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For publications that are currently unpublished or in-press, details are shown in italics.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 (67 outputs)

Year Citation Altmetrics Link
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, (2020)
DOI 10.1177/1941738120902991
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)
DOI 10.1016/j.jpain.2019.06.004
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)
DOI 10.1093/fampra/cmz046
Citations Scopus - 1Web of Science - 1
2020 Molloy JM, Pendergrass TL, Lee IE, Chervak MC, Hauret KG, Rhon DI, 'Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact', Military medicine, 185 e1461-e1471 (2020)

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the pub... [more]

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US. INTRODUCTION: Noncombat injuries ("injuries") greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers. Noncombat musculoskeletal injuries ("MSKIs") may account for nearly 60% of soldiers' limited duty days and 65% of soldiers who cannot deploy for medical reasons. Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates. MSKIs are also responsible for exorbitant medical costs to the U.S. government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs. The authors will review trends in U.S. Army MSKI rates, summarize MSKI readiness-related impacts, and highlight the importance of standardizing surveillance approaches, including injury definitions used in injury surveillance. MATERIALS/METHODS: This review summarizes current reports and U.S. Department of Defense internal policy documents. MSKIs are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function. This review focuses on various U.S. Army populations, based on setting, sex, and age; the review excludes combat or battle injuries. RESULTS: More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017. Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers' aerobic and muscular fitness performances are typically lower than men's performances, which could account for their higher injury rates. Older soldiers are at greater injury risk than younger soldiers. Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units. MSKIs account for 65% of medically nondeployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs. Once deployed, nonbattle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theaters (Iraq and Afghanistan). More than 85% of service members medically evacuated for MSKIs failed to return to the theater. MSKIs factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers' first year of service from 2010 to 2015. MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated U.S. Global War on Terrorism veterans. CONCLUSIONS: MSKIs significantly impact soldier health and U.S. Army readiness. MSKIs also figure prominently in medical disability discharges and long-term, service-connected disability costs. MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units. Coordinated injury surveillance efforts are needed to provide standardized metrics and accurately measure temporal changes in injury rates.

DOI 10.1093/milmed/usaa027
2020 Molloy JM, Pendergrass TL, Lee IE, Hauret KG, Chervak MC, Rhon DI, 'Musculoskeletal Injuries and United States Army Readiness. Part II: Management Challenges and Risk Mitigation Initiatives', Military medicine, 185 e1472-e1480 (2020)

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the pub... [more]

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US. INTRODUCTION: Noncombat injuries ("injuries") threaten soldier health and United States (U.S.) Army medical readiness, accounting for more than twice as many outpatient medical encounters among active component (AC) soldiers as behavioral health conditions (the second leading cause of outpatient visits). Noncombat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers' injuries and 65% of medically nondeployable AC soldiers. This review focuses on MSKI risk reduction initiatives, management, and reporting challenges within the Army. The authors will summarize MSKI risk reduction efforts and challenges affecting MSKI management and reporting within the U.S. Army. MATERIALS/METHODS: This review focuses on (1) initiatives to reduce the impact of MSKIs and risk for chronic injury/pain or long-term disability and (2) MSKI reporting challenges. This review excludes combat or battle injuries. RESULTS: Primary risk reduction Adherence to standardized exercise programming has reduced injury risk among trainees. Preaccession physical fitness screening may identify individuals at risk for injury or attrition during initial entry training. Forward-based strength and conditioning coaching (provided in the unit footprint) and nutritional supplementation initiatives are promising, but results are currently inconclusive concerning injury risk reduction. SECONDARY RISK REDUCTION: Forward-based access to MSKI care provided by embedded athletic trainers and physical therapists within military units or primary care clinics holds promise for reducing MSKI-related limited duty days and nondeployability among AC soldiers. Early point-of-care screening for psychosocial risk factors affecting responsiveness to MSKI intervention may reduce risk for progression to chronic pain or long-term disability. TERTIARY RISK REDUCTION: Operational MSKI metrics enable commanders and clinicians to readily identify soldiers with nonresolving MSKIs. Monthly injury reports to Army leadership increase command focus on soldiers with nonresolving MSKIs. CONCLUSIONS: Standardized exercise programming has reduced trainee MSKI rates. Secondary risk reduction initiatives show promise for reducing MSKI-related duty limitations and nondeployability among AC soldiers; timely identification/evaluation and appropriate, early management of MSKIs are essential. Tertiary risk reduction initiatives show promise for identifying soldiers whose chronic musculoskeletal conditions may render them unfit for continued military service.Clinicians must document MSKI care with sufficient specificity (including diagnosis and external cause coding) to enable large-scale systematic MSKI surveillance and analysis informing focused MSKI risk reduction efforts. Historical changes in surveillance methods and injury definitions make it difficult to compare injury rates and trends over time. However, the U.S. Army's standardized injury taxonomy will enable consistent classification of current and future injuries by mechanism of energy transfer and diagnosis. The Army's electronic physical profiling system further enablesstandardized documentation of MSKI-related duty/work restrictions and mechanisms of injury. These evolving surveillance tools ideally ensure continual advancement of military injury surveillance and serve as models for other military and civilian health care organizations.

DOI 10.1093/milmed/usaa028
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)
DOI 10.1056/NEJMoa1905877
Citations Scopus - 12Web of Science - 9
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, (2020)
DOI 10.1002/pmrj.12382
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)

© The Author(s) 2020. Objectives: Due to their potentially deleterious effects, minimizing the use of opioids for musculoskeletal pain is a priority for healthcare systems. The ob... [more]

© The Author(s) 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 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.

DOI 10.1177/2150132720957438
Co-authors Suzanne Snodgrass
2020 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, (2020)

© 2020, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply. Introduction/objectives: Prior opioid use can influe... [more]

© 2020, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply. 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.

DOI 10.1007/s10067-020-05307-w
Co-authors Suzanne Snodgrass
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)
DOI 10.1111/papr.12728
Citations Scopus - 2Web of Science - 2
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)
DOI 10.1093/pm/pnz186
Citations Web of Science - 2
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)
DOI 10.1016/j.bjpt.2018.10.010
Citations Scopus - 1Web of Science - 1
Co-authors Suzanne Snodgrass
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)
DOI 10.1177/0363546519882652
Citations Scopus - 2Web of Science - 4
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)
DOI 10.1097/BRS.0000000000003114
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)
DOI 10.1136/bjsports-2018-099294
Citations Scopus - 11Web of Science - 11
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)
DOI 10.1093/milmed/usy345
Citations Scopus - 2Web of Science - 2
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)
DOI 10.1002/msc.1378
Citations Scopus - 2
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)
DOI 10.1093/milmed/usz057
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)
DOI 10.2519/jospt.2019.8581
Citations Scopus - 1Web of Science - 1
Co-authors Jodi Young Uon
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)
DOI 10.1177/0269215519865013
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]
Citations Scopus - 3Web of Science - 3
Co-authors Suzanne Snodgrass
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)
DOI 10.1093/pm/pny212
Citations Scopus - 2Web of Science - 2
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)
DOI 10.1186/s12891-019-2646-5
Citations Scopus - 2Web of Science - 2
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)
DOI 10.2519/jospt.2018.7979
Citations Scopus - 7Web of Science - 8
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)
DOI 10.2519/jospt.2018.8259
Citations Scopus - 1Web of Science - 1
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)
DOI 10.1097/BRS.0000000000002619
Citations Scopus - 5Web of Science - 4
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
Citations Web of Science - 11
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 - 3Web of Science - 4
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)
DOI 10.1093/ptj/pzy088
Co-authors Suzanne Snodgrass
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)
DOI 10.26603/ijspt20181032
Citations Web of Science - 2
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 - 4Web of Science - 3
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 - 5Web of Science - 6
Co-authors Suzanne Snodgrass
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 & 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 - 17Web of Science - 14
Co-authors Suzanne Snodgrass, Jodi Young Uon
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 - 2Web of Science - 2
Co-authors Suzanne Snodgrass, Jodi Young Uon
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 - 50Web of Science - 47
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 - 3Web of Science - 3
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 - 14Web of Science - 16
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 - 8Web of Science - 9
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
Citations Scopus - 1Web of Science - 1
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 - 3Web of Science - 3
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
Citations Scopus - 2Web of Science - 2
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 - 2Web of Science - 3
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 Scopus - 1Web of Science - 3
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 - 6Web of Science - 6
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 - 10Web of Science - 10
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 - 10Web of Science - 10
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 - 12Web of Science - 12
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 - 2Web 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 - 42Web of Science - 46
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 - 38Web of Science - 36
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 - 8
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 - 13Web of Science - 14
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 - 20Web 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 - 6Web of Science - 7
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 - 38Web of Science - 29
Show 64 more journal articles

Conference (3 outputs)

Year Citation Altmetrics Link
2020 Carrignan JA, Simmet RT, Coddington M, Gill NW, Greenlee TA, McCafferty R, Rhon D, 'Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery?', ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, Washington, DC (2020)
DOI 10.1016/j.apmr.2020.04.006
2020 Kerns R, Fritz JM, Hastings SN, George S, Weber W, Rhon D, 'NIH-DOD-VA PAIN MANAGEMENT COLLABORATORY: PRAGMATIC CLINICAL TRIALS OF NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT', ANNALS OF BEHAVIORAL MEDICINE (2020)
2018 Rhon D, Perez K, Eskridge S, 'RISK OF POST TRAUMATIC KNEE OSTEOARTHRITIS AFTER TRAUMATIC KNEE INJURY IN DEPLOYED MILITARY SERVICE MEMBERS', OSTEOARTHRITIS AND CARTILAGE, Liverpool, ENGLAND (2018)
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Mr Daniel Rhon

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Email daniel.rhon@uon.edu.au
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