A proposal for a universal physical therapy diagnostic concept.

BACKGROUND: In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used. OBJECTIVE: To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context. METHODS: The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized. RESULTS: Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures. CONCLUSIONS: The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice.

Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness.

OBJECTIVE: To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness. STUDY DESIGN: Case controlled. SETTING: Otolaryngology clinic of a tertiary referral hospital center. PATIENTS: Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo. MAIN OUTCOME MEASURES: Symptoms description, Dizziness Handicap Inventory-short form (DHI), Trait anxiety score, cervical joint position error, the smooth pursuit neck torsion and cervical torsion tests on videonystagmography, and standing balance test (timed 10-meter walk with head turns). RESULTS: The results showed differences in reported symptoms, in mean cervical joint position error (p = 0.001), and cervical torsion test (p = 0.001) between the two groups. There was no between-group difference for DHI scores (p = 0.137), trait anxiety scores (p = 0.240), and walking test: time (p = 0.797), steps (p = 0.963). The Youden index is 0.60 for the predictive value of the cervical joint position error, and the smooth pursuit and the cervical torsion tests. CONCLUSION: This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.