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Thoomes-de Graaf M, Ottenheijm RPG, Verhagen AP, Duijn E, Karel YHJM, van den Borne MPJ, Beumer A, van Broekhoven J, Dinant GJ, Tetteroo E, Lucas C, Koes BW, Scholten-Peeters GGM. Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study. Musculoskelet Sci Pract 2019; 40:1-9. [PMID: 30660988 DOI: 10.1016/j.msksp.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/23/2018] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
STUDY DESIGN A systematic overview of the literature and an agreement study. OBJECTIVES The aim of this study is to explore the inter-professional agreement of diagnostic musculoskeletal ultrasound (DMUS) between physical therapists (PT) and radiologists, using a new classification strategy based upon the therapeutic consequences in patients with shoulder pain. BACKGROUND DMUS is frequently used by PTs, although the agreement regarding traditional diagnostic labels between PTs and radiologists is only fair. Nevertheless, DMUS could be useful when used as a stratifying-tool. METHODS First, a systematic overview of current evidence was performed to assess which traditional diagnostic labels could be recoded into new treatment related categories (referral to secondary care, corticosteroid injections, physical therapy, watchful waiting). Next, kappa values were calculated for these categories between PTs and radiologists. RESULTS Only three categories were extracted, as none of the traditional diagnostic labels were classified into the 'corticosteroid injection' category. Overall, we found moderate agreement to stratify patients into treatment related categories and substantial agreement for the category 'referral to secondary care'. Both categories 'watchful waiting' and 'indication for physical therapy' showed moderate agreement between the two professions. CONCLUSION Our results indicate that the agreement between radiologists and PTs is moderate to substantial when labelling is based on treatment consequences. DMUS might be able to help the PT to guide treatment, especially for the category 'referral to secondary care' as this showed the highest agreement. However, as this is just an explorative study, more research is needed, to validate and assess the consequences of this stratification classification for clinical care.
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Affiliation(s)
- M Thoomes-de Graaf
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, the Netherlands.
| | - R P G Ottenheijm
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - A P Verhagen
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - E Duijn
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, the Netherlands
| | - Y H J M Karel
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, the Netherlands
| | | | - A Beumer
- Department of Orthopaedic Surgery, AMPHIA Hospital, Breda, the Netherlands
| | | | - G J Dinant
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - E Tetteroo
- Department of Radiology, AMPHIA Hospital, Breda, the Netherlands
| | - C Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
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Karel YHJM, Scholten-Peeters GGM, Thoomes-de Graaf M, Duijn E, van Broekhoven JB, Koes BW, Verhagen AP. Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management. Physiotherapy 2016; 103:369-378. [PMID: 28801032 DOI: 10.1016/j.physio.2016.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Shoulder pain is one of the three main musculoskeletal complaints and more than 50% of the patients have symptoms longer than 6 months. Until now, limited data exist about the content of physiotherapy for patients with shoulder pain in primary care. OBJECTIVE Describe current physiotherapeutic diagnostic- and therapeutic management, including the use of diagnostic ultrasound, in patients with shoulder pain in primary care. DESIGN AND SETTING A prospective cohort study in primary care physiotherapy with a 12 week follow-up. METHODS Descriptive data from physiotherapists was collected, such as: the diagnostic hypotheses after patient history and physical examination, the use of specific tests and diagnostic ultrasound, the interventions used and possible changes in treatment plan. RESULTS Subacromial impingement syndrome was the most common hypothesis after patient history (48%) as well as physical examination (39%). Diagnostic ultrasound was used in 31% and of these patients the clinical diagnosis changed in 29%. Various interventions were used in all clinical diagnoses. After 12 weeks 41% of patients still received physiotherapy treatment. CONCLUSIONS Patients with shoulder pain in physiotherapy practice frequently show signs of subacromial impingement syndrome. The interventions used by the physiotherapists were generally in line with the guideline for subacromial impingement syndrome however a small proportion of physiotherapists used massage and tape/bracing techniques. A large proportion of patients were still receiving treatment after 12 weeks when no improvement was observed. If treatment for patients with subacromial impingement shows no benefit patients should be referred back to the general practitioner or orthopedic surgeon. Conclusions from this study might be slightly biased because of the selection of physiotherapists.
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Affiliation(s)
- Y H J M Karel
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - G G M Scholten-Peeters
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Faculty of Behavioural and Movement Sciences, MOVE Research Institute Amsterdam, VU University of Amsterdam, Amsterdam, The Netherlands
| | - M Thoomes-de Graaf
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Duijn
- Department of Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - B W Koes
- Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A P Verhagen
- Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Thoomes-de Graaf M, Scholten-Peeters G, Duijn E, Karel Y, van den Borne M, Beumer A, Ottenheijm R, Dinant G, Tetteroo E, Lucas C, Koes B, Verhagen A. Inter-professional agreement of ultrasound-based diagnoses in patients with shoulder pain between physical therapists and radiologists in the Netherlands. ACTA ACUST UNITED AC 2014; 19:478-83. [DOI: 10.1016/j.math.2014.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/12/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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