Citations

Background: Cervical muscle strength, proposed as a modifiable risk factor in concussions, can be assessed using various methods. The purpose of this study was to compare the reliability and force outputs of 3 methods that use handheld dynamometry (HHD) for assessing cervical muscle strength. Hypothesis: All 3 testing methods are reliable, and force outputs are significantly different between methods. Study Design: Repeated-measures reliability. Level of Evidence: Level 5. Methods: The study used a convenience sample of 30 participants. HHD “make tests” for cervical extension, flexion, and right and left side bending were performed using lying push tests, sitting push tests, and sitting pull tests. A sole examiner performed all tests. Two testing sessions were conducted 1 week apart. Analysis included intraclass correlation coefficients (ICCs), repeated-measures analyses of variance (α = 0.05) with post hoc Bonferroni tests, and minimal detectable change (MDC) calculations. Results: All testing methods were reliable; the lying push test had the greatest point estimate values (ICC, 0.89-0.95). Significant differences in force were found between the 3 testing methods. The MDC was most sensitive for the lying push method. Conclusion: Of the 3 cervical muscle testing methods investigated, the lying position with a push test had the largest ICC according to the point estimate and the most sensitive MDC. Force values between the 3 methods were significantly different, which suggests that consistent testing methods should be used. Clinical Relevance: Results from this study support the clinical use of an HHD “make test” in a lying position for assessing cervical muscle strength. The test is reliable and more sensitive to change compared with tests in a seated position.

Background and Purpose/Objective: Few studies have examined the efficacy of fall risk assessment tools for patients undergoing hematopoietic cell transplant (HCT). The purpose of this study was to determine whether the Hendrich II Fall Risk Model (HFRM II) can distinguish patients who fell from those who did not fall in the inpatient HCT population. Methods: Observational study. Design: Retrospective chart review. Setting: Academic medical center. Patients: Patients undergoing HCT who fell during the first 100 days posttransplant. Intervention: None. Measurements: Independent-sample t tests were performed to determine differences in HFRM II score, age, pulse, systolic and diastolic blood pressure, platelet count, hemoglobin concentration, and hematocrit for fallers compared with nonfallers. Chi-square tests of independence determined differences regarding sex, assistive device used on the day of fall, transplant type, and physical therapy. Logistic regression analysis detected odds of falling dependent on transplant type, pulse rate, and HFRM II score. Results: Forty-seven patients who fell within 100 days after HCT were control matched by transplant date with 2 nonfallers each. Significant differences included HFRM II mean score (5.36 for fallers vs 3.41 for nonfallers; t = 4.510, P < .001) and mean pulse rates (100.09 vs 88.70 bpm; t = 3.398, P = .001). Patients with allogeneic HCT were 3.46 times more likely to have fallen than those with autologous HCT (P = .007). Limitations: Potential selection bias of retrospective review. Conclusions: HCT patients with higher HFRM II scores, greater pulse rate, or allogeneic transplant were more likely to fall.

ObjectiveThe primary aim of this study was to determine the inter‐ and intrarater reliability of ultrasound (US) measurements of the ischiofemoral space (IFS) following a brief training session. A secondary aim was to determine if reliability correlated with sonographer experience.DesignProspective cohort study.SettingPhysical medicine and rehabilitation department within a tertiary care institution.ParticipantsSeven male and 3 female individuals were recruited to serve as models. Nine physician sonographers (3 postgraduate year [PGY]‐2 residents, 3 PGY‐4 residents, 3 physicians) were recruited to serve as sonographers.Methods or InterventionsSonographers received a 15‐minute educational session on identifying the IFS with US, followed by 20 minutes of practice. Models were then placed in a prone position and secured to prevent hip movement. All operators measured bilateral IFSs in each model twice with a washout period between measurements. Operators were blinded to all measurements.Main Outcome MeasuresPrimary outcomes were inter‐ and intrarater reliability interclass coefficients (ICCs) of IFS measurements among the groups with different levels of US experience. Secondary outcomes included comparisons of inter‐ and intrarater reliability ICCs of IFS measurements between groups, and the difference of mean IFS measurements between groups.ResultsIntrarater reliability ICCs were 0.829, 0.680, and 0.596 for physician, PGY‐4, and PGY‐2 groups, respectively. Interrater reliability ICCs were 0.722, 0.427, and 0.558 for physician, PGY‐4, and PGY‐2 groups, respectively. No statistically significant differences in reliability were identified between groups. Mean IFS measurements were 31.2, 33.4, and 34.0 mm for physician, PGY‐4, and PGY‐2 groups, respectively. Physician measurements were significantly smaller than the PGY‐4 and PGY‐2 measurements (P < .049 and P < .01).ConclusionsFollowing a brief training session, experienced sonographers demonstrated excellent IFS measurement intrarater reliability, whereas PGY‐4 and PGY‐2 sonographers demonstrated fair intrarater reliability. All sonographers demonstrated fair interrater reliability.Level of EvidenceII

Background: External rotation (ER) strengthening of the shoulder is an integral component of rehabilitative and preventative programs for overhead athletes. A variety of shoulder ER strengthening exercises are reported, including those intended to integrate the core musculature. The purpose of this study was to examine ER torque and electromyographic (EMG) activation of shoulder and trunk muscles while performing resisted isometric shoulder ER in 3 positions (standing, side lying, and side plank). Hypothesis: Significantly greater force and shoulder muscle activation would be generated while side lying given the inherent stability of the position, and greater trunk muscle activation would be generated in the less stable plank position. Study Design: Quasi-experimental repeated-measures study. Level of Evidence: Level 5. Methods: A convenience sample of 25 healthy overhead recreational athletes (9 men, 16 women) participated in this study. EMG electrodes were placed on the infraspinatus, posterior deltoid, middle trapezius, multifidi, internal obliques, and external obliques. EMG signals were normalized to a maximal isometric contraction. Participants performed resisted isometric ER in standing, side-lying, and side plank positions. Results were analyzed using a repeated-measures analysis of variance with post hoc Bonferroni corrections (α = 0.05). Results: There was no significant difference in ER torque between positions (α = 0.05). A significant difference in EMG activity of shoulder and trunk musculature between positions was found in 7 of the 8 muscles monitored. Significantly greater EMG activity in the infraspinatus, middle trapezius, and the nondominant external and internal obliques was found in the side plank position as compared with standing and side lying. Conclusion: While there was no difference in ER torque between the 3 exercise positions, EMG activity of the shoulder and trunk muscles was dependent on body position. Clinical Relevance: If a clinician is seeking to integrate trunk muscle activation while performing shoulder ER strengthening, the side plank position is preferred as compared with standing or side lying.