Editorial
Timothy W. Flynn
As our profession evolves, it is incumbent upon those of us in the academic and clinical education community to be persistent in the integration of evidence into practice, thus modeling the expectations we place on our students every day in the classroom and clinic.
J Orthop Sports Phys Ther. 2004; 34(4):169-170. doi:10.2519/jospt.2004.0104
Key Words: evidence, teaching
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Research Report
William G. Boissonnault, Jean M. Bryan, Kristin J. Fox
Study Design: Descriptive observational survey. Objective: To describe the status of joint manipulation curricula within physical therapist professional degree programs in the United States. Background: Studies have described the evolution of manual therapy curricula, including spinal and extremity joint mobilization, in physical therapist professional programs, but minimal information exists related to joint manipulation curricula. Methods and Measures: Primary faculty members responsible for teaching manual therapy curricular content at the 199 physical therapist professional degree programs located in the United States recognized by the Commission on Accreditation in Physical Therapy Education were asked to participate in this project. The survey documented joint manipulation curricula, faculty qualifications, attitudes and experience, and programs' future plans for teaching manipulation. Results: Of the 116 programs responding to our survey, 87 (75%) currently include joint manipulation in their curriculum or plan to soon include such content in their curriculum. Of the programs currently teaching joint manipulation, 75% taught it as part of a required integrated clinical science course. Faculty teaching manipulation content appear to be well qualified and are in clinical practice an average of 12 hours per week. The programs currently not teaching joint manipulation reported reasons, including belief that it was not an entry-level skill (45%), lack of time (26%), lack of qualified faculty (7%), and perceived lack of scientific evidence regarding efficacy (7%). Conclusions: Of the responding professional degree programs, 75% are either currently teaching joint manipulation or soon plan to do so. Our research may serve as a benchmark for faculty to assess existing manual therapy curricula and as a guide for developing curricula in new or existing physical therapy programs.
J Orthop Sports Phys Ther. 2004;34(4):171-181. doi:10.2519/jospt.2004.1239
Key Words: curriculum, manipulation, manual therapy, physical therapy education
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Resident's Case Problem
Donald Lee Goss, Josef H. Moore, Darryl B. Thomas, Thomas M. DeBerardino
Injuries to the ankle or foot are some of the most common orthopaedic complaints seen in primary care and sports medicine settings, accounting for 5% to 10% of all visits. Physical therapists working in a military setting are frequently the first credentialed providers to evaluate and diagnose patients with musculoskeletal complaints or orthopaedic trauma, using their privileges to order radiographs, bone scans, and electromyographical/nerve conduction study examinations. Because the presenting symptoms of sprains and fractures are often similar, it is imperative that physical therapists are competent and comfortable with their role of evaluating acute traumatic injuries without a physician referral. The validity of physical therapists managing patients with acute musculoskeletal injuries, without physician referral, has been previously established. This important role has enabled US Army orthopaedic surgeons to focus their practice on more complicated trauma or surgical cases. As direct access becomes more prevalent in the civilian profession of physical therapy, it becomes increasingly important that the physical therapist, as the first credentialed provider evaluating the patient, is proficient in distinguishing between ankle sprains and fractures. Even in the absence of direct access, physical therapists should still be able to determine when radiographs are appropriate in the event of a misdiagnosis and referral for an ankle sprain. The Ottawa Ankle Rules and the Buffalo modification are effective clinical decision rules to assist therapists in ruling out a fracture or determining whether radiographs are necessary for acute ankle injuries. We chose to report this case as example of how physical therapists can effectively apply these rules while serving in a direct-access role for the benefit of patients.
J Orthop Sports Phys Ther. 2004;34(4):182-186. doi:10.2519/jospt.2004.1310
Key Words: sprains, fractures, Ottawa Ankle Rules, Buffalo modification, direct-access
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Research Report
Gregory F. Spadoni, Patricia E. Solomon, Laurie R. Wishart, Paul W. Stratford
Study Design: Prospective observation study. Objectives: To compare the test-retest reliability and longitudinal validity (sensitivity to change) of 2 single-item numeric pain rating scales (NPRSs) with a 4-item pain intensity measure (P4). Background: Pain is a frequent outcome measure for patients seen in physical therapy; however, the error associated with efficient pain measures, such as the single-item NPRS, is greater than for self-report measures of functional status. Initial evaluation of the P4 suggests that it is more reliable and sensitive to change than the NPRS. Methods and Measures: Two single-item NPRSs and the P4 were administered on 3 occasions - initial visit (n = 220), within 72 hours of baseline (n = 213), and 12 days following baseline assessment (n = 183) - to patients with musculoskeletal problems receiving physical therapy. Reliability was assessed using a type 2,1 intraclass correlation coefficient. Longitudinal validity was assessed by correlating the measures' change scores with a retrospective rating of change that included patients' and clinicians' perspectives. Results: The test-retest reliability and longitudinal validity of the P4 were significantly greater (P1<.05) than both single-item NPRSs. Minimal detectable change of the P4 at the 90% confidence level was estimated to be a change of 22% of the scale range (9 points) compared to 27.3% (3 points) and 31.8% (3.5 points) for the 2-day NPRS and 24-hour NPRS, respectively. Conclusions: The findings of this study suggest the P4 is more adept at assessing change in pain intensity than popular versions of single-item NPRSs.
J Orthop Sports Phys Ther. 2004;34(4):187-193. doi:10.2519/jospt.2004.1157
Key Words: measurement, outcome, reliability, responsiveness, validity
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Research Report
Richard Holtby, Helen Razmjou
Study Design: Prospective blinded comparison of clinical examination and surgical findings of consecutive patients seen at a tertiary shoulder center. Objective: To investigate the validity of the supraspinatus test in diagnosing rotator cuff pathology using arthroscopy or open surgery as reference standards. A positive supraspinatus test was defined as pain for all types of rotator cuff pathology and weakness for full-thickness tears. Background: Rotator cuff tenopathy is a very common condition. However, there have been relatively few studies documenting the validity of physical examination for this condition and further investigation of the measurement properties of these tests is warranted. Methods and Measures: One hundred two consecutive subjects were examined. Fifty subjects, ranging in age between 24 and 79 years (mean age, 50 years; SD, 14.4 years) and composed of 16 females and 34 males, underwent surgery. Results: The sensitivity of the supraspinatus test was 62%, 41%, and 88% for ‘"supraspinatus tendonitis or partial thickness tear," "full-thickness tear,’’ and "large to massive tears," respectively. The specificity values were 54%, 70%, and 70% for the above conditions, respectively. The negative likelihood ratios varied from 0.17 to 0.84, and the positive likelihood ratios varied from 1.35 to 2.93, depending on the presence of pain or weakness. Conclusion: Application of the supraspinatus test in isolation is helpful in diagnosing large or massive rotator cuff tears. The change that this test makes in pretest probability of less extensive rotator cuff pathology is insignificant.
J Orthop Sports Phys Ther. 2004;34(4):194-200. doi:10.2519/jospt.2004.1237
Key Words: accuracy, clinical diagnosis, shoulder
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Research Report
Belinda Lange, Lucy Chipchase, Angela Evans
Study Design: A preintervention and postintervention, repeated-measures experimental design. Objectives: To investigate the immediate effect of low-Dye taping on peak and mean plantar pressures during gait in subjects with navicular drop exceeding 10 mm. Background: Low-Dye taping is commonly used to support the longitudinal and transverse arches of the foot in an attempt to reduce the effects of symptoms associated with excessive pronation. Plantar pressure measurement has been used as an indirect indicator of pronation during gait. Method and Measures: The right foot of 60 subjects was tested using the Emed-AT system to obtain plantar pressure values. Subjects performed 6 barefoot walks over the Emed pressure platform while taped and a further 6 walks while untaped. Plantar pressures were recorded. Each footprint obtained was divided into 10 sections or 'masks.' Average peak and mean plantar pressure values (N/cm2) were calculated for both taped and untaped walks for each mask. Results: Paired t tests demonstrated significant changes in peak plantar pressure in 8 of the 10 areas of the foot and significant changes in mean plantar pressure in 9 of the 10 areas of the foot. Low-Dye taping significantly decreased pressure under the heel and the medial and middle forefoot, while increasing pressure under the lateral midfoot and under the toes. A significant decrease in mean plantar pressure was observed under the lateral forefoot, while no significant difference was demonstrated in peak plantar pressure under this area. The area under the medial midfoot demonstrated no significant change in either peak or mean pressure. Conclusions: Low-Dye taping significantly altered peak and mean plantar pressure values in subjects with navicular drop exceeding 10 mm. In particular, peak and mean plantar pressure increased under the lateral midfoot and under the toes, and decreased under the heel and forefoot, suggesting that a decrease in the amount of pronation occurred.
J Orthop Sports Phys Ther. 2004;34(4):201-209. doi:10.2519/jospt.2004.1123
Key Words: arch taping, Emed, pronation
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