scholarly journals Enhancing Trigger Point Dry Needling Safety by Ultrasound Skin-to-Rib Measurement: An inter-Rater Reliability Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1958 ◽  
Author(s):  
Anna Folli ◽  
Alessandro Schneebeli ◽  
Simone Ballerini ◽  
Francesca Mena ◽  
Emiliano Soldini ◽  
...  
Keyword(s):  
Adverse Events ◽  
Physical Therapists ◽  
Intraclass Correlation ◽  
Trunk Muscles ◽  
Treatment Technique ◽  
Dry Needling ◽  
Rater Reliability ◽  
Myofascial Trigger Points ◽  
Reliable Technique ◽  
Depth Measurement

Dry needling (DN) is a minimally invasive treatment technique widely used by physical therapists to treat myofascial trigger points (MTrP). Even if its safety has been commonly declared and the majority of adverse events are considered mild, serious adverse events cannot be excluded and DN treatments of several trunk muscles can potentially result in pneumothorax. Ultrasound imaging (US) skin-to-rib measurement could ensure the safety of this treatment procedure. Therefore, the aim of this study was to determine the inter-rater reliability of depth measurement of different trunk muscles (i.e., rhomboid, lower trapezius, iliocostalis, and pectoralis major) between an expert and two novice physiotherapists. Skin-to-rib distance of 26 asymptomatic and normal weights subjects was consecutively, independently, and randomly measured for each muscle by the three examiners (1 expert and 2 novice physical therapists) with a handheld US wireless probe. Intraclass correlation coefficient (ICC3,k) and standard error of measurement (SEM) were used to assess inter-rater reliability. Inter-rater reliability of skin-to-rib measurements between the three examiners was good to excellent or excellent for every muscle, with an ICC3,k ranging from 0.92 and 0.98 (95% CI 0.86–0.99). The SEM never exceeded 10% of the skin-to-rib distance. In conclusion, skin-to-rib US measurements of the trunk muscles can be reliably performed by novice physical therapists using a handheld US device. These measures could be used as an innovative and reliable technique to improve the safety of some potential dangerous DN treatments.

Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 101 (3) ◽  
Author(s):  
Jorge Sánchez-Infante ◽  
Marcos J Navarro-Santana ◽  
Alfredo Bravo-Sánchez ◽  
Fernando Jiménez-Diaz ◽  
Javier Abián-Vicén
Keyword(s):  
Systematic Review ◽  
Rating Scale ◽  
Physical Therapists ◽  
Meta Analysis ◽  
Trigger Points ◽  
Body Region ◽  
Dry Needling ◽  
Level Of Evidence ◽  
Myofascial Trigger Points ◽  
Moderate Effect

Abstract Objective The main objective of this systematic review and meta-analysis was to determine the short-, medium-, and long-term effectiveness of dry needling (DN) applied by physical therapists to myofascial trigger points for the treatment of pain. Methods PubMed, Scopus, SportDiscus, and Web of Science databases were searched from their inception to February 2020. Randomized controlled trials that compared DN with other treatments or placebo and measured pain with a visual analog Scale or another numerical pain rating scale were included. Two authors used a personalized form to collect the following data relevant to the objectives of the review from each article independently: study design, purpose, sample size, diagnosis, characteristics of DN intervention, characteristics of placebo intervention, outcome measures, period of assessment, body region, DN technique, and number of sessions. The initial search identified 1771 articles. After the selection, 102 articles were assessed for eligibility; 42 of these articles measuring pain were used for the meta-analysis. Four meta-analyses were performed according to the follow-up period from the last reported treatment. Results This meta-analysis found a large effect to decrease pain within 72 hours (standardized mean difference [SMD] = −0.81; 95% CI = −1.21 to −0.40), a moderate effect in 1 to 3 weeks (SMD = −0.69; 95% CI = −1.02 to −0.35), a large effect in 4 to 12 weeks (SMD = −0.85; 95% CI = −1.30 to −0.40), and a large effect in 13 to 24 weeks (SMD = −0.81; 95% CI = −1.64 to −0.03). The risk of bias was generally low; however, the heterogeneity of the results downgraded the level of evidence. Conclusions Low-quality evidence that the immediate to 72-hour (large) effect, 4- to 12-week (large) effect, 13- to 24-week (large) effect, and moderate-quality 1- to 3-week (moderate) effect suggested that DN performed by physical therapists was more effective than no treatment, sham DN, and other therapies for reducing pain. Impact DN is commonly used by physical therapists to treat musculoskeletal pain, and it is very important for physical therapists to know the clinical conditions and time periods for which DN is effective in reducing pain in their patients.

scholarly journals Effectiveness of Visual Perceptual Learning on Inter-Therapist Reliability of Lumbar Spine Mobilization

2003 ◽  
Author(s):  
Chad Cook
Keyword(s):  
Manual Therapy ◽  
Physical Therapists ◽  
Intraclass Correlation ◽  
Force Plate ◽  
Treatment Technique ◽  
Educational Model ◽  
Educational Models ◽  
Asymptomatic Volunteers ◽  
Movement Assessment ◽  
Variable Success

Manual therapy is a widely used treatment technique among physical therapists and is effective in the treatment of musculoskeletal disorders. The theory behind the selection of the appropriate grade of mobilization dictates that proper assessment of the stiffness or resistance of a joint must occur in order to assign the therapeutic intensity. Educational models to teach this theory have shown variable success. In numerous studies, the reliability of clinicians' assessment of stiffness and movement assessment is poor. This present study involved a pre-perceptual educational model designed for 22 practicing physical therapists that performed Grade I, II, III and IV mobilizations on two asymptomatic volunteers. Therapists stood on a Kistler force plate™ during mobilization, and mobilization forces were calculated based on the magnitude of reduction of the therapist's ground reaction forces during mobilization. The five maximal force values for each grade and each subject were used for Intraclass correlation (ICC) analysis of inter-therapist reliability. The ICC value was -0.05 for Grade I mobilizations, -0.05 for Grade II mobilizations, -0.04 for Grade III, and -0.03 for Grade IV. The results for a pre-perceptual educational model are similar to past studies and indicate poor inter-therapist reliability in the performance of all grades of manual therapy mobilization.

scholarly journals Reliability of and Minimal Detectable Changes in Gait Performance Tests in Patients With Chronic Hemiplegic Stroke

2020 ◽  
Vol 3 (1) ◽  
pp. 34-39
Author(s):  
Jun Hayakawa ◽  
Mitsuhiro Ochi ◽  
Yudai Yano ◽  
Ryutaro Matsugaki ◽  
Yuto Ogata ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Physical Therapists ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Systematic Bias ◽  
Performance Tests ◽  
Walk Test ◽  
Timed Up And Go ◽  
Rater Reliability ◽  
Gait Performance

Purpose: This study aimed to determine the inter- and intra-rater reliability of and minimal detectable changes (MDCs) at the 95% confidence interval in gait performance tests in patients with chronic hemiplegic stroke who can walk independently. Materials and Methods: Thirty patients with chronic hemiplegic stroke (24 men, 6 women, mean age 62.5 ± 11.6 years) were enrolled. Physical therapists (mean clinical experience: 9.1 ± 9.3 years) performed the timed up and go test (TUG), 10-m walk test (10MWT), and 6-min walk test (6MWT) 1 day apart. Reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Results: The ICC was ≥0.9 for all tests, and no systematic bias was found. MDC at the 95% confidence interval was 1.9 s for the TUG, 0.16 m/s for the 10MWT, and 28.4 m for the 6MWT. Discussion: We demonstrated excellent intra- and inter-rater reliability of all tests. These results suggest that gait performance tests are reliable. Conclusion: These commonly used gait performance tests demonstrated high reliability and can be recommended to evaluate clinically meaningful improvements in patients with chronic hemiplegic stroke who can walk independently.

scholarly journals Ultrasound Imaging Evaluation of Textural Features in Athletes with Soleus Pathology—A Novel Case-Control Study

2021 ◽  
Vol 18 (4) ◽  
pp. 1983 ◽  
Author(s):  
Blanca De-la-Cruz-Torres ◽  
Emmanuel Navarro-Flores ◽  
Daniel López-López ◽  
Carlos Romero-Morales
Keyword(s):  
Ultrasound Imaging ◽  
Soleus Muscle ◽  
Muscle Injury ◽  
Intraclass Correlation ◽  
Muscle Thickness ◽  
Tendon Injury ◽  
Muscle Injuries ◽  
Imaging Evaluation ◽  
Rater Reliability ◽  
Group A

Background: the aim of this study was to compare the echotexture of patients with soleus muscle injury and age matched controls. Methods: a sample of 62 athletes was recruited at the private clinic and was divided in two group: a healthy group (n = 31) and a soleus pathology group whose athletes had soleus muscle injury, located in the central tendon (n = 31). The muscle thickness (MTh), echointensity (EI) and echovariation (EV) were analyzed. An intra-rater reliability test (Intraclass Correlation Coefficient-ICC) was performed in order to analyze the reliability of the values of the measurements. Results: Sociodemographic variables did not show statistically significant differences (p > 0.05). Ultrasound imaging measurements who reported statistically significant differences were EI (p = 0.001) and standard deviation (SD) (p = 0.001). MTh and EV variables did not show statistically significant differences (p = 0.381 and p = 0.364, respectively). Moreover, reliability values for the MTh (ICC = 0.911), EI (ICC = 0.982), SD (ICC = 0.955) and EV (ICC = 0.963). Based on these results the intra-rater reliability was considered excellent. Conclusion: Athletes with a central tendon injury of soleus muscle showed a lower EI when they were compared to healthy athletes. The echogenicity showed by the quantitative ultrasound imaging measurement may be a more objective parameter for the diagnosis and follow-up the soleus muscle injuries.

scholarly journals Intra-Rater (Live vs. Video Assessment) and Inter-Rater (Expert vs. Novice) Reliability of the Test of Gross Motor Development—Third Edition

2021 ◽  
Vol 18 (4) ◽  
pp. 1652
Author(s):  
Aida Carballo-Fazanes ◽  
Ezequiel Rey ◽  
Nadia C. Valentini ◽  
José E. Rodríguez-Fernández ◽  
Cristina Varela-Casal ◽  
...  
Keyword(s):  
Physical Education ◽  
Motor Development ◽  
Intraclass Correlation ◽  
Slow Motion ◽  
Healthy Children ◽  
Gross Motor ◽  
Rater Reliability ◽  
Video Assessment ◽  
Gross Motor Development ◽  
Ball Skills

The Test of Gross Motor Development (TGMD) is one of the most common tools for assessing the fundamental movement skills (FMS) in children between 3 and 10 years. This study aimed to examine the intra-rater and inter-rater reliability of the TGMD—3rd Edition (TGMD-3) between expert and novice raters using live and video assessment. Five raters [2 experts and 3 novices (one of them BSc in Physical Education and Sport Science)] assessed and scored the performance of the TGMD-3 of 25 healthy children [Female: 60%; mean (standard deviation) age 9.16 (1.31)]. Schoolchildren were attending at one public elementary school during the academic year 2019–2020 from Santiago de Compostela (Spain). Raters scored each children performance through two viewing moods (live and slow-motion). The ICC (Intraclass Correlation Coefficient) was used to determine the agreement between raters. Our results showed moderate-to-excellent intra-rater reliability for overall score and locomotor and ball skills subscales; moderate-to-good inter-rater reliability for overall and ball skills; and poor-to-good for locomotor subscale. Higher intra-rater reliability was achieved by the expert raters and novice rater with physical education background compared to novice raters. However, the inter-rater reliability was more variable in all the raters regardless of their experience or background. No significant differences in reliability were found when comparing live and video assessments. For clinical practice, it would be recommended that raters reach an agreement before the assessment to avoid subjective interpretations that might distort the results.

The effect of dry needling of myofascial trigger points on muscle stiffness and motoneuron excitability in healthy subjects

2021 ◽  
pp. 096452842110275
Author(s):  
Carolina Jiménez-Sánchez ◽  
Julio Gómez-Soriano ◽  
Elisabeth Bravo-Esteban ◽  
Orlando Mayoral-del Moral ◽  
Pablo Herrero-Gállego ◽  
...  
Keyword(s):  
Muscle Tone ◽  
Intervention Group ◽  
Trigger Points ◽  
Muscle Stiffness ◽  
Invasive Technique ◽  
Control Group ◽  
Dry Needling ◽  
Myofascial Trigger Points ◽  
Motoneuron Excitability

Background: Myofascial trigger points (MTrPs) are hypersensitive nodules in a taut band (TB) of skeletal muscle. Dry needling (DN) is an invasive technique recommended for the treatment of MTrPs. However, to our knowledge, no studies have investigated the influence of the DN technique on modification of muscle stiffness and neurophysiological properties of MTrPs. Objective: The objective was to examine the effect of DN on muscle stiffness and motoneuron excitability of a latent medial MTrP (nodule and TB) of the soleus muscle in non-injured subjects. Methods: A double-blinded randomised controlled trial of 46 subjects with latent medial MTrPs of the soleus was conducted, in which all received one session of DN. The intervention group (n = 23) were subjected to DN into the MTrP (the nodule), while the control group (n = 23) were subjected to DN into the TB. Assessment was carried out at baseline (pre-test), after the intervention (post-test) and 1 week after the intervention (follow-up). Biomechanical variables (muscle resistive force at 10°/s and 180°/s, muscle extensibility and strength), as measured with an isokinetic dynamometer, and neurophysiological variables (H-reflex), were recorded. Results: There were no statistically significant differences in biomechanical or neurophysiological assessments between groups. Considering the intra-group analysis, subjects in the intervention group exhibited increased maximal isometric voluntary force to ankle plantarflexion (MIVFp) at both post-intervention and follow-up assessment (p < 0.0125; 0.2 < d < 0.5), while no changes were found in the control group. Conclusion: One session of DN targeting latent MTrPs did not change muscle stiffness, muscle extensibility or motoneuron excitability. Further research on subjects with muscle tone disorders should be considered to better address the impact of DN on muscle tone. Trial registration number: NCT02575586 (ClinicalTrials.gov).

Intra- and Inter-Rater Reliability of a Ballet-based Dance Technique Screening Instrument

2020 ◽  
Vol 35 (1) ◽  
pp. 28-34
Author(s):  
Shaw Bronner ◽  
Ivetta Lassey ◽  
Jessie R Lesar ◽  
Zachary G Shaver ◽  
Catherine Turner
Keyword(s):  
Standardized Testing ◽  
Injury Risk ◽  
Online Survey ◽  
Physical Therapists ◽  
Screening Instrument ◽  
Risk Level ◽  
Level Of Evidence ◽  
Rater Reliability ◽  
Training Video ◽  
Dance Medicine

OBJECTIVES: To investigate intra- and inter-rater reliability of a ballet-based Dance Technique Screening Instrument used by physical therapists (PTs) and student PTs (SPTs) with prior dance medicine or dance experience. METHODS: Ten pre-professional dancers were video-recorded in the sagittal and frontal planes while performing four dance sequences: 1) second position grand plié; 2) développé à la seconde; 3) single-limb passé relevé balance; and 4) jumps in first position. Dance videos and electronic versions of the demographics and scoring forms were provided through a secure online survey to 28 PTs and SPTs who served as raters. Raters reviewed a training video prior to scoring the 10 dancers. Raters were asked to repeat their assessments 1–2 wks later. Intraclass correlations (ICC) were assessed for all-raters, PTs, and SPTs for total and sequence scores. RESULTS: Twenty-eight raters assessed the videos one time. Inter-rater reliability was ICC=0.98 (CI95=0.96–0.99) (all-raters), with PTs and SPTs displaying similar values (ICC=0.96 and 0.96, respectively). Eighteen raters (11 PTs, 7 SPTs) repeated the video analysis. Intra-rater reliability was ICC=0.78 (CI95=0.72–0.83) with PTs ICC=0.81 and SPTs ICC=0.70. CONCLUSIONS: Correlations were high for all-raters. SPTs were as reliable as PTs in inter-rater comparisons. PTs exhibited higher intra-rater reliability compared to SPTs. These results substantiate the reliability of a standardized testing instrument to conduct dance technique assessment. Validity of this instrument was demonstrated in a previous study which found dancers with better technique were less likely to sustain injury. The ability to identify technique deficits can guide preventative programs that may reduce injury risk. LEVEL OF EVIDENCE: Level III.

Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation

2021 ◽  
Author(s):  
Henriëtte A. W. Meijer ◽  
Maurits Graafland ◽  
Miryam C. Obdeijn ◽  
Marlies P. Schijven ◽  
J. Carel Goslings
Keyword(s):  
Range Of Motion ◽  
Intraclass Correlation ◽  
Internal Validity ◽  
Wrist Fracture ◽  
Serious Game ◽  
Reference Standard ◽  
Validity And Reliability ◽  
Good Reliability ◽  
Rater Reliability ◽  
Flexion Extension

Abstract Purpose To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. Methods As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test–retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland–Altman plots. Results Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of − 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion–extension arc and the radial deviation-ulnar deviation arc. Conclusion The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test–retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. Trial registration number (internal hospital registration only) MEC-AMC W17_003 #17.015.

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