Måleredskaber og krops- og funktionsændringer ved patienter med femoroacetabular impingement (FAI) Thomas Linding Jakobsen, Research Physiotherapist, MSc, PhD Section for Orthopaedic & Sports Rehabilitation (SOS-R) Health Centre Nørrebro, City of Copenhagen, Denmark
Evidensbaseret praksis Kliniske test Plan FADDIR (Flexion ADDuction Internal Rotation) Thomas test Måleredskaber Ledmåling Styrkemåling Patient rapporteret spørgeskema Patient rapporteret fysisk funktion Krops- og funktionsændring efter hofteartroskopi
Diagnostiske test Take home message FADDIR (høj sensitivitet), negativ test Rule out Thomas test (høj specificitet), positiv test Rule in Effektmål Ledmåling, isometrisk styrke, Copenhagen Hip And Groin Outcome Score (HAGOS) og Patient Specifik Funktionel Skala (PSFS) Krops- og funktionsændringer efter hofteartroskopi Forbedring fra 3 (Smerter, ledbevægelighed),12 (HAGOS) og 28 måneder postoperativt (Styrke) Præliminær (foreløbig) evidens
Evidensbaseret praksis * Environment & organizational context *EBM: Evidence Based Medicine
Måleredskaber Diagnostiske test Effektmål Mokkink. BMC Medical Research Methodology 201010:22
Måleredskaber International Classification of Functioning, Disability and Health (ICF)
Undersøgelse
Thomas Test https://www.youtube.com/watch?v=lybsvntc1pm
FADDIR/ Thomas Diagnostisk statistik Artroskopi Positiv Positiv Sand positiv a Negativ Få falsk Falsk positive Positiv = Rule b in Negativ Få falsk Falsk negative Negativ = Rule c out Sand Negativ d Sensitivitet = a / a+c Grænseværdi: > 0.80 for at være anvendelig Specificitet = d / b+d
Måleusikkerhed (measurement error) Hvis målefejlen på dit måleredskab er mindre end (<) ændringen mellem gentagne målinger (start- og slutvurdering), har du registreret en reel klinisk fremgang eller forværring Eksempel på fremgang Reel klinisk fremgang Start: 90 Slut: 105 Forbedring: (105-90 ) = +15 > Måleusikkerhed (intratester): Minimal detectable change95: 10 Smallest real difference95:
Ledbevægelighed
SEM95 MDC95 7,72 10,92 4,63 6,54 4,63 6,54 4,74 6,71 4,96 7,01
Muskelstyrke
Intratester måleusikkerhed (MDC 95 /%MDC 95 ) Abduktion - rygliggende: 10 N (7%) Ekstension maveliggende: 45 N (21%) Adduktion rygliggende: 20 N (15%) Fleksion - rygliggende: 25 N (11%)
%MDC95 30 31 29 49 130 51 Link: http://koos.nu/
Patient Specifik Funktionel Skala (PSFS)
Krops- og funktionsændring Krops- og funktionsændring efter hofteartroskopi Operation Dage Uger
Ledbevægelighed N=10, 3 mdr. postoperativt MDC 95 Fleksion 11 grader Indadrotation 7 grader
Muskelstyrke og smerte N=8, 2.5 år postoperativt Fleksion Abduktion Adduktion < Normale aldersmatchede Ekstension Indadrotation Udadrotation Normale aldersmatchede
Patient rapporteret effektmål - HAGOS %MDC95 18.8 17.7 20 22.2 33.8 17.7
Diagnostiske test Take home message FADDIR (høj sensitivitet), negativ test Rule out Thomas test (høj specificitet), positiv test Rule in Effektmål Ledmåling, isometrisk styrke, Copenhagen Hip And Groin Outcome Score (HAGOS) og Patient Specifik Funktionel Skala (PSFS) Krops- og funktionsændringer efter hofteartroskopi Forbedring fra 3 (Smerter, ledbevægelighed),12 (HAGOS) og 28 måneder postoperativt (Styrke) Præliminær (foreløbig) evidens
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