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      Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome

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          Abstract

          Background

          The Close Kinetic Chain Upper Extremity Stability Test (CKCUES test) is a low cost shoulder functional test that could be considered as a complementary and objective clinical outcome for shoulder performance evaluation. However, its reliability was tested only in recreational athletes’ males and there are no studies comparing scores between sedentary and active samples. The purpose was to examine inter and intrasession reliability of CKCUES Test for samples of sedentary male and female with (SIS), for samples of sedentary healthy male and female, and for male and female samples of healthy upper extremity sport specific recreational athletes. Other purpose was to compare scores within sedentary and within recreational athletes samples of same gender.

          Methods

          A sample of 108 subjects with and without SIS was recruited. Subjects were tested twice, seven days apart. Each subject performed four test repetitions, with 45 seconds of rest between them. The last three repetitions were averaged and used to statistical analysis. Intraclass Correlation Coefficient ICC 2,1 was used to assess intrasession reliability of number of touches score and ICC 2,3 was used to assess intersession reliability of number of touches, normalized score, and power score. Test scores within groups of same gender also were compared. Measurement error was determined by calculating the Standard Error of the Measurement (SEM) and Minimum detectable change (MDC) for all scores.

          Results

          The CKCUES Test showed excellent intersession reliability for scores in all samples. Results also showed excellent intrasession reliability of number of touches for all samples. Scores were greater in active compared to sedentary, with exception of power score. All scores were greater in active compared to sedentary and SIS males and females. SEM ranged from 1.45 to 2.76 touches (based on a 95% CI) and MDC ranged from 2.05 to 3.91(based on a 95% CI) in subjects with and without SIS. At least three touches are needed to be considered a real improvement on CKCUES Test scores.

          Conclusion

          Results suggest CKCUES Test is a reliable tool to evaluate upper extremity functional performance for sedentary, for upper extremity sport specific recreational, and for sedentary males and females with SIS.

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          Most cited references13

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          Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM.

          Reliability, the consistency of a test or measurement, is frequently quantified in the movement sciences literature. A common metric is the intraclass correlation coefficient (ICC). In addition, the SEM, which can be calculated from the ICC, is also frequently reported in reliability studies. However, there are several versions of the ICC, and confusion exists in the movement sciences regarding which ICC to use. Further, the utility of the SEM is not fully appreciated. In this review, the basics of classic reliability theory are addressed in the context of choosing and interpreting an ICC. The primary distinction between ICC equations is argued to be one concerning the inclusion (equations 2,1 and 2,k) or exclusion (equations 3,1 and 3,k) of systematic error in the denominator of the ICC equation. Inferential tests of mean differences, which are performed in the process of deriving the necessary variance components for the calculation of ICC values, are useful to determine if systematic error is present. If so, the measurement schedule should be modified (removing trials where learning and/or fatigue effects are present) to remove systematic error, and ICC equations that only consider random error may be safely used. The use of ICC values is discussed in the context of estimating the effects of measurement error on sample size, statistical power, and correlation attenuation. Finally, calculation and application of the SEM are discussed. It is shown how the SEM and its variants can be used to construct confidence intervals for individual scores and to determine the minimal difference needed to be exhibited for one to be confident that a true change in performance of an individual has occurred.
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            The Penn shoulder score: reliability and validity.

            Psychometric evaluation of a cross-sectional survey. The purpose of this study was to examine the psychometric properties of reliability and validity of the Penn Shoulder Score (PSS). Shoulder outcome measures are used to assess patient self-report levels of pain, satisfaction, and function. The PSS is a 100-point shoulder-specific self-report questionnaire consisting of 3 subscales of pain, satisfaction, and function. This scale has been utilized in the literature. However, the measurement properties of reliability and validity, including responsiveness, of the PSS subscales and overall scale need to be established. Patients (n = 40) with shoulder disorders undergoing a course of outpatient physical therapy completed the PSS at initial visit and again within 72 hours to assess test-retest reliability. The Constant Shoulder Score (CSS) and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) were also completed at the initial visit and compared to the PSS to assess convergent construct validity. A separate cohort of patients (n = 109) completed the PSS at initial visit and 4 weeks later. These scores were used to assess internal consistency and responsiveness. Reliability analysis revealed a test-retest ICC2,1 of 0.94 (95% CI, 0.89-0.97). Internal consistency analysis revealed a Cronbach alpha of 0.93. The standard error of measurement (SEM) was +/- 8.5 scale points (based on a 90% CI) and the minimal detectable change (MDC) was +/- 12.1 scale points (based on a 90% CI). The minimal clinically important difference (MCID) for improvement was 11.4 points. Pearson product moment correlation coefficients between the PSS and the CSS and ASES were 0.85 and 0.87, respectively. Responsiveness analysis revealed an effect size of 1.01 and a standardized response mean of 1.27. This study has demonstrated that the PSS is a reliable and valid measure for reporting outcome of patients with various shoulder disorders.
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              Maintenance of EMG activity and loss of force output with instability.

              Swiss Balls used as a platform for training provide an unstable environment for force production. The objective of this study was to measure differences in force output and electromyographic (EMG) activity of the pectoralis major, anterior deltoid, triceps, latissimus dorsi, and rectus abdominus for isometric and dynamic contractions under stable and unstable conditions. Ten healthy male subjects performed a chest press while supported on a bench or a ball. Unstable isometric maximum force output was 59.6% less than under stable conditions. However, there were no significant differences in overall EMG activity between the stable and unstable protocols. Greater EMG activity was detected with concentric vs. eccentric or isometric contractions. The decreased balance associated with resistance training on an unstable surface may force limb musculature to play a greater role in joint stability. The diminished force output suggests that the overload stresses required for strength training necessitate the inclusion of resistance training on stable surfaces.
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                Author and article information

                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central
                1471-2474
                2014
                3 January 2014
                : 15
                : 1
                Affiliations
                [1 ]Department of Human Movement Science, Federal University of São Paulo, Santos, Brazil
                [2 ]Department of Biomechanics, Medicine and Rehabilitation of Locomotor Apparatus, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
                [3 ]Physiotherapy Orthopedic Clinic, Ribeirão Preto, Brazil
                [4 ]Post-Graduation Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, Brazil
                Article
                1471-2474-15-1
                10.1186/1471-2474-15-1
                3890535
                24387196
                b0006792-5b14-4cc9-b8a4-7602796b07cc
                Copyright © 2014 Tucci et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 May 2013
                : 10 December 2013
                Categories
                Research Article

                Orthopedics
                upper extremity,reliability,functional test
                Orthopedics
                upper extremity, reliability, functional test

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