Orthopaedic Physical Therapy Research Articles

Neurophysiological Effects of Manual Therapy in Aging and Older Adults

Musculoskeletal conditions are a common occurrence among older adults, often requiring physical therapy services. Physical therapy interventions, including manual therapy, have demonstrated positive outcomes in older adults. Decades of clinical research in the field of orthopedic physical therapy indicates the positive outcomes of this approach; however, the underlying basis regarding the efficacy of manual therapy interventions remains unknown. The purpose of this article is to review the evidence surrounding the neurophysiological effects of manual therapy, specifically mobilization and manipulation, in aging and older adults (ie, those ≥50 years of age).

Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort.

Literature review and cross-sectional study. Direct access to physical therapy necessitates greater responsibility to determine appropriateness of care by recognizing the potential for concomitant disease or systemic involvement. Recent research has identified excessive variability in the reporting of red flag symptoms. An initial step to improve the identification of red flag symptoms is the development of a standardized screening tool. To describe the development of a review-of-systems screening tool appropriate for use by orthopaedic physical therapists. First, a red flag symptom item bank was compiled from a systematic literature review to allow for further psychometric testing and development of a screening tool. Second, physical therapists in 11 outpatient clinics recruited patients presenting with primary complaints of neck, shoulder, low back, or knee pain. Patients completed the red flag symptom item bank and standard questionnaires for comorbidities, negative mood, quality of life, pain, and function. The development of the screening tool involved identifying and combining different 3-item sets that characterized the highest number of patients reporting at least 1 positive symptom response (operationally defined as "red flag symptom responder"). The literature search yielded 103 studies that met the inclusion criteria, and the final item bank consisted of 97 items representing 8 body systems. Four hundred thirty-one patients with primary complaints of neck (n = 93), shoulder (n = 108), low back (n = 119), or knee (n = 111) disorders contributed to the cross-sectional study. The number of red flag symptom responders was 393 of 431 (91.2%). These patients were older, more likely to be female, had lower income, and were more likely to report neck or back pain (all, P<.05). A 10-item review-of-systems screening tool correctly identified 372 of 393 (94.7%) responders, and a 23-item version identified all 393 (100%) responders. The review-of-systems screening tools and the complete 97-item bank had similar correlations with concurrent clinical measures, except for depressive symptoms. Concise red flag symptom identification appears to be feasible in outpatient orthopaedic physical therapy settings. Future research will determine how this review-of-systems screening tool needs refinement for different patient populations and whether it predicts clinical outcomes or the need for referral to other providers.

Implementing 7-day working in trauma and orthopaedic physiotherapy

Implementing 7-day working in trauma and orthopaedic physiotherapy

Attitudes and perceptions of family physicians and physiotherapists regarding orthopedic physiotherapy in the community

recording behavioral outcomes articular ankles, knees and hips, in jumpmoments 1 and 2 phases. Fat and fat free mass were measured by scale OMRON. Interventions: Use Pearson, setting r2 value for joint mobility range (RMA) ankle, knee and hip pulse 1 with fat mass and fat – free mass phase and RMA ankle, knee and hip pulse 2 with fat and fat – free mass. Results: Correlation between ankle RMA phase pulse 1 with fat mass (r2 =−0.487, p= 0.04). Correlation r2 = 0.475 and p= 0.05, between 1 phase impulse RMA ankles and fat-free mass. Correlation between pulse 1 RMA knee with fat mass (r2 =−0.247, p= 0.07) phase. Correlation between pulse 1 phase RMA knee and fat-free mass (r2 = 0.193 and p= 0.130). Correlation between ankle pulse 2 RMA and fat mass (r2 = 0.06 and p=−0.417). Correlation between RMA ankle pulse 2 and fat-free mass (r2 = 0.567 and p= 0.05). Conclusion(s): The range of joint mobility measured in both phases of momentum, not only depend on the arrangement of executing tissue (reflected in muscle mass), but also on thewillingness of fatmass,which is opposed to the amount of tissue available as a prime mover in the kinetic chains of Lower Limbs. Implications: Implications obtain from the results of this study, and others that are made taking into account the determinants of fitness in this age group (older adults), are applicable to the establishment of processes for assessment and intervention are made from physiotherapy and have as their purpose the improve or maintain physical fitness of elderly individuals, ensuring adequate quality of life.

Development of a new assessment rubric for a short-answer test of clinical reasoning in orthopaedic manual physical therapy (OMPT)

Development of a new assessment rubric for a short-answer test of clinical reasoning in orthopaedic manual physical therapy (OMPT)

Promoting evidence-based practice in orthopaedic manual physical therapy education: an approach to developing competence in instructors and learners

Promoting evidence-based practice in orthopaedic manual physical therapy education: an approach to developing competence in instructors and learners

CSM 2015 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL63)

CSM 2015 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL63)

Past and Future of Science for Orthopaedic Physical Therapy

Past and Future of Science for Orthopaedic Physical Therapy

Heel pain-plantar fasciitis: revision 2014.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain.

Nonarthritic hip joint pain.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to nonarthritic hip joint pain.

Comparison of static plantar foot pressure between healthy subjects and patients with adolescent idiopathic scoliosis

The objective of the present study was to compare changes in plantar foot pressure parameters during quiet standing between patients with adolescent idiopatic scoliosis (AIS) and healthy subjects. Twenty-one volunteers (AIS, n=10; healthy, n=11) were recruited for a simple blinded study. Using X-ray imaging, Cobb’s angle and pelvic height were measured in the monitor. Using a force plate, plantar foot pressure parameters were measured during quiet standing. In the analysis of Cobb’s angle and pelvic height, the AIS patients showed a significant increase compared to the healthy subjects. Furthermore, the regional plantar foot pressure of the AIS patients was significantly increased compared to that of the healthy subjects. These results suggest that AIS affects plantar foot pressure parameters. Therefore, the present data may contribute to our understanding of the body alignment of patients undergoing orthopedic physiotherapy.

Cost-effectiveness of a physiotherapist-led service for orthopaedic outpatients.

Non-surgical treatment can be effective for many musculoskeletal conditions. Improving access to these options may improve the efficiency of hospitals. The Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service offers early comprehensive assessment and coordinated, patient-centred care within a multidisciplinary framework. Our aim was to assess its cost-effectiveness compared with usual orthopaedic care. A Markov model was constructed to estimate the quality-adjusted life years and health care costs from the perspective of health care payers for outpatients with low back, knee or shoulder conditions compared to usual orthopaedic care. Data were obtained from a retrospective chart review, administrative sources, literature and expert opinion. The time frame was five years and all costs were reported in 2011 $AUD. Compared with usual orthopaedic care, the physiotherapist-led service costs an additional $495 per Quality Adjusted Life Year gained. The model remained cost-effective over a range of one-way sensitivity analyses. The physiotherapist-led service is likely to be highly cost-effective. Determining the optimal mix of hospital orthopaedic outpatient services may require more advanced modeling techniques to be applied.

Effect of Ultrasound Combined with Conventional Therapy on Neck Pain, Function, and Disability in Patients with Cervical Spondylosis: A Randomized Placebo-Controlled Trial

AbstractObjective: The purpose of this study was to evaluate the effect of continuous ultrasound [US] compared with placebo US combined with conventional physiotherapy program for patients with cervical spondylosis.Methods: This was a randomized placebo-controlled trial. Patients, diagnosed with cervical spondylosis, were randomly assigned to one of two groups in an orthopedic physical therapy clinic: a group that received electrotherapy, exercise, hot packs, and therapeutic US [True US group] and a group that received electrotherapy, exercise, hot packs, and sham US [Sham US group]. Patients were treated, on average, three times per week for 4 weeks. Outcome measurements were collected at baseline and after 4 weeks using the Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index.Results: Analysis of variance showed that both groups had improved regarding Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index [p < 0.05]. There was no signif...

Clinical Assessment of the Ankle Sprain Using Imaging(Orthopaedic Physical Therapy

Clinical Assessment of the Ankle Sprain Using Imaging(Orthopaedic Physical Therapy

Research Strategy in Orthopedic Physical Therapy for Health Care Fee

Research Strategy in Orthopedic Physical Therapy for Health Care Fee

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Residency Education in Every Town: Is It Just So Simple?

Kornelia Kulig, PT, PhD, FAPTA, FAAOMPT(Hon), is a physical therapist, educator, and scholar whose work focuses on exploring the mechanisms behind the causes and presentations of and interventions for recurrent pain of seemingly musculoskeletal origin such as low back pain and tendinopathies. Currently Professor in the Division of Biokinesiology and Physical Therapy, University of Southern California, Dr Kulig also serves as Co-Director of the Division's Musculoskeletal Biomechanics Research Laboratory. Previous posts include Associate Professor at Oakland University and Director of the Orthopedic Physical Therapy Residency Program. Dr Kulig earned a PhD in Biomechanics and an MS in Physical Therapy and Physical Education from the Academy of Physical Education, Wroclaw, Poland; a BS in Physical Therapy from Oakland University, Rochester, Michigan; and was a postdoctoral fellow in Biomechanics at the Biomechanics Laboratory, University of Iowa, Iowa City. Dr Kulig's research explores tissue morphology, biomechanics, physiology, and pathology in relation to degenerative processes in connective tissues and accompanying muscle activation and movement strategies, signs, symptoms, and loss of function. A sought-after lecturer, she has presented at the Annual International Conference on Foot Biomechanics and Orthotic Therapy, The Hong Kong Polytechnic University, Annual Conference of PTAROC (Taiwan), Nordic OMT Conference, University of Potsdam, and the American Physical Therapy Association, among many others. Dr Kulig is an active and contributing member of the American Physical Therapy Association, where she has served on the Board of Directors of the Orthopaedic Section. In addition, she is a member of the American and International Societies of Biomechanics and the American College of Sports Medicine, as well as a Founding Member of the American Academy of Orthopedic Manual Physical Therapists. Thank you, Mr Maley, for introducing me (Fig. 1). Each year, with this lecture, we honor your father's life, and it is a privilege for me to do …

Assessing the influence of treating therapist and patient prognostic factors on recovery from axial pain

Background:Limited research exists regarding the influence of a treating physical therapist on patient recovery (deemed therapist effects). Recent randomized clinical trials data provide an indication of small therapist effects for manual therapy; however, the extent to which therapist effects exist in the average outpatient facility is not clear. Moreover, patient-related prognostic factors, like fear-avoidance or pain duration, are important to consider since these may also influence the extent of therapist effects.Objective:To assess therapist effects and the influence of patient prognostic factors on recovery from axial pain in an outpatient orthopedic physical therapy facility.Methods:Clinical data were collected from consecutive patients with musculoskeletal neck and low back pain. Patient outcomes included pain intensity (visual analog scale) and functional measure (CareConnections functional outcomes index) scores. Therapist effects estimates and the influence of intake fear-avoidance (fear-avoidance beliefs questionnaire) and pain duration (days) were examined using multilevel linear or regression modeling.Results:A total of 258 patients (160 females; mean age 46·4±14·9 years) completed physical therapy and the required outcome measures. Five physical therapists (1–13 years of experience, mean 5·8 years) provided treatment. Therapists effects did not exist for discharge pain intensity or function after accounting for intake scores (P > 0·05). Further, therapist experience did not influence patient outcomes. Patient prognostic factors of fear-avoidance and pain duration did not influence therapists effects on the same patient outcome measures (P > 0·05).Discussion:Preliminary findings suggest that there are no major differences in patient outcome based on either the individual therapist (therapist effect) or therapist experience in this type of PT setting. Established prognostic factors had no influence on therapist effects for this cohort. Future analyses should consider intrinsic therapist factors (beliefs, equipoise), specific treatment parameters (dosage, type), and other patient prognostic factors (psychological, age, expectation, satisfaction) to further elucidate the influence of therapist effects.

Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to ankle ligament sprain. J Orthop Sports Phys Ther 2013;43(9):A1–A40. doi:10.2519/jospt.2013.0305