Bellin College

OBJECTIVE: To explore patients’ understanding of how manual therapy works. DESIGN: Qualitative interview study. METHODS: Patients receiving outpatient physical therapy for a musculoskeletal condition were interviewed using an interpretive description research approach, and their responses were analyzed and coded into themes. An online survey was used to gather demographic data. RESULTS: Twenty six participants (mean [standard deviation] age: 60.5 [8.8]) were interviewed. Three major themes emerged and centered largely around the perceived outcomes, not mechanisms, of manual therapy: mechanical, neurophysiological, and psychological. Eight subthemes were extracted, the most common of which included 1) increased mobility, 2) improved circulation, 3) decreased pain, and 4) realignment of the body. CONCLUSION: Patients’ understanding of how manual therapy works centered on mechanical, neurophysiological, and psychological effects. Patients believed that structural changes occurred during manual therapy treatment, ultimately impacting their overall outcomes. Providers should be aware of patients’ beliefs when using manual therapy interventions.

Polynomial multiplication stands out as a highly demanding arithmetic process in the development of post-quantum cryptosystems. The importance of the number-theoretic transform (NTT) extends beyond post-quantum cryptosystems, proving valuable in enhancing existing security protocols such as digital signature schemes and hash functions. CRYSTALS-KYBER stands out as the sole public key encryption (PKE) algorithm chosen by the National Institute of Standards and Technology (NIST) in its third round selection, making it highly regarded as a leading post-quantum cryptography (PQC) solution. Faults have the potential to disrupt cryptographic systems, compromise data integrity, and enable side-channel attacks, making the incorporation of robust error detection mechanisms essential. This article introduces algorithm-level fault detection schemes in the NTT multiplication using Negative Wrapped Convolution ( NWC ) and the NTT tailored for Kyber Round 3, representing a significant enhancement compared with previous research. We evaluate this through the simulation of a fault model, ensuring that the conducted assessments accurately mirror the obtained results. Our fault detection scheme is designed to address both malicious fault injection attacks on Kyber and naturally occurring faults. Furthermore, we assessed the effectiveness of the proposed error detection scheme for the NTT implemented in both NWC and Kyber , using AMD/Xilinx Artix-7 FPGA, HLS and processor-based approaches. In our FPGA implementation of NWC , the integration of our error detection approach achieves near-100% fault coverage with minimal area overhead and results in only a 12% increase in latency compared with the original hardware design. Finally, we attained an error detection ratio of nearly 100% for the NTT operation in Kyber , with a clock cycle overhead of 16% on the Cortex-A72 processor.

Physical therapy education best practice includes the development of adaptive lifelong learners because of a constantly changing health care landscape. The purpose of this study was to identify how self-directed learning (SDL) changes in traditional Doctor of Physical Therapy (DPT) students over the course of the didactic curriculum. The Master Adaptive Learning (MAL) framework has been proposed as a framework that physical therapy educators adopt to create and educate physical therapists who embrace continuous change and build a culture of creativity and innovation. Fifty students from a midwestern DPT program participated in the quantitative portion, and 14 participated in the qualitative portion of the study. A mixed-methods approach was used to assess students' SDL using the Motivated Strategies of Learning Questionnaire (MSLQ) and the Short Grit scale across the 3-year curriculum. Focus group interviews were conducted following quantitative data collection to develop themes and determine relationships of these themes with existing learning paradigms. There was a statistically significant decrease in students' MSLQ scores from the students' first semester to third and sixth semesters. In the sixth and eighth semester, scores stabilized or had limited improvement. Grit scores remained consistent. Themes that emerged from focus group interviews included deep learning, habits of the heart, and vulnerability. Multiple subthemes were also found that overlap with the MAL framework. This study provides preliminary data to understand DPT students' SDL journey in a traditional DPT program and highlights the need for continued research and efforts toward improving SDL strategies in DPT students. Providing students with necessary resources and support to transition to more self-directed behaviors aligns with the recent call to action to infuse the MAL framework into the PT educational continuum.

OBJECTIVES: To assess the reproducibility of manual therapy interventions used in clinical trials for low back pain (LBP), and summarize knowledge gaps in assessing the reproducibility of manual therapy interventions for LBP. DESIGN: Scoping review. LITERATURE SEARCH: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Embase were searched for trials from inception through April 2023. STUDY SELECTION CRITERIA: Randomized controlled trials were included if they described the use of manual therapy to treat LBP in adults 18 to 65 years old and were accessible in English. DATA SYNTHESIS: The Consensus on Exercise Reporting Template (CERT) checklist, used for exercise reporting, was previously modified for manual therapy reporting. This 11-item modified CERT was used to extract details of manual therapy reporting in the included trials. Frequency counts were calculated to identify items most and least commonly reported. RESULTS: Of 128 trials, none reported all 11 items of the modified CERT. The most commonly reported items were the description of how the application of manual therapy was decided (n = 113, 88.3%) and a description of adjunct interventions provided (n = 82, 64.1%). The least reported items were the description of an associated home program (n = 27, 21.1%) and a detailed description of the application of manual therapy (n = 22, 17.2%). CONCLUSION: Reporting of manual therapy interventions in trials investigating LBP was poor overall, limiting the reproducibility of these treatments. Using a checklist designed explicitly for manual therapy intervention reporting may improve reproducibility of these interventions and help align clinical outcomes with experimental findings. J Orthop Sports Phys Ther 2024;54(4):1-10. Epub 29 January 2024. doi:10.2519/jospt.2024.12201.

To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p=0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p=0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r=-0.18, p=0.048) and higher physical function scores (r=0.22, p=0.03). Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.

As total ankle arthroplasty (TAA) becomes more common, chronic periprosthetic joint infections (PJIs) will be encountered more frequently. No studies have reported on patient-reported outcomes following a 2-stage revision procedure for a chronic PJI after a TAA. The primary purpose of this study was to investigate postoperative clinical outcomes at a minimum of 2 years following a 2-stage revision TAA for chronic PJI. Patients who underwent a 2-stage revision TAA for a chronic PJI (>4 weeks after a primary TAA) between January 2010 and December 2019 were eligible to be included in this study. Chronic PJI was defined as a sinus tract that directly communicated with the prosthesis or the same organism identified in ≥2 synovial fluid samples. Twelve patients were eligible to be included in this case series. One patient died prior to 2-year follow-up, which left 11 patients available for analysis. All 11 patients underwent reimplantation. The data were found not to be normally distributed; therefore, medians and interquartile ranges (IQRs) were reported. At a median of 3.0 years (IQR 2.0-4.0 years) following the second stage of their revision arthroplasty, the median Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sports scores were 60.7 (IQR 52.4, 79.8) and 31.3 (IQR 9.4, 40.6), respectively. At final follow-up, 10 patients (90.9%) were ambulating with a TAA in place. Seven patients (63.6%) required a reoperation including 1 patient who underwent a below-knee amputation. Our study suggests that a 2-stage revision TAA may be an option for patients with a chronic PJI. However, patients who undergo a 2-stage revision TAA for a chronic PJI have lower than previously published 2-year FAAM scores and a high rate of reoperation. Level IV, case series.

Posterior tibial tendon dysfunction (PTTD) and tarsal tunnel syndrome (TTS) are debilitating conditions reported to occur after ankle sprain due to their proximity to the ankle complex. The objective of this study was to investigate the incidence of PTTD and TTS in the 2 years following an ankle sprain and which variables are associated with its onset. In total, 22,966 individuals in the Military Health System diagnosed with ankle sprain between 2010 and 2011 were followed for 2 years. The incidence of PTTD and TTS after ankle sprain was identified. Binary logistic regression was used to identify potential demographic or medical history factors associated with PTTD or TTS. In total, 617 (2.7%) received a PTTD diagnosis and 127 (0.6%) received a TTS diagnosis. Active-duty status (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.70-2.79), increasing age (OR 1.03, 95% CI 1.02-1.04), female sex (OR 1.58, 95% CI 1.28-1.95), and if the sprain location was specified by the diagnosis (versus unspecified location) and did not include a fracture contributed to significantly higher (p < 0.001) risk of developing PTTD. Greater age (OR 1.06, 95% CI 1.03-1.09), female sex (OR 2.73, 95% CI 1.74-4.29), history of metabolic syndrome (OR 1.73, 95% CI 1.03-2.89), and active-duty status (OR 2.28, 95% CI 1.38-3.77) also significantly increased the odds of developing TTS, while sustaining a concurrent ankle fracture with the initial ankle sprain (OR 0.45, 95% CI 0.28-0.70) significantly decreased the odds. PTTD and TTS were not common after ankle sprain. However, they still merit consideration as postinjury sequelae, especially in patients with persistent symptoms. Increasing age, type of sprain, female sex, metabolic syndrome, and active-duty status were all significantly associated with the development of one or both subsequent injuries. This work provides normative data for incidence rates of these subsequent injuries and can help increase awareness of these conditions, leading to improved management of refractory ankle sprain injuries.