Biomedical subjects

T Worrell

Publications and source records attributed to T Worrell.

9 recordsLinked to original sources

PubMed2001

Analysis of pain behavior profiles and functional disability in outpatient physical therapy clinics.

STUDY DESIGN: Descriptive, ex post facto. OBJECTIVES: To determine the proportion of physical therapy outpatients with pain who exhibit various pain behavior profiles, and to determine whether there are differences in functional disability across the profiles. BACKGROUND: Physical therapists treat many patients who have chronic pain. Research suggests that early identification and multidisciplinary treatment are effective and economical for these patients. The Multidimensional Pain Inventory (MPI) and the Pain Disability Index (PDI) are potential screening tools that could be used in physical therapy clinics to determine which patients should be referred for multidisciplinary treatment. METHODS AND MEASURES: MPI and PDI data were gathered on 57 physical therapy outpatients (mean age 44.3 +/- 14.5 years, 22 men and 35 women) with pain of 3 or more months duration. ANOVA was used to analyze differences in mean PDI scores across the MPI profiles. RESULTS: Of all patients, 42.1% fit the Adaptive Coper profile, 29.8% fit the Interpersonally Distressed profile, and 28.1% fit the Dysfunctional profile. There were significant differences in PDI scores among profile groups. Post hoc analysis showed that the PDI scores of the Adaptive Coper and Interpersonally Distressed groups were different from the Dysfunctional group, but that there was no difference between the Adaptive Coper and Interpersonally Distressed groups. CONCLUSIONS: Many patients in outpatient physical therapy settings exhibit behavioral, affective, and cognitive characteristics associated with chronic pain. Thirty-three patients (57.9%) had MPI profiles (interpersonally distressed and dysfunctional) that suggest they might benefit from multidisciplinary treatment.

Adult↗

PubMed1998

Effect of patellar taping and bracing on patellar position as determined by MRI in patients with patellofemoral pain.

OBJECTIVE: To determine the effects of patellar taping, bracing, and not taping on patellar position. DESIGN AND SETTING: An experimental design was used to compare patellar taping, bracing, and not taping on patellar position as determined by magnetic resonance imaging (MRI). SUBJECTS: Twelve subjects with a diagnosis of patellofemoral pain participated in this study. MEASUREMENTS: Static MRI images were taken at 8 angles of knee flexion (10, 16, 25, 30, 34, 39, 41, and 45 degrees ). Patellofemoral congruence angle (PFC), lateral patellar displacement (LPD), and lateral patellar angle (LPA) were determined by digitization. RESULTS: A repeated-measures multivariate analysis of variance was used to compare experimental conditions. Across all angles of knee flexion, a more lateral PFC existed for the control condition (-4.1 degrees ) than the brace condition (-7.1 degrees ) or tape condition (-6.1 degrees ). Post hoc testing revealed that this difference was statistically different only at 10 degrees of knee flexion. Across all knee angles, LPD was more medial for the braced condition (1.7 mm) than for the tape (2.7 mm) or control (2.6 mm) condition. Post hoc testing revealed that this difference was statistically different only at 10 degrees of knee flexion. No differences existed between conditions for LPA. CONCLUSIONS: We conclude that patellar bracing and taping influenced patellar position (PFC and LPD) at 10 degrees of knee flexion during a static MRI condition.

Journal Article↗

PubMed1996

Assessment of quadriceps muscle performance by hand-held, isometric, and isokinetic dynamometry in patients with knee dysfunction.

One component of patient evaluation is muscle performance assessment. The purpose of this study was: 1) to determine the difference and correlation between hand-held, isometric, and isokinetic dynamometry test results in patients with knee dysfunction and 2) to determine the effect of pain during such testing. Bilateral quadriceps strength in 23 subjects with unilateral knee dysfunction was tested using concentric and eccentric isokinetic dynamometry at 60 degrees/sec, isometric dynamometry, and hand-held dynamometry, both at 60 degrees of knee flexion. Pain ratings were obtained before, during, and after each test. Statistical analysis revealed a significant difference between involved and uninvolved limbs for eccentric isokinetic dynamometry (p = 0.002) and hand-held dynamometry (p = 0.005); no difference was found between limbs for the concentric isokinetic and isometric dynamometry (p > 0.05). Mean percent deficits in quadriceps strength ranged from 11 to 18%, with no significant difference found between testing modes. Pearson product moment correlations ranged from 0.34 to 0.76 when comparing testing modes. No significant difference existed in pain scores before, during, and after each mode of testing. It was concluded that large variation existed between different testing modes, which results in different conclusions regarding the strength of the quadriceps in patients with knee dysfunction.

Adolescent↗

PubMed1995

Agility following the application of cold therapy.

Cold application is commonly used before strenuous exercise due to its hypalgesic effects. Some have questioned this procedure because of reports that cold may reduce isokinetic torque. However, there have been no investigations of actual physical performance following cold application. The purpose of this study was to determine if a 20-minute ice immersion treatment to the foot and ankle affected the performance of three agility tests: the carioca maneuver, the cocontraction test, and the shuttle run. Twenty-four male athletic subjects were tested during two different treatment sessions following an orientation session. Subjects were tested following a 20-minute 1 degrees C ice immersion treatment to the dominant foot and ankle and 20 minutes of rest. Following each treatment, subjects performed three trials of each agility test, with 30 seconds rest between each trial, and 1 minute between each different agility test. The order in which each subject performed the agility tests was determined by a balanced Latin square. A MANOVA with repeated measures was used to determine if there was an overall significant difference in the agility times recorded between the cold and control treatments and if the order of the treatment sessions affected the scores. Although the mean agility time scores were slightly slower following the cold treatment, cooling the foot and ankle caused no difference in agility times. Also, there was no difference resulting from the treatment orders. We felt that the slightly slower scores may have been a result of tissue stiffness and/or subject's apprehension immediately following the cold treatment. Cold application to the foot and ankle can be used before strenuous exercise without altering agility.

Journal Article↗

PubMed1994

Reliability of assessing patellar alignment: the A angle.

Anterior knee pain syndrome is a complex problem for clinicians and patients. One possible etiological factor that has been identified is malalignment of the patella. Recently, a clinical method to assess patellar malalignment has been proposed--the A angle. However, no reliability of this technique was reported. Therefore, the purpose of this study was to determine intrarater and interrater reliability for the A angle. Thirty-six subjects participated in this study. Three raters measured each knee twice (N = 70). Interclass correlation coefficients (ICC) and standard error of measurements (SEM) were determined for the A angle and component measurements. Intrarater A-angle values ranged from 11.8 to 23.5 degrees. Intrarater A-angle ICCs were poor (0.20-0.32, SEM = 5.30-7.95 degrees). Interrater A-angle ICC was poor (-0.01, SEM = 7.82 degrees). Results indicated that the A angle as determined in this study was not reproducible. Therefore, further study is needed before the A angle can be used as a reliable assessment tool for patellar position.

Adult↗

PubMed1994

Assessment of quadriceps muscle performance by a hand-held dynamometer and an isokinetic dynamometer.

Assessment of muscle performance is an integral component of patient evaluation. The primary purposes of this study were to examine the relationship between isokinetic dynamometer isokinetic peak force values and hand-held dynamometer isometric peak force values when assessing quadriceps muscle performance in subjects with orthopaedic knee dysfunctions (N = 21) and to test for differences in muscle performance between injured and noninjured lower extremities using a hand-held dynamometer and an isokinetic dynamometer. An analysis of variance was used to compare injured and noninjured extremities for both testing devices. A Pearson product moment correlation was used to examine the relationship between the hand-held dynamometer and isokinetic dynamometer values. No significant difference between extremities at 0 degrees (p = 0.1224) or 60 degrees (p = 0.8267) was revealed when testing with the hand-held dynamometer. The isokinetic dynamometer, however, revealed a significant difference between extremities at 60 degrees/sec (p = 0.0041). Correlations between the two devices were significant, ranging from r = 0.57 to 0.80. We concluded that these correlations were misleading because more force was generated by the quadriceps muscles tested than a tester of average strength could resist. Further research is needed to validate the use of the hand-held dynamometer by a tester of average strength.

Adolescent↗

PubMed1994

Rehabilitation compliance in an athletic training environment.

The purpose of this study was to determine the relationship between the rehabilitation adherence of athletes and their self-reported assessment of six variables that might influence rehabilitation adherence: pain, support from others, exertion, scheduling, motivation, and environment. Each of 44 Division II athletes sustained a musculoskeletal injury and was placed on a rehabilitation program. Adherence to the program was measured by attendance at and participation in scheduled rehabilitation sessions. Each athlete was classified as adherent (n = 27) or nonadherent (n = 17). Pain and support were significantly correlated to adherence. Pain and support from others were significantly different between the adherent and nonadherent groups. Principal components analysis was also performed and confirmed the t-test results that pain and support are the only subscales strongly associated with adherence scores. We conclude that controlling pain and providing emotional support is associated with sport rehabilitation adherence.

Journal Article↗

PubMed1993

Reliability of open and closed kinetic chain subtalar joint neutral positions and navicular drop test.

Subtalar joint (STJ) measurements are commonly made in the clinic to assess foot and ankle positions because of the high incidence of lower extremity dysfunctions. The purposes of this study were to investigate the intratester and intertester reliability of the open kinetic chain subtalar joint neutral (OKC STJN) and closed kinetic chain subtalar joint neutral (CKC STJN) positions and the navicular drop test (NDT). Two inexperienced testers performed repeated measurements on 15 subjects (N = 30 feet) during two testing sessions. Intratester and intertester reliability (ICC 1,1) and standard error of measurement (SEM) were determined for each dependent variable. For OKC STJN, the intratester ICC values were .06 and .27, and the intertester ICC value was .00. The intratester SEM values were 1.81 and 2.29 degrees, and the intertester was 2.51 degrees. The CKC STJN intratester ICC values were .14 and .18, with SEM values of 2.46 and 2.40 degrees. The intertester CKC ICC value was .15, with an SEM of 2.43 degrees. For the NDT, the intratester ICC values were .61 and .79, and the SEM values were 1.92 mm and 2.57 mm. The intertester ICC value was .57 and the SEM was 2.72 mm. The results reveal that both OKC and CKC STJN yield poor intratester and intertester reliability and the NDT yields poor to moderate intratester reliability and poor intertester reliability. We conclude that these foot and ankle measurements are not reliable when performed by inexperienced testers. Therefore, clinicians should practice these measurement techniques and determine their measurement error.

Adult↗

PubMed1993

Effects of patella taping on patella position and perceived pain.

Anterior knee pain syndrome (AKPS) represents a significant challenge for the sports medicine clinician. One proposed etiological factor for AKPS is poor vastus medialis obliquus (VMO) control, resulting in lateral glide of the patella. Patella taping has been advocated to increase VMO control. The purpose of this study was to determine the effects of patella taping on patella position and perceived pain. Twelve subjects (age = 29 +/- 9 yr; weight = 70.9 kg +/- 17.8; height = 174.0 cm +/- 8.1) with AKPS currently using patella taping procedures with a decrease in their symptoms participated. Each subject had Merchant's view x-rays taken pre- and post-taping while performing an isometric quadriceps contraction to determine patella rotation and patella congruency angles. Subjects also completed a visual analog pain scale after performing a 0.2 m (8") step-down both pre- and post-taping. Paired t-tests revealed no significant change in patellofemoral congruency (P = 0.98) and patella rotation angles (P = 0.80). Significant reduction (50%) in subject pain level was revealed by the visual analog scale (t(15) = 4.99; P < 0.0005). Results demonstrate that patella taping significantly reduced the perceived pain levels during a 0.2-m step-down; however, this reduction in pain was not associated with patella position changes.

Adult↗