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Background Understanding sources of microbial contamination in outpatient rehabilitation (REHAB) clinics is important to patients and healthcare providers. Purpose The purpose of this study was to characterize the microbiome of an outpatient REHAB clinic and examine relationships between clinic factors and contamination. Methods Forty commonly contacted surfaces in an outpatient REHAB clinic were observed for frequency of contact and swiped using environmental sample collection kits. Surfaces were categorized based on frequency of contact and cleaning and surface type. Total bacterial and fungal load was assessed using primer sets specific for the 16S rRNA and ITS genes, respectively. Bacterial samples were sequenced using the Illumina system and analyzed using Illumina-utils, Minimum Entropy Decomposition, QIIME2 (for alpha and beta diversity), LEfSe and ANCOM-BC for taxonomic differential abundance and ADONIS to test for differences in beta diversity (p<0.05). Results Porous surfaces had more bacterial DNA compared to non-porous surfaces (median non-porous = 0.0016ng/μL, 95%CI = 0.0077–0.00024ng/μL, N = 15; porous = 0.0084 ng/μL, 95%CI = 0.0046–0.019 ng/μL, N = 18. p = 0.0066,DNA. Samples clustered by type of surface with non-porous surfaces further differentiated by those contacted by hand versus foot. ADONIS two-way ANOVA showed that the interaction of porosity and contact frequency (but neither alone) had a significant effect on 16S communities (F = 1.7234, R2 = 0.0609, p = 0.032). Discussion Porosity of surfaces and the way they are contacted may play an underestimated, but important role in microbial contamination. Additional research involving a broader range of clinics is required to confirm results. Results suggest that surface and contact-specific cleaning and hygiene measures may be needed for optimal sanitization in outpatient REHAB clinics.

Context: Chronic pelvic pain syndrome (CPPS) is a complex pain syndrome that affects 15%–30% of people of childbearing age (~10–20 million, US). Etiologies range from musculoskeletal conditions and visceral disease to neurological and psychological disorders. The interplay of many systems and disorders can manifest into a complex pathophysiology that is difficult to diagnose and treat. Dysfunction of the musculoskeletal system is often involved in patients with CPPS, either as the cause of pain or the result of underlying disease or dysfunction. Hypertonicity of pelvic floor muscles, myofascial trigger points, and dysfunctional shortening of the levator ani group of muscles contribute to the structural and functional abnormalities involved in CPPS. Osteopathic physicians are in a unique position to directly address this somatic dysfunction with a nonpharmacologic, nonsurgical approach: osteopathic manipulative treatment (OMT). Objectives: The purpose of this article is to review the literature on manual treatment efficacy for high-tone pelvic floor dysfunction (HTPFD) and the standardization of diagnosis to provide rational, medically based treatments. The second purpose is to elucidate the steps that the medical, and specifically the osteopathic profession can take to standardize pelvic floor evaluation, diagnosis, and treatment in the primary care setting. Methods: A search was conducted on the US National Library of Medicine’s PubMed database for studies involving manual therapy treatment for HTPFD. The authors excluded studies that described manual therapy interventions aimed at increasing pelvic floor muscle tone in patients with urinary incontinence and/or pelvic organ prolapse. Results: For perspective, the initial search using the keywords “chronic pelvic pain syndrome” led to 2,281 publications since 1974; the addition of “osteopathic” led to 10 results since 2009. The search for “high-tone pelvic floor dysfunction” led to 30 publications since 1992; the addition of “osteopathic” yielded no results. To evaluate the efficacy of manual therapy for HTPFD, the search was expanded to include any manual therapy protocols. While the consensus in the literature is that manual treatment for chronic pelvic pain (CPP) is efficacious, the finding is limited by the lack of a comprehensive protocol to appropriately diagnose and treat the patient. The authors propose a system to standardize the assessment of a patient with CPP in the primary care setting by an appropriately trained physician so that pelvic floor dysfunction is recognized, properly diagnosed and treated, or referred to specialized care. Conclusion: The literature supports that manual therapy is an effective treatment for CPP, and as primary care providers, osteopathic physicians are uniquely placed to recognize and treat patients with HTPFD, providing an empathetic, patient-centered approach. Standardization of the diagnosis and manual treatment of HTPFD is required to assess and monitor patients systematically. Development of an advanced training program for clinicians to learn diagnostic approaches and OMT for the pelvic floor should be required since the techniques addressing the pelvic floor musculature are often not included in traditional training.

Introduction: Falls are the leading cause of death and disability among people 65 years of age and older. Likewise, falls have psychological consequences which often lead to avoidance of activities, fear of falling, and further disabilities. Even though the impact of falls on one’s daily life and independence are substantial, evidence suggests that falls can be prevented by multi-factorial assessments and client-specific interventions. Objective: The purpose of this study was to determine (a) perceived knowledge of falls, (b) reported confidence in fall prevention, (c) perceived likelihood of implementing falls screening recommendations, (d) reported fear of falling, and (e) perceived value and satisfaction among community-dwelling older adults who attended an interdisciplinary falls screening and education event. Methods: An interdisciplinary group of professionals from behavioral sciences, family medicine, occupational therapy, optometry, pharmacy, and physical therapy screened 33 community dwelling older adult participants (66-84 years of age) using multi-factorial assessments and discipline-specific screening tools. Individualized recommendations were provided to each participant in verbal and written formats. Participants then completed a questionnaire at the conclusion of the event regarding their perceptions of knowledge gained about falls, confidence in preventing falls, perceived likelihood of implementing fall screening recommendations, fear of falling, and overall feedback regarding the event. Results: The majority of the participants indicated increased perceived knowledge of falls, confidence in preventing falls, and perceived high likelihood of implementing recommendations, along with decreased fear of falling. The majority of the participants also found the event to be valuable (85%), enjoyable (94%), and easy to understand (100%). Conclusion: The results of this study suggest that participants found this falls screening event to be valuable and improved their knowledge regarding falls, as well as their confidence in being able to prevent falls. This study highlights the potential value of an interdisciplinary team approach to increase knowledge, enhance prevention, and decrease fear of falling in community dwelling older adults.