Presentation on theme: "Sara Cordell Ithaca College. Protocol timeline Concomitant injuries or complications Knee stability and strength Objective vs. subjective data Reliability,"— Presentation transcript:
Sara Cordell Ithaca College
Protocol timeline Concomitant injuries or complications Knee stability and strength Objective vs. subjective data Reliability, validity, accuracy, functional relevance of tests Individual circumstances, fears, values, motivation, etc Demands of particular sport(s) Clinical experience/judgment
90% symmetry between involved and uninvolved sides for objective testing (isokinetic testing, hop testing, etc) Full, nonpainful ROM No joint effusion Joint stability- KT test 3mm side-to-side difference MD and PT opinions
Biodex Isokinetic Testing KT Testing Agility testing- Modified T-test Balance testing- Stabilometer Goniometry to measure symmetry of movement Compare symmetry of GRFs Deceleration testing Hop testing
Common tests- single leg hop for distance, 6m timed hop, triple hop for distance, crossover hops for distance Limb symmetry index (LSI=involved/uninvolved x100% for distance measures, opposite for time) Begun ~12-16weeks post-op Pros- test many aspects of LE movement at once, time efficient, minimal equipment Cons- learning curve, functional relevance, dont address quality of movement, measurement error
TestReliability (ICC)MDC (%) Single hop.928.09 6m timed hop.8212.96 Triple hop.8810.02 Crossover hop.8412.25 Overall combination.937.05 Four tests together- sensitivity= 82% Single hop test alone- sensitivity= 38-52%
Vertical jump Single hop for distance Drop jump followed by double hop Square hop Side hop
StatisticVertical jump Hop for distance Drop jump w/ double hop Square hopSide hop Sensitivity8663 5169 Specificity87100 6787 Accuracy8674 5674
Vertical jump, single hop for distance, side hop Sensitivity: 91% for identifying patient as abnormal when at least 1 of the 3 tests was abnormal Accuracy: 84% for truly normal subjects and 88% for truly abnormal subjects
54% had abnormal LSI in ALL 3 tests 91% had an abnormal value in at least one of the 3 tests Only 9% had all normal LSI values
Test*LeftRightLSI Single Hop1.48m1.62m91.3% Vertical Jump10.43in13.03in80.0% Side Hop34in49in69.3% Test*LeftRightLSI Single Hop1.48m1.62m91.3% 6m Hop2.5s2.63s105.2% Triple Hop4.72m4.82m97.9% Crossover Hop4.1m4.8m85.4% Reid Test Battery Gustavsson Test Battery
Augustsson et al. evaluated effect of fatigue on single hop testing results Fatigue- repeat as many reps as possible at 50% 1RM All patients included in study had 90% symmetry in non-fatigued conditions After pre-exhaustion exercise, 68% demonstrated abnormal hop symmetry
Do not use only one or two testing methods Consider whole athlete and demands of sport Reference protocol timeline but also use functional goals as criteria for progression No objective tests are perfect, supplement with clinical judgment and experience Consider testing athlete in non-fatigued and fatigued conditions
Criteria based algorithm as proposed by Myer? Can you identify the most important factors when deciding return to sport? Most clinically useful objective measures? Most reliable/valid hop tests? Testing in fatigued vs. non-fatigued state? Commonly overlooked factors?
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