Osamu Fujinawa

Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test

OBJECTIVE This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test (FRT) to discriminate subjects with headache because of C1/2 dysfunction. In addition, this study evaluates agreement between experienced and inexperienced examiners. METHODS These were 2 single blind comparative measurement study designs. In study 1, 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls, 20 subjects with cervicogenic headache (CeH) where C1/2 was the primary dysfunctional level, and 10 subjects with CeH but without C1/2 as the primary dysfunctional level. In study 2, 2 inexperienced and 1 experienced blinded examiners evaluated the FRT in 12 subjects with CeH and 12 asymptomatic controls. Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer. An analysis of variance with planned orthogonal comparison, single measure intraclass correlation coefficient (2,1), and Bland-Altman plot were used to analyze FRT range of rotation between the examiners. Sensitivity, specificity, and examiner agreement for test interpretation were analyzed using cross tabulation and kappa. RESULTS In study 1, sensitivity and specificity of the FRT was 90% and 88% with 92% agreement for experienced examiners (P < .001). Overall diagnostic accuracy was 89% (P < .001) and kappa = 0.85. In study 2, for inexperienced examiners, FRT mobility was significantly greater than for experienced examiners, but sensitivity, specificity, agreement, and kappa values were all within clinically acceptable levels. CONCLUSIONS The FRT can be used accurately and reliably by inexperienced examiners and may be a useful aid in CeH evaluation.

Reliability and validity of an ultrasound-based imaging method for measuring interspinous process distance in the lumbar spine using two different index points.

[Purpose] This study assessed the reliability and validity of an ultrasound-based imaging method for measuring the interspinous process distance in the lumbar spine using two different index points. [Subjects and Methods] Ten healthy males were recruited. Five physical therapy students participated in this study as examiners. The L2–L3 interspinous distance was measured from the caudal end of the L2 spinous process to the cranial end of the L3 spinous process (E-E measurement) and from the top of the L2 spinous process to the top of the L3 spinous process (T-T measurement). Intraclass correlation coefficients were calculated to estimate the relative reliability. Validity was assessed using a model resembling the living human body. [Results] The reliability study showed no difference in intra-rater reliability between the two measurements. However, the E-E measurement showed higher inter-rater reliability than the T-T measurement (Intraclass correlation coefficients: 0.914 vs. 0.725). Moreover, the E-E measurement method had good validity (Intraclass correlation coefficients: 0.999 and 95% confidence interval for minimal detectable change: 0.29 mm). [Conclusion] These results demonstrate the high reliability and validity of ultrasound-based imaging in the quantitative assessment of lumbar interspinous process distance. Of the two methods, the E-E measurement method is recommended.

Relationship Between the Oxygen Uptake During Cardiopulmonary Exercise Testing and Left Ventricular Function in Patients with Acute Myocardial Infarction

The relationship between exercise capacity and left ventricular function has been evaluated in 35 patients with acute myocardial infarction (34 males and 1 female; mean age 55.5 ± 7.1 years). Single photon emission computed tomography (SPECT) was used to measure left ventricular function in the acute phase (4.9 ± 2.2 days after onset) and the chronic phase (188.5 ± 22.9 days after onset). More than 10% left ventricular dilatation from the acute phase to the chronic phase was defined as remodeling (RM) and the subjects were divided into 2 groups: RM and non-RM. Cardiopulmonary exercise testing was performed at 1 month (1M), 3 months (3M) and 6 months (6M) after onset. In the RM group, anaerobic threshold (AT) and peak oxygen uptake (Peak ) did not change significantly. In the non-RM group, AT was 15 ± 1 (ml/min/Kg) at 1M, 16 ± 2 at 3M and 18 ± 4 at 6M. Peak was 26 ± 3 (ml/min/Kg) at 1M, 30 ± 2 at 3M and 32 ± 3 at 6M. Both parameters in the chronic phase increased significantly compared with those at 1M (p<0.002 and p<0.0001). Thus, change in exercise capacity would correlate with change in left ventricular function.

Absolute and relative reliability of lumbar interspinous process ultrasound imaging measurements

[Purpose] The intra- and inter-examiner reliabilities of lumbar interspinous process distances measured by ultrasound imaging were examined. [Subjects and Methods] The subjects were 10 males who had no history of orthopedic diseases or dysfunctions. Ten lumbar interspinous images from 360 images captured from 10 subjects were selected. The 10 images were measured by nine examiners. The lumbar interspinous process distance measurements were performed five times by each examiner. In addition, four of the nine examiners measured the distances again after 4 days for test-retest analysis. In statistical analysis, the intraclass correlation coefficient was used to investigate relative reliability, and Bland-Altman analysis was used to investigate absolute reliability. [Results] The intraclass correlation coefficients (1, 1) for intra-examiner reliability ranged from 0.985 to 0.998. For inter-rater reliability, the intraclass correlation coefficient (2, 1) was 0.969. The intraclass correlation coefficients (1, 2) for test-retest reliability ranged from 0.991 to 0.999. The Bland-Altman analysis results indicated no systematic error. [Conclusion] The results indicate that ultrasound measurements of interspinous process distance are highly reliable even when measured only once by a single person.