John M. Mayer, DC, PhD of The Vert Mooney Research Foundation recently presented a virtual Shop Talk that was hosted by the Duke University Duke University Center of Excellence in Manual and Manipulative Therapy. The presentation’s title was “The influence of active, passive, and manual therapy interventions on escalation of health care events after physical therapy care in veterans with low back pain.” It discusses findings of a manuscript (doi: 10.1093/ptj/pzae101) that was part of the RESOLVE Trial – Resolving the Burden of Low Back Pain in Military Service Members and Veterans: A Multi-Site Pragmatic Trial (U.S. Department of Defense, W81XWH-18-2-0007)

The presentation was published online on October 9, 2024 and is available here:

https://sites.duke.edu/cemmt/dr-john-mayer/

A team from The Vert Mooney Research Foundation (DBA US Spine & Sport Foundation) recently published a manuscript in the Cureus Journal of Medical Science:

Mayer JM, Verna JL, Hubka M, Phelps B, Wolfinger C, Lane CL. Comparison of disability, physical performance, and other biopsychosocial factors in full duty career firefighters working with and without current low back pain. Cureus Journal of Medical Science. 2024;6(6):e62189. doi:10.7759/cureus.62189

The manuscript reports on findings from the grant: Implementation of a Regional Firefighter Wellness Initiative, U.S. Department of Homeland Security, grant # EMW-2013-FP-00723.

The full text manuscript is open access and found here:

https://www.cureus.com/articles/261601-comparison-between-disability-physical-performance-and-other-biopsychosocial-factors-in-full-duty-career-firefighters-working-with-and-without-current-low-back-pain#!/

Abstract

Introduction: Low back pain (LBP) is highly prevalent and a top cause of disability-related early retirement in firefighters. Those with a lifetime history of LBP have various deficiencies that are associated with increased injury risk and absenteeism. However, the influence of working with current LBP on disability, physical performance, and other biopsychosocial factors has not been fully characterized in this population. The purpose of this study was to compare anthropometric measures, exercise habits, physical fitness / performance, disability / work ability, and other biopsychosocial factors of firefighters working with and without current LBP.

Methods: A cross-sectional study was conducted using baseline assessments from 419 full duty career firefighters without documented work restrictions (age 37.6 ± 8.8 y, 5 F, 414 M) who were enrolled in a regional wellness initiative in Southern California, USA. Current LBP status was determined by a questionnaire and confirmed by an interview. Anthropometric measures, patient-reported outcomes, and physical fitness tests were used to assess body mass index; body fat %; waist circumference; strengthening, cardiovascular, and flexibility exercises frequency; back and core muscular endurance; functional movement quality, perceived back-related disability, lift and carry ability, and firefighter task ability; sleep quality; and perceptions of fear and fatigue and catastrophic injustice experience. Scores for participants with and without current LBP were compared using analysis of variance and chi-square analysis.

Results: The point prevalence of current LBP was 19.81% (83/419). For the entire cohort, those with current LBP had significantly worse scores than those without current LBP for all assessed variables, except core muscular endurance and functional movement quality. These trends held up when analyses were stratified by age and obesity categories, and approximately half of the comparisons retained statistical significance. A significantly greater percentage of participants with current LBP were working with some level of back-related disability and/or perceived physical demand characteristics of work level below the required very heavy job demands.

Conclusion: Nearly one-fifth of full duty career firefighters without documented work restrictions reported having current LBP, and these individuals had deficits in several modifiable biopsychosocial factors across five health domains. These findings can help guide future research and implementation efforts in the fire service designed to improve performance, resiliency, work readiness, recovery, and quality of life, as well as reduce impairment, disability, absenteeism, and presenteeism.

Key Words: firefighters, low back pain, injuries, work readiness, biopsychosocial model, wellness, fitness

February 17, 2024

A team from The Vert Mooney Research Foundation (DBA U.S. Spine & Sport Foundation) (www.usspineandsportfoundation.com) and Spine & Sport Physical Therapy (www.spineandsport.com) presented findings of their telehealth initiative at the 2024 American Physical Therapy Association Combined Sections Meeting. The presentation’s abstract is shown below.

Katz R, Schwartz S, Walls M, Verna JL, Mayer JM. Physical Long term follow up from implementation of telehealth in physical therapy practice: an administrative case report. American Physical Therapy Association Combined Sections Meeting. Boston, MA, February 2024.

ABSTRACT

Background and Purpose: Physical therapy utilization of telehealth services increased dramatically due to the COVID-19 pandemic. We previously reported our initial experiences as early adopters of telehealth in physical therapy practice for musculoskeletal disorders (MSDs) during this global emergency. The purpose of the administrative case report is to describe our long term-follow-up observations from implementation of telehealth in physical therapy practice.

Case Description: Telehealth services for MSDs were implemented in early 2020 across all clinics of an outpatient physical therapy organization in California. Initial patient outcomes were favorable and feedback from physical therapists about telehealth services was positive. Barriers and facilitators to implementation were identified. Since the 2020 implementation, telehealth services have continued at this organization. Observations at the 3-year follow-up timepoint are highlighted herein.

Outcomes: The usage of telehealth peaked at 7% of total volume (900 patient visits / month) during the pandemic in mid 2020. While volume has dropped significantly since then (currently 200 patient visits / month), telehealth continues to allow for earlier access to care by making the initial evaluation more accessible to those with geographical or scheduling challenges. It is primarily used to evaluate patients in rural, underserved, and understaffed areas, which helps avoid delays in recovery due to limited access. After the telehealth evaluation, most patients return to the clinic for follow-up visits. Although used less often, there are also patients that stay on telehealth due to scheduling conflicts. Telehealth visits are also delivered in two unique ways. Some patients still come to the clinic and the telehealth provider remotes in. This is a useful option when a clinic is understaffed. Other times, the patient is able to perform telehealth sessions from home. The ideal patients are those who have an orthopedic injury and are not at risk of falls. A major challenge regarding telehealth is convincing patients of the benefits of telehealth versus an in-person visit.

Discussion: In areas where there is an absence of access to physical therapy clinics, our experience with implementing and maintaining a telehealth program in an outpatient physical therapy practice suggests that telehealth can enhance quality of care, and remains a viable option for both evaluation and ongoing care. Telehealth is becoming more accepted as an alternative to in clinic follow-up as it is also becoming more prevalent for primary care providers to interact with patients. It has not become a substitute for care that involves manual interventions. Telehealth appears to be here to stay for the physical therapy management of MSDs. As more research is conducted on this topic, implementation barriers are reduced, and permanent solutions for regulations are legislated, we believe that telehealth will expand in this setting.

A manuscript authored by a team from The Vert Mooney Research Foundation (DBA US Spine & Sport Foundation) and Spine & Sport Physical Therapy (www.spineandsport.com) was recently published in the APTA Physical Therapy Journal of Policy, Administration, and Leadership:

Katz R, Schwartz S, Phelps B, Faust S, Mortimer D, Verna JL, Mayer JM. Telehealth in physical therapy practice for musculoskeletal disorders: case series. The APTA Physical Therapy Journal of Policy, Administration, and Leadership, November 2022.

The manuscript reports on the development and implementation of a telehealth program during the COVID-19 pandemic. The novel aspects of being an early adopter of physical therapy telehealth in a private practice environment, along with research design and analysis via a non-profit foundation, are particularly noteworthy. An abstract of the published manuscript is shown below.

ABSTRACT

Study Design: Administrative case report.

Objectives: The objectives of this paper are to: 1. summarize the current regulatory considerations for physical therapy telehealth services for musculoskeletal disorders; 2. describe the implementation process of a telehealth program by an outpatient physical therapy organization across its 20 clinics during the SARS-CoV-2 (COVID-19) pandemic; and 3. provide recommendations for regulatory, organizational and research changes needed to support implementation of long-term telehealth services in musculoskeletal physical therapy practice.

Background: The COVID-19 pandemic has greatly disrupted the delivery of healthcare services. Telehealth provides a possible solution for improving delivery of services by enhancing access and fostering patient-centered approaches but has not been well-described in physical therapy practice.

Methods: The implementation processes of telehealth services by a large outpatient physical therapy center in California are described. Three patient cases are summarized for a more detailed description of the experience.

Analysis: Telehealth services were successfully implemented in a large outpatient physical therapy center in response to the COVID-19 pandemic. Initial responses from patients with musculoskeletal disorders and physical therapists about telehealth services were positive.

Conclusions: Telehealth has the potential to enhance physical therapy practice, though its specific structure and magnitude are unclear. Regulatory and organizational changes as well as research trials are needed to help clarify the role of telehealth.

A team from The Vert Mooney Research Foundation (DBA US Spine & Sport Foundation) recently presented findings of a 3-year FEMA Fire Prevention & Safety grant – Implementation of a Regional Firefighter Wellness Initiative – at two national conferences – American College of Sports Medicine (ACSM) in June 2022 and American Chiropractic College – Research Agenda Conference (ACC-RAC) in July 2022.

1. Lane CL, Mayer JM. Worksite exercise adherence in firefighters: findings during a global pandemic and record wildfire season. American College of Sports Medicine Annual Meeting, San Diego, CA, June 2022 (e-poster).
2. Mayer JM, Verna JL, Lane CL. Implementation of a firefighter wellness initiative during record wildfires and a global pandemic. Association Chiropractic Colleges – Research Agenda Conference, San Diego, CA, July 2022 (podium).

Abstracts of the presentations are shown below.

ACSM, June 2022

ABSTRACT: Occupational injury is prevalent in firefighters and exercise programming is beneficial to prevent injury and hasten recovery. Yet, implementation of worksite exercise programs has been intermittently successful. PURPOSE: The purpose of this study was to assess adherence factors in firefighters enrolled in a worksite fitness program during a global pandemic and record wildfire season. METHODS: A cross sectional study was conducted in career firefighters (n = 429) from 15 Southern California departments enrolled in a 9-18 month worksite fitness program. Exercise adherence, completed exercise sessions in the intervention period, was compared to baseline age, history of musculoskeletal (MSK) conditions, completion of wellness educational courses and physical fitness measures. ANOVA, T-Tests, or Chi-square were used to assess relationships between exercise adherence and baseline characteristics. RESULTS: Exercise adherence was poorer than anticipated and was attributed to the COVID-19 pandemic and record wildfire season. Significant weak correlations with exercise adherence were noted for age (r = 0.112, p = 0.035), BMI (r = -0.113, p = 0.033), back muscular endurance (r = 0.217, p < 0.000), core muscular endurance (r = 0.113, p = 0.035), and flexibility exercise frequency (r = 0.113, p = 0.035). Those with MSK history had a higher adherence rate than those without (History: 13.2 +/- 22.7%, No History: 4.7 +/- 7.4%, p = 0.021). Those who completed wellness education courses had a higher adherence rate than those who did not (Completed: 29.9 +/- 31.1%, Did Not Complete: 7.2 +/- 14.9%, p < 0.000). No significant relationships were noted between exercise adherence and waist circumference, bodyfat%, Functional Movement Screen, or cardiovascular and resistance exercise frequencies. CONCLUSION: These findings suggest that the most adherent participants were more fit, older, and had a MSK history. However, the poor adherers were less fit, suggesting that firefighters who need exercise programming the most were not adherent. While more research is needed, future iimplementation efforts should minimize delivery barriers, consider a hybrid approach of face-to-face and virtual sessions, and focus on delivering to firefighters who are most vulnerable to MSK conditions.

ACC-RAC, July 2022

ABSTRACT: Objective: Firefighters have elevated rates of cardiovascular, musculoskeletal, and sleep disorders. However, specific guidance on implementing interventions to address these conditions is largely unavailable. The purpose of this project was to implement a firefighter wellness initiative targeting obesity, musculoskeletal injuries, and sleep disorders. Methods: An observational cohort project was conducted in 429 career firefighters from 15 California departments. Assessments included anthropometric, fitness, and patient-reported outcomes that are known health risk indicators. Physical fitness, injury prevention, and educational interventions were customized and triaged according to needs, goals, and risk levels. Interventions were delivered over 9-18 months in one-on-one and group settings, via face-to-face and telehealth sessions. The initiative was implemented during record wildfires and the COVID-19 pandemic, which disrupted delivery. Results: 127 firefighters completed 9-month follow-up assessments. For those at highest risk at baseline, significant improvements (p < 0.05) were observed in waist circumference, muscular endurance, functional movement, exercise frequency, dietary intake, and sleep quality. Conclusion: Improvements in key health risk indicators were observed in firefighters who participated in a wellness initiative. While the relatively low adherence may limit generalizability, the unprecedented environment provided an opportunity to inform future implementation of occupational wellness program