Secondary mediation and regression analyses of the PTClinResNet database: determining causal relationships among the International Classification of Functioning, Disability and Health levels for four physical therapy intervention trials.


BACKGROUND:Each of the 4 randomized clinical trials (RCTs) hosted by the Physical Therapy Clinical Research Network (PTClinResNet) targeted a different disability group (low back disorder in the Muscle-Specific Strength Training Effectiveness After Lumbar Microdiskectomy [MUSSEL] trial, chronic spinal cord injury in the Strengthening and Optimal Movements for Painful Shoulders in Chronic Spinal Cord Injury [STOMPS] trial, adult stroke in the Strength Training Effectiveness Post-Stroke [STEPS] trial, and pediatric cerebral palsy in the Pediatric Endurance and Limb Strengthening [PEDALS] trial for children with spastic diplegic cerebral palsy) and tested the effectiveness of a muscle-specific or functional activity-based intervention on primary outcomes that captured pain (STOMPS, MUSSEL) or locomotor function (STEPS, PEDALS). OBJECTIVE:The focus of these secondary analyses was to determine causal relationships among outcomes across levels of the International Classification of Functioning, Disability and Health (ICF) framework for the 4 RCTs. METHOD AND DESIGN:With the database from PTClinResNet, we used 2 separate secondary statistical approaches-mediation analysis for the MUSSEL and STOMPS trials and regression analysis for the STEPS and PEDALS trials-to test relationships among muscle performance, primary outcomes (pain related and locomotor related), activity and participation measures, and overall quality of life. RESULTS:Predictive models were stronger for the 2 studies with pain-related primary outcomes. Change in muscle performance mediated or predicted reductions in pain for the MUSSEL and STOMPS trials and, to some extent, walking speed for the STEPS trial. Changes in primary outcome variables were significantly related to changes in activity and participation variables for all 4 trials. Improvement in activity and participation outcomes mediated or predicted increases in overall quality of life for the 3 trials with adult populations. LIMITATIONS:Variables included in the statistical models were limited to those measured in the 4 RCTs. It is possible that other variables also mediated or predicted the changes in outcomes. The relatively small sample size in the PEDALS trial limited statistical power for those analyses. CONCLUSIONS:Evaluating the mediators or predictors of change between each ICF level and for 2 fundamentally different outcome variables (pain versus walking) provided insights into the complexities inherent across 4 prevalent disability groups.


Phys Ther


Physical therapy


Mulroy SJ,Winstein CJ,Kulig K,Beneck GJ,Fowler EG,DeMuth SK,Sullivan KJ,Brown DA,Lane CJ,Physical Therapy Clinical Research Network.




Has Abstract


2011-12-01 00:00:00














  • Toe-walking in children with cerebral palsy: contributions of contracture and excessive contraction of triceps surae muscle.

    abstract::The study was designed to provide a quantitative analysis of toe-walking in children with cerebral palsy (CP). The total internal moment developed about the ankle joint during locomotion and the passive component of this internal moment were measured. The contributions of the active and passive components were express...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Tardieu C,Lespargot A,Tabary C,Bret MD

    更新日期:1989-08-01 00:00:00

  • Participants' perspectives on the feasibility of a novel, intensive, task-specific intervention for individuals with chronic stroke: a qualitative analysis.

    abstract:BACKGROUND:Evidence-based practice promotes patient-centered care, yet the majority of rehabilitative research fails to take patient perspectives into consideration. Qualitative research provides a unique opportunity for patients to express opinions and provide valuable insight on intervention processes. OBJECTIVE:The...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Merlo AR,Goodman A,McClenaghan BA,Fritz SL

    更新日期:2013-02-01 00:00:00

  • Effect of a single 30-minute treatment of high voltage pulsed current on edema formation in frog hind limbs.

    abstract::The purpose of this study was to investigate the effect of a single treatment of high voltage pulsed current (HVPC) on edema formation. Twenty-four frogs were anesthetized, and both hind limbs of each frog were traumatized by impact. Limb volumes were measured by water displacement immediately before and after trauma ...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Taylor K,Fish DR,Mendel FC,Burton HW

    更新日期:1992-01-01 00:00:00

  • Successful treatment of long-term, poststroke, upper-limb spasticity with onabotulinumtoxinA.

    abstract:BACKGROUND AND PURPOSE:Poststroke spasticity often negatively affects functional activities and daily living and frequently is accompanied by pain, abnormal limb postures, and contractures. The purpose of this case report is to describe the long-term benefit of botulinum toxin A in a patient with poststroke spasticity....

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Patel AT

    更新日期:2011-11-01 00:00:00

  • A clinical trial of neuromuscular electrical stimulation in improving quadriceps muscle strength and activation among women with mild and moderate osteoarthritis.

    abstract:BACKGROUND:Neuromuscular electrical stimulation (NMES) has demonstrated efficacy in improving quadriceps muscle strength (force-generating capacity) and activation following knee replacement and ligamentous reconstruction. Yet, data are lacking to establish the efficacy of NMES in people with evidence of early radiogra...

    journal_title:Physical therapy

    pub_type: 杂志文章,随机对照试验


    authors: Palmieri-Smith RM,Thomas AC,Karvonen-Gutierrez C,Sowers M

    更新日期:2010-10-01 00:00:00

  • Electromyographic activity of selected leg musculature in subjects with normal and chronically sprained ankles performing on a BAPS board.

    abstract::The purpose of this study was to evaluate the magnitude and temporal features of tibialis anterior, peroneus longus, and gastrocnemius muscle activity during exercises performed on a Biomechanical Ankle Platform System (BAPS) board by subjects with normal and chronically sprained ankles. Fourteen participants in each ...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Soderberg GL,Cook TM,Rider SC,Stephenitch BL

    更新日期:1991-07-01 00:00:00

  • Reference values of physical performance in Thai elderly people who are functioning well and dwelling in the community.

    abstract:BACKGROUND:Because the number of elderly people is rapidly increasing, reference values for the physical abilities necessary to independently conduct daily activities are crucial for promoting good health. Although a few studies have reported reference values for functional tests relating to these abilities, all of tho...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Thaweewannakij T,Wilaichit S,Chuchot R,Yuenyong Y,Saengsuwan J,Siritaratiwat W,Amatachaya S

    更新日期:2013-10-01 00:00:00

  • A model for the physical therapist in the intensive care nursery.

    abstract::The importance of the physical therapist in the ICU nursery is in early detection and intervention, which is often critical to the success of treatment in any field of medicine or remedial education. Based on information about neurological development, movement is often the first and possibly only external indicator t...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Dickson JM

    更新日期:1981-01-01 00:00:00

  • Isometric exercise for an individual with hemophilic arthropathy.

    abstract::Several authors have described nonsurgical rehabilitative techniques for individuals with hemophilia who have single or recurrent hemarthroses. The effects of these low intensity exercise programs are not stated clearly in the literature. In this single-case experimental study, we investigated the effects of a trainin...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Pelletier JR,Findley TW,Gemma SA

    更新日期:1987-09-01 00:00:00

  • Development of a quality assurance program as an integral part of the physical therapy system.

    abstract::The purposes of this article are to describe the conditions that must be met and the process that must be carried out to develop, implement, and evaluate a quality assurance program. The conditions to be met are administrative support for the program; knowledge of quality assurance theories and components (including s...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Morgenstein S,Simpkins S,Maring J

    更新日期:1982-04-01 00:00:00

  • Barriers to exercise in people with Parkinson disease.

    abstract:BACKGROUND:Exercise is known to reduce disability and improve quality of life in people with Parkinson disease (PD). Although barriers to exercise have been studied in older adults, barriers in people with chronic progressive neurological diseases, such as PD, are not well defined. OBJECTIVE:The purpose of this study ...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Ellis T,Boudreau JK,DeAngelis TR,Brown LE,Cavanaugh JT,Earhart GM,Ford MP,Foreman KB,Dibble LE

    更新日期:2013-05-01 00:00:00

  • Factors influencing information seeking by physical therapists providing stroke management.

    abstract:BACKGROUND:Searching and reading the research literature are essential activities for enhancing the use of research and optimizing the quality of physical therapist practice. OBJECTIVES:The objectives of this study were to identify practitioner, organization, and research characteristics that are associated with searc...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Salbach NM,Guilcher SJ,Jaglal SB,Davis DA

    更新日期:2009-10-01 00:00:00

  • Neonatal assessment: an overview.

    abstract::The purpose of this paper is to provide an overview of assessment techniques used by physical therapists in the assessment of the neonate. An additional purpose is to provide a review of prenatal and postnatal development in the areas of muscle tone, range of motion, somatosensory skills, and reflex development. The r...

    journal_title:Physical therapy

    pub_type: 杂志文章,评审


    authors: Connolly BH

    更新日期:1985-10-01 00:00:00

  • Temporal stability of gait in Parkinson's disease.

    abstract::BACKGROUND AND PURPOSE. Evaluation of physical therapy for gait disorders in patients with Parkinson's disease (PD) requires an under-standing of how the patients' medication cycle affects function. Four experiments were conducted to investigate stability of gait variables. METHODS AND RESULTS. In experiment 1, 15 sub...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Morris ME,Matyas TA,Iansek R,Summers JJ

    更新日期:1996-07-01 00:00:00

  • Mandatory continuing education--a survey of current activity. A special communication.

    abstract::The purposes of this article are 1) to present a review of the literature addressing issues related to mandatory continuing education (MCE) and 2) to report the responses from three surveys conducted by the Task Force on Mandatory Continuing Education of the Florida Physical Therapy Association, Inc. Questionnaires we...

    journal_title:Physical therapy

    pub_type: 杂志文章,评审


    authors: Finley C

    更新日期:1988-03-01 00:00:00

  • Construct validation of a knee-specific functional status measure: a comparative study between the United States and Israel.

    abstract:BACKGROUND:Comparative effectiveness research (CER) requires valid outcome measures that discriminate patients by risk factors in similar ways across settings. Standardized functional status (FS) measures in physical therapy are used routinely in multiple countries, creating the potential for CER among countries. OBJE...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Deutscher D,Hart DL,Stratford PW,Dickstein R

    更新日期:2011-07-01 00:00:00

  • Relief of low back pain by epidural injection. A case report.

    abstract::This report describes the use of epidural injection in the treatment of a patient with severe back pain whose medical history and physical examination suggest a diagnosis of a lumbar disk lesion. The patient's medical history included recurrent episodes of buttock and hip pain that previously responded well to lumbar ...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Woodman R,Balavender H,Froeb R

    更新日期:1987-11-01 00:00:00

  • Fitkids Treadmill Test: Clinical Utility and Factors Associated With Its Use Among Physical Therapists.

    abstract:BACKGROUND:Although the Fitkids Treadmill Test (FTT) has been validated and normative values are available for healthy 6- to 18-year-old children and adolescents, these facts do not automatically imply uptake of the test in routine practice of physical therapists. OBJECTIVE:The objectives of this study were to evaluat...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Kotte EMW,de Groot JF,Winkler AMF,Veenhof C,Takken T

    更新日期:2019-04-01 00:00:00

  • Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease.

    abstract:BACKGROUND:Dual-task (DT) training is gaining ground as a physical therapy intervention in people with Parkinson disease (PD). Future studies evaluating the effect of such interventions need reliable outcome measures. To date, the test-retest reliability of DT measures in patients with PD remains largely unknown. OBJE...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Strouwen C,Molenaar EA,Keus SH,Münks L,Bloem BR,Nieuwboer A

    更新日期:2016-08-01 00:00:00

  • Effectiveness of an extension-oriented treatment approach in a subgroup of subjects with low back pain: a randomized clinical trial.

    abstract:BACKGROUND AND PURPOSE:The purpose of this multicenter randomized clinical trial was to examine the effectiveness of an extension-oriented treatment approach (EOTA) in a subgroup of subjects with low back pain (LBP) who were hypothesized to benefit from the treatment compared with similar subjects who received a lumbar...

    journal_title:Physical therapy

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Browder DA,Childs JD,Cleland JA,Fritz JM

    更新日期:2007-12-01 00:00:00

  • Electromyographic analysis of traditional and nontraditional abdominal exercises: implications for rehabilitation and training.

    abstract:BACKGROUND AND PURPOSE:Performing nontraditional abdominal exercises with devices such as abdominal straps, the Power Wheel, and the Ab Revolutionizer has been suggested as a way to activate abdominal and extraneous (nonabdominal) musculature as effectively as more traditional abdominal exercises, such as the crunch an...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Escamilla RF,Babb E,DeWitt R,Jew P,Kelleher P,Burnham T,Busch J,D'Anna K,Mowbray R,Imamura RT

    更新日期:2006-05-01 00:00:00

  • Report of the NIH Task Force on research standards for chronic low back pain.

    abstract:UNLABELLED:Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic ...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Deyo RA,Dworkin SF,Amtmann D,Andersson G,Borenstein D,Carragee E,Carrino J,Chou R,Cook K,Delitto A,Goertz C,Khalsa P,Loeser J,Mackey S,Panagis J,Rainville J,Tosteson T,Turk D,Von Korff M,Weiner DK

    更新日期:2015-02-01 00:00:00

  • Chronic fatigue syndrome: lack of association between pain-related fear of movement and exercise capacity and disability.

    abstract:BACKGROUND AND PURPOSE:Patients who experience pain, a symptom of chronic fatigue syndrome (CFS), often exhibit kinesiophobia (irrational fear of movement). The purpose of this study was to examine whether pain-related fear of movement is associated with exercise capacity, activity limitations, or participation restric...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Nijs J,Vanherberghen K,Duquet W,De Meirleir K

    更新日期:2004-08-01 00:00:00

  • Objective determinations of sensibility in the upper extremity. Part III. Application of cutaneous stimuli in patients with peripheral nerve lesions.

    abstract::Quantitative values for pressure, electrical, and two-point touch stimulation were examined in five patients with peripheral nerve injuries of the ulnar or median nerves. Analyses of profiles generated for each stimulus application in each patient participating in this preliminary study suggest that, following the rea...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Wolf SL,Nahai F,Brown DM,Jordan N,Kutner M

    更新日期:1977-10-01 00:00:00

  • Developing a clinical education program from the clinician's perspective.

    abstract::As the number of physical therapy programs increases, more physical therapy departments will be developing clinical education programs. A guide for clinicians who are developing clinical education programs is presented. Suggestions are made for developing a philosophy of clinical education and for structuring the prog...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Windom PA

    更新日期:1982-11-01 00:00:00

  • Passive ankle stiffness in subjects with diabetes and peripheral neuropathy versus an age-matched comparison group.

    abstract:BACKGROUND AND PURPOSE:Patients with diabetes mellitus and peripheral neuropathy (DM and PN) often complain of joint stiffness. Although stiffness may contribute to some of the impairments and functional limitations found in these patients, it has not been quantified in this population. The purpose of this study was to...

    journal_title:Physical therapy

    pub_type: 临床试验,杂志文章


    authors: Salsich GB,Mueller MJ,Sahrmann SA

    更新日期:2000-04-01 00:00:00

  • Mechanotransduction: Relevance to Physical Therapist Practice-Understanding Our Ability to Affect Genetic Expression Through Mechanical Forces.

    abstract::Mechanotransduction, the mechanism by which mechanical perturbation influences genetic expression and cellular behavior, is an area of molecular biology undergoing rapid exploration and discovery. Cells are sensitive to forces such as shear, tension, and compression, and they respond accordingly through cellular proli...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Dunn SL,Olmedo ML

    更新日期:2016-05-01 00:00:00

  • Application of Intervention Mapping to the Development of a Complex Physical Therapist Intervention.

    abstract:BACKGROUND:Physical therapist interventions, such as those designed to change physical activity behavior, are often complex and multifaceted. In order to facilitate rigorous evaluation and implementation of these complex interventions into clinical practice, the development process must be comprehensive, systematic, an...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Jones TM,Dear BF,Hush JM,Titov N,Dean CM

    更新日期:2016-12-01 00:00:00

  • Determinants of guideline use in primary care physical therapy: a cross-sectional survey of attitudes, knowledge, and behavior.

    abstract:BACKGROUND:Understanding of attitudes, knowledge, and behavior related to evidence-based practice (EBP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. OBJECTIVES:The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prer...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Bernhardsson S,Johansson K,Nilsen P,Öberg B,Larsson ME

    更新日期:2014-03-01 00:00:00

  • The development and testing of APTA Clinical Performance Instruments. American Physical Therapy Association.

    abstract:BACKGROUND AND PURPOSE:The purposes of this article are to describe the process of developing the physical therapist (PT) and physical therapist assistant (PTA) Clinical Performance Instruments (CPIs) and to present the available information on the psychometric properties of each instrument. SUBJECTS:Two hundred seven...

    journal_title:Physical therapy

    pub_type: 杂志文章


    authors: Task Force for the Development of Student Clinical Performance Instruments.

    更新日期:2002-04-01 00:00:00