Use of the Hypothesis-Oriented Algorithm to Prepare Students for an Objective Structured Clinical Examination in Physical Therapy Education.

OBJECTIVE: The purpose of this study is to examine the effect of using the Hypothesis-Oriented Algorithm for Clinicians (HOAC II) on student satisfaction and performance scores in a physical therapy Objective Structured Clinical Examinations (OSCE). METHODS: Forty-three Doctor of Physical Therapy students were recruited to participate in two exam preparation groups. One group (n=21) was assigned to study the HOAC II and the other group (n=22) was assigned to a control group. An independent t-test was used to assess the effect of group assignment on performance scores and satisfaction scores. RESULTS: The results of the independent t-test showed no significant difference in performance scores between groups. The results of the independent t-test were significant for question 2 on the student satisfaction survey, with the HOAC II group expressing more satisfaction, p=0.01. Additionally, the total satisfaction of the OSCE experience was significantly different between groups, p=0.03, with the HOAC II group expressing more satisfaction. CONCLUSION: The HOAC II has been shown to enhance the experience of completing an OSCE in second-year Doctor of Physical Therapy students.

Recommendations for the treatment of knee osteoarthritis, using various therapy techniques, based on categorizations of a literature review.

PURPOSE: This literature review is to evaluate current research articles pertinent to physical therapy treatment of osteoarthritis (OA) of the knee. Osteoarthritis of the knee is an increasingly common diagnosis, with a prognosis that can lead to loss in an individual's functional abilities. Literature on the subject of OA and its physical therapy treatment is vast and current, however, obtaining and analyzing it can be time consuming and costly to a Physical Therapist. The primary aim of this paper is to review current trends for treatment of OA of the knee, and to compare each intervention for effectiveness. This article provides a systematic categorization as well as recommendations for physical therapists based on current (1996 or sooner) literature. METHODS: Twenty-two articles were located using various online databases, critically analyzed, and categorized using Sackett's levels of evidence. Recommendations for the treatment of OA of the knee by a physical therapist were then made. RESULTS: Two grade A recommendations, 5 grade B recommendation, and 2 grade C recommendations were made from the categorization of the articles. This article also contains recommendations outside the scope of a therapist's practice, which a physical therapist could consider when treating a patient with knee osteoarthritis. Further research recommendations are also provided.

Reliability, validity, and responsiveness of the Balance Evaluation Systems Test (BESTest) in individuals with multiple sclerosis.

BACKGROUND: The Balance Evaluation Systems Test (BESTest) measures various aspects of postural control, but little data exist in persons with multiple sclerosis (MS). The purpose of this study was to determine the psychometrics of the BESTest in MS. DESIGN: Observational study. METHODS: 21 ambulatory subjects with MS participated. In the first session, demographic data was collected; each subject completed a questionnaire of self-perceived disability level and the BESTest. The BESTest was re-administered 1 week later. RESULTS: Test-retest reliability (ICC 3,1) for the total BESTest was 0.94, ranging 0.66 to 0.93 for the subsections. Internal consistency (Chronbach's alpha) for the total BESTest was 0.97; subsections scores ranged 0.79 to 0.96. Minimal detectable change (MDC) scores ranged from 2.25 to 4.58 for subsections with 9.47 points for total BESTest. Weak to moderate correlations were found between individual subsection scores (0.12 to 0.78), and BESTest total and subsection scores to fall (-0.08 to -0.62) frequency and self-perceived disability level (-0.24 to -0.64). Strongest correlations were found between BESTest total and individual subsection scores. No floor effects were found; five BESTest subsections had ceiling effects. CONCLUSIONS: The BESTest is reliable and valid in individuals with MS. Total BESTest scores demonstrated higher reliability and a lack of a ceiling effect as compared to subsection scores, suggesting that clinicians use the BESTest in its entirety. The correlations among subsection scores indicate that each assesses a unique aspect of balance, supporting its construct validity. The MDC scores will assist clinicians in assessing patient change.

Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke.

The primary purpose of this review article is to critically analyse the literature from 1999 to 2005 regarding effective interventions for upper extremity hemiparesis following stroke. The researchers narrowed the scope of the review based on inclusion and exclusion criteria, which yielded 11 pertinent studies congruent with the selection criteria. Studies were categorized using Sackett's levels of evidence, level I being the highest degree of certainty and level V the lowest. Grades of recommendations were then developed, grade A being highly recommended, grade B discretionary and grade C not endorsed. Two studies were endorsed as level I - grade A, six were level II - grade B, and three were level III - grade C. Clinical recommendations inferred from the present evaluation are as follows:* Electrical stimulation can be used to improve upper limb outcomes in patients with moderate to severe upper limb dysfunction and is feasible for home-based interventions.* Therapy that utilizes goal-directed reaching behaviours promotes more typical reaching patterns than non-goal-directed interventions.* Reach-to-grasp movements show greater improvement when compensatory trunk movements are reduced.* As an addition to regular exercise therapy time, Arm BASIS training may enhance selective movements of the upper extremity (i.e. reaching).* When performed in conjunction with active neuromuscular stimulation, random and blocked practice may improve pre-motor, motor and total reaction times of the upper extremity.

Relationship of closed and open chain measures of strength with perceived physical function and mobility following unilateral total knee replacement.

BACKGROUND AND PURPOSE: The association between closed-chain knee extensor strength and perceived physical function following primary knee replacement has not received much attention.The purpose of this investigation was to determine the relationship of closed and open chain measures of strength with self-reported measures of physical function and mobility following unilateral knee replacement. METHODS: Subjects were 9 individuals (68. 7 +/- 2.3 years) approximately 16 months postsurgery. The independent variables were closed-chain (elastic) and open-chain (isometric) measures of strength, while the dependent measures were perceived physical function (WOMAC) and mobility (Timed Up and Go, TUG). The relationship between independent and dependent variables was described using Spearman Rho correlation coefficients. RESULTS: Force produced during the closed-chain assessment was strongly associated to the WOMAC physical function dimension (-.96) and total WOMAC score (-.87). A poor to low relationship existed between the open-chain measure of strength and the physical function dimension (-.34) and the total WOMAC score (-.17). Force production of the entire lower limb, measured in the closed-chain was moderately related (-.62) with the TUG. The association between knee extensor isometric torque and the TUG (-.25) was low. CONCLUSIONS: Closed-chain assessment of entire lower limb strength, rather than open-chain measures of knee extensor strength, may provide greater insight to functional limitations.

Examiner Fatigue and Ability to Concentrate in Objective Structured Clinical Examinations for Physical Therapist Students.

PURPOSE: This study examined the effect of time, method of scoring, and method of recording on examiners' self-perceived fatigue and ability to concentrate, and if those factors have any effect on scoring student performance by the examiners during the administration of an objective structured clinical examination (OSCE). METHODS: Twenty-two clinicians and faculty were recruited to participate as examiners of two OSCEs in this study. The examiners were asked to rate their perceived level of fatigue and ability to concentrate at the end of pre-determined blocks of time during two OSCEs using a visual analog scale. Data were analyzed using a mixed-model multi-way ANOVA for repeated measures and paired t-tests. RESULTS: In both OSCEs, there was a significant difference over time, with examiner fatigue increasing over time (p<0.05) and the ability to concentrate decreasing over time (p<0.05). In one OSCE, there was a significant difference in student performance scores, with lower performance scores over time (p<0.05). There was a significant difference between paper and electronic recording in fatigue (p>0.009), with paper showing more fatigue than the electronic recording. CONCLUSION: The results of this study demonstrate that fatigue and ability to concentrate are factors to consider when conducting an OSCE.

A critical review of literature regarding the effectiveness of physical therapy management of hip fracture in elderly persons.

The purpose of this review is to analyze the research literature that has examined the effectiveness of physical therapy in the management of hip fractures in elderly persons. Using literature databases and keywords, we located relevant studies. Fifteen studies met the criteria and were then categorized according to Sackett's levels of evidence. Six studies were graded at level I, six at level II, and three at level V, with level I having the highest level of evidence. From the levels of evidence, one grade A, three grade B, and two grade C recommendations were developed, with grade A being the most significant recommendation. Clinical recommendations are offered about patients with dementia, therapeutic exercise, and when and for how long rehabilitation should continue. In addition, future research directions are provided.

Effectiveness of physical therapy treatments on lateral epicondylitis.

OBJECTIVE: To analyze research literature that has examined the effectiveness of various physical therapy interventions on lateral epicondylitis. DATA SOURCES: Evidence was compiled with data located using the PubMed, EBSCO, The Cochrane Library, and the Hooked on Evidence databases from 1994 to 2006 using the key words lateral epicondylitis, tennis elbow, modalities, intervention, management of, treatment for, radiohumeral bursitis, and experiment. STUDY SELECTION: The literature used included peer-reviewed studies that evaluated the effectiveness of physical therapy treatments on lateral epicondylitis. Future research is needed to provide a better understanding of beneficial treatment options for people living with this condition. DATA SYNTHESIS: Shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions. CONCLUSIONS: There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Mobility and perceived function after total knee arthroplasty.

Mobility using the timed up and go (TUG) and perceived pain, stiffness, and physical function (Western Ontario McMaster Universities Osteoarthritis Index) were documented after total knee arthroplasty (TKA). The relationships between mobility and perceived function are limited post-TKA. The first purpose of this study was to determine and compare the TUG test between individuals (n = 11) post-TKA and age-sex-related controls (n = 11). The second purpose of this study was to explore the relationships between mobility and self-reported function post-TKA. The TKA group was 28% (P < .05) slower in completing the TUG compared with controls and reported difficulty in attempting challenging tasks. The TUG was moderately related to the physical function (0.63) dimension of the Western Ontario and McMaster Universities Osteoarthritis Index, as well as the aggregate Western Ontario and McMaster Universities Osteoarthritis Index score (0.59).