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George, Steven Z; Delitto, Anthony
doi: 10.1093/ptj/85.4.306pmid: N/A
AbstractBackground and Purpose. Treatment-based classification (TBC) provides matched interventions for patients with acute low back pain (LBP) through key history and clinical findings. This study investigated the discriminant validity of TBC by determining whether commonly used clinical examination variables discriminated among TBC groups. Subjects. The mean age of the 131 participants was 37.7 years (SD=10.1), 66 participants (50.4%) were female, mean duration of LBP was 16.5 days (SD=16.1), and 60 participants (45.8%) had a prior history of LBP. Fifty-one study participants (38.9%) were classified for specific exercise, 42 (32.1%) for mobilization, 28 (21.4%) for immobilization, and 10 (7.6%) for traction. Methods. One-way analyses of variance and Kruskal-Wallis tests were used to investigate differences in clinical variables by TBC group. Then, discriminant function analysis (DFA) predicted TBC group membership. Results. The TBC groups differed on present pain intensity, duration of LBP, and history of LBP. Present pain intensity, duration of LBP, total lumbar flexion, presence of leg pain, and history of LBP produced 2 statistically significant discriminant functions that predicted TBC group membership. These functions correctly classified (cross-validation value in parentheses) 65% (65%) for specific exercise, 45% (40%) for mobilization, and 32% (32%) for immobilization. Discussion and Conclusion. This study provided evidence supporting the discriminant validity of TBC. Additional diagnostic information related to TBC groups was generated.
Gross, Douglas P; Battié, Michele C
doi: 10.1093/ptj/85.4.315pmid: N/A
AbstractBackground and Purpose. Physical and psychosocial factors are hypothesized to influence performance-based assessment. The purpose of this study was to evaluate the association between performance on the Isernhagen Work System Functional Capacity Evaluation (IWS-FCE) and various clinical and psychosocial factors. Subjects. The sample consisted of 170 workers' compensation claimants who were undergoing functional capacity evaluations (FCEs) for low back injuries. Methods. In this cross-sectional study, claimants completed a battery of work-related measures, including the IWS-FCE, the Pain Disability Index (PDI), a workplace organizational policies and practices scale, and a recovery expectations questionnaire. Functional capacity evaluation performance indicators were the number of tasks in which subjects did not meet work demands and weight lifted on the floor-to-waist lift. Analysis included multivariable regression. Results. Only the PDI, pain intensity, age, and sex independently contributed to floor-to-waist lift performance. The PDI, pain intensity, and duration of injury contributed to the number of failed tasks. Discussion and Conclusion. The results indicate that performance on FCEs is influenced by physical factors, perceptions of disability, and pain intensity. However, perceptions of workplace organizational policies and procedures were not associated with FCE results for workers' compensation claimants with chronic back pain disability. Functional capacity evaluations should be considered behavioral tests influenced by multiple factors, including physical ability, beliefs, and perceptions.
Cress, M Elaine; Petrella, John K; Moore, Trudy L; Schenkman, Margaret L
doi: 10.1093/ptj/85.4.323pmid: N/A
AbstractBackground and Purpose. The Continuous-Scale Physical Functional Performance Test (CS-PFP) can be used to obtain valid, reliable, and sensitive measurements of physical functional capacity. This test requires a fixed laboratory space and approximately 1 hour to administer. This study was carried out in 4 steps, or substudies, to develop and validate a short, community-based version (PFP-10) that requires less space and equipment than the CS-PFP. Subjects and Methods. Retrospective data (n=228) and prospective data (n=91) on men and women performing the CS-PFP or the PFP-10 are reported. A 12-week exercise program was used to examine sensitivity to change. Data analyses were done using paired t-test, Pearson correlation, intraclass correlation coefficient (ICC), and delta index (DI) procedures. Results. The PFP-10 total score and 4 of the 5 domain scores were statistically similar (within 3%) to those of the CS-PFP. The PFP-10 upper-body strength domain score was 17% lower, but was highly correlated (ICC=.97). Community and established laboratory PFP-10 scores were similar (ICC=.85–.97). The PFP-10 also is sensitive to change (DI=.21–.54). Discussion and Conclusion. The PFP-10 yields valid, reliable, and sensitive measurements and can be confidently substituted for the CS-PFP.
Van Dillen, Linda R; Sahrmann, Shirley A; Wagner, Joanne M
doi: 10.1093/ptj/85.4.336pmid: N/A
AbstractBackground and Purpose. The purpose of this case report is to describe the classification, intervention, and outcomes for a patient with lumbar rotation with flexion syndrome. Case Description. The patient was a 22-year-old man with a medical diagnosis of low back strain. Impairments in lumbar flexion and right rotation and lateral bending were identified. Daily activities and positions associated with these actions were associated with increased low back pain (LBP). Instruction focused on modifying lumbar rotation and flexion movements and alignments in daily activities. Exercises to address the direction-specific impairments were prescribed. Outcomes. The patient participated in 4 visits and completed a questionnaire 1 year after intervention. The patient reported a decrease in symptoms, disability, and frequency of recurrences. Discussion. Repetition of specific strategies (alignment and movement) during activities may result in specific impairments that contribute to LBP. Modification of the strategies and exercises to change contributing factors are proposed to help alleviate symptoms, disability, and recurrences.
Berná-Serna, Juan D; Sánchez-Garre, Juan; Madrigal, Manuel; Zuazu, Isabel; Berná-Mestre, Juan D
doi: 10.1093/ptj/85.4.352pmid: N/A
AbstractBackground and Purpose. Ultrasound (US) is one of the most common modalities used in intervention for musculoskeletal disorders, although its effectiveness is debated. The purpose of this case report is to describe the intervention, including the use of US, in the management of a large rectus sheath hematoma (RSH) in a patient receiving anticoagulant therapy. Case Description. The patient was a 62-year-old woman with RSH who was receiving oral anticoagulant therapy and had a history of bouts of coughing. Computed tomographic scans verified the diagnosis of RSH. The report describes the patient examination, management, intervention, and outcomes. Outcomes. The intervention, including the use of US therapy, may have enabled a rapid resolution of the hematoma. Discussion. This case report illustrates how US may be a useful modality for complementary management of RSH, helping the reabsorption of the hematoma.
Gregory, Chris M; Bickel, C Scott
doi: 10.1093/ptj/85.4.358pmid: N/A
AbstractElectromyostimulation (EMS) incorporates the use of electrical current to activate skeletal muscle and facilitate contraction. It is commonly used in clinical settings to mimic voluntary contractions and enhance the rehabilitation of human skeletal muscles. Although the beneficial effects of EMS are widely accepted, discrepancies concerning the specific responses to EMS versus voluntary actions exist. The unique effects of EMS have been attributed to several mechanisms, most notably a reversal of the recruitment pattern typically associated with voluntary muscle activation. This perspective outlines the authors' contention that electrical stimulation recruits motor units in a nonselective, spatially fixed, and temporally synchronous pattern. Furthermore, it synthesizes the evidence that supports the contention that this recruitment pattern contributes to increased muscle fatigue when compared with voluntary actions. The authors believe the majority of evidence suggests that EMS-induced motor unit recruitment is nonselective and that muscle fibers are recruited without obvious sequencing related to fiber types.
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