Physical therapy
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The purposes of this article are to introduce the reader to patient-controlled analgesia (PCA) and to summarize its use in several selected pain-related conditions. patient-controlled analgesia is a relatively new technique for managing pain in which patients are able to self-administer small doses of opioid analgesic medications when needed. The authors briefly review some of the problems associated with current and previous opioid delivery strategies and highlight the advantages of PCA over these other methods. They then discuss the components of the PCA system and briefly describe how the system is operated and controlled. ⋯ The authors close with a brief summary of several reports describing the use of PCA in the management of postoperative pain, cancer pain, and pain associated with labor and delivery. Indications and contraindications for use in these conditions are presented. Because physical therapists often play a major role in pain management, it is important for them to be well informed with regard to recent developments in this rapidly developing area of clinical practice.
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Review
Biobehavioral factors affecting pain and disability in low back pain: mechanisms and assessment.
Patients with recurrent or persistent low back pain (LBP) and disability represent a formidable challenge to physical therapists. Classic models of disease and pain mechanisms do not adequately explain the commonly observed discrepancies between the extent of pathology and reported pain, or the level of pain and disability. Research over the past decade that considers the interactive role of biological, environmental, and psychological processes in pain and disability has supported the involvement of a number of biobehavioral factors in these conditions. ⋯ Despite this recognition, little information is available that translates the implications of this research to direct care within physical therapy practice. The purposes of this article are (1) to provide an operational definition of biobehavioral factors; (2) to review the role of these factors in the clinical presentation of LBP, functional limitation, and disability; (3) to identify commonly used approaches for their recognition and quantification; (4) to illustrate how an understanding of biobehavioral factors can assist the physical therapist in evaluation and treatment of patients with LBP; and (5) to identify certain gaps in current knowledge of the role of biobehavioral factors and their application in physical therapy. Given the central role assumed by many physical therapists in the management of LBP, acknowledging and addressing these factors in clinical practice should assist in the prevention of chronic LBP and disability, as well as potentially improve physical therapy interventions and management.
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The efficacy of a physical therapy outpatient program with multiple interventions to treat low back pain in subjects receiving workers' compensation was examined. The primary purpose of the study was to describe the level of disability, physical impairment, and rate of return to work for compensated patients. ⋯ Compliance, chronicity, and leg symptoms are all factors that can affect the outcome of physical therapy. The positive outcomes for subjects who complied with therapy suggest that a physical therapy program with multiple interventions may decrease disability and impairment.
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This case report presents a patient who developed right shoulder pain following strenuous upper-extremity exercise. Approximately 6 weeks later his pain resolved, he noticed persistent right upper-extremity weakness. He was referred to physical therapy for evaluation and treatment. ⋯ A case is presented, illustrating how the clinical decision making is based on the pathokinesiology and pathophysiology. The patient was followed over the course of 17 months and has recovered full right shoulder active range of motion. His serratus anterior muscle strength has increased to Good minus, and he reports significantly improved functional use of the upper extremity.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.
Electrical stimulation has been shown to be effective in aiding the recovery of quadriceps femoris muscle force production after anterior cruciate ligament reconstruction. The actual dosage of stimulation (training intensity) has not been well described. The purpose of this investigation was to establish a dose-response curve for electrical stimulation regimens designed to improve quadriceps femoris muscle recovery in patients after anterior cruciate ligament reconstruction. ⋯ These results support the use of high-intensity electrical stimulation and do not support the use of low-intensity or battery-powered stimulators when the goal is recovery of quadriceps femoris muscle force production in the early phases of rehabilitation after anterior cruciate ligament surgery. [Snyder-Mackler L, Delitto A, Stralka SW, Bailey SL. Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.