David A. Krause

A randomized controlled evaluation of low-intensity laser therapy: Plantar fasciitis

OBJECTIVEnTo determine whether low-intensity laser irradiation, a widespread but controversial physical therapy agent, is an effective treatment of plantar fasciitis.nnnDESIGNnA randomized, double-blinded, placebo-controlled clinical study.nnnSETTINGnA sports medicine clinic.nnnSUBJECTSnThirty-two otherwise healthy individuals with plantar fasciitis of more than 1 months duration.nnnINTERVENTIONnDummy or active irradiation with a 30 mW .83 microm GaAlAs continuous-wave infrared (IR) diode laser three times a week for 4 weeks.nnnMEASUREMENTSnMorning pain, pain with toe walking, tenderness to palpation, windlass test response, medication consumption, and orthotic use were evaluated immediately before the study, as well as at the midpoint and end of treatment. Subjects were also evaluated at a follow-up 1 month after their last treatment.nnnRESULTSnNo significant differences were found between the groups in any of the outcome measures either during treatment or at the 1-month follow-up. Treatment, however, was well tolerated and side effects were minimal.nnnCONCLUSIONSnLow-intensity IR laser therapy appears safe but, at least within the parameters of this study, is not beneficial in the treatment of plantar fasciitis.

The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain

Reference values for standing lumbar curvature (SLC) obtained via noninvasive methods are not well established in persons without current low back pain. The effect of gender is considered to have a significant effect on SLC with women having more lumbar lordosis than men. The effect of age and degree of obesity are not considered to have a statistically significant effect on SLC. The purpose of this study was to test the assumption that measurements of SLC in healthy adults obtained by a flexible curve will differ between genders, whereas the SLC will not differ across categories of age and body mass index (BMI). Two hundred thirty-five volunteers (119 men and 116 women) whose ages ranged between 20 and 79 years participated in the study. Subjects were almost exclusively White and from the Midwest. Measurements of the SLC were obtained by a flexible curve. The curves shape was transferred to poster board, and the value of SLC was quantified by a previously described technique. A three-way analysis of variance (α = 0.05) was used to examine the main effects of gender, age, and BMI on SLC. The effect of gender (F1,199 = 21.4, p < 0.0001) and the effect of age (F5,199 = 2.8, p < 0.017) were statistically significant. The effect of BMI (F2,199 = 1.8, p = 0.176) was not significant. Women (mean, 49.5°±10.7°) demonstrated about 6.5° more SLC than their male (mean, 43.0°±10.7°) counterparts. For age, the only significant difference was between the 20 to 29- and 50 to 59-year-old age categories. This study provides physical therapists with typical values of SLC in men and women without current low back pain.

Hip strength and knee pain in high school runners: a prospective study.

To the Editor, It was with great interest that we read the article by Finnoff et al, “Hip Strength and Knee Pain in High School Runners: A Prospective Study,” published in the September 2011 issue of PM&R [1]. The article addresses an important clinical problem, and we applaud the authors for contributing a prospective study to the literature. Although we agree with the authors that hip strength may be a contributing factor to lower extremity injuries (ie, patellofemoral pain), we raise several questions in the following commentary in an effort to clarify the clinical relevance of the findings. Our first comment pertains to the between-group comparisons at baseline. The lack of a detailed description of the statistical analyses used for such comparisons makes it difficult to interpret the reported results. For example, according to Table 2 in the article, the only significant between-group difference was found in the external/internal rotation ratio; however, this variable had the smallest effect size (effect size 0.77). Using the data presented (means, SD, and sample sizes), we performed independent t-tests to estimate the between-group differences and found a discrepancy between our results and 3 of the variables reported in Table 2 of the article: external/internal rotation strength ratio, hip abduction strength, and abduction/adduction strength ratio. This finding is of concern because these 3 hip strength variables appeared in their subsequent logistic regression analysis and were the main emphasis of the manuscript. Our t-test results (Table 1) indicated no significant difference in

Long-term effect of a short interprofessional education interaction between medical and physical therapy students

Medicine is increasingly focused on team‐based practice as interprofessional cooperation leads to better patient care. Thus, it is necessary to teach teamwork and collaboration with other health care professionals in undergraduate medical education to ensure that trainees entering the workforce are prepared to work in teams. Gross anatomy provides an opportunity to expose students to interprofessional education (IPE) early in their training. The purpose of this study is to describe an IPE experience and report if the experience has lasting influence on the participating students. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was administered to first year medical (MD) and physical therapy (PT) students at Mayo Medical School and Mayo School of Health Sciences. Results demonstrated an openness on the part of the students to IPE. Interprofessional education experiences were incorporated into gross anatomy courses in both medical and PT curricula. The IPE experiences included a social event, peer‐teaching, and collaborative clinical problem‐solving sessions. These sessions enhanced gross anatomy education by reinforcing previous material and providing the opportunity to work on clinical cases from the perspective of two healthcare disciplines. After course completion, students again completed the RIPLS. Finally, one year after course completion, students were asked to provide feedback on their experience. The post‐curricular RIPLS, similar to the pre‐curricular RIPLS, illustrated openness to IPE from both MD and PT students. There were however, significant differences in MD and PT perceptions of roles and responsibilities. One‐year follow‐up indicated long‐term retention of lessons learned during IPE. Anat Sci Educ 8: 317–323.

Reliability of the dial test using a handheld inclinometer

PurposeThe 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/methodsTwenty-four healthy subjects (22.5xa0±xa02.8xa0years) 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.ResultsIntra-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°.ConclusionsThis 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 evidenceIII.

Does fair play reduce concussions? A prospective, comparative analysis of competitive youth hockey tournaments

Background/aim To determine if Boys Bantam and Peewee and Girls U14 sustain fewer concussions, head hits, ‘other injuries’ and penalties in hockey tournaments governed by intensified fair play (IFP) than non-intensified fair play (NIFP). Methods A prospective comparison of IFP, a behaviour modification programme that promotes sportsmanship, versus control (non-intensified, NIFP) effects on numbers of diagnosed concussions, head hits without diagnosed concussion (HHWDC), ‘other injuries’, number of penalties and fair play points (FPPs). 1514 players, ages 11–14u2005years, in 6 IFP (N=950) and 5 NIFP (N=564) tournaments were studied. Results Two diagnosed concussions, four HHWDC, and six ‘other injuries’ occurred in IFP tournaments compared to one concussion, eight HHWDC and five ‘other injuries’ in NIFP. There were significantly fewer HHWDC in IFP than NIFP (p=0.018). However, diagnosed concussions, ‘other injuries’, penalties and FPPs did not differ significantly between conditions. In IFP, a minority of teams forfeited the majority of FPPs. Most diagnosed concussions, HHWDC, and other injuries occurred to Bantam B players and usually in penalised teams that forfeited their FPPs. Conclusions In response to significant differences in HHWDC between IFP and NIFP tournaments, the following considerations are encouraged: mandatory implementation of fair play in regular season and tournaments, empowering tournament directors to not accept heavily penalised teams, and introducing ‘no body checking’ in Bantam.

Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis

Objective: This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment. Methods: The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments. Main Results: Sport-related head trauma has marked physiologic, pathologic, and psychological consequences for athletes. Although animal models have been used to simulate head trauma for pharmacologic testing, the current diagnosis and subsequent treatment in athletes still rely on an athletes motivation to report or deny symptoms. Bias-free, objective diagnostic measures are needed to guide quantification of concussion severity and assessment of treatment effects. Most of the knowledge and management guidelines of concussion in ice hockey are generalizable to other contact sports. Conclusions: There is a need for an objective diagnosis of SRC that will quantify severity, establish a prognosis, and provide effective evidence-based treatment. Potential methods to improve concussion diagnosis by health care providers include a standardized concussion survey, the King–Devick test, a quantified electroencephalogram, and blood analysis for brain cell-specific biomarkers.

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

PurposeAssessment 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.MethodsTwenty-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.ResultsThere 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°.ConclusionsClinical 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.Level of evidenceIII.

Ice hockey summit II: Zero tolerance for head hits and fighting

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, (2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, (4) Updates in Equipment: Their Relationship to Industry Standards, and (5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: (1) eliminate head hits from all levels of ice hockey, (2) change body checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Ice Hockey Summit II: Zero Tolerance for Head Hits and Fighting

To present currently known basic science and on‐ice influences of sport related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC.