Study Design: Descriptive survey. Objective: Describe the availability of thrust joint manipulation clinical educational opportunities for physical therapy professional degree students. Background: In the United States, most of the faculty teaching manual therapy content in physical therapy programs believe that the best way for their students to develop thrust joint manipulation skills is to receive additional training during clinical education experiences. There are no data that describe the availability of such training opportunities. Methods and Measures: Seventy-three physical therapy programs that include thrust joint manipulation in their curricula were divided into 5 geographic regions. Of these programs, 27% (total, n = 20) were randomly selected per region to participate. Program academic coordinators of clinical education (ACCEs) identified their clinical instructors working in outpatient orthopaedic settings. ACCEs and clinical instructors were surveyed regarding thrust joint manipulation clinical education opportunities for students. Results: Survey return rates were 100% for ACCEs and 67.4% for clinical instructors. Of ACCEs, 70% were unsure which sites employed clinical instructors trained in thrust joint manipulation and 85% did not consider whether thrust joint manipulation training was provided when scheduling the experience. The ACCEs who did consider availability cited lack of qualified instructors as the number-one barrier to finding sites that offered thrust joint manipulation. Of clinical instructors, 30% provide thrust joint manipulation training including lecture/theory, technique demonstration, practice on "normals," and direct patient care supervision. Clinical instructors who did not teach thrust joint manipulation cited reasons that included the belief that it is not an entry-level skill (57%), lack of qualified staff (53%), liability concerns (46%), and students not being academically prepared (41%). Conclusions: Results suggest that the availability and scope of thrust joint manipulation clinical educational opportunities are limited, vary considerably, and are not considered when selecting clinical education sites for students. Potential obstacles to offering thrust joint manipulation training were identified, which suggested the need for resources, including clinical education curricula and philosophical guidelines for clinical instructors. J Orthop Sports Phys Ther. 2005;35(7):416-423. Key Words: joint mobilization, manipulation, manual therapy, physical therapy education

Study Design: Cross-sectional study. Objective: The self-reported reasons for terminating isometric back extension endurance testing and their associations with test performance and other factors were investigated to gain insight into determinants of test performance. Background: Factors limiting isometric back extension endurance performance remain unclear. Better understanding the reasons for termination of isometric extension endurance testing could provide insights into what the test actually reflects. Methods and Measures: Lifetime work, leisure activities and back pain questionnaire data, isometric back extension endurance testing (holding time, as measured in seconds), and reasons for test termination were obtained for a population-based sample of 544 working-age men. Results: The most common reason for test termination was fatigue (62.5%), followed by pain in various parts of the lower extremities (12.6% ) and back (3.2% ). A history of daily low back pain over the prior 12 months and greater pain intensity of the worst back pain episode over the same period were associated with a greater likelihood of termination due to back pain. In a regression analysis, longer holding time was associated with stopping due to fatigue rather than low back pain, with a trend of 19 seconds (95% confidence interval [CI], -2-40) longer holding time. After controlling for low back pain history, those previously involved in competitive sports were 2.6 times more likely to stop due to pain. Those with a competitive sport history had 14 seconds (95% CI, 5-23) greater holding time than those without such a history. Conclusions: Isometric back extension endurance testing is most commonly reported to be terminated due to muscle-related capacity as indicated by fatigue. Back pain is more likely to decrease performance time in men with a history of significant (frequent, intense) low back symptoms. J Orthop Sports Phys Ther. 2005;35(7):437-442. Key Words: fatigue, low back pain, lumbar spine, muscle

Study Design: Cross-sectional descriptive analysis investigating intrinsic fall risk factors in postmenopausal women with osteoporosis. Objective: To examine the relationships between history of recent falls and balance, pain, quality of life, function, posture, strength, and mobility. Background: Women with osteoporosis who fall are at a high risk of fracture due to decreased bone strength. Identifying fall risk factors for older women with osteoporosis is a crucial step in decreasing the incidence of falls and fracture. Method and Measures: Seventy-three women over 60 years of age with established osteoporosis participated in comprehensive testing of fall history, physical function, and quality of life. Results: Significant correlations were found between a recent history of falls and degree of kyphosis (r = 0.29), fear of falls/emotional status (r = -0.27), and balance (r = -0.27). Degree of kyphosis and fear of falls/emotional status explained 20% of the variance of recent fall history using binary logistic regression. Women with an increased kyphosis were more likely to have had a recent fall (odds ratio [OR], 1.17; 95% CI, 1.03-1.34) and those with better emotional status and less fear of falling were less likely to have had a recent fall (OR, 0.61; 95% CI, 0.38-0.97). Conclusion: Increased thoracic kyphosis and fear of falling are 2 intrinsic factors associated with recent falls in women with osteoporosis. To design more effective interventions to decrease fall risk in this population, future prospective, longitudinal studies should monitor kyphosis, fear of falling, balance reactions, and other potential risk factors not identified in this study. J Orthop Sports Phys Ther. 2005;35(7):452-460. Key Words: fracture, frail elderly, quality of life