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Physiother Can. 2009 Fall; 61(4): 262–265.
Published online 2009 November 13. doi:  10.3138/physio.61.4.262
PMCID: PMC2793703

Book Reviews

Physiother Can. 2009 Fall; 61(4): 262–263.
Published online 2009 November 13. doi:  10.3138/physio.61.4.262

Pharmacology for the Physical Therapist

Pharmacology for the Physical Therapist.
Peter C. Panus, Bertram Katzung, Erin E. Jobst, Suzanne L. Tinsley, Susan B. Masters, Anthony J. Trevor New York: McGraw Hill. 2009 ISBN-13  978-007-146043-9 608 p., illustrated  CAN $81.95

Physical therapists need an awareness and a working knowledge of potential interactions between the medications their patients are taking and the physical therapist's recommendations. Pharmacology for the Physical Therapist accomplishes this goal.

Peter C. Panus et al. are to be commended for crafting a comprehensive compilation of basic and applied pharmacology and making it meaningful and useful for physical therapists. Clinical physical therapists in a range of practice settings, as well as students, teachers, researchers, and specialists, will find this book a valuable resource. With the current emphasis on interprofessional care and interprofessional education, it is well suited to serve as a bridge for dialogue on drug-related issues between physical therapists and other heath professionals; it will also be a valuable resource for physical therapy practitioners monitoring patient outcomes and entering into discussions with pharmacists, physicians, nurses, and other health care professionals. Understanding the languages and roles of other health professionals is a key component of interprofessional care and leads to mutual respect and to valuing others' contributions.

The physical therapist lacking extensive background in pharmacology or pharmacotherapy need not be intimidated by this subject area. I am impressed by the authors' efforts to make complex concepts easy to understand, always providing the reader with a foundation on which to ground each subsequent piece of information. For those who have already acquired a working knowledge of pharmacotherapy, each therapeutic chapter can stand alone.

There is a lot to like about this book, including its design, content, writing style, and level of detail. An extensive glossary and index complement the material in the book. The authors have cleverly provided an initial chapter covering basic principles of pharmacokinetics and pharmacodynamics to aid readers in understanding drug action and to serve as a basis for applying the material to clinical situations. While this subject area can be dry for some, the authors build a strong case for sticking with the preliminary material by stating the purpose or usefulness behind each principle, thereby priming the reader for an eventual payoff in later chapters. Once the physical therapist has grasped these basic concepts, he or she can apply them generally to various populations. For example, the elderly are more sensitive to medications and are at greater risk of adverse drug reactions, in part because of changes in pharmacokinetics and pharmacodynamics that occur with ageing; adults with renal or hepatic impairment have a reduced ability to handle medications compared to adults with normal organ function; and the autonomic and central nervous systems are major targets of drug therapy.

The sequence of chapters leads the reader in an orderly fashion through an exploration of important organ systems in the body and the medication categories that affect them. Chapters are clustered into sections; for example, eight chapters make up the section dealing with the cardiovascular system, ranging from an introduction to autonomic pharmacology through angina and heart failure to drugs affecting the blood. This structure allows the authors to explore concepts individually, yet enables the reader to grasp the pharmacology of drugs affecting an entire organ system.

Each chapter concludes with sections covering rehabilitation focus and clinical relevance for rehabilitation, as well as a problem-oriented patient study (POPS), medication table, and selected references. This method of organization works well. However, the reader should not rely completely on the medication list, since medications may be discontinued by the manufacturer at any time. The POPS attempts to put drug therapy into perspective for the physical therapist, and this is generally effective; it is unfortunate that meperidine is included in the scenario dealing with opioid analgesics, since it is seldom used in practice.

The chapter layout is exemplary, and illustrations are superb throughout, providing visual cues to concepts that are otherwise difficult to describe. The authors use tables to good effect, helping the reader to organize information into categories. The writing style is succinct and reflects a high degree of familiarity with the material, a hallmark of writers who are capable of making complex material easy to follow and understand. The material presented focuses on what is commonly seen in practice, rather than attempting to present all potential outcomes, and this focus gives the material a practical and relevant feel.

I believe that the information in Pharmacology for the Physical Therapist would be useful for both educators and students in a number of fields. I, for example, intend to use it in future for instruction of pharmacy students during their practical placement. Books such as this may lead to the development of similar books aimed at imparting foundational elements of practice from one profession to other health professionals.

I found the material in this book to be reliable and written in an accessible manner, and I can heartily endorse it.

Physiother Can. 2009 Fall; 61(4): 263.
Published online 2009 November 13. doi:  10.3138/physio.61.4.262

Solid to the Core: Simple Exercises to Increase Core Strength and Flexibility

Agnes Makowski, MScPT, BScPT, Diploma Sport Physiotherapist, FCAMT
Solid to the Core: Simple Exercises to Increase Core Strength and Flexibility.
Janique Farand-Taylor Oakland, CA: New Harbinger Publications. 2006 ISBN-13  978-157224430-6 144 p., photos  CAN $16.95

This user-friendly handbook is promoted as an effective resource for targeting total core muscle conditioning. The author draws an analogy between a house, which requires a strong foundation for support, and the core muscles, which act in a similar manner, fostering stability and support for all the activities of daily living that we engage in. The Solid to the Core programme focuses on two key muscles that are important for core stabilization: the multifidus and the transversus abdominis. The contributions of the secondary core muscle stabilizers are also described, including muscles of the abdominal wall (internal and external obliques) and the gluteals (maximus and medius, primarily). The author proposes that the core muscles not only prepare us for movement but also enable us to react to unexpected high force, load, and stress demands.

Key elements of exercise training are presented throughout the text and guide the reader in assessing his or her own unique fitness needs. Sound principles of exercise physiology are referenced, including the use of target and resting heart rates to monitor exercise intensity. A list of easily accessible equipment is included and affords flexibility to the exerciser, so that training can be performed at home, in a fitness facility, or when travelling.

The author also stresses the importance of proper postural alignment and provides verbal cues to promote optimal recruitment of the core, referred to as an “abdominal set.” Starting in a neutral spine position and activating an effective abdominal set is a requirement throughout the programme.

Principles of exercise physiology and tissue adaptation are used extensively in the text to guide the exerciser through several stages of core training. Readers are advised to start with the static pelvis stabilization series of exercises and progress through to dynamic pelvic stabilization, Swiss ball stabilization, and resistance band stabilization protocols. Exercisers are encouraged to reflect and re-evaluate their ability and tolerance for the series at the end of each training week. Readers can also track their progress through helpful tables provided with each core-conditioning phase.

The static pelvis stabilization protocol highlights five series of exercises. Introduction of the dynamic exercises is suggested after four weeks of the static stabilization exercises. The dynamic pelvis stabilization protocol includes four series of exercises that focus on lower-extremity patterns, upper-extremity patterns, functional drills, and plyometrics. The Swiss ball stabilization protocol includes three series of exercises for beginner, intermediate, and advanced exercisers, as does the resistance band stabilization protocol.

Overall, the exercises in this text are presented clearly, with helpful diagrams and appropriate progressions relevant for exercisers at diverse ability levels. Variations are provided for most of the exercises; however, it is unclear whether the modifications are intended as simple exercise advancements or, perhaps, as alternatives for participants who have some underlying dysfunction. When coordinated with feedback from a treating physiotherapist, a patient's core training regimen can be further individualized for safe and effective exercise programming.

Physiother Can. 2009 Fall; 61(4): 264.
Published online 2009 November 13. doi:  10.3138/physio.61.4.262

Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach

Susan Massitti, MPhty, BScPT, BPE Diploma in Advanced Orthopaedic Manual and Manipulative Physiotherapy Fellow of the Canadian Academy of Manipulative Physiotherapy (FCAMT) Active Release Techniques Provider Sports Physiotherapy Canada Diploma Certified Gunn Intramuscular Stimulation Practitioner, Certificate in Medical Acupuncture
Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach.
Judith E. Deutsch, Ellen Zambo Anderson St Louis, MO: Saunders, Elsevier. 2008 ISBN-13  978-0-7216-0111-3ISBN-10  0-7216-0111-1 325 p., illustrated  CAN $76.95

Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach highlights “complementary therapies,” organized and based on the National Center for Complementary and Alternative Medicine (CAM) classification system: manipulative and body based practices (reiki, rolfing, Feldenkrais, Alexander technique, craniosacral therapy); biologically based practices (arnica, ginkgo biloba, glucosamine and chondroitin); energy medicine (energy therapy, magnets); and mind body complements (tai chi, qigong, yoga). The intent of this book is to provide physiotherapists and occupational therapists with evidence-based information on the alternative treatments that their clients may be using.

For each CAM category, a literature review, examination findings, and goals for treatment are summarized. Case scenarios written by expert CAM practitioners illustrate the practical uses of alternative therapies within the physical therapy setting to help therapists incorporate them into their everyday practice. The overview of these therapies is basic, however, and the clinical decision-making structure provided is oversimplified.

Although the book contains a remarkable amount of research and information on numerous CAM therapies, the comprehension of the specific interventions is compromised by the inclusion of so many therapies. However, for professionals with very little knowledge of CAM therapies and how they may complement or negate physical or occupational therapy interventions, this is a reasonable reference text.

Physiother Can. 2009 Fall; 61(4): 264–265.
Published online 2009 November 13. doi:  10.3138/physio.61.4.262

Outcome Measurement and Management: First Steps for the Practicing Clinician

Susan Muir, BSc, BScPT, PhD
Outcome Measurement and Management: First Steps for the Practicing Clinician.
Sandra L. Kaplan PT, PhD Philadelphia: F.A. Davis Co.2007 ISBN-10  0-8036-0310-X ISBN-13  978-0-8036-0310-3 250 p., illustrated  CAN $38.95

Evidence-based practice as the standard of care has facilitated and encouraged the collection of outcome measures in routine practice. However, there has been a lack of guidance for the practising clinician on how the collected information can be used to evaluate the cost-effectiveness, quality, and efficiency of services. This book directly addresses these limitations. It integrates information on methods of collecting and analyzing data from different outcome measures to establish measurable evidence of results that is relevant and meaningful to patients and third party payers and reflects the needs of clinicians. This combined approach includes a necessary amount of theoretical background content, with explanations and practical examples of how to use outcome measures collected in routine practice, which makes Outcome Measurement and Management a highly relevant and approachable text for all clinicians.

The text is organized around two main themes: an introduction and overview of an outcome approach to patient care management, and strategies for the use of clinical documentation to evaluate practice patterns or effectiveness retrospectively. Kaplan uses one complete chapter to outline her theoretical framework and definitions for an outcome approach to patient care, making a clear distinction from impairment-based measures and treatment. This framework is strongly influenced by the World Health Organization's International Classification of Functioning, Disability and Health (ICF). For clinicians not already familiar with the ICF framework, another chapter gives an overview of disability models, providing the context that led to the development of the ICF. The author has clearly outlined a treatment paradigm that provides a “big picture” view of patient care, encompassing the different interest groups involved in treatment delivery, the patient or consumer of the service, and the service providers. My own exposure to and familiarity with the ICF model made the author's presentation of arguments for the use of this type of system less compelling, though still relevant. For clinicians not familiar with the ICF, the information is well presented as an introduction to this and related models. The chapters addressing the first theme of the text provide a context for the various types of information that therapists collect during routine patient care. The author then links this outcome-based approach to establishing reasonable and measurable goals for clients, which are ultimately reflected in the type of information documented in charts. This last point is linked to the second theme of the book, namely that both the type and format of the information collected will influence its utility.

The second part of the text provides a step-by-step description, in a sequence of six chapters, of how to set up a study using retrospective data from a clinician's own patient charts. The exercises at the end of the chapters allow the reader to consolidate and apply the core concepts and build on the previous chapter's material. The step-by-step format covers the complete range of topics necessary for a person implementing an outcome study and is a good reference for repeated application. The author rightly emphasizes that the focus of the book is on giving front-line clinicians the tools to generate useful information that can be applied directly back to their practice, and not necessarily on the goal of coming up with a publishable study for a journal. The chapter on using and sharing data is well written and contains valuable information on writing a report and disseminating the information; this chapter also includes a very relevant section on potential misuses of outcome data analysis that the clinician can anticipate during the preparation stage of presentations or reports. The appendices contain a sample pilot study, sample study data, and guidelines for conducting a pilot study of documentation patterns, representing a good template of how to apply the information outlined in the chapters to create a complete project.

The reader of this text should not expect a list or summary of available outcome measurement tools and their psychometric properties. The book is not a comprehensive review of the literature on the two theme topics. What it does provide is an overarching framework, which can be generalized to any area of clinical practice, on how to use the information you collect; this requires the practitioner to seek out measurement instruments that can be applied in their specific area of clinical practice. The text does not teach clinicians how to perform prospective studies on patient populations; rather, it outlines how to use retrospective chart data already in hand. References to policies on privacy rights and ethics are specific to an American setting, so it is important that clinicians clearly establish the correct requirements for their workplace setting and not rely solely on the information given in this text.

Overall, this book is a very useful and valuable resource in every practice setting to empower clinicians to implement, use, analyze, and disseminate the information that they routinely collect, thus providing a means to make evidence-based improvements in client care and support the care they already provide to clients.

Articles from Physiotherapy Canada are provided here courtesy of University of Toronto Press and the Canadian Physiotherapy Association