Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Alicia Fernandez-Fernandez

Date of original Performance / Presentation

January 2023

Publication Date / Copyright Date

1-1-2023

Abstract

Purpose/Hypothesis: Plantar fasciitis has been associated with heel pain, falls, poor quality of life, and disability. Orthotic outcomes have been described inconsistently throughout the literature, ranging from positive to no effect. The primary goal of this study was to explore any measurable factors, inherent or extraneous to the patient, which may assist in the prediction of positive outcomes with orthotic intervention in the treatment of plantar fasciitis. Materials/Methods: Retrospective data was collected from two hundred sixty-seven patient records. Data analyzed for predicting factors included: gender, age, dorsiflexion ROM, 1st MTP extension ROM, Windlass test results, concurrent physical therapy treatment, and duration of symptoms. For outcomes, groups were dichotomized into either positive or negative outcome based on meeting thresholds on Minimum Clinical Important Difference (MCID) of visual analog scale (VAS) or lower extremity functional scale (LEFS) measures. Descriptive statistics and logistic regression analysis were utilized to identify positive vs negative outcome characteristics and predictor significance. Results: Positive outcomes accounted for 49.4% (132/267) of the analyzed records. Positive outcomes were more frequent in females, subjects with shorter symptom duration, those who had concurrent physical therapy, and those who had increased ROM. Of the variables analyzed, concurrent physical therapy was the only significant predictor variable in the regression model (p= 0.015, Exp B= 3.000). Sensitivity was calculated to be 41.7%, specificity 56.0% and Positive Likelihood Ratio 0.93. Conclusions: Patients that were prescribed concurrent physical therapy with orthoses had 3 times the odds of experiencing a positive outcome as compared to orthoses alone. Results of this analysis demonstrated moderate predictive effects of this variable, and the likelihood ratio suggested minimal clinical importance. The absence of other significant variables, along with moderate predictive effects, suggest that there is value to future research into other potential predictors for positive orthotic outcomes. Clinical Relevance: These results show that there are some benefits to combining physical therapy intervention with orthotic treatment for plantar fasciitis, but positive outcomes are likely influenced by additional factors that should be explored in more depth.

Disciplines

Physical Therapy

Keywords

Orthotics; Outcomes; Physical Therapy; Plantar Faciitis; Predicting Values

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