Physical Therapist Intervention Research Articles

Planning, Implementing and Evaluating Health Promotion Programs: A Primer.

Planning, Implementing and Evaluating Health Promotion Programs: A Primer. 4th ed. McKenzie J F, Neiger B L, Smeltzer J. San Francisco, Calif, Benjamin Cummings, 2005, softcover, 432 pp, $78.80. Traditionally, physical therapist interventions have been designed to treat patients who have illnesses or impairments. The focus has been on meeting needs of individuals who are sick, rather than on providing services that would prevent illness from occurring in first place. The number of individuals living with chronic health conditions is a growing concern. Over next 25 years, number is expected to double as baby boomers age, creating enormous demands for health care and social services. The cost for these services will occur at same time that health care system is facing pressure to decrease expenditures. Diet, exercise, avoidance of tobacco, and moderate alcohol use would prevent many of these illnesses from occurring, while reducing both morbidity and mortality. Thus, need for health care providers who can promote a healthier lifestyle and prevent onset of chronic illness has become increasingly clear. With knowledge of efficacy of diet and exercise interventions, and skill in patient education, physical therapists are well suited to provide both primary and secondary prevention activities that would help address this problem. McKenzie, Neiger, and Smeltzer have written a text that covers theoretical and practical knowledge to develop and implement health promotion programs. It provides foundational material for learners who are new to this field of study. The initial chapter does an excellent job describing concept of health education as compared to health promotion. Most physical therapists will find role of health educator to be very familiar and comfortable while inaccurately assuming that this is synonymous with health promotion. Health promotion is a combination of activities that go beyond mere education to include the competent implementation of behavioral change strategies, health education, health protection measures, risk factor detection, health enhancement and health maintenance. The book is divided into 3 sections. Part One focuses on planning a health promotion program; Part Two addresses ways to implement a health promotion program; and Part Three covers evaluation of a health promotion program. Each chapter is well-organized and begins with clear, well-stated objectives. These objectives are followed by a list of key terms that will be covered in chapter, enhancing learner focus on material to be mastered. At end of each chapter are questions that test learner's knowledge of facts that were presented. The text then guides application of this information by providing activities that ask for comparison, analysis, evaluation, and development of ideas based on material. This is followed by a final set of learning activities that are based on information and resources that are found on World Wide Web. The inclusion of these learning activities provides instructor with multiple strategies to take student's knowledge beyond mere memorization of facts. Part One is designed to guide learner in developing and preparing a health promotion program. Chapter Two begins with Models for Program Planning in Health Promotion, including theoretical basis for how to approach problem, and how to identify basic components necessary to a successful plan. The remaining chapters in this section elaborate on components of planning process. Chapter Three describes importance of a planning committee to starting planning process, while Chapter Four provides information on assessing needs. Identifying data sources, selecting most appropriate source, and collecting data are described. …

Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials

Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was.56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was.68 (95% confidence interval=.57-.76). The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDro score was "fair" to "good."

Medial Pontine Hemorrhagic Stroke

This case report documents a rare opportunity to observe the motor function of an individual for nearly 6 months following a primary pontine hemorrhage in the medial pontine tegmentum of the brain stem. The purpose of this report is to illustrate how knowledge of the location of the hemorrhage, in conjunction with knowledge of brain-stem structure-function relationships, informs physical therapist examination and intervention. RM, a right-handed 81-year-old man with hypertension, had a hemorrhagic brain-stem stroke that severely compromised control of posture and whole-limb movements. Some residual ability to use the right hand and fingers remained, provided the trunk and right upper arm were stabilized. RM had undiminished intellectual abilities and unaltered memory because of sparing of cerebral cortices. RM's cognitive abilities, however, were obscured by severe impairments in interpersonal communication because of extensive damage to cranial nerve structures. Computed tomographic scans verified that the hematoma crossed the midline and was confined to the medial pontine tegmentum. We interpret motor deficits resulting from stoke in the medial pontine tegmentum in terms of damage to brain-stem descending motor systems and ascending somatosensory systems. Recognition of cognitive and residual motor abilities following brain-stem stroke can aid in the development of rehabilitation strategies.

Acute Care Physical Therapist Evaluation and Intervention for an Adult After Right Hemispherectomy

Hemispherectomy is performed to help control intractable seizures, yet little research quantifies and projects the clinical course of the impairments, functional limitations, and disabilities of patients who have undergone the procedure. This case report describes the physical therapist preoperative and postoperative examination, evaluation, and intervention during the acute hospitalization of an adult who underwent a right hemispherectomy. The patient was a 27-year-old man who had intractable seizures despite having tried multiple drug regimens and undergoing several surgical interventions after a brain injury at age 5 years. He underwent a right functional hemispherectomy and then had 9 postoperative physical therapy sessions during his acute hospitalization. The patient made rapid gains, surpassing all initial goals. At discharge, the patient had distal left-sided sensorimotor impairments, but he was able to ambulate 121.9 m (400 ft) with assistance to maintain his balance. The patient's posthemispherectomy recovery was rapid. His brain injury at a young age may have triggered preoperative transfer of function to the unaffected left hemisphere. The prognosis for this patient's improvements of impairments and functional limitations was better than initially expected, perhaps because of the redundant features and plasticity of the central nervous system.

Physical Impairment and Disability: Relationship to Performance of Activities of Daily Living in Community-Dwelling Older Men

The decline of physical function of older adults, associated with loss of independent living status, is a major public health concern. The purpose of this study was to examine the relationship of physical impairment and disability to performance of activities of daily living (ADL) among community-dwelling older adults. Eighty-three community-dwelling older men who were referred to a comprehensive outpatient geriatric evaluation program (mean age=75.5 years, SD=7.0, range=64-97) were examined. Measurements of physical impairment (muscle force production, flexibility, and fitness) and physical disability (gait speed, stride length, risk for recurrent falls, and physical function) were recorded. A stepwise linear regression was used to determine the relationship of physical impairments and disability measures with ADL. The results indicated that walking speed, fall risk, and muscle force contributed independently to the characterization of the activities of daily living of the community-dwelling older men studied (adjusted R2=.68; F=56.81; df=3,80; P<.001). Using a principal components factor analysis, 4 domains were identified that explained 68.2% of the variance in performance of ADL: (1) mobility/fall risk=26.5%, (2) coordination=15%, (3) fitness=14.7%, and (4) flexibility=12.0%. The identification of domains of physical function may be useful to physical therapists in the development of interventions targeted for physical impairments and disabilities that contribute to deficits in performance of ADL. Targeting interventions for physical impairments and disabilities related to function may improve the effectiveness of physical therapist interventions and reduce the loss of independence among community-dwelling older people.

Expert Consensus on Physical Therapist Intervention after Botulinum Toxin A Injection for Children with Cerebral Palsy

The purpose of this study was to gather expert consensus on physical therapist (PT) intervention after lower extremity botulinum toxin A (BtA) injection(s) for children with cerebral palsy (CP) and lower extremity spasticity. This study also examined differences in expert opinion on intervention for two groups of children with CP and differing levels of functional ability. The Guide to Physical Therapist Practice was used to develop a questionnaire. Sixty-two therapists identified as experts in the field of pediatric physical therapy rated the importance of the three PT intervention components and the seven types of direct intervention from Neuromuscular Pattern 5A for both groups. The Wilcoxon signed rank test was used to identify differences in expert responses between the groups. Experts also ranked the importance of specific intervention strategies. Consensus criteria were used to determine the importance of interventions. All three intervention components and four direct interventions (Therapeutic Exercise; Functional Training-Self-Care; Functional Training-Community and Work; and Prescription of Devices/Equipment) met consensus criteria for both groups. Significant differences between groups were found for Patient/Client-Related Instruction and Direct Interventions and for Therapeutic Exercise, Functional Training in Self-Care, Functional Training-Community and Work, and Electrotherapeutic Modalities, suggesting that these items were more important for children with greater functional abilities. Twenty (35%) specific intervention strategies met consensus criteria for one or both groups. All three intervention components and four direct interventions in Neuromuscular Pattern 5A are important in the PT plan of care after botulinum toxin A injection for children with CP and lower extremity spasticity. Functional ability influences therapists' intervention choices.

Expert Consensus on Physical Therapist Intervention after Botulinum Toxin A Injection for Children with Cerebral Palsy

Purpose: The purpose of this study was to gather expert consensus on physical therapist (PT) intervention after lower extremity botulinum toxin A (BtA) injection(s) for children with cerebral palsy (CP) and lower extremity spasticity. This study also examined differences in expert opinion on intervention for two groups of children with CP and differing levels of functional ability. Methods: The Guide to Physical Therapist Practice was used to develop a questionnaire. Sixty-two therapists identified as experts in the field of pediatric physical therapy rated the importance of the three PT intervention components and the seven types of direct intervention from Neuromuscular Pattern 5A for both groups. The Wilcoxon signed rank test was used to identify differences in expert responses between the groups. Experts also ranked the importance of specific intervention strategies. Consensus criteria were used to determine the importance of interventions. Results: All three intervention components and four direct interventions (Therapeutic Exercise; Functional Training-Self-Care; Functional Training-Community and Work; and Prescription of Devices/Equipment) met consensus criteria for both groups. Significant differences between groups were found for Patient/Client-Related Instruction and Direct Interventions and for Therapeutic Exercise, Functional Training in Self-Care, Functional Training-Community and Work, and Electrotherapeutic Modalities, suggesting that these items were more important for children with greater functional abilities. Twenty (35%) specific intervention strategies met consensus criteria for one or both groups. Discussion and Conclusions: All three intervention components and four direct interventions in Neuromuscular Pattern 5A are important in the PT plan of care after botulinum toxin A injection for children with CP and lower extremity spasticity. Functional ability influences therapists’ intervention choices.