Hypothesis-oriented algorithms.

This has been a brief review of the HOAC system. Direct access and the use of other algorithms to guide this process fit well with the HOAC system. An example would be an algorithm designed to guide the physical therapist through the process of being the first evaluator of a patient with low back pain (Physical Therapy Department, US Public Health Service Hospital, San Francisco, Calif; unpublished data; 1976). The review of the system occurs at the first step (collect initial data). The examination of the patient occurs at step three. Step four would be to generate a working hypothesis that could lead either to referral to an appropriate practitioner or to continuation through the next step in this algorithm. The HOAC system requires the physical therapist to deal with defined problems and to document the actions that have been taken. This system lends itself to peer review and quality assurance questions. It helps the physical therapist to review his or her own performance, and it can help to identify weaknesses in patient management and at which step in the process these weaknesses occurred (eg, at the goal-setting level, at the hypothesis-generation level). By creating a better understanding of the performance of the physical therapist, this model can help determine which continuing education needs must be met. This method can also help us to understand the scientific basis for practice in that it requires testing of assumptions of treatment planning and goal achievement.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability of a method of measuring backward bending of the thoracolumbar spine.

The purpose of this study was to determine intertherapist and intratherapist reliability in evaluating a method of measurement for backward bending. Twenty volunteers (age range: 2 1-32) were instructed to stand facing the wall: waist, hips, and toes touching the surface. Maintaining contact points, subjects were instructed to extend backward. Using a tape measure, the linear excursion from the wall to the jugular (suprasternal) notch of each subject was measured by two examiners, during two trials. Pearsons Product coefficient of correlation applied to the measurement results ranged from 0.83-0.89. One intraexaminer's results, however, were Qn the border of acceptability (r = 0.56). A t-test applied to the means of the measurements showed no significant difference at the 0.01 level between the trials. This study suggests that the method used is a reliable tool for measuring backward bending. With increased professional interest in back extension exercises for the treatment of spinal problems, the reliable measurement of this motion has assumed greater importance. J Orthop Sports Phys Ther 1987;8(12):574-577.

Hypothesis-oriented algorithm for clinicians. A method for evaluation and treatment planning.

The purpose of this article is to introduce the hypothesis-oriented algorithm for clinicians (HOAC), which is designed to aid physical therapists in clinical decision making and patient management. The HOAC consists of two parts. The first part is a sequential guide to evaluation and treatment planning; the second part consists of a branching program used for reevaluation and the analysis of treatment effectiveness. Problem statements used in the HOAC are similar to those used for problem oriented medical records. The HOAC, however, requires therapists to state hypotheses about why the problems exist and to generate criteria that can be used to test the hypotheses. The benefits of the HOAC are that therapists must clearly state problems in a consistent manner, generate and list hypotheses and test criteria, develop treatment strategies and methods based solely on the hypotheses, and systematically review treatment. The rationale for treatment is identified clearly in the algorithm, facilitating the identification of inappropriate treatments (ie, those not related to the hypotheses). In addition, the branching program is used to identify where in the treatment process failures may be occurring and when a therapist needs to make a referral or seek assistance from a colleague.

Evaluation of sensory nerve conduction velocity testing of the superficial radial nerve.

The purposes of this study were to evaluate the methods for examining the superficial radial nerve and to compare velocities and amplitudes of responses based on electrode shape and placement and site of stimulation. We selected 51 subjects with a mean age of 37 years from a healthy group. Twenty additional subjects with a mean age of 28 were also examined. Nerve conduction was done by stimulating over the dorsal forearm and lateral arm and recording from the superficial radial nerve where its branches cross the extensor pollicis longus tendon. The second group of subjects were stimulated at the same site and also at the elbow. Recording was done with a rectangular-shaped electrode placed in the area between the extensor pollicis longus and the extensor pollicis brevis tendons. We found a mean conduction velocity of 61 m/sec +/- 4.91 in the first group with a mean amplitude of response of 36.7 microV +/- 11.7 when we stimulated at the forearm site and 4.06 microV +/- 6.75 when we stimulated at the lateral arm site. In the second group of subjects, conduction velocity from lateral arm to forearm site was 63 m/sec +/- 4.50; from the lateral arm to elbow, 66 m/sec +/- 10.4; and from the elbow to the forearm site, 64 m/sec +/- 9.71. Amplitudes of response were 43.8 microV +/- 14.45 at the forearm stimulation site, 18.06 +/- microV +/- 7.37 at the elbow site, and 6.7 microV +/- 4.25 at the lateral arm site. We compared the mean velocities from the two methods and found no significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Charcot-Marie-Tooth disease: case report of electroneuromyographic abnormalities.

This patient showed many of the major clinical signs and electroneuromyographic features found in Charcot-Marie-Tooth disease. Electroneuromyographic examination revealed the characteristic severe slowing of conduction velocity and neuropathic muscle potentials. The electromyographic abnormalities correlated fairly well with muscle function, although muscle strength in general was surprisingly stronger than was anticipated. Goodgold and Eberstein have noted that dramatic slowing of conduction velocity cannot be directly related to severity of clinical symptoms. This patient seemed to demonstrate this principle.