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ObjectiveA pilot study to investigate whether the addition of grade B mobilization to a muscle strengthening home exercise programme improves outcomes for patients with symptomatic early-stage hip osteoarthritis.MethodsTwenty-three patients were randomized into either a home exercise group (n = 12) or grade B mobilization group (n = 11). Both groups carried out a muscle strengthening home exercise programme for 6 weeks. In addition, the grade B mobilization group received 6 weekly sessions of grade B hip mobilization (passive stretching techniques) and carried out stretches at home. Outcome measures included the visual analogue scale for pain, the Lower Extremity Functional Scale and goniometric measurement of hip flexion and medial rotation at baseline (week 1) and after the 6-week treatment period (week 7).ResultsTwenty-one participants (91%) completed the trial. Both groups showed improvement in all outcome measures. The change in pre-/post-treatment scores was significantly greater in the grad...

AimThis pilot study was designed to assess the effect of thoracic manipulation on shoulder range and function in patients with subacromial impingement syndrome (SIS).MethodsPatients attending a National Health Service physiotherapy department with SIS were considered for inclusion. Participants were randomized into one of two groups. Both groups received weekly physiotherapy for a maximum of 6 weeks. In addition, the experimental group received thoracic spinal manipulation. Outcome measures were shoulder range and function measured by a goniometer and the Disability of the Arm, Shoulder and Hand Score, respectively.ResultsNine participants were recruited; eight completed the study. Both groups improved, but numbers were inadequate for statistically significant conclusions.ConclusionsThis pilot study confirms the practicality of the study design used: a longer recruitment period and multicentre involvement is recommended together with a cost–benefit analysis.

Summary The scope of physiotherapy practice was extended in 1995 to include intra-articular and intra-lesional injections within musculoskeletal therapy, provided that physiotherapists had undertaken ‘appropriate training’. The purpose of this study was to investigate the experience of physiotherapists in applying their injection therapy skills following training. A qualitative study was used, based on a phenomenological approach, to be able to explore the actual experience of physiotherapists. Participants volunteered to take part in the study and unstructured interviews were conducted, transcribed and analysed. The investigation was performed as a step towards identifying facilitating factors and barriers to practice as experienced by physiotherapists in implementing their injection therapy skills. Four principal themes arose from the interviews relating to professional autonomy, professional relationships, affective factors and training issues. Extension of the investigation will aim to explore this investigation's findings further, to contribute to the theory underpinning the development of injection training programmes and to inform the profession as a whole.

(1999). The Thoracic Spine and Sport. Journal of Orthopaedic Medicine: Vol. 21, No. 3, pp. 80-86.

To develop an MRI enterography global score (MEGS) of Crohn’s disease (CD) activity compared with a reference standard of faecal calprotectin (fC), C-reactive protein (CRP) and Harvey-Bradshaw index (HBI). Calprotectin, CRP and HBI were prospectively recorded for 71 patients (median age 33, male 35) with known/suspected CD undergoing MRI enterography. Two observers in consensus scored activity for nine bowel segments, grading mural thickness, T2 signal, mesenteric oedema, T1 enhancement and pattern, and haustral loss. Segmental scores were multiplied according to disease length. Five points each were added for lymphadenopathy, comb sign, fistulae and abscesses to derive the MEGS. A previously validated MRI CD activity score (CDAS) was also calculated. MRI scores were correlated with clinical references using Spearman’s rank. A logistic regression diagnostic model was built to discriminate active (fC > 100 μg/g) from inactive disease. MEGS and CDAS were significantly correlated with fC (r = 0.46, P

Cleo H. Cherryholmes,* Columbia, Teachers College Press. ISBN 0‐8077‐2927‐2, 240 pp, $22.95 (hard back).

Several recent developments affecting graduate medical education (GME) have kindled an interest in curriculum. For the most part, however, GME curriculum is being conceived in terms of behavioral learning objectives. The authors find this approach to curriculum ill-suited for the reality and complexity of housestaff training. Several other approaches are considered but none, they conclude, fits well with the mission of GME. Instead, they propose a more comprehensive experiential conception of curriculum for GME. This approach stems from an experiential learning paradigm and a commitment to curriculum as an expression of valued activities rather than of predetermined objectives. Taking as an example a curriculum for an ambulatory care block rotation, the authors show how an experiential curriculum can be developed and how it can be used to frame the residents' rotation, including patient care and didactic program.

This book is too good to hurry. I was at first disappointed as I had misunderstood that it would address itself more exclusively to postgraduate issues, my chief domain. Its 36 chapters pertain to the education of the so termed “beginning practitioner”, defined as “the level of competence and stage of preparation the graduate has achieved on entry to their profession”. However, as the sections were unveiled, it was apparent from the scope of the book that it had intended to address comprehensively …

(1988). Reframing curriculum theory in terms of interpretation and practice: a hermeneutical approach. Journal of Curriculum Studies: Vol. 20, No. 5, pp. 437-448.