Physiopedia anatomy review 2016

Introduction

Physiotherapists require a high level of anatomy understanding in order to inform appropriate and detailed assessment and treatment of their patients. It is therefore a core learning requirement for many. Physiopedia should reflect this need with high quality articles that are well coordinated with other content on Physiopedia. This review will examine the current anatomy articles available using three case studies and considering what learning needs a therapist may have. To assess the quality of articles, the standards for content review identified on Physiopedia have been used as well as other objectives that identify high quality anatomy content that is specific to physiotherapy. Recommendations for anatomy on Physiopedia will be discussed at the close of this review.

Methods

Musculoskeletal, neurology, and cardiovascular respiratory have been represented by the three case studies. Potential anatomy needs of a physiotherapist have been suggested, with an attempt to cover the different types of structure. For example in the MSK case: muscle, ligament, bone, nerve and artery.

Each article was considered in terms of whether it adhered to Physiopedia’s quality standards, copyright policy and etiquette guidelines. Other factors, which contribute to high quality articles and are specific to physiotherapy were also evaluated. These were:

  • Content is well formatted.
  • Images are included to help further understanding. These images should be varied and of a high standard.
  • The function of the structure is discussed.
  • Clinical skills are discussed or clearly linked to.
  • The article is well categorised.
  • Links are made to other Physiopedia articles and external sources.

Each objective was rated as to whether it was: Complete (2); Partially complete (1); Incomplete (0). If a required article was missing this was documented. A complete article could score a maximum of 22.

A percentage was calculated for the available content for each case. The percentage completion of objectives was calculated for each article and averages of these values were reported for each case. A percentage was calculated for the ‘completeness’ of each objective.

Case 1 - MSK

59-year-old woman who complains of 3 month history of knee pain. The pain is located below apex of the patella and is aggravated by stairs, squats, and sitting for long periods of time. In January she began a fitness program with the goal of losing weight. She has no significant past medical history. She works in admin at a day care.

Anatomy

  • Quadriceps
  • Sartorius
  • Vastus lateralis
  • Patella
  • Tibia
  • Infrapatella fat pad
  • Femoral nerve
  • Obturator nerve
  • Anterior crucial ligament
  • Transverse ligament
  • Medial meniscus
  • Femoral artery
  • Prepatella bursa

Case 2 - Neuro

60-year-old woman admitted following dizziness, collapse and an episode of vomiting. MRI confirmed a medullary infraction. Patient had mild right sided weakness, upper and lower limbs were uncoordinated. Sensation and proprioception intact. Patient had scoliosis which was untreated.

Anatomy

  • Circle of willis
  • Posterior inferior cerebellar artery
  • Vertebral artery
  • Brainstem
  • Cerebellum
  • Spino-cerebellar tract
  • Cranial nerves

Case 3 - CVR

52-year-old man admitted for reverse ileostomy as a day case until patient became septic and was considered for admittance to intensive care. Poor volume output monitoring leading to acute kidney injury. Pt had a probable upper respiratory tract infection. Pt had 4x hernia repairs and a myocardial infraction in 2000.

Anatomy

  • Ileum
  • Kidney
  • Respiratory tract
  • Respiratory muscles
  • Heart

Results

Full results are depicted in the table (coming soon). 38% of content was available for the MSK case, 29% of content was available for the neuro case and 20% of content was available for the CVR case. The most complete article reviewed was anterior cruciate ligament with a score of 86%. There was a duplicate ACL page that was focused on structure and biomechanics that was not reviewed. The average completion score for the MSK case was 74%, the neuro case was 62% and the CVR case was 59%.

All articles were written in English, factually correct, and followed both the copyright policy and Physiopedia etiquette. A brief fact check was performed and reviewed articles were of a high quality. To make a criticism, some of the information provided was basic. In the example of muscle, simple attachments were described and nerve and blood supply were not always included. All but one article had references. Often references were few and some were from poor sources such as websites. There were also large sections of text in some articles without citations.

Formatting was an issue in 6 articles. There was inconsistent use of bold, caps and underline for headings, and bullet points. Images and videos were not always well formatted with the text. No article had no images however all could have benefitted from higher quality images. There were few images of cadavers or the operating table. Assessment and treatment were discussed once each in 2 separate articles. Furthermore, there were 0 links to any techniques discussed elsewhere on Physiopedia. All but one article was categorised. The location of the particular structure was used. Some articles had additional categories not relevant to the categorisation of anatomy. The ACL article had good links to internal and external sources. Other articles were poorly integrated with the rest of Physiopedia and offered few links outside of the website.

Conclusion

There was poor coverage of anatomy across all of the disciplines of physiotherapy. The best coverage was available for the MSK case with 38% of content available and available articles having an average completion score of 74%. Neuro and CVR had less coverage and poorer quality articles. Individual anatomy articles that were missing from Physiopedia were discussed in other pages such as other anatomy articles or clinically relevant anatomy sections of non-anatomy articles. Anatomy pages on Physiopedia rarely report on clinical skills of assessment or treatment which would make our content stand out for physiotherapists.

Limitations

This review has some limitations. For instance, only a small fraction of the anatomy content on Physiopedia has been reviewed and therefore caution should be taken generalising the findings. More anatomy was reviewed for the MSK case than the neuro and CVR cases. One content reviewer developed the additional objectives and reviewed all articles therefore individual biases may impact the results of this review.

Recommendations

Categorisation

Categorisation of articles needs to be uniform and structured across all articles.

Suggestion for how anatomy could be organised:

  • Anatomy – every anatomy page should have this tag
  • Location – A general location can be provided, for example the knee. Multiple tags could be provided in structures the cover multiple joints and regions.
  • Type – muscle, nerve, ligament, etc.
  • Discipline – When appropriate, a tag could be provided when anatomy is specific to a physiotherapy discipline
  • Other

Templates

The templates can be improved by including sections for images, videos, function and clinical skills.

Identify

Existing anatomy pages that need a review need to be flagged so that they are easily identifiable by reviewers and those using the website for research. This could be achieved by adding a header to the top of the page such as those used in other wikis.

A list of important anatomy articles that need to be created should be made, which is then updated regularly. This list should reflect the learning needs of Physiopedia plus and other content on Physiopedia.

Community

Those adding to the anatomy pages should be encouraged to contribute to the topic of the month. A list of suggested articles could be provided.

Those new to editing anatomy pages, such as those in the volunteer orientation program, should be facilitated with guides and exemplar pages.

Database

Due to the limited scope of this review, a database should be created which will detail all anatomy content on Physiopedia as well as identify articles that are missing. Articles included in the database would be quality assessed.