Quiz 1: PT Articles Review

These flashcards cover clinical decision-making, screening tools (OSPRO), medical diagnosis comparisons (PT vs MD), movement system classification, and VTE clinical practice guidelines based on the provided quiz article table summary.

What was the study design used by George et al. for the OSPRO Red Flags article?

Literature review and Cross-Sectional study.

How many patients were included in the George et al. sample and what body regions were focused on?

$431$ patients consisting of neck, shoulder, low back, and knee pain.

What percentage of patients in the George et al. study had at least one red flag?

$$91.2\%$$

According to the George et al. study, what were the demographics of therapists/patients who were positive responders to red flags?

Positive responders were older, female, low income, and had more neck/back pain than extremities.

What was the accuracy of the $10$ item OSPRO Red Flag tool?

$$94.7\%$$

What was the accuracy of the $23$ item OSPRO Red Flag tool?

$$100\%$$

What were the Top 3 items identified in the OSPRO Red Flag tool?

Abnormal sensation, headache, and night pain.

Which physiological system was NOT represented on the OSPRO red flag tools?

Urogenital system.

Which clinical measure had the strongest correlation in the George et al. study?

PHQ-9 with an $r=0.64$

Which clinical measure had the weakest correlation in the George et al. study?

STAI for Anxiety with $r=-0.06$

What were the primary study limitations of the George et al. OSPRO Red Flag article?

Study conducted only in Florida, focused only on neck/back/shoulder/knee pain, and the tool was not yet validated.

What was the primary summary for the George et al. quiz content?

They created a $97$ item red flag bank and derived a $10$ item and $23$ item screening tool that correlated similarly to the full bank.

What was the study design for Lentz et al. OSPRO Yellow Flags article?

Cross Section and Clinical Measurement.

How many items were in the initial bank for the OSPRO Yellow Flags study?

$136$ items from $10$ different questionnaires.

What are the three domains tested by the OSPRO Yellow Flags tools?

Negative Mood, Fear Avoidance (Vulnerability), and Positive Affect/Coping (Resilience).

How did Lentz et al. define 'Vulnerability' in their OSPRO Yellow Flags study?

Vulnerability = Above $75^{th}$ percentile scores.

How did Lentz et al. define 'Resilience' in their OSPRO Yellow Flags study?

Resilience = Below $25^{th}$ percentile scores.

What was the accuracy of the $17$ item OSPRO Yellow Flag tool?

$$85\%$$

The $17$ item OSPRO Yellow Flag tool consists of how many questions for each construct?

$6$ negative mood questions, $6$ for fear avoidance (vulnerability), and $5$ for positive coping (resilience).

What was the accuracy of the $10$ item OSPRO Yellow Flag tool?

$$81\%$$

What was the accuracy of the $7$ item OSPRO Yellow Flag tool?

$$75\%$$

Which two constructs were highly correlated in the Lentz et al. study?

Pain Acceptance and Catastrophizing.

Which two constructs had the lowest correlation in the Lentz et al. study?

Anger and the FABQ-W (Fear Avoidance Beliefs Questionnaire - Work).

Did the anatomical region interaction significantly affect the OSPRO Yellow Flag tool performance?

No, region interactions were NOT significant; the tool performed similarly for neck, back, shoulder, and knee.

How does the OSPRO Yellow Flag tool differ from the STarT Back tool?

STarT Back does not include resilience, whereas the OSPRO Yellow Flag tools did.

What was the summary outcome of the Lentz et al. study?

Developed a $17$ item tool with $85\%$ accuracy estimating $11$ yellow flag constructs; it explained additional variance in pain and disability after controlling for demographics.

What type of study was the Hon et al. article regarding PT for MSK Disorders vs. Physicians First?

Systematic Review and Meta-Analysis.

Which databases were searched for the Hon et al. meta-analysis?

PubMed, CINAHL, Cochrane, and PEDro.

How many patients were included in the Hon et al. meta-analysis?

$7,971$ patients across $5$ retrospective cohort studies.

What was the level of evidence for the studies included in Hon et al.?

Level $2b$ evidence.

What specific musculoskeletal conditions were included in the Hon et al. meta-analysis?

Spine Related Musculoskeletal Disorders (all neck/back pain, low back dysfunction).

What were the STROBE scores for the studies in the Hon et al. meta-analysis?

$17$ to $21$ out of $22$, indicating moderate to good quality.

What was the effect size for PT cost reduction in the Hon et al. study?

$d=-0.23$ ($95\%$ CI of $-0.35$ to $-0.11$).

What was the effect size for total healthcare cost reduction in the Hon et al. study?

$d=-0.19$ ($95\%$ CI of $-0.32$ to $-0.75$).

What was the effect size for the number of PT visits in the Hon et al. study?

$d=-0.17$ ($95\%$ CI of $-0.29$ to $-0.05$).

According to Hon et al., how many fewer PT visits per patient were associated with direct access?

$1.01$ fewer visits per patient.

What was the average amount saved specifically on PT costs per patient in the Hon et al. study?

Around $\$243$ per patient.

What was the average total healthcare cost savings per patient found by Hon et al.?

Around $\$1,828$ less per patient.

What was the outcome for functional improvement in the Hon et al. meta-analysis?

A large effect size was found; direct access to PT showed significantly greater improvement than physician-first.

What did the Hon et al. study report regarding adverse events or missed diagnoses?

No missed diagnoses or delays in care were attributed to direct access of PT.

What was a specific limitation of the Hon et al. meta-analysis regarding anatomy?

The study only included spine-only diagnoses; no extremities were included.

What type of article is Ludewig et al. regarding the shift to a Movement Based Classification System?

Clinical Commentary.

What is the primary argument of the Ludewig et al. article?

PTs should shift from the Pathoanatomic Model to a Movement System Diagnostic Model for MSK conditions.

What example pathology is used throughout the Ludewig et al. article?

Atraumatic shoulder pain.

What are some labels used in the Pathoanatomic Model according to Ludewig et al.?

Rotator Cuff Tendinopathy, Impingement, and Labral Tear.

What is a major problem with the Pathoanatomic Model regarding asymptomatic patients?

Pathoanatomy is often found in asymptomatic patients, complicating the model.

What does the Movement System Classification focus on?

It focuses on what movement is functionally limited instead of specific pathoanatomy.

What are the three shoulder categories proposed in the Ludewig et al. Movement System model?

Hypermobility/Stability Deficit, Hypomobility/Mobility Deficit, and Aberrant/Discoordinated Movement.

What are examples of Hypomobility classified shoulder conditions?

Adhesive Capsulitis, GH Osteoarthritis, and Post-Fracture Stiffness.

What are examples of Aberrant Movement classified shoulder conditions?

Rotator Cuff Tendinopathy, Biceps Tendinopathy, Subacromial Bursitis, and Labral Tears.

What are the primary Scapulothoracic patterns described by Ludewig et al.?

Insufficient upward rotation, excess internal rotation, insufficient posterior tilt, and excess clavicular elevation.

What is the first step in the Movement System Classification flow?

Rule out non-mechanical issues.

What is the second step in the Movement System Classification flow?

Distinguish between GH vs ST (Glenohumeral vs Scapulothoracic) impairments.

In the Movement System flow, when should tissue flexibility and strength be assessed?

After identifying the primary movement pattern.

When should pathoanatomy be considered in the Movement System Classification flow?

Last, as a modifier for the exam.

What diagnostic criteria does the APTA suggest for using movement-related terms?

They should be succinct, include pathology if needed, and span all populations/lifespans.

What is an advantage of the Movement System Model regarding treatment?

It directly links the diagnosis to the intervention/treatment.

How do surgeons and PTs divide their focus in a multi-disciplinary approach according to Ludewig et al.?

Surgeons focus on pathoanatomy/surgical intervention, while PTs focus on Pathokinesiology to guide rehab.

What key phrase is used to explain the different meaning of 'Impingement' for PTs and surgeons?

For surgeons, impingement is anatomic; for PTs, it implies movement causation.

What type of paper is Herbert et al. regarding the Standardized PT Diagnostic Concept (PT-Dx-C)?

Conceptual Paper/Expert Consensus.

How many members were on the committee for the Herbert et al. article?

$9$ PTs with clinical, academic, and research experience.

What was the time range for the literature search in the Herbert et al. study?

$1986$ to 2022

How many total documents were retrieved by Herbert et al. during their review?

$8,506$ documents.

What was the 'Category 1' designation in the Herbert et al. document organization?

High contributive and universal.

What was the key finding from the Herbert et al. literature review regarding universality?

No existing diagnostic concept was universally applicable across all PT domains.

What are the three components of the PT-Dx-C (Physical Therapy Diagnostic Concept)?

Health Problem, Primary Impairment, and Primary Activity Limitation or Participation Restriction.

Which classification system is used for 'Health Problem' in the PT-Dx-C?

ICD $11$

Which classification system is used for 'Primary Impairment' and 'Restrictions' in the PT-Dx-C?

ICF (International Classification of Functioning, Disability and Health)

How does Herbert et al. define 'Primary Impairment'?

Problem with anatomical structure or organic function that is the main contributor to a patient’s primary activity limitations or participation restrictions.

What is a major comparison between Movement System models and PT-Dx-C?

Movement models often focus on patterns without linking them to limitations, while PT-Dx-C requires a link to daily life activity.

What is the 'Diagnostic Disparity' example mentioned in the Herbert et al. article?

Different schools (like McKenzie or TBC) use different labels for the exact same condition.

What is a key advantage of using PT-Dx-C?

It uses interdisciplinary labels from the ICD and ICF to communicate across professions.

What is a listed limitation of the PT-Dx-C in the Herbert et al. study?

Reliability was not evaluated and validity is unknown.

What type of article is Hillegass et al. regarding Venous Thromboembolism (VTE)?

Clinical Practice Guideline (CPG).

Which populations were excluded from the Hillegass et al. VTE guideline?

Pediatrics (anyone below $18$) and case reports.

What score should be used for hospitalized patients to assess VTE risk according to the CPG?

Padua Score.

What score is used for VTE risk assessment in cancer patients?

Khorana Score.

What is the threshold for LE DVT being 'likely' under the Wells Criteria?

Score of $>2$

What screening tool is recommended for UE DVT according to Hillegass et al.?

Constans Criteria and D-Dimer.

What is the threshold for a 'high probability' of PE using the Revised Geneva Score?

Score of $>5$

Define 'hemoptysis' as listed in the revised Geneva Score.

Coughing up blood.

When can mobilization begin for a patient with LE DVT?

Once therapeutic anticoagulation is achieved.

Does early ambulation increase the risk of Pulmonary Embolism (PE)?

No, early ambulation does NOT increase PE risk.

What is the recommendation for routine compression stockings for a NEW DVT?

Do NOT routinely recommend them (SOX Trial showed no PTS prevention).

When should compression (stockings or IPC) be recommended for DVT patients?

When signs and symptoms of PTS (Post-Thrombotic Syndrome) are present.

Under what conditions can a patient with an IVC filter begin mobilization?

Once they are hemodynamically stable and have no bleeding at the puncture site.

What effect does an IVC filter have on PE and DVT risk?

Filters reduce PE risk by $50\%$ but increase DVT risk by $70\%$.

What is the mobilization criteria for Non-Massive Low Risk PE?

Mobilize once therapeutic anticoagulation is achieved.

What is the mobilization criteria for Massive or Submassive PE?

DO NOT MOBILIZE until hemodynamically stable and low risk criteria are met.

What is the waiting time for mobilization after initiating UFH IV anticoagulation?

Wait $24$ hours.

What is the waiting period for LMWH before mobilization?

$3$ to $5$ hours.

What is the waiting period for DOACs (Direct Oral Anticoagulants) before mobilization?

$2$ to $3$ hours.

What are the requirements for Warfarin before mobilization?

$INR > 2$ for $24$ hours.

Why is Warfarin not considered a first-line treatment for VTE?

Risk of intracranial bleed.

What type of study was the Manske et al. article on DVT diagnosis?

Cross-Sectional Survey Study.

Who was the target population for the Manske et al. survey?

Members of the Academy of Orthopaedic Physical Therapists and Academy of Sports Physical Therapy.

How many therapists responded to the Manske et al. survey?

$521$ respondents.

What percentage of respondents in the Manske et al. study rated themselves as competent in DVT screening?

$$91.7\%$$

What were the findings for Sensitivity and Specificity of the Modified Wells Criteria for LE DVT?

Sensitivity was $97\%$ and Specificity was $36\%$.

Did Manske find a correlation between board certification or residency training and DVT identification accuracy?

No, no associations could be drawn between those therapist characteristics and accuracy.