Citation

Donaghy A, Demott T, Allet L, Kim H, Ashton-Miller J, Richardson JK. PM R 2015; 8(4): 331-339.

Copyright

(Copyright © 2015, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1016/j.pmrj.2015.08.017

PMID

26409195

Abstract

BACKGROUND: In prior work laboratory-based measures of hip motor function and ankle proprioceptive precision were critical to maintaining unipedal stance and fall/fall-related injury risk. However, the optimal clinical evaluation techniques for predicting these measures are unknown.

OBJECTIVE: To evaluate the diagnostic accuracy of common clinical maneuvers in predicting laboratory-based measures of frontal plane hip rate of torque development (Hip(RTD)) and ankle proprioceptive thresholds (AnkPRO) associated with increased fall risk.

DESIGN: Prospective, observational study. SETTING: Biomechanical research laboratory. PARTICIPANTS: Forty-one older subjects (age 69.1 ± 8.3 years), 25 with varying degrees of diabetic distal symmetric polyneuropathy and 16 without. ASSESSMENTS: Clinical hip strength was evaluated by manual muscle testing (MMT) and lateral plank time (LPT), defined as the number seconds the laterally lying subject could lift hips from the support surface. Foot/ankle evaluation included Achilles reflex, and vibratory, proprioceptive, monofilament, and pinprick sensations at the great toe. MAIN OUTCOME MEASURES: Hip(RTD), abduction and adduction, using a custom whole-body dynamometer. AnkPRO determined with subjects standing using a foot cradle system and a staircase series of 100 frontal plane rotational stimuli.

RESULTS: Pearson correlation coefficients (r) and receiver operator characteristic (ROC) curves revealed that LPT correlated more strongly with Hip(RTD) (r/p =.61/<.001 and.67/<.001, for abductor/adductor, respectively) than did hip abductor MMT (r/p =.31/.044). Subjects with greater vibratory and proprioceptive sensation, and intact Achilles reflexes, monofilament, and pin sensation had more precise AnkPRO. LPT of < 12 seconds yielded a sensitivity/specificity of 91%/80% for identifying Hip(RTD) <.25 (body size in Newton-meters), and vibratory perception of < 8 seconds yielded a sensitivity/specificity of 94%/80% for the identification of AnkPRO > 1.0 degree.

CONCLUSIONS: LPT is a more effective measure of Hip(RTD) than MMT. Similarly, clinical vibratory sense and monofilament testing are effective measures of AnkPRO, whereas clinical proprioceptive sense is not.

Language: en