Free Thoughts

Back to School

Time to go back to school! Fingers crossed for a safe return for all students, employees, and faculty.

I’m looking forward to learning about college teaching, functional magnetic resonance imaging, grantsmanship, and motion capture this semester.

Conference updates:

  • AAOMPT has cancelled their annual conference that was supposed to be in Cleveland, OH this fall. I was set to present an educational session on The Wild West of Dry Needling: Why Research Needs to Catch Up To Clinical Practice. Hopefully this can happen next year!
  • CSM has officially been moved from in person to virtual with all educational and research presentations still to occur. More information coming out in September. A lot of  our work from the spring/summer has been submitted to different sections for posters/platforms. It will be interesting to see how the 100th APTA CSM will be now that it is going virtual.

Journal/Publication Updates:

  • JOSPT has accepted our musculoskeletal imaging article for publication! This will be featured in the December 2020 issue. We’re really excited to share this case! Stay tuned for the ahead of print release and the December issue of  JOSPT.
  • Members of the American Academy of Sports Physical Therapy received some sad news. The International Journal of Sports Physical Therapy is stopping operations and their last issue will come out in December 2020. Personally this journal has meant a lot to me and our group at OSU. My first ever publication was in IJSPT, and last year our fellow in training won best case report in the journal. We currently have a case report under review after a revision. Fingers crossed it makes it into print before the end of the year.

Podcasts:

JOSPT systematic reviews

Ever since our group published a systematic review in JOSPT and JMMT, I’ve become a go to person for systematic reviews and bit of a nerd when it comes to systematic review methodology. In Patient education for Patellofemoral Pain: A systematic Review I love how they reported the results from their meta-analysis but advocate caution due to high statistical heterogeneity of the results. So much caution, that they didn’t even put meta-analysis in the title.

It tends to be a faux pas in systematic reviews to report meta-analysis when there is high statistical heterogeneity. This happened to us when it came to our systematic review in JMMT on the sharp-purser test, where we performed meta-analysis but could not report it due to the high statistical heterogeneity between studies. In hindsight, I wish we could have done what they did in Patient education for Patellofemoral Pain: A systematic Review, and will consider it for future systematic reviews.

Evidence into practice:

  • If you’re looking to bone up on how to interpret the evidence and use it in practice, Dr. Kamper has an excellent series of papers titled Evidence into Practice.
  • The latest one was released in the August issue of JOSPT on understanding the type of research questions.

Those are my highlights before the start of the fall semester.

Best wishes,

 

Photos from the weekend:

Together As Buckeyes

Rocking the Homage ‘Together As Buckeyes’ shirt this weekend with portion of proceeds going to The OSU Wexner Med Center’s Greatest Need Fund.

Weekend read recommendations:

Weekend Vibes

Bike riding + fire + grilling + grant writing + manuscript writing + soccer

It’s been fun to see the response to our systematic review on the Sharp-Purser Test!

 

 

The article itself has been getting a lot more attention since being published last fall.

 

The commentary on the article on Twitter has been fun to read:

 

The Sharp-Purser Test may not be as Sharp as we thought!

The Sharp-Purser test is often used by physical therapists to identify atlantoaxial instability, however experts argue that it lacks reliability and validity along with concerns of safety.

  • The Sharp-Purser Test: A useful Clinical Tool or an Exercise in Futility and Risk
    • Jim Meadows published this article in the Journal of Manual and Manipulative Therapy in 1998 and it highlights 6 reasons we should reconsider using the Sharp-Purser Test in clinic.
    • The main points can be boiled down to this
      1. The test has not been studied in patients post trauma, only in patients with ankylosing spondylitis, rheumatoid arthritis and Down’s Syndrome.
      2. If paresthesia is produced with cervical flexion, which is rare, the Sharp-Purser maneuver should not be performed and could be dangerous.
      3. Paresthesia in more than one limb with cervical flexion would warrant a referral to another provider/imaging and then there is no need to perform the Sharp-Purser maneuver.
      4. Jim argues that the test is unlikely to change our clinical management, and in all scenarios the patient would be referred for more testing making the test obsolete with availability of x-rays, MRI, and CT scans.

As a physical therapist that’s a Fellow of AAOMPT, I always felt better about performing cervical manipulations if my examination revealed a negative Sharp-Purser Test.

  • It’s because of this case I no longer use the Sharp-Purser Test and primarily use a basic range of motion assessment and neurological screen for my physical exam in conjunction with the patient’s history.
    • Check out a great article by Dr. Sizer and colleagues on Medical Screening for Red Flags for patients referred for spine pain and considerations for your own examination.
    • I now agree with Jim, that if a patient demonstrates myelopathic signs and symptoms with cervical flexion, there really is no need to perform the Sharp-Purser maneuver since no matter what you’re going to refer the patient for imaging.

My experience with the Sharp-Purser Test motivated my colleagues and I to perform a systematic review with the goal of identifying all study types (including case reports) and was published in the Journal of Manual and Manipulative Therapy in 2019.

Our findings are highlighted in this infographic (Download full size PDF here: Sharp Purser Test Infographic):

We included all study types that performed the Sharp-Purser Test on a patient or participant, including RCTs, validity and reliability studies, and case reports.

Of the case reports we included, a negative Sharp-Purser Test often preceded manual therapy treatment to the neck or thoracic spine, whereas a positive Sharp-Purser Test  led to referral for more imaging.

Several randomized controlled trials that involved cervical/thoracic manipulation or dry needling used the Sharp Purser Test to exclude participants with potential cervical instability, however there’s no evidence that they ever excluded anyone.

Despite mounting evidence that the Sharp-Purser Test lacks validity, reliability and may be unsafe to use clinically, it still remains a widely used test.

In a very interesting musculoskeletal imaging case published in JOSPT a negative Sharp-Purser Test (along with other tests) preceded a diagnosis of vertebral artery dissection that was confirmed with imaging.

  • In this case, the negative Sharp-Purser Test likely decreased the clinician’s suspicion of upper cervical instability, however it’s tough to know if a negative test can help you rule out upper cervical instability.
  • Our systematic review, found a range of sensitivities reported in the literature for the Sharp-Purser Test from as low as 0.19 to as high as 1.00.

Lastly, we could not find any evidence in the scientific literature that that the Sharp-Purser maneuver is unsafe, however if the transverse ligament is compromised it may be a risky test to perform, and carry unnecessary risk if you’re going to refer the patient for imaging anyway.

Check out our systematic review for more information and download the PDF version of our infographic here: Sharp Purser Test Infographic.

Best wishes,

CJM

 

 

 

Introducing my new blog!

Working for OSU has it’s perks! Like the ability to start a blog with full access to tools of WordPress.

When I think of a blog, I often think of two blogs from the fictional Sherlock Holmes series on BBC, where Sherlock Holmes has a rarely viewed blog on the Science of Deduction and his colleague Dr. Watson has a successful personal blog where he details their adventures.

I want this blog to fall somewhere in between.

A blog where readers can find out about my ongoing research, my journey as a physical therapist and PhD student, as well as my commentary on various articles, travel and presentations.

So if you want to follow this blog, please check back regularly or you can subscribe with e-mail in the sidebar to the right for new posts!

Best wishes,

CJM