Study Design: Nonexperimental descriptive research design. Objective: To describe the frequency of use and perceived level of importance of professional responsibilities, procedures, and knowledge areas by physical therapists practicing in primary contact care settings and to compare these data to similar data from physical therapists practicing in nonprimary contact care settings. Background: Physical therapy services have moved toward a primary contact model of practice in response to changes in the health care delivery system. Several studies have reported the effectiveness of primary contact physical therapy. However, a practice analysis has not been performed to define the clinical practice of primary contact physical therapy. Methods and Measures: A sample of 212 physical therapists practicing as primary contact providers in the military and civilian sectors, and a comparison group of 250 physical therapists not practicing as primary contact providers were surveyed. A Delphi technique was used to develop the survey instrument, which was pretested by a pilot group. The final survey instrument consisted of 171 items. Chi-square and Kruskal-Wallis tests were conducted to examine significant differences among the 3 groups (P<.001). Results: Of the 212 surveys mailed to the primary contact group, 119 (56.1%) responses were received (82 military physical therapists and 37 civilian physical therapists). Of the 250 surveys mailed to the comparison group, 103 (41.2%) responses were received. There were numerous significant differences among the 3 groups in professional responsibilities, procedures, and knowledge areas, most notably in the areas of selecting and ordering of imaging procedures, identifying signs and symptoms of nonmusculoskeletal conditions, establishing physical therapy diagnoses, and prescribing over-the-counter medications. Conclusion: The study describes the clinical practice of physical therapists functioning in the role of primary contact providers or as members of a diverse team of health care professionals in primary care, which may provide curricular direction to professional, postprofessional, and clinical residency or fellowship-based educational settings.

J Orthop Sports Phys Ther. 2004;34(6):284-304. doi:10.2519/jospt.2004.1298

Key Words: clinical competencies, physical therapists, primary care

Study Design: Repeated-measures analysis of variance. Objective: To examine the effect of 2 different orthotic posting designs on first metatarsophalangeal (first MTP) joint kinematics during gait. Background: Common orthotic designs used to control abnormal pronation incorporate the use of a medial post in the forefoot and/or rearfoot locations. Although this design may favorably alter rearfoot and lower-limb kinematics, the incorporation of a forefoot post has been theorized to negatively impact first MTP joint function by limiting hallux dorsiflexion during push off. An alternative design that has been proposed to be more favorable for function of the hallux and first metatarsal is the medial arch support. Methods and Measures: Eighteen subjects with a mean age of 28.2 years (SD, 8.3 years) completed the study. All subjects were judged to have excessive pronation based on a clinical orthopaedic examination. Two different pairs of orthoses were custom molded for each subject. One design incorporated an extrinsic rearfoot and forefoot post and the second design had a high medial longitudinal arch in combination with an extrinsic rearfoot post. The "Flock of Birds" electromagnetic tracking device was used to collect 3-dimensional position and orientation data of 3 body segments (hallux, first metatarsal, and calcaneus) during the stance phase of walking for 3 conditions (no orthosis and each of the 2 different orthotic designs). A repeated-measures analysis of variance was used to assess differences in first MTP joint dorsiflexion at midstance and during the push-off period of gait, as well as metatarsal declination angle changes during relaxed stance. An exploratory regression analysis was used to investigate factors that related to the change in peak dorsiflexion for the orthotic conditions. Results: Peak first MTP joint dorsiflexion averaged between 38° and 40° across all conditions. Although slight increases in first MTP joint dorsiflexion values were noted with both types of orthotic designs, these differences were not significant at either phase of the stance cycle (P = .50). The metatarsal declination angle in relaxed stance significantly increased (P = .001) under both orthotic conditions. Considerable individual variability was present. For the rearfoot-forefoot posted orthosis, a change in the declination angle of the first metatarsal during relaxed stance with the orthosis was a significant nonlinear predictor of change in peak dorsiflexion during push off. Conclusions: Foot orthoses that incorporate a medial forefoot post do not have a consistent negative effect of reducing first MTP joint dorsiflexion during walking.

J Orthop Sports Phys Ther. 2004;34(6):317-327. doi:10.2519/jospt.2004.1246

Key Words: arch support, first metatarsal joint, hallux, medial orthotic posts

Study Design: Methodological study using correlational methods. Objective: To determine the intratester and intertester reliability and concurrent validity of the figure-of-eight method of measuring hand size in patients with hand pathology. Background: Measuring edema is an important component of the physical examination of patients with conditions affecting the hand. The figure-of-eight method of measuring hand size has been suggested as an alternative to volumetry. The reliability and concurrent validity of the figure-of-eight method has been established in individuals without hand pathology, but not in patients with conditions involving the hand. Methods and Measures: Participants were 24 patients with conditions affecting the hand, 9 with bilateral involvement. Two testers performed 3 figure-of-eight measurements of hand size each. A third tester performed 2 volumetric measurements. Intraclass correlation coefficient (ICC_3,1) was used to determine intratester reliability of both measurement procedures. ICC_2,3 was used to examine intertester reliability of the figure-of-eight method. Pearson product moment correlation coefficients examining the association between the 2 methods were used to establish concurrent validity of the figure-of-eight technique. Results: Intratester ICCs for figure-of-eight and volumetric methods were 0.98 to 0.99. The intertester ICC for the figure-of-eight method was 0.99. Pearson correlation coefficients examining the relationship between the 2 methods were 0.92 to 0.94. Conclusion: The figure-of-eight method is a reliable and valid measure of hand size in individuals with conditions affecting the hand.

J Orthop Sports Phys Ther. 2004;34(6):335-340. doi:10.2519/jospt.2004.1367

Key Words: edema, swelling, tape measure, volumetry