Journal of Orthopaedic & Sports Physical Therapy - Richard E. Baxter, MPT, DSc, OCS, ATC

Recipient of the 2003 Sports Physical Therapy Section Excellence in Research Award: Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of Patients Referred by Physical Therapists, Orthopaedic Surgeons, and Nonorthopaedic Providers

Josef H. Moore, Donald Lee Goss, Richard E. Baxter, Thomas M. DeBerardino, Liem T. Mansfield, Douglas W. Fellows, Maj Dean C. Taylor

Study Design: Nonexperimental, retrospective design. Objectives: This study was designed to compare clinical diagnostic accuracy (CDA) between physical therapists (PTs), orthopaedic surgeons (OSs), and nonorthopaedic providers (NOPs) at Keller Army Community Hospital on patients with musculoskeletal injuries (MSI) referred for magnetic resonance imaging (MRI). Background: US Army PTs are frequently the first credentialed providers privileged to examine and diagnose patients with musculoskeletal injuries. Physical therapists assigned at Keller Army Community Hospital have also been credentialed with privileges to order MRI studies for several years. Methods and Measures: To reduce provider bias, a retrospective analysis was performed on 560 patients referred for MRI over an 18-month period. An electronic review of each patient’s radiological profile was performed to assess agreement between clinical diagnosis and MRI findings. Data analyses were performed through descriptive statistics and contingency tables. Results:Analysis on agreement between clinical diagnosis and MRI findings produced a CDA of 74.5% (108/145) for PTs, 80.8% (139/172) for OSs, and 35.4% (86/243) for NOPs. There was a significant difference in CDA between PTs and NOPs (P<.001), and between OSs and NOPs (P<.001). There was no difference in CDA between PTs and OSs (P>.05). Conclusions: Clinical diagnostic accuracy by PTs and OSs on patients with musculoskeletal injuries was significantly greater than for NOPs, with no difference noted between PTs and OSs.

J Orthop Sports Phys Ther. 2005;35(2):67-71. doi: 10.2519/jospt.2005.1344

Key Words: diagnostic agreement, direct access, primary care

The Cardiopulmonary Cost of Backward Walking at Selected Speeds

Glen Myatt, Richard E. Baxter, Roger Dougherty, Glenn N. Williams, John S. Halle, Deborah M. Stetts, Frank B. Underwood

Backward walking has been advocated as a method of maintaining cardiovascular conditioning in patients undergoing knee rehabilitation because it may decrease patellofemoral joint compressive forces. The primary purpose of this study was to determine the relationship between the rate of oxygen consumption (VO2) and backward walking speed. Twenty-five healthy males, aged 18-35 years, participated in this study. The rate of oxygen consumption and heart rate were measured at the backward walking speeds of 0.89, 1.12, 1.34, 1.56, and 1.79 m/sec (2.0, 2.5, 3.0, 3.5, and 4.0 miles/hour, respectively). Analysis revealed a direct, curvilinear relationship between VO2, and backward walking speed. This research provides information that can be used to prescribe a backward walking rehabilitation program which may be appropriate to maintain aerobic fitness levels during rehabilitation of patients with patellofemoral pain syndrome.

J Orthop Sports Phys Ther. 1995;21(3):132-138.

Key Words: gait, oxygen consumption, knee injuries

Improvement in Sit-up Performance Associated With 2 Different Training Regimens

Richard E. Baxter, Josef H. Moore, Timothy L. Pendergrass, Todd A. Crowder, Shannon Lynch
Study Design: Factorial experimental design. Objective:To compare the outcomes of 2 different abdominal muscular fitness training regimens on sit-up performance across sex and abdominal muscular fitness level. Background: Researchers suggest that the curl-up, when compared to the sit-up, optimizes the challenge to the abdominal muscles while minimizing shear and compressive forces on the lumbar spine. Although researchers have compared curl-ups and sit-ups in many ways, a comparison of sit-up performance after training programs involving curl-ups and sit-ups has not been investigated. Methods and Measures: One hundred two active, healthy, college-aged subjects participated in this study. After stratification based upon maximal 2-minute sit-up performance during the orientation session, subjects were randomly assigned to either a training group using curl-up exercise, a training group using sit-up exercise, or a control group. Maximal 2-minute sit-up test performance was measured before and after a 6-week training program. Data were analyzed utilizing an ANOVA model. Significant interactions or main effects were analyzed utilizing Tukey’s Honestly Significant Difference Test. Level of significance for all testing was at a = 0.05. Results: The sit-up training group improved significantly (P<0.05). No significant difference in sit-up performance was noted for the curl-up or control groups after the 6-week training program. No statistically significant difference in improvement was noted between sex of subject and level of abdominal muscular fitness of subject. Conclusions: Short-term sit-up training with the Modified Kersey Method in this population significantly improved a maximum 2-minute sit-up test performance. Curl-up training utilizing the same method did not result in improvement in the number of sit-ups performed in 2 minutes. Specificity of training provides the primary explanation for our findings.

J Orthop Sports Phys Ther. 2003;33(1):40-47.

Keywords: abdominal muscular fitness, curl-up, strength training

Diagnosis and Treatment of Acute Exertional Rhabdomyolysis

Richard E. Baxter, Josef H. Moore

This case report involving a 20-year-old male in the military serves as a reminder that not every individual presenting with musculoskeletal dysfunction has a simple uncomplicated musculoskeletal problem. Always consider acute exertional rhabdomyolysis (AER) as a differential diagnosis in patients who have performed intense exercise recently and are now complaining of muscle pain and weakness, especially if they have any of the AER risk factors discussed in this report (poor physical condition, exercising in a hot, humid environment, and poor fluid intake). These patients have an excellent prognosis if AER is caught early and treated aggressively. However, serious complications can occur if AER is overlooked or dismissed as delayed onset muscle soreness.

J Orthop Sports Phys Ther. 2003;33(3):104-108.

Key Words: differential diagnosis, military