William Duquet

The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review

BackgroundThe assessment of outcomes from the patients perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability.MethodsA computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients.ResultsThe inter-observer reliability of the selection procedure was excellent (k = .86). Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT), the Functional Ankle Outcome Score (FAOS), the Foot and Ankle Disability Index (FADI) and the Functional Ankle Ability Measure (FAAM). The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88). Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all subscales. Responsiveness was demonstrated for the AJFAT, FADI and the FAAM. Only for the FAAM, a minimal clinical important difference (MCID) was presented.ConclusionThe FADI and the FAAM can be considered as the most appropriate, patient-assessed tools to quantify functional disabilities in patients with chronic ankle instability. The clinimetric qualities of the FAAM need to be further demonstrated in a specific population of patients with chronic ankle instability.

A Continuous Metabolic Syndrome Risk Score Utility for epidemiological analyses

This study was designed to validate a continuous metabolic syndrome risk score (cMSy) using the International Diabetes Federation risk factors (1). Increasing evidence supports using a cMSy instead of a binary definition for epidemiological analyses: 1 ) dichotomizing continuous outcome variables reduces statistical power (2); 2 ) cardiovascular risk is a progressive function of several metabolic syndrome (MSy) risk factors, eliminating the need to dichotomize these factors (3); and 3 ) cardiovascular and diabetes risk increase progressively with increasing numbers of MSy risk factors, eliminating the need to dichotomize …

Specific associations between types of physical activity and components of mental health.

Findings of previous studies suggest that the relationship between physical activity and mental health may change across different domains of physical activity, different dimensions of mental health, and different population subgroups. The present study examined associations between five types of physical activity with different contents: housework, leisure active transportation, biking to/from work, walking to/from work, and sports participation, and two dimensions of mental health: perceived stress and psychological distress, in 1919 participants aged 20-65 years, using the data from the Flemish Policy Research Centre Sport, Physical Activity and Health. Multiple logistic regression analyses were performed with the total sample, and with the sample stratified by gender, age, and occupational category. Further, separate models were used in the gender and age subgroups of each occupational category. Sports participation was the only type of physical activity inversely associated with both stress (OR=0.375; CI: 0.200-0.704) and distress (OR=0.480; CI: 0.253-0.910). Sports participation related to less distress in unemployed mid-aged adults, and to less stress in unemployed women, unemployed young adults, and young adults with blue-collar jobs. Housework was associated with more stress and more distress in women with blue-collar jobs. In young adults with white-collar jobs, however, an inverse association between housework and distress was found. Biking to and from work was associated with more stress in men with blue-collar jobs. Results invite consideration for the utility, and perhaps the necessity, of differentiated health recommendations for physical health and for mental health in different population subgroups.

Static and Dynamic Roentgenographic Analysis of Ankle Stability in Braced and Nonbraced Stable and Functionally Unstable Ankles

Patients suffering from functional ankle instability were selected based on a structured interview. Talar tilt was measured using supine ankle stress roentgenographs and standing talar tilt was measured using erect ankle stress roentgenographs. A digital roentgenocinematographic analysis of a 50° ankle sprain simulation was performed to measure dynamic talar tilt and inversion distance between two video images (inversion speed). A significant decrease in pathologic supine talar tilt in unstable ankles was found in the braced compared with the nonbraced situation (talar tilt 13.1° versus 4.8° with brace). The talar tilt with the brace after activity was still significantly lower than the initial value without the brace. The standing talar tilt of unstable ankles was shown to be significantly lower with the orthosis than without (standing talar tilt 16.6° versus 12.0° with brace). Roentgenocinematographic evaluation of ankle sprain simulation showed that the mean dynamic talar tilt during simulated sprain decreased significantly in the braced ankles compared with the nonbraced ankles (dynamic talar tilt 9.8° versus 6.4° braced). A significant decrease in the digital measurement of inversion distance (from 110.6 pixels to 92.4 pixels) was observed in the total sample of 39 ankles during the initial high-speed phase of the simulated sprain. The brace significantly slows down the inversion speed.

Dietary factors associated with obesity indicators and level of sports participation in Flemish adults: a cross-sectional study

BackgroundObesity develops when energy intake continuously exceeds energy expenditure, causing a fundamental chronic energy imbalance. Societal and behavioural changes over the last decades are held responsible for the considerable increase in sedentary lifestyles and inappropriate dietary patterns. The role of dietary fat and other dietary factors in the aetiology and maintenance of excess weight is controversial. The purposes of the present study were to investigate the dietary factors associated with body mass index (BMI) and waist circumference (WC), and to analyse whether dietary intake varies between subjects with different levels of sports participation.MethodsData for this cross-sectional study, including anthropometric measurements, 3-day diet diary and physical activity questionnaire, were collected by the Flemish Policy Research Centre Sport, Physical Activity and Health (SPAH) between October 2002 and April 2004. Results of 485 adult men and 362 women with plausible dietary records were analysed. Analyses of covariance were performed to determine the differences in dietary intake between normal weight, overweight and obese subjects, and between subjects with different levels of sports participation.ResultsTotal energy intake, protein and fat intake (kcal/day) were significantly higher in obese subjects compared to their lean counterparts in both genders. Percentage of energy intake from fat was significantly higher in obese men compared to men with normal weight or WC. Energy percentages from carbohydrates and fibres were negatively related to BMI and WC in men, whereas in women a higher carbohydrate and fibre intake was positively associated with obesity. Alcohol intake was positively associated with WC in men. Subjects participating in health related sports reported higher intake of carbohydrates, but lower intake of fat compared to subjects not participating in sports.ConclusionThis study supports the evidence that carbohydrate, fat, protein and fibre intake are closely related to BMI and WC. The sex differences for dietary intake between obese men and women might reflect the generally higher health consciousness of women. Alcohol intake was only associated with WC, emphasizing the importance of WC as an additional indicator in epidemiological studies. Besides enhancing sports and physical activity, it is necessary to improve the knowledge about nutrition and to promote the well-balanced consumption of wholesome food.

Socio-economic and lifestyle factors associated with overweight in Flemish adult men and women

BackgroundChanges in lifestyles and in the environment over the last decades are probably the most important cause of the overweight epidemic, but the findings are inconsistent among studies. The purpose of this study was to investigate the association of several socio-economic and lifestyle factors with overweight in Flemish adults, using BMI ≥ 25 kg/m2, waist circumference (WC) ≥ 94 cm (men) or ≥ 80 cm (women) and the combination of BMI and WC for identifying overweight.MethodsThis cross-sectional epidemiological study was conducted by the Flemish Policy Research Centre Sport, Physical Activity and Health between October 2002 and February 2004 in 46 Flemish communities. A total of 4903 Flemish adults (2595 men and 2308 women), aged 18 to 75 years, from a population-based random sample were included in the analysis. Body weight, height and WC were measured, and socio-economic and lifestyle factors were reported by means of validated questionnaires.ResultsThe results of the logistic regressions revealed that age is positively associated with overweight in both genders. Alcohol consumption is associated with overweight only in men. Men smoking in the past and watching TV >11 h/week have significantly higher ORs for overweight, while men who participate in health related sports >4 h/week have significantly lower ORs for overweight. In women, watching TV >9 h/week was positively associated with overweight. Women who are current smokers or participate in health related sports >2.5 h/week or with a higher educational level have significantly lower odds for overweight. Different results are observed between the first (BMI) and the second model (WC) in both genders. In men, the models differ for education and health related sports, while in women they differ for smoking status and leisure time physical activity.ConclusionThe present study confirms the contention that overweight is a multifactorial problem. Age and TV viewing are positively associated with overweight, while educational level and health related sports are negatively related to overweight in both genders. In men, alcohol consumption and smoking in the past are also among the lifestyle factors associated with overweight. This study also indicates that BMI and WC do not have the same discriminative function regarding different lifestyle factors.

Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy

OBJECTIVE To study the endogenous sex hormone levels in natural postmenopausal women and their association with the presence of internal carotid artery (ICA) atherosclerosis. DESIGN Case-control study METHODS We compared 56 patients with severe ICA atherosclerosis referred for carotid artery endarterectomy (CEA) with 56 age-matched control subjects free of severe atherosclerotic disease. The presence of atherosclerosis was determined by high-resolution B-mode ultrasound. Metabolic parameters and sex hormones were measured or calculated: total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, quantitative insulin sensitivity check index, insulin resistance index, IGF-I, DHEA, DHEA sulfate (DHEA-S), free testosterone, total testosterone, estrone, estradiol, androstenedione, and sex hormone-binding globulin. RESULTS The cases had statistically significant lower levels of both total testosterone (0.23 +/- 0.12 vs 0.31 +/- 0.20 microg/l, P = 0.043) and free testosterone (3.42 +/- 1.94 vs 4.59 +/- 2.97 ng/l, P = 0.009) and significantly lower levels of androstenedione (625.3 +/- 168.7 vs 697.0 +/- 211.9 ng/l, P = 0.017) when compared with controls. Multivariate linear regression analysis, adjusted for traditional cardiovascular risk factors, baseline and physiologic characteristics, showed a significant inverse relationship between both serum free testosterone (beta = -0.234, P = 0.028) and androstenedione (beta = -0.241, P = 0.028) levels with the presence of severe atherosclerosis of ICA. CONCLUSIONS The study provides evidence of a positive association between low serum androgen levels and severe ICA atherosclerosis in postmenopausal women. It suggests that higher, but physiological, levels of androgens in postmenopausal women have a protective role in the development of atherosclerosis of ICA.

Reproducibility of postural control measurement during unstable sitting in low back pain patients

BackgroundPostural control tests like standing and sitting stabilometry are widely used to evaluate neuromuscular control related to trunk balance in low back pain patients. Chronic low back pain patients have lesser postural control compared to healthy subjects. Few studies have assessed the reproducibility of the centre of pressure deviations and to our knowledge no studies have investigated the reproducibility of three-dimensional kinematics of postural control tests in a low back pain population. Therefore the aim of this study was to assess the test-retest reproducibility of a seated postural control test in low back pain patients.MethodsPostural control in low back pain patients was registered by a three dimensional motion analysis system combined with a force plate. Sixteen chronic low back pain patients having complaints for at least six months, were included based on specific clinical criteria. Every subject performed 4 postural control tests. Every test was repeated 4 times and lasted 40 seconds. The force plate registered the deviations of the centre of pressure. A Vicon-612-datastation, equipped with 7 infra-red M1 cameras, was used to track 13 markers attached to the torso and pelvis in order to estimate their angular displacement in the 3 cardinal planes.ResultsAll Intraclass Correlation Coefficients (ICC) calculated for the force plate variables did not exceed 0.73 (ranging between 0.11 and 0.73). As for the torso, ICCs of the mean flexion-extension and rotation angles ranged from 0.65 to 0.93 and of the mean lateral flexion angle from 0.50 to 0.67. For the pelvis the ICC of the mean flexion-extension angle varied between 0.66 and 0.83, the mean lateral flexion angle between 0.16 and 0.81 and the mean rotation angle between 0.40 and 0.62.Consecutive data suggest that the low test-retest reproducibility is probably due to a learning effect.ConclusionThe test-retest reproducibility of these postural control tests in an unstable sitting position can globally be considered as rather moderate. In order to improve the test-retest reproducibility, a learning period may be advisable at the beginning of the test.

Functional Performance Deficits in Patients With Cai: Validity of the Multiple Hop Test

Objectives:To investigate the reliability and validity of a functional performance test in patients with chronic ankle instability (CAI). Design:Cross-sectional study. Setting:All tests were conducted in the practice room of the physical therapy department of the Vrije Universiteit Brussel. Participants:Twenty-nine healthy subjects and 29 patients with CAI were selected. For the main outcome measurements, participants performed a multiple hop test two times, within a 1-week time interval. Subjects hopped on 10 different tape markers and had to try to avoid making any postural correction. Only when subjects stood still were they allowed to continue hopping. The time needed to complete the test and VAS scores for the perceived difficulty were assessed. Results:In unstable ankles, ICCs of time values were >0.90 (SEM = 2.3 seconds); Spearman rho values of VAS scores were >0.80. When hopping on their unstable ankles, patients (41.1 ± 12.6 seconds) needed significantly more time to complete the test than healthy subjects (31.4 ± 5.0 seconds; test: P = 0.000; retest: P = 0.002) or when compared with their unaffected contralateral ankles (38.0 ± 7.1 seconds; test: P = 0.047; retest: P = 0.009). Only with respect to the dominant ankles, patients (median = 64 mm) perceived the test as significantly more difficult than did healthy subjects (median = 37 mm; test: P = 0.018; retest: P = 0.002). VAS scores of unstable ankles in patients (median = 50 mm) were significantly higher than their contralateral, unaffected ankles (median = 30 mm; test: P = 0.001; retest: P = 0.002). Conclusions:The multiple hop test is a reliable test demonstrating functional performance deficits in patients with CAI.

Reliability and discriminative validity of sudden ankle inversion measurements in patients with chronic ankle instability.

BACKGROUND Studies investigating peroneal muscle reaction times in chronically unstable ankle joints present conflicting results. The degree of reliability and accuracy of these measurements is unknown in patients with chronic ankle instability (CAI). METHODS 40 patients with CAI and 30 healthy subjects were tested using a sudden ankle inversion of 50 degrees while standing on a trapdoor device. Sudden ankle inversion measurements were registered using electromyography, accelerometry and electrogoniometry. For reliability testing, intra-class coefficients (ICCs; model 3,1) and standard errors of measurements of the latency time, motor response time and electromechanical delay of the peroneus longus muscle, the time and angular position of onset of decelerations, the mean and maximum inversion speed and the total inversion time were calculated in 15 patients with CAI. To assess between-group differences, t-tests for independent samples (p<.05) were used. RESULTS ICCs ranged from .20 (angular position of onset of the second deceleration) to .98 (electromechanical delay of the peroneus longus muscle). Significant between-group differences were observed in only 2 of the 12 variables (for the electromechanical delay of the peroneus longus muscle, p=.001; time of onset of the second deceleration, p=.040). CONCLUSIONS The latency time and motor response time of the peroneus longus muscle, the total inversion time and the mean inversion speed demonstrate acceptable reliability in healthy subjects and patients. The latency time and motor response time of the peroneus longus muscle are not delayed in patients with CAI. Ankle inversion measurements are not discriminative for CAI.