2021 |
Fraser JJ, MacGregor A, Ryans CP, Dreyer MA, Gibboney MD, Rhon DI, 'Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes', Journal of Science and Medicine in Sport, (2021)
Objectives: To assess the risk of lateral ankle sprain (LAS) in male and female tactical athletes across different military occupations in the US military. Design: Retrospective c... [more]
Objectives: To assess the risk of lateral ankle sprain (LAS) in male and female tactical athletes across different military occupations in the US military. Design: Retrospective cohort. Methods: The Defense Medical Epidemiology Database was queried for the number of individuals with ICD-9 diagnosis codes 845.00 (sprain of ankle, unspecified) and 845.02 (calcaneofibular ligament sprain) on their initial encounter from 2006 to 2015. Relative risk (RR) and chi-square statistics were calculated assessing sex and occupational category on LAS risk. Results: 272,970 enlisted males (27.9 per 1000 person-years), 56,732 enlisted females (34.5 per 1000 person-years), 24,534 male officers (12.6 per 1000 person-years), and 6020 female officers (16.4 per 1000 person-years) incurred a LAS. Enlisted females in all occupational groups were at significantly higher risk for LAS than their male counterparts (RR 1.09¿1.68; p < 0.001), except for Engineers (p = 0.15). Female officers had consistently higher risk for LAS in all occupational groups (RR 1.10¿1.42; p < 0.001) compared with male officers, except Ground/Naval Gunfire (p = 0.23). Contrasted with Infantry, enlisted tactical athletes in the Special Operations Forces, Mechanized/Armor, Aviation, Maintenance, and Maritime/Naval Specialties were at lower risk (RR 0.38-0.93; p < 0.001), Artillery, Engineers, and Logistics Specialties were at higher risk (RR 1.04¿1.18; p < 0.001), and Administration, Intelligence, and Communications were no different (p = 0.69). Compared with Ground/Naval Gunfire officers, Aviation officers were at significantly lower risk (RR, 0.75; p < 0.001), and Engineers, Maintenance, Administration, Operations/Intelligence, and Logistics officers were at higher risk (RR, 1.08¿1.20; p < 0.001). Conclusions: Sex and military occupation were salient factors associated with LAS risk.
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2021 |
Garcia AN, Cook CE, Rhon DI, 'Adherence to Stepped Care for Management of Musculoskeletal Knee Pain Leads to Lower Health Care Utilization, Costs, and Recurrence', American Journal of Medicine, 134 351-360.e1 (2021)
Objectives: This study aimed to report compliance with stepped care management of patellofemoral pain and determine whether adherence to stepped care results in decreased recurren... [more]
Objectives: This study aimed to report compliance with stepped care management of patellofemoral pain and determine whether adherence to stepped care results in decreased recurrence and lower health care utilization. Methods: A total of 60,730 participants were included, using data from the Military Health System Data Repository, a large single-payer government health system. Outcomes included total knee-related care visits and costs, knee surgeries, opioid prescriptions, and 2-year recurrence. Stepped care was based on interventions delivered within the appropriate timing and in the appropriate order (low risk/cost before high risk/cost). Results: A total of 54,460 (89.7%) participants received adherent Step 1 care, 10,964 (18.1%) received step 2, and 4168 (6.9%) received step 3. A total of 32.0% and 50.8%, respectively, of all patients in Step 2 and Step 3 care were adherent. Of the 2385 participants (3.9% of cohort) that received both Step 2 and Step 3 care, 24.8% of participants received adherent care. For participants receiving both Step 2 and Step 3 care, adherence resulted in cost savings (mean difference [MD] $1708; 95% confidence interval [CI]: $1241, 2175), fewer knee-related visits (MD 3.4; 95% CI 2.2, 4.7), fewer episodes of knee pain (MD 0.7; 95% CI 0.5, 0.8), fewer knee surgeries (adjusted odds ratio 0.4; 95% CI 0.3, 0.5), and fewer opioid prescriptions (adjusted odds ratio 0.6; 95% CI 0.5, 0.8). Conclusion: These findings demonstrate the value of following stepped care guidelines for pain management in patients with patellofemoral pain.
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2021 |
Tenan MS, Galvin JW, Mauntel TC, Tokish JM, Bailey JR, Barlow BT, et al., 'Generating the American Shoulder and Elbow Surgeons Score Using Multivariable Predictive Models and Computer Adaptive Testing to Reduce Survey Burden', The American journal of sports medicine, 49 764-772 (2021)
BACKGROUND: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcome... [more]
BACKGROUND: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. PURPOSE: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3. METHODS: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative variables. Patients in MOTION research who underwent shoulder surgery and completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points were included in the present analysis. Nonlinear multivariable predictive models were created to establish an ASES index score and then validated using "leave 1 out" techniques and minimal clinically important difference /substantial clinical benefit (MCID/SCB) analysis. RESULTS: A total of 909 patients completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at presurgery, 6 weeks, 6 months, and 1 year after surgery, providing 1502 complete observations. The PROMIS CAT predictive model was strongly validated to predict the ASES (Pearson coefficient = 0.76-0.78; R2 = 0.57-0.62; root mean square error = 13.3-14.1). The MCID/SCB for the ASES was 21.7, and the best ASES index MCID/SCB was 19.4, suggesting that the derived ASES index is effective and can reliably re-create ASES scores. CONCLUSION: The PROMIS CAT predictive models are able to approximate the ASES score within 13 to 14 points, which is 7 points more accurate than the ASES MCID/SCB derived from the sample. Our ASES index algorithm, which is freely available online (https://osf.io/ctmnd/), has a lower MCID/SCB than the ASES itself. This algorithm can be used to decrease patient survey burden by 11 questions and provide a reliable ASES analog to clinicians.
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2021 |
Rhon DI, Cook CE, Cleland JA, Snodgrass SJ, 'The influence of prior opioid use on healthcare utilization and recurrence rates for non-surgical patients seeking initial care for patellofemoral pain', Clinical Rheumatology, 40 1047-1054 (2021)
Introduction/objectives: Prior opioid use can influence outcomes for patients with musculoskeletal disorders. The purpose of this study was to compare downstream medical utilizati... [more]
Introduction/objectives: Prior opioid use can influence outcomes for patients with musculoskeletal disorders. The purpose of this study was to compare downstream medical utilization-based outcomes (costs, visits, recurrent episodes) after an initial diagnosis of patellofemoral pain based on pre-injury utilization of opioids. Method: A total of 85,7880 consecutive patients were followed for a full 12¿months before and 24¿months after an initial diagnosis of patellofemoral pain (January 2009 to December 2013). Data were sourced from the Military Health System Data Repository, a single-payer closed government system. Opioid prescription fills were identified, and medical visits and costs were calculated for all knee-related medical care, to include recurrence rates in the 2-year surveillance period. Results: A relatively small number of individuals filled an opioid prescription in the year prior (n = 1746; 2.0%); however, these individuals had almost twice the mean costs of knee-related medical care ($1557 versus %802) and medical visits (8.4 versus 4.0). Patients with prior opioid use were more likely to have at least 1 recurrent episode of knee pain (relative risk 1.58, 95% CI 1.51, 1.65) with a higher mean number of episodes of knee pain (1.5 vs 1.8). The use of opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes of knee pain compared to the use of opioids in a lower risk category (Schedule IV). Conclusions: Prior opioid utilization was associated with a greater number of recurrent episodes of knee pain and higher downstream medical costs compared with individuals without prior opioid use. For individuals with prior opioid utilization, opioids with higher risk of misuse or dependency (Schedule II or III) resulted in greater medical costs (for any reason) and recurrent episodes compared to the use of lower-risk opioids (Schedule IV).Key Points¿ Patients with prior opioid use had much greater knee-related medical costs compared to patients without prior opioid use.¿ Patients with prior opioid use were more likely to have additional episodes of knee pain in the following 2¿years compared to patients without prior opioid use.¿ Prior opioid use has predicted higher costs and poor outcomes after surgery, but this is the first study to confirm similar findings in non-surgical patients.
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2020 |
Teyhen DS, Shaffer SW, Goffar SL, Kiesel K, Butler RJ, Rhon D, Plisky PJ, 'Identification of Risk Factors Prospectively Associated With Musculoskeletal Injury in a Warrior Athlete Population', SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH, 12 564-572 (2020)
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2020 |
Lentz TA, Rhon D, George SZ, 'Predicting Opioid Use, Increased Health Care Utilization and High Costs for Musculoskeletal Pain: What Factors Mediate Pain Intensity and Disability?', JOURNAL OF PAIN, 21 135-145 (2020)
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2020 |
Rhon D, Lentz TA, George SZ, 'Utility of catastrophizing, body symptom diagram score and history of opioid use to predict future health care utilization after a primary care visit for musculoskeletal pain', FAMILY PRACTICE, 37 81-90 (2020)
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2020 |
Deyle GD, Allen CS, Allison SC, Gill NW, Hando BR, Petersen EJ, et al., 'Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee', NEW ENGLAND JOURNAL OF MEDICINE, 382 1420-1429 (2020)
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2020 |
Ojha HA, Fritz JM, Malitsky AL, Wu J, Weiner MG, Brandi JA, et al., 'Comparison of Physical Therapy and Physician Pathways for Employees with Recent Onset Musculoskeletal Pain: A Randomized Controlled Trial', PM&R, 12 1071-1080 (2020)
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2020 |
Molloy JM, Pendergrass TL, Lee IE, Chervak MC, Hauret KG, Rhon D, 'Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact', MILITARY MEDICINE, 185 E1461-E1471 (2020)
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2020 |
Molloy JM, Pendergrass TL, Lee IE, Hauret KG, Chervak MC, Rhon D, 'Musculoskeletal Injuries and United States Army Readiness. Part II: Management Challenges and Risk Mitigation Initiatives', MILITARY MEDICINE, 185 E1472-E1480 (2020)
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2020 |
Fritz JM, Rhon DI, Teyhen DS, Kean J, Vanneman ME, Garland EL, et al., 'A sequential multiple-assignment randomized trial (smart) for stepped care management of low back pain in the military health system: A trial protocol', Pain Medicine (United States), 21 S73-S82 (2020)
Background. The Defense Health Agency has prioritized system-level pain management initiatives within the Military Health System (MHS), with low back pain as one of the key focus ... [more]
Background. The Defense Health Agency has prioritized system-level pain management initiatives within the Military Health System (MHS), with low back pain as one of the key focus areas. A stepped care model focused on nonpharmacologic treatment to promote self-management is recommended. Implementation of stepped care is complicated by lack of information on the most effective nonpharmacologic strategies and how to sequence and tailor the various available options. The Sequential Multiple-Assignment Randomization Trial for Low Back Pain (SMART LBP) is a multisite pragmatic trial using a SMART design to assess the effectiveness of nonpharmacologic treatments for chronic low back pain. Design. This SMART trial has two treatment phases. Participants from three military treatment facilities are randomized to 6 weeks of phase I treatment, receiving either physical therapy (PT) or Army Medicine's holistic Move2Health (M2H) program in a package specific to low back pain. Nonresponders to treatment in phase I are again randomized to phase II treatment of combined M2H PT or mindfulness-based treatment using the Mindfulness-Oriented Recovery Enhancement (MORE) program. The primary outcome is the Patient-Reported Outcomes Measurement Information System pain interference computer-adapted test score. Summary. This trial is part of an initiative funded by the National Institutes of Health, Veterans Affairs, and the Department of Defense to establish a national infrastructure for effective system-level management of chronic pain with a focus on nonpharmacologic treatments. The results of this study will provide important information on nonpharmacologic care for chronic LBP in the MHS embedded within a stepped care framework.
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2020 |
CLEWLEY D, IFTIKHAR Y, HORN ME, RHON DI, 'Do the number of visits and the cost of musculoskeletal care improve outcomes? more may not be better', Journal of Orthopaedic and Sports Physical Therapy, 50 642-648 (2020)
OBJECTIVES: To determine the relationship between health care use and the magnitude of change in patient-reported outcomes in individuals who received treatment for subacromial pa... [more]
OBJECTIVES: To determine the relationship between health care use and the magnitude of change in patient-reported outcomes in individuals who received treatment for subacromial pain syndrome. The secondary objective was to determine the value of care, as measured by change in pain and disability per dollar spent. DESIGN: Secondary analysis of a randomized clinical trial that investigated the effects of nonsurgical care for subacromial pain syndrome. METHODS: Two groups of treatment responders were created, based on 1-year change in Shoulder Pain and Disability Index (SPADI) score (high, 46.83 points; low, 8.21 points). Regression analysis was performed to determine the association between health care use and 1-year change in SPADI score. Baseline SPADI score was used as a covariate in the regression analysis. Value was measured by comparing health care visits and costs expended per SPADI 1-point change between responder groups. RESULTS: Ninety-eight patients were included; 38 were classified as high responders (mean 1-year SPADI change score, 46.83 points) and 60 were classified as low responders (1-year SPADI change score, 8.21 points). Neither unadjusted medical visits (5.89; 95% confidence interval [CI]: 4.35, 7.44 versus 6.30; 95% CI: 5.14, 7.46) nor medical costs ($1404.86; 95% CI: $1109.34, $1779.09 versus $1679.26; 95% CI: $1391.54, $2026.48) were significantly different between high and low responders, respectively. CONCLUSION: Neither the number of visits nor the financial cost of nonsurgical shoulder-related care was associated with improvement in shoulder pain and disability at 1 year.
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2020 |
Bastian LA, Cohen SP, Katsovich L, Becker WC, Brummett BR, Burgess DJ, et al., 'Stakeholder engagement in pragmatic clinical trials: Emphasizing relationships to improve pain management delivery and outcomes', Pain Medicine (United States), 21 S13-S20 (2020)
Background. The NIH-DOD-VA Pain Management Collaboratory (PMC) supports 11 pragmatic clinical trials (PCTs) on nonpharmacological approaches to management of pain and co-occurring... [more]
Background. The NIH-DOD-VA Pain Management Collaboratory (PMC) supports 11 pragmatic clinical trials (PCTs) on nonpharmacological approaches to management of pain and co-occurring conditions in U.S. military and veteran health organizations. The Stakeholder Engagement Work Group is supported by a separately funded Coordinating Center and was formed with the goal of developing respectful and productive partnerships that will maximize the ability to generate trustworthy, internally valid findings directly relevant to veterans and military service members with pain, front-line primary care clinicians and health care teams, and health system leaders. The Stakeholder Engagement Work Group provides a forum to promote success of the PCTs in which principal investigators and/or their designees discuss various stakeholder engagement strategies, address challenges, and share experiences. Herein, we communicate features of meaningful stakeholder engagement in the design and implementation of pain management pragmatic trials, across the PMC. Design. Our collective experiences suggest that an optimal stakeholder-engaged research project involves understanding the following: i) Who are research stakeholders in PMC trials? ii) How do investigators ensure that stakeholders represent the interests of a study's target treatment population, including individuals from underrepresented groups?, and iii) How can sustained stakeholder relationships help overcome implementation challenges over the course of a PCT? Summary. Our experiences outline the role of stakeholders in pain research and may inform future pragmatic trial researchers regarding methods to engage stakeholders effectively.
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2020 |
Rhon DI, Snodgrass SJ, Cleland JA, Cook CE, 'The Risk of Prior Opioid Exposure on Future Opioid Use and Comorbidities in Individuals With Non-Acute Musculoskeletal Knee Pain', Journal of Primary Care and Community Health, 11 (2020)
Objectives: Due to their potentially deleterious effects, minimizing the use of opioids for musculoskeletal pain is a priority for healthcare systems. The objective of this study ... [more]
Objectives: Due to their potentially deleterious effects, minimizing the use of opioids for musculoskeletal pain is a priority for healthcare systems. The objective of this study was to examine the risk of future opioid prescription use based on prior opioid use within a non-surgical cohort with musculoskeletal knee pain. We also examined the risk of pre-existing comorbidities on future opioid use, and the risk of prior opioid use on future comorbidities (sleep, mental health, cardiometabolic disorders). Methods: Data came from the Military Health System Data Repository for 80 290 consecutive beneficiaries with an initial episode of care for patellofemoral pain from January 1, 2010 through December 31, 2011. Risk was calculated using 2 × 2 tables based on pre- and post-opioid utilization and comorbid diagnosis. Risk ratios, relative and absolute risk increases, and numbers needed to harm were calculated, all with 95% confidence intervals. Results: Prior opioid use resulted in a risk ratio of 18.0 (95 CI 17.1, 19.0) and an absolute risk increase of 61.6% for future opioid use (numbers needed to harm = 2). The presence of all comorbidities (except cardiometabolic syndrome) were associated with a significant relative risk for future opioid use (RR range 1.2-1.5), but the absolute risk increase was trivial (range 0.7%-2.2%). The relative risk for a chronic pain diagnosis, traumatic brain injury/concussion, insomnia, depression, and PTSD were all significantly higher in those with prior opioid use (1.3-1.6), but absolute risk increase was minimal (1.1%-6.5%). Discussion: Prior opioid use was a strong risk factor for future opioid use in non-surgical patients with knee pain. These findings show that history of prior opioid use is important when assessing the risk of future opioid use, whereas prior comorbidities may not be as important. Opioid history assessment should be standard practice for all patients with patellofemoral pain in whom an opioid prescription is considered.
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2019 |
DiMarco LA, Ramger BC, Howell GP, Serrani AM, Givens DL, Rhon DI, Cook CE, 'Differences in Characteristics and Downstream Drug Use Among Opioid-Naive and Prior Opioid Users with Low Back Pain', PAIN PRACTICE, 19 149-157 (2019)
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2019 |
Kerns RD, Brandt CA, Peduzzi P, Ali J, Antonelli M, Bastian L, et al., 'NIH-DoD-VA Pain Management Collaboratory', PAIN MEDICINE, 20 2336-2345 (2019)
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2019 |
Hando BR, Rhon D, 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, 23 355-363 (2019)
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2019 |
Minniti MC, Statkevich AP, Kelly RL, Rigsby VP, Exline MM, Rhon D, Clewley D, 'The Safety of Blood Flow Restriction Training as a Therapeutic Intervention for Patients With Musculoskeletal Disorders: A Systematic Review', AMERICAN JOURNAL OF SPORTS MEDICINE, 48 1773-1785 (2019)
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2019 |
Rhon DI, O'Hagan E, Mysliwiec V, Lentz TA, 'Does Disordered Sleep Moderate the Relationship Between Pain, Disability and Downstream Health Care Utilization in Patients With Low Back Pain? A Longitudinal Cohort From the US Military Health System', SPINE, 44 1481-1491 (2019)
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2019 |
Rhon D, 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-+ (2019)
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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)
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2019 |
Rhon D, Perez KG, Eskridge SL, 'Risk of post-traumatic knee osteoarthritis after knee injury in military service members', MUSCULOSKELETAL CARE, 17 113-119 (2019)
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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', MILITARY MEDICINE, 184 788-796 (2019)
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2019 |
Young JL, Wright AA, Rhon D, 'Nonoperative Management Prior to Hip Arthroscopy for Femoroacetabular Impingement Syndrome: An Investigation Into the Utilization and Content of Physical Therapy', JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 49 593-600 (2019)
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2019 |
Garcia AN, Cook C, Rhon D, 'Which patients do not seek additional medical care after a self-management class for low back pain? An observational cohort', CLINICAL REHABILITATION, 33 1831-1842 (2019)
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2019 |
Rhon DI, Snodgrass SJ, Cleland JA, Cook CE, 'Comorbid Insomnia and Sleep Apnea are Associated with Greater Downstream Health Care Utilization and Chronic Opioid Use after Arthroscopic Hip Surgery.', Pain physician, 22 E351-E360 (2019) [C1]
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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, 20 476-485 (2019)
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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 MUSCULOSKELETAL DISORDERS, 20 (2019)
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2018 |
Teyhen DS, Goffar SL, Shaffer SW, Kiesel K, Butler RJ, Tedaldi A-M, et al., 'Incidence of Musculoskeletal Injury in US Army Unit Types: A Prospective Cohort Study', JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 48 749-+ (2018)
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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 & SPORTS PHYSICAL THERAPY, 48 878-886 (2018)
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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)
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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]
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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)
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2018 |
Rhon D, Snodgrass SJ, Cleland JA, Greenlee TA, Sissel CD, Cook CE, 'Comparison of downstream health care utilization, costs, and long-term opioid use for physical therapist management versus opioid therapy management after arthroscopic hip surgery (vol 98, pg 348, 2018)', PHYSICAL THERAPY, 98 902-902 (2018)
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2018 |
Narveson JR, Haberl MD, Vannatta CN, Rhon DI, 'CONSERVATIVE TREATMENT CONTINUUM FOR MANAGING FEMOROACETABULAR IMPINGEMENT SYNDROME AND ACETABULAR LABRAL TEARS IN SURGICAL CANDIDATES: A CASE SERIES', INTERNATIONAL JOURNAL OF SPORTS PHYSICAL THERAPY, 13 1032-1048 (2018)
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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)
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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]
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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]
STUDY DESIGN: Systematic review. BACKGROUND: Therapeutic exercise is commonly used to treat individuals with knee disorders, but dosing parameters for optimal outcomes are unclear... [more]
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.
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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]
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... [more]
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.
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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2015 |
Rhon DI, Boyles RB, Cleland JA, 'Management of the unilateral shoulder impingement syndrome: In response', Annals of Internal Medicine, 162 237-238 (2015)
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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)
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 ... [more]
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 ) 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. 2
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2015 |
Leib C, 'Management of the Unilateral Shoulder Impingement Syndrome', ANNALS OF INTERNAL MEDICINE, 162 237-237 (2015)
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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)
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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.
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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)
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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.
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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)
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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)
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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)
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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)
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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)
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2008 |
Rhon D, 'Lumbar spinal stenosis [6]', New England Journal of Medicine, 358 2647 (2008)
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2008 |
van Gijn J, 'Lumbar spinal stenosis.', The New England journal of medicine, 358 2647 (2008)
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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)
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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)
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