The reliability of clinical tools with and without ultrasound guidance to measure leg-length inequality.

Purpose: To determine and compare the reliability and efficiency of various methods of leg-length measurement. Methods: A total of 88 leg-lengths were measured among 50 subjects (79%-84% female, mean age = 30-33 years). Leg-lengths were measured in both supine and standing positions using multiple devices, including a tape measure, a LASER distance meter, and diagnostic ultrasound. Results: All methods of leg-length measurement using the middle of the femoral head as a reference point, identified via ultrasound, demonstrated excellent reliability (intraclass correlation coefficient = 0.95-1.00). Measurements performed in supine, using the anterior superior iliac spine as a reference point, with a tape measure, demonstrated good-to-excellent reliability (intraclass correlation coefficient = 0.86-0.95, standard error of the measurement = 16.1-19.9 cm). Standing measurements using the anterior superior iliac spine as a reference point, using a tape measure, demonstrated fair-to-excellent reliability (intraclass correlation coefficient = 0.71-0.95). Conclusion: Ultrasound-guided landmark identification appear to be a more reliable method compared to palpation of the anterior superior iliac spine for measurement of leg-length using clinical tools. When coupled with ultrasound guidance, a hand-held LASER distance meter/pitch locator apparatus or a retractable tape measure appears to be acceptable alternatives to a fixed LASER distance meter on a linear actuator for leg-length measurement.

Reliability of a Musculoskeletal Imaging Competency Examination for Physical Therapists.

INTRODUCTION: The Burley Readiness Examination (BRE) for Musculoskeletal (MSK) Imaging Competency assesses physical therapists' baseline MSK imaging competency. Establishing its reliability is essential to its value in determining MSK imaging competency. The purpose of this study was to test the reliability of the BRE for MSK Imaging Competency among physical therapists (PTs) with varying levels of training and education. REVIEW OF LITERATURE: Previous literature supports PTs' utility concerning diagnostic imaging; however, no studies directly measure their competency. With PTs expanding their practice scope and professional PT education programs, increasing their MSK imaging instruction, assessing competency becomes strategic in determining the future of MSK education and training. SUBJECTS: One hundred twenty-three United States licensed PTs completed the BRE. METHODS: Physical therapists completed the BRE through an online survey platform. Point biserial correlation (rpb) was calculated for each examination question. Final analyses were based on 140 examination questions. Examination scores were compared using independent sample t-test and one-way analysis of variance. Chi-square tests and odds ratios (ORs) assessed the relationship of a passing examination score (≥75%) and the type of training. Reliability of the BRE was assessed using Cronbach's alpha (α). RESULTS: Mean overall examination score was 75.89 ± 8.56%. Seventy PTs (56.9%) obtained a passing score. Physical therapists with additional MSK imaging training, board certification, and residency or fellowship training scored significantly higher (P < .001) compared with those with only entry-level PT program education. Physical therapists with additional MSK imaging training scored significantly higher (x̄ = 81.07% ± 8.93%) and were almost 5 times (OR = 4.74, 95% CI [1.95-11.50]) as likely to achieve a passing score than those without. The BRE demonstrated strong internal consistency (Cronbach's α = 0.874). DISCUSSION AND CONCLUSIONS: The BRE was reliable, consistently identifying higher examination scores among those with increased MSK imaging training. Training in MSK imaging influenced competency more than other factors. The BRE may be of analytical value to PT professional and postprofessional programs.

Development of a Musculoskeletal Imaging Competency Examination for Physical Therapists.

OBJECTIVE: The number of physical therapists with imaging ordering privileges is increasing; however, a known level of competency and knowledge is generally lacking within the profession, as is a method to determine practitioner competency. The purpose of this study was to develop a valid musculoskeletal (MSK) imaging competency examination for physical therapists. METHODS: This 3-round Delphi method study utilized experts to reach consensus on examination content and development. Round 1 was completed by 37 experts. The last 2 rounds were completed by 35 experts. Experts rated questions on a 5-point Likert rating scale of importance (1 = not at all important, 5 = very important). Consensus was achieved with an a priori decision of (1) >75% agreement of the expert panel rating and ≥4 on the Likert scale, and (2) ≥.90 on Cronbach alpha and intraclass correlation coefficients. Experts recommended a passing score of 75%. The examination was subsequently reviewed by a panel of 5 radiologists. RESULTS: The Delphi method and radiologist panel review resulted in the 151-question Burley Readiness Examination (BRE) for MSK Imaging Competency. Interrater agreement and internal consistency of the Delphi panel were excellent, with an average intraclass correlation coefficient and Cronbach alpha of .928 and .950, respectively. CONCLUSIONS: The BRE is a tool that has the potential to demonstrate practitioners' level of baseline competency with MSK imaging. Additional testing among physical therapists will provide further validation and reliability of the examination. IMPACT: The use and application of diagnostic imaging is becoming more widespread in physical therapist practice throughout the United States. The BRE could potentially have broader implications for health care utilization and cost in the area of MSK imaging.

Acute progressive neurological decline in an elderly man.

The patient was an 88-year-old man referred to a physical therapist by his primary care physician for a 1-week history of severe neck pain of insidious onset. Based upon the history and physical examination, the physical therapist concluded that the patient's neck pain was mechanical in nature. Initial physical therapist intervention included cervical taping, cervical collar use and instruction in home exercise. At his follow-up visit 4 days after his initial physical therapy visit, the patient reported no improvement. The patient's son, who accompanied him to this visit, also reported that his father had a recent onset of fever and mild confusion. The case was discussed with the patient's physician and it was recommended that the patient report to the emergency department. Evaluation in the emergency department revealed that the patient was febrile with diminished oxygen saturation and an elevated white blood cell count. Chest radiographs were consistent with pneumonia and blood cultures were positive for methicillin-resistant Staphylococcus aureus. The patient was hospitalized and over the next 6 days, his condition progressively declined and quadriplegia below the C4 myotomal level developed. Magnetic resonance imaging of the cervical spine revealed severe cervical central canal stenosis with extensive signal abnormality in the cervical cord, as well as diffuse oedema in the perivertebral soft tissues that was consistent with a retropharyngeal abscess. Despite medical management, the patient subsequently succumbed to the complications of pneumonia and quadriplegia.