Measuring the nursing work environment: translation and psychometric evaluation of the Essentials of Magnetism.

AIM: Translate the Essentials of Magnetism II© (EOMII; Dutch Nurses' Association, Utrecht, The Netherlands) and assess its psychometric properties in a culture different from its origin. BACKGROUND: The EOMII, developed in the USA, measures the extent to which organizations/units provide healthy, productive and satisfying work environments. As many healthcare organizations are facing difficulties in attracting and retaining staff nurses, the EOMII provides the opportunity to assess the health and effectiveness of work environments. METHODS: A three-phased (respectively N = 13, N = 74 and N = 2542) combined descriptive and correlational design was undertaken for translation and evaluation validity and psychometric qualities of the EOMII for Dutch hospitals (December 2009-January 2010). We performed forward-backward translation, face and content validation via cross-sectional survey research, and semi-structured interviews on relevance, clarity, and recognizability of instruments' items. Psychometric testing included principal component analysis using varimax rotation, item-total statistics, and reliability in terms of internal consistency (Cronbach's α) for the total scale and its subscales. RESULTS: Face validity was confirmed. Items were recognizable, relevant and clear. Confirmatory factor analysis indicated that five of eight subscales formed clear factors. Three original subscales contained two factors. Item-total correlations ranged from 0.43 to 0.83. One item correlated weakly (0.24) with its subscale. Cronbach's α for the entire scale was 0.92 and ranged from 0.58 to 0.92 for eight subscales. CONCLUSIONS: Dutch-translated EOMII (D-EOMII) demonstrated acceptable reliability and validity for assessing hospital staff nurses' work environment. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The D-EOMII can be useful and effective in identifying areas in which change is needed for a hospital to pursue an excellent work environment that attracts and retains well-qualified nurses.

Use of visual feedback in retraining balance following acute stroke.

BACKGROUND AND PURPOSE: Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke, although it is not clear whether functional balance ability also improves. This study compared the relative effectiveness of visual feedback training of center-of-gravity (CoG) positioning with conventional physical therapy following acute stroke. SUBJECTS: Forty-six people who had strokes within 80 days before the study, resulting in unilateral hemiparesis, and who were in need of balance retraining participated. METHODS AND MATERIALS: Initially, subjects were randomly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited. The next 14 subjects were assigned to a control group. All subjects received physical therapy and occupational therapy (regular therapy) 2 hours a day, and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge. The visual feedback group received information about their CoG position as they shifted their weight during various activities. The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting. Static (postural sway) and activity-based measures of balance (Berg Balance Scale, gait speed, and the Timed "Up & Go" Test) were contrasted across the 3 groups at baseline, at discharge, and at 1 month following discharge using an analysis of variance for repeated measures. RESULTS: All groups demonstrated marked improvement over time for all measures of balance ability, with the greatest improvements occurring in the period from baseline to discharge. No between-group differences were detected in any of the outcome measures. CONCLUSION AND DISCUSSION: Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke.

Isokinetic strength training of the hemiparetic knee: effects on function and spasticity.

PURPOSE: To determine whether isokinetic training can improve the strength of the hemiparetic knee musculature, functional mobility, and physical activity and to evaluate its effect on spasticity in long-term stroke survivors. DESIGN: Nonrandomized self-controlled trial. SUBJECTS: A volunteer sample of 15 community-dwelling stroke survivors of at least 6 months. INTERVENTION: A 6-week (3 days/week, 40 minutes/day) program consisting of warm-up, stretches, reciprocal knee extension and flexion isokinetic strengthening, and cool-down for the paretic limb. MAIN OUTCOME MEASURES: Peak isokinetic hamstring and quadriceps torque, quadriceps spasticity, gait velocity, timed Up and Go, timed stair climb, and the Human Activity Profile (HAP) scores were recorded at baseline, after training, and 4 weeks after training cessation (follow-up). RESULTS: Paretic muscle strength improved after training (p < .05) while tone remained consistent (p > .87). Gait velocity increased after training (p < .05) and at follow-up (p < .05). Changes in stair climbing and timed Up and Go were not significant (p > .37; p > .91), although subjects perceived gains in their physical abilities at follow-up (p < .01). CONCLUSIONS: Gains in strength and gait velocity without concomitant increases in muscle tone are possible after a short-term strengthening program for stroke survivors. The psychological benefit associated with physical activity is significant.

Reliability and validity of measures obtained from stroke patients using the Balance Master.

OBJECTIVE: To determine the test-retest reliability and validity of data obtained using the Balance Master (BM), a computerized balance assessment and training tool. DESIGN: Data were collected on three occasions, 1 week apart. Intraclass correlation coefficients (ICCs) were calculated if significant (p < .05) between-subject variance was found using a univariate analysis of variance for repeated measures. Concurrent validity of the BM data was determined using the Berg Balance Scale and gait velocity as criterion standards. PARTICIPANTS: Twenty ambulatory hemiparetic subjects who had no history of lower extremity orthopedic problems, no neurological deficits apart from stroke, and had not trained using the BM. MAIN OUTCOME MEASURES: BM data relating to static and dynamic balance performance, gait velocity, and the total score from the Berg Balance Scale. RESULTS: ICCs indicated that only the BM test requiring subjects to shift their center of gravity to randomly highlighted targets (positioned in a circle representing 75% of the individual's limits of stability) was reliable, both in terms of movement path (ICC = .84) and movement time (ICC = .88). Concurrent validity of the BM data was established for the dynamic measures of balance only, which correlated with both the Berg Balance Scale and gait velocity outcomes (r > or = .48, p < .05). CONCLUSIONS: These findings suggest that in stroke patients the test-retest reliability of data obtained using the BM is greatest for complex tests of balance and that dynamic rather than static balance measures are valid indicators of functional balance performance.

Upper extremity weight-bearing effect on corticospinal excitability following stroke.

The effects of upper extremity weight-bearing on the excitability of corticospinal neurons projecting to the flexor carpi ulnaris (FCU) muscle of patients having had cerebrovascular accidents (strokes) were examined. Alternate transcranial magnetic and ulnar nerve stimulation were applied and peristimulus time histograms of single FCU motor unit discharge times were generated to provide information about the cortical and segmental postsynaptic potentials (PSPs), respectively. Recordings from 10 patients and 5 control subjects indicated the cortically evoked PSPs were initially abnormally small in the stroke group (p < .01). Following weight-bearing the cortical projection strength to FCU motoneurons increased in stroke patients (p < .05) only. The composite group Ia PSP was reduced in 2 patients, but data could not be obtained from the remaining subjects. It is concluded that upper extremity weight-bearing normalizes corticospinal facilitation of FCU motor units in stroke patients. A sustained increase in motor cortical excitability through augmented afferent input may be responsible.

Running patterns of juveniles wearing SACH and single-axis foot components.

Concerns have been raised about the capability of conventional prosthetic foot components to provide adequate support and function for activities other than walking to persons with lower limb amputations. Degenerative changes of the lumbar spine and knee joints have been linked to prolonged asymmetric loading, which may be accentuated when force magnitudes are high, as in running. This study evaluated the extent and location of kinematic and kinetic asymmetries relative to the foot component worn. The running patterns of six children with unilateral below-knee amputations were evaluated on two occasions: first, while wearing the solid ankle-cushioned heel (SACH) component, and second, wearing the single-axis (SA) component. Cinematographic and forceplate data yielded bilateral temporal data, vertical ground reaction forces, joint angular trajectories, and moments. Results indicated that the SACH and SA components performed almost identically, despite the greater excursion allowed by the SA foot. Slower step speed on the affected side was related to significantly lower vertical ground reaction forces (p less than .01). The ankle angular displacement and moment curves revealed the incapacity of either component to stimulate natural foot-ankle function, with resulting significant interlimb asymmetries. The ipsilateral knee displayed marked reduction of the initial flexor wave, paired with a reduced extensor moment. Compensations predominated ipsilaterally, as evidenced by the similarity of the contralateral patterns to those of an able-bodied runner, except for a decreased hip flexor moment before toe-off. This study showed that interlimb asymmetries were attributable to the inadequacies of both components.