Evidence-Based Practice Doctor of Physical Therapy Curricular Guideline Utilization: A Convergent Parallel Mixed Methods Study.

INTRODUCTION: In 2014, an expert panel from the American Physical Therapy Association Academy of Research Evidence-Based Practice (EBP) special interest group created the Doctor of Physical Therapy (DPT) EBP Curricular Guideline (EBP-CG). This study describes faculty awareness of the EBP-CG, DPT curricular alignment with its terminal objectives, EBP-CG uses, and challenges addressing the objectives. REVIEW OF LITERATURE: DPT educators frequently use core curriculum guidelines (CGs) that articulate entry-level knowledge and skills to determine competencies. No such guidelines existed for EBP in 2012 leading to the EBP-CG development to assist educators. Few CGs have been studied for their impact on content standardization. A mixed methods design was chosen to more completely describe this CG's impact. SUBJECTS: Faculty teaching EBP in US accredited DPT programs. METHODS: A mixed-methods design explored what EBP-CG objectives are addressed, to what expected mastery levels, and how faculty use the document. RESULTS: Eighty-three of 252 accredited programs completed the survey; 14 respondents were interviewed. The EBP-CG was valued and viewed as reflecting curricular content. Its 33 objectives were taught by most respondents at knowledge and practice levels with independent mastery expected for 7. Interviewees described EBP as commonly practiced through group over individual projects. More EBP curriculum credits predicted more objectives taught (R = .29, R2 = .09, P = .03) and expected for mastery (R = .28, R2 = .08, P = .04). No interviewees shared the EBP-CG with clinical partners or Directors of Clinical Education; EBP carryover from classroom to practice is unknown. DISCUSSION AND CONCLUSION: Respondents confirmed that the EBP-CG objectives were useful and consistent with curricular content. Four EBP preparation gaps were identified: 1) limited EBP-CG awareness by faculty who teach EBP, 2) use of group over independent projects to practice EBP, 3) communication gaps between academic and clinical education settings about the EBP-CG, and 4) no consensus on minimum EBP competencies.

Efficacy of Kinesio Taping and McConnell Taping Techniques in the Management of Anterior Knee Pain.

CONTEXT: Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. OBJECTIVE: To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. DESIGN: Cross-sectional design. SETTING: Clinical biomechanics laboratory. PARTICIPANTS: Ten participants (age: 20.3 [1.5] y, height: 169.9 [10.4] cm, and mass: 70.17 [13.1] kg) with anterior knee pain and no history of trauma. INTERVENTION: Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. MAIN OUTCOME MEASURES: Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges' g), 95% confidence intervals, and repeated-measures analysis of variance (P < .05) compared baseline and taping conditions during exercises for pain Visual Analog Scale and knee flexion in all exercises, hip abduction during step-down and drop jump, frontal plane projection during step-downs, and knee translation in sagittal plane during squats. RESULTS: Significant reductions in Visual Analog Scale were recorded during squats between tapes (F2.505,12.867 = 3.407, P = .04, Hedges' g = -0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14 cm, P = .01) and Kinesio taping (mean difference = 1.54 cm, P = .02) compared with baseline during squats. CONCLUSIONS: A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.

Fatty Infiltrate of the Lumbar Multifidus Muscles Predicts Return to Play in Young Athletes With Extension-Based Low Back Pain.

OBJECTIVE: To evaluate the predictive value of fatty infiltrate of the lumbar multifidus muscles (LMM) for return to play in young athletes with extension-based low back pain (EB LBP). DESIGN: Retrospective cohort study. SETTING: Hospital-based sports medicine practice. PATIENTS: Sixty-two athletes, 61.3% female, and 38.7% male, mean age 14.8 years, with a primary complaint of EB LBP who underwent magnetic resonance imaging (MRI); 46.8% had a pars interarticularis stress reaction or fracture and 53.2% were MRI negative. INTERVENTIONS: A musculoskeletal fellowship-trained radiologist reviewed MRI for all subjects and graded the degree of fatty infiltrate of the LMM, using the Goutallier classification system (GCS), at the L4/L5 and L5/S1 levels. MAIN OUTCOME MEASURE: Days to return to play after first MD visit were correlated with the amount of fatty infiltrate in the LMM measured on MRI for each subject. RESULTS: When the level of fatty infiltrate increased to a 2 or 3 on the GCS (greater than fatty streaks in the muscle), the predicted probability of return to sport decreased significantly. CONCLUSION: Our study demonstrated that athletes with EB LBP and fatty infiltrate in the LMM had lower odds of return to sport compared with athletes with normal muscle. LEVEL OF EVIDENCE: II B. CLINICAL RELEVANCE: This study provides sports medicine clinicians with a prognostic tool to help manage young athletes with EB LBP. Clinicians can make decisions regarding rehabilitation and return to play based on MRI findings.

Patient age is related to the types of physical therapy interventions provided for chronic low back pain: an observational study.

STUDY DESIGN: Retrospective analysis of a longitudinal cohort of patients treated for chronic low back pain (CLBP). OBJECTIVES: To determine whether patient age is associated with types of physical therapy interventions received for CLBP. BACKGROUND: Advancing age is associated with less positive treatment outcomes in patients with CLBP. If patient age influences a therapist's choice of interventions, it may partially explain the difference in treatment outcomes. METHODS: Data were examined in a sample of 7392 patients (62% women, 38% men; mean ± SD age, 56.7 ± 16.5 years) with CLBP. We used a generalized estimating equation to examine the probability of each subject receiving each of the individual intervention categories in the presence of the other intervention categories. RESULTS: A significant interaction between intervention category and age existed after controlling for gender, duration of symptoms, comorbidities, payer source, and functional status at initial intake (χ(2) = 130.27, df = 8, P<.0001). The changes in probability of receiving an intervention category averaged 10% as patient age increased. The probability of receiving exercise or task-specific training did not change with advancing age. The probability of receiving postural exercises, pain modalities, joint mobility techniques, ice, or McKenzie exercises decreased with advancing age. The probability of receiving augmented soft tissue mobilization and balance/mobility training increased as age increased. CONCLUSION: The impact of age on physical therapist treatment choices varies depending on the type of intervention. Other variables in addition to age may have an impact on treatment choice. Further research is needed to determine how therapists incorporate age into their clinical decision making.