The Soleus (SOL) Hoffmann reflex (H-reflex) is commonly recorded in sitting position. However, the reliability of recording is unknown. We assessed the reliability of SOL H-reflex amplitude measurements across multiple traces and sessions during erect, slumped, and slouched sitting postures using the generalizability theory. Five traces of the SOL H-reflex maximum amplitude (Hmax) were recorded from 10 healthy participants during erect, slumped, and slouched sitting postures in two sessions. A decision study analysis was then conducted to calculate the reliability coefficients of the Hmax for five traces and two sessions and to mathematically calculate the coefficients for seven and ten traces, and one and three sessions in the three sitting postures. For five traces and two sessions, the results showed reliability coefficients between 0.970 and 0.971, 0.980 and 0.979, and equal to 0.943 for erect, slumped, and slouched sitting, respectively. Averaging five traces of the Hmax in a single recording session was sufficient to obtain acceptable reliability in the three sitting postures (reliability range, 0.892–0.988). It was concluded that the SOL Hmax can be recorded during erect, slumped, and slouched sitting postures with adequate reliability.

This randomized controlled trial examined the immediate effect of whole body vibration (WBV) on first position sauté height, and on static and dynamic balance, in 59 female professional contemporary dancers. Following instruction, a warm-up, and a training session, participants received a 75-second randomly assigned WBV intervention under four conditions: static demi-plié (0 Hz), static demi-plié (30 Hz), dynamic demi-plié (0 Hz), and dynamic demi-plié (30 Hz). Before and immediately after intervention, participants performed three sautés on the Just Jump® Mat System, provided dynamic balance data via the Star Excursion Balance Test, and static balance data via the Balance Error Scoring System. A two-way split-plot multivariate approach ANOVA was used to analyze sauté height (α = 0.025). Balance was examined with a 4 x 2 x 2 split-plot MANOVA (α = 0.025). Follow-up two-way split plot multivariate approach ANOVAs were also conducted (α = 0.0125). Dancers from the static first position demi-plié group were found to jump higher than those from the dynamic first position demi-plié group, regardless of WBV frequency (p = 0.001). The 30 Hz frequency resulted in significantly improved static balance (p = 0.001) for both static and dynamic demi-plié. Therefore, the use of WBV is worthy of consideration as a quick method of improving static balance, and use of the static first position demi-plié may be beneficial for improving sauté height.

Background: Prior studies have examined muscle power via the countermovement jump (CMJ). Studies to date have examined neither the reliability nor the construct validity of the ballet first position CMJ (hips in lateral rotation, toes facing away from one another, legs straight) as a measure of power. Hypotheses: There would be (1) good interrater reliability in the visual assessment of the best-quality first position CMJ (κ ≥ 0.60), (2) good test-retest reliability in the height of the first position CMJ of good quality (intraclass correlation coefficient [ICC] ≥ 0.80), and (3) a significant relationship between isokinetic torque of the quadriceps femoris and first position CMJ height (r ≥ 0.40). Study Design: Correlational study. Level of Evidence: Level 3. Methods: A convenience sample of 39 healthy young adults who reported moderate activity levels participated in a warm-up and 2 sessions of 6 jumps. Quadriceps femoris isokinetic torque was measured in the first session. Results: Significant agreement was found within the same day for the best-quality first position CMJ (κ = 0.81), and in the highest, best-quality first position CMJ between days (ICC2,1 = 0.88). The highest, best-quality first position CMJ, when solving for a single trial, was comparable to the average of 2 trials (single trial: ICC2,1 = 0.96 vs average of 2 trials: ICC2,k = 0.98). There was a good relationship between quadriceps femoris isokinetic strength and first position CMJ height (Pearson r = 0.69 and P < 0.001 at 60 deg/s; r = 0.64 and P < 0.001 at 180 deg/s; r = 0.65 and P < 0.001 at 300 deg/s). Conclusion: Visual video movement analysis has good to excellent interrater agreement and test-retest reliability. Selecting the single highest jump of good quality is acceptable. The first position CMJ is a measure of power. Clinical Relevance: Video analysis of the single highest first position CMJ of good quality is an acceptable method of assessing movement quality.

Whole Body Vibration (WBV) is a new exercise trend in fitness and performance enhancement.WBV platforms oscillate over a range of frequencies and amplitudes; however no study to date has examined the experience of perceived exertion with differences in vibration frequency and static or dynamic body position, nor examined the difference between sexes based on position and frequency during WBV.The purpose of this study was to assess the effects of position and frequency on perceived exertion during WBV in healthy, active adults.A convenience sample of 39 healthy young adults who participated in moderated exercise was blinded and randomly allocated to six WBV conditions composed of different frequency and position combinations.The participants received instruction, provided informed consent, participated in a warm-up session, and then reported rating of perceived exertion for each WBV condition.A 2×3 within-subjects multivariate approach ANOVA was conducted against an alpha of 0.05.A statistically significant main effect of position (p = 0.004) and significant main effect of frequency (p = 0.025) were found.Significant marginal means were found between the frequencies of 0 Hz and 50 Hz (p = 0.007).Statistically significant differences were found between sexes for all combinations.

The sit-to-stand (STS) is a simple test to evaluate the functional performance of the quadriceps muscle in patients with knee osteoarthritis (OA). The aim was to evaluate the electromyographic (EMG) activity of the ipsilateral quadriceps during STS task at different seat heights and feet positions in patients with severe unilateral OA. The EMG activity was recorded in a group of eight participants with unilateral OA during the performance of STS task in four conditions: (1) knee-height seat with feet together, (2) knee-height seat with feet askew (feet side by side and heel-to-toe), (3) low-height seat (25% lower than knee-height seat) with feet together, and (4) low-height seat with feet askew.

Introduction: A case series that examines the effects of a 12-week combined resistance and aerobic training program for four sedentary obese, Hispanic adolescents without weight loss. Subjects/Methods: Baseline and post-intervention anthropometric, metabolic and physical fitness measures were obtained. Body composition, hepatic, visceral, and intramuscular fat contents were analyzed via imaging. Fasting levels of alanine transaminase (ALT), insulin, glucose, free fatty acids, triglycerides, high- and low-density lipoproteins (LDL), and C-reactive protein were obtained via blood samples. Results: Two subjects decreased their glucose levels by 1.86% and 4.06%. Subjects 1, 3, and 4 increased their lean body mass by 4.12%, 9.70%, and 5.48%. ALT was reduced 13.0%, 16.0%, and 35.7% for subjects 2, 3, and 4, respectively. LDLs were reduced by 37.7%, 4.5%, and 7.5% for subjects 1, 2, and 3. Triglycerides were reduced by 25.4%, 37.8%, and 4.6% for subjects 1, 2, and 3. Visceral fat reductions by 16.5%, 14.2%, and 13.0% occurred for subjects 1, 2, and 3. C-reactive protein was reduced for subjects 1, 2, and 3 by 19.4%, 16.3%, and 32.0%. Conclusion: Expected directions of change were made for most indicators of metabolic function and body composition, but measures of physical fitness improved for all four subjects.

Study Design. Prospective cohort study of a cross-cultural low back pain (LBP) questionnaireObjective. The objectives of the present study were to translate and cross-culturally adapt the Fear-Avoidance Beliefs Questionnaire (FABQ) to create a version in Arabic and to test its psychometric properties.Summary of Background Data. The FABQ measures the effects that fear and avoidance beliefs have on work and on physical activity.Methods. An FABQ cross-culturally adapted for Arabic readers and speakers was created by forward translation, translation synthesis, and backward translation. Forty patients in Riyadh, Saudi Arabia, with LBP evaluated use of the questionnaire, and 70 patients from the same hospital participated in reliability, validity, and sensitivity studies. To determine test-retest reliability of the Arabic FABQ, patients completed it twice within 48 hours without receiving any active treatment between these two sessions. Patients completed the Arabic FABQ (and three other scales) at baseline and 14 days later to determine its validity and sensitivity.Results. Test-retest reliability was good (FABQ-work: intraclass coefficient [ICC]=0.74; FABQphysical activity: ICC=0.90; FABQ overall: ICC=0.76). Correlations between the FABQ and three other instruments for measuring pain and disability were weak. The strongest correlation was found at the follow-up session with the Arabic Oswestry Questionnaire (r=0.283; P < 0.05). Sensitivity to change was low.Conclusion. The translation and adaptation of the Arabic version of the FABQ was successful. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. The Arabic version of the FABQ shows promise in the assessment of fear-avoidance beliefs among patients with LBP who speak and read Arabic.

The purposes were to assess the bivariate and multivariate relationships among the subdomains of physical self-concept, self-esteem, and objective measures of physical fitness in young healthy female graduate students. Nineteen participants were recruited from a local university and completed the Physical Self-Description Questionnaire-Short Form (PSDQ-S) to assess each individual's perceptions of her global physical self-concept, self-esteem, and physical fitness. Subsequently, a maximal aerobic capacity and muscular strength tests were completed, and moderate and significant correlations were found between these measures and the corresponding subdomains of the PSDQ-S. Multivariate analyses revealed that age and height but not the physical fitness tests were significant predictors of physical self-concept, while none of the variables predicted self-esteem.

Women from minority backgrounds have the highest prevalence rates of obesity and physical inactivity. A prospective cohort pilot study was conducted to investigate the effectiveness of a 12-week intervention that consisted of a group exercise program with educational reinforcement to enhance physical activity, physical fitness and physical self-worth. Twenty-three minority women completed the intervention. The participants were obese, had a neuromusculoskeletal impairment, chronic medical condition or disability that required outpatient physical therapy services. The results of this study revealed no significant reduction in body-weight but improvement was made for functional cardiovascular endurance (p < .005), lower and upper body strength (p < .006 and .042, respectively), physical self-worth (p < .0005) and moderate physical activity (p < .009). Despite the absence of weight-loss for these participants, the exercise and education intervention provided improvements in levels of physical fitness, physical self-worth and engagement in health enhancing physical activity.

Background: The Day Center, Case Management, and Home Care components of a local senior health agency each have used different screening forms for assessing their clients for fall risk. A common instrument, easily administered by all components as part of their routine practice, would be helpful in systematically identifying elders at risk of falling. Developing a common screening instrument would be useful at other senior health agencies as well. Purpose: To gather information on the content and features that are most useful for fall screening, based on the needs of individual geriatric care workers in each component of a local senior health agency. Methods: A semistructured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. Results: Two major themes emerged: (1) factors that are relevant in assessing fall risk and (2) factors that affect the utility of the fall risk screening procedure. Under theme 1, there were 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme 2, there were 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature, health status and fear of falling, to produce a universal form for use by different agency components. Discussion: Integrating all fall-risk categories into a universal form improves the completeness of the form used in different agency components. However, to increase the utility of fall risk screening, service plans integrated with each screening procedure need to be developed according to specific agency structures. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) initial screening with an outreach worker using a quick question assessment; (2) follow-up with a more comprehensive fall risk assessment while receiving services from the Day Center, Case Management, or Home Care; and (3) a “what-to-do” action is presented for each item on the basis of each question's response on the comprehensive form. Conclusions: When designing a fall risk screening procedure, integrating all fall-risk factors into a single comprehensive form may not be the ideal strategy. The environment, the person who gathers the information, and the actions required to respond to information gathered should also be considered. On the basis of the results of this qualitative study, we have presented a 3-step procedure, with supporting forms to address these considerations.

The objective of this article was to investigate relationships among medication, dementia, and falls in community-dwelling elders with polypharmacy receiving home health care services from a senior services agency. As regards method, medical information on medication, dementia, and falls was obtained from clinical records of 147 clients. Chi-square tests were used to compare psychotropic drug use between elders with and without dementia. Logistic regression was performed to test the hypothesis that psychotropic drugs and dementia predicted falls in this population. Results reveal that this population had high rates of psychotropic drug use (61%), dementia (38%), and falls (37%). No significant differences were found in psychotropic drug use between elders with and without dementia. Neither psychotropic drugs nor dementia predicted falls. Conclusions show that in this population, no relationship was found between dementia, psychotropic drugs, and falls.

OBJECTIVE:The purpose of this study is to determine the inter-rater reliability of commonly used musculoskeletal screening components in a population of contemporary professional dancers.PARTICIPANTS:Study participants were 30 women from six contemporary dance companies between the ages of 18 and 32, with a mean age of 24, and Body Mass Index of 22.4.METHODS:101 items were assessed in the categories of Static Posture, the Beighton 9-Point Hypermobility Test, Flexibility, Strength, and Dynamic Posture, based upon the Pilot 2006 Dance USA Annual Post-Hire Health Screen for Professional Dancers. Testing was non-ordered, using 2 of the 4 available testers, with variable assignment of the lead tester.RESULTS:High percent agreement was found for the subcategories of hallux valgus, pelvic tilt, and forefoot alignment, flexor hallucis, iliopsoas, hip internal rotation flexed, external rotation extended, and soleus extensibility, composite Beighton, and for most measures within the dynamic posture category. Low to moderate percent agreement was found in the strength tests.CONCLUSION:Although this study demonstrated moderate to high percent agreement between raters, further test refinement is needed to improve the reliability of the measurement components.

ObjectiveTo compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction.DesignA case-control study.SettingA 3-dimensional motion analysis laboratory.ParticipantsTwenty-eight young women (range, 21-35 years) (15 control subjects and 13 subjects with ACL reconstruction).Patients and MethodsAll participants performed a side-to-side hopping task that consisted of hopping single-legged 10 times consecutively from side to side across 2 lines marked 30 cm apart on 2 individual force plates. The task was designated as a side hopping when the hop was to the opposite side of the stance leg and as crossover hopping when the hop was toward the side of the stance leg.Main Outcome MeasurementsPeak hip-/knee-joint angles; peak knee extension/abduction joint moments; electromyographic studies of the gluteus maximus, gluteus medius, rectus femoris, and hamstring muscles; and quadriceps/hamstring co-contraction ratio were compared between the groups by means of 2 × 2 multivariate analysis of variance tests (group × maneuver).ResultsNoninjured women and women with ACL reconstruction exhibited similar hip- and knee-joint angles during both types of hopping. Hip-joint angles were greater during the crossover hopping in both groups, and knee-joint angles did not differ between the groups or hops. Knee-joint moments demonstrated a significant group × maneuver interaction. Greater knee extension and valgus moments were noted in the control group during crossover hopping, and greater knee abduction moments were noted in the ACL group during side hopping. Electromyographic data revealed no statistically significantly differences between the groups.ConclusionsWomen with ACL reconstruction exhibited the restoration of functional biomechanical movements such as hip-/knee-joint angles and lower extremity neuromuscular activation during side-to-side athletic tasks. However, not all biomechanical strategies are restored years after surgery, and women who have undergone a procedure such as ACL reconstruction may continue to exhibit knee-joint abduction moments that increase the risk of additional knee injury.

Objective: To determine exercise efficacy in improving dynamic balance in community-dwelling elderly with a fall history. Methods: Thirty-five participants were randomly assigned to a treatment (TG: n = 19, 77 +/- 7 yr) or control group (CG; n = 16, 75 +/- 8 yr). The TO received an individualized home exercise program, and the CG received phone calls twice per week for 12 weeks. Participants' dynamic-balance abilities- directional control (DC), endpoint excursion (EE), maximum excursion (ME), reaction time (RT), and movement velocity (MV)-were measured using the Balance Master at 75% limits of stability. Functional reach (FR) was also measured. Results: At 12 weeks the TG demonstrated significant improvements in DC (p < .0025), EE (p < .0005), and ME (p < .0005), but the CO did not. No significant group differences were found for MV, RT, or FR. Conclusions: Excursion distances and directional control improved but not reaction time, suggesting that exercises requiring quick responses may be needed.

Movement patterns used during mechanical lifting are usually assessed subjectively by clinicians as a stoop or squat based on visual estimation of joint motion and position. Two-dimensional (2D) video analysis has the potential to objectively measure joint motion during a mechanical lifting task. This study investigated concurrent validity, intrarater, interrater, and test-retest reliability of 2D video analysis using Dartfish software for the measurement of sagittal plane angles at the hip and knee during mechanical lifting. Fifteen healthy female participants (mean age 27.1 ± 7.1 years) were recruited to perform mechanical lifting on 2 separate test days. Concurrent validity was determined by comparing 2D derived hip and knee flexion angles to goniometric measures. Intrarater and interrater reliability of the 2D kinematic procedures was determined by using examiners with varying experience in the use of Dartfish software. Between-day test-retest reliability of hip and knee 2D kinematics during mechanical lifting was assessed. Concurrent validity of 2D angle analysis using Dartfish software was supported by high correlations (Pearson r ≥ 0.95) and nonsignificant differences between 2D and goniometric measures of sagittal plane hip and knee motion. Both intrarater and interrater reliability values of hip and knee flexion angles were excellent (ICC ≥ 0.91). ICCs for test-retest reliability were 0.79 and 0.91 for hip and knee flexion, respectively. These findings and the ease of data capture using this system provide support for the clinical utility of 2D video analysis to provide objective measures of movement patterns at the hip and knee during a dynamic functional task.

Dynamic knee joint stability may be affected by the onset of metabolic fatigue during sports participation that could increase the risk for knee injury. The purpose of this investigation was to determine the effects of metabolic fatigue on knee muscle activation, peak knee joint angles, and peak knee internal moments in young women during 2 jumping tasks. Fifteen women (mean age: 24.6 +/- 2.6 years) participated in one nonfatigued session and one fatigued session. During both sessions, peak knee landing flexion and valgus joint angles, peak knee extension and varus/valgus internal moments, electromyographic (EMG) muscle activity of the quadriceps and hamstrings, and quadriceps/hamstring EMG cocontraction ratio were measured. The tasks consisted of a single-legged drop jump from a 40-cm box and a 20-cm, up-down, repeated hop task. The fatigued session included a Wingate anaerobic protocol followed by performance of the 2 tasks. Although participants exhibited greater knee injury-predisposing factors during the fatigued session, such as lesser knee flexion joint angles, greater knee valgus joint angles, and greater varus/valgus internal joint moments for both tasks, only knee flexion during the up-down task was statistically significant (p = 0.028). Metabolic fatigue may perhaps predispose young women to knee injuries by impairing dynamic knee joint stability. Training strength-endurance components and the ability to maintain control of body movements in either rested or fatigued situations might help reduce injuries in young women athletes.

Study Design Clinical Measurement. Introduction Thumb carpometacarpal (CMC) osteoarthritis is a frequent cause of thumb pain. Purpose of the Study To evaluate the interrater reliability and the criterion validity of the grind test for thumb CMC osteoarthritis. Methods Radiological evaluation was used as the gold standard. Seventy thumbs of 54 persons with various hand disorders were included in the study. The grind test was performed by two physical therapists, and radiographs were evaluated by a certified hand surgeon, all blinded to the participants' diagnosis and other test results. Interrater reliability was compared with a kappa statistic, and the sensitivity, specificity, likelihood ratios, and predictive values were calculated from a 232 table. Results A kappa value of 0.48 was calculated as the interrater reliability. The sensitivity of the grind test was 42% and 53%, depending on tester. The specificity of the grind test was 80% and 93%, depending on tester. The positive likelihood ratio was 2.65 and 6.00, and the negative likelihood ratio was 0.59 and 0.62. The positive predictive value was 91% and 96%, depending on tester. The negative predictive value was 68% and 70%, depending on tester. Conclusion The grind test has moderate reliability and accurately confirms the diagnosis of CMC osteoarthritis and identifies those who do not have CMC osteoarthritis. However, a negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis. Level of Evidence n/a

BACKGROUND:Neuromuscular electrical stimulation initiated by a surface electromyographic biofeedback threshold (sEMG-triggered NMES) has been studied in populations of patients with neurological problems, but has not been applied to orthopedic populations.OBJECTIVES:The purpose of this single-blinded, randomized clinical trial was to investigate sEMG-triggered NMES on knee extension active range of motion (AROM), function, and torque in patients with post-operative arthroscopic knee surgery.METHODS:Twenty-five participants were randomly assigned to either: (1) sEMG-triggered NMES with exercise group, or (2) exercise-only comparison group. Participants received outpatient physical therapy treatment 2 to 3 times a week for 12 visits. Knee AROM and function determined by the lower extremity functional scale (LEFS) were collected at the first, sixth, and twelfth visits. Peak isometric extensor torque was assessed using an electromechanical dynamometer at 3 months post surgery. Two analysis of variance tests with repeated measures were used to analyze knee AROM and LEFS data. An independent samples t-test was used to analyze the peak torque index (%) of the involved extremity compared to the uninvolved.RESULTS:A significant difference in AROM was found between groups. No significant difference was found between groups in the LEFS, nor in the peak isometric extensor torque. A 72.5% strength deficit was found compared to the uninvolved extremity.CONCLUSION:Using sEMG-triggered NMES intervention improved extension AROM but did not improve function or torque.