Diane U. Jette

Physical Therapy and Health Outcomes in Patients With Spinal Impairments

BACKGROUND AND PURPOSE Little is known concerning the effects of physical therapy on health outcomes in patients with spinal impairments. This research examined the pattern of health outcomes in patients with spinal impairments and the relationship of outcomes to the physical therapy provided. SUBJECTS Data were obtained from 1,097 patients with spinal impairments who completed an episode of care in any of 68 physical therapy practices across the United States. METHODS Data were derived from the Focus on Therapeutic Outcomes database during 1993 and 1994. Multivariate analyses were used to determine which of the treatment variables, controlled for baseline health status and relevant patient characteristics, were related to outcomes. RESULTS Improvement occurred in nearly all health scales. Inclusion of endurance exercise was most consistently associated with better outcomes. Inclusion of heat or cold modalities was associated with poorer outcomes. CONCLUSION AND DISCUSSION This study suggests that physical therapists take a broader view of patient-related goals and documentation of outcomes. It also provides evidence that the type of intervention is related to outcomes.

Lower extremity Muscle force measures and functional ambulation in patients with amyotrophic lateral sclerosis

OBJECTIVE To examine the relation between lower extremity muscle force production and functional ambulation in patients with amyotrophic lateral sclerosis (ALS). DESIGN Retrospective analysis of data collected from 1979 to 1995. PATIENTS Two hundred forty ALS patients referred to the New England Medical Center Neuromuscular Research Unit. MAIN OUTCOME MEASURES Muscle force production during a maximum, voluntary isometric contraction of ankle dorsiflexors, knee flexors, knee extensors, hip flexors, and hip extensors was calculated as percent predicted maximal force (PPMF). Functional ambulation status was classified as unable, home, or community. RESULTS The probability of community ambulation compared with home increased with progressively higher PPMF for all muscle groups. Subjects with knee flexion strength greater than 75% PPMF were 395 times more likely to ambulate in the community. Subjects with hip extension strength over 50% PPMF showed improved chance of ambulation at home. CONCLUSION Lower extremity PPMF is a critical factor determining functional ambulation in patients with ALS. Knee flexors play an important role in community ambulation while the hip extensors are important for home ambulation.

Physical Therapist Student Loan Debt

The cost of higher education in the United States is big news. One major reason for the media attention is rising student loan debt. Concerns about rising student loan debt are being voiced at the federal government level1 and by political candidates,2,3 institutions of higher education,4 professional organizations,5,6 and, of course, consumers.7 There seems to be little agreement on the reasons for escalating costs, although there is nearly universal agreement that the costs are out of control. Various authors have argued for and against the effects of several factors on increasing costs, including growing numbers of institutional administrators,8,9 increasing federal regulation,10 new campus buildings to attract students,9,11 rising costs of employee health insurance,12 costs of intercollegiate sports,9 and an increasing proportion of professors staying beyond traditional retirement age.13 State support for public institutions has declined over the past 2 to 3 decades,9,14,15 and both public and private institutions saw declines in gifts and endowments during the recent recession.9 Consequently, institutions have charged students more to make up for budget deficits.15 The result is that over the past 3 decades, tuition and fees have increased approximately 210% at 4-year public universities and by approximately 130% at private 4-year nonprofit institutions,9 while median household income has increased by approximately 2%.15 Although tuition increases have been accompanied by expansion of financial aid packages, increasing proportions of those packages are in the form of loans.9,16 Taken together, these forces have caused higher education costs to outstrip the capacity of many family budgets, requiring more borrowing than in the past. Consequences of high student loan debt are reported to include delays in starting families, …