bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Mobility in Older Adults: The UAB Study of Aging Life-Space Assessment
Authors: Peel Claire , Baker Patricia Sawyer , Roth David L , Brown Cynthia J , Bodner Eric V , Allman Richard M
Published: February 2017

Background and Purpose. The University of Alabama at Birmingham (UAB) Study of Aging Life-Space Assessment (LSA) is a relatively new instrument to measure mobility. The purpose of this report is to describe the relationships between LSA and traditional measures of physical function, sociodemographic characteristics, depression, and cognitive status. Subjects. Subjects were a stratified random sample of 998 Medicare beneficiaries aged ≥65 years. The sample was 50% African American, 50% male, and 50% from rural (versus urban) counties. Methods. In-home interviews were conducted. Mobility was measured using the LSA, which documents where and how often subjects travel and any assistance needed during the 4 weeks prior to the assessment. Basic activities of daily living (ADL) and instrumental activities of daily living (IADL), cognitive status, income level, presence of depressive symptoms, and transportation resources were determined. The Short Physical Performance Battery (SPPB) was used to assess physical performance. Results. Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence (rural versus urban). In a regression model, physical function (ADL, IADL) and physical performance (SPPB) accounted for 45.5% of the variance in LSA scores. An additional 12.7% of the variance was explained by sociodemographic variables, and less than 1% was explained by cognition and depressive symptoms. Discussion and Conclusion. The LSA can be used to document patients' mobility within their home and community. The LSA scores are associated with a person's physical capacity and other factors that may limit mobility. These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits.
Clinical Measurement of Sit-to-Stand Performance in People With Balance Disorders: Validity of Data for the Five-Times-Sit-to-Stand Test
Authors: Whitney Susan L , Wrisley Diane M , Marchetti Gregory F , Gee Michael A , Redfern Mark S , Furman Joseph M
Published: February 2017

Background and Purpose. People with balance disorders are characterized as having difficulty with transitional movements, such as the sit-to-stand movement. A valid and feasible tool is needed to help clinicians quantify the ability of people with balance disorders to perform transitional movements. The purpose of this study was to describe the concurrent and discriminative validity of data obtained with the Five-Times-Sit-to-Stand Test (FTSST). The FTSST was compared with the Activities-specific Balance Confidence Scale (ABC) and the Dynamic Gait Index (DGI). Subjects and Methods. Eighty-one subjects without balance disorders and 93 subjects with balance disorders were recruited for the study. Each subject was asked to stand from a 43-cm-high chair 5 times as quickly as possible. The ABC and DGI scores were recorded. Results. Subjects with balance disorders performed the FTSST more slowly than subjects without balance disorders. Discriminant analysis demonstrated that the FTSST correctly identified 65% of subjects with balance dysfunction, the ABC identified 80%, and the DGI identified 78%. The ability of the FTSST to identify subjects with balance dysfunction was better for subjects younger than 60 years of age (81%). Discussion and Conclusion. The FTSST displays discriminative and concurrent validity properties that make this test potentially useful in clinical decision making, although overall the ABC and the DGI are better than the FTSST at discriminating between subjects with and subjects without balance disorders.
Longitudinal Continuity of Care Is Associated With High Patient Satisfaction With Physical Therapy
Authors: Beattie Paul , Dowda Marsha , Turner Christine , Michener Lori , Nelson Roger
Published: February 2017

Background and Purpose. Recent literature has suggested that longitudinal continuity (ie, the patient is seen by the same practitioner for the entire course of treatment) may be linked to high degrees of patient satisfaction with medical care. The purpose of this study was to provide preliminary information regarding the association between longitudinal continuity and reports of patient satisfaction with physical therapy outpatient care. Subjects and Methods. A sample of 1,502 adult subjects completed the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care at the time of discharge from outpatient physical therapy. Relationships between satisfaction measures and the presence or absence of longitudinal continuity were assessed by use of binary logistic regression. Results. Overall, 36.8% of the subjects reported complete satisfaction on the internal subscale (patient-therapist), and 47.9% of the subjects reported complete satisfaction on the external subscale (patient-support staff). Higher percentages of women (40.2% and 51.1% for internal and external subscales, respectively) than of men (31.9% and 43.3% for internal and external subscales, respectively) were completely satisfied with care. Of subjects who reported complete satisfaction on the internal subscale, 71.2% had longitudinal continuity of care, and 28.8% did not. A similar trend was noted for the external subscale (patient-support staff); 66.8% of subjects who reported complete satisfaction had longitudinal continuity, and 33.2% did not. Odds ratios describing the probability of complete satisfaction with care for subjects who had longitudinal continuity and for those who did not were significant and ranged from 2.7 to 3.5. Discussion and Conclusion. Subjects who received their entire course of outpatient physical therapy from only 1 provider were approximately 3 times more likely to report complete satisfaction with care than those who received care from more than 1 provider. These findings suggest that clinicians and managers should make efforts to preserve longitudinal continuity of care as a means of improving patient satisfaction with care.
A Comparison of Pressure Pain Detection Thresholds in People With Chronic Low Back Pain and Volunteers Without Pain
Authors: Giesbrecht R Jason S , Battié Michele C
Published: February 2017

Background and Purpose. Palpation is often utilized in the physical examination of patients with low back pain. The purpose of this study was to compare the pressure pain detection threshold (PPDT) of people with chronic low back pain (CLBP) and subjects without pain. Subjects and Methods. Thirty female subjects with CLBP were recruited from the offices of primary care physicians and physical therapists and compared with 30 female volunteers without pain for differences in PPDT at 6 sites tested bilaterally. Results. A significantly lower mean PPDT was found for all test site groups in subjects with CLBP compared with subjects without pain. A lower global PPDT was found in subjects with CLBP compared with subjects without pain (5.6 lb/cm2 versus 6.9 lb/cm2). This also was the case for PPDT for the group of test sites unrelated to the lumbar spine (5.1 lb/cm2 versus 6.1 lb/cm2) and for PPDT related to the lumbar spine (5.9 lb/cm2 versus 8.0 lb/cm2). Discussion and Conclusion. Neurobiological or biopsychosocial influences may have contributed to the lower PPDT evident in subjects with CLBP. Subjects with CLBP demonstrated a lower global PPDT compared with subjects without pain, which should be taken into account when interpreting findings of pain or tenderness from palpation.
A Fitness Program for Children With Disabilities
Authors: Fragala-Pinkham Maria A , Haley Stephen M , Rabin Jeffrey , Kharasch Virginia S
Published: February 2017

Background and Purpose. This case report describes a fitness program for children with disabilities and provides preliminary information about the safety and feasibility of the program. Case Description. Nine children, 5 to 9 years of age with physical or other developmental disabilities, participated in a 14-week group exercise program held 2 times per week followed by a 12-week home exercise program. Energy expenditure index, leg strength (force-generating capacity of muscle), functional skills, fitness, self-perception, and safety were measured before intervention, after the group exercise program, and again after the home exercise program. Outcomes. No injuries occurred, and improvements in many of the outcome measures were observed. More improvements were observed after the group exercise program than after the home program, and adherence was better during the group exercise program. Discussion. This case report demonstrates that a group exercise program of strength and endurance training may be a safe and feasible option for children with disabilities. Further research is needed to evaluate the effectiveness of a group fitness program and optimal training parameters.
Patellofemoral Pain and Asymmetrical Hip Rotation
Authors: Cibulka Michael T , Threlkeld-Watkins Julie
Published: February 2017

Background and Purpose. Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain. Case Description. The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain. Outcomes. After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%. Discussion. The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain.
Contribution of Psychosocial and Mechanical Variables to Physical Performance Measures in Knee Osteoarthritis
Authors: Maly Monica R , Costigan Patrick A , Olney Sandra J
Published: February 2017

Background and Purpose. This cross-sectional study evaluated the relative contributions of psychosocial and mechanical variables to physical performance measures in people with knee osteoarthritis (OA). Subjects. Fifty-four subjects (age, in years: X̄=68.3, SD=8.7, range=50–87) with radiographically confirmed knee OA were included in this study. Methods. Physical performance measures included the Six-Minute Walk Test (SMW), the Timed “Up & Go” Test (TUG), and a stair-climbing task (STR). Responses to psychosocial questionnaires that reflect depression, anxiety, and self-efficacy (a person's confidence in his or her ability to complete a task) were collected. Mechanical variables measured included body mass index and knee strength (force-generatingcapacity of muscle). Stepwise linear regressions were performed with the SMW, TUG, and STR as separate dependent variables. Results. Functional self-efficacy explained the greatest amount of variance in all performance measures, contributing 45% or more. Knee strength and body weight also explained some variance in performance measures. Anxiety and depression did not explain any variance in performance. Discussion and Conclusion Physical therapists evaluating the significance of the SMW, TUG, and STR scores in subjects with knee OA should note that a large part of each score reflects self-efficacy, or confidence, for physical tasks, with some contributions from knee strength and body weight.
Factors Associated With the Level of Movement-Related Everyday Activity and Quality of Life in People With Chronic Heart Failure
Authors: van den Berg-Emons Rita J , Bussmann Johannes B , Balk Aggie H , Stam Henk J
Published: February 2017

Background and Purpose. Cardiac rehabilitation has been shown to be effective in people with chronic heart failure (CHF), particularly in terms of exercise capacity. However, no effects have been found onthe level of movement-related everyday activity. Therefore, rehabilitation programs also should focus on enhancing the level of movement-related everyday activity. The aim of this study was to explore factors associated with the level of movement-related everyday activity and with quality of life in people with CHF. Subjects and Methods. Measurements of movement-related everyday activity (using an accelerometry-based Activity Monitor), quality of life, and associated factors were performed in 36 people with stable CHF (New York Heart Association classes II and III). Results. Knee flexion and extension torque, and particularly extension torque, were significantlyassociated with movement-related everyday activity (r =.43–.49, P<.05), whereas non-physiological factors such as feelings of being disabled were associated with quality of life (r =.37–.77, P≤.01, P<.05). No relationship was found between movement-related everyday activity and quality of life (r =.20–.22, P>.05). Discussion and Conclusion. The results indicate that knee torque is associated with the level of movement-related everyday activity in people with CHF and that quality of life is mediated by nonphysiologicalfactors.
Locomotor Training Progression and Outcomes After Incomplete Spinal Cord Injury
Authors: Behrman Andrea L , Lawless-Dixon Anna R , Davis Sandra B , Bowden Mark G , Nair Preeti , Phadke Chetan , Hannold Elizabeth M , Plummer Prudence , Harkema Susan J
Published: February 2017

Background and Purpose. The use of locomotor training with a body-weight–support systemand treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report isto describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. Case Description. Following discharge from rehabilitation, a man with an incomplete SCI at C5–6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45sessions of locomotor training. Outcomes. Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for communitymobility. Walking activity (X̄±SD) per 24 hours increased from 1,054±543 steps to 3,924±1,629 steps. Discussion. In a person with an incomplete SCI, walking ability improved after locomotor trainingthat used a decision-making algorithm and progression across training environments.
Testing Functional Performance in People With Parkinson Disease
Authors: Brusse Kevin J , Zimdars Sandy , Zalewski Kathryn R , Steffen Teresa M
Published: February 2017

Background and Purpose. Although the Unified Parkinson's Disease Rating Scale (UPDRS) is the most common performance measure for people with Parkinson disease (PD), the Berg Balance Scale (BBS), Forward Functional Reach Test (FFR), Backward Functional Reach Test (BFR), Timed “Up & Go” Test (TUG), and gait speed may be used to quantify some aspects of functional performance not measured by the UPDRS. The purpose of this study was to describe the relationship among a set of tests of balance, walking performance, and mobility in people with PD. Subjects. Twenty-five community-dwelling adults (11 female, 14 male) with a diagnosis of PD were recruited from PD support groups in southeastern Wisconsin and consented to participate in the study. The mean age of the participants was 76 years (SD=7). The average Hoehn and Yahr Stage Scale score was 2. Methods. Functional abilities of each subject were assessed with the UPDRS, BBS, FFR, BFR, TUG, and gait speed. Spearman and Pearson correlations were performed. Results. The UPDRS total score was correlated with the BBS (r =−.64, P<.001), FFR (r =−.52, P<.05), and TUG (r =.50, P<.05) measurements. The BBS is the only test of functional performance where scores correlate with all other functional tests and the UPDRS. Discussion and Conclusions. The UPDRS total score may not reflect a comprehensive measure of mobility in people with PD. Because the BBS scores correlate both with UPDRS scores and with scores of all other tests of functional performance, the BBS appears to be a good overall measure of function in this population.
Limb-Loaded Cycling Program for Locomotor Intervention Following Stroke
Authors: Brown David A , Nagpal Sabina , Chi Sam
Published: February 2017

Background and Purpose. This case report describes implementation of a limb-loaded cycling (LLC) training program as a feasible exercise for people in early phases of locomotor training following stroke. Case Description. Two individuals with early-stage poststroke hemiplegia participated in the LLC program as an adjunct to physical therapy intervention. Performance of LLC involved cycling while supporting progressive amounts of applied load and weight shifting from one lower extremity to the other lower extremity. The LLC was conducted daily during 2 to 3 weeks of inpatient rehabilitation. Outcomes. The LLC progressed with increases in weight bearing and force generation, as evidenced by larger amounts of limb loading during pedaling. The patients tolerated all loads without cardiorespiratory distress. Discussion. Limb-loaded cycling can accommodate people with little force-generating capability or weight-bearing ability as they practice locomotor skills. Gains in locomotor ability may be aided by the addition of this exercise regimen to patients' daily physical therapy.
Trunk Muscle Stabilization Training Plus General Exercise Versus General Exercise Only: Randomized Controlled Trial of Patients With Recurrent Low Back Pain
Authors: Koumantakis George A , Watson Paul J , Oldham Jacqueline A
Published: February 2017

Background and Purpose. The purpose of this randomized controlled trial was to examine the usefulness of the addition of specific stabilization exercises to a general back and abdominal muscle exercise approach for patients with subacute or chronic nonspecific back pain by comparing a specific muscle stabilization–enhanced general exercise approach with a general exercise–only approach. Subjects. Fifty-five patients with recurrent, nonspecific back pain (stabilization–enhanced exercise group: n=29, general exercise–only group: n=26) and no clinical signs suggesting spinal instability were recruited. Methods. Both groups received an 8-week exercise intervention and written advice (The Back Book). Outcome was based on self-reported pain (Short-Form McGill Pain Questionnaire), disability (Roland-Morris Disability Questionnaire), and cognitive status (Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, Pain Locus of Control Scale) measured immediately before and after intervention and 3 months after the end of the intervention period. Results. Outcome measures for both groups improved. Furthermore, self-reported disability improved more in the general exercise–only group immediately after intervention but not at the 3-month follow-up. There were generally no differences between the 2 exercise approaches for any of the other outcomes. Discussion and Conclusion. A general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific low back pain. Stabilization exercises do not appear to provide additional benefit to patients with subacute or chronic low back pain who have no clinical signs suggesting the presence of spinal instability.
Physical Therapy Interventions for Patients With Stroke in Inpatient Rehabilitation Facilities
Authors: Jette Diane U , Latham Nancy K , Smout Randall J , Gassaway Julie , Slavin Mary D , Horn Susan D
Published: February 2017

Background and Purpose. The purpose of this study was to describe physical therapy provided to patients with stroke in inpatient rehabilitation facilities. Subjects and Methods. Data were collected from 972 patients with stroke receiving physical therapy services at 6 rehabilitation facilities in the United States. Descriptive statistics were derived to describe physical therapy sessions, including proportion of therapy time spent in specific functional activities and proportion of those activities that included any of 59 interventions. Results. Mean length of stay was 18.7 days (SD=10.3), and patients received physical therapy, on average, 13.6 days (SD=7.8). Patients attended, on average, 1.5 (SD=0.3) physical therapy sessions per day, with each session lasting 38.1 minutes (SD=17.1). Gait and prefunctional activities were performed most frequently (31.3% and 19.7% of total treatment time, respectively). For gait activity, physical therapists used balance and postural awareness training in more than 50% of sessions and used strength training for more than 50% of sessions of prefunctional activities. Eighty-six percent of the patients received evaluation, and 84% of the patients and families received education. Discussion and Conclusion. Therapists selected an eclectic approach to intervention rather than specific intervention techniques. The approach to patients' care included interventions to remediate impairments and to compensate for functional limitations. Therapists also reported frequently using motor control and motor learning approaches to facilitate all activities. This approach to care is largely consistent with existing stroke care guidelines and advances in the scientific theories of motor control and motor learning.
The Kappa Statistic in Reliability Studies: Use, Interpretation, and Sample Size Requirements
Authors: Sim Julius , Wright Chris C
Published: February 2017

Purpose. This article examines and illustrates the use and interpretation of the kappa statistic in musculoskeletal research. Summary of Key Points. The reliability of clinicians' ratings is an important consideration in areas such as diagnosis and the interpretation of examination findings. Often, these ratings lie on a nominal or an ordinal scale. For such data, the kappa coefficient is an appropriate measure of reliability. Kappa is defined, in both weighted and unweighted forms, and its use is illustrated with examples from musculoskeletal research. Factors that can influence the magnitude of kappa (prevalence, bias, and nonindependent ratings) are discussed, and ways of evaluating the magnitude of an obtained kappa are considered. The issue of statistical testing of kappa is considered, including the use of confidence intervals, and appropriate sample sizes for reliability studies using kappa are tabulated. Conclusions. The article concludes with recommendations for the use and interpretation of kappa.
Evaluation of Female Pelvic-Floor Muscle Function and Strength
Authors: Bø Kari , Sherburn Margaret
Published: February 2017

Evaluation of pelvic-floor muscle (PFM) function and strength is necessary (1) to be able to teach and give feedback regarding a woman's ability to contract the PFM and (2) to document changes in PFM function and strength throughout intervention. The aims of this article are to give an overview of methods to assess PFM function and strength and to discuss the responsiveness, reliability, and validity of data obtained with the methods available for clinical practice and research today. Palpation, visual observation, electromyography, ultrasound, and magnetic resonance imaging (MRI) measure different aspects of PFM function. Vaginal palpation is standard when assessing the ability to contract the PFM. However, ultrasound and MRI seem to be more objective measurements of the lifting aspect of the PFM. Dynamometers can measure force directly and may yield more valid measurements of PFM strength than pressure transducers. Further research is needed to establish reliability and validity scores for imaging techniques. Imaging techniques may become important clinical tools in future physical therapist practice and research to measure both pathophysiology and impairment of PFM dysfunction.
Decreased Trunk Angular Displacement During Sitting Down: An Early Feature of Aging
Authors: Dubost Véronique , Beauchet Olivier , Manckoundia Patrick , Herrmann François , Mourey France
Published: February 2017

Background and Purpose. Trunk motion plays an important role in achieving both sit-to-stand and stand-to-sit transfers. However, these 2 body transfers depend on different postural and mechanical constraints. Although the effects of aging on sit-to-stand transfers have been widely studied, there is a lack of information concerning stand-to-sit transfers. The aim of this study was to determine how angular displacements of the trunk and shank are affected by aging during sit-to-stand and stand-to-sit transfers. Subjects. Ten community-dwelling older adults (mean age=75.9 years, SD=3.2) and 9 young adults (mean age=26.8 years, SD=4.7) volunteered to participate. Methods. Maximal angular displacements of the trunk and shank with respect to the vertical (ie, orientation angles) were measured, during standing up and sitting down, using an optoelectronic movement analyzer. Results. For standing up, there was no difference between the young and older adults with regard to both maximal orientation angles. During sitting down, the maximal shank orientation angle was not affected by age, whereas the older adults had a smaller trunk motion compared with the young adults (approximately 10° less). Discussion and Conclusion. The results showed that older adults tended to minimize the forward body displacement during sitting down. This strategy could be seen as an adaptive mechanism to decrease the risk of anterior disequilibrium. The authors suggest that this feature could be used as an early marker of aging on postural control.
Development and Testing of a Self-report Instrument to Measure Actions: Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL)
Authors: Guccione Andrew A , Mielenz Thelma J , DeVellis Robert F , Goldstein Marc S , Freburger Janet K , Pietrobon Ricardo , Miller Sarah C , Callahan Leigh F , Harwood Kenneth , Carey Timothy S
Published: February 2017

Background and Purpose. Physical therapy is faced with the challenge of producing evidence that physical therapy interventions are effective. The fundamental question confronting physical therapy is whether or not physical therapy interventions make a contribution to function, health, and well-being. The individual's ability to perform actions can serve as a theoretical construct related to movement and health around which physical therapy interventions can be assessed. To this end, the aims of this study were: (1) to develop a self-report instrument to assess ability to perform mobility actions in an adult outpatient population and (2) to assess the psychometric properties of such an instrument in the appropriate population. Subjects and Methods. An instrument was developed to assess difficulty and confidence related to 24 actions. Descriptive statistics and measures of reliability, validity, and responsiveness were computed. A total of 391 patients participated in the study. Results. The coefficient for reliability was in the required range, and measures of validity and responsiveness were established as well. Three factors were identified. Discussion and Conclusion. The instrument provides the beginning of documentation of outcomes in movement to identify the unique contributions of physical therapist practice.
Collecting Health History Information: The Accuracy of a Patient Self-administered Questionnaire in an Orthopedic Outpatient Setting
Authors: Boissonnault William G , Badke Mary Beth
Published: February 2017

Background and Purpose. The utility of patient self-administered health history questionnaires has been extensively studied in physician practice settings, but little such research has been done in populations germane to physical therapist practice. The purpose of this study was to document the accuracy of a self-administered questionnaire for collecting patients' history of illness, surgery, and medication use. Subjects. Outpatient orthopedic surgery candidates (n=100, 54% female, 46% male; mean age=46.9 years) with common orthopedic disorders were recruited. Methods. Using the same form, patient health history information was recorded separately by patient self-report and by an experienced health care practitioner. Patient questionnaire responses were compared for accuracy with responses generated by the practitioner and those found in the medical record. Results. The mean percentage of agreement across questionnaire items was 96% (range=57%–100%); the mean kappa value was .69 (range=.154–1.0). Of the total questionnaire responses across all patients (n=9,436), 2.55% (n=241) of the responses were noted “yes” on the practitioner questionnaire, but not on the patient questionnaire; 1.8% of the items (n=174) were noted “yes” on the patient questionnaire, but not on the practitioner questionnaire. Discussion and Conclusion. The results support the accuracy of patient self-administered health history questionnaires in reporting important health history information.
Navicular Drop Measurement in People With Rheumatoid Arthritis: Interrater and Intrarater Reliability
Authors: Shrader Joseph A , Popovich John M , Gracey G Chris , Danoff Jerome V
Published: February 2017

Background and Purpose. Navicular drop (ND) measurement may be a valuable examination technique for patients with rheumatoid arthritis (RA). However, no data exist on reliability for this technique in patients with RA. The purposes of this study were: (1) to determine interrater and intrarater reliability of ND measurements in people with RA, (2) to compare ND values of people with RA with published normative data, and (3) to investigate ND measurement error associated with the use of skin markings. Subjects. Ten women (20 feet) with RA consented to participate. Methods. Patients completed demographic and function questionnaires. Navicular height (NH) measurements were taken by 2 physical therapists and 1 physical therapist student, following four 1-hour training sessions, using standardized methods and a digital height gauge. Four different NH measurements were taken 3 times on each foot by each of the 3 examiners during a morning session and then repeated during an afternoon session on the same day. Navicular drop values were calculated, including ND1 (as reported in the literature), ND2 (compensating for skin error), and ND3 (single-limb stance). Intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs) were used to establish reliability. Results. Means (±SD) for each ND measure for sessions 1 and 2, respectively, were as follows: ND1=8.36±5.29 mm and 8.29±5.24 mm, ND2=9.95±5.44 mm and 9.57±5.37 mm. The ICCs (2,1 and 2,k, respectively) for all interrater measurements ranged from .67 to .92 (SEM=2.0–3.3 mm) and from .85 to .97 (SEM=1.1–2.0 mm). The ICCs (2,1 and 2,k, respectively) for intrarater measurements ranged from .73 to .95 (SEM=1.3–2.8 mm) and from .90 to .98 (SEM=0.7–1.6 mm). Paired t tests showed the means of ND1 and ND2 for each examiner and for both sessions were significantly different. Discussion and Conclusion. The results suggest that ND measurements for people with RA can be taken reliably by clinicians with varied experience. The ND values for our subjects were slightly greater than reported normal values of 6 to 8 mm. Error associated with skin markings was statistically significant for all sessions and examiners.
Physical Therapist Management of an Adult With Osteochondritis Dissecans of the Knee
Authors: Johnson Michael P
Published: February 2017

Background and Purpose. Osteochondritis dissecans (OCD) primarily occurs between 10 and 20 years of age. Adult patients (>20 years) tend to respond poorly to nonsurgical management. This case report describes the physical therapist management of an adult with OCD at the tibiofemoral joint. Case Description. A 24-year-old woman had insidious onset of right knee pain. Magnetic resonance imaging confirmed the diagnosis of OCD. Interventions included iontophoresis, strengthening exercises, and instruction in strategies to minimize loading across the knee. Outcome. The patient received 5 intervention sessions. At discharge and 9-month follow-up, she reported 95% function (Single Assessment Numeric Evaluation) and no pain while performing full work duties. Discussion. This case illustrates the process, including the use of evidence, of making clinical decisions about the physical therapist management of an adult with OCD.
Sensitivity to Change and Responsiveness of the Global Physiotherapy Examination (GPE-52) in Patients With Long-Lasting Musculoskeletal Pain
Authors: Kvåle Alice , Skouen Jan Sture , Ljunggren Anne Elisabeth
Published: February 2017

Background and Purpose. The sensitivity to change and the responsiveness of the Global Physiotherapy Examination (GPE-52) were examined in patients with localized and widespread long-lasting musculoskeletal pain. Subjects. All included patients were on sick leave and constituted the treatment group in a randomized controlled study. Two hundred forty-seven patients (64% women; mean age=43.6 years, SD=10.4) were included. At entry, the patients were categorized into 3 groups according to pain localization. Patients who returned fully to work were compared with those who did not. Methods. The GPE-52 has composite scores in 5 main domains—posture (8 tests), respiration (8 tests), movement (16 tests), muscle (12 tests), and skin (8 tests)—and was administered before and after 4 weeks of multidisciplinary outpatient treatment and at a 6-month follow-up examination. The first 61 patients also were re-examined after 18 months. Results. In this study, the GPE-52 and its 5 main domains were demonstrated to be sensitive to change, measured 6 and 18 months after treatment, in different groups of patients with long-lasting musculoskeletal pain. Responsiveness to important change, defined in this study as return to work, was found only for the total GPE-52 score and within the movement and respiration domains. Responsiveness to important change was greater in patients with localized pain than in patients with widespread pain. Discussion and Conclusion. Although the total GPE-52 score was sensitive to change in patients with long-lasting musculoskeletal pain, a shorter test battery including only the respiration and movement domain scores might be appropriate as an outcome measure in intervention studies for patients with long-lasting musculoskeletal pain.
Specialized Neuromuscular Training to Improve Neuromuscular Function and Biomechanics in a Patient With Quiescent Juvenile Rheumatoid Arthritis
Authors: Myer Gregory D , Brunner Hermine I , Melson Paula G , Paterno Mark V , Ford Kevin R , Hewett Timothy E
Published: February 2017

Background and Purpose. The purpose of this case report is to describe a novel multidisciplinary approach for evaluating and preparing a patient with quiescent juvenile rheumatoid arthritis (JRA) for safe sports participation. Case Description. The patient was a 10-year-old girl with a history of bilateral knee arthritis who desired to participate in soccer and basketball. Range of motion and manual muscle testing of the lower extremity were within normal limits. Neuromuscular testing included kinematic and kinetic testing, isokinetic assessment, and postural stability testing. The patient's gait was near normal; however, she had narrowed step width and increased knee flexion at heel-strike. Landing analysis during a box drop vertical jump task showed increased and imbalanced (right versus left lower extremity) peak impact forces. The testing was followed by specialized neuromuscular training (SNT). Outcomes. Following SNT, heel-strike and step width were within normal limits, peak impact forces on the box drop test decreased by 31%, imbalance decreased by 46%, and vertical jump increased 15%. The isokinetic strength ratio between knee flexors and extensors and the overall balance measures were within normal limits and equal bilaterally. Discussion. Patients with quiescent JRA may have abnormal biomechanics, which could place them at increased risk for injury or future articular cartilage damage. Specialized neuromuscular training may have helped to decrease the patient's risk for future injury or disease progression.
Discriminative, Predictive, and Evaluative Properties of a Trunk Control Measure in Patients With Stroke
Authors: Wang Chun-Hou , Hsueh I-Ping , Sheu Ching-Fan , Hsieh Ching-Lin
Published: February 2017

Background and Purpose The trunk control items of the Postural Assessment Scale for Stroke Patients (PASS-TC) have been proposed for use in examining patients with stroke. The purpose of this study was to examine the discriminative and predictive validities and the evaluative properties of the PASS-TC at 14, 30, 90, and 180 days after stroke onset. Subjects and Methods A total of 269 patients with stroke participated in this prospective study. The PASS-TC was administered at the 4 time points after stroke onset. The distributions of the PASS-TC scores were used to determine the discriminative ability to distinguish between individuals at the 4 time points. A comprehensive activities of daily living (CADL) measure was administered 1 year after stroke onset as an external criterion for examining the predictive ability of the PASS-TC. Changes in PASS-TC scores between the intervals of 14 to 30, 30 to 90, and 90 to 180 days after stroke onset were used to examine the evaluative properties of the measure. Results The PASS-TC scores exhibited differences between the patients with disability and the patients without disability at the 4 time points. The scale, however, showed a notable ceiling effect at the 4 time points (>30% of the subjects), indicating a limited discriminative ability between individuals. The scores of the PASS-TC at the 4 time points were moderately correlated with the CADL scores at 1 year after stroke onset (Spearman ρ≥.5), evidence of its predictive validity. The responsiveness of the PASS-TC was moderate at 14 to 30 days after stroke (standardized response mean [SRM]=.65) and limited at 30 to 90 and 90 to 180 days after stroke (SRM=.42 and .02, respectively). Discussion and Conclusion The results provide evidence that the PASS-TC can predict CADL function at 1 year after a stroke, but the discriminative and evaluative abilities are limited over the first 6 months after a stroke. To promote the utility of the PASS-TC in stroke research, it will be necessary to reduce its ceiling effect and improve its evaluative ability.
Developing a Short Form of the Berg Balance Scale for People With Stroke
Authors: Chou Chia-Yeh , Chien Chi-Wen , Hsueh I-Ping , Sheu Ching-Fan , Wang Chun-Hou , Hsieh Ching-Lin
Published: February 2017

Background and Purpose. To improve the utility of the Berg Balance Scale (BBS), the aim of this study was to develop a short form of the BBS (SFBBS) that was psychometrically similar (including test reliability, validity, and responsiveness) to the original BBS for people with stroke. Subjects and Methods. A total of 226 subjects with stroke participated in this prospective study at 14 days after their stroke; 167 of these subjects also were examined at 90 days after their stroke. The BBS, Barthel Index, and Fugl-Meyer Motor Test were administered at these 2 time points. By reducing the number of tested items by more than half the number of items in the original BBS (ie, making 4-, 5-, 6-, and 7-item tests) and simplifying the scoring system of the original BBS (ie, collapsing the 5-level scale into a 3-level scale [BBS-3P]), we generated a total of 8 SFBBSs. Results. The distributions of scores for all 8 SFBBSs were acceptable but featured notable floor effects. The 4-item BBS, 5-item BBS, 5-item BBS-3P, and 7-item BBS-3P demonstrated good reliability. The subjects’ scores on the 6-item BBS, 6-item BBS-3P, 7-item BBS, and 7-item BBS-3P showed excellent agreement with those on the original BBS. The 6-item BBS-3P and 7-item BBS-3P exhibited great responsiveness. Only the 7-item BBS-3P demonstrated both satisfactory and psychometric properties similar to those of the original BBS. Discussion and Conclusion. The 7-item BBS-3P was found to be psychometrically similar to the original BBS. The 7-item BBS-3P, compared with the original BBS, is simpler and faster to complete in either a clinical or a research setting and is recommended. [Chou CY, Chien CW, Hsueh IP, et al. Developing a short form of the Berg Balance Scale for people with stroke.
Evidence for Electronic Health Record Systems in Physical Therapy
Authors: Vreeman Daniel J , Taggard Samuel L , Rhine Michael D , Worrell Teddy W
Published: February 2017

With increasing pressures to better manage clinical information, we investigated the role of electronic health record (EHR) systems in physical therapist practice through a critical review of the literature. We reviewed studies that met our predefined criteria after independent review by 3 authors. The investigators in all of the reviewed studies reported benefits, including improved reporting, operational efficiency, interdepartmental communication, data accuracy, and capability for future research. In 7 studies, the investigators reported barriers, including challenges with behavior modification, equipment inadequacy, and training. The investigators in all studies reported key success factors, including end-user participation, adequate training, workflow analysis, and data standardization. This review suggests that EHRs have potential benefits for physical therapists. The authors formed the following recommendations based on the studies’ themes: (1) incorporate workflow analysis into system design and implementation; (2) include end users, especially clinicians, in system development; (3) devote significant resources for training; (4) plan and test carefully to ensure adequate software and hardware performance; and (5) commit to data standards. [Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy.
Factors Affecting Physical Activity Behavior in Urban Adults With Arthritis Who Are Predominantly African-American and Female
Authors: Greene Brenda L , Haldeman Gina F , Kaminski Ashley , Neal Kerryn , Lim S Sam , Conn Doyt L
Published: February 2017

Background and Purpose. Physical activity and exercise play a critical role in the management of arthritis. Understanding the factors affecting physical activity and exercise behavior is a necessary first step toward identifying the needs of, and intervention strategies for, people with arthritis. The purpose of this study was to identify factors affecting physical activity and exercise behavior in urban subjects with osteoarthritis (OA) and rheumatoid arthritis (RA). Subjects. Seventy-two consecutive subjects were recruited from the rheumatology clinic at a large urban public hospital. The sample was predominantly African American (92%), female (87%), and not working (90%). The subjects’ average age was 60.9 years (SD=13.9, range=30–90). Methods. Time per day spent sitting or lying down and time per week spent in exercise, leisure, and household activities were determined by individual interview. Self-efficacy, outcome expectations, disability, pain, body mass index, and social support were measured as possible explanatory factors. Results. The average daily total activity time was 3.1 hours. Household and leisure activities accounted for 85% of that time. Explanatory factors for physical activity behavior were not the same for subjects with OA and RA, despite similar between-group characteristics. Self-efficacy was present in all of the significant explanatory models. Discussion and Conclusion. The results indicate that factors that affect physical activity behavior among urban and predominantly African-American adults are dependent upon the type of physical activity and are different for people with OA and RA. Self-efficacy was the most consistent explanatory factor. [Greene BL, Haldeman GF, Kaminski A, et al. Factors affecting physical activity behavior in urban adults with arthritis who are predominantly African-American and female.
Effect of Therapeutic Exercise on Gait Speed in Community-Dwelling Elderly People: A Meta-analysis
Authors: Lopopolo Rosalie B , Greco Melissa , Sullivan Dorianne , Craik Rebecca L , Mangione Kathleen K
Published: February 2017

Background and Purpose. Inconsistent research findings make it unclear whether therapeutic exercise improves gait speed in community-dwelling elderly people. Using meta-analytical procedures, we examined the effect of therapeutic exercise on changing gait speed in community-dwelling older adults and the effect of type, intensity, and dose of therapeutic exercise on gait speed. Method. Studies were retrieved using a comprehensive database search. Two independent reviewers determined study eligibility based on inclusion criteria, rated study quality, and extracted information on study methods, design, intervention, and results. Data were combined to obtain an overall effect size, its 95% confidence interval, and a measure of significance. In addition, analyses to characterize the clinical relevance of the findings were performed. Results. One hundred seventeen studies were evaluated, with 24 studies (n=1,302 subjects) meeting the inclusion criteria for habitual gait speed and 18 studies (n=752 subjects) meeting the inclusion criteria for fast gait speed. Therapeutic exercise—or, more specifically, strength training and combination training (aerobic plus other exercise)—had significant effects (r=.145, P=.017; r=.176, P=.002, respectively) on habitual gait speed. High-intensity (effort expended by subjects) exercise and high-dosage (frequency and duration of exercise sessions) intervention also had a significant effect (r=.184, P=.001; r=.190, P=.001, respectively) on gait speed, whereas there was no effect for moderate- and low-intensity exercise or for low-dosage exercise. No exercise intervention affected fast gait speed in this analysis. Discussion and Conclusion. The results provide support for the belief that therapeutic exercise can improve gait speed in community-dwelling elderly people and that intensity and dosage are important contributing factors. The relatively weak correlation found between therapeutic exercise and gait speed merits further study. [Lopopolo RB, Greco M, Sullivan DH, et al. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis. Phys Ther. 2006;86:520–540.]