Comparison Between Movement Pattern Training and Strengthening on Kinematics and Kinetics in Patients With Chronic Hip-Related Groin Pain.

The purpose of this study was to compare the preliminary effects of movement pattern training (MoveTrain) versus strengthening/flexibility (standard) treatment on hip and pelvic biomechanics in patients with chronic hip-related groin pain. This is a secondary analysis of data collected during a pilot randomized clinical trial. Thirty patients with hip pain, between the ages of 15 and 40 years, were randomized to MoveTrain or standard. Both groups completed 10 treatment sessions over 12 weeks along with a daily home exercise program. Three-dimensional motion analysis was used to collect kinematic and kinetic data of the pelvis and hip during a single-leg squat task at pretreatment and immediately posttreatment. Compared with the standard group, the MoveTrain group demonstrated smaller hip adduction angles (P = .006) and smaller hip external adduction moments (P = .008) at posttreatment. The desired changes to hip joint biomechanics, as found in this study, may require specificity in training that could allow health care professionals to better customize the rehabilitation of patients with hip pain. These findings can also be applied to the design and implementation of future clinical trials to strengthen our understanding of the long-term implications of different rehabilitation techniques for patients with hip pain.

Race Differences in Postacute Physical Therapy Utilization and Patient-Reported Function After Total Knee Arthroplasty.

OBJECTIVE: This observational cohort study included patients of Black and White race and non-Hispanic ethnicity with end-stage knee osteoarthritis who were scheduled to receive total knee arthroplasty (TKA) surgery. Our objective was to examine whether race differences exist in the use of physical therapy (PT) across all postacute settings and to examine patient-reported physical function following TKA. METHODS: We collected pre- and postoperative physical function data and postoperative rehabilitation data on 104 Black and White individuals undergoing TKA. Regression analyses and independent samples t-tests were used to explore the predictive value of race on postoperative functional outcome and to compare PT utilization within each postacute setting and across all postacute rehabilitation settings. RESULTS: Total PT received was similar between White and Black participants, but significant race differences in PT utilization existed within specific settings. Race did not significantly predict function after TKA, but Black participants had slightly lower self-reported function both before and after surgery than White participants. CONCLUSION: This is the first study to examine both PT utilization and functional outcomes in a sample of individuals undergoing TKA, and results indicate differences in where postoperative PT is received between Black and White patients.

Exploring Race Differences in Satisfaction With Rehabilitation Following Total Knee Arthroplasty: A Qualitative Study.

BACKGROUND: The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). METHOD: We conducted a series of qualitative focus group discussions with groups of non-Hispanic White and non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of postoperative physical therapy received, and overall satisfaction with the postoperative rehabilitation process. RESULTS: Thirty-six individuals participated in focus groups. Three major themes emerged: (i) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation," and often mentioned specific interventions they felt were most helpful in their recovery. (ii) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (iii) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. CONCLUSIONS: Individuals undergoing TKA can largely expect positive rehabilitation experiences postoperatively. However, some barriers to postoperative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.

A Qualitative Study of Preparation for Lumbar Spinal Stenosis Surgery: Perceptions of Patients and Physical Therapists.

OBJECTIVES: To gain the perspectives of patients who underwent lumbar spinal stenosis (LSS) surgery and physical therapists who treat spine-related disorders regarding rehabilitation and other care prior to LSS surgery. DESIGN: Qualitative focus group study. METHODS: Sixteen patients (4 female; average ± SD age, 64.3 ± 8.8 years; time since surgery, 9.9 ± 4.4 months) and 10 physical therapists (2 female; average ± SD age, 40.9 ± 6.6 years; time in practice, 17.2 ± 7.7 years) participated. Four groups were conducted: 2 with patients post LSS surgery and 2 with physical therapists who treat spine-related disorders. Participants were asked open-ended questions by a trained facilitator regarding their perceptions of preoperative LSS education and rehabilitation. Transcripts were coded and themes were identified. RESULTS: Analyses revealed 4 themes within the discussions: (1) desire for helpful information, (2) benefits of preoperative rehabilitation, (3) downfalls of preoperative rehabilitation, and (4) desire for coordinated care. Varying opinions on preoperative physical therapy between patients and physical therapists were discussed, revealing that similar numbers of participants held positive and negative perceptions of preoperative physical therapy. A desire for more thorough preoperative education and care was expressed by both groups. CONCLUSION: There is a clear need for standardized preoperative LSS care and education. This may decrease misunderstandings about LSS surgery and its treatments in the future as well as improve coordinated care between surgeons and physical therapists. J Orthop Sports Phys Ther 2020;50(4):198-205. Epub 30 Oct 2019. doi:10.2519/jospt.2020.8887.

Movement pattern training compared with standard strengthening and flexibility among patients with hip-related groin pain: results of a pilot multicentre randomised clinical trial.

STUDY DESIGN: Pilot, multicentre randomised clinical trial (RCT). OBJECTIVES: Assess viability of performing a definitive RCT and compare preliminary effects of movement pattern training (MoveTrain) and strengthening/flexibility (Standard) to improve function in people with chronic hip-related groin pain (HRGP). BACKGROUND: To determine the best physical therapist-led intervention for patients with HRGP, we must understand treatment effects of different treatment modes. METHODS: Forty-six patients (17M:29F; 29±5.3 years; body mass index 25.6±6.3 kg/m2) with HRGP were randomised. MoveTrain included task-specific training to optimise biomechanics during daily tasks. Standard included strengthening/flexibility. Treatment included 10 visits/12 weeks and home exercise programme (HEP). Primary outcomes for feasibility were recruitment, retention, treatment adherence and treatment fidelity. Secondary outcomes were patient-reported function (Hip disability and Osteoarthritis Outcome Score (HOOS)), lower extremity kinematics and hip muscle strength. RESULTS: We achieved target recruitment, and retention was excellent (91%). Patient session attendance was high (93%); however, reported HEP adherence (62%) was lower than expected. Physical therapists' adherence to treatment protocols was high (90%). Patients demonstrated high treatment receipt; 91% of exercises performed were rated independent. Both groups demonstrated clinically important improvements in function (HOOS) and muscle strength; however, there were no between-group differences (HOOS subscales, p≥0.13, strength, p≥0.34). Compared with Standard, MoveTrain demonstrated greater reductions in hip adduction (p=0.016) and pelvic drop (p=0.026) during a single leg squat. No adverse events were noted. CONCLUSION: Our experience in completing this RCT confirmed that a larger, multicentre RCT is feasible and highlighted modifications we will implement to optimise the future RCT. TRIAL REGISTRATION NUMBER: NCT02913222.

Providing no-cost transport to patients in an underserved area: Impact on access to physical therapy.

Background: Barriers to accessing outpatient health care services are common and contribute to poor health outcomes. We describe the efforts of a private practice physical therapy (PT) clinic to reduce these barriers by offering a door-to-door van service at no cost to patients. Methods: Clinic records and national census databases were retrospectively reviewed to explore the impact of offering no-cost van rides to patients attending outpatient PT appointments. We used descriptive statistics and linear regression to describe volume of utilization of the van service over a 40-month period. Paired t-tests compared PT clinic attendance rates (percentage of scheduled visits that were attended) before and after implementation of the van service. Results: Use of the van service increased significantly over time, from a mean of 83 riders per month in 2010 to 205 riders per month in 2013 (p < 0.001). Overall clinic attendance rate increased from 80.1% to 84.1% after implementation of the service (p = 0.002). Following introduction of the van service, 48% of patients using the van, compared to 25% of clinic patients overall, were uninsured or insured by Medicaid. Conclusion: Use of the van service increased over time, and availability of no-cost van transportation was associated with increased visit attendance for patients at an outpatient PT clinic.

Patients' experience with nonsurgical treatment for lumbar spinal stenosis: a qualitative study.

BACKGROUND CONTEXT: Lumbar spinal stenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. Research into optimal nonsurgical treatment approaches for LSS is lacking. PURPOSE: The purpose of this qualitative study is to assess the opinions of participants in a randomized clinical trial of nonsurgical LSS treatments regarding the interventions they received, factors contributing to adherence to the interventions, and methods of outcomes assessment. STUDY DESIGN/SETTING: This study used a qualitative focus group design conducted at an academic research center. PATIENT SAMPLE: Individuals participating in a randomized clinical trial (RCT) for non-surgical LSS treatment were invited to discuss their study treatments and general experiences with LSS. The three treatment arms in the study were medical care, community-based group exercise, and clinic-based manual therapy and individual exercise. OUTCOME MEASURES: Following coding of qualitative data, kappa statistic was used to calculate agreement between observers. Themes were identified and agreed upon by both coders. METHODS: This study was funded by the Patient-Centered Outcomes Research Institute (PCORI). Fifty individuals (28 women, mean age 73±7.7 years) participated in a focus group. Two focus groups based on modified grounded theory were held for participants of each of the three treatment arms, for a total of six focus groups. Discussion topics included perceived effectiveness of the assigned treatment, suggestions for improvement, barriers and facilitators to completing treatment, and opinions of research outcome measures. RESULTS: Several themes were evident across all treatment groups. First, patients prefer individualized treatment that is tailored to their specific impairments and functional limitations. They also want to learn self-management strategies to rely less upon formal health care providers. Participants consistently stated that exercise improved their pain levels and physical function. However, they noted that these effects are temporary, so commitment to exercising long-term is important. Common barriers to completing the assigned LSS treatment included transportation issues and other comorbid health conditions. All three treatment groups cited perceived treatment benefit as a strong facilitator to continuing treatment. In addition, the ability of the health care provider to relate to the patient and listen to the patient's concerns was a common facilitator. Within the community-based group exercise treatment arm, most individuals continued group exercise after study completion, and social support was often mentioned as a facilitator to continuing treatment. Medical care was most often associated with minimal to no effect of treatment. CONCLUSIONS: Many individuals with LSS report barriers to accessing non-surgical treatment, but may also be willing to commit to a long-term treatment strategy that includes exercise. Social support from others with LSS and from health care providers with good communication skills may facilitate compliance with treatment recommendations.

Individuals with lumbar spinal stenosis seek education and care focused on self-management-results of focus groups among participants enrolled in a randomized controlled trial.

BACKGROUND CONTEXT: The effectiveness of treatments for chronic, degenerative conditions of the lumbar spine can be influenced by patient perceptions and expectations regarding treatment. PURPOSE: The primary purpose of this study was to understand the factors that are important to individuals with lumbar spinal stenosis (LSS) regarding different nonsurgical treatments. These factors were considered within the context of each treatment received as a part of the parent randomized controlled trial (RCT). STUDY DESIGN: Focus group study of RCT participants. PATIENT SAMPLE: Convenience sample of 50 individuals with LSS (28 female, average age 73±7.7 years) from an RCT participated in one of six focus groups. Focus groups consisted of patients previously randomized to one of three nonsurgical treatments: (1) medical care; (2) community-based group exercise; and (3) clinic-based manual therapy and individualized exercise. OUTCOME MEASURES: Experiences, opinions, and preferences of individuals with LSS who participated in an RCT. Inter-coder agreement for qualitative analysis was conducted with kappa statistics. METHODS: Participants discussed their experiences and perceptions regarding study treatment and their general experience with LSS using open-ended questions provided by a facilitator. Transcripts were coded according to modified grounded theory in an open approach, using codes that addressed the primary focus group discussion topics (primary coding) and codes for emerging topics (secondary coding). Secondary coding sought to identify themes concerning living with LSS and seeking treatment that were emergent from the focus groups. This study was funded by the Patient-Centered Research Outcomes Institute. The authors report no conflicts of interest. RESULTS: Three themes related to medical treatment and symptom management arose from analyses: (1) an emotional response to LSS; (2) a desire for education about LSS and motivation to pursue education from any available source; and (3) a desire for individualized care based on self-management techniques and lifestyle changes. Emotional responses were more evident in individuals receiving medical care, whereas the other two themes were consistent across all three treatment groups. CONCLUSIONS: The chronic pain associated with LSS may result in negative emotional responses. Individuals with LSS may believe misinformation and information from nonmedical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with LSS.

Task-Specific Training for Adults With Chronic Knee Pain: A Case Series.

Study Design Case series. Background Recent evidence suggests that traditional impairment-based rehabilitation approaches for patients with knee pain may not result in improved function or reduced disability. This case series describes a novel task-specific training approach to exercise therapy for patients with chronic knee pain and reports changes in measures of clinical outcome (pain and physical function) following participation in the training program. Case Description Seven patients with chronic knee pain aged 40 years or older were included. Each reported at least "moderate" difficulty with sit-to-stand transfers, floor transfers, and/or stair negotiation at baseline. Experienced physical therapists provided between 8 and 16 treatment sessions focusing on improving performance of difficult or painful tasks. Outcomes A majority of patients demonstrated clinically important improvements in both patient-rated outcomes (Knee injury and Osteoarthritis Outcome Score, numeric pain-rating scale, modified Arthritis Self-Efficacy Scale) and performance-based outcomes (30-second chair-rise test, timed stair-climb test, floor transfer test, Performance Assessment of Self-Care Skills). Discussion A task-specific training approach for patients with chronic knee pain was described and yielded considerable improvement in pain and function for most of the individuals in this case series. Larger studies are needed to determine how task-specific training compares with more traditional impairment-based exercise approaches for chronic knee pain. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(8):548-556. doi:10.2519/jospt.2017.7349.

Test-Retest Reliability of Rating of Perceived Exertion and Agreement With 1-Repetition Maximum in Adults.

Study Design Clinical measurement. Background It has been suggested that rating of perceived exertion (RPE) may be a useful alternative to 1-repetition maximum (1RM) to determine proper resistance exercise dosage. However, the test-retest reliability of RPE for resistance exercise has not been determined. Additionally, prior research regarding the relationship between 1RM and RPE is conflicting. Objectives The purpose of this study was to (1) determine test-retest reliability of RPE related to resistance exercise and (2) assess agreement between percentages of 1RM and RPE during quadriceps resistance exercise. Methods A sample of participants with and without knee pathology completed a series of knee extension exercises and rated the perceived difficulty of each exercise on a 0-to-10 RPE scale, then repeated the procedure 1 to 2 weeks later for test-retest reliability. To determine agreement between RPE and 1RM, participants completed knee extension exercises at various percentages of their 1RM (10% to 130% of predicted 1RM) and rated the perceived difficulty of each exercise on a 0-to-10 RPE scale. Percent agreement was calculated between the 1RM and RPE at each resistance interval. Results The intraclass correlation coefficient indicated excellent test-retest reliability of RPE for quadriceps resistance exercises (intraclass correlation coefficient = 0.895; 95% confidence interval: 0.866, 0.918). Overall percent agreement between RPE and 1RM was 60%, but agreement was poor within the ranges that would typically be used for training (50% 1RM for muscle endurance, 70% 1RM and greater for strength). Conclusion Test-retest reliability of perceived exertion during quadriceps resistance exercise was excellent. However, agreement between the RPE and 1RM was poor, especially in common training zones for knee extensor strengthening. J Orthop Sports Phys Ther 2016;46(9):768-774. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6498.