Lower Eval Week 2 Flashcards
What does screening do?
Begins to rule out many possible diagnoses
Reliability
Extent a test is free from error, uses the intraclass correlation coefficient
Intrarater reliability
Reliable for a single person
Interater reliability
Reliable for a group
Dichotomous Outcomes
Either positive or negative that the patient has the pathology
What value is used to adjust for chance in dichotomous outcomes
Kappa value
Validity
The test is actually testing what you want tested
QUADAS
Quality Assessment of Diagnostic Accuracy Studies
Specificity
Fraction of people without the disease that got a negative test
Highly specific tests will not give many false positives
SPIN
Specificity rules in a diagnosis
Sensitivity
Fraction of people with the disease that got a positive result
Highly sensitive tests will identify nearly everyone with the disease
SNOUT
A test with a high sensitivity that is negative will rule out a diagnosis
Likelihood Ratio
Index developed to describe how reliably a test detects a condition
Calculations of Likelihood Ratios
LR+ = Sensitivity/(1-Specificity) LR- = (1-Sensitivity)/Specificity
To rule IN a disorder
Want a high LR+
When you want to rule OUT a disorder
A low LR-
What does LR of 1 mean?
Gives no information one way or the other
Utility Scores
- Evidence strongly supports the use of the test
- Evidence moderately supports the use of this test
- Evidence minimally supports the use of this test
? This test has not been sufficiently researched to determine its value
Lower Extremity Screening
Check static, gait, palpatory landmarks, ASIS, sacral sulcus, inferior lateral angle of sacrum, ischial tuberosities, sacrotuberous ligament, PSIS, sacral base, long dorsal ligament, pubic tubercles, functional procedures, hop, lower extremity motion screen, spinal side bend, standing forward flexion test, seated flexion test, stork test, relative leg-length test, prone motion, sphinx position, supine motion, Lasegue’s test- SLR
Static
Check standing posture from the front, behind, and at each side
Gait
Check gait from AP and lateral view, check functional capacity, cross patterning of the gait and symmetry of stride, check for pes planus/cavus
Palpatory Landmarks
Rib angles, iliac crests, greater trochanters
ASIS
Look for level and in-leveled
Functional Procedures
C-spine and upper thoracic, upper extremity motion screen, thoracic cage (smooth and symmetrical during inhalation and exhalation), lumbar spine
Lower Extremity Motion Screen
Squat Test
Spinal Side Bend
Looking for symmetry of tissue T1-L5 and a symmetrical C-shaped curve in both directions, a positive test includes a straitening of segments of the c-curve on the side of the concavity
Standing Forward Flexion Test
Thumbs move caudal and lateral, asymmetrical motion is the side that moves toward the head first or farthest is the restricted side if stuck with the sacrum or has an innominate rotation or symphysis problem
Seated Flexion Test
Asymmetrical motion is the side that moves toward the head first or farthest is the restricted side, if seated is positive do sacral tests
Stork Test
Identifies SI and TJ dysfunction, normal is PSIS drops inferiorly and moves laterally on lifted leg, abnormal there is no motion or moves up on lifted leg
Relative leg-length test
Standing and seated
Prone Motion
Thoraco-lumbar junction motion and lumbo-sacral junction motion
Supine Motion
Hamstring tension test, relative leg-length difference, Lasegue’s test, single leg with pain with PROM beyond 70º indicates joint pathology, same with double leg indicates SI pathology
