Comparison of Two Handheld Digital Dual Inclinometry Techniques in the Measurement of Lumbar Flexion Active Range of Motion.

CONTEXT: An accurate assessment of lumbar spine active range of motion (AROM) is clinically important. Dual inclinometry is recommended as the optimal technique for measuring lumbar flexion AROM; however, the procedures differ in the literature. OBJECTIVE: To compare 2 different handheld digital dual inclinometry (HDDI) techniques for evaluating lumbar flexion AROM. DESIGN: The study was a repeated-measures design consisting of 2 trials. SETTING: Laboratory. PARTICIPANTS: A sample of 69 adult volunteers (28 men and 41 women; mean age 23.8 [2.4] y) without pain or injury to their back, hips, or abdomen for at least 3 months participated in the study. INTERVENTION: Using standardized methods, 1 trained tester performed 2 different HDDI measurements of standing lumbar flexion AROM on each subject. Each subject performed one repetition of AROM lumbar flexion per HDDI measurement. The HDDI measures differed in the process for placing the upper inclinometer, with one technique identifying the upper landmark by skilled palpation of the T12 spinous process and the other technique by measuring 15-cm cephalad to the S2 region landmark to approximate the location of the T12 spinous process. MAIN OUTCOME MEASURES: A dependent t test, Pearson correlation coefficient (r), the 95% limits of agreement, and Bland-Altman plots were used to examine agreement between the techniques. RESULTS: Dependent t testing showed no significant differences between the techniques (mean difference = 1.2°, P = .11). A strong correlation existed between the 2 HDDI techniques (r = .80, P < .001). The Bland-Altman plot illustrated that 64 of the 69 data points were within the 95% limits of agreement for the 2 techniques. CONCLUSIONS: The findings suggest that HDDI measurements of lumbar flexion AROM are comparable when using either of the 2 HDDI techniques described. Clinicians can make an evidence-based choice for using either method of measuring lumbar flexion AROM.

Intrarater reliability of CROM measurement of cervical spine active range of motion in persons with and without neck pain.

STUDY DESIGN: Clinical measurement, intrarater reliability study. OBJECTIVES: To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM). BACKGROUND: Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM. METHODS AND MEASURES: Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized. RESULTS: The intraclass correlation coefficients (ICC3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees . The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees . Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain. CONCLUSION: Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred.

Effect of a modified, low-dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise.

STUDY DESIGN: Single-group repeated measures design pre- and postintervention. OBJECTIVES: To determine if the modified low-Dye medial longitudinal arch (MLA) taping procedure places the subtalar joint into the neutral position and maintains the subtalar joint neutral (STJN) position following 10 minutes of walking. BACKGROUND: Subtalar malalignment in excessive pronation is commonly accepted as a contributing factor to a variety of musculoskeletal pathologies. The modified low-Dye MLA taping procedure is often used on the plantar surface of the foot as a short-term corrective tool for excessive foot pronation. However, research that evaluates the efficacy of this taping technique during light exercise is lacking. Measurement of navicular height is commonly used as a measure of subtalar position. METHODS AND MEASURES: Prior to the study, one tester-established reliability in the navicular drop technique measurement by initially practicing the measurements on 400 feet, followed by a reliability study performed on 29 subjects. In this study, a screening procedure excluded subjects with ankle or foot pathology, supinated feet, or neutral feet, and included only subjects with pronated feet. The study, which included 40 subjects, involved four steps: (1) measuring navicular height in the relaxed position; (2) measuring navicular height in the STJN position; (3) measuring navicular height after application of the modified low-Dye MLA taping procedure; and (4) measuring navicular height after subjects had walked for 10 minutes with the taping. RESULTS: Results indicated an intrarater intraclass correlation coefficient (ICC) for measuring navicular height of 0.96 for the right foot and 0.94 for the left foot. Repeated measures ANOVA revealed that significant differences existed (P < 0.05) among the 4 measures. A Bonferroni post hoc analysis showed a difference between relaxed stance measurements and all other measurements, and between taped-prewalking measurements and taped-postwalking measurements. In addition, no significant difference was observed between navicular height measured in STJN and the taped-prewalking and taped-postwalking conditions. The average navicular height for the taped-prewalking condition was 1.6 mm higher than that for the STJN position. For the taped-postwalking condition, the average height of the navicular was 1.2 mm lower than that of the STJN position. CONCLUSION: These results demonstrate that the modified low-Dye MLA taping procedure places the subtalar joint near the neutral position. Despite a significant reduction in the height of the navicular after the subjects walked for 10 minutes with the tape on, the height of the navicular was still not significantly different than that of the STJN position.

Effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes: a randomized clinical trial.

BACKGROUND: Exercise training is effective for improving physical fitness and physical function in people with type 2 diabetes. However, limited research has been conducted on the optimal exercise training intensity for this population. OBJECTIVE: The primary study objective was to investigate the effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes. DESIGN: This was a randomized clinical trial. SETTING: The setting was a university campus. PARTICIPANTS: Twenty-one people with type 2 diabetes were randomly allocated to receive either moderate-intensity training (MOD group) or high-intensity training (HIGH group). INTERVENTION: The MOD group performed resistance training at an intensity of 75% of the 8-repetition maximum (8-RM) and aerobic training at an intensity of 30% to 45% of the heart rate reserve (HRR). The HIGH group performed resistance training at an intensity of 100% of the 8-RM and aerobic training at an intensity of 50% to 65% of the HRR. MEASUREMENTS: Muscle strength (peak torque [newton-meters]), exercise capacity (graded exercise test duration [minutes]), and physical function (Patient-Specific Functional Scale questionnaire) were measured at baseline and 3 months later. Acute exercise-induced changes in glucose levels were assessed immediately before exercise, immediately after exercise, and 1 hour after exercise during the first exercise training session. RESULTS: Although both groups showed improvements in physical fitness and physical function, the between-group effect sizes were not statistically significant (exercise capacity estimated marginal mean [EMM] difference=2.1, 95% confidence interval [95% CI]=-0.2, 4.5; muscle strength EMM difference=20.8, 95% CI=-23.3, 65.0; and physical function EMM difference=0.1, 95% CI=-0.6, 0.9). Mean percent changes in glucose levels measured immediately before exercise and immediately after exercise, immediately after exercise and 1 hour after exercise, and immediately before exercise and 1 hour after exercise for the MOD group were -11.4%, -5.0%, and -15.8%, respectively; those for the HIGH group were -21.5%, 7.9%, and -15.3%, respectively. LIMITATIONS: Sample size, lack of outcome assessor masking, and physical function measurement subjectivity were limitations. CONCLUSIONS: Moderate- and high-intensity exercise training, as defined in this study, may lead to similar improvements in physical fitness and physical function in people with type 2 diabetes.

Correlation between the 8-repetition maximum test and isokinetic dynamometry in the measurement of muscle strength of the knee extensors: A concurrent validity study.

The 8-repetition maximum test has the potential to be a feasible, cost-effective method of measuring muscle strength for clinicians. The purpose of this study was to investigate the concurrent validity of the 8-repetition maximum test in the measurement of muscle strength by comparing the 8-repetition maximum test to the gold standard of isokinetic dynamometry. Thirty participants (15 males and 15 females, mean age = 23.2 years [standard deviation = 1.0]) underwent 8-repetition maximum testing and isokinetic dynamometry testing of the knee extensors (at 60, 120, and 240 degrees per second) on two separate sessions with 2-3 days between each mode of testing. Linear regression was used to assess the validity by comparing the findings between 8-repetition maximum testing and isokinetic dynamometry testing. Significant correlations were found between the 8-repetition maximum and isokinetic dynamometry peak torque at each testing velocity (r = 0.71-0.85). The highest correlations were between the 8-repetition maximum and isokinetic dynamometry peak torques at 60 (r = 0.85) and 120 (r = 0.85) degrees per second. The findings of this study provide supportive evidence for the use of 8-repetition maximum testing as a valid, alternative method for measuring muscle strength.

Reliability of the 8-repetition maximum test in men and women.

OBJECTIVE: The 8-repetition maximum test has been recommended as a method of prescribing an intensity for resistance training in healthy adults, athletes, and patients with health conditions. Yet, limited research related to the reliability of 8-repetition maximum testing has been conducted. The purpose of this study was to determine the reliability of the 8-repetition maximum test in men and women. DESIGN: Test-retest reliability study. METHODS: Twenty-eight people (14 males, 14 females, mean age=23.0 years [standard deviation=1.3]) with no exercise contraindications participated in this study. After familiarization, each participant underwent 8-repetition maximum testing using 4 different exercises. For all participants, the 8-repetition maximum test was performed during 2 sessions with 2-3 days between sessions. The intraclass correlation coefficient (ICC([1,2])), typical error as the coefficient of variation (TE(CV)), and the Bland-Altman plot were used to assess reliability. Unpaired t-test was used to determine the influence of gender on differences between initial test and retest values. RESULTS: Excellent reliability of the 8-repetition maximum test was found for all exercises (ICC([1,2])>0.9). The range of TE(CV) values was 3.4-10.4%. The Bland-Altman plot illustrated that 27 out of 28 data points for total 8-repetition maximum scores were within the 95% limits of agreement. Unpaired t-test indicated no significant difference between men and women in variations between initial test and retest 8-repetition maximum scores. CONCLUSION: The findings of this study suggest that an 8-repetition maximum test protocol that includes familiarization is reliable in men and women.

Impact of physical therapist-directed exercise counseling combined with fitness center-based exercise training on muscular strength and exercise capacity in people with type 2 diabetes: a randomized clinical trial.

BACKGROUND: Assessing muscular strength (force-generating capacity) and exercise capacity in response to an intervention for people with type 2 diabetes is clinically important in the prevention of type 2 diabetes-related complications. OBJECTIVE: The purpose of this study was to investigate the impact of physical therapist-directed exercise counseling combined with fitness center-based exercise training on muscular strength and exercise capacity in people with type 2 diabetes. DESIGN: This study was a randomized clinical trial. SETTING: The study was conducted on a university campus, with patient recruitment from the local community. PATIENTS: Twenty-four people with type 2 diabetes were randomly allocated to either a group that received physical therapist-directed exercise counseling plus fitness center-based exercise training (experimental group) or a group that received laboratory-based, supervised exercise (comparison group). INTERVENTION: The experimental group received physical therapist-directed exercise counseling on an exercise program and was provided access to a fitness center. The comparison group received the same exercise program as the experimental group while under supervision. MEASUREMENTS: For all participants, chest press, row, and leg press muscular strength (1-repetition maximum [in kilograms]) and exercise capacity (graded exercise test duration [in minutes]) testing were conducted at baseline and 2 months later. RESULTS: No significant differences in improvements in muscular strength were found for the chest press (adjusted mean difference=1.2; 95% confidence interval [CI]=-5.5 to 7.8), row (adjusted mean difference=0.1; 95% CI=-9.0 to 9.1), or leg press (adjusted mean difference=2.7; 95% CI=-9.1 to 14.6) between the groups. No significant difference in improvement in exercise capacity (adjusted mean difference=0.2; 95% CI=-0.9 to 1.2) was found between the groups. LIMITATIONS: Lack of group allocation blinding and the small sample size were limitations of this study. CONCLUSIONS: The results suggest that physical therapist-directed exercise counseling combined with fitness center-based exercise training can improve muscular strength and exercise capacity in people with type 2 diabetes, with outcomes comparable to those of supervised exercise.

Unique positioning for using elastic resistance band in providing strengthening exercise to the muscles surrounding the ankle.

Ankle sprains are among the most common injuries incurred by participants in athletics. Conservative management of the patient after an ankle sprain includes a comprehensive rehabilitation program of which the resistance exercises are a part and are frequently advised by the clinician, many times as part of a home exercise program. The purpose of this Clinical Suggestion is to present a unique method of using elastic resistance band to provide strengthening activities to the inverters, ever-tors, plantarflexors, and dorsiflexors of the ankle. The method is unique, as well as convenient and efficient, as it allows the subject to perform all four exercises with a minimum of change in position, while staying seated in a chair.

Analysis of physicians' referrals: is further diagnosis needed?

BACKGROUND: As physical therapy gradually evolves into a more autonomous profession, physicians continue to play a major role in the clinical practice of physical therapists, particularly as a source of patient referral. The analysis of physicians' referrals to physical therapy may be a practical and effective way to study the relationship between physicians and physical therapists. OBJECTIVES: The objective of this study was to identify the primary reasons for physicians' referrals to an outpatient physical therapy clinic and to determine whether further diagnosis by the physical therapist is necessitated prior to treatment. METHODS: Between January 1, 2001 and March 31, 2003, 544 consecutive physicians' referrals were received in a rural physical therapy outpatient clinic. Physicians' specialties, diagnosis on referral (or reason for referral, if diagnosis not provided), and prescribed orders on referral were all reviewed by the authors. RESULTS: One-third (33%) of the referrals were sent to physical therapy with no medical diagnosis (non-specified referrals - NSRs), and the most common reason for the referral in this NSR category was "pain" (88%). Commonly recommended treatments accompanying the NSRs included: evaluation & treatment (60%) and routine rehabilitation protocol (24%) for the relevant joints. CONCLUSION: One-third (33%) of the referrals sent to physical therapy included no medical diagnosis, with the most common reason for the referral listed as "pain." Evaluation and treatment was the most recommended treatment accompanying these non-specific referrals (almost 2/3). Physical therapists cannot properly manage patients based on a physician referred diagnosis of "pain," therefore, it is necessary for physical therapists to make further diagnoses.