Physiotherapy - Research Publications
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ItemValidity and Reliability of a Novel Smartphone Tele-Assessment Solution for Quantifying Hip Range of Motion(MDPI, 2022-11)BACKGROUND: Tele-health has become a major mode of delivery in patient care, with increasing interest in the use of tele-platforms for remote patient assessment. The use of smartphone technology to measure hip range of motion has been reported previously, with good to excellent validity and reliability. However, these smartphone applications did not provide real-time tele-assessment functionality. We developed a novel smartphone application, the TelePhysio app, which allows the clinician to remotely connect to the patient's device and measure their hip range of motion in real time. The aim of this study was to investigate the concurrent validity and between-sessions reliability of the TelePhysio app. In addition, the study investigated the concurrent validity, between-sessions, and inter-rater reliability of a second tele-assessment approach using video analysis. METHODS: Fifteen participants (nfemales = 6) were assessed in our laboratory (session 1) and at their home (session 2). We assessed maximum voluntary active hip flexion in supine and hip internal and external rotation, in both prone and sitting positions. TelePhysio and video analysis were validated against the laboratory's 3-dimensional motion capture system in session 1, and evaluated for between-sessions reliability in session 2. Video analysis inter-rater reliability was assessed by comparing the analysis of two raters in session 2. RESULTS: The TelePhysio app demonstrated high concurrent validity against the 3D motion capture system (ICCs 0.63-0.83) for all hip movements in all positions, with the exception of hip internal rotation in prone (ICC = 0.48, p = 0.99). The video analysis demonstrated almost perfect concurrent validity against the 3D motion capture system (ICCs 0.85-0.94) for all hip movements in all positions, with the exception of hip internal rotation in prone (ICC = 0.44, p = 0.01). The TelePhysio and video analysis demonstrated good between-sessions reliability for hip external rotation and hip flexion, ICC 0.64 and 0.62, respectively. The between-sessions reliability of hip internal and external rotation for both TelePhysio and video analysis was fair (ICCs 0.36-0.63). Inter-rater reliability ICCs for the video analysis were 0.59 for hip flexion and 0.87-0.95 for the hip rotation range. CONCLUSIONS: Both tele-assessment approaches, using either a smartphone application or video analysis, demonstrate good to excellent concurrent validity, and moderate to substantial between-sessions reliability in measuring hip rotation and flexion range of motion, but less in internal hip rotation in the prone position. Thus, it is recommended that the seated position be used when assessing hip internal rotation. The use of a smartphone to remotely assess hip range of motion is an appropriate, effective, and low-cost alternative to the face-to-face assessments. This method provides a simple, cost effective, and accessible patient assessment tool with no additional cost. This study validates the use of smartphone technology as a tele-assessment tool for remote hip range of motion assessment.
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ItemEffects of Supervised Early Resistance Training versus standard care on cognitive recovery following cardiac surgery via median sternotomy (the SEcReT study): protocol for a randomised controlled pilot study(BMC, 2020-07-15)INTRODUCTION: Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than in the general population, with older age and comorbidities further increasing the risk of cognitive decline. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the effect of early moderate-intensity resistance training, compared to standard care, on cognitive recovery following cardiac surgery via a median sternotomy. The safety, feasibility and effect on functional recovery will also be examined. METHODS: This study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. The primary outcome, cognitive function, will be assessed using the Alzheimer's Disease Assessment Scale and cognitive subscale. Secondary measures include safety, feasibility, muscular strength, physical function, multiple-domain quality of recovery, dynamic balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months. DISCUSSION: The results of this pilot study will be used to determine the feasibility of a future large-scale randomised controlled trial that promotes the integration of early resistance training into existing aerobic-based cardiac rehabilitation programs in Australia. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001430325p . Registered on 9 October 2017. Universal Trial Number (UTN): U1111-1203-2131.
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ItemArchitectural anatomy of the quadriceps and the relationship with muscle strength: An observational study utilising real-time ultrasound in healthy adults(WILEY, 2021-10)Quadriceps atrophy and morphological change is a known phenomenon that can impact significantly on strength and functional performance in patients with acute or chronic presentations conditions. Real-time ultrasound (RTUS) imaging is a noninvasive valid and reliable method of quantifying quadriceps muscle anatomy and architecture. To date, there is a paucity of normative data on the architectural properties of superficial and deep components of the quadriceps muscle group to inform assessment and evaluation of intervention programs. The aims of this study were to (1) quantify the anatomical architectural properties of the quadriceps muscle group (rectus femoris, vastus intermedius, and vastus lateralis) using RTUS in healthy older adults and (2) to determine the relationship between RTUS muscle parameters and measures of quadriceps muscle strength. Thirty middle aged to older males and females (age range 55-79 years; mean age =59.9 ± 7.08 years) were recruited. Quadriceps muscle thickness, cross-sectional area, pennation angle, and echogenicity were measured using RTUS. Quadriceps strength was measured using hand-held dynamometry. For the RTUS-derived quadriceps morphological data, rectus femoris mean results; circumference 9.3 cm; CSA 4.6 cm2 ; thickness 1.5 cm; echogenicity 100.2 pixels. Vastus intermedius mean results; thickness 1.8 cm; echogenicity 99.1 pixels. Vastus lateralis thickness 1.9 cm; pennation angle 17.3°; fascicle length 7.0 cm. Quadriceps force was significantly correlated only with rectus femoris circumference (r = 0.48, p = 0.007), RF echogenicity (r = 0.38, p = 0.037), VI echogenicity (r = 0.43, p = 0.018), and VL fascicle length (r = 0.43, p = 0.019). Quadriceps force was best predicted by a three-variable model (adjusted R2 = 0.46, p < 0.001) which included rectus femoris echogenicity (B = 0.43, p = 0.005), vastus lateralis fascicle length (B = 0.33, p = 0.025) and rectus femoris circumference (B = 0.31, p = 0.041). Thus respectively, rectus femoris echogenicity explains 43%, vastus lateralis fascicle length explains 33% and rectus femoris circumference explains 31% of the variance of quadriceps force. The study findings suggest that RTUS measures were reliable and further research is warranted to establish whether these could be used as surrogate measures for quadriceps strength in adults to inform exercise and rehabilitation programs.
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ItemReliability of lumbar multifidus and iliocostalis lumborum thickness and echogenicity measurements using ultrasound imaging.(Wiley, 2021-08)PURPOSE: To establish the test-retest and inter-rater reliability of lumbar multifidus (LM) and iliocostalis lumborum (IL) muscle thickness and echogenicity as derived using ultrasound imaging. METHODS: Ultrasound images of the LM and IL were collected from 11 healthy participants on two occasions, 1 week apart, by two independent assessors. Measures of LM and IL thickness and echogenicity were subject to test-retest and inter-rater reliability, which was assessed by calculation of an F statistic, the interclass correlation coefficient (ICC), the standard error of measurement, 95% confidence intervals and Bland-Altman plots. This study was given approval by The University of Melbourne Behavioural and Social Sciences Human Ethics Sub-Committee (ref: 1749845). RESULTS: Assessors A and B showed good to excellent test-retest reliability for LM thickness (ICC3,3 A: 0.89 and B: 0.98), LM echogenicity (ICC3,3 A: 0.93 and B: 0.95) and IL echogenicity (ICC3,3 A: 0.87 and B: 0.83). Test-retest reliability for IL thickness was poor for Assessor A but excellent for Assessor B. Both assessors demonstrated excellent inter-rater reliability for LM thickness and echogenicity (ICC2,3: 0.79 and 0.94), but poor reliability for IL thickness and echogenicity (ICC2,3: 0.00 and 0.39). CONCLUSIONS: Inter-rater and test-retest reliability was excellent for LM but was less reliable for measures of the IL muscle.