Jacob Patijn

The Diagnostic Value Of Sacroiliac Tests In Patients With Non-Specific Low Back Pain

Several anatomical sites have been incriminated as possible sources of LBP. Among them, the sacroiliac joint remains the most controversial. The SI-joint is not generally accepted as a major source of low back pain. Arthrography of the sacroiliac (SI) joint in LBP patients can sometimes reproduce their pain syndrome. 8 According to the Manual/Musculoskeletal Medical literature, one third of LBP is directly related to the SI-joint.4 Studies in LPB patients with anaesthetic blocks of the SI-joint showed prevalence figures varying from 3% to 30%. 15•21 •24

Low Back Pain: Reproducibility of Diagnostic Procedures in Manual/Musculoskeletal Medicine

Abstract In musculoskeletal medicine, with its different schools of approach, examination and therapy, diagnostic routines for low back pain (LBP) are characterised by non-reproducible and/or non-validated test procedures. Numerous diagnostic tests and procedures have been developed, sometimes for the same anatomical structure. This paper reviews the current status of the diagnostic process in relation to medical history, inspection, palpation, examination routines and tests, composed from the literature and from data collected by the International Federation for Manual/musculoskeletal Medicine. The results show a meagre picture with mainly low but sometimes acceptable kappa values Methodological flaws are one of the reasons for these poor results. A second major reason to explain the poor reproducibility of many tests is their absence of validity. To test the validity of a test a gold standard is needed for comparison, and this is usually lacking. A third and probably the most important reason is the fact that patients with LBP are a heterogeneous group with different medical histories, different clinical features, different aetiology and prognosis. A valid classification system for LBP is needed.

Supplement for the International Federation of Manual / Musculoskeletal Medicine: The Rationale for Invasive Treatments in Manual / Musculoskeletal Medicine

Introduction In the treatment of locomotor pain, many conditions can be treated by manual methods alone, but invasive treatments are often used in combination with manual treatments, or are used on their own. This paper looks at the rationale for these invasive treatments and for evidence for or against their efficacy. The special skills of the doctor practising manual/musculoskeletal medicine (MMSM) are complemented by the general skills of a doctor treating general medical conditions, as many systemic conditions will influence or cause locomotor pain or dysfunction. The wide range of locomotor disorders can be divided, for the purpose of this paper, into conditions with structural disease causing pathomorphological change, and those with dysfunction (where there is a potentially reversible change of function). Certainly structural disease is itself likely to cause dysfunction as Lewit continues to remind us (39). A concern in treating locomotor pain is that delay in correcting dysfunction might result in non-reversible, structural change: since it was shown that results of treatment can be improved by avoidance of delay (40) and that good results can be obtained by combinations of manual and invasive treatments (4), there has been great interest in the efficacy of invasive treatments. In analysing the rationale for treatment, structural disease and dysfunction will be considered separately.

Fédération Internationale de Médecine Manuelle International Federation for Manual/Musculoskeletal Medicine Internationale Gesellschaft für Manuelle Medizin

In the past seven years of my chairmanship the Scientific Committee of FIMM has been occupied with the main problem in M/M Medicine and its consequences illustrated in the algorithm below. Outside defining the problem and its solutions, which form the central issue of the work of the SC, efficacy and diagnosis in M/M Medicine in the different regions of the locomotion system have been extensively discussed in the SC-meetings. In the past seven years 60 presentations were held during Sc-meetings of which a number have been published. Based on these presentations protocols have been developed to provide the National Societies of FIMM with proper tools to perform scientific work. In this period 6 protocols have been published, some of them in more than one edition. The development of these protocols finally ended in the publication of booklets of three scientific protocols. The defined problem is current in M/M Medicine and will remain the starting point of a future International Academy for Manual/Musculoskeletal Medicine. The work of the SC in the past seven years has contributed to a slow change in attitude in Manual/Musculoskeletal Medicine towards a more critical and evidence based approach within our profession. This is a slow process with its own natural speed and a period of seven years of a SC is too small to create a complete change in attitude. Therefore, for everyday practitiOners in Manual/Musculoskeletal Medicine represented in the General Assemblies it was not always clear what benefits they had and will have from the work of the Scientific Committee. It must be clear that the work of the Scientific Committee always was aimed to provide the everyday practitioner in M/M Medicine with a solid background with respect to the efficacy and theoretical base of their profession to find the best therapeutic solution for the patient.

Reproducibility studies in manual/musculoskeletal medicine: a new method for kappa independence from prevalence

Abstract In M/M Medicine, it has become increasingly important that diagnostic tests are reproducible. The kappa statistic is the measure most frequently used to define the interobserver agreement of diagnostic procedures. The main disadvantage of the kappa statistic is its dependence on the prevalence, making a good kappa value at the end of every reproducibility study always unpredictable. A previous published theoretical protocol proposed solving this problem by obtaining a prevalence near 0.50. This was evaluated in the present study of the passive hip flexion test. A prevalence of 0.44 was found with a good to excellent kappa value of 0.75. It is concluded that when implementing the proposed method in the protocol format for reproducibility studies, using kappa statistics, a prevalence P near 0.50 can easily be obtained avoiding unexpected low kappa values.

Fimm International Academy of Manual/Musculoskeletal Medicine: Future Scientific Policy and Academy Format

(2005). Fimm International Academy of Manual/Musculoskeletal Medicine: Future Scientific Policy and Academy Format. Journal of Orthopaedic Medicine: Vol. 27, No. 3, pp. 146-151.

Fédération Internationale De Médicine Manuelle International Federation ForManual/Musculoskeletal Medicine Internationale Gesellschaft Für Manuelle Medizin

The activities of the SC are presented in chronological order. The successes and failures are discussed. The problems defined within M/M Medicine are stated and the solutions developed and proposed by the SC will be mentioned and discussed. Plans for the next four period of the SC are presented in which priorities to tackle the failures of the past four years are included. The need for an International Collegium/Academy is emphasised, with the obvious reason being to involve more scientists of different countries in the scientific development of M/M Medicine. We state the reasons why a SC in the present form of eleven members is necessary for another period of four years. At the moment there is one vacancy since Paul Cohen resigned.