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1.
J Orthop Sports Phys Ther ; 51(2): CPG1-CPG81, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33522384

RESUMO

Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.

3.
Phys Ther ; 100(10): 1862-1871, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32949237

RESUMO

OBJECTIVE: Although Medicare assessment files will include Standardized Patient Assessment Data Elements from 2016 forward, lack of uniformity of functional data prior to 2016 impedes longitudinal research. The purpose of this study was to create crosswalks for postacute care assessment measures and the basic mobility and daily activities scales of the Activity Measure for Post-Acute Care (AM-PAC) and to test their accuracy and validity in development and validation datasets. METHODS: This cross-sectional study is a secondary analysis of AM-PAC, the Inpatient Rehabilitation Facility Patient Assessment Instrument, the Minimum Data Set, and the Outcome and Assessment Information Set data from 300 adults receiving rehabilitation recruited from 6 health care networks in 1 metropolitan area. Rasch analysis was used to co-calibrate items from the 3 measures onto the AM-PAC metric and to create look-up tables to create estimated AM-PAC (eAM-PAC) scores. Mean scores and correlation and agreement between actual and estimated scores were examined in the development dataset. Scores were estimated in a cohort of Medicare beneficiaries with hip, humerus and radius fractures. Correlations between eAM-PAC and Functional Independence Measure motor scores were examined. Differences in mean eAM-PAC scores were evaluated across groups of known differences (age, fracture type, dementia). RESULTS: Strong correlations were found between actual and eAM-PAC scores in the development dataset. Moderate to strong correlations were found between the eAM-PAC basic mobility and Functional Independence Measure motor scores in the validation dataset. Differences in basic mobility scores across known groups were statistically significant and appeared to be clinically important. Differences between mean daily activities scores were statistically significant but appeared not to be clinically important. CONCLUSION: Although further testing is warranted, the basic mobility crosswalk appears to provide valid scores for aggregate analysis of Medicare postacute care data. IMPACT: This study reports on a method to take data from different Medicare administrative data sources and estimate scores on 1 scale. This approach was applied separately for data related to basic mobility and to daily activities. This may allow researchers to overcome challenges with using Medicare administrative data from different sources.


Assuntos
Pessoas com Deficiência/reabilitação , Cuidados Semi-Intensivos/métodos , Inquéritos e Questionários/normas , Atividades Cotidianas , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Psicometria/estatística & dados numéricos , Recuperação de Função Fisiológica , Estados Unidos , Caminhada
4.
Arch Phys Med Rehabil ; 101(8): 1407-1413, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32437688

RESUMO

OBJECTIVE: To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain. DESIGN: Retrospective cohort study. SETTING: Marketscan research databases. PARTICIPANTS: Patients (N=427,966) with new-onset neck pain from 2010-2014. MAIN OUTCOME MEASURES: Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings. RESULTS: Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription in the first 30 days, and between 41%-87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47-3.69; P<.001). CONCLUSIONS: A patient's initial clinical contact for neck pain may be an important opportunity to influence subsequent opioid use. Understanding more about the roles that conservative therapists play in the treatment of neck pain may be key in unlocking new ways to lessen the burden of opioid use in the United States.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Cervicalgia/tratamento farmacológico , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Terapia por Acupuntura/estatística & dados numéricos , Adulto , Quiroprática/estatística & dados numéricos , Bases de Dados Factuais , Medicina de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/terapia , Neurologia/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos
5.
Phys Ther ; 100(7): 1153-1162, 2020 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31998949

RESUMO

BACKGROUND: Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. OBJECTIVE: The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy. DESIGN: This was a multi-center, pragmatic, randomized, comparative effectiveness trial. SETTING: Treatment took place within 8 outpatient physical therapy clinics. PATIENTS: This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training. INTERVENTION: This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. MEASUREMENTS: Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year.A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months but no significant reduction when viewed over the entire first year. LIMITATIONS: The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. CONCLUSION: The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.


Assuntos
Acidentes por Quedas , Terapia por Exercício/estatística & dados numéricos , Marcha/fisiologia , Modalidades de Fisioterapia , Equilíbrio Postural/fisiologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino
6.
J Bone Joint Surg Am ; 102(8): 703-718, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31977822

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction incidence has increased substantially in the past 25 years. Recently, there has been a focus on knee morphology as a contributor to ACL injury risk. The purpose of this study was to systematically review the literature to assess the influence of knee morphology on ACL injury. METHODS: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, and MEDLINE were searched in September 2017 for studies reporting on knee morphology and ACL injury. The search was updated in June 2018. The following inclusion criteria were used: English language; full text available; Level-I, II, or III evidence; human studies; and skeletally mature patients. RESULTS: After systematically screening 6,208 studies, 65 studies met the inclusion/exclusion criteria. Three additional studies were identified in the search update, for a total of 68 studies comprising 5,834 ACL-injured knees. Intercondylar notch stenosis, most commonly defined by an "A-shaped" notch, decreased notch width, or decreased notch width index, was the most commonly reported femoral morphological risk factor for ACL injury. Increased femoral condylar offset ratio (>63%) and decreased condylar radius of curvature also were associated with an increased risk of ACL injury. Increased medial and lateral tibial slopes were the most commonly reported tibial risk factors. A smaller tibial eminence, reduced ACL size, and poor tibiofemoral congruity were also associated with increased injury risk. CONCLUSIONS: Intercondylar notch stenosis, variations in sagittal condylar shape, increased tibial slope, reduced tibial eminence size, poor tibiofemoral congruity, and reduced ACL size are substantial risk factors for ACL injury. In future research, it would be valuable to identify a slope beyond which slope correction should be performed concomitantly with ACL reconstruction, and to determine whether an optimal relationship of notch size to graft size exists. To achieve optimal outcomes, the osseous morphological risk factors should be considered in individualized anatomic ACL reconstructions. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Lesões do Ligamento Cruzado Anterior/etiologia , Articulação do Joelho/anatomia & histologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Humanos , Fatores de Risco
7.
Phys Ther ; 100(1): 107-115, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31665461

RESUMO

BACKGROUND: Low back pain (LBP) is one of the most prevalent conditions for which patients seek physical therapy in the United States. The American Physical Therapy Association categorizes direct access to physical therapist services into 3 levels: limited, provisional, and unrestricted. OBJECTIVE: The objective of this study was to evaluate the association of level of access to physical therapist services with LBP-related health care utilization and costs. DESIGN: This was a retrospective cohort study of patients with new-onset LBP between 2008 and 2013; data were from OptumLabs Data Warehouse. METHODS: We identified 59,670 individuals who were 18 years old or older, who had new-onset LBP, and who had commercial or Medicare Advantage insurance through a private health plan. We examined 2 samples. The first was health care utilization among individuals who saw a physical therapist first in states with either unrestricted access or provisional access. The second was LBP-related costs among individuals who saw either a physical therapist or a primary care physician first. RESULTS: Individuals who saw a physical therapist first in states with provisional access had significantly higher measures of health care utilization within 30 days, including plain imaging and frequency of physician visits, than individuals who saw a physical therapist first in states with unrestricted access. Compared with individuals who saw a primary care physician first, pooled across provisional-access and unrestricted-access states, those who saw a physical therapist first in provisional-access states had 25% higher relative costs at 30 days and 32% higher relative costs at 90 days, whereas those who saw a physical therapist first in unrestricted-access states had 13% lower costs at 30 days and 32% lower costs at 90 days. LIMITATIONS: This was a claims-based study with limited information on patient characteristics, including severity and duration of pain. CONCLUSIONS: Short-term LBP-related health care utilization and costs were lower for individuals in unrestricted-access states than in provisional-access states.


Assuntos
Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde , Dor Lombar/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde , Modalidades de Fisioterapia , Adulto , Idoso , Algoritmos , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro , Masculino , Medicare , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Modalidades de Fisioterapia/economia , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos
8.
J Orthop Sports Phys Ther ; 49(9): CPG1-CPG95, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31475628

RESUMO

Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running). Symptoms can restrict participation in physical activity, sports, and work, as well as recur and persist for years. This clinical practice guideline will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.


Assuntos
Síndrome da Dor Patelofemoral/diagnóstico , Síndrome da Dor Patelofemoral/fisiopatologia , Síndrome da Dor Patelofemoral/terapia , Modalidades de Fisioterapia , Humanos , Exame Físico
9.
J Am Med Dir Assoc ; 20(3): 298-304, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824217

RESUMO

OBJECTIVES: Fractures of the hip, distal radius, and proximal humerus are common in the Medicare population. This study's objective was to characterize patterns and duration of opioid use, including regional variations in use, after both surgical and nonoperative management. DESIGN: Population-based cohort study. SETTING AND PARTICIPANTS: A cohort of opioid-naïve community-dwelling US Medicare beneficiaries who survived a hip, distal radius, or proximal humerus fracture between January 1, 2007 and December 31, 2010. Cohort members were required to be opioid-naïve for 4 months prior to fracture. MEASURES: We analyzed the proportion of patients with an active opioid prescription in each month following the index fracture, and report continued fills at 12 months postfracture. We also compared opioid prescription use in fractures treated surgically and nonsurgically and characterized state-level variation in opioid prescription use at 3 months postfracture. RESULTS: There were 91,749 patients included in the cohort. Hip fracture patients had the highest rate of opioid use at 12 months (6.4%), followed by proximal humerus (5.7%), and distal radius (3.7%). Patients who underwent surgical fixation of proximal humerus and wrist fractures had higher rates of opioid use in each of the first 12 postoperative months compared with those managed nonoperatively. There was significant variation of opioid use at the state level, ranging from 7.6% to 18.2% of fracture patients filling opioid prescriptions 3 months after the index fracture. CONCLUSIONS/IMPLICATIONS: Opioid-naïve patients sustaining fragility fractures of the hip, proximal humerus, or distal radius are at risk to remain on opioid medications 12 months after their index injury, and surgical management of proximal humerus and distal radius fractures increases opioid use in the 12 months after the index fracture. There is significant state-level variation in opiate consumption after index fracture in nonvertebral geriatric fragility fractures. Opportunity exists for targeted quality improvement efforts to reduce the variation in opioid use following common geriatric fragility fractures.


Assuntos
Analgésicos Opioides/administração & dosagem , Uso de Medicamentos , Fraturas por Osteoporose/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Estados Unidos
10.
Arch Phys Med Rehabil ; 100(8): 1442-1449, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30578775

RESUMO

OBJECTIVE: To assess psychometric properties of the improved Work Disability Functional Assessment Battery (WD-FAB 2.0). DESIGN: Longitudinal study. SETTING: Community. PARTICIPANTS: Three samples of working-age (21-66) adults (N=1006): (1) unable to work because of a physical condition (n=375); (2) unable to work because of a mental health condition (n=296); (3) general United States working age sample (n=335). INTERVENTION: NA. MAIN OUTCOME MEASURES: All samples completed the WD-FAB 2.0; the second administration came 5 days after the first. Construct validity was examined by convergent and divergent correlational analysis using legacy measures. Test-retest reliability was assessed by intraclass correlation coefficients (ICC3,1). Standard error of the mean (SEM) and minimal detectable change (MDC90) were calculated to measure scale precision and sensitivity. RESULTS: Physical function ICCs ranged from 0.69 to 0.77 in the general sample, and 0.66 to 0.86 in the disability sample. Mental health function scales ICCs ranged from 0.62 to 0.73 in the general sample, and 0.74 to 0.76 in the disability sample. SEMs for all scales indicated good discrimination; those for the physical function scales were generally lower than those for the mental health scales. MDC90 values ranged from 3.41 to 10.55. Correlations between all WD-FAB 2.0 scales and legacy measures were in the expected direction. CONCLUSIONS: The study provides substantial support for the reliability and construct validity of the WD-FAB 2.0 among 3 diverse samples. Although initially developed for use within the Social Security Administration (SSA), these results suggest that the WD-FAB 2.0 could be used for assessment and measurement of work-related physical and mental health function in other contexts as well.


Assuntos
Pessoas com Deficiência , Psicometria , Avaliação da Capacidade de Trabalho , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
11.
Neurotherapeutics ; 15(3): 669-683, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29987761

RESUMO

Neurological disorders, such as spinal cord injury, stroke, traumatic brain injury, cerebral palsy, and multiple sclerosis cause motor impairments that are a huge burden at the individual, family, and societal levels. Spinal reflex abnormalities contribute to these impairments. Spinal reflex measurements play important roles in characterizing and monitoring neurological disorders and their associated motor impairments, such as spasticity, which affects nearly half of those with neurological disorders. Spinal reflexes can also serve as therapeutic targets themselves. Operant conditioning protocols can target beneficial plasticity to key reflex pathways; they can thereby trigger wider plasticity that improves impaired motor skills, such as locomotion. These protocols may complement standard therapies such as locomotor training and enhance functional recovery. This paper reviews the value of spinal reflexes and the therapeutic promise of spinal reflex operant conditioning protocols; it also considers the complex process of translating this promise into clinical reality.


Assuntos
Condicionamento Operante/fisiologia , Reflexo/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Animais , Humanos , Plasticidade Neuronal/fisiologia
12.
J Orthop Sports Phys Ther ; 48(5): A1-A38, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29712543

RESUMO

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.


Assuntos
Tendão do Calcâneo , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Debilidade Muscular/etiologia , Dor/etiologia , Modalidades de Fisioterapia , Tendinopatia/diagnóstico , Tendinopatia/terapia , Tendão do Calcâneo/lesões , Traumatismos em Atletas/classificação , Árvores de Decisões , Diagnóstico Diferencial , Humanos , Educação de Pacientes como Assunto , Autorrelato , Tendinopatia/classificação , Tendinopatia/patologia , Resultado do Tratamento
13.
Arch Phys Med Rehabil ; 99(9): 1798-1804, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29752911

RESUMO

OBJECTIVE: To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE). DESIGN: Cross-sectional. SETTING: Outpatient rehabilitation. PARTICIPANTS: Adults (N=50) participating in physical therapy for musculoskeletal conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient's physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ability ratings in the Dynamic Strength, Position Tolerance, and Mobility subsections. RESULTS: Participating in the study were 50 patients with 1 or more conditions (shoulder, n=21; knee, n=16; low back, n=13; ankle/foot, n=10; neck, n=8; hip, n=7). The patient-based WD-FAB scores demonstrated moderate, statistically significant correlations with the provider proxy WD-FAB report (R=.49-.65). The WD-FAB Upper Body Function scale scores demonstrated moderate strength relationships with the PWPE overall ratings. The Whole Body Mobility and Changing and Maintaining Body Position scales did not demonstrate statistically significant relationships with the PWPE overall ratings. CONCLUSIONS: We found moderate evidence for validity for the WD-FAB Upper Body Function, Whole Body Mobility, and Changing and Maintaining Body Position scales relative to clinician report and varied evidence relative to the PWPE in this clinical sample.


Assuntos
Pessoas com Deficiência/reabilitação , Doenças Musculoesqueléticas/reabilitação , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Adulto , Estudos Transversais , Pessoas com Deficiência/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes
14.
Med Teach ; 40(12): 1264-1274, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29382270

RESUMO

PURPOSE: Addressing current healthcare challenges requires innovation and collaboration. Current literature provides limited guidance in promoting these skills in medical school. One approach involves transdisciplinary training in which students from different disciplines work together toward a shared goal. We assessed the need for such a curriculum at Dartmouth College. METHODS: We surveyed medical and engineering students' educational values; learning experiences; professional goals; and interest in transdisciplinary education and innovation. Data were analyzed using descriptive statistics. RESULTS: Shared values among student groups included leadership development, innovation, collaboration, and resource sharing. Medical students felt their curriculum inadequately addressed creativity and innovation relative to their engineering counterparts (p < 0.05). Medical students felt less prepared for entrepreneurial activities (p < 0.05), while engineering students indicated a need for basic medical knowledge and patient-oriented design factors. Despite strong interest, collaboration was less than 50% of indicated interest. CONCLUSIONS: Medical and engineering students share an interest in the innovation process and need a shared curriculum to facilitate collaboration. A transdisciplinary course that familiarizes students with this process has the potential to promote physicians and engineers as leaders and innovators who can effectively work across industry lines. A transdisciplinary course was piloted in Spring 2017.


Assuntos
Atitude , Educação de Graduação em Medicina/métodos , Engenharia/educação , Comunicação Interdisciplinar , Inovação Organizacional , Estudantes/psicologia , Currículo , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , New Hampshire , Faculdades de Medicina , Estudantes de Medicina , Inquéritos e Questionários , Universidades
15.
J Orthop Sports Phys Ther ; 48(2): A1-A50, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29385940

RESUMO

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to meniscus and articular cartilage lesions. J Orthop Sports Phys Ther. 2018;48(2):A1-A50. doi:10.2519/jospt.2018.0301.


Assuntos
Artralgia/etiologia , Artralgia/terapia , Cartilagem Articular/lesões , Traumatismos do Joelho/terapia , Limitação da Mobilidade , Modalidades de Fisioterapia , Lesões do Menisco Tibial/terapia , Cartilagem Articular/fisiopatologia , Cartilagem Articular/cirurgia , Humanos , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Lesões do Menisco Tibial/fisiopatologia , Lesões do Menisco Tibial/cirurgia
16.
J Orthop Sports Phys Ther ; 47(11): A1-A47, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29089004

RESUMO

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.


Assuntos
Traumatismos do Joelho/terapia , Ligamentos Articulares/lesões , Modalidades de Fisioterapia , Entorses e Distensões/terapia , Diagnóstico Diferencial , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Instabilidade Articular/terapia , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/fisiopatologia , Movimento , Entorses e Distensões/diagnóstico , Entorses e Distensões/fisiopatologia
17.
J Orthop Sports Phys Ther ; 47(6): A1-A37, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28566053

RESUMO

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to hip pain and mobility deficits. J Orthop Sports Phys Ther. 2017;47(6):A1-A37. doi:10.2519/jospt.2017.0301.


Assuntos
Artralgia/diagnóstico , Articulação do Quadril , Osteoartrite do Quadril/diagnóstico , Artralgia/terapia , Avaliação da Deficiência , Humanos , Osteoartrite do Quadril/classificação , Osteoartrite do Quadril/terapia , Modalidades de Fisioterapia , Amplitude de Movimento Articular
18.
Phys Ther ; 97(3): 280-289, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-28340130

RESUMO

Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population.


Assuntos
Acidentes por Quedas , Traumatismos do Braço/terapia , Fraturas Ósseas/terapia , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Braço/etiologia , Estudos de Coortes , Feminino , Fraturas Ósseas/etiologia , Marcha , Humanos , Modelos Logísticos , Masculino , Medicare , Medição de Risco , Estados Unidos
19.
Qual Life Res ; 26(3): 789-798, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28005243

RESUMO

PURPOSE: To expand content of the physical function domain of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration's (SSA) disability determination process. METHODS: Newly developed questions were administered to 3532 recent SSA applicants for work disability benefits and 2025 US adults. Factor analyses and item response theory (IRT) methods were used to calibrate and link the new items to the existing WD-FAB, and computer-adaptive test simulations were conducted. RESULTS: Factor and IRT analyses supported integration of 44 new items into three existing WD-FAB scales and the addition of a new 11-item scale (Community Mobility). The final physical function domain consisting of: Basic Mobility (56 items), Upper Body Function (34 items), Fine Motor Function (45 items), and Community Mobility (11 items) demonstrated acceptable psychometric properties. CONCLUSIONS: The WD-FAB offers an important tool for enhancement of work disability determination. The FAB could provide relevant information about work-related functioning for initial assessment of claimants; identifying denied applicants who may benefit from interventions to improve work and health outcomes; enhancing periodic review of work disability beneficiaries; and assessing outcomes for policies, programs and services targeting people with work disability.


Assuntos
Pessoas com Deficiência/psicologia , Qualidade de Vida , Avaliação da Capacidade de Trabalho , Adulto , Idoso , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Melhoria de Qualidade , Reprodutibilidade dos Testes , Estados Unidos , United States Social Security Administration , Adulto Jovem
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