Factors shaping e‐feedback utilization following electronic Objective Structured Clinical Examinations

The development of student‐practitioners' practical clinical skills is essential in health professional education. Objective Structured Clinical Examinations are central to the assessment of students performing clinical procedures on simulated patients (actors). While feedback is considered core to learning providing timely, individualised student OSCE feedback is difficult. This study explored the perceptions of students about the multiple factors which shape the utility of e‐feedback following an electronic Objective Structured Clinical Examinations, which utilized iPad and specialised software. The e‐feedback was trialled in four courses within occupational therapy and physiotherapy pre‐professional programs with a cohort of 204 students. Evaluation of student perceptions about feedback was collected using two surveys and eight focus groups. This data showed three factors shaped perceptions of the utility of e‐ Objective Structured Clinical Examinations feedback: 1) timely accessibility within one day of the assessment, 2) feedback demonstrating examiners' academic literacy and 3) feedback orientated to ways of improving future performance of clinical skills. The study found training in the provision of feedback using IPads and software is needed for examiners to ensure e‐feedback meets students' needs for specific, future‐oriented e‐feedback and institutional requirements for justification of grades.     

Differential Diagnosis and Management of Spinal Nerve Root-related Pain

Abstract: Pain originating from spinal nerve roots demonstrates multiple pathogeneses. Distinctions in the patho‐anatomy, biomechanics, and pathophysiology of spinal nerve roots contribute to pathology, diagnosis, and management of root‐related pain. Root‐related pain can emerge from the tension events in the dura mater and nerve tissue associated with primary disc related disorders. Conversely, secondary disc‐related degeneration can produce compression on the nerve roots. This compression can result in chemical and mechanical consequences imposed on the nervous tissue within the spinal canal, lateral recess, intervertebral foramina, and extraforminal regions. Differences in root‐related pathology can be observed between lumbar, thoracic, and cervical spinal levels, meriting the implementation of different diagnostic tools and management strategies.     

Exercises for Spine Stabilization: Motion/Motor Patterns, Stability Progressions, and Clinical Technique

McGill SM, Karpowicz A. Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique.

Objective

To quantify several forms of the curl-up, side-bridge, and birddog exercises (muscle activity and 3-dimensional [3D] spine position) including some corrective techniques to assist clinical decision-making.

Design

A basic science study of a convenience sample with a retest of expert intervention.

Setting

Spine Biomechanics Laboratory/Research Clinic.

Participants

Healthy men (N=8) performed the exercises, and 5 subjects repeated the exercises as an expert applied corrective techniques.

Interventions

Not applicable.

Main Outcome Measures

Surface electromyography of selected trunk and hip muscles together with video analysis and 3D spine posture were collected.

Results

Comparison of muscle activation levels showed there were justifiable progressions in each exercise form. In general, bracing of the abdominal wall enhanced activation of the obliques, but different techniques caused migration of muscle activity to other muscles. Examples of specific findings include the following. Movement during these traditionally isometric exercises such as drawing squares with the hand/foot while in the birddog posture enhances activation of many muscle groups. Breathing while holding the isometric exercises had differing effects on muscle activation which was exercise dependent. Some corrective exercise techniques, such as fascial raking, substantially changed relative activation between muscles in the abdominal wall.

Conclusions

The data presented in this study may be used to guide the clinical decision process when choosing a specific exercise form together with selecting the correct starting level, a logical progression, suitable dosage, and possible corrective technique to enhance tolerance of a patient.     

Factors Influencing Decisions to Admit Patients to Veterans Affairs Specialized Rehabilitation Units After Lower-Extremity Amputation

Bates BE, Kwong PL, Kurichi JE, Bidelspach DE, Reker DM, Maislin G, Xie D, Stineman M. Factors influencing decisions to admit patients to Veterans Affairs specialized rehabilitation units after lower-extremity amputation.

Objective

To understand patient- and facility-level characteristics that influence decisions to admit veterans to a specialized rehabilitation unit (SRU) after a lower-extremity amputation.

Design

Database study.

Setting

All Veterans Affairs Medical Centers (VAMCs).

Participants

Veterans with lower-extremity amputation discharged from VAMCs between October 1, 2002, and September 30, 2004.

Interventions

Not applicable.

Main Outcome Measure

Admission to an SRU.

Results

There were a total of 2922 veterans with lower-extremity amputations; 616 patients were admitted to an SRU, whereas 2306 received consultative rehabilitation services only. Patients admitted to an SRU waited longer to have their first rehabilitation assessment after surgery and had middle-range physical and cognitive disabilities. Patients who received consultative rehabilitation services only tended to have greater illness burden. They were more likely to have previous amputation complication, paralysis, or renal failure and either very severe or minimal physical and cognitive disabilities.

Conclusions

The selection of veterans with new lower-extremity amputations for admission to an SRU appears clinically reasonable and based on the likelihood of successful outcomes.     

A classification system for hip disease in cerebral palsy

In population-based studies, hip displacement affects approximately one-third of children with cerebral palsy (CP). Given the extreme range of clinical phenotypes in the CP spectrum, it is unsurprising that hip development varies from normality, to dislocation and degenerative arthritis. Numerous radiological indices are available to measure hip displacement in children with CP; however, there is no grading system for assessing hip status in broad categorical terms. This makes it difficult to audit the incidence of hip displacement, determine the relationship between hip displacement and CP subtypes, assess the outcome of intervention studies, and to communicate hip status between health care professionals. We developed a categorical, radiographic classification of hip morphology based on qualitative indices and measurement of the key continuous variable, the migration percentage of Reimers. One hundred and thirty-four radiographs were reviewed of 52 female and 82 male adolescents with CP who were at, or close to, skeletal maturity (mean age 16y 1mo [SD 1y 4mo] range 14y to 19y 1mo). Twenty-nine were classified at Gross Motor Function Classification System level I, 25 at level II, 27 at level III, 24 at level IV, and 29 at level V. A classification system was developed to encapsulate the full spectrum of hip morphology in CP, with and without intervention.     

A Novel Two‐Stage Surgical Approach to Treat Chronic Lymphedema

Surgical treatment of chronic lymphedema has seen significant advances. Suction‐assisted protein lipectomy (SAPL) has been shown to safely and effectively reduce the solid component of swelling in chronic lymphedema. However, these patients must continuously use compression garments to control and prevent recurrence. Microsurgery procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), have been shown to be effective in the management of the fluid component of lymphedema and allow for decreased garment use. SAPL and VLNT were applied together in a two‐stage approach in two patients with chronic lymphedema after treatment for breast cancer. SAPL was used first to remove the chronic, solid component of the soft‐tissue excess. Volume excess in our patients' arms was reduced an average of approximately 83% and 110% after SAPL surgery. After the arms had sufficiently healed and the volume reductions had stabilized, VLNT was performed to reduce the need for continuous compression and reduce fluid re‐accumulation. Following the VLNT procedures, the patients were able to remove their compression garments consistently during the day and still maintain their volume reductions. Neither patient had any postoperative episodes of cellulitis. SAPL and VLNT can be combined to achieve optimal outcomes in patients with chronic lymphedema.