Tummy Time Tracking: Examining Agreement Between Parent Recall and Direct Observation in Infants.

IMPORTANCE: Parent recall is the primary method for measuring positioning practices such as tummy time in infants. Concerns regarding the accuracy of parent recall have been raised in the literature. To date, no study has examined the agreement of tummy time recall measures with gold-standard methods. OBJECTIVE: To assess the agreement between parental recall versus direct observation of tummy time in infants, and to explore the impact of prematurity on this relationship. DESIGN: Cross-sectional observational study, spanning 1 yr. SETTING: Participants' homes Participants: Thirty-two infant-parent dyads (19 full-term, 13 preterm), with infants ages 3 to 6 mo and caregivers ages older than 18 yr. OUTCOME AND MEASURES: Home-recorded videos of infant play across 3 days were used as a proxy for direct observation of tummy time and compared with a 12-item parent recall survey. RESULTS: Parent recall had a significant moderate correlation (ρ = .54, p = .002) with direct observation in full-term infants but was not correlated (p = .23) with direct observation in preterm infants. On average, parents of preterm infants overestimated tummy time by 2.5 times per day compared with direct observation. CONCLUSIONS AND RELEVANCE: For full-term infants, parent recall measures of tummy time exhibit an acceptable level of agreement with direct observation and can be reliably used over shorter periods. Parents of preterm infants may display a bias in recalling tummy time, leading to overestimations. To accurately assess tummy time in this population, a combination of subjective and objective measures should be explored. Plain-Language Summary: Tummy time is an essential movement experience for infants, especially for preterm infants, who are at a higher risk for motor delays. The most common way to track tummy time is through parent reports, or recall, versus a practitioner directly observing tummy time in the home. Despite the widespread use of parent recall to track tummy time, no study has examined the accuracy of parent recall versus direct observation in the home. Accurately assessing tummy time is crucial for improving and supporting health outcomes for infants. This study found that prematurity may affect the accuracy of parent recall for assessing tummy time in young infants. The authors discuss the implications of this finding and provide suggestions to guide the selection of appropriate methods to measure tummy time in clinical practice and research studies.

Effect of Strength and Plyometric Training on Kinematics in Female Novice Runners.

ABSTRACT: Harrison, K, Williams, DSB III, Darter, BJ, Zernicke, RF, Shall, M, and Finucane, S. Effect of strength and plyometric training on kinematics in female novice runners. J Strength Cond Res 38(6): 1048-1055, 2024-Both running performance and injury have been associated with running kinematics. Plyometric training improves run performance and reduces injury risk in court-sport and field-sport athletes. The aim of this study was to assess longitudinal changes in kinematics in novice runners before and after a typical beginners' running program, compared with those who perform a plyometric intervention before running. Fifty-seven novice female runners were assigned to the control group (8 weeks walking +8 weeks running) or the intervention group (8 weeks strength or plyometric training +8 weeks running). Kinematics were assessed at baseline, 8 weeks, and 16 weeks. Joint angles throughout the stride of those who completed the training ( n = 21) were compared between groups and assessment time points using a statistical parametric mapping 2-way analysis of variance, with group and study time point as independent variables. There was no interaction effect of group and study time point ( p > 0.05), indicating that both training programs had similar effects on running kinematics. There was a main effect of time for sagittal plane knee and hip kinematics ( p < 0.001); after training, subjects ran with a more extended leg, particularly during swing. Programs of 8 weeks of preparatory training, followed by 8 weeks of running, resulted in altered sagittal plane biomechanics, which have previously been related to improved running economy. A greater volume of plyometric, run training or concurrent plyometric and run training may be required to elicit changes in running form associated with lower injury risk.

The Running Readiness Scale as an Assessment of Kinematics Related to Knee Injury in Novice Female Runners.

CONTEXT: Frontal- and transverse-plane kinematics have been prospectively identified as risk factors for running-related injuries in females. The Running Readiness Scale (RRS) may allow for clinical evaluation of these kinematics. OBJECTIVES: To determine the reliability and validity of the RRS as an assessment of frontal- and transverse-plane running kinematics. DESIGN: Cross-sectional study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 56 novice female runners (median [interquartile range] age = 34 years [26-47 years]). MAIN OUTCOME MEASURE(S): We collected 3-dimensional kinematics during running and RRS tasks: hopping, plank, step-ups, single-legged squats, and wall sit. Five clinicians assessed RRS performances 3 times each. Interrater and intrarater reliabilities of the total RRS score and individual tasks were calculated using the intraclass correlation coefficient and Fleiss κ, respectively. Pearson product moment correlation coefficients between peak joint angles measured during running and the same angles measured during RRS tasks were computed. Peak joint angles of high- and low-scoring participants were compared. RESULTS: Interrater and intrarater reliabilities of assessment of the total RRS scores were good (intraclass correlation coefficients = 0.75 and 0.80, respectively). Reliability of assessing individual tasks was moderate to almost perfect (κ = 0.58-1.00). Peak hip adduction, contralateral pelvic drop, and knee abduction during running were correlated with the same angles measured during hopping, step-ups, and single-legged squats (r = 0.537-0.939). Peak knee internal rotation during running was correlated with peak knee internal rotation during step-ups (r = 0.831). Runners who scored high on the RRS demonstrated less knee abduction during running (P ≤ .01). CONCLUSIONS: The RRS may effectively assess knee abduction in novice runners, but evaluation criteria or tasks may need to be modified to effectively characterize pelvic and transverse-plane knee kinematics.

Creating Interprofessional Readiness to Advance Age-Friendly U.S. Healthcare.

A successful interprofessional faculty development program was transformed into a more clinically focused professional development opportunity for both faculty and clinicians. Discipline-specific geriatric competencies and the Interprofessional Education Collaborative (IPEC) competencies were aligned to the 4Ms framework. The goal of the resulting program, Creating Interprofessional Readiness for Complex and Aging Adults (CIRCAA), was to advance an age-friendly practice using evidence-based strategies to support wellness and improve health outcomes while also addressing the social determinants of health (SDOH). An interprofessional team employed a multidimensional approach to create age-friendly, person-centered practitioners. In this mixed methods study, questionnaires were disseminated and focus groups were conducted with two cohorts of CIRCAA scholars to determine their ability to incorporate learned evidence-based strategies into their own practice environments. Themes and patterns were identified among transcribed interview recordings. Multiple coders were used to identify themes and patterns and inter-coder reliability was assessed. The findings indicate that participants successfully incorporated age-friendly principles and best practices into their own work environments and escaped the silos of their disciplines through the implementation of their capstone projects. Quantitative data supported qualitative themes and revealed gains in knowledge of critical components of age-friendly healthcare and perceptions of interprofessional collaborative care. These results are discussed within a new conceptual framework for studying the multidimensional complexity of what it means to be age-friendly. Our findings suggest that programs such as CIRCAA have the potential to improve older adults' health by addressing SDOH, advancing age-friendly and patient-centered care, and promoting an interprofessional model of evidence-based practice.

Comparison of Frontal and Transverse Plane Kinematics Related to Knee Injury in Novice Versus Experienced Female Runners.

Novice runners experience a higher incidence of knee injury than experienced runners, which may be related to aberrant frontal and transverse plane kinematics. However, differences in kinematics between novice and experienced runners have not been fully explored. For this study, 10 novice and 10 experienced female runners ran on a treadmill at 2.68 m/s. Ankle, knee, and hip joint angles during the stance phase were measured using a 3-dimensional motion capture system and modeled using cubic splines. Spline models were compared between groups using a generalized linear model (α = .05). Ninety-five percent confidence intervals of the difference between joint angles throughout stance were constructed to identify specific periods of stance where groups differed in joint position. Angle-angle diagrams of ankle and hip position in the frontal and transverse planes were constructed to depict joint coordination. Novice runners displayed less hip adduction, but greater knee abduction and knee internal rotation compared to experienced runners. Differences in knee joint position may be explained by coordination of hip and ankle motion. Greater knee abduction and knee internal rotation displayed by novice runners compared with experienced runners may help to explain their higher risk for injury.

Evaluation of an interprofessional, evidence-based falls training.

Fall-related injuries and mortality are increasing in older adults. Evidence suggests a need for a multifactorial, interprofessional approach to reducing falls. The Program for All-Inclusive Care for the Elderly (PACE) utilizes an interprofessional approach to care and serves a high-risk population. The purpose of this study was to investigate the effectiveness of an EBP falls prevention training program conducted at a PACE. The program was a revision of an established program and was led by an interprofessional team. The evaluation used a mixed-methods approach to assess program quality, learning and self-efficacy gains, and intended behavioral changes. Quantitative evaluation demonstrated program satisfaction and qualitative responses identified the depth and interprofessional delivery as favorable. Qualitative data identified opportunities to enhance content and learning design. Overall knowledge gains were statistically significant (mean difference 5%), with the greatest gains related to the evidence base (mean difference 2.67%). Self-efficacy ratings increased significantly after each session. Participants noted changes to team function and a willingness to consider practice changes as a result of the training. The findings support the effectiveness of this interprofessional, EBP training program on falls prevention practices in a PACE and highlight the value of a multifaceted assessment and iterative development.

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups. BACKGROUND: Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome. However, the mechanisms underlying these benefits are not well understood. METHODS: Participants with shoulder impingement symptoms (n = 52) were randomly assigned to receive a single session of thoracic SMT or sham SMT. Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention. Patient-reported outcomes measured were pain (numeric pain-rating scale), function (Penn Shoulder Score), and global rating of change. RESULTS: Following the intervention, there were no significant differences in changes between groups for thoracic kinematics or excursion, scapular kinematics, and patient-reported outcomes (P>.05). Both groups showed an increase in scapular internal rotation during arm raising (mean, 0.9°; 95% confidence interval [CI]: 0.3°, 1.6°; P = .003) and lowering (0.8°; 95% CI: 0.0°, 1.5°; P = .041), as well as improved pain reported on the numeric pain-rating scale (1.2 points; 95% CI: 0.3, 1.8; P<.001) and function on the Penn Shoulder Score (9.1 points; 95% CI: 6.5, 11.7; P<.001). CONCLUSION: Thoracic spine extension and excursion did not change significantly following thoracic SMT. There were small but likely not clinically meaningful changes in scapular internal rotation in both groups. Patient-reported pain and function improved in both groups; however, there were no significant differences in the changes between the SMT and the sham SMT groups. Overall, patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion. LEVEL OF EVIDENCE: Therapy, level 1b-.

Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study.

BACKGROUND: Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. OBJECTIVES: To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT) using pressure pain threshold (PPT), and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment. DESIGN: Randomized Controlled Study. METHODS: Subjects with unilateral subacromial impingement syndrome (n = 45) were randomly assigned to receive treatment with thoracic SMT or sham thoracic SMT. PPT was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. Patient-rated outcomes were pain (numeric pain rating scale - NPRS), function (Pennsylvania Shoulder Score - Penn), and global rating of change (GROC). RESULTS: There were no significant differences between groups in pre-to post-treatment changes in PPT (p ≥ 0.583) nor were there significant changes in PPT within either group (p ≥ 0.372) following treatment. NPRS, Penn and GROC improved across both groups (p < 0.001), but there were no differences between the groups (p ≥ 0.574). CONCLUSION: There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT. Both groups had improved patient-rated pain and function within 24-48 h of treatment, but there was no difference in outcomes between the groups.

The scapular assistance test results in changes in scapular position and subacromial space but not rotator cuff strength in subacromial impingement.

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To determine the effect of the modified scapular assistance test (SAT) on 3-dimensional shoulder kinematics, strength, and linear measures of subacromial space in patients with subacromial impingement syndrome (SAIS). BACKGROUND: Abnormal scapular kinematics have been identified in patients with SAIS. Increased scapular upward rotation and posterior tilt, as induced with manual assistance using the SAT, have been theorized to increase subacromial space and may alter shoulder strength. METHODS: Forty-two subjects (21 with SAIS and 21 controls) participated in this study. The anterior outlet of the subacromial space, measured via the acromiohumeral distance on ultrasound images, and 3-dimensional scapular kinematics, measured using motion analysis, were determined with the arm at rest, and at 45° and 90° of active elevation with and without the SAT. A dynamometer was used to measure isometric shoulder strength. Full factorial mixed-model analyses of variance evaluated the effects of the SAT on variables between groups. RESULTS: There was an increase in scapular posterior tilt at all angles, upward rotation at rest and 45° of elevation, and acromiohumeral distance at 45° and at 90° with the SAT. The SAT did not alter normalized isometric strength. There were no differences in response to the SAT between the SAIS and control groups. CONCLUSIONS: Manual scapular assistance using the SAT influences factors associated with SAIS, such as subacromial space and potentially scapular orientation during static arm elevation, but not more so in individuals with SAIS than in healthy individuals. The SAT performed statically may be a way to identify potential subgroups of individuals with SAIS for whom subacromial space narrowing may be a contributing factor.

The influence of referral source on characteristics of patients undergoing cardiac stress testing: emergency department versus outpatient office.

OBJECTIVES: Chest pain is a common reason for accessing an emergency department (ED) and a frequent cause of outpatient physician visits. Whether patients referred for cardiac stress testing from these referral sources differ in clinically significant ways is unknown, and is thus the purpose of this investigation. METHODS: This study prospectively assessed 301 patients presenting to Virginia Commonwealth University Medical Center with symptoms suggestive of myocardial ischemia. All subjects underwent nuclear stress testing as a part of their assessment. RESULTS: Patients referred from the ED were more likely to be African American and outpatients were more likely to be Caucasian. Outpatients were older than those referred from the ED. Patients referred from the ED were less likely to have a diagnosis of hypertension, dyslipidemia, or diabetes, but were more likely to smoke. The exercise response was similar, with a few exceptions. There were no differences in the frequency of equivocal or positive nuclear stress test results based on referral source. CONCLUSIONS: The results of the present study indicate that several characteristics of patients undergoing outpatient nuclear stress testing differ according to referral source. Future research should be directed toward developing effective strategies to reduce ED utilization and increasing outpatient management.

Overestimation of aerobic capacity with the bruce treadmill protocol in patients being assessed for suspected myocardial ischemia.

INTRODUCTION: Peak oxygen uptake (VO2) is prognostic for morbidity and mortality. Estimating aerobic capacity during traditional exercise stress testing is common as it has been shown that total treadmill time on the Bruce protocol predicts peak VO2. However, the potential to overestimate peak VO2 exists and may have clinical implications regarding the interpretation of exercise test data. METHODS: Subjects (N = 303) with symptoms suggestive of myocardial ischemia underwent a myocardial perfusion study and an exercise test with simultaneous ventilatory expired gas analysis. Estimated peak VO2 from the Bruce treadmill protocol was compared with measured peak VO2. The Duke Treadmill Score (DTS) was calculated with treadmill time (DTS(time)) and also with measured VO2 (DTS(measured)),expressed as metabolic equivalents (METs), and converted to time. RESULTS: Peak measured METs was significantly lower than peak estimated METs in the entire cohort (6.5 ± 1.9 vs 8.8 ± 2.8, P < .001) as well as in female (5.7 ± 1.4 and 7.8 ± 2.1, P < .001) and male (7.3 ± 2.0 and 9.7 ± 3.1, P < .001) subgroups. Calculation of the DTS with measured METs resulted in a significantly lower score compared with its calculation with treadmill time (2.7 ± 3.5 vs 5.8 ± 4.6, P < .001). Receiver operating characteristic curve analysis revealed that DTS(measured) produce a statistically significant model for diagnosing a perfusion defect in both men and women (P < .05), whereas DTS(time) was diagnostic only in men (P < .05). DISCUSSION: This study demonstrates that estimates of aerobic capacity are significantly higher than measured values and this difference may result in a significant underestimation of morbidity/mortality risk.

Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?

The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. The varied nature of these mechanisms indicates that rotator cuff tendinopathy is not a homogenous entity, and thus may require different treatment interventions. Treatment aimed at addressing mechanistic factors appears to be beneficial for patients with rotator cuff tendinopathy, however, not for all patients. Classification of rotator cuff tendinopathy into subgroups based on underlying mechanism may improve treatment outcomes.

Quantifying exertion level during exercise stress testing using percentage of age-predicted maximal heart rate, rate pressure product, and perceived exertion.

OBJECTIVE: To determine if the attainment of at least 85% of age-predicted maximal heart rate (APMHR), using the equation 220 - age, and/or at least 25,000 as the product of maximal heart rate and systolic blood pressure (rate pressure product, RPP) is an accurate indicator of exertion level during exercise stress testing. PATIENTS AND METHODS: From May 1, 2009, to February 15, 2010, 238 patients (mean ± SD age, 49.3±11.9 years; 50% male) with symptoms suggestive of myocardial ischemia underwent an exercise stress test with the addition of ventilatory expired gas analysis and a myocardial perfusion study. Ventilatory expired gas analysis determined the peak respiratory exchange ratio (RER), which is considered a valid and reliable variable for quantifying a patient's exertion during exercise. RESULTS: Of the patients, 207 (87%) attained a peak RER of 1.00 or more, and 123 (52%) attained a peak RER of 1.10 or more. An APMHR of 85% or more and peak RPP of 25,000 or more were both ineffective in identifying patients who put forth a maximal exercise effort (ie, peak RER, ≥1.10). Perceived exertion was a significant indicator (P=.04) of patient exertion, with a threshold of 15 (6-20 scale) being an optimal cut point. The percentage of equivocal myocardial perfusion study results was significantly higher in patients who demonstrated a submaximal exercise effort by peak RER (P≤.007). CONCLUSION: Aerobic exercise testing is an integral component in the assessment of patients with suspected myocardial ischemia. Our findings indicate that the currently used percentage of APMHR and peak RPP thresholds are ineffective in quantifying a patient's level of exertion during exercise stress testing.

Usefulness of decrease in oxygen uptake efficiency slope to identify myocardial perfusion defects in men undergoing myocardial ischemic evaluation.

Cardiopulmonary exercise testing (CPX) might aid in the diagnosis of coronary artery disease. However, a heterogeneous clinical population without previous workup bias has not been studied nor has a more extensive list of CPX variables. A total of 303 subjects (age 49.9 ± 11.6 years, 157 men) with symptoms suggestive of coronary artery disease underwent CPX and a single photon emission computed tomographic myocardial perfusion study (MPS). Ventilatory efficiency was calculated using the oxygen uptake efficiency slope (OUES). The change in the OUES was calculated by subtracting the OUES response during the first 50% of CPX from the OUES obtained during the last 25% of CPX. A negative change in the OUES (< 0) from the first 50% to the last 25% of CPX was predictive of positive MPS findings only in the male subjects. The diagnostic significance of the change in OUES in men was found for any level (including equivocal studies) of positive MPS findings (area under the curve 0.67, 95% confidence interval 0.59 to 0.76, p < 0.0001) and was even stronger in those with a more definitive (excluding equivocal studies) perfusion defect (area under the curve 0.76, 95% confidence interval 0.67 to 0.85; relative risk 5.4, 95% confidence interval 2.1 to 13.8, p < 0.0001). In conclusion, this is the first time that a change in ventilatory efficiency, assessed using the OUES, has been shown to be predictive of positive MPS findings However, the OUES change only provided diagnostic information for men, a finding that warrants additional analysis.

The effects of low-intensity ultrasound on medial collateral ligament healing in the rabbit model.

BACKGROUND: Ruptured medial collateral ligaments are capable of healing over time, but biomechanical and biochemical properties remain inferior to normal tissue. Low-intensity ultrasound may improve healing. HYPOTHESIS: Medial collateral ligaments treated with ultrasound will demonstrate superior healing. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-one late-adolescent male rabbits underwent bilateral ligament transection. One ligament from each rabbit received ultrasound treatment every other day for 6 total treatments. Contralateral ligaments received sham treatments. After 3 or 6 weeks, ligaments were evaluated biomechanically and assayed for collagen concentration and the relative proportions of types I and III collagen. RESULTS: Areas of sonicated specimens were significantly larger (10.6% +/- 4.90%) at 6 weeks. Ultimate load (39.5% +/- 17.0%), ultimate displacement (24.5% +/- 8.0%), and energy absorption (69.1% +/- 22.0%) were significantly higher for sonicated specimens at 6 weeks. No significant biomechanical differences were observed at 3 weeks. The relative proportion of type I collagen was significantly higher in sonicated ligaments at 3 weeks (8.61% +/- 4.0%) and 6 weeks (6.91% +/- 3.0%). No significant differences in collagen concentration were observed at either 3 or 6 weeks. CONCLUSION: Subtle improvement with ultrasound treatment may be apparent by 3 weeks after injury, suggested by increased proportion of type I collagen. Ultrasound appears to improve some structural properties and to modestly increase scar cross-sectional area and type I collagen present at 6 weeks after injury in this model. CLINICAL RELEVANCE: Ultrasound treatments after ligament injury may facilitate earlier return to activities and decrease risk of reinjury.