Short-term effect of a carbon fiber custom dynamic orthosis and integrated rehabilitation on self-reported physical function, pain, speed, and agility in civilians.

BACKGROUND: Ankle-foot orthoses (AFOs) are widely used to restore mobility and reduce pain in individuals with lower extremity pain and disability. The use of a carbon fiber custom dynamic orthosis (CDO) with integrated physical training and psychosocial intervention has been shown to improve outcomes in a military setting, but civilian data are limited. OBJECTIVES: To use existing clinical data to evaluate the initial effectiveness of an integrated CDO and rehabilitative program and identify baseline characteristics that impact patient response to the intervention. STUDY DESIGN: Retrospective cohort. METHODS: Records of 131 adult patients who received a CDO and device specific training were reviewed. Patient-reported measures of pain and lower extremity function and physical measurements of walking and agility were extracted at baseline and on training completion. RESULTS: A majority of patients reported improved or greatly improved physical function (92%), maximum pain (69%), and typical pain (55%) and experienced improved or greatly improved walking speed (92%) and agility (52%) irrespective of age and sex. Regression models for examining short-term improvement in pain and physical function accounted for 52% (p < 0.001) and 26% (p < 0.001) of the outcome variance, respectively. Improvement in typical pain was influenced by baseline typical and maximum pain, and functional improvement was influenced by sex and baseline physical function. CONCLUSIONS: Most patients (92.4%) reported a positive initial outcome after intervention as measured using patient-reported and objective measures.

Predictors of long-term pain and function in individuals who received a custom dynamic orthosis and device-centric care pathway.

INTRODUCTION: Carbon fiber custom dynamic orthoses (CDOs) have been shown to effectively reduce pain and improve function in military service members with lower-limb impairment, but data are limited for civilians. OBJECTIVES: To evaluate the long-term outcomes of individuals who completed a CDO-centric care pathway in a civilian clinic by comparing baseline pain, mobility, and function with outcomes at long-term follow-up. To identify baseline characteristics and postintervention outcomes predictive of outcomes at long-term follow-up. METHODS: Records of 131 adult patients who received a CDO and CDO-centric training were reviewed. Patient-reported measures of pain and physical function and timed assessment of walking and agility collected during routine clinical care were extracted. These patients were contacted on average 4 (±1) years postintervention to complete a survey including measures of pain and physical function. RESULTS: The 63 participants who responded reported improved or greatly improved function, maximum pain, and typical pain on average, irrespective of age or sex (P < 0.001). Change in function from baseline to long-term follow-up was predicted by short-term change in function (35.1% of the variance; P < 0.001). Change in pain from baseline to long-term follow-up was predicted by baseline typical pain and change in four square step test time (63% of variance; P < 0.001). CONCLUSIONS: Most survey respondents reported positive outcomes. Long-term pain reduction and improved function were predicted by baseline status and by short-term changes associated with receiving a CDO and completing an intensive training program.

Saliva-based SARS-CoV-2 serology using at-home collection kits returned via mail.

Serology provides tools for epidemiologic studies, and may have a role in vaccine prioritization and selection. Automated serologic testing of saliva, especially specimens that are self-collected at home and sent to a laboratory via the mail without refrigeration, could be a highly-scalable strategy for population-wide testing. In this prospective study, non-vaccinated patients were recruited after PCR testing to self-collect saliva and return their specimens via mail. Longitudinal specimens were analyzed in order to monitor seroconversion in the weeks after a diagnostic PCR test for SARS-CoV-2. Diverse users self-collected saliva and returned specimens via mail in compliance with shipping regulations. At our pre-established threshold (0.963 AU/mL), salivary IgG reactivity to full-length spike protein achieved 95.8% sensitivity and 92.4% specificity at 2-4 weeks after diagnostic testing, which is comparable to the typical sensitivity and specificity achieved for serum testing. Reactivity to N antigen also was detected with 92.6% sensitivity and 90.7% specificity at 4-8 weeks after diagnostic testing. Moreover, serologic testing for endemic coronaviruses performed in multiplex with SARS-CoV-2 antigens has the potential to identify samples that may require retesting due to effects of pre-analytical factors. The easy-to-use saliva collection kit, coupled with thresholds for positivity and methods of flagging samples for retest, provides a framework for large-scale serosurveillance of SARS-CoV-2.

Application of Athletic Movement Tests that Predict Injury Risk in a Military Population: Development of Normative Data.

Performance on movement tests helps to predict injury risk in a variety of physically active populations. Understanding baseline measures for normal is an important first step. OBJECTIVES: Determine differences in physical performance assessments and describe normative values for these tests based on military unit type. METHODS: Assessment of power, balance, mobility, motor control, and performance on the Army Physical Fitness Test were assessed in a cohort of 1,466 soldiers. Analysis of variance was performed to compare the results based on military unit type (Rangers, Combat, Combat Service, and Combat Service Support) and analysis of covariance was performed to determine the influence of age and gender. RESULTS: Rangers performed the best on all performance and fitness measures (p < 0.05). Combat soldiers performed better than Combat Service and Service Support soldiers on several physical performance tests and the Army Physical Fitness Test (p < 0.05). Performance in Combat Service and Service Support soldiers was equivalent on most measures (p < 0.05). CONCLUSIONS: Functional performance and level of fitness varied significantly by military unit type. Understanding these differences will provide a foundation for future injury prediction and prevention strategies.

What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study.

BACKGROUND: Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findings from this population may also be useful as hypothesis-generating work for particular civilian settings such as law enforcement officers (SWAT teams), firefighters (smoke jumpers), or others in physically demanding professions. QUESTIONS/PURPOSES: The purposes of this study were (1) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk; and (2) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers. METHODS: Our study was a planned secondary analysis from a prospective cohort examining how baseline factors predict musculoskeletal injury. Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures. Survey data included demographic variables, injury history, and biopsychosocial questions. Physical performance measures included ankle dorsiflexion, Functional Movement Screen, lower and upper quarter Y-balance test, hop testing, pain provocation, and the Army Physical Fitness Test (consisting of a 2-mile run and 2 minutes of sit-ups and push-ups). A total of 320 Rangers were invited to enroll and 211 participated (66%). Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys, medical record reviews, and a query of the Department of Defense healthcare utilization database. Injury surveillance data were available on 100% of the subjects. Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest. A logistic regression equation was then calculated to find the most pertinent set of predictors. Of the 188 Rangers (age, 23.3 ± 3.7 years; body mass index, 26.0 ± 2.4 kg/m(2)) remaining in the cohort, 85 (45.2%) sustained a musculoskeletal injury of interest. RESULTS: Smoking, prior surgery, recurrent prior musculoskeletal injury, limited-duty days in the prior year for musculoskeletal injury, asymmetrical ankle dorsiflexion, pain with Functional Movement Screen clearing tests, and decreased performance on the 2-mile run and 2-minute sit-up test were associated with increased injury risk. Presenting with one or fewer predictors resulted in a sensitivity of 0.90 (95% confidence interval [CI], 0.83-0.95), and having three or more predictors resulted in a specificity of 0.98 (95% CI, 0.93-0.99). The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 (95% CI, 2.0-9.2), relative risk of 1.9 (95% CI, 1.4-2.6), and an area under the curve of 0.64. CONCLUSIONS: Multiple factors (musculoskeletal injury history, smoking, pain provocation, movement tests, and lower scores on physical performance measures) were associated with individuals at risk for musculoskeletal injury. The summation of the number of risk factors produced a highly sensitive (one or less factor) and specific (three or more factors) model that could potentially be used to effectively identify and intervene in those persons with elevated risk for musculoskeletal injury. Future research should establish if screening and intervening can improve musculoskeletal health and if our findings among US Army Rangers translate to other occupations or athletes. LEVEL OF EVIDENCE: Level II, prognostic study.

Inter-rater reliability of ultrasound imaging of the trunk musculature among novice raters.

OBJECTIVE: The purpose of this study was to determine the inter-rater reliability of ultrasound imaging for assessing trunk muscle morphologic characteristics at rest and while contracted among different pairs of novice raters. The secondary purpose was to compare 3 different measurement techniques for assessing lateral abdominal muscle thickness. METHODS: A single-group repeated measures reliability study was conducted on 21 healthy participants (mean ± SD, 21.5 ± 4.4 years; 5 female and 16 male) without low back pain. Ultrasound images of the transversus abdominis, internal oblique, rectus abdominis, and lumbar multifidus muscles were obtained by different pairs of novice raters in a counterbalanced order. All raters received a standardized training program before obtaining measurements. RESULTS: The intraclass correlation coefficient (1, 3) point estimates ranged from 0.86 to 0.94; the standard error of the measurement ranged from 0.04 to 0.16 cm for the thickness values and 0.67 cm(2) for the cross-sectional area of the rectus abdominis muscle. There was no meaningful difference between the different measurement techniques used to analyze the lateral abdominal muscles. CONCLUSIONS: Good to excellent reliability was obtained for all measures by novice raters. Minimal differences in reliability were noted between the different measurement techniques to assess lateral abdominal muscle thickness.

Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test.

OBJECTIVE: To determine whether changes in the transversus abdominis (TrA) and internal oblique (IO) muscles, as seen on ultrasound imaging, during the active straight leg raise (ASLR) test differ between subjects with and without unilateral lumbopelvic pain. DESIGN: Cross-sectional, case-control study. SETTING: Clinical laboratory. PARTICIPANTS: Subjects (n=15) with unilateral symptoms in the lumbopelvic region and age-matched and sex-matched control subjects (n=15). INTERVENTIONS: Bilateral measurements of the deep abdominal muscles (TrA and IO) were obtained simultaneously using ultrasound imaging to compare the percent change in muscle thickness from rest with (1) immediately on raising, (2) after a 10-second hold, and (3) within 5 seconds after returning the lower extremity to the plinth. MAIN OUTCOME MEASURE: Percent change in muscle thickness of both muscles from rest to the other 3 time intervals during the ASLR test. RESULTS: The 3-way group x side measured x time and 2-way side measured x time interactions were not significant for either the TrA (P> or =.34) or the IO (P> or =.14) muscles. The 2-way interaction group x time was significant for both the TrA (P=.003) and the IO (P=.02) muscles. On lifting the lower extremity, the control group demonstrated a 23.7% and 11.2% increase in TrA and IO muscle thickness, respectively, while those with lumbopelvic pain demonstrated a 6.4% and 5.7% increase in TrA and IO muscle thickness, respectively. CONCLUSIONS: Although subjects with unilateral lumbopelvic pain demonstrated a smaller increase in muscle thickness, during the ASLR test there appears to be a symmetrical response in both of the deep abdominal muscles regardless of which lower extremity is lifted during the ASLR test or the unilateral nature of the symptoms. This study attests to the potential construct validity of using the ASLR test to assess different motor control strategies of the TrA and IO muscles in subjects with unilateral lumbopelvic pain.