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Edmond SL, Werneke MW, Grigsby D, Young M, Harris G. The association between self-efficacy on function and pain outcomes among patients with chronic low back pain managed using the McKenzie approach: a prospective cohort study. J Man Manip Ther 2023; 31:38-45. [PMID: 35603569 PMCID: PMC9848301 DOI: 10.1080/10669817.2022.2075202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Self-efficacy is a determinant of function and pain outcomes in patients with chronic low back pain receiving physiotherapy. The McKenzie approach is an effective intervention for patients with back pain that may affect self-efficacy. Study aims were to determine if, among patients with back pain being managed by McKenzie-credentialed physiotherapists: intake self-efficacy is correlated with intake function and pain; intake self-efficacy is associated with changes in function and pain during treatment; self-efficacy improves during treatment; and improvements in self-efficacy during treatment are associated with improvements in function and pain at discharge. METHODS Two-hundred-eighty-two subjects with chronic low back pain seen by McKenzie-credentialed clinicians provided data on self-efficacy, function and pain at intake and discharge. RESULTS Self-efficacy was correlated with function and pain at intake; however, intake self-efficacy was not associated with function or pain outcomes. Self-efficacy increased during treatment. This increase was associated with improvements in function and pain at discharge. CONCLUSION While intake self-efficacy was associated with function and pain when initiating physiotherapy, it did not result in improved treatment outcomes. Specific interventions may be necessary to improve self-efficacy. The increases in self-efficacy observed during treatment were associated with improvements in function and pain outcomes at discharge.
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Affiliation(s)
- Susan L Edmond
- Rutgers The State University of New Jersey, Physical Therapy Doctoral Programs, Newark, NJ, USA,CONTACT Susan L Edmond Doctoral Programs in Physical Therapy, Rutgers University of New Jersey, 65 Bergen Street, Suite 721, Newark, NJ07101-1709, USA
| | | | - David Grigsby
- Physical Therapy Department, MidSouth Orthopaedic Rehab, Cordova, TN, USA
| | - Michelle Young
- Valley Health Wellness and Fitness Center, Winchester, VA, USA
| | - Gary Harris
- IVY Rehab Physical Therapy, Medford, NJ, USA
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Harris S, Roddey T, Shelton T, Bailey L, Brewer W, Ellison J, Wang W, Gleeson P. The functional lumbar index: Validation of a novel clinical assessment tool for individuals with low back pain. Musculoskelet Sci Pract 2022; 62:102666. [PMID: 36179496 DOI: 10.1016/j.msksp.2022.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective Diagnostic Cohort Study. LEVEL OF EVIDENCE Level 3b. OBJECTIVES To examine the concurrent and predictive validity of a novel clinical assessment tool, the Functional Lumbar Index (FLI). BACKGROUND Lumbar surgeries have increased exponentially in the past decade, adding to healthcare costs without improving outcomes. Limitations in clinicians' abilities to identify those individuals who are most likely to benefit from surgery may be enhanced with an effective physical assessment tool. METHODS The FLI was assessed on 291 individuals (179 conservative and 113 pre-surgical) seeking care for low-back pain (LBP) over a 2.5-year period. The FLI consists of several physical performance tests (PPT) with a novel criterion-based scoring system. Pearson correlations and Poisson regression analysis were used to establish concurrent and predictive validity at alpha = 0.05. RESULTS The subscale FLI components showed good to excellent inter-rater reliability with intraclass correlation coefficient values as follows: front plank = .993, right side plank = .824, left side plank .861, Sorensen = 0.836, overhead squat = 0.937. A statistically significant, moderate negative correlation was observed between FLI and modified Oswestry Disability Index (r = -0.540, p < .001). Regression analysis showed the FLI as the only significant predictor (p = .004) of failed conservative management for individuals with LBP. An ROC curve showed significant group prediction of the FLI with an AUC of 0.788 (p < .001) and cut-off score of 7.5. CONCLUSION The FLI is a reliable and valid measure for predicting failed conservative care management in patients with LBP. Clinicians are encouraged to use the FLI as part of their physical assessment when screening individuals with LBP who might need surgical intervention. Further research is needed to determine validity of the FLI in other patient populations. PUBLIC TRIAL REGISTRY N/A.
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Affiliation(s)
- Sean Harris
- Texas Woman's University, Houston, TX, USA; Memorial Hermann Health System, Houston, TX, USA.
| | | | | | - Lane Bailey
- Memorial Hermann Health System, Houston, TX, USA
| | | | | | - Wanyi Wang
- Texas Woman's University, Houston, TX, USA
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Patients' Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106106. [PMID: 35627641 PMCID: PMC9140490 DOI: 10.3390/ijerph19106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen’s d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients’ perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.
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Rufa A, Kolber MJ, Rodeghero J, Cleland J. The impact of physical therapist attitudes and beliefs on the outcomes of patients with low back pain. Musculoskelet Sci Pract 2021; 55:102425. [PMID: 34298493 DOI: 10.1016/j.msksp.2021.102425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common problem that places a major burden on individuals and society. It has been proposed that patients treated by biomedically oriented clinicians will have worse outcomes than those treated by biopsychosocially oriented clinicians. OBJECTIVE To investigate the impact of physical therapist LBP related attitudes and beliefs on the outcomes of patients with LBP. DESIGN Retrospective cohort design. METHOD United States based physical therapists utilizing the Focus on Therapeutic Outcomes, Inc. (FOTO) database were surveyed using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using average Computerized Lumbar Functional Scale change scores (CLFS) and CLFS residual scores. RESULTS Analysis was performed on outcome data from 78 physical therapist and included 2345 patients. HC-PAIRS was a univariate predictor of average CLFS change scores and average CLFS residual scores. PABS-PT Biomedical subscale was a univariate predictor of average CLFS change scores. After adjusting for confounding variables, higher HC-PAIRS scores and PABS-BM scores were associated with a greater change in average CLFS score, and higher PABS-BM scores were associated with higher CLFS residual scores. CONCLUSION Physical therapists who believed in a stronger relationship between pain and disability had improved patient outcomes.
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Affiliation(s)
- Adam Rufa
- SUNY Upstate Medical University, Syracuse, NY, USA; Nova Southeastern University, Fort Lauderdale, FL, USA.
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Beneciuk JM, Brown-Taylor L, Alodaibi F, Kareha S, Holmes R, Fritz J. Patient- and Physical Therapist-Level Predictors of Patient-Reported Therapeutic Alliance: An Observational, Exploratory Study of Cohorts With Knee and Low Back Pain. Arch Phys Med Rehabil 2021; 102:2335-2342. [PMID: 34283991 DOI: 10.1016/j.apmr.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To identify patient- and physical therapist-level predictors for therapeutic alliance at the end of an episode of physical therapy for knee or low back pain (LBP). DESIGN Secondary analysis of observational cohort. SETTING Outpatient physical therapy clinics. PARTICIPANTS Patients receiving physical therapy for knee (n=189) or LBP (n=252) and physical therapists (n=19). Candidate predictor variables included demographics, patient clinical characteristics, and physical therapist attitudes and beliefs (Pain Attitudes and Beliefs Scale for Physical Therapists) and confidence in providing patient-centered care (Self-Efficacy in Patient-Centeredness Questionnaire). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient-reported therapeutic alliance was measured using the 12-item Work Alliance Inventory-Short Revised (WAI-SR). RESULTS Final linear mixed models indicated different patient- and physical therapist-level factor contributions in predicting final WAI-SR scores across cohorts with knee and LBP. Female sex was a consistent patient-level predictor for both knee (estimated β=1.57, P<.05) and LBP (β=1.42, P<.05), with age (β=-0.07, P<.01) and baseline function (β=0.06, P<.01) contributing to cohorts with knee and LBP, respectively. Physical therapist-level predictors included female sex (β=6.04, P<.05), Pain Attitudes and Beliefs Scale for Physiotherapists behavioral (β=0.65, P<.01), and Self-Efficacy in Patient-Centeredness Questionnaire (SEPCQ) Exploring Patient Perspective (β=-0.75, P<.01) subscale scores for LBP, with SEPCQ Sharing Information and Power subscale scores (β=0.56, P<.05) contributing to both cohorts with knee (β=0.56, P<.05) and LBP (β=0.74, P<.01). Random effects for patients nested within physical therapists were observed for both cohorts. CONCLUSIONS These findings provide preliminary evidence for inconsistent relationships among patient- and physical therapist-level factors and therapeutic alliance across cohorts with knee and LBP.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, FL; Brooks Rehabilitation, Jacksonville, FL.
| | - Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA, Salt Lake City, UT
| | - Faris Alodaibi
- Rehabilitation Science Department, King Saud University, Riyadh, Saudi Arabia
| | - Stephen Kareha
- Physical Therapy at St. Luke's University Health Network, Bethlehem, PA; Department of Physical Therapy, DeSales University, Bethlehem, PA
| | - Rett Holmes
- Physical Therapy at St. Luke's University Health Network, Bethlehem, PA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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Côté-Picard C, Tittley J, Mailloux C, Perreault K, Mercier C, Dionne CE, Roy JS, Massé-Alarie H. Effect of thermal therapy and exercises on acute low back pain: a protocol for a randomized controlled trial. BMC Musculoskelet Disord 2020; 21:814. [PMID: 33278897 PMCID: PMC7719244 DOI: 10.1186/s12891-020-03829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is the first cause of years lived with disability worldwide. This is due to the development of chronic pain. Thus, it is necessary to identify the best therapeutic approaches in the acute phase of LBP to limit the transition to chronic pain. Superficial heat presents the highest level of evidence for short-term reduction in pain and disability in acute LBP. Physical activity is also recommended to avoid transition to chronic LBP, but there is a lack of evidence to determine its effect to reduce acute LBP. Also, the long-term effects of these interventions are unknown. This is a protocol for a randomized controlled trial (RCT) to determine the short and long-term effects of wearable continuous low-level thermal therapy, in combination with exercises or not, on disability and pain. METHODS/DESIGN Sixty-nine participants with acute LBP will be randomly assigned to one of three intervention programs: 1) thermal therapy, 2) thermal therapy + exercises, and 3) control. The interventions will be applied for 7 continuous days. The primary outcome will be disability and secondary outcomes will be pain intensity, pain-related fear, self-efficacy, number of steps walked and perception of change. The evaluators will be blinded to the interventions, and participants will be blinded to other groups' interventions. Primary and secondary outcomes will be compared between intervention groups. DISCUSSION This study will provide new evidence about acute LBP treatments, to limit transition to chronicity. This will be the first study to measure the long-term effects of wearable continuous low-level thermal therapy, combined or not to exercises. TRIAL REGISTRATION This RCT has been retrospectively registered on ClinicalTrials.gov ( NCT03986047 ) on June 14th, 2019.
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Affiliation(s)
- Claudia Côté-Picard
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Jean Tittley
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Catherine Mailloux
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Kadija Perreault
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada.,Département de réadaptation, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada
| | - Catherine Mercier
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada.,Département de réadaptation, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada
| | - Clermont E Dionne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada.,Département de réadaptation, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada.,Centre de Recherche du CHU de Québec - Université Laval, 1050, chemin Sainte-Foy, Quebec, QC, G1S 4L8, Canada
| | - Jean-Sébastien Roy
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada.,Département de réadaptation, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada
| | - Hugo Massé-Alarie
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Université Laval, 525 Boulevard Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada. .,Département de réadaptation, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada.
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Netzer O, Shechtman Z. Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors). Int J Group Psychother 2020; 70:349-374. [PMID: 38449218 DOI: 10.1080/00207284.2020.1727746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition-change were more prevalent in group treatment.
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Abstract
STUDY DESIGN .: A retrospective observational study. OBJECTIVE Assess the time course of functional outcome improvements during a physical therapy (PT) episode of care for patients with low back pain. In addition, assess the impact of patient variables, such as symptom duration, on the time course of functional outcome improvements. SUMMARY OF BACKGROUND DATA Early improvement in patient-reported symptoms and functional limitations may play an important role in the eventual success of an intervention. Early improvements in pain are associated with greater improvement in disability and depression in patients with low back pain. METHODS A total 11,945 patients were included. Intake functional status (FS), FS change at discharge, predicted FS change at discharge, FS change at first progress report (FS1), duration of symptoms before treatment, and duration of PT episode of care were assessed. Pearson correlation analysis was used to assess correlation between collected variables and FS change. RESULTS The mean FS change was 16.995 units, mean FS1 was 12.024 units, total duration was 63.591 days, and duration at FS1 was 28.969 days, indicating 70.72% of FS change occurred in the first 45.45% of the episode of care. Similar results occurred in all symptom duration categories, ranging from "0 to 7 days' to "greater than 6 months' duration. Correlation analysis demonstrated that FS1 had the greatest correlation to FS. A strong correlation (r > 0.7) was demonstrated in all symptom duration categories ranging from 0.741 to 0.805. CONCLUSION The results of this study yield further support for the importance of rapid functional improvements during a PT episode of care. In addition, patients demonstrated roughly two-thirds of their improvement in the first 40% of visits regardless of their symptom duration. This study may help clinicians identify a need to modify a plan of care if insufficient early improvement is observed. LEVEL OF EVIDENCE 3.
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Wiitavaara B, Heiden M. Content and psychometric evaluations of questionnaires for assessing physical function in people with low back disorders. A systematic review of the literature. Disabil Rehabil 2018; 42:163-172. [PMID: 30324809 DOI: 10.1080/09638288.2018.1495274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders in the low back. Specifically:Which questionnaires are used to assess physical function in people with musculoskeletal disorders in the low back?What aspects of physical function do those questionnaires measure?What are the measurement properties of the questionnaires?Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations of them. The content of the questionnaires was categorised according to the International Classification of Function, Disability and Health, and the psychometric evaluations were categorised using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist.Results: The questionnaires measured disability or ability to cope in everyday life, rather than physical function as such. Different aspects of a person's mobility and ability to attend to one's personal care were most often included regarding activity and participation. For body functions, items about sleep and pain were most often included. The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.Conclusions: The extent of psychometric evaluations differed substantially, as did the items included. Focus of measurement was predominantly on activities in daily life.Implications for rehabilitationValid and reliable instruments that measure relevant aspects of low back disorders are needed to provide early diagnostics and effective treatment.Most questionnaires need more psychometric evaluations to establish the quality.The Oswestry Disability Index and the Quebec Back Pain Disability Scale showed adequate psychometric properties in most evaluations.The results may be useful when making decisions about which measurement instruments to use when evaluating low back disorders.
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Affiliation(s)
- Birgitta Wiitavaara
- Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Marina Heiden
- Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
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Werneke MW, Edmond S, Young M, Grigsby D, McClenahan B, McGill T. Association between changes in function among patients with lumbar impairments classified according to the STarT Back Screening Tool and managed by McKenzie credentialed physiotherapists. Physiother Theory Pract 2018; 36:589-597. [DOI: 10.1080/09593985.2018.1490839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Susan Edmond
- Doctoral Programs in Physical Therapy, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Michelle Young
- Rehabilitation Services, Valley Health Wellness and Fitness Center, Winchester, VA, USA
| | - David Grigsby
- MidSouth Orthopaedic Rehabilitation, Physical Therapy, Cordova, TN, USA
| | | | - Troy McGill
- Providence Rehabilitation Services, Outpatient Therapies, Providence Alaska Medical Center, Anchorage, AK, USA
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Wang YC, Sindhu BS, Kapellusch J, Yen SC, Lehman L. Global rating of change: perspectives of patients with lumbar impairments and of their physical therapists. Physiother Theory Pract 2018; 35:851-859. [DOI: 10.1080/09593985.2018.1458930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ying-Chih Wang
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Bhagwant S. Sindhu
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Sheng-Che Yen
- Department of Physical Therapy, Northeastern University, Boston, MA, USA
| | - Leigh Lehman
- Department of Occupational Therapy, Augusta University, Augusta, GA, USA
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Werneke M, Hayes D, Deutscher D. Clinical utility of the Oswestry Disability Index for measuring the function of patients with low back pain. Spine J 2018; 18:712-713. [PMID: 29685295 DOI: 10.1016/j.spinee.2017.06.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Mark Werneke
- Spine Rehabilitation, Physical Therapy & Consultation, 94-1265 Lumikula St, Waipahu, HI 96797, USA
| | - Deanna Hayes
- Focus on Therapeutic Outcomes, Coordinator Research and Development, 2910 Tazewell Pike, Suite E, Knoxville, TN 37918, USA
| | - Daniel Deutscher
- Department of Physical Therapy, Maccabi Healthcare Services, Tel-Aviv, Israel
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Werneke M. Criteria for Recommending a Patient Self-Report Functional Outcome. Arch Phys Med Rehabil 2016; 98:191-192. [PMID: 28010779 DOI: 10.1016/j.apmr.2016.08.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Mark Werneke
- Spine Rehabilitation, CentraState Medical Center, Freehold, NJ
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Pinto-Carral A, Fernández-Villa T, Molina de la Torre AJ. The Authors Respond. Arch Phys Med Rehabil 2016; 98:192-193. [PMID: 28010780 DOI: 10.1016/j.apmr.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Arrate Pinto-Carral
- School of Health Science, SALBIS Research Group, University of León, León, Spain
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health (GIIGAS), University of León, León, Spain
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Evaluation of Computerized Adaptive Tests (CATs) for longitudinal monitoring of depression, anxiety, and stress reactions. J Affect Disord 2016; 190:846-853. [PMID: 25481813 DOI: 10.1016/j.jad.2014.10.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 10/26/2014] [Accepted: 10/30/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Computerized adaptive testing (CAT) based on Item Response Theory, (IRT) offers an efficient way for accurate measurement of patient reported outcomes. The efficiency lies within a minimal response burden and a high measurement precision over a broad measurement range. The objective of the study was to evaluate and compare the responsiveness of CATs measuring anxiety, depression, and stress reaction to standard static self-assessment tools. METHODS Longitudinal data of n=595 psychosomatic inpatients were analyzed for evaluating retest-reliability and sensitivity to change of the CATs compared to static measures (GAD-7, PHQ-9, and PSQ) using correlational and ANOVA statistics. The study hypothesized that CATs are at least as retest-reliable and as sensitive to change as static tools. RESULTS The three CATs show a low burden for patients, administering on average 5-7 (±2-6SD) items with similar retest-reliability compared to the static tools applied (A-CAT: r=.78 vs. GAD-7: r=.75, D-CAT: r=.71 vs. PHQ-9: r=.75, S-CAT: r=.80 vs. PSQworries scale: r=.80). The CATs were overall as sensitive to change as the static tools (Cohen׳s d ranged between .19 and .69). LIMITATIONS This is a monocenter, observational, longitudinal study without external clinical criteria; thus generalization to other settings may be limited. CONCLUSIONS The tested CATs belong to the first generation of CATs being used in daily routine for more than a decade. They are as retest reliable and sensitive to change as static tools. Newer CATs may provide further practical advantages.
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Rodeghero J, Cook C, Cleland J, Mintken P. Risk stratification of patients with low back pain seen in physical therapy practice. ACTA ACUST UNITED AC 2015; 20:855-60. [DOI: 10.1016/j.math.2015.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/29/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
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The impact of physical therapy residency or fellowship education on clinical outcomes for patients with musculoskeletal conditions. J Orthop Sports Phys Ther 2015; 45:86-96. [PMID: 25579690 DOI: 10.2519/jospt.2015.5255] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A retrospective cohort design was conducted using data from an electronic survey and an existing commercial outcomes database. OBJECTIVE To compare the clinical outcomes of patients with musculoskeletal conditions treated by physical therapists who had completed residency or fellowship programs versus those who had not. BACKGROUND There is an increasing focus on specialization through postprofessional education in physical therapy residency and fellowship programs. Scant evidence exists that evaluates the influence of postprofessional clinical education on actual patient outcomes. METHODS Physical therapists using a national outcomes database were surveyed to determine their level of postprofessional education. Survey responders were categorized into 1 of 3 groups that included no residency or fellowship training, residency trained, or fellowship trained. Outcomes for 25 843 patients with musculoskeletal conditions treated by 363 therapists from June 2012 to June 2013 were extracted from the database. These data were analyzed to identify any differences in functional status change and efficiency achieved between the 3 groups. Potentially confounding variables were controlled for statistically. RESULTS The fellowship-trained group of physical therapists achieved functional status changes and efficiency that were greater than those of the other groups. No difference in functional status change was observed between the residency group and the therapists without residency or fellowship training. The group without residency or fellowship training was more efficient than the residency-trained group. Fellowship-trained therapists were more likely to achieve greater treatment effect sizes than therapists without residency or fellowship training. Residency-trained therapists were less likely to achieve greater treatment effect sizes than the therapists without residency or fellowship training. CONCLUSION These data demonstrate that fellowship training may contribute to statistically greater patient outcomes. Residency training did not appear to contribute to improved patient functional status change or efficiency. It is unknown whether the statistical differences observed would be clinically meaningful for patients.
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Physical therapists' level of McKenzie education, functional outcomes, and utilization in patients with low back pain. J Orthop Sports Phys Ther 2014; 44:925-36. [PMID: 25353260 DOI: 10.2519/jospt.2014.5272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Longitudinal, prospective, observational cohort. OBJECTIVE To examine associations between McKenzie training, functional status (FS) at discharge, and number of physical therapy visits (utilization) in patients receiving physical therapy for low back pain. BACKGROUND The McKenzie method is commonly used in treating patients with low back pain. METHODS A McKenzie postgraduate educational program was initiated in a large outpatient physical therapy service. Functional status data were collected at intake and at discharge. Separate hierarchical linear mixed models were used to examine associations between physical therapists' McKenzie training level (none; Parts A, B, C, and D; and credentialed), FS score at discharge, and utilization, controlling for patient risk factors. RESULTS The final data set included 20 882 patients (mean ± SD age, 51 ± 16 years; 57% women) who completed FS surveys at both admission and discharge. Patients treated by physical therapists with any McKenzie training had better outcomes (additional 0.7 to 1.3 FS points; P<.05 to <.001) and fewer visits (0.6 to 0.9, P<.001) compared to patients treated by physical therapists with no training. For patients treated by therapists with no versus some McKenzie education, 65% versus 70% achieved at least the minimal clinically important improvement, respectively. There were no significant differences in outcomes or utilization by level of McKenzie training. CONCLUSION There was a slightly greater improvement of 0.7 to 1.3 points in FS at discharge in patients receiving physical therapy for low back pain by physical therapists who underwent McKenzie training. This difference was clinically important for an additional 5% of patients who achieved the minimal clinically important improvement when treated by therapists with some McKenzie training. Reduction in physical therapy utilization was 0.6 to 0.9 visits, with the fewest visits utilized by patients of physical therapists at the McKenzie Part D and credentialed levels. Together, these findings suggest improved cost-effectiveness at advanced McKenzie training levels. Ways to improve ongoing education and patient outcomes were proposed.
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Implications of practice setting on clinical outcomes and efficiency of care in the delivery of physical therapy services. J Orthop Sports Phys Ther 2014; 44:955-63. [PMID: 25350133 DOI: 10.2519/jospt.2014.5224] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective analysis of episodes of care. OBJECTIVE To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services. BACKGROUND Many patients with musculoskeletal conditions benefit from care provided by physical therapists. The majority of physical therapists deliver services in either a private practice setting or in a hospital outpatient setting. There have not been any recent studies comparing whether clinical outcomes or efficiency of care differ based on practice setting. METHODS Practices that use the Focus On Therapeutic Outcomes, Inc system were surveyed to determine the specific type of setting in which outcomes were collected in patients with musculoskeletal impairments. Patient outcome data over 12 months (2011-2012) were extracted from the database and analyzed to identify differences in the functional status achieved and the efficiency of the care delivery process between private practices and hospital outpatient settings. RESULTS The data suggest that patients experience more efficient care when receiving physical therapy in hospital outpatient settings compared to private practice settings, as demonstrated by 3.1 points of greater improvement in functional status over 2.9 fewer physical therapy visits. However, the difference in improvement between settings is less than the minimum clinically important difference of 9 points in functional status outcome score. CONCLUSION In this cohort, our data suggest that more efficient care was delivered in the hospital outpatient setting compared to the private practice setting. However, we cannot conclude that care delivered in the hospital setting is more cost-effective, because it is possible that any difference in efficiency of care favoring the hospital outpatient setting is more than offset by higher costs of care.
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Patient global ratings of change did not adequately reflect change over time: a clinical cohort study. Phys Ther 2014; 94:534-42. [PMID: 24231227 DOI: 10.2522/ptj.20130162] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Global ratings of change (GROCs) are commonly used in research and clinical practice to determine which patients respond to therapy, but their validity as a criterion for change has not been firmly established. One factor related to their validity is the length of the recall period. OBJECTIVE The study objective was to examine the influence of the length of the recall period on the validity of a GROC for determining true change over time in the clinical setting. DESIGN This was a longitudinal, single-cohort observational study. METHODS Data from the Focus on Therapeutic Outcomes clinical database were collected for 8,955 patients reporting for physical therapy treatment of a knee disorder. Computerized adaptive testing was used to assess knee functional status (FS) at the initial and final (discharge) physical therapy visits. Each patient's GROC was obtained at discharge. Correlation and linear regression analyses of knee FS and GROC, stratified by length of time between intake and discharge, were conducted. RESULTS Correlations of GROC with knee FS change scores were modest even for the shortest period of recall (0-30 days) and were slightly lower for longer recall periods. Regression analyses using knee FS to predict GROC scores revealed similar findings. Correlations of GROC with intake and discharge scores indicated a strong bias toward discharge status, with little or no influence of baseline status. Standardized regression coefficients fitted the pattern expected for a valid measure of change but confirmed the strong bias toward discharge status. LIMITATIONS One version of the GROC administered serially in a cohort of patients seen in clinical practice was examined. CONCLUSIONS These results call into question the validity of GROCs for measuring change over time in routine clinical practice.
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