A novel clinical approach for assessing hop landing strategies: a 2D telescopic inverted pendulum (TIP) model.

PURPOSE: Single leg hop for distance is used to inform rehabilitation and return to sport following anterior cruciate ligament reconstruction. However, impairment of landing mechanics may persist after the recommended performance parameter (hop distance) has been met; therefore, alternative methods are required. This study follows the COSMIN guideline to investigate the measurement properties of data from a new instrument (2D TIP). This is a simple motion analysis instrument to assess landing strategy based on more complex biomechanical modelling. METHODS: Data collected in the clinical setting from 30 subjects with chronic ACL deficiency (mean 15.5, SD 4.3 months following injury) before and 6 months after ACL reconstruction and a healthy control group were analysed. Reliability and measurement error were calculated using two repeated measures from three independent raters. Construct validity was assessed by hypothesis testing, and known groups validity and responsiveness were defined by differences between groups. RESULTS: The data demonstrate excellent inter-rater (ICC = 0.81-1.00) and intra-rater (ICC = 0.85-1.00) reliability with low measurement error. Of the eight construct validity hypothesis, six were fully and two partially supported. Between-group differences were significant (P < 0.05) supporting the validity and responsiveness hypothesis. CONCLUSION: 2D TIP is a simple and inexpensive instrument for assessing landing strategy that has demonstrated appropriate reliability, validity and responsiveness in the ACL-injured population. The instrument will now be used to identify altered movement strategies and develop novel rehabilitation interventions that target strategy and performance. LEVEL OF EVIDENCE: Prospective diagnostic study, Level II.

Assessing participation in the ACL injured population: Selecting a patient reported outcome measure on the basis of measurement properties.

BACKGROUND/AIM: A return to pre injury activity participation remains a common but often elusive goal following ACL injury. Investigations to improve our understanding of participation restrictions are limited by inconsistent use of insufficiently investigated measurement tools. The aim of this study was to follow the consensus based standards for the selection of health measurement instruments (COSMIN) guideline to provide a comparative evaluation of four patient reported outcomes (PROMs) on the basis of measurement properties. This will inform recommendations for measuring participation of ACL injured subjects, particularly in the United Kingdom (UK) National Health Service (NHS). METHODS: Thirteen criteria were compiled from the COSMIN guideline. These included reliability, measurement error, content validity, construct validity, responsiveness and interpretability. Data from 51 subjects collected as part of a longitudinal observational study of recovery over the first year following ACLR was used in the analysis. RESULTS: Of the thirteen criteria, the required standard was met in 11 for Tegner, 11 for International Knee Documentation Committee (IKDC), 6 for Cincinnati Sports Activity Scale (CSAS) and 6 for Marx. The two weaknesses identified for the Tegner are more easily compensated for during interpretation than those in the IKDC; for this reason the Tegner is the recommended PROM. CONCLUSIONS: The Tegner activity rating scale performed consistently well in respect of all measurement properties in this sample, with clear benefits over the other PROMs. The measurement properties presented should be used to inform implementation and interpretation of this outcome measure in clinical practice and research. LEVEL OF EVIDENCE: Level II prospective study.

Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model.

BACKGROUND: Physiotherapy is a complex intervention frequently recommended for knee conditions. The International Classification of Functioning and Disability (ICF) can be used as a framework to evaluate evidence to develop care models and clinical guidelines. OBJECTIVE: To evaluate the clinical effectiveness of knee rehabilitation modalities categorised according to the ICF domains. DATA SOURCES: A keyword search of Medline, Cinahl, Amed, Embase and Cochrane databases from 1996 to 2010 using terms related to the knee joint and physiotherapeutic interventions. STUDY SELECTION: Reviewer assessment using inclusion/exclusion criteria and a quality assessment tool compiled from the Critical Appraisal Skills Programme Tool, Consort and Cochrane Bone Joint and Muscle Trauma Groups. DATA EXTRACTION: Information about the research design, intervention and subjects was extracted. Outcome measures and findings were categorised according to ICF domains. DATA SYNTHESIS: The majority of studies evaluated exercise. Findings were supportive but specific recommendations were limited due to variations in content and application. There was limited quality research to support the theory that manual therapy, electrotherapy or taping in isolation contributes to recovery. Multimodality physiotherapy programmes were found to be beneficial and to reflect clinical practice, but the effectiveness of each component is unknown. Outcome measures from the participation domain of the ICF were used least frequently and were not generally true measures of participation. CONCLUSION: Development of participation outcome measures is required to evaluate the long-term benefits of interventions. Rehabilitation should be based around delivery of effective exercise programmes incorporating participation outcomes to provide feedback and complement self-care for knee conditions.