The results of this study strongly support the hypothesis that spinal physical capacity in chronicity is not explained solely by the sensory perception of pain. The anticipation of pain and the fear-avoidance belief about physical activities were the strongest predictors of the variation in physical performance.

Clinical prediction rules use quantitative methods to build upon the body of literature and expert opinion and can provide quick and inexpensive estimates of probability. Clinical prediction rules can be of great value to assist clinical decision making but should not be used indiscriminately. They are not a replacement for clinical judgment and should complement rather than supplant clinical opinion and intuition. The development of valid clinical prediction rules should be a goal of physiotherapy research. Specific areas in need of attention include deriving and validating clinical prediction rules to screen patients for potentially serious conditions for which current tests lack adequate diagnostic accuracy or have unacceptable cost and risk, and to assist in classification of patients for treatments that are likely to result in substantially different outcomes in heterogeneous groups of patients.

Background and Purpose. Patient satisfaction with physical therapy is used as an outcome variable. The purpose of this study was to develop and test an instrument used to determine which variables are associated with the satisfaction of patients receiving outpatient physical therapy. Subjects. During the pilot study, 191 patients participated, and 1,868 patients then participated in the main phase of this work. Methods. Using a survey instrument developed by the authors, subjects responded to global questions concerning overall satisfaction with physical therapy. Content validation of the instrument was investigated using item correlation, principal components analysis, and factor analysis. Reliability was measured using the standard error of measurement. Concurrent validity was investigated by correlating summary scores of the final survey instrument with global measures of satisfaction. Results. Reliability was best for a 10-item questionnaire. Patient satisfaction was most associated with items that reflected a high-quality interaction with the therapist (eg, time, adequate explanations and instructions to patients). Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used were not strongly correlated with overall satisfaction with care. Discussion and Conclusion. Because the time the therapist spent with patients and the behavior of the therapists are important for patient satisfaction, emphasis on cost-cutting, high patient volume, and the use of “care extenders” may jeopardize satisfaction.

The purpose of this study was to examine the influence of anticipation of pain, sensory perception of pain and pain-related fear and disability beliefs on the gait characteristics of patients with chronic low back pain (CLBP). Thirty-one individuals with CLBP (16 men and 15 women) and 24 healthy individuals (11 men and 13 women) between 20 to 56 years of age participated in this study. Anticipated pain and the pain actually felt were measured with two separate visual analogue scales before and after preferred and fast walking performances. Pain-related fear and disability beliefs were measured with the Fear-Avoidance Belief Questionnaire (FABQ) and the Disability Belief Questionnaire (DBQ). Spatial and temporal walking parameters were measured at preferred and fast walking performances using a computerized gait mat. Analysis of variance demonstrated significant differences between patients and healthy individuals in step length, single support time and walking velocity (P<0.05). Within the CLBP group, stepwise regression analysis showed that FABQ (physical activity) and anticipated pain were the strongest predictors of velocity deficits in preferred and fast walking respectively. Anticipation and fear of pain accounted significantly for the velocity deficits in walking. Standard clinical gait assessments must incorporate psychological measures of pain experience.

Study Design: Psychometric evaluation of a cross-sectional survey. Objectives: To determine the validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) to differentiate between patient satisfaction with internal and external factors. Background: Self-report measures that sample a variety of items provide clinicians with an array of information that may assist in assessing patient satisfaction. An important measurement characteristic of these instruments is the ability to discriminate between different factors that may influence patient reports of satisfaction with care, ie, discriminant validity. In previous work, exploratory factor analysis suggested that the MRPS questionnaire has a 2-factor structure: ''internal,'' relating to the patient-therapist interaction, and ''external,'' describing nontherapist issues such as admissions and clinic environment. Methods and Measures: One thousand four hundred forty-nine adult patients completed the MRPS questionnaire upon finishing their course of outpatient physical therapy treatment. Discriminant validity of the 2-factor model was assessed using confirmatory factor analysis. The measures from the 2 factors were then evaluated for reliability by calculating the standard error of measurement (SEM), and for concurrent validity by correlating the mean score of the factors and individual items to global measures of satisfaction. Results: Confirmatory factor analysis supported a good to excellent model fit for the internal factor (7 items) and external factor (3 items). The SEM for the 2 factors was 0.19 and 0.24, indicating a low degree of measurement error. Both factors had high significant correlation with global measures of satisfaction (internal, r = 0.83 and 0.80; external, r = 0.71 and 0.71). All individual items within the 2 factors had significant correlations with global measures ranging from r = 0.33 to 0.80. Conclusions: Our findings provide evidence of discriminant and concurrent validity of the 2-factor solution for the MRPS questionnaire for the sample that was tested. This 2-factor solution yields

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Background and purpose: The purpose of this study was (1) to determine the validity of the GaitRite System in detecting footfall patterns and selected gait characteristics of person with early stage Parkinson's disease (PD) and (2) to investigate whether the Functional Ambulation Performance (FAP) scoring system is a valid tool to distinguish between selected gait characteristics of patients with early stage Parkinson's disease and similar age of non-impaired individuals. The FAP score is a quantitative means of assessing gait based on specific spatial and temporal gait parameters. Participants: 11 volunteers with idiopathic Parkinson's disease, (mean age = 74.3), and 11 age matched volunteers, (mean age = 70.3), with no history of neurological disorder participated in the study. The non-impaired control group were not matched in age and sex but of similar age and males and females were represented in the control group. Methods: Temporal and spatial parameters of gait were analyzed for both preferred-speed and fast-speed walking using the computerized GaitRite system. The system integrates specific components of locomotion to provide a single, numerical representation of gait, the Functional Ambulation Performance Score (FAP) score. Results: The most powerful and discriminating variable between Parkinson's and non-impaired groups for both walking speeds was the mean normalized velocity (MNV). Which is velocity divided by leg length. The MNV was 0.83 for PD at preferred walking speed and 1.14 at fast speed, the non-impaired group preferred-speed group walking was 1.33, while fast-speed walking MNV was 1.70. Note the fast walking of PD was slower than the preferred velocity of the non-impaired group. For preferredspeed walking, all gait variables analyzed in the study were different between the two groups beyond the p < 0.05 level of confidence with the single exception of right stance percentage. For fast-speed walking, three of the entered variables did not discriminate between the two groups: the fast walking FAP score, left fast-walking cadence, and right fast-walking single support percentage. Conclusion and discussion: Our results indicate that persons with Parkinson's disease (PD) attain a significantly lower FAP score when ambulating at their preferred rate and demonstrate shorter step length and a longer step time than the age matched non-impaired group during both preferred and fast velocities of walking. Stance duration and double support duration were increased for the Parkinson's population, whereas single support duration, mean cadence, and heel-to-heel base of support were markedly reduced for both walking speeds. The FAP score was significantly different from the non-impaired control group for preferred-speed walking. These results indicate that the GaitRite system can be useful in detecting footfall patterns and selected time and distance measurements of persons with early stage Parkinson's disease and the FAP score discriminates between the PD population and the non-impaired controls when walking ...

Patient satisfaction with musculoskeletal physiotherapy care in Australia is high and comparable with Northern Europe, North America, the United Kingdom and Ireland. Comparison of data between Australia and the US indicates that while some determinants of patient satisfaction are common, country-specific differences also exist.