Reproducibility of lower strength tests using a new portable dynamometer; measurement comparisons with a non-portable dynamometer

Objectives: Hand-held dynamometers have been used to assess lower limb muscle strength. However, they have been reported to have various reliability and be dependent on the strength of the participant and that of the examiner. A new way to assess lower limb muscle strength using a portable load cell is being introduced in assessing knee extensors, hip abductors, hip external rotators and combined hip abductors and external rotators (‘clam’ position). The study aimed to identify the test-retest reliability, intra-rater reliability and validity of the new assessment method. Method: Twenty healthy controls took part in this study which took place in a physiology lab and performed four isometric strength tests on the portable dynamometer at two times. The first time the tests were also performed in an isokinetic dynamometer to assess validity. Results: The new assessment method was found have high reliability (knee extension ICC=0.99; hip abduction ICC=0.94; hip external rotation=0.97; ‘clam’=0.95) and high validity (knee extension ICC=0.99; hip abduction ICC=0.98; hip external rotation=0.90; ‘clam’=0.98) when compared to a gold standard isokinetic dynamometer. Conclusion: The new method is reliable and valid. It is more time-consuming than a hand-held dynamometer however it provides precise results without being dependent on the examiner

Generalized Additive Models for Location Scale and Shape (GAMLSS) in R

GAMLSS is a general framework for fitting regression type models where the distribution of the response variable does not have to belong to the exponential family and includes highly skew and kurtotic continuous and discrete distribution. GAMLSS allows all the parameters of the distribution of the response variable to be modelled as linear/non-linear or smooth functions of the explanatory variables. This paper starts by defining the statistical framework of GAMLSS, then describes the current implementation of GAMLSS in R and finally gives four different data examples to demonstrate how GAMLSS can be used for statistical modelling.

A systematic review of reviews on patellofemoral pain syndrome. Exploring the risk factors, diagnostic tests, outcome measurements and exercise treatment

Abstract: Background: Literature has shown a growing number of published studies on Patellofemoral Pain Syndrome every year. The increasing evidence base has revealed a significant number of reviews which makes it confusing for clinicians and researchers to choose from the best evidence. This study aimed to gather the reviews on Patellofemoral Pain Syndrome and provide information about the most common clinical tests, risk factors, exercise treatment and outcome measures. In addition, secondary questions aimed to report the study settings and patient characteristics of the primary included studies. Methods: Studies eligible for this Review of Reviews were those published from 1993 to July 2013. Databases searched included PubMed, CINAHL, SPORTDiscus, Pedro and the Cochrane Library. Four key areas were searched using the words: PFPS, Anterior Knee Pain (AKP) or Chondromalacia patella (CP), plus a keyword. The keywords for the four research topics were a) risk factors; b) exercise treatment; c) diagnostic clinical tests and d) psychometric outcome measurements. Only reviews with clear methodological strategy were included. A two-stage evaluation was performed ineach review assessment. At first, the level of evidence was graded and then the methodological quality of each review was assessed. Results: Full text screening revealed that only 18 reviews were eligible for use. The selected reviews included 213 primary studies. After excluding duplicates, 144 primary studies were screened to answer the secondary questions. A gold standard clinical test for PFPS assessment cannot be reached and the use of functional tasks should be considered. The quadriceps strength deficits are still the only evidence based risk factors along with the dynamic malalignment of the lower limb. More research is still required on strength and flexibility deficits of other lower limb muscles. The quadriceps-based exercises are still the only ones to have strong evidence together with hamstrings, quadriceps, gastrocnemius and anterior hip muscles stretching. Finally, the usage of Activities of Daily Living Scale is recommended as the best outcome measure. Conclusion: There is no evidence on whether the above treatment and assessment methods should be used in sedentarypeople or differently across population groups or gender. More RCTs with large populations, powered correctly, inclinical environments are called for in further research

Angular Dependent Magnetization Dynamics of Kagome Artificial Spin Ice Incorporating Topological Defects

We report angular-dependent spin-wave spectroscopy on kagome artificial spin ice made of large arrays of interconnected Ni80Fe20 nanobars. Spectra taken in saturated and disordered states exhibit a series of resonances with characteristic in-plane angular dependencies. Micromagnetic simulations allow us to interpret characteristic resonances of a two-step magnetization reversal of the nanomagnets. The dynamic properties are consistent with topological defects that are provoked via a magnetic field applied at specific angles. Simulations that we performed on previously investigated kagome artificial spin ice consisting of isolated nanobars show characteristic discrepancies in the spin wave modes which we explain by the absence of vertices.Comment: 14 pages and 5 figure

Perceptions of physiotherapists of their role in reducing pain and increasing, function, strength and flexibility in patients with Patellofemoral Pain Syndrome

Study objectives: The purpose of this focus group study was to establish the physiotherapy treatment of Patellofemoral Pain Syndrome in North-West Wales. In addition the study aimed to report the barriers that stopped physiotherapists from increasing strength and flexibility and the contradictions of physiotherapists’ beliefs regarding their practice. Methods: The investigation was based on specific and priori designed questions. Two focus groups were conducted, where physiotherapists discussed the results of a feasibility study conducted in their department. 11 hypotheses discussed whilst 13 evidence statements reported by the merger of the answers to the hypotheses. A level of consensus was described using the moderator’s notes. Results: Patellofemoral Pain Syndrome physiotherapy works; not through strength and flexibility but through pain and function improvement. However, this practice often only has a short-term effect. Conclusions: Group classes and better education on the importance of specific exercises and self-managing should be researched whilst the long-term effect of these treatment components should also be assessed

Effectiveness of low level laser therapy (LLLT) in the treatment of lateral elbow tendinopathy (LET): an umbrella review

Purpose: The aim of this umbrella review is to determine the effectiveness of LLLT in the treatment of LET and to provide recommendations based on this evidence. Methods: A comprehensive and systematic review was undertaken using Medline, EBSCO and EMBASE. Systematic reviews or meta-analysis were included if they compared Laser with at least one of the following: (i) placebo, (ii) no treatment, (iii) another treatment, conservative (physical therapy intervention or medical) or operative of LET. Principal outcomes included the assessment of short and long-term effect on functional status, pain, grip strength (pain-free or maximum) and a global measure (overall improvement). Results: Seven papers met the inclusion criteria for the umbrella review, Five papers were of moderate and two of low methodological quality. All reviews reported benefits associated with laser therapy Vs other intervention or placebo, however the significance of the identified benefits differed between studies and reviews. No review reported negative effects of laser therapy or harm to patients. All reviews noted significant variance between included studies with 2 reviews citing statistically significant heterogeneity. It is essential to consider this in the interpretation of these data. Conclusion: This umbrella review found poor results for the effectiveness of LLLT in the management of LET. Therefore, further research with well-designed RCTs is required to provide meaningful evidence on the effectiveness (absolute and relative) of LLLT for the management of LET

An experimental examination of the role of re-engineering in the management of software quality

This paper reports on the design and the results of a randomised, controlled experiment estimating the effect of predetermined changes in module complexity on the maintainability of different program versions seeded with equivalent logic errors. The experiment measures maintainability which is a defining sub-attribute of quality. The hypothesis "low module complexity results in high maintainability" is tested experimentally by monitoring and recording the time taken to identify and correct the seeded errors. Prior to the experiment programs are statically analysed to produce measurements of internal sub-attributes of the fundamental attribute of complexity. A first program version is modularised according to established rules giving a new version with a larger number of modules and with smaller individual module complexity. The results of this work can be used to design tools capable of providing an indicator, or factor, for re-engineering whereby a given program can be restructured in such a way that quality improvement can be quantified or at least estimated. As maintainability is a defining attribute of quality the insights gained can be further applied in understanding the underlying processes involved and ultimately lead to quality improvements

Generalized Additive Models for Location Scale and Shape (GAMLSS) in R

GAMLSS is a general framework for fitting regression type models where the distribution of the response variable does not have to belong to the exponential family and includes highly skew and kurtotic continuous and discrete distribution. GAMLSS allows all the parameters of the distribution of the response variable to be modelled as linear/non-linear or smooth functions of the explanatory variables. This paper starts by defining the statistical framework of GAMLSS, then describes the current implementation of GAMLSS in R and finally gives four different data examples to demonstrate how GAMLSS can be used for statistical modelling

Cyriax physiotherapy, a supervised exercise programme and Bioptron light for the treatment of lateral epicondylitis

Lateral epicondylitis (LE) is one of the most common lesions of the arm. Physiotherapy is a conservative treatment that is usually recommended for LE patients and a wide array of physiotherapy treatments is used. Two of the most common physiotherapy treatments for LE are Cyriax physiotherapy and supervised exercise programmes. More recently physiotherapists are able to use a new modality called polarised polychromatic non-coherent light (Bioptron light) for the management of LE. The clinical value of these treatments for LE is not known. The aim of this project was to investigate the clinical use and clinical effectiveness of Cyriax physiotherapy, a supervised exercise programme and polarised polychromatic non-coherent light (Bioptron light) for the treatment of LE. Systematic review (Chapter 2) found that there was strong evidence for the short-term effectiveness of acupuncture for LE. It also found that there was strong evidence that four physiotherapy modalities, low power laser light, ultrasound, extracorporeal shock wave therapy, and pulsed electromagnetic field therapy were not effective treatments for the management of LE. There was insufficient evidence available for other treatments used for LE, such as iontophoresis and home exercise programmes, to judge their effectiveness. Chapter 2 recommended that more evidence is needed for Cyriax physiotherapy, supervised exercise programmes and polarised polychromatic non-coherent light (Bioptron light). It is necessary to establish optimal protocols for these treatments before a suitable clinical trial can be designed. A critical literature review (Chapter 3) found that treatment protocols for Cyriax physiotherapy, supervised exercise programmes and polarised polychromatic non-coherent light (Bioptron light) were mainly derived from the views of advocates of these treatments, based on their personal experience. Two preliminary clinical studies were conducted to pilot the use of treatment protocols derived from the critical review in Chapter 3 on overuses injuries that were similar to LE and were regularly presented to the clinic (Chapter 4). In the first study (section 4.3) Cyriax physiotherapy did not reduce the pain in patellar tendinopathy, while the supervised exercise programme did. In the second study (section 4.4) polarised polychromatic non-coherent light (Bioptron light) reduced nocturnal pain and paraesthesia in carpal tunnel syndrome (CTS). The findings of these two pilot studies should be interpreted cautiously because the number of patientsincluded in the patellar tendinopathy was small and in the CTS study it was not possible to attribute changes to the light per se because the study lacked a control group. Before the effectiveness of these protocols could be tested, a questionnaire survey was conducted to establish the current clinical practices of these physiotherapy treatments for LE. This survey was based on the self-reporting of chartered physiotherapists in Athens using these treatments in their clinical practice (Chapter 5). It may be confidently assumed that the results of the questionnaire present a representative view of current clinical practice of Cyriax physiotherapy, a supervised exercise programme and polarised polychromatic non-coherent light (Bioptron light) on LE at least as these treatments are applied in Athens. How much this reflects usage in the rest of the Greece, Europe, or even the world, is yet to be seen by extending the research. When the effectiveness of Cyriax physiotherapy, a supervised exercise programme and polarised polychromatic non-coherent light (Bioptron light) for LE was compared, the three treatments reduced pain and improved function at the end of the treatment and at any of the follow-up time points (Chapter 6). Whether this is due to placebo effects is not known. The supervised exercise programme produced the largest effect in the short, intermediate and long term (Chapter 6). This finding suggests that, of the three treatments, the supervised exercise programme should be used as a first treatment option when physiotherapists manage LE patients (Chapter 6; Chapter 7). If this is not possible, Cyriax physiotherapy and polarised polychromatic non-coherent light (Bioptron light) may be suitable (Chapter 6; Chapter 7). Although the three treatments are promising interventions for the management of patients with LE, further research is warranted to investigate and confirm the effectiveness of Cyriax physiotherapy, supervised exercise programmes and polarised polychromatic non-coherent light (Bioptron light) in the treatment of impairment and disability resulting from LE

An experimental examination of program maintainability as a function of structuredness

The general ethos of producing structured programs has been, at least in theory, adopted throughout the software engineering community. By studying and measuring the structure of existing software we can estimate the benefits to be gained from changes in the structure in terms of the external attributes (perceived behaviour) of the re- structured software. [13, 2, 3, 10, 6, 7]. In this paper we report the results of two controlled experiments measuring the improvement on the maintainability of differently structured code. These experiments build on the experience and insights gained through an earlier experiment [5]. We discuss a strategy for re-structuring based on an improved re-engineering factor [9] and present the static measures of morphology (depth and width of module calls), coupling and cohesion and module complexity of a range of programs. By plotting these measures and adopting target values (e.g. width of call< 5) we estimate the expected improvement in the maintainability after re-engineering. We subsequently carry out the re-engineering, measure the re-structured code statically and measure the actual maintainability experimentally. The results reveal that unstructured programmes take longer to 'reveal their secrets'. An integral part of this work are the design and execution of controlled experiments as well as the use of automated tools for the static analysis of code and the recording of the experimental data