Reliability of visual inspection and palpation to assess relative flexibility of the shoulder

IntroductionMovement compensations during internal rotation of the shoulder can provoke pain. Reliably observing and measuring compensations in the shoulder using visual and palpatory methods can result in more efficacious treatments of shoulder pathology. Despite this, the reliability of these measures and the relationship between them is unknown.MethodsBilateral shoulders of 33 Doctor of Physical Therapy (DPT) students were measured. Two third-year DPT student examiners used visual inspection and physical palpation to identify the first signs of internal rotation (IR) passive stiffness. Measurements were taken and recorded by a third examiner using the GetMyROM (Version 1.1) iPhone application.ResultsGood intra-rater reliability for both examiners was identified for physical palpation (ICC = 0.896, 95% CI = 0.830, 0.936, ICC = 0.901, 95% CI = 0.839, 0.939) and visual inspection (ICC = 0.813, 95% CI = 0.699, 0.884, ICC = 0.782, 95% CI = 0.667, 0.880). Moderate interrater reliability was found between the examiners for physical palpation (ICC = 0.681, 95% CI = 0.479, 0.797) while poor interrater reliability was found between examiners for visual inspection (ICC = 0.481, 95% CI = 0.234, 0.648). The correlation between physical palpation and visual inspection indicated moderate reliability for both examiners (r = 0.815, p = 0.01, r = 0.832, p = 0.01).ConclusionThe findings of this research study indicate that both physical palpation and visual inspection are reliable methods for measuring relative flexibility of shoulder IR when performed by the same examiner. However, the reliability for both methods decreases when performed by different examiners. Additionally, a strong correlation was found between both measures.     

Reliability and validity of the One Arm Hop Test and Seated Medicine Ball Throw Test in young adults: A cross-sectional study

BackgroundFunctional performance tests are inexpensive, accessible, and easy to apply tools that can be used to help practitioners in daily decision making process. The purpose of this study was to evaluate the reliability and validity of the One Arm Hop Test (OAHT) and Seated Medicine Ball Throw Test (SBMT) in young adults.MethodsCross-sectional study with a sample consisted of 59 young adults. The subjects performed the OAHT and SMBT in two moments separated by seven days and by two examiners. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) was performed at the second moment. The time in OAHT, distance in SMBT, mean number of touches, normalized score, and power of the CKCUEST were measured. Reliability was determined using Intraclass Correlation Coeficient (ICC) and Bland-Altman Plots. Validity was assessed via Pearson's Correlation Coefficient (r) between these tests and CKCUEST.ResultsWe found good reliability of the OAHT between different raters (dominant limb – ICC = 0.83; non-dominant limb – ICC = 0.80) and moderate reliability between the same rater (dominant limb – ICC = 0.63; non-dominant limb – ICC = 0.62). In the SMBT we found good reliability inter-examiner (ICC = 0.84) and intra-examiner (ICC = 0.77). Low to moderate correlations with the CKCUEST were found (r < 0.70; p < 0.05).ConclusionsThe OAHT and the SMBT show moderate/good reliability intra and inter-examiner, however these tests are poorly correlated with CKCUEST. The SMBT presented higher values of ICC than OAHT. A combination of the SMBT and CKCUEST is recommended in clinical practice.     

Reliability of 2D kinematics during landing of volleyball athletes after exhaustion

IntroductionIt is possible to quantify changes in movement patterns through kinematic analysis of landing, especially to quantify changes in pre and post exhaustion situations, however the reliability of this post exhaustion analysis is not known.ObjectiveTo verify the inter and intra-examiner reliability of two-dimensional kinematic analysis during the landing of a vertical jump of volleyball athletes, pre and post exhaustion protocol.ExperimentalThirty volleyball athletes were recruited, and kinematic analysis was performed during landing, pre and post exhaustion protocol. The angular measurements analyzed were: 1) frontal plane: knee valgus and 2) sagittal plane: anterior trunk inclination, knee flexion and tibiotarsal angle, performed by two examiners. The reliability calculation used the intraclass correlation coefficient (ICC), in addition to the error of measurement (SEM), the coefficient of variation (CV) and the minimum detectable difference (MDD).ResultsRegarding reliability: ICC = 0.95–0.98 (pre) and ICC = 0.83–0.98 (post exhaustion). The CV presented heterogeneous values for the knee valgus and the inclination of the trunk, both pre and post protocol. The SEM from all angles presented values that varied from 0.74°-2.33° and the MDD ranged from 2.55°-5.54° pre protocol and 2.05°-6.45° post protocol.Conclusion2D kinematic evaluation can be used during landing, before and after the application of an exhaustion protocol, but professionals should pay attention to the angles of the knee valgus and the inclination of the trunk, as they have a large CV.     

Repeatability and reproducibility of the pressure biofeedback unit

IntroductionAlthough the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability.ObjectiveThis study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF).MethodsFifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05).ResultsRepeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg.ConclusionsThe PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.     

Clinical Assessment of Mechanical Allodynia in Youth With Complex Regional Pain Syndrome: Development and Preliminary Validation of the Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense)

Youth with complex regional pain syndrome (CRPS) commonly experience mechanical allodynia and disability. Assessment of mechanical allodynia is typically binary (present or absent), making it difficult to assess the quality and degree of mechanical allodynia before and after treatment. This study developed and validated the Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense) to provide an easy way for rehabilitation clinicians to evaluate mechanical allodynia before and after intensive interdisciplinary pain treatment. The 6 Pedi-Sense items demonstrated adequate internal consistency reliability (CR) at admission (CR = .956) and discharge (CR = .973), reasonably fit the hypothesized linear model of stimulus intensity (P < .0001), and significantly loaded onto a single latent factor, mechanical allodynia (P < .0001), at admission and discharge. Pedi-Sense scores significantly correlated with disability (r_s = .40; P = .004) and pain catastrophizing (r_s = .33; P = .017) at admission. The Pedi-Sense appeared responsive to intervention as participants’ total scores improved by 1.44 points (95% CI: .72, 2.15) after IIPT interventions that included daily tactile desensitization. However, test-retest and interrater reliability and the specific contribution of desensitization treatment to the overall success of multi-modal pain rehabilitation still needs to be evaluated.PerspectiveThis article presents the development and preliminary validation of a novel clinical assessment of static and dynamic mechanical allodynia. The Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense) allows rehabilitation clinicians to easily evaluate mechanical allodynia at the bedside with minimal training and simple equipment to guide desensitization treatment in clinical settings.     

Randomized Controlled Trial of Advance Care Planning Video Decision Aid for the General Population

ContextAdvance care planning (ACP) in a healthy general population could improve the quality of care when a health problem arises.ObjectivesThe purpose of this study was to evaluate the efficacy of video decision support aid in increasing the intention to document ACP in the general healthy population.MethodsIn this randomized controlled trial, we enrolled 250 members of the general population (aged 20 years and older and determined to be healthy), stratified by age and sex. The intervention was a video that provided information about ACP and end-of-life care options such as cardiopulmonary resuscitation (CPR) and palliative care. An attention-control arm was given a booklet about advance directives. Primary outcome was a change in intention to document ACP. Secondary outcomes included the intention to refuse CPR at terminal status, CPR and palliative care knowledge score, and the Hospital Anxiety and Depression Scale.ResultsAbout 250 participants were randomly assigned, half to the video-assisted intervention group and half to the attention-control group. Within one week postintervention, the intention to document ACP was significantly higher in the video-assisted intervention arm (68.0% vs. 39.2%; P < 0.001), and changes in the intention to document ACP were significantly greater in the video group than in the brochure group (P = 0.008; Δ = 14.4%). Palliative care knowledge score was also significantly increased in the video group (P = 0.036).ConclusionA well-constructed video decision support intervention can increase the intention to document ACP in the general population that presumably had little opportunity to discuss ACP with physicians.     

Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study

BackgroundDespite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention.MeasuresRates of AD and GCD completion, as well as self-reported barriers to ACP.InterventionProvider-led ACP in patients with decompensated cirrhosis without a prior documented AD.OutcomesSixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers.Conclusions/Lessons LearnedAddressing provider and system-specific barriers dramatically improved documentation rates of ACP.     

A comparison of the reliability of the trochanteric prominence angle test and the alternative method in healthy subjects

A wide range of intra- and inter-rater reliabilities of the trochanteric prominence angle test (TPAT) has been reported. We introduced the transcondylar angle test (TCAT) as an alternative to the TPAT and using a smartphone as a reliable measurement tool for femoral neck anteversion (FNA) measurement. The reliabilities of the TPAT and the TCAT, the reliability of using a smartphone as a clinical measurement tool, and the correlation between the difference value of medial knee joint space (KJS) between rest and tested positions and the difference value between the TPAT and TCAT were assessed. Two physical therapists independently determined the reliabilities of the TPAT with a digital inclinometer, the TCAT with a digital inclinometer, and the TCAT with a smartphone in 19 hips of 10 healthy subjects (5 male and 5 female, 22.2 ± 1.69 years). The medial KJS in rest and the tested position were assessed using a sonography. The intra-class correlation coefficients (ICC) for the intra-rater reliabilities of TPAT with a digital inclinometer (ICC = 0.92), TCAT with a digital inclinometer (ICC = 0.94) and a smartphone (ICC = 0.95) in both testers were substantial. The inter-rater reliability of TPAT with a digital inclinometer was fair (ICC = 0.48) while TCAT with a digital inclinometer (ICC = 0.89) and a smartphone (ICC = 0.85) were substantial. The correlation between the difference value of medial KJS between rest and tested positions and the difference value between TPAT and TCAT was low and statistically non-significant (r = 0.114; p = 0.325). The TCAT would be more reliable than the TPAT in inter-rater test. Using a smartphone is a clinically comparable measuring tool to a digital inclinometer.     

Personal and Interpersonal Factors and Their Associations With Advance Care Planning Documentation: A Cross-sectional Survey of Older Adults in Australia

ContextPersonal and interpersonal factors may be influential in a person's decision to engage in advance care planning (ACP), including completion of ACP documentation.ObjectivesTo conduct a cross-sectional survey of older adults accessing Australian general practices, hospitals, and residential aged care facilities, with the aim of describing associations between personal and interpersonal factors and self-reported ACP documentation completion.MethodsEligible participants included in a national health record audit were approached to complete a survey measuring demographic and health characteristics, preferences for care, worries about the future, and experiences talking with others about ACP and completing ACP documentation.ResultsOf 1082 people eligible to participate in the survey, 507 completed the survey (response rate = 47%; median age 82 years) and 54% (n = 272) reported having completed ACP documentation. Having ever discussed ACP with other people (anyone) or a doctor were both significant predictors of ACP documentation completion, whereas having previously spoken specifically to a partner about ACP, currently living with children compared to living alone, and being aged 55–69 versus 90–99 years were associated with reduced odds of ACP documentation completion.ConclusionApproximately half the participants reported having completed ACP documentation. The strongest predictor of ACP documentation completion was having spoken to anyone about ACP followed by having spoken to a doctor about ACP. These findings suggest that discussions about ACP are an important part of the process of completing ACP documentation.     

The Effect of Discussing Pain on Patient-Physician Communication in a Low-Income,Black, Primary Care Patient Population

Patients and physicians report that discussions about pain are frequently frustrating and unproductive. However, the relationship between discussions about pain and patient-physician communication is poorly understood. We analyzed 133 video-recorded visits and patient self-report data collected at a clinic providing primary care to a low-income, black patient population. We used “thin slice” methods to rate two or three 30-second video segments from each visit on variables related to patient and physician affect (ie, displayed emotion) and patient-physician rapport. Discussions about pain were associated with a .32 increase in patient unease (P < .001) and a .21 increase in patient positive engagement (P = .004; standardized coefficients) compared to discussions about other topics during the same visit. Discussions about pain were not significantly associated with patient-physician rapport, physician unease, or physician positive engagement. Patient pain severity was significantly associated with greater physician and patient unease (P = .01), but not with other variables. Findings suggest that primary care patients, but not their physicians, display significantly greater emotional intensity during discussions about pain compared to discussions about other topics.PerspectiveThis study used direct observation of video-recorded primary care visits to show that discussions about pain are associated with heightened displays of both positive and negative patient emotions. These displays of emotion could potentially influence pain-related outcomes.     

Clinicians’ attitudes towards escalation and management of deteriorating patients: A cross-sectional study

BackgroundInternationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient.ObjectiveThe objective of this study was to explore clinicians’ attitudes towards the escalation, and management of the deteriorating patient.MethodsA cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians’ Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient.ResultsSurvey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001).ConclusionNurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.     

Chronic Breathlessness Explanations and Research Priorities: Findings From an International Delphi Survey

ContextExplanations provided by health professionals may underpin helpful or harmful symptom beliefs and expectations of people living with chronic breathlessness.ObjectivesThis study sought perspectives from health professionals with clinical/research expertise in chronic breathlessness on priority issues in chronic breathlessness explanations and research.MethodsAuthors (n = 74) of publications specific to chronic breathlessness were invited to a three-round Delphi survey. Responses to open-ended questions (Round 1 “What is important to: include/avoid when explaining chronic breathlessness; prioritize in research?”) were transformed to Likert scale (1–9) items for rating in subsequent rounds. A priori consensus was defined as ≥70% of respondents rating an item as important (Likert rating 7–9) and interquartile range ≤2.ResultsOf the 31 Round 1 respondents (nine countries, five professional disciplines), 24 (77%) completed Rounds 2 and 3. Sixty-three items met consensus (include n = 28; avoid n = 9; research n = 26). Explanations of chronic breathlessness should use patient-centered communication; acknowledge the distress, variability, and importance of this sensation; emphasize current management principles; clarify maladaptive beliefs and expectations; and avoid moral culpability and inappropriate reassurance. Research priorities included the need 1) for a comprehensive understanding of breathlessness science; 2) to optimize, explore, and develop effective interventions, both pharmacological and nonpharmacological; and 3) determine effective models of care including strategies for education and training of health professionals and people caring for, or living with, chronic breathlessness.ConclusionThese consensus-based concepts for chronic breathlessness explanations and research provide a starting point for conversations between patients, carers, clinicians, and researchers within the chronic breathlessness community.     

Rehabilitative ultrasound imaging of the levator scapula muscle at rest and during contraction: Technical description and reliability

BackgroundAltered scapular muscle activity is associated with abnormal scapular motions and shoulder pain. Hence, quantification of these activities is a challenging issue. Objectives: The purposes of this study were to establish the reliability of measuring levator scapula muscle thickness and to examine how thickness of this muscle changes with contraction.MethodsTwenty-one asymptomatic individuals (mean age 22.29 ± 2.17 years) participated in this study. Three separate ultrasound images of the levator scapula muscle were captured at the neck-shoulder junction at rest and during a loaded isometric contraction. The procedures were repeated twice, four to seven days apart to establish intra-rater test-retest reliability. Interclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to determine the reliability, and a paired t-test was performed to examine the difference in muscle thickness between two conditions.ResultsThe results demonstrated that intra-examiner reliability was good at rest (ICC = 0.88, SEM = 1.16 mm) and excellent during loaded isometric contraction (ICC = 0.95, SEM = 0.91 mm). Furthermore, the thickness of levator scapula muscle significantly increased from rest to the loaded isometric contraction (Effect size = 1.99, P < 0.001).ConclusionThis study demonstrates that the thickness of the levator scapula muscle can be measured reliably at the neck-shoulder junction. Furthermore, ultrasound measures can reliably detect changes in muscle thickness from rest to a contracted state. Therefore, if the need exists to evaluate muscle morphology before and after any treatment strategy, thickness measurement of levator scapula can be determined reliably using ultrasound.     

Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding,Treatment Preferences,and Advance Care Planning

ContextPatients with advanced cancer often worry about dying. Less is known about the role of worry in decision making regarding future care.ObjectivesTo explore relationships between patients' worry about dying and their illness understanding, treatment preferences, and advance care planning (ACP).MethodsThis cross-sectional study used baseline data from a primary palliative care intervention trial. All participants had metastatic solid tumors. Using patients' response to I worry about dying from the Functional Assessment of Chronic Illness—Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding, treatment preferences, and ACP.ResultsOf 672 patients, 47% reported worrying about dying not at all, whereas 9.7% worried quite a bit or very much. In regression analysis, compared with patients who reported not worrying about dying, those who reported high levels of worry were more likely to describe themselves as terminally ill (adjusted odds ratio [AOR] = 1.98; 95% CI = 1.10–3.54; P = 0.021) and prefer life-extending therapy over symptom-focused care (AOR = 2.61; 95% CI = 1.30–5.22; P = 0.007). They were less likely to have completed an advance directive (AOR = 0.49; 95% CI = 0.25–0.94; P = 0.032). The same relationships were seen using patients' response to I feel scared about my future from the Herth Hope Index.ConclusionPatients with advanced cancer who worry about dying are more likely to identify as terminally ill and desire life-extending treatment and are less likely to engage in ACP. Understanding how patients cope with worry and make medical decisions is important in providing quality care to these patients.     

Instrumented assessment of shoulder function: A study of inertial sensor based methods

BackgroundInertial sensors have the potential to provide objective and practical methods to assess joint and limb function in the clinical setting. The aim of this study is to evaluate the psychometric properties of inertial sensor metrics in the assessment of patients with subacromial shoulder pain.Methods25 patients with unilateral subacromial shoulder pain and 50 control subjects were recruited. Assessments were carried out on both shoulders for all participants during a short movement procedure. Patients had assessments repeated after receiving three months of physiotherapy. Inertial metrics evaluated included a smoothness measure and speed and power scores derived from the range of angular velocity and acceleration profiles. Individual shoulder scores and asymmetry scores were both evaluated in terms of reliability, known-group validity, convergent validity and responsiveness.FindingsRegression analysis identified age to be a significant predictor for all scores, therefore an age matched sub-cohort of control subjects was used for comparative analyses. All scores demonstrated inter-rater reliability (ICC = 0.48–0.82), were able to differentiate pathological from healthy shoulders (AUC = 0.62–0.91) and displayed significant changes following treatment. Scores derived from the range of acceleration and velocity profiles demonstrated the largest effect sizes (Cohens d = 0.8–1.35), and displayed the highest correlation with the Oxford Shoulder Score (r = −0.40 – -0.58).InterpretationThe scores investigated demonstrate good psychometric properties and have potential to complement existing methods of assessment in the clinical or research setting. Further work is required to fully understand their clinical relevance and optimise assessment methods and interpretation.     

Descriptive analysis of prostatitis in the emergency department

IntroductionProstatitis is one of the most common urologic diseases in ambulatory patients. However, prostatitis data are limited from the emergency department (ED) setting.MethodsA data set was examined of patients age 18 years or older who received urinalysis and urine culture or were tested for gonorrhea, chlamydia, or trichomonas in the ED from a health care system in northeast Ohio.ResultsOf 19,308 ED encounters of male patients, 77 encounters (0.4%) involved the diagnosis of prostatitis. Men with prostatitis were younger (52.4 vs 66.3 years), were less likely to be hospitalized (27.3% vs 43.1%), had shorter clinical encounters (1336.5 vs 3019.3 min), and were less likely to arrive by emergency medical services or police (6.5% vs 45.5%) than men diagnosed with urinary tract infection (UTI) without prostatitis (n = 2527) (P ≤ .007 for all). Of the men with urinalysis, those with prostatitis had less bacteria (0.9+ vs 1.8+), blood (0.9+ vs 1.5+), glucose (4.0% vs 13.0%), leukocyte esterase (0.9+ vs 2.3+), nitrite positive (8.0% vs 21.4%), protein (0.5+ vs 1.2+), squamous epithelial cells (0.6 vs 1.7 per high-power field [HPF]), red blood cells (18.3/HPF vs 29.5/HPF), and white blood cells (31.6/HPF vs 57.6/HPF) than men diagnosed with UTI and no prostatitis (P ≤ .005 for all). Escherichia coli was the most common bacterium growing in the urine (58.8%; n = 10) and the blood (100.0%; n = 2) of men with prostatitis; however 73.0% (n = 17) of urine cultures and 90.9% (n = 22) of blood cultures had no bacterial growth. Of 77 patient encounters with prostatitis, 16 (20.8%) underwent testing for Neisseria gonorrhoeae and Chlamydia trachomatis and 3 (3.9%) for Trichomonas vaginalis. Of those tested, only 1 person was infected, with C trachomatis.ConclusionProstatitis was uncommonly diagnosed in men undergoing urinalysis and urine culture or testing for sexually transmitted infections in the ED.     

Assessing a Nurse-Led Advance Directive and Advance Care Planning Seminar

BackgroundAdvance directives (AD) and advance care planning (ACP) are critical to making patient-centered end-of-life decisions. Despite their importance, completion rates for AD in the United States remain low at about 18–36%. Lack of education related to AD and not understanding AD have been cited as key reasons for not participating in ACP or completing AD.PurposeThe purpose of this quasi-experimental pilot study was to assess the effectiveness of a nurse led educational AD seminar that used the Five Wishes on attitudes related to AD, AD completion, and participation in ACP conversations.MethodsA post-test repeated measures design was used.ResultsOf the 86 participants who attended the seminar, most (n = 71, 82.6%) found the seminar useful, and 97.7% (n = 84) reported that they were likely to complete an AD and participate in ACP conversations with family or friends. Overall attitudes about ADs were high. Older females were more likely to complete AD than their younger male counterparts, and women were more likely than men to have ACP conversations.ConclusionThe results of this study lend support to the role of nursing-driven community-based educational interventions to improve AD completion and participation in the ACP process.     

Reliability of Muscle Quantity and Quality Measured With Extended-Field-of-View Ultrasound at Nine Body Sites

ObjectiveMeasuring muscle quantity and quality is very important because the loss of muscle quantity and quality is associated with several adverse effects specifically in older people. Ultrasound is a method widely used to measure muscle quantity and quality. One problem with ultrasound is its limited field of view, which makes it impossible to measure the muscle quantity and quality of certain muscles. In this study, we aimed to evaluate the intra- and inter-rater reliability of extended-field-of-view (EFOV) ultrasound for the measurement of muscle quantity and quality in nine muscles of the limbs and trunk.MethodsTwo examiners took two ultrasound EFOV images with a linear probe from each of the muscle sites. The intraclass correlation coefficient (ICC) was used, and the standard error of measurement and coefficient of variation were calculated.ResultsIntra-rater reliability was good to excellent (ICC = 0.2–1.00) for all muscle measurements. The inter-rater reliability for most of the muscle measurements was good to excellent (ICC = 0.82–0.98). Inter-rater reliability was moderate (0.58–0.72) for some muscle quantity measurements of the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris and triceps brachii muscles.ConclusionMuscle quantity and quality can be measured reliably using EFOV US.     

Impact of a Nurse-Led Advance Care Planning Intervention on Satisfaction,Health-Related Quality of Life,and Health Care Utilization Among Patients With Severe Respiratory Disease: A Randomized Patient-Preference Trial

ContextPrevious work has found that facilitated advance care planning (ACP) interventions are effective in increasing ACP uptake among patients with severe respiratory disease.ObjectivesThe objective of this study was to investigate whether a nurse-led, facilitated ACP intervention among participants with severe respiratory disease impacts self-reported or clinical outcomes.MethodsA multicenter, open-label, patient-preference, randomized controlled trial of a nurse-led facilitated ACP intervention was performed. Outcome measures included self-report scales (health care satisfaction and EQ-5D-5L health-related quality of life at three- and six-month follow-up), 12-month mortality, and health care utilization during the final 90 days of life.ResultsOne hundred forty-nine participants were recruited across two study settings (metropolitan tertiary hospital respiratory department and rural sites) and 106 were allocated to receive the ACP intervention. There was no effect of the intervention on satisfaction with health care, health-related quality of life, or 12-month mortality rates. Among those participants who died during the follow-up period (N = 54), those allocated to the ACP intervention had significantly fewer outpatient consultations (7.51 vs. 13.6, P < 0.001). There were no changes in emergency department attendances, total hospital admissions or length of stay, or home nursing visits. Among those allocated to the ACP intervention, there was a reduced length of stay in acute hospital settings (7.76 vs. 11.5 nights, P < 0.001) and increased length of stay in palliative hospital settings (5.54 vs. 2.08, P < 0.001) during the final 90 days of life.ConclusionA facilitated ACP intervention among patients with severe respiratory disease did not have an impact on satisfaction, health-related quality of life, or 12-month mortality rate. Facilitated ACP may be associated with a different type of health care utilization during the end-of-life period.