William D. Bandy

Intrarater Reliability of CROM Measurement of Cervical Spine Active Range of Motion in Persons With and Without Neck Pain

STUDY DESIGN Clinical measurement, intrarater reliability study. OBJECTIVES To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM). BACKGROUND Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM. METHODS AND MEASURES Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized. RESULTS The intraclass correlation coefficients (ICC3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees . The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees . Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain. CONCLUSION Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred.

Serial casting vs combined intervention with botulinum toxin A and serial casting in the treatment of spastic equinus in children.

Purpose Serial casting has been an effective tool used by physical therapists to increase ankle dorsiflexion range of motion and improve functional gait. The purpose of this retrospective study was to determine whether injection with botulinum toxin type A (BtA) before serial casting vs serial casting alone was associated with any changes in (1) the number of weeks necessary to reach the desired dorsiflexion range of motion and (2) the number of degrees of dorsiflexion range of motion gained per week of casting. Method Data were obtained through review of records maintained on patients undergoing serial casting. Thirty subjects comprised the two groups of 15 patients each. One group had received BtA before serial casting while the other group had received no BtA before serial casting. Data were analyzed using two t tests to determine whether there were significant differences, and the appropriate statistical adjustment (Bonferroni) was applied. Results Fewer weeks were required to reach the goal of 15 to 20 degrees of ankle dorsiflexion (or plateau) for the group receiving BtA than for the group that did not receive BtA. Results also indicated that the group receiving BtA had a significantly greater increase in range of motion per week than the group that received no BtA. Conclusions Using serial casting in conjunction with BtA may achieve range of motion goals in less time than serial casting alone.

Intrarater reliability of 1 repetition maximum estimation in determining shoulder internal rotation muscle strength performance.

The purpose of this study was to determine intrarater reliability of the 1 repetition maximum (1RM) estimation for shoulder internal rotation. The accuracy of the estimated 1RM was determined by establishing the actual 1RM. Fifteen subjects were positioned supine with the shoulder in 08 abduction (position 1) and prone with the shoulder in 908 abduction (position 2). Subjects were placed in both testing positions and performed resisted shoulder internal rotation. A 1RM estimation equation was used to estimate shoulder internal rotation strength. After 1 week, procedures were repeated and intrarater reliability was calculated. One week after 1RM estimation procedures were completed, the accuracy of an estimated 1RM was determined by establishing an actual 1RM. The results indicated excellent intrarater reliability for position 1 (intraclass correlation coefficient [ICC] = 0.99) and position 2 (ICC = 0.96). The correlation coefficients for accuracy indicated excellent concurrent validation was attained for position 1 (ICC = 0.99) and position 2 (ICC = 0.97). Shoulder internal rotation 1RM estimation appears to be reliable and accurate. Clinicians may use submaximal loads to estimate the 1RM and decrease the possibility of injury during actual 1RM strength testing.

Traumatic Dislocation of the Hip in a High School Football Player

Background: Although traumatic dislocation of the hip often occurs as a result of automobile accidents, dislocations have been reported to occur during sports activities. Objective: Using the experience in treating a 17-year-old high school football player with a posterior dislocation, complicated by involvement of the sciatic nerve, this case report provides background information on hip dislocations and provides a description of the immediate treatment by the physician, followed by 6 weeks of immobilization, and a detailed account of the 5-month intervention. Case Description: The patient was injured while making a tackle during a high school football game when another player fell on him from behind. The case report describes his plan of care after immediate hip reduction surgery and 6 weeks on crutches. Generally, the program utilized a progression of non–weight-bearing resistance training and stretching in the initial stages of intervention and progressed to weight-bearing activities (on land and in the pool) as the patient was able to tolerate more stress. In addition, the treatment of the sciatic nerve using electrical stimulation during treadmill walking is described. Outcomes: The patient was seen in an outpatient physical therapy clinic an average of 2 times per week for 5 months. At the end of 5 months, results of the Lower Extremity Functional Scale (LEFS) indicated that recreational and sporting activities were within normal limits, and the patient was able to return to playing on his high school football team the next year.

Test retest reliability and minimal detectable change of a novel submaximal graded exercise test in the measurement of graded exercise test duration.

Taylor, JD, Bandy, WD, and Whittemore, JD. Test-retest reliability and minimal detectable change of a novel submaximal graded exercise test in the measurement of graded exercise test duration. J Strength Cond Res 25(5): 1465-1469, 2011-Measurement of graded exercise test duration is clinically important and can be assessed by maximal graded exercise testing. Yet, limitations of maximal graded exercise testing exist. An alternative to maximal graded exercise testing is submaximal graded exercise testing. However, no studies have investigated the reliability of a submaximal graded exercise test in the measurement of graded exercise test duration. The purpose of this study was to determine the test-retest reliability and minimal detectable change (MDC) of a novel submaximal graded exercise test in the measurement of graded exercise test duration. Fifteen people (4 men, 11 women) with a mean age of 26.20 years (SD = 9.04) participated in this study. A novel submaximal graded exercise test was used to measure graded exercise test duration for each participant. Endpoints of the test were either 85% of age-predicted maximum heart rate or voluntarily stopping the test, whichever endpoint occurred first. Heart rate and graded exercise test duration were constantly measured throughout the test. Graded exercise test duration was defined as the total duration (minutes) of the test. For all participants, the submaximal graded exercise test was conducted at baseline and 48-72 hours thereafter. The intraclass correlation coefficient for the test-retest reliability of the test in determining graded exercise test duration was 0.94 (95% CI = 0.83-0.98). The MDC of the test in the measurement of graded exercise test duration was 0.86 minutes. The results suggest that clinicians can use this novel submaximal graded exercise test to reliably measure graded exercise test duration with a measurement error, as expressed by the MDC, of 0.86 minutes.

Strapped versus unstrapped technique of the prone press-up for measurement of lumbar extension using a tape measure: differences in magnitude and reliability of measurements11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

OBJECTIVES To determine (1) the reliability of the prone press-up to measure lumbar extension using a strap and not using a strap to control pelvic movement in experienced clinicians and students and (2) if a difference exists between the magnitude of lumbar extension range of motion between the strapped and unstrapped condition. DESIGN Prospective study. SETTING Academic laboratory. PARTICIPANTS Convenience sample of 63 unimpaired volunteers (mean age +/- standard deviation, 25.95+/-5.75 y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Lumbar extension was measured in the prone position by using a tape measure to measure the perpendicular distance of the sternal notch to the support surface while using a strap and not using a strap to control pelvic movement. All measurements were performed independently by 2 groups of examiners (1 experienced group, 1 student group) and repeated to determine intrarater and interrater reliabilities. RESULTS Intrarater and interrater reliability were good or excellent for all methods and all measurement group comparisons (intraclass correlation coefficient range, .82-.91). Additionally, the amount of lumbar extension, as measured by the prone press-up, during the strapped condition was significantly greater than with the unstrapped condition. CONCLUSION Use of a tape measure while the subject performs a prone press-up appears to be a reliable method for the measurement of lumbar extension. This technique is reliable whether the examiner is experienced or inexperienced and whether or not the subject has the pelvis secured with a strap.

Het effect van statische rek en dynamische training van de bewegingsuitslag op de elasticiteit van de hamstrings

Tot op heden is er nog maar weinig informatie over een betrekkelijk nieuwe rektechniek, ‘dynamische range of motion’ (drom), beschreven. Doel van dit onderzoek was het vergelijken van de effecten van drom en statische rek op de elasticiteit van de hamstrings.