Journal of Orthopaedic & Sports Physical Therapy - Cheryl M. Petersen, PT, MS

Effects of Pelvic and Lower Extremity Stabilization on Isometric Trunk Extension and Flexion Muscle Strength*

Cheryl M. Petersen, Louis R. Amundsen, Michael J. Schendel
The purpose of this study was to evaluate the effect of varying the type of pelvic and lower extremity stabilization on isometric trunk extension and flexion muscle strength measurements. Two pelvic stabilization systems, one consisting of fixation of the anterior superior iliac spines and sacrum (pelvic fixation) and the second, a strap across the anterior superior iliac spines and a posterior pad at the sacrum (pelvic strap) were compared. The lower extremities were or were not strapped at the thigh, calf, and feet. Torque values for the pelvic fixation system were not different from the pelvic strap system with lower extremity stabilization. Torque values were less with no lower extremity stabilization with both pelvic stabilization systems for flexion but not for extension muscle contractions. The use of an extensive pelvic stabilization system did not produce greater isometric force output than the use of a simple pelvic strap. The use of lower extremity stabilization did produce greater isometric flexion force output than the use of no lower extremity stabilization.

J Ortho Sports Phys Ther 1987;9(3):111-117.

Reliability of Classifications Derived From Cyriax’s Resisted Testing in Subjects With Painful Shoulders and Knees

Karen W. Hayes, Cheryl M. Petersen
Study Design: Intrarater and interrater reliability. Objectives: Examine intrarater and interrater reliability of the resisted-testing component of Cyriax’s selective tension testing for patients with painful shoulders and knees. Background: Clinicians make diagnostic and intervention decisions about lesions in contractile tissues based on resisted testing. Diagnostic and intervention decisions require reliable data gathering, especially when more than 1 physical therapist manages a patient. No studies have examined agreement of the results of the resisted tests used in selective tension testing, either within or between physical therapists, in subjects having pathology. Methods and Measures: Subjects with pain in 1 knee (18 male, 22 female; mean age ± SD = 31.8 ± 9.5 years) or shoulder (21 male, 25 female; mean age ± SD = 34.3 ± 12.9 years) were examined twice. Referring diagnoses included ligament injuries, overuse syndromes, joint instability, and postsurgical symptoms, with some subjects seeking initial diagnosis. Two physical therapists used standardized positions to evaluate 2 knee motions or 6 shoulder and elbow motions. Evaluators applied maximal isometric manual resistance and rated the contraction as strong or weak while subjects identified the presence or absence of pain during the contraction. Evaluators did not interview the subjects and were masked to previous test results. Analyses included percentage of agreement, kappa coefficients, confidence intervals, and maximum kappa coefficients. Results: Intrarater kappa coefficients ranged from 0.44 to 0.82 and interrater coefficients ranged from 0.00 to 0.46. The small number of subjects who were classified as weak affected the kappa coefficients. In the intrarater condition, evaluators averaged 91% of maximum kappa for the knee and 66.5% for the shoulder. In the interrater condition, they averaged 60.4% of the maximum kappa for both the knee and the shoulder. Conclusions: Based on 2 physical therapist evaluators with previous education in the selective tension system and an additional 6 hours of formal training on the methods, intrarater reliability of resisted tests was generally acceptable for the knee but not for the shoulder. Interrater reliability of these tests, however, was generally not acceptable. Results were limited by subjects who were younger and had mostly chronic conditions that were mildly to moderately severe and by the small subject samples in the analyses. Reliability might be improved by more intensive training of the evaluators and by standardizing the magnitude of the applied resistance and stabilization of the subjects.

J Orthop Phys Sports Ther. 2003;33(5):235-246.

Key Words: orthopedics, physical therapy, tests and measurements

Reliability of Assessing End-Feel and Pain and Resistance Sequence in Subjects With Painful Shoulders and Knees

Karen W. Hayes, Cheryl M. Petersen

Study Design: Descriptive. Objectives: Examine the intrarater and interrater reliability of end-feel and pain/resistance sequence for patients with painful shoulders and knees. Background: Clinicians make diagnostic and intervention decisions based on end-feel and pain/resistance sequence, but few studies have examined agreement within and between physical therapists when assessing subjects with pathology. Methods and Measures: Subjects with unilateral knee pain (18 men and 22 women with a mean age of 31.8 ± 9.5 years) or shoulder pain (21 men and 25 women with a mean age of 34.3 ± 12.9 years) were examined twice. Two physical therapists used standardized positions to evaluate 2 knee motions and 5 shoulder motions. Evaluators did not interview subjects and were blinded to previous test results. Evaluators applied overpressure and noted the end-feel while subjects identified the moment their pain was reproduced. Following testing, subjects rated their pain intensity. Analyses included: percentage of agreement; kappa, weighted kappa, and maximum kappa coefficients; and confidence intervals. Analyses were repeated for subjects whose pain intensity during testing did not change between examinations. Results: lntrarater kappa coefficients varied from 0.65 to 1.00 for end-feel, and intrarater weighted kappa coefficients varied from 0.59 to 0.87 for pain/resistance sequence. Most coefficients remained stable or improved for the unchanged subjects. lnterrater kappa coefficients for end-feel and weighted kappa coefficients for pain/resistance sequence varied from -0.01 to 0.70. End-feel kappa coefficients remained low for the unchanged subjects, but pain/resistance sequence weighted kappa coefficients improved. Unbalanced distribution affected many coefficients, producing low coefficients even when the percentage of agreement was high. Conclusions: The appropriate use of end-feel and pain/resistance sequence data requires reliable data gathering, especially when patients are managed by more than one physical therapist. lntrarater reliability of end-feel and pain/resistance judgments at the knee and shoulder were generally good, especially after accounting for subject change and unbalanced distributions. lnterrater reliability, however, was generally not acceptable, even after accounting for these factors.

J Orthop Sports Phys Ther. 2OO1;31(8):432-445.

Key Words: intrarater and interrater reliability, passive motion testing, selective tension testing

The Effect of a Soft Collar, Used as Normally Recommended or Reversed, on Three Planes of Cervical Range of Motion

Virginia M. Carter, Jo Ann M. Fasen, Juan M. Roman, Karen W. Hayes, Cheryl M. Petersen

Clinicians recommend soft cervical collars to immobilize the cervical spine following trauma. They apply them either as intended by the manufacturer or reversed (collar rotated 180°), purportedly to achieve limitation in a specific direction. This study investigated the effectiveness of soft cervical collars in limiting cervical range of motion when worn as recommended or reversed. All planes of cervical range of motion of 50 volunteer subjects without current or past cervical dysfunction were measured under 3 conditions (no collar, recommended use, and reversed) using the Orthopedic Systems Inc. Computerized Anatometry-6000 Spine Motion Analyzer. The instrument has been previously shown to produce measures with high reliability and to correlate strongly with known angular measures. Within subjects analyses of variance indicated significant differences in all 6 ranges of motions among the 3 conditions. Post hoc paired t tests showed that wearing a collar, either as recommended or reversed, decreased motion compared with not wearing a collar, and that the position of the collar affected range of motion in 3 of the 6 motions. Differences in range can be attributed to location of the collar closure and initial head posture. Soft cervical collars can physically limit motion when worn either way.

J Orthop Sports Phys Ther. 1996;23(3):209-215.

Key Words: cervical, orthosis, range of motion

Intraobserver and Interobserver Reliability of Asymptomatic Subjects’ Thoracolumbar Range of Motion Using the OSI CA 6207 Spine Motion Analyzer

Cheryl M. Petersen, Robert D. Johnson, Dale Schuit, Karen W. Hayes

Because spinal range of motion (ROM) is assessed routinely in clinical and research settings, a technique is needed that can be performed comfortably, quickly, and reliably. The purpose of this study was to determine if ROM data from asymptomatic subjects measured with the OSI CA 6000 Spine Motion Analyzer (OSI SMA) are reliable within and between observers. Thoracolumbar ROM, from approximately 17 to 52, was measured in all 3 planes in 8 male and 13 female asymptomatic adult subjects (x¯ age = 29.7 years, SD = 5.6; x¯ height = 1.7 m, SD = 3.4, x¯ weight = 78.25 kg, SD = 34.6). A standardized protocol was used to fit each subject with appropriate hardware. Foot placement at a comfortable foot angle was standardized by the use of a template. Subjects performed 3 practice trials of flexion, extension, right and left sidebending, and right and left rotation. During testing, subjects performed 4 trials of each maximal pain-free motion. The hardware was completely removed and replaced by the same examiner, and ROM trials in all 3 planes were repeated. The same procedure was completed by a second examiner. Repeated measures analysis of variance and intraclass correlation coefficients (ICC [2, 1]) were used to analyze intra- and interobserver data. Intraobserver ICCs were 0.89 or higher for all motions. Interobserver ICCs were 0.85 or higher for all motions. Measurements of thoracolumbar ROM using the OSI SMA are sufficiently reliable within and between observers for clinical assessment and research purposes.

J Orthop Sports Phys Ther. 1994;20(4):207-212.

Key Words: spine, motion, reliability