Intra-observer reliability for measuring first and second toe and metatarsal protrusion distance using palpation-based tests: a test-retest study

Background: Measurement of first and second metatarsal and toe protrusion is frequently used to explain foot problems using x-rays, osteological measurements or palpation-based tests. Length differences could be related to the appearance of problems in the foot. A test-retest design was conducted in order to establish the intra-rater reliability of three palpation-based tests. Methods: 202 feet of physical therapy students and teachers of the CEU San Pablo University of Madrid, 39 men and 62 women, were measured using three different tests. Data were analysed using SPSS version 15.0. Mean, SD and 95% CI were calculated for each variable. A normal distribution of quantitative data was assessed using the Kolmogorov-Smirnov test. The test-retest intra-rater reliability was assessed using an Intraclass Correlation Coefficient (ICC). The Standard Error Mean (SEM) and the Minimal Detectable Change (MDC) were also obtained. Results: All the ICC values showed a high degree of reliability (Test 1 = 0.97, Test 2 = 0.86 and Test 3 = 0.88) as did the SEM (Test 1 = 0.07, Test 2 = 0.10 and Test 3 = 0.11) and the MDC (Test 1 = 0.21, Test 2 = 0.30 and Test 3 = 0.31). Conclusions: Reliability of measuring first and second metatarsal and toe protrusion using the three palpation-based tests showed a high degree of reliability

Intra-observer reliability for measuring first and second toe and metatarsal protrusion distance using palpation-based tests: a test-retest study

Background: Measurement of first and second metatarsal and toe protrusion is frequently used to explain foot problems using x-rays, osteological measurements or palpation-based tests. Length differences could be related to the appearance of problems in the foot. A test-retest design was conducted in order to establish the intra-rater reliability of three palpation-based tests. Methods: 202 feet of physical therapy students and teachers of the CEU San Pablo University of Madrid, 39 men and 62 women, were measured using three different tests. Data were analysed using SPSS version 15.0. Mean, SD and 95% CI were calculated for each variable. A normal distribution of quantitative data was assessed using the Kolmogorov-Smirnov test. The test-retest intra-rater reliability was assessed using an Intraclass Correlation Coefficient (ICC). The Standard Error Mean (SEM) and the Minimal Detectable Change (MDC) were also obtained. Results: All the ICC values showed a high degree of reliability (Test 1 = 0.97, Test 2 = 0.86 and Test 3 = 0.88) as did the SEM (Test 1 = 0.07, Test 2 = 0.10 and Test 3 = 0.11) and the MDC (Test 1 = 0.21, Test 2 = 0.30 and Test 3 = 0.31). Conclusions: Reliability of measuring first and second metatarsal and toe protrusion using the three palpation-based tests showed a high degree of reliability

La protusión digital y metatarsal: comparación entre mediciones clínicas y radiológicas y su correlación con el soporte de cargas en el área plantar

Tesis descargada desde TESEOEn el presente trabajo nos planteamos estudiar, por un lado, si la evaluación de las protrusiones digitales y metatarsales mediante procedimientos manuales presenta la misma fiabilidad que los procedimientos radiológicos de evaluación. Por otro lado, también hemos estudiado si la fórmula metatarsal influye en las presiones que soporta la planta del pie en apoyo estático. Para ello, hemos llevado a cabo en una primera fase, un estudio de concordancia entre los test palpatorios y los test radiológicos donde participaron dos evaluadores independientes, estableciéndose la fiabilidad intraobservador e interobservador. En la segunda fase del mismo, se establecieron si existen diferencias entre las presiones plantares y la fórmula metatarsal. La población de estudio estuvo formada en la primera fase por 78 pies, y en la segunda fase por 170 pies. En la primera fase de nuestro trabajo, se recogieron las mediciones palpatorias según el protocolo descrito por Davidson et al14., seguidas de las radiológicas. En la segunda fase, se empleó una plataforma de presión portátil Footcheker, identificándose las zonas de mayor presión en cada una de las 10 zonas propuestas por Rodgers y Cavanagh4. Se ha realizado el análisis de los datos mediante técnicas descriptivas y de contraste, empleando los paquetes estadísticos SPSS versión 18.0 para Windows y GraphPad InStat 3.06. Las pruebas estadísticas de la primera fase fueron la prueba de Kolgomorov-Smirnov con la corrección de Lillie Fors para el análisis de normalidad de las variables cuantitativas. Además, se emplearon el coeficiente alfa de Cronbach y el Coeficiente de Correlación Intraclase, complementados con el Error Standard de Medición, el Cambio Mínimo Detectable y los análisis Bland y Altman, al tratarse de un estudio de concordancia entre dos sistemas de medición. Además estudiamos la fiabilidad de las variables cualitativas mediante el índice de Kappa de Cohen. En la segunda fase, tras analizar la normalidad de las variables cuantitativas, se analizó la homogeneidad de los grupos de pies según la variable fórmula metatarsal, en relación a la distribución por sexo de los sujetos mediante la prueba Chi-cuadrado, y en cuanto a su edad, peso, talla, presión media y presión máxima de todo el pie, mediante la prueba Anova de Kruskall-Wallis complementada con la prueba de Dunn. Además para conocer si existían diferencias entre el tipo de pie según la fórmula metatarsal en las presiones plantares máximas de cada zona, hemos empleado la prueba Chi-cuadrado. Además para determinar la existencia de diferencias en las presiones máximas en función de la fórmula metatarsal en cada una de las diez zonas en las que hemos dividido la planta del pie, se ha utilizado la prueba Anova de Kruskall-Wallis complementada con la prueba de Dunn, o la prueba Anova de un factor según corresponda. Finalmente se analizaron las posibles diferencias en cuanto a la presión máxima en función de la fórmula metatarsal en las zonas 5, 6 y 7 que se corresponden con las zonas del antepié, utilizándose la prueba Chi-cuadrado. La evaluación de las protrusiones digitales mediante procedimientos manuales presenta la misma fiabilidad que los procedimientos radiológicos con valores de fiabilidad altos en todos los test empleados. Sin embargo, la fiabilidad fue moderada en el caso de la comparativa entre los métodos manuales y radiológicos para la evaluación de la protrusión metatarsal. Podemos afirmar, por tanto, que el empleo de las técnicas palpatorias empleadas en nuestro trabajo constituyen un instrumento fiable para medir los valores de protrusión relativa entre la posición final del primer y segundo dedos y metatarsianos del pie. Por otro lado, la fórmula metatarsal influye en las presiones que soporta el pie en estática, al encontrarse diferencias significativas a nivel de la zona del retropié interno y en las cabezas metatarsales laterales

Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol

The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb functionality in hemiplegia infantile from 6 to 12 years old after the application of two intervention protocols: observation action therapy and mirror therapy combined with observation action therapy. Children with a diagnose of congenital infantile hemiplegia will be recruited to participate in a randomized controlled trial with two intervention protocols during four weeks (1 h per/day; 5 sessions per/week): Mirror Therapy Action Observation (MTAO) or Action Observation Therapy (AOT). The study variables will be: spontaneous use, measured with the Assisting Hand Assessment (AHA); manual ability measured with the Jebsen Taylor Hand Function Test (JTHFT); surface electromyography of the flexors and extensors muscles of the wrist and grasp strength through a grip dynamometer. Four assessments will be performed: At baseline situation, at the end of treatment, 3 and 6 months after treatment (follow-up assessments). This study will study the effects of these therapies on the use of the affected upper limb in children with hemiplegia

How Does the Execution of the Pilates Method and Therapeutic Exercise Influence Back Pain and Postural Alignment in Children Who Play String Instruments? A Randomized Controlled Pilot Study

Inappropriate posture in children while playing some string instruments can cause back pain and alterations of the spine. To date, there is no research on the effect of exercise on children who play a musical instrument, although it is known that transversus abdominis muscle control through the Pilates method has shown pain reduction and posture improvement in this population. Objective: To assess the effectiveness of the Pilates method combined with therapeutic exercise with respect to therapeutic exercise exclusively in reducing pain and improving postural alignment in children playing string instruments applying a protocol of low dose to increase children’s adherence to training. Methods: A randomized controlled pilot study was designed with two parallel intervention groups. Twenty-five children (10–14 years old) were randomized in two intervention groups: Pilates method with therapeutic exercise (experimental) and therapeutic exercise (control) for 4 weeks (50 min per day, one day per week). Two assessments were performed (before and after treatment) to assess back pain and shoulders and hips alignment using a visual analog scale and the Kinovea program. Results: Statistically significant differences were obtained for pain reduction before (p = 0.04) and after (p = 0.01) playing the instrument in the experimental group. There were no significant changes in alignment improvement in any of the two groups. Conclusion: The application of a low dose of the Pilates method combined with therapeutic exercise could be a beneficial intervention for pain reduction before and after musical practice in children who play string instrument