Study Design Multicenter randomized controlled trial. Background Cervicothoracic manual therapy has been shown to improve pain and disability in individuals with shoulder pain, but the incremental effects of manual therapy in addition to exercise therapy have not been investigated in a randomized controlled trial. Objectives To compare the effects of cervicothoracic manual therapy and exercise therapy to those of exercise therapy alone in individuals with shoulder pain. Methods Individuals (n = 140) with shoulder pain were randomly assigned to receive 2 sessions of cervicothoracic range-of-motion exercises plus 6 sessions of exercise therapy, or 2 sessions of high-dose cervicothoracic manual therapy and range-of-motion exercises plus 6 sessions of exercise therapy (manual therapy plus exercise). Pain and disability were assessed at baseline, 1 week, 4 weeks, and 6 months. The primary aim (treatment group by time) was examined using linear mixed-model analyses and the repeated measure of time for the Shoulder Pain and Disability Index (SPADI), the numeric pain-rating scale, and the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Patient-perceived success was assessed and analyzed using the global rating of change (GROC) and the Patient Acceptable Symptom State (PASS), using chi-square tests of independence. Results There were no significant 2-way interactions of group by time or main effects by group for pain or disability. Both groups improved significantly on the SPADI, numeric pain-rating scale, and QuickDASH. Secondary outcomes of success on the GROC and PASS significantly favored the manual therapy-plus-exercise group at 4 weeks (P = .03 and P<.01, respectively) and on the GROC at 6 months (P = .04). Conclusion Adding 2 sessions of high-dose cervicothoracic manual therapy to an exercise program did not improve pain or disability in patients with shoulder pain, but did improve patient-perceived success at 4 weeks and 6 months and acceptability of symptoms at 4 weeks. More research is needed on the use of cervicothoracic manual therapy for treating shoulder pain. Level of Evidence Therapy, level 1b. Prospectively registered March 30, 2012 at www.ClinicalTrials.gov (NCT01571674). J Orthop Sports Phys Ther 2016;46(8):617-628. doi:10.2519/jospt.2016.6319.

Although most patients are satisfied with outcomes after total knee arthroplasty (TKA), many retain preoperative altered gait mechanics. Identifying patient characteristics associated with gait mechanics will improve rehabilitation strategies and enhance our understanding of movement disorders. Therefore, the purpose of this study was to identify which patient characteristics are related to gait mechanics in the surgical limb during walking post‐TKA. Patient characteristics included age, body mass, sex, quadriceps strength, self‐reported function, and knee pain. General linear regression was used to compare patient characteristics associated with gait mechanics, after controlling for gait speed, functional capacity and time from surgery. We tested 191 patients cross‐sectionally at 6–24 months after primary, unilateral TKA. Quadriceps weakness in the surgical limb was associated with less peak vertical ground reaction force (PvGRF) (β = .245, p = .044), knee extension moment (β = .283, p = .049), and knee extension excursion (β = .298, p = .038). Older age (β = .168, p = .050) was associated with less PvGRF. Quadriceps strength in the nonsurgical limb (β = −.357, p = .021) was associated with greater knee extension excursion in the surgical limb. Females with TKA (β = −.276, p = .007) had less knee flexion excursion compared to males. Faster gait speed was also associated with greater PvGRF (β = .585, p < .001), knee extensor moment (β = .481, p < .001), and knee flexion excursion (β = .318, p < .001). Statement of Clinical Significance: This study showed quadriceps weakness, slower gait speed, older age and being female were related to altered gait mechanics post‐TKA. These findings will help clinicians better educate patients and develop targeted interventions for improving care in patients post‐TKA.

Study Design Secondary analysis of a randomized controlled trial. Background Prognostic variables identifying patients with shoulder pain who are likely to respond to cervicothoracic manipulation have been reported; however, they have yet to be validated. Objective To examine the validity of previously reported prognostic variables in predicting which patients with shoulder pain will respond to cervicothoracic manipulation. Methods Participants (n = 140) with a report of shoulder pain were randomly assigned to receive either 2 sessions of range-of-motion exercises plus 6 sessions of stretching and strengthening exercises (exercise group), or 2 sessions of cervicothoracic manipulation and range-of-motion exercises followed by 6 sessions of stretching and strengthening exercise (manipulative-therapy-plus-exercise group). Outcomes of disability (Shoulder Pain and Disability Index, shortened version of the Disabilities of the Arm, Shoulder and Hand Questionnaire) and pain (numeric pain-rating scale) were collected at baseline, 1 week, 4 weeks, and 6 months. Time, treatment group, status of predictor variables, and 2-way and 3-way interactions were analyzed using linear mixed models with repeated measures. Results There were no significant 3-way interactions for either disability (P = .27) or pain scores (P = .70) for time, group, and predictor status for any of the predictor variables. Conclusion The results of the current study did not validate the previously identified prognostic variables; therefore, we cannot support using these in clinical practice. Further updating of the existing prediction rule may be warranted and could potentially result in new prognostic variables and improved generalizability. Limitations of the study were a mean duration of symptoms of greater than 2 years and a loss to follow-up of 19% at 6 months. Level of Evidence Prognosis, level 1b. Trial prospectively registered March 30, 2012 at www.clinicaltrials.gov (NCT01571674). J Orthop Sports Phys Ther 2017;47(4):252-260. Epub 3 Mar 2017. doi:10.2519/jospt.2017.7100.

Background and Purpose. A main component of the conceptual model of excellence in physical therapist education, introduced by Jensen et al, is a culture of excellence. A culture of excellence relies on identifying accountable faculty who set high expectations and execute systems toward ongoing improvement. Peer review of teaching (PRT) is an established system that cultivates a culture of collaboration, reflection, and excellence through feedback and collegial discourse. The purpose of this scoping review was to understand PRT implementation by 1) summarizing the program development process, 2) identifying program characteristics, 3) identifying review instruments, and 4) determining program evaluation strategies. Methods. A scoping review was conducted using a methodological framework. With library scientist counsel, search terms were established, and 3 databases were queried for articles describing PRT programs in health care education. Articles were managed in the Covidence Systematic Review Management Software. Researchers independently screened search results for article inclusion and extracted data from included studies. Descriptive data analysis was conducted. Results. Thirty-five articles met inclusion criteria. Seven different health care professions have published PRT articles; however, none in Doctor of Physical Therapy (DPT) education. Results indicated that most programs underwent a systematic development process, included faculty input, and sought to ensure consistency between the program purpose and characteristics. A 3-step formative process was most common. Faculty were paired systematically or used self-selection. Evaluative instruments were often program specific, guided by core competencies of teaching excellence or previously published tools. Program outcomes commonly reported positive faculty opinion of PRT and teaching improvement. Only 2 articles evaluated student metrics to assess PRT impact and effectiveness. Discussion and Conclusion. Peer review of teaching has been successfully adopted by health care education faculty to promote teaching excellence and could be a foundation for creating a culture of excellence in DPT education. These results provide an understanding of the processes for implementing PRT to guide DPT educators establishing PRT programs.