Test-Retest Reliability of the Total Motion Release® Scale.

CONTEXT: Total Motion Release® (TMR®) is a novel treatment paradigm used to restore asymmetries in the body (eg, pain, tightness, limited range of motion). Six primary movements, known as the Fab 6, are performed by the patient and scored using a 0 to 100 scale. Clinicians currently utilize the TMR® scale to modify treatment, assess patient progress, and measure treatment effectiveness; however, the reliability of the TMR® scale has not been determined. It is imperative to assess scale reliability and establish minimal detectable change (MDC) values to guide clinical practice. OBJECTIVE: To assess the reliability of the TMR® scale and establish MDC values for each motion in healthy individuals in a group setting. DESIGN: Retrospective analysis of group TMR® assessments. SETTING: University classroom. PARTICIPANTS: A convenience sample of 61 students (23 males and 38 females; 25.48 [5.73] y), with (n = 31) and without (n = 30) previous exposure to TMR®. INTERVENTION: The TMR® Fab 6 movements were tested at 2 time points, 2 hours apart. A clinician with previous training in TMR® led participant groups through both sessions while participants recorded individual motion scores using the 0 to 100 TMR® scale. Test-retest reliability was calculated using an intraclass correlation coefficient (2,1) for inexperienced, experienced, and combined student groups. Standard error of measurement and MDC values were also assessed for each intraclass correlation coefficient. OUTCOME MEASURE: Self-reported scores on the TMR® scale. RESULTS: Test-retest reliability ranged from 0.57 to 0.95 across the Fab 6 movements, standard error of measurement values ranged from 4.85 to 11.77, and MDC values ranged from 13.45 to 32.62. CONCLUSION: The results indicate moderate to excellent reliability across the Fab 6 movements and a range of MDC values. Although this study is the first step in assessing the reliability of the TMR® scale for clinical practice, caution is warranted until further research is completed to establish reliability and MDC values of the TMR® scale in various settings to better guide patient care.

A Descriptive Analysis of Patient Outcomes and Experiences at a Student-Run Athletic Training Clinic.

CONTEXT: The prevalence of student-run clinics is rising due to educational benefits and the ability to provide cost-effective care to underserved patients. Current literature on the effect of athletic training student-run clinics on patient outcomes and experiences is limited. OBJECTIVE: To explore patient-reported outcomes (PROs), patient experiences, and patient demographics in an athletic training student-run clinic. DESIGN: Mixed-methods study: cross-sectional survey with retrospective analysis of deidentified patient outcomes from November 2017-October 2021. SETTING: Athletic training student-run clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 388 patients from the university (ie, students and staff) and local community with a variety of musculoskeletal injuries. MAIN OUTCOME MEASURE(S): Participants completed a packet to provide their responses to demographic items and PRO scales: Disablement in the Physically Active Scale Short Form-8, Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Global Rating of Change Scale at 3 time points. They also completed an electronic patient experience survey after their final visit to the student-run clinic. RESULTS: Most participants reported clinically significant improvements across all PRO scales: an average improvement of 39.1% in pain, 39.3% in function, and 43.1% in quality of life in <11 days, on average. Furthermore, they described a high level of satisfaction with care and a globally positive experience at the student-run clinic. CONCLUSIONS: Patients experienced clinically significant improvements in pain, function, disablement, and quality of life when receiving care from athletic training students at a student-run clinic. In addition, they indicated a high level of satisfaction with the care provided and a positive overall experience with an athletic training student-run clinic.

Clinical Practice Patterns Among Health Care Professionals for Instrument-Assisted Soft Tissue Mobilization.

CONTEXT: Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial intervention used by health care professionals. OBJECTIVE: To document IASTM clinical practice patterns among health care professionals in the United States. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 853 members of the National Athletic Trainers' Association (n = 249) and the American Physical Therapy Association (n = 604). MAIN OUTCOME MEASURE(S): Responses to a 55-item electronic survey that assessed 4 areas, namely, IASTM training and experience, IASTM application, perception of IASTM in practice, and demographic information. RESULTS: Most (n = 705, 83%) of the 853 respondents used IASTM in their practice, and they had an average of 15 years of work experience. Approximately 86% (n = 731) reported completing some type of formal training, and 61% (n = 518) had completed some type of informal training. Respondents used >34 different IASTM tools. Seventy-one percent (n = 606) indicated either not knowing how to quantify the amount of force applied by the tool during treatment or not trying to quantify. Fifteen percent (n = 128) estimated a force ranging from 100 to 500g. The treatment time for a specific lesion and location ranged from 1 to ≤5 minutes, with an average total treatment time of 14.46 ± 14.70 minutes. Respondents used 31 different interventions before or after IASTM. Approximately 66% (n = 564) reported following treatment recommendations, and 19% (n = 162) described rarely or never following recommendations learned during training. A total of 94% (n = 801) recounted using some type of clinical outcome measure to assess their treatment. Cluster analysis identified 3 distinct cluster groupings among professionals, with most (89%, n = 729/818) indicating that IASTM was an effective treatment. CONCLUSIONS: This survey documented the IASTM practice patterns of health care professionals. Cluster profiles characterized group differences in IASTM training and clinical application. The gaps among research, clinical practice, and training need to be bridged to establish IASTM best practices.

Invariance Testing of the Disablement in the Physically Active Scale Short Form-10.

CONTEXT: Psychometrically sound instruments are needed to accurately track the effectiveness of treatment and assess the quality of patient care. The Disablement in the Physically Active (DPA) scale Short Form-10 (SF-10) was developed as a more parsimonious version of the Disablement in the Physically Active scale to assess disablement in the physically active. Psychometric assessment of the DPA SF-10 has not been completed; specifically, the scale properties must be assessed among a sample of individuals who respond only to the 10-item scale at multiple time points. OBJECTIVE: To assess the psychometric properties of the DPA SF-10 using confirmatory factor analysis and invariance procedures across multiple time points. MAIN OUTCOME MEASURE(S): Confirmatory factor analyses and longitudinal invariance tests were conducted. RESULTS: The DPA SF-10 met contemporary fit index recommendations and demonstrated longitudinal invariance; however, localized fit concerns suggest further modification is needed. CONCLUSIONS: Adoption of the DPA SF-10 into widespread clinical practice and research is not recommended until further psychometric testing and scale modification are performed.

Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examination.

OBJECTIVES: To review the literature, identify and describe commonly used special tests for diagnosing injury to the ligaments of the ankle complex, present the distinguishing characteristics and limitations of each test, and discuss the current evidence for the clinical use of each test. DATA SOURCES: Multiple PubMed (1920-2018) and CINAHL (1920-2018) searches were conducted and various musculoskeletal examination textbooks were reviewed to examine common orthopedic tests used to assess the ankle. The articles were reviewed for additional references and the search continued until the original description was found when possible. STUDY SELECTION: All articles discussing the performance of the test or its validity (ie, sensitivity and specificity) were reviewed and summarized. DATA EXTRACTION: Articles were reviewed for additional references and the search continued until the original description was found when possible. DATA SYNTHESIS: The literature was reviewed, commonly used special tests for diagnosing ankle injuries were identified and described, distinguishing characteristics and limitations of each test were presented, and the current evidence for the clinical use of each test was discussed. CONCLUSIONS: A complete physical examination is critical in the diagnosis of ankle injuries. The combination of available information such as mechanism of injury, all signs and symptoms, and changes in gait, is key to a conclusive and correct diagnosis. Clinicians should be aware of the severely limited evidence supporting the use of many commonly used special tests. Applying evidence from the literature will improve diagnostic accuracy. Further research is needed to understand the performance ability of special tests, both individually and when grouped as part of a test battery.

Invariance Testing of the Disablement in the Physically Active Scale.

CONTEXT: The increased emphasis on implementing evidence-based practice has reinforced the need to more accurately assess patient improvement. Psychometrically sound, patient-reported outcome measures are essential for evaluating patient care. A patient-reported outcome instrument that may be useful for clinicians is the Disablement in the Physically Active Scale (DPAS). Before adopting this scale, however, researchers must evaluate its psychometric properties, particularly across subpopulations. OBJECTIVE: To evaluate the psychometric properties of the DPAS in a large sample using confirmatory factor analysis procedures and assess structural invariance of the scale across sex, age, injury status, and athletic status groups. DESIGN: Observational study. SETTING: Twenty-two clinical sites. PATIENTS OR OTHER PARTICIPANTS: Of 1445 physically active individuals recruited from multiple athletic training clinical sites, data from 1276 were included in the analysis. Respondents were either healthy or experiencing an acute, subacute, or persistent musculoskeletal injury. MAIN OUTCOME MEASURE(S): A confirmatory factor analysis was performed on the full sample, and multigroup invariance testing was conducted to assess differences across sex, age, injury status, and athletic status. Given the poor model fit, alternate model generation was used to identify a more parsimonious factor structure. RESULTS: The DPAS did not meet contemporary fit index recommendations or the criteria to demonstrate structural invariance. We identified an 8-item model that met the model fit recommendations using alternate model generation. CONCLUSIONS: The 16-item DPAS did not meet the model fit recommendations and may not be the most parsimonious or reliable measure for assessing disablement and quality of life. Use of the 16-item DPAS across subpopulations of interest is not recommended. More examination involving a true cross-validation sample should be completed on the 8-item DPAS before this scale is adopted in research and practice.