Extremities: Studies into assessment, diagnosis and procedures

Decary S; Ouellet P, Vendittoli PA, Roy JS, Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis , Physical Therapy in Sport, 23, 143-155, 2017

This systematic review and meta-analysis looks at the diagnostic validity of knee examination testing. It concludes that most commonly used tests have questionable validity to diagnose or exclude knee pathologies. There are however, a couple of noted exceptions.

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Heidar Abady A, Rosedale R, Chesworth B, Rotondi M, Overend T, Consistency of commonly used orthopedic special tests of the shoulder when used with the McKenzie system of mechanical diagnosis and therapy, Musculoskeletal Science and Practice, 38, 11-17, 2017

This study, with a cohort of shoulder patients, looked at the consistency of three orthopedic special tests (OSTs) between sessions and in relation to the MDT classification. Both Cervical Derangements and Shoulder Derangements had an adverse impact on the consistency of all 3 tests. The authors hypothesized that these presentations may be in some way responsible for the historic poor performance of OSTs

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HeidarAbady A, Rosedale R, Overend T, Chesworth B, Rotondi M, Inter-examiner reliability of diplomats in the Mechanical Diagnosis and therapy system in assessing patients with shoulder pain, J Man & Manip Ther, 22:4:199-205, 2014

54 clinical vignettes were created by Diploma holders. Another 6 Diploma holders classified each vignette accoring to the MDT system. Very good reliability was demonstrtaed in classifying patients with shoulder pain (Kappa 0.90)

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Kidd J, Treatment of shoulder pain utilizing mechanical diagnosis and therapy principles, JMMT, 21(3):168-173, 2013

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Lange T, Freiberg A, Dro€ge P, Lützner J, Schmitt J, Kopkow C, The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture: A systematic review, Manual Therapy, 20,402-411, 2014

This systematic review looked at the reliability of ACL testing. 7 articles were identified which examined 4 tests. The studies were of poor quality when assessed using the QAREL tool. Due to this, meta-analysis was not possible. The routine use of these tests for ACL diagnosis was questioned

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Littlewood C, Malliaris P, Mawson S, May S, Walters S., Patients with rotator cuff tendinopathy can successfully self-manage, but with certain caveats, a qualitative study., Physiotherapy, 100:80-85, 2014

Six patients and two therapists were recruited from a pilot randomised controlled trial, which compared usual physiotherapy to a self-managed loaded exercise programme. Preference and expectations for a more hands-on treatment approach was common amongst patients and therapists. There were several barriers to the self-managed approach, including these prior beliefs and response to therapy. However despite these beliefs some were positive about the self-managed approach, with good explanation, positive response, and patient_x0019_s self efficacy appearing key.

 

May S, Greasley A, Reeve S, Withers S, Expert therapists use specific clinical reasoning processes in the assessment and management of patients with shoulder pain: a qualitative study., Aust J Physiotherapy, 54(4):261-6, 2007

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May S, Ross J, The McKenzie classification system in the extremities: a reliability study using McKenzie assessment forms and experienced clinicians., J Manip Physiol Ther, 32:556-563, 2009

126 therapists with Diploma in MDT were sent 25 patients vignettes on extremity assessment forms with instructions to classify them in line of the mechanical syndromes, other or a spinal problem. 97 provided data, with 92% agreement and a kappa value of 0.83.

 

May SJ, Rosedale R, A survey of the McKenzie classification system in the extremities: prevalence of the mechanical syndromes and preferred loading strategy., Phys Ther, 92:1175-1186, 2012

Data on 388 patients with extremity problems gathered by 30 therapists: 120 had shoulder problems, 103 had knee problems, and 72 had ankle / foot problems; 37% had derangements, 17% had contractile dysfunctions, 10% had articular dysfunctions, and 36% were 'other'. Classification remained consistent between initial and final treatment in 86%. For derangements at the shoulder extension and medial rotation were the most common directional preferences, at the knee extension was directional preference in 40-44 derangements.

 

Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ, Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study, Am J Sports Med, 40(12):2720-4, 2012

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Reiman M, Goode A, Cook C, Hölmich P, Thorborg K, "Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: A Systematic Review with Meta-analysis, Br J Sports Med, 49, 811, 2015

This systematic review found that few tests were available for diagnosing hip femoralacetabular impingement/labral tear and further study is needed

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Takasaki H, Agreement of Mechanical Diagnosis and Therapy Classification in Patients With Extremity Conditions, Physical Therapy, 96(10):1525-1532, 2016

This study examined reliability of MDT in the extremities with examiners using two methodologies; concurrently seeing the patients and seeing the patients successively. Inter-examiner agreement was good with concurrent observation and poor with successive observation.

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Takasaki H, Iwasada Y, May S, Attitude towards the use of MDT and Reliability of Classification Extremity problems by Credentialed Therapists, Journal of Chiropractic Medicine, 14,32-38, 2016

The purpose of the study was two-fold. Firstly to explore the attitudes of MDT credentialed therapists towards the use of MDT in the extremities and secondly to test the inter-examiner reliability of credentialed therapists using MDT for extremity patients. The survey to gauge attitudes was completed by 60 therapists abd found that there was low confidence in using the system in the extremities. The vignette based reliability component found a good level of reliability in using MDT classification for extremity problems.

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Takasaki H, Okuyama K, Rosedale R, Inter-examiner classification reliability of Mechanical Diagnosis and Therapy for extremity problems - Systematic review, Musculoskeletal Science and Practice, 27, 78-84, 2017

This systematic review explores MDT's reliability with classification in the extremities. Six high quality studies were included. They demonstrated; strong evidence for acceptable reliability for vignette study design, limited evidence concurrent design and unacceptable reliability from a successive design study.

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Willis S, Rosedale R, Rastogi R, Robbins S, Inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy in the examination of the knee , J Man Manip Ther, 25, 2, 83-90, 2017

This vignette based reliability study showed substantial agreement (k=0.72) among MDT therapists in the use of MDT classification for the knee

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Woodley S, Nicholson H, Livinstone V, Doyle TC, Meikle GR, Macintosh JE, Mercer SR, Lateral Hip Pain: Findings From Magnetic Resonance Imaging and Clinical Examination, JOSPT, 38(6):313-328, 2008

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