Measurement properties of handheld dynamometry for assessment of shoulder muscle strength:A systematic review

Like any assessment tool, handheld dynamometry (HHD) must be valid and reliable in order to be meaningful in clinical practice and research. To summarize the evidence of measurement properties of HHD for the assessment of shoulder muscle strength. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and PEDro were searched up to February 2020. Inclusion criteria were studies (a) evaluating HHD used on the glenohumeral joint, (b) evaluating measurement properties, and (c) included individuals ≥ 18 years old with or without shoulder symptoms. Exclusion criteria were studies (a) including patients with neurologic, neuromuscular, systemic diseases, or critical illness or bed-side patients and (b) that did not report the results separately for each movement. In total, 28 studies with 963 participants were included. The reliability results showed that 98% of the intraclass correlation coefficient (ICC) values were ≥0.70. The measurement error showed that the minimal detectable change in percent varied from 0% to 51.0%. The quality of evidence was high or moderate for the majority of movements and type of reliability examined. Based on the evidence of low or very low quality of evidence, the convergent validity and discriminative validity of HHD were either sufficient, indeterminate, or insufficient. The reliability of HHD was overall sufficient, and HHD can be used to distinguish between individuals on the group level. The measurement error was not sufficient, and evaluation of treatment effect on the individual level should be interpreted with caution

Measurement properties of isokinetic dynamometry for assessment of shoulder muscle strength:a systematic review

OBJECTIVE: To investigate the evidence of measurement properties of isokinetic dynamometry (ID) for assessment of shoulder muscle strength in healthy individuals and patients with non-neurological shoulder pathology. DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed, EMBASE, and PEDro were searched up to February 2020 without restrictions. Reference lists and citations were hand-searched. STUDY SELECTION: Two review authors independently included studies that met the following criteria: 1) evaluating measurement properties of ID when used on the glenohumeral joint and 2) included individuals' ≥ 18 years. Studies including patients with neurologic, neuromuscular, or systemic diseases or critical illness were excluded. DATA EXTRACTION: The quality assessment and data synthesis were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. DATA SYNTHESIS: Twenty-one studies with a total of 597 participants were included. The results were combined separately for isometric, concentric, and eccentric test mode, for the velocities 30-60°/s, 90°/s, 120°/s and 240°/s, for the seated, supine and standing position, and for internal rotation (IR), external rotation (ER), and the ER/IR ratio. The reliability of ID was overall sufficient with the majority of intraclass correlation coefficients (ICC) ≥0.70. The quality of evidence was moderate or low for 20 out of 30 strata examined. The measurement error results were rated as insufficient for all strata. The standard error of measurement in percent (%SEM) ranged from 4% to 28%. The quality of evidence varied depending of strata examined. CONCLUSION: The reliability of ID for measurement of shoulder strength was overall sufficient for all positions, velocities and mode of strength. The measurement error was not sufficient. As most studies used the seated position, the velocities 30-60°/s or 120°/s, and the concentric test mode, the quality of evidence was highest for these conditions

The effects of various respiratory physiotherapies after lung resection:a systematic review

PURPOSE: The purpose of this review was to investigate the effect of respiratory physiotherapy after lung resection on mortality, postoperative pulmonary complications (PPC), length of stay, lung volumes, and adverse events. MATERIAL AND METHODS: Randomized or quasi-randomized controlled trials were searched in CENTRAL, PubMed, EMBASE, Cinahl, PEDro, and hand searching of related studies. Various respiratory physiotherapy interventions were compared to standard care, sham treatment, or no treatment. Two reviewers assessed eligibility and quality of studies using Cochrane guidelines. Meta-analyses were undertaken on subgroups of intervention. RESULTS: Various types of positive pressure breathing, deep breathing exercises, and strength and aerobic exercises as a supplement to standard care did not show any significant effect over standard care in preventing mortality or PPC, reducing length of stay, or improving lung volumes. CONCLUSION: Prophylactic continuous positive airway pressure does not seem to affect rate of mortality and PPC, when compared with standard care embodying respiratory physiotherapy such as airway clearance techniques and assistance with early ambulation. However, further research is still needed to make a final conclusion. The effect of standard respiratory physiotherapy as a package is still unknown, and may or may not be effective in preventing PPC among patients undergoing lung resection

Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury:A systematic review

Background: Performance-based measures that focus primarily on the ability to engage in ADL are routinely used by occupational therapists to assess a client's cognitive abilities.Objective: To perform a systematic review to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in individuals with traumatic brain injury.Material and methods: Pubmed, EMBASE, CINAHL, PsycINFO and OTseeker were searched. The Consensus-based Standards for the selection of health measurement instruments checklist was used to evaluate methodological quality of each included study. The quality criteria adapted by Terwee were applied to extract the results of each measurement property followed by a best evidence synthesis.Results: Twenty-eight articles, including 40 ratings of measurement properties, were included. The combination of the Functional Independence Measure and the Functional Assessment Measure showed moderate evidence of good internal consistency (Cronbach's alpha 0.99), but conflicting evidence of reliability (ICC 0.83) and poor evidence of construct validity. All other instruments showed limited or unknown evidence.Conclusions: This review provides an overview of measurement properties of performance-based instruments and contributes to such methodological considerations before choosing an instrument. Though, the results reveal a lack of high-quality evidence for any of the measurement properties, it is recommended to use tools with the highest possible evidence for positive ratings.Significance: This review contributes with psychometric evidence on instruments to use in occupational therapy practice and research

Measurement properties of objective methods to assess shoulder muscle strength (a systematic review protocol)

Introduction: Shoulder disorders cause significant impaired function and health-related quality of life. Treatment consists of either conservative or surgical treatment, and results in substantial health care utilization. Strengthening exercises of the rotator cuff muscles are often included in physiotherapy treatment of patients with shoulder disorders. Valid and reliable measurement methods to assess shoulder muscle strength are important to analyse the efficacy of treatment in both clinical practice and research. There is a need for an up to date systematic review that summarize the evidence of measurement properties of objective measurements of isometric and isokinetic shoulder muscle strength in individuals with and without shoulder symptoms. Aim: The aim of this review is to investigate measurement properties of objective methods to assess shoulder muscle strength. Methods: The following databases; Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed, EMBASE, and PEDro will be searched for relevant studies reporting the assessment of measurement properties of objective methods used to assess shoulder muscle strength. The methodological quality will be assessed with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The overall evidence of the measurement properties of the included instruments will be summarized in a best evidence synthesis

A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up

OBJECTIVE: To assess if a higher dose of exercise training in exercise-based cardiac rehabilitation could affect improvements in aerobic capacity and muscle strength. DESIGN: Assessor-blinded randomized controlled trial with 12-months follow-up. SETTING: Aarhus University Hospital, Aarhus, Denmark. SUBJECTS: A total of 164 cardiac patients referred to exercise-based cardiac rehabilitation were recruited. INTERVENTIONS: Patients were randomized to 1-hour exercise sessions either three times weekly for 12 weeks (36 sessions, high-dose group) or twice weekly for 8 weeks (16 sessions, low-dose group). The same standardized exercise and intensity protocol including aerobic and muscle strength training was used in all participants. MAIN MEASURES: Primary outcome was changes in VO2peak. Secondary outcomes were changes in maximal workload, muscle strength and power. Measures were obtained at baseline, after termination of the rehabilitation programme and at follow-up after 6 and 12 months. RESULTS: After the end of intervention, statistically significant between-group differences were seen in favour of the high-dose group in all outcomes: VO2peak 2.6 (mL kg-1 min-1) (95% confidence interval (CI): 0.4-4.8), maximal workload 0.3 W kg-1 (95%CI: 0.02-0.5), isometric muscle strength 0.7 N m kg-1 (95%CI: 0.1-1.2) and muscle power 0.3 W kg-1 (95%CI: 0.04-0.6). After 12 months, a significant between-group difference only persisted in VO2peak and maximal workload. CONCLUSION: A higher dose of exercise training had a small effect on all outcomes at termination of intervention. A long-term effect persisted in VO2peak and maximal workload. Although the effect was small, it is an important finding because VO2peak is the most important predictor of all-cause mortality in cardiac patients

Prognostic factors for high societal costs: a register-based study on 561,665 patients with shoulder disorders

Shoulder disorders are common and associated with high societal costs, especially for a small group of patients. Prognostic factors can help identify high-cost patients, which is crucial to optimize early identification and develop tailored interventions. We aimed to identify prognostic factors for high societal costs, to examine whether the prognostic factors were similar for high healthcare costs and high costs of sick leave, and to investigate the model's robustness across 4 diagnostic categories. Using national Danish registers, potential prognostic factors (age, sex, educational level, long-term sick leave, admission, visits to general practitioner and physiotherapist, comorbidity, diabetes, low back pain, and neck pain) were included in a logistic regression model with high societal costs, defined by the top 10th percentile, as the main outcome. The model's prognostic accuracy was assessed using the Nagelkerke R2 and its discriminative ability using area under the receiver operating curve (AUC). Data on 80% of the patients (n = 449,302) were used to develop the model and 20% (n = 112,363) to validate the model. By far the strongest prognostic factor for high societal costs and high costs of sick leave was sick leave at the time of diagnosis (OR: 20.2, 95% CI: 19.5-20.9). Prognostic factors for high healthcare costs were high age, comorbidity, and hospital admission the year before diagnosis. The model was robust across diagnostic categories and sensitivity analyses. In the validation sample, the primary model's discriminative ability was good (AUC = 0.80) and the model explained 28% of the variation in the outcome (Nagelkerke R2)