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SMT 421-480 Flashcards

1
Q
  1. What is a (+) ER test?
A

pain with extension combined with rotation towards the painful side

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2
Q
  1. Who obtained a concensus from expert Australian & NZ for LBP
A

Wilde et al 2007

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3
Q
  1. What did 94% of the panel agree on
A

localized unilateral LBP

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4
Q
  1. How did Delitto et al 1995 diagnose lumbar segment instability?
A

if LBP is caused by minimal perturbations

  • presence of lateral shift deformity
  • short term relief from manipulation
  • trauma
  • use of oral contraceptives
  • bracing improve symptoms
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5
Q
  1. Paris 1985 and Maitland 1986 diagnose LSI by?
A

presence of a step off between adjacent Spinous processes

hypermobility on PPVIM and PAIVM

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6
Q
  1. O’Sullivan in 2000 diagnose LSI by?
A
  • giving way, slipping out or locking with presence of reverse lumbopelvic rythm
  • presence of posterior shear stress using posterior force
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7
Q
  1. What 3 authors relate LSI to aberrant motions such as an instability catch?
A

Paris 1985 ; Nachemson 1985 and Ogon et al 1997

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8
Q
  1. What is an aberrant motion?
A
  • a sudden acceleration or deceleration of movement

and movements occuring outside the plane of motion like SB or rotation with flexion occurs from a flexed position

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9
Q
  1. Have aberrant motions ever been related to symptoms or abnormal movements in imaging studies?
A

No concurrent validity to date

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10
Q
  1. What did Barnes et al 2009 contribute to LSI studies
A

a variation from normal spine coupling

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11
Q
  1. Who attempted to demonstrate consistent coupling patterns?
A

Legaspi & Edmonds 2007

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12
Q
  1. Did Legaspi & Edmonds 2007 find a consistent coupling pattern between SB and Rot in Lx spine?
A

No.

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13
Q
  1. Is there evidence to support the use of coupled motion to evaluate or treat LBP?
A

No.

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14
Q
  1. Is coupling detectable by palpation?
A

No. The motion is only +/

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15
Q
  1. What 6 criteria did Paris 1985/2003 use as exam findings for LSI?
A
  • Instability catch
  • Hypertrophied band horizontal raised muscle tone on standing
  • Step off on standing that disappears on lying
  • shaking/shuddering on forward bending (Ogon et al 1997)
  • Imbalance on SLR
  • Grade 5 or 6 on PPIVM
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16
Q
  1. Kirkaldy-Wallis & Farfan 1982, O’Sullivan 2000 use what findings in their studies?
A
  • painful arc during motions

- inability to stand erect s assistance from hands

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17
Q
  1. How did Magee 1997 diagnose LSI?
A

Prone instability test: pos test if painful c Lx compression PA at rest but no pain while actively lifting legs. NO VALIDITY.

18
Q
  1. What did Friberg 1997 use?
A

Radiographs: Axial Compression c wt on shoulders, Axial Traction hanging from a bar.

19
Q
  1. What did Friberg 1997 measure?
A

AP translation: accurate for detection of LSI.

20
Q
  1. What did Hayes et al 1989 disprove in regards to radiographs?
  2. Who else supported the lack of clinical value in films?
A
  1. 42% of asymptomatic subjects have at least one segment exceeding the instability thresholds.
  2. Pitkanen et al 1997
21
Q
  1. What 2 categories did Hicks et al 2005 and Cook et al 2006 categorize LSI?
A
  1. a. Radiographic instability (structural instability), major disruption of passive osseoligamentous constraints
    b. Clinical Instability (segmental instability, neuromuscular system symptoms inconsistent with finding on radiographic analysis
22
Q
  1. According to Senntag and Maraiano 1976 what is considered excessive motion?
  2. What is treatment for these patients?
A
  1. Greater than 4 degrees translation or 10 degrees rotation
  2. Fusion if conservative treatment have failed
23
Q
  1. In regards to Algarni et al 2011 systematic review what test may be useful in ortho clinic to diagnose structural LSI?
  2. How is it performed?
  3. Sensitivity?
  4. Specificity?
  5. Positive likely hood ratio?
A
  1. Passive lumbar extension test
  2. Prone, PT lifts both LEs into extension to 30 cm while providing traction (+) test indicated by increased pain that disappears on return to starting position
  3. 84%
  4. 90%
  5. 8.8
24
Q
  1. Any tests for segmental instability?
A
  1. No all tests have limited ability to diagnose
25
Q
  1. According to Cook et al 2006 what were subjective indicators of LSI?
  2. What were objective indicators of LSI?
A
  1. a. “Giving way or giving out back” most related
    b. self-manipulator, feels the need to crack their back
    c. LBP epidsodes or symptoms
  2. a. Poor lumbopelvic control, segmental hinging or pivoting with movement, poor proprioceptive function
    b. Poor coordination/neuromuscular control, juddering or shaking
    c. decreased strength and endurance of local muscles at level of instability
26
Q
  1. What did Cook and Hegedus 2011 research?
A
  1. Examined sensitivity, specificity, +LR/-LR of 14 stand alone physical tests
27
Q
  1. In Cook and Hegedus 2011 what was the sensitivity cut off to rule out disorder?
  2. …to rule in disorder?
A
  1. -LR less than 0.20

455. +LR greater/equal to 5.0

28
Q
  1. In Cook and Hegedus 2011 what were tests for Thoracic spine?
  2. Cervical diagnostic test?
  3. Cervical screening tests?
  4. Neither Screen nor diagnostic tests?
A
  1. No test with adequate +LR and -LR
  2. +LR only lateral glide test for C2-3 Facet Dysfunction
  3. -LR only
    a. Prone unilateral/central PAs for facet dysfcn
    b. spurlings test for radiculopathy
  4. a. Upper Limb Tension Test (ULTT)
    b. C5-6 Lateral Glide Tests
29
Q
  1. In Cook and Hegedus 2011 what were tests for Lumbar diagnositcs?
  2. Lumbar screening tests?
A
  1. +LR
    a. Centralization for diagnostic
    b. PAIVM/PAVM diagnostic for radiologic instability
    c. Percussion and Supine sign for compression fracture
  2. -LR
    a. Ext-Rot for facet pain
    b. SLR for nerve root
30
Q
  1. What was Cook and Hegedus 2011 conclusions?
A
  1. Cluster of tests provide more promising findings
31
Q
  1. Who tried to use CPR to predict stabilization exercise response?
A

Hicks et al 2005

32
Q
  1. Although Hicks et al 2005 has some success, was the CPR valid?
A
  1. No there is not an accurately clinical way to diagnose LSI and Hicks et al 2005 used +prone instability test and + aberrant motions, these were no validated
33
Q
  1. Who found fair to poor reliability of each individual aspect of Hicks et al 2005?
A

Stanton et al 2011

34
Q
  1. Who found adequate inter-rater reliability of Hicks 2005?
  2. But has a CPR lumbar stabilization exercise been validated?
  3. Has the predictive validity of CPR for determining the need for lumbar stab exercise been determined?
A
  1. Rebin et al 2013
  2. No
  3. No
35
Q
  1. What were the results of Rubinstein et al 2011, 2012, 2013 Cochrane Review for Acute and Chronic LBP?
A
  1. Acute- low to moderate quality evidence suggest no difference in effect of SMT (HVLAT or non-thrust) compared to other intervention
    Chronic- high quality evidence that SMT has a small statistically significant but no clinically relevent short term effect on pain relief and functional status compared to other interventions
36
Q
  1. What type of evidence did Bronfort et al 2004 find regarding Acute, Chronic LBP and SMT?
A
  1. Acute- moderate evidence that SMT HVLAT has better short term effect that mobilization or diathermy
    Chronic- moderate evidence
    SMT- a. SMT + strength ex equal to Rx of NSAIDs and Ex for pain relief short and long term
    b. SMT/Mob superior to PCP and placebo short term
    c. SMT/Mob superior to PT for decreased disability long term
    d. SMT/Mob superior to HEP decreased disability long term
37
Q
  1. Who concluded for acute non-specific LBP, manipulation is better than non-steroidal anti-inflammatory drugs, diclofenac and superior to placebo?
A
  1. Wolfgang et al 2013
38
Q
  1. Manipulation and standard medical care better in pain reduction and disability compared to standard medical care alone?
A
  1. Goertz et al 2013
39
Q
  1. What did Hemmila et al 2002 find in regards to SMT pain and disability?
A
  1. Pain- HVLAT greater long term pain relief than PT

Disability- HVLAT greater short and long term decrease disability than PT or HEP

40
Q
  1. Who found failure rates compairing hypo/hyper moblity

475. Who has greater failure rates for SMT?

A
  1. Fritz et al 2005

475. hypermobile patients

41
Q
  1. What was the purpose of the UK Beam Trial 2004?
  2. What were the 3 method groups?
  3. Was there a difference bewteen SMT and SMT + Ex at 12 months
  4. Was there a difference betwen SMT and SMT + Ex for improvements in beliefs about LBP?
  5. What group did not have any effectiveness at 12 months?
  6. How about over general medical practice at 3 and 12 months?
A
  1. Determine effectiveness of SMT
  2. a. Exercise
    b. SMT
    c. SMT and Exercise
  3. No Difference both gave a small but significant benefit
  4. SMT +Ex a little more than just SMT
  5. Exercise group
  6. SMT statistically significant

SMT (11 decks)

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