EBPR Week 1

Purpose of ICF framework

Look at the pt as a whole not just medical condition

% of recovery contribution from socioeconomic, physical environment, health behaviours, and health care

40, 10, 30, 20

3 aspects of EBP

robust scientific evidence, clinical expertise, patient preference

Levels of evidence hiearchy

Meta analysis, systemic reviews, RCT, Cohort studies, case studies, expert opinion

SPin vs SNout

Low chance of false postivies and low chance of false negatives

Components of an orthopaedic assessment

hx, observation, examination of movement (arom, prom, resisted), neuro exam (dermatomes, myatomes, UMN, LMN), special tests, accessory movements, palpation

DARP notes

data, analysis and action, response, plan

SOCRATES

site, onsite, character, radiation, association, time course, ease/exacerbation, severity

NIFTI

neurological, infection, fracture, tumour, inflammation

yellow flags

psychosocial risk factors: negative beliefs, emotions, pain behaviour

blue and black flags

work and health relationships: insurance, symptoms flaring up

outcome measure

helps track progress over time

PHQ-4

anxiety and depression, 0 to 3, 4 questions, 0-2 = normal, 3-5 = mild, 6-8 = moderate, 9+ = severe

SF-36

generic population health measurement, 8 subscales, 1 to 5 scale, lower score = greater disability

examination of movement procedures

arom, prom, then resisted, uninjured side first, only apply overpressure if rom is full

what to look for examination of movement

willingness to move (active), rhythm and quality of movement (active), ROM (passive), end-feel (passive)

types of end feel

hard, firm, soft

springy block

stops with a rebound

empty

lack of ROM because of pain or spasm

four patterns of contractile or nervous lesions

strong and pain free, strong and painful, weak and painful, weak and pain free

lower extremity myotomes

L1-2: hip flex, L3: knee ext, L4: DF, L5: big toe ext, S1: PF, S2: knee flex

UMN tests

babinski: foot swipe to toe curl, clonus: ankle df to twiching, hoffman: flick middle finger to finger flex

SINSS

Severity, irritability, nature, stage, stability

severity

Activity VAS scale 0-10, 0-3 = mild, 4-7 = moderate, 8-10 = severe

irritability

severe = interrupt sleep and return >30 min, moderate = interrupt sleep and return <30 min

nature

mechanical (fracture, sprain) vs non mechanical (patellofemoral pain)

stage

0-6 weeks = acute, 6-12 = subacute, 12+ = chronic

stability

improving, worsening, no change, waning and waxing (ups and downs)

What do patients look for in PT

whats wrong with me (dx), how long will it take (px), what can i do and you do? (rx)

3 E’s of successful PT

Exercise, education, empowerment

Lower extremity function scale (LEFS)

Lower limb MSK conditions, 0-4 scale, lower score = greater disability

Foot and ankle ability measure (FAAM)

Foot and ankle impairment, ADL subscale and sport subscale, 0-4 scale, lower = greater disability

Patient-specific functional scale

Self-report function for varying independence and clinical presentation, 5 activities, 0-10 scale, lower score = greater disability

Capsular pattern

Loos of rom where joint is involved

Talocrural joint rom and resting

50 pf & 20 df, resting = 10 pf

Subtalar rom

20 inv & 10 ev

most common fracture with an ankle sprain

distal fibular fracture

Jones fracture

5th metatarsal fracture, common in runners

Ottawa Ankle Rules

Special test to rule OUT ankle fracture, positive = pain on palpation of either malleolus, navicular, or base of 5th, or pain when stepping or unable to walk 4 steps

Most sprained ankle ligament

ATFL, high ankle sprain, syndesmosis injury

Kleiger’s Test

syndesmosis injury, leg hung over bed at 90 degrees, lateral rotate foot, positive = lateral ankle pain

Squeeze test

syndesmosis injury, pt supine with leg relaxed, squeeze tib and fib together, positive = lateral ankle pain

Ankle sprain grading

1 = mild pain and loss of stability 2 = significant paint and moderate loss of stability 3 = significant pain and loss of stability

Anterior drawer test

Ankle sprain, pt sitting with knee in 90 degree, stabilize tib and fib and 20 pf ankle, push high ankle, positive = pain or greater translation than uninvolved side

Talar tilt test

Ankle sprain, pt side lying with knee 90 degrees, tilt talus into inversion, positive = pain or greater laxity than uninvolved side