Reliability of the OSCE for Physical and Occupational Therapists

[Purpose] To examine agreement rates between faculty members and clinical supervisors as OSCE examiners. [Subjects] The study subjects were involved physical and occupational therapists working in clinical environments for 1 to 5 years after graduating from training schools as OSCE examinees, and a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] The agreement rate between the examiners for each OSCE item was calculated based on Cohen’s kappa coefficient to confirm inter-rater reliability. [Results] The agreement rates for the behavioral aspects of the items were higher in the second than in the first examination. Similar increases were also observed in the agreement rates for the technical aspects until the initiation of each activity; however, the rates decreased during the middle to terminal stages of continuous movements. [Conclusion] The results may reflect the recent implementation of measures for the integration of therapist education in training schools and clinical training facilities.Key words: OSCE, Reliability, Physical and occupational therapists     

Difficulty levels of OSCE items related to examination and measurement skills

[Purpose] The difficulty levels of level-2 OSCE (examination and measurement skills) items were examined, with a view to providing reference data for the determination of students’ skills. [Subjects] A total of 284 graduates of physical (PT) and occupational (OT) therapy classes of 2011 (59 and 40), 2012 (46 and 36), and 2013 (61 and 42, respectively) were studied, with PT or OT faculty members as OSCE examiners and a simulated patient. [Methods] Scores for 11 level-2 OSCE items were compared between before and after clinical training. [Results] Scores markedly increased after clinical training. On comparison among the items, scores for sensory examination were the highest, and those for interviews were the lowest. [Conclusion] The results of this study indicate the necessity of considering an appropriate combination of different difficulty levels when adopting OSCE-based educational approaches.Key words: OSCE, Clinical skill, Physical and occupational therapists     

Standardization of Clinical Skill Evaluation in Physical/Occupational Therapist Education –Effects of Introduction of an Education System Using OSCE–

[Purpose] A major issue in physical/occupational therapist education is the improvement of students'' clinical techniques. In this study, we introduced an education system using an Objective Structured Clinical Examination (OSCE), and made an attempt at standardization of its evaluation. [Subjects] The subjects were 227 students in the classes of 2008 to 2010 who enrolled at our university between 2004 and 2006, before the introduction of the education system using OSCE, and 221 students in the classes of 2011 to 2013 who enrolled between 2007 and 2009, after the introduction. [Methods] Performances in attitude and skills (performance in clinical training and OSCE) were compared between before and after the introduction of OSCE. OSCE results were compared between before and after clinical trainings at each OSCE Level; and the correlation of between performances in clinical training and OSCE was examined. [Results] Performances in OSCE and clinical training (attitude, skills) were improved by the introduction of the education system using OSCE, but no significant correlation was observed in the relationship between performances in OSCE and clinical training. [Conclusion] Further studies should be conducted aiming at the standardization of clinical skill evaluation in postgraduate education to establish an education system using OSCE.Key words: OSCE, Clinical skill evaluation, Standardizing     

The Reliability and Validity of the Clinical Competence Evaluation Scale in Physical Therapy

[Purpose] To examine the internal consistency, criterion-related validity, factorial validity, and content validity of the Clinical Competence Evaluation Scale in Physical Therapy (CEPT). [Subjects] The subjects were 278 novice physical therapy trainees and 119 tutors from 21 medical facilities. [Methods] The trainees self-evaluated their clinical competences and the tutors evaluated trainee competences using the CEPT. Overall trainee autonomy was evaluated using a visual analog scale (VAS) for self-evaluation and the trainees were also evaluated by their tutors. The content validity of the CEPT was examined by asking if the CEPT could evaluate the competence of novice physical therapists on a four-point scale. [Results] Cronbach’s alpha of the CEPT was 0.96 for the trainees and 0.97 for the tutors. The correlation coefficient between the total score of the CEPT and whole competence by VAS was 0.83 for the trainees and 0.87 for the tutors. Factor analysis identified two factors, “the specialty of the physical therapist” and “the essential competence of a health professional”. Ninety percent or more of the trainees and the tutors answered that the CEPT could sufficiently evaluate the competence of novice physical therapists. [Conclusion] The CEPT is a reliable and valid scale for clinical competence evaluation of novice physical therapists.Key words: Clinical competence, Reliability, Validity     

Effects of clinical practice focusing on level-3 OSCE items

[Purpose] This study examined the effects of clinical training focusing on level-3 OSCE (analytical and therapeutic skills) items, and compared the achievement levels of physical (PT) and occupational (OT) therapist students. [Subjects] A total of 282 (165 PT and 117 OT) students enrolled at our university between 2008 and 2010 were studied. [Methods] OSCE scores were compared between before and after clinical training focusing on level-3 OSCE items, and between PT and OT students. [Results] Scores for 5 out of the 6 level-3a items were significantly higher after than before clinical training. Increases in scores of 2 or 3 level-3b and −3c items were also observed after clinical training. There were no marked differences between PT and OT students in scores for level-3a, −3b, and −3c items before clinical training. In contrast, after clinical training, OT students’ scores for 3a and 3c items related to dressing were higher than those of PT students, and the latter’s scores for 3b items related to transfer were higher than those of the former. [Conclusion] The results suggest level-3 OSCE items are effectively taught during clinical training.Key words: OSCE, Clinical skill, Clinical practice     

Factors that affect the changes in the satisfaction of Japanese physical therapists with their profession over the years

[Purpose] To analyze changes in the level of satisfaction of new physical therapists with their profession over time and in the factors that affect their satisfaction, focusing on the impact of previous experiences and working conditions. [Participants and Methods] This longitudinal survey study administered a questionnaire to 585 physical therapists who participated in the newcomer orientation at Hiroshima Prefectural Physical Therapy Association from 2017 to 2019 as follows: 210 in 2017, 188 in 2018, and 187 in 2019. The responses to the questions regarding professional satisfaction and the factors that affect it were investigated. The factors identified consisted of the motivation to become a physical therapist, learning in school, clinical internship, working environment, and workplace comfort. A 5-point Likert scale (strongly agree, agree, undecided, disagree, and strongly disagree) was used. [Results] A significant difference was observed in the satisfaction with profession over the 3 year period, and the results of the multiple comparison tests showed a difference between 2018 and 2019. Among the factors identified, positive professional perceptions in clinical internship strongly influenced professional satisfaction over time. [Conclusion] The 1 year longitudinal study revealed a decline in professional satisfaction among the new physical therapists. The characteristic changes in the factors of professional satisfaction were determined from the motivation to become a physical therapist to the clinical internship experience.Key words: Satisfaction, Physical therapists, Career development     

Relationship between activity limitations and participation restriction in school-aged children with cerebral palsy

[Purpose] This study investigated the relationship between activity limitation and participation restriction in school-aged children with cerebral palsy. [Subjects and Methods] Data were collected from 109 children with cerebral palsy aged 6–12 years. Activity limitations were assessed by using functional classification systems including the Korean-Gross Motor Function Classification System, the Korean-Manual Ability Classification System, and the Korean-Communication Function Classification System. Participation restriction was measured using the Korean-Frequency of Participation Questionnaire. Physical or occupational therapists and parents collected the data. [Results] All levels of the functional classification systems were significantly negatively correlated with Korean-Frequency of Participation Questionnaire ratings (r= −0.382 to −0.477). The Korean-Frequency of Participation Questionnaire ratings differed significantly with respect to the functional classification systems; in particular, the differences in the ratings of levels I and V were significant. The Korean-Communication Function Classification System and Korean-Gross Motor Function Classification System were significant predictors of participation, explaining 26.5% of the variance. [Conclusion] Intervention programs are required to promote communication skills and gross motor ability in order to improve the participation of children with cerebral palsy.Key words: Cerebral palsy, Functional classification system, Participation     

Inter-rater reliability of a wright respirometer to measure vital capacity in neuromuscular disorders

[Purpose] We examined the inter-rater reliability of the Wright respirometer between therapists who assessed the vital capacity of patients with neuromuscular disorders. [Participants and Methods] We examined 18 patients with neuromuscular disorders. We performed a test-retest method after measuring their vital capacities. Two physical therapists experienced in the use of the Wright respirometer, specifically, therapist A with six years of clinical experience and therapist B with one, each took one measurement of the vital capacity of the same patients. The measurements between the therapists were taken at intervals of 3–7 days. We made a manual to standardize the measurements between the therapists. [Results] The vital capacities were 905 ± 490 mL for therapist A and 897 ± 483 mL for therapist B. The inter-rater reliability of ICC_2,1 was 0.96 (95% CI: 0.89–0.98). Bland-Altman analyses revealed neither a fixed nor proportional bias. [Conclusion] These results demonstrated good to excellent inter-rater reliability of the Wright respirometer for patients with neuromuscular disorders using a manual and instructions.     

Changes in physical function in older females over a 5 year period

[Purpose] The quality of physical functions was evaluated prospectively in older females over a 5 year period to identify the physical functions that are more likely to consistently decline or be maintained in females aged 65‒74 years and more than 75 years. [Participants and Methods] Physical functions, including grip strength, walking speed, and balance, were measured for older females aged 65–74 years group and more than 75 years group from 2015 to 2019. T-scores of the physical performances were calculated to analyze the changes in the physical functions over 5 years. [Results] Based on the T-scores, physical functions in terms of the 5-m walking speed, timed up-and-go test, and functional reach test, improved from 2015 to 2019 in the 65–74 group, whereas all physical functions consistently deteriorated in the older than 75 group. [Conclusion] There was no significant decline of the physical functions in both groups; however, the T-score variations for physical functions during the 5 year observation period differed in each group.     

Properties of muscle nodules recognized by manual physical therapy practitioners

[Purpose] The purpose of this study was to describe the properties of muscle nodules (kinkoketsu) recognized by manual physical therapy practitioners. [Participants and Methods] A total of one hundred and thirty-three physical therapists, occupational therapists, judo therapists, and acupuncturists participated in this study. The shape, size, direction, depth, and hardness of muscle nodules, often treated in the buttocks, were investigated through the completion of a questionnaire. [Results] A total of 124 answer sheets were completed; 112 of these described the shape of muscle nodules as ellipsoidal. Of these 112 sheets, 97 effective sheets were analyzed. The results showed that the mean long axis length, short axis length, and thickness of the muscle nodules were 30.9 mm, 16.2 mm, and 9.3 mm, respectively. The most common responses on the long axis direction, depth, and hardness of the muscle nodules were the craniocaudal orientation, the second shallowest layer of 5 divisions, and the eraser level, respectively. [Conclusion] The typical muscle nodule found in the buttocks by manual physical therapy practitioners is roughly the shape of a large almond.Key words: Manual physical therapy, Muscle nodule, Palpation     

A 3-month multicomponent home-based rehabilitation program for older people with restricted life-space mobility: a pilot study

[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40–60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.Key words: Home-based rehabilitation, Life-Space mobility, Older people     

Analysis of the numbers of clinical trials on physical therapy in Japan: comparison with those in the North American register from 2010 to 2019

[Purpose] Information about clinical trials related to physical therapy (CTPT) in Japan, which has the highest aging rate in the world, is essential for physical therapy education, research, and policymaking to change and strengthen the education system and promote research grants. This survey aimed to clarify the proportion of CTPT in the clinical registry and compare the proportion of CTPT in Japan with that in North America. [Participants and Methods] The ClinicalTrials.gov (CTG) and National Institute of Public Health (NIPH) Clinical Trials were used. The number and proportion of CTPT were compared each year. The analyzed data spanned 10 years from 2010 to 2019. [Results] A total of 222,821 trials were registered in CTG during the 10 years. In search of “physical therapy”, 3,001 trials searched. The proportion of CTPT increased from 0.8% to 1.7%. In total 42,194 trials were registered in the NIPH Clinical Trials Search. From the CTPT, 141 trials were obtained. The proportion of CTPT increased from 0.05% to 0.5%. The proportion of CTPT in the NIPH Clinical Trials Search was one-third or less than that in the CTG. The proportion of CTPT in CTG increased yearly, but the proportion of CTPT in NIPH Clinical Trials Search has not increased since 2016. [Conclusion] The proportion of CTPT is relatively low in Japan, compared with that in North America, and it showed no increasing trend. It is important to provide education and support for clinical trials in an aging country such as Japan.     

Reliability of clinical competency evaluation list for novice physical and occupational therapists requiring assistance

[Purpose] This study examined the reliability of a clinical ability evaluation table developed in a previous study with the aim of clarifying the abilities necessary for therapists to independently implement their duties. [Subjects and Methods] Forty-eight physical therapists with less than 2 years of clinical experience were targeted for evaluation, 48 main supervisors, and 48 sub-supervisors, 144 in total, were studied. [Results] The total score was lower when the evaluation was conducted by the target therapists themselves than when it was conducted by the main or sub-supervisors. Regarding the reliability of the total scores for the entire scale and each category, values representing the intra-rater reliability were higher when the evaluation was conducted by the target therapists or main supervisors, while there were marked differences between high and low values for each item. Regarding the inter-rater reliability, both the total scores for the entire scale and each category, as well as values for each item, were low. [Conclusion] Values representing the intra-rater reliability of the study table were low, indicating the necessity of further improvement.Key words: Clinical competency, Evaluation, Reliability     

Reliability and validity of the Japanese version of the short questionnaire to assess health-enhancing physical activity (SQUASH) scale in older adults

[Purpose] We tested the reliability and validity of the Japanese version of the Short Questionnaire to Assess Health-enhancing Physical Activity scale in asymptomatic older adults and sought to confirm discriminator validity in women with osteoarthritis. [Subjects] The participants included an asymptomatic comparison group (men and women) and women with knee or hip osteoarthritis. [Methods] The test-retest method was used to assess reliability. The International Physical Activity Questionnaire was chosen to assess criterion-related validity. Discriminator validity was assessed by comparing the asymptomatic and osteoarthritis groups. [Results] Mean age for the asymptomatic groups was 63 ± 6 years for men (n = 23) and 61 ± 7 years for women (n = 51), and it was 63 ± 9 years for the osteoarthritis group (n = 32). The total score and scores for all items, except for heavy housework items, were significantly correlated with the retest. Criterion-related validity showed significantly weak to moderate correlations between the respective scale categories. For discriminator validity, the total scores and scores for bicycle commuting, light housework, and three leisure items differed significantly between the asymptomatic and osteoarthritis groups. [Conclusion] The Short Questionnaire to Assess Health-enhancing Physical Activity scale is a reliable and valid measure in asymptomatic older adults, and can discriminate between osteoarthritic and asymptomatic women.Key words: Physical activity scale, Older adults, Osteoarthritis     

Relationship between the characteristics of lower extremity function and activities of daily living in hospitalized middle-aged and older adults with subacute cardiovascular disease

[Purpose] To clarify the relationship between lower extremity function and activities of daily living and characterize lower extremity function in hospitalized middle-aged and older adults with subacute cardiovascular disease. [Participants and Methods] The Short Physical Performance Battery, 6-minute walk distance, and functional independence measure tests were conducted in 79 inpatients with subacute cardiovascular disease (mean age, 76.7 ± 11.9 years; 34 females). Multiple regression analysis used the functional independence measure score as the dependent variable and the Short Physical Performance Battery and 6-minute walk distance scores as independent variables. Cross-tabulations were performed for each age group, and patients who performed the Short Physical Performance Battery and 6-minute walk distance tests were divided into two groups by their respective cutoff values. [Results] Only the Short Physical Performance Battery (β=0.568) and 6-minute walk distance (β=0.479) scores were adopted as significant independent variables in each multiple regression model. The age <75 years group had the most patients with both good lower extremity function and aerobic capacity, whereas the age ≥75 years group had the most patients with both functions impaired. [Conclusion] Although cardiovascular disease is generally associated with decreased aerobic capacity, many older patients with cardiovascular disease in this study had decreased lower extremity function, too.     

Are Physical Therapy Interns Competent in Patient Management Skills? Assessment of the Views of Clinical and Academic Physical Therapists

[Purpose] This study aimed at evaluating PT interns’ performance from the perspectives of clinical and academic physical therapists (PTs). [Methods] An online questionnaire based on a modified version of the Clinical Internship Evaluation Tool (CIET) was used to evaluate PT interns’ performance in patient management skills. Assessors comprised clinical and academic PTs from Saudi Arabia. The survey aimed at assessing the competency of interns in 25 patient management skills comprising four major domains: clinical examination, patient evaluation, diagnosis and prognosis, and intervention. Assessors were also asked to rank the importance of possessing each skill and evaluating the internship programs at their facilities. A multivariate logistic regression analysis assessed whether the demographic variables between the two groups influenced their views. [Results] A total of 148 participants (112 clinical PTs and 36 academic PTs) responded to the survey. The majority of the participants agreed that interns were competent in all 25 skills. Differences between the two groups of assessors were observed for five out of the 25 skills. Interestingly, skills with the highest means were perceived as the most important skills by both groups of assessors. There was no association between sociodemographic variables and evaluation scores. [Conclusion] There were no differences observed between clinical and academic PTs in their evaluation of PT interns in 20 of the 25 clinical skills. There were indications of a need for further improvement in certain competencies and skills such as clinical examination, evaluation, diagnosis and prognosis, and intervention.Key words: Clinical internship, Physical therapy education, Clinical education     

Intra-observer reliability in three-dimensional kinematic analysis of sacroiliac joint mobility

[Purpose] Physical therapists, osteopathic practitioners, and chiropractors often perform manual tests to evaluate sacroiliac joint (SIJ) mobility. However, the available evidence demonstrates an absence of reliability in these tests and in investigations with kinematic analysis. The aim of this study was to verify the three-dimensional kinematic reliability in SIJ movement measurements. [Subjects] This cross-sectional study analyzed 24 healthy males, aged between 18 and 35 years. [Methods] Three-dimensional kinematic analysis was performed for measurements of posterior superior iliac displacement and greater trochanter (femur) displacement during hip flexion movement in an orthostatic position. The distance variations were measured from a reference point in 3 blocks. The intra-observer reliability was compared with the mean of three 3 blocks using the interclass correlation coefficient (ICC) and a 99% significance level. [Results] The measurements indicated a strong correlation among blocks: ICC = 0.94 for right side SIJ and ICC = 0.91 for left side SIJ. The mean displacement between the reference points was 7.7 mm on the right side and 8.5 mm on the left side. [Conclusion] Our results indicate that three-dimensional kinematic analysis can be used for SIJ mobility analyses. New studies should be performed for subjects with SIJ dysfunction to verify the effectiveness of this method.Key words: Sacroiliac joint, Reliability, Three-dimensional kinematic     

A novel objective evaluation method for trunk function

[Purpose] To investigate whether an objective evaluation method for trunk function, namely the “trunk righting test”, is reproducible and reliable by testing on different observers (from experienced to beginners) and by confirming the test-retest reliability. [Subjects] Five healthy subjects were evaluated in this correlation study. [Methods] A handheld dynamometer was used in the assessments. The motor task was a trunk righting motion by moving the part with the sensor pad 10 cm outward from the original position. During measurement, the posture was held at maximum effort for 5 s. Measurement was repeated three times. Interexaminer reproducibility was examined in two physical therapists with 1 year experience and one physical therapist with 7 years of experience. The measured values were evaluated for reliability by using intraclass correlation coefficients (ICC 1.1) and interclass correlation coefficients (ICC 2.1). [Results] The test-retest reliability ICC 1.1 and ICC 2.1 were all high. The ICC 1.1 was >0.90. The ICC 2.1 was 0.93. [Conclusion] We developed the trunk righting test as a novel objective evaluation method for trunk function. As the study included inexperienced therapists, the results suggest that the trunk righting test could be used in the clinic, independent of the experience of the therapists.Key words: Trunk function, Reliability, Handheld dynamometer     

Physical therapist-led swimming lessons for children with cerebral palsy: a report of 2 cases

[Purpose] The purpose of this study was to report that a physical therapist qualified for swimming instruction can provide swimming instruction to children with spastic paraplegia due to cerebral palsy. We examined the role of the physical therapist in the support. [Participants and Methods] Two elementary school children with cerebral palsy participated in this study. The swimming program consisting of 6 sessions was performed over 6 months in an indoor swimming pool. Each session lasted for 30 minutes and was instructed by a trained physical therapist. The 5 categories for evaluation were motor function, muscle tone, activities of daily living, swimming skill, and satisfaction level. [Results] Case A showed improvement in streamline floating distance and 15-m time. Case B could not swim 15 m in the first session but completed 15 m within 102 s in the last session. The 3 other categories besides swimming skills did not improve. [Conclusion] With a skilled physical therapist’s instruction, children with cerebral palsy may improve their swimming skills over a limited number of sessions without any adverse events.Key words: Children with a cerebral palsy, Swimming instruction, Physical therapist     

Efficacy of Kinesiology Taping for Recovery from Occupational Wrist Disorders Experienced by a Physical Therapist

[Purpose] The aim of this paper was to report the efficacy of kinesiology taping for recovery from wrist pain and limited range of motion (ROM) in a physical therapist with repetitive strain injuries. [Subjects] A 32 year-old male physical therapist developed recurring severe pain in the dominant wrist and limited active ROM with extremely painful supination. [Methods] The kinesiology tape was applied to the lumbricals, musculi interossei dorsales, palmares, the wrist extensor and flexor muscles, and the wrist joint for 3 weeks for an average of 10 h/day. [Results] After application of the kinesiology tape, the Numeric Pain Rating Scale and Patient-rated Wrist Evaluation scores decreased, and the Patient-Specific Functional Scale score increased in comparison with the initial score. [Conclusion] Repeated kinesiology taping of the wrist muscles and joint could be an effective method for recovery from occupational wrist disorders experienced by physical therapists.Key words: Occupational wrist pain, Kinesiology tape, Work-related musculoskeletal disorders