Clinical Orthopaedic Rehabilitation.

Brotzman S, ed. St Louis, MO 63146-3318 Mosby, 1996, hardback pp, illus, $89.95.

This textbook is designed to provide physicians and physical therapists with rehabilitation protocols that were developed by leaders in the field. Among the contributors are well-known and respected orthopedic surgeons and therapists such as Andrews, Donatelli, Jobe, and Wilk. The protocols form a unique and valuable collection. The editor maintains that his intent is not for the reader to utilize the protocols in a cookbook fashion, but rather as a framework for planning an individual patient's rehabilitation program. The protocols included in the text are based primarily on empirical models and on physicians' and therapists' clinical practice successes and failures. The trial-and-error protocols are a sample of the best that are currently used and are consistent with widely accepted orthopedic rehabilitation practices. The editor acknowledges that adaptations of these protocols may be indicated with further clinical research and biomechanical studies.

Seven of the 11 chapters are written collaboratively by orthopedic surgeons and physical therapists. One of the remaining four chapters is written by a physical therapist; the other three, by orthopedic physicians. Although the multiple authors maintain fairly consistent chapter organization, differences with respect to how the content and protocols are referenced and the detail, content, and description of rehabilitation protocols vary.

The first six chapters each discuss a peripheral joint. Other chapters address rehabilitation of patients with total joint arthroplasty, pediatric orthopedic conditions, reflex sympathetic dystrophy, and low back disorders. Another chapter discusses pathomechanics of the foot and foot orthoses. A preamble consisting of theoretical and clinical rationale for the rehabilitation protocols is included in each chapter. Figures and illustrations are clear and extensive and consist of both photographs and drawings. Each contributor includes an extensive bibliography at the end of the chapter. Within the text, however, the material is not clearly referenced. This makes it difficult for the reader to establish the degree of reliability and validity of the content.

The scope and content of this text is limited and strongly emphasizes postsurgical rehabilitation and rehabilitation of the athlete as opposed to that of patients receiving general orthopedic care. The chapters dedicated to reflex sympathetic dystrophy and foot orthoses appear out of place. It seems as though they were selected almost arbitrarily rather than to complete or complement a comprehensive discussion on orthopedic conditions. No clinical information on patients with cervical spine disorders is included. Few outcome data are submitted with respect to the protocols.

Although the poor reference system and lack of outcome reporting limit the usefulness of this text as a teaching tool, the student and clinician can utilize this information to develop and supplement their rehabilitation programs and to establish consistent methods for treating patients with selected orthopedic conditions. With the addition of outcome data, a second edition of this text would be a must for every practicing orthopedic physical therapist.

Elaine C Thompson, PhD, PT, OCS
University of Pennsylvania Medical Center
Philadelphia, Pa

Dr Thompson is Associate Hospital Director at the University of Pennsylvania and has taught orthopedic physical therapy at Beaver College. Her current research involves categorization and clinical pathway development for patients with low back pain.