Relationships between the seated single arm shot put test and Quick-DASH in patients being discharged from physical therapy

BACKGROUND

Research examining the relationship between patient reported outcomes (PRO) and upper extremity functional performance tests (UEFPT) in patients with shoulder pathology are limited.

OBJECTIVE

To assess the relationship between the seated single arm shot put test (SSASPT) and the PRO Quick-Disabilities of Arm, Shoulder, and Hand (DASH) in patients being discharged from physical therapy after shoulder injury or surgery.

METHODS

Six physical therapists who regularly use the SSASPT and DASH from six different clinical sites provided SSASPT scores and completed Quick-DASH forms on 75 patients being discharged from rehabilitation following shoulder injury or surgery. Patients were grouped according to whether the involved shoulder was the dominant (n = 43) or nondominant (n = 32) limb. Three separate simple linear regression models, whole cohort and two patient groups, were created to determine the magnitude of the relationships (standardized betas) and change (betas) between DASH scores and the SSASPT limb symmetry index (LSI).

RESULTS

Neither whole cohort nor two groups exhibited statistically significant (P > .05) relationships between LSI and Quick-DASH scores based upon the standardized betas (-0.197-0.038). Additionally, neither the standardized betas (z = 1.49, P = .135) nor betas (z = 1.28, P = .200) were statistically different between the two groups.

CONCLUSIONS

The current study revealed no association between SSASPT and the Quick-DASH at discharge from physical therapy following shoulder injury or surgery. Consequently, it may be important to perform a battery of tests that include both subjective PRO and objective UEFPT tests to obtain a comprehensive perspective of the patient's functional and perceived status.

Midterm functional performance following open surgical repair of acute Achilles tendon rupture

INTRODUCTION

Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair.

MATERIALS AND METHODS

This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis.

RESULTS

At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p < 0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing.

CONCLUSION

In summary, there are persisting functional deficits at > 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities.

LEVEL OF EVIDENCE

III, retrospective cohort study.

Neuromechanical activation of triceps surae muscle remains altered at 3.5 years following open surgical repair of acute Achilles tendon rupture

PURPOSE

To assess whether the neuromuscular activation pattern following Achilles tendon rupture and repair may contributes to the observable functional deficits in this severe and increasingly frequent injury.

METHODS

In this study, the neuromuscular activation using surface EMG of n = 52 patients was assessed during a battery of functional performance tasks to assess potential alterations of muscular activation and recruitment. We analyzed the injured leg vs. the contralateral healthy leg at a mean of 3.5 years following open surgical repair. The testing battery included isokinetic strength testing, bipedal and single-legged heel-rise testing as well as gait analysis.

RESULTS

During isokinetic testing, we observed a higher activation integral for all triceps surae muscles of the injured side during active dorsiflexion, e.g., eccentric loading on the injured leg, while concentric plantarflexion showed no significant difference. Dynamic heel-rise testing showed a higher activation in concentric and eccentric loading for all posterior muscles on the injured side (not significant); while static heel-rise for 10 sec. revealed a significantly higher activation. Further analysis of frequency of fast Fourier-transformed EMG revealed a significantly higher median frequency in the injured leg. Gait analysis revealed a higher pre-activation of the tibialis anterior before ground contact, while medial and lateral gastrocnemius muscles of the injured leg showed a significantly higher activation during push-off phase.

CONCLUSIONS

The results of this study provide evidence on the neuromuscular changes 3.5 years following open surgical Achilles tendon repair. These complex neuromuscular changes are manifested to produce the maximum force output whilst protecting the previously injured tendon. The observed alterations may be related to an increased recruitment of type II muscle fibers which could make the muscles prone to fatigue.

LEVEL OF EVIDENCE

III.

EVIDENCE-BASED PROCEDURES FOR PERFORMING THE SINGLE LEG SQUAT AND STEP-DOWN TESTS IN EVALUATION OF NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW

BACKGROUND

Functional performance tests are commonly utilized in screening for injury prevention, evaluating for athletic injuries, and making return-to-play decisions. Two frequently performed functional performance tests are the single leg squat and step-down tests.

PURPOSE

The purpose of this study was to systematically review the available psychometric evidence for use of the single leg squat and step-down tests for evaluating non-arthritic hip conditions and construct an evidence-based protocol for test administration.

STUDY DESIGN

Review of the Literature.

MATERIALS/METHODS

A search of the PubMed and SPORTSDiscus databases was performed. Psychometric evidence of reliability, validity, and responsiveness to support the use of the both tests were collected. The protocols used for administering these tests were extracted, summarized, and combined.

RESULTS

Of the 3,406 articles that were reviewed, 56 total articles met the inclusion criteria and were included in the review. Evidence for reliability and validity was available to support the use of the single leg squat and step-down tests. Both tests assess for neuromuscular control of the hip and surrounding muscular structures. Evaluation of these functional movement patterns enable the clinician to assess for limitations that may cause an increase in hip pain and dysfunction.

CONCLUSIONS

The single leg squat and step-down tests can assess for kinematic and biomechanical deficiencies and may be useful in the evaluation process for individuals with non-arthritic hip pain. The authors of this review present a comprehensive evidence-based protocol for standardized performance of these tests.

LEVEL OF EVIDENCE

2b.