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Assessing both physical and mental health is necessary in clinical settings to quantify the scope of disability and to evaluate the effectiveness of treatment programs. Changes in health-related quality of life following physical therapy treatment for many patients with orthopaedic-related diagnoses is not known. The purposes of this study were to describe changes in health-related quality of life between the initial assessment and the time of discharge from physical therapy for the most common orthopaedic diagnoses and to compare the patterns of deficit among diagnostic categories. Patient outcomes in this study were evaluated from a large database generated by the Focus on Therapeutic Outcomes (FOTO) network. Health-related and employment outcomes were described for adult patients who were classified using ICD-9-CM codes. The most common orthopaedic diagnostic categories were sacroiliac sprain, back sprain, low back pain (radiating and nonradiating), neck sprain, neck pain (radiating and nonradiating), adhesive capsulitis of the shoulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sprain, and knee derangement. The primary outcome measure was a 17-item questionnaire (the MOS-17) derived from the RAND 36-Item Health Survey (SF-36) and the 12-item Short Form Health Survey (SF-12). The comparison of each cohort to population norms was made by calculating a standard score on patient data adjusted for age and gender. An effect size was calculated to measure the change in health or employment status between the initial assessment and discharge from physical therapy. For all diagnostic categories, health-related quality of life with respect to norms and employment status showed a consistent pattern of improvement at the time of discharge compared with the initial assessment. There were only small changes in physical function for neck and shoulder diagnostic categories. Nearly all of the diagnostic categories had large reductions in bodily pain. The amount of clinical change in the physical components of health-related quality of life--especially the physical function and role physical domains--differed substantially across specific diagnostic categories. The largest improvements in the physical function occurred for patients with knee dislocation and knee sprain. Patients with knee dislocation also had the largest improvement in role limitations due to physical problems. The design of this study does not permit conclusions about the efficacy of physical therapy. Further study is needed to determine if the finding of different levels of health status improvement across diagnostic categories was due to the nature of the outcome measure, the type of treatments given to each patient, or other confounding variables, like depression or preinjury functional level.

Outcome of physical therapy for patients receiving workers' compensation may be related to a variety of factors, including the presence or absence of herniated lumbar intervertebral disc. The purpose of this study was to determine the level of disability, physical impairment, and rate of return-to-work for patients with disc disease and for those with mechanical low back pain syndrome without evidence of disc lesion. Twenty patients with disc disease and 22 patients with mechanical low back pain syndrome participated in this study. Physical therapy consisted of multiple interventions, including manual therapy based on the pattern of motion-provoked symptoms. The Oswestry disability questionnaire, fingertip-to-floor distance, and maximum pain-free isometric static lift were measured at the initial evaluation, 1 month following the initial assessment, and at discharge from the clinic. Patients with disc disease did not show significant improvement in the mean Oswestry score or in forward bending, but did show increased static lift capacity. In contrast, patients with mechanical low back pain syndrome had a significant reduction in disability and significant improvements in fingertip-to-floor distance and maximum pain-free isometric static lift. At the time of discharge, 90% of the patients followed with mechanical low back pain syndrome returned to work in some capacity compared with 45% of the patients followed with disc disease. A physical therapy program with multiple interventions that includes treatment based on the pattern of motion-provoked symptoms appears to have the greatest benefit for patients with mechanical low back pain syndrome.