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Biomedical subjects

Megan Davidson

Publications and source records attributed to Megan Davidson.

6 recordsLinked to original sources
PubMed2006

Evidence based practice: a survey of physiotherapists' current practice.

BACKGROUND AND PURPOSE: [corrected] Evidence-based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self-reported practice, skills and knowledge of evidence-based practice and to examine differences between recent and experienced graduates, physiotherapists with low and high levels of training and physiotherapists working in private practice and hospital settings. METHOD: A survey was sent to 230 physiotherapists working in hospitals and in private practice. One hundred and twenty-four were completed and returned. RESULTS: Although 69.4% of respondents said they frequently (at least monthly) read research literature, only 10.6%, 15.3% and 26.6% of respondents, respectively, searched PEDro, Cochrane and Medline or Cinahl databases frequently, and only 25.8% of respondents reported critically appraising research reports. Recent graduates rated their evidence-based practice skills more highly than more experienced graduates, but did not perform evidence-based practice tasks more often. Physiotherapists with higher levels of training rated their evidence-based practice skills more highly, were more likely to search databases and to understand a range of evidence-based practice terminology than those with lower levels of training. Private practice and hospital physiotherapists rated their evidence-based practice skills equally and performed most evidence-based practice activities with equal frequency. CONCLUSIONS: Respondents had a positive attitude toward evidence-based practice and the main barriers to evidence-based practice were time required to keep up to date, access to easily understandable summaries of evidence, journal access and lack of personal skills in searching and evaluating research evidence. Efforts to advance evidence-based practice in physiotherapy should focus on reducing these barriers.

Adult↗
PubMed2006

Monitoring the change: current trends in outcome measure usage in physiotherapy.

Physiotherapists have traditionally relied on impairment measures such as range of motion and muscle strength to monitor patient progress. The impact of treatment on patients' daily activities can be assessed with valid and reliable questionnaires, but the use of standardized questionnaires by physiotherapists appeared to be limited. A range of strategies were implemented that aimed to increase physiotherapists' use of standardized measures of functional activities. A simple random sample of 300 was drawn from a database of physiotherapy providers to a transport accident scheme, and was surveyed in March and September 2003, with response rates of 51% and 55%, respectively. There was a statistically significant (P<.05) increase in reported use of seven questionnaires and a significant reduction in the perception of barriers that were targeted by the interventions The most frequently utilized tests were a pain rating scale and questionnaires for lumbar and cervical problems. Physiotherapists' attitudes to outcome measurement were generally positive although there was a small but statistically significant (P=.02) reduction in mean attitude score over the re-test period. Physiotherapists in the population sampled significantly increased their reported use of a range of standardized outcome measures over the re-test period. The trend towards greater objectivity in measuring the progress of rehabilitation can enable physiotherapists to develop improved treatment plans with the patients' needs at the centre of the equation.

Activities of Daily Living↗
PubMed2004

A low back-specific version of the SF-36 Physical Functioning scale.

STUDY DESIGN: A prospective repeated measures design was used to produce a back-specific version of the Short Form-36 Physical Functioning scale (SF-36 PF) by Rasch analysis of a pool of items from the SF-36 PF, Oswestry Disability Questionnaire, and the Quebec Back Pain Disability Scale. OBJECTIVES: To identify items for a back-specific version of the SF-36 PF scale and to compare the psychometric properties of the new version with the original 10-item scale. SUMMARY OF BACKGROUND DATA: Adequate assessment of patient function requires the administration of a generic and a condition-specific questionnaire. A back-specific version of the SF-36 PF would facilitate comprehensive patient assessment in the clinical setting. METHODS: Consecutive patients with low back pain presenting for physiotherapy treatment were recruited at three public hospitals, three community health services, and four private practices. Patients completed questionnaires on two occasions 6 weeks apart. RESULTS: A scale of 18 items showed a better fit to the Rasch model than the original SF-36 PF scale. Items in the original scale that had a poor fit (INFIT/OUTFIT statistics outside the range 0.7-1.3) showed an acceptable fit in the new scale. The augmented scale had comparable reliability and improved responsiveness to the original 10-item SF-36 PF scale. The minimum detectable change (90% confidence) and the minimum clinically important difference were 12 points. Floor and ceiling effects were practically eliminated. The psychometric properties of the new scale were comparable to those of the Oswestry Disability Questionnaire. CONCLUSIONS: The Low-Back SF-36 PF18 comprises the 10-item SF-36 PF scale and four items each from the Oswestry and Quebec back pain questionnaires. The possible total score ranges from 0 to 100, with a higher score indicating better function. The new scale appears to offer advantages over the use of the original scale for the assessment of functioning in patients with low back pain.

Adolescent↗
PubMed2002

The interpretation of diagnostic test: a primer for physiotherapists.

This paper outlines a practical approach to assist physiotherapists to interpret the results of diagnostic or screening tests. Diagnostic tests are used during clinical assessment to increase or decrease the clinician's estimate of the likelihood that a client has a particular condition. A negative result for a test that is 100% sensitive can rule a condition out (SnOUT), and a positive result for a test that is 100% specific can rule a condition in (SpIN). However, tests are rarely 100% accurate, and false-positive and false-negative results can occur. The examining therapist needs to estimate the probability that a client has a particular condition (the pre-test probability), then estimate the extent to which they are more or less certain given a positive or negative test result (the post-test probability). The likelihood ratio, which combines the information provided by a test's sensitivity and specificity, is the most useful tool for the clinical interpretation of test results.

Data Interpretation, Statistical↗
PubMed2002

A comparison of five low back disability questionnaires: reliability and responsiveness.

BACKGROUND AND PURPOSE: The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. SUBJECTS AND METHODS: Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. RESULTS: Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other. DISCUSSION AND CONCLUSION: Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.

Adult↗