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Subject: HOT! JULY 2005 Physical Therapy Online


The July 2005 issue of PHYSICAL THERAPY is now available at
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Below is a preview of the July contents. If you have any questions about
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TABLE OF CONTENTS  Vol. 85 No. 7 July 2005

EDITOR'S NOTE
Research Capacity Building: A True Action Agenda
Alan M Jette, PT, PhD, FAPTA
Acting Editor in Chief

Excerpt: "A broad-based coalition of rehabilitation disciplines and
consumer groups that have a compelling interest and stake in
rehabilitation and in building rehabilitation research capacity could be
a powerful vehicle for positive change and progress in tight fiscal
times...." RESEARCH REPORTS The L Test of Functional Mobility:
Measurement Properties of a Modified Version of the Timed "Up & Go" Test
Designed for People With Lower-Limb Amputations A Barry Deathe, William
C Miller Abstract  | Article Background and Purpose. Walk tests provide
essential outcome information when assessing ambulation of individuals
with lower-limb amputation and a prosthetic device. Existing tests have
limitations such as ceiling effects or insufficient challenge. The
objective of this study was to assess the reliability and validity of
data for a clinical measure of basic mobility, the L Test of Functional
Mobility (L Test). Subjects. For this methodological study, 93 people
with unilateral amputations (74% transtibial, 26% transfemoral; 78%
male, 22% female; mean age=55.9 years) were consecutively recruited from
an outpatient clinic. Twenty-seven subjects returned for retesting.
Methods. To assess concurrent validity, subjects completed the L Test,
Timed "Up & Go" Test (TUG), 10-Meter Walk Test, and 2-Minute Walk Test,
followed by the Activities-specific Balance Confidence scale, Frenchay
Activities Index (FAI), and mobility subscale of the Prosthetic
Evaluation Questionnaire (PEQ-MS). Amputation cause and level, walking
aid use, automatic stepping, and age variables were used to assess
discriminant validity. Results. Intraclass correlation coefficients were
.96 for interrater reliability and .97 for intrarater reliability, and
minimal bias existed upon retesting. The magnitude of concurrent
validity correlations (r) was very high between the L Test data and data
for other walk tests and fair to moderate between the L Test data and
data for self-report measures. The L Test discriminated between all
groups as hypothesized. Discussion and Conclusion. The L Test is a 20-m
test of basic mobility skills that includes 2 transfers and 4 turns. It
demonstrated excellent measurement properties in this study. [Deathe AB,
Miller WC. The L Test of Functional Mobility: measurement properties of
a modified version of the Timed "Up & Go" Test designed for people with
lower-limb amputations. Phys Ther. 2005;85:626-635.]

Correlation of 3-Dimensional Shoulder Kinematics to Function in Subjects
With Idiopathic Loss of Shoulder Range of Motion Peter J Rundquist,
Paula M Ludewig Abstract | Article Background and Purpose. People with
idiopathic loss of shoulder range of motion (ROM) have difficulty
completing activities of daily living. This investigation was performed
to determine the association between active glenohumeral ROM and
function and to develop a multiple regression equation to explain
variation in function in people with idiopathic loss of shoulder motion.
Subjects and Methods. This was a comparative study of 21 subjects (18
female, 3 male), using measurements of shoulder kinematics and
administration of the Shoulder Rating Questionnaire (SRQ).
Electromagnetic tracking sensors monitored the 3-dimensional position of
the scapula and humerus throughout active shoulder motions. Correlations
were performed between the active ROMs of interest and various
demographic factors and the SRQ. A multiple regression equation was
generated. Results. A multiple regression equation including
scapular-plane abduction, external rotation at the side, external
rotation at 90 degrees of abduction, and weight explained 69% of the
variation in the SRQ scores. Discussion and Conclusion. The results
suggest that active ROM can be used to predict function in people with
idiopathic loss of shoulder ROM. [Rundquist PJ, Ludewig PM. Correlation
of 3-dimensional shoulder kinematics to function in subjects with
idiopathic loss of shoulder range of motion. Phys Ther.
2005;85:636-647.]

Incidence of and Risk Factors for Falls Following Hip Fracture in
Community-dwelling Older Adults Anne Shumway-Cook, Marcia A Ciol,
William Gruber, Cynthia Robinson
Abstract| Article
Background and Purpose. Hip fracture is a major medical problem among
older adults, leading to impaired balance and gait and loss of
functional independence. The purpose of this study was to determine the
incidence of and risk factors for falls 6 months following hospital
discharge for a fall-related hip fracture in older adults. Subjects.
Ninety of 100 community-dwelling older adults (?65 years of age)
hospitalized for a fall-related hip fracture provided data for this
study. Methods. An observational cohort study used interviews and
medical records to obtain information on demographics, prefracture
health, falls, and functional status. Self-report of falls and
performance-based measures of balance and mobility were completed 6
months after discharge. Results. A total of 53.3% of patients (48/90)
reported 1 or more falls in the 6 months after hospitalization. Older
adults who fell following discharge had greater declines in independence
in activities of daily living and lower performance on balance and
mobility measures. Prefracture fall history and use of a gait device
predicted postdischarge falls. Discussion and Conclusion. Falls
following hip fracture can be predicted by premorbid functional status.
[Shumway-Cook A, Ciol MA, Gruber W, Robinson C. Incidence of and risk
factors for falls following hip fracture in community-dwelling older
adults. Phys Ther. 2005;85:648-655.]

Navicular Drop Measurement in People With Rheumatoid Arthritis:
Interrater and Intrarater Reliability Joseph A Shrader, John M Popovich
Jr, G Chris Gracey, Jerome V Danoff Abstract | Article
Background and Purpose. Navicular drop (ND) measurement may be a
valuable examination technique for patients with rheumatoid arthritis
(RA). However, no data exist on reliability for this technique in
patients with RA. The purposes of this study were: (1) to determine
interrater and intrarater reliability of ND measurements in people with
RA, (2) to compare ND values of people with RA with published normative
data, and (3) to investigate ND measurement error associated with the
use of skin markings. Subjects. Ten women (20 feet) with RA consented to
participate. Methods. Patients completed demographic and function
questionnaires. Navicular height (NH) measurements were taken by 2
physical therapists and 1 physical therapist student, following four
1-hour training sessions, using standardized methods and a digital
height gauge. Four different NH measurements were taken 3 times on each
foot by each of the 3 examiners during a morning session and then
repeated during an afternoon session on the same day. Navicular drop
values were calculated, including ND1 (as reported in the literature),
ND2 (compensating for skin error), and ND3 (single-limb stance).
Intraclass correlation coefficients (ICCs) and standard errors of
measurement (SEMs) were used to establish reliability. Results. Means
(±SD) for each ND measure for sessions 1 and 2, respectively, were as
follows: ND1=8.36±5.29 mm and 8.29±5.24 mm, ND2=9.95±5.44 mm and
9.57±5.37 mm. The ICCs (2,1 and 2,k, respectively) for all interrater
measurements ranged from .67 to .92 (SEM=2.0-3.3 mm) and from .85 to .97
(SEM=1.1-2.0 mm). The ICCs (2,1 and 2,k, respectively) for intrarater
measurements ranged from .73 to .95 (SEM=1.3-2.8 mm) and from .90 to .98
(SEM=0.7-1.6 mm). Paired t tests showed the means of ND1 and ND2 for
each examiner and for both sessions were significantly different.
Discussion and Conclusion. The results suggest that ND measurements for
people with RA can be taken reliably by clinicians with varied
experience. The ND values for our subjects were slightly greater than
reported normal values of 6 to 8 mm. Error associated with skin markings
was statistically significant for all sessions and examiners. [Shrader
JA, Popovich JM Jr, Gracey GC, Danoff JV. Navicular drop measurement in
people with rheumatoid arthritis: interrater and intrarater reliability.
Phys Ther. 2005;85:656-664.]

Case Reports

Physical Therapist Management of an Adult With Osteochondritis Dissecans
of the Knee Michael P Johnson Abstract | Article
Background and Purpose. Osteochondritis dissecans (OCD) primarily occurs
between 10 and 20 years of age. Adult patients (>20 years) tend to
respond poorly to nonsurgical management. This case report describes the
physical therapist management of an adult with OCD at the tibiofemoral
joint. Case Description. A 24-year-old woman had insidious onset of
right knee pain. Magnetic resonance imaging confirmed the diagnosis of
OCD. Interventions included iontophoresis, strengthening exercises, and
instruction in strategies to minimize loading across the knee. Outcome.
The patient received 5 intervention sessions. At discharge and 9-month
follow-up, she reported 95% function (Single Assessment Numeric
Evaluation) and no pain while performing full work duties. Discussion.
This case illustrates the process, including the use of evidence, of
making clinical decisions about the physical therapist management of an
adult with OCD. [Johnson MP. Physical therapist management of an adult
with osteochondritis dissecans of the knee. Phys Ther. 2005;85:665-675.]

Exercise Prescription for a Patient 3 Months After Hip Fracture Kathleen
K Mangione, Kerstin M Palombaro Abstract | Article Background and
Purpose. Most patients with hip fracture do not return to prefracture
functional status 1 year after surgery. The literature describing
interventions, however, does not use classic overload and specificity
principles. The purpose of this case report is to describe the use of
resistance training to improve functional outcomes in a patient
following hip fracture. Case Description. The patient was a 68-year-old
woman who had a comminuted intertrochanteric fracture of the left hip 3
months previously. She used a cane for ambulation, and her walking was
limited. The patient received 16 sessions of lower-extremity
strengthening exercises, aerobic training on a stationary bicycle,
functional training supervised by a physical therapist, and a home
stretching program. Outcome. The patient's isometric muscle force for
involved hip extension, hip abduction, and knee extension improved by
86%, 138%, and 33%, respectively; walking endurance increased by 22.5%;
balance improved by 400%; balance confidence increased by 41%; and
self-reported ability to perform lower-extremity functional activities
increased by 20%. Discussion. The authors believe that some patients can
perform comprehensive exercise programs after hip fracture and that
properly designed programs can affect patient outcomes beyond observed
impairments. [Mangione KK, Palombaro KM. Exercise prescription for a
patient 3 months after hip fracture. Phys Ther. 2005;85:676-687.]

Letters to the Editor
"I am responding to the excellent Guest Editorial by Anthony Delitto
titled "Research in Low Back Pain: Time to Stop Seeking the Elusive
'Magic Bullet'".... He lists 2 possible explanations for failure to
implement evidence in practice.... I would like to offer 3 other
possibilities for the relative absence of evidence-based practice for
benign back pain in the physical therapy community...."







Jan P Reynolds
Associate Director
Publications Dept
Managing Editor, Phys Ther
800/999-2782, ext 3182 (voice)
703/706-3169 (fax)
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