Journal of Orthopaedic & Sports Physical Therapy - William P. Hanten, PT, EdD

Reliability by Surgical Status of Self-Reported Outcomes in Patients Who Have Shoulder Pathologies

Karon F. Cook, Toni S. Roddey, Sharon L. Olson, Gary M. Gartsman, Franz Felix T. Valenzuela, William P. Hanten
Study Design: A test-retest design was used to evaluate the reliability of the self-report sections of 4 shoulder pain and disability scales.

Objective:The objective of the study was to compare interitem consistency and test-retest reliability by surgical status (postoperative versus nonoperative) and to evaluate the effect of surgical status in the prediction of retest scores.

Background: Patients and healthcare providers evaluate shoulder status based on self-evaluations of pain and disability. Shoulder outcome measures have been developed that include self-reports, but the properties of these measures have not been assessed by surgical status.

Methods and Measures: A questionnaire containing self-report sections of 4 shoulder scales was administered to study participants twice with 1 week between administrations. The outcome measures examined were the: (1) University of California at Los Angeles (UCLA) Shoulder Score; (2) Constant-Murley Scale (CMS); (3) American Shoulder and Elbow Society (ASES) Shoulder Index; and (4) Shoulder Pain and Disability Index (SPADI). Intraclass correlation coefficients (ICC) were calculated to estimate the test-retest reliability of each of the scales and subscales. The interitem consistencies of the multi-item subscales were assessed using Cronbach’s alpha. The effect of surgical status on shoulder outcome scale reliability was evaluated using a general linear models approach.

Results: The interitem consistency estimates for the multi-item scales were high with both operative and nonoperative participants (0.88 to 0.96). With the exception of the satisfaction subscale of the UCLA Shoulder Score for the nonsurgical group, the estimated intraclass coefficients ranged from 0.51 to 0.91. The prediction of UCLA satisfaction and ASES-disability, pain, and total retest scores was improved with the addition of surgical status into a regression model.

Conclusions: The examined scales exhibited good internal consistency across surgical status. The postsurgical sample’s reproducibility estimates tended to be higher than those of the nonsurgical sample. Reliability of shoulder outcome scales can be affected by patient surgical status.

J Orthop Sports Phys Ther. 2002; 32(7):336–346.

Key Words: outcome assessment (healthcare), psychometrics, reliability, shoulder, validity

Craniosacral Rhythm: Reliability and Relationships With Cardiac and Respiratory Rates

Deborah D. Dawson, William P. Hanten, Megumi Iwata, Melissa Seiden, Fleta G. Whitten, Theresa Zink
Craniosacral rhythm (CSR) has long been the subject of debate, both over its existence and its use as a therapeutic tool in evaluation and treatment. Origins of this rhythm are unknown, and palpatory findings lack scientific support. The purpose of this study was to determine the intra- and inter-examiner reliabilities of the palpation of the rate of the CSR and the relationships between the rate of the CSR and the heart or respiratory rates of subjects and examiners. The rates of the CSR of 40 healthy adults were palpated twice by each of 2 examiners. The heart and respiratory rates of the examiners and the subjects were recorded while the rates of the subjects' CSR were palpated by the examiners. Intraclass correlation coefficients were calculated to determine the intra- and inter-examiner reliabilities of the palpation. Two multiple regression analyses, one for each examiner, were conducted to analyze the relationships between the rate of the CSR and the heart and respiratory rates of the subjects and the examiners. The intraexaminer reliability coefficients were 0.78 for examiner A and 0.83 for examiner B, and the interexaminer reliability coefficient was 0.22. The result of the multiple regression analysis for examiner A was R = 0.46 and adjusted R2 = 0.12 (p = 0.078) and for examiner B was R = 0.63 and adjusted R2 = 0.32 (p = 0.001). The highest bivariate correlation was found between the CSR and the subject's heart rate (r = 0.30) for examiner A and between the CSR and the examiner's heart rate (r = 0.42) for examiner B. The results indicated that a single examiner may be able to palpate the rate of the CSR consistently, if that is what we truly measured. It is possible that the perception of CSR is illusory. The rate of the CSR palpated by 2 examiners is not consistent. The results of the regression analysis of one examiner offered no validation to those of the other. It appears that a subject's CSR is not related to the heart or respiratory rates of the subject or the examiner. J Orthop Sports Phys Ther. 1998;27(3):213-218. Key Words: reliability, craniosacral, movement

Effects of Myofascial Release Leg Pull and Sagittal Plane Isometric Contract-Relax Techniques on Passive Straight-Leg Raise Angle

William P. Hanten, Sandra D. Chandler

Experimental evidence does not currently exist to support the claims of clinical effectiveness for myofascial release techniques. This presents an obvious need to document the effects of myofascial release. The purpose of this study was to compare the effects of 2 techniques, sagittal plane isometric contract-relax and myofascial release leg pull for increasing hip flexion range of motion (ROM) as measured by the angle of passive straight-leg raise. Seventy-five nondisabled, female subjects 18-29 years of age were randomly assigned to contract-relax, leg-pull, or control groups. Pretest hip flexion ROM was measured for each subject's right hip with a passive straight-leg raise test using a fluid-filled goniometer. Subjects in the treatment groups received either contract-relax or leg-pull treatment applied to the right lower extremity; subjects in the control group remained supine quietly for 5 minutes. Following treatment, posttest straight-leg raise measurements were performed. A 1-way analysis of variance followed by a Newman-Keuls post hoc comparison of mean gain scores showed that subjects receiving contract-relax treatment increased their ROM significantly more than those who received leg-pull treatment, and the increase in ROM of subjects in both treatment groups was significantly higher than those of the control group. The results suggest that while both contract-relax and leg-pull techniques can significantly increase hip flexion ROM in normal subjects, contract-relax treatment may be more effective and efficient than leg-pull treatment.

J Orthop Sports Phys Ther. 1994;20(3):138-144.

Key Words: myofascial, contract-relax, straight-leg raise

A Randomized Controlled Trial Comparing 2 Instructional Approaches to Home Exercise Instruction Following Arthroscopic Full-Thickness Rotator Cuff Repair Surgery

Toni S. Roddey, Sharon L. Olson, Gary M. Gartsman, William P. Hanten, Karon F. Cook
Study Design: A prospective unblinded randomized clinical trial.

Objectives: To compare the effectiveness of 2 types of home program instruction, videotape versus personal instruction by a physical therapist, on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear. Background: Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs. Therefore, assessing the effectiveness of different methods of home program instruction is important.

Methods and Measures: Patients who consented to undergo surgical repair were randomly assigned to either a videotape or personal instruction group. A self-reported compliance log categorized subjects as fully compliant, partially compliant, or noncompliant. The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12, 24, and 52 weeks postoperatively. The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time, were assessed by 2 separate 2×3×4 multiple analyses of variances (MANOVAs), 1 for each outcome measure (a= 0.025).

Results: Neither MANOVA was significant and the null hypotheses were not rejected. The main effect of time (number of weeks postsurgery) was significant across all time intervals for both outcome measures (P<0.0005).

Conclusions: With a therapist available for questions, patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist. Self-reported compliance with the rehabilitation program had little effect on the outcomes.

J Orthop Sports Phys Ther 2002;32(11):548–559.

Keywords: physical therapy, shoulder rehabilitation, shoulder surgery, videotape