John D Childs
Baylor University, Physical Therapy, Faculty Member
The purpose of this study was to describe knowledge in managing musculoskeletal conditions among physical therapists in the uniformed services based on their educational background and preparation. A cross-sectional design was used. A... more
The purpose of this study was to describe knowledge in managing musculoskeletal conditions among physical therapists in the uniformed services based on their educational background and preparation. A cross-sectional design was used. A total of 182 physical therapists in the uniformed services completed a standardized examination that assesses knowledge in managing musculoskeletal conditions. Physical therapists in the uniformed services who graduated from the U.S. Army-Baylor Doctoral Program in Physical Therapy or had attended a specific continuing medical education course that emphasizes the management of musculoskeletal conditions achieved higher scores and passing rates than their colleagues who had not. Compared with previously published data, physical therapists in the uniformed services demonstrated higher scores than medical students, physician interns and residents, active duty military physicians, and all physician specialists except for orthopedists. Physical therapists i...
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The purpose of this study was to determine if patients who do not receive manipulation for their low back pain (LBP) are at an increased risk for worsening disability compared to patients receiving an exercise intervention without... more
The purpose of this study was to determine if patients who do not receive manipulation for their low back pain (LBP) are at an increased risk for worsening disability compared to patients receiving an exercise intervention without manipulation. One hundred and thirty-one consecutive patients with LBP were randomly assigned to receive manipulation and an exercise intervention (n = 70) or an exercise intervention without manipulation (n = 61). Patients were classified as to whether they had experienced a worsening in disability upon follow-up. Relative risk and number needed to treat (NNT) statistics and associated 95% confidence intervals (CI) were calculated. Patients who completed the exercise intervention without manipulation were eight (95% CI: 1.1, 63.5) times more likely to experience a worsening in disability than patients who received manipulation. The NNT with manipulation to prevent one additional patient from experiencing a worsening in disability was 9.9 (95% CI: 4.9, 65....
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Patients with low back pain are frequently encountered in primary care. Although a specific diagnosis cannot be made for most patients, it is likely that sub-groups exist within the larger entity of nonspecific low back pain. One... more
Patients with low back pain are frequently encountered in primary care. Although a specific diagnosis cannot be made for most patients, it is likely that sub-groups exist within the larger entity of nonspecific low back pain. One sub-group that has been identified is patients who respond rapidly to spinal manipulation. The purpose of this study was to examine the association between two factors (duration and distribution of symptoms) and prognosis following a spinal manipulation intervention. Data were taken from two previously published studies. Patients with low back pain underwent a standardized examination, including assessment of duration of the current symptoms in days, and the distal-most distribution of symptoms. Based on prior research, patients with symptoms of <16 days duration and no symptoms distal to the knee were considered to have a good prognosis following manipulation. All patients underwent up to two sessions of spinal manipulation treatment and a range of moti...
Research Interests: Primary Care, Primary Health Care, Treatment Outcome, Low back pain, Humans, and 14 moreKnee, Female, Male, Middle Aged, Questionnaires, IRT-likelihood Ratio, Observer Variation, Adult, Public health systems and services research, Time Factors, Prognosis, Sensitivity and Specificity, Range of Motion, and Pain Measurement
Physical therapists increasingly provide direct access services to patients with musculoskeletal conditions, and growing evidence supports the cost-effectiveness of this mode of healthcare delivery. However, further evidence is needed to... more
Physical therapists increasingly provide direct access services to patients with musculoskeletal conditions, and growing evidence supports the cost-effectiveness of this mode of healthcare delivery. However, further evidence is needed to determine if physical therapists have the requisite knowledge necessary to manage musculoskeletal conditions. Therefore, the purpose of this study was to describe physical therapists' knowledge in managing musculoskeletal conditions. This study utilized a cross-sectional design in which 174 physical therapist students from randomly selected educational programs and 182 experienced physical therapists completed a standardized examination assessing knowledge in managing musculoskeletal conditions. This same examination has been previously been used to assess knowledge in musculoskeletal medicine among medical students, physician interns and residents, and across a variety of physician specialties. Experienced physical therapists had higher levels ...
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Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the... more
Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation. Seventy-five people with nonradicular low back pain (mean age=37.6 years, SD=10.6, range=19-59; mean duration of symptoms=41.7 days, SD=54.7, range=1-252) participated. Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no i...
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People with knee osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. The episodes of instability are similar to those reported by people with knee ligament injuries. The authors... more
People with knee osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. The episodes of instability are similar to those reported by people with knee ligament injuries. The authors believe that modifications of interventions that are used to promote knee stability in individuals with knee ligament injuries can be used to enhance knee stability and function in people with knee OA. The purpose of this case report is to describe the development and implementation of an agility and perturbation training program that was used in conjunction with traditional rehabilitation activities for a patient with knee OA. The patient was a 73-year-old woman with a diagnosis of bilateral knee OA. Her chief complaints were knee pain and episodes of partial "giving way" at the knee during walking, stair climbing, and participation in tennis and golf. The patient participated in 12 treatment sessions at a frequency of 2 visits per week. T...
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Research Interests: Biomedical Engineering, Data Analysis, Exercise therapy, Physical Therapy, Clinical Decision Making, and 22 moreClinical Practice, Prospective studies, Humans, Movement, Female, Male, Neck Pain, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Physical examination, Study design, Reproducibility of Results, Neck Muscles, Cervical Spine, Upper Limb, Logistic Regression Model, Exercise Test, Predictive value of tests, Traction, and Cohort Studies(Clinical Practice, Prospective studies, Humans, Movement, Female, Male, Neck Pain, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Physical examination, Study design, Reproducibility of Results, Neck Muscles, Cervical Spine, Upper Limb, Logistic Regression Model, Exercise Test, Predictive value of tests, Traction, and Cohort Studies)
(Clinical Practice, Prospective studies, Humans, Movement, Female, Male, Neck Pain, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Physical examination, Study design, Reproducibility of Results, Neck Muscles, Cervical Spine, Upper Limb, Logistic Regression Model, Exercise Test, Predictive value of tests, Traction, and Cohort Studies)
The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester... more
The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS. A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements. Thirty patients (age 29 +/- 8; 17 female) with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97); moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79); and poor for femo...
Research Interests: Decision Making, Skeletal muscle biology, Adolescent, Muscle strength, Humans, and 16 moreFemale, Male, Data Collection, Measurement Error, Patellofemoral Pain Syndrome, Clinical Sciences, Middle Aged, Repeated Measures, Adult, Reproducibility of Results, Ankle Joint, Physical Function, Knee Joint, Syndrome, Pain Measurement, and Predictive value of tests
Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and... more
Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR. Consecutive patients with LBP referred to physical therapy clinics in one of four geographical locations who satisfy the CPR will be invited to participate in this randomized clinical trial. Subjects who agree to participate will undergo a standard evaluation and complete a number of patient self-report questionnaires including the Oswestry Disability Index (OSW), which will serve as the primary outcome measure. Followi...
Research Interests: Biomedical Engineering, Spine, Biology, Prediction, Treatment, and 26 moreTreatment Outcome, Manual Therapy, Adolescent, Comparative Study, Exercise therapy, Medicine, Linear models, Physical Therapy, Low back pain, Humans, Female, Male, Technique, Follow-up studies, Manual, Clinical Sciences, Middle Aged, Questionnaires, Adult, Analysis of Variance, Retrospective Studies, Health surveys, Randomized Clinical Trial, Boolean Satisfiability, Clinical Protocols, and Pain Measurement(Treatment Outcome, Manual Therapy, Adolescent, Comparative Study, Exercise therapy, Medicine, Linear models, Physical Therapy, Low back pain, Humans, Female, Male, Technique, Follow-up studies, Manual, Clinical Sciences, Middle Aged, Questionnaires, Adult, Analysis of Variance, Retrospective Studies, Health surveys, Randomized Clinical Trial, Boolean Satisfiability, Clinical Protocols, and Pain Measurement)
(Treatment Outcome, Manual Therapy, Adolescent, Comparative Study, Exercise therapy, Medicine, Linear models, Physical Therapy, Low back pain, Humans, Female, Male, Technique, Follow-up studies, Manual, Clinical Sciences, Middle Aged, Questionnaires, Adult, Analysis of Variance, Retrospective Studies, Health surveys, Randomized Clinical Trial, Boolean Satisfiability, Clinical Protocols, and Pain Measurement)
Retrospective analysis of episodes of care. To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services.... more
Retrospective analysis of episodes of care. To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services. Many patients with musculoskeletal conditions benefit from care provided by physical therapists. The majority of physical therapists deliver services in either a private practice setting or in a hospital outpatient setting. There have not been any recent studies comparing whether clinical outcomes or efficiency of care differ based on practice setting. Practices that use the Focus On Therapeutic Outcomes, Inc system were surveyed to determine the specific type of setting in which outcomes were collected in patients with musculoskeletal impairments. Patient outcome data over 12 months (2011-2012) were extracted from the database and analyzed to identify differences in the functional status achieved and the efficiency of the care delivery process betwee...
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Research Interests: Biomedical Engineering, Skeletal muscle biology, Spine, Treatment Outcome, Linear models, and 17 moreLow back pain, Multivariate Analysis, Prospective studies, Humans, Female, Male, Young Adult, Clinical Sciences, Middle Aged, Questionnaires, Adult, Time Factors, Muscle contraction, Chi Square Distribution, Pilot Projects, Pain Measurement, and Biomechanical Phenomena
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Research Interests: Biomedical Engineering, Spine, Biology, Prediction, Treatment, and 26 moreTreatment Outcome, Manual Therapy, Adolescent, Comparative Study, Exercise therapy, Medicine, Linear models, Physical Therapy, Low back pain, Humans, Female, Male, Technique, Follow-up studies, Manual, Clinical Sciences, Middle Aged, Questionnaires, Adult, Analysis of Variance, Retrospective Studies, Health surveys, Randomized Clinical Trial, Boolean Satisfiability, Clinical Protocols, and Pain Measurement(Treatment Outcome, Manual Therapy, Adolescent, Comparative Study, Exercise therapy, Medicine, Linear models, Physical Therapy, Low back pain, Humans, Female, Male, Technique, Follow-up studies, Manual, Clinical Sciences, Middle Aged, Questionnaires, Adult, Analysis of Variance, Retrospective Studies, Health surveys, Randomized Clinical Trial, Boolean Satisfiability, Clinical Protocols, and Pain Measurement)
(Treatment Outcome, Manual Therapy, Adolescent, Comparative Study, Exercise therapy, Medicine, Linear models, Physical Therapy, Low back pain, Humans, Female, Male, Technique, Follow-up studies, Manual, Clinical Sciences, Middle Aged, Questionnaires, Adult, Analysis of Variance, Retrospective Studies, Health surveys, Randomized Clinical Trial, Boolean Satisfiability, Clinical Protocols, and Pain Measurement)
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Research Interests: Adolescent, Multidisciplinary, Low back pain, Humans, Cox Regression, and 22 moreBack Pain, Physical Health, Female, Male, Young Adult, Exercise, Risk factors, Logistic Regression Analysis, PLoS one, General Health, Physical Fitness, Psychological distress, Questionnaires, Adult, Surveillance System, Educational Status, Risk Factors, Pain Measurement, Military Personnel, Primary Prevention, Predictive value of tests, and Cohort Studies(Back Pain, Physical Health, Female, Male, Young Adult, Exercise, Risk factors, Logistic Regression Analysis, PLoS one, General Health, Physical Fitness, Psychological distress, Questionnaires, Adult, Surveillance System, Educational Status, Risk Factors, Pain Measurement, Military Personnel, Primary Prevention, Predictive value of tests, and Cohort Studies)
(Back Pain, Physical Health, Female, Male, Young Adult, Exercise, Risk factors, Logistic Regression Analysis, PLoS one, General Health, Physical Fitness, Psychological distress, Questionnaires, Adult, Surveillance System, Educational Status, Risk Factors, Pain Measurement, Military Personnel, Primary Prevention, Predictive value of tests, and Cohort Studies)
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Research Interests: Adolescent, Physical Therapy, Humans, Female, Male, and 16 moreNeck Pain, Physical, Group Intervention, Clinical Sciences, Rating Scale, Middle Aged, Repeated Measures, Adult, Analysis of Variance, Physical examination, Randomized Clinical Trial, Boolean Satisfiability, Side Effect, Thoracic Vertebrae, Pain Measurement, and Confidence Interval
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Randomized controlled trial among patients with low back pain (LBP). (1) Determine the reliability of real-time ultrasound imaging for assessing activation of the lateral abdominal muscles; (2) characterize the extent to which the... more
Randomized controlled trial among patients with low back pain (LBP). (1) Determine the reliability of real-time ultrasound imaging for assessing activation of the lateral abdominal muscles; (2) characterize the extent to which the abdominal drawing-in maneuver (ADIM) results in preferential activation of the transverse abdominis (TrA); and (3) determine if ultrasound biofeedback improves short-term performance of the ADIM in patients with LBP. Ultrasound imaging is reportedly useful for measuring and training patients to preferentially activate the TrA muscle. However, research to support these claims is limited. Thirty patients with LBP referred for lumbar stabilization training were randomized to receive either traditional training (n = 15) or traditional training with biofeedback (n = 15). Ultrasound imaging was used to measure changes in thickness of the lateral abdominal muscles. Differences in preferential changes in muscle thickness of the TrA between groups and across time were assessed using analysis of variance. Intrarater reliability measuring lateral abdominal muscle thickness exceeded 0.93. On average, patients in both groups demonstrated a 2-fold increase in the thickness of the TrA during the ADIM. Performance of the ADIM did not differ between the groups. These data provide construct validity for the notion that the ADIM results in preferential activation of the TrA in patients with LBP. Although, the addition of biofeedback did not enhance the ability to perform the ADIM at a short-term follow-up, our data suggest a possible ceiling effect or an insufficient training stimulus. Further research is necessary to determine if there is a subgroup of patients with LBP who may benefit from biofeedback.
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Research Interests: Military Medicine, Biomedical Engineering, Evidence Based Practice, Clinical Trial, Culture, and 21 moreSocial Support, Public Health, Adolescent, Linear models, Low back pain, Mass media, Patient education, Humans, Male, Cluster Analysis, Young Adult, Patient Compliance, Randomized Trial, Clinical Sciences, Questionnaires, Adult, Randomized Clinical Trial, Military Personnel, Primary Prevention, General Population, and Control Group(Social Support, Public Health, Adolescent, Linear models, Low back pain, Mass media, Patient education, Humans, Male, Cluster Analysis, Young Adult, Patient Compliance, Randomized Trial, Clinical Sciences, Questionnaires, Adult, Randomized Clinical Trial, Military Personnel, Primary Prevention, General Population, and Control Group)
(Social Support, Public Health, Adolescent, Linear models, Low back pain, Mass media, Patient education, Humans, Male, Cluster Analysis, Young Adult, Patient Compliance, Randomized Trial, Clinical Sciences, Questionnaires, Adult, Randomized Clinical Trial, Military Personnel, Primary Prevention, General Population, and Control Group)
Research Interests: Biomedical Engineering, Decision Making, Low back pain, Lumbar spine, Humans, and 14 moreFemale, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Retrospective Studies, Physical examination, Reproducibility of Results, Joint Instability, Range of Motion, Clinical Presentation, Predictive value of tests, Cohort Studies, and lumbar vertebrae
Research Interests: Biomedical Engineering, Data Analysis, Exercise therapy, Physical Therapy, Clinical Decision Making, and 22 moreClinical Practice, Prospective studies, Humans, Movement, Female, Male, Neck Pain, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Physical examination, Study design, Reproducibility of Results, Neck Muscles, Cervical Spine, Upper Limb, Logistic Regression Model, Exercise Test, Predictive value of tests, Traction, and Cohort Studies(Clinical Practice, Prospective studies, Humans, Movement, Female, Male, Neck Pain, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Physical examination, Study design, Reproducibility of Results, Neck Muscles, Cervical Spine, Upper Limb, Logistic Regression Model, Exercise Test, Predictive value of tests, Traction, and Cohort Studies)
(Clinical Practice, Prospective studies, Humans, Movement, Female, Male, Neck Pain, Clinical Sciences, Middle Aged, IRT-likelihood Ratio, Adult, Physical examination, Study design, Reproducibility of Results, Neck Muscles, Cervical Spine, Upper Limb, Logistic Regression Model, Exercise Test, Predictive value of tests, Traction, and Cohort Studies)
Research Interests: Biomedical Engineering, Psychometrics, Clinical Trial, Adolescent, Physical Therapy, and 13 moreLow back pain, Humans, Neck Pain, Cohort Study, Follow-up studies, Psychometric Properties, Clinical Sciences, Middle Aged, Intraclass Correlation Coefficient, Questionnaires, Adult, Indexation, and Cohort Studies
Research Interests: Mechanical Engineering, Biomedical Engineering, Skeletal muscle biology, Gait, Humans, and 18 moreWalking, Clinical Biomechanics, Gait Analysis, Movement, Female, Clinical, Male, Control Design, Aged, Middle Aged, Ground Reaction Force, Knee Osteoarthritis, Leg, Body Weight, Lower Extremity, Muscle Activity, Medial Gastrocnemius, and Case Control Studies
Research Interests: Nursing, Dentistry, Decision Making, Pain, Clinical Trial, and 41 moreStatistical Analysis, Quality of life, Survival Analysis, Treatment Outcome, Physical Therapy, Low back pain, Heart Failure, Humans, Cancer pain, Neuropathic pain, Female, Clinical, Oral Surgery, Male, Clinical oncology, Clinical Sciences, Peripheral Neuropathy, Aged, Middle Aged, Questionnaires, Stomatitis, Mouth mucosa, Analysis of Variance, Oral Hygiene, Lidocaine, Mouthwashes, Chlorhexidine, Chi Square Distribution, Randomized Clinical Trial, Management Strategy, Antineoplastic Agents, Sodium Chloride, Magnesium Hydroxide Industry Trend, Pain Measurement, Pulmonary disease, Proportional Hazards Models, Infrared Rays, Sodium Bicarbonate, Aluminum Hydroxide, Antacids, and Diphenhydramine(Statistical Analysis, Quality of life, Survival Analysis, Treatment Outcome, Physical Therapy, Low back pain, Heart Failure, Humans, Cancer pain, Neuropathic pain, Female, Clinical, Oral Surgery, Male, Clinical oncology, Clinical Sciences, Peripheral Neuropathy, Aged, Middle Aged, Questionnaires, Stomatitis, Mouth mucosa, Analysis of Variance, Oral Hygiene, Lidocaine, Mouthwashes, Chlorhexidine, Chi Square Distribution, Randomized Clinical Trial, Management Strategy, Antineoplastic Agents, Sodium Chloride, Magnesium Hydroxide Industry Trend, Pain Measurement, Pulmonary disease, Proportional Hazards Models, Infrared Rays, Sodium Bicarbonate, Aluminum Hydroxide, Antacids, and Diphenhydramine)
(Statistical Analysis, Quality of life, Survival Analysis, Treatment Outcome, Physical Therapy, Low back pain, Heart Failure, Humans, Cancer pain, Neuropathic pain, Female, Clinical, Oral Surgery, Male, Clinical oncology, Clinical Sciences, Peripheral Neuropathy, Aged, Middle Aged, Questionnaires, Stomatitis, Mouth mucosa, Analysis of Variance, Oral Hygiene, Lidocaine, Mouthwashes, Chlorhexidine, Chi Square Distribution, Randomized Clinical Trial, Management Strategy, Antineoplastic Agents, Sodium Chloride, Magnesium Hydroxide Industry Trend, Pain Measurement, Pulmonary disease, Proportional Hazards Models, Infrared Rays, Sodium Bicarbonate, Aluminum Hydroxide, Antacids, and Diphenhydramine)
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Research Interests: Military Medicine, Ultrasound Imaging, Clinical Trial, Attention, Treatment Outcome, and 23 moreAdolescent, Exercise therapy, Linear models, Low back pain, Humans, Female, Male, Statistical Significance, Young Adult, Patient Compliance, Health Status, Clinical Sciences, Questionnaires, Adult, Time Factors, Odds ratio, First Year, Chi Square Distribution, Chi Square Test, Occupational Diseases, Internet, Pain Measurement, and Military Personnel(Adolescent, Exercise therapy, Linear models, Low back pain, Humans, Female, Male, Statistical Significance, Young Adult, Patient Compliance, Health Status, Clinical Sciences, Questionnaires, Adult, Time Factors, Odds ratio, First Year, Chi Square Distribution, Chi Square Test, Occupational Diseases, Internet, Pain Measurement, and Military Personnel)
(Adolescent, Exercise therapy, Linear models, Low back pain, Humans, Female, Male, Statistical Significance, Young Adult, Patient Compliance, Health Status, Clinical Sciences, Questionnaires, Adult, Time Factors, Odds ratio, First Year, Chi Square Distribution, Chi Square Test, Occupational Diseases, Internet, Pain Measurement, and Military Personnel)