Shaping the Future of Physical Therapy with Clinical Research at Upstream Rehabilitation

One of the exciting opportunities for our associates and physical therapists at Upstream Rehabilitation is the ability to impact patient care in a variety of ways, including assisting with cutting-edge research to drive the industry forward. At Upstream Rehabilitation, one of the many career tracks we offer to our associates is the research track. With the research track through URI residency/fellowship programs, Upstream associates have the opportunity to investigate research questions as a principal investigator or a participant in data collection as a staff physical therapist.

Take a look at some of the exciting research that our clinical associates have done throughout the last several years and see how Upstream Rehabilitation associates are helping to push the physical therapy industry forward .

Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport

— Rachel Selman, Kate Early, Brianna Battles, Misty Seidenburg, Elizabeth Wendel, Susan Westerlund
International Journal of Sports Physical Therapy 2022; 17(6): 1170–1183.

Conclusions:
Women in the pregnant and postpartum periods have lacked adequate guidance regarding appropriate exercise prescription. The proposed timeline of rehabilitation is proposed to facilitate improved quality of life, increased likelihood of full and safe return to sport, and less medical care requirements for postpartum symptoms. Understanding the intricacies of the female athlete during this time may assist clinicians and coaches with guidance to assist in safe return to sport. Without a slow and graded return to exercise which is commonplace for other musculoskeletal events, the current paradigm may unintendedly be overly conservative in some respects (during pregnancy) while not addressing dysfunction during the postpartum recovery.^46,47

Despite evidence regarding the effectiveness of pelvic floor physical therapy,^24,48,49 no specific rehabilitation guidelines currently exist to assist clinicians in determining appropriate frequency or progression of exercise for the pregnant and postpartum athlete. This commentary presents suggestions regarding graded activity during pregnancy and rehabilitation during post-partum recovery that may decrease the likelihood complications. The importance of this commentary lies not only in the outline of a preventative approach to postpartum care, but in the recommendation of continuous reassessment of the changing body throughout pregnancy and the early postpartum period as athletes perform and return to activities of daily living, work, exercise activity, and sport participation. As musculoskeletal health has been largely unstudied in this population, this protocol may provide guidelines for the prevention of common musculoskeletal dysfunction in the pregnant and postpartum athlete and spark future research.

The influence of exercise therapy dosing on pain and functional outcomes in patients with subacromial pain syndrome: A systematic review*

— Ryan McConnell
Shoulder & Elbow 2022. Vol 0(0) 1-17

Discussion:
Exercise therapy for SAPS was associated with large effect sizes for improvement in pain and function but optimal exercise therapy dosing parameters could not be identified. Strong recommendations conditionally suggest treating SAPS with a variety of exercise therapy dosing parameters.

The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain

— Ryan McConnell and William “Bill” Owen
Brazilian Journal of Physical Therapy 27 (2023) 100532

Conclusions:
Depression was associated with greater pain intensity. No comorbidities were able to account for the extent of pain-related psychological distress.

Incomplete reporting of manual therapy interventions and a lack of clinician and setting diversity in clinical trials for neck pain limits repliclation and real-world translation. A scoping review

— William “Bill” Owen
Journal of Manual & Manipulative Therapy

Conclusion:
These results reveal incomplete reporting of essential treatment parameters, and a lack of clinician diversity. To foster reproducibility, researchers should report detailed descriptions of MT interventions. Future research should incorporate a variety of MT practitioners to improve generalizability.

Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a clsuter-randomized trial

— Daniel Maddox
Pain, 2022 May 1

Prevalence and extent of low back pain and low back-related disability in non-care-seeking working-age adults

— Daniel Maddox
Musculoskeletal Science and Practice 60 (2022) 102572

Conclusion:
Many non-care-seeking individuals reported some level of LBP and/or disability, suggesting that some level of pain and disability may be considered normal, acceptable, or manageable. One-third of individuals with no pain reported some disability.

Association between measures of function and pain perception in older adults with chronic low back pain

— Daniel Maddox
Journal of Pain Volume 20, Issue 4, Supplement, S52, April 2019

Over half of clinical trials of mobilization and manipulation for patients with low back pain may have limited real-world applicability: A systematic review of 132 clinical trials

— Daniel Maddox and Josh Subialka
Journal of Orthopaedic & Sports Physical Therapy

Conclusion:
Most trials investigating manual therapy for LBP lack pragmatism across the RITES domains (ie, they emphasize efficacy). To improve real-world implementation, more research emphasizing effectiveness is needed. This could be accomplished by recruiting from more diverse participant pools, involving multiple centers that reflect common clinical practice settings, involving clinicians with a variety of backgrounds/experience, and allowing flexibility in how interventions are delivered.

What do patients referred to physical therapy for a musculoskeletal condition expect? A qualitative assessment

— Josh Subialka
Musculoskeletal Science and Practice 59 (2022) 102543

Conclusions:
These identified themes highlight what patients may expect from a physical therapy experience and clinicians should work to identify and satisfy each patient’s individual expectations to optimize outcomes.

More than 1 in 3 patients with chronic low back pain continue to use opioids long-term after spinal fusion: A systematic review

— Chris Myers
The Clinical Journal of Pain 38(3):p 222-230, March 2022

An exploration of clinical variables that enhance therapeutic alliance in patients seeking care for musculoskeletal pain: A mixed methods approach

— Chris Meyers and Glenn Thompson
Musculoskeletal Care 2022 Sep;20(3):577-592. doi: 10.1002/msc.1615.

Conclusion:
This study highlights a relationship between TA and reduction of pain intensity after the initial evaluation and identifies key behavioural practices that could positively and negatively impact TA during the clinical encounter.

Identifying conservative interventions for individuals with subacromial pain syndrome prior to undergoing a subacromial decompression: A scoping review

— Glenn Thompson
International Journal of Sports Physical Therapy

Conclusion:
Conservative care that individuals with SAPS receive to prevent advancement to SAD appears inadequate based on the literature. Interventions, such as PT, SI, and NSAIDs, are either underreported or not offered to individuals with SAP prior to advancing to surgery. Many questions regarding optimal conservative management for SAPS persists.

Join Upstream Rehabilitation and Elevate Your Career

Pursuing your passion of clinical research is possible at Upstream Rehabilitation and our family of brands. Whether you’re interested in leading clinical research or participating in the data collection side, you have an opportunity to pursue that career track along with other interesting career opportunities as an Upstream Rehabilitation associate.

Join Upstream Rehabilitation and our family of brands to elevate your career. We’re actively hiring for clinical and non-clinical physical therapy positions nationwide.

1. The Influence of Exercise Therapy Dosing on Pain and Functional …, journals.sagepub.com/doi/abs/10.1177/17585732221124303. Accessed 13 Nov. 2023.
2. Spoonemore SL;McConnell RC;Owen WE;Young JL;Clewley DJ;Rhon DI; “The Influence of Pain-Related Comorbidities on Pain Intensity and Pain-Related Psychological Distress in Patients Presenting with Musculoskeletal Pain.” Brazilian Journal of Physical Therapy, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/37611373/#:~:text=Conclusions%3A%20Depression%20was%20associated%20with,of%20pain%2Drelated%20psychological%20distress. Accessed 13 Nov. 2023.
3. DI;, Leech JB;Owen WE;Young JL;Rhon. “Incomplete Reporting of Manual Therapy Interventions and a Lack of Clinician and Setting Diversity in Clinical Trials for Neck Pain Limits Replication and Real-World Translation. A Scoping Review.” The Journal of Manual & Manipulative Therapy, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/36047903/. Accessed 13 Nov. 2023.
4. Lane E;Magel JS;Thackeray A;Greene T;Fino NF;Puentedura EJ;Louw A;Maddox D;Fritz JM; “Effectiveness of Training Physical Therapists in Pain Neuroscience Education for Patients with Chronic Spine Pain: A Cluster-Randomized Trial.” Pain, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/34354017/. Accessed 13 Nov. 2023.
5. “Prevalence and Extent of Low Back Pain and Low Back-Related Disability in Non-Care-Seeking Working-Age Adults.” Musculoskeletal Science and Practice, Churchill Livingstone, 29 Apr. 2022, www.sciencedirect.com/science/article/abs/pii/S2468781222000716#:~:text=Low%20back%20pain%20(LBP)%20is,2019%3B%20Duthey%2C%202013.
6. (313) Association between Measures of Function and Pain Perception In …, www.jpain.org/article/S1526-5900(19)30575-9/fulltext. Accessed 13 Nov. 2023.
7. Over Half of Clinical Trials of Mobilization and Manipulation For …, www.jospt.org/doi/10.2519/jospt.2022.10962. Accessed 13 Nov. 2023.
8. Subialka JA;Smith K;Signorino JA;Young JL;Rhon DI;Rentmeester C; “What Do Patients Referred to Physical Therapy for a Musculoskeletal Condition Expect? A Qualitative Assessment.” Musculoskeletal Science & Practice, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/35334352/. Accessed 13 Nov. 2023.
9. DI;, Vraa ML;Myers CA;Young JL;Rhon. “More than 1 in 3 Patients with Chronic Low Back Pain Continue to Use Opioids Long-Term after Spinal Fusion: A Systematic Review.” The Clinical Journal of Pain, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/34856579/#:~:text=Long%2Dterm%20opioid%20use%20after,majority%20of%20lumbar%20fusion%20trials. Accessed 13 Nov. 2023.
10. Myers C;Thompson G;Hughey L;Young JL;Rhon DI;Rentmeester C; “An Exploration of Clinical Variables That Enhance Therapeutic Alliance in Patients Seeking Care for Musculoskeletal Pain: A Mixed Methods Approach.” Musculoskeletal Care, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/34984781/. Accessed 13 Nov. 2023.
11. JL;, Signorino JA;Thompson AG;Hando BR;Young. “Identifying Conservative Interventions for Individuals with Subacromial Pain Syndrome Prior to Undergoing a Subacromial Decompression: A Scoping Review.” International Journal of Sports Physical Therapy, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/37020452/. Accessed 13 Nov. 2023.
12. Selman, Rachel, et al. “Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport.” International Journal of Sports Physical Therapy, U.S. National Library of Medicine, 1 Oct. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9528725/.