DIAGNOSTIC ACCURACY OF THE LEVER SIGN IN DETECTING ANTERIOR CRUCIATE LIGAMENT TEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in the knee. With the prevalence of ACL tears increasing, there is a growing need for clinical tests to rule in and rule out a suspected tear. A new clinical test for detecting ACL tears has been introduced with preliminary studies showing promising results. HYPOTHESIS/PURPOSE: To systematically review and analyze information from the current literature on the diagnostic accuracy of the Lever Sign test for the use of diagnosing anterior cruciate ligament (ACL) injuries in a clinical setting. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A computerized search of PubMed, Cinahl, Scopus, and Proquest databases as well as a hand-search was completed on all available literature using keywords relating to the diagnostic accuracy of the Lever Sign Test. A quality assessment was performed on each article included in this review utilizing the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). RESULTS: Eight articles were included, with only three studies exhibiting high quality, however the study samples were heterogenous. Included studies indicated that the Lever Sign test is both sensitive and specific in diagnosing ACL tears. Pooled sensitivity and specificity were 0.77 and 0.90, respectively. The negative likelihood ratio is 0.22 and the positive likelihood ratio is 6.60. CONCLUSION: The Lever Sign test is comparable to other clinical tests used in current practice to detect an ACL rupture. The pooled data from current available literature on the Lever Sign indicate that a positive or negative test should result in a moderate shift in post-test probability. This test may be used in addition to other tests to rule in and rule out the presence of an ACL rupture. LEVEL OF EVIDENCE: 2a- Systematic Review of Level 2 diagnostic studies.

GAIT DEFICITS UNDER DUAL - TASK CONDITIONS IN THE CONCUSSED ADOLESCENT AND YOUNG ATHLETE POPULATION: A SYSTEMATIC REVIEW.

BACKGROUND: There are no current sport concussion assessments that capture the effects of dual-task conditions on gait. Multiple studies have evaluated changes, but none have comprehensively examined literature related to the adolescent and young adult population.Purpose: The purpose of this systematic review is to synthesize documented changes in gait under dual-task conditions in adolescents and young adults after sustaining a concussion.Study Design: Systematic Review. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was consulted to guide this systematic review. Six databases were searched: Cinahl, ProQuest, PubMed, Scopus, SPORTdiscus, and Web of Science. Concussion, gait, and dual-task, along with their synonymous terms were the search terms used. Inclusion criteria consisted of adolescent and young adult age groups, acute concussion, dual-tasking, and matched controls. Quality assessment was performed using The Joanna Briggs Institute Critical Appraisal Checklist for Case Control Studies. RESULTS: Ten full-text articles were selected for inclusion. Concussed individuals demonstrated longer stride times with shorter stride lengths, increased mediolateral displacement with corresponding increases in sagittal and frontal plane peak velocity, and decreased sagittal plane Center of Mass (COM) and Center of Pressure (COP) displacement. The majority of included studies demonstrated moderate to large effect sizes in these gait characteristics. CONCLUSION: Concussed individuals demonstrated decreased gait stability while ambulating with a dual-task condition. Though statistically significant differences between concussed individuals and matched controls lasted only 72 hours, concussed individuals demonstrated continued improvements in gait for up to two months post-injury, which has the potential to affect an athlete's ability to perform. Further research is needed to determine if a gait examination with a dual-task condition is a realistic, reliable, and valid measure to be included in return to sport testing. LEVEL OF EVIDENCE: 2a.

Hip abductor strength and lower extremity running related injury in distance runners: A systematic review.

OBJECTIVES: Determine the association between hip abduction strength and lower extremity running related injury in distance runners. DESIGN: Systematic review. METHODS: Prospective longitudinal and cross sectional studies that quantified hip abduction strength and provided diagnosis of running related injury in distance runners were included and assessed for quality. Effect size was calculated for between group differences in hip abduction strength. RESULTS: Of the 1841 articles returned in the initial search, 11 studies matched all inclusion criteria. Studies were grouped according to injury: iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture, and Achilles tendinopathy, and examined for strength differences between injured and non-injured groups. Meaningful differences were found in the studies examining iliotibial band syndrome. Three of five iliotibial band syndrome articles found weakness in runners with iliotibial band syndrome; two were of strong methodological rigor and both of those found a relationship between weakness and injury. Other results did not form associative or predictive relationships between weakness and injury in distance runners. CONCLUSIONS: Hip abduction weakness evaluated by hand held dynamometer may be associated with iliotibial band syndrome in distance runners as suggested by several cross sectional studies but is unclear as a significant factor for the development of patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture or Achilles tendinopathy according to the current literature. Future studies are needed with consistent methodology and inclusion of all distance running populations to determine the significance of hip abduction strength in relationship to lower extremity injury.

A COMPARISON BETWEEN CIVILIAN AND MILITARY PHYSICAL THERAPISTS' KNOWLEDGE IN MANAGING MUSCULOSKELETAL CONDITIONS: A DESCRIPTIVE STUDY.

BACKGROUND: Military physical therapists have been shown to have the necessary knowledge in musculoskeletal medicine in order to practice as a direct access provider. However, research about musculoskeletal knowledge in the civilian physical therapist (non-military) population is lacking. PURPOSE: The purpose of the current study was to compare the knowledge in managing musculoskeletal conditions between civilian and military physical therapists using a validated and standardized musculoskeletal competency examination. Furthermore, this study aims to investigate the potential factors that may lead to increased musculoskeletal competency. STUDY DESIGN: Cross-sectional, electronic survey. METHODS: This study involved a cross-sectional, electronic survey completed in August and September of 2014 in order to assess licensed physical therapists' knowledge in identifying and managing musculoskeletal conditions. Only physical therapists practicing in orthopedics were permitted to be involved in the study. Descriptive statistics of the participants, and logistic regressions analyzing variables correlated with passing the musculoskeletal exam were calculated using SPSS 22.0. Frequencies were produced for multiple variables. Binary logistic regressions were used to correlate the frequency variables with performing at competency level on the musculoskeletal exam. RESULTS: A total of 22,750 surveys were sent to physical therapists in Arizona, Ohio, Texas, Maine and Wyoming. Two thousand sixty-five surveys were returned for a response rate of 10.6%. Of the 2,065 surveys completed, 408 responses were included for analysis. The average score for the respondents on the exam was 65.08% and only 28.2% of all respondents met the competency cutoff score (previously established to be 73.1%). Respondents who were orthopedic certified specialists (OCS) or sports certified specialists (SCS) were 3.091 times more likely to perform at the competency level on the examination with a p-value of < 0.001 and a confidence interval >95%. CONCLUSION: The current study utilized the results from a previous study for a comparison between the civilian and military physical therapist populations. The results indicate that civilian physical therapists in the current study (65.08%) scored lower than their military counterparts in the previous study (75.9%) on the musculoskeletal exam. Potential reasons for this include less autonomous practice responsibilities and a disparity in educational experiences. Board certifications may enhance civilian physical therapists ability to practice with greater autonomy as primary care clinicians when managing musculoskeletal conditions. LEVEL OF EVIDENCE: Level 4.

The effect of manual therapy with augmentative exercises for neck pain: a randomised clinical trial.

OBJECTIVES: To compare the effect of manual therapy (MT) and an augmentative exercise programme (AEP) versus MT and general neck range of motion (ROM) on functional outcomes for patients with neck pain. A secondary objective was to examine changes in self-report measures and quantitative sensory testing (QST) following MT and AEP. METHODS: This was a randomised clinical trial. Seventy-two patients with neck pain were recruited. All patients received a single session of MT. Patients were randomly assigned to MT+AEP or MT+ROM. Clinical self-report outcome measures for disability and pain, and QST measures (pain and vibration thresholds) were collected at baseline, post MT treatment, at ∼48 hours, and at ∼96 hours. Repeated measures ANOVA and MANOVA were used to analyse within and between-group effects for clinical and QST measures. RESULTS: There were no between-group differences for disability, pain and QST measures. There was, however, a significant difference between groups for Global Rating of Change (GRoC) scores (P = 0.037). Patients in both groups showed improvements in pain, disability and trapezius pressure-pain threshold (PPT) (all P < 0.001). DISCUSSION: Augmentative exercise programme does not significantly improve disability, pain or QST measures in patients with chronic neck pain although it may enhance their GRoC scores. Over a 96-hour period, patients benefitted from MT plus exercise whether the exercise was general or specific.

Ohio physical therapists' accuracy in identifying abnormalities on diagnostic images with and without a clinical vignette.

BACKGROUND: A strong understanding of diagnostic imaging has been advocated for physical therapists. There have been recent changes in physical therapy curricula and increased opportunities to utilize imaging during clinical practice. PURPOSE: The aim of this study was to explore the ability of practicing clinicians to accurately identify selected musculoskeletal conditions on plain-film radiograph (X-ray), magnetic resonance imaging (MRI), and computed tomography scan (CT scan). Further, to determine whether improvements in identification of pathology occur when the clinical scenario is added to the imaging and whether there are related training/exposure factors. METHODS: A cross- sectional electronic survey was sent out to physical therapists in the state of Ohio. Participants were asked to identify conditions (cervical fracture, anterior cruciate ligament tear, and avascular necrosis of the femoral head) first given diagnostic images only, and then given the images and a clinical scenario. RESULTS: Eight hundred sixty-six surveys of the 7537 sent out were eligible for analysis. With clinical scenarios, 61.3% of respondents were correct with the ACL injury identified on MRI, 36.4% for identification of the cervical spine fracture on CT and 25.6% for identification of avascular necrosis on plain film. The accuracy significantly improved (p<0.01) with the addition of the clinical information for all three of the diagnoses. The most remarkable improvement was seen with the AVN diagnosis on plain film radiograph (365.5% improvement), followed by the ACL injury on MRI (27.2% improvement) and cervical fracture diagnosis on CT scan (17.8% improvement). Finally, formal and informal training, board certification through the APTA and to a lesser extent, degree level, all improved diagnostic accuracy. CONCLUSIONS: A clinical scenario paired with images notably improved identification of pathology. Physical therapists were better at identifying the ACL pathology that was presented on MRI. This is a common diagnosis to physical therapists and was paired with a relatively common imaging modality. This study suggests that physical therapists can improve accuracy with identifying pathologies on diagnostic images through a physical therapy curriculum or post-graduation through certifications and continuing education. LEVEL OF EVIDENCE: Level 4.