Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
ACR Open Rheumatol ; 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32403182

RESUMO

May 2020, the COVID-19 pandemic continues to unfold. Governments are investing in public health, clinical and research efforts to avoid the spread of the SARS-CoV-2 virus, reduce the number of deaths and prevent the collapse of health care systems. However, this pandemic will have unprecedented consequences for people who live with chronic conditions for the months and even years to come without coordinated actions.

2.
BMJ Evid Based Med ; 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439722

RESUMO

Patient decision aids are evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. Research shows that patient decision aids increase knowledge, accuracy of risk perceptions, alignment of care with patient values and preferences, and patient involvement in decision making. Some patient decision aids can reduce the use of invasive and potentially low-value procedures. On this basis, clinical practice guidelines and international organisations have begun to recommend the use of patient decision aids and shared decision making as a strategy to reduce medical overuse. Although patient decision aids hold promise for improving healthcare, there are fundamental issues with patient decision aids that need to be addressed before further progress can be made. The problems with patient decision aids are: (1) Guidelines for developing patient decision aids may not be sufficient to ensure developers select the best available evidence and present it appropriately; (2) Biased presentation of low-certainty evidence is common and (3) Biased presentation of low-certainty evidence is misleading, and could inadvertently support, low-value care. We explore these issues in the article and present a case study of online patient decision aids for musculoskeletal pain. We suggest ways to ensure patient decision aids help patients understand the evidence and, where possible, support high-quality care.

3.
J Orthop Sports Phys Ther ; 50(3): 113-115, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32116101

RESUMO

SUMMARY: This is the first article in a series on "Overcoming Overuse" in musculoskeletal health care. Overuse is the use of services that are unlikely to improve patient outcomes, result in more harm than benefit, and would not be desired by an informed patient. The Overcoming Overuse series explores the myriad ways diagnostic tests and treatments are overused in musculoskeletal health care, and proposes ways to ensure patients receive appropriate care. We focus on strategies to promote guideline-concordant care in rehabilitation practice and strategies to overcome overuse. J Orthop Sports Phys Ther 2020;50(3):113-115. doi:10.2519/jospt.2020.0102.

4.
J Orthop Sports Phys Ther ; 50(3): 118-120, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32116105

RESUMO

Clinicians who provide high-value musculoskeletal care offer evidence-based management that can improve pain, function, and quality of life. However, the current approach to improving outcomes emphasizes treatment strategies at the expense of accurate diagnosis. Guidelines rarely provide quality information on differential diagnosis and prognosis. The disconnect is worrying, because accurate diagnosis can lead to more appropriate care and improved patient outcomes. In this Viewpoint, we reflect on how the clinician can refine musculoskeletal diagnoses to provide high-value care. We (1) argue that the link between musculoskeletal diagnosis and patient outcomes must be strengthened, (2) introduce a diagnostic framework to help clinicians go beyond "special tests," and (3) present new methods for researchers to move forward from diagnostic accuracy studies. J Orthop Sports Phys Ther 2020;50(3):118-120. doi:10.2519/jospt.2020.0603.

5.
Curr Opin Rheumatol ; 32(3): 273-278, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32141955

RESUMO

PURPOSE OF REVIEW: Implementing shared decision-making (SDM) is a top international priority to improve care for persons living with rheumatoid arthritis. Using SDM tools, such as decision aids improve patients' knowledge and support communication with their clinicians on treatment benefits and risks. Despite calls for SDM in treat-to-target, studies demonstrating effective SDM strategies in rheumatology clinical practice are scarce. Our objective was to identify recent and relevant literature on SDM in rheumatoid arthritis. RECENT FINDINGS: We found a burgeoning literature on SDM in rheumatoid arthritis that tackles issues of implementation. Studies have evaluated the SDM process within clinical consultations and found that uptake is suboptimal. Trials of newly developed patient decision aids follow high methodological standards, but large-scale implementation is lacking. Innovative SDM strategies, such as shared goals and preference phenotypes may improve implementation of treat-to-target approach. Research and patient engagement are standardizing measures of SDM for clinical uses. SUMMARY: Uptake of SDM in rheumatoid arthritis holds promise in wider clinicians' and patients' awareness, availability of decision aids, and broader treat-to-target implementation strategies, such as the learning collaborative. Focused attention is needed on facilitating SDM among diverse populations and those at risk of poorer outcomes and barriers to communication.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32199757

RESUMO

BACKGROUND: Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic. METHODS: Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patient satisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohen κ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ2 tests to compare differences between providers in terms of treatment plan options and Student t tests to compare patient satisfaction between providers. RESULTS: Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging test request agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patient satisfaction with care was high, with no significant differences found between providers (P = .70). CONCLUSION: APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.

7.
Braz J Phys Ther ; 24(1): 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30723033

RESUMO

BACKGROUND: Differential diagnosis is a systematic process used to identify the proper diagnosis from a set of possible competing diagnoses. METHODS: The goal of this masterclass is to discuss the higher order thinking components of differential diagnosis. CONCLUSIONS: For healthcare providers, diagnosis is one of many necessary components during the clinical decision making process and it is hallmarked by differentiation of competing structures for a definitive understanding of the underlying condition. The diagnostic process involves identifying or determining the etiology of a disease or condition through evaluation of patient history, physical examination, and review of laboratory data or diagnostic imaging; and the subsequent descriptive title of that finding. Whereas differential diagnosis is a varied skill set among all healthcare providers, the concept of a diagnosis is equally germane, regardless of one's background. In theory, a diagnosis improves the use of classification tools, improves clarity and communication, provides a trajectory of treatment, improves understanding of a person's prognosis, and in some cases, may be useful for preventative treatments. To achieve these improvements, one must have an understanding of relation of the clinical utility of tests and measures with diagnosis, and how to best implement these findings in clinical practice. This requires a deeper understanding (higher order thinking) of the role of diagnosis in the management of patients.

8.
Med Decis Making ; 39(8): 1010-1018, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31731879

RESUMO

Background. We aimed to validate the SURE test for use with parents in primary care. Methods. A secondary analysis of cluster randomized trial data was used to compare the SURE test (index, higher score = less conflict) to the Decisional Conflict Scale (DCS; reference, higher score = greater conflict). Our a priori hypothesis was that the scales would correlate negatively. We evaluated the association between scores and estimated the proportion of variance in the DCS explained by the SURE test. Then, we dichotomized each measure using established cutoffs to calculate diagnostic accuracy and internal consistency with confidence intervals adjusted for clustering. We evaluated the presence of effect modification by sex, followed by sex-specific calculation of validation statistics. Results. In total, 185 of 201 parents completed a DCS and SURE test. Total DCS (mean = 4.2/100, SD = 14.3) and SURE test (median 4/4; interquartile range, 4-4) scores were significantly correlated (ρ = -0.36, P < 0.0001). The SURE test explained 34% of the DCS score variance. Internal consistency (Kuder-Richardson 20) was 0.38 (P < 0.0001). SURE test sensitivity and specificity for identifying decisional conflict were 32% (95% confidence interval [CI], 20%-44%) and 96% (95% CI, 93%-100%), respectively. The SURE test's positive likelihood ratio was 8.4 (95% CI, 0.1-17) and its negative likelihood ratio was 0.7 (95% CI, 0.53-0.87). There were no significant differences between females and males in DCS (P = 0.5) or SURE test (P = 0.97) total scores; however, correlations between test total scores (-0.37 for females v. for -0.21 for males; P = 0.001 for the interaction) and sensitivity and specificity were higher for females than males. Conclusions. SURE test demonstrated acceptable psychometric properties for screening decisional conflict among parents making a health decision about their child in primary care. However, clinicians cannot be confident that a negative SURE test rules out the presence of decisional conflict.

9.
J Orthop Sports Phys Ther ; 49(2): 87-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30501384

RESUMO

BACKGROUND: Evidence concerning the accurate clinical or imaging methods to diagnose hip instability or hip dysplasia is currently scarce. OBJECTIVE: To summarize the diagnostic accuracy of clinical and imaging tests for the diagnosis of hip dysplasia and instability. METHODS: A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases, using key words related to diagnostic accuracy of the hip joint, was conducted on March 6, 2018. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the searching and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Diagnostic accuracy, including sensitivity, specificity, likelihood ratio, and 95% confidence interval, was summarized. RESULTS: Out of 3109 citations, 7 articles were included. Two studies reported on 5 clinical tests for hip instability and 5 studies reported on 5 radiographic measures for hip dysplasia. Only 1 study was not of low methodological quality. The prone instability test moderately improved positive posttest probability by 38% to diagnose hip instability. The Shenton line moderately to highly improved posttest probability by 41% to 60% to diagnose hip dysplasia. CONCLUSION: This systematic review summarizes the diagnostic accuracy of various clinical tests and radiographic measures for hip instability and hip dysplasia. Further high-quality studies are necessary to examine the diagnostic accuracy of the clinical examination and radiography to assist in ruling in or ruling out the diagnoses of hip dysplasia and instability. Consensus is required to standardize the definitions of these diagnoses and their reference standards. The study was registered with the International Prospective Register of Systematic Reviews (CRD42018089019). LEVEL OF EVIDENCE: Diagnosis, level 3b. J Orthop Sports Phys Ther 2019;49(2):87-97. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8476.

11.
Int J Sports Phys Ther ; 13(5): 774-788, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30276010

RESUMO

Background: The Lever sign has gained recent notoriety for its purported anterior cruciate ligament (ACL) diagnostics and simplicity of performance. Purpose: The purpose of this systematic review with meta-analysis is to summarize the diagnostic accuracy of the Lever sign for use during assessment of the knee for an ACL tear in subjects with suspected acute and chronic knee injury. Study Design: Systematic review with meta-analysis. Methods: A computer-assisted literature search of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of the knee joint. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS). Mixed effects models were used to summarize accuracy. Results: Eight articles, with only two demonstrating high quality, were included. Six of the articles were included in a meta-analysis. Diagnostic values, utilizing arthroscopy as a gold standard, were: pooled SN 0.55 (95% CI 0.22 to 0.84), pooled SP 0.89 (95% CI 0.44 to 0.99), positive likelihood ratio (+LR) 9.2 (95% CI 0.70 to 46.1), negative likelihood ratio (-LR) 0.58 (95% CI 0.18 to 1.28). Post-test probability with a positive finding (57% sampling prevalence) reached 92% (95% CI 83 to 97%). Post-test probability with a negative finding (57% sampling prevalence) reached 43% (95% CI 39 to 47%). Conclusions: Based on limited evidence of heterogeneous methodological quality, the Lever sign can moderately change post-test probability to rule in an ACL tear. These results should be interpreted cautiously due to a limited number of studies, with small sample sizes and study quality affecting test accuracy. Future investigation should be expanded to include additional high-quality studies examining diverse clinical contexts, as they become available, to enable a more comprehensive clinical examination of this test. Level of evidence: 3aPROSPERO Registration # CRD42018084954.

12.
PLoS One ; 13(6): e0198797, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29894492

RESUMO

OBJECTIVE: To assess the diagnostic validity of clusters combining history elements and physical examination tests to diagnose partial or complete anterior cruciate ligament (ACL) tears. DESIGN: Prospective diagnostic study. SETTINGS: Orthopaedic clinics (n = 2), family medicine clinics (n = 2) and community-dwelling. PARTICIPANTS: Consecutive patients with a knee complaint (n = 279) and consulting one of the participating orthopaedic surgeons (n = 3) or sport medicine physicians (n = 2). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: History elements and physical examination tests performed independently were compared to the reference standard: an expert physicians' composite diagnosis including history elements, physical tests and confirmatory magnetic resonance imaging. Penalized logistic regression (LASSO) was used to identify history elements and physical examination tests associated with the diagnosis of ACL tear and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity (Se), specificity (Sp), predictive values and positive and negative likelihood ratios (LR+/-) with associated 95% confidence intervals (CI) were calculated. RESULTS: Forty-three individuals received a diagnosis of partial or complete ACL tear (15.4% of total cohort). The Lachman test alone was able to diagnose partial or complete ACL tears (LR+: 38.4; 95%CI: 16.0-92.5). Combining a history of trauma during a pivot with a "popping" sensation also reached a high diagnostic validity for partial or complete tears (LR+: 9.8; 95%CI: 5.6-17.3). Combining a history of trauma during a pivot, immediate effusion after trauma and a positive Lachman test was able to identify individuals with a complete ACL tear (LR+: 17.5; 95%CI: 9.8-31.5). Finally, combining a negative history of pivot or a negative popping sensation during trauma with a negative Lachman or pivot shift test was able to exclude both partial or complete ACL tears (LR-: 0.08; 95%CI: 0.03-0.24). CONCLUSION: Diagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of ACL tears compared to various knee disorders.


Assuntos
Atividades Cotidianas , Lesões do Ligamento Cruzado Anterior/diagnóstico , Anamnese , Exame Físico/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Musculoskeletal Care ; 16(3): 370-379, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29781110

RESUMO

INTRODUCTION: The aim of the present study was to assess the validity of clusters combining history elements and physical examination tests to diagnose symptomatic knee osteoarthritis (SOA) compared with other knee disorders. METHODS: This was a prospective diagnostic accuracy study, in which 279 consecutive patients consulting for a knee complaint were assessed. History elements and standardized physical examination tests were obtained independently by a physiotherapist and compared with an expert physician's composite diagnosis, including clinical examination and imaging. Recursive partitioning was used to develop diagnostic clusters for SOA. Diagnostic accuracy measures were calculated, including sensitivity, specificity, and positive and negative likelihood ratios (LR+/-), with associated 95% confidence intervals (CIs). RESULTS: A total of 129 patients had a diagnosis of SOA (46.2%). Most cases (76%) had combined tibiofemoral and patellofemoral knee OA and 63% had radiological Kellgren-Lawrence grades of 2 or 3. Different combinations of history elements and physical examination tests were used in clusters accurately to discriminate SOA from other knee disorders. These included age of patients, body mass index, presence of valgus/varus knee misalignment, palpable knee crepitus and limited passive knee extension. Two clusters to rule in SOA reached an LR+ of 13.6 (95% CI 6.5 to 28.4) and three clusters to rule out SOA reached an LR- of 0.11 (95% CI 0.06 to 0.20). DISCUSSION: Diagnostic clusters combining history elements and physical examination tests were able to support the differential diagnosis of SOA compared with various knee disorders without relying systematically on imaging. This could support primary care clinicians' role in the efficient management of these patients.


Assuntos
Avaliação da Deficiência , Traumatismos do Joelho/diagnóstico , Anamnese/métodos , Osteoartrite do Joelho/diagnóstico , Exame Físico/métodos , Fatores Etários , Idoso , Artralgia/diagnóstico , Artralgia/etiologia , Análise por Conglomerados , Estudos de Coortes , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ocupações , Medição da Dor , Prognóstico , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais
15.
Arch Phys Med Rehabil ; 99(4): 607-614.e1, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29128344

RESUMO

OBJECTIVE: To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP). DESIGN: Prospective diagnostic study. SETTINGS: Orthopedic outpatient clinics, family medicine clinics, and community-dwelling. PARTICIPANTS: Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated. RESULTS: Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2-14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06-.27). CONCLUSIONS: Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee disorders were developed. External validation is required before clinical use.


Assuntos
Anamnese/estatística & dados numéricos , Ortopedia/métodos , Síndrome da Dor Patelofemoral/diagnóstico , Exame Físico/estatística & dados numéricos , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Joelho/patologia , Funções Verossimilhança , Modelos Logísticos , Masculino , Anamnese/métodos , Pessoa de Meia-Idade , Articulação Patelofemoral/patologia , Exame Físico/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Síndrome
16.
PM R ; 10(5): 472-482, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29111463

RESUMO

BACKGROUND: The current approach to the clinical diagnosis of traumatic and degenerative symptomatic meniscal tears (SMTs) proposes combining history elements and physical examination tests without systematic prescription of imaging investigations, yet the evidence to support this diagnostic approach is scarce. OBJECTIVE: To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude traumatic and degenerative SMT compared with other knee disorders. DESIGN: Prospective diagnostic accuracy study. SETTINGS: Patients were recruited from 2 orthopedic clinics, 2 family medicine clinics, and from a university community. PATIENTS: A total of 279 consecutive patients who underwent consultation for a new knee complaint. METHODS: Each patient was assessed independently by 2 evaluators. History elements and standardized physical examination tests performed by a physiotherapist were compared with the reference standard: an expert physicians' composite diagnosis including a clinical examination and confirmatory magnetic resonance imaging. Participating expert physicians were orthopedic surgeons (n = 3) or sport medicine physicians (n = 2). Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of SMT and recursive partitioning was used to develop diagnostic clusters. MAIN OUTCOME MEASURES: Diagnostic accuracy measures were calculated including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (LR+/-) with associated 95% confidence intervals (CIs). RESULTS: Eighty patients had a diagnosis of SMT (28.7%), including 35 traumatic tears and 45 degenerative tears. The combination a history of trauma during a pivot, medial knee pain location, and a positive medial joint line tenderness test was able to diagnose (LR+ = 8.9; 95% CI 6.1-13.1) or exclude (LR- = 0.10; 95% CI 0.03-0.28) a traumatic SMT. Combining a history of progressive onset of pain, medial knee pain location, pain while pivoting, absence of valgus or varus knee misalignment, or full passive knee flexion was able to moderately diagnose (LR+ = 6.4; 95% CI 4.0-10.4) or exclude (LR- = 0.10; 95% CI 0.03-0.31) a degenerative SMT. Internal validation estimates were slightly lower for all clusters but demonstrated positive LR superior to 5 and negative LR inferior to 0.2 indicating moderate shift in posttest probability. CONCLUSION: Diagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of SMT. These results represent the initial derivation of the clusters and external validation is mandatory. LEVEL OF EVIDENCE: I.


Assuntos
Doenças das Cartilagens/diagnóstico , Articulação do Joelho , Anamnese , Exame Físico/métodos , Lesões do Menisco Tibial/diagnóstico , Doenças das Cartilagens/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Lesões do Menisco Tibial/complicações
18.
Phys Ther Sport ; 23: 143-155, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27693100

RESUMO

INTRODUCTION: More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests. OBJECTIVE: To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders. METHODS: A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR. RESULTS: Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions. CONCLUSION: When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos do Joelho/diagnóstico , Exame Físico/métodos , Diagnóstico Diferencial , Humanos
19.
Man Ther ; 26: 172-182, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27697691

RESUMO

Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on low-quality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests.


Assuntos
Técnicas e Procedimentos Diagnósticos/normas , Traumatismos do Joelho/diagnóstico , Exame Físico/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
20.
Am J Physiol Endocrinol Metab ; 302(2): E254-64, 2012 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-22045312

RESUMO

Physical activity improves glycemic control in type 2 diabetes (T2D), but its contribution to preserving ß-cell function is uncertain. We evaluated the role of physical activity on ß-cell secretory function and glycerolipid/fatty acid (GL/FA) cycling in male Zucker diabetic fatty (ZDF) rats. Six-week-old ZDF rats engaged in voluntary running for 6 wk (ZDF-A). Inactive Zucker lean and ZDF (ZDF-I) rats served as controls. ZDF-I rats displayed progressive hyperglycemia with ß-cell failure evidenced by falling insulinemia and reduced insulin secretion to oral glucose. Isolated ZDF-I rat islets showed reduced glucose-stimulated insulin secretion expressed per islet and per islet protein. They were also characterized by loss of the glucose regulation of fatty acid oxidation and GL/FA cycling, reduced mRNA expression of key ß-cell genes, and severe reduction of insulin stores. Physical activity prevented diabetes in ZDF rats through sustaining ß-cell compensation to insulin resistance shown in vivo and in vitro. Surprisingly, ZDF-A islets had persistent defects in fatty acid oxidation, GL/FA cycling, and ß-cell gene expression. ZDF-A islets, however, had preserved islet insulin mRNA and insulin stores compared with ZDF-I rats. Physical activity did not prevent hyperphagia, dyslipidemia, or obesity in ZDF rats. In conclusion, islets of ZDF rats have a susceptibility to failure that is possibly due to altered ß-cell fatty acid metabolism. Depletion of pancreatic islet insulin stores is a major contributor to islet failure in this T2D model, preventable by physical activity.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Dislipidemias/fisiopatologia , Ácidos Graxos/metabolismo , Células Secretoras de Insulina/metabolismo , Insulina/metabolismo , Condicionamento Físico Animal/fisiologia , Hormônio Adrenocorticotrópico/sangue , Animais , Peso Corporal/fisiologia , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/metabolismo , Dislipidemias/genética , Dislipidemias/metabolismo , Ingestão de Alimentos/fisiologia , Peptídeo 1 Semelhante ao Glucagon/sangue , Resistência à Insulina/fisiologia , Masculino , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiopatologia , Ratos , Ratos Zucker
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA