bluuebunny/crossref_metadata_2025 huggingface dataset:
Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement
Authors: Ludewig Paula M , Cook Thomas M
Published: February 2017

Background and Purpose. Treatment of patients with impingement symptoms commonly includes exercises intended to restore “normal” movement patterns. Evidence that indicates the existence of abnormal patterns in people with shoulder pain is limited. The purpose of this investigation was to analyze glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work. Subjects. Fifty-two subjects were recruited from a population of construction workers with routine exposure to overhead work. Methods. Surface electromyographic data were collected from the upper and lower parts of the trapezius muscle and from the serratus anterior muscle. Electromagnetic sensors simultaneously tracked 3-dimensional motion of the trunk, scapula, and humerus during humeral elevation in the scapular plane in 3 hand-held load conditions: (1) no load, (2) 2.3-kg load, and (3) 4.6-kg load. An analysis of variance model was used to test for group and load effects for 3 phases of motion (31°–60°, 61°–90°, and 91°–120°). Results. Relative to the group without impingement, the group with impingement showed decreased scapular upward rotation at the end of the first of the 3 phases of interest, increased anterior tipping at the end of the third phase of interest, and increased scapular medial rotation under the load conditions. At the same time, upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement in the final 2 phases, although the upper trapezius muscle changes were apparent only during the 4.6-kg load condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads and phases. Conclusion and Discussion. Scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function are important to consider in the rehabilitation of patients with symptoms of shoulder impingement related to occupational exposure to overhead work.
Effectiveness of a Bed Positioning Program for Treating Older Adults With Knee Contractures Who Are Institutionalized
Authors: Fox Patricia , Richardson Julie , McInnes Bonnie , Tait Diane , Bedard Michel
Published: February 2017

Background and Purpose. Although contractures in patients in long-term care institutions are an important issue, there have been only a few studies that have evaluated interventions for contractures. The purpose of this study was to determine the effectiveness of a bed positioning program (BPP) for the treatment of patients with knee flexion contractures. Subjects. Sixteen patients with a high level of cognitive and functional impairment (mean age=82 years, SD=6.48, range=71–93) in a chronic care hospital participated in the study. Methods. The BPP consisted of stretching a patient's knee into extension and then securing and maintaining the position for a period of 40 minutes, 4 times per week. Participants were randomly assigned to 2 groups (n=8 in each group). One group received a BPP for 8 weeks, followed by 8 weeks of no intervention. The other group received the intervention in the reverse order. Once a week, participants were assessed for range of knee extension, knee pain, and skin integrity. Results. Twelve participants completed the study. There was no improvement in participants' range of knee extension during the intervention period. Overall, there was no difference in mean range of knee extension between the intervention period and the no-intervention period. Conclusion and Discussion. The results of this study do not support the use of a BPP for treating patients with knee flexion contractures.
Experiences of Older Women With Cancer Receiving Hospice Care: Significance for Physical Therapy
Authors: Mackey Kimberly McCord , Sparling Joyce W
Published: February 2017

Background and Purpose. The number of older adults with cancer is growing, increasing the need for professionals who are able to meet these patients' special needs. In palliative care settings, physical therapists strive to promote quality of life. Minimal research exists, however, to guide therapists working with patients with terminal illness. The purpose of this study was to gain knowledge that can be used by physical therapists to more effectively assess and treat older people with cancer who are receiving hospice care. Subjects and Methods. A qualitative single-case study with replication was conducted with 3 older women with cancer who are receiving hospice care. Interview data were analyzed using grounded theory techniques. Results. Four themes emerged as central to the experience of the informants: social relationships, spirituality, outlook on mortality, and meaningful physical activity. Conclusion and Discussion. In addition to maintaining physical function, physical therapists, who attend to nonphysical as well as physical aspects of care, may foster social cohesion, help maximize life's meaning, and support stabilizing strategies of older women with cancer who receive hospice care.
Abdominal Muscle Response During Curl-ups on Both Stable and Labile Surfaces
Authors: Vera-Garcia Francisco J , Grenier Sylvain G , McGill Stuart M
Published: February 2017

Background and Purpose. With the current interest in stability training for the injured low back, the use of labile (movable) surfaces, underneath the subject, to challenge the motor control system is becoming more popular. Little is known about the modulating effects of these surfaces on muscle activity. The purpose of this study was to establish the degree of modulating influence of the type of surface (whether stable or labile) on the mechanics of the abdominal wall. In this study, the amplitude of muscle activity together with the way that the muscles coactivated due to the type of surface under the subject were of interest. Subjects. Eight men (mean age=23.3 years [SD=4.3], mean height=177.6 cm [SD=3.4], mean weight=72.6 kg [SD=8.7]) volunteered to participate in the study. All subjects were in good health and reported no incidence of acute or chronic low back injury or prolonged back pain prior to this experiment. Methods. All subjects were requested to perform 4 different curl-up exercises—1 on a stable surface and the other 3 on varying labile surfaces. Electromyographic signals were recorded from 4 different abdominal sites on the right and left sides of the body and normalized to maximal voluntary contraction (MVC) amplitudes. Results. Performing curl-up exercises on labile surfaces increased abdominal muscle activity (eg, for curl-up on a stable surface, rectus abdominis muscle activity was 21% of MVC and external oblique muscle activity was 5% of MVC; for curl-up with the upper torso on a labile ball, rectus abdominis muscle activity was 35% of MVC and external oblique muscle activity was 10% of MVC). Furthermore, it appears that increases in external oblique muscle activity were larger than those of other abdominal muscles. Conclusion and Discussion. Performing curl-ups on labile surfaces changes both the level of muscle activity and the way that the muscles coactivate to stabilize the spine and the whole body. This finding suggests a much higher demand on the motor control system, which may be desirable for specific stages in a rehabilitation program.
Seating and Mobility Considerations for People With Spinal Cord Injury
Authors: Minkel Jean L
Published: February 2017

For people with spinal cord injuries, the selection of a wheelchair and seating system involves many factors. This clinical perspective describes a model that includes consideration of the person, the wheelchair, the immediate environment between the person and the wheelchair, the intermediate environment of the home and work, and the community environment. The seated posture is examined biomechanically, and literature is reviewed that highlights the differences in the seated position of people with spinal cord injuries and people without spinal cord injuries. Reports regarding overuse injuries of the shoulder and wrists are discussed along with methods of relieving pressure at the buttock and seat interface. The impact that research findings should have on current clinical practice and the need for more research to provide evidence to either support or change current practice are discussed.
Comparison of the University of California–Los Angeles Shoulder Scale and the Simple Shoulder Test With the Shoulder Pain and Disability Index: Single-Administration Reliability and Validity
Authors: Roddey Toni S , Olson Sharon L , Cook Karon F , Gartsman Gary M , Hanten William
Published: February 2017

Background and Purpose. Shoulder scales are often used to evaluate treatment efficacy, yet little is known about the psychometric properties of these scales. Only one scale has undergone psychometric scrutiny: the Shoulder Pain and Disability Index (SPADI). This study compared 2 shoulder measures—the University of California-Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)—with the SPADI. Subjects. One hundred ninety-two patients with shoulder disorders were recruited from one physician's office to complete the self-report sections of the 3 scales. Methods. Cronbach alpha values and standard errors of measurement (SEM) were calculated for each of the multi-item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and the SST. Results. Cronbach alpha values ranged from .85 to .95. The SEM values for the multi-item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. Conclusion and Discussion. All scales demonstrated good internal consistency, suggesting that all items for each scale measure the same construct. However, the SEMs for all scales were high. Factor loading was inconsistent, suggesting that patients may not distinguish between pain and function.
Effects of Immobilization on Plantar-Flexion Torque, Fatigue Resistance, and Functional Ability Following an Ankle Fracture
Authors: Shaffer Michael A , Okereke Enyi , Esterhai John L , Elliott Mark A , Walter Glenn A , Yim Steven H , Vandenborne Krista
Published: February 2017

Background and Purpose. The goal of this investigation was to study the recovery of ankle plantar-flexor peak torque, fatigue resistance, and functional ability (stair climbing, walking) following cast immobilization in patients with ankle fractures. Subjects. The participants were 10 patients who underwent open reduction-internal fixation and 8 weeks of cast immobilization following a fracture of the ankle mortise and 10 age- and sex-matched, noninjured comparison subjects. Methods. Plantar-flexor torque and fatigue resistance were measured at 1, 5, and 10 weeks of rehabilitation using an isokinetic dynamometer. Ankle plantar-flexor peak torque and fatigue resistance were correlated to timed ambulation, timed stair climbing, and unilateral heel-rises. Results. Following immobilization, plantar-flexor peak torque was decreased at all angular speeds and positions. The decrease in peak torque was associated with an increase in fatigue resistance. With rehabilitation, ankle plantar-flexor torque and fatigue resistance normalized. Regression analysis revealed a strong relationship between plantar-flexor peak torque and functional measures. By 10 weeks post-immobilization, peak torque, fatigue resistance, and all measures of functional performance had returned to control levels. Conclusion and Discussion. The decrease in muscle performance, functional ability, and fatigue resistance induced by 8 weeks of cast immobilization can be reversed with 10 weeks of supervised physical therapy. In addition, this study demonstrated that ankle-plantar flexor torque is a good predictor of stair-climbing and walking performance in patients with ankle fractures.
Neuroanatomical Substrates of Functional Recovery After Experimental Spinal Cord Injury: Implications of Basic Science Research for Human Spinal Cord Injury
Authors: Basso D Michele
Published: February 2017

Human spinal cord injury (SCI) is a devastating condition that results in persistent motor deficits. Considerable basic and clinical research is directed at attenuating these deficits. Many basic scientists use animal models of SCI to: (1) characterize lesion development, (2) determine the role of spared axons in recovery, and (3) develop therapeutic interventions based on these findings. In this article, current research is reviewed that indicates: (1) most individuals with SCI will have some sparing of white matter at the lesion epicenter even when the lesion appears clinically complete, (2) even minimal tissue sparing has a profound impact on segmental systems and recovery of function, and (3) facilitatory intervention such as weight bearing and locomotor training after SCI may be more effective than compensatory strategies at inducing neuroplasticity and motor recovery. Body weight supported treadmill step training is discussed as an example of new facilitatory interventions based on basic science research using animal models.
Measurements Used to Characterize the Foot and the Medial Longitudinal Arch: Reliability and Validity
Authors: Williams Dorsey S , McClay Irene S
Published: February 2017

Background and Purpose. Abnormality in the structure of the medial longitudinal arch of the foot is commonly thought to be a predisposing factor to injury. The purpose of this investigation was to compare the reliability and validity of several measurements used to characterize various aspects of the foot, including the medial longitudinal arch. Subjects. One hundred two feet (both feet of 51 subjects) were measured to establish a reference database. From this group, a subset of 20 feet (both feet of 10 subjects) was used to determine intertester and intratester reliability. Radiographs of a further subset of 10 feet (right feet of 10 subjects) were used to determine validity. Methods. Five foot measurements were taken in 2 stance conditions: 10% of weight bearing and 90% of weight bearing. Results. Intraclass correlation coefficients (ICCs) for intertester and intratester measurements were between .480 and .995. The most reliable method of characterizing arch type in 10% of weight bearing between testers was dividing navicular height by foot length in 10% of weight bearing. However, this measure yielded highly unreliable measurements in 90% of weight bearing. The most valid measurements were navicular height divided by truncated foot length, navicular height divided by foot length in 10% of weight bearing, and navicular height divided by foot length in 90% of weight bearing. Dorsum height at 50% of foot length divided by truncated foot length showed relatively high intertester reliability (ICC=.811 in 10% of weight bearing, ICC=.848 in 90% of weight bearing) and validity (ICC=.844 in 10% of weight bearing, ICC=.851 in 90% of weight bearing). Conclusion and Discussion. These data suggest that, of the measures tested, the most reliable and valid method of clinically assessing arch height across 10% and 90% of weight bearing was dividing the dorsum height at 50% of foot length by truncated foot length.
Improved Scaling of the Gross Motor Function Measure for Children With Cerebral Palsy: Evidence of Reliability and Validity
Authors: Russell Dianne J , Avery Lisa M , Rosenbaum Peter L , Raina Parminder S , Walter Stephen D , Palisano Robert J
Published: February 2017

Background and Purpose. This study examined the reliability, validity, and responsiveness to change of measurements obtained with a 66-item version of the Gross Motor Function Measure (GMFM-66) developed using Rasch analysis. Subjects and Methods. The validity of measurements obtained with the GMFM-66 was assessed by examining the hierarchy of items and the GMFM-66 scores for different groups of children from a stratified random community-based sample of 537 children with cerebral palsy (CP). A subset of 228 children who had been reassessed at 12 months was used to test the hypothesis that children who are young (<5 years of age) and have “mild” CP will demonstrate greater change in GMFM-66 scores than children who are older (≥5 years of age) and whose CP is more severe. Data from an additional 19 children with CP who were assessed twice, one week apart, were used to examine test-retest reliability. Results. The overall changes in GMFM-66 scores over 12 months and a time × severity × age interaction supported our hypotheses. Test-retest reliability was high (intraclass correlation coefficient=.99). Conclusion and Discussion. This study demonstrated that the GMFM-66 has good psychometric properties. By providing a hierarchical structure and interval scaling, the GMFM-66 can provide a better understanding of motor development for children with CP than the 88 item GMFM and can improve the scoring and interpretation of data obtained with the GMFM.
Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test
Authors: Shumway-Cook Anne , Brauer Sandy , Woollacott Marjorie
Published: February 2017

Background and Purpose. This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are prone to falling. Subjects. Fifteen older adults with no history of falls (mean age=78 years, SD=6, range=65–85) and 15 older adults with a history of 2 or more falls in the previous 6 months (mean age=86.2 years, SD=6, range=76–95) participated. Methods. Time taken to complete the TUG under 3 conditions (TUG, TUG with a subtraction task [TUGcognitive], and TUG while carrying a full cup of water [TUGmanual]) was measured. A multivariate analysis of variance and discriminant function and logistic regression analyses were performed. Results. The TUG was found to be a sensitive (sensitivity=87%) and specific (specificity=87%) measure for identifying elderly individuals who are prone to falls. For both groups of older adults, simultaneous performance of an additional task increased the time taken to complete the TUG, with the greatest effect in the older adults with a history of falls. The TUG scores with or without an additional task (cognitive or manual) were equivalent with respect to identifying fallers and nonfallers. Conclusions and Discussion. The results suggest that the TUG is a sensitive and specific measure for identifying community-dwelling adults who are at risk for falls. The ability to predict falls is not enhanced by adding a secondary task when performing the TUG.
We Have Arrived!
Authors: Massey Ben F
Published: February 2017

APTA President Ben Massey shared the 2001 Presidential Address with members and other participants during the Opening Plenary at PT 2001: Annual Conference & Exposition of the American Physical Therapy Association, June 20, 2001. As part of Massey's enthusiastic and motivational presentation, he introduced a new 60-second video, “We Live for Moments Like These,” that APTA has developed for members to use as a promotional tool. The video is now available to members at cost and also can be viewed from the APTA Web site at www.apta.org.

When I ran for election a little more than a year ago, I did so with pride and passion and a profound commitment to this profession and our Association. I was prepared for the work that would be required of the job, but I was not as prepared for what I would experience in return. I've had the privilege of meeting hundreds of you this past year. And your pride, and your passion, and your commitment have inspired me.

I am so proud to be a member of a profession that transforms and restores people's lives. And I am equally proud to be part of an association membership who stands up for the public we serve—and who goes after what we believe in.

The images you just viewed [in APTA's new video “We Live for Moments Like These” are extraordinary. And what is perhaps equally extraordinary is that these are the images of everyday physical therapy—from making it possible for a grandmother with debilitating arthritis pain to hold her grandchild to enabling a prima ballerina who has been injured to return to the stage. Yes, any one of you could have been featured in this video for the extraordinary things that you do every single day, that you do with skill and expertise and a unique body of knowledge backed by scientific proof, that you do with heart, and soul, and passion.

[Massey BF Jr. 2001 APTA Presidential Address: We have arrived! Phys Ther. 2001;81:1830-1833.]
Is the Recovery of Stepping Following Spinal Cord Injury Mediated by Modifying Existing Neural Pathways or by Generating New Pathways? A Perspective
Authors: de Leon Ray D , Roy Roland R , Edgerton V Reggie
Published: February 2017

The recovery of stepping ability following a spinal cord injury may be achieved by restoring anatomical connectivity within the spinal cord. However, studies of locomotor recovery in animals with complete spinal cord transection suggest that the adult mammalian spinal cord can acquire the ability to generate stepping after all descending input is eliminated and in the absence of neuronal regeneration. Moreover, rehabilitative gait training has been shown to play a crucial role in teaching existing spinal pathways to generate locomotion and appropriately respond to sensory feedback. This brief review presents evidence that neural networks in the mammalian spinal cord can be modulated pharmacologically and/or with task-specific behavioral training to generate weight-bearing stepping after a spinal injury. Further, the role that spinal learning can play in the management of humans with spinal cord injury is discussed in relation to interventions that are designed primarily to enhance neuronal regeneration.
Relationship Between Duration of Therapy Services in a Comprehensive Rehabilitation Program and Mobility at Discharge in Patients With Orthopedic Problems
Authors: Kirk-Sanchez Neva J , Roach Kathryn E
Published: February 2017

Background and Purpose. The purpose of this study was to examine the relationship between duration of physical therapy and occupational therapy and mobility at the time of discharge from a comprehensive rehabilitation program in a group of patients with orthopedic diagnoses. Subjects. Subjects were 116 consecutive patients with orthopedic diagnoses (mean age=72.6 years, SD=12.0, range=21–99) who were admitted to a comprehensive inpatient rehabilitation program. Methods. This retrospective cohort study utilized the Uniform Data Set, social service records, and quality assurance records to provide demographic and medical information. The Functional Independence Measure (FIM) provided information regarding mobility at admission and discharge. The duration of physical therapy and occupational therapy was measured in hours. Results. Subjects received an average of 40.8 hours of therapy and showed an average change in FIM mobility subscale scores of 24.5. Multiple linear regression was used to demonstrate that duration of therapy was a predictor of FIM score at the time of discharge (partial correlation=.069) after controlling for length of stay, number of diagnoses, FIM cognitive subscale score at admission, and FIM mobility subscale score at admission. Duration of therapy accounted for 6.9% of the variance in the model. Conclusion and Discussion. This study indicates that the amount of physical therapy and occupational therapy that patients with orthopedic diagnoses receive during enrollment in an inpatient comprehensive rehabilitation program is related to the FIM mobility subscale score at the time of discharge. The authors suggest that increasing the hours of therapeutic intervention that a patient receives in inpatient rehabilitation could improve functional outcomes at discharge.
Physical Therapy for Spinal Accessory Nerve Injury Complicated by Adhesive Capsulitis
Authors: Laska Tadeusz , Hannig Kimberly
Published: February 2017

Background and Purpose. The authors found no literature describing adhesive capsulitis as a consequence of spinal accessory nerve injury and no exercise program or protocol for patients with spinal accessory nerve injury. The purpose of this case report is to describe the management of a patient with adhesive capsulitis and spinal accessory nerve injury following a carotid endarterectomy. Case Description. The patient was a 67-year-old woman referred for physical therapy following manipulation of the left shoulder and a diagnosis of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was identified during the initial physical therapy examination, and a program of neuromuscular electrical stimulation was initiated. Outcomes. The patient had almost full restoration of the involved muscle function after 5 months of physical therapy. Discussion. This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury.
Physical Therapy Management of Low Back Pain: An Exploratory Survey of Therapist Approaches
Authors: Li Linda C , Bombardier Claire
Published: February 2017

Background and Purpose. Since the release of acute low back pain management guidelines in 1994, little was known about the effect of these guidelines on clinical practice. The purpose of this study was to examine physical therapists' reported management of acute and subacute lumbar impairment. Subjects. One in 10 registered physical therapists who were randomly selected from southern Ontario, Canada, (n=454) and all registered physical therapists from northern Ontario (n=331) were surveyed. Methods. In the questionnaire, case scenarios covered 3 areas related to the management of lumbar impairment: (1) physical examination, (2) treatment and recommendations, and (3) therapists' beliefs regarding its management. Results. Five hundred sixty-nine questionnaires were returned (response rate=72.5%). Only data obtained for therapists (n=274) whose weekly workload included more than 10% of people with lumbar impairment were used in the analysis. Overall, patient education, exercise, and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment (symptom onset of less than 5 weeks) with or without sciatica, whereas exercise and work modification were preferred for subacute lumbar impairment (symptom onset of 5 weeks or longer). There was a trend of using electrotherapeutic and thermal modalities of uncertain effectiveness. Only 46.3% of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment. Discussion and Conclusion. Although the physical therapists surveyed, in general, followed the guidelines in managing acute lumbar impairment, they felt uncertain regarding the value of practice guidelines. Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines.
A Randomized Controlled Trial of a Passive Accessory Joint Mobilization on Acute Ankle Inversion Sprains
Authors: Green Toni , Refshauge Kathryn , Crosbie Jack , Adams Roger
Published: February 2017

Background and Purpose. Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains. A randomized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and 3 gait variables: stride speed (gait speed), step length, and single support time. Subjects. Forty-one subjects with acute ankle inversion sprains (<72 hours) and no other injury to the lower limb entered the trial. Methods. Subjects were randomly assigned to 1 of 2 treatment groups. The control group received a protocol of rest, ice, compression, and elevation (RICE). The experimental group received the anteroposterior mobilization, using a force that avoided incurring any increase in pain, in addition to the RICE protocol. Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met, and all subjects were given a home program of continued RICE application. Outcomes were measured before and after each treatment. Results. The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion. The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions. The experimental group also had greater increases in stride speed during the first and third treatment sessions. Discussion and Conclusion. Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone. Improvement in step length symmetry and single support time was similar in both groups.
Changes in Attitudes and Perceptions About Research in Physical Therapy Among Professional Physical Therapist Students and New Graduates
Authors: Connolly Barbara H , Lupinnaci Norwood S , Bush Andrew J
Published: February 2017

Background and Purpose. The physical therapy profession, through its published educational accreditation standards and its normative model of professional education, has addressed the importance of educating physical therapist students in the basic principles and application of research. The purpose of this study was to conduct a longitudinal study of students relative to (1) their perception of knowledge with respect to research, (2) their perception of what source should be used (evidence-based practice or traditional protocols) for clinical decision making, and (3) their perception of what should be used in a clinical setting for patient management. Subjects. Thirty-six students during the final year of their professional program from a sample of 115 physical therapist students who requested 2 consecutive physical therapist classes completed the entire sequence of pretest and posttest survey administrations. Seventy-nine students did not complete the entire sequence. Methods. A 10-item 5-point Likert-type questionnaire was designed by the authors to probe the students' attitudes and perceptions about research, their level of comfort and confidence in reading and applying research findings published in the literature, and their personal habits regarding reading the professional literature. An expert panel consisting of internal and external reviewers was used for construction of the questionnaire. The questionnaire was completed by the students immediately preceding their research methods course, immediately after the completion of that course, and following the second research course, which included statistics and development of a research proposal. The subjects also completed the questionnaire after 1 year of physical therapy practice. Friedman's analysis of variance was used as an omnibus test to detect differences across time. In addition, a follow-up analysis using the Wilcoxon signed-rank procedure to examine differences between baseline data and data obtained during each follow-up was done for all items to determine whether a difference occurred at a time other than at the final posttest survey administration. Results. The students showed differences on 5 of the 10 items on the questionnaire during the study. Discussion and Conclusion. These items related to reading peer-reviewed professional journals, critically reading professional literature, relevance and importance of evidence-based clinical practice, and level of comfort with knowledge in research.
Physical Therapist Management of Tuberculous Arthritis of the Elbow
Authors: Dahl Corey S
Published: February 2017

Background and Purpose. Tuberculous arthritis is not commonly seen by physical therapists in the United States. The purpose of this case report is to describe a case of tuberculous arthritis of the elbow. Case Description. The patient was a 36-year-old man referred for physical therapist evaluation and intervention for chronic elbow pain. After an evaluation and a trial of physical therapy, the patient was referred back to a primary care provider for additional tests to rule out systemic pathology. An open debridement of the synovium and a biopsy of the capitellum and radial head was positive for acid-fast bacilli, which was later identified as Mycobacterium tuberculosis. Outcomes. The patient was placed on a 4-drug antituberculosis regimen that resolved all patient complaints and restored full elbow function. Discussion. Tuberculous arthritis has characteristic findings during examination and in diagnostic tests. Although tuberculous arthritis is uncommon, it should be considered when patients have chronic or vague musculoskeletal complaints.
Development of the Professional Role Behaviors Survey (PROBES)
Authors: Lopopolo Rosalie B
Published: February 2017

Background and Purpose. This study examined the content validity, internal consistency, and underlying dimensions of the Professional Role Behaviors Survey (PROBES) for its use in future research. Methods. Using the 26-item PROBES, 253 clinical managers reported on the direction and magnitude of change in the role behaviors of physical therapists following hospital restructuring. Results. Descriptive and correlational statistics of the responses indicated that the nature of the role behavior changes was consistent with those identified in the literature and that the survey instrument had good internal consistency. A principal component factor analysis yielded 5 underlying role behavior dimensions: “evaluating and planning,” “productivity,” “inter-acting,” “information sharing,” and “administration/clinical.” This factor structure was found to provide a good fit with role classification schemes and a clear differentiation of physical therapist role behaviors. In addition, the finding supports viewing the professional role behaviors as a single construct rather than as multiple constructs. Discussion and Conclusion. The PROBES was found to have good content validity and internal consistency. It provides a useful tool for the study of the changing roles of professional practitioners and a link in the study of the effect of organizational change on organizational outcomes such as job satisfaction and organizational commitment.
Use of Prolonged Standing for Individuals With Spinal Cord Injuries
Authors: Eng Janice J , Levins Stephen M , Townson Andrea F , Mah-Jones Dianna , Bremner Joy , Huston Grant
Published: February 2017

Background and Purpose. Prolonged standing in people with spinal cord injuries (SCIs) has the potential to affect a number of health-related areas such as reflex activity, joint range of motion, or well-being. The purpose of this study was to document the patterns of use of prolonged standing and their perceived effects in subjects with SCIs. Subjects. The subjects were 152 adults with SCIs (103 male, 49 female; mean age=34 years, SD=8, range=18–55) who returned mailed survey questionnaires. Methods. A 17-item self-report survey questionnaire was sent to the 463 members of a provincial spinal cord support organization. Results. Survey responses for 26 of the 152 respondents were eliminated from the analysis because they had minimal effects from their injuries and did not need prolonged standing as an extra activity. Of the 126 remaining respondents, 38 respondents (30%) reported that they engaged in prolonged standing for an average of 40 minutes per session, 3 to 4 times a week, as a method to improve or maintain their health. The perceived benefits included improvements in several health-related areas such as well-being, circulation, skin integrity, reflex activity, bowel and bladder function, digestion, sleep, pain, and fatigue. The most common reason that prevented the respondents from standing was the cost of equipment to enable standing. Discussion and Conclusion. Considering the many reported benefits of standing, this activity may be useful for people with SCI. This study identified a number of body systems and functions that may need to be investigated if clinical trials of prolonged standing in people with SCI are undertaken.
Variation by Diagnostic and Practice Pattern Groups in the Mobility Outcomes of Inpatient Rehabilitation Programs for Children and Youth
Authors: Haley Stephen M , Dumas Helene M , Ludlow Larry H
Published: February 2017

Background and Purpose. The purpose of this study was to describe variation in functional mobility outcomes among children and youth with different diagnoses and belonging to groups with different practice patterns from an inpatient pediatric rehabilitation hospital setting. Subjects. A sample of 138 individuals between the ages of 1 and 22 years (X̄=9.4, SD=5.3) was enrolled. Methods. Physical therapists administered the “Mobility” domain of the Pediatric Evaluation of Disability Inventory at the time of admission and at the time of discharge. Mobility level (combined admission and discharge scores) and amount of change between and within 4 diagnostic groups (traumatic brain injury, non–traumatic brain injury, orthopedic, and neurological) and 5 neuromuscular and musculoskeletal practice pattern groups were calculated, and post hoc analyses were done for specific contrast comparisons. Results. Mobility scores between admission and discharge for all subgroups were different. Practice pattern groups were useful for identifying variations in level of motor performance. Diagnostic groups best described differences in mobility change during inpatient rehabilitation. Discussion and Conclusion. The use of practice patterns as grouping categories may enhance our understanding of variation in clinical outcomes of children during inpatient rehabilitation.
Sociocultural Influences on Disability Status in Puerto Rican Children
Authors: Gannotti Mary E , Handwerker W Penn , Groce Nora Ellen , Cruz Cynthia
Published: February 2017

Background and Purpose. This article describes culturally defined meanings of childhood function and disability in Puerto Rico to provide a context for the interpretation of test scores from the Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI). Subjects and Methods. More than 600 Puerto Rican teachers, parents and caregivers of children with and without disabilities, and members of the general community participated in ethnographic interviews, which were designed to describe their beliefs, attitudes, and knowledge about childhood function and disability. Results. Qualitative and quantitative data analysis confirmed that differences exist between Puerto Ricans and the norms established in the United States for the performance of functional skills by children, and the analysis also described Puerto Rican beliefs and attitudes toward disability. Discussion and Conclusion. Puerto Rican values of interdependence, añoñar (pampering or nurturing behaviors), and sobre protectiva (overprotectiveness) influence parental expectations for the capability of children with disabilities and should be considered when interpreting scores from the PEDI and establishing plans of care. Additional research is needed on the influence of contextual variables on child development and behavioral adaptations to disability.
Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction
Authors: Morrissey Matthew C , Drechsler Wendy I , Morrissey Dylan , Knight Philippa R , Armstrong Paul W , McAuliffe Thomas B
Published: February 2017

Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.
Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema
Authors: Donachy Julie E , Christian Emily L
Published: February 2017

Background and Purpose. This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. Case Description. The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. Outcomes. Following surgical release, the patient' s numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. Discussion. This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.
Physical Therapist Management of Fluoroquinolone-Induced Achilles Tendinopathy
Authors: Greene Brenda L
Published: February 2017

Background and Purpose. Use of fluoroquinolone antibiotics is reported to be a cause of adverse musculoskeletal effects, such as tendinopathies and tendon ruptures. The purpose of this case report is to describe the management and outcomes of a patient with bilateral Achilles tendinopathy secondary to fluoroquinolone antibiotic use. Case Description. The patient was a 41-year-old man who developed bilateral Achilles tendon pain on the third day of levofloxacin use. The physical therapy intervention consisted of an initial phase to reduce stress on the tendon through the use of crutches and orthoses and a second phase to progressively stress the tendon through exercise and functional activities. Outcomes. After 11 weeks of physical therapy (14 treatments), the patient's pain decreased from 3/10 to 1/10 on a visual analog scale and his Lower Extremity Functional Scale score increased from 28/80 to 71/80. Discussion. An overlapping 2-phased intervention approach based on connective tissue remodeling principles may be effective in elimination of pain and restoration of function following fluoroquinolone-induced Achilles tendinopathy.
Skin Cancer Screening
Authors: Wills Mary
Published: February 2017

Background. Skin cancer is the most common malignancy occurring in humans, affecting 1 in 5 Americans at some time during their lives. Early detection of cancerous lesions is important for reducing morbidity and mortality. Case Description. The patient was a 79-year-old woman who was receiving physical therapy for cervical stenosis. The physical therapist identified a mole with suspicious characteristics, using the ABCD checklist for skin cancer screening. The patient was referred to her primary care physician, and the lesion was removed and identified as basal cell carcinoma. Outcomes. Early detection of this lesion allowed for complete excision, with no further treatment of the area warranted. Discussion. Physical therapists can aid in detection of suspect lesions with knowledge of the basic screening techniques for skin cancer, which may help reduce the morbidity and mortality caused by these lesions.
Age- and Gender-Related Test Performance in Community-Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds
Authors: Steffen Teresa M , Hacker Timothy A , Mollinger Louise
Published: February 2017

Background and Purpose. The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities. The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults. Subjects. Ninety-six community-dwelling elderly people (61–89 years of age) with independent functioning performed 4 clinical tests. Methods. Data were collected on the Six-Minute Walk Test (6MW), Berg Balance Scale (BBS), and Timed Up & Go Test (TUG) and during comfortable- and fast-speed walking (CGS and FGS). Intraclass correlation coefficients (ICCs) were used to determine the test-retest reliability for the 6MW, TUG, CGS, and FGS measurements. Data were analyzed by gender and age (60–69, 70–79, and 80–89 years) cohorts, similar to previous studies. Means, standard deviations, and 95% confidence intervals for each measurement were calculated for each cohort. Results. The 6MW, TUG, CGS, and FGS measurements showed high test-retest reliability (ICC [2,1]=.95–.97). Mean test scores showed a trend of age-related declines for the 6MW, BBS, TUG, CGS, and FGS for both male and female subjects. Discussion and Conclusion. Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW, BBS, TUG, CGS and FGS. Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons.
Three Perspectives on Physical Therapist Managerial Work
Authors: Schafer D Sue
Published: February 2017

Background and Purpose. The nature of managerial work in the commercial sector has not been studied since the 1970s, and little is known about the work of managers in the health care sector. In this study, the perceived importance of managerial role and skill categories among 3 groups of physical therapists were studied to better understand the work priorities of physical therapist managers. Subjects. Two groups of subjects were physical therapist managers in hospitals or private practices. A third group consisted of faculty members in professional physical therapist education programs. Methods. Respondents (n=343) rated the importance of 75 managerial activities. Responses related to 16 predetermined work categories were placed in rank order by group. A multivariate analysis of variance (MANOVA) was used to identify differences among groups. Results. All groups identified communication, financial control, entrepreneur, resource allocator, and leader as the 5 most important categories and rated technical expert and figurehead as least important. The MANOVA showed differences between faculty members and private practice managers in 15 work categories, between hospital-based managers and private practice managers in 9 categories, and between faculty members and hospital-based managers in 8 categories. Discussion and Conclusion. Work setting appears to have an impact on level of importance placed on managerial work categories. The strongest candidates for “universal” physical therapist managerial work categories were communication, financial control, and resource allocator.