<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03237104</url>
  </required_header>
  <id_info>
    <org_study_id>IRB17-00258</org_study_id>
    <nct_id>NCT03237104</nct_id>
  </id_info>
  <brief_title>Back in the Game: An Immediate Functional Progression Program in Athletes With a Spondylolysis.</brief_title>
  <official_title>Back in the Game: A Pilot Study Assessing an Immediate Functional Progression Program in Athletes With a Spondylolysis.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Nationwide Children's Hospital</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Nationwide Children's Hospital</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Half of all adolescents report experiencing low back pain (LBP), and adolescents who are&#xD;
      active in sport report an even higher rate. The most common identifiable cause of LBP in the&#xD;
      adolescent athlete is a stress fracture in the low back, known as a spondylolysis.&#xD;
      Spondylolysis injuries have been found in up 47% of young athletes with LBP. The current&#xD;
      recommendations of care for a spondylolysis consist of rest for at least 3 months, bracing,&#xD;
      and physical therapy. These recommendations result in athletes being out of sport for as long&#xD;
      as 46 months, and are based on low level evidence and expert opinion. In addition to the long&#xD;
      period out of sport, 42% have poor long-term outcomes, and 1 in 6 athletes are no longer able&#xD;
      to play at their former level specifically due to their back injury. These long periods out&#xD;
      of sport and poor long-term clinical outcomes suggest current care recommendations are&#xD;
      suboptimal.&#xD;
&#xD;
      The overall objective of the proposed research is to test the feasibility of using an early&#xD;
      functional progression program to reduce athletes' time out of sport and improve clinical&#xD;
      outcomes. Specifically, to pilot altering the rest period in athletes with a spondylolysis&#xD;
      and begin rehabilitation immediately. These young athletes will return to sport as they are&#xD;
      able, after demonstrating predetermined pain free functional ability. Twelve young athletes&#xD;
      with a confirmed active spondylolysis will be recruited to undergo the early function&#xD;
      progression intervention. The specific aims of this study are to assess the feasibility of&#xD;
      implementing the immediate functional progression protocol, refine the protocol if necessary,&#xD;
      and estimate potential effectiveness of this intervention. The athletes' outcomes will be&#xD;
      compared to historical controls. The investigators hypothesize that the immediate functional&#xD;
      progression program can be successfully implemented and with only minor changes will be&#xD;
      suitable for use in larger trials. It is estimated the immediate functional progression&#xD;
      program has the potential to return athletes to sport more than a month sooner than current&#xD;
      practice. Once able to demonstrate the feasibility of the early functional progression&#xD;
      program, the investigators plan to progress this work into larger trials to fully assess&#xD;
      effectiveness, safety and long-term outcomes.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Athletes who meet the inclusion criteria and consent to participate in the pilot study will&#xD;
      be referred directly to physical therapy (PT) care for 2 times per week. Athletes will&#xD;
      follow-up with their co-investigating physician every 4 weeks until discharge. The immediate&#xD;
      functional progression program will be performed by physical therapists trained in the&#xD;
      treatment protocol. Athletes will perform phase I of the program and progress to phase II as&#xD;
      able without an increase in pain and without compensations noted in function. The athlete&#xD;
      will be assessed at each session to determine if they meet the criteria to begin the next&#xD;
      step of functional progression program. Once the athlete has met the criteria of phase II,&#xD;
      they will progress into the final phase of the functional progression program for return to&#xD;
      sport activity. As these athletes progress through the third phase, and are able to meet the&#xD;
      return to sport criteria, they will be released to return to sport. Athletes will not be&#xD;
      released to return to sport prior to their first physician follow-up visit at 4 weeks.&#xD;
&#xD;
      Phase I Immediate Functional Progression Program Core strengthening in neutral spine Treat&#xD;
      directional preference if identified Hip strengthening Peri-scapular strengthening&#xD;
      Flexibility exercises Manual Therapy as needed Modalities for pain (use sparingly)&#xD;
&#xD;
      Phase II Immediate Functional Progression Program Core strengthening in functional range Hip&#xD;
      and peri-scapular strengthening Flexibility exercises Manual Therapy (use sparingly) Phase&#xD;
      III Immediate Functional Progression Program- Return to Sport Return to sport activity with&#xD;
      focus on functional return to all aspect of sport.&#xD;
&#xD;
      Signs of not responding as anticipated during the immediate functional progression program:&#xD;
      Inability to meet long-term goals of care in PT including inability to return to sport due to&#xD;
      low back pain within three months, an increase in pain or no significant decrease in pain&#xD;
      (&lt;2/10) at physician visits until patient reports &lt;2/10 pain with activity.&#xD;
&#xD;
      Sample Size A sample size of 12 will be recruited for this pilot trial. As there is a&#xD;
      nonlinear relationship between confidence interval (CI) width and sample size, further&#xD;
      increases in participants beyond 12 have a diminishing benefit on precision for preliminary&#xD;
      studies.&#xD;
&#xD;
      Data Analysis Descriptive statistics of the patient demographics and outcome variables will&#xD;
      be reported. Inferential calculations will not be performed as this is a pilot to demonstrate&#xD;
      the feasibility of implementing the proposed immediate functional progression program.&#xD;
&#xD;
      Aim 1: Discussion of the success of implementing the immediate functional progression program&#xD;
      will occur during and after care of each patient. The PI will monitor patient documentation&#xD;
      to assess adherence to the research protocol in care. Adverse events will be monitored, the&#xD;
      immediate functional progression program will be considered acceptably tolerated by patients&#xD;
      if &lt;3 adverse events are observed.&#xD;
&#xD;
      Aim 2: (Potential Problems and Alternative strategies) Minor problems identified in the pilot&#xD;
      study will serve to refine to the protocol for the full randomized clinical trial. Larger&#xD;
      potential problems include non-adherence to the experimental treatment protocol. The risk of&#xD;
      this potential problem will be reduced by training of all staff involved in the research&#xD;
      process. If a problem is found in the experiment protocol that inhibits patients from&#xD;
      satisfactorily progressing in their care, the co-investigators will meet and decide on a&#xD;
      course of action to fix this issue. An alteration in the experimental protocol that results&#xD;
      in improved care would be considered a positive outcome, as the goal of this pilot study is&#xD;
      to demonstrate viability and feasibility for a larger clinical trial.&#xD;
&#xD;
      Aim 3: Clinical outcomes including pain, function, time to return to sport and recurrence of&#xD;
      symptoms will be compared against historical controls to assess for potential efficacy.&#xD;
      Historical controls for quality of life are not available in this population. Time to return&#xD;
      to sport will be the primary outcome of interest. A decrease in return to sport time of &gt; 30&#xD;
      days compared to the historical control time of 3.8 months without a notable worsening of&#xD;
      other outcomes will indicate future research is warranted.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">July 31, 2017</start_date>
  <completion_date type="Actual">January 8, 2021</completion_date>
  <primary_completion_date type="Actual">October 31, 2020</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Case-Control</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Time to return to sport (days)</measure>
    <time_frame>1-6 months</time_frame>
    <description>The number of days from diagnosis of spondylolysis to the point the patient passes all criteria of the PT program and is cleared to return to sport by the physician</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in Micheli Functional Scale (MFS)</measure>
    <time_frame>Baseline, 1 month, 3 months, 6 months, 1 year</time_frame>
    <description>Function</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Numeric Pain Rating Scale</measure>
    <time_frame>Baseline, 1 month, 3 months, 6 months, 1 year</time_frame>
    <description>Pain</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Recurrence of low back symptoms</measure>
    <time_frame>Baseline, 1 month, 3 months, 6 months, 1 year</time_frame>
    <description>Patients will be asked if there low back pain (must have impaired ability to play sport or activities of daily living)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>adverse reaction</measure>
    <time_frame>1-6 months</time_frame>
    <description>An adverse reaction will be defined as 1) lumbar symptoms increasing enough to cause an unplanned visit to a physician or 2) the patient being placed on hold from therapy during the episode of care</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in MRI</measure>
    <time_frame>Baseline, 3 months</time_frame>
    <description>Patients will have a repeat MRI performed at 3 months. A radiologist will assess for change in the spondylolytic lesion, edema and anterolisthesis.</description>
  </secondary_outcome>
  <number_of_groups>1</number_of_groups>
  <enrollment type="Actual">12</enrollment>
  <condition>Low Back Pain</condition>
  <condition>Spondylosis</condition>
  <arm_group>
    <arm_group_label>acute spondylolysis</arm_group_label>
    <description>Athletes who meet the inclusion criteria and consent to participate in the pilot study will be referred directly to PT care for 2 times per week until cleared to return to sport.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Immediate PT</intervention_name>
    <description>Athletes will perform phase I (neutral spine) of the program and progress to phase II (functional motion) as able without an increase in pain and without compensations noted in function. The athlete will be assessed at each session to determine if they meet the criteria to begin the next step of functional progression program. Once the athlete has met the criteria of phase II, they will progress into the final phase of the functional progression program for return to sport activity. As these athletes progress through the third phase, and are able to meet the return to sport criteria, they will be released to return to sport. Athletes will not be released to return to sport prior to their first physician follow-up visit at 4 weeks.</description>
    <arm_group_label>acute spondylolysis</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        The population of interest is young athletes with a recent spondylolysis injury.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          1. Age 10-19 years old&#xD;
&#xD;
          2. Diagnosed with a spondylolysis through magnetic resonance imaging (MRI) with active&#xD;
             signs of healing. Signs of active healing are defined as edema noted on MRI.&#xD;
&#xD;
          3. Participates in organized sport&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          1. Previous rest from activity &gt;4 weeks without improved symptoms&#xD;
&#xD;
          2. Red flags present (bowel/bladder problems, saddle anesthesia, progressive neurological&#xD;
             deficits, recent fever or infection, unexplained weight loss, unable to change&#xD;
             symptoms with mechanical testing)&#xD;
&#xD;
          3. Numbness and tingling in any lumbar dermatome&#xD;
&#xD;
          4. Other injury or condition that would alter the plan of care for spondylolysis (i.e.&#xD;
             pregnancy, anterior cruciate ligament (ACL) tear, concussion)&#xD;
&#xD;
          5. History of lumbar surgery&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>10 Years</minimum_age>
    <maximum_age>19 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Nationwide Children's Hospital Sports and Ortho PT Ortho Center</name>
      <address>
        <city>Columbus</city>
        <state>Ohio</state>
        <zip>43205</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Nationwide Children's Hospital Sports and Ortho PT East Broad</name>
      <address>
        <city>Columbus</city>
        <state>Ohio</state>
        <zip>43213</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Nationwide Children's Hospital Sports and Ortho PT Dublin</name>
      <address>
        <city>Dublin</city>
        <state>Ohio</state>
        <zip>43017</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Nationwide Children's Hospital Sports and Ortho PT New Albany</name>
      <address>
        <city>New Albany</city>
        <state>Ohio</state>
        <zip>43054</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Nationwide Children's Hospital Sports and Ortho PT Westerville</name>
      <address>
        <city>Westerville</city>
        <state>Ohio</state>
        <zip>43082</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Anderson K, Sarwark JF, Conway JJ, Logue ES, Schafer MF. Quantitative assessment with SPECT imaging of stress injuries of the pars interarticularis and response to bracing. J Pediatr Orthop. 2000 Jan-Feb;20(1):28-33.</citation>
    <PMID>10641684</PMID>
  </reference>
  <reference>
    <citation>Klein G, Mehlman CT, McCarty M. Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies. J Pediatr Orthop. 2009 Mar;29(2):146-56. doi: 10.1097/BPO.0b013e3181977fc5.</citation>
    <PMID>19352240</PMID>
  </reference>
  <results_reference>
    <citation>Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, Welder E, MacDonald J. Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review. Clin J Sport Med. 2017 May;27(3):296-301. doi: 10.1097/JSM.0000000000000334.</citation>
    <PMID>27347866</PMID>
  </results_reference>
  <results_reference>
    <citation>Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, MacDonald J. Long-Term Clinical Outcomes and Factors That Predict Poor Prognosis in Athletes After a Diagnosis of Acute Spondylolysis: A Retrospective Review With Telephone Follow-up. J Orthop Sports Phys Ther. 2016 Dec;46(12):1029-1036. doi: 10.2519/jospt.2016.7028. Epub 2016 Nov 8.</citation>
    <PMID>27825292</PMID>
  </results_reference>
  <verification_date>January 2021</verification_date>
  <study_first_submitted>July 31, 2017</study_first_submitted>
  <study_first_submitted_qc>August 1, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 2, 2017</study_first_posted>
  <last_update_submitted>January 8, 2021</last_update_submitted>
  <last_update_submitted_qc>January 8, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">January 11, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Nationwide Children's Hospital</investigator_affiliation>
    <investigator_full_name>Mitchell Selhorst</investigator_full_name>
    <investigator_title>Physical Therapist/Principle Investigator</investigator_title>
  </responsible_party>
  <keyword>Adolescent</keyword>
  <keyword>Athlete</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Spondylosis</mesh_term>
    <mesh_term>Spondylolysis</mesh_term>
    <mesh_term>Low Back Pain</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>Undecided</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03237104
org study id: IRB17-00258
nct id: NCT03237104
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Half of all adolescents report experiencing low back pain (LBP), and adolescents who are
      active in sport report an even higher rate. The most common identifiable cause of LBP in the
      adolescent athlete is a stress fracture in the low back, known as a spondylolysis.
      Spondylolysis injuries have been found in up 47% of young athletes with LBP. The current
      recommendations of care for a spondylolysis consist of rest for at least 3 months, bracing,
      and physical therapy. These recommendations result in athletes being out of sport for as long
      as 46 months, and are based on low level evidence and expert opinion. In addition to the long
      period out of sport, 42% have poor long-term outcomes, and 1 in 6 athletes are no longer able
      to play at their former level specifically due to their back injury. These long periods out
      of sport and poor long-term clinical outcomes suggest current care recommendations are
      suboptimal.

      The overall objective of the proposed research is to test the feasibility of using an early
      functional progression program to reduce athletes' time out of sport and improve clinical
      outcomes. Specifically, to pilot altering the rest period in athletes with a spondylolysis
      and begin rehabilitation immediately. These young athletes will return to sport as they are
      able, after demonstrating predetermined pain free functional ability. Twelve young athletes
      with a confirmed active spondylolysis will be recruited to undergo the early function
      progression intervention. The specific aims of this study are to assess the feasibility of
      implementing the immediate functional progression protocol, refine the protocol if necessary,
      and estimate potential effectiveness of this intervention. The athletes' outcomes will be
      compared to historical controls. The investigators hypothesize that the immediate functional
      progression program can be successfully implemented and with only minor changes will be
      suitable for use in larger trials. It is estimated the immediate functional progression
      program has the potential to return athletes to sport more than a month sooner than current
      practice. Once able to demonstrate the feasibility of the early functional progression
      program, the investigators plan to progress this work into larger trials to fully assess
      effectiveness, safety and long-term outcomes.
Athletes who meet the inclusion criteria and consent to participate in the pilot study will
      be referred directly to physical therapy (PT) care for 2 times per week. Athletes will
      follow-up with their co-investigating physician every 4 weeks until discharge. The immediate
      functional progression program will be performed by physical therapists trained in the
      treatment protocol. Athletes will perform phase I of the program and progress to phase II as
      able without an increase in pain and without compensations noted in function. The athlete
      will be assessed at each session to determine if they meet the criteria to begin the next
      step of functional progression program. Once the athlete has met the criteria of phase II,
      they will progress into the final phase of the functional progression program for return to
      sport activity. As these athletes progress through the third phase, and are able to meet the
      return to sport criteria, they will be released to return to sport. Athletes will not be
      released to return to sport prior to their first physician follow-up visit at 4 weeks.

      Phase I Immediate Functional Progression Program Core strengthening in neutral spine Treat
      directional preference if identified Hip strengthening Peri-scapular strengthening
      Flexibility exercises Manual Therapy as needed Modalities for pain (use sparingly)

      Phase II Immediate Functional Progression Program Core strengthening in functional range Hip
      and peri-scapular strengthening Flexibility exercises Manual Therapy (use sparingly) Phase
      III Immediate Functional Progression Program- Return to Sport Return to sport activity with
      focus on functional return to all aspect of sport.

      Signs of not responding as anticipated during the immediate functional progression program:
      Inability to meet long-term goals of care in PT including inability to return to sport due to
      low back pain within three months, an increase in pain or no significant decrease in pain
      (<2/10) at physician visits until patient reports <2/10 pain with activity.

      Sample Size A sample size of 12 will be recruited for this pilot trial. As there is a
      nonlinear relationship between confidence interval (CI) width and sample size, further
      increases in participants beyond 12 have a diminishing benefit on precision for preliminary
      studies.

      Data Analysis Descriptive statistics of the patient demographics and outcome variables will
      be reported. Inferential calculations will not be performed as this is a pilot to demonstrate
      the feasibility of implementing the proposed immediate functional progression program.

      Aim 1: Discussion of the success of implementing the immediate functional progression program
      will occur during and after care of each patient. The PI will monitor patient documentation
      to assess adherence to the research protocol in care. Adverse events will be monitored, the
      immediate functional progression program will be considered acceptably tolerated by patients
      if <3 adverse events are observed.

      Aim 2: (Potential Problems and Alternative strategies) Minor problems identified in the pilot
      study will serve to refine to the protocol for the full randomized clinical trial. Larger
      potential problems include non-adherence to the experimental treatment protocol. The risk of
      this potential problem will be reduced by training of all staff involved in the research
      process. If a problem is found in the experiment protocol that inhibits patients from
      satisfactorily progressing in their care, the co-investigators will meet and decide on a
      course of action to fix this issue. An alteration in the experimental protocol that results
      in improved care would be considered a positive outcome, as the goal of this pilot study is
      to demonstrate viability and feasibility for a larger clinical trial.

      Aim 3: Clinical outcomes including pain, function, time to return to sport and recurrence of
      symptoms will be compared against historical controls to assess for potential efficacy.
      Historical controls for quality of life are not available in this population. Time to return
      to sport will be the primary outcome of interest. A decrease in return to sport time of > 30
      days compared to the historical control time of 3.8 months without a notable worsening of
      other outcomes will indicate future research is warranted.
observational model: Case-Control
time perspective: Prospective
measure: Time to return to sport (days)
time frame: 1-6 months
description: The number of days from diagnosis of spondylolysis to the point the patient passes all criteria of the PT program and is cleared to return to sport by the physician
measure: Change in Micheli Functional Scale (MFS)
time frame: Baseline, 1 month, 3 months, 6 months, 1 year
description: Function
measure: Change in Numeric Pain Rating Scale
time frame: Baseline, 1 month, 3 months, 6 months, 1 year
description: Pain
measure: Recurrence of low back symptoms
time frame: Baseline, 1 month, 3 months, 6 months, 1 year
description: Patients will be asked if there low back pain (must have impaired ability to play sport or activities of daily living)
measure: adverse reaction
time frame: 1-6 months
description: An adverse reaction will be defined as 1) lumbar symptoms increasing enough to cause an unplanned visit to a physician or 2) the patient being placed on hold from therapy during the episode of care
measure: Change in MRI
time frame: Baseline, 3 months
description: Patients will have a repeat MRI performed at 3 months. A radiologist will assess for change in the spondylolytic lesion, edema and anterolisthesis.
arm group label: acute spondylolysis
description: Athletes who meet the inclusion criteria and consent to participate in the pilot study will be referred directly to PT care for 2 times per week until cleared to return to sport.
intervention type: Other
intervention name: Immediate PT
description: Athletes will perform phase I (neutral spine) of the program and progress to phase II (functional motion) as able without an increase in pain and without compensations noted in function. The athlete will be assessed at each session to determine if they meet the criteria to begin the next step of functional progression program. Once the athlete has met the criteria of phase II, they will progress into the final phase of the functional progression program for return to sport activity. As these athletes progress through the third phase, and are able to meet the return to sport criteria, they will be released to return to sport. Athletes will not be released to return to sport prior to their first physician follow-up visit at 4 weeks.
arm group label: acute spondylolysis
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 10 Years
maximum age: 19 Years
healthy volunteers: No
facility: 
facility: 
facility: 
facility: 
facility: 
country: United States
citation: Anderson K, Sarwark JF, Conway JJ, Logue ES, Schafer MF. Quantitative assessment with SPECT imaging of stress injuries of the pars interarticularis and response to bracing. J Pediatr Orthop. 2000 Jan-Feb;20(1):28-33.
PMID: 10641684
citation: Klein G, Mehlman CT, McCarty M. Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies. J Pediatr Orthop. 2009 Mar;29(2):146-56. doi: 10.1097/BPO.0b013e3181977fc5.
PMID: 19352240
citation: Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, Welder E, MacDonald J. Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review. Clin J Sport Med. 2017 May;27(3):296-301. doi: 10.1097/JSM.0000000000000334.
PMID: 27347866
citation: Selhorst M, Fischer A, Graft K, Ravindran R, Peters E, Rodenberg R, MacDonald J. Long-Term Clinical Outcomes and Factors That Predict Poor Prognosis in Athletes After a Diagnosis of Acute Spondylolysis: A Retrospective Review With Telephone Follow-up. J Orthop Sports Phys Ther. 2016 Dec;46(12):1029-1036. doi: 10.2519/jospt.2016.7028. Epub 2016 Nov 8.
PMID: 27825292
responsible party type: Principal Investigator
investigator affiliation: Nationwide Children's Hospital
investigator full name: Mitchell Selhorst
investigator title: Physical Therapist/Principle Investigator
mesh term: Spondylosis
mesh term: Spondylolysis
mesh term: Low Back Pain
sharing ipd: Undecided