Advanced practice physiotherapists are effective in the management of musculoskeletal disorders: a systematic review of systematic reviews.

BACKGROUND: There are increasing demands for orthopaedic specialist services due to the increasing burden of musculoskeletal (MSK) disorders. This situation creates a barrier for patients to access appropriate health care. Advanced practitioner physiotherapists (APP) may provide an alternative service for patients with MSK disorders. OBJECTIVE: To evaluate the evidence on whether APPs are accurate at diagnosis, can triage appropriately and improve patient treatment outcomes and access to care for patients with musculoskeletal disorders. DATA SOURCES: CINAHL, MEDline, Web of Science, SPORTdiscus, SCOPUS and AMED between January 2000 and March 2020. STUDY SELECTION: Systematic reviews evaluating the efficacy of APPs, in any healthcare setting, treating patients of any age range with MSK disorders, in comparison to orthopaedic surgeons or doctors. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted and synthesised data according to the inclusion and exclusion criteria. Methodological quality was independently assessed by two reviewers using the AMSTAR tool. A third reviewer resolved discrepancies. RESULTS: Thirteen systematic reviews met the inclusion criteria. The evidence consistently found APPs are accurate at diagnosis, can triage appropriately, and improve patient treatment outcomes and access to care. There was a lack of high-quality primary studies in the included reviews, however, the highest quality studies had similar findings. LIMITATIONS: A meta-analysis was not possible due to heterogeneity of outcome measures. There was an overlap of primary studies which may cause bias. CONCLUSION: The evidence of varying quality consistently shows that APPs can accurately diagnose, appropriately triage and effectively manage patients with musculoskeletal disorders in various clinical settings.

West Africa - a safe haven for frogs? A sub-continental assessment of the chytrid fungus (Batrachochytrium dendrobatidis).

A putative driver of global amphibian decline is the panzootic chytrid fungus Batrachochytrium dendrobatidis (Bd). While Bd has been documented across continental Africa, its distribution in West Africa remains ambiguous. We tested 793 West African amphibians (one caecilian and 61 anuran species) for the presence of Bd. The samples originated from seven West African countries - Bénin, Burkina Faso, Côte d'Ivoire, Ghana, Guinea, Liberia, Sierra Leone - and were collected from a variety of habitats, ranging from lowland rainforests to montane forests, montane grasslands to humid and dry lowland savannahs. The species investigated comprised various life-history strategies, but we focused particularly on aquatic and riparian species. We used diagnostic PCR to screen 656 specimen swabs and histology to analyse 137 specimen toe tips. All samples tested negative for Bd, including a widespread habitat generalist Hoplobatrachus occipitalis which is intensively traded on the West African food market and thus could be a potential dispersal agent for Bd. Continental fine-grained (30 arc seconds) environmental niche models suggest that Bd should have a broad distribution across West Africa that includes most of the regions and habitats that we surveyed. The surprising apparent absence of Bd in West Africa indicates that the Dahomey Gap may have acted as a natural barrier. Herein we highlight the importance of this Bd-free region of the African continent - especially for the long-term conservation of several threatened species depending on fast flowing forest streams (Conraua alleni ("Vulnerable") and Petropedetes natator ("Near Threatened")) as well as the "Critically Endangered" viviparous toad endemic to the montane grasslands of Mount Nimba (Nimbaphrynoides occidentalis).

Summary of an evidence-based guideline on soft tissue shoulder injuries and related disorders--Part 1: Assessment.

AIM: To provide a succinct summary of the diagnosis of soft tissue injuries to the shoulder for primary health care practitioners based on the New Zealand guideline. METHODS: A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tool for Epidemiology (GATE). Recommendations were derived from resulting evidence tables. RESULTS: Diagnostic ultrasound is a valid tool for the diagnosis of a full thickness rotator cuff tear. If a significant tear is suspected, referral for diagnostic ultrasound is recommended. There is a paucity of evidence for the diagnosis of soft tissue shoulder injuries and most recommendations are based on the consensus of the guideline team. CONCLUSION: Assessment relies on thorough history-taking and physician examination with appropriate referral where there is evidence of serious damage or the diagnosis remains unclear.

Manual physical assessment of spinal segmental motion: intent and validity.

Validity of a clinical test can be defined as the extent to which the test actually assesses what it is intended to assess. In order to investigate the validity of manual physical assessment of the spine, it is therefore essential to establish what physical therapists intend to assess when they are applying these tests. The aims of this study were to (1) establish what manual physical therapists are intending to assess while applying passive intervertebral motion tests; and (2) examine the face validity and content validity for manual physical assessment of the spine. We surveyed 1502 members of the national manual physical therapist organisations of New Zealand and the United States of America using a web-based survey instrument. Sixty-six percent of 466 respondents believed passive accessory intervertebral motion (PAIVM) tests were valid for assessing quantity of segmental motion, and 76% believed passive physiologic intervertebral motion (PPIVM) tests were valid for assessing quantity of segmental motion. Ninety-eight percent of manual physical therapists base treatment decisions at least in part on the results of segmental motion tests. Quality of resistance to passive segmental motion was considered of greater importance than quantity of kinematic motion during PAIVM tests, while the quality of complex kinematic motion was considered of greater importance than quantity of displacement kinematics during PPIVM tests. Manual physical therapists accept the face validity of manual physical assessment of spinal segmental motion to a great extent, however a minority voice scepticism. Content validity is dominated by concepts of segmental kinematics and the force-displacement relationship. Intent of assessment does, however, vary widely between therapists. These data will inform the design of concurrent validity studies. Further work is recommended to increase consistency of intent, methodology and terminology in manual physical assessment of the spine.

Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention.

Epicondylar injuries in sports with overhead or repetitive arm actions are frequent and often severe. Acute injury that results in inflammation should be termed epicondylitis and is usually the result of large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon. Epicondylalgia refers to elbow pain at either the medial or lateral epicondyl of the elbow related to tendinopathy of the common flexor or extensor tendon origins at these points. Pain is usually associated with gripping, resisted wrist extension and certain movements such as in tennis and golf, hence the common terms 'tennis elbow' (lateral epicondylsis) and 'golf elbow' (medial epicondylossi). A variety of assessment and diagnostic tools are available to aid the clinician in their comprehensive evaluation of the patient to ensure correct diagnosis and the appropriate conservative or surgical management strategy. Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness. The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. Medical practitioners should have a good understanding of the mechanisms of injury in order to help treat and prevent the re-occurrence of injuries. More emphasis by medical and sport science personnel working with coaches and athletes needs to be placed on prevention of elbow injury in sport through improved joint strength, biomechanically sound sport technique and use of appropriate sport equipment.