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针对膝关节损伤干预措施的提供者可靠性:一项促进基于多学科团队的膝关节干预分类法发展的初步调查。

Provider reliability with interventions for knee impairments: a preliminary investigation to facilitate development of an MDT-based knee intervention taxonomy.

作者信息

Yarznbowicz Richard, Tao Minjing, Wlodarski Matthew, Matos Alexandra

机构信息

DPT, Center for Orthopedic and Sports Physical Therapy, Tallahassee, FL, USA.

Department of Statistics, Florida State University, Tallahassee, FL, USA.

出版信息

J Man Manip Ther. 2018 Aug;26(4):218-229. doi: 10.1080/10669817.2018.1482099. Epub 2018 Jul 31.

DOI:10.1080/10669817.2018.1482099
PMID:30083045
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6071271/
Abstract

: The lack of a standardized intervention taxonomy in comparative effectiveness research trials has led to uncertainty regarding the management of individuals with knee impairments. Inconsistently and poorly defined interventions affect frontline-care providers' abilities to understand and assimilate research findings into practice. An intervention taxonomy could help overcome the lack of treatment specificity commonly found in research trials. : In the present study, we aimed to develop a Mechanical Diagnosis and Therapy (MDT)-based taxonomy and test the levels of reliability between providers who currently manage individuals with knee impairments in a rehabilitation setting. A total of 182 participants accessed the study during the study period, in which 180 consented to participate and 59 completed the survey (98.9% participation rate; 32.7% completion rate). : A total of 89.8% of the participants who completed the survey were physical therapists. Fleiss kappa values for the primary, secondary, and tertiary categories were 0.90, 0.89, and 0.71, respectively. The results of our investigation suggest substantial to almost perfect levels of reliability for identifying diverse MDT-based knee interventions displayed in video and vignette format within a sample population primarily of physical therapists who currently manage individuals with knee impairments in a rehabilitation setting. : Our findings show acceptable levels of reliability and provide support for using this standardized MDT-based intervention taxonomy as a way to improve intervention specificity and generalizability in comparative effectiveness research. : 5.

摘要

在比较效果研究试验中,缺乏标准化的干预分类法导致了膝关节损伤患者管理方面的不确定性。定义不一致且不完善的干预措施影响了一线护理人员理解研究结果并将其应用于实践的能力。一种干预分类法有助于克服研究试验中常见的治疗特异性不足的问题。:在本研究中,我们旨在开发一种基于机械诊断与治疗(MDT)的分类法,并测试目前在康复环境中管理膝关节损伤患者的医护人员之间的可靠性水平。在研究期间,共有182名参与者访问了该研究,其中180人同意参与,59人完成了调查(参与率为98.9%;完成率为32.7%)。:完成调查的参与者中,89.8%是物理治疗师。主要、次要和第三类别的Fleiss卡帕值分别为0.90、0.89和0.71。我们的调查结果表明,在主要由目前在康复环境中管理膝关节损伤患者的物理治疗师组成的样本群体中,对于识别以视频和案例形式展示的基于MDT的各种膝关节干预措施,可靠性达到了较高到几乎完美的水平。:我们的研究结果显示出可接受的可靠性水平,并支持使用这种基于MDT的标准化干预分类法,作为提高比较效果研究中干预特异性和可推广性的一种方法。:5.

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本文引用的文献

1
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Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial.麦肯锡机械诊断与治疗系统对膝骨关节炎运动干预效果的随机对照试验。
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J Man Manip Ther. 2011 Aug;19(3):172-81. doi: 10.1179/2042618611Y.0000000001.
8
Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies.康复实践证据研究:替代随机对照试验和传统观察性研究的方法。
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Shoulder pain: differential diagnosis with mechanical diagnosis and therapy extremity assessment - a case report.肩部疼痛:运用机械诊断与治疗肢体评估进行鉴别诊断——病例报告
Man Ther. 2013 Aug;18(4):354-7. doi: 10.1016/j.math.2012.06.011. Epub 2012 Jul 13.
10
A survey of the McKenzie Classification System in the Extremities: prevalence of mechanical syndromes and preferred loading strategies.四肢麦肯基分类系统调查:机械综合征的流行情况和首选负荷策略。
Phys Ther. 2012 Sep;92(9):1175-86. doi: 10.2522/ptj.20110371. Epub 2012 May 24.