Volume 8:4
Novice Versus Experienced Rater Reliability of the Mini Balance Evaluation Systems Test (Mini-BESTest) in Patients with Acquired Brain Injury (ABI)
Charity E Maqueda, PT, DPT, ATC, LAT; Rupal Patel, PT, MS
Texas Woman’s University, Houston, TX
TIRR Memorial Hermann, Houston, TX
University of Tennessee Medical Center, Knoxville, TN
ABSTRACT
Objectives: The purpose of this study was to examine novice versus experienced rater’s inter-rater and test retest reliability when scoring the Mini-BESTest in patients with acquired brain injury (ABI); and to provide clinically relevant information regarding the reliability and clinical feasibility of using the Mini-BESTest in a population with ABI.
Background: Individuals who sustain an ABI often have many functional deficits including impaired balance. Currently there is no gold standard for assessing balance in individuals with ABI. Many balance measures have been shown to have ceiling effects and inconsistent reliability results when measured by novice physical therapists verses experienced physical therapists.
Methods and Measures: Participants were selected using convenience sampling meeting specific inclusion and exclusion criteria. Each was video recorded while completing the Mini-BESTest, administered by one test-administrator who was not a rater. Inter-rater reliability was tested using four raters (two novice, two experienced), whom simultaneously and independently observed and rated performance from the same angle. All raters were blinded to others’ scores. Test retest reliability was tested using three raters (two novice, one experienced), whom independently viewed video recording in random order approximately four weeks later. All raters were blinded to each other’s scores and their own scores.
Results: There was a significant intra-class correlation coefficient (p < .001) demonstrating excellent inter-rater reliability and a significant Pearson’s correlation (p < .001) demonstrating high test retest reliability among all raters. Novice raters demonstrated slightly higher test retest reliability (r=.953) than the experienced raters (r=.933).
Conclusion: Both novice and experienced raters demonstrated excellent inter-rater and test retest reliability when rating individuals with ABI using the Mini- BESTest. The Mini-BESTest is a reliable tool, which uses multiple constructs to assess balance deficits in 4 specific constructs. It can be used by both novice and experienced physical therapists to guide interventions for the impaired systems. Increased time to administer and modifications to verbal instructions may be appropriate for use in the ABI population. Follow-up studies are necessary to determine the extent and validity of instruction modifications.
Effect of Hip Rotation Stretch on the Piriformis Muscle: A Pilot Study
Anne Waldner, SPT; Justin Monsrud, SPT; Matthew Franklin1, SPT; Daniel Bernath, SPT; F. Richard Clemente, PhD, PT; Philip A. Fabrizio, PT, DPT, MS, CEAS
Department of Physical Therapy, Mercer University, Atlanta, GA, USA
Department of Physical Therapy, Duquesne University, Pittsburgh, PA, USA
ABSTRACT
Objectives: The objective of the current study was to examine, using diagnostic ultrasound (US), the effect of stretching the piriformis muscle into medial and lateral rotation in varying degrees of hip flexion on the thickness at the muscle tendon unit of the piriformis muscle.
Background: Passive stretch is commonly used to assess piriformis muscle length and as a treatment to alter piriformis muscle tightness. However, current literature and practice suggests that the piriformis’ function may reverse from a hip lateral rotator to a hip medial rotator when the hip is flexed beyond 90 degrees. Anatomical studies suggest that there may be cases where the tendon’s distal attachment position on the femoral greater trochanter does not permit a reversal of function.
Methods and Measures: Twenty- six subjects’ left hips were placed in increasing flexion positions (0, 60, 90, 100, 110, and 120 degrees) and maximal lateral and medial rotation. Thickness at the muscle tendon unit of the piriformis muscle was visualized and measured using diagnostic ultrasound at each hip flexion and each rotation position.
Results: The data were analyzed using two-factor analysis of variance. The results demonstrated that the interaction effect, the difference between thickness during lateral or medial rotation, was not influenced by hip flexion position.
Conclusion: Considering that a muscle is stretched in a position opposite of its function, the current study showed no consistent change in piriformis muscle tendon unit thickness in medial or lateral rotation with increasing hip flexion. The current findings may call into question the clinical thought of the piriformis reversing function with increased degrees of hip flexion.
Follow-up Attendance Among USF BRIDGE Physical Therapy Patients
Jillian Donohue, SPT, Arántzazu Gárate, SPT, Rose Pignataro, PT, PhD, DPT, CWS, Rebecca Edgeworth, PT, DPT, OCS
University of South Florida Morsani College of Medicine, School of Physical Therapy and Rehabilitation Sciences Tampa, FL
ABSTRACT
Objectives: Establish baseline attendance data to inform quality improvement for patient follow-up care at BRIDGE Physical Therapy Clinic.
Background: The BRIDGE Healthcare Clinic is a student-run free clinic affiliated with the University of South Florida, serving the surrounding University Area community. Based on informal observation, there is potential for improving patient attendance. Quantitative assessment of baseline data regarding current attendance for initial visits, follow-up visits, and length of episodes of care were obtained via retrospective review of electronic health record (EHR).
Methods and Measures: HIPAA/CITI certified BRIDGE Physical Therapy Patient Coordinators abstracted data from patient records maintained in Practice Fusion, the EHR system utilized by BRIDGE Clinic, between October 2012 and September 2013 (N = 67). Patients seen for more than one initial evaluation within the designated time period (i.e. more than one episode of care) were excluded from the sample. Data regarding attendance for initial visit, follow-up visits, and length of episode of care were abstracted, de- identified, and reported in an Excel document. Frequency counts and percentages were derived using IBM SPSS Statistics, version 21. Likelihood of follow-up attendance based on attendance for initial visit was calculated using logistic regression. Associations between duration of care and overall attendance were examined using bivariate correlation.
Results: There was a low rate of attendance for both initial physical therapy visits (60%), and follow-up visits (43%).
Conclusion: Low rate of attendance indicates the need for quality improvement efforts targeting causative factors to improve initial and follow-up visit attendance. Suspected reasons for non-attendance include inconsistency of care, lack of transportation, and patient satisfaction. Findings from this study will inform further investigation towards subsequent changes in policy and procedures. Recommendations include implementation of a standardized classification system for patient chief complaints, efforts to ensure that follow-up visits are appropriately scheduled after initial visit, and maintenance of clinic operation throughout the entire year, opposed to the academic calendar.
