Hong Kong Physiotherapy Journal最新文献

Background: Normalized truncated navicular height (NTNH) is a non-invasive, easy to perform, and simple clinical measure of static foot posture. However, its sensitivity and specificity in evaluation of the static foot posture in children have not been investigated yet.

Objective: To investigate the intra-rater reliability, sensitivity, and specificity of NTNH in evaluation of the static foot posture in children using radiographic measure as a gold standard measure.

Methods: A cross-sectional study of a random sample of 300 school children aged 6-12 years old. Intra-rater reliability, minimal detectable change, sensitivity, and specificity of NTNH were investigated. NTNH as a clinical measure of static foot posture was calculated and compared to the radiographic measure and displayed on the receiver operating characteristic (ROC) curve.

Results: NTNH demonstrated an intra-rater reliability of $\text{ICC}=0.98$ . The sensitivity and specificity of NTNH were 88.1% and 99.5%, respectively. The optimal cutoff point for the diagnosis of flat foot using NTNH in children aged 6-12 years is NTNH $\le 0.19$ .

Conclusion: NTNH is a sensitive and specific measure of static foot posture in the children aged 6-12 years. It is recommended to be used as a screening measure of static foot posture in children as it is easy, simple to perform, and a non-invasive clinical measure.

Background: Low back pain is a common musculoskeletal disorder that can incur high financial burden. A significant proportion of this burden may be incurred from referrals to health services and subsequent healthcare usages. Patients' overall experience of pain and its related life interferences may also have some relevance to this usage.

Objective: This study aimed to examine the referral practices and subsequent health service utilization of patients with LBP within a tertiary specialist clinic setting. A secondary objective was to explore potential associations between primary independent variables of pain and life interferences with health service utilization.

Methods: Participants were patients with low back pain, who completed a set of self-reported low back pain measures. These included measures for pain intensity, pain interference, disability and quality of life. The participants' back pain-related referral and health service utilization in the subsequent 12 months were recorded.

Results: A total of 282 patients completed the full measures. Of these, 59.9% were referred for physiotherapy, 26.3% for diagnostic imaging and 9.2% for interventional procedures. Compared to patients who were referred from tertiary care, those from primary care had lower pain intensity ( $p=0.001$ ), pain interference ( $p=0.002$ ), disability ( $p=0.001$ ), but better physical and mental quality of life ( $p<0.001$ , $p=0.017$ ). High pain interference was a common factor among patients who were referred on to other services after first consultation. Levels of medical utilization and physiotherapy utilization were both associated with pain intensity ( $F=2.39$ , $p=0.027$ vs $F=3.87$ , $p=0.001$ ), pain interference ( $F=5.56$ , $p=0.007$ vs $F=4.12$ , 0.01) and disability ( $F=5.89$ , $p=0.001$ vs $F=3.40$ , $p=0.016$ ). Regression analysis showed that the source of referral contributed to 6% of the variance in medical utilization

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.

Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.

Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.

Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.

Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.

Background: Range of motion (ROM) asymmetry between sides is one indicator of a positive neurodynamic test, but this has been less well studied for the ulnar nerve.

Objective: The purpose of this study was to investigate side-to-side variation in elbow ROM during an ulnar neurodynamic test sequence, including contralateral cervical side flexion, in 40 asymptomatic subjects.

Methods: A traditional goniometer was used to measure elbow flexion ROM at two end points, onset of resistance ( $R$ 1) and symptom onset ( $P$ 1). Two repeated measures of $R$ 1 and $P$ 1 were taken on each side.

Results: Reliability for $R$ 1 and $P$ 1 was found to be good (ICC $\ge 0.83$ , SEM $\le 5.37$ ) with no significant difference in mean ROM between sides. A significant relationship between sides was seen ( $r$ values $\ge 0.48$ ) and $R^2$ values $>0.23$ ; this indicates at least 23% of the variance observed in one limb was accounted for by range in the opposite limb. This relationship was slightly stronger for $R$ 1 than $P$ 1. Lower bound scores indicate that intra-individual ROM difference $>23^{°}$ for $R$ 1 and 22^° for $P$ 1 would exceed normal ROM asymmetry.

Conclusion: These findings provide clinicians with background information of ROM asymmetry during the ulnar neurodynamic test.

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.