Measures of Skin Turgor in Humans: A Systematic Review of the Literature.

BACKGROUND: Many studies use similar methods to measure skin turgor, but there is no gold standard method that is being followed in clinics or hospitals. PURPOSE: The purpose of this systematic review was to determine if there is any consistent method to measure skin turgor in humans that is valid and reliable. METHODS: Topics of interest for turgor assessment included dehydration; skin integrity, including wounds and skin flaps; and fluid/electrolyte balance for adults 18 years and older. PubMed, ProQuest Medical, SPORTDiscus, PEDro, Web of Science Core Collection, and Cumulative Index of Nursing and Allied Health Literature complete databases were utilized. Levels of evidence were established with 2011 Oxford Centre for Evidence-Based Medicine scale. Methodological rigor was assessed with Quality Assessment of Diagnostic Accuracy Studies checklist. Two researchers graded rigor and level of evidence with a third researcher serving as a tie-breaker. RESULTS: Thirteen articles were included in the final analysis. Some researchers used skin turgor as a measure but did not give details regarding specifically how this measure was used. The pinch test was the most commonly used measure of skin turgor. There were 4 articles ranked as evidence level 2, 1 article as evidence level 3, and 8 articles as evidence level 4. Rigor scores ranged from 3 to 13/14. CONCLUSION: Skin turgor may not be the best assessment tool for some conditions or purposes in adults, such as dehydration, which could lead to a medical emergency.

Effects of assistive devices on postural control following a balance disturbance along the anterior-posterior direction.

BACKGROUND: Assistive devices provide balance and stability to those who require a greater base of support, especially during ambulation or in tasks essential to functional daily living. In ambulatory assistive device use, center of pressure (COP) movement as one of the measurements of postural control is a factor when assessing fall risk, with an overall goal of maintaining postural equilibrium. There is a lack of research on assistive devices, such as walkers, regarding measurable outcome variables related to fall risk. The purpose of this study was to determine how much the postural control in single limb stance during a balance perturbance is affected by utilizing three different walker types designed to promote stability: the standard walker, the front-wheeled walker with straight wheels and the front-wheeled walker with caster wheels. RESEARCH QUESTION: Is postural sway control in single limb stance during a balance perturbance affected by walker type? METHODS: Twenty-three healthy adults participated and gave consent. The NeuroCom® SMART EquiTest® system was utilized to simulate forward falls. Subjects stood on the system's force plate, which was tipped backwards quickly, forcing subjects to attempt to maintain balance. Each participant experienced 18 simulated perturbations, during which they were asked to maintain balance while using one of three walkers in single-limb stance. Each trial was completed using random assignment of three different walker types. Leg dominance of the stance leg was also randomized for each trial. RESULTS: The type of walker and the leg dominance in the standing limb significantly affected postural control in a balance perturbance in the A-P direction. The walker type significantly affected the COP maximum displacement in anterior-posterior (AP) direction. However, the leg dominance significantly affected COP maximum displacement in AP and medio-lateral (ML) directions and COP velocity in AP direction. SIGNIFICANCE: The findings suggest that when fully grounded, a standard walker is more stable than the front-wheeled walker. However, this does not indicate that the standard walker is more stable than other types of walkers when it is being picked up and moved forward during normal use.

Intra and inter-rater reliability of a goniometric lower trunk rotation measurement.

OBJECTIVES: Limited lower trunk rotation, which includes rotation of the lumbar spine, may hinder or even prevent functional activities. Currently, due to the lack of reliable, valid, and clinically useful tests, there is no standard objective measure of lower trunk rotation that can be easily performed in the clinic. The purpose of this study was to establish a standard protocol and to determine inter-rater and intra-rater reliability for a goniometric measurement developed to measure lower trunk rotation. METHODS: Lower trunk rotation was measured using a specific, goniometric method in 41 subjects. Each subject was measured 6 times by 2 different examiners for a total of 12 measurements. RESULTS: Pearson correlation coefficients indicate good intra-rater reliability ranging from 0.59 to 0.82 for right rotation (P< 0.001) and 0.76 to 0.82 for left rotation (P< 0.001), as well as good inter-rater reliability ranging from 0.62 to 0.83 with right rotation (P< 0.001) and 0.75 to 0.77 for left rotation (P< 0.001). CONCLUSION: This measure of trunk rotation may be useful for objectively documenting lower trunk rotation.

Long-term outcomes following anterior tibialis tendon reconstruction with hamstring autograft in a series of 3 cases.

UNLABELLED: Ruptures of the anterior tibialis tendon are uncommon, and there is a paucity of information regarding long-term ankle function following surgical reconstruction using hamstring autograft. In this case series, examinations were performed on 3 individuals who underwent anterior tibialis tendon reconstruction with hamstring autograft performed by the same surgeon. Two subjects were examined 8 years after reconstructive surgery, and 1 was examined at 5 years postoperative. Muscle strength and range of motion of subjects' ankles bilaterally were assessed using standard measures. The Tinetti Performance Oriented Mobility Assessment and the modified Gait Abnormality Rating Scale were used to assess gait and balance. The information gathered from these 3 cases indicates that tibialis anterior strength and ankle range of motion can be maintained or improved years after anterior tibialis reconstruction with hamstring autograft, and these individuals have a low risk of falling long after the repair has healed. LEVEL OF CLINICAL EVIDENCE: 4.