Physiotherapists’ perceptions of clients from culturally diverse backgrounds

Objectives

The aim of this study was to identify the perceptions, attitudes and beliefs of physiotherapists towards clients of non-English-speaking backgrounds.

Design

Qualitative methods of semi-structured interviews and observations were used to conduct an exploratory study.

Setting

Three hospitals in New South Wales, Australia.

Participants

Six physiotherapists from the hospitals were interviewed and other physiotherapists were observed.

Results

Some participants acted towards clients from cultural minorities based on stereotypes, whilst other participants with limited cultural knowledge incorrectly presumed that they were proficient at cross-cultural interactions. Cultural assimilation was favoured by one physiotherapist.

Conclusion

Physiotherapists need to be aware of their own cultural biases, and be willing to undergo a change within themselves to interact effectively and provide quality care to clients from non-English-speaking backgrounds.     

Physical assault by patients against physiotherapists working in mental health settings

Objectives

There is a lack of empirical research about physical assault by patients against physiotherapists who work in mental health settings. This study aimed to ascertain the lifetime prevalence and 12-month incidence of assault by patients against physiotherapists in UK mental health settings. This research will inform the development of pre- and post-registration training programmes for physiotherapists.

Design

Postal questionnaire survey.

Participants

Members of the Chartered Society of Physiotherapists’ special interest group for physiotherapists working in the field of psychiatry.

Main outcome measures

Self-reported experience of physical assault by patients. Secondary outcome was self-reported training received to manage violent and aggressive patients.

Results

Questionnaires were returned by 116/178 (65%) special interest group members. Fifty-one percent (59/116) reported that they had been assaulted at work during their career, and 24% (28/116) had been assaulted by a patient in the previous 12 months. Physiotherapists in mental health settings appear to be at greater risk of assault by patients than other non-nursing clinicians.

Conclusions

Physiotherapists who work in mental health are at similar risk of physical assault by patients as their nursing colleagues, who are required by the UK Nursing and Midwifery Council to receive education and training in the prevention and management of aggression and violence in their pre-registration training. The authors recommend that appropriate training should be included in pre-registration programmes for physiotherapists.     

Ability of People With Stroke to Learn Powered Wheelchair Skills: A Pilot Study

Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of people with stroke to learn powered wheelchair skills: a pilot study.

Objectives

Our primary objective was to test the hypothesis that people with stroke can learn to use powered wheelchairs safely and effectively. Our secondary objective was to explore the influence of visuospatial neglect on the ability to learn powered wheelchair skills.

Design

Prospective, uncontrolled pilot study using within-participant comparisons.

Setting

Rehabilitation center.

Participants

Inpatients (N=10; 6 with visuospatial neglect), all with a primary diagnosis of stroke.

Interventions

Participants received 5 wheelchair skills training sessions of up to 30 minutes each using the Wheelchair Skills Training Program (version 3.2).

Main Outcome Measures

Powered wheelchair skills were tested before and after training using the Wheelchair Skills Test, Power Mobility version 3.2 (WST-P).

Results

The group's total mean WST-P scores improved from 25.5% of skills passed at baseline to 71.5% posttraining (P=.002). The participants with neglect improved their WST-P scores to the same extent as the participants without neglect, although their pretraining and posttraining scores were lower. The training and testing sessions were well tolerated by the participants, and there were no serious adverse events.

Conclusions

Many people with stroke, with or without visuospatial neglect, can learn to use powered wheelchairs safely and effectively with appropriate training.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Generalization of Prism Adaptation for Wheelchair Driving Task in Patients With Unilateral Spatial Neglect

Watanabe S, Amimoto K. Generalization of prism adaptation for wheelchair driving task in patients with unilateral spatial neglect.

Objectives

To verify the efficacy of prism adaptation as a practical means of rehabilitation for subjects with unilateral spatial neglect by conducting goal-directed tasks in the presence of similar visual flankers in the right hemispace using an activity of daily living, namely, wheelchair operation.

Design

Prospective cohort study.

Setting

Rehabilitation center located in Japan.

Participants

Patients with unilateral spatial neglect (N=10).

Intervention

Prism adaptation.

Main Outcome Measures

A midpoint-directed task in which the subject faces the center of 2 symbols placed in front and moves the wheelchair toward it, and a goal-directed task in which the subject must differentiate a single target from multiple symbols and move the wheelchair toward it.

Results

In the midpoint-directed task, there was a significant shift in the reach position bias from +27.7cm prior to prism adaptation to +3.1cm after prism adaptation (P<.01). In the goal-directed task, the time taken to reach the outer left target decreased from 21.2 seconds prior to prism adaptation to 11.8 seconds after prism adaptation, and the difference between placement of the targets was eliminated.

Conclusions

Prism adaptation exhibited the potential to generalize the effects on activities of daily living such as driving a wheelchair and to ameliorate unilateral spatial neglect even in the presence of right-hemispace flankers. Prism adaptation is an effective therapeutic modality in rehabilitation because it prevents the appearance of neglect symptoms despite situational or contextual changes.     

Clinimetric evaluation of the physical mobility scale supports clinicians and researchers in residential aged care

Barker AL, Nitz JC, Low Choy NL, Haines TP. Clinimetric evaluation of the Physical Mobility Scale supports clinicians and researchers in residential aged care.

Objective

To investigate the interrater agreement and the internal construct validity of the Physical Mobility Scale, a tool routinely used to assess mobility of people living in residential aged care.

Design

Prospective, multicenter, external validation study.

Setting

Nine residential aged care facilities in Australia.

Participants

Residents (N=186). Phase 1 cohort (99 residents; mean age, 85.22±5.1y); phase 2 cohort (87 residents; mean age, 81.59±10.69y).

Interventions

Not applicable.

Main Outcome Measures

Kappa statistics, minimal detectable change (MDC₉₀) scores, and Bland-Altman plots were used to assess interrater agreement. Scale unidimensionality, item hierarchy, and person separation were examined with Rasch analysis for both cohorts.

Results

Agreement between raters on 6 of the 9 Physical Mobility Scale items was high (κ>.60). The MDC₉₀ value was 4.39 points, and no systematic differences in scores between raters were found. The Physical Mobility Scale showed a unidimensional structure demonstrated by fit to the Rasch model in both cohorts (phase 1: χ²=23.90, P=.16, person separation index=0.96; phase 2: χ²=22.00, P=.23, person separation index=0.96). Standing balance was the most difficult item in both cohorts (phase 1: logit=2.48, SE, 0.16; phase 2: logit=2.53, SE, 0.15). The person-item threshold map indicated no floor or ceiling effects in either cohort.

Conclusions

The Physical Mobility Scale demonstrated good interrater agreement and internal construct validity with good fit to the Rasch model in both cohorts. The comparative results across the 2 cohorts indicate generality of the findings. The Physical Mobility Scale total raw scores can be converted to Rasch transformed scores, providing an interval measure of mobility. The Physical Mobility Scale may be suited to a range of clinical and research applications in residential aged care.     

A national framework for supporting improvements in the physiotherapy assessment and management of low back pain: the Scottish experience

Background

Similar to other countries worldwide, Scotland lacked a national view of whether the quality of the physiotherapy management of low back pain was compliant with national guidelines. Anecdotal evidence suggested that standards of care varied considerably despite the wide availability of clinical guidelines to clinicians.

Aim

To develop a framework that supports National Health Service (NHS) Scotland in providing consistently applied high-quality physiotherapy assessment and management of low back pain in line with guideline recommendations.

Design

Prospective, multicentred national study, data collection and improvement phase.

Setting

All NHS boards in Scotland (n = 14) plus two private provider sites.

Participants

One hundred and eighty-six individual NHS sites and two private providers of services to patients with low back pain.

Method

A national dataset was developed from evidence- and consensus-based guideline sources. All sites collected data (two 5-week periods) over 1 year (2008-2009) using a web-based database. This was interspersed by an improvement phase during which required improvements were considered and implemented. Issues were shared through a national network and national meeting.

Results

Data from 2147 patients showed improvements in the documented physiotherapy management of low back pain over the two cycles. All participants developed and implemented remedial action plans based on the results of the first cycle.

Conclusion

It is possible to implement a framework, which is led nationally but driven and owned locally, supporting physiotherapists in an active programme of locally determined improvement. However, although process and outcome are linked, the direct impact of this initiative on patient outcome is not known.     

Reproducibility of the ABILOCO Questionnaire and Comparison Between Self-Reported and Observed Locomotion Ability in Adult Patients With Stroke

Caty GD, Theunissen E, Lejeune TM. Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

Objectives

To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist.

Design

Prospective study.

Setting

University hospital.

Participants

Adult stroke patients (N=28; 59±13y). The time since stroke ranged from 3 to 253 weeks.

Interventions

Not applicable.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively).

Conclusions

The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.     

Rasch analysis of the barthel index in the assessment of hospitalized older patients after admission for an acute medical condition

de Morton NA, Keating JL, Davidson M. Rasch analysis of the Barthel Index in the assessment of hospitalized older patients after admission for an acute medical condition.

Objective

To investigate the validity of item score summation for the original and modified versions of the Barthel Index.

Design

Rasch analysis of Barthel Index data.

Setting

General medical wards at 2 acute care hospitals in Australia.

Participants

Consecutive older medical patients (N=396).

Interventions

Not applicable.

Main Outcome Measures

Activity limitation was assessed by using the Barthel Index at hospital admission and discharge. At 1 hospital site, the original Barthel Index was used, and at the other hospital site the Modified Barthel Index (MBI) was used.

Results

More than half of the items showed misfit to the Rasch model for both versions of the Barthel Index. The continence items appear to measure a different construct to the other items. After the removal of the continence items, data for the remaining items still did not fit the Rasch model. Neither the original nor the MBI are unidimensional scales. An exception to this occurred when the original Barthel Index was rescored and only then for discharge and not for admission Barthel Index data.

Conclusions

Because clinicians do not typically rescore outcomes obtained by using the Barthel Index, these findings, combined with unacceptable ceiling effects, render the Barthel Index an assessment tool with limited validity for measuring and monitoring the health of older medical patients.     

Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes

Objectives

To examine whether patients with chronic low back pain exhibit changes in cognitive factors following Interactive Behavioural Modification Therapy (IBMT), delivered by physiotherapists; and to examine the association between pre- to post-treatment changes in cognitive factors (cognitive processes) and pre- to post-treatment changes in pain, disability and depression.

Design

Observational before-after study.

Setting

Outpatient physiotherapy department.

Participants

One hundred and thirty-seven patients with chronic low back pain.

Interventions

IBMT: ‘Work Back to Life’ rehabilitation programme.

Main outcome measures

Pre- to post-treatment changes in pain, disability and a range of cognitive factors.

Results

Patients demonstrated significant favourable changes for a range of cognitive factors. Furthermore, pre- to post-treatment changes in these cognitive factors explained an additional 22%, 17% and 15% of the variance in changes in pain, disability and depression, respectively, after controlling for other important factors.

Conclusions

Changes that emerge in cognitive factors are strongly related to treatment outcome within a physiotherapy treatment context. Specifically, reductions in fear of movement and catastrophising, and increases in functional self-efficacy appear to be particularly important. Modifying these cognitive factors should be seen as a priority when treating patients with chronic low back pain.     

A video analysis of how physiotherapists communicate with patients about errors of performance: insights for practice and policy

Objectives

To describe and elucidate skilled practices by which physiotherapists communicate with patients about problems of ongoing or recent performance of physical treatment activities; to offer a sociological perspective on this area of practice; to examine relations between actual communication practice and official (Chartered Society of Physiotherapy) recommendations; to explore problems associated with formulating standards pertaining to communication and suggest how these might be addressed.

Design

Video recordings of physiotherapy treatment sessions (n = 74) were analysed using conversation analysis—an observational, inductive, social science methodology.

Setting

Inpatient rehabilitation units in four English hospitals.

Participants

Twenty-one stroke patients aged 52-86 years and 10 senior physiotherapists with 3-23 years of postqualification experience.

Results and conclusions

A variety of practices were identified. Managing shortcomings of performance often involves identifying and/or correcting the problem in a manner that deals sensitively with the negative connotations of physical non-competence. Characteristics of these practices include indirectness and ambiguity. As such, they do not conform to some official recommendations. However, good interactional reasons underlie the observed patterns. It is suggested that official guidance should acknowledge the complexity of communication and its measurement. Recommendations should be based upon a thorough understanding of the interactional tasks and practices entailed in physiotherapy. Recommendations should be explicitly tentative and refer to broad principles. By elucidating specific communication strategies, their consequences and the considerations that underlie them, conversation analytic research into physiotherapy communication has the potential to inform guidelines, and provide resources for developing and teaching communication skills.     

An investigation into the alignment of a South African physiotherapy curriculum and the expectations of the healthcare system

Until 1994, physiotherapy education and training were aligned with the expectations of the South African healthcare system. Subsequent to policy shifts since 1994, the professional role of physiotherapists has expanded. In the absence of guiding strategies to support this change, physiotherapy curricula have remained relatively static.

Objective

The paper examines the discrepancies between physiotherapy education and training at a South African university post apartheid and the expectations of the healthcare system.

Design

Located within critical feminist research framings and employing narrative inquiry as the selected methodology, data were produced through multiple methods to obtain multiple perspectives and orientations.

Participants

This multisectorial data production approach involving student physiotherapists, physiotherapy academics and practising physiotherapists included in-depth focus group interviews, individual interviews, life-history biographies and open-ended questionnaires. The data were analysed separately for each group of research participants (physiotherapy students, practitioners and academics), followed by a cross-sector analysis.

Results

The analysis illustrated current disciplinary trends and shortcomings of the physiotherapy undergraduate curriculum, whilst highlighting that which is considered valuable and progressive in physiotherapy and health care. The dominant themes that emerged included issues relating to physiotherapy theory and practice, and issues that influenced the construction of relationships in the curriculum.

Conclusion

The significance of this study lies in the value of student and practitioner feedback to inform curriculum and professional development in the light of sociopolitical changes and healthcare expectations.     

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.

Objectives

To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.

Design

Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.

Setting

Biomechanics laboratory.

Participants

Healthy novice wheelchair users (N=13; 6 men) from a university student population.

Interventions

Not applicable.

Main Outcome Measures

Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.

Results

Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.

Conclusions

Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.     

The Effects of Foot Position on the Performance of the Sit-To-Stand Movement With Chronic Stroke Subjects

Camargos AC, Rodrigues-de-Paula-Goulart F, Teixeira-Salmela LF. The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.

Objective

To investigate the effects of different foot positions during the sit-to-stand (STS) movements with stroke subjects.

Design

Cross-sectional.

Setting

Research laboratory.

Participants

Twelve chronic stroke subjects (N=12).

Interventions

Not applicable.

Main Outcome Measures

Differential latency and electromyography (EMG) activity of the tibialis anterior, soleus, quadriceps, and hamstring muscles of the affected leg as well as the movement time, time of seat-off, weight symmetry, and rising index were obtained while the subjects performed the STS movements by using 4 different strategies: spontaneous; symmetric; asymmetric-1, with the affected foot behind; and asymmetric-2, with the unaffected foot behind.

Results

Compared with the spontaneous strategy, the soleus showed the greatest differential latency in the asymmetric-2 strategy, the hamstrings had lower EMG activity in the symmetric strategy, and the movement time was greater in the asymmetric strategies.

Conclusions

The asymmetric 2 strategy appeared to be the least favorable, whereas the spontaneous and the symmetric strategies appeared to be more favorable in improving the STS performance. Based on these findings, allowing the subjects to adopt the spontaneous strategy or training of the symmetric strategy could result in greater benefits for subjects with higher chronicity and higher functional levels, such as those evaluated in the present study.     

Assessment of flow waves and colorimetric CO2 detector for endotracheal tube placement during neonatal resuscitation

Aim

Clinical assessment and end-tidal CO₂ (ETCO₂) detectors are routinely used to verify endotracheal tube (ETT) placement. However, ETCO₂ detectors may mislead clinicians by failing to identify correct placement under a variety of conditions. A flow sensor measures gas flow in and out of an ETT. We reviewed video recordings of neonatal resuscitations to compare a colorimetric CO₂ detector (Pedi-Cap^®) with flow sensor recordings for assessing ETT placement.

Methods

We reviewed recordings of infants <32 weeks gestation born between February 2007 and January 2010. Airway pressures and gas flow were recorded with a respiratory function monitor. Video recording were used (i) to identify infants who were intubated in the delivery room and (ii) to observe colour change of the ETCO₂ detector. Flow sensor recordings were used to confirm whether the tube was in the trachea or not.

Results

Of the 210 infants recorded, 44 infants were intubated in the delivery room. Data from 77 intubation attempts were analysed. In 35 intubations of 20 infants both a PediCap^® and flow sensor were available for analysis. In 21 (60%) intubations, both methods correctly identified successful ETT placement and in 3 (9%) both indicated the ETT was not in the trachea. In the remaining 11 (31%) intubations the PediCap^® failed to change colour despite the flow wave indicating correct ETT placement.

Conclusion

Colorimetric CO₂ detectors may mislead clinicians intubating very preterm infants in the delivery room. They may fail to change colour in spite of correct tube placement in up to one third of the cases.     

An under-used yet easily understood statistic: the number needed to treat (NNT)

Objectives

Interpretation of the research literature can be difficult, yet it is essential in order for physiotherapists to convey the details of risks and benefits associated with therapeutic interventions to patients. The number needed to treat (NNT) statistic is one such statistic that is easily interpretable. Using several examples from the physiotherapy literature representing a range of conditions, this article demonstrates how to convert more commonly used statistics into the NNT statistic. The purpose of this is to show how the NNT can help clinicians to converse with patients to convey details about the likelihood of benefit with treatment and/or the likelihood of risk, in order that a decision may be made with respect to therapy.

Design

The Australian Physiotherapy Evidence Database (PEDro) was searched in order to locate a selection of physiotherapy research articles that reported various dichotomous outcomes that could be converted to the NNT statistic for the purpose of this analysis.

Results

The NNT statistic for nine studies with a PEDro score ≥6 was calculated using the Internet-based downloadable spreadsheet on the PEDro website. For six studies, the NNT point estimates ranged from 2 to 4 (95% confidence interval 1-10). One study had a NNT of 8, while two other studies produced number needed to harm values.

Conclusion

The NNT can be calculated quickly and efficiently using Internet-based calculators and/or other decision-making tools, and may be an alternative that provides readily interpretable information to assist in conveying the likely benefits (and/or risks) of treatment to patients.     

Motivating patients with shoulder and back pain to self-care: can a videotape of exercise support physiotherapy?

Objectives

The National Health Service is developing an ethos of self-care. Patients are being encouraged to become proficient in helping themselves. This has long been a philosophy of the physiotherapy profession, where self-care between consultations has been an integral part of the treatment process through encouraging the uptake of self-care skills training. This study explored how patients with shoulder and back pain perceived videotaped exercises and instructions to support their routine physiotherapy, and how the videotape was used.

Design

A videotape, developed by physiotherapists for patients with musculoskeletal problems, of exercises to view at home was given to patients by their physiotherapists to support their routine physiotherapy consultations. A qualitative methodology was used to examine how patients responded to being given a videotape of exercises and instructions between consultations. Data were collected through semi-structured interviews.

Setting

The study was based in 26 general practices that had access to practice-based physiotherapists in two primary care trusts in the north-west of England.

Participants

Thirty-three patients with shoulder and back pain who received a videotape of exercises and advice were interviewed.

Results

Three themes emerged from the data: finding space for exercise; remembering and doing exercises; and supporting the physiotherapy-patient relationship. Patients discussed aspects of motivation, and described how a videotape of exercises might support or inhibit the performance of exercises prescribed by physiotherapists. Patients identified a range of different ways in which they derived support from the videotape.

Conclusions

The videotape supported patients with a variety of different needs as it enhanced their ability to complete exercises correctly. Videotapes (or DVDs) are useful for patients and could be adopted as a tool to support treatment.     

Higher glucose on admission is associated with need for angioembolization in stable pelvic fracture

Background

Angioembolization is an effective adjunct to the management of retroperitoneal hemorrhage in pelvic fractures. Most patients with stable-type pelvic fracture are treated conservatively. However, in some stable pelvic fracture cases, patients should receive angioembolization for hemostasis upon incidental finding of contrast extravasation on computed tomography (CT). In this study, we attempted to define the characteristics of patients with stable pelvic fracture requiring angioembolization.

Methods

We retrospectively reviewed the charts of patients with pelvic fractures between January 2005 and November 2009. We focused on stable pelvic fracture patients with contrast extravasation on CT who then received angioembolization. The demographics, Injury Severity Score (ISS), Abbreviated Injury Scale score, and the blood glucose levels on admission were analyzed.

Results

In total, 334 patients were enrolled. Patients with higher blood glucose level on admission with stable pelvic fracture had a higher rate of angioembolization. Furthermore, these patients presented with a higher Abbreviated Injury Scale score and ISS.

Conclusions

In patients with stable pelvic fracture, higher blood glucose level on admission was associated with a higher likelihood of needing angioembolization. Blood glucose level should be checked during the initial survey of a pelvic fracture, and greater attention should be given to patients with higher blood glucose level or with an ISS of 25 or greater, even when the imaging study only reveals a stable pelvic fracture.     

A Comparison of Balance Performance: Computerized Dynamic Posturography and a Random Motion Platform

Broglio SP, Sosnoff JJ, Rosengren KS, McShane K. A comparison of balance performance: computerized dynamic posturography and a random motion platform.

Objective

To establish the clinical utility of the PROPRIO 5000 as a balance assessment device by establishing convergent validity with the NeuroCom sensory organization test (SOT).

Design

Cross-sectional.

Setting

Balance research laboratory.

Participants

Young adults (N=40; 21.1±1.4y).

Interventions

Not applicable.

Main Outcome Measures

Performance on each of the 6 NeuroCom SOT testing conditions and PROPRIO 5000 dynamic motion analysis score.

Results

Correlational analyses between output variables yielded significant relationships between the dynamic motion analysis score from the 0 to 10 second (r=−.38), 10 to 20 second (r=−.34), and 20 to 30 second (r=−.35) intervals and the SOT composite balance score.

Conclusions

The initial stages of the PROPRIO 5000 and the NeuroCom SOT battery may evaluate similar aspects of postural control. However, as the magnitude of PROPRIO perturbations increased, the relationship between the devices diverged and the complete PROPRIO assessment is not thought to pair with the SOT assessment. Differences between the 2 devices may be associated with varying degrees of test difficulty and the necessary postural control strategies involved in responding to continual balance perturbations (PROPRIO 5000) or to different sensory inputs (SOT).