Common Physical Examination Tests for Patellofemoral Instability Demonstrate Weak Inter-Rater Reliability

We examined the validity and reliability of a physiotherapy examination of the elbow, using telerehabilitation. The patho-anatomical diagnoses, systems diagnosis and physical examination findings of face-to-face physiotherapy examinations were compared with telerehabilitation examinations. Ten participants attended a single session, during which they were interviewed, a face-to-face physical examination was performed and a remote physical examination was conducted, guided by an examiner at a different location via a telerehabilitation system. Conventional face-to-face physiotherapy physical examination test results, diagnoses and systems diagnoses were compared to those produced by an examiner using the telerehabiliation system. There was substantial agreement for systems diagnosis (73%; P = 0.013) for validity and almost perfect agreement for intra-rater reliability (90%; P = 0.001). The inter-rater reliability had a weaker and non-significant agreement (64%; P = 0.11). Physical examination data demonstrated >68% agreement across all three datasets, between the examination methods. Performing a telerehabilitation physical examination to determine a musculoskeletal diagnosis of the elbow joint complex is both valid and reliable.

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Assessing physical examination skills using direct observation and volunteer patients

Diagnosis ◽

10.1515/dx-2019-0089 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Bennett W. Clark ◽

Yi Zhen Joan Lee ◽

Timothy Niessen ◽

Sanjay V. Desai ◽

Brian T. Garibaldi

Keyword(s):

Physical Examination ◽

Direct Observation ◽

Clinical Skill ◽

Management Plan ◽

Formative Assessments ◽

Rater Reliability ◽

Online Test ◽

Ongoing Training ◽

Clinician Educators ◽

Graduate Trainees

AbstractBackgroundFeedback based on direct observation of the physical examination (PE) is associated with enhanced educational outcomes, yet attending physicians do not frequently observe graduate trainees performing the PE.MethodsWe recruited volunteer patients (VPs), each with an abnormality of the cardiovascular, respiratory, or neurological system. Interns examined each VP, then presented a differential diagnosis and management plan to two clinician educators, who, themselves, had independently examined the VPs. The clinician educators assessed interns along five domains and provided post-examination feedback and teaching. We collected data on intern performance, faculty inter-rater reliability, correlation with a simulation-based measure of clinical skill, and resident and VP perceptions of the assessment.ResultsA total of 72 PGY-1 interns from a large academic training program participated. Performance on the cardiovascular and respiratory system was superior to performance on the neurologic exam. There was no correlation between results of an online test and directly observed cardiovascular skill. Interns preferred feedback from the direct observation sessions. VPs and faculty also rated the experience highly. Inter-rater reliability was good for the respiratory exam, but poor for the cardiovascular and neurologic exams.ConclusionsDirect observation of trainees provides evidence about PE skill that cannot be obtained via simulation. Clinician educators’ ability to provide reliable PE assessment may depend on the portion of the PE being assessed. Our experience highlights the need for ongoing training of clinician educators in direct observation, standard setting, and assessment protocols. This assessment can inform summative or formative assessments of physical exam skill in graduate medical education.

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Tools and Resources: Web Sites of Interest

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2001.marapr03 ◽

2001 ◽

Vol 6 (2) ◽

pp. 6-8

Author(s):

Christopher R. Brigham

Keyword(s):

Informed Consent ◽

Physical Examination ◽

Functional Status ◽

Web Sites ◽

Satisfaction Survey ◽

High Quality ◽

Diagnostic Studies ◽

Physician Relationship ◽

Complete History

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, explains that independent medical evaluations (IMEs) are not the same as impairment evaluations, and the evaluation must be designed to provide the data to answer the questions asked by the requesting client. This article continues discussions from the September/October issue of The Guides Newsletter and examines what occurs after the examinee arrives in the physician's office. First are orientation and obtaining informed consent, and the examinee must understand that there is no patient–physician relationship and the physician will not provide treatment bur rather will send a report to the client who requested the IME. Many physicians ask the examinee to complete a questionnaire and a series of pain inventories before the interview. Typical elements of a complete history are shown in a table. An equally detailed physical examination follows a meticulous history, and standardized forms for reporting these findings are useful. Pain and functional status inventories may supplement the evaluation, and the examining physician examines radiographic and diagnostic studies. The physician informs the interviewee when the evaluation is complete and, without discussing the findings, asks the examinee to complete a satisfaction survey and reviews the latter to identify and rectify any issues before the examinee leaves. A future article will discuss high-quality IME reports.

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1587: Correlation of Testicular Size on Physical Examination with Pathologic Findings on Testicular Biopsy

The Journal of Urology ◽

10.1016/s0022-5347(18)38795-0 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 420-420

Author(s):

Brian R. Matlaga ◽

Dennis J. Kubinski ◽

Dominick J. Carbone

Keyword(s):

Physical Examination ◽

Testicular Biopsy ◽

Pathologic Findings ◽

Testicular Size

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Structured Interview for Hoarding Disorder (SIHD)

European Journal of Psychological Assessment ◽

10.1027/1015-5759/a000433 ◽

2019 ◽

Vol 35 (4) ◽

pp. 512-520

Author(s):

Caterina Novara ◽

Paolo Cavedini ◽

Stella Dorz ◽

Susanna Pardini ◽

Claudio Sica

Keyword(s):

Convergent Validity ◽

Structured Interview ◽

Diagnostic Process ◽

Schizophrenia Spectrum Disorders ◽

Clinical Environment ◽

Obsessive Compulsive ◽

Rater Reliability ◽

Hoarding Disorder ◽

Compulsive Disorder ◽

Schizophrenia Spectrum

Abstract. The Structured Interview for Hoarding Disorder (SIHD) is a semi-structured interview designed to assist clinicians in diagnosing a hoarding disorder (HD). This study aimed to validate the Italian version of the SIHD. For this purpose, its inter-rater reliability has been analyzed as well as its ability to differentiate HD from other disorders often comorbid. The sample was composed of 74 inpatients who had been diagnosed within their clinical environment: 9 with HD, 11 with obsessive-compulsive disorder (OCD) and HD, 22 with OCD, 19 with major depressive disorder (MDD), and 13 with schizophrenia spectrum disorders (SSD). The results obtained indicated “substantial” or “perfect” inter-rater reliability for all the core HD criteria, HD diagnosis, and specifiers. The SIHD differentiated between subjects suffering from and not suffering from a HD. Finally, the results indicated “good” convergent validity and high scores were shown in terms of both sensitivity and specificity for HD diagnosis. Altogether, the SIHD represents a useful instrument for evaluating the presence of HD and is a helpful tool for the clinician during the diagnostic process.

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