Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia.
Am J Sports Med. 2011 Apr;39(4):866-73. doi: 10.1177/0363546510395456. Epub 2011 Feb 18.
Contemporary clinical expertise and emerging research in anterior knee pain indicate that treatment of hip muscle function will result in greater effects, if such treatments can be provided to those with hip muscle dysfunction. Thus, it is imperative to develop and evaluate a clinical assessment tool that is capable of identifying people with poor hip muscle function.
The clinical assessment of single-leg squat performance will have acceptable inter- and intrarater reliability. Furthermore, people with good performance on the single-leg squat will have better hip muscle function (earlier onset of gluteus medius activity and greater lateral trunk, hip abduction, and external rotation strength) than people with poor performance.
Cohort study (diagnosis); Level of evidence, 2.
A consensus panel of 5 experienced clinicians developed criteria to rate the performance of a single-leg squat task as "good," "fair," or "poor." The panel rated the performance of 34 asymptomatic participants (mean ± SD: age, 24 ± 5 y; height, 1.69 ± 0.10 m; weight, 65.0 ± 10.7 kg), and these ratings served as the standard. The ratings of 3 different clinicians were compared with those of the consensus panel ratings (interrater reliability) and to their own rating on 2 occasions (intrarater reliability). For the participants rated as good performers (n = 9) and poor performers (n = 12), hip muscle strength (hip abduction, external rotation, and trunk side bridge) and onset timing of anterior (AGM) and posterior gluteus medius (PGM) electromyographic activity were compared.
Concurrency with the consensus panel was excellent to substantial for the 3 raters (agreement 87%-73%; κ = 0.800-0.600). Similarly, intrarater agreement was excellent to substantial (agreement 87%-73%; κ = 0.800-0.613). Participants rated as good performers had significantly earlier onset timing of AGM (mean difference, -152; 95% confidence interval [CI], -258 to -48 ms) and PGM (mean difference, -115; 95% CI, -227 to -3 ms) electromyographic activity than those who were rated as poor performers. The good performers also exhibited greater hip abduction torque (mean difference, 0.47; 95% CI, 0.10-0.83 N·m·Bw(-1)) and trunk side flexion force (mean difference, 1.08; 95% CI, 0.25-1.91 N·Bw(-1)). There was no difference in hip external rotation torque (P > .05) between the 2 groups.
Targeted treatments, although considered ideal, rely on the capacity to identify subgroups of people with chronic anterior knee pain who might respond optimally to a given treatment component. Clinical assessment of performance on the single-leg squat task is a reliable tool that may be used to identify people with hip muscle dysfunction.
当代临床专业知识和膝关节前侧疼痛的新兴研究表明，如果可以为髋关节肌肉功能障碍患者提供相关治疗，那么髋关节肌肉功能的治疗将会产生更大的效果。因此，开发和评估一种能够识别髋关节肌肉功能不良人群的临床评估工具是当务之急。
单腿深蹲表现的临床评估将具有可接受的组内和组间可靠性。此外，单腿深蹲表现良好的人群的髋关节肌肉功能（臀中肌起始活动更早，以及更大的躯干侧屈、髋关节外展和外旋力量）将优于表现不佳的人群。
队列研究（诊断）；证据水平，2 级。
由 5 名经验丰富的临床医生组成的共识小组制定了标准，以评定单腿深蹲任务的表现为“良好”、“中等”或“差”。该小组对 34 名无症状参与者（平均±标准差：年龄 24±5 岁；身高 1.69±0.10 m；体重 65.0±10.7 kg）进行了评分，这些评分作为标准。3 名不同临床医生的评分与共识小组的评分（组内可靠性）以及他们自己在 2 次评估中的评分（组内可靠性）进行了比较。对于被评为表现良好（n=9）和表现较差（n=12）的参与者，比较了髋关节外展、外旋和躯干侧桥的肌肉力量以及前（AGM）和后（PGM）臀中肌肌电图活动的起始时间。
3 名评估者与共识小组的一致性为极好到高度一致（一致性 87%-73%；κ=0.800-0.600）。同样，组内可靠性也极好到高度一致（一致性 87%-73%；κ=0.800-0.613）。与被评为表现差的参与者相比，被评为表现好的参与者的 AGM（平均差异，-152；95%置信区间 [CI]，-258 至-48 ms）和 PGM（平均差异，-115；95% CI，-227 至-3 ms）肌电图活动的起始时间更早。表现好的参与者还表现出更大的髋关节外展力矩（平均差异，0.47；95% CI，0.10-0.83 N·m·Bw(-1)）和躯干侧屈力（平均差异，1.08；95% CI，0.25-1.91 N·Bw(-1)）。两组之间的髋关节外旋力矩无差异（P＞0.05）。
尽管靶向治疗被认为是理想的，但仍依赖于识别出可能对特定治疗成分反应最佳的慢性膝关节前侧疼痛亚组人群的能力。单腿深蹲任务表现的临床评估是一种可靠的工具，可用于识别髋关节肌肉功能障碍患者。
