Biomedical subjects

Andrea E Bialocerkowski

Publications and source records attributed to Andrea E Bialocerkowski.

8 recordsLinked to original sources

PubMed2006

Comparison of visual and objective quantification of elbow and shoulder movement in children with obstetric brachial plexus palsy.

BACKGROUND: The Active Movement Scale is a frequently used outcome measure for children with obstetric brachial plexus palsy (OBPP). Clinicians observe upper limb movements while the child is playing and quantify them on an 8 point scale. This scale has acceptable reliability however it is not known whether it accurately depicts the movements observed. In this study, therapist-rated Active Movement Scale grades were compared with objectively-quantified range of elbow flexion and extension and shoulder abduction and flexion in children with OBPP. These movements were chosen as they primarily assess the C5, C6 and C7 nerve roots, the most frequently involved in OBPP. Objective quantification of elbow and shoulder movements was undertaken by two-dimensional motion analysis, using the v-scope. METHODS: Young children diagnosed with OBPP were recruited from the Royal Children's Hospital (Melbourne, Australia) Brachial Plexus registry. They participated in one measurement session where an experienced paediatric physiotherapist facilitated maximal elbow flexion and extension, shoulder abduction and extension through play, and quantified them on the Active Movement Scale. Two-dimensional motion analysis captured the same movements in degrees, which were then converted into Active Movement Score grades using normative reference data. The agreement between the objectively-quantified and therapist-rated grades was determined using percentage agreement and Kappa statistics. RESULTS: Thirty children with OBPP participated in the study. All were able to perform elbow and shoulder movements against gravity. Active Movement Score grades ranged from 5 to 7. Two-dimensional motion analysis revealed that full range of movement at the elbow and shoulder was rarely achieved. There was moderate percentage agreement between the objectively-quantified and therapist-rated methods of movement assessment however the therapist frequently over-estimated the range of movement, particularly at the elbow. When adjusted for chance, agreement was equal to chance. CONCLUSION: Visual estimates of elbow and shoulder movement in children with OBPP may not provide true estimates of motion. Future work is required to develop accurate, clinically-acceptable methods of quantifying upper limb active movements. Since few children attained full range of motion, elbow and shoulder movement should be monitored and maintained over time to reduce disability later in life.

Journal Article↗

PubMed2006

Reliability of the V-scope system in the measurement of arm movement in children with obstetric brachial plexus palsy.

This study reports on a novel methodology using the V-scope to quantify elbow and shoulder movement in young children with obstetric brachial plexus palsy (OBPP), and the intra- and interreliability of this method. The V-scope, a portable, inexpensive movement analysis system, was configured in an L-shape, with two transmitting towers placed on the floor and one 1.35m off the ground. These towers received ultrasonic pulses from buttons that were placed over standardized landmarks of the child's trunk, chest, and upper limb. Two physiotherapists (a paediatric and a generalist) facilitated the maximum range of active elbow flexion/extension and shoulder abduction/flexion in 30 children with OBPP (18 females, 12 males; age range 6mo-4y 7mo; mean age 2y 6mo [SD 1y 2mo]). Assessments were conducted on two occasions, one week apart. The V-scope was found to be feasible to use by a specialist and a generalist physiotherapist, demonstrating moderate to high reliability coefficients, small measurement errors, and lack of missing data. The pediatric physiotherapist was more reliable in measuring elbow and shoulder movement compared with the generalist physiotherapist, which suggests that the same experienced, pediatric physiotherapist should assess elbow and shoulder movement across all occasions of testing.

Arm↗

PubMed2005

Conservative interventions for positional plagiocephaly: a systematic review.

This review aimed to synthesize current research evidence to determine the effectiveness of conservative interventions for infants with positional plagiocephaly. A systematic review was conducted, where papers were sourced from 13 library and internet databases. Research was included if published in English between 1983 and 2003. Level of evidence and quality of each paper was assessed to determine studies' magnitude of inherent bias. Results were synthesized in a narrative format and were considered with respect to homogeneity of participants, response rate, and outcome measures. Sixteen papers met inclusion criteria: 12 were case series and four were comparative studies. The methodological quality of the studies was moderate to poor, thus their results should be interpreted with caution. A consistent finding was that counterpositioning +/- physiotherapy or helmet therapy may reduce skull deformity; however, it was not possible to draw conclusions regarding the relative effectiveness of these interventions. Further investigation is required to compare the effect of helmet therapy with counterpositioning alone or when combined with physiotherapy. First, there is a need to develop an outcome measurement battery which incorporates psychometrically-sound measures from the perspectives of clinicians and patients.

Humans↗

PubMed2004

A systematic review of the content of critical appraisal tools.

BACKGROUND: Consumers of research (researchers, administrators, educators and clinicians) frequently use standard critical appraisal tools to evaluate the quality of published research reports. However, there is no consensus regarding the most appropriate critical appraisal tool for allied health research. We summarized the content, intent, construction and psychometric properties of published, currently available critical appraisal tools to identify common elements and their relevance to allied health research. METHODS: A systematic review was undertaken of 121 published critical appraisal tools sourced from 108 papers located on electronic databases and the Internet. The tools were classified according to the study design for which they were intended. Their items were then classified into one of 12 criteria based on their intent. Commonly occurring items were identified. The empirical basis for construction of the tool, the method by which overall quality of the study was established, the psychometric properties of the critical appraisal tools and whether guidelines were provided for their use were also recorded. RESULTS: Eighty-seven percent of critical appraisal tools were specific to a research design, with most tools having been developed for experimental studies. There was considerable variability in items contained in the critical appraisal tools. Twelve percent of available tools were developed using specified empirical research. Forty-nine percent of the critical appraisal tools summarized the quality appraisal into a numeric summary score. Few critical appraisal tools had documented evidence of validity of their items, or reliability of use. Guidelines regarding administration of the tools were provided in 43% of cases. CONCLUSIONS: There was considerable variability in intent, components, construction and psychometric properties of published critical appraisal tools for research reports. There is no "gold standard' critical appraisal tool for any study design, nor is there any widely accepted generic tool that can be applied equally well across study types. No tool was specific to allied health research requirements. Thus interpretation of critical appraisal of research reports currently needs to be considered in light of the properties and intent of the critical appraisal tool chosen for the task.

Allied Health Occupations↗

PubMed2004

Application of current research evidence to clinical physiotherapy practice.

This paper reviews the nature of physiotherapy intervention studies published in core physiotherapy journals (Australian Journal of Physiotherapy, Physiotherapy Theory and Practice, Physical Therapy, Physiotherapy, and Physiotherapy Canada) between October 2001 and September 2002. The clinical applicability of their evidence was considered in light of the clinical relevance of diagnostic criteria used for subject recruitment, the nature of the interventions tested, and the outcome measures used to determine effectiveness of the intervention. Most studies investigated a "package of care" and used clinician-oriented measures of outcomes to determine the effectiveness of an intervention. This mirrors current clinical practice. However, few studies used tissue-based diagnostic criteria for subject recruitment, tested interventions within an episode-of-care model, or measured outcome from multiple stakeholders' perspectives. These findings highlight potential barriers for clinicians in the uptake and sustained application of research evidence in the clinical setting. Both clinical and research physiotherapists need to be involved in producing generalizable research findings to ensure that evidence-based practice can be widely and readily adopted.

Australia↗

PubMed2003

Validity of the patient-focused wrist outcome instrument: do impairments represent functional ability?

The development of outcome instruments has been reported to be a long process, often taking years to complete. In a previous article, we reported on the rationale behind the construction of a new wrist outcome instrument that assesses, from the wrist-injured individual's perspective, their ability to perform activities of daily living following a wrist disorder. Content validity and test-retest reliability of the wrist outcome instrument also was demonstrated. Here we report on the results of the assessment of other aspects of validity, specifically construct validity of the wrist outcome instrument and the ability of the instrument to detect change over time. We evaluated these psychometric properties against frequently used clinical tests that assess impairments and thus report on the relationship between the ability to perform activities of daily living and impairment measures.

Activities of Daily Living↗

PubMed2003

Development of a patient-focused wrist outcome instrument.

Many types of wrist outcome instruments are used in the clinical setting to determine the effectiveness of treatment. The authors have previously identified that the individual's perspective and the use of compensatory mechanisms are important factors to consider in the measurement of outcome following a wrist disorder. No published wrist outcome instrument currently addresses these factors, however. Therefore, the aim of this study was to develop a wrist outcome instrument that assessed, from the wrist-injured individual's perspective, their actual ability to perform activities of daily living following a wrist disorder. This article reports on the rationale and procedures used to construct the new instrument and presents the results of preliminary psychometric testing of the wrist outcome instrument.

Activities of Daily Living↗

PubMed2002

Difficulties associated with wrist disorders--a qualitative study.

OBJECTIVE: To explore the range of functional difficulties and compensatory mechanisms reported by individuals with a wrist disorder, to provide a basis for development of a patient-focused outcome instrument. DESIGN: Descriptive study using a qualitative, interview-based framework. SETTING/SUBJECTS: A volunteer sample of individuals, who were diagnosed with a unilateral, localized wrist disorder, were recruited from a wide range of health care settings situated in different socio-economic and geographic areas of Adelaide, Australia. Recruitment continued until theoretical saturation of the data occurred. INTERVENTIONS: Semi-structured, audiotaped interviews were conducted with each individual to elicit information concerning 'how your wrist disorder has affected your ability to perform daily activities'. MAIN OUTCOME MEASURES: Trends regarding reporting of difficult activities and compensatory mechanisms used. RESULTS: Forty-two individuals were interviewed. This was the point where theoretical saturation of research information had been reached. A few individuals reported difficulty with functional tasks prior to wrist injury. Following diagnosis, a wide range of difficulties, which included heavy, gross and fine motor activities, was reported. Compensatory mechanisms were used by all individuals, with requesting someone else to do the task, using the other hand, and using other parts of the body to lift or grasp being the most common. CONCLUSIONS: Current wrist outcome instruments do not contain the full range of difficult activities that were elicited from our sample, which casts doubt on these instruments' ability to fully measure change in capacity. Our results should provide the basis for the development of a relevant, sensitive, patient-focused outcome instrument.

Activities of Daily Living↗