I am honored and proud to write this 25th Anniversary Edition editorial on behalf of the late Jim Gould and me. I am also proud of the response from our outstanding profession to the vision expressed in the first editorial published in the Journal of Orthopaedic & Sports Physical Therapy 25 years ago by its cofounders and initial coeditors. That vision was ‘‘to further the understanding of basic sciences as applied to musculoskeletal conditions and to promote justification of clinical procedures in orthopaedic and sports medicine.''1 As Guy Simoneau, the current editor-in-chief of JOSPT, said in his September 2002 editorial,2 ‘‘While the term evidence-based practice was not part of the physical therapy vernacular in 1979, Gould and Davies' vision for the role of JOSPT could not have been more accurate.'' Over the past 25 years, how electrifying it has been to see our profession progress up the ladder of evidence in providing the scientific and clinical rationale for the value and efficacy of our interventions!

J Orthop Sports Phys Ther. 2004; 34(6):281-283. doi:10.2519/jospt.2004.0106

Key Words: JOSPT, anniversary

Study Design: Nonexperimental descriptive research design. Objective: To describe the frequency of use and perceived level of importance of professional responsibilities, procedures, and knowledge areas by physical therapists practicing in primary contact care settings and to compare these data to similar data from physical therapists practicing in nonprimary contact care settings. Background: Physical therapy services have moved toward a primary contact model of practice in response to changes in the health care delivery system. Several studies have reported the effectiveness of primary contact physical therapy. However, a practice analysis has not been performed to define the clinical practice of primary contact physical therapy. Methods and Measures: A sample of 212 physical therapists practicing as primary contact providers in the military and civilian sectors, and a comparison group of 250 physical therapists not practicing as primary contact providers were surveyed. A Delphi technique was used to develop the survey instrument, which was pretested by a pilot group. The final survey instrument consisted of 171 items. Chi-square and Kruskal-Wallis tests were conducted to examine significant differences among the 3 groups (P<.001). Results: Of the 212 surveys mailed to the primary contact group, 119 (56.1%) responses were received (82 military physical therapists and 37 civilian physical therapists). Of the 250 surveys mailed to the comparison group, 103 (41.2%) responses were received. There were numerous significant differences among the 3 groups in professional responsibilities, procedures, and knowledge areas, most notably in the areas of selecting and ordering of imaging procedures, identifying signs and symptoms of nonmusculoskeletal conditions, establishing physical therapy diagnoses, and prescribing over-the-counter medications. Conclusion: The study describes the clinical practice of physical therapists functioning in the role of primary contact providers or as members of a diverse team of health care professionals in primary care, which may provide curricular direction to professional, postprofessional, and clinical residency or fellowship-based educational settings.

J Orthop Sports Phys Ther. 2004;34(6):284-304. doi:10.2519/jospt.2004.1298

Key Words: clinical competencies, physical therapists, primary care

Study Design: Controlled single-group pretest/posttest design. Objective: The purpose of this study was to determine if a 6-week neuromuscular training program designed to decrease the incidence of anterior cruciate ligament (ACL) injuries would improve single-limb postural stability in young female athletes. We hypothesized neuromuscular training would result in an improvement in postural stability, with the greatest improvement taking place in the medial-lateral direction. Background: Balance training has become a common component of programs designed to prevent ACL injury. Rehabilitation programs can improve postural stability following ACL injury and reconstruction; however, there is limited information available which quantifies improvement of postural stability following neuromuscular training designed to prevent ACL injuries in a healthy population. Methods and Measures: Forty-one healthy female high school athletes (mean age, 15.3 years; age range, 13-17 years) participated in this study. Single-limb postural stability for both lower extremities was assessed with a Biodex Stability System. The neuromuscular training program consisted of three 90-minute training sessions per week for 6 weeks. Following the completion of the training program, each subject was re-evaluated to determine change in total, anterior-posterior, and medial-lateral single-limb stability. Two-way analysis of variance models were used to determine differences between pretraining and posttraining and between limbs. Results: The subjects showed a significant improvement in single-limb total stability (P = .004) and anterior-posterior stability (P = .001), but not medial-lateral stability (P = .650) for both the right and left lower extremity following training. In addition, the subjects demonstrated significantly better total postural stability on the right side as compared to the left (P = .026). Conclusions: A 6-week neuromuscular training program designed to decrease the incidence of ACL injuries improves objective measures of total and anterior-posterior single-limb postural stability in high school female athletes.

J Orthop Sports Phys Ther. 2004;34(6):305-316. doi:10.2519/jospt.2004.1325

Key Words: anterior cruciate ligament, balance, knee, prevention, proprioception

Study Design: Repeated-measures analysis of variance. Objective: To examine the effect of 2 different orthotic posting designs on first metatarsophalangeal (first MTP) joint kinematics during gait. Background: Common orthotic designs used to control abnormal pronation incorporate the use of a medial post in the forefoot and/or rearfoot locations. Although this design may favorably alter rearfoot and lower-limb kinematics, the incorporation of a forefoot post has been theorized to negatively impact first MTP joint function by limiting hallux dorsiflexion during push off. An alternative design that has been proposed to be more favorable for function of the hallux and first metatarsal is the medial arch support. Methods and Measures: Eighteen subjects with a mean age of 28.2 years (SD, 8.3 years) completed the study. All subjects were judged to have excessive pronation based on a clinical orthopaedic examination. Two different pairs of orthoses were custom molded for each subject. One design incorporated an extrinsic rearfoot and forefoot post and the second design had a high medial longitudinal arch in combination with an extrinsic rearfoot post. The "Flock of Birds" electromagnetic tracking device was used to collect 3-dimensional position and orientation data of 3 body segments (hallux, first metatarsal, and calcaneus) during the stance phase of walking for 3 conditions (no orthosis and each of the 2 different orthotic designs). A repeated-measures analysis of variance was used to assess differences in first MTP joint dorsiflexion at midstance and during the push-off period of gait, as well as metatarsal declination angle changes during relaxed stance. An exploratory regression analysis was used to investigate factors that related to the change in peak dorsiflexion for the orthotic conditions. Results: Peak first MTP joint dorsiflexion averaged between 38° and 40° across all conditions. Although slight increases in first MTP joint dorsiflexion values were noted with both types of orthotic designs, these differences were not significant at either phase of the stance cycle (P = .50). The metatarsal declination angle in relaxed stance significantly increased (P = .001) under both orthotic conditions. Considerable individual variability was present. For the rearfoot-forefoot posted orthosis, a change in the declination angle of the first metatarsal during relaxed stance with the orthosis was a significant nonlinear predictor of change in peak dorsiflexion during push off. Conclusions: Foot orthoses that incorporate a medial forefoot post do not have a consistent negative effect of reducing first MTP joint dorsiflexion during walking.

J Orthop Sports Phys Ther. 2004;34(6):317-327. doi:10.2519/jospt.2004.1246

Key Words: arch support, first metatarsal joint, hallux, medial orthotic posts

Patients are frequently referred to physical therapy for musculoskeletal injuries. These injuries range from muscle strains to ligament ruptures and bone avulsion fractures. On occasion, what first may appear to be a common musculoskeletal injury can actually develop unexpected sequellae. It is imperative that the physical therapist continue to treat the patient while observing for signs and symptoms that would indicate changes to the initial diagnosis. Reevaluations include examining the progress of the patient and modifying or redirecting interventions.

This is a case report of a patient referred from his primary care physician to physical therapy 6 weeks after suffering a common musculoskeletal injury (diagnosed by the physician as a hamstring muscle contusion). The patient was later determined by a neurologist, and confirmed by a neurosurgeon, to have developed a saphenous neuropathy. Saphenous neuropathy is an uncommon syndrome, accounting for less than 1% of adult patients presenting with lower-extremity pain. True diagnosis is often delayed due to the rarity of the syndrome and the reliance on clinical presentation. Optimal treatment is not known but usually requires injection of local anesthetics with steroids or a surgical nerve release/decompression.

It is important for physical therapists to understand and recognize the signs and symptoms of a saphenous neuropathy. This syndrome is not reported often and can be overlooked or misdiagnosed as it develops. It is equally important for physical therapists to understand their involvement in the primary care team. In that capacity, physical therapists have the opportunity to interact with and refer to other providers. It is important to assimilate the findings of these other care providers as well as the information gathered during initial and follow-up evaluations in the clinic.

J Orthop Sports Phys Ther. 2004; 34(6):328-334. doi:10.2519/jospt.2004.1269

Key Words: saphenous neuropathy, knee, primary care

Study Design: Methodological study using correlational methods. Objective: To determine the intratester and intertester reliability and concurrent validity of the figure-of-eight method of measuring hand size in patients with hand pathology. Background: Measuring edema is an important component of the physical examination of patients with conditions affecting the hand. The figure-of-eight method of measuring hand size has been suggested as an alternative to volumetry. The reliability and concurrent validity of the figure-of-eight method has been established in individuals without hand pathology, but not in patients with conditions involving the hand. Methods and Measures: Participants were 24 patients with conditions affecting the hand, 9 with bilateral involvement. Two testers performed 3 figure-of-eight measurements of hand size each. A third tester performed 2 volumetric measurements. Intraclass correlation coefficient (ICC_3,1) was used to determine intratester reliability of both measurement procedures. ICC_2,3 was used to examine intertester reliability of the figure-of-eight method. Pearson product moment correlation coefficients examining the association between the 2 methods were used to establish concurrent validity of the figure-of-eight technique. Results: Intratester ICCs for figure-of-eight and volumetric methods were 0.98 to 0.99. The intertester ICC for the figure-of-eight method was 0.99. Pearson correlation coefficients examining the relationship between the 2 methods were 0.92 to 0.94. Conclusion: The figure-of-eight method is a reliable and valid measure of hand size in individuals with conditions affecting the hand.

J Orthop Sports Phys Ther. 2004;34(6):335-340. doi:10.2519/jospt.2004.1367

Key Words: edema, swelling, tape measure, volumetry

It is now well understood that to make effective decisions based on patient data physical therapists need to know the psychometric properties of the clinical measurements they use. What may not be as well understood is that the calculation of various reliability coefficients often reported in the literature are not all based on the same statistical concepts. This technical note explores how variability among subjects affects interpretation of various reliability coefficients and how different coefficients, used with the same data, can lead to paradoxical interpretation.

J Orthop Sports Phys Ther. 2004; 34(6):341-349. doi:10.2519/jospt.2004.0797

Key Words: reliability coefficients, psychometric properties, clinical measurements