Moving past sleight of hand.

Medical care historically has had a strong association with magic, illusion, and secrecy. Although we profess to be modern healthcare practitioners, utilizing manual therapy techniques, and strive for evidence-based practice, the reality is that one of the most ubiquitous of all manual therapy techniques, manipulation, is obscured by illusive and ill-defined terminology. As a first step in moving from magician to modern clinician, we recently proposed a nomenclature intended to standardize and clarify the terminology used in describing specific manual therapy techniques, recommending the use of 6 key characteristics. The persistent obfuscations appear to be aimed at obscuring the differentiation of manipulation from mobilization. The time has come for a more precise delineation between manipulation and mobilization and to move beyond seeing these valuable interventions simply as some sleight-of-hand technique.J Orthop Sports Phys Ther 2010;40(5):253-255. doi:10.2519/jospt.2010.0105.

Conceptual model for physical therapist management of chronic fatigue syndrome/myalgic encephalomyelitis.

Fatigue is one of the most common reasons why people consult health care providers. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is one cause of clinically debilitating fatigue. The underdiagnosis of CFS/ME, along with the spectrum of symptoms that represent multiple reasons for entry into physical therapy settings, places physical therapists in a unique position to identify this health condition and direct its appropriate management. The diagnosis and clinical correlates of CFS/ME are becoming better understood, although the optimal clinical management of this condition remains controversial. The 4 aims of this perspective article are: (1) to summarize the diagnosis of CFS/ME with the goal of promoting the optimal recognition of this condition by physical therapists; (2) to discuss aerobic system and cognitive deficits that may lead to the clinical presentation of CFS/ME; (3) to review the evidence for graded exercise with the goal of addressing limitations in body structures and functions, activity, and participation in people with CFS/ME; and (4) to present a conceptual model for the clinical management of CFS/ME by physical therapists.

AAOMPT clinical guidelines: A model for standardizing manipulation terminology in physical therapy practice.

We propose describing a manipulative technique using 6 characteristics: Rate of force application: Describe the rate at which the force was applied. Location in range of available movement: Describe whether motion was intended to occur only at the beginning of the available range of movement, towards the middle of the available range of movement, or at the end point of the available range of movement. Direction of force: Describe the direction in which the therapist imparts the force. Target of force: Describe the location to which the therapist intended to apply the force. Relative structural movement: Describe which structure or region was intended to remain stable and which structure or region was intended to move, with the moving structure or region being named first and the stable segment named second, separated by the word "on." Patient position: Describe the position of the patient, for example, supine, prone, recumbent. This would include any premanipulative positioning of a region of the body, such as being positioned in rotation or side bending.

Physiotherapists' perceptions and use of medical imaging information in practice.

BACKGROUND AND PURPOSE: Physiotherapists must take responsibility for all aspects of patient care. Information from medical imaging studies can influence clinical decisions. The purpose of the present study was to gather information about physiotherapists' perceptions and use of medical imaging information in clinical practice. METHOD: A survey questionnaire was developed, validated and pilot tested. Subjects were randomly selected from a pool of licensed physiotherapists practising in four California Physical Therapy Association Districts. The survey was sent to 500 physiotherapists. Data gathered from the survey were transcribed to spreadsheets for analysis. RESULTS: One hundred and twenty participants completed and returned the survey. Information from radiographs was most frequently available, followed by MRI and CT scan information, respectively. Respondents reported more use of information from reports than from images. Respondents also indicated that it was important to be able to review medical imaging information (70%), that they use medical imaging information in their practice when it is available (83.4%), that physiotherapists have the necessary knowledge and skills to use this type of information (77.3%), and that medical imaging should be covered in entry-level educational programmes (84.2%). Respondents additionally indicated that medical imaging information could be used to understand a patient's disease process (85%), improve communication about patient care (90%), improve diagnosis, prognosis and interventions for patients (81.6%), and identify contraindications to examination and interventions (87.5%). CONCLUSIONS: Physiotherapists have access to some medical imaging information and perceive that this information could be valuable in patient care; however, not all therapists are confident in their ability to interpret this information. Curricula in entry-level physiotherapist educational programmes should include information about medical imaging.