Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer

Women's experience of breast cancer is complex, affecting all aspects of life during and after treatment. Patients' perspectives about common impairments and functional limitations secondary to breast cancer treatment, including upper extremity motion restriction, lymphedema, fatigue, weight gain, pain, and chemotherapy-induced peripheral neuropathy, are addressed. Women often report being uninformed regarding these side effects and surprised that they do not always disappear after treatment, but remain part of their lives. Breast cancer patients express strong, unmet needs for education, information, and intervention for these side effects. Evidence suggests that rehabilitation and exercise are effective in preventing and managing many physical side effects of breast cancer treatment. Nevertheless, few women are referred to rehabilitation during or after treatment, and fewer receive baseline assessments of impairment and function to facilitate early detection of impairment and functional limitations. The prospective surveillance model of rehabilitation will serve the needs of women with breast cancer by providing education and information about treatment side effects, reducing the incidence and burden of side effects through early identification and treatment, and enhancing access to timely rehabilitation. Integration of exercise as a component of the model benefits patients at every phase of survivorship, by addressing individual concerns about exercise during and after treatment and highlighting the important contribution of exercise to overall health and survival. The prospective surveillance model of rehabilitation can meet the evident and often expressed needs of survivors for information, guidance, and intervention--thus addressing, and potentially improving, overall quality of life for individuals diagnosed with and treated for breast cancer.

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's 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.

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 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.

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 > or = 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.

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.

Effects of treadmill training on gait in a hemiparetic patient

The purpose of this study was to investigate the effects of treadmill training on temporal-distance gait variables. An A-B-A treatment-withdrawal, single-subject experimental design was used on a hemiparetic patient who was 3 years post-injury. The inked footprint method was used to obtain the variables of walking velocity, cadence, base of support, stride length, and step length. Treatment was a maximum of 10 minutes on a motorized treadmill without elevation at a comfortable walking speed. Data collection for all three phases (A-B-A) and treadmill training during the treatment phase were performed three times per week for 3 weeks. Data were analyzed using a celeration line approach and a C statistic. Treatment was found to affect the base of support and right step length. An increase in symmetry between right and left step length was apparent after treadmill training. There was no effect on right or left stride length, left step length, cadence, or walking velocity. The results indicate improvement in some aspects of gait with treadmill training in the patient studied. Further research is needed to confirm the generalizability of these findings and to identify which patients might benefit from treadmill training.

Effect of altering handle position of a rolling walker on gait in children with cerebral palsy

The purpose of this study was to determine whether altering the handle position on a rolling walker would affect the gait pattern of children with spastic cerebral palsy (CP). Sixteen children with CP (2-10 years old) performed six gait trials, three with the handle on the rolling walker positioned horizontally and three with the handle positioned vertically. Using the footprint-on-paper method, gait characteristics of right and left step width, step length, and stride length; cadence; and velocity were determined. A two-way analysis of variance for two repeated measures indicated no significant differences in the measured gait characteristics between handle positions. Significant differences between the first trial and subsequent trials for both horizontal and vertical handle positions were found using Duncan's multiple comparison test. This study suggests that in this sample of children, altering the handle position did not lead to any immediate statistically significant changes in the gait characteristics measured. Results suggest that walkers with vertical handles should not be prescribed under the assumption that the gait characteristics of the child using the walker will be changed. This study does not rule out other changes that might occur with the use of vertical-handled walkers.

Effects of selected assistive devices on normal distance gait characteristics

The purpose of this study was to investigate the effects of selected assistive devices on normal standards of gait. The gait characteristics of stride length, step length, step width, and foot angle were analyzed for 24 right-dominant, healthy men under four conditions: right ankle-foot orthosis (AFO), right hemiplegic arm sling (HAS), both devices (AFO+HAS), and no devices. The dependent variables were measured by a standard method from ink traces left by subjects walking on newsprint. Order of conditions was controlled, and cadence remained consistent across all four conditions for each subject. The AFO and AFO+HAS conditions produced statistically significant changes from normal gait characteristics. The HAS alone did not produce significant changes. Data from the study may be used as a basis for goal setting and as a guideline for the optimal level of function possible for a person wearing these devices. The extent of the patient's orthopedic and neurologic involvement should of course be considered.

Perceived role responsibilities of physical therapists and adapted physical educators in the public school setting

Right to Education legislation has brought physical therapists and adapted physical educators together in the public school setting to serve the child with special needs. Investigation of the role responsibilities of these professionals would facilitate not only communication between the groups, but also understanding of their functions by other school personnel and administrators. We analyzed questionnaires returned by 79 physical therapists and 30 adapted physical educators to determine areas of uniqueness or similarity in 18 identified role responsibilities performed by these two groups. Each subject rated the appropriateness of each role to physical therapists and to adapted physical educators. On 10 of the 18 items, a statistically significant interaction indicated disagreement with regard to the relative contributions of the two professions. On the other 8 items, the two groups agreed that the role responsibility tends to belong to one profession or agreed that either profession could assume the responsibility. These data should provide information to help further delineate the role definitions for each of these professionals. In addition, the most efficient use of available resources may be used to meet the educational needs of these children.

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's 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.