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Hughey L, Flynn TW, Dunaway J, Moore J, Sabbahi A, Fritsch A, Koszalinski A, Reynolds B. Mindfulness, exercise, diet, and sleep - A necessary and urgently needed skill set of the musculoskeletal practitioner. Musculoskeletal Care 2023; 21:198-201. [PMID: 35989616 DOI: 10.1002/msc.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Jeff Moore
- South College, Knoxville, Tennessee, USA
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Reeves NA, Flynn TW, Schuff RZ. Ableism to Empowerment: Navigating School Structures When Working With Students Who Stutter. Lang Speech Hear Serv Sch 2023; 54:8-26. [PMID: 36608333 DOI: 10.1044/2022_lshss-22-00026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE School-based speech-language pathologists (SLPs) face uniquely complex webs of guidelines and criteria that can undermine their ability to move toward disability-affirming practices. The purpose of this clinical focus article is to present a contrast between ableist and disability-affirming practices in school-based stuttering therapy while highlighting the critical perspectives of students who stutter. Practical examples of disability-affirming stuttering therapy in public school settings are provided. CONCLUSIONS This clinical focus article outlines practical guidelines and specific examples of affirming collaboration, eligibility decisions, goal choice, and accommodations for students who stutter. These discussions demonstrate how SLPs can adopt updated assessment therapy planning and institutional practices to affirm students who stutter while informing school cultures and society about the dignity and value of stuttered voices. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21818028.
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Affiliation(s)
| | | | - Reuben Z Schuff
- American Board of Fluency and Fluency Disorders, Kimberly, WI
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Rhon DI, Flynn TW, Shepherd MH, Abbott JH. Leveraging the Short-Term Benefits of Manual Therapy which Includes Exercise Over Exercise Therapy Alone Appears Justified for Knee Osteoarthritis. J Orthop Sports Phys Ther 2023; 53:49-50. [PMID: 36587263 DOI: 10.2519/jospt.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Letter to the Editor-in-Chief in response to JOSPT article "The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients with Knee or Hip Osteoarthritis: A Systematic Review with Meta-analysis" by Runge et al. J Orthop Sports Phys Ther 2023;53(1):49-50. doi:10.2519/jospt.2023.0201.
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Flynn TW. It Would Take Combat Relevance to Put a Chiropractor in Khakis— This Is Why That Has Not Happened. Mil Med 2022; 187:257-260. [DOI: 10.1093/milmed/usac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
ABSTRACT
The purpose of this article is to challenge the premise of a recent commentary suggesting that chiropractors should become commissioned officers. An overview of the early practice guidelines and current scientific evidence for the use of spine and peripheral manipulation is provided. The Military Health System is designed to support military operations and currently includes a large contingent of active duty musculoskeletal healthcare experts to include sports medicine–trained family physicians, orthopedic surgeons, physician assistants/associates, doctors of physical therapy/physical therapists, occupational therapists, and podiatrists. The evidence is clear that it is not in the best interest of our military services to commission alternative practitioners whose practices are out of step with the rest of medicine.
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Affiliation(s)
- Timothy W Flynn
- School of Physical Therapy, South College, Knoxville, TN 37922, USA
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McClinton SM, Heiderscheit BC, McPoil TG, Flynn TW. Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel pain: a randomized clinical trial. BMC Musculoskelet Disord 2019; 20:630. [PMID: 31883516 PMCID: PMC6935140 DOI: 10.1186/s12891-019-3009-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
Background Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will also be seen by a physical therapist. Physical therapists can provide treatment that is not a part of routine podiatric care for PHP and may provide additional improvement. Therefore, the purpose of this study was to examine the effects of interdisciplinary care for PHP that incorporated physical therapy treatment after initiating podiatric treatment. Methods Eligible individuals with PHP that presented to a podiatrist were randomized to receive usual podiatric care (uPOD) or usual podiatric care plus physical therapy treatment (uPOD+PT). The primary outcome was change in foot and ankle ability measure (FAAM) at 6-months. Secondary outcomes included change in numeric pain rating scale (NPRS), patient-reported success, and 6-week and 1-year endpoints. Patient-reported success was defined as the top two global rating of change scale rankings. Primary analysis was intention-to-treat (ITT) using analysis by covariance adjusted to baseline scores, and a secondary per-protocol (PP) analysis was performed analyzing only those who completed treatment. Results Ninety-five individuals participated and were included in the ITT analysis, and 79 were included in the PP analysis. For the primary outcome of FAAM change from baseline to 6-months, both groups improved significantly (uPOD+PT: 26.8 [95% CI 21.6, 31.9]; uPOD: (20 [15.6, 24.4]), but there was no between-group difference (4.3 [− 1, 9.6]). For secondary outcomes, the uPOD+PT group demonstrated greater improvement in NPRS at 6 weeks (0.9 [0.3, 1.4]) and 1 year (1.5 [0.6, 2.5]) in the ITT analysis. In the PP analysis, the uPOD+PT group demonstrated greater improvement in FAAM at 6 months (7.7 [2.1, 13.3]) and 1 year (5.5 [0.1, 10.8]), NPRS at 6 weeks (0.9 [0.2, 1.6]), 6 months (1.3 [0.6, 2.1]) and 1 year (1.3 [0.6, 2.1]), and in patient-reported success (relative risk [95% CI]) at 6 weeks (2.8 [1.1, 7.1]), 6 months (1.5 [1.1, 2.1]), and 1 year (1.5 [1.1, 1.9]). Conclusions There was no significant benefit of uPOD+PT in the primary outcome of FAAM change at 6 months. Secondary outcomes and PP analysis indicated additional benefit of uPOD+PT, mostly observed in individuals who completed treatment. Trial registration Prospectively registered May 24, 2013 at www.clinicaltrials.gov (NCT01865734).
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Affiliation(s)
- Shane M McClinton
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA, USA.
| | - Bryan C Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison, 1636 Highland Ave, Madison, WI, USA
| | - Thomas G McPoil
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College, Knoxville, TN, USA
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Cahanin Iv RL, Jefferson JR, Flynn TW, Goyeneche N. ILIAC CREST HEIGHT DIFFERENCE AND OTHER RUNNING-RELATED VARIABLES' RELATIONSHIP WITH RUNNING INJURY. Int J Sports Phys Ther 2019; 14:957-966. [PMID: 31803528 PMCID: PMC6878858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Leg-length inequality (LLI) is a common condition that may contribute to various spinal, pelvic, and lower extremity dysfunctions. Iliac crest height difference (ICHD) has been demonstrated to be a good estimate for LLI and may be a useful measure for identifying individuals who are at risk for injury. PURPOSE To investigate the relationship between ICHD and other running-related variables with running injury. METHODS An observational retrospective case-control design was used. Data were collected via questionnaire and physical examination from a purposive sample of 100 runners and were analyzed using chi-squared tests of independence. RESULTS The prevalence of ICHD ≥ 5mm reported by subjects via questionnaire was ∼40%. There was no difference in report of injury between subjects with ICHD >5mm and those with ICHD <5mm (χ2 = 0.02, p = 0.88); however, lifetime history of injury (χ2 = 15.68, p = 0.00) and the number of running events participated (χ2 = 3.09, p = 0.04) were significant factors associated with injury; although not significant, there was a trend towards relationship with gender (χ2 = 3.2, = 0.07). CONCLUSION Small ICHD is not associated with running injury among recreational runners. There appears to be an increased risk of running injury among runners who participate in more than one running event annually and those that have had a past history of running injury. Also, males may be at slightly greater risk of sustaining a running injury compared to females. LEVEL OF EVIDENCE Therapy, level 3b.
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Affiliation(s)
- Richard L Cahanin Iv
- Department of Physical Therapy, University of South Alabama, Mobile, AL, USA
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
- School of Physical Therapy, South College, Knoxville, TN, USA
- Department of Physical Medicine and Rehabilitation, Sports Medicine, Ochsner Health System, Covington, LA, USA
| | - John R Jefferson
- Department of Physical Therapy, University of South Alabama, Mobile, AL, USA
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
- School of Physical Therapy, South College, Knoxville, TN, USA
- Department of Physical Medicine and Rehabilitation, Sports Medicine, Ochsner Health System, Covington, LA, USA
| | - Timothy W Flynn
- Department of Physical Therapy, University of South Alabama, Mobile, AL, USA
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
- School of Physical Therapy, South College, Knoxville, TN, USA
- Department of Physical Medicine and Rehabilitation, Sports Medicine, Ochsner Health System, Covington, LA, USA
| | - Nicholas Goyeneche
- Department of Physical Therapy, University of South Alabama, Mobile, AL, USA
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
- School of Physical Therapy, South College, Knoxville, TN, USA
- Department of Physical Medicine and Rehabilitation, Sports Medicine, Ochsner Health System, Covington, LA, USA
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Cahanin Iv RL, Jefferson JR, Flynn TW, Goyeneche N. PAIN AND PHYSICAL PERFORMANCE AMONG RECREATIONAL RUNNERS WHO RECEIVE A CORRECTION FOR AN ILIAC CREST HEIGHT DIFFERENCE: A CASE SERIES. Int J Sports Phys Ther 2019; 14:794-803. [PMID: 31598417 PMCID: PMC6769274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Leg-length inequality (LLI) is a musculoskeletal condition where one lower extremity is longer than the other. There is conflicting evidence on the relevance of LLI and conservative treatment options. Iliac crest height difference (ICHD) is a good estimate of LLI. OBJECTIVE To observe changes in pain and performance among recreational runners with running-induced lower extremity pain who received ICHD correction. METHODS A 12-week case series with multiple baseline and intervention (A-B-A-B) phases was used to observe the effects of ICHD correction on pain and performance among three symptomatic recreational runners. Primary outcome measures included the Lower Extremity Functional Scale (LEFS), the Visual Analog Scale -Worst Pain (VAS-W), symptom-free running distance, and average running speed. A standardized procedure for fabricating an in-shoe shim was utilized for ICHD correction. RESULTS There were no clinically important differences in functional capacity for any subject between any phases. Also, two subjects demonstrated trends towards increased pain over the 12-week experimental period, whereas one subject demonstrated a decrease. One subject demonstrated a statistically significant increase in running distance during intervention phases, but the others demonstrated reductions. All subjects demonstrated trends towards increased running speed, but none were statistically significant. CONCLUSION The correction of small ICHD < 9mm did not improve pain or performance among recreational runners. Individuals with small ICHD may be able to effectively compensate for lower extremity asymmetries; therefore, correction seems to be unnecessary and potentially harmful in short-term. LEVEL OF EVIDENCE Therapy, level 4.
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Affiliation(s)
| | - John R Jefferson
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College, Knoxville, TN, USA
| | - Nicholas Goyeneche
- Department of Physical Medicine and Rehabilitation, Sports Medicine, Ochsner Health System, Covington, LA, USA
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McClinton S, Heiderscheit B, McPoil TG, Flynn TW. Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial. Physiother Theory Pract 2018; 36:638-662. [PMID: 29979912 DOI: 10.1080/09593985.2018.1490941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1-2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP.
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Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University , Des Moines, IA, USA
| | - Bryan Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison , Madison, WI, USA
| | - Thomas G McPoil
- School of Physical Therapy, Regis University , Denver, CO, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College , Knoxville, TN, USA
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St Louis KO, Flynn TW. Maintenance of Improved Attitudes Toward Stuttering. Am J Speech Lang Pathol 2018; 27:721-736. [PMID: 29623339 DOI: 10.1044/2017_ajslp-17-0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/30/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE This study sought to determine the extent to which experimentally induced positive attitudes in high school students in a previous investigation were maintained 7 years later. METHOD Authors and assistants recruited 36 adults in their early 20s (Follow-up group) who, in high school, had witnessed either a live oral talk by a person who stutters or a professionally made video on stuttering designed for teens followed by a short talk by the same speaker. The Public Opinion Survey of Human Attributes-Stuttering was administered before and after the interventions in high school and 7 years later such that pre-post group comparisons were made. Previously, the Follow-up group had demonstrated highly positive changes in their attitudes after the interventions. In addition, a control group of 56 former high school students from the same state, who did not participate in the interventions, were recruited and compared to the Follow-up group. RESULTS The Follow-up group, which was found to be representative of the original high school cohort, held more positive Public Opinion Survey of Human Attributes-Stuttering mean ratings than the Control group, although somewhat less positive than their previous postintervention ratings. CONCLUSIONS The Follow-up group maintained many of the positive changes in their beliefs and self reactions regarding stuttering that were induced 7 years earlier after witnessing personal stories and facts about stuttering.
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Affiliation(s)
- Kenneth O St Louis
- Department of Communication Sciences and Disorders, West Virginia University, Morgantown
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Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Erratum to: Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res 2016; 16:444. [PMID: 27566246 PMCID: PMC5002126 DOI: 10.1186/s12913-016-1681-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- John D Childs
- Army Medical Department Center and School, US Army-Baylor University Doctoral Program in Physical Therapy, 3151 Scott Rd., Rm. 2307, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA.
| | - Julie M Fritz
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Samuel S Wu
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1329 SW 16th St., Rm. 5231, Gainesville, FL, 32610-0177, USA
| | - Timothy W Flynn
- EIM School of Physical Therapy, South College, 3904 Lonas Dr, Knoxville, TN, 37909, USA
| | - Robert S Wainner
- EIM School of Physical Therapy, South College, 3904 Lonas Dr, Knoxville, TN, 37909, USA
| | - Eric K Robertson
- Doctor of Physical Therapy Program, University of Texas at El Paso, 500 W. University Avenue, El Paso, TX, 79968, USA
| | - Forest S Kim
- US Army Medical Department Center and School, US Army-Baylor MHA/MBA Program, 3599 Winfield Scott Rd., Bldg. 2841, JBSA Fort Sam Houston, San Antonio, TX, 78234-6135, USA
| | - Steven Z George
- Department of Physical Therapy, Director, Brooks-PHHP Research Collaboration, University of Florida, P.O. Box 100154, Gainesville, FL, 32610-0154, USA
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Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res 2015; 15:150. [PMID: 25880898 PMCID: PMC4393575 DOI: 10.1186/s12913-015-0830-3] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/30/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). METHODS Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models. RESULTS 753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs. CONCLUSIONS The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.
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Affiliation(s)
- John D Childs
- Army Medical Department Center and School, US Army-Baylor University Doctoral Program in Physical Therapy, 3151 Scott Rd., Rm. 2307, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA.
| | - Julie M Fritz
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Samuel S Wu
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1329 SW 16th St., Rm. 5231, Gainesville, FL, 32610-0177, USA.
| | - Timothy W Flynn
- EIM School of Physical Therapy, South College, 3904 Lonas Dr, Knoxville, TN, 37909, USA.
| | - Robert S Wainner
- EIM School of Physical Therapy, South College, 3904 Lonas Dr, Knoxville, TN, 37909, USA.
| | - Eric K Robertson
- Doctor of Physical Therapy Program, University of Texas at El Paso, 500 W. University Avenue, El Paso, TX, 79968, USA.
| | - Forest S Kim
- US Army Medical Department Center and School, US Army-Baylor MHA/MBA Program, 3599 Winfield Scott Rd., Bldg. 2841, JBSA Fort Sam Houston, San Antonio, TX, 78234-6135, USA.
| | - Steven Z George
- Department of Physical Therapy, Director, Brooks-PHHP Research Collaboration, University of Florida, P.O. Box 100154, Gainesville, FL, 32610-0154, USA.
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Abstract
BACKGROUND Age, weight, and duration of symptoms have been associated with a poor response to treatment for plantar heel pain (PHP), but no studies were identified that examined predictors of response to physical therapy intervention. The purpose of this investigation was to examine the influence of age, body mass index (BMI), and symptom duration on treatment response to physical therapy intervention. METHODS Sixty participants received 6 visits over 4 weeks of physical therapy intervention that included manual therapy and exercise or electrophysiological agents and exercise. Outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GRC). Logistic regression (P < .05) was used to analyze age, BMI, and symptom duration as potential predictors of a successful response based on the minimal clinically important difference of the outcome measures. Sensitivity analysis was used to assess the influence of success based on minimal clinically important changes in the FAAM, NPRS, and GRC or only the FAAM and NPRS. Receiver operating curves were used to determine the cut point for the significant predictor. RESULTS At the 6-month follow-up to physical therapy intervention, NPRS was improved by 3 points (95% CI, 2.4-3.6) and FAAM improved by 22.5 points (95% CI, 16.8-28.2). Individuals with symptoms less than 7.2 months were 4.2 (95% CI, 1.3-13.8; P = .016) and 8.5 (95% CI, 2.5-28.9; P = .001) times more likely to respond to treatment based on the NPRS/FAAM/GRC and NPRS/FAAM success criteria, respectively. Age and BMI were not significant predictors (P ≥ .455 and P ≥ .450, respectively). CONCLUSION Age and BMI were not associated with outcomes and obese individuals did achieve a successful outcome with the physical therapy intervention used in the clinical trial. Individuals with PHP symptoms longer than 7 months require additional consideration and further investigation of effective strategies to improve treatment response. LEVEL OF EVIDENCE Prognosis, level 2b comparative study.
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Affiliation(s)
- Shane M McClinton
- Physical Therapy Department, Des Moines University, Des Moines, IA, USA Orthopaedic and Sports Science Program, Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Joshua A Cleland
- Physical Therapy Department, Franklin Pierce University, Manchester, NH, USA
| | - Timothy W Flynn
- Physical Therapy Department, Rocky Mountain University of Health Professions, Provo, UT, USA
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O'Laughlin SJ, Flynn TW, Westrick RB, Ross MD. Diagnosis and expedited surgical intervention of a complete hamstring avulsion in a military combatives athlete: a case report. Int J Sports Phys Ther 2014; 9:371-376. [PMID: 24944856 PMCID: PMC4060315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Hamstring injuries are frequent injuries in athletes, with the most common being strains at the musculotendinous junction or within the muscle belly. Conversely, hamstring avulsions are rare and often misdiagnosed leading to delay in appropriate surgical interventions. The purpose of this case report is to describe the history and physical examination findings that led to appropriate diagnostic imaging and the subsequent diagnosis and expedited surgical intervention of a complete avulsion of the hamstring muscle group from the ischium in a military combatives athlete. CASE DESCRIPTION The patient was a 25 year-old male who sustained a hyperflexion injury to his right hip with knee extension while participating in military combatives, presenting with acute posterior thigh and buttock pain. History and physical examination findings from a physical therapy evaluation prompted an urgent magnetic resonance imaging (MRI) study, which led to the diagnosis of a complete avulsion of the hamstring muscle group off the ischium. OUTCOME Expedited surgical intervention occurred within 13 days of the injury potentially limiting comorbidities associated with delayed diagnosis. CONCLUSION Recognition of the avulsion led to prompt surgical evaluation and intervention. Literature has shown that diagnosis of hamstring avulsions are frequently missed or delayed, which results in a myriad of complications. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
| | | | - Richard B. Westrick
- United States Military – Baylor University Sports Physical Therapy Doctoral Program, West Point, NY, USA
| | - Michael D. Ross
- Department of Physical Therapy, University of Scranton, Scranton, PA, USA
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McClinton SM, Flynn TW, Heiderscheit BC, McPoil TG, Pinto D, Duffy PA, Bennett JD. Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial. Trials 2013; 14:414. [PMID: 24299257 PMCID: PMC3866618 DOI: 10.1186/1745-6215-14-414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 11/18/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. METHODS A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life--Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery generally, and specific to physical therapy and podiatry treatment, will also be analyzed. DISCUSSION This study will be the first pragmatic trial to investigate the clinical outcomes and cost-effectiveness of ePT and uPOD in individuals with PHP. The results will serve to inform clinical practice decisions and management guidelines of multiple disciplines. TRIAL REGISTRATION ClinicalTrials.gov: NCT01865734.
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Affiliation(s)
- Shane M McClinton
- Rocky Mountain University of Health Professions, 561 East 1860 South, Provo, Utah 84606, USA
- Department of Physical Therapy, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Timothy W Flynn
- Department of Physical Therapy, Rocky Mountain University of Health Professions, 561 East 1860 South, Provo, Utah 84606, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin – Madison, 1300 University Avenue, Madison, Wisconsin 53706, USA
| | - Thomas G McPoil
- School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, 3333 Regis Boulevard, Denver, Colorado 80221, USA
| | - Daniel Pinto
- Department of Physical Therapy and Human Movement Sciences/Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 1100, Chicago, Illinois 60611, USA
| | - Pamela A Duffy
- Public Health Program, Des Moines University, 3200 Grand Avenue, Des Moines, Iowa 50312, USA
| | - John D Bennett
- Podiatric Medicine Program, Des Moines University, 3200 Grand Avenue, Des Moines, Iowa 50312, USA
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Cleland JA, Flynn TW, Palmer JA. Incorporation of Manual Therapy Directed at the Cervicothoracic Spine in Patients with Lateral Epicondylalgia: A Pilot Clinical Trial. J Man Manip Ther 2013. [DOI: 10.1179/106698105790824932] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Cleland JA, Flynn TW, Childs JD, Eberhart S. The audible pop from thoracic spine thrust manipulation and its relation to short-term outcomes in patients with neck pain. J Man Manip Ther 2011; 15:143-54. [PMID: 19066662 DOI: 10.1179/106698107790819828] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes. The purpose of this study was to determine the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. In this prospective cohort study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. The treating clinician recorded the presence or absence of a pop during each manipulation. Outcomes were assessed at a 2-4 day follow-up with an 11-point numeric pain rating (NPRS), the Neck Disability Index, the patient Global Rating of Change (GROC), and measurements of cervical range of motion (CROM). The relationship between the number of pops and change scores for pain, disability, and CROM was first examined using Pearson correlation coefficients. Individuals were then categorized as having received </=3 or >3 pops. Repeated measures analyses of variance were used to examine whether achievement of >3 pops resulted in improved outcome. Seventy-eight patients with a mean age of 42 (SD 11.3) years participated in the study. Pearson correlation coefficients revealed no significant correlation existed between the number of pops and outcomes with the exception of 3 of the 6 CROM measurements, which were inversely related. There was no significant interaction for group X time for any of the dependent measures (P>0.05). The odds ratio for patients experiencing dramatic improvement was in favor of the group experiencing </=3 pops but this was not clinically meaningful (1.3: 95% CI 0.46, 3.7). The results of this analysis provide preliminary evidence for the hypothesis that there is no relationship between the number of audible pops during thoracic spine thrust manipulation and clinically meaningful improvements in pain, disability, or CROM in patients with mechanical neck pain. Additionally, a greater number of audible pops experienced was not associated with a dramatic improvement with manipulation treatment.
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Flynn TW, St Louis KO. Changing adolescent attitudes toward stuttering. J Fluency Disord 2011; 36:110-121. [PMID: 21664529 DOI: 10.1016/j.jfludis.2011.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 05/30/2023]
Abstract
PURPOSE Live oral or recorded video presentations on stuttering were delivered to high school students in order to determine the extent to which their attitudes toward stuttering could be improved. METHODS A classroom teacher administered the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) to two health classes before and after an oral live presentation by a person who stutters. She also gave the POSHA-S to two other similar classes before and after a True Life(®): I Stutter video presentation. The stuttering person in the oral condition was one of three people featured in the video. Also, following the video condition, students filled out the POSHA-S a third time after a short oral presentation by the same person who stutters. RESULTS Measured attitudes improved overall on the POSHA-S and on selected items. CONCLUSIONS High school students hold similar attitudes toward stuttering and stutterers as adults, and these attitudes can be improved, at least temporarily, by a presentation on stuttering but more via a live presentation than a professionally prepared video. EDUCATIONAL OBJECTIVES (1) The reader will identify different ways to improve attitudes toward stuttering in high school students. (2) The reader will list advantages and disadvantages of live oral presentations and recorded video presentations as strategies to change attitudes toward stuttering. (3) The reader will identify characteristics of a speaker that can assist in attitude changes of high school students.
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Backstrom KM, Whitman JM, Flynn TW. Lumbar spinal stenosis-diagnosis and management of the aging spine. ACTA ACUST UNITED AC 2011; 16:308-17. [PMID: 21367646 DOI: 10.1016/j.math.2011.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/03/2011] [Accepted: 01/22/2011] [Indexed: 11/18/2022]
Abstract
Low back pain and lumbar spinal stenosis (LSS) is an extensive problem in the elderly presenting with pain, disability, fall risk and depression. The incidence of LSS is projected to continue to grow as the population ages. In light of the risks, costs and lack of long-term results associated with surgery, and the positive outcomes in studies utilizing physical therapy interventions for the LSS patient, a non-invasive approach is recommended as a first line of intervention. This Masterclass presents an overview of LSS in terms of clinical examination, diagnosis, and intervention. A focused management approach to the patient with LSS is put forward that emphasizes a defined four-fold approach of patient education, manual physical therapy, mobility and strengthening exercises, and aerobic conditioning.
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Affiliation(s)
- Karen Maloney Backstrom
- Rehabilitation Department, University of Colorado Hospital, 1635 Aurora Court Mail Stop F712, Aurora, CO 80045, USA.
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Young BA, Gill HE, Wainner RS, Flynn TW. Thoracic costotransverse joint pain patterns: a study in normal volunteers. BMC Musculoskelet Disord 2008; 9:140. [PMID: 18922181 PMCID: PMC2587465 DOI: 10.1186/1471-2474-9-140] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 10/15/2008] [Indexed: 11/10/2022] Open
Abstract
Background Pain referral patterns of asymptomatic costotransverse joints have not been established. The objective of this study was to determine the pain referral patterns of asymptomatic costotransverse joints via provocative intra-articular injection. Methods Eight asymptomatic male volunteers received a combined total of 21 intra-articular costotransverse joint injections. Fluoroscopic imaging was used to identify and isolate each costotransverse joint and guide placement of a 25 gauge, 2.5 inch spinal needle into the costotransverse joint. Following contrast medium injection, the quality, intensity, and distribution of the resultant pain produced were recorded. Results Of the 21 costotransverse joint injections, 16 (76%) were classified as being intra-articular via arthrograms taken at the time of injection, and 14 of these injections produced a pain sensation distinctly different from that of needle placement. Average pain produced was 3.3/10 on a 0–10 verbal pain scale. Pain was described generally as a deep, dull ache, and pressure sensation. Pain patterns were located superficial to the injected joint, with only the right T2 injections showing referred pain 2 segments cranially and caudally. No chest wall, upper extremity or pseudovisceral pains were reported. Conclusion This study provides preliminary data of the pain referral patterns of costotransverse joints. Further research is needed to compare these findings with those elicited from symptomatic subjects.
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Affiliation(s)
- Brian A Young
- Department of Physical Therapy, Sheppard Air Force Base, Texas, USA.
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Abbott JH, Flynn TW, Fritz JM, Hing WA, Reid D, Whitman JM. Manual physical assessment of spinal segmental motion: intent and validity. ACTA ACUST UNITED AC 2007; 14:36-44. [PMID: 17997344 DOI: 10.1016/j.math.2007.09.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 08/10/2007] [Accepted: 09/13/2007] [Indexed: 11/19/2022]
Abstract
Validity of a clinical test can be defined as the extent to which the test actually assesses what it is intended to assess. In order to investigate the validity of manual physical assessment of the spine, it is therefore essential to establish what physical therapists intend to assess when they are applying these tests. The aims of this study were to (1) establish what manual physical therapists are intending to assess while applying passive intervertebral motion tests; and (2) examine the face validity and content validity for manual physical assessment of the spine. We surveyed 1502 members of the national manual physical therapist organisations of New Zealand and the United States of America using a web-based survey instrument. Sixty-six percent of 466 respondents believed passive accessory intervertebral motion (PAIVM) tests were valid for assessing quantity of segmental motion, and 76% believed passive physiologic intervertebral motion (PPIVM) tests were valid for assessing quantity of segmental motion. Ninety-eight percent of manual physical therapists base treatment decisions at least in part on the results of segmental motion tests. Quality of resistance to passive segmental motion was considered of greater importance than quantity of kinematic motion during PAIVM tests, while the quality of complex kinematic motion was considered of greater importance than quantity of displacement kinematics during PPIVM tests. Manual physical therapists accept the face validity of manual physical assessment of spinal segmental motion to a great extent, however a minority voice scepticism. Content validity is dominated by concepts of segmental kinematics and the force-displacement relationship. Intent of assessment does, however, vary widely between therapists. These data will inform the design of concurrent validity studies. Further work is recommended to increase consistency of intent, methodology and terminology in manual physical assessment of the spine.
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Affiliation(s)
- J Haxby Abbott
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
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Childs JD, Whitman JM, Pugia ML, Sizer PS, Flynn TW, Delitto A. Knowledge in Managing Musculoskeletal Conditions and Educational Preparation of Physical Therapists in the Uniformed Services. Mil Med 2007; 172:440-5. [PMID: 17484321 DOI: 10.7205/milmed.172.4.440] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to describe knowledge in managing musculoskeletal conditions among physical therapists in the uniformed services based on their educational background and preparation. A cross-sectional design was used. A total of 182 physical therapists in the uniformed services completed a standardized examination that assesses knowledge in managing musculoskeletal conditions. Physical therapists in the uniformed services who graduated from the U.S. Army-Baylor Doctoral Program in Physical Therapy or had attended a specific continuing medical education course that emphasizes the management of musculoskeletal conditions achieved higher scores and passing rates than their colleagues who had not. Compared with previously published data, physical therapists in the uniformed services demonstrated higher scores than medical students, physician interns and residents, active duty military physicians, and all physician specialists except for orthopedists. Physical therapists in the uniformed services have the requisite knowledge to provide direct access for patients with musculoskeletal conditions. These data may have implications for health and public policy decisions within the military health care system related to the utilization and educational preparation of physical therapists in the uniformed services.
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Affiliation(s)
- John D Childs
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, Army Medical Department Center and School, Fort Sam Houston, San Antonio, TX 78234, USA
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Abstract
STUDY DESIGN A prospective, case-control design. OBJECTIVES To develop a kinematic model that characterizes frequently observed movement patterns in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA Understanding arthrokinematics of lumbar motion in those with LBP may provide further understanding of this condition. METHODS Digital fluoroscopic video (DFV) was used to quantify the magnitude and rate of attainment of sagittal plane intersegmental angular and linear displacement from 20 individuals with LBP and 20 healthy control subjects during lumbar flexion and extension. Three fellowship-trained spine surgeons subsequently qualitatively analyzed the DFVs to determine normality of movement. Final classification was based on agreement between their symptom and motion status (11 with LBP and aberrant motion and 14 healthy controls without aberrant motion). Independent t tests, receiver operator characteristic curves, and accuracy statistics were calculated to determine the most parsimonious set of kinematic variables able to distinguish patients with LBP. RESULTS Eight kinematic variables had a positive likelihood ratio > or = 2.5 and entered the model. Six of the variables described a disruption in the rate of attainment of angular or linear displacement during midrange postures. When 4 or more of these variables were present, the positive likelihood ratio was 14.0 (confidence interval 3.2-78.5), resulting in accurately identifying 96% of participants. CONCLUSIONS DFV was useful for discriminating between individuals with and without LBP based on kinematic parameters. Disruptions in how the motion occurred during midrange motions were more diagnostic for LBP than range of motion variables. Cross validation of the model is required.
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Affiliation(s)
- Deydre S Teyhen
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA.
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Abstract
BACKGROUND AND PURPOSE A clinical prediction rule (CPR) has been reported to identify patients with low back pain who are likely to benefit from stabilization exercises. The aim of this study was to characterize the spinal motion, using digital fluoroscopic video, of a subgroup of subjects with low back pain. SUBJECTS Twenty subjects who were positive on the CPR were compared with 20 control subjects who were healthy. METHODS The magnitude and timing of lumbar sagittal-plane intersegmental angular and linear displacement were assessed. Receiver operating characteristic curves and accuracy statistics were used to develop a kinematic model. RESULTS A 10-variable model was developed that could distinguish group membership. Seven of these variables described a disruption in timing of angular or linear displacement during mid-range movements. None of the variables suggested hypermobility. DISCUSSION AND CONCLUSION The findings suggest that individuals with mid-range aberrant motion without signs of hypermobility are likely to benefit from these exercises. The developed model describes altered kinematics of this subgroup of subjects and helps to provide construct validity for the developed CPR.
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Affiliation(s)
- Deydre S Teyhen
- US Army-Baylor Doctoral Program in Physical Therapy, MCCS/HMT, 3151 Scott Rd, Room 1303, Fort Sam Houston, TX 78234-6138, USA.
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Childs JD, Flynn TW, Fritz JM. A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain. ACTA ACUST UNITED AC 2006; 11:316-20. [PMID: 16839800 DOI: 10.1016/j.math.2005.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 07/30/2005] [Accepted: 09/21/2005] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to determine if patients who do not receive manipulation for their low back pain (LBP) are at an increased risk for worsening disability compared to patients receiving an exercise intervention without manipulation. One hundred and thirty-one consecutive patients with LBP were randomly assigned to receive manipulation and an exercise intervention (n = 70) or an exercise intervention without manipulation (n = 61). Patients were classified as to whether they had experienced a worsening in disability upon follow-up. Relative risk and number needed to treat (NNT) statistics and associated 95% confidence intervals (CI) were calculated. Patients who completed the exercise intervention without manipulation were eight (95% CI: 1.1, 63.5) times more likely to experience a worsening in disability than patients who received manipulation. The NNT with manipulation to prevent one additional patient from experiencing a worsening in disability was 9.9 (95% CI: 4.9, 65.3) and 4 weeks with manipulation was 11.6 (95% CI: 5.2, 219.2). The results of this study offer an additional perspective for considering the risks and benefits of spinal manipulation and help to inform the integration of current evidence for spinal manipulation into healthcare policy.
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Affiliation(s)
- John D Childs
- US Army-Baylor University Doctoral Program in Physical Therapy, 3151 Scott Rd., Rm 2307, Fort Sam Houston, TX 78234, USA
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Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, Garber MB, Bennett AC, Fritz JM. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine (Phila Pa 1976) 2006; 31:2541-9. [PMID: 17047542 DOI: 10.1097/01.brs.0000241136.98159.8c] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter randomized, controlled trial. OBJECTIVE To compare two physical therapy programs for patients with lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA Scant evidence exists regarding effectiveness of nonsurgical management programs for lumbar spinal stenosis. METHODS Fifty-eight patients with lumbar spinal stenosis were randomized to one of two 6-week physical therapy programs. One program included manual physical therapy, body weight supported treadmill walking, and exercise (Manual Physical Therapy, Exercise, and Walking Group), while the other included lumbar flexion exercises, a treadmill walking program, and subtherapeutic ultrasound (Flexion Exercise and Walking Group). Perceived recovery was assessed with a global rating of change scale. Secondary outcomes included: Oswestry, a numerical pain rating scale, a measure of satisfaction, and a treadmill test. Testing occurred at baseline, 6 weeks, and 1 year. Perceived recovery, pain, and other healthcare resources used were collected with a long-term follow-up questionnaire. RESULTS A greater proportion of patients in the manual physical therapy, exercise, and walking group reported recovery at 6 weeks compared with the flexion exercise and walking group (P = 0.0015), with a number needed to treat for perceived recovery of 2.6 (confidence interval, 1.8-7.8). At 1 year, 62% and 41% of the manual therapy, exercise, and walking group and the flexion exercise and walking group, respectively, still met the threshold for recovery. Improvements in disability, satisfaction, and treadmill walking tests favored the manual physical therapy, exercise, and walking group at all follow-up points. CONCLUSIONS Patients with lumbar spinal stenosis can benefit from physical therapy. Additional gains may be realized with the inclusion of manual physical therapy interventions, exercise, and a progressive body-weight supported treadmill walking program.
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Affiliation(s)
- Julie M Whitman
- Department of Physical Therapy, Regis University, 3333 Regis Blvd., G-4, Denver, CO 80221-1099, USA.
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Flynn TW, Wainner RS, Fritz JM. Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice. J Orthop Sports Phys Ther 2006; 36:577-87. [PMID: 16915979 DOI: 10.2519/jospt.2006.2159] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Spinal manipulation for low back complaints is an intervention supported by randomized clinical trials and its use recommended by clinical practice guidelines. Physical therapists in this country and internationally have used thrust spinal manipulation at much lower-than-expected rates, despite evidence supporting its efficacy for the treatment of acute low back pain (LBP). The purpose of this clinical commentary is to describe a physical therapist professional degree curriculum in thrust spinal manipulation and outline a method of monitoring ongoing student performance during the clinical education experience. Increased emphasis on evidence-based decision making and on the psychomotor skills of thrust spinal manipulation was introduced into a physical therapist professional degree curriculum. As part of ongoing student performance monitoring, physical therapy students on their first full-time (8-week) clinical education experience, collected practice pattern and outcome data on individuals with low back complaints. Eight of 18 first-year students were in outpatient musculoskeletal clinical settings and managed 61 individuals with low back complaints. Patients were seen for an average (+/-SD) of 6.2 +/- 4.0 visits. Upon initial visit the student therapists employed spinal manipulation at a rate of 36.2% and spinal mobilization at 58.6%. At the final visit, utilization of manipulation and mobilization decreased (13% and 37.8%, respectively), while the utilization of exercise interventions increased, with 75% of patients receiving some form of lumbar stabilization training. Physical therapist students used thrust spinal manipulation at rates that are more consistent with clinical practice guidelines and substantially higher then previously reported by practicing physical therapists. Education within an evidence-based framework is thought to contribute to practice behaviors and outcomes that are more consistent with best practice guidelines.
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Affiliation(s)
- Timothy W Flynn
- Department of Physical Therapy, Regis University, Denver, CO 80221-1099, USA.
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Flynn TW, Childs JD, Fritz JM. The Audible Pop From High-Velocity Thrust Manipulation and Outcome in Individuals With Low Back Pain. J Manipulative Physiol Ther 2006; 29:40-5. [PMID: 16396728 DOI: 10.1016/j.jmpt.2005.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Revised: 05/13/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the relationship between an audible pop with spinal manipulation and improvement in pain and function in patients with low back pain. METHODS In this pragmatic study, 70 patients from a multicenter clinical trial were randomly assigned to receive high-velocity thrust manipulation and included in this secondary analysis. Patients were managed in physical therapy twice the first week, then once a week for the next 3 weeks, for a total of 5 sessions. A single high-velocity thrust manipulative intervention purported to affect the lumbopelvic region was used during the first two sessions. Therapists recorded whether an audible pop was heard by the patient or therapist. Outcome was assessed with an 11-point pain rating scale, the Oswestry Disability Questionnaire, and measurement of lumbopelvic flexion range of motion. Repeated measures analyses of variance were used to examine whether achievement of a pop resulted in improved outcome. RESULTS An audible pop was perceived in 59 (84%) of the patients. No differences were detected at baseline or at any follow-up period in the level of pain, the Oswestry score, or lumbopelvic range of motion based on whether a pop was achieved (P > .05). The odds ratios and 95% confidence intervals for achieving a successful outcome at each of the follow-up periods all approximated a value of 1, suggesting no improvement in the odds of successful outcome among patients in which an audible pop occurred. CONCLUSIONS The results of this pragmatic study suggest that a perceived audible pop may not relate to improved outcomes from high-velocity thrust manipulation for patients with nonradicular low back pain at either an immediate or longer-term follow-up.
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Affiliation(s)
- Timothy W Flynn
- Department of Physical Therapy, Regis University, Denver, CO 80221-1099, USA.
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Abstract
As consumer access to physical therapy practice expands, it is important that physical therapists are familiar with and implementing accepted methods of identifying the cardiovascular status of their clients. Established guidelines for assessing cardiovascular risk prior to initiating aerobic exercise programs are available and can be readily adopted by physical therapists in diverse clinical settings. We have provided a process for integrating existing guidelines into clinical practice. Because little evidence exists regarding the clinical behaviors and knowledge of orthopedic physical therapists in the area of cardiovascular risk, we conducted a survey to assess current practice patterns. The results suggest that orthopedic physical therapists are performing cardiovascular screening at frequencies similar to other components of the history and systems review, but that monitoring baseline or exercising vital signs does not occur with every exercise session.
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Affiliation(s)
- Susan A Scherer
- Regis University, Department of Physical Therapy, 3333 Regis Blvd, Code G-4, Denver, CO 80221, USA.
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Abstract
Pulmonary embolism is a rare but serious medical condition, with an estimated mortality of 5% to 20%. Many patients receiving physical therapy may be at risk for developing pulmonary embolism, especially after periods of immobilization or surgery. Patients presenting with dyspnea, chest pain, or tachypnea, particularly after trauma or surgery, have an increased likelihood of pulmonary embolism. Clinical prediction rules have been developed, which can aid the practitioners in assessing the risk a patient has for developing pulmonary embolism. The present clinical commentary discusses the existing evidence for screening patients for pulmonary embolism. To illustrate the importance of the screening examination, a patient is presented who was referred to physical therapy 5 days after cervical discectomy and fusion. This patient was subsequently referred for medical evaluation and a confirmatory diagnosis of pulmonary embolism.
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Affiliation(s)
- Brian A Young
- Physical Therapy Department, Wilford Hall USAF Medical Center, San Antonio, TX 78244, USA.
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Abstract
STUDY DESIGN Methodological reliability. OBJECTIVE Develop a measurement technique to assess dynamic motion of the lumbar spine using enhanced digital fluoroscopic video (DFV) and a distortion compensated roentgen analysis (DCRA). SUMMARY OF BACKGROUND DATA Controversy over both the definition and consequences of lumbar segmental instability persists. Information from static imaging has had limited success in providing an understanding of this disorder. DFV has the potential to provide further information about lumbar segmental instability; however, the image quality is poor and clinical application is limited. METHODS DFV from 20 male subjects (11 with and nine without low back pain) were obtained during eccentric lumbar flexion (30 Hz). Each DFVs was enhanced with a series of filters to accentuate the vertebral edges. An adapted DCRA algorithm was applied to determine segmental angular and linear displacement. Both intraimage and interimage reliability were assessed using intraclass correlation coefficients (ICC) and standard error of the measurement (SEM). RESULTS.: Intraimage reliability yielded an average ICC of 0.986, and the SEM ranged from 0.4-0.7 degrees and 0.2-0.3 mm. Interimage reliability yielded an average ICC of 0.878, and the SEM ranged from 0.7-1.4 degrees and 0.4-0.7 mm. CONCLUSIONS Enhanced DFV combined with a DCRA resulted in reliable assessment of lumbar spine kinematics. The error values associated with this technique were low and were comparable to published error measurements obtained when using a similar algorithm on hand-drawn outlines from static radiographs.
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Affiliation(s)
- Deydre S Teyhen
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Houston, Texas 78234, USA.
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Fritz JM, Childs JD, Flynn TW. Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention. BMC Fam Pract 2005; 6:29. [PMID: 16018809 PMCID: PMC1180432 DOI: 10.1186/1471-2296-6-29] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Accepted: 07/14/2005] [Indexed: 11/29/2022]
Abstract
Background Patients with low back pain are frequently encountered in primary care. Although a specific diagnosis cannot be made for most patients, it is likely that sub-groups exist within the larger entity of nonspecific low back pain. One sub-group that has been identified is patients who respond rapidly to spinal manipulation. The purpose of this study was to examine the association between two factors (duration and distribution of symptoms) and prognosis following a spinal manipulation intervention. Methods Data were taken from two previously published studies. Patients with low back pain underwent a standardized examination, including assessment of duration of the current symptoms in days, and the distal-most distribution of symptoms. Based on prior research, patients with symptoms of <16 days duration and no symptoms distal to the knee were considered to have a good prognosis following manipulation. All patients underwent up to two sessions of spinal manipulation treatment and a range of motion exercise. Oswestry disability scores were recorded before and after treatment. If ≥ 50% improvement on the Oswestry was achieved, the intervention was considered a success. Sensitivity, specificity, and positive likelihood ratio were calculated for the association of the two criteria with the outcome of the treatment. Results 141 patients (49% female, mean age = 35.5 (± 11.1) years) participated. Mean pre- and post-treatment Oswestry scores were 41.9 (± 10.9) and 24.1 (± 14.2) respectively. Sixty-three subjects (45%) had successful treatment outcomes. The sensitivity of the two criteria was 0.56 (95% CI: 0.43, 0.67), specificity was 0.92 (95% CI: 0.84, 0.96), and the positive likelihood ratio was 7.2 (95% CI: 3.2, 16.1). Conclusion The results of this study demonstrate that two factors; symptom duration of less than 16 days, and no symptoms extending distal to the knee, were associated with a good outcome with spinal manipulation.
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Affiliation(s)
- Julie M Fritz
- Division of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
- Rehab Agency, Intermountain Health Care, 2200 South 1685 West, Salt Lake City, UT, 84119, USA
| | - John D Childs
- Department of Physical Therapy, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX, 78236, USA
| | - Timothy W Flynn
- Department of Physical Therapy, Regis University, Denver, CO, 80221, USA
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Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists' knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord 2005; 6:32. [PMID: 15963232 PMCID: PMC1177956 DOI: 10.1186/1471-2474-6-32] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 06/17/2005] [Indexed: 11/20/2022] Open
Abstract
Background Physical therapists increasingly provide direct access services to patients with musculoskeletal conditions, and growing evidence supports the cost-effectiveness of this mode of healthcare delivery. However, further evidence is needed to determine if physical therapists have the requisite knowledge necessary to manage musculoskeletal conditions. Therefore, the purpose of this study was to describe physical therapists' knowledge in managing musculoskeletal conditions. Methods This study utilized a cross-sectional design in which 174 physical therapist students from randomly selected educational programs and 182 experienced physical therapists completed a standardized examination assessing knowledge in managing musculoskeletal conditions. This same examination has been previously been used to assess knowledge in musculoskeletal medicine among medical students, physician interns and residents, and across a variety of physician specialties. Results Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists. Physical therapist students enrolled in doctoral degree educational programs achieved significantly higher scores than their peers enrolled in master's degree programs. Furthermore, experienced physical therapists who were board-certified in orthopaedic or sports physical therapy achieved significantly higher scores and passing rates than their non board-certified colleagues. Conclusion The results of this study may have implications for health and public policy decisions regarding the suitability of utilizing physical therapists to provide direct access care for patients with musculoskeletal conditions.
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Affiliation(s)
- John D Childs
- US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, TX, USA
| | - Julie M Whitman
- Department of Physical Therapy, Regis University, Denver, CO, USA
| | - Phillip S Sizer
- Department of Physical Therapy, Texas Tech University, Lubbock, TX, USA
| | - Maria L Pugia
- Department of Physical Therapy, Los Angeles Air Force Base, Los Angeles, CA, USA
| | - Timothy W Flynn
- Department of Physical Therapy, Regis University, Denver, CO, USA
| | - Anthony Delitto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Teyhen DS, Miltenberger CE, Deiters HM, Del Toro YM, Pulliam JN, Childs JD, Boyles RE, Flynn TW. The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J Orthop Sports Phys Ther 2005; 35:346-55. [PMID: 16001906 DOI: 10.2519/jospt.2005.35.6.346] [Citation(s) in RCA: 279] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized controlled trial among patients with low back pain (LBP). OBJECTIVES (1) Determine the reliability of real-time ultrasound imaging for assessing activation of the lateral abdominal muscles; (2) characterize the extent to which the abdominal drawing-in maneuver (ADIM) results in preferential activation of the transverse abdominis (TrA); and (3) determine if ultrasound biofeedback improves short-term performance of the ADIM in patients with LBP. BACKGROUND Ultrasound imaging is reportedly useful for measuring and training patients to preferentially activate the TrA muscle. However, research to support these claims is limited. METHODS AND MEASURES Thirty patients with LBP referred for lumbar stabilization training were randomized to receive either traditional training (n = 15) or traditional training with biofeedback (n = 15). Ultrasound imaging was used to measure changes in thickness of the lateral abdominal muscles. Differences in preferential changes in muscle thickness of the TrA between groups and across time were assessed using analysis of variance. RESULTS Intrarater reliability measuring lateral abdominal muscle thickness exceeded 0.93. On average, patients in both groups demonstrated a 2-fold increase in the thickness of the TrA during the ADIM. Performance of the ADIM did not differ between the groups. CONCLUSION These data provide construct validity for the notion that the ADIM results in preferential activation of the TrA in patients with LBP. Although, the addition of biofeedback did not enhance the ability to perform the ADIM at a short-term follow-up, our data suggest a possible ceiling effect or an insufficient training stimulus. Further research is necessary to determine if there is a subgroup of patients with LBP who may benefit from biofeedback.
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Affiliation(s)
- Deydre S Teyhen
- Center for Physical Therapy Research, US Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA.
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Childs JD, Flynn TW, Fritz JM, Piva SR, Whitman JM, Wainner RS, Greenman PE. Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty. J Orthop Sports Phys Ther 2005; 35:300-6. [PMID: 15966541 DOI: 10.2519/jospt.2005.35.5.300] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, "How does one proceed in the absence of certainty?" Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.
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Affiliation(s)
- John D Childs
- US Army-Baylor University Doctoral Program in Physican Therapy, Fort Sam Houston, San Antonio, TX, USA.
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Boyles RE, Flynn TW, Whitman JM. Manipulation following regional interscalene anesthetic block for shoulder adhesive capsulitis: a case series. ACTA ACUST UNITED AC 2005; 10:164-71. [PMID: 15922238 DOI: 10.1016/j.math.2004.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robert E Boyles
- US Army-Baylor University Doctoral Program in Physical Therapy, AMEDDC & S, Fort Sam Houston, TX 78234, USA.
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Allen CS, Flynn TW, Kardouni JR, Hemphill MH, Schneider CA, Pritchard AE, Duplessis DH, Evans-Christopher G. The use of a pneumatic leg brace in soldiers with tibial stress fractures--a randomized clinical trial. Mil Med 2005; 169:880-4. [PMID: 15605935 DOI: 10.7205/milmed.169.11.880] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
STUDY DESIGN Single blind randomized controlled replication study. OBJECTIVES Evaluate the effect of a pneumatic leg brace on return-to-activity and pain in soldiers with tibial stress fractures. METHODS AND MEASURES Thirty-one subjects diagnosed with tibial stress fractures were randomly assigned to either a brace or control group. Dependent variables included time to pain-free single-leg hopping, visual analog pain scale, and time to a pain-free 1-mile run. Twenty subjects (10 brace, 10 control) completed a detailed functional progression culminating in a 1-mile run. RESULTS There was no difference between groups for time to pain-free hop (p > 0.86; power = 0.43) and time to pain-free 1-mile run (p > 0.24; power = 0.92). Subjects in both groups experienced statistically significant improvements in pain measurements (p < 0.002), but no difference was found between groups (p > 0.93). CONCLUSION The current study demonstrated no added benefit of Aircast leg braces in the treatment of tibial stress fractures in the military training environment.
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Affiliation(s)
- Christopher S Allen
- Bayne-Jones Army Community Hospital, Physical Therapy Department, 1585 Third Street, Fort Polk, LA 71459, USA
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Boyles RE, Flynn TW, Whitman JM. Manipulation following regional interscalene anesthetic block for shoulder adhesive capsulitis: a case series. Man Ther 2005; 10:80-7. [PMID: 15681274 DOI: 10.1016/j.math.2004.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Revised: 12/16/2003] [Accepted: 05/04/2004] [Indexed: 05/01/2023]
Affiliation(s)
- Robert E Boyles
- US Army-Baylor University Doctoral Program in Physical Therapy, 3151 Scott Rd, Rm 1303, Fort Sam Houston, TX 78234-6138, USA.
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Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med 2004; 141:920-8. [PMID: 15611489 DOI: 10.7326/0003-4819-141-12-200412210-00008] [Citation(s) in RCA: 543] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Conflicting evidence exists about the effectiveness of spinal manipulation. OBJECTIVE To validate a manipulation clinical prediction rule. DESIGN Multicenter randomized, controlled trial. SETTING Physical therapy clinics. PATIENTS 131 consecutive patients with low back pain, 18 to 60 years of age, who were referred to physical therapy. INTERVENTION Patients were randomly assigned to receive manipulation plus exercise or exercise alone by a physical therapist for 4 weeks. MEASUREMENTS Patients were examined according to the clinical prediction rule criteria (symptom duration, symptom location, fear-avoidance beliefs, lumbar mobility, and hip rotation range of motion). Disability and pain at 1 and 4 weeks and 6 months were assessed. RESULTS Outcome from spinal manipulation depends on a patient's status on the prediction rule. Treatment effects are greatest for the subgroup of patients who were positive on the rule (at least 4 of 5 criteria met); health care utilization among this subgroup was decreased at 6 months. Compared with patients who were negative on the rule and received exercise, the odds of a successful outcome among patients who were positive on the rule and received manipulation were 60.8 (95% CI, 5.2 to 704.7). The odds were 2.4 (CI, 0.83 to 6.9) among patients who were negative on the rule and received manipulation and 1.0 (CI, 0.28 to 3.6) among patients who were positive on the rule and received exercise. A patient who was positive on the rule and received manipulation has a 92% chance of a successful outcome, with an associated number needed to treat for benefit at 4 weeks of 1.9 (CI, 1.4 to 3.5). LIMITATIONS The response rate for the 6-month follow-up resulted in inadequate power to detect statistically significant differences for some comparisons. CONCLUSIONS The spinal manipulation clinical prediction rule can be used to improve decision making for patients with low back pain.
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Affiliation(s)
- John D Childs
- Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA.
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Fritz JM, Whitman JM, Flynn TW, Wainner RS, Childs JD. Factors related to the inability of individuals with low back pain to improve with a spinal manipulation. Phys Ther 2004; 84:173-90. [PMID: 14744207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation. SUBJECTS Seventy-five people with nonradicular low back pain (mean age=37.6 years, SD=10.6, range=19-59; mean duration of symptoms=41.7 days, SD=54.7, range=1-252) participated. METHODS Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no improvement with the manipulation. Baseline variables were tested for univariate relationship with the outcome of the manipulation. Variables showing a univariate relationship were entered into a logistic regression equation, and adjusted odds ratios were calculated. RESULTS Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation range of motion, and a negative Gaenslen sign. The resulting logistic regression model explained 63% of the variance in manipulation outcome. DISCUSSION AND CONCLUSION The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve.
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Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA.
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Sutlive TG, Mitchell SD, Maxfield SN, McLean CL, Neumann JC, Swiecki CR, Hall RC, Bare AC, Flynn TW. Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation. Phys Ther 2004; 84:49-61. [PMID: 14992676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE In patients with patellofemoral pain syndrome (PFPS), the authors determined which aspects of the examination could be used to identify those patients most likely to respond to off-the-shelf foot orthoses and instruction in activity modification. PARTICIPANTS AND METHODS Fifty participants were enrolled in the study, and data for 5 individuals were excluded from analysis. Thirty-four men and 11 women completed the study. Participants were given foot orthoses and instructed in activity modification for 3 weeks. A 50% reduction in pain was considered a success. Likelihood ratios (LRs) were computed to determine which examination findings were most predictive of success. RESULTS The best predictors of improvement were forefoot valgus alignment of 2 degrees (+LR=4.0, 95% confidence interval [CI]=0.7-21.9), great toe extension of 78 degrees (+LR=4.0, 95% CI=0.7-21.9), and navicular drop of 3 mm (+LR=2.4, 95% CI=1.3-4.3). DISCUSSION AND CONCLUSION The results suggest that patients with PFPS who have forefoot valgus alignment of 2 degrees, passive great toe extension of 78 degrees, or navicular drop of 3 mm are most likely to respond favorably to initial intervention with an off-the-shelf foot orthosis and instruction in activity modification.
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Affiliation(s)
- Thomas G Sutlive
- US Army-Baylor University Graduate Program in Physical Therapy, Fort Sam Houston, TX 78234-6138, USA.
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Flynn TW, Fritz JM, Wainner RS, Whitman JM. The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain. Arch Phys Med Rehabil 2003; 84:1057-60. [PMID: 12881834 DOI: 10.1016/s0003-9993(03)00048-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the relationship between an audible pop and symptomatic improvement with spinal manipulation in patients with low back pain (LBP). DESIGN A prospective cohort study. SETTING Two outpatient physical therapy clinics located in military medical centers. PARTICIPANTS A cohort of 71 patients with nonradicular LBP referred to physical therapy. INTERVENTIONS Participants underwent a standardized examination and standardized spinal manipulation treatment program. All patients were treated with a sacroiliac (SI) region manipulative technique and the presence or absence of an audible pop was noted. MAIN OUTCOME MEASURES Subjects were reassessed 48 hours after the manipulation for changes in range of motion (ROM), numeric pain rating scale (PRS) scores, and modified Oswestry Disability Questionnaire (ODQ) scores. RESULTS An audible pop occurred in 50 of the 71 subjects during the manipulative procedure. Both groups-those who had an audible pop and those who did not-improved over time in flexion ROM, PRS scores, and modified ODQ scores; however, there were no differences between groups (P>.05). Nineteen of the 71 (27%) patients improved dramatically (mean drop in modified ODQ, 67.6%). In 14 of the 19 dramatic responders, an audible pop occurred. However, the odds ratio (1.2; 95% confidence interval, 0.38-4.04) suggested that the occurrence of a manipulative pop would not improve the odds of achieving a dramatic reduction in symptoms after the manipulation. CONCLUSION There is no relationship between an audible pop during SI region manipulation and improvement in ROM, pain, or disability in individuals with nonradicular LBP. Additionally, the occurrence of a pop did not improve the odds of a dramatic improvement with manipulation treatment.
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Affiliation(s)
- Timothy W Flynn
- US Army-Baylor University Graduate Program in Physical Therapy, San Houston, Texas, 78234-6138, USA.
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Petrone MR, Guinn J, Reddin A, Sutlive TG, Flynn TW, Garber MP. The accuracy of the Palpation Meter (PALM) for measuring pelvic crest height difference and leg length discrepancy. J Orthop Sports Phys Ther 2003; 33:319-25. [PMID: 12839206 DOI: 10.2519/jospt.2003.33.6.319] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Test-retest reliability and validity. OBJECTIVE To determine the validity and reliability of the Palpation Meter (PALM). BACKGROUND Leg length discrepancy (LLD) has been associated with a variety of musculoskeletal disorders. Therefore, the clinical measurement of LLD has become a routine and important part of the physical examination. The PALM is an instrument that was recently developed to indirectly measure LLD, but little is known about its measurement properties. METHODS AND MEASURES Fifteen healthy and 15 symptomatic subjects with suspected LLD participated in this study. Measurements of pelvic crest height difference (PD) were obtained by 2 examiners using the PALM. A standing antero-posterior (AP) radiograph of each subject's pelvis was taken, and PD and LLD (femoral head height difference) were determined from the radiograph for comparison with the PALM values. Intraclass correlation coefficients (ICCs) were calculated to determine the validity and reliability estimates of the PALM. RESULTS For all subjects, the validity estimates (ICC2,3) of the PALM for PD were excellent (0.90 for rater 1 and 0.92 for rater 2) when compared with the standing AP radiograph of the pelvis. The PALM was less accurate (ICC2,3 of 0.76 and 0.78 for rater 1 and 2, respectively) as an indirect estimate of LLD. Intrarater reliability for each rater was excellent (ICC3,3 = 0.97 and 0.98) and interrater reliability was very good (ICC2,3 = 0.88). CONCLUSION The PALM is a reliable and valid instrument for measuring PD. Clinicians should consider this convenient, cost-effective clinical tool as an alternative to radiographic measurement of pelvic crest height difference.
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Affiliation(s)
- Matthew R Petrone
- US Army, Baylor University Graduate Program in Physical Therapy, USA
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