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

Context:

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.

Objective:

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

Design:

Nonexperimental, descriptive validation study.

Setting:

University laboratory.

Participants:

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.

Results:

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°).

Conclusions:

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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Scott W. Cheatham

Background: In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented. Purpose: To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States. Design: Cross-sectional descriptive survey study. Methods: A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education. Results: One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research. Conclusion: The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

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Lewis J. Macgregor, Massimiliano Ditroilo, Iain J. Smith, Malcolm M. Fairweather and Angus M. Hunter

Context:

Assessments of skeletal-muscle functional capacity often necessitate maximal contractile effort, which exacerbates muscle fatigue or injury. Tensiomyography (TMG) has been investigated as a means to assess muscle contractile function after fatigue; however, observations have not been contextualized by concurrent physiological measures.

Objective:

To measure peripheral-fatigue-induced alterations in mechanical and contractile properties of the plantar-flexor muscles through noninvasive TMG concurrently with maximal voluntary contraction (MVC) and passive muscle tension (PMT) to validate TMG as a gauge of peripheral fatigue.

Design:

Pre- and posttest intervention with control.

Setting:

University laboratory.

Participants:

21 healthy male volunteers.

Interventions:

Subjects’ plantar flexors were tested for TMG parameters, along with MVC and PMT, before and after either a 5-min rest period (control) or a 5-min electrical-stimulation intervention (fatigue).

Main Outcome Measures:

Temporal (contraction velocity) and spatial (radial displacement) contractile parameters of the gastrocnemius medialis were recorded through TMG. MVC was measured as an indicator of muscle fatigue, and PMT was measured to assess muscle stiffness.

Results:

Radial displacement demonstrated a fatigue-associated reduction (3.3 ± 1.2 vs 4.0 ± 1.4 mm, P = .031), while contraction velocity remained unaltered. In addition, MVC significantly declined by 122.6 ± 104 N (P < .001) after stimulation (fatigue). PMT was significantly increased after fatigue (139.8 ± 54.3 vs 111.3 ± 44.6 N, P = .007).

Conclusions:

TMG successfully detected fatigue, evident from reduced MVC, by displaying impaired muscle displacement accompanied by elevated PMT. TMG could be useful in establishing skeletalmuscle fatigue status without exacerbating the functional decrement of the muscle.

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Scott Cheatham, Morey J. Kolber and Michael P. Ernst

Context:

Pulse oximetry has become mobile with the use of smartphone and Bluetooth wireless technology. This technology offers many benefits but has not been extensively studied. There is a need to further validate its clinimetric properties for health professionals to provide proper guidance to patients.

Objective:

This investigation assessed the concurrent validity of the iSpO2 pulse oximeter against a traditional pulse oximeter in measuring short-term resting blood oxygen saturation (SpO2) and pulse rate.

Design:

Observational study of reliability.

Setting:

University kinesiology laboratory.

Participants:

Thirty healthy, recre-ationally active adults (18 men, 12 women; mean age = 25.7 ± 5.46 years, mean height = 170.3cm ± 9.51, mean body mass = 76.4 kg ± 19.33).

Intervention:

Resting measurement of SpO2 and pulse rate using the iSpO2 pulse oximeter with the iPad Mini and a traditional pulse oximeter with Bluetooth.

Main Outcome Measure:

Resting SpO2 and pulse rate were concurrently measured over 5 min.

Results:

The concurrent validity between the iSpO2 and traditional pulse oximeter was moderate for measuring SpO2, intraclass correlation coeffcient (ICC)(3, 1) = .73, SEM = 0.70%, and good for pulse rate, ICC(3, 1) = .97, SEM = 1.74 beats per minute (bpm). The minimal detectable change at the 95% confidence interval for both instruments suggests that there may be 1.94% disagreement for SpO2 and 4.82 bpm disagreement between pulse oximetry methods. The 95% limits of agreement (LoA) for measuring SpO2 suggests that the iSpO2 and traditional pulse oximeters may vary -0.28 ± 1.98%, or approximately 2%. The 95% LoA for measuring pulse rate suggests that the iSpO2 and traditional pulse oximeter may vary 1.74 ± 4.98 bpm, potentially upward of 6 bpm. On the basis of the results of the LoA, it appears that there may be a slight systematic bias between the two devices, with the traditional pulse oximeter producing higher pulse rates than the iSpO2.

Conclusion:

The findings suggest that both instruments may be beneficial for indirect short-term measurements of resting SpO2 and pulse rate.

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Robert J. de Vos, Marinus P. Heijboer, Harrie Weinans, Jan A.N. Verhaar and Hans T.M. van Schie

Context:

Chronic midportion Achilles tendinopathy is a common and hard-to-treat disorder characterized by degenerative changes of the tendon matrix. Ultrasonographic tissue characterization (UTC) was successfully used to quantify structural human Achilles tendon changes. This novel and reliable technique could be used in follow-up studies to relate tendon structure to symptoms.

Objective:

To quantify structural tendon changes and assess clinical change in patients with tendinopathy.

Design:

Prospective observational study.

Setting:

Orthopedic department in a university medical center.

Patients:

23 patients with chronic midportion Achilles tendinopathy.

Intervention:

The patients performed a 16-wk home-based eccentric exercise program. An experienced researcher performed the ultrasonographic data collection with the UTC procedure. These data were assessed by a blinded observer. The severity of symptoms was established with the validated Victorian Institute of Sport Assessment–Achilles (VISA-A) questionnaire.

Main Outcome Measures:

UTC was performed to quantify tendon structure through measuring the proportion of 4 echo types. Echo types I and II represent more or less organized tendon bundles, and echo types III and IV represent disintegrated tendon structure. On the VISA-A, the total possible score is divided by 100 for a percentage score, with a perfect score of 100. Follow-up was at 2, 8, 16, and 24 wk.

Results:

The mean percentage of echo types I and II changed by 0.3% after 24 wk (P = .92, 95% CI −5.8 to 5.3). The mean VISA-A score increased slightly but significantly by 11.3 points after 24 wk (P = .01, 95% CI 2.6–20.0). An increased VISA-A score was not correlated with an increased percentage of echo types I and II (P = .94, r = −.02), and the baseline percentage of echo types I and II did not correlate with an increased VISA-A score (P = .74, r = .07).

Conclusions:

There is no short-term increase in organized tendon structure after eccentric exercises. Tendon structure is not related to symptom severity and cannot be used as a predictor of clinical outcome.

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. Fowler * Adrian Lees * 8 1998 14 3 260 275 10.1123/jab.14.3.260 Validation of a Mathematical Model for Road Cycling Power James C. Martin * Douglas L. Milliken * John E. Cobb * Kevin L. McFadden * Andrew R. Coggan * 8 1998 14 3 276 291 10.1123/jab.14.3.276 Dynamic Angular Stiffness of the

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Mark A. Sutherlin

Collegiate Swimmers Shoulder Functional Performance Status on National Collegiate Athletic Association Swimmers: Baseline Kerlan-Jobe Orthopedic Clinic Scores Development and Validation of a Swimmer’s Functional Pain Scale Study Participants 18 NCAA Division II female swimmers 99 NCAA swimmers 58 USA

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Original Research Validation of the Volume Function within Jensen’s (1978) Elliptical Cylinder Model Jason Wicke * Becky Lopers * 2 2003 19 1 3 12 10.1123/jab.19.1.3 Research Rearfoot Kinematics during Initial Takeoff of Elite High Jumpers: Estimation of Spatial Position and Orientation of

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Technique for Determining the Ground Reaction Forces in Human Bipedal Stance Musa L. Audu 1 Robert F. Kirsch 1 Ronald J. Triolo 1 11 2003 19 4 361 371 10.1123/jab.19.4.361 3-D Kinematics Using Moving Cameras. Part 1: Development and Validation of the Mobile Data Acquisition System Dany Lafontaine 1

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.4.261 Validation of the 12-Minute Cycle Ergometer Test Using a Higher Resistance Setting Paul M. Vanderburgh * Ronald E. DeMeersman * 11 1993 2 4 268 273 10.1123/jsr.2.4.268 Case Studies Bilateral Isokinetic Knee Rehabilitation Following Bilateral Total Knee Replacement Surgery Lee E. Brown * Michael