Hong Kong Physiotherapy Journal最新文献

Background: Peak Torque (PT), Rate of Torque Development (RTD) and Average Torque (AT) over a single contraction assess the three components of muscle function during isometric contractions. Surprisingly, AT has never been reported or its reliability confirmed.

Objectives: This study aims to establish protocol reliability for ankle dorsiflexion and elbow extension isometric muscle function (PT, RTD, AT) in healthy participants using the Biodex System 3 Dynamometer.

Methods: Twelve participants (6 male, 6 female, mean age $39.8\pm 16.0$ years) performed four maximal isometric contractions on two occasions. Intraclass Correlation Coefficient (ICC), Typical Error (TE) and Coefficient of Variation (CV) for PT, RTD and AT were reported.

Results: The ICC for all strength parameters varied from 0.98-0.92. TE for ankle dorsiflexion PT was 1.38 Nm, RTD 7.43 Nm/s and AT 1.33 Nm, CV varied from $6.26\pm 6.25\%$ to $11.72\pm 8.27\%$ . For elbow extension, TE was 3.36 Nm for PT, 14.87 Nm/s for RTD and 3.03 Nm for AT, CV varied from $5.97\pm 4.52\%$ to $18.46\pm 14.78\%$ .

Conclusion: Maximal isometric ankle dorsiflexion and elbow extension PT, RTD and AT can be evaluated with excellent reliability when following the described protocol. This testing procedure, including the application of AT, can be confidently applied in research, exercise or clinical settings.

Background: Clinical communication impacts on physiotherapy treatment outcome and its competence warrants being assessed during training for physiotherapists given the increasing need to improve patient outcomes.

Objective: This study aimed to investigate the assessment of clinical communication in entry-level physiotherapy programs in Nigeria.

Methods: In a cross-sectional survey, questionnaires were sent by e-mail or hand-delivered to the heads of physiotherapy programs, asking them to consult with faculty members involved in the assessment of clinical communication in undergraduate education.

Results: Six of seven physiotherapy programs responded (an 86% response rate). Assessment of clinical communication and methods of assessing clinical communication by the programs showed wide variation. There was an average of two assessments per year. The objective structured clinical examination with patients (21; 38%) and written communications (report/chart) (13; 23%) were the most commonly used assessment methods. Perceived challenges included a lack of facilities, validity, inexperienced examiners, and difficulties in integrating processes and content.

Conclusion: A variety of assessment methods are being used in entry-level physiotherapy programs in Nigeria, which target different components of clinical communication skills acquisition. More effort is needed to improve limited facilities and human resources training to enhance clinical communication assessment in Nigerian physiotherapy programs.

Background: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM).

Objective: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness.

Methods: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks.

Results: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being $11.7\pm 2.8$ , 95%CI(5.9,17.4) and $8.5\pm 2.0$ , 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being $1.2\pm 0.2$ , 95%CI(0.6,1.8) and $18.2\pm 2.2$ , 95%CI(13.5,22.8) for VAS and DASH scores, respectively.

Conclusion: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.

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.

The number of smartphone users is growing dramatically. Using the smartphone frequently forces the users to adopt an awkward posture leading to an increased risk of musculoskeletal disorders and pain. The objective of this study is to conduct a systematic review of studies that assess the effect of smartphone use on musculoskeletal disorders and pain. A systematic literature search of AMED, CINAHL, PubMed, Proquest, ScienceDirect using specific keywords relating to smartphone, musculoskeletal disorders and pain was conducted. Reference lists of related papers were searched for additional studies. Methodological quality was assessed by two independent reviewers using the modified Downs and Black checklist. From 639 reports identified from electronic databases, 11 were eligible to include in the review. One paper was found from the list of references and added to the review. The quality scores were rated as moderate. The results show that muscle activity of upper trapezius, erector spinae and the neck extensor muscles are increased as well as head flexion angle, head tilt angle and forward head shifting which increased during the smartphone use. Also, smartphone use in a sitting position seems to cause more shift in head-neck angle than in a standing position. Smartphone usage may contribute to musculoskeletal disorders. The findings of the included papers should be interpreted carefully in light of the issues highlighted by the moderate-quality assessment scores.

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.