The availability of population-based survey data provides a unique opportunity to understand issues related to access and utilization of physical therapy in the United States, and to better gauge public perceptions of the profession. In our day-to-day routine, we all tend to consider our work as physical therapists on a one-to-one level with the patients we serve. Examining data from national population-based surveys can elevate our daily, ground-level viewpoint to a 30 000-foot perspective on the profession. This vantage point allows certain things to come into focus that would otherwise be obscured, and the vision may not always comport with our expectations.

J Orthop Sports Phys Ther 2011;41(7):465-466. doi:10.2519/jospt.2011.0105

KEY WORDS: physical therapy, population-based survey

STUDY DESIGN: Secondary analysis, cross-sectional study. OBJECTIVES: To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups. BACKGROUND: Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings. METHODS: Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as “nonsevere” or “severe,” based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group. RESULTS: Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (Χ² = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (Χ² = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (Χ² = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities. CONCLUSION: Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain. LEVEL OF EVIDENCE: Differential diagnosis/symptom prevalence, level 3b.

J Orthop Sports Phys Ther 2011;41(7):477-485, Epub 7 June 2011. doi:10.2519/jospt.2011.3686

KEY WORDS: comorbidity, medical screening, musculoskeletal pain

SYNOPSIS: With the focus on evidence-based practice in healthcare, a well-conducted systematic review that includes a meta-analysis where indicated represents a high level of evidence for treatment effectiveness. The purpose of this commentary is to assist clinicians in understanding meta-analysis as a statistical tool using both published articles and explanations of components of the technique. We describe what meta-analysis is, what heterogeneity is, and how it affects meta-analysis, effect size, the modeling techniques of meta-analysis, and strengths and weaknesses of meta-analysis. Common components like forest plot interpretation, software that may be used, special cases for meta-analysis, such as subgroup analysis, individual patient data, and meta-regression, and a discussion of criticisms, are included.

J Orthop Sports Phys Ther 2011;41(7):496-504. doi:10.2519/jospt.2011.3333

KEY WORDS: forest plot, literature review, statistical analysis, systematic review

STUDY DESIGN: Case series. BACKGROUND: Intersection syndrome is an overuse injury of the forearm. Taping has been described for the management of soft tissue injuries, yet there has been no report for the management of intersection syndrome using this method. The purpose of this case series was, therefore, to describe the efficacy of taping for the management of intersection syndrome. CASE DESCRIPTION: Five patients with intersection syndrome were managed by taping, in an effort to reduce crepitus induced by thumb movements. Nonstretch sports tape was applied, with an ulnarly directed tension force across the dorsal aspect of the forearm. Taping was performed daily for 3 weeks. Follow-up took place at 1, 2, 3, and 4 weeks, and at 1 year from the initial consultation. OUTCOMES: All patients demonstrated complete elimination of crepitus with the application of tape. Crepitus induced by wrist movements, tenderness over the dorsal forearm, and swelling were no longer present at 3-week follow-up. Disability identified by the disability/symptom subscale of the Disabilities of the Arm, Shoulder and Hand questionnaire decreased at 3-week follow-up, and this reduction was maintained at 4-week and 1-year follow-ups. DISCUSSION: Taping improved symptoms and function in this small case series. One possible explanation for this improvement may be the alteration of soft tissue alignment. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2011;41(7):514-519, Epub 6 April 2011. doi:10.2519/jospt.2011.3569

KEY WORDS: overuse syndrome, tape, thumb, wrist

STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To evaluate the effect of low-intensity therapeutic ultrasound on the murine calcaneus tendon healing process. BACKGROUND: Therapeutic ultrasound promotes formation and maturation of scar tissue. METHODS: Calcaneus tendon tenotomy and tenorrhaphy was performed on 28 Wistar rats. After the procedure, the animals were randomly divided into 2 groups. The animals in the experimental group received a 5-minute ultrasound application, once a day, at a frequency of 1 MHz, a spatial average temporal average intensity of 0.1 W/cm2, and a spatial average intensity of 0.52 W/cm2 at a 16-Hz frequency pulse mode (duty cycle, 20%). Data for the injured side were normalized in relation to the data from the contralateral healthy calcaneus tendon (relative values). The animals in the control group received sham treatment. After a 28-day treatment period, the animals were sacrificed and their tendons surgically removed and subjected to mechanical stress testing. The parameters analyzed were cross-sectional area (mm2), ultimate load (N), tensile strength (MPa), and energy absorption (mJ). RESULTS: A significant difference between groups was found for the relative values of ultimate load and tensile strength. The mean ± SD ultimate load of the control group was –3.5% ± 32.2% compared to 33.3% ± 26.8% for the experimental group (P = .005). The mean tensile strength of the control group was –47.7% ± 19.5% compared to –28.1% ± 24.1% for the experimental group (P = .019). No significant difference was found in cross-sectional area and energy absorption. CONCLUSION: Low-intensity pulsed ultrasound produced by a conventional therapeutic ultrasound unit can positively influence the calcaneus tendon healing process in rats.

J Orthop Sports Phys Ther 2011;41(7):526-531, Epub 2 February 2011. doi:10.2519/jospt.2011.3468

KEY WORDS: biomechanical testing, physical agents, therapeutic ultrasound

The patient was a 50-year-old woman who was referred to a physical therapist for management of chronic low back pain. Intervention by the physical therapist included therapeutic exercises and manual therapy. However, after 3 weeks, the patient was referred to a neurosurgeon due to worsening of symptoms and failure to respond to conservative interventions. Lumbar spine magnetic resonance imaging and myelography revealed a lesion consistent with a synovial cyst at the level of the left L3-4 facet joint. Following surgical excision of the cyst, the patient's symptoms resolved completely.

J Orthop Sports Phys Ther 2011;41(7):533. doi:10.2519/jospt.2011.0415

KEY WORDS: low back pain, magnetic resonance imaging, myelography

JOSPT offers invited reviews of current titles. The July 2011 column includes 5 reviews of the following books: Treat Your Own Shoulder; Musculoskeletal Ultrasound With MRI Correlations; Clinical Prediction Rules: A Physical Therapy Reference Manual; MRI for Orthopaedic Surgeons; and Examination of Musculoskeletal Injuries: Third Edition.

J Orthop Sports Phys Ther 2011;41(7):536-540.