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With the rapidly expanding number of studies reporting on treatment subgroups come new challenges in analyzing and interpreting this sometimes complex area of the literature. This article discusses 3 important issues regarding the analysis and interpretation of existing trials or systematic reviews that report on treatment effect modifiers (subgroups) for specific physical therapy interventions. The key messages are: (1) point estimates of treatment modifier effect size (interaction effect) and their confidence intervals can be calculated using group-level data when individual patient-level data are not available; (2) interaction effects do not define the total effect size of the intervention in the subgroup but rather how much more effective it is in the subgroup than in those not in the subgroup; (3) recommendations regarding the use of an intervention in a subgroup need to consider the size and direction of the main effect and the interaction effect; and (4) rather than simply judging whether a treatment modifier effect is clinically important based only on the interaction effect size, a better criterion is to determine whether the combined effect of the interaction effect and main effect makes the difference between an overall effect that is clinically important and one that is not clinically important., Identifying subgroups of patients who respond best to physical therapy interventions has recently become a topic of great clinical interest and a research priority. (1,2) This focus has been driven, [...]

Abstract In order to evaluate the Dynasplint Trismus System (DTS) for the relief of trismus secondary to the treatment of head and neck cancer, we conducted a retrospective chart review [...]

Background. Few studies have examined the responsiveness of physical tests. Objective. The purpose of this study was to explore the responsiveness of 10 physical tests used for patients with back pain in order to illuminate the significance of changes in scores. Design. Cross-sectional and longitudinal designs within a prospective cohort study were applied. Methods. Distribution-based and anchor-based methods were used. Ninety-eight patients (18-65 years of age) with long-lasting back pain were recruited consecutively at an outpatient spine clinic. Measurements. The participants were assessed using 10 physical tests and 2 questionnaires (Hannover Functional Ability Questionnaire and Roland-Morris Disability Questionnaire) at inclusion and after rehabilitation. Six predefined hypotheses for each test were examined regarding the association between changes in scores on the physical tests and the self-report measures of functioning and regarding the relationship of changes in scores on the physical tests and external anchors of important change. Results. Five physical tests demonstrated responsiveness by both distributionbased and anchor-based methods: spondylometry, lateral flexion test, fingertip-tofloor test, lift test, and Back Performance Scale (4 hypotheses confirmed). The minimal important change values were all within the range of the smallest detectable change for individual patients. Responsiveness by distribution-based methods only (3 hypotheses confirmed) was shown for the Biering-Sorensen test and the loaded reach test, whereas little evidence of responsiveness (1 hypothesis confirmed) was shown for the Global Physiotherapy Examination flexibility subscale, the Progressive Isoinertial Lifting Evaluation, and the 15-m (50-ft) walk test. Limitations. The smallest detectable change values were examined in a small sample of patients and need further exploration. Conclusions. Responsiveness varied among the 10 physical tests., Physical tests are commonly used by physical therapists to customize treatment to the needs of individual patients with back pain. The tests also are used to record functional changes, with [...]

Background. Medicare beneficiaries frequently receive physical therapy for musculoskeletal conditions. Little information is available about this care. Objective. The purposes of this study were: (1) to describe characteristics, clinical outcomes, and utilization for Medicare beneficiaries receiving physical therapy in outpatient clinics within one integrated health care system; (2) to compare characteristics, outcomes, and utilization based on the body region affected; and (3) to examine factors predictive of outcomes and utilization. Design. This was a prospective, longitudinal study. Methods. Medicare beneficiaries aged 65 years or older (n=1,840 episodes of care) participated in the study. Descriptive statistics were calculated for patient characteristics and outcomes. Comparisons were made based on body region. Regression models evaluated factors associated with change in pain, improved outcome, and utilization. Results. The patients' mean age was 74.2 years (SD=6.3), and 65.3% were female. The most common body regions were the lumbar spine, shoulder, and knee, collectively accounting for 71.3% of the episodes of care. Patients attended a mean of 6.8 visits (SD=4.7), and 63.9% experienced an improved outcome. Episodes of care for lumbar spine conditions had less reduction in pain, whereas shoulder conditions and foot/ankle conditions showed the greatest improvement. Care for hip conditions was least likely to result in an improved outcome. Knee conditions were most likely to have an improved outcome. Care for shoulder and knee conditions had the highest number of visits. Factors associated with greater reduction in pain and improved outcomes included greater initial pain or disability and attending more visits. Factors associated with greater utilization included a postsurgical condition and higher initial pain rating. Limitations. The study was performed in one geographic region within a single health care delivery system. Conclusion. The results provide information on outcomes of physical therapy for Medicare beneficiaries in one health care system. Further research is needed to examine optimal utilization and care for these patients., Musculoskeletal conditions are highly prevalent in the United States and throughout the world. Musculoskeletal conditions can significantly diminish an individual's quality of life and impose a substantial economic burden on [...]

DENVER -- Extended physiotherapy significantly reduced the rate of falls among patients with a prior hip fracture, and high-dose vitamin D significantly reduced the rate of hospital readmissions in a [...]