Sensitivity and specificity of normalized truncated navicular height in assessment of static foot posture in children aged 6-12 years.

BACKGROUND: Normalized truncated navicular height (NTNH) is a non-invasive, easy to perform, and simple clinical measure of static foot posture. However, its sensitivity and specificity in evaluation of the static foot posture in children have not been investigated yet. OBJECTIVE: To investigate the intra-rater reliability, sensitivity, and specificity of NTNH in evaluation of the static foot posture in children using radiographic measure as a gold standard measure. METHODS: A cross-sectional study of a random sample of 300 school children aged 6-12 years old. Intra-rater reliability, minimal detectable change, sensitivity, and specificity of NTNH were investigated. NTNH as a clinical measure of static foot posture was calculated and compared to the radiographic measure and displayed on the receiver operating characteristic (ROC) curve. RESULTS: NTNH demonstrated an intra-rater reliability of ICC = 0 . 98 . The sensitivity and specificity of NTNH were 88.1% and 99.5%, respectively. The optimal cutoff point for the diagnosis of flat foot using NTNH in children aged 6-12 years is NTNH ≤ 0 . 19 . CONCLUSION: NTNH is a sensitive and specific measure of static foot posture in the children aged 6-12 years. It is recommended to be used as a screening measure of static foot posture in children as it is easy, simple to perform, and a non-invasive clinical measure.

Kinematic characteristics of reaching in children with hemiplegic cerebral palsy: A comparative study.

BACKGROUND: Practitioners need more sensitive measures to quantify reaching movement for judgement of the treatment effects and reflecting the degrees of motor impairment in upper extremities. OBJECTIVE: The purposes of this study were to differentiate between spastic and normal reaching using three-dimensional (3D) motion analysis and to quantify the interference of spasticity on reaching movement in children with congenital hemiplegic cerebral palsy. METHODS: Fifteen children with hemiplegic CP as a study group and 15 normal typically-developing (TD) children as a control group were studied. Participants were asked to reach forward, at a self-selected pace, toward one target at a normalized distance. A motion analysis system was used to record the trajectory of reaching performance. Kinematic parameters were computed and analysed. RESULTS: There were significant differences between the normal and spastic reaching (p < 0.001). Hemiplegic CP demonstrated slower and less smooth (higher normalized jerk score and more movement units) movement than the TD group, this reflects feedback guidance to correct spatial inaccuracy of reaching in hemiplegic CP. CONCLUSION: Kinematic analysis quantifies reaching characteristics and provides objective information about the motor strategies associated with goal-oriented tasks.

Validity and Diagnostic Accuracy of the Clarke's Angle in Determining Pediatric Flexible Flatfoot Using Radiographic Findings as a Criterion Standard Measure: A Cross-sectional Study.

BACKGROUND: Clinical diagnosis of pediatric flexible flatfoot is still a challenging issue for health-care professionals. Clarke's angle (CA) is frequently used clinically for assessing foot posture; however, there is still debate about its validity and diagnostic accuracy in evaluation of static foot posture especially in the pediatric population, with some previous studies supporting and others refuting its validity. The present study aimed to investigate the validity and diagnostic accuracy of the CA using radiographic findings as a criterion standard measure to determine flexible flatfoot between ages 6 and 18 years. METHODS: A cross-sectional study of 612 participants (1224 feet) with flexible flatfoot aged 6 to 18 years (mean ± SD age, 12.36 ± 3.39 years) was recruited. The clinical measure results were compared with the criterion standard radiographic measures and displayed on the receiver operating characteristic curve, and the area under the curve was computed. Intrarater reliability, sensitivity, specificity, predictive values, and likelihood ratios were calculated for the CA. A Fagan nomogram was used to detect post-test probability. RESULTS: The CA demonstrated higher intrarater reliability (intraclass correlation coefficient = 0.997), sensitivity (98.4%), specificity (98.8), positive predictive value (97.3), negative predictive value (99.3), positive likelihood ratio (84), and negative likelihood ratio (0.02). The area under the curve was 0.98. The positive likelihood ratio yielded a post-test probability of 97%, and the negative likelihood ratio yielded a post-test probability of 0.02. CONCLUSIONS: The CA is a valid measure with high diagnostic accuracy in the diagnosis of flexible flatfoot between ages 6 and 18 years.

Comparing Validity and Diagnostic Accuracy of Clarke's Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation.

OBJECTIVE: Clinically, the foot posture index-6 (FPI-6) and Clarke's angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents' flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure. DESIGN: Cross-sectional study. SETTING: Governmental hospitals. PARTICIPANTS AND METHODS: A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram. RESULTS: CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95-1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77-0.85). CONCLUSION: FPI-6 and Clarke's angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke's angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.

Effect of postoperative high load long duration inspiratory muscle training on pulmonary function and functional capacity after mitral valve replacement surgery: A randomized controlled trial with follow-up.

OBJECTIVES: Although, pre-operative inspiratory muscle training has been investigated and reported to be an effective strategy to reduce postoperative pulmonary complications, the efficacy of postoperative inspiratory muscle training as well as the proper load, frequency, and duration necessary to reduce the postoperative pulmonary complications has not been fully investigated. This study was designed to investigate the effect of postoperative high-load long-duration inspiratory muscle training on pulmonary function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries. DESIGN: Prospective randomized controlled trial. METHODS: A total of one hundred patients (mean age 38.3±3.29years) underwent mitral valve replacement surgery were randomized into experimental (n = 50) and control (n = 50) groups. The control group received conventional physiotherapy care, while experimental group received conventional care in addition to inspiratory muscle training, with 40% of the baseline maximal inspiratory pressure targeting a load of 80% by the end of the 8 weeks intervention protocol. Inspiratory muscle training started on the patient's first day in the inpatient ward. Lung functions, inspiratory muscle strength, and functional capacity were evaluated using a computer-based spirometry system, maximal inspiratory pressure measurement and 6MWT respectively at 5 time points and a follow-up assessment was performed 6 months after surgery. Repeated measure ANOVA and post-hoc analyses were used (p <0.05). RESULTS: Group-time interactions were detected for all the studied variables (p<0.001). Between-group analysis revealed statistically significant postoperative improvements in all studied variables in the experimental group compared to the control group (p <0.001) with large effect size of η2 ˃0.14. Within-group analysis indicated substantial improvements in lung function, inspiratory pressure and functional capacity in the experimental group (p <0.05) over time, and these improvements were maintained at follow-up. CONCLUSION: High intensity, long-duration postoperative inspiratory muscle training is highly effective in improving lung function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries.

Effect of lidocaine iontophoresis combined with exercise intervention on gait and spasticity in children with spastic hemiplegic cerebral palsy: A randomized controlled trial.

BACKGROUND: Gait deviations and spasticity are common impairments seen in children with cerebral palsy (CP) and may interfere with functional performance and effective walking pattern. Lidocaine iontophoresis is effective for reducing muscle spasticity in adults. PURPOSE: To investigate the effect of lidocaine epinephrine iontophoresis combined with exercises on gait and spasticity in children with spastic hemiplegic cerebral palsy (HCP). METHODS: Thirty children with spastic HCP aged 4-6 (5.20±0.32) years were randomly assigned to the experimental group (n = 15) and control group (n = 15). Children in both groups received one hour of exercises, three times a week for three months. Children in the experimental group received 2% lidocaine iontophoresis immediately before the exercises. The lidocaine iontophoresis was delivered for 20 minutes (1mA/min). Spatio-temporal gait parameters were assessed within one week before and after the intervention using 3D motion analysis. Surface electromyography was used to assess muscle tone using H/M ratio of the soleus muscle. ANOVA was used to investigate the differences between experimental and control groups. Statistical significance was set at P value less than 0.05. RESULTS: There was no difference between groups at baseline. Post-intervention, the experimental group showed significant improvements when compared to the control group for gait speed (p = 0.03), stride length (p = 0.04), cadence (p = 0.0001), cycle time (p = 0.0001), and H/M ratio (p = 0.02). CONCLUSION: Lidocaine iontophoresis combined with exercises was effective in improving gait spatiotemporal parameters and reducing spasticity in children with CP.

Validity and diagnostic accuracy of foot posture Index-6 using radiographic findings as the gold standard to determine paediatric flexible flatfoot between ages of 6-18 years: A cross-sectional study.

BACKGROUND: Diagnosis of flexible flatfoot is usually based upon radiographic or clinical measures. Radiographic measures pose a potential risk of radiation exposure especially in Paediatric population. Clinicians need a valid, accurate, easily used, noninvasive and cost effective measure to evaluate static foot posture clinically. Although, foot posture index-6 (FPI-6) are commonly used in clinical practice, its validity and diagnostic accuracy in evaluation of paediatric flexible flatfoot have not been fully proven yet. OBJECTIVES: To investigate validity and diagnostic accuracy of FPI-6 to determine Paediatric flexible flatfoot between ages of 6-18 years using radiographic findings as the gold standard measure. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study conducted on 612 participants (1224 feet) with flexible flatfoot aged 6-18 years (mean age ± standard deviation of 12.36 ± 3.39 years). The results of FPI-6 were compared to the gold standard radiographic measures and displayed on the receiver operating characteristic curve. Intra-rater reliability, sensitivity, specificity, predictive values and likelihood ratios were calculated. Posttest probability was calculated from Fagan nomogram. RESULTS: FPI-6 demonstrate high intra-rater reliability (ICC = 0.96) with p value < 0.001. FPI-6 showed a sensitivity of 83.7%, a specificity of 80.4, a positive predictive value of 64.7, a negative predictive value of 92, a positive likelihood ratio of 4.62 and a negative likelihood ratio of 0.20. FPI-6 shows moderate diagnostic accuracy [AUC = 0.82; 95%CI (0.78-0.85)]. CONCLUSION: FPI-6 is valid with moderate diagnostic accuracy to determine paediatric flexible flatfoot between ages of 6-18 years.

Validation of normalized truncated navicular height as a clinical assessment measure of static foot posture to determine flatfoot in children and adolescents: A cross sectional study.

BACKGROUND: Reliability of clinical measures of static foot posture has been widely debated. However, validity of these measures has not been fully established especially in a pediatric population. The purpose of the study was to investigate reliability and validity of normalized truncated navicular height (NTNH) in assessment of static foot posture to determine flatfoot in children and adolescents using radiographic measures as a criterion gold standard measure. METHODS: A sample of 612 participants aged 6-18 years (12.3±3.3) were enrolled in the study. Clinical assessment of static foot posture using NTNH was compared to the gold standard radiographic measures. Reliability, validity and diagnostic accuracy were investigated. The optimal cutoff point for flatfoot using NTNH was calculated. RESULTS: NTNH demonstrated sensitivity of 98.4%, high positive predictive (PV +) value of 89.2%. The positive likelihood ratio was 19 and the negative likelihood ratio was 0.02. The area under the receiver operating curve (AUC) was 0.96 indicating high validity and diagnostic accuracy of NTNH. The optimal cutoff point for diagnosing flatfoot was NTNH≤0.195. CONCLUSION: NTNH is a valid and diagnostically accurate clinical measure of static foot posture in children and adolescents.