Background and Purpose: The primary purpose of this study was to develop a clinical prediction rule (CPR) for identifying patients with knee pain and clinical evidence of knee osteoarthritis (OA) with favorable short-term response to hip mobilizations. The secondary purpose was to determine the predictive validity of individual clinical tests for identifying these same patients.Subjects and Methods: Sixty subjects with knee OA, aged 51 to 79 years, completed self-report questionnaires, a clinical examination of the hip and knee, and functional tests and were treated with 4 hip mobilizations. Follow-up testing was completed 2 days later. The reference criterion for determining a favorable response was either (1) a decrease of at least 30% on composite Numerical Pain Rating Scale score obtained during functional tests or (2) a Global Rating of Change Scale score of at least 3.Results: The CPR developed in this study comprised 5 variables: (1) hip or groin pain or paresthesia, (2) anterior thigh pain, (3) passive knee flexion less than 122 degrees, (4) passive hip medial (internal) rotation less than 17 degrees, and (5) pain with hip distraction. Based on the pretest probability of success (68%), the presence of one variable had a positive likelihood ratio of 5.1 and increased the probability of a successful response to 92% at 48-hour follow-up. If 2 variables were present, the positive likelihood ratio was 12.9 and the probability of success increased to 97%.Discussion and Conclusion: The results suggest that the CPR developed in this study could improve clinicians’ decision making and efficiency in examining and treating patients with knee OA.

Context: Specific movement patterns have been identified as possible risk factors for noncontact lower extremity injuries. The Dynamic Integrated Movement Enhancement (DIME) was developed to modify these movement patterns to decrease injury risk.Objective: To determine if the DIME is effective for preventing lower extremity injuries in US Military Academy (USMA) cadets.Design: Cluster-randomized controlled trial. Setting: Cadet Basic Training at USMA. Patients or Other Participants: Participants were 1313 cadets (1070 men, 243 women).Intervention(s): Participants were cluster randomized to 3 groups. The active warm-up (AWU) group performed standard Army warm-up exercises. The DIME groups were assigned to a DIME cadre-supervised (DCS) group or a DIME expertsupervised (DES) group; the former consisted of cadet supervision and the latter combined cadet and health professional supervision. Groups performed exercises 3 times weekly for 6 weeks.Main Outcome Measure(s): Cumulative risk of lower extremity injury was the primary outcome. We gathered data during Cadet Basic Training and for 9 months during the subsequent academic year. Risk ratios and 95% confidence intervals (CIs) were calculated to compare groups.Results: No differences were seen between the AWU and the combined DIME (DCS and DES) groups during Cadet Basic Training or the academic year. During the academic year, lower extremity injury risk in the DES group decreased 41% (relative risk [RR] ¼ 0.59; 95% CI ¼ 0.38, 0.93; P ¼ .02) compared with the DCS group; a nonsignificant 25% (RR ¼ 0.75; 95% CI ¼ 0.49, 1.14; P ¼ .18) decrease occurred in the DES group compared with the AWU group. Finally, there was a nonsignificant 27% (RR ¼ 1.27; 95% CI ¼ 0.90, 1.78; P ¼ .17) increase in injury risk during the academic year in the DCS group compared with the AWU group.Conclusions: We observed no differences in lower extremity injury risk between the AWU and combined DIME groups. However, the magnitude and direction of the risk ratios in the DES group compared with the AWU group, although not statistically significant, indicate that professional supervision may be a factor in the success of injury-prevention programs.

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A 21-year-old male Army basic trainee was evaluated in a direct-access physical therapy clinic for left-sided low back pain. Following examination, radiographs and a bone scan were ordered. The findings prompted referral for a computed tomography scan of the pelvis, which characterized an infiltrative soft tissue mass. The therapist immediately contacted an orthopaedic surgeon, who recommended that the physical therapist order immediate magnetic resonance imaging (STAT MRI). The patient underwent a tissue biopsy and subsequently was diagnosed with Ewing's sarcoma. J Orthop Sports Phys Ther 2020;50(5):276. doi:10.2519/jospt.2020.9109