“Working” With “Data”
January 26, 2006 – PT542
Bert Chesworth
The Question
• Can we reliably “feel” joint movement?
Where “Working” & “Data” Meet
• Patients: Mixed Shoulder Problems
• Lateral Rotation of Shoulder
• Movement Diagram
• Cyriax End-feel
Chesworth et al, Phys Ther 78 (6), 1998; 593-601
What Was Done
• 2 PTs - 2 assessments
• shoulder lateral rotation
• 34 patients
• recorded pain & resistance findings
– movement diagram
– Cyriax end-feel
The Patients
• Patients:
– wide spectrum of pathology:
• hyper & hypo mobile (instability vs frozen)
• bony & soft tissue (fracture vs tendinitis)
• surgical (cuff repair) & non surgical
• anatomic and arthroplasty (TSR) joints
– Excluded:
• dislocation, bony union problems
• malignancy, CNS lesion
• post-op contraindication to Lateral Rotation
The Clinicians
• Clinical practice:  = 16 yr
• Manual Therapy:  = 14 yr
• Instructors
– Professional PT program
– CPA – OD continuing education
• Movement Diagram Use:
– Teaching: >75 %
– Clinical: < 50 %
Procedure Overview
• Procedures:
– reviewed
• movement diagram construction
• end-feel category definitions
– random order of patients to assess x 2
– no dx, no hx
The Assessment
• Evaluating lateral rotation
– Supine, Shoulder: ~20º abd, Elbow: 90º flex
– Subject:
• report - onset & change in pain
• inform – no further mov’t
– PT:
•
•
•
•
•
Max 5 passive movements
Uninvolved – involved
Draw mov’t diagram
Record end-feel
Blinded to 1st assess’t findings
End-Feel Categories
Movement Diagram
From Your’s to Mine
Bev’s MD
Study MD
P2
P1
Movement Diagram
Measurements
H to R2
H to P2
V to R2
H to P1
H to R1
H to L
V to P2
Results - What Will We See?
• Agreement / Reliability repeat assessments
• Agreement / Reliability between PTs
• Correlation among MD measures
• Measures
– End-feel category
– MD:
– Onset Pain / Resistance (H to P1, R1)
– MD:
– Maximum Pain and Resistance (H to P2, R2)
– Limit of movement (H to L, i.e. ROM)
Before We See Results
• ICC: Reliability Coefficient
• Pearson r: Correlation Coefficient
• Both vary from 0 to 1
• 0 = no reliability / correlation
• 1 = perfect reliability / correlation
• Agreement: raw %, verbal descriptor for ‘k’
Reliability Results - I
1st vs 2nd Assessment
Single PT feel same thing twice?
When no true change?
Reliability Results - II
PT A vs PT B
Two PTs feel same thing once?
When no true difference?
Correlation Results - I
Onset Pain / Resistance vs H to L
Correlation Results - II
Max Pain / Resistance vs H to L
End-Feel Results
Summary
• In Summary:
Good reliability between 1st & 2nd assessments
Good reliability between PTs, like having a 2nd
round
Correlations with H to L on MD:
• .573 - .956 for H to P1, R1 (where we put ‘onset’ wrt ROM)
• .914 - .999 for H to P2, R2 (where we put ‘max’ wrt ROM)
Good agreement assigning end-feel categories:
note: end-feel categories defined by end-range P/R