Predicting Short-Term Response to Thrust and Nonthrust Manipulation and Exercise in Patients Post Inversion Ankle Sprain

Fri, 24 Oct 2008 00:00:00 EST

Julie M. Whitman, Michael A. Keirns, Melanie L. Bieniek, Stephanie R. Albin, Jake S. Magel, Thomas G. McPoil, Joshua A. Cleland, Paul E. Mintken
STUDY DESIGN: Prospective-cohort/predictive-validity study. OBJECTIVES: To develop a clinical prediction rule (CPR) to identify patients who had sustained an inversion ankle sprain who would likely benefit from manual therapy and exercise. BACKGROUND: No studies have investigated the predictive value of items from the clinical examination to identify patients with ankle sprains likely to benefit from manual therapy and general mobility exercises. METHODS AND MEASURES: Consecutive patients with a status of post inversion ankle sprain underwent a standardized examination followed by manual therapy (both thrust and nonthrust manipulation) and general mobility exercises. Patients were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success. RESULTS: Eighty-five patients were included in the data analysis, of which 64 had a successful outcome (75%). A CPR with 4 variables was identified. If 3 of the 4 variables were present the accuracy of the rule was maximized (positive likelihood ratio, 5.9; 95% CI: 1.1, 41.6) and the posttest probability of success increased to 95%. CONCLUSIONS: The CPR provides the ability to a priori identify patients with an inversion ankle sprain who are likely to exhibit rapid and dramatic short-term success with a treatment approach, including manual therapy and general mobility exercises. LEVEL OF EVIDENCE: Prognosis, level 2b.

J Orthop Sports Phys Ther 2009;39(3):188-200, Epub 24 October 2008. doi:10.2519/jospt.2009.2940

KEY WORDS: ankle pain, clinical prediction rule, manual therapy

Manual Physical Therapy: We Speak Gibberish

Wed, 27 Feb 2008 00:00:00 EST

Timothy W. Flynn, Maj John D. Childs, Stephania Bell, Jake S. Magel, Robert H. Rowe, Haideh Plock

In December of 2006, the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) convened a task force to create a framework for standardizing manual physical therapy procedures. The impetus came from many years of frustration with our ability to precisely communicate to each other, as well as to stakeholders outside our profession. To this end, a contribution titled "A Model for Standardizing Manipulation Terminology In Physical Therapy Practice" is published in this issue of the Journal.

J Orthop Sports Phys Ther. 2008;38(3):97-98. doi:10.2519/jospt.2008.0103

KEY WORDS: guidelines, manual physical therapy, terminology

Journal of Orthopaedic & Sports Physical Therapy - Jake S. Magel, PT, DSc

Predicting Short-Term Response to Thrust and Nonthrust Manipulation and Exercise in Patients Post Inversion Ankle Sprain

Manual Physical Therapy: We Speak Gibberish