Intra-rater and inter-rater reliability,minimal detectable change,and construct validity of the Edinburgh Visual Gait Score in children with cerebral palsy

BackgroundThe Edinburgh Visual Gait Score (EVGS) has been used for observational gait assessment in children with cerebral palsy (CP). However, the measurement error of the EVGS and its detailed relationship with gross motor function remain unclear.Research questionsThis study aimed to confirm the intra-rater and inter-rater reliability as well as the minimal detectable change (MDC) values for the EVGS with the use of the video analysis software and examine the relationship between the EVGS and the Gross Motor Function Measure 66 (GMFM-66) with regard to construct validity.MethodsThis cross-sectional study was conducted for 62 children (mean age 11.3 ± 3.9 years) with spastic CP at Gross Motor Function Classification System (GMFCS) level I (32 children), II (25 children) or III (5 children). Three raters independently scored the EVGS using Kinovea video analysis software. The intra-rater and inter-rater reliability were calculated using intra-class correlation coefficients (ICC_2,1), and the MDC₉₀ was calculated using standard error of measurement. The construct validity was examined by correlating the EVGS with the GMFM-66.ResultsThe EVGS showed good or excellent reliability within each rater (ICC_2,1 = 0.90–0.97) and between raters (ICC_2,1 = 0.91). The MDC₉₀ of the EVGS ranged from 3.6 to 6.0. There was a significant correlation between the EVGS and the GMFM-66 (r = − 0.69 to − 0.73, p < 0.001).SignificanceThe intra-rater and inter-rater reliability of the EVGS is sufficient for observational gait assessment. The high correlation between the EVGS and the GMFM-66 supports its construct validity. The authors propose an MDC of 6.0 for the EVGS. These results can help in the application of EVGS to children with CP at GMFCS level I-II with mild to moderate gait pathology, as there were few children with CP at GMFCS level III.     

Hand-held dynamometry strength measures for internal and external rotation demonstrate superior reliability,lower minimal detectable change and higher correlation to isokinetic dynamometry than externally-fixed dynamometry of the shoulder

ObjectivesTo investigate inter and intra-rater reliability of hand held (HHD) and externally fixed (EFD) dynamometry for shoulder internal (IR) and external rotation (ER) strength and their correlation to isokinetic testing.DesignWithin participant, inter and intra-rater reliability study.ParticipantsTwenty active, healthy male and female participants underwent testing by two examiners.Outcome measuresIntra-class coefficients (ICC), percentage standard error of measurement (%SEM), and percentage minimal detectable change (%MDC) were calculated for inter-rater, intra-day and intra-rater, inter-week reliability. Maximum and average of three repetitions were compared to the isokinetic results at three speeds (60°/sec, 180°/sec, 240°/sec) for both concentric and eccentric contractions.ResultsInter and intra-tester values demonstrated good to high agreement (HHD, ICC range = 0.89–0.97, %SEM = 4.80–8.60%, %MDC = 13.29–23.70%; EFD, ICC = 0.88–0.96, %SEM = 6.60–11.00%, %MDC = 18.40–30.04%). HHD and EFD showed moderate to very strong correlations to the isokinetic testing (HHD, r = 0.45–0.86; EFD, r = 0.49–0.83).ConclusionsThe results of this study indicate that both EFD and HHD are suitable for clinical practice and research. Hand-held dynamometry is preferred due to its higher intra- and inter-rater reliability and smaller MDC and lower SEM.     

Trunk muscle endurance tests: Reliability, and gender differences in athletes

Adequate trunk muscle endurance may play an important role in injury-free performance among athletes. However, reliability of tests of isometric trunk muscle endurance in common use has not been clearly established and few studies have reported normative data for athletes. This study first examined intra-rater and inter-rater reliability of the side bridge endurance test and a test of trunk flexor endurance in a group of non-athletes, then measured performance of a group of elite athletes on tests of trunk muscle endurance commonly used in the clinic. The side bridge endurance test and the trunk flexor endurance test were found to have high intra-rater and inter-rater reliability, albeit with relatively large standard error of measurement (S.E.M.) values. In contrast with previous studies of non-athletes, male athletes had equivalent holding times on the Biering–Sørensen trunk extensor endurance test to those of female athletes. However, female athletes had significantly lower holding times on the side bridge endurance tests than their male counterparts. The implication of the significant difference in endurance performance between male and female athletes in some muscle groups but not others is that testing and training of trunk muscle endurance should be ‘multidirectional’ for all athletes who aim to optimise performance and minimise injury risk.     

Test-retest reliability and minimal detectable change of ankle kinematics and spatiotemporal parameters in MS population

BackgroundMany people with multiple sclerosis (pwMS) experience walking impairments often including foot drop, evident as either reduced dorsiflexion at initial contact and/or at the swing phase of the gait cycle. To measure even subtle differences in ankle kinematics, 3D gait analysis is considered a ‘gold’ standard. However, the psychometric properties of ankle kinematics in the MS population have not yet been examined.ObjectiveThe aim of the study was to examine test-retest relative and absolute reliability of sagittal ankle kinematics and spatiotemporal parameters in two groups of pwMS with different levels of walking impairment.MethodsTwo groups of pwMS underwent 3D gait analysis on two occasions 7–14 days apart. Group A consisted of 21 (14 female) people with Expanded Disability Status Scale (EDSS) 1–3.5 and group B consisted of 28 participants (14 female) with EDSS 4-6. The Intraclass Correlation Coefficient (ICC_2,2), standard error of measurement (SEM) and minimal detectable change (MDC_95%) were calculated for peak dorsiflexion (DF) in swing, ankle angle at initial contact (IC), gait profile score (GPS), walking speed, cadence and step length.ResultsBoth groups presented ‘excellent’ ICC values (>0.75) for DF in swing, IC and step length of most and least affected limbs, walking speed and cadence, with GPS for both limbs exhibiting ‘fair’ to ‘good’ ICCs (0.489–0.698). The MDC_95% values for all ankle kinematic parameters in group A were lower (1.9°–4.2°) than those in group B (2.2°–7.7°).ConclusionThe present results suggest that ankle kinematic and spatiotemporal parameters derived from 3D gait analysis are reliable outcome measures to be used in the MS population. Further, this study provides indices of reliability that can be applied to both clinical decision making and in the design of studies aimed at treating foot drop in people with MS.     

The shoulder endurance test (SET): A reliability and validity and comparison study on healthy overhead athletes and sedentary adults

ObjectivesThe primary purpose was to examine the reliability of a new shoulder physical performance test -the Shoulder Endurance Test (SET)- in young healthy overhead athletes and sedentary adults and to provide preliminary reference values. The secondary objective was to determine whether there are differences on SET scores based on groups, sides and days. The third objective was to evaluate the relationship between the SET and shoulder rotational isometric strength in both groups.DesignReliability and validity study.SettingLaboratory setting.ParticipantsA total sample of 92 participants volunteered to participate in this study (30 healthy overhead athletes - 62 sedentary adults).Main outcome measuresWe used a two-session measurement design separated by seven days to evaluate the reliability. We calculated intraclass correlation coefficients to determine relative reliability and used standard error of measurement and minimal detectable change to quantify absolute reliability.Systematic differences in SET scores between groups, days and sides were analysed with a two-way analysis of variance (ANOVA) for repeated measures. To check for systematic differences within groups between day 1 and day 2, a Wilcoxon Signed Rank Test was performed. Relationship between shoulder rotational isometric strength and the SET was determined using the Spearman Rank test (r_s).ResultsRelative reliability was high to very high in both groups (intraclass correlation coefficient [2,1] range = 0.78–0.93) and absolute reliability was clinically acceptable. The standard error of measurement varied from 10.7 s to 16.45 s. The minimal detectable change ranged from 29.6 s to 45.6 s. Weak correlations were found between the SET and isometric shoulder rotational strength (r_s range = 0.309–0.431).Resultsof the ANOVA for repeated measures showed a significant two-way interaction effect for day x groups (p = 0.020) and a significant main effect for side (p= < 0.001). Results of the Wilcoxon Signed Rank Test showed no systematic differences in group 1 between day 1 and day 2 for both sides (p = 0.79 dominant side; p = 0.66 non-dominant side).ConclusionsThe SET is a reliable clinically applicable shoulder physical performance test in young adult overhead athletes and sedentary adult.     

Interrater reliability of the cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain

ObjectiveExamine the interrater reliability of cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain.DesignSingle-group repeated-measures design for interrater reliability.SettingOrthopaedic physical therapy clinics.ParticipantsTwenty-one patients with a primary complaint of shoulder pain underwent a standardized examination by a physical therapist (PT). A PT conducted the first examination and one of two additional PTs conducted the 2nd examination.Main outcome measuresThe Cohen κ and weighted κ were used to calculate the interrater reliability of ordinal level data. Intraclass correlation coefficients model 2,1 (ICC2,1) and the 95% confidence intervals were calculated to determine the interrater reliability.ResultsThe kappa coefficients ranged from −.24 to .83 for the mobility assessment of the glenohumeral, acromioclavicular and sternoclavicular joints. The kappa coefficients ranged from −.20 to .58 for joint mobility assessment of the cervical and thoracic spine. The kappa coefficients ranged from .23 to 1.0 for special tests of the shoulder and cervical spine.ConclusionsThe present study reported the reliability of a comprehensive upper quarter physical examination for a group of patients with a primary report of shoulder pain. The reliability varied considerably for the cervical and shoulder examination and was significantly higher for the examination of muscle length and cervical range of motion.     

Three dimensional multi-segmental trunk kinematics and kinetics during gait: Test-retest reliability and minimal detectable change

Background and AimTrunk kinematics and kinetics can contribute to more detailed information on gait impairment, however, data about reliability and measurement error of multi-segment trunk on three-dimensional gait analysis (3DGA) is lacking. The aim of this study is to investigate test-retest reliability and MDC of 3DGA kinematic and kinetic data in a sample of healthy individuals, using a two rigid segment model for the trunk.MethodsA test-retest study with a median interval of 7 days and a sample of 23 healthy individuals was conducted. Anthropometric, time-distance parameters and peak values for lower limb and trunk joint angles/moments were computed. The intraclass correlation coefficient (ICC_3,k), standard error of measurement (SEM), minimal detectable change (MDC) and 95% limits of agreement (LOA) were calculated.ResultsWe found acceptable test-retest reliability for most joint angles and a SEM ≤4°. The ICCs were above 0.7 for joint moments and the SEM and MDC were ≤0.2 Nm/kg and ≤0.6 Nm/kg, respectively. Bland–Altman plots with 95% LOA revealed a good agreement and time-distance parameters were all highly repeatable (majority ICCs > 0.90).ConclusionsThe results of this study suggest varied reliability indices for multi-segment trunk joint angles and moments during gait and an acceptable level of error, particularly for sagittal plane parameters. Some parameters showed wide 95% CIs for ICCs and higher SEM%. However, we believe that this study provides preliminary data regarding reliability indices for multi-segment trunk during gait, which may be valuable for clinical reasoning and decision making when dealing with movement disorders.     

Test-retest,intra- and inter-rater reliability of the reactive balance test in healthy recreational athletes

ObjectiveThe reactive balance test (RBT) is a recently developed neurocognitive balance test. The aim of this study was to determine test-retest, intra- and inter-rater reliability of the RBT in healthy recreational athletes.DesignReliability study design.SettingPrimary.ParticipantsTwenty-one volunteers (age = 22 ± 1 years, height = 175 ± 9 cm, weight = 69 ± 7 kg) participated.InterventionsThe two experimental trials were separated by an average of 33 ± 15 days. During experimental trials participants performed the Y-balance test (to determine maximal reach distances), and RBT once.Main outcome measuresVisuomotor response time and accuracy. Test-retest, intra- and inter-rater reliability were estimated for both these RBT outcome measures.ResultsExcellent intra- and inter-rater reliability was observed for visuomotor response time and accuracy. Test-retest reliability for visuomotor response time was considered good, while moderate test-retest reliability was found for accuracy.ConclusionsOur results indicate that overall test-retest, intra- and inter-rater reliability of the RBT was moderate to excellent. Thus, the RBT possesses acceptable reliability to use in group level analyses. Future research should further determine the clinimetric properties of the RBT in specific populations and research the RBT along the sport injury continuum.     

The reliability of shoulder range of motion measures in competitive swimmers

ObjectivesInvestigate reliability of shoulder internal and external rotation (IR, ER), abduction in internal rotation (ABIR) and combined elevation (CE) range of motion tests in competitive swimmers.DesignWithin participants, inter- and intra-examiner reliability.SettingPhysiotherapy Department, University of Melbourne, Australia.Participants17 competitive swimmers (aged 12–24 years) who participate in at least 5 weekly swimming sessions and two physiotherapy examiners.Main outcome measuresInter- and intra-examiner reliability of IR, ER, ABIR and CE.ResultsGood to excellent intra-examiner reliability across tests (ICCs: 0.85–0.96) with standard error of measurement (SEM)and minimal detectable change at 90% confidence interval (MDC₉₀) ranging from 2 to 5, and 5–12°, respectively. Good to excellent inter-examiner reliability for all tests (ICCs: 0.77–0.94) except left IR (ICC: 0.65). Inter-examiner SEM and MDC₉₀ ranged from 2 to 5° and 5–12°, respectively.ConclusionShoulder range of motion tests were reliable when applied by the same examiner. Inter-examiner reliability was acceptable for all tests except IR, which was affected by inconsistent manual scapula stabilisation between examiners.     

Reliability and minimal detectable change of gait variables in community-dwelling and hospitalized older fallers

PurposeGait variables may constitute surrogate outcomes for fall risk. Their reliability in a specific population of older fallers has not been fully established, which limits their research and clinical applications. This study aimed to determine test–retest reliability and minimal detectable change (MDC) values for selected fall-related gait variables in older adults with a recent fall history.MethodsCommunity-dwelling (n = 30) and hospitalized (n = 30) fallers aged ≥ 65 years were assessed twice using an instrumented pressure-sensitive walkway, under single- and dual-task gait conditions. Intraclass correlation coefficient (ICC_(2,1)), standard error of measurement (SEM; SEM%) and MDC at 95% confidence level (MDC₉₅; MDC₉₅%), were used as reliability estimates.ResultsThe ICC_(2,1) for gait velocity was greater than 0.84 across all gait conditions and groups; SEM% and MDC₉₅% did not exceed 6.5% and 18.1%, respectively. Gait variability measures returned lower ICC_(2,1) (range 0.18–0.79), and markedly higher SEM% (16.3–31.9%) and MDC₉₅% (45.3–88.3%). Overall, hospitalized fallers exhibited larger SEM and MDC₉₅ values for variability measures compared to community-dwellers in all gait conditions, while larger values were found for all variables while dual-tasking compared to single-tasking in both groups.ConclusionsGait velocity was found to be highly reliable and likely to be sensitive to change over repeated sessions in community-dwelling and hospitalized older fallers, both under single- and dual-task conditions. Gait variability measures showed lower reliability, irrespective of gait condition or group, displaying consistently larger measurement error, particularly under dual-task conditions. Clinicians should consider MDC₉₅ values before using gait variability variables as evaluative outcome measures at patient level.     

Isokinetic performance at diagonal pattern and shoulder mobility in elite overhead athletes

The purpose of this study was to measure isokinetically glenohumeral joint movement peak torque and work in professional basketball, volleyball, handball and baseball players and determine whether significant differences exist between the dominant and non-dominant extremity in athletes and controls. Eighty healthy professional overhead athletes (basketball, volleyball, handball and baseball players) and 20 controls were tested bilaterally on a CYBEX 6000 isokinetic dynamometer at 60 degrees and 180 degrees s(-1) for diagonal pattern of the glenohumeral joint. A standardized protocol and testing guidelines were strictly followed. The range of motion of internal rotation (IR) on the dominant side of baseball players was significantly smaller than those on the dominant side of basketball, handball and volleyball players, and controls (P<0.01). Flexion/abduction/external rotation were consistently higher on the dominant arm (8.5%) for peak torque at 60 degrees s(-1) in baseball players, and bilateral ratios were lower on the dominant arm (14.8%) for peak torque at 180 degrees s(-1) in basketball players. The results of this study are important for the application and interpretation of isokinetic data and flexibility and mobility characteristics on unilaterally dominant overhead athletes. Functional weakness in external rotators, mobility impairments in IR and muscle imbalance have been shown in the dominant arm of these overhead athletes.     

Reliability and minimal detectable change of gait kinematics in people who are hypermobile

ObjectiveTo evaluate intra- and inter-session reliability of gait data in hypermobile and normal adults, and from this, determine the minimum detectable change (MDC) through 3D gait analysis (GA) measurement.MethodsThirteen people with normal flexibility (Beighton score 0.82 ± 1.2) and 14 hypermobile people (Beighton score 5.6 ± 1.6) completed three separate GA sessions. Lower limb joint kinematics were recorded in three planes of motion. Intra- and inter-session variability was calculated and compared using single factor ANOVA. MDC at 95% confidence level was calculated for the hypermobile cohort.ResultsThere was no significant difference between hypermobile and normal flexibility adults in intra- or inter-session variability for any parameters measured. For both groups, mean intra-session variability was under 2.0° for all joints in all three planes. Inter-session variability was greater; sagittal plane joint angles were most reliable, showing less than 3.0° variability for all joints. Frontal plane variability was below 3.5°. Highest variability was seen in internal/external rotation angles, with hip, knee and ankle showing 4.6°, 5.1° and 3.2° variability respectively. These reliability values are reflected in MDC results, with pelvis and sagittal plane joint angles showing the lowest MDCs.ConclusionsIn hypermobile people, 3DGA kinematic parameters are repeatable. Hypermobile people's joint laxity does not affect variability of their kinematic gait analysis measures. The results will help guide future clinical trial design; future work should ensure that differences expected to be observed are measurable, and exceed the MDC for a given parameter.     

Within-assessor reliability and minimal detectable change of gait kinematics in a young obese demographic

IntroductionThree-dimensional gait analysis (3DGA) in obese populations is a difficult task due to a great amount of subcutaneous fat. This makes it more challenging to identify anatomical landmarks, thus leading to inconsistent marker placement. Therefore, the purpose of this study was to investigate the test-retest reliability for kinematic measurements of obese children and adolescents.MethodsNine males and two females with an age-based BMI above the 97th percentile (age: 14.6 ± 2.6 years, BMI: 33.4 ± 4.4 kg/m²) were administered to two 3DGA sessions. To quantify reliability of discrete parameters the intraclass correlation coefficient (ICC_2,k), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. To quantify waveform similarity, the coefficient of multiple correlation (CMC) and the linear fit method (LFM) were used.ResultsFrom 28 kinematic parameters, 23 showed acceptable ICCs (≥0.70) and the remaining parameters demonstrated moderate values. These were peak hip extension during stance (0.58), mean pelvis rotation (0.60), mean anterior pelvic tilt (0.64), peak knee flexion during swing (0.67) and peak hip abduction during swing (0.69). The SEM was below 5° for all parameters. The MDC for the sagittal, frontal, and transversal plane were on average 7.5° ± 2.2, 4.6° ± 1.3 and 6.0° ± 0.9 respectively. Both the LFM and CMC showed, in general, moderate to good reliability except for pelvis tilt and hip rotation.ConclusionData demonstrated acceptable error margins especially for the sagittal and frontal plane. Low reliability for the pelvis tilt indicates that great effort is necessary to position the pelvic markers consistently during repeated sessions.     

Effects of submaximal and supramaximal interval training on determinants of endurance performance in endurance athletes

We compared the effects of submaximal and supramaximal cycling interval training on determinants of exercise performance in moderately endurance‐trained men. Maximal oxygen consumption (VO_2max), peak power output (P_peak), and peak and mean anaerobic power were measured before and after 6 weeks (3 sessions/week) of submaximal (85% maximal aerobic power [MP], HIIT₈₅, n = 8) or supramaximal (115% MP, HIIT₁₁₅, n = 9) interval training to exhaustion in moderately endurance‐trained men. High‐intensity training volume was 47% lower in HIIT₁₁₅ vs HIIT₈₅ (304 ± 77 vs 571 ± 200 min; P < 0.01). Exercise training was generally associated with increased VO_2max (HIIT₈₅: +3.3 ± 3.1 mL/kg/min; HIIT₁₁₅: +3.3 ± 3.6 ml/kg/min; Time effect P = 0.002; Group effect: P = 0.95), P_peak (HIIT₈₅: +18 ± 9 W; HIIT₁₁₅: +16 ± 27 W; Time effect P = 0.045; Group effect: P = 0.49), and mean anaerobic power (HIIT₈₅: +0.42 ± 0.69 W/kg; HIIT₁₁₅: +0.55 ± 0.65 W/kg; Time effect P = 0.01; Group effect: P = 0.18). Six weeks of submaximal and supramaximal interval training performed to exhaustion seems to equally improve VO_2max and anaerobic power in endurance‐trained men, despite half the accumulated time spent at the target intensity.     

Reliability,minimal detectable change,and responsiveness of the Quick-FAAM

ObjectiveTo determine the test-retest reliability, minimal detectable change (MDC) and responsiveness of the Quick-FAAM in people with chronic ankle instability (CAI).Design10-week controlled laboratory study.SettingLaboratory.ParticipantsA total of 20 adults with self-reported CAI.Main outcome measuresParticipants completed a supervised 4-week intervention. The Quick-FAAM was assessed 4-weeks before the intervention (T1), prior to the first intervention (T2), 24-h post-intervention (T3), and 2-weeks after the intervention (T4). The Quick-FAAM is a 12-item region specific PRO scored on 5-point Likert scale, often reported as a percentage, and a lower percentage indicates decreased ankle function. Test-retest reliability was determined using Intraclass-correlation coefficients (ICC_2,1) and standard error of measure (SEM). The MDC was calculated using the equation: SEM*√2. Hedges g effect sizes and associated 95% confidence intervals (95%CI) were calculated as a measure of group responsiveness.ResultsThe test-retest reliability was clinically acceptable (ICC_2,1 = 0.82, SEM = 4.56). The MDC was 6.5% and pre-post intervention effect sizes were large between T2-T3 (ES = 1.27, 95%CI:0.59–1.95) and T2-T4 (ES = 1.49, 95%CI:0.79–2.19).ConclusionThe Quick-FAAM demonstrated clinically acceptable reliability and was responsive to treatment. Future research should examine these properties in patients with acute ankle and foot conditions, determine patient acceptability, and clinician feasibility.     

Energy availability and the female athlete triad in elite endurance athletes

The female athlete triad (Triad), links low energy availability (EA), with menstrual dysfunction (MD), and impaired bone health. The aims of this study were to examine associations between EA/MD and energy metabolism and the prevalence of Triad‐associated conditions in endurance athletes. Forty women [26.2 ± 5.5 years, body mass index (BMI) 20.6 ± 2.0 kg/m², body fat 20.0 ± 3.0%], exercising 11.4 ± 4.5 h/week, were recruited from national teams and competitive clubs. Protocol included gynecological examination; assessment of bone health; indirect respiratory calorimetry; diet and exercise measured 7 days to assess EA; eating disorder (ED) examination; blood analysis. Subjects with low/reduced EA (< 45 kcal/kg FFM/day), had lower resting metabolic rate (RMR) compared with those with optimal EA [28.4 ± 2.0 kcal/kg fat‐free mass (FFM)/day vs 30.5 ± 2.2 kcal/kg FFM/day, P < 0.01], as did subjects with MD compared with eumenorrheic subjects (28.6 ± 2.4 kcal/kg FFM/day vs 30.2 ± 1.8 kcal/kg FFM/day, P < 0.05). 63% had low/reduced EA, 25% ED, 60% MD, 45% impaired bone health, and 23% had all three Triad conditions. 53% had low RMR, 25% hypercholesterolemia, and 38% hypoglycemia. Conclusively, athletes with low/reduced EA and/or MD had lowered RMR. Triad‐associated conditions were common in this group of athletes, despite a normal BMI range. The high prevalence of ED, MD, and impaired bone health emphasizes the importance of prevention, early detection, and treatment of energy deficiency.     

Validity,reliability, minimal detectable change,and methodological considerations for HHD and portable fixed frame isometric hip and groin strength testing: A comparison of unilateral and bilateral testing methods

ObjectivesComparative assessment of bilateral (KangaTech) and unilateral (HHD) testing modalities through concurrent validity and test-retest reliability. Methodological considerations explored include minimum repetitions and comparison of average and maximum values.DesignExperimental, observational.SettingBiomechanics laboratory.ParticipantsThirty-three participants.Main outcome measuresConcurrent validity using peak force. Test-retest reliability used Abduction and Adduction using 2 trials, randomised between devices. Maximum peak force and average of both trials were used.ResultsHHD and KT360 are concurrently valid (r = 0.996); with no significant difference (z = −0.681). Excellent HHD reliability (ICC:0.92–0.96) and KT360 (ICC:0.89–0.97). Significant difference between max peak force and average peak force but within the calculated MDC(%). No significant differences between max peak force between trials. Spearman-Brown prophecy predicted excellent reliability for one trial (ICC:0.81–0.95). Bilateral facilitation was demonstrated using the KT360 with 94.6–101.2% increase in force compared to HHD.ConclusionsWith no significant difference between first and second max effort, and excellent prophesised reliability, one rep max effort should be acceptable to use. Body positioning within the KT360 seems to elicit bilateral facilitation rather than deficit, therefore unilateral and bilateral force values are not interchangeable.     

Prevalence of asthma-like symptoms, asthma and its treatment in elite athletes

The objective was to determine the prevalence of asthma-like symptoms and asthma and the use of asthma medication in Danish elite athletes. A cross-sectional questionnaire survey of Danish elite athletes was conducted in 2006. All elite athletes ( N =418) financially supported by the national organization of elite athletes comprised the study group; 329 (79%) completed the questionnaire concerning their sport, asthma-like symptoms, asthma and use of asthma medication. Asthma-like symptoms at rest were reported by 41% of respondents; 55% reported asthma-like symptoms at rest or at exercise. Physician-diagnosed asthma was present in 16% and 14% had current asthma. Asthma medication was taken by 7% of the athletes, of whom 79% used inhaled corticosteroids and 21% used inhaled β₂-agonists only. Athletes participating in endurance sports had higher prevalences of current asthma (24%) and use of asthma medication (15%) than all other athletes ( P <0.01). Athletes participating in endurance sports have a higher prevalence of asthma and use of asthma medication. The frequency of asthma medication is lower than the prevalence of current asthma indicating that there is no overuse of asthma medication among Danish elite athletes.     

The inter- and intrarater reliability and agreement for field-based assessment of scapular control,shoulder range of motion,and shoulder isometric strength in elite adolescent athletes

ObjectivesTo investigate the intra- and interrater reliability and agreement for field-based assessment of scapular control, shoulder range of motion (ROM), and shoulder isometric strength in elite youth athletes.DesignTest-retest reliability and agreement study.SettingEight blinded raters (two for each assessment) assessed players on field during two testing sessions separated by one week.Participants162 elite youth handball players with or without a history of previous shoulder pain within the preceding six months.Main outcome measuresKappa (κ) and prevalence-adjusted bias-adjusted kappa (PABAK) coefficients for scapular control reliability, and 95% limits of agreement (LOA) for ROM and strength agreement.ResultsScapular control demonstrated substantial to almost perfect reliability (κ 0.67 to 0.84, PABAK from 0.68 to 0.88). Mean strength values ranged from 0.9 N/kg to 1.6 N/kg, and LOAs ranged from −0.7 N/kg to 0.8 N/kg. Rotational strength revealed additionally systematic bias between and within rater. No or acceptable systematic bias were evident for ROM and abduction strength measures. Mean values and LOAs for ROM ranged between 39.9° to 52.3°, and from −12.6° to 9.9°, respectively.ConclusionsScapular control and ROM can be assessed on the field with acceptable reliability. The threshold for reliable measurements of isometric strength using handheld-dynamometers is high.