Reliability and validity of spinal coordination patterns during treadmill walking in persons with thoracic spine pain--a preliminary study.

BACKGROUND: Persons with low back pain fail to show the same transition as healthy individuals from in-phase to anti-phase rotation of the thorax and pelvis as walking speed increases. The purpose of this study was to determine if the relative phase of the thorax and pelvis during walking was a reliable (within day test-retest) and valid measure for persons with thoracic pain. METHODS: The time series motion of the spine over C7, T8 and sacrum were measured at five treadmill walking speeds (0.67, 0.89, 1.12, 1.34, 1.56 m/s) in 19 persons with thoracic spine pain and 19 healthy control subjects. After a 20 minute rest, all tests were repeated. The average relative phases of the transverse plane rotation between C7-T8, C7-sacrum and T8-sacrum during a one-minute walk were calculated. The standard error of measurement (SEM) and the intra-class correlation coefficient (ICC) were used to estimate test-retest reliability. Three-way repeated measures analyses of variance were performed to determine the influence of group, walking speed and session on the relative phases. RESULTS: The minimum transverse plane motion amplitudes, across all participants and speeds, for the C7-T8, C7-sacrum, and T8-sacrum were 2.9, 5.1 and 2.8 degrees, respectively. The C7-T8 relative phase changed little with speed. The C7-sacrum and T8-sacrum relative phases showed increases as subjects walked faster, but both groups had similar patterns of change. Only the C7-T8 relative phase at 0.67 and 0.89 m/s exhibited good reliability (ICC > 0.80, SEM 4.2-5.7, no significant time effects) for both groups. The C7-T8 and T8-sacrum relative phases demonstrated significant group by speed effects. CONCLUSIONS: The C7-T8 relative phase showed reasonable reliability and some discrimination between groups, but changes in response to walking speed were small. The T8-sacrum relative phase showed some discriminative ability, but reliability was not adequate.

Longitudinal study of emotional intelligence, leadership, and caring in undergraduate nursing students.

This study describes the development of emotional intelligence (EI), leadership, and caring in undergraduate nursing students throughout their educational program. A correlational, repeated measures study design was used. Fifty-two nursing students completed four self-report questionnaires on three occasions (T1, T2, T3): BarOn Emotional Quotient Inventory: Short (EQ-i:S), Self-Assessment Leadership Instrument (SALI), Caring Ability Inventory (CAI), and Caring Dimensions Inventory (CDI). Mean scores for Total EI did not change significantly over time (T1, 100.1 ± 13.8; T2, 103.1 ± 13.8; T3, 101.6 ± 14.7). However, EI adaptability was higher at T2 (101.6 ± 13.1) and T3 (101.8 ± 14.1) than at T1 (97.0 ± 12.5; p = 0.03), as was CAI Courage (64.2 ± 9.5, 66.7 ± 9.5, 66.9 ± 8.7; p = 0.04) and the CDI (96.8 ± 18.1, 103.0 ± 7.3, 102.0 ± 10.9; p = 0.02). Changes in EI were positively correlated (r > 0.50, p < 0.001) with changes in SALI, CAI Knowing, and CAI Courage. During the undergraduate program, significant increases occurred in caring and EI adaptability but not in overall EI or leadership.

Muscle activation during hand dexterity tasks in women with hand osteoarthritis and control subjects.

STUDY DESIGN: Descriptive cross-sectional study. INTRODUCTION: Hand osteoarthritis (OA) is a condition that results in hand pain and disability. It is important to understand how muscle function impairments contribute to impaired dexterity. PURPOSE OF THE STUDY: To compare muscle activation in women with and without hand OA and determine if the activation relates to measures of impairment and disability. METHODS: Electromyography (EMG) was recorded from four muscles of the hand/forearm while subjects threaded (assembly) and unthreaded (disassembly) a small bolt. The groups were compared on the integrated EMG (IEMG) of four muscles using two-way repeated-measures analyses of covariance for the assembly and disassembly tasks. RESULTS: No differences were found in muscle activation between groups when IEMG values were normalized by time (p>0.05). CONCLUSIONS: Patients with OA have some indicators of altered muscle function. It is unclear whether these are adaptive or predisposing changes. When controlling for the time to perform a task, there were no significant IEMG differences between women with hand OA and control subjects. LEVEL OF EVIDENCE: 2b.

Lower extremity kinematics of females with patellofemoral pain syndrome while stair stepping.

STUDY DESIGN: Cross-sectional case-control design. BACKGROUND: Although the etiology of patellofemoral pain syndrome (PFPS) is not completely understood, there is some evidence to suggest that hip position during weight-bearing activities contributes to the disorder. OBJECTIVE: To compare the knee and hip motions (and their coordination) during stair stepping in female athletes with and without PFPS. METHODS: Two groups of female recreational athletes, 1 group with PFPS (n = 10) and a control group without PFPS (n = 10), were tested. All participants ascended and descended stairs (condition) at 2 speeds (self-selected comfortable and taxing [defined as 20% faster than the comfortable speed]), while the knee and hip angles were measured with a magnetic-based kinematic data acquisition system. Angle-angle diagrams were used to examine the relationship between flexion/extension of the knee and flexion/extension, adduction/abduction, and internal/external rotation of the hip. The angle of the knee and the 3 angles of the hip at foot contact on the third step were compared between groups by means of 3-way analyses of variance (ANOVA), with repeated measures on speed and condition. RESULTS: Group-by-speed interaction for knee angle was significant, with knee flexion being greater for the PFPS group for stair ascent and descent at a comfortable speed. Both the angle-angle diagrams and ANOVA demonstrated greater adduction and internal rotation of the hip in the individuals with PFPS compared to control participants during stair descent. CONCLUSION: Compared to control participants, females with PFPS descend stairs with the knee in a more flexed position and have the hip in a more adducted and internally rotated position at foot contact during stair stepping at a comfortable speed.

Reliability, validity, and responsiveness of the lower extremity functional scale for inpatients of an orthopaedic rehabilitation ward.

STUDY DESIGN: Single-group, repeated-measures study. OBJECTIVE: To estimate the test-retest reliability, construct validity, and responsiveness of the Lower Extremity Functional Scale (LEFS) on inpatients attending an orthopaedic rehabilitation ward. BACKGROUND: The LEFS has acceptable validity on outpatients in assessing functional mobility, but it has not been tested for use on an inpatient orthopaedic ward. METHODS AND MEASURES: Inpatients in an orthopaedic ward (n = 142) completed the 20-item, self-report LEFS on admission, 7 to 10 days after admission, and on discharge. To test reliability, 24 patients had the LEFS repeated 1 day after the admission test, and the intraclass correlation (ICC) and the standard error of measurement (SEM) were calculated. Change scores of the LEFS were evaluated against patients' and therapists' rating of improvement, and change scores of comparison measures that included pain, functional performance, and the composite index created from scores of these comparison measures. The standardized response mean (SRM) of the LEFS was also computed. RESULTS: The ICC of the LEFS was 0.88, and the SEM was 4 LEFS points (LEFS score range, 0-80). The change in LEFS correlated with changes of comparison measures in the same direction of improvement. Patients rated as improved by both themselves and their therapists had significantly larger change in LEFS scores than subjects rated as no change. The SRM of the LEFS from admission to discharge was 1.76 on patients rated as improved. CONCLUSION: The LEFS is reliable and valid to assess group and individual change, and has large responsiveness. The LEFS and the comparison measures likely assess different constructs.

The timed up and go test for use on an inpatient orthopaedic rehabilitation ward.

STUDY DESIGN: Single-group repeated-measures study. OBJECTIVE: To examine the test-retest reliability of the timed up and go (TUG) test and its validity for measuring change and predicting length of stay (LOS) on an inpatient orthopaedic rehabilitation ward. BACKGROUND: The TUG test is used to measure functional mobility of persons with musculoskeletal conditions but it has not been thoroughly tested for use in an inpatient orthopaedic rehabilitation ward. METHODS AND MEASURES: The TUG test was administered to 142 patients on admission to an orthopaedic rehabilitation ward 7 to 10 days after admission and on discharge. To test reliability, 24 subjects had these tests repeated 1 day after admission, and the intraclass correlation (ICC) and standard error of measurement (SEM) were calculated. Change scores of the TUG test were evaluated against change scores in pain and function, and the rating of improvement of the patient and therapist. The standardized response mean (SRM) was also calculated. A regression analysis was performed to determine whether the admission TUG test score could predict LOS. RESULTS: The ICC of the TUG test was 0.80 and the SEM was 10.2 seconds. The change in TUG test scores correlated with the changes in pain (r = 0.21, P<.01) and function (r = -0.23, P<.01), and resulted in an SRM of 0.89 for subjects rated as improved. The admission TUG test scores accounted for only 3.4% of the variance in inpatient LOS. CONCLUSION: The TUG test is reliable and valid to assess group change of inpatients on an orthopaedic rehabilitation ward but is not a good predictor of LOS. LEVEL OF EVIDENCE: Prognosis, level 1b.

Modeling early recovery of physical function following hip and knee arthroplasty.

BACKGROUND: Information on early recovery after arthroplasty is needed to help benchmark progress and make appropriate decisions concerning patient rehabilitation needs. The purpose of this study was to model early recovery of physical function in patients undergoing total hip (THA) and knee (TKA) arthroplasty, using physical performance and self-report measures. METHODS: A sample of convenience of 152 subjects completed testing, of which 69 (mean age: 66.77 +/- 8.23 years) underwent THA and 83 (mean age: 60.25 +/- 11.19 years) TKA. Postoperatively, patients were treated using standardized care pathways and rehabilitation protocols. Using a repeated measures design, patients were assessed at multiple time points over the first four postoperative months. Outcome measures included the Lower Extremity Function Scale (LEFS), the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC PF), the 6 minute walk test (6 MWT), timed up and go test (TUG) and a timed stair test (ST). Average recovery curves for each of the measures were characterized using hierarchical linear modeling. Predictors of recovery were sequentially modeled after validation of the basic developmental models. RESULTS: Slopes of recovery were greater in the first 6 to 9 weeks with a second-degree polynomial growth term (weeks squared) providing a reasonable fit for the data over the study interval. Different patterns of recovery were observed between the self-report measures of physical function and the performance measures. In contrast to the models for the WOMAC PF and the LEFS, site of arthroplasty was a significant predictor (p = 0.001) in all of the physical performance measure models with the patients post TKA initially demonstrating higher function. Site of arthroplasty (p = 0.025) also predicted the rate of change for patients post THA and between 9 to 11 weeks after surgery, the THA group surpassed the function of the patients post TKA. CONCLUSION: Knowledge about the predicted growth curves will assist clinicians in referencing patient progress, and determining the critical time points for measuring change. The study has contributed further evidence to highlight the benefit of using physical performance measures to learn about the patients' actual level of disability.

The factor validity of the Western Ontario Rotator Cuff Index.

BACKGROUND: The Western Ontario Rotator Cuff Index (WORC) is a self-report questionnaire developed specifically to evaluate disability in persons with pathology of the rotator cuff of the shoulder. The authors created items in 5 categories based on a model of quality of life, but never validated this structure. The purpose of this study was to examine the validity of the original 5-domain model of the WORC by performing factor analysis. METHODS: Three hundred twenty nine subjects (age, mean: 52, SD: 12) were tested prior to undergoing surgery for rotator cuff pathologies. They completed the WORC, a self-report questionnaire, which has 21 items on the effect of the rotator cuff problem on symptoms, activities and emotions. Statistical calculations included correlations between items, Cronbach's alpha of the total scale and subscales, and principal component factor analysis with oblique rotation. RESULTS: Correlations ranged from .09 to .70 between all the items, from .29 to .70 between items within a subscale, and from .53 to .72 between subscale scores. Cronbach's alpha was .93 for the total scale, and .72 to .82 for the subscales. The factor analysis produced 3 factors that explained 57% of the variance. The first factor included symptoms and emotional items, the second included strength items and the third included daily activities. CONCLUSION: The results of this study did not support the 5-domain model of the WORC.

Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty.

BACKGROUND: Physical performance measures play an important role in the measurement of outcome in patients undergoing hip and knee arthroplasty. However, many of the commonly used measures lack information on their psychometric properties in this population. The purposes of this study were to examine the reliability and sensitivity to change of the six minute walk test (6MWT), timed up and go test (TUG), stair measure (ST), and a fast self-paced walk test (SPWT) in patients with hip or knee osteoarthritis (OA) who subsequently underwent total joint arthroplasty. METHODS: A sample of convenience of 150 eligible patients, part of an ongoing, larger observational study, was selected. This included 69 subjects who had a diagnosis of hip OA and 81 diagnosed with knee OA with an overall mean age of 63.7 +/- 10.7 years. Test-retest reliability, using Shrout and Fleiss Type 2,1 intraclass correlations (ICCs), was assessed preoperatively in a sub-sample of 21 patients at 3 time points during the waiting period prior to surgery. Error associated with the measures' scores and the minimal detectable change at the 90% confidence level was determined. A construct validation process was applied to evaluate the measures' abilities to detect deterioration and improvement at two different time points post-operatively. The standardized response mean (SRM) was used to quantify change for all measures for the two change intervals. Bootstrapping was used to estimate the 95% confidence intervals (CI) for the SRMs. RESULTS: The ICCs (95% CI) were as follows: 6MWT 0.94 (0.88,0.98), TUG 0.75 (0.51, 0.89), ST 0.90 (0.79, 0.96), and the SPWT 0.91 (0.81, 0.97). Standardized response means varied from .79 to 1.98, being greatest for the ST and 6MWT over the studied time intervals. CONCLUSIONS: The test-retest estimates of the 6MWT, ST, and the SPWT met the requisite standards for making decisions at the individual patient level. All measures were responsive to detecting deterioration and improvement in the early postoperative period.

Reflections of physiotherapy students in the United Arab Emirates during their clinical placements: a qualitative study.

BACKGROUND: Although Western models of education are being used to establish health professional programs in non-Western countries, little is known about how students in these countries perceive their learning experiences. The purpose of this qualitative study was to describe the reflections of physiotherapy students from a Middle East culture during their clinical placements and to compare them to reflections of physiotherapy students from a Western culture. METHODS: Subjects were six senior students (3 females, 3 males, mean age 22.6 years) and 15 junior, female students (mean age 20.1 years) in the baccalaureate physiotherapy program at a university in the United Arab Emirates (UAE). They wrote weekly entries in a journal while in their clinical placements. They described an event, their reaction to it, and how it might affect their future behavior. Two evaluators independently read and coded the content of all the journals, and then worked together to categorize the data and develop themes. A third evaluator, an UAE national, independently read the journals to validate the content analysis. A feedback session with students was used to further validate the data interpretation. The themes were compared to those derived from a similar study of Canadian physiotherapy students. RESULTS: The content of the students' reflections were grouped into 4 themes: professional behavior, awareness of learning, self-development and shift to a patient orientation, and identification and analysis of ethical issues. Although the events were different, students from the UAE considered many of the same issues reflected on by Canadian students. CONCLUSION: Physiotherapy students from a Middle East culture consider many of the same issues as students from a Western culture when asked to reflect on their clinical experience. They reflect on their personal growth, on how they learn in a clinical setting, and on the ethical and professional behaviors of themselves and others.