The availability of population-based survey data provides a unique opportunity to understand issues related to access and utilization of physical therapy in the United States, and to better gauge public perceptions of the profession. In our day-to-day routine, we all tend to consider our work as physical therapists on a one-to-one level with the patients we serve. Examining data from national population-based surveys can elevate our daily, ground-level viewpoint to a 30 000-foot perspective on the profession. This vantage point allows certain things to come into focus that would otherwise be obscured, and the vision may not always comport with our expectations.J Orthop Sports Phys Ther 2011;41(7):465-466. doi:10.2519/jospt.2011.0105.
Position of the leg while using the KT-1000 knee arthrometer may be an important variable in attaining accurate and reliable measurements. The purpose of this study was to compare the anterior translation of the tibia on the femur with the tibia in neutral, internal rotation (IR), and external rotation (ER). Additionally, data were analyzed to determine the intratester and intertester reliability of the KT-1000 knee arthrometer with the leg in neutral. Data were collected from 50 subjects by two testers and one recorder, according to MEDmetric protocol. Tester 1 performed three pulls or one sequence in neutral, IR, and ER. A second sequence was performed in neutral. Tester 2 performed two sequences in the neutral position. Data in each sequence were averaged and evaluated. Intertester reliability was calculated at r = .64 (poor), while intratester reliability for tester 1 was r = .90 (high) and for tester 2 was r = .86 (good). A repeated measure, one-way ANOVA was used, and results demonstrated a statistical difference of p < .0001, with the difference found between IR when compared with ER and neutral. In conclusion, differences in tibial translation occurred between neutral, IR, and ER of the lower extremity. This may prove valuable for clinicians using the KT-1000.
Prospective, observational study.
To determine the association between KT-1000 measurements with an anterior translation force of 89 N and other measures of outcome (the Tegner activity score, the modified Lysholm score, subjective rating of instability, Lachman test, and pivot-shift test) 1 year following anterior cruciate ligament (ACL) reconstruction.
Health care professionals often use the side-to-side difference measured with the KT-1000 arthrometer to determine ACL integrity during passive motion. It has been postulated that a 5-mm or greater difference between impaired and nonimpaired knees represents a procedural failure.
Ninety patients (46 men, 44 women) with a mean age of 30 +/- 8 years were examined 1 year after surgery. Patients were classified in 1 of 3 groups depending on the amount of laxity between the impaired knee and the nonimpaired knee. Seventy percent of the subjects had a side-to-side difference less than or equal to 3 mm (tight), 13% had a difference of between 3 and 5 mm (moderate), and 17% had a difference greater than or equal to 5 mm (loose) on examination using the KT-1000.
Mean Lysholm and Tegner scores did not differ significantly among groups. Side-to-side differences in KT-1000 measurements at 89 N were not associated with the Lysholm score (r = -0.09) or Tegner score (r = 0.02). Lachman tests were related to involved-knee KT-1000 measurements (r = 0.39) but not to side-to-side differences in KT-1000 measurements (r = 0.15). Similarly, pivot-shift tests were related to involved-knee KT-1000 measurements (r = 0.26) but not to side-to-side differences (r = -0.08).
These results suggest that side-to-side KT-1000 measurements obtained with an anterior translation force of 89 N should not be used in isolation to determine ACL reconstruction success or failure 1 year following surgery.
Single group repeated measures with multiple raters.
To determine the inter-rater reliability of KT-1000 measurements of novice and experienced raters and to provide error estimates for these raters.
The KT-1000 arthrometer is often used clinically to quantify anterior tibial displacement. Few data have been documented, however, about the relative reliability of KT-1000 measurements obtained by novice compared with experienced users.
Two novice and two experienced KT-1000 users performed measurements on 29 knees of 25 patients after anterior cruciate ligament (ACL) reconstruction or with a diagnosis of ACL deficiency. Measurements were performed at 131 N. Interrater and intertrial reliability coefficients (interclass correlation coefficient; ICC) and the standard error of measurement were calculated for expert and novice raters.
The interrater ICC for novices was 0.65 and the interrate error was +/- 3.52 mm (90% confidence interval [CI]). The interrater ICC for experts was 0.79 and the interrater error was +/- 2.94 mm (90% CI).
These results suggest that experience in using the KT-1000 is related to the interrater error of measurements and that training is an important consideration when using the KT-1000 arthrometer.
Single-group repeated measures.
To adapt an existing arthrometer to allow simple quantification of glenohumeral translation and to assess the arthrometer's reliability.
The measurement of glenohumeral translation is an integral part of the clinical examination of the shoulder. However, no objective and reliable measure for glenohumeral translation has been reported.
The KT-1000 Knee Ligament Arthrometer was used to measure the amount of anterior-to-posterior (AP) translation of the humeral head at the glenohumeral joints of 28 (16 women and 12 men) nonimpaired undergraduate university students (age 22.1 +/- 2.9 years). Two assessments were made (20 minutes apart), by a single tester, of the dominant and nondominant shoulders of each participant.
Anterior-to-posterior translation varied from 10 to 32 mm (20.9 +/- 4.9). The test-retest reliability of the KT-1000 when measuring the nondominant shoulders was good (ICC [intraclass correlation coefficient] 0.76), and it was moderate (ICC = 0.67) when measuring the dominant shoulders. The reliability findings were influenced by large amounts of random error. Analysis by ANOVA showed that compared to women (dominant shoulder, 22.6 +/- 4.6 mm; nondominant, 23.8 +/- 4.2 mm), men showed significantly less glenohumeral translation (dominant, 17.1 +/- 3.7 mm; nondominant, 18.3 +/- 3.7 mm).
The KT-1000 arthrometer has the potential to provide therapists with a clinically viable method of measuring glenohumeral translation.
Clinicians frequently measure anterior tibial displacement on patients following surgical reconstruction for a torn anterior cruciate ligament (ACL). Little is known about the reliability of measurements of anterior tibial displacement obtained on patients following an ACL reconstruction. The purpose of this study was to describe the degree of error associated with repeated measurements of anterior tibial displacement on patients with reconstructed ACLs. Random pairs of physical therapists used the KT-1000 to measure the anterior tibial displacement of 30 subjects. Each pair of examiners took measurements according to the manufacturer's instructions. Examiners took three sets of measurements while applying 6.8, 9.1, and 13.6 kg (15, 20, and 30 lbs) of force to the handle of the KT-1000. Intraclass correlation coefficients (ICC 2,1) and the standard error of the difference (SED) were calculated to describe the intertester reliability of the mean of three measurements of anterior tibial displacement at each force level and of the individual measurements at each force level. The SED was then multiplied by 2 to provide a 95% confidence estimate of the magnitude of error present with KT-1000 measurements. The SED estimates the magnitude of change in anterior tibial displacement necessary to infer that a real change in anterior tibial displacement has occurred. Clinicians can be 95% confident that changes in anterior tibial displacement of greater than 5 mm (+/- 2 SED) during KT-1000 tests at 6.8, 9.1, or 13.6 kg (15, 20, or 30 lbs) of force indicate that a true change in anterior tibial displacement has occurred.
Results of physical therapy evaluation of 112 patients with extensor mechanism disorders (chondromalacia patella, infrapatellar tendinitis, and peripatellar pain) are presented. An equal number of male and female patients were evaluated and of the 73 patients with unilateral involvement (65%) there were equal numbers of right and left involved knees. Running was the activity most commonly associated with pain, followed by basketball and tennis. Stairclimbing was painful in 79% of the patients, with ascending being more painful than descending in patients reporting a clear-cut difference. Hamstring and quadriceps tightness was statistically significant relative to the uninvolved limb although clinically, negligible differences were measured. The inferior pole of the patella was the most tender site to palpation, followed by medial peripatellar structures, then lateral sites. Biomechanical malalignment was not detected by the attending therapist in the majority of patients. The authors emphasize careful assessment of flexibility, quadriceps (VMOIVL) imbalance, and biomechanical alignment in performing a thorough evaluation of patients with extensor mechanism disorders. J Orthop Sports Phys Ther 1986;8(5):248-254.
The Agency for Health Care Policy and Research Low Back Guideline Panel (AHCPR, Guideline #14) truly brought to life sports medicine principles in the care of the most common and expensive musculoskeletal problem by focusing on the basic activity paradigm of musculoskeletal limitations. Twenty-three experts and seven international consultants led a review of over 10,000 abstracts and evaluation of over 4,600 articles. This effort was to establish scientifically how any clinician can: 1) safely be sure that the patient only has a back problem, 2) offer safe options for comfort, and 3) concentrate on the real treatment for an activity intolerance with sports medicine principles: activity, not rest, begets activity tolerance. Evidence tables and their subsequent derivation as "Finding and Recommendation Statements" provide an understanding of what medical science can and cannot presently support as predictable.
The Fourth International Ankle Symposium (IAS4), a multidisciplinary conference focused on topics related to ankle injury, was recently held in Sydney, Australia at the University of Sydney. The conference theme was "new dimensions on old problems," with a different emphasis on each day of the symposium: new dimensions on science, new dimensions on interventions, and new dimensions in the clinic, reflecting the mix of basic science and clinical practice. This issue includes a summary statement of the conference, abstracts of the invited lectures and workshops, and the abstracts of the original research presentations, both podium and poster presentations, from IAS4.J Orthop Sports Phys Ther 2009;39(10):A1-A24.
This was the third research meeting focused on scapular function and dysfunction, following similar meetings in 2003 and 2006. The purpose of this meeting, hosted by the Shoulder Center of Kentucky, was to continue to examine the biomechanical and clinical factors thought to be associated with the role of the scapula in shoulder function and dysfunction. Since the last Summit, much more information has been created in this area, and it was thought that enough progress had been made that an organized overview of current knowledge could provide some consensus statements to guide further research and provide assessment and treatment guidelines. A call for abstracts was extended to researchers with proven interest and published research on the scapula. The meeting was organized around 3 primary categories of information: scapular kinematics and dysfunction, clinical evaluation of the scapula, and interventions. The last session of the meeting involved development of consensus statements for each category. This document represents the current state of knowledge concerning the aspects of scapular function and dysfunction discussed at the Summit. It is expected that, as more knowledge is developed, the gaps will be filled in and a clearer understanding of the roles of the scapula in shoulder function will emerge. This issue includes the consensus statements and abstracts from the Summit.
Although often advocated for arthritis rehabilitation, several studies conducted on healthy subjects have demonstrated conflicting results as to whether isometric strengthening exercises performed at one joint angle can result in strength gains at other angles. The objective of this study was to determine whether midrange strength training of the quadriceps surrounding an osteoarthritic knee would increase strength in this part of the range of motion as well at other knee angles. The midrange position was chosen because the subject, a 57-year-old female with a 2-year history of moderately severe osteoarthritis of the left knee, had greatest weakness in this position. The training occurred three times per week for 16 months using a resistance training program of three sets of two maximal isometric contractions at a knee angle of 60 degrees. The dependent variable of maximal isometric knee extensor torque was recorded on an isokinetic dynamometer at knee angles of 90, 60, and 30 degrees at 6 weeks, 1 year, and 16 months. These data demonstrated a progressive torque increase at all angles over the 16-month period, with a steeper slope at the training angle. Contrary to the specificity of training concept, angle-specific strengthening in midrange may be sufficient to strengthen the extensors surrounding an osteoarthritic knee through a wide range of motion. Mid-range isometric strengthening exercises might thus prove useful in the rehabilitation of patients with knee osteoarthritis who are unable to exercise their weakened quadriceps at other angles due to pain or swelling.
The Fifth International Ankle Symposium (IAS5), a multidisciplinary conference focused predominantly on ankle injury evaluation, rehabilitation, and prevention, was held in Lexington, KY in October 2012. IAS5 brought together over 90 clinicians and scientists from disciplines such as athletic training, physical therapy, sports medicine, orthopaedics, and biomechanics. In this supplement, you will find a summary statement, keynote addresses from invited lectures and workshops, a program schedule, and the abstracts of the original research, both podium and poster presentations, from IAS5.J Orthop Sports Phys Ther 2013;43(3):A1-A27. doi:10.2519/jospt.2013.0301.
The purpose of this study is to provide a statistical analysis of the length of treatment patients experience with one or more of the most common athletic diagnoses seen at a sports medicine clinic. Based on a computerized analysis of 1707 patients the following statistical trends were documented. A hierarchy of the 18 most common diagnoses was established, indicating the importance of injury to the anterior cruciate ligament in the sports medicine clinic setting. Surgical groups required longer treatment times than those patients with nonsurgical diagnoses. Patients who required longer treatment programs could be statistically separated from shorter treatment programs based on their condition (fully active versus improved versus status quo) when released from therapy. Multiple injuries had no effect of increased treatment time when compared to isolated injuries for long-term or short-term diagnoses.
An addendum update from 1984's statistics to 1986 appears in the article as Table 5.J Ortho Sports Phys Ther 1987;9(1):40-46.
*This Study was funded in part by a grant from the Chicagoland Orthopaedic Physical Therapy study Group. The purpose of this study was to determine the incidence of forefoot varus, forefoot valgus, subtalar varus, subtalar valgus, and tibiofibular varum in healthy females between the ages of 18 and 30 years. Fifty-eight females had both lower extremities evaluated to determine their foot type. Chi-square testing was used to determine significance between extremities for both the forefoot and rearfoot deformity groups. The relationship between left or right extremities for forefoot or rearfoot deformities was not significant. The forefoot valgus deformity was the most common forefoot imbalance in this sample. Rearfoot varus was present in 97 (83.6%) of the feet surveyed. Eighteen (31%) of the subjects had a different forefoot or rearfoot foot type bilaterally.J Orthop Sports Phys Ther 1988;9(12):406-109.
lncreased interest has developed in the use of electrical stimulation as either an adjunct or a substitution for voluntary muscle contraction as a technique to improve strength in normal individuals. This study was conducted in an attempt to determine if electrical stimulation does significantly increase the strength of normal musculature. A sample using 17 normal subjects (1 0 male, 7 female) with an average mean age of 26 years was obtained. In this study the subjects were divided into two groups. Three different speeds (0, 60, and 240 degrees /sec) with 3-5 contractions at each speed were used to determine the maximum strength of each subject's nondominant leg as measured by a Cybex(R) II dynamometer. Group A consisted of 8 subjects (3 male, 5 female) who served as a control group. Group B consisted of 9 subjects (7 male, 2 female) who received electrical stimulation to the nondominant leg for 20 treatment sessions (5 days/week for 4 weeks). Results indicate that group B did have a significant strength gain which was achieved after 4 weeks of stimulation. These results were only significant at an isometric mode (OO/sec) and did not carry over to dynamic measurement. J Orthop Sports Phys Ther 1985;7(2):50-53.
Low back internal loads are dependent, in part, upon the weight of the body segments and the lengths of their moment arms. Musculoskeletal performance appears to be influenced by anthropometric characteristics. The purpose of this investigation was to compare dynamic isoinertial performance values to selected individual and permutated anthropometric characteristics. Torque production was assessed during repetitive movements in the axis of trunk flexion/extension in 7 sedentary healthy females. Body fat, stature, and other anthropometric characteristics were measured to predict segmental weights and heights and to express relative performance scores. Pearson correlations ranged from 0.67 to 0.93 between peak torque production and peak torque expressed by both the weight and length of the spine motion segment. These findings appear to be significant because they enable a precise comparison of performance. J Orthop Sports Phys Ther 1990;12(2):60-65.
Knee ligament arthrometers are used during rehabilitation to assess changes in knee laxity after anterior cruciate ligament injury. This study investigated the reliability and error associated with measurements of knee laxity using three different instrumented devices: the KT-2000, the Knee Signature System (KSS), and the Genucom Knee Analysis System to aid in the interpretation of instrumented laxity measurements during rehabilitation. Ten subjects with unilateral anterior cruciate deficiency were examined by two testers on two separate days. Measurement error was calculated as the minimum difference required to assume a true change in laxity between two measurements (p < 0.05). Between-day reliability was relatively high for both the KSS and the KT-2000 (.95 and .83, respectively) but substantially lower for the Genucom (.22). Intertester reliability was slightly lower for the KT-2000 and the KSS (.92 and .78, respectively) and slightly higher but still low for the Genucom (.27). When monitoring changes in anterior laxity of an anterior-cruciate-deficient knee, the following error values were determined to be needed in order to assume a true difference between successive measurements: KT-2000, 2.0 mm; KSS, 4.2 mm; and Genucom, 5.9 mm. The results of this study suggest that measurements of anterior laxity taken by a single examiner using the KT-2000 provide the most reliable measurements.
One tool that has potential to assist with improving physical therapists' ability to evaluate and treat motor control impairments is the use of rehabilitative ultrasound imaging (RUSI) based on its ability to provide real-time visual feedback of the underlying muscular morphology and function to both the patient and the physical therapist. Although the research and clinical applications of this emerging technology have steadily grown, there has not previously been an international meeting to organize a research agenda that could ultimately guide its role in clinical practice. The US Army-Baylor University Doctoral Program in Physical Therapy hosted a RUSI Symposium in May 2006 in San Antonio, TX. Provided in this supplement are this overview and the abstracts presented at the symposium. Synopsis statements in the format of clinical commentaries are being developed by these working groups and our goal is to have them ready for publication in 2007. J Orthop Sports Phys Ther 2006;36(8):A1–A17. doi:10.2519/jo...
Continued advances in communication technologies have made publishing an increasingly dynamic venture, offering authors and editors the ability to reach and interact with readers around the world in exciting and enlightening ways. Today's publications share information more quickly through diverse and sophisticated means. The new international partnerships and recent print and online enhancements described in this editorial reflect JOSPT's response to the technological possibilities now within our grasp. We believe that, ultimately, our expanding global audience and additional features will provide the profession as a whole with a better Journal.
During APTA's Combined Sections Meeting in Las Vegas, Nevada in February 2009, the Journal of Orthopaedic & Sports Physical Therapy recognized for the fifth time the most outstanding research article and clinical practice article published in the JOSPT within a calendar year. The JOSPT Excellence in Research Award is presented to the best article published within the category of research reports. The George G. Davies - James A. Gould Excellence in Clinical Inquiry Award is given to the best article among the categories of case reports, resident's case problems, clinical commentaries, and literature reviews. An award committee consisting of the JOSPT editor-in-chief, 2 JOSPT associate editors, and the research chairs of the Orthopaedic and Sports Physical Therapy Sections selected the recipients for the past year.J Orthop Sports Phys Ther 2009;39(3):162-163. doi:10.2519/jospt.2009.0111.
Patellofemoral pain syndrome (PFPS) is a clinical condition that is characterized by retropatellar and/or peripatellar pain associated with activities involving lower limb loading (eg, walking, running, jumping, stair climbing, and prolonged sitting and kneeling). PFPS is the most common overuse injury of the lower extremity, and is particularly prevalent in those who are physically active. While treatment for PFPS may be successful for the short-term, long-term results are less promising. The lack of long-term success in treating this condition may be due to the underlying etiologic factors not being addressed. While it is generally agreed that many factors can lead to PFPS, it is our contention that these factors are still not well-understood. The mission of this first international research retreat was to bring scientists together from around the world who were conducting research aimed at understanding the factors that are related to the development, and consequently the treatment, of PFPS. These etiologic factors were classified as local, distal, and proximal. A call for abstracts for the retreat was made in the summer of 2008. All abstracts were peer-reviewed for scientific merit and relevance to the retreat. In the end, 32 abstracts were accepted for podium presentations and 11 were accepted as posters. In total, 55 participants from 10 countries, including Australia, Belgium, Brazil, Canada, Israel, Italy, the Netherlands, Singapore, United Kingdom, and the United States, contributed to the retreat. The format of the 2-day meeting included 3 keynote presentations interspersed with 15-minute podium presentations and 5-minute poster presentations. This first retreat was held in Fells Point, Baltimore, Maryland and was hosted by the Division of Biokinesiology and Physical Therapy at the University of Southern California. Included in this PDF is a consensus statement, a listing of the presentations and authors, and abstracts of each of the presentations made at the conference. J Orthop Sports Phys Ther 2010;40(3):A1-A48. doi:10.2519/jospt.2010.0302KEY WORD: PFPS.
During APTA's Combined Sections Meeting in San Diego, California in February 2010, the Journal of Orthopaedic & Sports Physical Therapy recognized for the sixth time the most outstanding research article and clinical practice article published in the JOSPT within a calendar year. The JOSPT Excellence in Research Award is presented to the best article published within the category of research reports. The George G. Davies - James A. Gould Excellence in Clinical Inquiry Award is given to the best article among the categories of case reports, resident's case problems, clinical commentaries, and literature reviews. An award committee consisting of the JOSPT editor-in-chief, 2 JOSPT associate editors, and the research chairs of the Orthopaedic and Sports Physical Therapy Sections selected the recipients for the past year. J Orthop Sports Phys Ther 2010;40(4):195-196. doi:10.2519/jospt.2010.0104.
The JOSPT offers invited reviews of current titles. The July 2010 column includes 5 reviews of the following books: Against the Tide: Back Pain Treatment -The Breakthrough; Solutions for Complex Upper Extremity Trauma; Biomechanical Analysis of Fundamental Human Movements; AO Manual of Fracture Management: Elbow and Forearm; and Color Atlas of Human Anatomy Volume 1: Locomotor System.J Orthop Sports Phys Ther 2010;40(7):448-450.
The JOSPT offers invited reviews of current titles. The October 2010 column includes 7 reviews of the following books: Orthopaedic Trauma Care; Mechanisms and Management of Pain for the Physical Therapist; Fundamentals of Musculoskeletal Imaging, Third Edition; Gait Analysis: Normal and Pathological Function, Second Edition; The Lumbar Intervertebral Disc; Spine Classifications and Severity Measures; and Physical Agents in Rehabilitation: From Research to Practice, Third Edition.J Orthop Sports Phys Ther 2010;40(10):668-673.
The JOSPT offers invited reviews of current titles. The April 2010 column includes 7 reviews of the following books: Biological Joint Reconstruction: Alternatives to Arthroplasty; Tension-type and Cervicogenic Headache: Pathophysiology, Diagnosis, and Management; AO Handbook: Musculoskeletal Outcomes Measures and Instruments (Volumes 1 and 2); Arthroscopic Techniques of the Knee: A Visual Guide; Arthroscopic Techniques of the Shoulder: A Visual Guide; Manipulative Thrust Techniques: An Evidence Based Approach; and Functional Testing in Human Performance. J Orthop Sports Phys Ther 2010;40(4):239-244.
JOSPT offers invited reviews of current titles. The July 2011 column includes 5 reviews of the following books: Treat Your Own Shoulder; Musculoskeletal Ultrasound With MRI Correlations; Clinical Prediction Rules: A Physical Therapy Reference Manual; MRI for Orthopaedic Surgeons; and Examination of Musculoskeletal Injuries: Third Edition. J Orthop Sports Phys Ther 2011;41(7):536-540.
JOSPT offers invited reviews of current titles. The April 2011 column includes 7 reviews of the following books: Arthroscopic Techniques of the Hip: A Visual Guide; Neurotrauma and Critical Care of the Spine; Therapeutic Exercise for Musculoskeletal Injuries: Third Edition; Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation, Second Edition; Effective Functional Progressions in Sport Rehabilitation; Aquatic Exercise for Rehabilitation and Training; and Core: Clinical Orthopaedic Exam. J Orthop Sports Phys Ther 2011;41(4):283-287.
Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in orthopaedic practice. The mission of the second International Patellofemoral Pain Research Retreat was to bring together scientists and clinicians from around the world who are conducting research aimed at understanding the factors that contribute to the development and, consequently, the treatment of PFP. The format of the 2.5-day retreat included 2 keynote presentations, interspersed with 6 podium and 4 poster sessions. An important element of the retreat was the development of consensus statements that summarized the state of the research in each of the 4 presentation categories. In this supplement, you will find the consensus documents from the meeting, as well as the keynote addresses, schedule, and platform and poster presentation abstracts.
JOSPT offers invited reviews of current titles. The October 2011 column includes 5 reviews of the following books: Athletic and Sports Issues in Musculoskeletal Rehabilitation; Biomechanics of Human Motion: Basics and Beyond for the Health Professions; Nerve and Vascular Injuries in Sports Medicine; Assessment and Treatment of Muscle Imbalance: The Janda Approach; and Ther Ex Notes: Clinical Pocket Guide. J Orthop Sports Phys Ther 2011;41(10):797-801.
Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning opportunities through a conference held every 4 years. In 2012, IFOMPT is partnering with The International Private Practitioners Association (IPPA) to host this prestigious event in Quebec City, Canada. As more than 51% of the Canadian Physiotherapy Association membership is working in private practice, this adds even greater value to this quadrennial event. This conference emulates best-evidence practice in the marriage of research and clinical excellence by pulling together some of the best and brightest hands and minds in orthopaedic physiotherapy. Through a call for proposals that equally emphasized research, clinical excellence, and the knowledge translation link between the two, the IFOMPT mandate of clinical and academic excellence has been kept at the forefront of this year's conference. Included in this supplement are the IFOMPT 2012 keynote addresses, schedule, and abstracts. J Orthop Sports Phys Ther 2012;42(10):A1-A83. doi:10.2519/jospt.2012.0302.
JOSPT offers invited reviews of current titles. The July 2012 column includes 5 reviews of the following books: Mobilization With Movement, Modalities for Therapeutic Intervention (5th Edition), Low back Pain Clinical Management Guidelines, The Hand (4th Edition), and Strap Taping for Sports and Rehabilitation. J Orthop Sports Phys Ther 2012;42(7):662-665.
During the American Physical Therapy Association's Combined Sections Meeting in San Diego in January 2013, JOSPT recognized the authors of the most outstanding research and clinical practice manuscripts published in JOSPT during the 2012 calendar year. The 2012 JOSPT Excellence in Research Award was presented to Ivan Mulligan, Mark Boland, and Justin Payette for their paper titled "Prevalence of Neurocognitive and Balance Deficits in Collegiate Football Players Without Clinically Diagnosed Concussion." The 2012 George J. Davies-James A. Gould Excellence in Clinical Inquiry Award was presented to Richard B. Souza, Thomas Baum, Samuel Wu, Brian T. Feeley, Nancy Kadel, Xiaojuan Li, Thomas M. Link, and Sharmila Majumdar for their work titled "Effects of Unloading on Knee Articular Cartilage T1rho and T2 Magnetic Resonance Imaging Relaxation Times: A Case Series." J Orthop Sports Phys Ther 2013;43(3):115-116. doi: 10.2519/jospt.2013.0102.
JOSPT offers invited reviews of current titles. The April 2012 column includes 7 reviews of the following books: Idiopathic Scoliosis: The Harms Study Group Treatment Guide; Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines; The Scaphoid; Palpation Techniques: Surface Anatomy for Physical Therapists; The 5-Minute Sports Medicine Consult, 2nd Edition; Spine and Spinal Cord Trauma: Evidence-Based Management; and Mobile Orthopaedic Manipulative Therapy (OMT). J Orthop Sports Phys Ther 2012;42(4):393-398.
Descriptive online observational survey.
To identify the extent of thrust joint manipulation (TJM) integration into first-professional physical therapy program curricula.
The most recent survey of TJM curricula was published in 2004, with a wide variation in faculty responses noted. Since that time, faculty resources have been developed and TJM language in "A Normative Model of Physical Therapist Professional Education" from the American Physical Therapy Association has been updated, leaving the current status of TJM education in curricula unknown.
Faculty from 205 accredited physical therapy programs were invited to participate in an anonymous 35-item electronic survey during the summer of 2012.
Seventy-two percent of programs responded to the survey, with 99% of programs teaching TJM and 97% of faculty believing TJM to be an entry-level skill. Cervical spine TJM is still being taught at a lower rate than techniques for other body regions. Faculty deemed 91% and 77% of students, respectively, at or above entry-level competency for implementing TJM in their clinical practice upon graduation. Most respondents indicated that increased utilization of TJM during clinical affiliations (78%) and lab hours (78%) would be beneficial to the student's knowledge/application of TJM.
The utilization of TJM and faculty perceptions in first-professional physical therapy programs in the United States have evolved over the past decade. With TJM content more fully integrated into educational curricula, programs can now look to refine teaching strategies that enhance learning outcomes.
Editor-in-Chief Dr. Guy Simoneau recognizes the authors, associate editors, International Editorial Review Board members, and manuscript and musculoskeletal imaging reviewers who contributed to the various aspects of the Journal over the past 12 months. J Orthop Sports Phys Ther 2012;42(12):982-984. doi:10.2519/jospt.2012.0112.
JOSPT offers invited reviews of current titles. The October 2012 column includes 5 reviews of the following books: Physical Therapy Management of Low Back Pain: A Case-Based Approach; Kinesiology Taping: Fundamentals; Therapeutic Exercise: From Theory to Practice; Orthopaedic Manual Therapy Diagnosis: Spine and Temporomandibular Joints; and Pocket Orthopaedics: Evidence-Based Survival Guide.J Orthop Sports Phys Ther 2012;42(10):888-891.
JOSPT offers invited reviews of current titles. The October 2013 column includes 7 reviews of the following books: Clinical Epidemiology of Orthopedic Trauma; Core Concepts in Athletic Training and Therapy, With Web Resource; Physical Therapy of the Shoulder: Fifth Edition; Foot and Ankle Sports Medicine; Treat Your Own Knee; Why Do I Hurt? A Patient Book About the Neuroscience of Pain; and Your Fibromyalgia Workbook: A Neuroscience Approach to the Understanding and Treatment of Fibromyalgia. J Orthop Sports Phys Ther 2013;43(10):760-765. doi:10.2519/jospt.2013.43.10.760.
Editor-in-Chief Dr. Guy Simoneau recognizes the authors, associate editors, International Editorial Review Board members, and manuscript and musculoskeletal imaging reviewers who contributed to the various aspects of the Journal over the past 12 months. J Orthop Sports Phys Ther 2011;41(12):911-913. doi:10.2519/jospt.2011.0112.
JOSPT offers invited reviews of current titles. The April 2013 column includes 5 reviews of the following books: Diagnosis for Physical Therapists: A Symptom-Based Approach; FIMS Sports Medicine Manual: Event Planning and Emergency Care; Brunnstrom's Clinical Kinesiology: 6th Edition; Atlas of Anatomy: 2nd Edition; and Anatomy & Physiology Revealed.J Orthop Sports Phys Ther 2013;43(4):276-279. doi:10.2519/jospt.2013.43.4.276.
Letter to the Editor-in-Chief of JOSPT as follows:"Critical Assessment of Patient-Reported Outcome Measures" J Orthop Sports Phys Ther 2013;43(7):513-514. doi:10.2519/jospt.2013.0201.
Re: Vincent et al. Validity and sensitivity to change of patient-reported pain and disability measures for elbow pathologies. J Orthop Sports Phys Ther 2013;43(4) 263-74.
We commend the authors on this publication that provides new insight into the use and clinimetric properties of elbow-related patient reported outcome (PRO) measures. The findings on internal consistency and factor structure for the three investigated PROs are essential for the interpretation of conclusions on validity and subsequently sensitivity. Furthermore, the influence of practical characteristics also requires consideration.
Internal Consistency (IC) has an accepted Alpha (α) range of 0.70-0.951, which was not mentioned. Outside this ‘window’, low IC causes a lack of item-correlation where analysis is unjustified; while high IC may indicate ‘item-redundancy’ from too many similar items. The IC ‘window’ ensures the highly complex balance is retained between conflicting themes of ‘the items of interest and the statistical process of psychometric analysis’2. Consequently, findings that the PREE and DASH both exhibited α>0.95, questions their capacity to provide a balanced measure.
Factor Analysis (FA) examines whether all items reflect the same construct, in this case elbow function, which helps establish validity despite high item diversity2. A single-factor structure is generally required to defend using a single summated score. In contrast, multiple factors require subscales and it is not acceptable to have a single summed items-score from different factors3,4. Exploratory factor analysis preferably uses maximum likelihood extraction with subject-to-item ratios of at least n=20:1 to facilitate generalizability and reproducibility4. Subsequent confirmatory methodology is used to minimise ‘noise often prevalent among items in PROs with a maximised IC’2. Use of principal component analysis is a ‘common error by researchers which inflates the variance estimates’ and should ‘only be used when assumptions of multivariate normality are severely violated’4.
Practicality is paramount for purpose and patient satisfaction. This is achieved through high readability (Flesch levels <Grade 7), limited missing responses (<5%) and realistic times for completion (3-5 minutes) and scoring (30-60 seconds) with minimal errors5.
Clinimetrics are essential; however, critical analysis of the implications of characteristics beyond the accepted boundaries is often overlooked. Consequently, validity should be questioned for any PRO that does not conform.
Charles Philip Gabel
Jason W. Osborne and