Modelling pelvic and lower extremity bone measurements for individual identification: a radiological study

Introduction:The Lower Extremity Measure (LEM) was developed to provide a specific instrument to detect changes in physical function in patients with hip fracture. Of 29 questions, 3 have a valid “not applicable” answer option. The goal of this study was to validate the LEM in German and to determine the added value to the physical functioning (pf) subscale of the Short Form 36 (SF-36).Materials and Methods:The LEM was translated according to published guidelines and administered to patients with hip fracture (31 A1-A3 and 31 B1-B3) shortly after surgery (baseline), at 3 months (3M), and for reliability testing at 3 months plus 1 week (3M+). The reproducibility, internal consistency, floor and ceiling effects, construct validity, and responsiveness of the German LEM were assessed.Results:A total of 106 patients completed the LEM and SF-36 (mean age 75.5; 67% women) at baseline (mean of 4.9 days after operation), and 88 completed both questionnaires at both the 3M and 3M+ assessments. At each assessment time point, between 6% and 23% of the patients answered 7 questions as “not applicable.” Reproducibility and internal consistency were high (intraclass correlation coefficient = 0.93; Cronbach's α = .96). No floor effect (0%) and a minor ceiling effect (7.87%) were found for the total LEM score. The strongest correlation was found between the LEM and the SF-36 subscale pf (Spearman ρ = .93). Responsiveness was similar for the SF-36 pf subscale and the LEM when using effect size (SF-36 pf 0.71 vs LEM 0.72) and better for the LEM when using standardized response mean (SF-36 pf 0.65 vs LEM 0.76).Discussion:The German LEM is a reliable, valid, and responsive measure for the self-assessment of patients after hip fracture surgery. As a number of questions are not applicable to elderly patients, the added value of this lengthy questionnaire in these often frail, sometimes cognitively impaired patients is still open for debate.

The purpose of this study was to determine whether currently published outcome measures of physical function would be suitable for use for older adults with a hip fracture. The measures that were considered were the Musculoskeletal Function Assessment (MFA) Instrument, the Older Americans' Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire physical function subscale, the Toronto Extremity Salvage Score (TESS), and the Short Form-36 (SF-36). Following suggestions by an expert panel and patient interviews, the MFA was not tested further. The TESS was modified and renamed the Lower Extremity Measure (LEM). Forty-three community-dwelling patients with a hip fracture completed the LEM, OARS, and SF-36 in the hospital so that the prefracture status could be obtained; they were then followed prospectively at six weeks and at six months. All patients were interviewed twice in the hospital to assess the reliability of the LEM (intraclass correlation coefficient = 0.85). To establish criterion validity, the measures were compared with the Timed Up and Go (TUG) test at six weeks. We tested a number of hypotheses to determine construct validity. Only the LEM scores were significantly correlated with the TUG scores (r = -0.53, p = 0.03). The LEM scores were significantly correlated with the SF-36 subscale scores and the OARS scores. Patients with at least one comorbidity had a lower mean prefracture LEM score (90.0 +/- 9.7) than patients with no comorbidity (96.9 +/- 8.1) (p = 0.02). Patients who had used no walking aids before the fracture had a higher mean prefracture LEM score than those who had used a cane (95.5 +/- 5.8 compared with 85.5 +/- 12.7; p = 0.0007). Both the LEM and the SF-36 scores changed significantly between all of the time-periods (p < 0.05). Measures of responsiveness indicated that the LEM was the best measure for detecting changes in physical function. The LEM can detect clinically important changes in physical function over time in patients with a hip fracture and would be most useful for clinical trials or cohort studies. Orthopaedists who are currently utilizing the SF-36 can be reassured that the physical function subscale is a valid measure for patients with a hip fracture.

Reliability and Validity of a Low Load Endurance Strength Test for Upper and Lower Extremities in Patients With Fibromyalgia

Selected physical capacity norms for Australian football players at the non-elite level

A reliable, versatile means of assessing visuo-motor reaction time (V-MRT) is important to football (soccer) players for many reasons, including the fact that faster V-MRT is a critical sport skill that may even play a role in reducing common sports injuries to the lower muscle extremities that can be associated with lost time on the field. We aimed to determine the test-retest reliability and minimum detectable change (MDC) of the Brain Pro System for assessing lower-extremity V-MRT in young male football players. We had 68 participants (M age = 16.35, SD = 1.71years) perform two assessment sessions one-week apart. For test-retest reliability, we calculated a one-way intra-class correlation coefficient (ICC) at the 95% confidence interval and provided the standard error of measurement (SEM) and minimum detectable change (MDC) (MDC = SEM × 1.96 × √2) for V-MRTs. We obtained excellent V-MRT test-retest reliability for dominant lower-extremity, non-dominant lower-extremity, and dominant and non-dominant lower-extremities (ICC2,1 = .93, 95%CI = .89-.96; ICC2,1 = .94, 95%CI = .91-.96; ICC2,1 = .96, 95%CI = .94-.97; respectively). The calculated MDC for the dominant lower-extremity V-MRT, the non-dominant lower-extremity V-MRT, and dominant and non-dominant lower-extremities (random) V-MRT were 1.21seconds, 1.13seconds, and 1.21seconds, respectively. Brain Pro System had excellent reliability for assessing lower-extremity V-MRT in young male football players. The MDC values at the 95% confidence level (MDC95) we obtained were reliable for assessing clinically meaningful V-MRT changes.

Background: Understanding whether there is an agreement between older persons who provide information on their functional status and clinicians who assess their function is an important step in the process of creating sound outcome instruments. Objectives: To examine whether there is agreement between self-reported and clinician assessment of similar performance items in older adults. Methods: Fifty independent older adults aged 70–91 years (mean age 80.3 ± 5.2 years) who live in the community were examined separately and blindly in two data collection sessions. Self-reported and observed lower and upper extremity physical tasks were compared. Life Function and Disability Instrument (LLFDI) was used in both sessions. We performed intra-class correlation coefficients (ICC) as indices of agreement and “mountain plots” that were based on a cumulative distribution curve. Associations between self-reported and observed function with Fear of Fall Scale (FES) and Geriatric Depression Scale (GDS) were also assessed. Results: ICCs were high between self-reported lower extremity function and observed lower extremity function (ICC = 0.83), and were poorer for self-reported and observed upper extremity function (ICC = 0.31). In both comparisons, mountain plots revealed a right shift that was larger for upper than lower extremity functions, indicating systematic differences in self-reported and observed assessments. Associations with FES and GDS were higher for self-reported than observed function. Conclusion: There is a systematic bias between self-reported and clinician observation. Professionals should be aware that information provided by patients and observation of activity assessed by clinicians could differ substantially, especially for upper extremity function.Implications for RehabilitationThere is a systematic bias between self-reported and clinician assessment of similar performance items in older adults. In general, older adults overestimate their physical function or clinicians underestimate older adults function.The bias between self-reported and clinician assessment for upper extremity function is larger than that for lower extremity function.The conclusions regarding agreement across upper extremity and lower extremity function scores are not different when using mountain plots graphs versus relying solely on the value of the ICCs. However, the graphs expand our understanding of the direction and magnitude of score differences.Professionals should be aware that information provided by patients and assessment by clinicians could differ substantially, especially for upper extremity function.

Lower extremity long bone, femoral and tibial shaft, fractures often have associated injuries. Patients with lower extremity long bone fractures in the Department of Orthopaedics can land up in high dependency unit admissions, mostly due to underlying complications. The study aimed to find out the prevalence of high dependency unit admissions among patients with lower extremity long bone fractures visiting the Department of Orthopaedics in a tertiary care centre. A descriptive cross-sectional study was conducted among patients with lower extremity long bone fractures in a tertiary care centre. The data from 1 March 2017 to 31 January 2020 was collected from the medical records from 1 August 2020 to 30 September 2020. All patients with femoral or tibial shaft fractures in isolation or a part of a multi-system injury were included. Patients with inadequate data were excluded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 507 patients with lower extremity long bone fractures, 137 (27.55%) (23.66-31.44, 95% Confidence Interval) required high dependency unit admission. Among them, 119 (86.86%) were males. A total of 71 (51.82%) cases involved 2-wheelers. The prevalence of high dependency unit admission among patients with lower extremity long bone fractures was high and majority of them required multidisciplinary approach. femoral fractures; prevalence; tibial fractures; traffic accidents.

Relationship between selected static an dynamic lower extremity measures

Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device

Medial tibial stress syndrome (MTSS) is a common lower extremity injury in track and field athletes. Many risk factors are associated with MTSS, and lower extremity performance may become altered in athletes suffering from prior symptoms, potentially increasing risk of future injury. The purpose of this study was to first examine the effect a prior history of MTSS has on lower-extremity measures, per gender, in collegiate level track and field athletes, and then determine if such measures predict future injury. Fifty-three healthy Division III collegiate track and field athletes (mean age = 19.40 ± 1.13 years) completed an injury history questionnaire along with five preseason lower-extremity functional tests including: ankle dorsiflexion (DF), single-leg anterior reach (SLAR), two timed single-leg balance (SLBAL) tests on a force plate, and single-leg hop for distance (SLH). Performance data were compared across gender and questionnaire data regarding injury history and occurrence of MTSS. Fifteen subjects (28%) reported previous MTSS symptoms within the last 2 years. Chi-square analyses revealed females experienced more diagnoses compared to males (p = .03). Independent t-tests revealed differences between gender on all SLBAL tests, as males performed better on all recorded measures (p &lt; .001 – p = .003). No significant differences were noted in lower-extremity performance tests between subjects with and without prior MTSS injuries. Regression analyses using postseason injury questionnaire data revealed prior MTSS injuries had 17.3 higher odds of experiencing MTSS during the season (adjusted odds ratio [AOR] = 17.33, 95% CI: 3.5 – 86.4; p = .001).

The main method of treatment for tumor lesions of the bones of the pelvis and lower extremities is resection of the affected bone with endoprosthesis. Functional results after oncologic endoprosthetics remain unsatisfactory in 35—40% of cases. The need to improve functional outcomes is a significant medical and social problem. Objective. To evaluate the influence of perioperative rehabilitation on functional results in oncologic patients undergoing surgical treatment with pelvic and lower limb bone resection with endoprosthesis. Material and methods. A comprehensive analysis of the treatment results of 348 patients who underwent resection of the affected pelvic and lower limb bones with endoprosthesis was performed. There were 150 (43.1%) men and 198 women (56.9%), the average age was 51.3 (19—82) years. The distribution of patients by volume and type of surgical intervention was as follows: pelvic bone resection with the use of “Lumic” type endoprosthesis was performed in 23 patients; resection of proximal femur with endoprosthesis — 124; resection of distal femur with endoprosthesis — 108; resection of proximal tibia with endoprosthesis — 75; resection of distal tibia with endoprosthesis — 6; resection of diaphyses of long bones — 12 patients. Results. In the group using the perioperative rehabilitation program, which included 167 patients, the functional results were better than in the group that did not receive the rehabilitation complex and were 81.2%. Mechanical complications were detected in 18 (10.7%) patients. The average functional results in 181 patients from the group that did not receive a full-fledged perioperative rehabilitation complex amounted to 71.8%, and mechanical complications were found in 24 patients (13.25%). Conclusion. Full-fledged perioperative rehabilitation is an important component, it significantly improves the functional outcome of the operated limb, contributes to earlier activation, restoration of self-care in the shortest time after surgery. Improvement of functional results in patients also reduces the risk of mechanical complications.

Kinematics during lower extremity functional screening tests–Are they reliable and related to jogging?

BackgroundVirtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation.ObjectiveThe objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP).MethodsItem generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability.ResultsExcellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left).ConclusionsPoor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements.

Motor slowing is associated with risk of Alzheimer's disease. Whether β-amyloid (Aβ) burden is associated with motor decline, independent of cognitive decline, is unknown. About 59 cognitively unimpaired older participants had baseline PET-PiB scans and repeated measures of lower (usual gait speed, 400-m time, Health ABC Physical Performance Battery (HABCPPB) score, total standing balance time) and upper (mean tapping time) extremity performance during a mean follow-up of 4.7 years. Linear mixed effect models examined the relationship between baseline Aβ burden and motor decline, adjusting for age, sex, body mass index, cardiovascular risk, APOE ɛ4 status, memory decline, depressive symptoms, ankle-arm index, processing speed, executive function, and cerebrovascular disease. Higher mean cortical Aβ burden was associated with greater declines in gait speed and HABCPPB score and a greater increase in 400-m time. Higher Aβ of putamen was associated with declines in all lower extremity measures, including balance. Higher Aβ of dorsolateral prefrontal cortex and lateral temporal lobe was associated with declines of gait speed and 400-m time, and of precuneus with a greater increase in 400-m time. Associations remained similar after further adjustment. In cognitively unimpaired older adults, Aβ burden overall and in specific brain regions are risk factors for lower extremity motor decline, independent of memory function. These findings provide the first empirical evidence that Aβ burden is a risk factor for mobility decline in older adults.

Background: Recent clinical guidelines for adults with neurological disabilities suggest the need to assess measures of static and dynamic balance using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) as core outcome measures. Given that the BBS measures both static and dynamic balance, it was unclear as to whether either of these instruments was superior in terms of its convergent and concurrent validity, and whether there was value in complementing the BBS with the DGI. Objective: The objective was to evaluate the concurrent and convergent validity of the BBS and DGI by comparing the performance of these two functional balance tests in people with multiple sclerosis (MS). Methods: Baseline cross-sectional data on 75 people with MS were collected for use in this study from 14 physical therapy clinics participating in a large pragmatic cluster-randomized trial. Convergent validity estimates between the DGI and BBS were examined by comparing the partial Spearman correlations of each test to objective lower extremity functional measures (Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Timed 25-Foot Walk (T25FW) test) and the self-reported outcomes of physical functioning and general health using the 36-Item Short Form Health Survey (SF-36). Concurrent validity was assessed by applying logistic regression with gait disability as the binary outcome (Patient Determined Disease Steps (PDDS) as the criterion measure). The predictive ability of two models, a reduced/parsimonious model including the BBS only and a second model including both the BBS and DGI, were compared using the adjusted coefficient of determinations. Results: Both the DGI and BBS were strongly correlated with lower extremity measures overall as well as across the two PDSS strata with correlations. In PDDS ≤ 2, the difference in the convergence of BBS with TUG and DGI with TUG was −0.123 (95% CI: −0.280, −0.012). While this finding was statistically significant at a type 1 error rate of 0.05, it was not significant (Hommel’s adjusted p-value = 0.465) after accounting for multiple testing corrections to control for the family-wise error rate. The BBS–SF-36 physical functioning correlation was at least moderate and significant overall and across both PDDS strata. However, the DGI–physical functioning score did not have a statistically significant correlation within PDDS ≤ 2. None of the differences in convergent and concurrent validity between the BBS and DGI were significant. The additional variation in 6MWT explained by the DGI when added to a model with the BBS was 7.78% (95% CI: 0.6%, 15%). Conclusions: These exploratory analyses on data collected in pragmatic real-world settings suggest that neither of these measures of balance is profoundly superior to the other in terms of its concurrent and convergent validity. The DGI may not have any utility for people with PDDS ≤ 2, especially if the focus is on mobility, but may be useful if the goal is to provide insight on lower extremity endurance. Further research leveraging longitudinal data from pragmatic trials and quasi-experimental designs may provide more information about the clinical usefulness of the DGI in terms of its predictive validity when compared to the BBS.