Rehabilitation Guidelines, 3 vols.

Schunk C, Reed K, eds. Beaverton, OR 97005, Therapeutic Associates Inc. 1995, three-ring binder, Vol 1, Lower Extremity, 214 pp; Vol 2, Spine and Temporomandibular Joint, 189 pp; Vol 3, Upper Extremity, 198 pp; $185.00 per volume.

Rehabilitation Guidelines represents a concerted effort by clinicians to establish and document a framework for orthopedic clinical practice. The authors clearly state in the preface that this work is designed to provide parameters to guide therapeutic intervention using sound clinical judgment and that it is not intended to dictate rigid standards of patient care. The three volumes are edited by physical therapists with contributions from other physical therapists, physical therapist assistants, athletic trainers, and occupational therapists.

Within each volume, sections are organized by anatomical regions. Volume I presents guidelines for the physical therapy management of the foot and ankle, knee, and hip. Volume 2 provides guidelines for diagnoses related to the lumbar spine, cervical and thoracic spine, and headache and temporomandibular joint. Volume 3 describes management of the shoulder, elbow, wrist and hand. For each mayor anatomical region, information is presented to address a broad range of general and postoperative diagnoses.

Management includes the initial examination, treatment planning, discharge planning, and patient responsibilities. The initial evaluation lists relevant clinical examination tools with expected clinical findings. Appropriate impairment and functional goals are presented as suggestions, and outcomes are discussed in terms of expected ranges. Treatment plans suggest appropriate modalities, therapeutic exercises, home exercise programs, patient instruction, estimated range of treatment sessions, and potential complications. The importance of the patient's role in the process is evident throughout each section.

Several sections include information describing progressions designed to facilitate the patient's return to common functional and recreational activities. Functional progressions are outlined for upper- and lower-extremity dysfunction. Some examples include return to throwing, tennis, running, and a walking program. Criteria are presented along with guidelines for progression, relevant patient instruction, and goals stated in general terms. An additional section in the lower-extremity volume addresses the biomechanics of lower-extremity function, specifically orthoses and footwear selection.

The breadth of material described in this work reflects a comprehensive approach to patient management. The depth of coverage is appropriate to provide the reader with the parameters necessary to guide the process of patient care and is consistent with the intended purpose of the guidelines. Most of the information is presented in outline form that is clear and concise in both organization and content. Although a variety of health care professionals contributed to this endeavor, the three volumes are written in a consistent manner.

Each volume is contained in a three-ring binder. This method is useful either for removing information to be copied or for augmenting specific areas with additional data. The ICD-9 codes are included for each diagnosis and are indexed at the conclusion of each volume. Information within each volume may be readily located using the table of contents, which is organized by anatomical section, or the alphabetical index. At the conclusion of each section, key components of evaluation, treatment, and discharge planning are highlighted on laminated pages for the most common diagnoses. Current primary and secondary references are provided at the conclusion of each diagnostic group. In addition, the reader is directed to specific information for additional insight on surgical procedures. An expansion of the suggested reading list or bibliography would provide a stronger basis for the guidelines and augment the resources available to the reader.

Combining comprehensive management parameters with sound clinical experience and judgment will serve to enhance patient care. Rehabilitation Guidelines provides a user-friendly resource for clinically relevant patient management guidelines. Entry-level and experienced health care practitioners will find these volumes useful in providing a basis to evaluate existing strategies for patient management and to guide the care of patients with less frequently treated conditions. These volumes may help physical therapy educators in the development of instructional materials such as case studies and may serve as a useful reference for physical therapist students.

Douglas R Keshula, PhD, PT, ATC Medical College of Georgia Augusta, Ga.

Dr. Keskula is Assistant Professor in the Department of Physical Therapy, with research interests in the reliability and validity of clinical measures with a specific focus on functional outcome assessment for lower-extremity dysfunction.