Mr Daniel Rhon

Mr Daniel Rhon

Research student

Career Summary

Biography

I am an Austalian-born physiotherapist, but currently living in the United States.  My research interests include improving the efficiency of health care systems and care management pathways for musculoskeletal disorders.  Prevention of disability from chronic ailments! 

Keywords

  • Musculoskeletal Disorders
  • Opioids
  • Physiotherapy
  • Prescription Opiates

Languages

  • English (Mother)
  • Spanish (Fluent)

Fields of Research

Code Description Percentage
110317 Physiotherapy 100
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (51 outputs)

Year Citation Altmetrics Link
2019 Rhon DI, Greenlee TA, Sissel CD, Reiman MP, 'The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome.', BMC Musculoskelet Disord, 20 266 (2019)
DOI 10.1186/s12891-019-2646-5
2019 Young JL, Wright AA, Rhon DI, 'Nonoperative Management Prior to Hip Arthroscopy for Femoroacetabular Impingement Syndrome: An Investigation Into the Utilization and Content of Physical Therapy.', J Orthop Sports Phys Ther, 1-27 (2019)
DOI 10.2519/jospt.2019.8581
2019 Rhon DI, Greenlee TA, Marchant BG, Sissel CD, Cook CE, 'Comorbidities in the first 2 years after arthroscopic hip surgery: Substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions', British Journal of Sports Medicine, 53 547-553 (2019)

© Author(s) (or their employer(s)) 2019. Objectives We aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiov... [more]

© Author(s) (or their employer(s)) 2019. Objectives We aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy. Methods Data from individuals (ages 18-50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery. Results 1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%. Conclusions Major (potentially â ¿ hidden') clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery. Level of evidence Prognostic, level III.

DOI 10.1136/bjsports-2018-099294
2019 Rhon D, Schmitz M, Mayhew R, Dry K, Greenlee T, 'Arthroscopy for Management of Femoroacetabular Impingement Syndrome in the Military Health System: A 10-Year Epidemiological Overview of Cases with 2-year Follow-up.', Mil Med, (2019)
DOI 10.1093/milmed/usz057
2019 DiMarco LA, Ramger BC, Howell GP, Serrani AM, Givens DL, Rhon DI, Cook CE, 'Differences in Characteristics and Downstream Drug Use Among Opioid-Naïve and Prior Opioid Users with Low Back Pain', Pain Practice, 19 149-157 (2019)

Published 2018. This article is a U.S. Government work and is in the public domain in the USA Background: Recent clinical practice guidelines have suggested conservative treatment... [more]

Published 2018. This article is a U.S. Government work and is in the public domain in the USA Background: Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. Objective: The primary purpose was to compare characteristics and downstream medication use between patients with LBP with prior opioid exposure vs. those who were opioid-naïve. The secondary purpose was to explore the role of prior opioid use by LBP disability. Methods: Seven hundred and nine participants in a LBP self-management class were evaluated utilizing self-report data at baseline and longitudinal claims data from the Military Health System Data Repository. Participants were dichotomized into opioid-naïve and prior opioid use groups and then further divided into low and high disability groups based on Oswestry Disability Index (ODI) scores. Patient characteristics, comorbidities, and medication use were compared between groups. Results: Prior opioid users had significantly higher baseline ODI and Fear Avoidance Beliefs Questionnaire physical activity subscale and work subscale scores as well as pre-index instances of mental health disorders, chronic pain, and insomnia than opioid-naïve individuals. Prior opioid users filled significantly more pain medication prescriptions in the year after the index date than did opioid-naïve individuals. Prior opioid users were significantly more likely to be taking opioids at 1¿year after the index date, regardless of disability level. Conclusion: In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1¿year after the index date.

DOI 10.1111/papr.12728
2019 Rhon DI, Greenlee TA, Fritz JM, 'The influence of a guideline-concordant stepped care approach on downstream health care utilization in patients with spine and shoulder pain', Pain Medicine (United States), 20 476-485 (2019)

© 2018 American Academy of Pain Medicine. All rights reserved. Background. Stepped care approaches are emphasized in guidelines for musculoskeletal pain, recommending less invasiv... [more]

© 2018 American Academy of Pain Medicine. All rights reserved. Background. Stepped care approaches are emphasized in guidelines for musculoskeletal pain, recommending less invasive or risky evidence-based intervention, such as manual therapy (MT), before more aggressive interventions such as opioid prescriptions. The order and timing of care can alter recovery trajectories. Objective. To compare one-year downstream health care utilization in patients with spine or shoulder disorders who received only MT vs MT and opioids. The secondary aim was to compare differences based on order and timing of opioids and MT. Design. Retrospective observational cohort. Methods. Patients with an initial consultation for a spine or shoulder disorder who received at least one visit for MT were included. Person-level data from the Military Health System Management and Reporting Tool (M2) database were aggregated by a senior health care analyst at Madigan Army Medical Center. Groups were created based on the order and timing of interventions provided. Outcomes included health care utilization (medical costs and visits) over the year following initial consultation. Control measures included metabolic, mental health, chronic pain, sleep, and substance abuse comorbidities, as well as prior opioid prescriptions. Generalized linear models with gamma log links were run due to the heavily skewed nature of cost data. Results. From 1,876 unique patients with spine or shoulder disorders receiving MT, 1,162 (61.9%) also received prescription opioids. Mean one-year costs in the MT-only group ($5,410, 95% confidence interval [CI] ¼ $5,109 to $5,730) were significantly lower than in the MTþopioid group ($10,498, 95% CI ¼ $10,043 to $10,973). When patients had both treatments, mean one-year costs in the MT-first ($10,782, 95% CI ¼ $10,050 to $11,567) were significantly lower (P ¼ 0.030) than opioid-first ($11,938, 95% CI ¼ $11,272 to $12,643), and MT-first had a significantly lower mean days¿ supply of opioids (34.2 vs 70.9, P < 0.001) and mean number of unique opioid prescriptions (3.1 vs 6.5, P < 0.001). Conclusions. MT alone resulted in lower downstream costs than with opioid prescriptions. Both the order of treatment (MT before opioid prescriptions) and the timing of treatment (MT < 30 days) resulted in a significant reduction of resources (costs, visits, and opioid utilization) in the year after initial consultation. Clinicians should consider the implications of first-choice decisions and the timing of care for treatment choices utilized for patients with spine and shoulder disorders.

DOI 10.1093/pm/pny212
2019 Rhon DI, Perez KG, Eskridge SL, 'Risk of post-traumatic knee osteoarthritis after knee injury in military service members', Musculoskeletal Care, 17 113-119 (2019)

Published 2019. This article is a U.S. Government work and is in the public domain in the USA Purpose: The aims of the present study were: (a) to identify the incidence of osteoar... [more]

Published 2019. This article is a U.S. Government work and is in the public domain in the USA Purpose: The aims of the present study were: (a) to identify the incidence of osteoarthritis (OA) after a traumatic knee injury; (b) identify the risk of post-traumatic osteoarthritis (PTOA) based on the type of injury; and (c) identify the time from injury to OA diagnosis. Patients and methods: The Expeditionary Medical Encounter Database, containing healthcare utilization for all deployment injuries sustained by military service members, was queried for traumatic knee injuries between 2001 and 2016. Subsequent diagnosis of knee OA was identified, defined as PTOA. Time to knee PTOA diagnosis was determined and logistic regression was used to obtain odds ratios (ORs) (95% confidence interval [CI]) between knee injury type and development of PTOA. Results: A total of 345 (9.57%) of the 3,605 subjects were diagnosed with PTOA. The median time to diagnosis was 4.10¿years. Four primary diagnoses remained significantly associated with PTOA after adjusting for age and injury severity score: fracture (adjusted OR [aOR]¿=¿1.36; 95% CI 1.02, 1.82), sprain (aOR¿=¿1.59; 95% CI 1.23, 2.06), dislocation (aOR¿=¿3.70; 95% CI 2.09, 6.55) and derangement (aOR¿=¿2.38; 95% CI 1.33, 4.28). Subjects were significantly less likely to develop PTOA after a soft-tissue injury (aOR¿=¿0.44; 95% CI 0.41, 0.75). Conclusions: A substantial number of individuals with a traumatic knee injury developed early PTOA (9.6%). Certain knee injuries have a greater association with PTOA. Future studies should implement longer surveillance periods and identify other healthcare variables associated with the risk of developing PTOA, to include appropriate and timely interventions.

DOI 10.1002/msc.1378
2019 Schoonover CM, Turner SL, Woods Y, Smith-Forbes E, Rhon DI, 'Perceptions and response to conservative treatment of low back pain in soldiers during initial entry training: A convergence mixed methods study', Military Medicine, 184 550-556 (2019)

© 2019 Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States. Low back pain (LBP) is a common condition suffered by military ... [more]

© 2019 Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States. Low back pain (LBP) is a common condition suffered by military personnel. Psychosocial factors play a role in LBP prognosis and can be addressed with self-management tools. This study's purpose was to (1) describe clinical changes in psychosocial factors of LBP following a self-management intervention and (2) explore the LBP experience of military trainees. Ten participants in Initial Entry Training (IET) were included in this mixed methods study. A self-management intervention of exercises and psychosocial education was provided. Quantitative instruments assessing psychosocial factors were delivered at baseline and 6 weeks. Qualitative data were gathered after treatment and analyzed using a phenomenological approach. Low levels of psychosocial risk factors were reported. Patient satisfaction (COPM-Satisfaction subscale) was the only outcome that achieved statistical significance at 6 weeks (p = 0.037). Three themes emerged from the qualitative results: The influence of the military culture on recovery from LBP, the LBP experience of a trainee, and promoting the self-management of LBP. While this cohort of IET soldiers exhibited low levels of psychosocial risk factors, qualitative reports indicate that LBP has a negative impact on participation in training, academics, and interpersonal relationships. The constraints of military training make seeking care and applying treatment strategies challenging.

DOI 10.1093/milmed/usy345
2018 Clewley D, Rhon DI, Flynn TW, Sissel CD, Cook CE, 'Does health care utilization before hip arthroscopy predict health care utilization after surgery in the US military health system? An investigation into health-seeking behavior', Journal of Orthopaedic and Sports Physical Therapy, 48 878-886 (2018)

© 2018 Journal of Orthopaedic and Sports Physical Therapy. BACKGROUND: The influence of prior patterns of health care utilization on future health care utilization has had minimal... [more]

© 2018 Journal of Orthopaedic and Sports Physical Therapy. BACKGROUND: The influence of prior patterns of health care utilization on future health care utilization has had minimal investigation in populations with musculoskeletal disorders. UUOBJECTIVES: The purpose of this study was to explore the relationship between presurgical health care utilization and postsurgical health care utilization in a population of patients undergoing hip surgery in the US Military Health System. METHODS: In this observational cohort study, person-level data were collected for patients undergoing hip arthroscopy in the Military Health System from 2003 to 2015, capturing all encounters 12 months before and 24 months after surgery for every individual. Cluster analysis was used to categorize individuals with high and low health care utilization, based on preoperative health care visits. Unadjusted and adjusted Poisson and generalized linear models were generated. Health care utilization outcomes were targeted, including costs, visits, and medication use. RESULTS: There were 1850 individuals in the final cohort (mean age, 32.18 years; 55.4% male). The high health care utilization group averaged 57.69 ± 25.87 visits, compared to 20.43 ± 8.36 visits in the low utilization group. There were significant differences between groups for total health care visits (58.17; 95% confidence interval [CI]: 57.39, 58.58), total health care costs ($11 539.71; 95% CI: $10 557.26, $12 595.04), hip-related visits (12.77; 95% CI: 12.59, 12.96), hip-related costs ($3325.07; 95% CI: $2886.43, $3804.51), days' supply of pain medications (752.67; 95% CI: 751.24, 754.11), opioid prescriptions (48.83; 95% CI: 48.47, 49.21), and cost of pain medications ($1074.80; 95% CI: $1011.91, $1137.68). CONCLUSION: Presurgical patterns of health care utilization were associated with postsurgical patterns of health care utilization, indicating that those patients who used more care before surgery also used more care after surgery. Clinicians should consider prior patterns of health care utilization, including utilization unrelated to the index condition, when determining care plans and prognosis.

DOI 10.2519/jospt.2018.8259
2018 Rhon DI, Miller RB, Fritz JM, 'Effectiveness and downstream healthcare utilization for patients that received early physical therapy versus usual care for low back pain: A randomized clinical trial', Spine, 43 1313-1321 (2018)

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Study Design. Randomized controlled trial. Objective. The aim of this study was to compare early physical therap... [more]

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Study Design. Randomized controlled trial. Objective. The aim of this study was to compare early physical therapy versus usual care in patients with low back pain. Summary of Background Data. Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system. Methods. Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute selfmanagement class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week followup, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. Trial Registration: clinicaltrials.gov: NCT01556581 Results. A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m 2 ; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference=4.4; 95% CI: 0.41-10.1; P=0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171-$6082 and PT $5299; 95 CI $4367-$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855-$1405) compared to PT ($2016, 95% CI $1570-$2590). Conclusion. There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC.

DOI 10.1097/BRS.0000000000002619
Citations Scopus - 1
2018 Rhon DI, Snodgrass SJ, Cleland JA, Sissel CD, Cook CE, 'Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule', PERIOPERATIVE MEDICINE, 7 (2018) [C1]
DOI 10.1186/s13741-018-0105-8
Co-authors Suzanne Snodgrass
2018 Rhon D, Greenlee T, Fritz J, 'Utilization of Manipulative Treatment for Spine and Shoulder Conditions Between Different Medical Providers in a Large Military Hospital', ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 99 72-81 (2018)
DOI 10.1016/j.apmr.2017.06.010
Citations Scopus - 2Web of Science - 3
2018 Rhon DI, Teyhen DS, Shaffer SW, Goffar SL, Kiesel K, Plisky PP, 'Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme', INJURY PREVENTION, 24 81-88 (2018)
DOI 10.1136/injuryprev-2016-042234
Citations Scopus - 2Web of Science - 1
2018 Rhon DI, Snodgrass SJ, Cleland JA, Greenlee TA, Sissel CD, Cook CE, 'Comparison of Downstream Health Care Utilization, Costs, and Long-Term Opioid Use: Physical Therapist Management Versus Opioid Therapy Management After Arthroscopic Hip Surgery.', Phys Ther, 98 348-356 (2018) [C1]
DOI 10.1093/ptj/pzy019
Citations Scopus - 1Web of Science - 3
Co-authors Suzanne Snodgrass
2018 Teyhen DS, Goffar SL, Shaffer SW, Kiesel K, Butler RJ, Tedaldi AM, et al., 'Incidence of musculoskeletal injury in US army unit types: A prospective cohort study', Journal of Orthopaedic and Sports Physical Therapy, 48 749-757 (2018)

Copyright © 2018 Journal of Orthopaedic &amp; Sports Physical Therapy®. BACKGROUND: Musculoskeletal injuries during military service are a primary source of disability, resultin... [more]

Copyright © 2018 Journal of Orthopaedic & Sports Physical Therapy®. BACKGROUND: Musculoskeletal injuries during military service are a primary source of disability, resulting in 2.4 million annual health care visits and 25 million limited-duty days. While the injury incidence during basic training is well documented, there is little understanding of injury distribution by organization type in the US Army following initial training. OBJECTIVE: To compare injury incidence, distribution, and impact across various military units. METHODS: In this prospective observational cohort study, comprehensive injury data from subject questionnaires and medical chart reviews were collected over 12 months for 1430 initially healthy Army personnel, representing combat, combat support, combat service support, and ranger units. Health care utilization and time loss due to injury were also collected. RESULTS: Of 1430 soldiers, 481 (33.6%) had time-loss injury, 222 (15.5%) were injured without limited work, 60 (4.2%) reported an injury but did not seek medical care, and 667 (46.6%) were uninjured. Across the whole sample, injuries were responsible for 5.9 ± 14.4 medical visits per soldier, 21 902 days of limited work, and $1 337 000 ($1901 ± $6535 per soldier) in medical costs. Considering only those reporting injury, each person averaged 36.3 ± 59.7 limited-work days. The injury incidence was highest in combat service support units (65.6%), with a risk ratio 1.60 times that of the reference group (combat, 41.1%). CONCLUSION: Combat support and combat service support personnel were more likely to have 1 or more injuries compared to rangers and combat personnel. The higher relative risk of injury in support units should be explored further.

DOI 10.2519/jospt.2018.7979
Citations Scopus - 2
2018 Young JL, Rhon DI, Cleland JA, Snodgrass SJ, 'The influence of exercise dosing on outcomes in patients with knee disorders: A systematic review', Journal of Orthopaedic and Sports Physical Therapy, 48 146-161 (2018) [C1]

Copyright © 2018 Journal of Orthopaedic &amp; Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Systematic review. BACKGROUND: Therapeutic exercise is commonly used t... [more]

Copyright © 2018 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved. STUDY DESIGN: Systematic review. BACKGROUND: Therapeutic exercise is commonly used to treat individuals with knee disorders, but dosing parameters for optimal outcomes are unclear. Large variations exist in exercise prescription, and research related to specific dosing variables for knee osteoarthritis, patellar tendinopathy, and patellofemoral pain is sparse. OBJECTIVES: To identify specific doses of exercise related to improved outcomes of pain and function in individuals with common knee disorders, categorized by effect size. METHODS: Five electronic databases were searched for studies related to exercise and the 3 diagnoses. Means and standard deviations were used to calculate effect sizes for the exercise groups. The overall quality of evidence was assessed using the Physiotherapy Evidence Database scale. RESULTS: Five hundred eighty-three studies were found after the initial search, and 45 were included for analysis after screening. Physiotherapy Evidence Database scale scores were "fair" quality and ranged from 3 to 8. For knee osteoarthritis, 24 total therapeutic exercise sessions and 8- and 12-week durations of exercise were parameters most often associated with large effects. An exercise frequency of once per week was associated with no effect. No trends were seen with exercise dosing for patellar tendinopathy and patellofemoral pain. CONCLUSION: This review suggests that there are clinically relevant exercise dosing variables that result in improved pain and function for patients with knee osteoarthritis, but optimal dosing is still unclear for patellar tendinopathy and patellofemoral pain. Prospective studies investigating dosing parameters are needed to confirm the results from this systematic review.

DOI 10.2519/jospt.2018.7637
Citations Scopus - 4Web of Science - 4
Co-authors Jodi Young Uon, Suzanne Snodgrass
2018 Young JL, Rhon DI, de Zoete RMJ, Cleland JA, Snodgrass SJ, 'The influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders: a systematic review', Brazilian Journal of Physical Therapy, 22 20-32 (2018) [C1]

© 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia Objective: The purpose of this review was to identify doses of exercise therapy associated with greater tr... [more]

© 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia Objective: The purpose of this review was to identify doses of exercise therapy associated with greater treatment effect sizes in individuals with common musculoskeletal disorders of the foot and ankle, namely, achilles tendinopathy, ankle sprains and plantar heel pain. Methods: AMED, EMBASE and MEDLINE were searched from 2005 to August 2017 for randomized controlled trials related to exercise for these three diagnoses. The Physiotherapy Evidence Database scale was used for methodological quality assessment. Exercise dosing variables and outcome measures related to pain and function were extracted from the studies, and standardized mean differences were calculated for the exercise groups. Results: Fourteen studies met the final inclusion. A majority of the studies showed large effects and two small trends were identified. Patients with plantar heel pain may benefit more from a daily home exercise program than two supervised visits per week (SMD = 3.82), but this recommendation is based on weak evidence. In achilles tendinopathy, a relationship was also seen when sets and repetitions of eccentric exercise were performed as tolerated (SMD = 1.08 for function, -1.29 for pain). Conclusions: Session duration, frequency, total number of visits, and overall length of care may all be dosing variables with limited value for determining effective exercise prescription. However, the limited number of studies prevents any definitive conclusions. Further investigation is warranted to improve our understanding of the influence exercise dosing has on treatment effect sizes. Future randomized controlled trials comparing specific exercise dose variables should be conducted to clarify the impact of these variables.

DOI 10.1016/j.bjpt.2017.10.001
Citations Scopus - 1Web of Science - 1
Co-authors Jodi Young Uon, Suzanne Snodgrass
2018 Hando BR, Rhon DI, Cleland JA, Snodgrass SJ, 'Dry needling in addition to standard physical therapy treatment for sub-acromial pain syndrome: a randomized controlled trial protocol', Brazilian Journal of Physical Therapy, (2018)

© 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia Background: Trigger point dry needling interventions are utilized by physical therapists to manage shoulde... [more]

© 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia Background: Trigger point dry needling interventions are utilized by physical therapists to manage shoulder pain. Observational studies have shown positive short-term outcomes in patients with subacromial pain syndrome receiving trigger point dry needling. However, little research has been done to evaluate the long-term effectiveness of trigger point dry needling specifically as it compares to other commonly utilized interventions such as exercise and manual therapy. The purpose of this study is to assess the additive short and long-term effectiveness of trigger point dry needling to a standard physical therapy approach of manual therapy and exercise for patients with subacromial pain syndrome. Methods: This multicenter randomized trial with 3 arms was designed following the standard protocol items for randomized interventional trials. Results will be reported consistent with the consolidated standards of reporting trials guidelines. 130 participants will be randomized to receive standard PT interventions alone (manual therapy and exercise), standard PT and trigger point dry needling or standard PT and sham trigger point dry needling. The primary outcome measures will be the Shoulder Pain and Disability Index and Patient Reported Outcomes Measurement Information Systems (PROMIS-57) scores collected at baseline, 6-weeks, 6-months and one year. Healthcare utilization will be collected for 12 months following enrollment and groups analyzed for differences. Discussion: It is not known if trigger point dry needling provides long-term benefit for individuals with subacromial pain syndrome. This study will help determine if this intervention provides additive benefits over those observed with the commonly applied interventions of exercise and manual therapy. Trial registration: Identifier: NCT03442894 (https://clinicaltrials.gov/ct2/show/NCT03442894) on 22 February 2018.

DOI 10.1016/j.bjpt.2018.10.010
Co-authors Suzanne Snodgrass
2018 Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG, 'Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome A Randomized Controlled Trial With 2-Year Follow-up', AMERICAN JOURNAL OF SPORTS MEDICINE, 46 1306-1314 (2018)
DOI 10.1177/0363546517751912
Citations Scopus - 20Web of Science - 16
2018 Rhon DI, Marchant BG, Mansell NS, 'Randomized Controlled Trial of Hip Arthroscopy Surgery vs Physical Therapy: Response', AMERICAN JOURNAL OF SPORTS MEDICINE, 46 NP38-NP39 (2018)
DOI 10.1177/0363546518777482
Citations Scopus - 2Web of Science - 1
2018 Reiman MP, Peters S, Rhon DI, 'Most Military Service Members Return to Activity Duty With Limitations After Surgery for Femoroacetabular Impingement Syndrome: A Systematic Review', ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 34 2713-2725 (2018)
DOI 10.1016/j.arthro.2018.05.011
Citations Scopus - 1Web of Science - 1
2018 Ciewley D, Rhon D, Flynn T, Koppenhaver S, Cook C, 'Physical therapists familiarity and beliefs about health services utilization and health seeking behaviour', BRAZILIAN JOURNAL OF PHYSICAL THERAPY, 22 336-343 (2018)
DOI 10.1016/j.bjpt.2018.02.002
Citations Scopus - 2Web of Science - 1
2018 Rhon DI, Clewley D, Young JL, Sissel CD, Cook CE, 'Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository', BMC MEDICAL INFORMATICS AND DECISION MAKING, 18 (2018)
DOI 10.1186/s12911-018-0588-8
Citations Scopus - 5Web of Science - 6
Co-authors Jodi Young Uon
2018 Clewley D, Rhon D, Flynn T, Koppenhaver S, Cook C, 'Health seeking behavior as a predictor of healthcare utilization in a population of patients with spinal pain', PLOS ONE, 13 (2018)
DOI 10.1371/journal.pone.0201348
Citations Scopus - 2Web of Science - 1
2017 Hando BR, Rhon DI, Boyles RE, Whitman JM, English JL, 'Translational manipulation under anesthesia for patients with frozen shoulder: a case series study with five-year health care utilization and post-manipulative arthroscopic findings', JOURNAL OF MANUAL & MANIPULATIVE THERAPY, 25 270-278 (2017)
DOI 10.1080/10669817.2017.1292615
2017 Rhon DI, Golden KJ, Trevino AJ, Hatler BS, 'Soldier Readiness Processing: Time for a New Paradigm in Managing Musculoskeletal Injuries After Deployment?', MILITARY MEDICINE, 182 E1569-E1574 (2017)
DOI 10.7205/MILMED-D-16-00124
Citations Scopus - 1Web of Science - 1
2017 Rhon DI, Lentz TA, George SZ, 'Unique Contributions of Body Diagram Scores and Psychosocial Factors to Pain Intensity and Disability in Patients With Musculoskeletal Pain', JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 47 88-96 (2017)
DOI 10.2519/jospt.2017.6778
2017 Cook CE, Rhon DI, Lewis BD, George SZ, 'Post-operative opioid pain management patterns for patients who receive hip surgery', SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY, 12 (2017)
DOI 10.1186/s13011-017-0094-5
Citations Scopus - 1Web of Science - 1
2017 Hearn D, Rhon D, Goss D, Thelen M, 'Evaluation of a Novel Field Expedient Musculoskeletal Readiness Screening Tool in an Army Basic Training Population', MILITARY MEDICINE, 182 E1862-E1868 (2017)
DOI 10.7205/MILMED-D-16-00384
Citations Web of Science - 1
2016 Teyhen DS, Shaffer SW, Butler RJ, Goffar SL, Kiesel KB, Rhon DI, et al., 'Application of Athletic Movement Tests that Predict Injury Risk in a Military Population: Development of Normative Data', MILITARY MEDICINE, 181 1324-1334 (2016)
DOI 10.7205/MILMED-D-15-00297
Citations Scopus - 4Web of Science - 5
2016 Kardouni JR, Shing TL, Rhon DI, 'Risk Factors for Low Back Pain and Spine Surgery A Retrospective Cohort Study in Soldiers', AMERICAN JOURNAL OF PREVENTIVE MEDICINE, 51 E129-E138 (2016)
DOI 10.1016/j.amepre.2016.06.005
Citations Scopus - 7Web of Science - 5
2016 Teyhen DS, Rhon DI, Butler RJ, Shaffer SW, Goffar SL, McMillian DJ, et al., 'Association of Physical Inactivity, Weight, Smoking, and Prior Injury on Physical Performance in a Military Setting', JOURNAL OF ATHLETIC TRAINING, 51 866-875 (2016)
DOI 10.4085/1062-6050-51.6.02
Citations Scopus - 4Web of Science - 3
2016 Mansell NS, Rhon DI, Marchant BG, Slevin JM, Meyer JL, 'Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement: A protocol for a randomized clinical trial', BMC MUSCULOSKELETAL DISORDERS, 17 (2016)
DOI 10.1186/s12891-016-0914-1
Citations Scopus - 7Web of Science - 10
2016 Deyle GD, Gill NW, Rhon DI, Allen CS, Allison SC, Hando BR, et al., 'A multicentre randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injections', BMJ OPEN, 6 (2016)
DOI 10.1136/bmjopen-2015-010528
Citations Scopus - 1Web of Science - 4
2016 Deyle GD, Gill NW, Rhon D, 'A multicentre randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injections (vol 6, e010528, 2016)', BMJ OPEN, 6 (2016)
DOI 10.1136/bmjopen-2015-010528corr1
Citations Scopus - 2
2015 Rhon DI, Boyles RB, Cleland JA, 'Management of the unilateral shoulder impingement syndrome: In response', Annals of Internal Medicine, 162 237-238 (2015)
DOI 10.7326/L15-5043-2
Citations Scopus - 1Web of Science - 1
2015 Teyhen DS, Shaffer SW, Butler RJ, Goffar SL, Kiesel KB, Rhon DI, et al., 'What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study', Clinical Orthopaedics and Related Research, 473 2948-2958 (2015)

© 2015, The Association of Bone and Joint Surgeons®. Background: Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding i... [more]

© 2015, The Association of Bone and Joint Surgeons®. Background: Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findings from this population may also be useful as hypothesis-generating work for particular civilian settings such as law enforcement officers (SWAT teams), firefighters (smoke jumpers), or others in physically demanding professions. Questions/purposes: The purposes of this study were (1) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk; and (2) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers. Methods: Our study was a planned secondary analysis from a prospective cohort examining how baseline factors predict musculoskeletal injury. Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures. Survey data included demographic variables, injury history, and biopsychosocial questions. Physical performance measures included ankle dorsiflexion, Functional Movement Screen, lower and upper quarter Y-balance test, hop testing, pain provocation, and the Army Physical Fitness Test (consisting of a 2-mile run and 2 minutes of sit-ups and push-ups). A total of 320 Rangers were invited to enroll and 211 participated (66%). Occurrence of musculoskeletal injury was tracked for 1¿year using monthly injury surveillance surveys, medical record reviews, and a query of the Department of Defense healthcare utilization database. Injury surveillance data were available on 100% of the subjects. Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest. A logistic regression equation was then calculated to find the most pertinent set of predictors. Of the 188 Rangers (age, 23.3 ± 3.7¿years; body mass index, 26.0 ± 2.4¿kg/m 2 ) remaining in the cohort, 85 (45.2%) sustained a musculoskeletal injury of interest. Results: Smoking, prior surgery, recurrent prior musculoskeletal injury, limited-duty days in the prior year for musculoskeletal injury, asymmetrical ankle dorsiflexion, pain with Functional Movement Screen clearing tests, and decreased performance on the 2-mile run and 2-minute sit-up test were associated with increased injury risk. Presenting with one or fewer predictors resulted in a sensitivity of 0.90 (95% confidence interval [CI], 0.83¿0.95), and having three or more predictors resulted in a specificity of 0.98 (95% CI, 0.93¿0.99). The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 (95% CI, 2.0¿9.2), relative risk of 1.9 (95% CI, 1.4¿2.6), and an area under the curve of 0.64. Conclusions: Multiple factors (musculoskeletal injury history, smoking, pain provocation, movement tests, and lower scores on physical performance measures) were associated with individuals at risk for musculoskeletal injury. The summation of the number of risk factors produced a highly sensitive (one or less factor) and specific (three or more factors) model that could potentially be used to effectively identify and intervene in those persons with elevated risk for musculoskeletal injury. Future research should establish if screening and intervening can improve musculoskeletal health and if our findings among US Army Rangers translate to other occupations or athletes. Level of Evidence: Level II, prognostic study.

DOI 10.1007/s11999-015-4342-6
Citations Scopus - 24Web of Science - 27
2015 Leib C, 'Management of the Unilateral Shoulder Impingement Syndrome', ANNALS OF INTERNAL MEDICINE, 162 237-237 (2015)
DOI 10.7326/L15-5043
2015 Rhon D, Fritz J, 'COMParative Early Treatment Effectiveness between physical therapy and usual care for low back pain (COMPETE): study protocol for a randomized controlled trial.', Trials, 16 423 (2015)
DOI 10.1186/s13063-015-0959-8
Citations Scopus - 5Web of Science - 4
2014 Rhon DI, Boyles RB, Cleland JA, 'One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: A pragmatic randomized trial', Annals of Internal Medicine, 161 161-169 (2014)

Background: Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared. Ob... [more]

Background: Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared. Objective: To compare the effectiveness of 2 common nonsurgical treatments for SIS. Design: Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov: NCT01190891) Setting: Military hospital-based outpatient clinic in the United States. Patients: 104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012. Intervention: Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 6 sessions of manual physical therapy. Measurements: The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use. Results: Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, -6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, -2 to 1]) and pain rating (0.4 [CI, -0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported. Limitation: The study occurred at 1 center with patients referred to physical therapy. Conclusion: Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group.

DOI 10.7326/M13-2199
Citations Scopus - 28Web of Science - 27
2014 Rhon D, Hando B, 'Letter to the editor: External rotation immobilization for primary shoulder dislocation: a randomized controlled trial.', Clin Orthop Relat Res, 472 1992-1993 (2014)
DOI 10.1007/s11999-014-3568-z
Citations Scopus - 1Web of Science - 1
2013 Rhon DI, Deyle GD, Gill NW, 'Clinical reasoning and advanced practice privileges enable physical therapist point-of-care decisions in the military health care system: 3 clinical cases', Physical Therapy, 93 1234-1243 (2013)

Background and Purpose. Physical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), the... [more]

Background and Purpose. Physical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), these decisions may occur while therapists are deployed in support of combat troops, as well as in a more traditional hospital setting. Proficiency with the musculoskeletal examination, including a fundamental understanding of the diagnostic role of musculoskeletal imaging, is an important competency for physical therapists. The purpose of this article is to present 3 cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision making. Case Description. Three cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist's clinical privileges, including the ability to order appropriate musculoskeletal imaging procedures, were helpful in making clinical decisions that facilitate timely management. The cases involve patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain. Outcomes. Clinical pathways from point of care are discussed, as well as the reasoning that led to decisions affecting definitive care for each of these patients. In each case, emergent treatment and important combat evacuation decisions were based on a combination of examination and management decisions. Discussion. Physical therapists can provide important contributions to the primary management of patients with musculoskeletal conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role. © 2013 American Physical Therapy Association.

DOI 10.2522/ptj.20120148
Citations Scopus - 6Web of Science - 7
2013 Rhon D, Deyle G, Gill N, Rendeiro D, 'Manual physical therapy and perturbation exercises in knee osteoarthritis.', J Man Manip Ther, 21 220-228 (2013)
DOI 10.1179/2042618613Y.0000000039
Citations Scopus - 3
2012 Jordan CL, Rhon DI, 'Differential Diagnosis and Management of Ankylosing Spondylitis Masked as Adhesive Capsulitis: A Resident's Case Problem', JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 42 842-852 (2012)
DOI 10.2519/jospt.2012.4050
Citations Scopus - 6Web of Science - 7
2011 Rhon DI, Boyles RE, Cleland JA, Brown DL, 'A manual physical therapy approach versus subacromial corticosteroid injection for treatment of shoulder impingement syndrome: a protocol for a randomised clinical trial', BMJ OPEN, 1 (2011)
DOI 10.1136/bmjopen-2011-000137
Citations Scopus - 12Web of Science - 12
2010 Rhon DI, Gill N, Teyhen D, Scherer M, Goffar S, 'Clinician Perception of the Impact of Deployed Physical Therapists as Physician Extenders in a Combat Environment', MILITARY MEDICINE, 175 305-312 (2010)
DOI 10.7205/MILMED-D-09-00099
Citations Scopus - 9Web of Science - 6
2010 Rhon DI, 'A Physical Therapist Experience, Observation, and Practice With an Infantry Brigade Combat Team in Support of Operation Iraqi Freedom', MILITARY MEDICINE, 175 442-447 (2010)
DOI 10.7205/MILMED-D-09-00097
Citations Scopus - 18Web of Science - 17
2008 Rhon D, 'Lumbar spinal stenosis [6]', New England Journal of Medicine, 358 2647 (2008)
DOI 10.1056/NEJMc080600
2008 van Gijn J, 'Lumbar spinal stenosis.', The New England journal of medicine, 358 2647 (2008)
DOI 10.1056/nejmc080600
2008 Rhon D, 'Re: Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62', OSTEOARTHRITIS AND CARTILAGE, 16 1585-1585 (2008)
DOI 10.1016/j.joca.2008.04.019
Citations Scopus - 3Web of Science - 5
2004 Cliborne AV, Wainner RS, Rhon DI, Judd CD, Fee TT, Matekel RL, Whitman JM, 'Clinical hip tests and a functional squat test in patients with knee osteoarthritis: Reliability, prevalence of positive test findings, and short-term response to hip mobilization', JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 34 676-685 (2004)
DOI 10.2519/jospt.2004.34.11.676
Citations Scopus - 37Web of Science - 28
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Mr Daniel Rhon

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