Jessica A. Palmer

The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy.

Study Design. Cohort study of patients with cervical radiculopathy undergoing physical therapy. Objectives. Examine the test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and Patient Specific Functional Scale (PSFS) in cohort of patients with cervical radiculopathy. Summary of Background Data. To date, no studies have investigated the psychometric properties of the NDI or PSFS in a cohort of patients with cervical radiculopathy. Methods. Thirty-eight patients with cervical radiculopathy undergoing physical therapy completed the NDI and PSFS, and Numerical Pain Rating Scale (NPRS) at the baseline examination and at a follow-up. In addition, at follow-up, patients completed a 15-point global rating of change (GROC), which was used to dichotomize patients as improved or stable. Changes in the NDI and PSFS were then used to assess test-retest reliability, construct validity, and minimal levels of detectable and clinically important change. Results. Test-retest reliability was moderate for the NDI (intraclass correlation coefficient [ICC] = 0.68; 95% confidence interval [CI], 0.30–0.90) and high for the PSFS (ICC = 0.82; 95% CI, 0.54–0.93). The PSFS was more responsive to change than the NDI. The minimal detectable change for the NDI was 10.2 and for the PSFS 2.1. The minimally clinically important change for the NDI was 7.0 and PSFS 2.0. Conclusions. Our results suggest that the PSFS exhibits superior reliability, construct validity, and responsiveness in this cohort of patients with cervical radiculopathy compared with the NDI. Further research is needed to examine the ability of these measures to accurately reflect changes in individuals, as well as large samples of patients.

Incorporation of Manual Therapy Directed at the Cervicothoracic Spine in Patients with Lateral Epicondylalgia: A Pilot Clinical Trial

Abstract Recent trends in the use of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia have been observed. However, only short-term preliminary evidence exists to support the use of these techniques. This pilot clinical trial describes the outcomes of patients with lateral epicondylalgia undergoing local treatment (LT) solely directed at the elbow and a program consisting of local treatment plus manual therapy aimed at the cervicothoracic spine (LT + MTCT). Ten consecutive patients referred to physical therapy by their primary care physician with a diagnosis of lateral epicondylalgia were randomly assigned to receive LT or LT + MTCT. Both groups received 10 treatments over a 6-week period. Outcome measures, including the Numeric Pain Rating Scale; pain-free grip strength; Disability of the Arm, Shoulder, and Hand questionnaire; and a global rating of change were completed at discharge and at 6-month follow-up. Patients in both groups exhibited clinically meaningful improvement at discharge and at the 6-month follow-up. The LT + MTCT group demonstrated greater improvement in all outcome measures as compared to the LT group. The results suggest that the incorporation of manual therapy directed at the cervicothoracic spine may be an effective adjunct to treatment directed solely at the elbow for patients with lateral epicondylalgia.

Effectiveness of Neural Mobilization in the Treatment of a Patient with Lower Extremity Neurogenic Pain: A Single-Case Design

Abstract It is postulated that neural tissue mechanosensitivity contributes to symptoms associated with peripheral neurogenic pain disorders. However, there is a paucity of literature regarding the most effective clinical practices for managing pain of peripheral neurogenic origin. As clinical use of neural mobilization continues to flourish in the management of these pain syndromes, it is imperative to document outcomes associated with these techniques. The purpose of this single-case A1-B1-A2-B2 design was to investigate the effectiveness of neural mobilization in the management of a 29-year-old female patient with symptoms suggestive of peripheral neurogenic involvement. The intervention phases (B1 and B2) consisted of neural mobilizations specifically directed at the sciatic continuum. Outcome measures (degrees of hip flexion during the straight-leg-raise and pain) demonstrated both visual improvement and statistically significant improvements following implementation of the neural mobilization techniques. This single-case design provides a measure of scientific support for the use of neural mobilizations with patients presenting with lower extremity neurogenic pain disorders. However, generalizability is poor, and further methodologically sound clinical trials are necessary to investigate the effectiveness of neural mobilization in a larger patient population.

ETHNIC DIFFERENCES IN PAIN PERCEPTION

Abstract Pain is a complex multidimensional experience, which includes both a sensory and emotional component. With the increasing prevalence of multicultural societies consisting of numerous ethnic subgroups, each with differing beliefs, values, and customs, it has become increasingly important for the physical therapist to recognise how varying populations may experience pain differently. The purpose of this review is to describe the current healthcare literature regarding ethnic differences in pain perception; from this it can be ascertained that diverse ethnic groups express the quality and intensity or frequency of pain differently, and use varying amounts of analgesics in an attempt to control their pain. Physical therapists should recognise this and understand the implications this may have in the way patients express and communicate their pain. Recognising these individual differences, and that a patients response to pain depends on their physiology, personality, life experiences and ethnicity is essential in developing the patient–therapist relationship, appropriate management strategies, and optimal outcomes.

Can Physical Therapists Utilize Clinical Prediction Rules to Guide Decision-Making about Individual Patient Care?

S AAOMPT Conference, 2004 160 BOOK, CD, AND TAPE REVIEWS 171 ABSTRACTS OF CURRENT LITERATURE 172S OF CURRENT LITERATURE 172 MANUAL THERAPY ANNOUNCEMENTS 175 INFORMATION FOR AUTHORS 176 Copyright: All papers published in this journal remain the property of The Journal of Manual & Manipulative Therapy and should not be reproduced without the permission of the Editor. Contact us via E-mail: jmmt@gte.net or visit us online: www.jmmtonline.com The Journal of Manual & Manipulative Therapy a peer-reviewed journal Volume 12 Number 3 2004