Kenneth Mark Greenwood

Long-term stability and psychometric properties of the Composite Scale of Morningness.

Prompted by some discrepancies in the report detailing the development of the Composite Scale (CS) of Morningness (Smith et al. 1989) this study replicated the examination of the psychometric properties of the CS on a large sample (n = 424) of health science students. It was confirmed that the mean and range of CS scores previously reported were in error. The finding that the CS has good psychometric properties when used on samples of students was replicated and extended to a smaller (n = 35) sample of individuals working on rotating shifts. CS scores were found to be stable over time and did not change when subjects were exposed to night- and shiftwork.

Relationships between measures of dysfunctional breathing in a population with concerns about their breathing.

BACKGROUND Dysfunctional breathing (DB) is implicated in physical and psychological health, however evaluation is hampered by lack of rigorous definition and clearly defined measures. Screening tools for DB include biochemical measures such as end-tidal CO(2), biomechanical measures such assessments of breathing pattern, breathing symptom questionnaires and tests of breathing function such as breath holding time. AIM This study investigates whether screening tools for dysfunctional breathing measure distinct or associated aspects of breathing functionality. METHOD 84 self-referred or practitioner-referred individuals with concerns about their breathing were assessed using screening tools proposed to identify DB. Correlations between these measures were determined. RESULTS Significant correlations where found within categories of measures however correlations between variables in different categories were generally not significant. No measures were found to correlate with carbon dioxide levels. CONCLUSION DB cannot be simply defined. For practical purposes DB is probably best characterised as a multi-dimensional construct with at least 3 dimensions, biochemical, biomechanical and breathing related symptoms. Comprehensive evaluation of breathing dysfunction should include measures of breathing symptoms, breathing pattern, resting CO(2) and also include functional measures such a breath holding time and response of breathing to physical and psychological challenges including stress testing with CO(2) monitoring.

Traditional Chinese Medicine: An Update on Clinical Evidence

BACKGROUND As an alternative medical system, Traditional Chinese Medicine (TCM) has been increasingly used over the last several decades. Such a consumer-driven development has resulted in introduction of education programs for practitioner training, development of product and practitioner regulation systems, and generation of an increasing interest in research. Significant efforts have been made in validating the quality, effectiveness, and safety of TCM interventions evidenced by a growing number of published trials and systematic reviews. Commonly, the results of these studies were inconclusive due to the lack of quality and quantity of the trials to answer specific and answerable clinical questions. OBJECTIVES The methodology of a randomized clinical trial (RCT) is not free from bias, and the unique features of TCM (such as individualization and holism) further complicate effective execution of RCTs in TCM therapies. Thus, data from limited RCTs and systematic reviews need to be interpreted with great caution. Nevertheless, until new and specific methodology is developed that can adequately address these methodology challenges for RCTs in TCM, evidence from quality RCTs and systematic reviews still holds the credibility of TCM in the scientific community. CONCLUSIONS This article summarizes studies on TCM utilization, and regulatory and educational development with a focus on updating the TCM clinical evidence from RCTs and systematic reviews over the last decade. The key issues and challenges associated with evidence-based TCM developments are also explored.

Medically Unexplained Dyspnea: Partly Moderated by Dysfunctional (Thoracic Dominant) Breathing Pattern

Background. Dysfunctional breathing (DB) may contribute to disproportionate dyspnea and other medically unexplained symptoms. The extent of dysfunctional breathing is often evaluated using the Nijmegen Questionnaire (NQ) or by the presence of abnormal breathing patterns. The NQ was originally devised to evaluate one form of dysfunctional breathing - hyperventilation syndrome. However, the symptoms identified by the NQ are not primarily due to hypocapnia and may be due to other causes including breathing pattern dysfunction. Objectives. The relationships between breathing pattern abnormalities and the various categories of NQ symptoms including respiratory or dyspnea symptoms have not been investigated. This study investigates these relationships. Method. 62 patients with medically unexplained complaints, that seemed to be associated with tension and breathing dysfunction, were referred, or self-referred, for breathing and relaxation therapy. Dysfunctional breathing symptoms and breathing patterns were assessed at the beginning and end of treatments using the NQ for assessment of DB symptoms, and the Manual Assessment of Respiratory Motion (MARM) to quantify the extent of thoracic dominant breathing. Subscales for the NQ were created in 4 categories, tension, central neurovascular, peripheral neurovascular and dyspnea. Relationships between the NQ (sum scores and subscales) and the MARM were explored. Results. Mean NQ scores were elevated and mean MARM values for thoracic breathing were also elevated. There was a small correlation pre-treatment between MARM and NQ (r=0.26, p<0.05), but classification of subjects as normal/abnormal on both measurements agreed in 74% (p < 0.001) of patients. From the sub scores of NQ only the respiratory or ‘dyspnea’ items correlated with the MARM values. Dyspnea was only elevated for subjects with abnormal MARM. After treatment, both MARM and NQ returned to normal values (p< 0.0001). Changes in NQ were largest for subjects with abnormal MARM pre-treatment. There was a large interaction between the change in the NQ sub score dyspnea and initial MARM values. (p<0.001).

Self-reported sleep in systemic lupus erythematosus

The objectives of the study were to assess sleep disturbances in systemic lupus erythematosus (SLE) and to compare these with a working sample and a treatment-seeking sample reporting insomnia. The primary sample was 172 people with SLE. This sample represented 32% of all members of two lupus support association. Two comparison samples were used: 223 adults who expressed interest in taking part in a psychological treatment for sleep problems and 456 Australian adults who were working at a large organization. All individuals completed the Pittsburgh Sleep Quality Index (PSQI; 6). Data derived from the PSQI included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, as well as the global and seven component scores. The SLE sample reported significantly worse sleep on all parameters than the working sample, but significantly better sleep than the sample of those seeking treatment for sleep disorders, except for sleep onset latency. The percentages scoring >5 on the PSQI global score was 80.5% for SLE, 91.5% for those seeking treatment for sleep disorders, and 28.5% for the working sample. PSQI component scores for the SLE group more closely resembled those of the treatment-seeking group. Self-reported sleep in this sample of people with SLE was significantly better on most parameters than that of a group seeking treatment for sleep disorders. However, the values obtained tended to be worse than previous reports and indicated less than optimal sleep. However, the low response rate of the sample was of concern and may indicate that the sample was biased. The present results suggest that sleep disturbance is common in those with SLE and deserves more attention in a more representative sample.

Four-item fall risk screening tool for subacute and residential aged care: The first step in fall prevention

Aim:  To report the reliability, accuracy and compliance of a brief fall risk screening tool in subacute and residential aged care.

The influence of adult behaviors on child coping during venipuncture: A sequential analysis

The aim of this exploratory study was to investigate the influences of adult behaviors on child coping behaviors during venipunctures (VPs) in an emergency department. Observations of children and adults from 66 VPs were coded using a modified version of the Child-Adult Medical Procedure Interaction Scale and analyzed using sequential analysis. Results showed adult reassurance behavior promoted child distress behaviors, such as crying, as well as nondistress behaviors, such as information seeking; adult distraction behaviors promoted childrens distraction, control, and coping behaviors; and children frequently ignored adult behaviors. Findings suggest further exploration of childrens internal strategies for coping, such as appraisal, and clarifying the role of adult reassurance in child coping behaviors.

Psychometric properties of the Diurnal Type Scale of Torsvall and Åkerstedt (1980)

Abstract The psychometric properties of the Diurnal Type Scale (DTS) of Torsvall and Akerstedt (1980) when used on a young sample with no or limited experience of shiftwork were investigated. Four hundred and forty-five students completed the DTS, the Morningness-Eveningness Questionnaire (MEQ) (Home and Ostberg 1976), and the Circadian Type Questionnaire (CTQ) (Folkard et al. 1979). The DTS was not found to be a homogeneous scale (Cronbachs alpha = 0·29) and appeared to be assessing two relatively independent dimensions: morningness and eveningness. Adequate test-retest reliability was found when subjects remained as students (r = 0·78), however, scores obtained from students did not correlate highly (r = 0·43) with those obtained when they were working on rotating shifts. The DTS correlated only moderately with the MEQ (r = 0·50) and with the CTQ. Future researchers should be cautious in using the instrument until they have information about its psychometric properties when applied to their population ...

An evaluation of the Circadian Type Questionnaire

This study evaluates the psychometric properties and assesses the test-retest reliability and longer-term stability of scores on the Circadian Type Questionnaire (CTQ) of Folkard et al. (1979) in a sample of 445 students. The scales were found to lack internal consistency and the factor structure originally proposed was not replicated. Cultural variation in CTQ scores was suggested. Test-retest reliability, over three months in a subgroup of 36, was poor for the V and M scales. Longer-term stability, over nine months in a subgroup of 36 who were exposed to shiftwork, was better but significant decreases were found in rigidity of sleeping habits (Rs) and morningness (M) scores. A factor analysis suggested that the scales should be constructed differently; however, the properties of such scales were still not optimal. The CTQ has psychometric flaws and needs to be improved before it could be expected to reliably function as a predictive test of adaptation to shiftwork.

Further development of the High-level Mobility Assessment Tool (HiMAT)

Primary objectives: The high-level mobility assessment tool (HiMAT) was developed to measure high-level mobility limitations following traumatic brain injury (TBI). Rasch analysis was used in the development to ensure cognitive deficits would have a minimal impact on performance. The main aim of this study was to investigate the dimensionality of the HiMAT using recently developed advanced testing procedures. Research design: Results from the original sample of 103 adults with TBI used to develop the HiMAT were re-analysed using the RUMM2020 program. Revised minimal detectable change (MDC95) scores were also calculated. Main outcomes and results: Rasch analysis of all 13 HiMAT items suggested that the scale was multidimensional, showing a clear separation between the stair and non-stair items. The nine non-stair items of the HiMAT showed good overall fit, excellent internal consistency, with no disordered thresholds or misfitting items, however removal of one item was required to ensure a unidimensional scale. The final 8-item solution showed good model fit (p = 0.93), excellent internal consistency (PSI = 0.96), no disordered thresholds, no misfitting items and no differential item functioning for age or sex. The revised HiMAT total score is 32 points and the MDC95 was calculated to be ±2 points. Conclusion: The results of this study demonstrate that the revised HiMAT is unidimensional and valid to use in rehabilitation and community settings where there is no access to stairs.