Test-retest reliability of isometric shoulder muscle strength measurement with a handheld dynamometer and belt

[Purpose] The aim of this study was to develop a method of measuring isometric shoulder joint muscle strength using a handheld dynamometer with a belt and investigate its test-retest reliability. [Subjects] The subjects comprised 40 healthy adults. [Methods] Six types of isometric shoulder muscle strength were measured twice, and reliability was assessed. [Results] The intraclass correlation coefficient (1, 1) values ranged from 0.976 to 0.902. The result of a Bland-Altman analysis showed differences in the types of errors between measurement items. [Conclusion] The relative reliability of isometric shoulder muscle measurement using a handheld dynamometer with a belt was high. However, analysis of absolute reliability revealed errors that may affect interpretation of values; therefore, it was considered that adapting the greater of two measurement values is appropriate.Key words: Handheld dynamometer, Reliability, Shoulder muscle strength     

The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station

OBJECTIVE: To compare the inter- and intrarater reliability of a portable dynamometer anchoring station (DAS) to a handheld dynamometer (HHD). DESIGN: Repeated-measures design. SETTING: Human performance and movement analysis laboratory. PARTICIPANTS: Fifteen healthy participants, ages 23 to 44 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three consecutive measures of peak bilateral isometric strength were obtained for hip abduction, extension, and flexion by 2 investigators by using the DAS and the HHD after a 1-hour rest period. This testing scenario was repeated 1 week later. Intraclass correlation coefficients (ICCs) were used to determine reliability. RESULTS: Interrater ICCs of average peak strength ranged from.84 to.92 (hip flexors),.69 to.88 (hip abductors), and.56 to.80 (hip extensors). Intrarater ICCs ranged from.59 to.89 for tester A and from.72 to.89 for tester B using the DAS, and from.67 to.81 for the HHD across muscle groups. CONCLUSIONS: The DAS showed good intrarater reliability for hip flexion and abduction, whereas the HHD demonstrated higher reliability for hip extension. The results support the use of dynamometers that are quick and reliable and that reduce tester bias during hip strength assessment.     

Absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer

[Purpose] The aim of this study was to verify the absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD). [Subjects and Methods] The subjects were 33 healthy college students. The measurements were made three times with the HHD fixed using a belt (BFHHD) or with the examiner’s hand (conventional method; HFHHD). The absolute reliability of measurements was verified using Bland-Altman analysis, both in the all subjects group and a group of subjects showing measurements less than a fixed limit of 30 kgf. [Results] In the <30 kgf group, a systematic bias was not observed, and BFHHD values were greater than HFHHD values. BFHHD values in the all subjects group showed a systematic bias; the 3rd measurement value was less than the maximum value obtained during the 1st and 2nd measurements. [Conclusion] For obtaining an acceptable value during clinical measurements of horizontal adductor muscle strength, single measurements obtained using an HFHHD in the case of a <30 kgf group and the maximum value of two measurements obtained using a BFHHD are reliable.Key words: Absolute reliability, Handheld dynamometer, Shoulder joint horizontal adduction strength     

Reliability of measurements of knee extensor muscle strength using a pull-type hand-held dynamometer

[Purpose] The purpose of this study was to examine the intra-examiner and inter-examiner reliabilities of measurements of knee extensor muscle strength using a pull-type hand-held dynamometer (HHD). [Subjects] Fifty-four healthy adults (35 males; average age, 23 years) participated in this study. [Methods] Knee extensor muscle strength of each leg was measured three times using the HHD. To examine the intra- and inter-examiner reliabilities, measurements were performed by two examiners, a physical therapist and a physical therapy student. [Results] The intra-examiner reliabilities, ICC (1, 1) and ICC (1, 3) ranged from 0.94–0.99. The inter-examiner reliabilities, ICC (2, 1) and ICC (3, 1) ranged from 0.90–0.92 for the right leg, and 0.88−0.90 for the left leg. Neither constant nor proportional errors were found by Bland-Altman analysis. [Conclusion] Intra-examiner and inter-examiner reliabilities were acceptable, indicating that muscle strength can be measured with the pull-type HHD without dependence on skill of measurement. Pain was not caused by measurements with the pull-type HHD.Key words: Inter-examiner reliability, Intra-examiner reliability, Hand-held dynamometer     

Limits of the manipulative-fixed method for measurement of shoulder joint horizontal adduction muscle strength using a handheld dynamometer

[Purpose] The aim of this study was to verify the limit of isometric muscle strength of shoulder joint horizontal adduction using handheld dynamometer (HHD) manipulated by hand (referred to as the manipulative-fixed method). [Subjects and Methods] The subjects were 33 healthy college students. The examiner was a healthy college student. Shoulder joint horizontal adductor muscle strength was measured using HHD with the subject in the supine position. The belt-fixed and manipulative-fixed methods were used to secure the HHD sensor unit. The limitations of the manipulative-fixed method were assessed by simple regression analysis, in which the participants were divided into 2 groups according to a branch point. The slope of the straight line of the graph was visualized. [Results] Single regression analysis of the <30 kgf group revealed significant results. The results of single regression of the >30 kgf group were not significant. [Conclusion] The manipulative-fixed method is simple to perform. However, there exists the possibility that the actual muscle strength is not measurable by this method. The measurement limit of the shoulder horizontal adduction strength with the manipulative-fixed method was 30 kgf in the case of the examiner in the present study. The fixed limit was also found to influence in the muscle strength of the upper limbs.Key words: Handheld dynamometer, Shoulder joint horizontal adduction strength, Manipulative-fixed limit     

The supine hip extensor manual muscle test: a reliability and validity study

Perry J, Weiss WB, Burnfield JM, Gronley JK. The supine hip extensor manual muscle test: a reliability and validity study. Arch Phys Med Rehabil 2004;85:1345-50.

Objectives

To define the relative hip extensor muscle strengths values identified by the 4 grades obtained with a supine manual muscle test (MMT) and to compare these values with those indicated by the traditional prone test.

Design

Comparison of 4 manual supine strength grades with isometric hip extension joint torque; κ statistic-determined interrater reliability, and analyses of variance identified between grade differences in torque.

Setting

Pathokinesiology laboratory.

Participants

Adult volunteers recruited from local community and outpatient clinics. Reliability testing: 16 adults with postpolio (31 limbs). Validity testing (2 groups): 18 subjects without pathology (18 limbs), and 26 people with clinical signs of hip extensor weakness (51 limbs).

Interventions

Not applicable.

Main Outcome Measures

Supine hip extensor manual muscle grade and isometric hip extension torque.

Results

Reliability testing showed excellent agreement (82%). Subjects with pathology had significant differences in mean torque (P<.01) for the assigned grade 5 (176Nm), grade 4 (103Nm), grade 3 (67Nm), and grade 2 (19Nm). Healthy adults showed significant differences between grade 5 (212Nm) and grade 4 (120Nm) in mean torque (P<.05).

Conclusions

The supine MMT is a reliable and valid method with which to assess hip extension strength.     

Evaluation of neck muscle strength with a modified sphygmomanometer dynamometer: reliability and validity.

OBJECTIVE: Determine test-retest reliability, normative data and clinical validity of isometric muscle strength testing in the neck with a modified sphygmomanometer dynamometer (MSD). DESIGN: Analytic survey. Paired trials of various muscle strength tests were conducted on convenience samples of normal subjects and consecutive samples of symptomatic subjects. SETTING: Outpatient chiropractic research clinic. PATIENTS/SUBJECTS: For study 2, 40 normal male subjects, average age 25 +/- 2 yr, were studied for reliability and normative data. For study 3, 24 symptomatic patients, 12 males and 12 females, average age 39 +/- 7 yr, were studied, 8 with "whiplash"-type injuries (average duration 22.5 wk) and 16 with nontraumatic chronic neck pain (average duration 110 wk). INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURE: Pressure levels generated by subjects against a modified sphygmomanometer-type dynamometer as measured in kilopascals. RESULTS: Study 1. Repeated paired trials of a standardized weight column (20 lbs) produced a coefficient of variation of 0.84% and virtually no difference between the means of the first vs. second trials. Study 2. High test-retest correlation coefficients were found for all ranges of motion (.79-.97). Right-to-left asymmetry in rotation and lateral flexion was within 6-8%. The flexion/extension ratio was .57:1, indicating that in normal subjects, flexion was approximately 40% lower than extension. Lower cutoffs were established as the mean--1 SD as follows (in kPa): flexion--3300, extension--5800, rotation--5200 and lateral flexion--6200. Coefficients of variation ranged from 25 to 29%. Study 3. Differences between paired trials were analyzed by intraclass coefficients, which were very high (.95-.99), and by percentages, which ranged from 4 to 10.4%, with an average of 7%, indicating a high degree of test-retest consistency. The mean values for all symptomatic subjects for flexion, extension, right rotation and right lateral bending were all well below the normal cutoff values as found in study 2. The flexion/extension ratio for whiplash subjects was 0.25:1.00, which is half of that of normal subjects. CONCLUSIONS: The MSD has been found to be a reliable instrument for the evaluation of isometric muscle strength in the neck in normal and symptomatic subjects. Normative values for absolute test levels, bilateral symmetry and flexion/extension ratios have been determined. A symptomatic group demonstrated significant deviations from these norms in the form of reduced strength levels and reduced flexion/extension ratios, while still maintaining very high levels of test-retest consistency and bilateral symmetry. The MSD appears very promising in the evaluation of neck-injured patients.     

脑卒中患者偏瘫侧肌力测定的信度和效度—手持式测力仪测定规则

目的研究手持式测力仪（HHD）测定脑卒中患者偏瘫侧股四头肌肌力的信度和效度。 方法效度判定: 使用HHD分别测定2个已知砝码，将测定结果与砝码的标准重量进行相关性比较；并且将HHD与KIN-COM（肌力测定金标准）同时测定的结果进行相关性比较。信度判定：首先分析影响测定结果的因素，用HHD测量1例脑卒中患者取坐位、偏瘫侧膝关节分别屈曲90°和60°时，分别在偏瘫侧踝关节正前方和踝上7 cm处以及分别坐在有靠背和无靠背座椅时偏瘫侧股四头肌肌力，然后进行t检验比较各自差异，根据以上影响测定因素结果，制定测定规则；进而根据测定规则，由3名不同检查者对21例脑卒中偏瘫患者进行连续4 d、每日1次、共4次测定，分析影响测定结果的因素。 结果效度判定结果：2个砝码标准重量是8．972 kg和18．666 kg，利用HHD测量的结果分别是（8．98±0．00）kg和（18．57±0．00）kg；HHD与KIN-COM的测定结果完全一致。可信度的分析结果：偏瘫侧膝关节不同屈曲角度时测定结果之间差异无统计学意义；而不同测定部位测定结果之间和不同座椅的测定结果之间差异均有统计学意义。因此，规定患者取坐位于有靠背的坐椅上、膝关节屈曲90°、以踝关节正前方为测定点进行测量，发现患者间肌力差异有统计学意义，但3名检查者对相同患者测定的结果差异无统计学意义，同一患者4次测定结果差异无统计学意义。 结论用HHD测定脑卒中偏瘫患者偏瘫侧股四头肌肌力时，只要遵从一定测定规则可以保证其信度及效度。     

Reliability of measuring hip abductor strength following total knee arthroplasty using a hand-held dynamometer

Purpose: To investigate the test–retest reliability of measuring hip abductor strength in patients with total knee arthroplasty (TKA) using a hand-held dynamometer (HHD) with two different types of resistance: belt and manual resistance. Method: Test–retest reliability of 30 subjects (17 female, 13 male, 71.9?±?7.4 years old), 9.2?±?2.7 days post TKA was measured using belt and therapist resistance. Retest reliability was calculated with intra-class coefficients (ICC_3,1) and 95% confidence intervals (CI) for both the group average and the individual scores. A paired t-test assessed whether a difference existed between the belt and therapist methods of resistance. Results: ICCs were 0.82 and 0.80 for the belt and therapist resisted methods, respectively. Hip abductor strength increases of 8?N (14%) for belt resisted and 14?N (17%) for therapist resisted measurements of the group average exceeded the 95% CI and may represent real change. For individuals, hip abductor strength increases of 33?N (72%) (belt resisted) and 57?N (79%) (therapist resisted) could be interpreted as real change. Conclusions: Hip abductor strength can be reliably measured using HHD in the clinical setting with the described protocol. Belt resistance demonstrated slightly higher test–retest reliability.

• Implications for Rehabilitation

• Reliable measurement of hip abductor muscle strength in patients with TKA is important to ensure deficiencies are addressed in rehabilitation programs and function is maximized.

• Hip abductor strength can be reliably measured with a hand-held dynamometer in the clinical setting using manual or belt resistance.

     

Longitudinal assessment of grip strength using bulb dynamometer in Duchenne Muscular Dystrophy

BACKGROUND:

Grip strength is used to infer functional status in several pathological conditions, and the hand dynamometer has been used to estimate performance in other areas. However, this relationship is controversial in neuromuscular diseases and studies with the bulb dynamometer comparing healthy children and children with Duchenne Muscular Dystrophy (DMD) are limited.

OBJECTIVE:

The evolution of grip strength and the magnitude of weakness were examined in boys with DMD compared to healthy boys. The functional data of the DMD boys were correlated with grip strength.

METHOD:

Grip strength was recorded in 18 ambulant boys with DMD (Duchenne Group, DG) aged 4 to 13 years (mean 7.4±2.1) and 150 healthy volunteers (Control Group, CG) age-matched using a bulb dynamometer (North Coast- NC70154). The follow-up of the DG was 6 to 33 months (3-12 sessions), and functional performance was verified using the Vignos scale.

RESULTS:

There was no difference between grip strength obtained by the dominant and non-dominant side for both groups. Grip strength increased in the CG with chronological age while the DG remained stable or decreased. The comparison between groups showed significant difference in grip strength, with CG values higher than DG values (confidence interval of 95%). In summary, there was an increment in the differences between the groups with increasing age. Participants with 24 months or more of follow-up showed a progression of weakness as well as maintained Vignos scores.

CONCLUSIONS:

The amplitude of weakness increased with age in the DG. The bulb dynamometer detected the progression of muscular weakness. Functional performance remained virtually unchanged in spite of the increase in weakness.     

Reliability and validity of static knee strength measurements obtained with a chair-fixed dynamometer in subjects with hip or knee arthroplasty

OBJECTIVES: To evaluate the reliability (intertrial, interevaluator) and the concurrent validity of strength measurements obtained with a chair-fixed dynamometer and to recommend a clinical protocol that minimizes standard error of measurement (SEM). DESIGN: Within-session repeated measures of maximal static strength of knee flexors and extensors at 30 degrees and 60 degrees of flexion on the chair-fixed and Cybex dynamometers. SETTING: Ambulatory physiotherapy department of a rehabilitation hospital. PARTICIPANTS: Convenience sample of 50 subjects with total hip (n=25) or knee (n=25) arthroplasty. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reliability was quantified by indices of dependability and corresponding SEMs estimated with the generalizability theory, whereas coefficients of correlation were used to assess the validity. RESULTS: Indices of dependability confirmed excellent intertrial (0.98-1.00) and a very good interevaluator (.92-.99) reliability for the strength measures obtained for different movements and positions. An average of 3 trials minimized the magnitude of the SEMs (>2 Nm for all measurements). When comparing the strength values obtained with the Cybex dynamometer to those measured with the chair-fixed dynamometer, strongest relations were attained when the tested knee was positioned at 60 degrees compared with 30 degrees for subjects with a total knee (.78-.92 vs .87-.93) or hip (.73-.85 vs .86-.91) arthroplasty. CONCLUSIONS: A clinical protocol averaging 3 trials with the knee positioned at 60 degrees after a familiarization period, both for knee flexors and extensors, performed by a trained therapist is recommended to minimize measurement errors on strength values measured with the chair-fixed dynamometer.     

The validity and reliability of the sphygmomanometer for hip strength assessment in Australian football players

Objectives: To investigate the intra-rater and inter-rater reliability of the sphygmomanometer for the assessment of the adductor squeeze test and isometric hip abduction strength and to investigate the concurrent validity of the sphygmomanometer for the assessment of hip muscular strength. Method: Thirty-two healthy adult male community Australian football players (age 23.9 ± 4.5 years) were assessed by two blinded raters that measured the strength of the adductor squeeze test and isometric hip abduction, using a commercially available sphygmomanometer. Concurrent validity was calculated using handheld dynamometry as the reference standard. Results: Moderate to high intra-rater reliability (ICC = 0.61 to 0.92) and high inter-rater reliability (ICC = 0.77 to 0.91) were found. High concurrent validity (Pearson’s r = 0.77 to 0.91) was established. Sixteen of the participants reached the maximal reading of the sphygmomanometer, demonstrating a ceiling effect. Conclusions: A sphygmomanometer is a cost-efficient device that appears to be both reliable and valid for the assessment of hip strength, offering clinicians an alternate and easily accessible option to obtain objective strength data. A ceiling effect may limit the application of the sphygmomanometer as a strength measurement device in stronger individuals.     

Test-retest reliability of isometric ankle plantar flexion strength measurement performed by a hand-held dynamometer considering fixation: examination of healthy young participants

[Purpose] This study aimed to investigate the test-retest reliability of isometric ankle plantar flexion strength measurements performed by a hand-held dynamometer (HHD) using two belts and a newly devised fixation plate. [Participants and Methods] The participants were 83 healthy individuals (female, n=31; male, n=52) with an average age of 20 years. An HHD (μTas F-1) sensor was fixed using two belts and a newly developed metal device to the measurement site on the dominant foot of a participant who was in a sitting position. Measurements were performed twice for each participant. [Results] The average value was 65.6 kgf (bodyweight ratio, 127.3%) for female and 88.0 kgf (136.9%) for male participants. The intraclass correlation coefficients of the two measurements were 0.915 for female and 0.938 for male participants. The minimum detectable change at 95% was 10.1 kgf (12.1% of the average value) for female and 12.1 kgf (15.4%) for male participants. [Conclusion] The test-retest reliability of measuring the ankle plantar flexion strength performed by an HHD using a belt and plate is high. Therefore, the increase or decrease in muscle strength should be judged based on the minimal detectable change with 95% confidence.     

Reliability and validity of measurements of cervical retraction strength obtained with a hand-held dynamometer

Objectives: The purpose of this study was to describe the reliability and validity of measurements of cervical retraction strength obtained with a hand held dynamometer (HHD) from healthy adults.

Background: Impaired neck muscle strength is related to neck pain, abnormal posture, and various cervical pathologies. While sophisticated devices to objectively measure neck strength exist, many are not practicable in typical orthopedic practices or have questionable validity and reliability.

Methods: Forty participants were included in the analysis of neck strength using isometric testing with an HHD fixed in a cradle on a table top. The highest neck retraction force recorded in Newtons (N) for each participant, was used for data analysis.

Results: Both intratester and intertester reliability were excellent as judged by intraclass correlation coefficients (ICCs) (.885 – .974) and minimal detectable change (MDC) (21.1 to 47.6 N). Validity was confirmed on the basis of expected gender and age differences (ie, men were stronger than women and younger participants were stronger than older participants).

Conclusion: Fixed HHD is a reliable and valid tool for measuring isometric neck retraction strength in ostensibly healthy adults. Its value in the assessment of individuals with neck pathology awaits further examination.     

The reliability of evaluation of hip muscle strength in rehabilitation robot walking training

[Purpose] The primary purpose of this study was to evaluate the intraclass correlation coefficient in obtaining the torque of the hip muscle strength during a robot-assisted rehabilitation treatment. [Subjects] Twenty-four patients (15 males, 9 females) with spinal cord injury participated in the study. [Methods] The subjects were asked to walk during robot-assisted rehabilitation, and the torque of the muscle strength which was measured at hip joint flexion angles of −15, −10, −5, 0, 5, 10, 15, 20, 25, and 30 degrees. [Results] The intraclass correlation coefficient of the torque of the hip muscle strength measured by the rehabilitation training robot was excellent. [Conclusion] Our results show that measurement of torque can be used as an objective assessment of treatment with RAT.Key words: Hip muscle strength, Robot-assisted rehabilitation     

Kinematic characteristics of standing disequilibrium: reliability and validity of a posturographic protocol

OBJECTIVE: To investigate retest reliability and concurrent validity of the fundamental measurements made of a posturographic protocol that employs quiet standing to quantify the severity and the nature of patients' postural disturbances. STUDY DESIGN: Retrospective complete block design. SETTING: Geriatric rehabilitation department. PARTICIPANTS: Thirty-six participants (age range, 67 to 86 yrs) having normal, moderate, or severe levels of disequilibrium. METHODS: Quiet standing was evaluated on three occasions using a three-dimensional motion analysis system and a force platform. Eight testing conditions, designed to vary task difficulty by controlling the contributions of vision, foot proprioception, and base-of-support width, were administered. MAIN OUTCOME MEASURES: Retest reliability of body sway, joint alignment, body position, and motor coordination indicators were evaluated by intraclass correlation coefficients (ICCs). Concurrent validity of protocol measures was evaluated by the prediction of disequilibrium from a stepwise linear discriminant analysis. RESULTS: ICCs indicated high level of retest reliability for all variables but those of motor coordination, which was not influenced by testing conditions. Discriminant analysis resulted in a four-factor discriminator that included measures of body sway, position, alignment, and motor coordination. The derived linear discriminate function correctly classified 96% of the patients' level of disequilibrium. CONCLUSIONS: The posturographic protocol has the potential to be a useful tool for evaluating severity and nature of postural instability and the effects of pharmacologic and rehabilitative treatment. Results also indicate that combining direct body measurements with force-plate data has the potential to expose the underlying impairments that cause disequilibrium, determine their pathogenesis, and evaluate compensatory strategies.     

Cybex-6000系统测试肩关节伸肌群向心-离心收缩的信度研究

目的评价Cybex-6000型等速测试系统测试肩关节伸肌群向心-离心收缩的可靠性.方法对15名健康男性的优势肩关节伸肌采用Cybex-6000型等速测试系统进行向心-离心收缩测试,速度60°/s、120°/s和180°/s;等速测试指标峰力矩(PT)、平均功率(AP)和单次最大作功(TW).选用组内相关系数(ICC)作为可靠性判断指标.结果 PT、AP和TW的ICC范围0.86～0.97,具有良好的可重复性.结论 Cybex-6000型等速测试系统测试肩关节伸肌向心-离心收缩具有良好的可靠性.     

Portable dynamometer anchoring station for measuring strength of the hip extensors and abductors

OBJECTIVE: To assess the reliability of a specially designed dynamometer anchoring station in the measurement of hip muscle strength. DESIGN: Prospective study using test-retest design. SETTING: Outpatient clinic setting. PARTICIPANTS: Ten subjects, ages 25 to 35yrs. MAIN OUTCOME MEASURES: Using the apparatus, three consecutive measures were recorded for hip abduction and extension by an inexperienced examiner. Two weeks later, the same subjects were retested, with the evaluator blinded to the initial results. In both the test and retest, average and maximal values of strength were calculated for each muscle. Reliability of the device was assessed by computing the intraclass correlation coefficients and coefficients of variation (CVs). RESULTS: Intraclass correlation coefficients ranged from .94 to .98. The average CV for the maximal and average abduction strength had values of 4.77% and 4%, respectively. The maximal and average extension strength had average CV values of 8.06% and 7.83%, respectively. CONCLUSION: This specially designed dynamometer anchoring station has been found to be highly reliable in the measurement of hip girdle strength and has the advantage of easy adjustability and portability for large-scale screenings. This device enhances the reliability of the dynamometer, which may be subject to considerable variability when applied by hand to the powerful hip girdle musculature.     

Preeclampsia: a link between trophoblast dysregulation and an antiangiogenic state

A 24-year-old nulliparous woman developed mildly elevated blood pressure(140–150/90–100 mmHg) without proteinuria (20 mg protein in a 24-hoururine collection) at 30^6/7 weeks of gestation. The fetus was small forgestational age (estimated fetal weight under the fifth percentile). At32^5/7 weeks of gestation, the patient complained of epigastric pain,blood pressure was 180/110 mmHg, proteinuria was documented (780 mg protein in a24-hour urine collection), schistocytes were detected in the peripheral smear,platelet count was 60,000 cells per mm³, and serum glutamic oxaloacetictransaminase was 234 U/l. The patient was diagnosed with severe preeclampsia/HELLPsyndrome. Antenatal steroids were administered to induce fetal lung maturity. She andher family want to know the causes of this condition, what treatment is available,and whether there are any long-term implications of this diagnosis.