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Hi all I have had a very quick search and couldnt find anything on the sensitivity/specificity of the above test. I have noticed in clinic however that as cervical pain increases this test becomes more positive even though my suspicion during the history put it low on my DDx list ( Lower sensitivity??) I was wondering if anyone had any evidence on the above test or if anyone else has notcied a similar pattern.??
I'm looking for any information (thesis, books, articles, etc.)
56yo pt needs a unilateral hip replacement due to Osteoarthritis. No significant Past medical history. Pt is active and would like to continue activities such as basketball, snow and waterskiing. What type of replacement will allow hip to continue such activities for as long as possible, with as few revisions as possible.
The other tools used will be
Demographic data : including life style diseases, history of fall, medications
Fall Efficacy Scale- International (FES-I)
Physical Performance: Short Physical Performance Battery (SPPB)
Dynamic Balance: Four Square Step Test (FSST)
Credibility of randomized clinical trials
Randomized controlled trials (RCTs) are commonly conducted to test the effectiveness of interventions, for example, (manual-) physiotherapeutic interventions. Many researchers claim that the design by randomly distributing patients into treatment and control groups is the only reliable and valid means to properly inform clinical decisions. However, RCTs involve complex processes - from randomizing, blinding and controlling to implementation etc. - which is based on strong theoretical assumptions and can lead to biased results. See article of Alexander Krauss ‘Why all randomized controlled trails biased results’ (Annals of Medicine 2018;50(4):312-322). The study of Kraus assesses the 10 most cited RCTs worldwide and shows that trials inevitably produce bias.
In this context, an article by Artus and colleagues is particularly instructive for the effectiveness of primary care interventions in patients with low back pain (Rheumatology Oxford 2010;49(12):2346-2356). Based on results from a large number (n = 118) of RCTs, these authors show that the trend in pain reduction and improvement of functioning in patients with low back pain is virtually identical, regardless of the type of first-line treatment. The same trend can be observed in patients with neck pain. The most simple explanation for this finding is that improvements in individuals with low back pain and neck pain are simply due to the natural history. In my opinion this explanation is too simple. Many patients with chronic musculoskeletal pain are worldwide referred to physiotherapists after the period of natural recovery – sometimes after six months and later. Chronic (musculoskeletal) pain is oft context dependent, multifactorial and multidimensional. This requires a complex diagnostic reasoning process which results in identification of factors affecting functioning and recovery positively or negatively.
In this content again, an article by Maissan and colleagues is instructive for the evaluation of the completeness of the clinical reasoning process of physiotherapists in RCTS with patients with non-specific neck pain receiving physiotherapy treatment (Musculoskeletal Science and Practice 2018;35:8-17). In 70% of the studies (n=122) the clinical reasoning process is incomplete, particularly the diagnostic steps of the process. In my opinion, this means treatment without reliable and valid diagnostic process. This is in itself a peculiar course of events in which the effectiveness and efficacy of physiotherapy interventions are examined without a prior adequate indication of (manual) physiotherapy interventions.
As long as there are important uncertainties in the results of RCTs, it is very difficult to interpret the different outcomes between the treatment and control groups as simply reflecting the effectiveness of treatment, particularly physiotherapy treatment.
What can we do to become better aware of the biased results in RCTs and the evidentiary gaps concerning the completeness of the clinical reasoning process of (manual) physiotherapy used in RCTs?