Clinical Practice Guidelines: Examination and Intervention for Rehabilitation.

Clinical Practice Guidelines: Examination and Intervention for Rehabilitation Schunk C, Reed K. Gaithersburg, MD 20878, Aspen Publishers Inc, 2000, spiralbound, 493 pp, ISBN: 0-8342-1774-0, $99.

This is an updated version of an earlier notebook that was written to provide intervention guidelines for the practicing therapist. The authors state that the text is intended to provide direction for the clinician and should not take the place of sound clinical judgement. This text follows the terminology and categories used in the first edition of the Guide to Physical Therapist Practice.

Clinical Practice Guidelines: Examination and Intervention for Rehabilitation includes coverage of orthopedics, acute care, geriatrics, and neurology. Eighty-nine separate diagnostic groups are contained within 12 chapters, which were developed with contributions from 52 clinicians. Each diagnosis follows a consistent outline format that includes examination, goals/outcomes, intervention, and discharge planning. The examination section includes history, systems review, and tests and measures. The intervention segment is divided into 5 sections: coordination, communication and documentation, patient instruction, direct interventions, and functional carry-over. The recommended number of visits for each diagnosis during the acute and subacute phases of healing are also included.

Chapters 1 to 3 cover the lower extremity and are divided into foot/ankle, knee, and hip. I found the section in chapter 1 containing commonly asked questions about foot orthoses especially interesting. Besides the common orthopedic diagnoses, other areas in the first chapter included the diabetic foot and total knee arthroplasty.

The next 3 chapters discuss the spine and temporomandibularjoint. Included in these chapters are pelvic floor dysfunction, whiplash, and thoracic outlet syndrome. Chapters 7 to 9 concern the upper extremity and are divided into the shoulder, elbow, and wrist/hand. Chapter 10, "Return to Sport," includes recommendations for anterior cruciate ligament reconstruction, ankle sprain, shoulder injury, hamstring, hip pain in runners, and a walking program.

The next chapter "General Medicine" focuses on amputation, fitting prostheses, wrapping techniques, wound care, geriatric rehabilitation, arthritis, and vestibular rehabilitation. The final chapter, "Neurology," covers the diagnoses of cerebral vascular accident, Parkinson disease, multiple sclerosis, and Guillain-Barre syndrome. I was surprised that this chapter did not mention traumatic head injuries.

Other features of this book include ICD-9 codes, a one-page quick reference summary for each diagnosis, and an appendix with guidelines to the Guide to Physical Therapist Practice. A few references are enclosed at the end of each section.

It should be noted that this text is not a "how to" but rather a sequence of selected techniques. Interventions are presented in general terms with little emphasis on the actual techniques used to administer exercise or joint mobilization procedures. I could see the Clinical Practice Guidelines: Examination and Intervention for Rehabilitation being used as a general reference for students who are beginning clinical rotation or the new graduate who may need some guidance. I am not sure, however, how much the seasoned therapist would find this helpful.

Janice K Loudon, PT, PhD, SCS, ATC University of Kansas Medical Center Kansas City, Kan

Dr Loudon is Associate Professor in the Department of Physical Therapy. She has over 17 years of clinical experience in orthopedics. Her research interests are the study of biomechanics and prevention of injuries in sports.