Torbjörn Falkmer

The Case for Using the Repeatability Coefficient When Calculating Test-Retest Reliability

The use of standardised tools is an essential component of evidence-based practice. Reliance on standardised tools places demands on clinicians to understand their properties, strengths, and weaknesses, in order to interpret results and make clinical decisions. This paper makes a case for clinicians to consider measurement error (ME) indices Coefficient of Repeatability (CR) or the Smallest Real Difference (SRD) over relative reliability coefficients like the Pearson’s (r) and the Intraclass Correlation Coefficient (ICC), while selecting tools to measure change and inferring change as true. The authors present statistical methods that are part of the current approach to evaluate test–retest reliability of assessment tools and outcome measurements. Selected examples from a previous test–retest study are used to elucidate the added advantages of knowledge of the ME of an assessment tool in clinical decision making. The CR is computed in the same units as the assessment tool and sets the boundary of the minimal detectable true change that can be measured by the tool.

A comparison of eye movement behavior of inexperienced and experienced drivers in real traffic environments

Purpose. The importance of the visual system as the input channel for sensory information necessary when driving is often stated. There are several reports on differences in visual search strategies between experienced and inexperienced drivers, as well as in relation to the roadway. However, the results are ambiguous and are not sampled by similar procedures. Based on previous findings, the aim of the present study was to gain further knowledge on these differences by testing the hypotheses that inexperienced drivers, in comparison to experienced drivers, fixate closer to the vehicle, fixate more often on in-vehicle objects, spread their fixations less along the horizontal meridian, fixate more often on relevant traffic cues, and fixate more often on objects classified as potential hazards. Methods. Data from eye-tracker recordings of visual search strategies of the driver in real-world traffic were used for the analyses. Results. The results confirmed all stated hypotheses regarding differences between inexperienced and experienced drivers, with the exception of fixations closer to the vehicle, in which ambiguous results were found. Conclusions. The present study provides normative data for the understanding of the development of visual search strategies among drivers. The methodology used in the present study, i.e., to combine a quantitative analysis with a qualitative analysis proved, to be useful to compare visual search strategies among inexperienced and experienced drivers.

Fixation patterns of learner drivers with and without cerebral palsy (CP) when driving in real traffic environments

Among learner drivers with cerebral palsy (CP), driver education is problematic for those failing to fulfil their education as well as for those becoming licensed drivers. A crucial ingredient in the development of driving is the quality of the visual search. Problems increase for CP learners in those parts of training where high demands are set on visual search abilities. The aim of the study was to increase knowledge about search patterns among learners with CP in comparison with learners and experienced drivers without CP. The study was carried out in traffic by measuring eye movements and the duration and distribution of fixation. The results show that search strategies among learners with CP were less flexible than in the control groups. The results suggest a need for better methods for teaching CP learners search strategies and may provide a tool for such development.

The Cost of Autism Spectrum Disorders

Objective A diagnosis of an autism spectrum disorders is usually associated with substantial lifetime costs to an individual, their family and the community. However, there remains an elusive factor in any cost-benefit analysis of ASD diagnosis, namely the cost of not obtaining a diagnosis. Given the infeasibility of estimating the costs of a population that, by its nature, is inaccessible, the current study compares expenses between families whose children received a formal ASD diagnosis immediately upon suspecting developmental atypicality and seeking advice, with families that experienced a delay between first suspicion and formal diagnosis. Design A register based questionnaire study covering all families with a child with ASD in Western Australia. Participants Families with one or more children diagnosed with an ASD, totalling 521 children diagnosed with an ASD; 317 records were able to be included in the final analysis. Results The median family cost of ASD was estimated to be AUD

Effect of drivers' age and push button locations on visual time off road, steering wheel deviation and safety perception

34,900 per annum with almost 90% of the sum (

Pain and daily activities in rheumatoid arthritis.

29,200) due to loss of income from employment. For each additional symptom reported, approximately

Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia

1,400 cost for the family per annum was added. While there was little direct influence on costs associated with a delay in the diagnosis, the delay was associated with a modest increase in the number of ASD symptoms, indirectly impacting the cost of ASD. Conclusions A delay in diagnosis was associated with an indirect increased financial burden to families. Early and appropriate access to early intervention is known to improve a childs long-term outcomes and reduce lifetime costs to the individual, family and society. Consequently, a per symptom dollar value may assist in allocation of individualised funding amounts for interventions rather than a nominal amount allocated to all children below a certain age, regardless of symptom presentation, as is the case in Western Australia.

Face Recognition and Visual Search Strategies in Autism Spectrum Disorders: Amending and Extending a Recent Review by Weigelt et al.

The study examined the effects of manual control locations on two groups of randomly selected young and old drivers in relation to visual time off road, steering wheel deviation and safety perception. Measures of visual time off road, steering wheel deviations and safety perception were performed with young and old drivers during real traffic. The results showed an effect of both drivers age and button location on the dependent variables. Older drivers spent longer visual time off road when pushing the buttons and had larger steering wheel deviations. Moreover, the greater the eccentricity between the normal line of sight and the button locations, the longer the visual time off road and the larger the steering wheel deviations. No interaction effect between button location and age was found with regard to visual time off road. Button location had an effect on perceived safety: the further away from the normal line of sight the lower the rating.

The Nordic Stroke Driver Screening Assessment as predictor for the outcome of an on-road test

Aim: The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method: Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results: Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. Conclusion: The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation. Implications for Rehabilitation Pain in RA needs to be comprehensively analyzed and treated in the context of the patients’ perspective and needs. The relation between pain and performance of activities in RA highlights the importance of rehabilitative interventions to reduce pain in order to facilitate daily activity. The complexity of pain implies the need for multimodal approach in rehabilitation.

Perceptions of life balance among a working population in Sweden.

BackgroundRepetitive and stressful work tasks have been linked to the development of pain in the trapezius muscle, although the underlying mechanisms still remain unclear. In earlier studies, it has been hypothesized that chronic muscle pain conditions are associated with imbalance in the autonomic nervous system, predominantly expressed as an increased sympathetic activity. This study investigates whether women with chronic trapezius myalgia show higher muscle activity and increased sympathetic tone at baseline and during repetitive low-force work and psychosocial stress, compared with pain-free controls.MethodsEighteen women with chronic trapezius myalgia (MYA) and 30 healthy female controls (CON) were studied during baseline rest, 100 min of repetitive low-force work, 20 min of psychosocial stress (Trier Social Stress Test, TSST), and 80 min recovery. The subjects rated their pain intensity, stress and energy level every 20 min throughout the experiment. Muscle activity was measured by surface electromyography in the trapezius muscle (EMGtrap) and deltoid muscle (EMGdelt). Autonomic reactivity was measured through heart rate (HR), skin conductance (SCL), blood pressure (MAP) and respiration rate (Resp).ResultsAt baseline, EMGtrap, stress ratings, and HR were higher in MYA than in CON. Energy ratings, EMGdelt, SCL, MAP and Resp were, however, similar in the two groups. Significant main group effects were found for pain intensity, stress ratings and EMGtrap. Deltoid muscle activity and autonomic responses were almost identical in MYA and CON during work, stress and recovery. In MYA only, pain intensity and stress ratings increased towards the end of the repetitive work.ConclusionWe found increased muscle activity during uninstructed rest in the painful muscle of a group of women with trapezius myalgia. The present study could not confirm the hypothesis that chronic trapezius myalgia is associated with increased sympathetic activity. The suggestion of autonomic imbalance in patients with chronic local or regional musculoskeletal pain needs to be further investigated.