Patricia A. Miller

Development of the Chedoke Arm and Hand Activity Inventory: Theoretical Constructs, Item Generation, and Selection

Abstract The Chedoke Arm and Hand Activity Inventory (CAHAI) was developed to address the need for a valid, clinically relevant, responsive functional assessment of the recovering paretic upper limb. The purpose of this article is to describe the development of the measure including its theoretical constructs, item generation, and item selection. From the literature, survivors of stroke, and their caregivers, 751 items were generated. Using factor analyses stem leaf plots, clinical judgment, and pilot testing on individuals with stroke, the list was reduced to 13 bilateral, real-life items. Research continues to provide evidence of the CAHAI’s test-retest and interrater reliability as well as construct, concurrent, and longitudinal validity.

Integrating virtual reality video games into practice: Clinicians' experiences

The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a childrens rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

Of time and troubles: patient involvement and the production of health care disparities.

Patient involvement in care practice has many and diverse proponents. It is endorsed by health care institutions and promoted by community agencies representing people with illness. A vast literature documents the benefits of patient involvement and describes ways to enable it. This article contributes to a critical literature on patient involvement by documenting the work done by women with cancer in relation to care timelines and in responding to troubles with care. We highlight continuities and disjunctures between this work, and discourses of patient involvement as they manifest in documents circulating at an Ontario cancer centre. In making visible the social and material resources that underpin successful involvement, the study shows how initiatives that endorse and promote ‘the involved patient’ can function to exacerbate health care and social disparities. As well, the study extends analysis of the individualization and privatization of health by showing how contemporary discourses of involvement enlist patients to monitor and sustain not only their own health, but also the health care they receive.

Usual and virtual reality video game-based physiotherapy for children and youth with acquired brain injuries.

ABSTRACT Little is known about how therapists promote learning of functional motor skills for children with acquired brain injuries. This study explores physiotherapists’ description of these interventions in comparison to virtual reality (VR) video game-based therapy. Six physiotherapists employed at a childrens rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using thematic analysis. Physiotherapists describe using interventions that motivate children to challenge performance quality and optimize real-life functioning. Intervention strategies are influenced by characteristics of the child, parent availability to practice skills outside therapy, and therapist experience. VR use motivates children to participate, but can influence therapist use of verbal strategies and complicate interventions. Physiotherapists consider unique characteristics of this population when providing interventions that promote learning of motor skills. The VR technology has advantageous features but its use with this population can be challenging; further research is recommended.

Psychometric Properties of a Peer-Assessment Program to Assess Continuing Competence in Physical Therapy

Background The College of Physiotherapists of Ontario implemented an Onsite Assessment to evaluate the continuing competence of physical therapists. Objective This study was undertaken to examine the reliability of the various tools used in the Onsite Assessment and to consider the relationship between the final decision and demographic factors. Design This was a psychometric study. Methods Trained peer assessors (n=63) visited randomly selected physical therapists (n=106) in their workplace. Fifty-three physical therapists were examined by 2 assessors simultaneously. The assessment included a review of practice issues, record keeping, billing practices, the physical therapists professional portfolio, and a chart-stimulated recall process. The Quality Management Committee made the final decision regarding the physical therapists performance using the assessors summary report. Generalizability theory was used to examine the interrater reliability of the tools. Correlation coefficients and regression analyses were used to examine the relationships between demographic factors and performance. Results The majority of the physical therapists (88%) completed the program successfully, 11% required remediation, and 1% required further assessment. The interrater reliability of the components was above .70 for 2 raters’ evaluations, with the exception of billing practices. There was no relationship between the final decision and age or years since graduation (r<.05). Limitations Limitations include a small sample and a lack of data on system-related factors that might influence performance. Conclusions The vast majority of the physical therapists met the College of Physiotherapists of Ontarios professional standards. Reliability analysis indicated that the number of charts reviewed could be reduced. Strategies to improve the reliability of the various components must take into account feasibility issues related to financial and human resources. Further research to examine factors associated with failure to adhere to professional standards should be considered. These results can provide valuable information to regulatory agencies or managers considering similar continuing competence assessment programs.

Videoconferencing a stroke assessment training workshop: effectiveness, acceptability, and cost.

Introduction: Videoconferencing (VC) is becoming a common method for the delivery of continuing education (CE) to clinicians in remote locations. The purpose of this study was to compare the effectiveness, acceptability, and costs of a full‐day training workshop (TW) delivered through two different formats: face‐to‐face (FTF) and VC. The TW was designed to teach administration and scoring guidelines for the Chedoke‐McMaster Stroke Assessment, an outcome measure used by rehabilitation professionals. Methods: The TW was delivered simultaneously in FTF and VC formats to a total of five remote communities on two separate occasions. Participants completed a test of scoring competency at the beginning (pretest) and end (posttest) of the TW as well as a feedback questionnaire. A cost comparison was also undertaken. Results: Forty‐four physical and occupational therapists participated. No significant between‐group differences were found in posttest scoring competency related to delivery format (FTF or VC): (F1,38 = 0.6, MSE = 3.6, p > 0.4), or for the two workshops: (F1,38 = 1.4, MSE = 3.6, p > 0.2). Despite technical difficulties, participant experience was rated as “good” to “excellent.” The VC method offered considerable cost savings to participants and their organizations, at a minimum of

Self-Assessment: The Disconnect between Research and Rhetoric

7,437 (Canadian). Conclusion: Clinicians participating in the TW via VC performed as well as those in the FTF group on the competency test. Videoconferencing improves access to CE, is well received by participants, and provides a cost‐effective method of course delivery. Further evaluation of other CE events delivered through VC is indicated.

Factors predicting competence as assessed with the written component of the Canadian Physiotherapy Competency Examination

PURPOSE Physical therapists are expected to engage in self-assessment in order to ensure competent practice and to identify appropriate professional development activities. SUMMARY OF KEY POINTS This paper reviews the current literature on the accuracy and role of self-assessment in physical therapy. Current literature indicating that self-assessment cannot be conducted with any degree of accuracy is discussed, and a proposed reformulation of the concept of self-assessment is presented. RECOMMENDATIONS Practical strategies are offered for clinicians to improve the potential for obtaining reliable and valid information about their own clinical performance to guide the selection of appropriate professional development activities and to promote the provision of competent patient care.

PATIENT-REPORTED OUTCOMES IN RARE LYSOSOMAL STORAGE DISEASES: KEY INFORMANT INTERVIEWS AND A SYSTEMATIC REVIEW PROTOCOL

ABSTRACT Little is known about the predictors of success on the written component of the Physiotherapy Competency Examination (PCE), the requirement for licensure in most Canadian jurisdictions. The purpose of this study was to examine the relationship between educational factors and the performance of Canadian educated physical therapists (CEPTs) and internationally educated physical therapists (IEPTs). An anonymized database composed of 24 sittings of the examination from the years 2001 to 2004 was used. Pearson correlation analyses and regression analyses were conducted to examine the relationships between educational factors and scores. ANOVA was used to compare differences in scores between candidate groups. CEPTs, first-time writers, and candidates writing in their year of graduation had the highest pass rates. The performance of both CEPTS and IEPTs does not appear to decline for any candidate writing beyond the first year post-graduation. The novel finding that the performance of candidates did not decline with increasing years postgraduation warrants further study. Other future research initiatives should include additional demographic and educational factors and address the relationship between performance on both components of the PCE and actual clinical practice.

Limited responsiveness related to the minimal important difference of patient-reported outcomes in rare diseases

OBJECTIVES To investigate the use, challenges and opportunities associated with using patient-reported outcomes (PROs) in studies with patients with rare lysosomal storage diseases (LSDs), we conducted interviews with researchers and health technology assessment (HTA) experts, and developed the methods for a systematic review of the literature. The purpose of the review is to identify the psychometrically sound generic and disease-specific PROs used in studies with patients with five LSDs of interest: Fabry, Gaucher (Type I), Niemann-Pick (Type B) and Pompe diseases, and mucopolysaccharidosis (Types I and II). METHODS Researchers and HTA experts who responded to an email invitation participated in a telephone interview. We used qualitative content analysis to analyze the anonymized transcripts. We conducted a comprehensive literature search for studies that used PROs to investigate burden of disease or to assess the impact of interventions across the five LSDs of interest. RESULTS Interviews with seven researchers and six HTA experts representing eight countries revealed five themes. These were: (i) the importance of using psychometrically sound PROs in studies with rare diseases, (ii) the paucity of disease-specific PROs, (iii) the importance of having PRO data for economic analyses, (iv) practical and psychometric limitations of existing PROs, and (v) suggestions for new PROs. The systematic review has been completed. CONCLUSIONS The interviews highlight current challenges and opportunities experienced by researchers and HTA experts involved in work with rare LSDs. The ongoing systematic review will highlight the experience, opportunities, and limitations of PROs in LSDs and provide suggestions for future research.