Home Environmental Assessment Protocol-Revised Initial Psychometrics: A Pilot Study.

Efficient home assessments are needed for persons with dementia and their caregivers. Pilot studies to establish a content validity index (CVI), measure concurrent criterion validity, and examine test-retest reliability of the Home Environment Assessment Protocol-Revised (HEAP-R). Six experts reviewed the tool and scored content validity items. Twenty-one caregiver/person with dementia dyads engaged with HEAP and HEAP-R to examine concurrent criterion validity. Seventeen occupational therapists viewed 10 videos of home environments to examine reliability. The CVI score was .980. Concurrent criterion validity for domains: hazards (r =.792), adaptations (r = .742), clutter (r = .843), and comfort (r = .958). Test-retest reliability: hazards (r = .820), adaptations (r = .887), visual cues (r = .487), and clutter (r = .696). Pilot data suggest the HEAP-R has preliminary content and concurrent criterion validity and test-retest reliability. Robust psychometric analysis is needed prior to use in clinical practice.

Psychometric Properties of Segmental Assessment of Trunk Control in Infants and Toddlers With Down Syndrome.

PURPOSE: This study investigated infants and toddlers with Down syndrome (DS) to determine: reliability of the Segmental Assessment of Trunk Control (SATCo), concurrent validity of the SATCo with the Gross Motor Function Measure (GMFM), and whether age and SATCo score predict GMFM score. METHODS: Eighteen infants and toddlers with DS were tested on the SATCo by 2 physical therapist (PT) raters. One PT rater administered the GMFM. After 2 weeks, PT raters rescored their recorded SATCo sessions. A third PT rater also scored the SATCo videos. RESULTS: Interrater reliability of the SATCo was moderate to good and intrarater reliability was good to excellent. The SATCo and the GMFM had good to excellent significant correlations. Age and SATCo score were significant predictors of the GMFM. CONCLUSIONS: Trunk control appears to play a central role in gross motor function of infants and toddlers with DS. The SATCo has good psychometric properties in this population. WHAT THIS ADDS TO THE EVIDENCE: This study contributes to the literature on the psychometric properties of the SATCo and supports its use to measure trunk control in infants and toddlers with DS between the ages of 6 and 24 months.

Validity of the Sock Test for Sitting Balance: A Functional Sitting Balance Assessment.

There is a relationship between sitting balance and self-care functioning, but no occupation-based sitting balance assessment. The objective of this study was to determine whether the Sock Test for Sitting Balance (STSB) is a valid balance assessment for use by therapists in acute care. Results of the STSB were compared with those of the Adapted Functional Reach (AFR), the Functional Independence Measure (FIM™) chair transfer, and the Kansas University Sitting Balance Scale (KUSBS), in both hospitalized and healthy participants. There is a significant relationship between STSB results and AFR results for all participants (rs = -.382, p = .012). Relationships between STSB results and score on the FIM™ Chair Transfer subscale (p = .001), and score on the KUSBS (p = .003) are significant. The STSB can differentiate between a hospitalized population and healthy population (p = .017). Criterion and known-groups validity are demonstrated, but should be confirmed with further testing.

Reliability and validity of a smartphone pulse rate application for the assessment of resting and elevated pulse rate.

Purpose/hypothesis: This study was designed to investigate the test-retest reliability, concurrent validity, and the standard error of measurement (SEm) of a pulse rate assessment application (Azumio®'s Instant Heart Rate) on both Android® and iOS® (iphone operating system) smartphones as compared to a FT7 Polar® Heart Rate monitor. Number of subjects: 111. MATERIALS/METHODS: Resting (sitting) pulse rate was assessed twice and then the participants were asked to complete a 1-min standing step test and then immediately re-assessed. The smartphone assessors were blinded to their measurements. RESULTS: Test-retest reliability (intraclass correlation coefficient [ICC 2,1] and 95% confidence interval) for the three tools at rest (time 1/time 2): iOS® (0.76 [0.67-0.83]); Polar® (0.84 [0.78-0.89]); and Android® (0.82 [0.75-0.88]). Concurrent validity at rest time 2 (ICC 2,1) with the Polar® device: IOS® (0.92 [0.88-0.94]) and Android® (0.95 [0.92-0.96]). Concurrent validity post-exercise (time 3) (ICC) with the Polar® device: iOS® (0.90 [0.86-0.93]) and Android® (0.94 [0.91-0.96]). The SEm values for the three devices at rest: iOS® (5.77 beats per minute [BPM]), Polar® (4.56 BPM) and Android® (4.96 BPM). CONCLUSIONS: The Android®, iOS®, and Polar® devices showed acceptable test-retest reliability at rest and post-exercise. Both the smartphone platforms demonstrated concurrent validity with the Polar® at rest and post-exercise. CLINICAL RELEVANCE: The Azumio® Instant Heart Rate application when used by either platform appears to be a reliable and valid tool to assess pulse rate in healthy individuals.

An economic evaluation of a self-management programme of activity, coping and education for patients with chronic obstructive pulmonary disease.

The aim was to undertake a cost-utility analysis of a self-management programme of activity, coping and education (SPACE) for chronic obstructive pulmonary disease (COPD). The analysis was conducted alongside a six-month randomized controlled trial in 30 primary care settings. The economic analysis used data from 184 patients with confirmed diagnosis of COPD, forced expiratory volume in one second/forced vital capacity ratio <0.7 and with grade 2-5 on the Medical Research Council dyspnoea scale. Participants received either a self-management programme consisting of an education manual (SPACE for COPD) and consultation or usual care. Six-month costs were estimated from the National Health Service and Personal Social Services perspective and quality-adjusted life years (QALYs) were calculated based on patient responses at baseline and six months.The mean difference in costs between usual care and SPACE FOR COPD programme was -£27.18 (95% confidence interval (CI); -£122.59 to £68.25) while mean difference in QALYs was -0.10 (95% CI; -0.17 to -0.02). The results suggest that the intervention is more costly and more effective than usual care. The probability of the intervention being cost-effective was 97% at a threshold of £20,000/QALY gained. We conclude that the SPACE FOR COPD programme is cost-effective compared to usual care.

A self-management programme for COPD: a randomised controlled trial.

Studies of programmes of self-management support for chronic obstructive pulmonary disease (COPD) have been inconclusive. The Self-Management Programme of Activity, Coping and Education (SPACE) FOR COPD is a 6-week self-management intervention for COPD, and this study aimed to evaluate the effectiveness of this intervention in primary care. A single-blind randomised controlled trial recruited people with COPD from primary care and randomised participants to receive usual care or SPACE FOR COPD. Outcome measures were performed at baseline, 6 weeks and 6 months. The primary outcome was symptom burden, measured by the self-reported Chronic Respiratory Questionnaire (CRQ-SR) dyspnoea domain. Secondary outcomes included other domains of the CRQ-SR, shuttle walking tests, disease knowledge, anxiety, depression, self-efficacy, smoking status and healthcare utilisation. 184 people with COPD were recruited and randomised. At 6 weeks, there were significant differences between groups in CRQ-SR dyspnoea, fatigue and emotion scores, exercise performance, anxiety, and disease knowledge. At 6 months, there was no between-group difference in change in CRQ-SR dyspnoea. Exercise performance, anxiety and smoking status were significantly different between groups at 6 months, in favour of the intervention. This brief self-management intervention did not improve dyspnoea over and above usual care at 6 months; however, there were gains in anxiety, exercise performance, and disease knowledge.

Reliability and validity of goniometric iPhone applications for the assessment of active shoulder external rotation.

PURPOSE/HYPOTHESIS: The purpose of this study was to determine the reliability and validity of two smartphone applications: (1) GetMyROM - inclinometery-based and (2) DrGoniometry - photo-based in the measurement of active shoulder external rotation (ER) as compared to standard goniometry (SG). PARTICIPANTS: Ninety-four Texas Woman's University Doctor of Physical Therapy students from the School of Physical Therapy - Houston campus, were recruited to participate in this study. MATERIALS/METHODS: Two iPhone applications were compared to SG using both novice and experienced raters. Active shoulder ER range of motion was measured over two time periods in random order by blinded novice and experienced raters. RESULTS: Intra-rater reliability using novice raters for the two applications ranged from an intraclass correlation coefficient (ICC) of 0.79 to 0.81 with SG at 0.82. Inter-rater reliability (novice/expert) for the two applications ranged from an ICC of 0.92 to 0.94 with SG at 0.91. Concurrent validity (when compared to SG) ranged from 0.93 to 0.94. There were no significant differences between the novice and experienced raters. CONCLUSION: Both applications were found to be reliable and comparable to SG. A photo-based application potentially offers a superior method of measurement as visualizing the landmarks may be simplified in this format and it provides a record of measurement. CLINICAL RELEVANCE: Further study using patient populations may find the two studied applications are useful as an adjunct for clinical practice.

Qualitative assessment of component-specific, fall-risk screening procedures to create a fall risk screening form.

BACKGROUND: The Day Center, Case Management, and Home Care components of a local senior health agency each have used different screening forms for assessing their clients for fall risk. A common instrument, easily administered by all components as part of their routine practice, would be helpful in systematically identifying elders at risk of falling. Developing a common screening instrument would be useful at other senior health agencies as well. PURPOSE: To gather information on the content and features that are most useful for fall screening, based on the needs of individual geriatric care workers in each component of a local senior health agency. METHODS: A semistructured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. RESULTS: Two major themes emerged: (1) factors that are relevant in assessing fall risk and (2) factors that affect the utility of the fall risk screening procedure. Under theme 1, there were 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme 2, there were 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature, health status and fear of falling, to produce a universal form for use by different agency components. DISCUSSION: Integrating all fall-risk categories into a universal form improves the completeness of the form used in different agency components. However, to increase the utility of fall risk screening, service plans integrated with each screening procedure need to be developed according to specific agency structures. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) initial screening with an outreach worker using a quick question assessment; (2) follow-up with a more comprehensive fall risk assessment while receiving services from the Day Center, Case Management, or Home Care; and (3) a "what-to-do" action is presented for each item on the basis of each question's response on the comprehensive form. CONCLUSIONS: When designing a fall risk screening procedure, integrating all fall-risk factors into a single comprehensive form may not be the ideal strategy. The environment, the person who gathers the information, and the actions required to respond to information gathered should also be considered. On the basis of the results of this qualitative study, we have presented a 3-step procedure, with supporting forms to address these considerations.

Pain assessment and management in children with neurologic impairment: a survey of pediatric physical therapists.

PURPOSE: This study explored pain assessment measures and interventions used by physical therapists in the treatment of children with neurologic impairment. METHODS: Following extensive literature review on pain assessment and intervention, a survey was developed, pilot tested, and posted on the listserv of the Pediatric Section of the American Physical Therapy Association. RESULTS: Eighty percent of the respondents used subjective measures to assess pain, 70% used self-report scales, and 41% used behavioral and physiological measures. Behaviors frequently used included vocalizations, facial expression, and irritability. Rarely used cues included decreased attention, withdrawal, and changes in sleeping and eating behaviors. Therapists used research-supported pain interventions such as distraction and praise as well as potentially harmful distress producing measures such as procedural talk and reassurance. CONCLUSION: Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.