Monday, May 18, 2009

Interventions Associated With an Increased or Decreased Likelihood of Pain Reduction and Improved Function in Patients With Adhesive Capsulitis:

Dianne V Jewell, Daniel L Riddle and Leroy R Thacker

DV Jewell, PT, DPT, PhD, CCS, is Assistant Professor, Department of Physical Therapy, Virginia Commonwealth University, 1200 E Broad St, Suite 100, PO Box 980224, Richmond, VA 23298-0224 (USA).
DL Riddle, PT, PhD, FAPTA, is Otto D. Payton Professor, Department of Physical Therapy, Virginia Commonwealth University.
LR Thacker, PhD, is Assistant Professor, Department of Biostatistics, Virginia Commonwealth University.

Address all correspondence to Dr Jewell at:

Background and Purpose: The purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health, pain, and function for patients diagnosed with adhesive capsulitis.

Participants: Data were examined from 2,370 patients (mean age=55.3 years, SD=12.4; 65% female, 35% male) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy.

Methods: Principal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care. A nested logistic regression model was used to identify intervention categories that predicted a 50% or greater change in Physical Component Summary-12 (PCS-12), physical function (PF), bodily pain (BP), and hybrid function (HF) scores.

Results: None of the patients achieved a 50% or greater improvement in PCS-12 scores. Improvement in BP scores was more likely in patients who received joint mobility interventions (odds ratio=1.35, 95% confidence interval=1.10–1.65). Improvement in HF scores was more likely in patients who received exercise interventions (odds ratio=1.50, 95% confidence interval=1.03–2.17). Use of iontophoresis, phonophoresis, ultrasound, or massage reduced the likelihood of improvement in these 3 outcome measures by 19% to 32%.

Limitations: The authors relied on clinician-identified ICD-9 coding for the diagnosis. Impairment measures were not available to support the diagnosis, and some interventions were excluded because of infrequent use by participating therapists.

Discussion and Conclusions: These results are consistent with findings from randomized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis. Ultrasound, massage, iontophoresis, and phonophoresis reduced the likelihood of a favorable outcome, which suggests that use of these modalities should be discouraged.

Surplus Value of Hip Adduction in Leg-Press Exercise in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Surplus Value of Hip Adduction in Leg-Press Exercise in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial
Chen-Yi Song, Yeong-Fwu Lin, Tung-Ching Wei, Da-Hon Lin, Tzu-Yu Yen and Mei-Hwa Jan

CY Song, PT, MS, is a PhD student, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
YF Lin, MD, PhD, is Orthopedic Surgeon, Department of Orthopedics, West Garden Hospital, Taipei, Taiwan.
TC Wei, PT, MS, is Physical Therapist, Yeong-An Clinic, Taipei, Taiwan.
DH Lin, MD, is Orthopedic Surgeon, Department of Orthopedics, En Chu Kong Hospital, Taipei, Taiwan.
TY Yen, PT, MS, is Physical Therapist, Yeong-An Clinic.
MH Jan, PT, MS, is Associate Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F, No. 17, Xuzhou Rd, Zhongzheng District, Taipei 100, Taiwan, Republic of China.

Address all correspondence to Ms Jan at:

Background: A common treatment for patients with patellofemoral pain syndrome (PFPS) is strength (force-generating capacity) training of the vastus medialis oblique muscle (VMO). Hip adduction in conjunction with knee extension is commonly used in clinical practice; however, evidence supporting the efficacy of this exercise is lacking.

Objective: The objective of this study was to determine the surplus effect of hip adduction on the VMO.

Design: This study was a randomized controlled trial.

Setting: The study was conducted in a kinesiology laboratory.

Participants: Eighty-nine patients with PFPS participated.

Intervention: Participants were randomly assigned to 1 of 3 groups: hip adduction combined with leg-press exercise (LPHA group), leg-press exercise only (LP group), or no exercise (control group). Training consisted of 3 weekly sessions for 8 weeks.

Measurements: Ratings of worst pain as measured with a 100-mm visual analog scale (VAS-W), Lysholm scale scores, and measurements of VMO morphology (including cross-sectional area [CSA] and volume) were obtained before and after the intervention.

Results: Significant improvements in VAS-W ratings, Lysholm scale scores, and VMO CSA and volume were observed after the intervention in both exercise groups, but not in the control group. Significantly greater improvements for VAS-W ratings, Lysholm scale scores, and VMO volume were apparent in the LP group compared with the control group. There were no differences between the LP and LPHA groups for any measures.

Limitations: Only the VMO was examined by ultrasonography. The resistance level for hip adduction and the length of intervention period may have been inadequate to induce a training effect.

Conclusions: Similar changes in pain reduction, functional improvement, and VMO hypertrophy were observed in both exercise groups. Incorporating hip adduction with leg-press exercise had no impact on outcome in patients with PFPS.

Wednesday, September 17, 2008

Research shows physical therapy as effective as arthroscopic knee surgery ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery

ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery for osteoarthritis of the knee should encourage patients to consider physical therapy as an effective non-surgical option, according to the American Physical Therapy Association (APTA). The study was published in the September 11 issue of the New England Journal of Medicine (NEJM).

According to Eurekalert, the news service of the American Association for the Advancement of Science, the study found that physical therapy, combined with comprehensive medical management, is just as effective at relieving the pain and stiffness of moderate to severe osteoarthritis of the knee as surgery.

"This study offers hope and encouragement to persons with osteoarthritis who would like to avoid the pain and emotional toll of surgery," said APTA President R. Scott Ward, PT, PhD. "Too often, the first line of defense is surgery when it need not always be. Physical therapy can be equally effective and should be considered by not only patients themselves, but also the primary care doctors and orthopedists who are treating them."

According to physical therapist Christopher M Powers, PhD, PT, director of the Biokinesiology program and co-director of the Musculoskeletal Biomechanics Research Lab at the University of Southern California Division of Biokinesiology & Physical Therapy, "Many times knee pain is associated with abnormal movement patterns that cause increased stress on the joint. Arthroscopic surgery does little to correct the dynamic factors that may be contributing to knee pain and pathology. These findings reinforce the need for a comprehensive treatment approach for such patients."

The NEJM study adds to a growing body of evidence supporting physical therapy for treatment of osteoarthritis of the knee, including:

A report published in the January 2008 issue of the journal Physical Therapy that reviewed research on osteoarthritis of the knee from 2000 to 2007 and found "high-quality evidence that exercise and weight reduction reduce pain and improve physical function."

A study published in the Feb 1, 2000 issue of the Annals of Internal Medicine that concluded "a combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention."

A physical therapist will perform a thorough examination and design a plan of care that may include:

A series of exercises designed to help improve motion. Activities in this phase might include water walking, swimming, and flexibility exercises.

An exercise sequence to restore strength including a functional progression, that is, a gradual return to normal activities using exercises that simulate the knee stresses of your normal activities.

A knee's tolerance for stressful activities often decreases with age and loss of conditioning. As a result, stresses that would not have caused pain or injury to the knee last year could today. A decrease in levels of activity over a period of time may also contribute to the vulnerability of knees.

But there are steps one can take to help prevent injury in order to continue enjoying sports and exercise. Pursuing an exercise program designed by a physical therapist can be one of the best protections from injury.

The first step in designing your exercise program is an evaluation by your physical therapist. He or she can identify your predisposing factors, those body traits that may make you more or less vulnerable to a knee injury. Based on this evaluation, your physical therapist can design a program that will help you gain your optimum levels of function, strength and conditioning.