Diagnostic tests recommended for the clinical assessment of patients with wrist complaints, an e-Delphi study

IF 2.1 4区医学 Q2 ORTHOPEDICS

Journal of Hand Therapy Pub Date : 2024-10-01 DOI:10.1016/j.jht.2023.12.002

Patrick Krastman MD , Gerald Kraan MD, PhD , Yara E. van Kooij MSc, PT , Sita M.A. Bierma-Zeinstra PhD , Jos Runhaar PhD , Hand-Wrist Diagnostic Study group

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引用次数: 0

Abstract

Background

Evidence-based practice for history-taking and physical examination in the evaluation of wrist complaints is limited.

Purpose

To create a set of recommended diagnostic tests for the clinical assessment of patients with undifferentiated wrist complaints.

Study Design

An e-Delphi study, following the recommendations on conducting and reporting Delphi studies, was performed.

Methods

In this e-Delphi study, a national multidisciplinary panel of experts was invited to inventory diagnostic tests, based on several case scenarios, for the probability diagnosis in patients (age ≥18 years) with undifferentiated wrist complaints. Four case scenarios were constructed and presented to the expert panel members, which differed in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks) of the complaints. In consecutive rounds, the experts were asked to rate the importance of the inventoried diagnostic tests. Finally, experts were asked to rank recommended diagnostic tests for each case scenario.

Results

Merging all results, the following diagnostic tests were recommended for all case scenarios: ask whether a trauma has occurred, ask how the complaints can be provoked, ask about the localization of the complaints, assess active ranges of motion, assess the presence of swelling, assess the difference in swelling between the left and right, assess the deformities or changes in position of the wrist, and palpate at the point of greatest pain.

Conclusions

This is the first scientific study where experts clinicians recommended diagnostic tests when assessing patients with undifferentiated wrist complaints, varying in age of the patient (35 vs 65 years), location (radial vs ulnar), and duration (6 vs 10 weeks).

查看原文本刊更多论文

对腕部不适患者进行临床评估时建议采用的诊断测试，一项电子德尔菲研究。

背景：在评估腕部不适时，病史采集和体格检查的循证实践非常有限：目的：为腕部未分化症状患者的临床评估制定一套推荐的诊断测试：研究设计：根据德尔菲研究的实施和报告建议，进行了一项电子德尔菲研究：在这项电子德尔菲研究中，邀请了一个全国性多学科专家小组，根据几种病例情景，为腕部主诉未分化患者（年龄≥18 岁）的概率诊断列出诊断测试清单。我们设计了四种不同的病例，并将其提交给专家组成员，这些病例在患者年龄（35 岁 vs 65 岁）、病变部位（桡侧 vs 尺侧）和病程（6 周 vs 10 周）方面各不相同。在连续几轮中，专家们被要求对所列出的诊断测试的重要性进行评分。最后，专家们被要求对每个病例推荐的诊断测试进行排序：综合所有结果，建议对所有病例进行以下诊断测试：询问是否发生过外伤、询问如何引起主诉、询问主诉的定位、评估活动范围、评估是否存在肿胀、评估左右肿胀的差异、评估腕部畸形或位置变化以及触诊疼痛最剧烈的部位：这是第一项科学研究，在这项研究中，临床专家建议在评估未分化的腕部不适患者时进行诊断性测试，这些患者的年龄（35 岁与 65 岁）、部位（桡侧与尺侧）和持续时间（6 周与 10 周）各不相同。

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来源期刊

Journal of Hand Therapy 医学-外科

CiteScore

3.50

自引率

10.00%

发文量

审稿时长

19.2 weeks

期刊介绍： The Journal of Hand Therapy is designed for hand therapists, occupational and physical therapists, and other hand specialists involved in the rehabilitation of disabling hand problems. The Journal functions as a source of education and information by publishing scientific and clinical articles. Regular features include original reports, clinical reviews, case studies, editorials, and book reviews.