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mcap -> Re: Abnormal end-feel (October 26, 2001 9:44:00 AM)
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As usual......let the depression begin!!!!: J Orthop Sports Phys Ther 2001 Aug;31(8):432-45 Related Articles, Books
Reliability of assessing end-feel and pain and resistance sequence in subjects with painful shoulders and knees.
Hayes KW, Petersen CM.
Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, Evanston, IL, USA. k-hayes@northwestern.edu
STUDY DESIGN: Descriptive. OBJECTIVES: Examine the intrarater and interrater reliability of end-feel and pain/resistance sequence for patients with painful shoulders and knees. BACKGROUND: Clinicians make diagnostic and intervention decisions based on end-feel and pain/resistance sequence, but few studies have examined agreement within and between physical therapists when assessing subjects with pathology. METHODS AND MEASURES: Subjects with unilateral knee pain (18 men and 22 women with a mean age of 31.8 +/- 9.5 years) or shoulder pain (21 men and 25 women with a mean age of 34.3 +/- 12.9 years) were examined twice. Two physical therapists used standardized positions to evaluate 2 knee motions and 5 shoulder motions. Evaluators did not interview subjects and were blinded to previous test results. Evaluators applied overpressure and noted the end-feel while subjects identified the moment their pain was reproduced. Following testing, subjects rated their pain intensity. Analyses included: percentage of agreement; kappa, weighted kappa, and maximum kappa coefficients; and confidence intervals. Analyses were repeated for subjects whose pain intensity during testing did not change between examinations. RESULTS: Intrarater kappa coefficients varied from 0.65 to 1.00 for end-feel, and intrarater weighted kappa coefficients varied from 0.59 to 0.87 for pain/resistance sequence. Most coefficients remained stable or improved for the unchanged subjects. Interrater kappa coefficients for end-feel and weighted kappa coefficients for pain/resistance sequence varied from -0.01 to 0.70. End-feel kappa coefficients remained low for the unchanged subjects, but pain/resistance sequence weighted kappa coefficients improved. Unbalanced distribution affected many coefficients, producing low coefficients even when the percentage of agreement was high. CONCLUSIONS: The appropriate use of end-feel and pain/resistance sequence data requires reliable data gathering, especially when patients are managed by more than one physical therapist. Intrarater reliability of end-feel and pain/resistance judgments at the knee and shoulder were generally good, especially after accounting for subject change and unbalanced distributions. Interrater reliability, however, was generally not acceptable, even after accounting for these factors.
This one a little better........
: J Orthop Sports Phys Ther 2000 Sep;30(9):512-21; discussion 522-7 Related Articles, Books, LinkOut
Construct validity of Cyriax's selective tension examination: association of end-feels with pain at the knee and shoulder.
Petersen CM, Hayes KW.
Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, Chicago, Ill, USA. c-petersen@nwu.edu
STUDY DESIGN: Descriptive. OBJECTIVES: To examine the relationship between pain and normal and abnormal-pathologic end-feels during passive physiologic motion assessment at the knee and shoulder. We theorized that abnormal-pathologic end-feels would be more painful than normal end-feels. BACKGROUND: End-feel testing and pain intensity information are part of physical therapy musculoskeletal patient examinations. End-feels are categorized as normal or abnormal-pathologic. No previous studies have examined the relationship between pain during end-feel testing and the type of end-feel. METHODS AND MEASURES: Two physical therapists examined subjects with unilateral knee or shoulder pain. Each subject was examined twice. Passive physiologic motions, 2 at the knee and 5 at the shoulder, were tested by applying an overpressure at the end of range of motion using standardized positions. Subjects reported the amount of pain (0-10) immediately after the evaluator recorded the end-feel. Analyses included one-way ANOVAs and post-hoc Tukey's Honestly Significant Difference tests. RESULTS: Some abnormal-pathologic end-feels were significantly more painful than the normal end-feels at both the knee and the shoulder for all physiologic motions. Among the abnormal-pathologic end-feel categories there were no statistical differences in pain intensity, although small samples in some categories may be responsible for this finding. CONCLUSION: Abnormal-pathologic end-feels are associated with more pain than normal end-feels during passive physiologic motion testing at the knee or shoulder. Dysfunction should be suspected when abnormal-pathologic end-feels are present.
I could continue but I feel obliged to ask whether you bothered with the Medline search?
mcap
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