Alan Nasypany

Use of Protection Motivation Theory, Affect, and Barriers to Understand and Predict Adherence to Outpatient Rehabilitation

Background and Purpose: Protection motivation theory (PMT) has been used in more than 20 different health-related fields to study intentions and behavior, albeit primarily outside the area of injury rehabilitation. In order to examine and predict patient adherence behavior, this study was carried out to explore the use of PMT as a screening tool in a general sample of people with orthopedic conditions. Subjects and Methods: New patients who were more than 18 years old and who were prescribed 4 to 8 weeks of physical therapy treatment (n=229) were administered a screening tool (Sports Injury Rehabilitation Beliefs Scale, Positive and Negative Affect Schedule, and a barriers checklist) prior to treatment. Participants’ adherence was assessed with several attendance measures and an in-clinic assessment of behavior. Statistical analyses included correlation, chi-square, multiple regression, and discriminant function analyses. Results: A variety of relationships among affect, barriers, and PMT components were evident. In-clinic behavior and attendance were influenced by affect, whereas dropout status was predicted by affect, severity, self-efficacy, and age. Discussion and Conclusion: The screening tool used in this study may assist in identifying patients who are at risk for poor adherence and provide valuable information to enhance provider-patient relationships and foster patient adherence. However, it is recommended that more research be conducted to further understand the impact of variables on patient adherence and that the screening tool be enhanced to increase its predictive ability.

Trends in Doctoral Education Among Healthcare Professions: An Integrative Research Review

Context: Evidence suggests widespread adoption of the entry-level doctorate among health professions, although little is known about how these changes have impacted associated professions and influenced education, collaborative practice, professional advancement, or professional salaries. Objective: Threefold: (1) What doctoral education models are currently utilized among health care professional education programs in the United States? (2) How do entry-level clinical doctorates in health care professions impact research training and productivity? (3) How do clinical doctorates among health professions influence practice opportunities and salary? Design: Data were extracted from various sources including professional organizations, accrediting body Web sites, and the US Department of Labor database. Full-text articles published in English between the years 2001–2011 were extracted from a search of 38 databases in the University of Washington libraries. The remaining article abstracts were reviewed for co...

Innovative treatment of clinically diagnosed meniscal tears: a randomized sham-controlled trial of the Mulligan concept ‘squeeze’ technique

Objective: The purpose of this study was to assess the effects of the Mulligan Concept (MC) ‘squeeze’ technique compared to a sham technique in participants with a clinically diagnosed meniscal tear. Methods: A multi-site randomized sham-controlled trial of participants (n = 23), aged 24.91 ± 12.09 years, with a clinically diagnosed meniscal tear were equally and randomly divided into two groups. Groups received a maximum of six treatments over 14 days. Patient outcomes included the numeric pain rating scale (NRS), patient-specific functional scale (PSFS), the disablement in the physically active (DPA) scale and the knee injury osteoarthritis outcome score. Data were analysed using univariate ANOVA, univariate ANCOVA, and descriptive statistics. Results: All participants in the MC ‘squeeze’ group met the discharge criteria of ≤2 points on the NRS, ≥9 points on the PSFS, and ≤34 points or ≤23 on the DPA Scale for chronic or acute injuries, respectively within the treatment intervention timeframe. A significant difference was found in favor of the MC ‘squeeze’ technique in PSFS scores (F(1, 21) = 4.40, p = .048, partial eta squared = .17, observed power = .52) and in DPA Scale scores (F(1, 21) = 7.46, p = .013, partial eta squared = .27, observed power = .74). Discussion: The results indicate the MC ‘squeeze’ technique had positive effects on patient function and health-related quality of life over a period of 14 days and was clinically and statistically superior to the sham treatment. Further investigation of the MC ‘squeeze’ technique is warranted.

Immediate and short-term effects of mulligan concept positional sustained natural apophyseal glides on an athletic young-adult population classified with mechanical neck pain: an exploratory investigation

Abstract Objectives: Mechanical neck pain (MNP) is common in the athletic population. While symptoms may present at the cervical spine for patients complaining of MNP, thoracic spinal alignment or dysfunction may influence cervical positioning and overall cervical function. Clinicians often employ cervical high-velocity low-amplitude (HVLA) thrust manipulations to treat MNP, albeit with a small level of inherent risk. Mulligan Concept positional sustained natural apophyseal glides (SNAGs) directed at the cervicothoracic region are emerging to treat patients with cervical pain and dysfunction, as evidence supporting an interdependent relationship between the thoracic and cervical spine grows. The purpose of this a priori study was to evaluate outcome measures of patients classified with MNP treated with the Mulligan Concept Positional SNAGs. Methods: Ten consecutive young-adult patients, ages ranging from 15 to 18 years (mean = 16.5 ± 1.78), classified with MNP were treated utilizing Mulligan Concept Positional SNAGs. The Numeric Rating Scale (NRS), Patient-Specific Functional Scale (PSFS), Neck Disability Index (NDI), Disablement in the Physically Active (DPAS), and Fear-Avoidance Based Questionnaire-Physical Activity (FABQPA) were collected for inclusion criteria and to identify patient-reported pain and dysfunction. Results: Patients reported decreases in pain on the NRS [5.4 to .16, p = .001], increases in function on the PSFS [5.2 to 10, p = .001], and increases in cervical range of motion (CROM) [ext p = .003, flex p = .009, left rot p = .001, right rot p = .002] immediately post-treatment and between treatments. Discussion: Positional SNAGs directed at the cervicothoracic region may address a variety of patient reported symptoms for MNP, and the number of treatment sessions needed for symptom resolution may be closer to a single session rather than multiple treatments. Level of Evidence: 4.

Changes in Hamstring Range of Motion Following Neurodynamic Sciatic Sliders: A Critically Appraised Topic

Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared with stretching on traditional measures of range of motion (ROM)? Summary of Key Findings: The authors of a well-designed study found that neurodynamic sliders were more effective than static stretching, while the authors of 2 less-well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders. Clinical Bottom Line: Evidence exists to support the use of neurodynamic sliders to increase measures of hamstring ROM in patients who present with limited hamstring flexibility; however, the effectiveness of neurodynamic sliders compared with traditional stretching is inconclusive. Strength of Recommendation: Grade B evidence exists that neurodynamic sliders perform as well as traditional stretching techniques at increasing measures of hamstring ROM in patients with limited hamstring flexibility.

Patient Outcomes Utilizing the Mulligan Concept of MWM to Treat Intercollegiate Patients Diagnosed with Lateral Ankle Sprain: An A Priori Case Series.

CONTEXT While the incidence and reinjury rates of lateral ankle sprain (LAS) continue to persist at high rates across many sporting activities, further exploration of assessment and treatment beyond the traditional ligamentous and strength/proprioceptive model is warranted. Further, assessing and treating both arthrokinematic and osteokinematic changes associated with LAS can provide insight into a more diverse approach to treating ankle pathology. OBJECTIVE To examine the clinical use of the Mulligan Concept mobilization with movement (MWM) while treating patients diagnosed with an acute grade I or II LAS through authentic patient care. DESIGN An a priori case series. SETTING Intercollegiate athletic training clinic. PATIENTS Intercollegiate patients diagnosed with an acute grade I or II LAS. INTERVENTION The Mulligan Concept distal fibular anterior to posterior MWM. MAIN OUTCOME MEASURES Pain-Intensity Numeric Rating Scale (NRS) with Non-Weight Bearing (NRS-NWB) and Weight Bearing (NRS-WB), Disablement of the Physically Active Scale (DPAscale), Foot and Ankle Ability Measure (FAAM) with Activity of Daily living (FAMM-ADL) and Sport (FAAM-Sport), Client Specific Impairment Measure (CSIM), Y-Balance Composite (YBC), and Weight Bearing Measure for Dorsiflexion (WBDF). RESULTS Patients who are diagnosed with an acute grade I or II LAS and are treated with the Mulligan Concept report immediate and long-lasting minimal clinically important differences in patient outcome measures. CONCLUSION Clinicians who examine and use the Mulligan Concept MWM to treat acute LAS can expect immediate positive results that are progressively retained over time specific to patient-centered outcome measures as well as functional clinicianbased measures. Based on the immediate and positive results, clinicians should examine associated osteokinematic and arthrokinematic changes beyond that of the traditional ligamentous model.

A Treatment-Based Classification Algorithm to Treat Achilles Tendinopathy: An Exploratory Case Series

CONTEXT Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain. OBJECTIVE To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy. PARTICIPANTS 11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy. DESIGN Case series. SETTING Participants were evaluated, diagnosed, and treated at multiple clinics. MAIN OUTCOME MEASURES Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment-Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress. RESULTS A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC. CONCLUSION The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

Novel treatment of lateral ankle sprains using the Mulligan concept: an exploratory case series analysis

Abstract Objective: The purpose of this study was to examine the effect of the Mulligan Concept (MC) Mobilization with movement (MWM) in the treatment of clinically diagnosed acute lateral ankle sprains in competitive athletes. Methods: A prospective case series of 5 adolescent patients, ages ranging from 14 to 18 years (mean = 15.8 ± 1.64), that suffered an acute lateral ankle sprain (LAS). Patients were treated with the MC lateral ankle MWM. Mobilization was directed at the distal fibula or, using a modified MWM, 2–3 inches proximal to the distal fibula. Using paired t-tests and descriptive statistics (mean and standard deviation) results were analyzed. Results: Treatment lasted an average of 9 days (mean = 9.2, ±SD 3.96) from intake to discharge. During that time frame, patients reported decreases in pain on the numeric pain rating scale (NRS), disability on the Disablement in the Physically Active (DPA) scale and an increase in function on the patient-specific functional scale (PSFS); and an immediate decrease in pain on the NRS within the first treatment. The minimal detectable change for the PSFS and NRS were exceeded from intake to discharge. Additionally, the minimally clinical important differences were exceeded on the NRS and DPA scale. Discussion: The evidence presented in this Level-4 case series supports the use of the MC lateral ankle MWM to treat patients diagnosed with acute grade II LAS. Patients in this case series reported immediate decreases in pain and immediate increases in function. Therefore, further investigation of the MC lateral ankle MWM is warranted.

Analysis of Patient Outcomes Using the MyoKinesthetic System for the Treatment of Low Back Pain: A Case Series

Objective: The purpose of this case series was to test the feasibility of using the MyoKinesthetic (MYK) System as a treatment‐based classification system and intervention for a sample of patients with low back pain. Methods: This within‐subject intervention was completed in a university athletic training clinic. Nine participants (mean age: 31 years) with a primary complaint of LBP were evaluated and included. An athletic trainer performed the initial assessment, which contained the following components: patient history, palpation, range of motion testing, lower quarter neurologic screening, MYK System posture screen, orthopedic special tests, and baseline data for pain intensity, disability, and function. All participants were treated with the MYK System. The primary outcomes were pain, disability, function, active range of motion, posture, and global efficacy of treatment. Results: The mean number of MYK treatments administered was 12.11 (SD = 6.25), and the mean number of days until discharge was 28.67 (SD = 9.38). A repeated‐measures analysis of variance revealed statistically significant and clinically meaningful improvements in pain, disability, function, and posture from the initial evaluation to discharge and from the initial evaluation to a 1‐month follow‐up (P < .01). Conclusion: This study determined the feasibility of further evaluation of the MYK System as a treatment‐based classification system and intervention for patients with low back pain.

Treatment Utilizing a Muscle Energy Technique and the MyoKinesthetic System on Patients With a Diagnosed Disc Injury

Two physically active patients presented with low back pain (LBP) and were previously diagnosed with a herniated disc. A unique treatment combination of a muscle energy technique (MET) and MyoKinesthetic (MYK) treatments were used to decrease pain and improve function. The treatment combination displayed clinically significant short-term improvements in four treatments or less and both patients reported no recurrence of pain at their 1-year follow-up. It is questionable if the presence of an anatomical abnormality, such as a herniated disc, is truly the source or unrelated to those experiencing LBP; utilizing a MET and MYK treatment may be beneficial for other patients reporting similar symptoms.