Phys Ther. 2008 Nov 13;
Rundell SD, Davenport TE, Wagner T

BACKGROUND AND PURPOSE:/b> The World Health Organization's Classification of Functioning, Disability and Health (WHO-ICF) model was developed to describe, classify, and measure function in health care practice and research. Recently, this model has been promoted as a successor to the Nagi model by some authors in the physical therapy literature. However, conceptual work in demonstrating use of the WHO-ICF model in physical therapist management of individual patients remains sparse. The purpose of this case report series is to demonstrate the application of the WHO-ICF model in clinical reasoning and physical therapist management of acute and chronic low back pain. CASE DESCRIPTION: /b> Two patients, 1 with acute low back pain and 1 with chronic low back pain, were treated pragmatically using the WHO-ICF model and other applicable models of clinical reasoning. Intervention Manual therapy, exercise, and education interventions were directed toward relevant body structure and function impairments, activity limitations, and contextual factors based on their hypothesized contribution to functioning and disability. Outcome Both patients demonstrated clinically significant improvements in measures of pain, disability, and psychosocial factors after 3 weeks and 10 weeks of intervention, respectively. DISCUSSION:/b> The WHO-ICF model appears to provide an effective framework for physical therapists to better understand each person's experience with his or her disablement and assists in prioritizing treatment selection. The explicit acknowledgment of personal and environmental factors aids in addressing potential barriers. The WHO-ICF model integrates well with other models of practice such as Sackett's principles of evidence-based practice, the rehabilitation cycle, and Edwards and colleagues' clinical reasoning model. Future research should examine outcomes associated with the use of the WHO-ICF model using adequately designed clinical trials. ...»

Phys Ther. 2008 Nov 13;
Rauscher L, Greenfield BH

The purpose of this article is to advocate for the use of mixed methods designs in contemporary physical therapist research. Mixed methods research is a design for collecting, analyzing, and mixing both quantitative and qualitative data in a single study or series of studies to both explain and explore specific research problems, thereby enriching the breadth and depth of understanding phenomena. These designs are particularly well suited for physical therapist researchers to reveal the complexity of disablement, rehabilitation, and recovery processes. Although contextual factors influence a person's health condition and recovery, they remain empirically less understood and underexplored by physical therapist researchers. To address this gap, the authors describe various combinations of quantitative and qualitative methods and data within a single study or set of related studies and the decisions that underlie the uses of these combinations. They include examples from current physical therapist research and applications from the International Classification of Functioning, Disability and Health (ICF) model. They argue that the rigorous application of quantitative and qualitative methods and data can propel physical therapist research and practice forward by stimulating new research questions, creating a holistic understanding of patient injury and rehabilitation, and contributing to innovative, complex treatment interventions. ...»

Phys Ther. 2008 Nov 6;
Kluding P, Gajewski B

Background Body system impairments following stroke have a complex relationship with functional activities. Although gait and balance deficits are well-documented in people after stroke, the overlapping influence of body impairments makes it difficult to prioritize interventions. Objective This study examined the relationship between prospectively selected measures of body function and structure (body mass index, muscle strength, sensation, and cognition) and activity (gait speed, gait endurance, and functional balance) in people with chronic stroke. Design This was a cross-sectional, observational study. METHODS:/b> Twenty-six individuals with mean (SD) age of 57.6 (11) years and time after stroke of 45.4 (43) months participated. Four variables (body mass index, muscle strength difference between the lower extremities, sensation difference between the lower extremities, and Mini-Mental Status Exam score) were entered into linear regression models for gait speed, Six-Minute Walk Test distance, and Berg Balance Scale score. RESULTS: /b> Lower-extremity strength difference was a significant individual predictor for gait speed, gait endurance, and functional balance. Cognition significantly predicted only gait speed. Limitations The authors did not include all possible factors in the model that may have influenced gait and balance in these individuals. CONCLUSIONS:/b> Strength deficits in the hemiparetic lower extremity should be an important target for clinical interventions to improve function in people with chronic stroke. ...»

Phys Ther. 2008 Nov 6;
Gerber JP, Marcus RL, Dibble LE, Greis PE, Burks RT, Lastayo PC

BACKGROUND AND PURPOSE:/b> The authors previously reported that focused eccentric resistance training during the first 15 weeks following anterior cruciate ligament reconstruction (ACL-R) induced greater short-term increases in muscle volume, strength, and measures of function relative to standard rehabilitation. The purpose of this study was to evaluate the effects of early progressive eccentric exercise on muscle volume and function at 1 year after ACL-R. Participants and METHODS:/b> Forty patients who had undergone an ACL-R were randomly assigned to 1 of 2 groups: a group that received early progressive eccentric exercise (n=20) and a group that received standard rehabilitation (n=20). Seventeen participants in the eccentric exercise group and 15 participants in the standard rehabilitation group completed a 1-year follow-up. Magnetic resonance images of the thighs were acquired 1 year after ACL-R and compared with images acquired 3 weeks after surgery. Likewise, routine knee examinations, self-report assessments, and strength and functional testing were completed 1 year after surgery and compared with previous evaluations. A 2-factor analysis of variance for repeated measures (group x time) was used to analyze the data. RESULTS: /b> Compared with the standard rehabilitation group, improvements in quadriceps femoris and gluteus maximus muscle volume in the involved lower extremity from 3 weeks to 1 year following ACL-R were significantly greater in the eccentric exercise group. Improvements in quadriceps femoris and gluteus maximus muscle volume were 23.3% (SD=14.1%) and 20.6% (SD=12.9%), respectively, in the eccentric exercise group and 13.4% (SD=10.3%) and 11.6% (SD=10.4%), respectively, in the standard rehabilitation group. Improvements in quadriceps femoris muscle strength and hopping distance also were significantly greater in the eccentric exercise group 1 year postsurgery. DISCUSSION AND CONCLUSION::/b> A 12-week focused eccentric resistance training program, implemented 3 weeks after ACL-R, resulted in greater increases in quadriceps femoris and gluteus maximus muscle volume and function compared with standard rehabilitation at 1 year following ACL-R. ...»

Phys Ther. 2008 Nov 6;
Cleland JA, Fritz JM, Brennan GP, Magel J

BACKGROUND AND PURPOSE:/b> Physical therapists often attend continuing education (CE) courses to improve their overall clinical performance and patient outcomes. However, evidence suggests that CE courses may not improve the outcomes for patients receiving physical therapy for the management of neck pain. The purpose of this study was to investigate the effectiveness of an ongoing educational intervention for improving the outcomes for patients with neck pain. Participants The study participants were 19 physical therapists who attended a 2-day CE course focusing on the management of neck pain. All patients treated by the therapists in this study completed the Neck Disability Index (NDI) and a pain rating scale at the initial examination and at their final visit. METHODS:/b> Therapists from 11 clinics were invited to attend a 2-day CE course on the management of neck pain. After the CE course, the therapists were randomly assigned to receive either ongoing education consisting of small group sessions and an educational outreach session or no further education. Clinical outcomes achieved by therapists who received ongoing education and therapists who did not were compared for both pretraining and posttraining periods. The effects of receiving ongoing education were examined by use of linear mixed-model analyses with time period and group as fixed factors; improvements in disability and pain as dependent variables; and age, sex, and the patient's initial NDI and pain rating scores as covariates. RESULTS: /b> Patients treated by therapists who received ongoing education experienced significantly greater reductions in disability during the study period (pretraining to posttraining) than those treated by therapists who did not receive ongoing training (mean difference=4.2 points; 95% confidence interval [CI]=0.69, 7.7). Changes in pain did not differ for patients treated by the 2 groups of therapists during the study period (mean difference=0.47 point; 95% CI=-0.11, 1.0). Therapists in the ongoing education group also used fewer visits during the posttraining period (mean difference=1.5 visits; 95% CI=0.81, 2.3). DISCUSSION AND CONCLUSION:/b> The results of this study demonstrated that ongoing education for the management of neck pain was beneficial in reducing disability for patients with neck pain while reducing the number of physical therapy visits. However, changes in pain did not differ for patients treated by the 2 groups of therapists. Although it appears that a typical CE course does not improve the overall outcomes for patients treated by therapists attending that course, more research is needed to evaluate other educational strategies to determine the most clinically effective and cost-effective interventions. ...»

Phys Ther. 2008 Oct 23;
Zampieri C, Di Fabio RP

BACKGROUND AND PURPOSE:/b> Although vertical gaze palsy and gait instability are cardinal features of progressive supranuclear palsy (PSP), little research has been done to address oculomotor and gait rehabilitation for PSP. The purpose of this study was to compare the benefits of a program of balance training complemented with eye movement and visual awareness training versus balance training alone to rehabilitate gait in people with PSP. Participants Nineteen people moderately affected by the disease were assigned to either a treatment group (balance plus eye movement exercises, n=10) or a comparison group (balance exercises only, n=9) in a quasi-random fashion. METHODS:/b> The baseline characteristics assessed were diagnosis (possible versus probable), sex, age, time of symptom onset, dementia, and severity of symptoms. Within-group, between-group, and effect size analyses were performed on kinematic gait parameters (stance time, swing time, and step length) and clinical tests 8-ft [2.4-m] walk test and Timed "Up & Go" Test). RESULTS: /b> The within-group analysis revealed significant improvements in stance time and walking speed for the treatment group, whereas the comparison group showed improvements in step length only. Moderate to large effects of the intervention were observed for the treatment group, and small effects were observed for the comparison group. The between-group analysis did not reveal significant changes for either group. DISCUSSION AND CONCLUSION:/b> These preliminary findings support the use of eye movement exercises as a complementary therapy for balance training in the rehabilitation of gait in people with PSP and moderate impairments. Additional studies powered at a higher level are needed to confirm these results. ...»

Phys Ther. 2008 Oct 23;
Crow JB, Gelfand B, Su EP

BACKGROUND AND PURPOSE:/b> Hip resurfacing arthroplasty (HRA) is an alternative for management of end-stage osteoarthritis (OA) in young patients with high activity demands and offers several advantages over total hip arthroplasty. Severely restricted hip motion is a rare complication of the surgery. The purpose of this case report is to describe the treatment for a patient who developed severely restricted hip motion following bilateral HRA. CASE DESCRIPTION: /b> A 43-year-old, athletic man underwent bilateral HRA and developed severely restricted hip motion. At 3 months postoperatively, the patient had approximately 90 degrees of hip flexion and 10 degrees of lateral rotation bilaterally. A multimodal treatment approach with an emphasis on joint mobilization was incorporated to improve hip joint mobility by restoring accessory motion. OUTCOMES: /b> The patient's passive range of motion (PROM) and Harris Hip Score (HHS) at the time of discharge showed clinically significant improvements. Total disability, as measured by the HHS, improved by 13 points, and total PROM increased 82 degrees in the right hip and 101 degrees in the left hip. The patient became independent and had full return to all activities and sports. DISCUSSION:/b> The patient showed clinically meaningful improvements in PROM measurements and functional activities during a course of care using a multimodal treatment approach with an emphasis on joint mobilization. This is the first case report to describe the treatment for a patient who developed severely restricted hip motion following bilateral HRA. ...»

Phys Ther. 2008 Oct 16;
Grindley EJ, Zizzi SJ, Nasypany AM

BACKGROUND AND PURPOSE:/b> Protection motivation theory (PMT) has been used in more than 20 different health-related fields to study intentions and behavior, albeit primarily outside the area of injury rehabilitation. In order to examine and predict patient adherence behavior, this study was carried out to explore the use of PMT as a screening tool in a general sample of people with orthopedic conditions. SUBJECTS AND METHODS:/b> New patients who were more than 18 years old and who were prescribed 4 to 8 weeks of physical therapy treatment (n=229) were administered a screening tool (Sports Injury Rehabilitation Beliefs Scale, Positive and Negative Affect Schedule, and a barriers checklist) prior to treatment. Participants' adherence was assessed with several attendance measures and an in-clinic assessment of behavior. Statistical analyses included correlation, chi-square, multiple regression, and discriminant function analyses. RESULTS: /b> A variety of relationships among affect, barriers, and PMT components were evident. In-clinic behavior and attendance were influenced by affect, whereas dropout status was predicted by affect, severity, self-efficacy, and age. DISCUSSION AND CONCLUSION:/b> The screening tool used in this study may assist in identifying patients who are at risk for poor adherence and provide valuable information to enhance provider-patient relationships and foster patient adherence. However, it is recommended that more research be conducted to further understand the impact of variables on patient adherence and that the screening tool be enhanced to increase its predictive ability. ...»

Phys Ther. 2008 Oct 16;
Crow JL, Harmeling-van der Wel BC

BACKGROUND AND PURPOSE:/b> The upper-extremity (UE) and lower-extremity (LE) sections (excluding balance) of the motor function domain of the Fugl-Meyer (FM) assessment scale (a construct referred to here as the FM motor scale) are recognized as a robust part of the scale for use with people after stroke. However, it is frequently criticized as a lengthy and time-consuming measurement tool. The aims of this study were to support a shortened method of administration for the FM motor scale and to provide arguments for the use of a summed score. In pursuit of these aims, the hierarchical properties of both the UE and LE sections of the FM motor scale were investigated. Participants and METHODS:/b> A retrospective analysis of data from 62 people with a previous stroke was performed. Guttman scale analysis considered the hierarchy of items within each subsection and each stage, between subsections and stages, and across all of the scale items (ignoring the stage divisions) of the FM motor scale. RESULTS: /b> For the within-stage and subsection analyses and between-stage and subsection analyses, all of the results met or exceeded the acceptable levels for the coefficient of reproducibility and the coefficient of scalability. When stage divisions were ignored, the coefficient of reproducibility for both extremities was just below acceptable levels. DISCUSSION AND CONCLUSION:/b> The results support the use of the UE and LE sections of the FM motor scale as a stagewise and subsectionwise hierarchical assessment and outcome measure. This allows the use of a shortened method of administration, which can potentially reduce the time required for scale administration, and appropriate scores can be allocated for untested items, such that a legitimate total summed score can be used. A limitation of this study was that the study population consisted predominantly of older people with such severe disability that they were unable to function independently. ...»

Phys Ther. 2008 Oct 16;
Vaughn HT, Nitsch W

BACKGROUND AND PURPOSE:/b> This case report describes the examination, evaluation, and intervention by a physical therapist for a female collegiate tennis player with a right ilial anterior rotation hypermobility. CASE DESCRIPTION: /b> The patient was a 21-year-old, female collegiate tennis player who developed a right anterior ilial rotation hypermobility as a result of her tennis stroke. Functional limitations were related to sitting, squatting, gait, and playing tennis. Treatment interventions consisted of massage, joint manipulation, stretching, stabilization exercises, sport-specific exercises and modification of tennis stroke, proprioceptive taping, and the use of a sacroiliac belt. OUTCOMES: /b> After 26 weeks (33 treatments), tissue tenderness of the sacroiliac joint region was normalized, pelvic/trunk and lower-extremity mobility and flexibility were restored, sacroiliac symmetry and stability were regained, and the patient achieved her goal of returning to competitive tennis at the collegiate level. DISCUSSION:/b> The patient's right ilial anterior rotation hypermobility was directly related to the mechanics of her tennis stroke. Her outcomes suggest that rehabilitation should focus on the entire abdomino-sacro-pelvic-hip complex, addressing articular, neural, and muscular inhibitions and deficiencies. ...»

Phys Ther. 2008 Oct 10;
Schnall BL, Baum BS, Andrews AM

BACKGROUND AND PURPOSE:/b> No reports have analyzed the temporal-spatial, kinematic, or kinetic components of gait coupled with a metabolic analysis of patients with hip disarticulations. Most of the research on this population is based on older adults. As a result, guidelines for reasonable functional outcomes for patients with hip disarticulations who are young, premorbidly fit, and goal oriented are lacking. This report describes quantitative measures of energy cost and gait characteristics of a young soldier with a unilateral traumatic hip disarticulation. CASE DESCRIPTION: /b> One patient, a soldier with a unilateral hip disarticulation, was evaluated in the Gait and Motion Analysis Laboratory at 3 months and 38 months postinjury. OUTCOMES: /b> The patient progressed from use of crutches at 3 months postinjury to independent ambulation at the follow-up visit at 38 months postinjury. At 38 months postinjury, he wore his prosthesis 12 hours per day and achieved step-length symmetry, and his oxygen consumption was 14.49 mL/kg/min at self-selected walking speed. Self-selected walking speed increased from 0.57 m/s at 3 months to 0.86 m/s at 38 months postinjury. During both visits, support time remained greater on the intact limb (72%) than the involved limb (57%), compensatory trunk and pelvic motions were used to advance the prosthetic limb, and the vertical ground reaction force profile was within 2 standard deviations of the data for an uninjured comparison group on the prosthetic side and plateaued on the sound limb. DISCUSSION:/b> Young individuals with traumatic hip disarticulations can achieve and maintain functional independent ambulation with gait deviations. However, metabolic demands may not be as great as previously expected. ...»

Phys Ther. 2008 Oct 10;
Bell AL, Cavorsi J

BACKGROUND AND PURPOSE:/b> The optimal adjunctive therapy for wounds that fail to heal despite conventional wound care has not been established. Clinical evidence suggests improved healing in wounds treated with noncontact ultrasound therapy (NCUT). Although existing evidence supports the use of NCUT for enhanced wound healing, the total number of participants studied remains modest. This study was conducted to assess the impact of adjunctive NCUT on the healing of wounds that fail to progress to healing with conventional wound care alone. Participants and METHODS:/b> A retrospective review of charts for 76 patients who had received outpatient wound care at a single center between January 2005 and December 2006 and who were treated with NCUT as an adjunct to conventional wound care was conducted. All wound care interventions used during the study period were assessed. The primary effectiveness endpoint was the percentage of change in wound area from the start of NCUT to the end of NCUT. RESULTS: /b> Noncontact ultrasound was administered for a mean of 5.1 minutes per session for a mean of 2.3 times per week. The median duration of therapy was 4.3 weeks. The median wound area was reduced by 79% from the start of NCUT to the end of NCUT (from 2.5 to 0.6 cm(2)). The proportion of participants with greater than 75% granulation tissue increased from 32% before NCUT to 46% after NCUT. DISCUSSION AND CONCLUSION:/b> The single-arm, retrospective design did not allow for comparative assessments of the efficacies of noncontact ultrasound and other wound care interventions. The use of adjunctive NCUT appears to improve healing in wounds that fail to heal with conventional wound care alone. ...»

Phys Ther. 2008 Oct 10;
Talkowski JB, Brach JS, Studenski S, Newman AB

BACKGROUND AND PURPOSE:/b> Disagreement currently exists regarding the contributions of various factors to physical activity in older adults. The purpose of this cross-sectional study was to investigate the simultaneous impact of psychological (health perception and balance perception) and physiological (gait speed, fall history, and balance performance) factors on walking activity in older adults. SUBJECTS AND METHODS:/b> This cross-sectional secondary data analysis included 2,269 community-dwelling older adults from the Cardiovascular Health Study. A series of simultaneous linear regression models were constructed to examine the association of walking activity with health and balance perception, gait speed, fall history, and balance performance after controlling for potential confounding factors. RESULTS: /b> Health and balance perception and gait speed were significantly related to walking activity after controlling for potential confounding factors. Participants who perceived both their health and their balance to be good walked more blocks per week than those who reported a discordant perception, who walked more than those who perceived both their health and their balance to be poor. Participants who walked at a normal speed walked more blocks per week than those who walked at a slow speed. DISCUSSION AND CONCLUSION:/b> The measure of physical activity used in this study included only walking, not other low- to moderate-intensity activities that are common in older adults. Health and balance perception and gait speed were associated with walking activity more so than fall history or balance performance after controlling for potential confounding factors. ...»

Phys Ther. 2008 Oct 10;
Copeland JM, Taylor WJ, Dean SG

Background Rehabilitation of patients with low back pain forms an important component of musculoskeletal physical therapist practice, yet treatment outcomes often are poorly measured. Objective The study examined the methods used to evaluate treatment outcomes and factors influencing the use of outcome measures by New Zealand physical therapists. Design This cross-sectional study used qualitative and quantitative methods for data collection. METHODS:/b> Two focus groups were conducted: one in a private practice (n=6) and one in a public hospital (n=6). A survey questionnaire was mailed to all private practices listed in a telecommunication database and to outpatient physical therapy departments at public hospitals (n=579). RESULTS: /b> The mail survey achieved a 65% response rate and showed that physical therapists use improvements in person-specific functional activities as their main outcome measure. Only 40% of the respondents reported using back-related outcome measures. The statistically significant factors determining their use were having a master's degree and an increased level of knowledge of outcome measurement, but these factors explained only 22% of the variance in the logistic regression model. Lack of time, frequently mentioned as a reason for not using standardized outcome measures, did not reach statistical significance. Limitations The data collected relate to the physical therapists' reported or perceived behavior, which may be different from reality. CONCLUSION:/b> Physical therapists do not routinely use outcome measures in their clinical practice. A master's degree and increased knowledge were statistically significant factors supporting increased use of outcome measures. Further research is needed on how to convey to practitioners that the information they provide can be useful and can improve patient outcomes. ...»

Phys Ther. 2008 Oct; 88(10): 1231; author reply 1231-2
Halili A

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Phys Ther. 2008 Oct; 88(10): 1106-8
Craik RL

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Phys Ther. 2008 Sep 26;
Schmitt LC, Fitzgerald GK, Reisman AS, Rudolph KS

BACKGROUND AND PURPOSE:/b> Studies have identified factors that contribute to functional limitations in people with knee osteoarthritis (OA), including quadriceps femoris muscle weakness, joint laxity, and reports of knee instability. However, little is known about the relationship among these factors or their relative influence on function. The purpose of this study was to investigate self-reported knee instability and its relationships with knee laxity and function in people with medial knee osteoarthritis (OA). Participants Fifty-two individuals with medial knee OA participated in the study. METHODS:/b> Each participant was classified into 1 of 3 groups based on reports of knee instability. Limb alignment, knee laxity, and quadriceps femoris muscle strength (force-generating capacity) were assessed. Function was measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a stair-climbing test (SCT). Group differences were detected with one-way analyses of variance, and relationships among variables were assessed with the Eta(2) statistic and hierarchical regression analysis. RESULTS: /b> There were no differences in alignment, laxity, or strength among the 3 groups. Self-reported knee instability did not correlate with medial laxity, limb alignment, or quadriceps femoris muscle strength. Individuals reporting worse knee instability scored worse on all subsets of the KOOS. Self-reported knee instability scores significantly contributed to the prediction of all measures of function above that explained by quadriceps femoris muscle force, knee laxity, and alignment. Neither laxity nor alignment contributed to any measure of function. DISCUSSION AND CONCLUSION:/b> Self-reported knee instability is a factor that is not directly associated with knee laxity and contributes to worse function. Further research is necessary to delineate the factors that contribute to self-reported knee instability and reduced function in this population. ...»

Phys Ther. 2008 Sep 26;
Borello-France DF, Downey PA, Zyczynski HM, Rause CR

Background and Objectives Few studies have examined the effectiveness of pelvic-floor muscle (PFM) exercises to reduce female stress urinary incontinence (SUI) over the long term. This study: (1) evaluated continence and quality-of-life outcomes of women 6 months following formalized therapy and (2) determined whether low- and high-frequency maintenance exercise programs were equivalent in sustaining outcomes. SUBJECTS AND METHODS:/b> Thirty-six women with SUI who completed an intensive PFM exercise intervention trial were randomly assigned to perform a maintenance exercise program either 1 or 4 times per week. Urine leaks per week, volume of urine loss, quality of life (Incontinence Impact Questionnaire [IIQ] score), PFM strength (Brink score), and prevalence of urodynamic stress incontinence (USI) were measured at a 6-month follow-up for comparison with postintervention status. Parametric and nonparametric statistics were used to determine differences in outcome status over time and between exercise frequency groups. RESULTS: /b> Twenty-eight women provided follow-up data. Postintervention status was sustained at 6 months for all outcomes (mean [SD] urine leaks per week=1.2+/-2.1 versus 1.4+/-3.1; mean [SD] urine loss=0.2+/-0.5 g versus 0.2+/-0.8 g; mean [SD] IIQ score=17+/-20 versus 22+/-30; mean [SD] Brink score=11+/-1 versus 11+/-1; and prevalence of USI=48% versus 35%). Women assigned to perform exercises once or 4 times per week similarly sustained their postintervention status. DISCUSSION AND CONCLUSION::/b> Benefits of an initial intensive intervention program for SUI were sustained over 6 months. However, only 15 of the 28 women provided documentation of their exercise adherence, limiting conclusions regarding the need for continued PFM exercise during follow-up intervals of ...»

Phys Ther. 2008 Sep 26;
Liu-Ambrose TY, Ashe MC, Graf P, Beattie BL, Khan KM

Background Falls are a major health care problem for older people and are associated with cognitive dysfunction. Mild cognitive impairment (MCI) is an increasingly recognized clinical problem. No study has comprehensively compared people with and without MCI for fall risk factors in both the physiological and cognitive domains. Objective The purpose of this cross-sectional study was to comprehensively compare fall risk factors in community-dwelling older women with and without MCI. Design A cross-sectional design was used in the study. METHODS:/b> Community-dwelling women (N=158) with Folstein Mini Mental State Examination scores of >/=24 participated in the study. The Montreal Cognitive Assessment (MoCA) was used to categorize participants as either having or not having MCI. Each participant's fall risk profile was assessed with the Physiological Profile Assessment (PPA). Three central executive functions were assessed: (1) set shifting was assessed with the Trail Making Test (part B), (2) updating (ie, working memory) was assessed with the Verbal Digits Backward Test, and (3) response inhibition was assessed with the Stroop Colour-Word Test. RESULTS: /b> Both the composite PPA score and its subcomponent, postural sway performance, were significantly different between the 2 groups; participants with MCI had higher composite PPA scores and greater postural sway compared with participants without MCI. Participants with MCI performed significantly worse on all 3 central executive function tests compared with participants without MCI. Limitations A screening tool was used to categorize participants as having MCI, and fall risk factors were compared rather than the actual incidence of falls. CONCLUSIONS:/b> Fall risk screening may be prudent in older adults with MCI. ...»

Phys Ther. 2008 Nov; 88(11): 1417-24
Cohn R

Each year, more Americans are newly diagnosed with type 2 diabetes mellitus. The costs for managing this disease are high, and the cascade of problems associated with poorly controlled diabetes is significant. At the same time, the number of uninsured or underinsured Americans is growing. This article describes current trends in health insurance availability and coverage for the growing number of people with diabetes and addresses the direct costs associated with treating this disease. The economic burden of health care for people with diabetes continues to escalate. Payers and employers are interested in decreasing their direct and indirect costs, improving profit margins, decreasing employee absenteeism, and increasing employee productivity. For physical therapists to recognize existing or new opportunities to participate in the management of this costly disease, it is critical that they understand how employees, payers, and employers are responding to the changing market forces affecting health insurance. ...»