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Van Damme J, Dal Bello-Haas V, Strachan P, Kuspinar A, Kalu M, Zaide M. Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis. Musculoskeletal Care 2024; 22:e1881. [PMID: 38588022 DOI: 10.1002/msc.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme. METHODS This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined. RESULTS Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns. CONCLUSIONS Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.
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Affiliation(s)
- Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Michael Kalu
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Mashal Zaide
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Matijevich E, Minty E, Bray E, Bachus C, Hajizadeh M, Liden B. A Multi-Faceted Digital Health Solution for Monitoring and Managing Diabetic Foot Ulcer Risk: A Case Series. SENSORS (BASEL, SWITZERLAND) 2024; 24:2675. [PMID: 38732781 PMCID: PMC11085305 DOI: 10.3390/s24092675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. METHODS Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. RESULTS Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. CONCLUSION Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.
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Affiliation(s)
| | - Evan Minty
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Emily Bray
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada
| | - Courtney Bachus
- Orpyx Medical Technologies, Inc., Calgary, AB T2G 1M8, Canada
| | | | - Brock Liden
- Cutting Edge Research LLC, Circleville, OH 43113, USA
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Sara LK, Gaudette LW, Souza Júnior JRD, Tenforde AS, Wasserman L, Johnson CD. Cues to land softly and quietly result in acute reductions in ground reaction force loading rates in runners. Gait Posture 2024; 109:220-225. [PMID: 38364508 PMCID: PMC10939780 DOI: 10.1016/j.gaitpost.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND A common gait retraining goal for runners is reducing vertical ground reaction force (GRF) loading rates (LRs), which have been associated with injury. Many gait retraining programs prioritize an internal focus of attention, despite evidence supporting an external focus of attention when a specific outcome is desired (e.g., LR reduction). RESEARCH QUESTION Does an external focus of attention (using cues for quiet, soft landings) result in comparable reductions in LRs to those achieved using a common internal focus (forefoot striking while barefoot)? METHODS This observational study included 37 injured runners (18 male; mean age 36 (14) years) at the OMITTED Running Center. Runners wore inertial measurement units over the distal-medial tibia while running on an instrumented treadmill at a self-selected speed. Data were collected for three conditions: 1) Shod-Control (wearing shoes, without cues); 2) Shod-Quiet (wearing shoes, cues for quiet, soft landings); and 3) Barefoot-FFS (barefoot, cues for forefoot strike (FFS)). Within-subject variables were compared across conditions: vertical instantaneous loading rate (LR, primary outcome); vertical stiffness during initial loading; peak vertical GRF; peak vertical tibial acceleration (TA); and cadence. RESULTS Vertical LR, stiffness, and TA were lower in the Shod-Quiet compared to Shod-Control p < 0.001). Peak vertical GRF and cadence were not different between Shod-Quiet and Shod-Control. Reductions in stiffness and LR were similar between Shod-Quiet and Barefoot-FFS, and GRF in Barefoot-FFS remained similar to both shod conditions. However, runners demonstrated additional reductions in TA and increased cadence when transitioning from Shod-Quiet to the Barefoot-FFS condition (p < 0.05). SIGNIFICANCE These results suggests that a focus on quiet, soft landings may be an effective gait retraining method for future research.
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Affiliation(s)
- Lauren K Sara
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA; Department of Rheumatology, Boston University, Boston, MA 02215, USA.
| | - Logan W Gaudette
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA
| | - José Roberto de Souza Júnior
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA; Graduate Program of Sciences and Technologies in Health, University of Brasília, Brasília, Federal District 72220-275, Brazil
| | - Adam S Tenforde
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA
| | - Lindsay Wasserman
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA
| | - Caleb D Johnson
- Spaulding National Running Center, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA 02138, USA; United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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Fisher R, Kasper K, Trigg S, Davila K, Mette GT, Rivera K, Danley L, Salazar A, Cockerell M. Running Gait Training Improves Outcomes at United States Air Force Basic Military Training. Mil Med 2024; 189:692-697. [PMID: 35998101 DOI: 10.1093/milmed/usac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The aim is to investigate the impact of large-group, motor learning-based running gait training on injury risk in United States Air Force (USAF) Basic Military Training (BMT). DESIGN A prospective quasi-experimental program evaluation is used. MATERIALS AND METHODS Medical providers taught running gait form to groups of trainees in the first week of training of BMT from August 2020 to March 2021. The main outcome measures included risk ratio of reported injuries, removal from training because of injury, and separation from service because of injury. RESULTS Of BMT trainees, 2,205 underwent group, motor learning-based running gait training; this was compared with two intake groups (nA = 3,941 and nB = 2,041) who were only given introductions to sports medicine staff in a classroom setting. Reported pain complaints increased (χ2 = 27.4A and 20.83B, P < .001). Risk ratios for more severe injuries necessitating time out of training or separation from USAF were reduced, although these were statistically not significant (13%, P = .48 and 22%, P = .29, respectively). Leadership implemented gait training across BMT, and data from the following 8 weeks of intake (n = 6,223) demonstrated similar trends in increases in patient reports of pain (χ2 = 67.25, P < .001) but significantly reduced risk ratios of removal from training (32%, χ2 = 16.35, P < .001) or separation (32%, χ2 = 12.54, P < .001). CONCLUSIONS While not previously shown to mitigate injury, large-group, running gait training was associated with a significant reduction in injury severity defined by training delays and separation from service in USAF BMT.
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Affiliation(s)
- Reid Fisher
- 37th Training Wing, JBSA-Lackland, TX 78236, USA
- University of the Incarnate Word, San Antonio, TX 78209, USA
| | - Korey Kasper
- 559th Medical Group, JBSA-Lackland, TX 78236, USA
| | - Steven Trigg
- 559th Medical Group, JBSA-Lackland, TX 78236, USA
| | | | - G T Mette
- 37th Training Wing, JBSA-Lackland, TX 78236, USA
| | | | - Lyle Danley
- Texas A&M Mays Business School, College Station, TX 77843-4117, USA
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Silva PMM, Silva LWM, Vieira ER, Cavalvanti FAC, Morya E. Go Across Immersive Technology: A Preliminary Study of the Design and Development of a System for Gait Training Using Virtual Reality. Games Health J 2023; 12:472-479. [PMID: 37410502 DOI: 10.1089/g4h.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Virtual reality (VR) allows visuotactile interaction in a virtual environment. VR has several potential applications such as surgical training, phobia treatments, and gait rehabilitation. However, further interface development is required. Therefore, the objective of this study was to develop a noninvasive wearable device control to a VR gait training program. It consists of custom-made insoles with vibratory actuators, and plantar pressure sensor-based wireless interface with a VR game. System usability testing involved a habituation period and three gaming sessions. Significant gait improvement was associated with game scores (P < 0.05). This VR gait training system allowed real-time virtual immersive interaction with anticipatory stimulus and feedback during gait.
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Affiliation(s)
- Patrícia M M Silva
- Neuroengineering Program, Edmond and Lily Safra International Institute of Neurosciences, Macaíba, Brazil
- Physical Therapy Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Léon W M Silva
- Neuroengineering Program, Edmond and Lily Safra International Institute of Neurosciences, Macaíba, Brazil
| | - Edgar R Vieira
- Physical Therapy Department, Florida International University, Miami, Florida, USA
| | | | - Edgard Morya
- Neuroengineering Program, Edmond and Lily Safra International Institute of Neurosciences, Macaíba, Brazil
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Kafri M, Levron Y, Atun-Einy O. Assessing the impact of a knowledge translation intervention on physical therapists' self-efficacy and implementation of motor learning practice. BMC MEDICAL EDUCATION 2023; 23:369. [PMID: 37221530 DOI: 10.1186/s12909-023-04304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The application of motor learning (ML) principles and research in physical therapy can optimize patient outcomes. However, the translation of the accumulated knowledge in ML to clinical practice is limited. Knowledge translation interventions, which are designed to promote changes in clinical behaviors, have the potential to address this implementation gap. We developed, implemented, and evaluated a knowledge translation intervention for ML implementation that focuses on building clinical capacity among physical therapists for the systematic application of ML knowledge in clinical practice. METHODS A total of 111 physical therapists underwent the intervention, which consisted of the following: (1) an interactive didactic 20-hour course; (2) an illustrated conceptual model of ML elements; and (3) a structured clinical-thinking form. Participants completed the Physical Therapists' Perceptions of Motor Learning (PTP-ML) questionnaire pre and post intervention. The PTP-ML was used to assess ML-related self-efficacy and implementation. Participants also provided post-intervention feedback. A sub-sample (n = 25) provided follow-up feedback more than a year after the completion of the intervention. Pre-post and post-follow-up changes in the PTP-ML scores were calculated. The information gathered from the open-ended items of the post-intervention feedback was analyzed to identify emerging themes. RESULTS Comparing pre- and post-intervention scores, significant changes were found in the total questionnaire scores, self-efficacy subscale scores, reported implementation subscale scores (P < .0001), and general perceptions and work environment subscale score (P < .005). The mean changes in the total questionnaire and self-efficacy scores also significantly exceeded the Reliable Change Index. In the follow-up sample, these changes were maintained. Participants felt that the intervention helped them organize their knowledge in a structured manner and consciously link their practice elements to concepts in ML. Discussion of clinical cases was reported to be the most valuable educational method, and the illustrated conceptual model of ML elements was the least valued. Respondents also suggested support activities to maintain and enhance the learning experience, including on-site mentorship and hands-on experience. CONCLUSIONS Findings support the positive effect of an educational tool, most prominently on physical therapists' ML self-efficacy. The addition of practical modeling or ongoing educational support may enhance intervention effects.
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Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Yasmin Levron
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Michie T, Napier C. Running away from clinical heterogeneity. Br J Sports Med 2023:bjsports-2023-106715. [PMID: 37130618 DOI: 10.1136/bjsports-2023-106715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Tom Michie
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University Faculty of Science, Burnaby, British Columbia, Canada
| | - Christopher Napier
- Department of Biomedical Physiology & Kinesiology, Simon Fraser University Faculty of Science, Burnaby, British Columbia, Canada
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Muccio M, Atun-Einy O, Kafri M, Kaplan SL. Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article. Phys Occup Ther Pediatr 2023; 43:741-758. [PMID: 36922700 DOI: 10.1080/01942638.2023.2186198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/13/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
AIM This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. METHODS Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. CONCLUSIONS AND IMPLICATIONS As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.
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Affiliation(s)
- Marissa Muccio
- Division of PRNY PC, Scoliosis Specialty Center, Totowa, NJ, USA
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
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Frasie A, Houry M, Plourde C, Robert MT, Bouyer LJ, Roy JS. Feedback for the prevention and rehabilitation of work-related musculoskeletal disorders: A systematic review. Work 2023; 76:61-94. [PMID: 36872834 DOI: 10.3233/wor-220545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WRMSDs) remain a challenge despite research aimed at improving their prevention and treatment. Extrinsic feedback has been suggested for the prevention and rehabilitation of WRMSDs to improve sensorimotor control, and ultimately to reduce pain and disability. However, there are few systematic reviews on the effectiveness of extrinsic feedback for WRMSDs. OBJECTIVE To perform a systematic review investigating the effect of extrinsic feedback for the prevention and rehabilitation of WRMSDs. METHODS Five databases (CINAHL, Embase, Ergonomics Abstract, PsycInfo, PubMed) were searched. Studies of various designs assessing the effects of extrinsic feedback during work tasks on three outcomes (function, symptoms, sensorimotor control) in the context of prevention and rehabilitation of WRMSDs were included. RESULTS Forty-nine studies were included, for a total sample of 3387 participants (including 925 injured) who performed work-related tasks in the workplace (27 studies) or in controlled environments (22 studies). The use of extrinsic feedback was shown to be effective in controlled environments for short-term prevention of functional limitations and sensorimotor alterations (very limited to moderate evidence) and for improving, in injured participants, function, symptoms and sensorimotor control (moderate evidence). In the workplace, it was shown to be effective for short-term prevention of functional limitations (limited evidence). There was conflicting evidence regarding its effect for WRMSD rehabilitation in the workplace. CONCLUSION Extrinsic feedback is an interesting complementary tool for the prevention and rehabilitation of WRMSDs in controlled environments. More evidence is needed regarding its effect for the prevention and rehabilitation of WRMSDs in the workplace.
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Affiliation(s)
- Antoine Frasie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime Houry
- Centre d'Études des Transformations des Activités Physiques etSportives (CETAPS), Université de Rouen, Rouen, France
| | - Charles Plourde
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Maxime T Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), QuebecCity, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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DeJong Lempke AF, Stephens SL, Fish PN, Thompson XD, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial. BMJ Open Sport Exerc Med 2022; 8:e001293. [PMID: 36353183 PMCID: PMC9639130 DOI: 10.1136/bmjsem-2021-001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To assess the effects of a 4-week randomised controlled trial comparing an outdoor gait-training programme to reduce contact time in conjunction with home exercises (contact time gait-training feedback with home exercises (FBHE)) to home exercises (HEs) alone for runners with exercise-related lower leg pain on sensor-derived biomechanics and patient-reported outcomes. Design Randomised controlled trial. Setting Laboratory and field-based study. Participants 20 runners with exercise-related lower leg pain were randomly allocated into FBHE (4 male (M), 6 female (F), 23±4 years, 22.0±4.3 kg/m2) or HE groups (3 M, 7 F, 25±5 years, 23.6±3.9 kg/m2). Interventions Both groups completed eight sessions of HEs over 4 weeks. The FBHE group received vibrotactile feedback through wearable sensors to reduce contact time during outdoor running. Primary and secondary outcome measures Patient-reported outcome measures (PROMs) and outdoor gait assessments were conducted for both groups at baseline and 4 weeks. PROMs were repeated at 6 weeks, and feedback retention was assessed at 6 weeks for the FBHE group. Repeated measures analyses of variance were used to assess the influence of group and timepoint on primary outcomes. Results The FBHE group reported increased function and recovery on PROMs beyond the HE group at 6 weeks (p<0.001). There was a significant group by time interaction for Global Rating of Change (p=0.004) and contact time (p=0.002); the FBHE group reported greater subjective improvement and reduced contact time at 4 and 6 weeks compared with the HE group and compared with baseline. The FBHE group had increased cadence (mean difference: 7 steps/min, p=0.01) at 4 weeks during outdoor running compared with baseline. Conclusion FBHE was more effective than HE alone for runners with exercise-related lower leg pain, manifested with improved PROMs, reduced contact time and increased cadence. Trial registration number NCT04270565.
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Affiliation(s)
| | | | - Pamela N Fish
- Kidney Center, Fresenius Medical Care, Knoxville, Tennessee, USA
| | | | - Joseph M Hart
- Orthopaedics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J Hryvniak
- Physical Medicine & Rehabilitation, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jordan S Rodu
- Statistics, University of Virginia, Charlottesville, Virginia, USA
| | - Jay Hertel
- Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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