Study Design: Single-group repeated measures with 2 raters. Objectives: To determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling. Background. Measurements of ankle swelling are commonly performed to determine the nature and stage of injury and to monitor progress made during rehabilitation. Water volumetry and the figure of eight method are 2 techniques used to measure ankle swelling. Methods and Measures: Twenty-nine subjects with ankle swelling were measured by 2 raters with the hypothesis that both measurement techniques would be reliable. Each rater performed 3 measurements of the swollen ankle using both measurement techniques during a single test &ion. The order of the rater and of the measurement technique was randomized, and the raters were blinded to each other' s measurements. Results: We found high intenater reliability for both the water volumetry (KC [intraclass correlation coefficientl = 0.99) and figure of eight methods (ICC = 0.98). Additionally, intrarater reliability was high for both raters using both methods (ICCs = 0.98-0.99).Conclusions: Both methods are reliable measures of ankle swelling. The authors recommend the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower-extremity swelling. Reliability of these 2 methods was established using subjects with foot or ankle pathology. Therefore, the results are applicable and Clinicians and researchers have used several methods to measure limb volume. These methods include girth m e a s~r e r n e n t s ,~~~~~~~~ water displacement,lS:'.~~10-12.14~141833 bioelectric impedan~e,2~.~~ and computer m~d e l i n g .~.~ The 2 most common clinical methods to measure limb volume are girth measurements with a tape measure and ankle volume measurements with a water volumeter.
The objective of the study was to develop a clinical prediction rule (CPR) to identify patients with neck pain likely to improve with cervical traction. The study design included prospective cohort of patients with neck pain referred to physical therapy. Development of a CPR will assist clinicians in classifying patients with neck pain likely to benefit from cervical traction. Eighty patients with neck pain received a standardized examination and then completed six sessions of intermittent cervical traction and cervical strengthening exercises twice weekly for 3 weeks. Patient outcome was classified at the end of treatment, based on perceived recovery according to the global rating of change. Patients who achieved a change C?6 (''A great deal better'' or ''A very great deal better'') were classified as having a successful outcome. Univariate analyses (t tests and chi-square) were conducted on historical and physical examination items to determine potential predictors of successful outcome. Variables with a significance level of P B 0.15 were retained as potential prediction variables. Sensitivity, specificity and positive and negative likelihood ratios (LRs) were then calculated for all variables with a significant relationship with the reference criterion of successful outcome. Potential predictor variables were entered into a step-wise logistic regression model to determine the most accurate set of clinical examination items for prediction of treatment success. Sixty-eight patients (38 female) were included in data analysis of which 30 had a successful outcome. A CPR with five variables was identified: (1) patient reported peripheralization with lower cervical spine (C4-7) mobility testing; (2) (2009( ) 18:382-391 DOI 10.1007 test; (3) age C55; (4) positive upper limb tension test A; and (5) positive neck distraction test. Having at least three out of five predictors present resulted in a ?LR equal to 4.81 (95% CI = 2.17-11.4), increasing the likelihood of success with cervical traction from 44 to 79.2%. If at least four out of five variables were present, the ?LR was equal to 23.1 (2.5-227.9), increasing the post-test probability of having improvement with cervical traction to 94.8%. This preliminary CPR provides the ability to a priori identify patients with neck pain likely to experience a dramatic response with cervical traction and exercise. Before the rule can be implemented in routine clinical practice, future studies are necessary to validate the rule. The CPR developed in this study may improve clinical decision-making by assisting clinicians in identifying patients with neck pain likely to benefit from cervical traction and exercise.Eur Spine J
Objective: To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students. Methods: A randomized, controlled, crossover design was used. Twenty-four 1st Year DPT students were randomized into two groups. Group 1 (n = 12) practiced with the real-time feedback device first and then without it, while Group 2 (n = 12) practiced without the device first and then with it. Both practice periods with and without the device were 4 weeks long. Data were collected at Baseline, 5 weeks, 11 weeks, and 16 weeks. The crossover period was 5 weeks long, during which neither group practiced with or without the device. Eight force parameters were measured: R1 force; R2 force; Grade III and Grade IV mean peak force, frequency, and amplitude. Results: When students practiced with the real-time feedback device, they more closely matched the reference standard for two outcomes: 1) the mean difference in R2 force between student and reference standard was better with device (38.0 ± 26.7 N) than without it (51.0 ± 38.5 N); P = .013; and 2) the mean difference in Grade III peak to peak amplitude force was also better with device (8.9 ± 9.3 N) than without it (11.8 ± 11.0); P = .026. All other force parameters improved when students practiced with the real-time feedback device, however, the differences between when they practiced without the device were not statistically significant. Discussion: Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students.
Clinical mentorship is a cornerstone of postprofessional training programs and intended to develop advanced clinical reasoning skills. However, clinical reasoning is often subconscious and, therefore, a challenging skill to develop. The use of a tool such as the SCRIPT may facilitate developing clinical reasoning skills by providing a systematic approach to data gathering and making clinical judgments to bring clinical reasoning to the conscious level, facilitate self-reflection, and make a mentored physical therapist's thought processes explicit to his or her clinical mentor.
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