PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 1 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
PASSAGE TO THE USA, VIA CAPE OF NPTE.
NATIONAL PHYSIOTHERAPY EXAMINATION-PART-3
SPEC. BY: Abdulrehman S. Mulla
DATE: 03/21/2009
REVISION HISTORY
REV. DESCRIPTION CN No. BY DATE
01 Initial Release PT0013 ASM 04/25/2009
02/02 Replace the Front cover poster PT0014 ASM 05/04/2009
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
1

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 2 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
TABLE OF CONTENTS PAGE
14.0 EDUCATION & CONSULTATION: ................................................................................................................................................................... 6
14.1 PEDIATRIC PHYSIOTHERAPY EDUCATION & CONSULTATION: ........................................................................................................ 6
14.1.1 PAEDIATRIC PHYSIOTHERAPISTS DO: ................................................................................................................................ 6
14.1.2 PHYSIOTHERAPY INTERVENTIONS:..................................................................................................................................... 6
14.2 GERIATRIC PHYSIOTHERAPY EDUCATION & CONSULTATION:........................................................................................................ 7
14.2.1 PHYSIOTHERAPIST’S ROLE:.................................................................................................................................................. 7
14.2.2 SCREENING: ............................................................................................................................................................................ 7
14.2.3 ASSESSMENT:......................................................................................................................................................................... 8
14.2.4 CARE PLAN DEVELOPMENT:................................................................................................................................................. 8
14.2.5 INTERVENTION:....................................................................................................................................................................... 8
14.2.6 DOCUMENTATION:.................................................................................................................................................................. 8
14.2.7 DISCHARGE/ TRANSFER:....................................................................................................................................................... 8
14.2.8 DATA:........................................................................................................................................................................................ 8
14.3 ORTHOPEDIC PHYSIOTHERAPY EDUCATION & CONSULTATION: ................................................................................................... 9
14.3.1 PHYSIOTHERAPIST’S ROLE:.................................................................................................................................................. 9
14.3.2 SCREENING: ............................................................................................................................................................................ 9
14.3.3 ASSESSMENT:......................................................................................................................................................................... 9
14.3.4 CARE PLAN DEVELOPMENT:............................................................................................................................................... 10
14.3.5 INTERVENTION:..................................................................................................................................................................... 10
14.3.6 DOCUMENTATION:................................................................................................................................................................ 10
14.3.7 DISCHARGE/ TRANSFER:..................................................................................................................................................... 11
14.3.8 DATA:...................................................................................................................................................................................... 11
14.4 NEUROLOGICAL PHYSIOTHERAPY EDUCATION & CONSULTATION:............................................................................................. 11
14.4.1 PHYSIOTHERAPIST’S ROLE:................................................................................................................................................ 11
14.4.2 SCREENING: .......................................................................................................................................................................... 11
14.4.3 ASSESSMENT:....................................................................................................................................................................... 12
14.4.4 CARE PLAN DEVELOPMENT:............................................................................................................................................... 12
14.4.5 INTERVENTION:..................................................................................................................................................................... 12
A. IMPAIRMENT SPECIFIC: ....................................................................................................................................................... 12
B. ACTIVITY SPECIFIC:.............................................................................................................................................................. 13
C. ADVANCED INTERVENTION:................................................................................................................................................ 13
14.4.6 DOCUMENTATION:................................................................................................................................................................ 14
14.4.7 DISCHARGE/ TRANSFER:..................................................................................................................................................... 14
14.4.8 DATA:...................................................................................................................................................................................... 15
A. PROSTHETIC TERMINOLOGY:............................................................................................................................................. 15
14.5 CARDIO-PULMONARY PHYSIOTHERAPY EDUCATION & CONSULTATION: ................................................................................... 17
14.5.1 PHYSIOTHERAPIST’S ROLE:................................................................................................................................................ 17
14.5.2 SCREENING: .......................................................................................................................................................................... 17
A. IMPORTANCE OF MEDICAL EVALUATION:......................................................................................................................... 17
14.5.3 ASSESSMENT:....................................................................................................................................................................... 18
14.5.4 CARE PLAN DEVELOPMENT:............................................................................................................................................... 18
14.5.5 INTERVENTION:..................................................................................................................................................................... 18
14.5.6 DOCUMENTATION:................................................................................................................................................................ 19
14.5.7 DISCHARGE/ TRANSFER:..................................................................................................................................................... 19
14.5.8 DATA:...................................................................................................................................................................................... 19
14.6 LOCATIONS OF THE FISSURES AND LUNG LOBES AND SEGMENTS IN RELATION TO CHEST WALL LANDMARKS: .............. 20
14.6.1 THORACIC CONFIGURATION ABNORMALITIES: ............................................................................................................... 21
14.6.2 CHARACTERISTICS AND CAUSES OF ABNORMAL BREATHING PATTERNS:................................................................ 21
14.6.3 TECHNIQUES TO ACCESS LUNG PROBLEMS: .................................................................................................................. 22
A. TACTILE FREMITUS AND THE CAUSES OF INCREASED OR DECREASED FREMITUS (LOCAL AND DIFFUSE): ...... 22
B. ASSESSING THORACIC EXPANSION:................................................................................................................................. 22
C. ABNORMAL FINDING OF CREPITUS AND ITS SIGNIFICANCE UPON PALPATION OF THE SUBCUTANEOUS
TISSUES: ................................................................................................................................................................................ 22
D. TECHNIQUE FOR PERCUSSION AND SOUNDS PRODUCED WHEN THE UNDERLYING TISSUES ARE AIR-FILLED,
FLUID FILLED, OR SOLID:..................................................................................................................................................... 22
E. PULMONARY AND EXTRAPULMONARY ABNORMALITIES THAT ARE ASSOCIATED WITH THE THREE BASIC TYPES
OF PERCUSSION NOTES: .................................................................................................................................................... 23
F. FOUR PARTS OF THE STETHOSCOPE AND THE SITUATIONS IN WHICH IT IS BEST TO LISTEN WITH THE
DIAPHRAGM AND WHEN IT IS BEST TO LISTEN WITH THE BELL: .................................................................................. 23
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
2

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 3 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
G.
SOUNDS NORMALLY HEARD OVER THE CHEST: ............................................................................................................. 23
H.
\"ADVENTITIOUS\" BREATH SOUNDS: .................................................................................................................................. 23
I.
THE AIRWAY OR PARENCHYMAL ABNORMALITIES: ........................................................................................................ 24
J.
CONDITIONS IN WHICH A PATIENT MAY HAVE DIMINISHED OR ABSENT BREATH SOUNDS:.................................... 24
K.
THE PITCH AND INTENSITY OF STRIDOR AND THE POINT IN THE RESPIRATORY CYCLE IN WHICH STRIDOR IS
HEARD:................................................................................................................................................................................... 24
L. AIRWAY ABNORMALITIES ASSOCIATED WITH STRIDOR: ............................................................................................... 24
M. ADVENTITIOUS SOUNDS ASSOCIATED WITH THE FOLLOWING CONDITIONS:............................................................ 24
N. AUSCULTATION TECHNIQUES OF BRONCHOPHONY, EGOPHONY, AND WHISPERED PECTORILOQUOY AND
ABNORMAL FINDINGS AND THE CONDITIONS ASSOCIATED WITH EACH: ................................................................... 25
O. PATHOPHYSIOLOGICAL CONDITIONS IN WHICH BRONCHIAL BREATH SOUNDS ARE HEARD IN AREAS OF THE
CHEST WHERE NORMALLY VESICULAR BREATH SOUNDS ARE HEARD:..................................................................... 25
P. \"POINT OF MAXIMAL IMPULSE” ........................................................................................................................................... 25
15.0 RESEARCH AND EVIDENCE-BASED PRACTICE: ...................................................................................................................................... 26
15.1 EBP IS A FIVE-STEP PROCESS: .......................................................................................................................................................... 35
15.2 RESEARCH DESIGN:............................................................................................................................................................................. 37
15.2.1 HISTORICAL RESEARCH:..................................................................................................................................................... 37
15.2.2 DESCRIPTIVE RESEARCH: .................................................................................................................................................. 37
15.2.3 CORRELATIONAL RESEARCH: ............................................................................................................................................ 38
15.2.4. EXPERIMENTAL:.................................................................................................................................................................... 39
A. DESIGNS: ............................................................................................................................................................................... 39
I. TRUE EXPERIMENTS:................................................................................................................................................... 39
II. COHORT DESIGN, QUASI-EXPERIMENTAL DESIGN: ................................................................................................ 40
III. WITHIN SUBJECTS (REPEATED MEASURES) DESIGNS: ......................................................................................... 42
IV. MATCHED PAIRS DESIGNS:......................................................................................................................................... 42
V. BETWEEN SUBJECTS DESIGNS:................................................................................................................................. 42
VI. FACTORIAL DESIGNS: .................................................................................................................................................. 43
VII. SINGLE-SUBJECT RESEARCH: ................................................................................................................................... 43
VIII. THE AB DESIGN:............................................................................................................................................................ 43
IX. NPTE TYPE OF QUESTIONS EXAMPLE: ..................................................................................................................... 44
B. CAUSAL-COMPARATIVE:...................................................................................................................................................... 45
C. EPIDEMIOLOGY:.................................................................................................................................................................... 45
15.3 VARIABLES:........................................................................................................................................................................................... 46
15.4 HYPOTHESIS: ........................................................................................................................................................................................ 46
15.4.1 HYPOTHESIS TEST: .............................................................................................................................................................. 46
15.4.2 NULL HYPOTHESIS: .............................................................................................................................................................. 47
15.4.3 ALTERNATIVE HYPOTHESIS:............................................................................................................................................... 48
15.5 DATA TYPES: ......................................................................................................................................................................................... 48
15.5.1 DISCRETE DATA:................................................................................................................................................................... 48
15.5.2 CATEGORICAL DATA: ........................................................................................................................................................... 48
15.5.3 NOMINAL DATA: .................................................................................................................................................................... 48
15.5.4 ORDINAL DATA:..................................................................................................................................................................... 48
15.5.5 INTERVAL SCALE: ................................................................................................................................................................. 49
15.5.6 CONTINUOUS DATA:............................................................................................................................................................. 49
15.5.7 FREQUENCY TABLE: ............................................................................................................................................................ 49
A. PIE CHART: ............................................................................................................................................................................ 50
B. BAR CHART:........................................................................................................................................................................... 50
C. DOT PLOT: ............................................................................................................................................................................. 51
D. HISTOGRAM:.......................................................................................................................................................................... 51
E. STEM AND LEAF PLOT: ........................................................................................................................................................ 52
F. BOX AND WHISKER PLOT (OR BOXPLOT): ........................................................................................................................ 52
G. 5-NUMBER SUMMARY: ......................................................................................................................................................... 52
H. OUTLIER:................................................................................................................................................................................ 52
I. SYMMETRY: ........................................................................................................................................................................... 52
J. SKEWNESS: ........................................................................................................................................................................... 53
K. SCATTER PLOT: .................................................................................................................................................................... 53
L. ILLUSTRATIONS: ................................................................................................................................................................... 53
M. SAMPLE MEAN: ..................................................................................................................................................................... 53
15.6 SAMPLING: ............................................................................................................................................................................................. 54
15.6.1 TARGET POPULATION:......................................................................................................................................................... 54
15.6.2 MATCHED SAMPLES:............................................................................................................................................................ 54
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
3

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 4 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.6.3 INDEPENDENT SAMPLING: .................................................................................................................................................. 54
15.6.4 RANDOM SAMPLING:............................................................................................................................................................ 54
15.6.5 SIMPLE RANDOM SAMPLING:.............................................................................................................................................. 54
15.6.6 STRATIFIED SAMPLING:....................................................................................................................................................... 55
15.6.7 CLUSTER SAMPLING: ........................................................................................................................................................... 55
15.6.8 QUOTA SAMPLING: ............................................................................................................................................................... 55
15.6.9 SPATIAL SAMPLING: ............................................................................................................................................................. 55
15.6.10 SAMPLING VARIABILITY: ...................................................................................................................................................... 55
15.6.11 STANDARD ERROR:.............................................................................................................................................................. 55
15.6.12 BIAS: ....................................................................................................................................................................................... 56
15.6.13 PRECISION:............................................................................................................................................................................ 56
15.7 INSTRUMENTATION-GOLD STANDARD:............................................................................................................................................ 56
15.8 INFORMED CONSENT:.......................................................................................................................................................................... 56
15.9 PROBLEMS RELATED TO MEASUREMENT: ....................................................................................................................................... 56
15.9.1 CONTROL:.............................................................................................................................................................................. 56
A. CONTROL GROUP:................................................................................................................................................................ 56
B. EXPERIMENTAL GROUP: ..................................................................................................................................................... 57
C. INTERVENING VARIABLE: .................................................................................................................................................... 57
15.9.2 VALIDITY: ............................................................................................................................................................................... 58
A. STATISTICAL CONCLUSION VALIDITY:............................................................................................................................... 58
B. INTERNAL VALIDITY:............................................................................................................................................................. 58
C. CONSTRUCT VALIDITY:........................................................................................................................................................ 58
D. EXTERNAL VALIDITY: ........................................................................................................................................................... 59
E. ECOLOGICAL VALIDITY: ....................................................................................................................................................... 59
F. CONTENT VALIDITY: ............................................................................................................................................................. 60
G. FACE VALIDITY: ........................................................................................................................................................................ 60
H. CRITERION VALIDITY: .............................................................................................................................................................. 60
I. CONCURRENT VALIDITY: .......................................................................................................................................................... 60
J. PREDICTIVE VALIDITY: ............................................................................................................................................................. 60
K. CONVERGENT VALIDITY:......................................................................................................................................................... 60
L. DISCRIMINANT VALIDITY:......................................................................................................................................................... 60
15.9.3 THREATS TO VALIDITY:........................................................................................................................................................ 61
A. INTERNAL VALIDITY:............................................................................................................................................................. 61
B. EXTERNAL VALIDITY: ........................................................................................................................................................... 62
C. OTHER THREATS: ................................................................................................................................................................. 62
15.9.4 RELIABILITY: .......................................................................................................................................................................... 63
15.9.5 THREATS TO RELIABILITY: .................................................................................................................................................. 64
15.9.6 OBJECTIVITY: ........................................................................................................................................................................ 64
15.9.7 SUBJECTIVITY: ...................................................................................................................................................................... 64
15.9.8 SENSITIVITY: ......................................................................................................................................................................... 65
A. FALSE POSITIVE: .................................................................................................................................................................. 65
B. FALSE NEGATIVE:................................................................................................................................................................. 65
C. A NEGATIVE (LOW SENSITIVITY) RESULT RULES OUT THE DIAGNOSIS (SNOUT): ..................................................... 65
15.9.9 SPECIFICITY: ......................................................................................................................................................................... 66
15.10 DATA ANALYSIS AND INTERPRETATION: ......................................................................................................................... 66
15.10.1 DESCRIPTIVE STATISTICS:..................................................................................................................................................... 66
A. MEASURES OF CENTRAL TENDENCY:............................................................................................................................... 66
I. MEAN: ............................................................................................................................................................................. 66
II. MEDIAN: ......................................................................................................................................................................... 66
III. MODE:............................................................................................................................................................................. 66
B. MEASURES OF VARIABILITY: .............................................................................................................................................. 66
I. RANGE:........................................................................................................................................................................... 66
II. SD - STANDARD DEVIATION. ....................................................................................................................................... 66
C. NORMAL DISTRIBUTION: - ........................................................................................................................................... 67
I. PERCENTILES: ...................................................................................................................................................... 67
II. QUARTILES:........................................................................................................................................................... 67
15.10.2 INFERENTIAL STATISTICS: ..................................................................................................................................................... 68
A. DEGREES OF FREEDOM:..................................................................................................................................................... 68
I. ERRORS: ........................................................................................................................................................................ 68
1. STANDARD ERROR: ............................................................................................................................................. 68
2. TYPE I ERROR:...................................................................................................................................................... 68
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
4

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 5 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
3. TYPE II ERROR:..................................................................................................................................................... 69
15.10.3
PARAMETRIC STATISTICS: (INTERVAL AND RATIO DATA).............................................................................................. 69
A.
ASSUMPTIONS: ..................................................................................................................................................................... 69
B.
T-TEST.................................................................................................................................................................................... 69
I. T-TEST FOR INDEPENDENT SAMPLES: ..................................................................................................................... 69
II. T-TEST FOR NONINDEPENDENT SAMPLES: ............................................................................................................. 70
III. ONE-TAILED T-TEST: .................................................................................................................................................... 70
IV. TWO-TAILED T-TEST:.................................................................................................................................................... 70
a. When is a one-tailed test appropriate? ................................................................................................................... 71
b. When is a one-tailed test not appropriate? ............................................................................................................ 71
C. ANOVA - ANALYSIS OF VARIANCE:..................................................................................................................................... 71
I. ONE-WAY ANOVA:......................................................................................................................................................... 72
II. WHY NOT JUST USE THE T-TEST? ............................................................................................................................. 72
D. ANCOVA - ANALYSIS OF COVARIANCE:............................................................................................................................. 72
I. WHAT IS THE DIFFERENCE BETWEEN ANOVA AND ANCOVA?.............................................................................. 73
E. NON-PARAMETRIC STATISTICS:......................................................................................................................................... 74
I. CHI SQUARE: ................................................................................................................................................................. 74
F. CORRELATIONAL STATISTICS: ........................................................................................................................................... 75
G. PEARSON PRODUCT-MOMENT COEFFICIENT:................................................................................................................. 76
I. CORRELATION COEFFICIENT: .................................................................................................................................... 76
II. SPEARMAN'S RANK CORRELATION COEFFICIENT: ..................................................................................................... 76
III. COMMON VARIANCE: ................................................................................................................................................... 76
15.11 SAMPLE RESEARCH TEST:.................................................................................................................................................. 77
16.0 PATHOLOGICAL:........................................................................................................................................................................................... 80
16.1 PHYSIOTHERAPY IN HIV: ..................................................................................................................................................................... 80
16.1.1 ISSUES: .................................................................................................................................................................................. 80
16.1.2 DESCRIPTION:....................................................................................................................................................................... 80
16.1.3 RECOMMENDATIONS: .......................................................................................................................................................... 80
16.2 STRUCTURAL KNEE PROBLEMS:........................................................................................................................................................ 81
16.3 STRUCTURAL HIP PROBLEMS: ........................................................................................................................................................... 82
16.4 DISORDERS AND DISEASES:............................................................................................................................................................... 83
16.5 MEDS: 84
16.6 ALS AND MS:.......................................................................................................................................................................................... 85
16.7 DIABETES MELLITUS: ........................................................................................................................................................................... 85
17.0 SAMPLE NPTE QUESTIONS:........................................................................................................................................................................ 86
3.2 ANATOMY AND PHYSIOLOGY ONLINE LEARNING CENTER: ........................................................................................................... 93
3.3 WOUND CARE DEFINITIONS FLASH CARDS:..................................................................................................................................... 93
3.4 WOUND CARE TIPS AND DRESSINGS:............................................................................................................................................... 93
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
5

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 6 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.0 EDUCATION & CONSULTATION:
The physiotherapist will function as an educator and advocate to the clinical care team members, the
patient and their families/care givers, health care professionals and students. Education will include but is
not limited to:
 Physiotherapists are responsible for professional practice standards and evidence based practices;
taking a mentoring role in the Department of Rehabilitation Services research activities; performing
patient care functions within their practice area; and performing quality management, administrative,
and group leadership functions within the Division of Physical Therapy.
 They are responsible for the development of programs and program evaluation; facilitating education
programs and services within their practice area and performing other duties consistent with the
classification as delegated by their place of work.
14.1 PEDIATRIC PHYSIOTHERAPY EDUCATION & CONSULTATION:
 Paediatric physiotherapists are primarily members of the child health multidisciplinary team,
which includes occupational therapists, speech and language therapists, paediatricians and
health visitors who have specialised in assessing and managing conditions in children.
 They are often required to advise educational and social services teams on children's needs in
relation to their physical development, respiratory condition or musculoesketal condition.
14.1.1 PAEDIATRIC PHYSIOTHERAPISTS DO:
 Evaluate a child's ability in relation to his/her gross motor development and produce an
assessment, advising parents and medical staff on the child's needs. Specific
assessments are often requested by education as part of a child's \"Assessment of
special educational needs\", or by social services \"Children's with disability team\"
identifying a child's present needs in order to find suitable care takers or future needs
to plan housing needs or alterations.
 Advise parents, care takers and the child, if old enough, on the condition and informing
them on various physiotherapy options working in partnership with them on the most
appropriate strategies to enable each child to achieve his/her potential.
 The physiotherapist will work closely with the child's care takers teaching through
demonstration handling techniques to encourage the child's gross motor development
or specific techniques to maintain the child's health.
14.1.2 PHYSIOTHERAPY INTERVENTIONS:
 Specific exercises to be practiced regularly at home or at school. These are often
designed as games or play activities
 General advice to be incorporated into daily living activities
 Short intensive clinic based exercises
 Recommended specific equipment to meet the child's needs e.g. walking aids, postural
care equipment
 Assessment of moving and handling needs of the child advising on strategies to
minimise the risk to the child and the carer
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
6

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 7 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.2 GERIATRIC PHYSIOTHERAPY EDUCATION & CONSULTATION:
Objective:
 To minimise the impact of disease and disability upon the personal independence and
autonomy of older persons. This is achieved by the application of preventative measures, early
intervention, comprehensive medical and social assessment, remedial and rehabilative
procedures and integrated community support.
 A comprehensive geriatric evaluation is carried out by the Physiotherapist in which the multiple
problems of the older person are uncovered, described and explained, if possible, and in which
the resources and strengths of the person are catalogued, need for services assessed and a
coordinated care plan developed to focus interventions on the persons problems.
Comprehensive geriatric evaluation usually means evaluation of the patient in several domains,
most commonly the physical, mental, social, economic, functional and environmental.
14.2.1 PHYSIOTHERAPIST’S ROLE:
 It is the physiotherapist’s role to assess the physical function domains of balance,
mobility and transfers, and how these impact on personal activities of daily living and
instrumental activities of daily living.
 The physiotherapist’s role includes the assessment of bed skills, sit to stand, standing
balance, indoor and outdoor mobility, ability to negotiate stairs and details of any gait
aids Additional assessments may include neurological, respiratory and musculoskeletal
as indicated.
 The physiotherapists shall determine what level of function is safe for discharge by
taking into consideration the home environment (eg stairs, distances required to walk)
and available level of assistance.
 The physiotherapists shall always compare the ‘best’ level of recent premorbid physical
function with that as a current inpatient to identify if there is any additional limitation of
function associated with illness, treatment or hospitalisation. Identification of this
‘functional gap’ will help determine if rehabilitative interventions are indicated.
 The Physiotherapist shall implement acute intervention for problems amenable to
physiotherapy based on assessment findings and clinical reasoning.
14.2.2 SCREENING:
The physiotherapist as to the need for physiotherapy assessment and management will
screen patients.
Some indicators for physiotherapy include;
1. Respiratory disorders, which respond to physiotherapy (productive pneumonia,
infective exacerbation CAL, bronchiectasis)
2. Motor impairing neurological conditions (CVA, MS, MND, PD)
3. Gait disorders amenable to treatment
4. Falls
5. Musculoskeletal diseases and injuries, which impact on function
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
7

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 8 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.2.3 ASSESSMENT:
 Physiotherapy assessment shall include bed skills; sit to stand, standing balance,
indoor and outdoor mobility (as required), ability to negotiate stairs and details of any
gait aids.
 Additional assessments may include neurological, respiratory and musculoskeletal as
indicated.
14.2.4 CARE PLAN DEVELOPMENT:
 The physiotherapist shall liase with medical officers, nursing staff and other relevant
health professionals regarding the patient’s bed skills, mobility and transfer status,
physiotherapy treatment plan and further management of patients.
 They shall assist the organization team in making admission / discharge / referral
decisions.
14.2.5 INTERVENTION:
 Physiotherapists shall implement acute intervention for problems amenable to
physiotherapy based on assessment findings and clinical reasoning.
 Physiotherapists shall prescribe and deliver a safe, effective and individualised
exercise programme based on current research evidence.
 They shall incorporate education and prevention into the provision of the
physiotherapy service.
 Physiotherapists shall prescribe gait and transfer aids as identified by assessment
findings and clinical reasoning. They shall organise the provision of the equipment from
the appropriate source.
14.2.6 DOCUMENTATION:
 Physiotherapists shall thoroughly document the assessment, management plans and
progress of all patients seen. All medical record entries must comply with medicolegal
requirements.
 Mobility status must be clearly documented and communicated to ward staff using
standard terminology as described in the “Communication of Ward Mobility and
Functional Mobility for ADLs Policy”. Mobility/ transfer status must be written on
bedside communication board. This is to maximise patient and staff safety.
14.2.7 DISCHARGE/ TRANSFER:
Physiotherapists shall ensure appropriate referral and handover to ongoing physiotherapy
service, and inform the patient and carer of these arrangements.
14.2.8 DATA:
Physiotherapists shall maintain timely and accurate data of physiotherapy interventions in
CERNER. Departmental Activities (non patient related activities) stats entered into reports
database.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
8

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 9 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.3 ORTHOPEDIC PHYSIOTHERAPY EDUCATION & CONSULTATION:
Orthopaedic Physiotherapy is oriented towards the treatment of Musculo – Skeletal ailments. It
involves regaining appropriate health and function of structures surrounding the Joint regions and
normalizing the Biomechanics following any injury or Orthopaedic disease. The rehabilitation of
orthopaedically disabled individuals is also a major area of function
14.3.1 PHYSIOTHERAPIST’S ROLE:
Impaired posture, Impaired Muscle functions Impaired Joint Mobility, Motor function,
Muscle performance, and range of motion associated with Connective tissue dysfunctions
Localized inflammation As in
 Muscle pain, strain
 Muscle tear
14.3.2 SCREENING:
The physiotherapist as to the need for physiotherapy assessment and management will
screen patients.
 Joint stiffness
 Fractures
 Ligament strain, sprain, tear
 Inability to walk
 Inflammation of tendons and bursa
 Joint pain, poor posture
 Joint inflammation in case of osteoarthritis or rheumatoid arthritis
Care for persons with orthopaedic problems can be complex. Usually the first health
care contact for such a condition is the family physician. More than 60% of the people who
suffer from orthopaedic problems will seek attention from their family physician who will
typically treat the patient with anti-inflammatory medications and advice on rest. However,
family physicians may lack the background knowledge and sufficient contact time to
comprehensively manage orthopaedic conditions, and patients may not respond to
conservative treatment, leaving referral to a specialist as the typical course of action.
14.3.3 ASSESSMENT:
Physiotherapy assessment shall include bed skills; sit to stand, standing balance,
indoor and outdoor mobility (as required), ability to negotiate stairs and details of any gait
aids. In order to address access to care issues, many countries, have begun to examine
multidisciplinary collaborative models of care. Improved use of non-physician health care
providers can have a positive impact on the cost of health care, on efficiency of the health
care system in terms of human resources, on patient satisfaction with care, and on
physician productivity and satisfaction with the work environment.
In the health care system, the most obvious choice for collaborative care in the
management of orthopaedic problems is the physiotherapist because they are experts in
the conservative management of these conditions. Using physiotherapists to manage non-
surgical orthopaedic patients in a front-line, clinic setting is not new. The model of care in
which a physiotherapist assesses, triages and manages orthopaedic patients has been
successfully implemented in other countries.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
9

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 10 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
The new trend, particularly in hip and knee arthroplasty clinics, is for physiotherapists
to assess and triage patients for orthopaedic surgical assessment, and to manage those
patients who require conservative care with appropriate advice, or by referring them for
other management, such as a dietician. Patients who do require a consultation with the
surgeon are then prioritised for a visit within one, three or six months, allowing the surgeon
to deal with the more urgent cases first. Physiotherapists can also perform regular check-
ups of those patients who have been referred for arthroplasty but who have been deemed
by the surgeon as inappropriate at the current time, thereby taking the patient off the
surgeon's wait list. In addition, these Physiotherapists are able to manage postoperative
arthroplasty patients, especially for the six- and 12-month follow-up visits. This again
serves to reduce the number of clinic patients that orthopaedic surgeons are required to
see.
14.3.4 CARE PLAN DEVELOPMENT:
 The physiotherapist shall liase with medical officers, nursing staff and other relevant
health professionals regarding the patient’s bed skills, mobility and transfer status,
physiotherapy treatment plan and further management of patients.
 They shall assist the organization team in making admission / discharge / referral
decisions.
These Physiotherapists work in hospitals and have delegated acts that allow them to order
X-rays, blood work and other necessary tests in order to make appropriate care decisions
about patients. They will typically work with the surgeons for a period of time before starting
their own clinics in order to learn the criteria that each surgeon uses to judge the necessity
for surgery, and to learn additional radiographic diagnostic skills. This period of time also
familiarizes the surgeon with the capabilities of the physiotherapist so the surgeon can be
confident in the abilities of the person with whom they will work collaboratively.
14.3.5 INTERVENTION:
Physiotherapists can see patients in a timely manner and are able to identify those who
require conservative management or who need to see the surgeon. This allows the
orthopaedic surgeons to care for patients with conditions more amenable to surgical
intervention. This collaborative model of care between physicians and physiotherapists has
been shown to:
 Increase the number of patients seen in the outpatient orthopaedic clinics since only
those who may require surgery see the surgeon;
 Improve patient and physician satisfaction by easing the burden of excessive wait
times on both;
 May ultimately improve publicly-funded access to the appropriate care for orthopaedic
problems
14.3.6 DOCUMENTATION:
 Physiotherapists shall thoroughly document the assessment, management plans and
progress of all patients seen. All medical record entries must comply with medicolegal
requirements.
 Mobility status must be clearly documented and communicated to ward staff using
standard terminology as described in the “Communication of Ward Mobility and
Functional Mobility for policy”. Mobility/ transfer status must be written on bedside
communication board. This is to maximise patient and staff safety.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
10

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 11 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.3.7 DISCHARGE/ TRANSFER:
Physiotherapists shall ensure appropriate referral and handover to ongoing physiotherapy
service, and inform the patient and carer of these arrangements.
14.3.8 DATA:
Physiotherapists shall maintain timely and accurate data of physiotherapy interventions.
Departmental Activities (non patient related activities) entered into reports database.
14.4 NEUROLOGICAL PHYSIOTHERAPY EDUCATION & CONSULTATION:
14.4.1 PHYSIOTHERAPIST’S ROLE:
 A neurological physiotherapist works with patients/clients of all ages with disorders of, or
damage to, the brain, spinal cord and neuromuscular system, or degenerative conditions
affecting the brain, nerves or muscles. Neurological physiotherapists have a special interest
in the management of patients/clients with movement disorders arising from disturbances
of the motor or sensory systems. These conditions may include, but are not limited to,
stroke, traumatic or other brain injury, spinal cord injury, Parkinson’s disease and
neurogenetic conditions as well as dizziness and balance disorders and falls management
in older clients.
 Neurological physiotherapists have special expertise and training in the assessment of
physical function and mobility in clients with neurological disorders/disease, and in
planning/delivering treatment programs as well as offering preventative advice to optimise
physical function, mobility and quality of life.
 Neurological physiotherapists work in a wide range of settings including inpatient,
outpatient, private practice, private hospital and outreach services and rehabilitation in the
home. Inpatient facilities include acute hospitals, comprehensive stroke and neurological
units, rehabilitation hospitals and slow stream rehabilitation services. Outpatient settings
include public hospitals, community health and rehabilitation centres and domiciliary
care/home based services. In these varied settings, neurological physiotherapists work in
collaboration with other allied health professionals, general practitioners and case
coordinators, as well as families and care takers, to provide a seamless continuity of acute,
rehabilitation and ongoing care.
14.4.2 SCREENING:
Early treatment following onset of an acute neurological condition such as a stroke or
traumatic brain injury can help to maximise recovery. Ongoing neurological rehabilitation
will assist the client in achieving his or her best possible potential in the long term. In the
case of degenerative conditions, such as Parkinson’s disease or Motor Neurone disease,
the focus of ongoing treatment is to minimise disability and to promote optimal function and
independence at each stage of the disease.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
11

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 12 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.4.3 ASSESSMENT:
Physiotherapy assessment shall include
 Bed skills;
 Body structures/functions and impairments
 Muscle length and joint ROM
 Muscle stiffness/tone
 Muscle reflexes/spasticity
 Strength/weakness
 Motor Control (co-ordination and movement isolation)
 UMN dysfunction
 Sensation (e.g. proprioception, somatosensory, visual field)
 Perception (e.g. vertical and position in space)
 Secondary impairment
 Activities
 Transfers (bed mobility, between bed, chair, STS, SIT, on-off floor)
 Postural control – sitting and standing
 Gait in closed environment*
 Reaching
 Grasp &/or Manipulation
 Cognitive deficits and effect on function
 Neuropathic pain
 Environment e.g. Home/Work/school
 Incontinence, contributions
 Autonomic NS considerations
 Impact of pathology on outcomes (predicting prognosis)
14.4.4 CARE PLAN DEVELOPMENT:
 The physiotherapist shall liase with medical officers, nursing staff and other relevant
health professionals regarding the patient’s:
 TBI prioritising goals
 Suggesting trial of medication types
 Suggesting trial of botox
 Suggesting trial of other methods for managing hyperreflexia/tone
 Discharge planning with multiple community agencies
 Equipment for home, work or school
 Early planning for discharge
 Circuit classes, group work
14.4.5 INTERVENTION:
A. IMPAIRMENT SPECIFIC:
 Strengthening programs
 Co-ordination/motor control programs
 Managing tone & hyperreflexia
 Motor impairments
 Sensory retraining
 Prevention of secondary adaptations
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
12

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 13 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
B. ACTIVITY SPECIFIC:
 Bed mobility/ Transfer retraining
 STS retraining
 Postural control retraining
 Gait
 Running/HL skills
 Management of CVA UL
 Group/class exercise
 Splinting for UL
 Splinting for LL
 Wheelchair prescription
 Gait aid prescription
 Use of hoists/harness/slide sheet
 Application of FES
 Use of biofeedback
 Aquatic therapy for neurology
C. ADVANCED INTERVENTION:
 TBI spasm (hyperreflexia/tone) management, variety of options
 Bobath handling skills
 Perceptual problems
 Activating muscles in context of activity (facilitating activation through task)
 Retraining a complex gait pattern, facilitation of normal
 Retraining gait pattern with clonus
 Retraining gait in open environment
 Retraining running
 Retraining advanced postural control activities
 Safely stand and move a client unassisted, client has is dependent e.g. minimal
unilateral lower limb activity
 Teaching families skills for transfers for client with minimal activity
 Teaching families of those with progressive muscular disorders skills for handling,
assistance, exercise and positioning.
 Developing circuit based stroke group
 Application of spinal braces
 Application of FES
 Fitness testing with polar heart monitor
 Wheelchair and/or seating prescription
 Prescription of equipment for independent living
 Counselling for patients and families
 Teaching care takers how to maximise outcome
 Serial casting for upper and lower limbs
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
13

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 14 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.4.6 DOCUMENTATION:
 Physiotherapists shall thoroughly document the assessment, management plans and
progress of all patients seen. All medical record entries must comply with medicolegal
requirements.
 Mobility status must be clearly documented and communicated to ward staff using
standard terminology as described in the “Communication of Ward Mobility and
Functional Mobility for Policy”. Mobility/ transfer status must be written on bedside
communication board. This is to maximise patient and staff safety.
14.4.7 DISCHARGE/ TRANSFER:
Physiotherapists shall ensure appropriate referral and handover to ongoing physiotherapy
service, and inform the patient and carer of these arrangements.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
14

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 15 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.4.8 DATA:
Physiotherapists shall maintain timely and accurate data of physiotherapy interventions.
Departmental Activities (non patient related activities) entered into reports database.
A. PROSTHETIC TERMINOLOGY:
 AE: Above elbow - \"transhumeral.\"
 AK: Above knee -\"transfemoral.\"
 Amelia: Absence or partial absence of limbs at birth.
 BE: Below elbow also referred to as “transradial.”
 Bilateral amputee: A person missing either both arms or both legs; a double
amputee.
 BK: Below knee also referred to as “transtibial.”
 Bumper: A rubber like device inserted into a knee or ankle component as a
resistance or extension aid.
 DAK: Double AK, also referred to as \"bilateral transfemoral.\"
 ED: An amputation through the elbow joint.
 Edema: A local or generalized condition in which the body’s tissues contain an
excess of fluid.
 Endoskeletal Prosthesis: A prosthesis built more like a human skeleton with
support and components on the inside.
 Energy storing foot: A prosthetic foot designed with a flexible heel.
 Extension assist: A method of assisting the prosthetic to \"kick forward\" on the
swing through phase to help speed up the walking cycle.
 Hip Disarticulation. Amputation that removes the leg at the hip joint, leaving the
pelvis intact.
 Hemipelvectomy. An amputation where approximately half of the pelvis is
removed.
 Hybrid prosthesis: A prosthesis that combines several prosthetic options in a
single prosthesis.
 IPOP: \"Immediate Post Operative Prosthesis.\"
 Knee Disarticulation-through the knee (TDK): Amputation of the leg through the
knee.
 Liner: Suspension systems used to attach prosthesis to the residual limb and/or
provide additional comfort and protection of the residual limb.
 Long's Line: A straight line from the head of the femur through the distal end of the
femur down to the center of the heel of the prosthetic foot.
 Myoelectrics: muscle electronics used to control a prosthesis.
 Nylon sheath: A sock interface worn close to the skin on the residual limb to add
comfort and wick away perspiration.
 Partial Foot Amputation: - \"Choppart Amputation.\" - amputation on the front part of
the foot.
 Phantom pain: Pain that seems to originate in the portion of the limb that was
removed.
 Phantom sensation: The normal ghost image of the absent limb may feel normal at
times and at other times be uncomfortable or painful.
 Pistoning: Refers to the residual limb slipping up and down inside the prosthetic
socket while walking.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
15

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 16 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
 Ply: Thickness of stump sock material.
 PTB: Patellar Tendon Bearing. BK prosthesis where weight is on the tendon below
the kneecap.
 Pylon: A rigid member, usually tubular, between the socket or knee unit and the
foot that provides a weight bearing support shaft for an endoskeletal prosthesis.
 Quad Socket: A socket designed for an above the knee amputee that has four
distinctive sides allowing the muscles to function as much as possible.
 Residual limb: The portion of the arm or leg remaining after the amputation. Some
people refer to it as a \"stump.\"
 Rigid Dressing: A plaster wrap over the residual limb, usually applied in the
operating or recovery room immediately following surgery for the purpose of
controlling edema (swelling) and pain.
 SACH Foot: Solid-Ankle Cushion Heel.
 Shock Pylon: A prosthetic pylon that dampens the vertical forces exerted on the
residual limb and is used to cushion the impact when walking.
 Shoulder Disarticulation : Amputation through the shoulder joint.
 Shrinker: A prosthetic reducer made of elastic material and designed to help
control swelling of the residual limb (edema) and/or shrink it in preparation for a
prosthetic fitting.
 Single Axis Foot: A foot is based on an ankle hinge that provides dorsiflexion and
plantarflexion, i.e. toe up and toe down.
 Socket: The portion of the prosthesis that fits around the residual limb/stump and
to which the prosthetic components are attached.
 Stump Shrinker: An elastic wrap or compression sock worn on a residual limb to
reduce swelling and shape the limb.
 Suction socket: A socket designed to provide suspension by means of negative
pressure vacuum in a socket.
 Symes amputation: An amputation through the ankle joint that retains the fatty heel
pad portion and is intended to provide end weight bearing.
 Variable Volume Socket: Lightweight and custom-made. The two-piece design
makes it possible to don and doff the prosthesis without subjecting the dysvascular
limb to unnecessary shear.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
16

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 17 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.5 CARDIO-PULMONARY PHYSIOTHERAPY EDUCATION & CONSULTATION:
14.5.1 PHYSIOTHERAPIST’S ROLE:
Cardiopulmonary physiotherapists work with patients in a variety of settings. They treat
acute problems like asthma, acute chest infections and trauma; they are involved in the
preparation and recovery of patients from major surgery; they also treat a wide range of
chronic cardiac and respiratory conditions like Chronic Obstructive Pulmonary Disease
(COPD), cystic fibrosis (CF) and post-myocardial infarction (MI). They work with all ages
from premature babies to older adults at the end of their life.
Physiotherapists have pioneering new management techniques for non-organic respiratory
problems like hyperventilation and other stress-related disorders as well as leading the
development of cardio-pulmonary rehabilitation and non-invasive ventilation.
Cardiopulmonary physiotherapists use physical modalities to treat people. This may involve
using manual techniques to clear infected mucus from a person's chest, or using non-
invasive ventilation to help a person breathe, or prescribing exercises to improve a patient's
functional exercise capacity.
14.5.2 SCREENING:
The physiotherapist should perform physical examination. Physical examination components
such as body weight, body composition (percent body fat), neurological function test,
including reflexes, auscultation of the lungs, palpation of cardiac apical; impulse, auscultation
of lung, palpation of cardinal apical impulse, auscultation of the heart with specific attention to
murmur, palpation and inspection of the lower extremities for oedema and presence of
arterial pulse should be done.
 Blood pressure:
 Cholesterol and lipoprotein:
 Pulmonary function:
 Functional capacity test (Exercise Tolerance Test [ETT]):
A. IMPORTANCE OF MEDICAL EVALUATION:
 Medical screening (evaluation) is a useful and important part of the exercise
prescription.
 A comprehensive medical evaluation will help identify high risk individuals who
should not exercise at all or should be restricted to exercising only under medical
supervision.
 The information obtained in medical evaluation can be used to develop the exercise
prescription.
 The valves obtained from certain clinical measures such as BP, body fat content and
blood lipid levels can be used to motivate the person to adhere to the exercise
programme.
 A comprehensive medical evaluation, particularly of healthy people can provide a
baseline against which any subsequent charges in health status can be compared.
 Many illness and diseases such as cardiovascular diseases can be identified in their
earliest stages when chances of successful treatment are much higher.
 For the identification of individuals with other special needs.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
17

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 18 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.5.3 ASSESSMENT:
Physiotherapy assessment shall include
 Measurement and Documentation
 History
 Pulmonary Function
 Tests
 Arterial Blood Gases
 Imaging of the Chest
 Electrocardiogram Identification
 Multisystem Assessment and
 Laboratory Investigations
 Special Tests
 Clinical Assessment of
 the Cardiopulmonary System
 Monitoring Systems in the Intensive
 Care Unit
14.5.4 CARE PLAN DEVELOPMENT:
 The physiotherapist shall liase with medical officers, nursing staff and other relevant health
professionals regarding the patient’s bed skills, mobility and transfer status, physiotherapy
treatment plan and further management of patients.
 They shall assist the organization team in making admission / discharge / referral
decisions.
14.5.5 INTERVENTION:
Cardiopulmonary Physiotherapy is an essential non-invasive medical intervention that can
mitigate or reverse insults on oxygen transport.
Relating Interventions to an Individual?s
Facilitating Ventilation Needs
Patterns and Breathing Strategies Mobilization and Exercise
Exercise Testing and Training: Body Positioning
Physiological Basis for Airway
Primary Cardiopulmonary Dysfunction Clearance Techniques
Exercise Testing and Airway
Clearance Interventions: Clinical
Training: Secondary Cardiopulmonary Dysfunction Application
Respiratory Facilitating Airway
Muscle Training Clearance with Coughing Techniques
Complementary Therapies as Cardiopulmonary Physical Therapy Interventions
Patient Education
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
18

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 19 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.5.6 DOCUMENTATION:
 Physiotherapists shall thoroughly document the assessment, management plans and
progress of all patients seen. All medical record entries must comply with medicolegal
requirements.
 Mobility status must be clearly documented and communicated to ward staff using
standard terminology as described in the “Communication of Ward Mobility and
Functional Mobility for Policy”. Mobility/ transfer status must be written on bedside
communication board. This is to maximise patient and staff safety.
14.5.7 DISCHARGE/ TRANSFER:
Physiotherapists shall ensure appropriate referral and handover to ongoing physiotherapy
service, and inform the patient and carer of these arrangements.
14.5.8 DATA:
Physiotherapists shall maintain timely and accurate data of physiotherapy interventions.
Departmental Activities (non patient related activities) entered into reports database.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
19

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 20 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.6 LOCATIONS OF THE FISSURES AND LUNG LOBES AND SEGMENTS IN RELATION
TO CHEST WALL LANDMARKS:
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
20

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 21 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
 ANTERIOR:
o Top of lungs – is 2-4 cm above middle of clavicles
o Suprasternal notch – is top of manubrium
o Sternal angle (Angle of Louis) – articulate of 2nd rib and bifurcation of
trachea
o Bottom of lungs – 6th rib midclavicular and 8th rib midaxillary (at end of
exhalation)
 POSTERIOR:
o C-7 – most prominent spinal process at base of neck
o T-1 – articulate 1st rib and top of lungs
o T-4 – level so tracheal bifurcation
o T-8 – inferior angle of scapulae
o T-9 – top of right dome of diaphragm and bottom of right lung
o T-10 – top of left dome of diaphragm and bottom of left lung
 SEGMENTS:
o Transverse fissure 4th rib midclavicular
o Oblique fissure at 5th rib midaxillary
o Lung border at 8th rib midaxillary
o Pleural border at 10th rib midaxillary
14.6.1 THORACIC CONFIGURATION ABNORMALITIES:
May be seen upon inspection of the chest wall and the significance of these
findings.
 Barrel Chest: abnormal increase in AP diameter where the normal 45-degree angle
between the spine and the intercostal becomes almost horizontal, associated with
emphysema.
 Pectus Carinatum: Abnormal protrusion of the sternum.
 Pectus Excavatum: Depression of part or all of the sternum, which will produce a
restrictive lung defect.
 Kyphosis: Abnormal AP convex curvature of the thoracic spine.
 Scoliosis: abnormal lateral curvature that can cause respiratory compromise.
 Lordosis: exaggerated forward curvature of the lumbar and cervical regions of the
vertebrae.
14.6.2 CHARACTERISTICS AND CAUSES OF ABNORMAL BREATHING PATTERNS:.
Common causes of an increase in the work of breathing include:
1. Lung diseases that cause loss of lung volume such as pulmonary fibrosis and
atelectasis which cause the patient to take rapid, shallow breaths.
2. Lung diseases that cause intrathoracic airways to narrow such as with asthma or
bronchitis and cause the patient to have a long expiratory breath.
3. Respiratory disorders that cause the upper airway to narrow such as with croup or
epiglotitis and cause the patient to have a long inspiratory breath.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
21

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 22 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
14.6.3 TECHNIQUES TO ACCESS LUNG PROBLEMS:
A. TACTILE FREMITUS AND THE CAUSES OF INCREASED OR DECREASED FREMITUS
(LOCAL AND DIFFUSE):
Palpation is used to evaluate vocal fremitis (vibrations created by the vocal cords
during speech), estimate thoracic expansion, and assess the skin and subcutaneous
tissues of the chest. To assess for tactile fremitis, ask the patient to repeat the word
\"ninety nine\" while you palpate the thorax. Increased fremitis is caused by any
condition that increases the density of the lung as with consolidation that occurs in
pneumonia. Fremitis is reduced or absent in patients who are obese, or overly
muscular. Also, when the pleural space lining the lung becomes filled with air
(pneumothorax) or fluid (Pleural effusion). Lastly, people with emphysema have
bilateral reduction in fremitis due to reduction of the density of lung tissue.
B. ASSESSING THORACIC EXPANSION:
This palpation technique can be done either by placing hand anteriorly on the chest
with the thumbs extended along the costal margin toward the xiphoid process or
posteriorly by positioning your hands over the posterolateral chest with the thumbs
meeting at the T8 vertebrae. Instruct patient to exhale a maximum breath while you
extend your thumbs to meet at the midline. Next, instruct the patient to take a full, deep
breath and note the distance the tip of each thumb moves from the midline. Each
thumb should move an equal distance of 3-4 cm.
C. ABNORMAL FINDING OF CREPITUS AND ITS SIGNIFICANCE UPON PALPATION OF THE
SUBCUTANEOUS TISSUES:
Crepitus is when air leaks from the lung into the subcutaneous tissue causing fine
bubbles to produce a crackling sound and sensation when palpated. This condition is
called subcutaneous emphysema.
D. TECHNIQUE FOR PERCUSSION AND SOUNDS PRODUCED WHEN THE UNDERLYING
TISSUES ARE AIR-FILLED, FLUID FILLED, OR SOLID:
 Percussion is the art of tapping on a surface to evaluate the underlying structure.
Percussion of the chest wall produces a sound and a palpable vibration useful in
evaluating underlying lung tissue.
 The technique most often used in per cussing the chest wall is called mediate, or
indirect percussion. If you are right handed, place the middle finger of your left hand
firmly against the chest wall parallel to the ribs, with the palm and other fingers held off
the chest. Use the tip of the middle finger on your right hand or the lateral aspect of
your right thumb to strike the finger against the chest near the base of the terminal
phalanx with a quick, sharp blow. Movement of the hand striking the chest should be
generated at the wrist, not at the elbow or shoulder
 Percussion over normal lung is described as normal resonance. If you percuss over an
increased density the sound is said to be dull as with a fluid filled pleural space.
Overinflated lungs have an increased (hyperinflation) resonance.
 Percussion over muscle, fat or bone is characterized as flat.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
22

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 23 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
E. PULMONARY AND EXTRAPULMONARY ABNORMALITIES THAT ARE ASSOCIATED WITH
THE THREE BASIC TYPES OF PERCUSSION NOTES:
 Normal resonance signifies normal lung.
 Increased resonance can be detected with hyperinflated lungs as with
pneumothorax, emphysema or severe asthma.
 Decreased resonance is due to increased lung tissue density such as pneumonia,
atelectasis, tumor or pleural effusion.
F. FOUR PARTS OF THE STETHOSCOPE AND THE SITUATIONS IN WHICH IT IS BEST TO
LISTEN WITH THE DIAPHRAGM AND WHEN IT IS BEST TO LISTEN WITH THE BELL:
The stethoscope has
1. A bell
2. A diaphragm
3. Tubing and
4. Earpieces.
It is best to listen with the diaphragm to the lungs because they have a higher
frequency. The bell detects low- pitched heart sounds best.
G. SOUNDS NORMALLY HEARD OVER THE CHEST:
 Vesicular breath sounds are the “slight rustling of air” and are considered normal.
The exact mechanism is not known but is believed to be produced mostly during
inspiration by turbulent flow in the upper airway. They are heard mostly on
inspiration and over all areas of the chest distal to the central airways.
Vesicular breath  Bronchial (very similar to tracheal) breath sounds are harsher and higher pitch with
approximately equal inspiratory and expiratory components. The sound is heard
over a major bronchus during normal breathing.
H. \"ADVENTITIOUS\" BREATH SOUNDS:
Normal breath sounds have been traditionally divided into four types: Vesicular,
tracheal, bronchial and bronchovesicular.
Adventious breath sounds are the NOT normal sounds heard in the lungs. They are
continuous and discontinuous and are called wheezes, rhonchi, crackles etc. They are
abnormal sounds superimposed on the normal lung sounds.
Types of breath sounds
a. Rhonchi – low pitched, continuous
b. Wheeze – high pitched, continuous, proximal airways, often expiratory
c. Crackle or rale – discontinuous, distal airways (bases), often inspiratory
d. Friction rub – lower pitch, longer duration then crackles, both I and E
e. Stridor – Heard in the throat area, usually inspiratory if mild
Adventious breath
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
23

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 24 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
I. THE AIRWAY OR PARENCHYMAL ABNORMALITIES:
 Rhonchi are thought to result from airway narrowing that initially causes rapid
airflow past the site of obstruction. The added pressure causes the airway to
collapse and briefly touch. When airway pressure increases the airway returns to
a more open position, permitting airflow to return. The cycle repeats itself rapidly,
causing vibration of the airway walls. The airway obstruction can be relived with
coughing. The rapid flows and tighter obstruction result in higher-pitched sounds.
Lower flows and less obstruction will result in lower-pitched sounds.
 Crackles are probably produced by the bubbling of air through the airway
secretions or by the sudden opening of the small airway. These fine crackles are
often primarily inspiratory.
 Wheezes are caused by restriction caused by bronchospasm usually in the larger
airways.
 Friction rubs occur when the normally smooth, moist layers of the pleura develop
fibrin deposits or an inflammation that results in added friction. The sound has
been compared to the creaking sound of old leather.
J. CONDITIONS IN WHICH A PATIENT MAY HAVE DIMINISHED OR ABSENT BREATH
SOUNDS:
When vesicular breath sounds are found to be of less intensity than expected, they are
described as diminished (reduced) or even absent in extreme cases. This is caused by
a lack of sound transmission through the normal-air-filled lung. Any increase in density
of the lung tissue will deaden the normal sound transmission resulting in a diminished
sound.
K. THE PITCH AND INTENSITY OF STRIDOR AND THE POINT IN THE RESPIRATORY CYCLE
IN WHICH STRIDOR IS HEARD:
Stridor is caused by the partial obstruction of the upper airways (trachea, larynx). It is
often a high-pitched continuous sound heard mostly on inspiration.
L. AIRWAY ABNORMALITIES ASSOCIATED WITH STRIDOR:
Most often stridor is an inspiratory sound that is loud and can be heard at a distance
from the patient. It indicates that a partial laryngeal or tracheal obstruction is present.
Epiglotitis, viral croup, foreign body aspiration, airway inflammation following
extubation, tumors and tracheal stenosis can cause stridor. Stridor can be a sign of a
potentially serious and life-threatening problem, especially in children.
M. ADVENTITIOUS SOUNDS ASSOCIATED WITH THE FOLLOWING CONDITIONS:
a. Atelectasis – Decreased
b. Pneumonia – Bronchial or absent, possible inspiratory crackles
c. Emphysema – Diminished
d. Pneumothorax – Absent
e. Asthma – Absent, expiratory wheezes
f. Pleural effusion – Decreased
g. Pulmonary edema – Diminished, inspiratory crackles
h. Pulmonary fibrosis – Harsh, inspiratory crackles
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
24

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 25 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
N. AUSCULTATION TECHNIQUES OF BRONCHOPHONY, EGOPHONY, AND WHISPERED
PECTORILOQUOY AND ABNORMAL FINDINGS AND THE CONDITIONS ASSOCIATED WITH
EACH:
Part of a physical assessment may include assessment of vocal sounds. Vibrations
created by the vocal cords during speech travel down the airways and to through the
peripheral lung units to the chest wall.
1. Bronchophony is an increase in intensity and clarity of vocal resonance produced
by the enhanced transmission of vocal vibrations caused by increased lung density
such as with pneumonia. Hyperinflation of lungs or with pneumothorax results in
decrease in vocal vibrations. Easier to determine if only on one side.
2. Normal Egophony is the sound of normal voice tones as heard through the chest
wall during auscultation. The voice sound increases in intensity and takes on a
nasal or a ‘bleating’ quality. An E sounds like an E. Abnormal egophony is when an
E changes to an A with consolidation of lung above a pleural effusion or with a
pneumonia.
3. Whispered pectoriloquoy: Whispering is a high pitched sound that normally filters
out by lung tissue so whispers sound faint and non-distinct. When consolidation is
present, the whispering is transmitted to the chest wall with more clarity. This sign,
called whispered pectoriloquoy, helps identify areas of lung consolidation. The
patient is asked to whisper ‘1-2-3’ or ‘99’ and the doctor listens with his
stethoscope. Modern technology such as CAT scans, chest X-rays have caused a
shift away from this rather simple technique.
O. PATHOPHYSIOLOGICAL CONDITIONS IN WHICH BRONCHIAL BREATH SOUNDS ARE
HEARD IN AREAS OF THE CHEST WHERE NORMALLY VESICULAR BREATH SOUNDS
ARE HEARD:
Bronchial breath sounds heard in the peripheral lung regions where you normally hear
vesicular breath sounds are caused by increased density of lung tissue as in
consolidation, pneumonia and atelectasis.
P. \"POINT OF MAXIMAL IMPULSE”
The point of maximal impulse refers to heart sounds. It is the mid-clavicuar line at the
5th intercostal space. This point may move in an emergency situation of a tension
pneumothorax. The lung has collapsed and is pushing the trachea off mid-line and all
the internal thoracic organs away from the collapsed lung field. The tension ‘pneumo’
on the right will shift everything to the left side.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
25

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 26 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.0 RESEARCH AND EVIDENCE-BASED PRACTICE:
The traditional medical approach to diagnosis has focused on naming the pathophysiology of the patient. In this
view the end result of the diagnostic process is to label the pathology of the patient. Many in the medical and
physical therapy professions, however, have found inadequacies in this approach to diagnosis. Within the physical
therapy profession, diagnosis is not concerned with naming the pathology of the patient, but is concerned with
identifying the dysfunction towards which treatment will be directed. The end result of the process is no longer
labeling, but treatment planning.
The traditional medical approach to diagnosis
has focused on naming the pathophysiology of
the patient. In this view the end result of the
diagnostic process is to label the pathology of
the patient.
Many in the medical and physical therapy professions,
however, have found inadequacies in this approach to
diagnosis. Within the physical therapy profession,
diagnosis is not concerned with naming the pathology of
the patient, but is concerned with identifying the
dysfunction towards which treatment will be directed. The
end result of the process is no longer labeling, but
treatment planning.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
26

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 27 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Here are a couple examples from physical
therapy. The medical definitions offered do little
to help the therapist select treatments that are
likely to help the patient.
The PT diagnoses, however, should begin to
suggest treatment strategies.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
27

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 28 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
To operate in an hypothesis-driven approach, the
quality of the diagnostic information is
paramount. Clinicians must understand the value
of the data they are getting from a test in order to
utilize it properly.
If a test were ideal, all patients would fall into one of
the two red boxes. But in all tests there will be errors.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
28

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 29 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
In order to accurately place patients into the
categories on the above slide, a study should have
several characteristics:
A gold standard to define the condition is needed.
This may be a diagnostic test, however if a PT
diagnosis is to lead to treatment, a treatment
outcome may be the best gold standard.
The test must be defined well and applied
consistently. Good definitions of a positive test and
a negative test must be specified.
The subjects in the study should be similar to those
encountered in practice. All subjects should receive
both the test and the gold standard.
We can calculate two indices, sensitivity
and specificity, that will help to clarify the
amount of error present in a test.
Sensitivity gives the rate of true positive results
divided by the total number of subjects with the
condition. Tests with high sensitivity are valuable
for ruling out a condition when a negative test is
found. Therefore screening tests should be highly
sensitive.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
29

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 30 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Specificity represents the rate of true negatives of
all subjects in whom the condition is not present.
Tests with high specificity are valuable for ruling
in a condition when a positive test is found. Tests
with high specificity are useful as confirmatory
tests.
Sensitivity and specificity values do have some
shortcomings. First, they describe the rates of true
tests given that the condition is either present or
absent. In the clinical situation, however, we know
the test result only. Second, specificity or sensitivity
can be artificially inflated at the expense of the
other. An answer to these difficulties can be found
in the calculation of likelihood ratios.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
30

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 31 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Here are some examples of how likelihood ratios
are useful for diagnosis.
Here is an example from the literature. This
study compared multiple tests for PCL laxity.
The results appear to favour the
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
posterior drawer test.
31

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 32 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
This example illustrates the need to select the best
diagnostic test. If the posterior drawer was used, it
is more likely that the clinician would come to the
correct conclusion.
Here is another example. In this example the gold
standard is perhaps more relevant to PT because it
represents the outcome of treatment. The purpose
of the study was to examine the ability of Waddell’s
signs and symptoms to “diagnosis” an inability to
return to work.
The results indicate that none of these tests function very
well. The purpose of signs and symptoms should be as a
screening tool for identifying patients at risk for prolonged
Here are the results for the signs, symptoms, and disability, but the sensitivities are low and the negative
an index of signs+symptoms. LR are all >0.50.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
32

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 33 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
This example illustrates that Waddell’s
tests do not effectively screen for at risk
patients because they do little to alter the
probability of prolonged disability.
How can all this be integrated into practice to make
you and your students better diagnosticians? First,
when data does exist, find it and integrate it. This
may be particularly useful when several competing
tests exist for the same condition.
The more typical situation, however, will be that no
data exists, particularly data that uses diagnosis in
the terms that PT are interested in. In this case,
d t h ld b ll t d
How should a clinician go about collecting the data when
it doesn’t exist.
-The first step is deciding what condition it is that you are
trying to diagnose. This may be response to a particular
treatment.
-Second, make of list of what you think, or what the
literature supports, as being related to the diagnosis.
-Next decide on how you are going to measure the
diagnosis
-Finally, you must commit to measuring everyone on both
the test variables and the gold standard.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
33

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 34 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Here’s an example. Suppose you were a therapist in a
long-term care facility who was charged with
determining which residents should receive intervention
because they are at increased risk of falling. How
would you decide how to screen the patients? You
could consult the literature, but you may also want to
assess the accuracy yourself.
-What are you diagnosing - Fall risk across some
defined period of time (one year)
-What are the possible predictors - What do you think
might be important? What does the literature support?
(age, co-morbidity, balance tests, etc.)
-How will you determine if the patient has fallen over
one year? (incident reports, patient-report?)
-In order to get accurate information you must commit
to assessing everyone.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
34

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 35 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.1 EBP IS A FIVE-STEP PROCESS:
Step 1: is to convert the need for information into a clinically relevant, answerable question.
What exactly is it that you want to know?
One method for formulating the question is referred to as PICO.
 P refers to the patient or population of interest,
 I to the intervention,
 C to the comparison intervention (if one exists), and
 to the outcome.
An example of how to use the PICO method to refine a question regarding the role of exercise for
certain clinical problems is shown below.
 P What individual or patient populations do I have in mind?
People with post-polio syndrome.
 I What type of exercises am I considering?
Strength training.
 C How does my intervention compare to the effects of another intervention? What is that
other intervention?
Relaxation exercises.
 O What are the goals of the exercise intervention?
Increased daily activity level.
Putting this all together results in a more refined question.
\"For clients with post-polio syndrome, is strength training better than relaxation exercises
for increasing levels of daily physical activity?\"
Step 2: is to efficiently find the best evidence. This step is often easier said than done, but all
things considered, the Internet has greatly increased the ease with which many clinicians can
access and rapidly sort current information. Of the numerous databases available for information, a
few are particularly relevant to physical therapy.
PubMed is probably the best known database. It is maintained by the National Library of
Medicine and is free to the public at http://www.ncbi.nlm.nih.gov/PubMed. Most searches should
begin by looking at what is available through PubMed. PubMed allows you to search combinations
of key words, such as physical therapy and post-polio syndrome. Depending upon the number of
articles retrieved with these key words, one can either expand or narrow the search by removing or
adding key words.
A search can also be narrowed by limiting it to certain dates, e.g., after 1995, or by types of
articles, e.g., review articles. It is not unusual for an initial search to yield thousands of articles, but
with further refinement to be reduced to only a few highly relevant ones.
Step 3: Is to critically appraise the evidence. Surprisingly, there are only three critical questions
that you need to ask to appraise most clinical studies.
 Is the study valid?
 Are the findings clinically important?
 Do the findings apply to my client?
However, answering each of these three questions requires a systematic analysis. Indeed, a series
of factors needs to be considered when appraising the validity, such as
 Was the study retrospective or prospective?
 Was it randomised?
 Did it use human or animal subjects?
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
35

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 36 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Depending upon the answers to these and other questions, the validity of the evidence, or in other
words, how close it is to the truth, is ranked.
 To appraise the clinical importance of the evidence one needs to consider the magnitude of
the effect of the intervention, as well as the probability of the effect generalizing to whole
patient populations.
 To appraise the applicability of the findings, you must compare your client to the subjects
used in the study, consider the feasibility and risks and benefits of the intervention, and
also determine if it is in line with the client’s preferences.
Step 4: Involves applying critically appraised evidence to clinical practice. Of all the steps, this is
the one that may be the most difficult. Numerous challenges face health care providers interested
in changing their clinical practice based on EBP.
These challenges include, but are not limited to,
 A lack of control over their workload,
 Competing priorities,
 Limited access to the Internet and/or journals,
 Lack of training in information technology and critical appraisal of literature, and a
 Lack of institutional support for EBP.
To overcome these obstacles, it helps to remember the ancient proverb, \"A journey of a
thousand miles begins with one step.\" Start small.
Form a lunchtime journal club to critically appraise relevant clinical studies. Be a \"clinician-
scientist\" by using valid and reliable tests and measures to acquire baseline measurements and
evaluate outcomes of your clients.
Search for a topic of interest on PubMed or another database. Be part of the APTA Hooked on
Evidence Initiative. These are just a few of many possible ways to begin to integrate EBP into
clinical practice.
Step 5: Is to evaluate the effects of EBP on clinical outcomes.
 Whether incorporating EBP into physical therapy practice will increase the likelihood that
Michael J. Fox and all of our other clients receive interventions that are effective is
unknown.
 The essence of EBP is an argument for critical appraisal of therapeutic interventions.
Wisely, the people who developed EBP extended this requirement not only to clinical
interventions, but also to EBP itself. Future studies are needed to determine if there is a
correlation between the integration of EBP into clinical practice and improvements in
outcomes.
Conclusion;
In conclusion, EBP is a five-step process that aims to improve health care outcomes by balancing
findings from research with clinical experience and patient/family preferences. Extensive
information on EBP is available both in print and online. Additional information on how to
incorporate EBP into physical therapy practice was presented at the Fall 2002 PTWA Conference.
We have the technology for EBP. We have the intelligence to critically appraise evidence. The time
is right to incorporate EBP into physical therapy practice.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
36

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 37 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.2 RESEARCH DESIGN:
 Understanding the nature of the experiment, requires defining a few terms:
 Experimental or treatment group: this is the group that receives the experimental treatment,
manipulation, or is different from the control group on the variable under study.
 Control group:this group is used to produce comparisons. The treatment of interest is
deliberately withheld or manipulated to provide a baseline performance with which to compare
the experimental or treatment group's performance.
 Independent variable: this is the variable that the experimenter manipulates in a study. It can
be any aspect of the environment that is empirically investigated for the purpose of examining
its influence on the dependent variable.
 Dependent variable: the variable that is measured in a study. The experimenter does not
control this variable.
 Random assignment: in a study, each subject has an equal probability of being selected for
either the treatment or control group.
 Double blind: neither the subject nor the experimenter knows whether the subject is in the
treatment of the control condition.
15.2.1 HISTORICAL RESEARCH:
a. Primary research:
(also called field research) involves the collection of data that does not already exist.
This can be through numerous forms, including questionnaires and telephone
interviews amongst others.
The term is widely used in market research.
b. Secondary research:
(also known as desk research) involves the summary, collation and/or synthesis of
existing research rather than primary research, where data are collected from, for
example, research subjects or experiments
The term is widely used in market research and medical research The principle
methodology in medical secondary research is the systematic review, commonly using
meta-analytic statistical techniques, although other methods of synthesis, like realist
reviews and meta-narrative reviews, have been developed in recent years.
Secondary research can come from either internal or external sources.
15.2.2 DESCRIPTIVE RESEARCH:
Also known as statistical research, describes data and characteristics about the
population or phenomenon being studied. Descriptive research answers the questions
who, what, where, when and how.
Although the data description is factual, accurate and systematic, the research cannot
describe what caused a situation. Thus, descriptive research cannot be used to create a
causal relationship, where one variable affects another. In other words, descriptive
research can be said to have a low requirement for internal validity.
The description is used for frequencies, averages and other statistical calculations.
Often the best approach, prior to writing descriptive research, is to conduct a survey
investigation. Qualitative research often has the aim of description and researchers may
follow-up with examinations.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
37

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 38 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
EXAMPLES:
 Typical Descriptive Design:
 Examines characteristics of a single sample (explores aspects of phenomena of
interest).
 Comparative Descriptive Design:
 Compares two or more groups that occur naturally in a setting (explores for
differences).
 Case Study:
 Intensive exploration of a single unit of study (a person, family, group, community, or
institution).
 Longitudinal descriptive
 (not covered in the book): Studies a sample of individuals over time to examine
patterns of change, growth, or trends across time.
15.2.3 CORRELATIONAL RESEARCH:
In general, a correlational study is a quantitative method of research in which you have
2 or more quantitative variables from the same group of subjects, & you are trying to
determine if there is a relationship (or covariation) between the 2 variables (a similarity
between them, not a difference between their means). Theoretically, any 2 quantitative
variables can be correlated (for example, midterm scores & number of body piercings!) as
long as you have scores on these variables from the same participants; however, it is
probably a waste of time to collect & analyze data when there is little reason to think these
two variables would be related to each other.
Try to have 30 or more participants; this is important to increase the validity of the
research.
Your hypothesis might be that there is a positive correlation (for example, the number
of hours of study & your midterm exam scores), or a negative correlation (for example, your
levels of stress & your exam scores). A perfect correlation would be an r = +1.0 & -1.0,
while no correlation would be r = 0. Perfect correlations would almost never occur; expect
to see correlations much less than + or - 1.0. Although correlation can't prove a causal
relationship, it can be used for prediction, to support a theory.
EXAMPLES:
 Descriptive Correlational Design:
Describes the relationship among variables in a particular sample.
 Multifactorial Correlational:
Because we know reality in the world is multicausal, that is, there are many factors that
influence an outcome, most correlational studies now are multifactorial and examine
correlations between more than 2 variables simultaneously.
 Predictive Correlational:
Attempts to explore what factors predict (have an influence on) another variable.
Because this design explores causality, the term independent variable is used to
describe the predictor variables that are thought to predict the outcome variables (often
called the dependent variable). (Please note: This use of the terminology independent
variable and dependent variable is confusing because the terms have a much more
exact meaning in quasi and experimental designs).
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
38

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 39 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
These studies can be done prospectively (with all data collected at the same time), but
this is not a strong design. A strong design for a predictive correlational study collects
data on the independent (predictor) variables at one point in time then examines the
extent to which these variables relate to (predict) an outcome at another point in
time.Model Testing Design: This design is similar to a predictive correlational design
but is testing a hypothesized causal model. It requires a larger sample size and very
tight measurement of variables.
15.2.4. EXPERIMENTAL:
A design is experimental if subjects are randomly assigned to treatment groups and to
control (comparison) groups. Note that the control group may receive no treatment, or it
may be a group receiving a standard treatment (ex., students receiving computer-
supported classes versus those receiving conventional instruction). That is, the control
group is not necessarily one to be labeled \"no treatment.\"
A. DESIGNS:
I. TRUE EXPERIMENTS:
The true experiment is often thought of as a laboratory study. However, this is
not always the case. A true experiment is defined as an experiment conducted
where an effort is made to impose control over all other variables except the one
under study. It is often easier to impose this sort of control in a laboratory setting.
Thus, true experiments have often been erroneously identified as laboratory
studies.
First, every experiment must have at least two groups: an experimental and a
control group. Each group will receive a level of the independent variable. The
dependent variable will be measured to determine if the independent variable has
an effect. As stated previously, the control group will provide us with a baseline for
comparison. All subjects should be randomly assigned to groups, be tested a
simultaneously as possible, and the experiment should be conducted double blind.
Perhaps an example will help clarify these points.
Wolfer and Visintainer (1975) examined the effects of systematic preparation
and support on children who were scheduled for inpatient minor surgery. The
hypothesis was that such preparation would reduce the amount of psychological
upset and increase the amount of cooperation among thee young patients. Eighty
children were selected to participate in the study. Children were randomly assigned
to either the treatment or the control condition. During their hospitalization the
treatment group received the special program and the control group did not. Care
was take such that kids in the treatment and the control groups were not roomed
together. Measures that were taken included heart rates before and after blood
tests, ease of fluid intake, and self-report anxiety measures. The study
demonstrated that the systematic preparation and support reduced the difficulties
of being in the hospital for these kids.
Let us examine now the features of the experiment described above. First,
there was a treatment and control group. If we had had only the treatment group,
we would have no way of knowing whether the reduced anxiety was due to the
treatment or the weather, new hospital food, etc. The control group provides us
with the basis to make comparisons The independent variable in this study was the
presence or absence of the systematic preparation program. The dependent
variable consisted of the heart rates, fluid intake, and anxiety measures. The
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
39

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 40 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
scores on these measures were influenced by and depended on whether the child
was in the treatment or control group. The children were randomly assigned to
either group. If the \"friendly\" children had been placed in the treatment group we
would have no way of knowing whether they were less anxious and more
cooperative because of the treatment or because they were \"friendly\". In theory,
the random assignment should balance the number of \"friendly\" children between
the two groups. The two groups were also tested at about the same time. In other
words, one group was not measured during the summer and the other during the
winter. By testing the two groups as simultaneously as possible, we can rule out
any bias due to time. Finally, the children were unaware that they were participants
in an experiment (the parents had agreed to their children's participation in
research and the program), thus making the study single blind. If the individuals
who were responsible for the dependent measures were also unaware of whether
the child was in the treatment or control group, then the experiment would have
been double blind.
A special case of the true experiment is the clinical trial. A clinical trial is
defined as a carefully designed experiment that seeks to determine the clinical
efficacy of a new treatment or drug. The design of a clinical trial is very similar to
that of a true experiment. Once again, there are two groups: a treatment group (the
group that receives the therapeutic agent) and a control group (the group that
receives the placebo). The control group is often called the placebo group. The
independent variable in the clinical trial is the level of the therapeutic agent. Once
again, subjects are randomly assigned to groups, they are tested simultaneously,
and the experiment should be conducted double blind. In other words, neither the
patient or the person administering the drug should know whether the patient is
receiving the drug or the placebo.
II. COHORT DESIGN, QUASI-EXPERIMENTAL DESIGN:
Similar to experimental design, but does not have the same level of control
(e.g., are not able to control as many threats as possible). Aspects that might not
be controlled are:
 Not having a control group to which to compare results
 Not randomly assigning participants to control or experimental group
 Not having control over the intervention (e.g., using an intervention that is in
place in practice).
Many different quasi-experimental designs exist. You should understand the
concepts that make such a design different, but do not need to memorize each of
the many different types of quasi-experimental designs.
Quasi-experiments are very similar to true experiments but use naturally
formed or pre-existing groups. For example, if we wanted to compare young and
old subjects on lung capacity, it is impossible to randomly assign subjects to either
the young or old group (naturally formed groups). Therefore, this can not be a true
experiment. When one has naturally formed groups, the variable under study is a
subject variable (in this case - age) as opposed to an independent variable. As
such, it also limits the conclusions we can draw from such an research study. If we
were to conduct the quasi-experiment, we would find that the older group had less
lung capacity as compared to the younger group. We might conclude that old age
thus results in less lung capacity. But other variables might also account for this
result. It might be that repeated exposure to pollutants as opposed to age has
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
40

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 41 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
caused the difference in lung capacity. It could also be a generational factor.
Perhaps more of the older group smoked in their early years as compared to the
younger group due to increased awareness of the hazards of cigarettes. The point
is that there are many differences between the groups that we can not control that
could account for differences in our dependent measures. Thus, we must be
careful concerning making statement of causality with quasi-experimental designs.
Quasi-experiments may result from studying the differences between naturally
formed groups (ie. young & old; men & women). However, there are also instances
when a researcher designs a study as a traditional experiment only to discover that
random assignment to groups is restricted by outside factors. The researcher is
forced to divide groups according to some pre-existing criteria. For example, if a
corporation wanted to test the effectiveness of a new wellness program, they might
decide to implement their program at one site and use a comporable site (no
wellness program) as a control. As the employees are not shuffled and randomly
assigned to work at each site, the study has pre-existing groups. After a few
months of study, the researchers could then see if the wellness site had less
absenteeism and lower health costs than the non-wellness site. The results are
again restricted due to the quasi-correlational nature of the study. As the study has
pre-existing groups, there may be other differences between those groups than
just the presence or absence of a wellness program. For example, the wellness
program may be in a significantly newer, more attractive building, or the manager
from hell may work at the nonwellness program site. Either way, it a difference is
found between the two sites it may or may not be due to the presence/absence of
the wellness program.
In cohort studies, there is no random assignment. The participants have a right
to choose the group they want to join. The researcher measures differences
between groups without randominization in the cohort design.For example, the
researcher wants to measure the effect of folic-acid on reducing the risk of stroke
among people who have already suffered a stroke. Because of its novelty, she
does not want to risk the health of the participants. She recruits volunteers who are
willing to take folic-acid. During a follow-up period averaging a couple of years, the
number of death due to heart-related disease are counted to measure the effect of
folic-acid on the stroke.
 (D) - Death
 (S) - Survive
 Folic-Acid Group : (D)-15 (S)-672
 Vitamin Group : (D)-34 (S)-682
The odds ratio is (15*682)/(34*672)=.44. The odds of death in Folic-acid group
is .44 times the odds of death in Vitamin group. Taking folic-acid seems to reduce
the chance of having a stroke again.
There are two important facts to keep in mind when designing the cohort study.
First is an ethical problem. When designing the study, it is important to decide
whether the treatment may cause long-term side effects. Like the example above,
when the medicine is newly invented, and has no research done with human
subjects, the cohort design should be considered.Second is a validity problem.
Because of the lack of randominization in the cohort design, its external validity is
lower than that of the clinical trial study.
To summarize, quasi-experiments may result from either studying naturally
formed groups or use of pre-existing groups. When the study includes naturally
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
41

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 42 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
formed groups, the variable under study is a subject variable. When a study uses
pre-existing groups that are not naturally formed, the variable that is manipulated
between the two groups is an independent variable (With the exception of no
random assignment, the study looks similar in form to a true experiment). As no
random assignment exists in a quasi-experiment, no causal statements can be
made based on the results of the study.
III. WITHIN SUBJECTS (REPEATED MEASURES) DESIGNS:
In this type of design, the researcher is comparing measures for the same subjects
(hence, \"within subjects\"). The same subjects are used for each level of the
independent variable, as in before-after studies or panel studies. Since the
subjects are the same for all levels of the independent variable(s), they are their
own controls (that is, subject variables are controlled). However, there is greater
danger to validity in the form of carryover effects due to exposure to earlier levels
in the treatment sequence (ex., practice, fatigue, attention) and there is danger of
attrition in the sample. Counterbalancing is a common strategy to address
carryover effects: ex., half the subjects get treatment A first, then B, while the other
half get B first, then A, so that the carryover effect washes out in the sense that it is
counterbalanced in the overall sample. Keep in mind that counterbalancing does
not remove all effects - for instance, if there is a practice effect in a test situation,
with higher scores for the second-taken test, on the average both tests will score
higher in the overall sample than they would otherwise, since for both tests half the
sample had the benefit of a practice effect. Counterbalancing in this situation only
seeks that both test scores are biased equally upward, not that bias in absolute
scores is eliminated.
IV. MATCHED PAIRS DESIGNS:
Compared to between-subjects designs, within-subjects designs control for subject
variables better but at the expense of greater threat to validity in the form of
contamination from influences arising from subjects going from one experimental
level (condition) to another. Another type of repeated measures design is matched
pairs, where the repeated measurement is not of the same subjects but of very
similar subjects matched to have like key attributes. While matched pairs designs
avoid some types of invalidity of within subjects designs, such as the threat of
subject fatigue across repeated tests, matched pairs designs control only for the
matched attributes whereas same-subject within-subjects designs control for both
explicit and unmeasured subject variables.
V. BETWEEN SUBJECTS DESIGNS:
In this type of design, the researcher is comparing between subjects who
experience different treatments. There are different subjects for each level of the
independent variable(s) (ex., for each different type of media exposure in a study
of the effect of political advertising). Any given subject is exposed to only one level
and comparisons are made between subjects' reactions or effects. The researcher
relies on randomization of subjects among the treatment groups to control for
unmeasured variables, though sometimes stratification of subjects is employed to
guarantee proportions on certain key variables (ex., race).
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
42

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 43 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
VI. FACTORIAL DESIGNS:
Use categorical independent variables to establish groups. For instance in a two
factor design, the independent variables might be information type (fiction, non-
fiction) and media type (television, print, Internet ), generating 2 times 3 = 6
categories. An equal number of subjects would be assigned randomly to each of
the six possible groups (ex., to the fiction-television group). One might then
measure subjects on information retention. A null outcome would be indicated by
the average retention score being the same for all six groups of the factorial
design. Unequal mean retention scores would indicate a main effect of information
type or media type, and/or an interaction effect of both.
VII. SINGLE-SUBJECT RESEARCH:
Is the extreme case of small-n research. It is often used in situations where only
quasi-experimental research designs are applicable. This group of research
methods is used extensively in the experimental analysis of behavior and applied
behavior analysis with both human and non-human subjects. Four principal
methods in this type of research are: changing criterion, reversal (\"ABA\"),
alternating treatments, and multiple baseline. In verbal behavior research a
multipleprobe research method is often used as well.
VIII.THE AB DESIGN:
Is the simplest version of this design in which a baseline (\"A\") is tracked, and then
some treatment (\"B\") is implemented. If there is a change then the treatment is
said to have had an effect. However, it is subject to many possible competing
hypotheses, making it a very weak research design. The other variants essentially
introduce ways to control for the competing hypotheses.
 AB design- it has two phases. A refers to pre treatment or BASELINE, B refers
to intervention or treatment phase.
 ABA design- multiple baseline design, which includes baseline, treatment
phase followed by a second baseline phase. It is also called WITHDRAWAL
design, it is preferable to AB design because it may be easier to detect a true
treatment effect if the subject’s condition revert to baseline after the
experimental intervention is removed.
 ABAB- multiple baseline multiple treatment.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
43

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 44 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
IX. NPTE TYPE OF QUESTIONS EXAMPLE:
A PT is testing his hypothesis on his clinical research, which states that there
will be increase in ROM with the use of finger ladder in-patient with adhesive
capsulitis. Using a single case experimental design ABAB, he can accept his
hypothesis if.
a. A is equal to B
b. B is greater than A
c. A is less than B
d. B is less than A.
Answer here will be B. That only means ROM after treatment (B) using finger ladder
was INCREASED compared to ROM on baseline (A).
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
44

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 45 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
B. CAUSAL-COMPARATIVE:
Causal-comparative educational research attempts to identify a causative
relationship between an independent variable and a dependent variable. However, this
relationship is more suggestive than proven as the researcher does not have complete
control over the independent variable. If the researcher had control over the
independent variable, then the research would be classified as true experimental
research.There are many occassions while conducting educational research during
which the researcher is unable to control the independent variable, or it would be
unethical to control the independent variable, or it is simply too difficult to control the
independent variable. For example, someone attempting to find the effect of gender
(male or female) on an educational dependent variable would not be able to
experimentally manipulate gender, and thus would use a causal-comparative research
design rather than an experimental design for the research.The statement or title of a
causal-comparative research study takes the form: The effect of [independent variable]
on [dependent variable] for [subjects], with the understanding that the independent
variable is not under experimental control.
An example would be \"The effect of gender on a visual alertness measure for 6th
grade public school pupils.\" Here the independent variable is gender and the
dependent variable is the visual alertness task.
Another example of a causal-comparative research design would be \"Classroom
behavior of good and poor readers.\" In this study the independent variable would be
good readers versus poor readers. The researchers identified the three students with
the highest scores and three students with the lowest scores on a reading achievement
test for each of 18 classrooms. The dependent variable, classroom behavior, was
measured by having a trained observer, measure the frequency of seven classroom
behaviors during a 30 minute period of time over ten days. The observer did not know
which of the pupils she was observing were good readers and which were poor
readers.
\"An important difference between causal-comparative and correlational research is
that causal-comparative studies involve two or more groups and one independent
variable, while correlational studies involve two or more variables and one group.\"
C. EPIDEMIOLOGY:
Is the study of factors affecting the health and illness of populations, and serves as the
foundation and logic of interventions made in the interest of public health and
preventive medicine. It is considered a cornerstone methodology of public health
research, and is highly regarded in evidence-based medicine for identifying risk factors
for disease and determining optimal treatment approaches to clinical practice.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
45

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 46 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.3 VARIABLES:
Dependent variables and independent variables refer to values that change in relationship to each
other.
1. Independent Variable (IV): are those that are deliberately manipulated to invoke a change in the
dependent variables. In short, \"if x is given, then y occurs\", where x represents the independent
variables and y represents the dependent variables.
- The cause, intervention, or treatment that is designed in an effort to produce a change. The
variable that is varied or manipulated by the researcher. It is the presumed cause.
2. Dependent Variable (DV): are those that are observed to change in response to the independent
variables.
- Outcome that is being studied or evaluated. It is the response that is measured. It is the
presumed effect.
Examples:
1. There will be a statistically significant difference in graduation rates of at-risk high-school
seniors who participate in an intensive study program as opposed to at-risk high-school seniors
who do not participate in the intensive study program. IV: Participation in intensive study
program. DV: Graduation rates.
2. In a study of how different dosages of a drug are related to the severity of symptoms of a
disease, a measure of the severity of the symptoms of the disease is a dependent variable and
the administration of the drug in specified doses is the independent variable.
3. In a call centre, the number of customers serviced per hour, depends on the number of agents,
and average service time per customer. In this case number of customers is a dependent
variable, entirely dependent on the other two independent variables namely agents, and
average service time.
When an experiment is conducted, some variables are manipulated by the experimenter and others
are measured from the subjects. The former variables are called \"independent variables\" or
\"factors\" whereas the latter are called \"dependent variables\" or \"dependent measures\".
15.4 HYPOTHESIS:
15.4.1 HYPOTHESIS TEST:
Setting up and testing hypotheses is an essential part of statistical inference. In order to
formulate such a test, usually some theory has been put forward, either because it is believed
to be true or because it is to be used as a basis for argument, but has not been proved, for
example, claiming that a new drug is better than the current drug for treatment of the same
symptoms. In each problem considered, the question of interest is simplified into two competing
claims / hypotheses between which we have a choice; the null hypothesis, denoted H0, against
the alternative hypothesis, denoted H1. These two competing claims / hypotheses are not
however treated on an equal basis, special consideration is given to the null hypothesis. We
have two common situations: 1. The experiment has been carried out in an attempt to disprove
or reject a particular hypothesis, the null hypothesis, thus we give that one priority so it cannot
be rejected unless the evidence against it is sufficiently strong. For example, H0: there is no
difference in taste between coke and diet coke against H1: there is a difference. 2. If one of the
two hypotheses is 'simpler' we give it priority so that a more 'complicated' theory is not adopted
unless there is sufficient evidence against the simpler one. For example, it is 'simpler' to claim
that there is no difference in flavour between coke and diet coke than it is to say that there is a
difference. The outcome of a hypothesis test test is 'reject H0' or 'do not reject H0'.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
46

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 47 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.4.2 NULL HYPOTHESIS:
In statistics, a null hypothesis (H0) is a hypothesis set up to be nullified or refuted in order
to support an alternative hypothesis. When used, the null hypothesis is presumed true until
statistical evidence, in the form of a hypothesis test, indicates otherwise — that is, when the
researcher has a certain degree of confidence, usually 95% to 99%, that the data does not
support the null hypothesis. It is possible for an experiment to fail to reject the null hypothesis. It
is also possible that both the null hypothesis and the alternate hypothesis are rejected if there
are more than those two possibilities.
In scientific and medical applications, the null hypothesis plays a major role in testing the
significance of differences in treatment and control groups. The assumption at the outset of the
experiment is that no difference exists between the two groups (for the variable being
compared): this is the null hypothesis in this instance. Other types of null hypothesis may be,
for example, that:values in samples from a given population can be modelled using a certain
family of statistical distributions. The variability of data in different groups is the same, although
they may be centred around different values.
The null hypothesis, H0 represents a theory that has been put forward, either because it is
believed to be true or because it is to be used as a basis for argument, but has not been
proved. For example, in a clinical trial of a new drug, the null hypothesis might be that the new
drug is no better, on average, than the current drug. We would write H0: there is no difference
between the two drugs on average. We give special consideration to the null hypothesis. This is
due to the fact that the null hypothesis relates to the statement being tested, whereas the
alternative hypothesis relates to the statement to be accepted if / when the null is rejected. The
final conclusion once the test has been carried out is always given in terms of the null
hypothesis. We either 'reject H0 in favour of H1' or 'do not reject H0'; we never conclude 'reject
H1', or even 'accept H1'. If we conclude 'do not reject H0', this does not necessarily mean that
the null hypothesis is true, it only suggests that there is not sufficient evidence against H0 in
favour of H1; rejecting the null hypothesis then, suggests that the alternative hypothesis may be
true.
For example, one may want to compare the test scores of two random samples of men and
women, and ask whether or not one population has a mean score different from the other. A
null hypothesis would be that the mean score of the male population was the same as the
mean score of the female population:
H0 : μ1 = μ2
where:
H0 = the null hypothesis
μ1 = the mean of population 1, and
μ2 = the mean of population 2.
Alternatively, the null hypothesis can postulate that the two samples are drawn from the
same population, so that the variance and shape of the distributions are equal, as well as the
means.
Formulation of the null hypothesis is a vital step in testing statistical significance. Having
formulated such a hypothesis, one can establish the probability of observing the obtained data
or data more different from the prediction of the null hypothesis, if the null hypothesis is true.
That probability is what is commonly called the \"significance level\" of the results.
That is, in scientific experimental design, we may predict that a particular factor will produce
an effect on our dependent variable — this is our alternative hypothesis. We then consider how
often we would expect to observe our experimental results, or results even more extreme, if we
were to take many samples from a population where there was no effect (i.e. we test against
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
47

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 48 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
our null hypothesis). If we find that this happens rarely (up to, say, 5% of the time), we can
conclude that our results support our experimental prediction — we reject our null hypothesis.
15.4.3 ALTERNATIVE HYPOTHESIS:
The alternative hypothesis, H1, is a statement of what a statistical hypothesis test is set up
to establish. For example, in a clinical trial of a new drug, the alternative hypothesis might
be that the new drug has a different effect, on average, compared to that of the current
drug.
15.5 DATA TYPES:
15.5.1 DISCRETE DATA:
A set of data is said to be discrete if the values / observations belonging to it are distinct
and separate, i.e. they can be counted (1,2,3,). Examples might include the number of
kittens in a litter; the number of patients in a doctor’s surgery; the number of flaws in one
metre of cloth; gender (male, female); blood group (O, A, B, AB).
15.5.2 CATEGORICAL DATA:
A set of data is said to be categorical if the values or observations belonging to it can be
sorted according to category. Each value is chosen from a set of non-overlapping
categories. For example, shoes in a cupboard can be sorted according to colour; the
characteristic 'colour' can have non-overlapping categories 'black', 'brown', 'red' and 'other'.
People have the characteristic of 'gender' with categories 'male' and 'female'. Categories
should be chosen carefully since a bad choice can prejudice the outcome of an
investigation. Every value should belong to one and only one category, and there should
be no doubt as to which one.
15.5.3 NOMINAL DATA:
A set of data is said to be nominal if the values / observations belonging to it can be
assigned a code in the form of a number where the numbers are simply labels. You can
count but not order or measure nominal data. For example, in a data set males could be
coded as 0, females as 1; marital status of an individual could be coded as Y if married, N
if single.
15.5.4 ORDINAL DATA:
A set of data is said to be ordinal if the values / observations belonging to it can be ranked
(put in order) or have a rating scale attached. You can count and order, but not measure,
ordinal data. The categories for an ordinal set of data have a natural order, for example,
suppose a group of people were asked to taste varieties of biscuit and classify each biscuit
on a rating scale of 1 to 5, representing strongly dislike, dislike, neutral, like, strongly like. A
rating of 5 indicates more enjoyment than a rating of 4, for example, so such data are
ordinal. However, the distinction between neighbouring points on the scale is not
necessarily always the same. For instance, the difference in enjoyment expressed by
giving a rating of 2 rather than 1 might be much less than the difference in enjoyment
expressed by giving a rating of 4 rather than 3.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
48

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 49 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.5.5 INTERVAL SCALE:
An interval scale is a scale of measurement where the distance between any two adjacents
units of measurement (or 'intervals') is the same but the zero point is arbitrary. Scores on
an interval scale can be added and subtracted but can not be meaningfully multiplied or
divided. For example, the time interval between the starts of years 1981 and 1982 is the
same as that between 1983 and 1984, namely 365 days. The zero point, year 1 AD, is
arbitrary; time did not begin then. Other examples of interval scales include the heights of
tides, and the measurement of longitude.
15.5.6 CONTINUOUS DATA:
A set of data is said to be continuous if the values / observations belonging to it may take
on any value within a finite or infinite interval. You can count, order and measure
continuous data. For example, height; weight; temperature; the amount of sugar in an
orange; the time required to run a mile.
15.5.7 FREQUENCY TABLE:
A frequency table is a way of summarising a set of data. It is a record of how often each
value (or set of values) of the variable in question occurs. It may be enhanced by the
addition of percentages that fall into each category. A frequency table is used to
summarise categorical, nominal, and ordinal data. It may also be used to summarise
continuous data once the data set has been divided up into sensible groups. When we
have more than one categorical variable in our data set, a frequency table is sometimes
called a contingency table because the figures found in the rows are contingent upon
(dependent upon) those found in the columns.
Example:
Suppose that in thirty shots at a target, a marksman makes the following scores:
522344320303215
131552400454455
The frequencies of the different scores can be summarised as:
Score Freq. Freq. (%)
0 4 13%
1 3 10%
2 5 17%
3 5 17%
4 6 20%
5 7 23%
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
49

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 50 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
A. PIE CHART:
A pie chart is a way of summarising a set of categorical data. It is a circle which is
divided into segments. Each segment represents a particular category. The area of
each segment is proportional to the number of cases in that category.
B. BAR CHART:
A bar chart is a way of summarising a set of categorical data. It is often used in
exploratory data analysis to illustrate the major features of the distribution of the data in
a convenient form. It displays the data using a number of rectangles, of the same
width, each of which represents a particular category. The length (and hence area) of
each rectangle is proportional to the number of cases in the category it represents, for
example, age group, religious affiliation.
Bar charts are used to summarise nominal or ordinal data. Bar charts can be
displayed horizontally or vertically and they are usually drawn with a gap between the
bars (rectangles), whereas the bars of a histogram are drawn immediately next to each
other.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
50

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 51 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
C. DOT PLOT:
A dot plot is a way of summarising data, often used in exploratory data analysis to
illustrate the major features of the distribution of the data in a convenient form. For
nominal or ordinal data, a dot plot is similar to a bar chart, with the bars replaced by a
series of dots. Each dot represents a fixed number of individuals. For continuous data,
the dot plot is similar to a histogram, with the rectangles replaced by dots. A dot plot
can also help detect any unusual observations (outliers), or any gaps in the data set.
D. HISTOGRAM:
A histogram is a way of summarising data that are measured on an interval scale
(either discrete or continuous). It is often used in exploratory data analysis to illustrate
the major features of the distribution of the data in a convenient form. It divides up the
range of possible values in a data set into classes or groups. For each group, a
rectangle is constructed with a base length equal to the range of values in that specific
group, and an area proportional to the number of observations falling into that group.
This means that the rectangles might be drawn of non-uniform height.
The histogram is only appropriate for variables whose values are numerical and
measured on an interval scale. It is generally used when dealing with large data sets
(>100 observations), when stem and leaf plots become tedious to construct. A
histogram can also help detect any unusual observations (outliers), or any gaps in the
data set.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
51

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 52 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
E. STEM AND LEAF PLOT:
A stem and leaf plot is a way of summarising a set of data measured on an interval
scale. It is often used in exploratory data analysis to illustrate the major features of the
distribution of the data in a convenient and easily drawn form. A stem and leaf plot is
similar to a histogram but is usually a more informative display for relatively small data
sets (<100>
F. BOX AND WHISKER PLOT (OR BOXPLOT):
A box and whisker plot is a way of summarising a set of data measured on an
interval scale. It is often used in exploratory data analysis. It is a type of graph which is
used to show the shape of the distribution, its central value, and variability. The picture
produced consists of the most extreme values in the data set (maximum and minimum
values), the lower and upper quartiles, and the median.
A box plot (as it is often called) is especially helpful for indicating whether a
distribution is skewed and whether there are any unusual observations (outliers) in the
data set. Box and whisker plots are also very useful when large numbers of
observations are involved and when two or more data sets are being compared.
G. 5-NUMBER SUMMARY:
A 5-number summary is especially useful when we have so many data that it is
sufficient to present a summary of the data rather than the whole data set. It consists of
5 values: the most extreme values in the data set (maximum and minimum values), the
lower and upper quartiles, and the median.
A 5-number summary can be represented in a diagram known as a box and
whisker plot. In cases where we have more than one data set to analyse, a 5-number
summary is constructed for each, with corresponding multiple box and whisker plots.
H. OUTLIER:
An outlier is an observation in a data set which is far removed in value from the others
in the data set. It is an unusually large or an unusually small value compared to the
others. An outlier might be the result of an error in measurement, in which case it will
distort the interpretation of the data, having undue influence on many summary
statistics, for example, the mean. If an outlier is a genuine result, it is important
because it might indicate an extreme of behaviour of the process under study. For this
reason, all outliers must be examined carefully before embarking on any formal
analysis. Outliers should not routinely be removed without further justification.
I. SYMMETRY:
Symmetry is implied when data values are distributed in the same way above and
below the middle of the sample.
Symmetrical data sets
a) Are easily interpreted;
b) Allow a balanced attitude to outliers, that is, those above and below the middle
value ( median) can be considered by the same criteria;
c) Allow comparisons of spread or dispersion with similar data sets.
Many standard statistical techniques are appropriate only for a symmetric distributional
form. For this reason, attempts are often made to transform skew-symmetric data so
that they become roughly symmetric.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
52

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 53 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
J. SKEWNESS:
Skewness is defined as asymmetry in the distribution of the sample data values.
Values on one side of the distribution tend to be further from the 'middle' than values
on the other side.
For skewed data, the usual measures of location will give different values, for
example, mode
K. SCATTER PLOT:
A scatterplot is a useful summary of a set of bivariate data (two variables), usually
drawn before working out a linear correlation coefficient or fitting a regression line. It
gives a good visual picture of the relationship between the two variables, and aids the
interpretation of the correlation coefficient or regression model.
Each unit contributes one point to the scatterplot, on which points are plotted but
not joined. The resulting pattern indicates the type and strength of the relationship
between the two variables.
L. ILLUSTRATIONS:
a) The more the points tend to cluster around a straight line, the stronger the linear
relationship between the two variables (the higher the correlation).
b) If the line around which the points tends to cluster runs from lower left to upper
right, the relationship between the two variables is positive (direct).
c) If the line around which the points tends to cluster runs from upper left to lower
right, the relationship between the two variables is negative (inverse).
d) If there exists a random scatter of points, there is no relationship between the two
variables (very low or zero correlation).
e) Very low or zero correlation could result from a non-linear relationship between the
variables. If the relationship is in fact non-linear (points clustering around a curve,
not a straight line), the correlation coefficient will not be a good measure of the
strength.
 A scatterplot will also show up a non-linear relationship between the two
variables and whether or not there exist any outliers in the data.
 More information can be added to a two-dimensional scatterplot - for example,
we might label points with a code to indicate the level of a third variable.
 If we are dealing with many variables in a data set, a way of presenting all
possible scatter plots of two variables at a time is in a scatterplot matrix.
M. SAMPLE MEAN:
The sample mean is an estimator available for estimating the population mean . It
is a measure of location, commonly called the average.
The sample mean is calculated by taking the sum of all the data values and
dividing by the total number of data values.
Its value depends equally on all of the data which may include outliers. It may not
appear representative of the central region for skewed data sets.
It is especially useful as being representative of the whole sample for use in
subsequent calculations.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
53

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 54 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.6 SAMPLING:
15.6.1 TARGET POPULATION:
The target population is the entire group a researcher is interested in; the group about
which the researcher wishes to draw conclusions.
Example:
Suppose we take a group of men aged 35-40 who have suffered an initial heart attack. The
purpose of this study could be to compare the effectiveness of two drug regimes for
delaying or preventing further attacks. The target population here would be all men meeting
the same general conditions as those actually included in the study.
15.6.2 MATCHED SAMPLES:
a) Two samples in which the members are clearly paired, or are matched explicitly by the
researcher. For example, IQ measurements on pairs of identical twins.
b) Those samples in which the same attribute, or variable, is measured twice on each
subject, under different circumstances. Commonly called repeated measures.
Examples include the times of a group of athletes for 1500m before and after a week of
special training; the milk yields of cows before and after being fed a particular diet.
Sometimes, the difference in the value of the measurement of interest for each matched
pair is calculated, for example, the difference between before and after measurements, and
these figures then form a single sample for an appropriate statistical analysis.
15.6.3 INDEPENDENT SAMPLING:
Independent samples are those samples selected from the same population, or different
populations, which have no effect on one another. That is, no correlation exists between
the samples.
15.6.4 RANDOM SAMPLING:
Random sampling is a sampling technique where we select a group of subjects (a sample)
for study from a larger group (a population). Each individual is chosen entirely by chance
and each member of the population has a known, but possibly non-equal, chance of being
included in the sample.
By using random sampling, the likelihood of bias is reduced.
15.6.5 SIMPLE RANDOM SAMPLING:
Simple random sampling is the basic sampling technique where we select a group of
subjects (a sample) for study from a larger group (a population). Each individual is chosen
entirely by chance and each member of the population has an equal chance of being
included in the sample. Every possible sample of a given size has the same chance of
selection; that is, each member of the population is equally likely to be chosen at any stage
in the sampling process.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
54

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 55 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.6.6 STRATIFIED SAMPLING:
There may often be factors which divide up the population into sub-populations (groups
/ strata) and we may expect the measurement of interest to vary among the different sub-
populations. This has to be accounted for when we select a sample from the population in
order that we obtain a sample that is representative of the population. This is achieved by
stratified sampling.
A stratified sample is obtained by taking samples from each stratum or sub-group of a
population.
When we sample a population with several strata, we generally require that the
proportion of each stratum in the sample should be the same as in the population. Stratified
sampling techniques are generally used when the population is heterogeneous, or
dissimilar, where certain homogeneous, or similar, sub-populations can be isolated (strata).
Simple random sampling is most appropriate when the entire population from which the
sample is taken is homogeneous.
15.6.7 CLUSTER SAMPLING:
Cluster sampling is a sampling technique where the entire population is divided into
groups, or clusters, and a random sample of these clusters are selected. All observations
in the selected clusters are included in the sample.
Cluster sampling is typically used when the researcher cannot get a complete list of the
members of a population they wish to study but can get a complete list of groups or
'clusters' of the population. It is also used when a random sample would produce a list of
subjects so widely scattered that surveying them would prove to be far too expensive, for
example, people who live in different postal districts in the U.K. This sampling technique
may well be more practical and/or economical than simple random sampling or stratified
sampling.
15.6.8 QUOTA SAMPLING:
Quota sampling is a method of sampling widely used in opinion polling and market
research. Interviewers are each given a quota of subjects of specified type to attempt to
recruit for example, an interviewer might be told to go out and select 20 adult men and 20
adult women, 10 teenage girls and 10 teenage boys so that they could interview them
about their television viewing.
15.6.9 SPATIAL SAMPLING:
This is an area of survey sampling concerned with sampling in two (or more)
dimensions. For example, sampling of fields or other planar areas.
15.6.10 SAMPLING VARIABILITY:
Sampling variability refers to the different values which a given function of the data
takes when it is computed for two or more samples drawn from the same population.
15.6.11 STANDARD ERROR:
Standard error is the standard deviation of the values of a given function of the data
(parameter), over all possible samples of the same size.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
55

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 56 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.6.12 BIAS:
Bias is a term which refers to how far the average statistic lies from the parameter it is
estimating, that is, the error which arises when estimating a quantity. Errors from chance
will cancel each other out in the long run, those from bias will not.
15.6.13 PRECISION:
 Precision is a measure of how close an estimator is expected to be to the true value of
a parameter.
 Precision is usually expressed in terms of imprecision and related to the standard error
of the estimator. Less precision is reflected by a larger standard error.
15.7 INSTRUMENTATION-GOLD STANDARD:
An instrument with established validity can be used as a standard for assessing other
instruments.
15.8 INFORMED CONSENT:
Is a legal condition whereby a person can be said to have given consent based upon an
appreciation and understanding of the facts and implications of an action. The individual needs to
be in possession of relevant facts and also of his or her reasoning faculties, such as not being
mentally retarded or mentally ill and without an impairment of judgment at the time of consenting.
Such impairments might include illness, intoxication, insufficient sleep, and other health problems.
Some acts cannot legally take place because of a lack of informed consent. In cases where an
individual is considered unable to give informed consent, another person is generally authorized to
give consent on their behalf. Examples of this include the parents or legal guardians of a child and
caregivers for the mentally ill. In cases where an individual is provided limited facts, serious ethical
issues may arise. Examples of this in a clinical trial in medical research are anticipated and
prevented by an ethics committee or Institutional Review Board.
15.9 PROBLEMS RELATED TO MEASUREMENT:
15.9.1 CONTROL:
A. CONTROL GROUP:
Participants in a control group are used as a standard for comparison.
This group is used to produce comparisons. The treatment of interest is
deliberately withheld or manipulated to provide a baseline performance with which to
compare the experimental or treatment group's performance.
For example, a particular study may divide participants into two groups - an
\"experimental group\" and a \"control group.\" The experimental group is given the
experimental treatment under study, while the control group may be given either the
standard treatment for the illness or a placebo. At the end of the study, the results of
the two groups are compared.
A control group study uses a control group to compare to an experimental group in
a test of a causal hypothesis. The control and experimental groups must be identical in
all relevant ways except for the introduction of a suspected causal agent into the
experimental group. If the suspected causal agent is actually a causal factor of some
event, then logic dictates that that event should manifest itself more significantly in the
experimental than in the control group. For example, if 'C' causes 'E', when we
introduce 'C' into the experimental group but not into the control group, we should find
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
56

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 57 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
'E' occurring in the experimental group at a significantly greater rate than in the control
group. Significance is measured by relation to chance: if an event is not likely due to
chance, then its occurrence is significant.
B. EXPERIMENTAL GROUP:
Study participants in the experimental group receive the drug, device, treatment, or
intervention under study.
This is the variable that the experimenter manipulates in a study. It can be any
aspect of the environment that is empirically investigated for the purpose of examining
its influence on the dependent variable.
C. INTERVENING VARIABLE:
Is a hypothetical internal state that is used to explain relationships between
observed variables, such as independent and dependent variables, in empirical
research.
An intervening variable facilitates in a better understanding of the relationship
between the independent and dependent variables when the variables appear to not
have a definite connection. They are studied by means of operational definitions and
have no existence apart For example, an independent variable in a study on latent
learning in rats is the number of practice trials received. Each rat receives an
increasing number of trials, as one trial is given per day. The dependent variable is the
number of wrong turns (errors) the rats make on a trial. As time, and number of
practice trials, increases, the number of errors decreases. Theoretically, an internal
state of “learning” intervened between the independent and dependent variables. It
was this state that caused the errors to decrease, not the practice trials.
Other examples of intervening variables include: motivation, intelligence, intention,
and expectation.
****QUESTION****
A student wanted to know if higher temperatures would cause radish seeds to
germinate faster. He set up two petri dishes. He placed 10 radish seeds in each dish
on a wet paper towel. He kept one dish at room temperature. He put the second dish in
an incubator. He counted the number of days required for all the seeds to germinate.
a. What would be an appropriate hypothesis for this experiment?
b. What is the experimental group?
c. What is the control group?
d. What is the independent variable?
e. What is the dependent variable?
*ANSWERS:
a. If radish seeds are placed in an incubator, then they will germinate faster than those
at room temperature.
b. Radish seeds in the incubator
c. Radish seeds at room temperature
d.Temperature
e. Number of days required to germinate
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
57

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 58 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.9.2 VALIDITY:
A key concept relevant to a discussion of research methodology is that of validity. When an
individual asks, \"Is this study valid?\", they are questioning the validity of at least one aspect
of the study. There are four types of validity that can be discussed in relation to research
and statistics. Thus, when discussing the validity of a study, one must be specific as to
which type of validity is under discussion. Therefore, the answer to the question asked
above might be that the study is valid in relation to one type of validity but invalid in relation
to another type of validity.
Each of the four types of validity will be briefly defined and described below. Be aware that
this represents a cursory discussion of the concept of validity. Each type of validity has
many threats which can pose a problem in a research study. Examples, but not an
exhaustive discussion, of threats to each validity will be provided. For a comprehensive
discussion of the four types of validity, the threats associated with each type of validity, and
additional validity issues.
A. STATISTICAL CONCLUSION VALIDITY:
Unfortunately, without a background in basic statistics, this type of validity is difficult to
understand. According to Cook and Campbell (1979), \"statistical conclusion validity
refers to inferences about whether it is reasonable to presume covariation given a
specified alpha level and the obtained variances (p. 41).\" Essentially, the question that
is being asked is - \"Are the variables under study related?\" or \"Is variable A correlated
(does it covary) with Variable B?\". If a study has good statistical conclusion validity, we
should be relatively certain that the answer to these questions is \"yes\". Examples of
issues or problems that would threaten statistical conclusion validity would be random
heterogeneity of the research subjects (the subjects represent a diverse group - this
increases statistical error) and small sample size (more difficult to find meaningful
relationships with a small number of subjects).
B. INTERNAL VALIDITY:
Once it has been determined that the two variables (A & B) are related, the next
issue to be determined is one of causality. Does A cause B? If a study is lacking
internal validity, one can not make cause and effect statements based on the research;
the study would be descriptive but not causal. There are many potential threats to
internal validity. For example, if a study has a pretest, an experimental treatment, and a
follow-up posttest, history is a threat to internal validity. If a difference is found between
the pretest and posttest, it might be due to the experimental treatment but it might also
be due to any other event that subjects experienced between the two times of testing
(for example, a historical event, a change in weather, etc.)
Internal validity is an inductive estimate of the degree to which conclusions about
causes of relations are likely to be true, in view of the measures used, the research
setting, and the whole research design. Good experimental techniques in which the
effect of an independent variable on a dependent variable is studied under highly
controlled conditions, usually allow for higher degrees if internal validity than, for
example, single-case designs.
C. CONSTRUCT VALIDITY:
Construct validity refers to the totality of evidence about whether a particular
operationalization of a construct adequately represents what is intended by theoretical
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
58

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 59 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
account of the construct being measured. (Demonstrate an element is valid by relating
it to another element that is supposively valid.)
One is examining the issue of construct validity when one is asking the questions
\"Am I really measuring the construct that I want to study?\" or \"Is my study confounded
(Am I confusing constructs)?\". For example, if I want to know a particular drug
(Variable A) will be effective for treating depression (Variable B) , I will need at least
one measure of depression. If that measure does not truly reflect depression levels but
rather anxiety levels (Confounding Variable X), than my study will be lacking construct
validity. Thus, good construct validity means the we will be relatively sure that
Construct A is related to Construct B and that this is possibly a causal relationship.
Examples of other threats to construct validity include subjects apprehension about
being evaluated, hypothesis guessing on the part of subjects, and bias introduced in a
study by expectencies on the part of the experimenter.
D. EXTERNAL VALIDITY:
External validity addresses the issue of being able to generalize the results of your
study to other times, places, and persons. For example, if you conduct a study looking
at heart disease in men, can these results be generalized to women? Therefore, one
needs to ask the following questions to determine if a threat to the external validity
exists: \"Would I find these same results with a difference sample?\", \"Would I get these
same results if I conducted my study in a different setting?\", and \"Would I get these
same results if I had conducted this study in the past or if I redo this study in the
future?\" If I can not answer \"yes\" to each of these questions, then the external validity
of my study is threatened.
The issue of External validity concerns the question to what extent one may safely
generalize the (internally valid) causal inference (a) from the sample studied to the
defined target population and (b) to other populations (i.e. across time and space).
E. ECOLOGICAL VALIDITY:
This issue is closely related to external validity and covers the question to which
degree your experimental findings mirror what you can observe in the real world
(ecology= science of interaction between organism and its environment). Ecological
validity is whether the results can be applied to real life situations. Typically in science,
you have two domains of research: Passive-observational and active-experimental.
The purpose of experimental designs is to test causality, so that you can infer A causes
B or B causes A. But sometimes, ethical and/or methological restrictions prevent you
from conducting an experiment (e.g. how does isolation influence a child's cognitive
functioning?) Then you can still do research, but it's not causal, it's correlational, A
occurs together with B. Both techniques have their strengths and weaknesses. To get
an experimental design you have to control for all interfering variables. That's why you
conduct your experiment in a laboratory setting. While gaining internal validity
(excluding interfering variables by keeping them constant) you lose ecological validity
because you establish an artificial lab setting. On the other hand with observational
research you can't control for interfering variables (low internal validity) but you can
measure in the natural (ecological) environment, thus at the place where behavior
occurs.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
59

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 60 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
F. CONTENT VALIDITY:
This is a non-statistical type of validity that involves “the systematic examination of
the test content to determine whether it covers a representative sample of the
behaviour domain to be measured” (Anatasi & Urbina, 1997 p114).
A test has content validity built into it by careful selection of which items to include
(Anatasi & Urbina, 1997). Items are chosen so that they comply with the test
specification which is drawn up through a thorough examination of the subject domain.
Foxcraft et al (2004, p. 49) note that by using a panel of experts to review the test
specifications and the selection of items the content validity of a test can be improved.
The experts will be able to review the items and comment on whether the items cover a
representative sample of the behaviour domain.
G. FACE VALIDITY:
Face validity is very closely related to content validity. While content validity depends
on a theoretical basis for assuming if a test is assessing all domains of a certain
criterion (e.g. does assessing addition skills yield in a good measure for mathematical
skills? - To answer this you have to know, what different kinds of arithmetic skills
mathematical skills include ) face validity relates to whether a test appears to be a
good measure or not. This judgment is made on the \"face\" of the test, thus it can also
be judged by the amateur.
H. CRITERION VALIDITY:
Criterion-related validity reflects the success of measures used for prediction or
estimation. There are two types of criterion-related validity: Concurrent and predictive
validity. A good example of criterion-related validity is in the validation of employee
selection tests; in this case scores on a test or battery of tests is correlated with
employee performance scores.
I. CONCURRENT VALIDITY:
Concurrent validity refers to the degree to which the operationalization correlates with
other measures of the same construct that are measured at the same time. Going back
to the selection test example, this would mean that the tests are administered to
current employees and then correlated with their scores on performance reviews.
J. PREDICTIVE VALIDITY:
Predictive validity refers to the degree to which the operationalization can predict (or
correlate with) with other measures of the same construct that are measured at some
time in the future. Again, with the selection test example, this would mean that the tests
are administered to applicants, all applicants are hired, their performance is reviewed
at a later time, and then their scores on the two measures are correlated.
K. CONVERGENT VALIDITY:
Convergent validity refers to the degree to which a measure is correlated with other
measures that it is theoretically predicted to correlate with.
L. DISCRIMINANT VALIDITY:
Discriminant validity describes the degree to which the operationalization does not
correlate with other operationalizations that it theoretically should not correlated with.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
60

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 61 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.9.3 THREATS TO VALIDITY:
Campbell and Stanley (1963) define internal validity as the basic requirements for an
experiment to be interpretable — did the experiment make a difference in this instance?
External validity addresses the question of generalizability — to whom can we generalize
this experiment's findings?
A. INTERNAL VALIDITY:
1. History, the specific events occurring between the first and second measurements
in addition to the experimental variables. Intra-group History:This is related to
history. Specific events happen to one group and not to another, that affect the
experiment's outcome.
2. Maturation, processes within the participants as a function of the passage of time
(not specific to particular events), e.g., growing older, hungrier, more tired, and so
on. Normal biological, psychological, or physiological process occur within the
subjects as time passes. This is especially important with young children.
3. Testing, the effects of taking a test upon the scores of a second testing. The
effects of taking a pretest affect subsequent performance on a highly related (or
the same) posttest.
4. Instrumentation, changes in calibration of a measurement tool or changes in the
observers or scorers may produce changes in the obtained measurements.
Changes in the instrument (test, questionnaire) or the evaluators (different
observers) produce changes independent of any true experimental effects.
5. Statistical regression, operating where groups have been selected on the basis of
their extreme scores.
6. Selection, biases resulting from differential selection of respondents for the
comparison groups.
7. Experimental mortality, or differential loss of respondents from the comparison
groups.
8. Selection-maturation interaction, etc. e.g., in multiple-group quasi-experimental
designs. Any and all factors that make one group of subjects different from another
group of subjects at the beginning of an experiment. Random assignment, not
random selection, strengthens internal validity. If subjects are randomly assigned
to groups, it is not expected that selection will be a threat to internal validity.
9. John Henry effect--John Henry was a worker who outperformed a machine under
an experimental setting because he was aware that his performance was
compared with that of a machine.
10. Mortality -- A differential loss of subjects from the groups being compared in an
experiment. Just randomly throwing out subjects to keep the N equal will not fix
this threat.
11. Interaction -- Connection of two or more threats such that they result in an
interaction effect; particularly likely is the interaction between selection and one of
the other threats.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
61

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 62 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
B. EXTERNAL VALIDITY:
1. Reactive or interaction effect of testing, a pretest might increase.Do study
conditions (other than the treatment) cause subjects to react or behave differently
than they would if they weren't being studied?
 Pretest Sensitization: Like testing (threat to internal validity), the pretest
modifies the subject so he/she behaves differently than un-pretested subjects.
 Hawthorne Effect: (Placebo Effect) The fact that subjects know they are being
studied affects the results.
 Novelty Effect: This occurs when the responses of the study are partly a
function of the newness or novelty of the experimental approach.
 Experimenter Effect: One experimenter administers the treatment differently
from the way another experimenter does (this ties in with inter-rater reliability).
2. Unrepresentative sample: The sample does not represent or \"mirror\" the
population - usually results from an inability to randomly select the sample from the
population you want to generalize to.
3. Interaction effects of selection biases and the experimental variable.
4. Reactive effects of experimental arrangements, which would preclude
generalization about the effect of the experimental variable upon persons being
exposed to it in non-experimental settings.
5: Time: A historical event at the time of the study that happens to all subjects alters
the results (they would be different if the experiment were conducted at a different
time.) Note: If the event happened to only one group, then it is History, a threat to
internal validity, not external validity.
C. OTHER THREATS:
 Multiple-treatment interference, where effects of earlier treatments are not
erasable. Multiple treatments are applied sequentially and subjects experience
cumulative effects that cannot be sorted out. This is why you want to use that Latin
Square, a counterbalanced design.
 Nongeneralizability of the Dependent Variable: This is when the instrument used to
measure the DV is not representative of the population of such measures (two
anxiety scales may give different results for the same sample).
 Ambiguous Independent Variable: This occurs when the IV is not clearly and
operationally defined, so the study cannot be replicated exactly. Like \"The DARE
Program\" - just what does it mean? How was it conducted?
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
62

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 63 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.9.4 RELIABILITY:
In statistics, reliability is the consistency of a set of measurements or measuring
instrument, often used to describe a test.
1. Inter-rater reliability, inter-rater agreement, or Concordance:
Is the degree of agreement among raters. It gives a score of how much
homogeneity, or consensus, there is in the ratings given by judges. It is useful in
refining the tools given to human judges, for example by determining if a particular
scale is appropriate for measuring a particular variable. If various raters do not agree,
either the scale is defective or the raters need to be re-trained.
Interrater reliability is the extent to which two or more individuals (coders or raters)
agree. Interrater reliability addresses the consistency of the implementation of a rating
system.
A test of interrater reliability would be the following scenario: Two or more
researchers are observing a high school classroom. The class is discussing a movie
that they have just viewed as a group. The researchers have a sliding rating scale (1
being most positive, 5 being most negative) with which they are rating the student's
oral responses. Interrater reliability assesses the consistency of how the rating system
is implemented. For example, if one researcher gives a \"1\" to a student response,
while another researcher gives a \"5,\" obviously the interrater reliability would be
inconsistent. Interrater reliability is dependent upon the ability of two or more
individuals to be consistent. Training, education and monitoring skills can enhance
interrater reliability.
2. Intrarater (Intratester) Reliability:
The degree of stability exhibited when a measurement is repeated under identical
conditions by the same rater. Reliability refers to the degree to which the results
obtained by a measurement procedure can be replicated. Lack of intra-rater reliability
may arise from divergences between instruments of measurement or instability of the
attribute being measured.
3. Test-retest Reliability:
is a statistical method used to examine how reliable a test is: A test is performed twice,
e.g., the same test is given to a group of subjects at two different times. Each subject
should score different than the other subjects, but if the test is reliable then each
subject should score the same in both test.
4. Split-half Reliability:
A measure of the reliability of a test based on the correlation between scores on
two arbitrarily formed halves of the test, often the odd-numbered and even-numbered
test items.
In split-half reliability we randomly divide all items that purport to measure the
same construct into two sets. We administer the entire instrument to a sample of
people and calculate the total score for each randomly divided half. the split-half
reliability estimate, as shown in the figure, is simply the correlation between these two
total scores. In the example it is .87.
5. Internal Consistency Reliability
Used to assess the consistency of results across items within a test.
6. Parallel-Forms Reliability
used to assess the consistency of the results of two tests constructed in the same way
from the same content domain.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
63

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 64 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.9.5 THREATS TO RELIABILITY:
 Using too few items to measure objectives
 Using the wrong type of instrumentation to measure specific domains of knowledge
 Incomplete directions
 Unfamiliar vocabulary
 Unfamiliar assessment formates
 Uncomfortable room conditions
15.9.6 OBJECTIVITY:
The term \"objectivity\" designates both a feature of scientific investigators and a feature
of scientific inquiry itself.
To be objective is to adhere strictly to truth- conducive methods in one's thinking,
particularly, to take into account all available information, and to avoid any form of
prejudice, bias, or wishful thinking. The forms of observation and experimentation, and the
canons of deductive reasoning and inductive reasoning employed by scientists practising
the verification guide scientists to be objective.
As stated earlier, the term \"objective\" can be applied to methods used in this process
or results produced by it. For example, if a study to determine the effectiveness of a
pharmaceutical drug is double-blind, randomized, and placebo controlled, the study can be
called \"objective\" because it adheres to methods that are known to improve the reliability of
its results.
Law, medicine, and almost every academic field have developed rules of evidence and
guidelines for objectivity particular to their subject matter. In history, for example, objectivity
is achieved through the use of the historical method and peer review of journal articles in
which authors' proposed explanations and analyses of historical events are evaluated by
other experts, prior to publication.
It is a matter of dispute among experts to what degree aesthetic and ethical
judgements, as well as judgements involving the interpretation of the law, can be objective.
Some hold that the beauty or merit of artworks and literary works cannot be objectively
decided. Others deny this. Some claim that ethical judgements are relative to an
individual's values or to the norms, mores, and folk-ways of society. Others deny this.
There are impressive arguments on both sides.
Objectivity is what leads to accurate and unbiased results. If you lack objectivity, your
results may be skewed or may get nothing done beacuse you completley ignore studies
that will not support your point of view.
15.9.7 SUBJECTIVITY:
Refers to a subject's perspective, particularly feelings, beliefs, and desires. It is often used
casually to refer to unjustified personal opinions, in contrast to knowledge and justified
belief. In philosophy, the term is often contrasted with objectivity.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
64

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 65 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.9.8 SENSITIVITY:
Or recall rate, is a statistical measure of how well a binary classification test correctly
identifies a condition, whether this is medical screening tests picking up on a disease, or
quality control in factories deciding if a new product is good enough to be sold.
The results of the screening test are compared to some absolute (Gold standard); for
example, for a medical test to determine if a person has a certain disease, the sensitivity to
the disease is the probability that if the person has the disease, the test will be positive.
The sensitivity is the proportion of true positive of all diseased cases in the population.
It is a parameter of the test.
High sensitivity is required when early diagnosis and treatment is beneficial, and when
the disease is infectious.
A sensitivity of 100% means that the test recognizes all sick people as such.
Sensitivity alone does not tell us how well the test predicts other classes (that is, about
the negative cases). In the binary classification, as illustrated above, this is the
corresponding specificity test, or equivalently, the sensitivity for the other classes.
Sensitivity is not the same as the positive predictive value (ratio of true positives to
combined true and false positives), which is as much a statement about the proportion of
actual positives in the population being tested as it is about the test.
The calculation of sensitivity does not take into account indeterminate test results. If a
test cannot be repeated, the options are to exclude indeterminate samples from analyses
(but the number of exclusions should be stated when quoting sensitivity), or, alternatively,
indeterminate samples can be treated as false negatives (which gives the worst-case value
for sensitivity and may therefore underestimate it).
A. FALSE POSITIVE:
 Individuals are identified by a test as having a condition when they do not.
 The false positive rate is the proportion of negative instances that were
erroneously reported as being positive.
 It is equal to 1 minus the specificity of the test. This is equivalent to saying the false
positive rate is equal to the significance level.
 In statistical hypothesis testing, this fraction is given the symbol α, and 1 − α is
defined as the specificity of the test. Increasing the specificity of the test lowers the
probability of type I errors, but raises the probability of type II errors (false
negatives that reject the alternative hypothesis when it is true).
B. FALSE NEGATIVE:
 Individuals are identified by a test as not having a condition when they do.
 The false negative rate is the proportion of positive instances that were
erroneously reported as negative.
 It is equal to 1 minus the \"power\" of the test.
 In statistical hypothesis testing, this fraction is given the symbol β.
C. A NEGATIVE (LOW SENSITIVITY) RESULT RULES OUT THE DIAGNOSIS (SNOUT):
There is a very low likelihood ratio. Likelihood ratios are a measure of the power of
sensitivity/specificity.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
65

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 66 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.9.9 SPECIFICITY:
Specificity is a statistical measure of how well a binary classification test correctly identifies
the negative cases, or those cases that do not meet the condition under study. For
example, given a medical test that determines if a person has a certain disease, the
specificity of the test to the disease is the probability that the test indicates `negative' if the
person does not have the disease.
That is, the specificity is the proportion of true negatives of all negative cases in the
population. It is a parameter of the test.
High specificity is important when the treatment or diagnosis is harmful to the patient
mentally and/or physically.
15.10 DATA ANALYSIS AND INTERPRETATION:
15.10.1 DESCRIPTIVE STATISTICS:
A. MEASURES OF CENTRAL TENDENCY:
I. MEAN:
It is sometimes stated that the 'mean' means average.
 Eg. Scores given: 3,2,6,4,4,5,2,6
 Add all scores and divide by the number of subjects. (3+2+6+4+4+5+2+6 = 24)
/8=4
 Flag: Interval or Ratio Data.
II. MEDIAN:
Arranging all the observations from lowest value to highest value and picking the
middle one can find Median of a finite list of numbers.
 Eg: 1,2,3,4,5,6,7,
 Median = 4
 Flag: Ordinal Data
III. MODE:
The mode is the value that occurs the most frequently in a data set or a probability
distribution. In some fields, notably education, sample data are often called scores,
and the sample mode is known as the modal score.
 For example, the mode of the sample [1, 3, 6, 6, 6, 6, 7, 7, 12, 12, 17] is 6.
 Flag: Nominal data
B. MEASURES OF VARIABILITY:
I. RANGE:
The difference between the highest and lowest value E.g. Age 10-15
II. SD - STANDARD DEVIATION.
Is a measure of the dispersion of a set of values. It can apply to a probability
distribution, a random variable, a population or a multiset. The standard deviation
is usually denoted with the letter σ (lower case sigma). It is defined as the root-
mean-squar (RMS) deviation of the values from their mean, or as the square root
of the variance.
A Square Root of a number x is a number r such that r2 = x, or in words, a
number r whose square (the result of multiplying the number by itself) is x. Every
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
66

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 67 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
non-negative real number x has a unique non-negative square root, called the
principal square root and denoted with a radical symbol as √x. For example, the
principal square root of 9 is 2, denoted √9 = 3, because 32 = 3 × 3 = 9. If otherwise
unqualified, \"the square root\" of a number refers to the principal square root: the
square root of 2 is approximately 1.414
a. Standard Deviation:
 Step 1: find the arithmetic mean (or average) of 4 and 8, (4 + 8) / 2 = 6.
 Step 2: find the deviation of each number from the mean, 4 − 6 = − 2, 8 − 6 =
2.
 Step 3: square each of the deviations (amplifying larger deviations and
making negative values positive), ( − 2)2 = 4, 22 = 4.
 Step 4: sum the obtained squares (as a first step to obtaining an average), 4
+ 4 = 8.
 Step 5: divide the sum by the number of values, which here is 2 (giving an
average), 8 / 2 = 4.
 Step 6: take the non-negative square root of the quotient (converting squared
units back to regular units), _/ 4 = 2
So, the standard deviation of the set is 2.
Flag: Interval or Ratio data.
C. NORMAL DISTRIBUTION: -
Also called the Gaussian distribution, is an important family of continuous
probability distributions, applicable in many fields. Each member of the family may
be defined by two parameters, location and scale: the mean (\"average\", μ) and
variance (standard deviation squared) σ2, respectively. The standard normal
distribution is the normal distribution with a mean of zero and a variance of one
(the red curves in the plots to the right). Carl Friedrich Gauss became associated
with this set of distributions when he analysed astronomical data using them, and
defined the equation of its probability density function. It is often called the bell
curve because the graph of its probability density resembles a bell.
 Frequency of scores decreases further from the mean.
 68% of scores fall within +1 or -1 SD of mean
 95% of scores fall within +2 or -2 SD of mean.
 99% of scores fall within +3 or -3 SD of mean.
I. PERCENTILES:
Is the value of a variable below, which a certain percent of observations
fall. So the 20th percentile is the value (or score) below which 20 percent
of the observations may be found. The term percentile and the related term
percentile rank are often used in descriptive statistics as well as in the
reporting of scores from norm-referenced tests.
The 25th percentile is also known as the first quartile; the 50th percentile
as the median.
II. QUARTILES:
Is any of the three values which divide the sorted data set into four equal parts,
so that each part represents 1/4th of the sampled population.
Thus:
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
67

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 68 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
 First quartile (designated Q1) = lower quartile = cuts off lowest 25% of data
= 25th percentile
 Second quartile (designated Q2) = median = cuts data set in half = 50th
percentile
 Third quartile (designated Q3) = upper quartile = cuts off highest 25% of
data, or lowest 75% = 75th percentile
The difference between the upper and lower quartiles is called the interquartile
range.
There is no universal agreement on choosing the quartile values.
Use the median to divide the ordered data set into two halves. Do not include
the median into the halves.
The lower quartile value is the median of the lower half of the data. The upper
quartile value is the median of the upper half of the data.
The examples below assume this rule.
Example:
 Data Set: 6, 47, 49, 15, 42, 41, 7, 39, 43, 40, 36
 Ordered Data Set: 6, 7, 15, 36, 39, 40, 41, 42, 43, 47, 49
 Q1: 15
 Q2: 40
 Q3: 43
15.10.2 INFERENTIAL STATISTICS:
1. Standard Error Of Measurement:
2. Test of Significance:
Probability - is the likelihood or chance that something is the case or will happen.
Probability theory is used extensively in areas such as statistics, mathematics, science and
philosophy to draw conclusions about the likelihood of potential events and the underlying
mechanics of complex systems.
 Value of P.
 Commonly Set 0.05 or 0.01
A. DEGREES OF FREEDOM:
I. ERRORS:
1. STANDARD ERROR:
Of a method of measurement or estimation is the estimated standard deviation
of the error in that method. Specifically, it estimates the standard deviation of
the difference between the measured or estimated values and the true values.
Notice that the true value of the standard deviation is usually unknown and the
use of the term standard error carries with it the idea that an estimate of this
unknown quantity is being used. It also carries with it the idea that it measures,
not the standard deviation of the estimate itself, but the standard deviation of
the error in the estimate, and these can be very different.
2. TYPE I ERROR:
Also known as an \"error of the first kind\", an α error, or a \"false positive\": the
error of rejecting a null hypothesis when it is actually true. Plainly speaking, it
occurs when we are observing a difference when in truth there is none.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
68

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 69 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
A false positive normally means that a test claims something to be positive,
when that is not the case. For example, a pregnancy test with a positive result
(indicating that the woman taking the test is pregnant) has produced a false
positive in the case where the woman is not pregnant.
3. TYPE II ERROR:
Also known as an \"error of the second kind\", a β error, or a \"false negative\":
the error of failing to reject a null hypothesis when the alternative hypothesis is
the true state of nature. In other words, this is the error of failing to observe a
difference when in truth there is one. This type of error can only occur when
the statistician fails to reject the null hypothesis. In the example of a pregnancy
test, a type II error occurs if the test reports false when the woman is, in fact,
pregnant.
15.10.3 PARAMETRIC STATISTICS: (INTERVAL AND RATIO DATA)
A. ASSUMPTIONS:
Normal distribution of data. Equality of variances. Samples may be independent or
dependent, depending on the hypothesis and the type of samples:
Independent samples are usually two randomly selected groups
 Dependent samples are either two groups matched on some variable (for example,
age) or are the same people being tested twice (called repeated measures)
 Since all calculations are done subject to the null hypothesis, it may be very
difficult to come up with a reasonable null hypothesis that accounts for equal
means in the presence of unequal variances. In the usual case, the null hypothesis
is that the different treatments have no effect — this makes unequal variances
untenable. In this case, one should forgo the ease of using this variant afforded by
the statistical packages.
B. T-TEST
The t-test assesses whether the means of two groups are statistically different from
each other. This analysis is appropriate whenever you want to compare the means of
two groups.
I. T-TEST FOR INDEPENDENT SAMPLES:
The t-test is the most commonly used method to evaluate the differences in means
between two groups. For example, the t-test can be used to test for a difference in
test scores between a group of patients who were given a drug and a control group
who received a placebo. Theoretically, the t-test can be used even if the sample
sizes are very small (e.g., as small as 10; some researchers claim that even
smaller n's are possible), as long as the variables are normally distributed within
each group and the variation of scores in the two groups is not reliably different. As
mentioned before, the normality assumption can be evaluated by looking at the
distribution of the data (via histograms) or by performing a normality test. The
equality of variances assumption can be verified with the F test, or you can use the
more robust Levene's test. If these conditions are not met, then you can evaluate
the differences in means between two groups using one of the nonparametric
alternatives to the t- test.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
69

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 70 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
II. T-TEST FOR NONINDEPENDENT SAMPLES:
Within-group Variation. As explained in Elementary Concepts, the size of a relation
between two variables, such as the one measured by a difference in means
between two groups, depends to a large extent on the differentiation of values
within the group. Depending on how differentiated the values are in each group, a
given \"raw difference\" in group means will indicate either a stronger or weaker
relationship between the independent (grouping) and dependent variable. For
example, if the mean WCC (White Cell Count) was 102 in males and 104 in
females, then this difference of \"only\" 2 points would be extremely important if all
values for males fell within a range of 101 to 103, and all scores for females fell
within a range of 103 to 105; for example, we would be able to predict WCC pretty
well based on gender. However, if the same difference of 2 was obtained from very
differentiated scores (e.g., if their range was 0-200), then we would consider the
difference entirely negligible. That is to say, reduction of the within-group variation
increases the sensitivity of our test.
III. ONE-TAILED T-TEST:
If the null hypothesis is rejected only for values of the test statistic falling into one
specified tail of its sampling distribution. There are really two different one-tailed t-
tests, one for each tail. In a one-tailed t-test, all the area associated with a is
placed in either one tail or the other. Selection of the tail depends upon which
direction to be would be (+ or -) if the results of the experiment came out as
expected. The selection of the tail must be made before the experiment is
conducted and analysed. If you are using a significance level of .05, a one-tailed
test allots your entire alpha to testing the statistical significance in the one direction
of interest. This means that .05 is in one tail of the distribution of your test statistic.
When using a one-tailed test, you are testing for the possibility of the relationship in
one direction and completely disregarding the possibility of a relationship in the
other direction. Let's return to our example comparing the mean of a sample to a
given value x using a t-test. Our null hypothesis is that the mean is equal to x. A
one-tailed test will test either if the mean is significantly greater than x or if the
mean is significantly less than x, but not both. Then, depending on the chosen tail,
the mean is significantly greater than or less than x if the test statistic is in the top
5% of its probability distribution or bottom 5% of its probability distribution, resulting
in a p-value less than 0.05. The one-tailed test provides more power to detect an
effect in one direction by not testing the effect in the other direction.
IV. TWO-TAILED T-TEST:
if the null hypothesis is rejected for values of the test statistic falling into either tail
of its sampling distribution. A two-tailed t-test divides a in half, placing half in the
each tail. The null hypothesis in this case is a particular value, and there are two
alternative hypotheses, one positive and one negative. The critical value of t, tcrit,
is written with both a plus and minus sign (± ). For example, the critical value of t
when there are ten degrees of freedom (df=10) and a is set to .05, is tcrit= ± 2.228.
If you are using a significance level of 0.05, a two-tailed test allots half of your
alpha to testing the statistical significance in one direction and half of your alpha to
testing statistical significance in the other direction. This means that .025 is in each
tail of the distribution of your test statistic. When using a two-tailed test, regardless
of the direction of the relationship you hypothesize, you are testing for the
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
70

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 71 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
possibility of the relationship in both directions. For example, we may wish to
compare the mean of a sample to a given value x using a t-test. Our null
hypothesis is that the mean is equal to x. A two-tailed test will test both if the mean
is significantly greater than x and if the mean significantly less than x. The mean is
considered significantly different from x if the test statistic is in the top 2.5% or
bottom 2.5% of its probability distribution, resulting in a p-value less than 0.05.
a. When is a one-tailed test appropriate?
Because the one-tailed test provides more power to detect an effect, you
may be tempting to use a one-tailed test whenever you have a hypothesis
about the direction of an effect. Before doing so, consider the consequences of
missing an effect in the other direction. Imagine you have developed a new
drug that you believe is an improvement over an existing drug. You wish to
maximize your ability to detect the improvement, so you opt for a one-tailed
test. In doing so, you fail to test for the possibility that the new drug is less
effective than the existing drug. The consequences in this example are
extreme, but they illustrate a danger of inappropriate use of a one-tailed test.
So when is a one-tailed test appropriate? If you consider the
consequences of missing an effect in the untested direction and conclude that
they are negligible and in no way irresponsible or unethical, then you can
proceed with a one-tailed test. For example, imagine again that you have
developed a new drug. It is cheaper than the existing drug and, you believe, no
less effective. In testing this drug, you are only interested in testing if it less
effective than the existing drug. You do not care if it is significantly more
effective. You only wish to show that it is not less effective. In this scenario, a
one-tailed test would be appropriate.
b. When is a one-tailed test not appropriate?
Choosing a one-tailed test for the sole purpose of attaining significance is
not appropriate. Choosing a one-tailed test after running a two-tailed test that
failed to reject the null hypothesis is not appropriate, no matter how \"close\" to
significant the two-tailed test was. Using statistical tests inappropriately can
lead to invalid results that are not replicable and highly questionable--a steep
price to pay for a significance star in your results table!
C. ANOVA - ANALYSIS OF VARIANCE:
A statistical technique which helps in making inference whether three or more samples
might come from populations having the same mean; specifically, whether the
differences among the samples might be caused by chance variation. A collection of
statistical models, and their associated procedures, in which the observed variance is
partitioned into components due to different explanatory variables. A test used to
compare 3 or more independent treatment groups. The initial techniques of the
analysis of variance were developed by the statistician and geneticist R. A. Fisher in
the 1920s and 1930s, and is sometimes known as Fisher's ANOVA or Fisher's analysis
of variance, due to the use of Fisher's F-distribution as part of the test of statistical
significance.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
71

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 72 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
I. ONE-WAY ANOVA:
One-factor ANOVA, also called one-way ANOVA is used when the study
involves 3 or more levels of a single independent variable. For example we might
look at average test scores for students exposed to one of three different teaching
techniques (three levels of a single independent variable). is used to test for
differences among two or more independent groups. Typically, however, the One-
way ANOVA is used to test for differences among at least three groups, since the
two-group case can be covered by a T-test (Gossett, 1908). When there are only
two means to compare, the T-test and the F-test are equivalent; the relation
between ANOVA and t is given by F = t2.
Factorial ANOVA: is used when the experimenter wants to study the effects of
two or more treatment variables. The most commonly used type of factorial
ANOVA is the 2×2 (read: two by two) design, where there are two independent
variables and each variable has two levels or distinct values. Factorial ANOVA can
also be multi-level such as 3×3, etc. or higher order such as 2×2×2, etc. but
analyses with higher numbers of factors are rarely done because the calculations
are lengthy and the results are hard to interpret.
II. WHY NOT JUST USE THE T-TEST?
The t-test tells us if the variation between two groups is \"significant\". Why not just
do t-tests for all the pairs of locations, thus finding, for example, that leaves from
median strips are significantly smaller than leaves from the prairie, whereas
shade/prairie and shade/median strips are not significantly different. Multiple t-tests
are not the answer because as the number of groups grows, the number of needed
pair comparisons grows quickly. For 7 groups there are 21 pairs. If we test 21 pairs
we should not be surprised to observe things that happen only 5% of the time.
Thus in 21 pairings, a P=.05 for one pair cannot be considered significant. ANOVA
puts all the data into one number (F) and gives us one P for the null hypothesis.
D. ANCOVA - ANALYSIS OF COVARIANCE:
Is a general linear model with one continuous explanatory variable and one or
more factors. ANCOVA is a merger of ANOVA and regression for continuous variables.
ANCOVA tests whether certain factors have an effect after removing the variance for
which quantitative predictors (covariates) account. The inclusion of covariates can
increase statistical power because it accounts for some of the variability.
Analysis of covariance is a more sophisticated method of analysis of variance. It is
based on inclusion of supplementary variables (covariates) into the model. This lets
you account for inter-group variation associated not with the \"treatment\" itself, but with
covariate(s).
Suppose you analyze the results of a clinical trial of three types of treatment of a
disease - \"Placebo\", \"Drug 1\", and \"Drug 2\". The results are three sets of survival
times, corresponding to patients from the three treatment groups. The question of
interest is whether there is a difference between the three types of treatment in the
average survival time.
You might use analysis of variance to answer this question. But, if you have
supplementary information, for example, each patient's age, then analysis of
covariance allows you to adjust the treatment effect (survival time, in this case) to a
particular age, say, the mean age of all patients. Age in this case is a \"covariate\" - it is
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
72

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 73 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
not related to treatment, but can affect the survival time. This adjustment allows you to
reduce the observed variation between the three groups caused not by the treatment
itself but by variation of age.
If the covariate(s) are associated with the treatment effect, then analysis of
covariance may have more power than analysis of variance.
I. WHAT IS THE DIFFERENCE BETWEEN ANOVA AND ANCOVA?
 The independent and dependent variable structures for Multiple Regression,
factorial ANOVA, and ANCOVA tests are similar. ANCOVA is differentiated
from the other two in that it is used when the researcher wants to neutralize the
effect of a continuous independent variable in the experiment. The researcher
may simply not be interested in the effect of a given independent variable
when performing a study.
 Another situation where ANCOVA should be applied is when an independent
variable has a strong correlation with the dependent variable, but does not
interact with other independent variables in predicting the dependent variable’s
value. ANCOVA is used to neutralize the effect of the more powerful, non-
interacting variable. Without this intervention measure, the effects of interacting
independent variables can be clouded.
 HCI Example:
 Nass and Lee perform a study of the effect of various Text-to-Speech (TTS)
interfaces on user behaviour. In the study, subjects view information about 5
books on a retail web site. In addition, they listen to TTS reviews for each book
and answer questions about the book reviewer. The researchers manipulate
the TTS in each condition so that it either sounds like the speech of an
extroverted person or introverted person. Extrovert speech is characterized by
higher and more diverse pitch, a faster rate, and louder volume.
 The researchers postulate subjects will find the book reviewer more credible if
the TTS interface personality of the audio review reflects their own personality
style. When analysing the results, the researchers believe the subject’s gender
also has a bearing on the subject’s assessment of the book reviewer. They use
ANCOVA to control the effect of gender, which allows them to just compare the
subject’s extrovert/introvert preference to the TTS extrovert/introvert style. The
team also conducts a factorial ANOVA test to see if the results differ from
ANCOVA, and they do not. Because both results were the same, gender did
not actually have a bearing on subject behaviour.
 ANCOVA is actually not the best statistical test for the Nass and Lee
experiment. A better test would have been two-way ANOVA. Two-way ANOVA
has a utility that allows the researcher to check if the independent variables
interact to predict the dependent variable. Further, an auxiliary technique is
available to neutralize the effect of a variable in two-way ANOVA if unwanted
interaction exists. ANCOVA is applied correctly when the neutralized
independent variable is measured on a continuous scale. In the Nass and Lee
experiment, gender, a categorical variable, is neutralized, so ANCOVA is not
the proper instrument.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
73

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 74 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
E. NON-PARAMETRIC STATISTICS:
Tests based on Ordinal and Nominal Data. does not depend on the population
fitting any parametrized distributions. Order statistics are one example of such a
statistic that plays a central role in many non-parametric approaches.
Non-parametric methods are widely used for studying populations that take on a
ranked order (such as movie reviews receiving one to four stars). The use of non-
parametric methods may be necessary when data has a ranking but no clear numerical
interpretation, such as when assessing preferences.
As non-parametric methods make fewer assumptions, their applicability is much
wider than the corresponding parametric methods. In particular, they may be applied in
situations where less is known about the application in question. Also, due to the
reliance on fewer assumptions, non-parametric methods are more robust.
Another justification for the use of non-parametric methods is simplicity. In certain
cases, even when the use of parametric methods is justified, non-parametric methods
may be easier to use. Due both to this simplicity and to their greater robustness, some
statisticians as leaving less room for improper use and misunderstanding see non-
parametric methods.
A histogram is a simple nonparametric estimate of a probability distribution.
I. CHI SQUARE:
 There are basically two types of random variables and they yield two types of
data: numerical and categorical. A chi square (X2) statistic is used to
investigate whether distributions of categorical variables differ from one
another. Basically categorical variable yield data in the categories and
numerical variables yield data in numerical form. Responses to such questions
as \"What is your major?\" or Do you own a car?\" are categorical because they
yield data such as \"biology\" or \"no.\" In contrast, responses to such questions
as \"How tall are you?\" or \"What is your G.P.A.?\" are numerical. Numerical data
can be either discrete or continuous.
 The Chi Square statistic compares the tallies or counts of categorical
responses between two (or more) independent groups. (note: Chi square tests
can only be used on actual numbers and not on percentages, proportions,
means, etc.)
 Pearson Chi-Square Test - There are several kinds of chi-square tests but the
most common is the Pearson chi-square test which allows us to test the
independence of two categorical variables. All chi-square tests are based upon
a chi-square distribution, similar to the way a t-test is based upon a t
distribution or an F-test is based upon an F distribution.
 Chi-Square Example
Suppose we have a hypothesis that the pass/fail rate in a particular
mathematics class is different for male and female students. Say we take a
random sample of 100 students and measure both gender (male/female) and
class status (pass/fail) as categorical variables.
 The data for these 100 students can be displayed in a contingency table, also
known as a cross-classification table. A chi-square test can be used to test the
null hypothesis (i.e., that the pass/fail rate is not different for male and female
students).
 Chi-Square Statistic
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
74

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 75 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Just as in a t-test, or F-test, there is a particular formula for calculating the chi-
square test statistic. This statistic is then compared to a chi-square distribution
with known degrees of freedom in order to arrive at the p-value.
 We use the p-value to decide whether or not we can reject the null hypothesis.
If the p-value is less than \"alpha\" which is typically set at .05, then we can
reject the null hypothesis, and in this case, we say that our data indicates that
the likelihood of passing the class is related to the student's gender.
F. CORRELATIONAL STATISTICS:
(Often measured as a correlation coefficient), indicates the strength and direction
of a linear relationship between two random variables. In general statistical usage,
correlation or co-relation refers to the departure of two variables from independence. In
this broad sense there are several coefficients, measuring the degree of correlation,
adapted to the nature of data.
In statistical data analysis we sometimes use a correlation coefficient to quantify
the linear relationship between two variables.
So far, you have been reading about statistics that describe sets of data. In many
research studies, psychologists might want to know the extent to which two variables
are related. Co relational statistics do just that. Co relational statistics yield a number
called the coefficient of correlation. The coefficient may vary from 0.00 to 1.00.
Correlations may also be either positive or negative. In a positive correlation, scores on
two different variables increase and decrease together. For example, there is a positive
correlation between high school average and freshmen grade point average in college.
In a negative correlation, as scores for one variable decrease, they increase for the
other variable. For example, there is a negative correlation between absenteeism and
course performance. The strength of a correlation depends on its size, not its sign. For
example, a correlation of -.72 is stronger than a correlation of +.53.
Co relational statistics are important because they permit us to determine the
strength and direction of the relationship between different sets of data or to predict
scores on one distribution based on our knowledge of scores on another. If the
correlation between two sets of data were a perfect 1.00, we could predict one score
from another with complete accuracy. But because correlations are almost always less
than perfect, we predict one score from another only with a particular probability of
being correct--the higher the correlation, the higher the probability.
It cannot be stressed strongly enough that correlation does not mean causation.
For example, years ago, authorities presumed that autistic children, who have poor
social and communication skills, were caused by “refrigerator mothers.” Mothers of
autistic children were aloof from them. This was taken as a sign that the children
suffered from mothers who were emotionally cold. Knowing that this is simply a
correlation, you might wonder whether causality was in the opposite direction. Perhaps
autistic children, who do not respond to their mothers, cause their mothers to become
aloof from them. Moreover, why would a mother have several normal children, then an
autistic child, and then several more normal ones? It would be difficult to believe she
was a warm parent to all but one. Today, evidence indicates that autism is a
neurological problem that has nothing to do with the mother’s emotionality.
As another example, although there is a positive correlation between smoking and
cancer in human beings, this correlation is not scientifically acceptable evidence that
smoking causes cancer. Perhaps another factor (such as a level of stress tolerance)
might make someone prone to both smoking and cancer, without smoking’s
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
75

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 76 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
necessarily causing cancer. Of course, correlation does not imply the absence of
causation. For example, there may indeed be a causal relationship between smoking
and cancer. The point is that if two variables are strongly correlated, one of the
variables may cause the other, or there may not be a causal link--we just cannot tell
from sure based on a correlation coefficient. But remember that knowing that two
variables are related is still an important piece of information.
G. PEARSON PRODUCT-MOMENT COEFFICIENT:
(Sometimes referred to as the MCV or PMCC) (r) is a common measure of the
correlation between two variables X and Y. When measured in a population the
Pearson Product Moment correlation is designated by the Greek letter rho (ρ). When
computed in a sample, it is designated by the letter r and is sometimes called
\"Pearson's r.\" Pearson's correlation reflects the degree of linear relationship between
two variables. It ranges from +1 to -1. A correlation of +1 means that there is a perfect
positive linear relationship between variables. A correlation of -1 means that there is a
perfect negative linear relationship between variables. A correlation of 0 means there is
no linear relationship between the two variables. Correlations are rarely if ever 0, 1, or -
2. A certain outcome could indicate whether correlations are negative or positive.
I. CORRELATION COEFFICIENT:
The Pearson correlation coefficient is a number between -1 and +1 that
measures both the strength and direction of the linear relationship between two
variables.
The magnitude of the number represents the strength of the correlation. A
correlation coefficient of zero represents no linear relationship (the scatter plot
does not resemble a straight line at all), while a correlation coefficient of -1 or +1
means that the relationship is perfectly linear (all of the dots fall exactly on a
straight line).
The sign (+/-) of the correlation coefficient indicates the direction of the
correlation. A positive (+) correlation coefficient means that as values on one
variable increase, values on the other variable tend to also increase; a negative (-)
correlation coefficient means that as values on one variable increase, values on
the other tend to decrease, that is, they tend to go in opposite directions.
Flag: Interval or Ratio Data
II. SPEARMAN'S RANK CORRELATION COEFFICIENT:
Is a non-parametric measure of correlation – that is, it assesses how well an
arbitrary monotonic function could describe the relationship between two variables,
without making any assumptions about the frequency distribution of the variables.
 Flag: Ordinal Data.
III. COMMON VARIANCE:
Variance in a variable shared with common factors. Factor analysis assumes that a
variable's variance is composed of three components: common, specific and error.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
76

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 77 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
15.11 SAMPLE RESEARCH TEST:
Scientific Method Worksheet Directions:
For each problem below, identify the independent and dependent variables. Also identify the
control and experimental group. Note that in some examples there are more than one independent
and dependent variable. (DV) Dependent Variable; (IV) Independent Variable; (CG) Control Group;
(EG) Experimental Group.
1. In an experiment, a scientist is interested in the effect of a drug on reaction time. She has four
groups: group 1 gets no drug, 2 gets a low dose of the drug, 3 gets a medium dose and 4 gets
a high dose. She then measures blood levels of the drug and the reaction time in a driving task.
DV__________________________IV__________________________
CG__________________________EG__________________________
2. You're conducting an experiment to determine the effect of a new drug on the incidence of
epileptic seizures. You select 20 epileptics from the 150 epileptics being treated at the nearby
hospital. 10 receive the new drug, and 10 don't. You record the number of seizures for each
subject for one month. DV__________________________IV__________________________
CG__________________________EG__________________________
3. An educator conducts an experiment to determine if the mode of presentation affects how well
prose material is remembered. 75 students form the sample. 25 receive prose passages
auditorily, 25 receive the prose visually (in a book), and 25 watch a videotape of the prose on
the screen while someone reads it. At the end of their respective presentations, the subjects
are asked to write down as much of the material as they can remember. The educator then
counts the number of words remembered by each person.
DV__________________________IV__________________________
CG__________________________EG__________________________
4. A clinical psychologist is interested in examining whether sons of alcoholic fathers react
differently to the ingestion of alcohol. Four hundred subjects are placed randomly into one of
four groups: #1 receives water, #2 receives two shots of vodka, #3 receives four shots of
vodka, and Group 4 receives six shots of vodka. EEG activity (electrical activity recorded from
the brain) is recorded and quantified in terms of average number of cycles per second. In
addition, each subject performs a short math test which the psychologist scores.
DV__________________________IV__________________________
CG__________________________EG_________________________
5. A social psychologist is interested in the effects of cooperation in reducing prejudice. 100
subjects are assigned to work with someone of their own race or someone of another race. In
addition, they are also assigned to a condition where they work with their partner in a
cooperative task or in a competitive task. At the end of the experiment subjects are asked to
rate how much they like their partner.
DV__________________________IV__________________________
CG__________________________EG__________________________
6. A member of a concerned parents group wants to know what the effects of music are on
children's academic performance. She finds 30 families willing to play only one kind of music
for a month in the house. Fifteen families only play Nine Inch Nails albums during the month,
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
77

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 78 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
whereas the other 15 play only recordings of Schubert piano Impromptus during the month. At
the end of the month, the researcher finds out what grade the student is currently earning in
math, English, and social studies.
DV__________________________IV__________________________
CG__________________________EG__________________________
7. A personality researcher measures shyness in 200 people. He then selects the 100 people
highest in shyness and the 100 people lowest in shyness and investigates their behavior in a
social situation. In this situation each subject (assume they are all heterosexual for this
example) must approach someone of the opposite sex on the street and ask him or her for a
date. The researcher then measures the length of time it takes for the subject to make the
request. DV__________________________IV__________________________
CG__________________________EG__________________________
POST YOUR ANSWERS Using the COMMMENT button below.
Answers will be available later...:)
Excerpt From: http://www.iss.k12.nc.us/schools/shs/jmcCartney/intrsci.html#Answers
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
78

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 79 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
79

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 80 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
16.0 PATHOLOGICAL:
16.1 PHYSIOTHERAPY IN HIV:
16.1.1 ISSUES:
It has been long observed that multisystem pathology of the HIV/AIDS disease necessitates
longer hospital stay. Complications such as muscle wastage, contractures, bedsores, stiff
joints delays the discharge or relieve. This clearly establishes a need for physiotherapeutic
care, in resource poor economies such as India.
Kaposi's sarcoma is the most common form of cancer in patients with human
immunodeficiency virus (HIV) infection. Although Kaposi sarcoma lesions may contribute to
significant physical impairments, there is a lack of scientific literature detailing the role of
physiotherapy in the treatment of HIV-associated Kaposi's sarcoma.
16.1.2 DESCRIPTION:
 Quality of health care delivery has had a direct impact in the reduction in mortality factors.
Most often the hospital care for People with HIV/AIDS (PWHA) is confined to lifesaving
and immediate care, often complications leading to disability are ignored. A program was
designed with the belief that extended life with treatment should include quality.
 Physiotherapeutic care was provided in the care regime for a wide range of problems
arising from neurological,
 Musculoskeletal,
\"HIV_AIDS  Respiratory and painful syndromes.
Programme.pdf\"  Observations in care settings have confirmed that physiotherapy as an intervention can
avoid complications and promote speedy recovery. It has changed the distorted body
image due to weight loss by progressive resisted exercises and pain management by
electrotherapy. The intervention has indeed accelerated early discharge of individuals.
 Early physiotherapy intervention will be more effective and can be given in any HIV care
settings and also at any physiotherapy units without any additional investment.
Physiotherapy reduces hospital stay and the individual will be discharged in a functionally
independent state.
16.1.3 RECOMMENDATIONS:
Physiotherapy should be included in the HIV/AIDS care manifesto. Early intervention should
be made available. Patient education and awareness among health care fraternity about the
potential benefits of physiotherapy is necessary in promoting appropriate referrals.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
80

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 81 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
16.2 STRUCTURAL KNEE PROBLEMS:
 Blount’s disease (3 to 8 years old; seldom otherwise)
 Excessive tibial vara (not genu). Not physiologic bowleg. Braces.
 Patellofemoral disease (peak early 10’s through early 20’s)
 Malalignment or subluxation. ~arthralgia (normal joint) ~arthrosis (joint degeneration). Movie theatre
knee. No significant swelling, pain anterior with prolonged sitting. Patellofemoral pain; not balottable,
no joint effusion. Strengthening of quadriceps, stretching of hamstrings. SAQ (isotonic) in OKC or
CKC. Patella cutout brace.
 Meniscal tears (early teens to mid 50’s)
 Young: frank tears. Older: degeneration. Clicking, locking, giving way. Swelling means joint damage.
Sometimes cortisone injection: short term reduction of inflammation and pain. Repair of removal of
part of meniscus. When locking advise use of crutches. Popliteal cysts in adults (usually medial)
usually result from meniscal tear that causes a hole in capsule through which synovial fluid leaks.
Treatment aims at meniscal tear.
 Chronic ligament injuries (peaks mid teens to late 30’s or 40’s)
 ACL, MCL most often involved. Giving way with turning, laxity of knee joint, joint swelling after activity
(also maybe due to meniscal tears). Anterior drawer sign effusion and med tenderness. Autograft or
allograft. ACL reconstruction.
 Gonarthrosis (uncommon before age 55 and 60)
 Gradual onset of pain during walking, climbing stairs and nightly after activity. Capsular pattern.
Inflammation and effusion can be absent due to limited use of joint. Severe: crepitus and pain with
movement. NSAID and exercise (aquatic, quadriceps). Unicompartmental knee replacement,
osteotomy, TKA.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
81

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 82 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
16.3 STRUCTURAL HIP PROBLEMS:
 Developmental dysplasia (newborns in the west)
 Pavlik harness, Ortolani sign, Barlow test
 Legg-Calvé-Perthes disease (4 to 10 years)
 Osteochondritis, avascular necrosis of epiphysis. Orthosis to keep head in acetabulum.
 Slipped capital femoral epiphysis (children and adolescents; peak 10 to 15 years)
 No IR possible. Pinning of epiphysis
 Osteonecrosis (20’s but more in 30’s and 40’s)
 Compromise of bloodsupply. Decompression/vascularized fibula grafting to the femoral head. When
collapse of head, THA.
 DJD (early 40’s)
 Groin pain, lateral hip pain. Limitation of bending. Capsular pattern. Cane use. THA or in young
patients osteotomy. NSAID.
 Hip fracture
 Femoral neck or intertrochanteric. Usually immediately diagnosed. Sometimes missed less
immobilizing fractures. MRI for these patients.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
82

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 83 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
16.4 DISORDERS AND DISEASES:
 M. Paget = Paget's disease of bone is a chronic skeletal disorder which may result in enlarged or
deformed bones in one or more regions of the skeleton. Excessive bone breakdown and formation can
result in bone which is dense but fragile. Pain is the most common symptom. Complications may
include arthritis, fractures, bowing of limbs and hearing loss if Paget's disease affects the skull.
Though the causes are not known, medical therapies are available to manage the disease.
 M. Scheuermann = a condition in which the normal roundback in the upper spine (called a kyphosis) is
increased. Most people with Scheuermann's disease will have an increased roundback (e.g. a hunch
back or hump back) but no pain.
 Syndr Klippel Feil = Type I is described as a massive fusion of the cervical spine. Type II is present
when the fusion of 1 or 2 vertebrae occurs. Type III occurs when thoracic and lumbar spine anomalies
are associated with type I or type II Klippel-Feil syndrome.
 Osgood Schlatter = A common form of growing pains or overuse in early adolescence involves the
shinbone and the knee.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
83

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 84 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
16.5 MEDS:
 Coumadin = Thrombosis profylaxe/treatment
 Celebrex = Pain relief for osteoarthritis
 Catapress = Treatment of hypertension. Vasodilitation and lowers HR.
 Habitrol = Chewing gum or skin patch to help stop smoking
 Nitrodur= A volatile vasodilator which relieves ANGINA PECTORIS by stimulating GUANYLATE
CYCLASE and lowering cytosolic calcium.
 Sulfonamide = Antibiotic
 Norixin = Antibacterial drug used for urinary tract infections, STD and prostatitis.
 Bactrim = Antibiotic. Treatment of different infections.
 Elavil = Tricyclic antidepressant
 Calcitonin = Hormone which plays role in suppressing bone resorption. Indictated with hypercalcemia,
M.Paget and certain types of Osteoporosis.
 Pergolide = Dopamine agonist used for Parkinson treatment. = Calcium channel blocker. Used to
control HBP and Angina Pectoris.
 Pentoxifylline = Decreses viscocity of blood to improve blood flow.
 Ciprofloxacin = an antibiotic used to treat certain infections caused by bacteria.
 Lepirudin = Lepirudin is indicated for anticoagulation in patients with heparin-induced
thrombocytopenia and associated thromboembolic disease in order to prevent further thromboembolic
complications.
 Naproxen = NSAID. Pain relief and anti inflammatory.
 Bumex = Loop Dieuretic
 Digoxin = Decrease venous pressure
 Phenotiazines = Used to treat serious mental and emotional disorders, including schizophrenia and
other psychotic disorders. Some are used also to control agitation in certain patients, severe nausea
and vomiting, severe hiccups, and moderate to severe pain in some hospitalized patients.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
84

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 85 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
16.6 ALS AND MS:
ALS = Amyotrophic Lateral Sclerosis --> degeneration of motor neurons in the CNS
A-myo-trophic comes from the Greek language. \"A\" means no or negative. \"Myo\" refers to muscle, and
\"Trophic\" means nourishment---\"No muscle nourishment.\" When a muscle has no nourishment, it
\"atrophies\" or wastes away. \"Lateral\" identifies the areas in a person's spinal cord where portions of the
nerve cells that signal and control the muscles are located. As this area degenerates it leads to scarring or
hardening (\"sclerosis\") in the region. Symptoms: muscle weakness in one or more of the following: hands,
arms, legs or the muscles of speech, swallowing or breathing. Twitching (fasciculation) and cramping of
muscles, especially those in the hands and feet. Impairment of the use of the arms and legs, \"thick
speech\" and difficulty in projecting the voice. In more advanced stages, shortness of breath, difficulty in
breathing and swallowing
MS = thought to be an autoimmune disease that affects the central nervous system (CNS). In MS, myelin
is lost in multiple areas, leaving scar tissue called sclerosis. These damaged areas are also known as
plaques or lesions. Sometimes the nerve fibre itself is damaged or broken. Forms: Relapsing-remitting;
Primary progressive; Secondary progressive; Progressive relapsing. Common symptoms: Bladder
dysfunction, bowel dysfunction, cognitive function, dizziness and vertigo, depression and emotional
changes, fatigue, difficulty in walking, numbness, pain, sexual dysfunction, spasticity, vision problems,
16.7 DIABETES MELLITUS:
 Type I = IDDM
Inability of Pancreas to create insulin because of destruction of Beta cells. Withdrawal of insulin -->
ketosis or ketoacidosis will develop.
 Type II = NIDDM
Characterized by peripheral insulin resistance with an insulin-secretory defect that varies in severity.
 Normal Values
FBS: 70-99 mg/dl (< 5.5mmol/L)
2 hours after eating: 70-145 mg/dl (< 7.9 mmol/L)
RBS: 70-125 mg/dl (< 7.0 mmol/L)
 High
A FBS (Fasting Blood Sugar) level is 126 mg/dl (7.0 mmol/L) or higher
A 2-hour oral glucose tolerance test result is 200 mg/dl (11.1 mmol/L) or higher
RBS (Random Blood Sugar) level is 200 mg/dl and symptoms of diabetes are present
 Low
A fasting glucose level below 40 mg/dl (2.2 mmol/L in women or below 50 mg/dl (2.8 mmol/L) in men
that is accompanied by symptoms of hypoglycaemia may mean insulinoma, a tumor that produces
abnormally high amounts of insulin. Low levels can also be caused by: Addison¡¦s disease,
hypothyroidism, pituitary gland tumor, liver disease, kidney failure, malnutrition, DM medication.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
85

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 86 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
17.0 SAMPLE NPTE QUESTIONS:
1. A physiotherapist is performing an evaluation on a patient that has fallen off a fork lift and injured his right
arm. The patient was evaluated by an MD 3 days ago. The patient reports, \"Yesterday my arm started to go
numb and turned purple.” A poor arterial pulse is found in the arm upon evaluation. Which step should the
physiotherapist take first?
A: Notify the MD of the changes immediately
B: Begin light exercise program per MD orders
C: Apply E-stim and Ice to the extremity
D: Special test the right arm
2. A physiotherapist is reviewing a patient’s medication during an evaluation. Which of the following
medication would be contraindicated if the patient were pregnant?
A: Coumadin
B: Celebrex
C: Catapress
D: Habitrol
3. A physiotherapist is reviewing a patient’s PMH. The history indicates photosensitive reactions to
medications. Which of the following drugs has not been associated with photosensitive reactions?
A: Nitrodur
B: Sulfonamide
C: Noroxin
D: Bactrim
4. A patient has a diabetic ulcer on his right foot first ray region. The ulcer is in a chronic state of tissue
inflammation and the patient is extremely obese. The wound is not infected at this time; however the patient is
unable to ambulate at this time without applying pressure to the first ray region. Which of the following
interventions would be the most beneficial to the patient?
A: Whirlpool 10 minutes followed by sharps debridement
B: Have the patient fitted to offload pressures on the first ray in a week.
C: Review the role of glucose and tissue healing with the patient.
D: Have the patient perform NWB gait with Axillary crutches with the extremity.
5. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to
urinate. Which of the following would you most likely suspect?
A: Atherosclerosis
B: Diabetic nephropathy
C: Autonomic neuropathy
D: Somatic neuropathy
6. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat,
induced vomiting and severe constipation. Which of the following would you most likely suspect?
A: Multiple sclerosis
B: Anorexia nervosa
C: Bulimia
D: Systemic sclerosis
7. A patient has a Right T8 facet joint that has become extremely tight. Which of the following movements
with stretch the joint with the best technique?
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
86

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 87 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
A: L Trunk Rotation and Extension
B: L Trunk Rotation and Flexion
C: R Trunk Rotation and Extension
D: R Trunk Rotation and Flexion
8. A fifty-year-old blind and deaf patient has been assigned to you for evaluation. As the lead physiotherapist
your primary responsibility for this patient is?
A: Let others know about the patient’s deficits
B: Communicate with your supervisor your concerns about the patient’s deficits.
C: Continuously update the patient on the social environment.
D: Provide a secure environment for the patient.
9. Your patient is getting discharged from a SNF facility. The patient has a history of severe COPD and PVD.
The patient is primarily concerned about their ability to breath easily. Which of the following would be the best
instruction for this patient?
A: Deep breathing techniques to increase O2 levels.
B: Cough regularly and deeply to clear airway passages.
C: Cough following bronchodilator utilization
D: Decrease CO2 levels by increase oxygen take output during meals.
10. Which of the following is the best exercise to correct a Trendelenburg gait pattern?
A: Bridging
B: Bridging with Resisted Abduction
C: Bridging with Straight Leg Raise
D: Squats
11. A physiotherapist is caring for an infant that has recently been diagnosed with a congenital heart defect.
Which of the following clinical signs would most likely be present?
A: Slow pulse rate
B: Weight gain
C: Decreased systolic pressure
D: Irregular WBC lab values
12. A mother has recently been informed that her child has Down’s syndrome. You will be evaluating the
patient in the afternoon. Which of the following characteristics is not associated with Down’s syndrome?
A: Simian crease
B: Brachycephaly
C: Oily skin
D: Hypotonicity
13. A patient asks a physiotherapist, “My doctor recommended I increase my intake of folic acid. What type
of foods contain folic acids?”
A: Green vegetables and liver
B: Yellow vegetables and red meat
C: Carrots
D: Milk
14. A patient has developed trochanteric bursitis that has gone untreated for 5 weeks. The patient is 34
years old. Which of the following Ultrasound settings is most appropriate?
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
87

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 88 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
A: Pulsed US at 3MHz
B: Pulsed US at 1MHz
C: Continuous US at 3MHz
D: Continuous US at 1MHz
15. A child is 5 years old and has been recently admitted into the hospital. According to Erickson which of
the following stages is the child in?
A: Trust vs. mistrust
B: Initiative vs. guilt
C: Autonomy vs. shame
D: Intimacy vs. isolation
16. When you are taking a patient’s history, she tells you she has been depressed and is dealing with an
anxiety disorder. Which of the following medications would the patient most likely be taking?
A: Elavil
B: Calcitonin
C: Pergolide
D: Verapamil
17. A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see
with this patient if this condition were acute?
A: Decreased HR
B: Paresthesias
C: Muscle weakness of the extremities
D: Migranes
18. A patient’s chart indicates a history of meningitis. Which of the following would you not expect to see with
this patient if this condition were acute?
A: Increased appetite
B: Vomiting
C: Fever
D: Poor tolerance of light
19. A fragile 87 year-old female has recently been admitted to the hospital with increased confusion and falls
over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most
likely to be performed?
A: FBC (full blood count)
B: ECG (electrocardiogram)
C: Thyroid function tests
D: CT scan
20. A physiotherapist is evaluating an adult that has recently been diagnosed with hypokalemia. Which of
the following clinical signs would most likely not be present?
A: Leg cramps
B: Respiratory distress
C: Confusion
D: Flaccid paralysis
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
88

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 89 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
21. A physiotherapist is evaluating an adult that has recently been diagnosed with respiratory acidosis.
Which of the following clinical signs would most likely not be present?
A: CO2 Retention
B: Dyspnea
C: Headaches
D: Tachypnea
22. A physiotherapist is caring for an adult that has recently been diagnosed with respiratory alkalosis.
Which of the following clinical signs would most likely not be present?
A: Anxiety attacks
B: Dizziness
C: Hyperventilation cyanosis
D: Blurred vision
23. A physiotherapist is evaluating a patient that has had damage to the ulnar nerve. Which of the following
muscles would most likely show signs of weakness?
A: Soleus
B: Triceps
C: Brachioradialis
D: Adductor Pollicus
24. A physiotherapist is reviewing a patient’s medication list. The drug Pentoxifylline is present on the list.
Which of the following conditions is commonly treated with this medication?
A: COPD
B: CAD
C: PVD
D: MS
25. A patient has been on long-term management for CHF. Which of the following drugs is considered a loop
dieuretic that could be used to treat CHF symptoms?
A: Ciprofloxacin
B: Lepirudin
C: Naproxen
D: Bumex
26. A patient has recently been diagnosed with polio and has questions about the diagnosis. Which of the
following systems is most affected by polio?
A: PNS
B: CNS
C: Urinary system
D: Cardiac system
27. A physiotherapist is educating a patient about right-sided heart deficits. Which of the following clinical
signs is not associated with right-sided heart deficits?
A: Orthopnea
B: Dependent edema
C: Ascites
D: Nocturia
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
89

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 90 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
28. A physiotherapist is reviewing a patient’s medication. The patient is taking Digoxin. Which of the
following is not an effect of Digoxin?
A: Depressed HR
B: Increased CO
C: Increased venous pressure
D: Increased contractility of cardiac muscle
29. A patient’s chart indicates the patient is suffering from Digoxin toxicity. Which of the following clinical
signs is not associated with digoxin toxicity?
A: Ventricular bigeminy
B: Anorexia
C: Normal ventricular rhythm
D: Nausea
30. Which of the following is the key risk factor for development of Parkinson’s disease dementia?
A: History of strokes
B: Acute headaches history
C: Edward’s syndrome
D: Use of phenothiazines
31. A physiotherapist is working in an outpatient orthopedic clinic. During the patient's history the patient
reports, “I tore 3 of my 4 Rotator cuff muscles in the past.” Which of the following muscles cannot be
considered as possibly being torn?
A. Teres minor
B. Teres major
C. Supraspinatus
D. Infraspinatus
32. A physiotherapist working on an ICU unit, notices a patient is experiencing SOB, calf pain, and warmth
over the posterior calf. All of these may indicate which of the following medical conditions?
A. Patient may have a DVT.
B. Patient may be exhibiting signs of dermatitis.
C. Patient may be in the late phases of CHF.
D. Patient may be experiencing anxiety after surgery.
33. A physiotherapist is caring for a patient who has recently been diagnosed with fibromyalgia and COPD.
Which of the following tasks should the physiotherapist delegate to an aide?
A. Transferring the patient during the third visit.
B. Ambulating the patient for the first time.
C. Taking the patient's vital sign while setting up an exercise program.
D. Educating the patient on monitoring fatigue.
34. A physiotherapist is instructing a person who had a left CVA and right lower extremity hemiparesis to use
a quad cane. Which of the following is the most appropriate gait sequence?
A. Place the cane in the patient's left upper extremity, encourage cane, then right lower extremity, then left
upper extremity gait sequence.
B. Place the cane in the patient's left upper extremity, encourage cane, then left lower extremity, then right
upper extremity gait sequence.
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
90

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 91 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
C. Place the cane in the patient's right upper extremity, encourage cane, then right lower extremity, then left
upper extremity gait sequence.
D. Place the cane in the patient's right upper extremity, encourage cane, then left lower extremity, then right
upper extremity gait sequence.
35. A physiotherapist is returning phone calls in a pediatric clinic. Which of the following reports most requires
the physiotherapist's immediate attention and phone call?
A. A 8 year-old boy has been vomiting and appears to have slower movements and has a history of an atrio-
ventricular shunt placement.
B. A 10 year-old girl feels a dull pain in her abdomen after doing sit-ups in gym class.
C. A 7 year-old boy has been having a low fever and headache for the past 3 days that has history of an
anterior knee wound.
D. A 7 year-old girl that had a cast on her right ankle is complaining of itching.
36. A physiotherapist is caring for a patient in the step down unit. The patient has signs of increased
intracranial pressure. Which of the following is not a sign of increased intracranial pressure?
A. Bradycardia
B. Increased pupil size bilaterally
C. Change in LOC
D. Vomiting
37. The charge nurse on a cardiac unit tells you a patient is exhibiting signs of right-sided heart failure. Which
of the following would not indicate right-sided heart failure?
A. Nausea
B. Anorexia
C. Rapid weight gain
D. SOB (shortness of breath)
38. A patient has recently been diagnosed with symptomatic bradycardia. Which of the following medications
is the most recognized for treatment of symptomatic bradycardia?
A. Questran
B. Digitalis
C. Nitroglycerin
D. Atropine
39. Which of the following arterial blood gas values indicates a patient may be experiencing a condition of
metabolic acidosis?
A. PaO2 (91%)
B. Bicarbonate 159
C. CO(2) 48 mm Hg
D. pH 7.33
40. A patient has suffered a left CVA and has developed severe hemiparesis resulting in a loss of mobility.
The physiotherapist notices on assessment that an area over the patient's left elbow appears as non-
blanchable erythema and the skin is intact. The physiotherapist should score the patient as having which of
the following?
A. Stage I pressure ulcer
B. Stage II pressure ulcer
C. Stage III pressure ulcer
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
91

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 92 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
D. Stage IV pressure ulcer
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
92

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 93 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
3.2 ANATOMY AND PHYSIOLOGY ONLINE LEARNING CENTER:
Multiple Choice Quiz 1
http://images.google.com/imgres?imgurl=http://highered.mcgraw-
hill.com/sites/dl/free/0072507470/234422/mc_ch08_fig20.jpg&imgrefurl=http://highered.mcgraw-
hill.com/sites/0072507470/student_view0/chapter8/multiple_choice_quiz_1.html&usg=__XwlcG_IGd8
bZuIvqXaxc71ntVec=&h=301&w=395&sz=51&hl=en&start=61&um=1&tbnid=inCNmkl90CSfsM:&tbnh
=94&tbnw=124&prev=/images%3Fq%3DTrapeziometacarpal%26ndsp%3D18%26hl%3Den%26sa%
3DN%26start%3D54%26um%3D1
3.3 WOUND CARE DEFINITIONS FLASH CARDS:
http://www.proprofs.com/flashcards/cardshow.php?title=wound-care-definitions&quesnum=1
3.4 WOUND CARE TIPS AND DRESSINGS:
Wound Care - Types of Dressings
When Are The Different Types Of Dressings Used?
Note: The following is only meant to explain the typical use of each type of medical dressing. Always
consult a physician when treating any type of serious or chronic wound, or any wound that you are
unsure about.
When are Calcium Alginate dressings used?
Calcium Alginate are for moderate to heavy wounds, because of their superior absorption ability. For
lighter wounds, try a thinner, less heavy dressing.
When are charcoal dressings used?
Charcoal dressings are primarily used for odor control. They usually require cover dressing or tape to
secure it in place.
When are collagen dressings used?
Collagen would are used for several different types of wounds including: burns, pressure ulcers,
scrapes, cuts.
When are composite dressings used?
Composite dressings can be used on anything from light to heavy wounds. Use extra caution fi the
patient has dehydrated or sensitive skin. Consult with the manufacturer to make sure that the
dressing can be used on infected wounds. The skin around the wound must be intact if the dressing
has an adhesive border. Check your insurance company's guidelines about reimbursement for
composite dressings used as secondary dressing with impregnated gauze or hydrogel.
When are compression dressings used?
Compression dressings are used to control swelling and promote circulation. Particularly useful for
diabetic patients and people with poor circulation.
When are enzymatic debriders used?
Enzymatic debriders are used for wounds that have necrotic(dead) tissue that won't easily slough off.
Depending on the size of the wound, you may want to have a secondary dressing to catch excess
drainage.
When are foam dressing used?
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
93

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 94 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
Foam dressings are for first and second degree burns, skin tears, pressure ulcers, and abrasions and
other moderate to heavy draining wounds.
When are hydrocolloid dressings used?
Hydrocolloid dressings can be used for light to moderate acute and chronic wounds. If monitoring the
wound is important, make sure that the dressing is transparent. Do not use a hydrocolloid if the skin
surrounding the wound is infected.
When are hydrogels used?
Hydrogels are used for burns(including those caused by radiation) skins tears, surgical wounds, and
pressure ulcers. Because of the high water content in hydrogels, this type of dressing is used for
wounds with small to moderate amounts of drainage.
When are silicon gel sheetings used?
Silicone gel sheeting prevents the formation of excessive scar tissue, sometimes called keloids.
Silicone gel sheeting does this by preventing moisture from entering the scar area. If the moisture at
the scar area is reduced, then there is less blood flow, and consequently less collagen, at the scar
area. This reduction in collagen is important because collagen is the material that makes up scar
tissue. By reducing collagen at the scar area, the scar becomes paler, making the scar's color closer
to the color of your skin. If you are specifically interested in Cica Care Silicone Gel Sheeting, step-by-
step instructions for usage, as well as a \"Cica Care diary,\" are available on Smith & Nephew's
website.
When are transparent dressings used?
Transparent dressings are for light wounds and blisters. They are also useful for viewing the wound
without exposing it to bacteria.
I. FUNCTIONS OF THE LOWER EXTREMITY
Bipedalism is the process by which we are able to stand upright and to move about on 2 limbs
Bipedalism imparts three unique functions on the lower limbs. The limbs must
 Bear weight
 Provide a means for locomotion
 Maintain equilibrium.
The lower limbs are adapted for stability rather than range of motion and that stability is achieved at
most of the major joints of the lower limb through the use of strong ligaments and tight fitting bony
surfaces rather than the expenditure of energy in the form of muscle contraction.
A. Weight Bearing Properties
1. Support weight of head and torso with minimal expenditure of energy
2. Bony Features
a. Relatively large areas of articulation
b. Close pack fit of articular surfaces of bones involved in the formation of joints
i. Hip joint
c. Wide surface areas
i. Knee joint
d. Weight supporting arches
i. Arches of the foot
3. Ligaments
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
94

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 95 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
a. Strong
b. Maintain stable configuration
B. Center of Gravity:
1. Center of mass of body generally falls halfway between iliac crests and in front of second
sacral vertebra
2. Position
a. Posterior to hip joint
b. Anterior to knee joint
c. Anterior to ankle joint
C. Stability:
1. Position of joints during normal upright standing
a. Due to center of mass of body
2. Can be maintained while bearing weight with minimal expenditure of energy (muscle
contraction)
3. Stable position maintained through use of :
a. Ligaments
b. Close packing of joints
4. Position
a. Hip joint = extension
b. Knee joint = extension
c. Ankle joint = dorsiflexion
d. No ligamentous support
e. Foot = supinated position
II. Locomotion
A. Position of the Lower Extremity \"locomotor training
1. Weight bearing / Fixed machine based.pdf\"
a. Motion occurs with foot fixed to ground
b. Limb is in good position to support weight
2. Non weight bearing / Free
a. Foot is not in contact with the ground
b. Limb is not in a position to support weight
3. Same relative motion occurs in both positions
a. Different bones will move
B. Movements of the Lower Extremity
1. Hip Joint
a. Weight bearing - pelvis moves on femur
b. Non weight bearing - femur moves on pelvis
c. Types
i. Flexion - Extension
ii. Abduction - Adduction
iii. Medial rotation - Lateral rotation
2. Knee Joint
a. Weight bearing - femur moves on tibia
b. Non weight bearing - tibia moves on femur
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
95

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M:013/3 Revision: 02 Page: 96 of 96
NPTE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
c. Types
i. Flexion - Extension
ii. Medial rotation - Lateral rotation
3. Ankle Joint
a. Weight bearing - tibia and fibula moves on foot
b. Non weight bearing - foot moves on tibia and fibula
c. Types
d. Dorsiflexion - Plantar flexion
4. Foot (Tarsal Joints)
a. Pronation - Supination
MEDICINE: It’S A NOBLE PROFESSION, IT SERVES HUMANITY
96