Background Three-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good–to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST. Study Design Repeated Measures Methods Ten videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of “1”, or not present, which were given a score of “0”. Video sequence was randomized in each rating session, and a two-week wash out period was given. Results The cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively). Conclusion These findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers. Level of Evidence Level 2 Diagnosis
Limited research has examined inspiratory muscle performance (IMP) and functional performance (FP) of patients after valve replacement surgery (VRS). The purpose of this study was to examine IMP as well as several measures of FP in patients post-VRS. The study results of 27 patients revealed that patients undergoing transcatheter VRS were significantly (p = 0.01) older than patients undergoing minimally invasive or median sternotomy VRS with the median sternotomy VRS group performing significantly (p < 0.05) better than the transcatheter VRS group in the 6-min walk test, 5x sit-to-stand test, and sustained maximal inspiratory pressure. The 6-min walk test and IMP measures in all groups were significantly (p < 0.001) lower than predicted values. Significant (p < 0.05) relationships were found between IMP and FP with greater IMP being associated with greater FP. Pre-operative and early post-operative rehabilitation may improve IMP and FP post-VRS.
Background Current clinical screening tools assessing risky movements during cutting maneuvers do not adequately address sagittal plane foot and ankle evaluations. The Cutting Alignment Scoring Tool (CAST) is reliable in evaluating frontal plane trunk and lower extremity alignment during a 45-degree side-step cut. The Expanded Cutting Alignment Scoring Tool (E-CAST) includes two new sagittal plane variables, knee flexion and ankle plantarflexion angle. Hypothesis/Purpose To assess the inter-and intra-rater reliability of the E-CAST to evaluate trunk and lower extremity alignment during a 45-degree side-step cut. Study Design Repeated Measures Methods Participants included 25 healthy females (13.8 ± 1.4 years) regularly participating in cutting or pivoting sports. Participants were recorded performing a side-step cut in frontal and sagittal planes. One trial was randomly selected for analysis. Two physical therapists independently scored each video using the E-CAST on two separate occasions, with randomization and a two-week wash-out between rounds. Observed movement variables were awarded a score of “1”, with higher scores representing poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the total score, and a kappa coefficient (k) was calculated for each variable. Results The cumulative intra-rater reliability was good (ICC=0.78, 95% CI 0.59-0.96) and the cumulative inter-rater reliability was moderate (ICC=0.71, 95% CI 0.50-0.91). Intra-rater kappa coefficients ranged from moderate to excellent for all variables (k= 0.50-0.84) and inter-rater kappa coefficients ranged from slight to excellent for all variables (k=0.20-0.90). Conclusion The addition of two sagittal plane variables resulted in lower inter-rater ICC compared to the CAST (ICC= 0.81, 95% CI 0.64-0.91). The E-CAST is a reliable tool to evaluate trunk and LE alignment during a 45-degree side-step cut, with good intra-rater and moderate inter-rater reliability. Level of Evidence Level 2, Diagnosis
Background: Up to 70% of all anterior cruciate ligament (ACL) injuries occur via a non-contact mechanism involving deceleration and direction change on a planted foot. Clinical screening tools analyzing movement patterns during a cutting task are reliable and valid. The Expanded Cutting Alignment Scoring Tool (E-CAST) is a reliable tool to qualitatively assess trunk and lower extremity (LE) alignment during a 45-degree side step cut (SSC). Previous works found two-dimensional (2D) kinematic analysis more reliable than qualitative assessments when evaluating jumping and squatting movements. However, there is limited evidence on the reliability of 2D assessments to evaluate SSC tasks. Hypothesis/Purpose: To determine if using 2D kinematic analysis with the E-CAST improves the tool’s reliability for evaluating trunk and LE alignment during a 45-degree SSC. Methods: 25 healthy females (age 13.8 ± 1.4 years, mass 52.4 ± 9.3 kg, height 161.7 ± 6.0 cm) who regularly participated in cutting or pivoting sports were included. A repeated measures study design was used. Each subject performed three SSC trials with one trial randomly selected for analysis. Trials were recorded in the frontal and sagittal planes. Two physical therapist raters independently viewed and scored each video on two separate occasions. Videos orders were randomized and a two-week wash out period occurred between rounds. The E-CAST evaluates six movement variables (Figure 1). The assessment criteria for each variable was adapted to utilize the Dartfish motion analysis application on a smart phone (Figure 2). If a movement variable falls outside of the motion analysis definition, the subject scores a point, therefore a higher score represents poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the E-CAST total score, and a kappa coefficient was calculated for each variable. Correlations were converted to z scores and compared for significance. Results: The cumulative intra-rater reliability was good (ICC= 0.821, 95% CI 0.687 – 0.898) and the cumulative inter-rater reliability was moderate (ICC= 0.752, 95% CI 0.565-0.859). Intra-rater kappa coefficients ranged from moderate to almost perfect for all variables (k= 0.505-0.875) and inter-rater kappa coefficients ranged from slight to good for all variables (k=0.336-0.733). Conclusion: The use of 2D kinematic analysis resulted in higher intra-and inter-rater reliability compared to the traditional qualitative E-CAST (ICC: 0.77, 95% CI 0.59-0.96 and ICC: 0.71, 95% CI 0.50-0.91), however, the difference was not significant (Zobs = -0.46 and Zobs = -0.30). References: 1. Butler LS, Milian EK, DeVerna A, et al. Reliability of the Cutting Alignment Scoring Tool (CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut. Int J Sports Phys Ther. 2021;16(2):312-321. Published 2021 Apr 1. doi:10.26603/001c.21419 2. Dempsey AR, Lloyd DG, Elliott BC, Steele JR, Munro BJ, Russo KA. The effect of technique change on knee loads during sidestep cutting. Med Sci Sports Exerc. 2007;39(10):1765-1773. doi:10.1249/mss.0b013e31812f56d1 3. Donelon TA, Dos’Santos T, Pitchers G, Brown M, Jones PA. Biomechanical Determinants of Knee Joint Loads Associated with Increased Anterior Cruciate Ligament Loading During Cutting: A Systematic Review and Technical Framework. Sports Med Open. 2020;6(1):53. Published 2020 Nov 2. doi:10.1186/s40798-020-00276-5 4. Dos’Santos T, McBurnie A, Donelon T, Thomas C, Comfort P, Jones PA. A qualitative screening tool to identify athletes with ‘high-risk’ movement mechanics during cutting: The cutting movement assessment score (CMAS). Phys Ther Sport. 2019;38:152-161. doi:10.1016/j.ptsp.2019.05.004 5. Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg. 2013;21(1):41-50. doi:10.5435/JAAOS-21-01-41 6. Weir G, Alderson J, Smailes N, Elliott B, Donnelly C. A Reliable Video-based ACL Injury Screening Tool for Female Team Sport Athletes. Int J Sports Med. 2019;40(3):191-199. doi:10.1055/a-0756-9659 [Figure: see text][Figure: see text]
Background and Purpose The Expanded Cutting Alignment Scoring Tool (E-CAST) is a two-dimensional qualitative scoring system that has demonstrated moderate inter-rater and good intra-rater reliability for the assessment of trunk and lower extremity alignment during a 45-degree sidestep cut. The primary purpose of this study was to examine the reliability of the quantitative version of the E-CAST among physical therapists and to compare the reliability of the quantitative E-CAST to the original qualitative E-CAST. The hypothesis was that the quantitative version of the E-CAST would demonstrate greater inter-rater and intra-rater reliability compared to the qualitative E-CAST. Study Design Observational cohort, repeated measures reliability study Methods Twenty-five healthy female athletes (age 13.8±1.4 years) performed three sidestep cuts with two-dimensional video capturing frontal and sagittal views. Two physical therapist raters independently scored a single trial using both views on two separate occasions. Based on the E-CAST criteria, select kinematic measurements were extracted using a motion analysis phone application. Intraclass correlation coefficients and 95% confident intervals were calculated for the total score, and kappa coefficients were calculated per kinematic variable. Correlations were converted to z-scores and compared to the six original criteria for significance (α<0.05). Results Cumulative intra- and inter-rater reliability were both good (ICC=0.821, 95% CI 0.687-0.898 and ICC=0.752, 95% CI 0.565-0.859). Cumulative intra-rater kappa coefficients ranged from moderate to almost perfect, and cumulative inter-rater kappa coefficients ranged from slight to good. No significant differences were observed between the quantitative and qualitative criteria for either inter- or intra-rater reliability (Zobs(intra)= -0.38, p=0.352 and Zobs(inter)= -0.30, p=0.382). Conclusion The quantitative E-CAST is a reliable tool to assess trunk and lower extremity alignment during a 45-degree sidestep cut. No significant differences were observed in reliability of the quantitative versus qualitative assessment. Level of evidence 3b
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