The reliability of data gathered with hand-held dynamometers (HHD) and the relationship between HHD measurements and manual muscle tests (MMT) have been assessed only with healthy subjects and patients with neuromuscular disorders, not with homogeneous groups of patients with orthopaedic problems. In this study, HHD and MMT were used to measure the strength of knee extensor muscles of 43 patients with osteoarthritis. Test-retest reliability of HHD was determined, and the two testing systems were compared. The HHD measurements indicated that the knee extensor muscles were weak; the MMT grades indicated good strength. The HHD intraclass correlation coefficient for knee extensor strength measurements was 0.92. The HHD measurements increased as the MMT grades increased. The Kendall tau correlation coefficient between HHD measurements and MMT grades for the knee extensor muscles was 0.24. Hand-held dynamometry is less subjective than MMT, especially at the stronger grades. For the purpose of documenting progress of patients, HHD provides a reliable, quantitative method. The use of HHD with weak examiners, weak patients, and inadequate trunk stabilization is questionable. Hand-held dynamometry is useful for clinical and research settings where isokinetic testing is either unfeasible (ie., home care) or cost-prohibitive.

J Orthop Sports Phys Ther 1992;16(3):145-149.

Key Words: osteoarthritis, knee, muscle strengthening

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

Key Words: orthopedics, physical therapy, tests and measurements

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

Study Design: Descriptive. Objectives: To examine the relationship between pain and normal and abnormal-pathologic end-feels during passive physiologic motion assessment at the knee and shoulder. We theorized that abnormal-pathologic end-feels would be more painful than normal end-feels. Background: End-feel testing and pain intensity information are part of physical therapy musculoskeletal patient examinations. End-feels are categorized as normal or abnormal-pathologic. No previous studies have examined the relationship between pain during end-feel testing and the type of end-feel. Methods and Measures: Two physical therapists examined subjects with unilateral knee or shoulder pain. Each subject was examined twice. Passive physiologic motions, 2 at the knee and 5 at the shoulder, were tested by applying an overpressure at the end of range of motion using standardized positions. Subjects reported the amount of pain (0-10) immediately after the evaluator recorded the end-feel. Analyses included one-way ANOVAs and post-hoc Tukey's Honestly Significant Difference tests. Results: Some abnormal-pathologic end-feels were significantly more painful than the normal end-feels at both the knee and the shoulder for all physiologic motions. Among the abnormal-pathologic end-feel categories there were no statistical differences in pain intensity, although small samples in some categories may be responsible for this finding. Conclusion: Abnormal-pathologic end-feels are associated with more pain than normal end-feels during passive physiologic motion testing at the knee or shoulder. Dysfunction should be suspected when abnormal-pathologic end-feels are present.

J Orthop Sports Phys Ther. 2000;30(9):512-527.

Key Words: manual therapy, orthopedics, physical therapy, tests and measurements

Primary shoulder impingement syndrome is a common shoulder problem that, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were 8 men and 6 women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), 3 blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after 9 treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (1-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.

J Orthop Sports Phys Ther. 1998;28(1):3-14.

Key Words: shoulder, impingement, joint mobilization

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

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