Research Day 2022

Agenda

SESSION ONE
9-9:05 AMOpening Remarks
9:05-9:25Factors Influencing Fall Assessment Tool Selection by Homecare Physical Therapists

Student Researchers: Jonathan Gallub, Katrina Quimpo, Emrul Arshad, Bobby Henning, Sammy Aziz, Kari Delemarre-Brand

Research Advisor: Dr. Christopher Voltmer, PT, DPT, NCS, MSCS
9:25-9:45The Ideal PT & Activity During COVID-19

Student Researchers: Albert Gambale, Elizabeth Leung, Madeline Rodgers, Matthew Marra, Maya Nisani, Danny Chillianis

Research Advisor: Dr. Daniel J. Lee, PT, DPT, PhD, GCS, COMT
9:45-10:05Are smartphones reliable and valid tools to detect fractures in long bones by analyzing change in frequency?

Student Researchers: Distefano J., Bettex K., Miksits M., Neuman J., Stern D., Zhao J.

Research Advisors: Dr. Ofra Pottorf PT, DPT, OCS and Dr. Vanessa Reddin Ph.D.
10:05-10:15Intermission
SESSION TWO
10:15-10:35Impact of Foot Posture on Static and Dynamic Balance

Student Researchers: Anthony Accetturi, Charmy Patel, Amanda Woo, Brian Steiger, Josh Pernick, Gehrig Montoro

Research Advisor: Dr. Joseph Hayes PT, DPT, OCS
10:35-10:55The Correlation Between AMPPro and TAPES-R in Patients with Lower Limb Amputations

Student Researchers: Kelly Felicetta, Michael Percoco, Tyler Mok

Research Advisors: Dr. Robert Troiano PT, DPT, CHT and Dr. Frances Corio PT, PhD, OCS
10:55-11:15One Day You Will be Older: Teaching Empathy with an Older Adult Simulator Suit

Student Researchers: Ashley Willoughby, Max Pignotti, Brianna McNulty, Natalie Fagan, Jay Patel, Alexander Kapoutsos

Research Advisor: Dr. Daniel J. Lee, PT, DPT, PhD, GCS, COMT
11:15-11:20 Closing Remarks

Abstracts

Title: Factors Influencing Fall Assessment Tool Selection by Homecare Physical Therapists

Student Researchers: Jonathan Gallub, Katrina Quimpo, Emrul Arshad, Bobby Henning, Sammy Aziz, Kari Delemarre-Brand

Research Advisor: Dr. Christopher Voltmer, PT, DPT, NCS, MSCS

Purpose: The purpose of this study is to determine which fall risk assessments are used by home care physical therapists and the factors that contribute to their decision-making process.

Subjects: A total of 68 home care physical therapy candidates were recruited from home care agencies via email; of those, 9 subjects consented to participate in the study. Inclusion criteria consisted of having a license to practice physical therapy, practicing for a minimum of 5 years, and being able to communicate in English.

Methods: This study was designed to survey licensed home care physical therapists on their professional experiences and decision-making factors regarding their selection of screening tools within a home care setting. Exclusion criteria consisted of the inability to participate in the survey via zoom. Participants were individually interviewed and provided a survey that included a set of demographic questions, a questionnaire on a 5-point Likert-scale, and an open discussion on the decision-making process for a case-based scenario. The survey data was analyzed using Microsoft excel. Responses were reviewed for descriptive statistics for central tendencies, frequencies, and distributions.

Results: Out of 9 participants, 6 stated that home care was their primary setting of employment. Survey results on a 5-point Likert scale showed that 77% of participants strongly agreed on having an appropriate level of education for evaluation & management skills and the ability to confidently identify a patient as a fall risk. All participants agreed (56% strongly agreed, 44% agreed) that reimbursement constraints had no impact on their clinical decisions among this patient population. Regarding the influence of time constraints, 45% of the participants disagreed in having enough time to complete a fall risk evaluation. Furthermore, 22% of the participants disagreed on having support for professional growth and the necessary equipment in the management of a fall risk patient. The case-based survey found that 88% of participants selected the Timed Up and Go Test as their primary assessment tool in appropriately identifying a fall risk; 33% of the participants selected the Functional Reach Test as their secondary assessment choice.

Conclusion: The participating home care physical therapists agreed on the significance of utilizing effective assessment tools for identifying fall risks in the elderly population. Our study found that the Timed Up and Go Test was the most used screening tool among the participants, followed by the Functional Reach Test. Moreover, we identified that factors such as ease of administration and time constraint influenced their decision-making process. Further research is required to determine the decision-making process in the selection of effective fall risk assessments.


Title: Survey of physical activity in persons with limb loss during the COVID-19 pandemic in the United States

Student Researchers: Albert Gambale, Elizabeth Leung, Madeline Rodgers, Matthew Marra, Maya Nisani, Danny Chillianis

Research Advisor: Dr. Daniel J. Lee, PT, DPT, PhD, GCS, COMT

Purpose/Hypothesis: Physical activity has been shown to be fundamental in the prevention of numerous diseases and disorders. Achieving and maintaining physical activity levels can be particularly challenging in those with impairments, such as those experiencing a lower limb amputation. To slow the spread of the virus, COVID-19 lockdown mandates imposed by the US state governments may have inadvertent consequences on physical activity levels of those dependent on specific forms of exercise. Understanding how physical activity levels may have affected persons with limb loss can inform intervention strategies for this vulnerable population.

Methods: All data were collected remotely using web-based surveys and video conferencing interviews secondary to social distancing mandates present at the time of the data collection (August 2020). Participants who attended the conference had the ability to visit the researchers of this study’s virtual booth to learn about the survey and interview. An anonymous Qualtrics link was provided to the survey. If a participant additionally wanted to participate in an interview after the survey, then they were eligible for a $10 digital gift card. Interviews were conducted using Zoom and audio recorded. Recordings were then transcribed before being analyzed. Quantitative data were analyzed using SPSS v25, whereas qualitative data were analyzed using constant comparison to formulate themes.

Results: There was a significant effect on the amount of physical activity minutes performed per day, a negative effect on the ability to exercise and participate in societal engagements, and a series of barriers to performing physical activity because of the pandemic.

Conclusion: Physical activity was reduced significantly in persons with limb loss during the COVID-19 pandemic. A combination of health concerns, fitness center closures, and social distancing mandates were the primary drivers behind the decrease in activity.


Title: Are smartphones reliable and valid tools to detect fractures in long bones by analyzing change in frequency?

Student Researchers: Distefano J., Bettex K., Miksits M., Neuman J., Stern D., Zhao J.

Research Advisors: Dr. Ofra Pottorf PT, DPT, OCS and Dr. Vanessa Reddin Ph.D.

Purpose/Hypothesis: Long bone fractures are a commonly seen injury in orthopedics. The gold standard for diagnosing these fractures has been diagnostic imaging such as an x-ray. Sound waves have been used previously to rule in the possibility of fractures with the use of tuning forks. The objective of this study was to determine if using a smartphone application is a reliable and valid tool to diagnose fractures by detecting changes in sound waves through a long bone.

Subjects: The study included six cadavers that, while alive, approved to donate their bodies for science. All tests were done on the tibia of each cadaver and a simulated fracture with the same dimensions were created with a bone saw. Lower extremities for cadavers that had a total knee arthroplasty or any former tibial fractures that were still present were excluded.

Methods: To test the reliability and validity of an iPhone 7S to detect fractures in cadavers, frequency was recorded using the LARSA application. All tests were done on the Tibia of each cadaver and a simulated fracture with the same dimensions was created with a bone saw. Each lower extremity was scanned 10 times at a frequency of 150Hz and 10 times at a frequency of 500Hz before the fracture was created. After the fracture was created, the same scanning process was repeated.

Results: Statistical analysis was performed using Microsoft Excel. A t-test using parametric values was selected for analysis because there were 40 data points collected for each cadaver. The alpha level was set to p ≤ 0.05, a paired t-test was run comparing the means at 500Hz and the p value was calculated to be 0.08. The paired t-test comparing means at 150Hz calculated the p value to be 0.47. No significant difference was found between fractured and unfractured readings using the iphone at both 150Hz and 500Hz.

Conclusion/ Clinical Relevance: The data suggests that the smartphone was unable to measure a consistent difference in decibel (dB) readings between fractured and unfractured bones. The results of this study do not support the ability of a smartphone to be able to detect bone fractures. More research is needed to determine whether the LARSA application on a smartphone can be a reliable and valid tool in detecting long bone fractures.With technological progressions and smartphones becoming more involved in the healthcare field, clinicians would benefit from having access to a reliable and valid tool to be able to detect fractures.


Title: Impact of Foot Posture on Static and Dynamic Balance

Student Researchers: Brian Steiger, Josh Pernick, Charmy Patel, Gehrig Montoro, Anthony Accetturi, and Amanda Woo

Research Advisor: Dr. Joseph Hayes PT, DPT, OCS 

Purpose/Hypothesis: The purpose of this study is to investigate the consequences of specific foot postures on one’s static and dynamic balance using the FPI (Foot Posture Index) and comparing them to the results found in ULS (Unilateral Stance) and LOS (Limits of Stability) testing. We hypothesize that the presence of an overly supinated or pronated foot will have a negative impact on one’s ability to maintain sufficient static or dynamic balance.

 Subjects: Thirty-five subjects participated in this study. The inclusion criteria for this study were as follows: (1) between the ages of 18 and 70, (2) have the cognitive ability to follow all directions given by the researchers, and (3) are capable of bearing weight on both lower extremities. As well, individuals who suffer from musculoskeletal and neuromuscular conditions that were deemed to be physically limiting were excluded from this study.

Methods: This is a single-blind experimental study consisting of three groups: supinated, pronated, and neutral. Each subject was assigned to a group in accordance with their scores determined by the FPI. Following the foot posture assessment, each subject underwent static (ULS) and dynamic balance (LOS) testing using the Neurocom Balance Master. In ULS, the testers recorded values for sway velocity with eyes closed and eyes open (SVEO and SVEC). In LOS, the testers recorded reaction time (RT), movement velocity (MVL), end-point excursions (EPE), maximum excursion (MXE), and directional control (DCL).

Results: In the One-Way ANOVA for the left foot (Table 7), the p-value for  SVEO and SVEC was determined to be 0.195 and 0.795 respectively. In the One-Way ANOVA for the right foot, the p-value for SVEO and SVEC was determined to be 0.021 and 0.490 respectively. In accordance with our corrected a-value, this data was found to be insignificant and no post-hoc tests were run. For the variables analyzed in the LOS testing, using a Kruskal-Wallace analysis, no significant differences were found between groups.

Conclusion/Clinical Relevance: To our knowledge, this is the first study to attempt to use FPI, LOS, and ULS in order to compare foot posture with balance performance. Regardless of the results of this study, the Neurocom Balance Master has shown to be a reliable tool in quantifying balance performance. Taking into consideration the results of this study with this study’s limitations, we find that the impacts of an individual’s foot posture on their static and dynamic balance is still unknown.


Title: The Correlation Between AMPPro and TAPES-R in Patients with Lower Limb Amputations

Student Researchers: Kelly Felicetta, Michael Percoco, Tyler Mok

Research Advisor: Dr. Robert Troiano PT, DPT, CHT and Dr. Frances Corio PT, PhD, OCS

Purpose/ Hypothesis: The purpose of this study is to determine a correlation between the Amputee Mobility Predictor with Prosthesis (AMPPro) and the quality of life survey, Trinity amputation and prosthesis experience scales revised (TAPES-R)

Subjects: A sample of convenience was used without an attempt for random selection. The subjects were made aware of the logistics of the study and signed informed consent documents before participation. The inclusion criteria consisted of patients with transtibial and transfemoral amputations with a prosthesis. This study was not limited to participants with bilateral amputations and included no limitation of how long a participant had their prosthesis.

MethodsPhysical therapists at the 2 First Step facility for amputees, located in Melville and Brightwater New York, used the AMPPro to assess the subject’s functional mobility . The  TAPES-R, a 33 item self administered questionnaire that assesses 6 aspects of psychosocial adjustments to lower limb amputation was given to the subjects to fill out afterwards. The data collected was de-identified and data analysis was performed using Microsoft Excel and SPSS.

Results: There was a significant fair negative correlation between AMPPro Scores and TAPES-R activity restrictions when only comparing the two categories. Meaning the higher the AMPPro score, the less activity restrictions a patient has. However, when adjusting the alpha due to multiple comparisons, there was no significance between AMPPro Scores and TAPES-R activity restrictions. All other comparisons did not have a significant correlation.

Conclusion/ Clinical Relevance: There is a potentially significant inverse correlation between AMPPro scores and activity restrictions. TAPES-R deemed activity restrictions as a key aspect of quality of life in patients with a lower limb amputation. Further studies have the potential to make this correlation stronger. Clinicians may want to use the AMPPro as an outcome measure for patients with lower limb loss and direct their plan of care in order to reduce activity restrictions. This would potentially correlate to increasing a patient’s quality of life.


Title: One Day You Will be Older: Teaching Empathy with an Older Adult Simulator Suit

Student Researchers: Ashley Willoughby, Max Pignotti, Brianna McNulty, Natalie Fagan, Alexander Kapoutsos, Jay Patel

Research Advisor: Dr. Lee

Purpose/Hypothesis: The purpose of this study was to determine the effect of an older adult simulation suit on empathy, rate of perceived exertion, functional mobility, and physical difficulty within students enrolled in a physical therapy program. We hypothesized that students would experience an increase in empathy after using the suit.

Number of Subjects: 24

Methods: The study was a mixed-methods design consisting of both qualitative and quantitative data collection. The older adult simulation suit was described in another submission (#31022). The primary outcome measure was empathy as measured by a modified version of the Jefferson Empathy Scale (JES). Secondary outcomes included rate of perceived exertion (measured by the Borg), functional mobility (measured by the Physical Performance Test (PPT)), and physical difficulty (measured by the Physical Difficulty Score (PDS) measure). Inclusion criteria for the study were that the participants were students enrolled in a health science program at Touro College, free of injury, capable of donning and doffing the suit with assistance, and capable of performing the PPT. Using a counterbalanced design, participants were randomized to either the suit or non-suit condition for first performance of the PPT, then the remaining condition for the second (repeat) performance of the PPT. Participants completed the JES prior to the first, and after the last, performance of the PPT. Between each of the individual PPT activities, participants were asked to report their rate of perceived exertion and assign a value to the difficulty of the task. Following completion of the study, participants completed a short interview about their experience. Quantitative data were analyzed using SPSS v25 (paired T-tests and Wilcoxon Rank Sum tests) while qualitative data were analyzed using constant comparison to generate themes.

 Results: For the primary outcome of empathy, there was a significant difference on the JES (t=2.51, p=.02) indicating that empathy scores increased (meaning higher empathy) after using the suit than before. For secondary outcomes, perceived exertion significantly increased in the suit condition (t=5.61, P<.001), as well as a significant difference on the PPT scores (t=9.18, p<.001) indicating lower (poorer) scores when the suit was worn. There was no significant difference (t=.85, p=.93) for the PDS. From the qualitative analysis, three prominent themes were developed: 1)Understanding helps to build empathy, 2) Empathy can help guide treatments, and 3) Getting older is not for the weak.

Conclusions: From the results of this study we have determined that an older adult simulator suit can affect changes in empathy in student physical therapists regarding mobility in older adults. Thematic analysis demonstrated that the benefits of having experienced the older adult simulator will help guide student physical therapists in making treatment decisions when working with older adults on clinical affiliations.