Primary Physical Therapist Research Articles

Carrying the Load Together: The Role of the Therapeutic Alliance in a Patient With Bilateral Achilles Tendon Repair With Unilateral Failure and Subsequent Infection: A Case Report

BACKGROUND: Adverse events can complicate the rehabilitation process. In complex clinical situations, the therapeutic alliance can aid the therapist and patient in navigating clinical challenges and facilitate a successful outcome. CASE PRESENTATION: A 38-year-old male presented to physical therapy after sequential bilateral Achilles tendon repairs following a 2-year history of chronic bilateral Achilles tendinopathy that did not respond to limited conservative care. The patient subsequently experienced traumatic failure and infection of the left Achilles tendon repair, necessitating prolonged medical management and physical therapy care over 56 weeks. His goals were to return to high-level physical activity and collegiate basketball officiating. OUTCOME AND FOLLOW UP: Approximately 80 weeks following initial physical therapy evaluation, the patient had returned to collegiate basketball officiating and was fully participating in high-intensity interval-based circuit training, including strength training, plyometric training, and sprint training, 3 times per week. DISCUSSION: The primary physical therapist in this case sought to intentionally develop the therapeutic alliance with the patient through use of core components of the therapeutic alliance and components of psychologically informed practice. Specific strategies were utilized to develop the therapeutic alliance and leverage it in ways that positively influenced outcomes. This case report demonstrates the theories of the therapeutic alliance in practice and serves as an example to clinicians managing complex clinical cases. JOSPT Cases 2023;3(4):235-244. Epub 13 October 2023. doi:10.2519/josptcases.2023.11557

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Quadriceps Isometric Strength at 90° and 60° of Knee Flexion Following a Medial Meniscus Root Tear: A Case Report

Background Meniscus injury can significantly impair an individual's quality of life. Meniscus root disruption can more quickly lead to joint degradation than other types of meniscus injuries can. Existing clinical diagnostic testing specific to a meniscus root tear is insufficient. Case Presentation A 51-year-old man unknowingly tore a meniscus root repair, had negative diagnostic testing performed by his primary physical therapist, and subsequently underwent isometric quadriceps and functional testing 2 weeks after his reinjury. Differential diagnosis included bone, muscle, ligament, and general joint irritation from the injury. Outcome and Follow-Up Isometric quadriceps strength (measured as torque production) at 90° was significantly lower (8 times) than at 60° of knee flexion in the presence of a meniscus root tear. Discussion Diagnostic tests for the meniscus may not always be reliable when it comes to diagnosing a root tear. Strength testing at specific angles of knee flexion may be used as a potential clinical indicator that a root tear is present. JOSPT Cases 2021;1(4):268–272. doi:10.2519/josptcases.2021.10493

LESS THAN HALF OF ACL‐RECONSTRUCTED ATHLETES ARE CLEARED FOR RETURN TO PLAY BASED ON PRACTICE GUIDELINE CRITERIA: RESULTS FROM A PROSPECTIVE COHORT STUDY

A recently published Dutch practice guideline emphasizes criterion-based rehabilitation after anterior cruciate ligament reconstruction (ACLR) instead of time-based. As a consequence of this criterion-based rehabilitation, return to play is only suggested when athletes meet specific return to play (RTP) criteria. The goal of this prospective observational study was to analyze if physical therapists adhere to ACLR practice guideline RTP criteria for testing and return to sport decisions, and to explore whether there is a difference in adherence between physical therapists specialized in sports versus those who are not. When the treating physical therapist cleared an athlete for RTP after ACLR, the primary researcher performed RTP measurements according to the ACLR practice guideline to investigate if all nine quantitative and qualitative RTP criteria were met. Of the 158 athletes (54 females and 104 males, mean age 24 ± 6 years, 12 ± 3 months after surgery), 69 (44%) had performed the RTP measurements with their primary physical therapist. Of the athletes tested by their primary physical therapist 23% met all RTP criteria compared to 10% of the athletes who were not tested at all by their primary physical therapist (p = 0.026). Of the athletes rehabilitating with a sports physical therapist, 52% had been tested by their primary physical therapist compared to 34% of the athletes rehabilitating with a non-sports physical therapist (p = 0.024). Only 44% of the athletes were tested according to the guideline RTP criteria and only 23% of them were given an RTP advice consistent with the ACLR guideline. Although sports physical therapists adhered to the guideline more often than non-sports physical therapists, the adherence is still alarmingly low. More attention for the implementation of ACLR guidelines and RTP criteria is needed. Therapy, level 2b.

Test-Retest Reliability and Minimal Detectable Change of Gait Speed in Individuals Undergoing Rehabilitation After Stroke

Gait speed is commonly used to assess walking ability in persons with stroke. Previous research related to the psychometric properties of gait speed has been conducted primarily with individuals who were able to walk independently and/or were in the later stages of recovery after stroke. The purpose of this research was to examine the test-retest reliability and minimal detectable change (MDC90) of gait speed in individuals with stroke who required varying levels of assistance to ambulate during rehabilitation. Patients who could ambulate with or without physical assistance and were undergoing inpatient rehabilitation were recruited. Gait speed was measured over the middle five meters of a nine-meter walk at a comfortable pace. Data were analyzed using the intraclass correlation coefficient (ICC2,1) and the MDC90. Thirty-five patients who were a mean 34.5 (standard deviation = 17.7) days post-stroke agreed to participate. For all the subjects combined, the ICC2,1 was 0.862 and MDC90 was 0.30 m/sec. For the 13 subjects who required physical assistance to walk, the ICC2,1 = 0.971 and MDC90 = 0.07 m/sec. For the 22 subjects who could walk without physical assistance, the ICC2,1 = 0.80 and MDC90 = 0.36 m/sec. Gait speed is a reliable measure of walking ability for a wide variety of patients undergoing rehabilitation after stroke. Gait speed is more sensitive to change in patients who require physical assistance to walk than in those who can walk without assistance. A change of more than 0.30 m/sec may be necessary in order to determine whether a change in gait speed exceeds measurement error and patient variability.

Is there evidence to support the use of constraint-induced therapy to improve the quality or quantity of upper extremity function of a 2 ½-year-old girl with congenital hemiparesis? If so, what are the optimal parameters of this intervention?

The purpose of “Evidence in Practice” is to illustrate how evidence is gathered and used to guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 28-month-old girl came to our physical therapy department with left-sided spastic hemiparesis, the result of a right cerebrovascular accident (CVA) in utero. Although she had delays in gross and fine motor development because of her hemiparesis, her cognitive and language development were typical for her age. Spontaneous use of her left upper extremity (UE) was markedly impaired in both quantity and quality of movement; however, she was able to use the left UE with prompting when she was given a 2-handed task (eg, holding a “sippy” cup with handles, holding a big ball with 2 hands) or when her right UE was therapeutically constrained. The child’s parents were well educated and well versed in therapeutic opportunities for improving left UE function, and they approached our university through their primary physical therapist to investigate the opportunity of involving their daughter in a student research project on pediatric constraint-induced therapy (PCIT). Through their support and information network, they had heard many anecdotal success stories related to the use of PCIT with children with sensory and motor impairments in the UE, and they were excited at the prospect of their daughter receiving this intervention. They contacted researchers conducting controlled clinical trials on PCIT in Alabama and New York. They put their child on a waiting list for a program at a university conducting PCIT clinical trials, but they recognized many drawbacks to attending this program, including the financial burden and the need to leave their home. The child was without any major medical complications or procedures since her diagnosis at 6 months of age. Upon diagnosis, …

Validation of a lateropulsion scale for patients recovering from stroke.

To determine the validity and reliability of a clinical scale for assessing lateropulsion following stroke. Serial observational study of Lateropulsion Scale scores. Inpatient stroke rehabilitation unit. A convenience sample of 85 patients examined 19 +/- 2 SEM days post stroke. An empirically derived 17-point Lateropulsion Scale was used to assess and follow postural responses to rolling, sitting, standing, transferring and walking. Intraclass correlation coefficients were calculated by having patients evaluated twice by their primary physical therapist (days 1 and 3), and once by an alternate physical therapist (day 2). Concurrent validity was estimated by computing Spearman's rank order correlations between the lateropulsion score and other markers for motor control dysfunction: Fugl-Meyer balance subscore, the Functional Independence Measure (FIM) mobility subscore, and length of rehabilitation hospital stay. Inter-rater and intra-rater reliability were r = 0.93 (p < 0.001) and r = 0.94 (p < 0.05), respectively. Concurrent validity estimates showed the initial lateropulsion score to be correlated with the Fugl-Meyer balance subscore (r = -0.57 p < 0.001), with the admission and discharge FIM mobility subscores (r = -0.56, p < 0.0001 and r = -0.58, p < 0.0001), respectively, and with length of rehabilitation hospital stay (r = 0.6, p < 0.0001). The Lateropulsion Scale is both a reliable and a valid assessment of lateropulsion following stroke.

Physical therapy treatment choices for musculoskeletal impairments.

The primary goal of this investigation was to describe outpatient physical therapy treatments provided to patients with lumbar, cervical, or knee impairments. Patients in this analysis received outpatient physical therapy for a primary orthopedic complaint during July 1993 through June 1994 from one of 68 practices participating in the Focus on Therapeutic Outcomes database. Data were available on 2,598 completed physical therapy episodes of care provided by 141 therapists. At each patient's discharge, the primary physical therapist gave information on the treatments provided to each patient during the initial, middle, and final thirds of the episode of therapy as well as information on primary source of reimbursement. Patients provided information on the date of onset of their symptoms or surgery. These outpatient physical therapy episodes of care were characterized by a diverse array of modalities, exercises, and manual therapy treatments. Treatment choices varied by type of impairment and across thirds of the episode. Fee-for-service versus managed care payment arrangements were associated with increased use of devices, therapeutic massage, strengthening, and endurance exercises. The study's findings revealed that although physical agents were frequently used in physical therapy episodes of care, they were applied along with exercise and manual therapy interventions. Future research should relate specific treatments to variation in patient outcomes following physical therapy.