Berit Heir Bunkan

What are the basic dimensions of movements? A psychometric evaluation of the Comprehensive Body Examination III

The movements were examined in accordance with the Comprehensive Body Examination. The study objects were 99 persons: 17 pain syndrome patients (PSP group), 27 psychotic patients (PP group), 4 non-psychotic patients (NPP group), and a comparison group consisting of 51 students and staff members (SS group). On the basis of factor analysis three subscales were made: 1) Resistance to Passive Movements (RPM), with nine items, 2) Assistance to Passive Movements (APM), with six items, and 3) Motor Disturbances (MD), with three items. The internal consistency of the subscales was high (Chronbachs alpha, 0.81-0.96), and the intercorrelation low to moderate. The RPM subscale distinguished significantly between the SS group and both patient groups; the APM and MD subscales distinguished between the SS group and the PP group. The MD subscale also distinguished between patients taking drugs and those who did not, but there was no difference between patients without medication and the SS group.The movements were examined in accordance with the Comprehensive Body Examination. The study objects were 99 persons: 17 pain syndrome patients (PSP group), 27 psychotic patients (PP group), 4 non-psychotic patients (NPP group), and a comparison group consisting of 51 students and staff members (SS group). On the basis of factor analysis three subscales were made: 1) Resistance to Passive Movements (RPM), with nine items, 2) Assistance to Passive Movements (APM), with six items, and 3) Motor Disturbances (MD), with three items. The internal consistency of the subscales was high (Chronbachs alpha, 0.81-0.96), and the intercorrelation low to moderate. The RPM subscale distinguished significantly between the SS group and both patient groups; the APM and MD subscales distinguished between the SS group and the PP group. The MD subscale also distinguished between patients taking drugs and those who did not, but there was no difference between patients without medication and the SS group.

What are the basic dimensions of body posture? An empirical evaluation of the Comprehensive Body Examination. I.

There has been a lack of psychometrically sound scales for physiotherapeutic body examinations. The purpose of this paper is to evaluate the psychometric properties of the body posture items of the Comprehensive Body Examination (CBE). Ninety-nine persons were examined: 17 pain syndrome patients, 27 patients with psychoses, 4 patients with non-psychotic mental disorder, and a comparison group consisting of 51 students and staff members. On the basis of a factor analysis 2 posture subscales were made: Peripheral flexion (PF) with seven items and Spinal flexion (SF) with five items. Cronbachs alpha was 0.81 for the PF and 0.61 for the SF subscale. The PF subscale proved to distinguish significantly between the patient groups and normal controls, even when we controlled for the use of medication. The second subscale did not distinguish significantly among the groups. The results indicate that 12 of the posture items of the CBE form 2 subscales with satisfactory psychometric properties.

Interrater reliability of the comprehensive body examination

The purpose of this study was to examine the inter-rater reliability of the Comprehensive Body Examination (CBE) subscales. These are psychometrically based subscales developed to measure the dimensions of body posture, respiration, movements, and muscular consistency. Three independent raters examined 25 individuals (23 patients and two students). Seventeen patients had personality disorders, three had been psychotic, and three were chronic pain patients attending an ordinary physiotherapy clinic. One of the students had bronchial asthma; the other was a refugee with muscular pain. The inter-rater reliability was estimated as intra-class correlations (ICC(1.1)). This coefficient was chosen as it is sensitive both to random and systematic variation between raters. The ICC(1.1) for subscales ranged from 0.79 to 0.99 (median 0.94) indicating that properly trained raters can obtain very accurate ratings.

The Comprehensive Body Examination (CBE): From Global Impressions to Specific Sub-scales

In order to get a global perspective of bodily expressions of tensions and feelings in patients, physiotherapists have made comprehensive clinical examinations comprising the following domains: Posture, Respiration, Movements and Muscles. However, in reporting the results one has relied mostly on global impressions or used domain scores, or overall global scores. The purpose of this study was to determine to what extent clearly defined and psychometrically sound sub-scales can contribute to a more specific evaluation. By use of the Comprehensive Body Examination (CBE), we examined 99 individuals and calculated the correlation between global scores, domain scores and sub-scale scores. Furthermore, we investigated to what extent the scores discriminated among three groups of individuals. The global and domain scores discriminated very well between the three groups. However, some of the sub-scales were almost as good at discriminating. Three sub-scales were very correlated with the global score. The scores of two of these subscales could explain 95% of the variance in the global scores. To discriminate between groups of patients, only a few sub-scales are necessary. However, to get the full clinical picture, and to discriminate within diagnostic groups, the full range of sub-scales seems valuable.

Development of the Movement domain in the Global Body Examination

The purpose of this study was to develop a new Movement domain, based on 16 items from the Global Physiotherapy Examination-52 (GPE-52) and 18 items from the Comprehensive Body Examination (CBE). Furthermore, we examined how well the new domain and its scales would discriminate between healthy individuals and different groups of patients, compared to the original methods. Two physiotherapists, each using one method, independently examined 132 individuals (34 healthy, 32 with localized pain, 32 with generalized pain, and 34 with psychoses). The number of items was reduced by means of correlational and exploratory factor analysis. Internal consistency was examined with Cronbachs alpha. For examination of discriminative validity, Mann-Whitney U-test and Area under the Curve (AUC) were used. The initial 34 items were reduced to two subscales with 13 items: one for range of movement and balance and one for flexibility. Cronbachs alpha was 0.84 and 0.87 for the two subscales. The new subscales showed very good to excellent discriminating ability between healthy persons and the different patient groups (p < 0.001; AUC 0.82–0.95). Furthermore, patients with localized pain had significantly less movement aberrations than the other patient groups. The new Movement domain had fewer items than the GPE-52 and CBE, without losing discriminative validity.

Development of the Posture domain in the Global Body Examination (GBE)

Abstract The aim was to develop a new Posture domain based on eight postural items from the Global Physiotherapy Examination-52 (GPE-52) and 17 items from the Comprehensive Body Examination (CBE), and furthermore, to examine how the new scale discriminated between healthy individuals and different groups of patients compared with the original methods. Two physiotherapists independently examined 132 persons (34 healthy, 32 with localized pain, 32 with widespread pain, 34 with psychoses), each using one method. Exploratory factor analysis was performed to reduce number of items. Internal consistency of the final scales was examined with Cronbachs alpha. Discriminative ability was examined with Mann–Whitney U-test and receiver operating characteristics curve area. The initial 25 items were reduced to nine and integrated into three new subscales and one main domain scale for Posture with acceptable psychometric properties. The new scale showed very good discriminating ability between healthy persons and the different patient groups (p<0.001; ROC 0.85–0.95), as well as showing that pain patients had better scores than patients with psychoses. The new Posture domain was overall better than GPE-52 and as good as CBE regarding discriminative ability, but with half the number of items.

Palpation of Skeletal Muscles: A Psychometric Evaluation of the Muscular Items of the Comprehensive Body Examination

Objectives: The present study aims at evaluating the psychometric properties of a palpatory examination of skeletal muscles. Methods: Fifty-one nonpatients [NP group], 17 Patients with Pain Syndromes [PSP group], 27 Patients with Psychosis [PP group] and four patients with nonpsychotic mental disorders were examined by palpation. Results: Through factor analyses four sub-scales emerged: 1. Peripheral Slackness [PS], 2. Central Hardness [CH], 3. Peripheral Hardness [PH], and 4. Central Slackness [CS]. The subscales showed high internal consistency [Chronbachs alpha:. 72–.92] and were slightly to moderately intercorrelated. The PS, CH and CS subscales discriminated significantly between the NP and the PP groups. Compared with males, the females were characterized by more slack and less hard muscular consistency. No significant differences for any of the subscales emerged when comparing scores for patients with and without medication. Conclusions: The new subscales will be relevant for physiotherapists, physicians, and psychologists who want to study the state of muscular consistency in individuals with various mental disorders.

Development of the Palpation Domain for Muscle and Skin in the Global Body Examination

Objectives To develop new scales within palpation of muscle and skin domains based on 16 items from the Global Physiotherapy Examination and 46 items from the Comprehensive Body Examination [CBE], and to investigate how well these new scales would discriminate between healthy individuals and different groups of patients, when compared with the original methods. Methods Two physiotherapists independently examined 132 persons [34 healthy, 32 with localized pain, 32 with widespread pain, and 34 with psychoses]. Muscle and skin domains were studied separately. The numbers of items were reduced by omitting items with too high a correlation and by exploratory factor analysis [EFA]. Internal consistency was examined with Cronbachs α. Discriminative validity was examined using the Mann–Whitney U-test and the area under the curve. Results Only items from the left body half was included in the EFA, as very high correlation [mean r  =  0.90] was found in the 23 bilateral palpation pairs in CBE. The initial 62 items were reduced to 11 for palpation of muscle and 5 for palpation of skin. Cronbachs α was 0.88 for the subscales for Muscle and Skin. The new Palpation domain in the Global Body Examination showed excellent discriminative ability between healthy persons and the different patient groups [P  <  0.001; area under the curve 0.81–0.94]. Patients with localized pain had significantly less muscular and skin aberration than patients with widespread pain. Conclusions A new Global Body Examination Palpation domain with acceptable psychometric properties was developed. It had fewer items than the Global Physiotherapy Examination and CBE, but with almost the same discriminating ability.

The Global Body Examination (GBE). A useful instrument for evaluation of respiration.

Background and aims: Assessment of respiration is important in medicine and physical therapy. As respiration is multifaceted, we need several specific examination methods. The purpose of this study was to develop a method for examination of visible respiratory movements, by extracting from two examinations the items with best ability to discriminate among healthy controls, patients with pain disorders and patients with psychotic disorders. Methods: Two physiotherapists independently examined 132 individuals (34 healthy persons, 32 with localized pain, 32 with widespread pain and 34 with psychoses). Items were assigned to subscales by explorative factor analysis. Internal consistency of subscales was examined with Cronbachs alpha. To examine validity, one-way analysis of variance and the area under the curve (AUC) were used. Results: We identified four subscales: Tension, Position of Thorax, Basal respiration and Thoracic movements. Cronbachs alpha ranged from 0.75 to 0.86. The subscales’ discriminating ability was excellent between healthy controls and patients, and fair between patients with localized pain and the two other patient groups. Conclusions: The respiration domain of the new Global Body Examination has 21 items, which comprise four subscales with high internal consistency and good ability to discriminate between healthy persons and patients with pain disorders or psychosis.

The Global Body Examination (GBE): A useful instrument for examination of patients with long-lasting musculoskeletal and/or psychological disorders

Abstract The aims of this study were to present a newly developed clinical tool for examination of physical aberrations in different patient groups, and examine the degree to which this new instrument, the Global Body Examination (GBE), can discriminate between healthy people and patients. Two physiotherapists independently examined 132 individuals (34 healthy, 32 with localized pain, 32 with widespread pain, 34 with psychoses). One tester used the Comprehensive Body Examination with 112 items and the other used the Global Physiotherapy Examination with 52 items when examining posture, respiration, movements, muscle and skin. To extract the most useful items for the new GBE, correlational analysis, exploratory factor analysis and examination of internal consistency were used. Sumscores from the different main domains and subscales of GBE were used to examine the discriminative ability between healthy individuals and the three patient groups. Mann–Whitney U test and area under the curve (AUC) were used to compare the different groups. GBE’s four main domains and 11 subscales discriminated significantly between healthy people and patients (AUC from 0.79 to 0.95), and to some extent also between the patient groups. The new instrument demonstrated acceptable to outstanding discriminative abilities and seems useful for examining different patient groups.