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Biomedical subjects

D L Hart

Publications and source records attributed to D L Hart.

At least 19 recordsLinked to original sources
PubMed2001

Centralization phenomenon as a prognostic factor for chronic low back pain and disability.

STUDY DESIGN: Two hundred twenty-three consecutive adults with acute low back pain with or without referred spinal symptoms were treated conservatively and followed prospectively for 1 year. OBJECTIVES: To investigate the predictive value of centralization phenomenon (CP) with psychosocial variables previously identified as important risk factors for patients with acute onset of nonserious or nonspecific low back pain who subsequently develop chronic pain or disability. SUMMARY OF BACKGROUND DATA: Psychosocial factors have been shown to be predictors of chronic disability, but measures from physical examination rarely predict chronic behavior. The authors of the present study investigated whether dynamic assessment of changes in clinical measures during treatment could be used to classify patients and predict occurrence of chronic pain or disability. METHODS: Patients with acute symptoms and no history of surgery were treated by five physical therapists trained in McKenzie evaluation/treatment methods. Seventy-three percent were receiving workers' compensation benefits. At initial evaluation and discharge, 23 independent variables were assessed representing psychosocial, clinical, and demographic factors. Pain location changes to repeated trunk movements were assessed at every visit. Patients were placed in two groups: 1) those with pain that did not centralize and 2) those who completely centralized or demonstrated partial reduction of pain location with time. Treatment was individualized and based on McKenzie methods. Patients were contacted at 12 months after discharge, and dependent variables of pain intensity, return to work status, sick leave at work, activity interference at home, and continued use of health care were assessed. RESULTS: Nine independent variables influenced pain symptoms or disability. Pain pattern classification (noncentralization) and leg pain at intake were the strongest predictive variables of chronicity. CONCLUSION: Dynamic assessment of change in anatomic pain location during treatment and leg pain at intake were predictors of developing chronic pain and disability.

Adult↗
PubMed2000

Influence of orthopaedic clinical specialist certification on clinical outcomes.

STUDY DESIGN: Effect of clinical specialization was studied in a retrospective analysis of a commercial outcomes database. OBJECTIVE: To assess effectiveness of care as measured by changes in health status and efficiency as measured by visits, duration of treatment episode, and net revenue between patients treated by clinicians with and without orthopaedic clinical specialist certification (OCS). BACKGROUND: Clinical specialization is becoming common in physical therapy, but there are no studies to support improved efficiency or effectiveness with advanced practitioner competencies. METHODS AND MEASURES: A total of 258 adults treated in practices participating in the Focus on Therapeutic Outcomes process during 1996 comprised the data set. Seven physical therapists with OCS treated 129 patients (clinical specialist group). These patients were matched to 129 patients not treated by physical therapists with OCS (comparison group) randomly chosen from the aggregate data set. All patients completed a standardized health status questionnaire at initial evaluation and discharge. Standardized response means (SRMs) were calculated to measure change during treatment. RESULTS: Therapists with OCS were more efficient than therapists without OCS, using fewer visits (9.1 +/- 6.7 vs 11.2 +/- 7.4) for less estimated cost ($949 +/- $736 vs $1238 +/- $1227) during the same treatment duration (35.9 +/- 48.3 vs 35.4 +/- 25.6 days) and performed fewer treatment procedures. Overall, there was no difference in effectiveness as measured by change in health status, that is, unit of functional improvement per episode (0.89 +/- 1.0 SRM for clinical specialists compared with 0.88 +/- 1.0 SRM for comparison group). The OCS group had better value (unit of functional improvement per estimated dollar) and utilization (unit of functional improvement per visit) for the constructs of physical functioning (value: 1.31 +/- 2.7 vs 0.78 +/- 1.8; utilization: 1.25 +/- 2.2 vs 0.76 +/- 1.6) and role physical (value: 1.26 +/- 2.9 vs 0.44 +/- 3.5; utilization: 1.11 +/- 1.9 vs 0.51 +/- 2.3) (SRMs for OCS group vs comparison group, respectively). CONCLUSIONS: Our data support the conclusion that physical therapists with OCS are more efficient compared with clinicians without OCS. Study limitations in design, small sample size, and low number of clinicians are discussed.

Adult↗
PubMed2000

Assessment of unidimensionality of physical functioning in patients receiving therapy in acute, orthopedic outpatient centers.

Physical functioning is a common construct of interest for patients receiving rehabilitation. This report describes the assessment of hierarchial structure, unidimensionality and reproducibility of item calibrations along the continuum of physical functioning defined by the PF-10 of the MOS SF-36. Three new questions specific to patients with upper extremity impairments were added, and item calibrations were compared across several groups of patients with different musculoskeletal impairments. Reproducibility of item calibrations over testing times was supported. Item order was dependent on impairment in a clinically logical pattern. Construct validity of the physical functioning scale was supported and improved with the new questions for patients with upper extremity impairments as well as for patients with some lower level extremity impairments.

Activities of Daily Living↗
PubMed1999

A descriptive study of the centralization phenomenon. A prospective analysis.

STUDY DESIGN: Occurrence and treatment responses associated with the centralization phenomenon were analyzed prospectively in 289 patients with acute neck and back pain with or without referred spinal symptoms. OBJECTIVES: To document symptom changes to mechanical assessment during initial evaluation and during consecutive visits. Using standard operational definitions, patients were categorized reliably into three inclusive and mutually exclusive pain pattern groups: centralization, noncentralization, and partial reduction. It was hypothesized that the occurrence of centralization would be less than previously reported and that the centralization group would have better treatment results. SUMMARY OF BACKGROUND DATA: Centralization has been reported to occur with high frequency during mechanical assessments of patients with acute spinal syndromes. When centralization is observed, a favorable treatment result is expected. Because centralization has not been defined consistently in the literature, the true prevalence and treatment responses associated with centralization have not been confirmed. METHODS: Consecutive patients with neck or back pain syndromes and referred to outpatient physical therapy services were categorized into three pain pattern groups by experienced therapists trained in the McKenzie system. Changes in distal pain location were scored and documented before and after each visit. Maximal pain intensity over 24 hours, perceived functional status, and number of treatment visits were compared between groups. RESULTS: Patients could be categorized reliably according to movement signs and symptoms. The centralization pain pattern group had significantly fewer visits than the other two groups (P < 0.001). Pain intensity rating and perceived function were different between the centralization and noncentralization groups (P < 0.001). There was no difference in treatment response between the centralization and partial-reduction groups (P = 0.306). Prevalence of patients assigned to the three groups was 30.8% in the centralization group, 23.2% in noncentralization, and 46% in the partial-reduction group. CONCLUSION: Categorization by changes in pain location to mechanical assessment and treatment allowed identification of patients with improved treatment outcomes and facilitated planning of conservative treatment of patients with acute spinal pain syndromes. If a proximal change in pain location is not observed by the seventh treatment visit, the results of this study support additional medical evaluation for physical or nonphysical factors that could be delaying quick resolution of the acute episode.

Acute Disease↗
PubMed1994

Development of clinical standards in industrial rehabilitation.

Before discussing adjustments in the fees for the clinical services of industrial rehabilitation, the Medical Free Guide Committee of the Maryland Industrial Commission requested a copy of the clinical standards for these services. However, there were no multidisciplinary standards for industrial services that had state-wide approval. Therefore, a committee was formed to write the standards. Following a review of the literature and unpublished work from other associations and state organizations, standards were developed. Constructive criticism was solicited from national and local professionals and organizations with demonstrated interest and experience in providing or using these services or with experience writing standards. Further comment was solicited from individuals in the state of Maryland before final editing. Because of the dearth of outcome studies supporting the efficacy of clinical services in industrial rehabilitation, the standards describing a level of expectation from clinical services have become important for state organizations responsible for making decisions on reimbursement for clinical services. This paper summarizes the process used for the development of clinical standards of industrial rehabilitation services.

Contraindications↗
PubMed1993

Guidelines for functional capacity evaluation of people with medical conditions.

Functional capacity evaluation is an important and widely available service provided by rehabilitation professionals, including many physical therapists. In the absence of agreed-upon professional standards, guidelines for practice have been developed. These guidelines provide a basis for the development of standards of practice which the authors believe should be undertaken on an interdisciplinary basis. These guidelines provide a baseline level of care that should be maintained by physical therapists and others who provide functional capacity evaluation services.

Disability Evaluation↗
PubMed1987

Effect of lumbar posture on lifting.

Twenty laborers assumed specific lumbar spine postures and lifted a 157 N crate to three different hand heights to determine if lumbar spine flexion moments or trunk muscle activity were affected by the lifting postures. Lumbar flexion moments were lowest when the workers used the lordotic and straight back postures, while the average erector spinae muscle activity tended to be highest in the lordotic and straight back postures. The kypohotic posture regularly reduced the activity of the erector spinae to bursts of activity while lifting and caused more discomfort during the lifting tasks than any other posture. Therefore, the lumbar lordotic posture is recommended as the posture of choice while lifting, particularly when lifting from the floor level.

Adult↗
PubMed1985

Effect of cooling on force oscillations during maximal voluntary eccentric exercise.

The effect of superficial cooling on force oscillations during maximal eccentric exercises of the quadriceps femoris was studied in 10 adults. Maximal (i) shortening (concentric) and (ii) lengthening (eccentric) exercises were performed at a velocity of 120 degrees/s through 60 degrees of knee flexion while linear envelope EMG signals were recorded from the surface of the vastus medialis muscle. Force oscillations (12.4 +/- 2.8 Hz) were present in all subjects in the first series of eccentric exercises. After 30 min of cooling, the oscillations were eliminated in two subjects and were reduced in number in two others of the five subjects in the experimental group. In contrast, all subjects in the control group still had oscillations when retested after a 30-min rest period. During the eccentric exercises, a synchronous silent period in the EMG tracings was evident just before a decrease in force. Subsequently, the EMG activity resumed and the force increased (force oscillation). Because the force oscillations were of large amplitude and occurred only during eccentric exercise, we conclude that the force oscillations were similar to physiological action tremor. Because the force oscillations and EMG patterns were altered by cooling, the mechanisms that initiate such oscillations during maximal eccentric exercise are suspected to include a neural component.

Cold Temperature↗
PubMed1984

Effect of trunk stabilization on quadriceps femoris muscle torque.

The purpose of this study was to determine if differences exist in angle-specific torque, torque-velocity relationships, and power-velocity relationships of the quadriceps femoris muscle group when the trunk was and was not stabilized and the starting position was varied. We calculated isokinetic torques from seven adult men while the trunk was and was not stabilized for nine combinations of velocity of movement 0, 30, and 105 degrees/sec) and starting position (40, 60, and 100 degrees of knee flexion). The results suggest that peak angle-specific torques and instantaneous power are greater when the trunk is stabilized, the increase in the trunk-stabilized torque and power was greater at the higher velocity and for the larger ranges of motion, and the testing movement should not begin beyond 30 degrees of the angle of interest.

Adult↗
PubMed1982

Symptoms of TMJ dysfunction as related to stress measured by the social readjustment rating scale.

The data supported both research hypotheses. Patients with TMJ pain syndrome scored higher (p = .009) than the control subjects o the SRRS. As the number of symptoms increased, there was a tendency for scores on the SRRS to increase for all subjects (r = 0.58, p less than or equal to .05). The SRRS may be useful in evaluation and treatment planning of patients with these symptoms. Further research utilizing a larger sample size is necessary to determine the consistency of rating scores of patients versus nonpatients. Continued research is needed involving TMJ dysfunction to improve the multidisciplinary approach to and treatment of patients with problems in this area.

Disease Susceptibility↗
PubMed1982

TMJ symptoms and referred pain patterns.

The purpose of this study was to determine the relationship between TMJ symptoms, (muscle tenderness, joint noise, deviant jaw opening and closing patterns, and limited jaw opening), and a history of referred pain patterns (earaches, headaches, neck pain, and sinus problems). A questionnaire was completed by 100 subjects regarding histories of the previously mentioned problems. The researcher then examined the subject's TMJs, and their symptoms were recorded as being present or absent. The following relationships were found to be significant: Headaches and lateral pterygoid muscle tenderness, Earache and medial pterygoid muscle tenderness, Neck pain and one or more tender muscles, Sinus problems and one or more tender muscles, Sinus problems and temporal muscle tenderness, Sinus problems and medial pterygoid muscle tenderness. However, r values for the above relationships were between 0.22 and 0.3 indicating that the relationships were not strong. It appears that some normal patients already have patterns of masticatory muscle tenderness and associated referred pain patterns prior to seeking treatment for acute TMJ symptoms.

Adult↗
PubMed1978

Review of cervical orthoses.

Six commonly prescribed cervical orthoses are presented for a qualitative review of their structural properties and their clinical applicability. A quantitative review of each brace has previously been reported. The characteristics of 1) structure, 2) ease of donning, 3) ease of adjusting, 4) comfort, and 5) general clinical applicability are summarized for each brace. Generally, as the orthosis becomes more restrictive, it also becomes more cumbersome and more difficult to don. Ease of adjustment and comfort are compromised. The one exception was the Somi orthosis which was comfortable, easy to don and adjust, and which still provided good stability in forward flexion. The information presented in this paper in conjunction with information on the quantitative qualities of each brace and the services available at most health care facilities may be used as a guide for selecting specific cervical orthoses.

Braces↗
PubMed1978

The yale cervical orthosis: an evaluation of its effectiveness in restricting cervical motion in normal subjects and a comparison with other cervical orthoses.

The Yale cervical orthosis is a lightweight polyethylene foam Philadelphia collar with molded fiberglass extensions over the thorax. This orthosis was studied on 17 normal subjects in the extremes of the ranges of flexion, extension, rotation, and lateral bending using roentgenograms and axial photographs to assess how effectively it limited motion of the neck. Overall, it satisfactorily controlled cervical motion and was similar to the most effective rigid cervical orthoses. Flexion and extension ranges were compared at different segmental levels of the spine. The Yale orthosis was most successful in restricting flexion in the area of the middle and lower cervical spine and was acceptable in controlling extension range. The orthosis was least effective in controlling motion in the upper spine, particularly at the atlantoaxial articulation. The Yale orthosis is recommended for postsurgical protection of the middle and lower cervical spine and in select situations of spinal instability, but it is not recommended for control of odontoid fractures or atlantoaxial subluxation.

Adult↗
PubMed1977

Cervical orthoses. A study comparing their effectiveness in restricting cervical motion in normal subjects.

The effectiveness of five cervical orthoses in restricting cervical motion was evaluated quantitatively in normal subjects using roentgenograms and overhead photographs made at the extremes of three planes of motion, while the effectiveness of the halo with a plastic body-vest was studied in seven patients with cervical fractures or local fusions. Flexion and extension were measured at each cervical intervertebral joint and combined cervical motion was measured for rotation and lateral bending. The best conventional braces restricted only 45 per cent of flexion-extension at the atlanto-axial joint; the halo restricted 75 per cent. The conventional braces were more effective in the middle and lower portions of the cervical spine. The results may prove to be useful guidelines for the selection of an appropriate orthosis to control motion in different planes and at different levels of the spine.

Adult↗