Intra- and inter-rater reliability, agreement, and minimal detectable change of the handheld dynamometer in individuals with symptomatic hip osteoarthritis.

INTRODUCTION: The handheld dynamometer has been validated to measure muscle strength in different muscle groups. However, to date, it has not been tested in individuals who experience pain induced by hip osteoarthritis. The current study aimed to evaluate the intra- and inter-rater reliability, agreement, and minimal detectable change of the Lafayette handheld dynamometer, model 1165, to assess the peak force (Pk) and average peak force (Af) of hip muscles in individuals with symptomatic hip osteoarthritis. METHODS: Twenty participants with hip osteoarthritis (mean ± SD age: 58.7±15.3 years; body mass index: 28.8±4.2 kg/m2) and pain intensity on the Visual Analogue Scale ≥ 4 (8.05±1.2) were recruited to participate in this study. Pk and Af of hip flexors (seated position), abductors and adductors (supine position), and extensors (prone position) were collected in a single day by two independent raters, each one obtaining test and retest in randomly ordered separate sessions. RESULTS: The intra-rater intraclass correlation coefficient (ICC) was classified as good (>0.75) or excellent (≥0.90) for all muscle groups and all inter-rater ICCs were classified as excellent. Rater A had a lower standard error of measurement compared to rater B, ranging from 0.15 to 0.58 kilogram-force (Kgf) compared with 0.34 to 1.25 kg, respectively. However, the inter-rater comparison showed a minimal detectable change (MDC) of < 10% for all Pk and Af measures for hip adductors and extensors. Finally, the inter-rater Bland-Altman analysis demonstrated good agreement for abductors, adductors, and extensors. CONCLUSION: Despite pain and dysfunction related to hip osteoarthritis, the mean of two measures using a handheld dynamometer was shown to be a reliable tool to assess hip muscle strength, with good to excellent intra- and inter-rater ICCs, satisfactory agreement, and small values for MDC.

Stroke with postoperative visual loss as the first clinical manifestation of antiphospholipid antibody syndrome: Case report.

INTRODUCTION: Postoperative visual loss (POVL) is a rare and devastating complication. Its incidence in nonophthamologic surgeries varies from 0.056 % to 1.3 %. Autoimmune rheumatic diseases with a predisposition to thrombotic events, such as antiphospholipid antibody syndrome (APS), may constitute an important risk factor for this complication. PRESENTATION OF CASE: A 34-year-old female patient, who was a former smoker and had no other comorbidities. She underwent orthopedic surgery and presented with bilateral POVL associated with the loss of secondary muscle strength and intraoperative venous and arterial cerebral thrombosis. She was thoroughly investigated regarding the etiology of her condition, and high levels of antiphospholipid antibodies were found. DISCUSSION: APS is an autoimmune disease that predisposes the patient to thrombotic events. Among these, stroke is one of the main causes of POVL secondary to ischemia of the cortical territory, or also known as "cortical blindness." CONCLUSION: The rare incidence of POVL in nonophthalmological surgeries and the consequence and preservation in the literature on the subject, explain the limitations of its pathophysiology, and especially the development of guidelines focused on the prevention of patients with risk factors for this condition. Thus, this case report warns about the risks and anesthetic care that patients with risk factors should have when undergoing nonophthalmological surgeries.