Research Report Abstracts - Gesundheit

eS1012
Research Report Platform Presentation
Number: RR-PL-2757 Tuesday 21 June 09:00
RAI: Forum
USING SONOGRAPHY FOR THE EVALUATION OF
TENDON PATHOLOGY IN TENNIS ELBOW:
RELIABILITY OF ASSESSMENT SCALES
Poltawski L., Watson T.
University of Hertfordshire, School of Health & Emergency
Professions, Hatfield, United Kingdom
Purpose: Sonography may be used for diagnosis and monitoring
tissue changes in tendinopathic disorders such as
tennis elbow. Despite its growing use in clinical and research
contexts, its reliability for measuring change has received
little attention. In this study, sonographic scales of tendon
structural abnormality and hyperaemia in tennis elbow were
developed and their reliability evaluated.
Relevance: Sonographic assessment of tennis elbow can provide
valuable information to both researchers and clinicians:
it can help elucidate the relationship between tissue changes
and clinical manifestations of the disorder; and it may enable
identification of stages or forms of tendinopathy that respond
better to different management strategies. Reliability of the
measurement process is key to sonography’s utility in these
applications.
Participants: The lateral elbows of twenty people with a clinical
diagnosis of tennis elbow were assessed sonographically
twice, 1–2 weeks apart.
Methods: Assessment was conducted by a physiotherapist
who had received focussed training in musculoskeletal
sonography and supervised experience in imaging the lateral
elbow. A standard assessment protocol was developed,
involving longitudinal and transverse greyscale and Power
Doppler imaging of the common extensor tendon. Representative
one-minute greyscale movie clips and static Doppler
images were recorded for subsequent independent analysis
by the physiotherapist and by a radiologist with 10 years’
experience of musculoskeletal sonography. Tendon thickening,
hypoechogenicity, fibrillar disruption and calcification
were rated on a 4-point severity scale, and hyperaemia was
rated on a 5-point scale. Ratings were based on subjective estimations
of the physical extent of the abnormality. Ratings of
greyscale features were aggregated to form a 16-point overall
scale of structural abnormality.
Analysis: Inter-rater reliability was evaluated by comparing
ratings by the physiotherapist and the radiologist of images
recorded at one of the assessment points. Test–retest reliability
was evaluated by comparing ratings carried out by the
physiotherapist at both assessment points. The Intra-class
Correlation Coefficient (ICC) was used as an indicator of
reliability, and minimum detectable change (MDC) values
were calculated for the aggregate greyscale and hyperaemia
scores.
Results: Inter-rater ICC for individual features ranged
from 0.35 (95%CI 0.05–0.60) for fibrillar disruption
to 0.77 (0.55–0.88) for aggregate greyscale score and
0.89 (0.79–0.95) for hyperaemia score. Test–retest ICC
ranged from 0.70 (0.48–0.84) for tendon thickening to
0.82 (0.66–0.90) for aggregate greyscale score and 0.78
(0.58–0.89) for hyperaemia score. MDC values for aggregate
and hyperaemia scores were 2.0 and 1.1 respectively.
Conclusions: The study suggests that the aggregate greyscale
and hyperaemia scoring systems can be used with reasonable
reliability for rating severity and quantifying changes in tendon
abnormalities in tennis elbow; it also demonstrates also
that a physiotherapist with focussed training can image and
rate tendinopathy in tennis elbow. The scale does not address
some potentially significant features, such as frank tears and
cortical irregularity, however.
Implications: This is the first published reliability study for
sonographic rating in tennis elbow. Further definition and
validation of the scales is required, but they have potential
for use in clinical trials and clinical practice.
Keywords: Sonography; Tennis elbow; Reliability
Funding acknowledgements: None received.
Ethics approval: provided by the School of Health &
Emergency Professions Ethics Committee of the authors’
institution.
Research Report Platform Presentation
Number: RR-PL-3924 Thursday 23 June 09:15
RAI: E106-107
BALANCE IMPROVEMENT IN PATIENTS WITH
PARKINSON’S DISEASE AFTER MOTOR AND
COGNITIVE TRAINING
Pompeu J., Mendes F., Silva K., Mondenesi A., Oliveira T.,
Peterson A., Piemonte M.E.P.
Universidade de São Paulo, Fisioterapia, São Paulo, Brazil
Purpose: The aim of this study was to compare the effectiveness
of motor and cognitive training versus motor training
alone for improving balance and functional performance in
PD patients.
Relevance: Postural instability is one of the most incapacitating
symptoms of PD since it leads to progressive loss
of patients’ independence in activities of daily living. This
symptom is the least responsive to medication, enhancing
the importance of physiotherapeutic treatment. However, it is
known that deficiency in control of the automatic responses,
essential for balance, secondary to PD is associated to the
postural instability presented by these patients who are more
susceptible to falls during tasks of divided attention. Thus,
a training program was devised to improve balance in PD
patients in which automatic balance responses were stimulated
under conditions of high cognitive demand.
Participants: 20 patients with idiopathic PD, mean age of
65.7 years (S.D. = 8.24), 12 men and 8 women, at stages 1
and 2 of the disease according to the Hoehn and Yahr Clas-