Responsiveness of a Balance Assessment Using a Mobile Application

Background: Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app. Hypothesis: The K-D Balance app will demonstrate acceptable responsiveness for balance assessment. Study Design: Repeated-measures study. Level of Evidence: Level 5. Methods: A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC). Results: The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58. Conclusion: The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app. Clinical Relevance: Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.

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A Comparison of Various Cervical Muscle Strength Testing Methods Using a Handheld Dynamometer

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118812767 ◽

2018 ◽

Vol 11 (1) ◽

pp. 59-63 ◽

Cited By ~ 1

Author(s):

David A. Krause ◽

Kelsey A. Hansen ◽

Matthew J. Hastreiter ◽

Taylor N. Kuhn ◽

Molly L. Peichel ◽

...

Keyword(s):

Muscle Strength ◽

Repeated Measures ◽

Intraclass Correlation ◽

Point Estimate ◽

Minimal Detectable Change ◽

Testing Methods ◽

Level Of Evidence ◽

Convenience Sample ◽

Cervical Muscle ◽

Muscle Testing

Background: Cervical muscle strength, proposed as a modifiable risk factor in concussions, can be assessed using various methods. The purpose of this study was to compare the reliability and force outputs of 3 methods that use handheld dynamometry (HHD) for assessing cervical muscle strength. Hypothesis: All 3 testing methods are reliable, and force outputs are significantly different between methods. Study Design: Repeated-measures reliability. Level of Evidence: Level 5. Methods: The study used a convenience sample of 30 participants. HHD “make tests” for cervical extension, flexion, and right and left side bending were performed using lying push tests, sitting push tests, and sitting pull tests. A sole examiner performed all tests. Two testing sessions were conducted 1 week apart. Analysis included intraclass correlation coefficients (ICCs), repeated-measures analyses of variance (α = 0.05) with post hoc Bonferroni tests, and minimal detectable change (MDC) calculations. Results: All testing methods were reliable; the lying push test had the greatest point estimate values (ICC, 0.89-0.95). Significant differences in force were found between the 3 testing methods. The MDC was most sensitive for the lying push method. Conclusion: Of the 3 cervical muscle testing methods investigated, the lying position with a push test had the largest ICC according to the point estimate and the most sensitive MDC. Force values between the 3 methods were significantly different, which suggests that consistent testing methods should be used. Clinical Relevance: Results from this study support the clinical use of an HHD “make test” in a lying position for assessing cervical muscle strength. The test is reliable and more sensitive to change compared with tests in a seated position.

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Validity and Reliability of the Vestibular/Ocular Motor Screening and Associations With Common Concussion Screening Tools

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738116678411 ◽

2016 ◽

Vol 9 (2) ◽

pp. 174-180 ◽

Cited By ~ 40

Author(s):

Amy M. Yorke ◽

Laura Smith ◽

Mitch Babcock ◽

Bara Alsalaheen

Keyword(s):

Intraclass Correlation ◽

Vestibular Function ◽

Screening Tools ◽

Minimal Detectable Change ◽

Ocular Motor ◽

Validity And Reliability ◽

Level Of Evidence ◽

Test Items ◽

Symptom Scores ◽

The Individual

Background: Sustaining a concussion commonly results in vestibular impairments that may be associated with balance deficits. To screen for vestibular impairments after a concussion, the Vestibular/Ocular Motor Screening (VOMS) tool was developed. The relationship between the VOMS and other concussion screening tools, such as the Balance Error Scoring System (BESS) and King-Devick (K-D), have not been explored. Hypotheses: (1) VOMS would provide reliable results and not provoke symptoms in healthy adolescents and (2) VOMS test items would measure related aspects of vestibular function that are not measured through the BESS or K-D. Study Design: Cross-sectional, descriptive. Level of Evidence: Level 4. Methods: A total of 105 healthy adolescents (53 male, 52 female; mean age, 15.4 years) completed the VOMS, BESS, and K-D tests. A subsample of 21 adolescents (16 male, 5 female; mean age, 15.5 years) completed the VOMS twice. Results: The median total symptom score for all 7 VOMS items was 0 (0-5). The majority of the individual VOMS test items total symptom scores demonstrated a significant correlation with each other ( rs = 0.25-0.66, P < 0.02). The individual VOMS items did not demonstrate a significant relationship to the BESS or K-D. VOMS items demonstrated high agreement in total symptom scores between testing trials, with near point convergence (NPC) distance demonstrating an intraclass correlation coefficient (ICC) of 0.95 (95% CI, 0.89-0.98; P < 0.001). The MDC95 (minimal detectable change with 95 confidence) for NPC distance was 4 cm. Conclusion: The VOMS did not provoke vestibular symptoms in healthy adolescents. The VOMS items measured unique aspects of vestibular function other than those measured by the BESS or K-D with good reliability. Clinical Relevance: Clinicians should consider implementing the VOMS as part of a comprehensive concussion assessment if vestibular impairment is suspected. If NPC distance is measured twice, a difference of >4 cm would be considered real change outside of measurement error.

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Consistency and variability in human performance during simulate infant CPR: a reliability study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00785-y ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Debora Almeida ◽

Carol Clark ◽

Michael Jones ◽

Phillip McConnell ◽

Jonathan Williams

Keyword(s):

Chest Compression ◽

Duty Cycle ◽

Repeated Measures ◽

Human Performance ◽

Life Support ◽

Intraclass Correlation ◽

Minimal Detectable Change ◽

Compression Rate ◽

Quality Indices ◽

Compression Depth

Abstract Background Positive outcomes from infant cardiac arrest depend on the effective delivery of resuscitation techniques, including good quality infant cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR skills decay within weeks or months after training. It is not known if the change in performance should be considered true change or inconsistent performance. The aim of this study was to investigate consistency and variability in human performance during iCPR. Methods An experimental, prospective, observational study conducted within a university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years, 74.1% female). On completion of paediatric basic life support (BLS) training, participants performed three trials of 2-min iCPR on a modified infant manikin on two occasions (immediately after training and after 1 week), where performance data were captured. Main outcome measures were within-day and between-day repeated measures reliability estimates, determined using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC95%) for chest compression rate, chest compression depth, residual leaning and duty cycle along with the conversion of these into quality indices according to international guidelines. Results A high degree of reliability was found for within-day and between-day for each variable with good to excellent ICCs and narrow confidence intervals. SEM values were low, demonstrating excellent consistency in repeated performance. Within-day MDC values were low for chest compression depth and chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual leaning (22%). Between-day MDC values were low for chest compression depth and chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual leaning (22%). Reliability reduced when metrics were transformed in quality indices. Conclusion iCPR skills are highly repeatable and consistent, demonstrating that changes in performance after training can be considered skill decay. However, when the metrics are transformed in quality indices, large changes are required to be confident of real change.

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Reliability of 5 Novel Reaction Time and Cognitive Load Protocols

Journal of Sport Rehabilitation ◽

10.1123/jsr.2018-0042 ◽

2018 ◽

Vol 27 (5) ◽

Cited By ~ 2

Author(s):

Kelsey Picha ◽

Carolina Quintana ◽

Amanda Glueck ◽

Matt Hoch ◽

Nicholas R. Heebner ◽

...

Keyword(s):

Reaction Time ◽

Cognitive Load ◽

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Repeated Measures ◽

Sports Medicine ◽

Intraclass Correlation ◽

Minimal Detectable Change ◽

Good Reliability ◽

Medicine Research

Context: Reaction time (RT) is crucial to athletic performance. Therefore, when returning athletes to play following injury, it is important to evaluate RT characteristics ensuring a safe return. The Dynavision D2® system may be utilized as an assessment and rehabilitation aid in the determination of RT under various levels of cognitive load. Previous research has demonstrated good reliability of simple protocols when assessed following a 24- to 48-hour test–retest window. Expanding reliable test–retest intervals may further refine novel RT protocols for use as a diagnostic and rehabilitation tool. Objective: To investigate the test–retest reliability of a battery of 5 novel RT protocols at different time intervals. Design: Repeated measures/reliability. Setting: Interdisciplinary sports medicine research laboratory. Participants: Thirty healthy individuals. Methods: Participants completed a battery of protocols increasing in difficulty in terms of reaction speed requirement and cognitive load. Prior to testing, participants were provided 3 familiarization trials. All protocols required participants to hit as many lights as quickly as possible in 60 seconds. After completing the initial testing session (session 1), participants waited 1 hour before completing the second session (session 2). Approximately 2 weeks later (average 14 [4] d), the participants completed the same battery of tasks for the third session (session 3). Main Outcome Measures: The intraclass correlation coefficient, standard error of measurement, minimal detectable change, and repeated-measures analysis of variance were calculated for RT. Results: The intraclass correlation coefficient values for each of the 5 protocols illustrated good to excellent reliability between sessions 1, 2, and 3 (.75–.90). There were no significant differences across time points (F < 0.105, P > .05). Conclusions: The 1-hour and 14-day test–retest intervals are reliable for clinical assessment, expanding the time frames previously reported in the literature of when assessments can be completed reliably. This study provides novel protocols that challenge cognition in unique ways.

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Depth Sensor–Based Assessment of Reachable Work Space for Visualizing and Quantifying Paretic Upper Extremity Motor Function in People With Stroke

Physical Therapy ◽

10.1093/ptj/pzaa025 ◽

2020 ◽

Vol 100 (5) ◽

pp. 870-879 ◽

Cited By ~ 1

Author(s):

Kohei Okuyama ◽

Michiyuki Kawakami ◽

Shohei Tsuchimoto ◽

Miho Ogura ◽

Kohsuke Okada ◽

...

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Repeated Measures ◽

Intraclass Correlation ◽

Minimal Detectable Change ◽

Motor Score ◽

Depth Sensor ◽

Intensive Training ◽

Work Space ◽

Hemiparetic Stroke

Abstract Background Quantitative evaluation of upper extremity (UE) motor function is important in people with hemiparetic stroke. A depth sensor–based assessment of reachable work space (RWS) was applied to visualize and quantify paretic UE motor function. Objective The objectives of this study were to examine the characteristics of RWS and to assess its validity, reliability, measurement error, and responsiveness in people with hemiparetic stroke. Design This was a descriptive, repeated-measures, observational study. Methods Fifty-eight people with stroke participated. RWS was assessed on both paretic and nonparetic UEs, and the RWS ratio was determined by dividing the RWS of the paretic UE by that of the nonparetic UE. The concurrent validity of the RWS was determined by examining the relationship with the Fugl-Meyer Assessment UE motor score. Test-retest reproducibility was examined in 40 participants. Responsiveness was determined by examining the RWS results before and after 3 weeks of intensive training of the paretic UE in 32 participants. Results The lower area of RWS bordering shoulder was significantly larger than the upper area, and the medial-lower area of RWS bordering shoulder was significantly larger than the lateral-lower area. The RWS ratio was highly correlated with the Fugl-Meyer Assessment UE motor score (r = 0.81). The RWS ratio showed good intrarater relative reliability (intraclass correlation coefficient = 0.94) and no fixed or proportional bias. The minimal detectable change of the RWS ratio was 16.6. The responsiveness of the RWS ratio was large (standardized response mean = 0.83). Limitations Interexaminer reliability was not assessed. Conclusions The RWS assessment showed sufficient validity, reliability, and responsiveness in people with hemiparetic stroke. A depth sensor–based RWS evaluation is useful for visualizing and quantifying paretic UE motor function in the clinical setting.

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Validity and Intrarater Reliability Using a Smartphone Clinometer Application to Measure Active Cervical Range of Motion Including Rotation Measurements in Supine

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0422 ◽

2020 ◽

pp. 1-5

Author(s):

Christanie Monreal ◽

Lindsay Luinstra ◽

Lindsay Larkins ◽

James May

Keyword(s):

Range Of Motion ◽

Repeated Measures ◽

Pearson Correlation ◽

Minimal Detectable Change ◽

Detectable Change ◽

Intrarater Reliability ◽

Convenience Sample ◽

Clinical Measurement ◽

Cervical Range Of Motion ◽

Flexion Extension

Context: Technological advances have given smartphones the capabilities of sensitive clinical measurement equipment at lesser cost and higher availability. The Clinometer is a smartphone application that can be used to measure the joint range of motion in a clinical setting, but psychometric properties of the tool’s use measuring cervical range of motion (CROM) are not established. Objectives: The purpose of this study was to examine the validity and intrarater reliability of the Clinometer application for the measurement of CROM (ie, flexion, extension, rotation, lateral flexion) and to determine the minimal detectable change and SEM. Design: A blinded, repeated-measures correlational design was employed. Setting: The study was conducted collaboratively between 2 athletic training clinics. Participants: A convenience sample of healthy adults ages 18–30 years were recruited. Participants with any history in the last 3 months of cervical or thoracic pathology, pain, or any musculoskeletal injury were excluded. Main Outcome Measures: Three repetitions of each motion were measured by a primary researcher with a goniometer. The same researcher then conducted 3 blinded measurements with the Clinometer application following the same procedure. A second researcher, blinded to the goniometer measurements, recorded the results. Thirty minutes later, testing was repeated with the application. The Pearson correlation was calculated to determine validity of the application compared with goniometry. Results: The measurements between devices had moderate to excellent concurrent validity, with the coefficients ranging between 0.544 and 0.888, P < .01. Test–retest reliability of the CROM measurement using the application was moderate to excellent, with intraclass correlation coefficients ranging between .774 and .928. Across all movements, the SEM ranged from 1.17° to 2.01°, and the minimal detectable change ranged from 1.18° to 2.02°. Conclusion: The Clinometer application is a valid and reliable instrument for measuring active CROM. Level of evidence: clinical measurement, level 1b.

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Intersession Reliability and Concurrent Validity of Isometric Endurance Tests for the Lateral Trunk Muscles

Journal of Sport Rehabilitation ◽

10.1123/jsr.21.2.161 ◽

2012 ◽

Vol 21 (2) ◽

pp. 161-166 ◽

Cited By ~ 1

Author(s):

Paul F. Greene ◽

Christopher J. Durall ◽

Thomas W. Kernozek

Keyword(s):

Upper Extremity ◽

Repeated Measures ◽

Pearson Correlation ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Trunk Muscles ◽

Fisher Exact Test ◽

Convenience Sample ◽

Suitable Alternative ◽

Exact Test

Context:A torso-elevated side support (TESS) has previously been described for measuring endurance of the lateral trunk muscles. In some individuals, however, TESS performance may be hindered by upper extremity pain or fatigue. For this reason a novel test, the feet-elevated side-support test (FESS), was examined.Objective:To determine intersession reliability of a FESS and a TESS on the left and right sides using a single examiner, to evaluate the relationship between tests, and to compare reasons for test termination.Design:Nonexperimental prospective repeated measures.Setting:University laboratory.Participants:A convenience sample of 60 healthy participants from a university community (17 men, 43 women; age 21.1 ± 2.2 y; height 169.9 ± 9.5 cm; weight 67.1 ± 11.9 kg).Results:Intraclass correlation coefficient between 3 testing sessions = .87 with right FESS, .86 with left FESS, .78 with right TESS, and .91 with left TESS. Pearson correlation coefficients ranged from .59 (between left FESS and left TESS in women) to .75 (between left FESS and left TESS in men). Upper extremity pain or fatigue was the reason given for test termination in 42.5% of participants during the TESS and 5.0% during the FESS (P = .000, Fisher exact test).Conclusions:FESS and TESS had comparable intersession reliability by the same evaluator. Moderate to high correlations were found between FESS and TESS scores, suggesting that the tests assess similar qualities. Far fewer participants terminated the FESS because of upper extremity pain or fatigue. Thus, the FESS may be a suitable alternative to the previously validated TESS, particularly for individuals with upper extremity pain or weakness.

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Detecting anxiety and depression among people with limited literacy living with chronic low back pain in Nigeria: adaptation and validation of the hospital anxiety and depression scale

Archives of Public Health ◽

10.1186/s13690-021-00586-4 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Chinonso Nwamaka Igwesi-Chidobe ◽

Rosemary C. Muomah ◽

Isaac Olubunmi Sorinola ◽

Emma Louise Godfrey

Keyword(s):

Back Pain ◽

Factor Structure ◽

Intraclass Correlation ◽

Depression Scale ◽

Anxiety And Depression ◽

Minimal Detectable Change ◽

Fear Avoidance ◽

Convenience Sample ◽

Fear Avoidance Beliefs ◽

Limited Literacy

Abstract Background The Hospital Anxiety and Depression Scale (HADS) is one of the most popular measures of anxiety and depression. The original HADS is mostly used in Nigeria precluding people with limited literacy. This study aimed to cross-culturally adapt and psychometrically test the HADS for rural and urban Nigerian Igbo populations with chronic low back pain (CLBP) who have limited literacy. Methods The HADS was forward translated, back translated, and appraised. Face and content validity was ensured by pre-testing the translated measure among a convenience sample of twelve rural Nigerian dwellers with CLBP. Reliability utilising Cronbach’s alpha, intraclass correlation coefficient, Bland–Altman plots and minimal detectable change were investigated amongst a convenience sample of 50 people living with CLBP in rural and urban Nigerian communities. Construct validity testing involving correlations between Igbo-HADS and Roland Morris Disability Questionnaire measuring self-reported back pain-specific disability, World Health Organisation Disability Assessment Schedule assessing generic self-reported disability, Fear Avoidance Beliefs Questionnaire measuring fear avoidance beliefs, and eleven-point box scale assessing pain intensity, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among a random sample of 200 adults with CLBP in rural Nigerian communities were conducted. Results Idioms and colloquialisms were difficult to adapt. Internal consistency was good (α = 0.78) and acceptable (α = 0.67) for anxiety and depression subscales respectively. Intraclass correlation coefficients were very good (ICC ≃ 0.8) for both subscales. Minimal detectable change was 6.23 and 5.06 for anxiety and depression subscales respectively. The Igbo-HADS and the anxiety subscale had strong correlations (≃ 0.7) with generic self-reported disability; moderate correlations (≃ 0.5–0.6) with pain intensity, self-reported back pain-specific disability, and fear avoidance beliefs. The depression subscale had the lowest correlations (≃ 0.3–0.4) with these outcomes. The EFA produced a two-factor structure with cross-loading of items. The CFA showed poor fit indices for the EFA structure, the original two-factor structure, and one-factor structure. Conclusion The HADS may not be suitable for assessing anxiety and depression, or emotional distress in this population due to difficulty achieving cross-cultural equivalence with western idioms; and the expression of emotional distress through somatisation in this culture.

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Cross-cultural translation and validation of the Spanish version of the patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF)

BMC Research Notes ◽

10.1186/s13104-021-05619-3 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Juan Pablo Martinez-Cano ◽

Daniel Vernaza-Obando ◽

Julián Chica ◽

Andrés Mauricio Castro

Keyword(s):

Intraclass Correlation ◽

Patellofemoral Pain ◽

Spanish Version ◽

Minimal Detectable Change ◽

Global Rating ◽

Minimal Important Change ◽

Specific Patient ◽

Retest Reliability ◽

Patient Reported ◽

Test Retest Reliability

Abstract Objective The aim of this study was to translate to Spanish the patellofemoral pain and osteoarthritis subscale of the knee injury and osteoarthritis outcome score (KOOS-PF) and validate this Spanish version of a disease-specific patient-reported outcome measure (PROM) for patellofemoral pain. Results The KOOS-PF was translated to Spanish and sixty patients with patellofemoral pain and/or osteoarthritis accepted to complete the questionnaire. 1-week later 58 patients answered the questions again for the test–retest reliability validation and finally 55 patients completed 1-month later for the responsiveness assessment. The Spanish version showed very good internal consistency (Cronbach’s alpha: 0.93) and test–retest reliability (intraclass correlation coefficient: 0.82). Responsiveness was confirmed, showing a strong correlation with the global rating of change (GROC) score (r 0.64). The minimal detectable change was 11.1 points, the minimal important change was 17.2 points, and there were no floor or ceiling effects for the score.

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Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

Foot & Ankle International ◽

10.1177/1071100716687367 ◽

2017 ◽

Vol 38 (5) ◽

pp. 485-495 ◽

Cited By ~ 17

Author(s):

Riccardo D’Ambrosi ◽

Camilla Maccario ◽

Chiara Ursino ◽

Nicola Serra ◽

Federico Giuseppe Usuelli

Keyword(s):

Bone Graft ◽

Repeated Measures ◽

Osteochondral Lesion ◽

Young Patients ◽

Case Series ◽

Autologous Bone Graft ◽

Lesion Size ◽

Level Of Evidence ◽

Significant Difference ◽

Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

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