The efficacy of an adapted Roland-Morris disability questionnaire in measuring functional status of Patients with low back pain

The purpose of this study was to determine whether an adapted Roland Morris Disability Questionnaire (ARMDQ) could be used to determine functional status in subjects with chronic mechanical low back pain, and thereby assist the surgeon in deciding on the appropriateness of spinal fusion surgery for individual patients. The study aimed to detem1ine whether the Roland-Morris Disability Questionnaire (RMDQ) improved its ability to measure function and different aspects of function through the addition of a 26-item scale (AddS). The study design was retrospective and descriptive. A convenience sample of 42 subjects who consulted one Orthopaedic surgeon working in a private practice in the South Peninsula Municipal area of Cape Town, South Africa, was drawn. All subjects were diagnosed with chronic mechanical low back pain and no other known pathology. Subjects consulted the surgeon between August 2000 and July 200 I. All subjects had completed the adapted RMDQ (ARMDQ). A series of analyses were performed in which the items in the AddS scale were compared with those of the RMDQ to assess the degree to which they enhanced the performance of the RMDQ. Although there was a high correlation between the two scales (R=. 72; P<.00), Cronbach's alpha showed the reliability of the RMDQ to be higher than the AddS and the ARMDQ. This finding was supported in a number of subsequent analyses. There was a low correlation between the rating for surgery and total RMDQ scores (r=.40; P<.01). Despite deficiencies in the RMDQ, it is recommended as the basis for comparison in future studies within a variety of South African contexts

Evidence-based practice in the occupational therapy profession in South Africa and the Western Cape

Includes bibliographical references (leaves 257-276).Research from upper-income countries has revealed the difficulties occupational therapists experience in implementing evidence-based practice (EBP). This thesis investigated the state of EBP in occupational therapy in South Africa and evaluated the effectiveness of two EBP educational interventions. The research consisted of three linked studies: a national cross-sectional survey of 436 registered occupational therapists; the development of a questionnaire and audit checklist to evaluate EBP knowledge, attitudes and behaviour; and a randomised controlled trial that tested whether an interactive educational intervention (IE) was more effective than a didactic one (DE) for improving EBP knowledge, attitudes and behaviour in occupational therapists

The Psychometric properties of the Roland Morris Disability Questionnaire for Patients with Chronic Mechanical Low Back Pain

Purpose: Functional status measures are currently not widely used in South Africa to facilitate clinical decision-making or document treatment outcomes for patients with low back pain (LBP). This study investigated the internal consistency and clinical utility of a back-specific functional status measure, the Roland Morris Disability Questionnaire (RMDQ), and determined its ability to confirm the need for spinal fusion surgery. Method: Aretrospective, descriptive design was used with 42 patients with chronic mechanical low back pain who consulted a private Orthopaedic surgeon in Cape Town over a one year period. All patients completed the RMDQ prior to their consultation. On completion of the medical examination, a rating for surgery was determined for each patient. The completed questionnaires were analysed using Statistical Package for the Social Sciences (SPSS). Results: The mean RMDQ score was 8.6 (N=42; median=9.0; range=2-21). Cronbach’s alpha showed a high internal consistency between items (.92). A categorical principal component analysis (CATPCA) identified two distinct dimensions in the RMDQ. Item reduction improved the internal consistency and thus the construct validity of the RMDQ. There was a low correlation between the surgeon’s rating for surgery and RMDQ scores (r=.40; P<.01). Conclusion: The RMDQ shows some good psychometric properties but some adjustments could improve it. The RMDQ cannot be used to predict the need for spinal fusion surgery

Measuring evidence-based practice knowledge and skills in occupational therapy - a brief instrument

Background: Valid and reliable instruments are required to measure the effect of educational interventions to improve evidence-based practice (EBP) knowledge and skills in occupational therapy. The aims of this paper are to: 1) describe amendments to the Adapted Fresno Test of Competence in EBP (AFT), and 2) report the psychometric properties of the modified instrument when used with South African occupational therapists. Methods: The clinical utility of the AFT was evaluated for use with South African occupational therapists and modifications made. The modified AFT was used in two studies to assess its reliability and validity. In Study 1 a convenience sample of 26 occupational therapists in private practice or government-funded health facilities in a South African province were recruited to complete the modified AFT on two occasions 1 week apart. Completed questionnaires were scored independently by two raters. Inter-rater, test-retest reliability and internal consistency were determined. Study 2 was a pragmatic randomised controlled trial involving occupational therapists in four Western Cape Department of Health district municipalities (n = 58). Therapists were randomised in matched pairs to one of two educational interventions (interactive or didactic), and completed the modified AFT at baseline and 12 weeks after the intervention. An intention-to-treat analysis was performed. Data were not normally distributed, thus non-parametric statistics were used. Results: In Study 1, 21 of 26 participants completed the questionnaire twice. Test-retest (ICC = 0.95, 95 % CI = 0.88–0.98) and inter-rater reliability (Time 1: ICC = 0.995, 95 % CI = 0.99–0.998; Time 2: ICC = 0.99, 95 % CI = 0.97–0.995) were excellent for total scores. Internal consistency based on time 1 scores was satisfactory (α = 0.70). In Study 2, 28 participants received an interactive educational intervention and completed the modified AFT at baseline and 12 weeks later. Median total SAFT scores increased significantly from baseline to 12-weeks (Z = −4.078, p < 0.001) with a moderate effect size (r = 0.55). Conclusion: The modified AFT has demonstrated validity for detecting differences in EBP knowledge between two groups. It also has excellent test-retest and inter-rater reliability. The instrument is recommended for contexts where EBP is an emerging approach and time is at a premium

Editorial: How is Quality Addressed Within Practice-Based Learning?

In 2011, the World Health Organization (2011) proposed a three-pillar radical plan of educational reforms addressing the quality, quantity, and relevance of health professionals to address global health challenges and improve health outcomes. Seven years on, it seems pertinent to consider how educators are addressing the three pillars outlined in this bold plan in the context of practice-based learning. The increasing pressure on higher educational institutions to produce graduates who are adequately equipped for the workforce (Cooper, Orrell, and Bowden 2010) validates the critical contribution of practice-based learning in preparing health professionals for the future. Practice-based learning provides an ideal forum for educating health professionals who are not only “technically competent and efficient” but are also “able to work in teams, to adapt to a changing practice environment and to initiate change where needed” (World Health Organization 2011: 7). But, how is quality addressed within practice-based learning

Doing Things Differently: The Outcomes of Teachers Researching Their Own Practice in Teaching Writing

In this study we investigated whether teachers’ pedagogical and content knowledge of writing would increase as an outcome of teachers taking a research lens to their practice to raise students’ writing achievement. Using student achievement data as a baseline, teachers examined and refined their practice using an inquiry process. The study took place over a two‐year period and involved over 20 teachers from six low socio‐economic urban primary schools in Auckland, New Zealand. Literacy leaders in the schools and four university researchers also took part in the inquiry project. Data collected from teachers’ records, researchers’ field notes, and transcripts from focus groups of teachers and literacy leaders indicated enhanced pedagogical and content knowledge of writing, as well as marked gains for students on a standardized test of writing. This study contributes to research demonstrating that, through researchingtheir own practice and teaching targeted to students’ strengths and needs, achievement in writing can be raised