Introduction: Psychometric properties of clinical measurement instruments are crucial because they indicate quality, reliability, and validity of data collected in clinical settings as well as how accurately and consistently a tool measures change. The aim was to systematically review and report the measurement properties of performance-based (PerFOMS) or clinicianreported (ClinROM) outcome measurement instruments (OMIs) in adult people with hemophilia (PwH). The second aim was to evaluate the methodological quality and the level of evidence of the reported measurement properties.Methods: Data search, extraction, and evaluation were conducted in accordance with the COSMIN methodology while following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: The literature search identified 2557 articles. After title and abstract screening, 166 were included for full-text screening. The 14 included studies reported measurement properties of 11 OMI’s (5 ClinROM & 6 PerFOMS). Reliability (intra-rater, inter-rater, or test-retest), measurement error, internal consistency, criterion validity, convergent validity, discriminant validity, and responsiveness were reported. The most reported measurement property was convergent validity. The OMI Hemophilia Joint Health Score (HJHS 2.1) fulfilled sufficient methodological quality for convergent validity and moderate Quality of Evidence (QE). None of the other included OMI’s reported sufficient measurement properties.Conclusion: Researchers and clinicians are challenged when comparing studies and selecting appropriate OMI’s when evaluating the functioning of adult PwH, due to unsatisfactory reporting of measurement properties, hampered methodological quality, and a low level of evidence. Therefore, studies investigating measurement properties of ClinROM and PerFOMS in adult PwH with rigorous methodology are required.
Introduction:The Cranio-Cervical Flexion Test (CCFT) is a validated clinical test used to evaluate deep cervical flexor muscle function. A pressure biofeedback unit (PBU) has traditionally been the reference device. Recently, a new portable digital device known as the Neuromuscular Cranio-cervical Device (NOD) has been developed as a potential alternative. Methods:In this cross-sectional concurrent validation study, 88 participants were recruited from four outpatient physiotherapy practices, including individuals with current neck pain and individuals with a previous history of neck pain. All participants performed the CCFT using both devices. The PBU was inflated to a baseline pressure of 20 mmHg, with the participant then performing C-CF to increase the pressure in increments of 2 mmHg over five progressive stages, while the NOD was calibrated to corresponding force targets. Agreement and concurrent validity between the devices were assessed, and C-CF range of motion (ROM) was analyzed using linear mixed-effects models. Results:Agreement between CCFT performance scores obtained with the NOD and the PBU was 94.3%, with a very strong positive correlation (Spearman's ρ = 0.930, p < 0.001). The NOD measured slightly greater C-CF ROM than the PBU (mean difference 0.68°), with significant differences at lower CCFT stages that converged at higher stages of the test. Conclusion:These findings demonstrate strong concurrent validity between the NOD and the PBU, supporting the NOD as a valid digital alternative for assessment of the CCFT.
Introduction:The lumbar roll and modified SIMS are two common manipulation techniques used in clinical practice for sacroiliac joint dysfunction (SIJD), a common cause of low back and pelvic pain. However, there hasn't been clear evidence of these methods' relative clinical efficacy in recent literature. Methods:This review was registered in PROSPERO (Reg. No. CRD420251253094) and adhered to PRISMA 2020 guidelines. Studies published between January 2021 and December 2025 were found through a search of PubMed, Scopus, Web of Science, CINAHL, PEDro, Cochrane Library, and Google Scholar (first 200 results). Randomized controlled trials, quasi-experimental trials, and controlled clinical studies evaluating lumbar roll or modified SIMS manipulation in adults with SIJD using imaging-assisted criteria or validated provocation tests were all considered eligible. Screening, data extraction, and risk-of-bias assessment (RoB-2 and ROBINS-I) were carried out independently by two reviewers. Results:Nine of the 1,264 records that were found satisfied the requirements for inclusion. The number of participants in the sample varied from 30 to 90. Following manipulation, the majority of trials reported significant short-term reductions in pain (VAS/NPRS) and disability (ODI/functional measures), with lumbar roll and modified SIMS demonstrating similar clinical benefit. Improvements in pelvic alignment and mobility have been documented in several studies. There were a few transient adverse events, and no significant complications were noted. Conclusion:Although more high-quality trials are required to confirm long-term efficacy and ideal treatment protocols, lumbar roll and modified SIMS manipulation techniques consistently show short-term clinical benefits for SIJD. However, due to the absence of direct head-to-head comparisons and reliance on indirect classification of techniques, these findings should be interpreted as exploratory rather than definitive.
Introduction:Pre-COPD is characterized by the presence of respiratory symptoms and/or structural abnormalities, without spirometry-confirmed airflow limitation. However, pre-COPD may be associated with extrapulmonary manifestations that are not apparent at rest. The aim of this study was to assess postural stability through center of pressure (CoP) dynamics during low-intensity inspiratory and expiratory loading between adults with pre-COPD and healthy adults. Methods:This cross-sectional observational study included 31 volunteer adults (17 with pre-COPD, 14 healthy adults; mean age 47.9 years). CoP was calculated from ground reaction forces and torques recorded with a force plate during quiet standing across three breathing conditions (without, inspiratory, and expiratory loads). Respiratory loads were set at 10% of the individuals' maximal inspiratory and expiratory pressures. CoP mean amplitude (m-1) and velocity (m-1·s-1) in anteroposterior and mediolateral directions, normalized by the base of support area, were calculated from a 30-second period, averaged across three trials. Results:During inspiratory loading, all mean velocity outcomes were significantly higher in adults with pre-COPD compared to healthy adults (anteroposterior: p = 0.002, 95% CI [0.991, 4.014]; mediolateral: p < 0.001, 95% CI [0.971, 3.324]; total: p = 0.002, 95% CI [1.314, 5.270]). Although mean amplitude showed no overall group difference, significant load × group interaction revealed that adults with pre-COPD exhibited a greater postural disturbance during inspiratory loading than healthy adults. Expiratory loading only significantly differentiated groups for mediolateral velocity (p = 0.034, 95% CI [0.096, 2.292]). Conclusions:During quiet standing, low-intensity inspiratory loading was associated with increased CoP differences between adults with pre-COPD and healthy adults.
Introduction:Due to shortages of general practitioners and increasing emergency department (ED) presentations for non-urgent musculoskeletal conditions (MSKDs), Advanced Physiotherapy Practice (APP) roles have been implemented internationally. However, this model remains novel in Switzerland. This study evaluated agreement in diagnosis, treatment, and discharge decisions between physiotherapists and resident physicians compared with senior physicians as the reference standard in the ED of Bethesda Hospital Basel (BSAG). Methods:A randomized controlled trial was conducted from October to December 2023. Patients presenting musculoskeletal complaints without evidence of serious pathology were allocated to either an intervention group managed by physiotherapists or a control group receiving standard care by resident physicians. Clinical decisions from both groups were reviewed by senior physicians. Agreement was assessed using Cohen's Kappa (κ) and Gwet's AC1 statistics. Results:A total of 102 patients were included (mean age 52 years, SD 16.3; 61% female; 51% with low back pain). Physiotherapists demonstrated good to excellent agreement with senior physicians for diagnosis (κ = 0.72-0.96; AC1 = 0.73-0.97) and management (κ = 0.69-0.88; AC1 = 0.71-0.89). Residents showed high agreement for diagnosis (κ = 0.85; AC1 = 0.86) and perfect agreement for management (κ = 1.00; AC1 = 1.00). No adverse events occurred. Patient satisfaction was higher in the physiotherapy group (mean 4.79 vs. 4.19/5). Conclusion:Experienced physiotherapists demonstrated high agreement with senior physicians in diagnosing and managing MSKDs in the ED. APP appears safe and may improve patient satisfaction without increasing adverse events.
