Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults.

BACKGROUND: Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established. PURPOSE: This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based. STUDY DESIGN: This was a quasi-experimental cross-sectional study. METHODS: Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation. RESULTS: A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function. CONCLUSIONS: CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.

Ethical leadership in physical therapy: a developing construct that demands consideration.

PURPOSE: This paper aims to introduce the Theory of Ethical Leadership as a possible means of actualizing the mission and vision statements of the American Physical Therapy Association as well as individual professional objectives. Specific examples of how this can be applied directly to the profession of physical therapy will be presented. DESIGN/METHODOLOGY/APPROACH: Leadership influences can profoundly affect a profession, an organization and an individual. This has led to exploring which leadership style would be most effective in moving their organization forward. Through a review of the literature, this viewpoint paper compares leadership theories present in the health-care literature, as well as why they may fall short of actualizing the mission and vision statements of the American Physical Therapy Association as well as individual professional objectives. FINDINGS: Most research has separated ethics from leadership, but all agree that to be successful, the leader needs to exhibit a strong moral compass and demonstrate positive ethical behavior. At the intersection of ethics and leadership is the emerging theory of ethical leadership. Ethical leadership is based on the premise that employees look outside of themselves for ethical guidance and that leaders have an opportunity to provide this moral awareness by making an ethical message sufficiently salient to be recognized in the organizational context as well as allowing the leader to stand out against an ethically neutral ground. ORIGINALITY/VALUE: This paper is an original work and has not been published previously, either in whole or in part. Additionally, this paper is not under consideration for publication by any other journal.

Impostor phenomenon and ambiguity tolerance in practicing physical therapists: an exploratory correlational study.

Objectives: Investigate the prevalence and contextualize the relationship of impostor phenomenon (IP) and ambiguity tolerance (AT) in practicing physical therapists (PTs). Methods: Online survey including demographic questions, Clance Impostor Phenomenon Scale (CIPS), and Tolerance of Ambiguity Scale (TAS).  Descriptive analyses assessed (N = 422) demographic data, CIPS, and TAS scores. Chi-square tests determined distribution across demographic variables.  Kruskal-Wallis tests assessed differences between CIPS and TAS.  Age was a proxy for career stage in Pearson product-moment correlations to assess relationships between CIPS and TAS. Results: In practicing PTs (M age = 42.12, SD = 12.34), moderate (48.6%; n = 205) to frequent (26.8%; n = 113) IP feelings were prevalent, but only 31.5% (n = 133) were true impostors.  Significant differences exist in clinical experience for CIPS, H(7, n = 422) = 67.82, p <.001 and TAS, H(7, n = 422) = 21.79, p= .003. Most PTs tolerate ambiguity (M = 54.93, SD = 8.19).  A moderate negative correlation between age and CIPS, r = -.36, p <.001 and a small negative correlation between age and TAS, r=-.19, p <.001 exists. Age accounts for 13% of the variance per IP and 3.6% variance per TAS score.  A small positive relationship exists between CIPS and TAS, r = .10, p <.05. Conclusions: Practicing PTs experience moderate to frequent IP and are ambiguity tolerant.  Clinical experience is inversely related to IP and AT.  Almost half of early-career PTs feel like impostors, which can lead to decreased job satisfaction, burnout, psychological distress, feelings of self-doubt, and depression.

Social Power and the Movement System: Why and How Physical Therapists Might Influence the Upstream Currents of Health.

Social determinants of health are an emerging focus within physical therapist practice, research, education, and advocacy as a necessary condition for movement system health disparities. Fundamental cause theory suggests that the sociopolitical environment sets the context for individuals' socioeconomic positioning, which determines the availability of resources that are necessary for groups and individuals to maintain health. These resources include knowledge, money, power, prestige, and social connections. Yet, it is the hierarchical organization of society that dictates both the availability of socioeconomic resources and the ability of patients and clients to use those resources to promote and maintain movement system health. The presence of social hierarchies indicates the need for physical therapists to consider social power as a key determinant of movement system health. Consideration of social power in clinical initiatives and advocacy agendas would provide a framework for physical therapists to begin the dynamic, and often, adversarial process of breaking down social hierarchies and redistributing social power, rather than simply redistributing socioeconomic resources, in pursuit of societal transformation and community-building. This Perspective discusses social power as the fundamental driver of movement system health inequalities and explores the effects of social power on exposure, susceptibility, experience, and recovery related to movement system pathology-including the influence of social power on the ability of people to acquire socioeconomic resources and convert them to health-relevant resources. This perspective concludes with recommendations for physical therapists to identify and dismantle inequalities in social power through structural competency.

Beyond "Exercise as Medicine" in Physical Therapy: Toward the Promotion of Exercise as a Public Good.

Physical therapists are uniquely positioned through their knowledge and skills to help people become more physically active, which may reduce the consequences of physical inactivity for health-related quality of life and the global economy. The "Exercise Is Medicine" campaign was introduced in 2007. It holds that exercise may be prescribed like a medicine. Although this analogy doubtlessly has promoted innumerable life-changing conversations between clinicians and patients, there are important shortcomings to considering physical activity and exercise as medicine. In the United States, many of these shortcomings relate to how medical services are provided and remunerated. Medical care is provided in the context of exclusive groups, which are established by insurance, preferred service populations, or other characteristics that determine a basis for providing care. Exclusivity means that medical care is frequently provided in a type of club. The club structure of medical care jeopardizes the ability of nonmembers to benefit. Medical care clubs based on payment create an environment in which nonpaying customers may not benefit in the same manner as paying customers from approaches that consider exercise prescribed as medicine. This clinical perspective reviews the characteristics of exercise as a good, focusing on how it is prescribed by physical therapists. It discusses how physical therapists may become involved in the process of making exercise a public good by reducing its exclusivity. Multiple levels of involvement are recommended at the societal, community, and individual levels. These involvements may be guided by an existing construct proposed by the World Health Organization, which would bring the global physical therapy profession into a common alignment. This Perspective concludes with a discussion that anticipates the shortcomings of conceptualizing exercise as a public good to be addressed in future service delivery models.

Reliability and Validity of the ActivForce Digital Dynamometer in Assessing Shoulder Muscle Force across Different User Experience Levels.

Background: Currently available hand-held dynamometers (HHD) offer a more objective and reliable assessment of muscle force production as compared to a manual muscle test (MMT). Yet, their clinical utility is limited due to high cost. The ActivForce (AF) digital dynamometer is a new low-cost HHD with unknown psychometric properties, and its utilization may benefit clinical practice. Hypothesis/Purpose: This study aimed to determine the AF intra- and inter-tester reliabilities, standard error of measurement (SEM), minimal detectable change (MDC), and criterion validity for assessing shoulder isometric force as compared to the microFET2 (MF2) across testers with different experiences. Design: Descriptive observational study. Methods: A convenience sample of 29 healthy adults were assessed twice by each of three testers (two experienced clinicians and a novice PT student) on shoulder external rotation (ER), internal rotation (IR), and forward elevation (FE) using both the AF and MF2 devices. Tester, HHD, and shoulder motion assignment orders were randomized. All testing was performed in a standardized seated position. ER and IR were tested with the shoulder fully adducted. FE was tested at 45° at the scapular plane. All testing and rest periods between testers and tested motions were standardized and monitored via a stopwatch. Results: Both devices had high intra- [ ER (.95-.98), IR (.97 - .99), FE (.96 - .99)] and inter-tester [ ER (.85-.96), IR (.95 - .97), FE (.88 - .95)] intraclass correlation coefficient (ICC) with comparable intra- (1.68-1.80) and inter-tester (2.36-2.98) SEM, and intra- (4.64-4.97) and inter-tester (6.50-8.24) MDC values across all motions. Tester experience did not affect these values. High (.89-.93) statistically significant Pearson correlations were found between HHDs for all shoulder motions. Conclusion: Both the AF and MF2 HHDs were found to have high reliability levels across all shoulder motions regardless of tester clinical experience. The AF was also found to be valid for measuring shoulder isometric force production compared to the criterion standard device, the MF2. Its low-cost and electronic accessibility features may promote better compliance for clinicians using dynamometry to objectively assess and store muscle force data in a cost-effective manner. Level of Evidence: 3.

The use of mastoid vibration with canalith repositioning procedure to treat persistent benign paroxysmal positional vertigo: A case report.

The Canalith Repositioning Procedure (CRP) was originally described as a non-invasive treatment for Benign Paroxysmal Positional Vertigo (BPPV) by Epley. Since its inception, the maneuver has undergone several modifications; and currently is performed in the absence of induced mastoid vibration (oscillation). Clinically, mastoid vibration may be used to assist in treatment of persistent cases of BPPV, where a simple CRP may fail to improve symptoms. This case describes a patient with a three-month history of BPPV (right posterior canalithiasis), who was previously treated unsuccessfully with standard CRP. Mastoid vibration was introduced as part of the treatment due to persistent BPPV. After one treatment utilizing CRP with mastoid vibration, the patient had complete resolution of symptoms, and remained symptom free at a six-month follow-up. It can be concluded that introducing mastoid oscillation via vibration to the CRP in persistent cases of semicircular canalithiasis BPPV may produce positive patient outcomes.