Impact of Concussions on Postural Stability Performance Using the Head Shake-Sensory Organization Test.

Background: A concussion is a traumatic brain injury that can result in vestibular and oculomotor dysfunctions. The Head Shake-Sensory Organization Test was developed from the original Sensory Organization Test to measure a subject's ability to maintain balance while moving their head. Purpose: The purpose of this study was to compare the performance of adults with no history of concussion to those with a history of concussion on the Head Shake-Sensory Organization Test to determine if long-standing balance deficits are present after concussion. Study Design: Cross-sectional study. Methods: Subjects with a history of concussion and healthy normal controls completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence Scale, the sensory organization test, the head shake SOT, and the Foam Head Shake-Sensory Organization test in a single testing session. Scores were analyzed for differences between the two groups. Results: Twenty-five participants (nine patients with history of concussion and 16 healthy controls; mean age, 21.08±4.10 years) completed testing. The equilibrium scores in both groups significantly decreased with more complex tasks. Furthermore, the concussion group had significantly worse equilibrium scores than the control group during the Head Shake (p = 0.007) and Foam Head Shake-Sensory Organization Test (p = 0.002) tasks but not during the Sensory Organization Test task. Conclusion: Adding head shake and foam cushion conditions to postural stability tests improves sensitivity in detecting balance deficits in individuals with a concussion. Level of Evidence: 3.

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review.

Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists' characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.

Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice.

BACKGROUND: The prevalence of Thoracic Pain (TP) is estimated to be low compared to other common musculoskeletal disorders such as nonspecific low back pain (LBP). Notably, compared to LBP, TP or referral pain to the thoracic area potentially may involve serious pathologies. Visceral referral of pain may present to the thoracic spine or anteriorly in the abdomen or chest. Rupture of the spleen in the absence of trauma or previously diagnosed disease is rare and rarely documented in emergency medicine literature. The incidence of red flags are higher in the thoracic area in comparison to the lumbar or cervical regions, but TP can also be of musculoskeletal origin and for this reason it is important to assess the origin of pain. CASE DESCRIPTION: This case report describes the clinical history, evaluation and management of a 60-year-old complaining of upper thoracic, bilateral shoulder, and right upper quadrant abdominal pain. The patient's clinical findings from a physiotherapist's assessment led to a referral to a physician to explore a potential non-musculoskeletal origin. A splenectomy was required due to a non-traumatic rupture of the spleen. After 20 days of hospitalization from the surgery, the patient returned to all normal activities of daily living. DISCUSSION AND CONCLUSION: The purpose of this current case report is to describe the clinical reasoning of a physiotherapist screening a patient who presented with thoracic pain due to a spontaneous rupture of the spleen, that resulted in a referral to another health practitioner.

Recognition of pulmonary pathology in a patient presenting with shoulder pain.

Background. Shoulder pain is a common symptom of musculoskeletal disorder about the shoulder. However, shoulder pain can also be symptomatic of other non- musculoskeletal disease. Careful assessment of the clinical presentation is essential in differential diagnosis and decisions to treat or refer.Case Description. A 56-year-old male preseted with shoulder pain and a previous diagnosis of subacromial impingement of the left shoulder. The shoulder pain increased with effort, was present at night making it difficult to sleep and became disabling for the patient in work and activities of daily living. In addition, the patient reported left thoracic pain and increasing episodes of dry coughing, shortness of breath, fever and unusual generalized fatigue. Physical examination did not reveal a musculoskeletal concern about the patient's shoulder. An increased body temperature was detected and when combined with auscultation and thorax percussion led the physiotherapist to hypothesize pulmonary involvement, later reinforced by the evocation of the patient's symptoms while measuring his peak expiratory flow.Discussion. An underlyng serious pathology can be easily masked by shoulder pain. Physiotherapists need to consider that when a patient presents with a cluster of history and physical examination findings that are negative for mechanical shoulder pain, other systems must be considered as the source of presenting symptoms. Through the identification of risk factors and red flag findings, the physiotherapist can identify the need for referral.

A Comparison of Resting Scapular Posture and the Davies Closed Kinetic Chain Upper Extremity Stability Test.

BACKGROUND: In orthopaedic practice, it is well established that weak scapular stabilizers and an unstable scapula is related to shoulder dysfunction. Faulty scapular position has been linked to decreased scapular stability and is thought to be a result of weak or unbalanced timing in the recruitment of scapulothoracic dynamic stabilizing muscles. Kibler has described a four-type classification of scapulothoracic dysfunction. Functional performance testing is used to objectively measure activities that simulate various desired activities. The reliability of assessing the four static scapular positions may be important in diagnosing shoulder dysfunction. An understanding of the scapular position and its relationship to functional performance testing is needed. PURPOSE: The purpose of this study was to determine if a static scapular test, the Kibler scapula classification, in healthy participants affects the ability to perform a closed chain functional test that involves the use of the scapula and the upper extremity, the Davies Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). A secondary analysis was performed to evaluate the reliability of a student physical therapist and an experienced physical therapist to identify scapular type by observation. STUDY DESIGN: Multicenter, single session descriptive cohort. METHODS: Sixty-one healthy participants (33 males, 28 females; mean age 24.19±2.61) completed testing across two locations in one testing session. Blood pressure and heart rate as well as height and weight were measured for each participant. Participants were classified by visual observation of Kibler scapular classification. The average number of CKUEST touches, a normalized score, and a power score were calculated for each participant. Three trials were performed and participants were required to take a 45-second rest break between each CKCUEST trial. RESULTS: One way analysis of variance (ANOVA) showed statistically significant differences in Type I and Type IV Kibler scapula classification for the CKCUEST power score, however when an ANCOVA controlled for body mass index, there was no statistically significant difference. A strong correlation r=.94 was observed between student and experienced physical therapist in evaluating all four types of Kibler scapular classification. CONCLUSIONS: Visually observed Kibler scapular position does not affect the ability to perform the Davies CKCUEST in healthy young adults. The ability to identify Kibler scapular position was reliable between student and experienced physical therapists. Additional studies are required to identify the usefulness of the Kibler scapular position classification. LEVEL OF EVIDENCE: 2b: Individual Cohort Study.

A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure.

The American Physical Therapy Association has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation, a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (assessment, behavior modification, cardiorespiratory fitness, dosage, and education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions, and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

Determining Near Point of Convergence: Exploring a Component of the Vestibular/Ocular Motor Screen Comparing Varied Target Sizes.

BACKGROUND: Near point of convergence (NPC), a component of the Vestibular Ocular Motor Screening (VOMS) assessment, may be helpful in diagnosing concussion. The VOMS uses a standardized approach to measure NPC; however, methods of screening for NPC are not standardized. PURPOSE: The purpose of this study was to determine whether four different methods of measuring NPC yielded different estimates. STUDY DESIGN: Descriptive within-subjects laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: Healthy recreational athletes participated in a comparison of 4 commonly used methods of measuring NPC: a 12-point font target, the VOMS (14-point font target), the tip of a black pen, and the Bernell VergelTM device (9-point font target). The order of the presentation of the 4 targets was randomized. RESULTS: Seventy-five participants (59 females, 16 males; mean [SD] age=21.0 [6.12] years) completed 3 trials. The mean (SD) of the 900 NPC measurements was 7.11 (3.67) cm. Measurements for all targets had excellent reliability (r=0.94 to 0.98). In a comparative analysis, participant age was associated with NPC (p<0.01) and was covaried. The NPCs derived from both the 12-point and 14-point font targets were smaller than NPCs from the tip of the black pen and the 9-point font device (p<0.01). Measurements between the tip of the black pen and the 9-point font device (p=0.25) and between the 12-point and 14-point font targets (p=0.84) did not differ. CONCLUSIONS: The method used to measure NPC as a screening test for concussion should be standardized because the estimate differs depending on the technique chosen. The current study supports previous findings that the type of target used to measure NPC should be standardized for concussion assessment. CLINICAL RELEVANCE: Screening of NPC should be standardized for concussion assessment to improve the reliability of NPC testing.

Low back pain and calf pain in a recreational runner masking peripheral artery disease: A case report.

Background: Running is one of the most popular sports worldwide due to its low costs and its beneficial impact on health. Recent evidence suggests 11% to 85% of recreational runners experience at least one running-related injury each year and most of these are related to musculoskeletal conditions. The aim of this case report is to describe the clinical decision-making process that guided a physiotherapist to suspect a non-musculoskeletal cause in a recreational runner presenting with low back pain and calf pain secondary to Peripheral Artery Disease.Case Presentation: This case report describes the clinical history, clinical exam, laboratory and imaging tests, and surgical procedure of a 65 y.o. amateur runner suffering low back pain and left calf pain for 3 months. The patient's clinical findings suggested that referral to another health-care provider was required to explore potential non-musculoskeletal sources of pain. An angioplasty was necessary to solve the patient's clinical situation.Discussion and Conclusion: In this patient case, clinical findings along with a comprehensive family and personal history, ruled out a musculoskeletal condition and implicated a vascular condition.

ELECTROMYOGRAPHIC ANALYSIS OF GLUTEAL RECRUITMENT: AN EXPLORATION OF ACTIVATION DURING JUMPING TASKS.

BACKGROUND: Inability to maintain proper alignment of the pelvis and femur due to gluteal muscle weakness has been associated with numerous lower extremity pathologies. Therefore, many lower extremity rehabilitation and injury prevention programs employ exercises that target gluteal muscle strength and activation. While information regarding muscle activation during exercises that are typically done in the beginning stages of rehabilitation is available, evidence regarding the gluteal muscle activity during more functional and advanced exercises used during later stages of rehabilitation is sparse. PURPOSE: To explore the recruitment of the gluteal muscles during jumping tasks in healthy participants to determine which jumping exercise best elicits gluteal muscle activation. STUDY DESIGN: Prospective cohort design. METHODS: Eighteen healthy recreational athletes (23.5 ± 3.8 years, 8M/10F, 67.56 ± 3.2 inches, 66.73 ± 9.5 kg) completed three trials of four jumping tasks: hurdle jump, split jump, V2 lateral jump, and cross-over jump in random order. Surface EMG electrodes were placed on each participant's bilateral gluteus medius (GMed) and maximus (GMax) to measure muscle activity during the jumping tasks. Maximal voluntary isometric muscle contraction (MVIC) was established for each muscle group in order to express each jumping task as a percentage of MVIC and allow standardized comparison across participants. EMG data were analyzed for all jumps using a root-mean-square algorithm and smoothed with a 62.5 millisecond time reference. Rank ordering of muscle activation during jumping tasks was performed utilizing the peak percent MVIC recorded during each jumping task. RESULTS: Three of the jumping tasks produced greater than 70% MVIC of the GMed muscle. In rank order from highest EMG value to lowest, these jumping tasks were: crossover jump (103% MVIC), hurdle jump (93.2% MVIC), and V2 lateral jump (84.7% MVIC). Two of the exercises recruited GMax with values greater than 70% MVIC. In rank order from highest EMG value to lowest, these jumping tasks were: hurdle jump (76.8% MVIC) and split jump (73.1% MVIC). Only the hurdle jump produced greater than 70% MVIC for both GMed and GMax muscles. CONCLUSIONS: The jumping task that resulted in greatest activation of the GMed was the crossover jump, while hurdle jump led to the greatest activation of the GMax. The high %MVIC for the GMed during the crossover jump may be attributed to lack of maximal effort or lack of motivation during performance of maximal contractions during the manual muscle testing. Alternatively, substantial co-contraction of core muscles during the crossover jumping task may have led to higher values. LEVEL OF EVIDENCE: 2b Individual Cohort Study.

A COMPARISON OF THE PAPER AND COMPUTERIZED TABLET VERSION OF THE KING-DEVICK TEST IN COLLEGIATE ATHLETES AND THE INFLUENCE OF AGE ON PERFORMANCE.

BACKGROUND: Sport-related concussion is a public concern with between 1.6 and 3.8 million sport- and recreation-related injuries occurring annually. An estimated 65% to 90% of concussed athletes show oculomotor disruption such as difficulty with saccades, accommodation, smooth pursuit, and fixation. A rapid number-naming saccade test, the King-Devick (K-D) test, has shown promising results as part of a multifaceted concussion assessment tool. PURPOSE: The purpose of the current study was to evaluate the two versions of the K-D in collegiate aged (18-24) athletes to determine the agreement between versions. A secondary purpose was to investigate the association of K-D scores with sport, sex, use of glasses or contacts, and age of the athlete. STUDY DESIGN: Descriptive laboratory study. METHODS: Division 1 NCAA collegiate athletes across ten sports were recruited to participate in baseline concussion assessments at the beginning of their respective athletic season. Correlations and multivariable logistic regression analyses were used to investigate the association of K-D scores with sex and age. RESULTS: One-hundred and nine athletes (69 males, 40 females; mean age = 20.40 ± 1.38 years) were baseline tested. There was excellent agreement (ICC=0.93, 95% CI: 0.90, 0.95) between the paper and computer version. Preseason K-D scores were statistically different (r2=0.873, p<0.05) with athletes scoring a mean of 37.58 seconds on the paper version (95% CI, 36.21, 38.96) and athletes scoring a mean of 41.48 seconds for the computerized tablet version (95% CI, 40.17, 42.91). There were no significant differences in sex, sport, or use of glasses noted for both versions. Age differences were identified; eighteen-year-old athletes took statistically longer than their peers for both K-D versions. Pairwise comparisons showed statistically significant differences between 18-year olds up to the age of 21-year-olds (p<0.05) for the computer version and statistically significant differences between 18-year olds up to 22-year-olds (p<0.05) for the paper version. CONCLUSION: This study supports the use of either version of the K-D test as a potential part of a multifaceted concussion assessment. The age of the athlete influences scores and therefore a K-D baseline should be repeated annually for collegiate athletes. Clinicians should not substitute K-D versions (computer vs. paper) in comparing baseline to a post-concussion K-D score as the scores are quite different. LEVEL OF EVIDENCE: Level 3.

Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure.

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.

EVALUATION OF VERTICAL AND HORIZONTAL SACCADES USING THE DEVELOPMENTAL EYE MOVEMENT TEST COMPARED TO THE KING-DEVICK TEST.

BACKGROUND: Oculomotor function is impaired when an individual has a concussion and as such, it is important to identify tests that are able to assess oculomotor impairment. The King-Devick (K-D) test assesses horizontal saccadic eye movement and attention. The Developmental Eye Movement (DEM) test is designed to identify oculomotor dysfunction in children. It measures both horizontal and vertical saccades. The K-D test shows promise as a concussion-screening tool and part of a multifactorial assessment. The DEM has not been tested as a concussion assessment tool, but the neuroanatomical control of horizontal and vertical saccades originates from different areas of the brain, so one might expect to see differences in performance on the K-D and DEM tests when administered to concussed patients. First, it is important to determine if performance on the DEM and K-D tests, particularly with respect to the measurement of vertical and horizontal saccades, is similar in a healthy population.Hypothesis/Purpose: The primary purpose was to evaluate the relationship between horizontal and vertical saccade tests over repeated trials in normal, healthy subjects. A secondary purpose of this study was to determine the number of trials needed to reach a performance plateau for both the DEM and K-D tests.Study Design: This study used a prospective cohort research design. METHODS: Forty-two healthy non-concussed participants (22 males, 20 females; mean age, 24.2 ± 2.92 years) completed six repeated trials of both the DEM, and then six trials of the K-D test in a single testing session. Trials within each test were performed in random order and participants were offered short rest breaks as needed between test administrations. RESULTS: Results indicated strong correlations, r=.67, or greater, between measurements of horizontal and vertical saccades. Performance plateaued on the K-D at trial three and on the DEM at trial two for both horizontal and vertical saccades. CONCLUSION: It appears that the DEM and K-D tests measure similar constructs in healthy individuals and that no additional information is provided by assessment of vertical saccades. Additional studies are required to investigate the usefulness of the DEM in concussed individuals. LEVEL OF EVIDENCE: 3: Laboratory study with repeated measures.

THE EFFECTS OF AN AQUATIC MANUAL THERAPY TECHNIQUE, AQUASTRETCH™ ON RECREATIONAL ATHLETES WITH LOWER EXTREMITY INJURIES.

BACKGROUND: When paired together, manual therapy and exercise have been effective for regaining range of motion (ROM) in multiple conditions across varied populations. Although exercise in an aquatic environment is common, research investigating manual therapy in this environment is limited. There is little evidence on AquaStretchTM an aquatic manual therapy technique, but anecdotal clinical evidence suggests its effectiveness. PURPOSE: To investigate the effects of AquaStretch™ on ROM and function in recreational athletes with self-reported lower extremity injury and pain. STUDY DESIGN: Quasi-experimental design. METHODS: Injured recreational athletes participated in a 30-minute intervention session of AquaStretch.™ Injuries ranged from ankle (sprains and overuse), knee (contusions, sprains, and overuse), and hip conditions (contusions, overuse, and pain). Before a single intervention (preintervention) and within 24 hours after the intervention (postintervention), participants completed the following patient-reported outcome instruments: the Lower Extremity Functional Scale (LEFS) and the Foot and Ankle Ability Measure (FAAM) Sports subscale. AROM measurements of the ankle, knee, and hip and the following muscle length tests were measured: Ober's test, measurement of the popliteal angle, and the modified Thomas test. Finally, the overhead deep squat test was performed as a test of function. RESULTS: Twenty-six recreational athletes with lower extremity injuries of the ankle, knee, and hip, aged 18-60 years (18 males, 8 females, mean age 27.4 years) completed the study. The overall group by time interaction for the mixed-model Generalized Estimating Equations analysis was statistically significant for the LEFS (all p<.002) and for the FAAM Sports subscale (p<.01). There were no statistically significant time (pre vs post) by group interactions for range of motion and other measures, including the Ober's test, the overhead deep squat test, popliteal angle, and the modified Thomas test for injured athletes. CONCLUSION: One session of AquaStretch™ in recreational athletes improved the patient-rated outcome measures of function specifically the LEFS and FAAM Sports subscale. These results suggest that AquaStretch™ may be an effective form of manual therapy to improve lower extremity function in injured athletes. LEVELS OF EVIDENCE: 2b, Individual Cohort Study.

RELATIONSHIPS AMONG COMMON VISION AND VESTIBULAR TESTS IN HEALTHY RECREATIONAL ATHLETES.

BACKGROUND: Disruption of the visual and vestibular systems is commonly observed following concussion. Researchers have explored the utility of screening tools to identify deficits in these systems in concussed patients, but it is unclear if these tests are measuring similar or distinct phenomena. PURPOSE: To determine the relationships between common vestibular tests including the King-Devick (K-D) test, Sensory Organization Test (SOT), Head Shake-Sensory Organization Test (HS-SOT), and Dynamic Visual Acuity (DVA) test, when administered contiguously, to healthy recreational athletes aged 14 to 24 years. STUDY DESIGN: This study used a prospective design to evaluate relationships between the K-D, SOT, HS-SOT, and DVA tests in 60 healthy individuals. METHODS: Sixty participants (30 males, 30 females; mean age, 19.9 ± 3.74 years) completed the four tests in a single testing session. RESULTS: Results did not support a relationship between any pair of the K-D, SOT, HS-SOT, and DVA tests. Pearson correlations between tests were poor, ranging from 0.14 to 0.20. As expected the relationship between condition 2 of the SOT and HS-SOT fixed was strong (ICC=0.81) as well as condition 5 of the SOT with HS-SOT sway (ICC=0.78). The test-retest reliability of all 4 tests was evaluated to ensure the relationships of the 4 tests were consistent between test trials and reliability was excellent with intraclass correlations ranging from 0.79 to 0.97. CONCLUSIONS: The lack of relationships in these tests is clinically important because it suggests that the tests evaluate different aspects of visual and vestibular function. Further, these results suggest that a comprehensive assessment of visual and vestibular deficits following concussion may require a multifaceted approach. LEVEL OF EVIDENCE: 2b: Individual Cohort Study.

Survey of methods used to determine if a patient has a deep vein thrombosis: An exploratory research report.

BACKGROUND: The use of evidence-based practice (EBP) is encouraged in the physical therapy profession, but integrating evidence into practice can be difficult for clinicians because of lack of time and other constraints. OBJECTIVE: To survey physical therapy clinical instructors and determine the methods they use for screening for deep vein thrombosis (DVT), a type of venous thromboembolism (VTE) in the lower extremities. DESIGN: Exploratory survey. METHODS: Twelve survey questions written specifically for this study were sent to a convenience sample of clinical instructors associated with seven universities across 43 states. RESULTS: Eight hundred fifty clinical instructors (22.4% response rate) completed the survey. Of those who responded, 80.5% were taught to use Homans sign to screen for a possible DVT in their entry-level education and 67.9% continued to use Homans sign in clinical practice. Regardless of post-graduate education, respondents were more likely to choose Homans sign than a clinical decision rule (CDR) to screen for a suspected DVT. Additionally, nearly two-thirds of respondents failed to correctly identify one or more of the major risk factors for developing a DVT/VTE. LIMITATIONS: The response rate was 22.4% and therefore may not fully represent the population of physical therapy clinical instructors in the United States. CONCLUSIONS: Results from this exploratory survey indicated that approximately two-thirds of physical therapy clinical instructors used outdated DVT/VTE screening methods that they were taught in their entry-level education and nearly two-thirds did not identify the major risk factors associated with DVT/VTE. These results suggest that change is necessary in physical therapy education, clinical practice, and continuing professional development to ensure a more evidenced-based identification of DVT and VTE.

Recognition of signs and symptoms of a Type 1 chondrosarcoma: a case report.

BACKGROUND: Hip pain in the absence of trauma is difficult to diagnose due to the number of structures that refer pain to the hip and thigh. When identifying the origin of pain, the ability to increase or decrease the patient's pain level with rest, posture or movement is important to determine a clinical pattern. If that pattern does not make sense, other causes of the onset of pain need to be considered. CASE DESCRIPTION: A 47-year-old male experienced intermittent hip pain for two years that varied in intensity and duration after weight-bearing activities. The patient was ultimately diagnosed with a low grade chondrosarcoma (type 1) of the right proximal femur. DISCUSSION: This case highlights the medical management of a patient eventually diagnosed with a chondrosarcoma and the post-surgical physical therapy management. It also describes the multidisciplinary care of the patient from onset of hip pain to discharge from physical therapy and illustrates the importance of recognizing atypical signs and symptoms to facilitate referral and accurate diagnosis.

Physical therapist recognition of signs and symptoms of infection after shoulder reconstruction: a patient case report.

STUDY DESIGN: Patient case report. BACKGROUND: Clinical reasoning associated with patient evaluation leads physical therapists to one of three choices: 1) treat; 2) treat and refer; or 3) refer. Patients seen postoperatively require screening for potential complications, including infection. Inconsistent or unusual signs and symptoms following orthopedic surgery should lead to consultation and referral, and modifications to the physical therapy plan of care. CASE DESCRIPTION: A 35-year-old female with Type II glenohumeral instability was referred to physical therapy 5 weeks after a capsular shift surgical procedure of the right shoulder. During the initial physical therapy examination, unexpected complaints were noted including bilateral diffuse multi-joint arthralgia as well as fatigue that significantly limited the patient's abilities and functions. These and other atypical signs were recognized by the physical therapist as indicative of a possible infection or other type of medical complication. Recognition of the atypical findings led the therapist to immediately contact the referring physician, an action which influenced the timely addition of antibiotic therapy. After antibiotic therapy was added to the medical care of the patient, she was able to fully participate in postoperative rehabilitation and successfully completed postoperative rehabilitation within the expected time frame. DISCUSSION: This case illustrates the importance of physical therapists recognizing and reporting atypical signs and symptoms during postoperative care. Prompt communication between the physical therapist and the referring physician in this case led to appropriate medical management in the addition of antibiotic therapy that facilitated patient recovery.