Intra-rater and inter-rater reliability of the standardized ultrasound protocol for assessing subacromial structures

Background: US-examinations related to shoulder impingement (SI) often vary due to methodological differences, examiner positions, transducers, and recording parameters. Reliable US protocols for examination of different structures related to shoulder impingement are therefore needed. Objectives: To investigate the intra- and inter-rater reliability of the existing ultrasound (US) examinations of the subacromial space, the subacromial-subdeltoid bursa, and the supraspinatus tendon. Method: In a three-phased design, two physiotherapists using a standardized US protocol examined the thickness of the supraspinatus tendon (SUPRA) and subacromial subdeltoid (SASD) bursa in two imaging positions, and the acromial humeral distance (AHD) in one position. Additionally, agreement on dynamic impingement (DI) examination was performed. The intra- and inter-rater reliability was carried out on the same day. Participants: Forty-six sports active participants with a mean age of 37 years (range 18–57) participated. Twenty-two had SI and pain within previous week and 24 did not have SI or pain within previous week. Results: Intra- and inter-rater reliability ICC (2,3) models were all above 0.80 (range 0.82–0.99) with no systematic bias (Bland Altman plots). For the DI examination, the overall agreement was 98% and 93%, with Kappa of 0.96 and 0.82, for intra- and inter-rater reliability, respectively. Conclusion: The reliability of the current standardized protocol for US examination of SI was excellent and considered feasible for clinical practice.     

Moderate exercise improves gait stability in disabled elders

Background: Decreased muscle strength impedes elders' functional performance in daily activities such as gait. The mechanisms whereby increased strength improves gait are unknown.Methods: A prospective, blinded, randomized trial of moderate intensity strength exercise was conducted and its impact was measured on functional mobility during gait in 132 functionally limited elders. Lower extremity strength was measured, including hip abductor, hip extensor, and knee extensor strength. Of the 132 subjects, 120 subjects (mean age, 75.lyrs) completed 6 months of elastic band resistance training at least 3 times a week or served as no-exercise controls.Results: Subjects increased their lower extremity strength in the exercise and control groups, by 17.6% and 7.3% (p < .01), respectively. Gait stability improved significantly more in the exercise group than in the control group (p < .05). Increases in forward gait velocity were not significantly different between groups. Peak mediolateral velocity and base of support improved in the exercise group, but not in the control group. Change in lower extremity strength correlated significantly but weakly with many of the gait variables.Conclusions: Gait stability, especially mediolateral steadiness, improved in the exercise group but not in the control group. These results show that even moderate strength gains benefit gait performance in elders and thus provide a sound basis for encouraging low-intensity strength training for elders with functional limitations.     

The difference in anatomy of the lumbar anterior longitudinal ligament in young african-americans and scandinavians

Objective: To examine possible structural differences in the lumbar anterior longitudinal ligament between young African-American and Scandinavian people.Design: The lumbar anterior longitudinal ligament was examined in 48 African-American and Scandinavian young men and women (17 to 30 years old). Apart from the selection of gender, age, height, and weight, all subjects were recruited consecutively during routine forensic autopsies. Sections of the ligament were obtained from the L1 and the L5 vertebra for thickness and width measurements and histologic preparations. The measurements were performed with a digital vernier caliper with an accuracy of 0.1mm.Results: The width of the L1 part of the lumbar anterior longitudinal ligament in the African-American group (27.5 ± 1.8mm) was greater than that in the Scandinavian group (17.7 ± 1.5mm) (p < .001), and the thickness of the L1 part in the African-American group (3.8 ± 0.4mm) was greater than that in the Scandinavian group (3.3 ± 0.3mm) (p < .001). The width of the L5 part in the African-American group (34.1 ± 2.0mm) was greater than that in the Scandinavian group (25.0 ± 1.5mm) (p < .001), and the thickness of the L5 part in the African-American group (3.3 ± 0.3mm) was greater than that in the Scandinavian group (2.2 ± 0.3mm) (p < .001). The cross-sectional area was greater in the African-American group in both sections (L1, African-American 106.4 ± 13.7mm2 vs Scandinavian 52.8 ± 7.9mm²; L5, African-American 112.2 ± 14.6mm² vs Scandinavian 55.6 ± 6.7mm²) (p < .001). No histologic differences between the two groups were observed.Conclusions: The lumbar anterior longitudinal ligament was considerably wider and thicker, which yielded a markedly greater cross-sectional area, in African-American than in Scandinavian subjects. In contrast, the ligament appears to be histologically similar in the two groups. These are previously unrecognized differences in anatomy between young African-American and Scandinavian people.     

Evaluation of the Personal Impact Health Assessment Questionnaire (PI HAQ) to capture the impact of disability in osteoarthritis

Aim: Measuring facts about disability may not reflect their personal impact. An individualized values instrument has been used to weight difficulty in performing activities of daily living in rheumatoid arthritis, and calculate personal impact (Personal Impact Health Assessment Questionnaire; PI HAQ). This study aimed to evaluate the PI HAQ in osteoarthritis (OA). Study design: Study 1: 51 people with OA completed short and long versions of the value instrument at 0 and 1 week. Study 2: 116 people with OA completed the short value instrument, disability and psychological measures at 0 and 4 weeks. Results: Study 1: The eight‐category and 20‐item value instruments correlated well (r = 0.85) and scores differed by just 2.7%. The eight‐category instrument showed good internal consistency reliability (Cronbach's α = 0.85) and moderate one‐week test‐retest reliability (r = 0.68, Wilcoxon signed‐rank test p = 0.16, intra‐class correlation coefficient [ICC] 0.62). Study 2: Values for disability were not associated with disability severity or clinical status. After weighting disability by value, the resulting PI HAQ scores were significantly associated with dissatisfaction with disability, perceived increase in disability, poor clinical status and life dissatisfaction, and differed significantly between people with high and low clinical status (convergent and discriminant construct validity). There was moderate association with the disease repercussion profile disability subscale (r = 0.511; p < 0.001) (criterion validity). The PI HAQ was stable over four weeks (ICC 0.81). Conclusions: These studies provide an initial evaluation of an instrument to measure the personal impact of disability in people with OA, setting disability within a personal context. Further studies, including sensitivity to change, are required. Copyright © 2010 John Wiley & Sons, Ltd.