老年人膝关节和踝关节位置觉的重测信度

背景：目前国内外关节位置觉的研究主要以青年人为对象,而老年人在不同角度关节位置重现的重测信度研究比较缺乏。目的：观察老年人膝关节和踝关节在不同角度关节复位测试的重测信度。方法：在Biodex system 3等速系统上用被动复位测试法测试28名健康老年人的膝、踝关节本体感觉,以被动复位绝对误差角度作为个体位置觉能力优劣的代表。重测信度评价指标为组内相关系数（ICC）。结果与结论：左右两侧膝关节位置觉测试在不同角度都具有良好的重测信度,ICC值为0.851～0.973;左右两侧踝关节位置觉测试在跖屈与背伸位具有中等以上的重测信度,ICC值为0.742～0.964;左侧踝关节复位的绝对误差角度小于右侧踝关节（P〈0.05）,且左侧（ICC为0.870～0.964）踝关节重测的相关系数高于右侧（ICC为0.742～0.944）。提示老年人膝关节和踝关节位置觉重测的相关性良好,并且左侧踝关节的相关性高于右侧。     

踝关节位置觉和肌肉力觉的重测信度

背景:目前对于踝关节矢状面内本体感觉的研究较为缺乏,踝关节本体感觉的测试没有统一的标准.目的:分析踝关节矢状面内运动位置觉和力觉的重测信度.方法:踝关节位置觉采用对踝关节跖屈5°的被动定位被动复位能力进行测试,肌肉力觉采用受试者踝关节对跖屈肌群25%最大等长峰值力矩值的复制能力进行测试;运用组内相关系数和测量的标准误来判断位置觉和力觉重复测量结果的一致性程度.结果与结论:用来衡量关节位置觉和肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小.常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大.提示用来衡量位置觉和力觉的常数误差重测信度较差,用来衡量位置觉和力觉的可变误差和绝对误差重测信度较好.     

老年人腰椎位置觉重测信度研究

目的观察老年人在站立位时腰椎被动位置觉的重测信度。方法筛选社区老年健康志愿者58例,利用等速训练系统,位置觉重现法,测试腰椎前屈15°、30°、60°和背屈15°目标角度,计算绝对误差角度(AE)。1周后再次测试。计算组内相关系数(ICC)和标准误差(SEM,SEM%)。结果两次测试ICC=0.699～0.833,SEM=1.18～3.26,SEM%=26.84%～37.13%。其中男性ICC=0.462～0.818,SEM=1.60～3.68, SEM%=36.37%～48.78%;女性ICC=0.782～0.891, SEM=1.48～2.71, SEM%=28.48%～33.34%。结论老年人站立位被动位置测试重测信度较好,但误差范围较大,需进一步探索更合适的方法。     

膝骨关节炎患者下肢动静态位置觉的临床测试分析

目的了解Tetrax平衡测试训练系统中下肢关节静态位置觉测试和功能性蹲屈测试训练系统中下肢关节运动位置觉测试的重测信度,明确膝骨关节炎患者下肢关节静态位置觉和运动位置觉之间的关系。方法 利用Tetrax平衡测试训练系统和功能性蹲屈测试训练系统在1周内对30例膝骨关节炎患者进行2次下肢关节静态位置觉测试和运动位置觉测试。结果 双下肢中高频率段摆动系数和的组内相关系数(ICC)为0.95(P<0.001);健侧或症状相对较轻侧、患侧或症状相对较重侧的下肢复位误差平均值的ICC分别为0.59和0.60(P<0.001)。双下肢中高频率段摆动系数和分别与健侧或症状相对较轻侧的复位误差平均值、患侧或症状相对较重侧的复位误差平均值之间的Pearson相关系数为0.40和0.54(均P<0.05)。结论 Tetrax平衡测试训练系统中下肢关节静态位置觉测试重测信度极好,功能性蹲屈测试训练系统中下肢关节运动位置觉测试重测信度较好,两种本体感觉测试方法联合应用可以更为全面地反映膝骨关节炎患者的下肢本体感觉功能状况。     

老年人两侧踝关节本体感觉及其与肌力的相关性研究

目的:对比老年人左右两侧踝关节本体感觉的差异和左右两侧峰力矩之间的差异,分析踝关节本体感觉与其肌力的相关性。方法:在Biodex System3等速系统上用被动复位测试法测试53名正常老年人(其中男23名、女30名;平均年龄66.2±5.1岁)的踝关节本体感觉,本研究以被动复位绝对误差角度作为个体本体感觉能力优劣的代表。同时采用Biodex System3等速系统对踝关节屈肌、伸肌肌群在30°/s的角速度下进行向心测试,主要观察指标为各肌群的峰力矩与相对峰力矩。结果:①左侧踝关节复位的绝对误差角度小于右侧踝关节(P=0.011);②左侧踝关节屈肌、伸肌的峰力矩都小于右侧踝关节(P<0.001),左侧踝关节伸肌的相对峰力矩小于右侧踝关节(P<0.001);③踝关节本体感觉误差和肌力之间没有相关性(P>0.05)。结论:左侧踝关节的本体感觉优于右侧踝关节,而左侧踝关节屈肌与伸肌的峰力矩和相对峰力矩均小于右侧踝关节,老年人踝关节本体感觉功能与肌力无相关性。     

使用Biodex等速测试仪进行踝关节内外翻本体感觉测试的信度研究

目的：探讨使用Biodex system-3多关节等速测试及康复系统（Biodex corporation,Newyork,USA）对踝关节进行内外翻本体感觉测试的信度,为临床应用提供客观依据。方法：由一名测试人员利用同一测试程序分别对40例健康自愿者（被测者）进行踝关节内外翻本体感觉测定,包括主动性关节位置觉,被动性关节位置觉及运动觉;1周后再由另一名测试人员使用同一方法分别对40例被测者进行再次测定。使用组内相关系数（ICC）对所得结果进行信度分析。结果：不同测试人员前后2次对同一被测者踝关节内外翻本体感觉测试的ICC均〉0.75（P〈0.05）。结论：使用Biodex等速测试仪进行踝关节内外翻本体感觉评定的测试人员间信度稳定可靠,对临床关节功能的评定有指导意义。     

等速运动系统测试膝关节本体感觉功能的信度研究

目的 研究等速测试系统评定膝关节位置觉的重复测试信度和不同测试者间测试信度.方法 应用Biodex System 3型等速系统测试16例健康志愿者双侧膝关节位置觉(采用被动角度重建测试法),选择屈膝30°、45°和60°为目标角度,记录受试者实际角度与目标角度间的差值绝对值(误差角).由2名测试者负责重复测试和不同测试者间重复测试,前、后2次测试中间间隔3d.结果 受试者屈膝30°、45°和60°时,其误差角的重复测试信度组内相关系数(ICC)分别为0.728、0.780和0.807,不同测试者间信度Pearson相关系数分别为0.676、0.610和0.705,提示均具有显著相关性(P＜0.05).通过单因素方差分析发现受试者双膝、前后2次测试时各目标角度误差角间差异均无统计学意义(P＞0.05),所有受试者角度重建时误差角的95％可信区间上限均＜3°.结论 采用等速系统评定受试者膝关节位置觉具有较好的重复测试信度,在屈膝30 ～60°范围内选择1个目标角度测试即可,当受试者膝关节角度重建误差角＞3 a时应考虑其临床意义.     

不同目标力矩时距小腿关节肌肉力觉的重测信度(英文)

背景:目前对于距小腿关节矢状面内肌肉力觉的研究较为缺乏,距小腿关节肌肉力觉的测试没有统一的标准。目的:通过分析不同目标力矩时距小腿关节矢状面内运动肌肉力觉的重测信度,探讨距小腿关节肌肉力觉的测量方法。方法:选取跖屈肌群最大等长峰值力矩值的25%,50%和75%作为距小腿关节肌肉力觉的目标力矩值,测试距小腿关节肌肉对这些目标力矩值的复制能力;运用组内相关系数和测量的标准误来判断肌肉力觉的重复测量结果的一致性程度。结果与结论:结果显示用来衡量关节肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小;常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大。在目标力矩较小时,用来衡量肌肉力觉的可变误差和绝对误差重测信度较好。     

老年人握力重测的信度研究

目的研究老年人握力重测的信度,为临床用于评估老年人手部力量的方式、方法提供实验依据。方法采用方便性抽样法选取60名年龄大于65岁的健康老年人,平均年龄为(75.18±6.58)岁。使用JAMAR 30107041型握力器,受试者左、右两手均分别测试握力2次,2次测试间隔时间为7d;以等级相关系数(interclass correlation coefficient,ICC)作为重测信度指标并行统计学分析。结果老年人左手与右手两侧握力重测结果均高度相关,且重复测试信度较高(ICC分别为0.932 6、0.930 8,95%CI分别为0.834 0～0.972 0、0.838 0～0.972 8)。结论健康增龄老年人握力重测信度较高,JAMAR30107041型握力器可作为老年人手部力量评定的简便、快捷、可靠的一种测量工具。     

不同目标力矩时距小腿关节肌肉力觉的重测信度（英文）

背景：目前对于距小腿关节矢状面内肌肉力觉的研究较为缺乏,距小腿关节肌肉力觉的测试没有统一的标准。目的：通过分析不同目标力矩时距小腿关节矢状面内运动肌肉力觉的重测信度,探讨距小腿关节肌肉力觉的测量方法。方法：选取跖屈肌群最大等长峰值力矩值的25%,50%和75%作为距小腿关节肌肉力觉的目标力矩值,测试距小腿关节肌肉对这些目标力矩值的复制能力;运用组内相关系数和测量的标准误来判断肌肉力觉的重复测量结果的一致性程度。结果与结论：结果显示用来衡量关节肌肉力觉的可变误差和绝对误差的组内相关系数均大于0.75,而且测量的标准误相对较小;常数误差的组内相关系数均小于0.75,而且测量的标准误相对较大。在目标力矩较小时,用来衡量肌肉力觉的可变误差和绝对误差重测信度较好。     

Concurrent validity and reliability of two-dimensional video analysis of hip and knee joint motion during mechanical lifting

Movement patterns used during mechanical lifting are usually assessed subjectively by clinicians as a stoop or squat based on visual estimation of joint motion and position. Two-dimensional (2D) video analysis has the potential to objectively measure joint motion during a mechanical lifting task. This study investigated concurrent validity, intrarater, interrater, and test-retest reliability of 2D video analysis using Dartfish software for the measurement of sagittal plane angles at the hip and knee during mechanical lifting. Fifteen healthy female participants (mean age 27.1?±?7.1 years) were recruited to perform mechanical lifting on 2 separate test days. Concurrent validity was determined by comparing 2D derived hip and knee flexion angles to goniometric measures. Intrarater and interrater reliability of the 2D kinematic procedures was determined by using examiners with varying experience in the use of Dartfish software. Between-day test-retest reliability of hip and knee 2D kinematics during mechanical lifting was assessed. Concurrent validity of 2D angle analysis using Dartfish software was supported by high correlations (Pearson r?≥?0.95) and nonsignificant differences between 2D and goniometric measures of sagittal plane hip and knee motion. Both intrarater and interrater reliability values of hip and knee flexion angles were excellent (ICC?≥?0.91). ICCs for test-retest reliability were 0.79 and 0.91 for hip and knee flexion, respectively. These findings and the ease of data capture using this system provide support for the clinical utility of 2D video analysis to provide objective measures of movement patterns at the hip and knee during a dynamic functional task.     

Test-retest reliability of joint position and kinesthetic sense in the elbow of healthy subjects

Proprioception is an important effect measure in neuromuscular function training in physiotherapy. Reliability studies of methods for measuring proprioception are few on joint position sense (JPS) and threshold to detection of a passive movement (TDPM) on the elbow. The aim was to study test-retest reliability of elbow-JPS and elbow-TDPM. A total of 45 healthy subjects participated in the study (mean age 33 years, range 18-57 years). In the active-active test-retest of JPS 26 subjects and in test-retest of TDPM 19 subjects participated. The duration between test and retest was approximately 30 minutes. There was no significant difference (p<0.05) between test and retest. The intraclass correlation coefficients, (ICC, model 2.1) of test-retest on absolute error were 0.59 and 0.69 for JPS and TDPM, respectively, indicating a fair to good reliability. ICCs of variable error were 0.45 for TDPM, indicating a fair to good reliability, whereas for JPS it was 0.007, indicating poor reliability. TDPM can be recommended as an examination tool for absolute error, but to a minor degree for consistency of error. JPS can only be recommended to a minor degree for absolute error, but for consistency of error it is not reliable and can therefore not be recommended.     

Test-retest reliability of joint position and kinesthetic sense in the elbow of healthy subjects

Proprioception is an important effect measure in neuromuscular function training in physiotherapy. Reliability studies of methods for measuring proprioception are few on joint position sense (JPS) and threshold to detection of a passive movement (TDPM) on the elbow. The aim was to study test-retest reliability of elbow-JPS and elbow-TDPM. A total of 45 healthy subjects participated in the study (mean age 33 years, range 18–57 years). In the active-active test-retest of JPS 26 subjects and in test-retest of TDPM 19 subjects participated. The duration between test and retest was approximately 30 minutes. There was no significant difference (p<0.05) between test and retest. The intraclass correlation coefficients, (ICC, model 2.1) of test-retest on absolute error were 0.59 and 0.69 for JPS and TDPM, respectively, indicating a fair to good reliability. ICCs of variable error were 0.45 for TDPM, indicating a fair to good reliability, whereas for JPS it was 0.007, indicating poor reliability. TDPM can be recommended as an examination tool for absolute error, but to a minor degree for consistency of error. JPS can only be recommended to a minor degree for absolute error, but for consistency of error it is not reliable and can therefore not be recommended.     

Reliability of the passive knee flexion and extension tests in healthy subjects

ObjectiveInformation on the reliability of the passive knee extension (PKE) and passive knee flexion (PKF) tests is still incomplete. Moreover, standardization of the 2 test procedures could be enhanced. The present study investigates interrater and test-retest reliability of the modified versions of the PKE and PKF tests to establish whether the level of reliability is sufficiently high to justify their use in scientific studies and clinical practice.MethodsA total of 14 healthy subjects met the selection criteria. The 2 tests were carried out successively by each of the 3 clinicians/raters involved in the study, and each test was repeated 3 times. Two series of such measurements were performed. To evaluate interrater and test-retest reliability of the 2 tests, we calculated the intraclass correlation coefficients (ICCs), the standard errors of measurement, and the smallest detectable differences.ResultsThe PKE and PKF tests showed excellent and good reliability, respectively. Mean ICCs for the PKE were greater than those for the PKF. Mean ICCs for the interrater reliability (0.88-0.93) were higher than those for test-retest reliability (0.84-0.93). No mean ICCs lower than 0.84 were found (test-retest for PKF). The lowest ICCs of 0.73 and 0.75 were registered for the test-retest reliability of PKF in the case of rater 1.ConclusionThese results show excellent and good interrater and test-retest reliability of the PKE and PKF, respectively. The PKE test seems to be slightly more reliable. These findings may help clinicians when using these tests. For research purposes, investigators must critically evaluate whether the presented amount of error is acceptable for a specific setting.     

Reliability of position sense testing assessed with a fully automated system

Position sense testing has increased as a tool for augmenting evaluation of joint injury. In the present study, we investigated the inter‐day reliability for four different types of position sense tests using a fully automated system. The tests included (1) passive presentation/active replication, (2) passive presentation/passive replication, (3) semi‐passive presentation/semi‐passive replication (where semi‐passive denotes passive movement during antagonist muscle contraction), and (4) active presentation/active replication. The absolute difference between presented target and replicated position was used as a measure of position sense accuracy. Ten healthy subjects who were blindfolded and seated with the arm in a moveable rig performed the tests on two occasions, separated by 3–4 days. For each type of position sense test, horizontal abduction from a starting position of 0° (relative to the sagittal plane) to target positions of 32° and 64°, and horizontal adduction from a starting position of 80° to 48° and 16° were conducted. A two‐way ANOVA revealed no differences in absolute error between days or between testing procedures. However, intra‐class correlations (ICC), which are most often used to express test–retest reliability, were moderate at best, ranging from 0·40 to 0·61 for the four types of position sense tests. Hence, the present study indicates that the ability of repositioning tests to detect alterations in proprioceptive function is limited, suggesting that their use in clinical evaluation be approached with prudence.     

Evaluating test-retest reliability in patient-reported outcome measures for older people: A systematic review

ObjectivesThis study aimed to evaluate the components of test-retest reliability including time interval, sample size, and statistical methods used in patient-reported outcome measures in older people and to provide suggestions on the methodology for calculating test-retest reliability for patient-reported outcomes in older people.DesignThis was a systematic literature review.Data sourcesMEDLINE, Embase, CINAHL, and PsycINFO were searched from January 1, 2000 to August 10, 2017 by an information specialist.Review methodsThis systematic review was guided by both the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and the guideline for systematic review published by the National Evidence-based Healthcare Collaborating Agency in Korea. The methodological quality was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist box B.ResultsNinety-five out of 12,641 studies were selected for the analysis. The median time interval for test-retest reliability was 14 days, and the ratio of sample size for test-retest reliability to the number of items in each measure ranged from 1:1 to 1:4. The most frequently used statistical methods for continuous scores was intraclass correlation coefficients (ICCs). Among the 63 studies that used ICCs, 21 studies presented models for ICC calculations and 30 studies reported 95% confidence intervals of the ICCs. Additional analyses using 17 studies that reported a strong ICC (>0.09) showed that the mean time interval was 12.88 days and the mean ratio of the number of items to sample size was 1:5.37.ConclusionsWhen researchers plan to assess the test-retest reliability of patient-reported outcome measures for older people, they need to consider an adequate time interval of approximately 13 days and the sample size of about 5 times the number of items. Particularly, statistical methods should not only be selected based on the types of scores of the patient-reported outcome measures, but should also be described clearly in the studies that report the results of test-retest reliability.     

Comparison of Common Methodologies for the Determination of Knee Flexor Muscle Strength

BackgroundKnee flexion strength may hold important clinical implications for the determination of injury risk and readiness to return to sport following injury and orthopedic surgery. A wide array of testing methodologies and positioning options are available that require validation prior to clinical integration. The purpose of this study was to 1) investigate the validity and test-retest reliability of isometric knee flexion strength measured by a fixed handheld dynamometer (HHD) apparatus compared to a Biodex Dynamometer (BD), 2) determine the impact of body position (seated versus supine) and foot position (plantar- vs dorsiflexed) on knee flexion peak torque and 3) establish the validity and test-retest reliability of the NordBord Hamstring Dynamometer.Study DesignValidity and reliability study, test-retest design.MethodsForty-four healthy participants (aged 27 ± 4.8 years) were assessed by two raters over two testing sessions separated by three to seven days. Maximal isometric knee flexion in the seated and supine position at 90^o knee flexion was measured with both a BD and an externally fixed HHD with the foot held in maximal dorsiflexion or in plantar flexion. The validity and test-retest reliability of eccentric knee flexor strength on the NordBord hamstring dynamometer was assessed and compared with isometric strength on the BD.ResultsLevel of agreement between HHD and BD torque demonstrated low bias (bias -0.33 Nm, SD of bias 13.5 Nm; 95% LOA 26.13 Nm, -26.79 Nm). Interrater reliability of the HHD was high, varying slightly with body position (ICC range 0.9-0.97, n=44). Isometric knee flexion torque was higher in the seated versus supine position and with the foot dorsiflexed versus plantarflexed. Eccentric knee flexion torque had a high degree of correlation with isometric knee flexion torque as measured via the BD (r=0.61-0.86). The NordBord had high test-retest reliability (0.993 (95%CI 0.983-0.997, n=19) for eccentric knee flexor strength, with an MDC₉₅ of 26.88 N and 28.76 N for the left and right limbs respectively.ConclusionCommon measures of maximal isometric knee flexion display high levels of correlation and test-retest reliability. However, values obtained by an externally fixed HHD are not interchangeable with values obtained via the BD. Foot and body position should be considered and controlled during testing.Level of Evidence2b     

Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities

BACKGROUND AND PURPOSE: The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities. SUBJECTS: The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30). METHODS: The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). RESULTS: The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97. DISCUSSION AND CONCLUSION: Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.     

肘关节屈伸肌群等速等张与等长收缩的重测信度

目的：观察健康青年人肘关节屈伸肌群在不同收缩形式中的重测信度。方法：选取28例正常青年者在1周内进行2次肘关节的等速、等张与等长测试,将所得数据进行重测信度评价,指标为组内相关系数（Intraclass Correlation Coefficient,ICC）。结果：①肘关节屈伸肌群在不同收缩形式中均具有良好的重测信度,ICC值为0.738～0.912。②肘关节屈肌重测的相关系数高于伸肌（ICC分别为0.853～0.947与0.738～0.872）。结论：健康青年者肘关节屈伸肌群在不同收缩形式中重测信度良好,肘关节屈肌的相关性要优于伸肌。