Validity and intra-rater reliability of an Android phone application to measure cervical range-of-motion

Concurrent validity and intra-rater reliability using a customized Android phone application to measure cervical-spine range-of-motion (ROM) has not been previously validated against a gold-standard three-dimensional motion analysis (3DMA) system

The reliability of a maximal isometric hip strength and simultaneous surface EMG screening protocol in elite, junior rugby league athletes

Objectives Firstly to describe the reliability of assessing maximal isometric strength of the hip abductor and adductor musculature using a hand held dynamometry (HHD) protocol with simultaneous wireless surface electromyographic (sEMG) evaluation of the gluteus medius (GM) and adductor longus (AL). Secondly, to describe the correlation between isometric strength recorded with the HHD protocol and a laboratory standard isokinetic device. Design Reliability and correlational study. Methods A sample of 24 elite, male, junior, rugby league athletes, age 16–20 years participated in repeated HHD and isometric Kin-Com (KC) strength testing with simultaneous sEMG assessment, on average (range) 6 (5–7) days apart by a single assessor. Strength tests included; unilateral hip abduction (ABD) and adduction (ADD) and bilateral ADD assessed with squeeze (SQ) tests in 0 and 45° of hip flexion. Results HHD demonstrated good to excellent inter-session reliability for all outcome measures (ICC\ua0=\ua00.76–0.91) and good to excellent association with the laboratory reference KC (ICC\ua0=\ua00.80–0.88). Whilst intra-session, inter-trial reliability of EMG activation and co-activation outcome measures ranged from moderate to excellent (ICC\ua0=\ua00.70–0.94), inter-session reliability was poor (all ICC\ua

Are hip biomechanics during running associated with symptom severity or cam morphology size in male football players with FAI syndrome?

Background: Femoroacetabular impingement (FAI) syndrome is considered a motion-related condition. Little is known about the influence of symptom severity and cam morphology on hip biomechanics for individuals with FAI syndrome. Research question: Are hip biomechanics during running associated with symptom severity or cam morphology size in male football players with FAI syndrome? Methods: Forty-nine male, sub-elite football (soccer or Australian football) players (mean age= 26 years) with FAI syndrome completed the International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score (HAGOS) and underwent radiographic evaluation. Biomechanical data were collected during overground running (3–3.5 m∙s−1) using three-dimensional motion capture technology and an embedded force plate. Various discrete hip angles and impulses of joint moments were analysed during the stance phase. Linear regression models investigated associations between running biomechanics data (dependent variables) and iHOT-33 and HAGOS scores and cam morphology size (independent variables). Results: Hip joint angles during running were not associated with symptom severity in football players with FAI syndrome. A positive association was found between the impulse of the hip external rotation moment and HAGOS-Sport scores, such that a smaller impulse magnitude occurred with a lower HAGOS-Sport score (0.026 *10−2 [95%CI &lt;0.001 *10−2 to 0.051 *10−2], P = 0.048). Larger cam morphology was associated with a greater peak hip adduction angle at midstance (0.073 [95%CI 0.002–0.145], P = 0.045). Significance: Hip biomechanics during running did not display strong associations with symptom severity or cam morphology size in male football players with FAI syndrome who were still participating in training and match play. Future studies might consider investigating associations during tasks that utilise end range hip joint motion or require greater muscle forces.</p

Associations between gait and isometric lower limb strength following stroke

Stroke is a leading cause of disability worldwide. The most commonly stated goal following stroke is to regain the ability to walk independently, resulting in a large amount of rehabilitation time focussed on gait retraining. Identification of key variables that relate to and affect gait function is important in order to understand the factors associated with impaired gait and to guide future intervention strategies. Reduced muscle strength has been proposed as a key contributor to physical limitations after stroke and is commonly assessed in clinical and research settings. The aim of this thesis was to examine the associations between lower limb isometric strength and gait following stroke. A systematic literature review was conducted for Study One in order to collate the results of previous research which reported on the correlations between muscle strength and gait velocity following stroke. The review identified 21 articles that had examined this association with varied results. The majority of the identified studies had a small sample size (n ≤ 30) and received low scores for methodological quality. The studies with a larger sample size and methodological quality revealed a trend which suggested the strength of the ankle dorsiflexors provides the strongest bivariate association with gait velocity. Due to the limitations of the included studies, further research is needed. Another important consideration of muscle function is not only the peak amount of force a muscle group can produce (muscle strength) but how quickly force can be produced (muscle power). The second study of this thesis examined the psychometric properties of a clinically accessible device, hand-held dynamometry, for assessment of isometric muscle strength and power. The results from Study Two showed that hand-held dynamometry demonstrated acceptable reliability across eight lower limb muscle groups for the assessment of isometric strength and power in a healthy and unimpaired cohort. Concurrent validity of hand-held dynamometry also demonstrated acceptable results for the majority of lower limb muscle groups when compared against a laboratory-based fixed dynamometer. The muscle groups of the ankle were found to have lower than expected validity, however this may be due to the ankle attachment used on the fixed dynamometer, which demonstrated larger measurement error. Nevertheless, hand-held dynamometry has shown promising results for assessment of strength and power for the muscles of the lower limb in a sample of adults without impairments. To expand on the results of the systematic review (Study One), Study Three provided a detailed analysis of the relationships between isometric strength and gait velocity following stroke, as well as examining a previously underutilised outcome measure in the stroke population, isometric muscle power. Study Three was undertaken to examine if isometric power provided additional value in the relationship with gait velocity over muscle strength and to determine which muscle group of the lower limb demonstrates the strongest relationship with gait velocity. Results revealed isometric strength provided significant additional value in the relationship with gait velocity over isometric power. Comparison of seven lower limb muscle groups revealed the strength of the ankle plantarflexors and hip flexors to explain the most variance in gait velocity. The final study of this thesis (Study Four) examined the relationship between isometric measures of strength and power, assessed with hand-held dynamometry, and joint power generation during gait following stroke. Ankle plantarflexor strength and power showed a significant relationship with peak ankle joint power generation during gait. Similar to Study Three, comparison between strength and power revealed ankle plantarflexor strength had a stronger relationship over ankle plantarflexor power. The program of research presented in this thesis found hand-held dynamometry provided psychometrically-sound measures of isometric strength and power. The relationship between hand-held dynamometry derived measures of strength and power with gait function revealed isometric strength provided additional value over isometric power. The strength of the ankle plantarflexors demonstrated a strong relationship with gait velocity and ankle power generation during gait. Future research may examine the ankle plantarflexors further to see if improved plantarflexor strength results in improved gait function following stroke. This thesis provides a substantial contribution to the knowledge in this field and may assist clinical decision making when considering gait function post-stroke as well as guiding future research in the design of intervention strategies aimed at improving gait

Predicting dynamic foot function from static foot posture : Comparison between visual assessment, motion analysis, and a commercially available depth camera

Study Design: Controlled laboratory study. Objective: To evaluate the ability of 3 methods to assess static foot posture to predict rearfoot and midfoot kinematics during gait. Background: Static foot posture is commonly used clinically to infer dynamic function. Limitations of static clinical assessments may be overcome through advances in technologies, including commercially available depth cameras. Methods: The Foot Posture Index (FPI) of 31 males (average age, 22.5 years) was assessed using visual observation, a 3-D motion-analysis system, and a depth camera. Pearson correlations were used to evaluate relationships between FPI items and rearfoot and midfoot kinematics during walking. The ability of the static variables to predict dynamic function was assessed using multiple linear regression. Results: Most FPI items (85%) were not correlated with foot kinematics, regardless of assessment method. There were 6 fair to moderate correlations between visual FPI items and total rearfoot (r = −0.36 to −0.39, P < .05) and midfoot (r = 0.37 to 0.61, P < .05) motion, 2 fair correlations between 3-D motion-analysis FPI items and total midfoot (r = −0.43, P = .02) and peak rearfoot (r = −0.40, P = .03) motion, and 2 fair correlations between the depth-camera FPI items and average rearfoot (r = −0.38 to 0.44, P < .05) motion. Visual assessment of the FPI provided the best prediction model, explaining 37% of the variance in total midfoot inversion/eversion. Conclusion: Static measures of foot posture are weakly correlated with rearfoot or midfoot kinematics, and have limited dynamic prediction ability. Our findings suggest that the FPI may not be an accurate representation of rearfoot or midfoot movement during walking, regardless of the measurement technique employed

Reliability and concurrent validity of a smartphone, bubble inclinometer and motion analysis system for measurement of hip joint range of motion

Objectives: Traditional methods of assessing joint range of motion (ROM) involve specialized tools that may not be widely available to clinicians. This study assesses the reliability and validity of a custom Smartphone application for assessing hip joint range of motion. Design:Intra-tester reliability with concurrent validity. Methods: Passive hip joint range of motion was recorded for seven different movements in 20 males on two separate occasions. Data from a Smartphone, bubble inclinometer and a three dimensional motion analysis (3DMA) system were collected simultaneously. Intraclass correlation coefficients (ICCs), coefficients of variation (CV) and standard error of measurement (SEM) were used to assess reliability. To assess validity of the Smartphone application and the bubble inclinometer against the three dimensional motion analysis system, intraclass correlation coefficients and fixed and proportional biases were used. Results: The Smartphone demonstrated good to excellent reliability (ICCs > 0.75) for four out of the seven movements, and moderate to good reliability for the remaining three movements (ICC = 0.63–0.68). Additionally, the Smartphone application displayed comparable reliability to the bubble inclinometer. The Smartphone application displayed excellent validity when compared to the three dimensional motion analysis system for all movements (ICCs > 0.88) except one, which displayed moderate to good validity (ICC = 0.71). Conclusions: Smartphones are portable and widely available tools that are mostly reliable and valid for assessing passive hip range of motion, with potential for large-scale use when a bubble inclinometer is not available. However, caution must be taken in its implementation as some movement axes demonstrated only moderate reliability

Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): a protocol for a participant and assessor-blinded randomised controlled trial

Introduction This double-blind, randomised controlled trial (RCT) aims to estimate the effect of a physiotherapist-led intervention with targeted strengthening compared with a physiotherapist-led intervention with standardised stretching, on hip-related quality of life (QOL) or perceived improvement at 6 months in people with femoroacetabular impingement (FAI) syndrome. We hypothesise that at 6 months, targeted strengthening physiotherapist-led treatment will be associated with greater improvements in hip-related QOL or greater patient-perceived global improvement when compared with standardised stretching physiotherapist-led treatment.Methods and analysis We will recruit 164 participants with FAI syndrome who will be randomised into one of the two intervention groups, both receiving one-on-one treatment with the physiotherapist over 6 months. The targeted strengthening physiotherapist-led treatment group will receive a personalised exercise therapy and education programme. The standardised stretching physiotherapist-led treatment group will receive standardised stretching and personalised education programme. Primary outcomes are change in hip-related QOL using International Hip Outcome Tool-33 and patient-perceived global improvement. Secondary outcomes include cost-effectiveness, muscle strength, range of motion, functional task performance, biomechanics, hip cartilage structure and physical activity levels. Statistical analyses will make comparisons between both treatment groups by intention to treat, with all randomised participants included in analyses, regardless of protocol adherence. Linear mixed models (with baseline value as a covariate and treatment condition as a fixed factor) will be used to evaluate the treatment effect and 95% CI at primary end-point (6 months).Ethics and dissemination The study protocol was approved (La Trobe University Human Ethics Committee (HEC17-080)) and prospectively registered with the Australian New Zealand Clinical Trials Registry. The findings of this RCT will be disseminated through peer reviewed scientific journals and conferences. Patients were involved in study development and will receive a short summary following the completion of the RCT.Trial registration number ACTRN1261700135031

Exercise interventions for the prevention and treatment of groin pain and injury in athletes : A critical and systematic review

Background: Groin injury is a common musculoskeletal complaint for athletes competing in a variety of sports. The extent to which exercise interventions incorporating external load are an appropriate option for the treatment and prevention of groin injury in athletes is not yet clear. Objectives: The aim of this review was to describe and evaluate exercise therapy interventions and outcomes for the treatment and prevention of groin injury with specific attention to application of external load. Data Sources: The databases Medline, PubMed, SPORTDiscus, Web of Science, and Cochrane were searched on 18 April 2016. Study Eligibility Criteria: This review was registered as PROSPERO CRD42016037752 and a systematic search was conducted with the following inclusion criteria: any study design evaluating exercise interventions for the prevention or treatment of groin pain in athletes. Data Analysis: Two independent authors screened search results, performed data extraction, assessed risk of bias using the modified Downs and Black appraisal tool and determined strength and level of evidence. Reporting standards for exercise interventions were assessed using the Consensus for Exercise Reporting Template (CERT). Results: A total of 1320 titles were identified with 14 studies satisfying the inclusion criteria, four (29%) of which demonstrated low risk of bias. Ten (71%) studies utilised external load as a component of the exercise intervention. Reporting standards for exercise intervention scores ranged from 0 to 63%. Conclusion: There is limited evidence from level 2 and 3 studies indicating exercise therapy may reduce the incidence and hazard risk of sustaining a groin injury in athletes. There is strong evidence from level 4 studies indicating exercise therapy is beneficial as a treatment for groin injury in athletes in terms of symptom remission, return to sport and recurrence outcomes. However, there are limited studies with low risk of bias, and exercise interventions for the treatment of groin injury are poorly described. © 2017, Springer International Publishing Switzerland

Reliability and validity of the Microsoft Kinect for evaluating static foot posture

Background: The evaluation of foot posture in a clinical setting is useful to screen for potential injury, however disagreement remains as to which method has the greatest clinical utility. An inexpensive and widely available imaging system, the Microsoft Kinect™, may possess the characteristics to objectively evaluate static foot posture in a clinical setting with high accuracy. The aim of this study was to assess the intra-rater reliability and validity of this system for assessing static foot posture.Methods: Three measures were used to assess static foot posture; traditional visual observation using the Foot Posture Index (FPI), a 3D motion analysis (3DMA) system and software designed to collect and analyse image and depth data from the Kinect. Spearman's rho was used to assess intra-rater reliability and concurrent validity of the Kinect to evaluate foot posture, and a linear regression was used to examine the ability of the Kinect to predict total visual FPI score.Results: The Kinect demonstrated moderate to good intra-rater reliability for four FPI items of foot posture (ρ = 0.62 to 0.78) and moderate to good correlations with the 3DMA system for four items of foot posture (ρ = 0.51 to 0.85). In contrast, intra-rater reliability of visual FPI items was poor to moderate (ρ = 0.17 to 0.63), and correlations with the Kinect and 3DMA systems were poor (absolute ρ = 0.01 to 0.44). Kinect FPI items with moderate to good reliability predicted 61% of the variance in total visual FPI score.Conclusions: The majority of the foot posture items derived using the Kinect were more reliable than the traditional visual assessment of FPI, and were valid when compared to a 3DMA system. Individual foot posture items recorded using the Kinect were also shown to predict a moderate degree of variance in the total visual FPI score. Combined, these results support the future potential of the Kinect to accurately evaluate static foot posture in a clinical setting. © 2013 Mentiplay et al.; licensee BioMed Central Ltd

Associations between lower limb strength and gait velocity following stroke: A systematic review

Objective: The aim of this systematic review was to identify literature examining associations between isometric strength and gait velocity following stroke. Methods: An electronic search was performed using six online databases. Targeted searching of reference lists of included articles and three relevant journals was also performed. Two independent reviewers identified relevant articles, extracted data and assessed the methodological quality of included articles. Inclusion criteria involved studies that assessed univariate correlations between gait velocity and isometric strength of individual lower limb muscle groups in a stroke population. Results: Twenty-one studies were included for review. The majority of included studies had a relatively small sample size. After accounting for sample size and methodological quality, the knee extensors showed poor-to-moderate correlations with gait velocity while the ankle dorsiflexors showed the strongest association with gait velocity. Conclusions: Current evidence suggests that the strength of the ankle dorsiflexors has a stronger correlation to gait velocity compared with other lower limb muscle groups. Consequently, a focus on increasing ankle dorsiflexor strength to improve gait velocity following stroke may be beneficial. However, due to limitations of the research identified, further research is needed to determine the associations between lower limb strength and gait velocity following stroke