David A. Scalzitti

Physical activity among adult survivors of childhood lower-extremity sarcoma.

IntroductionAdult survivors of childhood lower-extremity sarcoma are largely physically inactive, a behavior which potentially compounds their health burden. Altering this behavior requires understanding those factors that contribute to their physical inactivity. Therefore, this investigation sought to identify factors associated with inactivity in this subpopulation of cancer survivors.MethodsDemographic, personal, treatment, and physical activity information from adult survivors of childhood lower-extremity sarcomas was obtained from the Childhood Cancer Survivor Study (CCSS) cohort. Generalized linear models were used to identify variables that best identified those individuals who were physically inactive.ResultsOnly 41% of survivors met Center for Disease Control (CDC) activity guidelines. Survivors were 1.20 (95% confidence intervals (CI) 1.11–1.30) more likely compared to CCSS sibling cohort and 1.12 (95% CI 1.10–1.15) times more likely than the general population to fail to meet CDC guidelines. Significant predictors of physical inactivity included female sex, hemipelvectomy surgery, and platinum and vinca alkaloid chemotherapy.ConclusionsThe primary findings of this study are that survivors of childhood onset lower-extremity sarcoma are (1) highly likely to be physically inactive and (2) less likely than their siblings or the general population to regularly exercise. This study has identified treatment-related risk factors associated with inactivity that will help health and wellness practitioners develop successful exercise interventions to help these survivors achieve recommended levels of physical activity for health.Implications for cancer survivorsThese results suggest that physical activity interventions for adult survivors of childhood lower-extremity sarcomas should be sex specific and responsive to unique physical late effects experienced by these survivors.

Vitalizing Practice Through Research and Research Through Practice: The Outcomes of a Conference to Enhance the Delivery of Care

The American Physical Therapy Association (APTA) provided funding for a series of meetings among a small group of leaders representing the research and clinical communities whose task was to plan a conference, the outcome of which would be a “road map” for the process of generating evidence that would be implemented by clinicians so that the provision of services might be enhanced. Two of these planning sessions were held and resulted in a decision to focus a conference on the identification of strategies to lessen perceived “gaps” between physical therapist clinicians and researchers and the development of strategies to bridge the “gaps” between the 2 groups. These meetings ultimately resulted in the Vitalizing Practice Through Research and Research Through Practice Conference hosted by APTA. A perceived gap between research and practice has been cited as a problem by others within and outside the profession as well. In a recent editorial in the Journal of Orthopaedic and Sports Physical Therapy , Bechtel et al stated, “We have a problem in manual therapy, and perhaps in the whole profession of physical therapy. Our problem is the growing chasm between researchers on the one hand, and clinicians on the other.”1(p451) A recent Institute of Medicine workshop titled “Transforming Clinical Research in the United States: Challenges and Opportunities” echoed this theme and identified bridging the divide between research and practice as one of the most critical needs facing clinical research.2 Discussion of the perceived gap between research and practice extends internationally, as Demers and Poissant3 lamented that research would be meaningless if it did not affect clinical practice. Furthermore, Demers and Poissant discussed the value of creating partnerships across the research process, from conception to dissemination of results. Translational research , at its most macroscopic level, essentially refers to efficient movement …

Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organizations International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to meniscus and articular cartilage lesions. J Orthop Sports Phys Ther. 2018;48(2):A1-A50. doi:10.2519/jospt.2018.0301.

In a 36-year-old woman with neck pain, will manipulation and mobilization be beneficial for reducing her reports of neck pain?

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a patient with neck pain. Can manipulation or mobilization reduce her neck pain? Neck pain is a common condition, with estimates of the prevalence in the previous 12 months between 30% and 50% and activity limitations from neck pain between 1.7% and 11.5%.2 The impact of neck pain on society is large due to high medical costs, time off from work, and associated disability.3,4

On “Physical therapists make accurate and appropriate discharge recommendations…” Smith BA, Fields CJ, Fernandez N. Phys Ther. 2010;90:693–703.

The retrospective study by Smith et al1 reported an odds ratio (OR) of 2.9 for the association between hospital readmission and the predictor variable mismatch with services lacking (ie, the physical therapists discharge recommendation was not implemented and follow-up services were lacking). The authors are correct in the interpretation of …

Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention

The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organizations International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on the exercise-based prevention of knee injuries. J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303.

The effects of joint mobilization on individuals with patellofemoral pain: a systematic review

Objective: To investigate and synthesize the effects of joint mobilization on individuals with patellofemoral pain syndrome. Data sources: Five electronic databases (CINAHL, the Cochrane Central Register of Controlled Trials, PubMed, Scopus, and SPORTDiscus) were used. Review methods: Each database was searched from inception to 1 November 2017. Randomized controlled trials investigating a manual therapy intervention, with or without co-interventions, for persons with patellofemoral pain were included. Two reviewers independently screened the retrieved literature and appraised the quality of the selected studies using the PEDro rating scale. A third reviewer was used in cases of discrepancy to create a consensus. Results: A total of 361 articles were identified in the search. Twelve randomized trials with a total of 499 participants were selected for full review. Within-group improvements in pain and function were noted for the manual therapy groups. Between-group improvements for short-term outcomes (three months or less) were greatest when joint mobilization was directed to the knee complex and used as part of a comprehensive approach. Conclusion: In the articles reviewed, joint mobilization appears to be most effective in improving pain and function when coupled with other interventions, although its discrete effect is unclear due to the reviewed studies’ design and reporting.

Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organizations International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.

Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis

Background Persons with multiple sclerosis (MS) commonly have difficulty walking. The 6-Minute Walk Test (6MWT) assesses functional capacity but may be considered burdensome for persons with MS, especially those with higher disability levels. The 2-Minute Walk Test (2MWT) may be an alternative measure to the 6MWT. The purpose of this study was to investigate the validity of the 2MWT in persons with MS. Methods Twenty-eight ambulatory persons with MS aged 18 to 64 years participated in this cross-sectional study. Participants completed five measures of walking performance (2MWT, 6MWT, usual and fast gait speed, and Timed Up and Go test) and two functional measures (Berg Balance Scale and five-times sit-to-stand test) during a testing session. Participants were classified into two subgroups based on Disease Steps scale classification. Results The 2MWT was significantly correlated with the 6MWT (r = 0.947), usual gait speed (r = 0.920), fast gait speed (r = 0.942), the Timed Up and Go test (r = -0.911), and other functional measures. The 2MWT explained 89% of the variance seen during the 6MWT. The distances completed on the 2MWT and 6MWT accurately distinguished the subgroups. Conclusions This study demonstrated good construct and discriminant validity of the 2MWT in persons with MS, providing an efficient and practical alternative to the 6MWT. Validation of the 2MWT with other functional measures further supports these findings.