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9. Impact of Prolonged Sport Stoppage on Knee Injuries in High School Athletes: An Ecological Study.

Author

Knapic, Hannah, Shanley, Ellen, Thigpen, Charles A., Prats-Uribe, Albert, Fair, Cynthia D., and Bullock, Garrett S.

Subjects
RISK assessment, MENISCUS injuries, SPORTS, SPORTS injuries, RELATIVE medical risk, ANTERIOR cruciate ligament, DESCRIPTIVE statistics, LONGITUDINAL method, SPORTS participation, SPORTS re-entry, PUBLIC health, CONFIDENCE intervals, KNEE injuries, REGRESSION analysis, COVID-19 pandemic, DISEASE risk factors
Abstract

Context : In March 2020, public health concerns resulted in school closure throughout the United States . The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019-2020 and 2020-2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region . Design : Historical-prospective cohort study . Methods : This historical- prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30,2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years . Results: 94, 847 and 72,521 high school athletes participated in the 2019-2020(19-20) and 2020-2021 (20-21) seasons. Knee injury risk was higher in the 20-21 season (19-20: 28.89% [27.82-29.96-]; 20-21: 33.82% [32.50-35.14]). Risk increased for male athletes from 2019- 2020 to 2020-2021 (19-20: 29.42% [28.01-30.83]; 20-21 : 40.32% [38.89-41.75]). Female knee injury risk was similar between years (19-20: 25.78% [24.29-27.27]; 20-21: 26.03% [24.31-27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1- 1.3], P <.001) during 2020-2021. Conclusions,· Knee injury risk and relative risk increased among males in 2020-2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Risk Adjustment of the Modified Low Back Pain Disability Questionnaire and Neck Disability Index to Benchmark Physical Therapist Performance: Analysis From an Outcomes Registry

Author

Lutz, Adam D., Brooks, John M., Chapman, Cole G., Shanley, Ellen, Stout, Chris E., and Thigpen, Charles A.

Subjects
Usage, Surveys, Patient outcomes, Back pain -- Patient outcomes, Physical therapy -- Usage -- Surveys, Medical research -- Surveys -- Usage, Medical care quality -- Surveys -- Usage, Pain management -- Surveys -- Usage, Surgery, Physical therapists, Neck pain, Disabilities
Abstract

The economic burden of health care in the United States has risen dramatically in the last 50 years. In 2015, health spending accounted for 17.8% of the annual gross domestic [...], Background. Patient-reported outcomes (PROs) have been touted as the ultimate assessment of quality medical care and have been proposed as performance measures after appropriate risk adjustment. Although spine conditions represent the most common orthopedic disorders, the most used PROs for disabilities related to the back and neck--the Modified Low Back Pain Disability Questionnaire (MDQ) and the Neck Disability Index (NDI) -- have not been evaluated as performance measures. Objective. The objective of this study was to benchmark physical therapists' performance in the management of spine conditions not involving surgery through the use of risk-adjusted MDQ and NDI outcomes. Design. This was a retrospective observational study. Methods. Data were accessed for patients seeking physical therapy with no history of related surgery for back or neck pain (315,274 treatment episodes) between January 2015 and June 2018. Patients with complete data, including initial and matched final MDQ or NDI, were considered for analysis (182,276 patients; 2799 physical therapists). Linear models controlling for baseline PRO and patient characteristics predicted PRO change for each patient. An aggregated performance ratio of actual PRO change to predicted PRO change was calculated for each physical therapist, and then empirical bootstrapping was used to develop the median performance ratio and its confidence intervals. Physical therapists who met a 40-patient threshold for either cohort (MDQ or NDI) were classified as 'outperforming,' 'meeting expectations,' or 'underperforming' relative to predicted values using these 95% confidence intervals. Results. Performance ratios indicated that 10% and 11% of physical therapists outperformed, 79% and 78% met expectations, and 11% and 11% underperformed relative to the risk-adjusted predicted change in the MDQ (1240 therapists; 97,908 patients) and NDI (461 therapists; 26,123 patients), respectively. To demonstrate the clinical importance of risk adjustment, clinical performance was evaluated in the seemingly homogeneous subset of 208 physical therapists within 0.5 SD of the median baseline MDQ and the median actual change in the MDQ. Following risk adjustment, 2 physical therapists were classified in each of the outperforming and underperforming cohorts. Limitations. The secondarily obtained observational data used were not collected for research purposes. Additionally, the analyses were limited by missing baseline information and follow-up PROs. Conclusions. The risk-adjusted performance ratios for the MDQ and NDI resulted in disparate conclusions regarding the quality of care compared with the raw, unadjusted change scores. According to the baseline and unadjusted change in the MDQ, even physical therapists in the most homogeneous sample were differentiated following appropriate risk adjustment. Clinically important improvements in actual PROs were observed in the outperforming but not in the underperforming physical therapists. Clinically meaningful differences in the performance ratio are unknown and are a limitation to clinical application and an opportunity for future research.

Published
2020
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37. Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver?

Author

Lentz, Trevor A., Goode, Adam P., Thigpen, Charles A., and George, Steven Z.

Subjects
Research, Evidence-based medicine -- Research, Physical therapy -- Research, Decision making -- Research, Physical therapists -- Research, Pain management -- Research, Sustainable development
Abstract

The American Physical Therapy Association's (APTA) Vision Statement focuses on improving quality, innovation, value, and access to physical therapy services. Since those guiding principles were adopted in 2013, the shift [...], Early physical therapy models hold great promise for delivering high-value care for individuals with musculoskeletal pain. However, existing physical therapist practice and research standards are misaligned with value-based principles, which limits the potential for growth and sustainability of these models. This Perspective describes how the value proposition of early physical therapy can be improved by redefining harm, embracing a prognostic approach to clinical decision making, and advocating for system-wide guideline-adherent pain care. It also outlines the need to adopt a common language to describe these models and embrace new, rigorous study designs and analytical approaches to better understand where and how early physical therapy delivers value. The goal is to define a clear path forward to ensure physical therapists are aligned within health care systems to deliver on the American Physical Therapy Association's vision of high-value care in a rapidly changing health care environment.

Published
2020
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42. ICD-10 Diagnosis Codes in Electronic Health Records Do Not Adequately Capture Fracture Complexity for Proximal Humerus Fractures

Author

Floyd, Sarah B., primary, Walker, J. Todd, additional, Smith, Justin T., additional, Jones, Patrick E., additional, Boes, Nathan, additional, Lindros, Sydney, additional, Carroll, Maile, additional, Brooks, John M., additional, Thigpen, Charles A., additional, Pill, Stephan G., additional, and Kissenberth, Michael J., additional

Published
2023
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47. Using Randomized Controlled Trials in the Sports Medicine and Performance Environment: Is It Time to Reconsider and Think Outside the Methodological Box?

Author

Bullock, Garrett S, Ward, Patrick, Hughes, Tom, Thigpen, Charles A, Cook, Chad E, Shanley, Ellen, Bullock, Garrett S, Ward, Patrick, Hughes, Tom, Thigpen, Charles A, Cook, Chad E, and Shanley, Ellen

Abstract

Randomized controlled trials (RCTs) are ubiquitous in medicine and have facilitated great strides in clinical care. However, when applied in sport, RCTs have limitations that hinder implementing effective interventions in the real-world clinical setting. Pragmatic clinical trials offer some solutions. Yet due to the competitive, high-pressure nature of sport at the individual, team, and governing body level, RCTs are likely infeasible in certain sport settings. The small number of athletes at the elite team level, along with the potential financial consequences of randomizing at the individual athlete and team level, also restricts study power and feasibility, limiting conclusions. Consequently, researchers may need to "think outside the box" and consider other research methodology, to help improve athlete care. In this Viewpoint, we detail alternative study designs that can help solve real-world problems in sports medicine and performance, while maintaining robust research standards and accounting for the challenges that RCTs pose. We also provide practical examples of alternative designs.

Published
2023

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