Ultrasonographic reliability and repeatability of simultaneous bilateral assessment of diaphragm muscle thickness during normal breathing.

Background: The diaphragm is considered the main muscle involved in breathing and also linked to trunk stabilization functions. Up to date, rehabilitative ultrasound imaging (RUSI) has been the most used technique to evaluate unilaterally the transcostal diaphragm thickness. Nevertheless, the inspiratory activity of both hemi-diaphragms is bilaterally performed at the same time, and its simultaneous evaluation with a thoracic orthosis could improve its assessment as well as its re-education with visual biofeedback of both hemi-diaphragms at the same time. The purpose was to evaluate the reliability and repeatability of simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing using a thoracic orthosis that allowed bilateral fixation of both right and left ultrasound probes. Methods: The study was conducted in 46 healthy subjects, whose diaphragm thickness was measured bilaterally and simultaneously in the anterior axillary line during relaxed breathing with a designed thoracic orthosis and 2 ultrasound tools. Intra-examiner (same examiner), inter-examiner (2 examiners), intra-session (1 hour) and inter-session (1 week) reliability and repeatability between each pair of measurements of diaphragm muscle thickness were analyzed during normal breathing. Results: Reliability and repeatability for intra-session evaluations using the thoracic orthosis were excellent to evaluate simultaneous thickness of both hemi-diaphragms by bilateral probes fixation (intraclass correlation coefficient =0.919-0.997; standard error of measurement =0.002-0.007 cm; minimum detectable change =0.006-0.020 cm), without systematic errors (P>0.05) between each pair of measurements. Nevertheless, inter-session evaluations varied from good to excellent using the bilateral probes fixation (intraclass correlation coefficient =0.614-0.984; standard error of measurement =0.006-0.028 cm; minimum detectable change =0.017-0.079 cm), although some systematic errors were presented (P<0.05). Conclusions: Good to excellent reliability and repeatability was shown for simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing. Despite systematic errors were presented for some inter-examiner assessments, the use of the thoracic orthosis that allowed bilateral fixation of ultrasound probes could be recommended for simultaneous hemi-diaphragms breathing re-education by visual biofeedback.

A New Test for Achilles Tendinopathy Based on Kager's Fat Pad Clinical Assessment Predictive Values.

Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy. STUDY DESIGN: Observational study. METHODS: Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David's test. RESULTS: Most (86%) subjects demonstrated Kager's fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David's sign). No healthy tendons had David's sign. CONCLUSIONS: The presence of asymmetry in Kager's fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David's test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.

Effect of foot health-related quality of life in rural population: A case-control study.

BACKGROUND: Foot health problems can affect quality of life and general health producing a source of discomfort and pain. Low levels of foot health-related quality of life (HRQoL) are present in patients with foot disabilities, such as hallux valgus, plantar fasciitis, or minor toe deformities. OBJECTIVE: The objective was to analyze the foot health status in patients with and without foot problems in a rural population and its relationship with quality of life. MATERIAL AND METHODS: A prospective case-control study was developed with a sample of 152 patients, 76 subjects with podiatric pathologies and 76 without, in a rural population. HRQoL was measured through the SF-36 Health Questionnaire in the Spanish version. RESULTS: The case group had a mean age of 49.18 ± 14.96 and the control group 44.16 ± 11.79. Regarding the score of the lowest levels of quality of life related to foot problems, the case group compared to the controls showed: for physical function (79.86 ± 26.38 vs. 92.63 ± 11 0.17, p < 0.001); for the physical role (73.68 ± 41.00 vs. 88.48 ± 27.51, p < 0.0022); for body pain (45.81 ± 27.18 vs. 73.68 ± 41.00, p < 0.035); and for general health (60.36 ± 30.58 vs. 68.71 ± 18.52, p < 0.047). The differences between groups were analyzed using the Mann-Whitney U test, which showed statistical significance (P < 0.05). CONCLUSIONS: In the rural population, people with foot pathologies present a worse quality of life compared to those who do not present foot pathology, especially for the health domains: physical function, physical role, body pain and health general.

Repeatability and reliability of the footwear assessment tool in Spanish patients: A transcultural adaptation.

BACKGROUND: The footwear assessment tool was designed to advise an appropriate footwear for each situation and patient. Footwear alterations structures can influence in musculoskeletal disorders, developing foot ulcers, increase the peak plantar pressure, bacterial growth, low back pain. METHODS: To validate the study 101 subjects were recruited. The study was tested by two expert podiatrists using the tool for the assessment of footwear characteristics that is composed by five domains, fit, general features, general structure, motion control properties and cushioning system. Each domain analyzes different shoe items. RESULTS: An excellent agreement between the test-retest. A suitable Cronbach's α was suggested for the five domains of fit (α = 0.952), general features (α = 0.953), general structure (α = 0.947), motion control properties (α = 0.951), and cushioning system (α = 0.951). Test-retest reliability was excellent for all domains. There were no significant differences between any domain (p > 0.05). There was only statistically significant difference in the item forefoot height (p = 0.011). For all the domains items there were no statistically significant difference (p > 0.05). CONCLUSIONS: The tool for the assessment European footwear is a suitable repeatability and reliability footwear tool that can be used in Spanish language subjects.

Assessment and indicators of hallux limitus related with quality of life and foot health in school children.

Background: Functional Hallux Limitus (FHL) is a dynamic foot dysfunction characterized by a limitation of hallux dorsiflexion when the first metatarsal head is under load. FHL plays a role in the development of osteoarthrosis in the first metatarsophalangeal joint (IMTPJ). Forefoot disorders can significantly impact an individual's quality of life, leading to dysfunction and pain. The aim of this project was to evaluate the quality of life of school-aged individuals with and without FHL using the Foot Health Status Questionnaire (FHSQ). Methods: A case-control study was conducted to evaluate the outcomes in paediatric age. A total sample of 116 children between 6 and 12 years old was used to conduct this research. The sample was divided into two groups: (i) the healthy group (n = 58) and the FHL group (n = 58). The FHSQ was completed and the FHL test was performed in a seated position to classify the patients into the selected group. Results: Non-significant changes were observed when the mean values of the FHSQ domains were compared between the groups with and without FHL, except for the "general foot health" domain (p = 0,024) associated with the specific foot health section (section 1) of the Questionnaire. For the domains linked with the general well-being section (section 2), there was not a statistically difference in the mean of the scores obtained between the two school-aged groups with and without FHL, being slightly lower in the group with the presence of FHL for the overall health and physical function domains. Both the healthy and case groups obtained and identical range of scores (10-100) for the "foot pain" domain. Nevertheless, the mean of the score was lower for the participants with FHL. Conclusions: The perception of the quality of general foot health was poorer in the school-aged group with FHL. Variables such as foot pain and footwear are likely contributors influencing the perception of foot health quality. The school-aged population with FHL faces a decline in the quality of foot life. Ensuring adequate foot control in children and implementing future foot programs for this population are imperative for enhancing school children's perception of foot health and managing the development of pain and footwear-related issues.

Cross-Cultural Adaptation and Test-Retest Reliability of the Spanish ROWAN Foot Pain Assessment Questionnaire (ROFPAQ-S).

BACKGROUND: The ROWAN Foot Pain Assessment Questionnaire (ROFPAQ) may be considered as a self-reported health questionnaire with 45 items to measure foot health problems such as foot pain. To date, the ROFPAQ has only been validated into an English-language version. OBJECTIVES: Therefore this study aim was to perform the cross-cultural adaptation and test-retest reliability of the Spanish ROFPAQ version (ROFPAQ-S). STUDY DESIGN: A cross-sectional descriptive study. SETTINGS: Podiatry and physiotherapy clinical centers. METHODS: The recommended forward/backward translation protocol was applied for the procedure of translation and cross-cultural adaptation from United Kingdom to Spain. RESULTS: An adequate internal consistency (Cronbach alpha) was shown for the 3 domains about cognitive (alpha = 0.763-0.792), affective (alpha = 0.751-0.801), and sensory (alpha = 0.741-0.733) subscales, as well as for the total score (alpha= 0.822-0.813). Good test-retest reliability by intraclass correlation coefficients (ICC [95% confidence interval]) was shown for the total score (ICC = 0.909 [0.850-0.944]), and each domain such as cognitive (ICC = 0.785 [0.648- 0.869]), affective (ICC = 0.995 [0.991-0.997]), and sensory (ICC = 0.662 [0.447-0.794]) subscales. The Spearman correlations (rs) were adequate for the cognitive (rs = 0.81-0.83), affective (rs = 0.73-0.72), and sensory (rs = 0.67-0.63) subscales. LIMITATIONS: The original ROFPAQ was developed from a podiatry department of the health care national service. CONCLUSIONS: The ROFPAQ-S was shown as a valid and reliable tool with an acceptable use in the Spanish population. KEY WORDS: Foot, quality of life, chronic pain, health impact assessment, validation studies.

Reliability and Repeatability of the Instrument for the Assessment of Stress in Nursing Students (ASNS).

Background and objectives: Stress in nursing students is a very common experience, especially when they face clinical practice. The aims of this study were to perform a transcultural adaptation and to examine the reliability and repeatability of the Instrument for the Assessment of Stress in Nursing Students for a Spanish population. Methods: A test-retest analysis was carried out in two face-to-face sessions with the students with a lapse of 10 days between the two sessions. A cross-sectional descriptive study was carried out between the months of May and June 2018. Sixty-four nursing students were recruited with a consecutive sampling method that targeted individuals in the freshman class. Results: A good internal consistency was shown for the total score (α = 0.8861) and for each of the six domains. The test-retest reliability, using the Wilcoxon paired test, was not significant, indicating no differences between the total scores or the domain scores (p ≥ 0.05). Finally, Bland and Altman plots of visual distributions did not show differences between the total scores and the domain scores. Conclusion: The Instrument for the Assessment of Stress in Nursing Students was shown to be a reliable tool for measuring stress factors among Spanish nursing students.

Validation in the General Population of the iHealth Track Blood Pressure Monitor for Self-Measurement According to the European Society of Hypertension International Protocol Revision 2010: Descriptive Investigation.

BACKGROUND: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. OBJECTIVE: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. METHODS: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (≤5, ≤10, and ≤15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (≤3, ≤5, and ≤8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. RESULTS: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. CONCLUSIONS: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population.