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Nikhilphysio: 02 Jun : 03:55 AM

I am working as physiotherapist in Shalby hospital ahmedabad for 4 years. I have passed out from Rajiv gandhi university of health and sciences Bangalore. I want to apply for Newzealand physiotherapy board registration so anyone there from India who got registered as physiotherapist in new zealand please help me.

Arun: 10 May : 12:36 AM

Hi Priyank, welcome. Feel free to go through these forum threads returned by search [link]

Priyank: 09 May : 10:28 PM

Hi..need advice. What are the options in Australia after MPT?

Arun: 04 Mar : 02:01 AM

Happy birthday Boopathi and somasimple

PTebook: 04 Nov : 09:39 AM

hello everyone!!!!!!!

Clinical Prediction Rules(CPRs) identified for manipulation therapy success in low back pain by Physical therapy department of Pittsburgh University

Tuesday 15 March 2011 - 19:49:02

manipulation.jpgAlthough most of the systematic and quantitative reviews of the literature have demonstrated the effectiveness of thrust techniques, the limitation has always been in the marginal effect sizes seen in these studies. Marginal effect sizes would appear to contradict the clinical experience of practitioners who commonly use thrust techniques — techniques that provide dramatic pain relief in many cases and virtually no effect in others.
With such seemingly equivocal outcomes, from a decision-making standpoint, the trick is to be able to identify, the patient characteristics that predict a greater probability of success with manipulation. Such issues are tailor-made for Clinical Prediction Rule approaches.
Clinical prediction rules (CPRs) are tools designed to improve decision making in clinical practice by assisting practitioners in making a particular diagnosis, establishing a prognosis, or matching patients to optimal interventions based on a parsimonious subset of predictor variables from the history and physical examination. CPRs have been developed and adopted to improve decision making in many situations. They are useful diagnostic aids for conditions as diverse as strep throat, proximal deep vein thrombosis, coronary artery disease, and pulmonary embolism. CPRs are also valuable for evaluating prognostic indicators in, for example, deciding whether to discontinue resuscitative efforts following in-hospital cardiac arrest, determining the four-year mortality risk for a person with coronary artery disease, identifying children at risk for urinary tract infection, or recognizing risk factors for post-anesthesia nausea and vomiting.
Given the variable responsiveness of patients to thrust techniques, many practitioners would welcome a scheme of clinical prediction rules applicable to this approach. Pioneering work at the University of Pittsburgh Department of Physical Therapy attempts to identify characteristics that predispose patients to a positive response to lumbar thrust techniques.
In the process of establishing clinical prediction rules, the first step is simply to develop the rule. For thrust techniques, an experiment is carried out in which patients with general acute low-back pain enter the study and undergo a series of tests and measures, each of which is presumed to have some value for predicting responsiveness to manual therapy. From among these measures, a reasonable list of predictors is selected, on the basis of clinical experience and prior research supporting the prognostic value or diagnostic accuracy of the given patient characteristic, measurement, or test result. Once a clinical prediction rule is established, it must be validated in a randomized, controlled trial. Lastly, the rule’s impact is assessed with a cost-effectiveness analysis.
Researchers in the Department of Physical Therapy found that a CPR consisting of five simple variables was highly predictive of a positive response to a thrust technique. The variables include:
• duration of pain < 16 days
• no pain distal to the knee
• low fear avoidance beliefs (Fear Avoidance Beliefs score < 19)
• hypomobility of the lumbar spine
• greater hip internal rotation (> 35 degrees)
The presence of 4 of the 5 variables resulted in a likelihood ratio of immediate success of 13.2. “Immediate success” was defined as >50% improvement in symptoms within 72 hours of treatment. Further, if a patient has symptoms distal to the knee, the negative likelihood ratio was 0.16, indicating only a remote likelihood that patients with distal symptoms will realize any benefit from manual therapy. These studies have been extended to postpartum women, a number of whom have shown excellent responsiveness to thrust techniques. As a result of clinical prediction rule experiments, Manipulation specialists are better equipped to recommend interventions for people with LBP.
Source: Rehab Newsletter summer 2008, Dept. of Physical medicine and Rehabilitation, University of Pittsburgh.


emanpt says:

02 May : 04:25 PM

Good article with good informetion

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