Impact of climate change on greenhouse gas emissions and water balance in a dryland-cropping region with variable precipitation.

Wheat covers a significant fraction of the US Pacific Northwest (PNW) dryland agriculture. Past studies have suggested that management practices can differentially affect productivity and emission of greenhouse gases (GHGs) across the different agro-ecological Zones (AEZs) in PNW. In this study we used CropSyst, a biophysically-based cropping systems model that simulates crop processes and water and nitrogen cycles, with the purpose of evaluating relevant scenarios and contributing analyses to inform adaptation and mitigation strategies aimed at reducing and managing the risks of climate change. We compared the baseline historical period of 1980-2010 with three future periods: 2015-2045 (2030s), 2035-2065 (2050s), and 2055-2085 (2070s). The uncertainty of the future climate was captured using 12 general circulation models (GCMs) forced with two representative carbon dioxide concentration pathways (RCP 4.5 and 8.5). The study region was divided into three AEZs: crop-fallow (CF), continuous cropping to fallow transition (CCF), and continuous cropping (CC). The results indicated that areas with higher precipitation, N fertilization, and mineralization produced more N2O emissions during both baseline and future periods. The average annual N2O emission during the baseline period was between 1.8 and 4.1 kg ha-1 depending on AEZ. The overall N2O emission showed decreasing future trends from 2030s to 2070s which resulted from a higher proportion of N used by crops. From 2015 to 2085 under RCP 4.5, the average N2O emission was between 1.8 and 4.4 kg ha-1 year-1. They are slightly higher under RCP 8.5 since it is a warmer scenario. The soil organic carbon (SOC) content decreased during the baseline period while SOC did not reach equilibrium with the cropping systems considered in the study. SOC decreased during the future periods as well, with rate of change ranging from -146 to -352 kg ha-1year-1 depending on AEZ and RCP. Warming increased SOC oxidation in future scenarios, but after an initial increase of SOC losses during the 2030s period, the rate of SOC losses decreased in the 2050s, and more so in the 2070s as SOC and carbon input reached equilibrium with losses. Higher carbon input resulted from higher biomass production under elevated CO2 scenarios. The total GHG emissions were 1.95, 3.16 and 4.84 Mg CO2-equivalent ha-1year-1 under RCP 4.5, and 1.99, 3.43 and 5.49 Mg CO2-equivalent ha-1year-1 under RCP 8.5 during 2070s in CF, CCF and CC respectively, with N2O accounting for about 81% of total GHG emissions.

Differences among health care settings in utilization and type of physical rehabilitation administered to patients receiving workers' compensation for musculoskeletal disorders.

INTRODUCTION: There is a paucity of data describing the relationship between practice setting and the delivery of physical rehabilitation to injured workers. PURPOSE: To determine differences in the number of visits, the number of treatment units, and the proportion of billing for physical agents over an episode of care between different practice settings' providing physical rehabilitation to patients receiving workers' compensation for a musculoskeletal problem. METHODS: A large administrative database was evaluated retrospectively. Practice settings were classified as physician office, corporate physical therapy clinic, occupational medicine clinic, hospital-based outpatient clinic, or private physical therapy practice. RESULTS: 70,306 subjects (72.7 % male; mean age = 44.6, SD = 11.8 years) were included in this study. Corporate physical therapy clinics had the highest mean values for total visits (13.1, SD = 12.7) and for total units (66.8, SD = 85.5), and the lowest mean values for proportion of physical agents during the episode of care (.22, SD = .18). Occupational medicine clinics had the lowest mean values for total visits (6.8, SD = 7.9) and for total units (30.4, SD = 36.5), and the highest mean value for proportion of physical agents during the episode of care (.41, SD = .22). When controlling for ICD-9-CM codes, body-part treated, surgical status, and geographical region there were small changes in effect size; however, the significance and directionality of differences between practice settings were not changed. CONCLUSIONS: There were significant differences in billing for physical rehabilitation services between practice settings for patients receiving workers' compensation. Corporate physical therapy clinics billed for more total visits and total units over an episode of care than did other practice settings; however they also billed for a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.

Intercultural comparison of patient satisfaction with physiotherapy care in Australia and Korea: an exploratory factor analysis.

OBJECTIVES: The aim of this study was to conduct a cross-cultural comparison of the factors that influence patient satisfaction with musculoskeletal physiotherapy care in Australia and Korea. METHODS: Prospective studies were conducted in Australia and Korea. Patient satisfaction data were collected using the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) from a total of 1666 patients who were attending clinics for physiotherapy treatment of a musculoskeletal condition. Exploratory factor analysis was conducted to identify factors determining patient satisfaction in each cohort. RESULTS: A four-factor solution for the MRPS was found for the Australian and Korean data sets, explaining 61 and 55% of the variance respectively. Communication and respect, convenience and quality time and person-focused care were factors common to both countries. One factor unique to Korea was courtesy and propriety. For both cultures, global patient satisfaction was significantly but weakly correlated with the outcome of treatment. CONCLUSIONS: The interpersonal aspect of care, namely effective communication and respect from the therapist, appears to be the predominant and universal factor that influences patient satisfaction with physiotherapy care, although other culturally specific factors were identified. Physiotherapists can maximize patient satisfaction with care by addressing those features that uniquely contribute to patient satisfaction in the cultural context in which they are working.

Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison.

OBJECTIVES: (1) To attain a quantitative estimate of patient satisfaction with physiotherapy care for musculoskeletal conditions in Australia; (2) to compare the observed level of patient satisfaction with care in Australia with those from other countries; and (3) to compare factors contributing to patient satisfaction between Australia and the United States (US). METHODS: We conducted a prospective study of 274 patients presenting for physiotherapy treatment of a musculoskeletal disorder in Australian clinics. Patient satisfaction was measured using the 20-item MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) and satisfaction scores were compared with those from Northern Europe, North America, the United Kingdom, and Ireland. To investigate factors contributing to patient satisfaction between Australia and the US, we compared 20-item MRPS data from Australian and Spanish-speaking US cohorts. RESULTS: Mean Australian MRPS satisfaction score was 4.55 (95% confidence interval: 4.51-4.59) on a scale of 1 to 5, where 1 indicates high dissatisfaction and 5 indicates high satisfaction. This high level of patient satisfaction is consistent with international data. Australian respondents specifically valued interpersonal aspects of care, including advice and information about their condition and an explanation about self-management. The correlation between treatment outcomes and global patient satisfaction was low (r = -0.22). A comparison of data collected from Australia and the US showed that MRPS items regarding interpersonal aspects of care, such as the therapists' communication skills, correlated strongly with global satisfaction in both countries. However, there were other questionnaire items for which the correlation with global satisfaction was significantly different between Australia and the US. CONCLUSIONS: Patient satisfaction with musculoskeletal physiotherapy care in Australia is high and comparable with Northern Europe, North America, the United Kingdom and Ireland. Comparison of data between Australia and the US indicates that while some determinants of patient satisfaction are common, country-specific differences also exist.

Development and preliminary validation of the MedRisk instrument to measure patient satisfaction with chiropractic care.

OBJECTIVE: The purpose of this study is to provide preliminary information regarding the factor-structure, group- and individual-level reliability, and criterion-referenced validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction with Chiropractic Care. METHOD: Three hundred twenty-three subjects who had completed a course of chiropractic care responded to questionnaire in which they rated their degree of satisfaction from 1 to 5 (1 = very unsatisfied to 5 = very satisfied) for each of 20 items. Factor structure was assessed using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed by calculating Cronbach α, and individual-level reliability was determined using the standard error of measure. Criterion-referenced validity was investigated by comparing the item scores and mean scores of individual factors to global measures of satisfaction. RESULTS: Individual item scores ranged from 3.98 for "Office location was convenient" to 4.77 for "My chiropractor treats me respectfully." The items that were most highly correlated with overall patient satisfaction were "My chiropractor thoroughly explained the treatment I received" (r = 0.77) and "My chiropractor answered all of my questions" (r = 0.71). Exploratory factor analysis suggested a 2-factor solution: a 5-item "internal" factor and a 6-item "external" factor. The mean scores from these factors were correlated with the 2 global measures ranging from r = 0.68 to r = 0.80. The standard error of measure was 0.20 for the internal factor and 0.17 for the external factor. CONCLUSIONS: Preliminary assessment suggests that a 13-item version of the MedRisk instrument provides psychometrically sound measures to assess patient satisfaction with chiropractic care; however, additional confirmatory validation should be performed.

Supply chains for processed potato and tomato products in the United States will have enhanced resilience with planting adaptation strategies.

Food systems are increasingly challenged to meet growing demand for specialty crops due to the effects of climate change and increased competition for resources. Here, we apply an integrated methodology that includes climate, crop, economic and life cycle assessment models to US potato and tomato supply chains. We find that supply chains for two popular processed products in the United States, French fries and pasta sauce, will be remarkably resilient, through planting adaptation strategies that avoid higher temperatures. Land and water footprints will decline over time due to higher yields, and greenhouse gas emissions can be mitigated by waste reduction and process modification. Our integrated methodology can be applied to other crops, health-based consumer scenarios (fresh versus processed) and geographies, thereby informing decision-making throughout supply chains. Employing such methods will be essential as food systems are forced to adapt and transform to become carbon neutral due to the imperatives of climate change.

Novel multimodel ensemble approach to evaluate the sole effect of elevated CO2 on winter wheat productivity.

Elevated carbon-dioxide concentration [eCO2] is a key climate change factor affecting plant growth and yield. Conventionally, crop modeling work has evaluated the effect of climatic parameters on crop growth, without considering CO2. It is conjectured that a novel multimodal ensemble approach may improve the accuracy of modelled responses to eCO2. To demonstrate the applicability of a multimodel ensemble of crop models to simulation of eCO2, APSIM, CropSyst, DSSAT, EPIC and STICS were calibrated to observed data for crop phenology, biomass and yield. Significant variability in simulated biomass production was shown among the models particularly at dryland sites (44%) compared to the irrigated site (22%). Increased yield was observed for all models with the highest average yield at dryland site by EPIC (49%) and lowest under irrigated conditions (17%) by APSIM and CropSyst. For the ensemble, maximum yield was 45% for the dryland site and a minimum 22% at the irrigated site. We concluded from our study that process-based crop models have variability in the simulation of crop response to [eCO2] with greater difference under water-stressed conditions. We recommend the use of ensembles to improve accuracy in modeled responses to [eCO2].

Discovery of abundant cellulose microfibers encased in 250 Ma Permian halite: a macromolecular target in the search for life on other planets.

In this study, we utilized transmission electron microscopy to examine the contents of fluid inclusions in halite (NaCl) and solid halite crystals collected 650 m below the surface from the Late Permian Salado Formation in southeastern New Mexico (USA). The halite has been isolated from contaminating groundwater since deposition approximately 250 Ma ago. We show that abundant cellulose microfibers are present in the halite and appear remarkably intact. The cellulose is in the form of 5 nm microfibers as well as composite ropes and mats, and was identified by resistance to 0.5 N NaOH treatment and susceptibility to cellulase enzyme treatment. These cellulose microfibers represent the oldest native biological macromolecules to have been directly isolated, examined biochemically, and visualized (without growth or replication) to date. This discovery points to cellulose as an ideal macromolecular target in the search for life on other planets in our Solar System.

Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study.

OBJECTIVE: To determine outcomes after administration of a prone lumbar traction protocol. DESIGN: Prospective, longitudinal, case series. SETTING: Suburban, chiropractic practice. PARTICIPANTS: A total of 296 subjects with low back pain (LBP) and evidence of a degenerative and/or herniated intervertebral disk at 1 or more levels of the lumbar spine. We excluded patients involved in litigation and those receiving workers' compensation. INTERVENTION: An 8-week course of prone lumbar traction, using the vertebral axial decompression (VAX-D) system, consisting of five 30-minute sessions a week for 4 weeks, followed by one 30-minute session a week for 4 additional weeks. MAIN OUTCOME MEASURES: The numeric pain rating scale and the Roland-Morris Disability Questionnaire (RMDQ) were completed at preintervention, discharge (within 2 weeks of the last visit), and at 30 days and 180 days after discharge. Intention-to-treat strategies were used to account for those subjects lost to follow-up. RESULTS: A total of 250 (84.4%) subjects completed the treatment protocol. On the 30-day follow-up, 247 (83.4%) subjects were available; on the 180-day follow-up, data were available for 241 (81.4%) subjects. We noted significant improvements for all postintervention outcome scores when compared with preintervention scores (P<.01). CONCLUSIONS: Traction applied in the prone position using the VAX-D for 8 weeks was associated with improvements in pain intensity and RMDQ scores at discharge, and at 30 and 180 days after discharge in a sample of patients with activity-limiting LBP. Causal relationships between these outcomes and the intervention should not be made until further study is performed using randomized comparison groups.

Evaluating research studies that address prognosis for patients receiving physical therapy care: a clinical update.

A prognosis is a broad statement that predicts a patient's likely status, or degree of change, at some time in the future. Clinicians are likely to improve the accuracy of their judgments of prognosis by incorporating relevant research findings. In recent years, there has been substantial growth in the number of primary studies and systematic reviews addressing prognosis for people likely to receive physical therapy care. The purpose of this clinical update is to provide a framework for identifying, appraising, and utilizing these research findings to help make prognostic judgments.

Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS): preliminary validation.

BACKGROUND AND PURPOSE: An instrument that provides valid measurements of satisfaction with physical therapy care for Spanish-speaking patients will enhance communication and ensure their representation in quality assurance analyses and research on health care disparities. The purpose of this investigation was to provide preliminary information on the factor structure, group- and individual-level reliability, and criterion-referenced validity of measurements obtained from a Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS). SUBJECTS: A total of 203 Spanish-speaking patients in the New York City area participated in this study. METHODS: Consenting subjects completed a 20-item MRPS after discharge from outpatient physical therapy care. Several translators performed "forward" and "backward" translation of the MRPS, followed by consensus agreement on item structure. Factor structure was investigated using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed using the Cronbach alpha, and individual-level reliability was assessed by calculating the standard error of the measure (SEM). Concurrent validity was tested by comparing the item scores and mean scores of factors to global measures of satisfaction. RESULTS: The means of individual item scores (1-5) ranged from 3.22 for "I did not wait too long" to 4.80 for "My therapist treated me respectfully." There were no sex-based differences in item scores. Exploratory factor analysis suggested a 2-factor solution: a 7-item "external" factor and a 3-item "internal" factor. The correlations (r) of the mean scores from these factors with the 2 global measures ranged from .59 to .82. The SEM was 0.16 for the internal factor and 0.25 for the external factor. DISCUSSION AND CONCLUSION: The underlying factor structure of the Spanish-language version of the MRPS was identical to the English-language version. Our findings provide preliminary support for the reliability and validity of measurements obtained from the Spanish-language version of the MRPS. Further study is needed to assess the stability of these findings in other samples. As with English-speaking patients, Spanish-speaking patient's satisfaction with physical therapy care is most strongly linked to the professional behavior of the clinician.

Weighting the Parameters, a Response to Bancel׳s "Searching for Global Consciousness: A Seventeen Year Exploration".

This brief report is a response to the article by Peter Bancel entitled "Searching for Global Consciousness: A Seventeen Year Exploration" in which he compares a goal orientation (GO) model with a field-like model he refers to as global consciousness (GC). He first attempts to exclude the latter, and then presents selected tests that compare the models. While the article appears to provide support for Bancel׳s conclusion that GC cannot explain the data and must be supplanted by GO, there are good reasons to believe this conclusion is premature at best. I address the vulnerable assumptions underlying Bancel׳s rejection of GC, and then provide multiple examples of parametric structure in the data, which cannot be attributed to GO, but are amenable to explanation by field-like models.

Reexamining psychokinesis: comment on Bösch, Steinkamp, and Boller (2006).

H. Bösch, F. Steinkamp, and E. Boller's review of the evidence for psychokinesis confirms many of the authors' earlier findings. The authors agree with Bösch et al. that existing studies provide statistical evidence for psychokinesis, that the evidence is generally of high methodological quality, and that effect sizes are distributed heterogeneously. Bösch et al. postulated the heterogeneity is attributable to selective reporting and thus that psychokinesis is "not proven." However, Bösch et al. assumed that effect size is entirely independent of sample size. For these experiments, this assumption is incorrect; it also guarantees heterogeneity. The authors maintain that selective reporting is an implausible explanation for the observed data and hence that these studies provide evidence for a genuine psychokinetic effect.

Clinical prediction rules: what are they and what do they tell us?

QUESTION: Clinical prediction rules are research-based tools that quantify the contributions of relevant patient characteristics to provide numeric indices that assist clinicians in making predictions. Clinical prediction rules have been used to describe the likelihood of the presence or absence of a condition, assist in determining patient prognosis, and help the classification of patients for treatment. The recent rapid rise in the use of clinical prediction rules raises questions about the conditions under which they may be used most appropriately. What is the potential role of clinical prediction rules in physiotherapy practice and what are the strategies by which clinicians can determine their appropriate use for a given clinical setting? CONCLUSION: Clinical prediction rules use quantitative methods to build upon the body of literature and expert opinion and can provide quick and inexpensive estimates of probability. Clinical prediction rules can be of great value to assist clinical decision making but should not be used indiscriminately. They are not a replacement for clinical judgment and should complement rather than supplant clinical opinion and intuition. The development of valid clinical prediction rules should be a goal of physiotherapy research. Specific areas in need of attention include deriving and validating clinical prediction rules to screen patients for potentially serious conditions for which current tests lack adequate diagnostic accuracy or have unacceptable cost and risk, and to assist in classification of patients for treatments that are likely to result in substantially different outcomes in heterogeneous groups of patients.

Longitudinal continuity of care is associated with high patient satisfaction with physical therapy.

BACKGROUND AND PURPOSE: Recent literature has suggested that longitudinal continuity (ie, the patient is seen by the same practitioner for the entire course of treatment) may be linked to high degrees of patient satisfaction with medical care. The purpose of this study was to provide preliminary information regarding the association between longitudinal continuity and reports of patient satisfaction with physical therapy outpatient care. SUBJECTS AND METHODS: A sample of 1,502 adult subjects completed the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care at the time of discharge from outpatient physical therapy. Relationships between satisfaction measures and the presence or absence of longitudinal continuity were assessed by use of binary logistic regression. RESULTS: Overall, 36.8% of the subjects reported complete satisfaction on the internal subscale (patient-therapist), and 47.9% of the subjects reported complete satisfaction on the external subscale (patient-support staff). Higher percentages of women (40.2% and 51.1% for internal and external subscales, respectively) than of men (31.9% and 43.3% for internal and external subscales, respectively) were completely satisfied with care. Of subjects who reported complete satisfaction on the internal subscale, 71.2% had longitudinal continuity of care, and 28.8% did not. A similar trend was noted for the external subscale (patient-support staff); 66.8% of subjects who reported complete satisfaction had longitudinal continuity, and 33.2% did not. Odds ratios describing the probability of complete satisfaction with care for subjects who had longitudinal continuity and for those who did not were significant and ranged from 2.7 to 3.5. DISCUSSION AND CONCLUSION: Subjects who received their entire course of outpatient physical therapy from only 1 provider were approximately 3 times more likely to report complete satisfaction with care than those who received care from more than 1 provider. These findings suggest that clinicians and managers should make efforts to preserve longitudinal continuity of care as a means of improving patient satisfaction with care.

The MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care: a psychometric analysis.

STUDY DESIGN: Psychometric evaluation of a cross-sectional survey. OBJECTIVES: To determine the validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) to differentiate between patient satisfaction with internal and external factors. BACKGROUND: Self-report measures that sample a variety of items provide clinicians with an array of information that may assist in assessing patient satisfaction. An important measurement characteristic of these instruments is the ability to discriminate between different factors that may influence patient reports of satisfaction with care, ie, discriminant validity. In previous work, exploratory factor analysis suggested that the MRPS questionnaire has a 2-factor structure: "internal," relating to the patient-therapist interaction, and "external," describing nontherapist issues such as admissions and clinic environment. METHODS AND MEASURES: One thousand four hundred forty-nine adult patients completed the MRPS questionnaire upon finishing their course of outpatient physical therapy treatment. Discriminant validity of the 2-factor model was assessed using confirmatory factor analysis. The measures from the 2 factors were then evaluated for reliability by calculating the standard error of measurement (SEM), and for concurrent validity by correlating the mean score of the factors and individual items to global measures of satisfaction. RESULTS: Confirmatory factor analysis supported a good to excellent model fit for the internal factor (7 items) and external factor (3 items). The SEM for the 2 factors was 0.19 and 0.24, indicating a low degree of measurement error. Both factors had high significant correlation with global measures of satisfaction (internal, r = 0.83 and 0.80; external, r = 0.71 and 0.71). All individual items within the 2 factors had significant correlations with global measures ranging from r = 0.33 to 0.80. CONCLUSIONS: Our findings provide evidence of discriminant and concurrent validity of the 2-factor solution for the MRPS questionnaire for the sample that was tested. This 2-factor solution yields measures that are relatively free of error and may discriminate between internal and external factors influencing patient satisfaction. Patients who complete their course of physical therapy report that the professional interaction between the therapist and patient, especially the meaningful exchange of relevant information, is critical for patient satisfaction with care. The generalizability of our data to patients who do not complete their physical therapy care or who are receiving care in other health care environments is unknown.

Stress induction in the bacteria Shewanella oneidensis and Deinococcus radiodurans in response to below-background ionizing radiation.

PURPOSE: The 'Linear no-threshold' (LNT) model predicts that any amount of radiation increases the risk of organisms to accumulate negative effects. Several studies at below background radiation levels (4.5-11.4 nGy h(-1)) show decreased growth rates and an increased susceptibility to oxidative stress. The purpose of our study is to obtain molecular evidence of a stress response in Shewanella oneidensis and Deinococcus radiodurans grown at a gamma dose rate of 0.16 nGy h(-1), about 400 times less than normal background radiation. MATERIALS AND METHODS: Bacteria cultures were grown at a dose rate of 0.16 or 71.3 nGy h(-1) gamma irradiation. Total RNA was extracted from samples at early-exponential and stationary phases for the rt-PCR relative quantification (radiation-deprived treatment/background radiation control) of the stress-related genes katB (catalase), recA (recombinase), oxyR (oxidative stress transcriptional regulator), lexA (SOS regulon transcriptional repressor), dnaK (heat shock protein 70) and SOA0154 (putative heavy metal efflux pump). RESULTS: Deprivation of normal levels of radiation caused a reduction in growth of both bacterial species, accompanied by the upregulation of katB, recA, SOA0154 genes in S. oneidensis and the upregulation of dnaK in D. radiodurans. When cells were returned to background radiation levels, growth rates recovered and the stress response dissipated. CONCLUSIONS: Our results indicate that below-background levels of radiation inhibited growth and elicited a stress response in two species of bacteria, contrary to the LNT model prediction.

Patient satisfaction with outpatient physical therapy: instrument validation.

BACKGROUND AND PURPOSE: Patient satisfaction with physical therapy is used as an outcome variable. The purpose of this study was to develop and test an instrument used to determine which variables are associated with the satisfaction of patients receiving outpatient physical therapy. SUBJECTS: During the pilot study, 191 patients participated, and 1,868 patients then participated in the main phase of this work. METHODS: Using a survey instrument developed by the authors, subjects responded to global questions concerning overall satisfaction with physical therapy. Content validation of the instrument was investigated using item correlation, principal components analysis, and factor analysis. Reliability was measured using the standard error of measurement. Concurrent validity was investigated by correlating summary scores of the final survey instrument with global measures of satisfaction. RESULTS: Reliability was best for a 10-item questionnaire. Patient satisfaction was most associated with items that reflected a high-quality interaction with the therapist (eg, time, adequate explanations and instructions to patients). Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used were not strongly correlated with overall satisfaction with care. DISCUSSION AND CONCLUSION: Because the time the therapist spent with patients and the behavior of the therapists are important for patient satisfaction, emphasis on cost-cutting, high patient volume, and the use of "care extenders" may jeopardize satisfaction.

One-time physical therapist consultation in primary health care.

BACKGROUND AND PURPOSE: One-time physical therapist consultation, prior to possible referral for physical therapy intervention, may enhance the quality of patient care, particularly if the referring physician is uncertain as to whether intervention by a physical therapist will be beneficial. The purpose of this study was to describe the use of consultation by a group of primary care physicians (PCPs) who could refer patients for a one-time consultation. SUBJECTS AND METHODS: A 7-month observational study was conducted in the Netherlands with 59 pairs of randomly selected PCPs and physical therapists practicing in primary health care. Data were collected for the PCPs, the physical therapists, and the patients. Self-administered questionnaires (completed at the start and at the completion of the study), consultation request and report forms, and treatment referral records from health insurance agencies were used to obtain data. National reference data on patients referred by PCPs for intervention by a physical therapist were used to compare the data of patients referred by PCPs for a one-time consultation. The number and nature of consultation requests were determined as well as patient characteristics. The PCPs' satisfaction with the outcome and process of a one-time consultation and its impact on PCPs' management decisions also were described. RESULTS: The number of referrals for a one-time consultation was 352 (X=5.9 per PCP, SD=5.4, range=0-20), resulting in a mean referral rate of 4.7 per 1,000 patients (SD=4.6). Characteristics of patients referred for a one-time consultation differed from national reference data of patients referred by their PCP for intervention by a physical therapist. DISCUSSION AND CONCLUSION: The results show that PCPs used the opportunity for a one-time physical therapist consultation and were satisfied with the outcome and process of consultation. The findings suggest that a one-time consultation is an appropriate and beneficial component of PCPs' patient management process.

The validity of the GaitRite and the Functional Ambulation Performance scoring system in the analysis of Parkinson gait.

BACKGROUND AND PURPOSE: The purpose of this study was (1) to determine the validity of the GaitRite System in detecting footfall patterns and selected gait characteristics of person with early stage Parkinson's disease (PD) and (2) to investigate whether the Functional Ambulation Performance (FAP) scoring system is a valid tool to distinguish between selected gait characteristics of patients with early stage Parkinson's disease and similar age of non-impaired individuals. The FAP score is a quantitative means of assessing gait based on specific spatial and temporal gait parameters. PARTICIPANTS: 11 volunteers with idiopathic Parkinson's disease, (mean age = 74.3), and 11 age matched volunteers, (mean age = 70.3), with no history of neurological disorder participated in the study. The non-impaired control group were not matched in age and sex but of similar age and males and females were represented in the control group. METHODS: Temporal and spatial parameters of gait were analyzed for both preferred- speed and fast-speed walking using the computerized GaitRite system. The system integrates specific components of locomotion to provide a single, numerical representation of gait, the Functional Ambulation Performance Score (FAP) score. RESULTS: The most powerful and discriminating variable between Parkinson's and non-impaired groups for both walking speeds was the mean normalized velocity (MNV). Which is velocity divided by leg length. The MNV was 0.83 for PD at preferred walking speed and 1.14 at fast speed, the non-impaired group preferred-speed group walking was 1.33, while fast-speed walking MNV was 1.70. Note the fast walking of PD was slower than the preferred velocity of the non-impaired group. For preferred-speed walking, all gait variables analyzed in the study were different between the two groups beyond the p < 0.05 level of confidence with the single exception of right stance percentage. For fast-speed walking, three of the entered variables did not discriminate between the two groups: the fast walking FAP score, left fast-walking cadence, and right fast-walking single support percentage. CONCLUSION AND DISCUSSION: Our results indicate that persons with Parkinson's disease (PD) attain a significantly lower FAP score when ambulating at their preferred rate and demonstrate shorter step length and a longer step time than the age matched non-impaired group during both preferred and fast velocities of walking. Stance duration and double support duration were increased for the Parkinson's population, whereas single support duration, mean cadence, and heel-to-heel base of support were markedly reduced for both walking speeds. The FAP score was significantly different from the non-impaired control group for preferred-speed walking. These results indicate that the GaitRite system can be useful in detecting footfall patterns and selected time and distance measurements of persons with early stage Parkinson's disease and the FAP score discriminates between the PD population and the non-impaired controls when walking at preferred rate but not at fast walking.