Reliability of Strength and Performance Testing Measures and Their Ability to Differentiate Persons with and without Shoulder Symptoms

BACKGROUND: Upper extremity physical performance measures exist but none have been universally accepted as the primary means of gauging readiness to return to activity following rehabilitation. Few reports have described reliability and/or differences in outcome with physical performance measures between individuals with and without shoulder symptoms. HYPOTHESES/PURPOSE: The purpose of this study was to establish the reliability of traditional upper extremity strength testing and the CKCUEST in persons with and without shoulder symptoms as well as to determine if the testing maneuvers could discriminate between individuals with and without shoulder symptoms. The authors hypothesized that strength and physical performance testing would have excellent test/re-test reliability for individuals with and without shoulder symptoms and that the physical performance maneuver would be able to discriminate between individuals with and without shoulder symptoms. METHODS: Male and female subjects 18-50 years of age were recruited for testing. Subjects were screened and placed into groups based on the presence (Symptomatic Group) or absence of shoulder symptoms (Asymptomatic Group). Each subject performed an isometric strength task, a task designed to estimate 1-repetition maximum (RM) lifting in the plane of the scapula, and the closed kinetic chain upper extremity stability test (CKCUEST) during two sessions 7-10 days apart. Test/re-test reliability was calculated for all three tasks. Independent t-tests were utilized for between group comparisons to determine if a performance task could discriminate between persons with and without shoulder symptoms. RESULTS: Thirty-six subjects (18/group) completed both sessions. Test/re-test reliability for each task was excellent for both groups (intraclass correlations ≥ .85 for all tasks). Neither strength task could discriminate between subjects in either group. Subjects with shoulder symptoms had 3% less touches per kilogram of body weight on the CKCUEST compared to subjects without shoulder symptoms but this was not statistically significantly different (p=.064). CONCLUSIONS: The excellent test/re-test reliability has now been expanded to include individuals with various reasons for shoulder symptoms. Traditional strength testing does not appear to be the ideal assessment method for making discharge and/or return to activity decisions due to the inability to discriminate between the groups. The CKCUEST could be utilized to determine readiness for activity as it was trending towards being discriminatory between known groups. LEVEL OF EVIDENCE: Basic Science Reliability Study, Level 3

Do Three Different Passive Assessments of Quadriceps Spasticity Relate to the Functional Activity of Walking for Children Diagnosed with Cerebral Palsy?

A stiff-knee gait pattern is frequently associated with several impairments including quadriceps spasticity in children diagnosed with cerebral palsy (CP). The relationship of clinical measures of quadriceps spasticity and the stiff-knee gait pattern in children diagnosed with CP has not been well established. Therefore, the purpose of this study was to determine the ability of clinical measures of quadriceps spasticity (modified Ashworth scale [MAS], Ely tests, and pendulum test) to categorize a stiff-knee gait pattern in children with CP. Children were categorized as having a stiff-knee gait pattern based on kinematic and EMG gait data. Results of a logistic regression model revealed that the only significant measure was A1 of the pendulum test. Discriminant analysis functions were used to predict group membership (stiff-knee, not stiff-knee gait pattern) for each measure. The A1 of the pendulum test demonstrated the highest classification accuracy and the highest sensitivity compared to the other measures. Therefore, a negative pendulum test (indicated by an A1 value of 45 degrees or more) is more useful for ruling out a stiff-knee gait pattern compared to the other clinical measures

Do Three Different Passive Assessments of Quadriceps Spasticity Relate to the Functional Activity of Walking for Children Diagnosed with Cerebral Palsy?

A stiff-knee gait pattern is frequently associated with several impairments including quadriceps spasticity in children diagnosed with cerebral palsy (CP). The relationship of clinical measures of quadriceps spasticity and the stiff-knee gait pattern in children diagnosed with CP has not been well established. Therefore, the purpose of this study was to determine the ability of clinical measures of quadriceps spasticity (modified Ashworth scale [MAS], Ely tests, and pendulum test) to categorize a stiff-knee gait pattern in children with CP. Children were categorized as having a stiff-knee gait pattern based on kinematic and EMG gait data. Results of a logistic regression model revealed that the only significant measure was A1 of the pendulum test. Discriminant analysis functions were used to predict group membership (stiff-knee, not stiff-knee gait pattern) for each measure. The A1 of the pendulum test demonstrated the highest classification accuracy and the highest sensitivity compared to the other measures. Therefore, a negative pendulum test (indicated by an A1 value of 45 degrees or more) is more useful for ruling out a stiff-knee gait pattern compared to the other clinical measures

Increasing Ball Velocity in the Overhead Athlete: A Meta-Analysis of Randomized Controlled Trials

Overhead athletes routinely search for ways to improve sport performance, and one component of performance is ball velocity. The purpose of this meta-analysis was to investigate the effect of different strengthening interventions on ball and serve velocity. A comprehensive literature search with pre-set inclusion and exclusion criteria from 1970 to 2014 was conducted. Eligible studies were randomized control trials including the mean and SDs of both pretest and posttest ball velocities in both the experimental and the control groups. The outcome of interest was ball/serve velocity in baseball, tennis, or softball athletes. Level 2 evidence or higher was investigated to determine the effect different training interventions had on velocity. Pretest and posttest data were extracted to calculate Hedges\u27s g effect sizes with 95% confidence intervals (CIs). Methodological qualities of the final 13 articles within the analysis were assessed using the Physiotherapy Evidence Database scale. The majority of the articles included in this analysis had an effect on velocity with the strongest effect sizes found in periodized training (Hedges\u27s g = 3.445; 95% CI = 1.976-4.914). Six studies had CI that crossed zero, indicating that those specific interventions should be interpreted with caution. Consistent and high-quality evidence exists that specific resistance training interventions have an effect on velocity. These findings suggest that interventions consisting of isokinetic training, multimodal training, and periodization training are clinically beneficial at increasing velocity in the overhead athlete over different windows of time

Hybrid Diffuse Optical Techniques for Continuous Hemodynamic Measurement in Gastrocnemius During Plantar Flexion Exercise

Occlusion calibrations and gating techniques have been recently applied by our laboratory for continuous and absolute diffuse optical measurements of foreann muscle hemodynamics during handgrip exercises. The translation of these techniques from the foreann to the lower limb is the goal of this study as various diseases preferentially affect muscles in the lower extremity. This study adapted a hybrid near-infrared spectroscopy and diffuse correlation spectroscopy system with a gating algorithm to continuously quantify hemodynamic responses of medial gastrocnemius during plantar flexion exercises in 10 healthy subjects. The outcomes from optical measurement include oxy-, deoxy-, and total hemoglobin poncentrations, blood oxygen ~aturation, and relative changes in blood flow (rBF) and oxygen consumption rate (rV02) . We calibrated rBF and rV02 profiles with absolute baseline values of BF and V02 obtained by venous and arterial occlusions, respectively. Results from this investigation were comparable to values from similar studies. Additionally, significant correlation was observed between resting local muscle BF measured by the optical technique and whole limb BF measured concurrently by a strain gauge venous plethysmography. The extensive hemodynamic and metabolic profiles during exercise will allow for future comparison studies to investigate the diagnostic value of hybrid technologies in muscles affected by disease

Physical Therapists’ Assessment of Patient Self-Efficacy for Home Exercise Programs

# Background Patient adherence to home exercise programs (HEPs) is low, and poor patient self-efficacy is a barrier clinicians can influence. However, little evidence suggests that clinicians assess level of patient self-efficacy before prescribing HEPs. # Purpose To determine the importance of patient self-efficacy to physical therapists (PTs) when addressing patient barriers, determine how PTs assess and use patient self-efficacy for HEPs, and describe the barriers facing PTs when assessing patient self-efficacy for HEPs. # Study Design Survey. # Methods Practicing PTs were recruited from the American Physical Therapy Association’s Orthopedic Section and emailed the electronic survey. # Results Email invitations were sent to 17730 potential participants, and 462 PTs completed the survey over one month. PTs rated self-efficacy as “very” to “extremely” important for patient adherence (58%, 265/454). Most (71%, 328/462) reported assessing self-efficacy before prescribing HEPs and did so through verbal discussion and observation of the patient (50% and 38% respectively). Half of respondents individualized HEPs through self-efficacy related themes. PTs not assessing self-efficacy reported not knowing how (51%, 68/134), being unsure what to do with the information (24%, 32/134), or reporting other barriers (21%, 28/134). # Conclusions Most PTs indicated that self-efficacy was important for patient adherence, but assessment strategies reported, such as verbal discussion and observation, may not be the most accurate. PTs who did not assess self-efficacy reported not knowing how or what to do with the information once collected. These findings suggest that there is a gap in knowledge related to how to evaluate self-efficacy for HEPs. Better assessment of self-efficacy may lead to more appropriate and effective implementation strategies. # Level of Evidence Level I

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

UK Great Teacher Spotlight: Tim Uhl

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