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Study was terminated due to lack of referral sources and limited participant enrollment.
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The purpose of this study is to examine the role of a Mechanical Diagnosis and Therapy (MDT) examination in identifying participants diagnosed with concussion who display a directional preference compared to who don't display a directional preference.
Directional preference describes the clinical phenomenon where a specific direction of repeated movement and / or sustained position results in a clinically relevant improvement in symptoms. This improvement is usually accompanied by an improvement in function or mechanics or both. Its presence and relevance is determined over 2-3 visits. This study aims to identify the proportion of participants with concussion who present with a directional preference during the course of physical therapy. A secondary aim of this study is to investigate whether directional preference is associated with the eventual patient related outcomes following care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Directional preference responder | This group is comprised of participants who responded to repeated movements in a direction (e.g., neck flexion) that significantly improved their symptoms and/or their ability to move their head/neck. |
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| Directional preference non-responder | This group is comprised of participants who did not respond to repeated movements in any specific direction that significantly improved their symptoms and/or their ability to move their head/neck. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physical Therapy | Behavioral | As part of their normal care, participants will receive any combination of the following interventions to address their specific needs identified during the initial evaluation: cervical spine repeated movements (active range of motion), cervical spine stabilization exercise, aerobic exercise, motor control training, oculomotor/vestibular rehabilitation, stretching, soft-tissue mobilization, joint mobilization, and postural re-education activities. |
| Measure | Description | Time Frame |
|---|---|---|
| Directional preference classification | Outcome represents the patient's directional preference at the time of discharge from care. Patients will be classified as directional preference responders or non-responders. | Through study completion, up to 1 year. |
| Measure | Description | Time Frame |
|---|---|---|
| Post-Concussion Symptom Scale | The PCSS is a patient self-reported outcome measure that measures the amount of interference associated with a concussion across four domains: physical, cognitive, emotion, and sleep. The measure consists of 22 questions that relate to post-concussive symptoms. The measure uses a 7-point Likert scale, where 0 = no symptoms and 6 = severe symptoms. The greatest possible score is 132 and the lowest score is 0. Higher scores indicate higher severity of post-concussive symptoms. |
| Measure | Description | Time Frame |
|---|---|---|
| Return to sport/activity | This outcome represents the number of days it takes a patient to return to their prior level of participation in sport/activity | Up to 1 year |
| Number of treatments | This outcome represents the number of physical therapy visits they completed before being discharged by the physician or physical therapist. |
Inclusion Criteria:
Exclusion Criteria:
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The study population will consist of patients who have been diagnosed with a concussion and referred for outpatient physical therapy services.
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| Name | Affiliation | Role |
|---|---|---|
| Michael R Brown, DPT, PhD | University at Buffalo | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Goodlife Physical Therapy | Orland Park | Illinois | 60467 | United States | ||
| Summit Healthplex Physcial Therapy/Niagara Falls Memorial Medical Center |
Individual participant data will not be shared with other researchers.
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| ID | Term |
|---|---|
| D001924 | Brain Concussion |
| ID | Term |
|---|---|
| D000070642 | Brain Injuries, Traumatic |
| D001930 | Brain Injuries |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| ID | Term |
|---|---|
| D026741 | Physical Therapy Modalities |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
| D012046 | Rehabilitation |
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|
| Through study completion, up to 1 year. |
| Neck Disability Index | The NDI is a patient self-reported outcome measure that measures the amounts of pain interference and self-reported disability related to neck pain. The measure consists of ten questions in the following domains: pain intensity, personal care, lifting, reading, sleeping, work, recreation, reading, concentration, and headaches. Each item is rated on a 0 to 5 scale, where 0 = no disability and 5 = complete disability. The highest possible raw score equals 50 points, the lowest possible score equals 0. The raw scores can also be converted to a percentage from 0 to 100%. Higher scores indicate higher levels of self-reported disability. | Through study completion, up to 1 year. |
| Dizziness Handicap Inventory | The DHI is a patient self-reported outcome measure that measures the impact of dizziness on daily life. The DHI consists of 25 items measuring the impact of dizziness across three domains: functional (9 questions,= 36 points), emotional (9 questions = 36 points), and physical (7 questions = 28 points). Each item is rated on a 3 point scale (yes = 4, sometimes = 2, no = 0). Item scores are summed, with a possible total of 100 points. The best possible score is a 0. Higher scores indicate greater perceived handicap due to dizziness. | Through study completion, up to 1 year. |
| Up to 1 year |
| Niagara Falls |
| New York |
| 14304 |
| United States |
| D009422 | Nervous System Diseases |
| D006259 | Craniocerebral Trauma |
| D020196 | Trauma, Nervous System |
| D016489 | Head Injuries, Closed |
| D014947 | Wounds and Injuries |
| D014949 | Wounds, Nonpenetrating |