Nathan J Hunt

Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England, United Kingdom

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Publications (5)8.58 Total impact

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    ABSTRACT: Background: This paper assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) Score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD). Methods: Fifty patients were recruited, providing 130 completed datasets over 12months. The NPI Score, Lysholm Knee Score, Tegner Level of Activity Score and isometric knee extension strength were assessed at baseline, six weeks, six and 12months post-injury. Results: There was high convergent validity with a statistically significant correlation between the NPI Score and the Lysholm Knee Score (p<0.001), Tegner Level of Activity Score (p<0.001) and isometric knee extension strength (p<0.002). Principal component analysis revealed that the NPI Score demonstrated good concurrent validity with four components account for 70.4% of the variability. Whilst the NPI Score demonstrated a flooring-effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency with a Cronbach Alpha value of 0.93 (95% CI: 0.91 to 0.93). The NPI Score was responsive to change over the 12months period with an effect size of 1.04 from baseline to 12months post-injury. Conclusions: The NPI Score is a valid tool to assess patellar instability symptoms in people conservatively managed following FTPD. Level of evidence: Level II.
    Full-text · Article · Jan 2016 · The Knee
  • TO Smith · R Chester · N Hunt · JL Cross · A Clark · ST Donell

    No preview · Article · Aug 2015 · International Journal of Therapy and Rehabilitation
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    T O Smith · R Chester · J Cross · N Hunt · A Clark · S T Donell
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    ABSTRACT: We aimed to define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscle strengthening following first-time patellar dislocation (FTPD). Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or a specific-VM exercise and rehabilitation regime (n=25). The primary outcome was the Lysholm knee score, and secondary outcomes included the Tegner Level of Activity score, the Norwich Patellar Instability (NPI) score, and isometric knee extension strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12months. There were statistically significant differences in functional outcome and activity levels with the Lysholm knee score and Tegner Level of Activity score at 12months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% confidence interval (CI): -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI score and isometric strength at any follow-up interval. The trial experienced substantial participant attrition (52% at 12months). Whilst there was a statistical difference in the Lysholm knee score and Tegner Level of Activity score between general quadriceps and VM exercise groups at 12months, this may not have necessarily been clinically important. This trial highlights that participant recruitment and retention are challenges which should be considered when designing future trials in this population. Therapeutic study, Level I. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Apr 2015 · The Knee
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    Toby O Smith · Nathan J Hunt · Simon T Donell
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    ABSTRACT: The quadriceps or Q-angle is an index of the vector for the combined pull of the extensor mechanisms and the patellar tendon. It is used as an indicator for patellofemoral joint dysfunction. The purpose of this article is to systematically review and appraise the literature to determine the reliability and validity of this test. An electronic database search was performed accessing AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, ovid Medline, Physiotherapy Evidence Database (PEDro), PsycINFO, Pubmed and Zetoc to April 2008. All English language, human subject, clinical trials, assessing the inter- or intra-tester reliability, or the criterion validity, were included. The Critical Appraisal Skills Programme appraisal tool was used to establish the methodological quality of each study. Ten articles including 569 control and 179 patellofemoral disorder knees were reviewed. The findings suggest that there is considerable disagreement on the reliability and validity of the clinical Q-angle measurement. This may be due to a lack of standardisation in the measurement procedure. Further study is advocated to re-evaluate this topic using well-designed, and sufficiently large observational studies of specific patellofemoral dysfunction populations.
    Full-text · Article · Nov 2008 · Knee Surgery Sports Traumatology Arthroscopy
  • Toby O Smith · Nathan J Hunt · Sarah J Wood
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    ABSTRACT: Muscle haematomas may present in athletes following a muscle tear or contusion injury. The objective of this literature review was to examine the literature pertaining to the physiotherapeutic management of muscle haematomas. An electronic literature search was performed of the databases AMED, Cinahl, Embase, PEDro and Ovid Medline from their inception to April 2006. Human and animal subject, clinical trials, written in English, which could assist in the assessment of this topic, were included. Seventeen (of 7794) papers met the inclusion criteria and were reviewed. The review concluded that few clinical trials have been published assessing the efficacy of these strategies. Furthermore, since numerous methodological weaknesses plagued the limited evidence-base, it was not possible to support or refute the application of different physiotherapy modalities, for the treatment of muscle haematomas. Further study is recommended to identify the best therapeutic interventions to treat muscle haematomas.
    No preview · Article · Nov 2006 · Physical Therapy in Sport