Correspondence of diagnosis to initial treatment for neck pain

The results of this study suggest that PTs with post-graduate training through the McKenzie Institute or through Orthopaedic Manual Physical Therapy (OMPT) Fellowship training may demonstrate an inherent bias toward their advanced training in the assessment and treatment of acute cervical derangement. Although no significant findings can be reported secondary to sample size limitations, future studies may be performed to further explore this topic.

Section: Discussionmentioning

confidence: 84%

Clinical decision-making in the management of cervical spine derangement: a case study survey using a patient vignette

Hahn

Kelly

Murphy

et al. 2013

“…This finding is consistent with prior cervical spine prevalence research regarding common directions of preference and loading strategies. An extension DP has been shown to be pervasive, typically exhibiting an 80% prevalence or higher [10,12,31,32]. In a recent report by Otero and Bonnet [31], 297 patients with neck pain were examined via MDT methods.…”

Section: Discussionmentioning

confidence: 99%

Directional preference constructs for patients’ neck pain in the absence of centralization

Yarznbowicz

Tao

2019

Objectives: We conducted a secondary analysis of a prospective, observational cohort study to (1) report the prevalence of Directional Preference (DP) constructs at first examination for patients with cervical spine challenges, and (2) determine the association between DP constructs and clinical outcomes at discharge from physical therapy. Methods: We analyzed data collected from 718 consecutive patients who presented to outpatient, private practice clinics with primary complaints of non-specific neck pain; 200 patients met the inclusion criteria and completed first examination and discharge data. Statistical analysis determined the association between DP constructs at first examination and clinical outcomes at discharge. Results: The findings in this investigation were that (1) the most prevalent DP constructs at first examination were related to ROM and pain intensity including Patient Reported Improvement in ROM (79.5%), Increase in Spine ROM (32.5%), and Pain Intensity Change (15.0%), (2) all DP groups improved and met the MCID for disability and pain intensity change at discharge except for the group that did not exhibit Increase in Spine ROM for pain intensity, (3) no clinically significant differences in pain intensity or disability existed between DP groups at discharge, and (4) 28.5% and 6.5% of patients exhibited a relative increase in cervical spine extension and flexion ROM, respectively, post-repeated movement testing on the first examination. Discussion: The most prevalent DP constructs at first examination were related to ROM and pain intensity, and each was associated with a comparable clinical trajectory in terms of pain and disability outcomes at discharge. The findings of this study help Mechanical Diagnosis and Therapy (MDT) providers understand the common DP constructs encountered in routine clinical practice and their relation to pain and disability outcomes for patients with cervical spine challenges.

“…Videotaping has been previously used by many researchers for examining reliability of visual analysis of gait 56,57 and scapular positioning 58 as well as determining classification sub groupings for patients with cervical or lumbar impairments. 53,[59][60][61][62][63] The advantages of videotapes and vignettes include improved feasibility for testing different therapists from different geographical regions, standardizing testing procedures to mitigate possible subject changes between a test and retest, and a reduction of potential stress on patients that alters clinical presentation. 60 Despite these advantages we recognize the limitations of using video and paper case vignettes to estimate intertherapist reliability for identifying interventions.…”

Section: Limitationsmentioning

confidence: 99%

Clinician’s ability to identify neck and low back interventions: an inter-rater chance-corrected agreement pilot study

Werneke

Hart²,

Deutscher

et al. 2011

Objective: To estimate inter-rater agreement of physical therapists trained in MDT approach and participating in practice-based evidence (PBE) research to identify 72 physical therapy interventions in video demonstrations on a single model and clinical vignettes. PBE is a well designed observational study and demonstrating clinician observational consistency is an important step in conducting PBE research design. Methods: Two physical therapists volunteered to participate in pilot reliability testing and seven other physical therapists trained in McKenzie Mechanical Diagnosis and Therapy (MDT) methods volunteered for the inter-rater chance-corrected agreement study. All therapists identified interventions presented within 52 videos and 5 written clinical vignettes describing 20 more intervention techniques. Therapists independently identified all interventions. We assessed inter-rater chance-corrected agreement of therapists' ability to identify intervention techniques using Kappa coefficients with associated 95% confidence intervals and indices for bias and prevalence. Results: Of the 147 kappa coefficients estimated, 7% were (0.6, 10% were .0.6 and (0.8, and 83% were .0.8. Agreement was lowest for identifying cognitive behavioral techniques (median kappa50.79). The minimum and maximum prevalence and bias indices were 0.33 and 0.85 and 0 and 0.33, respectively suggesting kappa coefficient estimates were strong. Generalized kappa coefficients ranged from 0.73 to 1.00. Discussion: Results provide evidence that substantial to almost perfect inter-rater agreement could be expected when trained therapists identify physical therapy interventions used for patients with spinal impairments from staged videos and vignettes. This may be helpful to reassure clinicians of the quality of the reporting of intervention(s) performed when conducting multivariable analyses in future pragmatic PBE studies. Additional studies are needed to test whether these results can be validated using larger groups of therapists, trained and not trained in MDT methods, as well as examining different methods to examine inter-rater agreement for identifying diverse interventions commonly used for managing patients during routine practice.