Musculoskeletal Physiotherapy: Clinical Science and Practice.

Refshauge K, Gass E, eds. Oxford, England, Butterworth-Heinemann, 1995, paperback, 238 pp, illus, $45.

The authors have set a lofty goal for this text: to provide a collection of writings that analyze and interpret scientific knowledge of musculoskeletal physical therapy procedures, including evaluation, examination interpretation, and patient management. While many texts have been written to document treatment and evaluation methodology, this book has been written to provide therapists with the theoretical basis of clinical practice.

The text consists of nine chapters. The first chapter, which serves as an introduction to the text, discusses the context and the environment of current practice. Although it is evident throughout the book, and certainly in the opening chapter, that the authors are writing about practice in Australia, the parallels to practice in the United States are many, including an emphasis on accountability and outcomes.

Chapter 2 is a compendium of information on the theoretical concepts underlying clinical decisions. The chapter is divided into subtopics on clinical reasoning, pharmacology, biomechanics, tissue adaptation, and skill learning.

Each of these subtopics is authored by an expert on the subject. Unfortunately, this chapter does not flow well, and the reader is left with the feeling that each subtopic would have been worthy of more attention.

The next chapter delves into diagnostic imaging, clearly describing techniques and views as well as application and interpretation by physical therapists. The middle section of the book addresses topics related to patient examination. An excellent overview of the basic issues of measurement theory, and the relevant research available concerning the history-taking and physical examination processes, is presented. In an extremely well-written chapter, by Nikolai Bogduk and Susan Mercer, the rationale behind treatment is examined using a three-axis model. The axes are convention, biological basis, and empirical proof; current treatment practices are examined in relation to each of these axes. The book is rounded out by a chapter that synthesizes the theories through a case study approach and a chapter on the role of the physical therapist in treating chronic pain.

On the whole, the authors are successful in accomplishing their stated goal. The text does have a bias toward discussing the theoretical basis of practice based on theories of Geoffrey Maitland, but it does not completely ignore other musculoskeletal approaches. Chapters are well referenced, and the photographs and illustrations are clear and useful. The intended and appropriate audience for this book is therapists in orthopedic practice settings. It would be a recommended book, however, for any therapist who is interested in the science underlying common practice approaches, and it would be an excellent partner text to books on practice and evaluation procedures.

Julia Chevan, PT; OCS Springfield College Springfield, Mass

Ms Chevan is Assistant Professor in the physical therapy program where she teaches courses on musculoskeletal evaluation and treatment. She is also involved in the care of patients with orthopedic conditions in a local clinic.