Numerous health conditions affecting the musculoskeletal, cardiopulmonary, and nervous systems can result in physical dysfunction, impaired performance, muscle weakness, and disuse-induced atrophy. Due to its well-documented anabolic potential, creatine monohydrate has been investigated as a supplemental agent to mitigate the loss of muscle mass and function in a variety of acute and chronic conditions. A review of the literature was conducted to assess the current state of knowledge regarding the effects of creatine supplementation on rehabilitation from immobilization and injury, neurodegenerative diseases, cardiopulmonary disease, and other muscular disorders. Several of the findings are encouraging, showcasing creatine’s potential efficacy as a supplemental agent via preservation of muscle mass, strength, and physical function; however, the results are not consistent. For multiple diseases, only a few creatine studies with small sample sizes have been published, making it difficult to draw definitive conclusions. Rationale for discordant findings is further complicated by differences in disease pathologies, intervention protocols, creatine dosing and duration, and patient population. While creatine supplementation demonstrates promise as a therapeutic aid, more research is needed to fill gaps in knowledge within medical rehabilitation.

Introduction.: Higher education has been experiencing funding shortfalls in the past several years. While it is apparent that the financial burden has been impacting students in all fields in both undergraduate and graduate education, there is a potentially even greater impact to those earning professional doctoral degrees. With continuously rising costs of professional education, many concerns are arising in regard to the student debt that is being accumulated by students in these disciplines. Therefore, the objective of this research article is to examine the affordability of doctoral education in medicine, pharmacy, and physical therapy. The primary aim is to analyze the financial impact and economic burden of the degree attainment on graduates in their early careers with a secondary aim to assess the trends in historic physical therapy education costs. Methodology.: This study utilized publicly available data from the US Bureau of Labor Statistics to identify salary trends in the professions with a cross comparison to economic frameworks defining the hardships due to loan repayment dollar amounts and structure to examine economic strain on early career providers in medicine, pharmacy, and physical therapy. To assess trends in physical therapy education, Consumer Price Index adjustments were made to professional data, outlining annual and total costs of physical therapy education. Key Findings, Discussion, and Implications.: Student indebtedness and salary data suggest significant impact to all disciplines upon their entry into their given profession. However, the implications to entry-level and early career physical therapists are much more severe due to lower earning potential compared to the other disciplines. Conclusion.: Students in professional doctoral health care disciplines of medicine, pharmacy, and physical therapy need to be cognizant of their borrowing patterns and institutional costs of their education to avoid possessing financial hardships upon their entry into their given field of practice. Physical therapy students, however, possess high potential for obtaining unmanageable debt due to the costs of education and earning potential early in their career.

Introduction. Collaborative models in clinical education are increasing in popularity, but concerns exist over the potential impact on patient productivity of clinical instructors. Little empirical research has examined the impact of patient productivity in the models of clinical education in the acute care setting. The objective of this study is to examine the productivity impact of physical therapists (PTs) participating in both the 1:1 and 2:1 models of clinical education over a 3-year time period in an acute care hospital setting. Methods. This study utilized a longitudinal, retrospective design. Productivity data of 20 PTs was examined over a 3-year timeframe (8,981 days of productivity). Productivity of each PT was cross-referenced with their clinical education schedules to evaluate patient productivity while serving as a clinical instructor in a 1:1 or 2:1 clinical education model. Results. PTs serving as clinical instructors in a 2:1 model (mean 21.53 units per day; 95% confidence interval (CI), 21.15–21.91) achieved a significantly greater productivity (P < .001) than those serving in a 1:1 model (17.05 units per day, 95% CI, 16.91–17.18). Within-group differences demonstrated a significant increase (P < .001) of units billed per day with the addition of each student, both in the transition from 0 to 1 student (0.591 units per day; 95% CI, 0.18–0.99) and from 1 to 2 students (4.75 units per day, 95% CI, 4.21–5.29) for therapists who participate in the 2:1 model, and for those who participate in a 1:1 model of clinical education (0.82 units per day; 95% CI, 0.51–1.13). Discussion and Conclusions. PT productivity can increase during both a 1:1 and 2:1 model of clinical education in the acute care setting. Formal training of clinical instructors and continued mentorship of clinical education faculty is necessary to create an institutional culture that optimizes physical therapy clinical education.

Background: Repetitive application of high forces to the shoulder and scapular musculature during the pitching motion over the course of a collegiate baseball season may lead to changes in strength and increased fatigue, potentially predisposing pitching athletes to injury. The purpose of this study was to investigate periscapular strength profiles of Division I collegiate baseball players over the course of a season. Methods: This study was a retrospective data analysis of 18 Division I baseball pitchers. Isometric scapular plane abduction (scaption), external rotator, internal rotator, middle trapezius, and lower trapezius isometric strength was measured on throwing arm of each subject using a MicroFET 2 handheld dynamometer. Data were collected in a single session at the preseason, midseason, and postseason of the college baseball season, which spanned a five-month period. A repeated measures ANOVA was utilized to determine if there was a significant change in periscapular strength across the baseball season. Results: Over the three time-points, all strength values decreased for each muscle group, with decreases ranging from 3-14%. Changes in scaption strength values were statistically significant (p=0.018, partial eta squared =0.284) with an 8% reduction over the entire season, specifically with a 5% decline from mid-season to post-season. While external rotator, internal rotator, middle trapezius, and lower trapezius strength values all decreased over the course of the season (range 0.02kg to 1.8kg), these differences were not statistically significant. However, the middle trapezius strength value change (1.3kg loss) exceeded the minimal detectible change. Conclusion: Periscapular muscles in baseball pitchers diminish in strength over the course of a collegiate baseball season. Understanding strength changes over the course of a season may influence training and therapeutic interventions. Level of Evidence: 3b