Improving Tinnitus with Mechanical Treatment of the Cervical Spine and Jaw

2013 ◽  
Vol 24 (07) ◽  
pp. 544-555 ◽  
Author(s):  
Kay Cherian ◽  
Neil Cherian ◽  
Chad Cook ◽  
James A. Kaltenbach
Keyword(s):  
Cervical Spine ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Self Report ◽  
Blurred Vision ◽  
Flexion Extension ◽  
Spine Mobility ◽  
Emotional Deficits ◽  
Therapy Interventions ◽  
Cervical Motion

Background: Tinnitus affects approximately 30–50 million Americans. In approximately 0.5–1.0% of the population, tinnitus has a moderate to severe impact on their quality of life. Musculature and joint pathologies of the head and neck are frequently associated with tinnitus and have been hypothesized to play a contributing role in its etiology. However, specific physical therapy interventions to assist in improving tinnitus have not yet been reported. Purpose: To describe the examination and treatment intervention of a patient with subjective tinnitus. Patient Description: The patient was a 42-yr-old male experiencing intermittent bilateral tinnitus, headaches, blurred vision, and neck tightness. His occupation required long-term positioning into neck protraction. Examination found limitations in cervical extension, bilateral rotation, and side bending. Asymmetry was also noted with temporomandibular joint (TMJ) movements. Upon initial evaluation the patient demonstrated functional, physical, and emotional deficits per neck, headache, and dizziness self-report scales and a score on the Tinnitus Handicap Inventory (THI) of 62. Resisted muscle contractions of the cervical spine in flexion, extension, and rotation increased his tinnitus. Intervention: Treatment focused on normalizing cervical spine mobility through repetitive movements, joint mobilization, and soft tissue massage. Results: At 2.5 mo, the patient demonstrated a complete reversal of his tinnitus after 10 physical therapy sessions as noted by his score of 0 on the THI upon discharge. He also demonstrated objective improvements in his cervical motion. This case reflected treatment targeted at cervical and TMJ impairments and notable improvements to tinnitus. Future studies should further explore the direct and indirect treatment of tinnitus by physical therapists through clinical trials.

scholarly journals Physical Therapy Interventions for Patients With Osteoarthritis of the Knee: An Overview of Systematic Reviews

2008 ◽  
Vol 88 (1) ◽  
pp. 123-136 ◽  
Author(s):  
Gro Jamtvedt ◽  
Kristin Thuve Dahm ◽  
Anne Christie ◽  
Rikke H Moe ◽  
Espen Haavardsholm ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Knee Osteoarthritis ◽  
Systematic Reviews ◽  
Physical Therapists ◽  
Low Level Laser Therapy ◽  
Osteoarthritis Of The Knee ◽  
Quality Of Evidence ◽  
Therapy Interventions ◽  
Quality Evidence

Patients with osteoarthritis of the knee are commonly treated by physical therapists. Practice should be informed by updated evidence from systematic reviews. The purpose of this article is to summarize the evidence from systematic reviews on the effectiveness of physical therapy for patients with knee osteoarthritis. Systematic reviews published between 2000 and 2007 were identified by a comprehensive literature search. We graded the quality of evidence across reviews for each comparison and outcome. Twenty-three systematic reviews on physical therapy interventions for patients with knee osteoarthritis were included. There is high-quality evidence that exercise and weight reduction reduce pain and improve physical function in patients with osteoarthritis of the knee. There is moderate-quality evidence that acupuncture, transcutaneous electrical nerve stimulation, and low-level laser therapy reduce pain and that psychoeducational interventions improve psychological outcomes. For other interventions and outcomes, the quality of evidence is low or there is no evidence from systematic reviews.

scholarly journals The Use of a Knowledge Translation Program to Increase Use of Standardized Outcome Measures in an Outpatient Pediatric Physical Therapy Clinic: Administrative Case Report

2015 ◽  
Vol 95 (4) ◽  
pp. 613-629 ◽  
Author(s):  
Joseph Schreiber ◽  
Gregory F. Marchetti ◽  
Brook Racicot ◽  
Ellen Kaminski
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Knowledge Translation ◽  
Outcome Measures ◽  
Physical Therapists ◽  
Practice Change ◽  
Knowledge Broker ◽  
Self Report ◽  
Knowledge Assessment ◽  
Frequency Of Use

Background and Purpose Pediatric physical therapists face many challenges related to the application of research evidence to clinical practice. A multicomponent knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this case report is to describe the use of a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic. Case Description This program occurred at a pediatric outpatient facility with 1 primary clinic and 3 additional satellite clinics, and a total of 17 physical therapists. The initial underlying problem was inconsistency across staff recommendations for frequency and duration of physical therapist services. Formal and informal discussion with the department administrator and staff identified a need for increased use of standardized outcome measures to inform these decisions. The KT program to address this need spanned 6 months and included identification of barriers, the use of a knowledge broker, multiple workshop and practice sessions, online and hard-copy resources, and ongoing evaluation of the KT program with dissemination of results to staff. Outcome measures included pre- and post-knowledge assessment and self-report surveys and chart review data on use of outcome measures. Outcomes Participants (N=17) gained knowledge and increased the frequency of use of standardized outcome measures based on data from self-report surveys, a knowledge assessment, and chart reviews. Discussion Administrators and others interested in supporting practice change in physical therapy may consider implementing a systematic KT program that includes a knowledge broker, ongoing engagement with staff, and a variety of accessible resources.

scholarly journals Interventions That Increase or Decrease the Likelihood of a Meaningful Improvement in Physical Health in Patients With Sciatica

2005 ◽  
Vol 85 (11) ◽  
pp. 1139-1150 ◽  
Author(s):  
Dianne V Jewell ◽  
Daniel L Riddle
Keyword(s):  
Physical Therapy ◽  
Physical Health ◽  
Physical Therapists ◽  
Summary Score ◽  
Health Improvement ◽  
Joint Mobility ◽  
Short Term ◽  
Meaningful Improvement ◽  
General Exercise ◽  
Therapy Interventions

Abstract Background and Purpose. The purpose of our study was to determine whether physical therapy interventions predicted meaningful short-term improvement in physical health for patients diagnosed with sciatica. Subjects. We examined data from 1,804 patients (age: X̄=52.1 years, SD=15.6 years; 65.7% female, 34.3% male) who had been diagnosed with sciatica and 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 plan of care. A nested-model logistic regression analysis identified intervention categories that predicted meaningful improvement in physical health. Meaningful improvement was defined as a change of 14 or more points on the Physical Component Scale-12 (PCS-12) summary score. Results. Twenty-six percent (n=473) of patients had a meaningful improvement in physical health. Improvement was more likely in patients receiving joint mobility interventions (odds ratio [OR]=2.5, 95% confidence interval [CI]=1.5–4.4) or general exercise (OR=1.5, 95% CI=1.2–2.0). Patients who received spasm reduction interventions were less likely to improve (OR=0.77, 95% CI=0.60–0.98). Discussion and Conclusion. Physical therapists should emphasize the use of joint mobility interventions and exercise when treating patients with sciatica, whereas interventions for spasm reduction should be avoided.

scholarly journals Development and Testing of a Self-report Instrument to Measure Actions: Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL)

2005 ◽  
Vol 85 (6) ◽  
pp. 515-530 ◽  
Author(s):  
Andrew A Guccione ◽  
Thelma J Mielenz ◽  
Robert F DeVellis ◽  
Marc S Goldstein ◽  
Janet K Freburger ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
Well Being ◽  
Descriptive Statistics ◽  
Self Report ◽  
Study Results ◽  
Movement Assessment ◽  
Adult Outpatient ◽  
Therapy Interventions ◽  
Health And Well Being

Abstract Background and Purpose. Physical therapy is faced with the challenge of producing evidence that physical therapy interventions are effective. The fundamental question confronting physical therapy is whether or not physical therapy interventions make a contribution to function, health, and well-being. The individual's ability to perform actions can serve as a theoretical construct related to movement and health around which physical therapy interventions can be assessed. To this end, the aims of this study were: (1) to develop a self-report instrument to assess ability to perform mobility actions in an adult outpatient population and (2) to assess the psychometric properties of such an instrument in the appropriate population. Subjects and Methods. An instrument was developed to assess difficulty and confidence related to 24 actions. Descriptive statistics and measures of reliability, validity, and responsiveness were computed. A total of 391 patients participated in the study. Results. The coefficient for reliability was in the required range, and measures of validity and responsiveness were established as well. Three factors were identified. Discussion and Conclusion. The instrument provides the beginning of documentation of outcomes in movement to identify the unique contributions of physical therapist practice.

Comparison of cervical spine kinematics using a fluoroscopic model for adjacent segment degeneration

2007 ◽  
Vol 7 (5) ◽  
pp. 509-513 ◽  
Author(s):  
Joseph S. Cheng ◽  
Fei Liu ◽  
Richard D. Komistek ◽  
Mohamed R. Mahfouz ◽  
Adrija Sharma ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Healthy Individuals ◽  
Inverse Dynamic ◽  
Kinematic Data ◽  
Spine Kinematics ◽  
Flexion Extension ◽  
Cervical Motion ◽  
Flexion And Extension

Object In this cervical spine kinematics study the authors evaluate the motions and forces in the normal, degenerative, and fused states to assess how alteration in the cervical motion segment affects adjacent segment degeneration and spondylosis. Methods Fluoroscopic images obtained in 30 individuals (10 in each group with disease at C5–6) undergoing flexion/extension motions were collected. Kinematic data were obtained from the fluoroscopic images and analyzed with an inverse dynamic mathematical model of the cervical spine that was developed for this analysis. Results During 20° flexion to 15° extension, average relative angles at the adjacent levels of C6–7 and C4–5 in the fused patients were 13.4° and 8.8° versus 3.7° and 4.8° in the healthy individuals. Differences at C3–4 averaged only about 1°. Maximum transverse forces in the fused spines were two times the skull weight at C6–7 and one times the skull weight at C4–5, compared with 0.2 times the skull weight and 0.3 times the skull weight in the healthy individuals. Vertical forces ranged from 1.6 to 2.6 times the skull weight at C6–7 and from 1.2 to 2.5 times the skull weight at C4–5 in the patients who had undergone fusion, and from 1.4 to 3.1 times the skull weight and from 0.9 to 3.3 times the skull weight, respectively, in the volunteers. Conclusions Adjacent-segment degeneration may occur in patients with fusion due to increased motions and forces at both adjacent levels when compared with healthy individuals in a comparable flexion and extension range.

scholarly journals Interventions Used by Physical Therapists in Home Care for People After Hip Fracture

2008 ◽  
Vol 88 (2) ◽  
pp. 199-210 ◽  
Author(s):  
Kathleen Kline Mangione ◽  
Rosalie B Lopopolo ◽  
Nancy P Neff ◽  
Rebecca L Craik ◽  
Kerstin M Palombaro
Keyword(s):  
Hip Fracture ◽  
Physical Therapy ◽  
Home Care ◽  
Usual Care ◽  
Management Practices ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Balance Training ◽  
Gait Training ◽  
Therapy Interventions

Background and PurposeThe majority of older people who survive a hip fracture have residual mobility disabilities. Any attempt to systematically reduce mobility disabilities after hip fracture, however, requires knowledge of the adequacy of current management practices. Therefore, the purpose of this study was to begin to understand the nature of physical therapy home care management by describing “usual care” for people after hip fracture.Subjects and MethodsIn 2003 and 2004, a national survey was conducted of all members of the American Physical Therapy Association who identified home care as their primary practice setting (n=3,130). “Usual care” was operationally defined as when more than 50% of respondents reported that they “always” or “often” use a specific intervention.ResultsSurvey questionnaires (1,029) were returned with a response rate of 32.9%. Functional training activities, including bed mobility, transfer and gait training, balance training, safety training, and patient education, were reported very frequently. Active-range-of-motion exercises were performed much more frequently than exercises involving added resistance.Discussion and ConclusionThis study provides a detailed description of the physical therapy interventions provided in the home care setting for patients after hip fracture. The sample size and national representation increase our confidence that this description accurately depicts physical therapist practice.

scholarly journals Development of a Feasible Implementation Fidelity Protocol Within a Complex Physical Therapy–Led Self-Management Intervention

2016 ◽  
Vol 96 (8) ◽  
pp. 1287-1298 ◽  
Author(s):  
Elaine Toomey ◽  
James Matthews ◽  
Suzanne Guerin ◽  
Deirdre A. Hurley
Keyword(s):  
Physical Therapy ◽  
Phase 1 ◽  
Implementation Fidelity ◽  
Self Report ◽  
Self Management ◽  
Phase 2 ◽  
Intervention Delivery ◽  
Direct Observations ◽  
Initial Implementation ◽  
Therapy Interventions

AbstractBackgroundImplementation fidelity is poorly addressed within physical therapy interventions, which may be due to limited research on how to develop and implement an implementation fidelity protocol.ObjectiveThe purpose of this study was to develop a feasible implementation fidelity protocol within a pilot study of a physical therapy–led intervention to promote self-management for people with chronic low back pain or osteoarthritis.DesignA 2-phase mixed-methods design was used.MethodsPhase 1 involved the development of an initial implementation fidelity protocol using qualitative interviews with potential stakeholders to explore the acceptability of proposed strategies to enhance and assess implementation fidelity. Phase 2 involved testing and refining the initial implementation fidelity protocol to develop a finalized implementation fidelity protocol. Specifically, the feasibility of 3 different strategies (physical therapist self-report checklists, independently rated direct observations, and audio-recorded observations) for assessing implementation fidelity of intervention delivery was tested, followed by additional stakeholder interviews that explored the overall feasibility of the implementation fidelity protocol.ResultsPhase 1 interviews determined the proposed implementation fidelity strategies to be acceptable to stakeholders. Phase 2 showed that independently rated audio recordings (n=6) and provider self-report checklists (n=12) were easier to implement than independently rated direct observations (n=12) for assessing implementation fidelity of intervention delivery. Good agreement (79.8%–92.8%) was found among all methods. Qualitative stakeholder interviews confirmed the acceptability, practicality, and implementation of the implementation fidelity protocol.LimitationsThe reliability and validity of assessment checklists used in this study have yet to be fully tested, and blinding of independent raters was not possible.ConclusionsA feasible implementation fidelity protocol was developed based on a 2-phase development process involving intervention stakeholders. This study provides valuable information on the feasibility of rigorously addressing implementation fidelity within physical therapy interventions and provides recommendations for researchers wanting to address implementation fidelity in similar areas.

scholarly journals Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community

2016 ◽  
Vol 96 (8) ◽  
pp. 1125-1134 ◽  
Author(s):  
Jason R. Falvey ◽  
Robert E. Burke ◽  
Daniel Malone ◽  
Kyle J. Ridgeway ◽  
Beth M. McManus ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Therapy ◽  
Hospital Readmission ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Hospital Readmissions ◽  
Functional Decline ◽  
Care Transitions ◽  
Models Of Care ◽  
Therapy Interventions

AbstractHospital readmissions in older adult populations are an emerging quality indicator for acute care hospitals. Recent evidence has linked functional decline during and after hospitalization with an elevated risk of hospital readmission. However, models of care that have been developed to reduce hospital readmission rates do not adequately address functional deficits. Physical therapists, as experts in optimizing physical function, have a strong opportunity to contribute meaningfully to care transition models and demonstrate the value of physical therapy interventions in reducing readmissions. Thus, the purposes of this perspective article are: (1) to describe the need for physical therapist input during care transitions for older adults and (2) to outline strategies for expanding physical therapy participation in care transitions for older adults, with an overall goal of reducing avoidable 30-day hospital readmissions.

scholarly journals Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain

2007 ◽  
Vol 87 (5) ◽  
pp. 513-524 ◽  
Author(s):  
Julie M Fritz ◽  
Gerard P Brennan
Keyword(s):  
Physical Therapy ◽  
Neck Pain ◽  
Classification System ◽  
Interrater Reliability ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Neck Disability Index ◽  
Mean Difference ◽  
Classification Methods ◽  
Therapy Interventions

Background and PurposeNeck pain frequently is managed by physical therapists. The development of classification methods for matching interventions to subgroups of patients may improve clinical outcomes. The purpose of this study was to describe a proposed classification system for patients with neck pain by examining data for consecutive patients receiving physical therapy interventions.Subjects and MethodsStandardized methods for collecting baseline and intervention data were used for all patients receiving physical therapy interventions for neck pain over 1 year. Outcome variables were the Neck Disability Index (NDI), numeric pain rating, and number of visits. Treatment was provided at the discretion of the physical therapist. After the completion of treatment, each patient was classified by use of baseline variables. The interventions received by the patient were categorized as being matched or not matched to the classification. Outcomes for patients who received matched interventions were compared with those for patients who received nonmatched interventions. The interrater reliability of the classification algorithm was examined with a subset of 50 patients.ResultsA total of 274 patients were included in this study (74% women; age [X̄±SD]=44.4±16.0 years). The most common classification was centralization (34.7%); next were exercise and conditioning (32.8%) and mobility (17.5%). The interrater reliability for classification decisions was high (kappa=.95, 95% confidence interval [CI]=0.87–1.0). A total of 113 patients (41.2%) received interventions matched to the classification. Receiving matched interventions was associated with greater improvements in the NDI (mean difference=5.6 points, 95% CI=2.6–8.6) and in pain ratings (mean difference=0.74 point, 95% CI=0.21–1.3) than receiving nonmatched interventions.Discussion and ConclusionThe development of classification methods for patients with neck pain may improve the outcomes of physical therapy intervention. This study was done to examine a previously proposed classification system for patients receiving physical therapy interventions for neck pain. Receiving interventions matched to the classification system was associated with better outcomes than receiving nonmatched interventions. Although the design of this study prohibited drawing conclusions about the effectiveness of the system, the results suggest that further research on the system may be warranted.

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