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The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists’ knowledge and skills related to managing patients taking prescription opioid medications for pain.

In studies of major dance companies that employ mostly adult dancers, measuring the effect of comprehensive medical management that includes daily on-site physical therapy has shown a decrease in the incidence of dance injuries, days missed from dance, injury-related costs, and Workers Compensation claims. As no comparable data have been collected with regard to youth and adolescent dancers, we sought to assess the effect of physical therapist involvement in the care of injuries sustained by young dancers on the incidence and amount of time missed from dancing. A cross sectional study was conducted by questionnaire of 55 students attending a US school for the arts summer dance program. Dancers ranged in age from 13 to 17 years, with a mean age of 15.0 ± 1.0. Most (87.3%) were female. Participants reported dancing a mean of 4.4 ± 2.6 hours per day prior to arrival at the program. They recorded 37 prior injuries, most of which (51.4%) were diagnosed by a physician, although a substantial proportion were diagnosed by a physical therapist (43.2%). Dancers whose injuries were diagnosed by a physician were more likely to miss dance class than those diagnosed by a physical therapist (100% vs. 50%; p = 0.014). When an injury did result in missed dance time, the median number of days missed was greater when the diagnosis was made by a physician as opposed to a physical therapist, although this finding was not statistically significant (6.0 vs. 2.5 days; p = 0.203). This supports previous literature showing a beneficial effect of health care management that involves physical therapists, especially those with expertise in dance injuries, on outcomes from dance injuries sustained by adult dancers.

Objectives: The lockdown during the COVID-19 crisis deprived the majority of patients who had undergone ACL surgery of access to their physical therapist. The objective of the study was to analyze the benefit of using a self-rehabilitation application to combat post-ligament reconstruction flexion contracture in the absence of rehabilitation during the lockdown. Methods: We conducted a retrospective study that compared 2 groups of patients who had undergone ACL reconstruction: the "App" group that underwent surgery between 10 February and 15 March 2020 were partially or totally deprived of access to a physiotherapist due to the COVID-19 lockdown and had completed rehabilitation using a self-rehabilitation application, and the "Physio" group that underwent surgery between 16 May and 23 December 2019 and had completed rehabilitation with a physiotherapist. Results: 148 patients were included in the study: 47 in the "App" group and 101 in the "Physio" group. Mean flexion contracture 3 weeks postoperatively was 1.3° +/- 3.8 in the "App" group versus 3.3° +/- 4 in the "Physio" group (p=0.002). The rate of flexion contractures was 45% in the “App” group and 65% in the “Physio” group (p=0.025). 71.4% of the patients acquired knee locking on weight-bearing with crutches in the "App" group, compared to 40.6% in the "Physio" group (pConclusion: Our study showed that the use of a self-rehabilitation application that targets flexion contracture control and quadriceps recovery in the first 6 weeks after ACL reconstruction provides similar results to a rehabilitation protocol by an independent physiotherapist.

COVID-19 has accelerated the adoption of telehealth among various specialties, including rehabilitation. The fast-paced implementation of telerehabilitation has laid bare its challenges, providing an opportunity for innovation in order to enhance the experience of remote care. The purpose of this study sought to understand the attitudes toward telerehabilitation from physical therapist (PT) and patient perspectives. Two surveys administered to PTs, and the general patient population explored beliefs regarding telerehabilitation. There were a total of 289 participant responses in this study. There were 228 PT respondents and 61 patients who responded to the patient survey. Qualitative results describe current attitudes toward telerehabilitation. Results indicated both groups were receptive to virtual therapy sessions; however, some challenges were also reported. Current challenges and trends in utilizing telerehabilitation are further discussed.

Background: Physical therapists have a disproportionately high risk of work-related musculoskeletal disorders (WMSDs) that may be attributed to the substantial physical support and facilitation they provide during physical rehabilitation. Over the last decade, safety efforts have focused primarily on patients. To decrease the incidence and prevalence of WMSDs, health and safety hazards affecting physical therapists need to be addressed. Method: Two semi-quantitative ergonomic assessment tools, the rapid entire body assessment (REBA) and rapid upper limb assessment (RULA), were used to evaluate a physical therapist’s posture during three overground gait training sessions, which included three sit-to-stand transfers. The tools stratified the therapist’s posture into a WMSD risk level and accompanying action level. Results: The REBA stratified the therapist’s posture into the very high risk level, implement change now during the sit-to-stand transfer and high risk level, investigate and implement change soon during overground gait. The RULA stratified the therapist’s posture into action level 4, investigate and implement change immediately for both the sit-to-stand transfer and overground gait. Conclusion: Physical therapists are at high risk for WMSDs while performing sit-to-stand transfers and overground gait training. Urgent implementation of engineering and administrative controls is needed to reduce the risk of injury for physical therapists.

Background. Exercise - contributes to improved treatment-related outcomes. We reviewed characteristics of cancer patients referred for physical therapist–led exercise counseling at a comprehensive cancer center and its effects on self-reported symptoms and quality of life. Methods. Patients presenting for outpatient exercise counseling from February 2016 to May 2017 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre-encounter/post-encounter and Patient-Reported Outcomes Measurement Information System (PROMIS10) global health assessment pre-encounter. Counseling included assessment and education. ESAS individual items and subscales of physical distress (PHS), psychological distress, and global distress (GDS) were analyzed. We used paired t-tests to compare (1) ESAS symptoms pre-encounter/post-encounter and (2) ESAS and PROMIS10 scores at baseline (pre-encounter) and first follow-up. Results. Of 350 participants, most were female (77.7%), Caucasian (66.3%), and had breast cancer (43%). Baseline (pre-encounter) symptom scores (frequency; mean) included poor sleep (68.2%; 3.5), poor well-being (67.4%; 3.2), and fatigue (64.7%; 3.1). Comparing pre-encounter/postencounter ESAS outcomes, we observed statistically and clinically significant reduction in GDS (−3.32; SD = 6.52; P < .001). On follow-up, statistically and clinically significant improvements were observed for fatigue (−1.22; P = .01), GDS (−4.81; P = .01), PHS (−3.1; P = .03) and PROMIS10 global health, mental health, and physical health scores (all P

Performing independent exercises after clinical visits are crucial for patients recovering from injury. However, patients often fail to comply with physical therapist prescriptions due to lack of time and lack of appropriate feedback. The present study investigated the current medium used for prescribed exercises and compared it to mediums used in web-based applications. In Phase I, we surveyed thirteen practicing physical therapists and twenty-two patients of physical therapy. Responses suggested that video instruction of exercises and video-conference meetings between clinic visits would be beneficial to patient rehabilitation. In Phase II, with fifty-eight undergraduate participants, we examined the influence of self-efficacy and format of instructional materials on willingness to comply, satisfaction with information, and anxiety related to completing rehabilitation. We found that video with text instructions were most satisfying to students. Results are discussed with limitations of the present study and future works.

This was a qualitative study utilizing a phenomenological approach. The purpose was to determine what rehabilitation strategies physical therapists use with dancers and to discuss techniques for implementing these strategies from both the dancer's and the physical therapist's perspectives. Self-administered questionnaires were sent via email to dancers and physical therapists. Purposeful sampling was done through use of a criterion sampling method that required participants to have experienced dancer rehabilitation. Data were correlated to find common strategies and to encourage modification of current approaches. Physical therapists returned 29 surveys, while dancers returned eight. Five themes were identified in the areas of: 1. evaluation, 2. dance modification, 3. interventions, 4. education, and 5. communication. The conclusion of this study was that successful rehabilitative strategies involve ongoing evaluation that incorporates knowledge of dance technique and performance, dance-centered movement modification that is clearly defined, and an understanding of dance lingo.

The purpose of this study was to document the prevalence and characteristics of physical pain in a sample of severely obese children and adolescents. In this retrospective chart review, primary measures included current and past pain, pain intensity, and pain characteristics during a 5-minute walk test. Pain assessments for 74 patients (mean age 11.7 years; 53% female; 41% African American) were conducted by a physical therapist. Past pain was reported by 73% of the sample, with 47% reporting pain on the day of program enrollment. Although average pain intensity was moderate (M = 5.5/10), alarmingly, 42% of those with current pain reported severe pain (6/10 to 10/10). Overall, pain occurred primarily in the lower extremities and with physical activity. Patients reporting current pain had a significantly higher body mass index than those reporting no pain. These findings suggest that pain is common in severely obese youth, and furthermore, that pain should be recognized as a comorbidity of pediatric obesity. Routinely screening severely obese children and adolescents for pain presence and intensity is recommended.

Context:Information regarding the structure, composition, and function of the knee menisci has been scattered across multiple sources and fields. This review contains a concise, detailed description of the knee menisci—including anatomy, etymology, phylogeny, ultrastructure and biochemistry, vascular anatomy and neuroanatomy, biomechanical function, maturation and aging, and imaging modalities.Evidence Acquisition:A literature search was performed by a review of PubMed and OVID articles published from 1858 to 2011.Results:This study highlights the structural, compositional, and functional characteristics of the menisci, which may be relevant to clinical presentations, diagnosis, and surgical repairs.Conclusions:An understanding of the normal anatomy and biomechanics of the menisci is a necessary prerequisite to understanding the pathogenesis of disorders involving the knee.

Background: Effective treatments for chronic lateral epicondylosis have not been studied adequately. Eccentric overload exercises have been used with success for other chronic tendinopathy, mainly Achilles and patellar. Hypothesis/Purpose:: To compare a wrist extensor eccentric strengthening exercise program with a wrist extensor stretching/modality program for the treatment of chronic lateral epicondylosis. The authors hypothesized that the eccentric strengthening program would produce more favorable results than a stretching/modality program. Study Design: Prospective randomized controlled trial. Methods: Twenty-eight adults with lateral epicondylosis of greater than 4 weeks’ duration were randomized to an eccentric strengthening group or a stretching group. Exercises were taught by a physical therapist, and participants performed most of the exercises on their own at home. Pain scores with visual analog scale from 0 to 100 were obtained at baseline and then at 4, 8, 12, 16, and 20 weeks after the start of the exercise program. Results: Both groups improved their pain scores from baseline to the 4-week time point, followed by nonsignificant further decreases in pain scores thereafter. No statistically significant differences were found between the eccentric strengthening group and stretching groups at any follow-up time point. Conclusions: Despite previous reports documenting favorable results with eccentric exercises for other tendinopathy, the authors were unable to show any statistical advantage to eccentric exercises for lateral epicondylosis during these periods compared with local modalities and stretching exercises.

We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment. We compared the degree of satisfaction of patients undergoing a virtual reality (VR) therapy programme at home (Tele-VR group) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting (VR-group). The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient's movement was represented. In tele-therapy, the patient equipment was installed in their homes, connected to the hospital by four ISDN lines at a total bandwidth of 512 kbit/s. Rehabilitation data were transmitted via one line and videoconferencing via the other three. Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke, were randomized into VR or Tele-VR groups. A questionnaire was used at the end of treatment to measure each patient's degree of satisfaction. Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated, except one. In motor performance, the Tele-VR group improved significantly ( P ≤ 0.05), while the VR group showed no significant change. Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required.

This research explores the career development of men who cross over into the historically female occupation of physical therapy, drawing from a critical feminist perspective on sport, work, and the gender order. Data gathered from thirty-two semistructured interviews with early- and mid-career men indicate that a traditional emphasis on athleticism shaped men's career entry and early specialty choices. Men in physical therapy described a “good physical therapist” as displaying both stereotypically masculine and feminine traits. Although athleticism shaped men's abilities to comfortably accept alternative masculinities in the form of caring work, early-career specialty choices reinforced hegemonic patterns of occupational segregation. Implications for gender equality at work are discussed and limitations to feminist perspectives are noted.

Purpose.To evaluate the treatment outcome of the modified Ilizarov technique in infected nonunion of the femur.Methods.Between 1989 and 2002, records of 20 patients with infected nonunion of the femur treated with the modified Ilizarov technique were retrospectively reviewed. The modified Ilizarov frame was fixed after necrectomy of the dead infected bone and tissues. A proximal or distal corticotomy was performed following biological principles. For regeneration of gap, segmental transport was performed in 11 patients with a gap of more than 5 cm; acute docking followed by lengthening at the corticotomy site was performed in 9 patients with a gap of smaller than 5 cm. Mobilisation was started early with active participation of the physical therapist and the patients. Bone and functional results were measured and complications were categorised according to the Association for the Study and Application of the Method of Ilizarov guidelines.Results.The mean follow-up period was 62.8 months. Bony union and eradication of the infection was achieved in all patients except one who underwent amputation due to uncontrolled infection. Bone results were excellent in 13 patients, good in 4, fair in one, poor in one, and treatment failure (amputation) in one. Functional results were excellent in 3 patients, good in 9, fair in 3, poor in 4, and failure in one. A total of 71 complications occurred: 35 problems, 6 obstacles, and 30 true complications. The mean healing index was 38.3 day/cm (standard deviation, 1.6 day/cm).Conclusion.The Ilizarov technique is a good salvage operation for infected nonunion of the femur. Limb salvage is preferable to prosthesis if the limb is viable, adequately innervated and the patient is mentally and financially committed to save the limb.

The flexor digitorum longus, the tendon most often used for transfer in posterior tibial tendon insufficiency, is one-half to one-third the size of the posterior tibial tendon. Occasionally it may be particularly small or may have been previously used for transfer. In these cases, the senior author has felt that the addition of a transfer of the Peroneus Brevis (PBr) tendon may be helpful in maintaining sufficient tendon and muscle mass to rebalance the foot. Thirteen patients who underwent this procedure were retrospectively identified and matched by age and length of follow-up to patients who underwent a more standard tendon transfer operation minus the addition of the PBr transfer. Pain and functional status were then assessed by the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale. Each patient was tested by an independent physical therapist to evaluate inversion and eversion strength.The mean duration of follow-up was 20.6 months (12 to 34 months). The average AOFAS score of the PBr group was 75.8 compared to 71.5 for the standard control group. There was no significant difference between the groups when inversion or eversion strengths were compared. Inversion strength and eversion strength was rated good or excellent (4 or 5) in 12 out of 13 of the PBr transfer group patients. No major complications were encountered in either group. Although it does not increase inversion strength, a PBr transfer can be used to augment a small FDL without causing significant eversion weakness. This can be useful when the FDL is particularly small or in revision surgery.

The role of the physical therapist in hospice care is different from the role the therapist plays when a member of a rehabilitation team. This article will address the need for a fundamental role change and offer suggestions for ways physical therapists can contribute to the care of the hospice patient. In working with hospice patients, therapists must, for the most part, change from a controlling role to one of listener and problem-solver. In this manner; therapists can: • Assist the patient to maintain functional abilities for as long as possible; • Reduce the burden of care for the caregivers; • Assist in pain control. Physical therapists can provide hospice nurses with valuable assistance in caring for hospice patients.

Throughout the progressive stages of dementia, there is a need for an interdisciplinary team approach in the long term care of Alzheimer patients. This article describes the need for a shift in our therapeutic strategies and will address ways in which the physical therapist can positively impact Alzheimer patient care and reduce caregiver burden, whether the patient is at home or in an institution. This can be accomplished in part by: • Designing a daily exercise program; • Making modifications to the environment to decrease sensory stress andfacilitate autonomy; • Designing appropriate cues to help the patient with activities of daily living; • Evaluating home safety, equipment needs and falls prevention; and finally • Teaching safe transfers and bed-bound care.

In 1983 I was awarded a Fullbright scholarship to come to the United States, up until then I had been working as a Paediatric Physical Therapist in a Children's Hospital and in private practice.

The Rehabilitation Team at New Eng land Deaconess Hospital includes the surgical and medical attendees, the dressing nurse, physical therapist, and prosthetist. The importance of wound healing, dressings, and progressive ambulation is stressed. A study of 260 diabetic amputees gives a basis for the most appropriate post operative timing for initial exercises, ambulation, fitting of prosthesis, and training with the prosthesis.

Making music can be a vital experience for individuals of all ages and abilities, but those with physical limitations have difficulty and are often unable to participate even in therapeutic activities involving traditional instruments. Although the professions of occupational and physical therapy have long suggested devices and prostheses to aid handicapped clients in developing independent performance, it is a relatively new application in the field of music therapy. In 1954, Vally Weigl introduced music as a treatment for the physically handicapped, stating that its use can accomplish relaxation, stimulate activity, and strengthen muscles. Since then Juliette Alvin, E. Thayer Gaston, Philip Bailey, and other music therapists have documented successful techniques in using music with this population. In addition, Margaret Johnson found music to be of great value in establishing relationships between children and therapists. Renowned physical therapist Nancie Finnie first suggested simple holding and hitting tasks to be included in home management of the cerebral palsied child around 1974. Writing on exceptional children, Richard Graham charged the music specialist with modifying traditional instruments to make them playable by special populations and devising novel methods of usage. Nordoff and Robbins published melodic-percussive and rhythmic adaptations in

The concept of physical medicine is one of emphasis on and consideration of, the all-over rehabilitation needs of the patient as a whole. Those who affirm that they have a place on the team have, or should have, that same concept, and think in terms of mind and body. It is not enough to recognize that individuality exists. Each team member must understand and consciously, in a scientific manner, apply her knowledge of the psychological variables, as she would the variables of the physical structure. Consequently, throughout this paper the term therapy is used to include both the occupational therapist and the physical therapist, and very particularly, those therapists who are trained in the two areas. The viewpoint presented is of course basic to the occupational therapist and much of the reference material is familiar to her. It is with gratitude that the souces of these references are acknowledged, and any reader who is not familiar with them is strongly urged to read them in full. "There is a 4th therapist in the treatment team—namely the patient himself. He is the most important therapist in the team because his voluntary effort is the driving force of the programme. Anything that interferes with his participation will be detrimental to the programme's success." (1) The author of the article from which this statement has been taken describes his paper as a brief discussion of assessment of the injured workman. The reader who is discriminating and experienced cannot fail to see a far broader implication which, in the last analysis, is fundamental in principle to every field of disability.

The treatment program for speech and reading disorders employed by the Institutes for the Achievement of Human Potential is discussed and relevant research and opinion cited. Questions related to the viability of the theoretical formulations and efficacy of the treatment procedures are raised. The authors conclude that the theory of neurological organization and the remedial principles based on that theory are scientifically unsubstantiated. In 1959 C. H. Delacato wrote the Treatment and Prevention of Reading Problems. This book, along with a book which appeared four years later, The Diagnosis and Treatment of Speech and Reading Problems (Delacato, 1963), outlined an approach to the diagnosis and treatment of brain-injured children which has generated considerable controversy and is generally known as the theory of "neurological organization." This approach was developed at the Institutes for the Achievement of Human Potential by Delacato and physical therapist, G. J. Doman, and was based largely on the work of the Philadelphia neurologist, Temple Fay (1955). The earlier historical roots of Delacato's approach lie with the work of Samuel T. Orton (1937) and his theory of hemispheric dominance and laterality as related to reading and language disorders. According to Orton's view it is necessary for the left hemisphere to be sufficiently dominant in language functioning to suppress interference from the right hemisphere in order to prevent confusion in oral language and reading. When dominance is incomplete the confusion is most evident in letter and word reversals which he called strephosymbolia (twisted symbols). However, while Orton's theory did encourage motor activities of the right side (contralateral to the language hemisphere) in order to enhance left hemisphere dominance, his approach to remediation of reading and language disorders was quite unlike Delacato's. Working in collaboration with Orton, Anna Gillingham developed a remedial program (Gillingham & Stillman, 1968) that employed a synthetic phonic approach in direct academic instruction. The heavy motoric emphasis in remediation seen in Delacato's approach was not employed by Orton.