July 2002 Volume 32, No. 7

Assessment of Isokinetic Muscle Strength in Women Who Are Obese

Albrecht L. Claessens, Maria Hulens, Roeland Lysens, Erik Muls, Greet Vansant
Study Design: Cross-sectional study of isokinetic trunk and knee muscle strength in women who are obese.

Objective:To provide reference values, to identify variables that affect peripheral muscle strength, and to provide recommendations for isokinetic testing of trunk and knee muscles in women who are obese and morbidly obese.

Background: The assessment of peripheral muscle strength is useful for the quantification of possible loss of strength, for exercise prescription, and for the evaluation of the effect of training programs in obese individuals.

Methods and Measures: Isokinetic trunk and leg muscle strength was assessed in 241 women who were obese (18�65 years, body mass index (BMI) = 30 kg/m2). Trunk flexion and extension peak torque (PT) were measured using the Cybex TEF dynamometer; trunk rotation (TR) PT was measured using the Cybex TORSO dynamometer; and knee flexion/extension (KFE) PT was measured using the Cybex 350 dynamometer. Body composition was assessed using the bioelectrical impedance method; physical activity was assessed using the Baecke questionnaire; and peak VO2 was assessed using an incremental exercise capacity test on a bicycle ergometer. To identify variables related to muscle strength, Pearson correlations were computed and a stepwise multiple regression analysis was performed.

Results: Pearson correlation coefficients of all strength measurements at 60�/s revealed low-to-moderate negative associations with age and positive associations with mass, height, fat free mass (FFM), and peak VO2 (P < 0.05), except for gravity-uncorrected trunk extension strength, which was not related to mass. The sports index of the Baecke questionnaire was associated with TR PT (r = 0.20, P < 0.01) and KFE PT (r = 0.18, P < 0.05).

Conclusion: The weight of the trunk accounts largely for the measured trunk extensor and flexor strength in women who are obese. Contributing variables of isokinetic trunk flexion and extension strength in women who are obese are age, height, and FFM; whereas sports activities and aerobic fitness are contributing factors for trunk rotational and knee extension strength. Recommendations for measuring isokinetic muscle strength in individuals who are obese are provided.

J Orthop Sports Phys Ther. 2002; 32(7):347�356.

Key Words: isokinetic muscle strength, obesity, reference values, women

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

Karon F. Cook, Gary M. Gartsman, William P. Hanten, Sharon L. Olson, Toni S. Roddey, Franz Felix T. Valenzuela
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

Thoracolumbar Proprioception in Individuals With and Without Low Back Pain: Intratester Reliability, Clinical Applicability, and Validity

George A. Koumantakis, Jacqueline A. Oldham, Julie Winstanley
Study Design: Repeated measures design of active spinal position sense in individuals with and without low back pain (LBP).

Objectives: Reproducibility and validity evaluation of thoracolumbar proprioception measurement.

Background: Proprioception studies in peripheral joints and the spine suggest that there may be proprioception deficits due to injury, pain, or degeneration. Kinesthetic retraining may be useful in rehabilitation of patients with LBP, but appropriate measures are required to quantify spinal proprioception objectively.

Methods and Measures: Active-target reproduction in the sagittal, horizontal, and coronal planes was assessed (3 separate occasions for 18 asymptomatic volunteers and 2 occasions for 62 patients with LBP). Repositioning accuracy was expressed as absolute errors (AE) and variable errors (VE). Reliability was analyzed with intraclass correlation coefficient (ICC) and precision with standard error of measurement (SEM) and calculation of the smallest detectable difference (SDD) index. Repeated measures ANOVA and correlations were used for within-group comparisons and discriminant analysis for between-group comparisons.

Results: Reproducibility was better for the asymptomatic group, with AE for flexion and rotation being the most reliable (ICC = 0.76�0.80, SEM = 0.91��1.34�). SDDs were high for all tests, suggesting limited clinical applicability. Reproducibility for the same tests was poor-moderate (ICC = 0.31�0.64, SEM = 0.45��3.90�) for the patient group. AE for right-side rotation could discriminate between subject groups with 83.3% specificity but only 54.8% sensitivity.

Conclusions: Proprioception testing, with the methods employed, did not demonstrate good measurement properties in a sample of patients with recurrent LBP. Neither could it sufficiently discriminate between individuals with and without LBP. Possible reasons for these findings are discussed.

J Orthop Sports Phys Ther. 2002; 32(7):327�335.

Key Words: electrogoniometer, muscle spindle, neuromuscular dysfunction, position sense

Pregnancy, Low Back Pain, and Manual Physical Therapy Interventions

Julie M. Whitman

Bioflavonoids: Proanthocyanidins and Quercetin and Their Potential Roles in Treating Musculoskeletal Conditions

Shan Teixeira
As a clinician treating musculoskeletal conditions, one is continually in search of safe and more effective treatment methods that will hasten tissue healing. Chronic inflammation has been shown to cause connective tissue degradation. Typically, nonsteroidal anti-inflammatory drugs (NSAIDs) and/or corticosteroids are used to control the inflammatory process, however, long-term use has been associated with potentially serious side effects. The purpose of this article is to introduce and describe literature on 2 natural compounds, namely, proanthocyanidin (PCO) and quercetin, which are 2 specific types of bioflavonoids, and to discuss their potential benefits in treating musculoskeletal conditions. There is evidence to suggest that flavonoids may be beneficial to connective tissue for several reasons, which include the limiting of inflammation and associated tissue degradation, the improvement of local circulation, as well as the promoting of a strong collagen matrix. An overview of bioflavonoids as well as relevant research, safety issues, absorption, and specific sources of PCO and quercetin in foods and through supplementation is included.

J Orthop Sports Phys Ther. 2002; 32(7):357�363.

Key Words: connective tissue, inflammation, proteolytic enzymes

The Use of a Modified Classification System in the Treatment of Low Back Pain During Pregnancy: A Case Report

Susan Mais Requejo, Robert Barnes, Robert F. Landel, Susana Gonzalez, Kornelia Kulig
Study Design: Case study. Objective: To describe the use of a classification approach in the evaluation and treatment of a pregnant patient with low back pain (LBP). Background: The patient was a 28-year-old primigravida in her 20th week of pregnancy. She presented with a chief complaint of LBP without precipitating trauma. Her pain limited her sitting to 20 minutes or less and restricted her ability to bend forward. Methods and Measures: This patient was treated 4 times during a period of 2 weeks. The patient was classified as stage 1 extension syndrome. Because of the patient’s pregnancy, treatment with active extension exercises commonly prescribed for this syndrome was deemed inadequate. Therefore, manual joint mobilization was applied to the symptomatic vertebral segment. Additional intervention included moist heat, soft tissue mobilization to the thoracolumbar paraspinals, manual stretching of the hip flexors, abdominal bracing, and wall squat exercises. Results: After 4 treatments, the patient was able to bend forward without pain, sit longer than 1 hour without discomfort, and work with minimal discomfort. She improved from a stage 1 classification to a stage 3 classification. Conclusion: This case illustrates the use of a classification system to guide physical therapy intervention. It also demonstrates an effective and safe use of manual techniques in the treatment of a pregnant patient.

J Orthop Sports Phys Ther. 2002; 32(7):318–326.

Key Words: extension syndrome, manual therapy, thoracic spine