J Orthop Sports Phys Ther 1989;11(4):142-145.

STUDY DESIGN: A prospective methodological study of interrater reliability. OBJECTIVES: To examine the interrater reliability of a movement impairment-based classification system for patients with chronic low back pain (LBP). BACKGROUND: Movement impairment-based classification for the lumbar spine categorizes LBP based on the findings derived from a patient history and standardized examination. Though many presume this classification to be useful for directing treatment of individuals with LBP, agreement between examiners for assigning a lumbar spine category to a patient has not been studied thoroughly. METHODS AND MEASURES: Two physical therapists independently examined 24 patients (8 men, 16 women) with chronic LBP (pain duration greater than 12 weeks). All patients enrolled in the study had been diagnosed with LBP that was believed to be due to mechanical causes, and the duration of their symptoms ranged from 20 to 1040 weeks. The examiners used a standardized examination to assess patients and classify them into 1 of 5 lumbar spine categories. Percent agreement and kappa coefficients were calculated between the examiners for the lumbar movement impairment-based classifications. RESULTS: Percent agreement between examiners was 75% and the kappa coefficient was 0.61. The most prevalent lumbar spine categories identified by both examiners were lumbar extension rotation syndrome (41.7% of patients by examiner 1, 37.5% of patients by examiner 2) and lumbar rotation syndrome (41.7% of patients by both examiners). CONCLUSIONS: Interrater reliability between 2 physical therapists classifying patients with chronic LBP patients into 1 of 5 lumbar spine movement impairment categories had substantial agreement.

J Orthop Sports Phys Ther. 2008;38(6):371-376, published online 22 January 2008. doi:10.2519/jospt.2008.2760

KEY WORDS: agreement, diagnostic categories, kappa statistic

The Nicholas Hand-Held Dynamometer (HHD) has been shown to have excellent interday and intraday reliability when using the same HHD. Since clinics may have more than one HHD with which to evaluate patients, it would be of value to know if 2 identical HHDs measure the same variable consistently. The purpose of this investigation was to assess interdevice reliability of the Nicholas HHD as well as to determine its validity. Thirty healthy female subjects between the ages of 20 and 56 years (x¯ age = 28.4) were tested for hamstring strength. Three measurements of maximum hamstring contractions were obtained using the first HHD (Device A). The average of these 3 measurements was compared with the average of 3 measurements obtained after a brief rest using a second HHD (Device B). Measurements from the 2 HHDs were also compared with measurements obtained from a Kin-Com isokinetic dynamometer. The Kin-Com measurements were used as criteria to determine validity of the HHD. An intraclass correlation coefficient (ICC) calculated to determine reliability between the 2 HHDs was low (ICC = 0.58). Pearson product-moment correlation coefficients were calculated between the Kin-Com and each of the 2 HHDs. These values were 0.85 and 0.83 for Device A and B, respectively. Analysis of variance showed no significant difference between the Kin-Com and Device A but a significant difference between the Kin-Com and Device B (p<.001). Measurements obtained from 2 identical HHDs may be significantly different and should not be compared.

J Orthop Sports Phys Ther. 1994;20(6):302-306.

Key Words: muscle strength, validity, Kin-Com

Objectives: To assess outcomes of total hip arthroplasty (THA) by comparing range of motion (ROM), muscle strength, and postural stability in the surgical hip to those of the uninvolved hip 1 year postsurgery. An additional objective was to assess degree of relationship among ROM, strength, and postural stability impairments to a measure of self-assessed function.

Background: Most patients who have THA receive physical therapy that consists mainly of self-care instructions and an exercise protocol that emphasizes mobility during the acute phase of recovery. But, outcomes of THA 1 year postsurgery indicate that current physical therapy programs used during the acute phase of recovery do not effectively restore physical and functional performance.

Methods and Measures: Subjects consisted of 11 women and 4 men (mean age ± standard deviation = 62 ± 8 years) with unilateral THA performed 1 year prior to data collection. Assessment variables consisted of self-assessment of function and measures of postural stability, muscle strength, and hip ROM. The 12-Item Hip Questionnaire was used for self-assessment of function. Three separate repeated measures MANOVA were used to compare the involved side to the uninvolved side in measures of postural stability, strength, and ROM. The Spearman’s rho was used to assess degree of association between the subjects’ score of self-assessed function and impairments in strength and postural stability.

Results: Measures of postural stability were significantly lower (P = 0.01) on the side of the replaced hip. Differences in strength values between the involved and uninvolved sides were not statistically significant. Correlations between scores of self-assessed function and hip abductor and knee extensor strength were statistically significant (r = 0.56, P = 0.03). Self-assessed function was not significantly correlated to postural stability impairments.

Conclusion: The brief postsurgical rehabilitation program received by patients with THA may not be sufficient. A second phase of rehabilitation implemented 4 months or more after surgery that emphasizes weight bearing and postural stability may be advisable.

J Orthop Sports Phys Ther. 2002; 32(6):260–267.

Key Words: isometric strength, postural stability, self-assessed function, THA