Proposing six criteria to improve reproducibility of "usual care" interventions in back pain trials: a systematic review.

OBJECTIVES: The aim of this study is to determine how usual care is defined in clinical trials for low back pain and the components of care that inform its definition. Six components were proposed and assessed for inclusion: type of practitioner providing care, type of self-management education, addressing physical activity, type of medication, dose of the intervention, and reporting whether care was consistent with current guidelines. STUDY DESIGN AND SETTING: Systematic review of clinical trials published between January 1993 and June 2020. RESULTS: One hundred eighty-four studies with 37,989 pooled participants from 11 various settings were included. Only one study provided all six components; 86 (47%) studies provided at least three of six components, the most common being practitioner type, use of self-management education, and addressing physical activity. CONCLUSION: Most studies had fewer than 50% of the components, limiting reproducibility. There was wide variability in the characterization and number of definition components. Usual care interventions are poorly defined in back pain trials and limit understanding of comparator treatment effect sizes and reproducibility of interventions.

Acute Medial Plantar Fascia Tear.

A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

Direct Access to Physical Therapy Services Is Safe in a University Student Health Center Setting.

OBJECTIVES: The purpose of this retrospective descriptive study was to determine if direct access to physical therapy (PT) in a university health center placed patients at risk for adverse events. BACKGROUND: Direct access to PT is underutilized, even though it has been reported to reduce medical costs; however, there is a paucity of evidence on the clinical risks related to this practice. METHODS: The University of Colorado at Boulder instituted a direct access musculoskeletal injury clinic in 2000. A retrospective analysis was performed on patient visits to Wardenburg Student Health Center from January 1, 2001 to December 31, 2011. Descriptive statistics were analyzed for the number of new patients examined with and without a referral, documented patient adverse events, and any disciplinary or legal action against a physical therapist. RESULTS: During the 10-year data collection period, 12,976 patients accessed PT without a referral. There were no reported unidentified cases of serious medical pathology or adverse events and none of the PTs had their credentials or licenses modified or revoked for disciplinary action. CONCLUSIONS: Patients managed through direct access are at minimal to no risk for negligent care when evaluated and treated by PTs in a university student health center setting.