bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interpreting Validity Indexes for Diagnostic Tests: An Illustration Using the Berg Balance Test
Authors: Riddle Daniel L , Stratford Paul W 
Published: February 2017

Abstract
Physical therapists routinely make diagnostic and prognostic decisions in the course of patient care. The purpose of this clinical perspective is to illustrate what we believe is the optimal method for interpreting the results of studies that describe the diagnostic or prognostic accuracy of examination procedures. To illustrate our points, we chose the Berg Balance Test as an exemplar measure. We combined the data from 2 previously published research reports designed to determine the validity of the Berg Balance Test for predicting risk of falls among elderly people. We calculated the most common validity indexes, including sensitivity, specificity, predictive values, and likelihood ratios for the combined data. Clinical scenarios were used to demonstrate how we believe these validity indexes should be used to guide clinical decisions. We believe therapists should use validity indexes to decrease the uncertainty associated with diagnostic and prognostic decisions. More studies of the accuracy of diagnostic and prognostic tests used by physical therapists are urgently needed.
Endurance Training of the Trunk Extensor Muscles in People With Subacute Low Back Pain
Authors: Chok Beverley , Lee Raymond , Latimer Jane , Tan Seang Beng 
Published: February 2017

Abstract
Background and Purpose. Clinicians treating patients with low back pain often use exercise to reduce pain and improve function. The aim of this study was to evaluate the effectiveness of trunk extensor endurance training in reducing pain and decreasing disability in subjects with subacute low back pain (ie, onset of back pain within 7 days to 7 weeks). Subjects and Methods. Patients were randomly assigned to either an experimental group or a control group. A visual analog scale and the Pain Rating Index (PRI) of the McGill Pain Questionnaire (MPQ) were used to obtain baseline measurements of pain. The Roland-Morris Disability Questionnaire (RMDQ) was used to measure disability, and the Sorensen Test was used to measure trunk extensor endurance. Subjects in the experimental group attended exercise sessions 3 times per week for 6 weeks. Subjects in the control group did not do exercises. Both groups were given back care advice and hot packs for 15 minutes, 3 to 5 times per week. Reassessments were carried out at 3 and 6 weeks. Results. There were differences between the 2 groups at 3 weeks with regard to pain intensity during the evaluation session, pain experienced over the preceding 24 hours, the total MPQ PRI, the sensory component of the MPQ PRI, and the RMDQ. At 6 weeks, no differences were found for pain measurements, disability scores, and holding time on the Sorensen Test. Conclusion and Discussion. Trunk extensor endurance training reduced pain and improved function at 3 weeks but resulted in no improvement at 6 weeks when compared with the control group. Endurance exercise is considered to expedite the recovery process for patients with an acute episode of low back pain.
Measurement of Sacroiliac Joint Dysfunction: A Multicenter Intertester Reliability Study
Authors: Freburger Janet K , Riddle Daniel L 
Published: February 2017

Abstract
Background and Purpose. Previous research suggests that visual estimates of sacroiliac joint (SIJ) alignment are unreliable. The purpose of this study was to determine whether handheld calipers and an inclinometer could be used to obtain reliable measurements of SIJ alignment in subjects suspected of having SIJ dysfunction. Subjects. Seventy-three subjects, evaluated at 1 of 5 outpatient clinics, participated in the study. Methods. A total of 23 therapists, randomly paired for each subject, served as examiners. The angle of inclination of each innominate was measured while the subject was standing. The position of the innominates relative to each other was then derived. An intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and a kappa coefficient were calculated to examine the reliability of the derived measurements. Results. The ICC was .27, the SEM was 5.4 degrees, and the kappa value was .18. Conclusion and Discussion. Measurements of SIJ alignment were unreliable. Therapists should consider procedures other than those that assess SIJ alignment when evaluating the SIJ.
Development of the Physical Therapy Outpatient Satisfaction Survey (PTOPS)
Authors: Roush Susan E , Sonstroem Robert J 
Published: February 2017

Abstract
Background and Purpose. The purposes of this 3-phase study were (1) to identify the underlying components of outpatient satisfaction in physical therapy and (2) to develop a test that would yield reliable and valid measurements of these components. Subjects. Three samples, consisting of 177, 257, and 173 outpatients from 21 facilities, were used in phases 1, 2, and 3, respectively. Methods and Results. In phase 1, principal component analyses (PCAs), reliability checks, and correlations with social desirability scales were used to reduce a pool of 98 items to 32 items. These analyses identified a 5-component model of outpatient satisfaction in physical therapy. The phase 2 PCA, with a revised pool of 48 items, indicated that 4 components rather than 5 components represented the best model and resulted in the 34-item Physical Therapy Outpatient Satisfaction Survey (PTOPS). Factor analyses conducted with phase 2 and phase 3 data supported this conclusion and provided evidence for the internal validity of the PTOPS scores. The 4-component scales were labeled “Enhancers,” “Detractors,” “Location,” and “Cost.” Responses from subsamples of phase 3 subjects provided evidence for validity of scores in that the PTOPS components of “Enhancers,” “Detractors,” and “Cost” appeared to differentiate overtly satisfied patients from overtly dissatisfied patients. “Location” and “Enhancer” scores discriminated subjects with excellent attendance at scheduled physical therapy sessions from those with poor attendance. Conclusion and Discussion. In this study, we identified components of outpatient satisfaction in physical therapy and used them to develop a test that would yield valid and reliable measurements of these components.
The Relationship Between Submaximal Activity of the Lumbar Extensor Muscles and Lumbar Posteroanterior Stiffnesss
Authors: Shirley Debra , Lee Michael , Ellis Elizabeth 
Published: February 2017

Abstract
Background and Purpose. Some patients with low back pain are thought to have increased lumbar posteroanterior (PA) stiffness. Increased activity of the lumbar extensors could contribute to this stiffness. This activity may be seen when a PA force is applied and is thought to represent much less force than occurs with a maximal voluntary contraction (MVC). Although MVCs of the lumbar extensors are known to increase lumbar PA stiffness, the effect of small amounts of voluntary contraction is not known. In this study, the effect of varying amounts of voluntary isometric muscle activity of the lumbar extensors on lumbar PA stiffness was examined. Subjects. Twenty subjects without low back pain, aged 26 to 45 years (X̄=34, SD=5.6), participated in the study. Methods. Subjects were asked to perform an isometric MVC of their lumbar extensor muscles with their pelvis fixed by exerting a force against a steel plate located over their T4 spinous process. They were then asked to perform contractions generating force equivalent to 0%, 10%, 30%, 50%, and 100% of that obtained with an MVC. Posteroanterior stiffness at L4 was measured during these contractions. Results. A Friedman one-way analysis of variance for repeated measures demonstrated a difference in PA stiffness among all levels of muscle activity. Conclusion and Discussion. Voluntary contraction of the lumbar extensor muscles will result in an increase in lumbar PA stiffness even at low levels of activity.
Back Care Instructions in Physical Therapy: A Trend Analysis of Individualized Back Care Programs
Authors: Kerssens Jan J , Sluijs Emmy M , Verhaak Peter FM , Knibbe Hanneke JJ , Hermans Irma MJ 
Published: February 2017

AbstractBackground and Purpose. The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. Subjects. Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. Methods. Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. Results. Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. Conclusion and Discussion. The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs.
Use of Computed Tomography and Plantar Pressure Measurement for Management of Neuropathic Ulcers in Patients With Diabetes
Authors: Mueller Michael J , Smith Kirk E , Commean Paul K , Robertson Douglas D , Johnson Jeffrey E 
Published: February 2017

AbstractBackground and Purpose. Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%–57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. Case Description. The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. Outcomes. The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. Discussion. Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.
Status of the Year 2000 Health Goals for Physical Activity and Fitness
Authors: Francis Kennon T 
Published: February 2017

AbstractIn Healthy People 2000, the national strategy for improving the health of the American people by the year 2000, lifestyle factors such as physical inactivity are major determinants of chronic disease and disability. Despite the documented benefits of exercise in enhancing health and reducing the risk of premature death, only 1 of the 13 physical activity and fitness objectives of Healthy People 2000 has been met or exceeded. Although progress toward 5 objectives for the year 2000 has been made, 3 objectives are actually farther from attainment. Coronary heart disease death rates (Objective 1.1) have declined, and the prevalence of overweight people (Objective 1.2) has increased. Overall physical activity in adults (Objectives 1.3 and 1.4) and strengthening and stretching activities in children (Objective 1.6) have increased, but reduction in the percentage of sedentary persons (Objective 1.5) has showed no change. The proportion of the population adopting sound dietary practices combined with regular physical activity to attain appropriate body weight (Objective 1.7) has declined. Even though participation in daily school physical education (Objective 1.8) has shown a decline during the past several years, students who are enrolled in physical education classes are spending more time performing physical activities (Objective 1.9). The proportion of work sites offering employer-sponsored physical activity and fitness programs (Objective 1.10) has increased substantially, surpassing the year 2000 goal. Data to update progress for increasing physical activity levels of children (Objectives 1.3–1.5), community exercise facilities (Objective 1.11), clinician counseling about physical activity (Objective 1.12), and improvement in personal self-care activities (Objective 1.13) are not yet available.
Cardiopulmonary Responses of Middle-Aged Men Without Cardiopulmonary Disease to Steady-Rate Positive and Negative Work Performed on a Cycle Ergometer
Authors: Chung Frank , Dean Elizabeth , Ross Jocelyn 
Published: February 2017

Abstract
Background and Purpose. Understanding physiological responses to negative work allows therapists to be more knowledgeable when they prescribe this form of exercise. The physiological responses of 12 men without cardiopulmonary disease, aged 39 to 65 years (x̄=49.7, SD=9.3), to negative work (eccentric muscle contractions) and to positive work (concentric muscle contractions) were compared. Subjects and Methods. Subjects performed the 2 types of work on a motorized cycle ergometer at pedaling frequencies of 35, 55, and 75 rpm with a constant power output of 60 W. Steady-rate values of oxygen consumption (V̇o2), heart rate (HR), minute ventilation (V̇e), tidal volume (Vt), and breathing frequency (fb) were obtained during 6 test conditions (positive and negative work at each of the 3 pedaling frequencies). Results. Values for all measures were greater during positive work than during negative work, except for fb. During positive work, values for all variables were greatest at 75 rpm, except for fb. During negative work, V̇o2 and HR were greater at 75 and 35 rpm than at 55 rpm, and V̇e and Vt were greater at 75 rpm than at 55 rpm. Breathing frequency was not different among pedaling frequencies. Conclusion and Discussion. The results confirmed that negative work performed on a cycle ergometer is associated with low metabolic cost in older men without cardiopulmonary disease. Although V̇e was determined primarily by changes in Vt during negative work, a comparable disproportionate increase in fb was observed at the start of negative work. Such changes in breathing patterns have implications for the prescription of negative work for patients with lung disease.
Diagnosis of Intermittent Vascular Claudication in a Patient With a Diagnosis of Sciatica
Authors: Gray John C 
Published: February 2017

Abstract
Background and Purpose. The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms. Case Description. This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side. Outcomes. She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a “high-grade circumferential stenosis of the distal-most aorta at its bifurcation.” Discussion. This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.
Behaviors That Cause Clinical Instructors to Question the Clinical Competence of Physical Therapist Students
Authors: Hayes Karen W , Huber Gail , Rogers Jean , Sanders Babette 
Published: February 2017

AbstractBackground and Purpose. Clinical instructors (CIs) observe behavior to determine whether students have the skills assumed necessary for safe and effective delivery of physical therapy services. Studies have examined assumptions about necessary skills, but few studies have identified the types of student behaviors that are “red flags” for CIs. This study examined the student behaviors that negatively affect students' clinical performance, which can alert CIs to inadequate performance. Subjects. Twenty-eight female and 5 male CIs discussed the performance of 23 female and 17 male students who were anonymous. Methods. Using questionnaires and semistructured interviews that were taped and transcribed, CIs described demographics and incidents of unsafe and ineffective physical therapy. After reading the transcripts, investigators identified and classified the behaviors into categories and checked their classification for reliability (κ=.60–.75). Results. Behaviors in 3 categories emerged as red flags for CIs: 1 cognitive category—inadequate knowledge and psychomotor skill (43% of 134 behaviors)—and 2 noncognitive categories—unprofessional behavior (29.1%) and poor communication (27.6%). The CIs noticed and valued noncognitive behaviors but addressed cognitive behaviors more often with students. Students who did not receive feedback about their performance were unlikely to change their behavior. The CIs used cognitive behaviors often as reasons to recommend negative outcomes. Conclusion and Discussion. Clinical instructors need to identify unacceptable cognitive and noncognitive behaviors as early as possible in clinical experiences. Evidence suggests that they should discuss their concerns with students and expect students to change.
Low-Intensity Laser Therapy for Benign Fibrotic Lumps in the Breast Following Reduction Mammaplasty
Authors: Nussbaum Ethne L 
Published: February 2017

Abstract
Background and Purpose. Fibrotic masses in the breast secondary to fat necrosis or hematoma are a complication of breast reduction mammaplasty. The treatment commonly recommended for this condition is early surgical debridement of necrotic tissue from the entire area, which causes scarring. This case report describes the use of low-intensity laser therapy for fibrotic lumps following reduction mammaplasty. Case Description. The patient was a 46-year-old woman who had breast reduction surgery 80 days prior to referral for physical therapy. At the time of referral, the largest mass was 8.0 cm in diameter. The patient reported pain and said she was distressed about the breast disfigurement. Laser irradiation was initiated at an energy density (ED) of 20 J/cm2 and a pulse repetition rate of 5,000 pulses per second. The laser settings were adjusted during the 8-month treatment period. The final ED was 50 J/cm2. Outcomes. The mass was 33% of its original size after 3 treatments over the initial 11-day period. Pain relief was immediate. The rate of resolution decreased after the initial period. The patient had some tissue thickening at the time of discharge after 6 months of treatment. Discussion. This case demonstrates the potential use of laser therapy as a treatment for benign breast lumps following mammaplasty.
Acute Effects of Thirty Minutes of Light-Intensity, Intermittent Exercise on Patients With Chronic Fatigue Syndrome
Authors: Clapp Lisa L , Richardson Mark T , Smith Joe F , Wang Minqi , Clapp Anthony J , Pieroni Robert E 
Published: February 2017

Abstract
Background and Purpose. Currently, there is no consensus on exercise prescription for patients with chronic fatigue syndrome (CFS). This investigation examined whether light-intensity, intermittent physical activity exacerbated symptoms in patients with CFS immediately following exercise to 7 days following exercise. Subjects. Subjects were 9 women (mean age=44.2 years, SD=8.4, range=29-56; mean weight=74.2 kg, SD=18.8, range=56.36-110.91; and mean height=1.63 m, SD=0.8, range=1.55-1.78) and 1 man (age=48 years, weight=97.1 kg, and height=1.98 m) who met the Centers for Disease Control and Prevention's criteria for CFS. Methods. Subjects performed 10 discontinuous 3-minute exercise bouts (separated by 3 minutes of recovery) at a self-selected, comfortable walking pace on a treadmill. Oxygen consumption, minute ventilation, respiratory exchange ratio, and heart rate were measured every minute during the exercise session. To assess degree of disability, general health status, activity level, symptoms, and mood, subjects completed various questionnaires before and after exercise. Results. Results indicated that degree of disability, general health status, symptoms, and mood did not change immediately and up to 7 days following exercise. Conclusion and Discussion. Thirty minutes of intermittent walking did not exacerbate symptoms in subjects with CFS. The physiological data did not show any abnormal response to exercise. Although this study did not determine whether 30 minutes of continuous versus intermittent exercise would exacerbate symptoms, all 10 subjects felt that they could not exercise continuously for 30 minutes without experiencing symptom exacerbation. Despite this limitation, the results indicate that some individuals with CFS may be able to use low-level, intermittent exercise without exacerbating their symptoms.
An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke
Authors: Blanton Sarah , Wolf Steven L 
Published: February 2017

Abstract
Background and Purpose. The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a “learned nonuse phenomenon.” Case Description. The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). Outcomes. For the Wolf Motor FunctionTest, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both “how well” and “how much” the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Discussion. Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.