Browsing by Person "Coutts, Fiona"

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25. Upper limb morbidity after treatment for breast cancer: A cross-sectional study of lymphedema and function
(2012-11) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Tan, Chee-Wee; Barber, Matthew; Breast Cancer Institute
Introduction: This study explored the prevalence of impaired upper limb function (ULF) and lymphoedema (LO) after breast cancer treatment, their relationships with each other, quality of life, and with patient/treatment characteristics.
A Morbidity Screening Tool for identifying fatigue, pain, upper limb dysfunction and lymphedema after breast cancer treatment: A validity study
(Elsevier, 2013-11-15) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, Wilma; Chetty, Udi; Barber, Matthew; Tan, Chee-Wee
Purpose: This study aimed to investigate validity of a newly developed Morbidity Screening Tool (MST) to screen for fatigue, pain, swelling (lymphedema) and arm function after breast cancer treatment. Methods: A cross-sectional study included women attending reviews after completing treatment (surgery, chemotherapy and radiotherapy), without recurrence, who could read English. They completed the MST and comparator questionnaires: Disability of the Arm, Shoulder and Hand questionnaire (DASH), Chronic Pain Grade Questionnaire (CPGQ), Lymphedema and Breast Cancer Questionnaire (LBCQ) and Functional Assessment of Cancer Therapy questionnaire with subscales for fatigue (FACT F) and breast cancer (FACT B + 4). Bilateral combined shoulder ranges of motion were compared (upward reach; hand behind back) and percentage upper limb volume difference (%LVD =/>10% diagnosed as lymphedema) measured with the vertical perometer (400T). Results: 613 of 617 participants completed questionnaires (mean age 62.3 years, SD 10.0; mean time since treatment 63.0 months, SD 46.6) and 417 completed objective testing. Morbidity prevalence was estimated as 35.8%, 21.9%, 19.8% and 34.4% for fatigue, impaired upper limb function, lymphedema and pain respectively. Comparing those self-reporting the presence or absence of each type of morbidity, statistically significant differences in comparator variables supported validity of the MST. Statistically significant correlations resulted between MST scores focussing on impact of morbidity, and comparator variables that reflect function and quality of life. Conclusion: Analysis supports the validity of all four short-forms of the MST as providing indications of both presence of morbidity and impacts on participants' lives. This may facilitate early and appropriate referral for intervention. 2013 Elsevier Ltd. All rights reserved.
Antecedent anterior cruciate ligament reconstruction surgery and optimal duration of supervised physiotherapy
(IOS Press, 2015-12) Darain, Haider; Alkitani, Abdulhameed; Yates, Christopher; Bailey, Andrea; Roberts, Simon; Coutts, Fiona; Gleeson, Nigel
A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6th, 12th and 24th week post-surgery). The patient scored 30, 56, 60 and 85 on IKDC (maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6th, 12th and 24th week following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12th and 24th week post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session (verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury, immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the patient during the 24 week rehabilitation period. The latter number of physiotherapy sessions was substantially less than the average supervised physiotherapy sessions reported in the literature. 2015 - IOS Press and the authors. All rights reserved.
Classifying Outcome Measures According to the International Classification of Functioning, Disability and Health: a Pilot Study.
(2009-11-25) Williamson, Julia; Bulley, Catherine; Coutts, Fiona; Macmillan, Fiona
at which level of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF) (WHO 2001) a selection of low back pain outcome tools measure. The ICF describes several categories of impact, those on body systems, activity, participation in life roles as well as environmental and personal factors. These categories can be used to relate an outcome measure to the level of the intervention. The results of a study may be compromisedif the outcome measure does not correspond to the level of intervention. For example, a treatment designed to reduce pain should be measured by a tool that measures at a body systems level while an intervention designed to improve return to work needs to measure at the participation level. In order to conduct a trial examining the effects of rehabilitation strategies after lumbar surgery it has been necessary to examine the qualities of commonly used low back pain outcome measures in light of the ICF. Confusion exists as to whether the entities of activity and participation are separate (Dahl 2002). Several attempts have been made to distinguish between the two but as yet, no consensus exists (Granlund2004). It was therefore necessary to define activity and participation and to validate this with a group of qualified health practitioners. J Williamson, C Bulley, F. Coutts, F. MacMillan
Comparison of breast cancer-related lymphedema (Upper Limb Swelling) prevalence estimated using objective and subjective criteria and relationship with quality of life
(Hindawi, 2013-05) Bulley, Catherine; Gaal, S.; Coutts, Fiona; Blyth, Christine; Jack, W.; Chetty, U.; Barber, M.; Tan, Chee-Wee
This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95-10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema. 2013 Catherine Bulley et al.
Congruency and responsiveness of perceived exertion and task duration associated with an intermittent isometric fatigue task
(Elsevier, 2021-11-21) Peer, M. A.; Gallacher, P. D.; Coutts, Fiona; Gleeson, Nigel
Purpose: The shift away from supervised rehabilitation towards greater self-management requires that people are able to accurately self-monitor their exercise performance and exertion and apply appropriately dosed exercise to achieve optimal outcomes. An extended period of sub-optimal exercise may result in insufficient physiological stress to restore knee function and recovery to a level of PA similar to asymptomatic peers. Subsequently greater post-operative healthcare burdens may be imposed on limited NHS resources. It is currently unclear whether measures of exercise self-perception of exertional stress (CR-10 and perceived task duration [PTD]) demonstrate a similar pattern of change in a clinical population such as total knee arthroplasty (TKA) and thus, may be recommended as a scale for regulating exercise performance during resistance training. The aim was to enhance the understanding regarding whether people are able to accurately calibrate self-perceived exercise performance capability and perceptions of exertional stress. Further, this study intended to identify whether perceived exertion offers a precise reflection of task duration.
Does a mobile-bearing, high-flexion design increase knee flexion after total knee replacement?
(British Editorial Society of Bone and Joint Surgery, 2012-08) Nutton, R. W.; Wade, F. A.; Coutts, Fiona; van der Linden, Marietta
This prospective randomised controlled double-blind trial compared two types of PFC Sigma total knee replacement (TKR), differing in three design features aimed at improving flexion. The outcome of a standard fixed-bearing posterior cruciate ligament-preserving design (FB-S) was compared with that of a high-flexion rotating-platform posteriorstabilised design (RP-F) at one year after TKR. The study group of 77 patients with osteoarthritis of the knee comprised 37 men and 40 women, with a mean age of 69 years (44.9 to 84.9). The patients were randomly allocated either to the FB-S or the RP-F group and assessed pre-operatively and at one year postoperatively. The mean post-operative non-weight-bearing flexion was 107 (95% confidence interval (CI) 104 to 110)) for the FB-S group and 113 (95% CI 109 to 117) for the RP-F group, and this difference was statistically significant (p = 0.032). However, weight-bearing range of movement during both level walking and ascending a slope as measured during flexible electrogoniometry was a mean of 4 lower in the RP-F group than in the FB-S group, with 58 (95% CI 56 to 60) versus 54 (95% CI 51 to 57) for level walking (p = 0.019) and 56 (95% CI 54 to 58) versus 52 (95% CI 48 to 56) for ascending a slope (p = 0.044). Further, the mean post-operative pain score of the Western Ontario and McMaster Universities Osteoarthritis Index was significantly higher in the RP-F group (2.5 (95% CI 1.5 to 3.5) versus 4.2 (95% CI 2.9 to 5.5), p = 0.043). Although the RP-F group achieved higher non-weight-bearing knee flexion, patients in this group did not use this during activities of daily living and reported more pain one year after surgery. 2012 British Editorial Society of Bone and Joint Surgery.
Early initiation of home-based sensori-motor training improves muscle strength, activation and size in patients after knee replacement: A secondary analysis of a controlled clinical trial
(Springer Nature, 2019-05-17) Moutzouri, Maria; Coutts, Fiona; Gliatis, John; Billis, Evdokia; Tsepis, Elias; Gleeson, Nigel
Background There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR.
Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial
(SAGE Publications, 2018-02-23) Moutzouri, Maria; Gleeson, Nigel; Coutts, Fiona; Tsepis, Elias; John, Gliatis
Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8-weeks post surgery, and 14-weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45-minutes). Results: Consistently greater improvements (F2,98-=-4.3 to 24.8; P-<-0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8--2.9-seconds vs. 4.6--2.6-seconds); balance (2.1--0.9 vs. 0.7--1.2); joint position error (13.8--7.3 vs. 6.2--9.1); Knee Outcome Survey Activities of Daily Living Scale (44.2--11.3 vs. 26.1--11.4); and pain (5.9--1.3-cm vs. 4.6--1.1-cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3-6.5. Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.
Effects of tuning of ankle foot orthoses-footwear combination using wedges on stance phase knee hyperextension in children with cerebral palsy-Preliminary results
(Taylor & Francis, 2009-10-12) Jagadamma, Kavi; Coutts, Fiona; Mercer, Tom; Herman, J.; Yirrell, Jacqueline; Forbes, L.; van der Linden, Marietta
Purpose. This pilot study investigated the feasibility of reducing stance phase knee hyperextension in children with cerebral palsy by tuning the ankle foot orthoses-footwear combination (AFO-FC) using different sizes of wedges. Methods. Five children with cerebral palsy underwent three dimensional gait analysis and tuning of their AFO-FC using wedges. Data analysis was carried out by comparing relevant gait parameters between the non-tuned and tuned prescription. Results. Knee hyperextension during stance significantly decreased, and the shank to vertical angle was closer to normal after tuning. Although none of the other parameters showed statistically significant changes, the wide confidence intervals and lack of power indicated the likelihood of a type II error. Further, it was noted that the influence of tuning on temporalspatial parameters was different between children with diplegia and those with hemiplegia. It was estimated that a sample size of 15 is required to detect significant changes at p_0.05 and power of 0.8. Conclusions. The findings of this study clearly indicate the potential clinical utility of tuning using wedges to correct knee hyperextension during the stance phase in children with cerebral palsy. However, observations support the need for an adequately powered study to assess the long-term effects of tuning on gait parameters, activity level and quality of life.
Effects of tuning of the Ankle Foot Orthoses Footwear Combination (AFOFC) on the stance phase knee kinematics of children with cerebral palsy(CP) during gait.
(Edizioni Minerva Medica, 2008) Jagadamma, Kavi; Coutts, Fiona; Mercer, Tom; Herman, J.; Yirrell, Jacqueline; Hogg, L.; van der Linden, Marietta
Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle
(Maney Publishing, 2012-11) Barbero, Marco; Bertoli, P.; Cescon, C.; Macmillan, Fiona; Coutts, Fiona; Gatti, Roberto
Objectives: Myofascial trigger points (MTrPs) are considered the principal clinical feature of myofascial pain syndrome (MPS). An MTrP consists of spot tenderness within a taut band of muscle fibers and its stimulation can produce both local and referred pain. The clinical diagnosis of MPS depends on correct history taking and a physical examination aimed at identifying the presence of MTrP. The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle. Methods: Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values. Results: The intraclass correlation coefficient ICC(1,1) values were 0.62 (95% CI: 0.30-0.81) for X and 0.81 (95% CI: 0.61-0.91) for Y. The Bland-Altman plots for X and Y showed a mean of difference of 0.04 and -0.2 mm, respectively. Limits of agreement for X ranged from -26.3 to 26.2 mm and for Y from -27 to 26.4 mm. Discussion: The ICC(1,1) for the observed values revealed a moderate to high correlation and the Bland-Altman analysis showed means of difference very close to zero with narrow limits of agreement. An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol.
Measurement of lower limb volume: Agreement between the vertically oriented perometer and a tape measure method
(Elsevier Science B.V. Amsterdam, 2013-09) Tan, Chee-Wee; Coutts, Fiona; Bulley, Catherine
Objective: To investigate the agreement between lower limb volume measurements for the vertically oriented perometer and a tape measure method. Design: Between-methods agreement and test-retest reliability study. Setting: University setting. Participants: Thirty university staff and students were recruited using convenience sampling with no participant drop-outs. Interventions: All participants' dominant lower limb volumes were measured using the vertically oriented perometer and a tape measure method. Main outcome measures: The Bland-Altman difference plot was reported for determining the bias between the two methods and its 95% confidence interval. Test-retest reliability and the measurement error for the perometer method were determined using the ICC(2,1) model and within-subject standard deviation (sw) respectively. Results: There was a lack of agreement between the tape measure and perometer method. The Bland-Altman difference plot showed that the tape measure method overestimated limb volume by 157 ml compared to the perometer method. A 95% confidence interval of -834 ml to 519 ml was observed. The test-retest reliability of the perometer method was ICC(2,1) = 0.99. The measurement error of the perometer method was clinically acceptable (sw = 121 ml). Conclusions: There was a lack of agreement between the two methods investigated. Therefore the perometer and tape measure methods are not interchangeable. It is recommended that future validity and reliability studies for the vertically oriented perometer are conducted on clinical populations. 2012 Chartered Society of Physiotherapy.
Myofascial trigger points and innervation zone locations in upper trapezius muscles
(BioMed Central, 2013-06) Barbero, Marco; Cescon, Corrado; Tettamanti, Andrea; Leggero, Vittorio; Macmillan, Fiona; Coutts, Fiona; Gatti, Roberto
Background Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius. Methods We screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject's trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants. Results No significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 5.8 mm. Conclusions According to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.
Optimising the effects of rigid ankle foot orthoses on the gait of children with cerebral palsy (CP) - an exploratory trial
(Informa Healthcare, 2014-04-24) Jagadamma, Kavi; Coutts, Fiona; Mercer, Tom; Herman, J.; Yirrell, Jacqueline; Forbes, L.; van der Linden, Marietta
Purpose: This exploratory trial investigated the effects of rigid ankle foot orthoses (AFO) with an optimally cast Angle of the Ankle in the AFO (AAAFO) on the gait of children with Cerebral Palsy (CP), and whether tuning of the AFO - Footwear Combination (AFO-FC) further affected gait. Methods: Eight children with CP underwent gait analysis and tuning of their AFO-FCs using a 3-D motion analysis system. Comparisons were carried out for selected gait parameters between three conditions - barefoot, non-tuned AFO-FC and tuned AFO-FC. Results: In comparison to barefoot gait, walking with a non-tuned AFO-FC produced significant (p50.05) improvements in several key gait parameters. Compared to the non-tuned AFO-FC, on average a tuned AFO-FC produced a significant reduction in peak knee extension and knee ROM during gait. However, when examined as case studies, it was observed that the type of gait pattern demonstrated while wearing a non-tuned AFO-FC affected the outcomes of tuning. Conclusions: The findings of the current study indicate the potential benefits of using rigid AFO-FC with optimal AAAFO and tuning of AFO-FCs. This study emphasises the need for categorising children with CP based on their gait patterns when investigating the effects of interventions such as AFOs.
Peri-surgical change in objective functional, neuromuscular and sensorimotor performance of people awaiting total knee arthroplasty
(Elsevier, 2021-11-21) Peer, M. A.; Gallacher, P. D.; Coutts, Fiona; Gleeson, Nigel
Purpose: Total knee replacement (TKA) surgery is acknowledged as an effective management option to reduce pain symptoms, improve perceived function and quality of life. Nevertheless, considerable impairment of physical function and aberrant neuromuscular alterations often persist following surgery intervention and the reason for this is unclear. Accordingly, there is a need to examine objectively peri-surgical performance capabilities and neurophysiological changes of this clinical population to optimise the constituents and dosages for effective exercise conditioning interventions. The aim of this study was to perform a single-leg contra-lateral control limb model to investigate peri-TKA surgery and conditioning-related changes in objective measures of physical function and neuromuscular and sensorimotor performance.
Perometry limb volume measurement: Protocol development and reliability
(2013-12) Bulley, Catherine; Coutts, Fiona; Tan, Chee-Wee
Aims: Perometry measurement of limb volume involves non-invasive optoelectronic scanning and is increasingly used due to its practicality and increasing evidence for its validity. This study aimed to develop a standardized protocol for the measurement of upper and lower limb volume using a vertical perometer (400T) and test its reliability. Methodology: Multiple pilot studies were conducted in a laboratory-based setting to investigate specific procedural questions and develop the final standardized protocol. This included elements such as standardization of the proportion of limb being measured, and of limb positioning within the perometer frame. The standardized protocol was tested for inter-and intra-rater reliability in two raters, on two separate test occasions, 24-48 h apart. The study included 30 volunteers with no known clinical conditions (n = 23 women, seven men; mean age 23). Major findings: High intra-class correlation coefficient (ICC) values resulted for intra-rater and inter-rater reliability in the upper and lower limbs (0.953-0.989). Limits of agreement analysis demonstrated less positive results, however. Principal conclusion: The results provide support for the use of this protocol to increase standardization and comparability of measurement in clinical and research contexts. Further investigation in different clinical populations is required. 2013 Informa Healthcare.
Perometry measurement of lower limb volume: an investigation of criterion validity.
(2007-06) Bulley, Catherine; Coutts, Fiona; Grainger, Andrew
PURPOSE: This study aimed to develop a measurement protocol for the Perometer (400T) and compare it with the tape measure method for the calculation of lower limb volume in healthy individuals. RELEVANCE: A variety of musculoskeletal, vascular and neurological conditions impact on limb volume, therefore its measurement is important in their management. It is frequently measured using geometric calculations from limb circumferences using a tape measure (TM). The Perometer (P) optoelectronic imaging device demonstrates potential to become a gold standard of measurement. However, there is a lack of standardised protocol and research into its validity in the lower limb. PARTICIPANTS: Thirty healthy volunteers participated in the study (22 women, 8 men; mean age 26.0; mean height 67.2 cm; mean weight 171.0 kg). Individuals were excluded if they had relevant specified past medical history. The study was approved by an ethics committee at Queen Margaret University College. METHODS: Pilot work was undertaken to establish a standardised limb position, lower limb landmarks and a percentage of limb length for measurement. Participants were requested to avoid vigorous exercise and alcohol consumption 24 hours prior to testing, and food/fluid intake one hour before. After a 15-minute rest period with the limb elevated to 90 degrees, standardised reference marks were placed to indicate the start and end of TM and P volume calculations. The dominant limb was placed within the P frame in a standardised position. Three P measurements were taken, followed by TM measurements at three-centimetre intervals. Volumes in ml were calculated between the two reference marks using the P computer software and using the TM Disc model method (Man et al, 2004: Clinical Physiology and Functional Imaging. 24: 352- 358). ANALYSIS: Statistical analysis involved testing for normality of distribution before using parametric inferential statistics: an ICC (3,1) was used to assess the correlation, and limits of agreement were calculated to assess the degree of agreement, between P and TM limb volume estimates. RESULTS: Limb volume calculations (mean of 3 readings) were 8560 ml (P) and 8717 ml (TM), with a difference of 157 ml. Data were normally distributed (Shapiro-Wilk: p = 0.268 P; 0.602 TM). While the ICC (3,1) indicated good associations between the two measures (r = 0.952), limits of agreement analysis indicated that 95% of the time P limb volume estimates will be between 519 ml greater, and 834 ml less than TM estimates, indicating 15.67% variation, and poor agreement. CONCLUSIONS: Results indicated poor agreement and therefore measurement methods are not interchangeable. However, results cannot determine the respective accuracy of each method. IMPLICATIONS: This was the first study to calculate limits of agreement between estimates of lower limb volume using the TM method and upright 400T model of Perometer. Further work is needed in relation to different aspects of validity and reliability to determine which method is more accurate and should therefore be used as a gold standard
Perometry measurement of lower limb volume: an investigation of criterion-related validity
(2006-10) Coutts, Fiona; Geraghty, M.; Bulley, Catherine
Prevalence and impacts of upper limb morbidity after treatment for breast cancer: a cross-sectional study of lymphedema and function.
(2013) Bulley, Catherine; Coutts, Fiona; Blyth, Christine; Jack, W.; Chetty, U.; Barber, M.; Tan, Chee-Wee; Breast Cancer Institute
A cross-sectional study screened lymphedema, impaired upper limb function (ULF) and quality of life (QOL) in women post-breast cancer. Women attending review appointments who had completed surgery, chemotherapy and radiotherapy, were without recurrence, and could complete questionnaires in English were invited. Medical records were reviewed and questionnaires completed: the Morbidity Screening Tool (MST), Disability of the Arm, Shoulder and Hand questionnaire (DASH), and Functional Assessment of Cancer Therapy for breast cancer QOL questionnaire (FACTB+4). The vertical perometer (400T) measured percentage upper limb volume difference (%LVD), with 10% or greater difference diagnosed as lymphedema. Of 617 participants (mean age 62.3y, SD 10.0; mean time since treatment 63.0 months, SD 46.6), sufficient questionnaire data were available for 613 and perometry data for 417. Using the MST, 21.9% self-reported impaired ULF, 19.8% lymphedema, and 9.2% both. Based on %LVD, 26.5% had lymphedema. Histogram analysis for individuals in the first eight twelve-month intervals after treatment found impaired ULF prevalence peaked at three to five years and lymphedema at three years. Significantly worse function (DASH) and QOL (FACT B+4) resulted for those with morbidity (p<0.000). This provides evidence that impaired ULF and lymphedema negatively affect QOL years after treatment and are not necessarily linked.