İZOKİNETİK DİNAMOMETRE İLE YAPILAN GLENOHUMERAL EKLEM POZİSYON VE HAREKET HİSSİ TESTLERİNİN DEĞERLENDİRİCİLER ARASI VE DEĞERLENDİRİCİLER İÇİ GÜVENİRLİKLERİ

Öz

Amaç: Bu çalışmanın amacı; sağlıklı bireylerde izokinetik dinamometrenin glenohumeral eklem (GHE) pozisyon ve hareket hissi testlerindeki değerlendiriciler içi ve değerlendiriciler arası test güvenilirliğini araştırmaktır. Yöntem: Çalışmaya toplamda 17 sağlıklı katılımcı (8 Kadın) dahil edildi. Katılımcıların dominant ekstremitesine izokinetik dinamometre ile glenohumeral eklem pozisyon ve hareket hissi testi iki farklı değerlendirici tarafından yapıldı. Her iki test de glenohumeral eklem 900 abdüksiyonda ve dirsek eklemi 90° fleksiyonda yapıldı. Pozisyon hissi için referans açıları 300–600 internal ve eksternal rotasyondu, hareket hissi testi ise 0.1°/s hızda internal and eksternal yönlerinde yapıldı. Hata skoru, hedef açı ile gözlemlenen açı arasındaki mutlak fark üç denemenin ortalaması alınarak kaydedildi. Sonuçlar: Pozisyon hissi için hesaplanan farklı hata türü ortalamaları; 0.02±1.62 ile 5.42±1.74 arasındaydı. Farklı hata türleri için; değerlendiriciler içi testlerin ICC değeri 0.038 ile 0.657 arasında, değerlendiriciler arası testlerin ICC değerleri 0.095 ile 0.779 arasında değişmekteydi. Farklı yön ve açılara ait hareket hissi test sonuçları 9.61±2.61 ile 11.18±2.89 arasındaydı. Hareket hissi için değerlendiriciler içi testlerin ICC değerleri 0.687 ile 0.912 arasında, değerlendiriciler arası testlerin ICC değerleri 0.844ile 0.925 arasında bulundu. Tartışma: İzokinetik dinamometre GHE internal rotasyon hareket hissini ölçmede orta-iyi düzey değerlendiriciler içi ve değerlendiriciler arası test güvenilirliği göstermiştir. Eksternal rotasyon değerlendiriciler içi test güvenilirliği zayıftır fakat değerlendiriciler arası test güvenilirliği orta-iyi düzeydedir. Diğer taraftan izokinetik dinamometre hareket hissi ölçümünde mükemmel seviyede değerlendiriciler içi ve değerlendiriciler arası test güvenilirliği göstermiştir. Hem pozisyon hem de hareket hissi testlerinin uyumu ve dolayısıyla tekrarlanabilirliği oldukça iyidir. Ayrıca her iki test için de izokinetik dinamometre küçük farkları ortaya çıkarmada başarılıdır.

Anahtar Kelimeler

• Kinestezi
• Propriosepsiyon
• Omuz
• Güvenirlik
• Reliability

THE INTER-RATER AND INTRA-RATER RELIABILITY OF GLENOHUMERAL JOINT POSITION AND MOVEMENT SENSE TESTS APPLIED USING AN ISOKINETIC DYNAMOMETER

Abstract

Purpose: This study aimed to test the inter-rater and intra-rater reliability of glenohumeral joint (GHJ) position and movement sense tests of an isokinetic dynamometer in healthy individuals. Methods: The study included 17 healthy subjects (8 female). GHJ position and movement sense tests were applied by two raters with an isokinetic dynamometer to the dominant extremity. Both tests were performed while GHJ positioned 90° abduction and elbow flexion, reference angles for position sense were 30°-60° internal and external rotation and movement sense tests were conducted at 0.1°/s to the both internal and external rotation directions. The error score, by averaging the three trials, was measured as the absolute difference between the target angle and the observed angle. Results: The different error types calculated for position sense were in the range of mean 0.02±1.62- 5.42±1.74. The ICC value for the different error types was determined in the range of 0.038 - 0.657 for the intra-rater tests, and 0.095-0.779 for the inter-rater tests. The movement sense test results for different directions and angles ranged from 9.61±2.61 to 11.18±2.89. The ICC values for movemeent sense were in the range of 0.687-0.912 for the intra-rater tests, and 0.844-0.925 for the inter-rater tests. Conclusion: The isokinetic dynamometer showed moderate-good intra-rater and inter-rater test reliability in the measurement of the GHJ internal rotation movement sense. The intra-rater test reliability was poor in external rotation but the inter-rater test reliability was moderate-good. However in the measurement of movement sense, the isokinetic dynamometer showed intra-rater and inter-rater test reliability at an excellent level. The conformity of both the position and the movement sense tests, and therefore, the repeatability, was extremely good.

Keywords

• Kinesthesia
• Proprioception
• Shoulder
• Reliability

References

1. Referans1. Hillier S, Immink M, Thewlis D. Assessing proprioception: a systematic review of possibilities. Neurorehabil Neural Repair. 2015;29(10):933-49. https://doi.org/10.1177/1545968315573055
2. Referans2. Ager AL, Roy JS, Roos M, Belley AF, Cools A, Hébert LJ. Shoulder proprioception: how is it measured and is it reliable? A systematic review. J Hand Ther. 2017;30(2):221-31. https://doi.org/10.1016/j.jht.2017.05.003
3. Referans3. Tuthill JC, Azim E. Proprioception. Curr Biol. 2018;28(5):194-203. https://doi.org/10.1016/j.cub.2018.01.064
4. Referans4. Aman JE, Elangovan N, Yeh I, Konczak J. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci. 2015;8:1075. https://doi.org/10.3389/fnhum.2014.01075
5. Referans5. Cappellino F, Paolucci T, Zangrando F, Iosa M, Adriani E, Mancini P, et al. Neurocognitive rehabilitative approach effectiveness after anterior cruciate ligament reconstruction with patellar tendon. A randomized controlled trial. Eur J Phys Rehabil Med. 2012;48(1):17-30.
6. Referans6. Miller AH, Evans K, Adams R, Waddington G, Witchalls J. Shoulder injury in water polo: A systematic review of incidence and intrinsic risk factors. J Sci Med Sport. 2018;21(4):368-377. https://doi.org/10.1016/j.jsams.2017.08.015
7. Referans7. Marzetti E, Rabini A, Piccinini G, Piazzini DB, Vulpiani MC, Vetrano M, et al. Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome: a single-blind randomized controlled clinical trial. Eur J Phys Rehabil Med. 2014;50(3):255-64.
8. Referans8. Fyhr C, Gustavsson L, Wassinger C, Sole G. The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Man Ther. 2015;20(1):28-37. https://doi.org/10.1016/j.math.2014.08.006

9. Referans9. Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. Int Orthop. 2019;43(1):229-35. https://doi.org/10.1007/s00264-018-4150-1
10. Referans10. Contemori S, Biscarini A, Botti FM, Busti D, Panichi R, Pettorossi VE. Sensorimotor control of the shoulder in professional volleyball players with isolated infraspinatus muscle atrophy. J Sport Rehabil. 2018;27(4):371-9. https://doi.org/10.1123/jsr.2016-0183
11. Referans11. Ager AL, Borms D, Deschepper L, Dhooghe R, Dijkhuis J, Roy JS, et al. Proprioception: How is it affected by shoulder pain? A systematic review. J Hand Ther. 2020;33(4):507-16. https://doi.org/10.1016/j.jht.2019.06.002
12. Referans12. Langer L, Osborne R, Rowe RH, Beneciuk JM. Laser testing for upper extremity proprioceptive deficits following rotator cuff injury: two case reports. Physiother Theory Pract. 2020;36(12):1493-501. https://doi.org/10.1080/09593985.2019.15711141
13. Referans13. Lin YL, Karduna A. Errors in shoulder joint position sense mainly come from the glenohumeral joint. J Appl Biomech. 2017;33(1):32-8. https://doi.org/10.1123/jab.2016-0034
14. Referans14. Fabis J, Rzepka R, Fabis A, Zwierzchowski J, Kubiak G, Stanula A, et al. Shoulder proprioception–lessons we learned from idiopathic frozen shoulder. BMC Musculoskelet Disord. 2016;17(1):1-8. https://doi.org/10.1186/s12891-016-0971-5
15. Referans15. Dilek B, Gulbahar S, Gundogdu M, Ergin B, Manisali M, Ozkan M, et al. Efficacy of proprioceptive exercises in patients with subacromial impingement syndrome: a single-blinded randomized controlled study. Am J Phys Med Rehabil. 2016;95(3):169-82. https://doi.org/10.1097/PHM.0000000000000327
16. Referans16. Vafadar AK, Côté JN, Archambault PS. Sex differences in the shoulder joint position sense acuity: a cross-sectional study. BMC Musculoskelet Disord. 2015;16(1):1-7. https://doi.org/10.1186/s12891-015-0731-y
17. Referans17. Uysal SA, Ekinci Y, Çoban F, Yakut Y. Edinburgh el tercihi anketi Türkçe güvenirliğinin araştırılması. JETR. 2019;6(2):112-8.
18. Referans18. Morgan R, Herrington L. The effect of tackling on shoulder joint positioning sense in semi-professional rugby players. Phys Ther Sport. 2014;15(3):176-80. https://doi.org/10.1016/j.ptsp.2013.10.003
19. Referans19. Sole G, Osborne H, Wassinger C. The effect of experimentally-induced subacromial pain on proprioception. Man Ther. 2015;20(1):166-70. https://doi.org/10.1016/j.math.2014.08.009
20. Referans20. Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH. Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol. 2004;91(1):22-9. https://doi.org/10.1007/s00421-003-0933-0
21. Referans21. Dover G, Powers ME. Reliability of joint position sense and force-reproduction measures during internal and external rotation of the shoulder. J Athl Train. 2003;38(4):304.
22. Referans22. Vafadar AK, Côté JN, Archambault PS. Interrater and intrarater reliability and validity of 3 measurement methods for shoulder-position sense. J Sport Rehabil. 2016;25(1): 2014-0309. https://doi.org/10.1123/jsr.2014-0309
23. Referans23. Relph N, Herrington L. Criterion-related validity of knee joint-position-sense measurement using image capture and isokinetic dynamometry. J Sport Rehabil. 2015;24(1): 2013-0119. https://doi.org/10.1123/jsr.2013-0119
24. Referans24. Han J, Waddington G, Adams R, Anson J, Liu Y. Assessing proprioception: a critical review of methods. J Sport Health Sci. 2016;5(1):80-90. https://doi.org/10.1016/j.jshs.2014.10.004
25. Referans25. Elangovan N, Herrmann A, Konczak J. Assessing proprioceptive function: evaluating joint position matching methods against psychophysical thresholds. Phys Ther. 2014;94(4):553-61. https://doi.org/10.2522/ptj.20130103
26. Referans26. Boerboom AL, Huizinga MR, Kaan WA, Stewart RE, Hof AL, Bulstra SK, et al. Validation of a method to measure the proprioception of the knee. Gait Posture. 2008;28(4):610-4. https://doi.org/10.1016/j.gaitpost.2008.04.007
27. Referans27. Rankin G, Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil. 1998 Jun;12(3):187-99. https://doi.org/10.1191/026921598672178340