J. William Myrer

Relative and Absolute Reliability of the KT-2000 Arthrometer for Uninjured Knees Testing at 67, 89, 134, and 178 N and Manual Maximum Forces

We assessed the reliability of the KT-2000 knee ar thrometer at 67, 89, 134, and 178 N and at manual maximum forces on 30 college students who were free from present or previous knee injuries. Two examiners tested all subjects on two occasions. Anterior laxity (P < 0.0001) and side-to-side difference (P < 0.05) sig nificantly increased as force increased. There was a significant difference (P < 0.0001) between testers for anterior laxity but not for side-to-side difference. We used intraclass correlation coefficients to estimate rel ative reliability. Anterior laxity intraclass correlation co efficients (2,1) between testers ranged from 0.81 to 0.86 and within tester correlations ranged from 0.92 to 0.95. Intraclass correlation coefficients for between testers for side-to-side differences ranged from 0.38 to 0.58 and within tester correlations ranged from 0.53 to 0.64. Subject-to-subject variability needs to be taken into account when interpreting intraclass correlation coefficient values. Our absolute reliability estimates (95% confidence intervals) were small, indicating little variability. Our data demonstrate the KT-2000 arthrom eter to be reliable. Researchers should present both relative and absolute reliability estimates, although we believe absolute estimates are of greater clinical value. Side-to-side differences are better discriminators than individual absolute values. We recommend that a <3 mm side-to-side difference be used to indicate stable knees.

Restless legs syndrome and near-infrared light: An alternative treatment option

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1–4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.

Whole-body vibration strengthening compared to traditional strengthening during physical therapy in individuals with total knee arthroplasty

ABSTRACT This study investigated the use of whole-body vibration (WBV) as an alternative strengthening regimen in the rehabilitation of individuals with total knee arthroplasty (TKA) compared with traditional progressive resistance exercise (TPRE). Individuals post TKA (WBV n = 8; TPRE n = 8) received physical therapy with WBV or with TPRE for 4 weeks. Primary dependent variables were knee extensor strength, quadriceps muscle activation, mobility, pain, and range of motion (ROM). There was a significant increase in knee extensor strength and improvements in mobility, as measured by maximal volitional isometric contraction and the Timed Up and Go Test (TUG), respectively, for both groups (p < 0.01). The WBV knee extensor strength improved 84.3% while TPRE increased 77.3%. TUG scores improved 31% in the WBV group and 32% for the TPRE group. There were no significant differences between groups for strength or muscle activation (Hotellings T2 = 0.42, p = 0.80) or for mobility (F = 0.54; p = 0.66). No adverse side effects were reported in either group. In individuals with TKA, both WBV and TPRE showed improved strength and function. Influence of WBV on muscle activation remains unclear, as muscle activation levels were near normal for both groups.

Topically applied dimethyl sulfoxide Its effects on inflammation and healing of a contusion

This study investigated the effects of topically applied dimethyl sulfoxide (DMSO) to traumatized muscle of adult male rats. Eighty rats were randomly assigned to one of two groups and subsequently traumatized, treated, and sacrificed. One group was used to examine inflammation; the other, healing. Each group was fur ther divided into an experimental group (70% DMSO and 30% distilled water) and a control group (100% distilled water); each group had five sacrifice times. Each treatment consisted of painting 1 ml of either the treatment or control solution on the contused tissue. The inflammation group received 15 additional treat ments, 3 per day for the next 5 days. A three-phased, single blind, histologic examination was performed. The principle findings were: (1) significantly fewer healing cells were present in the experimental group than in the control group during the period inflammation was examined, and (2) no significant difference existed be tween the experimental and control groups during the period healing was examined.

Assessing Body Composition of Children and Adolescents Using Dual-Energy X-Ray Absorptiometry, Skinfolds, and Electrical Impedance

To determine the validity and reliability of percent body fat estimates in 177 boys and 154 girls between 12–17 years of age, percent body fat was assessed once using dual-energy X-ray absorptiometry and twice using the sum of two skinfolds and three bioelectrical impedance analysis devices. The assessments were repeated on 79 participants on a second day. The agreement between the percent body fat estimates from the four prediction methods and dual-energy X-ray absorptiometry was evaluated using Bland–Altman analyses and a mixed linear model. All methods were reliable within and between days. The sum of two skinfolds (±6.8% body fat), OMRON (OMRON Healthcare Inc., Vernon Hills, Illinois, USA) bioelectrical impedance analysis (0 ± 7.3% body fat), and TANITA 521 (TANITA Corporation, Tokyo, Japan) bioelectrical impedance analysis (±7.6% body fat) had wide prediction intervals and are acceptable for use in large population-based studies. The TANITA 300A bioelectrical impedance analysis is not recommended for use in children and adolescents due to its wide prediction interval (±8.1% body fat) and large bias. A criterion method should be used when the accurate assessment of body composition of an individual is critical.

The Time Course of Dexamethasone Delivery Using Iontophoresis Through Human Skin, Measured via Microdialysis

STUDY DESIGN Controlled laboratory study. OBJECTIVE To determine the time course of dexamethasone sodium phosphate (Dex-P) during iontophoresis to underlying tissues using microdialysis. BACKGROUND In human participants, real-time information of Dex-P transdermal delivery during iontophoresis is unknown. METHODS Sixty-four healthy male participants (mean ± SD age, 24.2 ± 3.3 years; height, 181.8 ± 26.1 cm; mass, 82.4 ± 11.8 kg; subcutaneous fat thickness, 0.61 ± 0.19 cm) were randomly assigned into 1 of 6 groups: (1) 1-mA current, 1-mm probe depth; (2) 1-mA current, 4-mm probe depth; (3) 2-mA current, 1-mm probe depth; (4) 2-mA current, 4-mm probe depth; (5) in vivo retrodialysis; and (6) skin perfusion flowmetry. Microdialysis probes were used to assess the combined recovery (Dex-total) of Dex-P, dexamethasone, and its metabolite. RESULTS There was no difference in Dex-total between current intensities (P = .99), but a greater amount of Dex-total was recovered superficially at 1 mm compared to the 4-mm depth (P<.0001). Peak concentration mean ± SD values for the 1- and 2-mA currents at 1 mm were 10.8 ± 8.1 and 7.7 ± 5.5 µg/mL, and at 4 mm were 2.0 ± 0.8 and 1.3 ± 0.9 µg/mL, respectively. Peak skin perfusion was 741.4% ± 408.7% and 711.6% ± 260.8% at baseline for 1- and 2-mA intensities, respectively. Skin perfusion returned to baseline levels earlier during 1-mA intensity at a 110 mA · min dose within the treatment, compared to 2 mA at 60 minutes posttreatment. CONCLUSION Transdermal delivery of Dex-P during iontophoresis was successfully measured in vivo through human skin. Measurable concentrations of Dex-total were found regardless of current intensity. Although current-induced vasodilation occurred, it did not significantly affect the tissue accumulation of Dex-total.

Understanding the complete pathophysiology of chronic mild to moderate neck pain: Implications for the inclusion of a comprehensive sensorimotor evaluation

BACKGROUND Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood. OBJECTIVE The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status. METHODS A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control). RESULTS A statistically significant increase in NRE in flexion (2.75∘± 1.52∘ vs. 4.53∘± 1.74∘ and in extension (3.78∘± 1.95∘ vs 5.77∘± 2.73∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain.