Silvernail Jason L, Gill Norman W, Teyhen Deydre S, Allison Stephen C
Army-Baylor Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, TX, USA.
J Man Manip Ther. 2011 Aug;19(3):162-71. doi: 10.1179/2042618611Y.0000000012.
The purpose of this study was to quantify the biomechanical properties of specific manual therapy techniques in patients with symptomatic knee osteoarthritis.
Twenty subjects (7 female/13 male, age 54±8 years, ht 1·7±0·1 m, wt 94·2±21·8 kg) participated in this study. One physical therapist delivered joint mobilizations (tibiofemoral extension and flexion; patellofemoral medial-lateral and inferior glide) at two grades (Maitland's grade III and grade IV). A capacitance-based pressure mat was used to capture biomechanical characteristics of force and frequency during 2 trials of 15 second mobilizations. Statistical analysis included intraclass correlation coefficient (ICC(3,1)) for intrarater reliability and 2×4 repeated measures analyses of variance and post-hoc comparison tests.
Force (Newtons) measurements (mean, max.) for grade III were: extension 45, 74; flexion 39, 61; medial-lateral glide 20, 34; inferior glide 16, 27. Force (Newtons) measurements (mean, max.) for grade IV were: extension 57, 76; flexion 47, 68; medial-lateral glide 23, 36; inferior glide 18, 35. Frequency (Hz) measurements were between 0·9 and 1·2 for grade III, and between 2·1 and 2·4 for grade IV. ICCs were above 0·90 for almost all measures.
Maximum force measures were between the ranges reported for cervical and lumbar mobilization at similar grades. Mean force measures were greater at grade IV than III. Oscillation frequency and peak-to-peak amplitude measures were consistent with the grade performed (i.e. greater frequency at grade IV, greater peak-to-peak amplitude at grade III). Intrarater reliability for force, peak-to-peak amplitude and oscillation frequency for knee joint mobilizations was excellent.
本研究旨在量化有症状膝关节骨关节炎患者特定手法治疗技术的生物力学特性。
20名受试者（7名女性/13名男性，年龄54±8岁，身高1.7±0.1米，体重94.2±21.8千克）参与了本研究。一名物理治疗师进行了两个等级（梅特兰三级和四级）的关节松动术（胫股关节伸展和屈曲；髌股关节内外侧及向下滑动）。使用基于电容的压力垫在两次15秒松动术试验期间捕捉力和频率的生物力学特征。统计分析包括用于评估评分者内信度的组内相关系数（ICC(3,1)）以及2×4重复测量方差分析和事后比较检验。
三级的力（牛顿）测量值（均值、最大值）为：伸展45、74；屈曲39、61；内外侧滑动20、34；向下滑动16、27。四级的力（牛顿）测量值（均值、最大值）为：伸展57、76；屈曲47、68；内外侧滑动23、36；向下滑动18、35。三级的频率（赫兹）测量值在0.9至1.2之间，四级在2.1至2.4之间。几乎所有测量的ICC均高于0.90。
最大力测量值处于类似等级下颈椎和腰椎松动术报告的范围之间。四级的平均力测量值大于三级。振荡频率和峰峰值幅度测量值与所执行的等级一致（即四级频率更高，三级峰峰值幅度更大）。膝关节松动术的力、峰峰值幅度和振荡频率的评分者内信度极佳。
