The Functional Movement Screen (FMS) is a series of 7 tests that categorize fundamental movement. Each test is scored on an ordinal scale with 4 categories. The purpose of this study was to determine the interrater reliability of the FMS. Forty healthy subjects were videotaped while performing the FMS. The videos were independently scored by 4 raters, including 2 experts who instruct FMS training courses and 2 novices who completed a standardized training course on the FMS. Interrater reliability was analyzed using the weighted kappa statistic. The novice raters demonstrated excellent or substantial agreement on 14 of the 17 tests, whereas the expert raters did the same on 13 of the 17 tests. When the novice raters were paired with the expert raters, all 17 components demonstrated excellent or substantial agreement. These data indicate that the FMS can confidently be applied by trained individuals. This would suggest that the FMS can be confidently used to assess the movement patterns of athletes and to make decisions related to interventions for performance enhancement, and the FMS may assist in identifying athletes at risk for injury.
It seems that individuals who have undergone ACL reconstruction exhibit an increased peak knee-abduction moment that may establish a potential mechanism of the earlier onset of knee OA in this population.
Key Points
Question
Is the transition from acute to chronic low back pain (LBP) associated with risk strata, defined by a standardized prognostic tool, and/or with early exposure to guideline nonconcordant care?
Findings
In this cohort study of 5233 patients with acute LBP from 77 primary care practices, nearly half the patients were exposed to at least 1 guideline nonconcordant recommendation within the first 21 days after the index visit. Patients were significantly more likely to transition to chronic LBP as their risk on the prognostic tool increased and as they were exposed to more nonconcordant recommendations.
Meaning
In this study, the transition rate to chronic LBP was substantial and increased correspondingly with risk strata and early exposure to guideline nonconcordant care.
Background: Many patients with acute low back pain (LBP) first seek care from primary care physicians. Evidence is lacking for interventions to prevent transition to chronic LBP in this setting. We aimed to test if implementation of a risk-stratified approach to care would result in lower rates of chronic LBP and improved self-reported disability. Methods: We conducted a pragmatic, cluster randomized trial using 77 primary care clinics in four health care systems across the United States. Practices were randomly assigned to a stratified approach to care (intervention) or usual care (control). Using the STarTBack screening tool, adults with acute LBP were screened low, medium, and high-risk. Patients screened as high-risk were eligible. The intervention included electronic best practice alerts triggering referrals for psychologically informed physical therapy (PIPT). PIPT education was targeted to community clinics geographically close to intervention primary care clinics. Primary outcomes were transition to chronic LBP and self-reported disability at six months. Trial Registry: Clini-calTrials.gov NCT02647658 Findings: Between May 2016 and June 2018, 1207 patients from 38 intervention and 1093 from 37 control practices were followed. In the intervention arm, around 50% of patients were referred for physical therapy (36% for PIPT) compared to 30% in the control. At 6 months, 47% of patients reported transition to chronic LBP in the intervention arm (38 practices, n = 658) versus 51% of patients in the control arm (35 practices, n = 635; OR=0.83 95% CI 0.64, 1.09; p = 0.18). No differences in disability were detected (difference -2¢1, 95% CI -4.9À0.6; p = 0.12). Opioids and imaging were prescribed in 22%À25% and 23%À26% of initial visits, for intervention and control, respectively. Twelve-month LBP utilization was similar in the two groups. Interpretation: There were no differences detected in transition to chronic LBP among patients presenting with acute LBP using a stratified approach to care. Opioid and imaging prescribing rates were non-concordant with clinical guidelines.
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