STUDY DESIGN: Reliability study. OBJECTIVES: To determine intrarater test-retest and interrater reliability of the Functional Movement Screen (FMS) among novice raters. BACKGROUND: The FMS is used by various examiners to assess movement and predict time-loss injuries in diverse populations (eg, youth to professional athletes, firefighters, military service members) of active participants. Unfortunately, critical analysis of the reliability of the FMS is currently limited to 1 sample of active college-age participants. METHODS: Sixty-four active-duty service members (mean ± SD age, 25.2 ± 3.8 years; body mass index, 25.1 ± 3.1 kg/m²) without a history of injury were enrolled. Participants completed the 7 component tests of the FMS in a counterbalanced order. Each component test was scored on an ordinal scale (0 to 3 points), resulting in a composite score ranging from 0 to 21 points. Intrarater test-retest reliability was assessed between baseline scores and those obtained with repeated testing performed 48 to 72 hours later. Interrater reliability was based on the assessment from 2 raters, selected from a pool of 8 novice raters, who assessed the same movements on day 2 simultaneously. Descriptive statistics, weighted kappa (κ_w), and percent agreement were calculated on component scores. Intraclass correlation coefficients (ICCs), standard error of the measurement, minimal detectable change (MDC₉₅), and associated 95% confidence intervals (CIs) were calculated on composite scores. RESULTS: The average ± SD score on the FMS was 15.7 ± 0.2 points, with 15.6% (n = 10) of the participants scoring less than or equal to 14 points, the recommended cutoff for predicting time-loss injuries. The intrarater test-retest and interrater reliability of the FMS composite score resulted in an ICC_3,1 of 0.76 (95% CI: 0.63, 0.85) and an ICC_2,1 of 0.74 (95% CI: 0.60, 0.83), respectively. The standard error of the measurement of the composite test was within 1 point, and the MDC₉₅ values were 2.1 and 2.5 points on the 21-point scale for interrater and intrarater reliability, respectively. The interrater agreement of the component scores ranged from moderate to excellent (κ_w = 0.45-0.82). CONCLUSION: Among novice raters, the FMS composite score demonstrated moderate to good interrater and intrarater reliability, with acceptable levels of measurement error. The measures of reliability and measurement error were similar for both intrarater reliability that repeated the assessment of the movement patterns over a 48-to-72–hour period and interrater reliability that had 2 raters assess the same movement pattern simultaneously. The interrater agreement of the FMS component scores was good to excellent for the push-up, quadruped, shoulder mobility, straight leg raise, squat, hurdle, and lunge. Only 15.6% (n = 10) of the participants were identified to be at risk for injury based on previously published cutoff values.

J Orthop Sports Phys Ther 2012;42(6):530-540, Epub 14 May 2012. doi:10.2519/jospt.2012.3838

KEY WORDS: injury prediction, injury prevention, injury risk, interrater, intrarater

STUDY DESIGN: Prospective case series. OBJECTIVE: To examine the relation between improved disability and changes in abdominal and lumbar multifidus (LM) thickness using ultrasound imaging following spinal manipulative therapy (SMT) in patients with low back pain (LBP). BACKGROUND: Although there is a growing body of literature demonstrating physiologic effects following the application of SMT, few studies have attempted to correlate these changes with clinically relevant outcomes. METHODS: Eighty-one participants with LBP underwent 2 thrust SMT treatments and 3 assessment sessions within 1 week. Transversus abdominis (TrA), internal oblique (IO), and LM muscle thickness was assessed during each session, using ultrasound imaging of the muscles at rest and during submaximal contractions. The Modified Oswestry Disability Index was used to quantify participants’ improvement in LBP-related disability. Stepwise hierarchical multiple linear regression and repeated-measures analysis of variance were performed to examine the multivariate relationship between change in muscle thickness and clinical improvement over time. RESULTS: After controlling for the effects of age, sex, and body mass index, change in contracted LM muscle thickness was predictive of improved disability at 1 week (P = .02). As expected, larger increases in contracted LM muscle thickness at 1 week were associated with larger improvements in LBP-related disability. Contrary to our hypothesis, significant decreases in both contracted TrA and IO muscle thickness were observed immediately following SMT; but these changes were transient and unrelated to whether participants experienced clinical improvements. CONCLUSION: These findings provide evidence that clinical improvement following SMT is associated with increased thickening of the LM muscle during a submaximal task. LEVEL OF EVIDENCE: Prognosis, level 4.

J Orthop Sports Phys Ther 2011;41(6):389-399, Epub 6 April 2011. doi:10.2519/jospt.2011.3632

KEY WORDS: low back pain, muscle contraction, transversus abdominis, ultrasound

STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To explore potential associations between foot posture index (FPI-6) composite scores and dynamic plantar pressure measurements, and to describe each of the 6 subscales and the FPI-6 composite scores across our sample. BACKGROUND: The FPI-6 is a static foot posture assessment comprised of 6 observations. Extreme scores have been associated with increased injury risk. However, knowledge describing the relationship between FPI-6 scores and plantar pressure distributions during gait is limited. METHODS: Participants (n = 1000; 566 males, 434 females) were predominantly active adults (mean ± SD age, 30.6 ± 8.0 years; body mass index, 26.2 ± 3.7 kg/m²), who ran 3.1 ± 1.4 d/wk. Static and dynamic foot characteristics were compared using the FPI-6 and a capacitance-based pressure platform. Correlation and hierarchical stepwise regression analyses were performed to determine the most parsimonious set of dynamic pressure data associated with FPI-6 scores. RESULTS: The mean ± SD FPI-6 score was 3.4 ± 2.9 (range, –6.0 to 11.0). Only 31 participants received a score of –2 (supinated foot) on any FPI-6 subscale. Classification of a pronated foot was 2.4 times more likely than a supinated foot. A 5-variable model (R = 0.57, R² = 0.32) was developed to describe the association between dynamic plantar pressures and FPI-6 scores. CONCLUSION: The multivariate model associated with FPI-6 scores comprised clinically plausible variables which inform the association between static and dynamic foot postures. Different cutoff values may be required when using the FPI-6 to screen for individuals with supinated feet, given the limited number of high-arched participants identified by FPI-6 classifications.

J Orthop Sports Phys Ther 2011;41(2):100-107, Epub 22 October 2010. doi:10.2519/jospt.2011.3412

KEY WORDS: anthropometrics, arch height, foot, foot posture index, podography

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To determine if changes in transversus abdominis (TrA) and internal oblique (IO) muscle thickness and side-to-side symmetry differ in individuals with and without unilateral lumbopelvic pain while at rest and during the abdominal drawing-in maneuver (ADIM). BACKGROUND: Although the ADIM has been found to produce a symmetrical change in TrA and IO muscle thickness in healthy subjects, how these muscles are activated in those with unilateral lumbopelvic pain during the ADIM remains unknown. METHODS: Fifteen subjects with lumbopelvic pain and 15 age- and gender-matched control subjects were recruited. To investigate a similar subgroup of patients with lumbopelvic pain that has been used in previous research, subjects were required to have unilateral symptoms, a positive sacroiliac provocation test, and a positive active straight-leg raise test. Ultrasound images were obtained bilaterally at 2 different points during each trial of the ADIM: (1) at rest and (2) while maintaining the ADIM. Average percent change in thickness of the TrA and IO muscles was obtained over 3 trials. RESULTS: The percent change in thickness of the TrA was 20.9% less in those with lumbopelvic pain compared to the control group (P = .035), while the percent change in IO thickness was equivalent between groups (P = .522). No differences were observed for the TrA or IO muscles between the symptomatic and asymptomatic sides in those with (TrA, P = .263; IO, P = .172) or without (TrA, P = .780; IO, P = .635) lumbopelvic pain during the ADIM. Changes in TrA muscle thickness were greater than the IO muscle during the ADIM for both groups (P<.001). Specifically, the increases in TrA muscle thickness in those with and without lumbopelvic dysfunction were 32.7% and 47.3% greater, respectively, compared to changes in the IO muscle. CONCLUSIONS: Individuals with unilateral lumbopelvic pain demonstrated a smaller increase in thickness of the TrA muscle during the ADIM. This finding provides an element of construct validity for the use of the ADIM for assessing TrA muscle thickness in those with unilateral lumbopelvic pain. However, both groups demonstrated a symmetrical side-to-side change in TrA and IO muscle thickness despite the symptomatic group having unilateral symptoms. Further, we detected a preferential change in TrA muscle thickness during the ADIM in both groups.

J Orthop Sports Phys Ther 2009;39(11):791-798, Epub 15 October 2009. doi:10.2519/jospt.2009.3128

KEY WORDS: internal oblique, lumbar stabilization exercise, sacroiliac dysfunction, transversus abdominis, ultrasound imaging

STUDY DESIGN: Clinical measurement, reliability study. OBJECTIVES: To investigate the improvements in precision when averaging multiple measurements of percent change in muscle thickness of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles. BACKGROUND: Although the reliability of TrA and LM muscle thickness measurements using rehabilitative ultrasound imaging (RUSI) is good, measurement error is often large relative to mean muscle thickness. Additionally, percent thickness change measures incorporate measurement error from both resting and contracted conditions. METHODS: Thirty volunteers with nonspecific low back pain participated. Thickness measurements of the TrA and LM muscles were obtained using RUSI at rest and during standardized tasks. Percent thickness change was calculated with the formula (thickness_contracted – thickness_rest/thickness_rest). Standard error of measurement (SEM) quantified precision when using 1 or a mean of 2 to 6 consecutive measurements. RESULTS: Compared to when using a singlemeasurement, SEM of both the TrA and LM decreased by nearly 25% when using a mean of 2 measures, and by 50% when using the mean of 3 measures. Little precision was gained by averaging more than 3 measurements. CONCLUSION: When using RUSI to determine percent change in TrA and LM muscle thickness, intraexaminer measurement precision appears to be optimized by using an average of 3 consecutive measurements.

J Orthop Sport Phys Ther 2009;39(8):604-611 Epub 24 June 2009. doi:10.2519/jospt.2009.3088

KEY WORDS: abdominal muscles, lumbar spine, reliability, ultrasonography

The Orthopaedic Section of the American Physical Therapy Association presents this second set of clinical practice guidelines on neck pain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

J Orthop Sports Phys Ther. 2008;38(9):A1-A34. doi:10.2519/jospt.2008.0303

The original article was corrected in April 2009, and the amended article PDF is provided here. Please see: April 2009 Errata

KEY WORDS: APTA, cervical spine, clinical practice guidelines, ICD, ICF, Orthopaedic Section

STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P<.001) was found. The horizontal side-support (mean ± SD contracted-rest thickness ratio: TrA, 1.95 ± 0.69; IO, 1.88 ± 0.52) and the abdominal crunch (mean ± SD contracted-rest thickness ratio: TrA, 1.74 ± 0.48; IO, 1.63 ± 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean ± SD contracted-rest thickness ratio: TrA, 1.73 ± 0.36; IO, 1.14 ± 0.33) and quadruped opposite upper and lower extremity lift (mean ± SD contracted-rest thickness ratio: TrA, 1.59 ± 0.49; IO, 1.25 ± 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription. LEVEL OF EVIDENCE: Therapy, level 5.

J Orthop Sports Phys Ther. 2008;38(10):596-605, published online 22 August 2008. doi:10.2519/jospt.2008.2897

KEY WORDS: internal oblique, low back pain, lumbar stabilization, sonography, therapeutic exercise, transversus abdominis

SYNOPSIS: This commentary provides an overview of the current concepts and the emerging evidence related to rehabilitative ultrasound imaging (RUSI) for biofeedback purposes. Specifically, the role of RUSI to assess improvements in trunk muscle performance and motor learning will be discussed, highlighting the importance of retention and transfer testing to assess motor learning. The use of RUSI as an extrinsic (augmented) feedback tool and its ability to provide both knowledge of performance and knowledge of results information will be defined. An analysis of the limited available literature related to the role of RUSI as an augmented feedback tool to enhance motor skill acquisition related to the deep trunk muscles will be provided. Future research directions and priorities are recommended.

J Orthop Sports Phys Ther. 2007;37(10):627-634. doi:10.2519/jospt.2007.2555

KEY WORDS: motor control, multifidus, therapeutic exercise, transversus abdominis

In this issue of the journal, we explore rehabilitative ultrasound imaging's potential as a tool that physical therapists use in examining low back muscle function. As an assessment tool, RUSI can assist practitioners in recognizing impairments such as a decreased ability to increase muscle thickness (eg, transversus abdominis or multifidus) during specific physical tasks, excessive use of more global muscles (eg, rectus abdominis or erector spinae muscles) during low-level activities, and muscular atrophy. Identifying these impairments can help practitioners formulate a specific exercise program matched to the patient's underlying impairments during early stages of rehabilitation. From a treatment perspective, RUSI can provide feedback to both the physical therapist and patient that may help determine which verbal or tactile cues are most effective to facilitate proper performance of therapeutic exercises during the early phase of rehabilitation. Additionally, it may assist physical therapists in their decision-making process related to exercise prescription and progression. Finally, RUSI may help determine when specific impairments have been sufficiently addressed to permit the exercise progression necessary to achieve maximal pain-free function.

J Orthop Sports Phys Ther. 2007;37(10):579-580. doi:10.2519/jospt.2007.0109

KEY WORDS: rehabilitative ultrasound imaging, low back

This special issue of the JOSPT is part I of a collection of commentaries, case reports, and research reports that document current applications and evidence for rehabilitative ultrasound imaging (RUSI) in patients with neuromusculoskeletal disorders.

J Orthop Sports Phys Ther. 2007:37(8):431-433. doi:10.2519/jospt.2007.0107

KEY WORDS: low back pain, neuromusculoskeletal disorders, rehabilitative ultrasound imaging (RUSI)

J Orthop Sports Phys Ther. 2007:37(8):472-479; published online 12 July 2007. doi:10.2519/jospt.2007.2523

J Orthop Sports Phys Ther. 2007:37(8):487-498; published online 20 June 2007. doi:10.2519/jospt.2007.2548

KEY WORDS: levator ani, sonography, therapeutic exercise, transabdominal ultrasound imaging, transperineal ultrasound imaging

J Orthop Sports Phys Ther. 2007:37(8):499-504; published online 30 May 2007. doi:10.2519/jospt.2007.2538

KEY WORDS: biofeedback, pelvic floor muscles, transversus abdominis, sonography, spine

The use of ultrasound imaging by physical therapists is growing in popularity. This commentary has 2 aims. The first is to introduce the concept of rehabilitative ultrasound imaging (RUSI), provide a definition of the scope of this emerging tool in regard to the physical therapy profession, and describe how this relates to the larger field of medical ultrasound imaging. The second aim is to provide an overview of basic ultrasound imaging and instrumentation principles, including an understanding of the various modes and applications of the technology with respect to neuromusculoskeletal rehabilitation and in relation to other common imaging modalities.

J Orthop Sports Phys Ther. 2007:37(8):434-449; published online 30 May 2007. doi:10.2519/jospt.2007.2530

KEY WORDS: elastography, magnetic resonance imaging, rehabilitation, sonography

Rehabilitative ultrasound imaging (RUSI) of the abdominal muscles is increasingly being used in the management of conditions involving musculoskeletal dysfunctions associated with the abdominal muscles, including certain types of low back and pelvic pain. This commentary provides an overview of current concepts and evidence related to RUSI of the abdominal musculature, including issues addressing the potential role of ultrasound imaging in the assessment and training of these muscles. Both quantitative and qualitative aspects associated with clinical and research applications are considered, as are the possible limitations related to the interpretation of measurements made with RUSI. Research to date has utilized a range of methodological approaches, including different transducer placements and imaging techniques. The pros and cons of the various methods are discussed, and guidelines for future investigations are presented. Potential implications and opportunities for clinical use of RUSI to enhance evidence-based practice are outlined, as are suggestions for future research to further clarify the possible role of RUSI in the evaluation and treatment of abdominal muscular morphology and function.

J Orthop Sports Phys Ther. 2007:37(8):450-466; published online 30 May 2007. doi:10.2519/jospt.2007.2558

KEY WORDS: morphometry, obliquus internus abdominis, rectus abdominis, sonography, transversus abdominis

Study Design: Randomized controlled trial among patients with low back pain (LBP). Objectives: (1) Determine the reliability of real-time ultrasound imaging for assessing activation of the lateral abdominal muscles; (2) characterize the extent to which the abdominal drawing-in maneuver (ADIM) results in preferential activation of the transverse abdominis (TrA); and (3) determine if ultrasound biofeedback improves short-term performance of the ADIM in patients with LBP. Background: Ultrasound imaging is reportedly useful for measuring and training patients to preferentially activate the TrA muscle. However, research to support these claims is limited. Methods and Measures: Thirty patients with LBP referred for lumbar stabilization training were randomized to receive either traditional training (n = 15) or traditional training with biofeedback (n = 15). Ultrasound imaging was used to measure changes in thickness of the lateral abdominal muscles. Differences in preferential changes in muscle thickness of the TrA between groups and across time were assessed using analysis of variance. Results: Intrarater reliability measuring lateral abdominal muscle thickness exceeded 0.93. On average, patients in both groups demonstrated a 2-fold increase in the thickness of the TrA during the ADIM. Performance of the ADIM did not differ between the groups. Conclusion: These data provide construct validity for the notion that the ADIM results in preferential activation of the TrA in patients with LBP. Although, the addition of biofeedback did not enhance the ability to perform the ADIM at a short-term follow-up, our data suggest a possible ceiling effect or an insufficient training stimulus. Further research is necessary to determine if there is a subgroup of patients with LBP who may benefit from biofeedback.

J Orthop Sports Phys Ther. 2005;35(6):346-355. doi:10.2519/jospt.2005.1780

Key Words: lumbar stabilization, real-time ultrasound imaging, therapeutic exercise, transverse abdominis

Study Design: Exploratory.

Objectives: To explore whether hand dominance, gender, and body mass index (BMI) influence the thickness of the lateral abdominal muscles as measured by ultrasound imaging. To document the extent of improvement in response stability when an average of multiple measures was utilized.

Background: Ultrasound imaging is a relatively new tool used to assess the lateral abdominal muscles. A better understanding of how these muscles contract in a healthy population can provide a reference for comparison to patients with low back pain (LBP).

Methods and Measures: Thirty-two healthy participants (17 males, 15 females) aged 18 to 45 years (mean ± SD, 31.9 ± 7.8 years) were studied. Measurements of muscular thickness of the lateral abdominal muscles were obtained bilaterally while the subjects were at rest, and while they performed the abdominal drawing-in maneuver. To determine the possible influence of hand dominance and gender on muscle thickness, t tests were used. Correlation coefficients were used to assess the relationship between BMI and muscle thickness. Standard error of the measurement was used to assess response stability of the ultrasound imaging technique.

Results: No differences in the thicknesses of the transversus abdominis (TrA) muscle were measured during rest or while contracted, based on hand dominance (P≥.73). Men had greater muscular thickness (P<.01), while the TrA in women represented a greater proportion of the total lateral abdominal muscles (P<.01). BMI was positively associated with muscle thickness (r≥.66). Compared to a singular measurement, response stability improved by greater than 50% when an average of 3 measurements was used.

Conclusions: Future researchers should assess the need to control for gender and BMI as potential covariates in ultrasound imaging studies of the lateral abdominal muscles. Asymmetry in the lateral abdominal muscles in those with LBP would be in direct contrast to the bilateral symmetry measured in those without LBP. J Orthop Sports Phys Ther. 2006;36(5):289-297. doi:10.2519/ jospt.2006.2217

Key Words: low back pain, lumbar stabilization, real-time ultrasound imaging, sonography, transversus abdominis

As physical therapists, we routinely evaluate and treat motor control impairments associated with neuromusculoskeletal disorders. Over the last decade, researchers have found that deep muscle activation patterns are different in those with lumbopelvic dysfunction compared to those without. Additionally, when exercises are prescribed that target motor control impairments, favorable effects on pain, disability, and recurrence are observed. However, it has proved more difficult to establish reliable and valid noninvasive clinical measurement tools to evaluate muscle and related soft tissue morphology and function during physical tasks to improve the design of therapeutic interventions.

One tool that has potential to assist with improving physical therapists’ ability to evaluate and treat motor control impairments is the use of rehabilitative ultrasound imaging (RUSI) based on its ability to provide real-time visual feedback of the underlying muscular morphology and function to both the patient and the physical therapist. Although ultrasound imaging (USI) has been used for medical purposes since the 1950s, its application for rehabilitative sciences only started in the 1980s with the work of Dr Archie Young, a physician at the University of Oxford whose research team included physiotherapists. Although the research and clinical applications of this emerging technology have steadily grown, there has not previously been an international meeting to organize a research agenda that could ultimately guide its role in clinical practice.

The US Army-Baylor University Doctoral Program in Physical Therapy hosted a RUSI Symposium in May 2006 in San Antonio, TX. The purpose of this meeting was to develop best practice guidelines for the use of RUSI for the abdominal, pelvic, and posterior spine muscles and develop an international and collaborative research agenda related to the use of USI. Participants included leading international experts from around the world in the field of RUSI and clinical research. The objectives of the symposium were to:

1. Contribute to the development of an international set of RUSI measurement standards in the assessment of muscle function
2. Identify and synchronize current and future international efforts to promote the use of RUSI in clinical practice, research, and education
3. Initiate the development of an international and collaborative research agenda
4. Develop models for the implementation of RUSI to clinical practice within the Military Healthcare System
5. Explore future applications

Delegates represented 6 countries and 13 universities around the world. Topics discussed at the symposium included:

• Role of USI in rehabilitation
• Professional, political, ethical, and legal issues
• Clinical applications
• RUSI of the pelvic floor muscles
• RUSI of the lateral abdominal muscles
• RUSI of the posterior paraspinal muscles
• RUSI of other muscles
• Technology and techniques

Abstracts from the presenters are provided. Additionally, for each of the main topics, committees were established to develop synopsis statements addressing what is known, what remains unknown, what are the future directions and research priorities, and what are the best clinical applications of this technology.

One of the outcomes of the symposium was that the delegates unanimously agreed to a ‘‘Rehabilitative Ultrasound Imaging International Consensus Statement’’ to help define this emerging tool in the field of physical therapy. In addition, a diagram was developed to present a visual representation of how the practice of RUSI fits into the larger field of USI. The consensus statement follows:

RUSI is a procedure used by physical therapists to evaluate muscle and related soft tissue morphology and function during exercise and physical tasks. RUSI is used to assist in the application of therapeutic interventions aimed at improving neuromuscular function. This includes providing feedback to the patient and physical therapist to improve clinical outcomes. Additionally, RUSI is used in basic, applied, and clinical rehabilitative research to inform clinical practice. Currently, the international community is developing education and safety guidelines in accordance with World Federation for Ultrasound in Medicine and Biology (WFUMB). Dated: 10 May, 2006.

Synopsis statements in the format of clinical commentaries are being developed by these working groups and our goal is to have them ready for publication in 2007. Additionally, it is the intention of the group to hold future international meetings, particularly for enhancing collaborative research and steering the international physical therapy co]]> Mon, 05 Feb 2007 09:45:00 EST http://www.jospt.org/issues/articleID.1157/article_detail.asp