The Bilateral Deficit Phenomenon in Elbow Flexion: Explanations for Its Inconsistent Occurrence and Detection

The underlying mechanism(s) of the Bilateral Deficit (BLD) phenomenon is without consensus. Methodological inconsistencies across prior works may be an important source of equivocal results and interpretations. Based on repeatability problems with the BLD measure and maximal force definition, the presence or absence of the BLD phenomenon is altered, shifting conclusions of its mechanistic cause. Our purpose in this study was to examine methodological inconsistencies in applying the BLD measure to establish optimal methods for evaluating the underlying mechanism. Eleven healthy participants engaged in one familiarity and five test sessions, completing bilateral and unilateral elbow maximal voluntary isometric contractions. We defined maximal force by averaged and absolute peak and plateau values. BLD was evident if the bilateral index (BI), the ratio of the bilateral over summed unilateral forces, was statistically different from zero. We addressed interclass correlations (ICC), Chronbach’s α, standard error of the mean, and minimal detectable change between and within sessions for all force measures and BI. We evaluated all combinations of sessions (i.e., 1–2, 3–5, 5–6) and maximal forces to establish the optimal number of sessions to achieve reliability. BLD was present for test sessions, but not for familiarization. All measures of maximal force were highly reliable between and within sessions (ICC(2,1) ≥ .895). BI was only considered significantly reliable in sessions 3–5 ( p < .027), defined by absolute and average plateau forces, but reliability was still quantifiably poor (absolute: ICC(2,1) = .392; average: ICC(2,1) = .375). These results demonstrate that high force reliability within and between sessions does not translate to stable and reliable BI, potentially exposing the lack of any defined BLD mechanism.

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An Analysis of Arches of Foot: A Comparison between Ink Foot Print Method and Custom Made Podoscope Device Method

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i34b31866 ◽

2021 ◽

pp. 249-256

Author(s):

K. Vijayakumar ◽

Rameshkumar Subramanian ◽

S. Senthilkumar ◽

D. Dineshkumar

Keyword(s):

Rural Areas ◽

Descriptive Analysis ◽

Intraclass Correlation ◽

Minimal Detectable Change ◽

Detectable Change ◽

Intrarater Reliability ◽

Custom Made ◽

The Mean ◽

Arch Index ◽

Healthy Participants

The present study aimed to assess the validity of the podoscopic images compared with ink footprint methods (comparing the two different methods using the same parameters). Objective: The evaluation of the reliability and accuracy of arch angle (AA) is the purpose of this paper's study. It includes Chippaux-Smirak Index (CSI), Staheli Index (SI), and Arch Index (AI) by comparing footprints obtained from ink footprint and custom-made podoscopic footprints. Methods: Measurements of AA, CSI, SI, and AI are obtained from ink footprints and custom-made podoscope among 416 healthy participants (aged 21 to 65). Accuracy and reliability were calculated for all the footprint indices obtained using the two methods. Minimal detectable change and the Standard error (SE) of measurement were also calculated. Results: SPSS Statistical software (version 20) at 95% confidence interval was used to execute and observe the statistical analysis. Descriptive analysis was used to calculate the Mean and standard deviations (SD). The intrarater reliability of ink footprints and podoscopic footprints were analyzed using Intraclass correlation (IC) executed at 95% confidence intervals (CIs). Reliability of the podoscopic method was interpreted when the values (≥0.75) as excellent, (0.4-0.74) as moderate, and (0-0.39) as poor. Our study reported that AA, CSI, SI, and AI obtained from the ink footprints and podoscope had high intrarater reliability and reproducible. The podoscope was designed in a lightweight manner for transportation purposes and utilized in under-served and rural areas. This custom-made device may be utilized in orthopedics, and it can also be used to collect data and for diagnostic purposes.

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Minimum Detectable Change of Visual Acuity Measurements Using ETDRS Charts (Early Treatment Diabetic Retinopathy Study)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157876 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7876

Author(s):

María Carmen Sánchez-González ◽

Raquel García-Oliver ◽

José-María Sánchez-González ◽

María-José Bautista-Llamas ◽

José-Jesús Jiménez-Rejano ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Early Treatment ◽

High Reliability ◽

Minimal Detectable Change ◽

High Contrast ◽

Detectable Change ◽

Low Contrast ◽

Minimum Detectable Change ◽

The Mean

In our work, we determined the value of visual acuity (VA) with ETDRS charts (Early Treatment Diabetic Retinopathy Study). The purpose of the study was to determine the measurement reliabilities, calculating the correlation coefficient interclass (ICC), the value of the error associated with the measure (SEM), and the minimal detectable change (MDC). Forty healthy subjects took part. The mean age was 23.5 ± 3.1 (19 to 26) years. Visual acuities were measured with ETDRS charts (96% ETDRS chart nº 2140) and (10% SLOAN Contrast Eye Test chart nº 2153). The measurements were made (at 4 m) under four conditions: Firstly, photopic conditions with high contrast (HC) and low contrast (LC) and after 15 min of visual rest, mesopic conditions with high and low contrast. Under photopic conditions and high contrast, the ICC = 0.866 and decreased to 0.580 when the luminosity and contrast decreased. The % MDC in the four conditions was always less than 10%. It was minor under photopic conditions and HC (5.83) and maximum in mesopic conditions and LC (9.70). Our results conclude a high reliability of the ETDRS test, which is higher in photopic and high contrast conditions and lower when the luminosity and contrast decreases.

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Standard Error of the Mean and Minimal Detectable Change of Gait Speed in Older Adults Using Japanese Long-Term Care Insurance System

Gerontology and Geriatric Medicine ◽

10.1177/23337214211048955 ◽

2021 ◽

Vol 7 ◽

pp. 233372142110489

Author(s):

Yui Takada ◽

Shigeharu Tanaka

Keyword(s):

Older Adults ◽

Standard Error ◽

Gait Speed ◽

Long Term Care ◽

Minimal Detectable Change ◽

Detectable Change ◽

Term Care ◽

Long Term Care Insurance ◽

The Mean

Evaluation of motor function, such as gait ability, can accurately predict the subsequent occurrence of disability in older adults. There are no reports of standard error of the mean (SEM) or minimal detectable change (MDC) with respect to gait in Japanese long-term care insurance-certified individuals. The purpose of this study was to investigate the values of preferred gait, fast gait, and the timed up and go (TUG) test. This study included 46 participants using the Japanese long-term care insurance system. (age 86.5 ± 6.6 years, 12 men, 34 women). The duration of three gait were measured twice using a stopwatch. The SEM was 0.07 for preferred gait, 0.09 for fast gait and 2.59 for TUG. The MDC was 0.19 for preferred gait, 0.26 for fast gait, and 7.17 for TUG. The SEM and MDC values of preferred gait, fast gait, and TUG in this study corroborated with those of previous studies, whereas others were different. Considering that gait speed differs with the country, it may be difficult to compare it among different population groups. We obtained the results of gait speed of Japanese long-term care insurance-certified individuals, which is a new finding

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Minimal clinically important difference and minimal detectable change of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) amongst patients with chronic musculoskeletal pain

Clinical Rehabilitation ◽

10.1177/0269215520942573 ◽

2020 ◽

Vol 34 (12) ◽

pp. 1506-1511

Author(s):

Niina Katajapuu ◽

Ari Heinonen ◽

Mikhail Saltychev

Keyword(s):

Musculoskeletal Pain ◽

Minimal Clinically Important Difference ◽

Chronic Musculoskeletal Pain ◽

World Health ◽

Minimal Detectable Change ◽

Average Intensity ◽

Detectable Change ◽

Whodas 2.0 ◽

Clinically Important Difference ◽

The Mean

Objectives: The aim of this study is to estimate a minimal clinically important difference (MCID) and a minimal detectable change (MDC) of the 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. Design: Cross-sectional cohort study. Setting: Outpatient Physical and Rehabilitation Medicine clinic. Subjects: A total of 1988 consecutive patients with musculoskeletal pain. Interventions: A distribution-based approach was employed to estimate a minimal clinically important difference, a minimal detectable change, and a minimal detectable percent change (MDC%). Results: The mean age of the patients was 48 years, and 65% were women. The average intensity of pain was 6,3 (2.0) points (0–10 numeric rating scale) and the mean WHODAS 2.0 total score was 13 (9) points out of 48. The minimal clinically important difference ranged between 3.1 and 4.7 points. The minimal detectable change was 8.6 points and minimal detectable % change was unacceptably high 66%. Conclusions: Amongst patients with chronic musculoskeletal pain, the 12-item WHODAS 2.0 demonstrated a high minimal detectable change of almost nine points. As the minimal detectable change exceeded the level of minimal clinically important difference, nine points were considered to be the amount of change perceived by a respondent as clinically significant.

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Clinical Utility of the Cognitive Test for Severe Dementia: Factor Analysis, Minimal Detectable Change, and Longitudinal Changes

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000488937 ◽

2018 ◽

Vol 8 (2) ◽

pp. 214-225

Author(s):

Hiroyuki Tanaka ◽

Yuma Nagata ◽

Daiki Ishimaru ◽

Yasuhiro Ogawa ◽

Keita Fukuhara ◽

...

Keyword(s):

Factor Analysis ◽

Longitudinal Change ◽

Cognitive Test ◽

Minimal Detectable Change ◽

Detectable Change ◽

Passage Rate ◽

Severe Dementia ◽

Cosmin Checklist ◽

The Mean ◽

Standard Error Of Measurement

Aims: This study sought to conduct additional analyses of the Cognitive Test for Severe Dementia (CTSD) using the COSMIN checklist to ensure the development of adequate outcome measures. Methods: The following analyses were conducted: (1) factor analyses were used to evaluate construct validity; (2) the standard error of measurement (SEM) and minimal detectable change (MDC) were assessed to evaluate reliability and interpretability; and (3) longitudinal change was assessed to evaluate responsiveness. Results: The CTSD factor analysis yielded 2 factors, each of which was dichotomized by the passage rate of each item. We calculated a SEM and MDC of 1.6 and 3.6 points, respectively. Finally, the mean CTSD score showed a significant reduction (p < 0.001) over time, and the change in score exceeded the SEM and MDC. Conclusion: Our results indicate that the CTSD could provide a reliable outcome measure in severe dementia.

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Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

Journal of Neurosurgery ◽

10.3171/2019.2.jns182620 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1914-1924 ◽

Cited By ~ 2

Author(s):

Liang Li ◽

Jiantao Yang ◽

Bengang Qin ◽

Honggang Wang ◽

Yi Yang ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Functional Outcomes ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Allograft Reconstruction ◽

Acellular Nerve Allograft ◽

The Mean ◽

Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

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Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽

10.1177/1558944717744280 ◽

2017 ◽

Vol 13 (6) ◽

pp. 621-626 ◽

Cited By ~ 2

Author(s):

Hyuma A. Leland ◽

Beina Azadgoli ◽

Daniel J. Gould ◽

Mitchel Seruya

Keyword(s):

Systematic Review ◽

Brachial Plexus ◽

Donor Site ◽

Elbow Flexion ◽

Donor Site Morbidity ◽

Intercostal Nerve ◽

Optimal Number ◽

Musculocutaneous Nerve ◽

Nerve Transfers ◽

Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

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A prospective study to establish the minimal clinically important difference of the Mini-BESTest in individuals with stroke

Clinical Rehabilitation ◽

10.1177/02692155211025131 ◽

2021 ◽

pp. 026921552110251

Author(s):

Marla K Beauchamp ◽

Rudy Niebuhr ◽

Patricia Roche ◽

Renata Kirkwood ◽

Kathryn M Sibley

Keyword(s):

Stroke Rehabilitation ◽

Minimal Clinically Important Difference ◽

Clinical Importance ◽

Minimal Detectable Change ◽

Global Rating ◽

Detectable Change ◽

Clinically Important Difference ◽

Before And After ◽

Small Change ◽

A Prospective Study

Objective: To determine the minimal clinically important difference of the Mini-BESTest in individuals’ post-stroke. Design: Prospective cohort study. Setting: Outpatient stroke rehabilitation. Subjects: Fifty outpatients with stroke with a mean (SD) age of 60.8 (9.4). Intervention: Outpatients with stroke were assessed with the Mini-BESTest before and after a course of conventional rehabilitation. Rehabilitation sessions occurred one to two times/week for one hour and treatment duration was 1.3–42 weeks (mean (SD) = 17.4(10.6)). Main measures: We used a combination of anchor- and distribution-based approaches including a global rating of change in balance scale completed by physiotherapists and patients, the minimal detectable change with 95% confidence, and the optimal cut-point from receiver operating characteristic curves. Results: The average (SD) Mini-BESTest score at admission was 18.2 (6.5) and 22.4 (5.2) at discharge (effect size: 0.7) ( P = 0.001). Mean change scores on the Mini-BESTest for patient and physiotherapist ratings of small change were 4.2 and 4.3 points, and 4.7 and 5.3 points for substantial change, respectively. The minimal detectable change with 95% confidence for the Mini-BESTest was 3.2 points. The minimally clinical importance difference was determined to be 4 points for detecting small changes and 5 points for detecting substantial changes. Conclusions: A change of 4–5 points on the Mini-BEST is required to be perceptible to clinicians and patients, and beyond measurement error. These values can be used to interpret changes in balance in stroke rehabilitation research and practice.

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Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120965185 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096518

Author(s):

Karen Brage ◽

Birgit Juul-Kristensen ◽

John Hjarbaek ◽

Eleanor Boyle ◽

Per Kjaer ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Structural Changes ◽

Supraspinatus Tendon ◽

Patient Reported Outcome ◽

Minimal Detectable Change ◽

Detectable Change ◽

Tendon Stiffness ◽

Patient Reported ◽

Tendon Thickness

Background: Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose: To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design: Controlled laboratory study. Methods: A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results: No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion: Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance: In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration: NCT03425357 ( ClinicalTrials.gov identifier).

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The Igbo Brief Illness Perceptions Questionnaire: A cross-cultural adaptation and validation study in Nigerian populations with chronic low back pain

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-191687 ◽

2021 ◽

pp. 1-13

Author(s):

Chinonso N. Igwesi-Chidobe ◽

Isaac O. Sorinola ◽

Emma L. Godfrey

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Cultural Adaptation ◽

Illness Perceptions ◽

Cross Cultural ◽

Minimal Detectable Change ◽

Low Back ◽

Detectable Change ◽

Cross Cultural Adaptation

BACKGROUND: Illness perceptions predict chronic low back pain (CLBP) disability. This study cross-culturally adapted and validated the Igbo Brief Illness Perceptions Questionnaire (Igbo-BIPQ) in people with CLBP in rural/urban Nigeria. METHODS: A cross-cultural adaptation and validation of the Igbo-BIPQ was undertaken. The BIPQ was forward/back-translated by clinical/non-clinical translators. An expert review committee appraised the translations. The questionnaire was pre-tested on twelve rural Nigerian dwellers with CLBP. Internal consistency using Cronbach’s alpha; test-retest reliability using intra-class correlation coefficient and Bland-Altman plot; and minimal detectable change were investigated amongst 50 people with CLBP in rural and urban Nigeria. Construct validity was determined by correlating the Igbo-BIPQ score with those of eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ) using Pearson’s correlation analyses in 200 adults with CLBP in rural Nigeria. Ceiling and floor effects were investigated in both samples. RESULTS: Good face/content validity, internal consistency (α= 0.76) and intraclass correlation coefficient (ICC = 0.78); standard error of measurement and minimal detectable change of 5.44 and 15.08 respectively; moderate correlations with pain intensity and self-reported disability (r⩾ 0.4); no ceiling/floor effects were observed for Igbo-BIPQ. CONCLUSION: This study provides evidence of some aspects of validity and reliability of the Igbo-BIPQ.

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