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Reliability and Validity of an Innovative Device for ACL Testing: The Mobil-Aider

Dawn T. Gulick

Background: Knee disorders prevalence is estimated at more than 50% in a lifetime. There are over 250,000 anterior cruciate ligament (ACL) injuries per year in the United States. There are over 175,000 ACL reconstructions annually. This study was a double-blinded design to establish the reliability and validity of a new orthopedic device to measure linear translation of the tibia on the femur (ACL testing). Methods: A Zeiss Smartzoom microscope was used as the gold standard to assess the ability of the Mobil-Aider to measure linear translation. Sixty blinded measures were taken with each of 6 different devices. Results: Both the intraclass correlation and the Pearson correlation were .986. The Cronbach alpha reliability analysis was 0.992. Independent 1-sample t tests were performed on the differences between the Mobil-Aider and Zeiss values, and were not found to be significant (P = .42); that is, they were the same. Bland–Altman plot and a linear regression revealed no propositional bias. Finally, with 360 measures over 6 devices, the power of this study was calculated to be 100%. Discussion: This data are the first step in establishing reliability and concurrent validity of a new device. As a result of the current data, the Mobil-Aider device is deemed a promising orthopedic tool for use in assessing the laxity of the ACL. Additional testing needs to be performed on both healthy and injured knees. Conclusions: There is potential for the Mobil-Aider to contribute to the assessment of ACL injuries, but additional human testing is needed.

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Delayed Onset Muscle Soreness: What Is It and How Do We Treat It?

Dawn T. Gulick and Iris F. Kimura

Muscle soreness, a familiar phenomenon to most athletes, has been differentiated into “acute” and “delayed onset.” The etiology of acute muscle soreness has been attributed to ischemia and the accumulation of metabolic by-products. However, the etiology of delayed onset muscle soreness (DOMS) is not so clear. Six theories have been proposed: lactic acid, muscle spasm, torn tissue, connective tissue, enzyme efflux, and tissue fluid theories. The treatment of DOMS has also been investigated. Studies in which anti-inflammatory medications have been administered have yielded varying results based on the dosage and the time of administration. Submaximal concentric exercise may alleviate soreness but does not restore muscle function. Neither cryotherapy nor stretching abates the symptoms of DOMS. Transcutaneous electrical stimulation has been shown to decrease soreness and increase range of motion, but the effect on the recovery of muscle function is unknown. Therefore, the treatment of DOMS remains an enigma.

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Field Test for Measuring Aerobic Capacity in Paralympic Goalball Athletes

Dawn T. Gulick and Laurie A. Malone

Edited by Monique Mokha

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Differential Diagnosis of Morton’s Neuroma

Dawn T. Gulick and Tabitha K. Charles

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Iliotibial Band Friction Syndrome

Elizabeth A. Racioppi and Dawn T. Gulick

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Double-Blind Clinical Efficacy Study of Pulsed Phonophoresis on Perceived Pain Associated with Symptomatic Tendinitis

Caroline E. Penderghest, Iris F. Kimura, and Dawn T. Gulick

The purpose of this study was to determine the clinical efficacy of dexametha-sone-lidocaine (DX-L) phonophoresis on perceived pain associated with symptomatic tendinitis. Twenty-four subjects were randomly assigned to a DX-L or placebo phoresis group. All subjects received strengthening, stretching, and cryotherapy. Five double-blind sessions were administered over a 5- to 10-day period, with 24 to 48 hr between sessions. Perceived pain was quantified using a visual perceived pain scale (VPPS) and a punctate tenderness gauge (PTG). Data were collected before stretching, strengthening, and DX-L/placebo phoresis treatments, 1 min after treatment, and 10 min after cryotherapy. There were no significant differences for VPPS or PTG between groups. There was a significant difference between treatment sessions, regardless of group or test, and there were significant decreases in perceived pain between Tests 1 and 3 and between Treatment Sessions 1 and 5. It was concluded that stretching, strengthening, and cryotherapy significantly decreased the levels of perceived pain associated with symptomatic tendinitis regardless of whether the subjects received phonophoresis.

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Validity and Reliability of 2 Goniometric Mobile Apps: Device, Application, and Examiner Factors

Robert H. Wellmon, Dawn T. Gulick, Mark L. Paterson, and Colleen N. Gulick


Smartphones are being used in a variety of practice settings to measure joint range of motion (ROM). A number of factors can affect the validity of the measurements generated. However, there are no studies examining smartphone-based goniometer applications focusing on measurement variability and error arising from the electromechanical properties of the device being used.


To examine the concurrent validity and interrater reliability of 2 goniometric mobile applications (Goniometer Records, Goniometer Pro), an inclinometer, and a universal goniometer (UG).


Nonexperimental, descriptive validation study.


University laboratory.


3 physical therapists having an average of 25 y of experience.

Main Outcome Measures:

Three standardized angles (acute, right, obtuse) were constructed to replicate the movement of a hinge joint in the human body. Angular changes were measured and compared across 3 raters who used 3 different devices (UG, inclinometer, and 2 goniometric apps installed on 3 different smartphones: Apple iPhone 5, LG Android, and Samsung SIII Android). Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to examine interrater reliability and concurrent validity.


Interrater reliability for each of the smartphone apps, inclinometer and UG were excellent (ICC = .995–1.000). Concurrent validity was also good (ICC = .998–.999). Based on the Bland-Altman plots, the means of the differences between the devices were low (range = –0.4° to 1.2°).


This study identifies the error inherent in measurement that is independent of patient factors and due to the smartphone, the installed apps, and examiner skill. Less than 2° of measurement variability was attributable to those factors alone. The data suggest that 3 smartphones with the 2 installed apps are a viable substitute for using a UG or an inclinometer when measuring angular changes that typically occur when examining ROM and demonstrate the capacity of multiple examiners to accurately use smartphone-based goniometers.

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Exploration of the KT1000 as a Tool to Assess Dynamic Anterior Tibial Translation

Dawn T. Gulick, Brian LaRue, and Brian Berge

Column-editor : Carl G. Mattacola

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Intra- and Intertester Reliability of Chatillon and MicroFet Hand-Held Dynamometers in Measuring Force Production

Iris F. Kimura, LouAnne M. Jefferson, Dawn T. Gulick, and R. David Coll

The purpose of this study was to investigate intratester and intertester reliability when using the Chatillon and MicroFet hand-held dynamometers (HHDs) to measure isometric force production of the wrist extensors, elbow flexors, ankle dorsiflexors, and knee extensors. Twelve subjects participated, with each joint tested four times with each HHD. Intratester and intertester intraclass con-elation coefficients were measured for both devices separately and between the devices- Results indicated that the HHDs were more reliable when used by a single examiner who had been properly trained in their use. Reliability of the HHDs appears to be affected by both the magnitude of the force produced by the subject and the examiner's ability to resist the force. There was no correlation between examiner's stature and consistent force production values. Caution should be taken when interpreting data obtained from different testers or different HHDs. The same clinician should use the same HHD for successive tests to yield the most reliable data.