Reliability of a functional clinical test battery evaluating postural control, proprioception and trunk muscle activity

OBJECTIVE: The purpose of this study was to examine the repeatability and reproducibility of the different tests of a clinical test battery evaluating the components of functional spinal stability: postural control (sway velocity data), proprioception (repositioning error), and muscle activation (electromyographic data). DESIGN: A total of 28 healthy volunteers participated in this study: 14 in the repeatability study and 14 in the reproducibility study. Each subject was tested three times, with an interval of 1 wk between the test sessions. The intraclass correlation coefficients and the standard error of the measurements as a percentage of the grand mean were calculated. RESULTS: The intraclass correlation coefficients for both the repeatability and the reproducibility evaluation showed good to excellent reliability for all variables (intraclass correlation coefficient, 0.60-0.98). The standard error of the measurements as a percentage of the grand mean ranged from 0.004 to 19.94. CONCLUSIONS: The functional clinical test battery investigated in this study proved to be a reliable tool in the assessment of healthy subjects. The evaluation of postural control, proprioception, and muscle activity (coordination, stabilization, maximal voluntary isometric contraction, endurance, and flexion-relaxation) showed good to excellent repeatability and reproducibility. Further analysis of the reliability of these variables in a clinical setting, particularly in patients with low back pain, seems appropriate.     

A clinical test of lumbopelvic control: Development and reliability of a clinical test of dissociation of lumbopelvic and thoracolumbar motion

LBP is often associated with changes in motor control. Some subgroups of LBP have been argued to have a compromised ability to dissociate lumbopelvic movement from that of the thoracolumbar junction. Clinical methods to evaluate this task may aid identification of this LBP subgroup and determine the utility of this information to guide clinical interventions. The study aimed to develop a clinical test to assess the ability to dissociate lumbopelvic movement from that of the thoracolumbar junction, and to evaluate the inter-rater reliability of the test in individuals with and without low back pain (LBP) when performed by experienced and novice therapists. A clinical scale was developed to characterise quality of performance of lumbopelvic motion with limited motion at the thoracolumbar junction. Inter-tester repeatability was measured in three experiments. Test outcomes for pain-free controls were compared between three assessors with different amounts of clinical experience. Test scores for LBP participants were compared between two assessors, and between assessments undertaken from video recordings. Agreement between assessors was tested with weighted Kappa Coefficient. The test had acceptable reliability in pain-free and LBP participants, but was better when undertaken by experienced therapists. Kappa index ranged from 0.81 to 0.66 for live assessments, and 0.62 for video assessments. The results showed that the test is reliable when performed by experienced assessors. The test can assess thoracolumbar movements in different groups of individuals.     

Reliability and agreement of 5 Ergo-Kit functional capacity evaluation lifting tests in subjects with low back pain

OBJECTIVE: To assess interrater reliability and agreement of 5 Ergo-Kit functional capacity evaluation lifting tests in subjects with low back pain (LBP). DESIGN: Within-subjects design, with 2 repeated measurements. SETTING: Academic medical center in The Netherlands. PARTICIPANTS: Twenty-four subjects (10 men, 14 women) with LBP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Five Ergo-Kit lifting tests (2 isometric, 3 dynamic) were assessed on 2 occasions (t1, t2), by 2 different raters (R1, R2). The interval between the test sessions was 3 days. Interrater reliability level was expressed with the intraclass correlation coefficient (ICC), and the level of agreement between raters with the standard error (SE) of measurement. RESULTS: ICCs means (reliability) of isometric and dynamic Ergo-Kit lifting tests ranged from .94 to .97, and SE of measurement values (agreement) ranged from 1.9 to 8.6 kg. CONCLUSIONS: There was good reliability and agreement between raters of the isometric and dynamic Ergo-Kit lifting tests in subjects with LBP, which supports the use of these tests to assess functional lifting capacity.     

Ultrasound Quantification of Acetabular Rounding in Hip Dysplasia: Reliability and Correlation to Treatment Decisions in a Retrospective Study

Currently, acetabular rounding is only subjectively assessed on ultrasound for developmental dysplasia of the hip. We tested whether acetabular rounding can be quantified reliably and can distinguish between hips requiring and not requiring treatment. Consecutive infants (n = 90) suspected of having dysplasia of the hip, seen at a pediatric orthopedic clinic, were separated into four diagnostic categories (normal, borderline but resolved, treated by brace, treated surgically). Acetabular rounding was assessed by semi-quantitative grade (0 = nil, 1 = mild, 2 = moderate, 3 = severe) by three observers and by direct measurement of acetabular radius of curvature (AROC) by two observers. Inter-observer reliability of rounding grade was poor (κ = 0.30–0.37). AROC had an inter-observer intra-class correlation coefficient of 0.84 and coefficient of variation of 29%–34%. Mean AROC was significantly higher for hips requiring treatment than for those not requiring treatment (3.3 mm vs. 1.6 mm, p = 0.007). AROC reliably quantifies an observation currently being made subjectively by radiologists and surgeons, and may be useful as a supplementary ultrasound index of dysplasia of the hip in future prospective studies.     

Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests

Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests.

Objective

To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain.

Design

Prospective repeated-measures design.

Setting

Private practices for physical therapy and hospital outpatient physical therapy divisions.

Participants

Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder.

Interventions

Not applicable.

Main Outcome Measures

Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test.

Results

The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach α coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found.

Conclusions

These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests’ outcomes, however, is questionable.     

A systematic review and meta-analysis of dynamic tests and related force plate parameters used to evaluate neuromusculoskeletal function in foot and ankle pathology

Background

Force plates are commonly used to register ground reaction forces in order to assess neuromusculoskeletal function of the ankle joint. There exists a great variety in dynamic tests on force plates and in parameters calculated from ground reaction forces in order to evaluate neuromusculoskeletal function of the ankle. The purpose of this study was to evaluate which dynamic tests and force plate parameters are most sensitive to differences between and within groups with regard to foot and ankle pathology.

Methods

A systematic review and meta-analysis was performed evaluating studies that compared force plate parameters of dynamic tests between patients with foot and ankle pathology, and healthy controls. Data were pooled per parameter and test category. Given the clinical heterogeneity, we constructed comprehensive recommendation criteria to indicate a ‘proven relevant parameter’ or ‘candidate relevant parameter’.

Results

A total of 34 studies were included, and 58 relevant comparisons were identified. Results were subdivided by test category: walking, running, landing (in anteroposterior direction), sideways (movement in mediolateral direction) and termination (movement in anteroposterior direction). The ‘walking’ test showed significant differences in a great variety of pathologies, with the magnitude and timing of the ‘second peak vertical force’ as proven relevant parameters. The ‘landing’ test detected differences due to ankle instability, with ‘time to stabilization in anteroposterior direction’ as proven relevant parameter.

Interpretation

This study provides recommendations concerning the potential of various dynamic tests and force plate parameters as a tool to compare neuromusculoskeletal function between patients with foot and ankle pathology and healthy controls.     

The novel association between red complex of oral microbe and body mass index in healthy Japanese: a population based cross-sectional study

Microbiota has been thought to be one of important environmental factors for obesity or Type 2 diabetes mellitus. Among oral microbe, Porphyromonas gingivalis, Treponema denticola and Tannellera forsythia are known as risk factors, so called red complex, for periodontitis. Red complex could also be a risk factor for obesity. However, recent study indicated that obesity was not improved by periodontal therapy. Thus, we performed a cross sectional study to reveal the association of oral microbe with body mass index in a healthy population. Healthy individuals were randomly recruited. The infections of oral microbe were identified by Taqman polymerase chain reaction. The relationships between number of red complex and body mass index or waist circumference were analyzed. Two hundred and twenty-two apparently healthy Japanese were enrolled. BMI and waist circumference as well as age, periodontitis, number of brushing teeth were significantly associated with the number of red complex after adjusting covariance. The effect size of body mass index or waist circumference was 0.023 (p = 0.028) or 0.024 (p = 0.024), respectively. Body mass index and waist circumference were independently associated with the number of red complex among apparently healthy Japanese. The current observation implies the possibility that oral microbe was associated with obesity in healthy population.     

A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up

ObjectiveThe primary objective of this study was to compare the long-term (1-year follow-up) effects of the McKenzie method and motor control exercises on trunk muscle thickness in people with chronic low back pain (LBP) and a directional preference.DesignRandomized controlled trial.SettingA secondary public health facility in Sydney, Australia.ParticipantsSeventy adults with greater than 3-month history of LBP and a directional preference.InterventionsParticipants were randomized to receive 12 treatments of either the McKenzie method or motor control exercises over 8-weeks.Outcome measuresMuscle thickness of the transversus abdominis, obliquus internus, and obliquus externus measured from ultrasound images. Secondary outcomes included function, perceived recovery, and pain. Outcomes were collected at baseline, post intervention at 8-weeks, and at 1-year follow-up by blinded assessors. The current paper focuses on the 1-year follow-up.ResultsFifty-eight participants completed data collection for the primary outcome at 1-year. There were no significant between group differences for changes in trunk muscle thickness for any of the three investigated muscles: transversus abdominis [3%, 95% confidence interval (CI): ?5%, 11%], obliquus internus [?4%, 95% CI: ?9%, 2%] and obliquus externus [3%, 95% CI: ?4%, 11%]. Similarly, there were no significant differences between groups for the secondary outcomes of function, perceived recovery and pain.ConclusionTrunk muscle thickness, function, perceive recovery and pain are similar between patients receiving McKenzie method or motor control exercises at a 1-year follow-up in a population of people with chronic LBP and a directional preference.
Clinical Trials Registration number CTRN12611000971932.     

Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects

Abstract

Purpose: Ice sledge (or sled) hockey is a fast-paced sport that enables individuals with physical disabilities to play ice hockey. As the attraction to the sport continues to rise, the need for developing better equipment and installing preventative measures for injury will become increasingly important. One such injury includes skin pressure ulceration. Method: A total of 26 subjects including active controls and those with spinal cord injury, multiple sclerosis, limb amputation and traumatic brain injury were studied using a pressure mapping device at the 2012 National Disabled Veterans Winter Sports Clinic to determine the risk for skin pressure ulceration and the impact of cushioning and knee angle positioning on seated pressure distributions. Results: Sledge hockey athletes may be at increased risk for skin pressure ulceration based on seated pressure distribution data. This experiment failed to demonstrate a benefit for specialty cushioning in either group. Interestingly, knee angle positioning, particularly, knee extension significantly lowered the average seated pressures. Conclusions: When considering the risk for skin pressure ulceration, knee angle positioning is of particular clinical importance. More research is warranted, specifically targeting novel cushion and sledge designs and larger groups of individuals with sensory loss and severe spinal deformities.

• Implications for Rehabilitation

• Ice sledge (or sled) hockey is a fast-paced and growing adaptive sport played at the Paralympic level.

• Rehabilitation professionals should consider the potential for skin ulceration in this population of athletes.

• The effects of cushioning used in the sledge design warrants further investigation.

• Knee angle positioning; particularly, knee extension significantly lowers seated pressures and may reduce the potential for skin ulceration.

     

Incidence and predictors of screen failures due to positive urine tests for alcohol, drugs of abuse, and cotinine among normal healthy research volunteers (NHRVs): analysis of data from 687 NHRVs screened at a large clinical pharmacology unit in the United States

Accurate medical histories for all NHRVs screening to participate in clinical pharmacology trials are vital to ensure volunteers' safety, and integrity of study results. Evidence from previous studies illustrate the potential for NHRVs to misrepresent their histories, especially when monetary incentives are offered, and the need to objectively verify these self-reported histories whenever practical. This study demonstrates that among the sample participants, all of whom self-reported a negative history of drug and alcohol abuse and tobacco smoking, 16% failed urine testing for either alcohol and drugs of abuse (6%), or cotinine (11%). Male sex and increased number of screenings in the preceding 12 months were significantly associated with increased odds for urine screen failure whereas increased enrollments in the same time period and increased study stipend decreased the same odds. These results emphasize the importance of diligently screening NHRVs participating in phase I clinical trails.     

药物灌注球囊以及股动脉逆行内膜剥脱术治疗下肢动脉粥样硬化闭塞症腔内治疗术后再狭窄

目的:探讨下肢动脉粥样硬化症(arteriosclerosis obliterans,ASO)支架植入术后再狭窄治疗策略的可行性及安全性。方法:回顾分析2016年1月1日—2016年7月1日5例行药物球囊灌注后支架植入术及2012年6月1日—2016年7月1日15例股动脉逆行内膜剥脱术的下肢ASO支架植入术后再狭窄患者的临床资料,分析手术效果及随访期内并发症的发生情况,评价上述治疗手段的可行性、安全性。结果:20例患者行药物球囊灌注后支架植入术或股动脉逆行内膜剥脱术后,远端肢体得到充分的血流灌注,患肢皮温较前明显改善,足背动脉可触及搏动;患者自觉患肢温暖,疼痛症状明显减轻,术后随访均无再狭窄发生。结论:药物球囊灌注后支架植入术及股动脉逆行内膜剥脱术治疗下肢ASO支架植入术后再狭窄安全有效,能降低支架植入术后再狭窄的风险。