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Advanced Physical therapy Procedures Ahmed alhowimel History taking ,observation Active Functional ROM Passive ROM Resisted Muscle Testing Special Tests Special Tests • It enables the clinician to both assemble information and to interpret the findings in order to assist in identifying the nature and stage of the patient’s disease or injury, determine the need for further investigations, provide a prognosis, guide treatment and measure outcome Which test to choose! • When you want to confirm your primary hypothesis of e.g. Torn ACL ligament, there are many tests available to use, good tests are those with high Specificity and Sensitivity. Interpreting the evidence • Essentially, we want to know whether a diagnostic test is accurate i.e. that it is positive when a particular pathology is present (true positive) and negative when it is not (true negative). Unless the test is perfect (which none are), it will sometimes prove positive when pathology is not present (false positive) or fail to reveal pathology when it is present (false negative). Result test Target condition present Target condition absent Positive A B Negative C D • • • • A=True Positive B=True Negative C=False Positive D=False Negative Sensitivity • Sensitivity is the proportion of people with the condition of interest (target condition) who have a positive test. If 100 people have the condition, then a test that is 98% sensitive will detect 98 of those cases and miss two. Sensitivity is calculated using the figures from the table • Sensitivity= A⁄A+C Specificity • Specificity measures the proportion of people without the condition of interest (target condition) who have a negative test. If 100 people are free from the condition, then a test that is 98% specific will correctly exclude 98 of those cases but will incorrectly identify two people as having the condition. Specificity is calculated using figures from the table • Specificity= B/B+D Likelihood ratios • Likelihood ratios (LR) are the best statistics to assess the clinical usefulness of a diagnostic test as they combine the sensitivity and specificity into a ratio that quantifies a shift in the probability of a condition being present or absent in the event of a negative or positive test. As most musculoskeletal tests have two outcomes positive or negative we can talk about two ratios; one for a positive test outcome (LR+) and one for a negative outcome (LR-). • LR+ indicates the increase in odds favoring the target condition being present when the test result is positive. A large LR+ indicates that the condition is more likely to be present. This can be calculated from the sensitivity and specificity values: LR+= Sen⁄1-Sp • LRthe probability of the target condition being present given a negative test result. A small LR- indicates that the condition is less likely to be present: LR-= 1-Sen⁄Sp LR+ LR- Meaning Usefulness >10 <0.1 Generates large and Excellent often conclusive shift in probability 5-10 0.1_0.2 Generates Moderate shift in probability Good 2-5 0.2—0.5 Generate small but sometimes important shift in probability Fair 1-2 0.5-1 Alters probability to Poor small and rarely important degree Shoulder Joint 1. 2. 3. 4. 5. Tendon Tests Impingement Tests LABRAL tests Instability Tests AC joint Tests Tendon tests 1-Speed Test 2- Yergason’s Test 3-Empty/Full Can Test Impingement tests 1-Neer Test 2-Hawkins–Kennedy Labral Tests Crank Test Instability Tests Apprehension and Relocation Test ACJ Tests Active Compression Test Elbow Joint Tests 1- Tennis Elbow Test 2-Glofer’s Elbow Test Wrist Tests Finkelstein’s Tests Phalen’s Test