Rehabilitation_Medicine RSS : Gourt

Clinical Director of Spinal Cord Rehabilitation, Southern Metro, SEC University Town,#5178 :: Alabama :: Timeline Recruiting

Welcome to classic southern charm and hospitality. This vibrant, beautiful city is nestled in the rolling foothills of the Appalachian Mountains and serves up nationally recognized dining, shopping

Northern CA's Sierra Foothills near Sonora an hour from Sacramento :: California :: California Physician Opportunities

MT-1017 Gold-rush town made famous by the immortal Mark Twain, Historic downtown, modern conveniences in a rural mountain atmosphere. Enjoy a plethora of outdoor activities from Golf

Med Director need - 40 Mile SW Of Chicago :: Illinois :: Enterprise Medical Service

Excellent PMR inpatient medical directorship position is now available in Illinois, located 40 miles SW of Chicago. Client is looking for an experienced PMR physician to serve as the medical director

Excellent PMR opportunity in Tucson, AZ :: Arizona :: Enterprise Medical Service

Excellent PMR opportunity in availability in Tucson, AZ! Group practice, no call! Inpatient and Outpatient setting. Busy practice, need 1 more PMR physician. Works schedule is 8a - 5p Monday - Friday.

Quad City Area PMR Position Available :: Iowa :: Enterprise Medical Service

Excellent PMR position is available in Iowa, located 2 hours of Chicago. Inpatient and Outpatient practice. 22-bed inpatient rehab unit. Large referral base covering 20 healthcare facilities. Hospital

Rochester, NY Needs PMR/PAIN Physician :: Nevada :: Enterprise Medical Service

Excellent PMR/PAIN position is available in New York, 4 hours to NYC, 60Miles to Buffalo. New Spine Center has opened and client is looking for a PMR physician with fellowship training in Interventional

Practice is 1 Hour from Sacramento :: California :: Enterprise Medical Service

Excellent new physician medical & rehabilitation opportunity is available in California, located 1 hour from Sacramento. PMR candidate must have completed or will be completing a fellowship in Interventional

Great Opportunity Near Chicago :: Indiana :: Enterprise Medical Service

Physical Medicine and Rehabilitation opportunity is available in Indiana close to Chicago, IL. Inpatient only practice. Outpatient work will be available in the future. Salary and full benefits.

Indiana University Community :: Indiana :: Medical Search Consultants

This is an excellent opportunity for a BE/BC PM&R physician to join two others in a very busy practice setting as an expansion to the group. The primary responsibility for this new member will be to

30 Minutes from Raleigh :: North Carolina :: Enterprise Medical Service

Excellent new PMR opportunity is now available in North Carolina, located within 30 miles of Raleigh. Client will consider both general and pain/spine trained candidates. Group practice opportunity

Coastal Carolina :: South Carolina :: Sunbelt Management Associates

This 5-man neurosurgery group is seeking a Board Certified or Board Eligible Physical Medicine and Rehab doctor for collaborative office-based practice, focused on physiatry and rehab, no procedures,

University Town :: Illinois :: Fidelis Partners

PSYCHIATRY $300,000 POTENTIAL / 1-YEAR PARTNERSHIP TURN-KEY PRACTICE SERVING COMMUNITY 29 YEARS! ALL-AMERICAN CITY WINNER Opportunities like this dont last long. We are currently scheduling interviews

Peterborough :: New Hampshire :: New England Physician Recruitment Center

South Central NH Orthopedic group is seeking to add an Interventional focused PM&R physician to join their 3 physician practice. Located onsite at Monadnock Community Hospital. Private orthopaedic practice

New London :: Connecticut :: New England Physician Recruitment Center

Physiatrist PMRSouthern Connecticut Reason for current opening: expanding practice, succession planning Physicians in practice 2 full time, 2 part-time Qualifications: Residency or fellow graduate

Middletown :: New York :: New England Physician Recruitment Center

Interventional Physiatry -Middletown region NewYork- about 1 hour to NYC- join group expanding their services and have recently moved into another modern office building....group is a premier physician

Middletown :: New York :: New England Physician Recruitment Center

PMR to join oneinterested in Pain. TOP Salaries and Incentives- New Yorks finest group e top money-interviewing early We are looking for PMR to join oneinterested in Pain. Would you have an interest

Manalatan :: New Jersey :: New England Physician Recruitment Center

Northern NJ 1 Hour to NYC Non-Interventional Opportunity - $250k Base+ Multiple specialty practice centrally located in Northern NJ and easily accessible to both NYC and the Jersey Coast is seeking a

Rochester :: New York :: Nationwide Physician Recruitment

BE/BC Pain Management Physician who utilizes a multidisciplinary approach to patient care including diagnostic and therapeutic injections; treatment of muscular/skeletal systems and management of pain

Carlisle :: California :: Health Search, Inc.

Physiatrist / Pain physician needed for a multi-discipline clinic in Los Angeles. Candidate must have clean record, be CA licensed, and must have completed a pain management fellowship. If interested

Rutland :: Vermont :: Execu-Tech

Medical Director We are looking for a Medical Director and inpatient clinical psychiatrist to join our Psychiatric Services Department here at Medical Center. This is a hospital employed position.

Clinical outcomes of exercise in the management of subacromial impingement syndrome: a systematic review

Objective: To assess the clinical outcomes of types of exercise in the management of subacromial impingement syndrome.Design: Systematic review of randomized controlled trials.Methods: Studies were identified from databases searched to May 2009: MEDLINE, EMBASE, CINAHL, Sports Discus, PEDro, AMED, Cochrane Library, National Research Register, Index Chiropractic Literature. Two reviewers selected studies meeting inclusion criteria. The methodological quality of the included studies was independently assessed by two reviewers using the PEDro quality assessment tool.Results: Eight studies with sample sizes ranging from 14 to 125 were included in the systematic review and appraised for content. Four papers achieved a score of 6 or above indicating good quality, with the remaining four achieving 4 or lower, indicating poor quality. Synthesis showed only limited evidence to support the use of exercise in the treatment of subacromial impingement syndrome.Conclusion: There is a need for further well-defined clinical trials on specific exercise interventions for the treatment of shoulder dysfunction including subacromial impingement syndrome.

Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review

Objective: To systematically review the effectiveness of medications used to improve attention in people with non-progressive acquired brain injury.Design: A systematic review.Methods: MEDLINE, EMBASE, CINALH, PUBMED and PsychINFO databases were used to identify studies published between 1987 and 2008 meeting the following criteria: studies with subjects older than 18 years; diagnosis of new onset or previous acquired brain injury; medication given to improve attention and use of outcome to measure attention. Studies involving subjects in low arousal states or with neurogenerative conditions were excluded. The studies were categorized into three evidence levels: I — Randomized controlled trials; II — Prospective studies, controlled trials with methodological limitations; and III — Retrospective studies, clinical case series.Results: Forty-seven articles were identified on initial search. Twenty-six met the pre-specified criteria. Five articles were assessed as meeting the level I evidence criteria, 12 were level II studies and 9 were level III studies. Methylphenidate can improve information processing speed but not all attention aspects in some people after traumatic brain injury. There is weak evidence for use of dopamine agonists to improve neglect/inattention after stroke. There is little evidence on the frequency of adverse effects and long-term functional benefits.Conclusion: Although there is lack of robust evidence to recommend the routine use of medication to improve attention after traumatic brain injury and stroke, the existing evidence indicates potential for benefit in some patents and therefore further research is warranted.

An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life

Objective: To assess whether a maintenance integrated health care programme is effective in improving functional and emotional dimensions of quality of life in patients with chronic obstructive pulmonary disease (COPD) after a first pulmonary rehabilitation.Design: Prospective controlled trial.Setting: Three rehabilitation centres and three patient self-help associations within a health care network in France.Subjects: Forty patients with moderate to severe COPD.Interventions: After a first four-week inpatient pulmonary rehabilitation programme, patients took part in a maintenance integrated health care programme or usual care for 12 months.Main measures: The primary outcomes were the change in functional and emotional dimensions of quality of life measured by the St George’s Respiratory Questionnaire (SGRQ), the brief World Health Organization Quality of Life questionnaire (Brief-WHOQOL) and six specific questions using a 10-cm visual analogue scale. Secondary outcomes were change in exercise tolerance measured by six-minute walking test and cycle exercise.Results: At one year, the maintenance intervention (n = 11) produced improvements in functional and emotional dimensions scores of quality of life and exercise tolerance. Patients in the usual aftercare group (n = 16) exhibited maintenance of functional dimension scores of quality of life, but a clinically relevant decline in emotional scores of quality of life and in six-minute walking distance one year after the pulmonary rehabilitation.Conclusion: Patient self-help association seems to be an innovative and efficient organizational structure to support patients with COPD after pulmonary rehabilitation in real-life settings. A distinction between emotional and functional dimensions of quality of life may improve the design and evaluation of integrated health care programmes in patients with COPD.

Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial

Objective: To evaluate the outcome after spinal surgery when adding prehabilitation to the early rehabilitation.Design: A randomized clinical study.Setting: Orthopaedic surgery department.Subject: Sixty patients scheduled for surgery followed by inpatient rehabilitation for degenerative lumbar disease.Interventions: The patients were computer randomized to prehabilitation and early rehabilitation (28 patients) or to standard care exclusively (32 patients). The intervention began two months prior to the operation. The prehabilitation included an intensive exercise programme and optimization of the analgesic treatment. Protein drinks were given the day before surgery. The early postoperative rehabilitation included balanced pain therapy with self-administered epidural analgesia, doubled intensified mobilization and protein supplements.Main measures: The outcome measurements were postoperative stay, complications, functionality, pain and satisfaction.Results: At operation the intervention group had improved function, assessed by Roland Morris Questionnaire (P = 0.001). After surgery the intervention group reached the recovery milestones faster than the control group (1—6 days versus 3—13, P =0.001), and left hospital earlier (5 (3—9) versus 7 (5—15) days, P =0.007). There was no difference in postoperative complications, adverse events, low back pain and radiating pain, timed up and go, sit-to-stand or in life quality. Patient satisfaction was significantly higher in the intervention group compared with the control group.Conclusion: The integrated programme of prehabilitation and early rehabilitation improved the outcome and shortened the hospital stay — without more complications, pain or dissatisfaction.

The value of physical tests for subacromial impingement syndrome: a study of diagnostic accuracy

Objective: To determine the diagnostic accuracy of commonly used physical tests for subacromial impingement syndrome, using ultrasound as the reference standard.Design: A cross-sectional study of 59 participants with chronic shoulder pain of more than four months duration with a referral for diagnostic ultrasound scanning were invited to participate in the study.Main measures: Thirty-four participants met the inclusion criteria and had an ultrasound scan followed immediately by application of the following tests: Neer’s sign, Hawkins and Kennedy test, painful arc of abduction, empty and full can tests, resisted isometric shoulder abduction and resisted isometric shoulder external rotation. Using the two-way contingency table method sensitivity, specificity, likelihood ratios and overall accuracy were calculated for each physical test.Results: Diagnostic values for each test varied considerably. The Hawkins and Kennedy test was the most accurate test for diagnosing any degree of subacromial impingement syndrome (71.0%). The most accurate tests for diagnosing subcategories of impingement were pain on resisted external rotation and weakness during the full can test (63.6%) for presence of subdeltoid fluid, pain on resisted external rotation (58.8%) for partial thickness tears and the painful arc test (62.1%) for full thickness tears.Conclusions: As the predictive values of these tests are shown to be variable in this study it indicates that the clinical tests identified have limited use in informing diagnosis. Emphasis on the management of dysfunction may be more appropriate rather than reliance on clinical tests with inconclusive sensitivity and specificity if ultrasound scanning is not available.

A qualitative study exploring the experiences of African-Caribbean informal stroke carers in the UK

Objective: To explore the experiences of African-Caribbean informal stroke carers in the UK.Design: Qualitative methodology.Setting: Three urban locations in southern England.Participants: Nine African-Caribbean informal stroke carers providing support to a relative with stroke for at least six months.Method: Semi-structured interviews were used to explore both predetermined and unexpected topics relating to any aspects of the carers’ experiences. Interview transcriptions were analysed using inductive thematic analysis.Results: Several themes resembled those identified in previous qualitative studies with informal stroke carers from other ethnic backgrounds. However, new themes emerged which were related to the carers’ ethnicity and cultural values. These themes were ‘understanding of individual needs’, ‘battle’, ‘independence from services’, ‘faith in God’, ‘family ties’ and ‘avoiding institutionalised care.’Conclusions: This small-scale study provides an insight into African-Caribbean stroke carers’ own perspectives. These have much in common with those of other ethnicities, but also exhibit important areas of difference. Several themes indicate issues with existing service provision. Stereotypical assumptions about informal stroke carers based on ethnicity appear to be unwarranted; there is diversity within ethnic groups. Individual contexts of ethnicity, culture and religious beliefs shape expectations and perceptions. Several themes signpost service attributes that are perceived as relevant to acceptability by African-Caribbean stroke carers. Recruitment challenges could be addressed in future projects with ethnic minority carers by collaborative planning and the development of individual relationships with key informants.

Development and validation of prognostic models designed to predict wheelchair skills at discharge from spinal cord injury rehabilitation

Objective: To develop and validate a statistical model to predict wheelchair skills at discharge (t 2) from personal and lesion characteristics and wheelchair skills at the start of spinal cord injury inpatient rehabilitation (t1).Design: Prospective cohort studySetting: Eight Dutch rehabilitation centres.Subjects: One hundred and forty-two patients with a spinal cord injury.Main measures: Models were developed with the performance time and ability score at t2 as dependent variables and t1 scores of performance time and ability score, age, gender, body mass index, level and completeness of the lesion as independent variables. The statistical models were evaluated by comparing individual estimated scores with actual measured scores.Results: The main independent variables to predict wheelchair skills at discharge were the t1 performance time and ability score, age, gender and lesion level. The intraclass correlation coefficient between the estimated and actual ability score was 0.79 and for the performance time 0.86. However, the 95% limits of agreement and their confidence intervals were relatively wide for both ability score (—2.3 to 3.4, range 0—8) and performance time (—12.5 to 8.2, range 11—40 seconds).Conclusion: The prognostic models developed in this study to predict future wheelchair skills might help planning the course of rehabilitation. The models should be used with caution in daily clinical practice, but may add useful information to clinical expertise and knowledge of the individual patient.

Psychological distress after stroke and aphasia: the first six months

Objective: We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia.Design: Prospective longitudinal observational study.Setting and subjects: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke.Main measures: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months.Results: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R2 = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (2 (1) = 8.61, P<0.01).Conclusions: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one’s social network are particularly important and contribute to long-term psychological distress.

Erratum

Measures of arch height and their relationship to pain and dysfunction in people with lower limb impairments

Background and Purpose. Debate surrounds the theory that foot structure, and more specifically, the attitude of the midfoot as typified by the longitudinal arch, is associated with complaints of pain and injuries of the lower extremity. Recently, two simple clinical measures of arch height, the arch ratio (AR) and the longitudinal arch angle (LAA), have been reported as valid and reliable in the literature. The LAA has been found to approximate the lowest point of the arch during walking and running while the main strengths of the AR are that the measure takes into account foot size and arch mobility. We modified the AR so that the modified AR (mAR) would be measured in a similar fashion as the LAA to investigate if this new measure, which would account for foot size, correlated well with an established measure (LAA) that estimated the behaviour of the arch with walking and running. Also, we hoped to contribute to the literature correlating longitudinal arch height with pain - numeric pain rating scale - and dysfunction - Lower Extremity Functional Scale (LEFS) and Single Assessment Numeric Evaluation (SANE). Methods. Thirty-five subjects for this prospective correlational study were recruited from a community based outpatient practice that was part of a tertiary care academic medical centre. Reliability and validity of our investigator and of the mAR was first examined. We then examined the correlation of the clinical classification of arch height (high, normal, or low) produced by these two measures with each other. We also explored the correlation of multiple measures of dysfunction and pain with arch height. Results. Intrarater reliability and validity of the LAA showed an intraclass correlation (ICC) of 0.978 and Pearson's correlation coefficient (PCC) of 0.885, respectively. Intrarater reliability and validity of the mAR showed an ICC of 0.961 and PCC of 0.827, respectively. The LAA and our new measure, the mAR, were correlated with each other. The self-report measures of general health and activity level were significantly positively correlated (PCC = 0.598). Also significant and positively correlated were the LEFS and the SANE (PCC = 0.617), two measures of function. Conclusions. Pain and dysfunction may be positively correlated but longitudinal arch height does not predict either pain or dysfunction. Copyright © 2010 John Wiley & Sons, Ltd.

Physiotherapy management of low back pain in India - a survey of self-reported practice

Background. Physiotherapy is commonly used in the management of low back pain and from previous studies appears to be eclectic and not always in line with evidence-based practice. Most previous studies have been conducted in Western countries, and no previous studies have sought to explore physiotherapy management of low back pain in India. Purpose. The aim of this study was to explore the self-reported management strategies employed by physiotherapists in India as it is unknown if these are in line with contemporary guidelines. Methods. Study design was a self-completed questionnaire, which was sent to the 350 physiotherapists registered with the Indian Physiotherapy Association in the state of Maharashtra in India. To maximize response rate there was repeat e-mailing and telephone follow-up. Results. Thirty-eight therapists did not treat patients with back pain and 45 were not working in India and so were excluded. Out of a sample frame of 267 physiotherapists, 186 responded to the e-mailed questionnaire (70%). All therapists reported that they gave some kind of advice to patients, used exercises and electrotherapy, and in addition about half used manual therapy. The majority of therapists used 8-12 sessions of treatment. Conclusions. This first mapping of Indian physiotherapy management of low back pain has shown several areas of 'good practice' in line with contemporary guidelines. It also highlighted potential areas of concern regarding evidence-based practice; namely, very common use of passive electrotherapy modalities and potential excessive treatment. This report has implications for physiotherapy practice and education in India. Copyright © 2010 John Wiley & Sons, Ltd.

What does the clinical doctorate in physical therapy mean for rural communities?

Background and Purpose. The transition to the Doctor of Physical Therapy (DPT) as the entry-level degree for physical therapists in the United States is nearly complete. Little is known about how the transition has affected the characteristics of the physical therapy workforce or the provision of physical therapy services. Effects may be particularly acute in rural communities with persistent health-care provider shortages. The study objectives were to explore the early impact of the DPT on the supply and quality of physical therapy care in rural areas and to identify issues for future research. Methods. Qualitative and quantitative data were collected through semi-structured telephone interviews. The interview subjects were education programme directors, directors of physical therapy at rural hospitals and presidents of state physical therapy associations. Results. The respondents provided little evidence that the DPT has had a significant impact on the supply or quality of physical therapy in rural areas thus far. There are problems with the supply of physical therapists in rural communities, but few respondents attributed this directly to the DPT. Few respondents believed the DPT has improved the quality of physical therapy care in rural settings, noting that experience was the main factor that contributed to quality of care. However, several respondents believed the DPT may impact the supply and quality of rural physical therapy in the future; about half were concerned about the potential for negative effects on the supply of physical therapists in rural areas. Conclusions. In general, the respondents did not indicate that the DPT has had large effects on rural health care. However, future research should consider the negative and positive effects that may occur as DPT therapists make up a larger share of the workforce. Further, there are several areas where increased collaboration could be mutually beneficial to physical therapy educators, practitioners and rural communities. Copyright © 2010 John Wiley & Sons, Ltd.

Study of peripheral muscle strength and severity indexes in individuals with chronic obstructive pulmonary disease

Background and Purpose. Individuals with chronic obstructive pulmonary disease (COPD) present reduced peripheral muscle strength, which leads to impaired mobility and increased mortality risk. However, it is not clear whether there is any relationship between muscle strength, muscle mass and the body mass index, airflow obstruction, dyspnea, exercise performance (BODE) index scale, which is considered to be the best predictor of survival for individuals with COPD. The BODE Index is a multidimensional system that measures body composition (B), airway obstruction (O), dyspnea perception (D) and the ability to exercise (E), and rates the severity of the major changes found in individuals with COPD. The objective of this study was to verify any relationship between the BODE Index, muscle mass and maximum muscle strengths of the upper limb (UL) and lower limb (LL) in subjects with moderate to very severe COPD. Methods. Twenty-six individuals with moderate to very severe COPD were evaluated by body composition (body mass index and muscle mass), BODE Index, handgrip strength (HS) and one repetition maximum (1RM) test of the UL and LL. Results. There was a positive correlation (Pearson, p < 0.05) of peripheral muscle strength, evaluated by HS and 1RM (pectoral and triceps, round muscles and dorsal section, quadriceps), to muscle mass (0.74, 0.57, 0.74 and 0.62, respectively) and the distance walked in the six-minute walking test (0.52, 0.50, 0.46 and 0.58, respectively), but no correlation of muscle strength was found to forced expiratory volume in one second to dyspnea or the BODE Index. Conclusion. In accordance with the results of this study, peripheral muscle strength as measured by HS and 1RM is not related to the severity indexes for COPD, unlike UL and LL muscle strength. Therefore, UL and LL measurements now have an additional importance in COPD evaluation. Copyright © 2010 John Wiley & Sons, Ltd.

Six minute walk distance or stair negotiation? Choice of activity assessment following total knee replacement

Background and Purpose. Physiotherapists evaluating changing functional performance in patients who have undergone total knee replacement (TKR) will often measure a number of gait-related activities, including six-minute walk distance (6MWD) and the capacity to ascend and descend stairs. In this report, we investigated the correlations between the 6MWD and stair ascent and descent power in a group of patients who had participated in a clinical trial at 2, 8 and 26 weeks post-TKR to establish whether there is redundancy in conducting all three tests. Methods. Retrospective analysis of data from a clinical trial was used. One hundred patients (57 female, 43 male) were tested on their 6MWD and power generated and absorbed during stair ascent and descent, respectively. Linear regression modelling was used to determine correlations between pairs of variables at the three measurement intervals. Results. There were consistent relationships between each pair of variables at each measurement interval (r > 0.70; p < 0.001) and also a consistency in the regressions between measurements. Conclusion. The findings indicate that there is no particular benefit to the therapist in measuring more than one of the three variables if the purpose of the measurement is to serve as an indicator of ambulatory functional status for routine clinical assessment. Copyright © 2009 John Wiley & Sons, Ltd.

Does the addition of non-invasive ventilation during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease augment patient outcome in exercise tolerance? A literature review

Background. Non-invasive ventilation (NIV) during exercise in patients with chronic obstructive pulmonary disease (COPD) has been shown to increase exercise time and intensity. Feasibly then, NIV during pulmonary rehabilitation will enhance post-rehabilitation training effects. The purpose of this review is to systematically consider and critique the literature concerning the effects of NIV, when used during an exercise programme in COPD patients on exercise tolerance. Method. An electronic literature search was completed and the reference lists of the articles that fitted the following inclusion criteria were screened. Studies that used any mode of NIV during an exercise programme with a primary outcome measure focusing on exercise tolerance and were written after the year 2000 to reflect current practice. Studies that were not written in English or had been included in previous literature reviews were excluded. The studies were then critically appraised and assigned a level of evidence based upon Scottish Intercollegiate Guidelines Network. Results. Twenty-eight articles were screened, of which six fitted the inclusion criteria. The methodological quality ranged from level 1- to 1+. All but one study by Bianchi et al. (2002) demonstrated a statistically significant improvement in exercise tolerance with the addition of some form of NIV during pulmonary rehabilitation. The benefits may be greater in patients with more severe airway obstruction as determined by Forced Expiration Volume (FEV), (%pred). Conclusion. This review would suggest that NIV may allow an increased exercise intensity and duration during pulmonary rehabilitation in patients with moderate to very severe COPD, (according to the American Thoracic Society guidelines), resulting in a greater training effect and a prolonged exercise capacity. Further research looking at long-term follow-up is recommended. Copyright © 2009 John Wiley & Sons, Ltd.

Choice of treatment modalities was not influenced by pain, severity or co-morbidity in patients with knee osteoarthritis

Background and Purpose. Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA. Methods. Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses. Results. Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08-3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19-0.68 and OR = 8.92, 95% CI = 4.37-18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12-11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice. Conclusions. Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet access at work, physiotherapists having searched databases for the last six months and the gender of the therapist. There is a need for more studies of determinants for physiotherapy practice. Copyright © 2009 John Wiley & Sons, Ltd.

Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

Background and Purpose. Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. Method. The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC2,1) and smallest real difference (SRD) were calculated. Results. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6° and 10° (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. Conclusions. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. Copyright © 2009 John Wiley & Sons, Ltd.

Pain and hip lateral rotator muscle strength contribute to functional status in females with patellofemoral pain

Background and Purpose. Patellofemoral pain (PFP) is a common musculoskeletal pain condition, especially in females. Decreased hip muscle strength has been implicated as a contributing factor, yet the relationships between pain, hip muscle strength and function are not known. The purpose of this study was to test the hypothesis that pain and hip muscle strength explain unique portions of variance in the functional status of females with PFP. Methods. An observational, cohort study was conducted. The subjects for this study were twenty-one females with PFP (age: 26 ± 7 years; height: 163 ± 4 cm; and body mass: 62 ± 10 kg). Subjects had a minimum pain duration of two months (mean pain duration: 4.9 ± 3.6 years). The main measures were pain during a unilateral squat, measured with a visual analogue scale; isometric muscle force of gluteus medius, gluteus maximus and hip lateral rotators; and Kujala score (self-report measure of function). Hierarchical multiple regression analysis was performed with Kujala score as the dependent variable. Pain and hip lateral rotator muscle strength were independent variables, entered in that order. Other strength measures were not correlated with the Kujala score, and as such, were not used in the analysis. Results. Pain explained 22% of the variance in the Kujala score (p = 0.03). Hip lateral rotator strength explained an additional 14% of the variance, after accounting for pain level (p = 0.06). Conclusions. Pain and hip lateral rotator strength contributed to the functional status of females with PFP. Improving pain and hip lateral rotator muscle strength may improve function in females with this common pain condition. Copyright © 2009 John Wiley & Sons, Ltd.

Reproducibility and validity of digital inclinometry for measuring cervical range of motion in normal subjects

Background and Purpose. Measurements of cervical range of motion (CROM) have been extensively reported in the past decade employing simple (goniometers) as well as sophisticated (electro-, magneto- and ultrasonography-based) systems. The recent introduction of the simple, user-friendly and relatively cheap digital inclinometer (DI) has opened a potentially new venue for measurement of this segment's motion. The purpose of the present study was to assess intra-tester reproducibility of DI-based findings as well as its validity in comparison to the ultrasonography-based Zebris CMS 70P (Zebris Medizintechnik GmbhTM, Isny, Germany) for measuring CROM in normal subjects. Methods. Active CROM of healthy women (n = 15) and men (n = 15) aged 24.2(2.4) years was measured on two sessions, Test 1 and Test 2, spread over 7.2(±0.7) days apart. On Test 1, the six primary movements of the neck (flexion, F; extension, E; right and left lateral flexion, RLF and LLF; and right and left rotations, RR and LR) were measured using the DI and the Zebris. On Test 2, the same measurements were performed using the DI only. All measurements were conducted by the same tester, with the subject in the seated position. The only exception was DI measurement of cervical rotation that was performed in the supine position due to the DI gravity-dependence, rendering DI measurements in the transverse plane irrelevant. Results. No significant differences were revealed between the two instruments with respect to the sagittal and frontal planes, whereas the DI-based CROM in rotation was significantly greater then its Zebris-based counterpart. The inter-device interclass correlation coefficients (ICCs) for the frontal were 0.72 (RLF) and 0.62 (LLF), and 0.77 (F) and 0.83 (E). Poor correlations were indicated for the rotations. The intra-tester reproducibility derived from the test-retest DI measurement indicated good to excellent reproducibility in all planes with ICCs ranging from 0.82 (LLF) to 0.94 (E). The Standard Error of Measurement ranged from 1.6° (RR) to 2.6° (F). Conclusion. DI-based CROM measurements are reproducible and valid for recording sagittal and frontal plane motions in healthy subjects. The higher range in rotations, relative to the Zebris-based findings, is most probably attributable to the test position. Being relatively cheap, portable and convenient for tester and subject alike, the DI seems to be an effective instrument for assessing CROM. Copyright © 2009 John Wiley & Sons, Ltd.

Prevalence, risk factors and preventive strategies in work-related musculoskeletal disorders among Israeli physical therapists

Background and Purpose. Although physical therapists (PTs) have extensive knowledge of body mechanisms and injury prevention, work-related musculoskeletal disorders (WRMD) are quite common in this population. The purposes of this study were: to determine the prevalence and impact of WRMD among Israeli PTs; to investigate WRMD risk factors and to identify preventive strategies used by PTs; and to compare the risk of injuries in two professional settings: rehabilitation centres (RCs) and outpatient clinics (OPCs). Method. A validated, modified Cromie questionnaire, translated into Hebrew, was distributed to the PTs at their workplaces. The relationship between WRMD symptoms and professional settings was analysed by Pearson chi-square. The risk models were developed by logistic regression. One hundred and twelve PTs working in OPCs and RCs who defined themselves as healthy individuals were the subjects of this study. Results. Lifetime prevalence of WRMD was 83%. The highest prevalence of WRMD was in the lower back area (80%). Rehabilitation treatment was associated with an increased risk of lower back (odds ratio [OR] = 1.05) and shoulder symptoms (OR = 1.04); manual treatment was associated with an increased risk of wrist/thumb symptoms (OR = 1.11). Discussion. Work in RCs was associated with an increased prevalence of lower back/shoulder symptoms, whereas work in OPCs was associated with an increased prevalence of thumb/wrist symptoms. PT's used different strategies to reduce risk of WRMD, including altering practice technique. The respondents recommended administrative and ergonomic changes in the workplace. Conclusion. Workplace-specific interventions to reduce WRMD in PTs should be developed and tested in future studies. Copyright © 2009 John Wiley & Sons, Ltd.

The perceptions of Athenian physiotherapists on the referral service in Greece and its impact on professional autonomy

Background and Purpose. The attainment of professional autonomy is considered a priority of any profession. The development of autonomy in physiotherapy has differed among countries, with some achieving a high degree of autonomy while others have struggled. The current literature reveals little about the autonomy of physiotherapists in Greece, although it would appear they face both external and internal threats to autonomous practice and to the development of their profession. This exploratory study investigated Athenian physiotherapists' experiences of the referral system in Greece and its impact on professional autonomy. Methods. A qualitative, phenomenological approach was chosen, using a cluster sampling method. Ten physiotherapists participated in a 30-minute, one-to-one, semi-structured interview. The interview audio tapes were transcribed and an inductive analysis was carried out. When all transcripts had been coded, categories and themes were compared to record commonalities and differences to construct a hierarchy of essential themes expressing general views. Results. Physiotherapists were frustrated by the physiotherapy referral system in Greece. They revealed that their practice was restricted by factors, which included a long-standing dominance by the medical profession, bureaucratic process and the public perception of the profession in addition to restrictions from within the profession itself. To overcome the perceived restrictions to practice and the development of autonomy, participants had adopted strategies in an attempt to effectively address the patients' needs. Conclusions. There are clear issues related to the management and delivery of the physiotherapy referral system in Greece which impact on professional autonomy. Physiotherapists are forced to manipulate the referral system to provide a more appropriate level of care, resulting, however, in an inequitable service across the physiotherapy provision. If professional autonomy of physiotherapists in Greece is to move forward, these issues need to be acknowledged by governmental and professional bodies, as therapists can not be expected to undertake this journey alone. Copyright © 2009 John Wiley & Sons, Ltd.