RESUMO
PURPOSE: To assess the test-retest and inter-rater reliability of goniometry and fleximetry in measuring cervical range of motion in individuals with chronic neck pain. METHODS: A reliability study. Thirty individuals with chronic neck pain were selected. Cervical range of motion was measured by goniometry and fleximetry at two time points 7 days apart. To characterize the sample, we used the numerical pain rating scale, Pain-Related Catastrophizing Thoughts Scale, and Neck Disability Index. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Correlations between goniometry and fleximetry measurements were performed using Spearman's correlation coefficient (rho). RESULTS: For goniometry, we found excellent test-retest reliability (ICC ≥ 0.986, SEM ≤ 1.89%, MDC ≤ 5.23%) and inter-rater reliability (ICC ≥ 0.947, SEM ≤ 3.91%, MDC ≤ 10.84%). Similarly, we found excellent test-retest reliability (ICC ≥ 0.969, SEM ≤ 2.71%, MDC ≤ 7.52%) and inter-rater reliability (ICC ≥ 0.981, SEM ≤ 1.88%, MDC ≤ 5.20%) for fleximetry. Finally, we observed a strong correlation between the goniometry and the fleximetry for all cervical movements (rho ≥ 0.993). CONCLUSION: Goniometry and fleximetry measurements are reliable for assessing cervical range of motion in individuals with chronic neck pain.
Assuntos
Artrometria Articular , Vértebras Cervicais , Dor Crônica , Cervicalgia , Amplitude de Movimento Articular , Humanos , Cervicalgia/fisiopatologia , Cervicalgia/diagnóstico , Amplitude de Movimento Articular/fisiologia , Feminino , Reprodutibilidade dos Testes , Masculino , Dor Crônica/fisiopatologia , Dor Crônica/diagnóstico , Artrometria Articular/métodos , Adulto , Pessoa de Meia-Idade , Vértebras Cervicais/fisiopatologia , Medição da Dor/métodos , Variações Dependentes do ObservadorRESUMO
O presente trabalho surgiu da necessidade de aprimorar o tratamento de pacientes com insuficiência venosa crônica (IVC) que apresentam úlcera venosa. Foram avaliados os 40 membros inferiores de 20 pacientes portadores de úlcera venosa cicatrizada (C5) ou ativa (C6) que foram submetidos ou não à cirurgia de varizes. Foi estabelecida a relação entre a amplitude de movimento da articulação talocrural e a presença de úlcera venosa C5 ou C6, sendo para isso utilizada a goniometria dessa articulação dentro da normalidade como preditor de cicatrização e tendo como desfecho a cicatrização ou não da úlcera venosa. Dessa forma, ao se identificar redução ou imobilidade talocrural em pacientes com úlcera venosa, poderão ser oferecidas novas formas terapêuticas, a fim de aumentar a mobilidade dessa articulação para prevenir ou retardar complicações da IVC
The present study arose from the need to improve treatment of patients with chronic venous insufficiency (CVI) who present with venous ulcers. A total of 40 lower limbs were assessed from 20 patients with healed venous ulcers (C5) or active venous ulcers (C6) who had undergone varicose vein surgery. The relationship between the range of motion of the ankle joint and presence of C5 or C6 venous ulcer was analyzed. For this purpose, normal goniometry findings for this joint were used as a predictor of venous ulcer healing, defined as the outcome. Thus, when identifying reduced ankle joint movement or immobility in these patients, new treatment options could be offered in order to increase joint mobility and prevent or delay CVI complications
Assuntos
Úlcera Varicosa , Insuficiência Venosa , Cicatrização , Artrometria Articular/métodos , Estudos Transversais , Extremidade InferiorRESUMO
BACKGROUND: Juvenile osteochondritis dissecans of the talus is rare, and the literature provides little data to guide treatment. The purpose of the present study was to evaluate our clinical and radiographic results with arthroscopic retrograde drilling in patients who were refractory to conservative care. METHODS: We retrospectively evaluated all patients with juvenile osteochondritis dissecans of the talus who underwent surgery for the treatment of stable lesions that failed conservative treatment. Medical records were reviewed for symptoms and demographic information. Preoperative and latest postoperative radiographs were used to determine degree of healing. AOFAS Ankle/Hindfoot scale and visual analog scale for pain were used to evaluate clinical outcomes. RESULTS: We identified 6 patients (6 ankles). The mean age was 13 years, and the mean duration of follow-up was 37 months (range, 16 to 69 mo). All of them had progressed toward healing and were asymptomatic, but only 3 out of 6 had a complete radiographic healing at last follow-up. The average AOFAS Ankle/Hindfoot score improved from 69 points (55 to 75, IQR=10) preoperatively to 98 points (90 to 100, IQR=7) (P<0.0027). Visual analog scale improved from 6.2 (4 to 8, IQR=3) to 0.3 (0 to 2, IQR=1) (P<0.002). All patients expressed satisfaction with operative results. CONCLUSIONS: Arthroscopic retrograde drilling seems to be effective for symptoms relief, although 50% of the cases have had persistent lesions on radiographs. A longer follow-up is necessary to assess joint function in those cases with partial radiographic healing. LEVEL OF EVIDENCE: Level IV-therapeutic.
Assuntos
Articulação do Tornozelo , Artroscopia , Osteocondrite Dissecante , Tálus , Adolescente , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Argentina , Artrometria Articular/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Feminino , Humanos , Masculino , Osteocondrite Dissecante/diagnóstico , Osteocondrite Dissecante/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição da Dor , Radiografia/métodos , Amplitude de Movimento Articular , Estudos Retrospectivos , Tálus/diagnóstico por imagem , Tálus/patologia , Tálus/cirurgia , Resultado do TratamentoRESUMO
Today, the manual goniometer is a common tool used in clinical practice to measure the range of motion (ROM) of joints in the hand. This device is not only tedious and highly timeconsuming to use, but its accuracy mainly depends on the experience of the examiner. The majority of electronic goniometers currently available on the market exhibit these same limitations. This document presents the physical design and attributes of a system known as the MULTIELGON, which can be used automatically to obtain multiple measurements of the angles of the hand's small finger joints simultaneously using a novel angle-to-voltage transducer. The reproducibility and repeatability of the transducer were evaluated; low dispersion and high homogeneity were demonstrated. Correlation and Bland-Altman analyses were used to compare the accuracy of the novel transducer (A) and traditional manual goniometer (B); the correlation coefficient was 0.9995. The Bland-Altman analysis determined the limits of agreement (1.4° to 1.7°) with a 95% confidence interval for any variation between the instruments (A and B), which gave readings differing by less than 3.1°. Differences were sufficiently small to propose that the manual goniometer can be replaced by the transducer; moreover A is best to evaluate the hand's small finger joints than B. The system is comprised of the device, the interface and the MULTIELGON GUI. The device consists of 14 angle-to-voltage transducers that can be attached to joints in the hand using a PVC clamp and an elastic glove. The MULTIELGON can be utilized to evaluate patients, as well as record and manage ROM data for surgical and rehabilitation decisions.
Assuntos
Artrometria Articular/métodos , Mãos/fisiologia , Amplitude de Movimento Articular/fisiologia , Artrometria Articular/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
Los trastornos patelofemorales son una de las causas más frecuentes de consulta en ortopedia, y múltiples son los factores etiológicos descriptos en la fisiopatogenia. Un examen físico completo es imprescindible para detectar él o los factores influyentes en cada paciente para realizar un tratamiento a la carta. En la bibliografía se suele considerar a la realineación distal del aparato extensor como sinónimo de transposición de la TAT, sin embargo este concepto no contempla el factor rotacional generador de grandes fuerzas desestabilizantes en esta articulación. En este trabajo se describe un signo semiológico muy útil para decidir la realineación distal del aparato extensor, donde se agrega un vector más al ángulo Q clásico, desde el polo inferior de la rótula y paralelo a la diáfisis tibial y su relación con la posición del pie. Este signo se mide con rodilla en 30° de flexión, rótulas al cenit. Se describen 2 tipos de ángulo Q aumentado, contemplando la posición del pie que es fundamental para detectar trastorno rotacional con intrarotación de rodilla durante la marcha. También se describe y fundamenta la necesidad de diferenciar los 2 tipos de ángulo Q extendido para un tratamiento de realineación distal que respeta la biomecánica patelofemoral.
Patellofemoral problems are one of the most common cause of consult in orthopaedic practice. Multiple etiologic factors have been described in the genesis of the pathology. A complete physical exam is very important for the detection of factors that affect each patient, so that we can make a a la carte treatment. In the literature the distal realignement is consider as sinonym of transfer of the tibial tuberosity, but this concept not consider the rotational influence that generate grate forces at the articulation. Here we describe a new sign for the physical exam, useful for deciding distal realignement, where we add and other vector from the distal pole of the patella and paralel to the tibial diafisis and the relantionship with the foot. The sign must be taken in 30° of knee flexion, patellas facing straight to the cenit . We find that there is two types of extended Q angles considering the position of the foot and the presence of a rotational problem wich produce an inward knee. We describe the importance of different type of treatment for each extended Q angles in distal realignement procedures considering more physiological and anatomic treatment for patellofemoral problems.
Assuntos
Humanos , Masculino , Feminino , Articulação Patelofemoral/fisiopatologia , Articulação do Joelho/anatomia & histologia , Artrometria Articular/métodos , Instabilidade Articular/diagnóstico , Síndrome da Dor Patelofemoral/diagnóstico , Síndrome da Dor Patelofemoral/fisiopatologia , Exame Físico/métodos , Fêmur/anatomia & histologia , Patela/anatomia & histologiaRESUMO
Introdução: A limitação da amplitude de movimento de dorsiflexão é o parâmetro mais utilizado na avaliação e evolução da abordagem fisioterapêutica. Objetivos: Avaliar a confiabilidade e aplicabilidade da goniometria e do teste Weight-Bearing para a mensuração de dorsiflexão do tornozelo. Método: Participaram 25 voluntários, do sexo masculino, com idade média de 38,81 (± 6,26), distribuídos em dois grupos: G1 (n=13 Não-atleta) e G2 (n=12 Atletas). A medida da dorsiflexão do tornozelo foi realizada com goniômetro universal adaptado com haste metálica de 45 cm e por meio do teste Weigth-Bearing. Os dois métodos foram aplicados nos participantes por três examinadores, cada um efetuando a mensuração seis vezes. Com o ICC, verificou-se a confiabilidade dos testes. Resultados: Obtiveram-se ICC de 0,98 na goniometria, para o G1, e 0,97, para o G2. Já para o Weight-Bearing, obteve-se ICC de 0,98 para o G1 e o mesmo para o G2. Todas essas medidas foram consideradas muito elevadas. Conclusão: Ambos os métodos são de alta confiabilidade para aplicação clínica nessas condições experimentais.
Introduction: The limitation of the dorsiflexion movement range is the most used parameter in evaluation and evolution of physiotherapeutic approach. Objective: To evaluate the inter-tester reliability and the applicability of goniometry and Weight-Bearing test for measuring the ankle dorsiflexion. Method: Twenty five volunteers, male sex, average aged 38.81 (+6.26), were included in the study and distributed in: G1 (13 non-athletes) and G2 (12 athletes). The measurement of the ankle dorsiflexion was made by using a universal goniometer, which was adapted with a 45 cm metal rod, and also by using the Weight-Bearing test. The two methods were applied in all the participants, by three clinical examiners, each of whom made the measurement six times. The ICC was used to verify the reliability of the tests. Results: In goniometry, the ICC was 0.98 for G1 and 0.97 for G2. When it comes to Weight-Bearing, the ICC was 0.98 for G1 and the same for G2. All these measures were considered high values. Conclusion: As a conclusion, it may be said that both methods are of great reliability for clinical application in these experimental conditions.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Artrometria Articular/métodos , Treinamento Resistido/métodos , Artrometria Articular/instrumentação , Treinamento Resistido/instrumentação , Atletas , TornozeloRESUMO
O propósito deste foi determinar o grau de concordância inter-avaliador de dois testes que mensuram a propriocepção do joelho por meio da goniometria, em uma amostra de universitárias (n=13; 23,8±6,4 anos). Mensurou-se a acurácia proprioceptiva pelos testes de percepção do limiar de movimento passivo lento (T1), movendo-se passivamente a perna até o ângulo alvo; e pelo teste de senso de posição articular (T2), solicitando-se movimento ativo até o ângulo alvo, previamente atingido passivamente. Os ângulos alvos foram sorteados e as medições feitas simultaneamente, de forma cega, por dois avaliadores, por meio de dois goniômetros idênticos posicionados nas faces medial e lateral do joelho. As participantes sinalizavam ao atingir o ângulo alvo, registrando-se, por ambos os avaliadores, os valores angulares efetivamente alcançados. A diferença (em números absolutos) entre o ângulo alvo e aquele alcançado foi considerada o valor de erro, que reflete a acuidade proprioceptiva. Determinou-se a concordância inter-avaliador pelo teste de concordância de Kappa; os valores encontrados (T1, Kappa=0,55; T2, Kappa=0,58) mostram concordância moderada. Como a concordância inter-avaliador nos dois testes foi moderada, conclui-se que a goniometria é limitada, na avaliação proprioceptiva de movimento do joelho...