Physical Therapy Provider Continuity Predicts Functional Improvements in Inpatient Rehabilitation.

BACKGROUND AND PURPOSE: Health care continuity has been linked to improved patient outcomes in a variety of professions and settings. Patients in inpatient rehabilitation receive a consistent dosage of physical therapy (PT) treatment; however, the providing physical therapist may vary. Despite the potential influence of PT provider continuity on functional outcomes in the inpatient rehabilitation setting, this association has not yet been studied. METHODS: An observational retrospective chart review was conducted on 555 discharged inpatient rehabilitation patients. The relationship between the number of PT providers from whom a patient received care and Quality Indicator (QI) Mobility discharge scores was examined with Pearson product-moment correlation coefficients, initially with the entire patient group and secondarily with distinct diagnostic groups. Data from subgroups for whom a significant relationship was established were then included in a hierarchical linear regression analysis accounting for relevant covariates. RESULTS: The number of PT providers correlated negatively with QI Mobility discharge scores ( r = -0.41, P ≤ 0.001). When controlling for QI Mobility admission scores, the "Stroke" (partial r = -0.17, P = 0.02), "Spinal Cord Injury" (partial r = -0.28, P = 0.002), and "Other Neuromuscular" (partial r = -0.35, P = 0.03) groups demonstrated significant inverse relationships. A hierarchical linear regression incorporating these 3 diagnostic groups revealed that the number of PT providers remained a significant predictor of QI Mobility discharge scores ( B = -1.50, P ≤ 0.001) when accounting for covariates. DISCUSSION AND CONCLUSIONS: PT provider continuity is related to the functional improvement of neurologically impaired patients in inpatient rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A405 , which discusses the findings of this work in a narrative format).

Validity Indices of the King-Devick Concussion Test in Hockey Players.

OBJECTIVE: To compare the validity indices of the King-Devick (KD) test in hockey players using any increase in test time over baseline to a 6-second increase as a positive concussion test. We hypothesized the KD test using the 6-second change would yield greater validity indices. DESIGN: Prospective observational cohort study. SETTING: Sports complex. PARTICIPANTS: Sixty-five male hockey players aged 13 to 20 years. INDEPENDENT VARIABLE: Concussion diagnosis. MAIN OUTCOME MEASURES: Time to complete the KD test. Sensitivity (SN), specificity (SP), and the positive likelihood ratios (LRs+) were calculated using 2 thresholds for a positive test: (1) any increase in time and (2) an increase of 6 seconds or greater. RESULTS: Eighteen players (27.7%) were diagnosed with a concussion. Using any increase in time as a positive test yielded the following: SN 72.2%, SP 78.7%, LR+ 3.4, and LR- 0.4. Using the 6-second threshold yielded the following: SN 44.4%, SP 93.6%, LR+ 7.0, and LR- 0.6. A receiver operator curve analysis confirmed 6.40 seconds or greater maximized the LR+. CONCLUSIONS: A 6-second or greater increase in the KD test performance provides greater validity in diagnosing concussion as compared with any increase in performance time.

Qualitative and quantitative evaluation of an interprofessional workshop between physical therapy and medical students.

Interprofessional education (IPE) is an important component of medical education, preparing students for the collaboration necessary for high-quality patient care. This study aimed to compare IPE readiness in pre-qualification physical therapy (PT) and medical (MD) students before and after an interprofessional workshop and identify factors influencing the workshop's perceived educational value. In two consecutive years, students were surveyed with the Readiness for Interprofessional Learning Scale (RIPLS) following a four-hour, case-based workshop. During the second year, students were also surveyed before the workshop and answered open-ended questions about its educational value. PT and MD students had similar mean pre-workshop RIPLS scores (83.0, SD 5.3 vs. 80.7, SD 7.9; p = .27), but post-workshop scores were higher among PT students (86.3, SD 6.5 vs. 80.3, SD 8.8; p < .001). Qualitative thematic analysis of responses to open-ended questions revealed students valued IPE within the workshop. However, MD students in particular identified improvement opportunities in workshop delivery, timing, and content. These factors undermined the perceived educational value for MD students and may have contributed to their lower post-workshop RIPLS scores. This study suggests that a brief workshop can improve readiness for IPE among pre-professional students and highlights the importance of content, delivery, and timing to IPE success.

Effect of an Exercise Program That Includes Deadlifts on Low Back Pain.

Clinical Scenario: Low back pain is a common condition for the general population with 29% of adults having low back pain within the last 3 months. A deadlift is described as a free weight exercise in which a barbell is lifted from the floor in a continuous motion by extending the knees and hips. For those without low back pain, the deadlift was found to have the highest muscle activation of paraspinal musculature compared with other exercises. There are a limited number of studies that investigate the usefulness of incorporating deadlifts as part of a rehabilitation program for low back pain. Clinical Question: For those who live with low back pain, is an exercise routine that includes a deadlift a viable treatment option to improve pain and/or function? Summary of Key Findings: The literature search yielded 3 total studies meeting the inclusion and exclusion criteria: 1 randomized control trial, 1 secondary analysis of a randomized control trial, and 1 cohort study. Exercise programs that include deadlifts can yield improvements in both pain and function for those living with low back pain but were not found to be more beneficial than low load motor control exercises. Those with lower pain levels and higher baseline lumbar extension strength may be most appropriate to participate in an exercise program that includes deadlifts. Further research is needed to compare exercise programs that include deadlifts to other interventions for those living with low back pain. Clinical Bottom Line: There is minimal evidence that exercise programs that included deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures. Strength of Recommendation: Level B evidence exists that exercise programs that include deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures.

Coupled Gluteus Maximus and Gluteus Medius Recruitment Patterns Modulate Hip Adduction Variability During Single-Limb Step-Downs: A Cross-Sectional Study.

CONTEXT: Examining the coordinated coupling of muscle recruitment patterns may provide insight into movement variability in sport-related tasks. OBJECTIVE: The purpose of this study was to examine the relationship between coupled gluteus maximus and medius recruitment patterns and hip-adduction variability during single-limb step-downs. DESIGN: Cross-sectional. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty healthy adults, including 26 women and 14 men, mean age 23.8 (1.6) years, mean body mass index 24.2 (3.1) kg/m2, participated. INTERVENTIONS: Lower-extremity kinematics were acquired during 20 single-limb step-downs from a 19-cm step height. Electromyography (EMG) signals were captured with surface electrodes. Isometric hip-extension strength was obtained. MAIN OUTCOME MEASURES: Hip-adduction variability, measured as the SD of peak hip adduction across 20 repetitions of the step-down task, was measured. The mean amplitudes of gluteus maximus and gluteus medius EMG recruitment were examined. Determinism and entropy of the coupled EMG signals were computed with cross-recurrence quantification analyses. RESULTS: Hip-adduction variability correlated inversely with determinism (r = -.453, P = .018) and positively with entropy (r = .409, P = .034) in coupled gluteus maximus/medius recruitment patterns but not with hip-extensor strength nor with magnitudes of mean gluteus maximus or medius recruitment (r = -.003, .081, and .035; P = .990, .688, and .864, respectively). CONCLUSION: Hip-adduction variability during single-limb step-downs correlated more strongly with measures of coupled gluteus maximus and medius recruitment patterns than with hip-extensor strength or magnitudes of muscle recruitment. Examining coupled recruitment patterns may provide an alternative understanding of the extent to which hip neuromuscular control modulates lower-extremity kinematics beyond examining muscle strength or EMG recruitment magnitudes.

Recruitment of Shoulder Prime Movers and Torso Stabilizers During Push-Up Exercises Using a Suspension Training System.

CONTEXT: Suspension training devices use body weight resistance and unstable support surfaces that may facilitate muscle recruitment during push-up exercises. OBJECTIVE: The authors examined muscle recruitment with surface electromyography on 4 shoulder and 4 torso muscles during (1) standard push-ups, (2) feet-suspended push-ups, (3) hands-suspended push-ups, and (4) dual-instability push-ups in which feet were suspended and hands were on unstable surfaces. DESIGN: Cross-sectional design with repeated measures. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-two healthy men and women (mean age, 24.3 y; mean body mass index, 24.6 kg·m-2) participated. INTERVENTION: Participants were tested while performing 2 repetitions each of 4 variations of push-ups. MAIN OUTCOME MEASURES: Muscle recruitment, normalized to maximum voluntary isometric contraction, was measured in 4 prime movers (anterior deltoid, pectoralis major, serratus anterior, and triceps brachii) and 4 torso stabilizers (external oblique, internal oblique, rectus abdominis, and upper erector spinae). RESULTS: Muscle recruitment in the anterior deltoid, pectoralis major, and serratus anterior during suspended exercises was no greater than during standard push-ups. In contrast, torso stabilizer recruitment was significantly greater in the external oblique, internal oblique, and rectus abdominis during all 3 suspended exercises compared with standard push-ups. Suspended exercises under a dual-instability condition did not generate greater levels of muscle activation compared with conditions of single instability. CONCLUSIONS: Push-ups performed with suspension training systems may provide benefit if one's goal is to enhance torso muscle training. One unstable surface may be sufficiently challenging for the client or athlete when performing push-up exercises with a suspension training device.

Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial.

CONTEXT: Hip extension with hamstring-dominant rather than gluteus maximus-dominant recruitment may increase anterior femoracetabular forces and contribute to conditions that cause hip pain. Cueing methods during hip extension exercises may facilitate greater gluteus maximus recruitment. OBJECTIVE: We examined whether specific verbal and tactile cues facilitate gluteus maximus recruitment while inhibiting hamstring recruitment during a bridging exercise. DESIGN: Randomized controlled trial. SETTING: Biomechanics laboratory. PARTICIPANTS: 30 young adult women (age 24 [3] y; BMI 22.2 [2.4] kg/m2). INTERVENTION: Participants were tested over 2 sessions, 1 week apart, while performing 5 repetitions of a bridging exercise. At their second visit, participants in the experimental group received verbal and tactile cues intended to facilitate gluteus maximus recruitment and inhibit hamstring recruitment. Control group participants received no additional cues beyond original instructions. MAIN OUTCOME MEASURES: Gluteus maximus and hamstring recruitment were measured with surface electromyography, normalized to maximal voluntary isometric contractions (MVICs). RESULTS: Gluteus maximus recruitment was unchanged in the control group and increased from 16.8 to 33.0% MVIC in the cueing group (F = 33.369, P < .001). Hamstring recruitment was unchanged in the control group but also increased from 16.5 to 29.8% MVIC in the cueing group (F = 6.400, P = .02). The effect size of the change in gluteus maximus recruitment in the cueing group (Cohen's d = 1.5, 95% CI = 0.9 to 2.2) was not significantly greater than the effect size in hamstring recruitment (Cohen's d = 0.8, 95% CI = 0.1 to 1.5). CONCLUSIONS: Verbal and tactile cues hypothesized to facilitate gluteus maximus recruitment yielded comparable increases in both gluteus maximus and hamstring recruitment. If one intends to promote hip extension by facilitating gluteus maximus recruitment while inhibiting hamstring recruitment during bridging exercises, the cueing methods employed in this study may not produce desired effects.

Variability of ischiofemoral space dimensions with changes in hip flexion: an MRI study.

OBJECTIVE: The primary aim of this study was to determine if ischiofemoral space (IFS) dimensions vary with changes in hip flexion as a result of placing a bolster behind the knees during magnetic resonance imaging (MRI). A secondary aim was to determine if IFS dimensions vary between supine and prone hip neutral positions. DESIGN: The study employed a prospective design. SETTING: Sports medicine center within a tertiary care institution. PARTICIPANTS: Five male and five female adult subjects (age mean = 29.2, range = 23-35; body mass index [BMI] mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. METHODS: An axial, T1-weighted MRI sequence of the pelvis was obtained of each subject in a supine position with their hips in neutral and flexed positions, and in a prone position with their hips in neutral position. Supine hip flexion was induced by placing a standard, 9-cm-diameter MRI knee bolster under the subject's knees. The order of image acquisition (supine hip neutral, supine hip flexed, prone hip neutral) was randomized. The IFS dimensions were then measured on a separate workstation. The investigator performing the IFS measurements was blinded to the subject position for each image. MAIN OUTCOME MEASUREMENTS: The main outcome measurements were the IFS dimensions acquired with MRI. RESULTS: The mean IFS dimensions in the prone position were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). In the supine hip neutral position, the IFS dimensions were 25.1 (SD 5.6) mm. The mean difference between the two positions of 3.15 (3.6) mm was statistically significant (95 % CI of the difference = 1.4 to 4.8 mm, t19 = 3.911, p = .001). The mean IFS dimensions in the hip flexed position were 36.9 (SD 5.7) mm. The mean difference between the two supine positions of 11.8 (4.1) mm was statistically significant (95 % CI of the difference = 9.9 to 13.7 mm, t19 = 12.716, p < .001). CONCLUSIONS: Our findings demonstrate that the IFS measurements obtained with MRI are dependent upon patient positioning with respect to hip flexion and supine versus prone positions. This finding has implications when evaluating for ischiofemoral impingement, an entity resulting in hip and/or buttock pain secondary to impingement of the quadratus femoris muscle within a pathologically narrowed IFS. One will need to account for patient hip flexion and supine versus prone positioning when evaluating individuals with suspected ischiofemoral impingement.

Influence of Neck Laceration Protectors on Cervical Range of Motion.

OBJECTIVE: To examine the effect of a hockey neck laceration protector (NLP) on cervical range of motion (ROM) along with the athlete's perception on comfort and restrictiveness. Our hypothesis was that all styles of NLPs would limit cervical ROM compared to no NLP, and that certain designs of NLPs would be perceived as more restrictive and less comfortable. DESIGN: Cross-sectional observational analytic. SETTING: Outpatient sports medicine clinic. PARTICIPANTS: Forty-six male and female high school hockey players (age 14-18). INDEPENDENT VARIABLES: Four commercially available NLPs and no NLP. MAIN OUTCOME MEASURES: Cervical ROM and participant feedback regarding restrictiveness and comfort. RESULTS: ROM values while wearing any of the NLPs were significantly less than no NLP for all cervical motion measurements (P < 0.05) with the exception of the Bauer Premium NLP for left rotation (P = 0.792). Significant differences were found between the 4 NLPs in terms of perceived restrictiveness and comfort (P < 0.05). CONCLUSIONS: NLPs may reduce the risk of a neck laceration, but appear to have a negative impact on cervical ROM. This study challenges manufactures to design NLPs that cover vulnerable neck anatomy but do not limit a player's ROM. NLP designs that are most comfortable and least restrictive are recommended.

Activation of Spinal Stabilizers and Shoulder Complex Muscles During an Inverted Row Using a Portable Pull-up Device and Body Weight Resistance.

Youdas, JW, Keith, JM, Nonn, DE, Squires, AC, and Hollman, JH. Activation of spinal stabilizers and shoulder complex muscles during an inverted row using a portable pull-up device and body weight resistance. J Strength Cond Res 30(7): 1933-1941, 2016-We recorded muscle activation normalized to a maximum voluntary isometric contraction (% MVIC) during an inverted body weight row using a commercially available portable pull-up device. Surface electromyographic (EMG) analysis was conducted on 13 male and 13 female subjects performing 4 inverted row exercises: (a) pronated grip both feet weight-bearing (WB); (b) supinated grip both feet WB; (c) pronated grip one leg WB; and (d) supinated grip single-leg WB. Nine muscles were analyzed: (a) posterior deltoid (PD), (b) latissimus dorsi (LD), (c) biceps brachii (BB), (d) lower trapezius (LT), (e) upper trapezius (UT), (f) lumbar multifidus (LM), (g) middle trapezius (MT), (h) lumbar thoracis (LTh), and (i) rectus abdominis (RA). Normalized peak EMG activity was examined separately for each muscle with 9 repeated measures analysis of variance (ANOVA) at α = 0.05. Post hoc comparisons of EMG activation across exercises for statistically significant ANOVAs were conducted with Bonferroni corrections for multiple comparisons. We observed statistically significant differences in EMG activation of the LD between supinated and pronated double-leg WB (p = 0.001) condition. Additionally, we found statistical significance in the UT between pronated and supinated single-leg WB (p = 0.007). No statistically significant differences in muscle activation existed between single- and double-leg WB in any muscles. Four muscles (BB, LD, LT, and PD) demonstrated very high (>61% MVIC) EMG activation during all 4 exercise conditions. Three muscles (UT, MT, and LM) demonstrated high (41-60% MVIC) activation, whereas 2 muscles (LTh and RA) demonstrated moderate (21-40% MVIC) activation. Four inverted row exercises activated the LD, UT, MT, LT, and BB at levels conducive to strengthening.

Reliability of hip internal rotation range of motion measurement using a digital inclinometer.

PURPOSE: Assessment of hip internal rotation (IR) is a critical element in the evaluation of a painful hip, yet there currently exists no consistent method of determining this measurement. The purpose of this study is to report the intra-rater and inter-rater reliability of active and passive hip IR measurement using a digital inclinometer. METHODS: Twenty-five subjects (8 men, 17 women) with asymptomatic hip joints, and no known pathology between the ages of 22 and 42 participated. Two examiners measured hip IR for each subject using a digital inclinometer while visually monitoring pelvic motion. Measurements included passive IR, active IR, and active IR while internally rotating both legs simultaneously. Statistical analysis was performed including intra-rater and inter-rater reliability. RESULTS: There was no significant difference in measured IR values. Mean range of motion values for all techniques and both examiners ranged from 30.7° to 32.8°. Intra-rater reliability for examiner 1 ranged from 0.84 to 0.92. Inter-rater reliability ranged from 0.89 to 0.93. Of the methods utilized, active IR of a single leg was the most responsive technique with a minimal detectable change value of 5.4°. CONCLUSIONS: Clinical assessment of hip IR range of motion can be performed efficiently and reliably with a digital inclinometer along with visual monitoring of the pelvis for unwanted motion. Findings from this study support unilateral active hip IR in a seated position as a reliable and responsive technique for obtaining hip IR measurements.

Effects of examiner strength on reliability of hip-strength testing using a handheld dynamometer.

CONTEXT: Hip-muscle impairments are associated with a variety of lower-extremity dysfunctions. Accurate assessment in the clinical setting can be challenging due to the strength of hip muscles relative to examiner strength. OBJECTIVE: To examine the influence of examiner strength and technique on manual hip-strength testing using a handheld dynamometer. DESIGN: Repeated measures. SETTING: Research laboratory. PARTICIPANTS: 30 active adults (age 24 ± 1.4 y). INTERVENTIONS: Three examiners of different strength performed manual muscle tests (MMT) in 2 different positions for hip extension, abduction, and external rotation using a MicroFet handheld dynamometer. Examiner strength was quantified via a 1-repetition-maximum leg press and chest press with a Keiser A420 pneumatic resistance machine. MAIN OUTCOME MEASURES: Intrarater reliability (ICC3,1), interrater reliability (ICC2,1), and measured torque values. RESULTS: Intrarater reliability for all measurements ranged from .82 to .97. Interrater reliability ranged from .81 to .98. Main effects for hip extension revealed a significant difference in torque values between examiners and between techniques. For the short-lever hipabduction and seated hip-external-rotation tests, there was a significant difference between examiners. There was no significant difference in measured torque values between examiners with the long-lever hip-abduction or the prone hip-external-rotation tests. CONCLUSIONS: MMT of the hip may be performed with high reliability by examiners of different strength. To obtain valid MMT measurements of hip muscles, examiners must consider their own strength and testing techniques employed. The authors recommend a long-lever technique for hip abduction and a prone position for testing hip external rotation to minimize the influence of examiner strength. Both positions appear to provide mechanical advantages to the examiner compared with the alternative techniques. The authors are unable to recommend a preferred hip-extension-testing technique to minimize the influence of examiner strength.

Muscle activation levels of the gluteus maximus and medius during standing hip-joint strengthening exercises using elastic-tubing resistance.

CONTEXT: No published studies have compared muscle activation levels simultaneously for the gluteus maximus and medius muscles of stance and moving limbs during standing hip-joint strengthening while using elastic-tubing resistance. OBJECTIVE: To quantify activation levels bilaterally of the gluteus maximus and medius during resisted lower-extremity standing exercises using elastic tubing for the cross-over, reverse cross-over, front-pull, and back-pull exercise conditions. DESIGN: Repeated measures. SETTING: Laboratory. PARTICIPANTS: 26 active and healthy people, 13 men (25 ± 3 y) and 13 women (24 ± 1 y). INTERVENTION: Subjects completed 3 consecutive repetitions of lower-extremity exercises in random order. MAIN OUTCOME MEASURES: Surface electromyographic (EMG) signals were normalized to peak activity in the maximum voluntary isometric contraction (MVIC) trial and expressed as a percentage. Magnitudes of EMG recruitment were analyzed with a 2 × 4 repeated-measures ANOVA for each muscle (α = .05). RESULTS: For the gluteus maximus an interaction between exercise and limb factor was significant (F3,75 = 21.5; P < .001). The moving-limb gluteus maximus was activated more than the stance limb's during the back-pull exercise (P < .001), and moving-limb gluteus maximus muscle recruitment was greater for the back-pull exercise than for the cross-over, reverse cross-over, and front-pull exercises (P < .001). For the gluteus medius an interaction between exercise and limb factor was significant (F3,75 = 3.7; P < .03). Gluteus medius muscle recruitment (% MVIC) was greater in the stance limb than moving limb when performing the front-pull exercise (P < .001). Moving-limb gluteus medius muscle recruitment was greater for the reverse cross-over exercise than for the cross-over, front-pull, and back-pull exercises (P < .001). CONCLUSIONS: From a clinical standpoint there is no therapeutic benefit to selectively activate the gluteus maximus and gluteus medius muscles on the stance limb by resisting sagittal- and frontal-plane hip movements on the moving limb using resistance supplied by elastic tubing.

Interrater reliability of the modified prone instability test for lumbar segmental instability in individuals with mechanical low back pain.

OBJECTIVE: The purpose of this study was to establish the interrater reliability of measures obtained with a novel Modified Prone Instability Test (mPIT), which, like the original Prone Instability Test (PIT), is proposed to identify lumbar segmental instability. The mPIT has clinical feasibility advantages to the PIT, but its psychometric properties are yet to be determined. DESIGN: Repeated measures (test-retest) design, methods study. METHODS: The mPIT was administered by two blinded testers, an orthopedic physical therapy resident with < 1 year experience and board-certified orthopedic specialist physical therapist with >25 years' experience. Procedures were administered at an outpatient physical therapy clinic of a tertiary Medical Center. Participants included 50 adults (≥18 years old) with mechanical low back pain and no radicular (below the knee) symptoms (mean age 50.7 years, 66% female, 76% reported previous episodes of low back pain). Interrater reliability was measured via Fleiss' kappa coefficient. RESULTS: Assessments of the mPIT had moderate interrater agreement (κ = .579 [95% CI = .302 to .856], p < .001.). CONCLUSION: Measures obtained using the mPIT demonstrated moderate interrater reliability between a new graduate and an experienced clinician, which aligns with several studies examining interrater reliability of the original PIT. Further study examining comparative validation of the mPIT with other lumbar instability measures is warranted.

Detecting Artificial Intelligence-Generated Personal Statements in Professional Physical Therapist Education Program Applications: A Lexical Analysis.

OBJECTIVE: The objective of this study was to compare the lexical sophistication of personal statements submitted by professional physical therapist education program applicants with those generated by OpenAI's Chat Generative Pretrained Transformer (ChatGPT). METHODS: Personal statements from 152 applicants and 20 generated by ChatGPT were collected, all in response to a standardized prompt. These statements were coded numerically, then analyzed with recurrence quantification analyses (RQAs). RQA indices including recurrence, determinism, max line, mean line, and entropy were compared with t-tests. A receiver operating characteristic curve analysis was used to examine discriminative validity of RQA indices to distinguish between ChatGPT and human-generated personal statements. RESULTS: ChatGPT-generated personal statements exhibited higher recurrence, determinism, mean line, and entropy values than did human-generated personal statements. The strongest discriminator was a 13.04% determinism rate, which differentiated ChatGPT from human-generated writing samples with 70% sensitivity and 91.4% specificity (positive likelihood ratio = 8.14). Personal statements with determinism rates exceeding 13% were 8 times more likely to have been ChatGPT than human generated. CONCLUSION: Although RQA can distinguish artificial intelligence (AI)-generated text from human-generated text, it is not absolute. Thus, AI introduces additional challenges to the authenticity and utility of personal statements. Admissions committees along with organizations providing guidelines in professional physical therapist education program admissions should reevaluate the role of personal statements in applications. IMPACT: As AI-driven chatbots like ChatGPT complicate the evaluation of personal statements, RQA emerges as a potential tool for admissions committees to detect AI-generated statements.

Assessment of Gender Differences in Letters of Recommendation for Physical Therapy Residency Applications.

INTRODUCTION: Letters of recommendation (LOR) are an integral component of physical therapy residency applications. Identifying the influence of applicant and writer gender in LOR will help identify whether potential implicit gender bias exists in physical therapy residency application processes. REVIEW OF LITERATURE: Several medical and surgical residency education programs have reported positive, neutral, or negative LOR female gender bias among applicants and writers. Little research exists on gender differences in LOR to physical therapy education programs or physical therapy residency programs. SUBJECTS: Seven hundred sixty-eight LOR were analyzed from 256 applications to 3 physical therapy residency programs (neurologic, orthopaedic, sports) at one institution from 2014 to 2020. METHODS: Thematic categories were developed to identify themes in a sample of LOR. Associations between writer and applicant gender were analyzed using summary statistics, word counts, thematic and psycholinguistic extraction, and rule-based and deep learning Natural Language Processing . RESULTS: No significant difference in LOR word counts were found based on writer or applicant gender. Increased word counts were seen in sports residency LOR compared with the orthopaedic residency. Thematic analysis showed LOR gender differences with male applicants receiving more positive generalized recommendations and female applicants receiving more comments regarding interpersonal relationship skills. No thematic or psycholinguistic gender differences were seen by LOR writer. Male applicants were 1.9 times more likely to select all male LOR writers, whereas female applicants were 2.1 times more likely to choose all female LOR writers. DISCUSSION AND CONCLUSION: Gender differences in LORs for physical therapy residencies were found using a comprehensive Natural Language Processing approach that identified both a positive recommendation male applicant gender bias and a positive interpersonal relationship skill female applicant gender bias. Applicants were not harmed nor helped by selecting LOR writers of the opposite gender. Admissions committees and LOR writers should be mindful of potential implicit gender biases in LOR submitted to physical therapy residency programs.

Subtle gait changes in patients with REM sleep behavior disorder.

Many people with rapid eye movement (REM) sleep behavior disorder (RBD) have an underlying synucleinopathy, the most common of which is Lewy body disease. Identifying additional abnormal clinical features may help in identifying those at greater risk of evolving to a more severe syndrome. Because gait disorders are common in the synucleinopathies, early abnormalities in gait in those with RBD could help in identifying those at increased risk of developing overt parkinsonism and/or cognitive impairment. We identified 42 probable RBD subjects and 492 controls using the Mayo Sleep Questionnaire and assessed gait velocity, cadence, and stride dynamics with an automated gait analysis system. Cases and controls were similar in age (79.9 ± 4.7 and 80.1 ± 4.7, P = 0.74), Unified Parkinson's Disease Rating Scale Part III (UPDRS) score (3.3 ± 5.5 and 1.9 ± 4.1, P = 0.21) and Mini-Mental State Examination scores (27.2 ± 1.9 and 27.7 ± 1.6, P = 0.10). A diagnosis of probable RBD was associated with decreased velocity (-7.9 cm/s; 95% confidence interval [CI], -13.8 to -2.0; P < 0.01), cadence (-4.4 steps/min; 95% CI, -7.6 to -1.3; P < 0.01), significantly increased double limb support variability (30%; 95% CI, 6-60; P = 0.01), and greater stride time variability (29%; 95% CI, 2-63; P = 0.03) and swing time variability (46%; 95% CI, 15-84; P < 0.01). Probable RBD is associated with subtle gait changes prior to overt clinical parkinsonism. Diagnosis of probable RBD supplemented by gait analysis may help as a screening tool for disorders of α-synuclein.

Reliability of the dial test using a handheld inclinometer.

PURPOSE: The primary purpose of this study was to investigate the intra-tester and inter-tester reliability of the dial test using a handheld digital inclinometer. Additionally, we examined the responsiveness of the test, and side-to-side differences for meaningful comparison. MATERIALS/METHODS: Twenty-four healthy subjects (22.5 ± 2.8 years) participated in the study. The dial test was performed on both knees at 30° and 90° of knee flexion with the subject supine. While maintaining a neutral position of the ankle, an inclinometer was positioned parallel to the medial border of the foot to quantify external rotation of the tibia. Two examiners performed the dial test in a blinded manner. The minimal detectable change across repeated measures and side-to-side difference was calculated. RESULTS: Intra-tester reliability for examiner 1 (E1) was 0.83 at 30° knee flexion and 0.89 at 90° knee flexion. Reliability values for examiner 2 (E2) were 0.86 at 30° and 0.87 at 90° knee flexion. Inter-tester reliability was 0.74 at 30° and 0.83 at 90°. The minimal detectable change (MDC) for E1 at 30° was ±9.4° and ±7.4° at 90°. For E2, the MDC value was ±9.1° at 30° and ±8.3° at 90°. Ninety-five percent limits of agreement for side-to-side difference was 16.1° and 11.3° ° for E1 at 30° and 90° and for E2 13.9° at 30° and 14.1° at 90°. CONCLUSIONS: This instrumented dial test using a handheld digital inclinometer to measure external rotation can be performed with acceptable reliability in the clinical setting. A difference of 10° between two measurements on the same knee suggests that a meaningful change has occurred. For right to left comparison, differences greater than 15° suggest clinical significance. LEVEL OF EVIDENCE: III.

Modulation of frontal-plane knee kinematics by hip-extensor strength and gluteus maximus recruitment during a jump-landing task in healthy women.

CONTEXT: Abnormal lower extremity kinematics during dynamic activities may be influenced by impaired gluteus maximus function. OBJECTIVE: To examine whether hip-extensor strength and gluteus maximus recruitment are associated with dynamic frontal-plane knee motion during a jump-landing task. DESIGN: Exploratory study. SETTING: Biomechanics laboratory. PARTICIPANTS: 40 healthy female volunteers. MAIN OUTCOME MEASURES: Isometric hip-extension strength was measured bilaterally with a handheld dynamometer. Three-dimensional hip and knee kinematics and gluteus maximus electromyography data were collected bilaterally during a jump-landing test. Data were analyzed with hierarchical linear regression and partial correlation coefficients (α = .05). RESULTS: Hip motion in the transverse plane was highly correlated with knee motion in the frontal plane (partial r = .724). After controlling for hip motion, reduced magnitudes of isometric hip-extensor strength (partial r = .470) and peak gluteus maximus recruitment (partial r = .277) were correlated with increased magnitudes of knee valgus during the jump-landing task. CONCLUSION: Hip-extensor strength and gluteus maximus recruitment, which represents a measure of the muscle's neuromuscular control, are both associated with frontal-plane knee motions during a dynamic weight-bearing task.

Machine Learning in Admissions?: Use of Chi-Square Automatic Interaction Detection (CHAID) to Predict Matriculants to Physical Therapy School.

PURPOSE: Machine learning algorithms provide methods by which patterns in admissions data may be discovered that predict admissions yields in education programs. We used a chi-square automatic interaction detection (CHAID) analysis to examine characteristics that predict applicants most likely to matriculate into a physical therapy program after being admitted. METHODS: Data from applicants admitted to our physical therapy program from the 2015-2016 through 2021-2022 admissions cycles were evaluated (n=413). Variables included applicants' ages, grade point averages, graduate record examination (GRE) scores, admissions and behavioral interview scores, sex/gender, race/ethnicity, home state classification, undergraduate major classification, institutional classification, socioeconomic status, and first generation to college status. A CHAID algorithm identified which variables predicted matriculation after being admitted. RESULTS: Overall, 47.2% of admitted applicants matriculated. The CHAID algorithm generated a 3-level model with 5 terminal nodes that classified matriculants with 64.9% accuracy. Applicants more likely to matriculate than to decline an admission offer included in-state applicants and White/Caucasian border-state/out-of-state applicants with GPAs below 3.65. DISCUSSION: While findings are program-specific, the CHAID analysis provides a tool to analyze admissions data that admissions committees may use to analyze their admissions processes and outcomes.