The Association Between Static Pelvic Asymmetry and Low Back Pain

Study Design: A cross-sectional case–control approach was used to estimate the association between low back pain of less than 12 months’ duration and pelvic asymmetry among 21–50-year-old patients seeking physical therapy services. Objective. To evaluate the premise that asymmetrical positioning of the innominates of the pelvis is a source of low back pain. Summary of Background Data: No published studies have been conducted to evaluate systematically the association between low back pain and pelvic asymmetry in a clinic-based sample. Methods: Pelvic landmark data were obtained in 144 cases and 138 control subjects. The associations of low back pain with levels of pelvic asymmetry were estimated by use of odds ratios and 95% confidence intervals. Effect modification and confounding of the low back pain–pelvic asymmetry association by several factors was assessed and alternative asymmetry measures considered. Results: Pelvic asymmetry was not positively associated with low back pain in any way that seemed clinically meaningful. Asymmetry of posterior superior iliac spine landmarks showed some evidence of a weak positive association with low back pain. Conclusions: In the absence of meaningful positive association between pelvic asymmetry and low back pain, evaluation and treatment strategies based on this premise should be questioned

Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain

Background and Purpose. The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and the Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. Subjects. A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. Methods. The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive values. Results. Individual test sensitivities were low (8%-44%), as were negative predictive values (28%-38%), for identifying the presence of innominate torsion. Combining tests and controlling for sex, age group, leg-length difference, or iliac crest level did not improve performance characteristics. The associations of test results with low back pain were weak, with the exception of the Gillet test (odds ratio=4.57). Conclusion and Discussion. The data do not support the value of these tests in identifying innominate torsion, although the use of these tests for identifying other phenomena (eg, sacroiliac joint hypomobility) cannot be ruled out. Further exploration of the association of Gillet test results with low back pain is warranted

Seeking God (in the details)

Entrepreneurs tend to be self-styled “idea” people. They often believe they have the next “Big Concept”—one which could change the world, reaffirm their self-worth, and, of course, make them and their venture team a fortune. In contrast, as they build a company to implement their business dream, entrepreneurs also tend to eschew or trivialize administrative details. Why should they waste their creative juices on minutia? As a result of this insensitivity to detail, these captains of capitalism often trip in their entrepreneurial journey. For example, they might: • Forget to remit payroll taxes on schedule. • Fail to document the justification underpinning the dismissal of a key employee. • Allow the company’s liability insurance to lapse. • Neglect to report sales usage tax. • Verbally grant employee incentive stock options during an informal luncheon meeting, at a yet-to-be-determined exercise price and without the board of directors’ approval

Public School Physical Therapists: Role Definition and Educational Needs

Questionnaires returned by 328 physical therapists were analyzed to 1) establish a role definition for public school therapists and 2) determine the educational needs of therapists preparing for public school service. The therapists ranked 15 skills in importance to the role of the public school physical therapist and in urgency of their need to develop each skill. They also indicated which educational format they believed would be most appropriate for developing each skill. The respondents were divided into four groups matched by experience in treating children and by exposure to public school physical therapy. Rank-order correlations within each of these four groups showed little similarity in their perception of the public school therapist\u27s role or in their own educational needs. On the other hand, between-group correlations based on averaged role definitions and educational needs were high. Generated role definitions indicated the tendency of therapists to perceive themselves as part of the traditional medical model, rather than as participants in the educational process. Responses to questions about educational needs produced data useful for organizations developing educational programs

Preparing Students for EBP

Describes one particular approach to teaching evidence-based practice in physical therapy. At Sacred Heart University students begin course work that is foundational to preparing them for evidence-based practice. In the first semester of study, they take a Concepts in Measurement unit. During the second semester, I teach a semester-long Clinical Research course that focuses on understanding concepts of clinical research and on critical review of physical therapy literature. During the third and fourth semesters of study, when they are doing their clinical coursework, the emphasis is on the concepts of validity and reliability of the tools they use. The students also have an additional opportunity to do some limited critical review of the literature. Then, in the fifth semester of study - their fifth and final academic semester - the students take a course called Research in Evidence-Based Practice. This course is the so-called capstone experience in the state of Connecticut

Association of Low Back Pain With Self-Reported Risk Factors Among Patients Seeking Physical Therapy Services

Background and Purpose. This study investigated the magnitude of association between low back pain (LBP) and self-reported factors thought to increase the risk of LBP. Subjects and Methods. Questionnaires were completed by 150 patients who were receiving physical therapy for LBP and by 138 patients who were being treated for other reasons. The solicited information was used to estimate odds ratios and 95% confidence intervals for the LBP-risk factor association. Results. Low back pain was positively associated with smoking status, pregnancy, industrial vibration exposure, and time spent in a car (odds ratios [is greater than or equal to] 2.21). Daily lifting, body mass index, activity level, and time sitting or standing showed at most a weak positive association with LBP. Comparisons with estimated associations from other studies were made. Conclusion and Discussion. Data from this study support a statistically significant association between LBP and some factors found in other research to increase the risk of LBP. Study findings may have implications for targeting at-risk groups for back care education or intervention programs

Application and Interpretation of Simple Odds Ratios in Physical Therapy-Related Research

Over the past several decades, physical therapists have demonstrated an increasing responsiveness to the profession\u27s obligation to generate objective evidence for examination and intervention strategies employed in physical therapy practice. This trend is evident, not only in the increasing number of journals that are publishing physical therapy research, but in the growing sophistication of research design and analytic options used by investigators. At the same time, physical therapists are held increasingly accountable for adopting an evidence-based approach to practice. The result for many of us is a growing concern about our ability to interpret study findings. The ability to independently weigh the importance to our own practice of evidence reported in a study requires that we understand the strengths and potential weaknesses of the sample, design, and analyses being used. The odds ratio (OR) is one of the analytic measures that has only recently appeared in the physical therapy literature. Because the OR may be unfamiliar to physical therapists, the goal of this paper is to provide a description of the simple OR and a discussion of its uses, interpretation, and potential limitations

No Mulligans: When Good Entrepreneurs Make Bad Decisions

Some of the best entrepreneurs fail early and often. Less talented or less committed entrepreneurs do not even get a second chance. Failure and setbacks, however, can be instructive. What lessons can be learned from these experiences? How can the entrepreneur (and investors) navigate around the potholes on the New Venture Highway? Read on