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INTRODUCTION: The physician assistant (PA) profession is based on previous healthcare experience (HCE), yet few studies have examined the influence of HCE on outcomes. This exploratory study examined possible differences between type of HCE and End of Rotation scores as a surrogate for clinical acumen and medical knowledge. METHODS: Participants included consecutive classes of PA students (2017-2020) from a single public institution (N = 196). Self-reported HCE was used to classify students into HCE groups: group 1, lower decision-making professions; and group 2, higher decision-making professions. RESULTS: Group 1 (n = 124) and group 2 (n = 72) had no significant difference in the 7 individual End of Rotation exam scores and HCE ( p =.163 to .907). A correlation was found between average End of Rotation exam score and PANCE scores ( r =.80, p ≤ .001). DISCUSSION: The impact of HCE during the clinical year of education and its influence on noncognitive attributes, such as communication skills and professionalism, is not known. HCE might have a role in hard to measure noncognitive, nonquantifiable qualities.

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PURPOSE: Learning to perform and document patient history taking and physical exam (H&P) entails a major component of the 1st year academic education of physician assistant (PA) students at Wayne State University, USA. The H&P is summative of multiple aspects of PA education, and students must master communication with patients and other health care providers. The objectives of this study were first, to determine if there was a correlation between scores on GRE component testing and scores on graded H&Ps. The second objective was to identify a correlation between proficiency with H&P documentation and academic and clinical year grade point average (GPA)s and Physician Assistant National Qualifying (PANCE) score. METHODS: Subjects included 147 PA students from Wayne State University from 2014-2016. PA students visited local hospitals or outpatient clinics during the academic year to perform and document patient H&Ps. Correlation between The H&P mean scores and GRE component scores, GPAs, and PANCE scores were analyzed. RESULTS: The subjects were 26.5 years-old (+ 6.5) and 111 female (75.5%). There was no correlation between the GRE component score and the H&P mean score. The H&P score was positively correlated with GPA 1 (r = 0.512, P<0.001), with GPA 2 (r = 0.425, P<0.001) and with PANCE score (r = 0.448, P<0.001). CONCLUSION: PA student skill with H&P documentation was positively related to academic performance score during PA school and achievement score on the PANCE at Wayne State University, USA.

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OBJECTIVE: To determine the short-term effectiveness of thoracic manipulation when compared to sham manipulation for individuals with low back pain (LBP). DESIGN: Randomized controlled trial. METHODS: Patients with LBP were stratified based on symptom duration and randomly assigned to a thoracic manipulation or sham manipulation treatment group. Groups received 3 visits that included manipulation or sham manipulation, core stabilization exercises, and patient education. Factorial repeated-measures analysis of variance and multiple regression were performed for pain, disability, and fear avoidance. The Mann-Whitney U test was used to analyze patient-perceived improvement, via the global rating of change scale, at follow-up. RESULTS: Ninety participants completed the study (mean ± SD age, 38 ± 11.5 years; 70% female; 72% with chronic LBP). The overall group-by-time interaction was not significant for the Modified Oswestry Disability Questionnaire, numeric pain-rating scale, and Fear-Avoidance Beliefs Questionnaire outcomes. The global rating of change scale was not significantly different between groups. CONCLUSION: Three sessions of thoracic manipulation, education, and exercise did not result in improved outcomes when compared to a sham manipulation, education, and exercise in individuals with chronic LBP. Future studies are needed to identify the most effective management strategies for the treatment of LBP. LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2020;50(1):24-32. Epub 6 Dec 2019. doi:10.2519/jospt.2020.8928.

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Low-frequency ultrasound may facilitate debridement and healing of chronic wounds, including lower leg wounds in patients with chronic venous insufficiency (CVI). To evaluate the use of a low-frequency ultrasound (LFU) device with a curette, two patients with CVI and chronic wounds were treated for a period of 2 to 3 weeks. A 63-year-old woman with rheumatoid arthritis and two wounds, one on the right lower leg (250 cm³) and one wound on the left medial leg (0.80 cm³), present for 12 months; and a 77-year-old man with cardiopulmonary issues with seven wounds, three on the left medial calf (1.2 cm³, 11.40 cm³, and 0.72 cm³), one on the left anterior calf (0.30 cm³), two on the right posterior calf (0.90 cm³, 0.30 cm³), and one on the right anterior calf (0.14 cm³), present for 3 months consented to participate in the study. Both patients received low-intensity (50-70 µm), low-frequency (35 kHz) ultrasound at an intensity of 50% through a saline mist in addition to antimicrobial dressing with silver, a multilayer compression bandage system applied at every visit, and pain medication as needed. Both patients received treatments every 1 to 3 weeks that were not timed. Treatment continued until no additional slough or other necrotic tissue could be removed from the wound bed; the female patient received two treatment sessions and the male received three. Average wound volume did not change significantly from the first to last treatment session (t(8)-1.2, P = 0.26). Five wounds (56%) with initial measurements of 0.8 cm³, 0.72 cm³, 0.3 cm³, 0.3 cm³, and 0.14 cm³ reduced in volume by 100%. Mean wound characteristic scores changed significantly (P <0.05) for amount of fibrin, periwound skin, drainage amount, and color. In addition, the number of wounds filled with slough decreased from 89% at the first session to 22% at the final treatment session. The results of this study suggest LFU may have been beneficial for these patients with CVI. Additional studies using larger sample sizes are needed to evaluate the effect of this treatment on a variety of chronic wounds and to compare its effectiveness to other debridement methods.

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Estimates of low back pain prevalence in USA ballet dancers range from 8% to 23%. Lumbar stabilization and extensor muscle training has been shown to act as a hypoalgesic for low back pain. Timing and coordination of multifidi and transverse abdominis muscles are recognized as important factors for spinal stabilization. The purpose of this study was to explore the effects of training methods using home exercises and a dynamic sling system on core strength, disability, and low back pain in pre-professional ballet dancers. Five participants were randomly assigned to start a traditional unsupervised lumbar stabilization home exercise program (HEP) or supervised dynamic sling training to strengthen the core and lower extremities. Measurements were taken at baseline and at weeks 3 and 6 for disability using the patient specific functional scale (PSFS), pain using the Numerical Pain Rating System (NPRS), core strength and endurance using timed plank, side-plank, and bridge positions, and sciatic nerve irritability using the straight leg raise (SLR). Data were analyzed using descriptive statistics. From initial to final measurements, all participants demonstrated an improvement in strength and SLR range, and those with initial pain and disability reported relief of symptoms. These results suggest that dynamic sling training and a HEP may help to increase strength, decrease pain, and improve function in dancers without aggravating sciatic nerve irritation.

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