The assessment of procedural skills in physiotherapy education: A measurement study using the Rasch model

Gillian Baer - ORCID 0000-0002-1528-2851 https://orcid.org/0000-0002-1528-2851Replaced AM with VoR 2020-05-26Background: Procedural skills are a key element in the training of future physiotherapists. Procedural skills relate to the acquisition of appropriate motor skills, which allow the safe application of clinical procedures to patients. In order to evaluate procedural skills in physiotherapy education validated assessment instruments are required. Recently the assessment of procedural skills in physiotherapy education (APSPT) tool was developed. The overall aim of this study was to establish the structural validity of the APSPT. In order to do this the following objectives were examined: i) the fit of the items of APSPT to the Rasch-model, ii) the fit of the overall score to the Rasch model, iii) the difficulty of each test item and iv) whether the difficulty levels of the individual test items cover the whole capacity spectrum of students in pre-registration physiotherapy education.Methods: For this observational cross-sectional measurement properties study a convenience sample of 69 undergraduate pre-registration physiotherapy students of the HES-SO Valais-Wallis was recruited. Participants were instructed to perform a task procedure on a simulated patient. The performance was evaluated with the APSPT. A conditional maximum likelihood approach was used to estimate the parameters of a partial credit model for polytomous item responses. Item fit, ordering of thresholds, targeting and goodness of fit to the Rasch model was assessed.Results: Item fit statistics showed that 25 items of the APSPT showed adequate fit to the Rasch model. Disordering of item thresholds did not occur and the targeting of the APSPT was adequate to measure the abilities of the included participants. Undimensionality and subgroup homogeneity were confirmed.Conclusion: This study presented evidence for the structural validity of the APSPT. Undimensionality of the APSPT was confirmed and therefore presents evidence that the latent dimension of procedural skills in physiotherapy education consists of several subcategories. However, the results should be interpreted with caution given the small sample size.https://doi.org/10.1186/s40945-020-00080-010pubpu

Geometric Optimisation of Hinge-less Deployment System for an Active Rotorblade

The Green Rotorcraft project (part of Clean Sky JTI) is\ud studying the Gurney flap as a demonstrator of a smart adaptive\ud rotorblade. Deployment systems for the Gurney flap need to\ud sustain large centrifugal loads and vibrations while maintaining\ud precisely the displacement under aerodynamic loading. Designing\ud such a mechanism relies on both the actuation technology\ud and the link which transmits motion to the control surface. Flexible\ud beams and piezoelectric patch actuators have been chosen as\ud components to design this mechanism. Flexible beams are providing\ud an hinge-less robust structure onto which the piezoelectric\ud actuators are bonded. A candidate topology is determined\ud by investigating the compliance of a simple wire structure with\ud beam elements. A parametrized finite element model is then built\ud and optimized for displacement and force through surrogate optimization.\ud The whole process does not requires many finite element\ud analyses and quickly converge to an optimized mechanism

Le renforcement musculaire chez les patients hémiplégiques post accident vasculaire cérébral, une méta-analyse

Introduction : La faiblesse musculaire est un des principaux symptômes apparaissant à la suite d’un accident vasculaire cérébral et peut conduire à une réduction de l’activité physique. Une atteinte de la performance de marche peut alors être observée, se traduisant par une asymétrie et une diminution de la vitesse ainsi qu’une augmentation du coût énergétique. Objectif : L’objectif de notre travail de Bachelor est de définir dans quelle mesure le renforcement musculaire chez les patients hémiplégiques chroniques suite à un AVC, améliore la force, la marche et l’équilibre. Méthode : Nous avons effectué nos recherches d’articles sur cinq bases de données, soit Pubmed, Cinhal, Cochrane, Web of science et Embase, et avons trié les études randomisées contrôlées trouvées, avant d’évaluer leurs risques de biais. Les résultats de dix études ont été extraits afin de réaliser une revue systématique de la littérature et une méta-analyse.Hintergrund: Muskelschwäche ist eines der häufigsten Symptome nach Schlaganfall, und kann zu einer Abnahme von körperlicher Aktivität führen. Die Gehfähigkeit kann durch Asymmetrie, verringerte Geschwindigkeit und höhere Energiekosten verschlechtert sein. Ziel: Das Ziel unserer Bachelorarbeit ist es, zu definieren inwiefern Muskelkrafttraining beim chronischen hemiplegischen Patienten nach Schlaganfall hilft, Kraft, Gehen und Gleichgewicht bei funktionellen Aktivitäten zu verbessern. Methode: Die fünf Datenbanken Pubmed, Cinhal, Cochrane, Web of Science und Embase wurden nach Artikeln durchsucht. Daraufhin haben wir die Kontrollierten Randomisierten Studien ausgewählt und deren Risk of Bias bewertet. Die Ergebnisse von zehn Studien wurden extrahiert, um eine systematische Literaturrecherche und Meta-Analyse durchzuführen

Slackline: création d'un programme d'entraînement progressif de l'équilibre

La slackline commence à faire son apparition dans le milieu thérapeutique. Cette discipline exige des capacités précises qui allient concentration et équilibre. C’est ce dernier terme que nous cherchons à développer ici. Les études sont encore très restreintes et aucun programme d’entraînement n’a été validé.Slacklinen, das als eigenständiger Sport angesehen werden kann, wird immer öfter als Therapie eingesetzt. Diese Disziplin benötigt präzise Fähigkeiten wie Konzentration und Gleichgewicht. In dieser Arbeit werden wir den Aspekt des Gleichgewichts bearbeiten. Es gibt nur wenige Studien zum Thema Gleichgewicht, Slackline und Therapie und kein Trainingsprogramm wurde validiert

Création d’un programme de réhabilitation à la marche avec utilisation de la double-tâche en neurologie: une scoping review et une validation d’experts

Les troubles neurologiques touchent à ce jour des millions de personnes dans le monde et ont pour conséquences diverses atteintes motrices et/ou cognitives : la marche est une des activités fréquemment affectée. Aucune étude n’a encore été réalisée sur la rééducation de la marche à l’aide de la double-tâche pour l’ensemble des maladies neurologiques. Notre travail comporte deux objectifs : 1) analyser les effets d’un entraînement basé sur la double-tâche pour rééduquer la marche chez des patients ayant des pathologies neurologiques variées, 2) créer un programme progressif et adapté en prenant les exercices des études sélectionnées

Use of Rasch analysis to investigate structural validity of a set of movement control tests for the neck

In pressBackground: Movement control abilities are often reduced in persons with neck pain. In physiotherapeutic practice observational tests are frequently used to assess the impaired abilities. Several tests for movement control abilities are available, but no evidence exists on how to combine and interpret them. Objective: The aim was to investigate structural validity of a set of movement control tests with Rasch analysis. Design: Cross-sectional study Methods: Thirty persons with and thirty without neck pain were recruited for this study. All persons performed ten movement control tests. A partial credit model was applied to investigate item fit, ordering of the item response functions, dimensionality and hierarchy of the tests. Results: The majority of persons with neck pain had moderate disabilities and the mean value in the Neck disability index was 10.7. Functioning of the movement control tests to measure the construct “movement control abilities” was adequate for the majority of tests. Three movement control test showed considerable misfit. Possible explanations were a reactive movement control instead of an active control and a more challenging test position. Test difficulties and person abilities could be estimated for the complete sample. The most difficult test was “sitting rocking forward” (1.13 logits) and the least difficult test was “lifting the right arm” (-1.30 logits). The highest person ability estimate was 3.61 logits indicating that movement control tests are missing to evaluate persons with moderate neck disabilities. Conclusion: Modifying the existing set of tests is required to evaluate the complete spectrum of persons with neck pain

Is power training or conventional resistance training better for function in elderly persons? A meta-analysis

Objective: to determine the effects of power training with high movement velocity compared with conventional resistance training with low movement velocity for older community-dwelling people. Design: systematic review of randomised controlled trials. Data sources: the Cochrane Central Register of Controlled Trials, PubMed (Medline), EMBASE, CINAHL, PEDro and Scholar-Google. Trials: all randomised or quasi-randomised trials investigating power training with high movement velocity versus conventional resistance training with low movement velocity in elderly persons over the age of 60 years. The primary outcomes were measures of functional outcomes; secondary outcomes were balance, gait, strength, power, muscle volume and adverse effects. Results: eleven trials were identified involving 377 subjects. The pooled effect size for the follow-up values of the functional outcomes was 0.32 in favour of the power training (95% CI 0.06 to 0.57) and 0.38 (95% CI −0.51 to 1.28) for the change value. The pooled effect from three studies for self-reported function was 0.16 in favour of power training (95% CI −0.17 to 0.49). Conclusion: power training is feasible for elderly persons and has a small advantage over strength training for functional outcomes. No firm conclusion can be made for safet

Predictive value of the Acute Low Back Pain Screening Questionnaire and the Örebro Musculoskeletal Pain Screening Questionnaire for persisting problems

Introduction: A small proportion of individuals with non-specific low back pain (NSLBP) develop persistent problems. Up to 80% of the total costs for NSLBP are owing to chronic NSLBP. Psychosocial factors have been described to be important in the transition from acute to chronic NSLBP. Guidelines recommend the use of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) and the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) to identify individuals at risk of developing persistent problems, such as long-term absence of work, persistent restriction in function or persistent pain. These instruments can be used with a cutoff value, where patients with values above the threshold are further assessed with a more comprehensive examination. Methods: We systematically reviewed studies evaluating the accuracy of the ALBPSQ and ÖMPSQ to predict persistent problems. Results: The 13 included studies used different cutoff values for the screening questionnaires ranging from 68 to 147. The pooled sensitivity was 0.59 (0.43-0.74), while the pooled specificity was 0.77 (0.66-0.86). Heterogeneity (I 2) was 90.02% for sensitivity and 95.41% for specificity. Conclusion: Thus, we do not recommend the use of one cutoff value, but the use of a prediction model with all the individual item

Acquisition of procedural skills in pre-registration physiotherapy education comparing mental practice against no mental practice: The Learning of Procedures in Physiotherapy Education Trial - a development of concept study

Kavi Jagadamma - ORCID 0000-0003-2011-0744 https://orcid.org/0000-0003-2011-0744Gillian Baer - ORCID 0000-0002-1528-2851 https://orcid.org/0000-0002-1528-2851Introduction: Procedural skills are a central element in the education of physiotherapists. Procedural skills relate to the execution of a practical task. An educational intervention, which can be used to support skill acquisition of procedural skills, is mental practice (MP). Several studies have investigated the use of MP or imaging in medical education. This pilot study evaluated the application of MP on the acquisition of procedural skills in physiotherapy education.Methods: This pilot randomised controlled study recruited a convenience sample of 37 BSc physiotherapy student participants. Two different complex task procedures (transfer and vestibular rehabilitation) were trained during this study. Participants in both the transfer (task procedure 1) and the vestibular rehabilitation (task procedure 2) arm of the study were randomly assigned to either MP or no MP.Results: For the transfer task, median performance at post-acquisition testing showed a moderate effect size in favour of the group using MP (r: −0.3), but the findings were not statistically significant (P: 0.2). Similar results were found for the vestibular rehabilitation task (r: 0.29; P: 0.21). In addition, the self-reported confidence was higher in the MP group.Conclusion: Moderate effect sizes were identified in favour of MP at post-acquisition testing. In addition, the between-group difference was higher than the minimally important difference. The feasibility of the study was high based on quantitative feasibility measures such as the recruitment rate. Both these findings suggest larger well-powered studies should be considered to confirm the findings of this pilot study.https://doi.org/10.1177/23821205209273827pubpu

ACQUISITION OF COMPLEX THERAPEUTIC PROCEDURES IN PRE-REGISTRATION PHYSIOTHERAPY EDUCATION USING MOTOR LEARNING PRINCIPLES

This thesis focuses on the acquisition of complex procedures in physiotherapy education using two motor learning principles and reports on five separate key studies: Chapter II: A study about the definition of procedural skills in physiotherapy education using a systematic review design and a text mining approach. Chapter III: A systematic review about the effectiveness of different attentional foci on the acquisition of complex motor skills. Chapter IV: A critical analysis of mental practice interventions in health professions education: A condensed review. Chapter V: The development and validation of a mental practice script for a transfer procedure for people with hemiparesis after stroke. Chapter VI: A randomised controlled trial evaluating the effectiveness and feasibility of two motor learning principles on the acquisition of complex procedures in physiotherapy education Chapter II: Randomised controlled trials and systematic review reporting about procedural skills were systematically searched. A qualitative analysis identified several relevant sub-concepts of procedural skills such as “execution of a motor task” or “decision-making”. A quantitative analysis was performed to identify term occurrences and to create a network of associations between the used terms. Based on both analyses a novel definition of “procedural skills in physiotherapy education” was proposed and operationalised. Chapter III: Studies comparing the effectiveness of an external focus of attention versus an internal focus of attention on the acquisition of complex motor skills were systematically searched in Medline, Embase, ERIC and SPORTDiscus. Findings of a meta-analysis were in favour of external focus of attention (SMD: -0.54; 95% CI between -0.86 and -0.22). Meta-regression identified “task complexity” as potential relevant predictor variable. Chapter IV: This study analysed how mental practice interventions designed for health professions were defined, structured and adhered to proposed best practice variables of mental practice. Chapter V: A mental practice script for a transfer procedure for people with hemiparesis was developed and validated in this study. Experienced physiotherapists were interviewed how they perform the procedure. Analysis of the interviews resulted in the development of a preliminary script, which was piloted to validate the manuscript. Chapter VI: The effectiveness and feasibility of two motor learning principles (mental practice and focus of attention) was evaluated on two different task procedures in pre-registration physiotherapy education. The difference between mental practice and no mental practice was not statistically significant. Findings of the comparison of the attentional focus differed between task procedures. An internal focus of attention was more effective for the acquisition of a transfer task procedure. For the second task procedure in vestibular rehabilitation the performance between the internal and external focus of attention groups was similar. Conclusions: This was the first study, to the authors knowledge, that investigated the acquisition of complex motor task skills in pre-registration physiotherapy students. The results presented in this thesis will help inform educators and researchers regarding the use of mental practice and different attentional foci to support the teaching approach for acquisition of complex skills in physiotherapy education