Letters to the Editor-in-Chief of the JOSPT as follows:

• Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0201
• Authors' response. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0202
• Slipped Capital Femoral Epiphysis in a Patient Referred to Physical Therapy for Knee Pain. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0203
• Authors' response. J Orthop Sports Phys Ther. 2008;38(3):159-161. doi:10.2519/jospt.2008.0204

STUDY DESIGN: Prospective cohort/predictive validity study. OBJECTIVE: To determine the predictive validity of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients with patellofemoral pain syndrome (PFPS) have a positive immediate response to lumbopelvic manipulation. BACKGROUND: Quadriceps muscle function in patients with PFPS was recently shown to improve following treatment with lumbopelvic manipulation. No previous study has determined if individuals with PFPS experience symptomatic relief of activity-related pain immediately following this manipulation technique. METHODS AND MEASURES:  Fifty subjects (26 male, 24 female; age range, 18-45 years) with PFPS underwent a standardized history and physical examination. After the evaluation, each subject performed 3 typically pain-producing functional activities (squatting, stepping up a 20-cm step, and stepping down a 20-cm step). The pain level perceived during each activity was rated on a numerical pain scale (0 representing no pain and 10 the worst possible pain). Following the assessment, all subjects were treated with a lumbopelvic manipulation, which was immediately followed by retesting the 3 functional activities to determine if there was any change in pain ratings. An immediate overall 50% or greater reduction in pain, or moderate or greater improvement on a global rating of change questionnaire, was considered a treatment success. Likelihood ratios (LRs) were calculated to determine which examination items were most predictive of treatment outcome. RESULTS: Data for 49 subjects were included in the data analysis, of which 22 (45%) had a successful outcome. Five predictor variables were identified. The most powerful predictor of treatment success was a side-to-side difference in hip internal rotation range of motion greater than 14^º (+LR, 4.9). If this variable was present, the chance of experiencing a successful outcome improved from 45% to 80%. CONCLUSION: A CPR was developed to predict an immediate successful response to lumbopelvic manipulation in patients with PFPS. However, in light of a limited sample size and omission of potentially meaningful predictor variables, future studies are necessary to validate the CPR. LEVEL OF EVIDENCE: Prognosis, level 2b.

This article features an invited commentary by Christopher M. Powers, PT, PhD, as well as an authors' response.

J Orthop Sports Phys Ther. 2008;38(6):297-312, published online 22 January 2008. doi:10.2519/jospt.2008.2669

KEY WORDS: anterior knee pain, physical examination, rehabilitation, spinal manipulation

For physical therapists to justify our services for patients with musculoskeletal problems, we need to achieve clinical outcomes superior to those associated with natural history or due to the passage of time. If a patient's presentation is unclear or if the response to intervention is less favorable than expected, practical application of the regional-interdependence model may add clarity to the patient's clinical picture and guide subsequent interventions. Likewise, further investigation of the regional-interdependence concept in a systematic fashion may add clarity to the nature of many musculoskeletal problems and guide subsequent decision making in clinical care.

J Orthop Sports Phys Ther 2007;37(11):658-660. doi:10.2519/jospt.2007.0110

KEY WORDS: regional interdependence

The diagnosis and nonoperative management of hip disorders are important clinical issues. Physical therapists can provide an alternative to surgical and pharmacological solutions for patients with lower quarter musculoskeletal complaints with noninvasive, low-risk interventions that are effective for reducing pain and disability. These interventions have none of the health risks associated with medications, surgery, and other invasive treatment options. Although effective low-risk physical therapy interventions exist for these patients, the real question is whether patients know about physical therapy and whether they are afforded an opportunity to access this type of care. Equally important is whether we physical therapists are adequately delivering it.

J Orthop Sports Phys Ther. 2007;37(9):511-513. doi:10.2519/jospt.2007.0108

It is has been said that close only counts in a game of horseshoes. The reason being, of course, that when playing horseshoes you get points for having the shoe closest to the stake even if it isn't touching. In reality, this saying is true for many psychomotor activities. For example, a baseball pitch only counts as a strike if it is within the strike zone, a thrown dart counts as a bull's-eye only if it hits somewhere within the red center, and a field goal in football is only worth 3 points if it passes between the uprights. In each of these tasks, there is a certain margin of error that is acceptable, and the margin of error for each has been operationally defined. Likewise, the clinical examination, which is comprised of the history and physical examination, consists of psychomotor tasks that are performed on a regular basis by all practicing clinicians. The ultimate goal, of course, is to accurately establish a diagnosis, direct the choice of intervention, and establish a prognosis. The practical question that the clinician must ask is, ‘‘Should I include this clinical test or measure as part of my examination?'' Often the answer is based on whether the test or measure being considered has a reliability coefficient that surpasses some predefined threshold. But is this the proper approach? If only one could get a straight answer!

J Orthop Sports Phys Ther. 2003; 33(9):488-491.

Key Words: history, physical examination, psychomotor tasks

Study Design: One group pretest-posttest exploratory design. Objectives: Primary purposes of this study were to examine the short-term effect of hip mobilizations on pain and range of motion (ROM) measurements in patients with knee osteoarthritis (OA) and to determine the prevalence of painful hip and squat test findings in both patients with knee OA and asymptomatic subjects. The secondary purposes were to assess intrarater reliability and to determine whether fewer subjects experienced painful test findings following hip mobilization. Background: Conservative intervention, including manual physical therapy applied to the lower extremity, has been shown to reduce impairments associated with knee OA. Methods and Measures: One rater pair administered 4 clinical hip tests to 22 patients with knee OA (mean age, 61.2 years; SD, 6.1 years) and 17 subjects without lower extremity symptoms or known pathology (mean age, 64.0 years; SD, 7.9 years). Intrarater reliability was examined for each clinical test. Patients with knee OA and painful-hip and squat test findings received hip mobilizations. Pain and ROM responses for each test were dependent variables. Results: Intraclass correlation coefficients for all tests were greater than 0.87. Composite and individual test pain scores and ROM scores improved significantly following hip mobilization. All clinical test findings were more frequent in the group with knee OA, except for those of the FABER test, and the number of subjects with painful test findings following hip mobilization was reduced for all tests except the hip flexion test. Conclusions: Patients experienced increases in ROM, decreased pain, and fewer subjects had painful test findings immediately following a single session of hip mobilizations. Examination and intervention of the hip may be indicated in patients with knee OA.

J Orthop Sports Phys Ther. 2004;34(11):676-685. doi:10.2519/jospt.2004.1432

The original article was corrected in September 2007, and the amended article PDF is provided here. Please see Correction: Altman's criteria for osteoarthritis of the hip and knee. J Orthop Sports Phys Ther. 2007; 37(9):573.

Key Words: arthritis, lower extremity, manual therapy, provocation