Sharon L. Olson

Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain

Study Design. The psychometric properties and clinical use of a battery of physical performance measures were tested on 44 patients with low back pain and 48 healthy, pain‐free control subjects. Objectives. Reliability, validity, and clinical use of nine physical performance measures were evaluated. Summary of Background Data. Although physical performance measures have potential use in evaluation, treatment planning, and determination of treatment outcome, there is sparse systematic investigation of their reliability, validity, and clinical use. Methods. Forty‐four subjects with low back pain and 48 healthy pain‐free subjects participated. The following physical performance measures were tested: distance walked in 5 minutes; 50‐foot walk at fastest speed; 50‐foot walk at preferred speed; 5 repetitions of a sit‐to‐stand task; 10 repetitions of a repeated trunk flexion task; timed up‐and‐go task; unloaded forward reach task; loaded forward reach task; and Sorensen fatigue test. Subjects were assessed twice on 2 days. Results. All measures had excellent intertester reliability (intraclass correlation coefficient [ICC]1,1 >0.95). Test‐retest (within session) reliability was adequate for all measures (ICC1,1 >0.83) except repeated trunk flexion (ICC1,1 >0.45) in the low back pain group. Test‐retest (day‐to‐day) reliability ranged between 0.59 and 0.88 in the low back pain group and between 0.46 and 0.76 in the control group. Day‐to‐day reliability improved when the averages of two trials of repeated trunk flexion and sit‐to‐stand were used (0.76‐0.91 low back pain group and 0.62‐0.89 control group). Results of a multivariate analysis of variance showed a significant effect of group (F10,65 = 3.52, P = 0.001). Results of univariate analyses showed significant group differences on all measures except the 50‐foot walk at preferred speed and unloaded forward reach. Self‐report of disability was moderately correlated with the performance tasks (r = 0.400 to −0.603). Conclusions. The results provide support for the use of these physical performance measures as a complement to patient self‐report.

Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm.

Wang WTJ, Olson SL, Campbell AH, Hanten WP, Gleeson PB: Effectiveness of physical therapy for patients with neck pain: An individualized approach using a clinical decision-making algorithm. Am J Phys Med Rehabil 2003;82:203–218. Objective The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. Design One treatment group of 30 patients with neck pain completed physical therapy treatment. The control group of convenience was formed by a cohort group of 27 subjects who also had neck pain but did not receive treatment for various reasons. There were no significant differences between groups in demographic data and the initial test scores of the outcome measures. A quasi-experimental, nonequivalent, pretest-posttest control group design was used. A physical therapist rendered an eclectic intervention to the treatment group based on a clinical decision-making algorithm. Treatment outcome measures included the following five dependent variables: cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion endurance test, and the Patient Specific Functional Scale. Both the treatment and control groups completed the initial and follow-up examinations, with an average duration of 4 wk between tests. Results Five mixed analyses of variance with follow-up tests showed a significant difference for all outcome measures in the treatment group compared with the control group. After an average 4 wk of physical therapy intervention, patients in the treatment group demonstrated statistically significant increases of cervical range of motion, decrease of pain, increases of physical performance measures, and decreases in the level of disability. The control group showed no differences in all five outcome variables between the initial and follow-up test scores. Conclusions This study delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain. The algorithm can help clinicians classify patients with cervical pain into clinical patterns and provides pattern-specific guidelines for physical therapy interventions. An organized and specific physical therapy program was effective in improving the status of patients with neck pain.

Landing Mechanics between Noninjured Women and Women with Anterior Cruciate Ligament Reconstruction during 2 Jump Tasks

Background Women with anterior cruciate ligament reconstruction have different neuromuscular strategies than noninjured women during functional tasks after ligament reconstruction and rehabilitation. Hypothesis Landing from a jump creates high loads on the knee creating dynamic instability in women with anterior cruciate ligament reconstruction, whereas noninjured women have stable knee landing mechanics. Study Design Controlled laboratory study. Methods Fifteen noninjured women and 13 women with anterior cruciate ligament reconstruction performed 5 trials of a single-legged 40-cm drop jump and 2 trials of a 20-cm up-down hop task. Multivariate analyses of variance were used to compare hip and knee joint kinematics, knee joint moments, ground-reaction forces, and electromyographic findings between the dominant leg in noninjured women and reconstructed leg in women with anterior cruciate ligament reconstruction. Results No statistically significant differences between groups were found for peak hip and knee joint angles for the drop jump task. Statistically significant differences in neuromuscular activity (P = .001) and anterior-posterior knee shear forces (P < .001) were seen in women with anterior cruciate ligament reconstruction compared with noninjured women in the drop jump task. However, no statistically significant differences (P > .05) between groups were found for either peak hip and knee joint angles, peak joint kinetics, or electromyographic findings during the up-down hop task. Conclusion Women with anterior cruciate ligament reconstruction have neuromuscular strategies that allow them to land from a jump similar to healthy women, but they exhibit joint moments that could predispose them to future injury if they participate in sports that require jumping and landing.

Total head excursion and resting head posture: Normal and patient comparisons

OBJECTIVE To determine whether significant differences existed between normal and patient groups on three postural measurements: anterior-posterior total head excursion (THE), resting head posture in sitting (RHPsit), and resting head posture in standing (RHPstd). SUBJECTS Forty-two healthy subjects, 13 men and 29 women between the ages of 20 and 60 years, were matched to 42 patients according to gender and age. DESIGN Measurements of THE, RHPsit, and RHPstd were taken for each subject. Patients were measured during their initial evaluation and had neck pain as a primary or secondary complaint. RESULTS A two-way multivariate analysis of variance followed by two-way analyses of variance showed that normal subjects had a significantly (p<.05) greater THE than did the patients and that men (patients and controls) scored significantly higher (p<.05) than women (patients and controls) on both THE and RHPstd. CONCLUSION Clinical assessment of patients with cervical pain should focus on cervical mobility rather than resting head posture. Head/neck posture is different for males and females and they should not be judged by the same standard.

Psychometric Properties of the Berg Balance Scale in a Community-dwelling Elderly Resident Population in Taiwan

BACKGROUND/PURPOSE To investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) and identify the most challenging items of the Berg Balance Scale (BBS) for elderly people living in the community. METHODS A total of 268 community-dwelling adults 65 years of age or older volunteered to participate in this study. Each subjects performance was assessed with the BBS, timed up and go (TUG) test, and usual gait speed. For testing interrater reliability, the other 68 community-dwelling older adults who met the criteria were also recruited. RESULTS The BBS demonstrated good internal consistency reliability (Cronbachs alpha = 0.77), good interrater reliability (ICC(2,1) = 0.87), and moderate correlation with the TUG and usual gait speed (Spearmans rho = -0.53 and 0.46, respectively). The BBS score of the mobility/IADL (instrumented activities of daily living) able group was also significantly higher than that of the disabled group. Among all items on the BBS, tandem stance (item 13) and one-legged stance (item 14) were found to be the most challenging items for the subjects in the sample. CONCLUSION The results of this study suggest that the internal consistency reliability, interrater reliability, and construct validity of the BBS are adequate for measuring balance in community-dwelling older adults. Among all items in the BBS, the tandem stance and one-legged stance are the most challenging items. Further study of their applicability for screening use in the community is warranted.

Development and psychometric evaluation of the Flexilevel Scale of Shoulder Function.

Background. Existing measures of self‐reported shoulder function fail to measure effectively the full range of shoulder functioning. The classic approach for improving the reliability of a scale is adding items, but a scale with a substantial number of items imposes a large response burden on participants. A more efficient approach is to use modern psychometric methods to construct an adaptive scale in which patients respond only to items that are targeted at their level of shoulder function. Objectives. We developed a Flexilevel Scale of Shoulder Function (FLEX‐SF). This scale includes three testlets that target low, medium, and high shoulder function. Scores on the testlets were equated to a common mathematical metric. Design and Subjects. We developed an initial pool of 68 items. This pool was administered to 400 patients, and responses were calibrated using a rating scale model. Subsets of items were identified for an easy, medium difficulty, and hard testlet. Properties of the scale were evaluated in a 3‐month longitudinal study of 200 shoulder patients. Results. The FLEX‐SF exhibited high reliability at both the scale level (intraclass correlation coefficient [3,1] = 0.90) and specific trait levels. The validity of the FLEX‐SF was supported by its internal and external responsiveness (Guyatt responsiveness index = 1.12) and the pattern of its associations with other health status measures. Conclusions. The FLEX‐SF can be used as a primary endpoint in clinical trials even when there are relatively few people in each treatment group. The scale also has excellent properties for use in clinical settings tracking individual changes over time.

Physical performance: Differences in men and women with and without low back pain

OBJECTIVE To determine the extent to which there may be major differences in scores on a battery of physical performance tasks among men with nonspecific, mechanical low back pain (LBP), women with LBP, healthy men, and healthy women. DESIGN Case series survey. SETTING A referral-based orthopedic clinic. PATIENTS Thirty-three men and 46 women with LBP. Control Subjects: Twenty-one men and 25 women healthy controls. INTERVENTION Completion of six clinician-assessed physical performance tasks and self-report inventories. MAIN OUTCOME MEASURE Performance scores on distance walked in 5 minutes, 50-foot walk at fastest speed, repeated sit-to-stand, repeated trunk flexion, loaded forward reach, and the Sorensen fatigue tasks. RESULTS Discriminant function analysis revealed that the four groups of subjects performed the physical tasks significantly different in two major ways: (1) healthy control subjects outperformed LBP patients, irrespective of gender, on tasks involving trunk control, coordination, and stability while withstanding heavy or quickly changing loads on the spine; (2) men outperformed women, irrespective of patient or nonpatient status, on tasks involving anthropometric features of limb length. The findings provide guidance on reasonable performance expectations for men and women patients with LBP. Future studies of treatment effectiveness also will be able to assess physical performance change in terms of the intersection between standards set by the men and women healthy control subjects and those of men and women patients. However, whether a return to nonpatient status is an appropriate treatment goal is left to future research.

Functional activities characteristics of shoulder complex movements: Exploration with a 3-D electromagnetic measurement system.

The high prevalence of shoulder-related dysfunction has focused increased attention on functional activity assessment. This study (1) tested the reliability of three-dimensional shoulder complex movements during four functional tasks representing different levels of task difficulty, (2) characterized the four functional tasks, and (3) examined the relationships between age and shoulder movements. Twenty-five asymptomatic subjects, all veterans aged 30-82, performed the four functional tasks. Good within-session reliability was found (movement pattern: similarity index = 0.81 to 0.97, peak values: intraclass correlation coefficients = 0.88 to 0.99). The raising arm to overhead height task (hard task) placed the greatest demand on scapular motions and humeral elevation (p < 0.005). During the functional tasks, significant correlations existed between age and scapular tipping, humeral elevation, and scapular upward rotation (r = -0.62 to 0.50, p < 0.05). Correlation results indicated that elderly subjects have a greater potential for serratus anterior muscle weakness and shoulder capsule tightness.

The Effectiveness of CV-4 and Resting Position Techniques on Subjects with Tension-Type Headaches

AbstractTension-type headache (TTH) is a common reason for consulting a clinician. Manual therapies are being used in clinical settings to treat TTH with no documented research to validate their efficacy. This study investigated the effectiveness of CV-4 and resting position techniques on TTH sufferers. Sixty adults between the ages of 21 and 65 (x=36, SD=12) who were experiencing a TTH were randomly assigned to groups. Subjects in the first group received a 10-minute session wherein multiple still points were induced using the CV-4 craniosacral technique. Subjects in the second group were placed supine in a resting position with the head and neck positioned for ten minutes in the most comfortable points in the ranges of protraction-retraction and flexion-extension. Subjects in the third group received no treatment; they lay quietly for 10 minutes. Pain intensity and the affective component of pain were measured before and after the treatments using visual analog scales. To determine if significant differ...

Concurrent validity and reliability of two-dimensional video analysis of hip and knee joint motion during mechanical lifting.

Movement patterns used during mechanical lifting are usually assessed subjectively by clinicians as a stoop or squat based on visual estimation of joint motion and position. Two-dimensional (2D) video analysis has the potential to objectively measure joint motion during a mechanical lifting task. This study investigated concurrent validity, intrarater, interrater, and test-retest reliability of 2D video analysis using Dartfish software for the measurement of sagittal plane angles at the hip and knee during mechanical lifting. Fifteen healthy female participants (mean age 27.1 ± 7.1 years) were recruited to perform mechanical lifting on 2 separate test days. Concurrent validity was determined by comparing 2D derived hip and knee flexion angles to goniometric measures. Intrarater and interrater reliability of the 2D kinematic procedures was determined by using examiners with varying experience in the use of Dartfish software. Between-day test-retest reliability of hip and knee 2D kinematics during mechanical lifting was assessed. Concurrent validity of 2D angle analysis using Dartfish software was supported by high correlations (Pearson r ≥ 0.95) and nonsignificant differences between 2D and goniometric measures of sagittal plane hip and knee motion. Both intrarater and interrater reliability values of hip and knee flexion angles were excellent (ICC ≥ 0.91). ICCs for test-retest reliability were 0.79 and 0.91 for hip and knee flexion, respectively. These findings and the ease of data capture using this system provide support for the clinical utility of 2D video analysis to provide objective measures of movement patterns at the hip and knee during a dynamic functional task.