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Physical therapy [journal]
- Assessing Proprioceptive Function: Evaluating Joint Position Matching Methods Against Psychophysical Thresholds. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 21.
The importance of assessing proprioceptive function for rehabilitation after neurological or orthopedic injury has long been recognized. Yet, neither the validity nor accuracy of the available tests is firmly established. Testing typically involves repeated matching of a given joint position with the same or opposite limb where the difference between the two positions indicates proprioceptive acuity. To establish the accuracy and relationships between these joint matching methods, this study compared position sense acuity between ipsilateral and contralateral matching methods against a psychophysical threshold method. Assessment of forearm position sense for a 10° movement in 27 healthy young adults showed psychophysical thresholds to be the most precise and least variable acuity measure. The mean threshold (1.05°± 0.47°) was significantly different from the mean position errors obtained by both joint position matching tasks (ipsilateral: 1.51°± 0.64°; contralateral: 1.84°± 0.73°) - 44-75% loss in measurement accuracy. Individual subject position errors correlated poorly with respective thresholds indicating a lack of concurrent validity of such measures. Error values of both matching methods only correlated mildly with each other.The differences in measurements arise because threshold testing and joint position matching methods test different physiological aspects of proprioceptive function. While joint position matching involves active movement, threshold testing involves passive movement. Thus, thresholds primarily reflect the processing of afferent sensory feedback (i.e., proprioception), while the results of matching methods are influenced by additional sensorimotor processes. In addition, factors like working memory and transmission between brain hemispheres influence joint matching task outcome measures. The implications of these findings for clinical research are discussed.
- A Path Model for Evaluating Dosing Parameters for Children With Cerebral Palsy. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 21.
Dosing of pediatric rehabilitation services for children with cerebral palsy (CP) has been identified as a national priority. Establishing dosing parameters for pediatric physical therapy (PT) interventions is critical for informing clinical decision-making, health policy, and guidelines for reimbursement. The purpose of this paper is to describe a path model for evaluating dosing parameters of interventions for children with CP. The model is intended for dose-related and effectiveness studies of pediatric PT interventions. The premise of the model is: Intervention type (focus on body structures, activity, or the environment) acts on a child first through the family, then through the dose (frequency, intensity, time), to yield structural and behavioral changes. As a result, these changes are linked to improvements in functional independence. Community factors impact dose as well as functional independence (performance and capacity), influencing the relationships between type of intervention and intervention responses. The constructs of family characteristics, child characteristics (e.g. age, level of severity, comorbidities, readiness to change, and preferences), plastic changes in bone, muscle, and brain, motor skill acquisition, and community access warrant consideration from researchers who are designing intervention studies. Multiple knowledge gaps are identified, and a framework is provided for conceptualizing dosing parameters for children with CP.
- Knee Pain With Daily Tasks, Knee Osteoarthritis Severity, and Widespread Pain. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
The presence of widespread pain is simple to determine and is known to increase risk for persistent symptoms.We hypothesized that persons with minimal or no knee osteoarthritis and high WOMAC Pain scores would be more likely to report widespread pain than other subgroups.We used data from the Multicenter Osteoarthritis Study (MOST), a multi-center study of people with or at high risk for knee OA. A total of 755 persons with unilateral knee pain and 851 persons with bilateral knee pain met our inclusion criteria. Widespread pain was assessed by use of body diagrams and radiographic Kellgren and Lawrence grades were recorded for each knee. The WOMAC Pain score quantified knee pain with daily tasks.A higher proportion of persons in the high knee pain/low knee OA subgroup had widespread pain as compared to the high pain/high knee OA, low pain/high knee OA and low pain/low knee OA subgroups, particularly for persons with bilateral knee pain (relative risk estimates ranging from 1.7 (95%CI=1.2, 2.4) to 2.3 (95%CI = 1.6, 3.3)).The cross sectional design is a limitation of the study.Patients with either no or minimal knee OA and high knee pain with daily tasks are particularly likely to report widespread pain. This subgroup of patients is likely to be at risk for not responding to knee OA treatment that focuses only on physical impairment. Assessment of the presence of widespread pain along with knee pain intensity and osteoarthritis status may assist physical therapists in identifying subgroups of patients who may require additional treatment.
- Validity of the AM-PAC "6-Clicks" Inpatient Daily Activity and Basic Mobility Short Forms. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
Standardized assessment of patients' activity limitations in acute care settings can provide valuable information. Existing measures have not been widely implemented.To provide evidence for validity of scores on '6-Clicks' measures of Basic Mobility and Daily Activity in acute care.Retrospective measurement study.We used a database from one health system containing '6-Clicks' scores from first and last physical and occupational therapist visits for 84,446 patients. Validity was analyzed by examining differences in '6-Clicks' scores across categories of patient characteristics; ability of '6-Clicks' scores to predict patients' having more than one therapy visit; correlation of '6-Clicks' scores with Functional Independence Measure (FIM) scores; and internal responsiveness over the episode of care. Internal consistency reliability was also determined.'6-Clicks' scores differed across patients' age, pre-admission living situation, and number of therapy visits (P=.000). The areas under receiver operating characteristics curves derived using '6-Clicks' scores at the first visit to predict patients receiving more than one visit were 0.703 and 0.652 using Basic Mobility and Daily Activity scores, respectively. '6-Clicks' scores at the final visit were correlated with scores on subscales of FIM completed on admission to in-patient rehabilitation facilities (r=0.65 and 0.69). Standardized response means were 1.06 and 0.95, and minimal detectable changes (MDC90) were 4.72 and 5.49, for Basic Mobility and Daily Activity scores, respectively. Internal consistency reliability of Basic Mobility and Daily Activity scores was 0.96 and 0.91, respectively.Using clinical databases for research purposes has limitations including missing data, misclassifications and selection bias. Rater reliability is not known.This study provides evidence for the validity of '6-Clicks' scores for assessing patients' activity limitations in acute care settings.
- Conservative Treatment of a Proximal Full-Thickness Biceps Brachii Muscle Tear in a Special Operations Soldier. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
A transection of the short head of the biceps brachii muscle is an uncommon injury seen among outpatient sports medicine physical therapy clinics. The highest rate of occurrence and the majority of literature that discusses this specific injury are related to U.S. military parachuting. The purpose of this case report is to outline the episode of care from two days after the injury thru six months of conservative treatment within an outpatient sports medicine physical therapy clinic in a military setting which consisted of therapeutic exercise, manual therapy, and cryotherapy.This case report outlines the initial evaluation, diagnostic imaging, treatment, and six month follow-up measures for a 23 year old male who sustained a static line injury resulting in a full thickness tear of his biceps brachii muscle and a partial tear of the coracobrachialis muscle.The individual described in this study reported no functional limitations in regards to his job and leisure activities and furthermore denied any pain at his six month follow-up with a score of 0% noted on his Quick-DASH. Isokenitic testing revealed a 39.1% decrease in elbow flexion peak torque and a 60.8% decrease in elbow flexion total work output at this same follow-up interval.In determining the appropriate course of treatment for this injury type one should consider conservative physical therapy intervention as a viable treatment option as there have been no decisive studies to suggest superior outcomes with other methods such as surgical correction. It is further recommended that research be conducted in an effort to prevent such injuries from occurring as this mechanism of injury has proven to be much higher among the US military population as compared to other foreign militaries.
- Patient Global Ratings of Change Did Not Adequately Reflect Change Over Time: A Clinical Cohort Study. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
Global ratings of change are commonly used in research and clinical practice to determine responders to therapy, but their validity as a criterion for change has not been firmly established. One factor related to their validity is the length of the recall period.To examine the influence of length of recall on the validity of a global rating of change (GROC) for determining true change over time in the clinical setting.Longitudinal single cohort observational study METHODS: Data from the Focus on Therapeutic Outcomes clinical database were collected for 8955 patients reporting to physical therapy with a knee disorder. Computerized adaptive testing was used to assess knee functional status (FS) at the initial and final (discharge) physical therapy visit. Each patient's GROC was obtained at discharge. Correlation and linear regression analyses of knee FS and GROC were conducted, stratified by length of time between intake and discharge.Correlations of GROC with knee FS change scores were modest even for the shortest period of recall (0-30 days) and were slightly less for longer recall periods. Regression analysis using knee FS to predict GROC scores showed similar findings. Correlations of the GROC with intake and discharge scores indicated strong bias toward discharge status with little or no influence of baseline status. Regression analyses fitted the expected pattern for a valid measure of change, but confirmed the strong bias toward discharge status.This study examined one version of the GROC administered serially in a cohort of patients seen in clinical practice.These results call into question the validity of global ratings of change to measure change over time in routine clinical practice.
- Declining Cognition and Falls: Role of Risky Performance of Everyday Mobility Activities. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
Declining cognition is a risk factor for falls among older adults. The extent to which impaired judgment in performance of daily activities increases falls risk is unclear.To determine if engagement in mobility activities in a risky manner explains the association between declining cognition and rate of falls.Secondary analysis of baseline and prospective data from subjects enrolled in the intervention arm of a randomized clinical trial.Two hundred forty five community-dwelling older adults (79% female, mean age 79, SD 8.0) at-risk for falls received physical, cognitive, and functional evaluations. Cognition was assessed with the Short Portable Mental Status Questionnaire (SPMSQ). Using interview and in-home assessment data, physical therapists determined whether participants were at-risk when performing mobility-related Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs). Falls were measured prospectively for one year using monthly falls diaries.Declining cognition was associated with increased number of mobility activities designated as risky (1.5% of mobility activities performed in a risky manner per SPMSQ point) and with increased rate of falls (rate ratio 1.16 for each unit change in SPMSQ score. Risky performance of mobility activities mediated the relationship between cognition and rate of falls.Risk assessment was based on clinical judgment of experienced physical therapists. Cognition was measured with a relatively insensitive instrument, and only selected mobility activities were evaluated.Engagement in mobility ADL's/IADL's in a risky manner emerged as a link between declining cognition and increased number of falls, suggesting a mechanism through which rate of falls may increase. Specifically, declining cognition is associated with performance of mobility activities in an unsafe manner, thereby increasing risk for falls.
- Psychometric Properties of Three Functional Mobility Tests for People With Parkinson Disease. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
Standardized outcome measures with high clinical utility are of paramount importance for clinical practice.The purpose of this study was to examine interrater and intrarater reliability, construct validity, discriminant ability, and smallest detectable differences of the sit-to-stand test (STS), Timed "Up & Go" Test (TUG), and bed mobility test for people with Parkinson disease.A cross-sectional, psychometric evaluation study was conducted.A group of individuals with PD (PD group) and a group of individuals who were healthy (control group) were recruited through local Parkinson disease groups and assessed in a movement laboratory in their "on" phase. Measurements of time to perform one STS, TUG, and bed mobility test were collected based on video recordings of that single performance.Thirty-eight individuals with PD (Hoehn and Yahr stages I-IV) and 19 age-matched control participants were recruited. Intraclass correlation coefficients for interrater and intrarater reliability for the PD group ranged from .95 to .99. Bland-Altman plots showed mean differences close to zero and narrow confidence intervals. Construct validity was established by means of moderate to good Spearman rho correlation coefficients with part III of the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr stage (range=.51-.63). Timings of all tests discriminated participants in the PD group from those in the control group and participants in the PD group in Hoehn and Yahr stages I and II from those in Hoehn and Yahr stages III and IV, but did not discriminate "nonfallers" or those with single falls from repeat "fallers" or "nonfreezers" from "freezers." Applicable smallest detectable differences were established.The results are not generalizable to people with in the late stage of PD (Hoehn and Yahr stage IV: n=3).Timings of video recordings of 3 functional mobility tests with high clinical utility showed good psychometric properties for community-dwelling, ambulatory people with PD.
- Association Between Physical Activity and Sleep in Adults With Chronic Pain: A Momentary, Within-Persons Perspective. [JOURNAL ARTICLE]
- Phys Ther 2013 Nov 14.
Individuals with chronic pain consider improved sleep as one of the most important outcomes of treatment. Physical activity has been shown to have beneficial effects on sleep in the general population. Despite this, the physical activity-sleep relationship has not been directly examined in a chronic pain sample.This study aimed to examine the association between objective daytime physical activity and subsequent objective sleep for individuals with chronic pain while controlling for pain and psychosocial variables.An observational prospective within-persons study design was employed.A clinical sample of fifty adults with chronic pain was recruited. Participation involved completing a demographic questionnaire followed by five days of data collection. Over this period participants wore a tri-axial accelerometer to monitor their daytime activity and sleep. Participants also carried a Palm Hand Held Computer that administered a questionnaire measuring pain, mood, catastrophizing, and stress, six times throughout the day.Results demonstrated that higher fluctuations in daytime activity significantly predicted shorter sleep duration. Furthermore, higher mean daytime activity levels and a greater number of pain sites contributed significantly to the prediction of longer periods of wakefulness at night.The small sample size used in this study limits the generalizability of findings. Missing data may have led to over- or under-estimations of effect sizes, and additional factors that may be associated with sleep (such as medication usage and environmental factors) were not measured.Results of this study suggest engagement in high intensity activity and high fluctuations in activity are associated with poorer sleep at night; hence, activity modulation may be a key treatment strategy to address sleep complaints in individuals with chronic pain.
- Author response. [Comment, Letter]
- Phys Ther 2013 Oct; 93(10):1427-8.