Therapist Perception Of The Clarity And Implementability Of Relevant Recommendations From American Academy Of Orthopedic Surgeon’s Distal Radius Fracture Clinical Practice Guidelines

Fractures of the distal radius are common and can cause substantial either transient or permanent impairment and disability. Clinical practice guidelines (CPGs) are systematically developed statements or recommendations based on the best available evidence and aimed at assisting health care practitioners in clinical decision-making. Many professional organizations have developed practice guidelines for common clinical conditions. The overall objective of this thesis is to evaluate the therapist\u27s perception of the clarity and implementability of rehabilitation relevant recommendations from The American Academy of Orthopaedic Surgeons (AAOS) CPG for distal radius fractures (DRF) and to identify the quality of CPG related to DRF. To address my study objective, first, I categorized the AAOS DRF CPG using the International Classification of Functioning Disability and Health (ICF) and International Classification of Diseases ICD-10 using linking procedures and compare the content codes of the CPG with the ICF hand core sets as the reference standard. Then I conducted a cognitive interview study to understand the therapist\u27s perceptions of the clarity and implementability of the recommendations. To further understand the implementability of the AAOS DRF CPG, I conducted a cross-sectional survey on the implementability of the AAOS DRF guidelines using the guideline implementability appraisal tool (GLIA). And we conducted a systematic literature review to identify and appraise CPGs relevant to the management of DRF s using the AGREE II tool. The results of the thesis indicate that the AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the CF constructs (activity or participation) and the ICF Hand Core Set. In my qualitative study, I found that eight of ten recommendations sampled from the AAOS DRF CPG were considered vague and unimplementable by therapists in their clinical practice, due to the lack of clarity and information on what to implement, how to implement, and to measure the adherence and outcomes of the recommendation. In the systematic review I found that for the selected CPGs developed by professional organizations in the UK, Canada, USA, Denmark, and Norway, the AGREE score for the scope and purpose domain ranged from 61% to 94% and the stakeholder involvement domain ranged from 13% to 97%. The rigor of the development domain score ranged from 38% to 95%. and for the clarity of the presentation domain score ranged from 63% to 83%. Scores were lowest on the domain of applicability and ranged from 18% to 60% and the score for the editorial independence domain ranged from 54% to 79% This work implicates that CPG that focus on rehabilitation after DRF are needed and improving the implementability of the CPG recommendations by making them more specific and actionable while providing resources would assist with the implementation. Therapists need to be aware and understand variability existing in quality, the rigor of development, and the applicability of these guidelines. The future guideline should consider implementation during development including ready access to the details about the level recommended in intervention reporting guidelines

Measuring health-related quality of life (HRQOL) in HIV-positive individuals— Content analyses of measures based on the international classification of functioning, disability, and health (ICF) and generic and disability core set

© 2015 by Begell House, Inc. Purpose: The purpose of the study is to conduct a content analysis of the items of the Medical Outcome Study-HIV (MOS-HIV), the Multidimentional Quality of Life-HIV (MQOL-HIV), and the HIV Disability Questionnaire (HDQ) by linking these to the ICF and its generic and disability core set. Methods: Four raters individually linked 145 items from the measures based on standardized linking rules. Interrater agreement was determined. For items where there was no agreement among raters, the opinion of a fifth rater, an expert in applying the ICF, was obtained. Results: The items were linked to 74 ICF categories across the three measures. Final interrater agreement was 83.3%. The content of all three measures was highly linkable with ICF. The HDQ had the best representation among the three measures. The HDQ had 27 items linked with the generic and disability core set; of these 16 items were linked with disability codes. Discussion: The HDQ provides a more precise description of the disablement experienced by people living with HIV by addressing the body function, activities, participation, and environmental factors specific to people living with HIV. The HDQ is thus recommended for those who are interested in measuring HIV-specific disabilities more precisely

Rasch analysis of the patient-rated wrist evaluation questionnaire

Abstract Background The Patient-Rated Wrist Evaluation (PRWE) was developed as a wrist joint specific measure of pain and disability and evidence of sound validity has been accumulated through classical psychometric methods. Rasch analysis (RA) has been endorsed as a newer method for analyzing the clinical measurement properties of self-report outcome measures. The purpose of this study was to evaluate the PRWE using Rasch modeling. Methods We employed the Rasch model to assess overall fit, response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality and person separation index (PSI). A convenience sample of 382 patients with distal radius fracture was recruited from the hand and upper limb clinic at large academic healthcare organization, London, Ontario, Canada, 6-month post-injury scores of the PRWE was used. RA was conducted on the 3 subscales (pain, specific activities, and usual activities) of the PRWE separately. Results The pain subscale adequately fit the Rasch model when item 4 “Pain - When it is at its worst” was deleted to eliminate non-uniform DIF by age group, and item 5 “How often do you have pain” was rescored by collapsing into 8 intervals to eliminate disordered thresholds. Uniform DIF for “Use my affected hand to push up from the chair” (by work status) and “Use bathroom tissue with my affected hand” (by injured hand) was addressed by splitting the items for analysis. After background rescoring of 2 items in pain subscale, 2 items in specific activities and 3 items in usual activities, all three subscales of the PRWE were well targeted and had high reliability (PSI = 0.86). These changes provided a unidimensional, interval-level scaled measure. Conclusion Like a previous analysis of the Patient-Rated Wrist and Hand Evaluation, this study found the PRWE could be fit to the Rasch model with rescoring of multiple items. However, the modifications required to achieve fit were not the same across studies, our fit statistics also suggested one of the pain items should be deleted. This study adds to the pool of evidence supporting the PRWE, but cannot confidently provide a Rasch-based scoring algorithm

Linking of the American academy of orthopaedic surgeons distal radius fracture clinical practice guidelines to the international classification of functioning, disability, and health; international classification of diseases; and ICF core sets for hand conditions

© American Association for Hand Surgery 2016. Background: American Academy of Orthopaedic Surgeons (AAOS) distal radius fracture (DRF) clinical practice guidelines (CPG) are readily available to clinicians, patients, and policymakers. International Classification of Functioning, Disability, and Health (ICF) provides a framework for describing the impact of health conditions. The International Classification of Diseases-10th Revision (ICD-10) is a classification system to classify health conditions as specific disease or disorders. The aim of this study is to analyze and describe the scope and focus of the AAOS DRF CPG using the ICF and ICD-10 as a basis for content analysis, and to compare the content of the CPG with the ICF hand core sets as the reference standard. Methods: Established linking rules were used by 2 independent raters to analyze the 29 recommendations of the AAOS DRF CPG. ICD-10 codes were assigned in the same process. Summary linkage statistics were used to describe the results for ICF and the hand core sets. Results: Among the 29 recommendations of the AAOS DRF CPG, 5 meaningful concepts were linked to the ICF codes. Of these, 5 codes appeared on the comprehensive ICF core set and only 3 codes appeared in the brief ICF core set, and 7 conditions were covered in ICD-10 codes. Conclusions: The AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the ICD-10 and ICF. It does not address activity or participation (disability), and is not well linked to key concepts relevant to hand conditions

Calorimetric Study on EuCoGe 3 and EuRh 2 In 8 under Pressure

International audienc

Calorimetric Study on EuCoGe 3 and EuRh 2 In 8 under Pressure

International audienc

Additional file 1: of Rasch analysis of the patient-rated wrist evaluation questionnaire

Patient Rated Wrist Evaluation. (DOCX 18 kb