Calculating the random guess scores of multiple-response and matching test items

For achievement tests, the guess score is often used as a baseline for the lowest possible grade for score to grade transformations and setting the cut scores. For test item types such as multiple-response, matching and drag-and-drop, determin-ing the guess score requires more elaborate calculations than the more straight-forward calculation of the guess score for True-False and multiple-choice test item formats. For various variants of multiple-response and matching types with respect to dichotomous and polytomous scoring, methods for determining the guess score are presented and illustrated with practical applications. The implica-tions for theory and practice are discussed

Providing patients with direct access to musculoskeletal physiotherapy: the impact on general practice musculoskeletal workload and resource use. The STEMS-2 study.

OBJECTIVES: This study examined the real-world impact of patient direct access to NHS physiotherapy (self-referral) on (a) general practice consultations for musculoskeletal (MSK) conditions and (b) specified clinical management for patients with MSK conditions. DESIGN AND SETTING: Natural experiment in four general practices and the associated physiotherapy service. METHODS: Anonymised routinely collected data were obtained. MSK coded GP consultations, recorded fit notes, MSK-related prescription medication, X-rays and MRI requests, and referrals to secondary care for patients consulting with MSK conditions were identified and trends described across a 6-year period (June 2011 to June 2017). Joinpoint regression analysis was used to identify any significant changes in GP MSK consultation trends before and after the introduction of self-referral to physiotherapy. Physiotherapy service data examined access methods used by patients (GP referred, GP recommended self-referral, true self-referral) and the number of physiotherapy sessions. RESULTS: Direct access resulted in inconsistent impact on general practices. In one arm of the experiment a significant increase in GP consultations was observed and in one arm was stable. Exploratory examination of clinical management showed only requests for X-rays (arm 1) and possibly requests for MRI (arm 2) changed over time. Physiotherapy service referrals showed a low uptake of true self-referral (10% and 6%) in each arm respectively. CONCLUSION: This is the first study to examine the real-world impact of patient direct access to physiotherapy at general practice level. We found no consistent impact of patient direct access on GP MSK workload. Impact on some clinical management was observed but not consistently in the direction suggested by previous studies

Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up

Low back pain (LBP) is a major health challenge globally. Research has identified common trajectories of pain over time. We aimed to investigate whether trajectories described in one primary care cohort can be confirmed in another, and to determine the prognostic value of factors collected 5 years prior to the identification of the trajectory. The study was carried out on 281 patients who had consulted primary care for LBP, at that point completed a baseline questionnaire, and then returned a questionnaire at 5-years follow-up plus at least 3 (of 6) subsequent monthly questionnaires. Baseline factors were measured using validated tools. Pain intensity scores from the 5-year follow-up and monthly questionnaires were used to assign participants into 4 previously derived pain trajectories (no or occasional mild, persistent mild, fluctuating, persistent severe), using latent class analysis. Posterior probabilities of belonging to each cluster were estimated for each participant. The posterior probabilities for the assigned clusters were very high (>0.90) for each cluster except for the smallest 'fluctuating' cluster (0.74). Lower social class and higher pain intensity were significantly associated with a more severe trajectory 5-years later, as were patients' perceptions of the greater consequences and longer duration of pain, and greater passive behavioural coping. LBP trajectories identified previously appear generalizable. These allow better understanding of the long-term course of LBP and effective management tailored to individual trajectories needs to be identified