Inter-tester reliability of selected clinical tests for long-lasting temporomandibular disorders.

OBJECTIVE: Clinical tests used to examine patients with temporomandibular disorders vary in methodological quality, and some are not tested for reliability. The purpose of this cross-sectional study was to evaluate inter-tester reliability of clinical tests and a cluster of tests used to examine patients with long-lasting temporomandibular disorders. METHODS: Forty patients with pain in the temporomandibular area treated by health-professionals were included. They were between 18-70 years, had 65 symptomatic (33 right/32 left) and 15 asymptomatic joints. Two manual therapists examined all participants with selected tests. Percentage agreement and the kappa coefficient (k) with 95% confidence interval (CI) were used to evaluate the tests with categorical outcomes. For tests with continuous outcomes, the relative inter-tester reliability was assessed by the intraclass-correlation-coefficient (ICC3,1, 95% CI) and the absolute reliability was calculated by the smallest detectable change (SDC). RESULTS: The best reliability among single tests was found for the dental stick test, the joint-sound test (k = 0.80-1.0) and range of mouth-opening (ICC3,1 (95% CI) = 0.97 (0.95-0.98) and SDC = 4 mm). The reliability of cluster of tests was excellent with both four and five positive tests out of seven. CONCLUSION: The reliability was good to excellent for the clinical tests and the cluster of tests when performed by experienced therapists. The tests are feasible for use in the clinical setting. They require no advanced equipment and are easy to perform.

Negative perceptions of illness and health are associated with frequent use of physiotherapy in primary healthcare.

BACKGROUND: There is growing concern that an ageing population and increasing number of patients with chronic illnesses in the future will foster a need for health services beyond the resources available in society. Patients with chronic illnesses are reported to be frequent users of physicians' services in the primary health sector. Therapies for patients with chronic musculoskeletal illnesses are delivered by physiotherapists in this sector. However, we know little about the use of physiotherapy services and the factors that may explain their use. PURPOSE: The aim of the present study was to examine the association between the regular/non-regular use of physiotherapy services, impacts of illness, and perceptions of illness and health. METHODS: A cross-sectional survey included patients between 18 and 70 years of age who visited a physiotherapy outpatient clinic in Oslo during one randomly chosen week. Patient characteristics and use of physiotherapy were mapped. The Brief Illness Perception Questionnaire (BIPQ), a single item of the Short Form Health Survey (SF-12) and the Ørebro Musculoskeletal Pain Questionnaire (ØMPQ) were used to assess perceptions of illness and health, and impacts of illness. Data were analysed using independent sample t-tests and logistic regression analysis. RESULTS: A total of 507 patients with a mean age of 46 (standard deviation 12) years participated, of whom 54% were regular users of physiotherapy. BIPQ (p = 0.02; ß = 0.03) and the single-item on general health perception (p = 0.001; ß = 0.44,) were the only significant variables in the final equation associated with regular use of physiotherapy. CONCLUSION: About half of the participants were regular, high consumers of physiotherapy, and negative perceptions of illness and health were associated with this regular use.

Is regular use of physiotherapy treatment associated with health locus of control and self-management competency? A study of patients with musculoskeletal disorders undergoing physiotherapy in primary health care.

OBJECTIVE: To investigate the relationship between regular use of physiotherapy treatment, health locus of control and self-management competency in people with musculoskeletal disorders. METHODS: This cross-sectional study included 507 patients between 18 and 70 years of age with musculoskeletal disorders who attended a physiotherapy clinic. The Health Education Impact Questionnaire (heiQ) was used to assess self-management competency; the Health Locus of Control Scale (HLCS) was used to assess health locus of control. Multiple linear regression analyses were performed to estimate the relationships between variables. RESULTS: Results showed that patients who attended physiotherapy on a regular basis had lower levels of internal control than those who did not. Furthermore, regular patients reported more health-directed activities and more emotional distress than patients not attending physiotherapy on a regular basis. Finally, internal health locus of control showed statistically significant associations with all heiQ domains, indicating that a stronger internal control is associated with higher levels of self-management competency. CONCLUSION: Our findings suggest that attending physiotherapy on a regular basis is related to self-management competency and internal health locus of control. PRACTICAL IMPLICATIONS: A treatment aim in primary care for people with long term conditions should include development of self-management capacity.