Using Kern's Model to Redesign a Postgraduate Curriculum for Orthopaedic Physician Assistants.

ABSTRACT: Postgraduate physician assistant (PA) specialty training expands entry-level education, allowing PAs to work in concentrated fields. The United States Army - Baylor University Doctor of Science in PA Studies Orthopaedics program provides formal education to fill the capability gap caused by surgeon shortages in the military. Based on several sources of feedback, the authors recognized that the curriculum needed modernization and set forth to rewrite the curriculum. This article describes the use of Kern's 6-Step Approach for Curriculum Development for Medical Education to redesign a curriculum for an 18-month postgraduate doctoral program for military orthopaedic PAs. The resulting formal curriculum enables 4 geographically separated sites to execute an orthopaedic PA degree program that addresses a critical specialty care access challenge for the military. Kern's 6-Step approach could be used to design or redesign any PA educational content, from a single course to an entire degree program.

Effect of Compression Therapy in the Treatment of Tibial Stress Syndrome in Military Service Members.

CONTEXT: Tibial stress syndrome (TSS) is an overuse injury of the lower extremities. There is a high incidence rate of TSS among military recruits. Compression therapy is used to treat a wide array of musculoskeletal injuries. The purpose of this study was to investigate the use of compression therapy as a treatment for TSS in military service members. DESIGN: A parallel randomized study design was utilized. METHODS: Military members diagnosed with TSS were assigned to either a relative rest group or compression garment group. Both groups started the study with 2 weeks of lower extremity rest followed by a graduated running program during the next 6 weeks. The compression garment group additionally wore a shin splints compression wrap during the waking hours of the first 2 weeks and during activity only for the next 6 weeks. Feelings of pain, TSS symptoms, and the ability to run 2 miles pain free were assessed at baseline, 4 weeks, and 8 weeks into the study. RESULTS: Feelings of pain and TSS symptoms decreased during the 8-week study in both groups (P < .05), but these changes were not significantly different between groups (P > .05). The proportion of participants who were able to run 2 miles pain free was significantly different (P < .05) between the 2 groups at the 8-week time point with the compression garment group having a significantly increased ability to complete the run without pain. CONCLUSIONS: Although perceptions of pain at rest were not different between groups, the functional ability of running 2 miles pain free was significantly improved in the compression garment group. These findings suggest that there is a moderate benefit to using compression therapy as an adjunct treatment for TSS, promoting a return to training for military service members.

A randomized controlled trial evaluating methylsulfonylmethane versus placebo to prevent knee pain in military initial entry trainees.

BACKGROUND: Methylsulfonylmethane (MSM) is a naturally occurring sulfur containing substance that has been shown to have anti-inflammatory and antioxidative properties. Previous studies using MSM as an oral supplement to improve pain in those patients with knee osteoarthritis have shown superiority compared to placebo. However, these studies are not translatable to active individuals performing high impact activities and have not evaluated MSM as a preventative measure. METHODS: A total of 180 subjects ranging in age from 18 to 40 years were enrolled. Subjects were randomized into 2 groups receiving either 3 grams OptiMSM methylsulfonylmethane (Bergstrom Nutrition, Vancouver, WA) or a placebo for 8 weeks. Outcomes measured were the Knee Osteoarthritis Outcome Score (KOOS) and the Profile of Moods States (POMS). RESULTS: Three grams of MSM administered daily did not provide significant improvements in the 5 KOOS subscales or the 6 POMS subscales at 30 days or 60 days. CONSLUSION: Although 3 grams of MSM daily can be used safely, there does not appear to be a significant improvement in KOOS or POMS.

Comparative Study of Assisted Ambulation and Perceived Exertion With the Wheeled Knee Walker and Axillary Crutches in Healthy Subjects.

BACKGROUND: Functional limitations after lower extremity surgery often require the use of an assistive device for ambulation during rehabilitation and recovery. There are no known objective data evaluating the wheeled knee walker as an assistive device for protected ambulation. The purpose of this study was to compare assisted ambulation and perceived exertion with the wheeled knee walker and the axillary crutches in healthy participants. METHODS: A prospective, randomized crossover study was performed using 24 healthy volunteers. Each participant performed a 6-minute walk test (6MWT) using each assistive device in a crossover manner. Preactivity and postactivity heart rates were recorded. The self-selected walking velocity (SSWV) was calculated and the participant's rating of perceived exertion was recorded using the OMNI Rating of Perceived Exertion (OMNI-RPE). Participant's preference for assistive device was identified. RESULTS: The 6MWT, SSWV, and the Omni-RPE were evaluated using paired t tests and determined to be statistically significant for the wheeled knee walker compared with axillary crutches. Evaluation of the preactivity and postactivity heart rates demonstrated a statistically significant difference for the wheeled knee walker compared with axillary crutches. The wheeled knee walker was preferred by 88% of participants. CONCLUSIONS: The wheeled knee walker provided increased assisted ambulation and had a lower rating of perceived exertion than axillary crutches on level surfaces in healthy participants. LEVEL OF EVIDENCE: Level III, comparative study.