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Abby Morris Chad Cook Amy Hassen 《International Journal of Sports Physical Therapy》2014,9(5):674-690
Background:
A strong understanding of diagnostic imaging has been advocated for physical therapists. There have been recent changes in physical therapy curricula and increased opportunities to utilize imaging during clinical practicePurpose:
The aim of this study was to explore the ability of practicing clinicians to accurately identify selected musculoskeletal conditions on plain‐film radiograph (X‐ray), magnetic resonance imaging (MRI), and computed tomography scan (CT scan). Further, to determine whether improvements in identification of pathology occur when the clinical scenario is added to the imaging and whether there are related training/exposure factors.Methods:
A cross‐ sectional electronic survey was sent out to physical therapists in the state of Ohio. Participants were asked to identify conditions (cervical fracture, anterior cruciate ligament tear, and avascular necrosis of the femoral head) first given diagnostic images only, and then given the images and a clinical scenario.Results:
Eight hundred sixty‐six surveys of the 7537 sent out were eligible for analysis. With clinical scenarios, 61.3% of respondents were correct with the ACL injury identified on MRI, 36.4% for identification of the cervical spine fracture on CT and 25.6% for identification of avascular necrosis on plain film. The accuracy significantly improved (p<0.01) with the addition of the clinical information for all three of the diagnoses. The most remarkable improvement was seen with the AVN diagnosis on plain film radiograph (365.5% improvement), followed by the ACL injury on MRI (27.2% improvement) and cervical fracture diagnosis on CT scan (17.8% improvement). Finally, formal and informal training, board certification through the APTA and to a lesser extent, degree level, all improved diagnostic accuracy.Conclusions:
A clinical scenario paired with images notably improved identification of pathology. Physical therapists were better at identifying the ACL pathology that was presented on MRI. This is a common diagnosis to physical therapists and was paired with a relatively common imaging modality. This study suggests that physical therapists can improve accuracy with identifying pathologies on diagnostic images through a physical therapy curriculum or post‐graduation through certifications and continuing education.Level of Evidence:
Level 4 相似文献5.
Background
Clinical examination and management of patients with meningiomas is primarily dependent upon appropriate diagnosis of tumor type and surgical intervention. Physical therapists should be able to identify patients presenting with signs and symptoms suggestive of potential central nervous system (CNS) disorders and refer the patient appropriately.Patient characteristics
In this case report, a 52-year-old female was referred to physical therapy after 18 months of unresolved dizziness.Examination
Oculomotor examination revealed evidence of peripheral vestibular and potential CNS disorders. The physical therapist referred the patient to a physician who ordered magnetic resonance imaging (MRI).Intervention
The patient received five physical therapy sessions while waiting for the MRI which revealed a meningioma. The meningioma was surgically removed and the patient was subsequently relieved of all symptoms.Outcomes
Despite the presence of the meningioma, the patient reported improved stability during work-related activities and decreased dizziness as a result of physical therapy intervention pre-operatively.Discussion
This case report emphasizes the importance of a physical therapists ability to perform and interpret an oculomotor examination in a patient presenting with signs consistent with peripheral vestibular and CNS disorders. It also demonstrates the role of physical therapy in collaboration with physicians in order to provide appropriate patient care management. 相似文献6.
Susan Shultz Amanda Olszewski Olivia Ramsey Michelle Schmitz Verrelle Wyatt Chad Cook 《International Journal of Sports Physical Therapy》2013,8(6):838-848
Background Context:
A variety of self‐report and physical performance‐based outcome measures are commonly used to assess progress and recovery in the lower leg, ankle, and foot. A requisite attribute of any outcome measure is its ability to detect change in a condition, a construct known as “responsiveness”. There is a lack of consistency in how responsiveness is defined in all outcome measures.Purpose:
The purpose of this study was to review the currently used recovery outcome measures for lower leg, ankle and foot conditions in order to determine and report recommended responsiveness values.Methods:
A systematic literature search that included electronic searches of PubMed, CINAHL and SportDiscus as well extensive cross‐referencing was performed in January, 2013. Studies were included if each involved: 1) a prospective, longitudinal study of any design; 2) any condition associated with the lower leg, ankle or foot; 3) a measure of responsiveness; and 4) was an acceptable type of outcome measure (eg. self‐report, physical performance, or clinician report). The quality of the included articles was assessed by two independent authors using the responsiveness sub‐component of the Consensus‐based Standards for the selection of health Measurement Instruments (COSMIN).Results:
Sixteen different studies met the inclusion criteria for this systematic review. The most commonly used outcome measures were the Foot and Ankle Ability Measure and the Lower Extremity Functional Scale. Responsiveness was calculated in a variety of methods including effect size, standardized response mean, minimal clinically important difference/importance, minimal detectable change, and minimal important change.Conclusion:
Based on the findings of this systematic review there is a lack of consistency for reporting responsiveness among recovery measures used in the lower leg, ankle or foot studies. It is possible that the variability of conditions that involve the lower leg, ankle and foot contribute to the discrepancies found in reporting responsiveness values. Further research must be conducted in order to standardize reporting measures for responsiveness.Level of evidence:
2a 相似文献7.
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Christiane S. G. Macedo Carolina S. Alonso Rogério F. Liporaci Fernando Vieira Rinaldo R. J. Guirro 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2014,18(1):93-97
Background
Cryotherapy has been associated with a significant decrease in nerve conduction velocity and muscle contraction with possible effects on exercise and physical training.Objectives
To quantify the electromyographic response of the lateral gastrocnemius, tibialis anterior, fibularis longus, rectus femoris and gluteus medius to ankle inversion following cold water immersion.Method
The peak values of the root mean square (RMS) were obtained from 35 healthy and active university subjects after the use of a tilt platform to force the ankle into 30º of inversion before, immediately after, and 10, 20, and 30 minutes after water immersion at 4±2ºC, for 20 minutes. The Shapiro-Wilk test, repeated measures analysis, Bonferroni''s post-hoc, and linear regression analysis provided the results.Results
Peak RMS was significantly lower at all times after cold water immersion, with residual effect of up to 30 minutes, when compared to pre-immersion for all muscles, except for immediate post-immersion for the gluteus medius.Conclusions
After cold water immersion of the ankle, special care should be taken in activities that require greater neuromuscular control. 相似文献12.
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A. Russo S. Cappabianca Francesco Iaselli A. Reginelli A. D’Andrea G. Mazzei C. Martiniello R. Grassi A. Rotondo 《Journal of Ultrasound》2013,16(4):201-207
Purpose
To assess the impact of ultrasonography on defining the diagnostic and therapeutic pathways for pediatric patients admitted to the emergency department for acute abdominal pain.Methods
We performed a retrospective study of all patients aged <16 years with acute abdominal pain who underwent ultrasound examination at our Diagnostic Imaging Department from October 2010 to March 2012. We investigated for each patient the pathway following ultrasound examination and definitive diagnosis. The impact of ultrasonography was defined based on the frequency with which the information resulting from this examination confirmed or denied the diagnostic suspicion made by the emergency physician on the basis of clinical and laboratory findings.Results
In 497/729 patients (69 %), ultrasound examination did not determine variations in the diagnostic and therapeutic pathways, either because it confirmed the outcome of clinical examination and laboratory tests, or because, even addressing in the opposite direction to these, the emergency physician did not consider its result because of being particularly alarmed or sufficiently reassured by clinical examination and laboratory tests. In the remaining 232/729 cases (31 %), ultrasound examination determined an increase or a reduction of the provided care and attention (subsequently proved justified in the vast majority of cases) in spite of what was initially assessed based on clinical examination and laboratory tests.Conclusions
The results of our retrospective study demonstrated that ultrasonography was a valuable tool in the management of pediatric patients with acute abdominal pain together with clinical examination and laboratory tests. 相似文献15.
Jessica Fulton Kathryn Wright Margaret Kelly Britanee Zebrosky Matthew Zanis Corey Drvol Robert Butler 《International Journal of Sports Physical Therapy》2014,9(5):583-595
Background:
Active adults commonly present with lower extremity (LE) injuries from a variety of professional and amateur sports activities. Decreased LE function significantly alters daily life and subsequent injuries increase this impact. The purpose of this systematic review was to examine the association between previous injury and the risk of re‐injury, and to describe the changes in kinematics and motor programming that may contribute to this relationship.Methods:
A preliminary search was conducted to determine the four most common LE injuries on PubMed, CINAHL and Web of Science. These injuries, in a healthy active adult population, were hamstring strain (HS), anterior cruciate ligament injury (ACL), achilles tendon pathology, and ankle sprain. After these injuries were established, the search for this systematic review found evidence relating these injuries to re‐injury. Articles related to degenerative changes were excluded. Twenty‐six articles were included in the systematic review detailing the risk of re‐injury from a previous injury and were graded for quality.Results:
ACL injury was linked to a successive injury of the same ACL, and other injuries in the LE. HS was associated with subsequent ipsilateral HS and knee injuries. Previous achilles tendon rupture increased the risk of an analogous injury on the contralateral side. An ankle sprain was associated with a re‐injury of either the ipsilateral or the contralateral ankle. Post‐injury changes were present in strength, proprioception, and kinematics, which may have led to overall changes in motor control and function.Conclusion:
This review provides insight into the changes occurring following common LE injuries, how these changes potentially affect risk for future injury, and address the needs of the active adult population in rehabilitation.Clinical Relevance:
Current research on previous injury and re‐injury is of high quality, but scarce quantity. Deficits following an injury are known, but how these deficits correlate or lead to re‐injury requires further exploration.Level of Evidence:
1 相似文献16.
Amir Letafatkar Malihe Hadadnezhad Sadredin Shojaedin Elham Mohamadi 《International Journal of Sports Physical Therapy》2014,9(1):21-27
Background and Aim:
The Functional Movement Screen (FMS™) is a screening instrument that evaluates selective fundamental movement patterns. The main aim of this study was to investigate the relationship between the FMS™ score and history of injury, and attempt to determine which active students are prone to injury.Methods:
One hundred physically active (50 females and 50 males) students, between 18 and 25 years of age, with no recent (<6 weeks) history of musculoskeletal injury were recruited. All participants performed the FMS™ and were scored using the previously established standardized FMS™ criteria. The chi square, independent t‐test, one‐way analysis of variance, and POSTHOC Bonferroni tests were used for data analysis with a preset alpha value of p < 0.05.Results:
Of the 100 subjects, 35 suffered an acute lower extremity (ankle = 20, knee = 15) injury in practice or competition. An odds ratio was calculated at 4.70, meaning that an athlete had an approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they scored less than 17 on the FMS™. There were statistical differences between the pre‐season FMS™ scores of the injured and non‐injured groups, the ankle injury, knee injury, and non‐injured groups, and also between contact injury, non‐contact injury, and non‐injured groups.Discussion and Conclusion:
This cross‐sectional study provides FMS™ reference values for physically active students, which will assist in the interpretation of individual scores when screening athletes for musculoskeletal injury and performance factors. More research is still necessary before implementing the FMS™ into a pre‐participation physical examination (PPE) for athletics, but due to the low cost and its simplicity to implement, it should be considered by clinicians and researchers in the future.Level of Evidence:
2B 相似文献17.
Federico Pozzi Marilyn Moffat Gregory Gutierrez 《International Journal of Sports Physical Therapy》2015,10(4):520-529
Design
Cross‐sectional, controlled laboratory studyBackground
Lateral ankle sprains are common injuries and often lead to chronic ankle instability (CAI). Individuals who previously sustained a lateral ankle sprain, but did not develop CAI, termed copers, may have altered postural control strategies compared to individuals who have developed CAI. These altered postural control strategies may allow for more appropriate dynamic stabilization of the ankle joint after injury compared to those seen in patients who have developed CAI.Objective
To compare lower leg biomechanics, as well as electromyographic (EMG) activation of the tibilias anterior and peroneus longus muscles, during the posteromedial reach of the Star Excursion Balance Test (SEBT) in individuals with healthy ankles, copers, and those with CAI.Participants and Methods
30 participants (12 control, 9 copers, 9 CAI) divided into three groups based on ankle sprain history and Cumberland Ankle Instability Tool score. Kinematic, kinetic, and EMG data were collected during three posteromedial reach trials on the SEBT.Main Outcome Measures
Primary outcome measures include SEBT normalized reach distance in the posteromedial direction and average integrated EMG activation of the tibialis anterior and peroneus longus muscles during the reach. Secondary outcome measures included sagittal and frontal plane ankle complex angles and moments and sagittal plane knee angles and moments. Data were analyzed between groups using a one‐way ANOVA model.Results
No significant differences in reach distance or kinematic and kinetic outcomes were found between groups. The activation of the tibialis anterior and peroneus longus muscles was significantly different between groups (p=0.033 and p=0.014, respectively). The post‐hoc analysis revealed that the coper group had significantly higher muscle activation compared to the control group, but not to the CAI group.Conclusion
CAI did not alter kinematic, kinetic, or reach performance during the SEBT. When compared to controls, copers appeared to have greater activation of the ankle musculature, which may increase stability of the ankle complex during a dynamic balance task.Level of Evidence
Prospective Cohort level II 相似文献18.
Kate McGirr Stine Ibsen Harring Thomas Sean Risager Kennedy Morten Frederik Schuster Pedersen Rogerio Pessoto Hirata Kristian Thorborg Thomas Bandholm Michael Skovdal Rathleff 《International Journal of Sports Physical Therapy》2015,10(3):332-340
Background
Home‐exercise is commonly prescribed for rehabilitation of the shoulder following injury. There is a lack of technology available to monitor if the patient performs the exercises as prescribed.Purpose
The purpose of this study was to investigate the validity of using three dimensional (3D) gyroscope data recorded with the Bandcizer™ sensor to differentiate between three elastic band exercises performed in the shoulder joint: abduction, flexion, and external rotation.Design
Concurrent validity study.Methods
This study was performed over two phases. In the first phase, 20 subjects performed three sets of 10 of shoulder abduction, external rotation and flexion exercises with a Thera‐Band mounted with a Bandcizer, while supervised by a physical therapist. The Bandcizer has an inbuilt three‐dimensional gyroscope, capable of measuring angular rotation. Gyroscope data were analyzed in Matlab, and a one‐way ANOVA was used to test for significant differences between each of the three exercises. An algorithm was then created in Matlab based on the exercise‐data from the gyroscope, to enable differentiation between the three shoulder exercises. Twenty new subjects were then recruited to cross‐validate the algorithm and investigate if the algorithm could differentiate between the three different shoulder exercises.Results
A blinded assessor using the Matlab algorithm could correctly identify 56 out of 60 exercise sets. The kappa agreement for the three exercises ranged between 0.86‐0.91.Conclusion
The ability to differentiate between the home exercises performed by patients after shoulder injury has great implications for future clinical practice and research. When home exercises are the treatments‐of‐choice, clinicians will be able to quantify if the patient performed the exercise as intended. Further research should be aimed at investigating the feasibility of using the Bandcizer™ in a home‐based environment.Word count
2429Level of Evidence
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David A. Krause Michael S. Boyd Allison N. Hager Eric C. Smoyer Anthony T. Thompson John H. Hollman 《International Journal of Sports Physical Therapy》2015,10(1):37-44