Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices

Context:

A lack of published comparisons between measures from commercially available computerized posturography devices and the outcome measures used to define the limits of stability (LOS) makes meaningful interpretation of dynamic postural stability measures difficult.

Objectives:

To compare postural stability measures between and within devices to establish concurrent and construct validity and to determine test-retest reliability for LOS measures generated by the NeuroCom Smart Balance Master and the Biodex Balance System.

Design:

Cross-sectional study.

Setting:

Controlled research laboratory.

Patients or Other Participants:

A total of 23 healthy participants with no vestibular or visual disabilities or lower limb impairments.

Intervention(s):

The LOS were assessed during 2 laboratory test sessions 1 week apart.

Main Outcome Measure(s):

Three NeuroCom LOS variables (directional control, endpoint excursion, and movement velocity) and 2 Biodex LOS variables (directional control, test duration).

Results:

Test-retest reliability ranged from high to low across the 5 LOS measures (intraclass correlation coefficient [2,k] = 0.82 to 0.48). Pearson correlations revealed 4 significant relationships (P < .05) between and within the 2 computerized posturography devices (r = 0.42 to −0.65).

Conclusions:

Based on the wide range of intraclass correlation values we observed for the NeuroCom measures, clinicians and researchers alike should establish the reliability of LOS testing for their own clinics and laboratories. The low to moderate reliability outcomes observed for the Biodex measures were not of sufficient magnitude for us to recommend using the LOS measures from this system as the gold standard. The moderate Pearson interclass correlations we observed suggest that the Biodex and NeuroCom postural stability systems provided unique information. In this study of healthy participants, the concurrent and construct validity of the Biodex and NeuroCom LOS tests were not definitively established. We recommend that this study be repeated with a clinical population to further explore the matter.     

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies

Background

The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study

Aim

To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre.

Design and setting

A three-part longitudinal predictive validity study of selection into training for UK general practice.

Method

In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3).

Results

Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training.

Conclusion

In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered.     

Perceived frequency of peer-assisted learning in the laboratory and collegiate clinical settings

Context:

Peer-assisted learning (PAL) has been recommended as an educational strategy to improve students'' skill acquisition and supplement the role of the clinical instructor (CI). How frequently students actually engage in PAL in different settings is unknown.

Objective:

To determine the perceived frequency of planned and unplanned PAL (peer modeling, peer feedback and assessment, peer mentoring) in different settings.

Design:

Cross-sectional study.

Setting:

Laboratory and collegiate clinical settings.

Patients or Other Participants:

A total of 933 students, 84 administrators, and 208 CIs representing 52 (15%) accredited athletic training education programs.

Intervention(s):

Three versions (student, CI, administrator) of the Athletic Training Peer Assisted Learning Survey (AT-PALS) were administered. Cronbach α values ranged from .80 to .90.

Main Outcome Measure(s):

Administrators'' and CIs'' perceived frequency of 3 PAL categories under 2 conditions (planned, unplanned) and in 2 settings (instructional laboratory, collegiate clinical). Self-reported frequency of students'' engagement in 3 categories of PAL in 2 settings.

Results:

Administrators and CIs perceived that unplanned PAL (0.39 ± 0.22) occurred more frequently than planned PAL (0.29 ± 0.19) regardless of category or setting (F_1,282 = 83.48, P < .001). They perceived that PAL occurred more frequently in the collegiate clinical (0.46 ± 0.22) than laboratory (0.21 ± 0.24) setting regardless of condition or category (F_1,282 = 217.17, P < .001). Students reported engaging in PAL more frequently in the collegiate clinical (3.31 ± 0.56) than laboratory (3.26 ± 0.62) setting regardless of category (F_1,860 = 13.40, P < .001). We found a main effect for category (F_2,859 = 1318.02, P < .001), with students reporting they engaged in peer modeling (4.01 ± 0.60) more frequently than peer mentoring (2.99 ± 0.88) (P < .001) and peer assessment and feedback (2.86 ± 0.64) (P < .001).

Conclusions:

Participants perceived that students engage in unplanned PAL in the collegiate clinical setting with a stronger inclination toward engagement in peer modeling. Educators should develop planned PAL activities to capitalize on the inherent desire of the students to collaborate with their peers.     

Making short-term international medical volunteer placements work: a qualitative study

Background

International medical volunteering has grown in recent decades. It has the potential to benefit and harm the volunteer and host countries; but there is a paucity of literature on the impacts of international medical volunteering and a need to find ways to optimise the benefits of such placements.

Aim

In this study, one example of international medical volunteering was examined involving British GPs on short-term placements in Nepal. The intention was to explore the expectations and experiences of the local health workers, volunteers, and host organisation to try and understand what makes volunteer placements work.

Design

Qualitative study of key informant interviews.

Setting

Stakeholders of a short-term international medical volunteer (IMV) placement programme in Nepal.

Method

Key informant interviews were carried out via face-to-face or telephone/internet interviews with five previous volunteers, three representatives from a non-governmental organisation providing placements, and five local health workers in Nepal who had had contact with the IMVs. Interviews were recorded, transcribed, and analysed using standard thematic framework approaches.

Results

All the stakeholders had their own specific motives for participating in the IMV programme. The relationship between volunteers and the Nepalese health workers was complex and characterised by discrepant and occasionally unrealistic expectations. Managing these different expectations was challenging.

Conclusion

Contextual issues and cultural differences are important considerations in medical volunteer programmes, and this study highlights the importance of robust preparation pre-placement for the volunteer and host to ensure positive outcomes.     

Donepezil Improves Episodic Memory in Young Individuals Vulnerable to the Effects of Sleep Deprivation

Study Objectives:

We investigated if donepezil, a long-acting orally administered cholinesterase inhibitor, would reduce episodic memory deficits associated with 24 h of sleep deprivation.

Design:

Double-blind, placebo-controlled, crossover study involving 7 laboratory visits over 2 months. Participants underwent 4 functional MRI scans; 2 sessions (donepezil or placebo) followed a normal night''s sleep, and 2 sessions followed a night of sleep deprivation.

Setting:

The study took place in a research laboratory.

Participants:

26 young, healthy volunteers with no history of any sleep, psychiatric, or neurologic disorders.

Interventions:

5 mg of donepezil was taken once daily for approximately 17 days.

Measurements and Results:

Subjects were scanned while performing a semantic judgment task and tested for word recognition outside the scanner 45 minutes later. Sleep deprivation increased the frequency of non-responses at encoding and impaired delayed recognition. No benefit of donepezil was evident when participants were well rested. When sleep deprived, individuals who showed greater performance decline improved with donepezil, whereas more resistant individuals did not benefit. Accompanying these behavioral effects, there was corresponding modulation of task-related activation in functionally relevant brain regions. Brain regions identified in relation to donepezil-induced alteration in non-response rates could be distinguished from regions relating to improved recognition memory. This suggests that donepezil can improve delayed recognition in sleep-deprived persons by improving attention as well as enhancing memory encoding.

Conclusions:

Donepezil reduced decline in recognition performance in individuals vulnerable to the effects of sleep deprivation. Additionally, our findings demonstrate the utility of combined fMRI–behavior evaluation in psychopharmacological studies.

Citation:

Chuah LYM; Chong DL; Chen AK; Rekshan WR; Tan JC; Zheng H; Chee MWL. Donepezil improves episodic memory in young individuals vulnerable to the effects of sleep deprivation. SLEEP 2009;32(8):999-1010.     

Factors of persistence among graduates of athletic training education programs

Context:

Previous researchers have indicated that athletic training education programs (ATEPs) appear to retain students who are motivated and well integrated into their education programs. However, no researchers have examined the factors leading to successful persistence to graduation of recent graduates from ATEPs.

Objective:

To determine the factors that led students enrolled in a postprofessional education program accredited by the National Athletic Trainers'' Association (NATA) to persist to graduation from accredited undergraduate ATEPs.

Design:

Qualitative study.

Setting:

Postprofessional education program accredited by the NATA.

Patients or Other Participants:

Fourteen graduates (12 women, 2 men) of accredited undergraduate entry-level ATEPs who were enrolled in an NATA-accredited postprofessional education program volunteered to participate.

Data Collection and Analysis:

We conducted semistructured interviews and analyzed data through a grounded theory approach. We used open, axial, and selective coding procedures. To ensure trustworthiness, 2 independent coders analyzed the data. The researchers then negotiated over the coding categories until they reached 100% agreement. We also performed member checks and peer debriefing.

Results:

Four themes emerged from the data. Decisions to persist to graduation from ATEPs appeared to be influenced by students'' positive interactions with faculty, clinical instructors, and peers. The environment of the ATEPs also affected their persistence. Participants thought they learned much in both the clinic and the classroom, and this learning motivated them to persist. Finally, participants could see themselves practicing athletic training as a career, and this greatly influenced their eventual persistence.

Conclusions:

Our study gives athletic training educators insight into the reasons students persist to graduation from ATEPs. Specifically, athletic training programs should strive to develop close-knit learning communities that stress positive interactions between students and instructors. Athletic training educators also must work to present the athletic training field as exciting and dynamic.     

Daytime Sleepiness and Driving Performance in Patients with Obstructive Sleep Apnea: Comparison of the MSLT,the MWT,and a Simulated Driving Task

Study Objectives:

To test the reliability of a driving-simulation test for the objective measurement of daytime alertness compared with the Multiple Sleep Latency Test (MSLT) and with the Maintenance of Wakefulness Test (MWT), and to test the ability to drive safely, in comparison with on-road history, in the clinical setting of untreated severe obstructive sleep apnea.

Design:

N/A.

Setting:

Sleep laboratory.

Patients or Participants:

Twenty-four patients with severe obstructive sleep apnea and reported daytime sleepiness varying in severity (as measured by the Epworth Sleepiness Scale).

Interventions:

N/A.

Measurements and Results:

Patients underwent MSLT and MWT coupled with 4 sessions of driving-simulation test on 2 different days randomly distributed 1 week apart. Simulated-driving performance (in terms of lane-position variability and crash occurrence) was correlated with sleep latency on the MSLT and more significantly on the MWT, showing a predictive validity toward the detection of sleepy versus alert patients with obstructive sleep apnea. In addition, patients reporting excessive daytime sleepiness or a history of car crashes showed poorer performances on the driving simulator.

Conclusions:

A simulated driving test is a suitable tool for objective measurement of daytime alertness in patients with obstructive sleep apnea. Further studies are needed to clarify the association between simulated-driving performance and on-road crash risk of patients with sleep disordered breathing.

Citation:

Pizza F; Contardi S; Mondini S; Trentin L; Cirignotta F. Daytime sleepiness and driving performance in patients with obstructive sleep apnea: comparison of the MSLT, the MWT, and a simulated driving task. SLEEP 2009;32(3):382-391.     

Computer knowledge amongst clinical year medical students in a resource poor setting

Objective

To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria.

Design

A survey using validated structured questionnaires.

Setting

Medical school of Ahmadu Bello University, Zaria, Nigeria.

Subjects

Two hundred and thirty seven clinical year (4^th, 5^th and 6^th years) medical students.

Outcome measures

Computer knowledge, mode of acquiring computer knowledge, regular access to computer, desire for inclusion of computer training in curriculum.

Results

One hundred twenty (50.6%) students had knowledge of computer technology and it use. Of these, 108 (90%) had no regular access to a computer and none owned a computer; only 32 (26.7%) were sufficiently familiar with computer tools to perform advanced tasks, but 72 (60%) were comfortable with word processing. Seventy two of the 120 students acquired their computer knowledge through self-learning efforts while 45 (37.5%) attended short periods of formal training. Overall, 45.7% of males and 64.5% of females had computer knowledge. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. Eighty percent of all students would like computer education to be included in medical school curriculum.

Conclusion

Knowledge and use of computers amongst clinical year medical students in this setting is low. It is important that computer education be taught to the students to enhance their ability to use electronic information and communicate more effectively using computer resources.     

Early nephrology care provided by the nephrologist alone is not sufficient to mitigate the social and psychological aspects of chronic kidney disease

OBJECTIVE:

Patients with chronic kidney disease who receive early nephrology care have a better prognosis with maintenance dialysis. We aimed to determine whether early referral to a nephrologist can also improve the psychological burden of having chronic kidney disease.

SUBJECTS AND METHODS:

Thirty‐nine patients with chronic kidney disease that required hemodialysis were studied: 19 had a ≥ 6-month history of nephrology care (Group1), and 20 had never received any prior nephrology care (Group2). All patients participated in a semi‐structured interview that addressed their perceived knowledge and psychological aspects related to CKD and hemodialysis. Demographic and laboratory data as well as socioeconomic status were evaluated.

RESULTS:

In both groups, most of the patients were of low socioeconomic status. Group 1 had significantly better laboratory parameters (p<0.05). The patients'' answers to the questions showed no differences between the groups: 63% of Group 1 and 55% of Group 2 reported that they had no prior knowledge about dialysis; 58% and 40%, respectively, reported that they “don''t completely understand what the doctor says”; and 74% and 85%, respectively, believed that their “kidneys would work again”.

CONCLUSION:

Pre‐dialysis nephrology care improves the clinical conditions of the patients with chronic kidney disease but is insufficient for minimizing other aspects of having chronic kidney disease.     

Unmodified electroconvulsive therapy: changes in knowledge and attitudes of Nigerian medical students

Background

The relevance of ECT as a treatment option for some psychiatric disorders continues to generate debate in professional and lay circles. Scientific evidence as to the effectiveness of ECT (with anaesthesia) abounds. In some developing countries, the process of change towards the full implementation and use of modified ECT has been slow. The unmodified format is still used for largely economic reasons despite the ethical concerns it raises.

Objective

We assessed the effect of an intervention (60 minute lecture on ECT, viewing a live ECT session, following up a patient who had received ECT) during a clinical psychiatry rotation, on medical students'' knowledge of and attitude toward unmodified electroconvulsive therapy

Method

A 14-item self administered questionnaire was administered to 5^th year medical students at the commencement of their psychiatry rotation, then 4 weeks later to assess knowledge of and attitudes toward unmodified ECT

Results

There were significant improvements in knowledge and change in attitude measures to myth about ECT following our intervention. However, viewing live unmodified ECT sessions did not improve the students'' acceptability of the procedure.

Conclusion

Exposure of medical students to ECT and lectures are important in changing negative attitudes during clerkships and should be incorporated in their teaching curriculum. We may infer that future psychiatrists would prefer the modified form of ECT and acceptability would be better with this format.     

Evidence-based practice and the recognition and treatment of exertional heat stroke, part I: a perspective from the athletic training educator

Context:

Athletic trainers (ATs) know to diagnose exertional heat stroke (EHS) via rectal thermometry (T_re) and to treat EHS via cold-water immersion (CWI) but do not implement these recommendations in clinical practice.

Objective:

To gain an understanding of educational techniques used to deliver content regarding EHS.

Design:

Qualitative study.

Setting:

In-person focus groups at the National Athletic Trainers'' Association (NATA) Annual Meeting in June 2009 and 2 follow-up telephone interviews to confirm emergent themes.

Patients or Other Participants:

Thirteen AT educators (11 men, 2 women) from programs accredited by the Commission on Accreditation of Athletic Training Education, with an average of 22 ± 9 years of clinical experience and 16 ± 10 years of experience as educators. Five NATA districts were represented.

Data Collection and Analysis:

Data were analyzed using inductive content analysis. Peer review and data source triangulation also were conducted to establish trustworthiness.

Results:

Four themes emerged from the analysis: educational techniques, educational competencies, previous educational training, and privacy/public opinion. Educational techniques highlighted the lack of hands-on training for T_re and CWI. Educational competencies referred to the omission of T_re and CWI as psychomotor skills. Previous educational training addressed educators not having the skills or comfort with the skills necessary to properly educate students. Privacy/public opinion comprised external inputs from various groups (parents and coaches), legal considerations, and social bias.

Conclusions:

Educators supplied students with the appropriate didactic knowledge about EHS, but their lack of training and misgivings about T_re prevented them from allowing students to gain competence with this skill. Until the NATA competencies state the need to teach T_re and CWI and until educators are provided with their own learning opportunities, evidence-based practice regarding EHS will be lacking.     

Overcoming barriers to implementation of evidence-based practice concepts in athletic training education: perceptions of select educators

Context:

The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making.

Objective:

To evaluate athletic training educators'' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers.

Design:

Qualitative interviews of emergent design with grounded theory.

Setting:

Undergraduate CAATE-accredited athletic training education programs.

Patients or Other Participants:

Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06.

Data Collection and Analysis:

Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness.

Results:

Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective.

Conclusions:

Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions'' clinical practices and educational standards. Because today''s students are tomorrow''s clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our growing clinical practice.     

Interday reliability of peak muscular power outputs on an isotonic dynamometer and assessment of active trunk control using the chop and lift tests

Context:

Assessment techniques used to measure functional tasks involving active trunk control are restricted to linear movements that lack the explosive movements and dynamic tasks associated with activities of daily living and sport. Reliable clinical methods used to assess the diagonal and ballistic movements about the trunk are lacking.

Objective:

To assess the interday reliability of peak muscular power outputs while participants performed diagonal chop and lift tests and maintained a stable trunk.

Design:

Controlled laboratory study.

Setting:

University research laboratory.

Patients or Other Participants:

Eighteen healthy individuals (10 men and 8 women; age  =  32 ± 11 years, height  =  168 ± 12 cm, mass  =  80 ± 19 kg) from the general population participated.

Intervention(s):

Participants performed 2 power tests (chop, lift) using an isotonic dynamometer and 3 endurance tests (Biering-Sørensen, side-plank left, side-plank right) to assess active trunk control. Testing was performed on 3 different days separated by at least 1 week. Reliability was compared between days 1 and 2 and between days 2 and 3. Correlations between the power and endurance tests were evaluated to determine the degree of similarity.

Main Outcome Measure(s):

Peak muscular power outputs (watts) derived from a 1-repetition maximum protocol for the chop and lift tests were collected for both the right and left sides.

Results:

Intraclass correlation coefficients for peak muscular power were highly reliable for the chop (range, 0.87–0.98), lift (range, 0.83–0.96), and endurance (range, 0.80–0.98) tests between test sessions. The correlations between the power assessments and the Biering-Sørensen test (r range, −0.008 to 0.017) were low. The side-plank tests were moderately correlated with the chop (r range, 0.528–0.590) and the lift (r range, 0.359–0.467) tests.

Conclusions:

The diagonal chop and lift power protocol generated reliable data and appears to be a dynamic test that simulates functional tasks, which require dynamic trunk control.     

Postnatal women's experiences of management of depressive symptoms: a qualitative study

Background

Postnatal depression is a public health problem requiring intervention. To provide effective care, information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept, or decline, psychological intervention postnatally.

Aim

To provide the first integrated in-depth exploration of postnatal women''s experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PoNDER trial.

Setting

General practice: primary care within the former Trent regional health authority, England.

Method

Thirty women with 6-week Edinburgh Postnatal Depression Scale (EPDS) scores ≥18 and probable depression completed semi-structured interviews. All women had taken part in the Post-Natal Depression Economic Evaluation and Randomised controlled (PoNDER) trial where intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles.

Results

When accepted, psychological sessions were experienced as positive, effective, and ‘ideal care’. Women approved of using the EPDS but did not understand the health visitor''s role in supporting women. Seeking help and accepting sessions depended on women''s perspectives of their health visitor as an individual.

Conclusion

Women''s experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive. Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters. There is a case for specific enhancement of interpersonal skills in health visiting, or alternatively offering a choice of health visitors to women.     

Application of Generalizability Theory in Estimating the Reliability of Ankle-Complex Laxity Measurement

Context:

Generalizability theory is an appropriate method for determining the reliability of measurements obtained across more than a single facet. In the clinical and research settings, ankle-complex laxity assessment may be performed using different examiners and multiple trials.

Objective:

To determine the reliability of ankle-complex laxity measurements across different examiners and multiple trials using generalizability theory.

Design:

Correlational study.

Setting:

Laboratory.

Patients or Other Participants:

Forty male university students without a history of ankle injury.

Main Outcome Measure(s):

Measures of right ankle-complex anteroposterior and inversion-eversion laxity were obtained by 2 examiners. Each examiner performed 2 anteroposterior trials, followed by 2 inversion-eversion trials for each ankle at 0° of ankle flexion. Using generalizability theory, we performed G study and D study analyses.

Results:

More measurement error was found for facets associated with examiner than with trial for both anteroposterior and inversion-eversion laxity. Inversion-eversion measurement was more reliable than anteroposterior laxity measurement. Although 1 examiner and 1 trial had acceptable reliability (G coefficient ≥ .848), increasing the number of examiners increased reliability to a greater extent than did increasing the number of trials.

Conclusions:

Within the range of examiner and trial facets studied, any combination of examiners or trials (or both) above 1 can change ankle laxity measurement reliability from acceptable (1 examiner, 1 trial) to highly reliable (3 examiners, 3 trials). Individuals may respond to examiners and their procedural nuances differently; thus, standardized procedures are important.     

The validity and reliability of the sixth-year internal medical examination administered at the King Abdulaziz University Medical College

Background

Exams are essential components of medical students’ knowledge and skill assessment during their clinical years of study. The paper provides a retrospective analysis of validity evidence for the internal medicine component of the written and clinical exams administered in 2012 and 2013 at King Abdulaziz University’s Faculty of Medicine.

Methods

Students’ scores for the clinical and written exams were obtained. Four faculty members (two senior members and two junior members) were asked to rate the exam questions, including MCQs and OSCEs, for evidence of content validity using a rating scale of 1–5 for each item.Cronbach’s alpha was used to measure the internal consistency reliability. Correlations were used to examine the associations between different forms of assessment and groups of students.

Results

A total of 824 students completed the internal medicine course and took the exam. The numbers of rated questions were 320 and 46 for the MCQ and OSCE, respectively. Significant correlations were found between the MCQ section, the OSCE section, and the continuous assessment marks, which include 20 long-case presentations during the course; participation in daily rounds, clinical sessions and tutorials; the performance of simple procedures, such as IV cannulation and ABG extraction; and the student log book.Although the OSCE exam was reliable for the two groups that had taken the final clinical OSCE, the clinical long- and short-case exams were not reliable across the two groups that had taken the oral clinical exams. The correlation analysis showed a significant linear association between the raters with respect to evidence of content validity for both the MCQ and OSCE, r?=?.219 P?<?.001 and r?=?.678 P?<?.001, respectively, and r?=?.241 P?<?.001 and r?=?.368 P?=?.023 for the internal structure validity, respectively. Reliability measured using Cronbach’s alpha was greater for assessments administered in 2013.

Conclusion

The pattern of relationships between the MCQ and OSCE scores provides evidence of the validity of these measures for use in the evaluation of knowledge and clinical skills in internal medicine. The OSCE exam is more reliable than the short- and long-case clinical exams and requires less effort on the part of examiners and patients.

     

Generalizability Theory Analysis of Balance Error Scoring System Reliability in Healthy Young Adults

Context:

An assessment of postural control is commonly included in the clinical concussion evaluation. Previous investigators have demonstrated learning effects that may mask concussion-induced balance decrements.

Objective:

To establish the test-retest reliability of the Balance Error Scoring System (BESS) and to provide recommendations that account for known learning effects.

Design:

Test-retest generalizability study.

Setting:

Balance research laboratory.

Patients or Other Participants:

Young adults (n  =  48) free from injuries and illnesses known to affect balance.

Intervention(s):

Each participant completed 5 BESS trials on each of the assessment dates, which were separated by 50 days.

Main Outcome Measure(s):

Total score of the BESS was used in a generalizability theory analysis to estimate the overall reliability of the BESS and that of each facet. A decision study was completed to estimate the number of days and trials needed to establish clinical reliability.

Results:

The overall reliability of the BESS was G  =  0.64. The test-retest reliability was improved when male (0.92) and female (0.91) participants were examined independently. Clinically acceptable reliability (greater than 0.80) was established when 3 BESS trials were administered in a single day or 2 trials were administered at different time points.

Conclusions:

Learning effects have been noted in individuals with no previous exposure to the BESS. Our findings indicate that clinicians should consider interpreting the mean score from 3 BESS administrations on a given occasion for both normative data comparison and pretest and posttest design. The multiple assessment technique yields clinically reliable scores and provides the sports medicine practitioner with accurate data for clinical decision making.     

A methodologic approach for normalizing angular work and velocity during isotonic and isokinetic eccentric training

Context:

Resistance exercise training commonly is performed against a constant external load (isotonic) or at a constant velocity (isokinetic). Researchers comparing the effectiveness of isotonic and isokinetic resistance-training protocols need to equalize the mechanical stimulus (work and velocity) applied.

Objective:

To examine whether the standardization protocol could be adjusted and applied to an eccentric training program.

Design:

Controlled laboratory study.

Setting:

Controlled research laboratory.

Patients or Other Participants:

Twenty-one sport science male students (age = 20.6 ± 1.5 years, height = 178.0 ± 4.0 cm, mass = 74.5 ± 9.1 kg).

Intervention(s):

Participants performed 9 weeks of isotonic (n = 11) or isokinetic (n = 10) eccentric training of knee extensors that was designed so they would perform the same amount of angular work at the same mean angular velocity.

Main Outcome Measure(s):

Angular work and angular velocity.

Results:

The isotonic and isokinetic groups performed the same total amount of work (−185.2 ± 6.5 kJ and −184.4 ± 8.6 kJ, respectively) at the same angular velocity (21 ± 1°/s and 22°/s, respectively) with the same number of repetitions (8.0 and 8.0, respectively). Bland-Altman analysis showed that work (bias = 2.4%) and angular velocity (bias = 0.2%) were equalized over 9 weeks between the modes of training.

Conclusions:

The procedure developed allows angular work and velocity to be standardized over 9 weeks of isotonic and isokinetic eccentric training of the knee extensors. This method could be useful in future studies in which researchers compare neuromuscular adaptations induced by each type of training mode with respect to rehabilitating patients after musculoskeletal injury.     

Current Sport-Related Concussion Teaching and Clinical Practices of Sports Medicine Professionals

Context:

Various consensus and position statements recommend a multifaceted approach when diagnosing a possible concussion. The effectiveness of these materials depends largely on their content being disseminated to educators and to those in the clinical setting.

Objective:

To identify the concussion management methods and guidelines currently taught in the athletic training classroom and clinical settings and to track the dissemination of the Vienna guidelines throughout the educational curriculum.

Design:

A 17-question Internet survey.

Setting:

A Web link was e-mailed to the program directors and certified athletic trainers holding educational positions in athletic training at 300 accredited programs in the United States.

Patients or Other Participants:

513 program directors and athletic trainers.

Main Outcome Measure(s):

Survey questions addressed education level, years of certification, employment setting, concussion assessment and return-to-play guidelines used in the clinical setting and the classroom, and clinical and teaching preferences for existing position statements and concussion grading systems. The Vienna guidelines'' “simple” and “complex” definitions of concussions were provided with the return-to-play stepwise approach.

Results:

The National Athletic Trainers'' Association position statement was the most widely used method of assessing, managing (61%), and making return-to-play decisions (47%) among participants. More than half of participants (66%) had never heard of the Vienna guidelines. After reading the Vienna guidelines'' definitions and return-to-play criteria, nearly three-fourths of participants agreed with them. In addition, 68% said that they would use them, and 84% reported that they would teach them to students.

Conclusions:

The majority of program directors and certified athletic trainers used a multidimensional approach to assess and manage a concussion. The National Athletic Trainers'' Association position statement and Vienna guidelines were underused in both the classroom and clinical settings.