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Background. Many bibliographic databases index research studies evaluating the effects of health care interventions. One study has concluded that the Physiotherapy Evidence Database (PEDro) has the most complete indexing of reports of randomized controlled trials of physical therapy interventions, but the design of that study may have exaggerated estimates of the completeness of indexing by PEDro. Objective. The purpose of this study was to compare the completeness of indexing of reports of randomized controlled trials of physical therapy interventions by 8 bibliographic databases. Design. This study was an audit of bibliographic databases. Methods. Prespecified criteria were used to identify 400 reports of randomized controlled trials from the reference lists of systematic reviews published in 2008 that evaluated physical therapy interventions. Eight databases (AMED, CENTRAL, CINAHL, EMBASE, Hooked on Evidence, PEDro, PsycINFO, and PubMed) were searched for each trial report. The proportion of the 400 trial reports indexed by each database was calculated. Results. The proportions of the 400 trial reports indexed by the databases were as follows: CENTRAL, 95%; PEDro, 92%; PubMed, 89%; EMBASE, 88%; CINAHL, 53%; AMED, 50%; Hooked on Evidence, 45%; and PsycINFO, 6%. Almost all of the trial reports (99%) were found in at least 1 database, and 88% were indexed by 4 or more databases. Four trial reports were uniquely indexed by a single database only (2 in CENTRAL and 1 each in PEDro and PubMed). Limitations. The results are only applicable to searching for English-language published reports of randomized controlled trials evaluating physical therapy interventions. Conclusions. The 4 most comprehensive databases of trial reports evaluating physical therapy interventions were CENTRAL, PEDro, PubMed, and EMBASE. Clinicians seeking quick answers to clinical questions could search any of these databases knowing that all are reasonably comprehensive. PEDro, unlike the other 3 most complete databases, is specific to physical therapy, so studies not relevant to physical therapy are less likely to be retrieved. Researchers could use CENTRAL, PEDro, PubMed, and EMBASE in combination to conduct exhaustive searches for randomized trials in physical therapy., Evidence-based practice involves the integration of the best research evidence with clinical expertise and patient values to make optimal health care decisions for individual patients. (1) An evidence-based approach requires [...]

Objective. The objective of this study was to identify core journals in physical therapy by identifying those that publish the most randomized controlled trials of physical therapy interventions, provide the highest-quality reports of randomized controlled trims, and have the highest journal impact factors. Design. This study was an audit of a bibliographic database. Methods. All trials indexed in the Physiotherapy Evidence Database (PEDro) were analyzed. Journals that had published at least 80 trials were selected. The journals were ranked in 4 ways: number of trials published; mean total PEDro score of the trials published in the journal, regardless of publication year; mean total PEDro score of the trials published in the journal from 2000 to 2009; and 2008 journal impact factor. Results. The top 5 core journals in physical therapy, ranked by the total number of trials published, were Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Spine, British Medical Journal (BMJ), and Chest. When the mean total PEDro score was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, Journal of the American Medical Association (JAMA), Stroke, Spine, and Clinical Rehabilitation. When the mean total PEDro score of the trials published from 2000 to 2009 was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, JAMA, Lancet, BMJ, and Pain. The most highly ranked physical therapy-specific journals were Physical Therapy (ranked eighth on the basis of the number of trials published) and Journal of Physiotherapy (ranked first on the basis of the quality of trials). Finally, when the 2008 impact factor was used for ranking, the top 5 journals were JAMA, Lancet, BMJ, American Journal of Respiratory and Critical Care Medicine, and Thorax. There were no significant relationships among the rankings on the basis of trial quality, number of trials, or journal impact factor. Conclusions. Physical therapists who arc trying to keep up-to-date by reading the best available evidence on the effects of physical therapy interventions have to read more broadly than just physical therapy-specific journals. Readers of articles on physical therapy trials should be aware that high-quality trials are not necessarily published in journals with high impact factors., Evidence-based practice is now a central element of contemporary physical therapist practice. (1) Consistent application of evidence-based recommendations is advocated as an important and necessary step for improving the quality [...]

Background. There is limited information on the clinimetric properties of questionnaires of activity limitation in people after ankle fracture. Objective. The purpose of this study was to investigate the clinimetric properties of the Lower Extremity Functional Scale, an activity limitation questionnaire, in people with ankle fracture. Design. This was a measurement study using data collected from 2 previous randomized controlled trials and 1 inception cohort study. Methods. Participants with ankle fracture (N=306) were recruited within 7 days of cast removal. Data were collected at baseline and at short- and medium-term follow-ups. Internal consistency and construct validity were assessed using Rasch analysis. Concurrent validity, responsiveness, and floor and ceiling effects were evaluated. Results. The Lower Extremity Functional Scale demonstrated high internal consistency (α>.90). The variance in activity limitation explained by the items was high (98.3%). Each item had a positive correlation with the overall scale, and most items supported the unidimensionality of the scale. These findings suggest that the scale has high internal consistency and construct validity. The scale also demonstrated high concurrent validity and responsiveness in the short term and no floor or ceiling effects. However, the scale would benefit from more-challenging items, as evident at the medium-term follow-up. Limitations. This was a secondary analysis of existing data sets. Conclusion. The Lower Extremity Functional Scale is a useful tool to monitor activity limitation in people with ankle fracture up to the short-term follow-up. More-difficult items may need to be added to improve the responsiveness of the scale for longer-term follow-up., The Lower Extremity Functional Scale is a measure of activity limitation developed for musculoskeletal conditions of the lower extremity. (1) On this scale, participants rate the difficulty in performing 20 [...]

On 'Identifying items to assess methodological quality ...' Armio-Olivo A, Cummings GC, Fuentes J, et al. Phys Ther. 2014;94:1272-1284. We would like to respond to the statement by Armijo-Olivo and [...]

This perspective provides an overview of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy. Data from the Physiotherapy Evidence Database (PEDro) are used to describe key events in the history of physical therapy research and the growth of evidence of effects of interventions used in the various subdisciplines of physical therapy. The 11,494 records that were identified reveal a rich history of physical therapy research dating back to the first trial in 1929. Most of the randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physical therapy have been published since the year 2000. This rapid growth presents a challenge for physical therapists who want to keep up to date in clinical practice., Several physical therapy associations (1-3) now explicitly advocate an approach to practice that is informed by scientific evidence. This approach, however, presents a number of challenges to practitioners. One key [...]

Although there is a growing awareness of evidence-based practice among physical therapists, implementation of evidence-based practice has proved difficult. This article discusses barriers to access and interpretation of evidence. Some solutions are offered, including facilitating the publication of all research, use of an optimum format for reporting research, maximizing the efficient use of electronic databases, improving physical therapists' skills in critical appraisal of published research, and fostering consumer access to evidence. These strategies and others discussed in the article might facilitate implementation of evidence-based physical therapy. Key Words: Evidence-based practice., Evidence-based practice is defined as the "integration of the best research evidence with clinical expertise and patient values." (1(pl)) Within the international physical therapy community there is growing acceptance of [...]

Background and Purpose. Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. Method. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). Results. The kappa value for each of the 11 items ranged from .36 to .80 for individual assessors and from .50 to .79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was .56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was .68 (95% confidence interval=.57-.76). Discussion and Conclusion. The reliability of ratings of PEDro scale items varied from 'fair' to 'substantial,' and the reliability of the total PEDro score was 'fair' to 'good.' [Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713-721.] Key Words: Evidence-based medicine, Meta-analysis, Physical therapy, Randomized controlled trials., Systematic reviews of randomized controlled trials (RCTs) are considered by some authors (1-3) to constitute the best single source of information about the effectiveness of health care interventions. Most systematic [...]

Background and Purpose. Ankle plantar-flexion contractures are a common problem following traumatic head injury. Although serial casting is used to correct and prevent ankle plantar-flexion contractures, treatment efficacy has not been evaluated using an experimental design. The aim of this research was to establish the effect of a regimen of casting combined with stretching on passive ankle dorsiflexion motion. Subjects. Nine people who had sustained traumatic closed head injuries and had limited dorsiflexion motion participated in the study. Methods. A crossover design was used in the study. Subjects were assigned to both experimental and control groups. Torque-controlled measurements of passive ankle dorsiflexion motion were obtained for all subjects before and after 1 week of casting combined with stretching, as well as before and after a 1-week control period. The order of the experimental and control conditions was randomized. Results. Passive ankle dorsiflexion increased by a mean of 13.5 degrees (SD=9.3) during the experimental condition, as compared with a mean decrease of 1.9 degrees (SD=10.2) during the control condition. The difference between the experimental and control conditions was statistically significant. Conclusion and Discussion. These findings suggest that casting combined with stretching is an effective method of correcting ankle plantar-flexion contractures in patients with traumatic head injuries. [Moseley AM. The effect of casting combined with stretching on passive ankle dorsiflexion in adults with traumatic head injuries. Phys Ther. 1997;77:240-247.], Key Words: Ankle, Contracture, Head injuries, Physical therapy, Rehabilitation. Plantar-flexion contractures are a common problem following traumatic head injury (THI). The prevalence of restricted passive ankle dorsiflexion in persons with [...]