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The Journal of Manual & Manipulative... Feb 2021: To investigate the effect of the examination process (history taking and physical examination) on pain and function. : An observational cohort trial of patients... (Observational Study)
Observational Study
: To investigate the effect of the examination process (history taking and physical examination) on pain and function. : An observational cohort trial of patients presenting to outpatient physical therapy clinics for the first time with low back pain (n = 34, 57.7 ± 18.7 years, 53% female). A blinded investigator measured participants prior to the beginning of the initial evaluation and after each component of evaluation (history taking and physical examination). Another physical therapist provided normal history taking and physical examination as the patient case presented itself. Primary outcome measure was numeric pain rating scale (NPRS) for the low back and leg. Secondary outcomes and time during examination process and connection between PT and patient were also measured as potential confounders. : Participants showed a significant reduction in pain through just the history taking and physical exam for both the back with an NPRS reduction of 1.23 and the leg showing a 0.95 NPRS reduction. The most significant reduction occurs after history taking. : The evaluation process produced small, but significant, therapeutic effects related to pain, fear-avoidance, pain catastrophization, and functional measures of mobility and sensitivity. The therapist's report of connection with the patient did not alter the patient outcome.
Topics: Adult; Aged; Cohort Studies; Female; Humans; Low Back Pain; Male; Medical History Taking; Middle Aged; Pain Measurement; Physical Examination; Surveys and Questionnaires
PubMed: 32091317
DOI: 10.1080/10669817.2020.1730056 -
Annals of Family Medicine Jul 2019The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To...
PURPOSE
The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To reappraise its utility, we explored family physicians' experiences.
METHODS
Guided by principles of phenomenology, we conducted in-depth qualitative interviews exploring 16 family physicians' experiences of conducting physical examination: 7 (44%) men and 9 women (56%) whose clinical experience varied widely, from 11 (69%) urban and 5 (31%) rural locations. We recorded the interviews, transcribed them verbatim, and identified initial themes using template analysis. We worked reflexively, critiquing our own and other team members' interpretations, in order to synthesize and write a final interpretation.
RESULTS
Participants described 2 facets of physical examination: making diagnoses and estimating prognoses rationally and objectively; and responding subjectively and intuitively to patients' illnesses, which formed relationships between doctor and patient that enacted medical care in the moment. Physical examination allowed physicians to use their own bodies to experience patients' illnesses. Performing physical examination was integral to being a family doctor because it promoted rapport and developed trust.
CONCLUSIONS
Physical examination is part of the identity of family physicians. It not only contributes diagnostic information but is a therapeutic intervention in and of itself. Physical examination contributes to relationship-centered care in family practice.
Topics: Attitude of Health Personnel; Family Practice; Female; Humans; Male; Physical Examination; Physician-Patient Relations; Qualitative Research; Trust
PubMed: 31285207
DOI: 10.1370/afm.2420 -
Cell Dec 2019Understanding the genetic and molecular drivers of phenotypic heterogeneity across individuals is central to biology. As new technologies enable fine-grained and... (Review)
Review
Understanding the genetic and molecular drivers of phenotypic heterogeneity across individuals is central to biology. As new technologies enable fine-grained and spatially resolved molecular profiling, we need new computational approaches to integrate data from the same organ across different individuals into a consistent reference and to construct maps of molecular and cellular organization at histological and anatomical scales. Here, we review previous efforts and discuss challenges involved in establishing such a common coordinate framework, the underlying map of tissues and organs. We focus on strategies to handle anatomical variation across individuals and highlight the need for new technologies and analytical methods spanning multiple hierarchical scales of spatial resolution.
Topics: Anatomic Variation; Diagnostic Imaging; Humans; Physical Examination; Reference Standards
PubMed: 31835027
DOI: 10.1016/j.cell.2019.11.019 -
BMC Medical Education Nov 2017Physical examination (PE) is an essential clinical skill and a central part of a physician's daily activity. Teaching of PE has been integrated into medical school by... (Review)
Review
BACKGROUND
Physical examination (PE) is an essential clinical skill and a central part of a physician's daily activity. Teaching of PE has been integrated into medical school by many clinical disciplines with respective specific examination procedures. For instance, PE teaching in general practice may include a full-body examination approach. Studies show that PE-skills of medical students often need enhancement. The aim of this article was to scope the literature regarding the teaching and research of PE within general practice during undergraduate medical education. We evaluated a wide breadth of literature relating to the content, study design, country of research institution and year of publication.
METHODS
Literature search in Medline along the PRISMA-P protocol was performed by search syntax ("physical examination" AND "medical education" AND "undergraduate" AND general practice) considering Medline MeSH (Medical Subject Heading)-Terms and Medline search term tree structure. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. Full texts were analyzed by publication year, country of origin, study design and content (by categorizing articles along their main topic according to qualitative content analysis of Mayring).
RESULTS
One-hundred seven articles were included. The annual number of publications ranged from 4 to 14 and had a slightly rising trend since 2000. Nearly half of the publications originated from the United States (n = 54), 33 from Canada and the United Kingdom. Overall, intervention studies represented the largest group (n = 60, including uncontrolled and controlled studies, randomized and non-randomized), followed by cross-sectional studies (n = 29). The 117 studies could be assigned to five categories "teaching methods (n = 53)", "teaching quality (n = 33)", "performance evaluation and examination formats (n=19)", "students' views (n = 8)" and "patients' and standardized patients' views (n=4)".
CONCLUSIONS
The present work shows a wide spectrum of teaching and research activities and a certain level of evidence for the effectiveness of individual teaching methods. It can be used as orientation and impulse generator for the further development of medical education in the field of PE.
Topics: Clinical Competence; Clinical Trials as Topic; Curriculum; Education, Medical, Undergraduate; General Practice; Humans; Physical Examination; Students, Medical; Teaching
PubMed: 29178886
DOI: 10.1186/s12909-017-1074-1 -
Journal of Osteopathic Medicine May 2023In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the...
In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the authors that an organ and its function are best evaluated utilizing the following steps: anatomy-based inspection and palpation, imaging, and blood tests. Approximately half of the lateral part of the thyroid is deep to the sternocleidomastoid (SCM) and sternothyroid muscles, which makes it rather difficult to palpate the entire gland utilizing prior physical examination techniques. The goal of this modified anatomy-based thyroid examination is to minimize the number of structures between the physician's fingers and the patient's thyroid by utilizing neck flexion, side bending, and rotation. If one approaches the thyroid from behind the patient, nodules can be missed due to the muscles and transverse processes overlaying them. The incidence of thyroid cancer in the United States is drastically increasing, which demonstrates the importance of a more thorough thyroid palpation. Our anatomy-based approach may allow for earlier detection and therefore earlier treatment.
Topics: Humans; Thyroid Neoplasms; Physical Examination; Palpation
PubMed: 36940275
DOI: 10.1515/jom-2023-0005 -
Medical Science Monitor : International... Sep 2023BACKGROUND The aim of this study was to analyze the correlation and the accuracy of lower-extremity torsion deformities measured by physical examination, CT scan, and...
Comparative Analysis of Physical Examination, CT Scan, and Three-Dimensional Gait Analysis in Evaluating Lower Extremity Torsion Deformities in Children with Cerebral Palsy.
BACKGROUND The aim of this study was to analyze the correlation and the accuracy of lower-extremity torsion deformities measured by physical examination, CT scan, and three-dimensional gait analysis in children with CP. MATERIAL AND METHODS The study group included 72 children with CP with lower-extremity torsion deformities. All subjects were assessed by: 1. physical examination: maximum internal rotation (MIR), maximum external rotation (MER) for hip joint torsion, and transmalleolar axis (TMA) for tibial torsion; 2. CT scanning: femoral anteversion (FAV) and tibial torsion (TT); 3. three-dimensional gait analysis kinematic parameters: single-support phase of femoral rotation, double-support phase of femoral rotation, swing phase of femoral rotation and single-support phase of tibial rotation, double-support phase of tibial rotation, and swing phase of tibial rotation. Statistical analysis was performed using the Pearson correlation test. A significance level of P<0.05 was set. RESULTS In femurs, MIR and MER were correlated with FAV, and the correlation of MER was higher, while physical examination and FAV were not correlated with any kinematic data in gait analysis. In tibias, there was no correlation between TMA and TT, but both TMA and TT were correlated with the gait analysis kinematic data, and the correlation of TT was higher. TMA was more correlated with tibial rotation during swing phase, while TT was more correlated with tibial rotation in single-support phase. CONCLUSIONS Three-dimensional gait analysis can analyze the tibial rotation of children with cerebral palsy, which is highly correlated with CT and physical examination. However, femoral rotation was not associated with CT and physical examination.
Topics: Child; Humans; Gait Analysis; Cerebral Palsy; Physical Examination; Tomography, X-Ray Computed; Lower Extremity
PubMed: 37721931
DOI: 10.12659/MSM.940948 -
American Family Physician Feb 2021Telemedicine can provide patients with cost-effective, quality care. The coronavirus disease 2019 pandemic has highlighted the need for alternative methods of delivering...
Telemedicine can provide patients with cost-effective, quality care. The coronavirus disease 2019 pandemic has highlighted the need for alternative methods of delivering health care. Family physicians can benefit from using a standardized approach to evaluate and diagnose musculoskeletal issues via telemedicine visits. Previsit planning establishes appropriate use of telemedicine and ensures that the patient and physician have functional telehealth equipment. Specific instructions to patients regarding ideal setting, camera angles, body positioning, and attire enhance virtual visits. Physicians can obtain a thorough history and perform a structured musculoskeletal examination via telemedicine. The use of common household items allows physicians to replicate in-person clinical examination maneuvers. Home care instructions and online rehabilitation resources are available for initial management. Patients should be scheduled for an in-person visit when the diagnosis or management plan is in question. Patients with a possible deformity or neurovascular compromise should be referred for urgent evaluation. Follow-up can be done virtually if the patient's condition is improving as expected. If the condition is worsening or not improving, the patient should have an in-office assessment, with consideration for referral to formal physical therapy or specialty services when appropriate.
Topics: COVID-19; Humans; Medical History Taking; Muscle Strength; Musculoskeletal Diseases; Pandemics; Physical Examination; Range of Motion, Articular; Telemedicine
PubMed: 33507054
DOI: No ID Found -
Academic Medicine : Journal of the... Jun 2014
Topics: Clinical Clerkship; Clinical Competence; Curriculum; Education, Medical, Undergraduate; Humans; Physical Examination
PubMed: 24865828
DOI: 10.1097/ACM.0000000000000262 -
Clinical Medicine & Research Dec 2019An eponym in clinical medicine is an honorific term ascribed to a person(s) who may have initially discovered or described a device, procedure, anatomical part,...
BACKGROUND
An eponym in clinical medicine is an honorific term ascribed to a person(s) who may have initially discovered or described a device, procedure, anatomical part, treatment, disease, symptom, syndrome, or sign found on physical examination. Signs, although often lacking sufficient sensitivity and specificity, assist in some cases to differentiate and diagnose disease. With the advent of advanced technological tools in radiological imaging and diagnostic testing, the importance of inspection, the initial steps taught during the physical examination, is often overlooked or given only cursory attention. Nevertheless, in the era of evidence-based and cost-effective medicine, it becomes compelling, and we contend that a meticulously performed history and physical examination, applying the basic tenets of inspection, remains paramount prior to obtaining appropriate diagnostic tests.
DATA SOURCES
PubMed, Medline, online Internet word searches and bibliographies from source text and textbooks. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.
CONCLUSIONS
We describe the historical aspect, clinical application, and performance of medical eponymous signs of inspection found on physical examination during the 18th to 20th centuries.
Topics: Abdomen, Acute; Clinical Medicine; Eponyms; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Physical Examination
PubMed: 31308022
DOI: 10.3121/cmr.2019.1420 -
Journal of Physiotherapy Apr 2017
Topics: Arthrometry, Articular; Biomechanical Phenomena; Disability Evaluation; Humans; Muscle Spasticity; Neurologic Examination; Physical Examination; Range of Motion, Articular
PubMed: 28325481
DOI: 10.1016/j.jphys.2017.01.002