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A prognosis is a broad statement that predicts a patient's likely status, or degree of change, at some time in the future. (1-4) At the level of the individual, a [...], 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.

A 2003 report by the US Census Bureau estimated that 45 million people in the US population speak a language other than English in the home. (1) Within this group, [...], 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.

In the current health care environment, physical therapists are faced with the challenge of practicing in an increasingly competitive marketplace. The rapidly growing number of practicing physical therapists and the [...], 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. Key Words: Patient satisfaction, Physical therapy, Survey development.

Key Words: Back pain, Degenerative disk disease, Diagnosis, Intervertebral disk, Magnetic resonance imaging. The clinical manifestations of low back pain (LBP) result from a complex interaction of biologic, psychologic, and [...], The purpose of this article is to provide an overview of the general principles of lumbar magnetic resonance imaging (MRI), including signal generation and image interpretation. Additionally, a discussion of the clinical usefulness as it relates to lumbar MRI is presented using degenerative disk disease as an example. Lumbar MRI provides high-resolution, multiaxial, multiplanar views that have high contrast between soft tissues. Obtaining these images in vivo creates minimal risk for patients and provides examiners with an excellent mechanism to study anatomic detail and the biochemical composition of the lumbar spine. Different tissue characteristics known as [T.sub.1], [T.sub.2], and proton density may be accentuated, allowing examiners to detect variations in tissue shape and hydration that may correspond to disease processes. There is strong agreement that lumbar MRI is indicated for the evaluation of patients with risk factors for neoplastic or infectious disorders or in persons with coexisting evidence of neurologic impairment. The utilization of lumbar MRI in patients with low back pain (LBP), however, is controversial. Lumbar MRI has a high technical capacity to detect degenerative disk disease, bulging and herniated disks, and distortions in the thecal sac or nerve roots associated with these conditions. The diagnostic accuracy, however, of most lumbar anatomic impairments related to the symptoms of LBP is low or unknown. Although lumbar MRI remains as an excellent tool to study morphology, findings must be related to data from clinical examinations to provide meaningful judgments. [Beattie PF, Meyers SP. Magnetic resonance imaging in low back pain: general principles and clinical issues. Phys Ther. 1998;78:738-753.]

Key Words: Back pain, Magnetic resonance imaging Muscle strength, Physical activity, Twins. Exercises for the paraspinal and abdominal muscles are common elements of treatment regimens for patients with low back [...], Background and Purpose. The purpose of this study was to investigate the general magnitude and relative contributions of anthropometric, lifestyle, and medical history factors and familial aggregation (combined effects of genes and early environment) as determinants of paraspinal muscle cross-sectional area (CSA). Subjects. The subjects were 65 pairs of male monozygotic twins aged 35 to 65 years (X=49, SD=8). Methods. Study methods included magnetic resonance imaging, percentage body fat determination, and a detailed interview. Results. Most of the anthropometric factors were associated with the CSAs. Familial aggregation was the strongest determinant, however, explaining 66% to 73% of the variance in the outcomes beyond what age alone predicted. Levels of occupational, sport, and leisure-time physical activities reported by the subjects had negligible effects. Conclusion and Discussion. The CSAs of the paraspinal muscles were influenced more by some combination of genes and early environmental factors than by anthropometric factors and lifestyle choices in adulthood. [Gibbons LE, Videman T, Battie MC, Kaprio J. Determinants of paraspinal muscle cross-sectional area in male monozygotic twins. Phys Ther. 1998;78:602-612.]