-----Original Message----- From: Reynolds, Jan [mailto:[log in to unmask]] Sent: Friday, July 01, 2005 16:09 To: [log in to unmask] Subject: HOT! JULY 2005 Physical Therapy Online The July 2005 issue of PHYSICAL THERAPY is now available at www.ptjournal.org. NOTE: APTA recently migrated its Web site to a new system. Please let us know if you have any problems accessing the site. Below is a preview of the July contents. If you have any questions about PHYSICAL THERAPY, please contact managing editor [log in to unmask] PHYSICAL THERAPY has the highest impact factor among rehabilitation journals, as ranked by Journal Citation Reports. 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) -------------------------------------------------------- American Physical Therapy Association - 1111 N. Fairfax Street, Alexandria, VA, 22314. 800-999-APTA (2782). To manage the types of e-mail messages you receive from APTA, please visit www.apta.org/email.