Kinematic and Kinetic Predictors of Y-Balance Test Performance

BackgroundThe Y-Balance Test (YBT) assesses dynamic stability and neuromuscular control of the lower extremity. Several authors have analyzed kinematic predictors of YBT performance with conflicting results, but the influence of kinetic factors is not well understood.PurposeTo examine kinematic predictors of YBT performance and determine the joint kinetics which predict YBT performance.Study DesignCross-sectional study.MethodsThirty-one physically active individuals performed YBT trials on a force plate while whole body kinematics were recorded using a motion capture system. Sagittal, frontal, and transverse plane joint kinematics and joint moments were calculated at maximum reach in each YBT reach direction. Variables correlated with reach distances at the p < 0.2 level were entered into a stepwise linear regression.ResultsIn the anterior direction, knee flexion and torso rotation (R²=0.458, p<0.001) and knee extensor and hip abductor moments (R²=0.461, p<0.001) were the best kinematic and kinetic predictors of reach distance. In the posterior medial direction, hip flexion, ankle dorsiflexion, and ankle rotation accounted for 45.8% of the variance in reach direction (p<0.001) while hip and knee extensor, and hip abductor moments explained 72.6% of the variance in reach distance (p<0.001). In the posterior lateral direction, hip flexion and pelvic rotation (R²=0.696, p<.001) and hip extensor moments (R²=0.433, p=0.001) were the best kinematic and kinetic predictors of reach distance.ConclusionThe ability to generate large hip and knee joint moments in the sagittal and frontal plane are critical for YBT performance.Level of Evidence3.     

FUNCTIONAL MOVEMENT AND DYNAMIC BALANCE IN ENTRY LEVEL UNIVERSITY DANCERS

Background:Dance requires integration and synergy between movement, postural stability, and body alignment to effectively execute the technical and aesthetic requirements of the performance. Evaluation of movement competency and dynamic balance provides opportunity to identify dysfunctional movement which may negatively impact both artistic and technical aspects of dance performance. Investigation of the relationships between movement competency and postural control may aid in technical development, performance improvement, and ultimately injury reduction. Although the Functional Movement Screen™ (FMS™) and Y-Balance Test (YBT) have assessed movement competency in athletes, they have not been used extensively in the performing arts.Purpose:The purposes of this investigation were to examine movement competency in university dancers using the FMS™ and YBT and to determine the relationship between functional movement and dynamic balance.Study Design:Cross sectionalMethods:Fifteen, injury-free, female members (19.1 ± 1.18 years old) of an introductory university ballet class volunteered to participate. Pearson product correlations were used to determine relationships between variables.Results:The mean composite FMS™ score was 15.32 ± 2.30. Shoulder mobility (SM) (r = 0.63, p  =  0.01), In-line lunge (ILL) (r = 0.64, p  =  0.01), and Deep Squat (DS) (r = 0.62, p  =  0.01) were correlated with composite FMS™ score. Overall composite YBT score was 86.62% ± 8.17%. Reach asymmetry was 3.25 cm ± 3.53 cm (anterior), 4.06 cm ± 3.59cm (posteromedial (PM)), and 3.28cm ± 2.61cm (posterolateral (PL)). Composite FMS™ score was not correlated with composite YBT composite score (r = 0.44, p = 0.10). A moderate to good correlation was found between the ILL and YBT composite score (r = 0.64, p  =  0.01).Conclusion:Collectively the results indicate the FMS™ and YBT do not measure the same constructs. However, the associations between individual components of the FMS™ and YBT indicate a relationship between certain movements and dynamic balance, supporting their combined use in a dancer injury risk management program.Level of Evidence:2b     

Spatial distribution of lumbar erector spinae muscle activity in individuals with and without chronic low back pain during a dynamic isokinetic fatiguing task

BackgroundIndividuals with chronic low back pain (CLBP) commonly present with increased trunk muscle fatigability; typically assessed as reduced time to task failure during non-functional isometric contractions. Less is known about the specific neuromuscular responses of individuals with CLBP during dynamic fatiguing tasks. We investigate the regional alteration in muscle activation and peak torque exertion during a dynamic isokinetic fatiguing task in individuals with and without CLBP.MethodsElectromyography (EMG) was acquired from the lumbar erector spinae unilaterally of 11 asymptomatic controls and 12 individuals with CLBP, using high-density EMG (13 × 5 grid of electrodes). Seated in an isokinetic dynamometer, participants performed continuous cyclic trunk flexion-extension at 60^o/s until volitional exhaustion.FindingsSimilar levels of muscle activation and number of repetitions were observed for both groups (p > 0.05). However, the CLBP group exerted lower levels of peak torque for both flexion and extension moments (p < 0.05). The centre of lumbar erector spinae activity was shifted cranially in the CLBP group throughout the task (p < 0.05), while the control participants showed a more homogenous distribution of muscle activity.InterpretationPeople with CLBP displayed altered and potentially less efficient activation of their lumbar erector spinae during a dynamic fatiguing task. Future studies should consider using high-density EMG biofeedback to optimise the spatial activation of the paraspinal musculature in people with low back pain (LBP).     

Reliability and Validity of the Functional Movement Screen™ with a Modified Scoring System for Young Adults with Low Back Pain

BackgroundLow back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system.PurposeThe purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system.Study DesignReliability and validity study.MethodsTwenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant’s FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability.ResultsThe results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008).ConclusionsThe results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP.Levels of Evidence2b.     

Sex-related Anthropometrics in a Lower-Body Mobility Assessment Among Professional Soccer Athletes

BackgroundThe functional movement screen (FMS™) and Y-balance test (YBT) are commonly used to evaluate mobility in athletes.PurposeThe primary aim of this investigation was to determine the relationship between demographic and anthropometric factors such as sex, body composition, and skeletal dimension and scoring on YBT and FMS™ in male and female professional soccer athletes.Study DesignCross SectionalMethodsDuring pre-season assessments, athletes from two professional soccer clubs were recruited and underwent body composition and skeletal dimension analysis via dual-energy X-ray absorptiometry (DEXA) scans. Balance and mobility were assessed using the YBT and FMS™. A two-tailed t-test was used to compare YBT between sexes. Chi-square was used for sex comparisons of FMS™ scores. Correlation analysis was used to determine if body composition and/or skeletal dimensions correlated with YBT or FMS™ measures. Type-I error; α=0.05.Results40 Participants were successfully recruited: (24 males: 27±5yr, 79±9kg; |16 females: 25±3yr, 63±4kg). YBT: Correlations were found between anterior reach and height (r=-0.36), total lean mass (LM)(r=-0.39), and trunk LM(r=-0.39) as well as between posterolateral reach and pelvic width (PW)(r=0.42), femur length (r=0.44), and tibia length (r=0.51)(all p<0.05). FMS™: The deep squat score was correlated with height(r=-0.40), PW(r=0.40), LM(r=-0.43), and trunk LM (r =-0.40)(p<0.05). Inline lunge scores were correlated with height(r=-0.63), PW(r=0.60), LM(r=-0.77), trunk LM(r=-0.73), and leg LM(r=0.70)(all p<0.05). Straight leg raise scores were correlated with PW (r=0.45, p<0.05). Females scored higher for the three lower body FMS™ measures where correlations were observed (p<0.05).ConclusionsLower body FMS™ scores differ between male and female professional soccer athletes and are related to anthropometric factors that may influence screening and outcomes for the FMS™ and YBT, respectively. Thus, these anatomical factors likely need to be taken into account when assessing baseline performance and risk of injury to improve screening efficacy.Level of EvidenceLevel 3b     

The Dynamic Innovative Balance System Improves Balance Ability: A Single Blind,Randomized Controlled Study

BackgroundFunctional balance training is crucial for both rehabilitation and prevention. A Dynamic Innovative Balance System (DIBA) is readily available for utilization in both functional and postural control training in a wide variety of dynamic conditions.PurposeThe purpose of this study was to compare the effectiveness of the DIBA and standard balance training tools on dynamic and static balance.Study DesignRandomized controlled trialMethodsThirty-six healthy males (18 to 32 years) were randomly assigned to group DIBA (n=18) or to the control group (n=18) who performed balance training using a balance board, a wobble board, the BOSU, or a soft cushion block for eight weeks. Each participant was assessed before training, at the end of the fourth and eighth week by using the Flamingo balance test (FBT) for assessing static balance ability and using Y-Balance Test (YBT) for dynamic balance ability.ResultsNo significant differences were found in FBT and YBT between the DIBA and control groups at the end of fourth week (p>0.05). However, at the end of the eighth week, the DIBA group demonstrated statistically significantly better balance ability on the anterior component of YBT (p=0.001) and FBT (p=0.024) than controls.ConclusionThe results of this study suggest that the DIBA was effective in both static and dynamic balance training and it may be used alongside other balance tools in a clinical setting. Further studies should include in lower extremity problems to confirm that DIBA training adaptations are transferred to clinical improvements in performance and balance qualities.Level of Evidence2d     

Reliability,validity and minimal detectable change of the Mini-BESTest in Greek participants with chronic stroke

Objectives: This study aimed to investigate the psychometric characteristics of reliability, validity and ability to detect change of a newly developed balance assessment tool, the Mini-BESTest, in Greek patients with stroke. Design: A prospective, observational design study with test-retest measures was conducted. Methods: A convenience sample of 21 Greek patients with chronic stroke (14 male, 7 female; age of 63 ± 16 years) was recruited. Two independent examiners administered the scale, for the inter-rater reliability, twice within 10 days for the test-retest reliability. Bland Altman Analysis for repeated measures assessed the absolute reliability and the Standard Error of Measurement (SEM) and the Minimum Detectable Change at 95% confidence interval (MDC_95%) were established. The Greek Mini-BESTest (Mini-BESTest_GR) was correlated with the Greek Berg Balance Scale (BBS_GR) for assessing the concurrent validity and with the Timed Up and Go (TUG), the Functional Reach Test (FRT) and the Greek Falls Efficacy Scale-International (FES-I_GR) for the convergent validity. Results: The Mini-BESTestGR demonstrated excellent inter-rater reliability (ICC (95%CI) = 0.997 (0.995–0.999, SEM = 0.46) with the scores of two raters within the limits of agreement (mean_dif = ?0.143 ± 0.727, p > 0.05) and test-retest reliability (ICC (95%CI) = 0.966 (0.926–0.988), SEM = 1.53). Additionally, the Mini-BESTest_GR yielded very strong to moderate correlations with BBS_GR (r = 0.924, p < 0.001), TUG (r = ?0.823, p < 0.001), FES-I_GR (r = ?0.734, p < 0.001) and FRT (r = 0.689, p < 0.001). MDC₉₅ was 4.25 points. Conclusion: The exceptionally high reliability and the equally good validity of the Mini-BESTest_GR, strongly support its utility in Greek people with chronic stroke. Its ability to identify clinically meaningful changes and falls risk need further investigation.     

Reliability and validity of the Japanese version of the short questionnaire to assess health-enhancing physical activity (SQUASH) scale in older adults

[Purpose] We tested the reliability and validity of the Japanese version of the Short Questionnaire to Assess Health-enhancing Physical Activity scale in asymptomatic older adults and sought to confirm discriminator validity in women with osteoarthritis. [Subjects] The participants included an asymptomatic comparison group (men and women) and women with knee or hip osteoarthritis. [Methods] The test-retest method was used to assess reliability. The International Physical Activity Questionnaire was chosen to assess criterion-related validity. Discriminator validity was assessed by comparing the asymptomatic and osteoarthritis groups. [Results] Mean age for the asymptomatic groups was 63 ± 6 years for men (n = 23) and 61 ± 7 years for women (n = 51), and it was 63 ± 9 years for the osteoarthritis group (n = 32). The total score and scores for all items, except for heavy housework items, were significantly correlated with the retest. Criterion-related validity showed significantly weak to moderate correlations between the respective scale categories. For discriminator validity, the total scores and scores for bicycle commuting, light housework, and three leisure items differed significantly between the asymptomatic and osteoarthritis groups. [Conclusion] The Short Questionnaire to Assess Health-enhancing Physical Activity scale is a reliable and valid measure in asymptomatic older adults, and can discriminate between osteoarthritic and asymptomatic women.Key words: Physical activity scale, Older adults, Osteoarthritis     

Reference values for the Modified Timed Up and Go Test in Saudi children aged 4–12 years old in Riyadh city: cross-sectional study

PurposeThe study aimed to report within-session reliability, estimate the reference values for the Modified Timed Up and Go (mTUG) test in typically developing (TD) Saudi children aged 4–12 years old, develop a reference equation for the estimated mTUG, and compare the measured mTUG in the present study with the predicted mTUG obtained from the previous regression equation.MethodsIn this cross-sectional observational study, anthropometric measurements and mTUG test were investigated in 805 child. The association between the mTUG test and predictive variables was studied.ResultsAverage mTUG speed was 4.63 ± 0.68 s. Within-session reliability was excellent with intraclass correlation coefficient of 0.90. The test was significantly and negatively correlated with age, height, and weight (r = −0.66, p = .00), (r = −0.54, p = .01), and (r = −0.33, p = .01) respectively. According to the stepwise regression analysis, age and weight were the predictors and explained 47% of total variance of mTUG scores.ConclusionThis study provided the mTUG reference values that can be used clinically to evaluate functional mobility and dynamic balance in TD Saudi children aged 4–12 years. The mTUG scores can be predicted as a function of age and weight.

KEY MESSAGES

• Modified Timed Up and Go test used to assess the functional mobility and dynamic balance for children with or without developmental abnormalities.
• Availability of reference values according to age is helpful to compare the performance of children at same ages.

     

Star excursion balance test scores under different conditions: Effects of arms position and shoe-wear

ObjectivesThe purpose of this study was to investigate the effects of arms position (arms free or hands on the hips) and shoe-wear (with or without athletic shoe) on star excursion balance test (SEBT) scores in healthy physically active individuals.DesignCross-sectional study.MethodsFifty-one participants [Age: 22.74 ± 1.93 years; Body Mass Index: 22.52 ± 2.29 kg/m²] were included in the study. The anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions of the SEBT were performed under four conditions in a randomized order. Within session reliability analysis was performed for each test condition. The composite (COMP) score was calculated as the average of the normalized scores of anterior, posteromedial and posterolateral reach distances. Repeated measures of ANOVA was used for statistical analysis.ResultsThe ANT and PM reach distances and the composite (COMP) score were found greater with shoes (ANT p = 0.004; PM p < 0.001; COMP p < 0.001). However, the difference in the scores with shoes conditions did not exceed the measurement error. On the other hand, PM and PL reach distances and the COMP score were greater with arms free conditions and the difference in the scores exceeded the measurement error.ConclusionsThe results of the study suggest that the differences in the SEBT procedure should be taken into account when comparing the outcomes of different studies. In addition, measurement error values should be considered while interpreting the change in repeated measures of SEBT scores.     

Recovery of the lumbar multifidus muscle size in chronic low back pain patients by strengthening hip abductors: A randomized clinical trial

IntroductionDecrease in cross-sectional thickness of lumbar multifidus (MF) muscles during prolonged low back pain episodes commonly occurs. Restoration of the MF muscle size can be an effective way of treating chronic low back pain (CLBP) patients. Traditionally, clinicians apply muscle stabilization exercises for these patients. Recent studies support the need for active strengthening exercises for treatment of the CLBP patients.ObjectiveThe MF muscles provide lumbar stability, and therefore we hypothesized that strengthening of these muscles can be more effective than the MF muscle stabilization exercises in restoration of the muscle size.DesignStudy design was a randomized allocation control trial with two groups of adult female CLBP patients (n = 12 each; age range of 20–45). Patients in the control group underwent stabilization exercises and the patients in the intervention group underwent the hip abductor strengthening exercises.SettingFor all subjects of each group, the trials continued in 24 sessions distributed over 8 weeks and the MF muscles were measured in the beginning of the first session and one week after completion of the last session.Main outcome measuresStatistical significance (p-value) of the change in the average MF muscle thickness, pain, and disability scores along with for each group were estimated.ResultsBoth regimens of exercises can significantly decrease the pain and disability: average pain and disability reductions of 46% (p-value of 0.001) and 33% (p-value of 0.02) via stabilization versus average pain and disability reductions of 65% (p-value of 0.001) and 59% (p-value of 0.001) via hip abductor strengthening. However, the hip abductor strengthening is the sole statistically significant exercise regimen (p-value of 0.014 vs 0.94) for increasing the MF muscle size.ConclusionReplacement of the traditional stabilization exercises with the hip abductor strengthening exercises for effective treatment of female adults with CLBP is recommended.     

Validating the Functional Pain Scale for Hospitalized Adults

BackgroundEnhancing pain patient's ability to function and cope is important, but assessing only intensity ignores those aspects of pain. The Functional Pain Scale (FPS), addresses these dimensions but lacked validation in hospitalized adults with chronic pain.AimsThis research was conducted to establish the FPS psychometric properties in hospitalized adults.DesignA prospective pilot study examined the reliability and validity of the FPS in two acute care hospitals.SettingsAdult inpatients from medical/surgical units at two hospitals.Participants/SubjectsA convenience sample of 93 subjects from an Academic Medical Center and 51 from a tertiary care hospital who were 21-81 years old and primarily Caucasian.MethodsHospitalized adults with chronic pain at two facilities provided pain scores from the FPS, Numeric Rating Scale, Pain, Enjoyment of Life, and General Activities Scale, and Quality of Pain Care Scale. Test-retest reliability and construct validity were evaluated using standard correlation methods.ResultsHospitalized adults aged 21-88 years with chronic pain (N = 144) were evaluated. Data supported test-retest reliability of the FPS (r = .84; p < .001), which had strong, statistically significant correlations with the Numeric Rating Scale at different study sites (r = 0.75 and r = 0.45, respectively), indicating acceptable construct validity. Significant weak correlations between the FPS and other measures of mood and functioning failed to support discriminant validity.ConclusionsAlthough statistically significant, the reliability and validity of FPS were not as strong in hospitalized chronic pain patients as reported for older adults in other settings.     

The validity,reliability, and responsiveness of the modified Iowa Level of Assistance scale in hospitalized older adults in subacute care

Abstract

Objective: The objective of this study was to investigate the psychometric properties of the Modified Iowa Level of Assistance scale in hospitalized older adults in subacute care.

Design: A cohort, measurement-focused study.

Participants and setting: Fifty-eight older adults, aged 65?years and older, were recruited from a subacute rehabilitation hospital.

Methods: Inter-rater reliability was established by having two physiotherapists independently assess each participant within 24-h of each other. Construct validity was established using “known-groups” validity, while concurrent validity was also examined by correlating modified Iowa Level of Assistance scores with the Elderly Mobility Scale. Responsiveness was assessed by examining the difference in modified Iowa Level of Assistance scores from admission to discharge.

Results: The mean age of participants was 82.8?years (SD 7.5; range 68–97). The modified Iowa Level of Assistance scale was found to be reliable, valid, and responsive in this sample of hospitalized older adults. It had excellent inter-rater reliability (intraclass correlation coefficient [2,1] 0.96; 95% confidence intervals (CI) 0.93, 0.98) and no systematic differences across the range of scores. The scale displayed a mean difference between two known groups of 11.4 points and correlated significantly and negatively with the Elderly Mobility Scale (Spearman’s rho???0.90). The modified Iowa Level of Assistance score also changed significantly over the course of the hospital admission with an effect size of 1.2.

Conclusions: The modified Iowa Level of Assistance scale is a valid measure with excellent inter-rater reliability in hospitalized older adults. It is responsive to functional change during hospital admission and may be useful for routine outcome assessment for hospitalized older adults in subacute care.

• Implications for Rehabilitation

• The mILOA scale is a valid, reliable, and responsive outcome measure that can be used to quantify the gait and mobility impairments in hospitalized older adults in subacute care.

• For optimal reliability and responsiveness, consistent administration of the mILOA scale will be required particularly for higher level mobility tasks such as negotiating a step.

     

RELATIONSHIP BETWEEN THE Y BALANCE TEST SCORES AND SOFT TISSUE INJURY INCIDENCE IN A SOCCER TEAM

Background

Although the dynamic balance has been proposed as a risk factor for sports‐related injuries, few researchers have used the Y balance test to examine this relationship. The purpose of this study was to determine if the Y Balance Test (YBT) is a valid test for determining subjects susceptible to soft tissue injury among soccer players on a professional team.

Study Design

Prospective cohort

Methods and Measures

Prior to the 2011 football (soccer) season, the anterior, posteromedial and posterolateral YBT reach distances and limb lengths of 74 soccer players were measured. Athletes’ physiotherapists documented how many days the players were unable to play due to the injuries. After normalizing for lower limb length, each of the reach distances, right/left reach distance difference and composite reach distance were examined using odds ratios and logistic regression analysis.

Results

Logistic regression models indicated that players with a difference of equal or greater than 4cm between lower limbs in posteromedial direction were 3.86 more likely to sustain a lower extremity injury (p=0.001). Results indicate that players who had lower scores than the mean in each reach direction, independently, were almost two times more likely to sustain an injury.

Conclusions

The results suggest that YBT can be incorporated into physical examinations to identify soccer players who are susceptible to risk of injury.

Level of evidence

2b     

Reliability,Validity, and Reference Values for Functional Balance Test for Geriatric Patients (FBG)

ABSTRACT

The aim of this study was to establish the inter-rater reliability of the Functional Balance test for Geriatric patients (FBG) and concurrent validity between the FBG and the Berg balance scale, and to present reference values for the FBG. Patients (n = 22) aged between 66 and 87 years with varying diagnoses and elderly subjects without balance problems (n = 145) were assessed. The inter-rater reliability, calculated with intraclass correlation (ICC_2.1) for FBG total was 0.99. Cohen's kappa coefficient (κ) varied between 0.83 and 0.94 for the four items in the FBG. The correlation between the total scores for FBG and the Berg balance scale, calculated with Spearman's rank correlation coefficient (r_s) had a correlation of 0.96. The reference value for FBG total was 24 for men and woman aged 65–69 years, 23 for men and woman aged 70–79 years, 22 for men 80 years and older, and 21 for woman 80 years or older.     

THE INFLUENCE OF UPPER BODY FATIGUE ON DYNAMIC STANDING BALANCE

Purpose/Background:

Muscle fatigue is related to a decline in force output and proprioception. These can ultimately have an adverse effect on neuromuscular control and functional performance. Local muscle fatigue has been shown to have adverse consequences on dynamic standing balance; however, much less is known regarding the relationship between distant fatigue and dynamic standing. The purpose of this study was to investigate the effects of upper body fatigue on dynamic standing balance. It was hypothesized that distant fatigue in upper body musculature would show a significant decrease in dynamic standing balance as assessed by the Lower Quarter Y‐Balance Test (YBT‐LQ).

Methods:

Twenty healthy individuals (age: 25.0 ± 3.42 years, height: 172.72 ± 13.11 cm, mass: 71.36 ± 13.50 kg) participated in this study. A kayak ergometer was used to implement a fatigue protocol for the upper body. The protocol consisted of a graded intensity session ranging from 50% to 90% of maximum effort lasting ten minutes in duration (2 minutes each at 50% 60%, 70%, 80%, and 90%). The anterior (ANT), posteromedial (PM), and posterolateral (PL) reach directions were normalized to leg length and measured on the YBT‐LQ before and after the fatigue protocol for each participant. A fourth value termed overall balance was calculated as the sum of the furthest reach distance of the three directions. Blood lactate analysis taken before and immediately after the fatigue protocol was used to quantify fatigue. Multiple paired t‐tests were performed for pre‐fatigue and post‐fatigue balance assessment. A Bonferroni correction was applied to set the significance value ≤0.0125 a priori. Effect size was calculated using the effect size index.

Results:

Blood lactate values immediately following the fatigue protocol had an average concentration of 6.15 millimoles (pre: 2.3, post: 8.4). The ANT reach direction (ρ = 0.004) and the calculated overall balance (ρ = 0.011) significantly decreased post‐fatigue in the dominant lower extremity. No significant differences were found for the PM (ρ = 0.017) or PL (ρ = 0.021) directions. The ANT reach direction (0.64) and overall balance (0.44) also showed a moderate effect size based on the effect size index.

Conclusions:

ANT and overall dynamic standing balance were negatively affected after completing the upper body fatigue protocol. The findings of this research demonstrate that upper body fatigue has adverse effects on dynamic standing balance, as measured by performance on the YBT‐LQ. Significant and clinically relevant differences were noted in ANT and overall dynamic standing balance.

Clinical Relevance:

Physical therapists should be aware of the adverse influence distant fatigue may exhibit on neuromuscular control in muscles not actively involved in the fatiguing exercise. The balance deficits noted may indicate an increased risk of injury with muscle fatigue in muscles not directly contributing to standing balance.

Level of Evidence:

3b, Case‐control study     

The evolution of radiographic edema in ARDS and its association with clinical outcomes: A prospective cohort study in adult patients

PurposeTo assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes.Materials and methodsWe quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables.ResultsThe RALE score had good inter-rater agreement (r = 0.83, p < 0.0001) applied on 488 CXRs from 129 patients, with higher RALE scores in patients with ARDS (n = 108) compared to controls (n = 21, p = 0.01). Baseline RALE scores were positively correlated with levels of the receptor for end-glycation end products (RAGE) in ARDS patients (p < 0.05). Baseline RALE scores were not predictive of 30- or 90-day survival. Persistently elevated RALE scores were associated with prolonged need for mechanical ventilation (p = 0.002).ConclusionsThe RALE score is easily implementable with high inter-rater reliability. Longitudinal RALE scoring appears to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and can potentially predict prolonged need for mechanical ventilation.     

Assessing Electronic Note Quality Using the Physician Documentation Quality Instrument (PDQI-9)

Objective

To refine the Physician Documentation Quality Instrument (PDQI) and test the validity and reliability of the 9-item version (PDQI-9).

Methods

Three sets each of admission notes, progress notes and discharge summaries were evaluated by two groups of physicians using the PDQI-9 and an overall general assessment: one gold standard group consisting of program or assistant program directors (n = 7), and the other of attending physicians or chief residents (n = 24). The main measures were criterion-related validity (correlation coefficients between Total PDQI-9 scores and 1-item General Impression scores for each note), discriminant validity (comparison of PDQI-9 scores on notes rated as best and worst using 1-item General Impression score), internal consistency reliability (Cronbach’s alpha), and inter-rater reliability (intraclass correlation coefficient (ICC)).

Results

The results were criterion-related validity (r = –0.678 to 0.856), discriminant validity (best versus worst note, t = 9.3, p = 0.003), internal consistency reliability (Cronbach’s alphas = 0.87–0.94), and inter-rater reliability (ICC = 0.83, CI = 0.72–0.91).

Conclusion

The results support the criterion-related and discriminant validity, internal consistency reliability, and inter-rater reliability of the PDQI-9 for rating the quality of electronic physician notes. Tools for assessing note redundancy are required to complement use of PDQI-9. Trials of the PDQI-9 at other institutions, of different size, using different EHRs, and incorporating additional physician specialties and notes of other healthcare providers are needed to confirm its generalizability.