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

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

Inter- and intra-rater variability of testing velocity when assessing lower limb spasticity

Objective: To establish the variability of fast testing velocity and joint range of motion and position when assessing lower-limb spasticity in individuals following neurological injury. Design: Observational study of people with lower-limb spasticity. Subjects: Patients with an upper motor neurone lesion (n = 35) and clinicians experienced in spasticity assessment (n = 34) were included. Methods: The Modified Tardieu scale (MTS) was completed on the quadriceps, hamstrings (2 positions), gastrocnemius and soleus for each participant’s more affected lower limb by 3 assessors. Mean absolute differences (MADs) were used to calculate variability as a measure of reliability. Results: Variability of peak testing velocity was greater at the ankle joint compared with the knee joint. The greatest MAD for V3 (fast) inter-rater testing velocity was 119°/s in the soleus, representing 29.4% of the mean variable value, and least for the quadriceps (64.3°/s; 18.5%). Inter-rater variability was higher than intra-rater variability for all testing parameters. The MAD for joint end angle ranged from 2.6° to 10.7° and joint start angle from 1.2° to 14.4°. Conclusion: There was a large degree of inter- and intra-rater variability in V3 testing velocity when using the MTS to assess lower limb spasticity. The inter-rater variability was approximately double the intra-rater variability

Do video game interventions improve motor outcomes in children with developmental coordination disorder? A systematic review using the ICF framework

Abstract Background Children with developmental coordination disorder (DCD) experience a range of difficulties that can potentially limit their academic, social and physical ability. Recent research has developed interventions that aim to improve motor outcomes in a variety of paediatric cohorts using video gaming equipment. Therefore, we aimed to systematically review the literature on virtual reality or video game interventions that aim to improve motor outcomes in children with DCD. Methods Seven databases were searched for studies using the following criteria: a) virtual reality or video game based intervention; b) children with DCD; and c) motor outcomes relating to body structure and function, activity or participation. Data were extracted relating to study design, participant characteristics, details of the intervention, outcome measures, results, and feasibility/adherence. Results Fifteen articles were included for review, including eight randomised controlled trials. No studies used virtual reality equipment, with all interventions using video games (Nintendo Wii in 12/15 articles). Mixed effects of video game intervention on outcome were found, with conflicting evidence across studies. Studies that reported on feasibility found most children enjoyed and adhered to the video game interventions. Conclusions This review found limited evidence for the effectiveness of video game interventions for children with DCD to improve motor outcomes due to limitations in the research including low sample sizes and low to moderate methodological quality. Further research is needed to determine the effect of video game or virtual reality interventions on motor outcomes in children with DCD. Protocol registration The protocol for this systematic review can be found on PROSPERO (CRD42017064427)

Assessment of isometric muscle strength and rate of torque development with hand-held dynamometry: Test-retest reliability and relationship with gait velocity after stroke

Isometric rate of torque development examines how quickly force can be exerted and may resemble everyday task demands more closely than isometric strength. Rate of torque development may provide further insight into the relationship between muscle function and gait following stroke. Aims of this study were to examine the test-retest reliability of hand-held dynamometry to measure isometric rate of torque development following stroke, to examine associations between strength and rate of torque development, and to compare the relationships of strength and rate of torque development to gait velocity. Sixty-three post-stroke adults participated (60 years, 34 male). Gait velocity was assessed using the fast-paced 10 mwalk test. Isometric strength and rate of torque development of seven lower-limb muscle groups were assessed with hand-held dynamometry. Intraclass correlation coefficients were calculated for reliability and Spearman’s rho correlations were calculated for associations. Regression analyses using partial F-tests were used to compare strength and rate of torque development in their relationship with gait velocity. Good to excellent reliability was shown for strength and rate of torque development (0.82– 0.97). Strong associations were found between strength and rate of torque development (0.71–0.94). Despite high correlations between strength and rate of torque development, rate of torque development failed to provide significant value to regression models that already contained strength. Assessment of isometric rate of torque development with hand-held dynamometry is reliable following stroke, however isometric strength demonstrated greater relationships with gait velocity. Further research should examine the relationship between dynamic measures of muscle strength/torque and gait after stroke

Methods of assessing associated reactions of the upper limb in stroke and traumatic brain injury: A systematic review

<p><i>Objective</i>: To determine the assessment methods for upper limb (UL) associated reactions (ARs) in people with acquired brain injury (ABI).</p> <p><i>Methods</i>: A systematic search of 10 databases was performed for Stage 1 to identify methods that quantify ARs of the hemiplegic UL. Stage 2 searched four databases to examine the clinimetric properties and clinical utility of these methods. Two independent reviewers identified relevant articles, extracted data, assessed study methodological quality and rated the clinimetric properties and clinical utility.</p> <p><i>Results</i>: Eighteen articles were included. The methods used to evaluate ARs were surface electromyography (11), goniometry (5), dynamometry (5), electrogoniometry (1), subjective clinician (2) and patient rating forms (2). Electromyography, electrogoniometry and dynamometry implemented stationary, seated positions using maximal voluntary contractions of the less impaired UL as the provocative task. Standard goniometry most frequently tested ARs dynamically, using a mobility task to provoke the AR. There was limited clinimetric data available. Only half of the assessment methods were deemed clinically feasible. The most common methods were laboratory-based.</p> <p><i>Conclusion</i>: There were a limited number of methods used to assess ARs in people with ABI and the measurement properties of these outcomes were largely unreported. No gold standard was identified.</p

Exploring overweight and obesity beyond body mass index: A body composition analysis in people with and without patellofemoral pain

Background: We compared body mass index (BMI), body fat, and skeletal muscle mass between (1) a mixed-sex nonathletic cohort of people with patellofemoral pain (PFP) and pain-free people, and (2) a nonathletic cohort of people with PFP and pain-free people subgrouped by sex (i.e., men and women with PFP vs. pain-free men and women). Methods: This cross-sectional study included 114 people with PFP (71 women, 43 men) and 54 pain-free controls (32 women, 22 men). All participants attended a single testing session to assess body composition measures, which included BMI, percentage of body fat (%BFBioimpedance), and skeletal muscle mass (both assessed by bioelectrical impedance analysis), and percentage of body fat (%BFSkinfold) (assessed by skinfold caliper analysis). A one-way univariate analysis of covariance (age and physical activity levels as covariates) was used to compare body composition measures between groups (i.e., PFP vs. pain-free group; women with PFP vs. pain-free women; men with PFP vs. pain-free men). Results: Women with PFP presented significantly higher BMI, %BFBioimpedance, and %BFSkinfold, and lower skeletal muscle mass compared to pain-free women (p ≤ 0.04; effect size : ‒0.47 to 0.85). Men with PFP and men and women combined had no differences in BMI, %BFBioimpedance, %BFSkinfold, and skeletal muscle mass compared to their respective pain-free groups (p > 0.05). Conclusion: Our findings indicate that BMI and body composition measures should be considered as part of the evaluation and management of people with PFP, especially in women, who have demonstrated higher BMI and body fat and lower skeletal muscle mass compared to pain-free controls. Future studies should not assess body composition measures in a mixed-sex population without distinguishing men participants from women participants

Instrumenting gait assessment using the Kinect in people living with stroke: reliability and association with balance tests

Background: The Microsoft Kinect has been used previously to assess spatiotemporal aspects of gait; however the reliability of this system for the assessment of people following stroke has not been established. This study examined the reliability and additional information that the Kinect provides when instrumenting a gait assessment in people living with stroke. Methods: The spatiotemporal variables of step length, step length asymmetry, foot swing velocity, foot swing velocity asymmetry, peak and mean gait speed and the percentage difference between the peak and mean gait speed were assessed during gait trials in 30 outpatients more than three months post-stroke and able to stand unsupported. Additional clinical assessments of functional reach (FR), step test (ST), 10 m walk test (10MWT) and the timed up and go (TUG) were performed, along with force platform instrumented assessments of center of pressure path length velocity during double-legged standing balance with eyes closed (DLEC), weight bearing asymmetry (WBA) and dynamic medial-lateral weight-shifting ability (MLWS). These tests were performed on two separate occasions, seven days apart for reliability assessment. Separate adjusted multiple regressions models for predicting scores on the clinical and force platform assessments were created using 1) the easily assessed clinically-derived gait variables 10MWT time and total number of steps; and 2) the Kinect-derived variables which were found to be reliable (ICC > 0.75) and not strongly correlated (Spearman’s ρ < 0.80) with each other (i.e. non-redundant). Results: Kinect-derived variables were found to be highly reliable (all ICCs > 0.80), but many were redundant. The final regression model using Kinect-derived variables consisted of the asymmetry scores, mean gait velocity, affected limb foot swing velocity and the difference between peak and mean gait velocity. In comparison with the clinically-derived regression model, the Kinect-derived model accounted for >15% more variance on the MLWS, ST and FR tests and scored similarly on all other measures. Conclusions: In conclusion, instrumenting gait using the Kinect is reliable and provides insight into the dynamic balance capacity of people living with stroke. This system provides a minimally intrusive method of examining potentially important gait characteristics in people living with stroke.Medicine, Faculty ofPhysical Therapy, Department ofNon UBCReviewedFacult

Lower-limb biomechanics in football players with and without hip-related pain

Purpose: This study aimed to evaluate the differences in lower-limb biomechanics between adult subelite competitive football players with and without hip-related pain during two contrasting tasks-walking and single-leg drop jump (SLDJ)-and to determine whether potential differences, if present, are sex dependent. Methods: Eighty-eight football players with hip-related pain (23 women, 65 men) and 30 asymptomatic control football players (13 women, 17 men) who were currently participating in competitive sport were recruited. Biomechanical data were collected for the stance phase of walking and SLDJ. Pelvis, hip, knee, and ankle angles, as well as the impulse of the external joint moments, were calculated. Differences between groups and sex-specific effects were calculated using linear regression models. Results: Compared with their asymptomatic counterparts, football players with hip-related pain displayed a lower average pelvic drop angle during walking (P = 0.03) and a greater average pelvic hike angle during SLDJ (P < 0.05). Men with hip-related pain displayed a smaller total range of motion (excursion) for the transverse plane pelvis angle (P = 0.03) and a smaller impulse of the hip external rotation moment (P < 0.01) during walking compared with asymptomatic men. Women with hip-related pain displayed a greater total range of motion (excursion) for the sagittal plane knee angle (P = 0.01) during walking compared with asymptomatic women. Conclusion: Overall, few differences were observed in lower-limb biomechanics between football players with and without hip-related pain, irrespective of the task. This outcome suggests that, despite the presence of symptoms, impairments in lower-limb biomechanics during function do not appear to be a prominent feature of people with hip-related pain who are still participating in sport