Stefano Vercelli

Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and Its Shortened Version (QuickDASH)

STUDY DESIGN Prospective, single-group observational design. OBJECTIVES To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches. BACKGROUND Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process. METHODS The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale. RESULTS The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH. CONCLUSION The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.

How to assess postsurgical scars: A review of outcome measures

Purpose. Complications of surgical incision include pathological scars with functional, cosmetic or psychological consequences. Postsurgical scar assessment is fundamental for a complete functional evaluation and as an outcome measure. Scar assessment scales are here reviewed and discussed from a clinical and psychometric point of view, with a clear definition of different scar parameters. Method. An extensive review of the English-language literature was conducted using the Medline database. Results. Four scales that satisfy psychometrical criteria were identified: Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), Manchester Scar Scale (MSS) and Stony Brook Scar Evaluation Scale (SBSES). Conclusions. To date, VSS is the most widely used rating scale for scars but POSAS appears the most comprehensive, taking into account the important aspect of patients perspective. The MSS has been never used for research, while SBSES has only been very recently proposed.

Immediate effects of kinesiotaping on quadriceps muscle strength: a single-blind, placebo-controlled crossover trial.

Objective:To investigate the immediate effects on maximal muscle strength of kinesiotaping (KT) applied to the dominant quadriceps of healthy subjects. Design:Single-blind, placebo-controlled crossover trial. Setting:“Salvatore Maugeri” Foundation. Participants:With ethical approval and informed consent, a convenience sample of 36 healthy volunteers were recruited. Two subjects did not complete the sessions and were excluded from the analysis. Interventions:Subjects were tested across 3 different sessions, randomly receiving 2 experimental KT conditions applied with the aim of enhancing and inhibiting muscle strength and a sham KT application. Main Outcome Measures:Quadriceps muscle strength was measured by means of an isokinetic maximal test performed at 60 and 180 degrees per second. Two secondary outcome measures were performed: the single-leg triple hop for distance to measure limb performance and the Global Rating of Change Scale (GRCS) to calculate agreement between KT application and subjective perception of strength. Results:Compared with baseline, none of the 3 taping conditions showed a significant change in muscle strength and performance (all P > 0.05). Effect size was very low under all conditions (⩽0.08). Very few subjects showed an individual change greater than the minimal detectable change. Global Rating of Change Scale scores demonstrated low to moderate agreement with the type of KT applied, but some placebo effects were reported independently of condition. Conclusions:Our findings indicated no significant effect in the maximal quadriceps strength immediately after the application of inhibition, facilitation, or sham KT. These results do not support the use of KT applied in this way to change maximal muscle strength in healthy people.

Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review.

The aim of this study was to review and critically assess the most used and clinimetrically sound outcome measures currently available for postsurgical scar assessment in rehabilitation. We performed a systematic review of the Medline and Embase databases to June 2015. All published peer-reviewed studies referring to the development, validation, or clinical use of scales or questionnaires in patients with linear scars were screened. Of 922 articles initially identified in the literature search, 48 full-text articles were retrieved for assessment. Of these, 16 fulfilled the inclusion criteria for data collection. Data were collected pertaining to instrument item domains, validity, reliability, and Rasch analysis. The eight outcome measures identified were as follows: Vancouver Scar Scale, Dermatology Life Quality Index, Manchester Scar Scale, Patient and Observer Scar Assessment Scale, Bock Quality of Life (Bock QoL) questionnaire, Stony Brook Scar Evaluation Scale, Patient-Reported Impact of Scars Measure, and Patient Scar Assessment Questionnaire. Scales were examined for their clinimetric properties, and recommendations for their clinical or research use and selection were made. There is currently no absolute gold standard to be used in rehabilitation for the assessment of postsurgical scars, although the Patient and Observer Scar Assessment Scale and the Patient-Reported Impact of Scars Measure emerged as the most robust scales.

How much is Kinesio taping a psychological crutch

We read with interest the paper by Lins et al. (2012) regarding the immediate effects of the application of Kinesio Taping (KT) on the neuromuscular performance of quadriceps. The authors stated that KT was not capable of altering lower limb muscle strength or function in healthy women, confirming the results of another recent study (Wong et al., 2012). Shortly before the acceptance of these papers we published a placebo-controlled trial (Vercelli et al., 2012) comparing the effects of two KT conditions (applied with the aim of enhancing or inhibiting muscle strength, respectively) and a placebo KT application on the quadriceps of 36 healthy subjects. The main outcome measures were concentric peak knee extensor torque at 60 and 180 /sec, and single-leg triple hop for distance. No significant differences between baseline and KT application were observed, regardless of the type or direction of tape application. Such findings are perfectly in line with those more recently reported by Lins et al. (2012) and Wong et al. (2012), and confirm the lack of evidence on this topic. It should also be stressed that, to date, the mechanisms by which KT application might conceivably increase muscular strength have not been fully elucidated or confirmed (Lins et al., 2012). In the absence of an observed change in physiological or performance variables, however, our secondary exploratory analysis revealed that participants’ subjective perception of strength increased, irrespective of the KT condition. In a post-experiment interview in which we asked our subjects if they felt stronger, unchanged, or weaker after tape application, about 45% declared that they felt stronger after experimental KT (regardless of whether the technique was facilitating or inhibiting), while this percentage was about 30% after placebo application. Placebos could have specific effects on both objective (e.g. muscle power or strength, heart rate, running speed, jump height or length) and subjective (e.g. perceived exertion, internal states, feelings of wellbeing and safety) variables (Berdi et al., 2011). In a recent meta-analysis of the evidence for KT effectiveness in treatment and prevention of sports injuries, the placebo effects on objective variables showed conflicting results, but the types of tape used as placebo and their application in the different papers were not standardized (Williams et al., 2012). To our knowledge, our study is the first analyzing the placebo effects of KT on a subjective variable (perceived strength), similar results having been previously reported for non-elastic taping in ankle instability (Sawkins et al.,

Validation of a New Device to Measure Postsurgical Scar Adherence

Background and Purpose Scarring after surgery can lead to a wide range of disorders. At present, the degree of scar adhesion is assessed manually and by ordinal scales. This article describes a new device (the Adheremeter) to measure scar adhesion and assesses its validity, reliability, and sensitivity to change. Design This was a reliability and validity study. Setting The study was conducted at the Scientific Institute of Veruno. Participants and Methods Two independent raters, a physical therapist and a physical therapist student, used the Adheremeter to measure scar mobility and contralateral normal skin in a sample of 25 patients with adherent postsurgical scars before (T1) and after (T2) physical therapy. Two indexes of scar mobility, the adherences surface mobility index (SMA) and the adherence severity index (AS), were calculated. Their correlation with the Vancouver Scar Scale (VSS) and its pliability subscale (PL-VSS) was assessed for the validity analysis. Results Both the SMA and the AS showed good-to-excellent intrarater reliability (intraclass correlation coefficient [ICC]=.96) and interrater reliability (SMA: ICC=.97 and .99; AS: ICC=.87 and .87, respectively, at T1 and T2), correlated moderately with the VSS and PL-VSS only at T1 (rs=−.58 to −.66), and were able to detect changes (physical therapist/physical therapist student): z score=−4.09/−3.88 for the SMA and −4.32/−4.24 for the AS; effect size=0.6/0.4 for the SMA and 1.4/1.2 for the AS; standard error of measurement=4.59/4.79 mm2 for the SMA and 0.05/0.06 for the AS; and minimum detectable change=12.68/13.23 mm2 for the SMA and 0.14/0.17 for the AS. Limitations The measurement is based on the raters evaluation of force to stretch the skin and on the patients judgment of comfort. Discussion and Conclusions The Adheremeter showed a good level of reliability, validity, and sensitivity to change. Further studies are needed to confirm these results in larger cohorts and to assess the devices validity for other types of scars.

The Mini-BESTest: a review of psychometric properties.

The Mini-Balance Evaluation Systems Test (Mini-BESTest) has been identified as the most comprehensive balance measure for community-dwelling adults and elderly individuals. It can be used to assess balance impairments in several other conditions, mainly Parkinson’s disease and stroke. Despite increasing use of the Mini-BESTest since it was first published 5 years ago, no systematic review synthesizing its psychometric properties is available. The aim of this study was to provide a comprehensive review of the psychometric properties of the Mini-BESTest when administered to patients with balance deficits because of different diseases. A literature search was performed on articles published before July 2015 in journals indexed by MEDLINE and Scopus databases. The search produced 98 papers, 24 of which fulfilled the inclusion criteria for this review. Most papers (n=19) focused on patients affected by neurological diseases, mainly Parkinson’s disease. In 21 papers, the psychometric characteristics were analyzed using Classical Test Theory methods and in only three papers was Rasch analysis carried out. This review shows the interest of researchers in the Mini-BESTest despite the short time frame since its first publication. The Mini-BESTest is used widely in both clinical practice and research. The results support the reliability, validity, and responsiveness of this instrument and it can be considered a standard balance measure. However, it would be valuable to learn more about how this scale performs in different diseases causing balance deficits and to better define the minimal clinically important difference for each disease.

Accelerometer- and Photographic-Based Smartphone Applications for Measuring Joint Angle: Are They Reliable?

We read the article by Jenny [1] with great interest and agree that computer assisted measurement of joint angles using digital imaging, even though shown to be valid, could be too time consuming to be used on a routine basis (e.g. due to the necessity to transfer data from camera to personal computer). This disadvantage can be overcome by smartphones that are all-in-one instruments having computer-like functionality and an integrated digital camera as well as sensors as accelerometers. To date there are two kinds of software available for smartphones to measure joint angles: accelerometerand photographic-based applications. The first kind uses the built-in accelerometers of the mobile phone to measure the inclination of the device and thereby calculate angles. The second kind (photographic-based) does the measurement by positioning a virtual goniometer, visible on the smartphone screen, on a photograph obtained via the smartphone camera (Fig. 1). The article written by Jenny [1] was aimed to assess the agreement between a free accelerometer-based application – Angle, Smudge Apps – and a navigation system designed for total knee arthroplasty, in knee joint measurement. Observing the figure 5 of the paper, the twomethods seem to show a range of the limits of agreement (i.e. the interval of two standard deviations of the measurement differences either side of the mean difference) of 27.4° (−15.8°/+11.6°). Similarly, Hambly et al [2] and Ockendon and Gilbert [3] assessed the level of agreement between another accelerometer-based smartphone application – Knee Goniometer, Ockendon.net – and a long arm goniometer. In the measurement of the maximum active knee flexion (120–145°) the range was 7.01° (−2.13°/+4.88°) [2], while at knee angles between 5 and 45° of flexion the range was 15.2° (−8°/+7.2°) [3]. Recently, our group published two papers on the reliability of a photographic-based application –DrGoniometer, CDM S.r.L. – in the angle measurement of elbow [4] and knee [5]. The range of the limits The Journal of Arthroplasty 29 (2014) 448–451

Has the Italian Academia Missed an Opportunity

In universities around the world, physical therapist experts with a scientific background are appointed as professors of physical therapy. In the Italian academia, however, only 2 physical therapists have been appointed as professors in the academic sector known as “Sciences of nursing, rehabilitation and neuropsychiatric techniques” (MED/48).1 A total of 85 university programs of physical therapy are being taught in Italy, and thousands of credits are entrusted to physical therapists—yet most of these therapists are not officially part of the Italian academic world. In 2010, there was an expectation that this situation would change when the Italian Ministry of Education, University and Research (MIUR) introduced a new process for the appointment of Italian university professors.2 The first step of this new process (started in 2012) is national qualification for each scientific sector, with qualification awarded by specific commissions on the basis of the applicants educational and research productivity. Only researchers who are qualified by one of these commissions are subsequently permitted to participate in the second step for becoming an Italian university professor: a competitive examination issued locally by each university. Italian physical therapists had great hope for this new process, because a growing number of physical therapists in Italy are involved in scientific activities and publish in indexed journals.3 In 2010, …

Hematuria in a runner after treatment with whole body vibration: A case report

The use of whole body vibration (WBV) for therapeutic purposes is far from being standardized and the training protocols reported in the literature vary considerably. Currently, the optimal threshold for a beneficial effect is undetermined, and caution regarding potential health risks due to WBV is always necessary. In this case report, we present a 34‐year‐old otherwise healthy elite athlete (steeplechase runner) who suffered two episodes of hematuria (HT) after WBV training. Shortly after the third WBV, he had an episode of bright red urine. Seven days later, following the next WBV session (and again before his daily running session), a reddish‐colored urine reappeared. Our patient was advised to stop WBV training and to take fluid before and during exertion. He did not experience any episode of HT during a 1‐year follow‐up with periodic check‐ups, in spite of the continuation of his sporting career. The concomitance of the two types of trauma – daily running and WBV – could have been critical in this case for producing HT. In particular, we think that platforms providing side‐alternating vibration (such as the Galileo platform) may pose some health risks if the feet are positioned too far from the axis of rotation.