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Crowell MS, Thomasma E, Florkiewicz E, Brindle R, Roach M, Goss D, Pitt W. Validity and Responsiveness of a Modified Balance Error Scoring System Assessment Using a Mobile Device Application in Patients Recovering from Ankle Sprain. Int J Sports Phys Ther 2024; 19:440-450. [PMID: 38576835 PMCID: PMC10987306 DOI: 10.26603/001c.94608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/28/2024] [Indexed: 04/06/2024] Open
Abstract
Background Static balance is often impaired in patients after ankle sprains. The ability to identify static balance impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (SWAY App) (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess postural sway during a modified Balance Error Scoring System (mBESS) assessment and shows promise as an accessible method to quantify changes in static balance after injury. Purpose The primary purposes of this study were to determine the ability to differentiate between those with ankle sprain versus controls (construct validity) and ability to detect change over time (responsiveness) of a mBESS assessment using a mobile device application to evaluate static balance after an acute ankle sprain. Study Design Case-control study. Methods Twenty-two military academy Cadets with an acute ankle sprain and 20 healthy Cadets were enrolled in the study. All participants completed an assessment measuring self-reported function, ankle dorsiflexion range of motion (via the weightbearing lunge), dynamic balance, and static balance. Static balance measured with the mBESS using the SWAY App was validated against laboratory-based measures. Cadets with ankle sprains completed their assessment twice: once within two weeks of injury (baseline) and again after four weeks of rehabilitation that included balance training. Independent and paired t-tests were utilized to analyze differences over time and between groups. Effect sizes were calculated and relationships explored using Pearson's correlation coefficients. Results The mBESS scores measured by the SWAY App were lower in participants with acute ankle sprains than healthy Cadets (t = 3.15, p = 0.004). Injured participants improved their mBESS score measured by SWAY at four weeks following their initial assessments (t = 3.31, p = 0.004; Baseline: 74.2 +/- 16.1, 4-weeks: 82.7 +/- 9.5). The mBESS measured by the SWAY App demonstrated moderate to good correlation with a laboratory measure of static balance (r = -0.59, p \< 0.001). Conclusion The mBESS assessed with a mobile device application is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated construct (known groups) validity detecting balance differences between a healthy and injured group, concurrent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain. Level of Evidence Level 3.
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Affiliation(s)
- Michael S Crowell
- University of Scranton
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | | | - Erin Florkiewicz
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | | | - Megan Roach
- DoD-VA Extremity Trauma & Amputation Center of Excellence Womack Army Medical Center
| | | | - Will Pitt
- Army-Baylor Doctoral Program in Physical Therapy
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Chaaban CR, Hearn D, Goerger B, Padua DA. Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport after ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (PRIME). Int J Sports Phys Ther 2022; 17:445-455. [PMID: 35391856 PMCID: PMC8975580 DOI: 10.26603/001c.32529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Elite female athletes who successfully return to sport after anterior cruciate ligament reconstruction (ACLR) represent a high-risk group for secondary injury. Little is known about how the functional profile of these athletes compares to their teammates who have not sustained ACL injuries. Purpose To compare elite collegiate female athletes who were able to successfully return to sport for at least one season following ACLR to their teammates with no history of ACLR with regard to self-reported knee function, kinetics, and kinematics during a double limb jump-landing task. Study Design Cross-Sectional Study. Level of Evidence Level 3. Methods Eighty-two female collegiate athletes (17 ACLR, 65 control) completed the knee-specific SANE (single assessment numeric evaluation) and three trials of a jump-landing task prior to their competitive season. vGRF data on each limb and the LESS (Landing Error Scoring System) score were collected from the jump-landing task. Knee-SANE, vGRF data, and LESS scores were compared between groups. All athletes were monitored for the duration of their competitive season for ACL injuries. Results Athletes after ACLR reported worse knee-specific function. Based on vGRF data, they unloaded their involved limb during the impact phase of the landing, and they were more asymmetrical between limbs during the propulsion phase as compared to the control group. The ACLR group, however, had lower LESS scores, indicative of better movement quality. No athletes in either group sustained ACL injuries during the following season. Conclusion Despite reporting worse knee function and demonstrating worse kinetics, the ACLR group demonstrated better movement quality relative to their uninjured teammates. This functional profile may correspond to short-term successful outcomes following ACLR, given that no athletes sustained ACL injuries in the competition season following assessment.
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Affiliation(s)
| | - Darren Hearn
- Human Performance and Sports Medicine, Fort Bragg
| | - Benjamin Goerger
- Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Darin A Padua
- Exercise and Sport Science, University of North Carolina at Chapel Hill
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Plachel F, Jung T, Bartek B, Rüttershoff K, Perka C, Gwinner C. The subjective knee value is a valid single-item survey to assess knee function in common knee disorders. Arch Orthop Trauma Surg 2022; 142:1723-1730. [PMID: 33523264 PMCID: PMC9296395 DOI: 10.1007/s00402-021-03794-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The patient's perspective plays a key role in judging the effect of knee disorders on physical function. We have introduced the Subjective Knee Value (SKV) to simplify the evaluation of individual's knee function by providing one simple question. The purpose of this prospective study was to validate the SKV with accepted multiple-item knee surveys across patients with orthopaedic knee disorders. MATERIALS AND METHODS Between January through March 2020, consecutive patients (n = 160; mean age 51 ± 18 years, range from 18 to 85 years, 54% women) attending the outpatient clinic for knee complaints caused by osteoarthritis (n = 69), meniscal lesion (n = 45), tear of the anterior cruciate ligament (n = 23) and focal chondral defect (n = 23) were invited to complete a knee-specific survey including the SKV along with the Knee Injury Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee subjective knee form (IKDC-S). The Pearson correlation coefficient was used to evaluate external validity between the SKV and each patient-reported outcome measure (PROM) separately. Furthermore, patient's compliance was assessed by comparing responding rates. RESULTS Overall, the SKV highly correlated with both the KOOS (R = 0.758, p < 0.05) and the IKDC-S (R = 0.802, p < 0.05). This was also demonstrated across all investigated diagnosis- and demographic-specific (gender, age) subgroups (range 0.509-0.936). No relevant floor/ceiling effects were noticed. The responding rate for the SKV (96%) was significantly higher when compared with those for the KOOS (81%) and the IKDC-S (83%) (p < 0.05). CONCLUSION At baseline, the SKV exhibits acceptable validity across all investigated knee-specific PROMs in a broad patient population with a wide array of knee disorders. The simplified survey format without compromising the precision to evaluate individual's knee function justifies implementation in daily clinical practice. LEVEL OF EVIDENCE II, cohort study (diagnosis).
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Affiliation(s)
- Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Benjamin Bartek
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katja Rüttershoff
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Clemens Gwinner
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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O'Halloran B, Cook CE, Oakley E. Criterion validation and interpretability of the Single Assessment Numerical Evaluation (SANE) of self-reported recovery in patients with neck pain. Musculoskelet Sci Pract 2021; 56:102467. [PMID: 34673312 DOI: 10.1016/j.msksp.2021.102467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The SANE is a PROM of recovery, which may assist clinicians in clinical decision-making and discharge planning. The psychometric measurement properties of the SANE have yet to be determined for neck pain. OBJECTIVES Threefold objectives included: 1)determine the numerical threshold for the SANE at which patients with neck pain determine their symptoms are acceptable; 2)determine the association between scores for the NDI and VAS, with the SANE; 3)determine the average number of visits, costs and value associated with the management of neck pain. DESIGN Longitudinal repeated measures cohort design. METHODS Threshold measures for self-reported recovery with the SANE anchored to the PASS were examined using ROC. PCC determined the relationship between the VAS/pain and NDI raw/percentage change scores and the SANE at discharge. Descriptive statistics were used for number of visits and cost. Value was calculated as the proportion of change on the NDI and VAS/$100 US dollars spent. RESULTS 57 subjects completed full observation. ROC analysis indicates a threshold value of 82.5%(Sn = 56.0, Sp = 85.7,+LR = 1.68,-LR = 0.29) on the SANE with an AUC of 0.820(95%CI = 0.638, 1.00). A weak correlation was found between raw NDI(r = 0.39 p < 0.05)/Pain(r = 0.45 p < 0.05) scores and the SANE with a moderate correlation between percent change scores of NDI(r = 0.52 p < 0.05)/PAIN(r = 0.54 p < 0.05) and the SANE. The value proposition indicated cost of care amounted to a 10.5% and 12.9%; improvement in the NDI and pain scores/$100 spent. CONCLUSIONS Patients reporting greater than 82.5% on the SANE are likely to find their present status acceptable and potentially stop seeking care.
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Affiliation(s)
- Bryan O'Halloran
- School of Physical Therapy, Samson College of Health Sciences, University of the Sciences, 600 S 43rd St Philadelphia, PA, 19104, USA.
| | - Chad E Cook
- Doctor of Physical Therapy Division, DUMC 104002311 Trent Drive, Duke University, Durham, NC, 27710, USA.
| | - Elizabeth Oakley
- Physical Therapy Building 135, Andrews University, 8975 Old 31, Berrien Springs, MI, 49104, USA.
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Cohn MR, Kunze KN, Polce EM, Nemsick M, Garrigues GE, Forsythe B, Nicholson GP, Cole BJ, Verma NN. Establishing clinically significant outcome thresholds for the Single Assessment Numeric Evaluation 2 years following total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e137-e146. [PMID: 32711106 DOI: 10.1016/j.jse.2020.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Single Assessment Numerical Evaluation (SANE) is a simple, time-efficient patient-reported outcome measure (PROM) used to assess postoperative shoulder function. Clinically significant outcome values and ability to correlate with longer legacy PROM scores at 2 years following shoulder arthroplasty are unknown. METHODS A retrospective analysis was performed using SANE, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores that were collected at a minimum 2-year follow-up. A total of 153 patients who underwent anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) were included. A distribution-based method was used to determine the minimal clinically important difference (MCID). An anchor-based method was used to determine substantial clinical benefit (SCB). The following anchor question was collected alongside the PROMs and graded on a 15-point Likert-type scale to establish the SCB: "Since your surgery, has there been any change in the pain in your shoulder?" Linear regression was used to assess correlations between PROMs. RESULTS SANE showed moderate correlation with ASES (R2 = 0.493) and Constant (R2 = 0.586) scores (P < .001). The MCID value was 14.9, and the SCB absolute value was 80.4 (area under the curve = 0.663) for SANE. Multivariate logistic regression demonstrated that patients undergoing RTSA were less likely to achieve SCB on all 3 outcome measures (P < .02). CONCLUSIONS This study establishes concurrent construct validity for SANE and suggests that it is a valid metric to assess the MCID and SCB at 2 years following anatomic TSA and RTSA. SANE demonstrated moderate correlations with ASES and Constant scores. Patients undergoing RTSA demonstrated a lower propensity to achieve SCB at 2 years postoperatively compared with anatomic TSA.
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Affiliation(s)
- Matthew R Cohn
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Kyle N Kunze
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Evan M Polce
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Michael Nemsick
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Grant E Garrigues
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Gregory P Nicholson
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine & Shoulder, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA.
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Fomin S, Gauffin H, Kvist J. Short-term recovery of physical activity and knee function after an acute knee injury. BMJ Open Sport Exerc Med 2020; 6:e000950. [PMID: 33437496 PMCID: PMC7780533 DOI: 10.1136/bmjsem-2020-000950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives To describe self-reported knee function, participation in physical activity and the number of knee surgeries at 3 and 6 months following acute knee injury. Methods Prospective cohort study. Participants, aged 15–40 years with an acute knee injury sustained no more than 6 weeks prior to inclusion, were recruited. There were 279 participants with ACL injury and 101 participants with other acute knee injuries included. Follow-up questionnaires were sent at 3 and 6 months after injury. Demographic information, activity participation, International Knee Documentation Committee subjective knee form (IKDC-SKF) and the Single Assessment Numeric Evaluation (SANE) score were collected. Additional knee injuries were obtained from self-report and medical charts. Results The IKDC-SKF, SANE and physical activity participation were reduced at 3-month and 6-month follow-up. The number of participants who achieved health-promoting physical activity levels was reduced by 50% at 6-month follow-up compared with before injury. Seventeen per cent of participants with ACL injury and 41% of participants with other acute knee injuries had returned to their preinjury physical activity at 6 months. Participants with ACL injury reported worse knee function, lower physical activity participation and had more surgeries (128 surgeries, including 109 ACL-reconstructions) compared with participants with other acute knee injuries (six surgeries). Conclusion Acute knee injuries, including ACL injuries, affected self-reported knee function and physical activity participation for at least 6 months after index injury. More research is needed to understand how best to help people with acute knee injuries return to physical activity and achieve satisfactory knee function.
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Affiliation(s)
- Sanne Fomin
- Unit of Physioptherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Håkan Gauffin
- Orthopaedics. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physioptherapy, Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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