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BACKGROUND AND PURPOSE: Findings related to joint function can be recorded with movement diagrams or by characterizing the 'end-feel' according to the procedure described by Cyriax. Because both methods are used to classify pain and resistance in relation to joint range of motion (ROM), the purpose of this study was to simultaneously evaluate the reliability of these categorizations in a patient sample. SUBJECTS: Two physical therapists performed 2 assessments of passive lateral rotation of the shoulder in 34 patients. METHODS: Pain and resistance findings were recorded using movement diagrams and end-feel categories. Intraclass correlation coefficients (ICC[2,1]) were used to analyze the ratio (movement diagram) data, and kappa statistics (kappa) were used to analyze the categorical (end-feel) data. RESULTS: Intrarater ICCs varied from .58 to .89. Interrater ICCs for locating maximum pain and resistance in joint ROM varied from .85 to .91. Other interrater ICCs were lower (ICC = .34-.88). Intrarater kappa values for end-feel were moderate (kappa = .48-.59), and interrater kappa values were substantial (kappa = .62-.76). CONCLUSION AND DISCUSSION: Movement diagram measures conceptually related to the end of joint ROM and end-feel were highly reliable. This finding and the fact that additional end-feel categories were introduced in the study may partially explain the end-feel reliability findings. Consideration of their use in future studies may help to determine their clinical utility. [ABSTRACT FROM AUTHOR]

Background and Purpose. The purpose of this study was to quantify several variables of ankle stiffness and dorsiflexion (DF) range of motion (ROM) in the casted (fractured) and noncasted ankles of humans after cast removal. Subjects. Thirty subjects (chi square age = 32.4 years, SD=15.8) with malleolar ankle fractures were tested within 4 days of cast removal but before they began physical therapy. Methods. A torque motor system generated torque-versus-displacement graphs by recording angular displacement and resistive torque during a 6 degree/s passive cycling of the ankle from 10 degrees of plantar flexion to the limit of DF ROM. Maximum passive DF ROM, passive torque, and passive elastic stiffness at the neutral position and energy loss were measured. Testing was performed in the absence of triceps surae muscle electromyographic activity. For analysis, subjects were separated into two groups based on fracture severity. Results. There was no difference in passive torque between the fractured ankles and the matched noncasted ankles. There was a small difference in passive elastic stiffness between the more severely fractured ankles and the matched noncasted ankles. The fractured ankles were different in terms of energy loss from the matched noncasted ankles. For maximum passive DF ROM, there was a large difference between the fractured ankles (more severe: chi square = 4.4 degrees; less severe: chi square = 6.8 degrees) and the matched noncasted ankles (more severe: chi square = 15.1 degrees; less severe: chi square =19.1 degrees). Conclusion and Discussion. Altered length-tension relationships and neuromuscular mechanisms have been suggested to produce postimmobilization joint contractures. The results of this study on humans are consistent with both possibilities and support the theory that changes that occur during immobilization result in protection from overstretching of the fragile calf musculature after a period of ankle fixation. The time course of normalization of stretch reflexes warrants investigation. [ABSTRACT FROM AUTHOR]

Background: Prefracture physical function must be accurately determined to set appropriate and attainable goals for rehabilitation following hip fracture. This is especially important for people who were living independently prior to their fracture. This study determines reliability and internal consistency of a prefracture physical function questionnaire (PFPFQ) completed by both patients and knowledgeable informants (KIs).Methods: A 20-item PFPFQ, including ambulation, transfers, balance, and self-care domains, was developed using focus groups. Community-dwelling patients with a hip fracture (N = 40, 77.9 +/- 8 years) completed the PFPFQ on two occasions during postoperative acute care. Forty KIs were identified by the patients and also completed the PFPFQ on two occasions via telephone interview. Day-to-day reliability of the patients and KIs [intraclass correlation coefficients (ICC)], and internal consistency [Kuder-Richardson coefficient (KR)] of the PFPFQ were determined.Results: Intrarater reliability was high with ICCs (95% confidence interval) of 0.94 (0.89, 0.96) for patients and 0.96 (0.93, 0.98) for KIs. Interrater reliability on occasion 1 had an ICC of 0.81 (0.69, 0.88). Internal consistency of the patient responses on the first occasion was high (KR coefficient = 0.896).Conclusions: The PFPFQ is a reliable and internally consistent instrument for determining prefracture physical function in community-dwelling people who fracture their hip. In situations where patients with a hip fracture are unable to provide this necessary information, KIs can provide reliable estimates of prefracture function to assist in setting appropriate rehabilitation goals. [ABSTRACT FROM AUTHOR]

Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Identifying patients likely to be dissatisfied early in the recovery process could help reduce the number of dissatisfied patients. The purpose of this study was to create an easily administered short questionnaire to identify patients likely to be dissatisfied at 1 year post surgery early in the recovery process., Methods: The study included 275 patients who underwent primary TKA for osteoarthritis. Individual 3-month postsurgery questionnaire items from the Knee Injury and Osteoarthritis Outcome Score and Knee Society Knee Scoring System were pooled together and used as candidate items to create 3 different short questionnaires. Items included in each questionnaire were selected using least absolute shrinkage and selection operator logistic regressions, a backward elimination method, and theory-based approaches. The area under the curve for each short questionnaire was calculated to evaluate predictive performances., Results: All 3 questionnaires contained a small number of items and appeared to successfully predict 1-year postsurgery dissatisfaction early in the recovery process. The least absolute shrinkage and selection operator logistic regression, backward elimination, and theory-based questionnaires were comprised of 4, 7, and 5 items and had the area under the curve scores of 0.893, 0.902, and 0.890, respectively. A question evaluating rising from sitting and activities of daily living appeared in all of the created questionnaires., Conclusion: A short questionnaire that is easy to administer and interpret can effectively predict TKA patient dissatisfaction at 1 year post surgery early in the recovery process., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Stroke survivors often have unmet physical, psychological and/or social concerns. Patient Concerns Inventories (PCIs) have been developed for other health conditions to address concerns. Our objective was to develop a PCI for stroke care., Methods: This was a development study, including Modified Delphi study design, with academic and healthcare professionals with stroke care expertise. In Stage 1, a draft Stroke PCI (Version 1a) was created through identifying patient-reported concerns post-stroke from three previous studies and through expert panel discussions using Nominal Group Technique. In Stage 2, Version 1a was sent to 92 academic and healthcare professionals with stroke care expertise. Participants ranked their top 20 Stroke PCI items in order of importance and provided feedback. Rankings were converted into scores, and, with the feedback, used to amend the Stroke PCI. Two further rounds of feedback followed until consensus was reached between participants. A final draft of the Stroke PCI was created., Results: In stage 1, 64 potential Stroke PCI items were generated. In Stage 2, 38 participants (41.3%) responded to the request to rank Stroke PCI items. The three highest ranked items were 'Risk of another stroke', 'Walking', 'Recovery'. After three rounds of feedback and amendments, the final draft of the Stroke PCI consisted of 53 items., Conclusions: A Stroke PCI has been developed using patient-reported concerns in previous studies and input from academic and healthcare professionals. Future work will involve gathering further feedback on the tool and exploring its acceptability and usability in a pilot study., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore healthcare staff's experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration., Background: Optimal hydration post-stroke reduces the risk of neurological deterioration and other complications. Patients are at risk of dehydration in acute stroke, particularly those with dysphagia., Design: A descriptive qualitative study reported following the COREQ guidelines., Methods: Semi-structured interviews, utilising patient vignettes, were conducted in 2018 (Apr-Oct) with a purposive sample of 30 multidisciplinary staff members from two UK stroke units. Interviews were digitally recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework and the Behaviour Change Wheel., Results: The themes were mapped to twelve of the fourteen domains in the Theoretical Domains Framework. Participants believed that inadequate hydration management had potentially serious consequences, and described complex knowledge, skills and cognitive elements to effective hydration care. Participants felt that maintaining hydration was a multidisciplinary responsibility requiring good communication. Although the performance of initial dysphagia screening was reinforced by external audit, other areas of post-stroke hydration management were not; notably, there was no established method of assessing hydration. Barriers to maintaining good hydration included lack of staff, out-of-hours working patterns, low priority given to hydration, patients' comorbidities and complex post-stroke disabilities such as dysphagia, aphasia, inattention and hemiparesis., Conclusion: Findings highlighted the importance of assessing and maintaining hydration but identified barriers to, and variation in, clinical practice. To provide optimal care, barriers to the prevention and treatment of dehydration after stroke must be further understood and addressed., Relevance to Clinical Practice: Multidisciplinary teamwork is important in hydration care after stroke, but clarity is required about the specific contributions of each team member. Without this, hydration care becomes 'everybody's and nobody's job'., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Approximately 20% of total knee arthroplasty (TKA) patients are found to be dissatisfied or unsure of their satisfaction at 1-year post-surgery. This study attempted to predict 1-year post-surgery dissatisfied/unsure TKA patients with pre-surgery and surgical variables using logistic regression and machine learning methods., Methods: A retrospective analysis of patients who underwent primary TKA for osteoarthritis between 2012 and 2016 at a single institution was completed. Patients were split into satisfied and dissatisfied/unsure groups. Potential predictor variables included the following: demographic information, patella re-surfaced, posterior collateral ligament sacrificed, and subscales from the Knee Society Knee Scoring System, the Knee Society Clinical Rating System, the Western Ontario and McMaster Universities Osteoarthritis Index, and the 12-Item Short Form Health Survey version 2. Logistic regression and 6 different machine learning methods were used to create prediction models. Model performance was evaluated using discrimination (AUC [area under the receiver operating characteristic curve]) and calibration (Brier score, Cox intercept, and Cox slope) metrics., Results: There were 1432 eligible patients included in the analysis, 313 were considered to be dissatisfied/unsure. When evaluating discrimination, the logistic regression (AUC = 0.736) and extreme gradient boosted tree (AUC = 0.713) models performed best. When evaluating calibration, the logistic regression (Brier score = 0.141, Cox intercept = 0.241, and Cox slope = 1.31) and gradient boosted tree (Brier score = 0.149, Cox intercept = 0.054, and Cox slope = 1.158) models performed best., Conclusion: The models developed in this study do not perform well enough as discriminatory tools to be used in a clinical setting. Further work needs to be done to improve the performance of pre-surgery TKA dissatisfaction prediction models., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction., Methods: Patients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function., Results: Significant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly., Conclusion: Met expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations., Level of Evidence: Level IV., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: An important aim of high tibial osteotomy (HTO) is to prevent or delay the need for total knee replacement (TKR). We sought to estimate the frequency and timing of conversion from HTO to TKR and the factors associated with it., Methods: We prospectively evaluated patients with osteoarthritis (OA) of the knee who underwent medial opening wedge HTO from 2002 to 2014 and analyzed the cumulative incidence of TKR in July 2019. The presence or absence of TKR on the HTO limb was identified from the orthopedic surgery reports and knee radiographs contained in the electronic medical records for each patient at London Health Sciences Centre. We used cumulative incidence curves to evaluate the primary outcome of time to TKR. We used multivariable Cox proportional hazards analysis to assess potential preoperative predictors including radiographic disease severity, malalignment, correction size, pain, sex, age, body mass index (BMI) and year of surgery., Results: Among 556 patients who underwent 643 HTO procedures, the cumulative incidence of TKR was 5% (95% confidence interval [CI] 3%-7%) at 5 years and 21% (95% CI 17%-26%) at 10 years. With the Cox proportional hazards multivariable model, the following preoperative factors were significantly associated with an increased rate of conversion: radiographic OA severity (adjusted hazard ratio [HR] 1.96, 95% CI 1.12-3.45), pain (adjusted HR 0.85, 95% CI 0.75-0.96)], female sex (adjusted HR 1.67, 95% CI 1.08-2.58), age (adjusted HR 1.50 per 10 yr, 95% CI 1.17-1.93) and BMI (adjusted HR 1.31 per 5 kng/m 2 , 95% CI 1.12-1.53)., Interpretation: We found that 79% of knees did not undergo TKR within 10 years after undergoing medial opening wedge HTO. The strongest predictor of conversion to TKR is greater radiographic disease at the time of HTO., Competing Interests: Competing interests: Trevor Birmingham, Bert Chesworth, Dianne Bryant and J. Robert Giffin have received grants from the Canadian Institutes of Health Research and The Arthritis Society during the conduct of the study. Kevin Willits has received grants from Smith & Nephew outside of the submitted work. Robert Litchfield has received personal fees from ConMed Linvatec, Smith & Nephew, DePuy and Arthrosurface, and grants from Smith & Nephew and DePuy outside the submitted work. No other competing interests were declared., (© 2021 Joule Inc. or its licensors.)

Background: The increased use of electronic medical records (EMRs) in Canadian primary health care practice has resulted in an expansion of the availability of EMR data. Potential users of these data need to understand their quality in relation to the uses to which they are applied. Herein, we propose a basic model for assessing primary health care EMR data quality, comprising a set of data quality measures within four domains. We describe the process of developing and testing this set of measures, share the results of applying these measures in three EMR-derived datasets, and discuss what this reveals about the measures and EMR data quality. The model is offered as a starting point from which data users can refine their own approach, based on their own needs., Methods: Using an iterative process, measures of EMR data quality were created within four domains: comparability; completeness; correctness; and currency. We used a series of process steps to develop the measures. The measures were then operationalized, and tested within three datasets created from different EMR software products., Results: A set of eleven final measures were created. We were not able to calculate results for several measures in one dataset because of the way the data were collected in that specific EMR. Overall, we found variability in the results of testing the measures (e.g. sensitivity values were highest for diabetes, and lowest for obesity), among datasets (e.g. recording of height), and by patient age and sex (e.g. recording of blood pressure, height and weight)., Conclusions: This paper proposes a basic model for assessing primary health care EMR data quality. We developed and tested multiple measures of data quality, within four domains, in three different EMR-derived primary health care datasets. The results of testing these measures indicated that not all measures could be utilized in all datasets, and illustrated variability in data quality. This is one step forward in creating a standard set of measures of data quality. Nonetheless, each project has unique challenges, and therefore requires its own data quality assessment before proceeding.

Despite the exponential growth in the evidence base for stroke rehabilitation, there is still a paucity of knowledge about how to consistently and sustainably deliver evidence-based stroke rehabilitation therapies in clinical practice. This means that people with stroke will not consistently benefit from research breakthroughs, simply because clinicians do not always have the skills, authority, knowledge or resources to be able to translate the findings from a research trial and apply these in clinical practice. This "point of view" article by an interdisciplinary, international team illustrates the lack of available evidence to guide the translation of evidence to practice in rehabilitation, by presenting a comprehensive and systematic content analysis of articles that were published in 2016 in leading clinical stroke rehabilitation journals commonly read by clinicians. Our review confirms that only a small fraction (2.5%) of published stroke rehabilitation research in these journals evaluate the implementation of evidence-based interventions into health care practice. We argue that in order for stroke rehabilitation research to contribute to enhanced health and well-being of people with stroke, journals, funders, policy makers, researchers, clinicians, and professional associations alike need to actively support and promote (through funding, conducting, or disseminating) implementation and evaluation research.

Background: It has been suggested that total knee replacement is being performed in people with less-severe osteoarthritis. We aimed to determine whether there were differences in the presurgery profile, symptoms and disability of 2 cohorts who underwent total knee replacement over a 10-year period., Methods: Patients aged 18-85 years undergoing primary total knee replacement for osteoarthritis at 1 of 4 sites in Toronto and Strathroy, Ontario, were recruited in a cohort study during 2006-2008 (cohort 1) and 2012-2015 (cohort 2). Patients undergoing unicompartmental or revision arthroplasty were excluded. Demographic and health (body mass index [BMI], comorbidity) variables and osteoarthritis severity, as assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the disability component of the Late-Life Function and Disability Instrument (LLFDI-D), were collected before surgery. We calculated proportions, means and standard deviations with 95% confidence intervals (CIs) for all data. We constructed density plots by tertile score for the WOMAC pain and physical function subscales and the LLFDI-D limitation scale., Results: There were 494 patients in cohort 1 and 251 patients in cohort 2. There were no differences in age, sex, education, living status, BMI, comorbidity, pain severity or disability between the cohorts based on overlapping 95% CIs and the density plots. More patients in cohort 1 than in cohort 2 were single (176 [35.6%], 95% CI 32.5%-41.1% v. 63 [25.1%], 95% CI 20.3%-31.0%). Patients in cohort 2 reported less limitation in higher-demand activities than did those in cohort 1 (mean score on LLFDI-D 62.3 [95% CI 60.7-63.9] v. 59.2 [95% CI 58.2-60.2])., Interpretation: The patient profile and reported osteoarthritis severity were similar in 2 cohorts that had total knee replacement over a 10-year period. This suggests that increasing total knee replacement volumes over this period likely were not driven by these factors., Competing Interests: Competing interests: Rajiv Gandhi reports institutional research support received from Smith & Nephew and Zimmer Biomet. No other competing interests were declared., (Copyright 2018, Joule Inc. or its licensors.)

Background: Orthopedic surgeons recognize patient expectations of total knee arthroplasty (TKA) can be managed through education. E-learning is the application of educational technology. The objective of this study was to evaluate whether an e-learning tool could affect whether patients' expectations were met and they were satisfied 1 year following TKA., Methods: Patients with osteoarthritis from the London Health Sciences Centre, Canada, were randomly assigned to either a control group (n = 207) receiving standard patient education or an intervention group (n = 209) using the e-learning tool in addition to the standard. We used a web-based system with permuted block sizes, stratified by surgeon and first or second TKA. Preoperative measures were completed following the patients' preadmission clinic visit. Postoperative patient-reported outcome measures were completed at 6 weeks, 3 months, and 1 year after TKA. One year after TKA, risk difference was used to determine between-group differences for patient satisfaction and expectations being met., Results: One year postoperatively, the risk that expectations of patients were not met was 21.8% in the control group and 21.4% in the intervention group for an adjusted risk difference of 1.3% (95% confidence interval, -7.8% to 10.4%, P = .78). The proportion of patients satisfied with their TKA at 1 year postoperative was 78.6% in the intervention and 78.2% in the control groups., Conclusion: There was no between-group difference at 1 year between intervention and control groups for either the risk that expectations of patients were not met or the proportion of patients who were dissatisfied with their TKA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Shoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within Mechanical Diagnosis and Therapy (MDT) shoulder classifications may offer insight into the poor performance of these tests., Objectives: To investigate in patients with shoulder complaints, whether MDT classifications affect the agreement of OST results over the course of treatment., Methods: An international group of MDT clinicians recruited 105 patients with shoulder problems. Three commonly used OSTs (Empty Can, Hawkins-Kennedy, and Speed's tests) were utilized. Results of the OSTs were collected at sessions 1, 3, 5 and 8, or at discharge from an MDT classification-based treatment. The Kappa statistic was utilized to determine the agreement of the OST results over time for each of the MDT classifications., Results: The overall Kappa values for Empty Can, Hawkins-Kennedy and Speed's tests were 0.28 (SE = 0.07), 0.28 (SE = 0.07) and 0.29 (SE = 0.07), respectively. The highest level of agreement was for Articular Dysfunction for the Empty Can test (0.84, SE = 0.19). For shoulder Derangements, there was no agreement for any of the OSTs (P values > 0.05)., Conclusion: The lack of agreement when the OSTs were consecutively tested in the presence of the MDT Derangement classification contrasted with the other MDT classifications. The presence of Derangement was responsible for reducing the overall agreement of commonly used OSTs and may explain the poor consistency for OSTs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: In 2012, a new Knee Society Knee Scoring System (KSS) was developed and validated to address the needs for a scoring system that better encompasses the expectations, satisfaction, and physical involvement of a younger, more active population of patients undergoing TKA. Revalidating this tool in a separate population by individuals other than the developers of the scoring system seems important, because such replication would tend to confirm the generalizability of this tool., Questions/purposes: The purposes of this study were (1) to validate the KSS using a separate sample of patients undergoing primary TKA; and (2) to evaluate the internal consistency of the KSS., Methods: Intervention and control groups from a randomized controlled trial with no between-group differences were pooled. Preoperative and postoperative (6 weeks and 1 year) data were used. Patients with osteoarthritis undergoing primary TKA completed the patient-reported component of the KSS, Knee Injury and Osteoarthritis Outcome Score (KOOS), SF-12, two independent questions about expectations of surgery, and the Patient Acceptable Symptom State (PASS) single-question outcome. This study included 345 patients with 221 (64%) women, an average (SD) age of 64 (8.6) years, a mean (SD) body mass index of 32.9 (7.5) kg/m, and 225 (68%) having their first primary TKA. Loss to followup in the control group was 18% and loss to followup in the intervention group was 13%. We quantified cross-sectional (preoperative scores) and longitudinal validity (pre- to postoperative change scores) by evaluating associations between the KSS and KOOS subscales using Spearman's correlation coefficient. Preoperative known-group validity of the KSS symptoms and functional activity score was evaluated with a one-way analysis of variance across three levels of physical health status using the SF-12 Physical Component Score. Known-group validity of the KSS expectation score was evaluated with an unpaired t-test by comparing means across known expectation groups. Known-group validity of the KSS satisfaction score was evaluated with an unpaired t-test by comparing means across yes/no response groupings of the PASS single-question outcome. Internal consistency for each KSS subscale was evaluated with Cronbach's α., Results: Cross-sectional validity (ie, associations at a single point in time) was supported because correlation coefficients between KSS symptoms, functional activities, and satisfaction scores and scores on the KOOS pain subscale ranged from 0.60 to 0.73 (all correlations p < 0.01). Values were similar for associations with the KOOS function in the activities of daily living (ADL) subscale (0.66-0.69) and less (0.41-0.58) for correlations with the other three KOOS subscales. Longitudinal validity (ie, associations of change scores between two time points) was also supported because correlation coefficients between KSS symptoms, functional activities, and satisfaction change scores and the KOOS pain and ADL change scores varied from 0.63 to 0.73. Correlation coefficients were lower for the other three KOOS subscale change scores, suggesting a weaker relationship with KOOS symptoms (0.48-0.53), sports (0.47-0.51), and quality of life (0.60-0.65) (all correlations p < 0.01). Known-group validity (ie, differences between groups that are known to differ on a given characteristic) was confirmed by between-group differences for the symptoms and functional activities score comparisons as well as the comparisons with the expectations and satisfaction scores of the KSS (all p < 0.01). Cronbach's α (ie, association among subscale items) varied from 0.68 (discretionary activities) to 0.94 (postoperative expectations) across four KSS subscales., Conclusions: Moderate-sized correlation coefficients and consistent differences between known groups support the validity of the KSS. Internal consistency values were also acceptable. The patient-reported subscales of the KSS are a valid and internally consistent outcome assessment for TKA.

Objectives: The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment for shoulder complaints. The secondary objective was to describe the frequency of discharge over time by MDT classification., Methods: International, MDT-trained study collaborators recruited 93 patients attending physiotherapy for rehabilitation of a shoulder problem. The Numeric Pain Rating Scale (NPRS) and the Upper Extremity Functional Index (UEFI) were collected at the initial assessment and two and four weeks after treatment commenced. A two-way mixed model analysis of variance with planned pairwise comparisons was performed to identify where the differences between MDT classification groups actually existed., Results: The Derangement and Spinal classifications had significantly lower NPRS scores than the Dysfunction group at week 2 and week 4 ( p  < 0.05). The Derangement and Spinal classifications had significantly higher UEFI scores than the Dysfunction group at week 2 and week 4 ( p  < 0.05). The frequency of discharge at week 2 was 37% for both Derangement and Spinal classifications, with no discharges for the Dysfunction classification at this time point. The frequency of discharge at week 4 was 83, 82 and 15% for the Derangement, Spinal and Dysfunction classifications, respectively., Discussion: Classifying patients with shoulder pain using the MDT system can impact treatment outcomes and the frequency of discharge. When MDT-trained clinicians are allowed to match the intervention to a specific MDT classification, the outcome is aligned with the response expectation of the classification. Level of Evidence : 2b.

Study Design Delphi panel study. Background Biomechanical parameters measured during a drop vertical jump task are risk factors for anterior cruciate ligament (ACL) injury and are targeted during rehabilitation after ACL reconstruction. A clinically feasible tool that quantifies observed performance on the drop vertical jump would help inform treatment efforts. The content and scoring of such a tool should be deliberated on by a group of experts throughout its development. Objectives To establish consensus on the content and scoring of a clinician-rated drop vertical jump scale (DVJS) for use during rehabilitation after ACL reconstruction. Methods Using a modified Delphi process, a panel of experts (researchers and clinicians) on the risk factors, prevention, treatment, and biomechanics of ACL injury anonymously critiqued versions of a DVJS. The DVJS was developed iteratively, based on the feedback from the panel, using Likert scale responses to questions and providing written comments. Three to 5 rounds were planned a priori, with a requirement of 75% agreement on included items after the final round. Results Twenty of the 31 invited experts (65%) participated. Approximately 93% agreement was achieved after the fourth round. Final items on the scale included the rating of knee valgus collapse (no collapse to extreme collapse) and the presence of other undesirable movements, including lateral trunk lean, insufficient knee flexion, and limb-to-limb asymmetry. Conclusion The Delphi process resulted in a beta version of a DVJS. Expert consensus was achieved on its content and scoring to support further clinical testing of the scale. J Orthop Sports Phys Ther 2017;47(8):557-564. Epub 6 Jul 2017. doi:10.2519/jospt.2017.7183.

Objective: To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis., Methods: A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components., Results: Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively., Conclusions: Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis., (© 2016 World Institute of Pain.)

Background: In previous studies, 50%-70% of patients referred to orthopedic surgeons for total knee replacement (TKR) were not surgical candidates at the time of initial assessment. The purpose of our study was to identify and cross-validate patient self-reported predictors of suitability for TKR and to determine the clinical utility of a predictive model to guide the timing and appropriateness of referral to a surgeon., Methods: We assessed pre-consultation patient data as well as the surgeon's findings and post-consultation recommendations. We used multivariate logistic regression to detect self-reported items that could identify suitable surgical candidates., Results: Patients' willingness to undergo surgery, higher rating of pain, greater physical function, previous intra-articular injections and patient age were the factors predictive of patients being offered and electing to undergo TKR., Conclusion: The application of the model developed in our study would effectively reduce the proportion of nonsurgical referrals by 25%, while identifying the vast majority of surgical candidates (> 90%). Using patient-reported information, we can correctly predict the outcome of specialist consultation for TKR in 70% of cases. To reduce long waits for first consultation with a surgeon, it may be possible to use these items to educate and guide referring clinicians and patients to understand when specialist consultation is the next step in managing the patient with severe osteoarthritis of the knee.

Background: Researchers are concerned about the possibility of restricted access to data as a result of specific consent requirements in privacy legislation, potentially resulting in smaller samples and a lack of representativeness which could bias results. In addition, there is uncertainty about what influences individuals to give consent for the use of their personal health information., Objective: To measure joint replacement recipients' health information privacy views and to assess potential predictors of these views., Design: Cross-sectional survey., Setting and Participants: Potential joint replacement recipients from two teaching hospitals in London, Ontario, Canada., Main Variables: Age, gender, education, employment status, anticipated joint replacement, and expectations for surgery., Main Outcome Measures: Privacy concerns as measured by the Concern Scale., Results: The response rate was 182/253 or 72%. The mean Concern score was 143.9/235.0 for the total sample (range = 82-216). Women had higher levels of privacy concerns than men on slightly over half of the individual questionnaire items. In women, surgical joint, age and employment explained 15% of the variance in concerns about personal health information privacy (P = 0.001). The model explained 6% of the variance in concerns in men (P = 0.138) and was not statistically significant., Discussion and Conclusion: This study indicates that demographic characteristics and health-care experiences play a role in the variability of health information privacy concerns. A greater understanding of patients' privacy views about health information could lead to a greater harmonization among privacy rules, research and data access, and the preferences of health-care consumers., (© 2013 John Wiley & Sons Ltd.)

Background: The Questionnaire to Identify Knee Symptoms (QuIKS) was recently developed to promote activity by screening for experiences related to early symptoms in people with emergent chronic knee pain problems, such as osteoarthritis (OA) - like knee pain. The main purpose of the current study was to evaluate measurement properties of the QuIKS using Rasch analysis in a sample of people with knee symptoms consistent with symptomatic knee OA., Method: This study used cross-sectional data. The sample was 200 subjects along the following knee health continuum: pain-free healthy knees (n = 55) from a university community, knee pain with no knee OA diagnosis (n = 111) from a university-affiliated medical clinic, and patients with surgeon-diagnosed symptomatic knee OA awaiting high tibial osteotomy (n = 34) from a sports medicine surgical clinic. The 13-item QuIKS was evaluated for its factor structure, item- and person-fit, item's category response structure, differential item functioning by sex and obesity status, local item dependency, unidimensionality, and test precision. Subsequently, the QuIKS underwent known-groups analysis and convergent validity with the Knee injury and Osteoarthritis Outcome Score (KOOS)., Results: In the QuIKS, each item's category response structure was modified. No differential item functioning was observed. Local item dependency informed the formation of four testlets. This refined QuIKS obtained summary fit to the Rasch measurement model, unidimensionality, reliability (person separation index = 0.82), and interval-level scoring. Subsequently, the Rasch-validated QuIKS (QuIKS-R) demonstrated excellent known-groups validity and good convergent validity with the KOOS (Spearman's rho = 0.45 to 0.77)., Conclusions: The QuIKS-R provides interval-level quantification of knee symptoms-related experiences in people with knee symptoms consistent with symptomatic knee OA. Its scores might be useful for clinicians for promoting activity in individuals with early symptoms consistent with symptomatic knee OA.

Background: The implementation of strategies to monitor and enhance treatment fidelity is of paramount importance in trials of complex interventions. A recent framework published by the National Institutes of Health Behavior Change Consortium recommends addressing five areas of treatment fidelity, one of which is delivery of treatment. This study aimed to explore fidelity to treatment delivery of the ICONS intervention (a systematic voiding programme [SVP]). This included exploring the feasibility of a method to assess fidelity to treatment delivery and collecting preliminary evidence of the level of fidelity to SVP delivery in order to inform strategies for improving fidelity in a future trial., Methods: Delivery of treatment was recorded by nurses through completion of daily clinical logs, which included: a voiding interval, proposed voiding times and actual voiding times. The a priori method for assessment of fidelity - comparing actual voiding times with proposed voiding times - was trialled on a small amount of data. Due to errors in documentation of the voiding intervals and proposed voiding times it was not possible to assess fidelity directly as planned. A new method was devised, which included identification of 'key quality indicators'., Results: This new approach to assessing fidelity used key quality indicators based upon presence of the data needed to make the comparison between proposed and actual voiding times. The proportion of clinical logs with correct documentation of voiding intervals and proposed voiding times was less than 40 %. For clinical logs with correct documentation, an actual voiding time within 30 min of the proposed voiding time was identified on approximately 55 % of occasions., Conclusions: Lessons learnt from this study have implications for the future ICONS definitive trial and for other trials of complex interventions. Implementation of a complex intervention may often deviate from what is intended. While careful consideration should be given to the best method of fidelity assessment, an iterative approach allowing flexibility to adapt pre-planned methods is recommended within feasibility trials. As fidelity to treatment delivery in the ICONS feasibility trial appeared to be relatively low, more attention to implementation strategies will be required in the definitive trial., Trial Registration: Identifier: ISRCTN08609907 ; date registered: 07/07/2010.

Objective: This study used a rat model of post-traumatic knee osteoarthritis (OA) created by anterior cruciate ligament transection with partial medial meniscectomy (ACLT + pMMx). In this model, mild to moderate structural changes that are typical of knee OA have been observed within 2 and 8 weeks post-surgery. We aimed to determine whether pain-related behaviours can distinguish between an ACLT + pMMx and a sham surgery group., Design: Three-month old male Sprague-Dawley rats underwent ACLT + pMMx on their right hindlimb within two groups of n = 6 each, and sham surgery within two groups of n = 5 each. Assessments evaluated percent ipsilateral weight-bearing for static weight-bearing and 18 different variables of exploratory motor behaviour at multiple time points between 1 and 8 weeks post-surgery. Histology was performed on the right hindlimbs at 4 and 8 weeks post-surgery., Results: Histology confirmed mild to moderate knee OA changes in the ACLT + pMMx group and the absence of knee OA changes in the sham group. Compared to the sham group, the ACLT + pMMx group had significantly lower percent ipsilateral weight-bearing from 1 through 8 weeks post-surgery. Compared to the sham group, the ACLT + pMMx group had significantly lower vertical activity (episode count, time, and count) values., Conclusions: These findings suggest that ipsilateral weight-bearing deficit and vertical activity limitations resulted from the presence of knee OA-like changes in this model. When using the ACLT + pMMx-induced rat model of knee OA, percent ipsilateral weight-bearing and vertical activity distinguished between rats with and without knee OA changes. These variables may be useful outcome measures in preclinical research performed with this experimental post-traumatic knee OA model., (Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Establishing the effect of fluctuating extracellular fluid (ECF) volume on muscle strength in people with end-stage renal disease (ESRD) on hemodialysis (HD) is essential, as inadequate hydration of the skeletal muscles impacts its strength and endurance. Bioelectrical impedance spectroscopy (BIS) has been a widely used method for estimating ECF volume of a limb or calf segment. Magnetic resonance imaging (MRI)-acquired transverse relaxation times (T2) has also been used for estimating ECF volumes of individual skeletal muscles. The purpose of this study was to determine the association between T2 (gold standard) of tibialis anterior (TA), medial (MG), and lateral gastrocnemius (LG), and soleus muscles and calf BIS ECF, in healthy and in people with ESRD/HD. Calf BIS and MRI measures were collected on two occasions before and after HD session in people with ESRD/HD and on a single occasion for the healthy participants. Linear regression analysis was used to establish the association between these measures. Thirty-two healthy and 22 participants on HD were recruited. The association between T2 of TA, LG, MG, and soleus muscles and ratio of calf BIS-acquired ECF and intracellular fluids (ICF) were: TA: β = 0.30, P > 0.05; LG: β = 0.37, P = 0.035; MG: β = 0.43, P = 0.014; soleus: β = 0.60, P < 0.001. For the HD group, calf ECF was significantly associated with T2 of TA (β = 0.44, P = 0.042), and medial gastrocnemius (β = 0.47, P = 0.027) following HD only. Hence BIS-acquired measures cannot be used to measure ECF volumes of a single muscle in the ESRD/HD population; however, BIS could be utilized to estimate ratio of ECF: ICF in healthy population for the LG, MG, and soleus muscles., (© 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.)

Background: A validated and reliable instrument was developed to knowledge, attitudes and behaviours with respect to evidence-based practice (EBB-KABQ) in medical trainees but requires further adaptation and validation to be applied across different health professionals., Methods: A modified 33-item evidence-based practice scale (EBP-KABQ) was developed to evaluate EBP perceptions and behaviors in clinicians. An international sample of 673 clinicians interested in treatment of pain (mean age = 45 years, 48% occupational therapists/physical therapists, 25% had more than 5 years of clinical training) completed an online English version of the questionnaire and demographics. Scaling properties (internal consistency, floor/ceiling effects) and construct validity (association with EBP activities, comparator constructs) were examined. A confirmatory factor analysis was used to assess the 4-domain structure EBP knowledge, attitudes, behavior, outcomes/decisions)., Results: The EBP-KABQ scale demonstrated high internal consistency (Cronbach's alpha = 0.85), no evident floor/ceiling effects, and support for a priori construct validation hypotheses. A 4-factor structure provided the best fit statistics (CFI =0.89, TLI =0.86, and RMSEA = 0.06)., Conclusions: The EBP-KABQ scale demonstrates promising psychometric properties in this sample. Areas for improvement are described.

Objective: To investigate the inter-examiner reliability of Mechanical Diagnosis and Therapy (MDT)-trained diplomats in classifying patients with shoulder disorders. The MDT system has demonstrated acceptable reliability when used in patients with spinal disorders; however, little is known about its utility when used for appendicular conditions., Methods: Fifty-four clinical scenarios were created by a group of 11 MDT diploma holders based on their clinical experience with patients with shoulder pain. The vignettes were made anonymous, and their clinical diagnoses sections were left blank. The vignettes were sent to a second group of six international McKenzie Institute diploma holders who were asked to classify each vignette according to the MDT categories for upper extremity. Inter-examiner agreement was evaluated with kappa statistics., Results: There was 'very good' agreement among the six MDT diplomats for classifying the McKenzie syndromes in patients with shoulder pain (kappa = 0.90, SE = 0.018). The raw overall level of multi-rater agreement among the six clinicians in classifying the vignettes was 96%. After accounting for the actual MDT category for each vignette, kappa and the raw overall level of agreement decreased negligibly (0.89 and 95%, respectively)., Discussion: Using clinical vignettes, the McKenzie system of MDT has very good reliability in classifying patients with shoulder pain. As an alternative, future reliability studies could use real patients instead of written vignettes.

Introduction: Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1) examine the characteristics of the family caregivers' experience of communication and information sharing and (2) identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers., Methods: Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8) and health care providers (n = 24)., Results: Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting., Conclusion: As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.

Purpose: To examine the reliability, validity, and sensitivity to change of the 20-item version and the Rasch-refined 15-item version of the Upper Extremity Functional Index (UEFI-20 and UEFI-15, respectively) and to determine the impact of arm dominance on the positive minimal clinically important difference (pMCID)., Methods: Adults with upper-extremity (UE) dysfunction completed the UEFI-20, Upper Extremity Functional Scale (UEFS), Pain Limitation Scale, and Pain Intensity Scale at their initial physiotherapy assessment (Time 1); 24-48 hours later (Time 2); and 3 weeks into treatment or at discharge, whichever came first (Time 3). Demographics, including working status, were obtained at Time 1. Global ratings of change (GRC) were provided by the treating physiotherapist and patient at Time 3. The UEFI-15 was calculated from relevant items in the UEFI-20. The intra-class correlation coefficient (ICC) and minimal detectable change (MDC) quantified test-retest reliability (Time 1-Time 2). Cross-sectional convergent validity was determined by the association (Pearson's r) between Time 1 measures of function and pain. Known-groups validity was evaluated with a one-way ANOVA across three levels of working status. Longitudinal validity was determined by the association (Pearson's r) between function and pain change scores (Time 1-Time 3). Receiver operating characteristic (ROC) curves estimated the pMCID using Time 1-Time 3 change scores and average patient/therapist GRC., Results: Reliability for the UEFI-20 and UEFI-15 was the same (ICC=0.94 for both measures). MDC values were 9.4/80 for the UEFI-20 and 8.8/100 for the UEFI-15. Cross-sectional, known-groups, and longitudinal validity were confirmed for both UEFI measures. pMCID values were 8/80 for the UEFI-20 and 6.7/100 for the UEFI-15; pMCID was higher for people whose non-dominant arm was affected., Conclusions: Both UEFI measures show acceptable reliability and validity. Arm dominance affects pMCID. The UEFI-15 is recommended because it measures only one dimension: UE function.

Study Design: Randomized controlled trial. Objectives To examine the efficacy of exercise intervention in patients with knee osteoarthritis (OA), as directed by Mechanical Diagnosis and Therapy (MDT) assessment, and, secondarily, to explore outcomes between MDT assessment-defined subgroups within the exercise group., Background: Due to the high physical and economic burden of knee OA, the effectiveness of conservative interventions and determining those patients who will respond to them should be investigated., Methods: Patients with knee OA (n = 180) were randomized to an exercise intervention group or a control group. The intervention group, in which patients classified as having knee derangements (MDT derangement) received MDT directional exercises and patients classified as nonresponders (MDT nonresponders) received evidence-based exercises, was compared to a control group that received no exercise intervention. Pain and function were assessed at baseline, 2 weeks, and 3 months, using the P4 pain scale and Knee injury and Osteoarthritis Outcome Score (KOOS) pain and function subscales. Two-way analysis of covariance was used to examine treatment and time effects. Multiple comparisons were examined, and mean differences with 95% confidence intervals (CIs) were reported., Results: The exercise intervention group had significantly improved P4 scores (mean difference, -6; 95% CI: -8, -3), KOOS pain scores (mean difference, 9; 95% CI: 5, 13), and KOOS function scores (mean difference, 11; 95% CI: 7, 15) compared to those of the control group at 2 weeks. At 3 months, the exercise intervention group had significantly improved KOOS pain scores (mean difference, 7; 95% CI: 3, 11) and KOOS function scores (mean difference, 5; 95% CI: 1, 9) compared to controls., Conclusion: Patients with knee OA who were prescribed exercises based on an MDT assessment had superior outcomes compared to those of wait-list controls. The MDT subgroup of knee derangement may warrant further investigation in patients with knee OA. Protocol registered at ClinicalTrials.gov (NCT01641874)., Level of Evidence: Therapy, level 1b-.

Background: Improvements in generic and disease specific scores have been reported with medial opening wedge high tibial osteotomy (MOW HTO). However, meaningful comparisons between competing surgical interventions have been hampered by the lack of a preference based single index of health related quality of life (HRQoL). The primary aim of this study was to derive and report a single index measure of HRQoL for patients undergoing MOW HTO, preoperatively and at 12 and 24 postoperatively. Secondary aims were to evaluate changes in various additional measures of quality of life at these time points., Methods: The impact of MOW HTO was evaluated using generic and disease specific instruments. One hundred thirty eight patients completed the Medical Outcomes Study short form health survey (SF-12) and Knee Osteoarthritis Outcomes Score (KOOS) before, 12 and 24 months after surgery. A preference-based single index measure of HRQoL was calculated and changes were evaluated., Results: The mean change in the HRQoL suggested large, clinically significant improvements from 0.69 preoperatively to 0.82 (p<0.001) and 0.8 at 12 and 24 months postoperatively respectively. All dimensions of the SF-12, except role mental health, and all dimensions of the KOOS also demonstrated statistically significant improvements between pre and postoperative measurements., Conclusions: The preoperative HRQoL of young patients with mechanical varus alignment and medial compartment knee osteoarthritis is similar to older patients with knee osteoarthritis. Medial opening wedge high tibial osteomoty results in significant improvements in HRQoL, the magnitude of which is comparable to other surgical interventions for knee osteoarthristis., (Copyright © 2013. Published by Elsevier B.V.)

Background: Current diagnostic procedures for knee osteoarthritis (OA) identify individuals late in the disease process. A questionnaire may be a useful and inexpensive method to screen for early symptoms of knee OA., Objective: The purpose of this study was to develop a brief, self-administered questionnaire for clinical and research settings to identify emerging knee problems in people who could benefit from conservative interventions., Design: This prospective study utilized a mixed-methods approach., Methods and Results: Questionnaire items were generated from interview data from individuals with emerging chronic knee problems. These items were reviewed by 16 rheumatology experts, resulting in a 35-item draft questionnaire. To reduce the number of items, questionnaires were mailed to 228 adults, aged 40 to 65 years, with evidence of ongoing knee problems. One hundred thirteen completed questionnaires were returned (63.1% response rate), with 105 usable questionnaires. Using principal components analysis, the number of items was reduced to a final 13-item version, the Questionnaire to Identify Knee Symptoms (QuIKS). The QuIKS has 4 subscales: medications, monitoring, interpreting, and modifying. The QuIKS demonstrated strong internal consistency., Limitations: A sampling bias among respondents who provided data for item reduction likely means that the QuIKS reflects those who self-report knee problems to a health care provider, which may not be generalizable to the population., Conclusions: The QuIKS is a short, self-administered questionnaire used to promote activity by identifying the experiences associated with early symptoms consistent with knee OA, such as monitoring intermittent symptoms, interpreting the meaning of these symptoms, modifying behaviors, and including the use of medications. If future work validates the QuIKS, its use in developing samples could expand our understanding of early disease and improve interventions.

Purpose: To determine whether activity-modifying behaviour mediates the relationship between the severity of knee pain and each of physical function and knee-related quality of life., Methods: A total of 105 participants with medial knee pain and no diagnosis of knee osteoarthritis (mean age 52.2 [SD 6.7] y) completed two self-report questionnaires. The Questionnaire to Identify Knee Symptoms assessed activity-modifying behaviour; the Knee injury and Osteoarthritis Outcome Score assessed pain severity, physical function, and knee-related quality of life. Simple mediation analysis was performed using linear regression., Results: The unstandardized regression coefficient for activity-modifying behaviour revealed partial mediation of the effect of pain severity on physical function (0.31 (SE 0.09), p<0.001) and on knee-related quality of life (0.24 (SE 0.07), p<0.001). After accounting for activity-modifying behaviour, the variance in physical function that was explained by pain decreased from 45% to 15%, and the variance in knee-related quality of life that was explained by pain decreased from 64% to 25%., Conclusion: Activity-modifying behaviour partially mediates the relationship between pain severity and physical function and between pain severity and knee-related quality of life. Activity-modifying behaviour may thus counteract the impact of knee pain on physical function and knee-related quality of life, which explains why it is used by people with emergent knee pain.

Background: The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation., Objective: The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper extremity function) and whether a Rasch-validated UEFI has adequate reproducibility for individual-level patient evaluation., Design: This was a secondary analysis of data from a repeated-measures study designed to evaluate the measurement properties of the UEFI over a 3-week period., Methods: Patients (n=239) with musculoskeletal upper extremity disorders were recruited from 17 physical therapy clinics across 4 Canadian provinces. Rasch analysis of the UEFI measurement properties was performed. If the UEFI did not fit the Rasch model, misfitting patients were deleted, items with poor response structure were corrected, and misfitting items and redundant items were deleted. The impact of differential item functioning on the ability estimate of patients was investigated., Results: A 15-item modified UEFI was derived to achieve fit to the Rasch model where the total score was supported as a measure of upper extremity function only. The resultant UEFI-15 interval-level scale (0-100, worst to best state) demonstrated excellent internal consistency (person separation index=0.94) and test-retest reliability (intraclass correlation coefficient [2,1]=.95). The minimal detectable change at the 90% confidence interval was 8.1., Limitations: Patients who were ambidextrous or bilaterally affected were excluded to allow for the analysis of differential item functioning due to limb involvement and arm dominance., Conclusion: Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal disorders of the upper extremity.

Purpose: To examine information exchange by physiotherapists during care handoffs of patients with hip fracture in a rural health care setting., Methods: This qualitative ethnographic study used observation and interviews of 11 networks of patients with hip fracture (n=11), family caregivers (n=8), and health care providers (n=24). Patients were followed from acute care through each subsequent care setting. Data were supplemented by health care records and policy documents., Results: Findings revealed that handoffs were less successful when information transfer was untimely or incomplete. Family caregivers experienced challenges in obtaining information required to facilitate the handoff, especially when direct contact with physiotherapists was not possible as a result of distance or other factors. Physiotherapists had to navigate multiple data sources to retrieve important information, and managed information gaps in various ways. Information flow was often unidirectional and suggested no further clinical accountability for the discharging physiotherapist., Conclusions: Providing information in a structured and timely fashion facilitated physiotherapy handoffs. Inadequate handoffs compromised continuity of care, delayed progress in rehabilitation, and resulted in families' missing information of vital importance to their caregiving role. A multi-directional exchange of information is needed between patients, families, and health care providers across care settings.

Purpose: This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation., Methods: A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed., Results: The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; β, 95% CI=1.37, 0.89-1.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine., Conclusion: The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events.

Purpose: To examine reliability and validity of the Lunge Test (LT) of dorsiflexion range of motion and determine the impact of different approaches to obtain a score on these parameters., Methods: Fifty-three patients with ankle injury/dysfunction provided initial assessment data for cross-sectional convergent and known-groups validity analysis with the Pearson coefficient (r) and paired t-test, respectively; data after 4-8 weeks of treatment for longitudinal validity analysis with coefficient r; and data 3 days later for test-retest reliability using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). LT scores were determined for the affected leg only (LTAff) and for the difference between the two limbs (LTDiff). Two strategies were used to calculate LT scores: a single series and the mean of three series of lunges. LTs were correlated with the Lower Extremity Functional Scale and Global Foot and Ankle Scale., Results: Reliability coefficients were high (ICC=0.93-0.99). The MDC=1.0/1.5 cm, LTAff/LTDiff, respectively. Cross-sectional validity was confirmed for LTDiff (r=-0.40 to -0.50). Between-limb differences (p<0.05) supported known-groups validity. Longitudinal validity was supported for both LT change scores (r=0.39-0.63). The number of series of lunges used did not impact results., Conclusions: A single series of lunges produces a reliable LT score. From a validity perspective, clinicians should use LTDiff on initial assessment and either LT to assess change.