Effects of Tai Chi on Gait Kinematics, Physical Function, and Pain in Elderly with Knee Osteoarthritis — A Pilot Study

Our previous study has demonstrated that 6 weeks of Tai Chi exercise significantly improves knee pain and stiffness in elderly with knee osteoarthritis. This study also examine the effects of Tai Chi exercise on gait kinematics, physical function, pain, and pain self-efficacy in elderly with knee osteoarthritis. In this prospective, pretest-posttest clinical trial, 40 men and women (64.4 ± 8.3 years) diagnosed with knee osteoarthritis participated in 6 weeks of instructed Tai Chi training, 1 hour/session, 2 sessions/week. The following measures were taken at baseline and the conclusion of the intervention: (a) gait kinematics including stride length, stride frequency, and gait speed quantified using video analysis, (b) physical function, (c) knee pain, and (d) pain self-efficacy. Data were analyzed using repeated MANCOVA, MANOVA, ANOVA and Wilcoxon tests. After 6 weeks of Tai Chi exercise, stride length ( p = 0.023; 1.17 ± 0.17 vs. 1.20 ± 0.14 m ), stride frequency ( p = 0.014; 0.91 ± 0.08 vs. 0.93 ± 0.08 strides/s), and consequently gait speed (p < 0.025; 1.06 ± 0.19 vs. 1.12 ± 0.15 m/s ) increased in the participants. Physical function was significantly improved ( p < 0.001) and knee pain was significantly decreased ( p = 0.002), while no change was observed in pain self-efficacy. In conclusion, these findings support that Tai Chi is beneficial for gait kinematics in elderly with knee osteoarthritis, and a longer term application is needed to substantiate the effect of Tai Chi as an alternative exercise in management of knee osteoarthritis.

Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management

BACKGROUND

Proper management of thoracic outlet syndrome (TOS) requires an understanding of the underlying causes of the disorder. A comprehensive examination process, as described in Part 1 of this review, can reveal the bony and soft tissue abnormalities and mechanical dysfunctions contributing to an individual's TOS symptoms.

OBJECTIVE

Part 2 of this review focuses on management of TOS.

CONCLUSION

The clinician uses clinical examination results to design a rehabilitation program that focuses on correcting specific problems that were previously identified. Disputed neurogenic TOS is best managed with a trial of conservative therapy before surgical treatment options are considered. Cases that are resistant to conservative treatment may require surgical intervention. True neurogenic TOS may require surgical intervention to relieve compression of the neural structures in the thoracic outlet. Surgical management is required for cases of vascular TOS because of the potentially serious complications that may arise from venous or arterial compromise. Post-operative rehabilitation is recommended after surgical decompression to address factors that could lead to a reoccurrence of the patient's symptoms.

Relationships between clinical measures of static foot posture and plantar pressure during static standing and walking

BACKGROUND

Information is limited about the relationships between clinical measures of static foot posture and peak plantar pressures under the medial column of the foot. The purpose was to examine these relationships during static standing and walking.

METHODS

A single-group exploratory design using correlation and regression was used to determine relationships. Ninety-two healthy volunteers participated. Clinical measures of static foot posture including arch index, navicular drop and navicular drift were obtained during static standing. Peak plantar pressures under the hallux, medial forefoot, medial midfoot, and medial rearfoot were obtained during standing and walking.

FINDINGS

Static foot posture was related to peak plantar pressures during standing and walking, but the strengths of relationships ranged from poor to fair. During standing, navicular drop was correlated (P≤0.05) with hallux (r=0.29) and medial forefoot (r=-0.17) pressures, while arch index (r=-0.17) and navicular drift (r=0.25) were correlated (P≤0.05) with hallux pressure. During walking, arch index, navicular drop and navicular drift were correlated (P≤0.05) with hallux and medial forefoot pressures (r range -0.30 to 0.41), while arch index (r=-0.15) and navicular drop (r=0.16) were correlated (P≤0.05) with medial midfoot pressure. Regression models predicted (P≤0.05) hallux (R(2)=0.08) and medial midfoot (R(2)=0.05) pressures during standing, and hallux (R(2)=0.18), medial forefoot (R(2)=0.07), and medial rearfoot (R(2)=0.05) pressures during walking.

INTERPRETATION

In healthy participants, lower arch foot postures are associated with greater pressures under the hallux and medial mid-foot and lower pressures under the medial forefoot, but the strength of these relationships may be only poor to fair.

Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial

OBJECTIVE

To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression.

DESIGN

Single-blind, repeated-measures crossover design.

SETTING

Outpatient physical therapy clinic.

SUBJECTS

Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing.

INTERVENTION

Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction.

MEASUREMENTS

Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention.

RESULTS

The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only.

CONCLUSION

Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.

Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis

Thoracic outlet syndrome (TOS) is a frequently overlooked peripheral nerve compression or tension event that creates difficulties for the clinician regarding diagnosis and management. Investigators have categorized this condition as vascular versus neurogenic, where vascular TOS can be subcategorized as either arterial or venous and neurogenic TOS can subcategorized as either true or disputed. The thoracic outlet anatomical container presents with several key regional components, each capable of compromising the neurovascular structures coursing within. Bony and soft tissue abnormalities, along with mechanical dysfunctions, may contribute to neurovascular compromise. Diagnosing TOS can be challenging because the symptoms vary greatly amongst patients with the disorder, thus lending to other conditions including a double crush syndrome. A careful history and thorough clinical examination are the most important components in establishing the diagnosis of TOS. Specific clinical tests, whose accuracy has been documented, can be used to support a clinical diagnosis, especially when a cluster of positive tests are witnessed.

Association of disturbances in the thoracic outlet in subjects with carpal tunnel syndrome: a case-control study

INTRODUCTION

A limited amount of research has investigated the potential relationship between carpal tunnel syndrome (CTS) and thoracic outlet dysfunction.

PURPOSE OF THE STUDY

To compare the prevalence of positive clinical tests suggestive of disputed neurogenic thoracic outlet syndrome (TOS) in subjects with CTS (CTS+) with that of subjects without CTS (control).

STUDY DESIGN

Case-control study.

METHODS

Subjects with electrodiagnostically confirmed CTS (CTS+) were recruited consecutively and matched by age (±2 years) and gender with asymptomatic (control) subjects. Subjects underwent clinical testing for neurogenic TOS using two provocative tests: modified Cyriax release test and elevated arm stress test (EAST). Subjects were tested for the presence of an elevated first rib using cervical rotation lateral flexion (CRLF) test.

RESULTS

A total of 32 investigational subjects and 32 matched control subjects was included in each group (mean age: 43.5+5.9 years). A significantly greater number of CTS+ subjects presented with positive provocative testing for TOS (modified Cyriax release test p=0.005; EAST approached significance p=0.027) and for the presence of an elevated first rib (CRLF test p=0.003) as compared with controls. The likelihood of neck pain, shoulder pain, or an elevated first rib was 16 times greater in the CTS+ group as compared with that in the control group.

CONCLUSIONS

A greater number of subjects with CTS presented with proximal dysfunctions suggestive of TOS and history of neck and shoulder pain. Evaluation of proximal structures involved with thoracic outlet dysfunction in persons with CTS has clinical merit.

LEVEL OF EVIDENCE

Level III-b.

Change in spine height measurements following sustained mid-range and end-range flexion of the lumbar spine

Workers lose height during the day. Flexion-based exercises and body positions are commonly prescribed to unload the spine and prevent back pain. Lumbar extension positions have been researched and result in an increase in spine height. End-range lumbar extension postures increase spine height to a greater extent than mid-range lumbar extension postures, but these positions are not always tolerated by patients with lumbar conditions. No study to date has investigated the effect of end-range versus mid-range lumbar flexion postures on spine height changes. The purpose of this study was to investigate the effects of two techniques commonly used in clinical settings to unload the lumbar intervertebral disc (IVD) segments through increasing spine height in: (1) a sidelying mid-range lumbar flexion position; and (2) a sidelying end-range lumbar flexion position. A total of 20 asymptomatic women and 21 asymptomatic men with a mean age of 23.8 years (±2.5) participated in the study. Subjects were randomized systematically into 2 groups to determine the order of testing position. Measurements were taken with a stadiometer in the sitting position to detect change in spine height after each position. Results of the paired t-tests indicated that compared to the spine height in sitting, the sidelying end-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 4.78 mm (±4.01) while the sidelying mid-range lumbar flexion position resulted in a statistically significant (p < .001) mean spine height gain of 5.84 mm (±4.4). No significant difference between the height changes observed following the two sidelying positions was found (p = .22). Sidelying lumbar flexion positions offer valuable alternatives to lumbar extension positions to increase spine height, possibly through increasing hydration levels of the lumbar IVD and could be proposed as techniques to offset spinal shrinkage and the biomechanical consequences of sustained loads.

Evidence-supported rehabilitation of patellar tendinopathy

Chronic tendinopathy is a common musculoskeletal disorder that frequently affects athletes who train and compete at all levels. This Clinical Commentary presents a review of the etiology, incidence, and contributory factors related specifically to patellar tendinopathy. Examination and differential diagnosis considerations are provided, and an evidence-based, staged rehabilitation program is described.

Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study

OBJECTIVE

to evaluate the effects of tai chi exercise on risk factors for falls in postmenopausal women with osteopaenia through measurements of balance, gait, physical function and quality of life.

DESIGN

a randomized, controlled, single-blinded, 24-week trial with stratification by age and bone mass.

SETTING

general community.

PARTICIPANTS

Sixty-one independently living elderly females aged 65 years and older with low bone mass.

INTERVENTIONS

subjects were recruited and randomly assigned to 24 weeks of tai chi (60 minutes/session, three sessions/week, n = 30) or a control group (n = 31).

OUTCOME MEASURES

computerized dynamic posturography, gait, 'timed up and go', five-chair sit-to-stand and quality of life assessed at baseline, 12 and 24 weeks.

RESULTS

after 24 weeks, subjects in the tai chi group demonstrated an increase in stride width (P = 0.05) and improvement in general health (P = 0.008), vitality (P = 0.02) and bodily pain (P = 0.03) compared with those in the control group. There was no significant difference in balance parameters, 'timed up and go', five-chair sit-to-stand and other domains of quality of life.

CONCLUSION

tai chi exercise may reduce risk factors for falls by increasing the stride width, and may improve quality of life in terms of general health, vitality and bodily pain in postmenopausal women with osteopaenia.

Publishing a scientific manuscript on manual therapy

Publication in peer-reviewed journals is the way to introduce new information that has clinical implications. However, clinicians may be reluctant to embark on the publication process because of lack of confidence or uncertainty about the process. The aim of this paper is to summarize the requirements of that process and to provide tips for successful publication to encourage potential clinical authors of manual therapy articles. In general, articles should contribute knowledge, corroborate or contradict previous knowledge, or summarize existing knowledge. Articles should be clearly structured, with abstract, introduction, methods, discussion, conclusion, and references; and often include tables and figures. The content of each of these sections is described. The use of standardized checklists is encouraged and the format should adhere to each journal's author guidelines. Submission is electronic and typically first the editor or deputy editor reviews for suitability, adherence to journal format, and quality of writing. If deemed suitable, the article is then sent out for blinded review by two reviewers with expertise in that area. Review typically takes 6-8 weeks, and all communication is via the editor. A decision is made then to either accept, accept with amendments to be made, reject but with advice to resubmit, or reject outright. In any re-submissions, the review teams' comments should be diligently addressed, either making the recommended changes or justifying why they have not been adopted. Common reasons for rejection of articles are given. Finally, the authors provide some tips for publication to help readers with successful submission of articles.

The double crush syndrome: a common occurrence in cyclists with ulnar nerve neuropathy-a case-control study

OBJECTIVE

To evaluate the incidence of double crush syndrome in the upper limbs of cyclists with clinical diagnosis of ulnar nerve neuropathy.

DESIGN

Case-control study.

SETTING

Outpatient clinics and university setting.

PARTICIPANTS

Consecutive sampling of 70 cyclists (140 upper limbs) with a mean age of 36 years (+/-11.3). Seventy-two upper limbs were excluded, leaving 40 upper limbs with a clinical diagnosis of ulnar nerve neuropathy [ULNN (+)] and 28 without symptoms of ulnar nerve neuropathy [ULNN (-)].

ASSESSMENT

Cyclists were examined clinically for the presence of proximal dysfunction using the following testing (independent variables): (1) thoracic outlet syndrome provocation testing: elevated arm stress test and modified Cyriax release test; (2) presence of an elevated first rib: cervical rotation lateral flexion test; and (3) presence of proximal symptoms: reports of neck pain and shoulder pain.

MAIN OUTCOME MEASUREMENTS

The upper limbs of cyclists were categorized into 2 groups (dependent variable)-ULNN (+) and ULNN (-)-based on history, symptoms, motor, sensory, and provocative clinical testing.

RESULTS

A significantly greater number of upper limbs of cyclists with ULNN (+) presented with positive provocative testing for thoracic outlet syndrome (elevated arm stress test P = 0.005; modified Cyriax release test P = 0.002) than did the upper limbs of cyclists with ULNN (-). The likelihood for the presence of neck pain, shoulder pain, and an elevated first rib was 3, 5, and 12 times greater, respectively, in the ULNN (+) than the ULNN (-) group.

CONCLUSION

A statistically significant greater number of the upper limbs of cyclists with clinical diagnosis of ulnar nerve neuropathy presented with proximal dysfunctions suggestive of double crush syndrome.

Comparing the anatomical consistency of the posterior superior iliac spine to the iliac crest as reference landmarks for the lumbopelvic spine: A retrospective radiological study

A palpation reference line coursing between the superior-most aspect of the iliac crests has been reported to cross the L4 spinous process or L4/L5 intervertebral space in approximately 80% of the population. Comparable data have not been defined for the line coursing between the posterior superior iliac spines (PSIS). The purpose of this study was to compare the anatomical consistency of the PSIS to the iliac crest as landmarks used for spinal palpation. One hundred computerized tomographic images were reviewed in a three-dimensional setting. Two horizontal lines were constructed on each image: Line 1 representing the superior-most aspect of the iliac crest and Line 2 representing the inferior margin of the PSIS. The vertical distance between each horizontal line and the inferior edge of its respective spinous process were measured. The PSIS corresponded to the S2 spinous process in 81% of subjects and the iliac crest to the L4 spinous process in 59% of subjects. Distance measures suggest that the PSIS was closer to S2 versus the iliac crest to L4 (t = 6.998; P < 0.01). The PSIS crossed S2 more frequently than the iliac crest crossed L4 (chi(2) = 12.719, P < or = 0.01). The study findings support the relationship between the PSIS, and the spinous process of S2 is more consistent when compared to the iliac crest and the spinous process of L4. The PSIS reference line may be used to find S2 as a reference standard in validity and reliability palpation studies in the lower lumbar spine.

2006 Young Investigator Award Winner: lumbosacral nerve root displacement and strain: part 2. A comparison of 2 straight leg raise conditions in unembalmed cadavers

STUDY DESIGN

An inferential cadaveric study.

OBJECTIVES

To compare the displacement and strain of the lumbosacral nerve roots during different conditions of straight leg raise (SLR) with intact foraminal ligaments.

SUMMARY OF BACKGROUND DATA

Clinicians use sensitizing movements such as dorsiflexion during neurodynamic testing, assuming that these prepositions influence the displacement or strain to the lumbosacral nerve roots. Little is known about the effect of these prepositions on neurodynamic behavior.

METHODS

Lower limbs and associated nerve roots of 5 unembalmed cadavers (n = 10) were used to evaluate the displacement and strain of the L4, L5, and S1 roots during 2 different SLR conditions. Fluoroscopic images of intraneural metal markers were digitized to evaluate displacement and strain during SLR with no preposition (SLR NPP) of the ankle and SLR with dorsiflexion preposition (SLR DF) of the ankle, respectively.

RESULTS

SLR NPP produced larger distal displacement at L5 and S1, (P < 0.001) when compared with SLR DF. Displacement comparisons at L4 were nonsignificant (P = 0.051). While nonsignificant, medium to large effect sizes (0.60-0.96) suggest that SLR DF may produce more strain than the SLR NPP condition.

CONCLUSIONS

Prepositions of the SLR test alter the displacement and possibly the strain of the lumbosacral nerve roots in the lateral recess.

2006 Young Investigator Award Winner: lumbosacral nerve root displacement and strain: part 1. A novel measurement technique during straight leg raise in unembalmed cadavers

STUDY DESIGN

A descriptive cadaveric study incorporating a novel nerve root marking technique.

OBJECTIVES

To describe the displacement and strain of the lumbosacral nerve roots in the lateral recess during straight leg raise (SLR) without disrupting the foraminal ligaments.

SUMMARY OF BACKGROUND DATA

Previous studies document 2 to 8 mm of lumbosacral nerve root displacement during SLR. Prior dissection methods incorporated laminectomy and facetectomy.

METHODS

Lower limbs and associated nerve roots of 5 unembalmed cadavers (n = 10) were studied. Metal markers were inserted intraneurally within the lateral recess of L4, L5, and S1 with a modified spinal needle. Fluoroscopic images were digitized to evaluate displacement and strain during SLR.

RESULTS

The lumbosacral nerve roots in the lateral recess moved less and experienced less strain during SLR than described in previously published reports. Statistically significant distal displacement occurred at hip positions greater than 60 degrees of flexion at all nerve root levels (P < 0.01).

CONCLUSIONS

The lumbosacral nerve roots (L4, L5, S1) moved less and underwent less strain during SLR testing than previously reported and may require hip motion greater than 60 degrees to produce substantive displacement in the lateral recess. Additional research is needed to examine the effects of prepositioning during SLR.

Coupling Behavior of the Thoracic Spine: A Systematic Review of the Literature

OBJECTIVE

The knowledge of 3-dimensional spine coupling characteristics is important for treating patients with spinal pain. The purpose of this study was to examine the coupling directional pattern of the thoracic spine by systematic review. This review could help determine the use of coupling knowledge for manual therapy treatment.

METHODS

A systematic review of studies examining in vivo and in vitro thoracic spine coupled motion was conducted using PubMed and Cumulative Index to Nursing and Allied Health Literature searches (1960-2006), as well as a separate hand-search. Study abstracts were independently reviewed and selected by two investigators based on face validity. The reliability between investigators was established using the Kappa (K) coefficient. A third investigator resolved any inclusion disagreement. Full studies were then evaluated for compliance with inclusion criteria. Coupling patterns from accepted studies were then qualitatively compared.

RESULTS

Of the 56 citations originally identified in the searches, the first two investigators reached consensus on 41 citations and required further assistance by the third investigator on 15 citations. The reliability between investigators was rated fair (K = 0.38). Twenty-one citations were deemed acceptable for further review. Of 21 citations, 8 met the inclusion criteria and were fully reviewed. No consistent coupling pattern was observed across the 8 studies, where they exhibited ipsilateral, contralateral, or mixed coupling behaviors.

CONCLUSIONS

Differences in study design, measurement method, and tissue preparation may have contributed to differences between studies. More quality, in vivo investigations are needed to evaluate thoracic coupling in symptomatic subjects in both a flexed and extended position.

Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial

OBJECTIVE

To evaluate the effects of tai chi consisting of group and home-based sessions in elderly subjects with knee osteoarthritis.

DESIGN

A randomized, controlled, single-blinded 12-week trial with stratification by age and sex, and six weeks of follow-up.

SETTING

General community.

PARTICIPANTS

Forty-one adults (70 +/- 9.2 years) with knee osteoarthritis.

INTERVENTIONS

The tai chi programme featured six weeks of group tai chi sessions, 40 min/session, three times a week, followed by another six weeks (weeks 7 -12) of home-based tai chi training. Subjects were requested to discontinue tai chi training during a six-week follow-up detraining period (weeks 13-18). Subjects in the attention control group attended six weeks of health lectures following the same schedule as the group-based tai chi intervention (weeks 0 -6), followed by 12 weeks of no activity (weeks 7-18).

MAIN OUTCOME MEASURES

Knee pain measured by visual analogue scale, knee range of motion and physical function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were recorded at baseline and every three weeks throughout the 18-week study period. Data were analysed using a mixed model ANOVA.

RESULTS

The six weeks of group tai chi followed by another six weeks of home tai chi training showed significant improvements in mean overall knee pain (P = 0.0078), maximum knee pain (P = 0.0035) and the WOMAC subscales of physical function (P = 0.0075) and stiffness (P = 0.0206) compared to the baseline. No significant change of any outcome measure was noted in the attention control group throughout the study. The tai chi group reported lower overall pain and better WOMAC physical function than the attention control group at weeks 9 and 12. All improvements disappeared after detraining.

Medical Screening for Red Flags in the Diagnosis and Management of Musculoskeletal Spine Pain

When a patient presents with pain in the different regions of the spine, the clinician executes a region-appropriate basic examination that includes appropriate historical cues and specific physical examination tests that can be used to identify red flags. The clinical tests include a specific examination of the sensory and motor systems. Test outcomes are best interpreted in context with the entire examination profile, where the sensitivity and specificity of these tests can influence their utility in uncovering red flags. These red flags can be categorized based on the nature and severity or the specific elements of the patient's presentation. Many general red flags can be observed in any region of the spine, while specific red flags must be categorized and discussed for each spinal region. This categorization can guide the clinician in the direction of management, whether that management is aimed at redirecting the patient's care to another specialist, reconsidering the presentation and observing for clusters of findings that may suggest red flags, or managing the patient within the clinician's specialty in context with the severity of the patient's presentation.

Effect of sex hormones on neuromuscular control patterns during landing

The purpose of the study was to investigate the effects of sex hormones across menstrual cycle phases on lower extremity neuromuscular control patterns during the landing phase of a drop jump. A repeated-measures design was utilized to examine sex hormone effects in 26 recreationally active eumenorrheic women. Varus/valgus knee angle and EMG activity from six lower extremity muscles were recorded during three drop jumps from a 50 cm platform in each phase of the menstrual cycle. Blood assays verified sex hormone levels and cycle phase. The semitendinosus muscle exhibited onset delays (p0.006) relative to ground contact during the luteal phase, and demonstrated a significant (p0.05) difference between early and late follicular phases. Muscle timing differences between the gluteus maximus and semitendinosus were decreased (p0.05) in the luteal compared to early follicular phases. These results suggest a different co-contractive behavior between the gluteus maximus and semitendinosus, signifying a shift in neuromuscular control patterns. It appears that female recreational athletes utilize a different neuromuscular control pattern for performing a drop jump sequence when estrogen levels are high (luteal phase) compared to when they are low (early follicular phase).

Interrater Reliability of a Passive Physiological Intervertebral Motion Test in the Mid-Thoracic Spine

OBJECTIVE

To examine the interrater reliability of a passive physiological intervertebral motion (PPIM) test of a mid-thoracic spine motion segment.

METHODS

Nineteen males and 22 females with a mean age of 22.7 years (range, 19-40 years) and no known spinal pathologies were tested independently by 3 certified manual therapy instructors. Investigators performed 3-dimensional segmental mobility testing at a preselected thoracic motion segment. Interrater reliability was assessed with Cohen's kappa statistics, using 3 pairwise comparisons for determination of the direction of lateral flexion leading to the greatest amount of segmental rotation.

RESULTS

Percent agreement ranges were 63.4% to 82.5%, with kappa scores ranging from 0.27 to 0.65.

CONCLUSION

The PPIM testing demonstrated fair to substantial interrater reliability. A majority of females (91%) demonstrated greatest segmental PPIM motion in contralateral rotation with lateral flexion, whereas a majority of males (90%) demonstrated greatest segmental PPIM motion in ipsilateral rotation with lateral flexion. These findings are applicable to asymptomatic subjects of the same age category. Interrater reliability of 3-dimensional PPIM testing is fair to substantial for assessing passive segmental mobility of the mid-thoracic spine.