Estimating measurement equivalence of the 12-item General Health Questionnaire across ethnic groups in the UK.

BACKGROUND: This study investigates the extent to which the GHQ-12 exhibits configural, metric and scalar invariance across six ethnic groups in Britain and Northern Ireland, using the UK Household Longitudinal Study (N = 35 410). METHODS: A confirmatory factor analysis was carried out on a white British group in order to establish an adequate measurement model. Secondly, a multi-group confirmatory factor analysis was conducted in order to assess measurement invariance. A sensitivity analysis comparing summated and latent means across groups was carried out. Finally, revised estimates of scale reliability were derived using two different methods. RESULTS: A one-factor model including correlated error terms on the negatively phrased items showed superior fit in all ethnic groups. Tests for equal factor loadings and intercepts also showed adequate fit demonstrating metric and scalar invariance. Latent and summated scale estimates of mean group differences were similar for all groups. Scale reliability using McDonald's ω is lower than when using the more conventional Cronbach's α. Reliability across groups is reasonably consistent. CONCLUSIONS: We find that the GHQ-12 does not display obvious bias in regard to ethnic groups in the UK and that valid comparisons across these groups can be made for the purposes of population research. Caution is needed when using as a screening tool for individuals.

Use of Cine Loops and Structural Landmarks in Ultrasound Image Processing Improves Reliability and Reduces Error in the Assessment of Foot and Leg Muscles.

OBJECTIVES: Foot and leg muscle strength and size are crucial to proper function. It is important to assess these characteristics reliably. Our primary objective was to compare the measurement of still images to cine loops. The secondary purpose was to determine interoperator and intraoperator reliability between operators of different experience levels using video clips and internal and external landmarks. METHODS: Twelve healthy volunteers participated in our study. Internal (navicular tuberosity) and external (lateral leg length at 30% and 50% from the knee joint line) landmarks were used. Two operators each captured and later measured still and cine loop images of selected foot and leg muscles. RESULTS: The 12 participants included 8 male and 4 female volunteers (mean age ± SD, 23.5 ± 1.9 years). Good to excellent intraoperator and interoperator reliability was seen (intraclass correlation coefficient range of 0.946-0.998). The use of cine loops improved the intraclass correlation coefficients for both intraoperator and interoperator reliability (0.5%-4% increases). The use of cine loops decreased the intraoperator standard error of the measurement and limits of agreement of the novice operator (decreases of 45%-73% and 24%-51%, respectively), and these became comparable to those of experienced operators using still images. The interoperator standard errors of the measurement dropped by 42% to 53%, whereas the limits of agreement dropped by 27% to 40%. No substantial changes were noted in the tibialis anterior across reliability metrics. CONCLUSIONS: Improved protocols that take advantage of using internal bony landmarks and cine loops during both the image-gathering and measurement processes improve the reliability of research examining muscle size changes in the lower leg or foot associated with muscle changes due to exercise, injury, disuse, or disease.

The effects of cryotherapy on quadriceps electromyographic activity and isometric strength in patient in the early phases following knee surgery.

PURPOSE: To determine the effects of cryotherapy on quadriceps electromyographic (EMG) activity and isometric strength in early postoperative knee surgery patients. METHODS: Twenty-two volunteers with recent knee surgeries were included. EMG readings of the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) from the surgical leg were collected during a maximal voluntary quadriceps setting (QS) activity. Maximum isometric knee extension force measurements were also recorded. Subjects were randomly assigned to receive an ice bag or a sham room-temperature bag to the front of their postsurgical knee for 20 min. After treatment, the subjects repeated the above mentioned maximum QS and isometric knee extension force measurements. The subjects returned 24 h later to conduct the same test protocol but received the treatment (ice or sham) not applied during their first test session. RESULTS: A 38% increase in VM EMG activity during QS and a 30% increase in maximum isometric knee extension strength were found after cryotherapy treatment. No significant differences were found in RF or VL EMG activity during QS after cryotherapy. No significant differences were found in any measurements after the sham treatment. CONCLUSION: Clinicians should consider applying ice to knee joints prior to exercise for patients following knee surgery with inhibited quadriceps.

The Construction of Sham Dry Needles and Their Validity.

Appropriate control interventions are necessary to show the treatment effect of dry needling. Different control procedures, such as dry needling of the contralateral side, and sham treatments, such as random and superficial needle insertion, have been utilized in trials. However, those methods might elicit a physiological response and are subsequently not ideal for use as a control. This descriptive study illustrates the construction of low-cost sham dry needles and evaluates their validity. Forty-two healthy asymptomatic subjects received either sham or real dry needling intervention to their right gluteal muscles and reported if they felt that the needle pierced the skin. They also graded the severity and qualified (sharp or dull) the pain associated with the intervention. The results showed that most of the subjects in both groups believed the needle penetrated the skin. The quantity of pain associated with the treatment was similar in both groups, but the quality assigned was different. The authors conclude that sham dry needling can be accomplished and used as a valid control treatment in dry needling research using these low-cost sham needles.

Religion and the public ethics of stem-cell research: Attitudes in Europe, Canada and the United States.

We examine international public opinion towards stem-cell research during the period when the issue was at its most contentious. We draw upon representative sample surveys in Europe and North America, fielded in 2005 and find that the majority of people in Europe, Canada and the United States supported stem-cell research, providing it was tightly regulated, but that there were key differences between the geographical regions in the relative importance of different types of ethical position. In the U.S., moral acceptability was more influential as a driver of support for stem-cell research; in Europe the perceived benefit to society carried more weight; and in Canada the two were almost equally important. We also find that public opinion on stem-cell research was more strongly associated with religious convictions in the U.S. than in Canada and Europe, although many strongly religious citizens in all regions approved of stem-cell research. We conclude that if anything public opinion or 'public ethics' are likely to play an increasingly important role in framing policy and regulatory regimes for sensitive technologies in the future.

Shoulder injuries in rugby players: mechanisms, examination, and rehabilitation.

BACKGROUND: The sport of rugby is growing in popularity for players at the high school and collegiate levels. OBJECTIVE: This article will provided the sports therapist with an introduction to the management of shoulder injuries in rugby players. SUMMARY: Rugby matches results in frequent impacts and leveraging forces to the shoulder region during the tackling, scrums, rucks and maul components of the game. Rugby players frequently sustain contusion and impact injuries to the shoulder region, including injuries to the sternoclavicular, acromioclavicular (AC), and glenohumeral (GH) joints. Players assessed during practices and matches should be screened for signs of fracture, cervical spine and brachial plexus injuries. A three phase program will be proposed to rehabilitate players with shoulder instabilities using rugby specific stabilization, proprioception, and strengthening exercises. A plan for return to play will be addressed including position-specific activities.

Religious beliefs, knowledge about science and attitudes towards medical genetics.

The use of genetics in medical research is one of the most important avenues currently being explored to enhance human health. For some, the idea that we can intervene in the mechanisms of human existence at such a fundamental level can be at minimum worrying and at most repugnant. In particular, religious doctrines are likely to collide with the rapidly advancing capability for science to make such interventions. The key ingredient for acceptance of genetics, on the other hand, is prototypically assumed to be scientific literacy - familiarity and understanding of the critical facts and methods of science. However, this binary opposition between science and religion runs counter to what is often found in practice. In this paper, we examine the association between religiosity, science knowledge and attitudes to medical genetics amongst the British public. In particular, we test the hypothesis that religion acts as a 'perceptual filter' through which citizens acquire and use scientific knowledge in the formation of attitudes towards medical genetics in various ways.

Construct validity of Comprehensive High-Level Activity Mobility Predictor (CHAMP) for male servicemembers with traumatic lower-limb loss.

This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP) as a measure of high-level mobility in servicemembers (SMs) with traumatic lower-limb loss (LLL). The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT) as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP) as a measure of basic prosthetic mobility. The known group methods construct validity examined disparities in high-level mobility capability among SMs with different levels of LLL. The CHAMP score demonstrated a strong positive relationship between 6MWT distance (r = 0.80, p < 0.001) and AMP score (r = 0.87, p < 0.001), respectively. In addition, the CHAMP can discriminate between different levels of LLL. Study findings support the CHAMP as a valid performance-based assessment instrument of high-level mobility for SMs with traumatic LLL.

Comparison of 6-minute walk test performance between male Active Duty soldiers and servicemembers with and without traumatic lower-limb loss.

The rehabilitation of U.S. military servicemembers (SMs) who have sustained a traumatic loss of one or both lower limbs requires outcome measures that can assess their physical capabilities in comparison with their uninjured colleagues. Describing reference ranges for the 6-minute walk test (6MWT) in both populations will help clinicians develop appropriate goals for rehabilitation and document progress toward those goals. A convenience sample of 118 male U.S. SMs with and 97 without traumatic lower-limb loss participated in this study. All participants completed a 6MWT, and comparisons were made between SMs with and without limb loss and among the levels of limb loss. The SMs without lower-limb loss performed significantly better than all SMs with lower-limb loss. The SMs with transtibial limb loss performed significantly better than those with all other levels of limb loss. Statistically significant and clinically relevant differences were also noted between the other levels of limb loss. No differences were found between different prosthetic components. Reference ranges were established for U.S. SMs with and without various levels of limb loss, and the 6MWT was able to identify functional differences between groups.

Exploring public discourses about emerging technologies through statistical clustering of open-ended survey questions.

The primary method by which social scientists describe public opinion about science and technology is to present frequencies from fixed response survey questions and to use multivariate statistical models to predict where different groups stand with regard to perceptions of risk and benefit. Such an approach requires measures of individual preference which can be aligned numerically in an ordinal or, preferably, a continuous manner along an underlying evaluative dimension - generally the standard 5- or 7-point attitude question. The key concern motivating the present paper is that, due to the low salience and "difficult" nature of science for members of the general public, it may not be sensible to require respondents to choose from amongst a small and predefined set of evaluative response categories. Here, we pursue a different methodological approach: the analysis of textual responses to "open-ended" questions, in which respondents are asked to state, in their own words, what they understand by the term "DNA." To this textual data we apply the statistical clustering procedures encoded in the Alceste software package to detect and classify underlying discourse and narrative structures. We then examine the extent to which the classifications, thus derived, can aid our understanding of how the public develop and use "everyday" images of, and talk about, biomedicine to structure their evaluations of emerging technologies.

Incommensurable worldviews? Is public use of complementary and alternative medicines incompatible with support for science and conventional medicine?

Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, 'conventional' medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research.

Understanding support for complementary and alternative medicine in general populations: use and perceived efficacy.

Proponents of complementary and alternative medicine argue that these treatments can be used with great effect in addition to, and sometimes instead of, conventional medicine, a position which has drawn sustained opposition from those who advocate an evidence-based approach to the evaluation of treatment efficacy. Using recent survey data from the United Kingdom, this article seeks to establish a clearer understanding of the nature of the public's relationship with complementary and alternative medicine within the general population by focusing on beliefs about the perceived effectiveness of homeopathy, in addition to its reported use. Using recent data from the United Kingdom, we initially demonstrate that reported use and perceived effectiveness are far from coterminous and argue that for a proper understanding of the motivations underpinning public support of complementary and alternative medicine, consideration of both reported use and perceived effectiveness is necessary. We go on to demonstrate that although the profile of homeopathy users differs from those who support this form of medicine, neither outcome is dependent upon peoples' levels of knowledge about science. Instead, the results suggest a far greater explanatory role for need and concerns about conventional medicine.

Association of generalized joint hypermobility with a history of glenohumeral joint instability.

CONTEXT: Little is known about the relationship among sex, generalized joint hypermobility, and glenohumeral joint instability. OBJECTIVE: To examine the relationship among sex, generalized joint hypermobility scores, and a history of glenohumeral joint instability within a young, physically active cohort and to describe the incidence of generalized joint hypermobility within this population. DESIGN: Cross-sectional cohort study. SETTING: United States Military Academy at West Point, New York. PATIENTS OR OTHER PARTICIPANTS: Of the 1311 members of the entering freshman class of 2010, 1050 (80%) agreed to participate. MAIN OUTCOME MEASURE(S): Generalized joint hypermobility was assessed using the Beighton Scale. A history of glenohumeral joint instability was identified via a baseline questionnaire. RESULTS: Most participants (78%) had no signs of generalized joint hypermobility. Only 11 volunteers (1.5%) had Beighton Scale scores of 4 or greater. Logistic regression analysis revealed a relationship between generalized joint hypermobility and a history of glenohumeral joint instability (P = .023). When sex and race were controlled, those with a total Beighton Scale score of >or=2 were nearly 2.5 times as likely (odds ratio = 2.48, 95% confidence interval = 1.19, 5.20, P = .016) to have reported a history of glenohumeral joint instability. A relationship was observed between sex and nearly all individual Beighton Scale items. Although women had higher total Beighton Scale scores than men, sex (P = .658) and race (P = .410) were not related to a history of glenohumeral joint instability when other variables in the model were controlled. CONCLUSIONS: In these participants, generalized joint hypermobility and a history of glenohumeral joint instability were associated.

Patellar tendon versus hamstring tendon autografts for anterior cruciate ligament reconstruction: a randomized controlled trial using similar femoral and tibial fixation methods.

BACKGROUND: Controversy remains over the most appropriate graft for anterior cruciate ligament reconstruction. HYPOTHESIS: There is no significant difference in outcomes after 4-strand hamstring and patellar tendon autograft anterior cruciate ligament reconstructions using similar fixation techniques. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Between August 2000 and May 2003, 64 Keller Army Hospital patients with complete anterior cruciate ligament tears were randomized to hamstring (n = 32) or patellar tendon (n = 32) autograft anterior cruciate ligament reconstruction. Operative graft fixation and rehabilitative techniques were the same for both groups. Follow-up assessments included the Single Assessment Numeric Evaluation score, Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score. Postoperative radiographs were analyzed for tunnel location and orientation. RESULTS: Eleven women and 53 men were randomized. Eighty-three percent of the patients (53 of 64) had follow-up of greater than 2 years, or to the point of graft rupture or removal (average follow-up, 36 months). Four hamstring grafts (12.5%) and three patellar tendon grafts (9.4%) (P = .71) ruptured. One deep infection in a hamstring graft patient necessitated graft removal. Forty-five of the 56 patients with intact grafts had greater than 2-year follow-up. Patients with patellar tendon grafts had greater Tegner activity scores (P = .04). Single Assessment Numeric Evaluation scores were 88.5 (95% confidence interval: 83.1, 93.8) and 90.1 (95% confidence interval: 85.2, 96.1) for the hamstring and patellar tendon groups, respectively (P = .53). Lysholm scores were 90.3 (95% confidence interval: 84.4, 96.1) and 90.4 (95% confidence interval: 84.5, 96.3) for the hamstring and patellar tendon groups, respectively (P = .97). There were no significant differences in knee laxity, kneeling pain, isokinetic peak torque, International Knee Documentation Committee score, or Knee Injury and Osteoarthritis Outcome Scores. Postoperative graft rupture correlated with more horizontal tibial tunnel orientation. CONCLUSION: Hamstring and patellar tendon autografts provide similar objective, subjective, and functional outcomes when assessed at least 2 years after anterior cruciate ligament reconstruction.

The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.

STUDY DESIGN: Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. OBJECTIVES: To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. BACKGROUND: Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. METHODS AND MEASURES: Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. RESULTS: The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9 degrees +/- 23.2 degrees ; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. CONCLUSION: KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported. LEVEL OF EVIDENCE: Therapy, level 1b-.

Comparison of a lateral hop test versus a forward hop test for functional evaluation of lateral ankle sprains.

The purposes of this study were to determine whether a lateral hop test was a more sensitive functional test over time than a forward hop test in assessing lateral ankle sprains, and whether lateral hop performance can predict a subjective score from an ankle rating scale. At the United States Military Academy, cadets presenting with ankle sprains during an 8-month period were included in this observational study. Patients were asked to perform a lateral hop for distance and a forward hop for distance on both the injured and uninjured lower extremities. The order of testing was randomized. After the hop trials, individuals completed a subjective questionnaire designed to assess functional ankle health. The lateral hop and subjective scores are components of the Sports Ankle Rating System. Patients were evaluated at the day of consent and at 1 week, 3 weeks, and 6 weeks. There were 29 patients, ages 18 to 22 years; 8 were women and 21 were men. A multivariable regression of analysis was performed to determine which subjective factors best predict the individual's subjective score. Although both the lateral and forward hop were statistically significant factors, neither was determined to be better than the other.

Insidious onset of shoulder girdle weakness.

STUDY DESIGN: Resident's case problem. BACKGROUND: An 18-year-old man presented to physical therapy 3 days after insidious onset of painless left shoulder girdle weakness. DIAGNOSIS: Decreased light touch sensation was noted on the lateral left shoulder. In addition, weakness was present with shoulder abduction, flexion, external rotation, and internal rotation. Results of magnetic resonance imaging and radiography of the cervical spine, brachial plexus, and left shoulder were normal, Electromyography and nerve conduction velocity study findings were consistent with axillary nerve palsy. The results of the physical examination and diagnostic studies were most consistent with axillary nerve mononeuropathy, probably caused by traction or pressure due to wearing a pack while hiking or firing a weapon. DISCUSSION: With sling protection, limitation of physical activity, and gradual return to progressive resistance exercises, the patient had full return of strength and function 2 1/2 months after onset of symptoms. The differential diagnosis for shoulder girdle weakness should be well understood by physical therapists. This knowledge will help the therapist promptly identify the cause of shoulder girdle weakness and initiate appropriate treatment. If the condition requires further evaluation or treatment by another healthcare provider, prompt identification of pathology will allow appropriate timely referral.

Deep vein thrombosis in an athletic military cadet.

STUDY DESIGN: Resident's case problem. BACKGROUND: A 21-year-old healthy athletic male military cadet with complaint of worsening diffuse left knee pain was evaluated 4 days after onset. The knee pain began 2 hours after completing a long car trip, worsened over the subsequent 3 days, and became almost unbearable during the return trip. The patient reported constant pain, limited knee motion, and difficulty ambulating. In addition, he was unable to perform physical military training or attend academic classes due to the severe left knee pain. Past medical history revealed a mild left lateral calf strain 21/2 weeks prior, which completely resolved within 24 hours of onset. DIAGNOSIS: Our physical examination led us to either monoarticular arthritis, pseudothrombophlebitis (ruptured Baker's cyst), or a lower leg deep vein thrombosis (DVT) as the cause of knee pain. Diagnostic imaging of this patient revealed a left superficial femoral vein thrombosis and popliteal DVT, with bilateral pulmonary emboli (PE). DISCUSSION: A systematic differential diagnosis was undertaken to rule out a potentially fatal DVT diagnosis as the cause of knee pain, despite minimal DVT risk factors. The physical therapist in a direct-access setting must ensure timely evaluation and referral of a suspected DVT, even when patient demographics cause the practitioner to question the likelihood of this diagnosis. The physical examination findings, clinical suspicion, and established clinical prediction rules can accurately dictate the appropriate referral action necessary.