Diagnostic Validity of Criteria for Sacroiliac Joint Pain: A Systematic Review

A systematic literature review was conducted to determine the diagnostic validity of the criteria for sacroiliac (SI) joint pain as proposed by the International Association for the Study of Pain (IASP). Databases were searched up to September 2007. Quality of the studies was assessed using a Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated together with 95% confidence intervals (CI). Statistical pooling was conducted for results of provocative tests. Eighteen studies were included. Five studies examined the pattern of SI joint pain, whereas another 5 examined stressing test specific for SI joint pain. None of the studies evaluated the diagnostic validity of the SI joint infiltration or the diagnostic validity of the IASP criteria set as a whole. In all studies, the SI joint selective infiltration was used as a gold standard; however, the technique, medications, and required pain relief after the infiltration varied considerably between the studies. Taking the double infiltration technique as reference test, the pooled data of the thigh thrust test (DOR, 18.461; CI, 5.82 to 58.53), compression test (DOR, 3.88; CI, 1.7 to 8.9), and 3 or more positive stressing tests (DOR, 17.16; CI, 7.6 to 39) showed discriminative power for diagnosing SI joint pain.PerspectiveThis review of clinical studies focused on the diagnostic validity of the IASP criteria for diagnosing SI joint pain. A meta-analysis showed that the thigh thrust test, the compression test, and 3 or more positive stressing tests have discriminative power for diagnosing SI joint pain. Because a gold standard for SI joint pain diagnosis is lacking, the diagnostic validity of tests related to the IASP criteria for SI joint pain should be regarded with care.     

A systematic review of motor control tests in low back pain based on reliability and validity

BackgroundLow back pain (LBP) is common. Motor-control-dysfunctions (MCD) might play an important role in the development of LBP.ObjectivesFind reliable and valid clinical tests to identify MCD in patients with LBP.Data sourcesPubMed and Medline Library databases were searched over a period of ten years till November 2019.Data extractionStudies examining clinical tests for MCD published in English or German were included. Studies examining clinical outcome, apparatus-based tests or acute pain were excluded. The inclusion/exclusion was determined by stated criteria and consensus between two reviewers. The risk of bias was examined by the critical appraisal tool (Brink and Louw, 2012).MethodsThe studies were assessed according to aim, population and methods and by implementing criteria from literature (Landies and Koch, 1977; Portney and Watkins, 2015).ResultsNine studies (376 patients, 23 tests) met the inclusion criteria. 22 tests examined interrater reliability, five measured intra-rater-reliability, and five assessed the construct/discriminative validity.Fifteen tests showed good/very good interrater-reliability. The intra-rater-reliability ranged from moderate to good. Two studies evaluated construct validity with good results, and one discriminative validity with poor results.ConclusionsTests with good reliability should be considered for validity testingDiscussionOf all the tests reviewed, two can be recommended for clinical use. All the other tests should undergo further evaluation or be reconsidered.LimitationsRelevant studies might be missed, since they were older than ten years, not included in the searched databases, be published in other languages, or were not picked up by the set criteria.     

Reliability of position sense testing assessed with a fully automated system

Position sense testing has increased as a tool for augmenting evaluation of joint injury. In the present study, we investigated the inter‐day reliability for four different types of position sense tests using a fully automated system. The tests included (1) passive presentation/active replication, (2) passive presentation/passive replication, (3) semi‐passive presentation/semi‐passive replication (where semi‐passive denotes passive movement during antagonist muscle contraction), and (4) active presentation/active replication. The absolute difference between presented target and replicated position was used as a measure of position sense accuracy. Ten healthy subjects who were blindfolded and seated with the arm in a moveable rig performed the tests on two occasions, separated by 3–4 days. For each type of position sense test, horizontal abduction from a starting position of 0° (relative to the sagittal plane) to target positions of 32° and 64°, and horizontal adduction from a starting position of 80° to 48° and 16° were conducted. A two‐way ANOVA revealed no differences in absolute error between days or between testing procedures. However, intra‐class correlations (ICC), which are most often used to express test–retest reliability, were moderate at best, ranging from 0·40 to 0·61 for the four types of position sense tests. Hence, the present study indicates that the ability of repositioning tests to detect alterations in proprioceptive function is limited, suggesting that their use in clinical evaluation be approached with prudence.     

Measurement properties of quality assessment tools for studies of diagnostic accuracy

ObjectivesTo determine the reliability, internal consistency, measurement error, convergent validity, and floor and ceiling effects of three quality assessment tools commonly used to evaluate the quality of diagnostic test accuracy studies in physical therapy. A secondary aim was to describe the quality of a sample of diagnostic accuracy studies.Study design and setting50 studies were randomly selected from a comprehensive database of physical therapy-relevant diagnostic accuracy studies. Two reviewers independently rated each study with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS), Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) and Diagnostic Accuracy Quality Scale (DAQS) tools in random sequence.ResultsOnly 7% of QUADAS items, 14% of QUADAS-2 items, and 33% of DAQS items had at least moderate inter-rater reliability (kappa > 0.40). Internal consistency and convergent validity measures were acceptable (>0.70) in 33% and 50% of cases respectively. Floor or ceiling effects were not present in any tool. The quality of studies was mixed: most avoided case–control sampling strategies and used the same reference standard on all subjects, but many failed to enroll a consecutive or random sample of subjects or provide confidence intervals about estimates of diagnostic accuracy.ConclusionThe QUADAS, QUADAS-2 and DAQS tools provide unreliable estimates of the quality of studies of diagnostic accuracy in physical therapy.     

The validity and accuracy of clinical diagnostic tests used to detect labral pathology of the hip: a systematic review

Acetabular labral tears are an area of increasing interest to clinicians involved in the diagnosis of musculoskeletal complaints of the hip. This review systematically evaluated the evidence for the diagnostic accuracy and validity of reported symptoms, physical examination and imaging in this complex population. Studies published in English prior to May 2010 were included. One reviewer searched information sources to identify relevant articles. Two reviewers independently assessed studies for inclusion, extracted data and evaluated quality using the Quality Assessment of Diagnostic Studies Tool. Twenty one studies were included. Meta-analysis was limited owing to heterogeneity between studies. Results showed Magnetic Resonance Arthrography to consistently outperform Magnetic Resonance Imaging. Computerised Tomography also showed high accuracy levels for the few studies identified. Studies investigating physical tests were of poor quality demonstrating a need for further research in this area. Symptoms likely to be present in patients presenting with acetabular labral tears were found to be anterior groin pain and mechanical hip symptoms; however, additional good quality studies are needed to consolidate findings.     

Reliability of Sonoelastography Measurements of Lower Limb Tendon Properties: A Systematic Review

This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.     

First Systematic Review and Meta-analysis of the Validity and Test-Retest Reliability of Physical Activity Monitors for Estimating Energy Expenditure During Walking in Individuals With Stroke

ObjectiveTo evaluate the validity and test-retest reliability of physical activity trackers (accelerometer, multisensor, smartphone, pedometer) for estimating energy expenditure during walking in individuals with stroke.Data SourcesWebline, MEDLINE, Scopus, ScienceDirect, Bielefeld Academic Search Engine, and Wiley Online Library databases from 1980 to November 2020.Study SelectionThe inclusion criteria were studies that examined the validity of portable physical activity trackers for estimating energy expenditure in individuals with stroke during walking activities compared to indirect calorimetry.Data ExtractionThis systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of the included studies was determined with the Quality Assessment of Diagnostic Accuracy Studies. The study selection was made by 2 blind observers.Data SynthesisWe screened 3677 articles; 3647 were excluded after duplicate removal and title and abstract review. Thirty articles were included for full-text analysis. Eight articles met the inclusion criteria (184 individuals with stroke) and were included in the data synthesis and meta-analysis. For all monitors, activities, and placements, the overall level of correlation with indirect calorimetry was 0.34 (95% confidence interval [CI], 0.23-0.44). After subgroups analysis, we showed that type and placement have no effect on the level of validity. Test-retest reliability was high, with intraclass correlation equal to 0.89 (95% CI, 0.76-0.95).ConclusionsPortable physical activity monitors provided a low correlation with indirect calorimetry during walking in individuals with stroke. It seems essential to pursue studies to improve their validity in this population.     

Validity and Reliability of Palpatory Clinical Tests of Sacroiliac Joint Mobility: A Systematic Review and Meta-analysis

ObjectiveThe primary objective of this review was to investigate the reliability and validity of palpatory clinical tests of sacroiliac mobility. The secondary objective was to investigate which palpatory clinical tests of sacroiliac mobility exist in the literature.MethodsPubMed, Embase, Scopus, Medline, and the Physiotherapy Evidence Database were searched. There was no restriction on the study design or participants. The data extracted from each study were sample size, study deign, and clinical test used. If there was information on reliability values, number of examiners, concurrent validity values, gold standard used, or inferential statistical test used, that was also extracted. For intraexaminer reliability, the data were expressed as κ values that were meta-analyzed using random effects.ResultsFifteen palpatory clinical tests of sacroiliac mobility were identified from 28 studies; 14 studies performed inferential statistical analysis, all including analysis of interexaminer reliability, with κ values ranging from ?0.05 to 0.77. Analysis of intraexaminer reliability was performed in 8 studies, with κ values ranging from 0.08 to 0.73. No study included in this systematic review verified the concurrent validity of the tests. Our meta-analysis of intraexaminer reliability showed moderate to good agreement results for the Gillet test (κ = 0.46), the standing flexion test (κ = 0.61), and the sitting flexion test (κ = 0.68).ConclusionWe found 15 palpatory clinical tests of sacroiliac mobility in this systematic review. According to our meta-analysis, only the sitting flexion test obtained a good and statistically significant intraexaminer agreement. Further studies are necessary to evaluate the reliability and validity of these tests.     

Movement control tests for the lumbopelvic complex. Are these tests reliable and valid?

This study evaluated inter- and intra-observer reliability and discriminative validity of three movement control tests: 1) standing knee-lift test; 2) static lunge test; and 3) dynamic lunge test. Thirty-eight subjects, 21 with low-back pain and 17 healthy, were video-recorded while performing the tests. Four physical therapists scored the tests according to a standardized protocol and calculated a composite score for each test based on the number of incorrect test components. Inter-observer reliability for the composite scores ranged between 0.68 and 0.80 (ICC 2,k) and intra-observer reliability between 0.54 and0.82 (ICC 2,1). The separate test components ranged between 0.32 and 0.91 (κ_free) for inter-observer reliability and 0.42 and1.00 for intra-observer reliability. Test components showing the highest values were: back extension; arm lowering; and shoulders moving backwards. Components hip hitch, trunk lateral flexion, knee not lifted straight up and hips moving backwards did not reach accepted thresholds. Discriminative validity ranged between 0.47 and 0.56 (AUC). As our results showed an overall good agreement for the composite, scores and for the majority of the included test components the tests can be considered reliable enough. As the tests’ discriminative ability was close to “none”, they should, however, not be used for diagnostic purposes but should be further evaluated toward predicted validity.     

The Pediatric Version of the Eating Assessment Tool: a caregiver administered dyphagia-specific outcome instrument for children

Purpose: To develop and evaluate the psychometric properties of the Pediatric version of the caregiver administered Eating Assessment Tool.

Methods: The study included developmental phase and reported content, criterion validity, internal consistency and test–retest reliability of the Pediatric Eating Assessment Tool. Literature review and the original Eating Assessment Tool were used for line-item generation. Expert consensus assessed the items for content validity over two Delphi rounds. Fifty-one healthy children to obtain normative data and 138 children with cerebral palsy to evaluate test–retest reliability, internal consistency, and criterion validity were included. The Penetration-Aspiration Scale was used to assess criterion validity.

Results: All items were found to be necessary. Content validity index was 0.91. The mean score of Pediatric Eating Assessment Tool for healthy children and children with cerebral palsy was 0.26?±?1.83 and 19.5?±?11, respectively. The internal consistency was high with Cronbach’s alpha =0.87 for test and retest. An excellent correlation between the Pediatric Eating Assessment Tool and Penetration-Aspiration score for liquid and pudding swallowing was found (p?r?=?0.77; p?r?=?0.83, respectively). A score >4 demonstrated a sensitivity of 91.3% and specificity of 98.8% to predict penetration/aspiration.

Conclusions: The Pediatric Eating Assessment Tool was shown to be a valid and reliable tool to determine penetration/aspiration risk in children.

• Implications for rehabilitation

• The pediatric eating assessment tool: a new dyphagia-specific outcome survey for children.

• The Pediatric Version of the Eating Assessment Tool is a dysphagia specific, parent report outcome instrument to determine penetration/aspiration risk in children.

• The Pediatric Version of the Eating Assessment Tool has good internal consistency, test–retest reliability and criterion-based validity.

• The Pediatric Version of the Eating Assessment Tool may be utilized as a clinical instrument to assess the need for further instrumental evaluation of swallowing function in children.

     

Psychometric properties of functional postural control tests in children: A systematic review

BackgroundPostural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly.ObjectiveTo facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice.MethodsSystematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted.ResultsSeventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems.ConclusionCurrently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.     

Inter- and intrarater reliability of isokinetic thigh muscle strength tests in postmenopausal women with osteopenia

Eitzen I, Hakestad KA, Risberg MA. Inter- and intrarater reliability of isokinetic thigh muscle strength tests in postmenopausal women with osteopenia.ObjectiveTo evaluate inter- and intrarater reliability of isokinetic muscle strength measurements during knee extension and flexion in postmenopausal women with osteopenia.DesignReliability study assessing inter- and intrarater reliability.SettingGeneral community.ParticipantsA convenience sample of 27 postmenopausal women (mean age ± SD, 68.2±7.3y) with defined osteopenia from a bone mineral density T score of less than 1.5 and a wrist fracture within the last 2 years.InterventionsNot applicable.Main Outcome MeasuresIsokinetic concentric muscle strength during knee extension and flexion was measured for 2 test conditions: 5 repetitions at 60°/s, and 25 repetitions at 180°/s. Agreement between tests was evaluated with the intraclass correlation coefficient (ICC_2,1). Mean difference between tests, standard error of measurement (SEM and SEM%), and smallest real difference (SRD and SRD%) were calculated with 95% confidence intervals. SRD% and SEM% are emphasized in the results to allow congruent comparisons between the different test conditions.ResultsICC_2,1 reflected high agreement both for inter- and intrarater reliability, with most of the values .90 or greater. There were no significant differences between the left and the right leg at any of the 3 tests. Some differences were apparent between the test sessions, but these were not systematic. Agreements were overall higher for assessments during knee extension than knee flexion. The SEM% was between 3.5% and 10.2% for knee extension, and 7.0% and 17.7% for knee flexion. SRD% was suggested to be between 15% and 20% for knee extension, and 25% and 30% for knee flexion.ConclusionsIsokinetic assessments of thigh muscle strength in postmenopausal women with osteopenia are of high reliability, with a level of agreement comparable to the levels found in previous reliability studies concerning both the healthy elderly and elderly with different health conditions. The measurement errors are small to moderate. The established SRD% provides thresholds for whether observed changes in strength in this patient group represent true change, which allows evaluations of minimal clinical importance in future studies.     

Joint position sense in elderly fallers: a preliminary investigation of the validity and reliability of the SENSERite measure

OBJECTIVES: To establish the validity and reliability of the SENSERite system and to determine and compare proprioceptive acuity thresholds (PATs) among 3 groups. DESIGN: Between groups, repeated measures, with randomized sequence. SETTING: University research laboratory. PARTICIPANTS: Forty-six adults recruited into 1 of 3 groups: group 1, 10 healthy young adults (mean age, 22.20y); group 2, 22 healthy older adults (mean age, 73.12y); and group 3, 14 older adults with a history of falls (mean age, 73.21y). INTERVENTIONS: The validity of SENSERite's joint position measure was determined by comparing the system's performance with a validated goniometer measure. The test-retest reliability was determined by repeatedly measuring the established joint positions for the neutral, inversion, eversion, plantarflexion, and dorsiflexion on 2 separate occasions, approximately 24 hours apart. In addition, PATs were measured to determine group differences. Data were analyzed by means of a univariate analysis of variance (ANOVA), intraclass correlation coefficient (ICC(2,k)), and paired t tests. MAIN OUTCOME MEASURES: Error in active reproduction of position and PAT derived from the 5 respective joint position sense tests. RESULTS: Excellent clinical goniometer and SENSERite correlation (ICC(2,k)=1.0, P<.05) was found. The test-retest reliability for the 5 respective position sense tests were excellent (ICC(2,k) range, .88-.99; P<.05). ANOVA revealed a significant difference in PATs among the 3 groups. Post hoc analysis indicated that PAT was greater in groups 2 and 3 than in group 1. No significant difference in PAT was observed between groups 2 and 3. CONCLUSIONS: The ability of the SENSERite to measure joint angular position was as good as that of a clinical goniometer; it had an adequate reliability when tested on 2 separate occasions. The device detected differences between elderly and young subjects, but it did not discriminate differences between fallers and nonfallers. This finding indicates that there is no significant difference between the fallers and nonfallers in proprioceptive acuity.     

Clinimetric properties of the SATIS-Stroke questionnaire in the Brazilian population: A satisfaction assessment measure addressing activities and participation after a stroke

BackgroundSATIS-Stroke questionnaire has been translated and adapted for use in the Brazilian population, however, it is necessary to test the measurement properties in Brazilian population.ObjectiveTo test the reliability, agreement, concurrent validity, and diagnostic accuracy of the SATIS-Stroke.MethodsChronic stroke survivors were included. The calculations were made using scores in logits (Rasch Model). Reliability was tested using the intraclass correlation coefficient (ICC_2,1), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots. Concurrent validity was analyzed using Spearman's correlation coefficient. For such, the correlation between SATIS-Stroke and Stroke Specific Quality of Life (SS-QOL) questionnaires was determined. Diagnostic accuracy was estimated based on the area under the receiver operating characteristic (ROC) curve with a 95% confidence interval and considering the sensitivity and specificity of SATIS-Stroke in differentiating different types of activity and participation.ResultsEighty stroke survivors were analyzed. Mean age was 57.98±13.85 years and 45.2% had severe impairment. Excellent reliability was found (intra-observer ICC_2,1 = 0.90; 95% CI: 0.84, 0.93; inter-observer ICC_2,1 = 0.89; 95% CI: 0.83, 0.93). The Bland-Altman plot demonstrated satisfactory agreement. In the analysis of concurrent validity, a strong, positive, significant correlation was found between SATIS-Stroke and SS-QOL (r_s = 0.74; p <0.001 with an r²=0.44; p=0.001). Diagnostic accuracy was satisfactory, with 80.8% sensitivity and 85.2% specificity.ConclusionThe Brazilian version of the SATIS-Stroke questionnaire exhibited adequate reliability, concurrent validity, and diagnostic accuracy. Therefore, this is a valid, reproducible measure for the assessment of satisfaction with regard to activities and participation following a stroke.     

Effects of whole body vibration exercise on lumbar-abdominal muscles activation for patients with chronic low back pain

Background

Since World Rugby changed the laws regarding scrums in the 2013–2014 season, the sustained push phase of the scrum has increased in tactical importance. Therefore, the purpose of this systematic literature review was to examine the biomechanical demands during the sustained push phase of individual, unit, and full pack scrummaging.

Methods

Pubmed, EBSCO (specifically and simultaneously searching Academic Search Premier, CINAHL, and SPORTDiscus), and Google Scholar were searched for any research that presented force production in a live or simulated rugby scrum. Study quality was appraised using the National Institute of Health’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Recorded scrum forces, positioning of players including joint angles, and testing procedures were extracted and narratively synthesized.

Results

Twenty six studies were included in the review. 50% of included studies were rated good, 31% fair, and 19% poor. Major limitations included not reporting any effect size, statistical power, or reliability. Reported group mean values for average sustained forces against a machine generally ranged from 1000 to 2000 N in individual scrums and 4000–8000 N for full packs of male rugby players older than high school age. Individuals seem to optimize their force generation when their shoulders are set against scrum machine pads at approximately 40% of body height, with feet parallel, and with knee and hip angles around 120°. A 10% difference in pack force seems to be necessary for one pack to drive another back in the scrum, but little data exist to quantify differences in force production between winning and losing packs during live scrums. Data collection within studies was not standardized, making comparisons difficult. There is a lack of data in live scrums, and the current research indicates that machine scrums may not replicate many of the demands of live scrums. There is a lack of data for female rugby players.

Conclusions

This review indicates an optimal individual body position for players to strive to achieve during scrummaging, consisting of a low body height (40% of stature) and large extended hip and knee angles (120° each).

     

Classification of non-specific low back pain: a review of the literature on classifications systems relevant to physiotherapy

Abstract

A literature search identified eight classification systems that subdivide non-specific low back pain. These eight systems were selected on the basis of the following criteria: they were all developed for the purpose of guiding choice of physiotherapeutic treatments, and they were all based on symptoms and clinical tests. A critical appraisal was performed using a systematic approach including evaluation of validity, reliability, feasibility, and generalizability. None of the classification systems fulfilled all of the requirements and none were considered to have included all relevant categories separated in a way suitable for the purpose. Studies concerning reliability and validity were rarely reported. Generally aspects of validity and reliability were only tested for a few of the criteria used for categorizing patients and construct validity and reliability of the classification systems as a whole were not tested. Future studies ought to focus on the evaluation of existing classification systems and/or the development of new ones, which are capable of meeting basic measurement criteria.     

Medication administration evaluation and feedback tool: Inter-rater reliability in the clinical setting

AimsThis study assessed the inter-rater reliability, acceptability and usability of the Medication Administration Evaluation and Feedback Tool for nurses in the clinical setting.BackgroundMedication administration is a complex nursing task requiring multiple steps to ensure safe and accurate delivery of medications to patients. Currently, registered nurses are not routinely provided the opportunity for regular review of their practice. The Medication Administration Evaluation and Feedback Tool has been previously validated in the simulated environment.MethodsFour nurse observers were trained to use the tool. Thirty nurses participated to be observed in the clinical setting. Each nurse was assessed simultaneously by two observers. Inter-rater reliability was assessed using Fleiss’ Kappa coefficient. A postobservation survey was conducted to assess user acceptability. The Guideline for Reporting Reliability and Agreement Studies Enhancing the Quality and Transparency of Health Research was used.ResultsThe observed agreement between observers using the Medication Administration Evaluation and Feedback Tool in clinical practice was 0.90 and Fleiss’ kappa coefficient was 0.77 demonstrating excellent agreement and inter-rater reliability. Both nurses and observers reported the tool was useful and practical for use in evaluating medication administration practice in the clinical environment.ConclusionsInter-rater reliability testing of the Medication Administration Evaluation and Feedback Tool in the clinical environment demonstrated it is a reliable and valid tool when used by different observers. Both nurses and observers found using the tool a positive and useful experience when evaluating medication administration practice.     

Neuromuscular changes in football players with previous hamstring injury

BackgroundImpact of prior injury on myoelectrical activity of the hamstrings during isokinetic eccentric contractions has received increased literature attention. This cross-sectional study aimed to assess neuromuscular adaptations, namely proprioception, core stability, muscle strength, extensibility and activity, in football players with history of hamstring strain injury.MethodsSeventeen players, 10 with history of hamstring injury and 7 without prior injury underwent isokinetic strength testing, eccentric knee extension at 30 and 120°/s. Myoelectrical activity of bicep femoris and medial hamstrings was calculated at 30, 50 and 100 ms after onset of contraction. Functional tests included core stability, muscle strength, and knee proprioception tests.FindingDifferences were observed between Hamstring Group injured and uninjured and Control Group dominant limbs in the bicep femoris activity at almost all times in both velocities (p < 0.05). Joint position sense error was higher in the injured side compared to uninjured and control dominant limb; additionally there were also differences between injured and uninjured limb in the triple-hop test.InterpretationPreviously injured side showed deficits in bicep femoris myoelectrical activity after onset of contraction during eccentric testing, proprioceptive deficits, and functional asymmetry.     

Concurrent Criterion-Related Validity of Acromioclavicular Joint Physical Examination Tests: A Systematic Review

Abstract

This article systematically reviews the available research on concurrent criterionrelated validity of physical examination tests for the diagnosis of acromioclavicular joint (ACJ) dysfunction. A literature search yielded four research studies on the topic of concurrent criterion-related validity of physical examination tests of the ACJ. These studies had various methodological shortcomings. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) criteria yielded scores from 1/22 to 16/22. All studies examined pain provocation tests only. The currently available best research evidence supports the inclusion of a number of tests with a specific interpretation in a physical examination format for the diagnosis of painful ACJ dysfunction. A negative finding on the cross-body adduction test, tenderness on palpation of the ACJ, and the Paxinos sign may serve to rule out a painful ACJ dysfunction. A positive finding on the active compression test, the cross-body adduction test, and the acromioclavicular resisted extension test may serve to rule in a painful ACJ dysfunction. A positive finding on all three tests for the cross-body adduction, active compression, and resisted acromioclavicular extension may be relevant when the physical therapist is considering a medical-surgical referral and associated higher-risk interventions. This review indicates that future research is required 1) to evaluate the diagnostic utility of the gold standard tests used in the studies retrieved; 2) to examine the reliability and concurrent criterion-related validity (with validated gold standard tests) of these and other physical tests and history items commonly used in the diagnosis of ACJ lesions, both isolated and in the form of multi-test regimens; and 3) to study predictive validity of findings on tests and multi-test regimens for ACJ dysfunction coupled to outcomes with diagnosis-specific (orthopedic manual) physical therapy, medical, and surgical interventions.