Orthopaedic Manual Physical Therapy: A Modern Definition and Description.

Currently, orthopaedic manual physical therapy (OMPT) lacks a description of practice that reflects contemporary thinking and embraces advances across the scientific, clinical, and educational arms of the profession. The absence of a clear definition of OMPT reduces understanding of the approach across health care professions and potentially limits OMPT from inclusion in scientific reviews and clinical practice guidelines. For example, it is often incorrectly classified as passive care or incorrectly contrasted with exercise-therapy approaches. This perspective aims to provide clinicians, researchers, and stakeholders a modern definition of OMPT that improves the understanding of this approach both inside and outside the physical therapist profession. The authors also aim to outline the unique and essential aspects of advanced OMPT training with the corresponding examination and treatment competencies. This definition of practice and illustration of its defining characteristics is necessary to improve the understanding of this approach and to help classify it correctly for study in the scientific literature. This perspective provides a current definition and conceptual model of OMPT, defining the distinguishing characteristics and key elements of this systematic and active patient-centered approach to improve understanding and help classify it correctly for study in the scientific literature.

How sleep can help maximize human potential: The role of leaders.

OBJECTIVE: During multi-domain operations (MDO), soldiers need the physical supremacy, cognitive dominance, and emotional resilience to help defend and win our nation's wars. Optimal sleep has been shown to boost physical performance and cognitive processing. This manuscript will discuss how recent advances in sleep science strongly argue for the integration of sleep planning into military operations. DESIGN: Review article. METHODS: We reviewed the current understanding of how sleep affects Soldier readiness, how sleep and pain are interrelated, and unique challenges to obtaining adequate sleep in military training environments. We then address solutions that can be implemented by leaders and individuals to manage warfighter fatigue and optimize unit performance. RESULTS: Since sleep is foundational to soldier health and readiness, improving warfighter fatigue management is a priority for leaders. CONCLUSION: To succeed in MDO, military personnel require physical supremacy, cognitive dominance, and emotional resilience to fight and win. Sleep science is a rapidly emerging field, and the clear implications for maximizing human performance argue strongly for more deliberate integration into military training and operations. Leaders that incorporate sleep and fatigue management into the planning and execution phases of operations will help facilitate mission priorities and prove a powerful force multiplier.

When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness.

INTRODUCTION: Physical therapy (PT) is a high-volume service that treats musculoskeletal injury and improves return-to-duty rates. Our experience suggests that no-show (NS) and patient cancellation (PC) rates increase the further appointment that is booked in the future, impede access to care, and increase the healthcare delivery costs. The article's purpose is to examine PT National Capitol Region (NCR) appointment data to inform appointment policies. METHODS: We utilized one year of retrospective Military Health System Management and Reporting Tool and Composite Health Care System Ad Hoc Data Pulls to review NCR PT appointment data to evaluate the effect of timing on NS and PC rates. RESULTS: We analyzed 797 new appointments at Walter Reed National Military Medical Center. Data revealed that 16% of patients seen within 10 days NS or PC; 22% of patients seen between 11 and 20 days NS or PC; 28% of patients seen 21 to 30 days NS or PC; and 25% of patients seen over 30 days after consultation NS or PC. We analyzed 182,134 PT appointments (all types) in the NCR. The NS rate was 11.1% (range 8.4-14.9%). CONCLUSIONS: At Walter Reed National Military Medical Center, 17% of new appointments were lost when they were booked over 20 days in advance; additionally, NS and PC rates were greatest after 20 days from consultation.

Joint mobilization forces and therapist reliability in subjects with knee osteoarthritis.

OBJECTIVES: This study determined biomechanical force parameters and reliability among clinicians performing knee joint mobilizations. METHODS: Sixteen subjects with knee osteoarthritis and six therapists participated in the study. Forces were recorded using a capacitive-based pressure mat for three techniques at two grades of mobilization, each with two trials of 15 seconds. Dosage (force-time integral), amplitude, and frequency were also calculated. Analysis of variance was used to analyze grade differences, intraclass correlation coefficients determined reliability, and correlations assessed force associations with subject and rater variables. RESULTS: Grade IV mobilizations produced higher mean forces (P<0.001) and higher dosage (P<0.001), while grade III produced higher maximum forces (P = 0.001). Grade III forces (Newtons) by technique (mean, maximum) were: extension 48, 81; flexion 41, 68; and medial glide 21, 34. Grade IV forces (Newtons) by technique (mean, maximum) were: extension 58, 78; flexion 44, 60; and medial glide 22, 30. Frequency (Hertz) ranged between 0.9-1.1 (grade III) and 1.4-1.6 (grade IV). Intra-clinician reliability was excellent (>0.90). Inter-clinician reliability was moderate for force and dosage, and poor for amplitude and frequency. DISCUSSION: Force measurements were consistent with previously reported ranges and clinical constructs. Grade III and grade IV mobilizations can be distinguished from each other with differences for force and frequency being small, and dosage and amplitude being large. Intra-clinician reliability was excellent for all biomechanical parameters and inter-clinician reliability for dosage, the main variable of clinical interest, was moderate. This study quantified the applied forces among multiple clinicians, which may help determine optimal dosage and standardize care.

Biomechanical measures of knee joint mobilization.

BACKGROUND AND PURPOSE: The purpose of this study was to quantify the biomechanical properties of specific manual therapy techniques in patients with symptomatic knee osteoarthritis. METHODS: Twenty subjects (7 female/13 male, age 54±8 years, ht 1·7±0·1 m, wt 94·2±21·8 kg) participated in this study. One physical therapist delivered joint mobilizations (tibiofemoral extension and flexion; patellofemoral medial-lateral and inferior glide) at two grades (Maitland's grade III and grade IV). A capacitance-based pressure mat was used to capture biomechanical characteristics of force and frequency during 2 trials of 15 second mobilizations. Statistical analysis included intraclass correlation coefficient (ICC(3,1)) for intrarater reliability and 2×4 repeated measures analyses of variance and post-hoc comparison tests. RESULTS: Force (Newtons) measurements (mean, max.) for grade III were: extension 45, 74; flexion 39, 61; medial-lateral glide 20, 34; inferior glide 16, 27. Force (Newtons) measurements (mean, max.) for grade IV were: extension 57, 76; flexion 47, 68; medial-lateral glide 23, 36; inferior glide 18, 35. Frequency (Hz) measurements were between 0·9 and 1·2 for grade III, and between 2·1 and 2·4 for grade IV. ICCs were above 0·90 for almost all measures. DISCUSSION AND CONCLUSION: Maximum force measures were between the ranges reported for cervical and lumbar mobilization at similar grades. Mean force measures were greater at grade IV than III. Oscillation frequency and peak-to-peak amplitude measures were consistent with the grade performed (i.e. greater frequency at grade IV, greater peak-to-peak amplitude at grade III). Intrarater reliability for force, peak-to-peak amplitude and oscillation frequency for knee joint mobilizations was excellent.