Brazilian Journal of Physical Therapy最新文献_第2页

Reliability of the McKenzie Method of Mechanical Diagnosis and Therapy in the examination of spinal pain, including the OTHER classifications McKenzie 机械诊断和治疗方法在脊柱疼痛检查中的可靠性，包括 OTHER 分类：麦肯锡方法在脊柱疼痛中的可靠性。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101154

Hans van Helvoirt , Henk Tempelman , Puck van der Vet , Frank van der Vet , Job van Helvoirt , Richard Rosedale , Adri Apeldoorn

Background

The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is used worldwide to classify and manage musculoskeletal (MSK) problems. The assessment includes a detailed patient history and a specific physical examination. Research has investigated the reliability of the MDT spinal classification system (Derangement syndrome, Dysfunction syndrome, Postural syndrome, and OTHER), however no study has assessed the reliability of the 10 classifications grouped together as OTHER.

Objective

To investigate the inter-rater reliability of MDT trained clinicians when utilising the full breadth of the MDT system for patients with spinal pain.

Methods

Six experienced MDT clinicians each submitted potentially eligible MDT assessment forms of 30 consecutive patients. A MSK physician and a faculty of the McKenzie Institute checked the 180 forms for eligibility and completeness, where a provisional MDT classification was blinded. Apart from their own assessment forms, the six MDT clinicians each classified 150 forms. Each patient could be classified into 1 of 13 diagnostic classifications (Derangement syndrome, Dysfunction syndrome, Postural syndrome, and 10 classifications grouped as OTHER). Reliability was determined using Fleiss’ Kappa (k).

Results

The reliability among six MDT clinicians classifying 150 patient assessment forms was almost perfect (Fleiss’ κ = 0.82 [95% CI 0.80, 0.85]).

Conclusions

Among experienced MDT clinicians, the reliability in classifying patient assessment forms of patients with spinal pain is almost perfect when the full breadth of the MDT system is used. Future research should investigate the reliability of the full breadth of the MDT system among clinicians with lower levels of training.

背景：麦肯锡机械诊断和治疗法（MDT）在全球范围内被用于对肌肉骨骼（MSK）问题进行分类和管理。评估包括详细的病史和具体的体格检查。已有研究对 MDT 脊柱分类系统（错位综合征、功能障碍综合征、姿势综合征和其他）的可靠性进行了调查，但还没有研究对归类为其他的 10 个分类的可靠性进行评估：调查接受过 MDT 培训的临床医生在对脊柱疼痛患者使用完整的 MDT 系统时的互评可靠性：方法：六名经验丰富的 MDT 临床医生分别提交了 30 名连续患者的潜在合格 MDT 评估表。一名 MSK 内科医师和一名麦肯锡研究所的教师检查了 180 份表格的合格性和完整性，并对临时 MDT 分类进行了盲法处理。除了他们自己的评估表，六位 MDT 临床医生每人还对 150 份评估表进行了分类。每位患者可被归入 13 个诊断分类中的 1 个（错乱综合症、功能障碍综合症、姿势综合症和 10 个归类为 OTHER 的分类）。采用弗莱斯卡帕法（Kappa）确定信度：结果：六位 MDT 临床医生对 150 份患者评估表进行分类的可靠性几乎完美（Fleiss' κ = 0.82 [95% CI 0.80, 0.85]）：结论：在经验丰富的 MDT 临床医生中，如果全面使用 MDT 系统，脊柱疼痛患者评估表分类的可靠性几乎是完美的。未来的研究应调查培训水平较低的临床医生使用全广度 MDT 系统的可靠性。

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引用次数: 0

High-intensity interval training versus moderate-intensity continuous training on exercise capacity and health-related quality of life in patients with coronary artery disease: An updated systematic review and meta-analysis 高强度间歇训练与中强度连续训练对冠心病患者运动能力和健康相关生活质量的影响：一项最新的系统综述和荟萃分析

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101137

Mansueto Gomes-Neto , Andre Rodrigues Durães , Lino Sérgio Rocha Conceição , Cassio Magalhães Silva , Bruno Prata Martinez , Vitor Oliveira Carvalho

Background

Despite the well-known positive effects of exercise in patients with coronary artery disease, the best exercise training protocol is still under discussion.

Objective

We performed a systematic review and a meta-analysis to investigate the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on exercise capacity and health-related quality of life (HRQoL) in patients with coronary artery disease.

Methods

We searched MEDLINE/PubMed, the Cochrane Library EMBASE, and the PEDro database for randomized controlled trials that evaluated the effects of HIIT versus MICT. Mean difference and 95 % confidence intervals (CI) were calculated.

Results

27 studies, with 1454 patients, met the eligibility criteria. Twenty-four studies with 1259 patients assessed peak oxygen consumption (VO₂peak) as an outcome. The HIIT group showed an increase of VO₂peak (MD = 2.11 mL/kg/min; 95 % CI: 1.14, 3.07; I² = 78 %; N = 1259) compared with the MICT group. Six studies with 316 patients assessed HRQoL as outcome. No differences in physical, emotional, and social domains of HRQoL were found between the HIIT and MICT groups. In the subgroup analysis of 10 studies with isocaloric exercise training, the HIIT and MICT groups showed similar VO₂peak (MD = 0.72 mL/kg/min; 95 % CI:0.03, 1.48; I² = 44 %; N = 453).

Conclusions

Our meta-analysis showed low-quality evidence that HIIT training was more effective than MICT for improving VO₂peak but not HRQoL in patients with coronary artery disease. However, when the analysis was limited to isocaloric protocols no difference between HIIT and MICT was found for VO₂peak.

背景：尽管运动对冠状动脉疾病患者的积极作用众所周知，但最佳运动训练方案仍在讨论中。目的：我们进行了一项系统回顾和荟萃分析，研究高强度间歇训练（HIIT）与中强度连续训练（MICT）对冠状动脉疾病患者运动能力和健康相关生活质量（HRQoL）的影响。方法：我们检索了MEDLINE/PubMed、Cochrane Library EMBASE和PEDro数据库，寻找评估HIIT与MICT效果的随机对照试验。计算平均差值和95%置信区间（CI）。结果：27项研究，1454例患者符合入选标准。1259例患者的24项研究评估了峰值耗氧量（VO2peak）作为结果。HIIT组vo2峰值升高(MD = 2.11 mL/kg/min；95% ci: 1.14, 3.07；I2 = 78%；N = 1259)与MICT组比较。6项研究共纳入316例患者，评估HRQoL作为结果。HIIT组和MICT组在HRQoL的身体、情感和社会领域没有发现差异。在10项等热量运动训练研究的亚组分析中，HIIT组和MICT组显示出相似的vo2峰值(MD = 0.72 mL/kg/min；95% ci:0.03, 1.48；I2 = 44%；N = 453)。结论：我们的荟萃分析显示，低质量的证据表明，HIIT训练比MICT更有效地改善冠状动脉疾病患者的VO2peak，而不是HRQoL。然而，当分析仅限于等热量方案时，没有发现HIIT和MICT之间vo2峰值的差异。

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引用次数: 0

Physical therapist-delivered motivational interviewing and health-related behaviour change: A systematic review and meta-analysis 物理治疗师提供的动机访谈和健康相关行为改变：系统回顾和荟萃分析。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101168

Elizabeth Wintle , Nicholas F Taylor , Katherine Harding , Paul O'Halloran , Casey L Peiris

Background

Motivational interviewing (MI) promotes health-related behaviour change and improves patient health outcomes, but the effect of physical therapist-delivered MI is unclear.

Objective

To evaluate the effect of physical therapist-delivered MI on health-related behaviour change in adults attending physical therapy or rehabilitation.

Methods

CINAHL, Medline, PubMed, PEDro, Embase, and Cochrane databases were searched in August 2023. Randomised controlled trials evaluating physical therapist-delivered MI and health-related behaviour change were included. Internal validity was evaluated using the PEDro scale. GRADE approach was used for each meta-analysis.

Results

Ten publications from nine randomised controlled trials involving 909 participants were included. Physical therapist-delivered MI likely increased physical activity slightly (SMD 0.21, 95 % CI -0.05, 0.47) when compared to minimal intervention; however the evidence is very uncertain in relation to self-efficacy (SMD 0.51, 95 % CI -0.35, 1.38) and health-related quality of life (SMD 0.73, 95 % CI -0.64, 2.11). When physical therapist-delivered MI was combined with and compared to rehabilitation, there were no additional effects on physical activity (SMD 0.02, 95 % CI -0.37, 0.41), health-related quality of life (SMD 0.18, 95 % CI -0.27, 0.63), or endurance (SMD 0.15, 95 % CI -0.21, 0.52) and a likely small effect on self-efficacy (SMD 0.23, 95 % CI -0.1, 0.55).

Conclusion

Physical therapist-delivered MI is likely to produce a small improvement in physical activity, but only in the absence of other comprehensive rehabilitation. The most beneficial application of MI may be for patients who are not receiving rehabilitation or who have low levels of motivation and self-efficacy.

背景：动机性访谈（MI）促进与健康相关的行为改变并改善患者的健康结果，但物理治疗师提供的MI的效果尚不清楚。目的：评估物理治疗师提供的心肌梗死对参加物理治疗或康复的成人健康相关行为改变的影响。方法：检索于2023年8月的CINAHL、Medline、PubMed、PEDro、Embase和Cochrane数据库。纳入评估物理治疗师提供的心肌梗死和健康相关行为改变的随机对照试验。使用PEDro量表评估内部效度。每次荟萃分析均采用GRADE方法。结果：纳入了9项随机对照试验的10篇出版物，涉及909名受试者。与最小干预相比，物理治疗师提供的心肌梗死可能会略微增加身体活动（SMD为0.21,95% CI为-0.05,0.47）；然而，有关自我效能（SMD 0.51, 95% CI -0.35, 1.38）和健康相关生活质量（SMD 0.73, 95% CI -0.64, 2.11）的证据非常不确定。当物理治疗师提供的心肌梗死与康复相结合并进行比较时，对身体活动（SMD为0.02,95% CI为-0.37,0.41）、健康相关生活质量（SMD为0.18,95% CI为-0.27,0.63）或耐力（SMD为0.15,95% CI为-0.21,0.52）没有额外的影响，对自我效能的影响可能很小（SMD为0.23,95% CI为-0.1,0.55）。结论：物理治疗师提供的心肌梗死可能会对身体活动产生微小的改善，但仅在没有其他综合康复的情况下。心肌梗死最有益的应用可能是那些没有接受康复治疗或动机和自我效能水平较低的患者。

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引用次数: 0

Low back pain prevalence, capacity, and performance according to sociodemographic variables, population-based study in Chile 智利基于人群的研究：根据社会人口学变量，腰痛的患病率、能力和表现。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101151

Marina Carvalho Arruda Barreto , Fabianna Resende Jesus-Moraleida , Valeria Campos , Ricardo Cartes-Velásquez , Shamyr Sulyvan Castro

Background

Low back pain (LBP) is one of the main causes of disability and need for rehabilitation services. It is necessary to have a better understanding about the association of sociodemographic factors with the disability related to individuals with LBP.

Objective

Assess the prevalence of LBP and its association with capacity, performance, and sociodemographic variables in Chilean population.

Methods

Cross-sectional study was performed with data from the population survey from Chile, 2015. People over 17 years old were selected for the analysis (n = 12,265 people). The variables chosen were: presence of LBP, place of living in Chile, sex, age, marital status, education, income, work status, and type of home. Capacity and performance levels were assessed by the Model Disability Survey. The population characteristics, performance, and capacity values were presented through means or frequencies. A generalized linear model with logarithmic linkage and gamma distribution was employed to assess the associations between the explanatory variables and the outcomes, considering the distribution of the variables, while adjusting for all study variables.

Results

22 % of the population reported having LBP. People with LBP had worse levels of capacity and performance. Being female, older age, having worse education level, and worse health classification, were factors associated with worse capacity and performance in those with LBP. Conversely, being employed in the last week was correlated with improved capacity in this group.

Conclusion

Individuals with LBP demonstrated poorer capacity and performance outcomes, with sociodemographic variables influencing their functioning.

背景：腰痛是致残的主要原因之一，需要康复服务。因此，有必要进一步了解社会人口学因素与腰痛患者残疾的关系。目的：评估智利人群中腰痛的患病率及其与能力、表现和社会人口变量的关系。方法：采用智利2015年人口调查数据进行横断面研究。17岁以上的人被选为分析对象（n = 12265人）。选择的变量是：LBP的存在、在智利的居住地、性别、年龄、婚姻状况、教育程度、收入、工作状况和家庭类型。能力和表现水平由模范残疾调查评估。通过均值或频率表示种群特征、性能和容量值。考虑到变量的分布，同时对所有研究变量进行调整，采用对数联动和伽马分布的广义线性模型来评估解释变量与结果之间的关联。结果：22%的人群报告有LBP。患有LBP的人的能力和表现水平更差。女性、年龄较大、受教育程度较低、健康状况较差是导致LBP患者能力和表现较差的因素。相反，在这一组中，上周受雇与能力提高相关。结论：LBP患者表现出较差的能力和绩效结果，社会人口变量影响其功能。

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引用次数: 0

Association between white matter integrity and lower limb motor impairment after stroke: A systematic review 脑卒中后白质完整性与下肢运动障碍之间的关系：一项系统综述：脑卒中后白质完整性与下肢运动障碍。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101153

Renata Loureiro-Chaves , Elissa Embrechts , Amber van Hinsberg , Jonas Schröder , Cathy M. Stinear , Laetitia Yperzeele , Wim Saeys , Steven Truijen

Background

There is no clear consensus on the anatomical substrates required for recovery from lower limb (LL) impairment after stroke. Knowledge of biomarkers, such as white matter integrity (WMI), could fill this knowledge gap.

Objectives

To analyze the associations between WMI of the corticospinal tract (CST) and corticoreticulospinal pathway (CRP) and LL motor impairment after stroke, in terms of synergistic control and muscle strength. It also explores whether any associations depend on time post-stroke.

Methods

In April 2023, PubMed, Web of Science, and Scopus databases were systematically searched for studies associating WMI of the CST and CRP and LL motor impairment after stroke. Risk of bias was assessed using the Newcastle–Ottawa Quality Assessment Scales.

Results

Nineteen studies were included, 15 about the association between CST and motor impairment, and 4 concerning CST and CRP. Associations were consistently found between higher WMI of the CST and greater muscle strength, but not with synergistic control. There were no clear associations between WMI of the CRP and muscle strength, and associations could not be analyzed for synergistic control. The results could not determine whether the associations are time dependent.

Conclusions

The results of this review supported using WMI of the CST to understand LL muscle strength after stroke. However, the same cannot be said for LL synergistic control due to the small number of studies. There was no clear evidence of an association between WMI of the CRP and LL muscle strength or synergistic control due to mixed results or a lack of studies.

背景：对于脑卒中后下肢损伤恢复所需的解剖学基础，目前还没有明确的共识。生物标志物的知识，如白质完整性（WMI），可以填补这一知识空白。目的：分析脑卒中后皮质脊髓束（CST）和皮质网状脊髓通路（CRP） WMI与LL运动障碍的协同控制和肌力的关系。它还探讨了是否有任何关联取决于中风后的时间。方法：于2023年4月系统检索PubMed、Web of Science和Scopus数据库，检索脑卒中后CST和CRP WMI与LL运动障碍相关的研究。使用纽卡斯尔-渥太华质量评估量表评估偏倚风险。结果：共纳入19项研究，其中15项研究涉及CST与运动障碍的关系，4项研究涉及CST与CRP的关系。CST的高WMI与更大的肌肉力量之间一致存在关联，但与协同控制无关。CRP的WMI与肌肉力量之间没有明确的关联，并且无法分析这种关联以进行协同控制。结果不能确定这种关联是否与时间有关。结论：本综述的结果支持使用CST的WMI来了解脑卒中后LL肌肉力量。然而，由于研究较少，对于LL协同控制则不能这样说。由于结果不一或缺乏研究，没有明确的证据表明CRP的WMI与LL肌肉力量或协同控制之间存在关联。

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引用次数: 0

Acute effect of aerobic and resistance exercise on glycemia in individuals with type 2 diabetes: Systematic review and meta-analysis 有氧和阻力运动对2型糖尿病患者血糖的急性影响：系统回顾和荟萃分析

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101146

Josiane Aparecida de Almeida , Ana Paula Delgado Bomtempo Batalha , Carolina Vargas de Oliveira Santos , Tamiris Schaeffer Fontoura , Mateus Camaroti Laterza , Lilian Pinto da Silva

Background

Type 2 diabetes (T2D) is the most prevalent in the world population, and exercise is one of the main non-pharmacological interventions to treat this health condition.

Objective

To evaluate the effect of a single session of aerobic exercise (AE) and/or resistance exercise (RE) on post-exercise glycemia in individuals with T2D.

Methods

A literature search was conducted in CINAHL, Cochrane Library, EMBASE, Google Scholar, LILACS, MEDLINE/Ovid, SciELO, SPORTDiscus, and Web of Science up to May 2024, randomized and non-randomized clinical trials were included. The risk of bias and the certainty of evidence were assessed using the Cochrane "Risk of Bias" and GRADE tools, respectively.

Results

Initially, 7210 studies were identified, 26 were included in the systematic review, and 13 in the meta-analysis. A single session of continuous AE (CAE), interval AE (IAE), or RE promoted a significant reduction in glycemia in the first minute after exercise (-1.48 mmol/L [95 % CI:-1.73, -1.23]; -2.66 mmol/L [95 % CI:-3.48, -1.84]; -1.18 mmol/L [95 % CI:-2.15, -0.21], respectively), compared to the control session. This reduction persisted for up to 10 min after the CAE session (-1.61 mmol/L [95 % CI:-2.21, -1.01]) and up to 30 min after the IAE session (-1.11 mmol/L [95 % CI:-1.88, -0.35]). The risk of bias was assessed as uncertain, and the quality of the evidence was moderate.

Conclusion

CAE and IAE reduces glycemia for a period of up to 10 or 30 min after its completion, respectively, while a single session of RE reduces glycemia only in the first-minute post-exercise in individuals with T2D.

背景：2型糖尿病（T2D）在世界人口中最为普遍，运动是治疗这种健康状况的主要非药物干预措施之一。目的：评价单次有氧运动（AE）和/或阻力运动（RE）对T2D患者运动后血糖的影响。方法：检索截至2024年5月的CINAHL、Cochrane Library、EMBASE、谷歌Scholar、LILACS、MEDLINE/Ovid、SciELO、SPORTDiscus、Web of Science等数据库的文献，纳入随机和非随机临床试验。偏倚风险和证据确定性分别使用Cochrane“偏倚风险”和GRADE工具进行评估。结果：最初，确定了7210项研究，26项纳入系统评价，13项纳入荟萃分析。单次连续AE （CAE）、间歇AE （IAE）或RE可显著降低运动后第一分钟的血糖(-1.48 mmol/L [95% CI:-1.73, -1.23]；-2.66 mmol/L [95% CI:-3.48, -1.84]；-1.18 mmol/L [95% CI:-2.15, -0.21])，与对照组相比。这种减少在CAE治疗后持续10分钟（-1.61 mmol/L [95% CI:-2.21, -1.01]），在IAE治疗后持续30分钟（-1.11 mmol/L [95% CI:-1.88, -0.35]）。偏倚风险评估为不确定，证据质量为中等。结论：CAE和IAE分别在完成后10分钟或30分钟内降低血糖，而单次RE仅在T2D患者运动后1分钟内降低血糖。

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引用次数: 0

Is self-reported symptom duration in individuals with patellofemoral pain an accurate measure? An observational longitudinal study 髌股疼痛患者自我报告的症状持续时间是否准确？一项观察性纵向研究。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101167

Ronaldo Valdir Briani , Ana Flávia Botta Balotari , Marina Cabral Waiteman , Fernando Henrique Magalhães , David M. Bazett-Jones , Fábio Mícolis de Azevedo

Background

Although self-reported symptom duration of individuals with patellofemoral pain (PFP) is usually assessed for clinical and research purposes, its accuracy has never been investigated.

Objectives

We followed up individuals with PFP over 15 months to determine the agreement between self-reported symptom duration and calculated symptom duration.

Methods

Self-reported symptom duration of 39 participants was assessed at baseline and re-assessed at follow-up. Calculated follow-up symptom duration was determined by the summation of baseline self-reported symptom duration with the known follow-up duration. The symptom duration difference was determined by the subtraction of the calculated follow-up symptom duration and the self-reported follow-up symptom.

Results

We identified a symptom duration difference of 20.1 months (95 % confidence interval: 11.2, 29.1 months), with greater differences in individuals with longer symptom duration (r² = 0.12).

Conclusion

Our findings suggest that the accuracy of self-reported symptom duration measures in individuals with PFP is questionable and techniques should be used to improve it.

背景：尽管自我报告的髌股疼痛（PFP）患者的症状持续时间通常用于临床和研究目的，但其准确性从未被调查过。目的：我们对PFP患者进行随访超过15个月，以确定自我报告的症状持续时间和计算的症状持续时间之间的一致性。方法：对39名受试者在基线时进行自我报告的症状持续时间评估，并在随访时重新评估。计算的随访症状持续时间由基线自我报告的症状持续时间与已知随访时间的总和确定。症状持续时间的差异由计算的随访症状持续时间与自我报告的随访症状相减确定。结果：我们发现症状持续时间差异为20.1个月（95%置信区间：11.2,29.1个月），症状持续时间越长个体差异越大（r²= 0.12）。结论：我们的研究结果表明，PFP患者自我报告的症状持续时间测量的准确性值得怀疑，应该使用技术来改善它。

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引用次数: 0

Epigenetics as the molecular substrate of multimodal lifestyle approaches for patients with persistent pain 表观遗传学作为持续疼痛患者多模式生活方式途径的分子基础。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2025-01-01 DOI: 10.1016/j.bjpt.2024.101170

Andrea Polli , Jo Nijs , Bernard Thienpont

引用次数: 0

Walking biomechanics in women with patellofemoral osteoarthritis differ compared to men with and women without patellofemoral osteoarthritis 与患有髌骨关节炎的男性和未患有髌骨关节炎的女性相比，患有髌骨关节炎的女性的行走生物力学存在差异。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2024-11-01 DOI: 10.1016/j.bjpt.2024.101132

Matthew G King , David C Ackland , Harvi F Hart , Anthony G Schache , Prasanna Sritharan , Marcus G Pandy , Kay M Crossley

Background

Differences in walking biomechanics between women and men with patellofemoral joint (PF) osteoarthritis (OA) may contribute to the development or progression of persistent symptoms in people with PFJ OA.

Objective

Evaluate how walking biomechanics of women with PF OA differ from: (i) men with PFJ OA; and (ii) women without PF OA. Second, explore the relationship between knee-related symptoms/function and walking biomechanics in individuals with PF OA, and whether these are modified by sex.

Methods

Sixty-seven individuals with PF OA (43 women) and 14 women without PF OA were included. Biomechanics data were recorded during walking. Patient-reported symptoms and function were obtained using the Knee injury and Osteoarthritis Outcome Score. Differences in continuous biomechanical data were assessed using statistical parametric mapping, with discrete data and relationships evaluated using linear models.

Results

Women with PF OA walked with a greater hip adduction angle throughout stance (t > 2.757) and lower impulses for the hip flexion, knee flexion, and ankle dorsiflexion moments (adjusted mean differences [95 % CI]:3.3 × 10^–2 [-4.9 × 10^–2, -1.6 × 10^–2], -2.9 × 10^–2 [-5.3 × 10^–2, -0.4 × 10^–2], -5.1 × 10^–2 [-8.2 × 10^–2, -2.0 × 10^–2] Nms/kg, respectively) compared to men with PF OA. Compared to their asymptomatic peers, women with PF OA displayed a 5° offset towards greater hip flexion. Higher knee adduction moment impulse correlated with worse KOOS-ADL scores in men, not women.

Conclusion

Observed biomechanical differences were small in nature with moderate to weak relationship observed with the KOOS. Findings were not limited to the knee, indicating that women with PF OA display unique biomechanical features across the kinetic-chain.

背景：患有髌骨关节（PF）骨关节炎（OA）的女性和男性在行走生物力学方面的差异可能会导致PFJ OA患者持续症状的出现或恶化：评估患有 PF OA 的女性在行走生物力学方面与(i) 患有 PFJ OA 的男性和(ii) 未患 PF OA 的女性有何不同。其次，探讨膝关节相关症状/功能与 PF OA 患者行走生物力学之间的关系，以及这些关系是否因性别而改变：方法：纳入 67 名 PF OA 患者（43 名女性）和 14 名无 PF OA 的女性。在行走过程中记录生物力学数据。使用膝关节损伤和骨关节炎结果评分法获得患者报告的症状和功能。连续生物力学数据的差异使用统计参数图进行评估，离散数据和关系使用线性模型进行评估：结果：患有 PF OA 的女性在整个站立过程中行走时髋关节内收角度较大（t > 2.757），髋关节屈曲、膝关节屈曲和踝关节背屈力矩的脉冲较低（调整后的平均差异[95 % CI]：3.3 × 10-2 [-4.9 × 10-2, -1.6 × 10-2], -2.9 × 10-2 [-5.3 × 10-2, -0.4 × 10-2], -5.1 × 10-2 [-8.2 × 10-2, -2.0 × 10-2] Nms/kg）。与无症状的同龄人相比，PF OA 女性患者的髋关节屈曲度偏移了 5°。较高的膝关节内收力矩脉冲与男性患者较差的KOOS-ADL评分相关，而与女性患者无关：结论：观察到的生物力学差异较小，与 KOOS 的关系中度至微弱。研究结果并不局限于膝关节，这表明患有 PF OA 的女性在整个运动链中表现出独特的生物力学特征。

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引用次数: 0

Diagnostic accuracy of the flexion-rotation test and cut-off value in acute whiplash-associated disorders: A secondary analysis of a cross-sectional study1 急性鞭打相关疾病中屈曲旋转测试的诊断准确性和临界值：一项横断面研究的二次分析1。

IF 3.1 3区医学 Q1 ORTHOPEDICS

Brazilian Journal of Physical Therapy

Pub Date : 2024-11-01 DOI: 10.1016/j.bjpt.2024.101134

Ernesto Anarte-Lazo , Cleofas Rodriguez-Blanco , Carlos Bernal-Utrera

Background

Headache is common in people with whiplash-associated disorders (WAD). Upper-cervical structures may be involved in the presence of headache, and the flexion-rotation test (FRT) has been widely studied to assess cervicogenic headaches.

Objectives

To evaluate the diagnostic accuracy of the FRT for the presence of headache in people with WAD, and its cut-off value.

Methods

In this secondary analysis from a previously published study 47 people with WAD were consecutively recruited, 28 with and 19 without headache. FRT was assessed by a single blinded evaluator, with production of headache during the test as the reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were assessed through cross-tabulation. The cut-off value was calculated based on the Youden's Index. The positivity of the test was defined based on: a) range of motion (ROM) <32°; and ROM <32° combined with headache provocation.

Results

Differences between groups were significant for both most and least restricted sides of FRT in terms of ROM (p < 0.001). For the most restricted side, moderate sensitivity and specificity was found (82.1 % [95 %CI = 68.4 %, 95.8 %] and 63.2 % [95 %CI = 40.8 %, 85.6 %], respectively) when only ROM was considered. When headache provocation was included, sensitivity and specificity were 78.6 % (95 %CI = 63.1 %, 93.7 %) and 68.4 % (95 %CI = 47.5 %, 88.5 %), respectively. A cut-off value of 31.5° was found.

Conclusion

Moderate diagnostic accuracy through both ways of assessing the FRT was found for this test to detect the presence of whiplash-associated headache from upper cervical origin. The FRT may be considered positive if ROM is less than 31.5°.

背景：头痛是鞭打相关疾病（WAD）患者的常见病。头痛的出现可能与上颈部结构有关，屈-转试验（FRT）已被广泛用于评估颈源性头痛：目的：评估屈-转试验对 WAD 患者头痛的诊断准确性及其临界值：方法：对之前发表的一项研究进行二次分析，连续招募了 47 名 WAD 患者，其中 28 人有头痛，19 人无头痛。FRT 由一名单盲评估员进行评估，以测试过程中产生的头痛作为参考标准。通过交叉分析评估了敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。临界值根据尤登指数计算。测试的阳性定义基于： a) 运动范围（ROM）结果：就活动范围而言，FRT 受限最多的一侧和最少的一侧组间差异显著（P < 0.001）。对于活动受限最严重的一侧，仅考虑 ROM 时，灵敏度和特异性适中（分别为 82.1 % [95 %CI = 68.4 %, 95.8 %] 和 63.2 % [95 %CI = 40.8 %, 85.6 %]）。当包括头痛诱发因素时，敏感性和特异性分别为 78.6 %（95 %CI = 63.1 %，93.7 %）和 68.4 %（95 %CI = 47.5 %，88.5 %）。结论：结论：通过这两种方法评估 FRT，发现该测试在检测是否存在鞭打引起的上颈椎源性头痛方面具有适度的诊断准确性。如果 ROM 小于 31.5°，则 FRT 可被视为阳性。

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