bluuebunny/crossref_metadata_2025 huggingface dataset:
Movement Disorders in People With Parkinson Disease: A Model for Physical Therapy
Authors: Morris Meg E
Published: February 2017

People who are diagnosed with idiopathic Parkinson disease (PD) experience movement disorders that, if not managed, can lead to considerable disability. The premise of this perspective is that physical therapy for people with PD relies on clinicians having: (1) up-to-date knowledge of the pathogenesis of movement disorders, (2) the ability to recognize common movement disorders in people with PD, (3) the ability to implement a basic management plan according to a person's stage of disability, and (4) problem-solving skills that enable treatment plans to be tailored to individual needs. This article will present a model of physical therapy management for people with idiopathic PD based on contemporary knowledge of the pathogenesis of movement disorders in basal ganglia disease as well as a review of the evidence for physical therapy interventions. The model advocates a task-specific approach to training, with emphasis on treating people with PD-related movement disorders such as hypokinesia and postural instability within the context of functional tasks of everyday living such as walking, turning over in bed, and manipulating objects. The effects of medication, cognitive impairment, the environment, and coexisting medical conditions are also taken into consideration. An argument is put forward that clinicians need to identify core elements of physical therapy training that apply to all people with PD as well as elements specific to the needs of each individual. A case history is used to illustrate how physical therapy treatment is regularly reviewed and adjusted according to the changing constellation of movement disorders that present as the disease progresses.
Locomotor Training After Human Spinal Cord Injury: A Series of Case Studies
Authors: Behrman Andrea L , Harkema Susan J
Published: February 2017

Many individuals with spinal cord injury (SCI) do not regain their ability to walk, even though it is a primary goal of rehabilitation. Mammals with thoracic spinal cord transection can relearn to step with their hind limbs on a treadmill when trained with sensory input associated with stepping. If humans have similar neural mechanisms for locomotion, then providing comparable training may promote locomotor recovery after SCI. We used locomotor training designed to provide sensory information associated with locomotion to improve stepping and walking in adults after SCI. Four adults with SCIs, with a mean postinjury time of 6 months, received locomotor training. Based on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards, subject 1 had a T5 injury classified as ASIA A, subject 2 had a T5 injury classified as ASIA C, subject 3 had a C6 injury classified as ASIA D, and subject 4 had a T9 injury classified as ASIA D. All subjects improved their stepping on a treadmill. One subject achieved overground walking, and 2 subjects improved their overground walking. Locomotor training using the response of the human spinal cord to sensory information related to locomotion may improve the potential recovery of walking after SCI.
The Development of an Instrument to Measure Satisfaction With Physical Therapy
Authors: Goldstein Marc S , Elliott Steven D , Guccione Andrew A
Published: February 2017

Background and Purpose. Patient satisfaction continues to receive attention as a measure of the outcome of physical therapy intervention. However, a great deal more attention has been paid to the topic outside of, rather than within, physical therapy. This article describes the development of an instrument that measures patient satisfaction among physical therapists' patients and clients. Method. A 26-item instrument designed to measure the domains of patient satisfaction among patients was developed by the authors in preparation for this study and field tested on patients from several sites comprising a large clinical operation. Descriptive statistics and estimates of reliability of measurements obtained with the instrument were computed. Reliability and validity were assessed. A total of 289 individuals completed the instrument. Results. The coefficient for reliability (Cronbach alpha=.99) obtained for the instrument was clearly within a desired range. Different types of validity were established as well. Conclusion and Discussion. Instruments typically used by physical therapists to measure patient satisfaction have undergone little psychometric analysis. This instrument appears to meet the criteria required to make it a useful tool for measuring patient satisfaction.
Use of Visual Feedback in Retraining Balance Following Acute Stroke
Authors: Walker Catherine , Brouwer Brenda J , Culham Elsie G
Published: February 2017

Background and Purpose. Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke, although it is not clear whether functional balance ability also improves. This study compared the relative effectiveness of visual feedback training of center-of-gravity (CoG) positioning with conventional physical therapy following acute stroke. Subjects. Forty-six people who had strokes within 80 days before the study, resulting in unilateral hemiparesis, and who were in need of balance retraining participated. Methods and Materials. Initially, subjects were randomly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited. The next 14 subjects were assigned to a control group. All subjects received physical therapy and occupational therapy (regular therapy) 2 hours a day, and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge. The visual feedback group received information about their CoG position as they shifted their weight during various activities. The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting. Static (postural sway) and activity-based measures of balance (Berg Balance Scale, gait speed, and the Timed “Up & Go” Test) were contrasted across the 3 groups at baseline, at discharge, and at 1 month following discharge using an analysis of variance for repeated measures. Results. All groups demonstrated marked improvement over time for all measures of balance ability, with the greatest improvements occurring in the period from baseline to discharge. No between-group differences were detected in any of the outcome measures. Conclusion and Discussion. Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke.
Implicit Learning of a Perceptual-Motor Skill After Stroke
Authors: Pohl Patricia S , McDowd Joan M , Filion Diane L , Richards Lorie G , Stiers William
Published: February 2017

Background and Purpose. A motor skill can be learned implicitly, without awareness of what is being learned. The purpose of this study was to examine the ability of adults who had unilateral stroke to learn implicitly a perceptual-motor task. Subjects. Subjects were 47 people who were poststroke and 36 control subjects. Methods. Participants performed sequences of hand movements in response to target lights in 2 conditions: a patterned sequence and a random sequence. Participants were not given explicit knowledge of the presence of the 2 conditions. Those who had stroke performed with the upper-extremity ipsilateral to the lesion. Results. Subjects who had stroke performed more slowly than control subjects. For both groups, times decreased with practice of the patterned sequence, increased with introduction of the random sequence, and decreased again with reintroduction of the patterned sequence. Group differences persisted in a retention test given the next day of the patterned sequence, and both groups showed decreased times over the course of the retention test. Discussion and Conclusion. People with stroke are able to learn a perceptual-motor task even without explicit instructions regarding the patterned sequence embedded in the task.
Effect of Aerobic Exercise on Tracking Performance in Elderly People: A Pilot Study
Authors: Bakken Rachel C , Carey James R , Di Fabio Richard P , Erlandson Trevor J , Hake Jennifer L , Intihar Todd W
Published: February 2017

Background and Purpose. Although much is known about the benefits of aerobic exercise on cardiovascular health, little research has been done on the effect of aerobic exercise on motor performance. This study examined whether aerobic exercise has an effect on visuospatial information processing during finger-movement tracking in elderly subjects. Subjects. Fifteen elderly subjects (mean age=83.2 years, SD=5.7, range=72–91) from a senior housing complex were randomly assigned to a control group or an experimental (exercise) group. Twelve subjects completed the study, and data obtained for 10 subjects were used for data analysis (2 control subjects were eliminated to allow for matched-pairs analysis between the experimental and control groups). The control group (n=5) had a mean age of 80.2 years (SD=7.8). Subjects in the experimental group (n=5) had a mean age of 84.8 years (SD=2.5). Methods. The intervention consisted of group exercise 3 times a week for 8 consecutive weeks, and included calisthenics (eg, marching in place, side stepping, mock boxing), stationary bicycling, and walking. A finger-movement tracking test and submaximal graded exercise tolerance step tests were performed before and after training to determine changes in finger-movement tracking and any aerobic training effects. Results. Matched-pairs t tests showed a difference in tracking from pretest to posttest in the experimental group compared with the control group. Step test performance did not differ between the 2 groups. Discussion and Conclusion. The results of this small-scale study with a limited number of subjects indicate that, for elderly people, finger-movement tracking performance can improve with aerobic exercise, despite the absence of an aerobic training effect. Possible mechanisms for the treatment effect on information processing are discussed.
Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations
Authors: Miller Patricia A , Goddard Peggy , Spence Laschinger Heather K
Published: February 2017

Background and Purpose. Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. Subjects and Methods. A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. Results. Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (X̄=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (X̄=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. Discussion and Conclusion. Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted.
A Comparison of a Modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale
Authors: Fritz Julie M , Irrgang James J
Published: February 2017

Background and Purpose. The quality of a disability scale should dictate when it is used. The purposes of this study were to examine the validity of a global rating of change as a reflection of meaningful change in patient status and to compare the measurement properties of a modified Oswestry Low Back Pain Disability Questionnaire (OSW) and the Quebec Back Pain Disability Scale (QUE). Subjects. Sixty-seven patients with acute, work-related low back pain referred for physical therapy participated in the study. Methods. The 2 scales were administered initially and after 4 weeks of physical therapy. The Physical Impairment Index, a measure of physical impairment due to low back pain, was measured initially and after 2 and 4 weeks. A global rating of change survey instrument was completed by each subject after 4 weeks. Results. An interaction existed between patients defined as improved or stable based on the global rating using a 2-way analysis of variance for repeated measures on the impairment index. The modified OSW showed higher levels of test-retest reliability and responsiveness compared with the QUE. The minimum clinically important difference, defined as the amount of change that best distinguishes between patients who have improved and those remaining stable, was approximately 6 points for the modified OSW and approximately 15 points for the QUE. Conclusion and Discussion. The construct validity of the global rating of change was supported by the stability of the Physical Impairment Index across the study period in patients defined as stable by the global rating and by the decrease in physical impairment across the study period in patients defined as improved by the global rating. The modified OSW demonstrated superior measurement properties compared with the QUE.
Measurement of Scapular Asymmetry and Assessment of Shoulder Dysfunction Using the Lateral Scapular Slide Test: A Reliability and Validity Study
Authors: Odom Corrie J , Taylor Andrea B , Hurd Christine E , Denegar Craig R
Published: February 2017

Background and Purpose. The Lateral Scapular Slide Test (LSST) is used to determine scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Assessment of scapular position is based on the derived difference measurement of bilateral scapular distances. The purpose of this study was to assess the reliability of measurements obtained using the LSST and whether they could be used to identify people with and without shoulder impairments. Subjects. Forty-six subjects ranging in age from 18 to 65 years (X̄=30.0, SD=11.1) participated in this study. One group consisted of 20 subjects being treated for shoulder impairments, and one group consisted of 26 subjects without shoulder impairments. Methods. Two measurements in each test position were obtained bilaterally. From the bilateral measurements, we derived the difference measurement. Intraclass correlation coefficients (ICC [1,1]) and the standard error of measurement (SEM) were calculated for intrarater and interrater reliability of the difference in side-to-side measures of scapular distance. Sensitivity and specificity of the LSST for classifying subjects with and without shoulder impairments were also determined. Results. The ICCs for intrarater reliability were .75, .77, and .80 and .52, .66, and .62, respectively, for subjects without and with shoulder impairments in 0, 45, and 90 degrees of abduction. The ICCs for interrater reliability were .67, .43, and .74 and .79, .45, and .57, respectively, for subjects without and with shoulder impairments in 0, 45 and 90 degrees of abduction. The SEMs ranged from 0.57 to 0.86 cm for intrarater reliability and from 0.79 to 1.20 cm for interrater reliability. Using the criterion of greater than 1.0 cm difference, sensitivity and specificity were 35% and 48%, 41% and 54%, and 43% and 56%, respectively, for 0, 45, and 90 degrees of abduction. Sensitivity and specificity based on the criterion of greater than 1.5 cm difference were 28% and 53%, 50% and 58%, and 34% and 52%, respectively, for the 3 scapular positions. Conclusion and Discussion. Our results suggest that measurements of scapular positioning based on the difference in side-to-side scapular distance measures are not reliable. Furthermore, the results suggest that sensitivity and specificity of the LSST measurements are poor and that the LSST should not be used to identify people with and without shoulder dysfunction.
Reliability of Measurements Obtained With the Timed “Up & Go” Test in People With Parkinson Disease
Authors: Morris Susan , Morris Meg E , Iansek Robert
Published: February 2017

Background and Purpose. The Timed “Up & Go” Test (TUG) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning. This study investigated the retest reliability, interrater reliability, and sensitivity of TUG scores in detecting changes in mobility in subjects with idiopathic Parkinson disease (PD). Subjects. The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD. Methods. The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours (“off” phase of the medication cycle) as well as an additional 5 trials 1 hour after levodopa was administered (“on” phase of the medication cycle). They were scored on the Modified Webster Scale at both sessions. The comparison subjects also performed 5 TUG trials. All trials were videotaped and timed by 2 experienced raters. The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians. Results. For the subjects with PD, within-session performance was highly consistent, with correlations (r) ranging from .80 to .98 for the “off” phase and from .73 to .99 for the “on” phase. The performance of the comparison subjects across the 5 trials was also highly consistent (r=.90–.97). Comparisons showed differences between trials 1 and 2 on the TUG for both groups. Removal of data for trial 1 (the practice trial) further enhanced retest reliability. There was close agreement in TUG scores among raters despite different levels of experience (intraclass correlation coefficient [3,1]=.87–.99). Mean TUG scores were different between the “on” and “off” phases of the levodopa cycle and between subjects with PD and comparison subjects during the “on” phase. Conclusion and Discussion. Retest reliability and interrater reliability of the TUG measurements were high, and the measurements reflected changes in performance according to levodopa use. The TUG can also be used to detect differences in performance between people with PD and elderly people without PD.
Gait Re-education Based on the Bobath Concept in Two Patients With Hemiplegia Following Stroke
Authors: Lennon Sheila
Published: February 2017

Background and Purpose. This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy. Case Description. One patient (“NM”), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient (“SA”), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept. Outcomes. At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension. Discussion. These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.
Exercise Combined With Continuous Passive Motion or Slider Board Therapy Compared With Exercise Only: A Randomized Controlled Trial of Patients Following Total Knee Arthroplasty
Authors: Beaupré Lauren A , Davies Donna M , Jones C Allyson , Cinats John G
Published: February 2017

Background and Purpose. The primary purpose of this randomized controlled trial was to determine which method of mobilization—(1) standardized exercises (SE) and continuous passive motion (CPM), (2) SE and slider board (SB) therapy, using an inexpensive, nontechnical device that requires minimal knee active range of motion (ROM), or (3) SE alone—achieved the maximum degree of knee ROM in the first 6 months following primary total knee arthroplasty (TKA). The secondary purpose was to compare health-related quality of life among these 3 groups. Subjects. The subjects were 120 patients (n=40/group) who received a TKA at a teaching hospital between June 1997 and July 1998 and who agreed to participate in the study. Methods. Subjects were examined preoperatively, at discharge, and at 3 and 6 months after surgery. The examination consisted of measurement of knee ROM and completion of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results. The 3 treatment groups were similar with respect to age, sex, and diagnosis at the start of the study. There were no differences in knee ROM or in WOMAC Osteoarthritis Index or SF-36 scores at any of the measurement intervals. The rate of postoperative complications also was not different among the groups. Discussion and Conclusion. When postoperative rehabilitation regimens that focus on early mobilization of the patient are used, adjunct ROM therapies (CPM and SB) that are added to daily SE sessions are not required. Six months after TKA, patients attain a satisfactory level of knee ROM and function.
Balance and Mobility Following Stroke: Effects of Physical Therapy Interventions With and Without Biofeedback/Forceplate Training
Authors: Geiger Ruth Ann , Allen Jeffery B , O'Keefe Joanne , Hicks Ramona R
Published: February 2017

Background and Purpose. Visual biofeedback/forceplate systems are often used for treatment of balance disorders. In this study, the researchers investigated whether the addition of visual biofeedback/forceplate training could enhance the effects of other physical therapy interventions on balance and mobility following stroke. Subjects. The study included a sample of convenience of 13 outpatients with hemiplegia who ranged in age from 30 to 77 years (X̄=60.4, SD=15.4) and were 15 to 538 days poststroke. Methods. Subjects were assigned randomly to either an experimental group or a control group when the study began, and their cognitive and visual-perceptual skills were tested by a psychologist. Subjects were also assessed using the Berg Balance Scale and the Timed “Up & Go” Test before and after 4 weeks of physical therapy. Both groups received physical therapy interventions designed to improve balance and mobility 2 to 3 times per week. The experimental group trained on the NeuroCom Balance Master for 15 minutes of each 50-minute treatment session. The control group received other physical therapy for 50 minutes. Results. Following intervention, both groups scored higher on the Berg Balance Scale and required less time to perform the Timed “Up & Go” Test. These improvements corresponded to increased independence of balance and mobility in the study population. However, a comparison of mean changes revealed no differences between groups. Discussion and Conclusion. Although both groups demonstrated improvement following 4 weeks of physical therapy interventions, no additional effects were found in the group that received visual biofeedback/forceplate training combined with other physical therapy.
The Effect of Duration of Stretching of the Hamstring Muscle Group for Increasing Range of Motion in People Aged 65 Years or Older
Authors: Feland J Brent , Myrer J William , Schulthies Shane S , Fellingham Gill W , Measom Gary W
Published: February 2017

Background and Purpose. Stretching protocols for elderly people (≥65 years of age) have not been studied to determine the effectiveness of increasing range of motion (ROM). The purpose of this study was to determine which of 3 durations of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals. Subjects. Sixty-two subjects (mean age=84.7 years, SD=5.6, range= 65–97) with tight hamstring muscles (defined as the inability to extend the knee to less than 20° of knee flexion) participated. Subjects were recruited from a retirement housing complex and were independent in activities of daily living. Methods. Subjects were randomly assigned to 1 of 4 groups and completed a physical activity questionnaire. The subjects in group 1 (n=13, mean age=85.1 years, SD=6.4, range=70–97), a control group, performed no stretching. The randomly selected right or left limb of subjects in group 2 (n=17, mean age=85.5 years, SD=4.5, range=80–93), group 3 (n=15, mean age=85.2 years, SD=6.5, range=65–92), and group 4 (n=17, mean age=83.2 years, SD=4.6, range=68–90) was stretched 5 times per week for 6 weeks for 15, 30, and 60 seconds, respectively. Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects. Data were analyzed using a growth curve model. Results. A 60-second stretch produced a greater rate of gains in ROM (60-second stretch=2.4° per week, 30-second stretch=1.3° per week, 15-second stretch=0.6° per week), which persisted longer than the gains in any other group (group 4 still had 5.4° more ROM 4 weeks after treatment than at pretest as compared with 0.7° and 0.8° for groups 2 and 3, respectively). Discussion and Conclusion. Longer hold times during stretching of the hamstring muscles resulted in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects. These results may differ from those of studies performed with younger populations because of age-related physiologic changes.
Patient Participation in Physical Therapy Goal Setting
Authors: Baker Susan M , Marshak Helen H , Rice Gail T , Zimmerman Grenith J
Published: February 2017

Background and Purpose. An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. Subjects and Methods. Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (X̄=76.4 years of age, SD=7.1, range=65–94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. Results. Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. Discussion and Conclusion. In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.
Reasons Given by California Physical Therapists for Not Belonging to the American Physical Therapy Association
Authors: McGinty Susan M , Cicero Michael C , Cicero Jessica ME , Schultz-Janney Lori , Williams-Shipman Kari L
Published: February 2017

Background and Purpose. In 1997, only 22% of licensed physical therapists living in California were members of the American Physical Therapy Association (APTA). This 1998 study was designed to identify the reason(s) why most licensed physical therapists in California choose not to belong to their profession's national association and to examine the demographics of nonmembers. Subjects. The subjects were a random sample of 400 California licensed physical therapists who were not members of APTA. Methods. The survey instrument included a demographic questionnaire and statements for response using a 5-point Likert-type scale. Frequency distributions were calculated for responses and demographic data. Nonparametric analyses were used to determine statistical significance. Chi-square analysis was used to compare responses to statements by gender and by full-time versus part-time work status. Spearman rank correlation coefficients were used to determine any relationships between demographic data (eg, gender and work status). The Mann-Whitney U test was used to determine any differences in responses to specific representation questions by those respondents who worked in specific practice environments. All statistical tests were 2-tailed tests conducted at the P<.05 level, unless otherwise indicated. Means, standard deviations, and ranges were used where appropriate. Results. There was a 67% response rate. Eighty-nine percent of the respondents had been members of APTA. Eighty-eight percent of the respondents believed that APTA national dues were too high, and 90% thought California Chapter dues were too high. Discussion and Conclusion. Cost was the primary reason given for APTA nonmembership in California.
Making Geriatric Assessment Work: Selecting Useful Measures
Authors: VanSwearingen Jessie M , Brach Jennifer S
Published: February 2017

Often the goal of physical therapy is to reduce morbidity and prevent or delay loss of independence. The purpose of this article is to describe issues to consider when selecting measures of physical function for use with community-dwelling adults over the age of 65 years. We chose 16 measures of physical function for review because they have been used in studies of community-dwelling older adults and some psychometric properties of reliability and validity have been described in the literature. Three major issues are discussed: (1) appropriateness of the measure for community-dwelling older adults, (2) practical aspects of test administration, and (3) psychometric properties. These issues are illustrated using examples from the 16 measures. Two scenarios, applying the measures to the assessment of physical performance of community-dwelling well older people and to the assessment of physical performance of community-dwelling frail older people, are used to illustrate how this information can be used.
A Review of Therapeutic Ultrasound: Effectiveness Studies
Authors: Robertson Valma J , Baker Kerry G
Published: February 2017

Background and Purpose. Therapeutic ultrasound is one of the most widely and frequently used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions remains questionable. This article presents a systematic review of randomized controlled trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial was designed to investigate the contributions of active and placebo ultrasound to the patient outcomes measured. Depending on the condition, ultrasound (active and placebo) was used alone or in conjunction with other interventions in a manner designed to identify its contribution and distinguish it from those of other interventions. Methods. Thirty-five English-language RCTs were published between 1975 and 1999. Each RCT identified was scrutinized for patient outcomes and methodological adequacy. Results. Ten of the 35 RCTs were judged to have acceptable methods using criteria based on those developed by Sackett et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not. Discussion and Conclusion. There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to have adequate methods examined a wide range of patient problems. The dosages used in these studies varied considerably, often for no discernable reason.
Considerations for Planning and Conducting Clinic-Based Research in Physical Therapy
Authors: Fitzgerald G Kelley , Delitto Anthony
Published: February 2017

There is growing demand to increase the volume of clinic-based research in physical therapy. Special considerations, unique to the planning and conduct of clinic-based research, need to be addressed to increase the likelihood that these studies will be completed successfully. The purposes of this perspective are to discuss factors affecting clinic-based research and to offer suggestions for addressing these problems when designing and conducting research studies in a clinical setting. This perspective discusses issues such as patient management, determining the availability of target patient populations, acquiring support from physical therapists and physicians, reporting and managing research-related injury or illness, and modifying or terminating projects. Some of the points made in this perspective are illustrated using examples from the authors' experiences in conducting clinical research.
Cardiovascular Responses to Repetitive McKenzie Lumbar Spine Exercises
Authors: Al-Obaidi Saud , Anthony Joseph , Dean Elizabeth , Al-Shuwai Nadia
Published: February 2017

Background and Purpose. Repetitive exercises of the type recommended by McKenzie for the lumbar spine, such as flexion and extension exercises in standing (FIS and EIS) and lying positions (FIL and EIL), have been used in the management of low back pain for over 20 years. The cardiovascular effects of exercises that involve postural stabilization and the arms and of exercises performed in a lying position are well known. Therefore, the purpose of this study was to examine the cardiovascular effects of 4 exercises used in the McKenzie system. Subjects and Methods. One hundred subjects without cardiovascular or cardiopulmonary disease (mean age=31 years, SD=6.1, range=22–44) and who were representative of people susceptible to low back pain were studied. Subjects were randomly assigned to 1 of 4 exercise groups (ie, FIS, EIS, FIL, and EIL). Subjects performed sets of 10, 15, and 20 repetitions of the assigned exercise, with a 15-minute rest between sets. Heart rate, blood pressure, and rate-pressure product (an index of myocardial work) were recorded before and after each set of repetitions. Results. After 10 repetitions, flexion and extension in lying were more hemodynamically demanding than in standing. This trend persisted for 15 and 20 repetitions; however, at 20 repetitions, the hemodynamic demands were different across exercise groups (ie, FIL>EIL>FIS>EIS). Discussion and Conclusion. Repetitive exercises of the type suggested by McKenzie for the lumbar spine can have cardiovascular effects in people with no cardiovascular or cardiopulmonary conditions. These effects may be important with respect to cardiac work, and patients for whom these exercises are indicated should have a cardiac and pulmonary risk factor assessment to determine whether heart rate and blood pressure should be monitored.
The Use of Electrical Stimulation to Increase Quadriceps Femoris Muscle Force in an Elderly Patient Following a Total Knee Arthroplasty
Authors: Lewek Michael , Stevens Jennifer , Snyder-Mackler Lynn
Published: February 2017

Background and Purpose. Persistent residual quadriceps femoris muscle force deficits after total knee arthroplasty (TKA) are commonly reported and can prevent patients from returning quickly and fully to functional activities. Neuromuscular electrical stimulation offers a potentially more effective means of increasing muscle force than current rehabilitation protocols. Case Description. The patient was a 66-year-old man. Neuromuscular electrical stimulation for increasing quadriceps femoris muscle force was initiated 3 weeks after TKA for 11 sessions to supplement stretching exercises and a high-intensity volitional strengthening program. Outcome. The patient's isometric quadriceps femoris muscle force increased from 50% (involved/uninvolved) at 3 weeks after surgery to 86% at 8 weeks after surgery. A concurrent increase in his uninvolved quadriceps femoris muscle force concealed the patient's true increase in his involved quadriceps femoris muscle force in a side-to-side comparison. The patient's final involved quadriceps femoris muscle force (10 weeks after surgery) was 93% of the initial uninvolved quadriceps femoris muscle force. Discussion. Our patient was able to return to independent activities of daily living and recreational activities, with force gains that surpassed those reported in the literature.
A Comparison of Five Low Back Disability Questionnaires: Reliability and Responsiveness
Authors: Davidson Megan , Keating Jennifer L
Published: February 2017

Background and Purpose. The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. Subjects and Methods. Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as “unchanged” and a subgroup of 16 subjects who were self-rated as “about the same.” Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. Results. Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as “unchanged” and those who were self-rated as “about the same” were greater than .80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than .80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations–Physical and Bodily Pain scales. None of the scales were more responsive than any other. Discussion and Conclusion. Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations–Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.
Excessive Pressure in Multichambered Cuffs Used for Sequential Compression Therapy
Authors: Segers Patrick , Belgrado Jean-Paul , Leduc Andre , Leduc Olivier , Verdonck Pascal
Published: February 2017

Background and Purpose. Pneumatic compression devices, used as part of the therapeutic strategy for lymphatic drainage, often have cuffs with multiple chambers that are inflated sequentially. The purpose of this study was to investigate (1) the relationship between cuff chamber pressure (Pchamber) and the pressure on the cuff-skin interface (Pinterface) and (2) the mechanical interaction of cuff chambers and consequences for device control. Subjects and Methods. In this study, we used 3 cylindrical (60-, 80-, and 100-mm-diameter) model limbs and 1 ellipsoidal model of the arm to test a commercially available pressure controller using “target pressures,” indicated by the controller, of 30, 60, 80, and 100 mm Hg. We studied the time course of Pchamber and Pinterface during the inflation sequence and the effect of local curvature on Pinterface. Results. Our data indicated that, overall, Pinterface is of the same order of magnitude as Pchamber. There was some effect of model diameter and shape, with the smaller curvatures yielding the highest Pinterface. Cuff chamber interaction led to Pchamber and Pinterface values in the most distal (first inflated) chamber that were up to 80% higher than the target pressure. For the 80-mm cylindrical model, for instance, pressure in this chamber reached 54, 98, 121, and 141 mm Hg, respectively, instead of the 30, 60, 80, and 100 mm Hg indicated by the controller. Discussion and Conclusion. The discrepancy between the target pressure, indicated by the controller, and the pressure measured inside the cuff chambers undermines the therapeutic control and efficacy of the pneumatic compression devices. Because the measured pressures were far beyond the pressure level indicated by the controller, it is recommended that pneumatic compression devices be used at much lower target pressures (<30 mm Hg) than those applied in clinical practice.
Russian Electrical Stimulation: The Early Experiments
Authors: Ward Alex R , Shkuratova Nataliya
Published: February 2017

Russian forms of electrical stimulation became popular to a large extent as a result of the activities of Kots, who claimed force gains of up to 40% in elite athletes as a result of what was then a new form of stimulation. He did not provide details of his published work, nor did he give references. Russian electrical stimulation became popular despite the lack of research in the English-language literature. No studies published in English examined whether the “10/50/10” treatment regimen (10 seconds of stimulation followed by 50 seconds rest, repeated for 10 minutes) advocated by Kots is optimal, and only one study addressed whether maximum muscle torque was produced at an alternating current frequency of 2.5 kHz. The few studies that compared low-frequency monophasic pulsed current and Russian electrical stimulation are inconclusive. This article reviews and provides details of the original studies by Kots and co-workers. The authors contend that these studies laid the foundations for the use of Russian forms of electrical stimulation in physical therapy. The authors conclude that there are data in the Russian-language literature that support the use of Russian electrical stimulation but that some questions remain unanswered.
Knee Joint Movements in Subjects Without Knee Pathology and Subjects With Injured Anterior Cruciate Ligaments
Authors: Hollman John H , Deusinger Robert H , Dillen Linda R Van , Matava Matthew J
Published: February 2017

Background and Purpose. Although weight-bearing (WB) exercise and increased hamstring muscle activity may contribute to knee joint stability in knees with an injured anterior cruciate ligament (ACL), the relationship among ACL integrity, muscle activity, and joint surface motion is not fully understood. The purpose of this study was to investigate whether knee joint rolling and gliding movements and electromyographic (EMG) activity differed between subjects with injured ACLs and subjects without knee pathology. Subjects. Fifteen subjects with injured ACLs (9 men and 6 women; mean age=26 years, SD=7, range=18–36) and 15 age- and sex-matched subjects without knee pathology (9 men and 6 women; mean age=25 years, SD=6, range=18–36) participated in the study. Methods. Sagittal-plane knee joint rolling and gliding movements and lower-extremity EMG activity were measured during non-weight-bearing (NWB) and WB movements. Mixed-model analyses of variance were conducted to analyze rolling and gliding and EMG data. Results. During NWB knee extension, greater joint surface gliding occurred in knees with injured ACLs at full knee extension. During WB knee extension, greater gliding occurred in knees with injured ACLs throughout the range of motion tested. No differences in EMG activity occurred between groups. Discussion and Conclusion. The results suggest that, in the absence of increased hamstring muscle activity, anterior tibial displacement is not reduced in knees with injured ACLs during WB movement.
Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs
Authors: Fritz Julie M , George Steven Z
Published: February 2017

Background and Purpose. Psychosocial factors are known to affect recovery from acute low back pain. The factors with the greatest influence and the optimal methods of measurement and interpretation have not been established. The purpose of this study was to examine baseline psychosocial variables and their ability to predict prolonged work restrictions. Subjects. The subjects were 78 people with work-related low back pain who were participating in a clinical trial (mean age=37.4 years, SD=10.4, range=18–58; mean duration of pain=5.5 days, SD=4.6, range=0–19). Methods. A baseline examination including measures of impairment, disability, and psychosocial variables was performed. All subjects had physical therapy interventions. Work status was assessed after 4 weeks. Sensitivity, specificity, and likelihood ratios were calculated for the prediction of work status by the use of psychosocial variables. Receiver operator characteristic curves and logistic regression were used to identify the variables that were most predictive of work status. Results. Twenty-two subjects (29%) had persistent work restrictions. The work subscale of the Fear-Avoidance Beliefs Questionnaire was the strongest predictor of work status (negative likelihood ratio of 0.08 for scores less than 30, positive likelihood ratio of 3.33 for scores greater than 34). Discussion and Conclusion. Fear-avoidance beliefs about work was the psychosocial factor that could best be used to predict return to work in patients with acute work-related low back pain. Examination of fear-avoidance beliefs may serve as a useful screening tool for identifying patients who are at risk for prolonged work restrictions.