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The demand for total joint arthroplasty (TJA) is increasing each year because of our aging population and the impact of obesity. To address this issue, there has been a focus [...], Background: Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine if farther mobilization on POD0 led to shorter length of stay and to identify the predictors of farther mobilization and length of stay. Methods: A retrospective chart review was undertaken using data for patients who had a primary TJA and mobilized on POD0. Patients were categorized into the following 4 mobilization groups: sat on the bedside (Sat), stood by the bed or walked in place (Stood), walked in the room (Room) and walked in the hall (Hall). The primary outcome was length of stay. Predictors of farther mobilization on POD0 and length of stay were identified using regression analyses. Results: The sample comprised 283 patients. The Hall group had significantly shorter length of stay than all other groups. There were sex differences across the mobilization groups. Simultaneous regression analysis showed that farther mobilization was predicted by younger age, male sex, lower body mass index, spinal anesthesia and fewer symptoms limiting mobilization. Hierarchical regression showed that shorter length of stay was predicted by male sex, lower body mass index, lower American Society of Anaesthesiologists physical status classification score, less pain/stiffness and farther mobilization on POD0. Conclusion: Understanding the modifiable and nonmodifiable predictors of mobilization after TJA and length of stay can help identify patients more likely to mobilize farther on the day of surgery, which would contribute to better resource allocation and discharge planning. Focusing on symptom management could increase opportunities for farther mobilization on POD0 and thereby decrease length of stay. Contexte: La mobilisation le jour meme d'une arthroplastie totale (AT) est associee a une duree d'hospitalisation reduite. Or, le lien entre l'ampleur de la mobilisation le jour de la chirurgie (jour postoperatoire 0 JPO0]) et la reduction de la duree d'hospitalisation n'a pas ete largement etudie. La presente etude visait a determiner si une mobilisation plus importante au JPO0 reduit la duree d'hospitalisation, de meme qu'a reperer les facteurs predictifs de mobilisation importante et de duree d'hospitalisation. Methodes: Une analyse retrospective a ete menee a l'aide des dossiers de patients ayant subi une AT primaire et ayant ete mobilises au JPO0. Les patients ont ete classes en 4 groupes en fonction de l'ampleur de leur mobilisation: assis au bord du lit (assis), debout a cote du lit ou marche sur place (debout), marche dans la chambre (chambre) et marche dans le couloir (couloir). Le principal resultat a l'etude etait la duree d'hospitalisation. Les facteurs predictifs de mobilisation importante au JPO0 et de duree d'hospitalisation ont ete degages au moyen d'analyses de regression. Resultats: L'echantillon comprenait 283 patients. Le groupe couloir presentait une duree d'hospitalisation significativement plus courte que les autres. Des differences entre les sexes ont ete observees dans tous les groupes. Selon une analyse de regression simultanee, les facteurs predictifs de mobilisation importante etaient un jeune age, le sexe masculin, un faible indice de masse corporelle, une anesthesie rachidienne et un nombre limite de symptomes nuisant a la mobilisation. Une analyse de regression hierarchique a quant a elle montre que les facteurs predictifs de duree hospitalisation reduite etaient le sexe masculin, un faible indice de masse corporelle, un faible score a la classification de l'etat de sante physique de l'American Society of Anesthesiologists, une douleur ou des raideurs moindres, et une mobilisation importante au JPO0. Conclusion: La mise en evidence des facteurs predictifs modifiables et non modifiables de mobilisation et de duree d'hospitalisation apres une AT peut faciliter le reperage des patients susceptibles d'etre davantage mobilises, ce qui contribuerait a une meilleure allocation des ressources et faciliterait la planification des conges. Accorder une attention particuliere au soulagement des symptomes pourrait accroitre les occasions de mobilisation importante au JPO0 et, par consequent, reduire la duree d'hospitalisation.

Background: Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations [...]

Several approaches have been developed and implemented to use virtual reality for rehabilitation of walking for people poststroke. The purpose of this article is to compare and contrast these approaches [...]

The purpose of this article is to present the Kinesio[R] taping method used to improve the upper extremity function in the adult with hemiplegia. The article discusses various therapeutic methods [...]

To provide recommendations based on the best scientific evidence available about 'best practices,' the New York State Department of Health Early Intervention Program sponsored the development of an evidence-based clinical practice guideline for assessment and intervention for young children with motor disabilities. The author served on the multidisciplinary consensus panel convened to develop the guideline, holding a position as a parent of a child with motor disabilities, and in addition utilizing data from her qualitative anthropological research on mothers of young children newly diagnosed with disabilities. This article describes the state panel's process for developing the guideline, focusing on recommendations about physical therapy interventions for cerebral palsy. Although evidence-based practice privileges randomized clinical trials, few studies of physical therapy techniques for young children with motor disabilities meet such criteria for evidence. The panel's recommendations, in the absence of such scientific evidence, are analyzed in comparison with competing theories of motor development in physical therapy research and practice, and with interpretations of physical therapy held by mothers of young children with disabilities who were interviewed in the study. The article explores questions of what constitutes evidence in three arenas: (1) clinical practice guidelines, (2) physical therapy research, and (3) the lives of families of young children with motor disabilities. It has broader implications for understanding how information, variously derived, is transformed into evidence. While to some extent authority and power affect the range of knowledge that can be transformed into evidence, the more significant constraints may be the rules of evidence we value and the particular paradigm of our science. Keywords: US; Evidence-based practice; Clinical practice guidelines; Physical therapy; Disability; Early intervention; Children

The purpose of this review is to analyze the research literature that has examined the effectiveness of physical therapy in the management of hip fractures in elderly persons. Using literature databases and keywords, we located relevant studies. Fifteen studies met the criteria and were then categorized according to Sackett's levels of evidence. Six studies were graded at level I, six at level II, and three at level V, with level I having the highest level of evidence. From the levels of evidence, one grade A, three grade B, and two grade C recommendations were developed, with grade A being the most significant recommendation. Clinical recommendations are offered about patients with dementia, therapeutic exercise, and when and for how long rehabilitation should continue. In addition, future research directions are provided.

Byline: G. Ntoumenopoulos (1), J. Presneill (3), M. McElholum (2), J. Cade (3) Keywords: Artificial respiration Pneumonia Physical therapy Respiratory tract infections Abstract: Abstract Objective. Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. Design. Prospective controlled systematic allocation trial. Setting. Tertiary teaching hospital ICU. Patients and participants. Sixty adult patients intubated and mechanically ventilated for at least 48 h. Interventions. Chest physiotherapy (intervention group) or sham physiotherapy (control group). Measurements and results. Control and intervention groups were well matched for age, sex, and admission PaO.sub.2/FiO.sub.2 ratio, APACHE II score, and Glasgow Coma Score. There were no differences in the duration of mechanical ventilation, length of stay in ICU or mortality. VAP was assessed daily by combined clinical assessment and the clinical pulmonary infection score (CPIS). VAP occurred in 39% (14/36) of the control group and 8% (2/24) of the intervention group (OR=0.14, 95% CI 0.03 to 0.56, P=0.02). After adjustment was made by logistic regression for other important variables (APACHE II score, duration of mechanical ventilation, presence of tracheostomy, and GCS score), chest physiotherapy was independently associated with a reduced occurrence of VAP (adjusted OR=0.16, 95% CI 0.03 to 0.94, P=0.02). Conclusions. In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial. Author Affiliation: (1) Physiotherapy Department, The Alfred, Commercial Rd, Prahran 3181, Australia (2) Physiotherapy Department, The Royal Melbourne Hospital, Victoria 3050, Australia (3) Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia Article History: Received Date: 13/12/2001 Accepted Date: 12/02/2002 Article note: Electronic Publication