Student Physical Therapists' Competence and Self-Confidence in Basic Clinical Assessment and Musculoskeletal Differential Diagnosis.

UNLABELLED: Student physical therapists are expected to learn and confidently perform technical skills while integrating nontechnical behavioral and cognitive skills in their examinations and interventions. OBJECTIVE: The purpose of this study was to compare the self-confidence of entry-level doctoral student physical therapists during foundational assessment and musculoskeletal differential diagnosis courses and the students' competencies based on skills examinations. DESIGN: Methods using qualitative and quantitative procedures. METHODS: Student physical therapists (n=27) participated in a basic assessment course followed by a musculoskeletal differential diagnosis course. The students completed confidence surveys prior to skills examinations in both courses. A random sample of students participated in focus groups, led by a researcher outside the physical therapy department. RESULTS: Student confidence did not correlate with competency scores. At the end of the basic clinical assessment course and the beginning of the differential diagnosis course, students' confidence was significantly below baseline. However, by the end of the differential diagnosis course, student confidence had returned to original baseline levels. CONCLUSIONS: Over three semesters, the students lost confidence and then regained confidence in their abilities. Additional experience and practice influenced perceived confidence. However, increased competence may have been associated with poor self-appraisal skills instead of increased competency.

Home health physical therapy intervention for an adolescent after intramedullary skeletal kinetic distractor limb-lengthening surgery: a case report.

UNLABELLED: This case report describes the physical therapy episode of care for an adolescent following surgical placement of an intramedullary skeletal kinetic distractor (ISKD) to minimize a leg-length discrepancy (LLD). METHODS: A 14-year-old female was referred to home health physical therapy 2 weeks after ISKD placement in her right femur. The initial evaluation revealed the need to instruct in ISKD limb-lengthening exercises, strength, flexibility, and endurance exercises and provide functional mobility training. RESULTS: The patient received nine treatments over 8 weeks. Her right femur length increased by 4 cm. Improvements occurred with functional mobility, the Bruinincks-Oseretsky Test of Motor Proficiency, and the Pediatric Evaluation of Disability Inventory. DISCUSSION: Home health physical therapy assisted this patient with reducing her LLD and improving her functional mobility. Further research is needed to identify the effectiveness of physical therapy interventions on functional mobility for adolescents after ISKD placements.

Diagnosis and treatment of a patient with bilateral thoracic outlet syndrome secondary to anterior subluxation of bilateral sternoclavicular joints: a case report.

Thoracic outlet syndrome may result from a posterior sternoclavicular (SC) joint subluxation, or an anterior SC joint subluxation after surgical fixation. This case report presents the physical therapy management of a patient with bilateral thoracic outlet syndrome (TOS) secondary to bilateral idiopathic anterior SC joint subluxation. A 16-year-old female presented with a 2-year history of numbness, tingling, and coldness in bilateral upper extremities, and intermittent headaches with occasional vision loss. Ipsilateral upper extremity symptoms were reproduced with cervical rotation and shoulder flexion and abduction from 90° to end of the range. All TOS tests were positive. Passive horizontal abduction, through the plane of scaption, produced anterior subluxation of the ipsilateral SC joint. Sustained posterior glides to the medial clavicle relieved all symptoms during shoulder flexion and the Adson's test. Interventions consisted of manual therapy, therapeutic exercise, and the trial of two orthoses. After 12 treatment sessions, the patient's symptoms resolved and she improved by 10 points on the Upper Extremity Functional Index. She had no reproduction of symptoms with the thoracic outlet special tests. She maintained a static hold for 90 sec at 90° shoulder flexion, 90° shoulder abduction, and full shoulder flexion without symptoms. The outcomes describe a successful intervention for a patient with bilateral TOS secondary to idiopathic bilateral anterior SC joint subluxation. This case suggests that SC joint dysfunction should be considered as a cause of TOS and should be screened during the initial examination.

Impact of patient and caregiver transfer training provided by a physical therapist in the hospice setting: a case study.

BACKGROUND: As patients in hospice become increasingly dependent upon caregivers, physical therapy interventions can minimize the risk of injury to the patient or caregiver that may occur during transfers between surfaces. CASE DESCRIPTION: A 68-year-old male hospice patient was referred to physical therapy for strengthening and transfer training after a fall that resulted in the patient remaining in bed for 5 weeks due to an increased fear of falling. Treatments focused on caregiver training for correct transfer techniques. OUTCOME: During 10 treatment sessions, the patient and caregiver became independent and safe with all transfers. Although the patient's health declined, his risk for and fear of falling decreased. Confidence with transfers improved for the patient and caregiver. DISCUSSION: Physical therapy "benefits were immeasurable" for the patient and caregiver by teaching them how to safely perform patient transfers with reduced risk of injury.

Use of pulsed shortwave diathermy and joint mobilization to increase ankle range of motion in the presence of surgical implanted metal: A case series.

STUDY DESIGN: Case series. BACKGROUND: Traditionally, all forms of diathermy have been contraindicated over metal implants. There is a lack of research-based evidence for harm regarding the use of pulsed shortwave diathermy (PSWD) over orthopedic metal implants. Because PSWD is an effective modality for deep heating, we investigated whether ankle range of motion (ROM) could improve with the cautious use of PSWD and joint mobilizations, despite orthopedic metal implants being in the treatment field. CASE DESCRIPTIONS: Four subjects presented with decreased ankle ROM due to extensive fractures from traumatic injuries. All subjects were postsurgical, with several internal fixation devices. Subjects previously received rehabilitation therapy involving joint mobilizations, therapeutic exercises, moist heat, and ice, but continued to lack 15 degrees to 23 degrees of ankle dorsiflexion. The Human Subjects Review Board of Brigham Young University approved the methods of this case series. Subjects gave written informed consent. Initial dorsiflexion active ROM for each patient was -3 degrees, 0 degrees, 8 degrees, and 5 degrees, respectively. Treatment regime consisted of PSWD to the ankle for 20 minutes at 27.12 MHz, 800 pps, 400 microseconds (48 W). Immediately after PSWD, mobilizations were administered to the joints of the ankle and foot. Ice was applied posttreatment. OUTCOMES: Dorsiflexion improved 15 degrees, 15 degrees, 10 degrees, and 14 degrees, respectively, after 8 or 13 visits. All patients returned to normal activities with functional ROM in all planes. Follow-up 4 to 6 weeks later indicated that the subjects maintained 78% to 100% of their dorsiflexion. No discomfort, pain, or burning was reported during or after treatment. No negative effects were reported during the short-term follow-up. DISCUSSION: When applied with appropriate caution, we propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints, despite implanted metal. We continue to advise caution when applying diathermy with machines other than the Megapulse II. Further research is needed to determine the safety parameters of other diathermy machines. As a final caution, we advise that diathermy not be used in the presence of a cardiac pacemaker or neurostimulator.