Risk Factors Associated with First Time and Recurrent Shoulder Instability: A Systematic Review.

Background: Shoulder instabilities constitute a large proportion of shoulder injuries and have a wide range of presentations. While evidence regarding glenohumeral dislocations and associated risk factors has been reported, less is known regarding the full spectrum of instabilities and their risk factors. Purpose: The purpose of this systematic review was to identify modifiable risk factors to guide patient management decisions with regards to implementation of interventions to prevent or reduce the risk of shoulder instability. Study Design: Systematic Review. Methods: A systematic, computerized search of electronic databases (CINAHL, Cochrane, Embase, PubMed, SportDiscus, and Web of Science) was performed. Inclusion criteria were: (1) a diagnosis of shoulder instability (2) the statistical association of at least one risk factor was reported, (3) study designs appropriate for risk factors, (4) written in English, and (5) used an acceptable reference standard for diagnosed shoulder instability. Titles and abstracts were independently screened by at least two reviewers. All reviewers examined the quality studies using the Newcastle-Ottawa Scale (NOS). At least two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics with risk factors. Results: Male sex, participation in sport, hypermobility in males, and glenoid index demonstrated moderate to large risk associated with first time shoulder instability. Male sex, age \<30 years, and history of glenohumeral instability with concomitant injury demonstrated moderate to large risk associated with recurrent shoulder instability. Conclusion: There may be an opportunity for patient education in particular populations as to their increased risk for suffering shoulder instability, particularly in young males who appear to be at increased risk for recurrent shoulder instability. Level of Evidence: Level III.

Prematriculation Predictors of Academic Difficulties During the First Year of a Doctor of Physical Therapy Program.

PURPOSE: To analyze the ability of pre-matriculation metrics to predict difficulties during the first year of a Doctor of Physical Therapy (DPT) program with a pass-fail grading system. METHODS: Undergraduate cumulative, science, and pre-requisite grade point averages (GPAs) and verbal and quantitative Graduate Record Examination (GRE) percentiles were collected during the admissions process of 190 students in an accredited DPT program at a southeastern US private university between 2019-2021. Students were dichotomized to groups with and without academic difficulties in coursework and a first-year comprehensive assessment (CA). Independent t-tests identified differences between groups, and logistic regression analyses identified predictors of academic difficulties. Receiver operating characteristic (ROC) curve analyses were performed to identify cut-off scores and risk ratios were calculated. RESULTS: Students with coursework difficulties had lower verbal (d=0.36, p=0.009) and quantitative (d=0.31, p=0.02) GRE scores. Verbal GRE scores were also lower in students who failed the CA (p=0.049). Students who scored less than the 47th percentile on the verbal GRE were 53% more likely to have academic difficulties and 4.2 times more likely to fail the CA than those who scored in the 70th percentile or higher. CONCLUSION: Verbal GRE percentile best predicted academic difficulty in the first year of a DPT program.

Maximizing Participation During Walking in Children With Disabilities: Is Response to Unpredictability Important?

Walking ability is one of the primary components of human motor function, and interventions aimed at improving walking ability are common in physical therapy, particularly in children. One element encountered in a participatory, or natural, environment is unpredictability, defined as the presence of an unexpected obstacle, stimulus, or alteration of the environmental conditions. Little research has assessed the influence of unpredictability on biomechanical adaptations to walking in children who are developing typically or children with motor disabilities. A variety of impairments may result in an inadequate response to unpredictability, and we propose that there may be a relationship between response to an unpredictable visual cue and mobility-based participation.