Simulated cost-effectiveness of a novel precision-guided dosing strategy in adult patients with Crohn's disease initiating infliximab maintenance therapy.

BACKGROUND: Patients with Crohn's disease (CD) who lose response to biologics experience reduced quality of life (QoL) and costly hospitalizations. Precision-guided dosing (PGD) provides a comprehensive pharmacokinetic (PK) profile that allows for biologic dosing to be personalized. We analyzed the cost-effectiveness of infliximab (IFX) PGD relative to two other dose intensification strategies (DIS). METHODS: We developed a hybrid (Markov and decision tree) model of patients with CD who had a clinical response to IFX induction. The analysis had a US payer perspective, a base case time horizon of 5 years, and a 4-week cycle length. There were three IFX dosing comparators: PGD; dose intensification based on symptoms, inflammatory markers, and trough IFX concentration (DIS1); and dose intensification based on symptoms alone (DIS2). Patients that failed IFX initiated ustekinumab, followed by vedolizumab, and conventional therapy. Transition probabilities for IFX were estimated from real-world clinical PK data and interventional clinical trial patient-level data. All other transition probabilities were derived from published randomized clinical trials and cost-effectiveness analyses. Utility values were sourced from previous health technology assessments. Direct costs included biologic acquisition and infusion, surgeries and procedures, conventional therapy, and lab testing. The primary outcomes were incremental cost-effectiveness ratios (ICERs). The robustness of results was assessed via one-way sensitivity, scenario, and probabilistic sensitivity analyses (PSA). RESULTS: PGD was the cost-effective IFX dosing strategy with an ICER of 122,932 $ per quality-adjusted life year (QALY) relative to DIS1 and dominating DIS2. PGD had the lowest percentage (1.1%) of patients requiring a new biologic through 5 years (8.9% and 74.4% for DIS1 and DIS2, respectively). One-way sensitivity analysis demonstrated that the cost-effectiveness of PGD was most sensitive to the time between IFX doses. PSA demonstrated that joint parameter uncertainty had moderate impact on some results. CONCLUSIONS: PGD provides clinical and QoL benefits by maintaining remission and avoiding IFX failure; it is the most cost-effective under conservative assumptions.

The Acute Effects in Postural Sway as a Result of Self-Myofascial Release on the Lower Extremities in Collegiate Female Athletes.

Myofascial release is a popular therapy technique used to manipulate connective muscle tissue to become more pliable. The maintenance of body posture relies on mechanoreceptors located in connective tissue, thus manipulation of connective tissue should affect postural control. The effects of this phenomenon have not been well studied, leaving room for this investigation. PURPOSE: To observe if postural sway scores changed before and after foam rolling proximal (quadriceps and hamstrings) in comparison to distal (calves) muscles. METHODS: Thirty-six, college-aged female athletes (age 20.39 ± 0.25 years, mass 68.70 ± 1.97 kg, height 170.18 ± 1.56 cm.) performed approximately two and one-half minutes of moderate intensity foam rolling to their calves (n = 19, Group A) or to their hamstrings and quadricep muscle (n = 17, Group B). Center of Pressure (CoP) and Limit of Stability (LoS) testing was assessed both pre- and post-foam rolling using a computerized posturography balance plate. CoP sway was measured under both eyes open (EO) and eye closed (EC) Conditions on both stable and unstable surfaces. LoS was measured in the Anterior, Posterior, Left, and Right Directions. Effects of foam rolling on CoP and LoS were assessed using a repeated-measures MANOVA (α = 0.05). RESULTS: Eyes Open Stable Surface had the lowest postural sway (p = 0.001). However, CoP did not differ for any condition either between Groups (p ≥ 0.6) or from pre- to post-foam rolling (p = 0.3). LoS significantly differed between Directions such that LoS was greater in the frontal plane than in the sagittal plane (p = 0.011). There was also a significant Time X Group X Direction interaction effect (p = 0.001) such that LoS for Group A decreased after foam rolling (mean change = -1.621 cm) but increased for Group B after foam rolling (mean change = + 0.878 cm). No differences were found for any other Direction (p ≥ 0.1). CONCLUSION: This study demonstrated CoP and LoS improvements between the two groups based on acute effects of foam rolling intervention. Further research is suggested to determine if long-term gains are observed within or between groups.

Real-world impact of infliximab precision-guided dosing on management of patients with IBD.

OBJECTIVES: Evaluate the clinical utility of a precision-guided dosing test for infliximab (IFX) and its impact on treatment decision-making for inflammatory bowel disease (IBD). STUDY DESIGN: Prospective, multisite, clinical experience program. METHODS: Health care providers were given access to PredictrPK IFX, a precision-guided dosing test, for their patients with IBD on maintenance IFX therapy. Blood samples were drawn 20 to 56 days post infusion. A Bayesian data assimilation tool used clinical and serologic data to generate individual pharmacokinetic profiles and forecast trough IFX. Results were reported to providers to aid in-therapy management decisions and the decision-making process was assessed through questionnaires. Relationships between forecasted IFX concentration, disease activity, and therapy management decisions were analyzed by logistic regression. RESULTS: PredictrPK IFX was used for 275 patients with IBD by 37 providers. In 58% of cases, providers modified treatment plans based on the results, including dose modifications (41%; of these, one-third decreased dose) and discontinuation (8%) of IFX. Of the 42% where treatment was not modified, 97.5% had IFX levels of 5 µg/mL or greater. Patients with IFX concentrations less than 5 µg/mL were 3 and 7.3 times more likely to have active disease or discontinue IFX, respectively. There was unanimous agreement among providers who completed a postprogram survey that PredictrPK IFX was beneficial in guiding treatment decisions and added more value to their practice than routine therapeutic drug monitoring. CONCLUSIONS: PredictrPK IFX enables earlier and more precise dose optimization of IFX in patients with IBD, exerting a substantial impact on treatment decisions that may result in improved health outcomes and overall cost savings.

Strengthening mental health research outcomes through genuine partnerships with young people with lived or living experience: A pilot evaluation study.

BACKGROUND: Despite increasing support for stakeholder inclusion in research, there is limited evaluative research to guide safe (i.e., youth-friendly) and meaningful (i.e., non-tokenistic) partnerships with young people with lived experience of mental ill-health in research. This paper describes a pilot evaluation and iterative design of a Youth Lived Experience Working Group (LEWG) protocol that was established by the Youth Mental Health and Technology team at The University of Sydney's Brain and Mind Centre, based on the results of two studies. METHODS: Study one consisted of a pilot evaluation of the extent to which youth partners felt empowered to contribute, to qualitatively explore how LEWG processes could be improved. Youth partners completed online surveys, and results were shared over two LEWG meetings in 2021 to empower youth partners to collectively identify actions of positive change regarding LEWG processes. These meetings were audio-recorded and transcripts were subsequently coded using thematic analysis. Study two assessed whether LEWG processes and proposed improvements were acceptable and feasible from the perspective of academic researchers via an online survey in 2022. RESULTS: Quantitative and qualitative data collected from nine youth partners and 42 academic researchers uncovered initial learnings regarding facilitators, motivators, and barriers to partnering with young people with lived experience in research. Implementing clear processes for youth partners and academic researchers on effective partnership strategies, providing training opportunities for youth partners to develop research skills, and providing regular updates on how youth partner contributions led to research outcomes were identified as key facilitators. CONCLUSIONS: This pilot study provides insight into a growing international field on how to optimise participatory processes so that researchers and young people with lived experience can be better supported and engaged to make meaningful contributions to mental health research. We argue that more transparency is needed around participatory research processes so that partnerships with young people with lived experience are not merely tokenistic. CONSUMER CONTRIBUTIONS: Our study has also been approved by and reflects the concepts and priorities of our youth lived experience partners and lived experience researchers, all of whom are authors of this paper.

Tactical vests worn by law enforcement: is this improving stability for optimal job performance?

Objectives. The purpose of this study was to determine whether equipped tactical vests would improve postural stability of law enforcement officers (LEOs) versus a duty belt or without either condition. Methods. Volunteers were police officers (n = 25, 22 males, three females; age 42.4 ± 3.2 years; weight 101.65 ± 19.4 kg; height 178.92 ± 8.2 cm). The Institutional Review Board approved the investigation. A Bertec posturography plate (Bertec Inc., USA) determined four center of pressure (CoP) scores - eyes open stable surface (EOSS), eyes closed stable surface (ECSS), eyes open perturbed surface (EOPS), eyes closed perturbed surface (ECPS) - and four limit of stability (LoS) scores - frontal plane (LoSF), posterior plane (LoSP), left sagittal plane (LoSL), right sagittal plane (LoSR). Results. A repeated-measures multivariate analysis of variance (MANOVA) demonstrated no statistical difference within subject group CoP scores EOSS (p = 0.723), ECSS (p = 0.252), EOPS (p = 0.079) and ECPS (p = 0.137). Comparing between groups, the tactical vest demonstrated significance over the other CoP group conditions with ECPS (p = 0.001). The duty belt group showed significance with ECSS (p = 0.001). LoS variables indicated no significant results between groups. Conclusion. Tactical vests demonstrated improvements in ECPS scores (p = 0.001) compared to either group.

Vertical transmission of horizontally acquired social information in sticklebacks: implications for transgenerational plasticity.

There is growing evidence that offspring receive information about their environment vertically, i.e. from their parents (environmental parental effects or transgenerational plasticity). For example, parents exposed to predation risk may produce offspring with heightened antipredator defences. At the same time, organisms can gain information about the environment horizontally, from conspecifics. In this study, we provide some of the first evidence that horizontally acquired social information can be transmitted vertically across generations. Three-spined stickleback (Gasterosteus aculeatus) fathers produced larval offspring with altered antipredator behaviour when fathers received visual and olfactory cues from predator-chased neighbours. Although fathers did not personally witness their neighbours being chased (i.e. they never saw the predator), changes in offspring traits were similar to those induced by direct paternal exposure to predation risk. These findings suggest that two different non-genetic pathways (horizontal transfer of social information, vertical transfer via sperm-mediated paternal effects) can combine to affect offspring phenotypes. The implications of simultaneous horizontal and vertical transmission are widely appreciated in the context of disease and culture; our results suggest that they could be equally important for the maintenance of phenotypic variation and could have profound consequences for the rate at which information flows within and across generations.

Treatment Patterns With Antipsychotics in Long-Term Care Patients With Parkinson's Disease Psychosis.

This study assessed treatment change patterns in Parkinson's disease psychosis (PDP) residents receiving antipsychotic (AP) therapies in U.S. long-term care (LTC) facilities. Residents with PDP in LTC between 01/01/13 and 06/30/16 were identified with ≥1 claim of psychosis, hallucinations, or delusions after PD diagnosis. Treatment patterns were evaluated during the 12 months post index. We identified 864 PDP residents: 408 (47.2%) on AP therapy and 456 (52.8%) on no AP therapy. A total of 335 residents (82.1%) continued, 13 (3.2%) discontinued, 11 (2.7%) switched, and 49 (12.0%) augmented (used ≥2 APs) their index AP therapy. Based on the multivariate regression analysis, younger age, male gender, anemia, anxiolytic use or anxiety, sedatives/hypnotic use, bladder disorders including urinary tract infections, coronary conditions, diabetes, hypertension, and dementia were associated with a higher likelihood of treatment change. Understanding the factors associated with treatment change may inform ways to improve management of PDP in the U.S. LTC setting.

Does a relationship between handgrip strength and coincidence anticipation timing exist among young adults: a pilot study.

The purpose of this investigation was to observe whether a strong to moderate relationship exists between maximal handgrip strength best score and best coincidence anticipation timing (CAT) score in young adults. Handgrip strength has demonstrated a strong relationship with high levels of activities of daily living (ADLs) and reduced injury potential. A one-shot case-study design was selected for this investigation. Twenty-three females and one male volunteered for this investigation (age 22.29 ± 4.71 years, height 63.78 ± 6.22 cm, mass 56.66 ± 8.25 kg) from a local higher education institution. Participants (n = 24) utilized the Bassin anticipation timing device (Lafayette Instruments, USA) and a Camry digital hand dynamometer (Model EH101, Camry LLC, El Monte, CA, USA) during the same time and recorded all scores. The Pearson correlation coefficient (r = -0.413; p = 0.04) indicated a medium effect relationship between best maximal handgrip strength and best CAT score.

Is There a Relationship Between Foot Reaction Time and Ankle Frontal Plane Torque in Female Soccer Athletes? A Pilot Study.

The purpose of this study was to determine if a relationship existed between foot reaction time and ankle frontal plane peak torque in female soccer athletes. A one-shot case study design was selected for this investigation. Seventeen female college athletes volunteered to participate. Right and left foot reaction time measurements were assessed using 3×4 switch mats interfaced with a precise timing counter. Participants stood in front of the mat with eyes closed and responded to the auditory stimulus by touching the mat as fast as possible with their foot. Two trials were conducted per foot, and the best time was used to determine the reaction time score per foot. An isokinetic dynamometer assessed inversion and eversion peak torque for both right and left ankle joint at 120°/sec. Left peak torque eversion and right foot reaction time demonstrated a significant negative moderate relationship (r = -0.530; p value = 0.03). Left ankle peak torque eversion does have a significant moderate negative relationship to reaction time of the right foot; therefore, evasive dribbling movements which requires inversion and eversion torque could directly affect foot reaction time, resulting in improved dribbling performance for soccer athletes.

A Preliminary Investigation: Evaluating the Effectiveness of an Occupational Specific Training Program to Improve Lower Body Strength and Speed for Law Enforcement Officers.

Based on current law enforcement officer (LEO) duties, musculoskeletal injury risk is elevated due to the unpredictable nature of physically demanding tasks. The purpose of this 4-week study was to determine the effectiveness of a 15-min post-shift standardized occupational specific training program. The standardized program was designed to improve lower-body strength and speed to aid physically demanding task performance. Seven male LEOs completed the program after their 12-h shift. Subjects were required to use the department fitness center to perform the 15-min standardized program consisting of a dynamic warm-up, 4 sets of 3 repetitions on hex-bar deadlift and four 20-m sprints. Two minutes of rest was required between each set of 3 repetitions on hex-bar deadlift and 1 min of rest between each 20-m sprint. A dependent T-test was used between pre-test and post-test scores for hex-bar deadlift (HBD) and sprint. Data revealed significant improvements in relative lower-body strength with HBD (p ≤ 0.001). However, insignificant results were demonstrated with the 20-m sprint (p ≤ 0.262). In conclusion, a 15-min post-shift workout can improve lower-body strength as measured by the hex-bar deadlift. However, data indicated running speed may require a different training approach to improve the 20-m sprint.

Does a Recumbent Lateral Stability Trainer Improve Balance Scores Among Older Adults Within 4 Weeks?

BACKGROUD: Past literature has shown that balance and strength are important in preventing falls, but few studies have focused on developing strength and power in a lateral plane. The purpose of this study was to determine if a lateral pedal recumbent training device can improve balance scores among older adults in 4 weeks. METHODS: A 2-group experimental-control multivariate design (43 women, 13 men; age, 77.4 ± 3 years; weight, 78.91 ± 0.2 kg; height, 167.13 ± 0.8 cm; body mass index, 28.7 ± 0.5 kg/m) was selected for the study. Participants (n = 56) were divided into 2 groups and were pretested and posttested on a computerized posturography plate to determine center of pressure scores with eyes opened with stable surface (EOSS), with eyes closed with stable surface (ECSS), with eyes open with perturbed surface (EOPS), and with eyes closed with perturbed surface (ECPS). The experimental group used the lateral trainer for 15 minutes, 3 times per week, for 4 consecutive weeks; the control group maintained a sedentary lifestyle. A mixed-effects repeated measures multiple analysis of variance was used to determine significance. RESULTS: There were statistically significant differences over time for EOPS (p = 0.047) and ECPS (p = 0.047). Likewise, there were statistically significant differences for each univariate outcome with EOSS (p = 0.045), ECSS (p = 0.033), EOPS (p = 0.010), and ECPS (p = 0.026). CONCLUSION: A recumbent lateral stability device can improve balance scores among older adults within 4 weeks of training.

Association of Dementia-Related Psychosis With Long-term Care Use and Death.

OBJECTIVE: To determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC); we hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia. METHODS: A retrospective cohort study was performed. Medicare claims from 2008 to 2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of >100 consecutive days, and death. Patients with DRP were directly matched to patients with dementia without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model. RESULTS: We identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ± 8.7 years). Patients with DRP were slightly more likely to be female (71.0% vs 68.3%) and white (85.7% vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for patients without DRP were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (hazard ratio [HR] 2.36, 2.29-2.44) and death (HR 2.06, 2.02-2.10). CONCLUSIONS: DRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase in risk of the need for LTC.

The Effects of a Pedal-less Bicycle Intervention on Stability Scores among Preschool Aged Children.

The purpose of this preliminary investigation was to determine if an intervention program using pedal-less bicycles could improve stability scores among preschool aged children. Currently, there has not been literature demonstrating if this intervention will improve balance scores. Twenty healthy children, aged three to five years old were recruited to determine if pedal-less bicycles would improve balance scores after four weeks. This study used a two group experimental/control repeated measures design analyzed with mixed-effects repeated measures analysis of variances to determine if Center of Pressure (CoP) and Limit of Stability (LoS) scores changed during the four weeks. Significant differences in mean performance were detected in the experimental group for LoS in the anterior plane (p = .012), in the left sagittal (p = 0.010), and in the right sagittal plane (p < 0.001), especially during week three and four. There was evidence of significant associations with pedal-less bicycle riding and mean stability scores in three to five year old children within four weeks of training.

Increases in institutionalization, healthcare resource utilization, and mortality risk associated with Parkinson disease psychosis: Retrospective cohort study.

INTRODUCTION: Patients with Parkinson disease (PD) often develop psychosis (P). The association of PDP with death and long-term custodial care (CC) has not been well studied. METHODS: Medicare Parts A, B, and D data, 2007-2015, were used to define cohorts of PD and PDP patients. PD was defined by ≥ 2 ICD-9-CM codes (332.0x) at least 30, but no more than 365, days apart, and PDP by ≥ 2 codes for psychotic symptoms. Outcomes were CC use, defined as nursing home stays of >100 consecutive days, and death. To compare the association of PDP with outcomes, PDP patients were matched to PD patients without psychosis. RESULTS: Within 1 year of PDP diagnosis, 12.1% of PDP patients used CC, versus 3.5% of non-PDP patients 1 year after the matching date; corresponding percentages at 5 years were 25.8% and 10.0%. Cumulative incidence curves for CC and for death differed significantly (P < 0.0001). PDP was associated with RRs of 3.38 (95% CI, 2.93-3.90) for CC and 1.34 (1.23-1.45) for death. Other factors associated with CC were age (3.57, 2.08-6.14, age ≥90 versus ≤70 years) and female sex (1.37, 1.18-1.58). Female sex was associated with a lower RR for death (0.76, 0.70-0.82). Health care utilization and costs were substantially higher for PDP than for non-PDP patients. CONCLUSION: In PD patients, psychosis was associated with a more than 3-fold increased risk of CC and a nearly one-third increased risk of death. Women entered CC more often than men, likely because they lived longer in the setting of PD.

Does a Relationship Exist Between Lower Body Power and Balance Scores Among Older Adults?

CONTEXT: Falls are the second-leading cause of unintentional injury and death worldwide. OBJECTIVE: To determine if a relationship exists between lower body power scores and center of pressure (CoP) and limits of stability (LoS) scores. METHODS: A one-shot case study design (n = 13) was selected for the investigation. All participants were assessed stability scores via computerized posturography to determine CoP and LoS balance scores. Participants stood on a perturbed surface with their eyes open and closed. An experimental stair ramp with a switch mat timing device was used to determine lower body power scores in watts. RESULTS: There was a strong correlation (r = 0.725, p = 0.005) between the posterior (LoS) plane and relative peak power. An intraclass R revealed a strong correlation among the three trials (R = 0.831) performed on the stair ramp. CONCLUSION: Muscle power output and LoS scores have moderate to strong correlations with balance scores in older adults.

Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence.

BACKGROUND: Patient medication adherence is multidimensional and poses significant concerns to health care professionals. One aspect of adherence is a patient forgetting to take their prescribed medication, which may be improved with reminder packaging (RP). The objective of this analysis was to assess the impact of RP on patient adherence to antihypertensive therapy. METHODS: This retrospective, propensity score-matched study evaluated patients switching to a single-pill combination of valsartan-hydrochlorothiazide in RP compared with patients remaining on the combination without reminder packaging (non-RP). Patients receiving combination therapy between April 1, 2009 and July 31, 2010 were eligible for inclusion. Patients were propensity score-matched on baseline adherence and background demographic variables, including comorbidities. Medication possession ratio, proportion of days covered, time to refill, and time to discontinuation were evaluated as primary measures of subsequent adherence and persistence. RESULTS: In a total of 9266 matched patients (4633 participants in both cohorts), adherence was significantly higher in the RP cohort compared with patients in the non-RP cohort (medication possession ratio, RP 80% versus non-RP 73%; proportion of days covered, RP 76% versus non-RP 63%; both P < 0.001). Refill timing was 10 days for RP patients versus 16 days for non-RP patients (P < 0.001). Similar trends were observed with respect to time to discontinuation (RP 196 days, non-RP 174 days; P < 0.001). A higher proportion of RP patients remained on therapy compared with non-RP patients, with patients in the RP group being 17% less likely to discontinue therapy compared with patients in the non-RP group (hazards ratio 0.833; 95% confidence interval 0.793-0.875). CONCLUSION: This real-world assessment of differences in adherence and persistence rates demonstrated that patients receiving RP were more adherent and persistent with their treatment regimens.

Effects of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes.

Imbalance of the eccentrically-activated external rotator cuff muscles versus the concentrically-activated internal rotator cuff muscles is a primary risk factor for glenohumeral joint injuries in overhead activity athletes. Nonisokinetic dynamometer based strength training studies, however, have focused exclusively on resulting concentric instead of applicable eccentric strength gains of the external rotator cuff muscles. Furthermore, previous strength training studies did not result in a reduction in glenoumeral joint muscle imbalance, thereby suggesting that currently used shoulder strength training programs do not effectively reduce the risk of shoulder injury to the overhead activity athlete. Two collegiate women tennis teams, consisting of 12 women, participated in this study throughout their preseason training. One team (n = 6) participated in a 5-week, 4 times a week, external shoulder rotator muscle strength training program next to their preseason tennis training. The other team (n = 6) participated in a comparable preseason tennis training program, but did not conduct any upper body strength training. Effects of this strength training program were evaluated by comparing pre- and posttraining data of 5 maximal eccentric external immediately followed by concentric internal contractions on a Kin-Com isokinetic dynamometer (Chattecx Corp., Hixson, Tennessee). Overall, the shoulder strength training program significantly increased eccentric external total work without significant effects on concentric internal total work, concentric internal mean peak force, or eccentric external mean peak force. In conclusion, by increasing the eccentric external total exercise capacity without a subsequent increase in the concentric internal total exercise capacity, this strength training program potentially decreases shoulder rotator muscle imbalances and the risk for shoulder injuries to overhead activity athletes.

Concentric internal and eccentric external fatigue resistanc of the shoulder rotator muscles in female tennis players.

BACKGROUND: Shoulder muscle imbalance is a potential shoulder injury risk factor in athletes performing overhead sports. While normative functional peak strength of concentric external to concentric internal shoulder muscle fatigue data is available, comparisons of functional eccentric external to concentric internal shoulder rotator muscle fatigue resistance, which impacts muscle imbalance throughout the duration of play, have not been studied in this population. OBJECTIVES: To assess fatigue resistance of the internal and external shoulder rotator muscles in female tennis players. METHODS: Fifteen female collegiate tennis players were tested bilaterally for shoulder concentric internal and eccentric external peak torque production throughout 20 maximal repetitions on a Kin-Com isokinetic dynamometer. Twelve t - tests were conducted to evaluate for differences in peak torque, relative fatigue ratios, and functional peak torque ratios between extremities and mode of activation during the first, as well as, last five repetitions that were conducted. RESULTS: Non-dominant concentric internal and eccentric external peak torque production significantly decreased throughout the twenty repetitions. Neither dominant concentric internal peak torque decrements and eccentric peak torque decrements were not significantly different across the twenty contractions. These changes in peak torque upon subsequent repetitions resulted in relative fatigue ratios of dominant eccentric external rotation that were significantly greater than non-dominant eccentric external rotation. Relative fatigue ratios of dominant concentric internal rotation did not differ from non-dominant concentric internal rotation. CONCLUSIONS: The data suggest that eccentrically activated external shoulder rotator muscles could possibly adapt to overhead activities by becoming more fatigue resistant.