Pathology: Implications for the Physical Therapist, ed 2.

Goodman CC, Fuller KS, Boissonnault WG, eds. St Louis, MO 63146, Saunders, 2003, hardcover, 1,261 pp, illus, ISBN: 0-7216-9233-8, $79.95.

This text, now in its second edition, is one of the few texts on pathology that was written specifically for the physical therapist. The first edition was excellent, providing physical therapist students and clinicians with a useful resource for many types of information on pathology. This second edition eclipses the first.

The purpose of this text is to review the pathogenesis of many common conditions, including both cellular and clinical presentations of pathology. The chapters are organized so that physical therapists can use information to achieve 2 primary objectives: (1) to recognize common pathological conditions and know when to refer patients to other health care professionals and (2) to modify and monitor physical therapy intervention for patients with medical conditions. Books with similar content have been written primarily for nursing clinicians, combining a review of normal physiology and pathophysiology of each organ system. This text emphasizes clinical applications for physical therapists.

To produce a work of this scope, the editors of this text engaged in a major undertaking. The first chapter provides an excellent framework for understanding pathology in a physical therapy context. It includes a discussion of health and illness, followed by an overview of the disablement frameworks. The editors have taken a systems approach to organizing information and thereby include most pertinent areas of practice (medical, musculoskeletal, integumentary, neurological, cardiovascular/pulmonary). Pathology of all major organ systems is covered equally well, including chapters on oncology, immunology, and organ transplant.

Each chapter is organized in a similar fashion--starting with a description of major pathologies likely to he encountered by physical therapists, followed by common medical and surgical management principles for these conditions--and focuses on implications for the physical therapist. In addition, there are chapters pertaining to other issues that are critical in the management of patients with medical conditions but that are not generally included in pathology texts. One chapter addresses occupational and environmental issues related to health and disease; others address biopsychosocial and spiritual concepts related to disease or address multiple system issues such as medications, radiation therapy, and electrolyte imbalances. Several other chapters make Ibis text a com piece reference for physical therapists: the review of injury, inflammation, and healing in chapter 5 and the resource for common laboratory test values in chapter 39.

In a text of this length, it might be tempting to take shortcuts regarding up-to-date information. It appears that the editors and chapter authors have made the effort to provide the most current available knowledge and have referenced the information well. The use of tables and drawings facilitates understanding of the information. Wherever possible, the authors have included information on prevention of medical conditions.

Two features of this text stand out: (1) the emphasis on clinical implications for the physical therapist and (2) the inclusion of relevant Preferred Physical Therapist Practice Patterns(TM) from the Guide to Physical Therapist Practice. Throughout the text, any information specifically directed at physical therapist clinical practice is highlighted in text boxes marked in red margins entitled "Special Implications for the Therapist." This visual tool makes it easy for physical therapists to focus on specific safety or outcome issues. Suggested practice patterns for many of the pathologies are also new to this edition. For example, the "Special Implications for the Therapist" box for polymyositis includes practice patterns 4D and 7E and exercise considerations for patients with polymyositis.

Despite these strengths, there are several areas in which clarity could he improved. First, given that the editors have published several differential diagnosis texts, I was surprised that a chapter was not dedicated to reviewing principles of differential diagnosis. An additional chapter following the introductory chapter could cover the principles of differential diagnosis, provide several decision-making algorithms or strategies, and review concepts of visceral, referred, and somatic pain. Although the addition of a chapter on biopsychosocial and spiritual aspects of health was useful, I found the content in this chapter to be inconsistent with the purpose of the book. I would have preferred this chapter to address the issues and theories related to how social and spiritual aspects of lift should be included in physical therapist patient/ client management. A separate chapter devoted to psychological pathology would have made it easier to locate information about eating disorders and psychiatric conditions and still have been consistent with the organization of the remainder of the text.

In summary, no other text provides as broad, yet complete, a knowledge of pathology along with the implications for physical therapy. This text is unique because it focuses specifically on assisting physical therapists in providing safe and effective exercise, monitoring, and other interventions for patients with specific conditions. Given these strengths, this text should be considered mandatory for the library of every physical therapist and physical therapist student.

Susan A Scherer, PT

University of Colorado Health Sciences

Center

Denver, Colo

Ms Scherer is an Assistant Professor in the Physical Therapy Program, Department of Rehabilitation Medicine. She coordinates and teaches a sequence of 3 courses on physical therapist management of patients with medical conditions.