Hayes K W, Petersen C, Falconer J
Programs in Physical Therapy, Northwestern University Medical School, Chicago, IL 60611.
Phys Ther. 1994 Aug;74(8):697-707; discussion 707-9. doi: 10.1093/ptj/74.8.697.
We explored the construct validity and test-retest reliability of the passive motion component of the Cyriax soft tissue diagnosis system. We compared the hypothesized and actual patterns of restriction, end-feel, and pain/resistance sequence (P/RS) of 79 subjects with osteoarthritis (OA) of the knee and examined associations among these indicators of dysfunction and related constructs of joint motion, pain intensity, and chronicity.
Subjects had a mean age of 68.5 years (SD = 13.3, range = 28-95), knee stiffness for an average of 83.6 months (SD = 122.4, range = 1-612), knee pain averaging 5.6 cm (SD = 3.1, range = 0-10) on a 10-cm visual analogue scale, and at least a 10-degree limitation in passive range of motion (ROM) of the knee.
Passive ROM (goniometry, n = 79), end-feel (n = 79), and P/RS during end-feel testing (n = 62) were assessed for extension and flexion on three occasions by one of four experienced physical therapists. Test-retest reliability was estimated for the 2-month period between the last two occasions.
Consistent with hypotheses based on Cyriax's assertions about patients with OA, most subjects had capsular end-feels for extension; subjects with tissue approximation end-feels for flexion had more flexion ROM than did subjects with capsular end-feels, and the P/RS was significantly correlated with pain intensity (rho = .35, extension; rho = .30, flexion). Contrary to hypotheses based on Cyriax's assertions, most subjects had noncapsular patterns, tissue approximation end-feels for flexion, and what Cyriax called pain synchronous with resistance for both motions. Pain intensity did not differ depending on end-feel. The P/RS was not correlated with chronicity (rho = .03, extension; rho = .01, flexion). Reliability, as analyzed by intraclass correlation coefficients (ICC[3,1]) and Cohen's kappa coefficients, was acceptable (> or = .80) or nearly acceptable for ROM (ICC = .71-.86, extension; ICC = .95-.99, flexion) but not for end-feel (kappa = .17, extension; kappa = .48, flexion) and P/RS (kappa = .36, extension; kappa = .34, flexion).
The use of a quantitative definition of the capsular pattern, end-feels, and P/RS as indicators of knee OA should be reexamined. The validity of the P/RS as representing chronicity and the reliability of end-feel and the P/RS are questionable. More study of the soft tissue diagnosis system is indicated.
我们探讨了西里克斯软组织诊断系统被动运动部分的结构效度和重测信度。我们比较了79例膝骨关节炎（OA）患者受限、终末感觉以及疼痛/阻力序列（P/RS）的假设模式与实际模式，并研究了这些功能障碍指标与关节活动、疼痛强度和病程等相关结构之间的关联。
受试者的平均年龄为68.5岁（标准差=13.3，范围=28 - 95岁），膝关节僵硬平均持续83.6个月（标准差=122.4，范围=1 - 612个月），在10厘米视觉模拟量表上膝关节疼痛平均为5.6厘米（标准差=3.1，范围=0 - 10厘米），且膝关节被动活动范围（ROM）至少有10度的受限。
由四位经验丰富的物理治疗师之一对79例受试者进行三次被动ROM（角度测量，n = 79）、终末感觉（n = 79）以及终末感觉测试时的P/RS（n = 62）评估，分别测量伸展和屈曲情况。对最后两次测试之间的2个月期间进行重测信度评估。
与基于西里克斯对OA患者论断的假设一致，大多数受试者伸展时为关节囊终末感觉；屈曲时为组织挤压终末感觉的受试者比关节囊终末感觉的受试者有更大的屈曲ROM，且P/RS与疼痛强度显著相关（伸展时rho = 0.35；屈曲时rho = 0.30）。与基于西里克斯论断的假设相反，大多数受试者为非关节囊模式、屈曲时为组织挤压终末感觉，且两种动作的P/RS均为西里克斯所称的疼痛与阻力同步。疼痛强度不因终末感觉而异。P/RS与病程无关（伸展时rho = 0.03；屈曲时rho = 0.01）。通过组内相关系数（ICC[3,1]）和科恩kappa系数分析的信度，对于ROM是可接受的（≥0.80）或接近可接受（伸展时ICC = 0.71 - 0.86；屈曲时ICC = 0.95 - 0.99），但对于终末感觉（伸展时kappa = 0.17；屈曲时kappa = 0.48）和P/RS（伸展时kappa = 0.36；屈曲时kappa = 0.34）则不然。
应重新审视将关节囊模式、终末感觉和P/RS的定量定义用作膝OA指标的情况。P/RS代表病程的效度以及终末感觉和P/RS的信度值得怀疑。需要对软组织诊断系统进行更多研究。
