Upload
arturo-ruiz-leon
View
223
Download
4
Embed Size (px)
Citation preview
PHYSICAL THERAPY ENGLISH 2.2 2014
STUDENTS DOSSIER
Case reports:
A patient with Cervical Pain 1
Online search for clinical information: Cervical Pain 2
Case Reports: Slices of Real Life 5
Online search for clinical information: Chronic Ankle Sprain 6
Analyzing Language: Expressing Health Science Concepts in English 9
Oral Presentation: Evidence-Based Case Study 10
Professional Journal Reading:
Scanning to recognize article types and research design features 14
Pre-Listening: What is a systematic review? 28
Introduction to Systematic Reviews: Reflexology 29
Behavioral treatment for low back pain 31
Exercise for management cancer-related fatigue 33
Foot Orthosis A Systematic Review 35
Effects of IF current therapy in the management of MS Pain 36
Review of therapeutic Ultrasound 37
Group Project
Group Project steps 38
Selecting a general research project 39
Narrowing the topic 41
Finding general background information 43
Finding related research abstracts 44
Formulating a research question: The PICO method 45
Planning your search: Establishing inclusion criteria 49
Representing your search: Flow chart representations 50
Organizing your data: Data tables and data extraction 52
Methodological Quality 65
Presenting your Group Project 68
Writing a summary of findings 70
Citations 71
Answering Research Questions 74
Grammar Exercises
Connecting Ideas and Phrases 79
Summary chart of linker, transition expressions, etc. 81
Summary of patterns of punctuation 82
Linking Expressions 1 83
Linking Expressions 2 84
Paired conjunctions 85
Citation Practice 87
PH
YS
ICA
L T
HE
RA
PY
EN
GL
ISH
2.2
D
os
sie
r Te
rm 2
20
14
Dossier, Physical Therapy English 2.2 2014 page 1
UIC Idiomes jcp 28.2.12b Listening to a clinical description
A Patient with Cervical Pain
Listen to a Physical Therapists description of a patient. Take notes:
The patient:
Current problem:
Past Medical History:
Physical examination:
Treatment:
Outcome:
How will you search for information to clarify this case?
What keywords will you use?
Where will you look for information?
Dossier, Physical Therapy English 2.2 2014 page 2
UIC Idiomes Angls jcp 5.3.12 Table to document online search for information
Question What is the prevalence of neck pain?
Terms I used to find my answer neck pain prevalence (pubmed)
My source of information
The prevalence of neck pain in the world population: a systematic critical review of the literature. Fejer R, Kyvik KO, Hartvigsen J.Eur Spine J. 2006 Jun; 15(6):834-48. Epub 2005 Jul 6. http://www.ncbi.nlm.nih.gov/pubmed/15999284
My answer
The 1-year prevalence was estimated in 22 studies. Based on fairly homogeneous definitions of NP, the prevalence ranged from 16.7% [8] to 75.1% for the entire adult population (1770 years), with a mean of 37.2%
The authors answer
The reported 12-month prevalence of neck pain varies from 30% to 50%, and lifetime prevalence is approximately 70%.
The authors source of information
Gross AR, Haines T, Goldsmith CH, et al. Knowledge to action: a challenge for neck pain treatment. J Orthop Sports Phys Ther.2009;39:351363
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Dossier, Physical Therapy English 2.2 2014 page 3
UIC Idiomes Angls jcp 5.3.12 Table to document online search for information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Dossier, Physical Therapy English 2.2 2014 page 4
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Dossier, Physical Therapy English 2.2 2014 page 5
UIC/ Idiomes/ Angls Cincies de la salut mld.516
Objective to practice reading comprehension about case reports and become familiar with editorial structure
5
10
15
20
25
Case Reports: Slices of Real Life to Complement Evidence Irene R McEwen
With the growing emphasis on evidence-based practice, are case reports outdated relics of the
professional literature? Clinicians, educators, and students increasingly ask this question when
they see that case reports appear near the bottom of the hierarchy of evidencelisted above
only expert opinion. It's true that case reports cannot establish cause-and-effect
relationships between interventions
and outcomes. It's also true that case reports cannot prove reliability or validity
of measurements
and cannot identify prognostic variables. What, then, do case reports contribute to evidence-
based practice?
Case reports are descriptions of practice. Although most case
reports published in Physical
Therapy describe one or more patients, case reports can focus on any aspect of physical therapy
that has not already been described well in the professional literature.
No other type of written
professional communication gives the replicable, detailed, and credible descriptions of practice
that case reports provide. They describe every step in the physical therapist patient/client
management process: examination, evaluation, diagnosis, prognosis, and intervention.
Textbooks do not give this level of detail, and continuing education case examples
rarely
provide an evidence-based rationale for clinical decisions. Research reports often describe an
intervention or the use of a measurement in replicable detail, but they almost never describe
the
entire decision-making process for an individual patientand that process is the reality that
clinicians and students face every day. Case reports are real life.
Case reports describe what physical therapists and physical
therapists assistants ideally do. I say
"ideally" because a good case report exemplifies the definition of evidence-based
practice"the
integration of the best available research evidence with clinical experience and patient values."
Research evidence is important, but it is not the only component of evidence-based practice.
Even when research evidence is available, clinicians need to consider the evidence along with
their own experiences and their patients' preferences and unique circumstances.
What if research evidence is not available? This happens all
the time, and it is not a barrier to
writing a publishable case report. Authors just need to give solid rationale for their
decisions
and the necessary details about what they did and why. Perhaps the case report will stimulate
research that will provide needed evidence in the future. One of the purposes of
case reports is
to identify relevant variables for researchers to investigate.
Discussion Questions
1. To what audience is this article addressed?
2. Where would you find this article?
3. What is unique to case reports? What can they do that other research cannot?
4. What are case reports not able to do in the context of an evidence-base Physical Therapy
practice?
Dossier, Physical Therapy English 2.2 2014 page 6
UIC Idiomes Angls jcp 5.3.12 Table to document online search for information
Chronic Ankle Sprain
More practice searching online for clinical information: Documenting my search.
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Dossier, Physical Therapy English 2.2 2014 page 7
UIC Idiomes Angls jcp 5.3.12 Table to document online search for information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Dossier, Physical Therapy English 2.2 2014 page 8
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Question
Terms I used to find my answer
My source of information
My answer
The authors answer
The authors source of information
Dossier, Physical Therapy English 2.2 2014 page 9
UIC/ Idiomes/ Angls Cincies de salut mld.05.03.12
Objective to reflect on how certain concepts are expressed in English
Analyzing language: expressing health sciences concepts in English
1. Read the sentences below. They refer to certain health sciences concepts that are
widely used in the literature. How do you think the phrases in bold are expressed in
English?
a. En pacientes con un trastorno de ansiedad es frecuente observar embotamiento de la reactividad
general.
b. Estos signos y sntomas no son compatibles con el diagnstico de fibromialgia.
c. La clnico desarroll un proceso holstico de deteccin de sndrome de dolor regional complejo.
d. La incidencia de esguinces de tobillo en la poblacin no deportista es desconocida.
e. Las extremidades superiores son afectadas con mayor frecuencia que las extremidades inferiores.
f. Las mujeres tienen una mayor probabilidad de desarrollar trastornos depresivos.
g. Las vctimas reexperimentan el acontecimiento traumtico.
h. Los factores psicolgicos desempean un papel importante.
i. Representan un 18-30% de todas las fracturas con un pico de incidencia a los 11-12 aos.
j. Se evaluaron los resultados psicolgicos de los sobrevivientes de accidentes automovilsticos.
2. Scan the introduction that your teacher gives you for sentences that express the
phrases in bold. Based on the information you find, write these sentences in English.
3. Categorize the sentences. What aspect of health sciences is each sentence
referring to?
4. Discuss patterns in spelling, grammar and vocabulary that you observe in the English
expressions.
Dossier, Physical Therapy English 2.2 2014 page 10
Oral Presentation: Evidence-Based PT Case Study
You will prepare an EBPT case presentation. Based on a case of a patient you treated or
observed during your clinical training, you should think of a clinical question. You will
search online for information IN ENGLISH that answers your clinical question. In the Oral
Presentation you will present the case, the question, how you searched for the answer to the
question, and how to apply this information in the future, if applicable.
The EBPT oral presentation will be done individually and should last NOT MORE THAN
15 minutes. You should turn in a paper copy of your slides on the day of the presentation.
What information do you need to include?
Remember you may need more than one slide for some of these categories.
Physical Therapy English
2.2
EBPT Case Presentation
A patient with.
Name
Date
Patient presentation
Chief complaint
History: Current and
previous problems
Physical
examination/Diagnostic tests
Patient presentation
Treatment
Outcome
A Clinical Question that
arose:
Search for Evidence:
Term(s): What term(s) did I
use?
Source(s): What source(s)
did I consult?
Search results
What was the answer to my
question?
Clinical applications: How
can I apply this information?
Dossier, Physical Therapy English 2.2 2014 page 11
U.I.C. / Idiomes / Angls
Cincies de la Salut gn.418ap
Objective: To provide guidelines and tips for oral
presentations.
Guidelines and tips for oral presentations on an Evidence-based Physical
Therapy Case Study:
As you are preparing your presentation keep the following in mind.
Keep the text on the slide to a minimum, just enough to orient your audience to what you are talking about. Remember the audience needs a reason to listen to you and not
ignore you and read the slides by themselves.
Know more than what you have on the slides, so you can answer questions and explain.
It is useful to have a printout of your presentation with the pagina de notas. This way you do not have to keep looking back at the screen to know what is on it.
When you present remember to:
Look at the audience when you speak (all of the audience, not just the teacher).
Stand close enough to the screen so that you can point to what you are talking about.
Speak loud enough for your audience to hear you, including the people in the back.
Dossier, Physical Therapy English 2.2 2014 page 12
Notes on oral presentations
Notes for presenters
Good morning/afternoon. My name is________________. I am going to present a patient I
saw in my clinical training.
First / To begin with, this patient is ___________________________ (patients background. example: a 65-year-old, retired female. She plays golf and cares for grandchildren).
The patient presented with ________________ (chief complaint: symptoms). The patients
past medical history included _____________ (what, when, how?). The patient had
undergone ___________ (previous treatments and diagnostic tests). He/she was diagnosed
with_____________ (diagnosis). On examination, ______________ (signs) were observed.
Is that clear? Do you have any questions so far? (Check comprehension in the audience)
Has anyone seen a similar case? How was it similar / different? (Ask your audience to participate)
The patient was treated with ____________ (actual treatment).
Is that clear? Do you have any questions so far? (Check comprehension in the audience)
Finally, I would like to explain what the outcome for this patients was ____________ .
During my clinical training with this patient, some important questions arose. Firstly,
__________ (Clinical question #1). And secondly, ___________________. (Clinical question #2).
The terms that I used in my search for answers were: _____________________ (keywords).
In order to answer my clinical questions I consulted ________________ as my sources of
information. I identified these abstracts:______________________________. The answer
to my questions were the following: ______________________________(explain what you learned from the abstracts and how to apply this information into your clinical practice).
Now I would be happy to answer questions.
Thank you for your attention.
Vocabulary: present with, undergo, be diagnosed with, on examination, , be observed, be
treated with. Others:
Notes for audience 1. Treat the speakers with respect. Dont converse. 2. Take notes. 3. Ask questions if you want clarification or if you want further information. 4. When the presentation is finished, clap.
UIC / Idiomes / Angls / Cincies de la Salut / mks.139
Dossier, Physical Therapy English 2.2 2014 page 13
Evaluation of Oral Presentation
Student: ______________________________ Date of presentation: __________
Partner: _______________________________
Condition: ________________
1. Eye contact with audience
No eye contact Appropriate contact
2. Mode of delivery
Read / Not prepared Did not read / Prepared
3. Use/organization/clarity of PowerPoint slides
Too wordy, language errors Clear, concise, no mistakes
4. Clarification of vocabulary and content
None/Insufficient Appropriate
5. Language use (Grammar & Vocabulary)
Lack of variety and/or accuracy Wide variety and accuracy in
in structure and vocabulary structure and vocabulary
6. Clarity / Pronunciation (of crucial vocabulary)
Difficult to understand/Mispronunciations Easy to understand/Accurate
General comments:
0 10
0 10
0 10
0 10
0 10
UIC / Idiomes / Angls / Cincies de la Salut / Physiotherapy A2 jcp 27b
0 10
Dossier, Physical Therapy English 2.2 2014 page 14
Scanning to recognize article types and research design features
Rationale: An important skill is rapid scanning to assess article type and qualitythis
involves looking at Medline titles and abstracts or the first pages of journal
articles for certain key words like review, case report, etc. or trial, randomized,
retrospective, etc. Pages 15 to 27 contain texts from physical therapy journals.
Tasks: 1) Scan each page quickly and check the appropriate box in the columns under
article types (
Dossier, Physical Therapy English 2.2 2014 page 15
Text 1
PHYS THER
Vol. 81, No. 5, May 2001, pp. 1127-1134
Changes in Attitudes and Perceptions About Research in Physical Therapy Among Professional Physical Therapist Students and New Graduates
Barbara H Connolly, Norwood S Lupinnaci and Andrew J Bush BH Connolly, PT, EdD, is Professor and Chair, Department of Physical Therapy, College of Allied Health
Sciences, University of Tennessee Health Science Center, 822 Beale St, Memphis, TN 38363 (USA)
Background and Purpose. The physical therapy profession, through
its published educational accreditation
standards and its normative model of professional education, has addressed the importance
of educating
physical therapist students in the basic principles and application of research. The purpose of this study was to
conduct a longitudinal study of students relative to (1) their perception of knowledge with respect to research,
(2) their perception of what source should be used (evidence-based practice
or traditional protocols) for clinical
decision making, and (3) their perception of what should be used in a clinical setting
for patient management.
Subjects. Thirty-six students during the final year of their professional program from a sample of
115 physical
therapist students who requested 2 consecutive physical therapist classes completed the entire sequence of
pretest and posttest survey administrations. Seventy-nine students did not complete the entire sequence.
Methods. A 10-item 5-point Likert-type questionnaire was designed by the authors to probe
the students'
attitudes and perceptions about research, their level of comfort and confidence in reading and applying research
findings published in the literature, and their personal habits regarding reading the professional literature. An
expert panel consisting of internal and external reviewers was used for construction
of the questionnaire. The
questionnaire was completed by the students immediately preceding their research methods course,
immediately after the completion of that course, and following the second research course, which included
statistics and development of a research proposal. The subjects also completed the questionnaire
after 1 year of
physical therapy practice. Friedman's analysis of variance was used as an omnibus test to detect differences
across time. In addition, a follow-up analysis using the Wilcoxon signed-rank procedure to examine differences
between baseline data and data obtained during each follow-up was done for all
items to determine whether a
difference occurred at a time other than at the final posttest survey administration. Results. The
students
showed differences on 5 of the 10 items on the questionnaire during the study. Discussion and Conclusion.
These items related to reading peer-reviewed professional journals, critically reading
professional literature,
relevance and importance of evidence-based clinical practice, and level of comfort with knowledge in research.
Key Words: Attitudes Educational outcomes Research
1. Summarize the objectives of this study in your own words. 2. How many students began this study? _______ How many completed it? _______
3. How many times did students complete the questionnaire?
4. Infer some questions included in the survey
a) about attitudes and perceptions about research
b) about students level of comfort and confidence in reading and applying research
findings
published in the literature
c) about students personal habits
regarding reading the professional literature
Dossier, Physical Therapy English 2.2 2014 page 16
Text 2
PHYS THER
Vol. 86, No. 7, July 2006, pp. 910-911
Interpreting Systematic Reviews: Sometimes, More Is Better Rebecca L Craik, Editor in Chief
Many of us remember when it was common for journals to publish literature reviews in
which content experts summarized topical information for the reader. A review of the
literature, however, does not protect the reader against the bias of the content
expert. In fact,
a literature review provides an opportunity for experts to support their bias using relevant
literature.
The systematic review, on the other hand, is designed to locate, appraise, and synthesize
primary studies reliably, using a scientific method that is intended to decrease bias and
errors.1 The clinical
problem should be focused and clearly stated, and each component
of
the review should be carefully described: the systematic strategy used to search for relevant
articles, the method used to critically appraise the articles before they are included
in the
review, the method used to collect data from the selected articles, and the methods used to
synthesize those collected data.
2 The Cochrane Collaboration
3 is one of the best-known
organizations that provide an infrastructure for conducting, maintaining, and updating
systematic reviews of the effectiveness of health care interventions. However, because the
systematic reviews overseen by the Cochrane Collaboration are not comprehensive,
many
journals commonly publish systematic reviews on relevant topics, rather than literature
reviews.
You may be surprised to find that Physical Therapy has published 2 systematic reviews
examining the effectiveness of physical therapy interventions for temporomandibular
disorders. In the May 2006 issue, McNeely, Armijo Olivo, and Magee published "A
Systematic Review of the Effectiveness of Physical Therapy Interventions for
Temporomandibular Disorders"; in this issue, Medlicott and Harris publish "A Systematic
Review of the Effectiveness of Exercise, Manual Therapy, Electrotherapy, Relaxation
Training, and Biofeedback in the Management of Temporomandibular Disorder."
Medlicott
and Harris contacted me when the May issue was published and offered to forgo publication
of their article. Although their gesture was noble, I decided to publish both articles.
1. What is the source of this article?
2. What year was it published?
3. How many authors are there?
Circle True or False
4. True / False According to this article literature reviews provide objective analysis of
information from different studies.
5. True / False All systematic reviews are published by Chocrane Collaboration
6. True / False The Chocrane Collaboration is a well respected source of systematic
reviews.
http://www.ptjournal.org/cgi/content/full/86/7/910?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22literature+review%22&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT#R1#R1http://www.ptjournal.org/cgi/content/full/86/7/910?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22literature+review%22&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT#R2#R2http://www.ptjournal.org/cgi/content/full/86/7/910?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22literature+review%22&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT#R3#R3
Dossier, Physical Therapy English 2.2 2014 page 17
Text 3
PHYS THER
Vol. 87, No. 5, May 2007, pp. 545-555
Effect of Aerobic Training on Walking Capacity and Maximal Exercise Tolerance in Patients With Multiple Sclerosis: A Randomized Crossover Controlled Study Anais Rampello, Marco Franceschini, Massimo Piepoli, Roberto Antenucci, Gabriella
Lenti, Dario Olivieri and Alfredo Chetta Background and Purpose Physical deconditioning is involved in the impaired exercise
tolerance of patients with multiple sclerosis (MS), but data on the effects of aerobic training
(AT) in this population are scanty. The purpose of this study was to compare the effects
of
an 8-week AT program on exercise capacityin terms of walking capacity and maximum
exercise tolerance, as well as its effects on fatigue and health-related quality of lifeas
compared with neurological rehabilitation (NR) in subjects with MS.
Subjects and Methods
Nineteen subjects (14 female, 5 male; mean age [ SD]=418 years) with mild to moderate
disability secondary to MS participated in a randomized crossover controlled study. Eleven
subjects (8 female, 3 male; mean age [ SD]=446 years) completed the study.
Results
After AT, but not NR, the subjects walking distances and speeds during a self-paced walk
were significantly improved, as were their maximum work rate, peak oxygen uptake, and
oxygen pulse during cardiopulmonary exercise tests. The increases in
peak oxygen uptake
and maximum work rate, but not in walking capacity, were significantly higher after AT, as
compared with after NR. Additionally, the subjects who were most disabled
tended to benefit
more from AT. There were no differences between AT and NR in effects on fatigue, and the
results showed that AT may have partially affected health-related quality of life.
Discussion
and Conclusion The results suggest that AT is more effective than NR in improving
maximum exercise tolerance and walking capacity in people with mild to moderate disability
secondary to MS.
1. What journal was the article published in? __________________________________
2. How many authors contributed to this article? _______________________________
3. Were the results of this study positive, negative, or inconclusive?________________
4. What was/were the objective outcome measure(s) used?_______________________
______________________________________________________________________
5. What was/were the subjective outcome measure(s) were used? __________________
______________________________________________________________________
6. How many weeks total was the study period? ________________________________
7. What was the control treatment? __________________________________________
TRUE OR FALSE?
8. All the subjects received aerobic training. T / F
9. All the outcome measures showed improvement. T / F
10. NR was more effective than AT. T / F
11. Some subjects responded better to therapy than others. T / F
12. This study would rank high on the evidence ladder. T / F
13. Draw a scheme showing the groups of subjects and the treatments (if any) that they
received. Indicate the number of people involved in each group. Also draw the treatment
and assessment timeline.
Dossier, Physical Therapy English 2.2 2014 page 18
Text 4
The American Journal of Sports Medicine 28:S (2000)
2000 American Orthopaedic Society for Sports Medicine
Football Injuries and Physical Symptoms: A Review of the Literature Jiri Dvorak, MD
* and Astrid Junge, PhD
Schulthess Clinic, Zurich, Switzerland
Football is one of the most popular sports worldwide. The frequency of football injuries is
estimated to be approximately 10 to 35 per 1000 playing hours. The majority of injuries
occur in the lower extremities, mainly in the knees and ankles; the number
of head injuries is
probably underestimated. The average cost for medical treatment per football injury is
estimated to be $150 (U.S. dollars). Considering the number of active football
players
worldwide, the socioeconomic and financial consequences of injury are of such a proportion
that a prevention program to reduce the incidence of injuries is urgently required. For
this
reason, an analysis of intrinsic (person-related) and extrinsic (environment-related) risk
factors was undertaken based on a review of the current literature. It was concluded that the
epidemiologic information regarding the sports medicine aspects of football injuries is
inconsistent and far from complete because of the employment of heterogeneous methods,
various definitions of injury, and different characteristics of the assessed teams.
The aim of
this study was to analyze the literature on the incidence of injuries and symptoms in football
players, as well as to identify risk factors for injury and to demonstrate possibilities
for
injury prevention.
1. What was/were the authors objectives?
2. Were they able to achieve this objective? ______ Why or why not?
3. Based on the abstract, do you think this article is likely to have useful clinical applications for your practice? _______ Why or why not?
http://ajs.sagepub.com/misc/terms.shtml
Dossier, Physical Therapy English 2.2 2014 page 19
Text 5
Therapeutic Effects of Yoga for Children: A Systematic Review of the Literature.
Review Pediatric Physical Therapy. 20(1):66-80, Spring 2008.
Galantino, Mary Lou PT, PhD, MSCE; Galbavy, Robyn PT, MPT; Quinn, Lauren DPT
Abstract: Purpose: We completed a systematic review of the literature on the effect of yoga on quality
of life and physical outcome measures in the pediatric population. We explored various
databases and included case-control and pilot studies, cohort and randomized controlled
trials that examined yoga as an exercise intervention for children.
Summary of Key Points: Using the Sackett levels of evidence, this article reviews the
literature on yoga as a complementary mind-body movement therapy. We address the
research through three practice patterns according to the Guide to Physical Therapist
Practice and provide considerations for the inclusion of yoga into clinical practice.
Statement of Conclusions and Recommendations for Clinical Practice: The evidence shows
physiological benefits of yoga for the pediatric population that may benefit children through
the rehabilitation process, but larger clinical trials, including specific measures of quality of
life are necessary to provide definitive evidence.
1. Were the outcome measures in this study subjective, objective or both? ___________
2. According to the evidence ladder, how would you rank the four types of studies reviewed in this article.
3. The articles reviewed examined yoga as a substitute for other types of physical therapy. True / False
4. This review found that yoga had a positive result on some objective outcome measures, subjective outcome measures or both? ______________________
Dossier, Physical Therapy English 2.2 2014 page 20
Text 6
PHYS THER
Vol. 75, No. 12, December 1995, pp. 1075-1081
Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study
C Dumoulin, DE Seaborne, C Quirion-DeGirardi, and SJ Sullivan Hopital Ste-Justine de Montreal, Quebec, Canada.
BACKGROUND AND PURPOSE: This descriptive cohort study investigated a physical therapy
program of pelvic-floor neuromuscular electrostimulation (NMES) combined with exercises, with
the aim of developing a simple, inexpensive, and conservative treatment for postpartum genuine
stress incontinence (GSI). SUBJECTS: Eight female subjects with urodynamically established GSI
persisting more than 3 months after delivery participated in the study. The subjects ranged in age
from 24 to 37 years (X = 32, SD = 4.2). METHODS: This was a descriptive multiple-subject cohort
study. Each subject received a total of nine treatment sessions during 3 consecutive weeks,
consisting of two 15-minute sessions of NMES followed by a 15-minute pelvic-floor muscle exercise
program. Patients also practiced daily pelvic-floor exercises during the 3-week treatment period. The
treatment intervention was measured using three separate variables. Maximum muscle contractions
(pretraining, during training, and post-training) were measured indirectly as pressure, using
perineometry. Urine loss pretraining and posttraining was measured by means of a Pad test. Self-
reported frequency of incontinence was recorded daily throughout the period of the study, using a
diary. Data were analyzed using a one-way repeated-measures analysis of variance (ANOVA), a
Wilcoxon signed-ranks test, and a Friedman two-way ANOVA by ranks. RESULTS: The results
indicated that maximum pressure generated by pelvic-floor contractions was greater and both the
quantity of urine loss and the frequency of incontinence were lower following the implementation of
the physical therapy program. Five subjects became continent, and three others improved. A follow-
up survey 1 year later confirmed the consistency of these results. CONCLUSION AND
DISCUSSION: The results suggest that the proposed physical therapy program may influence
postpartum GSI. Further studies are needed to validate this simple, inexpensive, and conservative
physical therapy protocol. [Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Pelvic-
floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the
treatment of genuine stress incontinence in postpartum women--a cohort study.
1. What was the objective of this study?
2. What was the cohort for this study?
3. All interventions took place at the treatment center? TRUE / FALSE
4. What were the outcome measures?
5. According to the authors what type of study is this?
6. Based on what you have learned about different types of studies, what type of study would you say this is?
7. What features of this study helped you make this decision.
Dossier, Physical Therapy English 2.2 2014 page 21
Text 7
Arthroscopy. 2007 Dec;23(12):1320-1325.e6.
A meta-analysis of the incidence of anterior cruciate ligament tears as a function of
gender, sport, and a knee injury-reduction regimen.
Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K.
Illinois Sports Medicine & Orthopaedic Centers, Glenview, Illinois 60025, USA.
PURPOSE: The literature has shown that anterior cruciate ligament (ACL) tear rates vary by
gender, by sport, and in response to injury-reduction training programs. However, there is no
consensus as to the magnitudes of these tear rates or their variations as a function of these
variables. For example, the female-male ACL tear ratio has been reported to be as high as
9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate
accurate estimates of the true incidences of ACL tear as a function of gender, sport, and
injury-reduction training. METHODS: A PubMed literature search was done to identify all
studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to
identify additional articles. Meta-analytic principles were applied to generate ACL
incidences as a function of gender, sport, and prior injury-reduction training. RESULTS:
Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67;
lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female
subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08,
respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03,
with no gender variance. The two volleyball studies had no ACL tears. Training reduced the
ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball.
CONCLUSIONS: Female subjects had a roughly 3 times greater incidence of ACL tears in
soccer and basketball versus male subjects. Injury-reduction programs were effective for
soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear,
whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk
sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender
difference for ACL tear rate. Year-round female athletes who play soccer and basketball
have an ACL tear rate of approximately 5%. LEVEL OF EVIDENCE: Level IV, therapeutic
case series. 1. What is the source of this article? _________________________
2. What year was it published? __________________________
3. How many authors were there? __________________________
4. The authors wanted to study _____. a. the incidence of ACL tears among athletes b. gender differences in ACL tears c. the number of ACL tears in relation to preventative measures, sex and type of activity d. age-related risk factors contributing to ACL tears
5. What variables seem to affect the likelihood of person experiencing an ACL injury? ________
___________________________________________________________________________
6. Which sport had the highest incidence of ACL tears? __________________________
7. Which sport had the lowest incidence of ACL tears? __________________________
javascript:AL_get(this,%20'jour',%20'Arthroscopy.');http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Prodromos%20CC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Han%20Y%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Rogowski%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Joyce%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Shi%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1
Dossier, Physical Therapy English 2.2 2014 page 22
Text 8
PHYS THER
Vol. 77, No. 8, August 1997, pp. 812-819
Predicting the probability for falls in community-dwelling older adults A Shumway-Cook, M Baldwin, NL Polissar, and W Gruber
Department of Physical Therapy, Northwest Hospital, Seattle, WA 98133, USA.
BACKGROUND AND PURPOSE: The objective of this retrospective case-control study
was to develop a model for predicting the likelihood of falls among community-dwelling
older adults. SUBJECTS: Forty-four community-dwelling adults (> or = 65 years of age)
with and without a history of falls participated. METHODS: Subjects completed a health
status questionnaire and underwent a clinical evaluation of balance and mobility function.
Variables that differed between fallers and nonfallers were identified, using t tests and cross
tabulation with chi-square tests. A forward stepwise regression analysis was carried out to
identify a combination of variables that effectively predicted fall status. RESULTS: Five
variables were found to be associated with fall history. These variables were analyzed using
logistic regression. The final model combined the score on the Berg Balance Scale with a
self-reported history of imbalance to predict fall risk. Sensitivity was 91%, and specificity
was 82%. CONCLUSION AND DISCUSSION: A simple predictive model based on two
risk factors can be used by physical therapists to quantify fall risk in community-dwelling
older adults. Identification of patients with a high fall risk can lead to an appropriate referral
into a fall prevention program. In addition, fall risk can be used to calculate change resulting
from intervention 1.
What background information do the authors give for this study? ___________________
2. What is their objective?____________________________________________________
3. What group of patients represents the case in this study? ________________________
4. What group of patients represents the control in this study? ______________________
5. How many variables contribute to a history of falls?______________________________
6. What are they?__________________________________________________________
Dossier, Physical Therapy English 2.2 2014 page 23
Text 9
Md Med J 1999 Jan-Feb;48(1):7-11
Long-term functional results after manipulation of the frozen shoulder.
Reichmister JP, Friedman SL. Department of Orthopaedic Surgery, Sinai Hospital, USA.
The use of shoulder manipulation in the treatment of frozen shoulder syndrome remains
controversial. Opponents cite the risk of dislocation, fracture, nerve palsy, and rotator cuff
tearing as limiting the usefulness of manipulation. A retrospective study of 38 shoulder
manipulations in 32 patients was performed. These patients were followed for an average
time of 58 months. The patients were examined in follow up for combined shoulder range of
motion, external and internal rotation strength, and status of the long head of the biceps.
Manipulation was performed in all patients by the senior author and supervised physical
therapy was begun within 24 hours of the manipulation. The average recovery time was 13
weeks. In this series, 97% of patients had relief of pain and recovery of near complete range
of motion, although 8% required a second manipulation to obtain a successful result. Mild
weakness to manual muscle testing was present in 5.3% of patients in external rotation and
10.5% of patients in internal rotation. There was no deterioration of shoulder function with
time. In fact, most patients improved even more with passage of time. There was no
evidence of biceps tendon rupture or rotator cuff insufficiency at the time of follow up in
any of the patients. No fractures, dislocations or nerve palsies were observed, although one
patient who had no premanipulation arthrogram was found to have a rotator cuff tear a few
months after failed manipulation. Manipulation of the shoulder can therefore be offered to
reduce the pain and period of disability in patients who fail conservative treatment of frozen
shoulder syndrome.
1. This abstract describes a __.
a) randomized controlled trial
b) case report c) retrospective study
d) review of the medical literature
2. This study was probably carried out __.
a) because frozen shoulder syndrome is a painful disorder b) because other studies have criticized manipulation as a treatment for frozen shoulder
c) to determine if shoulder manipulation is an effective treatment for frozen shoulder d) to determine the long-term effect of frozen shoulder syndrome
TRUE or FALSE? 3. ___ The subjects were probably former patients of one of the authors.
4. ___ Shoulder manipulation can be considered a conservative treatment for frozen shoulder. 5. ___ The 32 subjects probably began treatment for frozen shoulder at different baselines.
6. ___ Patients received no treatment for frozen shoulder apart from shoulder manipulation. 7. ___ No injury that could have been due to shoulder manipulation was found in any of the
subjects.
8. ___ Three patients were given shoulder manipulation twice. 9. ___ One outcome measure was probably a VAS for pain.
Dossier, Physical Therapy English 2.2 2014 page 24
Text 10
Physical Therapy Volume 80 Number 4 April 2000 Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence, Severity, Risks, and Responses Jean E Cromie, Valma J Robertson, and Margaret O Best
Background and Purpose. Physical therapists are at risk for work-related musculoskeletal
disorders (WMSDs). Little is known of how therapists respond to injury or of what actions
they take to prevent injury. The purpose of this study was to investigate the prevalence and
severity of WMSDs in physical therapists, contributing risk factors, and their responses to
injury. Subjects. As part of a larger study, a systematic sample of 1 in 4 therapists on a state
register (n=824) was surveyed. Methods. An 8-page questionnaire was mailed to each
subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-
related risk factors, injury prevention strategies, and responses to injury. Results. Lifetime
prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the
profession as a result of WMSDs. Younger therapists reported a higher prevalence of
WMSDs in most body areas. Use of mobilization and manipulation techniques was related
to increased prevalence of thumb symptoms. Risk factors pertaining to workload were
related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors
were related to a higher prevalence of spinal symptoms. Conclusion and Discussion.
Strategies used to reduce work-related injury in industry may also apply to physical
therapists. Increased risk of thumb symptoms associated with mobilization techniques
suggests that further research is needed to establish recommendations for practice. The
issues for therapists who move within or leave the profession are unknown, and further
research is needed to better understand their needs and experiences. [Cromie JE, Robertson
VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: prevalence,
severity, risks, and responses. Phys Ther. 2000;80:336-351.] Key Words: Musculoskeletal disorders, Occupational injury, Physical therapy, Risk
factors.
1. What is the authors objective?
2. What were the features of the study population?
3. What was the study design?
4. Data was collected on ____. (Circle all that apply.)
5. What does WMSD mean? _______________________________________________
f) preventive measures adopted g) work history h) work responsibilities i) body mass index j) anthropometric variables
a) adaptation and attitudes toward injuries b) areas of expertise c) level of education d) occupational risk factors e) physical complaints
Dossier, Physical Therapy English 2.2 2014 page 25
6. The results showed that __________. a) 1 in 6 physical therapists reported lifetime prevalence of WMSDs. b) 91% of young physical therapists moved within or left the profession due to
WMSDs.
c) there is a higher prevalence of symptoms among younger physical therapists. d) use of mobilization and manipulation techniques was the cause of most disorders.
7. Based on your knowledge of your profession what types tasks performed by PTS are likely to lead to the development of musculoskeletal disorders? What types of
preventative measures do you know of to reduce the risk of developing a WMSD?
Discuss with a partner.
8. _______ led to thumb problems. a) lack of recommendations for practice b) performing mobilization techniques c) workload factors d) work-related musculoskeletal disorders
9. _____ triggered cervical and arm problems. a) amount and type of work b) lifting patients c) muscle strength d) posture
10. Poor sitting or standing positions put a physical therapist at risk for ________. a) back pain b) hip joint and circulation problems c) problems in the cervical vertebrae d) upper and lower limb joint pain
11. Do you find it surprising that younger therapists reported a higher prevalence of WMSDs in most body areas? What do you think might account for this phenomenon?
Discuss with a partner.
12. In the conclusion, the authors suggest that physical therapists can benefit from _____.
a) strategies used to prevent injury in industry b) mobilization techniques to strengthen their thumbs. c) existing research on their needs and experiences. d) exercises that industrial workers do to reduce such problems as thumb
hypermobility
13. Which issues does the author believe need further research?
Dossier, Physical Therapy English 2.2 2014 page 26
Text 11
Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a
randomized, double-blinded, placebo-controlled trial
The Clinical Journal of Pain 2007 May;23(4):316-322
OBJECTIVE: The aim of this study was to examine the effect of acupuncture-like
electrical stimulation on chronic tension-type headache (TTH) in a randomized, double-
blinded, placebo-controlled study. METHODS: Thirty-six patients (18 men, 18 women)
with chronic TTH in accordance with the criteria of International Headache Society were
investigated. The patients were randomly assigned into 2 groups: a treatment group and a
placebo group. Pain duration, pain intensity on a 0 to 10 cm visual analog scale, number of
headache attacks, and use of medication were recorded in a diary for 2 weeks before
treatment (baseline), early stage of treatment (Treat-1; 2 wk), late stage of treatment (Treat-
2; 4 wk), and after the end of treatment (Post-1, Post-2, Post-3 corresponding to 2, 4, and 6-
wk follow-up). The patients also provided an overall evaluation of the treatment effect at
each stage. Patients were taught how to use either an acupuncture-like electrical stimulator
or a sham stimulator (identical but incapable of delivering an electric current) and then
instructed to use the device at home. Six acupoints, bilateral EX-HN5, GB 20, LI 4, were
selected to be stimulated 3 minutes for each point, twice a day. Friedman repeated measure
analysis of variance on rank was used to test the data. RESULTS: The pain duration was
shortened at Treat-1 and pain intensity was decreased at Treat-1 and Treat-2 compared with
baseline. The overall evaluation of the 2 treatments indicated improvements in both the
treatment and the placebo groups, but with no significant difference between the groups (p >
0.061). Despite the apparent improvement in both the treatment and placebo groups, a
decrease in analgesic use was only observed in the treatment group. There was also a
significant positive correlation between the reported intensity of the stimulus-evoked
sensation and the evaluation of the effect of either active or placebo treatments (p = 0.039).
CONCLUSIONS: The use of acupuncture-like electrical stimulation was not associated
with significant adverse effects. These results indicate that acupuncture-like electrical
stimulation is a safe and potentially analgesic-sparing therapy that may be considered as an
adjunctive treatment for patients with chronic TTH although the clinical effect on pain
seems to be marginal in the present set-up. 1. During the study did the researchers know which patients were receiving the acupuncture-like
electrical stimulation and which patients were receiving the placebo? _______ 2. How many weeks was the duration of the study?_________ 3. Mark the timeline with the various stages of the study. 4. Did the placebo treatment cause a sensation? _______ 5. What factor affected the effect of the treatment?
a. the subjects sex b. whether patients received acupuncture-like electrical stimulation or placebo c. how intensely the patient felt the application of treatment
6. Do the authors feel acupuncture-like electrical stimulation is a possible substitute for other
treatments TTH? ________ 7. Could the results of this study be applied to anyone suffering a headache? Why or why not?
______________________________________________________________
Dossier, Physical Therapy English 2.2 2014 page 27
Text 12
PHYS THER
Vol. 88, No. 1, January 2008, pp. 98-104
DOI: 10.2522/ptj.20070033
Undetected Hangman's Fracture in a Patient Referred for Physical Therapy for the Treatment of Neck Pain Following Trauma Michael D Ross and John M Cheeks
Background and Purpose: This case report describes a patient referred for physical therapy
treatment of neck pain who had an underlying hangman's fracture that precluded physical
therapy intervention.
Case Description: This case involved a 61-year-old man who had a sudden onset of neck
pain after a motor vehicle accident 8 weeks before his initial physical therapy visit.
Conventional radiographs of his cervical spine taken on the day of the accident
did not reveal
any abnormalities. Based on the findings at his initial physical therapy visit, the physical
therapist ordered conventional radiographs of the cervical spine to rule out the
possibility of
an undetected fracture.
Outcomes: The radiographs revealed bilateral C2 pars interarticularis defects consistent
with a hangman's fracture. The patient was referred to a neurosurgeon for immediate review.
Based on a normal neurological examination, a relatively low level of pain,
and the results of
radiographic flexion and extension views of the cervical spine (which revealed no evidence
of instability), the neurosurgeon recommended that the patient continue with
nonsurgical
management.
Discussion: In patients with neck pain caused by trauma, physical therapists should be alert
for the presence of cervical spine fractures. Even if the initial radiographs are negative for
a
fracture, additional diagnostic imaging may be necessary for a small number of patients,
because they may have undetected injuries that would necessitate medical referral and
preclude physical therapy intervention.
1. What is the source of this abstract? ___________________
2. What year was it published? ___________________
3. The patients neck pain developed over time. True / False.
4. How was the hangmans fracture detected? ______________________
5. Was the patient able to continue with physical therapy? ___________
Why do the authors feel the presentation of this case was important?
Dossier, Physical Therapy English 2.2 2014 page 28
UIC/ Idiomes/Angls Cincies de la salut gn.66
Objective: Review of vocabulary for PowerPoint Presentation gn.66 What is a systematic review
PRE-LISTENING: In English 1 and 2.1 you learned about two basic types of research: non-
experimental and experimental. Look at the following types of studies and say what type of
research it is.
1. ______________________ Cohort
2. ______________________ Case Report
3. ______________________ Randomized Controlled Trial
4. ______________________ Cross-sectional Survey
5. ______________________ Case-control
What do you remember about the designs of each type of study? What types of research
questions are they best for answering?
Here is the hierarchy of evidence pyramid we looked at in English 1. Do you remember where each type
of research is located in the pyramid?
Case-control studies Case series and case reports
Systematic reviews Editorials and expert opinions
Randomized controlled trials Cohort studies
Dossier, Physical Therapy English 2.2 2014 page 29
UIC/ Idiomes/Angls Cincies de la salut gn.69
Objective: to reflect on the importance of systematic reviews
Before you read:
1. Reflexology is a popular complementary therapy. What do you know about it?
2. For what sorts of conditions might it be a useful treatment?
3. Do you think it is effective therapy?
Med J Aust. 2009 Sep 7;191(5):263-6.
Is reflexology an effective intervention? A systematic review of
randomised controlled trials.
Ernst E.
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth,
Exeter, United Kingdom. [email protected]
OBJECTIVE:
To evaluate the evidence for and against the effectiveness of reflexology for treating any
medical condition.
DATA SOURCES:
Six electronic databases were searched from their inception to February 2009 to identify all
relevant randomised controlled trials (RCTs). No language restrictions were applied.
STUDY SELECTION AND DATA EXTRACTION:
RCTs of reflexology delivered by trained reflexologists to patients with specific medical
conditions. Condition studied, study design and controls, primary outcome measures,
follow-up, and main results were extracted.
DATA SYNTHESIS:
Of 217 publications identified, 18 RCTs met all the inclusion criteria. The studies examined
a range of conditions: anovulation, asthma, back pain, dementia, diabetes, cancer, foot
oedema in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis,
the postoperative state and premenstrual syndrome. There were > 1 studies for asthma, the
postoperative state, cancer palliation and multiple sclerosis. Five RCTs yielded positive
results. Methodological quality was evaluated using the Jadad scale. The methodological
quality was often poor, and sample sizes were generally low. Most higher-quality trials did
not generate positive findings.
CONCLUSION:
The best evidence available to date does not demonstrate convincingly that reflexology is an
effective treatment for any medical condition.
1. What is the source of this abstract? ____________
2. When was it published? _______________
3. Where does the researcher work? __________________
4. What were the inclusion criteria? ___________________________________
5. How many different aspects of the trials were compared? ________________
6. How many studies were included in this review? ________________
http://www.ncbi.nlm.nih.gov/pubmed/19740047http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ernst%20E%22%5BAuthor%5D
Dossier, Physical Therapy English 2.2 2014 page 30
TRUE / FALSE: Write T or F in the blank
7. _____ The year of study publication was not an inclusion criteria.
8. _____ All the studies reviewed were in English.
9. _____ Five RCTs had high methodological quality.
10. _____ Only one RCT had been conducted for most conditions.
Reflect:
1. Why might the author be interested in whether more than one RCT had been conducted on a particular condition?
2. Read the following statement from Reflexology Association of Australia and discuss why the results of this systematic review are so different from the RAAs claims.
Think about what we have learned about different kinds of studies.
Reflexology can address your particular needs. Painful, congested or overactive states
within the body can be balanced and normalised. Thousands of documented case studies
from around the world have demonstrated the benefits for:
[premenstrual tension]
Migraine
Sinus
Colic
Menopause
Constipation/Diarrhoea
Back Pain
Neck Pain
Sciatica
Shoulder Pain
Asthma
Stroke
Menstrual Irregularities
Reflexology Association of Australia (http://www.reflexology.org.au)
Dossier, Physical Therapy English 2.2 2014 page 31
UIC/ Idiomes/Angls Cincies de la salut gn.67
Objective: Introduce basic concepts of systematic reviews
Behavioural treatment for chronic low-back pain
Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ,
Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of
Systematic Reviews 2010, Issue 7. Art. No.: CD002014. DOI:
10.1002/14651858.CD002014.pub3.
Abstract
Background: Behavioural treatment is commonly used in the management of chronic low-
back pain (CLBP) to reduce disability through modification of maladaptive pain behaviours
and cognitive processes. Three behavioural approaches are generally distinguished: operant,
cognitive, and respondent; but are often combined as a treatment package. Objectives: To
determine the effects of behavioural therapy for CLBP and the most effective behavioural
approach. Methods: The Cochrane Back Review Group Trials Register, CENTRAL,
MEDLINE, EMBASE, and PsycINFO were searched up to February 2009. Reference lists
and citations of identified trials and relevant systematic reviews were screened. Randomised
trials on behavioural treatments for non-specific CLBP were included. Two review authors
independently assessed the risk of bias in each study and extracted the data. If sufficient
homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was
performed. We determined the quality of the evidence for each comparison with the
GRADE approach.
Results: We included 30 randomised trials (3438 participants) in this review, up 11 from the
previous version. Fourteen trials (47%) had low risk of bias. For most comparisons, there
was only low or very low quality evidence to support the results. There was moderate
quality evidence that: i) operant therapy was more effective than waiting list (SMD -0.43;
95%CI -0.75 to -0.11) for short-term pain relief; ii) little or no difference exists between
operant, cognitive, or combined behavioural therapy for short- to intermediate-term pain
relief; iii) behavioural treatment was more effective than usual care for short-term pain relief
(MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to
long-term, or on functional status; iv) there was little or no difference between behavioural
treatment and group exercise for pain relief or depressive symptoms over the intermediate-
to long-term; v) adding behavioural therapy to inpatient rehabilitation was no more effective
than inpatient rehabilitation alone. Conclusion: For patients with CLBP, there is moderate
quality evidence that in the short-term, operant therapy is more effective than waiting list
and behavioural therapy is more effective than usual care for pain relief, but no specific type
of behavioural therapy is more effective than another. In the intermediate- to long-term,
there is little or no difference between behavioural therapy and group exercises for pain or
depressive symptoms. Further research is likely to have an important impact on our
confidence in the estimates of effect and may change the estimates.
1. What is the source of this abstract? ____________
2. When was it published? _______________
Dossier, Physical Therapy English 2.2 2014 page 32
3. The goal of this review was to _____ (Circle Two)
a. compare behavioral therapy to other types of physical therapy in the treatment of
low-back pain.
b. Determine if behavioral therapy is an effective intervention for chronic low-back
pain.
c. See if one type of behavioral therapy is better than another.
d. Determine how different types of behavioral therapy are combined in the
treatment of CLBP.
4. How many databases were searched? _________
5. What does this statement from the methods section mean? If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was
performed.
6. Based on this abstract, under what circumstances (if any) would you recommend behavioral therapy over other types of therapy?
7. In the conclusion the authors say that further research is likely to have an important impact on their confidence in the estimates of effect and may change the estimates.
Why do you think they say this?
TRUE / FALSE: Write T or F in the blank
8. _____ This review looks at RCTs of people suffering long-term back pain resulting
from an injury.
9. _____ About half of the studies had a moderate to high risk of bias.
10. _____ Waiting list most likely refers to a control group.
11. _____ The authors have conducted this type of systematic review before.
12. _____ Overall the evidence supporting the effectiveness of behavioral therapy is
good.
Vocabulary: Find the term in the text for the following definitions.
a. to select, reject, consider, or group (people, objects, ideas, etc.) by examining
systematically ___________________.
b. Grading of Recommendations Assessment, Development and Evaluation
_____________.
c. A distortion of results that may occur if randomization is not properly carried out or
if subjects or researchers know which group they have been allocated to
_____________.
d. a patient who stays in a hospital while receiving medical care or treatment
_____________.
http://dictionary.reference.com/browse/patienthttp://dictionary.reference.com/browse/whohttp://dictionary.reference.com/browse/Medical
Dossier, Physical Therapy English 2.2 2014 page 33
UIC Idiomes Angls jcp 10.04.12 Reading comprehension abstract of a systematic review
Exercise for the management of cancer-related fatigue in adults
1. Fiona Cramp1,*, 2. James Daniel2
Editorial Group: Cochrane Pain, Palliative and Supportive Care Group
Published Online: 21 JAN 2009
DOI: 10.1002/14651858.CD006145.pub2
Copyright 2010 The Cochrane Collaboration.
Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults.
Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006145. DOI:
10.1002/14651858.CD006145.pub2.
Author Information
1. University of the West of England, Faculty of Health & Life Sciences, Bristol, UK
2. University of the West of England, School of Psychology, Bristol, UK
Publication History
1. Published Online: 21 JAN 2009
Background Cancer-related fatigue is now recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects
of physical activity in reducing cancer-related fatigue with no definitive conclusions
regarding its effectiveness.
Objectives To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment.
Search methods The Cochrane Controlled Trials Register (CENTRAL/CCTR), MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), CINAHL (1982 to July
2007), British Nursing Index (January 1984 to July 2007), AMED (1985 to July 2007),
SIGLE (1980 to July 2007), and Dissertation Abstracts International (1861 to July 2007)
were all searched using key words. Reference lists off all studies identified for inclusion and
relevant reviews were also searched. In addition, relevant journals were hand searched and
experts in the field of cancer-related fatigue were contacted.
Selection criteria Randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults were included.
Data collection and analysis Two review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria. Where
data were available meta-analyses were performed for fatigue using a random-effects model.
Main results Twenty-eight studies were identified for inclusion (n = 2083 participants), with the majority carried out on participants with breast cancer (n = 16 studies; n = 1172
participants). A meta-analysis of all fatigue data, incorporating 22 comparisons provided
data for 920 participants who received an exercise intervention and 742 control participants.
At the end of the intervention period exercise was statistically more effective than the
control intervention (SMD -0.23, 95% Confidence Interval (CIs) -0.33 to -0.13).
Conclusions Exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post cancer therapy. Further research is required to determine the optimal
type, intensity and timing of an exercise intervention.
http://onlinelibrary.wiley.com/o/cochrane/clabout/articles/SYMPT/frame.html
Dossier, Physical Therapy English 2.2 2014 page 34
UIC Idiomes Angls jcp 10.04.12 Reading comprehension abstract of a systematic review
Exercise for the management of cancer-related fatigue in adults
1. What is the source of this abstract?
2. How many authors are listed?
3. Where do the authors work?
4. When was this abstract published?
5. This is a/an___ study.
a. non-experimental b. experimental c. integrative
6. Why do the authors think that this study is necessary?
7. What did the authors want to determine?
8. How many databases were searched?
9. What other sources of studies were identified?
10. What were the inclusion criteria for studies?
11. How many studies met the inclusion criteria?
12. How many studies included patients who did not have breast cancer?
13. How many studies were submitted to meta analysis?
14. What outcome measure was compared in the meta analysis?
15. Exercise___cancer fatigue.
a. increases b. decreases c. has no effect on
16. Which kind of exercise is better in the treatment of cancer fatigue?
17. What areas need to be explored in future research?
18. What are the clinical recommendations based on this study?
Dossier, Physical Therapy English 2.2 2014 page 35
Pre-reading activities TASK I Read the following text.
Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appraisal and commentary.
CLINICAL QUESTION: Among patients with or at risk for musculoskeletal overuse conditions,
(1) do foot orthoses provide clinically meaningful improvements, and (2) are foot orthoses cost-
effective? DATA SOURCES: Studies published through September 28, 2005, were identified by
using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Physiotherapy Evidence Database
(PEDro), PubMed, SPORTDiscus, Biological Abstracts, Web of Science, Allied Health and
Complementary Medicine Database, and the full Cochrane Library. Reference lists of included
randomized controlled trials (RCTs) and identified systematic reviews were searched by hand.
STUDY SELECTION: Studies were included if (1) they were RCTs that included the use of foot
orthoses (either custom or prefabricated) in 1 of the intervention groups, (2) the clinical problem was
an overuse condition as defined by the American College of Foot and Ankle Orthopedics and
Medicine guidelines for which foot orthoses were recommended, and (3) at least 1 clinically relevant
outcome was measured for a minimum of 1 week. Limits were not placed on year of publication,
status of publication, or language.
1. What were the authors inclusion criteria?
2. Where did they look for their information?
3. What do you think was the oldest source of information available in their search? The newest?
TASK II Answer the questions below about a study about interferential current therapy.
You are going to read an abstract about a study with the title, The effects of interferential current therapy in management of musculoskeletal pain.
1. Write what you think the authors initial research question was:
______________________________________________________________?
Analyze it using the PICO model.
2. How do you think this question arose? Why did they need to answer this question?
3. This study was a systematic review. If you were a member of this research team, what
inclusion criteria would you apply to find evidence to answer your question?
4. Where would you look?
5. How many articles do you think could meet your criteria? Explain your answer.
a. 500
6. Write a hypothesispredict the answer to this research question.
Dossier, Physical Therapy English 2.2 2014 page 36
TASK III Read the abstract below. Label the sections with the following terms:
BACKGROUND CONCLUSION
DATA EXTRACTION DATA SOURCES
DATA SYNTHESIS PURPOSE
The effects of interferential current therapy in management of
musculoskeletal pain
Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is
widely used, the available information regarding its clinical efficacy is debatable. The aim of this
systematic review and meta-analysis was to analyze the available information regarding the efficacy of
IFC in the management of musculoskeletal pain. Randomized controlled trials were obtained through a
computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE,
PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010. Two independent reviewers
screened the abstracts found in the databases. Methodological quality was assessed using a compilation
of items included in different scales related to rehabilitation research. The mean difference, with 95%
confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was
performed. A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven
articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3
articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative
pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were
considered to be of moderate methodological quality, and 3 studies were considered to be of poor
methodological quality. Fourteen studies were included in the meta-analysis. Interferential current as a
supplement to another intervention seems to be more effective for reducing pain than a control treatment
at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is
unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions.
Interferential current alone was not significantly better than placebo or other therapy at discharge or
follow-up. Results must be considered with caution due to the low number of studies that used IFC alone.
In addition, the heterogeneity across studies and methodological limitations prevent conclusive
statements regarding analgesic efficacy.
7. How did their question arise?
a. Because most practitioners question its effectiveness
b. Because of inconclusive evidence regarding its ability to reduce pain
c. The safety of IFC has not yet been tested
8. What were the authors inclusion criteria? Consider the following aspects:
a. Intervention
b. Study design
c. Outcome measures
d. Time limits
9. Where did they decide to search for their information?
10. How long have the effects of IFS been studied?
11. The results _____.
a. strongly support the use of IFS for musculoskeletal pain
b. do not support the use of IFS for musculoskeletal pain at all
c. suggest that the use of IFS in some cases of musculoskeletal pain may be somewhat
beneficial
d. cleared up the current debate about the use of IFS for musculoskeletal pain
Dossier, Physical Therapy English 2.2 2014 page 37
Physical Therapy Volume 81:7 (July 2001)
A Review of Therapeutic Ultrasound: Effectiveness Studies Valma J Robertson and Kerry G Baker
Background and Purpose. Therapeutic ultrasound is one of the most widely and frequently
used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of
ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions
remains questionable. This article presents a systematic review of randomized controlled
trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial
was designed to investigate the contributions of active and placebo ultrasound to the patient
outcomes measured. Depending on the condition, ultrasound (active and placebo) was used
alone or in conjunction with other interventions in a manner designed to identify its
contribution and distinguish it from those of other interventions. Methods. Thirty-five
English-language RCTs were published between 1975 and 1999. Each RCT identified was
scrutinized for patient outcomes and methodological adequacy. Results. Ten of the 35 RCTs
were judged to have acceptable methods using criteria based on those developed by Sackett
et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more
effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis
of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not.
Discussion and Conclusion. There was little evidence that active therapeutic ultrasound is
more effective than placebo ultrasound for treating people with pain or a range of
musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to
have adequate methods examined a wide range of patient problems. The dosages used in
these studies varied considerably, often for no discernible reason.
1. In your own words, why was this review carried out? _____________________________________________________________
2. Give the author-date citation formula for his article. _______________ 3. What does RCT stand for? _______________ 4. How many articles in total did the authors study? ______ 5. Why were the results of some of these articles excluded from this review? Explain in
your own words.
_____________________________________________________________
6. In all the studies reviewed, was ultrasound used alone as a treatment? _____________________________________________________________
7. Translate the first sentence of the Discussion & Conclusion section. _____________________________________________________________
8. In your own words, explain what the last sentence of the abstract means. _____________________________________________________________
9. Rate this article in terms of its relevance and importance to your profession.
10. In your professional opinion, what are the clinical implications of this research?
U.I.C. / Idiomes / Angls
Cincies de la Salut / Physiotherapy / mks.271
Objective: An abstract of a review article.
Not important Important
Dossier, Physical Therapy English 2.2 2014 page 38
Group Project Steps
Steps that you will follow:
Step
Worksheet/document/dossier page
Identify your areas of interest jcp.21.03.12 Selecting a research topic
(individual) p39/40
Form a research group + Decide on your
topic+ narrow the topic
MESH Keywords related to your topic
P41/42
Set up a group glossary
Review the literature for basic background
Information: General websites and
abstracts
Literature search: General Information: General
Websites related to the topic jcp.27.03.12 p43
Literature search:
5 abstracts related to the topic p44
Formulate a research question using PICO
method
Mld.10.04.12 Formulating an answerable
question p45/46/47/48
Planning your search: Inclusion criteria Planning your search p49
Documenting your search: Flowcharts P50/51
Extracting Information/Tables P52-62
Synthesizing Information/draw
conclusions
P63-64
Evaluating Methodological Quality P65-67
Oral Presentation of your research
process process.
P68/69
jcp.09.05.12 Oral presentation guidelines
Write up a written report of your research P70
Dossier, Physical Therapy English 2.2 2014 page 39
UIC/ Idiomes/ Angls Cincies de la salut mld.20.03.12
Objective to prepare for selecting an area of research
Selecting a general Topic
Identifying one workable study topic is perhaps the most challenging part of a
research project. Each of the infinite study topics has its own set of virtues and
shortcomings. Topic selection is one of the few steps in research
wherecreativity is not only allowed but required. Although study design, data
collection, and data analysis must all follow a restrictiveprotocol of accepted
methods, picking a study topic calls for expression of personal interests.
Brainstorming and concept mapping
A brainstorming session can be a good starting point for identifying a research
topic. Use the categories in (see table below) to identify areas of personal interest. Spend a day,
several days, or even weeks jotting down possible research areas. Check with friends and
colleagues about their ideas. Search abstract databases, and skim journals and books for ideas
about potential research themes.
The goal is to create a list of possible research topics and to make it as long as possible. This is not
the stage for eliminating ideas because they do not appear feasible. Think big! The ideas do not
need to be well formed. Begin by simply listing several health conditions or po