Ian Story

Measures of muscle and joint performance in the lower limb of children with cerebral palsy

The aim of this study was to determine the reliability and magnitude of error of three lower‐limb clinical measures for children with cerebral palsy (CP): the Modified Ashworth Scale of Spasticity (MAS), passive range of movement (PROM) and the modified Tardieu scale (MTS). Six physiotherapists measured 11 females and seven males (mean age 6 years 4 months, SD 2 years 4 months; age range 2 years 4 months to 10 years) on two occasions using a repeated measures design, collecting all data over 6 days. The severity of CP spanned all five levels of the Gross Motor Function Classification System and all children demonstrated varying degrees of spasticity. Exclusion criteria included botulinum toxin injections, inhibitory plasters, and orthopaedic surgery within the 6 months before study entry. For PROM and the MTS interrater reliability was acceptable with an intraclass correlation coefficient of 0.7, but results for MAS were lower. Standard error of measurement for repeated measures of PROM and MTS was about five degrees, but 95% confidence interval ranges were considerably higher. Test‐retest results varied widely, particularly for the MAS. These measurement tools should be used with caution when evaluating changes in young children with CP.

Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes?

The aim of this study was to establish whether removal of breathing exercises from a regimen including early mobilisation changes the incidence of post-operative pulmonary complications for patients after cardiac surgery. Two hundred and thirty patients undergoing open heart surgery at Monash Medical Centre, Melbourne, were enrolled in this randomised controlled trial. All patients received physiotherapy treatment pre-operatively and post-operatively for three days. Patients were mobilised as soon as possible after surgery. Breathing group (control) patients performed a set routine of deep breathing exercises at each physiotherapy visit while those in the intervention group did not perform this routine. Other than the breathing exercises, patient management was similar between groups in terms of assessment, positioning and mobility. The incidence of postoperative pulmonary complications, post-operative length of stay, oxyhaemoglobin saturation and pulmonary function were measured pre-operatively and post-operatively. Intention-to-treat analysis was performed for post-operative pulmonary complications and length of stay. Other data were analysed using t-tests, chi square and repeated measures analysis of variance. There were no significant differences between the groups in the primary dependent variables. It is concluded that removal of breathing exercises from the routine physiotherapy management of open heart surgery patients does not significantly alter patient outcome.

Classification systems for low back pain: a review of the methodology for development and validation

Abstract The classification of low back pain has been proposed as a high research priority due to the possible confounding effect of sample heterogeneity on effect sizes for outcome studies investigating treatment efficacy. However, the literature is unclear regarding methodological criteria for the development and validation of low back pain classification systems. The objectives of this paper were to describe and discuss the methodology used in studies researching the development and validation of low back pain classification systems. A database search for relevant papers was conducted, and data describing the frequency of utilisation of specific methodologies extracted and summarised. Seventy-seven papers were included in the review. Considerable variability in the methodological approaches used was found. Based on the results of the review and a comparison with the theory of classification, recommendations are made for future research into the classification of low back pain.

The test–retest reliability and concurrent validity of the Subjective Complaints Questionnaire for low back pain

Physiotherapists commonly record detailed patient information regarding subjective complaints for low back pain (LBP), particularly to assist in the process of classifying patients into specific subgroups. A self-administered Subjective Complaints Questionnaire for LBP (SCQ-LBP) measuring such information was developed for the purposes of future clinical research, particularly in the area of LBP classification. The development comprised literature review, feedback from experienced physiotherapists and pilot questionnaire testing in a patient population. Test-retest reliability of the questionnaire in a self administered format as well as concurrent validity against a suitable reference standard was evaluated. The agreement between the self administered questionnaire compared to when administered by a physiotherapist was also tested as the latter method is the most common form of retrieving subjective complaints in clinical practice. Thirty participants with LBP were recruited and at least moderate test-retest reliability was demonstrated in 56 of the 57 self administered questionnaire items. Preliminary evidence was found supporting the concurrent validity of selected items. At least moderate agreement was demonstrated in 51 of the 57 items when comparing between the self administered and physiotherapist administered conditions. The questionnaire is a useful tool for collecting subjective complaints information, particularly for clinical research on the classification of LBP, however, further research regarding validity is required.

The cost effectiveness of a pharmacist reviewing medication among the elderly in the community

Aims : The study aims to assess the cost effectiveness of medication review and advice by a consultant pharmacist to elderly people living in the community in Australia.