Orthopedic Physical Examination Tests: An Evidence-based Approach

Journal of Physical Therapy Education, Spring 2008 by White, Nancy T

Orthopedic Physical Examination Tests: An Evidence-based Approach. Cook C, Hegedus E. Upper Saddle River, N], Prentice Hall, 2008, softcover, 416 pp, $50.61.

Physical therapists have access to many textbooks and manuals that accurately describe the various tests and measures used during orthopedic physical examination. Why would we need yet another one? For the first time, we have access to a text that makes use of all available evidence to determine the value of currently-used physical examination tests. The authors, both physical therapists, have performed thorough reviews of the literature to provide readers with valuable information on the diagnostic accuracy of each test, which includes sensitivity, specificity, positive likelihood ratio (LR ), and negative likelihood ratio (LR-).

The authors gathered all available studies that have evaluated these tests and carefully reviewed them to determine whether sampling bias, operator bias, or poor study design could have influenced the findings of the studies. Based on this information, the quality of the research behind each test was evaluated using the quality tool QUADAS (Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews), which provides an analysis of the extent to which bias has influenced the diagnostic value of the test. Finally, a summary "utility" score is provided for each test based on the authors' interpretation of the research and their determination of the value of each test in clinical practice.

Statistical terminology may be less familiar to some orthopedic clinicians; therefore, the authors have written Chapter 1 as a user's guide to the text. Each statistical method is carefully explained with an emphasis on clinical utility. The authors clearly describe the methods they used to evaluate each physical examination test. They point out the frequent lack of high-quality research for certain tests; however, they also make use of the best available evidence to guide us in our choice of tests.

Subsequent chapters are grouped according to anatomical classification. Each test includes one or more color photographs to illustrate the technique. A written explanation of the performance of the test, using the original description when available, is included beside each photograph. Scores of diagnostic accuracy, QUADAS scores, and utility scores are provided with each test. The tests are listed in descending fashion from best to worst based on their utility score.

The authors have provided a book of tremendous value to orthopedic clinicians and students through their careful and exhaustive review of physical examination tests. The book's organization, clear illustrations, and descriptions make it a one-stop resource for busy clinicians. It is critical that students and physical therapists have access to this valuable information when determining which tests and measures to use in clinical orthopedic practice. I highly recommend this book for educational programs, students, and physical therapists.

Nancy T White, PT, MS, OCS

Adjunct Faculty

School of Physical Therapy

Howard University

Washington, DC