Peggy Gleeson

Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm.

Wang WTJ, Olson SL, Campbell AH, Hanten WP, Gleeson PB: Effectiveness of physical therapy for patients with neck pain: An individualized approach using a clinical decision-making algorithm. Am J Phys Med Rehabil 2003;82:203–218. Objective The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. Design One treatment group of 30 patients with neck pain completed physical therapy treatment. The control group of convenience was formed by a cohort group of 27 subjects who also had neck pain but did not receive treatment for various reasons. There were no significant differences between groups in demographic data and the initial test scores of the outcome measures. A quasi-experimental, nonequivalent, pretest-posttest control group design was used. A physical therapist rendered an eclectic intervention to the treatment group based on a clinical decision-making algorithm. Treatment outcome measures included the following five dependent variables: cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion endurance test, and the Patient Specific Functional Scale. Both the treatment and control groups completed the initial and follow-up examinations, with an average duration of 4 wk between tests. Results Five mixed analyses of variance with follow-up tests showed a significant difference for all outcome measures in the treatment group compared with the control group. After an average 4 wk of physical therapy intervention, patients in the treatment group demonstrated statistically significant increases of cervical range of motion, decrease of pain, increases of physical performance measures, and decreases in the level of disability. The control group showed no differences in all five outcome variables between the initial and follow-up test scores. Conclusions This study delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain. The algorithm can help clinicians classify patients with cervical pain into clinical patterns and provides pattern-specific guidelines for physical therapy interventions. An organized and specific physical therapy program was effective in improving the status of patients with neck pain.

Pain assessment and management in children with neurologic impairment: a survey of pediatric physical therapists.

Purpose: This study explored pain assessment measures and interventions used by physical therapists in the treatment of children with neurologic impairment. Methods: Following extensive literature review on pain assessment and intervention, a survey was developed, pilot tested, and posted on the listserv of the Pediatric Section of the American Physical Therapy Association. Results: Eighty percent of the respondents used subjective measures to assess pain, 70% used self-report scales, and 41% used behavioral and physiological measures. Behaviors frequently used included vocalizations, facial expression, and irritability. Rarely used cues included decreased attention, withdrawal, and changes in sleeping and eating behaviors. Therapists used research-supported pain interventions such as distraction and praise as well as potentially harmful distress producing measures such as procedural talk and reassurance. Conclusion: Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.

Qualitative assessment of component-specific, fall-risk screening procedures to create a fall risk screening form.

Background:The Day Center, Case Management, and Home Care components of a local senior health agency each have used different screening forms for assessing their clients for fall risk. A common instrument, easily administered by all components as part of their routine practice, would be helpful in systematically identifying elders at risk of falling. Developing a common screening instrument would be useful at other senior health agencies as well. Purpose:To gather information on the content and features that are most useful for fall screening, based on the needs of individual geriatric care workers in each component of a local senior health agency. Methods:A semistructured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. Results:Two major themes emerged: (1) factors that are relevant in assessing fall risk and (2) factors that affect the utility of the fall risk screening procedure. Under theme 1, there were 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme 2, there were 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature, health status and fear of falling, to produce a universal form for use by different agency components. Discussion:Integrating all fall-risk categories into a universal form improves the completeness of the form used in different agency components. However, to increase the utility of fall risk screening, service plans integrated with each screening procedure need to be developed according to specific agency structures. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) initial screening with an outreach worker using a quick question assessment; (2) follow-up with a more comprehensive fall risk assessment while receiving services from the Day Center, Case Management, or Home Care; and (3) a “what-to-do” action is presented for each item on the basis of each questions response on the comprehensive form. Conclusions:When designing a fall risk screening procedure, integrating all fall-risk factors into a single comprehensive form may not be the ideal strategy. The environment, the person who gathers the information, and the actions required to respond to information gathered should also be considered. On the basis of the results of this qualitative study, we have presented a 3-step procedure, with supporting forms to address these considerations.

Translation and Validation of the Arabic Version of the Fear-Avoidance Beliefs Questionnaire in Patients with Low Back Pain.

Study Design. Prospective cohort study of a cross-cultural low back pain (LBP) questionnaire Objective. The objectives of the present study were to translate and cross-culturally adapt the Fear-Avoidance Beliefs Questionnaire (FABQ) to create a version in Arabic and to test its psychometric properties. Summary of Background Data. The FABQ measures the effects that fear and avoidance beliefs have on work and on physical activity. Methods. An FABQ cross-culturally adapted for Arabic readers and speakers was created by forward translation, translation synthesis, and backward translation. Forty patients in Riyadh, Saudi Arabia, with LBP evaluated use of the questionnaire, and 70 patients from the same hospital participated in reliability, validity, and sensitivity studies. To determine test-retest reliability of the Arabic FABQ, patients completed it twice within 48 hours without receiving any active treatment between these two sessions. Patients completed the Arabic FABQ (and three other scales) at baseline and 14 days later to determine its validity and sensitivity. Results. Test-retest reliability was good (FABQ–work: intraclass coefficient [ICC] = 0.74; FABQ—physical activity: ICC = 0.90; FABQ overall: ICC = 0.76). Correlations between the FABQ and three other instruments for measuring pain and disability were weak. The strongest correlation was found at the follow-up session with the Arabic Oswestry Questionnaire (r = 0.283; P ⩽ 0.05). Sensitivity to change was low. Conclusion. The translation and adaptation of the Arabic version of the FABQ was successful. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. The Arabic version of the FABQ shows promise in the assessment of fear-avoidance beliefs among patients with LBP who speak and read Arabic. Level of Evidence: 3

Assessment of Impact of Medication Use and Dementia on Fall Risk in Clients Receiving Home Health Care

The objective of this article was to investigate relationships among medication, dementia, and falls in community-dwelling elders with polypharmacy receiving home health care services from a senior services agency. As regards method, medical information on medication, dementia, and falls was obtained from clinical records of 147 clients. Chi-square tests were used to compare psychotropic drug use between elders with and without dementia. Logistic regression was performed to test the hypothesis that psychotropic drugs and dementia predicted falls in this population. Results reveal that this population had high rates of psychotropic drug use (61%), dementia (38%), and falls (37%). No significant differences were found in psychotropic drug use between elders with and without dementia. Neither psychotropic drugs nor dementia predicted falls. Conclusions show that in this population, no relationship was found between dementia, psychotropic drugs, and falls.