scholarly journals Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain

2018 ◽  
Vol 4 (1) ◽  
pp. e000262 ◽  
Author(s):  
Kajsa Rennerfelt ◽  
Qiuxia Zhang ◽  
Jón Karlsson ◽  
Jorma Styf

AimWe validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.MethodsThe study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient’s history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).ResultsThe sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test–retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test–retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.ConclusionPPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.

2009 ◽  
Vol 99 (5) ◽  
pp. 438-442 ◽  
Author(s):  
Aksel Seyahi ◽  
Serkan Uludag ◽  
Senol Akman ◽  
Mehmet Demirhan

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient’s history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity. (J Am Podiatr Med Assoc 99(5): 438–442, 2009)


2011 ◽  
Vol 45 (2) ◽  
pp. e1-e1
Author(s):  
K. Rennerfelt ◽  
Q. Zhang ◽  
L. Hamilton ◽  
J. Styf

1996 ◽  
Vol 37 (3P2) ◽  
pp. 708-713 ◽  
Author(s):  
M. Lindbæk ◽  
U. L.-H. Johnsen ◽  
E. Kaastad ◽  
S. Dølvik ◽  
P. Møll ◽  
...  

Purpose: To study CT findings in general practice patients with a clinical diagnosis of acute sinusitis, and to examine the interobserver variation between 2 radiologists with regard to their CT evaluation. Material and Methods: Two hundred and one patients were examined with coronal CT images of the paranasal sinuses within 2 days of the clinical diagnosis. Patients with chronic sinusitis were excluded. Fluid level or total opacification of any sinus were used as evidence of sinusitis. Results: One hundred and twenty-seven (63%) patients had fluid level or total opacification in a sinus region, most in more than one region. One hundred and fifteen had CT signs of sinusitis in the ethmoid region, 84 in the maxillary, 18 in the frontal, and 10 in the sphenoid. Forty-nine patients had a negative CT. In the evaluation of interobserver agreement, the overall assessment of the CT yielded a kappa value of 0.70. Conclusion: The study demonstrated great variation in the CT findings in general practice patients with suspected acute sinusitis. More than one sinus region was affected in most patients in whom sinusitis was confirmed by CT imaging; the most common combination was ethmoid and maxillary sinuses. The interobserver agreement was substantial.


Author(s):  
van den Hurk Loreen ◽  
van den Besselaar marijn ◽  
Scheltinga Marc R

2015 ◽  
Vol 4 (4) ◽  
pp. e117 ◽  
Author(s):  
Renae Domaschenz ◽  
Nicole Vlahovich ◽  
Justin Keogh ◽  
Stacey Compton ◽  
David C Hughes ◽  
...  

2016 ◽  
Vol 21 (01) ◽  
pp. 24-29 ◽  
Author(s):  
Younis Kamal ◽  
Hayat Ahmad Khan ◽  
Naseem UI Gani ◽  
Munir Farooq ◽  
Adil Bashir Shah ◽  
...  

Background: The purpose of this study is to test the hypothesis of the new classification system of distal end radius fractures (Barzullah working classification) proposed by one of the author in a prospective cohort study, among the orthopaedic residents. Methods: The initial post-injury radiographs of 300 patients with distal radius fractures in a tertiary centre were classified by two junior residents (JR1 and JR2) and two senior residents (SR1 and SR2) in the emergency department over a period of two years. The collected data was analysed statistically by using Cohan's kappa for measuring Intraobserver reproducibility and Fleiss kappa for measuring Interobserver agreement. Results: The mean kappa value for Interobserver agreement was 0.53 (moderate agreement) at the end of one year and the mean kappa value at the end of study period was 0.64 (substantial agreement). The mean kappa value for Intraobserver reproducibility of JR1 was 0.45 (moderate agreement), JR2 was 0.39 (fair agreement), SR1 was 0.62 (substantial agreement) and SR2 was 0.67 (substantial agreement). Conclusions: Barzullah working classification of distal radius fractures presented in this study has good characteristics compared to those of already studied classification systems among orthopaedic residents.


1994 ◽  
Vol 11 (2) ◽  
pp. 12-17
Author(s):  
Jeff Sigafoos ◽  
Donna Couzens ◽  
Stephanie Gunn

ABSTRACTAdaptive behaviour scales represent an alternative to standardised intelligence tests for assessing children with multiple disabilities. The purpose of the present study was to evaluate the reliability of an adaptive behaviour scale used in Hungarian Conductive Education programs for children with neurological impairments. Forty-five children with multiple disabilities were assessed on two separate occasions by their teachers and physiotherapists. Scores were compared across raters (interobserver agreement) and across the two assessment occasions (test-retest reliability). Interobserver agreement averaged 55.5%, and the overall test-retest reliability was 75%. Suggestions for improving interobserver agreement and test-retest reliability are discussed.


2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Thomas Rauer ◽  
Matthias Boos ◽  
Valentin Neuhaus ◽  
Prasad Ellanti ◽  
Robert Alexander Kaufmann ◽  
...  

Abstract Background Although of great value in the management of lateral clavicle fractures, substantial variation in their classification exists. We performed a retrospective study to address the inter- and intraobserver reliability of three different classification systems for lateral clavicle fractures. Methods Radiographs of 20 lateral clavicle fractures that represented a full spectrum of adult fracture patterns were graded by five experienced radiologists and five experienced trauma surgeons according to the Orthopaedic Trauma Association (OTA), the Neer, and the Jäger/Breitner classification systems. This evaluation was performed at two different time points separated by 3 months. To measure the observer agreement, the Fleiss kappa coefficient (κ) was applied and assessed according to the grading of Landis and Koch. Results The overall interobserver reliability showed a fair agreement in all three classification systems. For the OTA classification system, the interobserver agreement showed a mean kappa value of 0.338 ranging from 0.350 (radiologists) to 0.374 (trauma surgeons). Kappa values of the interobserver agreement for the Neer classification system ranged from 0.238 (trauma surgeons) to 0.276 (radiologists) with a mean κ of 0.278. The Jäger/Breitner classification system demonstrated a mean kappa value of 0.330 ranging from 0.306 (trauma surgeons) to 0.382 (radiologists). The overall intraobserver reliability was moderate for the OTA and the Jäger/Breitner classification systems, while the overall intraobserver reliability for the Neer classification system was fair. The kappa values of the intraobserver agreements showed, in all classification systems, a wide range with the OTA classification system ranging from 0.086 to 0.634, the Neer classification system ranging from 0.137 to 0.448, and a range from 0.154 to 0.625 of the Jäger/Breitner classification system. Conclusions The low inter- and intraobserver agreement levels exhibited in all three classification systems by both specialist groups suggest that the tested lateral clavicle fracture classification systems are unreliable and, therefore, of limited value. We should recognize there is considerable inconsistency in how physicians classify lateral clavicle fractures and therefore any conclusions based on these classifications should be recognized as being somewhat subjective.


2018 ◽  
Vol 11 (3) ◽  
pp. 204-209 ◽  
Author(s):  
Paul J Cagle ◽  
Birgit Werner ◽  
Dave R Shukla ◽  
Daniel A London ◽  
Bradford O Parsons ◽  
...  

Background Glenoid morphology, glenoid version and humeral head subluxation represent important parameters for the treating physician. The most common method of assessing glenoid morphology is the Walch classification which has only been validated with computed tomography (CT). Methods CT images and magnetic resonance imaging (MRI) images of 25 patients were de-identified and randomized. Three reviewers assessed the images for each parameter twice. The Walch classification was assessed with a weighted kappa value. Glenoid version and humeral head subluxation were comparted with a reproducibility coefficient. Results The Walch classification demonstrated almost perfect intraobserver agreement for MRI and CT images (k = 0.87). Weighted interobserver agreement values for the Walch classification were fair for CT and MRI (k = 0.34). The weighted reproducibility coefficient for glenoid version measured 9.13 (CI 7.16–12.60) degrees for CT and 13.44 (CI 10.54–18.55) degrees for MRI images. The weighted reproducibility coefficient for percentage of humeral head subluxation was 17.43% (CI 13.67–24.06) for CT and 18.49% (CI 14.5–25.52) for MRI images. Discussion CT and MRI images demonstrated similar efficacy in classifying glenoid morphology, measuring glenoid version and measuring posterior humeral head subluxation. MRI can be used as an alternative to CT for measuring these parameters.


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