Musculoskeletal Science and Practice最新文献

Introduction: The assessment of physical function is central to clinical decision-making in rehabilitation and musculoskeletal care. Patient-reported outcome measures (PROMs) are widely used because they are simple, cost-effective, and patient-centred. However, many PROMs were developed using Classical Test Theory, which assumes equal distances between ordinal response options and overlooks differences in item difficulty and person ability. These limitations can reduce measurement precision and cause ceiling effects, particularly among individuals with high physical function. Rasch analysis, a modern psychometric approach based on Item Response Theory, addresses these issues and enhances the measurement properties of PROMs.

Purpose: This article introduces Rasch analysis as a methodological framework for developing and refining PROMs to assess physical function. It explains the principles of the Rasch model, its application to dichotomous and polytomous data, and how it transforms ordinal scores into interval-level measurements. Example figures illustrate key outputs such as category probability curves, person-item maps, and threshold ordering. Advantages, limitations, and practical considerations for integrating Rasch analysis into outcome measure development are discussed.

Implications: Rasch analysis enables clinicians and researchers to better understand item difficulty and estimate patients' functional ability with greater precision. Incorporating Rasch-developed PROMs enhances the validity, interpretability, and responsiveness of functional assessments. Clinicians can use these measures with increased confidence when monitoring progress and evaluating treatment outcomes, supporting more accurate goal setting and improved rehabilitation practice.

Background: Previous research has raised the question of the extent to which physical therapists possess sufficient knowledge of cervical vascular pathologies and blood flow limitations and the clinical reasoning skills to appropriately identify a patient who is having an underlying vascular pathology.

Objectives: This study aims to investigate: (1) which risk factors are assessed during patient interviews and their frequency; (2) the physical examination tests used, therapists' training in these tests, and their confidence in performing them; (3) therapists' knowledge of cervical spine treatment risks and associated risk factors; and (4) whether these outcomes differ based on therapist characteristics.

Design: A cross-sectional digital survey.

Methods: A combination of descriptive statistics and multivariate testing.

Results/findings: 774 completed surveys were included in the data analysis. Most respondents reported routinely addressing cardiovascular risk factors, trauma history and contraindications during patient interviews. Peripheral neurological examination was most frequently used (72%), whereas auscultation (8%) and arterial pulse palpation (5%) were rarely applied. Positional testing, although no longer recommended, remained commonly used. Confidence varied, particularly for cranial nerve examination. Forty-eight percent perceived increased dissection risk after manipulation versus 15% after mobilization, and mobilization was generally considered safer.

Conclusions: Respondents sufficiently addressed risk factors in the patient interview. Regarding the physical examination, improvement of physical therapists' knowledge and skills in cranial nerve examination is needed, and positional testing should be avoided as it is no longer recommended. Participants' knowledge of cervical spine treatment risks and risk factors is variable and ongoing updating of clinical knowledge is important, as conclusions may change over time.