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What Is the Accuracy of Shoulder Range of Motion Measurements on Physical Exam?

Open Journal of Orthopedics 2015年第9期5卷 264-276页

作者： yousef shishani Janice Flocken Reuben Gobezie Shoulder and Elbow Surgery The Cleveland Shoulder Institute Beachwood USA

The purpose of this study is to investigate a new method for measuring shoulder range of motion (ROM) in an orthopedic practice utilizing a smartphone application to improve accuracy from physical exam typically used in research. Our aim is to evaluate the application, Physio2Go (P2G), which uses a virtual goniometer, assessing validity by comparing its measurements to those taken by a universal goniometer (UG). Two observers of varying clinical experience, a research assistant and research fellow, compared measurements. Statistically, we used the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and the Pearson correlation coefficient (PCC). Following validation we tested P2G in symptomatic postoperative shoulder patients measuring forward flexion (FF) and external rotation (ER). We compared P2G measurements to visual estimation (VE) done by a fellowship trained orthopedic surgeon. Statistically we used ICC, Bland- Altman plots with 95% limits of agreement (LOA), and scatter plots. We examined the impact of the application using Welch’s t-test comparing pre-to-postoperative ROM improvements using the values obtained by P2G and VE. We found high intra-rater reliability of P2G for both observers, substantial correlation between UG and P2G measurements, highly correlated inter-observer reliability for UG and P2G, and statistically significant PCC values (p < 0.05). As expected, ROM measurements of symptomatic patients comparing P2G and VE measurements demonstrated lower correlation. Bland-Altman plots demonstrated wide confidence intervals;scatterplots and histograms confirmed low agreement among measurement methods. Clinical application demonstrated varying statistical significance depending on whether measurements were done by P2G or VE. Our study found that P2G provided superior reliability compared to the customary physical exam routinely used for orthopedic research. The value of using this application instead of a UG is the ease of

关键词： Shoulder Range of Motion Digital Assessment Goniometry Smartphone Application

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The Impact of Joint Replacement on Driver Function and Safety

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Open Journal of Orthopedics 2012年第3期2卷 121-125页

作者： Stephanie J. Muh yousef shishani Jonathan Streit Carissa Ann Lucas Vinod Sahgal Matthew Kraay Reuben Gobezie Case Shoulder and Elbow Service Case Western Reserve University School of Medicine University Hospitals of Cleveland Cleve- land USA Cleveland Shoulder Institute University Hospitals of Cleveland Cleveland USA Department of Hematology/Oncology—Solid Tumor Department The Cleveland Clinic Cleveland USA Department of Orthopaedics Case Western Reserve University School of Medicine University Hospitals of Cleveland Cleveland USA

Background: The timing of return-to-driving following total joint replacement has not been well-defined. The primary aim is to study the impact of joint replacement on driver safety. A secondary aim is to investigate the possible predictors for increased car accidents in patients undergoing total joint replacement surgery. This data will provide the background to support further prospective studies on the relationship of driver safety to joint replacement surgery. Methods: A retrospective analysis of driver safety in the postoperative period was performed by analyzing the self-reporting of 485 patients who had undergone a Total Hip Arthroplasty (n = 196), Total Knee Arthroplasty (n = 258) or Total Shoulder Arthroplasty (n = 31). The mean age was 70 (28 - 88) with 164 male (34%) and 319 female (66%). Patients were mailed a questionnaire and the responses were analyzed to determine what factors affect driving after joint replacement. Results: Overall, increased patient age and gender were associated with increased accidents following surgery. Our subgroup analysis demonstrated that in patients undergoing TSA, increased patient age was associated with increased accidents. TKA patients showed that older patient age predicted increased accidents following surgery. Conclusions: While age and gender are correlated with increased accidents after joint replacement in general, no factors specific to joint replacement surgery are related to increased incidence of accidents.

关键词： Total Hip Arthroplasty Total Knee Arthroplasty Total Shoulder Arthroplasty Driving Driver Safety Traffic Accidents

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Cigarette use attitudes and effects of acculturation among Arab immigrants in USA: A preliminary study

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Health 2012年第10期4卷 785-793页

作者： Linda Haddad Omar El-Shahawy Kawkab shishani Hala Madanat Sukaina Alzyoud Department of Family and Community Health & Institute for Drug and Alcohol Studies Faculty of Nursing Virginia Department of Social and Behavioral Health School of Medicine Virginia Commonwealth University Richmond USA Graduate School of Public Health San Diego State University San Diego USA Hashemite University School of Nursing Zarqa Jordan Washington State University Spokane Washington USA

The purpose of this study is to explore cigarette use patterns, which include current use, beliefs, attitudes, attempts to quit, and acculturation, among Arab immigrants. A sample of self-identified Arab immigrants (221) living in the Richmond, VA metropolitan area was recruited from Middle Eastern groceries, restaurants/lounges, and faith and charitable organizations. Men in this sample had higher rates of cigarette smoking (67.6%) than the rest of the general adult US population. Many smokers in the study had the desire to quit and had made attempts to quit. Further analysis of acculturation in relation to the risk of not considering quitting was performed using logistic regression. The older an individual was when he/she moved to the US (OR = 0.93, CI: 0.87, 0.98) and the more time an individual had spent in the US (OR = 0.93, CI: 0.88, 0.98) contributed significantly to the least number of quit attempts. Further random sampling and study is needed to confirm the high prevalence of tobacco use among this minority group.

关键词： Arab Immigrants Tobacco Smoking Acculturation Minority Smoking

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