Katy Mitchell

Reliability and validity of goniometric iPhone applications for the assessment of active shoulder external rotation.

ABSTRACT Purpose/hypothesis: The purpose of this study was to determine the reliability and validity of two smartphone applications: (1) GetMyROM – inclinometery-based and (2) DrGoniometry – photo-based in the measurement of active shoulder external rotation (ER) as compared to standard goniometry (SG). Participants: Ninety-four Texas Womans University Doctor of Physical Therapy students from the School of Physical Therapy – Houston campus, were recruited to participate in this study. Materials/methods: Two iPhone applications were compared to SG using both novice and experienced raters. Active shoulder ER range of motion was measured over two time periods in random order by blinded novice and experienced raters. Results: Intra-rater reliability using novice raters for the two applications ranged from an intraclass correlation coefficient (ICC) of 0.79 to 0.81 with SG at 0.82. Inter-rater reliability (novice/expert) for the two applications ranged from an ICC of 0.92 to 0.94 with SG at 0.91. Concurrent validity (when compared to SG) ranged from 0.93 to 0.94. There were no significant differences between the novice and experienced raters. Conclusion: Both applications were found to be reliable and comparable to SG. A photo-based application potentially offers a superior method of measurement as visualizing the landmarks may be simplified in this format and it provides a record of measurement. Clinical relevance: Further study using patient populations may find the two studied applications are useful as an adjunct for clinical practice.

Pain assessment and management in children with neurologic impairment: a survey of pediatric physical therapists.

Purpose: This study explored pain assessment measures and interventions used by physical therapists in the treatment of children with neurologic impairment. Methods: Following extensive literature review on pain assessment and intervention, a survey was developed, pilot tested, and posted on the listserv of the Pediatric Section of the American Physical Therapy Association. Results: Eighty percent of the respondents used subjective measures to assess pain, 70% used self-report scales, and 41% used behavioral and physiological measures. Behaviors frequently used included vocalizations, facial expression, and irritability. Rarely used cues included decreased attention, withdrawal, and changes in sleeping and eating behaviors. Therapists used research-supported pain interventions such as distraction and praise as well as potentially harmful distress producing measures such as procedural talk and reassurance. Conclusion: Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.

Pain, sleep disturbances, and functional limitations in people living with HIV/AIDS-associated distal sensory peripheral neuropathy.

Background: Pain, sleep, and functional disturbances are a common occurrence in people living with HIV/AIDS-related distal sensory peripheral neuropathy (PLWHA-DSPN) yet lack group classification and quantification. Methods: A total of 46 PLWHA-DSPN were recruited, as part of a 2-group intervention study, to complete the Neuropathic Pain Scale and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. The participant’s performance during a forward reach task and walking distance in 6 minutes was recorded as a measure of function. Results: The pain (60.77 ± 17.85) and sleep (14.62 ± 4.28) scores denote marked pain and sleep disturbances, compared to sero-negative, age-matched individuals. The ambulation distance was limited (243.99 ± 141.04 m) and inversely associated with the PSQI-sleep efficiency subscale (rs = −.35, P < .05). The average reaching distances measured (36.07 ± 7.37 cm) were similar to sero-negative, age-matched individuals. Pain, sleep, and functional measures exhibited significant associations. Conclusions: The data collected suggest that PLWHA-DSPN report moderate-to-severe pain and significant sleep disturbances and exhibit limited ambulation distances.

Reliability and validity of a smartphone pulse rate application for the assessment of resting and elevated pulse rate

ABSTRACT Purpose/hypothesis: This study was designed to investigate the test–retest reliability, concurrent validity, and the standard error of measurement (SEm) of a pulse rate assessment application (Azumio®’s Instant Heart Rate) on both Android® and iOS® (iphone operating system) smartphones as compared to a FT7 Polar® Heart Rate monitor. Number of subjects: 111. Materials/methods: Resting (sitting) pulse rate was assessed twice and then the participants were asked to complete a 1-min standing step test and then immediately re-assessed. The smartphone assessors were blinded to their measurements. Results: Test–retest reliability (intraclass correlation coefficient [ICC 2,1] and 95% confidence interval) for the three tools at rest (time 1/time 2): iOS® (0.76 [0.67–0.83]); Polar® (0.84 [0.78–0.89]); and Android® (0.82 [0.75–0.88]). Concurrent validity at rest time 2 (ICC 2,1) with the Polar® device: IOS® (0.92 [0.88–0.94]) and Android® (0.95 [0.92–0.96]). Concurrent validity post-exercise (time 3) (ICC) with the Polar® device: iOS® (0.90 [0.86–0.93]) and Android® (0.94 [0.91–0.96]). The SEm values for the three devices at rest: iOS® (5.77 beats per minute [BPM]), Polar® (4.56 BPM) and Android® (4.96 BPM). Conclusions: The Android®, iOS®, and Polar® devices showed acceptable test–retest reliability at rest and post-exercise. Both the smartphone platforms demonstrated concurrent validity with the Polar® at rest and post-exercise. Clinical relevance: The Azumio® Instant Heart Rate application when used by either platform appears to be a reliable and valid tool to assess pulse rate in healthy individuals.

Qualitative assessment of component-specific, fall-risk screening procedures to create a fall risk screening form.

Background:The Day Center, Case Management, and Home Care components of a local senior health agency each have used different screening forms for assessing their clients for fall risk. A common instrument, easily administered by all components as part of their routine practice, would be helpful in systematically identifying elders at risk of falling. Developing a common screening instrument would be useful at other senior health agencies as well. Purpose:To gather information on the content and features that are most useful for fall screening, based on the needs of individual geriatric care workers in each component of a local senior health agency. Methods:A semistructured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. Results:Two major themes emerged: (1) factors that are relevant in assessing fall risk and (2) factors that affect the utility of the fall risk screening procedure. Under theme 1, there were 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme 2, there were 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature, health status and fear of falling, to produce a universal form for use by different agency components. Discussion:Integrating all fall-risk categories into a universal form improves the completeness of the form used in different agency components. However, to increase the utility of fall risk screening, service plans integrated with each screening procedure need to be developed according to specific agency structures. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) initial screening with an outreach worker using a quick question assessment; (2) follow-up with a more comprehensive fall risk assessment while receiving services from the Day Center, Case Management, or Home Care; and (3) a “what-to-do” action is presented for each item on the basis of each questions response on the comprehensive form. Conclusions:When designing a fall risk screening procedure, integrating all fall-risk factors into a single comprehensive form may not be the ideal strategy. The environment, the person who gathers the information, and the actions required to respond to information gathered should also be considered. On the basis of the results of this qualitative study, we have presented a 3-step procedure, with supporting forms to address these considerations.

Randomized Trial of Lower Extremity Splinting to Manage Neuropathic Pain and Sleep Disturbances in People Living with HIV/AIDS

Background/Aims: Distal symmetrical peripheral neuropathy (DSPN) and sleep disturbances are among the most common complications reported in people living with the human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLWHA). DSPN-pain is predominantly managed by using systemic agents with little evidence supporting their analgesic efficacy. The purpose of this study is to evaluate the effect of nighttime lower extremity splinting application on DSPN-related pain and sleep disturbances compared to a parallel splint liner application in PLWHA. Methods: Forty-six PLWHA and DSPN were randomized to nighttime wearing of bilateral lower extremity splints or the liners only. Pain and sleep outcomes were measured at baseline, week 3, and week 6. The pain was measured using the Neuropathic Pain Scale and sleep using the Pittsburgh Sleep Quality Index. Results: Pain and sleep scores improved in both groups over time. The median percentage pain reduction at week 6 was 8% in the liner group and 34% in the splint group. The change in pain scores in the splint group was found to be significant over time, P < .0005. The contrast between the splint and liner groups was underpowered (26%) and was not found to be significant, P > .05. Sleep scores improved 20% from baseline to the end of the study in both groups; all participants were classified as poor sleepers. Conclusion: The 6-week use of nighttime splints reduces DSPN-pain possibly by providing peripheral inhibition of external stimuli. Future studies are needed to validate this inhibitory intervention to manage DSPN in PLWHA and other neuropathic conditions.

Assessment of Impact of Medication Use and Dementia on Fall Risk in Clients Receiving Home Health Care

The objective of this article was to investigate relationships among medication, dementia, and falls in community-dwelling elders with polypharmacy receiving home health care services from a senior services agency. As regards method, medical information on medication, dementia, and falls was obtained from clinical records of 147 clients. Chi-square tests were used to compare psychotropic drug use between elders with and without dementia. Logistic regression was performed to test the hypothesis that psychotropic drugs and dementia predicted falls in this population. Results reveal that this population had high rates of psychotropic drug use (61%), dementia (38%), and falls (37%). No significant differences were found in psychotropic drug use between elders with and without dementia. Neither psychotropic drugs nor dementia predicted falls. Conclusions show that in this population, no relationship was found between dementia, psychotropic drugs, and falls.

Comparison of simultaneous static standing balance data on a pressure mat and force plate in typical children and in children with cerebral palsy

BACKGROUND Balance testing is an important component in treatment planning and outcome assessment for children with Cerebral Palsy (CP). Objective measurement for static standing balance is typically conducted in motion labs utilizing force plates; however, a plantar pressure mat may prove to be a viable alternative for this type of balance assessment. METHODS This study examined static standing balance simultaneously on a force plate and a plantar pressure mat in 30 typically developing (TD) and 30 children with CP to determine if valid measures of static standing balance could be obtained in children with CP using a pressure mat. RESULTS Examination of the data provided evidence that reliable and valid measures of static standing balance can be produced with a plantar pressure mat for both groups. Five variables out of the 21 variables examined were found to be reliable and valid on both devices (pressure mat and force plate) for both subgroups (TD and CP). The variables medial/lateral (ML) average radial displacement, range moved-ML, anterior/posterior average velocity, ellipse area, and area per second were found to have high test-retest reliability (ICC > .6) and possess discriminant validity between the subgroups (TD vs. CP). Additionally, the ellipse area and area per second variables also had the ability to discriminate between GMFCS levels. A normative center of pressure (CoP) balance data set using all 21 variables was also established for typically developing children for both devices (pressure mat and force plate) within this study. SIGNIFICANCE The ability to utilize a portable plantar pressure mat for quick and reliable standing balance measurement allows for expanded ability to capture objective data in a variety of settings thereby increasing opportunity for outcomes analysis.

Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy

AIM The purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes. This study also investigated changes in GDI in children with spastic CP after surgery. METHODS Data from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs. RESULTS Differences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted. CONCLUSION This paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients.