Determining Near Point of Convergence: Exploring a Component of the Vestibular/Ocular Motor Screen Comparing Varied Target Sizes

# Background Near point of convergence (NPC), a component of the Vestibular Ocular Motor Screening (VOMS) assessment, may be helpful in diagnosing concussion. The VOMS uses a standardized approach to measure NPC; however, methods of screening for NPC are not standardized. # Purpose The purpose of this study was to determine whether four different methods of measuring NPC yielded different estimates. # Study Design Descriptive within-subjects laboratory study. # Level of Evidence Level 3. # Methods Healthy recreational athletes participated in a comparison of 4 commonly used methods of measuring NPC: a 12-point font target, the VOMS (14-point font target), the tip of a black pen, and the Bernell Vergel^TM^ device (9-point font target). The order of the presentation of the 4 targets was randomized. # Results Seventy-five participants (59 females, 16 males; mean $$SD$$ age=21.0 [6.12] years) completed 3 trials. The mean (SD) of the 900 NPC measurements was 7.11 (3.67) cm. Measurements for all targets had excellent reliability (r=0.94 to 0.98). In a comparative analysis, participant age was associated with NPC (*p*<0.01) and was covaried. The NPCs derived from both the 12-point and 14-point font targets were smaller than NPCs from the tip of the black pen and the 9-point font device (*p*<0.01). Measurements between the tip of the black pen and the 9-point font device (*p*=0.25) and between the 12-point and 14-point font targets (*p*=0.84) did not differ. # Conclusions The method used to measure NPC as a screening test for concussion should be standardized because the estimate differs depending on the technique chosen. The current study supports previous findings that the type of target used to measure NPC should be standardized for concussion assessment. # Clinical Relevance Screening of NPC should be standardized for concussion assessment to improve the reliability of NPC testing

Using Kinetic Energy with Potential Energy When Determining Power During the Stair Climbing Test

ABSTRACT Stair climbing is an important functional task that indicates independence, and generating power to climb stairs is a vital component of this task. Power during stair climbing is traditionally calculated using potential energy (PE), but it may be important to determine power expended using kinetic energy (KE). Purpose: The current study assessed power output for stair climbing with and without the inclusion of KE. Methods: Sixty participants (21-35 years) climbed a 12-step stairway with a 2-meter acceleration phase before the first step and a 2-meter deceleration phase after the last step. Participants completed 3 trials, and average time was used for calculating energy expended and power. Results: The mean difference between power from PE and total power was 6.16 W (SD = 2.50, t29 = 13.49, p \u3c 0.001) for males and 64.76 W (SD = 2.90, t29 = 8.99, p \u3c 0.001) for females. Agreement between power calculated from PE and total power was 0.99 (95% confidence interval = 0.98-1.0). Conclusion: Power calculated using PE and KE was significantly different from using PE alone, which may be clinically important. When conducting stair-climbing tests, both PE and KE may be necessary for the most accurate assessment of power

Agreement in Walking Speed Measured Using Four Different Outcome Measures: 6-Meter Walk Test, 10-Meter Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test

Background: Walking speed is considered the sixth vital sign because it is a valid, reliable, and sensitive measure for assessing functional status in various populations. Purpose: The current study assessed agreement in walking speed using the 6-meter walk test, (6MWT) 10-meter walk test (10MWT), 2-minute walk test (2minWT), and 6-minute walk test (6minWT). We also determined differences in walking speed. Methods: Seventy-three healthy adults (44 females, 29 males; mean [SD] age=31.36 [10.33] years) participated. Lafayette Electronic timing devices measured walking speed for the 6MWT and 10MWT. Measuring wheels and stopwatches measured walking distance and speed for the 2minWT and 6minWT. Participants completed 1 trial, and all tests were administered simultaneously. Results: The intraclass correlation coefficient (2, 4) for the different measures of walking speed was excellent at 0.90 (95% confidence intervals, 0.86-0.93). The correlation was 0.95 between 6MWT and 10MWT, 0.94 between 2minWT and 6minWT, 0.67 between 6MWT and 2minWT, 0.63 between 10MWT and 2minWT, and 0.59 between 10MWT and 6minWT (all p \u3c 0.05). No differences in walking speed were found between the four walking tests. Conclusion: Administration of any of the four walking tests provided reliable measurement of walking speed

A Comparison of Resting Scapular Posture and the Davies Closed Kinetic Chain Upper Extremity Stability Test

# BACKGROUND In orthopaedic practice, it is well established that weak scapular stabilizers and an unstable scapula is related to shoulder dysfunction. Faulty scapular position has been linked to decreased scapular stability and is thought to be a result of weak or unbalanced timing in the recruitment of scapulothoracic dynamic stabilizing muscles. Kibler has described a four-type classification of scapulothoracic dysfunction. Functional performance testing is used to objectively measure activities that simulate various desired activities. The reliability of assessing the four static scapular positions may be important in diagnosing shoulder dysfunction. An understanding of the scapular position and its relationship to functional performance testing is needed. # PURPOSE The purpose of this study was to determine if a static scapular test, the Kibler scapula classification, in healthy participants affects the ability to perform a closed chain functional test that involves the use of the scapula and the upper extremity, the Davies Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). A secondary analysis was performed to evaluate the reliability of a student physical therapist and an experienced physical therapist to identify scapular type by observation. # STUDY DESIGN Multicenter, single session descriptive cohort # METHODS Sixty-one healthy participants (33 males, 28 females; mean age 24.19±2.61) completed testing across two locations in one testing session. Blood pressure and heart rate as well as height and weight were measured for each participant. Participants were classified by visual observation of Kibler scapular classification. The average number of CKUEST touches, a normalized score, and a power score were calculated for each participant. Three trials were performed and participants were required to take a 45-second rest break between each CKCUEST trial. # RESULTS One way analysis of variance (ANOVA) showed statistically significant differences in Type I and Type IV Kibler scapula classification for the CKCUEST power score, however when an ANCOVA controlled for body mass index, there was no statistically significant difference. A strong correlation r=.94 was observed between student and experienced physical therapist in evaluating all four types of Kibler scapular classification. # CONCLUSIONS Visually observed Kibler scapular position does not affect the ability to perform the Davies CKCUEST in healthy young adults. The ability to identify Kibler scapular position was reliable between student and experienced physical therapists. Additional studies are required to identify the usefulness of the Kibler scapular position classification. # LEVEL OF EVIDENCE 2b: Individual Cohort Stud

Impact of Concussions on Postural Stability Performance Using the Head Shake-Sensory Organization Test

# Background A concussion is a traumatic brain injury that can result in vestibular and oculomotor dysfunctions. The Head Shake-Sensory Organization Test was developed from the original Sensory Organization Test to measure a subject's ability to maintain balance while moving their head. # Purpose The purpose of this study was to compare the performance of adults with no history of concussion to those with a history of concussion on the Head Shake-Sensory Organization Test to determine if long-standing balance deficits are present after concussion. # Study Design Cross-sectional study # Methods Subjects with a history of concussion and healthy normal controls completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence Scale, the sensory organization test, the head shake SOT, and the Foam Head Shake-Sensory Organization test in a single testing session. Scores were analyzed for differences between the two groups. # Results Twenty-five participants (nine patients with history of concussion and 16 healthy controls; mean age, 21.08±4.10 years) completed testing. The equilibrium scores in both groups significantly decreased with more complex tasks. Furthermore, the concussion group had significantly worse equilibrium scores than the control group during the Head Shake (p = 0.007) and Foam Head Shake-Sensory Organization Test (p = 0.002) tasks but not during the Sensory Organization Test task. # Conclusion Adding head shake and foam cushion conditions to postural stability tests improves sensitivity in detecting balance deficits in individuals with a concussion. # Level of Evidence

Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review

Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists’ characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261