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Assessment and Competence
Published in Ramesh Mehay, The Essential Handbook for GP Training and Education, 2021
Nigel De Kare-Silver, Ramesh Mehay
Validity is about relevance: does the assessment measure what you are trying to measure? For instance, you will remember from Miller’s Pyramid that an MCQ has high validity if all we are simply trying to assess is a candidate’s level of knowledge. However, it has low validity if you’re going to use it to test how good they are at doing a knee examination. For a knee examination, you would have to see them doing it!
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The knee is a complex joint, and its evaluation can be a challenge even to the most experienced. The main components of a complete knee examination are a detailed history, followed by a systematic clinical examination. Relevant imaging and laboratory investigations, as suggested by the history and clinical examination, may be obtained to arrive at a diagnosis.
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
A careful history of the mechanism of injury and the subsequent events is essential, as knee examination is often difficult or impossible immediately afterwards due to acute pain. Always lie the patient on an examination trolley properly undressed.
A novel clinical test for assessing patellar cartilage changes and its correlation with magnetic resonance imaging and arthroscopy
Published in Physiotherapy Theory and Practice, 2019
Paul Khoo, Abhijeet Ghoshal, Damien Byrne, Ramesh Subramaniam, Raymond Moran
Our results reveal that the PST has high sensitivity and specificity, which represents superiority over the CS in the diagnosis of CMP. This is confirmed through the study by Doberstein, Romeyn, and Reineke (2008) who compared the diagnostic value of the CS in the assessment of CMP in 106 patients using arthroscopic examination of the patellofemoral joint as the “gold standard.” A positive test was indicated by the presence of pain sufficient to prevent the patient from maintaining a quadriceps contraction against resistance for longer than 2 s. They found the CS to have both low sensitivity (39%) and specificity (67%) in the assessment of CMP. The authors also felt that if the CS was performed with considerable manual pressure, it could be painful and result in a false positive result. Based on these findings, the authors recommended against using the CS routinely during knee examination.
Is synovitis detected on non-contrast-enhanced magnetic resonance imaging associated with serum biomarkers and clinical signs of effusion? Data from the Osteoarthritis Initiative
Published in Scandinavian Journal of Rheumatology, 2018
LA Deveza, VB Kraus, JE Collins, A Guermazi, FW Roemer, MC Nevitt, DJ Hunter
Physical examination of both knees was performed at baseline, including clinical signs of effusion (i.e. bulge and patellar tap signs). The bulge sign is commonly used in clinical practice to detect small effusions, while the patellar tap sign is best for large effusions (28, 29). Examiners received central training and performed knee examination under supervision of physician examiners at each site. At least one examination performed by each examiner per month was either repeated or observed by the local investigator for quality assurance. The examinations were performed with the participants lying supine on an examination table in a relaxed, comfortable position with the knees extended to neutral and all muscles relaxed. Signs were scored as present or absent in each knee. Tests were repeated once by the same examiner to confirm findings (whether positive or negative) and were recorded as positive if confirmed in the second examination. Data regarding the reliability of these examinations were not available but interrater reliability of bulge and patellar tap signs has been previously reported as adequate (prevalence-adjusted bias-adjusted kappa = 0.78 for patellar tap and intraclass correlation coefficient = 0.97 for bulge sign) (30).
Setting defensible standards in small cohort OSCEs: Understanding better when borderline regression can ‘work’
Published in Medical Teacher, 2020
Matt Homer, Richard Fuller, Jennifer Hallam, Godfrey Pell
The analysis summarized in Table 1 suggests that BRM provides a feasible, and defensible approach to standard setting in these exams for a large percentage of stations (86%). A good example of where borderline regression is not doing so is shown in Figure 2, a knee examination station (Year 5, 2018, 22 candidates). The problem here is lack of spread in the global grades (only two of five possible grades employed), which leads to a low R-squared (=0.14) and subsequently to concern about the accuracy of the BRM pass mark for this administration.