Reliability and Validity of Clinical Tests for Measuring Strength or Endurance of Cervical Muscles: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the reliability and validity of clinical tests for measuring cervical muscle strength or endurance in participants with and without neck pain. DATA SOURCE: Systematic review and meta-analysis on reliability and validity. Literature search was conducted on January 28, 2020, using 5 databases: MEDLINE, Cumulative Index to Nursing and Allied Health, EMBASE, SPORTDiscus, and Scopus. STUDY SELECTION: We included studies that investigated the reliability or validity of clinical tests for measuring cervical muscle strength or endurance in participants with nonspecific chronic neck pain, with or without irradiation, or healthy participants. We included only those that were viable for daily practice and of low cost. DATA EXTRACTION: Data were extracted as follows: (1) author and year of publication, (2) demographic values and health condition, (3) reported clinical tests, (4) inclusion and exclusion criteria, (5) description of test, (6) interrater reliability, and (7) intrarater reliability. For validity studies we also extracted the (8) reference method and (9) validity estimates. DATA SYNTHESIS: Methodological quality was assessed with the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies. Data on reliability and validity were extracted from included articles and then analyzed. RESULTS: Thirty-one studies were included. Cervical flexor and extensor endurance test, craniocervical flexion test (CCFT), AND cervical muscle strength using a handheld dynamometer (HHD) showed moderate to good intra- and interrater reliability (intraclass correlation coefficients ranging from 0.64-0.90). Concurrent validity was measured by only 2 studies, which do not provide adequate evidence for a recommendation. CONCLUSIONS: The cervical flexor and extensor endurance tests, CCFT, and HHD for measuring cervical strength presented an acceptable interrater and intrarater reliability.

The relationship between urinary C-Telopeptide fragments of type II collagen, knee joint load, pain, and physical function in individuals with medial knee osteoarthritis.

OBJECTIVE: Considering the osteoarthritis (OA) model that integrates the biological, mechanical, and structural components of the disease, the present study aimed to investigate the association between urinary C-Telopeptide fragments of type II collagen (uCTX-II), knee joint moments, pain, and physical function in individuals with medial knee OA. METHODS: Twenty-five subjects radiographically diagnosed with knee OA were recruited. Participants were evaluated through three-dimensional gait analysis, uCTX-II level, the WOMAC pain and physical function scores, and the 40m walk test. The association between these variables was investigated using Pearson's product-moment correlation, followed by a hierarchical linear regression, controlled by OA severity and body mass index (BMI). RESULTS: No relationship was found between uCTX-II level and knee moments. A significant correlation between uCTX-II level and pain, physical function, and the 40m walk test was found. The hierarchical linear regression controlling for OA severity and BMI showed that uCTX-II level explained 9% of the WOMAC pain score, 27% of the WOMAC physical function score, and 7% of the 40m walk test. CONCLUSION: Greater uCTX-II level is associated with higher pain and reduced physical function and 40m walk test performance in individuals with medial knee OA.

Individual joint contributions to the total support moment during the sit-to-stand task differentiate mild and moderate knee osteoarthritis.

BACKGROUND: Knee osteoarthritis tends to modify the kinematics and kinetics of the sit-to-stand task. However, it is not clear whether the different degrees of knee osteoarthritis differentiate regarding these aspects. The objective was to identify if the trunk flexion, lower limb kinetics, total support moment, and individual joint contributions to the total support moment during the sit-to-stand task are different between patients with mild and moderate knee osteoarthritis. METHODS: Sixty-two participants were grouped as follows: moderate knee osteoarthritis (n = 16), mild knee osteoarthritis (n = 25), and controls (n = 21). The participants performed a sit-to-stand task, which was analyzed using a 3D-motion system and a force plate. FINDINGS: The three phases of the sit-to-stand task were analyzed. During Phase1, the moderate osteoarthritis group decreased the total support moment (P = 0.012). During Phase2, the moderate osteoarthritis group showed higher trunk flexion (P = 0.023) and lower internal hip and knee extension moments (P ≤ 0.001 and P ≤ 0.040, respectively) when compared to controls. Also in Phase2, both the mild and moderate groups used lower total support moment (P = 0.019, and P ≤ 0.001, respectively). When compared to the controls and mild osteoarthritis group, those with moderate osteoarthritis presented higher hip joint contribution to the total support moment (P ≤ 0.001 and P = 0.006, respectively) as well as lower knee joint contribution (P ≤ 0.003 and P = 0,013, respectively). INTERPRETATION: Those with moderate osteoarthritis showed modified sit-to-stand movement pattern. While in Phase3 a higher contribution of the hip joint to the total support moment was observed, during previous phases the individuals were able to decrease the load on the knee without influencing the lower limb load distribution.

The role of hip abductor strength on the frontal plane of gait in subjects with medial knee osteoarthritis.

OBJECTIVE: This study aimed to investigate the relationship of hip abductor strength with external hip and knee adduction moments, pain and physical function, and trunk, pelvis, and hip kinematics in the frontal plane during walking in subjects with medial knee osteoarthritis. METHODS: Twenty-five subjects with medial knee osteoarthritis were evaluated through an isokinetic strength test for hip abductor, three-dimensional gait analysis (kinetics and kinematics), and pain and physical function scores. Regression models were used to control the influence of other parameters such as pain, age, gender, severity, walking speed, mass, and height. RESULTS: No relationship was found of hip abductor strength with peak of external knee adduction moment and knee adduction angular impulse. Hip abductor strength explained 17% of contralateral pelvic drop and 21% of hip adduction angle. In addition, hip abductor strength explained 4% and 1% of the variance in the WOMAC physical function score and 40-m fast paced walk test, respectively. CONCLUSION: Considering the relationship of hip abductor strength with contralateral pelvic drop and hip adduction angle, specific exercises might improve physical function and lower limb dynamic alignment during gait.

Ankle strength impairments associated with knee osteoarthritis.

BACKGROUND: Knee Osteoarthritis seems to negatively impact ankle biomechanics. However, the effect of knee osteoarthritis on ankle muscle strength has not been clearly established. This study aimed to evaluate the ankle strength of the plantar flexors and dorsiflexors of patients with knee osteoarthritis in different degrees of severity. METHODS: Thirty-seven patients with knee osteoarthritis and 15 controls, subjected to clinical and radiographic analysis, were divided into three groups: control, mild, and moderate knee osteoarthritis. Participants answered a self-reported questionnaire and accomplished a muscle torque assessment of the ankle using the Biodex dynamometer in isometric, concentric and eccentric modes. FINDINGS: The mild osteoarthritis group (peak torque=26.85(SD 3.58)) was significantly weaker than the control (peak torque=41.75(SD 4.42)) in concentric plantar flexion (P<0.05). The control and mild osteoarthritis groups were not significantly different from the moderate osteoarthritis group (peak torque=36.12(SD 4.61)) in concentric plantar flexion. There were no significant differences for dorsiflexion among the groups; however the control and moderate osteoarthritis groups presented large and medium standardized mean differences. The mild osteoarthritis group was significantly lower than the control and moderate osteoarthritis groups in the concentric plantar flexion by concentric dorsiflexion torque ratio. INTERPRETATION: Ankle function exhibited impairments in patients with knee osteoarthritis, especially in the plantar flexion torque, in which the mild osteoarthritis group was weaker than the control. Interestingly, patients with moderate knee osteoarthritis showed results similar to the control group in plantar flexion torque. The results raise the possibility of a compensatory mechanism of the plantar flexors developed by patients in more advanced degrees to balance other muscle failures.

The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis.

PURPOSE: External knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle co-activation and external knee moments during walking in subjects with medial knee osteoarthritis. METHODS: 19 controls (11 males, aged 56.6±5, and BMI 25.2±3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3±5.3, and BMI 28.2±4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups. FINDINGS: Subjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments. INTERPRETATION: Muscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population.

Kinematic alterations of the lower limbs and pelvis during an ascending stairs task are associated with the degree of knee osteoarthritis severity.

BACKGROUND: Individuals with knee osteoarthritis (OA) generally demonstrate great difficulty in ascending stairs. The strategies and compensations used by these individuals in stair activities have not been fully established. The purpose of this study was to investigate the joint kinematics of the pelvis, hip, knee and ankle throughout the gait cycle, in the sagittal and frontal planes, in individuals with mild and moderate knee OA, during an ascending stairs task. METHODS: Thirty-one individuals with knee OA and 19 controls were subjected to clinical and radiographic analysis, divided into three groups: control, mild knee OA, and moderate knee OA. Participants answered a self-reported questionnaire, carried out performance-based tests, and their kinematic data were recorded during an ascending stairs task using an eight-camera Qualisys 3D-Motion analysis system. RESULTS: The individuals with moderate degrees of knee OA demonstrated kinematic alterations in the pelvis, hip, knee, and ankle in the sagittal plane. The individuals with mild degrees of knee OA demonstrated kinematic alterations of the hip in the frontal plane, and kinematic alterations of the ankle in the sagittal plane. CONCLUSIONS: The ascending stairs task allowed verification of meaningful information regarding gait strategies used by individuals with mild and moderate knee OA. The strategies of these two groups of individuals are different for this task, although more pronounced in individuals with moderate knee OA. The findings should be taken into account in the development of rehabilitation programs.

A biomecânica e a produção do conhecimento em fisioterapia: levantamento baseado nos anais do congresso brasileiro de biomecânica / The biomechanics and the production of knowledge in physiotherapy: survey based on the proceedings of Brazilian congress of biomechanics

O aumento gradual da participação da comunidade acadêmica da Fisioterapia nas edições do Congresso Brasileiro de Biomecânica (CBB) é notório. Os Anais do CBB passaram a ser importantes veículos para a divulgação científica em Fisioterapia no Brasil; porém, a caracterização dessa produção ainda não foi feita. O objetivo do presente estudo foi realizar um levantamento bibliográfico dos estudos em Fisioterapia publicados nas edições dos Anais do CBB, desde a primeira edição em 1992 (Anais do IV CBB) até a edição publicada em 2009 (Anais do XIII CBB), a fim de identificar quais especialidades da Fisioterapia têm aplicado o conhecimento em Biomecânica no contexto clínico e/ou científico, além de caracterizar o tipo de pesquisa que se tem desenvolvido. Seis revisores independentes levantaram os estudos pertencentes à área da Fisioterapia e coletaram informações de maneira padronizada através de questionários. Os resultados evidenciaram um grande crescimento da participação das diferentes áreas da Fisioterapia ao longo das dez edições do CBB. Embora os dados sejam positivos em relação à ampliação das pesquisas em Biomecânica, verificou-se uma carência da utilização dos recursos biomecânicos para avaliar efeitos de intervenções em pacientes. Dessa forma, recomenda-se que mais estudos sejam conduzidos em contextos clínicos e com acompanhamento longitudinal, de modo a ampliar a aplicação prática das ferramentas biomecânicas no campo da intervenção, bem como aperfeiçoar a avaliação em Fisioterapia.

The increasing presence of the Physical Therapy (PT) community in the Brazilian Congress of Biomechanics (CBB) is well known. The Proceedings of the CBB Congresses have turned to important vehicles to scientific publications in Physical Therapy, but the characteristics of these studies have not been focus of analysis. Thus, the purpose of this study was to identify the contribution of PT to the studies published in the Proceedings of the CBB Congresses, from the first edition in 1992 (Proceedings of the IV CBB) to the 2009 edition (Proceedings of the XIII CBB), in order to verify which subareas of expertise in PT are applying the biomechanical knowledge on clinical and/or scientific context and the kind of research being developed. Six independent reviewers collected data related to the PT production according to standardized questionnaires. The results evidenced that the area of PT has increased its publications along the ten CBB Proceedings. Despite positive findings, we noticed a lack of biomechanical studies aimed at investigating interventions in patients. Thus, we can suggest that clinical studies with a longitudinal design could be developed in order to improve the application of biomechanical tools in therapeutic settings and to contribute to evaluation procedures in PT.

Relação entre torque extensor e relação I: Q com salto unipodal triplo horizontal em jogadores profissionais de futebol / Relationship between extensor torque and H: Q ratio with triple hop distance in professional soccer players

OBJETIVOS: 1) Determinar e comparar o torque extensor, relação I:Q e distância do salto triplo entre os membros; 2) identificar a relação entre o torque extensor e relação I:Q com o desempenho no salto triplo em jogadores profissionais de futebol. MATERIAIS E MÉTODOS: Foram selecionados 21 indivíduos, homens, idade média de 23,2 anos (± 3,6), saudáveis, sem histórico de lesões, praticantes profissionais de futebol. Os atletas foram avaliados em um dinamômetro isocinético nas velocidades de 60, 180 e 300°/s, das quais foram obtidos os picos de torque e calculada a relação I:Q nas três velocidades. Foi realizada também a avaliação funcional por meio do salto unipodal triplo horizontal, e desse foi obtida a distância saltada em metros. RESULTADOS: Não houve diferença entre membros (dominante e não dominante) para os testes (p = 0,23). Além disso, foi observada baixa correlação entre o torque extensor e teste funcional nas três velocidades (membro dominante: 60°/s_r = 0,38; 180°/s_r = 0,43*; 300°/s_r = 0,26. Membro não dominante: 60°/s_r = 0,36; 180°/s_r = 0,30; 300°/s_r = 0,48*) (*p < 0,05), assim como na relação I:Q e teste funcional (membro dominante: 60_r = 0,01; 180_r = 0,11; 300_r = - 0,02. Membro não dominante: 60_r = - 0,20; 180_r = - 0,15; 300_r = - 0,18). CONCLUSÃO: Devido à baixa correlação, não é possível substituir a avaliação isocinética pelo salto unipodal triplo horizontal (teste funcional) na avaliação da condição muscular.

OBJECTIVE: The aims of this study were: 1) to determine and compare the extensor torque, H:Q ratio and triple hop distance in functional test between lower extremities; 2) to identify the relationship between extensor torque and H:Q ratio with the performance in triple hop distance in professional soccer players. MATERIALS AND METHODS: Twenty-one healthy male professional soccer players, average 23.2 (± 3.6) years old, without history of injury were selected. The athletes were assessed in an isokinetic dynamometer at three angular velocities: 60, 180 and 300°/s, and from this assessment the peak of torque and calculated H:Q ratio at the three velocities were obtained. The triple hop distance was also used to calculate the hopped distance in meters. RESULTS: No significant difference was found between the lower extremities (dominant and non-dominant) (p = 0.23). Also, a weak relationship between extensor torque and functional test at the three velocities was observed (Dominant: 60°/s_r = 0.38; 180°/s_r = 0.43*; 300°/s_r = 0.26. Non dominant: 60°/s_r = 0.36; 180°/s_r = 0.30; 300°/s_r = 0.48*) (*p < 0.05). Similar results were found for H:Q ratio (Dominant: 60_r = 0.01; 180_r = 0.11; 300_r = - 0.02. Non-dominant: 60_r = - 0.20; 180_r = - 0.15; 300_r = - 0.18). CONCLUSION: Due to a weak relationship, the isokinetic test cannot be replaced by the triple hop distance (functional test) for muscular function assessment.

Incidência de lesões nos jogadores de futebol masculino sub-21 durante os Jogos Regionais de Sertãozinho-SP de 2006 / Injury incidence in sub-21 male soccer players during Regional Games of Sertãozinho-SP 2006

INTRODUÇÃO: O futebol, o esporte mais popular e praticado pelo mundo, é também uma das modalidades esportivas onde o atleta é submetido a diversos tipos e intensidades de esforços. Atualmente essa modalidade sofreu modificações, deixando de dar ênfase à técnica e passando a privilegiar os componentes físicos, aumentando assim a probabilidade da ocorrência de lesões. OBJETIVO: Realizar um levantamento epidemiológico das lesões no Futebol de Campo Sub-21 durante os 50ºs Jogos Regionais de Sertãozinho de 2006. METODOLOGIA: Este é um trabalho do tipo epidemiológico descritivo e analítico, com desenho transversal. Realizou-se o acompanhamento de todas as partidas da modalidade, registrando as lesões ocorridas, seguido de um levantamento e caracterização das lesões. As mesmas foram classificadas de acordo com seu perfil e segmento anatômico, posteriormente divididas por posição dos atletas. RESULTADOS: Houve maior incidência das lesões nos membros inferiores, com 127 (74,7 por cento); quanto ao perfil, as lesões musculares foram mais prevalentes, com 64 (37,6 por cento) lesões. Os atletas do meio-campo foram os mais acometidos, com 72 (42,4 por cento) lesões. Dentro da classe de goleiros e defensores a maior prevalência de contusões foi de sete (63,6 por cento) e 11 (50 por cento), respectivamente. Já os atacantes, laterais e meio-campistas apresentaram como predomínio as lesões musculares, sendo os primeiros com 11 (36,7 por cento), seguidos de 12 (34,3 por cento) dos laterais e 33 (45,8 por cento) dos meio-campistas. CONCLUSÃO: Constatou-se que ocorreu maior índice de lesões em membros inferiores, sendo estas caracterizadas como as musculares de maior prevalência. Demonstrou-se ainda que as lesões apresentadas estão diretamente relacionadas com as características de cada posição.

Soccer is one of the most popular and practiced sports in the world. It is a sport in which athletes are submitted to many types and effort intensities. This sport has changed over the years, and instead of emphasizing technique, currently the physical components are more favored, increasing hence the injury risk. OBJECTIVE: The aim of this study was to perform an epidemiological survey of sub-21 male soccer player's injuries in the Regional Games 2006. METHODS: This study was of epidemiological descriptive and analytical type, with a transversal design. All games of the modality were followed, and the injuries found were registered by their prevalence and classification. Injuries were classified according to their profile and anatomical segment and according to athletes' position as well. RESULTS: The highest prevalence of injuries was found in the lower extremities 127 (74.7 percent), and muscular injuries were the most frequent 64 (37.6 percent). Midfielders were the most affected players 72 (42.4 percent). The most frequent injury type in goalkeepers and defenders were contusions with 7 (63.6 percent) and 11 (50 percent), respectively. Strikers, outside midfielders and midfielders showed mostly muscular injuries, with 11 (36.7 percent), 12 (34.3 percent) and 33 (45.8 percent), respectively. CONCLUSIONS: In conclusion, this study demonstrated higher incidence of injuries in lower extremities in sub-21 soccer players, being muscular injuries the most common ones. The results also suggest that injuries are directly related with the characteristics of each athlete's position.