STUDY DESIGN: Blinded, randomized controlled trial. OBJECTIVES: To determine if the combination of transcutaneous electrical nerve stimulation (TENS) set to a sensory level and therapeutic exercise would be more effective than the combination of placebo TENS and therapeutic exercises or therapeutic exercises only to increase quadriceps activation in individuals with tibiofemoral osteoarthritis. BACKGROUND: Quadriceps activation deficits are common in those with tibiofemoral osteoarthritis, and TENS has been reported to immediately increase quadriceps activation. Yet the long-term benefits of TENS for motor neuron activation have yet to be determined. METHODS: Thirty-six individuals with radiographically assessed tibiofemoral osteoarthritis were randomly assigned to the TENS and exercise, placebo and exercise, and exercise only groups. All participants completed a supervised 4-week lower extremity exercise program. TENS and placebo TENS were worn throughout the therapeutic exercise sessions, as well as during daily activities. Our primary outcome measures, quadriceps central activation ratio, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline and at 2 weeks and 4 weeks of the intervention. RESULTS: Quadriceps activation was significantly higher in the TENS with exercise group compared to the exercise only group at 2 weeks (0.94 ± 0.04 versus 0.82 ± 0.12, P<.05) and the placebo and exercise group at 4 weeks (0.94 ± 0.06 versus 0.81 ± 0.15, P<.05). WOMAC scores improved in all 3 groups over time, with no significant differences among groups. CONCLUSION: This study provides evidence that TENS applied in conjunction with therapeutic exercise and daily activities increases quadriceps activation in patients with tibiofemoral osteoarthritis and, while function improved for all participants, effects were greatest in the group treated with a combination of TENS and therapeutic exercises. LEVEL OF EVIDENCE: Therapy, level 1b–.

J Orthop Sports Phys Ther 2011;41(1):4-12. doi:10.2519/jospt.2011.3447

KEY WORDS: knee, OA, TENS, WOMAC

STUDY DESIGN: Prospective, longitudinal, observational cohort. OBJECTIVES: Primary aims were to determine (1) baseline prevalence of directional preference (DP) or no directional preference (no-DP) observed for patients with low back pain whose symptoms centralized (CEN), did not centralize (non-CEN), or could not be classified (NC), and (2) to determine if classifying patients at intake by DP or no-DP combined with CEN, non-CEN, or NC predicted functional status and pain intensity at discharge from rehabilitation. BACKGROUND: Although evidence suggests that patient response classification criteria DP or CEN improve outcomes, previous studies did not delineate relations between DP and CEN findings and outcomes. METHODS: Eight therapists classified patients using standardized definitions for DP and CEN. Prevalence rates for DP and no-DP and CEN,non-CEN, and NC were calculated. Ordinary least-squares multivariate regression models assessed whether multilevel classification combining DP and CEN (DP/CEN, DP/non-CEN, DP/NC, no-DP/non-CEN, and no-DP/NC categories) predicted discharge functional status (scale range, 0 to 100, with higher values representing better function) or pain intensity (scale range, 0 to 10, with higher values representing more pain). RESULTS: Overall prevalence of DP and CEN was 60% and 41%, respectively. For those with DP, prevalence rates for DP/CEN, DP/non-CEN, and DP/NC were 65%, 27%, and 8%, respectively. The amount of variance explained (R² values) for function and pain models was 0.50 and 0.39, respectively. Compared to patients classified as DP/CEN, patients classified as DP/non-CEN or no-DP/non-CEN reported 7.7 and 11.6 functional status units less at discharge (P<.001), respectively, and patients classified as no-DP/non-CEN reported 1.7 pain units more at discharge (P<.001). CONCLUSIONS: Findings suggest that classification by pain pattern and DP can improve a therapist’s ability to provide a short-term prognosis for function and pain outcomes. LEVEL OF EVIDENCE: Prognosis, level 1b–.

J Orthop Sports Phys Ther 2011;41(1):22-31, Epub 22 October 2010. doi:10.2519/jospt.2011.3415

KEY WORDS: computerized adaptive testing, lumbar spine, outcomes

The patient was a 53-year-old man referred to a physical therapist with a chief complaint of worsening right medial knee pain of 3 months' duration. He had a history of anterior cruciate ligament reconstruction 7 years prior, and recent diagnostic imaging studies had not been performed. Physical examination of the right knee was unremarkable, without reproduction of his chief complaint of medial knee pain. During examination of the right hip, however, combined movements of hip flexion, internal rotation, and adduction, as well as hip distraction and compression, reproduced the patient's knee pain. While radiographs of the right knee were unremarkable, radiographs of the right hip revealed acetabular undercoverage, superolateral joint space narrowing, and subchondral sclerosis. Magnetic resonance imaging of the hip, with and without intra-articular gadolinium, identified developmental dysplasia with marked acetabular undercoverage and moderately advanced degenerative joint disease. The patient did not respond to conservative management and subsequently underwent total hip arthroplasty 9 months after first being seen by the physical therapist, which resulted in complete resolution of his medial knee pain.

J Orthop Sports Phys Ther 2011;41(1):33. doi:10.2519/jospt.2011.0402

KEY WORDS: magnetic resonance imaging, radiography

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, OPL designates an Orthopaedic Section platform presentation.

J Orthop Sports Phys Ther 2011;41(1):A12-A38

KEY WORDS: Combined Sections Meeting, CSM

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, OPO designates an Orthopaedic Section poster presentation.

J Orthop Sports Phys Ther 2011;41(1):A52-A93

KEY WORDS: Combined Sections Meeting, CSM