Search Results (12)

Background: Instrument-assisted soft-tissue mobilization (IASTM) is a popular myofascial intervention used by healthcare professionals. Despite the growing body of research evidence, there is still a gap in understanding what healthcare professionals consider as treatment precautions or contraindications. To date, no consensus on precautions and contraindications has been established among IASTM experts. The purpose of this modified Delphi survey was to determine IASTM precautions and contraindications among international IASTM experts. Methods: A three-round Delphi study of 24 international IASTM experts was conducted. In round 1, experts chose from a list of 81 medical conditions and treatment considerations that could be a concern for IASTM treatment. Consensus was considered if more than 70% of experts agreed on an item. Round 2 included the updated list of 39 items, and the experts decided if each item should be a precaution, contraindication, or both. The strength of agreement grade scale was used to rank the precautions and contraindications, by the level of expert agreement using grades A-D (e.g., A-strong, B-moderate, C-weak, D-both). Grade D conditions could potentially be both a precaution and contraindication. In round 3, the final list of categories and items was presented to the experts for final approval. Results: All recruited experts (n = 24) participated in the three rounds and the final list of items received 100% approval. Contraindications had the highest number of conditions (n = 16) across the strength of agreement grade categories A–C followed by category D (both) (n = 8). Discussion: This Delphi study was the first survey to document expert consensus on precautions and contraindications based upon the strength of agreement. This study offers a beginner’s guide for clinicians to safely implement IASTM by establishing required precautions and contraindications through consensus agreement. Conclusions: This survey should be the first step in a series of planned IASTM studies on precautions and contraindications to establish the best-practice recommendations for the application of IASTM in clinical practice. Full article

Background: Student-athletes and competitive dancers experience significant physical, psychological, and emotional stress, often coupled with academic and social pressures. These stressors may lead to unhealthy coping mechanisms, negatively impacting mental health, quality of life, and athletic performance. While assessing mental illness is important, measuring positive mental health (PMH) can offer valuable insights into overall well-being and resilience. The positive mental health Instrument (PMHI) was developed to assess PMH, but its psychometric properties in student-athletes and competitive athletes have not been explored. Methods: Collegiate student-athletes and competitive dancers completed a survey, including the PMHI-19 and a demographic questionnaire. Confirmatory factor analysis (CFA) was conducted to assess the factor structure of the PMHI-19. An exploratory factor analysis (EFA) was then conducted to identify a more parsimonious structure. Results: The CFA of the PMHI-19 did not meet recommended model fit indices. EFA resulted in two different parsimonious models: a 4-factor, 11-item model (PMHI-11) and a 3-factor, 9-item model (PMHI-9), both meeting recommended fit indices. Conclusions: The condensed PMHI-11 and PMHI-9 models may be more suitable for use in collegiate athletic populations. Further research is needed to refine these instruments and explore their applicability across diverse athletic groups. Full article

Background/Objectives: Few studies have assessed barriers to providing care from the perspective of interprofessional healthcare providers. Despite Idaho’s predominantly rural geography, limited research exists assessing barriers to providing care within the state. This study sought to assess barriers to providing optimal healthcare using a sample of 400 healthcare providers at 22 clinic sites across the state. Methods: A barriers to providing optimal care 9-factor, 41-item survey was modified from an existing survey. Healthcare providers rated barrier items using an 11-point Likert scale. The survey was distributed to a convenience sample of healthcare providers in 22 different clinic sites in rural Idaho. Results: Four hundred interprofessional healthcare providers in Idaho across 13 professional disciplines completed surveys. Items in the Service Access (mean = 7.14), Patient Complexity (mean = 6.59), and Resource Limitations (mean = 6.18) factors were reported as the most commonly perceived barriers to providing optimal care. Conclusions: Few studies have assessed rural interprofessional providers’ perceived barriers to providing optimal, high-quality, care, specifically in the rural state of Idaho, where healthcare services are often not equitable compared to urban regions. The results suggest that commonly perceived barriers exist throughout the state, particularly Service Access, Patient Complexity, and Resource Limitations. Further research is needed to develop data-driven decisions to address these concerns. Full article

Background: The prevalence of mental health disorders calls for valid and reliable instruments that are easy to administer and assess for clinicians and researchers. The Depression Anxiety Stress Scale-21 (DASS-21) is a commonly used instrument to assess psychological distress; however, model fit and internal reliability issues have been reported. Our objective was to assess the factorial and structural validity of the DASS-21. Methods: A confirmatory factor analysis (CFA) was conducted on the full sample (n = 1036) to assess the proposed three-factor DASS-21 using a priori cut-off values. Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting three-factor structure (i.e., DASS-9) was then assessed using CFA and multigroup invariance testing procedures. Results: The proposed three-factor DASS-21 did not meet model fit criteria. The DASS-9 did meet recommended model fit criteria and was invariant between sex, injury status, mental health diagnosis, and activity level groups. Statistically different group means were found between mental health diagnosis and activity level groups, while no differences between sex or injury status groups were found. Conclusions: The current study provides support to use a condensed DASS-21 instrument, such as the DASS-9. Future research is necessary to establish the DASS-9 prior to its adoption in research and clinical practice. Additionally, there is a need to identify and review all condensed versions of the DASS-21, so individuals know which instrument can be used for clinical or research purposes. Full article

Hip Disability and Osteoarthritis Outcome Survey (HOOS) was developed as a region- and disease-specific outcome to assess hip disability. Despite the use of the HOOS in clinical practice and research, psychometric analyses of the scale in a large dataset of patients have not been performed. As such, the purposes of this study were to assess the structural validity of the HOOS in patients who underwent a total hip arthroplasty. Data were obtained from the Surgical Outcome System (SOS) global registry. Confirmatory factor analysis (CFA) was conducted to assess the scale structure of the 40-item HOOS and exploratory factor analysis (EFA) was conducted to identify a parsimonious scale structure. The parsimonious model identified was subjected to multi-group and longitudinal invariance testing and LGC modeling. The original five-factor, 40-item HOOS did not meet recommended model fit indices values (CFI = 0.822, TLI = 0.809, IFI = 0.822, RMSEA = 0.085). Alternate model generation identified an alternative model (i.e., HOOS-9). Sound model fit was identified for the HOOS-9 (CFI = 0.974, TLI = 0.961, RMSEA = 0.046). Invariance testing criteria were also met between groups (i.e., age and sex) and across time. Lastly, a nonlinear growth trajectory was identified in responses pertaining to hip disability. The original scale structure of the 40-item HOOS was not supported. The HOOS-9 met contemporary model fit recommendations, along with multi-group and longitudinal invariance testing. Our findings support the preliminary use of the HOOS-9 to assess hip function and disability in research and clinical practice. Full article

This study investigated the association between self-compassion and psychological pain across various demographic variables. Using canonical correlation analysis, we observed an inverse relationship between the combined factors of the Self-Compassion Scale (SCS) and the Orbach and Mikulincer Mental Pain Scale (OMMP-8). Subgroup analyses revealed differences in SCS subscales among demographic groups with females, individuals with mental health diagnoses, and non-athletes displaying higher scores on negative SCS subscales and PsyPn. Injury status did not significantly affect self-compassion levels, although injured individuals scored higher on the irreversibility subscale of PsyPn. Negative SCS factors exhibited larger group differences and stronger correlations with PsyPn, indicating the potency of negative thinking in influencing psychological pain. These findings underscore the importance of self-compassion in mental health and suggest potential implications for intervention strategies. Full article

Limited U.S. research has been conducted examining factors affecting healthcare provider recruitment in rural settings, necessitating community-level investigations due to community differences. The aim of this study was to explore the factors involved in healthcare provider recruitment in a rural community in Northern Idaho. A retooled version of the Nursing Community Apgar Questionnaire (NCAQ) was used to collect data from 50 healthcare providers to assess items influencing provider recruitment. Items were categorized into five factors: geographic, economic, scope of practice, medical support, and facility and community support classes. Healthcare providers ranked items based on perceived importance and how advantageous or challenging it was to recruitment. A “Community Apgar” score is a composite score calculated using the advantage/challenge and importance scores. In our sample, medical support was rated as the most important class. Additionally, facility and community support was rated as the highest advantage class and had the most impactful Apgar scores, meaning it contained the most important advantage and challenge. Our findings suggest that these classes contain dominant factors related to the recruitment of providers in rural areas. Rural healthcare organizations seeking to improve the recruitment of healthcare providers should consider the potential impact of these factors on their population. Further investigations should be conducted on diverse rural samples across the U.S. to enable comparisons of research findings. Full article

The Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) was developed as a short-form survey to measure progress after total hip arthroplasty (THA). However, the longitudinal validity of the scale structure pertaining to the modified five-item HOOS-JR has not been assessed. Therefore, the purpose of this study was to evaluate the structural validity, longitudinal invariance properties, and latent growth curve (LGC) modeling of the modified five-item HOOS-JR in a large multi-site sample of patients who underwent a THA. A longitudinal study was conducted using data from the Surgical Outcome System (SOS) database. Confirmatory factor analyses (CFAs) were conducted to assess the structural validity and longitudinal invariance across five time points. Additionally, LGC modeling was performed to assess the heterogeneity of the recovery patterns for different subgroups of patients. The resulting CFAs met most of the goodness-of-fit indices (CFI = 0.964–0.982; IFI = 0.965–0.986; SRMR = 0.021–0.035). Longitudinal analysis did not meet full invariance, exceeding the scalar invariance model (CFI_DIFF = 0.012; χ²_DIFF test = 702.67). Partial invariance requirements were met upon release of the intercept constraint associated with item five (CFI_DIFF test = 0.010; χ²_DIFF = 1073.83). The equal means model did not pass the recommended goodness-of-fit indices (CFI_DIFF = 0.133; χ²_DIFF = 3962.49). Scores significantly changed over time, with the highest scores identified preoperatively and the lowest scores identified at 2- and 3-years postoperatively. Upon conclusion, partial scalar invariance was identified within our model. We identified that patients self-report most improvements in their scores within 6 months postoperatively. Females reported more hip disability at preoperative time points and had faster improvement as measured by the scores of the modified five-item HOOS-JR. Full article

Patient-Reported Outcome Measures (PROMs), such as the six-item International Knee Documentation Committee Subjective Knee Form (IKDC-6), play a crucial role in assessing health conditions and guiding clinical decisions. Latent Growth Modeling (LGM) can be employed to understand recovery trajectories in patients post-operatively. Therefore, the purpose of this study was to assess LGM properties of the IKDC-6 in patients with knee pathologies that require surgical intervention and to assess differences between subgroups (i.e., sex and age). A cross-sectional study was conducted using the Surgical Outcome System (SOS) database with patients who had undergone knee arthroscopy. Our results found that preoperative scores did not influence the rate of change overtime. Perceived knee health improved over time, with varying rates among individuals. The adolescent age subgroup and male subgroup exhibited faster recovery rates compared to the older age subgroup and female subgroup. While initial hypotheses suggested IKDC-6 could serve as a prognostic tool, results did not support this. However, results indicated favorable outcomes irrespective of preoperative perceived knee impairment levels. This study provides valuable insights into recovery dynamics following knee surgery, emphasizing the need for personalized rehabilitation strategies tailored to individual patient characteristics. Full article

Instrument-assisted soft tissue mobilization (IASTM) techniques use specialized hand-held instruments for applying controlled mechanical forces to the body with the goal of facilitating healing, improving range of motion, and reducing pain. Nevertheless, an optimal range of forces for achieving clinical outcomes has yet to be established. A barrier to advancing research on IASTM force optimization is the lack of commercially available instruments that quantify treatment forces. The aim of the current study was to assess the feasibility of attaching a flexible force sensor to a commercially available IASTM instrument to obtain valid force measurements. The validity of this novel approach was assessed by comparing data between the flexible force sensor and a force plate during a simulated treatment. Intraclass correlation coefficients, linear regression models, and Bland Altman plots all indicated excellent agreement between the force plate and flexible sensor when the instrument was used at 45°, 65°, and 90° treatment angles. Agreement between measures decreased when the instrument was held at 30°. Thus, commercially available instruments with attached sensors could make force measurement more accessible and feasible for a wider range of research settings, facilitating the advancement of IASTM research and ultimately informing clinical decision-making to improve patient care. Full article

Background: The Knee Injury and Osteoarthritis Outcome Score (KOOS) scale is used to assess patient perspectives on knee health. However, the structural validity of the KOOS has not been sufficiently tested; therefore, our objective was to assess the KOOS in a large, multi-site database of patient responses who were receiving care for knee pathology. Methods: A cross-sectional study was conducted using the Surgical Outcome System (SOS) database. A confirmatory factor analysis (CFA) was conducted to assess the proposed five-factor KOOS using a priori cut-off values. Because model fit indices were not met, a subsequent exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting four-factor structure (i.e., KOOS SF-12) was then assessed using CFA and subjected to multigroup invariance testing. Results: The original KOOS model did not meet rigorous CFA fit recommendations. The KOOS SF-12 did meet model fit recommendations and passed all invariance testing between intervention procedure, sex, and age groups. Conclusion: The KOOS failed to meet model fit recommendations. The KOOS SF-12 met model fit recommendations, maintained a multi-factorial structure, and was invariant across all tested groups. The KOOS did not demonstrate sound structural validity. A refined KOOS SF-12 model that met recommended model fit indices and invariance testing criteria was identified. Our findings provide initial support for a multidimensional KOOS structure (i.e., KOOS SF-12) that is a more psychometrically sound instrument for measuring patient-reported knee health. Full article

The single leg squat (SLS), forward step down (FSD), and lateral step down (LSD) are clinically reliable movement screens for identifying motion imbalances. The current understanding for the kinematic profiles of each task is limited to discrete time points such as peak knee flexion. However, analyses of the entire movement would better aid clinicians when selecting the appropriate task for rehabilitation or movement screen purposes. The current study used Statistical Parametric Mapping to ascertain differences in the kinematic waveforms for the entire duration of each task. The trunk, pelvis, hip, and knee were analyzed in the sagittal and frontal planes. Data for each variable and task were analyzed from 0–100% of the movement. Primary findings indicated that the FSD provoked a greater magnitude of knee abduction than the SLS and LSD from 26–66% of the movement. The SLS generated the greatest amounts of trunk, pelvic, and hip flexion for the entirety of the movement. The LSD elicited the least amount of ipsilateral trunk lean (90–100%). Thus, the FSD may be optimal for assessing frontal plane knee motion as a screen for injury risk, while the SLS has potential to place increased sagittal plane demand on the muscles of the hip. Full article