Student Preferences for Virtual or In-Person Interprofessional Education Simulations.

The COVID-19 pandemic created a shift in interprofessional education (IPE) courses, causing programs to change pedagogical approaches. We sought to examine student preferences for taking IPE simulations. On post-simulation surveys from two courses (n=844 students, 2020-2022 academic years), we asked students if they preferred to take the simulation through a synchronous in-person or virtual format. More students preferred a virtual platform in academic year 2021-2022 than the previous year (p<0.001). Students who chose the virtual format believed it was more convenient, reduced COVID-19 transmission, and eased interprofessional collaboration. The downsides to in-person simulations included travel logistics and technical challenges in the simulation lab. Students suggested that in-person simulations more closely resembled 'real life' and that communication and body language are easier to convey in person.

Trunk movement compensation identified by inertial measurement units is associated with deficits in physical performance, muscle strength and functional capacity in people with hip osteoarthritis.

BACKGROUND: Trunk movement compensation characterized as ipsilateral trunk lean and posterior rotation with respect to pelvis during stance phase of walking is common in people with hip osteoarthritis and a biomarker of deficits in physical function in older adults. However, the relationship between trunk movement compensation on deficits in physical performance, muscle strength and functional capacity is unknown. METHODS: A cross-sectional study design was used. Two inertial measurement units were used to assess trunk movement compensation during the six-minute-walk-test. Knee extension, knee flexion and hip abduction strength were measured using hand-held dynamometer. Multivariate regression models, controlling for self-reported hip pain, were used to regress trunk movement compensation onto six-minute-walk-test and muscle strength measures. Pairwise t-tests were used to evaluate the difference trunk movement compensation has on functional capacity by comparing the first and last minute of the six-minute-walk-test. FINDINGS: Thirty-five participants (63.3 ± 7.4 years, 57% male, 28.6 ± 4.5 kg/m2) were enrolled. Greater trunk movement compensation was related to poorer six-minute-walk-test (p = 0.03; r = -0.46). Greater hip abduction weakness was related to increased trunk movement compensation in both the sagittal (p = 0.05; r = -0.44) and frontal (p = 0.04; r = -0.38) planes. Participants demonstrated greater frontal plane trunk movement compensation during the last minute compared to the first minute of the six-minute-walk-test (p < 0.01). INTERPRETATION: Trunk movement compensation, identified by inertial measure units, is a clinically relevant measure and has a moderate-to-strong relationship on deficits in physical performance, muscle strength and functional capacity. Inertial measurement units can be used as a practical means of measuring movement quality in the clinical setting.

Effects of Ice Massage Prior to an Iontophoresis Treatment Using Dexamethasone Sodium Phosphate.

CONTEXT: Low current intensity iontophoresis treatments have increased skin perfusion over 700% from baseline potentially altering drug clearance from or diffusion to the targeted area. OBJECTIVE: To determine the effects of a preceding 10-minute ice massage on subcutaneous dexamethasone sodium phosphate (Dex-P) concentration and skin perfusion during and after a 4-mA iontophoresis treatment. DESIGN: Controlled laboratory study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-four participants (male = 12, female = 12; age = 25.6 [4.5] y, height = 173.9 [8.51] cm, mass = 76.11 [16.84] kg). INTERVENTION(S): Participants were randomly assigned into 2 groups: (1) pretreatment 10-minute ice massage and (2) no pretreatment ice massage. Treatment consisted of an 80-mA·minute (4 mA, 20 min) Dex-P iontophoresis treatment. Microdialysis probes (3 mm deep in the forearm) were used to assess Dex-P, dexamethasone (Dex), and its metabolite (Dex-Met) concentrations. Skin perfusion was measured using laser Doppler flowmetry. MAIN OUTCOME MEASURE(S): Microdialysis samples were collected at baseline, at conclusion of treatment, and every 20 minutes posttreatment for 60 minutes. Samples were analyzed to determine Dex-Total (Dex-Total = Dex-P + Dex + Dex-Met). Skin perfusion was calculated as a percentage change from baseline. A mixed-design analysis of variance was used to determine Dex-Total and skin perfusion difference between groups overtime. RESULTS: There was no difference between groups (P = .476), but [Dex-Total] significantly increased over the course of the iontophoresis and posttreatment time (P < .001). Dex-P was measured in 18 of 24 participants with a mean concentration of 0.67 (1.09) µg/mL. Skin perfusion was significantly greater in the no ice treatment group (P = .002). Peak skin perfusion reached 27.74% (47.49%) and 117.39% (103.45%) from baseline for the ice and no ice groups, respectively. CONCLUSIONS: Ice massage prior to iontophoresis does not alter the tissue [Dex-Total] even with less skin perfusion.

Dexamethasone Sodium Phosphate Penetration During Phonophoresis at 2 Ultrasound Frequencies.

CONTEXT: The effect of ultrasound frequency on phonophoresis drug delivery in humans is unknown. OBJECTIVE: To determine if a low (45-kHz) or high (1-MHz) frequency delivered a higher dexamethasone (Dex) concentration through the skin. DESIGN: Controlled laboratory study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 40 healthy men between the ages of 18 and 45 years (age = 23.1 ± 2.6 years, height = 176.1 ± 7.2 cm, mass = 88.5 ± 19.4 kg, posterior calf subcutaneous thickness measured using musculoskeletal ultrasound imaging = 0.6 ± 0.2 cm). INTERVENTION(S): Participants were randomly assigned to 1 of 4 groups (ultrasound frequency at microdialysis probe depth): (1) 45-kHz frequency at 1 mm, (2) 45-kHz frequency at 4 mm, (3) 1-MHz frequency at 1 mm, or (4) 1-MHz frequency at 4 mm (n = 10 in each group). Three linear microdialysis probes were inserted at the desired tissue depth. We rubbed dexamethasone sodium phosphate (Dex-P) into the skin and then applied a 15-minute phonophoresis treatment. MAIN OUTCOME MEASURE(S): Dialysate was collected during the treatment and 60 minutes posttreatment and analyzed for Dex-P, Dex, and the metabolite form of Dex. The sum of the 3 analytes was calculated as total dexamethasone (Dex-total), and differences between the 45-kHz and 1-MHz treatment groups were determined by a repeated-measures analysis of variance. RESULTS: At 1 mm, 3 (30%) participants in the 45-kHz and 4 (40%) participants in the 1-MHz group had measurable levels of Dex-P. Total dexamethasone increased after the treatment ceased, independent of ultrasound frequency (P < .001), with a trend of the 45-kHz treatment to produce a greater increase in drug concentration (P = .006). At 4 mm, 5 (50%) participants in the 45-kHz and 1 (10%) participant in the 1-MHz group had measurable levels of Dex-P. We observed no difference in Dex-total concentration between treatment groups at 4 mm (P = .72). CONCLUSIONS: Phonophoresis provided a mechanism for Dex-total delivery at the 1- and 4-mm tissue depths. However, the effectiveness of the ultrasound frequencies varied between the 2 measured tissue depths.

A Novel Blue-Red Photobiomodulation Therapy Patch Effects on a Repetitive Elbow-Flexion Fatigue Task.

BACKGROUND: Photobiomodulation (laser/light) therapy has reduced skeletal muscle fatigue and improved performance in previous research. OBJECTIVE: To determine if the application of a novel blue (450 nm) and red (645 nm) light-emitting diode photobiomodulation therapy patch improves muscle function and decreases perceived exertion after an elbow-flexion fatigue protocol. PARTICIPANTS: Thirty-four strength-trained individuals (male = 32 and female = 2, age = 22.5 [2.7] y). METHODS: Participants were randomly assigned to an active or placebo treatment. On  visit 1, participants' 1-repetition maximal biceps curl was determined, and an orientation session of the fatigue task occurred to ensure no learning effects. Fifty percent of the participants' 1-repetition maximum was used during the fatigue protocol. On visit 2, participants performed biceps curl repetitions at a speed of 25 repetitions per minute until they could not physically move the weight past 90° of elbow flexion or stay with the set pace. After the fatigue protocol, a 30-minute blue/red light (wavelength = 450 and 645 nm, peak irradiance = 9 mW/cm2, duty cycle = pulsed 33%, and fluence = 5.4 J/cm2) or sham treatment was administered based on the randomized group assignment. Immediately following, the participants repeated the fatigue protocol. The number of complete repetitions was counted, and the participants rated their perceived level of exertion on the Borg scale immediately after each fatigue bout. RESULTS: Overall, fatigue occurred between the 2 exercise bouts (pretreatment = 44.1 [12.3] and posttreatment = 37.4 [9.6] repetitions, P = .02). However, less fatigue was noted in the number of participants of the active treatment group than the sham treatment group. During the posttreatment fatigue task, 29.4% of participants in the active treatment group improved compared to 0% in the sham treatment (P = .045). CONCLUSION: Nearly 30% of participants had an increase benefit during a repeated-bout fatigue task due to the blue/red light-emitting diode photobiomodulation light patch.

The Effectiveness of Photobiomodulation Therapy Versus Cryotherapy for Skeletal Muscle Recovery: A Critically Appraised Topic.

Clinical Scenario: Cryotherapy is one of the most commonly used modalities for postexercise muscle recovery despite inconsistencies in the literature validating its effectiveness. With the need to find a more effective modality, photobiomodulation therapy (PBMT) has gained popularity because of recent research demonstrating its ability to accelerate the muscle recovery process. Focused Clinical Question: Is PBMT more effective than cryotherapy at reducing recovery time and decreasing delayed onset muscle soreness after strenuous exercise? Summary of Key Findings: Three moderate- to high-quality double-blinded, randomized, placebo-controlled trials and 2 low- to moderate-quality translational studies performed on rats were included in this critically appraised topic. All 5 studies supported the use of PBMT over cryotherapy as a treatment for postexercise muscle recovery following exercise. PBMT was superior in reducing creatine kinase, inflammation markers, and blood lactate compared with cryotherapy, following strenuous/high intensity aerobic or strength muscular exercise. PBMT was also shown to improve postexercise muscle performance and function more than cryotherapy. Clinical Bottom Line: There is moderate evidence to suggest the use of PBMT over cryotherapy postexercise to enhance muscle recovery in trained and untrained athletes. Shorter recovery times and increased muscle performance can be seen 24 to 96 hours following PBMT application. Strength of Recommendation: Based on consistent findings from all 5 studies, there is grade B evidence to support the use of PBMT over cryotherapy for more effective postexercise recovery of skeletal muscle performance.

Effects of Long Duration Low Intensity Ultrasound for Active Trapezius Trigger Points: A Randomized Clinical Trial.

CONTEXT: Upper trapezius trigger points can be debilitating and often lead to chronic pain. OBJECTIVE: To determine if long duration low intensity therapeutic ultrasound is effective at treating upper trapezius trigger point pain compared to an inactive placebo treatment. DESIGN: Randomized control trial. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifty-one participants (19 males, 32 females, age = 31.8 ± 12.5 y, ht = 168.6 ± 15.9 cm, mass = 77.1 ± 16.1 kg) diagnosed with chronic upper trapezius pain. INTERVENTIONS: Participants were randomly assigned into an active (n = 32) or sham (n = 19) treatment group. Treatments were applied at least 3 times a week for 4 weeks and each ultrasound treatment lasted 4 h. MAIN OUTCOME MEASURES: Participants completed a daily numeric rating scale (NRS) pain diary. Pain pressure threshold was assessed via a pressure algometer. Repeated-measures ANCOVAs were used to examine differences over time and between groups. RESULTS: Pain on the NRS was significantly reduced from baseline (5.4 ± 1.7) to the conclusion of the study (4.2 ± 1.6) (F4,254 = 7.747, P < 0.001); however, the reduction did not significantly differ between the two groups (F4,254 = 1.096, P = 0.359). There was an average reduction in pain of 1.1 ± 1.8 points over the course of a 4 h treatment (F4,254 = 18.67, P = 0.001), but this reduction did not differ between groups, (F4,254 = 0.701, P = 0.592). Pain pressure threshold improved by 0.46 ± 1.29 and 0.44 ± 1.73 kg for active and sham groups, respectively, but was not different between groups (F2,142 = 1.168, P = 0.314). CONCLUSIONS: Four-weeks of low intensity long duration ultrasound reduced upper trapezius trigger point pain, but the improvement is attributed to a placebo effect.

Achilles Tendon Cross Sectional Area Changes Over a Division I NCAA Cross Country Season.

Tracking Achilles tendon cross sectional area (CSA) changes may help clinicians understand exercise adaptations and Achilles tendon injury mechanisms. To track adaptations in the Achilles tendon in response to a cross country season. DESIGN: Longitudinal study. Musculoskeletal (MSK) ultrasound images were obtained in a research laboratory. Cross country athletes ran with no restrictions outdoors and indoors. Participants were Division I NCAA cross country athletes (N = 24, age = 19.9 ± 2.1 years, mass = 61.32 ± 20.16 kg, height = 168.92 ± 17.16 cm, sex = 8 males and 16 females). Achilles tendon CSA was obtained through MSK ultrasound imaging at a pre-season baseline measurement, every 3 weeks throughout the season, and at post-season for a total of 4 measurements. Participants followed their normal running regimen outlined by their cross country coach. The dependent variable was Achilles tendon CSA measured by ultrasound imaging. We used a repeated measures ANCOVA to determine differences in CSA over the cross country season. CSA increased from baseline (0.439 ± .081 cm), to 0.466 ± 0.096 cm at 3-weeks, to 0.471 ± 0.092 cm 6-weeks, and decreased to 0.451 ± 0.104 cm at the post-season measurement. The 3-week and 6-week measures significantly increased from baseline (F3,72 = 8.575, p < .001). Achilles tendon CSA increased during the cross country season, but returned to baseline values at the end of a cross country season. Clinicians should be aware of the changing nature of the Achilles tendon CSA when treating cross country runners.

Wireless Versus Wired Iontophoresis for Treating Patellar Tendinopathy: A Randomized Clinical Trial.

CONTEXT: The efficacy of the relatively new wireless iontophoresis patch compared with the traditional wired dose controller is unknown. OBJECTIVE: To determine the differences among 2 iontophoresis drug-delivery systems (wireless patch versus wired dose controller) and a sham treatment in treating patellar tendinopathy. DESIGN: Randomized controlled clinical trial. SETTING: Physical therapy clinic. PATIENTS OR OTHER PARTICIPANTS: Thirty-one participants diagnosed with patellar tendinopathy (men = 22, women = 9, age = 24.5 ± 5.9 years). INTERVENTION(S): Participants were randomly assigned into 1 of 3 treatment groups: wireless patch, wired dose controller, or sham treatment. Participants in the active treatment groups received six 80 mA/min iontophoresis treatments using 2 mL of 4% dexamethasone sodium phosphate. During each visit, clinical outcome measures were assessed and then the assigned treatment was applied. MAIN OUTCOME MEASURE(S): Clinical outcome measures were Kujala Anterior Knee Pain Scale, pressure sensitivity, knee-extension force, and sit-to-stand pain assessment using a numeric rating scale. For each clinical outcome measure, we used a repeated-measures analysis of covariance to determine differences among the treatment groups over the treatment period. RESULTS: Participants reported a clinically important improvement on the Kujala Anterior Knee Pain Scale across all treatment groups, with no differences among groups (P = .571). A placebo effect was observed with pressure sensitivity (P = .0152); however, the active treatment decreased participants' pain during the sit-to-stand test (P = .042). CONCLUSIONS: A placebo effect occurred with the sham treatment group. Generally, improvement was noted in all groups regardless of treatment type, but greater pain reduction during a functional task was evident within the active treatment groups during the sit-to-stand test. The wireless patch and wired dose controller treatments were equivalent across all variables.

Intramuscular Heating Characteristics of Multihour Low-Intensity Therapeutic Ultrasound.

CONTEXT: The heating characteristics of a stationary device delivering sustained acoustic medicine with low-intensity therapeutic ultrasound (LITUS) are unknown. OBJECTIVE: To measure intramuscular (IM) heating produced by a LITUS device developed for long-duration treatment of musculoskeletal injuries. DESIGN: Controlled laboratory study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 26 healthy volunteers (16 men, 10 women; age = 23.0 ± 2.1 years, height = 1.74 ± 0.09 m, mass = 73.48 ± 14.65 kg). INTERVENTION(S): Participants were assigned randomly to receive active (n = 20) or placebo (n = 6) LITUS at a frequency of 3 MHz and an energy intensity of 0.132 W/cm(2) continuously for 3 hours with a single transducer or dual transducers on the triceps surae muscle. We measured IM temperature using thermocouples inserted at 1.5- and 3-cm depths into muscle. Temperatures were recorded throughout treatment and 30 minutes posttreatment. MAIN OUTCOME MEASURE(S): We used 2-sample t tests to determine the heating curve of the LITUS treatment and differences in final temperatures between depth and number of transducers. RESULTS: A mild IM temperature increase of 1 °C was reached 10 ± 5 minutes into the treatment, and a more vigorous temperature increase of 4 °C was reached 80 ± 10 minutes into the treatment. The maximal steady-state IM temperatures produced during the final 60 minutes of treatment at the 1.5-cm depth were 4.42 °C ± 0.08 °C and 3.92 °C ± 0.06 °C using 1 and 2 transducers, respectively. At the 3.0-cm depth, the maximal steady-state IM temperatures during the final 60 minutes of treatment were 3.05 °C ± 0.09 °C and 3.17 °C ± 0.05 °C using 1 and 2 transducers, respectively. We observed a difference between the temperatures measured at each depth (t78 = -2.45, P = .02), but the number of transducers used to generate heating was not different (t78 = 1.79, P = .08). CONCLUSIONS: The LITUS device elicited tissue heating equivalent to traditional ultrasound but could be sustained for multiple hours. It is a safe and effective alternative tool for delivering therapeutic ultrasound and exploring dosimetry for desired physiologic responses.

The time course of dexamethasone delivery using iontophoresis through human skin, measured via microdialysis.

STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To determine the time course of dexamethasone sodium phosphate (Dex-P) during iontophoresis to underlying tissues using microdialysis. BACKGROUND: In human participants, real-time information of Dex-P transdermal delivery during iontophoresis is unknown. METHODS: Sixty-four healthy male participants (mean ± SD age, 24.2 ± 3.3 years; height, 181.8 ± 26.1 cm; mass, 82.4 ± 11.8 kg; subcutaneous fat thickness, 0.61 ± 0.19 cm) were randomly assigned into 1 of 6 groups: (1) 1-mA current, 1-mm probe depth; (2) 1-mA current, 4-mm probe depth; (3) 2-mA current, 1-mm probe depth; (4) 2-mA current, 4-mm probe depth; (5) in vivo retrodialysis; and (6) skin perfusion flowmetry. Microdialysis probes were used to assess the combined recovery (Dex-total) of Dex-P, dexamethasone, and its metabolite. RESULTS: There was no difference in Dex-total between current intensities (P = .99), but a greater amount of Dex-total was recovered superficially at 1 mm compared to the 4-mm depth (P<.0001). Peak concentration mean ± SD values for the 1- and 2-mA currents at 1 mm were 10.8 ± 8.1 and 7.7 ± 5.5 µg/mL, and at 4 mm were 2.0 ± 0.8 and 1.3 ± 0.9 µg/mL, respectively. Peak skin perfusion was 741.4% ± 408.7% and 711.6% ± 260.8% at baseline for 1- and 2-mA intensities, respectively. Skin perfusion returned to baseline levels earlier during 1-mA intensity at a 110 mA · min dose within the treatment, compared to 2 mA at 60 minutes posttreatment. CONCLUSION: Transdermal delivery of Dex-P during iontophoresis was successfully measured in vivo through human skin. Measurable concentrations of Dex-total were found regardless of current intensity. Although current-induced vasodilation occurred, it did not significantly affect the tissue accumulation of Dex-total.

Heating capacity of rebound shortwave diathermy and moist hot packs at superficial depths.

CONTEXT: The effectiveness of a new continuous diathermy unit, ReBound, as a heating modality is unknown. OBJECTIVE: To compare the effects of ReBound diathermy with silicate-gel moist hot packs on tissue temperature in the human triceps surae muscle. DESIGN: Crossover study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 12 healthy, college-aged volunteers (4 men, 8 women; age = 22.2 ± 2.25 years, calf subcutaneous fat thickness = 7.2 ± 1.9 mm). INTERVENTION(S): On 2 different days, 1 of 2 modalities (ReBound diathermy, silicate-gel moist hot pack) was applied to the triceps surae muscle of each participant for 30 minutes. After 30 minutes, the modality was removed, and temperature decay was recorded for 20 minutes. MAIN OUTCOME MEASURE(S): Medial triceps surae intramuscular tissue temperature at a depth of 1 cm was measured using an implantable thermocouple inserted horizontally into the muscle. Measurements were taken every 5 minutes during the 30-minute treatment and every minute during the 20-minute temperature decay, for a total of 50 minutes. Treatment was analyzed through a 2 × 7 mixed-model analysis of variance with repeated measures. Temperature decay was analyzed through a 2 × 21 mixed-model analysis of variance with repeated measures. RESULTS: During the 30-minute application, tissue temperatures at a depth of 1 cm increased more with the ReBound diathermy than with the moist hot pack (F6,66 = 7.14, P < .001). ReBound diathermy and moist hot packs increased tissue temperatures 3.69°C ± 1.50°C and 2.82°C ± 0.90°C, respectively, from baseline. Throughout the temperature decay, ReBound diathermy produced a greater rate of heat dissipation than the moist hot pack (F20,222 = 4.42, P < .001). CONCLUSIONS: During a 30-minute treatment at a superficial depth, the ReBound diathermy increased tissue temperature to moderate levels, which were greater than the levels reached with moist hot packs.

Muscle heating with Megapulse II shortwave diathermy and ReBound diathermy.

CONTEXT: A new continuous diathermy called ReBound recently has been introduced. Its effectiveness as a heating modality is unknown. OBJECTIVE: To compare the effects of the ReBound diathermy with an established deep-heating diathermy, the Megapulse II pulsed shortwave diathermy, on tissue temperature in the human triceps surae muscle. DESIGN: Crossover study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Participants included 12 healthy, college-aged volunteers (4 men, 8 women; age = 22.2 ± 2.25 years, calf subcutaneous fat thickness = 7.2 ± 1.9 mm). INTERVENTION(S): Each modality treatment was applied to the triceps surae muscle group of each participant for 30 minutes. After 30 minutes, we removed the modality and recorded temperature decay for 20 minutes. MAIN OUTCOME MEASURE(S): We horizontally inserted an implantable thermocouple into the medial triceps surae muscle to measure intramuscular tissue temperature at 3 cm deep. We measured temperature every 5 minutes during the 30-minute treatment and each minute during the 20-minute temperature decay. RESULTS: Tissue temperature at a depth of 3 cm increased more with Megapulse II than with ReBound diathermy over the course of the treatment (F6,66 = 10.78, P < .001). ReBound diathermy did not produce as much intramuscular heating, leading to a slower heat dissipation rate than the Megapulse II (F20,220 = 28.84, P < .001). CONCLUSIONS: During a 30-minute treatment, the Megapulse II was more effective than ReBound diathermy at increasing deep, intramuscular tissue temperature of the triceps surae muscle group.