Pioneer physiotherapists and early adopters will meet the challenges of health care in the new millennium.  Relatively new approaches are available to analyze and synthesize the literature to provide clinicians with access to applicable research and clinical treatment.  Tele-physical therapy is introduced in this manuscript as a mechanism for electronic globalization of physiotherapy.  The agenda for pioneer physiotherapists and early adopters emphasize paradigm shifts including: a shift to provide primary preventative measures and to promote health and wellness; a lifespan approach and the modification of current practice strategies to reflect current population growth rates.

Is There a Relationship Between Knee Circumference of Range of Motion Measured Immediately Postoperatively and at Six Months After ACL Reconstruction?
Shaw T.

Objective: To determine if a relationship exists between day one postoperative range of motion (ROM) or swelling and outcome at six-months postoperatively, in subjects with anterior cruciate ligament reconstruction (ACL). Subjects: Thirty-four subjects underwent ACL reconstruction receiving either the bone-patella tendon (n=17) or hamstring graft (n=17). Background: Little scientific literature exists which investigates whether early postoperative outcome can be predicted from impairment deficits detected immediately following ACL reconstruction. Methods: Knee ROM and circumference were measured on day one following reconstruction. Six-months postoperatively, parameters were re-measured and a modified Cincinnati subjective knee questionnaire was completed. Results: Significant improvement was found between day one and six-months postoperatively for all ROM measurements and a significant reduction was observed for knee circumference measurements (p£0.001). Linear regression analyses did not demonstrate that day one measurements of knee ROM or circumference were able to predict six month re-measurement (R²=0-0.12, p=0.15-0.77) except at 10cm proximally to the tibial tuberosity where 30% of six month postoperative circumference variance was significantly predicted by day one postoperative measures (R²=0.30, p<0.01). Range of motion and circumference measurements were not shown to be significant predictors of modified Cincinnati scores or analogue satisfaction scores at six months postoperatively (R²=0-0.06, p=0.29-0.94). Conclusion: Although significant improvement of ROM and knee swelling may be expected after six-months following ACL reconstruction, the current findings appear to suggest that neither ROM or circumference of the reconstructed knee on the first postoperative day offer significant predictive value for outcome at six-months postoperatively.