Active movement measurements of the shoulder girdle in healthy subjects with goniometer and tape measure techniques: a study on reliability and validity

In response to the current need to develop objective measurement techniques for active movements of the shoulder girdle, this study had two goals: 1) to evaluate the reliability of the active range of motion (AROM) of shoulder girdle in elevation, protraction, and retraction with use of a goniometer and a tape measure and 2) to present the criterion-related validity of the reliable movements. Thirty healthy subjects performed two trials of each shoulder girdle AROM. They were assessed by two physical therapists, who used both evaluation techniques on two occasions. The generalizability theory was used to compute intratester (test-retest) and intertester reliability using dependability coefficients (phi) and standard errors of measurement (SEMs). The shoulder girdle movements were then evaluated with a movement analysis system (Optotrak 3020). The Pearson product-moment correlation coefficient (r) and paired t-tests were used to compare the results of clinical measurements with those of the movement analysis system. Overall, the reliability with the tape measure was good (phi = 0.78-0.91; SEM's = 0.7-1.1 cm) for the elevation motion. The goniometer was only reliable for intratester measures (phi = 0.78-0.79; SEM = 2.7 degrees) for the elevation motion. Retraction was reliable with the tape measure alone (phi = 0.76-0.84; SEM's = 0.5-0.7 cm). The criterion-related validity analysis revealed that measuring shoulder girdle elevation with the tape measure and goniometer, and retraction with the tape measure were not valid when evaluated against a gold standard, thus, both techniques have limitations in assessing true elevation and retraction measurements.     

The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC95) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer

This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry?=?0.87, intrarater digital inclinometry?=?0.88, interrater goniometry?=?0.92, and interrater digital inclinometry?=?0.89. The minimal detectable change (MDC₉₅) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.     

Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity

BACKGROUND AND PURPOSE: Scapular muscle performance evaluated with a handheld dynamometer (HHD) has been investigated only in people without shoulder dysfunction for test-retest reliability of data obtained with a single scapular muscle test. The purpose of this study was to assess the reliability, error, and validity of data obtained with an HHD for 4 scapular muscle tests in subjects with shoulder pain and functional loss. SUBJECTS AND METHODS: Subjects (N=40) with shoulder pain and functional loss were tested by measuring the kilograms applied with an HHD during 3 trials for muscle tests for the lower trapezius, upper trapezius, middle trapezius, and serratus anterior muscles. Concurrently, surface electromyography (sEMG) data were collected for the 4 muscles. The same procedures were performed 24 to 72 hours after the initial testing by the same tester. Muscle tests were performed 3 times, and the results were averaged for data analysis. RESULTS: Intraclass correlation coefficients for intratester reliability of measurements of isometric force obtained using an HHD ranged from .89 to .96. The standard error of the measure (90% confidence interval [CI]) ranged from 1.3 to 2.7 kg; the minimal detectable change (90% CI) ranged from 1.8 to 3.6 kg. Construct validity assessment, done by comparing the amounts of isometric muscle activity (sEMG) for each muscle across the 4 muscle tests, revealed that the muscle activity of the upper trapezius and lower trapezius muscles was highest during their respective tests. Conversely, the isometric muscle activity of the middle trapezius and serratus anterior muscles was not highest during their respective tests. DISCUSSION AND CONCLUSION: In people with shoulder pain and functional loss, the intrarater reliability and error over 1 to 3 days were established using an HHD for measurement of isometric force for the assessment of scapular muscle performance. Error values can be used to make decisions regarding individual patients. Construct validity was established for the lower and upper trapezius muscle tests; therefore, these tests are advocated for use. However, construct validity was not demonstrated for the serratus anterior and middle trapezius muscle tests as performed in this study. Further investigation of these muscle tests is warranted.     

The reliability and validity of measurements designed to quantify posterior shoulder tightness

Abstract

Background: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders; thus, reliable and valid methods for quantifying PST are necessary.

Objectives: To systematically review the literature pertaining to the reliability and validity of PST measurements.

Methods: Three investigators independently performed an electronic search using the MEDLINE-PubMed, SPORTDiscus, and CINAHL databases. Inclusion criteria consisted of English studies published in peer-reviewed journals that identified the reliability and/or validity of a PST measurement method as the primary focus.

Results: A total of 2860 articles were initially identified with 11 retained for final review. Two measurement procedures were reported that included supine and side lying horizontal adduction with scapular stabilization. PST was quantified with goniometry, inclinometry, and linear techniques. Intra-rater reliability ranged from intraclass correlation coefficient (ICC)?=?0.;40 to 0.;96, whereas inter-rater reliability ranged from ICC?=?0.;69 to 0.;91. Reliability among symptomatic and asymptomatic participants was comparable and there appeared to be no advantage of one measurement procedure versus another. A trend of higher reliability for inclinometric measurements was identified. In regard to convergent validity researchers reported correlations of r?=?0.;35–0.;88 between the aforementioned measurement techniques and internal rotation (IR).

Conclusion: PST measurement procedures have poor-to-good reliability and demonstrate convergence when compared to IR. An advantage of goniometry and inclinometry lies in their ability to gather ratio data, which may be used for inter-subject comparison unlike linear measurement techniques. No studies investigated PST measurements in the post-operative population suggesting a need for future research.     

Reliability of arthrometric measurement of shoulder lateral rotation movement in healthy subjects

Numerous pathologic conditions of the shoulder result in loss of range of motion with lateral rotation being one of the most affected movements. Therefore, it is essential to know the reliability of the methods to measure this motion from a treatment evaluation perspective. The purpose of this study was to examine the reliability of the shoulder lateral rotation movement measured by an arthrometric method. Fifteen healthy subjects participated in the study. The passive range of motion in lateral rotation of the shoulder was measured with an arthrometric method for three positions of shoulder abduction and with three loads. Two evaluators took each measurement on two separate occasions. The reliability was good at 60 degrees and 90 degrees abduction with dependability indexes (phi) ranging from 0.77 to 0.87 and SEMs lower than 5 degrees. The reliability at 25 degrees abduction was lower with dependability indexes (phi) ranging from 0.52 to 0.66 and SEMs of 7 degrees or 8 degrees. Reliability was highest with the heaviest load reaching 0.66, 0.84, and 0.87 for the 25 degrees, 60 degrees, 90 degrees abduction angles, respectively. In all conditions of measurement, differences between intratester and intertester reliability were minimal. Reliability of the shoulder lateral rotation measured by arthrometry was dependent on angle of abduction and load used to move the shoulder. Further studies are needed to confirm these findings in individuals with impaired shoulders.     

Ultrasonography of longus colli muscle: A reliability study on healthy subjects and patients with chronic neck pain

In this study, the reliability of the longus colli muscle (LCM) size was assessed in a relaxed state by a real time ultrasonography (US) device in a group of healthy subjects and a group of patients with chronic neck pain. Fifteen healthy subjects (19-41 years old) and 10 patients with chronic neck pain (27-44 years old) were recruited for the purpose of this study. LCM size was measured at the level of thyroid cartilage. Two images were taken on the same day with an hour interval to assess the within day reliability and the third image was taken 1 week later to determine between days reliability. Cross sectional area (CSA), anterior posterior dimension (APD), and lateral dimension (LD) were measured each time. The shape ratio was calculated as LD/APD. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were computed for data analysis. The ICC of left and right CSA for within day and between days reliability in healthy subjects were (0.90, 0.93) and (0.85, 0.82), respectively. The ICC of left and right CSA for within day and between days reliability in patients with neck pain were (0.86, 0.82) and (0.76, 0.81), respectively. The results indicated that US could be used as a reliable tool to measure the LCM dimensions in healthy subjects and patients with chronic neck pain.     

The reliability and validity of the physiological cost index in healthy subjects while walking on 2 different tracks

OBJECTIVE: To investigate the reliability and validity of the Physiological Cost Index (PCI) scores, as a measure of energy expenditure, when healthy subjects walk on 2 different tracks (20-m and 12-m figure eight tracks). DESIGN: Intra- and interrater reliability and construct validity. SETTING: Physiotherapy division of a university in London, UK. PARTICIPANTS: Forty healthy subjects (15 men, 25 women; mean age +/- standard deviation, 34.5+/-12.6 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Heart rate (in beats/min) and speed (in m/min) were used to calculate the PCI (in beats/m). Rate of oxygen consumption (VO2, in mL x kg(-1) x min(-1)) and oxygen cost (EO2, in mL x kg(-1) x m(-1)) were used as criterion estimates of energy cost EO2. Pearson correlation coefficients between the PCI, components of the PCI, EO2, and VO2 were used to quantify validity. Intrarater reliability was assessed in all participants and interrater reliability was assessed on a subset of 13 subjects using intraclass correlation coefficients and Bland-Altman plots. RESULTS: Intrarater (r=.73, r=.79) and interrater (r=.62, r=.66) reliability were acceptable between PCI scores from 20-m and 12-m tracks, respectively. Correlations between VO2 and EO2 with PCI were weak. PCI scores from the 20-m track were significantly lower than those on the 12-m track (P=.002). Subjects walked significantly faster on the 20-m track (P<.001). Results suggest a large difference in PCI scores would be necessary to indicate a "true" alteration in performance (52% for 20-m track, 43.4% for the 12-m track). CONCLUSIONS: The PCI is reliable but not valid as a measure of the energy cost of walking in healthy subjects, on either track. The 20-m track is recommended for clinical use because it enables subjects to walk at a faster pace.     

The validity and reliability of the GAITRite system's measurements: A preliminary evaluation

OBJECTIVE: To compare the concurrent validity and reliability of the GAITRite computerized gait analysis system with validated paper-and-pencil and video-based methods. DESIGN: Within-groups, repeated-measures design. SETTING: Research laboratory in a physical therapy education program. PARTICIPANT: One healthy woman, age 27 years. INTERVENTIONS: A subject walked across the walkway of the GAITRite system at various walking rates and degrees of step symmetry for 2 of the 3 analyses. Paper placed over the walkway enabled concurrent paper-and-pencil analysis. The subject was concurrently videotaped from the side. For the other analysis, a stride simulator with known step and stride lengths was applied to the walkway to simulate 2 steps and 1 stride. MAIN OUTCOME MEASURES: Cadence, walking speed, right and left step and stride lengths, and right and left step times. RESULTS: Excellent paper-and-pencil and GAITRite correlations (intraclass correlation coefficient [ICC] > 95) for spatial measures and excellent video-based and GAITRite correlations (ICC > 93) for temporal measures were found. GAITRite measures of step lengths and times were reliable in both walkway center and left-of-center measurements. CONCLUSIONS: Based on this data, GAITRite is a valid and reliable tool for measuring selected spatial and temporal parameters of gait.     

Development of the Hand Active Sensation Test: reliability and validity

OBJECTIVE: To develop and establish the reliability and validity of a new quantitative functional measure of haptic perception in the hand, the Hand Active Sensation Test (HASTe). DESIGN: Reliability was assessed by test-retest sessions. Validity was assessed via discriminant analysis, concurrent validity with 2-point discrimination and wrist position test, and receiver operating characteristic (ROC) curve construction. SETTING: Subject preference. PARTICIPANTS: Heterogeneous sample of 28 stroke survivors and 28 individually matched controls. INTERVENTION: Subjects used 1 hand to manipulate HASTe objects that vary by weight or texture to complete 18 match-to-sample trials. MAIN OUTCOME MEASURES: Two-point discrimination threshold, Wrist Position Sense Test (WPST) average error, and HASTe accuracy score. RESULTS: Test-retest reliability was strong (intraclass correlation coefficient model 3,1 = .77). The HASTe score significantly discriminated the groups (t = 8.3, P < .001) and correlated with 2-point discrimination (r = -.67, P < .001) and WPST (r = -.60, P < .001). ROC curve area was .94 for test 1 and .92 for the average of 2 tests. CONCLUSIONS: The HASTe is a reliable and valid functional measure of haptic perception, appears to detect impairment of haptic perception even in stroke survivors with no reported sensory deficits, and may provide valuable quantitative clinical data about complex sensory loss and hand function after stroke.     

Inter-day reliability of the Upper Body Test for shoulder and pelvic girdle stability in adults

BackgroundThere are a limited number of tests for the assessment of shoulder and pelvic girdle stability. Reliable instruments are important to evaluate movement dysfunction at these joints in order to provide more objective parameters.ObjectiveTo evaluate the inter-day reliability of the Upper Body Test in young adults.MethodsA reliability study was carried out with three assessments of the shoulder and pelvic girdle stability within 48-h intervals (Monday, Wednesday, and Friday). The OctoBalance® platform was used to perform the Upper Body Test in 31 active young adults (24.5 ± 8 years). Intraclass Correlation Coefficient (ICC_2,2) two-way mixed model, Coefficient of Variation, and Bland–Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD_95%) were calculated for clinical applicability.ResultsThe Intraclass Correlation Coefficient ranged from 0.87 to 0.94 – Featuring a mean difference of 0.89 (95%CI = −0.19–1.97) to left and 0.95 (95%CI = −0.38–2.27) for the right side, with a low variation coefficient (3.31–5.91%) between the second and third days of assessment. There was a statistically significant difference between the first assessment day and the other test sessions. The Bland–Altman analyses revealed low bias with scores within the limits of agreement. Minimum detectable difference scores were between 4.02 and 5.10, and standard error of measurement between 1.75 and 2.72, depending on the movement side.ConclusionThe Upper Body Test presented good inter-day reliability for assessing the stability of the shoulder and pelvic girdle in young active healthy adults.     

Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia

Clinical observations have suggested a relationship between shoulder range of movement (ROM) and lateral epicondylalgia. This study reports the effect of a single intervention of a mobilization with movement (MWM) applied to the elbow, on shoulder rotation ROM in subjects with lateral epicondylalgia. Twenty-three subjects with lateral epicondylalgia were included. In a one-group pretest-post-test design, ROM of shoulder internal and external rotation were measured by goniometer before and after the application of the MWM, of both the unaffected and the affected limbs. Significant differences in pre-intervention external rotation ROM were found between unaffected and affected shoulders of subjects with lateral epicondylalgia, but no significant difference remained post-intervention. It may be concluded that restriction of shoulder rotation ROM is present in patients with lateral epicondylalgia, probably due to a facilitated level of shoulder rotator muscle tone. Shoulder internal and external rotation ROM increases significantly following MWM to the elbow, in subjects with unilateral lateral epicondylalgia. Surprisingly, these ROM increases are also apparent on the 'unaffected' limb. These findings suggest that the MWM causes a neurophysiologically mediated decrease in resting muscle tone.     

Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial

BACKGROUND AND PURPOSE: The purpose of this study was to compare the use of 3 mobilization techniques--end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)--in the management of subjects with frozen shoulder syndrome (FSS). SUBJECTS: Twenty-eight subjects with FSS were recruited. METHODS: A multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics. RESULTS: Overall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did. DISCUSSION AND CONCLUSION: In subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.     

Comparison of visual and ultrasound based techniques to measure head repositioning in healthy and neck-pain subjects

Three-dimensional (3D) ultrasound based (US) and usual Revel visual techniques were compared to measure head repositioning ability in 41 healthy subjects and 41 subjects with neck pain. Head repositioning absolute value of the global error (AE) was calculated by both techniques after active head rotations. The AE was 3.6 degrees and 3.7 degrees for healthy subjects and 6.3 degrees and 6.1 degrees for neck-pain subjects for the visual and US techniques, respectively. The AE was higher in neck-pain subjects (p<0.001), and a value of 4.5 degrees was identified as a threshold of abnormal repositioning for both techniques. The test-retest reliability, calculated in the neck-pain subjects, was moderate (intraclass correlation coefficient [ICC]=0.68) for both techniques. The correlation between the two techniques for AE was poor for both groups with successive measurement of visual and US techniques (r=0.32 and 0.46, respectively) but excellent with simultaneous measurement (r=0.95 for both groups). Moreover, we showed substantial agreement between the techniques in discriminating healthy and neck-pain subjects (kappa=0.65). The Revel visual technique is more appropriate for clinical practice, but with improved software, the 3D US method could provide additional quantitative and qualitative data invaluable for research.