A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study.

BACKGROUND: Cervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated. METHODS: Twenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session. RESULTS: Intraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71-0.88 for intra-rater and 0.79-0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0-17.3% and 4.5-28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction. CONCLUSION: This study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility.

Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study-2.

OBJECTIVE: To compare cardiovascular risk factors between vegetarians and non-vegetarians in black individuals living in the USA. DESIGN: A cross-sectional analysis of a sub-set of 592 black women and men enrolled in the Adventist Health Study-2 (AHS-2) cohort of Seventh-day Adventists. SETTING: Members of the AHS-2 cohort, who lived in all states of the USA and provinces of Canada. SUBJECTS: Black/African-American members of two sub-studies of AHS-2 where blood and physiological measurements were obtained. RESULTS: Of these women and men, 25% were either vegan or lacto-ovo-vegetarians (labelled 'vegetarian/vegans'), 13% were pesco-vegetarian and 62% were non-vegetarian. Compared with non-vegetarians, the vegetarian/vegans had odds ratios for hypertension, diabetes, high blood total cholesterol and high blood LDL-cholesterol of 0·56 (95% CI 0·36, 0·87), 0·48 (95% CI 0·24, 0·98), 0·42 (95% CI 0·27, 0·65) and 0·54 (95% CI 0·33, 0·89), respectively, when adjusted for age, gender, education, physical activity and sub-study. Corresponding odds ratios for obesity in vegetarian/vegans and pesco-vegetarians, compared with non-vegetarians, were 0·43 (95% CI 0·28, 0·67) and 0·47 (95% CI 0·27, 0·81), respectively; and for abdominal obesity 0·54 (95% CI 0·36, 0·82) and 0·50 (95% CI 0·29, 0·84), respectively. Results for pesco-vegetarians did not differ significantly from those of non-vegetarians for other variables. Further adjustment for BMI suggested that BMI acts as an intermediary variable between diet and both hypertension and diabetes. CONCLUSIONS: As with non-blacks, these results suggest that there are sizeable advantages to a vegetarian diet in black individuals also, although a cross-sectional analysis cannot conclusively establish cause.

Nutritional status of highland and lowland children in Ecuador.

UNLABELLED: We assessed the nutritional status of children in Ecuador using anthropometric measurements and body composition. OBJECTIVES: To determine whether living in the highlands in Quito was a predisposing factor to poor nutrition in children. METHOD: We compared the children in highlands at 2772 m above sea level with their costal (605 m above sea level) counterparts at Santo Domingo de Los Colorados. By using the WHO standard reference 2007, we distinguished malnourished children from healthy children using Z-score of -2 as a cut-off point. RESULTS: Mean Z-score indices for both height-for-age (HFA) and weight-for-age (WFA) were found to be significantly lower among urban children than for rural children (p < 0.001). Urban children were also four times more likely of becoming mildly stunted (OR = 3.95%, 95% confidence interval (CI): 1.818-8.448) and three times more likely of being mildly underweight (OR = 3.95%, 95% CI: 1.241-7.551). CONCLUSION: Living in highland urban areas of Ecuador is a predisposing factor for poor nutrition among children.