The purpose of this study was to examine the differences in peak torque occurrence during knee extension range of motion between groups of subjects with varying quadriceps-angle (Q-angle). Fifty-six female subjects, aged 18 to 35, participated in the study. The subjects were separated into three groups: low (N = 12) consisted of subjects with Q-angles <11°; moderate (N = 27), 13-17°; and high (N = 17), > 19°. Three sets of subjects, grouped according to Q-angle, were evaluated using the Cybex II Isokinetic Dynamometer. Each subject was tested at three isokinetic speeds (30, 60, and 180°/sec) utilizing only the right lower extremity. The results suggest that the point at which peak torque occurs within knee extension range of motion is not significantly different between the three groups of subjects tested at the three test speeds.

J Orthop Sports Phys Ther 1988;9(7):250-253.

The purpose of this study was to investigate the validity of the flexible ruler as a noninvasive measure of lumbar lordosis in black and white adult females. The bony landmarks of the second lumbar vertebra (L2) and the intersection of the posterior superior iliac spines (PSIS) were palpated and marked on 45 adult females (21 blacks, 24 whites). Potential subjects with a previous history of activity-limiting low-back pain, spinal surgery, or spinal anomaly were excluded from the study. A lateral lumbosacral roentgenograph was taken of each subject, and an actual (skeletal) lumbosacral lordosis angle (ALS) was calculated from the roentgenograph. A flexible ruler was then molded to the contour of the subject's lumbosacral spine, and the previously marked L2 and PSIS intersection bony landmarks were located on the flexible ruler. The flexible ruler lordosis angle (FRA) was then calculated and correlated to the subject's ALS. The criterion validity of the flexible ruler as a measure of actual lumbosacral lordosis was poor (Pearsons' Correlation Coefficient = 0.30, N = 45). Because of the poor criterion validity of the flexible ruler compared to roentgenographically confirmed lumbar lordosis, the flexible ruler has questionable clinical value in the assessment of lumbar lordosis.

J Orthop Sports Phys Ther 1989;11(1):3-7.

The purpose of this study was to evaluate the validity of physical therapists' visual postural evaluation skills in assessing lumbar lordosis using photographs of clothed subjects compared to actual radiographic measurements. The study also addressed the efficacy of the use of a plumb line in postural assessment. Forty-eight physical therapists (raters) participated. After completing a demographic questionnaire, raters were given a set of pictures showing sagittal views of three subjects and asked to rank order the subjects from most to least amount of lumbar lordosis. Raters were then given a second set of pictures with different subjects to evaluate. During this second trial, raters were given a plastic overlay with a hairline to use as a plumb line. Each rater evaluated one set of subjects with 7-8° of difference in lordosis and one set with 13- 14°of difference as measured radiographically. The raters' rank order of the pictures was interpreted as either correct or incorrect. For 96 trials, 9 responses were correct for an accuracy rate of 9.3%. The use of the hairline as a plumb line did not improve the raters' accuracy. A chi-square test showed no relationship between ratings except under circumstances related to the gluteal prominence body contour. The strongest trend in interrater reliability identified was that the raters' perception of increased lordosis may have been influenced by gluteal prominence. The results indicate low validity in assessing relative amounts of lumbar lordosis using photographs of clothed subjects. This preliminary study indicates the need for more research in this area using both pictures and live subjects.

J Orthop Sports Phys Ther 1990;12(1):24-29.

The purpose of this study was to investigate the effects of 30-minute ice treatments to the quadriceps femoris muscle and subsequent recovery time on involuntary isometric torque production (the dependent variable) using the Electrostim 180-2. Twenty healthy, male subjects (age 18-35) on active military duty completed the study. Each subject served as his own control. Collected data included maximum current tolerated during electrical stimulation and maximum involuntary isometric torque production pretreatment, immediately posttreatment, and 90 minutes posttreatment. From the statistical analysis, it was concluded that ice application did not significantly affect an individual's ability to tolerate more electrical current or to produce higher maximum involuntary isometric contraction (MIIC) torque values. Results showed a wide variation in subjective response to electrical stimulation. Suggestions for further research and implications for the clinical use of ice in combination with electrical stimulation modalities are discussed.

J Orthop Sports Phys Ther 1991;13(5):240-248.

Industrial physical therapists (IPTs) are working as external consultants with business and industry to provide injury prevention and/or rehabilitation services. This consulting presents a very new practice setting for therapists and requires specialized nonclinical competencies. The purpose of this study was to identify these nonclinical competencies.

The research was based on an evaluation research model using a stakeholder group. Stakeholders represented 5 groups: 1) IPTs, 2) continuing education providers, 3) business and industry employers of IPTs, 4) safety/risk managers, and 5) human resource development professionals. Thirty-five nonclinical competencies were identified through qualitative analysis of in-depth interviews with 17 subject matter experts representing the 5 groups. The competencies addressed marketing, program planning, managing the consulting process, training, and understanding organizations.

This list of nonclinical competencies may serve as a self-assessment tool that IPTs can use to help plan their professional development. It may also facilitate planning continuing education programs for IPTs.

J Orthop Sports Phys Ther. 1993;18(6):673-681.

Key Words: competencies, industrial physical therapy

Study Design: Descriptive observational survey. Objective: To describe the status of joint manipulation curricula within physical therapist professional degree programs in the United States. Background: Studies have described the evolution of manual therapy curricula, including spinal and extremity joint mobilization, in physical therapist professional programs, but minimal information exists related to joint manipulation curricula. Methods and Measures: Primary faculty members responsible for teaching manual therapy curricular content at the 199 physical therapist professional degree programs located in the United States recognized by the Commission on Accreditation in Physical Therapy Education were asked to participate in this project. The survey documented joint manipulation curricula, faculty qualifications, attitudes and experience, and programs' future plans for teaching manipulation. Results: Of the 116 programs responding to our survey, 87 (75%) currently include joint manipulation in their curriculum or plan to soon include such content in their curriculum. Of the programs currently teaching joint manipulation, 75% taught it as part of a required integrated clinical science course. Faculty teaching manipulation content appear to be well qualified and are in clinical practice an average of 12 hours per week. The programs currently not teaching joint manipulation reported reasons, including belief that it was not an entry-level skill (45%), lack of time (26%), lack of qualified faculty (7%), and perceived lack of scientific evidence regarding efficacy (7%). Conclusions: Of the responding professional degree programs, 75% are either currently teaching joint manipulation or soon plan to do so. Our research may serve as a benchmark for faculty to assess existing manual therapy curricula and as a guide for developing curricula in new or existing physical therapy programs.

J Orthop Sports Phys Ther. 2004;34(4):171-181. doi:10.2519/jospt.2004.1239

Key Words: curriculum, manipulation, manual therapy, physical therapy education

Study Design: A crossover experimental design with repeated measures. Objective: To determine whether the forearm support band alters wrist extensor muscle fatigue. Background: Fatigue of the wrist extensor muscles is thought to be a contributing factor in the development of lateral epicondylitis. The forearm support band is purported to reduce or prevent symptoms of lateral epicondylitis but the mechanism of action is unknown. Methods and Measures: Fifty unimpaired subjects (36 men, 14 women; mean age = 29 ± 6 years) were tested with and without a forearm support band before and after a fatiguing bout of exercise. Peak wrist extension isometric force, peak isometric grip force, and median power spectral frequency for wrist extensor electromyographic activity were measured before and after exercise and with and without the forearm support band. A 2 x 2 repeated measures multivariate analysis of variance was used to analyze the data, followed by univariate analysis of variance and Tukey's multiple comparison tests. Results: Peak wrist extension isometric force, peak grip isometric force, and median power spectral frequency were all reduced after exercise. However, there was a significant reduction in peak grip isometric force and peak wrist extension isometric force values for the with-forearm support band condition (grip force 28%, wrist extension force 26%) compared to the without-forearm support band condition (grip force 18%, wrist extension force 15%). Conclusions: Wearing the forearm support band increased the rate of fatigue in unimpaired individuals. Our findings do not support the premise that wearing the forearm support band reduces muscle fatigue in the wrist extensors.

J Orthop Sports Phys Ther. 1999;29(11):677-685.

Key Words: forearm support band, lateral epicondylitis, median power spectral frequency

Study Design: Single-group repeated measures with 2 raters. Objectives: To determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling. Background: Measurements of ankle swelling are commonly performed to determine the nature and stage of injury and to monitor progress made during rehabilitation. Water volumetry and the figure of eight method are 2 techniques used to measure ankle swelling. Methods and Measures: Twenty-nine subjects with ankle swelling were measured by 2 raters with the hypothesis that both measurement techniques would be reliable. Each rater performed 3 measurements of the swollen ankle using both measurement techniques during a single test session. The order of the rater and of the measurement technique was randomized, and the raters were blinded to each other's measurements. Results: We found high interrater reliability for both the water volumetry (ICC [intraclass correlation coefficient] = 0.99) and figure of eight methods (ICC = 0.98). Additionally, intrarater reliability was high for both raters using both methods (ICCs = 0.98-0.99). Conclusions: Both methods are reliable measures of ankle swelling. The authors recommend the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower-extremity swelling. Reliability of these 2 methods was established using subjects with foot or ankle pathology. Therefore, the results are applicable and generalizable to the clinical setting.

J Orthop Sports Phys Ther. 1999;29(10):609-615.

Key Words: ankle swelling, measurement, reliability

Study Design: Descriptive survey. Objective: Describe the availability of thrust joint manipulation clinical educational opportunities for physical therapy professional degree students. Background: In the United States, most of the faculty teaching manual therapy content in physical therapy programs believe that the best way for their students to develop thrust joint manipulation skills is to receive additional training during clinical education experiences. There are no data that describe the availability of such training opportunities. Methods and Measures: Seventy-three physical therapy programs that include thrust joint manipulation in their curricula were divided into 5 geographic regions. Of these programs, 27% (total, n = 20) were randomly selected per region to participate. Program academic coordinators of clinical education (ACCEs) identified their clinical instructors working in outpatient orthopaedic settings. ACCEs and clinical instructors were surveyed regarding thrust joint manipulation clinical education opportunities for students. Results: Survey return rates were 100% for ACCEs and 67.4% for clinical instructors. Of ACCEs, 70% were unsure which sites employed clinical instructors trained in thrust joint manipulation and 85% did not consider whether thrust joint manipulation training was provided when scheduling the experience. The ACCEs who did consider availability cited lack of qualified instructors as the number-one barrier to finding sites that offered thrust joint manipulation. Of clinical instructors, 30% provide thrust joint manipulation training including lecture/theory, technique demonstration, practice on "normals," and direct patient care supervision. Clinical instructors who did not teach thrust joint manipulation cited reasons that included the belief that it is not an entry-level skill (57%), lack of qualified staff (53%), liability concerns (46%), and students not being academically prepared (41%). Conclusions: Results suggest that the availability and scope of thrust joint manipulation clinical educational opportunities are limited, vary considerably, and are not considered when selecting clinical education sites for students. Potential obstacles to offering thrust joint manipulation training were identified, which suggested the need for resources, including clinical education curricula and philosophical guidelines for clinical instructors.

J Orthop Sports Phys Ther. 2005;35(7):416-423.  doi:10.2519/jospt.2005.2115

Key Words: joint mobilization, manipulation, manual therapy, physical therapy education

Clinicians often rely on visual inspection and descriptive terms to document a patient's forward shoulder posture. The purpose of this study was to assess the validity and intrarater reliability of 4 objective techniques to measure forward shoulder posture. Subjects were 25 males and 24 females. Subjects had a lateral cervical spine radiograph taken, from which the horizontal distance from the C7 spinous process to the anterior tip of the left anterior acromion process was measured. Subjects then proceeded twice through a random order of 4 measurements: the Baylor square, the double square, the Sahrmann technique, and scapular position. These results were then used to determine the intrarater reliability of each technique. Multiple regression analyses were performed on each measure's mean scores to determine both the correlation with and the predictive value for the radiographic measurement. The intraclass correlation coefficients for intrarater reliability ranged from .89 to .91. The correlation coefficients ranged from -.33 to .77, and the coefficients of determination ranged from .10 to .59 (N = 49). The researchers demonstrated clinical reliability for each technique; however, validity compared with the radiographic measurement could not be established. These techniques may have clinical value in objectively measuring change in a patient's shoulder posture as a result of a treatment program. Before any of these measures could be universally recommended in clinical practice, future research is necessary to establish interrater reliability and assess each technique's ability to detect postural changes over time.

J Orthop Sports Phys Ther. 1997;25(1):34-42.

Key Words: shoulder, posture, method

This research was supported by the US Army Medical Specialist Corps as part of LTC Bryan's Long-Term Civilian Training Program to earn her PhD in Human Resource Development. The opinions or assertions in this research are the private views of the authors and are not to be construed as official or reflecting the views of the United States Army, the Department of Defense, or the United States government. Consulting with business and industry represents a very new world for physical therapists — a world in which most have had little formal academic preparation. Some competencies in consulting in occupational health physical therapy are beyond specific clinical skills and knowledge. The purpose of this research was to survey occupational health physical therapists (OHPTs) concerning a previously identified list of nonclinical competencies in consulting with business and industry. The survey addressed how OHPTs rated the importance of these competencies, how they rated their own level of competence for each, and how they developed these competencies. The survey sample was based on members of the American Physical Therapy Association Orthopaedic Section's Special Interest Group in Occupational Health Physical Therapy. The response rate was 98% (61/62). Mean importance of competencies was 3.66/4.00 (range 3.00-3.88), which further validated the list of nonclinical competencies. The mean level of competence was 3.17/4.00 (range 2.40-3.50). The mean importance of individual competencies was consistently higher than level of competence. This discrepancy is of practical significance in terms of professional development of OHPTs consulting with business and industry. Primary sources of competence were practical experience (59.87%) and continuing education for physical therapists (15.51%). These results may indicate that current continuing education programs are not meeting OHPTs' educational needs and may serve as a basis for developing programs to better meet these needs. The survey instrument may help OHPTs identify and prioritize their own educational needs and to plan their own professional development accordingly.

J Orthop Sports Phys Ther. 1994;19(5):305-311.

Key Words: competencies, occupational health, physical therapists