Julia M. Hush

Patient Satisfaction With Musculoskeletal Physical Therapy Care: A Systematic Review

Background Patient satisfaction is an important patient-centered health outcome. To date, no systematic review of the literature on patient satisfaction with musculoskeletal physical therapy care has been conducted. Purpose The purpose of this study was to systematically and critically review the literature to determine the degree of patient satisfaction with musculoskeletal physical therapy care and factors associated with satisfaction. Data Sources The databases CINAHL, MEDLINE, and EBM Reviews were searched from inception to September 2009. Study Selection Articles were included if the design was a clinical trial, observational study, survey, or qualitative study; patient satisfaction was evaluated; and the study related to the delivery of musculoskeletal physical therapy services conducted in an outpatient setting. The search located 3,790 citations. Fifteen studies met the inclusion criteria. Data Extraction Two authors extracted patient satisfaction data and details of each study. Data Synthesis A meta-analysis of patient satisfaction data from 7 studies was conducted. The pooled estimate of patient satisfaction was 4.44 (95% confidence interval=4.41–4.46) on a scale of 1 to 5, where 5 indicates high satisfaction and 1 indicates high dissatisfaction. Additional data were summarized in tables and critically appraised. Limitations Nonrespondent bias from individual studies may affect the accuracy and representativeness of these data. Conclusion Patients are highly satisfied with musculoskeletal physical therapy care delivered across outpatient settings in northern Europe, North America, the United Kingdom, and Ireland. The interpersonal attributes of the therapist and the process of care are key determinants of patient satisfaction. An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Physical therapists can enhance the quality of patient-centered care by understanding and optimizing these determinants of patient satisfaction.

PLANT MITOSIS PROMOTING FACTOR DISASSEMBLES THE MICROTUBULE PREPROPHASE BAND AND ACCELERATES PROPHASE PROGRESSION IN TRADESCANTIA

The regulation of mitosis in higher plant cells has been investigated by microinjecting protein kinase from the metaphase‐arresting (met1) mutant ofChlamydomonas. Biochemical characterization of this enzyme complex confirms the presence of a p34cdc2/cyclin B‐like kinase. The enzyme was injected into living stamen hair cells ofTradescantia virginianain which microtubules (MTs) were visualized using fluorescent analogue cytochemistry and confocal laser scanning microscopy. Microinjection of this p34cdc2/cyclin B‐like kinase caused rapid disassembly of the preprophase band of MTs but not of interphase‐cortical, spindle or phragmoplast MTs. Effects of the enzyme on the cytomorphology of live prophase cells were also monitored using video microscopy. We found that injection of this enzyme accelerated chromatin condensation and nuclear envelope breakdown. This indicates the presence and function in plants of an enzyme that can initiate nuclear division similar to the maturation or mitosis promoting factor (MPF) of animal cells. These studies provide the first direct evidence that the mitotically‐active form of plant MPF can drive disassembly of preprophase band MTs, chromosome condensation and initiation of mitosis in plant cells.

Behavior of microtubules in living plant cells

Cytoplasmic MTs are recognized as important elements in plant development. They are categorized in four principal arrays: the PPB, the MA, the phragmoplast, and the cortical array, and they appear to participate in fundamental aspects of cell division, growth, and differentiation. Thus, such diverse activities as prediction of the alignment of the cell plate, the movement of chromosomes and transport of cell plate vesicles, and the orientation of the cellulose wall microfibrils are all mediated by MTs to varying degrees. Our knowledge about the distribution and function of MTs has been gleaned largely from studies at the electron microscope level, and more recently at the light microscope level using immunofluorescence methods. Because most of these observations have been based on cells that have been fixed, it has not been possible to examine directly the dynamic properties and behavior of MTs. Transitional states have been inferred from looking at numerous isolated examples, which have then been placed into a sequence. Other aspects, such as the sensitivity of MTs to drugs, ions, or cold temperature, have also been approximated through studies in which cells have been fixed at periodic intervals following application of an agent. Some important aspects of MT behavior, including, notably, their turnover, have been beyond the reach of these indirect methods. To enlarge our understanding of the dynamic properties of MTs, we have introduced the technique of fluorescent analog cytochemistry as applied to plant cells (Zhang et al., 1990b). In this procedure fluorescently labeled exogenous tubulin, which is injected into the cell, incorporates into the endogenous pool and acts as a reporter. MTs, which are observed with the CLSM, can be examined under any experimental condition to which the cells are exposed. The results have produced new information about MT transitions and dynamic behavior in live cells, which we address in this Update. Other aspects of plant MTs, including the identification of MT organizing centers, tubulin isoforms, and MAPs have been considered in other recent topical reviews (Lambert, 1993; Cyr, 1994; Goddard et al., 1994; Shibaoka, 1994; Cyr and Palevitz, 1995; Joshi and Palevitz, 1996), so they will not be covered here. INCORPORATION OF HETEROLOGOUS ANIMAL TUBULIN INTO PLANT MTS; OBSERVATIONS BY CLSM

Multivariate Classification of Structural MRI Data Detects Chronic Low Back Pain

Chronic low back pain (cLBP) has a tremendous personal and socioeconomic impact, yet the underlying pathology remains a mystery in the majority of cases. An objective measure of this condition, that augments self-report of pain, could have profound implications for diagnostic characterization and therapeutic development. Contemporary research indicates that cLBP is associated with abnormal brain structure and function. Multivariate analyses have shown potential to detect a number of neurological diseases based on structural neuroimaging. Therefore, we aimed to empirically evaluate such an approach in the detection of cLBP, with a goal to also explore the relevant neuroanatomy. We extracted brain gray matter (GM) density from magnetic resonance imaging scans of 47 patients with cLBP and 47 healthy controls. cLBP was classified with an accuracy of 76% by support vector machine analysis. Primary drivers of the classification included areas of the somatosensory, motor, and prefrontal cortices--all areas implicated in the pain experience. Differences in areas of the temporal lobe, including bordering the amygdala, medial orbital gyrus, cerebellum, and visual cortex, were also useful for the classification. Our findings suggest that cLBP is characterized by a pattern of GM changes that can have discriminative power and reflect relevant pathological brain morphology.

Prevalence of sleep disturbance in patients with low back pain

Low back pain (LBP) is a common health condition that is often associated with disability, psychological distress and work loss. Worldwide, billions of dollars are expended each year trying to manage LBP, often with limited success. Recently, some researchers have reported that LBP patients also report sleep disturbance as a result of their LBP. However, as most of this evidence was obtained from highly selected groups of patients or from studies with small samples, high quality data on prevalence of sleep disturbance for patients with LBP are lacking. It is also unclear whether sleep disturbance is more likely to be reported by patients with recent-onset LBP than by patients with persistent LBP. Finally, it is not known whether high pain intensity, the most relevant condition-specific variable, is associated with higher rates of reported sleep disturbance. The present study aimed to determine the prevalence of reported sleep disturbance in patients with LBP. In addition, we aimed to determine whether sleep disturbance was associated with the duration of back pain symptoms and whether pain intensity was associated with reported sleep disturbance. Data from 1,941 patients obtained from 13 studies conducted by the authors or their colleagues between 2001 and 2009 were used to determine the prevalence of sleep disturbance. Logistic regression analyses explored associations between sleep disturbance, the duration of low back symptoms and pain intensity. The estimated prevalence of sleep disturbance was 58.7% (95% CI 56.4–60.7%). Sleep disturbance was found to be dependent on pain intensity, where each increase by one point on a ten-point visual analogue scale (VAS) was associated with a 10% increase in the likelihood of reporting sleep disturbance. Our findings indicate that sleep disturbance is common in patients with LBP. In addition, we found that the intensity of back pain was only weakly associated with sleep disturbance, suggesting that other factors contribute to sleep problems for LBP patients.

Electrical and mechanical fields orient cortical microtubules in higher plant tissues

Abstract Microtubules are a major component of the plant cytoskeleton. The factors which control the orientation of microtubules in plants are unknown. In this paper we describe preliminary findings that non-injurious electrical fields or mechanical fields, applied to pea roots, can cause a re-orientation of cortical microtubules which then lie in a plane approximately perpendicular to the direction of the applied field, within 6 hours. These results provide the first experimental evidence that physical fields can control the orientation of microtubules in plant tissues.

Re-orientation of cortical F-actin is not necessary for wound-induced microtubule re-orientation and cell polarity establishment

SummaryTo assess the relative roles of cortical actin and microtubule re-orientation in the establishment of new cell polarity, we have examined the kinetics of cortical actin re-orientation around a wedge-shaped wound in pea roots. Cortical actin re-orients from a transverse alignment to an approximately longitudinal orientation between 5 and 24h after wounding, that is, after the re-alignment of microtubules, which is known to occur before 5h post-wounding. F-actin in root cortical cells does not appear to be necessary for the establishment of new cell polarity around wounds, since normal MT re-alignment, and new planes of cell division are still established around a wound in cytochalasin treated roots. The cytochalasin treatment appeared to totally disrupt cortical and cytoplasmic F-actin in cells of the root cortex. However, in the apparent absence of F-actin in these cells, the rate of wound-induced cell division, but not cell expansion, is slower, and we suggest that an effect on the phragmosomal actin is involved. Finally, we demonstrate that new cell polarity around a wound is not established if microtubules are disrupted by the herbicide oryzalin, but after re-establishment of these arrays following a wash-out of the drug, the typical new planes of cell expansion are observed. We conclude that microtubules play a critical role in establishing and maintaining cell polarity in this system, and that cortical F-actin has a minor and presently unclear function in these processes.

Comparison of the Functional Rating Index and the 18-item Roland-Morris Disability Questionnaire: responsiveness and reliability

Study Design. Retrospective design. Objectives. To compare the responsiveness and test-retest reliability of the Functional Rating Index and the 18-item version of the Roland-Morris Disability Questionnaire in detecting change in disability in patients with work-related low back pain. Summary of Background Data. Many low back pain-specific disability questionnaires are available, including the Functional Rating Index and the 18-item version of the Roland-Morris Disability Questionnaire. No previous study has compared the responsiveness and reliability of these questionnaires. Methods. Files of patients who had been treated for work-related low back pain at a physical therapy clinic were reviewed, and those containing initial and follow-up Functional Rating Index and 18-item Roland-Morris Disability Questionnaires were selected. The responsiveness of both questionnaires was compared using two different methods. First, using the assumption that patients receiving treatment improve over time, various responsiveness coefficients were calculated. Second, using change in work status as an external criterion to identify improved and nonimproved patients, Spearman’s &rgr; and receiver operating characteristic curves were calculated. Reliability was estimated from the subset of patients who reported no change in their condition over this period and expressed with the intraclass correlation coefficient and the minimal detectable change. Results. One hundred and forty-three patient files were retrieved. The responsiveness coefficients for the Functional Rating Index were greater than for the 18-item Roland-Morris Disability Questionnaire. The intraclass correlation coefficient values for both questionnaires calculated from 96 patient files were similar, but the minimal detectable change for the Functional Rating Index was less than for the 18-item Roland-Morris Disability Questionnaire. Conclusion. The Functional Rating Index seems preferable to the 18-item Roland-Morris Disability Questionnaire for use in clinical trials and clinical practice.

The Bidirectional Relationship Between Pain Intensity and Sleep Disturbance/Quality in Patients with Low Back Pain

Objectives:This study investigated the bidirectional relationship between the intensity of low back pain (LBP) and sleep disturbance. Further, the study aimed to determine whether any relationship is dependent on pain duration, symptoms of depression and anxiety, and the method of sleep assessment (subjective vs. objective). Materials and Methods:Eighty patients with LBP completed a sleep diary. A subgroup of 50 patients additionally wore an electronic device (Armband) to measure sleep for 7 consecutive days. Pain intensity was assessed twice daily using a sleep diary. Depression and anxiety symptoms were assessed at baseline using the Depression Anxiety Stress Scale questionnaire. Generalized estimating equations (GEE) with an exchangeable correlation structure were used to examine the relationship between day-time pain intensity and sleep. Results:The GEE analysis showed that a night of poor sleep quality, difficulty falling sleep (assessed by the sleep diary), waking after sleep onset, and low sleep efficiency (assessed by the sleep diary and Armband) were followed by a day with higher pain intensity. Further, a day with higher pain intensity was associated with a decrease in the subsequent night’s sleep quality, an increase in sleep latency (assessed by the sleep diary), waking after sleep onset (assessed by both measures), and low sleep efficiency (assessed by the Armband). Discussion:The findings demonstrate that there is a bidirectional relationship between sleep and pain intensity in patients with LBP. The relationship is independent of pain duration and baseline symptoms of depression and anxiety and somewhat dependent on the method of sleep measurement (sleep diary or Armband). Future research is needed to determine whether targeting sleep improvement in patients with LBP contributes to pain reduction.

Does fear of movement mediate the relationship between pain intensity and disability in patients following whiplash injury? A prospective longitudinal study

Summary In a cohort of patients with whiplash injuries, fear avoidance partially mediated the relationship between pain soon after injury and disability 3 months later. ABSTRACT The aim of this study was to test the capacity of the Fear Avoidance Model to explain the relationship between pain and disability in patients with whiplash‐associated disorders. Using the method of Baron and Kenny [1], we assessed the mediating effect of fear of movement on the cross‐sectional and longitudinal relationships between pain and disability. Two hundred and five subjects with neck pain due to a motor vehicle accident provided pain intensity (0 to 10 numerical rating scale), fear of movement (Tampa Scale of Kinesiophobia and Pictorial Fear of Activity Scale) and disability (Neck Disability Index) scores within 4 weeks of their accident, after 3 months, and after 6 months. The analyses were consistent with the Fear Avoidance Model mediating approximately 20% to 40% of the relationship between pain and disability. Contrary to our initial hypothesis, the proportion of the total effect of pain on disability that was mediated by fear of movement did not substantially change as increasing time elapsed after the accident. The proportion mediated was slightly higher when fear of movement was measured by Tampa Scale of Kinesiophobia as compared with Pictorial Fear of Activity Scale. The findings of this study suggest that the Fear Avoidance Model plays a role in explaining a moderate proportion of the relationship between pain and disability after whiplash injury.