Fritz J M, Delitto A, Erhard R E, Roman M
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA.
Phys Ther. 1998 Oct;78(10):1046-56; discussion 1057-61. doi: 10.1093/ptj/78.10.1046.
The purpose of this study was to examine whether there is evidence to support 2 elements of the passive-range-of-motion (PROM) portion of Cyriax's selective tissue tension scheme for patients with knee dysfunction: a capsular pattern of motion restriction and the pain-resistance sequence.
One hundred fifty-two subjects with unilateral knee dysfunction participated. The subjects had a mean age of 40.0 years (SD=15.9, range=13-82).
Passive range of motion of the knee and the relationship between the onset of pain and resistance to PROM (pain-resistance sequence) were measured, and 4 tests for inflammation were used. Interrater reliability was assessed on 35 subjects.
Kappa values for the individual inflammatory tests ranged from .21 to .66 for categorization of the joint as inflamed, based on at least 2 positive inflammatory tests (kappa=.76). Reliability of PROM measurements was indicated by intraclass correlation coefficients of .72 to .97. Reliability of measurements of the pain-resistance sequence was indicated by a weighted kappa of .28. A capsular pattern, defined as a ratio of loss of extension to loss of flexion during PROM of between 0.03 and 0.50, was more likely than a noncapsular pattern in patients with an inflamed knee or osteoarthrosis (likelihood ratio=3.2). An association was found between a capsular pattern and arthrosis or arthritis.
These findings provide evidence to support the concept of a capsular pattern of motion restriction in persons with inflamed knees or evidence of osteoarthrosis.
本研究旨在探讨是否有证据支持西里克斯（Cyriax）选择性组织张力方案中针对膝关节功能障碍患者的被动活动范围（PROM）部分的两个要素：运动受限的关节囊模式和疼痛抵抗顺序。
152名单侧膝关节功能障碍的受试者参与了研究。受试者的平均年龄为40.0岁（标准差=15.9，范围=13 - 82岁）。
测量膝关节的被动活动范围以及疼痛发作与被动活动范围抵抗（疼痛抵抗顺序）之间的关系，并使用4种炎症检测方法。对35名受试者评估了评分者间信度。
根据至少2项阳性炎症检测将关节分类为发炎时，个体炎症检测的卡帕值范围为0.21至0.66（卡帕=0.76）。组内相关系数为0.72至0.97表明了被动活动范围测量的信度。加权卡帕值为0.28表明了疼痛抵抗顺序测量的信度。在膝关节发炎或患骨关节炎的患者中，被动活动范围中伸展丧失与屈曲丧失的比率在0.03至0.50之间定义的关节囊模式比非关节囊模式更常见（似然比=3.2）。发现关节囊模式与关节病或关节炎之间存在关联。
这些发现为支持膝关节发炎或有骨关节炎证据的人群中存在运动受限的关节囊模式这一概念提供了证据。
