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Validity of Combining History Elements and Physical Examination Tests to Diagnose Patellofemoral Pain
- Source :
- Archives of physical medicine and rehabilitation. 99(4)
- Publication Year :
- 2017
-
Abstract
- Objective To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP). Design Prospective diagnostic study. Settings Orthopedic outpatient clinics, family medicine clinics, and community-dwelling. Participants Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint. Interventions Not applicable. Main Outcome Measures History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated. Results Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2–14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06–.27). Conclusions Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee disorders were developed. External validation is required before clinical use.
- Subjects :
- Adult
Male
medicine.medical_specialty
Physical Therapy, Sports Therapy and Rehabilitation
Physical examination
Palpation
Likelihood ratios in diagnostic testing
Diagnosis, Differential
03 medical and health sciences
Patellofemoral Joint
0302 clinical medicine
Positive predicative value
medicine
Outpatient clinic
Humans
Knee
030212 general & internal medicine
Prospective Studies
Medical History Taking
Physical Examination
Aged
Likelihood Functions
medicine.diagnostic_test
business.industry
Rehabilitation
Reproducibility of Results
030229 sport sciences
Syndrome
Middle Aged
medicine.disease
Knee pain
Logistic Models
Orthopedics
Patellofemoral Pain Syndrome
Physical therapy
Female
medicine.symptom
business
Range of motion
Patellofemoral pain syndrome
Subjects
Details
- ISSN :
- 1532821X
- Volume :
- 99
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Archives of physical medicine and rehabilitation
- Accession number :
- edsair.doi.dedup.....8d920b82f91cc1dc75ea1346b74f4ca0