Reliability of lower leg muscle elasticity using shear wave elastography in non-weight-bearing and weight-bearing.

PURPOSE: Muscle elasticity can be quantified with shear wave elastography (SWE) and has been used as an estimate of muscle force but reliability has not been established for lower leg muscles. The purpose of this study was to examine the intra-rater and inter-rater reliability of elasticity measures in non-weight-bearing (NWB) and weight-bearing (WB) for the tibialis anterior (TA), tibialis posterior (TP), peroneal longus (PL), and peroneal brevis (PB) muscles using SWE. METHODS: A total of 109 recreationally active healthy adults participated. The study employed a single-cohort, same-day repeated-measures test-retest design. Elasticity, measured in kilopascals as the Young's modulus, was converted to the shear modulus. All four muscles were measured in NWB and at 90% WB. RESULTS: Intra-rater reliability estimates were good to excellent for NWB (ICC = 0.930-0.988) and WB (ICC = 0.877-0.978) measures. Inter-rater reliability estimates were moderate to good (ICC = 0.500-0.795) for NWB measures and poor to good (ICC = 0.346-0.910) for WB measures. CONCLUSION: Despite the studies poor to good inter-rater variability, the intra-rater reproducibility represents the potential benefit of SWE in NWB and WB. Establishing the reliability of SWE with clinical and biomechanical approaches may aid in improved understanding of the mechanical properties of muscle.

Interprofessional Education on the Neurology Clerkship for Physical Therapy and Medical Students.

Introduction: Globally, neurological disorders make up the second most common cause of death and are the leading cause of years lived with disability. Because neurological patients often require multidisciplinary care and future professionals will encounter increasing demands for neurological care, it is important to emphasize education on the interaction between physical therapy (PT) and neurology. Yet there is a dearth of interprofessional education (IPE) learning activities that include neurology clerkship students and physical therapists. Methods: We created a 4-hour IPE experience that incorporated hospitalized patients with neurological disorders who were examined at the bedside by pairs of second- and third-year PT students and second- and third-year medical students, followed by a debriefing. Participants completed the Self-Efficacy for Interprofessional Experiential Learning (SEIEL) survey before and after the session. Results: Significant pre/post improvements were seen for SEIEL total and domain scores (n = 75, p < .001). Qualitative comments were analyzed; major themes that emerged included a greater appreciation for the other discipline. Students felt the IPE activity was a great learning opportunity to understand roles and responsibilities and communicate with the other discipline. Discussion: Students noted significant increases in their ability to understand and explain the importance of interprofessional communication and in their capabilities as health care professionals to work together on an interprofessional collaborative team. This clinical IPE experience can be seamlessly incorporated into the workplace for medical and PT students. IPE activities like this should be encouraged and developed to reach more students and other health care providers.

Reliability and validity of modified Four Square Step Test (mFSST) performance in individuals with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a complex disorder marked with non-motor and motor impairments, including gait abnormalities and postural instability. As a result of balance dysfunction and postural instability, falls and injuries are common composite impairments of PD. The modified Four Square Step Test (mFSST) replaces the canes utilized in the traditional Four Square Step Test (FSST) with tape to evaluate dynamic standing balance while stepping in multiple directions. PURPOSE: Determine the reliability and validity of the mFSST in individuals with PD. METHODS: Twenty-seven participants diagnosed with PD on medication H&Y I-III, mean age 73.07 ± 6.4, completed the FSST and mFSST. Participants performed both assessments two times using the fastest time for interrater reliability and concurrent validity. To determine the test-retest reliability, participants performed the mFSST again 20-60 min following initial assessment. RESULTS: The interrater and test-retest reliability was excellent (r = 0.916-0.999, ICC2,2 = 0.96-0.99). The mFSST and FSST were highly correlated for concurrent validity (r = 0.823, p < .01). CONCLUSION: The mFSST demonstrates excellent reliability and validity while assessing dynamic standing balance in individuals with PD. The mFSST can be completed while requiring little equipment, space, and time in multiple rehabilitation settings.

The functional lumbar index: Validation of a novel clinical assessment tool for individuals with low back pain.

STUDY DESIGN: Retrospective Diagnostic Cohort Study. LEVEL OF EVIDENCE: Level 3b. OBJECTIVES: To examine the concurrent and predictive validity of a novel clinical assessment tool, the Functional Lumbar Index (FLI). BACKGROUND: Lumbar surgeries have increased exponentially in the past decade, adding to healthcare costs without improving outcomes. Limitations in clinicians' abilities to identify those individuals who are most likely to benefit from surgery may be enhanced with an effective physical assessment tool. METHODS: The FLI was assessed on 291 individuals (179 conservative and 113 pre-surgical) seeking care for low-back pain (LBP) over a 2.5-year period. The FLI consists of several physical performance tests (PPT) with a novel criterion-based scoring system. Pearson correlations and Poisson regression analysis were used to establish concurrent and predictive validity at alpha = 0.05. RESULTS: The subscale FLI components showed good to excellent inter-rater reliability with intraclass correlation coefficient values as follows: front plank = .993, right side plank = .824, left side plank .861, Sorensen = 0.836, overhead squat = 0.937. A statistically significant, moderate negative correlation was observed between FLI and modified Oswestry Disability Index (r = -0.540, p < .001). Regression analysis showed the FLI as the only significant predictor (p = .004) of failed conservative management for individuals with LBP. An ROC curve showed significant group prediction of the FLI with an AUC of 0.788 (p < .001) and cut-off score of 7.5. CONCLUSION: The FLI is a reliable and valid measure for predicting failed conservative care management in patients with LBP. Clinicians are encouraged to use the FLI as part of their physical assessment when screening individuals with LBP who might need surgical intervention. Further research is needed to determine validity of the FLI in other patient populations. PUBLIC TRIAL REGISTRY: N/A.

The Effect of Core Stabilization Training on Improving Gait and Self-Perceived Function in Patients with Knee Osteoarthritis: A Single-Arm Clinical Trial.

The treatment of patients with knee osteoarthritis is typically focused on the involved lower extremity. There is a gap in the literature concerning the effectiveness of core stabilization training on the treatment of patients with knee osteoarthritis. This investigation aimed to determine whether core stabilization improved the gait and functional ability of patients with knee osteoarthritis. Eighteen participants with knee osteoarthritis completed the six-week core stabilization intervention. Participants completed the gait motion analysis and the Knee Injury and Osteoarthritis Outcome Score to assess self-perceived function, pre- and post-intervention. Gait speed improved (p = 0.006, d = 0.59), while the external knee adduction moment decreased (p = 0.034, d = −0.90). Moreover, self-reported function improved (p < 0.001, d = 1.26). The gait speed and external knee adduction moment changes met minimal detectable change thresholds, while gait speed also met the minimal clinically important difference. A six-week core stabilization program can thus improve gait speed and reduce the external knee adduction moment, which is tied to disease progression. Increased functional scores post-intervention indicate an important clinical improvement. Core stabilization training is a safe and potentially effective treatment option for this population.

Transversus abdominis activation does not alter gait impairments in patients with and without knee osteoarthritis.

BACKGROUND: Knee osteoarthritis accounts for more years of disability than all other forms of osteoarthritis combined. Gait kinetic and kinematic changes, in addition to reduced gait speed, are commonly observed. This study investigates whether core activation, which modifies lower extremity movement in young, active populations, can alter the gait and baseline core activation of those with knee osteoarthritis as compared to controls, and alter osteoarthritic knee pain. METHODS: Forty-four participants (22 controls and 22 with knee osteoarthritis) underwent biomechanical gait assessment, examining kinetic and kinematic variables, in addition to gait speed, with and without volitional transversus abdominis activation. Surface electromyography was used to measure baseline transversus abdominis activation under both conditions. Knee pain ratings were examined for those with knee osteoarthritis. FINDINGS: No significant biomechanical differences were observed within groups, or in the time/group interaction. Between-groups kinetic (time to first peak ground reaction force and amplitude of second peak ground reaction force) and gait speed differences were observed under both conditions. There were no differences in baseline electromyography activation between or within-groups, or within-group for self-reported pain for the osteoarthritic group. INTERPRETATION: Although previous studies have shown the benefit of core activation in correcting lower extremity movement patterns and kinetic loading in young, athletic populations, this study is the first to show this is not the case for persons with knee osteoarthritis. Future studies should examine the value of a progressive core stabilization program, of sufficient dose and mode, in correcting the observed gait differences in those with knee osteoarthritis. CLINICAL TRIAL REGISTRATION NUMBER: NCT03776981.

Youth physical health and years in American homeschools: are they related?

Homeschooling is a growing trend in the USA and abroad with both reported consequences and benefits to youth physical health. The purpose of this study was to examine whether changes in youth physical health could be related to the number of years a student spends in homeschool. Body composition (body mass index and body fat), muscular fitness (lower extremity, abdominal and upper extremity) and cardiorespiratory fitness (Progressive Aerobic Capacity Endurance Run) were assessed in 211 youth ages 5-17. Data analysis showed weak or non-significant relationships between years in homeschool and all aspects of youth physical health. Time spent in homeschool is weakly or not at all related to multiple aspects of youth physical health. Parents and policy makers should not be concerned with detrimental physical health effects of homeschooling on youth.

Validation of Cardiorespiratory Fitness Measurements in Adolescents.

Cardiorespiratory fitness (CRF) is an important indicator of adolescent cardiovascular well-being and future cardiometabolic health but not always feasible to measure. The purpose of this study was to estimate the concurrent validity of the non-exercise test (NET) for adolescents against the Progressive Aerobic Capacity Endurance Run (PACER®) and direct measures of VO2max as well as to examine the concurrent validity of the PACER® with a portable metabolic system (K4b2™). Forty-six adolescents (12-17 years) completed the NET prior to performing the PACER® while wearing the K4b2™. The obtained VO2max values were compared using linear regression, intra-class correlation (ICC), and Bland-Altman plots, and α was set at 0.05. The VO2max acquired directly from the K4b2™ was significantly correlated to the VO2max indirectly estimated from the NET (r = 0.73, p < 0.001, r2 = 0.53, ICC = 0.67). PACER® results were significantly related to the VO2max estimates from the NET (r = 0.81, p < 0.001, r2 = 0.65, ICC = 0.72). Direct measures from the K4b2™ were significantly correlated to the VO2max estimates from the PACER® (r = 0.87, p < 0.001, r2 = 0.75, ICC = 0.93). The NET is a valid measure of CRF in adolescents and can be used when an exercise test is not feasible.

Criterion Validity and Sensitivity to Change of a Pediatric Bioelectrical Impedance Analysis Scale in Adolescents.

BACKGROUND: BMI measures are often used to infer body composition. Bioelectrical impedance analysis (BIA) is a more accurate way to estimate percent body fat (%BF), particularly when screening children who may be overweight. The aim of this study was to determine the validity, sensitivity to change, and diagnostic value of a BIA scale designed specifically for adolescents. METHODS: One hundred twelve adolescents had their body fat assessed using both BIA and dual-energy X-ray absorptiometry (DEXA). Mean difference and limits of agreement (LoA) were calculated for criterion validity. Intraclass correlation coefficients (ICCs) were calculated for sensitivity to change. Sensitivity/specificity for each classification was also assessed. Data from 46 returning adolescents (6-8 months later) were then used to assess sensitivity to change of BIA compared with DEXA. RESULTS: ICC for absolute agreement (range) comparing BIA and DEXA was 0.78 (0.48-0.88). The mean difference between the BIA %BF reading and DEXA was -4.05% (LoA = [4.80%, -12.90%]). Sensitivity and specificity values for the underfat, healthy, overfat, and obese classifications were 0.0/0.89, 0.79/0.46, 0.28/0.92, and 0.5/1.00, respectively. ICC for absolute agreement over time between the BIA %BF and the DEXA %BF was 0.71 (0.242-0.866). CONCLUSIONS: The Tanita BF-689 demonstrated poor-good agreement with DEXA when measuring %BF, poor-moderate agreement when measuring change in %BF over time, high sensitivity for classification into the healthy category and high specificity for classification into the underfat/overfat/obese categories. Compared to DEXA, the BF-689 is accurate, accessible, and efficient in classifying adolescents based on %BF.

Metabolic Responses to a Battling Rope Protocol Performed in the Seated or Stance Positions.

Brewer, W, Kovacs, R, Hogan, K, Felder, D, and Mitchell, H. Metabolic responses to a battling rope protocol performed in the seated or stance positions. J Strength Cond Res 32(12): 3319-3325, 2018-The purpose of this study is to compare the levels of oxygen consumption and heart rate responses elicited by a treadmill or cycle V[Combining Dot Above]O2max test with a standing or sitting battling rope protocol (BRP) (treadmill vs. standing BRP) (cycle vs. seated BRP). Forty healthy subjects performed either a ramped V[Combining Dot Above]O2max treadmill or cycle test. At least 3 days later, the subjects who performed the ramped treadmill test did the standing BRP, and the subjects who performed the ramped cycle test did the sitting BRP. Each BRP consisted of 10 sets of 15/45 seconds of work/rest for 10 sets. V[Combining Dot Above]O2peak and HRpeak were recorded. Metabolic responses were significantly lower for the sitting BRP and standing as compared to the HRmax and V[Combining Dot Above]O2max values derived from the bicycle and treadmill tests. The BRP produced a V[Combining Dot Above]O2peak that was 71.87% (sitting) and 68.37% (standing) of the subjects' V[Combining Dot Above]O2max assessed u the bicycle and treadmill protocol. Moderate correlations were found between the V[Combining Dot Above]O2 during the seated (r = 0.61; p = 0.003) and standing (r = 0.43; p = 0.03) BRP and the bicycle and treadmill V[Combining Dot Above]O2max tests, respectively. The HRpeak elicited by the BRP performed in sitting (r = 0.52; p = 0.009) and standing (r = 0.67; p = 0.001) had a moderate correlation with the HRmax derived from the bicycle and treadmill tests. Battling ropes may be a low cost, accessible option to improve cardiovascular endurance for individuals who cannot stand or move their lower extremities in a rhythmic manner to conduct aerobic exercise.

How Healthy Is Homeschool? An Analysis of Body Composition and Cardiovascular Disease Risk.

BACKGROUND: Public school children regularly participate in school-based physical activity, physical education, and fitness testing. However, almost 2 million American children are homeschooled. The purpose of this research was to assess the body composition of elementary school-aged homeschool children and their corresponding cardiovascular disease (CVD) risk. METHODS: This research explored the body composition and CVD risk of 145 homeschool children aged 5-11 years using body mass index (BMI), percent body fat, and waist circumference. Chi-square and Mann-Whitney U tests examined differences in CVD risk within the homeschool population. RESULTS: Overall, homeschool children had average BMI z-scores (SD [range]) with a mean of -0.11 (0.97 [-3.47 to 2.53]). Unhealthy classifications were seen in 11.2% of the sample by BMI, 19.6% by percent body fat, and 49.7% by waist circumference. Statistical analysis revealed no difference in CVD risk between sexes (χ2 (1) = 0.062, p = .804) or ethnicities (χ2 (1) = 0.927, p = .336) but increased prevalence in children aged 5-9 years (U = 1427, z = -4.559, p < .001). CONCLUSIONS: Almost half of elementary school-aged homeschool children showed increased risk for CVD and need regular assessment of central adiposity.

A pilot study to determine the effect of one physical therapy session on physical activity levels for individuals with chronic low back pain.

BACKGROUND: A pilot study was conducted to quantify the effect size of changes in physical activity after of one session of physical therapy for individuals with chronic low back pain and to determine factors that predict daily sedentary activity time. METHODS: Fourteen subjects with at least 3 days of physical activity accelerometer data were analyzed before and after one session of physical therapy. Data was analyzed using 1-tailed, paired t-tests with level of significance set at 0.05. Effect sizes were computed using the baseline and post intervention mean differences divided by the baseline and post-intervention differences in the standard deviation. RESULTS: A nonsignificant reduction in steps-per-day and time spent performing sedentary activities, with increases in light and moderate-vigorous physical activity were found (effect size: 0.15-0.33). A nonsignificant decrease in daily sitting and standing time 1 week immediately following the physical therapy session and an increase in daily lying time (p = 0.03) (effect size: 0.23-0.69) were found. CONCLUSION: One physical therapy session resulted in a small physical activity change for individuals with chronic low back pain. Baseline and post intervention levels of pain catastrophisation and perceptions of disability need to be explored in future studies to determine if these are factors that influence levels of physical activity change for these individuals Results are limited by the small sample size, however the ability to increase physical activity in this population may be of clinical relevance. Trial Registration NCT02823756; June 30, 2016: Retrospectively Registered.

Validity of Fitbit's active minutes as compared with a research-grade accelerometer and self-reported measures.

OBJECTIVES: The main purpose of the study was to assess the validity between the Fitbit and ActiGraph GT3X+ accelerometer. The specific aims were to determine the: (1) concurrent validity between the various models of the Fitbit and the GTX3+ accelerometer as the criterion measure for: number of steps and active minutes averaged over a single-day and 7-day period; (2) validity of the two devices with the International Physical Activity Questionnaire (IPAQ) for the number of daily active minutes performed. METHODS: Fifty-three subjects wore a Fitbit and ActiGraph concurrently for 7 days. Data were analysed using correlation coefficients, t-tests to assess mean comparisons and Bland-Altman plots to determine agreement between the Fitbit and the ActiGraph. RESULTS: The correlations between the Fitbit and ActiGraph for steps per day and per 7 days were r=0.862 and 0.820, respectively with significant mean differences between both devices. Bland-Altman analyses revealed agreement between the Fitbit and the ActiGraph for 7-day active minutes only. The correlations between the Fitbit and ActiGraph for active minutes per day and per 7 days were r=0.695 and r=0.658, respectively, with no significant mean differences between both devices. No significant correlations were found between the IPAQ and the other two devices. CONCLUSIONS: The data produced by the Fitbit were consistent with the ActiGraph when the means of each device were compared over the 1-day and 7-day time periods. However, Bland-Altman analyses revealed that the Fitbit agreed with the ActiGraph when used to measure physical activity levels over a 7-day span only.

Muscular and Cardiorespiratory Fitness in Homeschool versus Public School Children.

PURPOSE: The growth and unregulated structure of homeschooling creates an unknown population in regard to muscular and cardiorespiratory fitness. The purpose of this research was to compare muscular and cardiorespiratory fitness between elementary school aged homeschool and public school children. METHOD: Homeschool children ages 8-11 years old (n = 75) completed the curl-up, 90° push-up, and Progressive Aerobic Capacity Endurance Run (PACER) portions of the FitnessGram to assess abdominal and upper body strength and endurance as well as cardiorespiratory fitness. Comparisons to public school children (n = 75) were made using t tests and chi-square tests. RESULTS: Homeschool children showed significantly lower abdominal (t(148) = -11.441, p < .001; χ2 (1) = 35.503, p < .001) and upper body (t(148) = -3.610, p < .001; χ2 (1) = 4.881, p = .027) strength and endurance. There were no significant differences in cardiorespiratory fitness by total PACER laps (t(108) = 0.879, p = .381) or estimated VO2max (t(70) = 1.187, p = .239; χ2 (1) = 1.444, p = .486). CONCLUSION: Homeschool children showed significantly lower levels of both abdominal and upper body muscular fitness compared with their age and gender matched public school peers but no difference in cardiorespiratory fitness.

Can metabolic function and physical fitness improve without weight loss for inactive, obese, Hispanic adolescents? A feasibility study.

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.

MUSCLE ACTIVATION PATTERNS DURING SUSPENSION TRAINING EXERCISES.

BACKGROUND: Suspension training (ST) has been utilized over exercises performed on a stable surface to train multiple muscle groups simultaneously to increase muscle activation and joint stability. HYPOTHESIS/PURPOSE: The purpose of this study was to determine whether ST augments muscle activation compared to similar exercises performed on a stable surface. STUDY DESIGN: Cross-sectional study. METHODS: Twenty-five healthy adults (male: 16; women: 9; BMI: 23.50 ± 2.48 kg/m2) had 16 pre-amplified wireless surface EMG electrodes placed bilaterally on: the pectoralis major (PM), middle deltoid (MD), serratus anterior (SA), obliques (OB), rectus abdominis (RA), gluteus maximus (GM), erector spinae (ES), and middle trapezius/rhomboids (MT). Each participant performed reference isometric exercises (Sorensen test, push-up, sit-up, and inverted row) to establish a baseline muscle contraction. Muscle activation was assessed during the following exercises: ST bridge, ST push-up, ST inverted row, ST plank, floor bridge, floor push-up, floor row, and floor plank. The root mean square (RMS) of each side for every muscle was averaged for data analysis. Multivariate analyses of variance (MANOVA) for each exercise with post-hoc comparisons were performed to compare muscle activation between each ST exercise and its stable surface counterpart. RESULTS: MANOVAs for all exercise comparisons showed statistically significant greater muscle activation in at least one muscle group during the ST condition. Post-hoc analyses revealed a statistically significant increase in muscle activation for the following muscles during the plank: OB (p = 0.021); Push-up: PM (p = 0.002), RA (p<0.0001), OB (p = 0.019), MT (p<0.0001), and ES (p = 0.006); Row: MD (p = 0.016), RA (p = 0.059), and OB (p = 0.027); and Bridge: RA (p = 0.013) and ES (p<0.0001). CONCLUSIONS: Performing ST exercises increases muscle activation of selected muscles when compared to exercises performed on a stable surface. LEVEL OF EVIDENCE: 1b.

A comparison of work-related physical activity levels between inpatient and outpatient physical therapists: an observational cohort trial.

BACKGROUND: Physical therapists (PTs) work in a variety of healthcare settings with varied levels of physical activity demands placed on them. The purpose of this study is to compare the physical activity (PA) levels between PTs in inpatient versus outpatient environments for one work week using a cross-sectional design. METHODS: Sixty-one PTs (30 inpatient, 31 outpatient) wore a tri-axial accelerometer and inclinometer for one work-week. The number steps-per-day, PA intensities, energy expenditures and postural positions adopted during the work day were recorded. RESULT: Significantly longer amounts of time spent sitting was found for inpatient PTs regardless of the significantly higher number of steps-per-day. Outpatient PTs had a higher number of breaks from sedentary activity with those breaks being longer than the inpatient PTs. The percentage of time spent performing moderate-vigorous PA approached significance implying more time was spent performing these types of activities for outpatient PTs. The energy expenditures between the two groups of PTs were not different. CONCLUSION: This study compared the differences in physical activity levels between physical therapists who worked at inpatient versus outpatient environment as little is known about their activity levels. Inpatient physical therapists took more steps per day than outpatient physical therapists but the outpatient physical therapists were less sedentary and took more frequent and longer breaks from sedentary activities. The energy expenditures were similar between both types of therapists and this may be reflective of the gender and bodyweight differences between the groups that equalizes the energy expenditures. The findings of this study suggests that there are differences in the physical activity demands between inpatient and outpatient physical therapists. The results of this study may serve dual purposes: (1) employers may be able to more accurately describe the expected physical activity demands to future employees; (2) individuals tasked with preparing PTs to physically manage their work environment can outline training programs that are diverse based on the specific work environment of PTs.