Intrinsic Risk Factors for Noncontact Musculoskeletal Injury in Collegiate Swimmers: A Prospective Cohort Study.

CONTEXT: Shoulder pain is pervasive in swimmers of all ages. However, given the limited number of prospective studies, injury risk factors in swimmers remain uncertain. OBJECTIVE: To determine the extent to which the risk factors of previous injury, poor movement competency, erroneous freestyle swimming technique, and low perceived susceptibility to sport injury were associated with noncontact musculoskeletal injury in collegiate swimmers. DESIGN: Prospective cohort study. SETTING: College natatorium. PATIENTS OR OTHER PARTICIPANTS: Thirty-seven National College Athletic Association Division III swimmers (21 females, 16 males; median age = 19 years [interquartile range = 3 years], height = 175 ± 10 cm; mass = 70.0 ± 10.9 kg). MAIN OUTCOME MEASURE(S): Participants completed preseason questionnaires on their previous injuries and perceived susceptibility to sport injury. At the beginning of the season, they completed the Movement System Screening Tool and the Freestyle Swimming Technique Assessment. Logistic regression was used to calculate odds ratios (ORs) with 95% CIs for the association between each risk factor and injury. RESULTS: Eleven of the 37 participants (29.7%) sustained an injury. Univariate analyses identified 2 risk factors: previous injury (OR = 8.89 [95% CI = 1.78, 44.48]) and crossover hand positions during the freestyle entry phase (OR = 8.50 [95% CI = 1.50, 48.05]). After adjusting for previous injury, we found that a higher perceived percentage chance of injury (1 item from the Perceived Susceptibility to Sport Injury) decreased the injury odds (adjusted OR = 0.11 [95% CI = 0.02, 0.82]). Poor movement competency was not associated with injury (P > .05). CONCLUSIONS: Previous injury, a crossover hand-entry position in freestyle, and a low perceived percentage chance of injury were associated with increased injury odds. Ascertaining injury histories and assessing for crossover positions may help identify swimmers with an elevated injury risk and inform injury-prevention strategies.

Workload and Noncontact Musculoskeletal Injury in Collegiate Swimmers: A Prospective Cohort Study.

CONTEXT: Swimmers are known for experiencing high training loads and a high incidence of overuse injuries, but few researchers have investigated the relationship between the two at the collegiate level. OBJECTIVE: To determine the association between workload and noncontact musculoskeletal injury in collegiate swimmers. DESIGN: Prospective cohort study. SETTING: College natatorium. PATIENTS OR OTHER PARTICIPANTS: A total of 37 National Collegiate Athletic Association Division III swimmers, 26 uninjured (age = 19 years [interquartile range = 3 years], height = 175 ± 11 cm, mass = 70.2 ± 10 kg) and 11 injured (age = 19 years [interquartile range = 3 years], height = 173 ± 9 cm, mass = 69.4 ± 13.5 kg) individuals. MAIN OUTCOME MEASURE(S): Logistic regression using generalized estimating equations was conducted to calculate odds ratios (ORs) with 95% CIs for injury relative to high workloads and high acute:chronic workload ratio (ACWRs). Injury rates for several ranges of workloads and ACWRs were also calculated. RESULTS: A total of 11 participants (29.7%) sustained 12 injuries, with 7 injuries occurring during the participants' winter training trip. Injury was associated with high acute workloads (OR = 27.1; 95% CI = 8.2, 89.8) and high ACWRs (OR = 25.1; 95% CI = 7.7, 81.4) but not high chronic (OR = 2.6; 95% CI = 0.3, 20.0) or overall (OR = 1.00; 95% CI = 0.99, 1.01) workloads. High acute workloads (>37.2 km/wk) and ACWRs (>1.56) increased the injury rate from ≤1% to 15% and 14%, respectively, compared with all lower acute workloads and ACWRs. CONCLUSIONS: Collegiate swimmers tolerated high workloads spread out during the season. However, caution should be used when prescribing high acute workloads and high ACWRs (eg, winter training trip) because of the increased odds of injury.

Impact of Hospital-Based Rehabilitation Services on Discharge to the Community by Value-Based Payment Programs After Joint Replacement Surgery.

OBJECTIVE: The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models. METHODS: A secondary analysis of Medicare fee-for-service claims was conducted for beneficiaries 65 years of age or older who underwent hip and knee replacement surgery from 2016 to 2017. Independent variables were hospital participation in value-based programs categorized as: (1) BPCI, (2) CJR, and (3) non-BPCI/CJR; and total minutes per day of hospital-based rehabilitation services categorized into tertiles. The primary outcome variable was discharged to the community versus discharged to institutional post-acute care settings. The association between rehabilitation amount and community discharge among BPCI, CJR, and non-BPCI/CJR hospitals was adjusted for patient-level clinical and hospital characteristics. RESULTS: Participation in BPCI or CJR was not associated with community discharge. This analysis found a dose-response relationship between the amount of rehabilitation services and odds of community discharge. Among those who received a hip replacement, this relationship was most pronounced in the BPCI group; compared with the low rehabilitation category, the medium category had odds ratio (OR) = 1.28 (95% CI = 1.17 to 1.41), and the high category had OR = 1.90 (95% CI = 1.71 to 2.11). For those who received a knee replacement, there was a dose-response relationship in the CJR group only; compared with the low rehabilitation category, the medium category had OR = 1.21 (95% CI = 1.15 to 1.28), and the high category had OR = 1.56 (95% CI = 1.46 to 1.66). CONCLUSION: Regardless of hospital participation in BPCI or CJR models, higher amounts of rehabilitation services delivered during acute hospitalization is associated with a higher likelihood of discharge to community following hip and knee replacement surgery. IMPACT: In the era of value-based care, frontloading of rehabilitation care is vital for improving patient-centered health outcomes in acute phases of lower extremity joint replacement.

Medicare Claim-Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission.

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began. OBJECTIVE: Examine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke. DESIGN: Retrospective cohort study of Medicare claims data. PATIENTS: Medicare beneficiaries with ischemic stroke (N=43,241) acute hospitalization between October 2016 and November 2017. MEASUREMENTS: All-cause 30-day mortality and 30-day hospital readmission. NIHSS score was derived from ICD-10 codes and stratified into the following: minor to moderate, moderate, moderate to severe, and severe categories. RESULTS: Among 43,241 patients with ischemic stroke with NIHSS from 2,659 US hospitals, 64.6% had minor to moderate stroke, 14.3% had moderate, 12.7% had moderate to severe, and 8.5% had a severe stroke,10.1% died within 30 days, 12.1% were readmitted within 30 days. The NIHSS exhibited stronger discriminant property (C-statistic 0.83, 95% CI: 0.82-0.84) for 30-day mortality compared to Elixhauser (0.74, 95% CI: 0.73-0.75). A monotonic increase in the adjusted 30-day mortality risk occurred relative to minor to moderate stroke category: hazard ratio [HR]=2.92 (95% CI=2.59-3.29) for moderate stroke, HR=5.49 (95% CI=4.90-6.15) for moderate to severe stroke, and HR=7.82 (95% CI=6.95-8.80) for severe stroke. After accounting for competing risk of mortality, there was a significantly higher readmission risk in the moderate stroke (HR=1.11, 95% CI=1.03-1.20), but significantly lower readmission risk in the severe stroke (HR=0.84, 95% CI=0.74-0.95) categories. LIMITATION: Timing of NIHSS reporting during hospitalization is unknown. CONCLUSIONS: Medicare claim-based NIHSS is significantly associated with 30-day mortality in Medicare patients with ischemic stroke and significantly improves discriminant property relative to the Elixhauser comorbidity index.

Clinical instruments for bedside functional assessment: Convergent validity among the AM-PAC '6-Clicks' and BMAT.

AIMS AND OBJECTIVES: To determine the level of convergent validity of the '6-Clicks' Basic Mobility and Daily Activity with the Bedside Mobility Assessment Tool (BMAT) in patients admitted to a tertiary care academic hospital. BACKGROUND: Accurately measuring a patient's ability to mobilise during hospitalisation is necessary but can be challenging. Two instruments, the Activity Measure for Post-Acute Care short-form '6-Clicks' and the BMAT, are commonly used to determine patients' mobility levels; however, these instruments have not been psychometrically evaluated together. Understanding the characteristics between these tools can support the process of shared decision making amongst healthcare providers. DESIGN: Retrospective Cohort adhering to the STROBE statement. METHODS: Using 13,498 individual patient admissions from an electronic health record, the BMAT score measured closest in time to the '6-Clicks' Basic Mobility and Daily Activity evaluation was collected. Spearman rank correlations with 95% confidence intervals (CIs) were calculated to determine the level of convergent validity between the '6-Clicks' Basic Mobility and Daily Activity with the BMAT. Pairwise correlations were also calculated and stratified by admitting medical service. RESULTS: All correlations for the '6-Clicks' Basic Mobility or Daily Activity summative scores and the BMAT mobility levels were statistically significant and moderately correlated. The weakest correlations were seen within the Orthopaedic admitting service group. Most correlations stratified by admitting service [CVD/Pulmonary, Medicine/Hospitalist, Other Surgery and Solid Organ Transplant] were moderate. The strongest correlations were seen within the Neuro/Stroke admitting service. CONCLUSION: Moderate levels of convergent validity exist between the '6-Clicks' and the BMAT in this sample. These findings demonstrate that the construct of patient mobility is not being assessed similarly between the two instruments. RELEVANCE TO CLINICAL PRACTICE: These findings suggest the continued use of both instruments to allow interdisciplinary assessment of patient mobility status during a hospital stay.

Reliability of the Tuck Jump Assessment Using Standardized Rater Training.

BACKGROUND: The Tuck Jump Assessment (TJA) is a test used to assess technique flaws during a 10-second, high intensity, jumping bout. Although the TJA has broad clinical applicability, there is no standardized training to maximize the TJA measurement properties. HYPOTHESIS/PURPOSE: To determine the reliability of the TJA using varied healthcare professionals following an online standardized training program. The authors hypothesized that the total score will have moderate to excellent levels of intra- and interrater reliability. STUDY DESIGN: Cross-sectional reliability. METHODS: A website was created by a physical therapist (PT) with videos, written descriptors of the 10 TJA technique flaws, and examples of what constituted no flaw, minor flaw, or major flaw (0,1,2) using published standards. The website was then validated (both face and content) by four experts. Three raters of different professions: a PT, an AT, and a Strength and Conditioning Coach Certified (SCCC) were selected due to their expertise with injury and movement. Raters used the online standardized training, scored 41 videos of participants' TJAs, then scored them again two weeks later. Reliability estimates were determined using intraclass correlation coefficients (ICCs) for total scores of 10 technique flaws and Krippendorff α (K α) for the individual technique flaws (ordinal). RESULTS: Eleven of 50 individual technique flaws were above the acceptable level (K α = 0.80). The total score had moderate interrater reliability in both sessions (Session 1: ICC2,2 = 0.64; 95% CI (Confidence Interval) (0.34-0.81); Standard Error Measurement (SEM) = 0.66 technique flaws and Session 2: ICC2,2 = 0.56; 95% CI (0.04-0.79); SEM = 1.30). Rater 1had a good reliability (ICC2,2 = 0.76; 95% CI (0.54-0.87); SEM = 0.26), rater 2 had a moderate reliability (ICC2,2 = 0.62; 95% CI (0.24-0.80); SEM =0.41) and rater 3 had excellent reliability (ICC2,2 = 0.98; 95% CI (0.97-0.99); SEM =0.01). CONCLUSION: All raters had at least good reliability estimates for the total score. The same level of consistency was not seen when evaluating each technique flaw. These findings suggest that the total score may not be as accurate when compared to individual technique flaws and should be used with caution. LEVEL OF EVIDENCE: 3b.

Association of AM-PAC "6-Clicks" Basic Mobility and Daily Activity Scores With Discharge Destination.

OBJECTIVE: The objective was to use the Activity Measure for Post-Acute Care "6-Clicks" scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). METHODS: In this retrospective cohort study, initial "6-Clicks" Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility (≤40.78 vs >40.78) and Daily Activity (≤40.22 vs >40.22), accounting for patient and clinical characteristics. RESULTS: Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80-0.81) and Daily Activity was 0.81 (95% CI = 0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores ≤40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5-1.9]), SNF (OR = 7.8 [95% CI = 6.8-8.9]), and IRF (OR = 7.5 [95% CI = 6.3-9.1]), and the Daily Activity scores ≤40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7-2.0]), SNF (OR = 8.9 [95% CI = 7.9-10.0]), and IRF (OR = 11.4 [95% CI = 9.7-13.5]). CONCLUSION: 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. IMPACT: Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.

Association of Risk Factors with Receiving a Foot Check in People With Diabetes: NHANES 2013-2016.

AIMS: The American Diabetes Association (ADA) recommends annual foot examinations for those with diabetes. The factors related to who receives an annual examination is not completely understood. This study aims to identify factors that influence whether individuals with diabtes had their feet checked for sores or irritations. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES), were analyzed to determine the factors that influence whether an annual foot check was performed. RESULTS: Participants with abnormal A1C (> 6.5%) had higher odds of having their feet checked compared to those with a normal A1C (adjusted odds ratio [AOR] = 2.61; 95% confidence interval (CI): 1.28-5.30). The presence of retinopathy (AOR = 2.76; 95% CI:1.13-6.73) or kidney disease (AOR = 2.37; 95% CI:1.11-5.03) also increased the odds of a foot check. Finally, the number of risk factors for diabetic complications was significantly associated with having a foot check when modeled as a continuous variable (AOR = 1.36; 95% CI: 1.14-1.63). CONCLUSIONS: Whether an individual received an annual foot check for sores or irritations was influenced by the number of risk factors they had, especially an elevated A1C value, and the presence of retinopathy or kidney disease.

The Association Between the Single Leg Hop Test and Lower-Extremity Injuries in Female Athletes: A Critically Appraised Topic.

Clinical Scenario: Female college student-athletes (SA) often experience time loss from musculoskeletal injuries to the lower extremities. This can lead to lengthy rehabilitation, expensive medical bills, and declines in health-related quality of life. Identifying at-risk athletes prior to the start of an athletic season may allow coaches or athletic trainers to prescribe an injury prevention program. Clinical Question: In female college SA, are preseason single leg hop (SLH) scores associated with identifying those at risk for lower-extremity musculoskeletal injuries? Summary of Key Findings: Five prospective cohort studies in female SA scored athletes on the SLH prior to the start of the athletic sport season. One of 5 studies found an association of SLH with injury risk. An additional 2 studies found that the SLH as part of a battery of functional performance tests was associated with injury risk in some anatomic locations (eg, thigh/knee), but not overall injury risk. Clinical Bottom Line: Methodological limitations of the reviewed studies limits a final conclusion, and there is insufficient evidence to determine if the SLH should be used as a sole functional performance test to identify at-risk female SA; it may be useful as part of a battery of functional performance tests for female college SA. Strength of Recommendation: All studies were prospective cohort studies (level 3).

Association of Functional Screening Tests and Noncontact Injuries in Division I Women Student-Athletes.

Warren, M, Lininger, M, Smith, CA, Copp, A, and Chimera, NJ. Association of functional screening tests and noncontact injuries in Division I women student-athletes. J Strength Cond Res 34(8): 2302-2311, 2020-To determine the association between functional screening tests and lower-body, noncontact injuries in Division I women basketball, soccer, and volleyball student-athletes (SA). Sixty-eight injury-free women SA (age: 19.1 ± 1.1 years, height: 171.3 ± 8.7 cm, and mass: 68.4 ± 9.5 kg) were tested preseason with single hop (SH), triple hop (TH), and crossover hop (XH) for distance, and isometric hip strength (abduction, extension, and external rotation) in randomized order. The first lower-body (spine and lower extremity), noncontact injury requiring intervention by the athletic trainer was abstracted from the electronic medical record. Receiver operating characteristic and area under the curve (AUC) were calculated to determine cut-points for each hopping test from the absolute value of between-limb difference. Body mass-adjusted strength was categorized into tertiles. Logistic regression determined the odds of injury with each functional screening test using the hopping tests cut-points and strength categories, adjusting for previous injury. Fifty-two SA were injured during the sport season. The cut-point for SH was 4 cm (sensitivity = 0.77, specificity = 0.43, and AUC = 0.53), and for TH and XH was 12 cm (sensitivity = 0.75 and 0.67, specificity = 0.71 and 0.57, AUC = 0.59 and 0.41, respectively). A statistically significant association with TH and injuries (adjusted odds ratio = 6.50 [95% confidence interval: 1.69-25.04]) was found. No significant overall association was found with SH or XH, nor with the strength tests. Using a clinically relevant injury definition, the TH showed the strongest predictive ability for noncontact injuries. This hopping test may be a clinically useful tool to help identify increased risk of injury in women SA participating in high-risk sports.

Association and Dose-Response Relationship of Self-Reported Physical Activity and Disability Among Adults ≥50 Years: National Health and Nutrition Examination Survey, 2011-2016.

Disability is a tremendous public health challenge. No study has assessed whether meeting U.S. Physical Activity guidelines is associated with disability in mobility tasks, activities of daily living, and social participation among U.S. older adults. Using 2011-2016 National Health and Nutrition Examination Survey data, this study examined this relationship among 8,309 individuals aged ≥50 years. Most participants (n = 4,272) did not achieve guidelines, and 2,912 participants were completely inactive. People who did not meet guidelines had higher odds of disability compared with those who did (adjusted odds ratio [AOR] = 1.80) in addition to difficulty with mobility tasks (AOR = 1.85), activities of daily living (AOR = 1.66), and social participation (AOR = 2.09). There was a dose-response effect for each level of activity (inactive, insufficient, and meeting and exceeding recommendations). Among adults aged ≥50 years, meeting the U.S. guidelines was associated with better social and physical functioning.

Epidemiology of Incarceration: Characterizing Jail Incarceration for Public Health Research.

BACKGROUND: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to reincarceration. METHODS: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001 to 2018 from jail intake and release records. RESULTS: The median number of incarcerations during the study period was one (interquartile range [IQR] = 1-2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR = 0-5). The median total days incarcerated was 3 (IQR = 1-23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been reincarcerated. CONCLUSION: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research. See video abstract at, http://links.lww.com/EDE/B536.

Only 1 in 10 Patients Told to Lose Weight Seek Help From a Health Professional: A Nationally Representative Sample.

PURPOSE: Receiving weight loss advice from a health-care provider has been associated with more weight loss efforts and greater odds of achieving weight loss. However, whether patients seek help from their provider or other health professional with weight loss after receiving advice from them to lose weight is largely unknown. DESIGN: Cross-sectional data from the 2011 to 2012 National Health and Nutrition Examination Survey (NHANES). SAMPLE: A total of 3862 overweight/obese adults. MEASURES: Questionnaires asked whether participants received advice to lose weight, and whether they sought health professional's assistance with weight management. The NHANES 2011 to 2012 was the most recent year both questions were asked. ANALYSIS: Accounting for NHANES sampling and design, frequency distributions characterized demographics and proportions. Logistic regressions estimated odds of seeking weight loss help by demographics. RESULTS: Of 3682 overweight/obese adults, 1908 were told they were overweight or recommended to lose weight. Of 1908 people, 68% reported weight loss efforts, but only health 10.9% sought a health professional's help (dietician/nutritionist 4.7%, personal trainer 3.0%, doctor 2.8%). Females, people with health insurance and high health-care utilization had 1.5 to 3.5 times greater odds of seeking help; age, ethnicity, and income were not significantly associated with seeking help with weight management. CONCLUSION: In a nationally representative sample, only 10.9% of overweight/obese adults told to lose weight by a provider sought help from a health professional with weight loss. This underscores the opportunity for greater health professional involvement with weight management beyond giving recommendations.

Few adults with functional limitations advised to exercise more or lose weight in NHANES 2011-14 seek health professional assistance: An opportunity for physical therapists.

PURPOSE: Functional limitations are associated with decreased physical activity and increased body mass index. The purpose of this study was to assess the prevalence of functional limitations among adults who reported receiving health professional advice to exercise more or lose weight, and to assess involvement of health professionals, including physical therapists, in weight loss efforts with these individuals. DESIGN: A cross-sectional analysis of U.S. adults from the 2011 to 2014 National Health and Nutrition Examination Survey (n = 5,480). METHODS: Participant demographics, health history, and functional limitations were assessed via self-report and examination. Frequency distributions were calculated using SAS® analytical software, accounting for the complex survey design. Population estimates were calculated using the American Community Survey. RESULTS: 31.0% of individuals (n = 1,696), representing a population estimate of 35 million adults, advised to exercise more or lose weight by a health professional reported one or more functional limitation. Of the 31%, 57.6% attempted weight loss, and 40.1% used exercise for weight loss. Few sought health professional assistance. Physical therapists were not mentioned. CONCLUSIONS: Few individuals with functional limitations advised to lose weight or increase exercise seek health professional assistance for weight loss. Physical therapists have an opportunity to assist those with functional limitations with exercise prescription.

Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study.

BACKGROUND: Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. OBJECTIVE: This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. METHODS: The project has two processes-a secondary data analysis and primary data collection-which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the "honest broker" system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. RESULTS: To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. CONCLUSIONS: This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/10337.

Utility of FMS to understand injury incidence in sports: current perspectives.

The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen.

Exploration of Functional Limitation Codes for Outpatient Physical Therapy in the Medicare Population: A Retrospective Cohort Study.

Background: The Centers for Medicare & Medicaid Services (CMS) introduced functional limitation reporting (FLR) to capture patient progress in functional status in outpatient rehabilitation settings. FLR along with the severity modifier (SM) measure the effectiveness of the rehabilitation services at the physical therapist evaluation (initial examination [IE]) after 10 days of therapy and at discharge. Objective: The objective of this study was to explore the completeness of FLR codes and describe changes in SMs at scheduled checkpoints for patients receiving outpatient physical therapy. Design: The design was a retrospective cohort descriptive study. Methods: A 5% random sample of 2014 Part B fee-for-service Medicare claims for outpatient physical therapy was used. FLR codes with SMs were analyzed at required periods. The number of claims with FLR codes and SMs was calculated to describe the completeness for each period. Planned changes in SMs at the physical therapist IE (current status and projected goal status) and differences in SMs from the physical therapist IE (current status) to discharge (discharge status) were calculated. Results: For 114,588 beneficiaries, 166,572 physical therapist IE and 130,117 discharge claims were analyzed. Completion was greater than 90% for current status and projected goal status FLR codes at the physical therapist IE but was markedly lower for interim and discharge reporting (≤ 50% for all). More than 75% of claims had planned improvements in SMs at the physical therapist IE (projected goal status - current status), with variations by specific FLR codes. For the episodes with FLR codes at the physical therapist IE and discharge, improvements were reported in more than 2 of 3 episodes. Limitations: Limitations for these analyses include a missing discharge claim on many outpatient physical therapy episodes and potential coding errors with Medicare claims. Conclusions: Except for the physical therapist IE, FLR codes were not submitted consistent with regulations. Most physical therapy episodes showed improvements in FLR SMs from the physical therapist IE and discharge, although the low completion rate limited interpretation. Changes to the FLR program are warranted to understand whether changes in SMs correspond to changes in a patient's function.

Geographic Variability in Discharge Setting and Outpatient Postacute Physical Therapy After Total Knee Arthroplasty: A Retrospective Cohort Study.

Background: Despite the frequency of total knee arthroplasty (TKA) in the Medicare population, little is known about the use of postacute physical therapy among those discharged to home. Objective: The objectives of this study were to explore factors associated with geographic variability in discharge disposition and outpatient physical therapy utilization for Medicare patients after TKA discharged to home/self-care. Design: The design of the study was a retrospective cohort study. Methods: Medicare patients with TKA discharged alive from July 1, 2010, to June 30, 2011, with discharge disposition to home/self-care (HSC), home health agency (HHA), inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF) were selected. Geography was measured with Census region. Outpatient physical therapy utilization was calculated from Medicare Part B claims. Odds ratios for discharge disposition and adjusted means for physical therapy utilization variables by Census region were calculated, accounting for county-clustered data and adjusting for demographics, clinical, and environmental characteristics. Results: There was significant variation with discharge destination by Census region among 18,278 patients. With discharge disposition analysis, the patients from the West region who were discharged home were the referent group. The patients from the South and Northeast regions had higher odds for discharge to HHAs (adjusted odds ratio [95% CI = 1.80 [1.48-2.19] and 2.20 [1.70-2.84]), SNFs (1.34 [1.08-1.66] and 4.42 [3.38-5.79]), and IRFs (2.36 [1.80-3.09] and 8.83 [6.41-12.18]). For those discharged to HSC, 40.4% received outpatient physical therapy within 4 weeks. Significant differences were found with time to first physical therapy visit (Midwest

A Physical Education Intervention Effects on Correlates of Physical Activity and Motivation.

PURPOSE: The purpose of this study was to measure effects of a modified physical education (PE) unit on leisure time physical activity (LTPA), relative autonomy, and known correlates of LTPA in seventh-grade boys and girls. METHOD: A seventh-grade mountain biking unit was modified to include instructional activities targeting known correlates of PA behavior following principles of Physical Education Dedicated to Physical Activity for Life (PEDAL). A three-group design (intervention, standard PE, no PE) was employed. Participants completed a survey at baseline, postintervention, and follow-up at 4 weeks. RESULTS: A total of 300 seventh graders (girls = 151) from two schools completed the surveys. Data suggest PE may influence certain correlates of and autonomous motivation for PA although results revealed no intervention main effects for continuous and noncontinuous dependent variables. Results also provide evidence of sport-specific skill being improved through physical education. CONCLUSION: While results of this study showed no main effects from the intervention, data suggest PE may influence certain correlates of and autonomous motivation for PA. This warrants attention toward autonomy supporting PE environments and instruction sensitive to autonomous motivation. Future studies should examine PEDAL-designed PE programs over an entire year or more.