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Nicholas P Bent,1 Alison B Rushton,1 Chris C Wright,1 Emma-Jane Petherick,2 Mark E Batt3 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, 3Centre for Sports Medicine, Nottingham University Hospitals, Nottingham, UK Background: The Anteromedial Reach Test is a performance-based outcome measure for evaluating dynamic knee stability in patients with anterior cruciate ligament injury. No previously published study has adequately evaluated intrarater or interrater reliability of the Anteromedial Reach Test, so the purpose of this study was to assess these measurement properties in healthy participants prior to their investigation in patients with anterior cruciate ligament injury. Methods: Two raters (A and B) tested 39 healthy university staff and students (20 men, 19 women). For the intrarater reliability investigation, rater A tested participants on three separate test occasions (days 1, 2, and 3) at the same time of day. For the interrater reliability investigation, raters A and B independently tested participants on the same test occasion (day 3). Results: There was no significant systematic bias between test occasions or raters. Values of the intraclass correlation coefficient (2,1) were 0.96 for intrarater reliability of both the dominant leg and nondominant leg and 0.97 (dominant leg) and 0.98 (nondominant leg) for interrater reliability. Values for the standard error of measurement were 1.46 (dominant leg) and 1.62 (nondominant leg) for the intrarater investigation, and 1.26 (dominant leg) and 1.04 (nondominant leg) for the interrater investigation. At the 90% confidence level, the minimum detectable change was 3.8% and the error in an individual's score at a given point in time was ±2.7%. Conclusion: The Anteromedial Reach Test demonstrated excellent intrarater and interrater reliability in healthy participants. This provides a basis for future investigation of the measurement properties of the Anteromedial Reach Test in patients with anterior cruciate ligament injury. Keywords: anterior cruciate ligament, injury, dynamic stability, rehabilitation, outcome measures

The anteromedial reach test (ART) is a new outcome measure for assessing dynamic knee stability in anterior cruciate ligament-injured patients. The effect of learning and leg length on distance reached in the ART was examined. Thirty-two healthy volunteers performed 15 trials of the ART on each leg. There was a moderate correlation (r = .44-.50) between reach distance and leg length, therefore reach distances were normalized for leg length. Normalized reach distance increased significantly over the 15 trials (p < .01), reaching a plateau after 8 trials, identified by a moving average graph. It is recommended that participants be afforded eight practice trials and that reach distances be normalized by expressing them as a percentage of leg length. [ABSTRACT FROM AUTHOR]

Using examples from the field of anterior cruciate ligament rehabilitation, this review provides sports and health practitioners with a comprehensive, user-friendly, guide to selecting outcome measures for use with active populations. A series of questions are presented for consideration when selecting a measure: is the measure appropriate for the intended use? (appropriateness); is the measure acceptable to patients? (acceptability); is it feasible to use the measure? (feasibility); does the measure provide meaningful results? (interpretability); does the measure provide reproducible values? (reliability); does the measure assess what it is supposed to assess? (validity); can the measure detect change? (responsiveness); do substantial proportions of patients achieve the worst or best scores? (floor and ceiling effects); is the measure structured and scored correctly? (dimensionality and internal consistency); has the measure been tested with the types of patients with whom it will be used? (sample characteristics). Evaluation of the measure using these questions will assist practitioners in making their judgements. [ABSTRACT FROM AUTHOR]

The re-education of spinal posture is an integral part of shoulder impingement management yet supporting evidence is limited. The purpose of this study was to evaluate the effect of slouched versus erect sitting posture on shoulder pain intensity and range of motion (ROM) in subjects with impingement. A same-subject repeated-measures design was utilized. Maximum active shoulder flexion and associated pain intensity were measured in 28 subjects in slouched and erect sitting postures, using video-analysis and visual analogue scales, respectively. An intra-tester reliability study of the video-analysis system was completed and intra-class correlation coefficients calculated. Shoulder flexion differences between slouched and erect sitting posture were analysed using a repeated-measures analysis of variance (ANOVA). The intra-tester reliability of the video-analysis method was found to be 'excellent' (ICC = 0.99). Flexion ROM was significantly greater in the erect sitting posture (F = 100.3, P < 0.0001); the mean ROM difference between postures was 17.67 degrees (+/- 9.17 degrees). There was no significant difference in pain intensity between postures (F = 1.9, P = 0.179). An erect sitting posture appeared to increase active shoulder flexion in subjects with shoulder impingement, although there were no differences in reported pain intensity. Further research is required to investigate the long-term effects of postural re-education. [ABSTRACT FROM AUTHOR]

Working Horizons is an intervention designed to prevent work disability by addressing the internal and external barriers faced by people with arthritis in their attempts to enter or maintain their positions in the employment arena. The aim of the pilot study was to determine whether Working Horizons influenced participants' self-efficacy and psychological well-being and to describe the experience of Working Horizons from the perspectives of participants and employment advisors (EAs). The study was a pre-test post-test design with an Intervention Group (n=22) and Comparison Control Group (n=22). Quantitative data were collected by self-completed questionnaires at baseline and at six-months follow-up. Qualitative data were collected via open questions on the questionnaires, interviews with a sub-sample of 10 participants, and a focus group with EAs at the end of the programme. Pilot data suggested that Working Horizons was effective in terms of increasing participants' job-seeking self-efficacy. In addition, the Intervention Group showed significant improvements on self-esteem and satisfaction with life. Qualitative findings confirmed that participants felt more 'confident' in relation to seeking employment, were more accepting of their condition, felt more positive and had greater awareness of the social model of disability. Participants valued the emotional and instrumental support provided by the EAs, who acted as successful 'work' role models. Interventions, such as Working Horizons, may be an effective means of addressing work disability, acting as a gateway to statutory services. The value of suitable role models in mentoring capacities was highlighted. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the development of the 'Compliance of Hypertensive Patients' scale (=CHPS), and assessment of its reliability and validity. Previous scales incorporate only activity in health regimens as indicators of hypertensive patients' compliance. The 'Compliance of Hypertensive Patients' scale was developed to incorporate other indicators of compliance also, such as intention, responsibility and collaboration. Data were collected from a convenience sample of 103 patients, in five health care centres in Finland. Dimensionality was explored using principal component analysis and internal consistency was estimated according to a standard item analysis approach and Theta coefficient. Validity was assessed using face validity, content validity and criterion-related validity (through the use of concurrent validity). The data supported five subscales, labelled: lifestyle, intention, attitude, responsibility and smoking. Inter-item correlations ranged from 0.24 to 0.61 and corrected item-total correlations from 0.32 to 0.67, across subscales. The Theta coefficient demonstrated good internal consistency. This scale forms a useful starting point in the development of a reliable and valid tool to assess compliance of hypertensive patients, based on several indicators. [ABSTRACT FROM AUTHOR]

A lack of understanding of statistical concepts and procedures is a barrier to conducting research and to using research findings. This article will discuss some basic concepts of statistical hypothesis testing, the interpretation and clinical implications of ensuing results, and their role in health-care research. The distinction between statistical significance and practical importance is stressed. [ABSTRACT FROM AUTHOR]

This article will discuss key features of simple graphical and numerical summaries that are routinely used to describe numerical data. It considers the different types of data and how these influence the choice of appropriate summaries, and helps the consumer to identify information that has been presented in an inappropriate or misleading manner. [ABSTRACT FROM AUTHOR]

AIM: The aim of this study was to compare the safety and effectiveness of anticoagulant nurses and a consultant haematologist in managing anticoagulant patients in a hospital outpatient setting. BACKGROUND: Nurses are increasingly developing roles traditionally undertaken by medical staff. As a result nurse-led practice has expanded in many areas including anticoagulant services. Previous studies have attempted to demonstrate the effectiveness of using other professionals to manage anticoagulant clinics over short periods of time. This research evaluates the safety and effectiveness of a consultant-led and a nurse-led service over two sequential 18-month periods. RESEARCH METHODS: A nonexperimental design was adopted. Data were collected retrospectively, from a random sample of 197 patients, who had been managed by both the consultant-led and nurse-led service. Two main outcome measures were selected: anticoagulant control between professional groups and interval between outpatient clinic appointments. RESULTS: No statistically significant difference in anticoagulant control was found between professional groups (P=0.137). There was evidence that patients attended anticoagulant clinics on significantly fewer occasions with nurse-led management (P < 0.0005). CONCLUSION: At the department within which this research was conducted, anticoagulant nurses were found to be at least as safe and effective as the consultant haematologist in managing outpatient anticoagulant patients over the study period. These findings are of importance in both shaping the future provision of anticoagulant care and also contributing to the wider area in evaluating the impact of nurse-led practice within health care. [ABSTRACT FROM AUTHOR]

This article will describe the context within which statistics are used in health-care research, define 'statistics' in relation to this context and discuss the role of statistics in relation to researchers and consumers of research. Future articles will discuss key aspects of the use of statistics in health-care research. The series will aim to encourage critical interpretation and appropriate use of statistical information. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Though many contaminants are released into the atmosphere, in the US only six air pollutants-ozone, particulate matter, sulfur dioxide, carbon monoxide, nitrogen dioxide, and lead-are closely monitored and carefully assessed for health significance. Other pollutants, even if highly toxic, are neither widely monitored nor routinely assessed at the national level. The goal of this study was to analyze the availability of information needed to characterize the health significance of hazardous air pollutants, focusing on urban areas in California. METHODS: The authors compared different approaches to identifying which contaminants should be considered hazardous air pollutants of potential health concern; reviewed the availability of toxicity values for these pollutants; and analyzed the usefulness of air monitoring data from California agencies for determining populations risks, by comparing method detection limits with health benchmarks. RESULTS: Approaches to identifying air contaminants of possible health concern differ. Toxicity values are not available for many hazardous air pollutants, including those identified in the Clean Air Act. In California, monitoring data are available for many, though not all, pollutants of concern. Monitoring methods for several pollutants do not have adequate sensitivity to detect all relevant concentrations. CONCLUSION: The information necessary to fully assess the health significance of hazardous air pollutants is not currently available. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether the Arthritis Self-Management Programme (ASMP) is effective in promoting perceived control and self-management ability when delivered in an adult education setting. The study was a pre-test-post-test design based on a sample of 89 people attending an ASMP. Data were collected by self-administered questionnaires prior to the intervention and after the intervention, 4 months from baseline. The sample comprised 80% women, with a mean age of 57 years and a mean disease duration of 13 years. Most participants had either osteoarthritis or rheumatoid arthritis. After 4 months, participants demonstrated significant increases in arthritis self-efficacy (P < 0.0005), cognitive symptom management (P < 0.0005), communication with doctors (P = 0.018), exercise (P = 0.003) and relaxation (P < 0.00005). In addition, significant decreases were found in terms of pain (P = 0.034) and visits to other health professionals (P = 0.004). The first evaluation of the ASMP, delivered within the context of adult education, suggests that this form of community health education programme can offer substantial benefits for participants, particularly in terms of perceived ability to control various aspects of arthritis and in greater utilization of cognitive-behavioral techniques. [ABSTRACT FROM AUTHOR]

Objective.A previous UK evaluation of the Arthritis Self-Management Programme (ASMP) demonstrated 4 month improvements in physical and psychological well-being including increased arthritis self-efficacy and increased use of self-management behaviours such as cognitive symptom management, and reductions in pain, fatigue and anxiety. The purpose of this study was to determine whether these effects were maintained at 12 month follow-up. [ABSTRACT FROM PUBLISHER]

Despite the wide availability of disease-related leaflets, their impact on patients' knowledge and well-being has rarely been evaluated. A randomized controlled study of a 'Rheumatoid Arthritis' leaflet revealed increased knowledge among the intervention group after 3 weeks. In addition, the leaflet was viewed as a source of reassurance. The purpose of the follow-up study was to determine whether the increase in knowledge was maintained in the longer term and to examine psychological well-being. Eighty-four patients (42 intervention and 42 control) completed the 6 month follow-up. There were no significant changes (P > 0.01) in mean outcome measures over the period 3 weeks-6 months for either the intervention or control groups. Patients in the intervention group retained the increase in knowledge observed at 3 weeks. Moreover, there was no evidence of adverse reactions to the leaflet in terms of psychological distress. Leaflets can be effective in promoting longer term increases in knowledge. [ABSTRACT FROM PUBLISHER]

Objective.With the advent of community-based arthritis education programmes, it is important to determine the accuracy of participants' self-reported diagnoses. The purpose of this study was to determine the level of agreement between general practitioner (GP)-recorded and self-reported diagnoses of participants attending an Arthritis Self-Management Programme (ASMP). [ABSTRACT FROM PUBLISHER]