Sharon Switzer-McIntyre

Reliability and validity of the AGREE instrument used by physical therapists in assessment of clinical practice guidelines

BackgroundThe AGREE instrument has been validated for evaluating Clinical Practice Guidelines (CPG) pertaining to medical care. This study evaluated the reliability and validity of physical therapists using the AGREE to assess quality of CPGs relevant to physical therapy practice.MethodsA total of 69 physical therapists participated and were classified as generalists, specialist or researchers. Pairs of appraisers within each category evaluated independently, a set of 6 CPG selected at random from a pool of 55 CPGs.ResultsReliability between pairs of appraisers indicated low to high reliability depending on the domain and number of appraisers (0.17–0.81 for single appraiser; 0.30–0.96 when score averaged across a pair of appraisers). The highest reliability was achieved for Rigour of Development, which exceeded ICC> 0.79, if scores from pairs of appraisers were pooled. Adding more than 3 appraisers did not consistently improve reliability. Appraiser type did not determine reliability scores. End-users, including study participants and a separate sample of 102 physical therapy students, found the AGREE useful to guide critical appraisal. The construct validity of the AGREE was supported in that expected differences on Rigour of Development domains were observed between expert panels versus those with no/uncertain expertise (differences of 10–21% p = 0.09–0.001). Factor analysis with varimax rotation, produced a 4-factor solution that was similar, although not in exact agreement with the AGREE Domains. Validity was also supported by the correlation observed (Kendall-tao = 0.69) between Overall Assessment and the Rigour of Development domain.ConclusionThese findings suggest that the AGREE instrument is reliable and valid when used by physiotherapists to assess the quality of CPG pertaining to physical therapy health services.

Upper extremity disability in workers with hand–arm vibration syndrome

BACKGROUND Hand-arm vibration syndrome (HAVS) is a common occupational problem and it is important to understand the disability associated with this condition. AIMS To measure upper extremity disability using the disabilities of the arm, shoulder and hand (DASH) questionnaire in workers with HAVS and to determine how this disability is affected by the vascular and neurological components of HAVS and other factors, in particular musculoskeletal variables. METHODS Subjects were recruited from HAVS patients assessed at St Michaels Hospital, Toronto, Canada, over a 2-year period. All participants were assessed by an occupational medicine specialist to determine the specific components of HAVS and musculoskeletal variables including upper extremity pain score measured by the Borg scale. The DASH questionnaire was completed on the same day as the clinical assessment and before any feedback had been given about the clinical findings. RESULTS A total of 141 workers with HAVS were recruited and 139 agreed to participate in the study. This study group had a statistically significantly higher mean DASH score than the US population (P < 0.001). The multiple linear regression analysis indicated that upper extremity pain score (P < 0.001), the Stockholm sensorineural scale (P < 0.01) and the number of fingers blanching (P < 0.05) had a statistically significant association with an increase in the DASH score. The highest partial R(2) value was for the upper extremity pain score. CONCLUSIONS Workers with HAVS have significant upper extremity disability and musculoskeletal factors appear to make an important contribution to this disability.

DASH work module in workers with hand–arm vibration syndrome

BACKGROUND The Disabilities of the Arm, Shoulder and Hand work module (DASH-W) questionnaire has not previously been described in relation to hand-arm vibration syndrome (HAVS). AIMS To measure work-related disability in workers with HAVS using the DASH-W questionnaire and to determine how the various components of HAVS affect the DASH-W score. METHODS Workers with HAVS from a variety of industries were assessed over a 2-year period at the occupational health clinic, St Michaels Hospital, Toronto. Subjects completed the DASH-W questionnaire and were assessed by an occupational physician to determine their Stockholm sensorineural and vascular stages and upper extremity pain score measured by the Borg scale, as an indication of musculoskeletal problems associated with HAVS. The average DASH-W score was compared with the average value for the US population. Multiple linear regression was used to determine the contribution of the various components of HAVS to the DASH-W score. RESULTS There were 139 (134 men and 5 women) participants. The subjects with HAVS had a mean DASH-W score of 54.7 (95% CI: 50.3-59.1), which was considerably higher than the average for the US population (P < 0.001). Statistically significant HAVS variables in the multiple linear regression included the Stockholm sensorineural stage (P < 0.05) and the upper extremity pain score (P < 0.001) with the pain score having the highest partial R (2) value. CONCLUSIONS Workers with HAVS reported significant upper extremity work-related disability as measured by the DASH-W questionnaire, and the upper extremity pain score made the largest contribution to the DASH-W scores in these subjects.

Hand-arm vibration syndrome: Workers' experience with functional impairment and disability

STUDY DESIGN Qualitative and descriptive study. INTRODUCTION Hand-arm vibration syndrome (HAVS) is a prevalent disease in Canada. There is little work on the perspectives of HAVS patients. PURPOSE OF THE STUDY Explore perceptions of disability and functional compromise in patients with HAVS. METHODS Semi-structured telephone interviews were conducted with HAVS patients and analysed using content analysis. RESULTS The 11 participants reported numbness, pain, and reduced dexterity, strength, and sensation. Participants noted that HAVS was an inevitable aspect of their work. They indicated frustration with their condition and viewed it as a disability. To overcome impairments risky strategies are often used. Participants reported lack of support to manage symptoms and overcome work disability. DISCUSSION HAVS related impairment is disabling. Workers require improved resources and support to address symptom management and safe strategies to minimize work disability. CONCLUSION HAVS patients experience functional, social, emotional, and psychological disability. LEVEL OF EVIDENCE Not applicable.

Glove Use and Glove Education in Workers with Hand Dermatitis.

BackgroundOccupational skin diseases are common. The occurrence of occupational skin diseases represents a failure of primary prevention strategies that may include the use of personal protective equipment, most commonly gloves. ObjectiveThe objective of this study was to describe current glove use and education practices related to gloves in workers being assessed for possible work-related hand dermatitis. MethodsParticipants included consecutive patients being assessed for possible work-related hand dermatitis. A self-administered questionnaire obtained information on demographics, workplace characteristics and exposures, glove use, and education regarding gloves. ResultsNinety percent of the 105 participants reported using gloves. Only 44% had received training related to glove use in the workplace. Major gaps in training content included skin care when using gloves, warning signs of skin problems, and glove size. If the worker indicated no glove training received, the majority reported they would have used gloves if such training was provided. ConclusionsAlthough the majority of workers being assessed wore gloves, the minority had received training related to glove use. Particular gaps in training content were identified. Those who had not received training noted they would likely have used gloves if training had been provided.

Simulation Experiences in Canadian Physiotherapy Programmes: A Description of Current Practices

Purpose: Although health care professional education programmes around the world are increasingly using sophisticated simulation technology, the scope of simulation use in Canadian physiotherapy programmes is currently undefined. The current study explores the definitions of simulation, its current use, and the perceived benefits and barriers in Canadian entry-to-practice physiotherapy programmes. Method: Using a qualitative, descriptive study approach, we contacted Canadian physiotherapy programmes to identify faculty members with simulation experience. Using a semi-structured interview format, we asked participants to discuss their perspectives of simulation in their physiotherapy programmes. Interviews were audio recorded, transcribed, and analyzed for themes. Results: Of 13 eligible Canadian physiotherapy programmes, participants from 8 were interviewed. The interviews revealed three major themes: (1) variability in the definition of fidelity in simulation, (2) variability in simulation use, and (3) the benefits of and barriers to the use of simulation. Conclusions: Variability in the definition of fidelity in simulation among Canadian physiotherapy programmes is consistent with the current literature, highlighting a spectrum of complexity from low fidelity to high fidelity. Physiotherapy programmes are using a variety of simulations, with the aim of creating a bridge from theoretical knowledge to clinical practice. This study describes the starting point for characterizing simulation implementation in Canadian physiotherapy programmes and reflects the diversity that exists across the country.

Clinician's Commentary on van der Spuy et al.1

Admissions to health professional programmes are highly competitive; thus, programmes seek to ensure that they are extending offers of admission to candidates who best exemplify the profile of their profession. Considering applicants involves a multiple-sampling process that includes assessing academic ability, personal statements, interviews, and references.