Alison Rushton

Formative assessment: a key to deep learning?

A paradigm shift in assessment culture has emphasized the importance of formative assessment. The existing evidence supports the identification of feedback as the central component of formative assessment. Feedback provides information about the existing gap between the actual and desired levels of performance. The existing evidence suggests various characteristics of effective feedback, for example, ensuring that feedback is construct-referenced and student referenced. An exploration of the existing educational literature provides evidence for the emphasis on formative assessment. This paper evaluates the pedagogical implications of formative assessment to deep learning. A constructivist approach, emphasizing the principles of adult learning and placing emphasis on the student is advocated. However, in applying the wider educational literature to healthcare, it is questioned if the paradigm shift in assessment culture has occurred as the majority of the existing literature is centred on summative assessment.

The effects of cervical high-velocity low-amplitude thrust manipulation on resting electromyographic activity of the biceps brachii muscle.

There is a gap in the literature regarding the effects of spinal manipulation on extremity muscles that are unconnected to the vertebral column by an origin or insertion. This study investigated the effect of a right C5/6 high-velocity low-amplitude thrust (HVLAT) manipulation on resting electromyographic activity of the biceps brachii muscles bilaterally. A placebo-controlled, single-blind, repeated measures design employed an asymptomatic convenience sample (n=54) investigating three conditions: HVLAT, sham, and control. HVLAT demonstrated an excitatory effect with increased EMG activity of 94.20% (P=0.0001) and 80.05% (P=0.0001) for the right and left biceps respectively. A one-way repeated measures ANOVA revealed a significant difference (P=0.0001) in the mean percentage change of resting EMG activity, as did post hoc analyses (P=0.0001) between all three conditions. Subjects not experiencing cavitation post HVLAT demonstrated greater EMG increases for both right (P=0.0001) and left (P=0.014) biceps than those experiencing cavitation. The magnitude of mean EMG change for the right biceps was significantly greater than the left (P=0.011) post HVLAT. This study demonstrates a single HVLAT to the right C5/6 zygapophyseal joint elicits an immediate increase in resting EMG activity of the biceps bilaterally, irrespective of whether or not cavitation occurs.

International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention

A consensus clinical reasoning framework for best practice for the examination of the cervical spine region has been developed through an iterative consultative process with experts and manual physical therapy organisations. The framework was approved by the 22 member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (October 2012). The purpose of the framework is to provide guidance to clinicians for the assessment of the cervical region for potential of Cervical Arterial Dysfunction in advance of planned management (inclusive of manual therapy and exercise interventions). The best, most recent scientific evidence is combined with international expert opinion, and is presented with the intention to be informative, but not prescriptive; and therefore as an aid to the clinicians clinical reasoning. Important underlying principles of the framework are that 1] although presentations and adverse events of Cervical Arterial Dysfunction are rare, it is a potentially serious condition and needs to be considered in musculoskeletal assessment; 2] manual therapists cannot rely on the results of one clinical test to draw conclusions as to the presence or risk of Cervical Arterial Dysfunction; and 3] a clinically reasoned understanding of the patients presentation, including a risk:benefit analysis, following an informed, planned and individualised assessment, is essential for recognition of this condition and for safe manual therapy practice in the cervical region. Clinicians should also be cognisant of jurisdictionally specific requirements and obligations, particularly related to patient informed consent, when intending to use manual therapy in the cervical region.

Evaluation of cervical proprioceptive function: optimizing protocols and comparison between tests in normal subjects.

Study Design. A test-retest design evaluated stability as well as within and between day reliability. Objective. The study aimed to define optimum protocols for the cervical joint position error (JPE) and cervicocephalic kinesthesia tests and to investigate association between performances in the tests. Summary of Background Data. The cervical JPE and cervicocephalic kinesthesia tests are proposed as measures of cervical proprioception. However, there has been little investigation of the number of trials needed to obtain stable and reliable estimates of performance. Both tests have potential limitations in reflecting the underlying construct of cervical proprioception and association between performances in both has not been investigated previously. Methods. Head repositioning and head-tracking errors were measured using an electromagnetic-tracking system in 16 normal subjects, tested on 3 occasions over 2 days. The effect of different numbers of trial repeats was analyzed descriptively in terms of stability of measures obtained and by using intraclass correlation coefficients to assess reliability. Association between the tests was analyzed with the Pearson correlation coefficient. Results. Stable estimates of performance were obtained when data from 6 or more trials was included. The greatest test-retest reliability was obtained with 5 or more trials in both the cervical JPE (intraclass correlation coefficients = 0.73–0.84) and cervicocephalic kinesthesia (intraclass correlation coefficients = 0.90–0.97) tests. Correlation analyses indicated no significant association between performances in the 2 tests (r = −0.476–0.228, P > 0.05). Conclusion. Our finding that at least 6 trials were needed to optimize stability, and reliability of outcome measures has important implications for application of these tests. The lack of correlation between performances in the tests supports the suggestion that they are not comparable measures of cervical proprioception. Further planned studies will include a range of tests challenging different aspects of cervical proprioceptive contribution to sensorimotor control in different subcategories of neck pain patients.

Selecting outcome measures in sports medicine: a guide for practitioners using the example of anterior cruciate ligament rehabilitation

Using examples from the field of anterior cruciate ligament rehabilitation, this review provides sports and health practitioners with a comprehensive, user-friendly, guide to selecting outcome measures for use with active populations. A series of questions are presented for consideration when selecting a measure: is the measure appropriate for the intended use? (appropriateness); is the measure acceptable to patients? (acceptability); is it feasible to use the measure? (feasibility); does the measure provide meaningful results? (interpretability); does the measure provide reproducible values? (reliability); does the measure assess what it is supposed to assess? (validity); can the measure detect change? (responsiveness); do substantial proportions of patients achieve the worst or best scores? (floor and ceiling effects); is the measure structured and scored correctly? (dimensionality and internal consistency); has the measure been tested with the types of patients with whom it will be used? (sample characteristics). Evaluation of the measure using these questions will assist practitioners in making their judgements.

Cold hyperalgesia as a prognostic factor in whiplash associated disorders: A systematic review

OBJECTIVE To review and critically evaluate the existing literature for the prognostic value of cold hyperalgesia in Whiplash Associated Disorders (WAD). METHODS Embase, PsycINFO, and Medline databases were systematically searched (from inception to 20th September 2011) for prospective studies investigating a prognostic ability for cold hyperalgesia in WAD. Reference lists and lead authors were cross-referenced. Two independent reviewers selected studies, and consensus was achieved via a third reviewer. The risk of bias in identified studies was systematically evaluated by two reviewers using previously published guidance. The influences of seven potential covariates of cold hyperalgesia were considered. Quantitative synthesis was planned and homogeneity assessed. A modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to qualitatively assess trials. RESULTS The review screened 445 abstracts, from these 20 full text studies were retrieved and assessed for eligibility. Six prospective studies on four cohorts were identified and reviewed. Findings from all four cohorts supported cold hyperalgesia as a prognostic factor in WAD. CONCLUSIONS There is moderate evidence supporting cold hyperalgesia as a prognostic factor for long-term pain and disability outcome in WAD. Further validation of the strength of this relationship and the influence of covariates are required. The mechanism for this relationship is unknown.

Transcranial direct current stimulation for the reduction of clinical and experimentally induced pain: a systematic review and meta-analysis.

Objectives:To evaluate the effectiveness of transcranial direct current stimulation on clinical and experimental pain, and to identify the most beneficial stimulation parameters. Methods:Predefined search using key terms of information sources including: MEDLINE, EMBASE, CAB Abstracts, and PsychINFO, Cochrane Register of Controlled Trials, CINAHL, and PeDRO databases; reference lists of retrieved articles, journal contents, and conference proceedings. Two reviewers independently searched and evaluated publications. English and non-English controlled trials that applied direct current stimulation to the brain published before September 30, 2010 were included. Studies using magnetic stimulation or pulsed currents were excluded. Results:Trials investigating experimental pain in healthy participants (n=6) used a wide variety of stimulation and outcome parameters that did not allow a synthesis across outcome parameters. Trials investigating chronic pain (n=8) used anodal motor cortex stimulation of 1 or 2 mA intensity, either as a single dose or on a maximum of 10 consecutive days. Four trials on chronic pain were excluded due to a high risk of bias. A meta-analysis of 4 trials on chronic pain found a pooled effect size of −2.29 with a 95% confidence interval of −3.5 to −1.08. This effect does just reach minimal clinically important difference recommendations. Discussion:The level of evidence for the efficacy of transcranial direct current stimulation in experimental and chronic pain reduction is low. Evidence from high quality randomized controlled trials is required before this treatment should be recommended.

Chartered Society of Physiotherapy's identification of national research priorities for physiotherapy using a modified Delphi technique

OBJECTIVE To define research priorities to strategically inform the evidence base for physiotherapy practice. DESIGN A modified Delphi method using SurveyMonkey software identified priorities for physiotherapy research through national consensus. An iterative process of three rounds provided feedback. Round 1 requested five priorities using pre-defined prioritisation criteria. Content analysis identified research themes and topics. Round 2 requested rating of the importance of the research topics using a 1-5 Likert scale. Round 3 requested a further process of rating. Quantitative and qualitative data informed decision-making. Level of consensus was established as mean rating ≥ 3.5, coefficient of variation ≤ 30%, and ≥ 55% agreement. Consensus across participants was evaluated using Kendalls W. PARTICIPANTS Four expert panels (n=40-61) encompassing a range of stakeholders and reflecting four core areas of physiotherapy practice were established by steering groups (n=204 participants overall). FINDINGS Response rates of 53-78% across three rounds were good. The identification of 24/185 topics for musculoskeletal, 43/174 for neurology, 30/120 for cardiorespiratory and medical rehabilitation, and 30/113 for mental and physical health and wellbeing as priorities demonstrated discrimination of the process. Consensus between participants was good for most topics. Measurement validity of the research topics was good. The involvement of multiple stakeholders as participants ensured the current context of the intended use of the priorities. CONCLUSIONS From a process of national consensus involving key stakeholders, including service users, physiotherapy research topics have been identified and prioritised. Setting priorities provides a vision of how research can contribute to the developing research base in physiotherapy to maximise focus.

A survey of post-operative management for patients following first time lumbar discectomy.

This study aimed to identify current NHS physiotherapy practice following first time lumbar discectomy in the United Kingdom (UK) in order to inform future research priorities and design. Descriptive survey methodology was utilised employing a postal questionnaire. A total population sample was identified and questionnaires were posted to 87 NHS physiotherapy departments throughout the UK. Participants were senior physiotherapists working with spinal surgery patients. In the inpatient phase, the majority of patients receive physiotherapy. Management focused on mobility and education to facilitate early discharge with most patients being given exercises. However, there was a wide variation in the actual exercises prescribed. There was more variation in the provision of outpatient physiotherapy treatment. Not all patients have access to physiotherapy treatment post discharge in the UK and when treatment was available the content and amount was variable. There is evidence to support rehabilitation classes to assist early improvements in function and return to work but such classes are only available in around half of the centres involved in this study. Regarding the content of exercise classes and individual treatment sessions, a wide range of clinical practice was evident. This study raises many research questions and highlights the need for future research to optimise patient rehabilitation following first time lumbar discectomy.

Development of a clinical examination in non-specific low back pain: A Delphi technique

OBJECTIVE To establish the discriminatory items of the clinical examination of non-specific low back pain, important to physiotherapists. DESIGN A focus group and Delphi technique with UK physiotherapists. SUBJECTS A purposive sample of 30 physiotherapists attended a focus group and completed 3 rounds of Delphi questionnaires. METHODS Data were analysed using mixed qualitative and quantitative approaches. A frequency content analysis identified commonly identified tests and questions, whilst the Delphi consensus technique assumed consensus had been reached with greater than 80% agreement on item inclusion or exclusion. RESULTS The focus group established the structure of the clinical examination with 15 domains of questioning or physical testing. Three rounds of Delphi questionnaires established the important items of the clinical examination. The list of tests and questions included items evaluating both the psychosocial and biomedical status of the patient as well as questions screening for red flags. CONCLUSION This is the first work to establish discriminatory tests in the clinical examination of non-specific low back pain, important to physiotherapists. The clinical examination will subsequently be evaluated for item validity and data will undergo cluster analysis. The items of this clinical examination may provide evidence for the existence of homogenous sub-groups within the heterogeneous non-specific low back pain diagnosis.