Private physical therapy practice implementation of direct referral for radiograph imaging: an administrative case report.

BACKGROUND: Prior research indicates physical therapists make appropriate, judicious diagnostic imaging referrals, but have not described how to implement imaging referral processes in organizations without an imaging department. OBJECTIVE: This administrative case report describes the implementation of a direct referral process for radiographic imaging in a private physical therapy practice. CASE DESCRIPTION: Guided by the Interactive Systems Framework, a collaborative business agreement between a physical therapist-owned practice, musculoskeletal urgent care clinic, and radiology practice provided a clinical process for physical therapists to directly refer patients for radiographic imaging. OUTCOMES: When clinically appropriate, physical therapists signed referrals for radiographic imaging that was acquired by qualified urgent care clinic staff, interpreted by a radiologist, and reported to the physical therapist. The physical therapist, urgent care clinic, and radiologist bill for the physical therapy evaluation, technical component, and professional component, respectively. In the 5 months following implementation, 5 referrals were acquired within 15 minutes, the interpretation was returned within 30 minutes, and all entities received insurance reimbursement. CONCLUSION: This clinical process allows the physical therapist to execute clinical decision making within the scope of physical therapist practice, yet expeditiously acquire imaging studies to facilitate appropriate patient care. Formal collaboration between discrete organizations provided a system to deliver the necessary imaging services.

Reliability of a Barre-Mounted Dynamometer-Stabilizing Device in Measuring Dance-Specific Muscle Performance.

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. OBJECTIVE: To assess the intra and inter-rater reliability of a barre-mounted dynamometer stabilizing device in measuring muscle performance in common dance maneuvers. METHODS: Two testers assessed muscle performance of three common dance maneuvers--développé en avant, à la secondé, and arabesque--on 11 pre-professional and professional dancers on two separate occasions to establish intra- and inter-rater reliability of the barre-mounted dynamometer stabilizing device. RESULTS: Intra-rater reliability was moderate to high and inter-rater reliability of the device was excellent, with intraclass correlation coefficients ranging from 0.527-0.851 and 0.834-0.953, respectively, for all positions. CONCLUSIONS: The barre-mounted stabilizing device shows promise in mitigating tester strength or fatigue in assessing muscle performance of dancers. Initial assessment of the device suggests further study may be indicated to improve generalizability to applications of larger-scale muscle performance screening and assessment in dancers or other athletic populations who engage in movements that require extensive hip range of motion and multi-joint stability. CLINICAL RELEVANCE: Using a portable, barre-mounted stabilizing device in assessing multi-joint lower extremity muscle performance in dancers improves consistency of testing results. Application of this testing device into wider scale screenings could assist in developing normative data for a population that is lacking.

Hip and Trunk Muscle Activity During the Star Excursion Balance Test in Healthy Adults.

CONTEXT: Dynamic balance is a measure of core stability. Deficits in the dynamic balance have been related to injuries in the athletic populations. The Star Excursion Balance Test (SEBT) is suggested to measure and improve dynamic balance when used as a rehabilitative tool. OBJECTIVE: To determine the electromyographic activity of the hip and the trunk muscles during the SEBT. DESIGN: Descriptive. SETTING: University campus. PARTICIPANTS: Twenty-two healthy adults (11 males and 11 females; 23.3 [3.8] y, 170.3 [7.6] cm, 67.8 [10.3] kg, and 15.1% [5.0%] body fat). INTERVENTION: Surface electromyographic data were collected on 22 healthy adults of the erector spinae, external oblique, and rectus abdominis bilaterally, and gluteus medius and gluteus maximus muscle of the stance leg. A 2-way repeated measures analysis of variance was used to determine the interaction between the percentage maximal voluntary isometric contraction (%MVIC) and the reach directions. The %MVIC for each muscle was compared across the 8 reach directions using the Sidak post hoc test with α at .05. MAIN OUTCOME MEASURES: %MVIC. RESULTS: Significant differences were observed for all the 8 muscles. Highest electromyographic activity was found for the tested muscles in the following reach directions-ipsilateral external oblique (44.5% [38.4%]): anterolateral; contralateral external oblique (52.3% [40.8%]): medial; ipsilateral rectus abdominis (8% [6.6%]): anterior; contralateral rectus abdominis (8% [5.3%]): anteromedial; ipsilateral erector spinae (46.4% [20.2%]): posterolateral; contralateral erector spinae (33.5% [11.3%]): posteromedial; gluteus maximus (27.4% [11.7%]): posterior; and gluteus medius (54.6% [26.1%]): medial direction. CONCLUSIONS: Trunk and hip muscle activation was direction dependent during the SEBT. This information can be used during rehabilitation of the hip and the trunk muscles.

Knee osteoarthritis: Clinical connections to articular cartilage structure and function.

Articular cartilage is a unique biphasic material that supports a lifetime of compressive and shear forces across joints. When articular cartilage deteriorates, whether due to injury, wear and tear or normal aging, osteoarthritis and resultant pain can ensue. Understanding the basic science of the structure and biomechanics of articular cartilage can help clinicians guide their patients to appropriate activity and loading choices. The purpose of this article is to examine how articular cartilage structure and mechanics, may interact with risk factors to contribute to OA and how this interaction provides guidelines for intervention choices This paper will review the microstructure of articular cartilage, its mechanical properties and link this information to clinical decision making.

Effects of lower extremity and trunk muscles recruitment on serratus anterior muscle activation in healthy male adults.

BACKGROUND: Poor activation of the serratus anterior (SA) muscle may result in abnormal shoulder rhythm, and secondarily contribute to impingement and rotator cuff tears. Sequential activation of the trunk, pelvis, and lower extremity (LE) muscles is required to facilitate the transfer of appropriate forces from these body segments to the upper extremity. Myofascial connections that exist in the body, and LE and trunk muscles (TM) activity may influence scapular and upper limb activity. The purpose of this study was to investigate the effect of simultaneous recruitment of the LE muscles and TM on the SA muscle activation when performing a forward punch plus (FPP) and six variations of the FPP exercise. STUDY DESIGN: Experimental, within-subject repeated measures. METHODS: Surface electromyographic (EMG) activity of the SA, latissimus dorsi, and external oblique muscles on the dominant side, bilateral gluteus maximus muscles, and contra-lateral femoral adductor muscles were analyzed in forward punch plus (FPP) movement and six variations in twenty one healthy male adults. The percentage of maximum voluntary isometric contraction (%MVIC) for each muscle was compared across various exercises using a 1-way repeated -measures analysis of variance with Sidak pair wise comparison as post-hoc test (p < 0.05). RESULTS: Pairwise comparisons found that the EMG activity of the serratus anterior (SA) during the FPP with contralateral closed chain leg extension (CCLE), FPP with ipsilateral closed chain leg extension (ICLE), FPP with closed chain serape effect (CS), and FPP with open chain serape effect (OS) showed significantly higher EMG activity than the FPP. CONCLUSIONS: Simultaneous recruitment of the lower extremity and trunk muscles increases the activation of the SA muscle during the FPP exercise. CLINICAL RELEVANCE: Rehabilitation clinicians should have understanding of the kinetic chain relationships between the LE, the trunk, and the upper extremity while prescribing exercises. The results of this study may improve clinicians' ability to integrate the kinetic chain model in a shoulder rehabilitation program. LEVEL OF EVIDENCE: 2b.

Short-term effects of patellar kinesio taping on pain and hop function in patients with patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have become increasingly popular; however, there has been scant research supporting its use on patients with PFPS. HYPOTHESIS: The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-term pain and single-leg hop measures as compared with sham placement of KT. STUDY DESIGN: Nonrandomized controlled clinical trial with repeated-measures design. LEVEL OF EVIDENCE: Level 3. METHODS: Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing 4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired t tests to measure improvement on a numeric pain rating scale. A 2-way, 2 × 2 analysis of variance was used to analyze the relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores. RESULTS: Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect for side was not significant. The interaction between taping condition and side was significant. This showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects' STJT distances were significantly greater for the experimental KT application than the sham application for the involved side. CONCLUSION: Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg hop function in patients with PFPS when compared with a sham application. However, improvement in STJT scores did not surpass the minimally detectable change value, and therefore, the clinical effectiveness of KT for improving single-leg hop function was not established in the current study. CLINICAL RELEVANCE: Kinesio Tape provides a viable, short-term method to control pain.

Effective therapeutic exercise prescription: the right exercise at the right dose.

The prescription of an effective therapeutic exercise program requires the right dosage of the right exercise, at the right time for that patient. The therapist must understand and apply training principles effectively in the presence of pathology, injury, or otherwise unhealthy tissue. The intervention goal is to close the gap between current performance and the desired goal or capacity. Although there may be a preferred linear path from current performance to optimal outcome, complexities of the human body, internal factors, and external variables may create barriers to this direct path. Successful programs include key program design considerations such as ensuring a stable baseline before progression, treating the right impairments and activity limitations, understanding contextual factors, considering the principles of specificity and optimal loading, and applying dosing principles. Program progression can be achieved through increases in total exercise volume and/or through manipulation of exercise challenges at the same exercise volume. Effective application of these principles will guide patients toward their goals as quickly and efficiently as possible.

A comparison of human muscle temperature increases during 3-MHz continuous and pulsed ultrasound with equivalent temporal average intensities.

STUDY DESIGN: A repeated-measure crossover design was used. The independent variable was the type of ultrasound (pulsed or continuous) and the dependent variable was intramuscular temperature. OBJECTIVE: To compare changes in intramuscular temperature resulting from the use of pulsed ultrasound versus continuous ultrasound with an equivalent spatial average temporal average (SATA) intensity. BACKGROUND: There is a lack of research on the heat-generating capabilities of pulsed ultrasound within human muscle. METHODS AND MEASURES: The subjects were 16 healthy volunteers (mean age +/- SD, 21.3 +/- 2.5 years). Each subject was treated with pulsed ultrasound (3 MHz, 1.0 W/cm2, 50% duty cycle, for 10 minutes) and continuous ultrasound (3 MHz, 0.5 W/cm2, for 10 minutes) during a single testing session. Tissue temperature returned to baseline and stabilized between treatments and treatment order was randomized. Tissue temperature was measured every 30 seconds using a 26-gauge needle microprobe inserted at a depth of 2 cm in the left medial gastrocnemius muscle. Data were analyzed using a linear mixed model. RESULTS: Treatment with continuous ultrasound produced a mean (+/-SD) temperature increase of 2.8 degrees C +/- 0.8 degrees C above baseline. Treatment with pulsed ultrasound produced a mean (+/-SD) temperature increase of 2.8 degrees C +/- 0.7 degrees C above baseline. Statistical analysis revealed no significant differences in either the extent or rate of temperature increases between the 2 modes of ultrasound application. CONCLUSION: Pulsed ultrasound (3 MHz, 1.0 W/cm2, 50% duty cycle, for 10 minutes) produces similar intramuscular temperature increases as continuous ultrasound (3 MHz, 0.5 W/cm2, for 10 minutes) at a 2-cm depth in the human gastrocnemius. Spatial average temporal average intensity is an important consideration when selecting pulsed ultrasound parameters intended to deliver nonthermal effects.