Augmented home exercise program for a 37-year-old female with a clinical presentation of femoroacetabular impingement.

Previous researchers have reported on the use of augmented home exercise programs with potential carry-over effects from manual therapy treatment. While there is no direct evidence to support augmented manual therapy, tangential evidence demonstrates that specific, supervised, and adherent exercises result in improved outcomes. The purpose of this case report is to describe an augmented home program simulating the manual techniques provided by the therapist. A 37-year-old female presented with symptoms and signs consistent with femoroacetabular impingement (FAI). Grade III lateral and inferior femoral glides decreased reported pain from 5/10 to 0/10. Given the immediate response to hip mobilizations, the patient was prescribed standing lateral glides and supine inferior glides of the hip with the use of a belt. During this time, the patient's Lower Extremity Functional Scale score improved from 74 to 78 and she reported increased ability to self-manage her symptoms. The immediate report of decreased pain helped determine the specific home program selected for this individual patient. This case highlights the importance of a specific augmented home exercise program unique to the individual patient resulting in self-management of pain associated with FAI.

Development of a Quality Checklist Using Delphi Methods for Prescriptive Clinical Prediction Rules: the QUADCPR.

OBJECTIVE: Clinical prediction rules (CPRs) are clinician decision-making aids designed to improve the accuracy of a variety of decisions made during patient care. To our knowledge, there are no formally developed consensus-based guidelines designed to provide standards for the creation of CPRs. METHODS: The study used a 3-round Delphi method for consensus of a quality checklist initially developed based on recommendations derived from the literature. The 9 Delphi participants were randomly selected from the authors of peer-reviewed publications of prescriptive CPRs. RESULTS: During the 3 rounds, the Delphi participants modified the originally derived checklist and, based on a consensus standard, agreed upon a final 23-item checklist, which involved 4 constructs: (1) sample and participants, (2) outcome measures, (3) quality of tests and measures, and (4) statistical assumptions. CONCLUSIONS: Use of the checklist has potential for improving the design and reporting of future prescriptive CPRs.

Coupling behavior of the cervical spine: a systematic review of the literature.

OBJECTIVE: The purpose of this study was to investigate evidence of consistency of reported directional coupling patterns among selected studies and to determine its use in manual medical treatment. METHODS: The study was a systematic literature review of English-only journals using PubMed and CINAHL. The keywords included "cervical vertebrae," "biomechanics," "coupling," and "three-dimensional movement" and required coupling directional assessment of individual spine segments. RESULTS: Four 2-dimensional and 8 3-dimensional studies met inclusion criteria. This study found 100% agreement in coupling direction (side flexion and rotation to the same side) in lower cervical vertebral segments (C2-3 and lower) and variation in coupling patterns in the upper cervical segments of occiput-C1 (during side flexion initiation) and C1-2. Dissimilarities may be explained by differences in measurement devices, movement initiation, in vivo vs in vitro specimens, and anatomical variations. CONCLUSIONS: These findings suggest that use of 3-dimensional analyzed cervical coupling patterns for the lower cervical vertebral during apposition and treatment application may show clinical use for manual clinicians. The use of directional coupling based on 2-dimensional cervical coupling patterns or upper cervical spine coupling that addresses C1-2 should be questioned.