Related Articles

Background

Massage is a popular treatment choice of athletes, coaches, and sports physical therapists. Despite its purported benefits and frequent use, evidence demonstrating its efficacy is scarce.

Purpose

To identify current literature relating to sports massage and its role in effecting an athlete's psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries.

Methods

Electronic databases were used to identify papers relevant to this review. The following keywords were searched: massage, sports injuries, athletic injuries, physical therapy, rehabilitation, delayed onset muscle soreness, sports psychology, sports performance, sports massage, sports recovery, soft tissue mobilization, deep transverse friction massage, pre-event, and post exercise.

Results

Research studies pertaining to the following general categories were identified and reviewed: pre-event (physiological and psychological variables), sports performance, recovery, and rehabilitation.

Discussion

Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage.

Conclusion

Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.

In order for functional and sport specific activities to occur, knee flexion and extension range of motion (ROM) is necessary. Loss of full ROM at the knee joint can be detrimental to the function of the lower extremity and treatment is needed to regain full function of ROM. Research supports the use of the sustained force to increase knee ROM. This article presents a unique method of attaining sustained force. The technique is cost effective, involves equipment already available in most physical therapy clinics, conserves time, and provides consistent force overtime without causing the therapist fatigue.

Discussion

Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage.

Conclusion

Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.

Background

Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome.

Exercise therapy is also often prescribed although evidence on effectiveness is lacking.

The objective of this article is to present the design of a randomized clinical trial that examines the outcome of exercise therapy supervised by a physical therapist versus a clinically accepted "wait and see" approach (information and advice about the complaints only).

The research will address to both effectiveness and cost effectiveness of supervised exercise therapy in patients with patellofemoral pain syndrome (PFPS).

Methods/design

136 patients (adolescents and young adults) with patellofemoral pain syndrome are recruited in general practices and sport medicine centers. They will be randomly allocated receiving either 3 months of exercise therapy (or usual care.

The primary outcome measures are pain, knee function and perception of recovery after 3 months and 12 months of follow up and will be measured by self reporting.

Measurements will take place at baseline, 6 weeks, and 3 monthly until 1 year after inclusion in the study.

Secondary outcome measurements include an economic evaluation.

A cost-utility analysis will be performed that expresses health improvements in Quality Adjusted Life Years (QALYs) and incorporates direct medical costs and productivity costs

Discussion

This study has been designed after reviewing the literature on exercise therapy for patellofemoral pain syndrome. It was concluded that to merit the effect of exercise therapy a trial based on correct methodological concept needed to be executed.

The PEX study is a randomized clinical trial where exercise therapy is compared to usual care. This trial started in April 2005 and will finish in June 2007. The first results will be available around December 2007.

Purpose

The primary purpose of this study was to revalidate the competencies that define the practice of sports physical therapy. Additionally, the study allowed for the comparison of responses of board certified specialists in sports physical therapy to respondents who were not specialists.

Methods

A survey instrument based the on American Board of Physical Therapy Specialties practice analysis template and The Guide to Physical Therapist Practice was developed by the Sports Specialty Council and a panel of subject matter experts in sports physical therapy. The instrument was sent to 630 physical therapists, 315 of whom were board certified specialists in sports physical therapy and 315 of whom were randomly selected members of the Sports Physical Therapy Section who were not board certified specialists in sports physical therapy. Two hundred and thirty seven subjects returned completed surveys for a 41% response rate. One hundred and fifty eight respondents were sports specialists

Results

The survey results were reviewed by the Sports Specialty Council and another panel of subject matter experts. Using a defined decision making process, the results were used to determine the competencies that define the specialty practice of sports physical therapy. Survey results were also used to develop the sports physical therapy specialty board examination blue print. A number of significant comparisons between the specialists and non-specialists were identified.

Conclusion

The competency revalidation process culminated in the publication of the Sports Physical Therapy Description of Specialty Practice. This document serves to guide the process related to the attainment and maintenance of the board certified clinical specialist in sports physical therapy.

Summary of Background Data

The Spine Patient Outcomes Research Trial (SPORT) was designed to assess the relative efficacy and cost-effectiveness of surgical and non-surgical approaches to the treatment of common conditions associated with low back and leg pain.

Objectives

To describe the rationale and design of the SPORT project and discuss its strengths and limitations.

Study Design

Descriptive

Methods

First, we explain the rationale for embarking on SPORT, i.e. deficiencies in the existing scientific knowledge base for treatment of these conditions. Second, we describe the design of SPORT, including topics such as: specific aims; participating sites; study population; recruitment and enrollment; study interventions; follow-up; outcomes; statistical analysis; and study governance and organization. Finally, we discuss issues that complicate the performance of randomized trials in surgery as they relate to the design and conduct of SPORT.

Results

The SPORT project is being conducted at 11 clinical centers around the United States. It involves the simultaneous conduct of three multi-center, randomized, controlled clinical trials. The study includes patients with the three most common diagnoses for which spine surgery is performed: intervertebral disc herniation (IDH), spinal stenosis (SpS) and degenerative spondylolisthesis (DS), and compares the most commonly used standard surgical and non-surgical treatments for patients with these diagnoses. By the end of enrollment we anticipate a total of 500 IDH, 370 SpS, and 300 DS patients in the randomized trials. Patients who meet the eligibility criteria but decline to be randomized are invited to participate in an observational cohort study. Patients are being followed for a minimum of 24 months with visits scheduled at 6 weeks, 3, 6, 12, and 24 months.

Conclusions

The results of this study will provide high-quality scientific evidence to aid clinical decision making and improve treatment outcomes for these common, costly, and, in some instances, debilitating conditions.

A push for the use of evidence‐based medicine and evidence‐based practice patterns has permeated most health care disciplines. The use of evidence‐based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision‐making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well‐being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence‐based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.

Objective: To examine the evidence base of sports medicine research.

Methods: A sample of four major journals that present core research in sport and exercise medicine (British Journal of Sports Medicine, Medicine and Science in Sports and Exercise, Journal of Sports Medicine and Physical Fitness, and Physical Therapy) was examined using assessment criteria taken from the READER method.

Results: Randomised controlled trials comprised 10% or less of all original research articles. Observational/descriptive studies were the most commonly published study design. There was a highly significant difference (p<0.0001) in the contents of the four journals but when they were compared by categorising the better quality methods together (randomised control trial, case-control, and cohort studies), the difference was not significant (p = 0.09).

Conclusions: The overall pattern of publication type seems remarkably stable over medical journals, indicating that the quality of sports medicine research is comparable to that in other specialities.

Objective

To estimate inter-rater agreement of physical therapists trained in MDT approach and participating in practice-based evidence (PBE) research to identify 72 physical therapy interventions in video demonstrations on a single model and clinical vignettes. PBE is a well designed observational study and demonstrating clinician observational consistency is an important step in conducting PBE research design.

Methods

Two physical therapists volunteered to participate in pilot reliability testing and seven other physical therapists trained in McKenzie Mechanical Diagnosis and Therapy (MDT) methods volunteered for the inter-rater chance-corrected agreement study. All therapists identified interventions presented within 52 videos and 5 written clinical vignettes describing 20 more intervention techniques. Therapists independently identified all interventions. We assessed inter-rater chance-corrected agreement of therapists’ ability to identify intervention techniques using Kappa coefficients with associated 95% confidence intervals and indices for bias and prevalence.

Results

Of the 147 kappa coefficients estimated, 7% were ⩽0·6, 10% were >0·6 and ⩽0·8, and 83% were >0·8. Agreement was lowest for identifying cognitive behavioral techniques (median kappa = 0·79). The minimum and maximum prevalence and bias indices were 0·33 and 0·85 and 0 and 0·33, respectively suggesting kappa coefficient estimates were strong. Generalized kappa coefficients ranged from 0·73 to 1·00.

Discussion

Results provide evidence that substantial to almost perfect inter-rater agreement could be expected when trained therapists identify physical therapy interventions used for patients with spinal impairments from staged videos and vignettes. This may be helpful to reassure clinicians of the quality of the reporting of intervention(s) performed when conducting multivariable analyses in future pragmatic PBE studies. Additional studies are needed to test whether these results can be validated using larger groups of therapists, trained and not trained in MDT methods, as well as examining different methods to examine inter-rater agreement for identifying diverse interventions commonly used for managing patients during routine practice.

Purpose

This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children.

Design and Methods

In a sample of 140 children, activities were assessed using the Youth Risk Behavior Survey’s questions about physical activity and team sports.

Results

Thirty-nine percent were overweight (Body Mass Index (BMI) > 85%). Normal-weight children had higher levels of physical activity and team sports. Females had lower levels of physical activity and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity.

Practice Implications

Nurses should be aware that Hispanic urban children are at risk for lower activity.

Improving strength and power in the athlete who is being rehabilitated is a central focus of the sports physical therapist, particularly in the terminal phases of rehabilitation where the emphasis shifts to readiness to return to sport and sports performance enhancement. High load strength training and power training through plyometric exercises are two key components of performance enhancement programs. A current concept in the strength and conditioning literature that is relatively unknown in sports physical therapy is postactivation potentiation (PAP). Even though we have limited data and there may be limited application of the concept of PAP for the sports physical therapist, awareness of this phenomenon is important nonetheless. The purpose of this clinical commentary is to introduce the sports physical therapist to the concept of PAP.

Background

Many authors, as well as the American Physical Therapy Association, advocate that physical therapists adopt practice patterns based on research evidence, known as evidence-based practice (EBP). At the same time, physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy. The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP.

Methods

The study used a 69 item mailed self-completion questionnaire. The questionnaire had four major sections. The first three sections were each drawn from a different theoretical framework and from different authors' work. The instrument was developed to capture the propensity of physical therapists to adopt EBP, characteristics of the social system in the workplace of physical therapists, personal characteristics of physical therapists, and selected demographic variables of physical therapists. The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America. A random sample of 1320 potential participants was drawn.

Results

939 questionnaires were returned for a response rate of 73%. 831 of the participants' questionnaires were useable and became the basis for the study. There was a moderate association between desire for learning (r = .36, r2 = .13), highest degree held (r = .29, r2 = .08), practicality (r = .27, r2 = .07) and nonconformity (r = .24, r2 = .06) and the propensity to adopt EBP. A negative correlation was found between age, years licensed and percentage of time in direct patient care. The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality.

Conclusion

The study confirms there is no single factor to facilitate research evidence into day-to-day practice. Multiple practice change strategies will be needed to facilitate change in practice.

A commitment to physical activity is necessary for personal health, and is a primary goal of physical activity practitioners. Effective practitioners rely on theory and research as a guide to best practices. Thus, sound theory, which is both practical and parsimonious, is a key to effective practice. The purpose of this paper is to review the literature in search of such a theory - one that applies to and explains commitment to physical activity in the form of sport and exercise for youths and adults. The Sport Commitment Model has been commonly used to study commitment to sport and has more recently been applied to the exercise context. In this paper, research using the Sport Commitment Model is reviewed relative to its utility in both the sport and exercise contexts. Through this process, the relevance of the Investment Model for study of physical activity commitment emerged, and a more parsimonious framework for studying of commitment to physical activity is suggested. Lastly, links between the models of commitment and individuals' participation motives in physical activity are suggested and practical implications forwarded.

Background

The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil.

Methods

A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage.

Results

Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication.

Conclusion

A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects.

Purpose/Background:

Some physical therapists (PTs) provide services at sporting events, but there are limited studies investigating whether PTs are properly prepared to provide such services. The purpose of this study was to assess acute sports injury and medical condition management decision-making skills of PTs.

Methods:

A Web-based survey presented 17 case scenarios related to acute medical conditions and sport injuries. PTs from the Sports Physical Therapy Section of The American Physical Therapy Association were e-mailed a cover letter/Web link to the survey and invited to participate over a 30-day period. Data were analyzed using SPSS 18.0.

Results:

A total of 411 of 5158 PTs who were members of the Sports Physical Therapy Association in 2009 and had valid e-mail addresses completed the survey, of which 389 (7.5%) were appropriate for analysis. Over 75.0% of respondents felt “prepared” or “somewhat prepared” to provide immediate care for 13 out of 16 medical conditions, with seizures, spinal cord injuries, and internal organ injuries having the lowest percentages. Over 75.0% of the respondents made “appropriate” or “overly cautious” decisions for 11 of the 17 acute injury or medical condition cases.

Conclusions:

Results of the current study indicate that PTs felt more “prepared” and tended to make “appropriate” return to play decisions on the acute sports injury and medical condition case studies more often than coaches who participated in a similar study, regardless of level of importance of the game or whether the athlete was a starter vs. non-starter. However, for PTs who plan on assisting at sporting events, additional preparation/education may be recommended, such as what is taught in an emergency responder course.

Background and Purpose:

Rehabilitation and strength and conditioning are often seen as two separate entities in athletic injury recovery. Traditionally an athlete progresses from the rehabilitation environment under the care of a physical therapist and/or athletic trainer to the strength and conditioning coach for specific return to sport training. These two facets of return to sport are often considered to have separate goals. Initial goals of each are often different due to the timing of their implementation encompassing different stages of post-injury recovery. The initial focus of post injury rehabilitation includes alleviation of dysfunction, enhancement of tissue healing, and provision of a systematic progression of range-of-motion and strength. During the return to function phases, specific return to play goals are paramount. Understanding of specific principles and program parameters is necessary when designing and implementing an athlete's rehabilitation program. Communication and collaboration amongst all individuals caring for the athlete is a must. The purpose of this review is to outline the current evidence supporting utilization of training principles in athletic rehabilitation, as well as provide suggested implementation of such principles throughout different phases of a proposed rehabilitation program.

Evidence Acquisition:

The following electronic databases were used to identify research relevant to this clinical commentary: MEDLINE (from 1950–June 2011) and CINAHL (1982–June 2011), for all relevant journal articles written in English. Additional references were accrued by independent searching of references from relevant articles.

Results:

Currently evidence is lacking in the integration of strength and conditioning principles into the rehabilitation program for the injured athlete. Numerous methods are suggested for possible utilization by the clinician in practice to improve strength, power, speed, endurance, and metabolic capacity.

Conclusion:

Despite abundance of information on the implementation of training principles in the strength and conditioning field, investigation regarding the use of these principles in a properly designed rehabilitation program is lacking.

Background

Country by country similarities and differences in physical therapy practice exists. Therefore, before updates in practice can be provided, such as trainings in evidence-based practice, it is necessary to identify the profile and nature of practice in a given country or setting. Following a search of the international literature, no appropriate tool was identified to collect and establish data to create the profile of physical therapy practice in the Philippines. We therefore developed, validated and pilot tested a survey instrument which would comprehensively describe the practice of physical therapy in the Philippines

Findings

We used a mixed methods design to answer our study aims. A focus group interview was conducted among a group of physical therapists to establish the content and contexts of items to be included in the survey instrument. Findings were amalgamated with the information from the literature on developing survey instruments/questionnaires. A survey instrument was drafted and named as the Physical Therapy Profile Questionnaire (PTPQ). The PTPQ was then validated and pilot tested to a different group of physical therapists.

The final version consisted of five separate parts namely (A) General information and demographics, (B) Practice Profile, (C) Treatment Preferences, (D) Bases for clinical work and (E) Bases for educational/research work. At present the PTPQ is relevant to the Philippines and could be used by any country which has a similar nature of practice with the Philippines.

Conclusion

The Physical Therapy Practice Questionnaire (PTPQ) was shown to have good face and content validity among the Filipino physical therapists and their context of practice. It has also been found to be useful, easy to administer tool and in a format appealing to respondents. The PTPQ is expected to assist comprehensive data collection to create a profile of physical therapy practice in the Philippines.

Purpose:

To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed.

Background:

If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion.

Methods:

A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities.

Results:

There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data.

Conclusion:

Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation.

Knowledge gained in studies of genetic disorders is reported in a growing body of biomedical literature containing reports of genetic variation in individuals that map to medical conditions and/or response to therapy. These scientific discoveries need to be translated into practical applications to optimize patient care. Translating research into practice can be facilitated by supplying clinicians with research evidence. We assessed the role of existing tools in extracting answers to translational research questions in the area of genomic medicine. We: evaluate the coverage of translational research terms in the Unified Medical Language Systems (UMLS) Metathesaurus; determine where answers are most often found in full-text articles; and determine common answer patterns. Findings suggest that we will be able to leverage the UMLS in development of natural language processing algorithms for automated extraction of answers to translational research questions from biomedical text in the area of genomic medicine.

Knowledge gained in studies of genetic disorders is reported in a growing body of biomedical literature containing reports of genetic variation in individuals that map to medical conditions and/or response to therapy. These scientific discoveries need to be translated into practical applications to optimize patient care. Translating research into practice can be facilitated by supplying clinicians with research evidence. We assessed the role of existing tools in extracting answers to translational research questions in the area of genomic medicine. We: evaluate the coverage of translational research terms in the Unified Medical Language Systems (UMLS) Metathesaurus; determine where answers are most often found in full-text articles; and determine common answer patterns. Findings suggest that we will be able to leverage the UMLS in development of natural language processing algorithms for automated extraction of answers to translational research questions from biomedical text in the area of genomic medicine.

Abstract

Context:

The purpose of study, experimental, or research design in scientific manuscripts has changed significantly over the years. It has evolved from an explanation of the design of the experiment (ie, data gathering or acquisition) to an explanation of the statistical analysis. This practice makes “Methods” sections hard to read and understand.

Objective:

To clarify the difference between study design and statistical analysis, to show the advantages of a properly written study design on article comprehension, and to encourage authors to correctly describe study designs.

Description:

The role of study design is explored from the introduction of the concept by Fisher through modern-day scientists and the AMA Manual of Style. At one time, when experiments were simpler, the study design and statistical design were identical or very similar. With the complex research that is common today, which often includes manipulating variables to create new variables and the multiple (and different) analyses of a single data set, data collection is very different than statistical design. Thus, both a study design and a statistical design are necessary.

Advantages:

Scientific manuscripts will be much easier to read and comprehend. A proper experimental design serves as a road map to the study methods, helping readers to understand more clearly how the data were obtained and, therefore, assisting them in properly analyzing the results.

During the initial assessment of the injured athlete, the Sports Physical Therapist (PT) must first be concerned with life-threatening emergencies such as absence of breathing and pulse. The sports PT must also be aware of the possibility of “sudden cardiac death” that could occur in others, including coaches, officials, and fans. If the PT assumes the role of “most medical” person at the contest or event, the responsibility for life saving action falls squarely on their shoulders. Therefore, skills and ongoing certification in cardio- pulmonary resuscitation techniques and the use of an automated external defibrillator are a basic necessity. These skills are required as part of the specialty practice of sports PT (BLS Healthcare Provider course or CPR for the Professional Rescuer in addition to completion of the First Responder Course OR credentials as an EMT or ATC), and are mandatory for being qualified to sit for the exam to become a sports certified specialist (SCS) by the American Board of Physical Therapy Specialties (ABPTS).3

Background

This article describes policies, practices, and facilities that form the physical activity climate in Minneapolis/St. Paul, Minnesota metro area middle and high schools and examines how the physical activity climate varies by school characteristics, including public/private, school location and grade level.

Methods

Surveys examining school physical activity practices, policies and environment were administered to principals and physical education department heads from 115 middle and high schools participating in the Transdisciplinary Research on Energetics and Cancer-Identifying Determinants of Eating and Activity (TREC-IDEA) study.

Results

While some supportive practices were highly prevalent in the schools studied (such as prohibiting substitution of other classes for physical education); other practices were less common (such as providing opportunity for intramural (noncompetitive) sports). Public schools vs. private schools and schools with a larger school enrollment were more likely to have a school climate supportive of physical activity.

Conclusions

Although schools reported elements of positive physical activity climates, discrepancies exist by school characteristics. Of note, public schools were more than twice as likely as private schools to have supportive physical activity environments. Establishing more consistent physical activity expectations and funding at the state and national level is necessary to increase regular school physical activity.

There is strong and consistent evidence that eating disorders are prevalent in sport and especially in weight sensitive sports such as endurance, weight category and aesthetic sports as well as jumping events. These illnesses are not only common but lead to significant physical and psychological morbidity and impaired performances.

Sports organizations, and by extension the professionals whose job it is to help and support athletes, have important roles in dealing with these conditions. Preventative practices can be adopted if there is an understanding of how the sports environment contributes to the development of eating disorders. Some disorders can be difficult to detect especially in a sports environment and simple screening instruments are available. Athletes may also need help to access appropriate treatment whilst they are recovering.

In many sports prevention, screening and support programs have been developed for a variety of medical conditions or sportsrelated injuries. Similar programs should be developed for eating disorders.

Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.

Study Design

Retrospective subgroup analysis of prospectively collected data according to treatment received.

Objective

The purpose of this study is to determine if the duration of symptoms affects outcomes following the treatment of spinal stenosis (SS) or degenerative spondylolisthesis (DS).

Summary of Background Data

The Spine Outcomes Research Trial (SPORT) study was designed to provide scientific evidence on the effectiveness of spinal surgery versus a variety of non-operative treatments.

Methods

An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of SS or DS. A comparison was made between patients with SS with ≤12 months (n=405) and those with >12 months (n=227) duration of symptoms. A comparison was also made between patients with DS with ≤12 months (n=397) and those with >12 months (n=204) duration of symptoms. Baseline patient characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to 4 years. The difference in improvement among patients whose surgical or nonsurgical treatment began less than or greater than 12 months after the onset of symptoms was measured. In addition, the difference in improvement with surgical versus nonsurgical treatment (treatment effect) was determined at each follow-period for each group.

Results

At final followup, there was significantly less improvement in primary outcome measures in SS patients with >12 months symptom duration. Primary and secondary outcome measures within the DS group did not differ according to symptom duration. There were no statistically significant differences in treatment effect of surgery in SS or DS patients.

Conclusions

Patients with spinal stenosis with fewer than twelve months of symptoms experienced significantly better outcomes with surgical and nonsurgical treatment relative to those with symptom duration greater than twelve months. There was no difference in outcome of patients with degenerative spondylolisthesis according to symptom duration.