To determine whether the GAITRite system can reliably measure temporal and spatial gait parameter... more To determine whether the GAITRite system can reliably measure temporal and spatial gait parameters in patients with rheumatoid arthritic feet. Fifty patients diagnosed with rheumatoid arthritis were each measured on two separate occasions on the same outpatient visit. Temporal and spatial gait parameter readings were recorded for each of three walks across the GAITRite mat. Intraclass correlations (2,1) in combination with within-subject standard deviation were used to quantify within-day reliability. The intraclass correlation, ranging from 0.75 to 0.87, demonstrated excellent within-day repeatability for walking speed, cadence, step length and stride length. Good reliability was reported with cycle time (0.74) and base of support (0.62). Within-subject standard deviation allows these to be used in a clinical setting. The within-day reliability of temporal and spatial gait parameters in rheumatoid arthritic patients has been demonstrated in the current study. However, further investigation of between-day reliability is necessary and would provide clinicians with reliable data in the objective assessment and any form of intervention in rheumatoid arthritis patients.
... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumat... more ... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumatology, orthopaedic and rehabilitation medicine (Mulder et al, 1998). ... A wealth of literature refers to gait speed reliability (Andriacchi et al, 1977; Smith and Rome, 1996; Bohannon ...
Rotator cuff related disorders represent the largest subgroup of shoulder complaints. Despite the... more Rotator cuff related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physiotherapy for painful rotator cuff disorders. We searched Medline, Embase, Cinahl, Cochrane CENTRAL, PEDro and trial registries up to October 2015. We included primary studies exploring prognostic models in adults undergoing physiotherapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by two reviewers. We used a piloted form to extract data on key aspects of study design,...
Journal of Orthopaedic and Sports Physical Therapy
Evaluation of agreement between assessors. To evaluate agreement between an expert in selective t... more Evaluation of agreement between assessors. To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labelling of painful shoulders. Consensus on diagnostic labelling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious. Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean+/-SD age, 51+/-13 years], 21 female [mean+/-SD age, 57+/-12 years]), using STT in conjunction with a preliminary clinical history. Assessors labelled each painful shoulder as "rotator cuff lesion," "bursitis," "capsulitis," "other diagnosis," or "no diagnosis." Combinations of diagnoses w...
"Blind" shoulder injections are often inaccurate and infiltrate untargeted structures. ... more "Blind" shoulder injections are often inaccurate and infiltrate untargeted structures. We tested a hypothesis that optimizing certain anatomical and positional factors would improve accuracy and reduce dispersal. We evaluated one subacromial and one glenohumeral injection technique on cadavers. Mean accuracy was 91% for subacromial-targeted and 74 and 91% (worst- and best-case scenarios) for joint-targeted injections. Mean dispersal was 19% for subacromial-targeted and 16% for joint-targeted injections. All results bettered those reported previously. These "optimized" techniques might improve accuracy and limit dispersal of blind shoulder injections in clinical situations, benefiting efficacy and safety. However, evaluation is required in a clinical setting.
&... more "Blind" shoulder injections are often inaccurate and infiltrate untargeted structures. We tested a hypothesis that optimizing certain anatomical and positional factors would improve accuracy and reduce dispersal. We evaluated one subacromial and one glenohumeral injection technique on cadavers. Mean accuracy was 91% for subacromial-targeted and 74 and 91% (worst- and best-case scenarios) for joint-targeted injections. Mean dispersal was 19% for subacromial-targeted and 16% for joint-targeted injections. All results bettered those reported previously. These "optimized" techniques might improve accuracy and limit dispersal of blind shoulder injections in clinical situations, benefiting efficacy and safety. However, evaluation is required in a clinical setting.
Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (u... more Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting. To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders. We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English. We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials. Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed. We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition. There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.
These guidelines are meant to be accessible to a broad spectrum of readers (see Scope, below). So... more These guidelines are meant to be accessible to a broad spectrum of readers (see Scope, below). So, as far as possible, we have written them in non-technical language; but in some places, technical language and concepts have been unavoidable. We have differentiated ...
... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumat... more ... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumatology, orthopaedic and rehabilitation medicine (Mulder et al, 1998). ... A wealth of literature refers to gait speed reliability (Andriacchi et al, 1977; Smith and Rome, 1996; Bohannon ...
To determine whether the GAITRite system can reliably measure temporal and spatial gait parameter... more To determine whether the GAITRite system can reliably measure temporal and spatial gait parameters in patients with rheumatoid arthritic feet. Fifty patients diagnosed with rheumatoid arthritis were each measured on two separate occasions on the same outpatient visit. Temporal and spatial gait parameter readings were recorded for each of three walks across the GAITRite mat. Intraclass correlations (2,1) in combination with within-subject standard deviation were used to quantify within-day reliability. The intraclass correlation, ranging from 0.75 to 0.87, demonstrated excellent within-day repeatability for walking speed, cadence, step length and stride length. Good reliability was reported with cycle time (0.74) and base of support (0.62). Within-subject standard deviation allows these to be used in a clinical setting. The within-day reliability of temporal and spatial gait parameters in rheumatoid arthritic patients has been demonstrated in the current study. However, further investigation of between-day reliability is necessary and would provide clinicians with reliable data in the objective assessment and any form of intervention in rheumatoid arthritis patients.
... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumat... more ... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumatology, orthopaedic and rehabilitation medicine (Mulder et al, 1998). ... A wealth of literature refers to gait speed reliability (Andriacchi et al, 1977; Smith and Rome, 1996; Bohannon ...
Rotator cuff related disorders represent the largest subgroup of shoulder complaints. Despite the... more Rotator cuff related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physiotherapy for painful rotator cuff disorders. We searched Medline, Embase, Cinahl, Cochrane CENTRAL, PEDro and trial registries up to October 2015. We included primary studies exploring prognostic models in adults undergoing physiotherapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by two reviewers. We used a piloted form to extract data on key aspects of study design,...
Journal of Orthopaedic and Sports Physical Therapy
Evaluation of agreement between assessors. To evaluate agreement between an expert in selective t... more Evaluation of agreement between assessors. To evaluate agreement between an expert in selective tissue tension (STT) and 3 other trained assessors, all using STT in conjunction with a preliminary clinical history, on their diagnostic labelling of painful shoulders. Consensus on diagnostic labelling for shoulder pain is poor, hampering interpretation of the evidence for interventions. STT, a systematic approach to physical examination and diagnosis, offers potential for standardization, but its reliability is contentious. Four trained assessors, 1 of whom was considered an expert, separately assessed 56 painful shoulders in 53 subjects (32 male [mean+/-SD age, 51+/-13 years], 21 female [mean+/-SD age, 57+/-12 years]), using STT in conjunction with a preliminary clinical history. Assessors labelled each painful shoulder as "rotator cuff lesion," "bursitis," "capsulitis," "other diagnosis," or "no diagnosis." Combinations of diagnoses w...
"Blind" shoulder injections are often inaccurate and infiltrate untargeted structures. ... more "Blind" shoulder injections are often inaccurate and infiltrate untargeted structures. We tested a hypothesis that optimizing certain anatomical and positional factors would improve accuracy and reduce dispersal. We evaluated one subacromial and one glenohumeral injection technique on cadavers. Mean accuracy was 91% for subacromial-targeted and 74 and 91% (worst- and best-case scenarios) for joint-targeted injections. Mean dispersal was 19% for subacromial-targeted and 16% for joint-targeted injections. All results bettered those reported previously. These "optimized" techniques might improve accuracy and limit dispersal of blind shoulder injections in clinical situations, benefiting efficacy and safety. However, evaluation is required in a clinical setting.
&... more "Blind" shoulder injections are often inaccurate and infiltrate untargeted structures. We tested a hypothesis that optimizing certain anatomical and positional factors would improve accuracy and reduce dispersal. We evaluated one subacromial and one glenohumeral injection technique on cadavers. Mean accuracy was 91% for subacromial-targeted and 74 and 91% (worst- and best-case scenarios) for joint-targeted injections. Mean dispersal was 19% for subacromial-targeted and 16% for joint-targeted injections. All results bettered those reported previously. These "optimized" techniques might improve accuracy and limit dispersal of blind shoulder injections in clinical situations, benefiting efficacy and safety. However, evaluation is required in a clinical setting.
Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (u... more Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting. To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders. We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English. We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials. Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed. We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition. There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.
These guidelines are meant to be accessible to a broad spectrum of readers (see Scope, below). So... more These guidelines are meant to be accessible to a broad spectrum of readers (see Scope, below). So, as far as possible, we have written them in non-technical language; but in some places, technical language and concepts have been unavoidable. We have differentiated ...
... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumat... more ... Assessment of gait forms an important aspect of daily clinical practice in neurology, rheumatology, orthopaedic and rehabilitation medicine (Mulder et al, 1998). ... A wealth of literature refers to gait speed reliability (Andriacchi et al, 1977; Smith and Rome, 1996; Bohannon ...
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Papers by Nigel Hanchard