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Hage G, Buisseret F, Brismée JM, Dierick F, Detrembleur C, Hage R. Evaluating the additive diagnostic value of DidRen LaserTest: Correlating temporal and kinematic predictors and patient-reported outcome measures in acute-subacute non-specific neck pain. J Bodyw Mov Ther 2024; 39:201-208. [PMID: 38876626 DOI: 10.1016/j.jbmt.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Guillaume Hage
- Laboratoire de Neuro Musculo Squelettique (NMSK), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, 1200 Brussels, Belgium
| | - Fabien Buisseret
- Centre de Recherche et de Formation de la HELHa (CeREF), Chaussée de Binche 159, 7000 Mons, Belgium; Service de Physique Nucléaire et Subnucléaire, UMONS, Research Institute for Complex Systems, Place Du Parc 20, 7000 Mons, Belgium
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Frédéric Dierick
- Centre de Recherche et de Formation de la HELHa (CeREF), Chaussée de Binche 159, 7000 Mons, Belgium; Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation (Rehazenter), Rue André Vésale 1, 2674 Luxembourg, Luxembourg; Faculté des Sciences de La Motricité, UCLouvain, Place Pierre de Coubertin 1-2, 1348 Louvain-la-Neuve, Belgium
| | - Christine Detrembleur
- Laboratoire de Neuro Musculo Squelettique (NMSK), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, 1200 Brussels, Belgium
| | - Renaud Hage
- Centre de Recherche et de Formation de la HELHa (CeREF), Chaussée de Binche 159, 7000 Mons, Belgium; Faculté des Sciences de La Motricité, UCLouvain, Place Pierre de Coubertin 1-2, 1348 Louvain-la-Neuve, Belgium; Traitement Formation Thérapie Manuelle (TFTM), Private Physiotherapy/Manual Therapy Center, Avenue des Cerisiers 211A, 1200 Brussels, Belgium; Haute école Libre de Bruxelles Ilya Prigogine, Section Kinésithérapie, 808, Route de Lennik, Bâtiment P, 1070 Brussels, Belgium.
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Areeudomwong P, Jirarattanaphochai K, Ruanjai T, Buttagat V. Clinical utility of a cluster of tests as a diagnostic support tool for clinical lumbar instability. Musculoskelet Sci Pract 2020; 50:102224. [PMID: 33099174 DOI: 10.1016/j.msksp.2020.102224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Numerous clinical tests have been proposed for the diagnosis of clinical lumbar instability (CLI), but a cluster of clinical tests is still needed to increase the accuracy of CLI diagnosis. OBJECTIVE To evaluate a diagnostic support tool intended to identify the presence of CLI using a cluster of clinical tests. DESIGN Analytical cross-sectional study. METHODS Two hundred participants with chronic low back pain (LBP) were diagnosed with or without CLI by an orthopedic surgeon. The orthopedic surgeon made the diagnosis from classic clinical symptoms and signs. The diagnosis was used as the reference standard. An orthopedic physical therapist used four clinical tests to identify CLI in each participant, including the apprehension sign, the instability catch sign with/without the abdominal drawing-in maneuver (ADIM), the painful catch sign with/without the ADIM, and the prone instability test. RESULTS For an individual test, the apprehension sign showed a high specificity (92.6%) and a positive likelihood ratio (LR+; 2.4) but a very low sensitivity of 17.4%. A cluster of three of the four examined tests provided the most diagnostic accuracy for CLI, with a high LR+ (5.8) and a high specificity (91.7%) but low sensitivity (47.8%) and a negative likelihood ratio (LR-; 0.6). CONCLUSIONS A cluster of three of the four examined tests was determined to comprise a powerful clinical support tool for the identification of CLI patients as tested against a reference standard diagnosis. CLINICAL TRIAL REGISTRATION Name of the registry: Thai Clinical Trials Registry. Registration number: TCTR20190426002.
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Affiliation(s)
- Pattanasin Areeudomwong
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
| | - Kitti Jirarattanaphochai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Thapakorn Ruanjai
- Department of Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Vitsarut Buttagat
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
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Sillevis R, Shamus E, van Duijn A. Evaluation of anterotalofibular and calcaneofibular ligament stress tests utilizing musculoskeletal ultrasound imaging. Physiother Theory Pract 2020; 38:1488-1498. [PMID: 33249979 DOI: 10.1080/09593985.2020.1849478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Study Design: A quasi-experimentalBackground: The talar tilt test and the anterior drawer test are clinically used to evaluate the length of the anterotalofibular (ATFL) and calcaneofibular (CFL) ligaments. Based on the current literature, there is no clear diagnostic utility or preference for either test. This study investigated ligament lengthening during these special tests and compared the talar tilt test to the long axis distraction test for the CFL length.Methods: A convenience sample of 47 healthy subjects were recruited for this study. Musculoskeletal ultrasound imaging (MSK US) was used to measure the length of the ATFL and CFL during the talar tilt and anterior drawer tests. Additionally, CFL lengthening during the talar tilt was compared to the long axis distraction test.Outcomes: A significant difference was found (p < .001) in ATFL length between the talar tilt and anterior drawer test. This indicates that the talar tilt test is preferred to maximally lengthen the ATFL. There was a significant difference in CFL length (p < .001) between the talar tilt test and the long axis distraction test.Discussion: The results of this study identified that the talar tilt test resulted in more ATFL lengthening than the anterior drawer test and thus is the preferred test to assess ligament length. Additionally, both the long axis distraction test and the talar tilt test cause lengthening of the CFL. Therefore, the long axis distraction test can be used as a differentiation test to determine if either the ATFL or the CFL is the structure with increased laxity.
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Affiliation(s)
- Rob Sillevis
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Eric Shamus
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Arie van Duijn
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
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Anarte E, Ferreira Carvalho G, Schwarz A, Luedtke K, Falla D. Can physical testing be used to distinguish between migraine and cervicogenic headache sufferers? A protocol for a systematic review. BMJ Open 2019; 9:e031587. [PMID: 31712341 PMCID: PMC6858106 DOI: 10.1136/bmjopen-2019-031587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Differential diagnosis of migraine and cervicogenic headache (CGH) can be challenging given the large overlap of symptoms, commonly leading to misdiagnosis and ineffective treatment. In order to strengthen the differential diagnosis of headache, previous studies have evaluated the utility of physical tests to examine for musculoskeletal impairment, mainly in the cervical spine, which could be provoking or triggering headache. However, no systematic review has attempted to evaluate whether physical tests can differentiate CGH from migraine or both conditions from asymptomatic subjects. METHODS/ANALYSIS A systematic review protocol has been designed and is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). A sensitive topic-based search strategy is planned which will include databases, hand searching of key journals and consultation of relevant leading authors in this field. Terms and keywords will be selected after discussion and agreement. Two independent reviewers will perform the search and select studies according to inclusion and exclusion criteria, including any cohort or observational studies evaluating the topic of this review; a third reviewer will confirm accuracy. A narrative synthesis will be developed for all included studies and, if possible, a meta-analysis will be conducted. The overall quality of the evidence will be assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist for diagnostic accuracy studies and the Downs and Black scale for those studies where the QUADAS-2 checklist cannot be applied. ETHICS AND DISSEMINATION Ethical approval is not required since no patient information will be collected. The results will provide a deeper understanding about the possibility of using physical tests to differentiate cervicogenic headache from migraine and from asymptomatic subjects, which has direct relevance for clinicians managing people with headache. The results will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42019135269.
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Affiliation(s)
- Ernesto Anarte
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Annika Schwarz
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Luedtke
- Pain and Exercise Research, Universitat zu Lubeck Sektion Medizin, Lubeck, Germany
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Dewitte V, De Pauw R, Danneels L, Bouche K, Roets A, Cagnie B. The interrater reliability of a pain mechanisms-based classification for patients with nonspecific neck pain. Braz J Phys Ther 2018; 23:437-447. [PMID: 30389348 DOI: 10.1016/j.bjpt.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the interrater reliability and agreement of a pain mechanisms-based classification for patients with nonspecific neck pain (NSNP). METHODS Design - Observational, cross-sectional reliability study with a simultaneous examiner design. SETTING University hospital-based outpatient physical therapy clinic. PARTICIPANTS A random sample of 48 patients, aged between 18 and 75 years old, with a primary complaint of neck pain was included. INTERVENTIONS Subjects underwent a standardized subjective and clinical examination, performed by 1 experienced physical therapist. Two assessors independently classified the participants' NSNP on 3 main outcome measures. MAIN OUTCOME MEASURES The Cohen kappa, percent agreement, and 95% confidence intervals (CIs) were calculated to determine the interrater reliability for (1) the predominant pain mechanism; (2) the predominant pain pattern; and (3) the predominant dysfunction pattern (DP). RESULTS There was almost perfect agreement between the 2 physical therapists' judgements on the predominant pain mechanism, kappa=.84 (95% CI, .65-1.00), p<.001. There was substantial agreement between the raters' judgements on the predominant pain pattern and predominant DP with respectively kappa=.61 (95% CI, .42-.80); and kappa=.62 (95% CI, .44-.79), p<.001. CONCLUSION(S) The proposed classification exhibits substantial to almost perfect interrater reliability. Further validity testing in larger neck pain populations is required before the information is used in clinical settings. CLINICAL TRIAL REGISTRATION NUMBER NCT03147508 (https://clinicaltrials.gov/ct2/show/NCT03147508).
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Affiliation(s)
- Vincent Dewitte
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Robby De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Katie Bouche
- Centre for Musculoskeletal and Neurological Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Arne Roets
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Whiteford CM, Steinbeck L, Dommerholt J. On "Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain," Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162-171. Phys Ther 2018; 98:819-820. [PMID: 29961845 DOI: 10.1093/ptj/pzy078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Colleen M Whiteford
- Appalachian Physical Therapy, Broadway, Virginia. Dr Whiteford is a board-certified clinical specialist in orthopaedic physical therapy and a certified myofascial trigger point therapist (pain specialist)
| | - Larry Steinbeck
- Advance Rehabilitation Services, Jasper, Georgia. Mr Steinbeck is a certified myofascial trigger point therapist (pain specialist)
| | - Jan Dommerholt
- Bethesda Physiocare LLC, Bethesda, Maryland. Dr Dommerholt is a diplomate of the Academy of Integrative Pain Management
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Bier JD, Scholten-Peeters WGM, Staal JB, Pool J, van Tulder MW, Beekman E, Knoop J, Meerhoff G, Verhagen AP. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain. Phys Ther 2018; 98:162-171. [PMID: 29228289 DOI: 10.1093/ptj/pzx118] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.
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Affiliation(s)
- Jasper D Bier
- Department of General Practice, Erasmus University of Rotterdam, Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands
| | - Wendy G M Scholten-Peeters
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - J Bart Staal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands, and Research Group for Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Jan Pool
- Institute of Human Movement Studies, Department of Lifestyle and Health, HU University of Applied Sciences, Utrecht, the Netherlands
| | - Maurits W van Tulder
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, the Netherlands
| | - Emmylou Beekman
- The Research Centre for Autonomy and Participation for Persons With a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jesper Knoop
- The Research Centre for Autonomy and Participation for Persons With a Chronic Illness, Zuyd University of Applied Sciences
| | - Guus Meerhoff
- The Research Centre for Autonomy and Participation for Persons With a Chronic Illness, Zuyd University of Applied Sciences
| | - Arianne P Verhagen
- Department of General Practice, Erasmus University of Rotterdam, Rotterdam, the Netherlands
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Flavell CA, Gordon S, Marshman L. Classification characteristics of a chronic low back pain population using a combined McKenzie and patho-anatomical assessment. ACTA ACUST UNITED AC 2016; 26:201-207. [PMID: 27744135 DOI: 10.1016/j.math.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Physiotherapists use musculo-skeletal classification systems for patient assessment. Since its early development, the McKenzie lumbar spine assessment (MK) has been incorporated into examination algorithms and combined with a series of patho-anatomical diagnostic tests. No previous studies have used a MK and a combined examination (MK-C) to provide a detailed profile of patients, report and compare the classification characteristics of a chronic low back pain (CLBP) population. OBJECTIVE To report the classification characteristics of a CLBP population using MK and MK-C examinations, and conduct inter-classification comparison of the MK-C for demographics, the Oswestry Disability Index (ODI), Roland Morris Disability Index (RM), Modified Somatic Perceptions Questionnaire (MSPQ), symptom duration and intensity. METHOD A prospective cross-sectional study conducted in a spinal clinic by a MK trained physiotherapist. RESULTS Results were obtained in 150 patients. Using MK, 31% (n = 47) of participants were classified as inconclusive. Following MK-C only 6% of participants remained inconclusive (n = 9). The most frequent MK-C classification was facet joint syndrome (FJS) (49%). Participants with FJS were significantly older than those classified as discogenic (p < 0.001; CI 3.96 ̶ 19.74), or mixed (p < 0.001; CI 5.98 ̶ 36.41). Participants classified as discogenic had significantly higher RM (p = 0.022) and MSPQ (p = 0.005) scores than FJS. CONCLUSION Results indicated that 94% of CLBP patients could be classified using a MK-C. The most common presentation in CLBP was facet joint syndrome. Age, RM and MSPQ appeared to be distinguishing characteristics of this population. Future studies should be conducted to establish the validity and reliability of the MK-C.
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Affiliation(s)
- Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Douglas Campus, Townsville, Qld, 4811, Australia.
| | - Susan Gordon
- School of Health Sciences, Rehabilitation and Aged Care, Flinders University, Adelaide, SA, 5000, Australia.
| | - Laurence Marshman
- The Townsville Hospital, Angus Smith Drive, Townsville, Qld, 4811, Australia.
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Lindbäck Y, Tropp H, Enthoven P, Abbott A, Öberg B. PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol. BMC Musculoskelet Disord 2016; 17:270. [PMID: 27400960 PMCID: PMC4940916 DOI: 10.1186/s12891-016-1126-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/29/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Current guidelines for the management of patients with specific low back pain pathology suggest non-surgical intervention as first-line treatment, but there is insufficient evidence to make recommendations of the content in the non-surgical intervention. Opinions regarding the dose of non-surgical intervention that should be trialled prior to decision making about surgery intervention vary. The aim of the present study is to investigate if physiotherapy administrated before surgery improves function, pain and health in patients with degenerative lumbar spine disorder scheduled for surgery. The patients are followed over two years. A secondary aim is to study what factors predict short and long term outcomes. METHODS This study is a single blinded, 2-arm, randomized controlled trial with follow-up after the completion of pre-surgery intervention as well as 3, 12 and 24 months post-surgery. The study will recruit men and women, 25 to 80 years of age, scheduled for surgery due to; disc herniation, spinal stenosis, spondylolisthesis or degenerative disc disease. A total of 202 patients will be randomly allocated to a pre-surgery physiotherapy intervention or a waiting list group for 9 weeks. The waiting-list group will receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. The pre-surgery physiotherapy group will receive physiotherapy 2 times per week, consisting of a stratified classification treatment, based on assessment findings. One of the following treatments will be selected; a) Specific exercises and mobilization, b) Motor control exercises or c) Traction. The pre-surgery physiotherapy group will also be prescribed a tailor-made general supervised exercise program. The physiotherapist will use a behavioral approach aimed at reducing patient fear avoidance and increasing activity levels. They will also receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. Primary outcome measure is Oswestry Disability Index. Secondary outcome measures are the visual analogue scale for back and leg pain, pain drawing, health related quality of life, Hospital anxiety and depression scale, Fear avoidance beliefs questionnaire, Self-efficacy scale and Work Ability Index. DISCUSSION The study findings will help improve the treatment of patients with degenerative lumbar spine disorder scheduled for surgery. TRIAL REGISTRATION ClinicalTrials.gov reference: NCT02454400 (Trial registration date: August 31st 2015) and has been registered on ClinicalTrials.gov, identifier: NCT02454400 .
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Affiliation(s)
- Yvonne Lindbäck
- />Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden
| | - Hans Tropp
- />Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- />Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden
| | - Allan Abbott
- />Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden
- />Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD 4229 Australia
| | - Birgitta Öberg
- />Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden
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Abbott A. Evidence base and future research directions in the management of low back pain. World J Orthop 2016; 7:156-161. [PMID: 27004162 PMCID: PMC4794533 DOI: 10.5312/wjo.v7.i3.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/17/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Low back pain (LBP) is a prevalent and costly condition. Awareness of valid and reliable patient history taking, physical examination and clinical testing is important for diagnostic accuracy. Stratified care which targets treatment to patient subgroups based on key characteristics is reliant upon accurate diagnostics. Models of stratified care that can potentially improve treatment effects include prognostic risk profiling for persistent LBP, likely response to specific treatment based on clinical prediction models or suspected underlying causal mechanisms. The focus of this editorial is to highlight current research status and future directions for LBP diagnostics and stratified care.
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11
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Rubio-Ochoa J, Benítez-Martínez J, Lluch E, Santacruz-Zaragozá S, Gómez-Contreras P, Cook CE. Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review. ACTA ACUST UNITED AC 2015; 21:35-40. [PMID: 26423982 DOI: 10.1016/j.math.2015.09.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/22/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023]
Abstract
It has been suggested that differential diagnosis of headaches should consist of a robust subjective examination and a detailed physical examination of the cervical spine. Cervicogenic headache (CGH) is a form of headache that involves referred pain from the neck. To our knowledge, no studies have summarized the reliability and diagnostic accuracy of physical examination tests for CGH. The aim of this study was to summarize the reliability and diagnostic accuracy of physical examination tests used to diagnose CGH. A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in four electronic databases (MEDLINE, Web of Science, Embase and Scopus). Full text reports concerning physical tests for the diagnosis of CGH which reported the clinometric properties for assessment of CGH, were included and screened for methodological quality. Quality Appraisal for Reliability Studies (QAREL) and Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) scores were completed to assess article quality. Eight articles were retrieved for quality assessment and data extraction. Studies investigating diagnostic reliability of physical examination tests for CGH scored poorer on methodological quality (higher risk of bias) than those of diagnostic accuracy. There is sufficient evidence showing high levels of reliability and diagnostic accuracy of the selected physical examination tests for the diagnosis of CGH. The cervical flexion-rotation test (CFRT) exhibited both the highest reliability and the strongest diagnostic accuracy for the diagnosis of CGH.
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Affiliation(s)
- J Rubio-Ochoa
- Department of Physical Therapy, Faculty of Physiotherapy, University of Valencia, Spain
| | - J Benítez-Martínez
- Department of Physical Therapy, Faculty of Physiotherapy, University of Valencia, Spain
| | - E Lluch
- Department of Physical Therapy, Faculty of Physiotherapy, University of Valencia, Spain; Department of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije University Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium.
| | - S Santacruz-Zaragozá
- Department of Physical Therapy, Faculty of Physiotherapy, University of Valencia, Spain
| | - P Gómez-Contreras
- Department of Physical Therapy, Faculty of Physiotherapy, University of Valencia, Spain
| | - C E Cook
- Duke University, 2200 W. Main St. Durham, NC, USA.
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Reiman M, Burgi C, Strube E, Prue K, Ray K, Elliott A, Goode A. The utility of clinical measures for the diagnosis of achilles tendon injuries: a systematic review with meta-analysis. J Athl Train 2015; 49:820-9. [PMID: 25243736 DOI: 10.4085/1062-6050-49.3.36] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To summarize and evaluate the current diagnostic accuracy of clinical measures used to diagnose Achilles tendon injuries. DATA SOURCES A literature search of MEDLINE, CINAHL, and EMBASE databases was conducted with key words related to diagnostic accuracy and Achilles tendon injuries. STUDY SELECTION Original research articles investigating Achilles tendon injuries against an acceptable reference standard were included. DATA EXTRACTION Three studies met the inclusion criteria. Quality assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. DerSimonian-Laird random-effects models were used to pool sensitivity (SN), specificity (SP), and diagnostic odds ratios with their 95% confidence intervals (CIs). DATA SYNTHESIS The SN and negative likelihood ratio (-LR) values for Achilles tendon rupture measures ranged from 0.73 (95% CI = 0.65, 0.81) and 0.30 (95% CI = 0.23, 0.40) to 0.96 (95% CI = 0.93, 0.99) and 0.04 (95% CI = 0.02, 0.10), respectively, whereas SP and positive likelihood ratio (+LR) values ranged from 0.85 (95% CI = 0.72, 0.98) and 6.29 (95% CI = 2.33, 19.96) to 0.93 (95% CI = 0.84, 1.00) and 13.71 (95% CI = 3.54, 51.24), respectively, with the highest SN and SP both reported in the calf-squeeze test. The SN and -LR values for Achilles tendinopathy measures ranged from 0.03 (95% CI = 0.00, 0.08) and 0.97 (95% CI = not reported) to 0.89 (95% CI = 0.75, 0.98) and 0.19 (95% CI = not reported), whereas SP and +LR values ranged from 0.58 (95% CI = 0.38, 0.77) and 2.12 (95% CI = not reported) to 1.00 (95% CI = 1.00, 1.00) and infinity, respectively, with the highest SN and SP reported for morning stiffness and palpation for crepitus. Pooled analyses demonstrated similar diagnostic properties in all 3 clinical measures (arc sign, palpation, and Royal London Hospital test), with SN and -LR ranging from 0.42 (95% CI = 0.23, 0.62) and 0.68 (95% CI = 0.50, 0.93), respectively, for the arc sign, to 0.64 (95% CI = 0.44, 0.81) and 0.48 (95% CI = 0.29, 0.80), respectively, for palpation. Pooled SP and +LR ranged from 0.81 (95% CI = 0.65, 0.91) and 3.15 (95% CI = 1.61, 6.18), respectively, for palpation, to 0.88 (95% CI = 0.74, 0.96) SP for the arc sign and 3.84 (95% CI = 1.69, 8.73) +LR for the Royal London Hospital test. CONCLUSIONS Most clinical measures for Achilles tendon injury have greater diagnostic than screening capability.
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Hopkins RM, Jh A. Congenital 'butterfly vertebra' associated with low back pain: a case report. J Man Manip Ther 2015; 23:93-100. [PMID: 26109830 DOI: 10.1179/2042618613y.0000000057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The butterfly vertebral defect is a rare congenital anomaly of the spine, which is generally considered benign. In this report we present the case of an active young man who presented with recurrent low back pain (LBP), and was found to have a butterfly vertebral defect at the symptomatic L4 lumbar spinal level. We describe the genesis of the butterfly vertebral defect, in the context of normal embryological development of the human vertebra and intervertebral disk. We report the clinical examination findings and therapeutic interventions undertaken prior to the radiographic discovery of the vertebral defect, and discuss the impact that the presence of a butterfly vertebral defect presented to therapeutic decision-making.
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Affiliation(s)
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- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Validation of Palpatory Methods for Evaluating Anatomical Bone Landmarks of the Cervical Spine: A Systematic Review. J Manipulative Physiol Ther 2015; 38:302-10. [DOI: 10.1016/j.jmpt.2015.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 01/07/2015] [Accepted: 02/18/2015] [Indexed: 11/22/2022]
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15
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Castro MP, Stebbings SM, Milosavljevic S, Bussey MD. Criterion-concurrent Validity of Spinal Mobility Tests in Ankylosing Spondylitis: A Systematic Review of the Literature. J Rheumatol 2014; 42:243-51. [DOI: 10.3899/jrheum.140901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To examine the level of evidence for criterion-concurrent validity of spinal mobility assessments in patients with ankylosing spondylitis (AS).Methods.Guidelines proposed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to undertake a search strategy involving 3 sets of keywords: accura*, truth, valid*; ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; mobility, spinal measure*, (a further 16 keywords with similar meaning were used). Seven databases were searched from their inception to February 2014: AMED, Embase, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies (with modifications) was used to assess the quality of articles reviewed. An article was considered high quality when it received “yes” in at least 9 of the 13 items.Results.From the 741 records initially identified, 10 articles were retained for our systematic review. Only 1 article was classified as high quality, and this article suggests that 3 variants of the Schober test (original, modified, and modified-modified) poorly reflect lumbar range of motion where radiographs were used as the reference standard.Conclusion.The level of evidence considering criterion-concurrent validity of clinical tests used to assess spinal mobility in patients with AS is low. Clinicians should be aware that current practice when measuring spinal mobility in AS may not accurately reflect true spinal mobility.
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Coombes BK, Bisset L, Vicenzino B. Bilateral Cervical Dysfunction in Patients With Unilateral Lateral Epicondylalgia Without Concomitant Cervical or Upper Limb Symptoms: A Cross-Sectional Case-Control Study. J Manipulative Physiol Ther 2014; 37:79-86. [DOI: 10.1016/j.jmpt.2013.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 11/30/2022]
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Mathers JJ. Differential diagnosis of a patient referred to physical therapy with neck pain: a case study of a patient with an atypical presentation of angina. J Man Manip Ther 2013; 20:214-8. [PMID: 24179330 DOI: 10.1179/2042618612y.0000000011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND AND PURPOSE A 64-year-old man with acute onset neck pain was referred to physical therapy by a neurosurgeon. The purpose of this case study is to examine the process of differential diagnosis in a patient with neck pain and to discuss common diagnostic errors that can occur in the outpatient setting. CASE DESCRIPTION The patient had an 8-week history of neck pain, which was worse when running and lifting objects. He presented with imaging of the cervical spine demonstrating degenerative changes. During the examination, several differential diagnoses were considered. A thorough physical examination of the cervical spine and upper quarter failed to reproduce his symptoms. At that time, the physical therapist was suspicious that the origin of the patient's neck pain was non-mechanical in nature. Additional testing during the examination included having the patient exercise briefly on gym equipment; this reproduced his symptoms. After additional positional and postural changes did not alleviate the symptoms, he stopped exercising, and his pain ceased. OUTCOMES The patient was referred back to his primary care physician who ordered cardiovascular testing including an electrocardiogram and echocardiogram. These tests revealed significant cardiac abnormalities including multi-vessel blockage of the coronary arteries and evidence of infarction. He underwent a coronary artery bypass graft 4 days later. DISCUSSION To make an appropriate differential diagnosis, physical therapists must use a patient-centered model of clinical reasoning and meta-cognition and have an awareness of diagnostic errors such that they can be avoided. The goal of the physical therapy examination, including differential diagnosis, is to efficiently classify the patient for treatment or to direct patients to the proper healthcare provider, thereby minimizing and preventing mortality and morbidity.
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Reiman MP, Manske RC. The assessment of function. Part II: clinical perspective of a javelin thrower with low back and groin pain. J Man Manip Ther 2013; 20:83-9. [PMID: 23633887 DOI: 10.1179/2042618611y.0000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Assessment of an individual's functional ability can be complex. This assessment should also be individualized and adaptable to changes in functional status. In the first article of this series, we operationally defined function, discussed the construct of function, examined the evidence as it relates to assessment methods of various aspects of function, and explored the multi-dimensional nature of the concept of function. In this case report, we aim to demonstrate the utilization of a multi-dimensional assessment method (functional performance testing) as it relates to a high-level athlete presenting with pain in the low back and groin. It is our intent to demonstrate how the clinician should continually adapt their assessment dependent on the current functional abilities of the patients.
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Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. J Orthop Sports Phys Ther 2013; 43:223-31. [PMID: 23321899 DOI: 10.2519/jospt.2013.4343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. BACKGROUND The diagnosis of a hamstring injury has traditionally relied on various clinical measures (eg, palpation, swelling, manual resistance), as well as the use of diagnostic imaging. But a few studies have suggested the use of specific clinical tests that may be helpful for the diagnostic process. OBJECTIVE To summarize the current literature on the diagnostic accuracy of orthopaedic special tests for hamstring injuries and to determine their clinical utility. METHODS A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases (along with a manual search of grey literature) was conducted using key words related to diagnostic accuracy of hamstring injuries. To be considered for inclusion in the review, the study required (1) patients with hamstring or posterior thigh pain; (2) a cohort, case-control, or cross-sectional design; (3) inclusion of at least 1 clinical examination test used to evaluate hamstring pathology; (4) comparison against an acceptable reference standard; (5) reporting of diagnostic accuracy of the measures (sensitivity [SN], specificity [SP], or likelihood ratios); and (6) publication in English. SN, SP, and positive and negative likelihood ratios were calculated for each diagnostic test. RESULTS The search strategy identified 602 potential articles, of which only 3 articles met the inclusion criteria, with only 1 of these 3 articles being of high quality. Two of the studies investigated a single special test, whereas the third article examined a composite clinical assessment employing various special tests. The SN values ranged from 0.55 (95% confidence interval [CI]: 0.46, 0.69) for the active range-of-motion test to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test. The SP values ranged from 0.03 (95% CI: 0.00, 0.22) for the composite clinical assessment to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test, active range-of-motion test, passive range-of-motion test, and resisted range-of-motion test. The use of a single special test demonstrated stronger SP than SN properties, whereas the composite clinical assessment demonstrated stronger SN than SP properties. CONCLUSION Very few studies have investigated the utilization of clinical special tests for the diagnosis of hamstring injuries. Further studies of higher quality design are suggested prior to advocating independent clinical utilization of these special tests. LEVEL OF EVIDENCE Diagnosis, level 3b.
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Reiman MP, Goode AP, Hegedus EJ, Cook CE, Wright AA. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med 2012; 47:893-902. [DOI: 10.1136/bjsports-2012-091035] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Screening of patients suitable for diagnostic cervical facet joint blocks – A role for physiotherapists. ACTA ACUST UNITED AC 2012; 17:180-3. [DOI: 10.1016/j.math.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 11/13/2011] [Accepted: 11/17/2011] [Indexed: 01/03/2023]
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Editorial for the special issue of manual therapy based on the Third International Conference on Movement Dysfunction. ACTA ACUST UNITED AC 2010; 16:1-2. [PMID: 21106434 DOI: 10.1016/j.math.2010.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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