Orthopedic Physical Examination Tests An Evidence-Based Approach

This book is the first to truly demonstrate benefit, by using a test and measure for screening or for diagnostic confirmation, which shows appropriate diagnostic accuracy, is free from bias, and should be reproducible and effective for the condition and clinical environment at hand. Since for some orthopedic clinicians, the statistical terminology may be unfamiliar, chapter one is essentially a user’s guide for the book. Additional chapters include: Neurological and Structural Differentiation Testing , Special Clinical Tests of the Hip, and Special Clinical Tests of the Lower Leg, Ankle and Foot. For ease of access, the tests are listed in each chapter according to pathoanatomical classification and ordered in a descending fashion, from best to worst, based on their “Utility Score”.

Contents

Chapter 1 Special Clinical Tests

Chapter 1 outlines the two primary purposes of a special clinical test and the required elements including sensitivity, specificity, responsiveness, dedicated procedure, and referencing. The topic describes and discusses the use of a +LR and -LR. Furthermore, the reader is introduced to the STARD and QUADAS scoring methods used for each study.

Chapter 2 Neurological and Structural Differentiation Testing

Chapter 2 outlines neurological testing methods including reflex testing, sensibility testing, manual muscle testing, and selected procedures for upper motor neuron assessment. Structural differentiation testing is introduced to assist the clinician in differentiating between shoulder/cervical, lumbar/pelvis, and other difficult to isolated regions.

Chapter 3 Special Clinical Tests of the Cervical Spine

Chapter 3 outlines the special clinical tests of the cervical spine, and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 4 Special Clinical Tests of the Shoulder

Chapter 4 reports the special clinical tests of the shoulder and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 5 Special Clinical Tests of the Elbow/Wrist Hand

Chapter 5 reports the special clinical tests of the elbow/wrist hand and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 6 Special Clinical Tests of the Thoracic Spine

Chapter 6 reports the special clinical tests of the thoracic and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 7 Special Clinical Tests of the Lumbar Spine

Chapter 7 includes the special clinical tests of the lumbar spine and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 8 Special Clinical Tests of the Pelvic Girdle and Sacroiliac Joint

Chapter 8 includes the special clinical tests of the pelvic girdle and sacroiliac joint and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 9 Special Clinical Tests of the Hip

Chapter 9 reports the special clinical tests of the hip and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 10 Special Clinical Tests of the Knee

Chapter 10 reports the special clinical tests of the knee and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

Chapter 11 Special Clinical Tests of the Lower Leg, Ankle and Foot

Chapter 11 reports the special clinical tests of the lower leg, ankle and foot and includes all case series and cohorts designs that have investigated the diagnostic values. Each test includes a utility score and a QUADAS score per each test.

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Features

Diagnostic Value - [(Sensitivity, Specificity, Positive Likelihood Ratio (LR+) and Negative Likelihood Ratio (LR-)] for each of the tests (if they exist). Diagnostic accuracy scores for a given pathoanatomical diagnosis provide clinicians with quick information for appropriate test selection.

All Studies Gathered - attempted to gather all studies that have examined the diagnostic value of teach test. By reviewing numerous studies for each test, we have reduced the chance that sampling bias, operator bias, or poor study design could soundly influence the findings.

QUADAS instrument used - scored each of the studies that have evaluated the tests (no text does this) using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument. QUADAS assists the reader in appreciating the extent to which bias has influenced the estimates of diagnostic accuracy.

2 summary scores provided - 1) the diagnostic odds ratio (DOR) and 2) a “Utility Score”. The DOR is a statistic that combines sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio so that a clinician can view one number that reflects diagnostic accuracy and allows quick comparison between articles. Since, DOR lacks an easy translation to clinical practice, a summary "Utility Score” for the body of research surrounding each test is provided.

Easy test listings - For ease of access, the tests are listed in each chapter according to pathoanatomical classification and ordered in a descending fashion, from best to worst, based on their “Utility Score”.