Often we hear ourselves making the ...

Often we hear ourselves making the statement to equal physical therapists that all of our patients have a heart and lung What is apparent from reading this edition of the CPPT Journal, the August edition of the PT Journal, and the Summer Acute Care Perspectives, is our patients have tubes as well. The systemic tubes or 'arteries' feeding the functional unit of the connected view the 'capillaries' which then fill the 'veins' for turn back trip to the lungs, are highlighted in each of these professional journals. throughout 20 years ago, Ms. Cherry Koontz PT CVT (certified vascular tester) began to present to view me peripheral vascular tests to help differentiate arterial v venous disorders and the importance of physical therapists in understanding these exhibitions I will always be indebted to her for opening my organ of sights to the importance of these tubes and in what manner disorders can lead to signs/symptoms, impairments, functional limitations, and disabilities in many of our patients.

The articles in this Journal are in plain english wonderful and will certainly aid our clinical practice. While sum of two units deal with arterial disease and common with chronic venous disorders, I would like to focus for a import on physical therapy and the use of examination techniques for issues related to the vascular tree Please read the sum of two units articles written by Dr. Daniel Riddle and colleagues that were not long ago published in the August PT Journal. one as well as the other of these articles deal with the topic of difficult venous thrombosis.12 Dr. Riddle's gorgeous research into assessing outpatient PT in the Orthopaedic section's capability of classifying clinical vignettes into 'low' 'medium,' or 'high' risk of DVT and whether to assign the patient to a physician for further examination was illuminating. What was revealed was our negligence in utilizing a belonging to all clinical decision rule (CDR) which clusters sign/symptoms/history of a patient and predicts the patient's risk of a DVT and for what reason these PTs might handle a potentially life-threatening situation. The CDR that were disentangleed by Wells and colleagues appears to have the most numerous literature support and should be commonly used in our practice when opposeed with a patient who might have a DVT Unfortunately this CDR is ofttimes not used in the clinic and instead we still rely in succession examination techniques that we had learned eg the Homan's sign, that have been shown in the literature to be of little diagnostic value. We should all get by heart on the 'bandwagon' and use the evidence to practice better. As M Koontz had me do in the late 90 read the article on Anand et al,3 which describes the use of this CDR

Another example of a clinical ordeal which is brought out in the couple arterial articles in this issue is the use of the Ankle Brachial Index (ABI). This example which is highly sensitive and specific for ruling in or without arterial disease should be the first example we should use for this determination. An investigation published in this journal showed that PT learners can very easily be taught this criterion and are quite accurate in ABI determination.4 These ends should help us realize that this proof should be part of our examination of arterial insufficiency. And at the same time from my anecdotal evidence, this touchstone is still not common in PT practice.

Finally, at a latter meeting at APTA, Dr. Dianne Jewell and I were challenged to help with the design of a of recent origin pattern for the Guide to PT Practice. This of the present day vascular pattern would revolve around vascular disorders (both arterial and venous) and their ensuing impairments, functional limitations and disabilities. The pattern would be within the cardiovascular and pulmonary area still certainly impacts other practice areas from muscle performance to integumentary integrity. I believe the time is right for us (the section) to accept this challenge to begin the proces of creating this recently made known vascular practice pattern.

REFERENCES

1 Riddle DL Hillner BE, Wells P Johnson RE Huffman HJ Zuelzer WA Diagnosis of lower-extremity hard vein thrombosis in outpatients with musculoskeletal disorders: a national measure and estimate study of physical therapists. Phy Ther. 2004;84(8):71 7-728

2 Riddle DL Wells P Diagnosis of lower-extremity of great depth vein thrombosis in outpatients. Phy Ther. 2004;84(8):729-735

3 Anand S Wells P look D, Brill-Edwards P, Cook D Ginsberg J Does this patient have discerning vein thrombosis? JAMA. 1998;279(14):1094-1099.

4 Augustine MJ Eagleton KJ Graham DH et al. Reliability of ankle brachial urgency index measurements by physical therapists and physical therapy scholars Cardiopul Phys Ther J. 2000;11(3):99-104

Steve Tepper PT PhD

Guest Editor

Copyright Cardiopulmonary Physical Therapy Journal Sep 2004

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