Original article
Scapular balance angle reference values in a healthy population
Valores de referencia del ángulo de balance escapular en población sana
J. Contreras
, D. Gil, J. de Dios Errázuriz, P. Ruiz, C. Díaz, P. Águila, A. Rosselot, R. Espinoza, M. Beltrán, R. Liendo, F. Soza
Corresponding author
Departamento Científico-Docente, Instituto Traumatológico «Dr. Teodoro Gebauer Weisser», Universidad de Chile, Santiago, Chile
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Contreras, D. Gil, J. de Dios Errázuriz, P. Ruiz, C. Díaz, P. Águila, A. Rosselot, R. Espinoza, M. Beltrán, R. Liendo, F. Soza" "autores" => array:11 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Contreras" "email" => array:1 [ 0 => "JulioContrerasMD@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Gil" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "de Dios Errázuriz" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Ruiz" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Díaz" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Águila" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Rosselot" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Espinoza" ] 8 => array:2 [ "nombre" => "M." "apellidos" => "Beltrán" ] 9 => array:2 [ "nombre" => "R." "apellidos" => "Liendo" ] 10 => array:2 [ "nombre" => "F." "apellidos" => "Soza" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento Científico-Docente, Instituto Traumatológico «Dr. Teodoro Gebauer Weisser», Universidad de Chile, Santiago, Chile" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valores de referencia del ángulo de balance escapular en población sana" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1958 "Ancho" => 2754 "Tamanyo" => 138939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Graph showing the normal distribution of the scapular balance angle. The criterion for abnormality in the sample corresponds approximately to 7°. SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>standard deviation</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Normal scapular kinetics are a prerequisite to ensure proper shoulder function and prevent the onset of pain since they are crucial for a proper alignment of the glenohumeral and acromioclavicular joints.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physiologically, the scapula is important for coupled and coordinated movement between the scapula and the arm (scapulohumeral rhythm), which provides an optimal spatial arrangement of the arm.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">From the biomechanical standpoint, the scapula provides a stable base for muscle activation and a mobile platform to maintain glenohumeral kinematics.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition, it also serves as a permanent link between the core and upper limbs.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Alterations in scapular movement are associated with impingement syndrome, rotator cuff tear, labral lesions, acromioclavicular joint disease and multidirectional instability.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">These visual alterations in the position and movement patterns of the scapula are known as scapular dyskinesia.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> This pathology has been described very recently and the criteria for its diagnosis are not yet clear.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–7</span></a> The word dyskinesia (<span class="elsevierStyleItalic">dys</span> [alteration of] <span class="elsevierStyleItalic">kinesis</span> [movement]) is a general term used to describe the loss of control over normal movement.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Scapular dyskinesia is not a lesion in itself. It does not always lead to lesions and is not always directly related to a specific lesion.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Alternatively, it may interact with other shoulder pathologies and exacerbate any associated dysfunction.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In clinical terms, it is characterized by the prominence of the medial or inferomedial edge and scapular elevation. The most common visual findings are scapular protrusion and asymmetry.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Clinical evaluations of scapular position based on linear differences between both scapulae have proven to be scarcely reproducible.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> The most widely used test is the lateral scapular slide test (LSST) designed by Ben Kibler,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> which consists in a semi-dynamic test that evaluates the distance between the inferior angle of the scapula and the spine in 3 positions.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Some authors have described other methods with better reproducibility to conduct this assessment, but these are not cost-effective in everyday clinical practice and are mainly used for studies in elite athletes.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In 2010, our group developed a digital photographic test to evaluate the position and rotation of the scapula in daily clinical practice (scapular photographic analysis test [SPA]).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The SPA test analyses 3D movements through correlated 2D photographs (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">A new indicator of scapular dyskinesia called the scapular balance angle (SBA) was presented among the findings of the study. This represented the difference between the angles formed by the line joining the 2 inferior angles of the scapula with the vertical line passing through the spine.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The usefulness of an angle in the diagnosis of scapular dyskinesia is extensive, due to its simple calculation and independence from size and weight. No angles have been previously described in the diagnosis of scapular dyskinesia, as this has mostly been based on linear measurements.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The main objective of this study is to calculate the reference values of the SBA in a healthy population aged between 18 and 85 years and to define the sampling criteria for abnormality in this sample.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">General description</span><p id="par0060" class="elsevierStylePara elsevierViewall">We conducted a descriptive, cross-sectional study during the period between January 2011 and December 2012, in order to calculate the reference values of the SBA among a healthy population aged between 18 and 85 years, and to define the sampling criteria for abnormality in this sample. We obtained written informed consent after explaining the characteristics of the test. This study was conducted according to the principles of the Declaration of Helsinki.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sample</span><p id="par0065" class="elsevierStylePara elsevierViewall">The inclusion criteria defined a healthy population of both genders aged between 18 and 85 years. We excluded patients with shoulder pain (acute or chronic), acute or old fractures related to the shoulder, rotator cuff disease, adhesive capsulitis, current physical therapy treatment, morbid obesity, previous shoulder surgery (open or arthroscopic), brachial plexus injury (especially of the long thoracic nerve), neuromuscular disease, muscular dystrophies, cervical disease, scoliosis, kyphosis and prior spinal surgery.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In total, we selected 300 patients by simple random sampling following the criteria presented previously (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Measurement technique</span><p id="par0075" class="elsevierStylePara elsevierViewall">We used a booklet with photographs to standardize the measurement technique, along with 2 training sessions. A total of 7 participants were trained in the measurement of the SBA.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The SBA was defined as “the difference between the angles formed by the line joining the 2 inferior angles of the scapula with the vertical line passing through the spine”<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The measurement was obtained with the patient standing on both bare feet, with arms hanging on both sides of the pelvis and heels together (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>a). Next, the inferior angle of the scapula was marked bilaterally and the line connecting these marks and another vertical line between the C7 and T9–T10 spinous processes were drawn (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>b). Lastly, the angles formed by the line joining both inferior angles of the scapula with the vertical line running through the spine (<a class="elsevierStyleCrossRef" href="#fig0025">Figs. 5</a>c and d) were measured. The absolute value of the difference between these angles corresponded to the SBA.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">All the evaluators used a set of standard goniometers of the same model. The training period consisted of 2 talks explaining the theory behind SBA calculation, along with a demonstration. Next, the evaluators conducted measurement exercises among themselves, which were compared with assessments of the second session through the intraclass correlation coefficient (ICC). The ICC values obtained were 0.87 intraobserver and 0.84 interobserver.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The size measurement was performed using a 2<span class="elsevierStyleHsp" style=""></span>m stadiometer with 2 levels to ensure a perpendicular measurement, and the weight was measured with a standard electronic scale.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">Data were analyzed with the software package <span class="elsevierStyleItalic">Stata 12</span> and presented as percentages and mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD). A normal distribution was found for age with the Shapiro–Wilk test, so we used the Student <span class="elsevierStyleItalic">t</span> test to analyze significant differences. Regarding gender, we used the <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Statistical significance was set at a value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05 and the sampling abnormality criterion was considered to be a mean<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>2 SD (95% of the sample).</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">The mean SBA of the sample was 2.505<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.340. No significant differences by age and gender (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>) were found. We established a sample abnormality criterion of 7.185 (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Manual measurement of the SBA is a simple and reproducible technique in daily clinical practice enabling the overall assessment of the spatial arrangement of the scapula. The main findings of this study were the reference values for SBA and the statistical cutoff point to define abnormality.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The LSST, designed by Kibler<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> to assess scapular asymmetry, recorded intraobserver ICC values between 0.52 and 0.66 and interobserver ICC between 0.45 and 0.79 for subjects with shoulder dysfunction.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> For the same test, Nijs et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> in different positions, recorded ICC values ranging from 0.70 to 0.82. Methods based on an objective technique presented an ICC close to 1. Roy et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> reported an ICC close to 0.95 with a method for evaluating the 3D position of the scapula (Optotrak Probing System). Using a digital inclinometer adapted to rest on the scapula, Borsa et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> recorded an intraobserver ICC of 0.94. The disadvantage of these techniques is their high cost, taking into account that musculoskeletal disorders are among the most prevalent pathologies in everyday clinical practice.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–21</span></a> Manual measurement of the SBA is reproducible at an intraobserver (ICC: 0.87) and interobserver (ICC: 0.84) level. Being a manual technique, it is operator-dependent, but even taking this fact into consideration it presents adequate ICC values.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The anatomical landmarks determine the accuracy of this method. Working with embalmed cadavers, Lewis et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> showed that the skin surface can be used as a reliable and valid point of reference to determine the location of bony areas in the scapula and thoracic spine by palpation.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In 2010, our group developed a digital photographic test to evaluate the position and rotation of the scapula in everyday clinical practice.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The SPA test requires specific bone demarcation points in order to link these coordinates to a Cartesian plane generated by the vertical and horizontal axes formed in the C7 vertebra. This enables the analysis of 3D movements by 2D photographs, since the angles and distances are modified in a correlated manner. We showed that this test is a reliable, accurate and objective method to assess the position and rotation of the scapula. Moreover, it presents diagnostic criteria with high sensitivity and specificity for the diagnosis of scapular dyskinesia.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The SBA was presented among the findings of the study. Regarding the diagnostic capability of this angle, we observed a high sensitivity and specificity for the diagnosis of scapular dyskinesia (through ROC curve analysis, the optimal diagnosis of scapular dyskinesia was calculated with a difference greater than 5°. This criterion presented a sensitivity of 72.73%, specificity of 90.91% and odds ratio of 8). The usefulness of an angle in the diagnosis of scapular dyskinesia is significant because of its ease of calculation and independence of size and weight.</p><p id="par0140" class="elsevierStylePara elsevierViewall">With the sampling criteria of abnormality, we established that a SBA greater than 7° would entail the diagnosis of scapular dyskinesia for this sample (from a statistical point of view). On the other hand, a SBA greater than 5° (mean<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>1 SD) would establish a reasonable level of suspicion for the diagnosis of scapular dyskinesia for this sample. These findings were consistent with the study conducted in the year 2010.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However, we must take into account that this is only a statistical criterion and that no patients with scapular dyskinesia were evaluated in this study. In addition, the study conducted in 2010 employed a digital photographic method which provided accuracy, reliability and reproducibility. Despite these considerations, the values found were very similar, so they can probably be extrapolated. Nevertheless, it is necessary to conduct further studies to evaluate the diagnostic ability of the SBA in an environment employing manual measurement techniques.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The characteristics of this type of analysis are beneficial for clinical research, as they would allow the unification of criteria and generate clinical studies, making it possible to compare the results of different treatments in an objective manner. In addition, in the future, it could be used for patient assessment in daily clinical practice, in order to guide the evolution and treatment.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Level of evidence</span><p id="par0150" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">III</span>.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethical responsibilities</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protection of people and animals</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that this investigation adhered to the ethical guidelines of the Committee on Responsible Human Experimentation, as well as the World Medical Association and the Declaration of Helsinki.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidentiality of data</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data and that all patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Right to privacy and informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare having obtained written informed consent from patients and/or subjects referred to in the work. This document is held by the corresponding author.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interests</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres310857" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Materials and methods" 3 => "Results" 4 => "Discussion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec294077" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres310856" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Materiales y métodos" 3 => "Resultados" 4 => "Discusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec294076" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "General description" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Sample" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Measurement technique" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-02-25" "fechaAceptado" => "2013-09-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec294077" "palabras" => array:3 [ 0 => "Scapula" 1 => "Diagnosis" 2 => "Movement" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec294076" "palabras" => array:3 [ 0 => "Escápula" 1 => "Diagnóstico" 2 => "Movimiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To calculate the Scapular Balance Angle (SBA) reference values in a healthy population between 18 and 85 years old, and to define abnormality criteria for this sample.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was conducted on a total of 300 individuals (mean age: 44.83, range: 18–83; proportion male/female: 1.59), calculating the SBA through manual measurement with a goniometer. An intraobserver Intraclass Correlation Coefficient (ICC) of 0.87 and a interobserver ICC of 0.84 was observed.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The values for the SBA in healthy population were 2.505<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.340°. We define the abnormality criteria for this sample with an angle greater than 7.185°.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SBA manual measurement is a simple and reproducible assessment of the position and rotation of the scapula in clinical practice. The main findings of this study are the reference values for the SBA and a statistical cut-off to define abnormality.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Calcular los valores de referencia del ángulo de balance escapular (ABE) en la población sana entre 18 y 85 años de edad, y definir los criterios muestrales de anormalidad para esta muestra.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Materiales y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio de tipo descriptivo-transversal en un total de 300 individuos (edad promedio: 44,83; rango: 18–83; proporción mujer/varón: 1,59), calculándose el ABE a través de la medición manual con goniómetro. Se obtuvo un valor de coeficiente de correlación intraclase (<span class="elsevierStyleSmallCaps">CCI</span>) intraobservador de 0,87 y un valor de CCI interobservador de 0,84.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los valores para población sana del ABE fueron de 2,505<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,340°. Se define el criterio de anormalidad muestral con un ángulo mayor a 7,185°.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Discusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La medición manual del ABE es una técnica sencilla y reproducible en la práctica clínica diaria para la evaluación general de la posición y la rotación de la escápula. El principal hallazgo de este estudio son los valores de referencia para el ABE y el punto de corte estadístico para definir anormalidad.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Contreras J, Gil D, de Dios Errázuriz J, Ruiz P, Díaz C, Águila P, et al. Valores de referencia del ángulo de balance escapular en población sana. Rev Esp Cir Ortop Traumatol. 2014;58:24–30.</p>" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 967 "Ancho" => 2586 "Tamanyo" => 209846 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distances and angles in normal position. It is possible to observe the distances from reference points to the vertical and horizontal axes, along with the angles formed in a model with a normal position of the scapula. Point 1: C7 vertebra; point 2: medial edge of the scapular spine; point 3: inferior angle of the scapula, and point 4: posterior aspect of the acromion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 967 "Ancho" => 2586 "Tamanyo" => 174528 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distances and angles after medially rotating the inferior angle of the scapula. It is possible to observe the change in the distances and angles formed in the model, correlating with medial movement of the inferior angle of the scapula. Point 1: C7 vertebra; point 2: medial edge of the scapular spine; point 3: inferior angle of the scapula, and point 4: posterior aspect of the acromion.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 966 "Ancho" => 2586 "Tamanyo" => 179783 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distances and angles in scapular protraction. It is possible to observe the change in the distances and angles formed in the model, correlating with the protraction movement. Point 1: C7 vertebra; point 2: medial edge of the scapular spine; point 3: inferior angle of the scapula, and point 4: posterior aspect of the acromion.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1256 "Ancho" => 1251 "Tamanyo" => 47602 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Definition of the scapular balance angle. The difference between α and β defines the SBA. The solid line shows the union of the 2 lower edges of the scapula and the dashed line represents the C7 vertical axis.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1891 "Ancho" => 1251 "Tamanyo" => 177416 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Manual measurement of the scapular balance angle.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1958 "Ancho" => 2754 "Tamanyo" => 138939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Graph showing the normal distribution of the scapular balance angle. The criterion for abnormality in the sample corresponds approximately to 7°. SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>standard deviation</p>" ] ] 6 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female gender (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">184 (61.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male gender (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 (38.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.49 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18–83 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weight (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.91<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.7<span class="elsevierStyleHsp" style=""></span>kg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Size (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.64<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.09<span class="elsevierStyleHsp" style=""></span>m \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455485.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Summary of the characteristics of the sample selected.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">SBA: scapular balance angle; SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Angle β \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Angle α \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">SBA \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.985 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.505 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.719 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.718 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.340 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455486.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Summary of the reference SBA values in the sample selected.</p>" ] ] 8 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">No significant differences according to age were found. SBA: scapular balance angle; SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age range (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Angle β \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Angle α \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">SBA \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19–24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25–34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35–44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45–54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55–64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75–85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455487.png" ] ] ] ] 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 2 | 12 |
| 2024 October | 31 | 15 | 46 |
| 2024 September | 58 | 10 | 68 |
| 2024 August | 45 | 8 | 53 |
| 2024 July | 44 | 6 | 50 |
| 2024 June | 39 | 9 | 48 |
| 2024 May | 46 | 8 | 54 |
| 2024 April | 27 | 7 | 34 |
| 2024 March | 41 | 16 | 57 |
| 2024 February | 54 | 11 | 65 |
| 2024 January | 97 | 8 | 105 |
| 2023 December | 79 | 26 | 105 |
| 2023 November | 66 | 31 | 97 |
| 2023 October | 126 | 30 | 156 |
| 2023 September | 48 | 11 | 59 |
| 2023 August | 38 | 28 | 66 |
| 2023 July | 69 | 30 | 99 |
| 2023 June | 70 | 26 | 96 |
| 2023 May | 63 | 46 | 109 |
| 2023 April | 94 | 41 | 135 |
| 2023 March | 37 | 35 | 72 |
| 2023 February | 24 | 38 | 62 |
| 2023 January | 23 | 39 | 62 |
| 2022 December | 23 | 24 | 47 |
| 2022 November | 32 | 29 | 61 |
| 2022 October | 24 | 25 | 49 |
| 2022 September | 26 | 37 | 63 |
| 2022 August | 19 | 17 | 36 |
| 2022 July | 15 | 18 | 33 |
| 2022 June | 16 | 14 | 30 |
| 2022 May | 26 | 17 | 43 |
| 2022 April | 25 | 14 | 39 |
| 2022 March | 50 | 18 | 68 |
| 2022 February | 25 | 17 | 42 |
| 2022 January | 33 | 12 | 45 |
| 2021 December | 39 | 15 | 54 |
| 2021 November | 18 | 25 | 43 |
| 2021 October | 15 | 10 | 25 |
| 2021 September | 15 | 12 | 27 |
| 2021 August | 14 | 7 | 21 |
| 2021 July | 12 | 13 | 25 |
| 2021 June | 10 | 9 | 19 |
| 2021 May | 12 | 6 | 18 |
| 2021 April | 48 | 20 | 68 |
| 2021 March | 5 | 15 | 20 |
| 2021 February | 8 | 12 | 20 |
| 2021 January | 7 | 8 | 15 |
| 2020 December | 1 | 1 | 2 |
| 2018 February | 13 | 0 | 13 |
| 2018 January | 26 | 1 | 27 |
| 2017 December | 26 | 0 | 26 |
| 2017 November | 37 | 1 | 38 |
| 2017 October | 20 | 4 | 24 |
| 2017 September | 26 | 4 | 30 |
| 2017 August | 23 | 8 | 31 |
| 2017 July | 35 | 2 | 37 |
| 2017 June | 40 | 2 | 42 |
| 2017 May | 42 | 15 | 57 |
| 2017 April | 26 | 2 | 28 |
| 2017 March | 28 | 45 | 73 |
| 2017 February | 44 | 1 | 45 |
| 2017 January | 23 | 2 | 25 |
| 2016 December | 32 | 2 | 34 |
| 2016 November | 45 | 8 | 53 |
| 2016 October | 94 | 3 | 97 |
| 2016 September | 139 | 2 | 141 |
| 2016 August | 62 | 5 | 67 |
| 2016 July | 21 | 1 | 22 |
| 2016 June | 15 | 1 | 16 |
| 2016 May | 22 | 4 | 26 |
| 2016 April | 17 | 1 | 18 |
| 2016 March | 20 | 4 | 24 |
| 2016 February | 12 | 1 | 13 |
| 2016 January | 4 | 2 | 6 |
| 2015 August | 0 | 1 | 1 |
| 2014 July | 0 | 1 | 1 |
| 2014 February | 0 | 1 | 1 |
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