Steven J Rose

Total Contact Casting in Treatment of Diabetic Plantar Ulcers: Controlled Clinical Trial

This study compared the treatment of total contact casting (TCC) with traditional dressing treatment (TDT) in the management of diabetic plantar ulcers. Forty patients with diabetes mellitus and a plantar ulcer but with nogross infection, osteomyelitis, or gangrene were randomly assigned to the TCC group (n = 21) or TDT group (n = 19). Age, sex, ratio of insulin-dependent diabetes mellitus to non-insulin-dependent diabetes mellitus, duration of diabetes mellitus, vascular status, size and duration of ulcer, and sensation were not significantly different between groups (P > .05). In the experimental group, TCC was applied on the initial visit, and subjects were instructed to limit ambulation to ∼33% of their usual activity. Subjects in the control group were prescribed dressing changes and accommodative footwear and were instructed to avoid bearing weight on the involved extremity. Ulcers were considered healed if they showed complete skin closure with no drainage. Ulcers were considered not healed if they showed no decrease in size by 6 wk or if infection developed that required hospitalization. In the TCC group, 19 of 21 ulcers healed in 42 ± 29 days; in the TDT group, 6 of 19 ulcers healed in 65 ± 29 days. Significantly more ulcers healed (χ2 = 12.4, P < .05) and fewer infections developed (χ2 = 4.1, P < .05) in the TCC group. We conclude TCC is a successful method of treating diabetic plantar ulcers but requires careful application, close follow-up, and patient compliance with scheduled appointments to minimize complications.

Reliability of isokinetic measurements of trunk muscle performance

The purpose of this investigation was to assess the reliability of isokinetic trunk muscle performance. Sixtyone volunteers participated (29 men, 32 women; age range, 20-60 years). All subjects were without low-back symptoms at the time of testing. All testing was performed with the subject initially standing, using speeds of 60, 120, and 180° per second. Ten repetitions of flexion and extension were performed reciprocally at each speed, with a 3-minute rest period between speeds. Testretest intervals were 1 and 3 weeks from the initial test. Peak torque-to-body-weight ratios, extension-to-flexion ratios, and average work per repetition were calculated for each speed for flexion and extension. Data were analyzed with analysis of variance, intraclass correlation coefficients, and Pearson correlation coefficients. Intraclass correlation coefficient values ranged from .74 to .88 for measurements derived from peak torque, and from .88-.93 for measurements derived from work (with the exception of .69 for men at 180°/sec). Standard error of measurements ranged from 8 to 32 ft-lb, with a tendency to increase with increasing speeds. It was concluded that, when using this protocol, isokinetic measurements of muscle function offer the clinician sensitive and reliable measurements of trunk muscle performance and that incorporating increased practice with women and longer rest periods with men may further decrease error associated with these isokinetic trunk strength measurements.

Diagnosis and Direct Access: Reactions to Editorial

To the Editor: Having been a student in your 1971 neurophysiology class, I respect you for your gifted intellect and your genuine concern for the professions future. Additionally, I remember you as an extremely gracious person. However, the position advocated in your editorial published in the January 1989 issue of Physical Therapy was, in my opinion, completely unrealistic, naive, and counterproductive to efficiency in the health care market. You are correct when you state, “That diagnosis is a prerequisite for effective treatment is a central tenet of medical practice.” Then you argue that the direct-access mode of practice should not require a physical therapist to make a diagnosis. Instead, you suggest that physical therapists develop formulas for referral based on “clusters of signs and symptoms.” Dr Rose, the wheel has already been invented. The wheel in this situation is the medical model of diagnosis before treatment.… [ ARTICLE][1] [1]: /lookup/volpage/69/1-a?iss=1