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Background and Purpose. The purpose of this study was to examine the physical impairments and functional limitations of individuals with total knee arthorplasty (TKA), as compared with individuals with no diagnosed knee disease (control subjects). Subjects. Twenty-nine individuals 1 year following TKA (13 women, 16 men) and 40 age- and gender-matched control subjects (18 women, 22 men) were assessed. Methods. Walking speed, stair-climbing ability, knee torque (in newton-meters), and total work performed during 15 repeated contractions were evaluated. Results. Walking speeds for men with TKA were 13% and 17% slower at normal and fast speeds, respectively. Their stair-climbing ability was even more compromised (51% slower). Walking speeds for women with TKA were 17% and 18% slower at normal and fast speeds, respectively. Similarly, their stair-climbing time was more compromised (43% slower). Men with TKA were 37% to 39% weaker and performed 36% to 37% less total work of their knee extensors compared with the control subjects. Similarly, women with TKA had knee extensor strength deficits of 28% to 29% and performed 24% less total work. Conclusion and Discussion. One year after TKA, marked physical impairments and functional limitations persisted. [Walsh M, Woodhouse LJ, Thomas SG, Finch E. Physical impairments and functional limitations: a comparison of individual 1 year after total knee arthorplasty with control subjects. Phys Ther. 1998;78;248-258.], In North America and in other industrialized nations, the high pervalence of osteoarthritis (OA) of the knee[1-3] and OA's severe impact on disability have been well documented.[4] When conservative management [...]

Background and Purpose. The Roland-Morris Questionnaire (RMQ) is a self-administered disability measure in Which greater levels of disability are reflected by higher numbers on a 24-point scale. The RMQ has been shown to yield reliable measurements, which are valid for inferring the level of disability, and to be sensitive to change over time for groups of patients with low back pain. Little is known about the usefulness of this instrument in aiding decision making regarding individual patients. The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients. Subjects. The study sample consisted of 60 outpatients with low back pain. Methods. The RMQ was administered at the subjects' initial visit and again 4 to 6 weeks later. Conditional standard errors of measurement (CSEMs) were computed for initial and follow-up RMQ scores, and these values were used to estimate the minimum level of detectable change. Results. Minimum levels of detectable change at the 90% confidence level varied from 4 to 5 RMQ points. Conclusion and Discussion. The magnitude of CSEMS is sufficiently small to detect change in patients with initial scores in the central portion of the scale (4-20 RMQ points); however, the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20. [Stratford PW, Binkley J, Solomon P, et al. Defining the minimum level of detectable change for the Roland-Morris Questionnaire. Phys Ther. 1996;76:359-365., Physical therapists regularly use measurements (eg, of range of motion, pain, or disability) to determine whether a patient's status has changed over time. Often, when the results differ from one [...]

Background and Purpose. A survey of expert orthopedic physical therapists was conducted to assist in the development of a classification system for patients with low back pain (LBP). The goal of the survey was to measure levels of agreement on labels and accompanying constellations of signs and symptoms for subgroups of patients with LBP. Subjects. Twenty-four of the 30 expert orthopedic physical therapists who were originally contacted responded to the survey request. Methods. A modified Delphi technique was used. The first stage involved a review of the literature and identification of 25 diagnostic classes of LBP. Experts were asked to rate the "appropriateness" of each diagnostic class for inclusion in a classification scheme. Clinical findings relevant to each diagnostic class were identified and rated on the degree of "essentialness" to that class. Results. Three diagnostic classes--hypomobility dysfunction, nerve root adhesion, and sacroiliac hypermobility--were distinct in that the agreement criteria for the appropriateness of diagnostic classes as well as the surveyed essential signs and symptoms were met. Six of the 25 diagnostic classes did not meet the minimum levels required for agreement as appropriate diagnostic classes facet syndrome, chronic pain behavior, muscle strain, iliolumbar ligament sprain, posterior ligament sprain, and myofascial dysfunction. Conclusion and Discussion. The importance of developing homogeneous subgroups of patients with LBP based on constellations of reliable clinical findings is emphasized. [Binkley, Finch E, Hall J et al. Diagnostic classification of patients with low back pain: report on a survey of physical therapy experts. Phys Ther. 1993;73:138-155.], Key Words: Delphi technique, Diagnosis, Low back pain, Lumbar spine, Syndromes. The percentage of the population that will experience back pain at some point in their lives is estimated to [...]

The Movement Continuum Theory (MCT), published in 1995, (1) built on Hislop's notion of pathokinesiology. (2) Our intent was to stimulate discussion and debate about theory in physical therapy. Although [...]

Some studies have shown a relationship between trunk muscle strength and low back pain. Measures of trunk muscle strength and endurance, which are feasible in the clinical setting, are needed. The purpose of this study was to determine interrater reliability of 6 tests of abdominal and trunk extensor muscle strength and endurance. The tests included abdominal and extensor dynamic endurance, hand-held dynamometry of isometric flexion and extension, and abdominal and extensor static endurance. Thirty-nine healthy workers were recruited as subjects. Each was tested by 3 raters on 3 days within 1 week. Intraclass correlation coefficients (ICC) and the standard error of measurement (SEM) were calculated: abdominal dynamic endurance ICC = .89, SEM = 8 repetitions; extensor dynamic endurance ICC = .78, SEM = 9 repetitions; abdominal isometric force ICC = .25, SEM = 60 N; extensor isometric force ICC = .24, SEM = 68 N; abdominal static endurance ICC = .51, SEM = 35 seconds; extensor static endurance ICC = .59, SEM = 20 seconds. The dynamic endurance tests had acceptable interrater reliability. For the others, reliability was poor and the SEMs were large. J Orthop Sports Phys Ther. 1997;26(4):200-208.

The author discusses the factors that feed the perception of small and medium sized enterprises (SMEs) as being more innovative than large companies, citing the similarities and differences between SMEs and big companies in terms of innovation.

The author discusses the importance of digital technology for data collection and storage. According to the author, data is a vital part of the decision making process of designers and engineers; and information should be presented in a way that it can be understood by people who are not technical experts. The author says that data from sources such as smart ticketing and satellite navigation can create an insightful picture.

The article presents the author's views on scenario planning in Great Britain. Topics discussed include how digital engineering will change the construction industry design buildings and structures; argument that cheap fossil fuels could slow down investment in renewable energy in the country; and how cheap energy could support an increase in British manufacturing.

The author reflects on the impact of technological innovations in the construction industry citing reference to the use of three dimensional (3D) printed, self-healing and composite materials to create lightweight structures and printing buildings with 3D printers.

In this article the author focuses on innovation in engineering and comments that since engineers know how to solve problems naturally they can easily become innovators by having confidence in themselves.