Is Real-Time Poolside Assessment of Upper Limb Errors in Front Crawl Swimming Technique Reliable and Equivalent to Video Analysis?

CONTEXT: Swimming technique is widely believed to influence performance, but this relationship has rarely been tested objectively using a real-time poolside assessment. OBJECTIVE: To determine the (1) test-retest reliability, interrater reliability, and criterion validity (live vs video) of real-time poolside assessment of upper limb (UL) errors in front crawl (FC) swimming technique and (2) the relationship between UL errors and FC swimming performance. DESIGN: Cross-sectional reliability, validity, and correlational study. SETTING: Swim team practice at a college natatorium. PARTICIPANTS: Thirty-nine Division III college swimmers (21 women and 18 men, age = 19 [1] y, swimming experience = 11 [3] y). MAIN OUTCOME MEASURES: Seven UL errors in FC swimming technique, many of which involved unnecessary vertical and mediolateral motions, were assessed in real time from outside the pool during swim practice. Test-retest reliability, interrater reliability, and criterion validity were calculated using Cohen kappa (κ) and weighted kappa (κw). Swimming performance was determined by the participants' best FC events relative to the conference records. The correlation between total UL errors and FC swimming performance was assessed with Pearson r. RESULTS: Cohen κ and κw were moderate for the majority of errors, with the following ranges: 0.46 to 0.90 (test-retest), -0.01 to 1.00 (interrater), and 0.36 to 0.66 (criterion validity). There was a significant correlation between total UL errors and FC swimming performance: r(24) = -.59 (P = .001, R2 = .35). CONCLUSIONS: Reliability and validity were moderate for the majority of errors. The fewer UL errors swimmers made while practicing FC, the faster their best FC race times tended to be relative to the conference record. UL errors in FC swimming technique explained 35% of the variance in performance.

Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer-Related Lymphedema of the Upper Extremity.

OBJECTIVE: The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer-related lymphedema, for use in the context of outcome evaluation in clinical trials. DESIGN: Blinded repeated measures observational study. SETTING: Outpatient research laboratory. PARTICIPANTS: Breast cancer survivors with and without lymphedema (N=71). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The assessment of intraclass correlation coefficients (ICCs) for the Breast Cancer-Related Lymphedema of the Upper Extremity (CLUE) standardized clinical evaluation tool. RESULTS: Intrarater reliability for the CLUE tool was ICC: 0.88 (95% confidence interval [95% CI], 0.71-0.96). Interrater reliability for the CLUE tool was ICC: 0.90 (95% CI, 0.79-0.95). Concurrent validity of the CLUE score (Pearson r) was 0.79 with perometric interlimb difference and 0.53 with the Norman lymphedema overall score. CONCLUSIONS: The CLUE tool shows excellent inter- and intrarater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy.

Agreement of Musculoskeletal Ultrasound and Clinical Assessment of Shoulder Impairment in Manual Wheelchair Users With Various Duration of Spinal Cord Injury.

OBJECTIVES: To determine (1) agreement of musculoskeletal ultrasound (MSK-US) findings of shoulder pathology and related shoulder special test results in individuals with varied durations of manual wheelchair (MWC) use after spinal cord injury (SCI); and (2) whether shoulder musculoskeletal impairments, per MSK-US and clinical examination, differed in individuals with SCI and varying durations of MWC use. DESIGN: Cross-sectional cohort study. SETTING: Laboratory setting. PARTICIPANTS: Adult volunteers (N=23) with SCI who used an MWC for community mobility. Individuals were stratified into 3 groups based on duration of MWC use: <5 years, 5 to 15 years, and >15 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Special tests for shoulder impingement and bicipital tendonitis were performed. Bilateral shoulder MSK-US was performed, with the Ultrasound Shoulder Pathology Rating Scale (USPRS) quantifying biceps tendon, supraspinatus tendon, and greater tuberosity cortical surface impairments. RESULTS: No agreement was found between MSK-US and related special tests. Special tests failed to identify impairment in 33.3% to 100% of those identified on MSK-US. The total USPRS score was highest in those with >15 years' MWC use. A higher proportion of dynamic impingement (supraspinatus and biceps) was found in those with >15 years' MWC use, with other MSK-US items having moderate effect sizes among duration-use groups. CONCLUSIONS: MSK-US identified shoulder impairments more frequently than commonly used special tests. A significant increase in the presence of MSK-US shoulder impairments was identified in the longest-duration group. This was not the case for special tests or pain. MSK-US is an easily administered, low-cost, noninvasive method for determining shoulder impairments and should be used in routine screening of individuals who use an MWC after SCI.