Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey.

BACKGROUND: The use of measurement instruments in physiotherapy has been recommended in clinical practice guidelines to improve evidence-based practice. The aims of the study were (a) to describe the current use of measurement instruments by physiotherapists working in Germany and (b) to investigate the facilitators and barriers to use measurement instruments. METHODS: This cross-sectional study used a nationwide online survey, which was accessible to all physiotherapists working in Germany. RESULTS: In total, 522 adult physiotherapists working in Germany completed the questionnaire. The mean age of the respondents was 38 years, 63% were female, and 53% had >10 years of work experience. Thirty-one percent of the respondents used measurement instruments in ≥80% of their patients, and 26% used measurement instruments in ≤20%. Measurement instruments were used for diagnostic and prognostic purposes by 69% and 22% of respondents, respectively. The three most frequently reported measurement instruments were "goniometer" (n = 254), some kind of a "visual/numeric analogue scale" (n = 139), and the "manual examination of muscle-strength" (n = 54). Seven of the 13 most stated measurement instruments measure activities or participation. The most important facilitator was physiotherapists' positive attitudes towards measurement instruments. Two out of three respondents reported having sufficient knowledge and skills to apply measurement instruments in clinical practice. The most pronounced barriers were insufficient additional financial compensations and requiring extra time to document test scores. Seventy-eight percent of the respondents could imagine using an electronic device for a user-friendly patient health record system in clinical practice. CONCLUSIONS: The limited use of measurement instruments reported by physiotherapists working in Germany appears to be due to organisational issues, in combination with a lack of knowledge and skills needed to apply the measurement instruments, rather than due to individual or managerial reasons. To support the use of measurement instruments, sufficient time resources and adequate financial compensation are required. Educational approaches should focus on imparting patient-centred and patient-reported outcomes to quantify activities and participation. Electronic patient health record systems have potential to facilitate the application of standardised measurement instruments if the barriers identified in this survey are addressed properly.

[Hierarchical assessment of balance and mobility : German translation and cross-cultural adaptation]. / Hierarchical Assessment of Balance and Mobility : Deutsche Übersetzung und interkulturelle Adaptation.

BACKGROUND: The hierarchical assessment of balance and mobility (HABAM) is an internationally established clinical mobility test which has good psychometric properties, allows an easy assessment of mobility and the graphical illustration of change over time in geriatric patients. The aims of this study were the translation and cross-cultural adaptation of the English original HABAM into the German language as well as a preliminary analysis of the practicability and construct validity of the HABAM. MATERIAL AND METHODS: The HABAM was translated into German following international guidelines. A prefinal version was clinically tested by physiotherapists in two geriatric hospitals over a period of 5 weeks. In order to make a final revision of the German HABAM version, structured in-depth feedback was obtained from the seven therapists who had used the HABAM most often. RESULTS: A total of 18 physiotherapists used the HABAM for 47 elderly inpatients for the initial assessment. The translated items and instructions seemed comprehensible but problems occurred concerning the conducting and documentation of the HABAM. Modifications led to the final German HABAM version and 85 % of the HABAM assessments were performed within ≤ 10 min. There was a correlation of rs= 0.71 with the Tinetti test and of rs = 0.68 with the Barthel index. CONCLUSION: A German HABAM version is now accessible for use in clinical practice. The results of a preliminary psychometric analysis indicate a potentially good practicability and sufficient construct validity. A comprehensive analysis of psychometric properties is pending.

Validation of activity trackers to estimate energy expenditure in older adults with cardiovascular risk factors.

OBJECTIVES: To compare different types of activity trackers recording physical activity energy expenditure (PAEE) and examine their criterion validity against indirect calorimetry (IC) as the gold standard in adults over 60 years of age with a special focus on women with cardiovascular risk. DESIGN: Synchronous registrations of PAEE were performed with up to four different devices to determine criterion validity against IC while participants performed a protocol of simulated activities in a laboratory setting. METHOD: Thirty-four participants (25 women, 9 men) with at least a light cardiac risk performed a protocol of simulated activities in a laboratory setting (daily living activities, cycle ergometer test). PAEE was simultaneously assessed by IC, two research-grade activity trackers (ActiGraph-wGT3X-BT and Actiheart-4) and two consumer-level activity trackers (OMRON pedometer and Fitbit Charge-3). Tracker-derived PAEE was compared with PAEE calculated from IC descriptively and by Bland-Altman plots. RESULTS: The ActiGraph (0.7 ± 0.4 kcal/min), the Actiheart (1.1 ± 0.6 kcal/min) and the OMRON (0.8 ± 0.6 kcal/min) underestimated, while the Fitbit (3.4 ± 1.2 kcal/min) overestimated PAEE compared to IC-PAEE (2.0 ± 0.5 kcal/min). The Bland-Altman limits of agreement (LoA) against IC were +0.5/+2.2 kcal/min for the ActiGraph, -0.3/+2.1 kcal/min for the Actiheart, -3.7/+1.0 kcal/min for the Fitbit, and -0.5/+2.9 kcal/min for the OMRON. The magnitude of the deviation varied considerably depending on the activity (e.g. walking, cleaning, cycle ergometer test). CONCLUSIONS: The research-grade activity trackers estimated PAEE with higher validity than the commercially available activity trackers. The partly very wide LoA have to be critically considered when assessing PAEE in the context of health service research, as individual Physical Activity behaviour may be under- or overestimated.