Physical Therapy

Rothstein, Jules M

doi: 10.1093/ptj/76.2.126pmid: 8592716

A pebble rolling down a hill can easily be studied. Even from the perspective of one who stands before the pebble, the forces that set it in motion and the path that it takes can be considered, the anomalous bounces contemplated. The absence of danger provides the observer with time for reflection. When one stands before a rolling boulder, however, contemplation goes out the window, and action—or, more correctly, reaction— becomes the imperative.For three quarters of a century, visionaries in physical therapy beseeched us to contemplate our pebbles and cautioned us about the coming boulders. These visionaries were talking about the need for evidence-based practice, for a scientific basis for our treatment. They observed how each year there was a greater need for data and evidence, and they warned us that time was not on our side.…

Jette, Diane U; Downing, Jill

doi: 10.1093/ptj/76.2.130pmid: 8592717

Background and Purpose. Understanding the causes of differences in disability among individuals is an important research focus for rehabilitation professionals. The purpose of this study was to examine the relationship between health status and the impairments commonly associated with cardiovascular pathophysiology. Subjects. The subjects were patients (N=789) enrolled in 13 cardiac rehabilitation programs in Massachusetts. Methods. Data were collected on psychological and physiological impairments, demographic characteristics, and health status. Multivariate analyses were used to determine which measures of impairment and patient characteristics were related to health status. Results. Psychological impairment was related to all scales of the MOS 36-item Short-Form Health Survey (SF-36). Very few measures of physiological impairment and individual characteristics were related to SF-36 scores. The models accounted for 16% to 57% of the variability of the instrument's scales. Conclusion and Discussion. In patients entering cardiac rehabilitation, psychological distress is related to poor health in both the physical and psychological dimensions. Variability in health status is not well explained by traditional measures of impairment or demographic characteristics. Physical therapists working to address their patients' health needs must consider collecting data, setting goals, and devising interventions that address psychological impairment.

Crane, Linda; Janulaitis, Cynthia; Sadowsky, H Steven; Zadai, Cynthia C; Rothstein, Jules M

doi: 10.1093/ptj/76.2.140pmid: N/A

In “The Relationship of Cardiovascular and Psychological Impairments to the Health Status of Patients Enrolled in Cardiac Rehabilitation Programs” (pages 130–139), Jette and Downing examine the relationship between health status and the impairments commonly associated with cardiovascular pathophysiology. They emphasize that “understanding the causes of differences in disability among individuals is an important research focus for rehabilitation professionals.” Below, Linda Crane, Cynthia Janulaitis, Steven Sadowsky, and Cynthia Zadai discuss the practical implications of this study with Editor Jules Rothstein.

Jette, Diane U

doi: 10.1093/ptj/76.2.148pmid: N/A

Ehrmann-Feldman, Debbie; Rossignol, Michel; Abenhaim, Lucien; Gobeille, Denis

doi: 10.1093/ptj/76.2.150pmid: 8592718

Background and Purpose. This study described the physical therapy referral of workers compensated for back injury; characterized physical therapy by duration and choice of therapeutic techniques; and compared workers who were and were not referred for physical therapy in terms of age, gender, diagnosis, and absence from work. Subjects. A cohort of 2,147 subjects were randomly selected from 54,401 workers compensated for back injuries in 1988. Methods. Each subject was followed for 2 years from date of entry into the study. Data were obtained from the Quebec Worker's Compensation Board computerized files, medical files, and initial reports completed by physical therapists. Results. Of the cohort, 389 subjects (18%) had received physical therapy after referral by their physician. Exercise, heat, ultrasound, back education, manipulation, and transcutaneous electrical nerve stimulation were the most frequently selected treatments. Implementation of physical therapy within 1 month of back injury had a strong protective effect on return to work within 60 days. Female gender and presence of a specific diagnosis were predictors for greater than 60 days' absence. Conclusion and Discussion. This study demonstrated that physicians request physical therapy services based on certain patient characteristics. Patients who were referred earlier tended to return to work sooner than those who were referred later, which indicates that timing of physical therapy is an important factor in the rehabilitation of workers with low back pain.

Battié, Michele Crites

doi: 10.1093/ptj/76.2.156pmid: N/A

Ehrmann-Feldman, Debbie; Rossignol, Michel; Abenhaim, Lucian; Gobeille, Denis

doi: 10.1093/ptj/76.2.157pmid: N/A

Latimer, Jane; Goodsell, Michalene M; Lee, Michael; Maher, Christopher G; Wilkinson, Barry N; Moran, Carmen C

doi: 10.1093/ptj/76.2.158pmid: 8592719

Background and Purpose. This study determined the test-retest reliability of measurements of responses to posteroanterior (PA) forces made using a recently developed instrument. Subjects. Twenty-two subjects with nonspecific low back pain participated. Methods. The length of the low-stiffness or “toe“ region and the slope of the linear portion of the force-displacement curve were measured on two occasions. Reliability of repeated measurements was evaluated by intraclass correlation coefficients and percentage-of-agreement scores. The presence of a systematic change in the response to PA forces was evaluated by a paired-samples t test. Results. High reliability coefficients were obtained for both indices of the response to PA forces. The t test revealed no systematic change with repeated testing. Conclusion and Discussion. The new device provides highly reliable measurement of the lumbar PA force-displacement relationship and may prove useful in evaluating theories that have suggested a relationship between spinal symptoms and abnormal PA stiffness.

Mattingly, Gary E; Mackarey, Paul J

doi: 10.1093/ptj/76.2.166pmid: 8592720

Background and Purpose. Physical therapists often must either palpate tendons of the shoulder or, as part of treatment, apply forces to those tendons. Many methods have been suggested for minimizing the amount of soft tissue that overlies these tendons, but no data have been presented to justify the use of any approach. The purpose of this study was to evaluate methods described in the literature by use of cadaver models. Subjects. Twenty-four shoulders from 12 cadavers of individuals aged 55 to 92 years were dissected. Methods. Shoulders were placed in the positions described in the literature, and the positions in which the tendons were maximally exposed (ie, had the least overlying tissue) were noted. Results. Positions were found in which tendons were maximally exposed. Conclusion and Discussion. Positions described in the literature for optimizing the exposure of shoulder tendons are not always optimal, and palpation and treatment may be improved by using positions determined by research such as those suggested in this report.

Harris, Susan R

doi: 10.1093/ptj/76.2.175pmid: 8592721

The overall goal of this article is to provide physical therapists with some strategies for critically analyzing the scientific merit of physical therapy treatments. To accomplish this goal, five characteristics of nonstandard or alternative therapies are presented, with representative examples of each characteristic from the rehabilitation literature. Following discussion of nonstandard treatment approaches, six specific criteria for evaluating the scientific merit of a new (or existing) therapy approach are provided. The decision as to whether or not to use a specific treatment approach is the ethical responsibility of all physical therapists and should be based on careful examination of both the theoretical principles and the scientific rigor underlying the therapy approach.