STUDY DESIGN: Clinical measurement. OBJECTIVE: To determine the interrater reliability of a knee joint effusion grading scale in an outpatient orthopaedic physical therapy clinic. BACKGROUND: Knee joint effusion may indicate joint inflammation or irritation. Therefore, objective monitoring of effusion is important to decision making regarding patient prognosis and program progression. The clinicians in the authors' clinic use a modified stroke test to assess for knee joint effusion, which is operationally based on a 5-point grading scale. METHODS: Seventy-five patients (44 male, 31 female) receiving outpatient physical therapy for a unilateral knee problem, for whom effusion assessment was indicated, were tested. The subjects ranged from 16 to 65 years of age. Pairs of therapists graded the knee joint effusion using the clinical grading scale. A contingency table was constructed and analyzed using Cohen kappa values to establish interrater reliability. Percent agreement was also calculated. RESULTS: The kappa value was 0.75, observed as a proportion of the maximum possible kappa, and the percent agreement was 73%. Fifty-four of 75 pairs of tests had perfect agreement. Only 5 had disagreement of 2 grades, and there were no disagreements of greater than 2 grades. CONCLUSION: These findings provide evidence to support the proposed clinical effusion grading scale as a reliable method to assess knee joint effusion between therapists in an outpatient orthopaedic physical therapy clinic in patients with unilateral knee dysfunction. Only 5 of 75 ratings resulted in disagreement that could result in different clinical decisions being made by the therapists.

J Orthop Sports Phys Ther 2009;39(12):845-849, Epub 15 October 2009. doi:10.2519/jospt.2009.3143

KEY WORDS: hydroarthrosis, measurement, swelling, tibiofemoral

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To examine the effects of standing wall stretching with and without medial arch support (WMAS versus WOMAS) on the displacement of the myotendinous junction (DMTJ) of the medial gastrocnemius, rearfoot angle, and navicular height in subjects with neutral foot alignment and pes planus. BACKGROUND: Standing wall stretching is often prescribed to increase ankle dorsiflexion range of motion for sports fitness and rehabilitation. However, the effect of standing wall stretching WMAS on DMTJ is unknown. METHODS: Fifteen subjects with neutral foot alignment and 15 subjects with pes planus performed standing wall stretching under WMAS and WOMAS conditions. Measurements of DMTJ and rearfoot position were performed using ultrasonography and video imaging. Navicular height was measured using a ruler. Dependent variables were examined with a 2-way mixed-design analysis of variance. The 2 factors were foot type (neutral foot versus pes planus) and stretching condition (WMAS versus WOMAS). RESULTS: There were significant interactions of medial arch support by foot type for DMTJ, rearfoot angle, and navicular drop (P<.001). A post hoc paired t test showed that standing wall stretching in the WMAS condition significantly increased the DMTJ, compared to stretching in the WOMAS condition, in subjects with neutral foot (mean ± SD, 9.6 ± 1.6 versus 10.5 ± 1.6 mm; difference, 0.9 mm; 99% CI: 0.4-1.4 mm) and in those with pes planus (10.0 ± 1.8 versus 12.7 ± 2.0 mm; difference, 2.7 mm; 99% CI: 1.9-3.5 mm) (P<.001). When comparing WOMAS and WMAS, the difference in DMTJ (1.8 mm; 99% CI: 0.9-2.7 mm) was significantly greater in subjects with pes planus than in those with neutral foot (P<.001). CONCLUSION: Standing wall stretching with medial arch support maintained subtalar joint neutral position and increased the length of the gastrocnemius in subjects with pes planus. When prescribing standing wall stretching, clinicians need to emphasize the use of medial arch support to effectively stretch the gastrocnemius in subjects with pes planus.

J Orthop Sports Phys Ther 2009;39(12):867-874. doi:10.2519/jospt.2009.3158

KEY WORDS: ankle stretching, myotendinous junction, standing wall stretching, ultrasonography

STUDY DESIGN: Case report. BACKGROUND: Clinical practice guidelines regarding the conservative management of degenerative hip conditions in older adults routinely incorporate therapeutic exercise and manual therapy. However, the application of these recommendations to young, active adults is less clear. The purpose of this case report is to describe the management of a young adult with advanced hip arthrosis using a multifaceted rehabilitation program. CASE DESCRIPTION: A 28-year-old female with severe left hip degeneration, as identified with diagnostic imaging, was referred to physical therapy. Reduced hip range of motion and strength, sacroiliac joint asymmetries, and a modified Harris Hip Score of 76 were observed. She was seen for 12 visits over a 3-month period and treated with an individualized program including manual therapy, therapeutic exercise, and neuromuscular re-education. OUTCOME: Substantial improvements were noted in pain, hip range of motion, and strength and function (modified Harris Hip Score of 97). In addition, she discontinued the use of anti-inflammatory medications and returned to her prior level of activity. Improvements were maintained at a 3-month follow-up, with symptom recurrence managed using a self-mobilization technique to the left hip and massage to the left iliopsoas. DISCUSSION: Degenerative hip conditions are common among older adults but are relatively rare in the younger population. Although it is likely that this patient will experience a return of her symptoms and functional limitations as her hip disease progresses, the immediate improvements may delay the need for eventual surgical management. These outcomes suggest that physical therapy management should be considered in those with an early onset of degenerative hip disease and are consistent with results previously reported in the older population. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2009;39(12):858-866. doi:10.2519/jospt.2009.3207

KEY WORDS: manual therapy, OA, osteoarthritis, therapeutic exercise

A selection of products and developments of interest to JOSPT readers.

J Orthop Sports Phys Ther 2009;39(12):916-919.

Index by subject of all manuscripts published by the Journal during 2009.

J Orthop Sports Phys Ther 2009;39(12):907-915.