Biomedical subjects
J M Rothstein
Publications and source records attributed to J M Rothstein.
Direct access: beyond the diatribes.
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It's lonely laboring in the vineyards.
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Sticks and stones.
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Exercise-induced muscle soreness after concentric and eccentric isokinetic contractions.
The purpose of this two-part study was to determine whether the amount of exercise-induced muscle soreness differs between subjects who perform concentric and eccentric isokinetic contractions of their quadriceps femoris muscles. In experiment 1, subjects were randomly assigned to either an eccentric or a concentric exercise group and both groups exercised at the same power level. In experiment 2, subjects were randomly assigned to either an eccentric or a concentric exercise group and both groups exercised with maximal effort. Muscle soreness ratings, obtained by using a visual analogue scale, were taken immediately before exercise and at 24 and 48 hours postexercise. Changes in muscle soreness ratings between exercise groups from preexercise to postexercise periods were compared in both experiments, using a one-way between-subjects analysis of variance. There was no difference in the change in muscle soreness from preexercise to post-exercise periods between groups exercising at equal power levels. Subjects who exercised using eccentric contractions with maximal effort demonstrated greater increases in muscle soreness than those who performed concentric contractions. The results suggest that exercise intensity, rather than contraction type, may be the dependent factor in producing exercise-induced muscle soreness.
AIDS and the exodus.
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Heralding of break-throughs.
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Preparing to use technology.
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Validity of derived measurements of leg-length differences obtained by use of a tape measure.
Determining the difference in the length of an individual's legs is often an important component of a musculoskeletal examination. Although measurements are easily obtained with a tape measure, the validity of these measurements is not known. The purpose of this study was to examine the validity of determinations of leg-length differences (LLDs) obtained by use of a specified tape measure method (TMM). Leg-length differences using the TMM and a radiographic technique were determined for 10 subjects who were candidates for clinical leg-length measurements and for 9 healthy control subjects. Validity of the TMM measurements was determined by assessing the degree of agreement between TMM-obtained LLDs and those obtained by the radiographic method. Validity estimates as determined by intraclass correlation coefficients (ICCs) were .770 for patients, .359 for healthy subjects, and .683 for all subjects. When the means of the two values obtained by use of the TMM were compared with the radiographic measurements, the ICCs were .852 for the patient group, .637 for the healthy subjects, and .793 for all subjects. This study suggests that TMM-derived LLD measurements are valid indicators of leg-length inequality and that the estimates of validity are improved by using the average of two determinations rather than a single determination.
Reliability and validity of judgments of the integrity of the anterior cruciate ligament of the knee using the Lachman's test.
This study assessed the intratester and intertester reliability and the validity of judgments of the integrity of the anterior cruciate ligament (ACL) based on the use of the Lachman's test. End-feel and tibial translation judgments made during the Lachman's test were also assessed. Patients with unilateral knee problems (N = 32), 13 of whom had documented ACL damage, were examined by two physical therapists and two orthopedic surgeons. Intratester Kappa values for whether the test was positive or negative were .44 for physical therapists, .60 for orthopedic surgeons, and .51 for all examiners. Intertester Kappa values were .69 for the therapists, .61 for the surgeons, and .42 for all examiners. The predictive value of a positive test was 47% for all examiners, whereas the predictive value of a negative test was 70%. Results indicate that Lachman's test judgments have limited reliability and may be more useful for predicting that a patient does not have an ACL injury than for predicting that the ACL is injured. [Cooperman JM, Riddle, DL, Rothstein JM: Reliability and validity of judgments of the integrity of the anterior cruciate ligament of the knee using the Lachman's test.
Caveat emptor and conference abstracts.
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Reliability of clinical measurements of forward bending using the modified fingertip-to-floor method.
The purpose of this study was to examine the intratherapist and intertherapist reliability of measurements obtained with a modified version of the fingertip-to-floor method of assessing forward bending. With the modified fingertip-to-floor (MFTF) method, patients stand on a stool and forward bend so that measurements can be taken on patients who are able to touch the floor or reach beyond the level of the floor. Randomly paired physical therapists took repeated MFTF measurements on 73 patients with low back pain. Intraclass correlation coefficients (ICCs) were calculated for intratherapist and intertherapist reliability. The ICC value for intratherapist reliability was .98, and the ICC value for intertherapist reliability was .95. The results of this study suggest that measurements of forward bending obtained on patients with low back pain using the MFTF method are highly reliable.
Reliability of clinical measurements of lumbar lordosis taken with a flexible rule.
The purpose of this study was to examine the intratester and intertester reliability of lumbar lordosis measurements taken with a flexible rule. Two physical therapists (Tester 1 and Tester 2) took measurements on 40 subjects without low back pain (LBP) and on 40 subjects with LBP. Intraclass correlation coefficients (ICCs) were used to determine the degree of agreement between repeated measurements taken by the same therapist and between measurements taken by the two therapists. The ICC values for intratester reliability of Tester 1 were .84 for subjects without LBP and .94 for subjects with LBP. The ICC values of Tester 2 were .73 for subjects without LBP and .83 for subjects with LBP. Intertester reliability generally was poor, with ICC values of .41 for subjects without LBP and .50 for subjects with LBP. The results suggest that measurements of lumbar lordosis with a flexible rule may be reliable if taken by the same physical therapist. The degree of reliability, however, may vary from therapist to therapist. The intertester reliability of these measurements appears to be poor, but these conclusions must be interpreted carefully because of the limited number of therapists participating in this study.
Intrasession and intersession reliability of hand-held dynamometer measurements taken on brain-damaged patients.
Recent reports have characterized force measurements obtained with hand-held dynamometers from brain-damaged patients as being highly reliable. The purposes of this two-part study were to replicate essential parts of those studies and to further examine the reliability of these measurements in a clinical context. Repeated force measurements were taken from the nonparetic and paretic limbs of brain-damaged patients during the same testing session (Part 1) and during two testing sessions separated by two days (Part 2). The intratester intraclass correlation coefficients (ICCs) for all measurements taken during a single session ranged from .88 to .98. The ICCs for repeated measurements taken two days apart from the paretic limbs ranged from .90 to .98. The ICCs for repeated measurements taken two days apart from the nonparetic limbs ranged from .31 to .93. The ICCs for repeated measurements taken two days apart from the combined data for all limbs ranged from .79 to .97. Hand-held dynamometer measurements taken on brain-damaged patients appear to be highly reliable when taken during the same testing session. When repeated measurements are separated by a longer time interval, the measurements taken from the paretic limbs continue to be highly reliable, whereas most measurements taken on the nonparetic limbs exhibit poor reliability.
Intertester reliability of clinical judgments of medial knee ligament integrity.
The purpose of this study was to determine the intertester reliability of judgments based on tibiofemoral joint abduction (TFJA) tests of the medial collateral ligament (MCL). The TFJA tests were performed by three physical therapists on 50 patients with unilateral knee problems. The therapists used the techniques they normally use in clinical practice and tested TFJA with the knee in both 0 and 30 degrees of flexion. Three variables were evaluated: the amount of TFJA, pain elicited during the test, and the type of end-feel. When the test was performed with the subjects' knees in 0 degrees of flexion, the weighted Kappa value for judgments of motion was .06, the Kappa value for judgments of whether pain was elicited was .40, and the Kappa value for end-feel was .00. For the 30-degree test position, the weighted Kappa value for judgments of the amount of TFJA was .16, and the Kappa values for judgments of pain and end-feel were .33 and .38, respectively. The results suggest that judgments based on TFJA tests may not be reliable when taken in a clinical setting by physical therapists.
Hypothesis-oriented algorithms.
This has been a brief review of the HOAC system. Direct access and the use of other algorithms to guide this process fit well with the HOAC system. An example would be an algorithm designed to guide the physical therapist through the process of being the first evaluator of a patient with low back pain (Physical Therapy Department, US Public Health Service Hospital, San Francisco, Calif; unpublished data; 1976). The review of the system occurs at the first step (collect initial data). The examination of the patient occurs at step three. Step four would be to generate a working hypothesis that could lead either to referral to an appropriate practitioner or to continuation through the next step in this algorithm. The HOAC system requires the physical therapist to deal with defined problems and to document the actions that have been taken. This system lends itself to peer review and quality assurance questions. It helps the physical therapist to review his or her own performance, and it can help to identify weaknesses in patient management and at which step in the process these weaknesses occurred (eg, at the goal-setting level, at the hypothesis-generation level). By creating a better understanding of the performance of the physical therapist, this model can help determine which continuing education needs must be met. This method can also help us to understand the scientific basis for practice in that it requires testing of assumptions of treatment planning and goal achievement.(ABSTRACT TRUNCATED AT 250 WORDS)