Carol Oatis - Profile on Academia.edu (original) (raw)

Papers by Carol Oatis

A Cinderella Tale: Can New Shoes Change the Life of a Person With Knee Osteoarthritis?

Annals of Internal Medicine, Jul 12, 2016

Osteoarthritis is a common disease affecting large portions of the population (1). It is often ac... more Osteoarthritis is a common disease affecting large portions of the population (1). It is often accompanied by significant joint pain, and the knee is the most commonly affected site. Many patients with knee osteoarthritis try anything and everything to relieve the pain, often to no avail. Pain medications are recommended mostly for temporary relief rather than for long-term treatment. Physical therapy and prescribed exercise can provide benefit over the long term, but adherence often wanes and pain is often a barrier to regular exercise (2, 3). Many patients resort to alternative remedies, but because such therapies often have not been carefully studied, providers do not commonly recommend them. Thus, pain remains the enemy for patients with osteoarthritis and their health care providers. One approach to reducing knee pain in osteoarthritis is to reduce loading on the knee. This can be done through weight loss, use of a cane, or a varus knee brace that applies forces to realign the knee and redistributes load over the knee. Footwear, specifically variable-stiffness shoes, may be another means of unloading the knee. The premise underlying shoe modifications to reduce load on the knee is that repositioning the foot when it is in contact with the ground produces proximal alignment changes because the foot and knee are parts of the closed kinetic chain of the lower extremity. Most clinical guidelines recommend appropriate footwear for patients with knee osteoarthritis, but little evidence exists to inform shoe choice. Although laboratory studies have shown that footwear can change knee biomechanics (4, 5), clinical studies have been lacking. Hinman and colleagues report a promising avenue for patients with knee osteoarthritis (6). They randomly assigned 164 persons with knee osteoarthritis to new shoes with modified midsoles to unload the knee or to new conventional walking shoes, similar in appearance to the unloading shoes, to examine the effect of unloading shoes on knee pain and physical function. At 6 months, both groups showed large and clinically relevant improvements but no differences in pain or function. This study applied a relevant biomechanical intervention and used recommended outcome measures for knee osteoarthritis clinical trials. Differing designs, uses, and lifespans of shoes make footwear interventions difficult to study, but the researchers conducted a good head-to-head comparison of 2 footwear groups. The fact that outcomes improved in both groups leads one to wonder whether readily available, new, supportive lace-up shoes should be the current evidence-based recommendation for appropriate footwear while we await future studies of the biomechanics of knee osteoarthritis that might result in more effective special footwear. The trial has several limitations worth noting. First, collected data on biomechanical measures of foot posture, foot function, and gait were not included in the analyses. These data could identify subgroups whose improvements might be attributable to biomechanics that the study shoes should have corrected. Second, longer-term study of biomechanical aspects would enable exploration of whether unloading shoes slow the progression of knee osteoarthritis. Also, there was no control group of participants wearing their usual shoes. As noted by the authors, three quarters of osteoarthritis treatment effects for pain can be attributed to the placebo effect (6). The authors outline clear biomechanical links to radiographic severity, dysfunction, and osteoarthritis progression (6). Thus, it is unclear why documented changes in knee biomechanics that unload the knee joint in a laboratory do not yield benefits when applied outside the laboratory. Of note, the first study to report reduction in knee adduction moment with variable-stiffness shoes (7) noted that 18% of participants actually showed an increase in adduction moment and 30% had a reduction of less than 5%. Because the intervention is directed at a distant limb segment (the foot), perhaps the body acclimates to the intervention over time, thus reverting to the patient's original loading pattern. Transmission of the load-altering mechanism up to the knee may depend on the structure and function of the foot and lower leg joints. In addition, maybe the unique mechanical properties of the shoes decrease with time, diminishing the biomechanical benefit of the intervention. Closer examination of the lower extremity kinetic chain may provide insights into the mechanical pathways that contribute to knee pain and the best ways to alter them. The current knee osteoarthritis treatment paradigm is characterized by late disease identification, poor alignment of patient pain-relief needs with available treatments, and a unified treatment approach despite heterogeneous clinical presentations. Knee osteoarthritis is a disease with a broad spectrum of expression and multiple mechanisms contributing to progression. There is a desperate…

IFAC Proceedings Volumes, Mar 1, 1994

Arthritis Care and Research, Aug 30, 2019

Objective. Although total knee replacement surgery (TKR) is highly prevalent and generally succes... more Objective. Although total knee replacement surgery (TKR) is highly prevalent and generally successful, functional outcomes post-TKR vary widely. Most patients receive some physical therapy (PT) following TKR, but PT practice is variable and associations between specific content and dosage of PT interventions and functional outcomes are unknown. Research has identified exercise interventions associated with better outcomes but studies have not assessed whether such evidence has been translated into clinical practice. We characterized the content, dosage and progression of usual post-acute PT services following TKR, and examined associations of specific details of post-acute PT with patients' 6-month functional outcomes. Methods. Post-acute PT data were collected from patients undergoing primary unilateral TKR and participating in a clinical trial of a phone-based coaching intervention. PT records from the terminal episode of care were reviewed and utilization and exercise content data were extracted. Descriptive statistics and linear regression models characterized PT treatment factors and identified associations with 6-month outcomes. Results. We analyzed 112 records from 30 PT sites. Content and dosage of specific exercises and incidence of progression varied widely. Open chain exercises were utilized more frequently than closed chain (median and interquartile range (21(4,49) vs 13(4,28.5)). Median (interquartile range) occurrence of progression of closed and open chain exercise was 0 (0,2) and 1 (0,3) respectively. Shorter timed stair climb was associated with greater total number of PT interventions and use and progression of closed chain exercises.

The Use of a Mechanical Model to Describe the Stiffness and Damping Characteristics of the Knee Joint in Healthy Adults

Physical therapy, Nov 1, 1993

Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of t... more Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of this study was to determine the reliability of a relaxed oscillation test that yields stiffness and damping coefficients of the knee. These coefficients describe the knee joint's resistance to bending and the time-dependent nature of that resistance. Effects of age, gender, and knee position on these coefficients were assessed in 96 healthy volunteers aged 20 to 79 years. Measures were based on the premise that the knee joint can be modeled as a damped spring. Oscillations of the knee were recorded using an electrogoniometer with the knee oscillating through about 45 and 75 degrees of knee flexion. Intraclass correlation coefficients revealed moderate to high reliability in the measurements taken three times in the same test session and on three separate days. Analysis of variance showed significant increases in stiffness and damping coefficients in the male subjects as compared with the female subjects. Analysis of variance also suggested an age effect on stiffness coefficients at the 75-degree test position, with decreasing stiffness with age. Both stiffness and damping coefficients were significantly smaller when measured at the 75-degree test position compared with the 45-degree position (Student's t test). These results demonstrate a reliable method of measuring knee joint stiffness, and they correlate well with known morphological differences related to age and gender. This measure may prove to be more useful in evaluating the function of the knee than more commonly used assessments. It may also lead to a better understanding of how the knee functions in such activities as locomotion.

Gait & Posture, Mar 1, 2013

JMIR rehabilitation and assistive technologies, Oct 27, 2022

Background: Electronic health records (EHRs) have the potential to facilitate consistent clinical... more Background: Electronic health records (EHRs) have the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform health care system and its data to a "learning health care system" generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. Objective: The purpose of this paper was to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case was ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (or dose) used to treat patients with knee arthritis following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing physical therapists and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 physical therapists agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 physical therapists. No technical problems with data entry were reported, and data entry required less than 2 minutes per visit. A total of 42 (2%) interventions could not be categorized and were recorded using free text. Conclusions: The use of user-centered design principles provides a road map for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and disseminate knowledge to practice.

ACR open rheumatology, Jun 16, 2022

(1). In an era of chronic disease, the richness of existing data and the value to research driven... more (1). In an era of chronic disease, the richness of existing data and the value to research driven by these data will be enhanced when systematic and comprehensive clinical documentation of interventions is included in the EHR across settings. The EHR is the primary data source for real-world CER and PCOR applications but can be a source of bias when clinical documentation is inconsistent, incomplete, and potentially biased (2). Missing EHR data result from clinician inconsistencies in what and when to document or when patients receive care across multiple health systems or from community-based providers. Human decisions determine content and definition of the data elements (or not) in the EHR, hence contributing to incomplete intervention and outcome data (3). Thus, research using today's EHR, and its clinical data, risks validity because of two major factors: 1) inconsistent clinical intervention and outcome documentation in the course of care and 2) lack of integration of clinical documentation across time and place. Following total knee (TKR) and hip replacement surgeries, PT providers are commonly not affiliated with the health system where the surgery was performed. Thus, their documentation Author disclosures are available at https://onlinelibrary.wiley.com/action/ downloadSupplement?doi=10.1002%2Facr2.11465&file=acr211465-sup-0001-Disclosureform.pdf.

Journal of Rehabilitation Research and Development, 2003

Our long-term goal is to improve adherence to a home-based isometric program for rehabilitation o... more Our long-term goal is to improve adherence to a home-based isometric program for rehabilitation of knee osteoarthritis (OA) using a force-biofeedback device (Isopad TM). Our goal for Phase I was to design and evaluate an Isopad-based program in a supervised clinical setting. Our subjects were five patients with knee OA of Kellgren stage II or greater. A capacitive force sensor was tested for accuracy, repeatability, and durability. An Arthritis Foundation home-based isometric program inspired the Isopad design. The Isopad provided visual and auditory feedback instantaneously and continuously about force generated between the ankles. The five subjects completed a supervised 8-week progressive isometric program using the Isopad. Absolute isolated quadriceps and hamstring torques were quantified with a dynamometer, and patients completed a self-assessment of symptoms (Western Ontario and McMaster Universities Osteoarthritis Index). The capacitive sensor accuracy error averaged 10% and repeatability 4%. Cognitively intact subjects used the Isopad successfully for isometric progressive resistance training. Quadriceps and hamstrings absolute torques increased an average of 30%. Patients reported decreased functional complaints (Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index). All changes were trends. The Isopad helped subjects with knee OA adhere to a supervised isometric program and meet progressive strength targets. The next-generation Isopad will be employed in a home-based program.

Physical therapy, Dec 1, 1988

The purpose of this article is to discuss the static mechanics of the foot and ankle. First, the ... more The purpose of this article is to discuss the static mechanics of the foot and ankle. First, the motions of the ankle and foot available during nonambulatory activities are described by reviewing the literature discussing the axes of motion for the ankle and joints of the foot. Conflicting terminology is presented and clarified, and a scheme for a reasonable terminology is presented. The role of the ankle-foot complex in closed and open kinetic chains is also discussed. Terminology describing structural and functional positions of the foot is presented, including definitions of the subtalar neutral position. A systematic format of terminology is offered to reduce the current inconsistencies. Finally, the weightbearing area of the foot and muscle activity in quiet standing are reviewed.

Web-based system to capture consistent and complete real-world data of physical therapy interventions following total knee replacement Methods to define and test structured data to accelerate comparative effectiveness research (Preprint)

UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate con... more UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform the healthcare system, and its data, to a “learning healthcare system” generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. The purpose of this paper is to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case is ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (dose) used to treat knee arthritis patients following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing PTs and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical, structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 PTs agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 PTs. No technical problems with data entry were reported, and data entry required less than two minutes per visit. Two percent of interventions could not be categorized and were recorded using free text. Discussion: The use of user-centered design principles provides a roadmap for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and to disseminate knowledge to practice.

Physical therapy, Jan 12, 2022

Journal of Medical Internet Research, Apr 11, 2013

Background: The integrity of behavioral intervention trials depends on consistent intervention de... more Background: The integrity of behavioral intervention trials depends on consistent intervention delivery, and uniform, comprehensive process data collection. It can be challenging in practice due to complex human interactions involved. Objective: We sought to design a system to support the fidelity of intervention delivery and efficient capture of qualitative and quantitative process data for a telephone-delivered behavioral counseling intervention to increase physical activity and function after total knee replacement surgery. Methods: A tailored system was designed to prompt the intervention coach in the delivery of a 5 step counseling protocol to support intervention fidelity across patients. System features included structured data components, automated data exchange functions, user-friendly data capture screens, and real-time surveillance reporting. The system structured the capture of patient goals and open-ended conversation. Results: The system recorded intervention process data from each of 12 sessions held with the 92 intervention patients. During the trial, 992 telephone sessions were conducted, and more than 97% (4816/4960) of intervention process data fields were completed in the system. The coach spent 5-10 minutes preparing for each counseling call using system-generated summaries of historical data and 10-15 minutes entering intervention process data following each telephone session. Conclusions: This intervention delivery system successfully supported the delivery of a structured behavioral counseling intervention and collection of intervention process data. It addressed the unique needs of clinical behavioral intervention trials, and had promising potential to facilitate high-fidelity translation of the intervention to broad clinical practice and Web-based multicenter clinical trials in the future.

2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases

Arthritis & Rheumatology

ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adu... more ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs).MethodsThis guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers...

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis

Arthritis Care and Research, May 25, 2023

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis

Arthritis Care & Research

Kinesiology : the mechanics dan pathomechanics of human movement, 2nd ed./ Oatis

ix, 946.: ill.; 35 cm

A Anatomofisiologia Do Sistema Músculo Aponeurótico Superficial (Smas)

Gestão e políticas públicas em odontologia, 2022

IFAC Proceedings Volumes, 1994

Web-based system to capture consistent and complete real-world data of physical therapy interventions following total knee replacement Methods to define and test structured data to accelerate comparative effectiveness research (Preprint)

UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate con... more UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform the healthcare system, and its data, to a “learning healthcare system” generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. The purpose of this paper is to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case is ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (dose) used to treat knee arthritis patients following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Inp...

STUDY PROTOCOL Open Access

A randomized clinical trial of a peri-operative behavioral intervention to improve physical activ... more A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement

A Cinderella Tale: Can New Shoes Change the Life of a Person With Knee Osteoarthritis?

Annals of Internal Medicine, Jul 12, 2016

Osteoarthritis is a common disease affecting large portions of the population (1). It is often ac... more Osteoarthritis is a common disease affecting large portions of the population (1). It is often accompanied by significant joint pain, and the knee is the most commonly affected site. Many patients with knee osteoarthritis try anything and everything to relieve the pain, often to no avail. Pain medications are recommended mostly for temporary relief rather than for long-term treatment. Physical therapy and prescribed exercise can provide benefit over the long term, but adherence often wanes and pain is often a barrier to regular exercise (2, 3). Many patients resort to alternative remedies, but because such therapies often have not been carefully studied, providers do not commonly recommend them. Thus, pain remains the enemy for patients with osteoarthritis and their health care providers. One approach to reducing knee pain in osteoarthritis is to reduce loading on the knee. This can be done through weight loss, use of a cane, or a varus knee brace that applies forces to realign the knee and redistributes load over the knee. Footwear, specifically variable-stiffness shoes, may be another means of unloading the knee. The premise underlying shoe modifications to reduce load on the knee is that repositioning the foot when it is in contact with the ground produces proximal alignment changes because the foot and knee are parts of the closed kinetic chain of the lower extremity. Most clinical guidelines recommend appropriate footwear for patients with knee osteoarthritis, but little evidence exists to inform shoe choice. Although laboratory studies have shown that footwear can change knee biomechanics (4, 5), clinical studies have been lacking. Hinman and colleagues report a promising avenue for patients with knee osteoarthritis (6). They randomly assigned 164 persons with knee osteoarthritis to new shoes with modified midsoles to unload the knee or to new conventional walking shoes, similar in appearance to the unloading shoes, to examine the effect of unloading shoes on knee pain and physical function. At 6 months, both groups showed large and clinically relevant improvements but no differences in pain or function. This study applied a relevant biomechanical intervention and used recommended outcome measures for knee osteoarthritis clinical trials. Differing designs, uses, and lifespans of shoes make footwear interventions difficult to study, but the researchers conducted a good head-to-head comparison of 2 footwear groups. The fact that outcomes improved in both groups leads one to wonder whether readily available, new, supportive lace-up shoes should be the current evidence-based recommendation for appropriate footwear while we await future studies of the biomechanics of knee osteoarthritis that might result in more effective special footwear. The trial has several limitations worth noting. First, collected data on biomechanical measures of foot posture, foot function, and gait were not included in the analyses. These data could identify subgroups whose improvements might be attributable to biomechanics that the study shoes should have corrected. Second, longer-term study of biomechanical aspects would enable exploration of whether unloading shoes slow the progression of knee osteoarthritis. Also, there was no control group of participants wearing their usual shoes. As noted by the authors, three quarters of osteoarthritis treatment effects for pain can be attributed to the placebo effect (6). The authors outline clear biomechanical links to radiographic severity, dysfunction, and osteoarthritis progression (6). Thus, it is unclear why documented changes in knee biomechanics that unload the knee joint in a laboratory do not yield benefits when applied outside the laboratory. Of note, the first study to report reduction in knee adduction moment with variable-stiffness shoes (7) noted that 18% of participants actually showed an increase in adduction moment and 30% had a reduction of less than 5%. Because the intervention is directed at a distant limb segment (the foot), perhaps the body acclimates to the intervention over time, thus reverting to the patient's original loading pattern. Transmission of the load-altering mechanism up to the knee may depend on the structure and function of the foot and lower leg joints. In addition, maybe the unique mechanical properties of the shoes decrease with time, diminishing the biomechanical benefit of the intervention. Closer examination of the lower extremity kinetic chain may provide insights into the mechanical pathways that contribute to knee pain and the best ways to alter them. The current knee osteoarthritis treatment paradigm is characterized by late disease identification, poor alignment of patient pain-relief needs with available treatments, and a unified treatment approach despite heterogeneous clinical presentations. Knee osteoarthritis is a disease with a broad spectrum of expression and multiple mechanisms contributing to progression. There is a desperate…

IFAC Proceedings Volumes, Mar 1, 1994

Arthritis Care and Research, Aug 30, 2019

Objective. Although total knee replacement surgery (TKR) is highly prevalent and generally succes... more Objective. Although total knee replacement surgery (TKR) is highly prevalent and generally successful, functional outcomes post-TKR vary widely. Most patients receive some physical therapy (PT) following TKR, but PT practice is variable and associations between specific content and dosage of PT interventions and functional outcomes are unknown. Research has identified exercise interventions associated with better outcomes but studies have not assessed whether such evidence has been translated into clinical practice. We characterized the content, dosage and progression of usual post-acute PT services following TKR, and examined associations of specific details of post-acute PT with patients' 6-month functional outcomes. Methods. Post-acute PT data were collected from patients undergoing primary unilateral TKR and participating in a clinical trial of a phone-based coaching intervention. PT records from the terminal episode of care were reviewed and utilization and exercise content data were extracted. Descriptive statistics and linear regression models characterized PT treatment factors and identified associations with 6-month outcomes. Results. We analyzed 112 records from 30 PT sites. Content and dosage of specific exercises and incidence of progression varied widely. Open chain exercises were utilized more frequently than closed chain (median and interquartile range (21(4,49) vs 13(4,28.5)). Median (interquartile range) occurrence of progression of closed and open chain exercise was 0 (0,2) and 1 (0,3) respectively. Shorter timed stair climb was associated with greater total number of PT interventions and use and progression of closed chain exercises.

The Use of a Mechanical Model to Describe the Stiffness and Damping Characteristics of the Knee Joint in Healthy Adults

Physical therapy, Nov 1, 1993

Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of t... more Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of this study was to determine the reliability of a relaxed oscillation test that yields stiffness and damping coefficients of the knee. These coefficients describe the knee joint's resistance to bending and the time-dependent nature of that resistance. Effects of age, gender, and knee position on these coefficients were assessed in 96 healthy volunteers aged 20 to 79 years. Measures were based on the premise that the knee joint can be modeled as a damped spring. Oscillations of the knee were recorded using an electrogoniometer with the knee oscillating through about 45 and 75 degrees of knee flexion. Intraclass correlation coefficients revealed moderate to high reliability in the measurements taken three times in the same test session and on three separate days. Analysis of variance showed significant increases in stiffness and damping coefficients in the male subjects as compared with the female subjects. Analysis of variance also suggested an age effect on stiffness coefficients at the 75-degree test position, with decreasing stiffness with age. Both stiffness and damping coefficients were significantly smaller when measured at the 75-degree test position compared with the 45-degree position (Student's t test). These results demonstrate a reliable method of measuring knee joint stiffness, and they correlate well with known morphological differences related to age and gender. This measure may prove to be more useful in evaluating the function of the knee than more commonly used assessments. It may also lead to a better understanding of how the knee functions in such activities as locomotion.

Gait & Posture, Mar 1, 2013

JMIR rehabilitation and assistive technologies, Oct 27, 2022

Background: Electronic health records (EHRs) have the potential to facilitate consistent clinical... more Background: Electronic health records (EHRs) have the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform health care system and its data to a "learning health care system" generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. Objective: The purpose of this paper was to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case was ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (or dose) used to treat patients with knee arthritis following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing physical therapists and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 physical therapists agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 physical therapists. No technical problems with data entry were reported, and data entry required less than 2 minutes per visit. A total of 42 (2%) interventions could not be categorized and were recorded using free text. Conclusions: The use of user-centered design principles provides a road map for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and disseminate knowledge to practice.

ACR open rheumatology, Jun 16, 2022

(1). In an era of chronic disease, the richness of existing data and the value to research driven... more (1). In an era of chronic disease, the richness of existing data and the value to research driven by these data will be enhanced when systematic and comprehensive clinical documentation of interventions is included in the EHR across settings. The EHR is the primary data source for real-world CER and PCOR applications but can be a source of bias when clinical documentation is inconsistent, incomplete, and potentially biased (2). Missing EHR data result from clinician inconsistencies in what and when to document or when patients receive care across multiple health systems or from community-based providers. Human decisions determine content and definition of the data elements (or not) in the EHR, hence contributing to incomplete intervention and outcome data (3). Thus, research using today's EHR, and its clinical data, risks validity because of two major factors: 1) inconsistent clinical intervention and outcome documentation in the course of care and 2) lack of integration of clinical documentation across time and place. Following total knee (TKR) and hip replacement surgeries, PT providers are commonly not affiliated with the health system where the surgery was performed. Thus, their documentation Author disclosures are available at https://onlinelibrary.wiley.com/action/ downloadSupplement?doi=10.1002%2Facr2.11465&file=acr211465-sup-0001-Disclosureform.pdf.

Journal of Rehabilitation Research and Development, 2003

Our long-term goal is to improve adherence to a home-based isometric program for rehabilitation o... more Our long-term goal is to improve adherence to a home-based isometric program for rehabilitation of knee osteoarthritis (OA) using a force-biofeedback device (Isopad TM). Our goal for Phase I was to design and evaluate an Isopad-based program in a supervised clinical setting. Our subjects were five patients with knee OA of Kellgren stage II or greater. A capacitive force sensor was tested for accuracy, repeatability, and durability. An Arthritis Foundation home-based isometric program inspired the Isopad design. The Isopad provided visual and auditory feedback instantaneously and continuously about force generated between the ankles. The five subjects completed a supervised 8-week progressive isometric program using the Isopad. Absolute isolated quadriceps and hamstring torques were quantified with a dynamometer, and patients completed a self-assessment of symptoms (Western Ontario and McMaster Universities Osteoarthritis Index). The capacitive sensor accuracy error averaged 10% and repeatability 4%. Cognitively intact subjects used the Isopad successfully for isometric progressive resistance training. Quadriceps and hamstrings absolute torques increased an average of 30%. Patients reported decreased functional complaints (Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index). All changes were trends. The Isopad helped subjects with knee OA adhere to a supervised isometric program and meet progressive strength targets. The next-generation Isopad will be employed in a home-based program.

Physical therapy, Dec 1, 1988

The purpose of this article is to discuss the static mechanics of the foot and ankle. First, the ... more The purpose of this article is to discuss the static mechanics of the foot and ankle. First, the motions of the ankle and foot available during nonambulatory activities are described by reviewing the literature discussing the axes of motion for the ankle and joints of the foot. Conflicting terminology is presented and clarified, and a scheme for a reasonable terminology is presented. The role of the ankle-foot complex in closed and open kinetic chains is also discussed. Terminology describing structural and functional positions of the foot is presented, including definitions of the subtalar neutral position. A systematic format of terminology is offered to reduce the current inconsistencies. Finally, the weightbearing area of the foot and muscle activity in quiet standing are reviewed.

Web-based system to capture consistent and complete real-world data of physical therapy interventions following total knee replacement Methods to define and test structured data to accelerate comparative effectiveness research (Preprint)

UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate con... more UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform the healthcare system, and its data, to a “learning healthcare system” generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. The purpose of this paper is to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case is ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (dose) used to treat knee arthritis patients following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing PTs and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical, structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 PTs agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 PTs. No technical problems with data entry were reported, and data entry required less than two minutes per visit. Two percent of interventions could not be categorized and were recorded using free text. Discussion: The use of user-centered design principles provides a roadmap for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and to disseminate knowledge to practice.

Physical therapy, Jan 12, 2022

Journal of Medical Internet Research, Apr 11, 2013

Background: The integrity of behavioral intervention trials depends on consistent intervention de... more Background: The integrity of behavioral intervention trials depends on consistent intervention delivery, and uniform, comprehensive process data collection. It can be challenging in practice due to complex human interactions involved. Objective: We sought to design a system to support the fidelity of intervention delivery and efficient capture of qualitative and quantitative process data for a telephone-delivered behavioral counseling intervention to increase physical activity and function after total knee replacement surgery. Methods: A tailored system was designed to prompt the intervention coach in the delivery of a 5 step counseling protocol to support intervention fidelity across patients. System features included structured data components, automated data exchange functions, user-friendly data capture screens, and real-time surveillance reporting. The system structured the capture of patient goals and open-ended conversation. Results: The system recorded intervention process data from each of 12 sessions held with the 92 intervention patients. During the trial, 992 telephone sessions were conducted, and more than 97% (4816/4960) of intervention process data fields were completed in the system. The coach spent 5-10 minutes preparing for each counseling call using system-generated summaries of historical data and 10-15 minutes entering intervention process data following each telephone session. Conclusions: This intervention delivery system successfully supported the delivery of a structured behavioral counseling intervention and collection of intervention process data. It addressed the unique needs of clinical behavioral intervention trials, and had promising potential to facilitate high-fidelity translation of the intervention to broad clinical practice and Web-based multicenter clinical trials in the future.

2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases

Arthritis & Rheumatology

ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adu... more ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs).MethodsThis guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers...

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis

Arthritis Care and Research, May 25, 2023

Physical Therapists Play a Key Role in the Comprehensive Management of Rheumatoid Arthritis

Arthritis Care & Research

Kinesiology : the mechanics dan pathomechanics of human movement, 2nd ed./ Oatis

ix, 946.: ill.; 35 cm

A Anatomofisiologia Do Sistema Músculo Aponeurótico Superficial (Smas)

Gestão e políticas públicas em odontologia, 2022

IFAC Proceedings Volumes, 1994

Web-based system to capture consistent and complete real-world data of physical therapy interventions following total knee replacement Methods to define and test structured data to accelerate comparative effectiveness research (Preprint)

UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate con... more UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform the healthcare system, and its data, to a “learning healthcare system” generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. The purpose of this paper is to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case is ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (dose) used to treat knee arthritis patients following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Inp...

STUDY PROTOCOL Open Access

A randomized clinical trial of a peri-operative behavioral intervention to improve physical activ... more A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement