The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial.

OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.

NICUs in the US: levels of acuity, number of beds, and relationships to population factors.

OBJECTIVE: To 1) define the number and characteristics of NICUs in the United States (US) and 2) identify hospital and population characteristics related to US NICUs. STUDY DESIGN: Cohort study of US NICUs. RESULTS: There were 1424 NICUs identified in the US. Higher number of NICU beds was positively associated with higher NICU level (p < 0.0001). Higher acuity level and number of NICU beds related to being in a children's hospital (p < 0.0001;p < 0.0001), part of an academic center (p = 0.006;p = 0.001), and in a state with Certificate of Need legislation (p = 0.023;p = 0.046). Higher acuity level related to higher population density (p < 0.0001), and higher number of beds related to increasing proportions of minorities in the population up until 50% minorities. There was also significant variation in NICU level by region. CONCLUSIONS: This study contributes new knowledge by describing an updated registry of NICUs in the US in 2021 that can be used for comparisons and benchmarking.

Lipid-engineered nanotherapeutics for cancer management.

Cancer causes significant mortality and morbidity worldwide, but existing pharmacological treatments are greatly limited by the inherent heterogeneity of cancer as a disease, as well as the unsatisfactory efficacy and specificity of therapeutic drugs. Biopharmaceutical barriers such as low permeability and poor water solubility, along with the absence of active targeting capabilities, often result in suboptimal clinical results. The difficulty of successfully reaching and destroying tumor cells is also often compounded with undesirable impacts on healthy tissue, including off-target effects and high toxicity, which further impair the ability to effectively manage the disease and optimize patient outcomes. However, in the last few decades, the development of nanotherapeutics has allowed for the use of rational design in order to maximize therapeutic success. Advances in the fabrication of nano-sized delivery systems, coupled with a variety of surface engineering strategies to promote customization, have resulted in promising approaches for targeted, site-specific drug delivery with fewer unwanted effects and better therapeutic efficacy. These nano systems have been able to overcome some of the challenges of conventional drug delivery related to pharmacokinetics, biodistribution, and target specificity. In particular, lipid-based nanosystems have been extensively explored due to their high biocompatibility, versatility, and adaptability. Lipid-based approaches to cancer treatment are varied and diverse, including liposomal therapeutics, lipidic nanoemulsions, solid lipid nanoparticles, nanostructured lipidic carriers, lipid-polymer nanohybrids, and supramolecular nanolipidic structures. This review aims to provide an overview of the use of diverse formulations of lipid-engineered nanotherapeutics for cancer and current challenges in the field, as researchers attempt to successfully translate these approaches from bench to clinic.

Development and validation of the Self-Management Assessment for the Residuum and prosThesis system designed for persons with limb loss (SMART).

OBJECTIVE: To develop a system of reliable and valid knowledge assessments of self-management in persons with lower limb loss, along with the accompanying targeted educational interventions (TEIs), known as the Self-Management Assessment for the Residuum and prosThesis (SMART) system. DESIGN: This 2-phase study used mixed methodology. Phase 1 was development, face validation, and content validation of the 60-item knowledge assessment measure (SMART 60) and the TEI. Phase 2 assessed internal consistency reliability using Kuder-Richardson Formula 20 and the creation of the SMART system, consisting of modules developed from the SMART 60. Validity of the measures using known groups' comparison was analyzed by comparing clinicians (prosthetists and physical therapists) with persons with lower limb loss. Participants were recruited from the Amputee Coalition National Conference in 2018 and 2019. RESULTS: A total of 140 participants completed this study. Four modules from the SMART 60 were created and designed to integrate as a system. Face validity survey average scores found that 9/10 participants either agreed or strongly agreed that the SMART system has high readability, perceived usefulness, and value for both new and experienced prosthetic users. Measure length ranged from 10 to 45 items with a reliability ranging from Kuder-Richardson Formula 20 = 0.70-0.82. The SMART system demonstrated known-groups validity ( p < 0.05). CONCLUSION: The SMART system is an integrated series of self-management knowledge assessments with reasonable to good internal consistency reliability and known-groups validity. The TEIs provide directed solutions to identified knowledge gaps on the assessments.

The experience of self-managing from the perspective of persons with lower limb loss, prosthetists, and physical therapists.

PURPOSE: Persons with lower limb loss (PwLLL) must self-manage their residual limb and their prosthesis to prevent self-management related complications (SMRC). However, the experience of PwLLL as it relates to self-management has not been reported. Thus, the purpose of this study was to explore the experience of self-management from the perspective of PwLLL, prosthetists, and physical therapists. METHODS: This study had a qualitative design. Twenty-three participants were interviewed (PwLLL = 10, prosthetists = 7, physical therapists = 6). Interviews were transcribed and then coded using constant comparison. RESULTS: Four prominent themes were developed from the transcripts: (1) embodying the duty of self-management, (2) being a vigilant self-advocate, (3) setting goals collaboratively, and (4) making informed decisions. Each of the four themes were influenced by the health beliefs of the PwLLL, specifically motivation and presence of an internal locus of control. CONCLUSION: Clinicians should emphasize the therapeutic relationship, including open communication, collaborative goal setting, and promoting an internal locus of control in interactions with PwLLL, as it may play a role in decreasing SMRC and improving clinical outcomes.Implications for rehabilitationSelf-management is a crucial aspect of preventing secondary complications associated with limb loss and prosthesis use.Self-management requires an internal locus of control, problem-solving abilities, and foundational knowledgeClinicians can promote self-management through collaborative goal setting and systematic education.

Mentoring for INnovative Design Solutions (MINDS): Key Design Considerations and Collaborative Teamwork across Universities for Clinical Translation.

The main purpose of this paper is to share the Mentoring for INnovative Design Solutions (MINDS) Scholars Program developed by Alpha Eta Mu Beta, the International Biomedical Engineering Honor Society. The program's goals are to (1) introduce biomedical engineering students to an open-ended design experience as part of interuniversity teams with industry and faculty mentors, and (2) develop the ability to create designs considering clinical translatability on teams with different backgrounds and areas of expertise. MINDS uses an experiential learning approach to (1) enrich student curricular experiences through inter-institutional collaboration, (2) build engineering design skills, including three key design considerations for clinical/commercial success: intellectual property protection, regulatory strategy, and market identification; and (3) emphasize the importance of end-user considerations. From 2015 to 2022, MINDS has involved 131 students from 50 universities and 22 faculty and industry mentors. Pre- and post-program surveys show statistically significant improvements in understanding of the design process, regulatory strategy, intellectual property protection, market definition, and key product requirements and features. Students also improved communication and teamwork skills. Many students indicated that MINDS participation made them more likely to choose careers that involve product development and/or entrepreneurship. Students attained a working ability to integrate market needs, regulatory strategy, and intellectual property considerations into the design process. They also further developed soft skills, such as conflict resolution, time management, and effective communication through the challenges of inter-institutional collaboration. Additionally, the program heightened their awareness of how biomedical devices and technologies can benefit society.

The Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score used as a Patient-Reported Outcome Measure for the Youth and High School Aged Baseball Athlete.

Background: The Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC) provides questions for the overhead athlete that can aid with determining if someone is throwing with or without pain. However, this scale was initially created for the adult baseball athlete and has not been validated for younger male demographics. Hypothesis/Purpose: To (1) determine if the scores on the KJOC are different between those throwing with and without pain in male youth and high school-aged baseball athletes, and (2) establish a prediction score for whether a young baseball athlete is throwing with symptoms. Methods: The KJOC questionnaire was used to compare scores in male baseball players between the ages of 10 through 18. This questionnaire consists of 10 questions that each contain a 10-point visual analogue scale (VAS). When all questions are added together the highest possible score is 100 points, with a higher score equating to a better outcome of throwing without symptoms. Retrospective data from 28 subjects with throwing arm pain were compared to 28 prospective subjects actively participating in baseball with no pain. A Mann Whitney-U test was used to compare the mean scores, and regression analysis was used to establish a threshold score between those throwing with and without pain. Results: Significant differences were found between the groups (U = 698.5, p < .001) with capability to discriminate those throwing with pain versus those throwing without pain (Area Under Curve (AUC) .891). Results indicate this discriminating threshold score to be at 68.6 points, which signifies anyone scoring above this threshold would be throwing with no pain and a score below this number indicating throwing with pain. Conclusion: The KJOC can differentiate between younger baseball athletes throwing with and without pain. The predictive threshold score can be used in a clinical setting to aid with determining if a youth or high school-aged athlete is suffering from pain while participating in overhead throwing, and to guide rehabilitation management. Level of Evidence: Level III.

Professional development and lifelong learning: the impact of physical therapy residency training in Kenya.

Introduction: To assist with the professional development of physical therapists in Kenya, a post-graduate residency program was developed and implemented in the country.Purpose: The purpose of this study was to explore the influence of residency training on the professional development of physical therapists.Methods: The influence of the program on professional development of residents was explored through a mixed-methods research design, including a survey and semi-structured interviews with residents at program completion.Results: The graduates reported a positive impact of residency education on their ability to perform a comprehensive evaluation, utilize clinical reasoning, provide an effective treatment to achieve projected outcomes, treat complex patients, communicate with patients and other health professionals, perform overall patient management, and implement a treatment plan based on scientific literature. Four themes emerged from the interviews: 1) evolution of practice from protocol-driven to individualized treatment plans; 2) promotion of professional development within the wider physical therapy community; 3) positive change in physical therapy practice; and 4) commitment to lifelong learning.Conclusion: The residents expressed how their new knowledge and skills fostered their commitment to providing mentorship to colleagues and lifelong learning. This commitment can provide the framework for advancing the practice of physical therapy in their respective communities.

Knee Strength and Ankle Range of Motion Impacts on Timed Function Tests in Duchenne Muscular Dystrophy: In the Era of Glucocorticoids.

BACKGROUND: Duchenne Muscular Dystrophy (DMD) is a neuromuscular disorder that presents in childhood and is characterized by slowly progressive proximal weakness and lower extremity contractures that limit ambulatory ability [1, 2]. Contractures develop in the ankles, knees, and hips due to muscle imbalances, fibrotic changes, loss of strength, and static positioning [2, 5]. Currently, standards of care guidelines emphasize the importance of maintaining good musculoskeletal alignment through stretching, bracing, and glucocorticoid (GC) therapy to preserve strength and function. METHODS: This is a retrospective analysis of prospectively collected data through the CINRG Duchenne Natural history study (DNHS). The objectives of this analysis are to understand the progression of ankle contractures for individuals with DMD and to investigate the relationship between progressive lower limb contractures, knee strength, and Timed Function Tests.A collection of TFTs including supine to stand (STS), 10 meter walk test (10MWT), and timed stair climbing (4SC) have been used to monitor disease progression and are predictive of loss of ambulation in these patients [4]. Multiple factors contribute to loss of ambulation, including progressive loss of strength and contracture development that leads to changing biomechanical demands for ambulation. A better understanding of the changes in strength and range of motion (ROM) that contribute to loss of function is important in a more individualized rehabilitation management plan. In this longitudinal study, we measured strength using quantitative muscle testing (QMT) with the CINRG Quantitative Measurement System (CQMS)), ROM was measuresed with a goniometer and TFTs were measured using a standard stopwatch and methodology. RESULTS: We enrolled 440 participants; mean baseline age was 8.9 (2.1, 28.0) years with 1321 observations used for analysis. GC use was stratified based on duration on drug with 18.7%at < 6 months or naïve; 4.3%<1 year; 58.0%1 < 10 years; and 19.3%between 10-25 years of GC use. Ankle ROM was better for those on GC compared to GC naive but did not significantly influence long-term progression rates. QMT, ROM, age and GCs contribute to speed of TFTs. Knee extension (KE) strength and Dorsiflexion (DF) ROM are significant predictors of speed for all TFTs (p < 0.001). Of the variables used in this analysis, KE strength is the primary predictor of walking speed, estimating that every pound increase in KE results in a 0.042 m/s improvement in 10MWT, and a smaller similar increase of 0.009 m/s with every degree of ankle DF ROM. CONCLUSION: GC use provides an improvement in strength and ROM but does not affect rate of change. Knee strength has a greater influence on speed of TFTs than DF ROM, although both are statistically significant predictors of speed. Results show that retaining knee strength [1, 2], along with joint flexibility, may be important factors in the ability to perform walking, climbing and supine to stand activities.

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors.

OBJECTIVES: This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors. STUDY DESIGN: This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States. RESULTS: We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circumstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT). CONCLUSION: Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families. KEY POINTS: · We estimated that there are 4,232 neonatal therapists working in NICUs in the United States.. · Dedicated therapy teams for the NICU are more common in large, high acuity NICUs.. · An average of 17 beds per neonatal therapy FTE was observed.. · In 2020, 22% of NICUs had CNTs, and CNTs were more common in large and high acuity NICUs.. · Benchmarking neonatal therapy staffing can aid in expanding NICU therapy services where needed..

Nanomaterials to target immunity.

Critical advances have recently been made in the field of immunotherapy, contributing to an improved understanding of how to harness and balance the power of immune responses in the treatment of diseases such as cancer, cardiovascular disease, infectious diseases, and autoimmune diseases. Combining nanomedicine with immunotherapy provides the opportunity for customization, rational design, and targeting to minimize side effects and maximize efficacy. This review highlights current developments in the design and utilization of nano-based immunotherapy systems, including how rationally-designed nanosystems can target and modify immune cells to modulate immune responses in a therapeutic manner. We discuss the following topics: targeted immuno-engineered nanoformulations, commercial formulations, clinical applicability, challenges associated with current approaches, and future directions.

The Minimal Clinical Important Difference (MCID) in Annual Rate of Change of Timed Function Tests in Boys with DMD.

BACKGROUND: Duchenne muscular dystrophy (DMD) is a rare x-linked recessive genetic disorder affecting 1 in every 5000-10000 [1, 2]. This disease leads to a variable but progressive sequential pattern of muscle weakness that eventually causes loss of important functional milestones such as the ability to walk. With promising drugs in development to ameliorate the effects of muscle weakness, these treatments must be associated with a clinically meaningful functional change. OBJECTIVE: The objective of this analysis is to determine both distribution, minimal detectable change (MDC), and anchor-based, minimal clinically important difference, (MCID) of 12 month change values in standardized time function tests (TFT) used to monitor disease progression in DMD. METHOD: This is a retrospective analysis of prospectively collected data from a multi-center prospective natural history study with the Cooperative International Neuromuscular Research Group (CINRG). This study calculated MDC and MCID values for 3 commonly used timed function tests typically used to monitor disease progression; supine to stand (STS), 10 meter walk/run (10MWT), and 4 stair climb (4SC). MDC used standard error of measurement (SEM) while MCID measurements used the Vignos scale as an anchor to determine clinical change in functional status. RESULTS: All 3 TFT were significantly important clinical endpoints to detect MDC and MCID changes. MDC and MCID 12 month changes were significant in 10MWT (-0.138, -0.212), Supine to Stand (-0.026, -0.023) and 4 stair climb (-0.034, -0.035) with an effect size greater or close to 0.2. CONCLUSION: The 3 TFT are clinically meaningful endpoints used to establish change in DMD. MCID values were higher than MDC values indicating that an anchor-based approach using Vignos as a clinically meaningful loss of lower extremity abilities is appropriate to assess change in boys with DMD.

Effect of a Psychologically Informed Intervention to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial.

OBJECTIVE: To determine whether the addition of a brief psychologically informed video to traditional physical therapy influenced function (primary aim), pain, and psychological beliefs (secondary aims) among adolescents with patellofemoral pain (PFP). DESIGN: Double-blind randomized controlled trial. SETTING: Outpatient physical therapy clinics of a single pediatric hospital. PARTICIPANTS: Sixty-six adolescents with PFP (14.8±1.7 years old, 65% female). INTERVENTION: Adolescents were randomly assigned to view a brief psychologically informed video (n=34) or control video (n=32). The psychologically informed video targeted pain-related fear and pain catastrophizing, and the control video related basic anatomy and factors involved in PFP. MAIN OUTCOME MEASURES: The primary outcome was change in function (Anterior Knee Pain Scale). Secondary outcomes were change in psychological beliefs (fear-avoidance beliefs, kinesiophobia, pain catastrophizing) and pain. Outcomes were assessed at baseline, immediately post intervention, at 2 weeks, at 6 weeks, and at 3 months. RESULTS: Using a 2-way mixed analysis of variance, change in function in the intervention group was greater than the control group, with a moderate treatment effect noted (P=.001, partial η2=0.1). Post hoc testing revealed that there was a significant interaction between the intervention and time from baseline to 2 weeks, but no interaction was noted between 2 weeks and 3 months. The psychologically informed video significantly reduced maladaptive psychological beliefs (P=.01, η2=0.32). No significant between-group differences in pain were noted. CONCLUSIONS: Incorporating a brief one-time psychologically informed video into standard physical therapy care significantly reduced pain-related fear, reduced pain catastrophizing, and improved function among adolescents with PFP. The immediate effect noted on function did not continue throughout the course of care.

Reliability and Concurrent Validity of Shoulder Tissue Irritability Classification.

OBJECTIVE: Rating tissue irritability has been recommended to aid decision making in several recent clinical practice guidelines. An explicit method for rating tissue irritability was proposed as part of the Staged Algorithm for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder), but the reliability and validity of this classification are unknown. The purpose of this study was to examine the reliability and concurrent validity of shoulder tissue irritability ratings as part of a system designed to guide appropriate treatment strategy and intensity. METHODS: A clinical measurement, prospective repeated-measures cross-sectional design was used. The 101 consecutive participants with primary complaints of shoulder pain were assessed by pairs of blinded raters (24 raters in total) and rated for tissue irritability. Patients completed 3 patient-reported outcome (PRO) measures reflecting both pain and disability, and these scores were compared with ratings of tissue irritability. Paired ratings of irritability were analyzed for reliability with prevalence-adjusted, bias-adjusted Kappa for ordinal scales. Analysis of variance was used to compare PRO measures across different levels of irritability. Receiver operating characteristic curve analysis was utilized to derive cut-off scores for 3 PRO instruments. RESULTS: Interrater reliability was 0.69 (95% CI = 0.59-0.78), with 67% agreement. All PRO measures were significantly different among 3 levels of tissue irritability. CONCLUSION: There appears to be acceptable reliability and a strong relationship between PRO measures and therapist-rated tissue irritability, supporting the use of the STAR-Shoulder irritability rating system. IMPACT: Several clinical practice guidelines have recommended that clinicians rate tissue irritability as part of their examination. This study provides important new information supporting the reliability and validity of the STAR-Shoulder tissue irritability rating system.

Adolescent psychological beliefs, but not parent beliefs, associated with pain and function in adolescents with patellofemoral pain.

OBJECTIVES: The purpose of this study was to assess the association of adolescent and parent psychological beliefs with 1) self-reported functional ability, 2) pain and 3) objective measures of function. STUDY DESIGN: Cross-sectional study. SETTING: Pediatric Outpatient Hospital. PARTICIPANTS: Eighty-six adolescents with patellofemoral pain (PFP) (14.6 ± 1.7 years old, 62% female) and 72 parents. MAIN OUTCOME MEASURES: Patient questionnaires were used to describe pain, knee function, fear avoidance (Fear Avoidance Beliefs Questionnaire-Physical Activity; FABQ-PA), kinesiophobia (Tampa Scale for Kinesiophobia-11; TSK-11), and pain catastrophizing (Pain Catastrophizing Scale; PCS) in adolescents with PFP. Parents (n = 72) completed FABQ-PA, TSK-11, and PCS questionnaires. Hip and knee strength, quadriceps and dorsiflexion motion, the single-leg hop for distance and lateral-step down test measured physical performance. RESULTS: Adolescent psychological beliefs were significantly associated with pain (FABQ-PA r = 0.33, and PCS r = 0.34), function (FABQ-PA r = -0.59,TSK-11 r = -0.33), hip strength (FABQ-PA r = -0.41, TSK-11 r = -0.32), and single leg hop for distance (FABQ-PA r = -0.38). Parent psychological beliefs were not associated with the adolescent's beliefs, pain or function. CONCLUSIONS: Adolescent, but not parent, psychological beliefs were associated with pain, self-reported function and objective measures of function.

Rasch analysis of the anterior knee pain scale in adolescents with patellofemoral pain.

OBJECTIVE: The aim of this study was to evaluate the Anterior Knee Pain Scale in a cohort of adolescents being treated conservatively for patellofemoral pain using Rasch analysis. DESIGN: This is a psychometric study. SETTING: Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States). SUBJECTS: A total of 646 adolescent patients with patellofemoral pain (76% female, 14.6 ± 1.6 years old). INTERVENTION: Not applicable. MAIN MEASURE: The Anterior Knee Pain Scale. RESULTS: The median Anterior Knee Pain Scale score was 73 (interquartile range 64-81), with scores ranging from 7 to 100 on the 100-point scale. The Rasch person reliability for the Anterior Knee Pain Scale was 0.74 and the Cronbach's alpha was 0.75, representing an acceptable person reliability. Principal component analysis revealed a ratio of 5.2:1 demonstrating acceptable unidimensionality of the Anterior Knee Pain Scale. A significant misfit was observed in the item "Abnormal Painful Kneecap Movements" (Outfit Means Square 2.74, Infit Means Square 1.41). Ordering of item responses was unsatisfactory as only five of the 13 items demonstrated appropriate distinction between each of the responses. There was no differential item functioning for sex or age for all items of the Anterior Knee Pain Scale, based upon the criterion of ⩾ 0.5 logit difference. CONCLUSION: The Anterior Knee Pain Scale does not meet interval-level measurement criteria and should be considered ordinal level data.

THE EFFECT OF HUMERAL RETROTORSION ON PITCH VELOCITY IN YOUTH BASEBALL PLAYERS.

BACKGROUND: Pitching velocity is a critical measure of performance, but it may also play a role in the development of injury. It has been proposed that increased humeral retrotorsion (HRT) may be an advantageous adaptation among throwers, resulting in increased throwing velocity. However, there is limited published data directly investigating this relationship. PURPOSE / HYPOTHESIS: The purpose of this study was to examine the effects of HRT on pitching velocity in a group of youth baseball players. We hypothesized that there would be a positive association between pitching velocity and increased humeral retrotorsion. STUDY DESIGN: Cross-sectional cohort study. METHODS: Demographic and physical variables that may correlate to pitching velocity (age, height, weight, glenohumeral external rotation (ER) range of motion, dominant arm humeral retrotorsion and shoulder internal rotation (IR) strength) were assessed. Univariate analysis using Pearson correlation coefficients examined the relationship of each variable to pitching velocity. Significant variables were retained and entered into a multivariable regression analysis. RESULTS: All variables significantly correlated with pitching velocity (p<0.05) with the exception of ER (r = -0.169,p = 0.145). Multivariable regression model was significant and accounted for 81.7% of pitching velocity (R2 = 0.817 F(5,70) = 62.59,p<0.001). Player age (B = 1.7,p < 0.001), height (B = 0.225,p = 0.001) and shoulder IR strength (B = 0.622, p < 0.001) significantly contributed to the model. After accounting for all other variables, HRT had a non-significant (B = 0.005,p = 0.884) and very small contribution to pitching velocity adding only .005mph per degree of HRT. CONCLUSIONS: Pitching velocity in youth baseball players is strongly influenced by age, height and IR strength. In opposition to the hypothesis, the degree of humeral retrotorsion did not have a significant effect on pitching velocity. LEVEL OF EVIDENCE: Level 3.

Psychologically-informed video reduces maladaptive beliefs in adolescents with patellofemoral pain.

OBJECTIVES: To test the hypothesis that a brief psychologically-informed video can reduce maladaptive psychological beliefs in adolescents with patellofemoral pain. DESIGN: Case series. SETTING: Pediatric Outpatient Hospital. PARTICIPANTS: Twenty adolescents receiving physical therapy for patellofemoral pain (14 ±â€¯1.7 years, 50% female), 3 participants were lost to follow-up at 2 weeks. MAIN OUTCOME MEASURES: None. RESULTS: The baseline FABA-PA score was 12.0 ±â€¯5, TSK-11 was 22.1 ±â€¯4.0 and the PCS-c was 14.3 ±â€¯8. Immediate reductions in FABQ-PA (mean difference = 4.52, 95% CI 1.99, 7.07; 32% reduction), TSK-11 (mean difference = 5.06, 95% CI 1.88, 8.24; 22% reduction) and PCS-c (mean difference = 3.65, 95% CI 0.62, 6.68; 26% reduction) were observed immediately post-video intervention (p < 0.01). At 2 weeks, these maladaptive beliefs remained lowered. CONCLUSIONS: This study provides preliminary evidence that incorporating a brief one-time psychologically-informed video into standard physical therapy care may significantly reduce maladaptive psychological beliefs in adolescents with patellofemoral pain.