Experiences of the use of portfolio in dental education - A qualitative meta-ethnographic literature review.

INTRODUCTION: Portfolio with a collection of evidence has become popular in higher education, including dental education. It is valuable to study the experiences of the use and implementation processes. Meta-ethnography can be a suitable method to analyse, synthesize and construct interpretations of qualitative research. Our aim was to explore experiences from the use of a portfolio/e-portfolio in dental education, from the students' and teachers' perspectives. MATERIALS AND METHODS: A systematic search in the databases PubMed, Scopus and ERC was performed, and the established seven steps of a meta-ethnographic review were used. 278 papers were initially identified, and seven were included in the final analysis. RESULTS: Two themes (Issues to Address and Consequences) and five subthemes (Purpose, Roles, Support and Structure, Challenges and Enablers, and Gains) were constructed. DISCUSSION: Our synthesis reflects various challenges, yet the learning gains are recognized and expressed to be important once the students and teachers have overcome early thresholds. Beyond the conclusions drawn in each paper, our synthesis provides new perspectives on the complexity of an implementation process and the balance of not seeing the woods for the trees being overwhelmed by technical and other practical aspects, reducing the opportunity for learning. CONCLUSION: The portfolio implementation in undergraduate dental education should address clarification to all stakeholders of the purpose and role, presenting a purposeful portfolio structure and timely support.

Entrustable professional activities (EPAs) for undergraduate medical education - development and exploration of social validity.

BACKGROUND: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders. AIM: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs. METHOD AND MATERIAL: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater's perception of the present graduates' required level of supervision when performing the activity. Free-text comments were also included and analyzed. RESULTS: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as "important" by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported "independent". The three themes of the free text comments were: 'relevant target areas and content'; 'definition of the activities'; and 'clinical practice and learning'. CONCLUSION: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners' attitudes and practices in low-income countries.

INTRODUCTION: In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners' knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners' knowledge, attitudes and practices concerning SRHR in low-income countries. OBJECTIVES: 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners' SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees' characteristics, their SRHR work environment and transfer of training. METHODS: A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees' pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees' baseline characteristics and post-training attitudes and practices. RESULTS: Trainees' self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. CONCLUSION: The findings indicate that the ITP was effective in improving trainees' self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.

Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher.

INTRODUCTION: Patient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants' perceptions of learning in a patient simulation scenario. METHODS: We conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis. RESULTS: Three themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague. CONCLUSIONS: The mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating. This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.

Embedding environmental sustainability within oral health professional curricula-Recommendations for teaching and assessment of learning outcomes.

The FDI World Dental Federation suggests that "dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life." This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.

Predictors of health care practitioners' normative attitudes and practices towards sexual and reproductive health and rights: a cross-sectional study of participants from low-income countries enrolled in a capacity-building program.

Background: Sexual and Reproductive Health and Rights (SRHR) is a concept of human rights applied to sexuality and reproduction. Suboptimal access to SRHR services in many low-income countries results in poor health outcomes. Sustainable development goals (3.7 and 5.6) give a new impetus to the aspiration of universal access to high-quality SRHR services. Indispensable stakeholders in this process are healthcare practitioners who, through their actions or inactions, determine a population's health choices. Often times, healthcare practitioners' SRHR decisions are rooted in religious and cultural influences. We seek to understand whether religious and cultural influences differ significantly according to individuals' characteristics and work environment. Objective: The purpose of this study was to examine the role of healthcare practitioners' individual characteristics and their work environment in predicting normative SRHR attitudes and behaviours (practices). We hypothesized that religion and culture could be significant predictors of SRHR attitudes and practices. Methods: A quantitative cross-sectional study of 115 participants from ten low-income countries attending a capacity-building programme at Lund University Sweden was conducted. Linear regression models were used to assess for the predictive values of different individual characteristics and workplace environment factors for normative SRHR attitudes and SRHR practices. Results: Self-rated SRHR knowledge was the strongest predictor for both normative SRHR attitudes and normative SRHR practices. However, when adjusted for other individual characteristics, self-rated knowledge lost its significant association with SRHR practices, instead normative SRHR attitudes and active knowledge-seeking behaviour independently predicted normative SRHR practices. Contrary to our hypothesis, importance of religion or culture in an individual's life was not correlated with the measured SRHR attitudes and practices. Conclusion: Healthcare practitioners' cultural and religious beliefs, which are often depicted as barriers for implementing full coverage of SRHR services, seem to be modified by active knowledge-seeking behaviour and accumulated working experience with SRHR over time.

'One-size doesn't fit all': Understanding healthcare practitioners' perceptions, attitudes and behaviours towards sexual and reproductive health and rights in low resource settings: An exploratory qualitative study.

Although progress has been made to improve access to sexual and reproductive health services globally in the past two decades, in many low-income countries, improvements have been slow. Discrimination against vulnerable groups and failure to address health inequities openly and comprehensively play a role in this stagnation. Healthcare practitioners are important actors who, often alone, decide who accesses services and how. This study explores how health care practitioners perceive sexual and reproductive health and rights (SRHR) and how background factors influence them during service delivery. Participants were a purposefully selected sample of health practitioners from five low income countries attending a training in at Lund University, Sweden. Semi-structured interviews and qualitative content analysis were used. Three themes emerged. The first theme, "one-size doesn't fit all' in SRHR" reflects health practitioners' perception of SRHR. Although they perceived rights as fundamental to sexual and reproductive health, exercising of these rights was perceived to be context-specific. The second theme, "aligning a pathway to service delivery", illustrates a reflective balancing act between their personal values and societal norms in service delivery, while the third theme, "health practitioners acting as gatekeepers", describes how this balancing act oscillates between enabling and blocking behaviours. The findings suggest that, even though health care practitioners perceive SRHR as fundamental rights, their preparedness to ensure that these rights were upheld in service delivery is influenced by personal values and society norms. This could lead to actions that enable or block service delivery.

[EPA (Entrustable professional activities) - an international approach to define key tasks that a doctor should be able to perform]. / EPA ­ en modell för att träna och bedöma dagligt läkarjobb.

Entrustable Professional Activities (EPAs) define observable key tasks that a doctor should be able to do independently after having completed a certain level of education. Progression is facilitated by frequent assessments of the defined activities, with increased degree of independence. The observations should be supported by constructive feed-forward. EPA is currently used in several countries both in undergraduate and post graduate education. In the context of pending changes in Swedish legislation regarding undergraduate education qualifications ordinance and medical licensing, a Swedish national work group has begun to define Swedish EPA for the future undergraduate education.

Using the case method to explore characteristics of the clinical reasoning process among ambulance nurse students and professionals.

Clinical reasoning is proposed to represent cognitive processes, skills and decision-making aspects of nursing practice and is important for quality care. It has been suggested that the reasoning processes should be practiced during education to develop decision-making competence among nurses. The aim of the study was to explore and describe clinical reasoning processes at different times during specialist ambulance nurse education and among specialist ambulance nurses. Nurses were invited to participate: at initiation of specialist education (n = 19) and during the final weeks of specialist education (n = 17). We also invited nurses employed in ambulance service (n = 13). At each session a written case was presented for small group discussions. Discussions were recorded and transcribed. A mapping sentence was used to analyse the meaning units of the text capturing different elements of clinical reasoning. For interpretation of data the results were then plotted in a three-dimensional diagram. Professional experiences and reflectivity seemed to influence both the content and the process of clinical reasoning. At initiation of specialist education, more analytical reasoning was used, while the specialist nurses mainly used a non-analytical approach. Specialist nurses incorporated a larger variety of content during their reasoning. Based on the findings here, the case-method might be useful for practicing various clinical reasoning skills and elaborating on decision-making processes.

Associations between altered movement patterns during single-leg squat and muscle activity at weight-transfer initiation in individuals with anterior cruciate ligament injury.

BACKGROUND: Little is known about factors contributing to the altered movement patterns observed in many individuals with anterior cruciate ligament (ACL) injury. We addressed whether altered muscular activity is such a factor. METHODS: 16 participants with unilateral, non-reconstructed ACL rupture were scored for altered movement patterns according to Test for Substitution Patterns (TSP), which includes the single-leg squat (SLS). Surface electromyography (SEMG), was recorded in the lower extremities at initiation of weight-transfer from double-leg to single-leg stance (eyes closed), simulating the initiation of an SLS. Normalised SEMG amplitudes 200-300 ms after weight-transfer initiation were compared between injured and non-injured sides, and correlated to the TSP scores for the SLS. Peak absolute SEMG amplitudes during 5 TSP test movements were also compared between sides. RESULTS: At weight-transfer initiation, muscle activity was lower in the tibialis anterior, gastrocnemius and peroneus longus muscles on the injured side. Low muscle activity correlated moderately to worse TSP scores for the SLS for the gluteus medius (rs=-0.56, p=0.03), and gastrocnemius muscles (rs=-0.56, p=0.02). Median peak absolute amplitude during TSP movements was lower in the quadriceps, gastrocnemius and peroneus longus muscles on the injured side. CONCLUSIONS: The altered patterns of muscle activity at weight-transfer initiation, correlations between lower activity at movement initiation and altered movement patterns during SLS and the altered peak amplitudes during TSP movements together indicate alterations in sensorimotor control that may contribute to the observed altered movement patterns. Future studies will determine if exercises targeting muscle activity initiation should complement customary ACL injury rehabilitation.

Is that really my movement? - Students' experiences of a video-supported interactive learning model for movement awareness.

Healthcare staff and students have a great risk of developing musculoskeletal symptoms. One cause of this is heavy load related work activities such as manual handling, in which the quality of individual work technique may play a major role. Preventive interventions and well-defined educational strategies to support movement awareness and long-lasting movement changes need to be developed. The aim of the present study was to explore nursing students' experiences of a newly developed interactive learning model for movement awareness. The learning model, which is based on a life-world perspective with focus on interpersonal interaction, has been used with 11 undergraduate students from the second and final year. Each student participated in three individual video sessions with a facilitator. Two individual interviews were carried out with each student during the learning process and one interview 12-18 months after the last session. The interviews were audio-recorded and transcribed verbatim, and a phenomenological hermeneutic method inspired by Paul Ricoeur and described by Lindseth and Norberg was used to interpret the interviews and diary notes. The interpretation resulted in three key themes and nine subthemes. The key themes were; "Obtaining better preconditions for bodily awareness," "Experiencing changes in one's own movement," and "Experiencing challenges in the learning process." The interactive learning model entails a powerful and challenging experience that develops movement awareness. The experience of meaningfulness and usefulness emerges increasingly and alternates with a feeling of discomfort. The learning model may contribute to the body of knowledge of well-defined educational strategies in movement awareness and learning in, for example, preventive interventions and ergonomic education. It may also be valuable in other practical learning situations where movement awareness is required.

External and internal factors influencing self-directed online learning of physiotherapy undergraduate students in Sweden: a qualitative study.

PURPOSE: Online courses have become common in health sciences education. This learning environment can be designed using different approaches to support student learning. To further develop online environment, it is important to understand how students perceive working and learning online. The aim of this study is to identify aspects influencing students' learning processes and their adaptation to self-directed learning online. METHODS: Thirty-four physiotherapy students with a mean age of 25 years (range, 21 to 34 years) participated. Qualitative content analysis and triangulation was used when investigating the students' self-reflections, written during a five week self-directed, problem-oriented online course. RESULTS: Two categories emerged: 'the influence of the structured framework' and 'communication and interaction with teachers and peers.' The learning processes were influenced by external factors, e.g., a clear structure including a transparent alignment of assignments and assessment. Important challenges to over-come were primarily internal factors, e.g., low self-efficacy, difficulties to plan the work effectively and adapting to a new environment. CONCLUSION: The analyses reflected important perspectives targeting areas which enable further course development. The influences of external and internal factors on learning strategies and self-efficacy are important aspects to consider when designing online courses. Factors such as pedagogical design, clarity of purpose, goals, and guidelines were important as well as continuous opportunities for communication and collaboration. Further studies are needed to understand and scaffold the motivational factors among students with low self-efficacy.

Altered movement patterns and muscular activity during single and double leg squats in individuals with anterior cruciate ligament injury.

BACKGROUND: Individuals with Anterior Cruciate Ligament (ACL) injury often show altered movement patterns, suggested to be partly due to impaired sensorimotor control. Here, we therefore aimed to assess muscular activity during movements often used in ACL-rehabilitation and to characterize associations between deviations in muscular activity and specific altered movement patterns, using and further exploring the previously developed Test for substitution Patterns (TSP). METHODS: Sixteen participants (10 women) with unilateral ACL rupture performed Single and Double Leg Squats (SLS; DLS). Altered movement patterns were scored according to TSP, and Surface Electromyography (SEMG) was recorded bilaterally in six hip, thigh and shank muscles. To quantify deviations in muscular activity, SEMG ratios were calculated between homonymous muscles on injured and non-injured sides, and between antagonistic muscles on the same side. Correlations between deviations of injured/non-injured side SEMG ratios and specific altered movement patterns were calculated. RESULTS: Injured/non-injured ratios were low at transition from knee flexion to extension in quadriceps in SLS, and in quadriceps and hamstrings in DLS. On injured side, the quadriceps/hamstrings ratio prior to the beginning of DLS and end of DLS and SLS, and tibialis/gastrocnemius ratio at end of DLS were lower than on non-injured side. Correlations were found between specific altered movement patterns and deviating muscular activity at transition from knee flexion to extension in SLS, indicating that the more deviating the muscular activity on injured side, the more pronounced the altered movement pattern. "Knee medial to supporting foot" correlated to lower injured/non-injured ratios in gluteus medius (rs = -0.73, p = 0.001), "lateral displacement of hip-pelvis-region" to lower injured/non-injured ratios in quadriceps (rs = -0.54, p = 0.03) and "displacement of trunk" to higher injured/non-injured ratios in gluteus medius (rs = 0.62, p = 0.01). CONCLUSIONS: Deviations in muscular activity between injured and non-injured sides and between antagonistic muscular activity within injured as compared to non-injured sides indicated specific alterations in sensorimotor control of the lower limb in individuals with ACL rupture. Also, correlations between deviating muscular activity and specific altered movement patterns were suggested as indications of altered sensorimotor control. We therefore advocate that quantitative assessments of altered movement patterns should be considered in ACL-rehabilitation.

Impact of musculoskeletal symptoms on general physical activity during nursing education.

Nursing education should prepare students for a lifelong professional career including managing clinical physical demands. Musculoskeletal symptoms, such as bodily pain, have been reported among nurses and nursing students but less is known about the impact of symptoms in daily activities. The aim was to explore the prevalence of self-reported musculoskeletal symptoms and their impact on general physical activity among nursing students. This cross-sectional study was based on a questionnaire to all undergraduate nursing students at one university. The prevalence of symptoms and physical impact during past 3 and 12 months was calculated for each study year. Odds ratio was analysed with logistic regression. Of 348 students 224 responded, 84% women, mean age 24.6 years (range 20-46). Of those 143 (64%) reporting symptoms during the past 12 months, 91 (64%) reported impact on physical activities. Most commonly reported were everyday activities such as transportations and prolonged sitting. The odds ratio for reporting symptoms was 1.8 for year 2 (95% CI: 0.9-3.5), and 4.7 for year 3 (95% CI: 2.1-10.7). The prevalence of musculoskeletal symptoms was high among nursing students and higher the final study year and not only resulted in discomfort but had an impact on the students' general physical activities.

The six-item CTS symptoms scale and palmar pain scale in carpal tunnel syndrome.

PURPOSE: To evaluate measurement properties of 2 brief outcome measures for carpal tunnel syndrome: the 6-item carpal tunnel symptoms scale (CTS-6) and the 2-item palmar pain scale (measuring severity of pain in the scar/palm and pain-related activity limitation). Our hypothesis was that the CTS-6 is responsive to change in symptoms after surgical treatment and the pain scale is a valid measure of surgery-related pain. METHODS: This study followed 447 consecutive patients with carpal tunnel syndrome undergoing open release; 308 completed the CTS-6 and the Disabilities of the Arm, Shoulder, and Hand-short form (QuickDASH) before surgery and the CTS-6, QuickDASH, palmar pain scale, and 2 items regarding global rating of change and treatment satisfaction once after surgery (range, 2-13 mo). The mean scores for the CTS-6 (range, 1-5) and QuickDASH and palmar pain scales (range, 0-100) were calculated (lower score is better). Responsiveness was assessed with the effect size (ES). We estimated the CTS-6 score change indicating minimal clinically important difference based on scores for patients with moderate self-rated improvement. RESULTS: The mean baseline CTS-6 score was 3.16, mean change after surgery was -1.54 (95% confidence interval [CI], -1.65 to -1.44), and ES was 2.0. The ES was large (2.5) in patients with the largest self-rated improvement and decreased with lower self-rated improvement. A score change of 0.9 indicated a minimal clinically important difference. The mean change in QuickDASH score was -25.4 (95% CI, -27.8 to -23.0), and ES was 1.25. The mean palmar pain score for patients with time since surgery of less than 3 months was 38.5, at 3 to 6 months was 35.4, and greater than 6 months was 19.5; the mean score was significantly higher among patients with lower satisfaction. CONCLUSIONS: The CTS-6 is highly responsive to change in symptoms, and the palmar pain scale is a valid measure of surgery-related pain. These brief scales can be appropriate primary and secondary outcomes measures in clinical trials studying carpal tunnel syndrome.

Longitudinal construct validity of the GMFM-88 total score and goal total score and the GMFM-66 score in a 5-year follow-up study.

BACKGROUND: The Gross Motor Function Measure (GMFM) is the instrument most commonly used to measure gross motor function in children with cerebral palsy (CP). Different scoring options have been developed, and their measurement properties have been assessed. Limited information is available regarding longitudinal construct validity. OBJECTIVE: The objective of this research was to study the longitudinal construct validity of 3 scoring options: the 88-item GMFM (GMFM-88) total, the GMFM-88 goal total, and the 66-item GMFM (GMFM-66). DESIGN: A clinical measurement design was used in this study. METHODS: Forty-one children with CP diplegia who were undergoing selective dorsal rhizotomy (SDR) were monitored with the GMFM for 5 years. The mean age at SDR was 4.4 years (range=2.5-6.6). Two subgroups for gross motor function before surgery were created according to the Gross Motor Function Classification System (GMFCS): GMFCS levels I to III and GMFCS levels IV and V. This study included results obtained before SDR and at 6, 12, and 18 months and 3 and 5 years after SDR. The effect size (ES) and the standardized response mean (SRM) were calculated. RESULTS: At 6 months postoperatively, ES and SRM values were small (

The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome.

OBJECTIVE: To develop a psychometrically appropriate brief symptoms measure of carpal tunnel syndrome (CTS). METHODS: Preoperative CTS 11-item symptom severity and 8-item functional status scales from 693 patients (71% women) with CTS were subjected to exploratory factor analysis and item response theory (IRT) analysis yielding a revised CTS symptoms scale. A validation sample of 213 patients (68% women) with CTS completed the 11-item disabilities of the arm, shoulder and hand (QuickDASH), and the revised symptoms scale and 116 patients also completed the original CTS symptom severity scale (median interval 11 days). RESULTS: Of the 11 CTS symptom severity scale items, 2 items that on factor analysis associated with the functional status items were removed. After IRT recalibrations of the remaining symptom severity scale items, 2 non-fitting items were removed and 2 items were merged creating the 6-item CTS symptoms scale. Factor analysis showed one dominant factor explaining 58% of the variance. Reliability was high (Cronbach alpha = 0.86; IRT person separation reliability = 0.88). No item displayed significant differential item functioning. The 6-item CTS symptoms scale showed strong correlation with the QuickDASH (r = 0.70) and agreement with the original symptom severity scale (ICC = 0.80). CONCLUSION: The 6-item CTS symptoms scale has good reliability and validity and can be used to measure symptom severity and treatment outcome in CTS.

Carpal tunnel syndrome and keyboard use at work: a population-based study.

OBJECTIVE: To investigate the relationship between carpal tunnel syndrome (CTS) and keyboard use at work in a general population. METHODS: A health status questionnaire was mailed to 2,465 persons of working age (25-65 years) who were randomly selected from the general population of a representative region of Sweden. The questionnaire required the subjects to provide information about the presence and severity of pain, numbness and tingling in each body region, employment history, and work activities, including average time spent using a keyboard during a usual working day. Those reporting recurrent hand numbness or tingling in the median nerve distribution were asked to undergo a physical examination and nerve conduction testing. The prevalence of CTS, defined as symptoms plus abnormal results on nerve conduction tests, was compared between groups of subjects that differed in their intensity of keyboard use, adjusting for age, sex, body mass index, and smoking status. RESULTS: Eighty-two percent responded to the questionnaire, and 80% of all symptomatic persons attended the examinations. Persons who had reported intensive keyboard use on the questionnaire were significantly less likely to be diagnosed as having CTS than were those who had reported little keyboard use, with a prevalence that increased from 2.6% in the highest keyboard use group (> or = 4 hours/day), to 2.9% in the moderate use group (1 to <4 hours/day), 4.9% in the low use group (<1 hour/day), and 5.2% in the no keyboard use at work group (P for trend = 0.032). Using > or = 1 hour/day to designate high keyboard use and <1 hour/day to designate low keyboard use, the prevalence ratio of CTS in the groups with high to low keyboard use was 0.55 (95% confidence interval 0.32, 0.96). CONCLUSION: Intensive keyboard use appears to be associated with a lower risk of CTS.

The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.

BACKGROUND: The 30-item disabilities of the arm, shoulder and hand (DASH) questionnaire is increasingly used in clinical research involving upper extremity musculoskeletal disorders. From the original DASH a shorter version, the 11-item QuickDASH, has been developed. Little is known about the discriminant ability of score changes for the QuickDASH compared to the DASH. The aim of this study was to assess the performance of the QuickDASH and its cross-sectional and longitudinal validity and reliability. METHODS: The study was based on extracting QuickDASH item responses from the responses to the full-length DASH questionnaire completed by 105 patients with a variety of upper extremity disorders before surgery and at follow-up 6 to 21 months after surgery. The DASH and QuickDASH scores were compared for the whole population and for different diagnostic groups. For longitudinal construct validity the effect size and standardized response mean were calculated. Analyses with ROC curves were performed to compare the ability of the DASH and QuickDASH to discriminate among patients classified according to the magnitude of self-rated improvement. Cross-sectional and test-retest reliability was assessed. RESULTS: The mean DASH score was 34 (SD 22) and the mean QuickDASH score was 39 (SD 24) at baseline. For the different diagnostic groups the mean and median QuickDASH scores were higher than the corresponding DASH scores. For the whole population, the mean difference between the QuickDASH and DASH baseline scores was 4.2 (95% CI 3.2-5.3), follow-up scores was 2.6 (1.7-3.4), and change scores was 1.7 (0.6-2.8). The overall effect size and standardized response mean measured with the DASH and the QuickDASH were similar. In the ROC analysis of change scores among patients who rated their arm status as somewhat or much better and those who rated it as unchanged the difference in the area under the ROC curve for the DASH and QuickDASH was 0.01 (95% CI -0.05-0.07) indicating similar discriminant ability.Cross-sectional and test-retest reliability of the DASH and QuickDASH were similar. CONCLUSION: The results indicate that the QuickDASH can be used instead of the DASH with similar precision in upper extremity disorders.