Mostafaee Neda, Yazdi Mohammad J Shaterzadeh, Negahban Hossein, Goharpey Shahin, Mehravar Mohammad, Pirayeh Nahid
Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Arch Bone Jt Surg. 2017 May;5(3):153-167.
The main goal of physiotherapy for patients with anterior cruciate ligament reconstruction (ACL-R) is to improve postural control and retain knee function. Therefore, clinicians need to use evaluative tools that assess postural changes during physiotherapy. To maximize the clinical utility of the results of these tools, the extracted measures should have appropriate psychometric properties of reliability, validity and responsiveness. No study has yet addressed responsiveness of postural measures in these patients. This study was designed to investigate the responsiveness and determine the minimal clinically important changes (MCIC) of static and dynamic postural measures in patients with (ACL-R) following physiotherapy.
Static and dynamic postural measures were evaluated at first occasion and again after four weeks physiotherapy. The static measures consisted of center of pressure (COP) parameters while dynamic measures included the stability indices. Correlation analysis and ROC curve were applied for assessing the responsiveness.
The meanand SD velocity of COP had acceptable responsiveness in both conditions of standing on injured leg with open-eyes and on uninjured leg with closed-eyes, both with nocognitive task. For dynamic measures, stability indices in double-leg standing with closed-eyes with cognitive task condition attained acceptable responsiveness. MCICs for mean and SD velocity in anteroposterior and mediolateral directions were 0.28cm/s, 0.008cm/s, 0.02cm/s, respectively in standing on injured leg with open-eyes; and 0.14cm/s, 0.07cm/s, 0.06cm/s, respectively in uninjured leg with closed-eyes condition. Also, MCICs for anteroposterior, mediolateral and total stability indices were 0.51°, 0.37°, 0.34°, respectively in DCT condition.
Our findings provide evidence for selection of appropriate static and dynamic postural measures for assessment of changes in these patients. MCICs for these measures were determined, which provide practical information for clinicians to make decision on clinical significance of changes in patients' status.
前交叉韧带重建（ACL-R）患者物理治疗的主要目标是改善姿势控制并保留膝关节功能。因此，临床医生需要使用能够评估物理治疗期间姿势变化的评估工具。为了最大限度地提高这些工具结果的临床实用性，提取的测量指标应具有可靠性、有效性和反应性等适当的心理测量特性。尚无研究探讨这些患者姿势测量指标的反应性。本研究旨在调查物理治疗后ACL-R患者静态和动态姿势测量指标的反应性，并确定最小临床重要变化（MCIC）。
在物理治疗开始时和四周后再次评估静态和动态姿势测量指标。静态测量指标包括压力中心（COP）参数，而动态测量指标包括稳定性指数。应用相关性分析和ROC曲线评估反应性。
在睁眼单腿受伤站立和闭眼单腿未受伤站立且无认知任务的两种情况下，COP的平均速度和标准差速度均具有可接受的反应性。对于动态测量指标，在闭眼双腿站立且有认知任务的情况下，稳定性指数具有可接受的反应性。在睁眼单腿受伤站立时，前后方向和内外侧方向的平均速度和标准差速度的MCIC分别为0.28cm/s、0.008cm/s、0.02cm/s；在闭眼单腿未受伤站立时，分别为0.14cm/s、0.07cm/s、0.06cm/s。此外，在DCT条件下，前后、内外侧和总稳定性指数的MCIC分别为0.51°、0.37°、0.34°。
我们的研究结果为选择合适的静态和动态姿势测量指标以评估这些患者的变化提供了证据。确定了这些测量指标的MCIC，为临床医生判断患者状态变化的临床意义提供了实用信息。
