Evidence Based Rehab

A committee formed by the Osteoarthritis Research Society International (OARSI) released a document on what they feel are evidence based recommendations for treatment of hip and knee Osteoarthritis (OA). The stated goal of this committee was:

To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world.

A very noble goal indeed. What I'm excited about is that the committee did not include a single physiotherapist/physical therapist, yet our profession figures very prominently in most of the "non-pharmacological" treatment recommendations. The paper goes on to state, specifically, that referral to PT for symptomatic knee and hip OA was "strongly supported" and recommended by "100% of the experts" on the panel.

Good news for us. Now if we can get this into the hands of the public, all would be even better.

Jason L. Harris, PT

Labels: Direct access, evidence based medicine, Healthcare, OA, Osteoarthritis, physical therapy, special test

I have recently begun using a nice new clinical test for meniscus tears. It is called the Thessaly Test (I thought we were going to quit naming things like this after ourselves, lol). It is a weight bearing test, so it's fairly functional. The Abstract can be found on the Journal of Bone and Joint surgery. The test basically requires the practitioner to hold the hands of the patient who is standing on one leg. The patient then bends to 5° and twists medially then laterally. The test is repeated at 20°. Positive test equates to reproduction of pain, catching or popping.

Here is a summary from EBM Online:

Diagnosis Sensitivity (95% CI) Specificity (CI) Accuracy +LR –LR Medial meniscal tear 89% (83 to 94) 97% (94 to 98) 94% 26.9 0.11 Lateral meniscal tear 92% (78 to 98) 96% (93 to 98) 96% 22.9 0.08 *Diagnostic terms defined in glossary; CI and LRs calculated from data in article.

In my experience, the test is easy to administer and less physical work needed by the practitioner compared to McMurray's or Apley Grind. However, like McMurray's or Apley, in the clinic, they don't quit appear as strong individually as they do when grouped.

Labels: EBM, meniscus tear, special test, Thessaly