Browsing by Author "Hicks, Gregory E."

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    Adults with lower-limb amputation: Reduced multifidi muscle activity and extensor muscle endurance is associated with worse physical performance
    (Clinical Physiology and Functional Imaging, 2023-05-24) Sions, Jaclyn M.; Seth, Mayank; Beisheim-Ryan, Emma H.; Hicks, Gregory E.; Pohlig, Ryan T.; Horne, John R.
    Trunk muscles may be an overlooked region of deficits following lower-limb amputation (LLA). This study sought to determine the extent that trunk muscle deficits are associated with physical function following amputation. Sedentary adults with a unilateral transtibial- (n = 25) or transfemoral-level (n = 14) amputation were recruited for this cross-sectional research study. Participants underwent a clinical examination that included ultrasound imaging of the lumbar multifidi muscles, the modified Biering-Sorensen Endurance Test (mBSET), and performance-based measures, that is, the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-m Walk Test (10mWT). Associations between trunk muscle metrics and performance were explored with regression modeling, while considering covariates known to impact performance postamputation (p ≤ 0.100). Average ultrasound-obtained, lumbar multifidi activity was 14% and 16% for transfemoral- and transtibial-level amputations, respectively, while extensor endurance was 37.34 and 12.61 s, respectively. For TUG, nonamputated-side multifidi activity and an interaction term (level x non-amputated-side multifidi activity) explained 9.4% and 6.2% of the total variance, respectively. For 10mWT, beyond covariates, non-amputated-side multifidi activity and the interaction term explained 6.1% and 5.8% of the total variance, respectively. For TUG, extensor endurance and an interaction term (level x mBSET) explained 11.9% and 8.3% of the total variance beyond covariates; for BBS and 10mWT, extensor endurance explained 11.2% and 17.2% of the total variance, respectively. Findings highlight deficits in lumbar multifidi activity and extensor muscle endurance among sedentary adults with a LLA; reduced muscle activity and endurance may be important factors to target during rehabilitation to enhance mobility-related outcomes.
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    Classification of Geriatric Low Back Pain Based on Hip Characteristics With a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings From Delaware Spine Studies
    (Physical Therapy, 2021-09-24) Hicks, Gregory E.; Pohlig, Ryan T.; Coyle, Peter C.; Sions, J. Megan; Weiner, Debra K.; Pugliese, Jenifer M.; Velasco, Teonette O.; O’Brien, Victoria A.
    Objective: The purpose of this study is to identify geriatric chronic low back pain (LBP) subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time. Methods: Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and 6-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models. Results: Regarding LVMM, a model with 3 classes/subgroup fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic, subgroup 2 = weak and nonsymptomatic, and subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared with the WS subgroup, whereas the strong and nonsymptomatic subgroup had better mobility function than the 2 “weak” subgroups. Conclusion: These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup given their consistently poor LBP and mobility function outcomes. Impact: Among older adults with chronic low back pain, there are 3 hip subgroups: “strong and nonsymptomatic,” “weak and nonsymptomatic,” and “weak and symptomatic.” People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, because their outcomes are consistently poorer than those in the other subgroups.
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    Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain
    (Pain Medicine, 2023-03-21) Knox, Patrick J.; Simon, Corey B.; Pohlig, Ryan T.; Pugliese, Jenifer M.; Coyle, Peter C.; Sions, Jaclyn M.; Hicks, Gregory E.
    Objective: Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. Design: Cross-sectional analysis of an observational study. Setting: Clinical research laboratory. Subjects: 226 older adults with chronic LBP. Methods: This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. Results: Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = –0.870, t = –3.110, P = .002), and physical function (b = –0.017, t = –2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). Conclusions: Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.
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    Gait asymmetry is associated with performance-based physical function among adults with lower-limb amputation
    (Physiotherapy Theory and Practice, 2021-10-17) Seth, Mayank; Coyle, Peter C.; Pohlig, Ryan T.; Beisheim, Emma H.; Horne, John R.; Hicks, Gregory E.; Sions, Jaclyn Megan
    BACKGROUND Adults with lower-limb amputation walk with an asymmetrical gait and exhibit poor functional outcomes, which may negatively impact quality-of-life. OBJECTIVE To evaluate associations between gait asymmetry and performance-based physical function among adults with lower-limb amputation. METHODS A cross-sectional study involving 38 adults with a unilateral transtibial (N = 24; 62.5 ± 10.5 years) or transfemoral amputation (N = 14; 59.9 ± 9.5 years) was conducted. Following gait analysis (capturing step length and stance time asymmetry at self-selected (SSWS) and fast walking speeds (FWS)), participants completed performance-based measures (i.e. Timed Up and Go (TUG), the 10-Meter Walk Test (10mwt), and the 6-Minute Walk Test (6MWT)). RESULTS Step length and stance time asymmetry (at SSWS and FWS) were significantly correlated with each performance-based measure (p < .001 to p = .035). Overall, models with gait measures obtained at SSWS explained 40.1%, 46.8% and 40.1% of the variance in TUG-time (p = .022), 10mwt-speed (p = .003) and 6MWT-distance (p = .010), respectively. Models with gait measures obtained at FWS explained 70.0%, 59.8% and 51.8% of the variance in TUG-time (p < .001), 10mwt-speed (p < .001), and 6MWT-distance (p < .001), respectively. CONCLUSIONS Increases in step length or stance time asymmetry are associated with increased TUG-time, slower 10mwt-speed, and reduced 6MWT-distance. Findings suggest gait asymmetry may be a factor in poor functional outcomes following lower-limb amputation.
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    Research Agenda for Physical Therapy From the American Physical Therapy Association
    (Physical Therapy & Rehabilitation Journal, 2023-09-15) Stevens-Lapsley, Jennifer; Hicks, Gregory E.; Zimney, Kory; Slaven, Emily J.; Manal, Tara Jo; Jeffries, Lynn M.
    Research agendas play an important role in directing scholarly inquiry in a field. The Research Agenda for Physical Therapy From the American Physical Therapy Association (APTA) outlines research priorities that are vital to advancing physical therapist practice and the profession. The development of the research agenda included multiple iterative steps and feedback from stakeholders. A research agenda subgroup (n = 6) of the APTA Scientific and Practice Affairs Committee (SPAC), with APTA staff support, gathered information on existing research agendas, developed draft priority descriptions, and gathered feedback via surveys. The subgroup first conducted an environmental scan of the research agendas in the physical therapy and rehabilitation fields. To gather information about research priorities, APTA’s Technology and Organizational Performance department distributed a survey to 3 samples. APTA staff organized the feedback, and SPAC edited and synthesized a draft agenda. This draft was sent out in survey form to the original samples and to members of the APTA Academy of Research. Concurrently, a repeat environmental scan was conducted. A final draft of the research agenda was sent for final review to a smaller cohort (n = 95) that included content experts in each of the main categories of the agenda as identified by the APTA Academy of Research. The SPAC research agenda subgroup reviewed and incorporated the information into the final draft. The final research agenda includes priorities in topical areas (population health, mechanistic research, clinical research, education/professional development research, health services research, and workforce development) identified as key in the evolution of our profession. Impact The Research Agenda for Physical Therapy From APTA identifies research priorities within the profession vital to advancing the practice and profession of physical therapy. The research agenda has 6 key areas of focus: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Researchers, funding agencies, and public policy makers can use the research agenda to concentrate research efforts around these areas.