Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain.

OBJECTIVES: Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting. METHODS: The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists' (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists' clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses. RESULTS: The percentage of agreement between the experts and PTs was 72-77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0.63 [95% confidence interval (CI): 0.47-0.77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0.63 (0.49-0.77) indicating good level of agreement. DISCUSSION: Our results indicate that PTs' were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP.

Generation and Characterization of iPS Cells Derived from APECED Patients for Gene Correction.

APECED (Autoimmune-Polyendocrinopathy-Candidiasis-Ectodermal-Dystrophy) is a severe and incurable multiorgan autoimmune disease caused by mutations in the AIRE (autoimmune regulator) gene. Without functional AIRE, the development of central and peripheral immune tolerance is severely impaired allowing the accumulation of autoreactive immune cells in the periphery. This leads to multiple endocrine and non-endocrine autoimmune disorders and mucocutaneous candidiasis in APECED patients. Recent studies have suggested that AIRE also has novel functions in stem cells and contributes to the regulatory network of pluripotency. In preparation of therapeutic gene correction, we generated and assessed patient blood cell-derived iPSCs, potentially suitable for cell therapy in APECED. Here, we describe APECED-patient derived iPSCs's properties, expression of AIRE as well as classical stem cell markers by qPCR and immunocytochemistry. We further generated self-aggregated EBs of the iPSCs. We show that APECED patient-derived iPSCs and EBs do not have any major proliferative or apoptotic defects and that they express all the classical pluripotency markers similarly to healthy person iPSCs. The results suggest that the common AIRE R257X truncation mutation does not affect stem cell properties and that APECED iPSCs can be propagated in vitro and used for subsequent gene-correction. This first study on APECED patient-derived iPSCs validates their pluripotency and confirms their ability for differentiation and potential therapeutic use.

Clinical perspective: how do clinical test results differentiate chronic and subacute low back pain patients from "non-patients"?

Our limited understanding of underlying conditions for back pain is reflected in the common use of pain-duration-based groupings. The aim of this paper was to investigate typical clinical tests used in examining low back pain (LBP) patients in order to discover how tests distinguish between chronic low back pain patients (CLBP) and subacute low back pain patients (SLBP) and if they distinguish these groups from those with no "patient status." CLBP patients in this study were from a university hospital and SLBP patients were from five occupational health care centers. Control subjects were recruited from a university. Determination of the best predictors between CLBP and SLBP patients and between CLBP and SLBP patients and non-patients was made by a forward stepwise logistic model. A total of 157 subjects were included in the study. Of all the clinical tests, several tests in each category had high odds ratio, differentiating CLBP patients from controls. Only a few tests differentiated between CLBP and SLBP patients. The only clinical differences between SLBP patients and controls were in the mobility test and in one test of muscle tightness. The best predictor for CLBP was the lumbar spine flexion test. SLBP patients seemed to differ from the control group in lumbar flexion, in a specific anterior-posterior mobility test, and in tightness of hip flexor muscles. CLBP patients differed from SLBP patients in functional tests, in the presence of sensation in the feet, and in different pain provocation tests. Whether these tests are sufficiently sensitive to classify a more specific diagnostic or clinical subgroup remains untested, and further studies with clinical tests to differentiate among pathological conditions are necessary.