Developing questionnaires for educational research: AMEE Guide No. 87

In this AMEE Guide, we consider the design and development of self-administered surveys, commonly called questionnaires. Questionnaires are widely employed in medical education research. Unfortunately, the processes used to develop such questionnaires vary in quality and lack consistent, rigorous standards. Consequently, the quality of the questionnaires used in medical education research is highly variable. To address this problem, this AMEE Guide presents a systematic, seven-step process for designing high-quality questionnaires, with particular emphasis on developing survey scales. These seven steps do not address all aspects of survey design, nor do they represent the only way to develop a high-quality questionnaire. Instead, these steps synthesize multiple survey design techniques and organize them into a cohesive process for questionnaire developers of all levels. Addressing each of these steps systematically will improve the probabilities that survey designers will accurately measure what they intend to measure

Lumbopelvic Stability During a Single Leg Step Down Predicts Elbow Varus Torque During Baseball Pitching

During a baseball pitch, energy is transferred from the lower extremities through the lumbopelvic junction to produce ball velocity. Reduced lumbopelvic stability has been associated with elbow injury in pitchers, and commonly ulnar collateral ligament (UCL) tears. The primary biomechanical mechanism of UCL tears is high elbow varus torque. Understanding how decreased lumbopelvic stability influences the development of elbow varus torque could identify risk factors of UCL elbow injury. PURPOSE: Characterize the predictive ability of lumbopelvic stability on elbow varus torque during a baseball pitch. METHODS: NCAA Division 1 baseball players (N=44; 19.6+1.3yrs) participated. Pitchers threw ten fastballs from a mound to a catcher over regulation distance. Elbow varus torque was recorded using an inertial measurement unit and ball velocity was recorded with a radar gun. Pitchers also completed a single leg step down (SLSD) task. Triplanar kinematics were recorded for both legs, pelvis and trunk using inertial measurement units. Statistical analysis consisted of a cluster analysis, principal component analysis (PCA), and a multivariate logistic regression model to determine the relationship between lumbopelvic stability and elbow varus torque. RESULTS: Cluster analysis revealed 2 subgroups of pitchers: Low Torque-High Velocity and High Torque-Low Velocity. PCA analysis indicated 4 patterns of SLSD motion variability (principal components): 1-sagittal plane, 2-transverse plane, 3-frontal plane trail limb, and 4-frontal plane lead limb. Increased transverse plane motion of the trunk and pelvis predicted higher odds of belonging to the High Torque-Low Velocity cluster; trunk [Odds Ratio=2.9 (95%CI:1.1,8.0), p=0.036] and pelvis [Odds Ratio=2.6 (95%CI:1.1,6.0), p=0.031]. CONCLUSIONS: Lumbopelvic motion assessed during the SLSD in pitchers can identify deficits that predict high elbow varus torque and low ball velocity during the baseball pitch. Specifically, higher pelvis and trunk transverse plane motion was associated with pitchers in the High Torque-Low Velocity cluster. The SLSD provides an easily accessible method for coaches and clinicians to identify a potential risk factor related to increased elbow varus torque and UCL injury in pitchers

New approaches to selection system design in healthcare: The practical and theoretical relevance of a modular approach

This chapter presents a modular approach to healthcare selection system design. Contrary to the traditional holistic view on selection procedures, a modular approach highlights the components underlying selection procedures. Our framework identifies seven key design components of selection procedures (The stimulus format, contextualization, stimulus presentation consistency, the response format, response evaluation consistency, information source, and instructions) and reviews studies in the healthcare selection literature that compared the effect of these components on key selection outcomes. A modular approach allows (1) gaining insights into how the different components underlying selection procedures affect selection outcomes and (2) drawing conceptual similarities between components of different selection procedures. At a practical level, a modular approach permits developing a myriad of new selection procedures by "mixing and matching" different building blocks. We present two case studies and future research avenues to further illustrate these merits of a modular approach

Epidemiology of psychiatric disorders sustained by a U.S. Army brigade combat team during the Iraq War

The article of record as published may be found at http://dx.doi.org/10.1016/j.genhosppsych.2010.10.007This study was designed to describe the epidemiology of psychiatric illnesses experienced by soldiers in a combat environment, which has been previously underreported.Approved for public release; distribution is unlimited