Rod Green

Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review

QUESTION Do clinical tests accurately diagnose rotator cuff pathology? DESIGN A systematic review of investigations into the diagnostic accuracy of clinical tests for rotator cuff pathology. PARTICIPANTS People with shoulder pain who underwent clinical testing in order to diagnose rotator cuff pathology. OUTCOME MEASURES The diagnostic accuracy of clinical tests was determined using likelihood ratios. RESULTS Thirteen studies met the inclusion criteria. The 13 studies evaluated 14 clinical tests in 89 separate evaluations of diagnostic accuracy. Only one evaluation, palpation for supraspinatus ruptures, resulted in significant positive and negative likelihood ratios. Eight of the 89 evaluations resulted in either significant positive or negative likelihood ratios. However, none of these eight positive or negative likelihood ratios were found in other studies. Of the 89 evaluations of clinical tests 71 (80%) did not result in either significant positive or negative likelihood ratio evaluations across different studies. CONCLUSION Overall, most tests for rotator cuff pathology were inaccurate and cannot be recommended for clinical use. At best, suspicion of a rotator cuff tear may be heightened by a positive palpation, combined Hawkins/painful arc/infraspinatus test, Napoleon test, lift-off test, belly-press test, or drop-arm test, and it may be reduced by a negative palpation, empty can test or Hawkins-Kennedy test.

Accuracy of clinical tests to diagnose superior labral anterior and posterior (SLAP) lesions

Abstract Numerous clinical tests to diagnose superior labral anterior and posterior (SLAP) lesions of the glenoid labrum have been described. The current systematic review of the relevant literature was undertaken to ascertain the accuracy of these tests as determined by likelihood ratios. Searching of electronic databases yielded 16 papers that had reported test accuracy on a total of 16 separate clinical tests for SLAP lesions, and some combinations of these tests. Although many tests appeared to be highly accurate when initially reported, all tests that had been evaluated by authors other than those who devised the test typically showed poor levels of accuracy in subsequent studies. The results of this review suggest that no one clinical test can be recommended for use in clinical practice to diagnose accurately the presence or absence of a SLAP lesion. It is possible that further investigations into the anatomical basis of these tests may explain the variability in accuracy.

Secondary school science predictors of academic performance in university bioscience subjects

In 2009 the Faculty of Health Sciences at La Trobe University in Melbourne, Australia is introducing a common first year for 11 different undergraduate courses in the faculty. Current prerequisite science entry requirements vary with course and range from none to at least two science or mathematics subjects and from ∼50 to 99 in Equivalent National Tertiary Entrance Rank (ENTER) scores. Under the previous structure, students in different courses completed a variety of different subjects at first year. Concern about the ability of such disparate groups to complete a common first year led to the current investigation of the relationships between year 12 (final year of secondary school) science subjects and performance in first year university bioscience subjects. Year 12 results for all science‐related units and ENTER scores were obtained for all Victorian students enrolling in a first year course in the Faculty of Health Sciences in 2005 and 2006. Regression and other analyses were conducted for five first year bioscience subjects. The ENTER score was the best predictor of academic performance in all units except regional anatomy. Performance in many secondary school science subjects was highly predictive of performance in physiology, combined systematic physiology and anatomy and biomechanics units, but again not for regional anatomy units. It appears that year 12 performance in science subjects and ENTER scores may be important predictors of success in physiology, but not regional anatomy subjects at university. It is possible that regional anatomy is an entirely new subject area that requires new types of learning unrelated to year 12 science subjects. Anat Sci Ed 2:113‐118, 2009.

A survey of the health of Victorian primary school principals

In recent years responsibility for the administration of schools internationally has shifted from education departments towards self‐governing schools. This trend has resulted in major changes to the role of school principals. Such changes in role may impact on the psychological and physical health of principals, but there has been very little research into this population. A survey of the health and wellbeing of a representative sample of 50 principals of State primary schools in Victoria, Australia is reported. Subjects completed questionnaires measuring health‐related behaviour and stress and arousal levels and participated in comprehensive health appraisals. Principals reported better smoking patterns than the population as a whole. Despite a higher socioeconomic status than the population as a whole, the health status of the principals was not apparently better. Principals reported higher stress levels and worse physical health than a group of white‐collar employees of similar socioeconomic status.

Impact of a health promotion program on the health of primary school principals

The role of a school principal has changed dramatically in the last decade and there has been widespread concern regarding the impact of this change of role on principal health and wellbeing. Worksite health promotion programs have been used in many different settings to encourage employee health, but there is very little information on the effectiveness of such programs, particularly in improving principal health. This study evaluated the impact of a 12‐month health promotion program on a group of 50 volunteer principals. Participants in the program reported improvements in their diet and exercise habits and this was reflected in improvements in blood pressure, cholesterol and body fat measures. These results indicate that worksite health promotion can play a significant role in improving the health and wellbeing of school principals.

Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial – Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial

BackgroundClinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis.MethodsNinety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)).DiscussionThis will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction.Trial registrationAustralian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017. Protocol version 3.0.