When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness.

Introduction: Physical therapy (PT) is a high-volume service that treats musculoskeletal injury and improves return-to-duty rates. Our experience suggests that no-show (NS) and patient cancellation (PC) rates increase the further appointment that is booked in the future, impede access to care, and increase the healthcare delivery costs. The article's purpose is to examine PT National Capitol Region (NCR) appointment data to inform appointment policies.

Does a microprocessor-controlled prosthetic knee affect stair ascent strategies in persons with transfemoral amputation?

Background: Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2(®)) uses flexion/extension resistance to allow step-over-step stair ascent.

Factors related to high-level mobility in male servicemembers with traumatic lower-limb loss.

The purpose of this study was to examine the possible relationship between factors modifiable by rehabilitation interventions (rehabilitation factors), other factors related to lower-limb loss (other factors), and high-level mobility as measured by the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in servicemembers (SMs) with traumatic lower-limb loss. One-hundred eighteen male SMs with either unilateral transtibial amputation (TTA), unilateral transfemoral amputation (TFA), or bilateral lower-limb amputation (BLLA) participated. Stepwise regression analysis was used to develop separate regression models of factors predicting CHAMP score.

Construct validity of Comprehensive High-Level Activity Mobility Predictor (CHAMP) for male servicemembers with traumatic lower-limb loss.

This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP) as a measure of high-level mobility in servicemembers (SMs) with traumatic lower-limb loss (LLL). The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT) as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP) as a measure of basic prosthetic mobility.

Development and reliability testing of the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in male servicemembers with traumatic lower-limb loss.

The opportunity for wounded servicemembers (SMs) to return to high-level activity and return to duty has improved with advances in surgery, rehabilitation, and prosthetic technology. As a result, there is now a need for a high-level mobility outcome measure to assess progress toward high-level mobility during and after rehabilitation. The purpose of this study was to develop and determine the reliability of a new outcome measure called the Comprehensive High-Level Activity Mobility Predictor (CHAMP).

Prevalence of late amputations during the current conflicts in Afghanistan and Iraq.

During the current conflicts, over 950 soldiers have sustained a combat-related amputation. The majority of these are acute, but an unknown number are performed months to years after the initial injury. The goal of this study is to determine the prevalence of late amputations in our combat wounded.

Amputation is not isolated: an overview of the US Army Amputee Patient Care Program and associated amputee injuries.

Rates of amputation as a percentage of all combat injuries have increased significantly since the Korean War. Following traumatic and combat-related amputation, definitive treatment and rehabilitation require a large, multidisciplinary team to provide comprehensive medical and supportive care. Associated injuries are remarkably frequent, complicating treatment and potentially delaying rehabilitation and/or limiting outcomes.

Advanced medical care for soldiers injured in Iraq and Afghanistan.

War inevitably advances medical knowledge, particularly in the area of orthopedic surgery. This article presents an overview of the types of injuries emerging from the current conflicts in Iraq and Afghanistan, the majority of which are extremity injuries, and the care soldiers are receiving on the battlefield, while being evacuated, and at Walter Reed Army Medical Center. It highlights the Army's use of new therapeutic approaches such as use of methyl methacrylate antibiotic beads, vacuum-assisted closure devices, and new prosthetic technologies.

Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets.

Background: The causes of noncontact anterior cruciate ligament injury remain an enigma.

Purpose: To prospectively evaluate risk factors for noncontact anterior cruciate ligament injuries in a large population of young athletic people.

Study Design: Prospective cohort study.

Upper body fatiguing exercise and shooting performance.

This study assessed the effect of upper extremity muscle fatigue on shooting performance while in a standing, unsupported firing position. Nine male and three female soldiers fired at targets before and after performing upper extremity exercise to fatigue using both (1) an upper body ergometer and (2) a Military Operations in Urban Terrain obstacle course. Shooting accuracy, assessed by the number of hits, misses, and shot group size, was significantly decreased (p < 0.

Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.

Background: Little data exist on the effect of routine use of postoperative drainage after arthroscopic anterior cruciate ligament reconstruction, although clinical studies of other procedures have not shown benefit to this practice.

Hypothesis: Use of a postoperative drain will not result in decreased suprapatellar girth, increased range of motion, and decreased pain compared with nonuse.

Study Design: Prospective randomized clinical trial.

Gender differences in regional body composition and somatotrophic influences of IGF-I and leptin.

This study evaluated the arm, trunk, and leg for fat mass, lean soft tissue mass, and bone mineral content (BMC) assessed via dual-energy X-ray absorptiometry in a group of age-matched (approximately 29 yr) men (n = 57) and women (n = 63) and determined their relationship to insulin-like growth factor I (IGF-I) and leptin. After analysis of covariance adjustment to control for differences in body mass between genders, the differences that persisted (P < or = 0.05) were for lean soft tissue mass of the arm (men: 7.