Study Design: Cross-sectional observational design.
Objective: To compare physical activity levels in men and women with end stage knee osteoarthritis to those of a comparison group and to examine the relationship between physical activity level and physical performance.
Background: Osteoarthritis of the knee is associated with significant losses in functional performance and high social costs. Although reductions in physical activity are reported, they have not been quantified or explored.
Methods and Measures: Fifty-nine candidates awaiting total knee arthroplasty (TKAC group) and 79 individuals without osteoarthritis (comparison group) participated. Physical activity was assessed using the Voorrips Questionnaire. Performance measures included fast self-paced walk test, timed up-and-go test, and a timed stair performance measure. A subset of subjects completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and underwent muscular strength and endurance testing. The effects of gender and group were tested using GLM ANOVA. Pearson product moment correlations were used to examine relationships between the variables.
Results: All aspects of physical activity were lower (P<.001) in the TKAC group, with a moderate difference in household score (18%) and a large difference in leisure activities (63%). Unlike the comparison group, modest but significant correlations (r = 0.31-0.33, P<.03) were observed between overall physical activity and performance test scores for the TKAC group. Physical activity was not significantly related to pain reported on the WOMAC or during the performance tasks.
Conclusion: The belief that pain limits the physical activity of patients with severe osteoarthritis requires further investigation. The profound differences between a comparison group and patients with end stage osteoarthritis in physical activity have critical implications for the well-being and effective treatment of this population. J Orthop Sports Phys Ther. 2003;33(12):745-754.
Key Words: exercise, pain, physical performance, total knee replacement

Study Design: Test-retest reliability study.
Objective: To assess test-retest reliability and estimate minimal detectable change of an overall measure and 2 summary measures of patient self-report of health status.
Background: Change in patient self-report of health status is a common outcome measure following rehabilitation. Because collection of health status data takes time and clinicians are required to be productive, selected items from reliable instruments were used to form a new, abbreviated instrument of health status relevant to patients in outpatient rehabilitation. There are no test-retest reliability statistics of these health status measures in this population.
Methods and Measures: A convenience sample of 71 patients (mean age ± SD, 41.9 ± 17.9 years; age range, 15-83 years; sex, 35% male), with a variety of orthopaedic diagnoses, seeking rehabilitation in 2 outpatient facilities, volunteered. Patients completed health status questionnaires at initial evaluation and at 24 to 72 hours following evaluation. Intraclass correlation coefficients (ICC2,1) were used to estimate test-retest reliability and to estimate measurement error and minimal detectable changes.
Results: ICCs with 1-sided lower limit 95% confidence intervals (CI) of the Overall Health Status measure and the Physical and Mental Component Summary measures for patients with chronic symptoms were 0.92 (0.85), 0.82 (0.68), and 0.85 (0.74), respectively. Minimal detectable changes (90% CI) were ±12 (scale range, 100), ±9 (scale range, 60), and ±9 (scale range, 60) scale points, respectively, for the same measures.
Conclusion: Results support the test-retest reliability of the Overall Health Status measure and summary measures for patients with chronic symptoms and demonstrate ability of the Overall Health Status and Physical Summary Scale measures to detect improvement of patient self-report of health status within the first few days of rehabilitation. J Orthop Sports Phys Ther. 2003;33(12):734-742.
Key Words: minimal detectable change, questionnaire, reliability, SF-12, SF-36

Study Design: Randomized controlled 2-group, pretest-posttest, multivariate study of patients with shoulder musculoskeletal disorders.
Objective: The purpose of this study was to evaluate the immediate effect of soft tissue mobilization (STM) with proprioceptive neuromuscular facilitation (PNF) to increase glenohumeral external rotation at 45° of shoulder abduction and overhead reach.
Background: It is postulated that limitation in glenohumeral external rotation, when measured at 45° of shoulder abduction, represents subscapularis muscle flexibility deficits and is associated with the inability to fully reach overhead. No research, however, is available to demonstrate whether intervention strategies intended to improve subscapularis flexibility and glenohumeral external rotation range of motion at 45° of shoulder abduction will improve a patient’s ability to reach overhead.
Methods and Measures: Twenty patients (10 males, 10 females; age range, 21-83 years) with limited glenohumeral external rotation and overhead reach of 1 year duration or less served as subjects. The subjects were randomly assigned to a treatment group, which consisted of soft tissue mobilization to the subscapularis and proprioceptive neuromuscular facilitation to the shoulder rotators, or a control group. Goniometric measurements of glenohumeral external rotation at 45° abduction and overhead reach were taken preintervention and immediately postintervention for the treatment group or at prerest and postrest periods for the control group.
Results: The treatment group improved by a mean of 16.4° (95% confidence interval [CI], 12.5°-20.3°) of glenohumeral external rotation, as compared to less than a 1° gain (95% CI, -0.2°-2.0°) in the control group (P<.0005). Overhead reach in the treatment group improved by a mean of 9.6 cm (95% CI, 5.2-14.0 cm) in comparison to a mean gain of 2.4 cm (95% CI, -0.8-5.6 cm) for the control group (P = .009).
Conclusion: These findings suggest that a single intervention session of STM and PNF was effective for producing immediate improvements in glenohumeral external rotation and overhead reach in patients with shoulder disorders. J Orthop Sports Phys Ther. 2003;33(12):713-718.
Key Words: manual therapy, proprioceptive neuromuscular facilitation, range of motion, shoulder, subscapularis

This index includes all authors and co-authors of manuscripts published in the Journal during 2003.

J Orthop Sports Phys Ther. 2003;33(12):763-778.