“Working” With “Data”

data

January 26, 2006 – PT542Bert Chesworth

The Question

• Can we reliably “feel” joint movement?

Where “Working” & “Data” Meet

• Patients: Mixed Shoulder Problems

• Lateral Rotation of Shoulder

Chesworth et al, Phys Ther 78 (6), 1998; 593-601

• Movement Diagram

• Cyriax End-feel

What Was Done

• 2 PTs - 2 assessments

• shoulder lateral rotation

• 34 patients

• recorded pain & resistance findings

– movement diagram

– Cyriax end-feel

The Patients

• Patients:– wide spectrum of pathology:

• hyper & hypo mobile (instability vs frozen)• bony & soft tissue (fracture vs tendinitis)• surgical (cuff repair) & non surgical• anatomic and arthroplasty (TSR) joints

– Excluded:• dislocation, bony union problems• malignancy, CNS lesion• post-op contraindication to Lateral Rotation

The Clinicians

• Clinical practice: = 16 yr• Manual Therapy: = 14 yr• Instructors

– Professional PT program– CPA – OD continuing education

• Movement Diagram Use:– Teaching: >75 %– Clinical: < 50 %

Procedure Overview

• Procedures:– reviewed

• movement diagram construction• end-feel category definitions

– random order of patients to assess x 2– no dx, no hx

The Assessment

• Evaluating lateral rotation– Supine, Shoulder: ~20º abd, Elbow: 90º flex– Subject:

• report - onset & change in pain• inform – no further mov’t

– PT:• Max 5 passive movements• Uninvolved – involved• Draw mov’t diagram• Record end-feel• Blinded to 1st assess’t findings

End-Feel Categories

Movement DiagramFrom Your’s to Mine

P1

P2

Bev’s MD Study MD

H to P1

H to P2

V to P2H to R1

H to R2

V to R2

Movement DiagramMeasurements

H to L

Results - What Will We See?

• Agreement / Reliability repeat assessments• Agreement / Reliability between PTs• Correlation among MD measures

• Measures– End-feel category – MD:

– Onset Pain / Resistance (H to P1, R1)

– MD:– Maximum Pain and Resistance (H to P2, R2)– Limit of movement (H to L, i.e. ROM)

Before We See Results

• ICC: Reliability Coefficient

• Pearson r: Correlation Coefficient

• Both vary from 0 to 1• 0 = no reliability / correlation• 1 = perfect reliability / correlation

• Agreement: raw %, verbal descriptor for ‘k’

Reliability Results - I1st vs 2nd Assessment

Single PT feel same thing twice?

When no true change?

Reliability Results - IIPT A vs PT B

Two PTs feel same thing once?

When no true difference?

Correlation Results - IOnset Pain / Resistance vs H to L

Correlation Results - IIMax Pain / Resistance vs H to L

End-Feel Results

Summary

• In Summary:

Correlations with H to L on MD: • .573 - .956 for H to P1, R1 (where we put ‘onset’ wrt ROM)• .914 - .999 for H to P2, R2 (where we put ‘max’ wrt ROM)

Good agreement assigning end-feel categories:

note: end-feel categories defined by end-range P/R

Good reliability between 1st & 2nd assessments

Good reliability between PTs, like having a 2nd round