1. Ganz, Sandy B. MS, PT, GCS, Issue Editor

Article Content

The art and science of physical therapy have changed dramatically in the last half a century, but the goals of physical therapy have remained the same, the primary goal being restoring function. There is no consensus within the field of physical therapy or related fields on what is meant by the terms "function" or "functional outcome." Function has many definitions: the action performed by any structure: the act of carrying on or performing a special activity as well as an individual's performance. Function has been used to describe characteristics of bodily parts, eg, the function of the hand, and the performance of specific organs, eg, heart function. Regardless of the definition you choose to use, measuring functional outcomes is an essential component of our physical therapy practice.


Measuring functional outcomes is essential to the art and science of the physical therapy profession. When the question is asked "why carry out clinical research?" the answer is to further broaden the efficacy of physical therapy through evidence-based clinical practice. It is necessary to utilize functional outcome measures because of their inherent ability to measure the change over time, enabling rehabilitation professionals to evaluate the effect of their treatment intervention.


This issue of Topics in Geriatric Rehabilitation presents various venues of evidence-based practice and how they relate to functional outcomes following common pathology seen in the geriatric population.


The following 6 articles address functional outcomes following amputation, osteoporosis, hip fracture, and total hip and knee arthroplasty in a variety of venues, ranging from a case study to a randomized controlled trial.


The first article entitled "A historic look at functional outcome following total hip and knee arthroplasty" addresses an evidence-based approach to the postoperative management of patients who have undergone total hip and knee arthroplasty, and the influence on clinical practice spanning 2 decades. This article describes the evolution of a valid and reliable functional milestone form used to track the postoperative day of achievement of specific functional milestones throughout a patient's hospitalization. Over the past 20 years, the total hip and knee functional milestone form was the catalyst that generated a plethora of clinical questions that evolved into evidence based research studies, many of which resulted in the change in the standard of care for patients who have undergone total hip and knee arthroplasty at the Hospital for Special Surgery.


In the article by Audrey Zucker-Levin, functional outcome following major lower-extremity amputation as it relates to the geriatric population is discussed. A thorough review of the literature is presented, including a description of the population, clinical presentation, complications, outcomes, and functional tests used in the geriatric population.


Traci McGuire presents a case study of a geriatric patient who underwent a transtibial amputation. She demonstrates how specific performance-based measures were utilized as outcome measures, and because the outcome measures had properties that enhanced their ability to measure the change over time, Traci was able to document functional progression utilizing objective measures of function throughout the resident's subacute stay in a nursing home. Traci did an excellent job demonstrating the efficacy of physical therapy intervention in a patient who underwent a transtibial amputation.


Dr Peterson reports on functional outcomes following a randomized controlled trial entitled "High-intensity exercise training following hip fracture." Dr Peterson reports quite frankly on the trials and tribulations of performing a randomized controlled trial over a 3-year period, and how a change in the standard of postoperative care following hip fracture affects the control of variables in the study.


Dr Honkanen does a superb job of giving us an overview of the literature pertaining to functional outcomes in hip fracture prevention, morbidity, mortality, institutionalization, costs, osteoporosis treatment, fall prevention, and falls self-efficacy. As a geriatrician, her area of expertise is in external hip protectors and she eloquently educates us on findings from adherence and cost-effectiveness studies.


Shingpui Betty Chow looks at a performance-based measure, the Functional Reach test, and performed a pilot study that addresses the relationship between the magnitude of thoracic kyphosis in women with osteoporosis and osteopenia to functional reach and lower-extremity joint range of motion and muscle length.


In this issue of TGR, the authors aim at demonstrating how evidence-based physical therapy practice has the power to change clinical practice and influence the standard of care in the management of the geriatric population.