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Sherra Solway

Publications and source records attributed to Sherra Solway.

5 recordsLinked to original sources
PubMed2005

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

BACKGROUND: The 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. METHODS: A 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. RESULTS: Reliability 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. CONCLUSION: These 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.

Cardiology↗
PubMed2003

Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration.

STUDY DESIGN: A systematic review of randomized and/or double-blinded controlled trials. SUMMARY OF BACKGROUND DATA: The use of muscle relaxants in the management of nonspecific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. OBJECTIVES: The aim of this review was to determine if muscle relaxants are effective in the treatment of nonspecific low back pain. METHODS: A computer-assisted search of the Cochrane Library (Issue 2, 2002), MEDLINE (1966 up to October 2001), and EMBASE (1988 up to October 2001) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Randomized and/or double-blinded controlled trials, involving patients diagnosed with nonspecific low back pain, treated with muscle relaxants as monotherapy or in combination with other therapeutic methods, were included for review. Two reviewers independently carried out the methodologic quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong," "moderate," "limited," "conflicting," or "no" evidence. RESULTS: Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality; 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 nonbenzodiazepines, and 2 antispasticity muscle relaxants in comparison with placebo. Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute low back pain on short-term pain relief. The pooled relative risk for nonbenzodiazepines versus placebo after 2 to 4 days was 0.80 (95% confidence interval: 0.71 to 0.89) for pain relief and 0.49 (95% confidence interval: 0.25 to 0.95) for global efficacy. Adverse events, however, with a relative risk of 1.50 (95% confidence interval: 1.14 to 1.98) were significantly more prevalent in patients receiving muscle relaxants and especially the central nervous system adverse effects (relative risk 2.04; 95% confidence interval: 1.23 to 3.37). The various muscle relaxants were found to be similar in performance. CONCLUSIONS: Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or nonsteroidal anti-inflammatory drugs.

Controlled Clinical Trials as Topic↗
PubMed2003

Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease.

OBJECTIVES: To investigate the feasibility of an outdoor 6-minute walk test (6MWT) as a measure of functional status among individuals with chronic obstructive pulmonary disease (COPD), and to examine the relationship between performance on an indoor and an outdoor 6MWT. DESIGN: An experimental, repeated-measures crossover design. Subjects were studied on 2 separate days in the same week. Two 6MWTs-one indoors and the other outdoors-were performed on each study day, with a rest in between. The test order was randomly selected on the first day and reversed on the second day. Outdoor tests were performed on days of moderate weather conditions (mean temperature +/- standard deviation, 21 degrees +/-3 degrees C; mean wind speed, 15+/-7km/h; no precipitation) and on a flat surface (sidewalk). SETTING: Outpatient rehabilitation program in Ontario. PARTICIPANTS: Eighteen subjects with COPD (10 men, 8 women; age, 70+/-8y), 5 using supplemental oxygen at rest (forced expiratory volume in 1s, 1.0+/-0.3L; 42%+/-8% of predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Distance walked in 6 minutes (in meters), duration of rest (in seconds), and change in rate of perceived dyspnea. RESULTS: There was no significant effect of setting (indoors vs outdoors) on distance walked (394+/-86m vs 398+/-84m, P=0.4), duration of rest (13+/-28s vs 9+/-20s, P=0.4), or change in rate of perceived dyspnea (2.3+/-1.7 vs 2.3+/-2.0, P=0.8). Testing day had no significant effect on walk test performance (all P>0.1). CONCLUSIONS: The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors.

Aged↗
PubMed2002

The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD.

STUDY OBJECTIVES: This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use. DESIGN: Repeated-measures randomized crossover design using the 6-min walk test (6MWT) as the primary outcome measure. SETTING: Respiratory rehabilitation center. PATIENTS: Forty stable subjects who had received a diagnosis of COPD. INTERVENTIONS: Two 6MWTs were performed on each study day. One 6MWT was performed unaided, and the other was performed with a rollator. The order was randomized on the first day and reversed on the second day. RESULTS: Use of the rollator was associated with a significant reduction in dyspnea (p < 0.001) and duration of rest (reduction for the total group, 19 s; and reduction for those who walked < 300 m unaided, 40 s; p = 0.001) during the 6MWT. For subjects who walked < 300 m unaided, there was also a significant improvement in distance walked (p = 0.02). No changes were found for the measures of cardiorespiratory function or gait (p > 0.05). The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator (p < 0.005). The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided. CONCLUSIONS: Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD. Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea, reduced rest time, and improved distance walked.

Aged↗