PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY
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2004 - Vol. 12, No. 1
Interexaminer Reliability of Symptom-Provoking Active Sidebend, Rotation and Combined Movement Assessments of Patients with Low Back Pain
Kate Haswell, MHSc (Hons), PT, MT, Maynard Williams, MSc (Hons), Dip Tchg, Wayne Hing, MSc (Hons), PT, MT
Abstract: Symptom-provoking active movements can be useful assessments of patients with low back pain. They may give an early indication of the likelihood of chronicity and can also assist the clinician in selecting treatment interventions. Reliability data for such movements is incomplete. While symptom-provoking flexion and extension movements have consistently shown acceptable reliability and results for sidebend tests have suggested moderate reliability, results for symptom-provoking active rotation are variable and only one study has investigated the reliability of combined movements. The purpose of this study was to further investigate the interexaminer reliability of symptom-provoking active sidebend, rotation and combined movement assessments. Symptom-provoking movements were identified on the basis of aggravation or reproduction of the patient's pain complaint, that is, the symptoms for which the patient was seeking treatment. Pairs of therapists from a pool of four therapists independently examined patients with low back pain during a routine clinic visit. Percent agreement and Kappa values (95% Confidence Interval) for the movement assessments were sidebend 81.4% and 0.60 (0.40; 0.79), rotation 70% and 0.17 (-0.08; 0.42), sidebend-rotation 64.3% and 0.29 (0.06; 0.51), flexion-sidebend-rotation 70% and 0.39 (0.18; 0.61), and extension-sidebend-rotation 67.1% and 0.29 (0.06; 0.52). The majority of schemes described for the physical examination of patients with low back pain include symptom-provoking active sidebend, and findings from this study support the ongoing clinical use of this assessment. While symptom-provoking active rotation and combined movements were found to be unreliable, these assessments have been shown to have potential diagnostic value. Further research is warranted to investigate procedural changes that may improve reliability and to further investigate their diagnostic accuracy.
The Journal of Manual & Manipulative Therapy Vol. 12 No. 1 (2004), 11 - 20
Evidence-Based Practice in Physical and Manual Therapy: Development and Content of Dutch National Practice Guidelines for Patients with Non-Specific Low Back Pain
Rob A. B. Oostendorp, PhD, PT, MT, Gwendolyne G. M. Scholten-Peeters, MSc, PT, MT, Raymond A. H. M. Swinkels, MSc, PT, MT, Geertruida E. Bekkering, PhD, PT, Marcel W. F. G. J. Heijmans, MSc, PT, MT, Peter A. Huijbregts, DPT, FAAOMPT, FCAMT, Erik J. M. Hendriks, PhD, PT
Abstract: Clinical practice in physical and manual therapy is experiencing a paradigm shift from an experience- and authority-based model to a more evidence-based model. National Practice Guidelines (NPG) are examples of this shift towards research-based knowledge. This article discusses the five steps in the development of NPGs. These steps are illustrated by a discussion of development and content of two NPGs produced recently in the Netherlands for the treatment of patients with non-specific low back pain.
The Journal of Manual & Manipulative Therapy Vol. 12 No. 1 (2004), 21 - 31
Influence of Advanced Orthopaedic Certification on Clinical Outcomes of Patients with Low Back Pain
Linda Resnik, PT, PhD, OCS, Dennis L. Hart, PT, PhD
Abstract: PURPOSE: To determine differences in outcomes of care for patients treated by clinicians with or without advanced orthopaedic certification. Levels of certification studied included orthopaedic clinical specialist certification (OCS), graduation from residency programs approved by the American Academy of Orthopaedic Manual Therapy (AAOMPT) and miscellaneous manual therapy certifications (MTC). SUBJECTS: Retrospective study was performed using Focus On Therapeutic Outcomes, Inc. (Knoxville, TN) data, which was obtained from 930 therapists (28 OCS, 7 AAOMPT, 7 MTC, 2 OCS/AAOMPT) from 39 states who treated 24,276 patients with lumbar impairments in 1999 and 2000. METHODS: Patients completed health status surveys at intake and discharge. Three health status measures were calculated: overall health status (OHS), SF-12 Physical Component Summary scale (PCS), and SF-36 physical functioning scale (PF-10). Change in health status over the episode of rehabilitation was risk adjusted by developing linear mixed models and analyzed across certification processes. RESULTS: Patients treated by therapists with MTC reported higher OHS, PCS, and PF-10 discharge scores than patients treated by therapists without MTC (P<.001). CONCLUSIONS: Findings suggest a positive influence of therapist manual therapy certification on patient outcomes.
The Journal of Manual & Manipulative Therapy Vol. 12 No. 1 (2004), 32 - 43
Abdominal Ultrasound Imaging of Pelvic Floor Muscle Function in Individuals with Low Back Pain
Jackie Whittaker, BScPT, FCAMT, CAFCI
Abstract: Research reveals that the primary impairment of the muscular system in individuals with low back pain is not one of strength or functional capacity but rather one of motor control of the deep muscles of the trunk. These deep muscles include the transversus abdominis, the deep segmental fibers of lumbar multifidus, the pelvic floor, and the diaphragm. Advances in knowledge regarding load transfer in the lumbopelvic region have provided the orthopaedic manual therapist with the necessary tools to assess most components of lumbopelvic dysfunction with the exclusion of an evaluation technique for pelvic floor motor control. The use of ultrasound imaging to observe the real-time contraction of muscles is a valuable tool, specifically when the muscles of interest are deep and not readily observable. The author proposes a novel abdominal ultrasound imaging method to assess voluntary pelvic floor motor control and discusses the rationale for its application in a population with lumbopelvic dysfunction.
The Journal of Manual & Manipulative Therapy Vol. 12 No. 1 (2004), 44 - 49
