Decision Making In Screening, Diagnostics, & Imaging

Practice flashcards based on the lecture notes for PT 830: Decision Making in Screening, Diagnostics, and Imaging focusing on the role of physical therapists as diagnosticians.

According to the US Bone and Joint Initiative 2011, what percentage of the US gross domestic product did MSK conditions represent in 2006?

$$7\%$$

Which group scored higher in MSK management knowledge than medical students, interns, residents, and all MD specialists except orthopedists?

Physical Therapists (PTs)

Which specific PT certifications are associated with higher MSK knowledge scores according to Childs et al. 2005?

$OCS$ (Orthopaedic Certified Specialist) and $SCS$ (Sports Certified Specialist)

In which degree program did PTs score higher for MSK management according to Childs et al. 2005?

$DPT$ program scored higher than Master’s program

What are the three levels of direct access to Physical Therapy services mentioned in the lecture?

Unrestricted Direct Access, Direct Access with Provisions, and Limited Direct Access

Within US Civilian Health Services, list three reductions resulting from direct access to Physical Therapy.

Reductions in total PT costs, total healthcare costs, and number of PT visits

What four approaches to diagnosis are mentioned for physical therapists?

Pathoanatomic diagnosis, movement system impairments, mechanism approach (pain presentation), and treatment based classification

What are the three tiers of first-level classification in Physical Therapy decision making?

Physical Therapy Only, Consultation, and Referral

According to the Stage model by Delitto et al. 1995, what processes require medical consultation or referral?

Inflammatory Process (Medical), Psychological, and Surgical

What is the literal translation of the Greek components of 'Diagnosis'?

Dia means ‘between two’ and Gnosis means ‘knowledge; to know’

Which author published a justification for PTs acting as patient evaluators in 1970?

Worthingham

When did the US Military first utilize PTs as primary screeners for patients with low back pain (LBP)?

$$1975$$

In which regions did PTs begin functioning as the entry point into the health care system in the early 1970s?

Australia and New Zealand

What term did Helen Hislop introduce in 1975 to describe the diagnostic focus of PT?

pathokinesiology

What concept did Sahrmann establish as a prerequisite for treatment in 1988?

Diagnosis of movement disorders

How did Jette (1989) describe the difference between MD and PT diagnoses?

MD diagnoses focus on cause, while PT diagnoses focus on consequences

What was introduced by Delitto et al. in 1995 regarding diagnosis?

Treatment-based classification

List the four main categories of Physical Therapist practice patterns established in 1997.

Musculoskeletal, Neuromuscular, Cardiovascular/Pulmonary, and Integumentary

In MSK diagnostic classification, what characterizes the 'MD oriented' approach?

Etiologic-based diagnosis, organism-specific treatment, and essentialism

In MSK diagnostic classification, what characterizes the 'PT oriented' approach?

Impairment-based classification, movement disorders, clusters of signs and symptoms, and nominalism

What model should be used to determine the appropriateness of a PT referral according to Boissonnault et al. 2006?

Body Systems Screening Model

What are the six elements of patient/client management leading to optimal outcomes?

Examination, Evaluation, Diagnosis, Prognosis, Intervention, and Outcomes

How does the Guide to Physical Therapist Practice (1999) define Diagnosis?

Defined clusters, syndromes, or categories used to determine the most appropriate intervention

How does the Guide to Physical Therapist Practice (1999) define Evaluation?

Clinical judgment based on data collected

According to PTJ June 2007, what does the diagnostic process include?

Integrating and evaluating data obtained during the exam to guide prognosis, plan of care, and intervention strategies

What consensus was reached in the 2007 'Focus on Diagnosis' regarding labels like 'Physical therapy diagnosis'?

Do not use qualifiers like ‘for physical therapy’ or ‘by the physical therapist’ except as required by context

What does sub-classification (staging or grading) allow for in a diagnosis?

Focusing on syndromes of the human movement system

How did Ludewig et al. (2017/2022) propose to change the diagnostic paradigm?

Transitioning to a movement system diagnostic classification

In the Ludewig model (2017), what is the surgeon’s primary intervention focus compared to the PT’s?

Surgeons focus on Pathoanatomy/Surgery/Pharmacology; PTs focus on Pathokinesiology/Movement Intervention

What is the core focus of the Sahrmann (2017/2021) diagnostic model?

Movement system impairment syndromes

What vision for PT practitioners did Davenport et al. 2011 link to the diagnostic process?

Vision $2020$, practitioners of choice for movement dysfunction

What are the four components of the 4 Element Movement System Model (McClure et al. 2021)?

Motion, Force, Energy, and Control

What does the 'Isometric Diagnostic Force Dilemma' illustrate?

The tension between Guru Dx Force and Guide Dx Force

Who are the authors of the paper titled 'Red Flags: To Screen or Not to Screen?' (2010)?

Ross and Boissonnault

In the era prior to evidence-based practice, what was the simplified assumption of a (+) clinical test?

That a patient with a (+) test definitively had the condition, and one with a (-) test did not

What are CPRs or CDRs in physical therapy?

Clinical Prediction Rules or Clinical Decision Rules

Why are CPRs necessary for heterogeneous diagnostic categories like Low Back Pain?

To develop more homogeneous subgroups for treatment decisions

For which type of categories are randomized controlled trials (RCTs) preferred over CPRs?

Homogeneous categories like a ‘Grade II ankle sprain’

List three criteria for the CPR for Carpal Tunnel Syndrome diagnosis by Wainner et al. 2005.

Shaking hands for symptom relief, wrist-ratio index > $0.67$, and age > $45$

What is the (+) Likelihood Ratio (LR) for Carpal Tunnel Syndrome if all 5 CPR tests are positive?

$$18.3$$

According to Fritz et al. 2005, what is one criterion for LBP patients to have a good prognosis with spinal manipulation?

Symptom duration of < $16\,days$

What is the specificity of the CPR for LBP manipulation success presented by Fritz et al. 2005?

$$0.92$$

What percentage of the LBP population could be subclassified based on a single factor if 12 factors contribute to the condition?

$$0.5\%$$

What are the three steps in the CPR development process?

Derivation studies, Validation studies, and Impact analysis on clinical behavior

Which CPR study achieved the highest '% Overall Quality Score' of 74.0?

Stabilization exercise for low back pain (LBP) by Hicks et al.

In what percentage of countries did Tracy et al. 2013 find that PT professional education equipped therapists for direct access?

$$69\%$$

What was the diagnostic accuracy (CDA) of military PTs for hip labral tears compared to orthopedic surgeons?

PTs ($85.3\%$) vs Orthopedic Surgeons ($84.4\%$)

According to McGill 2013, how much greater was the return to duty rate for PTs compared to family medicine physicians?

$50\%$ greater

What was the rate of imaging use for family practice physicians versus PTs in a combat location?

Family Practice: $82\%$; PT: $11\%$

Which study compared the clinical diagnostic accuracy of PTs, Orthopedic surgeons, and Non-Orthopedic Providers (NOPs)?

Moore et al. 2005

In Moore et al. 2005, between which groups was there NO significant difference in diagnostic accuracy?

Physical Therapists and Orthopedic Surgeons

What was the clinical outcome of letting ED patients access a PT immediately after triage instead of usual care?

Statistically lower levels of pain and pain interference at $1$ and $3\,months$ after discharge

How often were PT discharge recommendations implemented in acute care settings in the Smith et al. 2010 study?

$83\%$ of the time

How much more likely were patients to be readmitted when PT discharge recommendations were NOT implemented?

$2.9$ times more likely

Besides basic entry-level ortho education, what certification is helpful for sideline coverage according to Smith 2012?

Emergency Medical Responder certification

What Board Certified Specialist credential is relevant for sideline coverage?

ABPTS Sports Certified Specialist ($SCS$)

In Switzerland, where direct access is absent, what was the correct management decision rate for MSK conditions by PTs?

$$73\%$$

According to Jette et al. 2006, in what percentage of critical medical conditions did PTs make correct clinical decisions?

$$79\%$$

What was noted regarding the documentation of red flags for LBP by Leerar et al. 2005?

Only $9$ of $17$ red flags were documented

In the study by Riddle et al. 2004, what percentage of PTs would NOT contact an MD about a suspected DVT?

$$25\%$$

According to Petersen et al. 2023, what are linked cognitive activities of high-value referral capability?

Decision-making and referral

What is a characteristic of a 'Novice Clinician' regarding an exam approach according to Jensen et al.?

The use of exam-forms and lack of medical history integration

How does a 'Master Clinician' utilize exam data differently from a Novice?

Uses exam-algorithms, integrates illness/disease data, and relies on clusters of signs/symptoms and research

Who said: ‘Don’t be afraid to be wrong, the quicker you admit to yourself you were wrong, the quicker you adjust course and test out a new null hypothesis’?

David Magee, PT, PhD

Who stated ‘Each patient is a teacher, so learn from each one’?

George Davies

What are the four components of the 1997 MSK practice pattern classification summarized in Figure 4?

Prevention of Demineralization, Impaired Posture, Impaired Muscle Performance, and Impaired Connective Tissue

Which practice pattern category includes 'Falls Prevention' and 'Progressive CNS'?

Neuromuscular

Which practice pattern category includes 'Impaired Airway Clearance' and 'Impaired CV Pump'?

Cardiovascular Pulmonary

Which practice pattern category includes 'Superficial Skin Disorders' and 'Partial-Thickness Scar'?

Integumentary

What duration of required MSK instruction was standard for medical schools that included a rotation?

$$2 \pm 1\,weeks$$