Magister Scientiae Dentium - MSc(Dent) / Aim: The aim of this study was to investigate the accuracy, intra- and inter-observer reliability of identifying occlusal markings made by articulating paper on complete dentures intra-orally. Methods: A series of photographs of 14 tissue borne complete dentures with occlusal markings was obtained. Articulating paper was used intra-orally at the delivery visit to make the occlusal markings. The denture sets were divided into two groups. Group 1 comprised pictures of the 14 complete lower dentures on their own, and group 2 comprised pictures of the same 14 lower dentures together with their opposing upper denture. The two groups of images were loaded into a Microsoft PowerPoint presentation as well as Keynote. Two experienced observers analysed the complete dentures independently and noted the number and distribution of the markings that they felt required adjustment. They differed, but discussed these and reached consensus. These data served as the control. Three groups of observers (10 per group) were then asked to analyse the occlusal markings of the 2 groups of denture images twice, with a two-week interval between each assessment. Before each subsequent assessment, the images were randomised by means of computer-generated random number sequence. The mean number of markings was established for each group and compared with the control mean. Intra-rater reliability was established by comparing the difference of the means of sequential observations for each rater by establishing the z-value. Inter-rater reliability within each group was established by means of analysis of variance. Results: Considering all the data, in only 17 instances (of the possible 60), did observers’ mean scores not differ from the control mean scores with good intra-rater reliability. In all other 43 instances the observers’ mean scores differed from the control mean scores and/or displayed poor intra-rater reliability. Considerable variation in inter-rater reliability was also found within every group of observers. Conclusion: The results indicate that observers are generally unable to reliably identify occlusal markings warranting occlusal adjustment, made by articulating paper on a lower complete denture. Clinical significance: Articulating paper should not be used intra-orally when delivering removable complete dentures.

Bakgrund En handhållen dynamometer (HHD) är ett kliniskt användbart mätverktyg för att mäta muskelstyrka. På Akademiska sjukhuset i Uppsala finns en HHD av märket MicroFET2® (Hoggan Scientific). Det finns ett fåtal studier gjorda som undersöker intrabedömarreliabiliteten vid mätningar av isometrisk muskelstyrka av knäledens muskelgrupper med denna dynamometer. Syfte Syftet med studien var att undersöka den absoluta och relativa reliabiliteten vid mätningar av maximal muskelstyrka i knäledens muskelgrupper med en HHD. Metod Psykometrisk design med test-retest förfarande. Totalt undersöktes 24 friska vuxna vid två mättillfällen med 6–8 dagars mellanrum. Den relativa reliabiliteten presenterades med Intraclass correlation coefficient (ICC 2,1). Den absoluta reliabiliteten presenteras i standard error of measurement (SEM), SEM% samt smallest detectable change (SDC). Resultat Resultaten visade mycket hög relativ reliabilitet för knäledens extensioner (ICC = 0,950,96) och för knäledens flexorer (ICC = 0,94–0,96). SEM varierade mellan 33,58N-34,81N för knäledens extensorer och 14,16N-17,16N för knäledens flexorer. SDC varierade mellan 93,08N–96,49N för knäledens extensorer och 39,25N-47,57N för knäledens flexorer. Konklusion Resultaten indikerar att HHD har mycket hög relativ reliabilitet för bedömning av styrka i knäledens stora muskelgrupper hos ett bekvämlighetsurval med friska vuxna människor.  Den relativa och absoluta reliabiliteten bedömdes överlag vara i enlighet med tidigare studier. För implementering i klinik behöver framtida studier utvärdera absolut och relativ reliabilitet på specifika patientpopulationer. / Background Hand held dynamometry (HHD) is a practical device for testing muscle strength. There is currently a HHD (MicroFET2® - Hoggan Scientific) available at Uppsala University hospital. Few reliability studies excist where the objective is to examine the intra-rater reliability of isometric maximal knee-strength using this device. Objective To examine the absolute and relative reliability of isometric maximal knee-strength using a MicroFET2. Method Psychometric design through test-retest with 6–8 days between measures on 24 healthy adults. The relative reliability expressed as Intra-class correlation coefficient (ICC 2,1) and the absolute reliability as standard error of measurement (SEM), SEM%, and smallest detecatble change (SDC). Results The results of this study showed very good reliability for both knee extensors (ICC = 0,950,96) and knee flexors (ICC = 0,94–0,96). Regarding the absolute reliability SEM ranged from 33,58N-34,81N for knee extensors and 14,16N-17,16N for knee flexors. SDC ranged from 93,08N-96,49N for knee extensors and 39,25N-47,57N for knee flexors. Conclusion The results indicate that HHD has a very good relative reliability for assessing strength in the large muscle groups of the knee joint when examined on a group of healty adults. The relative and absolute reliability was generally in accordance when compared with previous studies. Before being implemented in praxis, future studies need to evaluate absolute and relative reliability on specific patient populations.

Problem Statement: Because of the lack of evidence in support of a pathology-based approach to low back pain (LBP), many researchers advocate the use of classification systems that classify patients with LBP based on common clinical characteristics. Treatment based on direction tolerance can improve circulation, diminish pain and inflammation, restore normal motion, and reduce fear-avoidance beliefs. Treatment performed in the standing position can functionally integrate related regions of the body, can replicate normal tissue loading in standing position, replicate normal proprioceptive demands of motion performed in standing position, and address underlying movement impairments in related regions that may contribute to compensatory tissue pathology in the low back. The problem is that none of the existing functional classification systems for evaluation and treatment of LBP are designed for this purpose. The Direction Tolerance System (DTS) is a new functional classification system that is based on direction tolerance and performed entirely in the standing position. Objectives: The purpose of this research was to investigate the reliability, outcome, and prognostic ability of the DTS for evaluation and treatment of LBP. Methods: This exploratory research was a prospective cohort study with 60 patients seeking physical therapy (PT) for treatment of LBP by 5 different therapists. All patients were evaluated and treated for 8 visits using the DTS. Reliability was measured by comparing DTS scores (DTI) on visits 1 and 2. DTS treatment consisted of a scripted flexibility and strengthening exercise program based on motions that were determined to be non-aggravating during the DTS examination. Outcome was assessed using the DTI, modified Oswestry Disability Questionnaire (ODQ), Numeric Pain Rating Scale (NPRS) and Fear-Avoidance Beliefs Questionnaire Physical Activity Subscale (PABQ-PA). Baseline variables were assessed for correlation with successful outcome and ability to predict a successful outcome. Results: (1) Group intra-rater reliability between visits 1 and 2 using ICC (3,1) was good (.80, p<.001); (2) The group success rate was 62%, which exceeded the expected 50% success rate. (3) Baseline variables were not associated with a successful outcome and did not significantly predict a successful outcome. Discussion: The DTS is a simple, reliable and effective method of evaluating and treating LBP, and with proper training, can be used by clinicians.