Evidence-based diagnosis (FS-07)

Introduction video



R. Herbert1, A. Cadogan2, C. Cook3, A. Narciso Garcia4
1Neuroscience Research Australia (NeuRA), Sydney, Australia, 2Private Practice Advance Physiotherapy, Christchurch, New Zealand, 3Duke University, Duke Doctor of Physical Therapy Program, Durham NC, United States, 4Duke University, Department of Orthopaedic Surgery, Durham, United States
Learning objectives:
  1. to be able to describe the logic and process of making an evidence-based diagnosis
  2. to be able to locate and interpret studies of the accuracy of diagnostic tests used by physiotherapists
  3. have some appreciation of issues in the design of studies of diagnostic test accuracy

Description: This symposium is designed to help clinical physiotherapists understand how to make evidence-based diagnoses, and it will help researchers design and conduct studies that can inform clinical diagnosis. It draws on material in books published by three of the presenters [1, 2] as well as recent advances in the field.
Rob Herbert will open the symposium by providing context to the subsequent discussion of diagnosis in physiotherapy practice, including global differences in diagnostic roles of physiotherapists, the need for diagnostic skills to support autonomous practice, the scope of existing research into the accuracy of diagnostic tests used by physiotherapists, and the new DiTA database of diagnostic test accuracy studies relevant to physiotherapy. (10 minutes)
Angela Cadogan will then provide an overview of the process of evidence-based diagnosis. This will be pitched at a level that is accessible to those who have little familiarity with evidence-based diagnosis, but will also allude to complexities that arise when the evidence is weak. Angela will describe diagnostic test accuracy studies and summarise what they can tell us about the accuracy of diagnostic tests. She will briefly outline how different measures of the accuracy of diagnostic tests should be interpreted and can inform the diagnostic process. (15 minutes + 5 minutes discussion)
Chad Cook will discuss issues the in the design, conduct and interpretation of studies of diagnostic test accuracy. He will explore why many tests appear to be inaccurate, examine common errors in the design of studies of diagnostic test accuracy studies, and consider the implications of framing most diagnoses in terms of a pathology of a specific tissue or anatomical structure. (15 minutes + 5 minutes discussion)
Alessandra Garcia will discuss the juxtaposition of diagnosis and prognosis, and will outline the similarity in modelling. She will outline how prognosis has been conspicuously absent in medicine and physiotherapy training programs and why understanding prognosis may minimize overtreatment and unnecessary care. Ale will finish with suggestions on how to balance (carefully) both assessment objectives (diagnosis and prognosis) during patient management. (15 minutes + 5 minutes discussion)
The audience will be given the opportunity to discuss issues raised by the presenters, as well as other issues. (15 minutes)
Rob Herbert will summarise the main themes of the symposium including issues raised by the audience. (5 minutes).
Implications/conclusions: This symposium will contribute to the development of physiotherapists’ ability to use high quality clinical research to inform clinical diagnosis and optimise practice.
[1] Cook C, Hegedus E (2013) Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd edition). Prentice Hall. 
[2] Herbert RD, Jamtvedt G, Mead J & Hagen KB (2011) Practical Evidence-Based Physiotherapy. Elsevier.
Key-words: 1. Diagnosis 2. Prognosis 3. Test accuracy

Funding acknowledgements: Not applicable.

All authors, affiliations and abstracts have been published as submitted.

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