The Examination of Patient-Reported Outcomes and Postural Control Measures in Patients With and Without a History of ACL Reconstruction: A Case Control Study

2018 ◽  
Vol 27 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Johanna M. Hoch ◽  
Cori W. Sinnott ◽  
Kendall P. Robinson ◽  
William O. Perkins ◽  
Jonathan W. Hartman
Keyword(s):  
Postural Control ◽  
Diagnostic Accuracy ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Force Plate ◽  
Area Under The Curve ◽  
Case Control ◽  
Control Measures ◽  
Balance Test ◽  
Patient Reported

Context: There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. Objective: To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. Design: Case control. Setting: Laboratory. Participants: A total of 20 post-ACLR and 40 healthy control participants. Main Outcome Measures: The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. Results: There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. Conclusions: Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.

Influence of Foot Type and Orthotics on Static and Dynamic Postural Control

2004 ◽  
Vol 13 (1) ◽  
pp. 54-66 ◽  
Author(s):  
Lauren C. Olmsted ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Athletic Training ◽  
Outcome Measures ◽  
Repeated Measures ◽  
Center Of Pressure ◽  
Group Interaction ◽  
Force Plate ◽  
Balance Test ◽  
Repeated Measures Design ◽  
Plate Dynamic

Context:The effects of custom-molded foot orthotics on neuromuscular processes are not clearly understood.Objective:To examine these effects on postural control in subjects with different foot types.Design:Between-groups, repeated-measures design.Setting:Athletic training laboratory.Subjects:30 healthy subjects assigned to groups by foot type: planus (n = 11), rectus (n = 12), or cavus (n = 7).Interventions:Custom-fit semirigid orthotics.Main Outcome Measures:Static postural control was measured on a force plate. Dynamic postural control was measured using the Star Excursion Balance Test. Both measurements were assessed with and without orthotics at baseline and 2 weeks later.Results:For static postural control, a significant condition-by-group interaction was found. Subjects with cavus feet had a decreased center-of-pressure velocity while wearing orthotics. For dynamic postural control, a significant condition-by-direction-by-group interaction was found. Subjects with cavus feet had increased reach distances in 3 of 8 directions while wearing orthotics.Conclusions:Custom orthotics were associated with some improvements in static and dynamic postural control in subjects with cavus feet.

The Effect of Trial Duration on Single-Limb Stance Postural Control Measures

2014 ◽  
Vol 19 (4) ◽  
pp. 32-37 ◽  
Author(s):  
Cameron Powden ◽  
Matthew Hoch
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Force Plate ◽  
Healthy Adults ◽  
Control Measures ◽  
Practice Trial ◽  
Trial Duration ◽  
Cross Sectional ◽  
Eyes Open ◽  
Main Effects

Context:Currently, there are limited guidelines for the trial duration of quiet single-limb postural control tests. However, trial duration may influence the results of postural control assessments.Objective:To examine the effect of trial duration on instrumented measures of postural control in healthy adults.Design:Cross-sectional.Setting:Laboratory.Patients or Other Participants:Ten healthy adults (eight females, two males; age = 22.1 ± 1.5 years; 167.4 ± 9.3 cm; 67.4 ± 12.3 kg).Interventions:Static postural control was assessed using quiet single-limb stance on a force plate. With eyes open and closed, participants stood barefoot on one limb. Instructions were stand with hands on hips and remain as motionless as possible. A practice trial was performed before the collection of three 10 s trials on each limb for each visual condition. The data collected during each trial were analyzed as the initial 2.5 s, the initial 5 s, and 10 s.Main outcome Measures:The independent variables included vision, limb, and trial duration. The dependent variables included postural control examined using time-to-boundary (TTB) variables: mean of TTB minima (TTB-M) and the standard deviation of TTB minima (TTB-SD) in the anterior-posterior (AP) and medial-lateral (ML) directions.Results:No significant 3-way or 2-way interactions or limb main effects were identified. Main effects were identified for vision and trial duration in all TTB variables. Post hoc analysis revealed significant differences between all trial durations in all TTB variables.conclusions:Greater TTB values were exhibited during the 10 s trial durations compared with 5 s and 2.5 s, and 5 s trial durations compared with 2.5 s, indicating postural control improved with longer trial durations. This suggests differing aspects of postural control may be examined with different trial durations.

The Effects of Gender and Fatigue on Dynamic Postural Control

2009 ◽  
Vol 18 (2) ◽  
pp. 240-257 ◽  
Author(s):  
Phillip A. Gribble ◽  
Richard H. Robinson ◽  
Jay Hertel ◽  
Craig R. Denegar
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Performance Measures ◽  
Knee Flexion ◽  
Mixed Model ◽  
Sagittal Plane ◽  
Model Design ◽  
Balance Test ◽  
Before And After ◽  
And Gender

Context:Deficits in static postural control related to fatigue have been investigated previously, but there is little evidence to link fatigue to performance measures of dynamic postural control.Objective:To investigate the effects of fatigue and gender on performance measures of the Star Excursion Balance Test (SEBT).Design:Mixed-model design.Setting:Research laboratory.Participants:16 healthy young adults.Intervention:Subjects performed the SEBT before and after 4 different fatiguing conditions.Main Outcome Measures:The normalized reach distances and sagittal-plane kinematics of the knee and hip were recorded.Results:Fatigue produced deficits in normalized reach distances and decreased knee flexion in all 3 reaching directions. Overall, women were able to reach farther than men while simultaneously demonstrating a greater amount of knee flexion.Conclusions:Gender differences were observed during performance of the SEBT, with women demonstrating greater reach distances and knee flexion, and fatigue amplified these differences.

The Effect of Textured Insoles on Postural Control in Double and Single Limb Stance

2007 ◽  
Vol 16 (4) ◽  
pp. 363-372 ◽  
Author(s):  
Dawn M. Corbin ◽  
Joseph M. Hart ◽  
Patrick O. McKeon ◽  
Christopher D. Ingersoll ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Healthy Subjects ◽  
Crossover Trial ◽  
Center Of Pressure ◽  
Control Measures ◽  
Eyes Closed ◽  
Type Design ◽  
Afferent Information ◽  
Balance Trials

Context:Increased plantar cutaneous afferent information may improve postural control.Objective:To compare postural control measures between balance conditions with and without textured insoles.Design:crossover trial.Setting:Research Laboratory.Patients or Other Participants:33 healthy subjects (27.4 ± 9.1yrs, 172.6 ± 10.3 cm, 75.4 ± 16.4 kg).Intervention(s):Subjects performed 24, 10-second bipedal and unilateral stance balance trials with eyes opened and eyes closed, with and without a textured insole in subjects’ shoes.Main Outcome Measures:Average velocity and area of center of pressure (COP) excursions.Results:We observed an interaction among balance conditions during bilateral stance, but not during unilateral stance. On average, subjects exhibited greater area and velocity of COP excursions with eyes closed compared to eyes opened. Significant differences in area and velocity of COP excursions were observed during bilateral stance only when subjects were not wearing textured insoles. There were no significant differences while subjects balanced in bilateral stance with textured insoles.Conclusions:Increased afferent information from textured insoles improves postural control in bilateral stance.

scholarly journals Accuracy of a 7-Item Patient-Reported Stand-Alone Tool for Periodontitis Screening

2021 ◽  
Vol 10 (2) ◽  
pp. 287
Author(s):  
Caroline Sekundo ◽  
Tobias Bölk ◽  
Olivier Kalmus ◽  
Stefan Listl
Keyword(s):  
Diagnostic Accuracy ◽  
Area Under The Curve ◽  
German Society ◽  
Screening Tools ◽  
University Hospital ◽  
Predictive Values ◽  
Periodontal Inflammation ◽  
Specificity And Sensitivity ◽  
Patient Reported ◽  
Sensitivity Specificity

Periodontitis is interrelated with various other chronic diseases. Recent evidence suggests that treatment of periodontitis improves glycemic control in diabetes patients and reduces the costs of diabetes treatment. So far, however, screening for periodontitis in non-dental settings has been complicated by a lack of easily applicable and reliable screening tools which can be applied by non-dental professionals. The purpose of this study was to assess the diagnostic accuracy of a short seven-item tool developed by the German Society for Periodontology (DG PARO) to screen for periodontitis by means of patient-reported information. A total of 88 adult patients filled in the patient-reported Periodontitis Risk Score (pPRS; range: 0 points = lowest periodontitis risk; 20 points = very high periodontitis risk) questionnaire before dental check-up at Heidelberg University Hospital. Subsequent clinical assessments according to Periodontal Screening and Recording (PSR®) were compared with pPRS scores. The diagnostic accuracy of pPRS at different cutoff values was assessed according to sensitivity, specificity, positive, and negative predictive values, as well as Receiver-Operator-Characteristic curves, Area Under the Curve (AUC), and logistic regression analysis. According to combined specificity and sensitivity (AUC = 0.86; 95%-CI: 0.76–0.95), the diagnostic accuracy of the pPRS for detecting periodontal inflammation (PSR® ≥ 3) was highest for a pPRS cutoff distinguishing between pPRS scores < 7 vs. ≥ 7. Patients with pPRS scores ≥ 7 had a 36.09 (95%-CI: 9.82–132.61) times higher chance of having a PSR® ≥ 3 than patients with scores < 7. In conclusion, the pPRS may be considered an appropriately accurate stand-alone tool for the screening for periodontitis.

scholarly journals Baseline Analysis of Patients Presenting for Surgical Review of Anterior Cruciate Ligament Rupture Reveals Heterogeneity in Patient-Reported Outcome Measures

2020 ◽  
Author(s):  
Chee Han Ting ◽  
Corey Scholes ◽  
David Zbrojkiewicz ◽  
Christopher Bell
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Outcome Measures ◽  
Cruciate Ligament ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cluster Membership ◽  
Patient Reported ◽  
Rehabilitation Protocols ◽  
Anterior Cruciate

AbstractDespite the establishment of successful surgical techniques and rehabilitation protocols for anterior cruciate ligament (ACL) reconstruction, published return to sport rates are less than satisfactory. This has led orthopaedic surgeons and researchers to develop more robust patient selection methods, and investigate prognostic patient characteristics. No previous studies have integrated baseline characteristics and responses to patient-reported outcome measures (PROMs) of patients with ACL rupture presenting for surgical review. Patients electing to undergo ACL reconstruction under the care of a single orthopaedic surgeon at a metropolitan public hospital were enrolled in a clinical quality registry. Patients completed Veterans RAND 12-item Health Survey (VR-12) Physical Component Summary and Mental Component Summary scores, Tegner activity scale, and International Knee Documentation Committee (IKDC) questionnaires at presentation. Total scores were extracted from the electronic registry, and a machine learning approach (k-means) was used to identify subgroups based on similarity of questionnaire responses. The average scores in each cluster were compared using analysis of variance (ANOVA; Kruskal–Wallis) and nominal logistic regression was performed to determine relationships between cluster membership and patient age, gender, body mass index (BMI), and injury-to-examination delay. A sample of 107 patients with primary ACL rupture were extracted, with 97 (91%) available for analysis with complete datasets. Four clusters were identified with distinct patterns of PROMs responses. These ranged from lowest (Cluster 1) to highest scores for VR-12 and IKDC (Cluster 4). In particular, Cluster 4 returned median scores within 6 points of the patient acceptable symptom state for the IKDC score for ACL reconstruction (70.1, interquartile range: 59–78). Significant (p < 0.05) differences in PROMs between clusters were observed using ANOVA, with variance explained ranging from 40 to 69%. However, cluster membership was not significantly associated with patient age, gender, BMI, or injury-to-examination delay. Patients electing to undergo ACL reconstruction do not conform to a homogenous group but represent a spectrum of knee function, general physical and mental health, and preinjury activity levels, which may not lend itself to uniform treatment and rehabilitation protocols. The factors driving these distinct responses to PROMs remain unknown but are unrelated to common demographic variables.

Performance in Static, Dynamic, and Clinical Tests of Postural Control in Individuals with Recurrent Ankle Sprains

2004 ◽  
Vol 13 (3) ◽  
pp. 255-268 ◽  
Author(s):  
Lyn Nakagawa ◽  
Mark Hoffman
Keyword(s):  
Postural Control ◽  
Outcome Measures ◽  
Sports Medicine ◽  
Center Of Pressure ◽  
Dynamic Balance ◽  
Ankle Sprains ◽  
Clinical Tests ◽  
Balance Test ◽  
Medicine Research ◽  
Balance Tests

Objective:To evaluate postural control in individuals with recurrent ankle sprains with static, dynamic, and clinical balance tests and to examine the relationships between performances in each of these tests.Design:Postural control was evaluated with 3 different balance tests in individuals with and without recurrent ankle sprains.Participants:19 volunteers with recurrent ankle sprains and 19 uninjured control subjects.Interventions:None.Setting:University sports-medicine research laboratory.Main Outcome Measures:Total excursion of the center of pressure (COP) was calculated for the static and dynamic balance tests. Total reach distance was measured for the Star Excursion Balance Test.Results:Subjects with recurrent ankle sprains demonstrated significantly greater excursion of the COP in both the static and dynamic balance tests. Correlations between performances in all tests were very low.Conclusions:Recurrent ankle sprains might be associated with reduced postural control as demonstrated by decreased performance in static and dynamic balance tests.

scholarly journals Effects of Taping and Elastic Bandage on Postural Control in Athletes with Patellofemoral Pain: A Randomized Control Trial

2015 ◽  
Vol 4 (3) ◽  
pp. 82-89
Author(s):  
Seyed Mojtaba Ojaghi ◽  
Fahimeh Kamali ◽  
Ali Ghanbari ◽  
Samaneh Ebrahimi ◽  
Ahmad Reza Nematollahi
Keyword(s):  
Postural Control ◽  
Center Of Pressure ◽  
Center Of Mass ◽  
Force Plate ◽  
Pain Syndrome ◽  
Patellofemoral Pain ◽  
Balance Test ◽  
Moment Arms ◽  
Group 2 ◽  
Elastic Bandage

Background: Patellofemoral pain syndrome (PFPS) is the most common overuse syndrome in athletes. The aim of this study was to compare the effects of taping and elastic bandage on postural control in athletes with PFPS. Materials and Methods: Fifteen males and 19 females with PFPS participated in this clinical trial study for more than 1 month and were randomly divided into two groups; group 1 was taped based on McConnell method and in group 2 elastic bandage was used. The static postural control in both groups was measured before and after interventions using the force- plate through measuring the center of pressure (COP) and estimation of differences between center of pressure and center of mass (COP-COM moment arms) in AP and ML directions. Moreover, dynamic postural control was measured by star excursion balance test (SEBT). Paired t-test and covariance analysis were used for analysis of the data. Results: Results indicated that after taping reach distances increased significantly (p< 0.05) in anterior, anterolateral, lateral and posterior directions but after elastic bandage reach distances increased in posterior, posteromedial and medial directions. After both taping and bandage, COP and COP-COM moment arm measures did not show significant differences. Conclusion: The findings of this investigation showed that in athletes with patellofemoral pain, taping and elastic bandage improved dynamic postural control. However, dynamic methods are successfully used to assess the effects of taping and bandage on postural control. Static variables compared with dynamic measures potentially lack the ability to detect subtle differences of postural control in athletes with PFPS. [GMJ. 2015;4(3):82-89]

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