Short-term combined effects of thoracic spine thrust manipulation and cervical spine non-thrust manipulation in patients with mechanical neck pain : a randomized clinical trial

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy]

Thoracic spine manual therapy for aging and older individuals

With the advancement of medicine and technology, along with improvements in preventative medicine, the average age of the US population continues to rise. Research estimates that by the year 2050, there will be more than 65 million older adults living, with 19 million being older than 85 years. As the population ages, more individuals will seek out physical therapy services for spine-related pathologies. Little evidence is currently available on the safety and effectiveness of manual therapy interventions in older adults. The purpose of this review was to discuss the safety and effectiveness of manual therapy interventions targeted at the thoracic spine in older individuals

Utilization And Payments Of Office-Based Physical Rehabilitation Services Among Individuals With Commercial Insurance In New York State

Background. Limited research exists on the utilization and payments of physical rehabilitation services, especially among individuals with commercial insurance. Objective. This study aimed to characterize the utilization and payments of office-based physical rehabilitation services among nonelderly individuals with commercial insurance from New York State. Design. This was a retrospective descriptive study with a cross-sectional design. Methods. A cohort of 1.8 million individuals in the 2012 Truven Health MarketScan Research Database was constructed for review. A total of 109,821 unique patients who received any type of physical rehabilitation provided by physical therapists, chiropractors, and physicians in the office setting were included for analyses. Results. Physical therapists provided the largest proportion of physical rehabilitation services (54.5%), followed by chiropractors (27.5%) and physicians (18.0%). Six out of 100 individuals used physical rehabilitation services in 2012. The mean annual payment of physical rehabilitation per patient was $820 (median=$323). Women and older individuals were more likely to use rehabilitation services and have higher annual utilization and payments. For the 5 most common physical rehabilitation services, payment rates for chiropractors were the highest and those for physical therapists were the lowest, with payment rates for physicians in between. Limitations. This study was based on commercial insurance claims data from one state. Conclusions. Findings from this study recognize that rehabilitation services are delivered by various types of health care professionals and the payment rates vary across provider specialties in New York State. Of particular interest is that although physical therapists provide the largest proportion of services, their payment rates are lower than the rates for chiropractors and physicians. Future research should assess regional variations and explore interprovider cost-effectiveness in delivering these interventions

Emotional intelligence and clinical performance across practice areas: Implications for health professions educators and practitioners

Objective: The evaluation of student clinical competencies is multifactorial, with emotional intelligence (EI) considered as an essential component for success. Currently there is a lack of knowledge on whether distinct EI competencies are related to specific practice areas. This study purpose was to explore the relationship between supervisor’s perception of student EI and clinical performance across practice areas. Methods: This cross-sectional study utilized a sample of convenience to gather data from 52 full-time occupational therapy students and their respective supervisors at the completion of their clinical rotations. The Fieldwork Performance Evaluation (FWPE) and The Emotional and Social Competency Inventory-University version (ESCI-U) were used. A Pearson’s correlation coefficient analysis was used to explore the associations between EI competencies and clinical performance. Results: Higher EI scores were associated with higher scores on clinical performance during physical disability rotations. Findings show EI competencies of conflict management and self and organizational awareness to be associated with student ability to use clinical reasoning to deliver client-centered occupation-based goals, including proficiency of technical skills in a physical disabilities practice area. Conclusion: Findings provide additional support and suggestions for the context related role of EI in health profession clinical education

Timing Of Rehabilitation On Length Of Stay And Cost In Patients With Hip Or Knee Joint Arthroplasty: A Systematic Review With Meta-Analysis

Objective: To investigate the role of early initiation of rehabilitation on length of stay (LOS) and cost following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty. Data sources: Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, and the Cochrane Library were searched in July 2016. Five additional trials were identified through reference list scanning. Study selection: Eligible studies were published in English language peer-reviewed journals; included participants that had undergone total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty reported clearly defined timing of rehabilitation onset for at least two groups; and reported at least one measure of LOS or cost. Inclusion criteria were applied by 2 independent authors, with disagreements being determined by a third author. Searching identified 1,029 potential articles, of which 17 studies with 26,614 participants met the inclusion criteria. Data extraction: Data was extracted independently by 2 authors, with disagreements being determined by a third author. Methodological quality of each study was evaluated independently by 2 authors using the Downs and Black checklist. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate standardized mean differences (SMD) and 95% confidence intervals for LOS. Data synthesis: When compared with standard care, early initiation of physical therapy demonstrated a decrease in length of stay for the 4 randomized clinical trials (SMD = -1.90; 95% CI -2.76 to -1.05; I2 = 93%) and for the quasi-experimental and 5 prospective studies (SMD = -1.47; 95% CI -1.85 to -1.10; I2 = 88%). Conclusion: Early initiation of rehabilitation following total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty is associated with a shorter LOS, a lower overall cost, with no evidence of an increased number of adverse reactions. Additional high quality studies with standardized methodology are needed to further examine the impact of early initiation of physical therapy among patients with joint replacement procedures

Immediate Physical Therapy Initiation In Patients With Acute Low Back Pain Is Associated With A Reduction In Downstream Health Care Utilization And Costs

Background. Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. Objective. The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. Design. The design was a retrospective cohort study. Methods. Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed. Results. Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. Limitations. This study was based on commercial insurance claims data from 1 state. Conclusions. When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs

Rotator Cuff Tendinopathy: An Evidence-Based Overview For The Sports Medicine Professional

ROTATOR CUFF TENDINOPATHY IS A PREVALENT CONDITION AMONG BOTH THE GENERAL AND ATHLETIC POPULATIONS, WITH MANY OF THESE INDIVIDUALS SEEKING CONSERVATIVE CARE AT SOME POINT. THE UNDERSTANDING OF TENDINOPATHIES HAS CHANGED DRAMATICALLY OVER THE PAST DECADE, AS HAVE MANAGEMENT OPTIONS. THIS ARTICLE PROVIDES AN OVERVIEW OF CURRENT TRENDS IN THE UNDERSTANDING OF ROTATOR CUFF TENDINOPATHY INCLUDING THE UNDERLYING PATHOPHYSIOLOGY, RISK FACTORS, AS WELL AS THE EVIDENCE UNDERSCORING PHARMACOLOGICAL AND EXERCISE-BASED INTERVENTIONS

Methodological Quality.

<p>Methodological Quality.</p

Influence Of Femoral Acetabular Impingement On Squat Performance

The squat is a fundamental movement for weightlifting and sport performance and may be used for assessing injury risk and functional independence. The purpose of this column is to present an evidence-based discussion of the influence that femoral acetabular impingement may have on squat performance