Jason Zafereo - Academia.edu (original) (raw)

Papers by Jason Zafereo

Journal of Manual & Manipulative Therapy

OBJECTIVES To use ultrasound (US) imaging to determine the validity and reliability of needle pla... more OBJECTIVES To use ultrasound (US) imaging to determine the validity and reliability of needle placement of two dry needling (DN) protocols for the lumbar multifidus (LM) in individuals with a high body mass index (BMI). METHODS Twenty-one participants with a BMI higher than 25 kg/m2 completed the study. A US scanner was used to determine the location of needle placement after a 100 mm long needle was inserted in the LM at L4 and L5 following two DN protocols for the deep LM muscle. US images were saved and viewed 6 months later to determine the intra-tester reliability. RESULTS The probability of reaching the deep LM muscle was high (85-95%) at L4 and L5. Although the needle reached a bony landmark 85-100% of the time, it only reached the vertebra lamina as intended 70-75% of the time. The intra-tester reliability of needle placements based on analysis of real-time and recorded US images was poor-to-moderate. CONCLUSIONS Although the bony drop may not indicate that the needle has reached the vertebra lamina as the protocol intended, reaching a bony drop is still meaningful as it coincided with reaching the LM in the majority of participants.

Pain Management

Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in a... more Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in an interdisciplinary pain program (IPP). Patients & methods: Participants (n = 53) enrolled in an IPP completed pretreatment assessments of QST and the PROMIS-29 quality of life survey. Results & conclusion: Compared with completers, non-completers (24.5%) reported significantly higher pain intensity (7.1, 95% CI [5.8, 8.4] versus 5.4, 95% CI [4.8, 6.1]) and cold hyperalgesia (14.6°C, 95% CI [8.8, 20.4] versus 7.5°C, 95% CI [4.8, 6.1]), with both variables also predicting attrition. This finding highlights a potentially novel and clinically significant use of QST. Higher overall pain intensity and the presence of remote cold hyperalgesia may identify patients at risk for dropping out of an IPP.

Physical Therapy, 2021

Objective The Commission on Accreditation in Physical Therapy Education has introduced a requirem... more Objective The Commission on Accreditation in Physical Therapy Education has introduced a requirement that 50% of core faculty members in a physical therapist education program should have an academic doctoral degree, which many programs are not currently meeting. Competition between programs for prestige and resources may explain the discrepancy of academic achievement among faculty despite accreditation standards. The purpose of this study was to identify faculty and program characteristics that are predictive of programs having a higher percentage of faculty with academic doctoral degrees. Methods Yearly accreditation data from 231 programs for a 10-year period were used in a fixed-effects panel analysis. Results For a 1 percentage point increase in the number of core faculty members, a program could expect a decline in academic doctoral degrees by 14% with all other variables held constant. For a 1% increase in either reported total cost or expenses per student, a program could e...

Journal of Back and Musculoskeletal Rehabilitation, 2021

BACKGROUND: The Movement System Impairment (MSI) model is useful for identifying spine-hip mobili... more BACKGROUND: The Movement System Impairment (MSI) model is useful for identifying spine-hip mobility and motor control deficits that may contribute to low back pain (LBP). While previous studies have found differences in global spine-hip movement impairments between lumbar MSI subgroups, no studies have compared segmental spine movement impairments between these subgroups. Therefore, the purpose of this study is to analyze segmental lumbar mobility in participants with LBP and a lumbar flexion- or extension-based MSI. METHODS: Forty participants with subacute-chronic LBP were placed into one of three age groups (< 35, 35–54, or > 54 years-old) and then classified into a flexion- or extension-based MSI sub-group. Segmental lumbar range of motion (ROM) was measured in degrees using a skin-surface device. Total lumbar and segmental flexion and extension ROM of L1-L2 to L5-S1 was compared between MSI sub-groups for each age group using separate two-way ANOVAs. RESULTS: Significant ...

The aim of this chapter is to provide an overview of the most common, evidence-based techniques a... more The aim of this chapter is to provide an overview of the most common, evidence-based techniques and approaches used by physical therapists to evaluate and treat patients with pain. The first section on evaluation includes examination techniques, prognosis, and patient diagnosis/classification. The second section on treatment presents management strategies linked to a pain mechanism classification scheme of nociceptive, neuropathic, or nociplastic pain. Specific recommendations from clinical practice guidelines are included for the physical therapy management of spinal pain, lower extremity osteoarthritis, radiculopathy, carpal tunnel syndrome, fibromyalgia, and complex regional pain syndrome, type I.

Complementary Therapies in Clinical Practice, 2021

Complex regional pain syndrome (CRPS) is a pain syndrome with no singular mechanism and no specif... more Complex regional pain syndrome (CRPS) is a pain syndrome with no singular mechanism and no specific cure. The aim of this case report is to study the impact of Lymphatic Enhancement Technology (LET) treatment on CRPS-related symptoms. A 51 year-old female presented with a chief complaint of severe, refractory ankle pain and CRPS related to a tibial and fibular fracture sustained three years earlier. The patient completed twelve cognitive behavioral therapy sessions over a 4-week period, and eleven physical therapy sessions over a four-month period, six of which utilized LET. Pain and swelling were largely unchanged with interdisciplinary treatment before the introduction of LET. A within-session change of 37.5% in pain intensity and 87.5% in ankle girth was observed immediately after the first application of LET. Three months after beginning LET treatment, the patient maintained a 43.8% improvement in pain intensity and 100% improvement in measurements of lower extremity girth and ankle range of motion. No side effects or adverse events were associated with the LET treatment. Swelling, pain, and mobility loss are common symptoms and features of CRPS. LET is a novel, non-invasive treatment that appears to be quite safe and effective for improving pain, swelling, and mobility loss related to CRPS.

JBMR Plus, 2021

Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) therapy. It... more Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) therapy. Its use is associated with a loss of bone mineral density (BMD) and a greater risk of falls and osteoporotic fractures. In this prospective cohort study, we examined the impact of ADT on muscle and bone strength in men initiating ADT for PCa. Participants were evaluated at three time points: immediately before (week 0), and 6 and 24 weeks after ADT initiation. Study measures included fasting blood levels (for markers of muscle and bone metabolic activity), MRI and QCT imaging (for muscle fat content, and bone density and architecture), and validated clinical tests of muscle strength and gait. Sixteen men completed all study visits. At baseline and throughout the study, participants exercised a median of four times/week, but still experienced weight gain (+2.0 kg at week 24 versus week 0, p = 0.004). Biochemically, all men sustained dramatic early and persistent reductions in sex hormones post-ADT, along with a progressive and significant increase in serum C-telopeptide of type I collagen (CTX, +84% at week 24 versus week 0). There was a trend for rise in serum sclerostin (p = 0.09) and interleukin 6 (IL-6) (p = 0.08), but no significant change in serum myostatin (p = 0.99). Volumetric BMD by QCT declined significantly at the femoral neck (À3.7% at week 24 versus week 0), particularly at the trabecular compartment. On MRI, there were no significant changes in thigh muscle fat fraction. On physical testing, men developed weaker grip strength, but experienced no worsening in lower extremity and lumbar spine muscle strength, or on functional tests of gait. In conclusion, in physically active men, ADT for 24 weeks results in a significant increase in bone resorption and reduction in BMD, but nonsignificant changes in thigh muscle quality (on imaging) or strength and gait (on functional testing).

Archives of Physical Medicine and Rehabilitation, 2021

Research Objectives: 1. To compare patient attendance in an interdisciplinary pain program (IPP) ... more Research Objectives: 1. To compare patient attendance in an interdisciplinary pain program (IPP) before and during the COVID-19 pandemic. 2. To describe programmatic changes in response to patient needs during the pandemic. Design: Cohort comparison of IPP attendance rates before versus during the pandemic. Setting: Outpatient IPP (consisting of physical therapy [PT], cognitive behavioral therapy [CBT], and medication management [MM]) within an academic medical center. Participants: Adults diagnosed with chronic pain (N=259) who attended ≥ 1 IPP session between March 2017 and February 2020. Interventions: Before COVID-19, PT, CBT, and MM delivered in-person. During COVID-19, PT and MM delivered remotely and in person; CBT delivered via telehealth to individuals and groups to allow social distance and respond to facial affect. Main Outcome Measures: Objective 1. Patient attendance = attending ≥ 6 days of PT or CBT (individual and/or group). Results: Objective 1. Before COVID-19, IPP attendance (from 3/20/2017 to 3/4/2020) was 76%. Since COVID-19 and through 2/2021, attendance was 65%. Objective 2: During COVID-19, PT included both telehealth and masked, in-person sessions. CBT was delivered through telehealth. IPP psychologist's role grew to promote evidence-based nonpharmacologic intervention for COVID-19 and reduce vaccination hesitation. Conclusions: Overall, IPP clinicians and staff maintained safe access to interdisciplinary care for adults with chronic pain. Despite the global pandemic 65% of the patients completed the IPP. The 11% reduction in attendance may reflect increased biopsychosocial burdens experienced by patients with chronic pain during COVID-19. As chronic pain affects more Americans than diabetes, heart disease, and cancer combined, future studies are needed to identify the barriers to attendance among patients before and after COVID-19. Determining how to best reduce the risk of attrition will assist patients in benefiting fully from IPP treatment.

Physical Therapy, 2020

Objective Graduation rates and first-time National Physical Therapy Examination (NPTE) pass rates... more Objective Graduation rates and first-time National Physical Therapy Examination (NPTE) pass rates among Doctor of Physical Therapy (DPT) programs have ranged from 30% to 100% and 0% to 100% between 2008 and 2017, respectively. Prior studies on predictors of graduation rates and NPTE pass rates from DPT programs have used cross-sectional data and have not studied faculty data. This study sought to understand how trends in DPT faculty and program characteristics correlated with graduation rates and first-time NPTE pass rates. Methods This study was a retrospective panel analysis of yearly data from 231 programs between 2008 and 2017. Random effects models estimated the correlations between faculty and program characteristics regarding graduation rates and first-time NPTE pass rates. Results Graduation rates peaked when programs devoted 25% of faculty time, on average, to scholarship. The number of peer-reviewed publications was positively correlated with graduation rates; however, the...

Journal of Manual & Manipulative Therapy, 2018

Objectives: Clinical practice guidelines recommend a focus on regional interdependence for the ma... more Objectives: Clinical practice guidelines recommend a focus on regional interdependence for the management of chronic low back pain (CLBP). This study investigated the additive effect of regional manual therapy (RMT) when combined with standard physical therapy (SPT) in a subgroup with CLBP. Methods: Forty-six participants with CLBP and movement coordination impairments were randomly assigned to receive SPT consisting of a motor control exercise program and lumbar spine manual therapy, or SPT with the addition of RMT to the hips, pelvis, and thoracic spine. Outcome measures included disability level, pain intensity, pain catastrophizing, fear avoidance beliefs, and perceived effect of treatment. Appropriate parametric and non-parametric testing was used for analysis. Results: Both groups demonstrated improvements in disability level, pain intensity, pain catastrophizing, and fear avoidance beliefs across time (P < 0.001). There was no difference between groups for any variable over 12 weeks, although a significantly greater proportion of participants in the RMT group exceeded the minimal clinically important difference (MCID) for disability. The perceived effect of treatment also was significantly higher in the group receiving RMT at two weeks and four weeks, but not 12 weeks. Discussion: SPT with or without RMT resulted in significant improvements in disability level, pain intensity, pain catastrophizing, and fear avoidance beliefs over 12 weeks in persons with CLBP and movement coordination impairments. RMT resulted in greater perceived effect of treatment, and a clinically meaningful improvement in disability, across four weeks compared to SPT alone.

Pain Practice, 2021

Chronic musculoskeletal pain affects an estimated one in three individuals worldwide, and is the ... more Chronic musculoskeletal pain affects an estimated one in three individuals worldwide, and is the leading cause of global disability. 1 Currently, the majority of treatments for musculoskeletal pain provide small effects when viewed across a large number of individuals. 2 One reason for this may be related to differences in the underlying mechanisms perpetuating chronic pain, which would suggest that not all treatments will affect pain equally. The ability to distinguish patients by their specific pain mechanisms may allow for more targeted treatment approaches, 2-4 and thus reduce the global burden of pain. Several pain mechanism classification schemes have been proposed to improve upon the management of various musculoskeletal conditions. 5-7 Acceptable reliability and validity has been reported for classification schemes that divide patients with musculoskeletal pain into nociceptive, peripheral neuropathic, or central sensitization (CS) categories. 5,6,8 Although identification of CS in humans is not

Journal of Manual & Manipulative Therapy, 2020

Objectives: The purpose of this study was to compare the effects of deep dry needling (DN) with a... more Objectives: The purpose of this study was to compare the effects of deep dry needling (DN) with and without needle manipulation on pressure pain thresholds (PPTs) and electromyographic (EMG) amplitude of the lumbosacral multifidus (LM) in adults with low back pain (LBP). Methods: Participants were randomized into two treatment groups: with needle manipulation (n = 21) and without needle manipulation (n = 21). All participants received a single session of the assigned DN intervention. PPTs and EMG amplitude of the LM muscle were collected three times: before DN, immediately after DN, and one week after DN. Results: The needle manipulation group had a significantly greater increase in PPT immediately after the intervention and at the one-week follow-up as compared to the no needle manipulation group. The increase of PPT in the needle manipulation group was significant immediately after the intervention, and the increase remained significant at the one-week follow-up. However, there was no significant difference in EMG amplitude of the LM muscle between groups across the three time points. Discussion: Deep DN with needle manipulation appeared to reduce mechanical pressure sensitivity more than DN without manipulation for patients with LBP. Although a single session of DN could reduce pressure pain sensitivity, it may not be sufficient to improve LM muscle function. Level of Evidence: 1b. Trial registration numbers: NCT03970486.

Advances in Health Sciences Education, 2020

The physical therapy profession in the United States suffers from a shortage of providers of colo... more The physical therapy profession in the United States suffers from a shortage of providers of color. This is unlikely to change with newly graduating students, as 2.6% of 2017 graduates were African American and 5.7% were Hispanic or Latino. Faculty mentorship has a more profound influence on the retention of underrepresented minority students as compared with students from privileged backgrounds, according to undergraduate literature. The influences of faculty characteristics on physical therapy graduates of color are unknown. The purpose of this study was to determine faculty and programmatic characteristics that could influence the percentage of physical therapy graduates of color. This study implemented the theory of academic capitalism to inform the results of a retrospective panel analysis, which used accreditation data from 2008 to 2017. Data from 231 programs was used to create fixed effects and random effects models to estimate the effects that faculty and program characteristics had on the percentage of graduates of color that a program produced. There was a statistically significant positive relationship between faculty of color and graduates of color (p < 0.001), but faculty must be sufficiently diverse before a program can expect a meaningful change in their percentage of graduates of color. Academic capitalist principles suggest that competition between programs for resources could negatively influence the proportion of graduates of color. Cause and effect associations between variables cannot be established. The authors concluded that professional physical therapy programs appeared to have increases in the percentages of graduates of color when they had more core faculty members of color.

Journal of Manipulative and Physiological Therapeutics, 2019

Objective: The purpose of this study was to determine the psychometric properties of pressure pai... more Objective: The purpose of this study was to determine the psychometric properties of pressure pain threshold (PPT) testing in adults with and without neck-shoulder pain and tenderness and to compare the differences in PPT measurements between the seated and prone positions. Methods: Thirty asymptomatic adults and 30 symptomatic patients with intermittent neck-shoulder pain and tenderness completed the study. A pressure algometer was used to assess PPTs at specific points on the middle deltoid, levator scapulae, and upper trapezius muscles of the dominant side of the asymptomatic individuals and the painful side of the patients. Four trials were performed on each muscle in both the seated and prone positions. To determine between-day reliability, a subset of the participants returned to repeat the testing. Results: The intraclass correlation coefficients showed good to excellent within-session reliability and fair to excellent between-day reliability of PPT measurements in both the seated and prone positions for both groups. There were significant differences between groups for all muscles in both positions (P b .05) except for the upper trapezius muscle in the prone position. In addition, significant differences were found between the 2 testing positions for the middle deltoid and upper trapezius muscles in the symptomatic group and for the middle deltoid muscle in the asymptomatic group. Conclusion: The results of the study suggest that PPT testing could be useful for distinguishing individuals with and without neck-shoulder pain and tenderness. Further, the patient's position should be considered when testing PPT, specifically at the middle deltoid or upper trapezius muscles.

Journal of Bodywork and Movement Therapies, 2019

A single patient (male, 67) with a medical diagnosis of idiopathic peripheral neuropathy (G60.9) ... more A single patient (male, 67) with a medical diagnosis of idiopathic peripheral neuropathy (G60.9) was referred to physical therapy. The patient presented with signs and symptoms consistent with peripheral neuropathy, including bilateral single leg balance deficits, sensation impairments, and antalgic gait. Treatment consisted of dry needling (DN) with electrical stimulation and a home exercise program involving a neurodynamic exercise to be performed daily. Dry needling included the use of thin filiform needles to stimulate the underlying structures directed at eliciting a change within the tissues. The needles were left in situ and connected to an electrical stimulation unit. The neurodynamic exercise used in this case study was designed to target the distal branches of the sciatic nerve. The patient was directed to complete 3 sets of 10 repetitions in the slumped position and moving between ankle plantar flexion and dorsiflexion. The patient was treated for a total of 4 visits over a 5-week period. The Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), Romberg Test, and sensation testing were collected at baseline and then again after the 4th treatment. A Global Rating of Change (GROC) score was obtained at the end of treatment. After the 4th visit, functional self-report scores were not improved (93.75% to 86.9% at completion), while NPRS decreased to 2 from a baseline rating of 4. The eyes closed portion of the Rhomberg balance test improved from 5 seconds on the right limb to 15 seconds and from 8 seconds to 20 seconds on the left limb. Sharp/dull sensation testing of the L4 dermatome also improved from 2 out of 5 correctly selected on the left lower limb to 5 out of 5. At the S1 level, sensation improved on the left lower limb from 2 out of 5 to 4 out of 5 and from 2 out of 5 on the right lower limb to 5 out of 5. The patient's GROC score was rated as quite a bit better (+5). The outcomes of this case study suggest that clinicians may consider the addition of DN with electrical stimulation and

Journal of Womenʼs Health Physical Therapy, 2019

Background: Insuffi cient stability of the lumbopelvic region has been reported as an underlying ... more Background: Insuffi cient stability of the lumbopelvic region has been reported as an underlying cause of lumbopelvic pain in postpartum women. Women early postpartum have been shown to have decreased ability to contract the deep abdominal muscles; however, differentiation has not been made between women who deliver via cesarean delivery versus those who have vaginal births. Objectives: To compare deep abdominal muscle performance in women who delivered vaginally versus those who delivered via cesarean delivery. The secondary purpose was to determine the reliability of the testing protocol using ultrasound imaging. Study Design: Case-control design. Methods: Twenty postpartum women (10 vaginal births and 10 cesarean delivery births) who had given birth within the past 12 months completed the study. Muscle thickness of the transverse abdominis (TrA) and internal oblique abdominis (IO) muscles was measured using ultrasound imaging while the participant performed the abdominal drawing-in maneuver (ADIM). Percent change of muscle thickness was used for statistical analysis as follows: Percent Change = [(Contracted-Rest)/(Rest)] × 100%. Results: There was no signifi cant difference between groups for the percent change of muscle thickness for the TrA (P = .53) or IO group (P = .80). Interrater reliability was excellent, with intraclass correlation coeffi cient values of 0.97 for both the TrA and IO groups, respectively. Conclusion: The results showed no differences in the percent change of deep abdominal muscle thickness during ADIM between women who delivered vaginally and those who delivered via cesarean delivery, indicating that

Journal of bodywork and movement therapies, 2018

Reduced lumbar multifidus (LM) muscle contraction has been observed in patients with low back pai... more Reduced lumbar multifidus (LM) muscle contraction has been observed in patients with low back pain (LBP). Clinicians often use various strategies to ensure LM activation, including tactile feedback and verbal instruction. However, the effects of tactile feedback on muscle activation have not been studied previously. Therefore, the purpose of this study was to investigate whether or not tactile feedback would increase LM muscle activity in adults with and without LBP. Twenty asymptomatic adults and 20 patients with existing LBP completed the study. Two electromyographic (EMG) electrodes were applied to both sides of the LM at the L5 segment. EMG activity was collected three times at rest with and without tactile feedback, then five times during contralateral arm lifts with and without tactile feedback. The tactile feedback was applied by direct and continuous hand contact to the bilateral LM over the lumbosacral area. Lastly, two 5-second trials of maximum voluntary isometric contrac...

Rheumatology international, Jan 28, 2017

Fibromyalgia is a chronic musculoskeletal condition characterized by widespread pain in the body ... more Fibromyalgia is a chronic musculoskeletal condition characterized by widespread pain in the body and is associated with tender points at the shoulder, back and hip regions. A wide variety of pharmacologic drugs and dietary supplements have been used with limited success in treating the musculoskeletal pain. Early clinical studies with low level laser therapy (LLLT) alone or in combination with drugs commonly used to treat fibromyalgia suggested that LLLT may be effective in reducing musculoskeletal pain and stiffness, as well as the number of tender locations. However, a sham-controlled study reported that LLLT was not significantly better than the sham treatment and kinesiotape. Preliminary studies with high-intensity laser therapy (HILT) suggest that it may be more effective than LLLT for treating chronic pain syndromes. Therefore, we evaluated low (1 W), intermediate (42 W) and high level (75 W) HILT in a woman with long-standing fibromyalgia syndrome which was resistant to both ...