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Biomedical subjects

Timothy W Flynn

Publications and source records attributed to Timothy W Flynn.

30 records · Page 2Linked to original sources
PubMed2004

The use of a pneumatic leg brace in soldiers with tibial stress fractures--a randomized clinical trial.

STUDY DESIGN: Single blind randomized controlled replication study. OBJECTIVES: Evaluate the effect of a pneumatic leg brace on return-to-activity and pain in soldiers with tibial stress fractures. METHODS AND MEASURES: Thirty-one subjects diagnosed with tibial stress fractures were randomly assigned to either a brace or control group. Dependent variables included time to pain-free single-leg hopping, visual analog pain scale, and time to a pain-free 1-mile run. Twenty subjects (10 brace, 10 control) completed a detailed functional progression culminating in a 1-mile run. RESULTS: There was no difference between groups for time to pain-free hop (p > 0.86; power = 0.43) and time to pain-free 1-mile run (p > 0.24; power = 0.92). Subjects in both groups experienced statistically significant improvements in pain measurements (p < 0.002), but no difference was found between groups (p > 0.93). CONCLUSION: The current study demonstrated no added benefit of Aircast leg braces in the treatment of tibial stress fractures in the military training environment.

Adult↗
PubMed2004

Factors related to the inability of individuals with low back pain to improve with a spinal manipulation.

BACKGROUND AND PURPOSE: Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation. SUBJECTS: Seventy-five people with nonradicular low back pain (mean age=37.6 years, SD=10.6, range=19-59; mean duration of symptoms=41.7 days, SD=54.7, range=1-252) participated. METHODS: Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no improvement with the manipulation. Baseline variables were tested for univariate relationship with the outcome of the manipulation. Variables showing a univariate relationship were entered into a logistic regression equation, and adjusted odds ratios were calculated. RESULTS: Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation range of motion, and a negative Gaenslen sign. The resulting logistic regression model explained 63% of the variance in manipulation outcome. DISCUSSION AND CONCLUSION: The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve.

Adult↗
PubMed2004

Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation.

BACKGROUND AND PURPOSE: In patients with patellofemoral pain syndrome (PFPS), the authors determined which aspects of the examination could be used to identify those patients most likely to respond to off-the-shelf foot orthoses and instruction in activity modification. PARTICIPANTS AND METHODS: Fifty participants were enrolled in the study, and data for 5 individuals were excluded from analysis. Thirty-four men and 11 women completed the study. Participants were given foot orthoses and instructed in activity modification for 3 weeks. A 50% reduction in pain was considered a success. Likelihood ratios (LRs) were computed to determine which examination findings were most predictive of success. RESULTS: The best predictors of improvement were forefoot valgus alignment of 2 degrees (+LR=4.0, 95% confidence interval [CI]=0.7-21.9), great toe extension of 78 degrees (+LR=4.0, 95% CI=0.7-21.9), and navicular drop of 3 mm (+LR=2.4, 95% CI=1.3-4.3). DISCUSSION AND CONCLUSION: The results suggest that patients with PFPS who have forefoot valgus alignment of 2 degrees, passive great toe extension of 78 degrees, or navicular drop of 3 mm are most likely to respond favorably to initial intervention with an off-the-shelf foot orthosis and instruction in activity modification.

Adolescent↗
PubMed2003

The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain.

OBJECTIVE: To determine the relationship between an audible pop and symptomatic improvement with spinal manipulation in patients with low back pain (LBP). DESIGN: A prospective cohort study. SETTING: Two outpatient physical therapy clinics located in military medical centers. PARTICIPANTS: A cohort of 71 patients with nonradicular LBP referred to physical therapy. INTERVENTIONS: Participants underwent a standardized examination and standardized spinal manipulation treatment program. All patients were treated with a sacroiliac (SI) region manipulative technique and the presence or absence of an audible pop was noted. MAIN OUTCOME MEASURES: Subjects were reassessed 48 hours after the manipulation for changes in range of motion (ROM), numeric pain rating scale (PRS) scores, and modified Oswestry Disability Questionnaire (ODQ) scores. RESULTS: An audible pop occurred in 50 of the 71 subjects during the manipulative procedure. Both groups-those who had an audible pop and those who did not-improved over time in flexion ROM, PRS scores, and modified ODQ scores; however, there were no differences between groups (P>.05). Nineteen of the 71 (27%) patients improved dramatically (mean drop in modified ODQ, 67.6%). In 14 of the 19 dramatic responders, an audible pop occurred. However, the odds ratio (1.2; 95% confidence interval, 0.38-4.04) suggested that the occurrence of a manipulative pop would not improve the odds of achieving a dramatic reduction in symptoms after the manipulation. CONCLUSION: There is no relationship between an audible pop during SI region manipulation and improvement in ROM, pain, or disability in individuals with nonradicular LBP. Additionally, the occurrence of a pop did not improve the odds of a dramatic improvement with manipulation treatment.

Adolescent↗
PubMed2003

Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy.

This article critically reviews the available literature regarding nonsurgical management for lumbar spinal stenosis (LSS) and presents a case series of three patients managed with manual physical therapy. This case series uses a well-defined, impairment-based, noninvasive, outpatient treatment program for patients with LSS and provides patient-centered, long-term outcome information. The outpatient treatment program focuses on patients' individualized, prioritized impairments identified on initial examination, and emphasizes manual physical therapy techniques targeting each patient's impairments, specific exercises to either reinforce the manual physical therapy treatment or strengthen specific muscles, and a walking program. The results demonstrate that patients with LSS can make significant gains in disability, symptoms, and function in relatively short periods of time and that these gains can be maintained for up to 18 months. Under this physical therapy program, patients experienced significant improvements, and the potential adverse effects of invasive therapies or pharmacologic management strategies, which often are included in other "nonsurgical" treatment programs, were avoided.

Aged↗
PubMed2003

The accuracy of the Palpation Meter (PALM) for measuring pelvic crest height difference and leg length discrepancy.

STUDY DESIGN: Test-retest reliability and validity. OBJECTIVE: To determine the validity and reliability of the Palpation Meter (PALM). BACKGROUND: Leg length discrepancy (LLD) has been associated with a variety of musculoskeletal disorders. Therefore, the clinical measurement of LLD has become a routine and important part of the physical examination. The PALM is an instrument that was recently developed to indirectly measure LLD, but little is known about its measurement properties. METHODS AND MEASURES: Fifteen healthy and 15 symptomatic subjects with suspected LLD participated in this study. Measurements of pelvic crest height difference (PD) were obtained by 2 examiners using the PALM. A standing antero-posterior (AP) radiograph of each subject's pelvis was taken, and PD and LLD (femoral head height difference) were determined from the radiograph for comparison with the PALM values. Intraclass correlation coefficients (ICCs) were calculated to determine the validity and reliability estimates of the PALM. RESULTS: For all subjects, the validity estimates (ICC2,3) of the PALM for PD were excellent (0.90 for rater 1 and 0.92 for rater 2) when compared with the standing AP radiograph of the pelvis. The PALM was less accurate (ICC2,3 of 0.76 and 0.78 for rater 1 and 2, respectively) as an indirect estimate of LLD. Intrarater reliability for each rater was excellent (ICC3,3 = 0.97 and 0.98) and interrater reliability was very good (ICC2,3 = 0.88). CONCLUSION: The PALM is a reliable and valid instrument for measuring PD. Clinicians should consider this convenient, cost-effective clinical tool as an alternative to radiographic measurement of pelvic crest height difference.

Adult↗
PubMed2002

Tibial flexural wave propagation in vivo: potential for bone stress injury risk assessment.

OBJECTIVE: To determine the reliability of tibial flexural wave propagation velocity (FWPV) and the effect of overlying soft-tissues on the result. DESIGN: The velocity of tibial flexural wave propagation was repeatedly measured in healthy subjects. BACKGROUND: The tibia is the most frequently stress-fractured bone of runners and in military training populations. Developing techniques to measure tibial bone strength and, thereby, fracture resistance may be useful in pre-participation examinations in order to identify at-risk individuals. One such method, tibial flexural wave propagation velocity (FWPV) has been reported to be a measure of tibial stiffness. METHODS: The tibial FWPV was measured 80 times per subject (10 trials X 2 setups/day X 4 days) in a sample of 25 young women. Two methods of calculating FWPV were used (Peak method time domain and Phase method frequency domain). Intraclass correlations (ICCs) were calculated. RESULTS: The results demonstrated that the peak method was more reliable then the phase method. The ICCs ranged from 0.81-0.96 for the peak method and from 0.59-0.89 for the phase method. The 95% confidence intervals demonstrated that the FWPV could discriminate between subjects with low, medium, or high velocity values with reasonable accuracy and confidence. The soft-tissue overlying the tibia was not significantly (p = 0.63) correlated with FWPV. CONCLUSION: In summary, it is possible to discriminate between varying levels of tibial FWPV. Furthermore, if FWPV is related to bone stress fracture resistance, then this method may be useful in determining stress fracture risk prior to intensive physical activity. RELEVANCE: The tibia is the most frequently stress-fractured bone of runners and in military training populations. This study explores the feasibility of tibial FWPV as a potential method to assess tibial stress fracture resistance.

Adult↗