Editorial Policies

All submissions accepted for peer review are privileged communications. Author identity is kept confidential from reviewers, unless otherwise indicated. All correspondence is sent to the author who submits the article.

Immediate Decisions

The Editor in Chief and Editorial Board reserve the right to reject, without full review, any manuscript that does not meet Journal criteria. Manuscripts are prescreened by an Editor and/or Editorial Board member. Manuscripts are immediately rejected by PTJ when:

* Study participants are able bodied, without a compelling justification for relevance to physical therapist practice.
* Manuscript does not contain sufficiently new information and therefore does not offer a sufficient contribution to the literature.
* Reliability study does not include a discussion of the impact that the error will have on clinical decision making.
* Study evaluates a new test without a sound comparison to current tests.
* Study has fatal flaws in the methods section.
* Study does not have a theoretical or evidence-based argument for the relevance of the work to physical therapy or rehabilitation.

Fast-Track Review

Manuscripts that have the potential to make a strong and immediate impact on physical therapist practice are considered for fast-track peer review (30 days from submission to first decision). Only original research papers, particularly clinical trials, are considered. If you believe that your manuscript meets the criterion for high impact, please contact the managing editor at janreynolds{at}apta.org, and include an abstract and your rationale for why the paper should be fast tracked.

Redundant, Duplicate, or Simultaneous Publication

PTJ reviews and considers a manuscript for exclusive publication with the understanding that the manuscript, or any substantial portion of the manuscript (as judged by the Editor in Chief), has not been published previously and is not under consideration for publication elsewhere, whether in print or electronic form. This policy does not usually preclude consideration of (1) a manuscript that has been rejected by another journal or (2) a complete report that follows publication of a preliminary report or pilot study. Press reports on papers presented at a scientific meeting usually will not be considered to constitute prior publication, but such reports should not be amplified by additional data or copies of tables and illustrations (see also Prior Disclosure and Media Embargo Policy).

Redundancy in publications occurs when the work of 2 or more papers from the same author overlaps substantially. Authors submitting manuscripts to PTJ, are asked to include in their cover letter an explanation of any prior submission or publication (eg, published article, article in press, manuscript under review, posting of results in registries, published abstract) that includes data from the same subjects studied in the submitted manuscript. Previous publication of a small fraction of the content of a manuscript does not necessarily preclude its being published in PTJ, but the editors need information about previous publication. Secondary analyses based on previous publications can be important scientific contributions, but the editors need to be able to judge potential redundancy. If the submitted manuscript is a report of secondary analyses, the source of the data should be properly referenced and the rationale for the secondary analysis must be provided.

In addition to the cover letter explanation, authors must provide a copy of related papers-that is, submitted or published papers that deal with the same data, in part or in full, that are reported in the manuscript being submitted to PTJ. These materials will be confidential and will be viewed only by the editors.

Duplicate publication is the publication of the same paper or substantially similar papers in the same journal or in more than one journal. PTJ's Editorial Board holds that publication more than once of the same study results, regardless of whether the wording is the same or different, is rarely justified. Articles previously published in another language will not be considered for publication in PTJ.

The Editorial Board reserves the right to consult with other journals about the content of the papers in question. Furthermore, PTJ may decide to take one or more of the following actions: (1) Immediately reject the manuscript without review. (2) Decline to consider any manuscripts from the author(s) for a period of time. (3) Announce publicly, within PTJ, that the authors have submitted a previously published article. If a paper is accepted and published before evidence of duplication is discovered, PTJ probably will publish a notification of redundant or duplicate publication, with or without the author's explanation or approval. Typically, PTJ will request that the authors write a letter acknowledging the duplicate publication. The Editorial Board may notify appropriate institutions, ranging from national databases to the authors' academic departments or university administrators, at its discretion. The Editorial Board may decide not to consider submissions from the author(s) for a period of time.

Simultaneous Submission. Authors may not submit the same manuscript simultaneously to more than one journal. If the Editorial Board learns of possible simultaneous submission, it reserves the right to consult with the other journal to which the manuscript was submitted. Furthermore, the Editorial Board may return the manuscript without review or may reject it without regard to peer reviewer recommendations and may decide not to consider any submissions from the author(s) for a period of time.

Prior Disclosure and Media Embargo Policy

New Submissions: As described in detail above, prior disclosure of any part of the contents of any manuscript in a widespread and substantive form, print or electronic, may make the manuscript ineligible for consideration by or publication in PTJ. Publication of abstracts and presentations at meetings do not constitute prior disclosure. Media coverage of presentations at scientific meetings will not constitute prior disclosure, as long as such coverage is not amplified by additional data or copies of tables and illustrations; however, direct release of information through press releases or news media briefings may jeopardize consideration of the submission. During the submission process, you will be prompted to indicate whether your manuscript has been presented orally at a scientific meeting or at a professional forum. Authors who need clarification of this policy are encouraged to contact the janreynolds{at}apta.org before releasing or distributing information from the manuscript that they want to submit.

Accepted Papers: All information regarding the content and publication date of accepted manuscripts is strictly confidential. Information contained in or about accepted articles must not appear in print, audio, video, or digital form or be released by the news media until the day before its publication date (or other specified embargo release date in the case of articles that are released early or published online ahead of print). PTJ is willing to work with authors who wish to present their accepted papers at conferences prior to publication. Authors are allowed to alert their university media office at the rapid proof stage but must inform PTJ and must ensure that the university media office observes PTJ's media embargo policy.

Copyright and Authorship

Authors agree to execute copyright transfer as requested during the submission process. Authors will be prompted to upload a signed copyright release, authorship, and financial disclosure form. (Please upload one form per author.) Manuscripts published in PTJ become the property of the American Physical Therapy Association (APTA) and may not be published elsewhere, in whole or in part, in print or electronic form, without the written permission of APTA, which has the right to use, reproduce, transmit, derivate, publish, and distribute the contribution, in PTJ or otherwise, in any form or medium.

Commercial/Financial Associations and Conflict of Interest

All funding sources supporting the work should be acknowledged. During the submission process, authors will be required to enter this information. They also will be prompted to upload a disclosure statement, signed by all authors. This information will be held in confidence by the Editor in Chief during the review process and, if the paper is accepted for publication, will be shared with readers as appropriate.

Protection of Participants

In the cover letter that is submitted with the manuscript, authors of Research Reports should provide the name of the institutional review board (IRB), institutional animal care and use committee, or other similar body that approved the study. For those authors who do not have formal ethics review committees, the principles outlined in the Declaration of Helsinki should be followed, and authors should include a statement within the manuscript (eg, in the “Participants” section) confirming that these principles were followed. Authors also should submit patient consent forms for photographs or videos. Within the manuscript, authors must include a statement in the “Method” section that they obtained informed consent of participants, when required for protection of human subjects. Along with their signed copyright release forms, authors of Case Reports should submit a signed patient consent form. Case Report authors who practice in the United States should also include a statement about meeting the HIPAA (Health Insurance, Portability, and Accountability Act) requirements of the institution for disclosure of protected health information.

PubMed Central Deposits

In January 2008, the National Institutes of Health (NIH) announced that its voluntary Public Access Policy (NOT-OD-05-022) was now mandatory. The law states:

The Director of the National Institutes of Health shall require that all investigators funded by the NIH submit or have submitted for them to the National Library of Medicine’s PubMed Central an electronic version of their final, peer-reviewed manuscripts upon acceptance for publication, to be made publicly available no later than 12 months after the official date of publication: Provided, That the NIH shall implement the public access policy in a manner consistent with copyright law.

This policy applies to all articles, including all graphics and supplemental materials generated by the authors, that (1) are accepted for publication on or after April 7, 2008, and (2) arise in whole or in part from direct costs funded by NIH or from NIH staff. The policy also may apply to systematic reviews of randomized controlled trials that were funded by NIH. More information about the policy is available at http://publicaccess.nih.gov/policy.htm and http://grants.nih.gov/grants/guide/notice-files/NOT-OD-08-033.html.

To assist authors with this funding requirement, PTJ will make the direct deposit to the National Library of Medicine’s PubMed Central (PMC) on their behalf. If an author received financial support from NIH to conduct the research that is reported in an article that PTJ accepts and publishes, PTJ will submit an electronic copy of the final, published version to PMC before or soon after the time of publication (at most, within 4 weeks after publication). The National Institutes of Health Manuscript System will extract the necessary identifying information from the article and transfer it to NIH’s grants management system to fulfill the authors’ responsibility for providing publications as part of progress reports. The “bottom line”: PTJ authors do not have to deposit their accepted manuscripts. In fact, because PTJ has entered into an agreement with NIH to provide direct deposits, authors will be blocked from depositing manuscripts accepted by PTJ.

To be consistent with the spirit of NIH’s public access policy, PTJ has reduced its customary 12-month embargo to allow PMC to make these articles available to the public at 6 months following publication.

PTJ began making PMC deposits with articles from the May 2008 issue.

Upon submitting articles to PTJ via ScholarOne (PTJ Manuscript Central), NIH-funded authors are now asked to indicate the specific NIH funding agency. Authors also are asked to provide funding information in the copyright release form that they submit with their manuscript.

Important note for NIH-funded authors: NIH states that:

Beginning May 25, 2008, anyone submitting an application, proposal or progress report to the NIH must include the PMC or NIH Manuscript Submission reference number when citing applicable articles that arise from their NIH funded research. This policy includes applications submitted to the NIH for the May 25, 2008 due date and subsequent due dates. [NOT-OD-08-033]

PTJ recognizes that other funders, such as the Wellcome Trust in the United Kingdom and the European Research Council, require making articles available to the public within 6 months. PTJ will work with authors whose manuscripts report on research funded in whole or in part by these agencies to meet their obligations regarding deposit requirements.

If you have any questions regarding PTJ’s policy on direct deposits, please contact the managing editor at janreynolds{at}apta.org.

CONSORT

PTJ adopted the CONSORT (Consolidated Standards of Reporting Trials) Statement in March 2007 and the CONSORT Statement extension for nonpharmacologic treatment (NPT) interventions in February 2008. Click here for requirements.

Clinical Trials Registration

Effective January 1, 2009, PTJ requires clinical trial registration. Click here for details.

Photograph and Video Release

Authors must obtain and submit written permission to publish photographs or post video clips in which subjects are recognizable. This statement must be signed by the subject, parent, or guardian. You will be prompted to upload this statement during the submission process.

Reprinted Tables and Figures

Authors must obtain and submit written permission from the original sources, in the name of APTA, to publish illustrations, photographs, figures, or tables taken from those sources. Authors will be prompted to upload these permissions during the submission process.

Letters to the Editor

Letters to the editor are processed more quickly when they are submitted via PTJ's Rapid Response mechanism. To comment on a particular article, please click on the "Submit a response" link in the navigation box that is located on the righthand side of the page in the article. If you want to submit a letter that does not relate to a specific article, please e-mail it to ptjourn{at}apta.org.

Once a Rapid Response is submitted, it is reviewed by the Editors and approved or declined. If approved, the Response is copyedited only for minor grammar, punctuation, and formatting and then posted online, usually within 48 to 72 hours of submission. Please note that PTJ editorial staff may contact you for further information about your Rapid Response, and we may not be able to notify you when the Rapid Response is posted. Authors of the articles being discussed are alerted and are encouraged to respond. Rapid Responses often are published in the next available print issue.

General Instructions

The following are general instructions for preparing manuscripts for PTJ. Please also see specific types of manuscripts.

Are there other articles using the same data set or otherwise related to this manuscript that have been published or are under review by other journals? If so, please submit a masked copy of the article(s) along with your manuscript.

People-First Language

PTJ promotes "people-first" language. That is, patients and subjects should not be referred to by disability or condition (eg, use "patients who have had a stroke" or "patients with stroke," rather than "stroke patients" or "stroke survivors"). Terms that could be considered biasing or discriminatory in any way should not be used.

Scientific Writing Style

PTJ follows the American Medical Association [AMA] Manual of Style, 10th ed, published by Williams & Wilkins (Baltimore, Md).

Measurements

Please use the International System of Units. (English units may be given in parentheses.)

Manufacturer Footnotes

For all equipment and products mentioned in the text, place a footnote containing the manufacturer's full address with ZIP code at bottom of the page on which the item is mentioned, and use consecutive symbols (*, †, ‡, §, ||, #, **, ††, ‡‡, §§, ||||, ##).

Formatting

All manuscripts must be formatted double-spaced, with pages AND lines numbered. Please use 12-point font. Most manuscripts undergo a masked review process, so you will submit both a masked copy and an unmasked copy. In the masked version, please remove author names and any affiliations within the article.

Sections, in order of appearance: (1) Title page, (2) Abstract, (3) Body of article, (4) Acknowledgments, (5) References, (6) Tables, (7) Figure legends, (8) Figures, (9) Legends for supplemental materials, (10) Appendixes.

Different article types have different requirements for word count, headings in the body of the manuscript, and number of tables and figures, please see the section on the article type for this information.

References

References should be indicated by numerical superscripts that appear consecutively in the text. If you use End Notes, please use version 6.0 or higher. References should be listed in consecutive order on a separate sheet at the end of the manuscript. Follow AMA style for reference style. Cite the reference number in the text each time an author is mentioned. Use MEDLINE/PubMed journal abbreviations. References should be listed in the order of appearance in the manuscript, not in alphabetical order.

Tables

Tables should be formatted in Word, numbered consecutively, and placed together at the end of the manuscript, after the reference list. Please refer to recent issues of PTJ for style.

Figures

For peer-review purposes, figures can be attached to the manuscript after the figure legends; however, figures also should be submitted as separate, high-res graphic files in tif, jpg, eps, or pdf format, with the resolution set at a minimum of 300 dpi. The separate image files will help PTJ staff to produce the sharpest images both in print and online. Rule of thumb: the larger the figure (eg, 8.5" × 11"), the better. If electronic formats are not available to you, figures must be submitted as 5" × 7" camera-ready glossies and mailed to the Editorial Office. Figures should be numbered consecutively. For helpful guidelines on submitting figures online, visit Cadmus Journal Services. Lettering should be large, sharp, and clear, and abbreviations used within figures should agree with Journal style. Color photographs are encouraged, in sharp focus and with good contrast.

Appendixes

Appendixes should be numbered consecutively and placed at the very end of the manuscript. Use appendixes to provide essential material not suitable for figures, tables, or text. If the manuscript is accepted for publication, the review team may recommend that an appendix appear online only.

Online-Only Materials

The PTJ Web site has the capability to host a variety of supplemental data that cannot be published in print or that exceeds PTJ’s limits on word counts or on tables and figures. Supplemental files can include tables, figures, appendixes, video clips, PowerPoint files, or Excel spreadsheets.

If a manuscript contains tables or figures that exceed PTJ’s maximum, the review team may recommend that some of them appear online only as a PDF. These tables and figures would have the same format and style as those in the final published article.

To help the reader, PTJ recommends that Research Report and Case Report authors submit study protocols, treatment manuals, detailed descriptions of evaluation and intervention procedures, treatment progression algorithms, etc. These can be submitted as online-only tables, figures, appendixes, or video clips. They are reviewed by the editors and Editorial Board and should be submitted at the same time that the manuscript is submitted. The videos can be of patients, procedures, interventions, or any other relevant part of the study or case. (See Video Central for recent examples.)

Video Requirements. PTJ's preferred format for video clips is MPEG (Moving Picture Experts Group). Because of sophisticated compression techniques, MPEG files are much smaller than other formats for the same quality. These files also are compatible with both Windows Media Player (PC) and QuickTime (Mac). Other acceptable formats include: .mov (QuickTime Movie), .wmv (Windows Media Video), .mp4, and .avi (Audio Video Interleave).

If the manuscript is accepted for publication, PTJ staff will convert the video file to MPEG format and it will accompany the final print version of the article online.

File size: less than 10 MB preferred
Minimum dimensions: 320 pixels wide by 240 pixels deep
Maximum length: 5 minutes

Citations and Legends. Where applicable, include a citation to each video in the manuscript text and include the title (10-15 words maximum) and a legend for the video in the manuscript after the figure captions.

Patient Permission. If patients are in the video, either the subjects should not be identifiable or they must give written permission to use the figure.

If you have questions about videos, please contact the steveglaros{at}apta.org.

Research Reports

Essentials of Writing Research Reports: Slideshow from PT 2009

Requirements for Presenting Data

Strategies for Common Analytic Approaches

Specific Guidelines for:

Clinical Trials
Diagnostic Test Studies
Measurement Studies
Observational Studies
Qualitative Studies
Systematic Reviews and Meta-analyses

These guidelines were developed because many manuscripts submitted for review lack design or analytic detail, which limits the ability of the reviewer (and ultimately the reader) to interpret the meaningfulness of the work. In addition, some manuscripts use an analytic strategy that is not the most appropriate for their topic.

Requirements for Presenting Data

Percentages. Report percentages to one decimal place (ie, xx.x%) when sample size is e"200. To avoid the appearance of a level of precision that does not exist with small samples, do not use decimal places (ie, xx%, not xx.xx%) when sample size is <200.

Standard deviations. Use "mean (SD)" rather than "mean±SD" notation. The ± symbol is ambiguous and can represent standard deviation or standard error.

Standard errors. When possible, report confidence intervals (CI) rather than standard errors.

P values. When reporting the results of statistical tests, P values alone are insufficient. A description of the magnitude of the effect or the association with CI is required. Report exact P values to 2 decimal places except when P<.001; in which case, "P<.001" is sufficient.

Confidence intervals. If point estimates (eg, an intraclass correlation coefficient [ICC] in a reliability study, a likelihood ratio in a diagnosis study) are calculated, CI must be reported to provide an estimate of the precision of a point estimate. Interpretations of the meaningfulness of the point estimate and CI must be provided in the discussion.

"Trend". Use the term "trend" only when describing a test for trend or dose-response in, for example, epidemiological studies of rate of disease given various exposure levels of a risk factor. Avoid the term "trend" when referring to P values that are close to, but not below, .05. In such instances, simply report a difference and the confidence interval (CI) of the difference (if appropriate) with or without the P value. If you decide to discuss findings that do not reach the significant P value, an appropriate level of caution should be used when discussing the meaningfulness of the findings. Emphasis should be placed on potential clinical impact and not on statistical meaningfulness.

Statistical software. In the data analysis section, specify the statistical software—version, manufacturer, and manufacturer's location—that was used for analyses.

Data analysis section. The preferred statistics are those that are in common use for the type of study being reported. The description should be readily understood by the reader and easily applied to clinical decision making.

Missing data. Always report the frequency of missing data, the reasons and any patterns for the missing data, and how you handled missing data in the analyses.

Sample size estimation. Both qualitative and quantitative studies must provide a rationale for the sample size.

Descriptive tables. In tables that simply describe characteristics of 2 or more groups (eg, Table 1 of a clinical trial):

(1) Report averages with standard deviations, not standard errors, when data are normally distributed.

(2) Report median (minimum, maximum) or median (25th, 75th percentile [interquartile range, or IQR]) when data are not normally distributed.

Multi-factor (multi-way) analyses of variance. Reports results of main effects and then the relevant interactions before reporting any additional post hoc findings. Provide a rationale for any post hoc testing that is done.

Tables reporting multivariable analyses. Authors sometimes present tables that compare an outcome one by one with multiple individual factors, followed by a multivariable analysis that adjusts for confounding. If confounding exists, as is often the case, the one-way comparisons are simply intermediate steps that may offer little useful information for the reader. In general, we suggest omitting these intermediate steps in the manuscript—but this is left to your discretion as author.

When describing results of linear regression analyses, beta coefficients, CI, and P values are the preferred data to report in a table. For logistic regression, odds ratios (not beta coefficients) and CI are recommended.

Making tables and figures as informative as possible. The following references give useful information about the design and format of informative tables and figures:

Tufte ER. The Visual Display of Quantitative Information. Cheshire Conn: Graphic Press; 1983:178. ISBN: 0961392142

Wainer H. How to display data badly. The American Statistician. 1984;38:137-147. Google Scholar

Wainer H. Visual Revelations: Graphical Tales of Fate and Deception from Napoleon Bonaparte to Ross Perot. Mahwah, NJ: Lawrence Erlbaum Associates Inc; 1997. ISBN: 038794902X

Pocock SJ, Clayton TC, Altman DG. Survival plots of time-to-event outcomes in clinical trials: good practice and pitfalls. Lancet. 2002; 359:1686-89. PMID: 12020548

You also can follow a few simple rules of thumb:

1. Avoid pie charts.
2. Avoid simple bar plots or histograms that do not present measurements of variability.
3. Consider using box-plots to illustrate non-normally distributed data.
4. Provide raw data (numerators and denominators) in the margins of meta-analysis forest plots.

Suggested Strategies for Common Analytic Approaches

Multivariable Analysis

Screening covariates. Use caution when selecting covariates for multivariable analyses. Approaches that select factors for inclusion in a multivariable model only if the factors are "statistically significant" in "bivariate screening" may not be optimal. A factor can be a confounder even if it is not statistically significant by itself because it changes the effect of the exposure of interest when it is included in the model or because it is a confounder only when included with other covariates. You are encouraged to provide theoretical or data-driven justifications for the selection of covariates.

Reference

Sun GW, Shook TL, Kay GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol. 1996;49:907-916. PMID: 8699212

Model building. The approach for model building in a multivariable analysis is up to your discretion as author, but it should address theory as part of the model-building process. Stepwise methods of model building should be avoided except for the narrow application of hypothesis generation for subsequent studies. Stepwise methods include forward, backward, or combined procedures for the inclusion and exclusion of variables in a statistical model based on predetermined P value criteria. Variables that use external clinical judgment are better strategies than P value–driven approaches for selecting variables. You might use a bootstrap procedure to determine which variables, under repeated sampling, would end up in the model using stepwise variable selection procedures. Regardless, you should describe how model fit was assessed, how and which interactions were explored, and the results of those assessments.

References

Collett D, Stepniewska K. Some practical issues in binary data analysis. Stat Med. 1999;18:2209-2221. PMID: 10474134

Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129:125-137. PMID: 2910056

Steyerberg EW, Eijkemans MJC, Harrell FE Jr, Habbema JDF. Prognostic modeling with logistic regression analysis: a comparison of selection and estimation methods in small data sets. Stat Med. 2000;19:1059-1079. PMID: 10790680

Steyerberg EW, Eijkemans MJ, Habbema DF. Stepwise selection in small data sets: a simulation study of bias in logistic regression analysis. J Clin Epidemiol. 1999;52:935-942. PMID: 10513756

Altman DG, Andersen PK. Bootstrap investigation of the stability of a Cox regression model. Stat Med. 1989;8:771-783. PMID: 2672226

Mick R, Ratain MJ. Bootstrap validation of pharmacodynamic models defined via stepwise linear regression. Clin Pharmacol Ther. 1994;56:217-222. PMID: 8062499

Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361-387. PMID: 8668867

Measurement error in multivariable analyses. If several risk factors for disease are considered in a logistic regression model and some of these risk factors are measured with error, the point and interval estimates of relative risk corresponding to any of these factors may be biased either toward or away from the null value; the direction of bias is never certain. In addition to potentially biased estimates, confidence intervals (CI) of correctly adjusted estimates will be wider, sometime substantially, than naïve CI. You are encouraged to consult the references below for strategies to address this problem.

References

Rosner B, Spiegelman D, Willett WC. Correction of logistic regression relative risk estimates and confidence intervals for measurement error: the case of multiple covariates measured with error. Am J Epidemiol. 1990;132:734-745. PMID: 2403114

Carroll R. Measurement error in epidemiologic studies. In: Armitage P, Colton T, eds. Encyclopedia of Biostatistics. New York, NY: John Wiley & Sons; 1998. ISBN: 0471975761.

Measures of Effect and Risk

Clinically meaningful estimates. Authors should report results for meaningful metrics rather than reporting raw results. For example, rather than reporting the log odds ratio from a logistic regression, you should transform coefficients into the appropriate measure of effect size, odds ratio, relative risk, or risk difference. Don't give readers an estimate, such as an odds ratio or relative risk, for a one-unit change in the factor of interest when a one-unit change lacks clinical meaning (age, mm Hg of blood pressure, or any other continuous or interval measurement with small units). All estimates should reflect a clinically meaningful change, along with 95% confidence bounds.

Between-group differences. For comparisons of interventions (eg, trials), focus on between-group differences, with 95% confidence intervals of the differences, and not on within-group differences. State the results using absolute numbers (numerator/denominator) when feasible. When discussing effects, refer to the confidence intervals rather than P values, and point out for readers if the confidence intervals (CI) exclude the possibility of significant clinical benefit or harm.

Odds ratios and predicted probabilities. Authors often report odds ratios for multivariable results when the odds ratio is difficult to interpret or not meaningful. First, the odds ratio might overstate the effect size when the reference risk is high. For example, if the reference risk is 25% (odds=0.33) and the odds ratio is 3.0, the relative risk is only 2.0. Statements such as "threefold increased risk" or "three times the risk" are incorrect. Second, readers want an easily understood measure of the level of risk (and the confidence intervals) for different groups of patients as defined by treatment, exposure, and covariates. Consider providing them a table of predicted probabilities for each of the factors of interest, and confidence intervals (CI) of those predicted probabilities. Moreover, a multiway table that cross-classifies predicted probabilities by the most important factor and then adjusts for the remaining factors will often be more meaningful than a table of adjusted odds ratios. Standard commercial software can produce predicted probabilities and confidence bounds.

Reference

Altman DG, Deeks JJ, Sackett DL. Odds ratios should be avoided when events are common. BMJ. 1998;317:1318. PMID: 9804732

Missing Data

Missing variables. Always report the frequency of missing variables and how the analysis handled missing data. Consider adding a column to tables or a row under figures that makes clear the amount of missing data. In some cases, the use of dummy variables to represent missing values should be avoided. Replacing missing predictors with dummy variables or missing indicators can lead to biased estimates. Your approach to the handling of missing data should be explained, and the limitations should be discussed.

References

Vach W, Blettner M. Biased estimation of the odds ratio in case-control studies due to the use of ad hoc methods or correcting for missing values for confounding variables. Am J Epidemiol. 1991;134:895-907. PMID: 1670320

Vach W, Blettner M. Missing data in epidemiologic studies. In: Armitage P, Colton T, eds. Encyclopedia of Biostatistics. New York: John Wiley & Sons; 1998:2641-2654. ISBN: 0471975761

Greenland S, Finkle WD. A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol. 1995;142:1255-1264. PMID: 7503045

Allison PD. Missing Data. Thousand Oaks, Calif: Sage Publications, Inc; 2002. ISBN: 0761916725

Missing outcomes. Always report the frequency of missing outcomes and follow-up data, the reasons and any patterns for the missing data, and how you handled missing data in the analyses.

A variety of methods exist for handling missing outcomes. The last observation carried forward approach (LOCF) to address incomplete follow-up can, at times, provide biased estimates, and the direction of the bias is not predictable. Other, potentially more appropriate methods for handling missing data include imputation, pattern-mixture (mixed) models, and selection models. Application of these methods requires consideration of the patterns and potential mechanisms behind the missing data. The method of addressing missing data may have little impact on findings when the proportion of missing data is small (eg, <5%).

Provide a justification for the method used for handling missing data, and discuss the impact this approach may have on the findings.

References

Fitzmaurice GM, Laird NM, Ware JH. Applied Longitudinal Analysis. New York, NY: John Wiley & Sons; 2004:chapter 14. ISBN: 0471214876

Molenberghs G, Verbeke G. Models for Discrete Longitudinal Data. New York, NY: Springer; 2005:chapters 26-32. ISBN: 0387251448

Longitudinal analyses. Consider using longitudinal analyses if outcome data were collected at more than one time point. With an appropriate model for longitudinal analysis, you can report differences within groups over time, differences between groups, and differences across groups of their within-group changes over time (usually the key contrast of interest). You can control for any confounding that might emerge, such as a difference in a variable (eg, body weight), among those who remained in the study until completion.

Longitudinal analysis options include a population averaged analysis (eg, generalized estimating equations [GEE]) that estimates the time by treatment interaction and adjusts variance for the repeated measures within individuals over time.

Another option is a mixed effects model, with random effects for patient and the estimate of interest being the time by treatment interaction. In choosing a model, consider whether any missing data are missing at random (ie, "ignorable" missing data) or missing dependent on the observed data (ie, informative missing data). In GEE analyses, missing data are assumed to be missing completely at random independent of both observed and unobserved data. In random coefficient analysis, missing data are assumed missing at random dependent on observed data but not on unobserved data. Other types of repeated measures analyses are acceptable but are not optimal for the reasons cited above.

Reference

Twisk JWR. Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide. New York, NY: Cambridge University Press; 2003. ISBN: 0521819768

Clinical Trials

Reports of trials of interventions for the treatment, diagnosis, course, or prevention of disease. Recent examples: Cleland et al and Nawoczenski et al

Clinical Trials Registry

As defined by the International Committee of Medical Journal Editors (ICMJE), a clinical trial is any research project that prospectively assigns human subjects to intervention or comparison groups to a cause-and-effect relationship between an intervention and an outcome. To help ensure transparency and accountability in the reporting of clinical trials, PTJ has adopted a policy on clinical trial registration, effective January 1, 2009:

Trials that begin enrollment after January 1, 2009, must be registered at or before the onset of patient enrollment.
Trials that began enrollment before January 1, 2009, must be registered before authors submit their manuscripts, effective for manuscripts submitted on or after January 1, 2009.

Trial registration is free and typically takes no more than 30 minutes. Acceptable registries must meet the following ICMJE requirements: be publicly available, searchable and open to all prospective registrants; have a validation mechanism for registration data; and be managed by a not-for-profit organization. An acceptable registry includes, at a minimum, the following information:

a unique identifying number,
a statement of the intervention (or interventions) and comparison (or comparisons) studied
a statement of the study hypothesis
definitions of the primary and secondary outcome measures
eligibility criteria
key trial dates (registration date, anticipated or actual start date, anticipated or actual date of last follow-up, planned or actual date of closure to data entry, and date trial data considered complete)
target number of subjects
funding source
contact information for the principal investigator.

Authors should specify where the trial is registered and the trial's unique registration number at the end of the abstract of their manuscript.

A trial must have at least one prospectively assigned concurrent control or comparison group in order to trigger the requirement for registration. Non-randomized trials are not exempt from the registration requirement if they meet the above criteria.

Two large registries are:

International Standard Randomized Controlled Trial Number (http://www.controlled-trials.com/isrctn/)
ClinicalTrials.gov (http://www.clinicaltrials.gov)

Read Editor in Chief Rebecca Craik's editorial for more on clinical trial registration. For additional information, visit www.icmje.org

Special circumstances: In the cover letter accompanying their submission, authors may make a case to the Editor in Chief as to why they have NOT registered their trial.

For more about reporting clinical trials:

Zarin DA, Tse T. Moving toward transparency of clinical trials. Science. 2008;319:1340-1342.

Questions? Contact janreynolds{at}apta.org.

Guidelines and Checklists

PTJ adopted the CONSORT (Consolidated Standards of Reporting Trials) Statement (see Moher) in March 2007 and the CONSORT Statement extension for nonpharmacologic treatment (NPT) interventions in February 2008. This extension takes into account many of the issues that physical therapist researchers face, such as "difficulties of blinding, the complexity of the intervention and the influence of care providers' expertise and volume of care of centres on treatment effect."

Authors are required to submit, as part of their manuscript, the modified CONSORT flow diagram for individual randomized, controlled trials of nonpharmacologic treatment (see page 5 of the PDF).

Authors are strongly encouraged to refer to the revised checklist (see page 4 of the PDF) while preparing their manuscript. A completed checklist is not required for submission at this time.

Background: According to the CONSORT Group, "The adoption by journals of the CONSORT Statement has been associated with improved quality of reporting," but reports of trials of nonpharmacologic treatments (NPT)-including "surgery, technical interventions, rehabilitation, psychotherapy, behavioural interventions, implantable and non-implantable devices, and complementary medicine-have been "suboptimal" (http://www.consort-statement.org/index.aspx?o=1416). The CONSORT Group, therefore, published an extension of the CONSORT Statement for trials of nonpharmacological treatment interventions (Ann Intern Med. 2008;148:295-309).

Other CONSORT guidelines

All RCTs: Harms extension (see Ioannidis)

CONSORT extension for cluster RCTs (see Campbell)

CONSORT extension for noninferiority and equivalence RCTs (see Piaggio)

Title

Titles should not be vague and should reflect measured variables. For instance, instead of using "physical therapy" to refer to intervention, state specific interventions (eg, "strengthening exercises"). For randomized trials, add the subtitle "A Randomized, Controlled Trial" to the full title of your manuscript. For example: "Effect of Resistive Exercise on the Functional Status of Patients with Osteoarthritis of the Knee: A Randomized, Controlled Trial."

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words

Structure. Background, Objective, Design, Setting, Patients, Intervention, Measurements, Results, Limitations, Conclusions (see Haynes).

Other. If applicable, specify where the trial is registered and the trial's unique registration number at the end of the abstract. For more information, visit www.icmje.org. Also see upcoming editorial on clinical trials registry April 1.

Body of Manuscript

Word limit. 4,500 words (excluding abstract and references). Please provide the manuscript word count on the abstract page of your manuscript. Additional materials may be submitted in the form of an appendix, which would appear only as supplemental data on the PTJ Web site if the paper is accepted.

Sections. Introduction, Methods, Results, and Discussion

Use the following Methods section subheadings:
• Design Overview
• Setting and Participants
• Randomization and Interventions
• Outcomes and Follow-up
• Statistical Analysis
• Role of the Funding Source

References. 75 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. Include a CONSORT flow diagram for nonpharmacological trials. (See here for more information on formatting)

Comments. Always end the introduction section with a clear statement of the study's objectives or hypotheses.

Identify the funding source for the study and its role in the study's design, conduct, and reporting. Put this information last in the Methods section and title the subhead "Role of the Funding Source."

In the Methods section, state (if correct) that the study was approved by an Institutional Review Board (IRB). If the study was not submitted to an IRB, provide documentation that not seeking IRB review for this type of study was in accordance with the policy of your institution.

Statistical analysis. In randomized controlled trials, the primary analysis must examine between-group differences (not exclusively within-group change). Estimates of treatment effects with 95% CI must be provided. The preferred statistics are those that are in common use, readily understood by the reader, and easily applied to clinical decision making. Examples include the effect size for continuous data and number needed to treat (NNT) for categorical data. The reporting of P values alone is insufficient.

Data. PTJ works to maintain the highest levels of integrity and accountability. The Editors therefore reserve the right to ask researchers to provide the raw data for their studies during review or at any time up to 5 years after publication in PTJ. This would likely happen only in rare instances, when credibility of the research is brought into serious question.

Reporting. Authors are expected to follow a pre-specified data analysis plan. If you deviate from the pre-planned analysis, the rationale should be made clear in the paper. The findings of a trial must be presented in a way that will enhance a reader’s understanding of the study’s contribution to the evidence. The discussion should include a consideration of the importance of the between-groups difference. More information is provided in Requirements for Presenting Data.

It is essential that reports of trials provide sufficient details on interventions so that readers can judge the applicability and clinical relevance of results. You are encouraged to provide a trial treatment manual as an electronic-only appendix.

Diagnostic Test Studies

Reports of studies of the accuracy of diagnostic tests.

Guidelines and Checklists

Consult STARD guidelines and checklist (see Bossuyt). The STAndards for the Reporting of Diagnostic accuracy studies (http://www.stard-statement.org/) are intended to (1) help authors improve the accuracy and completeness of reporting of diagnostic studies, (2) help readers to assess the potential for bias (internal validity), and (3) help readers to evaluate the level of generalizability (external validity). The STARD statement includes the use of a 25-item checklist and a flow diagram to describe the design of the study and the flow of patients.

Title

Identify the article as a study of diagnostic accuracy somewhere in the title. Titles should not be vague and should reflect measured variables. For instance, instead of using "physical therapy" to refer to intervention, state specific interventions (eg, "strengthening exercises").

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstracts

Word limit. 275 words

Structure. Background, Objective, Design, Setting, Patients, Measurements, Results, Limitations, Conclusions (see Haynes).

Body of Manuscript

Sections. Introduction, Methods, Results, and Discussion.

References. 75 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. Include a STARD flow diagram (see Bossuyt). (See here for more information on formatting)

Comments. Always end the Introduction section with a clear statement of the study's objectives or hypotheses.

State (if correct) that the study was approved by an Institutional Review Board (IRB). If the study was not submitted to an IRB, provide documentation that not seeking IRB review for this type of study was in accordance with the policy of your institution.

Statistical analysis. The likelihood ratio (LR) with CI must be reported, along with an interpretation of the clinical relevance of the findings.

Measurement Studies

Reports of development or testing of impairment-specific, disease-specific, or generic health-related measurement tools designed to determine various aspects of body function or structure, activity, or participation of individuals and populations within their environments.

Guidelines and Checklists

None at this time.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstracts

Word limit. 275 words

Structure. Background, Objective, Design, Methods, Results, Limitations, Conclusions

Body of Manuscript

Sections. Introduction, Methods, Results, and Discussion

References. 50 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6 (See here for more information on formatting)

Comments. Always end the Introduction section with a clear statement of the study's objectives.

Protocol. PTJ encourages submission of the original study protocol.

Statistical analysis. Provide a rationale for the analytical approach used in the study. As indicated by the objectives of the study, report appropriate test results, including: estimates of reliability (eg, for quantitative data, the ICC with 95% CI are appropriate along with single score error estimates such as the SEM; for nominal and ordinal level data, the kappa or weighted kappa are commonly used); evidence for content, criterion-based, and/or construct validity; information on the interpretability and clinical meaningfulness of measurements.

Observational Studies

Reports of cohort, case-control, and cross-sectional studies of the prevalence, causes, mechanisms, course, treatment, and prevention of disease. Authors who are reporting data on several patients and want to perform data analyses in an attempt to identify correlations, test hypotheses, or determine cause-and-effect relationships should submit the manuscript following the Observational Studies format.

Guidelines and Checklists

STROBE statement and checklist

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstracts

Word limit. 275 words

Structure. Background, Objective, Design, Methods, Results, Limitations, Conclusions (see Haynes).

Body of Manuscript

Sections. Introduction, Methods, Results, and Discussion

References. 75 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6 (See here for more information on formatting)

Comments. Always end the Introduction section with a clear statement of the study's objectives or hypotheses.

For studies that examine the reliability of a measurement or series of measurements, the patient and clinician sample sizes must be of adequate size to be generalizable. In addition, the study must make a clear and compelling argument for how the findings would have an impact on clinical practice. Issues such as single score interpretation and the interpretation of change scores for the measures under study should be addressed.

Protocol. PTJ encourages submission of the original study protocol. If you are using an existing database, indicate the source of the data and permission to use the data. Describe methods used to maximize completeness, validity, and quality of the data.

Statistical analysis. Describe primary and secondary analyses, including summary measures used, and methods of analysis. Detail how adjustments are made for confounders and any planned subgroup analyses. Account for missing/incomplete data or loss to follow-up.

Qualitative Studies

Reports of research that is concerned with understanding the processes which underlie behavioral patterns. Focus is on the meanings and interpretations of the participants' contributions. Data generally are derived from observation, interviews, verbal interactions, and examination of documents.

Guidelines and Checklists

http://www.qualres.org/HomeGuid-3868.html

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstracts

Word limit. 275 words

Structure. Background, Objectives, Design, Methods, Results, Conclusions

Body of Manuscript

Word limit. 5,500 words (excluding abstract and references). Please provide the manuscript word count on the abstract page of your manuscript. Additional materials may be submitted in the form of an appendix, which would appear only on the PTJ Web site if the paper is accepted.

Sections. Introduction, Methods, Results, Discussion

References. Fewer than 50 (See here for more information about formatting)

Tables and figures. Maximum of 6; one figure of the theoretical model if grounded theory. (See here for more information on formatting)

Comments. Always end the Introduction section with a clear statement of the study's objectives, aims or questions.

Sampling. The sampling strategy should be justified in the Methods section. Indicate how the sample is sufficient to understand the study context.

Analysis. The analysis procedure(s) should be made explicit, avoiding jargon, and/or defining terms. If thematic analysis is used, detail how the categories/themes were derived from the data. Indicate how data were selected from the original sample in the analysis process. If software is used, indicate the name, version, and manufacturer. Provide sufficient data to support the findings and consider any contradictory data. Specify the methods to enhance methodological rigor.

Results. Include quotes or other evidence to support the conclusions from the analysis. Indicate methods of triangulation or data cross-checking and whether findings have been validated by participants.

Systematic Reviews and Meta-analyses

Reviews that systematically find, select, critique, and synthesize evidence relevant to well-defined questions about diagnosis, prevention, prognosis, or therapy.

Guidelines and Checklists

PTJ recently endorsed and adopted PRISMA (Preferred Reporting Items for Systematic reviewers and Meta-analyses), as discussed in the September 2009 editorial. For meta-analyses of randomized controlled trials, follow the PRISMA statement and checklist. Click here for an explanatory document.

For meta-analyses of observational studies in epidemiology, follow MOOSE reporting guidelines and checklist (page 3 of PDF).

Title

Titles should not be vague and should reflect measured variables. For instance, instead of using "physical therapy" to refer to intervention, state specific interventions (eg, "strengthening exercises"). For studies that are meta-analyses or systematic reviews, add that descriptor as the subtitle at the end of the title.

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstracts

Word limit. 275 words

Structure. Background, Purpose, Data Sources, Study Selection, Data Extraction, Data Synthesis, Limitations, Conclusions (see Haynes).

Body of Manuscript

Sections. Introduction, Methods, Results, and Discussion.

The Methods section subheadings should be:
• Data Sources and Searches
• Study Selection
• Data Extraction and Quality Assessment
• Data Synthesis and Analysis

References. 75 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 8. Include a flow diagram that depicts search and selection processes; include evidence tables. (See here for more information on formatting)

Comments. Justify why the review makes an important contribution to the literature and should be a priority for publication. This is particularly critical when there are already other published reviews on the same topic or when the review locates only a few studies. Reviews that fail to provide a clear answer to the study objective are a low priority for publication.

Always end the Introduction section with a clear statement of the study's objectives or hypotheses.

Outline the steps that have been taken to optimize data quality (eg, independent rating of study attributes and/or data extraction, double data entry, piloting of data extraction form, training of raters). For studies that have numerical data and use statistical inference, include a section under Methods that describes the methods and specific statistical software used for the statistical analysis.

Where pooling is undertaken, a quantitative approach (levels of evidence, vote counting) is preferred to a qualitative approach. Include a consideration of trial heterogeneity (statistical, methodological, clinical).

Figures such as forest plots and funnel plots need to be of high quality and usually are best prepared on meta-analysis software designed to produce such plots.

Statistical analysis. Please see the recommendations in the PRISMA and MOOSE checklists for issues related to statistical analyses. Included in these recommendations are assessments of heterogeneity, study quality, and confounding.

Case Reports

Case Reports describe various aspects of clinical practice (eg, examination, intervention, administrative approaches, risk management, etc) related to the field of physical therapy. Case Reports differ from Research Reports in that they do not test hypotheses or establish cause-and-effect relationships.

Because many different aspects of physical therapy could be described in a case report, a "one size fits all" format is unrealistic. The PTJ Editors and Editorial Board, therefore, have established 7 focus-based case report formats:

Diagnosis/Prognosis
Clinical Measurement Procedures
Intervention
Application of Theory to Practice
Risk Management
Administrative/Educational Process
"Full" Traditional Case Report

Protection of Participants. Along with their signed copyright release forms, authors of Case Reports should submit a signed patient consent form. Case Report authors who practice in the United States should also include a statement about meeting the HIPAA (Health Insurance, Portability, and Accountability Act) requirements of the institution for disclosure of protected health information.

Case report authors are required to identify their focus and follow the format corresponding to that focus. Case Reports receive masked review by 2 reviewers and 1 Editorial Board member.

A Word About Case Series. For the purposes of PTJ, "case series" is a case report describing multiple patients. Like single-patient case reports, a case series describes the episode of care for the patients, including descriptions of the examination procedures, interventions, and outcomes of care. Authors submitting a case series should use the same format that is required by PTJ for single-patient case reports. To condense information so that the case series meets the maximum word-limit criterion (3,500 words), PTJ recommends that authors use tables whenever possible to provide selected history, examination, intervention, and outcome information for each patient in the case series.

If authors reporting data on several patients want to perform data analyses in an attempt to identify correlations, test hypotheses, or determine cause-and-effect relationships, they should NOT submit the manuscript as a case report. Instead, they should submit the manuscript following the Observational Studies format. Likewise, if the case series is reporting on more than 10 patients, it is likely that the paper would be more appropriately categorized as an observational study.

Case Report authors submitting on or after October 1, 2007: as part of the review process, you may be asked to revise your reports to include some of the information that is requested in these guidelines.

Diagnosis/Prognosis

Emphasis is on the diagnostic or prognostic aspect of patient care. May cover the process and logic associated with differential diagnosis (ie, clinical decision making), unusual or difficult diagnostic/prognostic events, missed diagnoses, etc. Detail should be concentrated in the patient history and physical examination and in the conclusion or decisions made based on the examination. The case report should challenge readers to deduce the diagnosis and determine how the diagnosis relates to the care of the patient. Interventions and outcomes may be included but should not have as much detail.

Title

The title should indicate that the manuscript is a case report. Titles should not be vague. For instance, instead of using "physical therapy" to refer to intervention, state specific interventions (eg, "strengthening exercises").

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Word limit. 3,500 words (excluding abstract and references). Please provide the manuscript word count on the abstract page of your manuscript. Additional materials may be submitted in the form of an appendix that would appear only as supplemental data on the PTJ Web site if the paper is accepted.

Sections.

Background and Purpose
Patient History and Review of Systems
- Clinical Impression
Examination
- Clinical Impression
Intervention
Outcome
Discussion

Background and Purpose. Scholarly discussion on the current issues related to the diagnostic/prognostic aspect of the case (eg, current state of knowledge, problems with differential diagnoses, mimicking or missed diagnoses).

Rationale for why the approach needs to be demonstrated in a case.

Purpose statement that clearly indicates the focus as related to diagnosis/prognosis (eg, "The purpose of this case report is to demonstrate the diagnostic process in….").

Patient History and Review of Systems. Detailed demographic characteristics and history (eg, chief complaints, other relevant medical history, prior or current services related to the current episode, comorbidities) that are relevant to the diagnostic/prognostic approach being demonstrated.

Patient/family goals for physical therapy.

Clinical Impression: Based on the data provided so far, explain what you believe is the primary problem, the potential differential diagnoses that need to be addressed, and any further information not provided in the initial patient interview or history that you requested from the patient. Include the reasons for asking for this additional information as it pertains to the diagnostic/prognostic aspect of the case. The plan for examination (eg, test selection) should be clearly described. State why, at this point, this particular patient is a good candidate for the purpose of the case report.

Examination. Examination procedures should be consistent with the clinical impression above and with the diagnostic/prognostic issues that are the focus of the case. Procedures directly related to the diagnostic/prognostic process being demonstrated should be described so that readers can replicate them (figures, tables, and supplemental appendixes and videos can be used to provide adequate detail).

Available studies on reliability and validity of measurements should be cited. If not available, provide acknowledgement of this fact. Reviewers may request a presumptive argument for the potential of reliability and validity in these cases.

Clinical Impression: Provide a statement confirming or denying initial impressions based on the examination data, and give a working diagnosis. Indicate the plan of action (eg, proceed with intervention, further testing, referral for other consultation). State why the patient continues to be appropriate for the case. If the decision is to proceed, state the plan for intervention based on the current data.

Include the plan for follow-up evaluation of outcomes (measures, time points). If further examination is required, address this next, indicating the additional tests and why particular tests are chosen.

Another Clinical Impression: State the revised course of action, based on the additional information.

Intervention. Summarize the physical therapy and/or medical interventions used (eg, surgery, radiation therapy). If physical therapy interventions were performed, provide a general description of the strategy and intervention tactics. Tables, figures, and appendixes can be used to provide details. Include enough detail so that the reader understands what was done, but extensive details should not be necessary. Clearly link treatment intervention back to the diagnostic decision-making process.

Outcome. Briefly describe the outcome measures, and cite evidence for reliability and validity. If reliability and validity have not been established for a measure, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case.

Present the outcomes over the time points indicated in the follow-up plan above.

Compare follow-up outcomes to baseline. Tables and figures can be used to enhance the description.

Discussion. Provide a scholarly, critical analysis of how the diagnostic dilemma, if any, was resolved, and how the diagnostic process guided further decision making from a treatment and/or prognostic perspective.

Compare the case to other similar reports in the literature, and provide rationale for how this case makes a novel contribution and improves existing diagnostic decision-making strategies.

Offer suggestions for future research.

Relative dates. Please use relative dates (eg, years or months or days relative to onset of injury or to start of treatment) in your manuscript rather than absolute dates (ie, calendar dates). It is usually easier to grasp the chronology of events when the amount of time since the event or start of treatment is reported, rather than forcing the reader to calculate the amount of time.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. (See here for more information on formatting)

Clinical Measurement Procedures

Emphasis is on introducing a new clinical measurement procedure or modifying an existing procedure to deal with a specific problem or measurement issue. The difference between this category and diagnosis/prognosis is that the focus is on one specific procedure. Detail should be concentrated in the scientific rationale or theory for the procedure, the conditions under which the procedure should be used, and a thorough description of the procedure so that readers could replicate it (supplemental videos may be appropriate). The case demonstrates the clinical use of the test. If evidence of reliability or validity is not yet available in the literature, the authors should make strong theoretical and presumptive arguments that the procedure provides reliable and valid measurements and has the potential to influence decision making.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Sections.

Background and Purpose
Patient History and Review of Systems
- Clinical Impression
Examination
- Clinical Impression
Intervention
Outcome
Discussion

Background and Purpose. Because this focus introduces a new measurement procedure or a modification to an existing procedure, the background information should be a scholarly discussion on the gaps in the literature for assessing the target problem or clinical outcome that would provide the rationale for either developing the new procedure or modifying an existing one. The background also should provide the underlying theoretical basis for the development of the new test or modification. This could be based on biological, physiological, biomechanical, psychosocial, measurement, or any other knowledge and theory.

Purpose statement should clearly indicate that the focus relates to the clinical measurement procedure (eg, " The purpose of this case report is to demonstrate the use of a new clinical measurement procedure for….").

Patient History and Review of Systems. Demographic characteristics and history (eg, chief complaints, other relevant medical history, prior or current services related to the current episode, comorbidities) in sufficient detail to demonstrate that the patient is appropriate for the target measurement procedure.

Clinical Impression: Based on the data provided so far, explain why you believe that the patient is a good candidate for the measurement procedure.

Detail the examination plan for further determining whether the patient is appropriate for this type of measurement procedure (ruling in or ruling out relevant differential diagnoses).

Examination. Statement confirming that the patient is appropriate for the measurement procedure, based on the examination data. Describe any tests needed to confirm this, as stated in the above clinical impression.

Clinical Impression: Describe why the measurement procedure is appropriate for the patient and how the results will influence decision making.

Intervention (Measurement Procedure). In this case format, the measurement procedure is viewed as the "intervention." Describe the measurement procedure in detail. Details of how the measure was developed and how it is applied to the patient should be thorough so that others can replicate the procedure. Tables, figures, and appendixes can be used to enhance the detailed description.

List the basic rules and criteria used to interpret the results or scoring of the procedure.

Clinical Impression: Present the results and interpretation of the measurement procedure. Describe how the results fit in with the other history and examination data to inform further decisions about interventions, referrals, etc. If the procedure results in intervention, describe the intervention plan.

Outcome. If an intervention or consultation was performed based on the result of the measurement procedure, report the outcome of the intervention or consultation.

Compare outcome measures to pretreatment measures.

Discussion. Reflect back on how the measurement procedure helped identify the patient's problem(s) and assisted in treatment planning and evaluating clinical outcomes.

Presumptive arguments might be introduced for the procedure's validity based on the case.

Offer suggestions for further study of reliability and validity.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6 (See here for more information on formatting)

Intervention

Emphasis is on the intervention aspect of patient care. May cover the development of a new intervention or a modification to an existing intervention to deal with a clinical problem. Detail is concentrated in the rationale for the new or modified intervention, the development process, the direct application to the patient, and the setting in which it is used. The patient history and examination should indicate why the patient is appropriate for the new or modified intervention. Outcome is included but should not have as much detail.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Sections.

Background and Purpose
Patient History and Review of Systems
    - Clinical Impression
Examination
    - Clinical Impression
Intervention
    - Clinical Impression
Outcome
Discussion

Background and Purpose. Provide the underlying theoretical basis for the development of a new intervention or for the modification of an existing intervention, and provide relevant scholarly discussion on the gaps in the literature and in practice for treating the target problem. This would be based on biological, physiological, biomechanical, psychosocial, or any other knowledge and theory.

Purpose statement should clearly indicate the focus of the case as it relates to the intervention (eg, "The purpose of this case report is to describe the development and demonstrate the use of a new intervention for ….").

Patient History and Review of Systems. Demographic characteristics and diagnosis, patient's chief complaints, other relevant medical history, prior or current services related to the current episode, and comorbidities in sufficient detail to demonstrate that the patient is appropriate for the intervention.

Clinical Impression: Based on the data provided so far, explain why you believe the patient is a good candidate for the intervention.

Detail the examination plan for further determining whether the patient is appropriate for this type of intervention (ruling in or ruling out relevant differential diagnoses, prognostic factors that suggest appropriateness for the intervention approach).

Examination. In this case format, the examination section would be used to confirm that the patient is appropriate for the focus intervention. Provide descriptions of any tests needed to confirm this, as stated in the above clinical impression.

Clinical Impression: Discuss why the patient is appropriate for use of the target intervention based on the examination data. Describe the plan for examination to determine the outcome of the intervention (measures to be used, follow-up time points), providing hypotheses of what should be observed if the intervention were to be successful.

Intervention. Describe the intervention in detail. Details of how the intervention was developed and how it is applied to the patient should be thorough so that others can replicate the procedure. Tables, figures, and appendixes can be used to enhance the detailed description.

Provide the parameters of the intervention (ie, intensity, frequency, and duration) and rules for progression.

State changes in treatment over time, along with the rationale for such changes.

List any co-interventions that the patient may have received but that are not directly related to the purpose of the case; detailed descriptions may not be necessary. Reviewers might ask for more detail if it is believed that the co-intervention would have a significant impact on the management of the patient.

Outcome. If not already in the examination section, provide operational definitions of the outcome measures and their purpose, and cite evidence for reliability and validity. Priority is given to validated outcome measures. If reliability and validity have not been established for a measure, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case.

Present the outcomes over the time points indicated in the follow-up plan above.

Compare follow-up outcomes to baseline.

Tables and figures can be used to enhance the description.

Discussion. Reflect back on how the intervention may have assisted in addressing the target problem. This should be done in the context of other co-interventions that may have been provided. The key points of development and application should be tied back to the rationale for the treatment and literature on previous treatment approaches for a similar problem.

Suggestions for future research should be made.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. (See here for more information on formatting)

Application of Theory to Practice

Case demonstrates how a theoretical principle was used to develop an intervention, evaluation procedure, administrative/educational process, etc. Detail is heaviest in fully explaining the theory, the implication of the theory for practice, the development of the intervention, test procedure, etc, based on the principles of the theory. The patient or setting is described in enough detail to show that it is appropriate for demonstrating application of the theory. Outcomes may be reported, but with less emphasis.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Sections.

Background and Purpose
Patient History and Review of Systems
- Clinical Impression
Examination
- Clinical Impression
Intervention
Outcome
Discussion

Background and Purpose. Discuss thoroughly the theory to be demonstrated, citing the major references related to the theory.

Discuss how you believe the theory could be applied to physical therapist practice, citing supporting literature. This discussion may relate to how the theory could be applied to an evaluation or intervention approach.

The purpose statement should clearly indicate that the focus of the case is to demonstrate how the theory was applied to some aspect of physical therapist practice (eg, "The purpose of this case report is to demonstrate how [name of theory] was used to develop an intervention approach for….").

Patient History and Review of Systems. Demographic characteristics, diagnosis, patient's chief complaints, other relevant medical history, prior or current services related to the current episode, and comorbidities in sufficient detail to demonstrate that the patient is appropriate for the demonstration of the theory application.

Clinical Impression: Based on the data provided, explain why you believe the patient is a good candidate for the procedures. Describe the plan for examination to further determine whether the patient would be appropriate for this type of approach (ruling in or ruling out relevant differential diagnoses).

Examination. Use the examination section to confirm that the patient is appropriate for the procedures. Describe any tests needed to confirm this, as stated in the above clinical impression.

Clinical Impression: Discuss why the patient is appropriate for use of the approach based on the examination data. Describe the plan to determine the outcome of the intervention (measures to be used, follow-up time points), providing hypotheses of what should be observed if the approach were to be successful.

Intervention (Application of Theory to Practice). Describe the approach (evaluation, intervention, or both) in detail. Details of how the intervention was developed should be in the context of the theory being demonstrated. Descriptions of the procedures should provide enough detail that readers can replicate them. Tables, figures, and appendixes can be used to enhance the detailed description.

Where applicable, provide parameters such as intensity, frequency, and duration and rules for progression.

State changes in treatment over time, along with the rationale for such changes. List any co-interventions that the patient may have received but that are not directly related to the demonstration of the theory; detailed descriptions may not be necessary. Reviewers might ask for more detail if it is believed that the co-intervention would have a significant impact on the management of the patient or on application of the theory to practice.

Outcome. If not already presented in examination section, provide operational definitions of the outcome measures and their purpose, and cite evidence for reliability and validity. If reliability and validity have not been established for a measure, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case.

Present the outcomes over the time points as indicated in the follow-up plan above.

Compare follow-up outcomes to baseline.

Tables and figures can be used to enhance the description.

Discussion. Reflect back on how the approach adequately demonstrates the application of the theory to practice. The key points of development and application of the approach should be tied back to the original theory. Discuss whether the outcomes might suggest that the theory was successfully applied.

Refer to previous literature to justify that application of this theory to practice as presented in the case may enhance future practice.

Suggestions for future research should be made.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. (See here for more information on formatting)

Risk Management

Case describes risk management issues or demonstrates how risk management issues were handled. May cover topics such as accidents, adverse events, emergencies, and risk reduction strategies that are associated with physical therapist practice. Emphasis is on describing the nature of the risk, the rationale for dealing with the risk, methods for resolving or reducing the risk, and involvement of any other personnel or agencies.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Sections.

Background and Purpose
Details of the Current Risk Management Issue
- Clinical Impression
Actions Taken to Address the Risk
Outcome
Discussion

Background and Purpose. Background information should include a thorough review of the risk management issue (accidents, adverse events, emergencies), including the nature and prevalence of the problem and how it can affect physical therapist practice. Other consequences of the risks—such as legal, punitive, or budgetary and financial burdens—should be discussed to justify the importance of the topic.

The purpose statement should clearly indicate that the focus of the case is to demonstrate a risk management issue in practice (eg, "The purpose of this case report is to describe an approach designed to prevent an adverse event X in the care of a patient with….").

Details of the Current Risk Management Issue. Detailed description of the patient involved (history, pertinent examination data, the plan of care, and any other events leading up to the risk management issue).

Discuss the current best-evidence guidelines for the management issue and the expected consequences of deviating from the guidelines.

Clinical Impression: Based on the data provided, explain why you believe the current situation represents the risk management issue. Describe what you believe needs to be done to correct, minimize, or prevent the risk at this point, and summarize the next course of action. Discuss plans for determining the outcome of the action plan.

Actions Taken to Address the Risk. Describe in detail the steps taken to address the risk.

Where applicable, cite literature that provides the rationale for the actions taken. If the steps involve the addition of an intervention, describe it in detail so that the reader can replicate it. If the steps involve interaction with other professionals, describe the purpose and nature of these interactions.

Outcome. Discuss the results of the actions taken to address the risk, consistent with the stated plan for determining outcome. If measurement procedures are used, they should be operationally defined, and evidence for reliability or validity should be cited, if available. If such information is not available, acknowledge this, and make a presumptive argument for validity.

Discussion. Reflect back on how well the actions used adequately addressed the risk. Care must be taken to keep this discussion in the context of the case and not make generalized conclusions about how to address the risk.

Suggestions for future research should be provided.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. (See here for more information on formatting)

Administrative/Educational Processes

Case describes or demonstrates the development and implementation of new administrative/educational processes or modifications to existing approaches to address special problems or needs. Detail is concentrated in the rationale for the new or modified process, steps taken to develop the process, and the direct application of the process in the context of the intended target population and setting in which it would be used.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Sections.

Background and Purpose
Target Setting
Development of the Process
Application of the Process
Outcome
Discussion

Background and Purpose. The background should provide enough review of the literature to justify the development or demonstration of the process. Explain what has been done or not been done currently or in the past that justifies a change in the paradigm or a modification of an existing paradigm.

The purpose statement should clearly indicate that the focus of the case is to demonstrate an administrative/educational process (eg, "The purpose of this case report is to describe the development and demonstrate the implementation of an X management approach in outpatient physical therapy clinics to….")

Target Setting. Provide details about the setting for which the process will be developed and in which it will be implemented. The description may include previous or current data about the setting sufficient to justify why this setting needs the process and why the facility is appropriate for it. State directly why this setting is appropriate for the demonstration of the process, based on the data provided in this section.

Development of the Process. Provide a detailed description of the steps taken to develop the process. The rationale for each developmental step should be supported by the literature or other solid rationale.

Discuss any other special considerations—such as, but not limited to, stakeholder consultations—that were taken into account in developing the process.

Describe the plan to determine the outcome of implementing the process (measures, follow-up time points), providing hypotheses of what should be observed if the approach were to be successful.

Application of the Process. Provide details of how the approach was implemented in the target setting. Discuss the technical aspects of implementing the process, and identify the time-dependent factors (eg, frequency, duration). Describe any training procedures that were used for those involved in implementation of the process. Explain what was done to get acceptance by staff involved with implementing the process.

Outcome. Discuss the outcomes of the actions taken to implement the process, consistent with the stated plan for determining outcome. If measurement procedures are used, they should be operationally defined, and evidence for reliability or validity should be cited if available. If such information is not available, acknowledge this, and make a presumptive argument for validity.

Discussion. Reflect back on how well the implementation of the process achieved its goals, based on the outcome data. Care must be taken to keep this discussion in the context of the case and not make generalized conclusions about use of the process in other settings.

Discuss any difficulties encountered during the development and implementation of the process that could have affected the outcome.

Refer to previous literature to justify that the application of the process in the case may or may not enhance administrative/educational processes in physical therapy.

Suggestions for future research should be made.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. (See here for more information on formatting)

"Full" Traditional Case Report

Case describes the overall management of an unusual case or a condition that is infrequently encountered in practice or poorly described in the literature. The entire care of the patient from start to finish is described, with no one aspect of care receiving greater focus.

Title

Titles (including subtitles) should be no longer than 150 characters (including punctuation and spaces). Titles in excess of this limit will be edited, subject to author approval.

Abstract

Word limit. 275 words or fewer

Structure. Background and Purpose, Case Description, Outcomes, Discussion

Body of Manuscript

Sections.

Background and Purpose
Patient History and Review of Systems
- Clinical Impression
Examination
- Clinical Impression
Intervention
Outcome
Discussion

Background and Purpose. Scholarly presentation of the importance of the topic and the rationale for the case. Cite background literature concerning the clinical problem and the evaluation and treatment procedures that will be emphasized, culminating in a purpose statement that is supported by the background information.

Patient History and Review of Systems. Demographic characteristics, diagnosis, other relevant medical history, prior or current services related to the current episode, comorbidities, patient's chief complaints.

Patient/family goals for physical therapy.

Clinical Impression: Based on the data provided so far, explain what you believe to be the primary problem, the potential differential diagnoses that need to be addressed, and the plan for examination (tests to be used, etc), and state why this particular patient is a good candidate for the purpose of the case report.

Examination. Examination procedures should be consistent with the clinical impression above.

Procedures that might not typically be used by physical therapists should be described so that readers can replicate them (figures, tables, and supplemental videos and appendixes can be used to provide adequate detail).

Provide citations for more commonly used procedures.

Cite available studies on reliability and validity of measurement. If such studies are not available, acknowledge this fact. Reviewers may request a presumptive argument for the potential of reliability and validity in these cases.

Clinical Impression: Provide a statement confirming or denying the initial impression, based on the examination data. Indicate the next plan of action (eg, proceed with intervention, further testing, referral for other consultation). State why the patient continues to be appropriate for the case. If the decision is to proceed, state the plan for intervention based on the current data. Provide the plan for follow-up evaluation of outcomes (measures, time points).

Another Clinical Impression: If further examination is required, discuss it, and state the revised course of action.

Intervention.

The interventions indicated in the plan of action from the section above should be described so that the reader can replicate the interventions (figures, tables, and supplemental videos and appendixes can be used to provide adequate detail).

Purpose statements for each of the interventions should be provided.

Provide parameters such as intensity, frequency, and duration and rules for progression.

State changes in treatment over time, along with the rationale for such changes.

Outcome. If not already presented in the examination section, provide operational definitions of the outcome measures and their purpose, and cite evidence for reliability and validity. If a measure is used for which reliability and validity are not yet known, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case.

Present the outcomes over the time points indicated in the follow-up plan above.

Compare follow-up outcomes to baseline.

Tables and figures can be used to enhance the description.

Discussion. Summarize how the case demonstrated the intended purpose. Relate what happened to other cases in the literature and/or to the background given at the beginning of the case report.

Avoid any definitive cause-and-effect statements about interventions.

Avoid making definitive generalizations to other patients.

Speculate on potential implications for clinical practice.

Offer suggestions for future research.

References. 30 or fewer (See here for more information about formatting)

Tables and figures. Maximum of 6. (See here for more information on formatting)

Technical Reports

Technical Reports are original reports that describe and document the specifications or mechanical aspects of a device used by physical therapists in intervention or measurement. Evaluation of the device should be part of the report. References should be minimal, with major emphasis on the description of the methods used to evaluate the device. Authors should refer to the submission requirements for Research Reports. Technical Reports receive masked review by 2 reviewers and 1 Editorial Board member.

Perspectives

Highly scholarly papers expounding on a specific clinical approach to patient care (on either a theoretical or practical basis) or addressing professional issues in physical therapy, health care, and related areas. Perspectives are not classic literature reviews (PTJ does not publish literature reviews). Perspectives contain new ideas, interpretations, and opinions and are intended to inform and advance practice in important ways. Perspectives can address translational research. Perspectives are one of the most highly cited manuscript types. Typically, these manuscripts are written by leaders and innovators in the field of health care. References should number 75 or fewer. Potential authors are encouraged to browse previously published Perspectives. The editors consider the following to be a model for prospective Perspective authors:

Topp KS, Boyd BS. Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice. Phys Ther. 2006 Jan;86:92-109.

Perspectives receive nonmasked review by 2 reviewers and 1 Editorial Board member.

How to Submit a Manuscript

If you've never used PTJ Manuscript Central as an author or reviewer before, click on Create a New Account, and follow the prompts to submit your information and establish a user ID and password. Once you have your user ID and password, login, click on your Author Center, and then click on Submit First Draft of New Manuscript. You will be prompted to enter data into 10 screens and then upload your manuscript.

If you're a manuscript reviewer or an author who has already used PTJ Manuscript Central, you already have a user ID and password. Login, click on Author Center, and either click on Submit First Draft of New Manuscript (if you are submitting a new manuscript) or Revised Manuscripts (only for those who received a manuscript decision of "Accept With Revision" or "Major Revision").

Technical assistance is available by clicking on an icon at the top of the screen; you also may contact Manuscripts Coordinator karendarley{at}apta.org or Managing Editor janreynolds{at}apta.org if you have any questions.

Author Reprints

Authors are invited to order reprints of their articles. A reprint order form is sent to the corresponding author at the time of publication, along with a copy of the issue in which the article appears. Readers can contact the corresponding author of the article to obtain reprints.

Table of Contents

Editorial Policies

Immediate Decisions

Fast-Track Review

Redundant, Duplicate, or Simultaneous Publication

Prior Disclosure and Media Embargo Policy

Copyright and Authorship

Commercial/Financial Associations and Conflict of Interest

Protection of Participants

PubMed Central Deposits

CONSORT

Clinical Trials Registration

Photograph and Video Release

Reprinted Tables and Figures

Letters to the Editor

General Instructions

Related Articles

People-First Language

Scientific Writing Style

Measurements

Manufacturer Footnotes

Formatting

References

Tables

Figures

Appendixes

Online-Only Materials

Research Reports

Requirements for Presenting Data

Suggested Strategies for Common Analytic Approaches

Multivariable Analysis

Measures of Effect and Risk

Missing Data

Clinical Trials

Clinical Trials Registry

Guidelines and Checklists

Title

Abstract

Body of Manuscript

Diagnostic Test Studies

Guidelines and Checklists

Title

Abstracts

Body of Manuscript

Measurement Studies

Guidelines and Checklists

Title

Abstracts

Body of Manuscript

Observational Studies

Guidelines and Checklists

Title

Abstracts

Body of Manuscript

Qualitative Studies

Guidelines and Checklists

Title

Abstracts

Body of Manuscript

Systematic Reviews and Meta-analyses

Guidelines and Checklists

Title

Abstracts

Body of Manuscript

Case Reports

Diagnosis/Prognosis

Title

Abstract

Body of Manuscript

Clinical Measurement Procedures

Title

Abstract

Body of Manuscript

Intervention

Title

Abstract

Body of Manuscript

Application of Theory to Practice

Title

Abstract