Category: Sports Introduction/Purpose: Since its introduction into clinical practice, the Patient-Reported Outcome Measurement Information System (PROMIS) has become commonplace across multiple different orthopaedic sub-specialties for a wide variety of patient populations. PROMIS computer adaptive tests (CATs) are increasingly administered following injury and/or surgical intervention. Yet, a gap in the literature remains with regard to the results of PROMIS scores in populations that may not conform to mean normal values in the NIH PROMIS scoring database. Examples include young, healthy patients and young, elite athletes. Our objective was to evaluate the performance of scoring tools in six PROMIS domains in young, healthy non-athlete individuals and young, uninjured elite athletes, comparing both to National Institute of Health (NIH) developed normal PROMIS means and Standard deviations. Methods: In an IRB approved prospective cohort study, healthy subjects were recruited from a large University with a National Collegiate Athletic Association (NCAA) Division 1 athletics program between May and November 2017. Subjects were administered a one-time survey, including the following six PROMIS domains: Pain Interference CAT, Physical Functioning CAT, Mobility CAT, Social Functioning CAT, Depression CAT, and Global Health Short Form. Demographics included age, gender, sport and level of participation (where applicable), self-reported health status, history of recent orthopaedic injury, and history of foot/ankle surgery. Elite athletes were defined as participants > 18 years old actively participating in NCAA Division 1 athletics. Young people were defined as non-NCAA Division 1 athletes ages 18 to 35 years old. Following completion of data collection, results were analyzed using SAS 9.4. Results: The final cohort consisted of a total of 206 participants, which included 39 elite athletes, and 167 healthy non-athletes. All six PROMIS domains demonstrated statistically significant differences (p-value < 0.01) comparing elite athletes to NIH normal values. Compared to healthy non-athletes, elite athletes’ scores were all significant different (p-value < 0.01) except for the PROMIS Social Functioning CAT (p = 0.0766) and PROMIS Global Health Short Form Physical Functioning T-score (p = 0.0916). Furthermore, when elite athletes were compared to similar age undergraduates students (n = 25) only PROMIS Depression CAT and Global Health Short Form Mental Health T-score were statistically significant (p-value < 0.01). Conclusion: Elite athletes’ baseline PROMIS scores are significantly different than both the NIH normal values, and young healthy non-athletes across PROMIS domains. This highlights the need to interpret the results of elite athletes’ scores in the context of normal values for this specific population, and taking this into account over the of course of care following injury and/or surgery. There is a need for further research to establish baseline normal values for PROMIS scores for elite athletes and ot...
Background: Chronic non-specific low back pain (CNSLBP) is a common ailment treated by chiropractors. Most chiropractors focus on the localised lumbar area of pain. Other chiropractors focus on restoring function to compensating articulations in the ‗full kinematic chain‘ by assessing and treating the lower extremity in conjunction to the low back. Patients with LBP often exhibit decreased hip-related ranges of motion that may result in future LBP, relapse and a prolonged recovery time. Studies investigating the effect of treating the kinematic chain in relation to LBP are limited and the literature, although widely taught and practiced, is largely anecdotal. Chiropractic manipulation has shown to be effective in the treatment of LBP and many lower extremity conditions. Objectives: This study set out to determine if a combination of low back and hip manipulation would result in a more beneficial outcome for the participant, suffering with CNSLBP, than low back manipulation alone in terms of objective and subjective outcomes. Method: The study was a randomised controlled clinical trial which, through purposive sampling, consisted of 50 participants with CNSLBP and hip joint dysfunction. The participants were randomly divided into two groups of 25 each [A and B]. Group A received low back manipulation alone and Group B received combined low back and hip manipulation. Subjective data was obtained through the Oswestry Low Back Pain Disability Index (ODI) and the Numerical Pain Rating Scale (NPRS). Objective data was obtained through the use of a Force Dial Algometer and an Inclinometer. Data collection occurred at the first, third and fifth consultations and was coded and analysed using IBM SPSS version 24.0. A p-value value of less than 0.05 was considered to be statistically relevant. Results: Intra-group testing showed that there was a significant difference over time, within both groups, with regards to internal rotation and external rotation of the hip, flexion of the lumbar spine, increased pain tolerance in Algometer tests, decreased NPRS values and decreased ODI scores. Within Group A, the mean scores for hip flexion reflected a more significant increase over time than those of Group B. Within Group B, the mean scores for left and right rotation of the lumbar spine reflected a more significant change over time than those of Group A. Inter-group testing showed no significantly differential treatment effect for any of the subjective and objective outcomes. This means that both treatments were equally effective and the hypothesis, that suggested that Group B would improve more than Group A, was incorrect. Conclusion: Both treatment groups improved subjectively and objectively with regards to CNSLBP. Inter-group testing showed that statistically, and for all outcome measurements, there were no significant differences between the two treatment group‘s results. This suggested that there was no additional benefit in combining hip joint manipulation with low back manipulation in the treatment of CNSLBP.
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