key ligamentous support of the trapeziometacarpal (TMC) joint. To examine the potential of the TMC joint screw home torque mechanism (SHTM) in estimating the integrity of the posterior ligament complex in older adult population. Cross-sectional laboratory-based study. Twenty cadaver hands presenting with various degrees of TMC joint degradation ranging from none to severe osteoarthritis (OA) were radiographed in multiple positions to establish their degeneration status, joint mobility, and amount of dorsal subluxation at rest and with the application of the SHTM. Comparisons and correlations between degeneration status, joint mobility, subluxation reduction and ligament status obtained from dissection were calculated. No significant statistical correlation was demonstrated with the subluxation reduction ratio of the SHTM and the combined ligament complex value however, a moderate negative correlation was found with dorsal central ligament injury at 21 Nm (τb = −0.46, p < 0.05) and 34 Nm (τb = −0.45, p < 0.05). A statistically significant reduction of radial subluxation of the TMC joint was observed between the subluxation at rest (M = 5.2, SD = 1.9) and subluxation with SHTM of 21 Nm (M = 4.4, SD = 2.4), t (19) = 3.2, p = 0.01, 95% CI [0.3, 1.4] and subluxation with SHTM of 34 Nm (M = 4.3, SD = 2.6), t (19) = 2.6, p = 0.02, 95% CI [0.2, 1.5]. Our results did not support the SHTM as indicator of the TMC posterior ligament complex integrity however, it demonstrated 100% stabilization effect with non-arthritic TMC population. •SHTM was not a clear indicator of TMC joint posterior ligament complex integrity.•DCL damage was moderately correlated with a decline in subluxation reduction.•SHTM demonstrated positive stabilization results with non-arthritic population.•Decreased radial abduction may suggest more significant joint degradation.

Background Cadaveric studies suggest neck postures may affect cervical intradiscal pressure (CIDP) and potentially contribute to intervertebral disc (IVD) pathologies. Despite neck flexion and protraction posture prevalence and potential impact on cervical IVD health, no studies have investigated CIDP during end-range protraction and retraction. This study investigated (1) CIDP differences between cervical traction, six sagittal plane cervical end-ranges, and neutral posture; (2) CIDP and segmental cervical range of motion (ROM) correlation; and (3) CIDP measurement reliability. Methods Seven cadaveric specimens, mean age 80.6±7.2 years, had cervical segmental ROM assessed by lateral radiographs and CIDP responses measured by fiberoptic pressure sensors in C4-5, C5-6, and C6-7 IVDs for supine end-range chin to neck, chin to sternum, protraction-flexion, occiput to neck, occiput to thorax, retraction-extension, and neutral traction. Results Friedman tests revealed greater CIDP in (1) chin to sternum as compared to traction at C4-5, C5-6 and C6-7 ( p  < .02); (2) chin to sternum as compared to retraction-extension at C5-6 and C6-7 ( p  = .027); and (3) chin to sternum as compared to protraction-flexion at C5-6 ( p  = .042). End-range postures demonstrated moderate effect sizes on CIDP at C4-5 (ES = 0.31), C5-6 (ES = 0.46), and C6-7 (ES = 0.36) using Kendall’s W. Strong correlations between cervical segmental ROM and CIDP were identified at C4-5 chin to neck, r S =0.79, p  = .04; C5-6 occiput to thorax, r S =0.79, p  = .04; and C6-7 protraction-flexion, r S =0.82, p  = .02. Reliability was good to excellent for CIDP and segmental ROM measurements (ICC > 0.92, 95%CI 0.86-0.98). Conclusions Consistent chin to sternum increases and traction decreases in CIDP occurred at all cervical IVD levels. The CIDP tended to increase during flexion end-ranges at all IVD levels, while extension, protraction, and retraction tended to decrease at C5-6, C6-7 and increase at C4-5. Large positive or negative CIDP variations with even larger standard deviations were observed within and between cervical IVD segments during various postures.

Sensorimotor control strategies during cervical axial rotation movements have been previously explored in narrow age ranges but never concurrently in Children and Seniors during a well-standardized task. However, the lifespan developmental approach provides a framework for research in human sensorimotor control of the head-neck complex. A cross-sectional design was used to investigate the influence of age on head-neck dynamic performance adopted by asymptomatic Children, Adults and Seniors using a standardized task (DidRen Laser test). Participants performed 5 cycles of left/right head-neck complex fast rotational movements toward 3 targets with 30° of angular separation. Dynamic performances were computed from total execution time of the test and kinematic variables derived from rotational motion of head measured by an optoelectronic system. Eighty-one participants, aged 8-85 yrs, were stratified in four groups: Children, Younger adults, Older adults and Seniors. Children were significantly slower than Younger (p<0.001) and Older adults (p<0.004) and Seniors slower than Younger adults (p<0.017) to perform the test. Children adopted a lower average speed compared to Younger (p<0.001) and Older adults (p<0.008). Children reached the peaks speed significantly later than Younger (p<0.004) and Older adults (p<0.04) and acceleration significantly later than Younger (p<0.001) and Older adults (p<0.013). From the peak acceleration, Children reached end of the cycle significantly slower than Younger (p<0.008) and Older adults (p<0.008). Children significantly differed from all other groups for rotational kinetic energy, with smaller values compared to Younger adults (p<0.001), Older adults (p<0.005) and Seniors (p<0.012). Variability was also significantly higher for Seniors and Children. In conclusion, age influences head-neck visually elicited rotational dynamics, especially in Children. These results suggest that age should be taken into account when establishing normative data and assessing dynamic head-neck sensorimotor control of patients with neck pain.

Before and immediately after passive upper limb neurodynamic mobilizations targeting the median nerve, grip ( G F ) and load ( L F ) forces applied by the thumb, index and major fingers (three-jaw chuck pinch) were collected using a manipulandum during three different grip precision tasks: grip-lift-hold-replace (GLHR), vertical oscillations (OSC), and vertical oscillations with up and down collisions (OSC/COLL/u, OSC/COLL/d). Several parameters were collected or computed from G F and L F . Maximum pinch strength and fingertips pressure sensation threshold were also examined. After the mobilizations, L F max changes from 3.2 ± 0.4 to 3.4 ± 0.4 N ( p = 0.014), d G F from 89.0 ± 66.6 to 102.2 ± 59.6 N s - 1 ( p = 0.009), and d L F from 43.6 ± 17.0 to 56.0 ± 17.9 N s - 1 ( p < 0.001) during GLHR. L F SD changes from 0.9 ± 0.3 to 1.0 ± 0.2 N ( p = 0.004) during OSC. L F peak changes from 17.4 ± 8.3 to 15.1 ± 7.5 N ( p < 0.001), G F from 12.4 ± 6.7 to 11.3 ± 6.8 N ( p = 0.033), and L F from 2.9 ± 0.4 to 3.00 ± 0.4 N ( p = 0.018) during OSC/COLL/u. G F peak changes from 13.5 ± 7.4 to 12.3 ± 7.7 N ( p = 0.030) and L F from 14.5 ± 6.0 to 13.6 ± 5.5 N ( p = 0.018) during OSC/COLL/d. Sensation thresholds at index and thumb were reduced ( p = 0.001, p = 0.008). Precision grip adaptations observed after the mobilizations could be partly explained by changes in cutaneous median-nerve pressure afferents from the thumb and index fingertips.

Background The assessment of cervical spine kinematic axial rotation performance is of great importance in the context of the study of neck sensorimotor control. However, studies addressing the influence of the level of provocation of spinal pain and the potential benefit of passive manual therapy mobilizations in patients with acute-subacute non-specific neck pain are lacking. Methods A non-randomized prospective clinical trial with an intervention design was conducted. We investigated: (1) the test-retest reliability of kinematic variables during a fast axial head rotation task standardized with the DidRen laser test device in 42 Healthy pain-free Control Participants (HCP) (24.3 years ±6.8); (2) the differences in kinematic variables between HCP and 38 patients with Acute-subacute Non-Specific neck Pain (ANSP) assigned to two different groups according to whether their pain was localized in the upper or lower spine (46.2 years ±16.3); and (3) the effect of passive manual therapy mobilizations on kinematic variables of the neck during fast axial head rotation. Results (1) Intra-class correlation coefficients ranged from moderate (0.57 (0.06-0.80)) to excellent (0.96 (0.91-0.98)). (2) Kinematic performance during fast axial rotations of the head was significantly altered in ANSP compared to HCP (age-adjusted) for one variable: the time between peaks of acceleration and deceleration ( p <0.019). No significant difference was observed between ANSP with upper vs lower spinal pain localization. (3) After the intervention, there was a significant effect on several kinematic variables, e.g., ANSP improved peak speed ( p <0.007) and performance of the DidRen laser test ( p <0.001), with effect sizes ranging from small to medium. Conclusion (1) The DidRen laser test is reliable. (2) A significant reduction in time between acceleration and deceleration peaks was observed in ANSP compared to HCP, but with no significant effect of spinal pain location on kinematic variables was found. (3) We found that neck pain decreased after passive manual therapy mobilizations with improvements of several kinematic variables. Trial registration Registration Number: NCT 04407637

Pain perception, trunk mobility and apparent diffusion coefficient ( ADC ) within all lumbar intervertebral discs (IVDs) were collected before and shortly after posterior-to-anterior (PA) mobilizations in 16 adults with acute low back pain. Using a pragmatic approach, a trained orthopaedic manual physical therapist applied PA mobilizations to the participants’ spine, in accordance with his examination findings. ADC all was computed from diffusion maps as the mean of anterior ( ADC ant ), middle ( ADC mid ), and posterior ( ADC post ) portions of the IVD. After mobilization, pain ratings and trunk mobility were significantly improved and a significant increase in ADC all values was observed. The greatest ADC all changes were observed at the L 3 -L 4 and L 4 -L 5 levels and were mainly explained by changes in ADC ant and ADC post , respectively. No significant changes in ADC were observed at L 5 -S 1 level. The reduction in pain and largest changes in ADC observed at the periphery of the hyperintense IVD region suggest that increased peripheral random motion of water molecules is implicated in the IVD nociceptive response modulation. Additionally, ADC changes were observed at remote IVD anatomical levels that did not coincide with the PA spinal mobilization application level.

Purpose: This study investigated the prevalence of burnout in physical therapists in the United States and the relationships between burnout and education, mentorship, and self-efficacy.Methods: This was a cross-sectional survey study. An electronic survey was distributed to practicing physical therapists across the United States over a 6-week period from December 2020 to January 2021. The survey was completed by 2,813 physical therapists from all states. The majority were female (68.72%), White or Caucasian (80.13%), and employed full-time (77.14%). Respondents completed questions on demographics, education, mentorship, self-efficacy, and burnout. The Burnout Clinical Subtypes Questionnaire 12 (BCSQ-12) and self-reports were used to quantify burnout, and the General Self-Efficacy Scale (GSES) was used to measure self-efficacy. Descriptive and inferential analyses were performed.Results: Respondents from home health (median BCSQ-12=42.00) and skilled nursing facility settings (median BCSQ-12=42.00) displayed the highest burnout scores. Burnout was significantly lower among those who provided formal mentorship (median BCSQ-12=39.00, P=0.0001) compared to no mentorship (median BCSQ-12=41.00). Respondents who received formal mentorship (median BCSQ-12=38.00, P=0.0028) displayed significantly lower burnout than those who received no mentorship (median BCSQ-12=41.00). A moderate negative correlation (rho=-0.49) was observed between the GSES and burnout scores. A strong positive correlation was found between self-reported burnout status and burnout scores (rrb=0.61).Conclusion: Burnout is prevalent in the physical therapy profession, as almost half of respondents (49.34%) reported burnout. Providing or receiving mentorship and higher self-efficacy were associated with lower burnout. Organizations should consider measuring burnout levels, investing in mentorship programs, and implementing strategies to improve self-efficacy.

Background Coracohumeral ligament (CHL) thickening, contracture, and fibroplasia have been identified in glenohumeral idiopathic adhesive capsulitis (GHIAC). The CHL is the main structure responsible for the range of motion limitations. Favorable outcomes have been reported with CHL surgical release. Intra-articular glenohumeral joint corticosteroid infiltrations are utilized to disrupt the inflammatory process and reduce pain in GHIAC. The aim of this study was to investigate whether the CHL could be accurately targeted with a periligamentous infiltration. Methods A convenience sample of 12 unembalmed cadaver shoulders (mean age: 74.5 years, range 66–87 years) without evidence of previous injury or surgery were utilized in this exploratory double factor feasibility cadaveric (unguided and ultrasound (US) guided) case series. Two clinicians trained in musculoskeletal infiltration techniques carried out the infiltrations on each shoulder with colored latex. One clinician infiltrated without guidance, the other with US-guidance. The injecting clinicians were blinded to the others infiltration procedure and the order was randomized. An anatomist blinded to the infiltration order performed a shoulder dissection and recorded the infiltrate location. Percentage calculation for accuracy of infiltration and a chi-square evaluation of the difference between unguided and US-guided infiltrations was applied. Results An accuracy of 75% was achieved for unguided infiltration and 80% for US-guided infiltration techniques. Chi-squared indicated there was no significant difference ( p =  0.82) between the unguided and US-guided techniques. Conclusion US-guided and unguided infiltrations achieved good accuracy targeting the CHL, suggesting infiltrations can specifically and accurately target the CHL. In vivo investigation using such infiltration techniques are warranted.