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Background: Many complex new procedures involve a learning curve, and patients treated by individuals who are new to a procedure may have more complications than those treated by a practitioner who has performed the intervention more frequently. Still, at some point on the learning curve, each individual must decide that he or she is qualified to perform a procedure, presumably on the basis of his or her level of confidence, background, education, and skill. To evaluate the interrelationship of these factors, we designed a study in which we assessed the performance of a simulated knee joint injection.Methods: Ninety-three practitioners attending a continuing medical education session on knee injection were randomized to receive skills instruction through the use of a printed manual, a video, or hands-on instruction; each performed one injection before and after instruction. The participants completed pre-instruction and post-instruction questionnaires gauging confidence and also provided self-assessments of their performances of injections before and after instruction. Self-assessments were compared with objective performance standards measured by custom-designed knee models with electronic sensors that detected correct needle placement.Results: Before instruction, the participants' confidence was significantly but inversely related to competent performance (r = -0.253, p = 0.02); that is, greater confidence correlated with poorer performance. Both men and physician-practitioners displayed higher pre-instruction confidence (p < 0.01), which was not correlated with better performance. After instruction, performance improved significantly in all three training groups (p < 0.001), with no significant differences in efficacy detected among the three groups (p = 0.99). After instruction, confidence correlated with objective competence in all groups (r = 0.24, p = 0.04); however, this correlation was weaker than the correlation between the participants' confidence and their self-assessment of performance (r = 0.72, p = 0.001).Conclusions: Even low-intensity forms of instruction improve individuals' confidence, competence, and self-assessment of their skill in performing the fairly straightforward psychomotor task of simulated knee injection. However, men and physicians disproportionately overestimated their skills both before and after training, a finding that worsened as confidence increased. The inverse relationship between confidence and competence that we observed before the educational intervention as well as the demographic differences that we noted should raise questions about how complex new procedures should be introduced and when self-trained practitioners should begin to perform them. [ABSTRACT FROM AUTHOR]

This study identified clinical (e.g., etiology) and demographic factors related to prosthesis use in persons with upper- and lower-limb amputation (ULA and LLA, respectively) and the effect of phantom limb pain (PLP) and residual limb pain (RLP) on prosthesis use. A total of 752 respondents with LLA and 107 respondents with ULA completed surveys. Factors related to greater use (hours per day) for persons with LLA included younger age, full- or part-time employment, marriage, a distal amputation, an amputation of traumatic etiology, and an absence of PLP. Less use was associated with reports that prosthesis use worsened RLP, and greater prosthesis use was associated with reports that prosthesis use did not affect PLP. Having a proximal amputation and reporting lower average PLP were related to greater use in hours per day for persons with an ULA, while having a distal amputation and being married were associated with greater use in days per month. Finally, participants with LLA were significantly more likely to wear a prosthesis than those with ULA. These results underscore the importance of examining factors related to prosthesis use and the differential effect that these variables may have when the etiology and location of amputation are considered. [ABSTRACT FROM AUTHOR]

The movement of the center of mass (COM) during human walking has been hypothesized to follow a sinusoidal pattern in the vertical and mediolateral directions. The vertical COM displacement has been shown to increase with velocity, but little is known about the mediolateral movement of the COM. In our evaluation of the mediolateral COM displacement at several walking speeds, 10 normal subjects walked at their self-selected speed and then at 0.7, 1.0, 1.2, and 1.6 m/s in random order. We calculated COM location from a 15-segment, full-body kinematic model using segmental analysis. Mediolateral COM displacement was 6.99 +/- 1.34 cm at the slowest walking speed and decreased to 3.85 +/- 1.41 cm at the fastest speed (p < 0.05). Vertical COM excursion increased from 2.74 +/- 0.52 at the slowest speed to 4.83 +/- 0.92 at the fastest speed (p < 0.05). The data suggest that the relationship between the vertical and mediolateral COM excursions changes substantially with walking speed. Clinicians who use observational gait analysis to assess walking problems should be aware that even normal individuals show significant mediolateral COM displacement at slow speeds. Excessive vertical COM displacement that is obvious at moderate walking speeds may be masked at slow walking speeds. [ABSTRACT FROM AUTHOR]