The Creation and Validation of the Dynamic Injury Screening Tool for the Lower Extremity (DISTLE) A thesis presented to the faculty of the College of Health Sciences and Professions of Ohio University In partial fulfillment of the requirements for the degree Master of Science Christine O. Samson May 2014 © 2014 Christine O. Samson. All Rights Reserved. 2 This thesis titled The Creation and Validation of the Dynamic Injury Screening Tool for the Lower Extremity (DISTLE) by CHRISTINE O. SAMSON has been approved for the School of Applied Health Sciences and Wellness and the College of Health Sciences and Professions by Brian G. Ragan Assistant Professor of Health Sciences and Wellness Randy Leite Dean, College of Health Sciences and Professions 3 Abstract SAMSON, CHRISTINE O., M.S., May 2014, Athletic Training The Creation and Validation of the Dynamic Injury Screening Tool for the Lower Extremity (DISTLE) Director of Thesis: Brian G. Ragan Context: The healthcare needs of special populations have been met with the application of telemedicine. Running related injuries (RRIs) are frequent among the running population in which clinician conducted gait assessments to identify gait abnormalities are not easily accessible. To increase accessibility of clinician conducted gait assessments, a system was developed with a telemedicine approach. Objective: To determine clinical importance, viewing parameters, and the reliability of clinicians to identify gait abnormalities to develop the Dynamic Injury Screening Tool for the Lower Extremity (DISTLE). The use of DISTLE was then validated. Participants: The participants were currently licensed and practicing athletic trainers. Other participants included physically active volunteers who served as walkers and standardized patients for the third and fourth phases, respectively. Conclusions: The cumulative results display a need for standardization of observation gait assessments and video parameters prior to the application of a telemedicine approach to address the running population’s needs. 4 Dedication Challenges are what make life interesting; Overcoming them is what makes life meaningful. -Ralph Waldo Emerson 5 Acknowledgments I would like to thank my thesis advisor Dr. Brian Ragan for his hard work and dedication to my progress throughout the entire process. The second, third, and fourth phases would not have been possible without the patience, cooperation, and assistance of my fellow graduate classmates. I greatly appreciate the generous funding from the College of Health Sciences and Professions Student Research Grant that promoted the successful completion of my third and fourth phases. The use and disbursement of funds would not have been possible without the patience and guidance of Jane Boney. Special thanks to Mr. Tedd Girouard and all of the athletic trainers associated with the University of Nevada, Las Vegas (UNLV) Athletic Training Education Program for serving as a second data collection site on multiple occasions. Additionally I would like to extend my deepest gratitude to my thesis committee: Dr. Andrew Krause, Dr. Jason White, and Ms. Christina Orozco. 6 Table of Contents Page Abstract ................................................................................................................................3 Dedication ............................................................................................................................4 Acknowledgments................................................................................................................5 List of Tables .......................................................................................................................8 List of Figures ......................................................................................................................9 Chapter 1: Introduction ......................................................................................................10 Significance .................................................................................................................. 12 Purpose .......................................................................................................................... 12 Specific Aims ................................................................................................................ 13 Research Questions ....................................................................................................... 13 Chapter 2: Literature Review .............................................................................................14 Popularity of Running ................................................................................................... 14 Normal Gait Patterns .................................................................................................... 15 Observable Gait Abnormalities .................................................................................... 20 Running Related Injuries .............................................................................................. 24 Current Gait Assessment Methods ............................................................................... 25 Current Clinical Evaluation Tests for Lower Extremity Pathologies ........................... 29 Telemedicine ................................................................................................................. 30 Summary ....................................................................................................................... 34 Chapter 3: Methods ............................................................................................................36 Phase I: Identification of Gait Abnormalities in Literature .......................................... 38 Phase II: Clinical Relevance ......................................................................................... 38 Phase III: Establishing Reliability for Video Medium ................................................. 40 Phase IV: Validating DISTLE ...................................................................................... 42 Chapter 4: Results ..............................................................................................................47 Phase I: Identification of Gait Abnormalities ............................................................... 47 Phase II: Clinical Relevance ......................................................................................... 49 Phase III: Establishing Reliability for Video Medium ................................................. 52 Phase IV: Validating DISTLE ...................................................................................... 59 7 Chapter 5: Discussion ........................................................................................................68 Lack of Gait Assessment Standardization .................................................................... 68 Telemedicine: Store and Forward Approach ................................................................ 71 Experience of Clinician ................................................................................................ 73 Limitations .................................................................................................................... 74 Significance .................................................................................................................. 75 Future Research ............................................................................................................ 76 Conclusion .................................................................................................................... 77 References ..........................................................................................................................79 Appendix A-1: GACIS Recruiting Email ..........................................................................89 Appendix A-2: GACIS Consent Form ..............................................................................90 Appendix A-3: Gait Abnormalities: Clinical Importance Survey .....................................92 Appendix B-1: ROGAT Volunteer Walker Photo/Video Release ...................................97 Appendix B-2: ROGAT Volunteer Walker Physical Examination Chart .........................98 Appendix B-3: ROGAT Recruiting Email ......................................................................100 Appendix B-4: ROGAT Consent Form ...........................................................................101 Appendix B-5: ROGAT Educational Training Session PowerPoint ...............................104 Appendix B-6: ROGAT Sample Questions .....................................................................110 Appendix C-1: DISTLE Standardized Patient Photo/Video Release ..............................113 Appendix C-2: DISTLE Survey Portion ..........................................................................114 Appendix C-3: DISTLE Standardized Patient Physical Examination Chart ...................118 Appendix C-4: DISTLE Recruiting Email ......................................................................120 Appendix C-5: DISTLE Participant Screening Survey (Screenshot) ..............................121 Appendix C-6: DISTLE Consent Form ...........................................................................122 Appendix C-7: DISTLE Educational Training Session PowerPoint ...............................125 Appendix C-8: DISTLE Sample