Analysis of pain behavior profiles and functional disability in outpatient physical therapy clinics.

STUDY DESIGN: Descriptive, ex post facto. OBJECTIVES: To determine the proportion of physical therapy outpatients with pain who exhibit various pain behavior profiles, and to determine whether there are differences in functional disability across the profiles. BACKGROUND: Physical therapists treat many patients who have chronic pain. Research suggests that early identification and multidisciplinary treatment are effective and economical for these patients. The Multidimensional Pain Inventory (MPI) and the Pain Disability Index (PDI) are potential screening tools that could be used in physical therapy clinics to determine which patients should be referred for multidisciplinary treatment. METHODS AND MEASURES: MPI and PDI data were gathered on 57 physical therapy outpatients (mean age 44.3 +/- 14.5 years, 22 men and 35 women) with pain of 3 or more months duration. ANOVA was used to analyze differences in mean PDI scores across the MPI profiles. RESULTS: Of all patients, 42.1% fit the Adaptive Coper profile, 29.8% fit the Interpersonally Distressed profile, and 28.1% fit the Dysfunctional profile. There were significant differences in PDI scores among profile groups. Post hoc analysis showed that the PDI scores of the Adaptive Coper and Interpersonally Distressed groups were different from the Dysfunctional group, but that there was no difference between the Adaptive Coper and Interpersonally Distressed groups. CONCLUSIONS: Many patients in outpatient physical therapy settings exhibit behavioral, affective, and cognitive characteristics associated with chronic pain. Thirty-three patients (57.9%) had MPI profiles (interpersonally distressed and dysfunctional) that suggest they might benefit from multidisciplinary treatment.

An objective measurement technique for posterior scapular displacement.

Contemporary shoulder rehabilitation programs emphasize scapular control in the treatment of shoulder pathology. In addition, scapular winging and scapular tipping are often cited as key components to both the evaluative and rehabilitative phase of treatment. However, the lack of objective measurement procedures makes clinical evaluation of these phenomena difficult. The purpose of this project was to develop a reliable technique to quantify posterior scapular displacement (direction of scapular movement for winging and/or tipping). Forty healthy subjects (21 males, 19 females) who reported no current shoulder pain participated in this study. A measurement instrument was designed to quantify, to the nearest whole degree of motion, the posterior displacement of the inferior angle of the scapula from the posterior thorax. Subjects' scapulae were each measured two times without holding weight (unweighted position) and two times while the subjects held 10% of their body weight (weighted position). During all trials, two testers were blinded from the measurement readings. Intraclass correlation coefficients (ICC) were calculated based on a repeated measure analysis of variance to determine intertester and intratester reliability. The standard error of measurement (SEM) was used to determine the measurement error. Intratester within-day reliability ICCs ranged from 0.97 to 0.98, and SEM ranged from 0.6 to 1.1 degrees. Intertester within-day reliability ICCs ranged from 0.92 to 0.97, and SEM ranged between 1.1 and 1.7 degrees. None of the calculated p values for intratester and intertester reliability were statistically significant (p < 0.05). We conclude that this measurement technique is a reliable method to quantify posterior scapular displacement. Further research utilizing this measurement technique is recommended.

A reliability study of measurement techniques to determine static scapular position.

Current shoulder rehabilitation programs encourage scapular stabilization components although, to date, no scientific studies have evaluated changes in scapular position following such rehabilitation. Four different measurement methods of scapular position have been reported in the literature. The purpose of this study was to examine the intratester and intertester reliability of these four methods and to also examine if significant differences exist in scapular position between dominant and nondominant extremities. Thirty-two subjects volunteered for this study. Intraclass correlation coefficients (ICC) revealed acceptable intratester reliability (ICC = 0.81-0.95) for all measurement methods. However, while one method also proved to be acceptable (ICC = 0.91-.92) for intertester measurements, the other three methods were unacceptable (ICC = 0.18-0.69). One tester reported significant differences in scapular position of the dominant and nondominant extremities when using the most reliable method. The second tester found no significant differences with either method. Future research is recommended to reexamine reliability of these methods and measure subjects with shoulder pathology.

Athletic trainer utilization in sports medicine clinics.

Increased use of athletic trainers in sports medicine clinics has created a need for information related to actual and ideal use of these professionals in these settings. The purposes of this study were to 1) describe the characteristics of sports medicine clinics and their personnel, 2) determine whether there were differences between opinions of certified athletic trainers (ATCs), physical therapists (PTs), and professionals with dual credentials (PT/ATCs) about the ideal role of the ATC in sports medicine clinics, and 3) determine whether there were differences in actual usage of ATCs between states with and without athletic training laws. Subjects included 46 PTs, 43 PT/ATCs, and 73 ATCs from six different states. A questionnaire ascertained opinions about ideal ATC utilization and about current practice of ATCs with respect to 28 different clinical procedures. For 27 of the 28 procedures, there were significant differences of opinion about ideal ATC utilization between individuals with the three credentials. No significant differences in actual athletic trainer use in sports medicine clinics were found between states with and without athletic training laws.

Facilitating Cervical Flexion Using a Feldenkrais Method: Awareness through Movement.

Feldenkrais methods appear to be gaining popularity and utilization by physical therapists. The need for scientific justification of their usage is indicated. The purpose of this study was to quantify the results of a Feldenkrais method-Awareness Through Movement-involving a neck flexion task. The study examined 30 normal subjects to determine if a Feldenkrais Awareness Through Movement sequence would result in an increase in neck flexion range of motion and if the subjects would indicate a significantly lower level of perceived effort posttest. Measurements of range of motion were taken using a gravity-based cervical range of motion goniometer. The subjects recorded their perceived efforts on a visual analogue scale. The range of motion data were analyzed using a one-way ANOVA. The visual analogue scale data were analyzed with a Mann-Whitney U test. The data supported both hypotheses. Based on these findings, further investigation of Feldenkrais methods in the treatment of patients appears warranted. J Orthop Sports Phys Ther 1992;16(1):25-29.

The diagonal medial plica: an underestimated clinical entity.

Patellar plical syndrome is a commonly reported, yet controversial entity. Arguments exist as to which component of the patella plica is most commonly involved clinically. The authors describe a plical structure which is seldom identified as a source of pathology. This structure, however, can be a primary source of pain accompanying extensor mechanism dysfunction. The aforementioned structure has been identified via arthroscopic technique, cadaveric dissection, and by palpation during clinical examinations. Conservative and surgical management is discussed.J Orthop Sports Phys Ther 1988;9(9):305-309.

Survey of scholastic athletic health care and sports medicine clinics.

The increasing number of athletes requiring health care has spurred the growth of the development of sports medicine clinics. The diversity of such clinics is readily apparent. These clinics primarily function to provide evaluative and rehabilitative measures to all groups of athletic participants. Scholastic health care for athletic participants has not proceeded in a similar pattern. Sports medicine clinics are not effectively meeting the needs of the scholastic athlete, primarily because of location and financial limitations. This survey was conducted to collect information to further delineate the problems associated with scholastic health care of athletic participants. It appears that sports medicine clinics are manned by several levels of health care professionals. Scholastic athletes are least adequately covered by insurance and also suffer from being within a somewhat isolated environment. The need for on-field care and follow-up care within the school system remains a key problem associated with scholastic health care. Further research into the relationship of insurance policies which will adequately meet the needs of the scholastic population must be pursued. J Orthop Sports Phys Ther 1983;5(2):78-81.

The construction and implementation of functional progressions as a component of athletic rehabilitation.

Physical therapists are becoming increasingly visible as contributing members of sports medicine teams. Secondary to this public awareness, many physical therapists with minimal athletic backgrounds may be called upon to prepare a seriously injured athlete for competition. It is the purpose of this paper to introduce the physical therapists to the construction, implementation, and benefits of functional progressions as utilized as an augmentation to athletic rehabilitation.J Orthop Sports Phys Ther 1983;5(1):14-19.