Aims
To investigate the intra‐ and inter‐rater reliability of two‐dimensional (2D) transperineal ultrasound imaging (USI) measures of bladder wall thickness (BWT), urethral length (UL), and ...parameters related to levator plate length (LP) and transient changes in LP during pelvic floor muscle (PFM) contraction, and on Valsalva in women who received radiation therapy (RT) for treatment of pelvic cancer.
Methods
Twenty women with a history of RT for the treatment of pelvic cancer were assessed independently by two raters on the same day. Five outcomes were assessed for reliability: BWT, UL, and LP at rest (LP‐R), during a maximal voluntary contraction of the PFMs (LP‐MVC), and during a maximal‐effort Valsalva maneuver (LP‐MVM). Reliability was determined using intra‐class correlation coefficients (ICC) and Bland–Altman analyses. Measurement error was determined using standard error of the measurement (SEM) and minimal detectable difference.
Results
Intra‐rater reliability was very good for LP‐R, LP‐MVC, LP‐MVM, and UL (ICC: 0.97 0.93–0.99, 0.95 0.88–0.98, 0.84 0.59–0.94, and 0.96 0.89–0.98, respectively). Inter‐rater reliability was very good for LP‐R (ICC: 0.82 0.55–0.93), and good for LP‐MVC, LP‐MVM, and UL (ICC: 0.79 0.46–0.92, 0.79 0.49–0.92, and 0.75 0.36–0.90, respectively). BWT had poor intra‐ and inter‐rater reliability. The variability between measurements was the smallest for LP‐R, LP‐MVC, and UL for intra‐rater assessments, and for LP‐R and UL for inter‐rater assessments. SEM values for intra‐rater assessments were LP‐R: 1.5 mm, LP‐MVC: 1.84 mm, LP‐MVM: 4.33 mm, and UL: 1.16 mm.
Conclusions
Although these results support the reliability of 2D‐transperineal USI for the evaluation of UL and PFM parameters, they do not support its use for the assessment of BWT.
Lateral ankle sprain (LAS) has often been considered an injury leading to localized joint impairments affecting the musculoskeletal system. Persistent chronic ankle instability and bilateral ...alterations in motor control after a first ankle sprain episode suggest that the origin of relapses might be a maladaptive reorganization of central motor commands. The objectives of this study were (1) to compare the quality of motor control through motor strategy variables of two groups (with and without LAS) from a military population (n = 10/group), (2) to evaluate the contribution of the lower limbs and the trunk to global body strategy and (3) to identify which global variable best estimates performance on the Star Excursion Balance Test (SEBT) for each group, reaching direction, and lower limb.
Personal and clinical characteristics of the participants of both groups were collected. Their functional ability was measured using questionnaires and they performed a series of functional tests including the SEBT. During this test, the maximal reach distance (MRD) and biomechanical data were collected to characterize whole body and segmental strategies using a 3D motion capture system.
At maximal lower limb reach, participants with LAS had a smaller variation in their vertical velocity in lowering-straightening and lowered the body centre of mass less for all injured limb conditions and some conditions with the uninjured lower limb. The global body centre of mass variables were significantly correlated to SEBT performance (MRD).
Modifications in global motor strategies were found in participants with LAS as well as a decreased performance on the SEBT for the injured and uninjured lower limbs. These results support the hypothesis that following LAS, there may be a maladaptive reorganization of the central motor commands.
3b.
In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential ...competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used.
To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context.
The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized.
Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures.
The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice.
Purpose: This proof of concept study tested the ability of a dual task walking protocol using a recently developed avatar-based virtual reality (VR) platform to detect differences between military ...personnel post mild traumatic brain injury (mTBI) and healthy controls.
Methods: The VR platform coordinated motion capture, an interaction and rendering system, and a projection system to present first (participant-controlled) and third person avatars within the context of a specific military patrol scene. A divided attention task was also added. A healthy control group was compared to a group with previous mTBI (both groups comprised of six military personnel) and a repeated measures ANOVA tested for differences between conditions and groups based on recognition errors, walking speed and fluidity and obstacle clearance.
Results: The VR platform was well tolerated by both groups. Walking fluidity was degraded for the control group within the more complex navigational dual tasking involving avatars, and appeared greatest in the dual tasking with the interacting avatar. This navigational behaviour was not seen in the mTBI group.
Conclusions: The present findings show proof of concept for using avatars, particularly more interactive avatars, to expose differences in executive functioning when applying context-specific protocols (here for the military).
Implications for rehabilitation
Virtual reality provides a means to control context-specific factors for assessment and intervention.
Adding human interaction and agency through avatars increases the ecologic nature of the virtual environment.
Avatars in the present application of the Virtual Reality avatar interaction platform appear to provide a better ability to reveal differences between trained, military personal with and without mTBI.
Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse ...effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.
We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.
Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (
= 11), occupational therapy (
= 2), prosthetics (
= 1), exercise physiology (
= 1) and multidisciplinary (
= 4) services. The methodological quality varied (
= 10 high quality,
= 6 medium,
= 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.
This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.
To quantify the contribution of each scapular rotation to the scapular total range of motion (ROM) in both shoulders of persons with a unilateral shoulder impingement syndrome (SIS), to compare ...3-dimensional (3D) scapular attitudes of their symptomatic and asymptomatic shoulders in flexion and in abduction, and to characterize the scapular behavior of these subjects by classifying them into subgroups based on scapular tilting differences between their symptomatic and asymptomatic shoulders.
Comparisons of 3D scapular attitudes, scapular total ROM, and percentage of contributions of each scapular rotation to the scapular total ROM.
A motricity laboratory.
Fifty-one subjects, including 41 with a SIS (29 had an asymptomatic contralateral shoulder) and 10 healthy subjects.
The 3D scapular attitudes were calculated with the subjects in a standardized seated position; with the arm at rest; or at 70 degrees, 90 degrees, and 110 degrees of shoulder flexion and abduction. Axial rotation angles were calculated using a fixed set of Cardanic angles.
At 90 degrees of arm elevation, data from 10 shoulders of healthy subjects were used to set up normative values (99% confidence interval of mean 3D scapular attitudes) to compare with 3D scapular attitudes of symptomatic and asymptomatic shoulders of SIS subjects. We analyzed the scapula behavior of subjects with SIS and classified them into subgroups based on scapular anterior tilting asymmetry.
In flexion, almost half of the scapular total ROM was provided by anterior tilting (48.2%-51.3%), whereas in abduction, external rotation (40.3%-42.4%) was the main contributor. Scapular total ROM was higher in abduction than in flexion in all arm positions for both shoulder groups (P <.01). Also, 3D scapular attitude patterns of both shoulders of SIS subjects were different from those of healthy subjects. At 90 degrees, scapular asymmetry in anterior tilting allowed us to classify SIS subjects with respect to more (lead) or less (lag) scapular tilting in the affected side (P <.0001) or no difference (P =.11) between the sides (symmetrical). No significant differences (P >.05), except for a small 2 degrees difference in transverse rotation during arm flexion at 110 degrees (P =.002), were observed in 3D scapular attitudes and scapular total ROM between both shoulders of SIS subjects. Patterns of 3D scapular attitudes and scapular total ROM were significantly different between flexion and abduction arm positions (P <.05).
The contribution of rotations and scapular total ROM differed according to the plane of arm elevation in SIS subjects. Group analyses revealed no differences in 3D scapular attitudes between symptomatic and asymptomatic shoulders of subjects with unilateral SIS. This could be caused by the use, in SIS subjects, of inappropriate neuromuscular strategies affecting both shoulders. However, individual analyses revealed scapular asymmetry in the sagittal plane, which suggests that SIS subjects with less anterior tilting in the symptomatic shoulder, as compared with the asymptomatic contralateral one, may be at high risk of developing chronic SIS. This last finding provides scientific evidence to focus rehabilitation protocols toward a restoration of anterior tilting.
•Existing literature regarding handheld dynamometer (HHD) strength reference values is scarce.•The current literature includes gaps relating to strength units used and well-described protocols.•There ...is a critical need to develop HHD reference values in adults.•Considering the increased availability of high quality HHD, this issue is urgent.
To map the body of existing literature regarding reference values of maximal isometric muscle strength (MIMS) of upper and lower limbs obtained with handheld dynamometers (HHD) in healthy adults to identify potential gaps in the literature and specify future research needs.
A scoping review in which PubMed, EMBASE, CINAHL plus, PEDRO, and Cochrane databases were searched before May 1, 2020.
All studies using standardized HHD protocols for the purpose of establishing reference values in healthy adult population were included. Two independent reviewers completed an initial screening of article titles and abstracts, and the remaining articles were read in their entirety and screened according to the inclusion and exclusion criteria. Disagreements were discussed, with recourse to a third reviewer when needed.
Data of the selected studies were extracted and charted by 2 independent reviewers using a tested data extraction grid to ensure method standardization. Data were subsequently merged to produce the complete final extracted data.
Titles and abstracts of 4015 studies were screened, 46 articles were fully reviewed, and 9 manuscripts were selected for the final analysis. A large variability exists between protocols used for muscle testing in terms of type of device, measurement units, subject positioning, and muscle groups tested.
The existing literature regarding HHD reference values of MIMS is scarce and presents gaps notably relating to strength units and well-described protocols with known psychometric properties, despite the development and increased availability of high quality HHD. This observation emphasizes the critical need to develop reference values in manual dynamometry in adults to optimize the use of manual dynamometry for diagnostic and prognostic decisions.
To establish hand-held dynamometry (HHD) maximal isometric muscle torque (MIT) reference values for children and adolescents who are developing typically.
The MIT of 10 upper and lower limb muscle ...groups was assessed in 351 Caucasian youth (4 years 2 months to 17 years) using a standardized HHD protocol, previously shown to be feasible, valid, and reliable.
The mean MIT and 95% confidence interval of the mean for all muscle groups, for each of the 14 age groups (1 year age span for each group), and for each sex, were reported in both absolute (Nm) and normalized (Nm/kg) values.
These HHD reference values may be helpful in the identification of muscle strength impairments in several pediatric populations, especially when bilateral impairments are present.
Highlights (85 characters per bullet point, 3-5 bullet points) • Physical function assessments are essential in myotonic dystrophy type 1 (DM1) • Performance-based measures of walking, mobility and ...fine hand use are commonly used • Number of trials needed at a same-day test occasion was explored in 70 adults with DM1 • Depending on test, one or two trials seem sufficient for a same-day assessment • People with severe muscular impairments had difficulties to perform repeated trials
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