RESUMO
OBJECTIVE: To develop a quantitative, inexpensive and easy to use tool, for assessing proprioception of the lower extremity of individuals post-stroke, and examine its test-retest reliability and known-groups validity. METHODS: The Lower Extremity Position Test was developed. Testing procedure: seated subjects were asked to reproduce 12âcm or 22âcm distances on a plastic surface, by verbally stopping passive movement of the foot produced by the tester. The deviation from the target point was measured as the mismatch score. Fifty one subjects post-stroke (nâ=â51) participated in prospective test-retest assessment. The tests were performed one week apart by a single assessor, in physical therapy out-patient clinics. The t-test, ICC and Bland-Altman tests were used to determine known-groups validity by determining leg differences and test-retest reliability. RESULTS: Post-stroke involved foot demonstrated significantly higher mismatch scores then the uninvolved foot did (pâ<â0.0001). Good test-retest reliability was demonstrated for the involved leg for both 12âcm and 22âcm distances (ICCâ=â0.79 and 0.85, respectively). The 95% repeatability ranges were leg related. CONCLUSIONS: The Lower Extremity Position Test (LEPT) is a newly-developed testing tool with good clinical utility, reliable in post-stroke population and has known-group validity (involved versus uninvolved foot).
Assuntos
Extremidade Inferior/fisiopatologia , Propriocepção/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Pé/fisiologia , Pé/fisiopatologia , Humanos , Extremidade Inferior/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/terapiaRESUMO
PURPOSE: To examine validity and test-retest reliability of a sensory test developed to evaluate ability of elderly subjects with/out a stroke to discriminate between textures with the sole of their foot. METHODS: Subjects poststroke, old adults and young subjects were tested twice. Twelve materials relevant to foot function (e.g., gravel, sand) were used. Blindfolded subjects were requested to discriminate with the sole of each foot one outstanding texture among three textures presented in each of 12 subtests. ANOVA, ICC and Bland-Altman tests were used to determine group/leg differences and test-retest reliability. RESULTS: Discrimination ability of the involved lower extremity poststroke is significantly reduced. Ability in individuals with no neurological impairment is age related. Good test-retest (ICC = 0.81) reliability was demonstrated for the impaired foot of subjects poststroke. The 95% repeatability ranges were age related with the highest range demonstrated for the involved foot poststroke. A significant fair negative correlation was demonstrated between texture discrimination ability and tactile detection threshold measured by Semmes-Weinstein monofilaments for the involved foot in poststroke subjects. CONCLUSION: This newly developed assessment tool demonstrates concurrent and known-groups validity and is reliable for determining texture discriminative ability of the foot in individuals post-stroke and in older adults with no neurological impairment. Implications for rehabilitation The texture discrimination test presented here is a valid and reliable tool, providing quantitative assessment of sensory function at the sole of the foot in older adults with no neurologic deficits and in subjects poststroke. Lower extremity texture discrimination test is easy to administer in the clinic and might suggest directions for individually tailored, lower extremity, sensory retraining protocols.
Assuntos
Pé/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Percepção do Tato/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
OBJECTIVE: We have previously described a breaking bad news (BBN) training program for primary care physicians [Ungar L, Alperin M, Amiel GE, Beharier Z, Reis S. Breaking bad news: structured training for family medicine residents. Patient Educ Couns 2002;48:63-68]. In this paper, we present the assessment of an educational intervention aimed at improving this important skill. METHODS: The assessment tool was an eight station objective structured clinical examination (OSCE) utilizing standardized patients (SPs). Intervention and control groups of 17 general practitioners (GP) each were evaluated before and after an educational intervention, or a Balint group (control). RESULTS: Intervention group GPs significantly increased their average grade on the post-test as compared to the pre-test (58.5, S.D. 12.7 versus 68.4, S.D. 9.2), effect size 0.94. Improvement in the control group was minimal (pre-test 57, S.D. 10.4 versus 58.1, S.D. 9.5 for the post-test), effect size 0.23. Reliability of the OSCE was alpha = 0.81. CONCLUSION: The performance assessment used in this study proved to be a reliable and valid tool to assess the ability of physicians to break bad news. It provided evidence of the effectiveness of the intervention. PRACTICE IMPLICATIONS: BBN training can and should be evaluated by valid and reliable measures. SPs can serve as reliable evaluators of BBN training.