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Background and Purpose. The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not been clearly established. The purpose of this study was to compare the effects of TAL and total-contact casting (TCC) with TCC alone on ankle muscle performance in subjects with diabetes mellitus (DM) and a neuropathic plantar ulcer. Subjects. Subjects were randomly assigned to either a TAL group (3 female and 12 male subjects) or a TCC group (4 female and 10 male subjects). Methods. Muscle performance measurements were obtained using an isokinetic dynamometer. Results. Concentric plantar-flexor peak torque decreased 31% after TAL but returned to the baseline level after 8 months. Dorsiflexor peak torque did not change in either group. Plantar-flexor passive torque at 0 degrees of dorsiflexion decreased after TAL but increased to 60% of the baseline level after 8 months. Maximal dorsiflexion angle increased 11 degrees after TAL and remained increased at 8 months. Discussion and Conclusion. The TAL resulted in an increase in ankle dorsiflexion range of motion and a temporary reduction in concentric plantarflexor peak torque and passive torque at 0 degrees of dorsiflexion. If TAL is being considered for people with DM and a neuropathic forefoot ulcer, the initial compromise in plantar-flexor muscle performance should be addressed. Key Words: Ankle, Clinical trial, Stiffness, Torque., One of the most serious complications involving patients with diabetes mellitus (DM) and associated loss of protective sensation is the development of recurrent ulcers on the plantar surface of the [...]

Background and Purpose. Understanding the factors that contribute to student satisfaction may lead to improved education in physical therapy. This study tested the extent to which variables in the personal, interpersonal, and organizational domains influence satisfaction with clinical experiences. Subjects. Physical therapist students (N = 113) in 2 phases of their clinical experiences at one private school participated. Methods. A nonexperimental design tested 3 models for predicting overall satisfaction. Students completed 3 surveys and weekly logs during 8-week-long clinical experiences. Results. The survey return rate was 96%. Overall satisfaction with the clinical experience was predicted by life satisfaction, gender, off-site events, on-site events, interaction between negative events and gender, instructor teaching skills, interaction between education phase and gender, variety, and use of selected orientation methods. Conclusion and Discussion. Overall satisfaction is predicted by variables in all 3 domains. Overall satisfaction was best explained by factors in the interpersonal domain and student gender. Causal research is needed to confirm whether satisfaction can be improved and whether the results apply to other students at other, schools. The relationships among satisfaction, performance, later job satisfaction, and career commitment need to be explored further. [Stith JS, Butterfield WH, Strube MJ, et al. Personal, interpersonal, and organizational influences on student satisfaction with clinical education. Phys Ther. 1998;78:635-645.], Key Words: Clinical education, Education: physical therapist, Professional education, Satisfaction Student. Professional education faculties should be concerned with student satisfaction as an outcome of the educational process because student satisfaction [...]

Background and Purpose. Diagnoses, to be useful, should be accurate. The purpose of this study using fictitious patients and student judges was to test the theory that diagnostic errors would occur when students saw simulated patients who were similar to previously seen simulated patients. Subjects. Sixty physical therapist (PT) students and 60 nonphysical therapist (NPT) students were studied. Subjects were assigned randomly to one of three groups. Methods. Instructions to the three groups differed in terms of rules provided for diagnoses and instructions to remember the patients. Students first diagnosed the same eight fictitious patients five times. The students then diagnosed eight new patients with similar characteristics interspersed with the original eight patients. Half of the new patients had a diagnosis different from that of the most similar old patient. Results. Students who were given a rule for diagnosis made fewer errors than students who were not given a rule. Students in the PT group took longer but made fewer errors on the critical opposite-diagnosis new cases than did students in the NPT group. Conclusion and Discussion. The results do not provide support for the theory that diagnostic errors would occur when students saw patients who were similar to previously seen patients. Students in the PT group appeared to emphasize accuracy at the expense of speed in making their diagnoses. Given the nature of the simulated patient information and the mode of presentation used in the experiment, however, the conclusion that therapists in actual practice do not make errors because of the similarity between new and previously seen patients is not yet warranted. [Norton BJ, Strube MJ. The influence of experience with a set of simulated patients on diagnosis of simulated patients not previously diagnosed. Phys Ther. 1998;78:375-385.], Key Words: Accuracy, Categorization, Clinical judgment, Diagnosis. According to Rose,[1-3] Sahrmann,[4] and the recently published Guide to Physical Therapist Practice,[5] a clinical diagnosis that is relevant to the issues commonly [...]

Background and Purpose. Reports in the surgical and rehabilitation literature suggest that patients with transmetatarsal amputations (TMAs) function well with regular shoes and a toe filler. Functional limitations, however, have not been documented in this population. The purpose of this study was to compare the function of patients with diabetes mellitus (DM) and TMA with that of age- and gender-matched control subjects. Subjects. Thirty subjects (15 subjects with DM and TMAs and 15 control subjects), with a mean age of 62.3 years (SD=9.2, range=43-83), were studied. Methods. Function was measured using the Functional Reach Test (FRT), the Physical Performance Test (PPT), walking speed for 15.2 m (50 ft), and the Sickness Impact Profile (SIP). Subjects in the TMA-DM group wore standard shoes with a toe filler. Results. The TMA-DM group scored lower (mean+standard deviation) than did the control group on all tests (FRT: 19.1 [+ or -] 8.6 vs 31.5 [+ or -] 9.1 cm [7.5 [+ or -] 3.4 vs 12.4 [+ or -] 3.6 in]; PPT: 18.7 [+ or -] 4.8 vs 24.1 [+ or -] 2.2 points [28 points possible]; walking speed: 51.5 [+ or -] 13.2 vs 75.6 [+ or -] 9.3 m/mini SIP: 17.0 [+ or -] 12.7 vs 3.7 [+ or -] 4.7). Conclusion and Discussion. Persons with DM and TMAs have considerable functional limitations. Research is needed to determine whether therapeutic footwear or other forms of rehabilitation can improve their function. [Mueller MJ, Salsich GB, Strube MJ. Functional limitations in patients with diabetes and transmetatarsal amputations. Phys Ther. 1997;77:937-943.], Key Words: Diabetes mellitus, Foot, Function, Rehabilitation. There is little data in the literature describing the functional capabilities of patients with diabetes mellitus (DM) and transmetatarsal amputations (TMAs). A TMA [...]

Background and Purpose. Limited ankle plantar-flexor moments and power during walking have been documented in several patient populations and are believed to contribute to gait deviations. The primary purpose of this study was to determine the relationship of plantar-flexor peak torque (PFPT) and dorsiflexion range of motion (ROM) to peak ankle moments and power during walking in a group of subjects without diabetes mellitus (DM) and in a group of subjects with DM and associated peripheral neuropathies. Subjects. Nineteen subjects, 9 with DM and associated peripheral neuropathies (mean age = 58 years, SD= 14, range = 35-7 5years) and 10 without DM (mean age = 57 years, SD= 11, range = 37-68 years), were evaluated. Methods. The following data were collected on all subjects. PFPT, dorsiflexion ROM, and ankle moments and power during walking (using a two-dimensional link-segment model). Hierarchical multiple regression was used for data analysis. Results. Plantar-flexor peak torque made substantial contributions to the ankle moment (40%) and ankle plantar-flexor power (53%) during walking. There also was a high correlation between PFPT and dorsiflexion ROM (r=.78) and between dorsiflexion ROM and ankle Power (r=.72). Conclusion and Discussion. Plantar-flexor peak torque and dorsiflexion ROM are interrelated and appear to be important factors that contribute to ankle plantar-flexor moments and power during walking. This finding suggests that increasing PFPT and dorsiflexion ROM may help decrease gait deviations such as decreased step length and walking speed. When increasing PFPT is not possible, the natural occurrence of limited dorsiflexion ROM may help to maximize ankle moments during walking. Further research is needed to test whether these proposed treatment strategies can have a clinically useful effect., Research investigating human walking often has been focused on kinematic variables, which describe motion without regard to the forces that cause the motion. Kinetics is the study of forces that [...]

Background and Purpose. patients with diabetes and peripheral neuropathy have a high incidence of injuries while walking. Biomechanical analysis of their walking may lead to treatments to reduce these injuries. The purpose of this study was to compare (1) the gait characteristics, (2) the plantar-flexor peak torques, and (3) the ankle range of motion of subjects with diabetes mellitus (DM) and peripheral neuropathy with those of age-matched controls. Subjects. Twenty subjects, 10 with DM and a history of peripheral neuropathy (DM group) (mean age =58 years, SD = 15, range =35-75) and 10 subjects without diabetes (NODM group) (mean age=57years, Sd=11, range=37-68), were evaluated. Methods. The following data were collected on all subjects ankle joint mobility, plantar-flexor peak torque (ankle strength), kinematics of the trunk and lower extremity during normal walking, and ground reaction forces. Moments and power at the ankle, knee, and hip during walking were calculated using a two-dimensional link-segment model, Results. The DM group subjects showed less ankle mobility, ankle moment, ankle power, velocity, and stride length during walking than the NODM group subjects A significant decrease in ankle strength and mobility appeared to be the primary factor contributing to the altered walking patterns of the DM group. Conclusion and Discussion. The DM group subjects appeared to pull their legs forward using hip flexor muscles (hip strategy) rather than pushing the legs forward using plantar-flexor muscles (ankle strategy), as seen in the NODM group subjects Implications for treatment are presented to attempt to reduce the number of injuries during walking in patients with DM and peripheral neuropathy. [Mueller MJ, Minor SD, Sahrmann SA, et at Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther 1994; 74-299-313.], Patients with diabetes and peripheral neuropathy have a high incidence of injuries during walking[1-3] and a low level of perceived safety.[1] Cavanagh et al[1] report that subjects in a group [...]

The primary purpose of this study was to investigate the influence of personality variables and contractile forces on magnitude estimates of pain unpleasantness and pain intensity during varying levels of neuromuscular electrical stimulation (NMES). Thirty volunteers, according to their scores on a preferred coping-style questionnaire, were assigned to one of two groups, one designated 'monitors' (information seekers) and the other designated 'blunters' (information avoiders). All subjects were administered varying levels of two types of NMES, one causing both afferent stimulation and muscle contraction and one causing only afferent stimulation. Subjects judged the intensity and unpleasantness of each current type using magnitude estimation. Data were analyzed using a 2x2x2x3 (coping style x current type x pain descriptor x current level) analysis of variance. The results indicated that the rate of increase of magnitude estimates for unpleasantness and pain intensity that corresponded to increases in current were dependent on (1) the preferred coping style of the subject, (2) whether the stimulus caused a muscle contraction, and (3) whether the subject was judging the intensity or the unpleasantness of the applied stimulus. Behavioral styles appear to affect how subjects characterize the discomfort associated with NMES, and involuntary muscle contractions contribute to the discomfort felt from NMES. These results suggest that interventions tailored to a preferred coping style may increase a subject's level of tolerance to NMES and thus provide a more beneficial treatment [Delitto A, Strube MJ, Shulman AD, Minor SD. A study of discomfort with electrical stimulation. Phys. Ther. 1992;72:410-424.], Transcutaneous neuromuscular electrical stimulation (NMES) has many therapeutic applications, including electrically induced analgesia (usually referred to as transcutaneous electrical nerve stimulation), diagnostic uses (eg, nerve conduction studies), and the rehabilitation [...]

Making Decisions Based on Group Designs and Meta-analysis The need to apply formal decision-making theories in clinical practice is becoming more apparent. One of the major decisions with which clinicians [...]