Sensitivity to change of mobility measures in musculoskeletal conditions on lower extremities in outpatient rehabilitation settings

RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol)

INTRODUCTION

Most simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based on retrospective observational studies have reported that virtual fracture clinics can deliver follow-up care that is safe and cost-effective. However, no randomised controlled trial has investigated if a virtual fracture clinic can provide non-inferior physical function outcomes compared with an in-person clinic for patients with simple fractures.

METHODS AND ANALYSIS

312 participants will be recruited from 2 metropolitan hospitals located in Sydney, Australia. Adult patients will be eligible if they have an acute simple fracture that can be managed with a removable splint and is deemed appropriate for follow-up at either the virtual or in-person fracture clinic by an orthopaedic doctor. Patients will not be eligible if they have a complex fracture that requires a cast or surgery. Eligible participants will be randomised to receive their follow-up care either at the virtual or the in-person fracture clinic. Participants at the virtual fracture clinic will be reviewed within 5 days of receiving a referral through video calls with a physiotherapist. Participants at the in-person fracture clinic will be reviewed by an orthopaedic doctor within 7-10 days of receiving a referral. The primary outcome will be the patient's function measured using the Patient-Specific Functional Scale at 12 weeks. Secondary outcomes will include health-related quality of life, patient-reported experiences, pain, health cost, healthcare utilisation, medication use, adverse events, emergency department representations and surgery.

ETHICS AND DISSEMINATION

The study has been approved by the Sydney Local Health District Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The trial results will be submitted for publication in a reputable international journal and will be presented at professional conferences.

TRIAL REGISTRATION NUMBER

ACTRN12623000934640.

Responsiveness of monopodal postural stability tests in recreational athletes

Background

Stabilometry, the modified Star Excursion Balance Test (mSEBT) or the Emery balance test (EBT) are reported in the literature to reflect changes after an intervention in monopodal postural stability. Even so, the responsiveness of those tests has not been evaluated after an instability training programme or analysed using multiple statistical indicators of responsiveness. The main aim of this study was to analyse the responsiveness of the stabilometry, mSEBT or EBT.

Methods

Thirty healthy recreational athletes performed a 4-week programme with three weekly sessions of instability training of the dominant lower limb and were evaluated using stabilometry, mSEBT, and EBT tests. Responsiveness was quantified based on internal and external responsiveness.

Results

EBT and all parameters in mSEBT for the dominant lower limb showed large internal responsiveness (SRM > 0.8). Furthermore, mSEBT values for the non-dominant lower limb (except anterior displacement) also experienced significant changes with an associated large internal responsiveness. None of the stabilometry platform parameters showed a significant change after the intervention. The ability of the EBT to discriminate between the dominant and non-dominant lower limb (i.e., trained vs untrained, respectively) was generally acceptable (AUCs = 0.708). However, none of the parameters of the mSEBT test showed an acceptable AUC.

Conclusions

EBT showed a positive responsiveness after instability training compared to mSEBT, which only showed internal responsiveness, or stabilometry platform measures, whose none of the parameters could identify these changes.

Measurement Properties of the Patient-Specific Functional Scale and Its Current Uses: An Updated Systematic Review of 57 Studies Using COSMIN Guidelines

OBJECTIVE

To systematically review measurement properties, including acceptability, feasibility, and interpretability, and current uses of the Patient-Specific Functional Scale (PSFS).

DESIGN

Systematic review of a patient-reported outcome measure using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines.

LITERATURE SEARCH

We searched 11 databases from January 2010 to July 2020 for articles on measurement properties or use of PSFS.

STUDY SELECTION CRITERIA

Published primary articles without language restrictions.

DATA SYNTHESIS

Two independent reviewers screened all records, extracted data, and performed risk of bias assessments using COSMIN guidelines. We qualitatively synthesized findings for each measurement property in musculoskeletal and nonmusculoskeletal conditions, and 2 reviewers independently performed Grading of Recommendations Assessment, Development and Evaluation assessments. This study was preregistered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/42UZT).

RESULTS

Of the 985 articles screened, we included 57 articles on measurement properties and 255 articles on the use of PSFS. The PSFS had sufficient test-retest reliability in musculoskeletal (22 studies, 845 participants, low-to-moderate certainty) and nonmusculoskeletal conditions (6 studies, 197 participants, very low certainty), insufficient construct validity as a measure of physical function (21 studies, 2 945 participants, low-to-moderate certainty), and sufficient responsiveness (32 studies, 13 770 participants, moderate-to-high certainty). The standard error of measurement ranged from 0.35 to 1.5. The PSFS was used in 87 unique health conditions, some without prior evidence of validity.

CONCLUSION

The PSFS is an easy-to-use, reliable, and responsive scale in numerous musculoskeletal conditions, but the construct validity of PSFS remains uncertain. Further study of the measurement properties of the PSFS in nonmusculoskeletal conditions is necessary before clinical use. J Orthop Sports Phys Ther 2022;52(5):262-275. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10727.

Tensiomyographical responsiveness to peripheral fatigue in quadriceps femoris

Background

Fatigue influences athletic performance and can also increase the risk of injury in sports, and most of the methods to evaluate it require an additional voluntary effort. Tensiomyography (TMG), which uses electrical stimulation and a displacement sensor to evaluate muscle contraction properties of one or more muscle bellies, has emerged as a technique that can assess the presence of peripheral and central fatigue without requiring additional voluntary efforts. However, the evaluation of the TMG’s ability to detect fatigue is limited, both at the level of muscle bellies and statistical methods. Thus, the aim of the present study was twofold: (i) to examine and compare the tensiomyographical responsiveness to quadriceps femoris (QF) fatigue by multiple statistical methods and (ii) to analyze sex differences in the variation produced by fatigue in TMG parameters.

Methods

Thirty-nine recreational athletes participated (19 males/20 females; aged 22 ± 2 years). TMG parameters of QF bellies and maximal voluntary isometric contraction (MVIC) were measured before and after a fatigue protocol. TMG parameters used were maximum radial deformation (Dm), contraction time between 10–90% of the Dm (Tc), contraction velocity between 10–90% (Vc) and of the first 10% (V10) of the Dm. Internal responsiveness of TMG to fatigue was analyzed by paired t-test and standardized response mean (SRM). External responsiveness was examined by correlations, regression models, and receiver operating characteristic (ROC) curves.

Results

All TMG parameters, except for Tc of rectus femoris and vastus medialis, showed large internal responsiveness. In adjusted regression models by sex, only Dm and V10 of rectus femoris were statistically associated (p < 0.05) with b coefficients of 0.40 and 0.43, respectively. r2 explained the 22% of the total variance. In addition, these parameters could discriminate between QF with and without fatigue.

Conclusion

Since the QF is the main strength contributor during multiple physical activities, clinicians and trainers will be able to discriminate the presence of fatigue and the magnitude of changes in the QF strength by TMG evaluation.