During the conflicts in Afghanistan and Iraq, the media have called attention to post-traumatic stress syndrome, concussive injuries, and the development of improved prosthetic devices, but PTJ's special issue on military rehabilitation broadens our perspective to consider such topics as depression, sleep deprivation, transition back to community, and occupation. This issue also sheds light on the important role that physical therapists in the military play in diagnosing and treating a variety of musculoskeletal conditions.
Although this issue focuses on the armed services in North America, the guest co-editors, Lt Col John Childs and Dr Alice Aiken, and I believe that the findings are relevant to military personnel around the world—and to civilians as well. Several models of health care delivery presented in this issue may serve as models for effective accountable care organizations and medical homes and merit investigation. I thank Lt Col Childs and Dr Aiken for “joining forces” to create this issue. The idea began with a discussion with Dr Aiken at the World Confederation for Physical Therapy conference in June 2011; when you read their editorials, you will understand their passion and the timeliness of the topics.
In his editorial, Lt Col Childs remarks, “Regardless of your political leanings, war is the closest thing to hell on Earth….” This is a perfect opening for us to contemplate the life of someone who chose an alternate path to the military for his public service. As a Quaker, John “Jack” L. Echternach Sr, PT, DPT, EdD, ECS, FAPTA—who died on July 11, 2013 at the age of 81—opted to serve his country through the US Public Health Service (USPHS) rather than through the military. After graduating from the University of Pennsylvania in 1954, he was commissioned as an officer in the USPHS and served for 24 years, ascending to leadership roles similar to those described for physical therapists in the military. He performed electrodiagnostic testing to identify sites for nerve compression/injury, for example, and was the officer in charge of Physical and Occupational Therapy Activities in the Division of Hospital and Clinics. He taught other physical therapists to perform nerve conduction velocity and electromyographic assessments during and following his career in the USPHS. As a result of his experience and expertise, he is one of the physical therapists identified with APTA's Section on Clinical Electrophysiology and Wound Management who argued for a role in this assessment for civilian physical therapists. He achieved specialization in clinical electrophysiology and maintained a practice in this area through much of his career. Jack retired from the USPHS with the rank of captain and received the USPHS meritorious service medal.
Jack's civilian life as a physical therapist was equally distinguished. He was a master clinician, educator, scholar, colleague, and friend. Prior to 45 years of service to the Virginia Chapter (including a sustained role as a delegate to the APTA House of Delegates), he held office and was on committees for the Maryland Chapter and the Greater New York District. Although I cannot substantiate it, there is a legend that Jack was involved in an anti-Vietnam war motion that was defeated in the House. I am sorry that he didn't have the chance to discuss the new vision statement adopted by the 2013 House: “Transforming society by optimizing movement to improve the human experience.” It reflects his longstanding view of our role in promoting the welfare of society.
Jack founded the physical therapy education program at Old Dominion University in Norfolk, Virginia, and continued to lecture there as eminent scholar and professor; he served as an associated faculty member at Nova Southeastern University in the physical therapy PhD program and provided online courses until a few months before his death. At the airport after the APTA conference in Salt Lake City this June, I met a student in the Nova PhD program; he extolled Professor Echternach's expertise as a teacher and mentor and told me that Jack cried online when he announced to his students that he was teaching his last course at Nova.
Jack was the humble contemporary of Jules Rothstein, Steve Rose, and others who understood the need for physical therapists to go beyond receiving a “prescription” for physical therapy and who promoted our role as members of the health care team rather than as ancillary practitioners. Today, students and practicing clinicians select tools to examine patients and assess outcomes, assuming that the tools are valid, reliable, and responsive to change. This was not the case in 1987 when APTA created a 6-member task force to develop standards for tests and measures. Although physical therapists commonly examined patients using tests such as range of motion and manual muscle tests, there were no criteria for selecting the best tool or developing assessment tools. Standards for Tests and Measures in Physical Therapy Practice was published in PTJ in 1991 (71:589-622) with an editorial by Editor in Chief Jules Rothstein (71:554). Jules and Jack recognized that the document would be very difficult for both researchers and clinicians, so they wrote a companion book, Primer on Measurement: An Introductory Guide to Measurement, in 1993. These 2 documents have served as the backbone for literally hundreds of research publications reporting on the validity, reliability, and responsiveness of diagnostic tools and outcome measures. The relevance of this work continues today as APTA sections go about the task of identifying meaningful tools to assess the relevance of physical therapist intervention to treatment outcomes. The other significant contribution made by Jack and Jules, with colleague Dan Riddle, was the HOAC—the Hypothesis-Oriented Algorithm for Clinicians I and II (1986;66:1388-1394; 2003;83:455-470). Although leaders in the profession pushed the clinician to assume the role of diagnostician, both educators and clinicians were seeking a template to assist in training for this new role. Remarkably, these articles are still being cited.
Jack's contributions to PTJ began with a manuscript published in March 1958 on Burger's exercises and continued through 2009, and he received the Golden Pen Award in 1991. Thus far in 2013, his work has been cited in 6 published manuscripts related to the validity and reliability of measurement tools. A thoughtful, insightful, and instructive reviewer for PTJ since 1975, Jack performed his last manuscript review in February of this year.
It's impossible to count the number of physical therapists whose lives were enriched in the classroom, in the clinic, or in the profession by Jack Echternach. I cherish the Saturday night sessions that he and I shared with several others at APTA annual conferences and Combined Sections Meetings where we debriefed about our progress in meeting the goals of the profession and talked about the important role that physical therapy plays in society. I was privileged to learn about his family, too, and how important they were to him. Sadly, Jack's funeral took place almost a year to the day after the funeral of his beloved son, Jack Jr, a physical therapist who also was devoted to public service: a volunteer firefighter and emergency medical technician, Jack Jr died while helping a trapped motorist.
As we consider “duty, honor, country” and the legacy of all who serve or have served, whether in the military or in public service, I hope that Jack's mentees will assume his mantle and move our profession forward in the same gentle and professional way that he did.
- © 2013 American Physical Therapy Association
