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Weber M, Müller M, Mathieu-Kälin M, Caminada S, Häberli M, Baur H. Evaluation of hop test movement quality to enhance return to sport testing. A cross-sectional study. Front Sports Act Living 2024; 6:1305817. [PMID: 38500546 PMCID: PMC10944867 DOI: 10.3389/fspor.2024.1305817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Return to Sport tests with functional hop tests are often used to decide when a person is ready to return to sport after an anterior cruciate ligament (ACL) injury. Poor movement quality, such as knee valgus, hip adduction and hip internal rotation is considered a risk factor for ACL injury. However, it is unclear whether existing tests adequately cover the aspect of movement quality. This study aims to investigate whether there is a relationship between the calculated limb symmetry index (LSI) of hop tests as an indication of performance and the total score of the "Quality First" assessment (movement quality). The second aim is to examine the reliability of the newly developed "Quality First" assessment for evaluating movement quality in hop tests. Methods The cross-sectional study recruited 34 patients with an ACL reconstruction. The vertical hop, single-leg hop for distance, and side hop tests were performed and recorded. The video recordings were assessed using the "Quality First" assessment. The Spearman correlation coefficient was calculated using the LSI and the "Quality First" total score. Intraclass correlation coefficients (ICC) and standard error of measurements (SEM) were used to calculate intra- and interrater reliability. In addition, the minimal detectable change (MDC) was determined. Results The correlation test between the LSI and the "Quality First" total score showed no correlation for all three jumps (r = -0.1-0.02/p-value = 0.65-0.93). The interrater reliability of the "Quality First" assessment showed fair to good reliability (ICC2: 0.45-0.60), with SEM ranging from 1.46 to 1.73 and the MDC from 4.06 to 4.8. Intrarater reliability was good to excellent (ICC3: 0.73-0.85), with SEM values ranging from 0.89 to 1.09 and the MDC from 2.47 to 3.01. Conclusion The quality of movement, measured with the "Quality First" assessment, indicated no correlation with the calculated LSI from jump performance, therefore movement quality should also be examined in Return to Sport tests. The "Quality First" assessment shows fair to good reliability when used by different raters. When used multiple times by the same rater, the assessment has good to excellent reliability.
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Affiliation(s)
- Melanie Weber
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Mirjam Müller
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Moritz Mathieu-Kälin
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Marina Häberli
- Altius Swiss Sportmed CenterAG, Rheinfelden, Switzerland
| | - Heiner Baur
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Martonick NJP, McGowan CP, Baker RT, Larkins LW, Seegmiller JG, Bailey JP. Examining movement asymmetries during three single leg tasks using interlimb and single subject approaches. Phys Ther Sport 2023; 63:24-30. [PMID: 37441835 DOI: 10.1016/j.ptsp.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE s: To examine whether healthy individuals displayed asymmetric trunk and lower extremity kinematics in the frontal and sagittal planes using both interlimb and single subject models. METHODS Trunk, pelvis, and lower extremity kinematic waveforms were analyzed bilaterally during the single leg squat (SLS), forward step down (FSD), and lateral step down (LSD). Participants identified task specific preferred and non-preferred legs based on perceived stability for interlimb analyses. Movement patterns were also analyzed with a single subject approach that included Fisher's exact tests to assess whether asymmetries were related to the task. RESULTS Participants were found to have increased pelvic drop on the non-preferred leg during the LSD from 41 to 77% of the movement (p = 0.01). No other bilateral differences were found for interlimb analyses. Single subject analyses indicated that no task had a greater probability of finding or not finding asymmetries. Associations were found between the FSD and SLS for frontal plane hip (p < 0.01) and knee motion (p < 0.01). CONCLUSIONS Interlimb analyses can be influenced by intraparticipant movement variability between preferred and non-preferred legs. Movement asymmetries during single leg weightbearing are likely task dependent and a battery of tests is necessary for assessing bilateral differences.
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Affiliation(s)
- Nickolai J P Martonick
- Department of Movement Sciences, University of Idaho, Moscow, ID, 83844, USA; WWAMI Medical Education Program, University of Idaho, Moscow, ID, 83844, USA.
| | - Craig P McGowan
- Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA, 90089, USA
| | - Russell T Baker
- WWAMI Medical Education Program, University of Idaho, Moscow, ID, 83844, USA
| | - Lindsay W Larkins
- Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA, 90089, USA
| | - Jeff G Seegmiller
- WWAMI Medical Education Program, University of Idaho, Moscow, ID, 83844, USA
| | - Joshua P Bailey
- Department of Movement Sciences, University of Idaho, Moscow, ID, 83844, USA
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Visual assessment of movement quality: a study on intra- and interrater reliability of a multi-segmental single leg squat test. BMC Sports Sci Med Rehabil 2021; 13:66. [PMID: 34099021 PMCID: PMC8186063 DOI: 10.1186/s13102-021-00289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022]
Abstract
Background The Single Leg Squat test (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but there is not one established SLS test used in the clinic. Based on previous scientific findings on the reliability of the SLS test and with a methodological rigorous setup, the aim of the present study was to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test. Methods We performed a study of measurement properties to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test including the assessment of the foot, knee, pelvis, and trunk. Novice and experienced physiotherapists rated 65 video recorded SLS tests from 34 test persons. We followed the Quality Appraisal for Reliability Studies checklist. Results Regardless of the raters experience, the interrater reliability varied between “moderate” for the knee variable (ĸ = 0.41, 95% CI 0.10–0.72) and “almost perfect” for the foot (ĸ = 1.00, 95% CI 1.00–1.00). The intrarater reliability varied between “slight” (pelvic variable; ĸ = 0.17, 95% CI -0.22-0.55) to “almost perfect” (foot variable; ĸ = 1.00, 95% CI 1.00–1.00; trunk variable; ĸ = 0.82, 95% CI 0.66–0.97). A generalised kappa coefficient including the values from all raters and segments reached “moderate” interrater reliability (ĸ = 0.52, 95% CI 0.43–0.61), the corresponding value for the intrarater reliability reached “almost perfect” (ĸ = 0.82, 95% CI 0.77–0.86). Conclusions The present study shows a “moderate” interrater reliability and an “almost perfect” intrarater reliability for the variable all segments regardless of the raters experience. Thus, we conclude that the proposed standardised multi-segmental SLS test is reliable enough to be used in an active population. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00289-x.
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MacMillan C, Olivier B, Benjamin-Damons N. The interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab ® screening protocol amongst professional rugby players. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1504. [PMID: 34007937 PMCID: PMC8111643 DOI: 10.4102/sajp.v77i1.1504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Considering the injury incidence rate (IR) associated with elite-level rugby, measures to reduce players' injury risk are important. Establishing scientifically sound, pre-season musculoskeletal screening protocols forms part of injury prevention strategies. Objective To determine the interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® (SSL) screening protocol. Methods We determine the interrater and intrarater reliability of 11 flexibility and nine strength tests. Twenty-four injury-free, elite, adult (> 18 years), male rugby players were screened by two raters on two occasions. To establish intrarater and interrater reliability, Gwet's AC1, AC2 and intraclass correlation coefficients (ICC) were used for the analysis of binary, ordinal and continuous variables, respectively. Statistical significance was set at 95%. Results Flexibility tests which require lineal measurement had at least substantial interrater (ICC = 0.70-0.96) and intrarater reliability (ICC = 0.89-0.97). Most of the flexibility tests with binary outcomes attained almost perfect interrater and intrarater reliability (Gwet's AC1 = 0.8-0.97). All strength tests attained at least substantial interrater (Gwet's AC2 = 0.73-0.96) and intrarater (Gwet's AC2 = 0.67-0.97) reliability. Conclusion The level of interrater and intrarater reliability of most of the flexibility and strength tests investigated supports their use to quantify various aspects of neuromusculoskeletal qualities and possible intrinsic risk factors amongst elite rugby players. Clinical implications Establishing the reliability of tests, is one step to support the inclusion thereof in official screening protocols. Results of our study, verify the reliability of the simple, clinically friendly strength and flexibility tests included and therefore support their use as preparticipation screening tools for rugby players. Further investigation as to the association thereof to athletes' injury risk and performance is warranted.
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Affiliation(s)
- Candice MacMillan
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Benita Olivier
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Natalie Benjamin-Damons
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ressman J, Rasmussen-Barr E, Grooten WJA. Reliability and validity of a novel Kinect-based software program for measuring a single leg squat. BMC Sports Sci Med Rehabil 2020; 12:31. [PMID: 32426141 PMCID: PMC7216608 DOI: 10.1186/s13102-020-00179-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/27/2020] [Indexed: 12/02/2022]
Abstract
Background The Single leg squat (SLS) is a movement screening test widely used in clinical settings. The SLS is highly subjective in its nature. Objective measures, such as 3D-motion analyses, are seldom used in daily clinical work. An interactive, Kinect-based 3D-movement analysis system, the Qinematic™, is proposed to be easily used in clinical settings to assess the SLS. The aim of this study was to establish the test-retest reliability and construct validity of Qinematic™ for assessing the SLS. A further aim was to identify angles of medial knee displacement, to summarise the discriminative ability of the SLS measured by Qinematic™. Methods We performed a test-retest reliability study (n = 37) of the SLS using Qinematic™ and a construct validity study, in which Qinematic™ data were compared with visual assessment of video-recorded SLS. Results Three variables (left knee down, right knee up and down) reached “substantial reliability” (ICC = 0.64–0.69). One variable, “left knee up”, showed a significant difference between the two test occasions (T1–6.34°, T2 0.66°, p = 0.013, ICC = 0.50), and “poor absolute reliability” was seen for all variables (SEM = 9.04–10.66, SDC = 25.06–29.55). A moderate agreement between the visual assessment and Qinematic™ data for various knee angles was shown (Kappa = 0.45–0.58). The best discriminative ability of the SLS was found at a knee angle of 6° (AUC = 0.82, sensitivity = 0.86, specificity = 0.78, PPV = 0.58, NPV = 0.94). Conclusions Qinematic™ shows a poor absolute reliability, and a substantial relative reliability, in measuring a SLS at the way down. This indicates that Qinematic™ should not be recommended for the use on an individual level, but it can possibly be used on a group level. The merged results of the construct validity study indicate that Qinematic™ at 6° of medial displacement can identify subjects with a knee over foot position. In summary, the use of the Qinematic™ net trajectory angle, which estimates the “line of best fit” cannot be recommended to assess a knee medial to foot position and should be reconsidered.
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Affiliation(s)
- John Ressman
- 1Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| | - Eva Rasmussen-Barr
- 1Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| | - Wilhelmus Johannes Andreas Grooten
- 1Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden.,2Allied Health Professionals Function, Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Whatman C, Toomey C, Emery C. Visual rating of movement quality in individuals with and without a history of intra-articular knee injury. Physiother Theory Pract 2019; 37:1474-1480. [PMID: 31838933 DOI: 10.1080/09593985.2019.1703229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate the use of visually rated movement quality in a group including those with a history of intra-articular knee injury.Design: Historical cohort study.Setting: Laboratory.Participants: A total of 115 youth and young adults (62 previously injured).Main outcome measures: Inter-rater agreement for ratings of movement quality during single limb squat and vertical drop jump (VDJ) were assessed. Odds ratios were calculated to determine if the history of knee injury was associated with greater odds of poor movement quality. The difference in knee:ankle separation ratio between the injured and uninjured groups was compared.Results: Rater agreement was moderate to excellent (κ = 0.55 to 0.93). Comparing the injured and uninjured limb in previously injured participants or injured participants to matched uninjured controls, there was no significant difference in the proportion of good versus poor movement ratings (diff = 0% to 10%; p ≥ 0.23). Prior history of knee injury did not increase the odds of poor movement quality during the VDJ (OR 0.91; 95% CI 0.41 to 2.03) or single leg squat (OR 1.04; 95% CI 0.38 to 2.85) and there was no significant difference in the knee:ankle separation ratios (mean diff -0.03; p = 0.30).Conclusion: Visual rating of movement in individuals with and without a history of knee injury is reliable. A history of knee injury does not increase the likelihood of poor visually rated movement quality.
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Affiliation(s)
- Chris Whatman
- AUT Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Clodagh Toomey
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Ressman J, Grooten WJA, Rasmussen Barr E. Visual assessment of movement quality in the single leg squat test: a review and meta-analysis of inter-rater and intrarater reliability. BMJ Open Sport Exerc Med 2019; 5:e000541. [PMID: 31275606 PMCID: PMC6579566 DOI: 10.1136/bmjsem-2019-000541] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2019] [Indexed: 01/05/2023] Open
Abstract
Single leg squat (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but also to assess lower extremity function in active people.
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Affiliation(s)
- John Ressman
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Wilhelmus Johannes Andreas Grooten
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals Function, Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Rasmussen Barr
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Warner MB, Wilson DA, Herrington L, Dixon S, Power C, Jones R, Heller MO, Carden P, Lewis CL. A systematic review of the discriminating biomechanical parameters during the single leg squat. Phys Ther Sport 2019; 36:78-91. [DOI: 10.1016/j.ptsp.2019.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
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Wilson DA, Booysen N, Dainese P, Heller MO, Stokes M, Warner MB. Accuracy of movement quality screening to document effects of neuromuscular control retraining exercises in a young ex-footballer with hip and groin symptoms: A proof of concept case study. Med Hypotheses 2018; 120:116-120. [PMID: 30220329 DOI: 10.1016/j.mehy.2018.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 11/15/2022]
Abstract
Hip and groin pain is common in footballers and altering movement patterns can reduce symptoms. Observational tests of movement control are thought to identify abnormal movement patterns, but their accuracy needs yet to be confirmed by comparison with an objective measure. To assess the accuracy, using 3D motion analysis, of observational movement control tests and their ability to detect changes, and document changes in symptoms following a neuromuscular control exercise programme in an ex-footballer with hip and groin pain. A 25-year-old male with chronic bilateral hip and groin pain had their movement control ability rated and kinematic data collected using 3D motion analysis while performing Small Knee Bend (SKB) and SKB with Rotation (SKB Rot) tests pre-and post-neuromuscular control exercise training. Movement control was rated as at fault if they were unable to control specific trunk and pelvic movements during the tests. The Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess symptoms. Following the intervention, observational rating during the SKB test improved from fault to no fault for anterior pelvic tilt, which decreased by 17° and 16° during right and left leg SKB tests respectively. The HAGOS symptoms subsection improved from 36% to 61%. Observational movement screening ratings were supported by 3-D motion analysis. These findings indicate that the screening tool was accurate for detecting improvements in trunk and pelvic movement control following an exercise programme in an ex-footballer who had presented with hip and groin pain.
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Affiliation(s)
- David A Wilson
- School of Health Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK.
| | - Nadine Booysen
- School of Health Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - Paolo Dainese
- Department of Medical Science, University of Turin, Italy
| | - Markus O Heller
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - Maria Stokes
- School of Health Sciences, University of Southampton, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - Martin B Warner
- School of Health Sciences, University of Southampton, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
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Brindle RA, Milner CE. The hip control test is a valid and reliable measure of hip neuromuscular control. Sports Biomech 2018; 19:235-244. [PMID: 29895207 DOI: 10.1080/14763141.2018.1466907] [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] [Indexed: 10/14/2022]
Abstract
Insufficient hip neuromuscular control may contribute to non-contact sport injuries. However, the current evaluative test of hip neuromuscular control, the single-leg squat, requires hip abductor muscle strength to complete. The purpose of this study was to develop the hip control test (HCT) and determine the test's reliability and construct validity. Nineteen healthy adults visited the laboratory twice. The HCT is a 10-s test of reciprocal toe-tapping accuracy. Both automated and manual HCT ratings were recorded simultaneously during each visit. Additionally, eccentric hip abductor torque was measured. HCT reliability was assessed with intra-class correlation coefficients (ICC). Agreement between automated and manual ratings was determined with Bland-Altman plots. Construct validity was established if HCT performance significantly decreased with a secondary cognitive task (p < 0.05). Bivariate regression determined the relationship between HCT performance and eccentric hip abductor torque. Automated and manual HCT ratings both had moderate reliability (ICC = 0.72) and yielded similar results (limits of agreement = -1 to 2 taps). The HCT had construct validity (p = 0.001), and no correlation with hip abductor muscle strength (r = 0.213). Thus, the HCT is a reliable and valid test. The HCT is simple to administer and measures hip neuromuscular control separately from strength.
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Affiliation(s)
- Richard A Brindle
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Clare E Milner
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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