Hong Kong Physiotherapy Journal最新文献

Background: Low back pain (LBP) with facet joint origin is a common diagnosis of patients referred to physical therapy clinic. An expert consensus of diagnostic criteria has been proposed. However, the reliability of the assessment has not been proved.

Objective: To test the degrees of agreement between two physical therapists for nine physical examination items and the diagnosis of facet joint origin.

Methods: The examination according to diagnostic criteria was performed independently by two physical therapists in 45 patients with chronic LBP. The percent agreements and Kappa coefficients of each examination item and diagnostic conclusion were calculated.

Results: The percent agreements of nine examined items ranged from 73.3-91.1%. The Kappa coefficients, widely ranged from 0.250-0.690 ( $p=0.48$ to $<0.001$ ), showed statistically significant agreements for all examination items. The low level of agreements was partly due to improper distributions of test results. The agreement of conclusion was 86.7% and Kappa coefficient was 0.492 ( $p=0.001$ ) which reflected good agreement of facet diagnosis.

Conclusion: There were adequate agreements for clinical examination of LBP with facet joint origin. The low level of agreement suggested the clinicians to have operational definition and rigorous training sessions although the examinations seemed to be routinely performed.

Background: Transfers are very important in functional activities of subjects with spinal cord injury (SCI). The transfer assessment instrument (TAI) was the first tool to standardize the assessment of transfer technique.

Objective: The purpose of this study was to establish the reliability and validity of TAI 3.0 in people with SCI in early rehabilitation phase.

Methods: Thirty subjects with acute traumatic SCI were recruited from a tertiary care center for SCI management. Four raters assessed the quality of transfer using TAI 3.0 and a fifth rater used global assessment of transfer scale (VAS). TAI 3.0's intraclass correlation coefficient (ICC) for intrarater and interrater reliability, standard error of measurement (SEM), minimal detectable change (MDC), limits of agreement and concurrent validity was determined.

Results: The intrarater ICC was 0.93 to 0.98 and interrater ICC was 0.99, indicating high levels of reliability. The SEMs among the raters for TAI 3.0 total was from 0.23 to 0.28. The MDC among the raters TAI 3.0 total was from 0.54 to 0.86. Correlation for different raters between the TAI 3.0 and VAS ranged between 0.88 and 0.90.

Conclusion: TAI 3.0 is a reliable and valid tool to assess the transfer skill in individuals with SCI in early rehabilitation phase.

Background: Although there is extensive research on falls prevention, most of this knowledge is from western countries, and this may limit its usefulness when implementing in countries with different culture and healthcare systems.

Objective: This study evaluated the feasibility and effectiveness of a falls prevention intervention programme for older people in Thailand.

Methods: Two hundred and seventy-seven community-dwelling older people were randomized to either an intervention programme which included an education about falls risk management plus a home-based balance exercise delivered by a physiotherapist for four-month duration or control group. Falls, balance, physical activity, and other falls risk factors were measured at baseline and after programme completion.

Results: About 90% of the participants in the intervention group completed the programme, with very high adherence to the exercise programme, though poor compliance with the suggestions of other falls risks management. There were no falls or injuries related to the exercise programme reported. There was no significant difference in falls rate between the two groups.

Conclusion: This falls prevention program was not effective in reducing falls in community-dwelling older people in Thailand. However, the study provided encouraging evidence that home-based balance exercise could be practically implemented in older people living in communities in Thailand.

Background: Most trials on symptom-modifying effects of glucosamine are limited to administration through oral route with dearth of empirical data on the use of electromotive force.

Objective: The study determined the effects of glucosamine sulphate (GS) iontophoresis (IoT) on radiographic parameters of patients with knee osteoarthritis (OA).

Methods: Fifty-three patients were randomly assigned to three groups. About 1 g each of GS was administered using IoT and cross-friction massage (CFM) for participants in groups 1 (IoT) and 2 (CFM), respectively. Group 3 ((Combined therapy) CoT) received 1 g of GS using both IoT and CFM. Interventions were twice a week for 12 weeks. Analysis of variance (ANOVA) was used to analyze the data ( $p<0.05$ ).

Results: After 12 weeks, the medial joint space width (JSW) of the CFM group was significantly higher than that of IoT and CoT groups ( $p=0.005$ and $p=0.004$ ). Lateral JSW of IoT group was significantly higher than both CFM ( $p=0.001$ ) and CoT groups ( $p=0.01$ ). There were significant decreases in pain intensities; increase in knee flexion and physical functions across the groups ( $F=9.33,p=0.01;F=3.23,p=0.01$ ; $H=4.97,p=0.01$ , respectively).

Conclusion: It was concluded that there were significant decreases in the degenerative changes at the knee joint.

Background: The inter-rater reliability of the craniocervical flexion test (CCFT) has not been established.

Objective: To investigate the intra-rater and inter-rater reliabilities of the CCFT in asymptomatic subjects.

Methods: Sixty asymptomatic subjects were randomly selected for the study. The CCFT was measured on each subject by two testers for inter-rater reliability and by one of the testers after a gap of seven days for the intra-rater reliability. Before testing, the participants were trained for the movement and compensations were corrected.

Results: The CCFT has high inter-rater reliability (intra-class correlation coefficient $=$ 0.907, standard error of mean $=$ 0.735) and high intra-rater reliability (intra-class correlation coefficient $=$ 0.986, standard error of mean $=$ 0.287). A Bland & Altman limits of agreement analysis has confirmed the high inter- and intra-rater reliabilities of the test.

Conclusion: The CCFT has high inter-rater and intra-rater reliabilities in asymptomatic subjects.

Background: Dysfunctional sacroiliac joint (SIJ) has been cited as a source of low backache (LBA). Numerous non-invasive clinical tests are available for its assessment having poor validity and reliability which challenges their clinical utility. Thus, introduction of a new clinical test may be necessary.

Objective: To assess reliability and validity of a new clinical test for the assessment of patients with SIJ movement dysfunction.

Methods: Forty-five subjects (23 having LBA of SIJ origin and 22 healthy asymptomatic volunteers) with mean age 28.62 $+∕-$ 5.26 years were assessed by 2 blinded examiners for 3 different clinical tests of SIJ, including the new test. The obtained values were assessed for reliability by intraclass correlation, kappa coefficient and percentage agreement. Validity was assessed by averaging sensitivity and specificity. Positive and negative predictive values and accuracy were assessed.

Results: The new test demonstrates good intra- $(r=0.81)$ and inter-rater $(r=0.82)$ reliability with substantial agreement between raters $(k>0.60)$ . It has 79.9% validity, 82% sensitivity, 77% specificity, 79% positive-predictive, 80% negative-predictive value and accuracy.

Conclusion: The new "Shimpi Prone SIJ test" has a good intra- and inter-rater reliability with a substantial rater agreement and a good validity and accuracy for the assessment of patients with SIJ movement dysfunction.

Background: Improving lower limb muscle strength is important in preventing progression of osteoarthritis (OA) and its symptoms. Exercise with branched-chain amino acid (BCAA) supplementation has been reported to affect protein anabolism in young and elderly persons. However, few studies provided daily BCAAs for patients with OA.

Objective: This study examined the effects of combined BCAAs and exercise therapy on physical function improvement in women with hip OA scheduled for total hip arthroplasty.

Methods: The subjects were 43 women with OA (age: 64.2 $\pm$ 9.4). The participants were randomly divided into two groups: BCAA ( $n=21$ ) and control ( $n=22$ ). The combined therapy was carried out for one month. Exercise intervention involved hip abductor muscle exercise in both groups. For the nutritional intervention, 6 g of BCAAs or 1.2 g of starch were consumed within 10 min before starting the exercise.

Results: There was a marginally significant difference in the main effect between the groups in 10-m timed gait time. The improvement rate in hip abductor muscle strength of the contralateral side was significantly greater in the BCAA group.

Conclusion: By combining BCAA intake and exercise therapy, a significant improvement in hip abductor muscle strength of the contralateral side was achieved in women with OA.

Background: Muscle energy technique (MET) and strain-counterstrain (SCS) technique are found to be effective as a sole treatment of acute low back pain (LBP), but the combined effect of these two techniques has not been evaluated.

Objective: The purpose of this randomized clinical trial was to evaluate the added effect of SCS to MET in acute LBP patients.

Methods: In this trial, 50 patients were randomly allocated to MET or MET-SCS group to receive the assigned two treatment sessions for two consecutive days. Oswestry disability index (ODI) and Roland Morris disability questionnaire (RMDQ), visual analogue scale (VAS), lumbar range of motion (ROM) were recorded at baseline, after first and second session.

Results: All the outcome measures showed statistically significant ( $p<0.05$ ) improvement in both the groups after second session. Between the groups, analysis showed no statistically significant difference ( $p>0.05$ ) after the first or second session.

Conclusions: The improvement after second treatment sessions was noted in pain, ROM, and disability in both the groups, but immediate effect was seen only on pain intensity after first treatment session. When compared between the groups, no added effect of SCS to MET was found in reducing pain and disability and increasing lumbar ROM in acute LBP patients.