Physical therapy
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A survey of expert orthopedic physical therapists was conducted to assist in the development of a classification system for patients with low back pain (LBP). The goal of the survey was to measure levels of agreement on labels and accompanying constellations of signs and symptoms for subgroups of patients with LBP. ⋯ The importance of developing homogeneous subgroups of patients with LBP based on constellations of reliable clinical findings is emphasized.
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Comparative Study
Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension.
The primary purpose of this study was to determine the reliability of lumbar flexion and extension range-of-motion measurements obtained with the modified-modified Schöber and the double inclinometer methods on subjects with low back pain. ⋯ The modified-modified Schöber method thus appears to be a reliable method for measuring lumbar flexion and extension for patients with low back pain, whereas the double inclinometer technique needs improvement.
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Clinical reasoning refers to the cognitive process or thinking used in the evaluation and management of a patient. In this article, clinical reasoning research and expert-novice studies are examined to provide insight into the growing understanding of clinical reasoning and the nature of expertise. Although hypothetico-deductive methods of reasoning are used by clinicians at all levels of experience, experts appear to possess a superior organization of knowledge. ⋯ Five categories of hypotheses are proposed for physical therapists using a hypothetico-deductive method of clinical reasoning. A model of the clinical reasoning process for physical therapists is presented to bring attention to the hypothesis generation, testing, and modification that I feel should take place through all aspects of the patient encounter. Examples of common errors in clinical reasoning are highlighted, and suggestions for facilitating clinical reasoning in our students are made.
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This case report describes the treatment of a patient who had symptoms and signs suggestive of a sacroiliac joint component of low back pain. The patient developed right-sided low back pain without provocation. ⋯ After treating the sacroiliac joint and restoring symmetrical hip rotation, the patient no longer complained of low back pain. This case report suggests that asymmetrical hip rotation may contribute to what is often called a sacroiliac joint component of low back pain.
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The purpose of this study was to explore the effect of various combinations of burst and carrier frequencies of neuromuscular electrical stimulation (NMES) on subjects' perception of pain intensity associated with induction of high intensity muscle contractions. Twenty-seven healthy volunteers completed the study. ⋯ The combinations of burst frequencies (50, 70, and 90 bps) and carrier frequencies (2,500 and 5,000 Hz) do not differ from each other in perceived pain intensity but do differ significantly in perceived pain from the combinations of burst frequencies at the carrier frequency of 10,000 Hz. Thus, the clinician may have to try different stimulus combinations on patients at different current training levels to obtain the least individually perceived pain.