Periacetabular osteotomy: an analysis of social media to determine the most common questions asked by the periacetabular osteotomy population.

BACKGROUND: The Bernese Periacetabular Osteotomy (PAO) has become a popular surgery for fixing development dysplasia of the hip, yet the most common concerns of the PAO population remains ambiguous. The aim of this study was to investigate Facebook, Instagram and Twitter to further understand what the most common preoperative and postoperative questions patients undergoing PAO are asking. We hypothesized most questions would be asked by patients in the preoperative timeframe with regards to education surrounding PAO surgery. METHODS: Facebook, Instagram and Twitter were queried consecutively from February 1, 2023 to November 23, 2011. Facebook was searched for the two most populated interest groups; "Periacetabular Osteotomy (PAO)" and "Periacetabular Osteotomy Australia". Instagram and Twitter were queried for the most popular hashtags: "#PAOwarrior", "#PAOsurgery", "#periacetabularosteotomy", "#periacetabularosteotomyrecovery", and "#paorecovery". Patient questions were categorized according to preoperative and postoperative questions. Questions were further placed into specific themes in their respective preoperative or postoperative question types. RESULTS: Two thousand five hundred and fifty-nine posts were collected, with 849 (33%) posts containing 966 questions. Of the 966 questions, 443 (45.9%) and 523 (54.1%) were preoperative and postoperative questions, respectively. The majority of questions were postoperative complication related (23%) and symptom management (21%). Other postoperative questions included recovery/rehabilitation (21%), and general postoperative questions (18%). The most common preoperative questions were related to PAO education (23%). Rehabilitation (19%), hip dysplasia education (17%), and surgeon selection (12%) were other preoperative questions topics included. Most questions came from Facebook posts. Of 1,054 Facebook posts, 76% were either preoperative or postoperative questions and from the perspective of the patient (87%). CONCLUSION: The majority of patients in the PAO population sought advice on postoperative complications and symptom management. Some patients asked about education surrounding PAO surgery. Understanding the most common concerns and questions patients have can help providers educate patients and focus on more patient-relevant perioperative conversations.

Perceived outcomes of periacetabular osteotomy.

Aims: Social media is a popular resource for patients seeking medical information and sharing experiences. periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic acetabular dysplasia with good long-term outcomes. However, little is known regarding the perceived outcomes of PAO on social media. The aims of this study were to describe the perceived outcomes following PAO using three social media platforms: Facebook, Instagram, and X (formerly known as Twitter). Methods: Facebook, Instagram, and X posts were retrospectively collected from 1 February 2023. Facebook posts were collected from the two most populated interest groups: "periacetabular osteotomy" and "PAO Australia." Instagram and X posts were queried using the most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomyrecovery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data (sex, race, location), perspective (patient, physician, professional organization, industry), timing (preoperative vs postoperative), and perceived outcome (positive, negative, neutral). Results: A total of 1,054 Facebook posts, 1,003 Instagram posts, and 502 X posts were consecutively assessed from 887 unique authors. The majority (63.3%) of these posts were from patients in the postoperative period, with a median of 84 days postoperatively (interquartile range 20 to 275). The longest follow-up timeframe postoperatively was 20 years. Regarding perceived outcomes, 52.8% expressed satisfaction, 39.7% held neutral opinions, and 7.5% were dissatisfied. Most dissatisfied patients (50.9%) reported pain (chronic or uncontrolled acute) as an attributing factor. Conclusion: Most PAO-perceived surgical outcomes on social media had a positive tone. Findings also indicate that a small percentage of patients reported negative perceived outcomes. However, dissatisfaction with PAO primarily stemmed from postoperative pain. Social media posts from other sources (physicians, hospitals, professional organizations, etc.) trend towards neutrality. Healthcare providers must consider the social media narratives of patients following PAO, as they may reveal additional outcome expectations and help improve patient-centred care, create informed decision-making, and optimize treatment outcomes.

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip.

BACKGROUND: Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. METHODS: This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman's rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1-0.3), moderate (r = ± 0.3-0.5) and strong (r > ± 0.5). RESULTS: Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. CONCLUSION: Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

Influences of Financial and Workplace Factors on Physical Therapist Job Satisfaction.

OBJECTIVE: The physical therapist labor market has recently noted higher rates of turnover and job vacancies. An understudied factor contributing to these trends in the profession is job satisfaction. The profession continues to experience relatively low wages compared with other health professions, and graduates of Doctor of Physical Therapy programs face increasingly high student debt. This study used the labor-search model as a conceptual framework to understand associations between job satisfaction, income, and educational debt. The purpose of this study is to observe the financial and workplace factors that are associated with higher levels of physical therapist job satisfaction. METHODS: Data from 4764 physical therapists in 1 state were captured retrospectively through the state's licensure renewal process from 2014 to 2020. A random effects panel analysis, with job satisfaction as the dependent variable, was used to evaluate the relationships between job satisfaction and income, educational debt, and a variety of work-related factors. RESULTS: Job satisfaction was negatively correlated with educational debt, number of hours worked per week, and some practice settings. Conversely, job satisfaction was positively correlated with the expected age of retirement. The percentage of time spent in research and administration was also positively correlated with job satisfaction, though additional research in this area is needed to draw meaningful conclusions on this association. CONCLUSION: The results support the conceptual framework, which suggests that early career physical therapists, motivated by high amounts of educational debt, may choose more financially advantageous practice settings and increased working hours to the detriment of job satisfaction. IMPACT: High levels of job satisfaction among physical therapists are correlated with low levels of educational debt, working 45 hours or less per week, a longer time horizon until retirement, and practice settings other than home health and skilled nursing facilities.

Impacts of educational debt on physical therapist employment trends.

BACKGROUND: Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model. METHODS: Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt. RESULTS: Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt. CONCLUSIONS: Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.

The Relationship Between Pelvic Tilt and Clinical Outcomes After Hip Preservation Surgery in Femoroacetabular Impingement Syndrome and Hip Dysplasia.

Pelvic tilt is thought to be a compensatory mechanism in hip pathology, specifically in patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. This study investigated the relationship between preoperative pelvic tilt and postoperative outcomes in patients undergoing hip preservation surgery for FAIS or hip dysplasia. We reviewed a prospective hip preservation database for demographic, radiographic, and outcome data for 89 patients who underwent hip preservation surgery with a primary diagnosis of FAIS or dysplasia from 2016 to 2020. Pelvic tilt was assessed on the standing anteroposterior radiograph with the pubic symphysis to sacroiliac joint (PS-SI) distance measurement. The International Hip Outcome Tool 12 (iHOT-12), Hip Outcome Score, Harris Hip Score, UCLA activity score, and European Quality of Life-Visual Analog Scale were used to assess hip function and pain preoperatively and postoperatively. The mean pelvic tilt (PS-SI distance) was 86.4±18.3 mm for the FAIS group and 96.2±15.1 mm for the dysplasia group. The statistical analysis demonstrated a positive relationship between pelvic tilt and change in iHOT-12 score (rs=0.262, P=.019) for all 89 patients with hip pathology and, separately, a trend toward significance for the 42 patients with FAIS (rs=0.330, P=.056). No other significant relationships were observed. The improvement in iHOT-12 score was greater for patients with more anterior tilt and less for patients with posterior pelvic tilt, regardless of underlying hip etiology. These results provide intriguing insights into an initial investigation on pelvic tilt in patients undergoing hip preservation surgery. Further investigation is necessary to assess pelvic tilt preoperatively and postoperatively, spinal parameters, and longer-term outcomes. [Orthopedics. 2023;46(6):e341-e346.].

How Advancement in Bone Science Should Inform the Examination and Treatment of Femoral Shaft Bone Stress Injuries in Running Athletes.

Stress fractures likely have a 1-2% incidence in athletes in general. In runners, a more vulnerable population, incidence rates likely range between 3.2 and 21% with female runners having greater susceptibility. The incidence of femoral shaft stress fractures is less well known. New basic and translational science research may impact the way clinicians diagnose and treat femoral stress fractures. By using a fictitious case study, this paper applies bone science to suggest new approaches to evaluating and treating femoral shaft stress fractures in the running population.

The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia.

The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.

Attributes, Attitudes, and Motivations of Personnel Involved with Sports Physical Therapy Residency Training.

BACKGROUND: Post-professional residency training in sports physical therapy has undergone rapid growth since its inception over 20 years ago with 58 programs currently accredited. PURPOSE: The purpose of this survey was to describe and contrast the demographics, motivations, and selection influences from the perspective of both potential training applicants and program faculty. STUDY DESIGN: Cross-sectional descriptive survey. METHODS: 156 physical therapists identified as stakeholders in sports residency and fellowship training were invited to participate in a 115-item survey. Descriptive measures of central tendencies to describe the data and Mann Whitney Rank Sum tests were used to detect differences between the perspectives of applicants and faculty. RESULTS: 50 program faculty and 57 applicants responded to the survey for a 69% response rate. Motivations for post-professional training categorized as extremely important were largely intrinsic behavioral modifiers centering on improved knowledge, skills, and outcomes while satisfying a passion for sports specialty training and enhancing job opportunities in the field. 7 of the 10 highest rated application motivations were rated as significantly more important by applicants than faculty members (p<0.05). The two most highly rated influences for choosing to apply to a specific residency site were the perception for subsequent job opportunities and perceived relationship and qualifications with the residency director and staff. The importance of job opportunities in sports PT was rated much higher by the applicant than the faculty (p=0.003). CONCLUSIONS: While the motivations for residency training may be slightly different between groups the importance of information acquisition and methods for residency selection criteria seem more congruent. Residency faculty may underestimate the importance of some of the most important motivations that prompt interest in residency training. Recognition of these factors may alter the presentation and content design of residency curriculums.

Correlation of the Imaging Features of Femoroacetabular Impingement Syndrome With Clinical Findings and Patient Functional Scores.

The relationship among the severity of the imaging features of femoroacetabular impingement syndrome (FAIS), patient symptoms, and function has not been elucidated. Understanding this relationship helps to improve the prognostic value of imaging. The goal of this study was to examine the correlation of clinical findings, patient pain, and function with severity, as measured with radiographic and 3-dimensional magnetic resonance imaging (3D-MRI). Data collected prospectively through a longitudinally maintained hip database were reviewed, and 37 hips from 31 patients were included. All patients were examined by an experienced orthopedic surgeon, and preoperative radiographs and 3D-MRI were obtained. Preoperatively, the patients completed validated patient-reported outcome measures (PROMs). Mean±SD alpha angles were 69.4°±10.3°, 70.0°±10.3°, 70.6°±8.4°, and 74.8°±9.2° at 12 o'clock, 1 o'clock, 2 o'clock, and 3 o'clock, respectively. Mean lateral center edge angle was 30.1°±5.3°. The authors did not observe a statistically significant correlation between PROMs and the features measured by radiographs and 3D-MRI (P>.05). In this subset of prospectively imaged patients with FAIS, the authors did not find a correlation between the severity of symptoms measured by PROMs and features on radiographs and 3D-MRI. The severity of dysfunction is multifactorial, and anatomic severity, as measured radiographically and with 3D-MRI, may not correlate with symptoms. Further investigation is necessary to address the sources of patient pain. [Orthopedics. 2021;44(4):e577-e582.].

CAN PROXIMAL HIP STRENGTH AND DYNAMIC CONTROL DIFFERENTIATE FUNCTIONAL ANKLE STABILITY CLASSIFICATIONS?

BACKGROUND: Ankle instability can be problematic in an active population with multiple risk factors associated with recurrence. PURPOSE: The aim of this study was to determine if deficits in weight-bearing and non-weight bearing assessment of hip strength or dynamic balance in lower extremity reaching tasks from flat and inclined surfaces can differentiate subjects classified as controls, ankle sprain copers, or those with chronic, recurrent ankle sprains. STUDY DESIGN: Quasiexperimental, Ex post facto. METHODS: A convenience sample of 60 subjects was classified into control, coper, or chronic ankle sprain groups based on the results of the Identification of Functional Ankle Instability Questionnaire. Subjects were tested for peak force production of their hip extensors, hip abductors, and a composite of hip extension and external rotation while in a standing position using a hand-held dynamometer. Additionally, each subject performed a modified Star Excursion Balance Test in anterior, posterolateral, and posteromedial directions from both a flat and 15 ° inverted stance position. One-way analysis of variance was calculated for between group differences of hip strength and balance reach ability and ankle stability classification. Pearson product-moment correlation coefficients were derived to evaluate relationships between hip strength and dynamic balance tests. RESULTS: Twenty-one subjects were assigned to the control group, 23 to the coper group, and 16 to the chronic group. There were no significant differences between groups in self-report of Foot and Ankle Ability Measures or Tegner activity levels. Mean hip strength was not significantly different between ankle sprain classification groups (p = 0.66 - 0.82). The mean limb symmetry index for hip strength comparing injured and uninjured ankles was nearly symmetrical in all ankle stability groups (p = 0.34 - 0.97). The same symmetry was present when comparing injured and uninjured abilities for all dynamic balance reach tasks from both flat and inclined surfaces. (p = 0.16 - 0.62). There was a fair relationship between hip extension and weight-bearing hip extension/external rotation strength and the posteromedial and posterolateral reach tasks with correlation coefficients in the range of 0.33 - 0.43. CONCLUSION: Performance measures of tri-planar, static, isometric hip strength and lower extremity reach in dynamic balance tasks could not differentiate subjects without a history of injury from those subjects with one or more lateral ligamentous ankle sprains. LEVEL OF EVIDENCE: 2b; Ex post facto.

Financial Literacy Among Health Professions Graduate Students.

AIMS: The impact of student debt management on mental health, career choices, and advanced training in allied health professions is unknown. The purpose of this project was to pilot a survey that identifies students' financial literacy and self-efficacy. METHODS: A cross-sectional survey containing 43 items related to financial habits, savings knowledge, credit and borrowing strategies, and investment knowledge was administered to assess financial literacy, self-efficacy, and career plans in a group of health professions graduate students. RESULTS: 134 of 268 surveys were completed by a variety of health professions. Financial habits and credit and borrowing categories scored the highest at 50% correct. Students scored the lowest on investment knowledge with an average of 25% correct responses. The overall mean self-efficacy score was 15.5±3.8. Three independent variables had a significant correlation of determination with overall financial literacy, which included marital status, older age, and individuals who identified as white non-Hispanic. Similarly, identification as white non-Hispanic had a significant correlation of determination with financial self-efficacy, but there were no significant differences based on age or marital status. CONCLUSIONS: Allied health students demonstrated low financial literacy and self-efficacy. Health care educators should consider delivering educational content to address these deficits.

Physical Therapists' Perspectives on Lifelong Learning.

INTRODUCTION: In today's healthcare environment, it is critical that allied health professionals maintain and grow the requisite knowledge and skills that defined their competence upon entering the field. Despite a strong emphasis on the attribute of lifelong learning in the physical therapy profession, no psychometrically sound instrument has been developed to assess it. METHODS: The Jefferson Scale of Physical Therapist Lifelong Learning (JSPTLL) was adapted from the Jefferson Scale of Physician Lifelong Learning. A national survey of physical therapists was conducted using mailing lists from state licensure boards from a geographically diverse sample. RESULTS: Out of 7,654 survey invitations sent, 540 complete surveys were returned. The mean score of the JSPTLL was 55.13 (SD 7.4), ranging from 19 to 68. Commitment to lifelong learning had a large correlation to the JSPTLL score (rs=0.51, p<0.0001). A medium correlation exists between the JSPTLL and the level of career satisfaction (rs=0.32, p<0.0001). A small correlation exists between commitment to lifelong learning and levels of career satisfaction (r=0.27). CONCLUSION: The JSPTLL provides a means to objectify the aptitude and beliefs of the physical therapist lifelong learner. Applicability to other health professions can be established with further research.

Sports Physical Therapy Education in the United States: Where Do We Go from Here? A Survey of American Academy of Sports Physical Therapy Members.

BACKGROUND: The specialty of sports physical therapy has grown substantially in size and scope over the past 50 years. Despite this growth, there is limited information on the educational opportunities and entry-level skills of clinicians in the management of sports-related injuries. PURPOSE: To characterize the opinions of sports physical therapists on: 1) factors that distinguish the practice of sports physical therapy, 2) the need for sports physical therapy content to be included as part of entry-level physical therapy curriculums, and 3) the perceived levels of competence for the typical new entry-level graduate regarding skills and knowledge unique to sports physical therapy. STUDY DESIGN: Cross-sectional descriptive survey. METHODS: A 54-item web-based questionnaire was distributed to student and professional members of the American Academy of Sports Physical Therapy (AASPT). RESULTS: In total, 565 (7.4%) AASPT members responded to the survey. 60% of respondents did not have a specific sports physical therapy curricular course during their physical therapy education training. 95% felt the patient's rehabilitation goals or activity level aspirations were a primary factor that differentiated the practice of sports physical therapy from orthopedic physical therapy. 59% believed that sports physical therapy curricular education should be required content by CAPTE, and 37% believed that elements of sports physical therapy practice represent entry-level skill and knowledge. Most respondents indicated that entry-level graduates were novice in 11 of the 18 content areas identified as inherent to sports physical therapy. CONCLUSION: The survey findings suggest further work is needed to define the extent of sports physical therapy content included in professional education curricula in the United States and how to best integrate it with post-professional education. The findings provide information for educators to discuss regarding the necessity, structure, and implementation of education content needed to prepare new graduates. LEVEL OF EVIDENCE: IV, cross-sectional descriptive survey design.

Sleep quality and nocturnal pain in patients with femoroacetabular impingement and acetabular dysplasia.

BACKGROUND: Femoroacetabular impingement (FAI) syndrome and acetabular dysplasia (AD) are common pathologies that lead to pain in the young adult hip. Nocturnal pain in these patients is often reported, yet little is known regarding the effect of these hip pathologies on overall sleep quality. The purpose of this study was to evaluate sleep quality in patients with AD and FAI syndrome. METHODS: This cross-sectional study consisted of 115 patients who complained of hip pain secondary to either FAI syndrome or AD. One hundred fifteen patients with hip pain secondary to FAI syndrome and AD were assessed using the Hip Outcome Score (HOS), Modified Harris Hip Score (mHHS), and then Hip disability and Osteoarthritis Outcome Score (HOOS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression, with adaptive LASSO variable selection, was used to assess factors associated with sleep quality. RESULTS: Of the 115 patients, 62 had a diagnosis of FAI syndrome and 53 with AD. The mean age was 34.55 ± 11.66 (age range: 14 to 58 years), 76.52% had an ASA classification of 1 (ASA range: 1 to 3), and all Tonnis grades were either 0 or 1. The mean PSQI global score for all patients was 8.46 ± 4.35 (PSQI range: 0 to 21), indicating poor sleep quality. The adaptive LASSO-penalized least squares multiple linear regression revealed that HOOS Pain, SF-12 Role Emotional, and SF-12 Mental Health significantly predicted Sleep Quality (Adjusted R2 = 0.4041). Sleep quality improved as pain, emotional problems, and mental health improved. CONCLUSION: Patients with symptomatic FAI syndrome and AD have poor sleep quality. Worsening pain from a patient's hip pathology is associated with poor sleep, even prior to the onset of osteoarthrosis of the hip. Patients presenting with hip pain from FAI syndrome and AD should be screened for sleep disturbance and may benefit from a multidisciplinary treatment approach.

Sleep quality and nocturnal pain in patients with hip osteoarthritis.

Osteoarthritis (OA) is a common condition of the hip. Patients with hip OA often report nocturnal pain, yet little is known how it affects sleep quality. The purpose of this paper was to assess how hip arthritis affects sleep quality. We hypothesized that hip pain caused by hip OA affects sleep quality in adult patients.This is a prospective, cross-sectional study of patients who were diagnosed with hip OA. Patients were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), hip outcome score (HOS), and modified Harris hip score (mHHS). Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). A multiple regression model was used to assess factors associated with poor sleep quality.A total of 106 patients were analyzed. All patients had a Tonnis grade of 2 or 3 and American Society of Anesthesiologists (ASA) classification of 2. WOMAC, HOS, and mHHS were significantly and negatively correlated with PSQI. The multiple regression model, WOMAC, short form health survey vitality, ASA classification, and history of obstructive sleep apnea were associated with poor sleep quality (R = 0.60, P < .001).Patients with hip OA, who report a symptomatic hip, are susceptible to reduced sleep quality. There is a correlation between worsening HOSs and sleep quality. The WOMAC score is a significant predictor of poor sleep quality. Patients with poor hip metrics should be screened for sleep disturbance.

Sleep Quality in Patients With Rotator Cuff Disease.

BACKGROUND: Little is known about the influence of rotator cuff pathology on sleep. The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease. METHODS: A nonrandomized, cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality. Data collected at time zero (before any treatment) included the Single Assessment Numeric Evaluation rating, the American Shoulder and Elbow Surgeons score, the Pittsburgh Sleep Quality Index, patient demographics, and medical comorbidities. Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance. RESULTS: Nocturnal pain was reported by 91% of the 391 participants (274 with tendinitis and 117 with rotator cuff tears). Participants had a mean age of 57 years. Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores (0.27 and 0.31; P = 0.004 and P < 0.0001, respectively), depression (0.27 and 0.30; P < 0.01), female sex (0.24 and 0.27; P < 0.001), presence of low back pain (0.25 and 0.27; P < 0.01), diabetes mellitus (0.24 in the rotator cuff tear group; P < 0.01), and increased body mass index (0.22 and 0.27; P = 0.02). DISCUSSION: The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index. These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity. CONCLUSION: Worse sleep quality scores in patients with rotator cuff disease are associated with pain, depression, female sex, low back pain, diabetes mellitus, and high body mass index. Overall, sleep quality did not differ among patients with varying rotator cuff disease severity. Only hypertension (in patients with rotator cuff tears) and concurrent cervical pathology (in patients with tendinitis) were uniquely related to the disease classification. Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease. LEVEL OF EVIDENCE: Level III prognostic cohort study.

THE DIAGNOSTIC ACCURACY OF THE LEVER SIGN FOR DETECTING ANTERIOR CRUCIATE LIGAMENT INJURY.

BACKGROUND: An alternative physical examination procedure for evaluating the integrity of the anterior cruciate ligament (ACL) has been proposed in the literature but has not been validated in a broad population of patients with a symptomatic complaint of knee pain for its diagnostic value. PURPOSE: To investigate the diagnostic accuracy of the Lever Sign to detect ACL tears and compare the results to Lachman testing in both supine and prone positions. STUDY DESIGN: Prospective, blinded, diagnostic accuracy study. METHODS: Sixty-two consecutive patients with a complaint of knee pain were independently evaluated for the status of the ACL's integrity with the Lever Sign and the Lachman test in a prone and supine by a blinded examiner before any other diagnostic assessments were completed. RESULTS: Twenty-four of the 60 patients included in the analysis had a torn ACL resulting in a prevalence of 40%. The sensitivity of the Lever Sign, prone, and supine Lachman tests were 38, 83, and 67 % respectively and the specificity was 72, 89, and 97% resulting in positive likelihood ratios of 1.4, 7.5, and 24 and negative likelihood ratios of 0.86, 0.19, and 0.34 respectively. The positive predictive values were 47, 83, and 94% and the negative predictive values were 63, 89, and 81% respectively. The diagnostic odds ratios were 1.6, 40, and 70 with a number needed to diagnose of 10.3, 1.4, and 1.6 respectively. CONCLUSIONS: The results of this study suggest that Lever Sign, in isolation, does not accurately detect the status of the ACL. During the clinical examination, the Lever Sign should be used as an adjunct to the gold standard assessment technique of anterior tibial translation assessment as employed in the Lachman tests in either prone or supine position. LEVEL OF EVIDENCE: 2.

SPORTS PHYSICAL THERAPY CURRICULA IN PHYSICAL THERAPIST PROFESSIONAL DEGREE PROGRAMS.

BACKGROUND: The specialty niche of sports physical therapy has grown at a significant rate over the past 40 years. Despite this growth there is little information or direction from the physical therapy education accreditation body or professional association to guide academic programs on the interest or necessity of this type of practice content in physical therapy professional degree programs. PURPOSE: The purpose of this survey study is to report on the prevalence, attitudes, barriers, resources, and faculty expertise in providing required or elective sports physical therapy course work. STUDY DESIGN: Cross-sectional descriptive survey. METHODS: A 57-item questionnaire with branching logic was distributed via a web-based electronic data capture tool to survey all Commission on Accreditation for Physical Therapy Education (CAPTE) accredited and candidate schools in the United States. Response data was analyzed to describe typical educational program profiles, faculty demographics, and correlational factors consistent with the presence or absence of specific sports physical therapy curricular content. RESULTS: Thirty one percent of the schools responded to the survey and the program demographics were consistent with all currently accredited schools in regards to their geography, Carnegie classification, and faculty and student size. Forty three percent of programs offered a required or elective course distinct to the practice of sports physical therapy. Descriptive information regarding the sequencing, curricular make-up, resources, and assessment of content competence is reported. The odds of providing this content nearly doubles for programs that have faculty with sports clinical specialist credentials, accredited sports residency curriculums, or state practice acts that allow sports venue coverage. CONCLUSIONS: This survey provides an initial overview of sports physical therapy educational efforts in professional physical therapy degree programs. The data can used to spur further discussion on the necessity, structure, and implementation of education content that is inherent to a growing specialty practice in the physical therapy profession. LEVEL OF EVIDENCE: 4, Cross-sectional descriptive survey design.