Reliability and validity of a return to sports testing battery for the shoulder.

OBJECTIVE: To determine the validity, intra- and inter-rater, and absolute reliability of a return to sport testing battery for the shoulder in a healthy cohort. DESIGN: Cross-sectional design. All participants completed a battery of strength (isokinetic, isometric, and repetition to failure) and functional assessments on two occasions. Concurrent validity to isokinetic testing was assessed, and intra-rater, inter-rater, and absolute reliability were established for all assessments. SETTING: Controlled clinical environment. PARTICIPANTS: Thirty healthy adults active in recreational sports participated, mean age 24.0 ± 1.6 years; MAIN OUTCOME MEASURES: Correlations (Pearson's r), reliability (Intraclass Correlation Coefficient), Standard error of the measurement, Minimal detectable change. RESULTS: Correlations to isokinetic assessments at 60° & 180°/second were moderate to strong for isometric (r: 0.68-0.80) and functional testing (r: 0.55-0.83) and weak for repetition to failure testing (r: 0.37-0.74). All isokinetic (ICC: 0.88-0.94), isometric (ICC: 0.83-0.94), and functional assessments (ICC: 0.80-0.92) had good to excellent intra-rater reliability, while repetition to failure testing had poor to moderate reliability (ICC: 0.48-0.57). The inter-rater reliability of the isometric assessments was moderate to excellent (ICC: 0.71-0.92) across movements. Expressed as a percentage of the mean, the standard error of the measurement ranged from 7% to 25% and the minimal detectable change ranged from 20% to 69% across all assessment methods. CONCLUSION: The isokinetic, isometric, and functional assessments used in this return to sports testing battery demonstrates acceptable validity and reliability. Further refinement to the methods used to assess muscular endurance is needed to improve reliability. This study offers clinicians information that can be utilized in clinical decision-making as it relates the testing battery's psychometric properties.

Evaluation of Chemical Effects on Network Formation in Cortical Neurons Grown on Microelectrode Arrays.

Thousands of chemicals to which humans are potentially exposed have not been evaluated for potential developmental neurotoxicity (DNT), driving efforts to develop a battery of in vitro screening approaches for DNT hazard. Here, 136 unique chemicals were evaluated for potential DNT hazard using a network formation assay (NFA) in cortical cells grown on microelectrode arrays. The effects of chemical exposure from 2 h postplating through 12 days in vitro (DIV) on network formation were evaluated at DIV 5, 7, 9, and 12, with cell viability assessed at DIV 12. Only 82 chemicals altered at least 1 network development parameter. Assay results were reproducible; 10 chemicals tested as biological replicates yielded qualitative results that were 100% concordant, with consistent potency values. Toxicological tipping points were determined for 58 chemicals and were similar to or lower than the lowest 50% effect concentrations (EC50) for all parameters. When EC50 and tipping point values from the NFA were compared to the range of potencies observed in ToxCast assays, the NFA EC50 values were less than the lower quartile for ToxCast assay potencies for a subset of chemicals, many of which are acutely neurotoxic in vivo. For 13 chemicals with available in vivo DNT data, estimated administered equivalent doses based on NFA results were similar to or lower than administered doses in vivo. Collectively, these results indicate that the NFA is sensitive to chemicals acting on nervous system function and will be a valuable contribution to an in vitro DNT screening battery.

Quality of life of women with urinary incontinence in rehabilitation treatment.

This article analyzed how sexual satisfaction, suffering, severity and impact of urinary incontinence, and psychological morbidity affected women's quality of life and whether suffering mediated the relationship between psychological morbidity and quality of life. The study included 80 women diagnosed with urinary incontinence receiving rehabilitation treatment. Regression analysis showed that sexual satisfaction, suffering, and urinary incontinence severity and impact predicted quality of life and that suffering mediated the relationship between psychological morbidity and quality of life. The findings suggest that interventions should be tailored according to the suffering reported by women and the impact of the urinary incontinence on the couple's sexual relationship.

Assaying Spontaneous Network Activity and Cellular Viability Using Multi-well Microelectrode Arrays.

Microelectrode array (MEA) technology is a neurophysiological method that allows for the spontaneous measure of activity in neural cultures and determination of drug and chemical effects thereon. Recent introduction of multi-well MEA (mwMEA) formats have dramatically increased the throughput of this technology, allowing more efficient compound screening. Rapid characterization of compounds for neuroactivity or neurotoxicity hazard evaluation following acute, chronic, or developmental exposures ideally would also consider compound effects on cell health, and to do so in the same well requires a multiplexed approach. Procedures describing the multiplexed method to acute and developmental screening are described in this chapter.

Diagnostic Accuracy of Handheld Dynamometry and 1-Repetition-Maximum Tests for Identifying Meaningful Quadriceps Strength Asymmetries.

Study Design Clinical measurement, cross-sectional. Background Quadriceps deficits are common in individuals with knee joint impairments and impact functional and quality-of-life outcomes. Quadriceps strength symmetry influences clinical decisions after knee injury. Isometric electromechanical dynamometry (ISO-ED) is the gold standard for measuring symmetry, but is not available in all clinical settings. Objectives To compare concurrent validity of handheld dynamometry and 1-repetition-maximum leg press, knee extension from 90° to 0°, and knee extension from 90° to 45° to that of ISO-ED in identifying meaningful quadriceps strength deficits. Methods Fifty-six participants with knee joint impairments completed ISO-ED and 4 alternative measures of quadriceps strength symmetry in a single session. Absolute agreement of alternative measures with ISO-ED was calculated with intraclass correlation coefficients (ICCs). Clinical agreement values at thresholds of 80% and 90% symmetry were compared between the alternatives and ISO-ED. Results Knee extension from 90° to 45° (ICC = 0.67) and handheld dynamometry (ICC = 0.70) had the greatest ICCs. Clinical agreement was also best for these measures for 80% symmetry (κ = 0.56 and 0.55, respectively) and 90% symmetry (κ = 0.19 and 0.33, respectively). Conclusion Handheld dynamometry and 1-repetition-maximum testing of knee extension from 90° to 45° are fair alternatives, although symmetry is typically overestimated. Receiver operating characteristic analysis identified alternative measure thresholds that correlated with the 80% and 90% symmetry thresholds on the ISO-ED. Clinicians should use more stringent symmetry values for these alternative tests to increase the probability that individuals have a minimum ISO-ED symmetry of 80% or 90%. J Orthop Sports Phys Ther 2017;47(2):97-107. doi:10.2519/jospt.2017.6651.

PATIENT-SPECIFIC AND SURGERY-SPECIFIC FACTORS THAT AFFECT RETURN TO SPORT AFTER ACL RECONSTRUCTION.

CONTEXT: Anterior cruciate ligament (ACL) reconstruction is frequently performed to allow individuals to return to their pre-injury levels of sports participation, however, return to pre-injury level of sport is poor and re-injury rates are unacceptably high. Re-injury is likely associated with the timeframe and guidelines for return to sport (RTS). It is imperative for clinicians to recognize risk factors for re-injury and to ensure that modifiable risk factors are addressed prior to RTS. The purpose of this commentary is to summarize the current literature on the outcomes following return to sport after ACL reconstruction and to outline the biologic and patient-specific factors that should be considered when counseling an athlete on their progression through rehabilitation. EVIDENCE ACQUISITION: A comprehensive literature search was performed to identify RTS criteria and RTS rates after ACL reconstruction with consideration paid to graft healing, anatomic reconstruction, and risk factors for re-injury and revision. Results were screened for relevant original research articles and review articles, from which results were summarized. STUDY DESIGN: Clinical Review of the Literature. RESULTS: Variable RTS rates are presented in the literature due to variable definitions of RTS ranging from a high threshold (return to competition) to low threshold (physician clearance for return to play). Re-injury and contralateral injury rates are greater than the risk for primary ACL injury, which may be related to insufficient RTS guidelines based on time from surgery, which do not allow for proper healing or resolution of post-operative impairments and elimination of risk factors associated with both primary and secondary ACL injuries. CONCLUSIONS: RTS rates to pre-injury level of activity after ACLR are poor and the risk for graft injury or contralateral injury requiring an additional surgery is substantial. Resolving impairments while eliminating movement patterns associated with injury and allowing sufficient time for graft healing likely gives the athlete the best chance to RTS without further injury. Additional research is needed to identify objective imaging and functional testing criteria to improve clinical decision making for RTS after ACLR. LEVEL OF EVIDENCE: Level 5.