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A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty., This clinical practice guideline (CPG) is based on a systematic review of published studies with regard to the physical therapist management of patients undergoing total knee arthroplasty. In addition to [...]

Background. The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. A systematic approach to determine a patient's functional limitations [...]

The recently published clinical practice guideline (CPG) for physical therapist management of patients with total knee replacement (TKA) highlights limitations in the quality of existing evidence that impact the ability [...]

Background. Medicare beneficiaries frequently receive physical therapy for musculoskeletal conditions. Little information is available about this care. Objective. The purposes of this study were: (1) to describe characteristics, clinical outcomes, and utilization for Medicare beneficiaries receiving physical therapy in outpatient clinics within one integrated health care system; (2) to compare characteristics, outcomes, and utilization based on the body region affected; and (3) to examine factors predictive of outcomes and utilization. Design. This was a prospective, longitudinal study. Methods. Medicare beneficiaries aged 65 years or older (n=1,840 episodes of care) participated in the study. Descriptive statistics were calculated for patient characteristics and outcomes. Comparisons were made based on body region. Regression models evaluated factors associated with change in pain, improved outcome, and utilization. Results. The patients' mean age was 74.2 years (SD=6.3), and 65.3% were female. The most common body regions were the lumbar spine, shoulder, and knee, collectively accounting for 71.3% of the episodes of care. Patients attended a mean of 6.8 visits (SD=4.7), and 63.9% experienced an improved outcome. Episodes of care for lumbar spine conditions had less reduction in pain, whereas shoulder conditions and foot/ankle conditions showed the greatest improvement. Care for hip conditions was least likely to result in an improved outcome. Knee conditions were most likely to have an improved outcome. Care for shoulder and knee conditions had the highest number of visits. Factors associated with greater reduction in pain and improved outcomes included greater initial pain or disability and attending more visits. Factors associated with greater utilization included a postsurgical condition and higher initial pain rating. Limitations. The study was performed in one geographic region within a single health care delivery system. Conclusion. The results provide information on outcomes of physical therapy for Medicare beneficiaries in one health care system. Further research is needed to examine optimal utilization and care for these patients., Musculoskeletal conditions are highly prevalent in the United States and throughout the world. Musculoskeletal conditions can significantly diminish an individual's quality of life and impose a substantial economic burden on [...]

Background and Purpose. Physical therapists frequently attend continuing education courses with the goal of providing better care, yet the effectiveness of continuing education for improving outcomes has not been examined. Subjects. Data were obtained for all eligible patients (n=1,365; mean age = 42.1 years, SD = 14.0 years; 69.9% female) with a chief complaint of neck pain who were treated in 13 physical therapy clinics over a 24-month period. Disability data (Neck Disability Index scores) from the initial and final therapy sessions were recorded from clinical databases. Methods. Thirty-four of 57 physical therapists employed within the 13 clinics attended a 2-day continuing education course. Eleven of the 34 attendees also participated in an ongoing clinical improvement project for patients with neck pain. Clinical outcomes were compared in the pre- and post-course periods for therapists attending or not attending the course, and for therapists participating or not participating in the ongoing project. Results. There were no differences in clinical outcomes based on attendance at the continuing education course. There was an interaction between time and participation in the ongoing project, such that participants achieved greater change in disability after the course. The percentage of patients achieving at least the minimum detectable amount of change in disability with treatment increased significantly for participants after the course. Discussion and Conclusion. Attendance at a 2-day continuing education course was not associated with improvement in clinical outcomes, but participation in an ongoing improvement project did result in greater clinical improvement for patients with neck pain. Further investigation of educational methods to improve clinical outcomes is needed. These results suggest that traditional continuing education formats may not be effective for improving patient care. Key Words: Continuing education, Health care, Neck pain, Outcome assessment., The goal of health care providers to offer patients the best possible care stems from good intentions and supports a large enterprise of continuing education (CE) in the United States. [...]