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Background. People with low back pain (LBP) may display an altered lumbar movement pattern of early lumbar motion compared to people with healthy backs. Modifying this movement pattern during a clinical test decreases pain. It is unknown whether similar effects would be seen during a functional activity. Objective. The objective of this study was to examine the lumbar movement patterns before and after motor skill training, effects on pain, and characteristics that influenced the ability to modify movement patterns. Design. The design consisted of a repeated-measures study examining early-phase lumbar excursion in people with LBP during a functional activity test. Methods. Twenty-six people with chronic LBP received motor skill training, and 16 people with healthy backs were recruited as a reference standard. Twenty minutes of motor skill training to decrease early-phase lumbar excursion during the performance of a functional activity were used as a treatment intervention. Early-phase lumbar excursion was measured before and after training. Participants verbally reported increased pain, decreased pain, or no change in pain during performance of the functional activity test movement in relation to their baseline pain. The characteristics of people with LBP that influenced the ability to decrease early-phase lumbar excursion were examined. Results. People with LBP displayed greater early-phase lumbar excursion before training than people with healthy backs (LBP: mean = 11.2°, 95% CI = 9.3°-13.1°; healthy backs: mean = 7.1°, 95% CI = 5.8°--8.4°). Following training, the LBP group showed a decrease in the amount of early-phase lumbar excursion (mean change = 4.1°, 95% CI = 2.4°-5.8°); 91% of people with LBP reported that their pain decreased from baseline following training. The longer the duration of LBP (β = - 0.22) and the more early-phase lumbar excursion before training (β = - 0.82), the greater the change in early-phase lumbar excursion following training. Limitations. The long-term implications of modifying the movement pattern and whether the decrease in pain attained was clinically significant are unknown. Conclusions. People with LBP were able to modify their lumbar movement pattern and decrease their pain with the movement pattern within a single session of motor skill training. [ABSTRACT FROM AUTHOR]

Background. Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. Objective. The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. Design. The design was a retrospective cohort study. Methods. Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed. Results. Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. Limitations. This study was based on commercial insurance claims data from 1 state. Conclusions. When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs. [ABSTRACT FROM AUTHOR]

Background. For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. Objective. The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. Design. This was a retrospective and observational study. Methods. An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. Results. Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. Limitations. Self-report, clinician memory, and convenience sampling are limitations of this type of survey research. Conclusions. The extremely high prevalence of IPSB among physical therapist professionals warrants practitioner and student education as well as clear workplace policy and support. [ABSTRACT FROM AUTHOR]

Background. Balance problems are common in children who have cerebral palsy (CP) but are active and ambulant. Control of the whole-body center of mass is critical in maintaining dynamic stability during challenging mobility tasks, such as clearing an obstacle while walking. Objective. The objective of this study was to compare trunk and lower limb kinematics and center-of-mass control in children with CP and those in children with typical development during obstacle crossing. Design. This was a cross-sectional study. Thirty-four children who were 5 to 17 years of age (17 with CP and 17 with typical development) and matched in age and height completed 2 gait trials involving crossing a 10-cm obstacle. Methods. Three-dimensional kinematic and kinetic data were captured with a general-purpose 3-dimensional motion tracking system and forceplates. Trunk data were captured with a validated model. Results. All children cleared the obstacle with similar hip and knee kinematics, step length, and single-support duration. In children with CP, step width was increased by 4.81 cm, and center-of-mass velocity was significantly slower at lead limb toe-off (0.31 m/s) and during lead limb clearance (0.2 m/s). Children with CP showed altered trunk and pelvis movement, characterized by significantly greater pelvic obliquity, pelvic tilt, and trunk rotation throughout the task, increased lateral trunk lean during lead limb crossing (37°), and greater sagittal trunk movement as the trail limb crossed (5.1°). Limitations. The study was not powered to analyze differences between children with diplegia and those with hemiplegia. Conclusions. Children with CP required greater adjustments at the trunk and pelvis to achieve successful obstacle crossing. The increase in trunk movement could have been compensatory for reduced stability distally or for a primary problem reflecting poor proximal control. The findings suggest that rehabilitation should focus on both proximal trunk control and distal stability to improve balance. [ABSTRACT FROM AUTHOR]

Background. Soft tissue massage and exercise are commonly used to treat episodes of shoulder pain. Objective. The study objective was to compare the effects of soft tissue massage and exercise with those of exercise alone on pain, disability, and range of motion in people with nonspecific shoulder pain. Design. This was a randomized controlled trial. Setting. The study was conducted in public hospital physical therapy clinics in Sydney, New South Wales, Australia. Participants. The study participants were 80 people with an average age of 62.6 years (SD=12.2) who were referred to physical therapists for treatment of nonspecific shoulder pain. Intervention. Participants were randomly assigned to either a group that received soft tissue massage around the shoulder and exercises (n=40) or a group that received exercise only (n=40) for 4 weeks. Measurements. The primary outcome was improvement in pain, as measured on a 100-mm visual analog scale, 1 week after the cessation of treatment. Secondary outcomes were disability and active flexion, abduction, and hand-behind-back range of motion. Measurements were obtained at baseline, 1 week after the cessation of treatment, and 12 "weeks after the cessation of treatment. Results. The between-group difference in pain scores from the baseline to 12 weeks after the cessation of treatment demonstrated a small significant difference in favor of the group receiving exercise only (mean difference= 14.7 mm). There were no significant differences between groups in any other variable. Limitations. It was not possible to mask therapists or participants to group allocation. Diagnostic tests were not used on participants to determine specific shoulder pathology. Conclusions. The addition of soft tissue massage to an exercise program for the shoulder conferred no additional benefit for improving pain, disability, or range of motion in people with nonspecific shoulder pain. [ABSTRACT FROM AUTHOR]

Background. Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome. Objective. The purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up. Design. A cross-sectional and longitudinal analysis was conducted. Methods. Baseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fearavoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses. Results. Correlations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months. Limitations. Patients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group. Conclusions. Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain. [ABSTRACT FROM AUTHOR]

Background. Pediatric physical therapy seems to reduce skull deformation in infants with positional preference. However, not all infants show improvement. Objective. The study objective was to determine which infant and parent characteristics were related to responses to pediatric physical therapy in infants who were 2 to 4 months old and had positional preference, skull deformation, or both. Design. This was a prospective cohort study. Methods. Infants who were 2 to 4 months old and had positional preference, skull deformation, or both were recruited by pediatric physical therapists at the start of pediatric physical therapy. The primary outcome was a good response or a poor response (moderate or severe skull deformation) at 4.5 to 6.5 months of age. Potential predictors for responses to pediatric physical therapy were assessed at baseline with questionnaires, plagiocephalometry, and the Alberta Infant Motor Scale. Univariate and multiple logistic regression analyses with a stepwise backward elimination method were performed. Results. A total of 657 infants participated in the study. At follow-up, 364 infants (55.4%) showed a good response to therapy, and 293 infants (44.6%) showed a poor response. Multiple logistic regression analysis resulted in the identification of several significant predictors for a poor response to pediatric physical therapy at baseline: starting therapy after 3 months of age (adjusted odds ratio [aOR]=1.50, 95% confidence interval [95% CI]=1.04–2.17), skull deformation (plagiocephaly [aOR=2.64, 95% CI=1.67–4.17] or brachycephaly [aOR=3.07, 95% CI=2.09–4.52]), and a low parental satisfaction score (aOR=2.64, 95% CI=1.67–4.17). A low parental satisfaction score indicates low parental satisfaction with the infant’s head shape. Limitations. Information about pediatric physical therapy was collected retrospectively and included general therapy characteristics. Because data were collected retrospectively, no adjustment in therapy for individual participants could be made. Conclusions. Several predictors for responses to pediatric physical therapy in infants who were 2 to 4 months old and had positional preference, skull deformation, or both were identified. Health care professionals can use these predictors in daily practice to provide infants with more individualized therapy, resulting in a better chance for a good outcome. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Background. Exercise is known to reduce disability and improve quality of life in people with Parkinson disease (PD). Although barriers to exercise have been studied in older adults, barriers in people with chronic progressive neurological diseases, such as PD, are not well defined. Objective. The purpose of this study was to identify perceived barriers to exercise in people with PD. Design. The study had a cross-sectional design. Methods. People who had PD, dwelled in the community, and were at stage 2.4 on the Hoehn and Yahr scale participated in this cross-sectional study (N=260; mean age=67.7 years). Participants were divided into an exercise group (n=l64) and a nonexercise group (n=96). Participants self-administered the barriers subscale of the Physical Fitness and Exercise Activity Levels of Older Adults Scale, endorsing or denying specific barriers to exercise participation. Multivariate logistic regression analysis was used to examine the contribution of each barrier to exercise behavior, and odds ratios were reported. Results. Three barriers were retained in the multivariate regression model. The nonexercise group had significantly greater odds of endorsing low outcome expectation (ie, the participants did not expect to derive benefit from exercise) (odds ratio [OR] = 3.93, 95% confidence interval [CI] = 2.08-7.42), lack of time (OR=3-36, 95% CI= 1.55-7.29), and fear of falling (OR=2.35, 95% CI=1.17-4.71) than the exercise group. Limitations. The cross-sectional nature of this study limited the ability to make causal inferences. Conclusions. Low outcome expectation from exercise, lack of time to exercise, and fear of falling appear to be important perceived barriers to engaging in exercise in people who have PD, are ambulatory, and dwell in the community. These may be important issues for physical therapists to target in people who have PD and do not exercise regularly. The efficacy of intervention strategies to facilitate exercise adherence in people with PD requires further investigation. [ABSTRACT FROM AUTHOR]

Background. Paresis acquired in the intensive care unit (ICU) is common in patients who are critically ill and independently predicts mortality and morbidity. Manual muscle testing (MMT) and handgrip dynamometry assessments have been used to evaluate muscle weakness in patients in a medical ICU, but similar data for patients in a surgical ICU (SICU) are limited. Objective. The purpose of this study was to evaluate the predictive value of strength measured by MMT and handgrip dynamometry at ICU admission for in-hospital mortality, SICU length of stay (LOS), hospital LOS, and duration of mechanical ventilation. Design. This investigation was a prospective, observational study. Methods. One hundred ten patients were screened for eligibility for testing in the SICU of a large, academic medical center. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses, and laboratory data were collected. Measurements were obtained by MMT quantified with the sum (total) score on the Medical Research Council Scale and by handgrip dynamometry. Outcome data, including in-hospital mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation, were collected for all participants. Results. One hundred seven participants were eligible for testing; 89% were tested successfully at a median of 3 days (25th–75th percentiles3–6 days) after admission. Sedation was the most frequent barrier to testing (70.6%). Manual muscle testing was identified as an independent predictor of mortality, SICU LOS, hospital LOS, and duration of mechanical ventilation. Grip strength was not independently associated with these outcomes. Limitations. This study did not address whether muscle weakness translates to functional outcome impairment. Conclusions. In contrast to handgrip strength, MMT reliably predicted in-hospital mortality, duration of mechanical ventilation, SICU LOS, and hospital LOS. [ABSTRACT FROM AUTHOR]

Background. Little evidence exists regarding parameter selection for hypoalgesia using interferential therapy (IFT). Objective. This study investigated segmental and extrasegmental hypoalgesic effects of different IFT parameter combinations upon experimentally induced pressure pain threshold (PPT) in pain-free volunteers. Design. The participants were randomly assigned to 6 groups: control, placebo, bipolar constant amplitude modulation frequency (AMF), bipolar sweep AMF, quadripolar constant AMF, and quadripolar sweep AMF. Setting. The study was conducted in a university laboratory. Participants. One hundred eighty adults who were healthy and pain-free participated in the study. Intervention. Interferential therapy was delivered to all groups at high, to-tolerance intensity and at high AMF. Stimulation to the dominant forearm was delivered for 30 minutes, with monitoring for a further 30 minutes. Measurements. Pain pressure threshold was measured at the area of first dorsal interosseous muscle of the dominant and nondominant hands (segmental measurements) and over the tibialis anterior muscle (extrasegmental measurement) at baseline and at 10-minute intervals using a pressure algometer. Square root transformed PPT data were analyzed using repeated-measures analysis of variance. Results. There was a significant change in PPT over time, but no significant between-subjects difference in segmental or extrasegmental PPT between any of the IFT groups and the placebo or control group. Thus, IFT delivered in any of these parameter combinations did not significantly affect the PPT of pain-free participants compared with the control or placebo group. Limitations. Success of blinding was not evaluated. Conclusions. This study showed that IFT delivered at high, to-tolerance intensity and high AMF does not produce significant segmental and extrasegmental hypoalgesic effects on PPT in participants who were healthy compared with a control or placebo group. Further research is warranted to investigate the hypoalgesic effect of different IFT parameter combinations and to explain its possible mechanism of action. [ABSTRACT FROM AUTHOR]

Background. The benefits of exercise for reducing disability in people with Parkinson disease (PD) are becoming more evident. Optimal benefit, however, requires regular and sustained participation. Factors associated with engaging in regular exercise have received little scientific scrutiny in people with PD. Objective. The purpose of this study was to explore factors associated with exercise behavior in patients with PD using the International Classification of Functioning, Disability and Health (ICF) as a guiding framework. Design. This was a cross-sectional study. Methods. The participants in this study were 260 patients with PD from 4 institutions. Participants were designated as "exercisers" or "non-exercisers" based on responses to the Stages of Readiness to Exercise Questionnaire. Exercise status was validated using the Physical Activity Scale for the Elderly and an activity monitor. Factors potentially associated with exercise behavior included measures of body structure and function, activity, participation, environmental factors, and personal factors. Their relative contributions were analyzed using logistic regression and quantified with odds ratios. Results. One hundred sixty-four participants (63%) were designated as exercisers. Participants with high self-efficacy were more than twice as likely to engage in regular exercise than those with low self-efficacy (adjusted odds ratio=2.34, 95% confidence interval=1.30-4.23). College educated and older participants also were more likely to exercise. Disabling influences of impairments, activity limitations, and participation restrictions were not associated with exercise behavior. Limitations. The cross-sectional nature of the study limited the ability to make causal inferences. Conclusions. Self-efficacy, rather than disability, appears to be strongly associated with whether ambulatory, community-dwelling people with PD exercise regularly. The results of this study suggest that physical therapists should include strategies to increase exercise self-efficacy when designing patient intervention programs for patients with PD. [ABSTRACT FROM AUTHOR]

Background. The Stair Climb Power Test (SCPT) is a functional test associated with leg muscle power in older people. Objective. The purposes of this study were to compare the results of the SCPT in people with chronic obstructive pulmonary disease (COPD) and people who were healthy and to explore associations of the SCPT with muscle strength (force-generating capacity) and functional performance. Design. The study was a cross-sectional investigation. Methods. Twenty-one people with COPD and a predicted mean (SD) percentage of forced expiratory volume in 1 second of 47.2 (12.9) and 21 people who were healthy and matched for age, sex, and body mass were tested with the SCPT. Knee extensor and flexor muscle torque was assessed with an isokinetic dynamometer. Functional performance was assessed with the Timed "Up & Go" Test (TUG) and the Six-Minute Walk Test (6MWT). Results. People with COPD showed lower values on the SCPT (28%) and all torque measures (~ 32%), except for eccentric knee flexor muscle torque. In people with COPD, performance on the TUG and 6MWT was lower by 23% and 28%, respectively. In people with COPD, the SCPT was moderately associated with knee extensor muscle isometric and eccentric torque (≥r .46) and strongly associated (r = .68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r≥.66); however, no significant relationship between the SCPT and measures of functional performance was found. Limitations. The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings. Conclusions. The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT is only moderately associated with muscle torque and thus cannot be used as a simple surrogate for muscle strength in people with COPD. [ABSTRACT FROM AUTHOR]

Background. Neuromuscular electrical stimulation (NMES) has demonstrated efficacy in improving quadriceps muscle strength (force-generating capacity) and activation following knee replacement and ligamentous reconstruction. Yet, data are lacking to establish the efficacy of NMES in people with evidence of early radiographic osteoarthritis. Objective. The purpose of this study was to determine whether NMES is capable of improving quadriceps muscle strength and activation in women with mild and moderate knee osteoarthritis. Design. This study was a randomized controlled trial. Methods. Thirty women with radiographic evidence of mild or moderate knee osteoarthritis were randomly assigned to receive either no treatment (standard of care) or NMES treatments 3 times per week for 4 weeks. The effects of NMES on quadriceps muscle strength and activation were evaluated upon study enrollment, as well as at 5 and 16 weeks after study enrollment, which represent 1 and 12 weeks after cessation of NMES among the treated participants. The Western Ontario and McMaster Universities Osteoarthritis Index and a 40-foot (12.19-m) walk test were used at each testing session. Results. Improvements in quadriceps muscle strength or activation were not realized for the women in the intervention group. Quadriceps muscle strength and activation were similar across testing sessions for both groups. Limitations. Women were enrolled based on radiographic evidence of osteoarthritis, not symptomatic osteoarthritis, which could have contributed to our null finding. A type II statistical error may have been committed despite an a priori power calculation. The assessor and the patients were not blinded to group assignment, which may have introduced bias into the study. Conclusions. Four weeks of NMES delivered to women with mild and moderate osteoarthritis and mild strength deficits was insufficient to induce gains in quadriceps muscle strength or activation. Future research is needed to examine the dose- response relationship for NMES in people with early radiographic evidence of osteoarthritis. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]