Clinical trial registration involves placing the protocol for a clinical trial on a free, publicly available, and electronically searchable register. Registration is considered to be prospective if the protocol is registered before the trial commences (ie, before the first participant is enrolled). Prospective registration has several potential advantages. It could help avoid trials being duplicated unnecessarily and it could allow people with health problems to identify trials in which they might participate. Perhaps more importantly, however, it tackles 2 big problems in clinical research: selective reporting and publication bias. Prospective clinical trial registration is of great potential value to the clinicians, consumers, and researchers who rely on clinical trial data, and that is why the International Society of Physiotherapy Journal Editors (ISPJE) is recommending that members enact a policy for prospective trial registration.

J Orthop Sports Phys Ther 2012;42(12):978-981. doi:10.2519/jospt.2012.0111

KEY WORDS: ISPJE, prospective registration, publication bias, selective reporting

STUDY DESIGN: Systematic review. OBJECTIVE: To summarize the research on accuracy of individual clinical diagnostic signs and tests for the presence of temporomandibular disorder (TMD), and for the subclassifications affiliated with TMD. BACKGROUND: Diagnosis of TMD through clinical diagnostic measures has been reported in many studies; however, few of these studies have identified individual clinical tests or signs that can aid in the diagnosis of TMD or differentiate between the subclassifications of TMD. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Computerized and hand searches were completed to locate articles on the diagnostic accuracy of clinical tests and signs. To be considered for review, the study required (1) an assessment of individual clinical measures of TMD, (2) a report of the diagnostic accuracy of these measures, and (3) an acceptable reference standard for comparison. Quality assessment of studies of diagnostic accuracy (QUADAS) scores were completed on each selected article. Sensitivity and specificity and negative and positive likelihood ratios were calculated for each diagnostic test described. RESULTS: The search strategy identified 131 potential articles, which were narrowed down to 7 that met the criteria for this review. After assessment using the QUADAS score, 3 of the 7 articles were of high quality. All 7 studies used tests to differentiate subclassifications of TMD. The 7 studies included (1) diagnostic tests/signs of joint sounds, (2) joint movements, or (3) clinically oriented pain measures. There were no studies that investigated TMD versus a competing, non-TMD condition. CONCLUSION: Only 3 studies presented in this literature review were of high quality. Because all of the included studies assessed diagnostic accuracy among subclassifications of individuals suspected of having TMD, the ability of any of these tests to distinguish between patients with TMD versus patients without TMD remains unknown. Because of the lack of clear findings indicating compelling evidence for clinical diagnosis of TMD, and because of the low quality of most of these studies, the data are insufficient to support or reject these tests. LEVEL OF EVIDENCE: Diagnosis, level 2a–.

J Orthop Sports Phys Ther 2011;41(6):408-416, Epub 18 February 2011. doi:10.2519/jospt.2011.3644

KEY WORDS: head, jaw, TMJ

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To establish the major clinically important improvement (MCII) of the timed up-and-go test (TUG), 40-meter self-paced walk test (40-m SPWT), 30-second chair stand (30 CST), and a 20-cm step test in patients with hip osteoarthritis (OA) undergoing physiotherapy treatment. As a secondary aim, a comparison of methods was employed to evaluate the effect of method on the reported MCII. BACKGROUND: Minimal clinically important difference scores are commonly used by rehabilitation professionals to determine patient response following treatment. A gold standard for calculating MCII has yet to be determined, which has resulted in problems of interpretation due to varied results. METHODS: As part of a randomized controlled trial, 65 patients were randomized into a physiotherapy treatment group for hip OA, in which they completed 4 physical performance measures at baseline and 9 weeks. Upon completion of physiotherapy, patients assessed their response to treatment on a 15-point global rating of change scale (GRCS). MCII was estimated using 3 variations of an anchor-based method, based on the patient’s opinion. RESULTS: A comparison of 3 methods resulted in the following change scores being best associated with our definition of MCII: a reduction equal to or greater than 0.8, 1.4, and 1.2 seconds for the TUG; an increase equal to or greater than 0.2, 0.3, and 0.2 m/s for the 40-m SPWT; an increase equal to or greater than 2.0, 2.6, and 2.1 repetitions for the 30 CST; an increase equal to or greater than 5.0, 12.8, and 16.4 steps for the 20-cm step test. CONCLUSION: The variation in methods provided very different results. This illustrates the importance of comparing methodologies and reporting a range of values associated with the MCII, as such values vary, depending upon the methodology chosen.

J Orthop Sports Phys Ther 2011;41(5):319-327, Epub 18 February 2011. doi:10.2519/jospt.2011.3515

KEY WORDS: outcome assessment, rehabilitation, task performance and analysis, timed up and go

STUDY DESIGN: Case control study. BACKGROUND: Myelopathy is a clinical diagnosis based largely on initial examination findings during a clinical screen, followed by imaging verification of cord injury or compression. At present, few studies have examined the reliability and diagnostic accuracy of clinical examination measures. OBJECTIVES: To determine the reliability and diagnostic accuracy of neurological tests associated with the diagnosis of myelopathy. METHODS AND MEASURES: Reliability and diagnostic accuracy of 7 frequently used tests and measures and subjective findings associated with myelopathy were examined on consecutive patients with cervical pain. Interrater reliability and diagnostic accuracy values, including posttest probability, based on a pretest probability of 40%, were calculated for each test and for combinations of tests and measures. RESULTS: Four of the 7 diagnostic tests were found to have a substantial interrater reliability. None of the single or clusters of tests yielded low negative likelihood ratios. Of the individual tests, the Babinski sign demonstrated the highest positive likelihood ratio (LR+, 4.0; 95% CI: 1.1-16.6) and posttest probability (73%) for diagnosis, but yielded only a moderate negative likelihood ratio (LR–, 0.7; 95% CI: 0.6-0.9). Combinations of tests did not yield improved accuracy values over single test results. CONCLUSION: This study demonstrated that 4 of 7 tests used to screen for myelopathy offered substantial levels of interrater agreement when used on individuals with cervical dysfunction. None of the tests when performed individually or in combinations are effective for screening; however, the Babinski sign did alter posttest probability more significantly than combinations of test findings. LEVEL OF EVIDENCE: Diagnosis, Level 2b.

J Orthop Sports Phys Ther 2009;39(3):172-178, Epub 17 December 2008. doi:10.2519/jospt.2009.2938

KEY WORDS: cervical spine, diagnostic test, neck, neurological screen, validity

A letter to the Editor-in-Chief expresses concern about the study by Iverson et al published in the June 2008 issue of JOSPT. While the letter writers appreciate the creative exploration of the authors, they are concerned with limitations of the methods and potential transferability of the findings of this clinical prediction rule for lumbopelvic manipulation for treating patients with patellofemoral pain syndrome.

J Orthop Sports Phys Ther. 2008; 38(11):722. doi:10.2519/jospt.2008.0205

KEY WORDS: clinical prediction rule

Letters to the Editor-in-Chief of the JOSPT as follows:

• Letter regarding the article, Does Evidence Support the Existence of Lumbar Spine Coupled Motion? A Critical Review of the Literature. J Orthop Sports Phys Ther. 2007:37(7):412. doi:10.2519/jospt.2007.0205.
• Authors' Response. J Orthop Sports Phys Ther. 2007:37(7):412-413. doi:10.2519/jospt.2007.0206.
• Letter regarding the article, The Effect of Anterior Versus Posterior Glide Joint Mobilization on External Rotation Range of Motion in Patients With Shoulder Adhesive Capsulitis. J Orthop Sports Phys Ther. 2007:37(7):413. doi:10.2519/jospt.2007.0207.
• Authors' Response. J Orthop Sports Phys Ther. 2007:37(7):414-415. doi:10.2519/jospt.2007.0208.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: To identify, analyze, and synthesize the literature to determine which physical examination tests, if any, accurately diagnose a torn tibial meniscus. BACKGROUND: Knee pain has a lifetime prevalence of up to 45% and as many as 31% of individuals with knee pain will consult a general practitioner. Roughly 5% of these individuals will undergo a tibial meniscectomy and many more will undergo partial meniscectomy or meniscus repair. Determining which of these individuals is appropriate for surgical consult depends on clinical examination findings. METHODS AND MEASURES: We searched MEDLINE, CINAHL, and SPORTDiscus from 1966 to August 2006 and extracted all English- and German-language studies that reported the diagnostic accuracy of individual physical examination tests for a torn meniscus. We retrieved data regarding true positives, false positives, true negatives, and false negatives to create 2x2 tables for each article and test. Like tests were then subjected to meta-analysis and subanalysis.  Cochran Q test and the I2 statistic were used to examine for the presence of heterogeneity and the extent of the effect of heterogeneity, respectively. A qualitative analysis was also performed using the QUADAS tool. RESULTS: Eighteen studies qualified for the final analyses. Three physical examination tests (McMurray's, Apley's, and joint line tenderness) were examined in more than 7 studies and had enough data to consider meta-analysis. However, study results were heterogeneous. Pooled sensitivity and specificity were 70% and 71% for McMurray's, 60% and 70% for Apley's, and 63% and 77% for joint line tenderness. Large between-study differences could not be explained by prevalence, study quality, or how well an index test was described. CONCLUSIONS: No single physical examination test appears to accurately diagnose a torn tibial meniscus and the value of history plus physical examination is unknown. Differences between studies in diagnostic performance remain unexplained, presumably due to local differences in the way the tests are defined, performed, and interpreted. We recommend a more standardized approach to performing and interpreting these tests and the development of a clinical prediction rule to aid clinicians in the diagnosis of a torn tibial meniscus.

J Orthop Sports Phys Ther. 2007;37(9):541-550, published online 30 May 2007. doi:10.2519/jospt.2007.2560

KEY WORDS: Apley's, diagnosis, joint line tenderness, McMurray's, primary care, tibiofemoral joint

Study Design: Resident’s case problem.
Background: The popularity of weight training has increased dramatically during the past 20 years. With the increase in popularity of weight training, the rate of injury has also increased dramatically. The types of injuries range from benign to life threatening.
Diagnosis: The patient was a 21-year-old woman originally referred for pelvic pain who presented with new complaints of right upper extremity swelling, discomfort, and cyanosis after recently beginning a comprehensive weight-lifting program. Additional signs, including paresthesias, decreased pulses, and venous distension, warranted a timely referral by the physical therapist back to the referring physician.
Discussion: The primary injury in this case report was hypothesized to have been induced by the recent start of a weight-lifting program, with no other significant contributing risk factors. A comprehensive examination by the physical therapist revealed clinical signs of an upper extremity deep vein thrombosis, leading to a same-day referral back to the referring physician. Further research, resulting in a clinical decision rule for upper extremity deep vein thrombosis or estimates of diagnostic accuracy of clinical signs and symptoms, would improve the diagnostic process.

J Orthop Sports Phys Ther. 2006; 36(11):882-886. doi:10.2519/jospt.2006.2250

Key Words: Paget-Schroetter syndrome, primary axillary-subclavian thrombosis, thoracic outlet syndrome, upper extremity deep vein thrombosis