Detectable Change Research Articles

Human Olivocochlear Effects: A Statistical Detection Approach Applied to the Cochlear Microphonic Evoked by Swept Tones.

The human medial olivocochlear (MOC) reflex was assessed by observing the effects of contralateral acoustic stimulation (CAS) on the cochlear microphonic (CM) across a range of probe frequencies. A frequency-swept probe tone (125-4757Hz, 90dB SPL) was presented in two directions (up sweep and down sweep) to normal-hearing young adults. This study assessed MOC effects on the CM in individual participants using a statistical approach that calculated minimum detectable changes in magnitude and phase based on CM signal-to-noise ratio (SNR). Significant increases in CM magnitude, typically 1-2dB in size, were observed for most participants from 354 to 1414Hz, where the size and consistency of these effects depended on participant, probe frequency, sweep direction, and SNR. CAS-related phase lags were also observed, consistent with CM-based MOC studies in laboratory animals. Observed effects on CM magnitude and phase were in the opposite directions of reported effects on otoacoustic emissions (OAEs). OAEs are sensitive to changes in the motility of outer hair cells located near the peak region of the traveling wave, while the effects of CAS on the CM likely originate from MOC-related changes in the conductance of outer hair cells located in the basal tail of the traveling wave. Thus, MOC effects on the CM are complementary to those observed for OAEs.

Reproductive system cancer in females of the Tyva Republic. Epidemiological characteristics

Background. The incidence of female reproductive system cancer, including breast, cervical, ovarian and uterine cancers, is steadily increasing, and therefore it is advisable to conduct an epidemiological analysis and assess the quality of medical care. The purpose of the study was to analyze the epidemiological characteristics of reproductive system cancer in females of the Tyva Republic. Material and Methods. The reporting forms № 7 “Cancer incidence in the Tyva Republic” for 2013–2022 were used. Age-standardized incidence rates were calculated using the “Oncostat” program, and cancer care quality was assessed using “Cancer Care Indicators” program. Results. Reproductive system cancer in the Tyva Republic accounted for 46.3 % of all malignant neoplasms in females during 2013–2022. In 2022, breast cancer was the most common cancer (16.2 %) followed by cervical cancer (13.7 %), ovarian cancer (6.7 %), and uterine cancer (4.0 %). During the study period, none of these cancers showed a statistically significant increase in agestandardized incidence rates (AS R). In 2022, age-standardized incidence rates in the Tyva Republic were higher than those in the Siberian Federal District for cervical cancer (27.5 ± 3.7 vs 16.3 ± 0.4 0/0000) and for ovarian cancer (14.1 ± 2.8 vs 12.7 ± 0.3 0/0000), but lower for breast cancer (32.4 ± 4.1 vs 58.7 ± 0.6 0/0000) and uterine cancer (8.6 ± 2.2 vs 19.7 ± 0.4 0/0000). Overall, cancer care quality indicators for reproductive system cancers had improved. Active detection increased from 22.0 to 29.8 %, p=0.039 (in the Siberian Federal District: from 27.6 to 37.2 %, p=0.001). The detection rate at I–II stages increased from 53.7 to 75.2 %, p=0.004 (in the Siberian Federal District: from 63.0 to 71.3 %, p=0.001). The percentage of advanced stages decreased from 37.4 % to 15.5 %, p=0.001 (from 27.4 % to 23.1 % in the Siberian Federal District, p=0.013). The oneyear mortality rates also decreased from 19.0 to 5.4 %, p=0.013 (in the Siberian Federal District: from 11.8 to 8.5 %, р<0.001). The high incidence of cervical cancer, the absence of noticeable optimal changes in the early detection and the high prevalence of HPV infection among the female population of the Tyva Republic indicate the relevance of mass HPV testing as a part of secondary cancer prevention. Conclusion. The high incidence of female reproductive system cancer and the current status of reproductive cancer care in the Republic of Tyva dictate the need to strengthen primary, secondary and tertiary cancer prevention.

Program Pengabdian Masyarakat Dengan Skrining Urin Dan Edukasi Kesehatan Untuk Pencegahan Infeksi Saluran Kemih

Urinary tract infection (UTI) is a medical condition caused by a bacterial infection of the urinary system. In the elderly, urinary tract infections can occur without obvious symptoms, so screening for urinary tract infections is needed for early detection and appropriate management. Education is also needed regarding risk factors, such as urinary retention habits and personal hygiene, so that the risk of infection can be reduced. This activity is carried out using the PDCA (Plan-Do-Check-Act) method, so it is hoped that it can increase effectiveness in preventing UTIs. This activity is carried out with the aim of maintaining and improving the quality of life of the elderly, especially in preventing urinary tract infections through early detection and healthy lifestyle changes. Keywords: Education, Elderly, Urinary tract infections, Urin examination

Validity and reproducibility of the ARL-RSI score to assess psychological readiness before returning to sport after lateral ankle sprain.

Although multiple scales exist to evaluate psychological readiness before returning to sport post-lateral ankle sprain (LAS), no score has been validated specifically for LAS or chronic ankle instability. The main aim of the study is to evaluate the validity and reproducibility of the ankle ligament reconstruction-return to sport injury (ALR-RSI) scale in assessing psychological readiness after LAS and its ability to identify patients who can return to their preinjury level. A total of 64 patients (35 females and 29 males; 33.8 ± 13.2 years) who recently experienced an acute LAS were included in this study. All patients participated in a predictive validation component of the study and were assessed at 2 and 4 months following an LAS. The ALR-RSI was completed twice by 20 patients at a 7-day interval to evaluate the reliability of the score in patients suffering from LAS. The ALR-RSI was significantly (p < 0.001) and positively correlated with the other scores. The correlation was strong with the Foot and Ankle Ability Measure Sports: r = 0.77; 95% confidence interval [CI]: 0.78-0.83) and moderate with the American Orthopaedic Foot and Ankle Society (r = 0.69; 95% CI: 0.60-0.78) and the Foot and Ankle Ability Measure Activities of Daily Living Scores (r = 0.63; 95% CI: 0.51-0.72). Two-month ALR-RSI scores had good ability for predicting nonreturners at 4 months (area under the curve = 0.76; 95% CI: 0.6-0.9; p = 0.005). A Youden index of 0.51 was observed at an ALR-RSI score of 46%, corresponding to a sensitivity of 67% and specificity of 83%. Test-retest reliability of the ALR-RSI was excellent, with an ICC of 0.98 (95% CI: 0.96-0.99), a standard error of measurement of 3.02% and a minimum detectable change of 8.37%. The results of the current study validated the ALR-RSI as an important questionnaire to assess psychological readiness to return to sport after LAS. Level II prospective cohort study.

Fortification of Pea and Potato Protein Isolates in Oat-Based Milk Alternatives; Effects on the Sensory and Volatile Profile.

Oat-based milk alternatives (OMAs) are an important alternative to bovine milk, with prevalence of lactose intolerance, as well as soy and nut allergies limiting consumers options. However, OMAs are typically lower in protein content than both bovine milk and soy-based alternatives, with protein quality limited by low lysine levels, which can reduce protein digestibility. Addition of alternative plant proteins may increase the quantity of protein, as well as balancing the amino acid profile. However, plant-based proteins have additional sensory qualities and off-flavours, which may lead to undesirable characteristics when introduced to OMAs. This study aimed to assess the effect of pea and potato protein addition on the sensory profile, volatile profile, colour, and particle size in an OMA control product. Results demonstrated that pea protein contributed to a bitter and metallic taste, astringent aftertaste, and a significantly increased overall aroma correlated with higher levels of key volatiles. Whilst potato protein resulted in less flavour changes, it did lead to increased powdery mouthfeel and mouthcoating supported by a substantially increased particle size. Both protein fortifications led to detectable colour changes and a staler flavour. Fortification of OMA product with the pea protein led to significant sensory, volatile and physical changes, whilst the potato protein led to predominantly physical changes. Further investigation into alternative plant-based proteins is necessary to optimise sensory qualities whilst increasing protein content and the amino acid profile.

Vibration-Induced Alteration in Trunk Extensor Muscle Proprioception as a Model for Impaired Trunk Control in Low Back Pain.

This study examined the impact of personalizing muscle vibration parameters on trunk control. We assessed how altered trunk extensor muscle (TEM) proprioception affects seated trunk control in healthy controls (HCs). To explore the link between altered TEM proprioception and impaired trunk control in chronic low back pain (cLBP), we performed equivalence testing between HCs undergoing TEM vibration and cLBP without vibration. Twenty HCs performed active joint reposition error (AJRE) testing to determine personalized vibration parameters. Each participant maintained balance on an unstable chair with eyes open and closed, with and without TEM vibration. We compared trunk control between HCs and twenty age- and sex-matched cLBP participants, using mean velocity and 95% confidence ellipse area of center-of-pressure changes to quantify trunk postural control. Equivalence was examined by comparing mean difference scores to minimal detectable change values and calculating between-group effect sizes. Personalized vibration parameters led to larger lumbopelvic repositioning errors (d = 0.89) than any single vibration frequency (d = 0.31-0.36). In healthy adults with no back pain, vision had large effects on postural control (ηp2 = 0.604-0.842), but TEM vibration had no significant effects (p > 0.105) or interactions with vision (p > 0.423). Between-group effect sizes (d = 0.32-0.51) exceeded our threshold for performance equivalence (d < 0.2). Muscle vibration altered position sense during AJRE testing, and personalizing parameters amplified this effect. However, TEM vibration had minimal impact on seated trunk postural control in adults with no back pain and did not lead to performance degradation comparable to that in cLBP.

Calculation of the minimum clinically important difference (MCID) using different methodologies: case study and practical guide

IntroductionEstablishing thresholds of change that are actually meaningful for the patient in an outcome measurement instrument is paramount. This concept is called the minimum clinically important difference (MCID). We summarize available MCID calculation methods relevant to spine surgery, and outline key considerations, followed by a step-by-step working example of how MCID can be calculated, using publicly available data, to enable the readers to follow the calculations themselves.MethodsThirteen MCID calculations methods were summarized, including anchor-based methods, distribution-based methods, Reliable Change Index, 30% Reduction from Baseline, Social Comparison Approach and the Delphi method. All methods, except the latter two, were used to calculate MCID for improvement of Zurich Claudication Questionnaire (ZCQ) Symptom Severity of patients with lumbar spinal stenosis. Numeric Rating Scale for Leg Pain and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire Walking Ability domain were used as anchors.ResultsThe MCID for improvement of ZCQ Symptom Severity ranged from 0.8 to 5.1. On average, distribution-based methods yielded lower MCID values, than anchor-based methods. The percentage of patients who achieved the calculated MCID threshold ranged from 9.5% to 61.9%.ConclusionsMCID calculations are encouraged in spinal research to evaluate treatment success. Anchor-based methods, relying on scales assessing patient preferences, continue to be the “gold-standard” with receiver operating characteristic curve approach being optimal. In their absence, the minimum detectable change approach is acceptable. The provided explanation and step-by-step example of MCID calculations with statistical code and publicly available data can act as guidance in planning future MCID calculation studies.

Measurement properties and interpretability of the Patient-Reported Impact of Dermatological Diseases (PRIDD) measure.

Patient-reported outcome measures (PROMs) are crucial for assessing the impact of dermatological conditions on patients' lives, but the existing dermatology-specific PROMs are not recommended for use according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). We developed the Patient-Reported Impact of Dermatological Diseases (PRIDD) measure in partnership with patients. It has strong evidence of content validity, structural validity, internal consistency, acceptability, and feasibility. To test PRIDD's remaining measurement properties and establish the interpretability of scores against the COSMIN criteria using classic and modern psychometric methods. A global longitudinal study consisting of two online surveys administered two to four weeks apart. Adults (≥ 18 years) living with a dermatological condition were recruited through the International Alliance of Dermatology Patient Organizations' (GlobalSkin) membership network. Participants completed PRIDD, a demographics questionnaire, and other related measures including the Dermatology Life Quality Index (DLQI). We tested PRIDD's criterion validity, construct validity and responsiveness (Spearman's ρ, independent-samples t-tests and ANOVA), test-retest reliability (interclass correlation coefficient [ICC]), measurement error (Smallest Detectable Change or Limits of Agreement [LoA], distribution-based Minimally Important Change [MIC]), floor and ceiling effects (number of minimum and maximum scores and Person-Item Location Distribution Maps), score bandings (κ coefficient of agreement) and anchor-based MIC. 504 patients with 35 dermatological conditions from 38 countries participated. Criterion validity (ρ = 0.79), construct validity (76% hypotheses met), test-retest validity (ICC = 0.93), and measurement error (LoA = 1.3 < MIC = 4.14) were sufficient. Floor and ceiling effects were in the acceptable range (< 15%). Score bandings were determined (κ = 0.47), however, the anchor-based MIC could not be calculated due to an insufficient anchor. PRIDD is a valid and reliable tool to evaluate the impact of dermatological disease on patients' lives in research and clinical practice. It is the first dermatology-specific PROM to meet the COSMIN criteria. These results support the value of developing and validating PROMs with a patient-centred approach and using classic and modern psychometric methods. Further testing of responsiveness and MIC, cross-cultural translation, linguistic validation, and global data collection are planned.

Complete absence of GLUT1 does not impair human terminal erythroid differentiation

AbstractThe glucose transporter 1 (GLUT1) is 1 of the most abundant proteins within the erythrocyte membrane and is required for glucose and dehydroascorbic acid (vitamin C precursor) transport. It is widely recognized as a key protein for red cell structure, function, and metabolism. Previous reports highlighted the importance of GLUT1 activity within these uniquely glycolysis-dependent cells, in particular for increasing antioxidant capacity needed to avoid irreversible damage from oxidative stress in humans. However, studies of glucose transporter roles in erythroid cells are complicated by species-specific differences between humans and mice. Here, using CRISPR–mediated gene editing of immortalized erythroblasts and adult CD34+ hematopoietic progenitor cells, we generate committed human erythroid cells completely deficient in expression of GLUT1. We show that absence of GLUT1 does not impede human erythroblast proliferation, differentiation, or enucleation. This work demonstrates, to our knowledge, for the first time, generation of enucleated human reticulocytes lacking GLUT1. The GLUT1–deficient reticulocytes possess no tangible alterations to membrane composition or deformability in reticulocytes. Metabolomic analyses of GLUT1–deficient reticulocytes reveal hallmarks of reduced glucose import, downregulated metabolic processes and upregulated AMP-activated protein kinase signaling, alongside alterations in antioxidant metabolism, resulting in increased osmotic fragility and metabolic shifts indicative of higher oxidant stress. Despite detectable metabolic changes in GLUT1–deficient reticulocytes, the absence of developmental phenotype, detectable proteomic compensation, or impaired deformability comprehensively alters our understanding of the role of GLUT1 in red blood cell structure, function, and metabolism. It also provides cell biological evidence supporting clinical consensus that reduced GLUT1 expression does not cause anemia in GLUT1–deficiency syndrome.

Polish Cultural Adaptation and Reliability of the Fugl-Meyer Assessment of Motor Performance and Sensory Assessment Scale in Stroke Patients.

Background and Purpose: The Fugl-Meyer Assessment of Motor Performance and Sensory Assessment Scale (FMA) is the most commonly used and recommended outcome measure for the sensorimotor impairment of the upper and lower limbs in stroke patients. The aim of this study was to perform cross-cultural translation and adaptation of the scale into Polish and to evaluate the FMA's reliability of motor performance and sensation of the upper and lower limb sections among ischemic stroke patients. Methods: The Polish version of the FMA (FMA-PL) was developed using a forward-backward translation performed by a group of experts and then evaluated by a panel of judges according to international guidelines. The study involved 86 patients (F = 30, M = 56, i.e., 35%; the average age of patients was 64 ± 12 years, 36 with right-sided stroke and 50 with left-sided stroke). The FMA-PL was carried out twice by two experienced neurological physiotherapists with a 2 h gap between assessments (test-retest and inter-rater). The reliability of the outcome measure was defined by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the minimum detectable change (MDC) were also calculated. The internal consistency of the test was determined by the Cronbach's alpha indicator. Results: Three domains were evaluated on the FMA-PL scale. From the whole test, results were obtained in the range of 12-124 points: 64 points for FMA-UE-PL 2, 34 points for FMA-LE-PL 4, and 24 points for FMA-S-PL 0. The ICC values were in the range of 0.99-1.00 for the total FMA-PL score and the results of each domain. The SEM and MDC for the entire FMA-PL calculated for test-retest measurements were 0.22 and 1.60, respectively. The SEM and MDC for the total FMA-PL score obtained during repeated measurements of the same investigator were 1.3 and 3.5 points, respectively. The Cronbach's alpha values calculated for the total FMA-PL, FMA-UE-PL, FMA-LE-PL, and FMA-S-PL items amounted to 0.938-0.939, 0.932-0.934, and 0.634-0.722, respectively. Conclusions: The Polish version of the FMA is a consistent and reliable outcome measure for the motor and sensory evaluation of the upper and lower limbs for patients in subacute and chronic stroke stages.

Automated speech analytics in ALS: higher sensitivity of digital articulatory precision over the ALSFRS-R

Objective: Although studies have shown that digital measures of speech detected ALS speech impairment and correlated with the ALSFRS-R speech item, no study has yet compared their performance in detecting speech changes. In this study, we compared the performances of the ALSFRS-R speech item and an algorithmic speech measure in detecting clinically important changes in speech. Importantly, the study was part of a FDA submission which received the breakthrough device designation for monitoring ALS; we provide this paper as a roadmap for validating other speech measures for monitoring disease progression. Methods: We obtained ALSFRS-R speech subscores and speech samples from participants with ALS. We computed the minimum detectable change (MDC) of both measures; using clinician-reported listener effort and a perceptual ratings of severity, we calculated the minimal clinically important difference (MCID) of each measure with respect to both sets of clinical ratings. Results: For articulatory precision, the MDC (.85) was lower than both MCID measures (2.74 and 2.28), and for the ALSFRS-R speech item, MDC (.86) was greater than both MCID measures (.82 and .72), indicating that while the articulatory precision measure detected minimal clinically important differences in speech, the ALSFRS-R speech item did not. Conclusion: The results demonstrate that the digital measure of articulatory precision effectively detects clinically important differences in speech ratings, outperforming the ALSFRS-R speech item. Taken together, the results herein suggest that this speech outcome is a clinically meaningful measure of speech change.

Individual patient data meta-analysis estimates the minimal detectable change of the Geriatric Depression Scale-15

ObjectivesTo use individual participant data meta-analysis (IPDMA) to estimate the minimal detectable change (MDC) of the Geriatric Depression Scale-15 (GDS-15) and to examine whether MDC may differ based on participant characteristics and study-level variables. Study Design and SettingThis was a secondary analysis of data from an IPDMA on the depression screening accuracy of the GDS. Datasets from studies published in any language were eligible for the present study if they included GDS-15 scores for participants aged 60 or older. MDC of the GDS-15 was estimated via random-effects meta-analysis using 2.77 (MDC95) and 1.41 (MDC67) standard errors of measurement. Subgroup analyses were used to evaluate differences in MDC by participant age and sex. Meta-regression was conducted to assess for differences based on study-level variables, including mean age, proportion male, proportion with major depression, and recruitment setting. Results5876 participants (mean age 76 years, 40% male, 11% with major depression) from 21 studies were included. The MDC95 was 3.81 points (95% confidence interval [CI] 3.59, 4.04), and MDC67 was 1.95 (95% CI 1.83, 2.03). The difference in MDC95 was 0.26 points (95% CI 0.04, 0.48) between ≥80-year-olds and <80-year-olds; MDC95 was similar for females and males (0.05, 95% CI −0.12, 0.22). The MDC95 increased by 0.29 points (95% CI 0.17, 0.41) per 10% increase in proportion of participants with major depression; mean age had a small association (0.04 points, 95% CI 0.00 to 0.09) with MDC95, but sex and recruitment setting were not significantly associated. ConclusionThe MDC95 was 3.81 points and MDC67 was 1.95 points. MDC95 increased with the proportion of participants with major depression. Results can be used to evaluate individual changes in depression symptoms and as a threshold for assessing minimal clinical important difference estimates.

Reliability of Quadriceps Twitch Muscle Properties and Explosive Voluntary Contractions at Different Knee Joint Angles

ABSTRACT Background Measures that assess muscle strength and its development, either voluntarily or involuntarily, are important in the clinical and research context. The main aim of this study was to verify the interday reliability and the minimum detectable change (MDC) of the knee extensors muscles torque using evoked contractions and explosive voluntary contractions (EVC), across six different joint angles. Methods 20 participants, 16 men and 4 women (26.5 ± 6.6 years; 174.5 ± 11.1 cm; 73.7 ± 11.3 kg), participated in this study. Evoked twitch contractions and voluntary explosive contractions of the knee extensors were performed in 2 days (test-retest) at 20, 40, 70, 90, 105 and 115 degrees. Results The most reliable twitch parameters were peak torque (PT), contraction time (CT), half relaxation-time (½ time), total impulse and peak rate of torque development (RTDPeak), with coefficient of variation (CV) ranging from ~ 8% at 20° to 5% at 115° angle. It was verified that CT and ½ time become more reliable as the knee angle changed from 20 to 115 degrees, from shorter to longer muscle lengths (7.3 to 2.7% and 8.8% to 4.0%, respectively). The more reliable parameters for voluntary contraction were PT, RTD250 ms, RTDPeak and impulse250 ms (CV from around ~ 8% at 20°/115° and 5% at 70°/90°). For voluntary contractions, all measures performed at 70° angle were more reliable compared to the other angles. Conclusion It was concluded that for the knee extensor muscles, evoked twitch contractions presented greater reliability across knee angles, with lower CV values when compared to the voluntary measures for the same time windows. Specifically, for the evoked twitch contractions, angles from 70 to 115 degree proved to be highly reliable. On the other hand, for the voluntary contractions, the central angles (70 and 90 degree) were the most reliable.

Identification and impact of failure of pelvic compensation in patients with adult spinal deformity

BACKGROUND CONTEXTPrevious research has identified a specific subtype known as failure of pelvic compensation (FPC) in patients with adult spinal deformity (ASD). However, the criteria for assessing FPC remain inconsistent, and its impacts on spinal sagittal alignment and health-related quality-of-life (HRQoL) scores remain unclear. PURPOSETo propose a novel criterion for identifying FPC based on variations in spinopelvic alignment during the transition from the supine to upright position and to evaluate the effects of FPC on patients' spinal sagittal alignment and HRQoL scores. STUDY DESIGN/SETTINGRetrospective cross-sectional study. PATIENT SAMPLEPatients with ASD from a monocenter database. OUTCOME MEASURESRadiographic measures, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt, pelvic incidence (PI), and sagittal vertical axis (SVA), were measured on lateral whole-spine radiographs. LL and SS were also measured on reconstructed lumbar computed tomography images in the sagittal view taken in the supine position. The relative functional cross-sectional area (rFCSA) of paraspinal muscles was evaluated via lumbar magnetic resonance imaging. HRQoL measures, encompassing visual analog scale for back pain (VAS-BP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22R (SRS-22R), were collected. METHODSA total of 154 patients were enrolled. Based on the calculated minimum detectable change of SS, FPC was defined as the change in SS of less than 3.4° between supine and upright positions. Patients were divided into 3 groups: sagittal balance with pelvic compensation (SI-PC), sagittal imbalance with pelvic compensation (SI-PC), and sagittal imbalance with failure of pelvic compensation (SI-FPC). Radiographic parameters and HRQoL scores were compared among the groups. RESULTSThirty-six patients were categorized into the SB-PC group, 87 into the SI-PC group, and 31 into the SI-FPC group. Patients with low PI and small paraspinal muscles rFCSA were more prone to experiencing FPC accompanied by severe sagittal imbalance. The SI-FPC group exhibited less TK and a larger SS than the SI-PC group exhibited and had a similar SVA as that of the SI-PC group. Additionally, they displayed worse VAS-BP, ODI, SRS-function, and SRS-22 total scores than the SB-PC group displayed. CONCLUSIONSIn patients with ASD, an inherently low pelvic compensatory reserve and a high fatty infiltration in paraspinal muscles are pivotal factors contributing to FPC. Compared with SI-PC patients, SI-FPC patients demonstrate a thoracic-dominant compensatory pattern for sagittal malalignment. In addition, these patients experienced more severe pain and functional decline than the SB-PC patients experienced.

Inter-rater reliability and test-retest reliability of the foot posture index (FPI-6) for assessing static foot posture in elderly female patients with knee osteoarthritis and its association with quadriceps muscle tone and stiffness.

1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA. The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed. Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6. The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.

The Bed Bridge Test: a new functional test for hospital inpatients – a feasibility and measurement study

Purpose To develop and assess the Bed Bridge Test’s (BBT) feasibility, safety, and clinimetric properties and evaluate functional capacity in hospitalised patients. Materials and methods This feasibility and measurement study examined four BBT versions, including the timed-limited at 30 and 60 s and repetition-limited at 5 and 10 times, in hospitalised patients in a university hospital in Brazil. Ninety-two functionally stable patients with respiratory, gastrointestinal, or post-surgical conditions participated. Participants completed the BBT versions in a random order. BBT concurrent criterion validity was evaluated using the Short Physical Performance Battery (SPPB), Sit-to-Stand (STS) test, and Functional Status Score (FSS). Results The participants were 51 ± 17 years old, 60% female, and 66% with clinical conditions. All participants completed the BBT versions without adverse events. Test–retest reliability was good–excellent (intraclass correlation coefficient >0.87) for all BBT versions, with acceptable agreement parameters and minimal detectable changes. The time-limited versions of the BBT might be affected by a ceiling effect. Floor effects were minimal for all BBT versions. BBT showed moderate associations with SPPB and STS and weak associations with FSS. Conclusions The BBT is feasible and has promising measurement properties.

Physical Therapy and Aminopyridine for Downbeat Nystagmus Syndrome: A Case Report.

Individuals with downbeat nystagmus (DBN) syndrome present with DBN, dizziness, blurred vision, and unsteady gait. Pharmacological intervention with 4-aminopyridine (4-AP) may be effective in improving oculomotor function, but there is minimal evidence to date that it improves gait. This suggests the possible benefit of combining pharmacotherapy with physical therapy to maximize outcomes. This case report documents improvements in gait and balance after physical therapy and aminopyridine (AP) in an individual with DBN syndrome. The patient was a 70-year-old man with a 4-year history of worsening dizziness and imbalance, diagnosed with DBN syndrome. He demonstrated impaired oculomotor function, dizziness, and imbalance, which resulted in falls and limited community ambulation. The patient completed a customized, tapered course of physical therapy over 6months. Outcome measures included the 10-meter walk test, the Timed Up and Go (TUG), the Dynamic Gait Index (DGI), and the modified clinical test of sensory integration and balance. Improvements exceeding minimal detectable change were demonstrated on the TUG and the DGI. Gait speed on the 10-meter walk test did not change significantly, but the patient was able to use a cane to ambulate in the community and reported no further falls. Controlled studies are needed to explore the potential for AP to augment physical therapy in people with DBN syndrome. Physical therapists are encouraged to communicate with referring medical providers about the use of AP as pharmacotherapy along with physical therapy for individuals with DBN syndrome.

The 1-min sit-to-stand test induces a significant and reliable level of neuromuscular fatigability: insights from a mobile app analysis.

The performance metric associated with the execution of the 1-min sit-to-stand (1STS) typically relies on the number repetitions completed in 1 min. This parameter presents certain limitations (e.g., ceiling effect, motivational factors) which can impede its interpretation. Introducing additional parameters, such as neuromuscular fatigability level, could enhance the informative value of the 1STS and facilitate its interpretation. This study aimed to assess (i) whether the 1STS induces fatigability and (ii) the reliability of the fatigability level. Forty young, healthy, and active participants underwent the 1STS twice during the same session. Isolated sit-to-stand maneuvers were performed before, immediately, and 1 min after completing the 1STS. A mobile app was utilized to obtain time (STST), velocity (STSV), and muscle power (STSP) from these sit-to-stand maneuvers. The pre-post change in these parameters served as the fatigability marker. Reliability was assessed using the intra-class correlation coefficient (ICC) and the coefficient of variation (CV). The mean number of repetitions during the 1STS was 63 ± 9. Significant decline in performance was observed for STST (13 ± 8%), STSV (-11.2 ± 6%), and STSP (-5.2 ± 3%), with more than 74% of participants exhibiting a decline beyond the minimal detectable change. Excellent between-session reliability (ICC ≥ 0.9; CV ≤ 5.3) was observed for the mobile app variables. The 1STS induces significant levels of fatigability. The fatigability indicators derived from the mobile app demonstrated remarkable reliability. Utilizing this user-friendly interface for computing fatigability may empower professionals to acquire insightful complementary indicators from the 1STS.

Adapting the stroke therapy outcome measure for use by Multidisciplinary Teams: considering reliability

Purpose The Therapy Outcome Measure (TOM) comprises many profession and client group-specific adapted scales based on the International Classification of Functioning Model, used by different Health Care Professionals (HCPs). A new Multidisciplinary stroke TOM scale (MDT Stroke TOMs) was developed by amalgamating the relevant scales. This study aimed to develop a scale to describe patients’ abilities and improve communication and collaboration within the stroke Multidisciplinary Team (MDT). The present study investigated the inter-rater and intra-rater reliability of this adaptation. Materials and Methods The MDT Stroke TOM Scale was developed by combining and rewording four profession-specific adapted TOM scales following iterative trials and discussions leading to an agreed version. 150 stroke Allied Health Professional (AHPs) and nurses were trained virtually in TOM and the MDT Stroke TOM Scale. Ten AHP and nursing raters from five professions evaluated ten composite stroke case studies for inter-rater reliability. Six participated in the intra-rater reliability review of the same three case studies at different time points. Reliability was quantified using intraclass correlation coefficients and measurement error using the smallest detectable change. Results There was good to excellent concordance between the raters in terms of scoring. Raters’ scores were also consistent. The MDT Stroke TOMs is being used consistently across the South West London Stroke Network. Conclusion The Stroke MDT TOMs is psychometrically robust and should assist with improving team work in the rehabilitation of stroke patients and their carers. Future research may use MDT Stroke TOM to promote interprofessional team working and facilitate communication in Stroke Rehabilitation.

Spatial distribution, sources and human health risk assessment of dissolved heavy metals and metalloids in Yalong River, China

The adverse effects of metal(loid) accumulation on ecological health and human health have attracted widespread attention from the society, and the reduction of species diversity in the whole Yalong River basin due to dam construction. In this study, we investigated the distribution characteristics of metal(loid)s in the whole Yalong River basin from the point of view of metal(loid)s, identified the pollution sources, assessed the risk level, and further evaluated the risk to human health. A total of 9 heavy metals (Cr, Mn, Fe, Ni, Ag, Cd, Pb, Cu and Zn) and 1 metalloid (As) were investigated and surface water samples were collected from 17 sites along the Yalong River, which were categorized into industrial and agricultural production zones (YL1–5), alpine canyon zones (YL6–12), and alpine meadow zones (YL13–17) based on altitude and habitat. The results indicated that the density of metal(loid) in the alpine meadow area was considerably highest compared to other areas. The Zn content ranged from 64.42 to 84.55 μg/L, the Mn concentration ranged from 7.47 to 20.03 μg/L, and the Pb value ranged from 0.63 to 3.44 μg/L. In other places, the concentrations for Zn ranged from 17.88 to 37.78 μg/L, for Mn they ranged from 2.84 to 12.86 μg/L, and for Pb they ranged from 0.16 to 0.50 μg/L. The main sources of the metal(loid)s were determined by correlation analysis (CA) and principal component analysis (PCA) to be from natural factors such as crustal movement, atmospheric deposition, and water-rock washout. The water quality of Yalong River was evaluated by HEI, NI and WQI indices, and the results showed that the overall water quality of Yalong River was "excellent", in which the water quality of the alpine meadow area was better than that of the industrial and agricultural production area and the alpine canyon area. HQdermal, HQingestion and HI values are calculated to expose the harm caused by metal(loid) elements. The results indicate that all of the aforementioned values are below 1, suggesting that the potential harm caused by these elements is minimal. The value of HQdermal tends to be higher than HQingestion. Consequently, skin contact is likely the primary mechanism of exposure. This study provides a reference basis for metal(loid) detection and ecological changes caused by the dam construction process, and provides an important basis for the use and protection of surface water in the Yalong River.