Exploring healthcare provider retention in a rural and frontier community in Northern Idaho.

BACKGROUND: A shortage of healthcare providers, particularly in primary care and mental health, exists in the predominately rural state of Idaho. There are also barriers to retaining healthcare providers to work in rural and remote communities. Limited research using U.S. samples has explored factors that may affect the retention of healthcare providers in rural areas. Additionally, due to differences between communities, it is important to conduct community-level investigations to better understand how these factors may affect retention in rural areas. Therefore, the purpose of this study was to explore factors affecting healthcare provider retention in a rural community in Northern Idaho. METHODS: A modified version of the Nursing Community Apgar Questionnaire (NCAQ) was completed by 30 healthcare providers in a rural and frontier community in Northern Idaho to assess factors influencing healthcare provider retention. Factors were classified into classes including geographic, economic, scope of practice, medical support, and facility and community support classes. Retention factors were assessed on their perceived importance to retention as well as whether they were perceived as an advantage or challenge to retention based on Likert scales. A "Community Apgar" score was also created by combining the importance and advantage/challenge factors. RESULTS: Overall, items in the medical support group had the highest importance of any other class and included factors such as nursing workforce. Additionally, the facility and community support class, which included factors such as televideo support, was rated the highest advantage class and had the highest Apgar score, indicating it contained the factor that healthcare providers identified as the most important advantage (i.e., medical reference resources). CONCLUSION: Our study identified multiple factors that healthcare providers deemed as important advantages or disadvantages to retaining healthcare providers in rural areas. Overall, facility and community support factors were found to have the highest advantage in the retention of rural providers. Rural healthcare organizations looking to increase healthcare provider retention should target retention efforts towards these factors. Additional research should also be conducted on other rural samples across the U.S. to make comparisons of findings.

Development of a hybrid point-of-care ultrasound curriculum for first year medical students in a rural medical education program: a pilot study.

BACKGROUND: The field of point-of-care ultrasound (POCUS) has advanced in recent decades due to the benefits it holds for medical providers. However, aspiring POCUS practitioners require adequate training. Unfortunately, there remains a paucity of resources to deliver this training, particularly in rural and underserved areas. Despite these barriers, calls for POCUS training in undergraduate medical education are growing, and many medical schools now deliver some form of POCUS education. Our program lacked POCUS training; therefore, we developed and implemented a POCUS curriculum for our first-year medical students. METHODS: We developed a POCUS curriculum for first year medical students in a rural medically underserved region of the United States. To evaluate our course, we measured learning outcomes, self-reported confidence in a variety of POCUS domains, and gathered feedback on the course with a multi-modal approach: an original written pre- and post-test, survey tool, and semi-structured interview protocol, respectively. RESULTS: Student (n=24) knowledge of POCUS significantly increased (pre-test average score = 55%, post-test average score = 79%, P<0.0001), and the course was well received based on student survey and interview feedback. In addition, students reported increased confidence toward a variety of knowledge and proficiency domains in POCUS use and their future clinical education and practice. CONCLUSIONS: Despite a lack of consensus in POCUS education, existing literature describes many curricular designs across institutions. We leveraged a combination of student initiatives, online resources, remote collaborations, local volunteers, and faculty development to bring POCUS to our institution in a rural and medically underserved region. Moreover, we demonstrate positive learning and experiential outcomes that may translate to improved outcomes in students' clinical education and practice. Further research is needed to evaluate the psychomotor skills, broader learning outcomes, and clinical performance of students who take part in our POCUS course.

Psychometric Properties of a Modified Athlete Burnout Questionnaire in the Collegiate Athletics Setting.

CONTEXT: Mental health is an important component of holistic care in athletic settings. Burnout is one of many factors associated with poor mental health, and clinicians should assess for these symptoms. The Athlete Burnout Questionnaire (ABQ) has been proposed as a measure of burnout in athletes; however, design concerns are prevalent within the scale, and psychometric analyses have resulted in inconsistent measurement properties, limiting the usefulness of the scale for accurate assessment of burnout in athletes. The objective of our study was to assess the factor structure of the Alternate Modified ABQ-15v2 using confirmatory factor analysis. If model fit was inadequate, a secondary purpose was to identify a psychometrically sound alternate ABQ model. DESIGN: Observational study. METHODS: Intercollegiate athletes and dancers pursuing a degree in dance (n = 614) were recruited from programs across the United States. Individuals had varied health statuses (eg, healthy, injured), scholarship support, and participated in a variety of intercollegiate sports. A confirmatory factor analysis was conducted on the modified 15-item ABQ (Alternate Modified ABQ-15v2). Exploratory factor analysis and covariance modeling of a proposed alternate 9-item scale (ABQ-9) was conducted and multigroup invariance analysis was assessed across athlete category, class standing, and student-athlete scholarship status to assess consistency of item interpretation across subgroups. RESULTS: The Modified ABQ did not meet recommended model fit criteria. The ABQ-9 met all recommended model fit indices but was not invariant across athlete category. CONCLUSIONS: The ABQ-9 may be a viable and efficient option for assessing burnout in the collegiate athletics setting. However, further research is needed to validate the ABQ-9 in a cross-validation study.

The Effects of Light Pressure Instrument-Assisted Soft Tissue Mobilization at Different Rates on Grip Strength and Muscle Stiffness in Healthy Individuals.

CONTEXT: Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial treatment utilized by health care professionals. Currently, there is a lack of research on the effects of a light pressure IASTM treatment on the forearm region. The purpose of this study was to explore the effects of a light pressure IASTM technique at different application rates on grip strength and muscle stiffness. This study was considered exploratory with the goal of establishing methodology for future controlled studies. DESIGN: Observational pretest and posttest clinical study. METHODS: Twenty-six healthy adults underwent one light pressure IASTM treatment to their dominant forearm muscles. Participants were allocated to 2 groups of 13 based upon treatment rate: 60 beats per minute and 120 beats per minute. Participants were tested pretreatment and posttreatment for grip strength and tissue stiffness via diagnostic ultrasound. One-way analyses of covariance were used to assess group differences posttreatment for grip strength and tissue stiffness. RESULTS: Statistically significant posttreatment changes for grip strength and tissue stiffness were not found. Despite the nonstatistical significance, there were small decreases in grip strength and tissue stiffness. Faster (120 beats/min) IASTM application may have produced clinically meaningful decreases in grip strength along with a small decrease in tissue stiffness. CONCLUSIONS: This report helps to establish methodology for future controlled studies on this topic. Sports medicine professionals should consider these results as exploratory and interpret them with caution. Future research is needed to confirm these findings and begin to postulate possible neurophysiological mechanisms.

Rasch Calibration of the International Knee Documentation Committee Subjective Knee Form.

CONTEXT: Among numerous knee-related patient-reported outcome measures, the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) has been used across a wide variety of knee pathologies. However, traditional validation procedures (classical test theory) and existing studies (estimating item parameters) have limitations in establishing the measurement properties of the IKDC-SKF. Rasch analysis reveals a strong validation approach to improve IKDC-SKF clinical interpretation with larger samples. OBJECTIVE: To assess psychometric properties, including differential item functioning, of the IKDC-SKF as a patient-reported measure of knee function. DESIGN: Cross-sectional study. SETTING: Secondary data. Data were extracted from the cloud-based orthopedic and sports medicine global registry Surgical Outcome System (Arthrex). PATIENTS: A total of 1725 individuals who underwent an arthroscopic knee procedure and completed all items on the IKDC-SKF. MAIN OUTCOME MEASURE(S): Rasch analysis including model-data fit, rating scale's function, item-person map (distribution of item difficulty and person ability), and differential item functioning (sex and age groups) was used to evaluate the psychometric properties of the IKDC-SKF. RESULTS: Ten misfit items were found and removed. The 5-point Likert scale of the 9-item IKDC-SKF worked well. Item difficulty ranged from 0.58 to 0.81 logits, and person's knee function had ranged from -5.56 to 4.86 logits, with a wide distribution. The IKDC-SKF was found to function similarly for sex (male vs female) and age. CONCLUSIONS: Rasch analysis identified a unidimensional structure retaining 9 of the original IKDC-SKF items; however, a more comprehensive inventory is necessary to assess a wider range of knee function and improve measurement validity.

Clinician Reliability of One-Handed Instrument-Assisted Soft Tissue Mobilization Forces During a Simulated Treatment.

Clinicians utilize instrument-assisted soft tissue mobilization (IASTM) to identify and treat myofascial dysfunction or pathology. Currently, little is known regarding the ability of clinicians to provide similar IASTM forces across treatment sessions. The authors' purpose was to quantify clinician reliability of force application during a simulated IASTM treatment scenario. Five licensed athletic trainers with previous IASTM training (mean credential experience = 5.2 [4.3] y; median = 5 y) performed 15 one-handed unidirectional sweeping strokes with each of the 3 instruments on 2 consecutive days for a total of 90 data points each. The IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke across 2 sessions. The authors' findings indicate IASTM trained clinicians demonstrated sufficient Fpeak and Fmean reliability across a treatment range during a one-handed IASTM treatment. Future research should examine if IASTM applied at different force ranges influences patient outcomes.

Instrument-Assisted Soft Tissue Mobilization Forces Applied by Trained Clinicians During a Simulated Treatment.

CONTEXT: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. OBJECTIVE: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. DESIGN: Experimental. SETTING: University research laboratory. PARTICIPANTS: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). INTERVENTION: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. MAIN OUTCOME MEASURES: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. RESULTS: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. CONCLUSIONS: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.

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.

Examining the factorial validity of the Quality of Life Scale.

BACKGROUND: Quality of life (QoL) is important to assess in patient care. Researchers have previously claimed validity of the Quality of Life Scale (QOLS) across multiple samples of individuals, but close inspection of results suggest further psychometric investigation of the instrument is warranted. Therefore, the purposes of this study were to: 1) evaluate the proposed five-factor, 15-item and three-factor, 16-item QOLS; 2) if the factor structure could not be confirmed, re-assess the QOLS using exploratory factor analysis (EFA) and covariance modeling to identify a parsimonious refinement of the QOLS structure for future investigation. METHODS: Participants varying in age, physical activity level, and identified medical condition(s) were recruited from clinical sites and ResearchMatch. Confirmatory factor analyses (CFA) were performed on the full sample (n = 1036) based on proposed 15- and 16-item QOLS versions. Subsequent EFA and covariance modeling was performed on a random subset of the data (n1 = 518) to identify a more parsimonious version of the QOLS. The psychometric properties of the newly proposed model were confirmed in the remaining half of participants (n2 = 518). Further examination of the scale psychometric properties was completed using invariance testing procedures across sex and health status sub-categories. RESULTS: Neither the 15- nor 16-item QOLS CFA met model fit recommendations. Subsequent EFA and covariance modeling analyses revealed a one-factor, five-item scale that satisfied contemporary statistical and model fit standards. Follow-up CFA confirmed the revised model structure; however, invariance testing requirements across sex and injury status subgroups were not met. CONCLUSIONS: Neither the 15- nor 16-item QOLS exhibited psychometric attributes that support construct validity. Our analyses indicate a new, short-form model, might offer a more appropriate and parsimonious scale from some of the original QOLS items; however, invariance testing across sex and injury status suggested the psychometric properties still vary between sub-groups. Given the scale design concerns and the results of this study, developing a new instrument, or identifying a different, better validated instrument to assess QoL in research and practice is recommended.

Exploring the Psychometric Properties of the Disablement in the Physically Active Scale Short Form-8 in Adolescents.

CONTEXT: Patient-reported outcomes are widely used in health care. The Disablement in the Physically Active (DPA) Scale Short Form-8 (SF-8) was recently proposed as a valid scale for the physically active population. However, further psychometric testing of the DPA SF-8 has not been completed, and scale structure has not been assessed using a sample of adolescent athletes. OBJECTIVE: To assess scale structure of the DPA SF-8 in a sample of adolescent high-school athletes. MAIN OUTCOME MEASURE(S): Adolescent athletes (n = 289) completed the DPA SF-8. Confirmatory factor analysis (CFA) was conducted to assess the psychometric properties of the scale. RESULTS: The CFA of the DPA SF-8 indicated that the model exceeded recommended fit indices (Comparative Fit Index = .976, Tucker-Lewis Index = .965, Root Mean Square Error of Approximation = .061, and Bollen's Incremental Fit Index = .976). All factor loadings were significant and ranged from .62 to .86. Modification indices did not suggest that meaningful cross-loadings were present or additional specifications that could further maximize fit or parsimony. CONCLUSIONS: The CFA of the DPA SF-8 met contemporary model fit recommendations in the adolescent athlete population. The results confirmed initial findings supporting the psychometric properties of the DPA SF-8 as well as the uniqueness of the quality-of-life and physical summary factors in an adolescent population. Further research (eg, reliability, invariance between groups, minimal clinically important differences, etc) is warranted to inform scale use in clinical practice and research.

The Effect of Total Motion Release on Functional Movement Screen Composite Scores: A Randomized Controlled Trial.

CONTEXT: The Functional Movement Screen (FMS™) provides clinicians with objective criteria to assess movement patterns and overall movement quality. A relationship between low FMS™ composite scores and increased risk of injury has been reported, and researchers have begun to test the effect of interventions to improve FMS™ composite scores. Total Motion Release (TMR®), a novel active movement intervention, has been found to produce improvements in range of motion, as well as patient-reported pain and dysfunction. The effect of TMR® on movement patterns or movement quality is unknown. OBJECTIVE: To assess the effect of a single treatment application of TMR® on FMS™ composite scores in participants with low baselines FMS™ composite scores. DESIGN: Single-blind randomized controlled study. SETTING: Athletic training laboratory. PARTICIPANTS: Twenty-four participants (12 males and 12 females) with FMS™ composite scores of 13 or lower were randomly assigned to either a treatment group or control group. The FMS™ screening procedure was completed on all participants in a pretest and posttest design. INTERVENTIONS: In between FMS™ testing sessions, participants assigned to the treatment group completed the TMR® FAB 6-treatment protocol, whereas the control group participants did not receive an intervention. Following the treatment period (ie, 20 min), participants again completed the FMS™. MAIN OUTCOME MEASURE: FMS™ composite scores. RESULTS: The improvement in FMS™ composite scores was significantly better (P ≤ .001, Cohen's d = 1.69) in the TMR® group (mean change = 3.7 [2.2]) compared with the control group (mean change = 0.7 [1.2]). CONCLUSIONS: A single application of the TMR® FAB 6 protocol produced immediate acute improvements in FMS™ composite scores in a young, physically active population compared with no intervention. CLINICAL RELEVANCE: Research evidence exists to suggest impaired or dysfunctional movement patterns or movement quality increases risk of injury. The FMS™ is commonly utilized to assess movement quality and risk of injury. This study provides initial evidence that the use of TMR® rapidly produces acute improvements in movement quality, as measured by the FMS™.

The Effects of Hip Mobilizations on Patient Outcomes: A Critically Appraised Topic.

Clinical Scenario: Hip osteoarthritis currently affects up to 28% of the population, and the number of affected Americans is expected to rise as the American population increases and ages. Limited hip range of motion (ROM) has been identified as a predisposing factor to hip osteoarthritis and limited patient function. Clinicians often apply therapy techniques, such as stretching and strengthening exercises, to improve hip ROM. Although traditional therapy has been recommended to improve hip ROM, the efficiency of the treatments within the literature is questionable due to lack of high-quality studies. More recently, clinicians have begun to utilize joint mobilization and the Mulligan Concept mobilization with movement techniques to increase ROM at the hip; however, there is a paucity of research on the lasting effects of mobilizations. Given the difficulties in improving ROM immediately (within a single treatment) and with long-lasting results (over the course of months), it is imperative to examine the evidence for the effectiveness of traditional therapy techniques and more novel manual therapy techniques. Focused Clinical Question: Is there evidence to suggest manual mobilizations techniques at the hip are effective at treating hip ROM limitations? Summary of Clinical Findings: 5 Randomized Controlled Studies, improved patient function and ROM with the Mulligan concept, high velocity low amplitude improved. Clinical Bottom Line: We found moderate evidence to suggest favorable outcomes following the use of hip mobilizations aimed at improving hip ROM and patient function. Strength of Recommendation: Strength of the studies identified are 1B.

Examining Practice and Learning Effects With Serial Administration of the Clinical Reaction Time Test in Healthy Young Athletes.

CONTEXT: The clinical reaction time (RTclin) test has been recommended as a valid test for assessing concussion and determining recovery of reaction time function following concussion. However, it is unknown whether repeat assessment, as is used in postconcussion testing, is affected by learning or practice phenomena. OBJECTIVE: To determine if a practice or learning effect is present with serial administration of the RTclin test. DESIGN: Randomized control trial. SETTING: University athletic training clinics. PARTICIPANTS: A total of 112 healthy collegiate athletes (age = 19.46 [1.34] y). INTERVENTIONS: The control group completed the RTclin test on days 1 and 60. The experimental group completed the RTclin test on days 1, 2, 3, 7, and 60. MAIN OUTCOME MEASURE: Reaction time as measured with the RTclin test. RESULTS: The difference in RTclin test performance from day 1 to day 60 was not significant (mean change = -2.77 [14.46] ms, P = .42, 95% confidence intervals, -6.40 to 0.862) between groups. The experimental group experienced significant improvement (λ = 0.784, F4,49 = 3.365, P = .02, η2 = .216, power = 0.81) with acute repeat testing. However, post hoc analysis did not reveal a significant difference between scores during the 5 test periods. CONCLUSIONS: The results suggest serial administration of the RTclin test does not produce a practice or learning effect. Clinicians, however, should be cautious as the results do provide evidence patients may demonstrate improved scores when testing occurs on repetitive days after initial exposure to the test.

Validity of a Smartphone Application for Measuring Ankle Plantar Flexion.

CONTEXT: Range of motion is a component of a physical examination used in the diagnostic and rehabilitative processes. Following ankle injury and/or during research, it is common to measure plantar flexion with a universal goniometer. The ease and availability of digital inclinometers created as applications for smartphones have led to an increase in using this method of range of motion assessment. Smartphone applications have been validated as alternatives to inclinometer measurements in the knee; however, this application has not been validated for plantar flexion in the ankle. OBJECTIVES: The purpose of this study was (1) to assess the validity of the Clinometer Smartphone Application™ produced by Plaincode App Development for use in the ankle (ie, plantar flexion) and (2) to assess the validity of the inclinometer procedures used to measure ankle dorsiflexion for measuring ankle plantar flexion. DESIGN: Blinded repeated measures correlational design. SETTING: University-based outpatient rehabilitative clinic. PARTICIPANTS: A convenience sample (N = 50) of participants (27 females and 23 males) who reported to the clinic (mean age = 30.48 y). INTERVENTION: Patients were long seated on a plinth, with the knee in terminal extension. Three plantar flexion measurements were taken with a goniometer on each foot by the primary researcher. The primary researcher then conducted 3 blinded measurements with The Clinometer Smartphone Application™ following the same procedure. A second researcher, who was blinded to the goniometer measurements, recorded the inclinometer measurements. After data were collected, a Pearson's correlation was calculated to determine the validity of the clinometer app compared with goniometry. MAIN OUTCOME MEASURE: Degrees of motion for ankle plantar flexion. RESULTS: Measurements produced using the Clinometer Smartphone Application™ were highly correlated for right foot (r = .92, P < .001), left foot (r = .92, P < .001), and combined (r = .92, P < .001) with goniometer measurements using a plastic universal goniometer. CONCLUSION: The Clinometer Smartphone Application™ is a valid instrument for measuring plantar flexion of the ankle.

Innovative treatment of clinically diagnosed meniscal tears: a randomized sham-controlled trial of the Mulligan concept 'squeeze' technique.

Objective: The purpose of this study was to assess the effects of the Mulligan Concept (MC) 'squeeze' technique compared to a sham technique in participants with a clinically diagnosed meniscal tear.Methods: A multi-site randomized sham-controlled trial of participants (n = 23), aged 24.91 ± 12.09 years, with a clinically diagnosed meniscal tear were equally and randomly divided into two groups. Groups received a maximum of six treatments over 14 days. Patient outcomes included the numeric pain rating scale (NRS), patient-specific functional scale (PSFS), the disablement in the physically active (DPA) scale and the knee injury osteoarthritis outcome score. Data were analysed using univariate ANOVA, univariate ANCOVA, and descriptive statistics.Results: All participants in the MC 'squeeze' group met the discharge criteria of ≤2 points on the NRS, ≥9 points on the PSFS, and ≤34 points or ≤23 on the DPA Scale for chronic or acute injuries, respectively within the treatment intervention timeframe. A significant difference was found in favor of the MC 'squeeze' technique in PSFS scores (F(1, 21) = 4.40, p = .048, partial eta squared = .17, observed power = .52) and in DPA Scale scores (F(1, 21) = 7.46, p = .013, partial eta squared = .27, observed power = .74).Discussion: The results indicate the MC 'squeeze' technique had positive effects on patient function and health-related quality of life over a period of 14 days and was clinically and statistically superior to the sham treatment. Further investigation of the MC 'squeeze' technique is warranted.

Changes in Hamstring Range of Motion After Neurodynamic Sciatic Sliders: A Critically Appraised Topic.

Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared with stretching on traditional measures of range of motion (ROM)? Summary of Key Findings: The authors of a well-designed study found that neurodynamic sliders were more effective than static stretching, while the authors of 2 less-well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders. Clinical Bottom Line: Evidence exists to support the use of neurodynamic sliders to increase measures of hamstring ROM in patients who present with limited hamstring flexibility; however, the effectiveness of neurodynamic sliders compared with traditional stretching is inconclusive. Strength of Recommendation: Grade B evidence exists that neurodynamic sliders perform as well as traditional stretching techniques at increasing measures of hamstring ROM in patients with limited hamstring flexibility.

Novel treatment of lateral ankle sprains using the Mulligan concept: an exploratory case series analysis.

OBJECTIVE: The purpose of this study was to examine the effect of the Mulligan Concept (MC) Mobilization with movement (MWM) in the treatment of clinically diagnosed acute lateral ankle sprains in competitive athletes. METHODS: A prospective case series of 5 adolescent patients, ages ranging from 14 to 18 years (mean = 15.8 ± 1.64), that suffered an acute lateral ankle sprain (LAS). Patients were treated with the MC lateral ankle MWM. Mobilization was directed at the distal fibula or, using a modified MWM, 2-3 inches proximal to the distal fibula. Using paired t-tests and descriptive statistics (mean and standard deviation) results were analyzed. RESULTS: Treatment lasted an average of 9 days (mean = 9.2, ±SD 3.96) from intake to discharge. During that time frame, patients reported decreases in pain on the numeric pain rating scale (NRS), disability on the Disablement in the Physically Active (DPA) scale and an increase in function on the patient-specific functional scale (PSFS); and an immediate decrease in pain on the NRS within the first treatment. The minimal detectable change for the PSFS and NRS were exceeded from intake to discharge. Additionally, the minimally clinical important differences were exceeded on the NRS and DPA scale. DISCUSSION: The evidence presented in this Level-4 case series supports the use of the MC lateral ankle MWM to treat patients diagnosed with acute grade II LAS. Patients in this case series reported immediate decreases in pain and immediate increases in function. Therefore, further investigation of the MC lateral ankle MWM is warranted.

Assessing the Structural Validity of the Knee Injury and Osteoarthritis Outcome Score Scale.

BACKGROUND: The Knee Injury and Osteoarthritis Outcome Score (KOOS) scale is used to assess patient perspectives on knee health. However, the structural validity of the KOOS has not been sufficiently tested; therefore, our objective was to assess the KOOS in a large, multi-site database of patient responses who were receiving care for knee pathology. METHODS: A cross-sectional study was conducted using the Surgical Outcome System (SOS) database. A confirmatory factor analysis (CFA) was conducted to assess the proposed five-factor KOOS using a priori cut-off values. Because model fit indices were not met, a subsequent exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting four-factor structure (i.e., KOOS SF-12) was then assessed using CFA and subjected to multigroup invariance testing. RESULTS: The original KOOS model did not meet rigorous CFA fit recommendations. The KOOS SF-12 did meet model fit recommendations and passed all invariance testing between intervention procedure, sex, and age groups. CONCLUSION: The KOOS failed to meet model fit recommendations. The KOOS SF-12 met model fit recommendations, maintained a multi-factorial structure, and was invariant across all tested groups. The KOOS did not demonstrate sound structural validity. A refined KOOS SF-12 model that met recommended model fit indices and invariance testing criteria was identified. Our findings provide initial support for a multidimensional KOOS structure (i.e., KOOS SF-12) that is a more psychometrically sound instrument for measuring patient-reported knee health.

Psychometric analysis of the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR).

Objective: Centers for Medicare and Medicaid Services (CMS) has requested hospitals collect and report patient-reported outcomes (PROs) beginning in 2024 including the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR). However, scale structural validity of the HOOS-JR has minimally been assessed. The purpose of this study was to assess internal consistency, structural validity, and multi-group invariance properties of the HOOS-JR in a large sample of patients who underwent a total hip arthroplasty (THA). Methods: A cross-sectional study using the Surgical Outcomes System was retrospectively queried for patients who underwent a THA. Internal consistency was assessed using Cronbach's alpha and McDonald's Omega. A confirmatory factor analysis (CFA) was performed on the HOOS-JR using a priori cut-off values. Multi-group invariance testing was also performed on the sample of patients across sex and age groups. Results: Internal consistency was acceptable for 6-item (alpha â€‹= â€‹0.88; omega â€‹= â€‹0.88) and 5-item (alpha â€‹= â€‹0.86; omega â€‹= â€‹0.86) HOOS-JR. The one-factor, 6-item CFA did not meet the recommended fit indices. The one-factor, 5-item CFA had acceptable fit for the sample data. Invariance testing criteria were met between the age groups; however, scalar invariance was not met for sex. Conclusion: The 6-item HOOS-JR did not meet contemporary model fit indices indicating that scale refinement is warranted. The 5-item met most goodness-of-fit indices and invariance criteria. However, further scale refinement may be warranted as localized fit issues were identified.

Exploring Healthcare Provider Recruitment in a Rural and Frontier Community in Northern Idaho.

Limited U.S. research has been conducted examining factors affecting healthcare provider recruitment in rural settings, necessitating community-level investigations due to community differences. The aim of this study was to explore the factors involved in healthcare provider recruitment in a rural community in Northern Idaho. A retooled version of the Nursing Community Apgar Questionnaire (NCAQ) was used to collect data from 50 healthcare providers to assess items influencing provider recruitment. Items were categorized into five factors: geographic, economic, scope of practice, medical support, and facility and community support classes. Healthcare providers ranked items based on perceived importance and how advantageous or challenging it was to recruitment. A "Community Apgar" score is a composite score calculated using the advantage/challenge and importance scores. In our sample, medical support was rated as the most important class. Additionally, facility and community support was rated as the highest advantage class and had the most impactful Apgar scores, meaning it contained the most important advantage and challenge. Our findings suggest that these classes contain dominant factors related to the recruitment of providers in rural areas. Rural healthcare organizations seeking to improve the recruitment of healthcare providers should consider the potential impact of these factors on their population. Further investigations should be conducted on diverse rural samples across the U.S. to enable comparisons of research findings.