Factors of presenteeism and its association with detrimental effects among employees in Switzerland working in different sectors - a cross-sectional study using a multi-item instrument.

PURPOSE: Presenteeism, the phenomenon of employees working despite illness, is a significant issue globally, impacting individual well-being and organizational efficiency. This study examines presenteeism among Swiss employees, exploring its occurrence, primary factors, reasons, and impact on employees' health. METHODS: This study used cross-sectional data from 1,521 employees in different sectors in Switzerland. Descriptive statistics and multiple linear models for influencing factors and detrimental effects, such as burnout symptoms, job satisfaction, general health, and quality of life, were calculated for data analysis. Presenteeism was measured using the Hägerbäumer multi-item scale, ranging from 1 = "Never in case of illness" - 5 = "Very often in case of illness." RESULTS: The employees reported that in case of illness, they rarely worked in the last 12 months M = 2.04 (SD = 1.00). A positive approach to presenteeism in the team was associated with less presenteeism (ß = -0.07) and problematic leadership culture in dealing with presenteeism with increased presenteeism (ß = 0.10). In addition to well-known factors, presenteeism was significant for burnout symptoms (ß = 1.49), general health status (ß = -1.5), and quality of life (ß = -0.01). CONCLUSION: The study offers insights into the phenomenon of presenteeism among Swiss employees in various sectors by applying a multi-item scale for presenteeism. The findings indicate that a positive team dynamic and organizational culture may significantly reduce presenteeism. Presenteeism behavior is a significant factor of adverse outcomes. This highlights the importance of acknowledging presenteeism in the context of occupational health.

Influencing factors on instrumental activities of daily living functioning in people with mild cognitive disorder - a secondary investigation of cross-sectional data.

BACKGROUND: Finding a strategy to reduce the impact of cognitive decline on everyday functioning in persons suffering from cognitive impairment is a public health priority. Instrumental activities of daily living (IADL) are key to everyday functioning. Hence, it is essential to understand the influencing factors on IADL to develop specific interventions to improve everyday functioning in persons with mild cognitive disorder. Therefore, this study aimed to 1) explore different influencing factors on IADL functioning considering all domains of the International Classification of Functioning, disability, and health and 2) rank these factors. METHODS: We performed a secondary analysis of a cohort including participants with amnestic mild cognitive impairment (a-MCI) or mild Alzheimer's Dementia (mild AD). The IADL functioning model was used as a starting point to estimate the effects of cognitive and physical function factors and personal and environmental factors on IADL functioning using multiple linear regression analysis, including subgroup analysis in persons with a-MCI. We used standardized coefficient estimates to relate the size of the predictor effects in the final model. RESULTS: We included 105 participants (64 a-MCI, 41 mild AD); the mean age was 81.9 years (SD 4.9), with 70% females. Based on a multi-step approach and model fit, the final model included IADL functioning as the response variable and memory, attention, executive function, vision and hearing, mobility, balance, education, and social support as predictors. The final model explained 75% of the variability. The significant predictors in the model were mobility, balance, attention, and education, and were the predictors with the most considerable effects based on standardized coefficient estimates. The subgroup analysis, including only a-MCI participants, revealed a similar pattern. CONCLUSION: Our results confirm that IADL functioning in people with mild cognitive disorder is influenced by cognitive and physical function and personal factors. The study provides further insight into understanding IADL functioning impairments in persons with mild impaired cognition and may be used to develop specific non-pharmacological interventions.

The effect of age on the pressure pain threshold of asymptomatic ankles and knees in young individuals with haemophilia.

INTRODUCTION: Despite adequate medical treatment, many young adults with haemophilia develop joint alterations-especially in ankles and knees. Undetected over years, subtle structural changes cause subclinical symptoms, before problems become obvious. To objectify these silent pressure pains, the pressure pain threshold (PPT) can be measured by algometry. AIM: The aim was to investigate and compare the effect of age on PPTs in asymptomatic ankles and knees between boys and young adults with haemophilia and age-matched controls, in order to gain better knowledge about the alteration of the periarticular structures with increasing age. MATERIAL AND METHODS: Nineteen persons with haemophilia (PwH; severe or moderate; 8-30 years) and 19 age-matched controls with 'healthy' ankles and knees were recruited. Asymptomatic joints with a Haemophilia Joint Health Score = 0 were included. The PPT was measured on four periarticular points per joint, and the data were analysed with a linear mixed model. RESULTS: The PPT of the control group increased with age, whereas the PPT of the PwH decreased. The difference in age effect per year in kPa between PwH and controls was as follows: ß [95%-CI]: -15.41 [-31.63; 0.79]. Although the result was not statistically significant (p = .08), a clear tendency was shown. CONCLUSION: The results suggest that subclinical alterations in the periarticular structures of these joints may evolve unnoticed over time. However, further research is warranted to determine whether this observed trend is confirmed in a larger sample and at what age the PPT begins to decrease in PwH compared to controls.

Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT.

BACKGROUND: Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. METHODS: A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants' steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. RESULTS: Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. CONCLUSIONS: In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. TRIAL REGISTRATION: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

The Coping with and Caring for Infants with Special Needs intervention was associated with improved motor development in preterm infants.

AIM: We compared the impact of standard infant physiotherapy and the family-centred programme, Coping with and Caring for Infants with Special Needs (COPCA), in infants born before 32 weeks without significant brain lesions. METHODS: This randomised controlled trial was carried out in patients' homes and outpatient settings in Switzerland between January 2016 and October 2019. We used data from the national SwissNeoNet register and an assessment battery that included infant and family outcomes and video analyses of therapy sessions. The Infant Motor Profile was the primary outcome instrument. RESULTS: The COPCA group comprised six boys and two girls with a median gestational age of 27 weeks (range 25-30), and the standard care group comprised seven boys and one girl with a median gestational age of 29.5 weeks (range 26-31). COPCA participants improved significantly more between baseline and 18 months in the IMP variation (9.0 percentage points, 95% confidence interval: 0.3-17.5) and performance (12.0 percentage points, 95% confidence interval: 4.1-20.6) domains than standard care participants. COPCA coaching was positively associated with IMP scores at 18 months, but some standard care actions were negatively associated. CONCLUSION: COPCA was associated with better motor outcome in infants born before 32 weeks than standard infant physiotherapy.

Prediction and trend of tactile acuity, pain and disability in acute LBP: a six-month prospective cohort study.

BACKGROUND: Chronic back pain is known to be associated with altered tactile acuity. Tactile acuity is measured using the Two-Point Discrimination (TPD) test in both clinical and research settings. In subjects with chronic low back pain, the TPD threshold (TPDT) is increased and is associated with persistent pain. It remains unknown, however, whether TPDT is also altered in cases of clinical acute pain, or whether it could be used as a predictor of future pain and disability at an early stage of LBP. The main objective of this study was to investigate the predictive value of baseline TPDT for pain and disability at 3 and 6 months after the onset of acute LBP. The TPDT in acute low back pain (LBP) and the development of TPDT over 6 months has also been assessed. METHODS: LBP participants (n = 124) with acute LBP (< 4 weeks) were included. Subjects were examined within 4 weeks of pain onset and followed-up after 3 and 6 months of pain onset. Horizontal and vertical TPDTs of the lower back were collected. Linear mixed models were subsequently used to evaluate the association of TPDT with pain and disability over time. RESULTS: The vertical TPDT showed a mean (SD) of 4.9 cm (1.6) and the horizontal TPDT a mean (SD) of 6.0 cm (1.5) at baseline. The vertical TPDT altered from baseline up to 6 months from 4.9 to 4.6 cm and the horizontal TPDT from 6.0 to 5.4 cm. The association between the TPDT and the Oswestry Disability Index (ODI) after 6 months was moderate. Linear mixed models revealed no association between TPDT, pain and disability over the progression of LBP. CONCLUSION: TPDTs appear to be raised in subjects with acute LBP. However, our study revealed no predictive capability of the TPDT for disability and pain. No comparisons are possible in the absence of similar studies, indicating the need for further research is in this area.

Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study.

BACKGROUND: Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients' multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. METHODS: This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. RESULTS: We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). CONCLUSIONS: Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients' multidimensional needs reduces LoS in primary care hospitals.

Cross-cultural adaptation and validation of the Amsterdam Instrumental Activities of Daily Living questionnaire short version German for Switzerland.

BACKGROUND: Instrumental Activities of Daily Living (IADL) limitations are associated with reduced health-related quality of life for people with mild cognitive impairment (MCI). For these people, the assessment of IADL is crucial to the diagnostic process, as well as for the evaluation of new interventions addressing MCI. The Amsterdam IADL Questionnaire Short Version (A-IADL-Q-SV) is an established assessment tool with good psychometric properties that has been shown to be robust to cultural differences in Western countries. The aims of this study were to: (1) cross-culturally adapt and validate the A-IADL-Q-SV for the German-speaking population of Switzerland; (2) investigate its cultural comparability; and (3) evaluate further psychometric properties. METHODS: The A-IADL-Q-SV German was pretested on clinicians and participants in a memory clinic setting. The psychometric properties and cultural comparability of the questionnaire were investigated in memory clinic settings including participants with MCI or mild dementia, as well as participants with normal cognition recruited from the community. Item response theory (IRT) was applied to investigate measurement invariance by means of differential item functioning to assess item bias. Additionally, the test-retest reliability on scale level, the construct validity through hypothesis testing and the discriminant validity of the A-IADL-Q-SV German were evaluated. RESULTS: Ninety-six informants of participants with normal cognition, MCI or mild dementia completed the A-IADL-Q-SV German. The basic assumptions for IRT scoring were met. No meaningful differential item functioning for culture was detected between the Swiss and Dutch reference samples. High test-retest reliability on scale level (ICC 0.93; 95% CI 0.9-0.96) was found. More than 75% of the observed correlations between the A-IADL-Q-SV German and clinical measures of cognition and functional status were found to be in the direction and of the magnitude hypothesized. The A-IADL-Q-SV German was shown to be able to discriminate between participants with normal cognition and MCI, as well as MCI and mild dementia. CONCLUSIONS: The A-IADL-Q-SV German is a psychometrically robust measurement tool for a Swiss population with normal cognition, MCI and mild dementia. Thus, it provides a valuable tool to assess IADL functioning in clinical practices and research settings in Switzerland. Trial registration This study was registered retrospectively in July 2019 on ClinicalTrials.gov (NCT04012398).

Validation of the 7-item knee replacement patient education questionnaire (KR-PEQ-7), based on the 16-item knee osteoarthritis patient education questionnaire (KOPEQ).

BACKGROUND: The aim of this study was to investigate the content validity including item reduction, construct validity and internal consistency of the existing 16-item Knee Osteoarthritis Patient Education Questionnaire. Former research had indicated that a reduction of items was necessary. Participants were patients with severe knee osteoarthritis who, prior to undergoing a knee replacement operation, participated routinely in a preoperative educational intervention. METHODS: A mixed method design was used. The first step was directed at the reduction in the number of items on the 16-item Knee Osteoarthritis Patient Education Questionnaire. Based on a priori hypotheses, this was followed by a cross-sectional validation study, performed to compare the resulting 7-item Knee Replacement Patient Education Questionnaire to a patient-testing Interview Protocol that was tailored to the same patient educational material. Additionally, the revised questionnaire was correlated with both the Short Test of Functional Health Literacy and the Mini-Mental State Examination score. RESULTS: A relatively high internal consistency was found for the 7-item Knee Replacement Patient Education Questionnaire, with a Cronbach's alpha of 0.84 (SE: 0.036). Explanatory factor analysis showed no evidence against a one-factor model, with the first and second eigenvalues being 3.8 and 0.31, respectively. Bayesian Estimation of the correlation between the 7-item Knee Replacement Patient Education Questionnaire and the Interview Protocol was 0.78 (mode) (95% HPD 0.58-0.89). CONCLUSIONS: The 7-item Knee Replacement Patient Education Questionnaire shows good psychometric properties and could provide valuable support to health professionals. It can provide valid feedback on how patients waiting for a knee replacement operation experience an applied patient education intervention. Further investigation is needed to assess the applicability of the 7-item Knee Replacement Patient Education Questionnaire to larger samples in different hospitals and countries.

Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis.

AIM: To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. DESIGN: Systematic review and indirect-comparisons meta-analysis. DATA SOURCES: Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. STUDY APPRAISAL AND SYNTHESIS: Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. RESULTS: We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of -0.77 (95% Credible Interval (CrI) -1.22 to -0.31), while massage (-0.78; -1.55 to -0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, -0.72; -1.34 to -0.09), combined aerobic and resistance training (-0.67; -1.01 to -0.34), resistance training (-0.53; -1.02 to -0.03), aerobic (-0.53; -0.80 to -0.26) and yoga (-0.51; -1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (-0.68; -0.93 to -0.43). Combined aerobic and resistance training (-0.50; -0.66 to -0.34), combined CBT (-0.45; -0.70 to -0.21), Tai-Chi (-0.45; -0.84 to -0.06), CBT (-0.42; -0.58 to -0.25), resistance training (-0.35; -0.62 to -0.08) and aerobic (-0.33; -0.51 to -0.16) showed all small-to-moderate SMDs. CONCLUSIONS: Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.

Changes in Therapist Actions During a Novel Pediatric Physical Therapy Program: Successes and Challenges.

PURPOSE: To monitor changes in time spent on pediatric physical therapy actions during a COPing With and CAring for Infants With Special Needs (COPCA) course. METHODS: Data were collected before (T0), during, and after (T3) the course, which was attended by 15 Swiss physical therapists. Four treatment sessions of each therapist were video recorded and analyzed with the Groningen Observation Protocol 2.0, allowing for quantification of relative duration of therapeutic actions. RESULTS: Between T0 and T3, time spent on caregiver coaching and hands-off approaches significantly increased. CONCLUSIONS: The shift from caregiver trainer to family coach and the increasing hands-off techniques represent successful changes in various domains of behavior. The moderate changes in hands-off approaches suggest that changing habits requires specific attention. The COPCA course will be adapted accordingly.

Effective therapy to reduce edema after total knee arthroplasty Multi-layer compression therapy or standard therapy with cool pack - a randomized controlled pilot trial / Lymphologischer Kompressionsverband oder Standardbehandlung mit Kältepackung zur Schwellungsreduktion nach Knietotalprothesen-Operation. Eine randomisiert-kontrollierte, einfach verblindete Pilotstudie

Background: After total knee arthroplasty (TKA) efficient control and reduction of postoperative edema is of great importance. Aim: The aim of this pilot study (EKNZ 2014 ­ 225 DRKS00006271) was to investigate the effectiveness of multi-layer compression therapy (MLCT) to reduce edema in the early period after surgery compared to the standard treatment with Cool Pack. Methods: In this randomized controlled pilot trial, sixteen patients after TKA were randomized into an intervention group (IG) or a control group (CG). Circumferential measurements were used to assess edema. Secondary outcomes were range of motion (ROM), pain (numeric rating scale, NRS) and function as measured with the fast Self Paced Walking Test (fSPWT). Results: Clinically relevant differences in edema reduction between the two groups were found in the early postoperative period and at the six weeks follow up. Six days postoperatively the group time interaction (IE) in favor of the IG were −3.8 cm (95 % CI: −5.1; −2.4) when measured 10 cm proximal to the joint space and −2.7 cm (CI: −4.1; −1.3) when measured 5 cm proximally. We further observed differences in secondary outcomes in favor of the CG. Six days postoperatively the IE for knee flexion was ­8.3 ° (CI: −22.0; 5.4) and for the fSPWT it was 12.8 seconds (CI: −16.4; 41.3). Six weeks postoperatively these differences diminished. Conclusions: The findings suggest that MLCT could be an alternative treatment to reduce postoperative edema in patients after total knee arthroplasty. Eventually possible negative effects on early knee flexion and function must be considered.

Effect of counselling during pulmonary rehabilitation on self-determined motivation towards physical activity in people with chronic obstructive pulmonary disease - protocol of a mixed methods study.

BACKGROUND: Physical activity promotion in people with Chronic Obstructive Pulmonary Disease (COPD) is focus of research and public health. Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour. Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD. METHODS: A two-armed, single blind randomised controlled trial including 56 people with COPD will be conducted in an outpatient pulmonary rehabilitation. Patients will participate in a 12-week-rehabilitation program; individuals randomized to the interventional group will additionally participate in five counselling sessions with a physiotherapist, based on the principles of motivational interviewing. The participants' physical activity level will be measured using an accelerometer (SenseWear Pro®) before, directly and 3 months after pulmonary rehabilitation. Semi-structured interviews will be conducted to learn more about barriers and facilitators regarding daily physical activity. DISCUSSION: If the strategy successfully improves the physical activity level in people with COPD, counselling might be implemented in pulmonary rehabilitation. TRIAL REGISTRATION: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

Intertester and intratester reliability of movement control tests on the hip for patients with hip osteoarthritis.

BACKGROUND: Hip joint complaints are a problem associated with increasing age and impair the mobility of a large section of the elderly population. Reliable and valid tests are necessary for a thorough investigation of a joint. A fundamental function of the hip joint is movement control and a test of this function forms a part of the standard examination. Until now there have been few scientific studies which specifically investigate the reliability of measurement tests of movement control of the hip joint. The aim of this study was to examine the intratester and intertester reliability of the movement control tests of the hip joint which are in use in current clinical practice. METHODS: Sixteen participants with hip joint complaints and 14 without hip joint impairment were recruited. All participants performed five active movement control tests for the hip joint and were video filmed whilst performing these tests. These films formed the basis for the evaluation and were assessed by two independent physiotherapists. For the intertester and intratester reliability calculations specially set weighted kappa values and the calculated percentages were used. RESULTS: The intertester reliability of the five examined movement control tests of the hip joint showed good to almost perfect values (weighted kappa (wk) = 0.56-0.87). The intratester reliability of the more experienced evaluator A was better in regards to the less experienced evaluator B (average wk = 0.62 vs 0.38). CONCLUSION: The visual evaluation of movement control tests of the hip joint is especially reliable when carried out by an experienced evaluator. 4 out of 5 tests also showed good results for intertester reliability and support their use in clinical practice.

Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain.

BACKGROUND: Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. METHODS: In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0-10%), Grade 1 (10-50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients' low back dysfunction. RESULTS: The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. CONCLUSION: This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

Psychometric Properties of a Standardized Observation Protocol to Quantify Pediatric Physical Therapy Actions.

PURPOSE: Pediatric physical therapy (PPT) is characterized by heterogeneity. This blurs the evaluation of effective components of PPT. The Groningen Observation Protocol (GOP) was developed to quantify contents of PPT. This study assesses the reliability and completeness of the GOP. METHODS: Sixty infant PPT sessions were video-taped. Two random samples of 10 videos were used to determine interrater and intrarater reliability using interclass correlation coefficients (ICCs) with 95% confidence intervals. Completeness of GOP 2.0 was based on 60 videos. RESULTS: Interrater reliability of quantifying PPT actions was excellent (ICC, 0.75-1.0) in 71% and sufficient to good (ICC, 0.4-0.74) in 24% of PPT actions. Intrarater reliability was excellent in 94% and sufficient to good in 6% of PPT actions. Completeness was good for greater than 90% of PPT actions. CONCLUSIONS: GOP 2.0 has good reliability and completeness. After appropriate training, it is a useful tool to quantify PPT for children with developmental disorders.

Comparison of clinical vignettes and standardized patients as measures of physiotherapists' activity and work recommendations in patients with non-specific low back pain.

OBJECTIVE: To validate clinical vignettes as a measure of physiotherapists' activity and work recommendations given to patients with non-specific low back pain. DESIGN: Validation study comparing two methods for measuring aspects of health providers' clinical management: Clinical vignettes and unannounced visits of standardized patients (the gold standard). SETTING: Outpatient physiotherapy clinics. SUBJECTS: Physiotherapists (N = 59) who consented to see unannounced standardized patients in their clinical practice. MAIN MEASURES: Clinical vignettes were used to initially measure physiotherapists' self-reported activity and work recommendations. Subsequently, actors performing as standardized patients visited physiotherapists in their clinical practice and rated the advice given by the physiotherapist regarding activity and work. A total of 23 standardized patients were randomly scheduled to physiotherapists. Physiotherapists were blinded towards the standardized patients. To test whether standardized patients were detected, physiotherapists reported if they suspected that they had treated an actor. RESULTS: The 23 standardized patients visited 22 different physiotherapists. Physiotherapists detected 12 out of 23 unannounced standardized patients (detection rate: 52%). The estimated agreement between the two measures was poor, for both activity and work recommendations (weighted kappa coefficients: 0.29 resp. -0.21). CONCLUSION: The poor concordance between clinical vignettes and standardized patients indicates the potentially limited validity of clinical vignettes as a measure of health providers' activity and work recommendations in low back pain practice.

Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial.

BACKGROUND: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. METHODS: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation. RESULTS: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively. CONCLUSIONS: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn't give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial.

Reliability of movement control tests on the cervical spine.

BACKGROUND: Movement control impairment reduces active control of movement. Patients with this might form an important subgroup among patients with mechanical cervical pain. Diagnosis is based on the observation of active movement tests. Although widely used clinically, few studies have been performed to determine the reliability of a test battery. The aim of this study was to determine the inter-tester reliability of movement control impairment [MCI] tests on the cervical spine. METHODS: Forty-five subjects (31 patients with neck pain, 14 healthy controls) were videotaped while performing a standardized test battery consisting of 13 tests of active movement control. Using observation, two experienced physiotherapists independently rated test performances as correct or incorrect. One of them was blinded to all other patient information and both to each other. Kappa coefficients and 95% confidence intervals [CI] for inter-tester results were calculated. RESULTS: The kappa values for inter-tester reliability ranged in from 0.47-1.0 of the 13 tests, 2 demonstrated perfect reliability (k = 1.0), 4 excellent (k 0.81-0.99), 6 substantial (k 0.61-0.8) and 1 good (k 0.41-0.6). CONCLUSIONS: The physiotherapists were able reliably rate the majority the tests in this series of motor control tasks. There have been studies performed describing the assessment and treatment of movement control impairment problems and low back pain. However, no study has involved the assessment of the cervical dysfunction subgroup. This study presents a reliable test battery, for clinical use, to perform more specific examination of this subgroup.

Head-eye movement control tests in patients with chronic neck pain; inter-observer reliability and discriminative validity.

BACKGROUND: Head-eye movement control deficit is an identified problem in patients with chronic neck pain, particularly in cases of whiplash associated disorders (WAD). To date, there is no evidence concerning the reliability and validity of visually assessed active head-eye movement control tests. Therefore, the objectives of the present cross-sectional study were, a) to develop a test battery; and b) to investigate inter-observer reliability and discriminative validity in patients with chronic neck pain compared to healthy controls. METHODS: The study was conducted at two physiotherapy clinics in Switzerland. Ethics Committee approval was obtained. Ten active head-eye coordination tests, on 23 patients with chronic neck pain and associated symptoms and 19 healthy controls, were videotaped. The tests included eye movements in the neutral head position and 45° relative neck rotation, gaze stability and sequential head-eye movements. All tests were performed in the sitting and standing positions. Two blinded physiotherapists independently rated the randomized videos. Performance was rated as "negative", "moderately positive" or "clearly positive". Weighted kappa (wK) and 95% confidence intervals (CI) were calculated to investigate inter-observer reliability. Good reliability was defined as wK >0.5 with a lower boundary of 95% CI >0.2. Odds ratios (to define cut-off points) and the distribution of the classificator, numbers of positive tests, were calculated. RESULTS: Three out of ten tests showed "excellent" (wK 0.82 to 0.86), five out of ten tests showed "substantial" (wK 0.69 to 0.79) and two out of ten tests showed "moderate" (wK 0.54 to 0.59) reliability. Results were comparable in the sitting and standing positions. On average, three out of five tests were rated positive in patients and one out of five tests was rated positive in healthy controls. An odds ratio of 13.3 to 18.6 was obtained using ≥2/5 tests as a cut-off point. CONCLUSION: Visual assessment by physiotherapists of head-eye movement control tests is reliable. The test battery is able to discriminate between patients with chronic neck pain and healthy controls. There were no differences in performance between the sitting and standing positions. The test battery can therefore be reduced to five tests. Further research is needed to identify the test-retest stability and responsiveness.