护理专科生临床能力指标体系的构建与信效度研究

目的建立一套科学、客观、系统的护理专科生临床能力评价指标体系。方法运用文献回顾资料调研法、质性研究法、专家小组讨论和德尔菲专家咨询法,确立护理专科生临床能力评价指标内涵、评价方法及权重,对93名实习护生进行能力评价即信效度检验。结果构建了包含临床护理专业能力、沟通合作能力、护理职业素质、专业发展能力4项I级指标、18项Ⅱ级指标和45项Ⅲ级指标的护理专科生临床能力评价指标体系,具有较高的信效度。结论护理专科生临床能力指标体系内容全面、合理,能有效评价护理专科生的临床能力。     

The inter-rater reliability of clinical tests that best predict the subclassification of lumbar segmental instability: structural,functional and combined instability

ObjectivesThis study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio (+ LR) against flexion–extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilisation exercises in patients with recurrent or chronic low-back pain (R/CLBP). The study also investigated the reliability of lumbar segmental instability, subclassification as: functional, structural and combined instability.MethodForty adults with R/CLBP (30 men and 10 women), aged 21–71 years, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability.ResultsAll functional-instability tests: the prone instability test (PIT), the aberrant motion test and the average passive straight-leg raise (PSLR>91°) test showed a high percentage agreement (90, 97·5 and 95%, respectively) and a high kappa coefficient (0·71, 0·79 and 0·77, respectively). In addition, two structural tests: the lumbar flexion range of motion (ROM) >53° and the passive lumbar extension test (PLET) showed a high percentage agreement (82 and 73%, respectively), and a moderate kappa coefficient (0·48 and 0·46, respectively). The lack of hypomobility with the posteroanterior (PA) glide test was found to be unreliable (agreement = 25%; k = − 0·02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k = 0·41). The subclassification categories of lumbar segmental instability (functional, structural and combined) were found to be significantly reliable (PABAK) 0·90, 0·70 and 0·95, respectively).DiscussionAll investigated tests (except the lack of hypomobility with the PA glide test), in addition to subclassifying the categories of lumbar segmental instability, were significantly reliable in the assessment of lumbar instability.     

Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests

Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests.

Objective

To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain.

Design

Prospective repeated-measures design.

Setting

Private practices for physical therapy and hospital outpatient physical therapy divisions.

Participants

Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder.

Interventions

Not applicable.

Main Outcome Measures

Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test.

Results

The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach α coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found.

Conclusions

These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests’ outcomes, however, is questionable.     

The development and validity of the Salford Gait Tool: an observation-based clinical gait assessment tool

OBJECTIVES: To develop the construct, content, and criterion validity of the Salford Gait Tool (SF-GT) and to evaluate agreement between gait observations using the SF-GT and kinematic gait data. DESIGN: Tool development and comparative evaluation. SETTING: University in the United Kingdom. PARTICIPANTS: For designing construct and content validity, convenience samples of 10 children with hemiplegic, diplegic, and quadriplegic cerebral palsy (CP) and 152 physical therapy students and 4 physical therapists were recruited. For developing criterion validity, kinematic gait data of 13 gait clusters containing 56 children with hemiplegic, diplegic, and quadriplegic CP and 11 neurologically intact children was used. For clinical evaluation, a convenience sample of 23 pediatric physical therapists participated. INTERVENTIONS: We developed a sagittal plane observational gait assessment tool through a series of design, test, and redesign iterations. The tool's grading system was calibrated using kinematic gait data of 13 gait clusters and was evaluated by comparing the agreement of gait observations using the SF-GT with kinematic gait data. MAIN OUTCOME MEASURES: Criterion standard kinematic gait data. RESULTS: There was 58% mean agreement based on grading categories and 80% mean agreement based on degree estimations evaluated with the least significant difference method. CONCLUSIONS: The new SF-GT has good concurrent criterion validity.     

Barriers and facilitators to providing undergraduate physiotherapy clinical education in the primary care setting: a three-round Delphi study

Background

With the global shift in health care from secondary to primary care, employment opportunities for newly qualified physiotherapists are likely to be in the primary care setting. However, to date, undergraduate physiotherapy clinical education has been centred around secondary care, focusing on acute services in large teaching hospitals. For contemporary physiotherapists to become effective first-contact primary care providers, they need to be exposed to the primary care environment during their undergraduate education.

Objectives

To explore the concept and identify perceived barriers and facilitators to providing physiotherapy undergraduate clinical placements in the primary healthcare setting

Design

A three-round Delphi survey was used. Participants were asked to answer open-ended questions with regard to: (i) student preparation for and (ii) provision of primary care placements (Round 1). Content analysis was employed to identify key themes. These themes generated statements for Round 2. In Round 2, participants were asked to rate their level of agreement/disagreement with the generated statements. In Round 3, a final rating process was conducted. Level of consensus was established as ≥70% agreement, with an interquartile range of ≤1.

Participants

One hundred and ninety-eight primary care physiotherapy staff.

Results

Barriers identified included shortage of resources (e.g. staff) and a lack of tradition; in other words, students are not traditionally educated in the primary care setting. Response rates were 60% (120/198), 70% (84/120) and 76% (64/84) for Rounds 1, 2 and 3, respectively. All seven key facilitators identified reached consensus. They included additional support for staff taking students and motivated students.

Conclusions

This study revealed that there is support for the provision of physiotherapy clinical education in the primary care setting. Through careful consideration with clear planning and collaboration with all stakeholders, it may be possible to convert the main barriers identified into facilitators to ensure that there will be an adequately prepared physiotherapy work force in the future.     

Interrater reliability of clinical examination measures for identification of lumbar segmental instability

OBJECTIVE: To determine the interrater reliability of common clinical examination procedures proposed to identify patients with lumbar segmental instability. DESIGN: Single group repeated-measures interrater reliability study. SETTING: Outpatient physical therapy (PT) clinic and university PT department. PARTICIPANTS: A consecutive sample of 63 subjects (38 women, 25 men; 81% with previous episodes of low back pain [LBP]) with current LBP was examined by 3 pairs of raters. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Repeat measurements of clinical signs and tests proposed to identify lumbar segmental instability. RESULTS: Kappa values for the trunk range of motion (ROM) findings varied (range,.00-.69). The prone instability test (kappa=.87) showed greater reliability than the posterior shear test (kappa=.22). The Beighton Ligamentous Laxity Scale (LLS) for generalized ligamentous laxity showed high reliability (intraclass correlation coefficient=.79). Judgments of pain provocation (kappa range,.25-.55) were generally more reliable than judgments of segmental mobility (kappa range, -.02 to.26) during passive intervertebral motion testing. CONCLUSIONS: The results agree with previous studies suggesting that segmental mobility testing is not reliable. The prone instability test, generalized LLS, and aberrant motion with trunk ROM demonstrated higher levels of reliability.     

The reliability of clinical measurements designed to quantify shoulder mobility

Abstract

Background: The assessment of shoulder mobility is an integral component of the physical therapy examination. Recognizing a mobility loss may assist the physical therapist in making a differential diagnosis, measuring improvement or deterioration, determining functional impairment, and planning interventions. Reliable measurement instruments and procedures are therefore essential to both the clinician and researcher desiring to objectively monitor disease progression, outcomes, and mobility impairments.

Objectives: The purpose of this review is to summarize the literature on the reliability and concurrent validity of clinical measurements used to quantify osteokinematic mobility of the shoulder.

Major findings: The reliability of shoulder mobility measurements is highly variable with no consistent advantage of instrumentation or procedures. Inclinometric measurement reliability coefficients ranged from 0·11 to 0·99, with goniometry ?0·22 to 0·99 and visual inspection 0·18 to 0·98. Reliability was independent of symptom state and measurement approach (passive versus active), although there was a trend for intrarater reproducibility exceeding interrater. Extension, horizontal abduction, and adduction measurements were limited to one investigation which utilized passive goniometric measurements. Research investigating the concurrent validity of instruments and procedures was limited, although favorable when comparing small versus large goniometers and goniometry to a digital level.

Conclusions: A consensus for choosing instruments and/or procedures was not conclusive based on comparable reliability reports and ranges. Instruments used to quantify shoulder mobility cannot be used interchangeably with confidence given the paucity of concurrent validity reports. Clinicians should recognize both the merits and limitations of the instruments and procedures that they incorporate into practice.     

Interrater reliability of the history and physical examination in patients with mechanical neck pain

OBJECTIVE: To examine the interrater reliability of the history and physical examination in patients with mechanical neck pain. DESIGN: Single-group repeated measures for interrater reliability. SETTING: Outpatient physical therapy clinic. PARTICIPANTS: Twenty-two patients with mechanical neck pain underwent a standardized history and physical examination by a physical therapist. INTERVENTION: Following a 5-minute break, a second therapist who was blind to the findings of examiner 1 performed the second standardized history and physical examination. MAIN OUTCOME MEASURES: The Cohen kappa and weighted kappa were used to calculate the interrater reliability of ordinal level data from the history and physical examination. Intraclass correlation coefficients model 2,1 (ICC(2,1)) and the 95% confidence intervals were calculated to determine the interrater reliability for continuous variables. RESULTS: The kappa coefficients ranged from -.06 to .90 for the variables obtained from the history. Reliability values for categorical data collected during the physical examination ranged from no to substantial agreement depending on the particular test and measure. ICC(2,1) for cervical range of motion (ROM) measurements ranged between .66 and .78. CONCLUSIONS: We have reported the interrater reliability of the history and physical examination in a group of patients with a primary report of neck pain. The reliability variables varied considerably for manual assessment techniques and were significantly higher for the examination of muscle length and cervical ROM. Ultimately, it will be up to each clinician to determine if a particular test or measure poses adequate reliability to assist in the clinical decision making process.     

In pursuit of an optimal model of undergraduate nurse clinical education: An integrative review

Clinical learning experiences are an essential part of nurse education programs. Numerous approaches to clinical education and student supervision exist. The aim of this integrative review was to explore how studies have compared or contrasted different models of undergraduate nurse clinical education. A search of eight databases was undertaken to identify peer-reviewed literature published between 2006 and 2015. Eighteen studies met the inclusion criteria. A diverse range of methodologies and data collection methods were represented, which primarily explored student experiences or perceptions. The main models of undergraduate nurse clinical education identified were: traditional or clinical facilitator model; the preceptorship or mentoring model; and the collaborative education unit model in addition to several novel alternatives. Various limitations and strengths were identified for each model with no single optimal model evident. Thematic synthesis identified four common elements across the models: the centrality of relationships; the need for consistency and continuity; the potential for variety of models; and the viability/sustainability of the model. The results indicate that effective implementation and key elements within a model may be more important than the overarching concept of any given model. Further research is warranted to achieve an agreed taxonomy and relate model elements to professional competence.     

心脏介入专科护士核心能力自评问卷的编制及信效度检验

目的 构建心脏介入专科护士核心能力自评问卷并检验其信效度。方法 2022年11月,以通过Delphi法和层次分析法建立的心脏介入专科护士核心能力框架为依据,编制自评问卷,并在全国范围内开展心脏介入专科护士核心能力的调查,根据调查结果开展自评问卷的信效度检验。结果 心脏介入专科护士核心能力自评问卷包括5个维度、45个条目。探索性因子分析累计方差贡献率为71.447%,各条目在维度上的因子载荷为0.538~0.856。验证性因子分析,修正后卡方/自由度为2.683,比较拟合指数为0.901,非规准适配度指数为0.889。自评问卷的Cronbach’s α 系数为0.973,折半信度为0.922,各维度的Cronbach’s α系数为 0.844～0.964,折半信度为 0.780～0.946,14天重测信度为0.681~1.000。结论 心脏介入专科护士核心能力自评问卷具有较好的信效度,可用于心脏介入专科护士核心能力的自评;护理管理者可将其作为岗位调配的依据。     

Between-days reliability of H-reflexes in human flexor carpi radialis

OBJECTIVES: To assess between-day reliability of the latency and peak-to-peak amplitude of a technique to elicit the H-reflex and M response of the flexor carpi radialis (FCR) and the ratio of maximum H-reflex and M-response amplitude (Hmax/Mmax). DESIGN: Test-retest reliability study. SETTING: Electrophysiology laboratory at a university. PARTICIPANTS: Fifteen consecutively recruited healthy volunteers (8 men, 7 women; age range, 22-65y). INTERVENTION: Volunteers were tested on 2 separate days at the same time of day for H-reflex and M response by stimulating the median nerve in the cubital fossa in the presence of a standardized voluntary contraction of the FCR muscle. MAIN OUTCOME MEASURES: Onset latencies, peak-to-peak amplitudes, and Hmax/Mmax. RESULTS: Latency measurements of H-reflex and M response showed excellent reliability between days, as did the maximum amplitude of the M response. The maximum amplitudes of the H-reflex and Hmax/Mmax ratio were less reliable but still within acceptable limits. CONCLUSIONS: The H-reflex and M response can be reliably elicited in the FCR. This technique provides a useful clinical tool for diagnostic purposes during the course of neurologic disorders and in preclinical and postclinical intervention studies.     

护理专业本科生临床能力评价指标的建立与论证

目的探讨并确立护理本科生临床能力的评价指标体系。方法采用文献检索法和特尔斐法对评价指标进行探讨和论证。结果确立了护理本科生临床能力的评价应包含核心能力、临床护理能力、相关护理能力3项一级指标和评判性思维能力、自主学习能力等10项二级指标及其权重。结论核心能力、相关护理能力、临床护理能力、评判性思维能力、自主学习能力等可以科学的地评价护理本科生的临床能力。     

急诊护士灾害护理能力评估量表的初步构建及信效度检验

目的构建适用于我国医院文化背景的急诊护士灾害护理能力评估量表。方法通过文献回顾,结合德尔菲(Delphi)法专家函询等方法形成初始量表。2017年6—12月采用便利抽样方法抽取上海市2所三级甲等医院急诊科护士272名进行测试,通过项目分析、因子分析形成正式量表,最后进行量表的信效度检验。结果量表各条目的Cronbach'sα系数均>0.900,总量表的Cronbach'sα系数为0.990,重测信度为0.946,各项目与总分相关性高(r值为0.530~0.870,P<0.01),主成分分析提取初始因子4个,解释累积总方差的76.56%。结论急诊护士灾害护理能力评估量表具有较好的信效度,可作为测量急诊护士灾害护理能力的工具。     

Intrasession reliability of force platform parameters in community-dwelling older adults

Bauer C, Gröger I, Rupprecht R, Gaßmann KG. Intrasession reliability of force platform parameters in community-dwelling older adults.

Objective

To investigate the intrasession reliability of center of pressure (COP) parameters calculated from force platform measurements.

Design

A cross-sectional study.

Setting

Gait and balance laboratory.

Participants

Community-dwelling healthy older adults (N=63) above the age of 62 years (mean age, 78.74y).

Interventions

Not applicable.

Main Outcome Measures

COP was estimated from a force platform, and the following parameters were calculated: (1) the total length of the COP displacement, (2) area of sway, (3) length of the COP displacement in the sagittal plane, and (4) length of the COP displacement in the frontal plane. Intraclass correlation coefficients (ICCs) were calculated by using 3 successive trials with 4 different test conditions. The test conditions were (1) normative standing with eyes open, (2) normative standing with eyes closed, (3) narrow stance with eyes open, and (4) narrow stance with eyes closed.

Results

The ICCs for the tests with eyes closed (.710-.946) were higher than those for tests with eyes open (.841-.945). The highest value was obtained for the vector sum of the COP during anteroposterior movement in narrow stance with eyes closed (.946). The value .710 was the lowest of all parameters and was an outlier for the narrow stance with eyes closed test, which was otherwise very reliable.

Conclusions

Eight of 16 calculated ICCs showed excellent reliability (>.90). They can be recommended for further use in clinical trials. Tests with closed eyes were more reliable than tests with eyes open. We recommend using eyes closed test conditions when assessing static balance control. For these tests, all the calculated ICCs were over .90, except for measurements of sway area.     

A system of performance intervention zones for use during student evaluation in the clinical environment

In order to support decision making during comprehensive clinical examinations involving patient care, a system of performance intervention zones was developed and implemented. The aims of the system were to assist examiners in deciding when to intervene during a clinical examination, to facilitate consistency in decision making, and to create the basis and language for shared understanding of examinee performance.The system was recently utilized in Ontario during assessment of internationally educated massage therapists in relation to provincially set competency standards. Feedback from examiners suggested that the system of intervention zones was effective in achieving the specified aims, and on the basis of this preliminary field test, further work is being planned in order to establish the reliability of the system.     

护理本科生临床实习教学现状的研究

目的调查三级甲等医院护理本科生临床实习教学现状,为提高本科生的临床教学质量提供依据。方法对参与护理本科生临床带教的125名护士进行问卷调查。结果有5年以上带教本科生经历的教师只占23.34%,45.83%有本科及以上学历;带教前正规培训的比例偏低,培训内容不全面;仿真模拟病房使用率低(3.33%),出科考核中综合素质考核少。影响带教质量的原因主要是时间和精力不足(67.50%)、缺乏正规教学培训(46.67%)。结论应加强护理本科生临床师资队伍的培训和教育,并推动仿真模拟病房的使用率,加强对本科生综合能力的培养和考核。     

The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station

OBJECTIVE: To compare the inter- and intrarater reliability of a portable dynamometer anchoring station (DAS) to a handheld dynamometer (HHD). DESIGN: Repeated-measures design. SETTING: Human performance and movement analysis laboratory. PARTICIPANTS: Fifteen healthy participants, ages 23 to 44 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three consecutive measures of peak bilateral isometric strength were obtained for hip abduction, extension, and flexion by 2 investigators by using the DAS and the HHD after a 1-hour rest period. This testing scenario was repeated 1 week later. Intraclass correlation coefficients (ICCs) were used to determine reliability. RESULTS: Interrater ICCs of average peak strength ranged from.84 to.92 (hip flexors),.69 to.88 (hip abductors), and.56 to.80 (hip extensors). Intrarater ICCs ranged from.59 to.89 for tester A and from.72 to.89 for tester B using the DAS, and from.67 to.81 for the HHD across muscle groups. CONCLUSIONS: The DAS showed good intrarater reliability for hip flexion and abduction, whereas the HHD demonstrated higher reliability for hip extension. The results support the use of dynamometers that are quick and reliable and that reduce tester bias during hip strength assessment.