Article

In prior work, laboratory-based measures of hip motor function and
ankle proprioceptive precision were critical to maintaining unipedal stance and
fall/fall-related injury risk. However, the optimal clinical evaluation
techniques for predicting these measures are unknown. OBJECTIVE: To evaluate the
diagnostic accuracy of common clinical maneuvers in predicting laboratory-based
measures of frontal plane hip rate of torque development (Hip(RTD)) and ankle
proprioceptive thresholds (AnkPRO) associated with increased fall risk. DESIGN:
Prospective, observational study. SETTING: Biomechanical research laboratory.
PARTICIPANTS: A total of 41 older subjects (aged 69.1 +/- 8.3 years), 25 with
varying degrees of diabetic distal symmetric polyneuropathy and 16 without.
ASSESSMENTS: Clinical hip strength was evaluated by manual muscle testing (MMT)
and lateral plank time, defined as the number of seconds that the laterally lying
subject could lift the hips from the support surface. Foot/ankle evaluation
included Achilles reflex and vibratory, proprioceptive, monofilament, and
pinprick sensations at the great toe. MAIN OUTCOME MEASURES: Hip(RTD), abduction
and adduction, using a custom whole-body dynamometer. AnkPRO determined with
subjects standing using a foot cradle system and a staircase series of 100
frontal plane rotational stimuli. RESULTS: Pearson correlation coefficients (r)
and receiver operator characteristic (ROC) curves revealed that LPT correlated
more strongly with Hip(RTD) (r/P = 0.61/<.001 and 0.67/<.001, for
abductor/adductor, respectively) than did hip abductor MMT (r/P = 0.31/.044).
Subjects with greater vibratory and proprioceptive sensation, and intact Achilles
reflexes, monofilament, and pin sensation had more precise AnkPRO. LPT of <12
seconds yielded a sensitivity/specificity of 91%/80% for identifying Hip(RTD) <
0.25 (body size in Newton-meters), and vibratory perception of <8 seconds yielded
a sensitivity/specificity of 94%/80% for the identification of AnkPRO >1.0 degrees . CONCLUSIONS: LPT is a more effective measure of Hip(RTD) than MMT.
Similarly, clinical vibratory sense and monofilament testing are effective
measures of AnkPRO, whereas clinical proprioceptive sense is not.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.
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Langue : ANGLAIS