“Working” With “Data” data January 26, 2006 – PT542 Bert 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; 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 1 st assess’t findings

End-Feel Categories

Movement Diagram From Your’s to Mine P1 P2 Bev’s MDStudy MD

H to P1 H to P2 V to P2 H to R1 H to R2 V to R2 Movement Diagram Measurements 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 - I 1 st vs 2 nd Assessment Single PT feel same thing twice? When no true change?

Reliability Results - II PT A vs PT B Two PTs feel same thing once? When no true difference?

Correlation Results - I Onset Pain / Resistance vs H to L

Correlation Results - II Max Pain / Resistance vs H to L

End-Feel Results

Summary In Summary: Correlations with H to L on MD: for H to P1, R1 (where we put ‘onset’ wrt ROM) 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 1 st & 2 nd assessments Good reliability between PTs, like having a 2 nd round