Feasibility of a Child-Friendly 2-Minute Walk Test: A Crossover Randomized Controlled Trial.

AIMS: Most studies that use the NIH Toolbox 2-Minute Walk Test with young children, modify the protocol, compromising the generalizability of outcomes. A standardizable protocol is needed. The purpose of this study was to compare the 2MWT performance of children ages 3-6 years on the standard NIH Toolbox protocol and on a modified protocol designed to support young children. METHODS: Cross-over randomized controlled trial. Fifteen typically developing children ages 3-6 years were randomly assigned to the performance order of the NIH toolbox 2MWT protocol and the Modified Accessibility Path (MAP) 2MWT protocol. Outcome variables and statistical analyses included test completion (McNemar test), distance walked (Wilcoxon signed-rank test), and accuracy (general estimating equation model with Poisson distribution). RESULTS: All children completed 2 min of walking with the MAP protocol. Only 40% of children completed the NIH Toolbox protocol, with 83% of these NIH completers bolstered by previous exposure to the MAP protocol. Collapsed across the order, children also had significantly fewer errors per lap with the MAP protocol (p < 0.0001), despite walking a significantly greater distance (p = 0.006). CONCLUSIONS: These findings lend preliminary support for standardized application of a 2MWT with young children when the protocol is designed to be child-friendly.

Hand-rim biomechanics during geared manual wheelchair propulsion over different ground conditions in individuals with spinal cord injury.

Geared manual wheelchair wheels, a recently developed alternative propulsion mechanism, have the potential to alleviate the high upper extremity demands required for wheelchair propulsion and help decrease the risk of secondary injuries in manual wheelchair users. The objective of this study was to investigate the effects of using geared manual wheelchairs on hand-rim biomechanics of wheelchair propulsion in individuals with spinal cord injury (SCI). Seven manual wheelchair users with SCI propelled their wheelchairs equipped with geared wheels over tile, carpet, and up a ramp in low gear (gear ratio 1.5:1) and standard gear (gear ratio 1:1) conditions. Hand-rim kinetics and stroke cycle characteristics were measured using a custom instrumented geared wheel. Using the geared wheels in the low gear condition, propulsion speed (P = 0.013), peak resultant force (P = 0.005), peak propulsive moment (P < 0.006), and peak rate of rise of the resultant force (P = 0.035) decreased significantly in comparison with the standard gear condition. The significant increase in the number of stroke cycles when normalized to distance (P = 0.004) and decrease in the normalized integrated moment (P = 0.030) indicated that although a higher number of stroke cycles are required for travelling a given distance in the low gear than the standard gear condition, the low gear condition might be less demanding for the upper extremity. These results suggest that geared wheels could be a useful technology for manual wheelchair users to independently accomplish strenuous propulsion tasks including mobility on carpeted floors and ramp ascension, while reducing the risk factors contributing to the incidence of secondary upper extremity injuries.

Technology Implementation and Associated Pharmacy Interruptions.

This study focuses on interruptions in an inpatient pharmacy setting and the impact of CPOE implementation on the types, frequency, and duration of interruptions. A cross-sectional observation study of pharmacy employees in an inpatient pharmacy was conducted. The independent variables included day of week, time of day, job position of the person interrupted, and description of each interruption. A total of 552 interruptions were observed with a mean frequency of 10.6 interruptions per hour lasting a mean (SD) duration of 1.34 (1.43) minutes. Incoming calls were the most frequent interruption type across all phases. Pharmacy employees spend almost a quarter of their time on interruptions, and pharmacists have longer interruptions than technicians. Immediately after CPOE implementation, durations tend to be one-and-a-half times longer than before. CPOE implementation did not affect the frequency of interruptions. Recommendations included redesign of work processes and job responsibilities.