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Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited. To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints. An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed. In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario. Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain. This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks). • Experts recommended a set of diagnostic tests when assessing wrist complaints. • The experts recommended several history-taking items. • Mainly simple physical examination tests and few provocation tests were recommended. • The recommended diagnostic tests need to be tested for accuracy in future studies. [ABSTRACT FROM AUTHOR]

Physical performance-based tests are useful indices for identifying and managing fall risk in community-dwelling older adults. However, measurement errors in these tests have not been examined. This study aimed to clarify the reliability and validity of balance tests in community-dwelling older adults with musculoskeletal ambulation disability symptom complex. This cross-sectional study used a test-retest design and included 52 participants from three medical facilities. The participants reported demographic and medical information using a questionnaire. Primary outcomes were the timed up-and-go test, five-times sit-to-stand test, one-leg standing test, and functional reach test results. Significant correlations were found between each balance test and fear of falling and between the four balance tests. Each balance test demonstrated discriminant validity with intraclass correlation coefficients (1,1) ≥0.81. The minimal detectable change was 1.4 s, 1.6 s, 3.3 s, and 4.0 cm for the timed up-and-go test, five-time sit-to-stand test, one-leg standing test, and functional reach test, respectively. Changes exceeding the minimal detectable change 95 in balance tests can be used to judge improvement or decline in physical function, which may inform clinical decision-making. The minimal detectable change 95 of balance tests should be used when implementing or modifying fall prevention programs. [ABSTRACT FROM AUTHOR]

Research into the aetiology of spinal pain has shown a clear tendency towards a sensorimotor control perspective. In contrast to the lumbar spine, the available motor control tests for the cervical spine are extremely varied, little studied and sometimes very costly. Review the quality and choice of the available cervical spine motor control tests. The diagnostic accuracy of the current low technology motor control tests was evaluated in a systematic review. A search for reliability and discriminative validity studies was conducted in the Pubmed MEDLINE® database (NCBI) and the Cochrane Central Register of Controlled Trials, according to the PRISMA–DTA protocol. Quality Appraisal for Reliability Studies (QAREL) and Standards for Reporting Diagnostic accuracy studies (STARD) were conducted to assess the quality of the included studies. The statistical parameters of ICC, kappa-value, sensitivity, specificity, Diagnostic Odds Ratio, Area Under the Curve, mean, standard deviation and/or the confidence interval were extracted. Two movement control test batteries, one head-eye-coordination test battery and the craniocervical flexion test were found to be standing out in terms of reliability, validity, applicability and cost-effectiveness (Kappa and ICC scores >0.8 for reliability and AUC 0,83 for validity.) To date only one study was published for each of the test batteries. Nevertheless, the risk of bias compared to all other cervical motor control tests found was significantly lower. Moreover, the application is possible completely without technical equipment, which makes the findings of the present work accessible to the majority of healthcare professionals. • This systematic review evaluates the diagnostic accuracy of the available, low technology motor control tests. • There is a large number of tests for motor control, which vary considerably in terms of diagnostic accuracy. • In terms of reliability and validity, combinations of tests were found to be superior to single tests. • Two movement control test combinations, one head-eye coordination test and the craniocervical flexion test are being recommended. [ABSTRACT FROM AUTHOR]

Strength assessment and comparison to normative values are an important benchmarking tool in human health and performance. However, population specific normative data are several decades old, lack information about adolescent and adult strength levels and are not representative of the strength levels of strength trained individuals. The purpose of this study was to develop contemporary strength norms for the squat, bench press, and deadlift using powerlifters competing in un-equipped, drug-tested competitions. Retrospective cross-sectional analysis. Retrospective data from global drug-tested, unequipped powerlifting competitions were collated with 809,986 samples (571,650 males, 238,336 females) included. Strength was assessed according to sex, United Nations age classifications, and competitive powerlifting weight class. Strength was expressed relatively (ratio of weight lifted/bodyweight) and computed for the 10th–90th percentile for each of the above categories. Relative strength was greatest for young adults (18–35 years; 90th percentile for squat [male: 2.83 × bodyweight, female: 2.26], bench press [male: 1.95, female: 1.35], deadlift [male: 3.25, female: 2.66]) before declining thereafter for all three exercises. Although lower than their younger counterparts, very old adults (> 80 years) had 90th percentile data for the squat of male: 1.72 and female: 1.01, bench press: male: 1.31 and female: 0.92, and deadlift: male: 2.30 and female: 1.68. These findings provide a comprehensive, accurate and precise representation of strength for drug-tested, unequipped powerlifters in each category and serve as a point of reference for other trained population groups. To facilitate uptake and ease of comparison, we have developed a freely available online tool (www.thestrengthinitiative.com). • Strength norms reported in practitioner textbooks are unsuitable for strength trained athletes. • Current strength norms do not account for adolescent and very old population groups. • Powerlifting athletes demonstrate relative strength values that substantially exceed previously published norms. • The norms established by this research are easily accessed and compared using the tool at www.thestrengthinitiative.com. [ABSTRACT FROM AUTHOR]

Differentiating between arteriovenous fistula (AVF) maturation and failure can help determine which AVF will undergo successful canulation and which ones will require immediate rescue. A prospective observational study was conducted at Vajira Hospital in Bangkok, Thailand, between October 2020–November 2022. A single vascular surgeon performed a physical examination on patients with chronic kidney disease undergoing AVF placement, and a radiologist conducted Doppler ultrasonography during the second and sixth postoperative weeks. Dialysis nurses determined AVF maturity by performing cannulation. The study compared the accuracy of physical examination and Doppler ultrasonography. A model was developed to predict the success of AVF use. Out Of the 125 recruited patients, 81% demonstrate unassisted maturation of their AVF. The male sex and brachiocephalic type are associated with AVF maturation. The physical examination findings of palpable thrill and the absence of a strong pulse at the 6th week show an area under the receiver operating curve (AUC) value of 0.79. Similarly, arterial end-diastolic velocity on ultrasonography at the 6th week also demonstrates a comparable predictive value with an AUC of 0.82 (p = 0.697). Meanwhile, the model that combined end-diastolic velocity and venous volume flow yields the best results for predicting AVF maturation, with an AUC of 0.92. These models provide more accurate predictions compared to physical examination alone (AUC: 0.92 vs. 0.79; p < 0.01). Although a prudent physician predicts AVF maturation through a thorough physical examination, Doppler ultrasonography is preferred in anticipating the success of postoperative AVF placement. [ABSTRACT FROM AUTHOR]

Injuries involving ankle stability and range of motion are among the most frequent in athletes and in the general population. In response, this study aimed to assess the immediate effects of toe separators on dynamic stability and ankle range of motion in healthy young individuals. Among the 68 eligible participants, 50 healthy and active subjects completed all trials. The impact of the intervention was evaluated using the Weight Bearing Lunge Test and Y-Test. The control condition performed the tests without toe separators, while the experimental condition performed the tests with toe separators. All participants performed both conditions with a wash-out period of at least 7 days between trials. Statistical analysis revealed no significant differences in dynamic balance (p > 0.05) and range of motion (p > 0.05) between the two conditions. Additionally, no asymmetries were detected between the lower limbs in both tests (p > 0.05). The results of this pilot study indicate that using toe separators does not have an immediate effect on ankle range of motion and dynamic balance in young, healthy individuals. Future research should consider evaluating intervention programs of longer duration and exploring different populations. [ABSTRACT FROM AUTHOR]

Given the important role of patient-ventilator assessments in ensuring the safety and efficacy of mechanical ventilation, a team of respiratory therapists and a librarian used Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend assessment of plateau pressure to ensure lung-protective ventilator settings (strong recommendation, high certainty); (2) We recommend an assessment of tidal volume (VT) to ensure lung-protective ventilation (4-8 mL/kg/predicted body weight) (strong recommendation, high certainty); (3) We recommend documenting VT as mL/kg predicted body weight (strong recommendation, high certainty); (4) We recommend an assessment of PEEP and auto-PEEP (strong recommendation, high certainty); (5) We suggest assessing driving pressure to prevent ventilator-induced injury (conditional recommendation, low certainty); (6) We suggest assessing FIO2 to ensure normoxemia (conditional recommendation, very low certainty); (7) We suggest telemonitoring to supplement direct bedside assessment in settings with limited resources (conditional recommendation, low certainty); (8) We suggest direct bedside assessment rather than telemonitoring when resources are adequate (conditional recommendation, low certainty); (9) We suggest assessing adequate humidification for patients receiving noninvasive ventilation (NIV) and invasive mechanical ventilation (conditional recommendation, very low certainty); (10) We suggest assessing the appropriateness of the humidification device during NIV and invasive mechanical ventilation (conditional recommendation, low certainty); (11) We recommend that the skin surrounding artificial airways and NIV interfaces be assessed (strong recommendation, high certainty); (12) We suggest assessing the dressing used for tracheostomy tubes and NIV interfaces (conditional recommendation, low certainty); (13) We recommend assessing the pressure inside the cuff of artificial airways using a manometer (strong recommendation, high certainty); (14) We recommend that continuous cuff pressure assessment should not be implemented to decrease the risk of ventilator-associated pneumonia (strong recommendation, high certainty); and (15) We suggest assessing the proper placement and securement of artificial airways (conditional recommendation, very low certainty). [ABSTRACT FROM AUTHOR]

Diagnosis of low back pain can be intriguing and complex. Careful history-taking and physical examination are essential to ensure red flags (serious issues) are not missed, that treatment is appropriate, evidence-based and timely, and that follow-up and review are well documented and understood by the patient. This article covers some of the more common causes of back pain in primary and urgent care. [ABSTRACT FROM AUTHOR]

The CTS-6 can be used clinically to diagnose carpal tunnel syndrome (CTS) and has demonstrated high levels of interrater reliability when administered by nonexpert clinicians. Our purpose was to assess sensitivity (Sn), specificity (Sp), and interrater reliability of the CTS-6 when administered by medical assistants (MAs). A series of patients presenting to an academic, upper-extremity surgery clinic were screened using CTS-6 between May and June of 2023. The CTS-6 was first administered by one of seven MAs and then by one of four fellowship-trained upper-extremity surgeons. In addition to recording baseline demographics, the results of each of the six history and examination components of the CTS-6 were recorded, as was the cumulative CTS-6 score (0–26). Surgeons were blinded to the scores obtained by the MAs. Interrater reliability (Cohen's kappa) was determined between the groups with respect to the diagnosis of CTS and the individual CTS-6 items. Sensitivity/specificity was calculated for the MA-administered CTS-6, using the score obtained by the surgeon as the reference standard. A CTS-6 score >12 was considered diagnostic of CTS. Two hundred eighteen patients were included, and 26% had a diagnosis of CTS. The MA group demonstrated a Sn/Sp of 84%/91% for the diagnosis of CTS. Interrater reliability was substantial (Cohen's kappa: 0.72, 95% confidence interval: 0.62–0.83) for MAs compared with hand surgeons for the diagnosis of CTS. For individual CTS-6 components, agreement was lowest for the assessment of two-point discrimination (fair) and highest for the assessment of subjective numbness (near perfect). The CTS-6 demonstrates substantial reliability and high Sn/Sp when administrated by MAs in an upper-extremity clinic. These data may be used to inform the development of CTS screening programs and future investigations in the primary care setting. Diagnostic II. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To compile the screening tools used to study temporomandibular disorders (TMD), classify and analyze their potential application in the field of physiotherapy. Methods: All gathered data included randomized clinical trials on humans over 18 years of age pulled from three databases up to November 2019. Results: Nineteen articles were retained, in which the subjects included 1095 women and 385 men. The 32 valuation systems reported were classified as follows: direct, requiring observation and/or palpation in situ by a clinician, which can be subdivided into protocols and instrumental systems; and indirect, requiring neither observation nor palpation by a clinician, which can be subdivided into questionnaires and scales. Conclusion: In order to evaluate TMD, the best choice is to combine direct and indirect assessment methodologies. The valuation of pressure pain threshold with an algometer and Fonseca's Anamnestic Index in combination with Anamnestic Questionnaire CMD, respectively, seems to provide the best results. [ABSTRACT FROM AUTHOR]

Throwing with high velocity requires extremes of glenohumeral external rotation of the abducted arm where particularly high forces in the shoulder and elbow are endured. Repeated throwing leads to dominant-arm bony remodeling of the humerus, glenoid, and elbow, and multiple soft tissue changes that would be considered abnormal. Many of these features are thought to be adaptive and protective. The purpose of this work is to (1) define the concept of adaptive pathology; (2) review the mechanics of the throwing motion; (3) review pertinent physical examination and imaging findings seen in asymptomatic throwers' shoulders and elbows and describe how these changes develop and may be adaptive—allowing the thrower to perform at high levels; and then (4) review the principles of surgical treatment in the throwing athletes, which should focus on reducing symptoms, but not necessarily restoring the thrower's anatomy to normal. [ABSTRACT FROM AUTHOR]

Subscapularis management is a critical component to the success of anatomic total shoulder arthroplasty (TSA). Failure to heal the subscapularis can result in pain, weakness, loss of function, and revision. However, not all patients have poor outcomes. The purpose of this study is to compare patients with normal and dysfunctional subscapularis function following TSA in regard to (1) patient-reported outcome measures (PROMs); (2) range of motion (ROM) and strength; (3) achievement of minimal clinically important differences (MCIDs); and (4) specific functional internal rotation tasks. A retrospective review of patients treated with TSA for osteoarthritis with a minimum 2-year follow-up was performed to identify patients with subscapularis dysfunction. Subscapularis dysfunction was diagnosed when any degree of weakness in internal rotation was detected on physical examination (positive belly press sign). These patients were case controlled matched on a 1:3 ratio to patients with normal subscapularis function based on age and sex. PROMs, measured active motion, revision rates, patient satisfaction, and postoperative radiographic findings were compared. Population-specific institutional anchor-based MCID values were used to compare the improvement in PROM. Of the 668 patients included, 34 patients (5.1%) demonstrated evidence of subscapularis dysfunction. Mean follow-up for the normal subscapularis function cohort was 63.4 ± 29.7 and 58.7 ± 26.8 for the dysfunctional subscapularis cohort. Patients with subscapularis dysfunction demonstrated significantly worse postoperative Simple Shoulder Test, Single Assessment Numerical Evaluation, visual analog scale (VAS) function, VAS pain, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores with higher rates of unsatisfactory results when compared to patients with normal subscapularis function. Abduction, elevation, internal rotation ROM, along with supraspinatus and external rotation strength were also significantly worse in the dysfunctional group. Similarly, these patients were more likely to have decreased ability to perform functional internal rotation tasks, with only 47% of the patients being able to reach the small of their back compared to 85% with normal subscapularis function. Radiographically, the dysfunctional cohort demonstrated higher rates of anterior subluxation (56% vs. 7%; P <.001) and glenoid loosening (24% vs. 5%; P =.004). Similarly, revision rates were significantly higher for patients with subscapularis dysfunction (8 patients, 23.5%). Nonetheless, the dysfunctional subscapularis cohort demonstrated improvements in VAS pain (4.0 ± 3.7) and ASES (46.4 ± 35.9) scores that exceeded MCID thresholds. Patients who develop subscapularis dysfunction after TSA have significantly worse PROMs, ROM, functional tasks of internal rotation, and radiographic outcomes, as well as increased rates of revision. Although patients show worse outcomes and high revision rates compared with their normal-functioning counterparts, these patients maintained improvement above MCID thresholds for pain and function at a mean 5-year follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica Herediana is the property of Universidad Peruana Cayetano Heredia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Scapular dyskinesis (SD) is defined as an altered position of the scapula or altered motion patterns and their relationship with shoulder pain (SP) is still under debate. The modified scapular assistance test (mSAT) modifies scapular kinematics and is used to determine the impact of scapular dyskinesis in shoulder pain. However, data about the relationship between SD and the result of mSAT is scarce. The aim of this study is to establish the frequency of positive mSAT in patients with SP and compare the prevalence in those with and without SD. As a secondary objective, we compare changes in pain intensity during the mSAT in patients with a positive test between those with and without SD. Cross-sectional study. Adult patients with a diagnosis of SP and with pain ≥2 during anterior flexion were included. The mSAT, scapular dyskinesis test (SDT), and shoulder function were assessed. The study was conducted between August 2018 and May 2022 and included 70 patients. The prevalence of SDT was 54.29%. No statistically significant associations were detected when assessing the relation between the presence of mSAT and SDT (p -value 0.83). When comparing pain response during the mSAT in patients with a positive test, no differences were seen between patients with SD and patients without SD (p -value 0.26). The prevalence of positive mSAT results was equal between individuals with and without SD. These findings suggest that the presence or absence of SD in individuals with SP was independent of the mSAT result. The mSAT should not be used solely for the assessment of SD in clinical practice nor be influenced by the SDT result. More research is needed to determine if the result of this test could inform prognosis and guide treatment choices. • There were no significant differences between the prevalence of positive mSAT in those with or without scapular dyskinesia. • Patients with dyskinesia did not exhibit larger pain modifications during the modified scapular assistance test than patients with normal scapular motion. • The prevalence of positive mSAT in patients with shoulder pain was 28.5%. [ABSTRACT FROM AUTHOR]

Although the initial description of the distal biceps tendon (DBT) hook test (HT) reported 100% sensitivity (Sn) and specificity (Sp), subsequent retrospective series have demonstrated imperfect validity. The purpose of this investigation was to prospectively assess the validity and reliability of the HT for complete DBT ruptures. We aimed to determine the Sn/Sp and interrater reliability for the HT. A consecutive series of adult patients presenting to our outpatient clinics with an elbow complaint was prospectively examined. Patients were included if they had undergone advanced imaging (magnetic resonance imaging or ultrasound) that imaged the DBT and underwent DBT repair. There were four participating surgeons, all of whom were blinded to magnetic resonance imaging/ultrasound prior to performing the HT. To determine the Sn/Sp of the HT and advanced imaging, intraoperative findings served as the primary reference standard. The interrater reliability of the HT was calculated for cases in which a primary examiner (surgeon) and secondary examiner (physician assistant or resident) performed the HT. Of 64 patients who had undergone advanced imaging, 28 (44%) underwent DBT surgery and were included in the assessment of Sn/Sp. The mean age was 49 years, and all patients were men. The Sn and Sp of the HT were 96% and 67%, respectively. Advanced imaging demonstrated 100% Sn and Sp. Twenty-five patients were evaluated by a primary and secondary examiner. The interrater reliability was substantial (Cohen kappa, 0.71). The Sn and Sp of the HT were 96% and 67%, respectively, when assessed prospectively. Advanced imaging findings (magnetic resonance imaging/ultrasound) demonstrated 100% Sn and Sp. The HT can be performed reliably by examiners with varying experience levels. Considering the imperfect validity of the HT, we caution against the use of this examination alone to diagnose DBT ruptures. Diagnostic II. [ABSTRACT FROM AUTHOR]

Insufficient physical function is strongly associated with decreased activity of daily living and health-related quality of life in middle-aged and older women. YOSAKOI Soran is one of the traditional Japanese dances to have naruko (wooden hand clappers) in their hands as they dance and incorporate the phrase from the Soran Bushi in their song. YOSAKOI Soran festivals can be seen being held in various places across the country, proving its growing popularity with residents as a celebration regardless of age or occupation. The purpose of this study was to examine the cross-sectional associations between YOSAKOI Soran and the physical functions of middle-aged and older women. A total of 30 middle-aged and older women practicing YOSAKOI Soran (YOSAKOI group) and 163 middle-aged and older women who had not practiced YOSAKOI Soran (control group) participated in this cross-sectional study. Handgrip strength, 30-second chair stand performance, and flexibility were used to measure physical functions. Handgrip strength was not significantly differed between the YOSAKOI group and the control group (P = 0.79). 30-second chair stand performance and flexibility were significantly higher in the YOSAKOI group than in the control group (both P < 0.05). These results remained significant after adjusting for age and body mass index (both P < 0.05). The present results suggest that practicing YOSAKOI Soran may increase lower extremity function and flexibility in middle-aged and older women. [ABSTRACT FROM AUTHOR]

To identify the extent and quality of fine motor skill alteration in patients with Dupuytren disease (DD) using an instrumented device measuring grip forces, beyond the commonly used measurement of contracture. Case–control study. University outpatient clinic. Patients with DD (N=27) and a contracture >45° (Tubiana stage II, III, and IV) were included and compared with age-matched healthy control patients (N=27). Not applicable. All individuals were subjected to a set of specific tests using a new instrumented device ("manipulandum"). These included lifting, grasping, and then holding the "manipulandum" with 4 different object characteristics (light and heavy weight, rough and smooth surface) along with a measurement of the precision grip strength. Standard measurements including the Nine-Hole Peg Test, a two-point discrimination, and the Disability of Arm, Shoulder and Hand score were evaluated in comparison. Although the measurements of precision grip, two-point discrimination, Nine-Hole Peg Test, and Disability of Arm, Shoulder and Hand score showed no statistically significant differences between both groups, patients with DD applied significantly greater forces when tested with the different subtests using the "manipulandum." Analysis of the 2-phase movement (lifting and holding the "manipulandum") revealed highly significant differences between the groups. Patients with DD use excessive grip forces when lifting and holding the "manipulandum" when compared with healthy control patients, independent of the degree of contracture. As no differences in precision grip strength were seen, the presented approach is useful to obtain additional important information about fine motor function in diseased hands. [ABSTRACT FROM AUTHOR]

There is a growing interest in diagnosis and treatment through telemedicine because of its convenience, accessibility, and lower costs. There are clinician and patient barriers to wider adoption of telemedicine. To support the effective and equitable use of telemedicine, we investigated the patient, illness, and surgeon factors associated with the specialist level of comfort in providing upper limb care via telemedicine. Seventy-five upper-extremity musculoskeletal specialists completed an online survey-based experiment in which they viewed 12 patient scenarios with randomized patient age, gender, diagnosis, pain intensity, and patient preference for surgical treatment (yes or no) and rated their comfort with telemedicine from 0, no comfort, to 10, complete comfort. The participants were able to provide a rationale for their stance in open text boxes. We recorded the following specialist factors: gender, location of practice, years in practice, subspecialty, the supervision of trainees, and surgeon-rated importance of a physical examination. In a multivariable analysis, greater surgeon comfort using telemedicine was associated with nontrauma conditions, four specific diagnoses, and patients who did not have severe pain. Lower surgeon comfort with telemedicine was associated with the higher clinician-rated importance of a hands-on physical examination and supervising trainees. Text-based reasons provided for relative comfort with telemedicine included nonsurgical treatment and facility of diagnosis based on interviews alone. Text-based reasons for relative discomfort with telemedicine included a perceived need for a hands-on physical examination and a preference for an in-person conversation for specific discussions, including scheduling surgery. Greater specialist enthusiasm for telemedicine is associated with personal preferences regarding the upper-extremity condition, patients with less severe pain, and a willingness to forego a hands-on examination. Utilization of telemedicine for upper-extremity specialty care may be facilitated by diagnosis-specific care strategies and strategies for video examination, with a focus on tactics that are effective for people with more intense symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To compare the correlation between 2D transperineal ultrasonography and physical examination (intravaginal palpation) for assessing pelvic floor and levator ani function. Methods: Due to symptoms of pelvic floor disorder, 40 women between the ages of 29 and 75 were enrolled in this study as candidates for urodynamic and structural evaluation of the pelvic floor. A pelvic floor gynaecologist and radiologist assessed the levator ani function via physical examination (graded based on the Oxford Grading System) and transperineal 2D ultrasound, respectively. Results: The ultrasound parameters for calculating the Levator Ani Index (LAI) demonstrate a difference between the anteroposterior dimension of the levator hiatus (r = 0.691, p < 0.001) and the cranial shift of muscle (r = 0.499, p < 0.001) at rest and during a squeezing manoeuvre in the mid-sagittal plane. Reduced anteroposterior diameter of the hiatus and increased cranial shift were associated with a higher Oxford Physical Examination Score (OPES). The association between LAI and OPES was independent of baseline variables such as age, BMI, number of births, and the presence of incontinence symptoms. Conclusion: Measures such as the LAI can be used to quantify the function of the levator ani muscle, which may be useful for evaluating the efficacy of pelvic floor physiotherapy and exercise. [ABSTRACT FROM AUTHOR]

Although carpal tunnel syndrome (CTS) can be diagnosed clinically with the Carpal Tunnel Syndrome 6 (CTS-6) evaluation tool, the relationship between disease severity and CTS-6 score has not been elucidated. The purpose of our study was to determine the correlation of the CTS-6 score and other physical examination maneuvers with the carpal tunnel severity grade by electrodiagnostic testing (EDT). We hypothesized that the CTS-6 score, Durkan test, and Semmes Weinstein Monofilament Testing (SWMT) positively correlate with EDT severity. We prospectively enrolled 105 consecutive patients who presented to the office with suspected CTS, excluding those with previous surgery, previous EDT from an outside facility, or concomitant neuropathy. Four fellowship-trained hand surgeons obtained the CTS-6 score, time to obtain a positive Durkan compression test, and SWMT of the thumb, index, and middle fingers. All patients were sent for EDT. Hand surgeons were blinded to the results of the EDT, and the electrodiagnosticians were blinded to the clinical data. We used the Bland criteria (0–6) to grade CTS severity on EDT. This grade was compared with the CTS-6 score, Durkan time, and SWMT results. Using Spearman correlation coefficients, we found a weakly positive correlation between a higher CTS-6 score and a higher severity grade on EDT. The mean CTS-6 score based on EDT grading were the following: (1) 14.8 (grade 0), (2) 16.0 (grade 1), (3) 14.8 (grade 2), (4) 16.7 (grade 3), (5) 18.7 (grade 4), (6) 18.3 (grade 5), and (7) 22.4 (grade 6). We also found a statistically significant association between the SWMT and a higher CTS-6 score as well as a higher severity grade on EDT. Durkan compression test did not appear to correlate with the EDT grade. The CTS-6 and SWMT show a positive correlation with EDT severity in CTS on the basis of the Bland criteria. The time to a positive Durkan test did not show any correlation. Diagnostic II. [ABSTRACT FROM AUTHOR]

This study aimed to explore chiropractic students' perceptions and attitudes about the appropriateness of peer physical examination as a teaching tool and their willingness and comfort with it. A modified version of a validated questionnaire was used. First- and 2nd-year chiropractic students at Murdoch University were approached during their practical sessions. The responses were analyzed using descriptive statistics reporting frequencies and percentages. Comparison between classes, age, and sex was evaluated by cross-tabulation. A total of 184 questionnaires were completed with a response rate of 76.6%. Our results demonstrated that most students were comfortable with and willing to participate in peer physical examination as well as trusted it as an appropriate part of their training and a valuable learning experience. Nevertheless, a small percentage were uncomfortable with peer physical examination and regarded it as an unprofessional activity. In addition, it was revealed that younger females (≤20 years) reported feeling unnecessarily exposed and therefore significantly less comfortable with peer physical examination. They were also less comfortable when examined in the inguinal area by a student of the opposite sex. Although peer physical examination appears to be a very popular training tool, it still has a few areas of concern that need to be investigated and addressed to improve students' attitude, perception, and comfort with this teaching technique. Further studies could investigate how other factors such as religious beliefs contribute toward students' perception and attitudes regarding peer physical examination. [ABSTRACT FROM AUTHOR]

Teaching complex physical examination skills in health care is currently challenging. Virtual reality (VR) with haptic feedback may help address the challenge. However, the current usage and/or role of VR with haptic feedback in improving physical examination skills of health care students is unclear. The following electronic databases will be searched from Jan 2010 to December 2021: PubMed, AMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), and SCOPUS. Two independent reviewers will review the articles retrieved from the databases to assess for eligibility. Studies of any design (quantitative, qualitative and mixed methods) that investigated the use of VR with haptic feedback in health care education will be included in the review. Primary outcomes will include any quantifiable measures and/or qualitative themes. The Mixed Methods Appraisal Tool (MMAT) will be used to appraise the quality of included studies. The overall quality of the evidence (high, moderate, low and very low) of quantitative studies and/or qualitative studies will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and/or GRADE CERQual tools. Discussion: As health care settings (including teaching and clinical practice) are becoming complex, the use of technology such as VR may play a crucial role in facilitating physical examination procedures undertaken by health care professionals. This review will provide a timely overview of the usage of VR with haptic feedback in health care education. [ABSTRACT FROM AUTHOR]

Background: Ankle-brachial index (ABI) is a screening tool for peripheral arterial disease (PAD). However, persons with normal ABI may still exhibit abnormalities in the physical examination of arterial system (PHEA). Objective: In older persons from the PolSenior study, we aimed to assess the risk of total mortality associated with abnormalities in PHEA in the context of dichotomised ABI. Methods: We used data from the PolSenior survey and matched them with mortality information from the Polish Census Bureau. We obtained sociodemographic, medical history, and lifestyle data. The PHEA by a geriatrician included carotid, femoral, popliteal, posterior tibial and the dorsalis pedis arterial pulses, and auscultation of aorta, carotid, femoral, and renal arteries. Ankle-brachial index was tibial to brachial SBP ratio. We plotted the stratified Kaplan–Meier curves and used Cox's regression to assess the unadjusted and adjusted influence of PHEA result on time to death. Results: The mean (standard deviation, SD) age of 852 persons (46.7% women) was 74.7 (10.6) years. In the ABI < 0.9 group, the PHEA was not associated with mortality. However, in the ABI ≥ 0.9 group, both in unadjusted and adjusted (RHR; 95% CI: 1.08; 1.02–1.16, p = 0.01) Cox regression, PHEA greater by 1 score was associated with mortality. Presence of 4 or more PHEA abnormalities was raising the risk in the ABI ≥ 0.9 group to the level associated with ABI < 0.9. Conclusions: In the older persons with normal ABI, the greater number of abnormalities during physical examination of arteries may be indicative of higher risk of death. [ABSTRACT FROM AUTHOR]

• Combined Simulation/MUTA sessions increased NP student's confidence and learning. • SP/MUTA's ranked NP students as well-prepared in history and physical exam skills. • Combined Simulation/MUTA sessions uniquely prepare NP students for clinical practice. Nurse practitioner (NP) programs use skills-based activities such as structured simulations and instructional sessions to prepare students for clinical practice. NP students often have limited opportunities to perform sensitive exams during their clinical experiences. This study combined simulation and Male Urogenital Teaching Associate (MUTA) instruction to evaluate student's preparedness, knowledge, perceived learning, and confidence in diagnosing/managing urogenital complaints. Twenty-six NP students entering their first clinical course completed a simulation/MUTA clinical encounter. The encounter included a pre-brief, simulation, urogenital examination instructional session, learning activities, and debrief. Descriptive and inferential statistics were analyzed on pre-test/post-test and post-evaluation questionnaires. Data revealed a statistically significant difference in student's confidence postintervention. Students reported an increase in knowledge and preparedness. There is a paucity of evidence on the use of simulation with MUTA instruction in NP curriculum. Findings suggests that a combined simulation/MUTA instruction can meet student needs and increase preparedness, knowledge, and confidence. [ABSTRACT FROM AUTHOR]

According to the specific requirements repeatedly put forward by many national documents in the past 20 years that "those who fail to meet the national standards for students' physical health" and ""those who are qualified can not graduate", the methods of literature, data statistics, ad logical analysis are used to carry put systematical design and overall promotion of the reform and practice of "unqualified physical examination can not graduate" in Yunnan university. Building co-educational physical education class teaching mode of "sport technique + fitness health" for male and female students; revising the syllabus so as to include such physical test item as 50m running, standing long jump, pull-up/sit-ups and 1000m for males 800m for females as class routine; establishing a curriculum evaluation system of "50% sports technique + 40% physical test + 10% usual grade"; establishing physical education class or physical examination class of 200 class hours covering four grades of undergraduate course; increasing students' physical examination times and opportunities for supplementary examinations; starting the second phase construction of nearly 60,000 square meters of school sports center; improving the campus app of 120km for boys and 100km for girls per semester; adjusting physical education teachers provision according to the ratio of 300:1 for undergraduates; adjusting the public physical education class salary coefficient from 0.7 to 1.0; helping students master more than 2 sports skills. A series of reform measures once attracted the attention of the mainstream media. The results showed that the reform and practice of "failing in physical examination and not graduating" show some initial effect, and the qualified rate and the rate of good physical fitness result reached 91.9% and 11.9% respectively, which get the highest for the last 5 years from 2017 till 2021 [ABSTRACT FROM AUTHOR]

To compare virtual and in-person physical examination (PE) learning among chiropractic students. Preexisting assessment data from 69 students enrolled in a Head and Neck PE course were analyzed for this study. The course comprised three 50-minute labs and one 50-minute lecture each week. Students had the option to attend the lab class in person or online. The virtual classroom was broadcasted simultaneously with the in-person class. Relevant class materials, including slides and videos, were available to all students on the learning management system. Student performance was evaluated through 8 weekly quizzes and 2 objective structured clinical examinations (OSCEs). Data for after-school practice and learning for each topic were also collected. Our results indicated that OSCE and weekly quiz scores were positively correlated with in-person class attendance (p =.000, r =.619 and p =.000, r =.488, respectively). Participants were broken down into 2 groups: (1) higher than 50% attendance rates and (2) 50% or lower attendance rates. The mean OSCE (p =.000) and quiz scores (p =.001) for group 1 (49.41 ±.72 and 22.48 ± 1.06) were significantly higher than those for group 2 (48.13 ± 1.30 and 21.22 ± 1.29). By contrast, the mean number of videos watched was lower for group 1 compared with group 2 (3.23 ± 2.61 vs 5.70 ± 3.35, p =.011). There were no significant differences in the number of practices between the 2 groups (p =.18). Students who participated in in-person PE learning outperformed those in virtual learning in this study. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Partial tears of the distal biceps tendon can be difficult to diagnose based on clinical examination and magnetic resonance imaging (MRI). Patients from a single surgeon's practice from 2000 to 2018 with a partial distal biceps tendon tear were retrospectively reviewed to determine the utility of the distal biceps palpation-rotation test in the detection of partial tears. This test is performed by palpating the bicipital tuberosity at the lateral forearm while ranging the forearm from supination to pronation with the arm adducted at the patient's side and the elbow flexed to 90°. A positive test elicits tenderness at the tuberosity with the arm in pronation but not in supination. Examination findings were correlated with MRI reports confirming a partial tear. Twelve cadaveric arms were dissected to determine overall pronosupination range of motion, the degree of pronation at which the bicipital tuberosity is maximally palpable, and anatomic measurements of the bicipital tuberosity to guide the optimal technique when carrying out the maneuver. Ninety-nine patients were diagnosed with a partial distal biceps tendon, of whom 34 had available MRI reports and complete physical examination documentation. Thirty-three of 34 patients (97%) had partial tears on MRI. The hook test was negative in all cases. All patients had tenderness with resisted supination. In those with MRI-confirmed partial tears, the palpation-rotation test was positive in all patients (100% sensitivity). The bicipital tuberosity was maximally palpated at the dorsolateral forearm at a mean 20° of pronation, and the proximal and distal boundaries of the radial tuberosity were 2.5 cm and 5.3 cm, on average, distal to the radial head, respectively. A positive palpation-rotation test was seen in 33 of 33 patients (100% sensitivity), as correlated with MRI. The combination of an intact distal biceps tendon within the antecubital fossa, tenderness on resisted supination, and a positive palpation-rotation test are highly suggestive of a partial distal biceps tendon tear. [ABSTRACT FROM AUTHOR]

Background: The clinical examination for laxity has been considered a mainstay in evaluation of the painful knee arthroplasty, especially for the diagnosis of instability. More than 10 mm of anterior-posterior (AP) translation in flexion has been described as important in the diagnosis of flexion instability. The inter-observer reliability of varus/valgus and AP laxity testing has not been tested.Methods: Ten subjects with prior to total knee arthroplasty (TKA) were examined by 4 fellowship-trained orthopedic knee arthroplasty surgeons. Each surgeon evaluated each subject in random order and was blinded to the results of the other surgeons. Each surgeon performed an anterior drawer test at 30 and 90 degrees of flexion and graded the instability as 0-5 mm, 5-10 mm or >10 mm. Varus-valgus testing was also graded. Motion capture was used during the examination to determine the joint position and estimate joint reaction force during the examination.Results: Inter-rater reliability (IRR) was poor at 30 and 90 degrees for both the subjective rater score and the measured AP laxity in flexion (k = 018-0.22). Varus-valgus testing similarly had poor reliability. Force applied by the rater also had poor IRR.Conclusion: Clinical testing of knee laxity after TKA has poor reliability between surgeons using motion analysis. It is unclear if this is from differences in examiner technique or from differences in pain or quadriceps function of the subjects. Instability after TKA should not be diagnosed strictly by clinical testing and should involve a complete clinical assessment of the patient. [ABSTRACT FROM AUTHOR]

Nurses need competency in trauma-informed care (TIC) to create supportive environments that encourage patient engagement and treatment adherence. Increased demand for TIC in nursing practice requires improved approaches to competency evaluation. This study aimed to evaluate the competency of advanced practice registered nursing (APRN) students in implementing TIC principles, utilizing a rubric tailored for simulation-based learning within an advanced health assessment course. Employing a non-experimental, observational approach, this project utilized a quantitative, rubric-based assessment to analyze video-recorded simulations and rate competency in implementation of TIC principles. The study included 64 graduate-level APRN students enrolled in a mandatory advanced health assessment course at a large midwestern university in the United States. The study assessed student competency in implementing seven TIC principles within a simulation-based experience (SBE), using a scale ranging from 1 (novice) to 5 (expert). While a few students demonstrated competency at, or above, level 3 in certain TIC principles, the overall average competency rating remained below 3. This outcome aligns with expectations for novice APRN students. Notably, the principles of communication and safety showed the highest average competency levels. Findings revealed that most students were at a novice competency level, struggling with implementation of TIC principles. This highlights the imperative for nurse educators to incorporate a variety of educational activities into the curriculum. Integrating TIC content into didactic lectures, providing formative assessment opportunities, and conducting post-lecture SBEs are recommended strategies to enhance TIC competency among APRN students, thereby equipping them with the essential skills to deliver exemplary care to trauma survivors. • There is a growing demand for trauma-informed clinicians. • Advanced-practice nurses lack training in trauma-informed care. • Competencies in trauma-informed care include assessment for a history of trauma. • Trauma-informed competencies can be evaluated in simulation-based experiences. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations. A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies. Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other. The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the accuracy of palpation methods for locating the transverse processes of the first cervical vertebra and masseter muscle using radiographic images as the gold-standard method and the association between personal characteristics with the observed accuracy. This was a single-blinded, diagnostic accuracy study. Ninety-five participants (49 women, 58 ± 16 years of age) were enrolled in this study. A single examiner palpated the neck and face region of all participants to identify the transverse processes of the first cervical vertebra and masseter muscles bilaterally. In sequence, participants underwent a multislice computed tomography scan for assessment of the superimposed inner body structure. Two radiologists assessed the computed tomography images using the same criteria and were blinded regarding each other's assessment and the anatomic landmarks under investigation. The palpation accuracy was calculated as the proportion of the correctly identified landmarks in the studied sample. The correlation of the palpation outcome (correct = 1; incorrect = 0) with age, sex (male = 1; female = 0), and body mass index was investigated using the point-biserial correlation coefficient. The right and left transverse processes were correctly located in 76 (80%) and 81 (85%) participants, respectively, and bilaterally in 157 events (83%), as evaluated by the consensus of the 2 radiologists. The masseter muscles were correctly localized bilaterally in 95 of 95 (100%) participants. Body mass showed statistical evidence of a weak, positive correlation with the correct location of the transverse processes of the first cervical vertebra at the right body side (r =.219; 95% confidence interval, 0.018-0.403; P =.033). Palpation methods used in this study accurately identified the location of the first cervical vertebra spinous processes and the masseter muscles. [ABSTRACT FROM AUTHOR]

This article is aimed at the general orthopaedic surgeon or trainee looking to have a useful summary and approach to clinical assessment of the shoulder joint. Here we discuss a systematic approach, including a description of some of the special tests. This is not exhaustive, as a large number (estimated at around 1301,2) of these special tests have been described in the literature – far too extensive a list to be discussed in detail. We have therefore concentrated on a core of common, simple and useful tests that can be applied alongside the rest of the clinical assessment to aid in differential diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Neurological emergencies, such as acute stroke, are especially challenging during the current Coronavirus disease-2019 (COVID-19) pandemic. Symptoms as aphasia or dysarthria are severely impacting cooperation and communication with patients. During physical examination, both the patient and the medical team are fitted routinely with surgical masks to minimize potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, such a practice can lead to concealment of particularly relevant physical signs. We report a case series of four acute stroke patients who were transferred for endovascular mechanical thrombectomy to our institute after intravenous thrombolysis was initiated at primary stroke centers. Upon arrival, after removing their masks, we observed oral angioedema, as a reaction to thrombolytic agent alteplase. Symptoms remained obscured by face masks through patient care at the referring stroke unit and during transportation, nevertheless they resolved after treatment. Most probably, there are a number of similar cases encountered at emergency departments and acute stroke units. To improve patient safety, a compromise between ensuring protection against the novel coronavirus and facilitating detection of potentially life-threatening physical signs must be found. [ABSTRACT FROM AUTHOR]

This study aimed to perform a systematic review of the diagnostic test accuracy of physical examination tests, including crepitus of the knee, pain during functional activities, and manual tests of the patella in suspected patellofemoral osteoarthritis (PF OA) cases. The searched languages were English, Chinese, Korean, and Japanese. The PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Korea Studies Information Service System, China National Knowledge Infrastructure, and Ichushi databases were searched electronically. The inclusion criteria of this systematic review were: (1) original articles; (2) prospective cohort or cross-sectional studies with isolated PF OA; (3) magnetic resonance imaging and/or orthopedic procedures used as the reference standard; and (4) odds ratio and/or test accuracy reported. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Seven citations were included in the systematic review. Overall, the risk of bias was favorable. Among the included studies, four reported the odds ratio of the physical examination tests, while three reported the sensitivity and specificity for test accuracy. The odds ratio of crepitus to identify cartilage lesions of the patella was between 1.74 and 5.49. Additionally, the odds ratio of pain during activities including walking and descending stairs was between 1.01 and 1.6 (original data = 0.60). The odds ratio of the manual tests of the patella was between 1.9 (original data = 0.52) and 2.7. Thus, crepitus was possibly the least efficient parameter for diagnosing PF OA among the three physical examination tests. [ABSTRACT FROM AUTHOR]

Manual clinical tests must be highly reliable and valid to help in diagnosing, monitoring, and treating patients. Recent research highlighted the role of the fascia; thus, it is important to develop inexpensive, easy-to-use, and clinically valid procedures to assess this tissue in the field of manual therapy. The purpose of this study was to determine the level of inter- and intra-examiner concordance when performing a fascial standing flexion test in children. The present study is a descriptive observational study. Two examiners tested 24 healthy children between 11 and 12 years of age performing two trials with the proposed fascial test. Inter- and intra-examiner data were analyzed using unweighted kappa coefficients and percentage agreement. We observed zero inter-examiner reliability in the fascial standing flexion test (mean κ = −0.071, mean percentage agreement of 43.7%), and moderate intra-examiner reliability (mean κ = 0.693, mean percentage agreement of 85.4%). The reliability and validity of the fascial standing flexion test must be improved before it can be recommended for use in a clinical setting. • Importance of manual tests evaluating the fascia to be used in daily practice. • The inter-examiner reliability of the presented test is insufficient, while the intra-examiner reliability is moderate. • Need to increase the reliability and validity of tests to improve in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: Clinical congestion is associated with adverse outcomes in patients with heart failure. The pathophysiological mediators of this association remain uncertain.Methods and Results: We prospectively enrolled a cohort of patients with heart failure and reduced left ventricular ejection fraction and performed a detailed clinical examination followed on the same day by an invasive right heart catheterization and blood sampling for biomarkers. High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured. A clinical congestion score was calculated based on jugular venous pressure (cm H20 <10 = 0, 10-14 = 1, >14 = 2 points), bendopnea (0 vs 1), a third heart sound (0 vs 1), or peripheral edema (0-2). Congestion was categorized into tiers as absent (0 points), mild (1 point), or moderate to severe (≥ 2 points). We tested for associations of high-sensitivity troponin T, NT-proBNP, and elevated ventricular filling pressures with clinical congestion in both univariate and multivariable analyses. Of 153 participants, 65 (42%) had absent, 35 mild (23%), and 53 (35%) had moderate to severe clinical congestion. Congestion tier was associated with higher NT-proBNP and hs-troponin levels, and the right atrial pressure and pulmonary capillary wedge pressure (P < .001 for each). Increased congestion tier was also associated with the coexistent presence of elevated troponin T (≥52 ng/L), NT-proBNP (≥1000 pg/mL), and pulmonary capillary wedge pressure (≥22 mm Hg). Specifically, 78% of those with absent clinical congestion had 0 to 1 of these findings, whereas 75% of those with moderate-severe congestion had 2 or all 3 of these abnormalities (P < .001). An elevated hs-troponin was associated with mild or greater clinical congestion (odds ratio 3, 95% confidence interval 1.2-7.5, P = .02) in multivariable analysis adjusting for potential confounders including the right atrial pressure, pulmonary capillary wedge pressure, and NT-proBNP levels.Conclusions: Clinical congestion is a phenotype in which there is a high coexistent presence of elevated ventricular filling pressures, elevated natriuretic peptide levels, and subclinical myocardial injury. An elevated troponin was associated with clinical congestion in multivariable models that adjusted for ventricular filling pressures and natriuretic peptide levels. These data strengthen the evidence base for an association of elevated troponin with clinical congestion, suggesting that subclinical myocardial injury may be an important contributor to the pathophysiology of the congested state. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the normal range of rotation occurring during rotation stress testing for alar ligament integrity and to ascertain whether rotation range on testing is affected by an individual's age. In this observational study, 88 people aged 18 to 86 years old with no current neck problems or known risk factors for craniocervical instability underwent rotation stress testing for the alar ligaments. The test was performed in each direction in neutral, flexion, and extension, with the participant both sitting and supine. Rotation range was recorded using an electromagnetic movement tracking system. Range was assessed overall and then compared by 10-year age groups using analysis of variance. Reliability of measurements was assessed by intraclass correlation coefficient (2,1) and standard error of measurement. Mean angles of upper cervical rotation ranged between 10.91° (standard deviation 3.38°) to 16.12° (standard deviation 5.13°). Overall measured rotation ranged from 1.37° to 33.22°. Participants in older age groups generally displayed reduced rotation; however, the reduction was less than 4°. Reliability of rotation measurements was good to excellent, with the intraclass correlation coefficient ranging from 0.80 to 0.99. Normal range of rotation measured during stress testing for the alar ligament varied widely but did not exceed 33o. All values measured in this study fell below recommendations for ligament integrity. Age-related change was not clinically significant in the interpretation of this test in this asymptomatic population. [ABSTRACT FROM AUTHOR]

We evaluated a comprehensive telemedicine pathway for carpal tunnel syndrome (CTS). Our primary aim was to compare telemedicine and in-person administration of the six item CTS-6 instrument (CTS-6) in patients undergoing carpal tunnel release (CTR) and to determine whether surgical plans determined via telemedicine were altered by in-person assessments. We additionally aimed to assess agreement between telemedicine and in-person examinations. In this prospective investigation, patients referred to a hand surgeon for evaluation of CTS were offered a telemedicine pathway. A modified, virtual CTS-6 was administered during the telemedicine consultation and a virtual exam was performed. Patients indicated for CTR were evaluated in person on the day of surgery. Agreement between the telemedicine and in-person CTS-6 and exam findings was determined. Patients were evaluated via telemedicine postoperatively to determine satisfaction with the program and assess surgical complications. A total of 32 cases were included. The mean CTS-6 score administered via telemedicine was 17.7, compared with 16.8 in person; this difference was not statistically significant. There were no cases indicated for CTR during the telemedicine visit that had a subsequent change in management based on the in-person evaluation. Agreement was lowest for the sensory assessment (63%). The Phalen and Durkan compression tests demonstrated high levels of agreement (97% and 94%, respectively). Satisfaction was high for patients in the telemedicine CTS pathway. Overall agreement between telemedicine and in-person administration of the CTS-6 is high for patients with CTS. In patients indicated for CTR via telemedicine, an in-person examination does not appear to alter management. The telemedicine examination of hand sensation demonstrates lower levels of agreement with the in-person assessment. Telemedicine can serve as an alternative to conventional, in-person clinic visits for the diagnosis and postoperative management of uncomplicated, primary CTS. Diagnostic II. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the adoption of and opinions on the Doha agreement meeting classification in groin pain in athletes.Design: Delphi survey and e-survey.Methods: A 2-round Delphi survey among the Doha agreement meeting expert group, and a separate international e-survey among clinicians who regularly assess athletes with groin pain. Clinical cases were presented, and participants provided their preferred terms for the diagnoses. All participants reported if they had adopted the Doha agreement meeting classification system in their practice. The Doha agreement meeting experts also shared opinions on amendments to the classification system, and reported their level of agreement with suggested statements.Results: In the Delphi survey, the Doha agreement meeting experts (n = 21) reported 8-11 different terms for their primary diagnosis of each presented case. The Doha agreement meeting terminology was used by 50-67% of these experts. In the international e-survey (n = 51), 12-15 different diagnostic terms were reported in each clinical case, and 43-55% of clinicians used the Doha agreement meeting terminology. Adoption of the Doha agreement classification system in practice was reported by 73-82% of the Doha agreement meeting experts and 57-69% of the clinicians in the international e-survey. The experts suggested 49 statements regarding amendments to the classification system. Seven of these reached >75% agreement or disagreement.Conclusions: Five years after publication, the majority of the Doha agreement expert group and independent international clinicians report adopting the Doha agreement meeting classification system. There is still considerable heterogeneity in diagnostic terminology when clinical cases are presented, and disagreement on statements related to amendments of the current classification system. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Education / Tiyu Xuekan is the property of Journal of Physical Education Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Joint mobility has been considered an important component of the physical fitness. Objective: This STROBE-based study aimed to evaluate the joint mobility in undergraduate students of Physical Education. Materials and methods: Data measurements were obtained for 239 students attending from 4th to 9th academic semester of a physical education major (200 men: 22±4.3 years, 1.72±0.05 m, 67±8.5 kg; and 39 women: 21±3.4 years, 1.61±0.07 m, 57±6.4 kg). Flexibility expressed as a General/global Index of Joint Mobility (GIJM) was measured through the Flexitest method, which assesses the maximum passive range of motion (ROM) of 20 body joint movements. We also reported the profile of ROM for the individual movements of the Flexitest battery. Results: The differences found between sexes, highlight index of general articular mobility (GIJM) and ROM (p< .05). This aspect is also observed when comparing standardized joint limitations (p< .01 ankle, knee, hip, trunk, elbow and shoulders). However, the homogeneity profile range of movement in the intermovement variability index, the interjoint variability index and the flexion-extension variability index indices don't reflect gender differences (p> .05), contrary to found in the between segment variability index and distal-proximal variability index (p< .01). Conclusions: The hierarchical clustering algorithm subdivided the study participants into groups according to GIJM. We identified two significantly different phenotypes representing younger, lighter, and with higher joint mobility (Cluster 1) versus older, heavier, and with lower joint mobility students (Cluster 2). More research is needed to evaluate associations with body composition, physical performance, quality of life and academic success. [ABSTRACT FROM AUTHOR]

The shoulder physical examination is frequently performed to diagnose rotator cuff tears in clinical practice; however, there is insufficient evidence on which physical tests are efficient for shoulder impingements in primary care settings. The purposes of this study were (1) to analyze the accuracy of 8 clinical tests to diagnose supraspinatus tendon lesions and investigate whether the combination of these tests can improve the diagnostic values; (2) to assess which are the best positivity criteria for shoulder maneuvers—pain and/or weakness; and (3) to investigate the ability of these tests to distinguish between partial- and full-thickness tears. A total of 733 consecutive patients were prospectively evaluated by 4 shoulder surgeons in this multicenter diagnostic study from May 2017 to December 2018, and 8 clinical tests (empty-can, full-can test, drop arm, painful arc, Neer sign, Hawkins test, Patte test, and resisted external rotation) were compared with magnetic resonance imaging performed by blinded radiologists. We assessed the sensitivity, specificity, accuracy, positive and negative predictive values, and diagnostic odds ratio (DOR) for all tests. For overall supraspinatus tears, the empty-can test showed the highest sensitivity (0.81), the Patte test (positive for pain and weakness) and the drop-arm test showed the highest specificity (0.99 and 0.98, respectively), and the best combination was the Neer sign and the drop-arm test (DOR, 12.92). The positivity criteria for pain associated with weakness showed the highest performance, with DORs of 16.94 for the Patte test and 10.45 for the empty-can test. The Patte test and resisted external rotation, positive for pain and weakness, showed the highest ability to distinguish between full- and partial-thickness tears (DOR, 5.69 and 5.35, respectively). The shoulder maneuvers showed low negative predictive values; the highest value (0.58) was found with the empty-can test. (1) The clinical tests demonstrated excellent diagnostic values; the empty-can test had the highest sensitivity, whereas the drop-arm test and the Patte test had the highest specificity; and the best combination for detecting supraspinatus tears was the Neer sign and the drop-arm test. On the other hand, the physical examination findings showed limited values to rule out tears. (2) The best positivity criterion for shoulder maneuvers was pain associated with weakness. (3) The Patte test and resisted external rotation showed the highest ability to distinguish between full- and partial-thickness tears. [ABSTRACT FROM AUTHOR]

• Patients with a palpable apex beat had a higher New York Heart Association functional class. • Patients with a palpable apex beat had a larger left ventricular volume, mass, and left atrial (LA) volume. • The LA volume is the strongest factor for palpability and shift of the apex beat. • A palpable apex beat shifted leftward has diagnostic value for LA enlargement. The palpation of the apex beat, one of the most fundamental physical examinations, provides a clue to left ventricular (LV) dilatation and hypertrophy; however, its relation to left atrial (LA) volume has rarely been investigated. The clinical value of the apex beat, especially in relation to LA volume was studied in 138 consecutive patients. Patients were examined in the supine position for a palpable apex beat. When an apex beat was felt, the apex beat distance, defined as the distance from the mid-clavicular line to the lateral border of the apex beat, was measured. The LA and LV geometry were assessed using echocardiography. Of the 138 patients, an apex beat was palpable in 52 (38%) patients and the apex distance of these 52 patients ranged from −2 to 8 cm. The parameters of LV dilatation or hypertrophy were significant according to univariate but not to multivariate analysis. Only LA volume index was significant both for the palpability of the apex beat (p =0.0042) and the apex distance (p =0.0017) by multivariate analysis. The best cut-off point for the apex distance was −1 cm for LA enlargement (sensitivity 61%, specificity 92%, p <0.0001). The LA volume is the most significant factor for the palpability and leftward deviation of the apex beat. Palpation of the apex beat is a crucial diagnostic tool for the detection of not only LV dilatation or hypertrophy but also of LA enlargement. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between clinical assessment and MRI measures of oedema and MRI grading in male athletes with acute adductor injuries.Design: Cross-sectional study.Methods: We included 81 consecutive athletes with acute adductor injuries. All athletes received a standardized clinical assessment and magnetic resonance imaging (MRI), blinded to clinical information. We analysed correlations between extent of palpation pain and extent of MRI oedema for the adductor longus. We compared the clinical assessment to MRI adductor injury grading (0-3) using ordinal regression. We analysed positive and negative predictive values (PPV/NPV) of a complete adductor longus avulsion.Results: Proximal-distal length of adductor longus palpation pain had fair correlation with MRI proximal-distal oedema length oedema (r=0.309, p=0.022). Cross-sectional surface area of palpation pain had poor correlation with corresponding cross-sectional MRI oedema area (r=0.173, p=0.208). The symptoms subscale of the Copenhagen Hip And Groin Outcome Score (HAGOS) for the period since injury (log odds ratio=0.97, p=0.021) and passive adductor stretch pain (log odds ratio=0.35, p=0.046) were associated with MRI injury grading. If there was a palpable defect, MRI always showed a complete avulsion (PPV=100%). Several tests had high negative predictive values: passive adductor stretch (100%), palpation pain at the adductor longus insertion (98%), and the FABER test (98%).Conclusions: The extent of palpation pain does not indicate the extent of MRI oedema in acute adductor longus injuries. A worse modified HAGOS symptoms subscale score and passive adductor stretch pain indicate a higher MRI adductor injury grade. Clinical examination tests have high ability to detect or rule out a complete adductor longus avulsion on MRI. [ABSTRACT FROM AUTHOR]

The primary objective of this review was to investigate the reliability and validity of palpatory clinical tests of sacroiliac mobility. The secondary objective was to investigate which palpatory clinical tests of sacroiliac mobility exist in the literature. PubMed, Embase, Scopus, Medline, and the Physiotherapy Evidence Database were searched. There was no restriction on the study design or participants. The data extracted from each study were sample size, study deign, and clinical test used. If there was information on reliability values, number of examiners, concurrent validity values, gold standard used, or inferential statistical test used, that was also extracted. For intraexaminer reliability, the data were expressed as κ values that were meta-analyzed using random effects. Fifteen palpatory clinical tests of sacroiliac mobility were identified from 28 studies; 14 studies performed inferential statistical analysis, all including analysis of interexaminer reliability, with κ values ranging from −0.05 to 0.77. Analysis of intraexaminer reliability was performed in 8 studies, with κ values ranging from 0.08 to 0.73. No study included in this systematic review verified the concurrent validity of the tests. Our meta-analysis of intraexaminer reliability showed moderate to good agreement results for the Gillet test (κ = 0.46), the standing flexion test (κ = 0.61), and the sitting flexion test (κ = 0.68). We found 15 palpatory clinical tests of sacroiliac mobility in this systematic review. According to our meta-analysis, only the sitting flexion test obtained a good and statistically significant intraexaminer agreement. Further studies are necessary to evaluate the reliability and validity of these tests. [ABSTRACT FROM AUTHOR]