Detectable Change Research Articles

Interpretability and appropriate cut-off score of occiput-bed distance to indicate risk of hyperkyphosis in older adults

Background: Age-related hyperkyphosis has been described as a new geriatric syndrome. Therefore, early screening is critical. The occiput-bed distance (OBD) was developed as a new tool; however, there needed to be clear evidence supporting its clinical utility compared to the data from standard measurement. Objective: To investigate the test-retest reliability and minimal detectable change (MDC) with standard measurement error (SEM). Moreover, the practical cut-off scores to determine the risk of hyperkyphosis are crucial compared to a standard Cobb’s method. Materials and methods: This study was designed as a cross-sectional study conducted in ninety-six hyperkyphosis older adults aged at least 60 years. All participants were assessed for their hyperkyphosis using the OBD. Within seven days, they were at a hospital to complete a radiographic examination to determine the appropriate cut-off score of hyperkyphosis. Additionally, the first 30 participants were assessed for their hyperkyphosis again using the OBD to determine the interpretability. Results: The outcomes of the OBD had excellent test-retest reliability (ICC 3,3 =0.887, p<0.001). The SEM and MDC95 values were 0.75 and 2.08 cm, respectively. In addition, the cut-off score of OBD was reported to be at least 7.40 cm (sensitivity 71.80%, specificity 73.70%, and AUC =0.734) to indicate the risk of hyperkyphosis. Conclusion: The OBD is consistent, reliable, and has good diagnostic properties for hyperkyphosis. The findings confirm the use of OBD as a practical alternative method for early detection of hyperkyphosis in older individuals, particularly those who cannot stand for long and cannot access radiology.

A quick balance assessment tool for all clinical settings: validity and reliability of the Hungarian version of the activities-specific balance confidence scale

ABSTRACT Background The Activities-specific Balance Confidence Scale was developed for testing the balance confidence of elderly individuals, and it has been used extensively for evaluating various patients. No such scale has been adapted for the Hungarian population. Objective To translate and culturally adapt the Activities-specific Balance Confidence Scale and test the reliability and validity of the Hungarian version. Methods The study included 167 independently mobile subjects, of whom 39 filled in the questionnaire twice, 1 week apart. Beaton’s six-step principle was applied for cross-cultural adaptation. Reliability was assessed by internal consistency measured by Cronbach's alpha and through test–retest analysis. Types of validity evaluated were concurrent validity using the Berg Balance Scale and cross-cultural validity. Results Excellent internal consistency was shown by Cronbach’s alpha = 0.977. Test–retest analysis resulted in an Intra-Class Correlation Coefficient of 0.962 (0.865–0.961, 95% CI, p < .001) for the whole test; no floor or ceiling effects were found. The convergent validity of the scale was tested by Spearman’s rank correlation analysis using the Berg Balance scale for external validation and showed a strong positive correlation (Rho = 0.755, p < .001). Receiver Operating Characteristic curve analysis showed an Area Under the Curve of 0.821 (CI 95% 0.75, 0.892). Mean detectable change based on the 95% confidence interval was 10.49% on the scale ranging from 0 to 100%. Conclusions The Hungarian version of the Activities-Specific Balance Confidence Scale provides a valid and reliable picture of the patients’ self-assessed balance. It is recommended both for clinicians and for clinical studies.

Which Gait Tasks Produce Reliable Outcome Measures of Freezing of Gait in Parkinson's Disease?

Measurement of freezing of gait (FOG) relies on the sensitivity and reliability of tasks to provoke FOG. It is currently unclear which tasks provide the best outcomes and how medication state plays into this. To establish the sensitivity and test-retest reliability of various FOG-provoking tasks for presence and severity of FOG, with (ON) and without (OFF) dopaminergic medication. FOG-presence and percentage time frozen (% TF) were derived from video annotations of a home-based FOG-provoking protocol performed in OFF and ON. This included: the four meter walk (4MW), Timed Up and Go (TUG) single (ST) and dual task (DT), 360° turns in ST and DT, a doorway condition, and a personalized condition. Sensitivity was tested at baseline in 63 definite freezers. Test-retest reliability was evaluated over 5 weeks in 26 freezers. Sensitivity and test-retest reliability were highest for 360° turns and higher in OFF than ON. Test-retest intra-class correlation coefficients of % TF varied between 0.63-0.90 in OFF and 0.18-0.87 in ON, and minimal detectable changes (MDCs) were high. The optimal protocol included TUG ST, 360° turns ST, 360° turns DT and a doorway condition, provoking FOG in all freezers in OFF and 91.9% in ON and this could be done reliably in 95.8% (OFF) and 84.0% (ON) of the sample. Combining OFF and ON further improved outcomes. The highest sensitivity and reliability was achieved with a multi-trigger protocol performed in OFF + ON. However, the high MDCs for % TF underscore the need for further optimization of FOG measurement.

New Protocol for Evaluating Maximum Inspiratory Pressure: Concurrent Validity and Test-Retest Reliability.

The purpose of this study was to validate a maximum inspiratory pressure test protocol based on the principles of the one-repetition maximum test, assess its test-retest reliability, and establish minimal detectable change in individuals with chronic obstructive pulmonary disease (COPD). Forty-nine individuals with COPD were included in the study, of whom 44 individuals attended 2 appointments separated by 7 to 10days for test-retest reliability. The maximum inspiratory pressure test was performed using a threshold valve device (one-repetition maximum-based protocol) and the digital manometer (reference test). The one-repetition maximum-based protocol consisted of an incremental phase (inspiratory load increase [10 cmH2O] to achieve respiratory failure) and an approach phase (load halfway between the lowest failed attempt and the last valid attempt was prescribed). The concurrent validity of the one-repetition maximum-based protocol for the maximum inspiratory pressure test was good with respect to the reference test (day 1, ICC = 0.81; day 2, ICC = 0.85). The test-retest reliability was excellent (ICC = 0.92), with a standard error of measurement of 6.3 cmH2O and a minimal detectable change of 17.5 cmH2O. This study validated a new one-repetition maximum-based protocol for the maximum inspiratory pressure test using an inspiratory muscle training device in individuals with COPD, showing good concurrent validity compared with the reference test, as well as excellent test-retest reliability. The minimal detectable change reported can be interpreted and applied in the clinical setting. There was a need for developing new, inexpensive, simple, and feasible methods for the maximum inspiratory pressure test. The validation of the one-repetition maximum-based protocol addresses this issue, allowing for the appropriate prescription of inspiratory muscle training, favoring its widespread use in people with COPD and therefore improving their physical therapist care.

Recently Emerging Liquid Biopsy-based Non-invasive Methylation Biomarkers for Gastric Cancer Diagnosis, Prognosis and Therapy Response Rrediction

Cancer, a burden upon the global population, has consistently maintained its prevalence throughout history. Gastric cancer compounds this burden and ranks as the fifth leading cause of cancer-related deaths worldwide. The clinical significance of early cancer diagnosis cannot be overstated. DNA methylation biomarkers, a rapidly growing field of liquid biopsy-based diagnostics, provide a minimal to non-invasive way to detect cancer at an early stage. In addition to diagnosis and prognosis, liquid biopsy is important in longitudinal monitoring and therapeutic response prediction, where traditional biopsy faces setbacks. Despite many challenges, DNA methylation being a stable and detectable molecular change attracts the scientific community to develop novel biomarkers and analytical methods to incorporate them into clinical practice. In this review, we have discussed non-invasive, DNA methylation-based gastric cancer biomarkers that have emerged recently. We have also addressed the prognosis and therapeutic response prediction associated with these biomarkers.

Danish translation, cultural adaptation and psychometric testing of the Brachial Assessment Tool (BrAT), designed to assess activity limitation in adults with traumatic brachial plexus injuries

Purpose To translate and cross-culturally adapt The Brachial Assessment Tool (BrAT) into Danish and assess its content validity and reproducibility in adults with traumatic brachial plexus injury (BPI). Material and methods Translation followed international guidelines. BrAT(DK) were cognitive tested with 19 adults with traumatic BPI to evaluate cross-cultural understanding, relevance, comprehensiveness and comprehensibility. Content validity and reproducibility were evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Participants were recruited from an outpatient hand clinic. Test-retest reliability was assessed using intra-class-correlation coefficient (ICC) and the smallest detectable change (SDC). Internal consistency was evaluated using Cronbach’s alpha. Results Minor cultural differences were observed in the content validity analysis of BrAT(DK). Cognitive testing revealing no significant issues. All participants found the items relevant and important. 63 participants with traumatic BPI were recruited; 49 completed the retest. ICC values for the sub-scales and the total score ranged from 0.91 to 0.95 (95% CI 0.85 to 0.97). Internal consistency ranged from 0.87 to 0.98. SDC ranged from 4.16 to 9.63 for subscales and 16.01 for the total score. Conclusion BrAT(DK) appeared to be content valid and reliabel as a measure of activity limitation in adults with traumatic BPI.

Factors Influencing Long-term Outcomes After Matrix-Induced Autologous Chondrocyte Implantation: Long-term Results at 10 Years

Background: Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power. Purpose: To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model. Results: The defects had a mean size of 4.8 cm2 (range, 1.2-12 cm2) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% ± 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up (P < .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 ± 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS (R2 = 0.41; f2 = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State (χ2 = 10.93; P = .012). Conclusion: The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.

Reliability and validity of the L test in people with multiple sclerosis

ObjectivesFunctional mobility is an essential factor affecting the activities of daily living in people with multiple sclerosis (PwMS). The L test is a comprehensive assessment tool for functional mobility that incorporates sit-to-stand, transfers and bidirectional turning. The purpose of this study was to determine the psychometric properties of the L test in PwMS. DesignCross-sectional study. ParticipantsThirty-four PwMS [Expanded Disability Status Scale (EDSS) score 0 to 5] and 34 healthy controls were included in this study. Main outcome measuresThe L test was administered along with the timed up and go (TUG) test, 10-m walk test (10-MWT), 6-minute walk test (6-MWT), timed 360 degree turn test, and EDSS by the same rater. Fall history was recorded to categorize PwMS with and without a history of falls. The L test was repeated after 1 week to determine test–retest reliability. ResultsThe L test showed excellent test–retest reliability (intraclass correlation coefficient 0.995). The minimum detectable change for the L test time was 1.4 seconds. The L test demonstrated significant positive correlations with the TUG test, timed 360 degree turn test and EDSS score, and significant negative correlations with the 10-MWT and 6-MWT (P < 0.001). Significant differences in the L test times were found between PwMS and healthy controls, and between PwMS with a history of falls and those without a history of falls (P < 0.05). The cut-off time of 14.7 seconds on the L test was found to best discriminate between PwMS and healthy people, while 16.4 seconds was found to best discriminate between PwMS with a history of falls and those without a history of falls. ConclusionThe L test is a reliable and valid tool for the assessment of functional mobility in PwMS. Clinical Trial Registration numberNCT05641714. Contribution of the Paper•The L test has excellent test–retest reliability and validity in PwMS.•The L test can provide insight into functional mobility, with high scores (long completion times) warranting further specific assessment of underlying components (turning, walking, etc.) that may contribute to the longer completion times.•The L test demonstrates a more comprehensive mobility assessment using an L-shaped pathway.

Translation, cross-cultural adaptation, and validation of the Italian version of the Parkinson's disease caregiver burden questionnaire (PDCB-I).

To translate and cross-culturally adapt the Parkinson's Disease Caregiver Burden questionnaire (PDBC) into Italian language and to evaluate the psychometric properties of the Italian version in terms of test-retest reliability, internal consistency, and construct validity. The PDBC-I was developed by forward-backward translation to establish correspondence with the original English latest version. Psychometric properties were estimated in a sample of primary caregivers of individuals with Parkinson's disease. Reliability testing included internal consistency (Cronbach's alpha), test-retest reliability (ICC), the standard error of measurement (SEM) and the minimal detectable change (MDC), also expressed as percentage (MDC%). Validity was estimated by comparing the PDBC -I to the Caregiver Burden Inventory (CBI) and the Short Form 36 (SF-36) (Pearson correlation coefficient). The questionnaire was administered to 65 caregivers, showing internal consistency of 0.934. ICC value was 0.811 (95% CI 0.708-0.880) for test-retest reliability, and the SEM and the MDC (MDC%) were 5.04 and 13.97 (38.21%), respectively. Low to moderate correlation with all other investigated scales (CBI: r=0.693; SF-36 physical score: r=-0.309; SF-36 mental score: r=-0.588; SF36 total score: -0.470) were found. Despite the PDCB-I holds acceptable psychometric properties to be used in clinical settings of Italian-speaking Countries as a measure of caregiver burden in caregivers of individuals with Parkinson Disease, the caregiver might require the support of a clinician to finalize the compilation of the questionnaire.

Uphill Treadmill Running and Joint Mobilization Improve Dynamic Stability and Ankle Dorsiflexion Range of Motion in Young Adults With Chronic Ankle Instability: A Four-Arm Randomized Controlled Trial

ObjectiveTo observe the effect of uphill running and the combined effect of uphill running plus joint mobilizations on dynamic stability and ankle dorsiflexion in young adults with chronic ankle instability (CAI). DesignFour-arm randomized controlled trial. SettingA college rehabilitation center. ParticipantsIndividuals with CAI (N=73). InterventionsParticipants were randomly assigned to 4 groups: combined uphill running and joint mobilization (URJM), uphill running alone (UR), joint mobilization alone (JM), and control group. The URJM and UR groups received 20-minute running sessions, and the URJM and JM groups received ankle joint mobilizations, all 3 times a week for 4 weeks. Main Outcome MeasuresCumberland Ankle Instability Tool (CAIT) and Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions for dynamic stability; weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree using a goniometer (NWBG) for dorsiflexion. ResultsThe UR group showed significant improvements in CAIT, YBT-PL, YBT-PM, and NWBG compared to the control group. The URJM group demonstrated large treatment effects in NWBG compared to both UR and JM groups. Responder analysis indicated that the UR, JM, and URJM groups had a higher likelihood of achieving clinically significant changes (exceeding minimal detectable change or minimal clinically important difference) in CAIT, YBT-PM, YBT-PL, and NWBG compared with the control group. Additionally, the combination of UR and JM was superior to either intervention alone for NWBG, with success rates 1.55 times greater than UR alone and 2.08 times greater than JM alone. ConclusionsA 4-week UR program improves the subjective feeling of instability, dynamic postural control, and ankle dorsiflexion in young adults with CAI. Compared to UR or JM alone, their combined application can better improve the non-weight-bearing ankle dorsiflexion range of motion.

Validity, Agreement and Reliability of the ForceFrame Dynamometer in Patients with Anterior Cruciate Ligament Injury.

Restoring maximal muscle strength of the knee extensors (KE) and knee flexors (KF) following anterior cruciate ligament (ACL) injury and ACL reconstruction is of great importance to reduce the re-injury rate after ACL reconstruction and to reduce the risk of knee osteoarthritis. Therefore, it is essential that clinicians and healthcare providers use valid and reliable measures to assess knee muscle strength to ensure a safe return to sport. To evaluate the reliability (test-retest reliability, inter-tester reliability and test-retest agreement) and validity (concurrent validity, convergent validity and ForceFrame (FF) vs.isokinetic dynamometer (ID) agreement) of the ForceFrame (FF) dynamometer during isometric testing of the knee extensors and flexors. Cross-sectional study. Twenty-seven participants with ACL injury or reconstruction were recruited for participation in this study. maximal voluntary isometric contration (MVIC) of the knee extensors and flexors was tested on two separate days. Day one included validity assessments with FF, a gold-standard ID and a handheld dynamometer (HHD). Day two included reliability assessments with FF performed by two assessors. Main outcome measures were day-to-day test-retest reliability and agreement and inter-tester reliability of FF, and concurrent validity (FF vs.an ID and a HHD). Reliability was tested as test-retest and inter-tester reliability using interclass correlation coefficient (ICC), while agreement was tested using Bland & Altman plots with limits of agreement (LOA), standard error of measurement (SEM) and smallest detectable change (SDC). Concurrent validity between FF, ID, and HHD was assessed using Pearson's correlations and mean difference was evaluated by Bland & Altman plots. Twenty-seven participants (10 females, 17 males) with a median age of 25 years (range 19-60) were included in this study. There was a good day-to-day test-retest reliability for MVIC of KE (ICC=0.77, CI95:0.48-0.90) and KF (ICC=0.83, CI95:0.61-0.92) and excellent inter-tester reliability for MVIC of KE (ICC=0.97, CI95:0.94-0.98) and KF (ICC=0.93, 95CI:0.85-0.97). Standard error of measurement (SEM) was 8% and 9%, while the smallest detectable change (SDC) was 22% and 27% for KE and KF, respectively. FF showed fair concurrent validity compared to ID for KE (r=0.56), poor concurrent validity for knee flexors (KF (r=0.24) and compared to HHD a moderate correlation for KE (r=0.74) and poor correlation for KF (r=0.12). Bland & Altman plots between FF and the ID showed a mean difference of -0.51 Nm/kg for KE and -0.32Nm/kg for KF. FF can be used to obtain reliable and valid results to assess MVIC of the KE, but not the KF. It should be noted that absolute results produced by the FF may be considered an underestimation of actual MVIC. The test position to assess KF in FF does not appear to be optimal, and different test-positions may be considered. Level 3.

226. PHILOSOPHICAL CONSIDERATIONS IN SURGICAL INNOVATION

Abstract Background Innovation in surgery has been viewed as synonymous with progress. This is not always the case as many new innovative processes, devices and techniques do not yield same results in "real world" as they do in the experimental stage. The purpose of this presentation is to discuss the role of philosophical experiment in the process of appraisal of surgical innovation. Methods A thought experiment was conducted analysing past surgical innovations. Introduction of electrosurgery, laparoscopic cholecystectomy, surgical safety checklist and laparoscopic aortic aneurysm repair were tested. All consequences (known and hypothetical) of these innovations were considered in attempt to establish a more holistic metric of success. Results Significant limitations exist in the current assessment methods of innovation "success" which is commonly defined based on the results of a study of chosen pre-set metrics (main outcome). The utility of key metric used to assess innovation (e.g. lengths of hospital stay or visual pain scores) is limited by the choice of these outcomes. This reduces the changes of detecting rate, but possibly, much more significant unintended effects both advantageous and harmful (e.g. discovery of insulin vs thalidomide). The magnitude of detectable change is dictated by practicality of powering controlled studies and exposes results to the sensitivity bias. Unanticipated effects of the innovation are frequently not discovered until it is adopted on a large scale. Various outcomes of innovation are non-commensurable and further complicate the definition of "success". A novel innovation outcome assessment process is proposed: net global utility, a composite outcome measure which considers all potential effects of innovation (clinical, social, economic, ethical and other). Net global utility is a subjective measure that allows observer to compare non-commensurable values by not using them in isolation. One of the main advantages of net global utility is that it only requires knowledge of available metrics and principles of logical argument, providing an easy assessment tool to boost local oversight of introduction of innovation and policy-making. It includes calculation of risk (probability x consequence) which allows to account for improbable but highly consequential outcomes. Net global utility is compared to the best available alternative and derives internal face validity from this. Net global utility encompasses potential incidental future benefits as well as assessment of innovation against the test of justice. Conclusion Defining success in surgical innovation can be challenging. The use of thought experiment and logical argument is described to introduce a novel metric "net global utility" allowing for composite assessment of innovation success. Various previous surgical innovations used to demonstrate the application of the net global utility.

Interrater Reliability and Precision of a Novel Hand Strength Assessment and Treatment Device: The GripAble.

Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings. To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials). Measurement study. Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis. Thirty volunteers, age ≥18 yr, without any hand problems. Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision. GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults. GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.

Intra- and Inter-Rater Reliability of Linear and Nonlinear Measures of Short-Term Heart Rate Variability Following Combat-Related Traumatic Injury.

Heart rate variability (HRV) is a marker of autonomic function. However, the reliability of short-term HRV measurement in individuals with combat-related traumatic injury (CRTI) remains undetermined. An intra- and inter-rater reliability study was conducted using a subsample (n = 35) of British servicemen with CRTI enrolled in the ongoing ADVANCE study. A five-minute epoch of single-lead electrocardiogram data collected during spontaneous breathing was used to measure HRV. HRV analyses were independently performed by two examiners using Kubios. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC), and coefficient of variance were calculated for linear [root mean square of successive difference (RMSSD), standard deviation of NN interval, low-frequency, high-frequency, total power] and nonlinear (SD1-2, acceleration and deceleration capacities, sample entropy) measures. Bland-Altman %plots were used to assess bias in intra- and inter-rater HRV data. The mean age of participants was 39.3 ± 6.3 years. An excellent ICC score of 0.9998 (95% CI 0.9997, 0.9999) was observed for intra-rater analyses of RMSSD, and similar excellent ICC scores were seen for all other HRV measures. The inter-rater reliability analyses produced an excellent ICC score (range 0.97-1.00). Comparatively, frequency-domain measures produced higher MDC% and SEM% scores than time-domain and nonlinear measures in both inter- and intra-rater analyses. The Bland-Altman plots revealed relatively higher bias for frequency-domain and nonlinear measures than time-domain measures. ECG-related short-term HRV measures were reliable in injured servicemen under spontaneous breathing. However, the reliability appeared better with the time-domain measure than frequency-domain and nonlinear measures in this sample.

Reliability and validity of balance tests for community-dwelling older adults with musculoskeletal ambulation disability symptom complex

IntroductionPhysical performance-based tests are useful indices for identifying and managing fall risk in community-dwelling older adults. However, measurement errors in these tests have not been examined. This study aimed to clarify the reliability and validity of balance tests in community-dwelling older adults with musculoskeletal ambulation disability symptom complex. MethodsThis cross-sectional study used a test-retest design and included 52 participants from three medical facilities. The participants reported demographic and medical information using a questionnaire. Primary outcomes were the timed up-and-go test, five-times sit-to-stand test, one-leg standing test, and functional reach test results. ResultsSignificant correlations were found between each balance test and fear of falling and between the four balance tests. Each balance test demonstrated discriminant validity with intraclass correlation coefficients (1,1) ≥0.81. The minimal detectable change was 1.4 s, 1.6 s, 3.3 s, and 4.0 cm for the timed up-and-go test, five-time sit-to-stand test, one-leg standing test, and functional reach test, respectively. ConclusionChanges exceeding the minimal detectable change95 in balance tests can be used to judge improvement or decline in physical function, which may inform clinical decision-making. The minimal detectable change95 of balance tests should be used when implementing or modifying fall prevention programs.

Reliability of Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in Participants with and without Chronic Shoulder Pain.

The objectives of this study were to estimate the intra-rater and inter-rater reliability of the Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in healthy participants and patients with chronic shoulder pain. Additionally, the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated. Thirty-one healthy volunteers and twenty patients with chronic shoulder pain were assessed using the PPT and CPM by two raters, with a 24 h interval between sessions. Excellent intra-rater reliability was demonstrated for PPT, with similar SEM and SDC when assessed by the same rater. The inter-rater reliability for PPTs in patients was moderate to good (ICC = 0.59-0.89) with higher SEM (73.83-121.98 kPa) and SDC (61.58-97.59) values than the asymptomatic group (ICC = 0.92-0.96, SEM = 49.61-103.12 kPa, SDC = 42.01-56.30) respectively. CPM's intra-rater reliability was good (ICC = 0.82) in the patients and moderate (ICC = 0.67) in the asymptomatic group, while inter-rater reliability was low for the asymptomatic group (ICC = 0.37) and extremely low (ICC = 0.074) for the patients, with comparable SEM and SDC outcomes in both groups. PPT and CPM measurements are highly reliable when conducted by the same rater on the same day. Patients had lower inter-rater PPT reliability but better intra-rater CPM reliability. Clinicians need to be mindful of potential variability when interpreting these test results.

Differential Functional Changes in Visual Performance during Acute Exposure to Microgravity Analogue and Their Potential Links with Spaceflight-Associated Neuro-Ocular Syndrome.

Spaceflight-Associated Neuro-Ocular Syndrome (SANS) is a complex pathology threatening the health of astronauts, with incompletely understood causes and no current specific functional diagnostic or screening test. We investigated the use of the differential performance of the visual system (central vs. perimacular visual function) as a candidate marker of SANS-related pathology in a ground-based microgravity analogue. We used a simple reaction time (SRT) task to visual stimuli, presented in the central and perimacular field of view, as a measure of the overall performance of the visual function, during acute settings (first 10 min) of vertical, bed rest (BR), -6°, and -15° head-down tilt (HDT) presentations in healthy participants (n = 8). We built dose-response models linking the gravitational component to SRT distribution parameters in the central vs. perimacular areas. Acute exposure to microgravity induces detectable changes between SRT distributions in the perimacular vs. central retina (increased mean, standard deviation, and tau component of the ex-Gaussian function) in HDT compared with vertical presentation. Functional testing of the perimacular retina might be beneficial for the earlier detection of SANS-related ailments in addition to regular testing of the central vision. Future diagnostic tests should consider the investigation of the extra-macular areas, particularly towards the optic disc.

Thylakoid-based green preparation of porous microneedles for antibiotic residues detection in food samples

BackgroundAntibiotic residues in food chain have raised concerns regarding their toxicity and involvement in antimicrobial resistance. However, most existing antibiotic biosensors are primarily applicable to liquid food samples. Given the complex matrix characteristics of foods, there is an urgent need for the development of effective antibiotic detection platforms that exhibit high universality and flexibility. Porous microneedles (PMN) are microdevice structures with needle-like shapes and microscale pores throughout their composition, which facilitate rapid sampling. Consequently, the integration of PMN with biosensors holds significant promise for the detection of antibiotic residues in complex food samples. ResultsIn this study, hydrogel-forming PMN are fabricated by leveraging the oxygen-production capacity of thylakoid to generate bubbles and form porous structures. These PMN are then integrated with a fluorescence aptasensor for the quantification of the antibiotic netilmicin. The aptasensor consists of a netilmicin (NET) aptamer with stem loop and hairpin structure, which facilitated the binding of SYBR Green I to produce a fluorescent signal. In the presence of NET, the complete binding between NET and the aptamer results in a reduction of fluorescence intensity, thereby generating a detectable signal change for the detection of NET. Utilizing capillary action accelerate fluid extraction (2.9 times faster than nonporous microneedles) and a large specific surface area (5.1072 m2/g) conducive to aptasensor adsorb, the PMN achieve efficient capture and quantification of antibiotic with limits of detection and quantitation of 5.99 nM and 19.8 nM, respectively. SignificancePorous microneedles with tunable porosity and desirable mechanical properties are successfully fabricated. The integration of PMN with aptasensor enable the efficient detection of netilmicin in fish, milk and river water samples, demonstrating high recovery rates. The PMN represent potential tools for the convenient and rapid detection of antibiotic residues within complex food matrices, thereby enhancing food safety monitoring.

Quantifying thoracolumbar fascia deformation to discriminate acute low back pain patients and healthy individuals using ultrasound

Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.

Adaptation and development of the instruction manual for a videoconference-based Motor Assessment Scale: validity, reliability and measurement error of Tele-MAS

Purpose To develop an instruction manual to administer the Motor Assessment Scale (MAS) via videoconferencing (Tele-MAS), investigate its validity, reliability and measurement error. Materials and methods In-person assessment, conducted at the participant’s home, was compared to remote assessment conducted by rater A. Then, within two days, the rater B, repeat the remote assessment (n = 41). Part of the sample (n = 10) was assessed again within seven days by rater A to determine test-retest reliability. Concurrent validity, agreement of alternate forms (in-person x remote) for total score and reliability of individual items were analyzed using respectively the Pearson correlation coefficient, Bland-Altman plots and weighted Kappa (Kw). Interrater and test-retest reliability were analyzed by Intraclass Correlation Coefficient (ICC). Standard Error of Measurement (SEM) and Minimal detectable changes (MDC) were computed. Results The Tele-MAS instruction manual was developed. In-person MAS and Tele-MAS present a high positive correlation (r = 0.97). Bland-Altman plots showed adequate agreement (MD=-0.0 point). Most Individual items showed excellent reliability (Kw > 0.70). Tele-MAS showed excellent interrater (ICC(2,1)=0.92) and test-retest (ICC(3,1)=0.98) reliability. Tele-MAS presents a SEM = 3% and MDC = 8%. Conclusion The Tele-MAS is a valid and reliable global motor assessment scale to be applied in individuals after stroke.