Special Tests for Orthopedic Examination, ed 3

Rural Early Intervention Therapists’ Perceptions of Emergency Remote Telehealth Use

Experiences from the SARS-CoV-2 Pandemic: How One Orthopaedic Practice Pivoted to Serve Their Community.

Gait speed is commonly used to assess walking ability in persons with stroke. Previous research related to the psychometric properties of gait speed has been conducted primarily with individuals who were able to walk independently and/or were in the later stages of recovery after stroke. The purpose of this research was to examine the test-retest reliability and minimal detectable change (MDC90) of gait speed in individuals with stroke who required varying levels of assistance to ambulate during rehabilitation. Patients who could ambulate with or without physical assistance and were undergoing inpatient rehabilitation were recruited. Gait speed was measured over the middle five meters of a nine-meter walk at a comfortable pace. Data were analyzed using the intraclass correlation coefficient (ICC2,1) and the MDC90. Thirty-five patients who were a mean 34.5 (standard deviation = 17.7) days post-stroke agreed to participate. For all the subjects combined, the ICC2,1 was 0.862 and MDC90 was 0.30 m/sec. For the 13 subjects who required physical assistance to walk, the ICC2,1 = 0.971 and MDC90 = 0.07 m/sec. For the 22 subjects who could walk without physical assistance, the ICC2,1 = 0.80 and MDC90 = 0.36 m/sec. Gait speed is a reliable measure of walking ability for a wide variety of patients undergoing rehabilitation after stroke. Gait speed is more sensitive to change in patients who require physical assistance to walk than in those who can walk without assistance. A change of more than 0.30 m/sec may be necessary in order to determine whether a change in gait speed exceeds measurement error and patient variability.

A-10 Virginians Report Unequal Access to Appropriate Licensed Healthcare Providers for Concussion

Effective treatment of orthopedic injuries requires a multidisciplinary team, including physical and occupational therapists, athletic trainers, massage therapists, and acupuncturists. Orthopedic surgeons commonly encounter these practitioners but may not be familiar with the training, credentialing, and most importantly, the appropriate use of members of this team. There are general similarities in practice locations as well as types of symptoms addressed by the providers discussed, which include the treatment of physical pain, evaluation and treatment of physical impairment, and some facilitation of adaptation to the limitations caused by injuries. Across the 5 types of providers discussed there are widely varying training and licensing requirements, specializations, and continuing education requirements to maintain licensure. This article provides a focused review of these members of the multidisciplinary team and highlights the current American Academy of Orthopaedic Surgeons recommendations for the use of occupational and physical therapists for orthopedic conditions, including hip fractures, total hip arthroplasty, and anterior cruciate ligament reconstruction.

The pediatric population is more susceptible to sustaining concussion and experiencing more severe and prolonged symptoms as compared with adults. Current evidence indicates conflicting beliefs within the interdisciplinary team in terms of best practices for managing pediatric concussion. (1)To describe current practices on interdisciplinary coordination among physical therapists (PTs) and athletic trainers (ATs) during management and return to play (RTP) of children and adolescents with concussion and (2)to describe their confidence in implementing RTP protocols, their comprehension of concussion legislation, and scope of practice of their profession regarding returning pediatric athletes to sport postconcussion. A 34-item anonymous survey containing questions regarding demographics, confidence with concussion management, knowledge of sports-related concussion state legislation, beliefs of interdisciplinary concussion management team, and referral/communication patterns was electronically distributed through alumni networks. 141 respondents (80 ATs and 61 PTs). Only 12.5% of ATs believed that PTs had any role in the initial concussion management, whereas 65% of PTs regarded the role of ATs in initial management as important. In terms of legislation, 44% of PTs and 12.5% of ATs were unsure of state laws pertaining to concussion management or health care professions responsible for RTP. There was consensus among PTs and ATs (61%) in the lack of interdisciplinary coordination of care and lack of awareness among physician groups regarding RTP protocols. Within their respective disciplines, a greater proportion of PTs (63%) agreed that the process of care lacked standardization as compared with ATs (21%). Lack of interdisciplinary communication and collaboration during management of pediatric concussion may cause premature RTP that may lead to catastrophic effects on the developing pediatric brain. Barriers regarding education, time management, knowledge of state laws, and understanding other professions' scope of practice need to be further addressed to ensure safe RTP.

The goal of rehabilitation following rotator cuff repair is to restore the functional capability of the shoulder. It requires integrated input from both the surgeon and the rehabilitation clinician (physical therapist, occupational therapist, and/or athletic trainer). It is based on the restoration of the anatomy, but requires restoration of the physiology. It requires adherence to basic principles of tissue healing, muscle flexibility, muscle strength, and progression through rehabilitation stages and demands attention to several aspects of functional restoration. This chapter will discuss the role of the surgeon and basic principles of the rehabilitation protocol and will present guidelines and progressions for physical therapists and other rehabilitation clinicians through the protocols.

Rehabilitation Providers' Prediction of the Likely Success of the SNF-to-Home Transition Differs by Discipline

Telehealth Opportunities in the Digital Age

Occupational Therapists' Perceptions on Orthopedic Injuries and Cognitive Deficits

Context: Quality of care is an ethical priority to all healthcare professionals. Healthcare fields such as nursing and physical therapy have made changes in staff size and focus that have increased the quality of care provided to patients. The athletic training field has not made changes to the organizational structure. Thus, the quality of care delivered by athletic trainers is an understudied topic. Likewise, the organizational models have just recently been explored in the literature. Objective: Identify differences in the three models of organization (academic, athletic, and medical) related to quality of care delivered and coverage versus care. Design: This study was a prospective exploratory questionnaire analysis. Setting: Clinically practicing athletic trainers in the NCAA Division I setting of the United States. Patients and Other Participants: A randomized list of 1,000 National Athletic Trainers’ Association (NATA) members who are Board of Certification (BOC) certified and clinically practicing in the NCAA Division I setting. The list was used to recruit participants to the questionnaire. Participants were required to be full-time, clinically practicing athletic trainers in the NCAA Division I setting. Participants were excluded if they are less than 18 years of age, not practicing in the Division I setting as an athletic trainer (AT), and are not employed full time (i.e. GAs, interns, residents). There were 66 valid responses recorded of the 1,000 potential participants (0.06% return rate). Intervention: Participants were contacted via the NATA Research Survey Service via e-mail. The e-mail contained a cover letter and link to a questionnaire. Two-weeks after the initial e-mail a follow-up letter with the link to the questionnaire was sent to encourage participation. The questionnaire contained 52-questions related to the perception of the quality of care delivered, whether the focus is on coverage or care, and demographic questions. Main Outcome Measures: Athletic trainers self-perception of the quality of healthcare they delivered and whether the focus is on coverage or care and the relationship to the model of organization (academic, athletic, medical) used. Results: 86.5% of participants were categorized into the athletics model of organization. There were 49 (74%) of participants in the high-quality care category. Seventy-seven percent of participants were in the high-coverage category. There was a significant relationship (p = .021) between the model of organization and the quality of care category. Conclusion: Athletic trainer self-perception of the quality of care delivered to patient is high. Athletic trainers in the medical model provided

Prevention and appropriate management of musculoskeletal (MSK) conditions is a key contributor to a healthy and well population. Physical therapists (PTs) and athletic trainers (ATs) are allied health professionals at the forefront of prevention and management of MSK conditions, working in wide-ranging healthcare settings, from outpatient clinics, with specialized populations (e.g., athletes), within schools, and in industrial settings and public health. PTs and ATs receive extensive education in evidence-based practice for the prevention and treatment of common MSK conditions, but little to no formal education in dissemination and implementation (D&I) science. This curricular omission may contribute to persistent challenges and gaps in the real-world translation of injury prevention and rehabilitation research into sustainable and effective PT and AT practice. Here the authors, five MSK injury prevention and management researchers and clinicians with experience or expertise in D&I science, present a brief background on the emergence of D&I in the MSK literature, and outline short- and longer-term goals for the integration of D&I into PT and AT education and training, setting forth a vision for the prominence of D&I in the PT/AT professions.

The reliability of a two-plane qualitative assessment tool for a single leg HOP task amongst multidisciplanary sports medicine practitioners.

To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center. This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013. The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure. Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test. This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.