Self-Assessment Quiz Question #4 Pain at night is considered a red flag finding and further medical evaluation is indicated. According to the Agency for Healthcare Policy and Research, night pain might be an indication of: a. Tumor or infection. b. Psychiatric disorder or tumor. c. Immunosuppression or tumor. d. Immunosuppression or infection. Relevant statistics in differential diagnosis Differential diagnosis frequently involves the application of special tests that are used to rule in or rule out a condition. Several of those tests are presented in this course. To use special tests effectively, the statistical properties of sensitivity, specificity, and likelihood ratios should be understood. Sensitivity Sensitivity is the ability of a test to correctly identify patients who have a disease or a condition (Swift et al., 2020). A test that is highly sensitive will identify a very high number of people who have a disease or condition (known as true positives ) while generating a minimal number of false negatives. ( False negatives refers to people who have the disease and should have tested positive; health (Swift et al., 2020). A test with 100% sensitivity would correctly identify all the patients with a disease or condition. A test with 80% sensitivity would detect 80% of the people with the disease, but 20% or people with the test would go undetected (Lalkhen et al., 2008). Specificity Specificity is the ability of a test to identify people who do not have a disease or condition (Swift et al., 2020). A test with high specificity will rule out the maximum number of people who do not have a disease or condition while minimizing the number of false positives. ( False positives refers to people who do not have a disease or condition and should have tested negative (Swift et al., 2020). A test with 100% specificity correctly detects all the patients without a disease or condition. A test with 80% specificity would correctly detect that 80% of people who do not have the disease but would identify 20% of patients as having the disease when they actually do not. Introduction Headaches are one of the most common health conditions. About 60 million Americans experience at least one severe headache each year. It is estimated that between 1.7% and 4% of the world’s population experiences recurrent headaches, making this the third leading cause of disability among the world’s adult population (Dale et al., 2020). About 10% of patients suffering from headaches are diagnosed with chronic daily headaches (Mohammandi et al., 2021). Chronic daily headaches are defined as those that occur 15 days a month or more for a period of three months. They are associated with a poor life quality (Mohammadi et al., 2021). The conversion from primary headaches to chronic daily headaches has been associated with overuse of analgesics (pain medications), hypertension, allergies, diabetes, obesity, and hypothyroidism (Mohammadi et al., 2021).
Sensitivity and specificity are inversely related. As sensitivity increases, specificity tends to decrease and vice versa. The sensitivity and specificity of a test should be considered together to provide a holistic picture of the test’s usefulness (Shreffler et al., 2022). Both sensitivity and specificity are expressed as decimals, so that a sensitivity of 0.80 is the equivalent of 80% test effectiveness. Likelihood ratios Likelihood ratios allow the clinician to determine how using a particular test will alter the probability of a disease or condition being present (Shreffler et al., 2022). The higher the likelihood ratio, the more likely the disease or condition is present. The lower the ratio, the more likely it is that the patient does not have the condition (Shreffler et al., 2022). Likelihood ratios range from zero to infinity. The higher the value of the likelihood ration, the more likely the patient has the condition. For example, if a positive test result has a likelihood ratio of 9.3, this means this result is 9.3 times more likely to happen in a patient with the condition than it would be in a patient without the condition. Self-Assessment Quiz Question #5 If 100 patients known to have a disease were tested and 43 were positive, then the test has a 43%____________. On the other hand, if 100 people with no disease are tested and 96 return a completely negative result, then the test has a 96% ______________. a. Positive likelihood ratio; negative likelihood ratio. b. Negative likelihood ration; positive likelihood ratio.
c. Specificity; sensitivity. d. Sensitivity; specificity. HEADACHE DIFFERENTIAL DIAGNOSIS
Self-Assessment Quiz Question #6 Headaches are considered chronic if they occur ___ days a month or more over a period of ___months.
a. 15; 3. b. 10; 2. c. 15; 6. d. 10; 6.
The brain itself does not feel pain because it has no pain receptors (Carvallaro Goodman et al., 2018). Differential diagnosis of headaches for physical therapists involves determining the type of headache or source of the headache symptoms. Physical therapists are not able to successfully treat all types of headaches. For example, migraine headaches are often addressed via medication, and the role of the physical therapist in their management
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