Initial Physical Therapy Visit Research Articles

Injury-related psychological distress and the association with perceived running ability in injured runners

ObjectiveExamine injury-related psychological distress and association with perceived running ability in injured runners. DesignProspective longitudinal study. ParticipantsForty-three patients with a running-related injury. Main outcome measuresData collection at initial physical therapy visit and 12–16 weeks later included Optimal Screening for Prediction of Referral and Outcome - Yellow Flag (OSPRO-YF) and Athlete Fear Avoidance Questionnaire (AFAQ) for injury-related psychological distress, and University of Wisconsin Running and Recovery Index (UWRI) for perceived running ability. OSPRO-YF composite score, total yellow flags, and yellow flags in each domain (negative mood, fear-avoidance, positive affect/coping) were calculated. ResultsUWRI score and OSPRO-YF composite score and yellow flags significantly improved over time, while AFAQ score and yellow flags in OSPRO-YF negative mood domain did not. AFAQ scores were significantly correlated with UWRI score at baseline, follow-up and change over time, while OSPRO-YF composite score and yellow flags were not. Baseline OSPRO-YF composite score and AFAQ score were not correlated with follow-up UWRI score. ConclusionsInjury-related psychological distress is elevated when injured runners start rehabilitation, and generally improves; however, negative mood and athletic fear-avoidance may persist. Higher athletic fear-avoidance is associated with lower perceived running ability at the same time point or interval.

The Self-Efficacy for Home Exercise Programs Scale: Development and Psychometric Properties.

The Self-Efficacy for Home Exercise Programs Scale (SEHEPS) was developed to help clinicians evaluate patients' self-efficacy for performing prescribed home exercise programs. Prior to clinical adoption, the scale's psychometric properties need to be examined. To determine the psychometric properties of the SEHEPS. Eighty-one patients (32 men, 49 women; mean ± SD age, 42 ± 17 years) with varying musculoskeletal conditions participated in this cohort study. Patients were given a home exercise program at the initial physical therapy visit and completed the SEHEPS and a modified Self-Efficacy for Exercise (SEE) scale. The SEHEPS is a 12-item patient-reported questionnaire designed to assess self-efficacy for prescribed home exercise. Patients rated their confidence on a 7-point scale that ranged from 0 (not confident) to 6 (very confident). Total scores ranged from 0 (low self-efficacy) to 72 (high self-efficacy). We assessed the internal consistency of the SEHEPS using Cronbach's alpha and its test-retest reliability using an intraclass correlation coefficient. Convergent validity between the SEHEPS and SEE scale was evaluated with a Spearman correlation. High internal consistency (α = .96) and good test-retest reliability (intraclass correlation coefficient = 0.88; SEM, 4; minimal detectable change at the 95% confidence level, 12) were demonstrated. The SEHEPS was strongly correlated with the SEE scale (ρ = 0.83, P<.01), indicating strong convergent validity. The SEHEPS demonstrates excellent internal consistency and convergent validity with the SEE scale. Overall, the SEHEPS is a clinically useful tool to evaluate a patient's self-efficacy in home-based musculoskeletal exercise programs. This scale can be used prior to prescribing a home exercise program for patients with musculoskeletal conditions. Therapy, level 4. J Orthop Sports Phys Ther 2019;49(9):647-655. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8779.

Role of Nonoperative Treatment of Subacromial Impingement

Subacromial impingement syndrome (SIS) occurs when the rotator cuff is compressed by the overlying acromion during shoulder flexion resulting in shoulder pain. The objective of this study was to demonstrate significant relief of symptoms and improved function from physical therapy over long-term follow-up. Eighty-one patients were followed. Patients had subjective and strength assessments at the initial physical therapy visit and 2-year follow-up. Statistical analysis was done using paired t tests for binomial data and Shapiro-Wilk test for the variable data. At 2 years, the Penn shoulder score (81) statistically significantly improved from the initial score (59) for 20 subjects (p = .002). The DASH score improved from 25 to 15 (p = .005). Average external rotation strength deficits compared with the contralateral side improved from 20% to 7% (p = .009). Physical therapy for SIS alleviates symptoms and improves function according to patient-based surveys and strength measurements over a 2-year period.

Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: A case report

Chronic low back pain (CLBP) remains prevalent in society, and conservative treatment strategies appear to have little effect. It is proposed that patients with CLBP may have altered cognition and increased fear, which impacts their ability to move, perform exercise, and partake in activities of daily living. Neuroscience education (NE) aims to change a patient's cognition regarding their pain state, which may result in decreased fear, ultimately resulting in confrontation of pain barriers and a resumption of normal activities. A 64-year-old female with history of CLBP was the patient for this case report. A physical examination, the Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), and Zung Depression Scale were assessed during her initial physical therapy visit, immediately after her first physical therapy session, and at 7-month follow-up. Treatment consisted of an abbreviated NE approach, exercises (range of motion, stretches, and cardiovascular), and aquatic therapy. She attended twice a week for 4 weeks, or 8 visits total. Pre-NE, the patient reported NPRS = 9/10; ODI = 54%; FABQ-W = 25/42,; FABQ-PA = 20/24, and Zung = 58. Immediately following the 75-minute evaluation and NE session, the patient reported improvement in all four outcome measures, most notably a reduction in the FABQ-W score to 2/42 and the FABQ-PA to 1/24. At a 7-month follow-up, all outcome measures continued to be improved. NE aimed at decreasing fear associated with movement may be a valuable adjunct to movement-based therapy, such as exercise, for patients with CLBP.

Cystic Fibrous Dysplasia of the Humerus

The patient was a 39-year-old woman with a 3-month history of worsening right distal humerus pain that was insidious in onset. At the time of the initial physical therapy visit, the patient complained of weakness and numbness throughout the entire right upper extremity, with an inability to perform daily activities. Magnetic resonance imaging revealed extensive bone marrow signal abnormalities extending from the proximal humeral epiphysis to the distal humeral diaphysis. Further evaluation with radiographs and computed tomography revealed multiple lytic lesions through the humerus. Tissue biopsy confirmed a diagnosis of cystic fibrous dysplasia.

Post-operative Rehabilitation Following Total Knee Arthroplasty Should Include Weight Management

The majority of persons with end-stage knee osteoarthritis (OA) are overweight and report that knee pain is a major barrier to physical activity and exercise. Total knee arthroplasty (TKA) improves functional mobility and reduces pain; however, the long-term effects of this surgical intervention on body mass index (BMI) have not been evaluated. A reduction in BMI may slow the progression of OA in the uninvolved limb and lower the chance of cardiopulmonary sequellae. PURPOSE: To determine if a reduction in body mass index was present following unilateral TKA compared to an age-matched healthy control group who did not have surgery. METHODS: One hundred and six adults with unilateral, end-stage knee osteoarthritis and 31 persons without knee pain participated in the prospective longitudinal study. Subjects with OA underwent primary unilateral TKA and received post-operative outpatient physical therapy. Height, weight, quadriceps strength and functional ability were measured at baseline and at a two year follow-up. RESULTS: There was a significant interaction effect between body mass over time and subject group (p=0.017). BMI significantly increased over two years for the surgical group (p<0.001), but not for the control group (p=0.842). Sixty-six percent of the persons in the surgical group gained weight over the two years with an average weight gain of 6.4 kg, or 14 pounds, 2 years after their initial physical therapy visit. Persons in the surgical group that gained weight also demonstrated a significant reduction in strength on the non-operated limb between 1 and 2 years after surgery (p=0.002), whereas persons that did not gain weight did not demonstrate a reduction in quadriceps strength (p=0.244). Educational level, marital status, income level and activity level prior to surgery were not related to post-surgical weight gain. CONCLUSION: The majority of subjects gain weight after surgery and this cannot be attributed to the effects of aging. Weight gain after TKA should be treated as an independent concern and management of orthopedic impairments will not result in weight loss. Post-operative care should include access to nutrition or weight management professionals in addition to medical and physical therapy services. Supported by NIH R01HD041055 and P20RR01645

Most patients gain weight in the 2 years after total knee arthroplasty: comparison to a healthy control group

While joint arthroplasty improves the functional ability of persons with severe knee osteoarthritis (OA), the long-term effects of surgical intervention on body mass have not been evaluated. The objective of this study was to determine if a reduction in body mass index (BMI) was present following unilateral total knee arthroplasty (TKA) compared to an age-matched healthy control group who did not have surgery. One hundred and six adults with unilateral, end-stage knee OA and thirty-one persons without knee pain participated in the prospective longitudinal study. Subjects with OA underwent primary unilateral TKA and received post-operative out-patient physical therapy. Height, weight, quadriceps strength and self-perceived functional ability were measured at baseline and at a 2-year follow-up. There was a significant interaction effect between body mass over time and subject group (P=0.017). BMI showed a significant increase over 2 years for the surgical group (P<0.001), but not for the control group (P=0.842). Sixty-six percent of the persons in the surgical group gained weight over the 2 years with an average weight gain of 6.4 kg, or 14 pounds, 2 years after their initial physical therapy visit. Educational level, marital status, income level and activity level prior to surgery were not related to post-surgical weight gain. The majority of subjects gain weight after surgery and this cannot be attributed to the effects of aging. Weight gain after TKA should be treated as an independent concern and management of orthopedic impairments will not result in weight loss. Post-operative care should include access to nutrition or weight management professionals in addition to medical and physical therapy services.

Effects of glucocorticoid treatment on the functional capacity of stem cell transplant recipients entering a rehabilitation program

7104 Background: Emerging data strongly supports the concept that stem cell transplant (SCT) recipients derive psychological and physiological benefit from participation in exercise training programs. Many SCT recipients receive glucocorticoids (GC) for prolonged periods, increasing their risk for proximal muscle damage and raising the possibility that SCT recipients on GC may differ from those SCT recipients not receiving GC in terms of their exercise/functional capacity. This becomes an important reconditioning issue because exercise prescription and progression is predicated on initial exercise capacity. Therefore the purpose of this study was to compare the initial functional capacity of outpatient STC recipients receiving GC to STC recipients not receiving GC. Methods: The medical records of 163 successive SCT recipients referred to Rehabilitation Services for reconditioning were retrospectively reviewed for demographic information and measures of exercise/functional capacity (6-min walk test, 50-ft fast walk, and repeated sit-to-stand times) collected at the initial physical therapy visit. Data from SCT recipients on GC (ON) were compared with that of SCT recipients not on GC (OFF) by means of an unpaired t-test (α=0.05). Data are presented as mean + standard deviation. Results: Demographic and functional measures are presented in the following tables. Significant differences between group means are denoted by an asterisk. Conclusions: STC recipients on steroids have comparable endurance capacity to those STC recipients not on steroids, but are less capable of performing lower extremity activities requiring rapid movement and receive rehabilitation services later in the post transplant recovery course. These results suggest rehabilitation strategies are 1) needed for STC patients, 2) should be individualized according to the patient's drug regime, and 3) should be initiated soon after the stem cell transplant. [Table: see text] No significant financial relationships to disclose.

Neck Pain and Headaches in a Patient After a Fall

The patient was a 64-year-old woman who reported a sudden onset of neck pain and headaches following a fall 2.5 months prior to her initial physical therapy visit. Cervical spine radiographs, which were ordered by the referring physician, revealed extensive degenerative disc disease of the lower cervical spine. At her initial physical therapy evaluation, cervical spine range of motion was within functional limits except for bilateral rotation, which was limited to 45 degrees due to pain and stiffness. The patient's headache symptoms were abolished with the Sharp-Purser test. Although assessment of symptoms was not the intent of the Sharp-Purser test, a reduction of symptoms during the test would warrant further evaluation. Therefore, the physical therapist ordered cervical spine flexion-extension radiographic views to assess for atlantoaxial instability. The radiologist's report noted a stable atlantodens interval that did not change with cervical flexion and extension and a course of physical therapy was initiated. At the time of discharge from physical therapy, the patient reported no neck pain and only very mild occasional headaches, which she believed she could manage on her own.

Clinical Decision Making Associated With an Undetected Odontoid Fracture in an Older Individual Referred to Physical Therapy for the Treatment of Neck Pain

Resident's case problem. The purpose of this paper is to provide the examination of and decision-making process for a patient referred to physical therapy for the treatment of neck pain following trauma. She was found to have an underlying odontoid fracture that precluded physical therapy intervention. This case involved a 73-year-old woman who had a sudden onset of neck and left upper extremity pain after a fall 15 days prior to her initial physical therapy visit. Conventional cervical spine radiographs completed 1 day prior to her initial physical therapy visit were negative for a fracture. However, several components of this patient's history and physical examination were consistent with a condition for which physical therapy intervention would not be indicated until more definitive cervical spine diagnostic imaging had been completed; more specifically, the physical therapist was primarily concerned about the possibility of an undetected fracture. The referring physician was contacted and immediate magnetic resonance imaging was requested, which revealed a type II fracture of the odontoid. Thirty-four days after her fall, the patient underwent a C1-C2 fusion. When evaluating patients with neck pain who have a history of cervical spine trauma, it is important that physical therapists understand the clinical findings associated with cervical spine fractures, as these findings provide guidance for the use of cervical spine diagnostic imaging and medical referral prior to implementing physical therapy interventions. Diagnosis, level 4.

Undetected Hangman's Fracture in a Patient Referred for Physical Therapy for the Treatment of Neck Pain Following Trauma

This case report describes a patient referred for physical therapy treatment of neck pain who had an underlying hangman's fracture that precluded physical therapy intervention. This case involved a 61-year-old man who had a sudden onset of neck pain after a motor vehicle accident 8 weeks before his initial physical therapy visit. Conventional radiographs of his cervical spine taken on the day of the accident did not reveal any abnormalities. Based on the findings at his initial physical therapy visit, the physical therapist ordered conventional radiographs of the cervical spine to rule out the possibility of an undetected fracture. The radiographs revealed bilateral C2 pars interarticularis defects consistent with a hangman's fracture. The patient was referred to a neurosurgeon for immediate review. Based on a normal neurological examination, a relatively low level of pain, and the results of radiographic flexion and extension views of the cervical spine (which revealed no evidence of instability), the neurosurgeon recommended that the patient continue with nonsurgical management. In patients with neck pain caused by trauma, physical therapists should be alert for the presence of cervical spine fractures. Even if the initial radiographs are negative for a fracture, additional diagnostic imaging may be necessary for a small number of patients, because they may have undetected injuries that would necessitate medical referral and preclude physical therapy intervention.

The Use of Nonthrust Manipulation in an Adolescent for the Treatment of Thoracic Pain and Rib Dysfunction

Case report. Back pain is a common presentation of patients in the orthopedic physical therapy setting. In an athletic environment, back pain can limit an athlete's ability to perform running, cutting, and throwing. This case report describes the use of a spinal nonthrust manipulation in conjunction with therapeutic exercise for the management of thoracic and rib pain in an adolescent athlete. A 16-year-old male presented to the outpatient clinic without physician referral. His chief complaint was right-sided thoracic and rib pain during running, jumping, cutting, and kicking that began 1 month before the initial physical therapy visit. He had no previous episodes of pain or associated injuries. A screening examination for serious underlying pathology was negative. After physical examination, it was determined that manual therapy was indicated. A thoracic nonthrust manipulation was applied to the painful area (the right-side thoracic facet joints of segments 5-7). Immediately after the thoracic nonthrust manipulation, the patient experienced a decrease in tenderness to palpation of the thoracic erector spinae musculature and the associated intercostal spaces of ribs 6 through 8 (a decrease of 1-2 points on the pain scale), an increase in thoracic side-bending active range of motion recorded at T3 and T9, and improved chest expansion, which had been limited by pain before treatment. This case report demonstrates the use of a spinal nonthrust manipulation that seems to have helped an adolescent return to pain-free sports activity, with an immediate decrease in pain after 1 visit. Follow-up telephone calls were made 1 month and 9 months after treatment, in which no return of symptoms was reported.

Expectations, Outcomes, and Medical Costs in Patients with Low Back Pain Referred to Physical Therapy

To describe treatment expectations among patients referred to physical therapy (PT) for low back pain (LBP) and to examine the relationship among expectations, outcomes, and medical care costs, 111 patients referred to PT for LBP within a managed care environment were studied in a prospective cohort study. Both χ2 and Student's t tests, as well as one-way analyses of variance, were used to assess bivariate differences in expectations, outcomes, and medical costs. A backward-stepping multivariate regression algorithm was used to assess the role of expectations, controlling for patient characteristics on (1) the change in patient-reported improvement between admission and discharge, and (2) annual medical expenditures. Patients' treatment expectations, pain levels, and functional levels were measured at the initial PT visit. Pain and functional status were also measured at PT discharge. Medical care expenditures were compiled for the 12 months following PT referral. Patients with the highest level of expect...