Inclinometer Reliability for Shoulder Ranges of Motion in Individuals With Subacromial Impingement Syndrome.

OBJECTIVE: This study aimed to determine the intra- and interrater reliability of active and passive range of motion in the shoulders of individuals with subacromial impingement syndrome using a digital inclinometer. METHODS: The raters evaluated active and passive range of motion in the shoulder of 50 individuals with unilateral subacromial impingement syndrome in movements including flexion, abduction, extension, external rotation in a neutral position, external rotation with the arm at 90° of abduction, and internal rotation with the arm at 90° of abduction. The tests were performed by 2 examiners on the same day, with a 10-minute interval, and were repeated by 1 examiner after a 2- to 4-day interval. Reliability was analyzed using the intraclass correlation coefficient (ICC2,3). RESULTS: There was moderate to excellent interrater (ICC2,3 = 0.50-0.95) and intrarater (ICC2,3 = 0.74-0.94) reliability. In the interrater analysis, the standard error of measurement (SEM) ranged from 4.1° to 10°, the percentage SEM (%SEM) ranged from 2% to 17%, and the minimum detectable change ranged from 9.5° to 23.4°. In the intrarater analysis, the SEM ranged from 4° to 9.2°, %SEM ranged from 3% to 14%, and the minimum detectable change ranged from 9.3° to 21.4°. CONCLUSION: The digital inclinometer showed moderate to excellent reliability for measuring active and passive range of motion in shoulders with unilateral subacromial impingement syndrome.

Assessment of Interrater and Intrarater Reliability of Cervical Range of Motion (CROM) Goniometer.

PURPOSE: The current study was designed to assess interrater and intrarater validity of cervical range of motion measurements performed with a CROM goniometer. Material and Methods. The study involved 95 healthy university students (31 males and 64 females) aged 20-24 years. Two examiners performed measurements of cervical range of motion using a CROM goniometer. The same subjects were examined again after two weeks, in the same conditions. The results acquired by one rater during the first and the second examination were compared for reproducibility, while the results obtained by the two examiners were compared to assess validity and reliability of the tool. Cronbach's alpha was applied to determine intrarater reliability, and the values of correlations were used to assess the interrater agreement. RESULTS: Analysis of the results showed both intrarater and interrater agreement in all the measures of cervical range of motion. The highest intrarater and interrater concordance was observed in the measure of extension. Intrarater agreement for Examiner 1 was reflected by Cronbach's alpha = 0.85, and for Examiner 2 by Cronbach's alpha = 0.89. As for the interrater agreement in the measure of extension, the value of correlation in both the first and the second measurement amounted to r = 0.89. CONCLUSIONS: Measurements performed with the CROM goniometer show interrater and intrarater agreement in assessments of cervical range of motion. The CROM goniometer can be recommended for use in daily clinical practice.

A reliable Q angle measurement using a standardized protocol.

BACKGROUND: Studies have shown that Q angle measurements were unreliable. Imaging studies have largely replaced the Q angle for measuring tibial tubercle lateralization. Creating a standardized protocol to measure the Q angle, with normative values, would provide a reliable reference without expensive imaging techniques. METHODS: Thirty men and 27 women without history of knee problems or family history of dislocating kneecaps were subjects. Exclusion criteria were: patellofemoral abnormalities upon examination. We measured the Q angles of both knees using a standardized protocol and a long-armed goniometer. These data were analyzed to calculate normative values. RESULTS: For all subjects, the mean was 14.8° (≈15°), 95% confidence interval (CI): ±5.4°. The male mean was 13.5°, 95% CI: ±5.2°. The female mean was 15.9°, 95% CI: ±4.8°. There was no significant difference between the right and left knees of the males (p = 0.52), nor of the females (p = 0.62), Beta = 0.14. The 2.4° difference between male and female means was due to the average height difference between the men and women. CONCLUSIONS: This study provides a standardized Q angle measurement protocol to assess tibial tubercle lateralization at a patient's first encounter (and intra-operatively) without resorting to expensive imaging studies. These values provide a reliable reference for clinical comparison, and will allow all clinicians and sports medicine personnel to assess tubercle lateralization with reliability and validity. When using this protocol, the term "Standard Q Angle" (SQA) should be used, to avoid confusion with other measurement protocols.

Photo-Based Range-of-Motion Measurement: Reliability and Concurrent Validity in Children With Cerebral Palsy.

PURPOSE: To investigate intrarater and interrater reliability, agreement, and concurrent validity of a smartphone photography-based application compared with a universal goniometer in children with cerebral palsy. METHODS: Range of motion of hip abduction, popliteal angle, and ankle dorsiflexion was measured with a universal goniometer and a photography-based application in children with cerebral palsy, Gross Motor Function Classification System levels I to V.A 2-way random-effects intraclass correlation coefficients and Bland-Altman plots, standard error of measurement, and smallest detectable change were used for analyses. RESULTS: The application had good to excellent reliability and concurrent validity compared with a universal goniometer, while the large measurement error of both methods suggests that changes of 10° to 23° are needed to be certain that changes over time are not results of measurement error. CONCLUSIONS: A photography-based goniometer can be a reliable and valid tool when measuring range of motion in children with cerebral palsy.

Assessing the Validity and Reliability of a New Video Goniometer App for Measuring Joint Angles in Adults and Children.

OBJECTIVE: To assess the convergent validity and reliability of joint angle measurements from a new video goniometer iPhone/iPad application separately in adults, older and young children. DESIGN: Cross-sectional. SETTING: Child care and university environments. PARTICIPANTS: Fifty-four adults (mean ± SD=22.5±4.5y), 20 older children (mean ± SD=10.9±2.2y), 20 younger children (mean ± SD=1.6±0.8y) (N=94). INTERVENTIONS: Adults and older children performed both standardized static positions and functional activities. Younger children performed only a functional activity protocol. MAIN OUTCOME MEASURES: Joint angle measurements using the app were validated against a commercially validated two-dimensional goniometric software program. In addition, validity of the app was compared to a standard mechanical goniometer for the measurement of angles drawn on a white board. Intra- and interrater reliability were assessed through independent rescoring of videos. RESULTS: Correlations between joint angle estimates obtained from the app and goniometer software or a mechanical goniometer were positive and very strong (r>.900; P<.0001). The intraclass correlation coefficient (ICC) for repeated scoring from the app indicated excellent intra- and interrater reliability (ICC>.900). CONCLUSIONS: High correlations for repeated measures and comparison to gold standard angle measurement instruments suggest that the new app is a valid and reliable tool for assessing joint angles during functional activity. This tool may provide clinicians an inexpensive yet accurate method for quantification of movements and immediate feedback on range of motion during tasks in a natural environment.

Minimal detectable difference of the finger and wrist range of motion: comparison of goniometry and 3D motion analysis.

BACKGROUND: The measurement of finger and wrist range of motion (ROM) is of great importance to clinicians when assessing functional outcomes of therapeutic interventions and surgical procedures. The purpose of the study was to assess the repeatability of ROM measurements of the hand joints with manual goniometer and 3D motion capture system and to calculate the minimal detectable difference for both methods. METHODS: Active finger and wrist joints ROM of 20 healthy volunteers were assessed using a manual goniometer and 3D motion capture system. Minimal detectable difference (MDD) and standard error of measurement (SEM) were calculated for both measurement systems and compared within the same task. Maximal ROM of all joints was registered twice on two different days to evaluate the test-retest repeatability. The intraclass correlation coefficients (ICC) was calculated and examined to determine if reliability ≥ 0.70 existed. RESULTS: MDD for the 3D motion capture was between 5 and 12° except for the metacarpophalangeal joint (MCP) 1, interphalangeal joint (IP), and MCP5. SEM values lay between 2 and 4° for all joints except for the MCP5, IP, and MCP1. For the goniometric measurements, MDD and SEM were between 12-30° and 4-11°, respectively. The reliability criterion (ICC > 0.7) was achieved for the ROM measurement with the 3D motion capture system for 94% of the joints and in only 65% of the joints with the manual goniometer. CONCLUSIONS: Joint ROM assessed with 3D motion analysis showed higher test-retest agreement demonstrating overall better repeatability for this method. Because of the smaller measurement error, the 3D motion capture system has a smaller MDD. Only individual test-rest differences bigger than the MDD can be considered as real changes, and therefore, in an experimental situation, the use of a more precise measurement method can greatly reduce the number of subjects needed for a statistical significance. Goniometer measurements of some joints should be carefully interpreted, due to a low repeatability and reliability. TRIAL REGISTRATION: This study is approved by the Ethical Committee Zurich ( Kek-ZH-Nr: 2015-0395 ).

A new method of estimating scapular orientation during various shoulder movements: A comparison of three non-invasive methods.

The conventional acromion marker cluster (AMC) method used to estimate scapular orientation cannot adequately represent complex shoulder movements due to soft tissue artifacts. The regression method may have nonlinear error changes depending on humeral elevation angle and elevation plane. Therefore, we aimed to develop a new method of estimating scapular orientation using curved surface interpolation during various shoulder movements, and to compare its accuracy with conventional and regression methods. Thirteen healthy men were recruited. AMC and refractive markers for bony landmarks were placed on the skin. During the preprocess, several shoulder postures, including different arm elevations and elevation planes, were measured using the motion capture system. Premeasured data were used to calibrate the positional relationship between AMC and scapula using curved surface interpolation. Subsequently, scapular orientations were estimated by measuring AMC and body markers of any shoulder posture. To evaluate the accuracy of our methods, 25 elevation postures and six tasks involving postures common to activities of daily living were applied. For tasks requiring greater arm elevation angles, the root mean square error was less in our method than in the conventional and regression methods. Therefore, our method could improve the accuracy of estimating scapular orientation in various elevation postures.

Optimal position of lipped acetabular liners to improve stability in total hip arthroplasty-an intraoperative in vivo study.

BACKGROUND: Lipped or elevated acetabular liners are frequently used in total hip arthroplasty to improve stability. However, the optimal position of the lip is not known. The purpose of this study was to determine the optimal position of lipped acetabular liners in total hip arthroplasty performed with a posterior approach. METHODS: In 14 hips, lipped trial liners were placed intraoperatively in various positions around the posterior clock-face of the implanted acetabular shell component. For each liner position, stability of the hip was tested at maximal hip flexion with gradually increasing internal rotation until subluxation occurred, at which point the position of the hip was measured using smartphone accelerometer-based goniometers. Smartphone goniometers were first validated against a computer-assisted navigation system. Post-operative radiographs were analyzed for cup inclination angle, cup anteversion angle, and femoral offset. RESULTS: Mean cup inclination angle in our series was 31° ± 6°. The most common liner position that imparted the greatest stability to posterior subluxation was posteriorly and inferiorly (4 o'clock position for left hip, or 8 o'clock position for right hip). The range for most stable liner position for different patients varied from postero-superior (11 o'clock/1 o'clock position) to directly inferior (6 o'clock position). Comparing a non-lipped liner to a lipped liner placed in the optimal position, the average difference in internal rotation gained before dislocation was 23°. There was no association between cup inclination or anteversion angle with liner position of greatest stability. CONCLUSION: In hip replacements performed through a posterior approach and with mean cup inclination angle of 31° ± 6°, placing the lip of the elevated liner in the postero-inferior quadrant may impart more stability than in the postero-superior quadrant.

Validity of the Digital Inclinometer and iPhone When Measuring Thoracic Spine Rotation.

CONTEXT: Spinal axial rotation is required for many functional and sporting activities. Eighty percent of axial rotation occurs in the thoracic spine. Existing measures of thoracic spine rotation commonly involve laboratory equipment, use a seated position, and include lumbar motion. A simple performance-based outcome measure would allow clinicians to evaluate isolated thoracic spine rotation. Currently, no valid measure exists. OBJECTIVE: To explore the criterion and concurrent validity of a digital inclinometer (DI) and iPhone Clinometer app (iPhone) for measuring thoracic spine rotation using the heel-sit position. DESIGN: Controlled laboratory study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 23 asymptomatic healthy participants (14 men, 9 women; age = 25.82 ± 4.28 years, height = 170.26 ± 8.01 cm, mass = 67.50 ± 9.46 kg, body mass index = 23.26 ± 2.79) were recruited from a student population. MAIN OUTCOME MEASURE(S): We took DI and iPhone measurements of thoracic spine rotation in the heel-sit position concurrently with dual-motion analysis (laboratory measure) and ultrasound imaging of the underlying bony tissue motion (reference standard). To determine the criterion and concurrent validity, we used the Pearson product moment correlation coefficient (r, 2 tailed) and Bland-Altman plots. RESULTS: The DI (r = 0.88, P < .001) and iPhone (r = 0.88, P < .001) demonstrated strong criterion validity. Both also had strong concurrent validity (r = 0.98, P < .001). Bland-Altman plots illustrated mean differences of 5.82° (95% confidence interval [CI] = 20.37°, -8.73°) and 4.94° (95% CI = 19.23°, -9.35°) between the DI and iPhone, respectively, and the reference standard and 0.87° (95% CI = 6.79°, -5.05°) between the DI and iPhone. CONCLUSIONS: The DI and iPhone provided valid measures of thoracic spine rotation in the heel-sit position. Both can be used in clinical practice to assess thoracic spine rotation, which may be valuable when evaluating thoracic dysfunction.

Evaluation of knee range of motion: Correlation between measurements using a universal goniometer and a smartphone goniometric application.

BACKGROUND: Goniometers are commonly used to measure range of motion in the musculoskeletal system. Recently smartphone goniometry applications have become available to clinicians. OBJECTIVE: Compare angular measures using a universal goniometer and a smartphone application. METHODS: Thirty four healthy women with at least 20° of limited range of motion regarding knee extension were recruited. Knee flexion angles of the dominant limb were measured with a universal goniometer and the ROM© goniometric application for the smartphone. Three trained examiners compared the two assessment tools. RESULTS: Strong correlations were found between the measures of the universal goniometer and smartphone application (Pearson's correlation and interclass correlation coefficient > 0.93). The measurements with both devices demonstrated low dispersion and little variation. CONCLUSION: Measurements obtained using the smartphone goniometric application analyzed are as reliable as those of a universal goniometer. This application is therefore a useful tool for the evaluation of knee range of motion.

Tensile properties of the hip joint ligaments are largely variable and age-dependent - An in-vitro analysis in an age range of 14-93 years.

INTRODUCTION: Hip joint stability is maintained by the surrounding ligaments, muscles, and the atmospheric pressure exerted via these structures. It is unclear whether the ligaments are capable of preventing dislocation solely due to their tensile properties, and to what extent they undergo age-related changes. This study aimed to obtain stress-strain data of the hip ligaments over a large age range. METHODS: Stress-strain data of the iliofemoral (IL), ischiofemoral (IS) and pubofemoral ligament (PF) were obtained from cadavers ranging between 14 and 93 years using a highly standardized setting. Maximum strains were compared to the distances required for dislocation. RESULTS: Elastic modulus was 24.4 (IL), 22.4 (IS) and 24.9N/mm2 (PF) respectively. Maximum strain was 84.5%, 86.1%, 72.4% and ultimate stress 10.0, 7.7 and 6.5N/mm2 for the IL, IS and PF respectively. None of these values varied significantly between ligaments or sides. The IS' elastic modulus was higher and maximum strain lower in males. Lower elastic moduli of the PF and higher maximum strains for the IS and PF were revealed in the ≥55 compared to the <55 population. Maximum strain exceeded the dislocation distance of the IS without external hip joint rotation in females, and of the IS and cranial IL under external rotation in both genders. DISCUSSION: Tensile and failure load properties of the hip joint ligaments are largely variable. The IS and PF change age-dependently. Though the hip ligaments contribute to hip stability, the IS and cranial IL may not prevent dislocation due to their elasticity.

[Adolescent idiopathic scoliosis : Guideline for practical application]. / Adoleszente idiopathische Skoliose : Leitfaden für die praktische Anwendung.

Juvenile or adolescent idiopathic scoliosis is a relatively common spinal deformity, with an incidence of more than 1 %. Early diagnosis can lead to successful therapy. In the case of pathological clinical findings, the anteroposterior X­ray of the whole spine leads the way to the correct grading, according to Cobb angle measurement. Depending on the individual risk of progression, brace treatment will be started with a Cobb angle range of 20-25°. Important predictors of therapeutic success are sufficient primary corrective power and patient compliance. COBB angles of 40-50° usually lead to the recommendation for surgery, which is performed as either anterior or posterior spinal fusion in skeletally mature adolescents, depending on the grade of the deformity according to Lenke's classification. To achieve the best possible results, it is recommended that both conservative and surgical treatments are carried out by scoliosis specialists.

Fiabilidad y validez de las mediciones en hombro y codo: análisis de una aplicación de Android y un goniómetro / Reliability and validity of shoulder and elbow measurements: analysis of an Android application and a goniometer

Introducción. La evaluación precisa del rango articular conforma una tarea esencial en la labor diaria para poder valorar correctamente la progresión del tratamiento. En esta investigación nos planteamos analizar la fiabilidad y la seguridad de una aplicación bajo el sistema Android para evaluar sus características y observar su utilidad como goniómetro en la clínica para medir los ángulos articulares, al igual que se ha realizado anteriormente para evaluar la movilidad cervical y lumbar. Material y método. Se usó el mismo goniómetro y smartphone con la aplicación Clinometer para medir de manera pasiva y bilateral la flexión y rotación de hombro, y la flexión de codo de 32 sujetos que toleraran el decúbito supino. Resultados. Se obtuvieron resultados de fiabilidad inter e intraobservadores mediante el coeficiente de correlación intraclase (ICC) entre 0,87-0,99. El cambio mínimo detectable (minimal detectable change) se encontró entre 2 y 5°, siendo la validez concurrente entre el goniómetro y la aplicación de un ICC = 0,88 y de acuerdo con un nivel de concordancia del 95% puede llegar a existir una diferencia de hasta 8° si se usan indistintamente. Discusión. El uso de las tecnologías de la información han supuesto una gran revolución en nuestras actividades diarias tanto laborales como de ocio. Los resultados obtenidos en este estudio nos muestran que estos dispositivos suponen un recurso adicional para evaluar los rangos de movilidad articular, aunque debido a los intervalos óptimos de funcionamiento inherentes a estos instrumentos no es recomendable su uso de forma indistinta durante la misma evaluación de un mismo paciente (AU)

Introduction. Precise assessment of joint range is an essential task in daily practice in order to properly assess treatment progress. The aim of this study was to analyse the reliability and safety of an Android application to evaluate its characteristics and its usefulness as a clinical goniometer to measure joint angles. Previous studies have assessed the utility of the clinometer and compass applications of the iPhone to evaluate cervical and lumbar mobility. Material and method. The same goniometer and smartphone Clinometer application were used to measure passive bilateral flexion and rotation of shoulder and elbow flexion in 32 participants who tolerated the supine position. Results. Inter- and intra-observer reliability were obtained using the intraclass correlation coefficient, which ranged from 0.87 to 0.99. The minimal detectable change was between 2° and 5°. Validity was concurrent between the goniometer and the application. With an ICC = 0.88 and 95% agreement, a difference of up to 8° was observed when the two devices were used interchangeably. Discussion. The use of information technologies has revolutionised both our daily work and leisure activities. The results obtained in this study show that these devices provide an additional resource to evaluate range of motion. However, due to the optimal ranges of operation inherent in these instruments, it is not recommended to use them interchangeably in a single assessment of the same patient (AU)

The role of radiology in the quantification of digital ulnar deviation in rheumatoid arthritis patients.

BACKGROUND: Rheumatoid arthritis (RA) is a common inflammatory polyarthritis, which causes functional digital ulnar deviation (UD). Radiographic and magnetic resonance imaging (MRI) assessment of the hands is essential in RA, but its role in the quantification of UD remains unclear. PURPOSE: To compare UD measurements in RA patients between clinical goniometric assessments versus standardized radiographs and MRI. METHODS: Fifteen RA patients with clinically apparent UD and 11 RA patients without UD underwent a rheumatological examination prior to recruitment to this study. Goniometric measurements for UD at the metacarpophalangeal (MCP) joints were performed by an occupational therapist (OT). Standardized hand radiographs, and MRI studies of the dominant hand using 3T MRI scanner with 16 channel hand/wrist coil were evaluated. Angulation measurements for radiographs and MRI were performed independently by two experienced musculoskeletal radiologists who were blinded to the rheumatologist's, occupational therapist's and each other's assessments. RESULTS: Inter-observer correlation between radiologists was >0.97 for both radiographic and MRI measurements. Correlation between OT goniometric measurements and the imaging-based measurements was limited at 0.496 for radiographs and 0.317 for MRI. Correlation between imaging modalities was 0.513. Compared to OT measurements, radiographic and MRI study measurements significantly underestimate the angulation in RA patients with UD (P < 0.001). CONCLUSIONS: The results of this study demonstrated discordance between radiological and goniometric measurements of digital ulnar angulation at the MCP joints in RA patients. Although imaging plays a key role in understanding structural damage and disease activity in RA, it should be emphasized that radiological measurements underrate joint malalignment.

Efeitos do Programa Escola de Postura e Reeducação Postural Global sobre a amplitude de movimento e níveis de dor em pacientes com lombalgia crónica / Efectos de un Programa de Escuela de Postura y Reeducación Postural Global sobre rango de movimiento y niveles de dolor en pacientes con dolor lumbar crónico (AU) / Effects of School-based exercise Program of Posture and Global Postural Reeducation on the range of motion and pain levels in patients with chronic low back pain

Objetivo. Comparar os efeitos do programa escola de postura (PEP) e reeducação postural global (RPG) sobre níveis de dor e amplitude de movimento em pacientes com lombalgia crônica. Método. A amostra foi dividida em 3 grupos de 10 sujeitos: grupo submetido ao tratamento através do PEP (idade: 46.30 ± 8.50 anos); grupo submetido ao tratamento através da RPG (idade: 43.60 ± 10.93 anos) e grupo controle (idade: 44.30 ± 10.68 anos). As intervenções foram realizadas em 10 sessões. Para avaliação do quadro álgico foi utilizada a escala subjetiva de dor CR10 de Borg. Para a análise da amplitude de movimento empregou‐se o protocolo de goniometria LABIFIE para os movimentos de extensão coxofemoral (ECF) e flexão da coluna lombar (FCL). Resultados. O teste de Wilcoxon mostrou uma redução nos escores dos níveis de dor nos grupos PEP e RPG (p < 0.0001) do pré para o pós‐tratamento. As comparações intergrupos, através do teste de Kruskal‐Wallis, apresentaram diminuição dos níveis de dor para o PEP (p < 0.0001) e o RPG (p < 0.0001) quando comparados ao CG no pós‐tratamento. A ANOVA com medidas repetidas revelou um aumento na amplitude do movimento para o PEP (ECF: p = 0.006; FCL: p = 0.002) e RPG (ECF: p = 0.034; FCL: p = 0.011) do pré para o pós‐tratamento. As comparações intergrupos apresentaram maiores amplitudes de movimento para o PEP (ECF: p = 0.006; FCL: p = 0.018) e RPG (EQ: p = 0.019; FCL: p = 0.020) quando comparados ao CG no pós‐tratamento. Não houve diferenças significativas entre o PEP e RPG. Conclusão. Os tratamentos PEP e RPG se mostraram eficientes para redução da lombalgia crónica (AU)

Objetivo. Comparar los efectos de un programa de escuela de postura (PEP) y reeducación postural global (RPG) individual sobre niveles de dolor y rango de movimiento en pacientes con dolor lumbar crónico. Método. La muestra se dividió en 3 grupos de 10 sujetos: grupo tratado por PEP (edad: 46.30 ± 8.50 años), grupo tratado por RPG (edad: 43.60 ± 10.93 años) y grupo control (edad: 44.30 ± 10.68 años). Las intervenciones se llevaron a cabo en 10 sesiones. Para la evaluación del dolor se utilizó la escala subjetiva del dolor CR10 Borg. Para el análisis de rango de movimiento, se utilizó el protocolo de goniometría en los movimientos de extensión de la cadera (EC) y flexión de la columna lumbar (FCL). Resultados. La prueba de Wilcoxon mostró una reducción en los niveles de dolor en los grupos de PEP y RPG (p < 0.0001). Las comparaciones entre los grupos mediante el test de Kruskal‐Wallis mostró disminución de los niveles de dolor para el PEP (p < 0.0001) y RPG (p < 0.0001) en comparación con CG después del tratamiento. El ANOVA con medidas repetidas reveló un aumento en rango de movimiento para el PEP (EC: p = 0.006; FCL: p = 0.002) y RPG (EC: p = 0.034; FCL: p = 0.011). Las comparaciones entre los grupos mostraron un mayor rango de movimiento para el PEP (EC: p = 0.006; FCL: p = 0.018) y RPG (EC: p = 0.019; FCL: p = 0.020) en comparación con el GC después del tratamiento. No hubo diferencias significativas entre el PEP y RPG. Conclusión. Los tratamientos de PEP y RPG fueron eficaces para reducir el dolor lumbar crônico (AU)

Objective. To compare the effects of school‐based exercise program of posture (SPP) and global postural reeducation (GPR) on pain levels and range of motion in patients with chronic low back pain. Method. The sample was divided into three groups of 10 subjects: group treated by SPP (age: 46.30 ± 8.50 years) group subjected to treatment by GPR (age: 43.60 ± 10.93 years) and control group (age: 44.30 ± 10.68 years). The interventions were performed in 10 sessions. For assessment of pain was used pain subjective scale CR10‐Borg. For the analysis of range of motion, we used the protocol to goniometry LABIFIE in the movements of hip extension (HE) and flexion of the lumbar spine (FLS). Results. The Wilcoxon test showed a reduction in levels of pain scores in groups SPP and GPR (p < 0.0001) of pre to post‐treatment. Comparisons between groups by the Kruskal‐Wallis test showed decreased levels of pain for SPP (p < 0.0001) and GPR (p < 0.0001) when compared to CG post‐treatment. Repeated measures ANOVA revealed an increase in range of motion for the SPP (HE: p = 0.006; FLS: p = 0.002) and GPR (HE: p = 0.034; FLS: p = 0.011) of pre to post‐treatment. Comparisons between groups showed greater range of motion for the SPP (HE: p = 0.006; FLS: p = 0.018) and GPR (HE: p = 0.019; FLS: p = 0.020) when compared to CG post‐treatment. There were no significant differences between the SPP and GPR. Conclusions. SPP and GPR treatments were effective for reducing chronic low back pain (AU)

Validity and reliability of arm abduction angle measured on smartphone: a cross-sectional study.

BACKGROUND: Measuring range of movement is important in clinical shoulder assessment. Over the years, different techniques have been used to analyze upper limbs mobility. Smartphone image-based goniometer offers a noninvasive easy-to-use method of measuring arm abduction angle. However, the validity of this method has not been previously established. The purpose of this study was to investigate the validity and reliability of an Internet and image-based app (mROM) regarding arm abduction angle in both healthy subjects and patients suffering from shoulder damage. METHODS: Twenty three subjects with shoulder pathology (14 female, 9 male) and 14 healthy subjects (8 female, 6 male) were examined (37 shoulders). mROM app was used to measure arm abduction angle. Two examiners measured 37 shoulders on 3 separate occasions over 2 days: 2 measurements on the first day and a third one the following day. Descriptive statistics were calculated for descriptive and anthropometric variables, as well as for the first measure of arm abduction angle by photographs and inertial sensors. Reliability was investigated by intraclass correlation coefficients and p values, and validity by Pearson correlation and P. RESULTS: Intra-rater and inter-rater reliability were high (intraclass correlation coefficients 0.998 and 0.984 respectively) for the total sample, although, for the healthy group, intrareliability was lower and interreliability was no reliable. Measurements from photographs and intertial sensors were highly correlated (Pearson r = 0.964) for the total sample. However, it was no significant for the healthy group. CONCLUSION: Smartphone photographs are a reliable and valid method to measure arm abduction angle, supporting the use of photography obtained through app for measuring joint ROM. This method provides a convenient and precise tool in assessment of arm motion.

What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice.

BACKGROUND: Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren's disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren's disease. METHODS: A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren's disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified. RESULTS: Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, 'lack of joint extension' and accounted for the most frequently used. CONCLUSIONS: Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren's disease requires consistency to address issues that fall into 3 main categories: Definition of terms, Protocol statement, Outcome reporting.

Reproducibility of and sex differences in common orthopaedic ankle and foot tests in runners.

BACKGROUND: For future etiologic cohort studies in runners it is important to identify whether (hyper)pronation of the foot, decreased ankle joint dorsiflexion (AJD) and the degree of the extension of the first Metatarsophalangeal joint (MTP1) are risk factors for running injuries and to determine possible sex differences.These parameters are frequently determined with the navicular drop test (NDT) Stance and Single Limb-Stance, the Ankle Joint Dorsiflexion-test, and the extension MTP1-test in a healthy population. The aim of this clinimetric study was to determine the reproducibility of these three orthopaedic tests in runners, using minimal equipment in order to make them applicable in large cohort studies. Furthermore, we aimed to determine possible sex differences of these tests. METHODS: The three orthopaedic tests were administered by two sports physiotherapists in a group of 42 (22 male and 20 female) recreational runners. The intra-class correlation (ICC) for interrater and intrarater reliability and the standard error of measurement (SEM) were calculated. Bland and Altman plots were used to determine the 95% limits of agreements (LOAs). Furthermore, the difference between female and male runners was determined. RESULTS: The ICC's of the NDT were in the range of 0.37 to 0.45, with a SEM in the range of 2.5 to 5 mm. The AJD-test had an ICC of 0.88 and 0.86 (SEM 2.4° and 8.7°), with a 95% LOA of -6.0° to 6.3° and -5.3° to 7.9°, and the MTP1-test had an ICC of 0.42 and 0.62 (SEM 34.4° and 9.9°), with a 95% LOA of -30.9° to 20.7° and -20° to 17.8° for the interrater and intrarater reproducibility, respectively.Females had a significantly (p<0.05) lower navicular drop score and higher range of motion in extension of the MTP1, but no sex differences were found for ankle dorsiflexion (p ≥ 0.05). CONCLUSION: The reproducibility for the AJD test in runners is good, whereas that of the NDT and extension MTP1 was moderate or low. We found a difference in NDT and MTP1 mobility between female and male runners, however this needs to be established in a larger study with more reliable test procedures.

Bench testing of a knee joint arthrometer.

The KT1000 and KT2000 knee joint arthrometers (MEDmetric Corp, San Diego, California) have been shown to overestimate the measurement of knee joint sagittal laxity. The purpose of this study was to investigate the accuracy of the KT arthrometers as measures of anterior and posterior linear displacement. The anterior and posterior linear displacements of 3 KT arthrometers (2 KT1000 arthrometers and 1 KT2000 arthrometer) were compared with the simultaneous displacement measured by a precision linear Vernier Dial Test Indicator (Davenport Ltd, London, United Kingdom). The displacement calculated using the analog output of the KT2000 was also compared with the values on the KT2000 displacement dial. Compared with the Vernier Dial Test Indicator, the KT arthrometers overestimated anterior linear displacement by between 22% and 24%. True anterior displacement for all 3 arthrometers, as recorded by the Vernier Dial Test Indicator, was found by multiplying the KT value by 0.79. When compared with the Vernier Dial Test Indicator, the KT arthrometers underestimated posterior linear displacement by between 18% and 19%. True posterior displacement, as recorded by the Vernier Dial Test Indicator, was found by multiplying the KT1000 value by 1.17 and the KT2000 value by 1.16. The internal apparatus of the KT2000 and KT1000 knee joint arthrometers overestimates anterior displacement and underestimates posterior displacement with a predictable relative systematic error. Future validation studies should use these correction equations to assess the accuracy of the KT arthrometers. Sagittal plane knee laxity measured with the KT devices requires systematic correction for optimal accuracy.

Reliability of goniometry-based Q-angle.

OBJECTIVE: To establish the stability reliability, precision, and minimum value for detecting real differences for quadriceps angle (Q-angle) measurements based on standardized protocols and surface goniometry. DESIGN: An intratester reliability study. SETTING: University research laboratory. PARTICIPANTS: Fifty-two healthy, young, relatively lean adults (25 men and 27 women) from the university community with no history of knee injury. METHODS: Q-angle was assessed with surface goniometry on 2 separate occasions separated by 48 hours. Subjects assumed a supine position with: (1) extended hips and knees, (2) neutral hip rotational position, (3) neutral foot position, and (4) isometrically contracted quadriceps femoris muscles. The axis of a manual extendable-arm goniometer was placed over the center of the right patella with the proximal arm situated over the anterior-superior iliac spine and the distal arm over the center of the tibial tuberosity. MAIN OUTCOME MEASURES: Stability reliability was calculated with use of intraclass correlation (ICC, 2-way random model) and precision was calculated by standard error of measurement (SEM). The 95% limits of agreement also were calculated to estimate the minimum detectable difference in Q-angles. The lowest acceptable ICC was set at ≥0.70 for stability reliability. RESULTS: The following ICC (SEM) values were found: all subjects = 0.88 (1.0°), men = 0.77 (1.0°), and women = 0.85 (1.0°). The 95% limits of agreement were 3° for the same 3 groups. CONCLUSIONS: The surface goniometry protocol described herein appeared to be reliable for relatively lean young men and women. Although measures were precise to 1.0°, it appears a difference of 3° may be needed to detect a real difference in Q-angles when measured in this fashion.