Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of M...Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of Mechanical Diagnosis and Therapy (MDT);2) balance of biomedical and behavioral (i.e. biopsychosocial) oriented approach for low back pain (LBP);3) demographics;4) academic degree and 5) the attitude towards updating information for evidence-based clinical practice. Aim 2 was to investigate whether therapists credentialed in MDT (Cred.MDT) were more behavioral oriented and less biomedical oriented than general physical therapists. Summary of Background Data: LBP practice guidelines are not adhered to by every physical therapist. MDT is a behavioral modification approach. Thus, it was hypothesized that the Cred.MDT therapist was more behavioral oriented and more adherent to LBP practice guidelines compared with general physical therapists. Methods: One-hundred-twenty Cred.MDT therapists and 2000 general physical therapists in Japan were contacted. For regression modeling, the dependent variable was adherent to guidelines using a questionnaire with a vignette. Independent variables included balance of biomedical and behavioral perspectives for LBP using the Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT), demographics, academic degree and the attitude towards updatinginformation for evidence-based clinical practice. The ratio of the two mean scores of the biomedical and behavioral subscales in the PABS-PT was compared between the Cred.MDT therapist group and the general physical therapists group. Results: Data of 46 general physical therapists and 44 Cred.MDT therapists were available. The Cred.MDT therapist group was significantly (P < 0.05) more behavioral oriented and more adherent to LBP practice guidelines compared with the general physical therapist group. The regression indicated significance of the two predictors of adherence to guidelines, Cred.MDT (β = 0.58, P < 0.001) and academic degree (β = 0.19, P = 0.03). Conclusions: Cred.MDT therapists are more guideline-consistent and have a more biopsychosocial treatment orientation than general physical therapists in Japan.展开更多
Relative flexibility between the hamstring and lumbar extensor muscles, which can be evaluated using lumbopelvic curvature during active knee extension in sitting, can sometimes be assessed in physical therapy. Howeve...Relative flexibility between the hamstring and lumbar extensor muscles, which can be evaluated using lumbopelvic curvature during active knee extension in sitting, can sometimes be assessed in physical therapy. However, reliability for its quantitative measure has not been established yet and its establishment was the aim of the current study. Twenty-seven individuals with clinically tight hamstring muscles were recruited. On two separate sessions, the lumbopelvic curvature was evaluated in sitting when the right knee was moved from 90° flexion to 10° flexion on 15 occasions using a flexible ruler by two examiners on Day 1 and one on Day 2. Lines drawn tangential to the lumbopelvic curvature were traced at T12 and S2 vertebral levels and the angle between the two vertical lines was calculated. Using Day 1 data, the minimum number of repetitions and inter-examiner reliability were assessed. Inter-session reliability was also examined. As a result, there was no statistical difference (P?> 0.05) in the mean absolute difference between the mean value of N-1 and N repetitions (6 ≤ N ≤ 15) in the lumbopelvic curvature angle, indicating that five was considered the minimum number of repetitions. Intraclass correlation coefficient (ICC)(1, 5)?for the inter-session reliability and ICC(2, 5)?for the inter-examiner reliability was 0.97 and 0.93, respectively, indicating excellent reliability. The measure for the lumbopelvic curvature during active knee extension in sitting, which was established in the current study, will be a foundation for further research regarding the relative flexibility of the lumbar and adjunct regions.展开更多
In a previous study, we established reliability of a method for determining the angle of lumbopelvic sagittal alignment during active knee extension in sitting (AKEiS) using a flexible ruler and image analysis softwar...In a previous study, we established reliability of a method for determining the angle of lumbopelvic sagittal alignment during active knee extension in sitting (AKEiS) using a flexible ruler and image analysis software (2-point-Method). In addition to this method, a flexible ruler can also be used to measure lumbopelvic sagittal alignment without image analysis software. This study primarily aimed to investigate the minimum number of repetitions, inter-session reliability and inter-examiner reliability of two alternative methods of measurement in a secondary analysis of our previous study. A flexible ruler was used to measure lumbopelvic curvature during AKEiS when the knee reached 10° flexion from 27 individuals with clinically tight hamstring muscles and subsequently analyzed. Lumbopelvic sagittal alignment was evaluated for the region between T12 and S2 using the maximum depth to the curvature (Max-Method) or depth to the curvature at the middle point between T12 and S2 vertebral levels (Mid-Method). It was determined that four repetitions for the Max-Method and 11 repetitions for the Mid-Method were required for the minimum number of repetitions, respectively. Inter-session reliability and inter-examiner reliability were assessed using Intraclass Correlation Coefficients and were 0.91 and 0.91 for the Max-Method and 0.90 and 0.91 for the Mid-Method, respectively. The current study suggests that the Mid-Method would not be recommended for use in the clinical setting as 11 repetitions of data sampling is required. The 2-point-Method or Max-Method may be promising but the ideal measurement method will be identified when the validity of these methods has been established.展开更多
<span style="font-family:Verdana;"><strong>Objective:</strong></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span sty...<span style="font-family:Verdana;"><strong>Objective:</strong></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> To investigate whether a physical therapist trained through the Mechanical Diagnosis and Therapy (MDT) diploma program could guess psychological Patient Reported Outcome Measure (PROM) scores of individuals with low back pain (LBP) by taking patient history and completing a physical evaluation.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods: </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Ten participants with LBP completed PROMs immediately before history taking and again after a physical evaluation. PROMs included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Hospital Anxiety and Depression Scale, and Pain Coping Strategy Questionnaire. A physical therapist who completed the MDT diploma program took the patients’ history and completed their physical evaluation. The therapist completed the same PROMs immediately after both history taking and physical evaluation. Correlations between patient and therapist scores were calculated using Spearman’s </span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Statistically significant positive correlations were detected in </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">the PCS (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.65) and TSK (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.78) before history taking, and in the PCS (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.81) and TSK (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.74) after physical evaluation.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Discussion: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The results are based on one MDT therapist and generalizability of the findings is limited. However, the current preliminary findings justify the need for further studies to explore effective post-graduate training to promote a patient centered approach.</span></span></span>展开更多
文摘Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of Mechanical Diagnosis and Therapy (MDT);2) balance of biomedical and behavioral (i.e. biopsychosocial) oriented approach for low back pain (LBP);3) demographics;4) academic degree and 5) the attitude towards updating information for evidence-based clinical practice. Aim 2 was to investigate whether therapists credentialed in MDT (Cred.MDT) were more behavioral oriented and less biomedical oriented than general physical therapists. Summary of Background Data: LBP practice guidelines are not adhered to by every physical therapist. MDT is a behavioral modification approach. Thus, it was hypothesized that the Cred.MDT therapist was more behavioral oriented and more adherent to LBP practice guidelines compared with general physical therapists. Methods: One-hundred-twenty Cred.MDT therapists and 2000 general physical therapists in Japan were contacted. For regression modeling, the dependent variable was adherent to guidelines using a questionnaire with a vignette. Independent variables included balance of biomedical and behavioral perspectives for LBP using the Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT), demographics, academic degree and the attitude towards updatinginformation for evidence-based clinical practice. The ratio of the two mean scores of the biomedical and behavioral subscales in the PABS-PT was compared between the Cred.MDT therapist group and the general physical therapists group. Results: Data of 46 general physical therapists and 44 Cred.MDT therapists were available. The Cred.MDT therapist group was significantly (P < 0.05) more behavioral oriented and more adherent to LBP practice guidelines compared with the general physical therapist group. The regression indicated significance of the two predictors of adherence to guidelines, Cred.MDT (β = 0.58, P < 0.001) and academic degree (β = 0.19, P = 0.03). Conclusions: Cred.MDT therapists are more guideline-consistent and have a more biopsychosocial treatment orientation than general physical therapists in Japan.
文摘Relative flexibility between the hamstring and lumbar extensor muscles, which can be evaluated using lumbopelvic curvature during active knee extension in sitting, can sometimes be assessed in physical therapy. However, reliability for its quantitative measure has not been established yet and its establishment was the aim of the current study. Twenty-seven individuals with clinically tight hamstring muscles were recruited. On two separate sessions, the lumbopelvic curvature was evaluated in sitting when the right knee was moved from 90° flexion to 10° flexion on 15 occasions using a flexible ruler by two examiners on Day 1 and one on Day 2. Lines drawn tangential to the lumbopelvic curvature were traced at T12 and S2 vertebral levels and the angle between the two vertical lines was calculated. Using Day 1 data, the minimum number of repetitions and inter-examiner reliability were assessed. Inter-session reliability was also examined. As a result, there was no statistical difference (P?> 0.05) in the mean absolute difference between the mean value of N-1 and N repetitions (6 ≤ N ≤ 15) in the lumbopelvic curvature angle, indicating that five was considered the minimum number of repetitions. Intraclass correlation coefficient (ICC)(1, 5)?for the inter-session reliability and ICC(2, 5)?for the inter-examiner reliability was 0.97 and 0.93, respectively, indicating excellent reliability. The measure for the lumbopelvic curvature during active knee extension in sitting, which was established in the current study, will be a foundation for further research regarding the relative flexibility of the lumbar and adjunct regions.
文摘In a previous study, we established reliability of a method for determining the angle of lumbopelvic sagittal alignment during active knee extension in sitting (AKEiS) using a flexible ruler and image analysis software (2-point-Method). In addition to this method, a flexible ruler can also be used to measure lumbopelvic sagittal alignment without image analysis software. This study primarily aimed to investigate the minimum number of repetitions, inter-session reliability and inter-examiner reliability of two alternative methods of measurement in a secondary analysis of our previous study. A flexible ruler was used to measure lumbopelvic curvature during AKEiS when the knee reached 10° flexion from 27 individuals with clinically tight hamstring muscles and subsequently analyzed. Lumbopelvic sagittal alignment was evaluated for the region between T12 and S2 using the maximum depth to the curvature (Max-Method) or depth to the curvature at the middle point between T12 and S2 vertebral levels (Mid-Method). It was determined that four repetitions for the Max-Method and 11 repetitions for the Mid-Method were required for the minimum number of repetitions, respectively. Inter-session reliability and inter-examiner reliability were assessed using Intraclass Correlation Coefficients and were 0.91 and 0.91 for the Max-Method and 0.90 and 0.91 for the Mid-Method, respectively. The current study suggests that the Mid-Method would not be recommended for use in the clinical setting as 11 repetitions of data sampling is required. The 2-point-Method or Max-Method may be promising but the ideal measurement method will be identified when the validity of these methods has been established.
文摘<span style="font-family:Verdana;"><strong>Objective:</strong></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> To investigate whether a physical therapist trained through the Mechanical Diagnosis and Therapy (MDT) diploma program could guess psychological Patient Reported Outcome Measure (PROM) scores of individuals with low back pain (LBP) by taking patient history and completing a physical evaluation.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods: </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Ten participants with LBP completed PROMs immediately before history taking and again after a physical evaluation. PROMs included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Hospital Anxiety and Depression Scale, and Pain Coping Strategy Questionnaire. A physical therapist who completed the MDT diploma program took the patients’ history and completed their physical evaluation. The therapist completed the same PROMs immediately after both history taking and physical evaluation. Correlations between patient and therapist scores were calculated using Spearman’s </span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Statistically significant positive correlations were detected in </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">the PCS (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.65) and TSK (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.78) before history taking, and in the PCS (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.81) and TSK (</span><i><span style="font-family:Verdana;">ρ</span></i><span style="font-family:Verdana;"> = 0.74) after physical evaluation.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Discussion: </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The results are based on one MDT therapist and generalizability of the findings is limited. However, the current preliminary findings justify the need for further studies to explore effective post-graduate training to promote a patient centered approach.</span></span></span>
