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Background: Neck pain is common and results in considerable economic burden. Deficits in motor control of the deep neck muscles are well documented in those with neck pain. The efficacy of strengthening exercises for individuals with neck pain has been established; however, it is unclear if motor control exercises offer a similar benefit. Objectives: The purpose of this manuscript is to systematically review the literature for randomized controlled trials that evaluate the outcomes for motor control exercise interventions in those with persistent neck pain. Methods: A computerized electronic search was performed to locate articles. Inclusion criteria consisted of studies that were randomized controlled trials, appeared in a peer reviewed journal, published in the English language, identified neck pain as the primary treatment focus, identified motor control exercise of the neck as the primary treatment in at least one group and included subjects who had had neck pain for 6 weeks. Two reviewers independently reviewed the articles for eligibility and results were cross-referenced. Results: The initial search of the electronic database revealed a total of 684 articles and hand searching of the reference lists revealed an additional two. Of those, 30 were selected as potentially meeting the inclusion criteria. Ultimately four articles were retained for final inclusion. Conclusions: The addition of motor control exercise to an exercise programme does not appear to be more effective than a standard exercise programme. Motor control exercise however was demonstrated to be superior to passive treatments alone. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To describe the clinical outcomes following outpatient physical therapy for postoperative rehabilitation in 4 categories of shoulder surgery. Furthermore, we sought to determine if differences in outcomes between genders existed. BACKGROUND: Improving the quality of care for patients following shoulder surgery requires an understanding of the clinical outcomes resulting from current clinical practice. METHODS: This study included 856 patients (43.7% female; mean +/- SD age, 51.8 +/- 14.2 years) who received outpatient physical therapy following shoulder surgery. Standardized methods for classification of patients to type of shoulder surgery and collection of outcome variables were used. Data were gathered from 57 therapists working in 12 clinics. Patients included had been classified into 1 of 4 surgical categories: repair of a unidirectional instability, rotator cuff repair, rotator cuff repair with a subacromial decompression, or subacromial decompression alone. Descriptive statistics were calculated for baseline characteristics of patients in each surgical category. For all patients, scores on the Disability of the Arm Shoulder and Hand (DASH) questionnaire and a numeric pain rating scale (NPRS) were obtained at the initial and final physical therapy visits, and the change between visits was calculated. Data on number of physical therapy sessions and length of stay (LOS) were collected. For each surgical category, independent-samples t tests were used to determine differences between genders for each initial and final clinical outcome of pain and disability, change scores, utilization of visits, and LOS. The percentage of patients who achieved a minimal clinically important difference (MCID) on the DASH was also determined for each surgical group. For each gender in each surgical category, paired t tests were used to determine if patients achieved significant change in pain and disability. RESULTS: Means for each clinical outcome for the initial and final pain and disability scores, change scores, and the percentage of patients that achieved an MCID are provided. Significant differences were observed between genders for clinical outcomes. In the group treated with unilateral instability repair, women reported significantly greater initial disability than men, and their DASH change scores were significantly greater. In the group that had rotator cuff repairs, women reported significantly greater disability initially and at the final follow-up. In the group that had rotator cuff repairs combined with subacrominal decompression, women reported significantly greater disability initially and greater change in DASH scores. Females also reported greater change in their pain scores than males (P<.05). There were no significant differences between men and women in the subacromial decompression group (P<.05). There were no significant differences between genders for number of physical therapy visits or LOS. Men and women in each surgical category achieved clinically meaningful and statistically significant improvement for pain and disability during treatments (P<.01). Greater than 75% of patients achieved an MCID (15 points) on the DASH score in each surgical category (range, 75.6%-94.5%). CONCLUSIONS: Differences were observed between men and women in 4 postoperative surgical categories in each of the clinical outcomes but not for number of physical therapy visits or LOS. Statistically significant and clinically meaningful pain and disability improvements were reported for each gender within each shoulder category. Results from this study may help therapists estimate the prognosis of males and females receiving nonstandardized postoperative physical therapy in 4 different shoulder surgical categories. LEVEL OF EVIDENCE: Therapy, level 2b. J Orthop Sports Phys Ther 2010;40(1):20-29, Epub 7 December 2009. doi:10.2519/jospt.2010.3043. [ABSTRACT FROM AUTHOR]

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To compare the effectiveness of 2 different conservative management approaches in the treatment of plantar heel pain. BACKGROUND: There is insufficient evidence to establish the optimal physical therapy management strategies for patients with heel pain, and little evidence of long-term effects. METHODS: Patients with a primary report of plantar heel pain underwent a standard evaluation and completed a number of patient self-report questionnaires, including the Lower Extremity Functional Scale (LEFS), the Foot and Ankle Ability Measure (FAAM), and the Numeric Pain Rating Scale (NPRS). Patients were randomly assigned to be treated with either an electrophysical agents and exercise (EPAX) or a manual physical therapy and exercise (MTEX) approach. Outcomes ofinterest were captured at baseline and at 4-week and 6-month follow-ups. The primary aim (effects of treatment on pain and disability) was examined with a mixed-model analysis of variance (ANOVA). The hypothesis of interest was the 2-way interaction (group by time). RESULTS: Sixty subjects (mean [SD] age, 48.4 [8.7] years) satisfied the eligibility criteria, agreed to participate, and were randomized into the EPAX (n = 30) or MTEX group (n = 30). The overall group-by-time interaction for the ANOVA was statistically significant for the LEFS (P = .002), FAAM (P = .005), and pain (P = .043). Between-group differences favored the MTEX group at both 4-week (difference in LEFS, 13.5; 95% CI: 6.3, 20.8) and 6-month (9.9; 95% CI: 1.2, 18.6) follow-ups. CONCLUSION: The results of this study provide evidence that MTEX is a superior management approach over an EPAX approach in the management of individuals with plantar heel pain at both the short- and long-term follow-ups. Future studies should examine the contribution of the different components of the exercise and manual physical therapy programs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Changing patterns of work in the hospital setting mean different teams look after the same group of patients over the course of any given day. Shift handovers, or hand/sign-off, can give rise to miscommunication of critical information, a patient safety issue. How can we best prepare new doctors for handover? METHODS: This was a qualitative, focus-group study, exploring the views of doctors (Foundation Year, Senior House Officers, Registrars and Consultants) and night nurse practitioners, in Aberdeen, UK. RESULTS: Five focus groups were carried out with 21 participants. Using framework analysis, five main themes relevant to the task of effectively handing over, and how to best teach handover, emerged. These were: definition of handover; experience of handover as a junior doctor; perceptions of junior doctors' handover skills and attitudes; systems factors, and their interaction with individual factors; and the 'what' and the 'how' of teaching handover. CONCLUSIONS: New doctors feel unprepared for handover and are seen as poor at handing over. Certain skills are required for effective handover, but professional attitudes are also critical. The skills identified reflect those suggested in policy documents based on expert panel views. Poor systems are a barrier to effective learning and practice. Our empirical approach adds to existing knowledge by highlighting that handover is not solely a skills-based task; there are complex interactions between individual and systems factors; and junior doctors should be prepared for handover prequalification. These data can be used to plan optimal handover teaching for medical students. [ABSTRACT FROM AUTHOR]

DESIGN: Randomized clinical trial. OBJECTIVES: To determine the short-term effects of Kinesio Taping, applied to the cervical spine, on neck pain and cervical range of motion in individuals with acute whiplash-associated disorders (WADs). BACKGROUND: Researchers have begun to investigate the effects of Kinesio Taping on different musculoskeletal conditions (eg, shoulder and trunk pain). Considering the demonstrated short-term effectiveness of Kinesio Tape for the management of shoulder pain, it is suggested that Kinesio Tape may also be beneficial in reducing pain associated with WAD. METHODS AND MEASURES: Forty-one patients (21 females) were randomly assigned to 1 of 2 groups: the experimental group received Kinesio Taping to the cervical spine (applied with tension) and the placebo group received a sham Kinesio Taping application (applied without tension). Both neck pain (11-point numerical pain rating scale) and cervical range-of-motion data were collected at baseline, immediately after the Kinesio Tape application, and at a 24-hour follow-up by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The group-by-time interaction for the 2-by-3 mixed-model ANOVA was statistically significant for pain as the dependent variable (F = 64.8; P<.001), indicating that patients receiving Kinesio Taping experienced a greater decrease in pain immediately postapplication and at the 24-hour follow-up (both, P<.001). The group-by-time interaction was also significant for all directions of cervical range of motion: flexion (F = 50.8; P<.001), extension (F = 50.7; P<.001), right (F = 39.5; P<.001) and left (F = 3.8, P<.05) lateral flexion, and right (F = 33.9, P<.001) and left (F = 39.5, P<.001) rotation. Patients in the experimental group obtained a greater improvement in range of motion than thosein the control group (all, P<.001). CONCLUSIONS: Patients with acute WAD receiving an application of Kinesio Taping, applied with proper tension, exhibited statistically significant improvements immediately following application of the Kinesio Tape and at a 24-hour follow-up. However, the improvements in pain and cervical range of motion were small and may not be clinically meaningful. Future studies should investigate if Kinesio Taping provides enhanced outcomes when added to physical therapy interventions with proven efficacy or when applied over a longer period. LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2009;39(7):515-521, Epub 24 February 2009. doi:10.2519/jospt.2009.3072. [ABSTRACT FROM AUTHOR]

BACKGROUND: To date, optimal strategies for the management of patients with cervical radiculopathy remain elusive. Preliminary evidence suggests that a multimodal treatment program consisting of manual therapy, exercise, and cervical traction may result in positive outcomes for patients with cervical radiculopathy. However, limited evidence exists to support the use of mechanical cervical traction in patients with cervical radiculopathy. OBJECTIVE: The purpose of this study was to examine the effects of manual therapy and exercise, with or without the addition of cervical traction, on pain, function, and disability in patients with cervical radiculopathy. DESIGN: This study was a multicenter randomized clinical trial. SETTING: The study was conducted in orthopedic physical therapy clinics. PATIENTS: Patients diagnosed with cervical radiculopathy (N=81) were randomly assigned to 1 of 2 groups: a group that received manual therapy, exercise, and intermittent cervical traction (MTEXTraction group) and a group that received manual therapy, exercise, and sham intermittent cervical traction (MTEX group). INTERVENTION: Patients were treated, on average, 2 times per week for an average of 4.2 weeks. MEASUREMENTS: Outcome measurements were collected at baseline and at 2 weeks and 4 weeks using the Numeric Pain Rating Scale (NPRS), the Patient-Specific Functional Scale (PSFS), and the Neck Disability Index (NDI). RESULTS: There were no significant differences between the groups for any of the primary or secondary outcome measures at 2 weeks or 4 weeks. The effect size between groups for each of the primary outcomes was small (NDI=1.5, 95% confidence interval [CI]=-6.8 to 3.8; PSFS=0.29, 95% CI=-1.8 to 1.2; and NPRS=0.52, 95% CI=-1.8 to 1.2). LIMITATIONS: The use of a nonvalidated clinical prediction rule to diagnose cervical radiculopathy and the lack of a control group without treatment were limitations of this study. CONCLUSIONS: The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain, function, or disability in patients with cervical radiculopathy. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective-cohort/predictive-validity study. OBJECTIVES: To develop a clinical prediction rule (CPR) to identify patients who had sustained an inversion ankle sprain who would likely benefit from manual therapy and exercise. BACKGROUND: No studies have investigated the predictive value of items from the clinical examination to identify patients with ankle sprains likely to benefit from manual therapy and general mobility exercises. METHODS AND MEASURES: Consecutive patients with a status of post inversion ankle sprain underwent a standardized examination followed by manual therapy (both thrust and nonthrust manipulation) and general mobility exercises. Patients were classified as having experienced a successful outcome at the second and third sessions based on their perceived recovery. Potential predictor variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success. RESULTS: Eighty-five patients were included in the data analysis, of which 64 had a successful outcome (75%). A CPR with 4 variables was identified. If 3 of the 4 variables were present the accuracy of the rule was maximized (positive likelihood ratio, 5.9; 95% CI: 1.1, 41.6) and the posttest probability of success increased to 95%. CONCLUSIONS: The CPR provides the ability to a priori identify patients with an inversion ankle sprain who are likely to exhibit rapid and dramatic short-term success with a treatment approach, including manual therapy and general mobility exercises. LEVEL OF EVIDENCE: Prognosis, level 2b. J Orthop Sports Phys Ther 2009;39(3):188-200, Epub 24 October 2008. doi:10.2519/jospt.2009.2940. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to investigate the effects of a spinal thrust manipulation directed to the upper cervical segments (atlanto-occipital joint) on active mouth opening and pressure pain sensitivity in a trigeminal nerve innervated region (sphenoid bone) in women with mechanical neck pain. METHODS: Thirty-seven women, ages 21 to 50 years old (mean age, 35 +/- 8 years) with mechanical neck pain were recruited for this study. Participants were randomly assigned into 1 of 2 groups as follows: an experimental group that received a spinal manipulation of the atlanto-occipital joint and a control group that received a manual contact placebo intervention. Outcomes collected were assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation and included active mouth opening and pressure pain thresholds (PPTs) over both sides of the sphenoid bone. A 2-way repeated measures analysis of variance (ANOVA) with time (pre-post) as the within subjects variable and group (control, experimental) as the between subjects variable was used to examine the effects of the intervention. The hypothesis of interest was group-time interaction. RESULTS: The ANOVA showed a significant effect for time (F = 23.1; P < .001) and an interaction between group and time (F = 37.7; P < .001) for active mouth opening as follows: the experimental group showed a greater improvement when compared to the control group. A large positive within-group effect size (d > 1.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group were identified. The ANOVA showed a significant interaction between group and time (F = 14.4; P < .001) for PPT levels at the sphenoid bone as follows: the experimental group showed a greater improvement when compared to the control group. A medium positive within-group effect size (d = -0.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group was found. CONCLUSIONS: Our findings suggest that the application of an atlantoaxial joint thrust manipulation resulted in an increase in active mouth opening and PPT over a trigeminal nerve distribution area (sphenoid bone) in women with mechanical neck pain. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To investigate if patients with mechanical neck pain receiving thoracic spine thrust manipulation would experience superior outcomes compared to a group not receiving thrust manipulation. BACKGROUND: Evidence has begun to emerge in support of thoracic thrust manipulation as an intervention in the management of mechanical neck pain. However, to make a strong recommendation for a clinical technique it is necessary to have multiple studies with convergent findings. METHODS AND MEASURES: Forty-five patients (21 females) were randomly assigned to 1 of 2 groups: a control group, which received electro/thermal therapy for 5 treatment sessions, and the experimental group, which received the same electro/thermal therapy program in addition to a thoracic spine thrust manipulation once a week for 3 consecutive weeks. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of treatment on pain (100-mm visual analogue scale), disability (100-point disability scale), and cervical range of motion, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction for pain. RESULTS: The group-by-time interaction effects for the ANOVA models were statistically significant for pain, mobility, and disability (P<.05), indicating greater improvements in the manipulation group for all the outcome measures. Patients receiving thoracic manipulation experienced greater improvements in pain at the fifth (final) treatment session and at the 2-week and 4-week follow-up periods (P<.001), with pain improvement scores in the manipulation group of 16.8 mm and 26.5 mm greater than those in the comparison group at the 2- and 4-week follow-up periods, respectively. The experimental group also experienced significantly greater improvements in disability with a between-group difference of 8.8 points (95% confidence interval [CI]: 7.5, 10.1; P<.001) at the fifth visit and 8.0 points (95% CI: 5.8, 10.2; P<.001) at the 2-week follow-up. CONCLUSIONS: The results of our study suggest that thoracic spine thrust manipulation results in superior clinical benefits that persist beyond the 1-month follow-up period for patients with acute neck pain. Future studies should continue to investigate the effects of thoracic spine thrust manipulation, as compared to other physical therapy interventions, in a population with mechanical neck pain. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A case series of consecutive patients referred to physical therapy with patellofemoral pain syndrome (PFPS). BACKGROUND: Physical therapists often treat patients with PFPS, yet there is currently no consensus as to the most effective management strategies. The purpose of this case series is to describe the outcomes of patients referred to physical therapy with PFPS who were treated with a multimodal approach. CASE DESCRIPTION: Five patients were treated with a combination of thrust and nonthrust manipulation directed at the joints of the lower quarter, trunk and hip stabilization exercises, patellar taping, and foot orthotics. Outcome measures used to capture change in patient status included the Numeric Pain Rating Scale, the Kujala Anterior Knee Pain Scale, the Lower Extremity Functional Scale, and the Global Rating of Change. OUTCOMES: Five patients (median age, 15 years; range, 14-50 years) with a median duration of knee pain for 8 months (range, 3-24 months) were included in this prospective case series. Four (80%) of the 5 patients demonstrated decreased pain and a clinically significant improvement in function. These gains in function were maintained at a 6-month follow-up. DISCUSSION: Although a cause-and-effect relationship cannot be inferred from a case series, the outcomes achieved by the patients are consistent with studies incorporating manual physical therapy, exercise, patellar taping, and orthotic prescription to the management of conditions of the lower extremity. Further randomized controlled trials should be performed to determine the effectiveness of this multimodal approach for the management of individuals with PFPS. LEVEL OF EVIDENCE: Therapy, level 4. [ABSTRACT FROM AUTHOR]

SYNOPSIS: The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This first commentary in a 2-part series will review principles relating to steps 1, 2, and 3 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in formulating foreground questions, searching for the best available evidence, and determining validity of results in studies of interventions for orthopaedic and sports physical therapy.J Orthop Sports Phys Ther. 2008;38(8):476-484, published online 27 June 2008. doi:10.2519/jospt.2008.2722. [ABSTRACT FROM AUTHOR]

SYNOPSIS: The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This second commentary in a 2-part series will review principles relating to steps 3 through 5 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in interpreting results, applying the evidence to patient care, and evaluating proficiency with EBP skills in studies of interventions for orthopaedic and sports physical therapy. J Orthop Sports Phys Ther. 2008;38(8):485-501, published online 27 June 2008. doi:10.2519/jospt.2008.2725. [ABSTRACT FROM AUTHOR]

Study Design. Case-control.Objective. To examine the association between adherence to the evidence-based recommendation for active physical therapy care and clinical outcomes along with subsequent healthcare utilization and charges for 1 year after completion of physical therapy.Summary of Background Data. Low back pain (LBP) is a common condition associated with high costs. Many patients with acute LBP receive physical therapy. The type of physical therapy care provided may impact subsequent healthcare costs.Methods. A retrospective review was undertaken of patients age 18-60 with acute (<90 days) LBP receiving physical therapy covered by 1 insurance provider. Adherence to the recommendation for active care was determined from billing records. Disability (Oswestry) and pain (numerical pain rating) were assessed at the beginning and completion of physical therapy. Subsequent healthcare utilization for LBP and charges were recorded from insurer's databases.Results. Four hundred and seventy-one patients were included (mean age 41.2 years [SD = 11.0], 54% female), 28.0% received adherent care. Patients receiving adherent care had fewer physical therapy visits (mean difference 1.3 visits, P < 0.05) with lower charges (nontransformed mean difference $167, P < 0.05), greater improvement in pain (mean difference 12.3%, 95% confidence interval [CI]: 3.2-21.3) and disability (mean difference 17.6%, 95% CI: 11.1-24.1). During the year after discharge, receiving adherent care was associated with a lower likelihood of receiving prescription medication (46.2% vs. 57.2%, P < 0.05), magnetic resonance imaging (MRI) (8.3% vs. 15.9%, P < 0.05), or epidural injections (5.3% vs. 12.1%, P < 0.05).Conclusion. Adherence to the recommendation for active care was associated with better clinical outcomes and decreased subsequent use of prescription medication, MRI, and injections. Improving adherence to this recommendation may present an opportunity to improve the cost-effectiveness of care for acute LBP. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine selected psychometric properties of these instruments in a cohort of patients with mechanical neck pain. DESIGN: Cohort design of 78 subjects completing self-report measures of pain, disability, and the Fear-Avoidance Beliefs Questionnaire Work (FABQW) and Physical Activity (FABQPA) subscales, as well as the Tampa Scale of Kinesiophobia (TSK) at baseline and a 2-day follow-up. Intraclass correlation coefficients were used to calculate test-retest reliability, and Cronbach's alpha was used to calculate internal consistency. Concurrent validity was analyzed between the FABQPA, FABQW, TSK, pain, and disability using Pearson correlation coefficients and hierarchical linear regression modeling. RESULTS: The FABQPA and FABQW subscales exhibited substantial test-retest reliability, whereas the TSK exhibited moderate reliability. Internal consistency was high for all measures. The FABQW subscale was the only measure that significantly contributed to the regression model for both pain and disability in this group of patients with neck pain. CONCLUSIONS: Whereas the reliability and internal consistency of all measures ranged between moderate and substantial, the results of this study suggest weaker relationships between measures of fear and avoidance beliefs and pain/disability among patients with mechanical neck pain than has been reported among patients with low-back pain. [ABSTRACT FROM AUTHOR]

The development of valid classification methods to assist the physical therapy management of patients with low back pain has been recognized as a research priority. There is also growing evidence that the use of a classification approach to physical therapy results in better clinical outcomes than the use of alternative management approaches. In 1995 Delitto and colleagues proposed a classification system intended to inform and direct the physical therapy management of patients with low back pain. The system described 4 classifications of patients with low back pain (manipulation, stabilization, specific exercise, and traction). Each classification could be identified by a unique set of examination criteria, and was associated with an intervention strategy believed to result in the best outcomes for the patient. The system was based on expert opinion and research evidence available at the time. A substantial amount of research has emerged in the years since the introduction of this classification system, including the development of clinical prediction rules, providing new evidence for the examination criteria used to place a patient into a classification and for the optimal intervention strategies for each classification. New evidence should continually be incorporated into existing classification systems. The purpose of this clinical commentary is to review this classification system, its evolution and current status, and to discuss its implications for the classification of patients with low back pain. [ABSTRACT FROM AUTHOR]

Lateral epicondylalgia or tennis elbow is a prevalent musculoskeletal disorder that is characterized by lateral elbow pain often associated with gripping tasks. The underlying pathology remains to be fully elucidated; however, evidence indicates that the disorder does not involve an inflammatory process but rather impairments of the pain and motor systems as well as morphological changes in the structure of both the extensor carpi radialis brevis muscle and tendon. Although the most efficient management approach remains controversial, there is a growing body of literature reporting the effects and underlying mechanisms of joint manipulation in the management of lateral epicondylalgia. Evidence exists demonstrating that joint manipulation directed at the elbow and wrist as well as at the cervical and thoracic spinal regions results in clinical alterations in pain and the motor system. In addition to presenting this evidence, this paper describes proposed underlying physiological mechanisms of joint manipulation associated with the observed clinical effects. We propose that this information will be useful for the physical therapist in making clinical decisions regarding the selection of treatment technique for the management of patients with lateral epicondylalgia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Well-designed trials are required to assess if complementary and alternative medicine (CAM) is effective.Aim:This study assessed the effectiveness of spiritual healing for asthma. DESIGN OF STUDY: Randomised, placebo-controlled trial. SETTING: Aberdeen, Scotland. METHOD: This was a single-blind, three-armed randomised, controlled trial of spiritual healing for asthma, comparing the effectiveness of five sessions of spiritual healing with placebo (delivered by an actor), and with a control group receiving normal care only. The primary outcome measure was the Juniper Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes were forced expiratory flow in one second (FEV1), peak expiratory flow (PEF), HADS (Hospital Anxiety Depression Scale), SF-36 and MYMOP (Measure Yourself Medical Outcome Profile). Baseline and follow-up data were collected. RESULTS: Eighty-eight adult patients receiving pharmacological treatment for asthma participated. AQLQ scores improved significantly from baseline and the end of treatment in all groups (spiritual healing P = 0.008; 'sham' healing P = 0.001 and control P = 0.01) but there was no significant difference between groups (P = 0.57). These improvements were maintained at follow-up 1 for two of the groups (spiritual healing P = 0.016; sham healing P = 0.001 and control P = 0.09) but none of the groups showed an improvement at follow-up 2 (spiritual healing P = 0.161; sham healing P = 0.016 and control P = 0.11). Similar proportions of patients in each group showed a clinically important improvement in AQLQ score. Analysis of AQLQ scores at end of treatment and both follow-up periods indicated no significance between group differences. No consistent changes were seen in secondary outcome measures, possibly due to the small sample size. CONCLUSION: Spiritual healing does not appear to have any specific affect on patient asthma related quality of life. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Cohort study of patients with cervical radiculopathy undergoing physical therapy. OBJECTIVES: Examine the test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and Patient Specific Functional Scale (PSFS) in cohort of patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA: To date, no studies have investigated the psychometric properties of the NDI or PSFS in a cohort of patients with cervical radiculopathy. METHODS: Thirty-eight patients with cervical radiculopathy undergoing physical therapy completed the NDI and PSFS, and Numerical Pain Rating Scale (NPRS) at the baseline examination and at a follow-up. In addition, at follow-up, patients completed a 15-point global rating of change (GROC), which was used to dichotomize patients as improved or stable. Changes in the NDI and PSFS were then used to assess test-retest reliability, construct validity, and minimal levels of detectable and clinically important change. RESULTS: Test-retest reliability was moderate for the NDI (intraclass correlation coefficient [ICC] = 0.68; 95% confidence interval [CI], 0.30-0.90) and high for the PSFS (ICC = 0.82; 95% CI, 0.54-0.93). The PSFS was more responsive to change than the NDI. The minimal detectable change for the NDI was 10.2 and for the PSFS 2.1. The minimally clinically important change for the NDI was 7.0 and PSFS 2.0. CONCLUSIONS: Our results suggest that the PSFS exhibits superior reliability, construct validity, and responsiveness in this cohort of patients with cervical radiculopathy compared with the NDI. Further research is needed to examine the ability of these measures to accurately reflect changes in individuals, as well as large samples of patients. [ABSTRACT FROM AUTHOR]

Abstract Background Over 60% of protein-coding genes in vertebrates express mRNAs that undergo alternative splicing. The resulting collection of transcript isoforms poses significant challenges for contemporary biological assays. For example, RT-PCR validation of gene expression microarray results may be unsuccessful if the two technologies target different splice variants. Effective use of sequence-based technologies requires knowledge of the specific splice variant(s) that are targeted. In addition, the critical roles of alternative splice forms in biological function and in disease suggest that assay results may be more informative if analyzed in the context of the targeted splice variant. Results A number of contemporary technologies are used for analyzing transcripts or proteins. To enable investigation of the impact of splice variation on the interpretation of data derived from those technologies, we have developed SpliceCenter. SpliceCenter is a suite of user-friendly, web-based applications that includes programs for analysis of RT-PCR primer/probe sets, effectors of RNAi, microarrays, and protein-targeting technologies. Both interactive and high-throughput implementations of the tools are provided. The interactive versions of SpliceCenter tools provide visualizations of a gene's alternative transcripts and probe target positions, enabling the user to identify which splice variants are or are not targeted. The high-throughput batch versions accept user query files and provide results in tabular form. When, for example, we used SpliceCenter's batch siRNA-Check to process the Cancer Genome Anatomy Project's large-scale shRNA library, we found that only 59% of the 50,766 shRNAs in the library target all known splice variants of the target gene, 32% target some but not all, and 9% do not target any currently annotated transcript. Conclusion SpliceCenter http://discover.nci.nih.gov/splicecenter provides unique, user-friendly applications for assessing the impact of transcript variation on the design and interpretation of RT-PCR, RNAi, gene expression microarrays, antibody-based detection, and mass spectrometry proteomics. The tools are intended for use by bench biologists as well as bioinformaticists.

Objective: The purposes of this study were to preliminarily report patient-identified change for the neck disability index (NDI) as either important or not important with time between follow-up of approximately 7 to 10 days and assess the credibility of the preliminary results with the use of a recently established credibility instrument., Methods: This study was a secondary analysis from a primary randomized clinical trial assessing short-term physical therapist care for individuals with mechanical neck pain. Neck disability index scores and participant-reported importance of global rating of change scores from 42 participants were analyzed from a randomized clinical trial assessing short-term responses to thoracic manipulation and dry needling for neck pain. Patient-important change was computed using receiver operating characteristic curves, and statistical error of the measurement was calculated using (SD × [1 - r] 1/2 ) × 1.96 to assess measurement error at the 95% CI., Results: Thirty-six participants rated global rating of change as important, and 6 rated it as not important. Patient-important change was calculated at 3.5 NDI points on a 0 to 50 NDI scoring scale. This value exceeded the statistical error, which was calculated at 2.16 NDI points. The credibility analysis revealed that 4 of 5 criteria showed strong credibility for the patient-important change estimate., Conclusion: Using patient-determined importance to dichotomize improvement may yield a lower threshold than current researcher-defined methods. Clinically, these results may be more responsive to patient-centric change than using previously reported minimal clinically important difference data., (Copyright © 2024. Published by Elsevier Inc.)