Full-textDOI: · Available from: Peter B O'Sullivan, Aug 16, 2015
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- Manual therapy 03/2007; 12(1):1-2. DOI:10.1016/j.math.2006.11.001 · 1.76 Impact Factor
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ABSTRACT: What are the key items in the clinical reasoning process which expert clinicians identify as being relevant to the assessment and management of patients with shoulder pain? Qualitative study using a three-round Delphi procedure. Twenty-six experts in the UK consented to be involved and were contactable, of whom 20 contributed, with 12, 15, and 15 contributing to the different rounds. Clinical reasoning was mostly about diagnostic reasoning, but also involved narrative reasoning. Diagnostic reasoning involved both pattern recognition and hypothetico-deductive reasoning. Diagnostic reasoning emphasised general history items, a constellation of signs and symptoms to identify specific diagnostic categories, and standard physical examination procedures. Narrative reasoning was highlighted by the communication involved in expert history taking, seeing patients in their functional and psychological context, and collaborative reasoning with the patient regarding management. These expert clinicians demonstrated the use of diagnostic pattern recognition, and hypothetico-deductive and narrative clinical reasoning processes. The emphasis was on the history and basic physical examination procedures to make clinical decisions.The Australian journal of physiotherapy 02/2008; 54(4):261-6. DOI:10.1016/S0004-9514(08)70005-9 · 3.48 Impact Factor
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ABSTRACT: A controlled clinical trial. To assess the effects of an integrated back stability (IBS) programme on a chronic low back pain (CLBP) population in a time restricted private clinic environment. Studies assessing stability training CLBP have reported inconsistent results. Methods used within trials vary, with some authors focusing on muscle isolation and others using whole body movements. IBS uses an exercise progression beginning with posturally based exercise and progressing from muscle isolation through to complex movements. Fifty-nine chronic low back patients were divided into control (n=32) and intervention (n=27) groups. Participants in the intervention group were prescribed a 6 week individualized exercise programme in three stages. In stage 1, exercises addressed posture and movement dysfunction and activated the core stabilizing muscles. In stage 2, 'back fitness' was enhanced using progressive exercise principles. Stage 3 emphasized technique specific actions. Participants in the control group received a backcare advice leaflet only. Pre- and post-test scores were analysed for each of the outcome measures within the control group using a Wilcoxin signed ranks test. At an alpha level of p<or=0.0071, no differences were observed. For the intervention group, a Mann-Whitney U-test showed significant differences between groups in the Roland and Morris Disability Questionaire (RMDQ), short form McGill Pain Questionnaire (SF-MPQ), and the Tampa Scale of Kinesiophobia (TSK) (p<or=0.0071). Patient satisfaction was assessed by questionnaire, 89% of patients considering their level of pain and functional impairment acceptable following the programme. IBS significantly reduced pain and disability in the subject group studied. Patients reported a positive experience of the programme.Complementary Therapies in Clinical Practice 12/2008; 14(4):255-63. DOI:10.1016/j.ctcp.2008.06.001