New Method to Assess Scapular Upward Rotation in Subjects With Shoulder Pathology

Andrew R. Karduna, Philip W. McClure, Michael P. Johnson
Study Design: Test-retest repeated measures and correlational design. Objectives: To examine the reliability and validity of a "modified" digital inclinometer to assess scapular upward rotation during humeral elevation in the scapular plane Background: Evidence exists that scapular motion is related to shoulder pathology; however, evaluation and treatment planning for shoulder rehabilitation often fails to include an objective assessment of scapular motion. Methods and Measures: Two-dimensional measurements by the inclinometer were taken with the arm in a static position. These data were compared to 3-dimensional measurements obtained using a magnetic tracking device with the arm fixed and during arm movement. Both methods were used to assess scapular upward rotation positions with the arm at rest and at 60�, 90�, and 120� of humeral elevation in the scapular plane. Both scapulae were tested on a total of 39 subjects, 16 with shoulder pathology and 23 without. Reliability was assessed using repeated measurements from the inclinometer. Validity was assessed using 2 separate comparisons: inclinometer and magnetic tracking device under static arm conditions and inclinometer and magnetic tracking device during active arm elevation. Reliability and validity were assessed at all 4 arm positions. Results: lntraclass correlation coefficients (ICC [3,1]) varied from 0.89 to 0.96. Pearson Product Moment correlation coefficients, used to assess validity of the static inclinometer, varied from r = 0.74 to 0.92 compared with the static magnetic tracking measures, and from r = 0.59 to 0.73 compared with the active magnetic tracking measures taken during arm elevation. Conclusions: The "modified" digital inclinometer demonstrated good to excellent intrarater reliability and good to excellent validity when measuring scapular upward rotation during static positions of humeral elevation in the scapular plane. J Orthop Sports Phys Ther. 2001;31(2):81-89. Key Words: inclinometer, measurement, scapular kinematics, scapular plane, three-dimensional

Historical Perspectives of Autonomy Within the Medical Profession: Considerations for 21st Century Physical Therapy Practice

Sandra L. Abrams, Michael P. Johnson
As a part of the American Physical Therapy Association’s (APTA) vision statement, by the year 2020, physical therapists ‘‘will hold all privileges of autonomous practice.’’ This vision statement and the ideals held within it are elemental to the direction of our continued growth as a profession. Many members and nonmembers, however, appear confused and perhaps even intimidated by the concept of autonomous practice.

This paper will review and discuss the processes used by other health care professions to gain autonomy within the US health care system – in particular, the processes used by physicians, which were extremely effective and have been used as a template by many other health professions, including physical therapy. Further discussion will focus on the physical therapy profession, emphasizing the parallels with medicine and considering many issues relevant to the goal of autonomous practice.

By understanding the past and considering the present, readers will develop an appreciation of (1) the foundation for autonomous practice in health care, (2) the vision of the APTA and why the profession is well positioned to achieve this vision, and (3) the factors we need to consider to hold (and maintain) all privileges of autonomous practice.

J Orthop Sports Phys Ther. 2005;35(10):628-636. doi:10.2519/jospt.2005.2085

Key Words: autonomous practice, interdependent practice, professional autonomy

Journal of Orthopaedic & Sports Physical Therapy - Michael P. Johnson, PT, MS

New Method to Assess Scapular Upward Rotation in Subjects With Shoulder Pathology

Historical Perspectives of Autonomy Within the Medical Profession: Considerations for 21st Century Physical Therapy Practice