Inae C. Gadotti

Scales to Assess the Quality of Randomized Controlled Trials: A Systematic Review

Background and Purpose: The methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales. Methods: Extensive electronic database searches, along with a manual search, were performed. Results: One hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence; however, its validity for physical therapy trials has not been supported. Discussion and Conclusion: Many scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed.

Importance and clarification of measurement properties in rehabilitation

Objective: The purpose of this paper was to critically review the concepts and types of measurement reliability, validity, and responsiveness, and to discuss their implications for rehabilitation research and high-quality clinical practice. Method: A critical literature review considering the strengths, limitations, and appropriate applications of measurement properties in rehabilitation was conducted. Results and Discussion: Measurement quality is assessed using criteria such as reliability, validity, and responsiveness. Many published studies do not report these measurement properties, which are related, sometimes overlapping, and are frequently confused. This review paper clarifies the meanings of the concepts and types of reliability, validity, and responsiveness. It gives examples that are relevant for the field of rehabilitation. It discusses how the measurement properties interact with each other and influence the size of the effect and the power of studies. Conclusion: Measurements are essential in rehabilitation research and clinical evaluation. Measurement properties should be reported to allow readers to evaluate the quality of the results presented. The clarification of measurement properties provided in this paper may contribute towards standardizing definitions and improving the quality of rehabilitation research and clinical practice.

Reliability of scapular positioning measurement procedure using the Palpation Meter (PALM)

BACKGROUND AND OBJECTIVES Observation and measurement of the static position of the scapula is important for investigating both shoulder and neck pathology. Measurement of scapular position is complex and lacks a clinically useful instrument. The objective of this study was to investigate the reliability of the Palpation Meter (PALM) for measuring scapular position when the glenohumeral joint is held in various positions. METHODS Thirty normal subjects were recruited for a test-retest reliability study. Three raters conducted measurements on two different occasions to estimate intra- and inter-rater reliability. The scapular positions evaluated in this study were: (1) the horizontal distance between the scapula and the spine in the scapular resting position and during elevation of the arm in the scapular plane; and (2) the vertical distance between C(7) and the acromion (C(7)-A). Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland and Altman limits of agreement were calculated. RESULTS Reliability values for measurements of the horizontal distance between the scapula and the spine were generally good for both intra-rater (ICC 0.81 to 0.89; SEM 0.56 to 1.17cm) and inter-rater (ICC 0.67 to 0.89; SEM 0.59 to 0.98cm) evaluation. Reliability values of measurement of depression of the acromion were also good for both intra-rater (ICC 0.72 to 0.78; SEM 0.66 to 0.79) and inter-rater (ICC 0.76; SEM 0.64) evaluation. No systematic bias was observed with Bland and Altman analysis. CONCLUSIONS The PALM is a reliable tool for the measurement of scapular positioning in a healthy sample. Future studies should be conducted to further investigate the clinometric properties of the PALM in patient populations before its clinical usefulness for measuring scapular position can be established.

Electromyographic activity of the cervical flexor muscles in patients with temporomandibular disorders while performing the craniocervical flexion test: a cross-sectional study

Background Most patients with temporomandibular disorders (TMD) have been shown to have cervical spine dysfunction. However, this cervical dysfunction has been evaluated only qualitatively through a general clinical examination of the cervical spine. Purpose The purpose of this study was to determine whether patients with TMD had increased activity of the superficial cervical muscles when performing the craniocervical flexion test (CCFT) compared with a control group of individuals who were healthy. Design A cross-sectional study was conducted. Methods One hundred fifty individuals participated in this study: 47 were healthy, 54 had myogenous TMD, and 49 had mixed TMD. All participants performed the CCFT. Data for electromyographic activity of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles were collected during the CCFT for all participants. A 3-way mixed-design analysis of variance for repeated measures was used to evaluate the differences in EMG activity for selected muscles while performing the CCFT under 5 incremental levels. Effect size values were calculated to evaluate the clinical relevance of the results. Results Although there were no statistically significant differences in electromyographic activity in the SCM or AS muscles during the CCFT in patients with mixed and myogenous TMD compared with the control group, those with TMD tended to have increased activity of the superficial cervical muscles. Limitations The results obtained in this research are applicable for the group of individuals who participated in this study under the protocols used. They could potentially be applied to people with TMD having characteristics similar to those of the participants of this study. Conclusion This information may give clinicians insight into the importance of evaluation and possible treatment of the deep neck flexors in patients with TMD. However, future research should test the effectiveness of this type of program through a randomized controlled trial in people with TMD in order to determine the real value of treating this type of impairment in this population.

Sensitivity of clinical assessments of sagittal head posture

RATIONALE, AIMS AND OBJECTIVES Historically, clinicians visually evaluate posture using anatomical landmarks. Advances in technology made digital photographs now feasible to use in clinical practice. Photogrammetry may increase the reliability of the assessment of postural changes. However, differences between visually estimated and photogrammetric recorded changes in posture need to be tested. The objective of this study was to evaluate the sensitivity of visual assessments of changes in head posture in the sagittal plane in relation to photogrammetric recorded data. METHODS The head posture of 29 female subjects in a sagittal plane was assessed visually and photogrammetrically. The visual assessment of head posture was conducted using a postural grid with a plumb for checking the alignment. The patients were classified as having forward head posture (FHP), slight FHP or no FHP. Photogrammetry of head posture was performed using the Alcimage software (Alcimar B. Soares, Uberlândia, MG, Brasil). Three reference points were used to measure the head posture angle: mentus, external auditory meatus and manubrium. The visually classified groups were compared in relation to the photogrammetric angles using one-way ANOVA. RESULTS A significant difference was found between the FHP and no FHP groups (P = 0.001), and between the FHP and slight FHP groups (P = 0.002). However, no significant difference was found between the slight FHP and no FHP groups. CONCLUSIONS Visual assessments of sagittal head posture were sensitive to detect differences between no FHP and FHP groups, but were not sensitive to detect differences between no FHP and slight FHP groups. Head posture photogrammetry is recommended to quantitatively detect less evident differences in head posture.

Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability.

AIMS To compare the masticatory and cervical muscle tenderness and pain sensitivity in the hand (remote region) between patients with temporomandibular disorders (TMD) and healthy controls. METHODS Twenty female subjects were diagnosed with chronic TMD, and 20 were considered healthy. Subjects completed the Neck Disability Index and Limitations of Daily Functions in a TMD questionnaire. Tenderness of the masticatory and cervical muscles and pain sensitivity in the hand were measured using an algometer. Three-way mixed analysis of variance (ANOVA) evaluated differences in muscle tenderness between groups. One-way ANOVA compared pain sensitivity in the hand between groups. Effect sizes were assessed using Cohen guidelines. RESULTS Significantly increased masticatory and cervical muscle tenderness and pain sensitivity in the hand were found in subjects with TMD when compared with healthy subjects. Moderate to high effect sizes showed the clinical relevance of the findings. CONCLUSION The results of this study have highlighted the importance of assessing TMD patients not only in the craniofacial region but also in the neck and other parts of the body. Future studies should focus on testing the effectiveness of treatments addressing the neck and the pain sensitivity in the hand in patients with TMD.

Reliability of the Craniocervical Posture Assessment: Visual and Angular Measurements Using Photographs and Radiographs

OBJECTIVE The purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters. METHODS One photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters. RESULTS Good to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37). CONCLUSION The raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.

Effect of mandibular mobilization on electromyographic signals in muscles of mastication and static balance in individuals with temporomandibular disorder: study protocol for a randomized controlled trial

BackgroundThe stomatognathic system and dysfunction in this system may be related to postural control. The proposal of the present study is to assess the effect of mandibular mobilization in individuals with temporomandibular disorder using surface electromyography of the muscles of mastication and stabilometric variables.Methods/DesignA randomized, controlled, blind, clinical trial will be carried out, with the participants divided into three groups: 1) facial massage therapy (control group), 2) nonspecific mandibular mobilization and 3) specific mandibular mobilization. All groups will be assessed before and after treatment using the Research Diagnostic Criteria for Temporomandibular Disorders, surface electromyography of the masseter and temporal muscles and stabilometry. This study is registered with the Brazilian Registry of Clinical Trials (RBR9x8ssz).DiscussionA large number of studies have employed surface electromyography to investigate the function/dysfunction of the muscles of mastication and associations with signs and symptoms of temporomandibular disorders. However, it has not yet been determined whether stabilometric variables offer adequate reliability in patients with this disorder. The results of the proposed study will help determine whether specific and/or nonspecific mandibular mobilization exerts an effect on the muscles of mastication and postural control. Moreover, if an effect is detected, the methodology defined in the proposed study will allow identifying whether the effect is local (found only in the muscles of mastication), global (found only in postural control) or generalized.

Assessment of intrasubject reliability of radiographic craniocervical posture of asymptomatic female subjects.

OBJECTIVE The objective of this study was to measure the reproducibility of the craniocervical posture (intrasubject reliability) of asymptomatic female subjects. METHODS Two radiographs of the craniocervical posture of 22 female subjects (mean ± SD: age, 28 ± 4.37 years; body mass index, 22.3 ± 3.24 kg/m(2)) in the sagittal view were taken 1 week apart and at the same time of day. Their posture was standardized in the self-balance position. Seven angles were measured in the digitalized radiographs and analyzed using the Alcimage software (Uberlândia, Minas Gerais, Brazil). Intraclass correlation coefficient (ICC), SEM, and 95% confidence intervals were analyzed. RESULTS Good-to-excellent ICC (ICC, 0.90-0.98) and small SEM (SEM, 0.25-0.70) were found. CONCLUSION The craniocervical posture of the subjects included in this study was reproducible (ie, intrasubject reliability) when measured a week apart using radiographs.

Cervical musculoskeletal impairments in cervicogenic headache: a systematic review and a meta-analysis

Abstract The differential diagnosis of cervicogenic headache (CEH) requires the presence of a pattern of symptoms and cervical musculoskeletal signs that distinguishes it from other types of headaches. The investigation of cervical musculoskeletal impairments (CMI) can help in the diagnosis and treatment of the CEH. In order to assess the evidence concerning CMI in CEH subjects, a systematic review and a meta-analysis was performed. Several electronic databases were searched. A checklist was used to identify suitable articles and a methodological scale was used to analyse their quality. Ten articles met the inclusion criteria. Based on our meta-analysis, patients with CEH have altered range of motion in rotation, flexion-extension, cervical rotation with cervical flexion, altered cervical flexor strength, and altered cervical flexor endurance. More controlled studies investigating the cervical impairments in CEH, with a clear history of patients, and greater sample sizes, are necessary.