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No. 34 Intrarater Reliability and Level of Agreement of Measurements From H-Reflex in Healthy People
PM&R
officials). Their median age and median years of professional carriers were 43 and 17. Setting: Training seminars. Interventions: A 2-day seminar consisting of 10 short lectures to master basic knowledge related with disaster relief and 5 practice sessions simulating coordination in the disaster setting. Main Outcome Measures: Past experience of disaster relief, the change of comprehension scores (25 items total score 100) before and after the seminar, and the disaster-related activities that were initiated after returning to their communities. Results: 83 participants (30 %) had experience of previously attending disaster-related seminars and 96 (34%) had experience of previously engaging in disaster relief. The median comprehension score improved from 17.5 to 61.0 (p<0.0001 Wilcoxon’s signed rank test). After returning to their own communities, disaster-related activities like multidisciplinary team meetings, briefing seminars, training seminars, and collaboration with local governments were initiated in all 47 prefectures. Conclusions: The change in comprehension scores and the initiation of community activities suggested preliminary effectiveness of the seminars. In a country like Japan where massive earthquakes are inevitable it is a great step forward to enhance disaster preparedness to have trained rehabilitation disaster coordinator teams in all prefectures.
No. 31 Understanding Adherence to Physiotherapy: Findings From Observational Clinical Study in Patients With Asthma. Robinson Ramírez-Vélez; Diana Duran-Palomino; Adriana Campos Rodríguez; Jaime Matínez-Santa. Disclosure: None. Objective: Health care provider adherence to asthma guidelines is poor. National study aimed to investigate current adherence of the recommendations in respiratory rehabilitation raised by the British Thoracic Society in the management of asthma among physiotherapists from both the primary and secondary care settings. Design: A cross-sectional study. Setting: Ten general hospitals in the four main cities of Colombia. Participants: 224 physiotherapists. Interventions: None. Main Outcome Measures: This self-report questionnaire was used to identify interventions and components of respiratory rehabilitation programs as recommended by the British Thoracic Society (from 1 for “always applied” to 5 for “never applied”). Demographic and practice data were collected. Results: The sample included 224 physiotherapists of which 169 were women (75.4%) and 55 were men (24.5%). Most of the sample age ranged from 20 to 29 years old (56.7%). Breathing exercises “an intervention with high level of evidence (grade A)” always applied in 35.3% of physiotherapists. In addition we found low response rates of interventions with moderate grade of recommendation (grade B) such as the Buteyko breathing technique and use of suitable tools (i.e: asthma-specific quality of life measure, measures of anxiety and depression and the Nijmegen questionnaire) was response (94% and 21%) respectively among respondents. Conclusions: We confirm important differences in therapeutic assistant components of the respiratory rehabilitation raised by the British Thoracic Society for patients with asthma.
ELECTRODIAGNOSIS No. 34 Intrarater Reliability and Level of Agreement of Measurements From H-Reflex in Healthy People. Mayerly Carolina Anaya Niño; Mayerly Carolina; Anaya Niño; Esperanza Herrera Villabona. Objective: To assess the intrarater reliability and agreement of the measurement parameters from Hoffmann reflex (H-reflex) registered in the soleus muscle of healthy subjects. Design: Evaluation of diagnostic tests with cross-sectional sampling. Setting: School of Physical Therapy, Bucaramanga, Colombia. Participants: The H reflex was elicited in 5 healthy participants (2 male and 3 females) age (254.17 years old) BMI (22.91.6 kg/m2). Interventions: The measurements were previously standardized. Subsequently the measurements were performed on each
Vol. 6, Iss. 8S2, 2014
S103
subject’s right leg by the same evaluator in two sessions with a minimum interval of 24 hours. The H reflex was obtained in the soleus muscle by stimulation of the posterior tibial nerve in the popliteal fossa following a previously described method. Recruitment curves were obtained for H-reflex and motor waves and normalized as a percentage of maximal M-wave and motor threshold. We analyzed the intraclass correlation coefficient (ICC2k) and the Bland and Altman’s limits of agreement of the electrophysiological variables. Main Outcome Measures: Electrophysiological measures that are used to assess neuromuscular excitability: latency amplitude duration of the wave H and M and ratios Hmax/ Mmax and HSLP/MSLP. Level of Evidence: Level 1. Results: The ICC obtained for latency, amplitude, and duration of the M-wave were 0.85, 0.99, and 0.87, respectively; for the H-wave ICC were 0.46, 0.97, and 0.99, respectively. The ratios Hmax/Mmax and HSLP/MSLP showed very good reliability (ICC 0.87 and 0.92, respectively). Bland Altman analysis determined mean difference near zero for all variables although confidence limits were wide; the best results were observed for the duration (-0.06 [-0.203-0.323]) and Hmax/Mmax ratio (-0.069 [-0.253-0.116]). Conclusions: The results indicate that the evaluated tests have good reproducibility and level of agreement in healthy people. However further studies are required to determine their reliability in participants with any pathology.
No. 35 Agenesis of the Abductor Pollicis Brevis and Atrophy of the Flexor Pollicis Longus Muscles: A Case Report. Koray Aydemir; Yasin Demir, MD (Gulhane); Volkan Yilmaz; Arif Kenan Tan (Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey). Disclosure: None. Setting: Tertiary care university hospital. Patient: A 21-year-old male with agenesis of the abductor pollicis brevis (APB) and atrophy of the flexor pollicis longus (FPL) muscles. Case Description: The patient presented to our clinic with weakness and dysfunction in his right hand. On physical examination, thenar eminence was flatted, the metacarpophalangeal joint of the thumb was 20 degrees ulnar deviated. Thumb flexion, abduction, and opposition were limited and weak (1/5 motor strength). The distal phalanx could be flexed slightly. Overall right hand function was not satisfactory and the cosmetic image was unpleasant. Assessments/Results: Ultrasonography of the hand revealed agenesis of the APB and atrophy of the FPL muscles. Magnetic resonance imaging supported these findings additionally reporting that the FPL tendon was normal at the wrist level but was atrophic after exiting the flexor retinaculum. Electrophysiological examination showed that the thenar branch of the median nerve was involved. Motor unit potentials and right median nerve compound muscle action potential in the APB muscle could not be obtained. Discussion: Congenital absence of the APB is a very rare condition and is usually associated with other congenital anomalies. Thenar aplasia is considered a partial form of the embryonic radial ray defect before the differentiation stage. The anomalies of thenar muscles are seen in several diseases and syndromes. There were no other diseases in our case. Conclusion: A rare case of selective absence of the APB and atrophy of the FPL which has not been previously reported is herewith presented. Congenital absence of the ABP muscle should be kept in mind in patients with thenar eminence atrophy. Reprinted with permission.
No. 37 Antidromic Median Palmar Sensory Latency: A New Test in Diagnosis of Carpal Tunnel Syndrome. Jorge Diaz-Ruiz; Fernando Ortiz-Corredor. Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in clinical practice. It is important to describe techniques easy to perform and having good sensitivity and specificity. Objective: Develop a new test in the diagnosis of CTS which must
officials). Their median age and median years of professional carriers were 43 and 17. Setting: Training seminars. Interventions: A 2-day seminar consisting of 10 short lectures to master basic knowledge related with disaster relief and 5 practice sessions simulating coordination in the disaster setting. Main Outcome Measures: Past experience of disaster relief, the change of comprehension scores (25 items total score 100) before and after the seminar, and the disaster-related activities that were initiated after returning to their communities. Results: 83 participants (30 %) had experience of previously attending disaster-related seminars and 96 (34%) had experience of previously engaging in disaster relief. The median comprehension score improved from 17.5 to 61.0 (p<0.0001 Wilcoxon’s signed rank test). After returning to their own communities, disaster-related activities like multidisciplinary team meetings, briefing seminars, training seminars, and collaboration with local governments were initiated in all 47 prefectures. Conclusions: The change in comprehension scores and the initiation of community activities suggested preliminary effectiveness of the seminars. In a country like Japan where massive earthquakes are inevitable it is a great step forward to enhance disaster preparedness to have trained rehabilitation disaster coordinator teams in all prefectures.
No. 31 Understanding Adherence to Physiotherapy: Findings From Observational Clinical Study in Patients With Asthma. Robinson Ramírez-Vélez; Diana Duran-Palomino; Adriana Campos Rodríguez; Jaime Matínez-Santa. Disclosure: None. Objective: Health care provider adherence to asthma guidelines is poor. National study aimed to investigate current adherence of the recommendations in respiratory rehabilitation raised by the British Thoracic Society in the management of asthma among physiotherapists from both the primary and secondary care settings. Design: A cross-sectional study. Setting: Ten general hospitals in the four main cities of Colombia. Participants: 224 physiotherapists. Interventions: None. Main Outcome Measures: This self-report questionnaire was used to identify interventions and components of respiratory rehabilitation programs as recommended by the British Thoracic Society (from 1 for “always applied” to 5 for “never applied”). Demographic and practice data were collected. Results: The sample included 224 physiotherapists of which 169 were women (75.4%) and 55 were men (24.5%). Most of the sample age ranged from 20 to 29 years old (56.7%). Breathing exercises “an intervention with high level of evidence (grade A)” always applied in 35.3% of physiotherapists. In addition we found low response rates of interventions with moderate grade of recommendation (grade B) such as the Buteyko breathing technique and use of suitable tools (i.e: asthma-specific quality of life measure, measures of anxiety and depression and the Nijmegen questionnaire) was response (94% and 21%) respectively among respondents. Conclusions: We confirm important differences in therapeutic assistant components of the respiratory rehabilitation raised by the British Thoracic Society for patients with asthma.
ELECTRODIAGNOSIS No. 34 Intrarater Reliability and Level of Agreement of Measurements From H-Reflex in Healthy People. Mayerly Carolina Anaya Niño; Mayerly Carolina; Anaya Niño; Esperanza Herrera Villabona. Objective: To assess the intrarater reliability and agreement of the measurement parameters from Hoffmann reflex (H-reflex) registered in the soleus muscle of healthy subjects. Design: Evaluation of diagnostic tests with cross-sectional sampling. Setting: School of Physical Therapy, Bucaramanga, Colombia. Participants: The H reflex was elicited in 5 healthy participants (2 male and 3 females) age (254.17 years old) BMI (22.91.6 kg/m2). Interventions: The measurements were previously standardized. Subsequently the measurements were performed on each
Vol. 6, Iss. 8S2, 2014
S103
subject’s right leg by the same evaluator in two sessions with a minimum interval of 24 hours. The H reflex was obtained in the soleus muscle by stimulation of the posterior tibial nerve in the popliteal fossa following a previously described method. Recruitment curves were obtained for H-reflex and motor waves and normalized as a percentage of maximal M-wave and motor threshold. We analyzed the intraclass correlation coefficient (ICC2k) and the Bland and Altman’s limits of agreement of the electrophysiological variables. Main Outcome Measures: Electrophysiological measures that are used to assess neuromuscular excitability: latency amplitude duration of the wave H and M and ratios Hmax/ Mmax and HSLP/MSLP. Level of Evidence: Level 1. Results: The ICC obtained for latency, amplitude, and duration of the M-wave were 0.85, 0.99, and 0.87, respectively; for the H-wave ICC were 0.46, 0.97, and 0.99, respectively. The ratios Hmax/Mmax and HSLP/MSLP showed very good reliability (ICC 0.87 and 0.92, respectively). Bland Altman analysis determined mean difference near zero for all variables although confidence limits were wide; the best results were observed for the duration (-0.06 [-0.203-0.323]) and Hmax/Mmax ratio (-0.069 [-0.253-0.116]). Conclusions: The results indicate that the evaluated tests have good reproducibility and level of agreement in healthy people. However further studies are required to determine their reliability in participants with any pathology.
No. 35 Agenesis of the Abductor Pollicis Brevis and Atrophy of the Flexor Pollicis Longus Muscles: A Case Report. Koray Aydemir; Yasin Demir, MD (Gulhane); Volkan Yilmaz; Arif Kenan Tan (Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey). Disclosure: None. Setting: Tertiary care university hospital. Patient: A 21-year-old male with agenesis of the abductor pollicis brevis (APB) and atrophy of the flexor pollicis longus (FPL) muscles. Case Description: The patient presented to our clinic with weakness and dysfunction in his right hand. On physical examination, thenar eminence was flatted, the metacarpophalangeal joint of the thumb was 20 degrees ulnar deviated. Thumb flexion, abduction, and opposition were limited and weak (1/5 motor strength). The distal phalanx could be flexed slightly. Overall right hand function was not satisfactory and the cosmetic image was unpleasant. Assessments/Results: Ultrasonography of the hand revealed agenesis of the APB and atrophy of the FPL muscles. Magnetic resonance imaging supported these findings additionally reporting that the FPL tendon was normal at the wrist level but was atrophic after exiting the flexor retinaculum. Electrophysiological examination showed that the thenar branch of the median nerve was involved. Motor unit potentials and right median nerve compound muscle action potential in the APB muscle could not be obtained. Discussion: Congenital absence of the APB is a very rare condition and is usually associated with other congenital anomalies. Thenar aplasia is considered a partial form of the embryonic radial ray defect before the differentiation stage. The anomalies of thenar muscles are seen in several diseases and syndromes. There were no other diseases in our case. Conclusion: A rare case of selective absence of the APB and atrophy of the FPL which has not been previously reported is herewith presented. Congenital absence of the ABP muscle should be kept in mind in patients with thenar eminence atrophy. Reprinted with permission.
No. 37 Antidromic Median Palmar Sensory Latency: A New Test in Diagnosis of Carpal Tunnel Syndrome. Jorge Diaz-Ruiz; Fernando Ortiz-Corredor. Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in clinical practice. It is important to describe techniques easy to perform and having good sensitivity and specificity. Objective: Develop a new test in the diagnosis of CTS which must