This month’s issue of JOSPT contains a bibliometric analysis of the publishing history of the Journal of Orthopaedic & Sports Physical Therapy. The results provide an opportunity to reflect on trends at JOSPT and, more generally, in the evidence base of orthopaedic and sports physical therapy practice. Results of the bibliometric review by Coronado and colleagues are encouraging for JOSPT and the profession of physical therapy as a whole. The results indicate an increase in the publication of research articles involving symptomatic subjects, with fewer narrative and nonsystematic review papers. The results also raise an interesting issue about whether we have a sufficient number of randomized controlled trials in our literature and to what extent our future progress should be based on the publication of more randomized trials.

J Orthop Sports Phys Ther 2011;41(12):907-908. doi:10.2519/jospt.2011.0110

KEY WORDS: evidence-based medicine, physical therapy, profession, randomized controlled trials

Editor-in-Chief Dr. Guy Simoneau recognizes the authors, associate editors, International Editorial Review Board members, and manuscript and musculoskeletal imaging reviewers who contributed to the various aspects of the Journal over the past 12 months.

J Orthop Sports Phys Ther 2011;41(12):911-913. doi:10.2519/jospt.2011.0112

KEY WORDS: authors, editorial board, reviewers

STUDY DESIGN: Descriptive bibliometric analysis. BACKGROUND: Content and bibliometric studies are useful for describing the publication patterns of a given profession, such as physical therapy, within the medical and allied health fields. However, few studies have conducted these analyses on specialty physical therapy journals. OBJECTIVES: To conduct a content and bibliometric assessment of publications within the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and report publication and citation trends over multiple years. METHODS: All available JOSPT manuscripts published from 1980 through 2009 were reviewed. Only research reports, topical reviews, and case reports were included in the current analysis. Articles were coded by 2 independent reviewers based on type, participant characteristics, research design, purpose, clinical condition, and intervention. We obtained additional citation information (eg, authors and institutions) from a subset of articles published from 1992 through 2009 using bibliometric software. RESULTS: Of the 2233 available JOSPT publications, 1732 (77.6%) met criteria for inclusion. Of these, 1172 (67.7%) were research reports, 351 (20.3%) topical reviews, and 209 (12.1%) case reports. Over the last 30 years there has been a significant increase in the number of articles published and the percentage of research reports, systematic reviews, articles focused on prognosis, and articles including symptomatic participants. Percentage decreases were observed for topical or nonsystematic reviews and articles focused on anatomy/physiology. Top institutions, authors, and cited papers from 1992 through 2009 were identified in the bibliometric analyses. CONCLUSION: JOSPT has shown publication trends for increased percentage of experimental and clinically relevant research. However, there may be a need for increased publication of randomized controlled trials and studies focused on diagnosis, prognosis, and treatment, if goals of evidence-based practice are to be met.

J Orthop Sports Phys Ther 2011;41(12):920-931. doi:10.2519/jospt.2011.3808

KEY WORDS: citation analysis, publication trends, research

STUDY DESIGN: Resident’s case problem. BACKGROUND: A 21-year-old athletic male college student presented to a direct-access physical therapy clinic with complaints of left calf pain 4 days in duration. After initial examination, a working diagnosis of calf strain was formulated. Three days following initial examination, the patient reported 80% improvement in symptoms and was performing activities of daily living pain free. Four weeks later, the patient returned with complaints of reoccurring calf pain. The patient’s signs, symptoms, and history at subsequent follow-up no longer presented a consistent clinical picture of calf strain; therefore, a D-dimer assay was ordered to rule out a deep vein thrombosis (DVT). DIAGNOSIS: The D-dimer was elevated so the patient was admitted to the hospital and started on low-molecular-weight heparin. A compression ultrasound revealed an extensive left superficial femoral and popliteal DVT in this otherwise healthy athlete. DISCUSSION: Lower extremity DVT is a serious and potentially fatal disorder. Physical therapists need to be diagnostically vigilant for vascular pathology in all patients with extremity pain and swelling. Employing the best current evidenced-based screening tools to rule out vascular pathology, such as deep and superficial vein pathology, should be the goal of every clinician. The Wells score is one such screening tool that has proven to be beneficial in this area. This case report presents a dilemma in diagnosis and illustrates the importance of revisiting differential diagnoses with each patient encounter. Clinicians must consider the possibility of a DVT with every patient seen with posterior leg pain. LEVEL OF EVIDENCE: Diagnosis, level 4.

J Orthop Sports Phys Ther 2011;41(12):942-947. doi:10.2519/jospt.2011.3823

KEY WORDS: clinical prediction rule, D-dimer assay, DVT

STUDY DESIGN: Clinical measurement. OBJECTIVES: To determine the interrater and intrarater reliability of the active hip abduction (AHAbd) test. BACKGROUND: The AHAbd test is used to assess lumbopelvic movement during a dynamic lower limb activity. The test has previously been shown to predict low back pain development during a prolonged standing exposure in previously asymptomatic individuals. As an observation-based assessment for which rater reliability has not been established, similar scoring on the test between clinicians is essential. METHODS: One hundred twenty-eight video clips of participants performing the AHAbd test were recorded. Sixteen practicing physical therapists scored test performance by viewing 20 preselected videos to establish interrater reliability. Fourteen of the 16 raters rescored the videos after a 3-week period to establish intrarater reliability. Demographic data were collected for all raters. Intraclass correlation coefficients (ICCs) were calculated for reliability statistics. Correlations were performed between demographic data and ICCs. RESULTS: Interrater reliability (ICC_2,1) for the test using the 4-point scale was 0.70 (95% confidence interval [CI]: 0.56, 0.84) and 0.59 (95% CI: 0.43, 0.76) when the scale was dichotomized into positive/negative scores. Intrarater reliability (ICC_3,1) was 0.74 on average. Demographic characteristics were not significantly associated with reliability scores. CONCLUSION: Interrater and intrarater reliability for scoring of the AHAbd test by practicing clinicians was similar, regardless of experience level or practice setting. The AHAbd test can be considered to be a reliable observational tool.

J Orthop Sports Phys Ther 2011;41(12):953-960, Epub 25 October 2011. doi:10.2519/jospt.2011.3684

KEY WORDS: low back pain, lumbar region, lumbopelvic control, stabilization

STUDY DESIGN: Prospective, longitudinal, observational cohort design. OBJECTIVE: The primary aim was to examine the association between changes in psychosocial distress (PD), and functional status (FS) and pain intensity at discharge from physical therapy. BACKGROUND: Patients with lumbar impairments seeking physical therapy commonly demonstrate elevated PD. However, it is not clear if PD changes that occur during physical therapy management are associated with improved clinical outcomes. METHODS: Data from adults (n = 692) with lumbar impairment were analyzed. Patients were screened using the Symptom Checklist Back Pain Prediction Model questionnaire (SCL BPPM) to identify patients at intake and discharge into 3 levels of risk for persistent disability (high, intermediate, or low). SCL BPPM classifications allowed for 5 patterns of change in PD during therapy (decreased, stable low, stable intermediate, stable high, or increased). Associations between PD change patterns and discharge FS and pain intensity were assessed using multivariable linear regression models, controlling for selected risk-adjustment variables. RESULTS: Proportions of patients classified by patterns of PD change for decreased, stable low, stable intermediate, stable high, and increased were 0.34, 0.52, 0.05, 0.06, and 0.03, respectively. Compared to the decreased PD group, (1) increased, stable high, and stable intermediate PD patterns were associated with worse discharge FS scores (–7.9 [95% CI: –13.5, –2.21], –10.9 [95% CI: –15.25, –6.49], and –8.9 [95% CI: –13.65, –4.21] units, respectively), and (2) stable high and stable intermediate PD patterns were associated with higher pain intensity (2.59 [95% CI: 1.81, 3.56] and 2.14 [95% CI: 1.25, 3.04] units, respectively). CONCLUSIONS: Lower FS and higher pain intensity outcomes were associated in similar but not identical patterns with patients whose SCL BPPM classification of PD increased, or remained at high or intermediate levels during physical therapy. Serial assessments of change in PD during rehabilitation are recommended as a possible treatment-monitoring tool.

J Orthop Sports Phys Ther 2011;41(12):969-980. doi:10.2519/jospt.2011.3814

KEY WORDS: computerized adaptive testing, depression, functional and pain outcomes, lumbar spine, psychosocial distress, somatization

The patient was a 17-year-old female who was referred to a physical therapist by her primary-care physician with a chief complaint of bilateral hip and groin pain. The patient was treated by the physical therapist for 8 weeks, but she was unable to successfully return to playing soccer. The patient was subsequently referred to an orthopaedic surgeon, who ordered a magnetic resonance arthrogram that did not reveal intra-articular pathology. To further evaluate bony morphology, computed tomography with 3-dimensional reconstructions was ordered, which demonstrated findings consistent with cam-type femoroacetabular impingement.

J Orthop Sports Phys Ther 2011;41(12):982. doi:10.2519/jospt.2011.0425

KEY WORDS: computed tomography, hip pain, groin pain, magnetic resonance imaging, radiography

This index includes all authors and co-authors of manuscripts published in the Journal during 2011.

J Orthop Sports Phys Ther 2011;41(12):988-1010.

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