Validation of a new test that assesses functional performance of the upper extremity and neck (FIT-HaNSA) in patients with shoulder pathology

<p>Abstract</p> <p>Background</p> <p>There is a lack of standardized tests that assess functional performance for sustained upper extremity activity. This study describes development of a new test for measuring functional performance of the upper extremity and neck and assesses reliability and concurrent validity in patients with shoulder pathology.</p> <p>Methods</p> <p>A series of developmental tests were conducted to develop a protocol for assessing upper extremity tasks that required multi-level movement and sustained elevation. Kinematics of movement were investigated to inform subtask structure. Tasks and test composition were refined to fit clinical applicability criteria and pilot tested on 5 patients awaiting surgery for shoulder impingement and age-sex matched controls. Test-retest reliability was assessed on 10 subjects. Then a cohort of patients with mild to moderate (n = 17) shoulder pathology and 19 controls (17 were age-sex matched to patients) were tested to further validate the Functional Impairment Test-Hand, and Neck/Shoulder/Arm (FIT-HaNSA) by comparing it to self-reported function and measured strength. The FIT-HaNSA, DASH and SPADI were tested on a single occasion. Impairments in isometric strength were measured using hand-held dynamometry. Discriminative validity was determined by comparing scores to those of age-sex matched controls (n = 34), using ANOVA. Pearson correlations between outcome measures (n = 41) were examined to establish criterion and convergent validity.</p> <p>Results</p> <p>A test protocol based on three five-minute subtasks, each either comprised of moving objects to waist-height shelves, eye-level shelves, or sustained manipulation of overhead nuts/bolts, was developed. Test scores for the latter 2 subtasks (or total scores) were different between controls as compared to either surgical-list patients with shoulder impingement or a variety of milder shoulder pathologies (p < 0.01). Test 1 correlated the highest with the DASH (r = -0.83), whereas Test 2 correlated highest with the SPADI (r = -0.76).</p> <p>Conclusion</p> <p>Initial data suggest the FIT-HaNSA provides valid assessment of impaired functional performance in patients with shoulder pathology. It discriminates between patients and controls, is related to self-reported function, and yet provides distinct information. Longitudinal testing is warranted.</p

A novel approach to mapping load transfer from the plantar surface of the foot to the walls of the total contact cast: A proof of concept study

This article is part of the series The Diabetic Foot

Intrinsic risk factors for inversion ankle sprains in females: a prospective study

Ankle sprains are extremely common. However, very little is known about the variables that predispose individuals to these injuries. The purpose of this study was to examine prospectively intrinsic risk factors for inversion sprains in a young physically active female population. One hundred and fifty-nine female physical education students were evaluated for several possible intrinsic risk factors for inversion sprains at the beginning of their academic study. The evaluated intrinsic risk factors included anthropometrical and physical characteristics, ankle joint position sense, isokinetic ankle muscle strength, lower leg alignment characteristics, postural control and muscle reaction time during a sudden inversion perturbation. All sports injuries were registered during 1-3 years and exposure to sport was recorded (mean: 15.33 +/- 4.33 h a week). Thirty-two (20%) of the 159 females sprained their ankle. The number of ankle sprains per 1000 h of sports exposure was 0.75. The Cox regression analysis revealed that females with less accurate passive joint inversion position sense [hazard ratio (HR): 1.08, 95% confidence interval (Cl): 1.02-1.14 for absolute error at 15 degrees inversion], a higher extension range of motion at the first metatarsophalangeal joint (HR: 1.03, 95% Cl: 1.00-1.06) and less coordination of postural control (HR: 0.96, 95% Cl: 0.93-1.00 for endpoint excursion; HR: 0.94, 95% Cl: 0.89-0.99 for maximal endpoint excursion) are at greater risk of an ankle sprain. The findings of this study suggest that effective prevention and conservative rehabilitation of ankle inversion sprains should include attention to these variables