STUDY DESIGN: Reliability study. OBJECTIVES: To determine intrarater test-retest and interrater reliability of the Functional Movement Screen (FMS) among novice raters. BACKGROUND: The FMS is used by various examiners to assess movement and predict time loss injuries in diverse populations (eg, youth to professional athletes, firefighters, military service members) of active participants. Unfortunately, critical analysis of the reliability of the FMS is currently limited to 1 sample of active college age participants. METHODS: Sixty-four active duty service members (mean ± SD age and body mass index: 25.2 ± 3.8 years, 25.1 ± 3.1 kg/m²) without a history of injury were enrolled. Participants completed the 7 component tests of the FMS in a counterbalanced order. Each component test was scored on an ordinal scale (0 to 3 points) resulting in a composite score from 0 to 21 points. Intrarater test-retest reliability was assessed between baseline scores and those obtained with repeated testing performed 48 to 72 hours later. Interrater reliability was assessed based on the assessment from 2 raters, selected from a pool of 8 novice raters, which assessed the same movements on day 2 simultaneously. Descriptive statistics, weighted Kappa (k_w), and percent agreement were calculated on component scores. Intraclass correlation coefficients (ICC), standard error of the measurements (SEM), minimal detectable chance (MDC₉₅), and associated 95% confidence intervals were calculated on composite scores. RESULTS: The average ± SD score on the FMS was 15.7 ± 0.2 points with 15.6% (n=10) of the participants scoring less than or equal to 14 points, the recommended cutoff for predicting time-loss injuries. The intrarater test-retest and interrater reliability of the FMS composite score resulted in an ICC_3,1  of 0.76 (95% CI: 0.63-0.85) and an ICC_2,1 of 0.74 (95% CI: 0.60-0.83) respectively. The SEM of the composite test was within 1 point and the MDC₉₅ was 2.1 and 2.5 points on the 21 point scale for inter- and intrarater reliability, respectively. The interrater agreement of the component scores ranged from moderate to excellent (k_w: 0.45 to 0.82). CONCLUSIONS: Among novice raters, the FMS composite score demonstrated moderate to good interrater and intrarater reliability with acceptable levels of measurement error. The measures of reliability and measurement error were similar for both intrarater reliability that repeated the assessment of the movement patterns over a 48 to 72 hour period and interrater reliability that had 2 raters assess the same movement pattern simultaneously.  The interrater agreement of the FMS component scores were good to excellent for the pushup, quadruped, shoulder mobility, straight leg raise, squat, hurdle, and lunge. Only 15.6% (n=10) of the participants were identified at-risk for injury based on previously published cut-off values.

J Orthop Sports Phys Ther, Epub 14 May 2012. doi:10.2519/jospt.2012.3838

KEY WORDS: injury prediction, injury prevention, injury risk, interrater, intrarater

STUDY DESIGN: Crossover. OBJECTIVES: To compare the time required to decrease intramuscular temperature 8°C below baseline temperature, and compare intramuscular temperature 90 minutes post-treatment between two cryotherapy modalities. BACKGROUND: Cryotherapy is used to treat pain from muscle injuries.  Cooler intramuscular temperatures may reduce cellular metabolism and secondary hypoxic injury to attenuate acute injury response, specifically the rate of chemical mediator activity.  Modalities that decrease intramuscular temperature quickly may be beneficial in the treatment of muscle injuries. METHODS: 18 healthy subjects received 2 cryotherapy conditions: crushed ice bag (CIB) and cold water immersion (CWI) in a randomly allocated order separated by 72 hours, applied until intramuscular temperature decreased 8°C below baseline.  Intramuscular temperature was monitored in the gastrocnemius 1cm below subcutaneous adipose tissue.  The primary outcome was time to decrease intramuscular temperature 8°C below baseline. A secondary outcome was intramuscular temperature at the end of a 90 minute rewarming period.  Paired t-tests were used to examine outcomes. RESULTS: Time to reach an 8°C reduction in intramuscular temperature was not significantly different between CIB and CWI (mean difference (95% CI) = 2.6 minutes (-3.10, 8.30)).  Intramuscular temperature remained significantly colder 90 minutes post-cold water immersion compared to crushed ice bag (mean difference (95% CI) = 2.8°C (2.07, 3.52)). CONCLUSION: There was no difference in time required to reduce intramuscular temperature 8°C 1cm below adipose tissue using CIB and CWI.  However, intramuscular temperature remained significantly colder 90 minutes following CWI.  These results provide clinicians with information that may guide treatment modality decisions.

J Orthop Sports Phys Ther, Epub 23 March 2012. doi:10.2519/jospt.2012.4200

KEY WORDS: adipose tissue, cold water immersion, ice bag

STUDY DESIGN: Prospective Cohort OBJECTIVES: To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition. BACKGROUND: Neurocognitive testing, balance assessments, and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected. Previous literature suggests many concussions go unreported.  Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider. METHODS: Forty-five Division IA Collegiate football players participated in this study.  Preseason baseline scores using the Balance Error Scoring System (BESS), the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), and the Post Concussion Symptom Score were compared to  posttest results obtained 48 hours following a game.  Prevalence of symptoms were analyzed and reported. RESULTS: Thirty-Two of the 45 (71%) athletes tested demonstrated at least one deficit in either the Post Concussion Symptom Score, BESS, or at least one composite score of the ImPACT.   Nineteen of the 32 subjects demonstrated a change in two or more categories of neurocognitive and balance function. CONCLUSION: In a cohort of subjects who were tested 48 hours following the last game of the season and did not seek medical attention related to a concussion, a significant number of football players demonstrated limitations in neurocognitive and balance performance suggesting further research needs to be performed to improve recognition of an athlete's deficits and improve the ability to assess concussion. LEVEL OF EVIDENCE: Therapy, level 2b.

J Orthop Sports Phys Ther, Epub 24 April 2012. doi:10.2519/jospt.2012.3798

KEY WORDS: BESS, ImPACT, test battery, traumatic brain injury

STUDY DESIGN: Retrospective longitudinal cohort. OBJECTIVES: To describe the clinical characteristics of patients with low back pain (LBP) according to physician referral source, and to identify associations between referral source and discharge functional status as well as number of physical therapy (PT) visits. BACKGROUND: Little is known about associations between physician referral source and outcomes of PT care for patients with LBP. Exploring these associations can contribute to better understanding of physician-PT relationships and may lead to improved referral patterns. METHODS: Data from a proprietary clinical database was examined retrospectively. Physician referral source was classified as primary care, specialist, or occupational medicine. Outcomes were overall health status (OHS) at discharge and number of PT visits. Descriptive statistics and bivariate associations between referral source and each outcome were assessed by calculating differences and 95% confidence intervals in means and proportions. In order to account for potential confounding, multi-level linear regression was used to adjust for baseline clinical covariates, and for effects related to clustering of patients treated by individual clinicians, and of clinicians working within individual clinics. RESULTS: Bivariate and multi-level analyses revealed significant associations between referral source and OHS and visits. Compared to specialist physician referral, referral from occupational medicine and primary care physicians was associated with higher discharge OHS scores and lower number of visits. CONCLUSIONS: After accounting for important clinical covariates and clustering, patients with LBP who were referred by occupational medicine and primary care physicians tended to have better functional outcomes and required fewer PT visits per episode of care. LEVEL OF EVIDENCE: Prognosis, level 2c.

J Orthop Sports Phys Ther, Epub 8 March 2012. doi:10.2519/jospt.2012.3957

KEY WORDS: lumbar spine, physician referral, practice-based evidence

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To determine if there is any sex difference in trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single leg squat in individuals with patellofemoral pain syndrome (PFPS) and controls. BACKGROUND: Although of greater incidence in females, PFPS is also quite common in males. Trunk kinematics have the potential to affect hip and knee function, however there is a lack of studies considering the influence of the trunk in individuals with PFPS. METHODS: Eighty subjects were distributed into 4 groups: females with PFPS, female controls, males with PFPS, and male controls. Trunk, pelvis, hip, and knee kinematics and gluteal muscle activation were evaluated during a single leg squat. Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer.  Group differences were assessed using 2-way MANOVA (sex x group). RESULTS: Compared to controls, subjects with PFPS had greater ipsilateral trunk lean (mean ±, SD, 9.3˚ ± 5.3˚ versus 6.7˚ ± 3.0˚, P=.012), contralateral pelvic drop (10.3˚ ± 4.7˚ versus 7.4˚ ± 3.8˚, P=.003), hip adduction (14.8˚ ± 7.8˚ versus 10.8˚ ± 5.6˚, P<.0001), and knee abduction (9.2˚ ± 5.0˚ versus 5.8˚ ± 3.4˚, P<.0001) when performing a single leg squat. Subjects with PFPS also had 18% less hip abduction and 17% less hip external rotation strength. Compared to the female controls, the females with PFPS had more hip internal rotation (P<.05) and less muscle activation of the gluteus medius (P=.017) during the single leg squat. CONCLUSION: Therefore, despite many similarities in findings for males and females with PFPS, there are some specific sex differences that may warrant consideration in future studies and clinically when evaluating and treating females with PFPS.

J Orthop Sports Phys Ther, Epub 8 March 2012. doi:10.2519/jospt.2012.3987

KEY WORDS: anterior knee pain, biomechanics, electromyography, patella