Journal of Orthopaedic & Sports Physical Therapy - Anthony Delitto, PT, PhD, FAPTA

Low Back Pain

Fri, 30 Mar 2012 00:00:00 EST

Anthony Delitto, Steven Z. George, Linda R. Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Joseph J. Godges

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.

J Orthop Sports Phys Ther. 2012;42(4):A1-A57. doi:10.2519/jospt.2012.0301

KEY WORDS: clinical practice guidelines, ICD, ICF, LBP, Orthopaedic Section

Visual Assessment of Foot Type and Relationship of Foot Type to Lower Extremity Injury

Wed, 10 Sep 2008 00:00:00 EST

Laurie K. Dahle, Michael J. Mueller, Anthony Delitto, Jay E. Diamond
The purpose of this study was 1) to establish the interrater reliability of classifying foot type by visual appraisal and 2) to determine any relationship between foot type and subsequent knee pain or ankle sprains. Seventy-seven athletes were evaluated by three trained physical therapists to determine interrater reliability of a visual appraisal to identify foot type. Feet were classified according to operational definitions, and specific criteria had to be met for the foot to be classified as supinated, pronated, or neutral. Questionnaires concerning knee pain were completed at the beginning of the season, and incidence of ankle sprain was followed throughout the football and cross country seasons for 55 athletes. The Kappa value for interrater reliability for visually assessing foot type was .72. There was a significant relationship between foot type and knee pain (X² = 4.45, N = 55, df = 2, p < .05). There was no relationship between foot type and incidence of ankle sprain. These results indicate that 1) physical therapists trained in the procedure can reliably use visual appraisal to classify foot type, and 2) athletes with excessively pronated or supinated foot types may be more susceptible to knee pain than athletes with neutral foot types.

J Orthop Sports Phys Ther 1991;14(2):70-74.

Key Words: Ankle, foot structure, alignment reliability

A Comparison of Two Different Methods to Treat Hip Pain in Runners

Mon, 08 Sep 2008 00:00:00 EST

Michael T. Cibulka, Anthony Delitto
Little or no research has been performed on the physical therapy treatment of hip pain. The purpose of this study was to compare two different treatments for hip pain. Twenty runners who had primary hip pain and sacroiliac joint dysfunction, without evidence of arthritic changes, were randomly assigned to two groups. One group received a mobilization technique to the involved hip, while the other was treated with a manipulative technique known to affect sacroiliac joint dysfunction. The subjects were evaluated by using a pain questionnaire and the Faber test to determine the response of the hip joint to treatment. Data were analyzed with the Mann-Whitney U statistic for perceived pain response and with the Chi-square statistic with Yates correction for the Faber test. Results showed a significant difference in perceived pain response, as well as reproduction of pain with the Faber test, between the two groups. The results suggest that a manipulative technique designed to reduce sacroiliac joint dysfunction is an effective method to reduce hip pain. Physical therapists should evaluate the sacroiliac joint in patients with hip pain.

J Orthop Sports Phys Ther 1993;17(4):172-176.

Key Words: sacroiliac joint, hip pain, joint manipulation

Letters to the Editor-in-Chief

Tue, 27 Feb 2007 00:00:00 EST

Michael T. Cibulka, Philip Paul Tygiel, Anthony Delitto

Letters to the Editor-in-Chief published in the December 2006 issue of the Journal.

J Orthop Sports Phys Ther. 2006;36(12):963-967. doi:10.2519/jospt.2006.0202

Diagnostic Classification and Orthopaedic Physical Therapy Practice: What We Can Learn From Medicine

Mon, 05 Feb 2007 09:45:00 EST

Nancy J. Zimny, Marilyn Moffat, Anthony Delitto, Peter B. O'Sullivan

Concepts of diagnosis and classification have a long history in medicine, while formal schemes of diagnostic classification in physical therapy are relatively new. Basic differences exist between medicine and physical therapy in the phenomena, which are diagnosed and classified. However, similarities in the diagnostic and classification process provide an opportunity to learn from medicine as the process now evolves in physical therapy. This paper provides a brief history of the development of the concept of diagnostic classification in medicine and physical therapy. Difficulties associated with the process are described. Knowledge of these difficulties is used to analyze some of the evolving concepts of diagnostic classification in physical therapy, especially those related to orthopaedic physical therapy practice.

J Orthop Sports Phys Ther. 2004;34(3):105-115. doi:10.2519/jospt.2004.0686

Key Words: clinical practice, diagnosis, essentialism, nominalism

Patient Outcomes and Clinical Performance: Parallel Paths or Inextricable Links?

Mon, 05 Feb 2007 09:45:00 EST

Anthony Delitto

Should a clinician's performance be held at least partially accountable to the outcome achieved by patients during episodes of care? I am promoting the use of outcomes in at least part of the formula of whatever comprises clinical performance assessment.

J Orthop Sports Phys Ther. 2006; 36(8):548-549. doi:10.2519/jospt.2006.0109

Systematic Review of the Quality of Randomized Controlled Trials for Patellofemoral Pain Syndrome

Thu, 07 Dec 2006 00:00:00 EST

Mario Bizzini, John D. Childs, Sara R. Piva, Anthony Delitto
Study Design: Systematic review of the literature. Objectives: To develop a grading scale to judge the quality of randomized clinical trials (RCTs) and conduct a systematic review of the published RCTs that assess nonoperative treatments for patellofemoral pain syndrome (PFPS). Background: Systematic reviews of the quality and usefulness of clinical trials allow for efficient synthesis and dissemination of the literature, which should facilitate clinicians’ efforts to incorporate principles of evidence-based practice in the clinical decision-making process. Methods and Measures: Using a scale based on criteria in the Cochrane Collaboration Handbook, we sought to critically appraise the methodology used in RCTs related to the nonoperative management of PFPS, synthesize and interpret our results, and report our findings in a user-friendly fashion. A scale to assess the methodological quality of trials was designed and pilot tested for its content and reliability. Published RCTs identified during a literature search were then selected and rated by 6 raters. We used predefined cutoff scores to identify specific weaknesses in the clinical research process that need to be improved in future clinical trials. Results: The quality scale we developed was demonstrated to be sufficiently reliable to warrant interpretation of the reviewers’ findings. The percentage of trials that met a minimum level of quality for each specific criterion ranged from a low of 25% for the adequacy of the description of the randomization procedure to a high of 95% for the description and standardization of the intervention. Conclusions: Based on the results of trials exhibiting a sufficient level of quality, treatments that were effective in decreasing pain and improving function in patients with PFPS were acupuncture, quadriceps strengthening, the use of a resistive brace, and the combination of exercises with patellar taping and biofeedback. The use of soft foot Orthotics in patients with excessive foot pronation appeared useful in decreasing pain. In addition, at a short-term follow-up, patients who received exercise programs were discharged earlier from physical therapy. Unfortunately, most RCTs reviewed contained qualitative flaws that bring the validity of the results into question, thus diminishing the ability to generalize the results to clinical practice. These flaws were primarily in the areas of randomization procedures, duration of follow-up, control of cointerventions, assurance of blinding, accountability and proper analysis of dropouts, number of subjects, and the relevance of outcomes. Also, given the limited number of high-quality clinical trials, recommendations about supporting or refuting specific treatment approaches may be premature and can only be made with caution.

J Ortho Sports Phys Ther. 2003;33(1):4-20.

Keywords: bias, decision making, evidence, grading, methodology