If you haven’t had the chance to update your clinical shelf on special tests since your academic days…well, you are probably lost somewhere in left field! Many of the tests that were taught have been out-dated and to be honest, are below par to begin with. This is not anyone’s fault, but just mediocre evidence available. I really enjoy clinical diagnostic tests and if you want to see any past posts from me on this matter, check out the differential diagnosis section here.
The way I keep up with what evidence is available, and best evidence at that, is with two different resources. I use both and each have their advantages and disadvantages. This post is dedicated to share with you what I use and get your opinion on any them, or any other resource you may have!
My favorite new tool is through the CORE (Clinical ORthopedic Exam) App on my Ipod Touch by Clinically Relevant Technologies. I wrote a post (found here) awhile ago on other applications by this company, and as chronicled last time, they do not let you down!
This is a well-organized, detailed and powerful program that does cover all bases that the everyday practitioner can use. Finding a specific test is simple and quick, as each can be found either by the Test Name, Body Region (even through a schematic) diagram) or under Pathology. The investigation is further broken-down to describe the purpose of the test and instructions in written and video format. The videos are high-quality and even load quickly. This is a great addition to the students out there and even young clinicians to compare your hand contact with an expert, rather than just seeing a picture.
The hard work isn’t the former information but really what CRT did to encompass the voluminous amount of research available. This makes the teaching and practicing clinician’s lives much easier! They label the diagnostic values under “Test Property” and go further to link the studies to PubMed so you can see the abstract. I admire this task as I know it is time-consuming and frustrating!
In my opinion, one of the best books available for clinical tests is by Chad Cook and Eric Hegedus, entitled “Orthopedic Physical Examination Tests: An Evidenced-Based Approach”. It can be found here on Amazon. As with most texts and the app described above, it provides the pertinent data including instructions, pictures and diagnostic values (sensitivity, specificity, LR+/-, etc.). They even go as far as providing a CD for various videos to go along with the written instructions.
One of the premier features of the book that I have not seen elsewhere is the inclusion of QUADAS, Diagnostic Odds Ratio (DOR), Utility Score and even a Comments Section. This information is really worth the buy. These additions help the “layman clinician” to further refine the results of the study and strengthen your clinical examination.
-QUADAS is used to assess the quality of diagnostic accuracy in research (basically point out biases). You can find a review of QUADAS here from a guest post that I wrote for MikeReinold.com.
-DOR is a indicator of test performance based on resistance to prevalence. The higher the number is better.
-Utility Score is a number given by the author’s based on their expertise in regards to the strength of the test in overall quality and support of its use clinically. The higher the number is better.
-Comments Section is the opportunity again for the seasoned authors to display their overall opinion of the test based on factors such as methodology and diagnostic value. This really helps put icing on top considering the volume of studies that could have been performed on a single test (i.e. McMurray’s Test). This really saves your back, and eyes, from crunching the data.
If you are in the market for a reference book or application, I highly recommend one or even both of these materials. It will definitely keep you on “top of your game” with both your students, patients and collaboration with physicians of your clinical findings.
What are your thoughts on the CORE app and Cook’s book? Do you use one or the other? Is there another tool out there that you use and you feel is better, or even worse? I would love to hear your feedback.