Evaluation of hip abductor and adductor strength in the elderly: a reliability study

Background

In elderly individuals an increased muscle strength contributes to the diminution of the falls risk and associated adverse events. An increasing interest in lateral control exists due to the fatal consequences of postero-lateral falls. Therefore a proper assessment of frontal plane hip muscle strength in elderly is important but remains challenging.Therefore we aimed to investigate the feasibility and repeatability of a hip abductor and adductor maximum voluntary isometric strength (MVIS) and rate of force generation (RFG) test in elderly. This represents an initial step in the development process of a new and clinically relevant test that could lead to more specific treatment protocols for this population.

Methods

In this measurement focused study hip abduction (ABD) and adduction (ADD) MVIS and RFG were tested twice within one to three hours with a dynamometer fixed to a custom made frame in a geriatric population including fallers and non-fallers. Intraclass correlation coefficient (ICC_agreement), standard error of measurement (SEM), and smallest detectable difference (SDD) were determined.

Results

All recruited persons (N?=?76; mean age (SD) 80.46 (7.05) years old) completed the tests. The average time needed to complete the strength tests was 10.58 min. (1.56) per muscle group. The reliability of the hip ABD and ADD was high with ICC’s_agreement ranging from 0.83 to 0.97. The SDD varied between 18.1 and 81.8% depending on the muscle group and type of strength that was evaluated.

Conclusion

Hip abductor and adductor strength measures in older person are feasible and reliable. However, the significance of moderate changes in these measurements may be limited by the large SDD and SEM. Therefore, physical therapist should be careful when using this measure for assessing the progress of an individual person in a daily clinical use.

     

An automatic robust Bayesian approach to principal component regression

Principal component regression uses principal components (PCs) as regressors. It is particularly useful in prediction settings with high-dimensional covariates. The existing literature treating of Bayesian approaches is relatively sparse. We introduce a Bayesian approach that is robust to outliers in both the dependent variable and the covariates. Outliers can be thought of as observations that are not in line with the general trend. The proposed approach automatically penalises these observations so that their impact on the posterior gradually vanishes as they move further and further away from the general trend, corresponding to a concept in Bayesian statistics called whole robustness. The predictions produced are thus consistent with the bulk of the data. The approach also exploits the geometry of PCs to efficiently identify those that are significant. Individual predictions obtained from the resulting models are consolidated according to model-averaging mechanisms to account for model uncertainty. The approach is evaluated on real data and compared to its nonrobust Bayesian counterpart, the traditional frequentist approach and a commonly employed robust frequentist method. Detailed guidelines to automate the entire statistical procedure are provided. All required code is made available, see ArXiv:1711.06341.     

New public management and professionals in the public sector. What new patterns beyond opposition?

The proliferation of reforms in public administration based on the principles and instruments of the “New Public Management” (NPM) have triggered protest from and collective action by many professional groups in various sectors (healthcare, education, justice, social work, research…) and raised questions about the future of professionals working in the public service, particularly as concerns their autonomy. However, after analyzing the situation, it seems that the opposition between NPM and certain professional groups is not the last word in the debate. Should changes be seen as the decline of professional groups and of their autonomy or as a transformation of professional models, an overhaul of professionalism, etc.? Such questions, which current events in France and Europe have brought to the fore, are food for ongoing sociological thought. They are broached here empirically, from the field, applying varied levels of analysis and research. The contributors to this dossier explore the different forms of tension existing between professional groups and NPM.