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Cameron J. Powden, Matthew C. Hoch and Johanna M. Hoch

Context The evaluation of change in patient status throughout and after the cessation of orthopedic rehabilitation is a vital component of health care and is often captured from the patient’s perspective by patient-based outcomes. Patient-based outcomes are used to assess the effect of the health

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Rebecca M. Hirschhorn, Cassidy Holland, Amy F. Hand and James M. Mensch

Orthopedic/family practice/pediatrician 26  Other 18 Sports medicine training  Yes 29  No 14 Experience working with an AT  Yes 29  No 14 State practice regulation  AT licensure 8  Nonlicensure 36 Abbreviation: AT = athletic trainer. Physicians’ age and years of practicing as a physician were not

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Column-editor : Robert D. Kersey

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Sheri L. Cameron

Column-editor : Robert D. Kersey

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Konstantinos Fousekis, Evdokia Billis, Charalampos Matzaroglou, Konstantinos Mylonas, Constantinos Koutsojannis and Elias Tsepis

Context:

Elastic bandages are commonly used in sports to treat and prevent sport injuries.

Objective:

To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic- and sports-injury prevention and rehabilitation.

Evidence Acquisition:

The researchers searched the electronic databases MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Physiotherapy Evidence Database (PEDro) with keywords elastic bandaging in combination, respectively, with first aid, sports injuries, orthopedic injuries, and sports injuries prevention and rehabilitation. Research studies were selected based on the use of the term elastic bandaging in the abstract. Final selection was made by applying inclusion and exclusion criteria to the full text. Studies were included if they were peer-reviewed clinical trials written in English on the effects of elastic bandaging for orthopedic-injury prevention and rehabilitation.

Evidence Synthesis:

Twelve studies met the criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures, and results. Studies were critically analyzed using the PEDro scale.

Conclusions:

The studies in this review fell into 2 categories: studies in athletes (n = 2) and nonathletes (n = 10). All included trials had moderate to high quality, scoring ≥5 on the PEDro scale. The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher- to moderate-quality methodological clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of elastic bandaging could not be confirmed.

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Sonia Lippke, Jochen P. Ziegelmann and Ralf Schwarzer

Patients in rehabilitation settings often face difficulties in complying with physical exercise regimens. To examine social-cognitive determinants in the adoption and maintenance of exercise, a study with four points in time was launched, scrutinizing beliefs and behaviors of 509 orthopedic patients. Although exercise levels increased over time, a sizable number of patients remained inactive. Perceived self-efficacy and outcome expectancies predicted levels of intention and action plans. The latter two in turn were proximal predictors of subsequent exercise. In light of the findings, it is argued that planning helps to bridge the intention-behavior gap. Planning is an alterable variable and is therefore suitable for effective intervention.

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E. Michael Loovis

Toy preference and associated gross and fine motor movements of preschool orthopedically handicapped children were evaluated in a free-play situation. Fifteen children between 3 and 5 years of age and representing two separate classes served as subjects. The study was conducted for 7 weeks in the subjects’ classroom. Sessions were scheduled 2 times per week in each class, each lasting 1 hour. Twenty toys were evaluated using a modified version of the procedure developed by the University of Kansas’ Living Environments Group. Measurement of movement behavior associated with toy play involved application of a movement glossary developed by the experimenter. A Wilcoxon two-sample rank test revealed no significant differences for either gender, age, or ambulation (ambulatory versus nonambulatory) in relation to toy preference or nature of movement demonstrated. Analysis revealed that subjects spent considerable time using toys in a manner which did not correspond to their design. It was recommended that orthopedically handicapped children might benefit from learning how to play under the direction of a parent, teacher, or similar individual.

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Tricia Majewski-Schrage and Kelli Snyder

Clinical Scenario:

Managing edema after trauma or injury is a primary concern for health care professionals, as it is theorized that delaying the removal of edema will increase secondary injury and result in a longer recovery period. The inflammatory process generates a series of events, starting with bleeding and ultimately leading to fluid accumulation in intercellular spaces and the formation of edema. Once edema is formed, the lymphatic system plays a tremendous role in removing excess interstitial fluid and returning the fluid to the circulatory system. Therefore, rehabilitation specialists ought to use therapies that enhance the uptake of edema via the lymphatic system to manage edema; however, the modalities commonly used are ice, compression, and elevation. Modalities such as these may be effective at preventing swelling but present limited evidence to suggest that the function of the lymphatic system is enhanced. Manual lymphatic drainage (MLD) is a manual therapy technique that assists the lymphatic system function by promoting variations in interstitial pressures by applying light pressure using different hand movements.

Focused Clinical Question:

Does MLD improve patient- and disease-oriented outcomes for patients with orthopedic injuries?

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Deidre Leaver-Dunn

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Paul Grace