On defining subjective and objective measurements.
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Clinical Competence↗
Biomedical subjects
J M Rothstein
Publications and source records attributed to J M Rothstein.
Reliability of isometric muscle testing of knee flexor and extensor muscles in patients with connective tissue disease.
This two-part study evaluated the reliability of inexpensive devices for isometric muscle testing on patients. First, the relationship between gauge readings of the devices and known weights was evaluated. Coefficients of determination and regression lines were used to determine the strength and nature of this relationship, which was determined to be linear. Second, intratester reliability for force measurements of isometric knee extension and flexion motions was determined for 30 patients with connective tissue diseases. Right knee extensor and flexor muscle forces were measured during two sessions. The measurements between sessions were compared for degree of agreement using intraclass correlation coefficients. Intraclass correlation coefficients ranged from .90 to .95 for knee flexor force measurements and from .75 to .85 for knee extensor force measurements. Based on the results of this study, this measuring device can be used reliably to measure knee extensor muscle force at 50 degrees and knee flexor muscle force at 30 and 70 degrees.
Adolescent↗
Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements.
Measurements of the subtalar joint neutral (STJN) position and passive range of motion (PROM) of the ankle joint and the subtalar joint (STJ) are often part of a physical therapy evaluation. These measurements may be used in treatment planning, such as in the prescription of specialized shoes or orthoses. Therefore, reliability of these measurements, as they are obtained clinically, must be determined. The purpose of this study was to examine the reliability of measurements of the STJN position and of ankle and STJ PROM. To determine reliability, repeated measurements of the STJN position and of STJ PROM were taken on the involved feet of 43 patients with neurologic orthopedic disorders (including both feet of 7 patients), and measurements of ankle PROM (dorsiflexion and plantar flexion) were taken on 42 of these patients (including both feet of 7 patients). Intraclass correlation coefficients (ICCs) for intratester reliability ranged from .74 to .90 for ankle and STJ measurements. The ICCs for intertester reliability were .25 for measuring the STJN position, .32 for STJ inversion, and .17 for SJJ eversion. The ICCs for intertester reliability were .50 for ankle dorsiflexion and .72 for ankle plantar flexion. Goniometric measurements of the STJN position and of PROM of the ankle and STJ appear to be moderately reliable if taken by the same therapist over a short period of time. With the exception of ankle plantar flexion, these measurements cannot be considered to be reliable between therapists.
Adolescent↗
Methods for taking subtalar joint measurements. A clinical report.
Physical therapists frequently evaluate the lower extremity, and this evaluation often includes measuring the subtalar joint neutral (STJN) position and subtalar joint (STJ) passive range of motion (PROM). This report critically reviews methods used to measure STJN position and STJ PROM. Standardized methods for taking these measurements, which have been clinically tested and appear to be theoretically sound, are presented. Although these methods are based on anatomical considerations, their reliability is less than optimal. However, these are the only methods of measuring STJN position and STJ PROM that have been tested adequately for reliability.
Biomechanical Phenomena↗
Clinical uses of isokinetic measurements. Critical issues.
Isokinetic measurements are widely used by physical therapists for evaluation and treatment planning. We believe that some use of isokinetic measurements is unwarranted in view of the paucity of credible scientific research on these measurements. With increased emphasis from third-party payers and from the medical community for documentation of the effectiveness of physical therapy services, we believe that therapists must be aware how they can and cannot use isokinetic measurements in their clinical settings. Concepts that relate to isokinetic testing are discussed and critically examined.
Humans↗
Reliability of the attraction method for measuring lumbar spine backward bending.
The distraction method is one method used to measure forward bending of the spine. Although this technique, which requires the use of a tape measure held over the spine and the location of anatomical landmarks, appears to be highly practical, previous studies have not examined its use for measuring backward bending. The purpose of our study was to determine the reliability of a similar technique, the attraction method, for measuring backward bending of the lumbar spine and to examine whether subjects with low back pain (LBP) could perform similar motion as subjects without LBP. Two groups composed of 100 subjects each, one with "significant" limiting low back pain (SLBP) and the other without "significant" limiting low back pain (NSLBP), were evaluated twice by a physical therapist to assess intrarater reliability. To assess interrater reliability, 11 subjects from the NSLBP Group were evaluated by a second therapist. For the total sample of 200 subjects, the intraclass correlation coefficient (ICC) for intrarater reliability was .95; for the SLBP Group, the ICC was .93; and for the NSLBP Group, the ICC was .90. For the sample of 11 NSLBP Group subjects examined for interrater reliability, the ICC was .94. Using a Kolmogorov-Smirnov test, we found the distribution for backward bending of the two groups to be significantly different. The attraction method, thus, appears to be a reliable method for measuring backward bending of the lumbar spine.
Adolescent↗
Relationships between lumbar lordosis, pelvic tilt, and abdominal muscle performance.
The purpose of this study was to examine the relationships between measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance during normal standing. In addition, the reliability of the measurements used in this study was examined. Measurements of lumbar lordosis, pelvic tilt, and abdominal muscle performance were taken of 31 healthy adults aged 20 to 33 years. Each measurement was taken twice, and the measurements were shown to be reliable. The Spearman's rho correlation of the abdominal muscle performance measurements with pelvic tilt was .18 and with lordosis was .06. The Pearson product-moment correlation of lordosis with pelvic tilt was .32. The results indicate that lumbar lordosis, pelvic tilt, and abdominal muscle function during normal standing are not related. This study demonstrates the need for a reexamination of clinical practices based on assumed relationships of abdominal muscle performance, pelvic tilt, and lordosis.
Abdominal Muscles↗
Goniometric reliability in a clinical setting. Shoulder measurements.
The purpose of this study was to examine the intratester and intertester reliabilities for clinical goniometric measurements of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. Patients were measured without controlling therapist goniometric placement technique or patient position during measurements. Repeated PROM measurements of shoulder flexion, extension, abduction, shoulder horizontal abduction, horizontal adduction, lateral (external) rotation, and medial (internal) rotation were taken of two groups of 50 subjects each. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .99. The ICCs for the intertester reliability of PROM measurements of horizontal abduction, horizontal adduction, extension, and medial rotation ranged from .26 to .55. The intertester ICCs for PROM measurements of flexion, abduction, and lateral rotation ranged from .84 to .90. Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used. The degree of intertester reliability for these measurements appears to be range-of-motion specific.
Adult↗
Pathokinesiology--a name for our times?
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Humans↗
Hypothesis-oriented algorithm for clinicians. A method for evaluation and treatment planning.
The purpose of this article is to introduce the hypothesis-oriented algorithm for clinicians (HOAC), which is designed to aid physical therapists in clinical decision making and patient management. The HOAC consists of two parts. The first part is a sequential guide to evaluation and treatment planning; the second part consists of a branching program used for reevaluation and the analysis of treatment effectiveness. Problem statements used in the HOAC are similar to those used for problem oriented medical records. The HOAC, however, requires therapists to state hypotheses about why the problems exist and to generate criteria that can be used to test the hypotheses. The benefits of the HOAC are that therapists must clearly state problems in a consistent manner, generate and list hypotheses and test criteria, develop treatment strategies and methods based solely on the hypotheses, and systematically review treatment. The rationale for treatment is identified clearly in the algorithm, facilitating the identification of inappropriate treatments (ie, those not related to the hypotheses). In addition, the branching program is used to identify where in the treatment process failures may be occurring and when a therapist needs to make a referral or seek assistance from a colleague.
Evaluation Studies as Topic↗
Intertester reliability for selected clinical tests of the sacroiliac joint.
The purpose of this study was to examine the intertester reliability of 13 tests for sacroiliac joint (SIJ) dysfunction. Eight therapists examined 17 patients in two clinical settings. In each case, two therapists independently examined the patients and obtained results on all 13 of the SIJ tests. Patients with lumbosacral pain and unilateral lower extremity symptoms of a duration less than one year were examined. All the therapists had specialized in orthopedic physical therapy and had been trained in SIJ examination. Reliability was poor; 11 of the 13 tests resulted in less than 70% agreement. The two tests that relied solely on subjective patient response and imparted no information on SIJ position or mobility were within a range of 70% to 90% agreement. Our findings suggest the necessity of reviewing examination methods for the SIJ and improving reliability of clinical testing of this joint.
Adult↗
Muscle function in rheumatic disease patients treated with corticosteroids.
Clinical and experimental data indicate that long-term corticosteroid use leads to atrophy of the type 2 muscle fibers. The purpose of this study was to characterize and quantify the nature of muscle function in rheumatic disease patients who have been on long-term corticosteroid therapy. Quadriceps function (i.e., peak torque and power) in 19 patients (11 with rheumatoid arthritis, five with systemic lupus erythematosis, and 3 other) and 11 age- and activity-matched normal controls was measured with an isokinetic dynamometer (Cybex II), during four constant velocity movements. Power was significantly lower for the patients at all speeds. At the higher speeds the patients' deficit in power production increased as indicated by a difference in the slopes of power-velocity regression lines. Measures of peak torque could not be consistently used to differentiate the groups. Patients with rheumatic diseases receiving corticosteroids have a decreased ability to generate muscle power. The method described allows for quantification of these deficits in a clinical setting.
Adrenal Cortex Hormones↗
Goniometric reliability in a clinical setting. Elbow and knee measurements.
Reliability of goniometric measurements has been examined only under standardized conditions and usually with healthy subjects. The purpose of this study was to assess goniometric reliability in a clinical setting. The reliability of goniometric measurements of passive elbow and knee positions was assessed using patients as subjects. The effect of using the means of repeated measurements and the interdevice reliability of three common goniometers were also examined. Results showed that intratester reliability for flexion and extension of the knee and the elbow joints was high (r = .91 to .99). Intertester reliability was also high (r = .88 to .97) for these measurements except for measurements of knee extension (r = .63 to .70). Although previous investigators have suggested that using the means of multiple measurements improves reliability, our data indicate that this procedure never improves the correlation coefficient more than .12. The reliability was similar for all three devices. The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable. The method described in this study provides a simple protocol that can be used clinically to investigate goniometric reliability.
Elbow Joint↗
Electromyographic, peak torque, and power relationships during isokinetic movement.
The use of isokinetic measurements for research and clinical practice becomes more meaningful when it can be demonstrated that subjects being tested at multiple velocities are making similar efforts and when the relationships between various biomechanical measures are understood. The purpose of this study was to examine 1) integrated electromyographic activity per second of the quadriceps femoris muscle at four isokinetic speeds (30, 60, 90, and 120 degrees/sec) and 2) the relationship of power to peak torque at each speed. Two groups were tested: "normals" (healthy subjects) and patients undergoing long-term steroid therapy for rheumatic diseases. The integrated electromyographic activity per second did not vary significantly across speeds, indicating that subjects in each group made equivalent efforts at all four speeds. At each speed, for each group, high correlations were found between peak torque and power. Population-specific and speed-specific linear regression equations were calculated that allowed for predictions of power from the more easily obtained clinical measure of peak torque.
Adult↗
Effect of damp on isokinetic measurements.
Meaningful use of isokinetic data requires understanding potential sources of variation and error. The purpose of this study was to examine one possible source of variation: the effect of recorder damp settings on Cybex II torque tracings. The effect of damp settings 0 through 4 at speeds of 30 degrees/sec and 75 degrees/sec was assessed by dropping loads of 13.65 kg and 36.85 kg attached to a lever arm of 30.5 cm on a Cybex II. The effect of damp settings at 180 degrees/sec was examined with the same weights at damp settings 2 and 4. Increasing damp resulted in 1) a decrease in amplitude of the entire torque curve and a decreased measurement of peak torque and 2) a shift of the torque curve to the right (later in time). The data underscore the need to record and to report the damp settings used during isokinetic testing.
Electronics, Medical↗
Muscle biology and physical therapy. A historical perspective.
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Central Nervous System Diseases↗
Muscle mutability. Part 1. General concepts and adaptations to altered patterns of use.
During the past two decades investigators have shown that muscle fiber is highly mutable. A variety of stimuli ranging from patterns of use to the nutritional state of the organism may lead to alterations in fiber structure and function. The purpose of this review is to provide the information necessary to understand muscle fiber mutability (ie, terms and muscle fiber classification schemes) and to critically review the literature about mutability in response to altered patterns of use. The relevance of these studies to physical therapy is discussed, and suggestions for clinical applications are made.
Adult↗
Muscle mutability. Part 2. Adaptation to drugs, metabolic factors, and aging.
Muscle fibers undergo changes in response to a variety of stimuli. This review examines metabolic, endocrine, and pharmacological factors that lead to alterations in muscle structure and function. These various stimuli may be considered nonphysical. This review also examines the interaction between physical stimuli (eg, exercise) and hormonal influences (eg, diabetes) on muscle. It is suggested that physical stimuli may often have a more potent effect on muscle than do nonphysical stimuli.
Adolescent↗