The main purpose of this study was to quantify improvement in performance of the sit-to-stand movement of patients with a TKA.

In this prospective study of 16 patients with end-stage knee osteoarthritis followed by a TKA, the maximal knee angular extension velocity and amount of unloading (shifting weight) of the affected leg during the sit-to-stand movement and the visual analog scale score for pain were assessed preoperatively and 6 months and 1 year postoperatively. These data were compared with data for a control group of individuals who were healthy (n=27).

Before surgery, the participants in the TKA group unloaded their affected leg, but within 6 months after implantation, the affected leg was almost fully loaded again and comparable to the loading symmetry ratio of the control group. Furthermore, knee extension velocity also had increased, but remained lower than that of the control group. The changes in knee extension velocity took place during the first 6 months, after which a plateau was visible.

A potential limitation of the study design was that the patients were not perfectly matched with the control subjects.

Implantation of a total knee prosthesis partly improved performance of the sit-to-stand movement. Participants in the TKA group could fully load their operated leg, but they could not generate enough knee angular velocity during rising compared with the control group.

This study aimed to systematically and critically review available literature to ascertain whether beneficial effects of ultrasound were associated with certain shoulder pathologies or particular ultrasound treatment protocols.

Five electronic databases were searched, and the included studies, identified through pair consensus, were randomized controlled trials (RCTs) that utilized ultrasound for soft tissue shoulder injury or pain.

Eight studies included in this review (n=586 patients, median PEDro score=8.0/10) evaluated various parameters, including the duration of patients' symptoms (0–12 months), duty cycle (20% and 100%), intensity (0.1–2.0 W/cm²), treatment time per session (4.5–15.8 minutes), number of treatments (6–39), and total energy applied per treatment (181–8,152 J).

Inconsistent outcome measures among studies precluded meta-analysis; however, 3 RCTs showed statistically significant benefits of ultrasound, 2 of which examined calcific tendinitis. Studies that showed beneficial effects of ultrasound typically had 4 times longer total exposure times and applied much greater ultrasound energy per session (average of 4,228 J) compared with studies that showed no benefit of ultrasound (average of 2,019 J). No studies that delivered ≤720 J per session showed improvement in treatment groups.

Current research involving ultrasound treatment protocols that delivered low levels of ultrasound energy do not adequately address whether ultrasound can improve outcomes for shoulder disorders.

Determining whether therapeutic ultrasound can affect soft tissue shoulder pathologies will require further research and systematic reviews that involve appropriate ultrasound treatment protocols.

The purpose of this study was to identify prognostic factors from the history and physical examination in individuals with shoulder pain who are likely to experience rapid improvement in pain and disability following cervical and thoracic spine manipulation.

This was a prospective single-arm trial.

This study was conducted in outpatient physical therapy clinics.

The participants were individuals who were seen by physical therapists for a primary complaint of shoulder pain.

Participants underwent a standardized examination and then a series of thrust and nonthrust manipulations directed toward the cervicothoracic spine. Individuals were classified as having achieved a successful outcome at the second and third sessions based on their perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success.

Data for 80 individuals were included in the data analysis, of which 49 had a successful outcome. Five prognostic variables were retained in the final regression model. If 3 of the 5 variables were present, the chance of achieving a successful outcome improved from 61% to 89% (positive likelihood ratio=5.3).

A prospective single-arm trial lacking a control group does not allow for inferences to be made regarding cause and effect. The statistical procedures used may result in "overfitting" of the model, which can result in low precision of the prediction accuracy, and the bivariate analysis may have resulted in the rejection of some important variables.

The identified prognostic variables will allow clinicians to make an a priori identification of individuals with shoulder pain who are likely to experience short-term improvement with cervical and thoracic spine manipulation. Future studies are necessary to validate these findings.

The aim of this study was to discern which early postoperative functional measures could predict functional ability at 1 year and 2 years after surgery.

One hundred fifty-five people who underwent unilateral TKA participated in the prospective longitudinal study. Functional evaluations were performed at the initial outpatient physical therapy appointment and at 1 and 2 years after surgery. Evaluations consisted of measurements of height, weight, quadriceps muscle strength (force-generating capacity), and knee range of motion; the Timed "Up & Go" Test (TUG); the stair-climbing task (SCT); and the Knee Outcome Survey (KOS) questionnaire. The ability to predict 1- and 2-year outcomes on the basis of early postoperative measures was analyzed with a hierarchical regression. Differences in functional scores were evaluated with a repeated-measures analysis of variance.

The TUG, SCT, and KOS scores at 1 and 2 years showed significant improvements over the scores at the initial evaluation (P<.001). A weaker quadriceps muscle in the limb that did not undergo surgery ("nonoperated limb") was related to poorer 1- and 2-year outcomes even after the influence of the other early postoperative measures was accounted for in the regression. Older participants with higher body masses also had poorer outcomes at 1 and 2 years. Postoperative measures were better predictors of TUG and SCT times than of KOS scores.

Rehabilitation regimens after TKA should include exercises to improve the strength of the nonoperated limb as well as to treat the deficits imposed by the surgery. Emphasis on treating age-related impairments and reducing body mass also might improve long-term outcomes.

The purpose of this study was to compare knee and ankle kinematics during the swing phase of gait when FES was delivered to the ankle dorsiflexor muscles using VFTs versus CFTs.

A repeated-measures design was used in this study.

Thirteen individuals with hemiparesis following stroke (9 men, 4 women; age=46–72 years) participated in the study.

Participants completed 20- to 40-second bouts of walking at their self-selected walking speeds. Three walking conditions were compared: walking without FES, walking with dorsiflexor muscle FES using CFTs, and walking with dorsiflexor FES using VFTs.

Functional electrical stimulation using both CFTs and VFTs improved ankle dorsiflexion angles during the swing phase of gait compared with walking without FES (X±SE=–2.9°±1.2°). Greater ankle dorsiflexion in the swing phase was generated during walking with FES using VFTs (X±SE=2.1°±1.5°) versus CFTs (X±SE=0.3±1.3°). Surprisingly, dorsiflexor FES resulted in reduced knee flexion during the swing phase and reduced ankle plantar flexion at toe-off.

The findings suggest that novel FES systems capable of delivering VFTs during gait can produce enhanced correction of foot drop compared with traditional FES systems that deliver CFTs. The results also suggest that the timing of delivery of FES during gait is critical and merits further investigation.

The purposes of this study were: (1) to examine muscle strength differences in older adults with and without SCK difficulty and (2) to examine the relative contributions of trunk and leg muscle strength to SCK difficulty.

This was a cross-sectional observational study.

Community-dwelling older adults (age [X±SD]=75.5±6.0 years) with SCK difficulty (n=27) or without SCK difficulty (n=21) were tested for leg and trunk strength and functional mobility. Isometric strength at the trunk, hip, knee, and ankle also was normalized by body weight and height.

Compared with older adults with no SCK difficulty, those with SCK difficulty had significant decreases in normalized trunk extensor, knee extensor, and ankle dorsiflexor and plantar-flexor strength. In 2 separate multivariate analyses, raw ankle plantar-flexor strength (odds ratio [OR]=0.97, 95% confidence interval [CI]=0.95–0.99) and normalized knee extensor strength (OR=0.61, 95% CI=0.44–0.82) were significantly associated with SCK difficulty. Stooping, crouching, and kneeling difficulty also correlated with measures of functional balance and falls.

Although muscle groups that were key to rising from SCK were examined, there are other muscle groups that may contribute to safe SCK performance.

Decreased muscle strength, particularly when normalized for body size, predicts SCK difficulty. These data emphasize the importance of strength measurement at multiple levels in predicting self-reported functional impairment.

The aims of this research were: (1) to determine the types and extent of reflection that informs the clinical decision-making process and (2) to compare the use of reflection to direct and assess clinical decisions made by novice and experienced physical therapists.

Qualitative research methods using grounded theory were used to gain insight into how physical therapists use reflection to inform clinical decision making.

Three participant pairs (each pair consisting of one novice and one experienced physical therapist) were purposively selected from 3 inpatient rehabilitation settings. Case summaries of each participant provided the basis for within- and across-case analysis. Credibility of these results was established through member check of the case summaries, presentation of low-inference data, and triangulation across multiple data sources and within and across the participant groups.

Although all participants engaged in reflection-on-action, the experienced participants did so with greater frequency. The experienced participants were distinguished by their use of reflection-in-action and self-assessment during therapist-patient interactions. An intermediate effect beyond novice practice was observed.

The results of this study may be used by educators and employers to develop and structure learning experiences and mentoring opportunities to facilitate clinical decision-making abilities and the development of the skills necessary for reflection in students and novice practitioners.

The purposes of this study were to validate the measure in older adults with walking difficulties and to explore correlates of the curved-path walking measure not represented by a straight-path walking measure.

Fifty-one community-dwelling older adults with mobility disability participated in 2 baseline visits as part of an intervention study.

The F8W time, steps, and smoothness and measures of gait (gait speed, modified Gait Abnormality Rating Scale [GARS-M]), physical function (Late Life Function and Disabilities Index [LLFDI], Survey of Activities and Fear of Falling in the Elderly [SAFFE], Gait Efficacy Scale [GES], Physical Performance Test [PPT], and fall history), and movement control and planning (gait variability, Trail Making Test B [Trails B]) were recorded in each test session. Bivariate correlations for the F8W with each variable were conducted to examine concurrent and construct validity. Adjusted linear regression analyses were performed to explore the variance in mobility explained by F8W independent of gait speed.

Figure-of-8 Walk Test time correlated with gait (gait speed, r=–.570; GARS-M, r=.281), physical function (LLFDI function, r=–.469; SAFFE restriction subscale, r=.370; PPT, r=–.353), confidence in walking (GES, r=–.468), and movement control (step length coefficient of variation, r=.279; step width coefficient of variation, r=–.277; Trails B, r=.351). Figure-of-8 Walk Test steps correlated with step width variability (r=–.339) and was related to fear of falling (t=–2.50). All correlations were significant (P<.05).

This pilot study had a small sample size, and further research is needed.

The F8W is a valid measure of walking skill among older adults with mobility disability and may provide information complementary to gait speed.

The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain.

This was a randomized, placebo-controlled trial.

The study was conducted in an outpatient physical therapy department in Australia.

The participants were 154 patients with chronic low back pain of more than 12 weeks’ duration.

Twelve sessions of motor control exercise (ie, exercises designed to improve function of specific muscles of the low back region and the control of posture and movement) or placebo (ie, detuned ultrasound therapy and detuned short-wave therapy) were conducted over 8 weeks.

Primary outcomes were pain intensity, activity (measured by the Patient-Specific Functional Scale), and patient's global impression of recovery measured at 2 months. Secondary outcomes were pain; activity (measured by the Patient-Specific Functional Scale); patient's global impression of recovery measured at 6 and 12 months; activity limitation (measured by the Roland-Morris Disability Questionnaire) at 2, 6, and 12 months; and risk of persistent or recurrent pain at 12 months.

The exercise intervention improved activity and patient's global impression of recovery but did not clearly reduce pain at 2 months. The mean effect of exercise on activity (measured by the Patient-Specific Functional Scale) was 1.1 points (95% confidence interval [CI]=0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95% CI=0.4 to 2.5), and the mean effect on pain was 0.9 points (95% CI=–0.01 to 1.8), all measured on 11-point scales. Secondary outcomes also favored motor control exercise.

Clinicians could not be blinded to the intervention they provided.

Motor control exercise produced short-term improvements in global impression of recovery and activity, but not pain, for people with chronic low back pain. Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups.

The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception.

This study was a randomized controlled trial.

A sample of convenience was recruited from community and outpatient clinics.

Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks.

Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and A fiber–mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity.

Hypoalgesia to A fiber–mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT.

Only immediate effects of SMT were measured, so the authors are unable to comment on whether the inhibition of temporal summation is a lasting effect. Furthermore, the authors are unable to comment on the relationship between their findings and changes in clinical pain.

Inhibition of A fiber–mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area.

The purposes of this study were: (1) to determine whether social and community participation of children and youth with CP differ based on age, sex, and gross motor function, and (2) to identify the types of activities in which social and community participation are highest.

A prospective cross-sectional analytic design was used. The participants were a sample of convenience of 291 children (6–12 years of age) and 209 youth (13–21 years of age) with CP (55.4% males, 44.6% females) receiving services from 7 children's hospitals. Participants completed the Children's Assessment of Participation and Enjoyment (CAPE) by structured interview. Gross Motor Function Classification System (GMFCS) level was determined by the researchers.

Youth did a higher percentage of activities with friends and others and outside the home than children. Children and youth in level I did a higher percentage of activities with friends and others compared with children and youth in levels II and III and in levels IV and V. Children and youth in level I and in levels IV and V did a higher percentage of activities outside the home than children and youth in levels II and III. Differences were not found between females and males. The percentage of activities done with friends and others and outside the home was highest for physical and skill-based activities.

Findings cannot be attributed only to GMFCS level.

The ability to walk without restrictions is desirable for social and community participation. For children and youth with CP who have limitations in mobility, physical therapists have roles as consultants for accessibility, activity accommodations, and assistive technology and as advocates for inclusive environments.

The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates.

This study was an observational cohort design with participants assigned to groups on the basis of BMD status.

Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing.

Significant between-group differences were found for step time and stance time variability.

The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years.

Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

The aim of this study was to test the hypothesis that there exists a threshold for function of the paretic arm and hand after therapy. If function is above this threshold, spontaneous use will increase in the months following therapy. In contrast, if function is below this threshold, spontaneous use will decrease.

New computer simulations are presented showing that changes in arm use following therapy depend on a performance threshold. This prediction was tested by reanalyzing the data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) trial, a phase III randomized controlled trial in which participants received constraint-induced movement therapy for 2 weeks and were tested both 1 week and 1 year after therapy.

The results demonstrate that arm and hand function measured immediately after therapy predicts, on average, the long-term change of arm use. Above a functional threshold, use improves. Below this threshold, use decreases.

The reanalysis of the EXCITE trial data provides a "group" threshold above which a majority of patients, but not all, improve spontaneously. A goal of future research is to provide the means to assess when patients reach their individual threshold.

Understanding of the causal and nonlinear relationship between limb function and daily use is important for the future development of cost-effective interventions and prevention of "rehabilitation in vain."

The objectives of this study were to explore variability in surgeon and physical therapist assessments of the need for physical therapy in patients with traumatic lower-extremity injuries and to determine the factors associated with assessments of need.

This study was a retrospective cohort investigation.

Participants were 395 patients treated by reconstruction in the Lower-Extremity Assessment Project. They were evaluated at 8 level I trauma centers at 3, 6, and 12 months after hospitalization by an orthopedic surgeon and a physical therapist to determine the need for physical therapy. Analyses included multilevel logistic regression.

Chi-square analyses showed that surgeon and therapist assessments of need differed statistically across trauma centers. Surgeons were more likely to assess a need for therapy at 3 months when participants had low work self-efficacy, impaired knee flexion range of motion (ROM), and weight-bearing limitations and at 6 and 12 months when participants had impaired knee flexion ROM and weight-bearing and balance limitations. Therapists were more likely to assess a need for therapy at 3 months when participants had moderate to severe pain and at 6 and 12 months when participants had low work self-efficacy, pain, impaired knee flexion ROM, and balance limitations.

The results revealed variability in assessments of the need for physical therapy at the provider and trauma center levels. Differences in provider assessments highlight the need for communication and further investigation into the outcomes and timing of physical therapy for the treatment of traumatic lower-extremity injuries.

The purpose of this study was to determine whether infants born preterm and infants born at full term differed in postural control at 1 to 3 weeks after term age.

This study included 17 infants born preterm (mean gestational age=31.9 weeks, range=25.0–34.6) and 15 infants born at full term (mean gestational age=38.9 weeks, range=37.3–40.6). All infants were without diagnosed neurological or genetic conditions.

Center-of-pressure (COP) data were recorded at 5 Hz while each infant was positioned supine on a pressure-sensitive mat in an alert behavioral state. Root mean square (RMS) displacement and approximate entropy (ApEn) were used to describe the COP movement variability in the time series. Differences between groups were identified using independent t tests.

The COP time series were found to be deterministic, suggesting order in the time series. Infants born preterm exhibited significantly larger RMS values in the caudal-cephalic direction than infants born at full term (1.11 and 0.83 cm, respectively; t=–2.6, df=30, P=.01). However, infants born at full term had significantly larger ApEn values in the caudal-cephalic direction (1.19 and 1.11, respectively; t=2.4, df=30, P=.02). The 2 groups did not differ in RMS or ApEn values in the medial-lateral direction or the resultant.

Infants born at full term exhibited COP displacements in the caudal-cephalic direction that were smaller in amplitude, but may be considered more complex or less predictable, than those of infants born preterm. One explanation is that infants born preterm exhibited more stereotypic patterns of movement, resulting in large, but repetitive, COP excursions. A combination of linear and nonlinear measures may provide insight into the control of posture of young infants.

The objectives of this systematic review are: (1) to investigate whether CIMT is supported with valid research of its effectiveness and (2) to identify key characteristics of the child and intervention protocol associated with the effects of CIMT.

A search of MEDLINE (1966 through March 2009), Entrez PubMed (1966 through March 2009), EMBASE (1980 through March 2009), CINAHL (1982 through March 2009), PsychINFO (1887 through March 2009), and Web of Science (1900 through March 2009) produced 23 relevant studies.

The 2 objectives of the review were addressed by: (1) scoring the validity and level of evidence for each study and calculating evidence-based statistics, if possible, and (2) recording and summarizing the inclusion and exclusion criteria, type and duration of constraint, intervention and study durations, and outcomes based on the International Classification of Functioning, Disability and Health (ICF).

Only studies published in journals and in English were included in the systematic review.

Studies varied widely in type and rigor of design; subject, constraint, and intervention characteristics; and ICF level for outcome measures. One outcome measure at the body functions and structure level and 4 outcome measures at the activity level had large and significant treatment effects (d≥.80), and these findings were from the most rigorous studies. Evidence from more-rigorous studies demonstrated an increased frequency of use of the upper extremity following CIMT for children with hemiplegic CP. The critical threshold for intensity that constitutes an adequate dose cannot be determined from the available research. Further research should include a priori power calculations, more-rigorous designs and comparisons of different components of CIMT in relation to specific children, and measures of potential impacts on the developing brain.

The purpose of this study was to examine the effectiveness of a new interventional protocol to improve functional performance in patients who have undergone a single-level lumbar microdiskectomy.

The study was conducted in physical therapy outpatient clinics.

Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy were randomly allocated to receive education only or exercise and education.

The exercise intervention consisted of a 12-week periodized program of back extensor strength (force-generating capacity) and endurance training and mat and upright therapeutic exercises. The Oswestry Disability Index (ODI) and physical measures of functional performance were tested 4 to 6 weeks postsurgery and 12 weeks later, following completion of the intervention program. Because some participants sought physical therapy outside of the study, postintervention scores were analyzed for both an as-randomized (2-group) design and an as-treated (3-group) design.

In the 2-group analyses, exercise and education resulted in a greater reduction in ODI scores and a greater improvement in distance walked. In the 3-group analyses, post hoc comparisons showed a significantly greater reduction in ODI scores following exercise and education compared with the education-only and usual physical therapy groups.

The limitations of this study include a lack of adherence to group assignment, disproportionate therapist contact time among treatment groups, and multiple use of univariate analyses.

An intensive, progressive exercise program combined with education reduces disability and improves function in patients who have undergone a single-level lumbar microdiskectomy.

The purposes of this study were to describe patient management by physical therapists in the acute care setting and to examine variations in patient management across facilities.

This was an observational study.

Fifty clinicians practicing at 3 academic medical centers in the northeastern United States agreed to participate. Over a 2-week period, clinicians completed checklists indicating the details of patient visits. Logistic analyses, controlling for patient age and diagnosis and accounting for clustering of data, were conducted to examine the odds of patients having several categories of examinations, goals, and interventions.

Participants provided 2,364 visits to 896 patients. More than 75% of patients in each facility received examinations, goals, and interventions related to functional ability. Median number of visits per patient, duration of visits, and number of visits in which the patient was not treated varied across facilities. Patients with orthopedic conditions were more likely than those with medical/surgical conditions to receive several types of examinations, goals, and interventions. The odds of patients having examinations, goals, and interventions related to functional abilities were greater in facility 2 than in facility 1.

Limitations include the convenience sample, use of an untested data collection tool, and use of only age and diagnosis to control for case mix.

This study of physical therapist practice in 3 acute care facilities suggests that patient management focuses on functional activity. There was no clear pattern of examinations, goals, and interventions related to specific diagnoses. A small degree of variation was found in practice across the facilities.

The aim of this study was to quantify the odds of failure on the NPTE for students experiencing academic difficulty and for institutional status and Carnegie Classification.

This investigation was a retrospective population-based cohort study.

Quota sampling was used to recruit a random sample of 20 professional physical therapist education programs across the United States. Individual student demographic, preadmission, and academic performance data were collected, as were data on program-level variables and data indicating pass/fail performance on the NPTE. A generalized linear mixed-effects logistic regression model was used to adjust for confounding factors and to describe relationships among the key predictor variables—academic difficulty, institutional status, and Carnegie Classification—and the dependent variable, NPTE performance.

Academic difficulty during a student's professional training was an independent predictor for NPTE failure. The odds of students who had academic difficulty (relative to students who did not experience academic difficulty) failing the NPTE were 5.89 (95% confidence interval=4.06–8.93). The odds of NPTE failure also varied depending on institutional status and Carnegie Classification.

The findings related to Carnegie Classification and institutional status should be considered preliminary.

Student performance on the NPTE was influenced by multiple factors, but the most important, potentially modifiable risk factor for poor NPTE performance likely is academic difficulty during professional training.

The purposes of this study were: (1) to identify and analyze the common structures and processes among established ISL programs within physical therapist education programs and (2) to develop a conceptual model of optimal ISL within physical therapist education programs.

A descriptive, exploratory study was completed using grounded theory.

Telephone interviews were completed with 14 faculty members who had been involved in international service, international learning, or ISL in physical therapist education programs. Interviews were transcribed, and transcriptions were analyzed using the grounded theory method.

Four major themes emerged from the data: structure, reciprocity, relationship, and sustainability. A conceptual model of and a proposed definition for optimal ISL in physical therapist education were developed. Seven essential components of the conceptual model are: a partner that understands the role of physical therapy, community-identified needs, explicit service and learning objectives, reflection, preparation, risk management, and service and learning outcome measures. Essential consequences are positive effects on students and community.

The conceptual model and definition of optimal ISL can be used to direct development of new ISL programs and to improve existing programs. In addition, they can offer substantive guidance to any physical therapist involved in global health initiatives.

The purpose of this study was to examine the electromyographic (EMG) amplitude of the gluteus medius (GM) muscles bilaterally during forward and lateral step-up exercises.

The study design involved single-occasion repeated measures.

Twenty-seven community-dwelling adults (7 men and 20 women) with a mean (SD) age of 79.4 (8.0) years performed forward and lateral step-up exercises while the surface EMG activity of the GM muscles was recorded bilaterally. Pressure switches and dual forceplates were used to identify the ascent and descent phases. Subjects were instructed to lead with the right lower extremity during ascent and the left lower extremity during descent. Differences in normalized root-mean-square EMG amplitudes with exercise direction (forward versus lateral) and phase (ascent versus descent) were examined by use of separate repeated-measures analyses of variance for the right and left lower extremities. The alpha level was set at .05.

Gluteus medius muscle EMG activity was significantly greater for lateral than for forward step-up exercises for the left lower extremity during the ascent phase and for both lower extremities during the descent phase. In addition, right GM muscle EMG activity was significantly greater during ascent than during descent for both exercise directions.

Study limitations include use of a convenience sample and collection of limited information about participants.

Step-up exercises are effective in activating the GM muscle, with lateral step-up exercises requiring greater GM muscle activation than forward step-up exercises. Further study is needed to determine whether exercise programs for hip abductor muscle strengthening in older adults should preferentially include lateral over forward step-up exercises.

The aims of this study were to longitudinally examine supported stepping in preterm and full-term infants and to explore the step parameters associated with walking attainment.

A cohort study with a longitudinal follow-up design was used.

Twenty-nine preterm infants and 20 full-term infants were examined bimonthly with supported stepping on a treadmill from 7 months of age until walking attainment or 18 months of corrected age. The associations between step variables and walking outcome were examined using Cox proportional hazard regression and logistic regression.

Walking attainment for preterm infants was later than for full-term infants (median=12.8 versus 11 months, respectively). The percentage of alternating steps, hip-knee correlation, hip-ankle correlation, and asymmetry ratio (AR) of stance time of stepping movement from 7 to 9 months of corrected age were found to be associated with age of walking attainment in all infants. Manifestation of at least 3 of 4 step features (ie, ≥80% alternating steps, ≤.37 hip-knee correlation, ≥.73 hip-ankle correlation, and ≤1.40 AR of stance time) at 7 months predicted walking attainment prior to 11 months of corrected age (accuracy=75%–77%). Failure to achieve such competencies at 7 or 9 months of corrected age was predictive of failure in walking attainment by 15 months (accuracy=72%–98%).

The limitations of this study included a small sample size and commencement of stepping assessment as early as 7 months of corrected age.

The emergence of walking may involve cooperation of alternating pattern generation, interjoint coordination, and interlimb coordination in supported stepping in preterm and full-term infants. The identified step predictors may assist clinicians in designing appropriate treadmill training programs for those infants with delayed walking.

The purpose of this study was to estimate chance-corrected agreement and test-retest reliability of the PGPQ. Chance-corrected agreement between the PGPQ and a similar therapist-guided goal identification tool, the Patient Goal Priority List (PGPL), also was estimated.

A correlative and prospective design with 3 measurement points (M1, M2, and M3) was used in the study.

Fifty-four people who consulted physical therapists in primary care for persistent musculoskeletal pain were included in the study. Analyses of chance-corrected agreement and test-retest reliability of the PGPQ were done at M1 and M2. Chance-corrected agreement between procedures (PGPQ and PGPL) also was analyzed at M1 and M3.

The percentage of agreement on content of the priority lists of the PGPQ at M1 and M2 was 52%. Cohen kappa values for agreement of rankings ranged between .47 and .64. Test-retest reliability coefficients for the self-report scales of the PGPQ ranged from .35 to .81. Chance-corrected agreement decreased when physical therapists were involved in the goal identification process using the PGPL (kappa=.08–.46).

Varying item content and a small, heterogeneous sample possibly increased variation and the standard error of measurements. The feasibility of using traditional approaches to psychometric evaluation of patient-specific measures is questionable.

Chance-corrected agreement and test-retest reliability of the PGPQ were moderate. Involving a physical therapist in the goal identification procedure possibly introduced further bias. The size of the measurement error must be taken into account when using the PGPQ for estimations of clinically important changes.