scholarly journals Patient Screening by a Physical Therapist for Nonmusculoskeletal Hip Pain

2009 ◽  
Vol 89 (3) ◽  
pp. 248-256 ◽  
Author(s):  
William R VanWye
Keyword(s):  
Lumbar Spine ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Hip Osteoarthritis ◽  
Care Physician ◽  
Hip Pain ◽  
Screening Tools ◽  
Positive Sign ◽  
Diagnostic Challenge ◽  
Trochanteric Bursitis

Background and Purpose Mechanical hip pain and disease-based hip pain can have similar signs and symptoms, thereby presenting a differential diagnostic challenge for clinicians. Hip pain is a common complaint addressed by physical therapists; therefore, it would be advantageous for them to be knowledgeable about differential diagnosis for hip pain, so that they can screen for possible serious conditions outside the realm of physical therapist practice and make the appropriate referral. Case Description A 77-year-old man was referred for physical therapy by his primary care physician (PCP) with diagnoses of lumbar spine and left hip osteoarthritis and possible trochanteric bursitis. After the examination, the physical therapist determined that the patient should return to his PCP for further testing. Findings leading to this conclusion were pain severity out of proportion to the reported injury, the presence of night pain, a positive “sign of the buttock,” and empty end feels of all hip joint motions, which represented a noncapsular pattern of joint restriction. Outcomes The patient was diagnosed later with primary lung adenocarcinoma with widespread metastases. A computerized tomography scan of the left hip revealed a metastatic lesion at the left proximal femur. Discussion Physical therapists’ ability to adequately screen for conditions requiring examination by a physician can lead to a more timely diagnosis of serious medical conditions. Investigators have found published descriptions of end feels, capsular versus noncapsular patterns of restriction, and the sign of the buttock to be beneficial screening tools for use in people with hip, pelvis, or lumbar spine pain.

scholarly journals Skin Cancer Screening

2002 ◽  
Vol 82 (12) ◽  
pp. 1232-1237 ◽  
Author(s):  
Mary Wills
Keyword(s):  
Cancer Screening ◽  
Skin Cancer ◽  
Early Detection ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Care Physician ◽  
Morbidity And Mortality ◽  
Skin Cancer Screening ◽  
Complete Excision ◽  
Mortality Case

Abstract Background. Skin cancer is the most common malignancy occurring in humans, affecting 1 in 5 Americans at some time during their lives. Early detection of cancerous lesions is important for reducing morbidity and mortality. Case Description. The patient was a 79-year-old woman who was receiving physical therapy for cervical stenosis. The physical therapist identified a mole with suspicious characteristics, using the ABCD checklist for skin cancer screening. The patient was referred to her primary care physician, and the lesion was removed and identified as basal cell carcinoma. Outcomes. Early detection of this lesion allowed for complete excision, with no further treatment of the area warranted. Discussion. Physical therapists can aid in detection of suspect lesions with knowledge of the basic screening techniques for skin cancer, which may help reduce the morbidity and mortality caused by these lesions.

scholarly journals Physical Therapists as Primary Practitioners in the Emergency Department: Six-Month Prospective Practice Analysis

2015 ◽  
Vol 95 (9) ◽  
pp. 1207-1216 ◽  
Author(s):  
Adam de Gruchy ◽  
Catherine Granger ◽  
Alexandra Gorelik
Keyword(s):  
Emergency Department ◽  
Resource Utilization ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Care Physician ◽  
Advanced Practice ◽  
Time Efficiency ◽  
Patient Demographics ◽  
Common Diagnosis ◽  
Life Threatening

Background Increasing pressure on the emergency department (ED) throughout the world has meant the introduction of innovative ways of working. One such innovation is the advanced practice physical therapist (APP) acting as a primary contact practitioner. There has been little research into the role beyond identifying patient satisfaction with management, cost-effectiveness, and time efficiency. In order to give further support and assist in development of an APP service in the ED, an increased exploration of patient caseload demographics, resource utilization, and management outcomes is needed. Objectives The purpose of this study was to provide quantitative data regarding patient demographics, time efficiency, resource utilization, and management outcomes to examine the APP role in the ED. Design This was a prospective observational study of practice. Setting The study was conducted in a single ED in Melbourne, Australia. Method Data collection was conducted over a 6-month period. Patient demographics and diagnoses, assessment times, hospital resource utilization, and discharge destinations were recorded. Results One thousand seventeen patients (45% female; median age=34 years, interquartile range=25–52) were managed by the APPs; 89% had conditions triaged as not serious or life threatening, and 97% had musculoskeletal pathologies, with the most common diagnosis being fracture or dislocation. Four-hour length-of-stay targets were met in 95% of the patients. Forty-six percent of the patients seen were managed independently, without any support from medical colleagues. The most frequent discharge destination was a referral back to the primary care physician or to hospital outpatient clinics. When comparing similar diagnostic groups, the APPs were significantly more time-efficient than ED physicians in their patient management. Conclusions This study described in detail the caseload managed by the APP in the ED and identified the role as a valuable asset to an ED, managing a great deal of their caseload independently, safely, and time efficiently.

scholarly journals Using Clinical Outcomes to Identify Expert Physical Therapists

2003 ◽  
Vol 83 (11) ◽  
pp. 990-1002 ◽  
Author(s):  
Linda Resnik ◽  
Dennis L Hart
Keyword(s):  
Lumbar Spine ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Clinical Experience ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Group Discussion ◽  
Group Versus ◽  
Self Report ◽  
Outpatient Rehabilitation

Abstract Background and Purpose. Previous studies of expert physical therapists have sampled therapists based on years of clinical experience or reputation, not on their patients' clinical outcomes. The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life (HRQL) following rehabilitation. Methods. Retrospective data were analyzed on 24,276 patients (mean age=47.8 years, SD=16, range=14–97) with lumbar spine syndromes treated by 930 physical therapists participating in the Focus On Therapeutic Outcomes database in 1999–2000. Physical therapists and staff answered questions concerning years of experience and practice setting when starting their participation in the outcomes system. Patient self-report HRQL data were collected at intake and discharge from outpatient rehabilitation. Discharge HRQL data were risk adjusted using patient characteristics. Data were aggregated by physical therapist. Risk-adjusted discharge HRQL scores were used to classify physical therapists whose patients reported mean HRQL improvement above the 90th percentile as experts and physical therapists whose patients reported mean HRQL improvement between the 45th and 55th percentiles as average. Results. Therapists classified as expert had fewer patients in the database than did therapists classified as average (X̄±SD) (19±17 versus 29±22). Mean treatment duration was different between groups (32±11 days for the expert group versus 31±8 days for the average group). Discussion and Conclusion. The results challenge assumptions that extensive clinical experience is necessary to achieve superior patient outcomes, and they provide information about the relationship between therapist characteristics and patient outcomes.

scholarly journals Dermatomyositis: Evolution of a Diagnosis

2003 ◽  
Vol 83 (10) ◽  
pp. 932-945 ◽  
Author(s):  
Joshua A Cleland ◽  
Jane Walter Venzke
Keyword(s):  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Short Form ◽  
Exercise Program ◽  
Signs And Symptoms ◽  
Care Physician ◽  
Direct Access ◽  
Home Exercise ◽  
Diagnostic Process

Abstract Background and Purpose. As direct access evolves, physical therapists will increasingly encounter patients with pathology that might have an underlying systemic origin. The purpose of this case report is to describe the diagnostic process that led a patient's physical therapist to recognize signs and symptoms of dermatomyositis. Case Description. The patient was an 18-year-old woman who was referred for physical therapy by her primary care physician on 3 occasions with 3 separate musculoskeletal diagnoses. During the third episode, the physical therapist recognized signs and symptoms that could be indicative of dermatologic disease and referred the patient to a dermatologist. Outcomes. A rheumatologist diagnosed the patient's condition as dermatomyositis and referred her for physical therapy. The physical therapy plan of care focused on strengthening and stretching, with an emphasis on a home exercise program. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) indicated that the patient continually made functional improvements over an 18-month period. Discussion. Although diagnosis of diseases such as inflammatory myopathies is not within a physical therapist's scope of practice, this case demonstrates the role a physical therapist can play in recognition of underlying systemic pathology by using the diagnostic process.

Nutrition in Physical Therapist Practice: Tools and Strategies to Act Now

2021 ◽  
Author(s):  
Patrick Berner ◽  
Janet R Bezner ◽  
David Morris ◽  
Donald H Lein
Keyword(s):  
Behavior Change ◽  
General Health ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Intervention Strategies ◽  
Screening Tools ◽  
Nutrition Information ◽  
Community Members ◽  
Nutritional Needs

Abstract It has been established that physical therapist practice includes screening for and providing information on diet and nutrition to patients, clients, and the community. Yet, an overwhelming amount of often contradictory diet and nutrition information poses a challenge for physical therapists to identify and maintain knowledge that they can rely on to screen for and discuss these topics with their patients, clients, and community members. The purposes of this perspective paper are to summarize the best known screening tools for general health, diet, and nutrition; provide intervention strategies that can be used to support behavior change related to diet and nutrition; and identify the most relevant resources and approaches from which physical therapist clinicians can build skill in addressing the nutritional needs of patients, clients, and the community.

scholarly journals Automatically evaluating balance using machine learning and data from a single inertial measurement unit

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Fahad Kamran ◽  
Kathryn Harrold ◽  
Jonathan Zwier ◽  
Wendy Carender ◽  
Tian Bao ◽  
...  
Keyword(s):  
Machine Learning ◽  
Inertial Measurement Unit ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Model Performance ◽  
Machine Learning Techniques ◽  
Measurement Unit ◽  
Balance Performance ◽  
Inertial Measurement ◽  
Self Assessments

Abstract Background Recently, machine learning techniques have been applied to data collected from inertial measurement units to automatically assess balance, but rely on hand-engineered features. We explore the utility of machine learning to automatically extract important features from inertial measurement unit data for balance assessment. Findings Ten participants with balance concerns performed multiple balance exercises in a laboratory setting while wearing an inertial measurement unit on their lower back. Physical therapists watched video recordings of participants performing the exercises and rated balance on a 5-point scale. We trained machine learning models using different representations of the unprocessed inertial measurement unit data to estimate physical therapist ratings. On a held-out test set, we compared these learned models to one another, to participants’ self-assessments of balance, and to models trained using hand-engineered features. Utilizing the unprocessed kinematic data from the inertial measurement unit provided significant improvements over both self-assessments and models using hand-engineered features (AUROC of 0.806 vs. 0.768, 0.665). Conclusions Unprocessed data from an inertial measurement unit used as input to a machine learning model produced accurate estimates of balance performance. The ability to learn from unprocessed data presents a potentially generalizable approach for assessing balance without the need for labor-intensive feature engineering, while maintaining comparable model performance.

scholarly journals Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

2021 ◽  
Vol 9 ◽  
pp. 205031212110225
Author(s):  
Mark A Pianka ◽  
Joseph Serino ◽  
Steven F DeFroda ◽  
Blake M Bodendorfer
Keyword(s):  
Wide Spectrum ◽  
Pain Syndrome ◽  
Operative Management ◽  
Hip Pain ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Treatment Indications ◽  
Careful Clinical Examination ◽  
Wide Range ◽  
Tendon Pathology

Greater trochanteric pain syndrome is a common cause of lateral hip pain, encompassing a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. Greater trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment. A thorough history and physical exam may be used to help differentiate greater trochanteric pain syndrome from other common causes of hip pain, including osteoarthritis, femoroacetabular impingement, and lumbar stenosis. Although not required for diagnosis, plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of greater trochanteric pain syndrome. The majority of patients with greater trochanteric pain syndrome respond well to conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Operative management is typically indicated in patients with chronic symptoms refractory to conservative therapy. A wide range of surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain. The purpose of this review is to highlight pertinent clinical and radiographic features used in the diagnosis and management of greater trochanteric pain syndrome. In addition, treatment indications, techniques, and outcomes are described.

scholarly journals Rethinking Telerehabilitation: Attitudes of Physical Therapists and Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110343
Author(s):  
Fereshteh Saaei ◽  
Susan G Klappa
Keyword(s):  
Patient Population ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Patient Survey ◽  
Patient Perspectives ◽  
Remote Care ◽  
Virtual Therapy ◽  
Therapy Sessions

COVID-19 has accelerated the adoption of telehealth among various specialties, including rehabilitation. The fast-paced implementation of telerehabilitation has laid bare its challenges, providing an opportunity for innovation in order to enhance the experience of remote care. The purpose of this study sought to understand the attitudes toward telerehabilitation from physical therapist (PT) and patient perspectives. Two surveys administered to PTs, and the general patient population explored beliefs regarding telerehabilitation. There were a total of 289 participant responses in this study. There were 228 PT respondents and 61 patients who responded to the patient survey. Qualitative results describe current attitudes toward telerehabilitation. Results indicated both groups were receptive to virtual therapy sessions; however, some challenges were also reported. Current challenges and trends in utilizing telerehabilitation are further discussed.

scholarly journals Evaluation of Individualized Functional Electrical Stimulation-Induced Acute Changes during Walking: A Case Series in Children with Cerebral Palsy

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4452
Author(s):  
Nicole Zahradka ◽  
Ahad Behboodi ◽  
Ashwini Sansare ◽  
Samuel C. K. Lee
Keyword(s):  
Cerebral Palsy ◽  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Case Series ◽  
Phase Detection ◽  
Lower Extremity Muscle ◽  
Children With Cerebral Palsy ◽  
Muscle Groups

Functional electrical stimulation (FES) walking interventions have demonstrated improvements to gait parameters; however, studies were often confined to stimulation of one or two muscle groups. Increased options such as number of muscle groups targeted, timing of stimulation delivery, and level of stimulation are needed to address subject-specific gait deviations. We aimed to demonstrate the feasibility of using a FES system with increased stimulation options during walking in children with cerebral palsy (CP). Three physical therapists designed individualized stimulation programs for six children with CP to target participant-specific gait deviations. Stimulation settings (pulse duration and current) were tuned to each participant. Participants donned our custom FES system that utilized gait phase detection to control stimulation to lower extremity muscle groups and walked on a treadmill at a self-selected speed. Motion capture data were collected during walking with and without the individualized stimulation program. Eight gait metrics and associated timing were compared between walking conditions. The prescribed participant-specific stimulation programs induced significant change towards typical gait in at least one metric for each participant with one iteration of FES-walking. FES systems with increased stimulation options have the potential to allow the physical therapist to better target the individual’s gait deviations than a one size fits all device.

Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

2019 ◽  
Vol 101-B (8) ◽  
pp. 902-909 ◽  
Author(s):  
M. M. Innmann ◽  
C. Merle ◽  
T. Gotterbarm ◽  
V. Ewerbeck ◽  
P. E. Beaulé ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Screening Tools ◽  
Sacral Slope ◽  
Sitting Position ◽  
Total Hip ◽  
Patient Reported ◽  
Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

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