Association between anthropometric, physical and demographic characteristics and performance among NCAA Division III swimmers.

BACKGROUND: Anthropometric, physical and demographic characteristics have the potential to affect performance in competitive pool swimmers. METHODS: Study aimed were therefore to examine the effect of 26 anthropometric, physical and demographic characteristics on qualification for Nationals and swim times among both male and female collegiate swimmers in separate analyses. Swim times were determined by swimmers' best swim time for their best swim stroke as a percent of the top swim time among Division III collegiate swimmers during the 2017-2018 swim season. RESULTS: Lower body fat measured mid-season and a greater ratio of height to arm span were associated with qualifying for Nationals among females. For males, associations were present for older age, shorter left-hand length and larger left arm circumference; and qualifying for Nationals. In relation to percent of top swim times, there was an association between larger right-hand width and left foot length among males. None of the other associations achieved statistical significance. CONCLUSIONS: Owing to the large number of analyses performed and the resultant likelihood of type I errors as well as the small effect sizes in most statistically significant associations, study results suggest that collegiate swimmers should not be chosen for swim teams based on any of the non-modifiable anthropometric or physical characteristics that were measured in this study. Results suggest however, that swim speed times are decreased among female collegiate swimmers with lower body fat percent when measured mid-season.

The association between self-efficacy on function and pain outcomes among patients with chronic low back pain managed using the McKenzie approach: a prospective cohort study.

INTRODUCTION: Self-efficacy is a determinant of function and pain outcomes in patients with chronic low back pain receiving physiotherapy. The McKenzie approach is an effective intervention for patients with back pain that may affect self-efficacy. Study aims were to determine if, among patients with back pain being managed by McKenzie-credentialed physiotherapists: intake self-efficacy is correlated with intake function and pain; intake self-efficacy is associated with changes in function and pain during treatment; self-efficacy improves during treatment; and improvements in self-efficacy during treatment are associated with improvements in function and pain at discharge. METHODS: Two-hundred-eighty-two subjects with chronic low back pain seen by McKenzie-credentialed clinicians provided data on self-efficacy, function and pain at intake and discharge. RESULTS: Self-efficacy was correlated with function and pain at intake; however, intake self-efficacy was not associated with function or pain outcomes. Self-efficacy increased during treatment. This increase was associated with improvements in function and pain at discharge. CONCLUSION: While intake self-efficacy was associated with function and pain when initiating physiotherapy, it did not result in improved treatment outcomes. Specific interventions may be necessary to improve self-efficacy. The increases in self-efficacy observed during treatment were associated with improvements in function and pain outcomes at discharge.

Accuracy of Functional Movement Screen Deep Squat Scoring and the Influence of Optimized Scoring Criteria: A 3-Dimensional Kinematic Approach.

CONTEXT: The deep squat (DS) test is a component of the functional movement screen, which is used to assess the quality of fundamental movement patterns; however, the accuracy of the DS has not been studied. The DS is a complex, total body movement pattern with evaluation required at several points along the kinematic chain. OBJECTIVE: To assess the accuracy of DS scoring by an athletic trainer, physical therapist, and exercise science professional via a comparative analysis with kinematic data (KD) and to identify scoring criteria that would improve agreement between raters and KD scores. DESIGN: Cross-sectional study. SETTING: Motion analysis laboratory. PARTICIPANTS: A rater from each of 3 movement science disciplines rated the DS of 23 male college athletes (20.3 [1.2] y; 70.5 [3.5] kg). INTERVENTIONS: Subjects were outfitted with reflective markers and asked to perform the DS. The DS performance was scored by 3 raters and kinematic analysis. Subsequently, the optimal set of criteria that minimized the difference between mode rater score and KD was determined via a Nelder-Mead simplex optimization routine. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were calculated using SPSS (version 23; IBM, Armonk, NY) to determine tester agreement with the KD score and between the mode score and KD score. RESULTS: Agreement was poor for the athletic trainer (ICC = .387), physical therapist (ICC = .298), exercise science professional (ICC = .378), and raters' DS scores when compared with the KD. Agreement was poor for the mode score when compared with KD prior to optimization and good following optimization (ICC = .830), thereby allowing identification of specific scoring errors. CONCLUSIONS: Agreement for DS scores is poor when compared with KD; however, it may be improved with optimization of DS scoring criteria.

Cognitive behavioural interventions, and function and pain outcomes among patients with chronic neck pain managed with the McKenzie approach.

OBJECTIVES: Graded activity and graded exposure in vivo are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific neck pain. The McKenzie method is a common treatment approach for patients with neck pain. The study objectives were to examine associations between interventions with graded activity and/or graded exposure, as determined by the treating physiotherapist, and function and pain outcomes for patients with chronic nonspecific neck pain managed by clinicians with credentials in the McKenzie approach. METHOD: A cohort study was carried out, in which subjects (n = 366) with chronic nonspecific neck pain completed intake surveys (i.e., the Neck Functional Status Computerized Adaptive Test and the Numeric Pain Rating Scale), and questions related to their demographic, lifestyle and health status. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Multivariable models examining associations between patients receiving versus not receiving graded activity/graded exposure, and pain and function outcomes were constructed, controlling for potential confounding effects. RESULTS: Despite statistical significance, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and function or pain outcomes. CONCLUSION: There is insufficient evidence to suggest that patients being managed with McKenzie methods will attain clinically relevant improvements in function or pain outcomes when augmenting treatment with graded activity and/or graded exposure when the choice to intervene with these cognitive behavioural approaches is determined by the treating physiotherapist.

Directional preference, cognitive behavioural interventions, and outcomes among patients with chronic low back pain.

OBJECTIVES: Graded activity and graded exposure are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific low back pain. Directional preference identified following the McKenzie method is also associated with favourable patient outcomes. Study objectives were to examine associations between graded activity and/or graded exposure, and directional preference or no directional preference combined with or without graded activity/graded exposure subgroups, and function and pain outcomes among patients with chronic nonspecific low back pain managed by clinicians credentialed in the McKenzie approach. METHOD: Cohort study: Subjects (n = 801) with chronic nonspecific low back pain completed intake surveys, that is, the Lumbar Computer Adaptive Test measuring function and the Numeric Pain Rating Scale measuring pain, and questions addressing their demographic, lifestyle, and health status. Directional preference was determined at intake. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Two models were developed controlling for potential confounding effects. The first model examined associations between patients receiving versus not receiving graded activity/graded exposure. The second model examined interaction effects between four combinations of directional preference and graded activity/graded exposure. Outcome measures were changes in function and pain during rehabilitation. RESULTS: Regarding the first objective, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and functional outcomes. Regarding the second objective, patients in the no-directional preference group were more likely to see benefits from the addition of graded activity/graded exposure to their treatment groups than those with a directional preference. CONCLUSION: Clinicians using McKenzie methods might attain improved patient functional outcomes when augmenting treatment with graded activity and/or graded exposure among patients who do not demonstrate directional preference.

Depression screening by physical therapists: Practices, beliefs, barriers.

BACKGROUND: Depression, a common comorbidity encountered in physical therapy (PT) practice, negatively impacts outcomes. There is limited knowledge of PT practice patterns relative to screening for depression. OBJECTIVE: Objectives were to describe beliefs regarding depression, and identify practice patterns and perceived barriers regarding screening for depression among APTA Board Certified Orthopedic Clinical Specialist (OCS) PTs. METHODS: Surveys were distributed to all PT OCSs in the US; 416 responses were analyzed. Descriptive, univariate and multiple regression analyses were performed. RESULTS: Ninety-five percent of respondents believed that depression has a moderate to high influence on PT outcomes, whereas 68% believed a pre-existing diagnosis of depression influences the plan of care. Most believed that 20% or more of their current patients presented with symptoms of depression. Nevertheless, only 18% formally screen for depression during the initial evaluation. Those with formal depression screening education were 2.3 times more likely to screen at initial examination. Common barriers to screening included lack of department policy, limited knowledge and lack of follow-up resources. CONCLUSIONS: Formal screening did not occur as frequently as expected, given the belief regarding depression's impact on plan of care and outcomes. Addressing barriers may assist in greater compliance with recommended screening guidelines.

Association between centralization and directional preference and functional and pain outcomes in patients with neck pain.

STUDY DESIGN: Retrospective cohort. OBJECTIVES: In subjects with neck pain, the present study aimed (1) to describe the prevalence of centralization (CEN), noncentralization (non-CEN), directional preference (DP), and no directional preference (no DP); (2) to determine if age, sex, fear-avoidance beliefs about physical activity, number of comorbid conditions, or symptom duration varies among subjects who demonstrate CEN versus non-CEN and DP versus no DP; and (3) to determine if CEN and/or DP are associated with changes in function and pain. BACKGROUND: CEN and DP are prevalent among patients with low back pain and should be considered when determining treatment strategies and predicting outcomes; however, these findings are not well investigated in patients with neck pain. METHODS: Three hundred four subjects contributed data. CEN and DP prevalence were calculated, as was the association between CEN and DP, and age, sex, number of comorbid conditions, fear-avoidance beliefs, and symptom duration. Multivariate models assessed whether CEN and DP predicted change in function and pain. RESULTS: CEN and DP prevalence were 0.4 and 0.7, respectively. Younger subjects and those with fewer comorbid conditions were more likely to centralize; however, subjects who demonstrated DP were more likely to have acute symptoms. Subjects who centralized experienced, on average, a 3.6-point (95% confidence interval: -0.3, 7.4) improvement in function scores, whereas subjects with a DP averaged a 5.4-point (95% confidence interval: 0.8, 10.0) improvement. Neither CEN nor DP was associated with pain outcomes. CONCLUSION: DP and, to a lesser extent, CEN represent evaluation categories that are associated with improvements in functional outcomes.

Association between centralization, depression, somatization, and disability among patients with nonspecific low back pain.

STUDY DESIGN: Secondary analysis of a prospective observational cohort study. OBJECTIVES: To evaluate whether depression and somatization subscores of the Symptom Checklist-90-Revised (SCL-90-R), which have been shown to identify chronic disability in individuals with nonspecific low back pain, are applicable to a different population of individuals with low back pain; and to determine if this potential association is confounded by a combination of centralization and subsequent treatment based on centralization. BACKGROUND: To help direct management of patients with nonspecific low back pain, recommendations include performing tests designed to identify psychosocial risk factors predictive of poor patient outcomes. SCL-90-R depression and somatization subscores have been shown to predict chronic disability among patients with low back pain. METHODS: SCL-90-R depression and somatization subscores and data on centralization were collected during the initial physical therapy examination of 231 consecutive patients treated for low back pain in 2 clinics. Disability was assessed by the Oswestry Disability Questionnaire at intake and discharge from physical therapy, and work status was determined by patient self-report at 6 and 12 months after discharge. Pain intensity was assessed by the numeric pain rating scale at the initial visit, and at 6- and 12-month follow-ups. Data were analyzed using logistic regression. RESULTS: Odds ratios for the association between depression and somatization subscores and patient outcomes ranged from 0.76 to 2.93. For analyses in which the data suggested a trend toward an association, the association was less evident following adjustment for centralization and centralization-based treatment. CONCLUSIONS: In our sample, in which all individuals received physical therapy, and those who centralized received interventions based on the direction of centralization, SCL-90-R depression and somatization subscores were moderately associated with chronic pain and disability. This association was reduced when centralization and centralization-based treatment was considered in multivariable analyses.

Does the evidence support the existence of lumbar spine coupled motion? A critical review of the literature.

STUDY DESIGN: Literature review. OBJECTIVES: To synthesize the current literature addressing coupled motion between side bending and rotation in the lumbar spine to determine if a consistent pattern exists across articles. BACKGROUND: [corrected] Low back pain is one of the most common conditions seen in outpatient physical therapy clinics. This condition is often treated with manual therapy techniques. Many approaches to manual therapy incorporate the concept of coupled motion. METHODS AND MEASURES: Using OVID databases, we reviewed and categorized articles published between 1982 and 2006 that addressed coupled motion between side bending and rotation in the lumbar spine. We identified 24 articles in which 32 analyses addressed our clinical question. RESULTS Seventeen of the 24 articles identified concluded that some form of coupled motion exists; however, there was little agreement across articles as to the specific characteristics of coupled motion. CONCLUSIONS: The inconsistency in reported patterns of coupled motion suggests that physical therapists should use caution when applying concepts of coupled motion to the evaluation and treatment of patients with low back pain.

Vertebral deformity, back symptoms, and functional limitations among older women: the Framingham Study.

Vertebral deformity is the most common manifestation of osteoporosis. The purpose of this study was to determine the relation between incident vertebral deformity and back symptoms; and limitations in nine specific functional activities. Subjects were participants in the Framingham Study, a longitudinal, population-based sample involving residents of Framingham, MA, USA. Subjects consisted of 444 surviving female members of the original cohort who had baseline (1968-1975) and follow-up (1992-1993) spine radiographs evaluated for deformity using a semiquantitative scale. Ages ranged from 72 to 96 years. At the follow-up examination, subjects were asked if they experienced pain, aching, or stiffness in their back on most days and if they had difficulty performing nine specific functional skills. We found that incident vertebral deformity was associated with limitations in several functional activities, most notably, pushing or pulling a large object (OR 2.51, 95% confidence interval 1.40, 4.52). For most activities, there was no increase in the risk of functional limitations among women with vertebral deformity who did not report back symptoms at the end of the follow-up compared with those without vertebral deformity or back symptoms. For several functional activities, individuals with both vertebral deformity and back symptoms had greater limitations than would be expected from the additive contribution of both conditions. Back symptoms were associated with limitations in most functional activities, even in the absence of vertebral deformity. Efforts to prevent and treat back pain, independent of vertebral deformity status, might help to reduce functional limitations in older women.

Function and back symptoms in older adults.

OBJECTIVES: To determine the relationship between back symptoms and limitations in nine specific functional activities. DESIGN: A cross-sectional study. SETTING: This study was conducted as part of the Framingham Heart Study, a population-based study performed on a representative sample of community-living residents of Framingham, Massachusetts. PARTICIPANTS: Subjects consisted of 1,007 surviving members of the original cohort who participated in the 22nd Biennial Examination in 1992-93. Ages ranged from 70 to 100. MEASUREMENTS: Subjects were asked whether they experienced pain, aching, or stiffness in their back on most days and whether they had difficulty performing nine specific functional skills. Odds ratios (ORs) and confidence intervals are reported for the entire sample and within categories of sex. The proportion of functional limitations attributable to back symptoms and the proportion of limitations ascribed by subjects to back symptoms among subjects with these limitations are also reported. RESULTS: The results provide evidence of a relationship between back symptoms and functional limitations. ORs were highest for difficulty standing in one place for about 15 minutes, pushing or pulling a large object, and walking half a mile. Of those with back symptoms, 43% to 63% of limitations in activities were due to back symptoms. Among all subjects, back symptoms were so prevalent that 18% to 34% of all functional limitations were attributable to back symptoms. The association between back symptoms and functional limitations was especially strong in women. CONCLUSION: Back symptoms account for a large percentage of functional limitations in older adults, especially in women.