Pitting Is Not Only a Measure of Oedema Presence: Using High-Frequency Ultrasound to Guide Pitting Test Standardisation for Assessment of Lymphoedema.

The pitting qualities of lymphoedema tissue change with disease progression. However, little is known about the underlying tissue response to the pitting test or the tissue characteristics that enhance or resist indentation. The pitting test is currently unstandardised, and the influence of test technique on pitting outcomes is unknown.

Localised Objective Characterisation Assessment of Lymphoedema (LOCAL): Using High-Frequency Ultrasound, Bioelectrical Impedance Spectroscopy and Volume to Evaluate Superficial Tissue Composition.

Lymphoedema tissue is characterised by excess free fluid and structural changes to the extracellular matrix (ECM) in the form of fibrotic and fatty deposition. These tissue characteristics are integral to the assessment of lymphoedema progression; however, clinicians and researchers often focus on changes in the free fluid, volume and function of lymphatic vasculature to inform practice. Subsequently, little is known about the effect of clinical interventions on lymphoedema tissue composition.

Patients report being satisfied with private musculoskeletal physical therapy when therapists educate effectively and facilitate shared decision making.

Background: Overall satisfaction with physical therapy care can improve patient adherence and active involvement in their management. However, which individual factors most influence satisfaction with private practice physical therapy care is not well established.

Objective: To identify which aspects of the private practice musculoskeletal physical therapy experience best delineated "completely satisfied" and "dissatisfied patients".

Developing fluency in a language of tactile communication.

Touch has been an integral part of physiotherapeutic approaches since the inception of the profession. More recently, advances in the evidence-base for exercise prescription and "active" management have brought "touch" into question. This, in part, assumes that the patient or recipient simply passively receives the input rather than being an active partner in the interaction.

Acoustic Radiation Force Impulse Elastography Assessment of Lymphoedema Tissue: An Insight into Tissue Stiffness.

Palpation remains essential for evaluating lymphoedema to detect subtle changes that may indicate progression. As palpation sense is not quantifiable, this study investigates the utility of ultrasound elastography to quantify stiffness of lymphoedema tissue and explore the influence of the pitting test on tissue stiffness. Fifteen women with unilateral arm lymphoedema were scanned using a Siemens S3000 Acuson ultrasound (Siemens, Germany) with 18 MHz and 9 MHz linear transducers to assess tissue structure and tissue stiffness with Acoustic Radiation Force Impulse elastography.

Localised manual therapy treatment has a preferential effect on the kinematics of the targeted motion segment.

Aim: An observational cohort study to determine whether localised manual therapy results in a preferential increase in mobility of the targeted motion segment.

Method: Eighteen participants with mechanical neck pain had three MRIs of their cervical spine. The first two were taken prior to treatment in neutral and at the end of active rotation in their more limited rotation.

A simulation-based learning experience in augmentative and alternative communication using telepractice: speech pathology students' confidence and perceptions.

Background: Simulation, as an activity in speech-language pathology training, can increase opportunities for students to gain required skills and competencies. One area that has received little attention in the simulation literature, yet is a growing area of clinical practice, is alternative and augmentative communication (AAC). Also growing, is the use of telepractice to deliver services.

Using stakeholder input to inform scenario content: an example from physiotherapy.

Background: Simulated learning environments (SLEs) are being embraced as effective, though potentially costly tools, by health educators in a variety of contexts. The selection of scenarios, however, can be arbitrary and idiosyncratic.

Methods: We conducted a stakeholder audit to determine priorities for student learning which would inform scenario design.

Simulated patient contributions to enhancing exercise physiology student clinical assessment skills.

Background: The aim of this study was to evaluate exercise physiology students' perceptions of two simulation-based learning modules focused on communication and interpersonal skills during history taking.

Methods: A prospective, repeated-measures cohort study was conducted with 15 participants. The study evaluated two simulation-based learning modules in a 1-year Graduate Diploma of Exercise Science program.

The effect of replacing 1 week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance.

Background: Simulation-based learning (SBL) activities are increasingly used to replace or supplement clinical placements for physiotherapy students. There is limited literature evaluating SBL activities that replace on-campus teaching, and to our knowledge, no studies evaluate the role of SBL in counteracting the negative impact of delay between content teaching and clinical placements. The aims of this study were to (i) determine the effect on clinical placement performance of replacing 1 week of content teaching with a SBL activity and (ii) determine if a delay between content teaching and clinical placement impacted clinical placement performance.

An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments.

Most literature on decision processes within physiotherapy relates to "reasoning that results in action" - decisions based on information including assessments that are gathered prior to treatment decisions. A process of "reasoning in interaction" that is often used, particularly by expert clinicians, has received less attention.   To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting.

Measurement of three-dimensional cervical segmental kinematics: Reliability of whole vertebrae and facet-based approaches.

Background: Previous studies have used orientation and translation of whole-vertebrae to describe three-dimensional cervical segmental kinematics. Describing kinematics using facet joint movement may be more relevant to pathology and effects of interventions but has not been investigated in the cervical spine. This study compared the reliability of two different methods (whole-vertebrae vs facet joint) to evaluate cervical kinematics.

Using Smart Socks to Detect Step-count at Slow Walking Speeds in Healthy Adults.

We examined the accuracy of Smart Socks - a device that measures foot pressure during gait for detecting step-count across various walking speeds. Thirty-six participants (17 men; 19 women) wore Smart Socks (Sock), a pedometer (Pedometer), and a smartphone with a commercially available Phone Application (Phone) pedometer to measure step-count during 3-min of treadmill or over-ground walking at 1.3, 2.

Spinal PA movements behave 'as if' there are limitations of local segmental mobility and are large enough to be perceivable by manual palpation: A synthesis of the literature.

Background: Posterio-anterior (PA) movements are one type of passive intervertebral movement used to assess and treat perceived deficits in localized segmental mobility.

Objectives: To describe: 1) The specific effects that reductions in segmental mobility would be expected to have on PA movements; 2) How differences in PA movements in clinical situations compare to what would be expected with reduced segmental mobility; and 3) Whether such differences in PA movements are likely to be perceivable by manual palpation.

Methods: Multiple modelling studies and in vivo measurements of PA movements are described.

Spondylodiscitis in a 54-year-old female scuba diver.

A 54-year-old woman presented to a Sports Physician with a 4-year history of haemochromatosis, and she had a medical history that included a congenital spondylolisthesis resulting in a fusion of L4-S1 at age 16 years, episodic mechanical low back pain and an absence of other significant musculoskeletal symptoms. On presentation, she reported 18 months of severe low back pain that started after a scuba diving trip. After the onset of this low back pain, she developed gastrointestinal symptoms from The gastrointestinal symptoms improved with a course of antibiotics, but the back pain persisted in spite of analgesics, non-steroidal anti-inflammatories and several attempts at different conservative management.

Tactile acuity testing at the neck: A comparison of methods.

Background: Interest in measurement of tactile acuity in musculoskeletal practice has emerged following its link to functional reorganization of the somatosensory cortex in ongoing pain states. Several tactile acuity measurement methods have been described but have not been thoroughly investigated in the cervical region.

Objective: This study examined reliability, concurrent validity and responsiveness of four tests of tactile acuity-Two-point discrimination, Point-to-point, Graphesthesia, and Localisation tests-at the cervical region.

Improving performance in golf: current research and implications from a clinical perspective.

Golf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed.

Reliability of the ECHOWS Tool for Assessment of Patient Interviewing Skills.

Background: History taking is an important component of patient/client management. Assessment of student history-taking competency can be achieved via a standardized tool. The ECHOWS tool has been shown to be valid with modest intrarater reliability in a previous study but did not demonstrate sufficient power to definitively prove its stability.

Reliability of 2 protocols for assessing pressure pain threshold in healthy young adults.

Objective: The purposes of this study were to determine whether there were differences in mean values or reliability for 2 frequently used protocols for pressure pain threshold (PPT) and to calculate how large a difference in PPT is necessary to be 95% confident that a real change has occurred.

Methods: Thirteen participants (8 females) aged 22.3 (±2.

Design and construction of a novel low-cost device to provide feedback on manually applied forces.

Study Design: Design and evaluation, technical note.

Objectives: To describe the design of a simple, low-cost device for providing feedback of manually applied forces to the cervical spine, and to assess the device against specific design criteria.

Background: The forces applied during manual therapy may vary by as much as 500% between practitioners.

Is it reasonable to use an individual patient's progress after treatment as a guide to ongoing clinical reasoning?

Systematic assessment of a patient's progress after an intervention is frequently used to inform decision making in ongoing conservative management of patients with musculoskeletal symptoms. Although reassessment of impairments immediately after treatment is commonplace in clinical practice, relatively little research has considered whether this method is reasonable. The history of, rationale behind, and evidence for the use of patient responses to inform clinical reasoning are explored in this commentary.

Relation between changes in posteroanterior stiffness and active range of movement of the cervical spine following manual therapy treatment.

Study Design: Repeated measures study of active and passive movements in patients with neck pain.

Objectives: To determine if, following manual therapy: (1) changes occur in active range of movement (AROM) and stiffness of posteroanterior (PA) movements, (2) such changes are dependent on the location treated, and (3) there is a relation between changes in PA stiffness and AROM.

Summary Of Background Data: PA movements are frequently used to assess patients with neck pain but little is known about how these movements are related to patient symptoms.

Posteroanterior movements in tender and less tender locations of the cervical spine.

In order to determine how posteroanterior movements (PAs) are related to tenderness and thus possibly symptom production, we measured PA movements to a force of 25N on each side of the cervical spines of asymptomatic subjects. From 10 subjects (six females and four males; mean age 37.2, range 21-50), 10 locations with a difference in tenderness to pressure between sides were used for analysis.

Postero-anterior movements of the cervical spine: repeatability of force displacement curves.

The repeatability of instrumented assessments of postero-anterior (PA) movements has been reported previously for lumbar and thoracic spines, but only in relation to limited parameters of the movement. This study describes a device for measuring PA movements of the cervical spine and reports on repeatability of the entire force/displacement (FD) curves. Repeatability was assessed using coefficients of multiple determination (CMDs) and adjusted CMDs (where the mean offset between the two curves are removed and the shape of the curve can be more directly assessed) for inter-rater intra-day (inter-rater), intra-rater inter-day (inter-day) and intra-rater intra-day (intra-rater) repeated measurements.

Change in impairments in the first two treatments predicts outcome in impairments, but not in activity limitations, in subacute neck pain: an observational study.

Question: Does change in impairments within and between the first two manual therapy treatments predict change in activity limitations by the end of treatment in patients with subacute neck symptoms?

Design: Longitudinal, observational study.

Participants: 29 people with neck pain for more than two weeks who subsequently received >or= three treatments.

Outcome Measures: Impairments measured were active neck ROM in six directions (total ROM), most limited direction of ROM (limited ROM), pain intensity, and pain location.