Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction.

PURPOSE: Hamstring tendon graft diameter less than 8 mm has been correlated with an increased risk of anterior cruciate ligament reconstruction (ACLR) graft failure. The purpose of this study was to measure and compare the diameter of 3-, 4-, 5-, and 6-strand gracilis and semitendinosus (ST) hamstring tendon (HT) ACLR grafts, and to determine if there is a correlation between anthropometric data, HT length, and diameter of the HT ACLR graft. METHODS: Male patients (n = 78) undergoing primary or revision ACLR with a HT autograft between July 2018 and March 2020 were recruited. Pre-operative anthropometric data was collected. Gracilis and ST tendons were harvested and the length and diameter measured. The following HT graft configurations were prepared in each patient: triple ST; double gracilis + double ST; double gracilis + triple ST; triple gracilis + triple ST. Paired t-tests and Pearson's correlation coefficients were used to assess demographics, anthropometrics, graft diameter, and tendon length. A non-parametric test was used to compare femoral and tibial ACL graft diameters of the 3-, 4-, 5-, and 6-strand HT graft configurations. RESULTS: For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5- and 6-strand HT graft configurations respectively. For the tibial end, 27%, 10%, 83%, and 92% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-, and 6-strand HT graft configurations respectively. The largest increases in HT graft diameters were noted between the femoral end of 6- vs. 3-strand grafts (mean difference 1.7 ± 0.5 mm; p < 0.001) and between the tibial end of 6- vs. 4-strand grafts (mean difference 2.0 ± 0.5 mm; p < 0.001). Height and leg length were moderately positively correlated with ST tendon length (r = 0.54-0.51) and gracilis tendon length (r = 0.52-0.45), and thigh and shank lengths were moderately positively correlated with ST tendon length (r = 0.43 and 0.40, respectively). CONCLUSION: Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8 mm in the majority of patients. LEVEL OF EVIDENCE: III.

Agreement between original and Rasch-approved neck disability index.

BACKGROUND: Given the high prevalence of neck pain, the neck disability index (NDI) has been used to evaluate patient status and treatment outcomes. Modified versions were proposed as solutions to measurement deficits in the NDI. However, the original 10-item NDI was scored out of 50 and is still the most frequently administered version. Examining the extent of agreement between traditional and Rasch-based versions using Bland-Altman (B&A) plots will inform our understanding of score differences that might rise from using different versions. Therefore, the objective of current study was to describe the extent of agreement between different versions of NDI. METHODS: The current study was a secondary data analysis. The study data was compiled from two prospectively collected data sources. We performed a comprehensive literature search to identify Rasch approved NDI within four databases including Embase, Medline, PubMed, and Google Scholar. Alternate forms and scorings were compared to each other and to the standard NDI. We graphed B&A plots and calculated the mean difference and the 95% limits of agreement (LoA; ±1.96 times the standard deviation). RESULTS: Two Rasch approved alternative versions (8 vs 5 items) were identified from 303 screened publications. We analyzed data from 201 (43 males and 158 females) patients attending community clinics for neck pain. We found that the mean difference was approximately 10% of the total score between the 10-item and 5-item (- 4.6 points), whereas the 10-item versus 8-item and 8-item versus 5-item had smaller mean differences (- 2.3 points). The B&A plots displayed wider 95% LoA for the agreement between 10-item and 8-item (LoA: - 12.0, 7.4) and 5-item (LoA: - 14.9, 5.8) compared with the LoA for the 8-item and 5-item (LoA: - 7.8, 3.3). CONCLUSION: Two Rasch-based NDI solutions (8 vs 5 items) which differ in number of items and conceptual construction are available to provide interval level scoring. They both provide scores that are substantially different from the ordinal NDI, which does not provide interval level scoring. Smaller differences between the two Rasch solutions exist and may relate to the items included. Due to the size and unpredictable nature of the bias between measures, they should not be used interchangeably.

Cross-cultural adaptions and measurement properties of the WORC (Western Ontario rotator cuff index): a systematic review.

BACKGROUND: To evaluate the translations, cross-cultural adaptation procedures and measurement properties of the Western Ontario Rotator Cuff Index (WORC), when it is adapted for different cultures. METHODS: A systematic review was performed, considering different cultural adaptions of the WORC accessible through MEDLINE, CINAHL, EMBASE and/or Google Scholar. Included were prospective cohort studies that used an adapted version of the WORC to measure QoL in patients with rotator cuff disorders. All studies were evaluated according to the current guidelines for cross-cultural adaptations and measurement properties. RESULTS: The search retrieved 14 studies that met the inclusion criteria. According to the recommended guidelines for cross-cultural adaptations, 8 studies performed 100% of the steps, 2 studies performed 80% of the steps and 4 studies used previously translated measures. When evaluating the studies' psychometric properties based on the quality criteria, none of the studies reported all recommended measurement properties. All of the studies reported the measurement property of reliability, but none of the studies reported agreement. Internal consistency was fully reported by 15% of studies. Construct validity was reported by 43% of studies. Only one study reported 100% of the cross-cultural adaption guidelines and 83% of the quality criteria. CONCLUSIONS: Although the majority of studies demonstrated proper adaptation procedures, testing of the measurement properties were inadequate. It is recommended that the current adapted versions of the WORC undergo further testing before use in clinical practise, and researchers continue to adapt the WORC for different cultures as it proves to be an appropriate instrument for assessing rotator cuff pathology.

Psychometric Properties of Performance-Based Functional Tests in Patients With Shoulder Pathologies: A Systematic Review and Meta-analysis.

OBJECTIVES: To identify, critically appraise, and synthesize the reported psychometric properties of shoulder performance-based functional tests in patients with shoulder diseases. DATA SOURCES: MEDLINE, Embase, Scopus, and Cumulative Index to Nursing and Allied Health databases from inception until March 2019 were searched. STUDY SELECTION: Randomized/prospective studies of patients with shoulder diseases that reported on the psychometric properties (reliability, validity, responsiveness) of performance-based functional tests (Standardized Index of Shoulder Function [FI2S], Functional Impairment Test-Hand and Neck/Shoulder/Arm, Closed Kinetic Chain Upper Extremity Stability Test, Timed Functional Arm and Shoulder Test, Shoulder Function Index [SFInX], and hand to neck, scapula, and opposite scapula). DATA EXTRACTION: We used the Consensus-Based Standards for the Selection of Health Measurement Instruments 2018 guideline for systematic reviews. We performed a qualitative synthesis in which the results were summarized based on reported measurement properties and study quality. DATA SYNTHESIS: Eight eligible studies were included with 28 measures (16 reliability; 10 validity; 2 responsiveness). Performance-based functional tests reliability (test-retest, intra- and interrater) measures indicated excellent reliability properties. Intraclass correlation coefficient (ICC) was ≥0.83 and standard error of the mean (SEM) ranged from 0.03-13.3 points. Validity (construct/convergent/concurrent) measures displayed correlations of -0.76 to 0.91 between performance-based functional tests and other patient-reported outcomes (Disabilities of the Arm, Shoulder, and Hand, Constant, Shoulder Pain and Disability Index). Two studies assessed the responsiveness measures performance-based functional tests. Effect sizes of 0.44 and 1.50 and minimal clinically important differences of 10.3 using the anchor-based approach were reported. CONCLUSIONS: The FI2S and the SFInX are reliable, valid, and responsive in patients with shoulder-related diseases.

Measurement Properties of a 2-Dimensional Movement Analysis System: A Systematic Review and Meta-analysis.

OBJECTIVES: To critically appraise, compare, and summarize the quality of the measurement properties of the Dartfish software across various populations and motion tasks. DATA SOURCES: Systematic electronic searches were performed in the PsychInfo, Embase, Medline@Ovid, CINAHL, and Google Scholar databases from January 1999 to January 2020. STUDY SELECTION: Prospective measurement studies published in English peer-reviewed journals that reported on at least 1 psychometric property (reliability, validity, measurement error) using Dartfish were included. An independent reviewer performed searches and identified studies. DATA EXTRACTION: We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for abstracting and assessing data quality. Independent extraction was performed by 2 individual authors. The extracted data involved the author, year, study population, setting, sample size, and measurement properties, as well as information on camera positions, analyzed movement variables, and the corresponding strategy for addressing perspective error. DATA SYNTHESIS: In total, 23 studies were included in this review. Studies were pooled to examine inter-rater reliability estimates for different tasks: single-leg squat angle (2 studies, 115 participants; intra-class correlation coefficient [ICC], 0.94; 95% confidence interval [CI], 0.62-0.99), single-leg vertical drop jump angle (2 studies, 94 participants; ICC, 0.92; 95% CI, 0.20-0.99), and vertical drop jump angle (2 studies, 100 participants; ICC, 0.88; 95% CI, 0.83-0.92). Concurrent validity (2-dimensional Dartfish vs 3-dimensional Vicon) was established using the push and release task, single leg stance, and single leg stance with acutely induced dizziness in 45 healthy Parkinson patients. A correlation of 0.59 to 0.98 was reported. For tracking angles across various movements, a measurement error of approximately 10° retest variation was reported in 3 studies. CONCLUSION: Dartfish is a reliable software for assessing a variety of tasks across multiple contexts of assessments. Evidence suggests that the estimates of motion obtained with Dartfish are valid for single plane movements.

Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis.

OBJECTIVE: The aim of this study was to critically appraise, compare, and summarize the quality of the measurement properties of grip strength (GS) in patients with musculoskeletal, neurologic, or systemic conditions and healthy participants without these conditions. DATA SOURCES: We followed the Consensus-based Standards for the Selection of Health Measurement Instruments guideline. To identify studies on measurement properties of GS, we searched the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Physiotherapy Evidence, and Cochrane Library databases from inception until June 2019. Meta-analyses were carried out using a random effects model and 95% CIs were calculated. STUDY SELECTION: Studies were included if they reported at least 1 measurement property of hand GS in a population with musculoskeletal, neurologic, and systemic conditions or a healthy population without these conditions. DATA EXTRACTION: The extracted data included the study population, setting, sample size, measurement evaluated, and the test interval. DATA SYNTHESIS: Twenty-five studies were included with 1879 participants. The pooled results indicated excellent intraclass correlation coefficient (ICC) of 0.92 (95% CI, -0.88-0.94 for healthy participants without any conditions, ICC of 0.95 (95% CI, -0.93-0.97) for upper extremity conditions, and an ICC of 0.96 (95% CI, -0.94-0.97) for patients with neurologic conditions. Minimum clinically important difference (MCID) scores for hand GS were 5.0 kg (dominant side) and 6.2 kg (nondominant side) for patients post stroke, 6.5 kg for the affected side after distal radius fracture, 10.5 lb and 10 kPa for immune-mediated neuropathies, 17 kg for patients with lateral epicondylitis, and 0.84 kg (affected side) and 1.12 kg (unaffected side) in the carpometacarpal osteoarthritis group; MCID GS estimates were 2.69-2.44 kg in the healthy group without conditions. CONCLUSION: Our synthesized evidence indicated that GS assessment is a reliable and valid procedure among healthy participants as well as across various clinical populations. Furthermore, our MCID summary scores provided useful information for evaluating (clinical importance) new interventions regarding hand GS.

Minimal Detectable Change Thresholds and Responsiveness of Zephyr Bioharness and Fitbit Charge Devices.

Nazari, G and MacDermid, JC. Minimal detectable change thresholds and responsiveness of zephyr bioharness and Fitbit Charge devices. J Strength Cond Res 34(1): 257-263, 2020-The aim of the current study was to define the minimal detectable change (MDC) thresholds for Zephyr Bioharness (ZB) and Fitbit Charge Heart Rate (FC-HR) variables and to establish the internal responsiveness of ZB and FC-HR devices in terms of their HR, respiratory rate variables, and number of steps taken variables, in a healthy sample of men and women at resting, submaximal activity and throughout recovery phases. A total of sixty participants (30 women, 48 ± 15) and (30 men, 48 ± 15) were recruited using stratified convenience and snowball sampling approaches from our university student, staff, and faculty population. At rest, MDC90 values of ±4.89 and ±5.15 were noted for ZB and FC-HR devices, respectively. Throughout the recovery, thresholds of ±8.14 for ZB and 8.74 for FC-HR were reported. During the submaximal phases, scores of ±8.18 and ±9.35 were established for ZB and FC-HR, respectively. From a resting to a submaximal state, the standardized response means (SRMs) for ZB and FC-HR variables exhibited large responsiveness of SRMZB-HR = 4.42; SRMFC-HR = 4.04. In addition, the ZB respiratory rate variable showed the largest effect size of SRMZB-RR = 2.55. Similarly, the large effect size of SRMFC-ST = 1.76 was reported for the FC-HR steps taken variable. From a submaximal to a recovery state, the SRMs for ZB and FC-HR variables demonstrated effect sizes of SRMZB-HR = -3.10; SRMFC-HR = -3.12. Furthermore, the ZB respiratory rate variable displayed similar internal responsiveness measures of SRMZB-RR = -2.45. To conclude, Similar MDC HR thresholds can be expected using the ZB and FC-HR devices and that the two devices demonstrated large internal responsiveness in our healthy male and female cohort when transitioning from resting to submaximal states and vice-versa. Our findings suggest that the ZB and FC-HR devices can be used in monitoring performance improvements or deterioration over time and would allow qualified personnel in assessing the effectiveness of exercise programs in healthy individuals.

Reliability of Zephyr BioHarness Respiratory Rate at Rest, During the Modified Canadian Aerobic Fitness Test and Recovery.

Nazari, G and MacDermid, JC. Reliability of Zephyr BioHarness respiratory rate at rest, during the modified Canadian Aerobic Fitness Test and recovery. J Strength Cond Res 34(1): 264-269, 2020-Technological innovations have led to the development of wearable physiological monitoring devices, such as the Zephyr BioHarness (ZB). It is necessary to establish the measurement properties of a device and to determine its reliability parameters, before its utilization. The purpose of current study was to determine the test-retest reliability of ZB respiratory rate variable at rest, during the modified Canadian Aerobic Fitness Test (mCAFT) (a submaximal test) and throughout recovery. Stratified convenience and snowballing were used to recruit 60 participants (30 females). Respiratory rate reliability was assessed at rest, with total of 20 measurements, during the mCAFT with total of 24 measures and throughout the recovery with total of 20 measures between the first and second sessions. At rest, test-retest respiratory rate intraclass correlation coefficients (ICCs) and SEM for ZB ranged from 0.76 to 0.84 (0.62-0.83). During the mCAFT, the ZB ICCs and (SEM) ranged from 0.76 to 0.89 (1.53-4.00). Throughout the recovery, the ICCs and SEM ranged from 0.79 to 0.90 (0.90-1.28). To conclude, ZB respiratory rate variable demonstrated excellent reliability measures in a large sample of healthy male and female individuals across different age groups at rest, during a submaximal activity and throughout recovery. Our study findings add to the existing pool of literature regarding the reliability parameters of ZB wearable device and propose that stable and consistent measures of respiratory rate can be obtained using ZB device among healthy male and female participants at rest, during submaximal activity (mCAFT) and throughout recovery.

The Effectiveness of Instrument-Assisted Soft Tissue Mobilization in Athletes, Participants Without Extremity or Spinal Conditions, and Individuals with Upper Extremity, Lower Extremity, and Spinal Conditions: A Systematic Review.

OBJECTIVE: To assess the effectiveness of instrument-assisted soft tissue mobilization (IASTM) to other treatments or placebo in athletes or participants without extremity or spinal conditions and individuals with upper extremity, lower extremity, and spinal conditions. DATA SOURCES: The MEDLINE, EMBASE, CINAHL, and PEDro electronic databases were searched from January 1998 to March 2018. STUDY SELECTION: Randomized controlled trials of participants without extremity or spinal conditions or athletes and people with upper extremity, lower extremity, or spinal conditions, who revived IASTM vs other active treatment, placebo, or control (no treatment), to improve outcome (function, pain, range of motion). DATA EXTRACTION: Two independent review authors extracted data, assessed the trials for risk of bias using the Cochrane Risk of Bias tool in included studies, and performed the rating of quality of individual trials per outcome across trials was also performed using the Grading of Recommendations, Assessment, Development, and Evaluations guidelines. DATA SYNTHESIS: Nine trials with 43 reported outcomes (function, pain, range of motion, grip strength), compared the addition of IASTM over other treatments vs other treatments. Six trials with 36 outcomes reported no clinically important differences in outcomes between the 2 groups. Two trials with 2 outcomes displayed clinically important differences favoring the other treatment (without IASTM) group. Six trials with 15 reported outcomes (pressure sensitivity, pain, range of motion, muscle performance), compared IASTM vs control (no treatment). Three trials with 5 outcomes reported no clinically important differences in outcomes between the 2 groups. Furthermore, in 1 trial with 5 outcomes, IASTM demonstrated small effects (standard mean difference range 0.03-0.24) in terms of improvement muscle performance in physically active individuals when compared to a no treatment group. CONCLUSION: The current evidence does not support the use of IASTM to improve pain, function, or range of motion in individuals without extremity or spinal conditions or those with varied pathologies.

Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review.

OBJECTIVE: This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion. DATA SOURCES: MEDLINE and other databases were searched for studies published in the last 20 years. STUDY SELECTION: Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion. DATA EXTRACTION: The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings. DATA SYNTHESIS: Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score. CONCLUSION: Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.

Reliability of Zephyr Bioharness and Fitbit Charge Measures of Heart Rate and Activity at Rest, During the Modified Canadian Aerobic Fitness Test, and Recovery.

Nazari, G, MacDermid, JC, Sinden, KE, Richardson, J, and Tang, A. Reliability of Zephyr Bioharness and Fitbit Charge measures of heart rate and activity at rest, during the modified Canadian Aerobic Fitness Test, and recovery. J Strength Cond Res 33(2): 559-571, 2019-The purpose of this study was to determine the intrasession and intersession reliability of Zephyr Bioharness (ZB) and Fitbit Charge variables in both healthy men and women at rest, during the Modified Canadian Aerobic Fitness Test (mCAFT), and throughout recovery. Stratified convenience and snowball sampling were used to recruit 60 participants (30 women, 48 ± 15 years) and (30 men, 48 ± 15 years) from McMaster University student, staff, and faculty population. At rest, intrasession average heart rate (b·min). Intraclass correlation coefficients (ICCs) and Standard Error of Measurement [SEM] for Zephyr ranged from (0.94-0.97) [1.17-1.70] to (0.92-0.97) [1.45-2.10] for Fitbit Charge. During the mCAFT, the Zephyr ICCs and (SEM) ranged from 0.31-0.99 (1.28-8.10) to 0.45-0.99 (1.45-8.71) for the Fitbit Charge. Throughout the recovery, the ICCs and (SEM) ranged from 0.44-0.98 (1.26-10.47) to 0.45-0.98 (1.15-11.90) for Zephyr and Fitbit devices, respectively. At rest, intersession ICCs (SEM) for Zephyr and Fitbit ranged from 0.90-0.94 (1.73-2.37) to 0.88-0.94 (1.83-2.67), respectively. At mCAFT, the Zephyr ICCs (SEM) ranged from 0.91-0.97 (3.12-4.64) to 0.85-0.98 (3.28-4.88) for the Fitbit. Throughout the recovery, the ICCs (SEM) ranged from 0.93-0.97 (2.65-4.66) to 0.76-0.91 (3.17-4.67) for Zephyr and Fitbit devices, respectively. To conclude, both the ZB and Fitbit Charge devices demonstrated excellent reliability measures throughout the 3 phases. The findings from our study add to the existing pool of literature regarding the reliability parameters of wearable devices and suggest that stable and consistent measures of heart rate and physical activity can be obtained using ZB and Fitbit Charge devices among healthy male and female participants at rest, during a standardized submaximal fitness test (mCAFT), and throughout recovery.

The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis.

STUDY DESIGN: Systematic review with meta-analysis. INTRODUCTION: Joint protection (JP) has been developed as a self-management intervention to assist people with hand arthritis to improve occupational performance and minimize joint deterioration over time. PURPOSE OF THE STUDY: We examined the effectiveness between JP and usual care/control on pain, hand function, and grip strength levels for people with hand osteoarthritis and rheumatoid arthritis. METHODS: A search was performed in 5 databases from January 1990 to February 2017. Two independent assessors applied Cochrane's risk of bias tool, and a Grading of Recommendations Assessement, Development and Evaluation (GRADE) approach was adopted. RESULTS: For pain levels at short term, we found similar effects between JP and control standardized mean difference (SMD; -0.00, 95% confidence interval [CI]: -0.42 to 0.42, I2 = 49%), and at midterm and long-term follow-up, JP was favored over usual care SMD (-0.32, 95% CI: -0.53 to -0.11, I2 = 0) and SMD (-0.27, 95% CI: -0.41 to -0.12, I2 = 9%), respectively. For function levels at midterm and long-term follow-up, JP was favored over usual care SMD (-0.49, 95% CI: -0.75 to -0.22, I2 = 34%) and SMD (-0.31, 95% CI: -0.50 to -0.11, I2 = 56%), respectively. For grip strength levels, at long term, JP was inferior over usual care mean difference (0.93, 95% CI: -0.74 to 2.61, I2 = 0%). CONCLUSIONS: Evidence of very low to low quality indicates that the effects of JP programs compared with usual care/control on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis.

Estimation of health-related-quality of life depends on which utility measure is selected for patients with carpal tunnel syndrome.

STUDY DESIGN: Cross-sectional. INTRODUCTION: Carpal tunnel syndrome (CTS) refers to the compression neuropathy of the median nerve at the wrist. PURPOSE OF THE STUDY: To establish the interinstrument reliability, convergent construct validity, and the levels of agreement of health utility indexes 2 and 3 (HUI-2 and HUI-3), EuroQol 5-dimensions (EQ-5D), EuroQol-visual analog scale (EQ-VAS) and to determine the difference of these utility measures based on age and gender in patients with carpal tunnel syndrome. METHODS: Seventy-four patients with a confirmed diagnosis of carpal tunnel syndrome completed the 3 questionnaires and EQ-VAS a month before surgery. Demographic characteristics were reported. Intraclass correlation coefficients were used to assess relative interinstrument reliability. Pearson correlation coefficients (r) were used to establish convergent construct validity. Bland-Altman plots and t tests were used to describe the levels of agreement between the 4 utility measures. A 2-way analysis of variance was performed to determine the effect of age and gender on the utility measures; HUI-2, HUI-3, and EQ-5D. RESULTS: The intraclass correlation coefficients were 0.85 for HUI-3 vs HUI-2 and 0.80 for HUI-2 vs EQ-VAS. Pearson correlation coefficients ranged from 0.60 to 0.89; HUI-3 vs HUI-2: 0.89, and HUI-3 vs EQ-5D: 0.60. One-sample t test demonstrated significant differences between HUI-3 vs HUI-2, HUI-3 vs EQ-5D, and HUI-3 vs EQ-VAS measures, with mean differences of -0.12, -0.15, and -0.14, respectively. A 2-way analysis of variance test controlling for age and gender indicated neither as predictors of outcome scores. CONCLUSIONS: The HUI-3 vs HUI-2 and HUI-2 vs EQ-VAS demonstrated excellent interinstrument relative reliability measures. The HUI-3 vs HUI-2 displayed very strong convergent construct validity measures, and strong validity measures were established between the remaining utility measures. In addition, the pair-wise utility comparisons demonstrated minimal bias between HUI-2 vs EQ-5D, HUI-2 vs EQ-VAS, and EQ-VAS vs EQ-5D measures. DISCUSSION: N/A. LEVEL OF EVIDENCE: N/A.

Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian Network Meta-Analysis.

OBJECTIVE: To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. DESIGN: A systematic review with network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: We searched the Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS MEDLINE, PSYNDEX, and PsycINFO databases from inception to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. DATA SYNTHESIS: We used Bayesian random-effects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomization process, large trials (>100 patients per arm) and musculoskeletal condition. RESULTS: Fifty-eight randomized controlled trials involving 10 278 participants (median sample size: 137; interquartile range [IQR]: 77-236) were included. Interactive voice response cognitive behavioral therapy (CBT; standardized mean difference [SMD] -0.66, 95% credible interval [CrI] -1.17 to -0.16), CBT in person (SMD -0.50, 95% CrI -0.97 to -0.04), and mobile app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-week follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT and telecare were superior to waitlist at 12-week follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. CONCLUSION: Interactive voice response CBT and mobile app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and depression had over 98% probability of superiority than waitlist control at 12-week follow-up. Internet-delivered CBT and telecare had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-week follow-up. J Orthop Sports Phys Ther 2024;54(6):1-16. Epub 26 February 2024. doi:10.2519/jospt.2024.12216.

Exploratory and confirmatory factor analysis of the new region-generic version of Fremantle Body Awareness-General Questionnaire.

BACKGROUND: As the field of pain evaluation grows, newer and more targeted tools are being published for patient-centric evaluation of specific aspects of the pain experience. The Fremantle Back Awareness Questionnaire (FreBAQ) is intended to capture alterations in bodily awareness or perception. To date only region-specific (back, neck, shoulder, knee) versions have been published. OBJECTIVES: The purpose of our study was to report on the properties of a new region-generic version of the FreBAQ, the FreBAQ-general. Structural validity, internal consistency, and convergent validity against external criteria were evaluated in a sample of Canadian military veterans with chronic pain, with results compared against those published for the region-specific FreBAQ versions. METHODS: Eligible participants were those that had prior military service, were at least 18 years of age and self-identified as having chronic pain. We used a split-sample approach to Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) on independent random samples. Factor structure, internal consistency, and associations with external criteria were used to compare against prior versions. RESULTS: 328 respondents (74% of consented) completed at least 7 of the 9 FreBAQ-general questions. EFA and CFA on two independent samples offered support for both 6- and 7-item versions. Comparisons against the external criteria (pain severity, interference, catastrophizing) indicated no statistical superiority of one over the other, so in the interest of parsimony the 6-item FreBAQ-general was endorsed. CONCLUSIONS: The Fremantle Body Awareness Questionnaire (FreBAQ-general) showed psychometric properties very much in alignment with those previously reported for the region-specific versions, and sound factorial validity accomplished with fewer items (6 vs. 9). We believe this version can be implemented in practice for those seeking a shorter scale without the need to have multiple region-specific versions on hand, though suggest that those seeking direct comparability with previously published work will still wish to use the original versions.

Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses.

PURPOSE: To critically appraise randomized controlled trials (RCTs) on Instrument-Assisted Soft Tissue Mobilisation (IASTM) and quantify the effects of IASTM compared with other treatment in individuals with or without pathologies on function, pain, and range of motion. MATERIALS AND METHODS: We search four electronic databases from January 1999 to January 2022 and included RCTs of healthy participants/athletes and people with upper, lower, or spinal conditions, who received IASTM versus other active treatment for clinical outcomes (function, pain, and range of motion). RESULTS: Forty-six RCTs were considered eligible for data analysis. Effects of IASTM plus other treatment versus other treatment on function and pain intensity were not statistically significant or clinically meaningful (very low quality, SMD -0.28, 95% CI -0.66 to 0.09) and (very low quality, SMD -0.05, 95% CI -0.53 to 0.43) at up to one-year follow-up respectively. No clinically meaningful improvements were found on range of motion outcomes. Out of the 46 included RCTs, only 10 assessed and reported IASTM-related adverse events. CONCLUSION: Evidence of very low-quality certainty does not support the efficacy of IASTM in individuals with or without various pathologies on function, pain, and range of motion in the management of upper body, lower body, or spinal conditions. IMPLICATIONS FOR REHABILITATIONThe included RCTs had a high risk of bias and were assessed as very-low quality evidence for all the included outcomes.IASTM does not lead to clinically meaningful improvements in function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.The publication of IASTM trials in suspected predatory journals is increasing.The available evidence on IASTM does not support its use to improve function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.Health care practitioners should consider other evidence-based management strategies (physical activity and exercise) to improve function, pain, or range of motion in individuals with musculoskeletal injuries and disorders.Given the rise of publications on IASTM in suspected predatory journals, health care practitioners should be judicious to examine the legitimacy of a journal when searching for evidence on IASTM treatment technique.

Rasch analysis of the firefighters' critical incident inventory questionnaire.

BACKGROUND: The Critical Incident Inventory (CII) was developed to assess stressful exposures in firefighters and emergency service workers. The CII includes six subscales: trauma to self, victims known to fire-emergency worker, multiple casualties, incidents involving children, unusual or problematic tactical operations, and exposure to severe medical trauma. OBJECTIVES: To examine the construct validity of all subscales of the Critical Incident Inventory (CII) by assessing the unidimensionality of the scales, and the interval properties of CII subscales by examining fit to the Rasch model and ordering of item thresholds. METHODS: This was a secondary data analysis based on survey data collected from a sample of 390 firefighters. RESULTS: Item 4 and Item 20 were removed with the confirmation of unacceptable fit residual. This revised version of the CII showed satisfactory fit to the Rasch model by non-significant Chi-square test and acceptable level of item fit. We rescored the CII original version and considered all items as only dichotomous response options where 0 represented the original no experience, and 1 presents the combination of experiencing 1, 2, 3 cases. CONCLUSION: The re-appraisal of the revised version CII indicated a satisfactory level of Rasch model fit.

Psychometric properties of Patient-Specific Functional Scale in patients with upper extremity disorders. A systematic review.

PURPOSE: To identify, critically appraise, and synthesise the measurement properties of Patient-Specific Functional Scale (PSFS) in patients with upper extremity musculoskeletal disorders. METHODS: Medline, Embase, PubMed, and Google Scholar databases from January 1999 to November 2020 were searched. Prospective measurement studies that included patients with upper extremity musculoskeletal disorders, that reported on the psychometric properties of PSFS were included. We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) 2018 guideline for systematic reviews to appraise the studies. RESULTS: Fourteen eligible studies were included. Three studies with adequate-very good quality and sufficient properties indicated excellent intra-class correlation coefficients (ICC) (≥0.75) in patients with shoulder pain (mean age 48 ± 11 years), multiple shoulder disorders (mean age 55 ± 16 years), and hand osteoarthritis (mean age 64 ± 9 years). The construct validity estimates of PSFS were moderate, when compared with Upper Extremity Functional Index (UEFI) (r = 0.50) and Numeric Pain Rating Scale (NPRS) (r = 0.51) in patients with combined upper extremity musculoskeletal disorders (shoulder/upper arm, wrist/hand and elbow/forearm). CONCLUSIONS: The patient-specific functional scale can be considered as a reliable, valid, and responsive tool in assessing functional change in patients with shoulder disorders/pain.Implications for rehabilitationThe Patient-Specific Functional Scale (PSFS) can be considered as: • a reliable outcome measure in assessing functional change in patients with shoulder pain and hand osteoarthritis; • a valid measure in assessing functional limitation in patients with upper extremity disorders; • a measure that is sensitive to change (displays longitudinal validity) in assessing functional change in patients with upper extremity disorders and in patients with shoulder pain; and • a responsive outcome measure in assessing functional change in patients with upper extremity disorders.

Psychometric Properties of the Patient-Specific Functional Scale in Patients with Low Back Pathology: A Systematic Review and Meta-Analysis.

Purpose: This systematic review and meta-analysis identifies, critically appraises, synthesizes, and meta-analyses the reported psychometric properties of the Patient-Specific Functional Scale (PSFS) in patients with low back pain or pathology. Method: The MEDLINE, Embase, PubMed, and Google Scholar databases were searched from their inception to September 2019. We included prospective measurement studies that reported on the psychometric properties (reliability, validity, responsiveness) of the PSFS in people with low back pain or pathology. We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for systematic reviews. We performed both quantitative and qualitative syntheses in which the results were summarized on the basis of the reported measurement properties and study quality. Results: Ten eligible studies were included. The pooled PSFS reliability measure was excellent (intra-class correlation coefficient = 0.89; 95% CI: 0.75, 0.95). Validity measures displayed correlations that ranged from -0.47 to 0.69 when compared with other patient-reported outcome measures (PROMs) or other tests. Eight studies had assessed the responsiveness of the PSFS. Effect sizes reported were large (≥ 0.91). Conclusions: The PSFS is a reliable, valid, and responsive PROM for patients with low back pain or pathology.

Objectif : procéder à la détermination, à l'évaluation critique, à la synthétisation et à la méta-analyse des propriétés psychométriques déclarées de l'échelle fonctionnelle propre aux patients (PSFS) ayant des douleurs ou une pathologie dorsales. Méthodologie : les chercheurs ont consulté les bases de données MEDLINE, Embase, PubMed et Google Scholar depuis leur création jusqu'en septembre 2019. Ils ont inclus les études de mesures prospectives sur les propriétés psychométriques (fiabilité, viabilité, réactivité) du PSFS chez les personnes souffrant de douleurs ou d'une pathologie dorsales. Ils ont respecté les directives COSMIN 2018 sur les normes consensuelles pour la sélection d'instruments de mesure de la santé en vue d'analyses systématiques. Ils ont effectué à la fois une synthèse quantitative et une synthèse qualitative dans lesquelles ils ont résumé les résultats en fonction des propriétés métriques déclarées et de la qualité des études. Résultats : dix études admissibles ont été retenues. La mesure de fiabilité regroupée de la PSFS était excellente, avec un coefficient de corrélation intraclasse de 0,89 (IC à 95 % : 0,75, 0,95). Les mesures de validité ont révélé des corrélations entre −0,47 et 0,69 par rapport à d'autres mesures de résultats déclarées par les patients (PROM) ou d'autres tests. Huit études ont évalué les mesures de réactivité du PSFS. Les ampleurs de l'effet déclarées étaient importantes, à 0,91 ou plus. Conclusion : la PSFS est une PROM fiable, valide et réactive chez les patients ayant des douleurs ou des pathologies lombaires.

The clinical outcome of physiotherapy after reversed shoulder arthroplasty: a systematic review.

PURPOSE: The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population. METHODS: A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria. RESULTS: There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1-10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion. CONCLUSIONS: High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4-6 weeks.Implications for RehabilitationThe reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures.A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs.Our systematic review concluded that a 12-week PT program starting with immobilization for 4-6 weeks, followed by 3-4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA.Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation.