Nature of clinical practice for specialists in orthopaedic physical therapy.

Clinical specialization is part of physical therapy's continued development as a profession. Clinical specialization in physical therapy has evolved with little discussion of how specialization is related to the development of professional expertise. The purposes of this paper were to compare the identified clinical competencies in orthopaedic physical therapy to selected clinical reasoning models and expertise development models in physical therapy and interpret these comparisons in light of current theoretical work in expertise. Descriptive content analysis using results from the 1993 Practice Analysis for Orthopaedic Physical Therapy Certified Specialists was done to link attributes identified in 3 selected theoretical models of clinical decision making and practice. Survey materials were linked to theories by use of a binary index (yes/no) of whether theoretical concepts were present or absent in the survey results. The attributes that characterize an expert physical therapy practitioner involve clinical reasoning, and the ability to teach patients. The skills of a master clinician were based not just on the application of knowledge, but also on thinking and reasoning that occurs with experience. We propose that knowledge is gained through the clinician's thinking and reasoning during practice which results in a transformation or change in the clinician's knowledge base. Describing the clinical specialization process in the context of expert theory provides a strong foundation for the specialization process in physical therapy.

Practice analysis survey: revalidation of advanced clinical practice in orthopaedic physical therapy.

The first orthopaedic physical therapy practice analysis survey was completed in 1983. Another practice analysis survey was conducted in 1993 to identify the advance practice of clinicians who practice in orthopaedic physical therapy settings. Since 10 years elapsed, a new practice analysis study was conducted to identify the practice of orthopaedic clinical specialists. The purpose of this report is to describe the results of this survey. Orthopaedic physical therapists, both specialists and nonspecialists, participated in group interviews, subject matter expert meetings, and a national practice survey to delineate important knowledges and responsibilities. The survey was.sent to a stratified convenience sample of 1,000 orthopaedic physical therapists, of which 325 were orthopaedic clinical specialists. The three-part survey contained 180 items. A total of 420 respondents, of which 241 were orthopaedic clinical specialists, rated the importance and application level for the items. The results of this study provide evidence for a core body of knowledge required by clinicians practicing with advanced skills in orthopaedic physical therapy and create the framework for the Orthopaedic Physical Therapy Specialty Exam.

Effects of exercise on hip range of motion, trunk muscle performance, and gait economy.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to examine the effects of a passive hip extension stretching exercise program on hip extension range of motion (ROM), (2) to examine the effects of a trunk flexor exercise program on trunk flexor muscle performance, and (3) to examine the effects of passive hip extension stretching or trunk flexor exercises on walking and running economy. ("Gait economy" is defined as the steady-state oxygen consumption per unit of body weight required to walk or run at a specified velocity.) SUBJECTS: Twenty-five healthy, athletic, male college students (mean age = 21 years, mean weight = 75 kg, mean height = 172 cm) were randomly assigned to one of three groups: a control group (n = 7), a hip extension stretching group (n = 9), or a trunk flexor exercise group (n = 9). METHODS: Before and after 3 weeks of intervention, the following measurements were obtained: right and left hip extension ROM, trunk flexor muscle performance, and walking and running economy. A three x two-way (groups x test sessions) analysis of variance (ANOVA) for repeated measures for unequal subject numbers was performed on each of the five dependent measures, with analysis of simple main effects applied when significant interactions were found. RESULTS: The ANOVA on right and left hip extension ROM revealed a significant interaction. Analyses of simple main effects showed that 3 weeks (six sessions) of passive hip extension stretching significantly improved right hip extension ROM (pretest = -20.4 degrees, posttest = -8.3 degrees) and left hip extension ROM (pretest = -16.8 degrees, posttest = -7.0 degrees). There also was a significant interaction for trunk flexor muscle performance. The analysis of simple main effects revealed that 3 weeks of daily trunk flexor exercises significantly improved trunk flexor muscle performance (pretest = 41.5 degrees, posttest = 60.4 degrees). The 3-week intervention program of hip extension stretching or trunk flexion exercises, however, did not produce significant changes in walking or running economy. CONCLUSION AND DISCUSSION: The results suggest that (1) six treatment sessions of passive stretching were sufficient to improve hip extension ROM; (2) 3 weeks of exercises performed daily improved trunk flexor muscle performance; and (3) training of isolated tasks, such as hip flexibility or trunk strengthening activities, did not produce the desired outcome in the economy of walking or running. Possible reasons for the results are discussed.

Relationship between Hip Extension Range of Motion and Postural Alignment.

The purpose of this study was to examine the relationships between hip extension range of motion (ROM) and three determinants of postural alignment: standing pelvic tilt, standing lumbar lordosis, and abdominal muscle performance. The subjects were 25 healthy adults ranging in age from 21 to 49 years. The Pearson product-moment correlation of hip extension ROM with pelvic tilt was -0.04, with lumbar lordosis -0.09, and with abdominal muscle performance 0.09. These results indicate that these variables are not related. This study demonstrates that the hypothetical correlation among these clinical parameters needs to be reassessed. J Orthop Sports Phys Ther 1990;12(6):243-247.

The effects of two stretching procedures on hip range of motion and gait economy.

The purpose of this study was to 1) compare two commonly practiced stretching techniques to determine which is most effective for improving hip range of motion, and 2) evaluate the effect of these techniques on gait economy. Seven asymptomatic males, 18-22 years of age, served as subjects. Goniometric measurements of hip range of motion (ROM) and gait economy, as measured by submaximal oxygen consumption of walking and running on a treadmill, were taken before and after each of the two stretching procedures, (a) static stretching, and (b) soft tissue mobilization with proprioceptive neuromuscular facilitation (STM/PNF). Static stretching procedures resulted in significant improvements in ROM for hip extension (p < 0.01) and hip flexion (p < 0.01). The STM/PNF also resulted in significant improvements in hip extension ROM (p < 0.01) and hip flexion ROM (p < 0.05). There was a significant improvement in gait economy at 40% VO2max (p < 0.05), at 60% VO2max (p < 0.05), and at 80% VO2max (p < 0.01) following the static stretching procedure. The STM/PNF procedure improved gait economy only at one workload, 60% of VO2max (p < 0.05). These results suggest that a single bout of static stretching or STM/PNF was effective for improving hip ROM but static stretching was more effective for improving gait economy in young, asymptomatic males. J Orthop Sports Phys Ther 1989;10(9):350-357.