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Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility.

https://arctichealth.org/en/permalink/ahliterature141066
Source
Man Ther. 2011 Apr;16(2):136-40
Publication Type
Article
Date
Apr-2011
Author
Corrie Myburgh
Henrik Hein Lauridsen
Anders H Larsen
Jan Hartvigsen
Author Affiliation
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. cmyburgh@health.sdu.dk
Source
Man Ther. 2011 Apr;16(2):136-40
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adult
Chiropractic - education
Denmark
Facial Neuralgia - diagnosis
Female
Humans
Male
Neck Pain - diagnosis
Observer Variation
Palpation - standards
Reference Standards
Reproducibility of Results
Shoulder Pain - diagnosis
Abstract
A diagnosis of Myofascial Pain Syndrome (MPS) requires palpation for the identification of at least one clinically relevant trigger point (TP). However, few comparable, high quality studies currently exist from which to draw firm conclusions regarding the robustness of TP examination. An inter-observer agreement study was conducted using two experienced and two inexperienced clinicians. All performed standardized palpation of the upper Trapezius musculature, judging the clinical relevance of TP(s) using clinician global assessment (GA). A random case mix of 81 female participants was examined, 14 asymptomatic and the remainder suffering from neck/shoulder pain. Examiners received psychomotor skills training and video feedback analysis to improve protocol standardization. Kappa co-efficient calculations indicated good agreement between the experienced pairing (? = 0.63), moderate agreement between the mixed pairings (? = 0.35 and 0.47) and poor agreement between the inexperienced pairing (? = 0.22). Inter-observer agreement was not stable with the experienced pairing exhibiting a sharp decline in agreement during the latter portion of the study. Identification of clinically relevant TPs of the upper Trapezius musculature is reproducible when performed by two experienced clinicians, however, a mixed observer pairing can yield acceptable agreement. A protracted period of data collection may be detrimental to inter-observer agreement; more investigation is needed in this regard.
PubMed ID
20813576 View in PubMed
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The Danish Neck Disability Index: New insights into factor structure, generalizability, and responsiveness.

https://arctichealth.org/en/permalink/ahliterature283632
Source
Pain Pract. 2017 Apr;17(4):480-493
Publication Type
Article
Date
Apr-2017
Author
Henrik H Lauridsen
Lotte O'Neill
Alice Kongsted
Jan Hartvigsen
Source
Pain Pract. 2017 Apr;17(4):480-493
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Adult
Cross-Cultural Comparison
Cross-Sectional Studies
Denmark - epidemiology
Disability Evaluation
Female
Humans
Male
Middle Aged
Neck Pain - diagnosis - epidemiology
Pain Measurement - methods - standards
Reproducibility of Results
Surveys and Questionnaires
Abstract
To (1) translate and culturally adapt and (2) determine the clinimetric properties of the Danish 8-item Neck Disability Index (NDI-8) in primary sector patients (PSPs) and secondary sector patients (SSPs).
Analyses included 326 patients with neck pain. Validity and reliability were assessed using a cross-validation factor analytical design, hypothesis testing, internal consistency, measurement error, the smallest detectable change (SDC), and a generalizability study. Criterion and construct responsiveness, minimal important change (MIC), and floor and ceiling effects were determined.
The original Danish version of the NDI was not unidimensional. Omitting 2 items (pain, headache) revealed a 1-factor structure (NDI-8). Construct validity correctly predicted 88% of the hypotheses. Internal consistency (Cronbach's a) ranged between 0.88 and 0.89, and generalizability was high (F = 0.90). The SDC was 6.8 in PSPs and 5.9 in SSPs. Criterion responsiveness revealed poor areas under the curve for SSPs (0.58 to 0.64), and construct responsiveness was poor for PSPs (43% correctly predicted hypothesis). A floor effect of 26.5% was found in PSPs, with a change of 4 points representing the MIC.
The modified Danish 8-item NDI was unidimensional, had construct validity, and was reproducible with a large but acceptable measurement error. However, responsiveness was poor and a significant floor effect was found in PSPs. A change score representing the MIC is proposed for PSPs.
PubMed ID
27440225 View in PubMed
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Reliability and measurement error of 3-dimensional regional lumbar motion measures: a systematic review.

https://arctichealth.org/en/permalink/ahliterature118901
Source
J Manipulative Physiol Ther. 2012 Oct;35(8):645-56
Publication Type
Article
Date
Oct-2012
Author
Rune M Mieritz
Gert Bronfort
Greg Kawchuk
Alan Breen
Jan Hartvigsen
Author Affiliation
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. rmieritz@health.sdu.dk
Source
J Manipulative Physiol Ther. 2012 Oct;35(8):645-56
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Denmark
Diagnostic Errors
Female
Humans
Imaging, Three-Dimensional
Low Back Pain - diagnosis - radiography
Lumbar Vertebrae - physiopathology - radiography
Male
Pain Measurement
Range of Motion, Articular - physiology
Reproducibility of Results
Severity of Illness Index
Abstract
The purpose of this study was to systematically review the literature on reproducibility (reliability and/or measurement error) of 3-dimensional (3D) regional lumbar motion measurement systems.
Electronic searches were performed in PubMed, Cumulative Index of the Nursing and Allied Health Literature, Embase, and Mantis databases. To be included, original studies had to report on the reproducibility of a 3D computerized regional lumbar spinal motion analysis system in human subjects. A detailed checklist was developed based on guidelines for reporting reliability and agreement studies, the standards for reporting of diagnostic accuracy, and quality assessment of diagnostic accuracy studies and used for data extraction and quality assessment. The checklist consisted of descriptive items divided into 4 domains: study population, testing circumstances, equipment, and data analysis and presentation. The descriptive items were used as foundation for the quality assessment reflecting the reporting level of the included articles.
A total of 15 articles were included in this study. We found incomplete reporting in 1 or more domains in all articles. A varying amount of measurement error was reported in 8 of the 15 articles. Because of incomplete reporting, these reliability and measurement error estimates are difficult to interpret.
The current literature on the reliability and measurement error of measures created by regional 3D spinal instruments contains uncertainties especially in relevant clinical populations. There is uncertainty with respect to the degree that repeated measurements by 3D regional spinal motion instruments are reproducible. However, limited to the studies where reliability estimates were provided, most instruments used under standardized conditions may be considered reliable enough to be used for research purposes on the group level, but it is uncertain if they can be used on the individual patient level.
PubMed ID
23158469 View in PubMed
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Medical school dropout--testing at admission versus selection by highest grades as predictors.

https://arctichealth.org/en/permalink/ahliterature130572
Source
Med Educ. 2011 Nov;45(11):1111-20
Publication Type
Article
Date
Nov-2011
Author
Lotte O'Neill
Jan Hartvigsen
Birgitta Wallstedt
Lars Korsholm
Berit Eika
Author Affiliation
Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. ldyhrberg@health.sdu.dk
Source
Med Educ. 2011 Nov;45(11):1111-20
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Achievement
Adolescent
Cohort Studies
College Admission Test
Denmark
Education, Medical, Undergraduate
Educational Measurement - methods
Female
Forecasting
Humans
Male
Prospective Studies
Reproducibility of Results
School Admission Criteria
Student Dropouts - statistics & numerical data
Students, Medical
Abstract
Very few studies have reported on the effect of admission tests on medical school dropout. The main aim of this study was to evaluate the predictive validity of non-grade-based admission testing versus grade-based admission relative to subsequent dropout.
This prospective cohort study followed six cohorts of medical students admitted to the medical school at the University of Southern Denmark during 2002-2007 (n=1544). Half of the students were admitted based on their prior achievement of highest grades (Strategy 1) and the other half took a composite non-grade-based admission test (Strategy 2). Educational as well as social predictor variables (doctor-parent, origin, parenthood, parents living together, parent on benefit, university-educated parents) were also examined. The outcome of interest was students' dropout status at 2 years after admission. Multivariate logistic regression analysis was used to model dropout.
Strategy 2 (admission test) students had a lower relative risk for dropping out of medical school within 2 years of admission (odds ratio 0.56, 95% confidence interval 0.39-0.80). Only the admission strategy, the type of qualifying examination and the priority given to the programme on the national application forms contributed significantly to the dropout model. Social variables did not predict dropout and neither did Strategy 2 admission test scores.
Selection by admission testing appeared to have an independent, protective effect on dropout in this setting.
PubMed ID
21988626 View in PubMed
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Choice of external criteria in back pain research: Does it matter? Recommendations based on analysis of responsiveness.

https://arctichealth.org/en/permalink/ahliterature165340
Source
Pain. 2007 Sep;131(1-2):112-20
Publication Type
Article
Date
Sep-2007
Author
Henrik H Lauridsen
Jan Hartvigsen
Lars Korsholm
Niels Grunnet-Nilsson
Claus Manniche
Author Affiliation
Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. hlauridsen@health.sdu.dk
Source
Pain. 2007 Sep;131(1-2):112-20
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Back Pain - classification - diagnosis
Biomedical Research - methods - standards
Choice Behavior
Denmark
Disability Evaluation
Female
Humans
Male
Middle Aged
Pain Measurement - methods - standards
Practice Guidelines as Topic
Questionnaires - standards
Reproducibility of Results
Sensitivity and specificity
Abstract
Understanding a change score is indispensable for interpretation of results from clinical studies. One way of determining the relevance of change scores is through the use of transition questions that assesses patients' retrospective perception of treatment effect. Unfortunately, results from studies using transition questions are difficult to compare since wording of questions and definitions of important improvements vary between studies. The objectives of this study were to determine the consequence of using different transition questions on pain and disability measures and make proposals for a standardised use of such questions. Two hundred and thirty-three patients with low back pain and/or leg pain were recruited. Participants were followed over an 8-week period and randomised to two groups receiving a 7- (TQ1) and 15-point (TQ2) transition question, respectively, in addition to a numeric rating scale evaluating the importance of the perceived change. Four external criteria were generated using both stringent and less stringent standards to dichotomise patients. Discrimination was determined using area under the receiver operating characteristic curve (ROC(auc)) and responsiveness using standardised response mean (SRM). Results demonstrated small variations in ROC(auc) across the external criteria for all outcome measures. 7% more patients were classified as improved in the group receiving the 15-point TQ compared to the 7-point TQ (stringent standard). SRMs were higher for the retrospective TQs in primary sector patients compared to the serial measures with no difference between TQ1 and TQ2. On the basis of our findings we have outlined a proposal for a standardised use of transition questions.
PubMed ID
17276006 View in PubMed
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Examination of musculoskeletal chest pain - an inter-observer reliability study.

https://arctichealth.org/en/permalink/ahliterature98649
Source
Man Ther. 2010 Apr;15(2):167-72
Publication Type
Article
Date
Apr-2010
Author
Mads Hostrup Brunse
Mette Jensen Stochkendahl
Werner Vach
Alice Kongsted
Erik Poulsen
Jan Hartvigsen
Henrik Wulff Christensen
Author Affiliation
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Source
Man Ther. 2010 Apr;15(2):167-72
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Chest Pain - diagnosis
Chiropractic
Denmark
Diagnosis, Differential
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Musculoskeletal Diseases - diagnosis
Observer Variation
Pain Measurement - methods
Palpation
Physical Examination - methods
Physical Therapy (Specialty)
Professional Competence
Reproducibility of Results
Severity of Illness Index
Students, Health Occupations
Abstract
Chest pain may be caused by joint and muscle dysfunction of the neck and thorax (termed musculoskeletal chest pain). The objectives of this study were (1) to determine inter-observer reliability of the diagnosis 'musculoskeletal chest pain' in patients with acute chest pain of non-cardiac origin using a standardized examination protocol, (2) to determine inter-observer reliability of single components of the protocol, and (3) to determine the effect of observer experience. Eighty patients were recruited from an emergency cardiology department. Patients were eligible if an obvious cardiac or non-cardiac diagnosis could not be established at the cardiology department. Four observers (two chiropractors and two chiropractic students) performed general health and manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs (chiropractors and students) and all. Musculoskeletal chest pain was diagnosed in 45 percent of patients. Inter-observer kappa values were substantial for the chiropractors and overall (0.73 and 0.62, respectively), and moderate for the students (0.47). For single items of the protocol, the overall kappa ranged from 0.01 to 0.59. Provided adequate training of observers, the examination protocol can be used in carefully selected patients in clinical settings and should be included in pre- and post-graduate clinical training.
PubMed ID
19962338 View in PubMed
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Categorising the severity of neck pain: establishment of cut-points for use in clinical and epidemiological research.

https://arctichealth.org/en/permalink/ahliterature51781
Source
Pain. 2005 Dec 15;119(1-3):176-82
Publication Type
Article
Date
Dec-15-2005
Author
René Fejer
Alan Jordan
Jan Hartvigsen
Author Affiliation
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. rfejer@health.sdu.dk
Source
Pain. 2005 Dec 15;119(1-3):176-82
Date
Dec-15-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Biomedical Research - methods
Denmark - epidemiology
Disability Evaluation
Epidemiologic Research Design
Female
Humans
Male
Middle Aged
Neck Pain - classification - diagnosis - epidemiology
Pain Measurement - methods
Questionnaires
Reproducibility of Results
Research Support, Non-U.S. Gov't
Risk Assessment - methods
Risk factors
Sensitivity and specificity
Severity of Illness Index
Sex Distribution
Abstract
Grading pain intensity scales into simple categories provides useful information for both clinicians and epidemiologists and methods to classify pain severity for numerical rating scales have been recommended. However, the establishment of cut-points is still in its infancy and little is known as to whether cut-points are affected by age or gender. The objectives of this paper were to establish optimal cut-points in pain severity in individuals with neck pain (NP) and to investigate if the cut-points were influenced by gender, age, and NP duration. Data from the population-based ;Funen Neck and Chest Pain Study' was used. Univariate and multivariate analyses of variance were performed to calculate optimal single and double cut-points for three different pain intensity scores within the past 2 weeks relative to two neck disability scales (;global assessment of NP' and the ;Copenhagen Neck Functional Disability Scale'). The two disability scales showed small differences in optimal cut-points. Furthermore, cut-points changed for each of the three pain intensity scales. Only small gender differences in cut-points were seen and no specific trend was noted in either single or double cut-points in different age groups. The cut-points were almost identical for acute, subacute, and chronic NP. This paper has implications for understanding the impact of using different pain intensity scales and provides reference cut-points in NP for use in future clinical and epidemiological research.
PubMed ID
16298059 View in PubMed
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Reproducibility of range of motion and muscle strength measurements in patients with hip osteoarthritis - an inter-rater study.

https://arctichealth.org/en/permalink/ahliterature118361
Source
BMC Musculoskelet Disord. 2012;13:242
Publication Type
Article
Date
2012
Author
Erik Poulsen
Henrik Wulff Christensen
Jeannette Østergaard Penny
Søren Overgaard
Werner Vach
Jan Hartvigsen
Author Affiliation
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. e.poulsen@nikkb.dk
Source
BMC Musculoskelet Disord. 2012;13:242
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Arthralgia - diagnosis - physiopathology
Arthrometry, Articular
Biomechanical Phenomena
Chiropractic
Denmark
Female
Hip Joint - physiopathology
Hospitals, University
Humans
Male
Middle Aged
Muscle strength
Muscle Strength Dynamometer
Muscle, Skeletal - physiopathology
Observer Variation
Orthopedics
Osteoarthritis, Hip - diagnosis - physiopathology
Pain Measurement
Physical Examination - instrumentation
Predictive value of tests
Range of Motion, Articular
Reproducibility of Results
Abstract
Assessment of range of motion (ROM) and muscle strength is fundamental in the clinical diagnosis of hip osteoarthritis (OA) but reproducibility of these measurements has mostly involved clinicians from secondary care and has rarely reported agreement parameters. Therefore, the primary objective of the study was to determine the inter-rater reproducibility of ROM and muscle strength measurements. Furthermore, the reliability of the overall assessment of clinical hip OA was evaluated. Reporting is in accordance with proposed guidelines for the reporting of reliability and agreement studies (GRRAS).
In a university hospital, four blinded raters independently examined patients with unilateral hip OA; two hospital orthopaedists independently examined 48 (24 men) patients and two primary care chiropractors examined 61 patients (29 men). ROM was measured in degrees (deg.) with a standard two-arm goniometer and muscle strength in Newton (N) using a hand-held dynamometer. Reproducibility is reported as agreement and reliability between paired raters of the same profession. Agreement is reported as limits of agreement (LoA) and reliability is reported with intraclass correlation coefficients (ICC). Reliability of the overall assessment of clinical OA is reported as weighted kappa.
Between orthopaedists, agreement for ROM ranged from LoA [-28-12 deg.] for internal rotation to [-8-13 deg.] for extension. ICC ranged between 0.53 and 0.73, highest for flexion. For muscle strength between orthopaedists, LoA ranged from [-65-47N] for external rotation to [-10 -59N] for flexion. ICC ranged between 0.52 and 0.85, highest for abduction. Between chiropractors, agreement for ROM ranged from LoA [-25-30 deg.] for internal rotation to [-13-21 deg.] for flexion. ICC ranged between 0.14 and 0.79, highest for flexion. For muscle strength between chiropractors, LoA ranged between [-80-20N] for external rotation to [-146-55N] for abduction. ICC ranged between 0.38 and 0.81, highest for flexion. Weighted kappa for the overall assessment of clinical hip OA was 0.52 between orthopaedists and 0.65 between chiropractors.
Reproducibility of goniometric and dynamometric measurements of ROM and muscle strength in patients with hip OA is poor between experienced orthopaedists and between experienced chiropractors. Orthopaedists and chiropractors can to a moderate degree differentiate between hips with or without osteoarthritis.
Notes
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PubMed ID
23217149 View in PubMed
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8 records – page 1 of 1.