Associates of physical function and pain in patients with patellofemoral pain syndrome.

OBJECTIVES: To explore whether impairment of muscle strength, soft tissue length, movement control, postural and biomechanic alterations, and psychologic factors are associated with physical function and pain in patients with patellofemoral pain syndrome (PFPS). DESIGN: Cross-sectional study. SETTING: Rehabilitation outpatient. PARTICIPANTS: Seventy-four patients diagnosed with PFPS. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements were self-reported function and pain; strength of quadriceps, hip abduction, and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fasciae latae complex, and lateral retinaculum; foot pronation; Q-angle; tibial torsion; visual observation of quality of movement during a lateral step-down task; anxiety; and fear-avoidance beliefs. RESULTS: After controlling for age and sex, anxiety and fear-avoidance beliefs about work and physical activity were associated with function, while only fear-avoidance beliefs about work and physical activity were associated with pain. CONCLUSIONS: Psychologic factors were the only associates of function and pain in patients with PFPS. Factors related to physical impairments did not associate to function or pain. Our results should be validated in other samples of patients with PFPS. Further studies should determine the role of other psychologic factors, and how they relate to anxiety and fear-avoidance beliefs in these patients.

Deep Neck Flexor Endurance in the Adolescent and Young Adult: Normative Data and Associated Attributes.

BACKGROUND: Deep neck flexor (DNF) muscles stabilize the neck and contribute to head acceleration control. The function of DNF in cervical spine dynamic stabilization has not been examined in athletes of any age group, including adolescents. This investigation was necessary prior to studying the DNF muscles' role in cervical spine injury patterns. OBJECTIVES: The objectives of this study were (1) to determine average Deep Neck Flexor Endurance Test (DNFET) time scores in high school-aged and university-aged subjects (aged 14-22 years); and (2) to establish the relationship between gender and age for adolescent DNFET time scores. DESIGN: Cross-sectional design. SETTING: Public high school and private university. PARTICIPANTS: A total of 81 (40 male, 41 female) healthy high school and collegiate athletes. INTERVENTION: DNFET time scores (in seconds) were collected and means values were calculated. Interrater reliability was established using the first 15 university-aged subjects enrolled in the study. MAIN OUTCOMES: Mean DNFET time (seconds) scores. RESULTS: The DNF muscle endurance interrater reliability coefficient of reproducibility for 4 allied health clinicians was intraclass correlation coefficient (2,4) 0.712 (confidence interval, 0.24-0.85). The mean (± standard deviation) DNFET time score for females was 31.86 (±8.53) seconds versus 35.57 (±10.43) seconds for males. The DNFET performance demonstrated a significant but fair correlation with age (r = 0.401, P = .0001). No significant performance differences were found between male and female subjects in the 14- to 17-year-old group (U = 187.0, P = .285), the 18- to 22-year-old group (U = 145.0, P = .215), or the total male versus female subject groups (U = 653.0, P = .083). CONCLUSION: Our study establishes a normative data set available for the DNFET in the adolescent population. The fair correlation between DNFET time scores and age is consistent with other studies. These findings serve as a basis for clinician testing, objectifying, and monitoring DNF dysfunction in an adolescent athletic population. LEVEL OF EVIDENCE: II.

Critical Thinking and Disposition Toward Critical Thinking Among Physical Therapy Students.

PURPOSE: Students who enter a physical therapist (PT) entry-level program with weak critical thinking skills may not be prepared to benefit from the educational training program or successfully engage in the future as a competent healthcare provider. Therefore, assessing PT students' entry-level critical thinking skills and/or disposition toward critical thinking may be beneficial to identifying students with poor, fair, or good critical thinking ability as one of the criteria used in the admissions process into a professional program. PARTICIPANTS/METHODS: First-year students (n=71) from the Doctor of Physical Therapy (DPT) program at Texas Tech University Health Sciences Center completed the California Critical Thinking Skills Test (CCTST), the California Critical Thinking Dispositions Inventory (CCTDI), and demographic survey during orientation to the DPT program. Three students were lost from the CCTST (n=68), and none lost from the CCTDI (n=71). OUTCOMES: Analysis indicated that the majority of students had a positive disposition toward critical thinking, yet the overall CCTST suggested that these students were somewhat below the national average. Also, individuals taking math and science prerequisites at the community-college level tended to have lower overall CCTST scores. CONCLUSION: The entering DPT class demonstrated moderate or middle range scores in critical thinking and disposition toward critical thinking. This result does not indicate, but might suggest, the potential for learning challenges. Assessing critical thinking skills as part of the admissions process may prove advantageous.

The deep neck flexor endurance test: normative data scores in healthy adults.

OBJECTIVE: To investigate (1) the average hold time for the deep neck flexors (DNF) endurance test in subjects without neck pain or pathology, and (2) whether different groups of subjects categorized by age, gender, and lifestyle display different hold times. DESIGN: Normative research. PATIENTS: A convenience sample of 126 adults participated. METHODS: Intertester reliability of 4 therapists was evaluated by using intraclass correlation coefficients. The DNF endurance test hold time was conducted on each subject twice. The 2 hold-time scores were averaged and recorded. RESULTS: Inter-rater reliability coefficient of reproducibility for DNF muscle endurance measured by 4 physical therapists was ICC (2,k) 0.66 (confidence interval, 0.34-0.86). The mean (SD) DNF endurance hold times for men was 38.9 ± 20.1 seconds, whereas women was 29.4 ± 13.7 seconds. Results of the 2 x 2 analysis of variance indicated that gender significantly influenced DNF endurance (F = 8.643; P = .004), whereas, the activity level did not (F = 3.143; P = .079). Correlations were not significant between age and DNF endurance (r = 0.11; P = .2) and between activity level and DNF endurance (r = -0.156; P = .08). CONCLUSIONS: Asymptomatic men displayed greater DNF endurance than women. The variability between subjects' DNF endurance capabilities was high. Age between 20 and 80 years and activity level did not affect DNF endurance. This is the first normative data set available for the DNF endurance test, which lays the foundation for further research in subjects with a history of cervicalgia and assists clinicians to objectify a milestone for DNF endurance deficits in patients.