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Biomedical subjects

A Delitto

Publications and source records attributed to A Delitto.

At least 19 recordsLinked to original sources
PubMed1998

Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain.

STUDY DESIGN: A cross-sectional study was used to determine whether limited range of motion in the hip was present in 100 patients--one group with unspecified low back pain and another group with signs suggesting sacroiliac joint dysfunction. OBJECTIVES: To determine whether a characteristic pattern of range of motion in the hip is related to low back pain in patients and to determine whether such a pattern is associated with and without signs of sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is often considered a potential site of low back pain. Problems with the sacroiliac joint, as well as with the low back, have often been related to reduced or asymmetric range of motion in the hip. The correlation between sacroiliac joint dysfunction and hip range of motion, however, has not been thoroughly evaluated with reliable tests in a population of patients with low back pain. METHODS: Passive hip internal and external rotation goniometric measurements were taken by a blinded examiner, while a separate examiner evaluated the patient for signs of sacroiliac joint dysfunction. Patients with sacroiliac joint dysfunction were further classified as having a left or a right posteriorly tilted innominate. RESULTS: The patients with low back pain but without evidence of sacroiliac joint dysfunction had significantly greater external hip rotation than internal rotation bilaterally, whereas those with evidence of sacroiliac joint dysfunction had significantly more external hip rotation than internal rotation unilaterally, specifically on the side of the posterior innominate. CONCLUSIONS: Clinicians should consider evaluating for unilateral asymmetry in range of motion in the hip in patients with low back pain. The presence of such asymmetry in patients with low back pain may help identify those with sacroiliac joint dysfunction.

Adolescent↗
PubMed1998

Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements.

The purpose of this review is to present current information from the literature regarding the pathoanatomy, clinical presentation, differential diagnosis, treatment, and outcome assessment methods for patients with lumbar spinal stenosis. Lumbar spinal stenosis is a frequently encountered condition, particularly in the elderly. Treatment requires an accurate diagnosis, but differential diagnosis of lumbar stenosis can be difficult. The literature to date has focused primarily on surgical treatment. The long-term efficacy of surgery has been questioned, and surgical procedures are associated with increased costs and risks of morbidity in an elderly population. A trial of conservative care is recommended in most cases, but there are presently no randomized controlled studies in the literature comparing surgical versus conservative management, or evaluating the effectiveness of any specific conservative treatment approach. The existing literature has further been criticized for having poorly defined outcome measures. The assessment of treatment outcomes should be multifactorial, including measures of pathoanatomy and impairments, as well as patient-centered measures such as level of disability, patient expectations, and satisfaction. The present level of understanding of lumbar spinal stenosis is deficient in many areas, including differential diagnosis, treatment, and outcome assessment. Future research should address these deficits to improve the management of patients with this condition.

Arthrodesis↗
PubMed1998

An examination of the selective tissue tension scheme, with evidence for the concept of a capsular pattern of the knee.

BACKGROUND AND PURPOSE: The purpose of this study was to examine whether there is evidence to support 2 elements of the passive-range-of-motion (PROM) portion of Cyriax's selective tissue tension scheme for patients with knee dysfunction: a capsular pattern of motion restriction and the pain-resistance sequence. SUBJECTS: One hundred fifty-two subjects with unilateral knee dysfunction participated. The subjects had a mean age of 40.0 years (SD=15.9, range=13-82). METHODS: Passive range of motion of the knee and the relationship between the onset of pain and resistance to PROM (pain-resistance sequence) were measured, and 4 tests for inflammation were used. Interrater reliability was assessed on 35 subjects. RESULTS: Kappa values for the individual inflammatory tests ranged from .21 to .66 for categorization of the joint as inflamed, based on at least 2 positive inflammatory tests (kappa=.76). Reliability of PROM measurements was indicated by intraclass correlation coefficients of .72 to .97. Reliability of measurements of the pain-resistance sequence was indicated by a weighted kappa of .28. A capsular pattern, defined as a ratio of loss of extension to loss of flexion during PROM of between 0.03 and 0.50, was more likely than a noncapsular pattern in patients with an inflamed knee or osteoarthrosis (likelihood ratio=3.2). An association was found between a capsular pattern and arthrosis or arthritis. CONCLUSION AND DISCUSSION: These findings provide evidence to support the concept of a capsular pattern of motion restriction in persons with inflamed knees or evidence of osteoarthrosis.

Acute Disease↗
PubMed1997

Impairment and disability in patients with facial neuromuscular dysfunction.

Integration of impairment measures and disability measures may provide clinicians with an accurate and comprehensive picture of the patient's dysfunction. The purpose of this study was to indicate the usefulness of two new scales of measuring facial impairment and disability in describing characteristics of individuals with facial neuromuscular dysfunction. Fifty-one individuals with unilateral facial neuromuscular dysfunction and a House-Brackmann grade of III or higher were included in the study. The subjects' movement impairments were assessed using the Facial Grading System (FGS). The subjects reported their physical and social function on the Facial Disability Index (FDI). Nine variables were subjected to a confirmatory principal-components factor analysis to indicate important factors in describing patients with facial nerve disorders. The confirmatory principal-components factor analysis identified three factors, impairment, disability, and temporal characteristics of disease, accounting for 72% of the variance in describing individuals with facial neuromuscular dysfunction. Integration of these measures may provide clinicians with an accurate and comprehensive picture of the patient's dysfunction, thus aiding in the determination of intervention and the measurement of clinical outcomes.

Adult↗
PubMed1997

Physical therapy treatment choices for musculoskeletal impairments.

BACKGROUND AND PURPOSE: The primary goal of this investigation was to describe outpatient physical therapy treatments provided to patients with lumbar, cervical, or knee impairments. SUBJECTS: Patients in this analysis received outpatient physical therapy for a primary orthopedic complaint during July 1993 through June 1994 from one of 68 practices participating in the Focus on Therapeutic Outcomes database. Data were available on 2,598 completed physical therapy episodes of care provided by 141 therapists. METHODS: At each patient's discharge, the primary physical therapist gave information on the treatments provided to each patient during the initial, middle, and final thirds of the episode of therapy as well as information on primary source of reimbursement. Patients provided information on the date of onset of their symptoms or surgery. RESULTS: These outpatient physical therapy episodes of care were characterized by a diverse array of modalities, exercises, and manual therapy treatments. Treatment choices varied by type of impairment and across thirds of the episode. Fee-for-service versus managed care payment arrangements were associated with increased use of devices, therapeutic massage, strengthening, and endurance exercises. CONCLUSION AND DISCUSSION: The study's findings revealed that although physical agents were frequently used in physical therapy episodes of care, they were applied along with exercise and manual therapy interventions. Future research should relate specific treatments to variation in patient outcomes following physical therapy.

Adult↗
PubMed1997

Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis.

This study assesses the ability of a two-stage treadmill test to distinguish stenotic from nonstenotic subjects by capitalizing on the postural dependency of stenotic symptoms. Forty-five subjects (26 stenotic, 19 nonstenotic) participated. An earlier onset of symptoms with level walking (p = 0.0009), increased total walking time on an inclined treadmill (p = 0.014), and prolonged recovery time after level walking (p = 0.001) were significantly associated with stenosis. Only one of four self-reported postural variables were significantly associated with stenosis. Linear discriminant analysis performed using the treadmill variables resulted in the correct classification of 76.9 and 94.7% of stenotic and nonstenotic subjects, respectively. Likelihood ratios for all treadmill variables were > 2.50, and < 2.00 for all self-report variables. A two-stage treadmill test may be useful in the differential diagnosis of lumbar stenosis, and clinical measurement of the postural nature of symptoms seems to be superior to subjects' self-reports.

Adult↗
PubMed1996

Lumbar spinal stenosis.

Symptoms for spinal stenosis apparently result from an incongruity between the capacity and contents of the spinal nerve passages. These symptoms are most frequently seen in men in their fifth or sixth decade of life. Spinal extension generally exacerbates the claudication-type symptoms (lower-extremity pain and paresthesia), whereas spinal flexion diminishes these symptoms. Differential diagnosis is needed to rule out vascular claudication due to atherosclerosis. Decisions regarding surgery should be made based not only on diagnostic imaging but also on a thorough history and clinical examination.

Diagnostic Imaging↗
PubMed1996

Outcomes of patients with pelvic-ring fractures managed by open reduction internal fixation.

The purpose of this multiple-subject case report is to describe the physical impairments, disabilities, and handicaps of patients with multiple traumas and pelvic-ring fractures after management with open reduction internal fixation. Nineteen men and 12 women, with a mean age of 38+/-16 years (chi+/-SD), were interviewed and examined at least 1 year (chi+/-14.5 months) after sustaining multiple traumas, including an unstable pelvic-ring fracture that was repaired by open reduction internal fixation. Disabilities and handicaps were assessed using the Oswestry Low Back Pain Questionnaire and the Sickness Impact Profile (SIP). Assessments of physical performance consisted of lift capacity, the amount of forward bending, and gait. A descriptive analysis by age and pelvic fracture classification is reported. The < or = 50-year-old group had the best physical testing scores, except for the lifting test. The > 50-year-old group had the lowest scores. Subjects with B1-class "open-book" pelvic fractures had a tendency to score higher in individual SIP categories. The average SIP scores of 9.34+/-7.47 for the total SIP score, 7.79+/-6.93 for the physical dimension, and 8.24+/-9.61 for the psychosocial dimension represent mild disability. The mean Oswestry score of 13.26%+/-15.41% also represents mild disability. Some subjects demonstrated impairments, disabilities, and handicaps 1 year postoperatively, but for the most part the subjects recovered almost all lost function. The data and clinical management information can be used as a basis of comparison for treatment and research with these types of patients.

Adolescent↗
PubMed1995

Body motion patterns during a novel repetitive wheel-rotation task. A comparative study of healthy subjects and patients with low back pain.

STUDY DESIGN: This study evaluated performance differences between patients with chronic low back pain and a control group during their performance of a novel functional capacity task. OBJECTIVE: To 1) evaluated strength and endurance differences between patients and control subjects, 2) test for movement pattern differences between these groups, and 3) evaluate how these patterns changed with repetitive performance of the wheel-turning task. SUMMARY OF BACKGROUND DATA: Despite increased emphasis on quantifying functional capacities, few well-controlled studies comparing the performances of patients with low back pain with those of control subjects have appeared in the literature, particularly for movement patterns. METHODS: Forty patients with low back pain and 40 control subjects performed a sustained isodynamic wheel turning task. This task was selected because it simultaneously combined several common pain-related movements. A set of kinematic measures to characterize the basic movement patterns during this task were developed. RESULTS: Control subjects produced significantly higher levels of static torque and completed significantly more wheel-turning repetitions. Patients with low back pain exhibited significantly less upper torso and pelvic motion, upper torso rotation, and lateral trunk flexion than those in the control group. CONCLUSION: The dissimilar movement strategies found between the patient and control groups suggests that factors beyond more global physical explanations (e.g., deconditioning) may be important in accounting for the large discrepancy between these groups regarding the amount of work performed. These findings, along with the basic kinematic patterns developed in this study, may have important implications for determining the efficacy of instruction in body mechanics and treatment outcome for patients with chronic low back pain.

Adult↗
PubMed1995

The diagnostic process: examples in orthopedic physical therapy.

Diagnosis by the physical therapist has received increased attention in the physical therapy literature. The contributions thus far are in agreement that although physical therapists do not identify disease in the sense of pathology, they certainly can identify clusters of signs, symptoms, symptom-related behavior, and other data from patient history and other testing. These clusters can be labeled as classifications or diagnoses by physical therapists and can guide management of the patient. The purpose of this article is to discuss what has yet to be included in articles about diagnosis: the diagnostic process. We first acknowledge the complexity of the diagnostic process, reviewing the study of clinical diagnosis mostly from the field of medicine, including statistical as well as process-tracing approaches. We next discuss steps we believe are important to consider in order to interface the diagnostic process into entry-level training curricula, urging teachers and mentors of future physical therapists to rethink our emphasis on the problem-oriented medical record's "SOAP" type of approach as a clinical decision-making format. We next discuss error and clinical judgment and strategies to constructively deal with error in the clinical environment. We urge physical therapists to strive to reach a point at which we can (1) identify and classify patients in such a manner that allows for more efficient treatment management and (2) demonstrate such abilities in peer-reviewed publication form.

Aged↗
PubMed1995

A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment.

We present a treatment-based classification approach to the conservative management of low back syndrome. The approach has three levels of classification based on historical information, behavior of symptoms, and clinical signs. We first distinguish patients whose conservative care can be managed predominantly and independently by physical therapists versus patients who require consultation with other services (eg, psychology) or who require referral because of possible serious nonmusculoskeletal pathology. Once patients who can be managed by physical therapists are identified, the next level of classification is to stage their condition with regard to severity. We propose three stages: stage I for patients in the acute phase where the therapeutic goal is symptom relief, stage II for patients in a subacute phase where symptom relief and quick return to normal function are encouraged, and stage III for selected patients who must return to activities requiring high physical demands and who demonstrate a lack of physical conditioning necessary to perform the desired activities safely. The remainder of the article focuses on a third level of classification for stage I only in which patients are classified into distinct categories that are treatment-based and that specifically guide conservative management. The entire approach is diagnosis based, with specific algorithms and decision rules as well as examples presented.

Acute Disease↗
PubMed1995

Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation.

Immediately after reconstruction of the anterior cruciate ligament, 110 patients were randomly assigned to treatment with high-intensity neuromuscular electrical stimulation (thirty-one patients), high-level volitional exercise (thirty-four patients), low-intensity neuromuscular electrical stimulation (twenty-five patients), or combined high and low-intensity neuromuscular electrical stimulation (twenty patients). All treatment was performed isometrically with the knee in 65 degrees of flexion. All of the patients participated in an intensive program of closed-kinetic-chain exercise. After four weeks of treatment, the strength of the quadriceps femoris muscle and the kinematics of the knee during stance phase were measured. Quadriceps strength averaged 70 per cent or more of the strength on the uninvolved side in the two groups that were treated with high-intensity electrical stimulation (either alone or combined with low-intensity electrical stimulation), 57 per cent in the group that was treated with high-level volitional exercise, and 51 per cent in the group that was treated with low-intensity electrical stimulation. The kinematics of the knee joint were directly and significantly (p < 0.05) correlated with the strength of the quadriceps. There was a clinically and statistically significant (p < 0.05) difference in the recovery of the quadriceps and the gait parameters according to the type of operation that had been performed: the patients who had had reconstruction of the anterior cruciate ligament with use of an autologous patellar-ligament graft did poorly compared with the other patients.

Adult↗
PubMed1995

Rehabilitation of the injured athlete.

The authors have presented basic guidelines and considerations for rehabilitation of the injured athlete. The use of various physical agents and therapeutic exercise in the rehabilitation of the injured athlete has been discussed. Clinical pathways for improving range of motion and muscle function and eliminating functional limitations and disability have also been presented. It should be remembered that rehabilitation of the injured athlete at any point in time may focus on any one or combination of these areas. The ultimate goal for rehabilitation of injured athletes is to return them to their prior level of sports activity. Athletes should be discharged from rehabilitation when they have achieved this goal or when no further improvement in their level of function can be expected. Individuals unable to return to their prior level of activity should be provided with alternate activities that they can continue to participate in to maintain an active lifestyle.

Adolescent↗
PubMed1994

Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Electrical stimulation has been shown to be effective in aiding the recovery of quadriceps femoris muscle force production after anterior cruciate ligament reconstruction. The actual dosage of stimulation (training intensity) has not been well described. The purpose of this investigation was to establish a dose-response curve for electrical stimulation regimens designed to improve quadriceps femoris muscle recovery in patients after anterior cruciate ligament reconstruction. SUBJECTS AND METHODS: We analyzed data from a subsample (n = 52) of patients receiving electrical stimulation (N = 110) who were involved in a large, multicenter randomized clinical trial investigating treatment strategies designed to enhance quadriceps femoris muscle recovery. Fifty-two subjects (40 male, 12 female), with an age range of 15 to 43 years (mean = 25, SD = 7), participated in 4 weeks of quadriceps femoris muscle training using either portable, battery-powered home stimulators or console stimulators designed for clinical use. Training intensities were monitored by logging the electrically elicited knee extension torque and expressing this torque as a percentage of the uninvolved quadriceps femoris muscles' maximal voluntary contraction force. After the 4 weeks of training, isometric muscle torque was assessed and a dose-response curve was generated. The relationship between training intensity and quadriceps femoris muscle torque was assessed with Pearson Product-Moment Correlation Coefficients. RESULTS: A significant, linear correlation was found between training intensity and quadriceps femoris muscle torque. Subjects training with console, clinical generators trained at higher intensities than those training with portable, battery-operated generators; such training resulted in higher quadriceps femoris muscle torque. CONCLUSION AND DISCUSSION: These results support the use of high-intensity electrical stimulation and do not support the use of low-intensity or battery-powered stimulators when the goal is recovery of quadriceps femoris muscle force production in the early phases of rehabilitation after anterior cruciate ligament surgery. [Snyder-Mackler L, Delitto A, Stralka SW, Bailey SL. Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.

Adolescent↗
PubMed1994

Quadriceps femoris muscle resistance to fatigue using an electrically elicited fatigue test following intense endurance exercise training.

BACKGROUND AND PURPOSE: Electrical stimulation has been used to assess skeletal muscle resistance to fatigue. The purpose of this study was to test the hypothesis that 12 weeks of intense endurance exercise training on a bicycle ergometer would reduce the percentage of decline in quadriceps femoris muscle torque during an electrically elicited fatigue test. SUBJECTS AND METHODS: Eleven nondisabled subjects performed 12 weeks of high-intensity endurance exercise training, and 6 subjects served as controls and did not exercise. Two electrically elicited fatigue tests, one with and one without prior voluntary fatiguing exercise, were administered to each subject before and after the 12-week training period. RESULTS: The percentage of decline in peak torque of the quadriceps femoris muscle over 50 electrically elicited muscle contractions did not change as a result of endurance exercise training, despite significant improvements in maximal oxygen consumption and quadriceps femoris muscle endurance. The recovery of maximal isometric torque immediately after exhausting voluntary exercise followed by electrical stimulation was significantly greater after 12 weeks of intense exercise training. CONCLUSION AND DISCUSSION: The percentage of decline in peak torque during an electrically elicited fatigue test does not detect improvements in quadriceps femoris muscle endurance induced by endurance exercise training. The percentage of initial torque recovered immediately after fatiguing exercise, however, is improved by endurance training. [Sinacore Dr, Jacobson RB, Delitto A. Quadriceps femoris muscle resistance to fatigue using an electrically elicited fatigue test following intense endurance exercise training.

Adult↗
PubMed1994

Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome.

BACKGROUND AND PURPOSE: The relative effectiveness of an extension program and a manipulation program with flexion and extension exercises was examined in patients with low back syndrome. SUBJECTS: Forty-nine patients with less than a 3-month history of low back pain were seen at physical therapy clinics in western Pennsylvania, southern Mississippi, and eastern Missouri during a 6-month period. Twenty-seven of the 49 patients were classified a priori into a treatment-oriented category of extension/mobilization and were then randomly assigned to participate in an extension program or a program of manipulation followed by hand-heel rocks (flexion and extension). Two patients dropped out of the study (1 patient returned to work, and the other patient was unable to comply with the treatment schedule), and 1 patient was eliminated from the study because of magnified illness behavior. The remaining 24 patients (15 male, 9 female; mean age = 44 years, SD = 15, range = 14-73) were assigned randomly and equally to the two groups. Eight physical therapists participated in the study. METHODS: A randomized clinical trial comparing the two regimens was conducted for a 1-week period. Outcome was assessed using an Oswestry Low Back Pain Questionnaire initially (before treatment) and at 3 and 5 days posttreatment, and data were analyzed using a 2 x 3 (group x time) analysis of variance. RESULTS: A significant interaction of the group and time variables was demonstrated, indicating that the rate of positive response was greater in the manipulation/hand-heel rock group than in the extension group. CONCLUSION AND DISCUSSION: In this category of patients with low back pain, the use of manipulation as an adjunct to an ongoing exercise program appears to be warranted.

Acute Disease↗
PubMed1994

Recovery from a 1-minute bout of fatiguing exercise: characteristics, reliability, and responsiveness.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to describe the characteristics of recovery of peak torque after a 1-minute bout of isokinetic exercise of the quadriceps femoris muscle, (2) to determine the short-term reliability of the recovery of peak torque, and (3) to determine whether the recovery of peak torque more closely associates with maximal endurance exercise capacity than does the decline in peak torque at the end of the fatigue test. SUBJECTS: Thirty-three nondisabled subjects, ranging in age from 23 to 34 years (X = 27, SD = 3.4), participated in the reliability portion (phase 1) of the study. A different group of 21 nondisabled subjects, ranging in age from 21 to 47 years (X = 27.5, SD = 5.2), participated in the correlational portion (phase 2) of the study. METHODS: The short-term reliability of percentage of decline in peak torque and recovery of peak torque was assessed in phase 1. Each subject performed two quadriceps femoris muscle fatigue tests (test-retest) on an isokinetic dynamometer. In phase 2, each subject performed a single fatigue test and a test of maximal oxygen uptake (VO2max) to examine the relationships between VO2max and percentage of decline in peak torque at the end of the fatigue test and recovery of peak torque. RESULTS: Intraclass correlation coefficient values at every 30-second interval during recovery were acceptable (ICC = .67-.87), indicating recovery of peak torque is a consistent measure of quadriceps femoris muscle performance. A high negative correlation (r = -.84) was found between the percentage of decline at 30 seconds of recovery and VO2max, but a lower negative correlation (r = -.48) was found between the percentage of decline in torque at the end of the fatigue test and VO2max. CONCLUSION AND DISCUSSION: These results suggest recovery of peak torque is a reliable measure of muscle performance and closely associates with maximal aerobic exercise capacity.

Adult↗