Evaluating Osteoarthritis Management Programs: outcome domain recommendations from the OARSI Joint Effort Initiative.

OBJECTIVE: To develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee Osteoarthritis (OA). DESIGN: We conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Round 1, participants ranked the importance of 75 outcome and descriptive domains in five categories: patient impacts, implementation outcomes, and characteristics of the OAMP and its participants and clinicians. Domains ranked as "important" or "essential" by ≥80% of participants were retained, and participants could suggest additional domains. In Round 2, participants rated their level of agreement that each domain was essential for evaluating OAMPs: 0 = strongly disagree to 10 = strongly agree. A domain was retained if ≥80% rated it ≥6. In Round 3, participants rated remaining domains using same scale as in Round 2; a domain was recommended as "core" if ≥80% of participants rated it ≥9 and as "optional" if ≥80% rated it ≥7. RESULTS: A total of 178 individuals from 26 countries participated; 85 completed all survey rounds. Only one domain, "ability to participate in daily activities", met criteria for a core domain; 25 domains met criteria for an optional recommendation: 8 Patient Impacts, 5 Implementation Outcomes, 5 Participant Characteristics, 3 OAMP Characteristics and 4 Clinician Characteristics. CONCLUSION: The ability of patients with OA to participate in daily activities should be evaluated in all OAMPs. Teams evaluating OAMPs should consider including domains from the optional recommended set, with representation from all five categories and based on stakeholder priorities in their local context.

Comparison of reliability, construct validity and responsiveness of the IPAQ-SF and PASE in adults with osteoarthritis.

BACKGROUND: This study assessed the measurement properties of two commonly used self-report physical activity (PA) measures: the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Physical Activity Scale for the elderly (PASE) in adults with osteoarthritis. METHODS: Secondary analysis of the MOSAICS cluster randomised controlled trial baseline and 3-month follow-up questionnaires, total scores and subdomains of the IPAQ-SF and PASE were compared. Intra-class correlations (ICC) were used to assess test-retest reliability, measurement error was assessed using standard error of measurement (SEM), smallest detectable change (SDC) and 95% limits of agreement (LoA). Responsiveness was assessed using effect size (ES), standard responsive measurement (SRM) and response ratio (RR). RESULTS: There was moderate correlation (r = 0.56) between the total IPAQ-SF scores (score ranges 0-16,398) and the total PASE scores (score ranges 0-400). Subdomain correlations were also moderate (ranges 0.39-0.57). The PASE showed greater reliability compared to the IPAQ-SF (ICC = 0.68; 0.61-0.74 95% CI and ICC = 0.64; 0.55-0.72, respectively). Measurement errors in both measures were large: PASE SEM = 46.7, SDC = 129.6 and 95% LoA ranges = -117 to 136, the IPAQ-SF SEM = 3532.2 METS-1 min-1 week , SDC = 9790.8 and 95% LoA ranges = -5222 to 5597. Responsiveness was poor: ES -0.14 and -0.16, SRM -0.21 and -0.21, and RR 0.12 and 0.09 for the IPAQ-SF and PASE, respectively. DISCUSSION: The IPAQ-SF and PASE appear limited in reliability, measurement error and responsiveness. Researchers and clinicians should be aware of these limitations, particularly when comparing different levels of PA and monitoring PA levels changes over time in those with osteoarthritis.

Moderators of the effects of therapeutic exercise for people with knee and hip osteoarthritis: A systematic review of sub-group analyses from randomised controlled trials.

Objective: 1) To identify potential moderators of the effect of therapeutic exercise explored in randomised controlled trials (RCTs) of knee and hip osteoarthritis (OA); 2) summarise the extent, strength and quality of evidence reported for moderators. Design: Systematic review (PROSPERO CRD42019148074). Inclusion criteria: a) RCTs with sub-group analyses investigating potential moderator variables; b) participants with knee and/or hip OA; c) therapeutic exercise interventions compared to either no exercise control or alternative exercise intervention(s), and; d) measuring pain or physical function outcomes. Included RCTs' risk of bias and sub-group analysis quality were assessed. Data were extracted on sub-group analyses (methods and potential moderators), outcomes (pain and function) and sub-group findings (associated statistics of potential moderator∗intervention effects). Findings were analysed using narrative synthesis. Results: 14 RCTs were included; 13 knee OA RCTs (n = 2743 participants) explored 23 potential moderators and 1 hip OA RCT (n = 203) explored 6 potential moderators. Sub-group analysis quality was mixed. Knee varus malalignment was the only moderator of therapeutic exercise compared to non-exercise control in 1 RCT (WOMAC-pain adjusted difference 12.7 in the neutral alignment sub-group and 1.8 in the malaligned sub-group, interaction term: p = 0.02). Varus thrust, knee laxity/instability, obesity and cardiac problems all moderated the effect of therapeutic exercise on pain or function compared to different comparison exercise. Conclusions: Therapeutic exercise may be effective for reducing pain in people with knee OA and neutral alignment but not for those with varus malalignment. The exercise moderator literature is limited. More robust evidence is required to inform sub-group exercise selection.

The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol.

INTRODUCTION: This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS: The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings.

Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial.

OBJECTIVE: To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. METHOD: Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. PARTICIPANTS: 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression. RESULTS: 525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3). CONCLUSION: Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months. TRIAL REGISTRATION: ISRCTN06984617.

Effect of a model consultation informed by guidelines on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care.

OBJECTIVE: To determine the effect of a model osteoarthritis (OA) consultation (MOAC) informed by National Institute for Health and Care Excellence (NICE) recommendations compared with usual care on recorded quality of care of clinical OA in general practice. DESIGN: Two-arm cluster randomised controlled trial. SETTING: Eight general practices in Cheshire, Shropshire, or Staffordshire UK. PARTICIPANTS: General practitioners and nurses with patients consulting with clinical OA. INTERVENTION: Following six-month baseline period practices were randomised to intervention (n = 4) or usual care (n = 4). Intervention practices delivered MOAC (enhanced initial GP consultation, nurse-led clinic, OA guidebook) to patients aged ≥45 years consulting with clinical OA. An electronic (e-)template for consultations was used in all practices to record OA quality care indicators. OUTCOMES: Quality of OA care over six months recorded in the medical record. RESULTS: 1851 patients consulted in baseline period (1015 intervention; 836 control); 1960 consulted following randomisation (1118 intervention; 842 control). At baseline wide variations in quality of care were noted. Post-randomisation increases were found for written advice on OA (4-28%), exercise (4-22%) and weight loss (1-15%) in intervention practices but not controls (1-3%). Intervention practices were more likely to refer to physiotherapy (10% vs 2%, odds ratio 5.30; 95% CI 2.11, 13.34), and prescribe paracetamol (22% vs 14%, 1.74; 95% CI 1.27, 2.38). CONCLUSIONS: The intervention did not improve all aspects of care but increased core NICE recommendations of written advice on OA, exercise and weight management. There remains a need to reduce variation and uniformly enhance improvement in recorded OA care. TRIAL REGISTRATION NUMBER: ISRCTN06984617.

Elementary school students' perceptions of stuttering: A mixed model approach.

PURPOSE: Past research studies have focused on perceptions of stuttering by various age groups and only a few have examined how children react to a peer who stutters. All of these studies used a quantitative analysis but only one included a qualitative analysis of elementary school age children's responses to stuttering. The aim of this study was to further explore the perceptions of elementary school students toward a peer who stutters using both quantitative and qualitative analyses of three levels of stuttering. METHODS: Participants included 88 elementary school children between 8 and 12 years of age. Each participant viewed one of four audiovisual samples of a peer producing fluent speech and mild, moderate, and severe simulated stuttering. Each participant then rated five Likert statements and answered three open-ended questions. RESULTS: Quantitative and qualitative results indicated that negative ratings and the percentage of negative comments increased as the frequency of stuttering increased. However, the children in this study indicated that they were comfortable listening to stuttering and would be comfortable making friends with the peer who stutters. CONCLUSION: The findings of this study together with past research in this area should help clinicians and their clients appreciate the range of social and emotional reactions peers have of a child who stutters. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (a) discuss past research regarding children's perceptions of stuttering; (b) summarize the need to explore the perceptions of elementary-aged children toward a peer who stutters; (c) describe the major quantitative and qualitative findings of children's perceptions of stuttering; and (d) discuss the need for disseminating more information about stuttering to children and teachers.

Patients with well-established ankylosing spondylitis show limited deterioration in a ten-year prospective cohort study.

This study aims to describe the deterioration of well-established ankylosing spondylitis (AS) over a 10-year period. Patients with well-established AS under secondary care review were assessed at baseline and re-assessed after a 10-year period. Data on patient characteristics, spinal mobility and self-reported health status (AS Quality of Life, Bath AS Disease Activity Index, EuroQoL, Revised Leeds Disability Questionnaire and Short Form-12) were compared between the two time points. One hundred fifty-nine patients took part in the initial assessment. After 10 years, 69/117 patients still under secondary care follow-up attended a second assessment. At the second assessment, this cohort was predominately male (92.8 %), mean age of 48.7 years (SD 9.7) and mean disease and symptom duration of 14.9 (SD 9.0) and 21.9 years (SD 13.3), respectively. Amongst the physical and patient-reported measures, only tragus to wall (p < 0.001), cervical rotation (p = 0.001) and disability (p = 0.02) had significantly deteriorated over time. The percentage of patients who had withdrawn from the workforce before normal retirement age increased from 37 to 53 % over the 10-year period. Many of the measures used in the assessment of AS do not generally deteriorate over time in those with well-established disease. This suggests that deterioration may plateau in established disease. However, AS has a long-term social impact with levels of employment in this cohort 30 % lower than the general population. Interventions directed at preventing deterioration may be more effective earlier in their disease course, before this plateau is reached.

Communication attitudes of Japanese school-age children who stutter.

UNLABELLED: Past research with the Communication Attitude Test (CAT) has shown it to be a valid and reliable instrument for assessing speech-associated attitude of children who stutter (CWS). However, in Japan, the CAT has not been used extensively to examine the communication attitude of CWS. The purpose of this study was to determine if a Japanese version of the CAT could differentiate between the communication attitude of Japanese elementary school CWS and children who do not stutter (CWNS). A Japanese translation of the 1991 version of the Communication Attitude Test-Revised (CAT-R) was used in this study. Eighty Japanese CWS and 80 gender- and grade level-matched CWNS participated in the study. The results showed that CWS had a significantly more negative communication attitude than CWNS. Both CWS and CWNS in 1st grade showed significantly more positive communication attitudes than children in 2nd, 3rd, 4th, 5th, and 6th grades. Furthermore, a link between stuttering severity and CWS' communication attitude was found. Additional research is needed to confirm the results of the current study, which indicate that the communication attitude of Japanese CWS becomes more negative as they get older. LEARNING OUTCOMES: The reader will be able to: (1) Describe the process that was used to develop a Japanese version of the Communication Attitude Test (CAT-J). (2) Discuss attitude differences between Japanese children who stutter and those who do not and how grade level impacts a negative attitude toward communication. (3) Explain the link between stuttering severity and attitudes of Japanese children who stutter.

The effects of duration and frequency of occurrence of voiceless fricatives on listeners' perceptions of sound prolongations.

UNLABELLED: The present study examined listeners' identification and rating of words in passages as stuttered when the duration and frequency of occurrence of sound prolongations were manipulated. Thirty-six participants listened to a 219-word passage containing voiceless fricatives digitally increased from their normal durations to 200, 300, and 420ms. Listeners heard one of three passages that contained 5%, 10% or 15% altered stimuli within the passage. In Condition 1, listeners identified words considered stuttered. In Condition 2, listeners rated specifically selected words in the passage relative to the extent they considered the words stuttered. The results showed that (1) both the duration and the frequency of occurrence of the altered phonemes within the paragraph length material had an impact on listeners' perception of words identified as a sound prolongation; (2) listeners gave significantly higher ratings in Condition 2 than Condition 1 when determining if a word was stuttered or produced fluently. The implications of these results are discussed. LEARNING OUTCOMES: After reading this article, the reader will be able to: (1) Describe the past literature on listener perceptions of stuttering. (2) Differentiate between listener's perceptions of sound prolongations that are altered in duration and frequency of occurrence. (3) Describe how paragraph-length speech material compares to past research that has used isolated utterances.

Evaluation of a modified arthritis self-efficacy scale for an ankylosing spondylitis UK population.

OBJECTIVES: To evaluate an Ankylosing Spondylitis-specific Arthritis Self-Efficacy Scale (ASES-AS) United Kingdom (UK) secondary care population. METHODS: The ASES-AS is based on the 8-item ASES with minor alterations in phraseology. Patients from ten secondary care rheumatology centres across England were asked to complete a postal questionnaire concerning sociodemographic and clinical characteristics: Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), numerical pain rating scale (NRS), Hospital Anxiety and Depression Scale (HADS), Short Form 36 (SF-36), Evaluation of AS Quality of Life questionnaire (EASi-QoL) and ASES-AS. Respondents received repeat questionnaires at 2 weeks and 6 months including health transition questions assessing change in AS-specific and general health. The ASES-AS was assessed for data quality, reliability, validity, and responsiveness. RESULTS: Response rate was 64% (n=612), 72% (n=438) were male, mean age 50.8yrs (SD 12.2 yrs), mean disease duration 17.3 yrs (SD 11.7 yrs) and mean symptom duration 22.4 yrs (SD 12.4 yrs). Missing data for each item/total score range was 0.7%-3.1%. Item-total correlations range was 0.66 to 0.83. Cronbach's alpha was 0.93 and test-retest reliability (intraclass correlation coefficient) 0.77. A priori hypothesised associations between ASAS-AS and disease status measures were supported. Social variables potentially related to self-efficacy demonstrated evidence of convergent validity (employment p<0.001, educational level p<0.005). A Modified Standard Response Mean (MSRM) of 0.44 and 0.26 in AS-specific and general health respectively at 6 months indicates moderate responsiveness. CONCLUSIONS: ASES-AS has good evidence supporting its application as an AS-specific self-efficacy measure in research including clinical trials at a group level.

Impact of ankylosing spondylitis on work in patients across the UK.

OBJECTIVES: To examine the impact of ankylosing spondylitis (AS) on patients across the UK and to identify factors associated with unemployment, absenteeism, and presenteeism. METHODS: One thousand patients with AS from 10 specialist rheumatology centres across the UK were invited to participate in a study evaluating a new outcome measure. Patients completed a questionnaire, which included questions relating to their work, sociodemographic and clinical characteristics. RESULTS: The questionnaire was completed by 612 patients (438 males; 72%). The mean age of the participants was 50.8 (SD 12.2) years, mean disease duration was 17.3 (SD 11.7) years, and mean symptom duration 22.4 (SD 12.4) years. A total of 206 (40%) patients of working age were not employed. Factors associated with not being employed were social deprivation [odds ratio (OR) 3.52, 95% confidence interval (CI) 2.14-5.80], poor function (OR 3.42, 95% CI 1.90-6.13), depression (OR 2.05, 95% CI 1.12-3.78), increasing age (OR 1.05 per year, 95% CI 1.02-1.08), and longer disease duration (OR 1.03 per year, 95% CI 1.01-1.06). Disease activity (OR 3.24, 95% CI 1.11-9.48) and depression (OR 3.22, 95% CI 1.22-8.48) were associated with absenteeism, while depression (OR 5.69, 95% CI 1.77-18.27, disease activity (OR 3.97, 95% CI 1.76-8.98), anxiety (OR 3.90, 95% CI 1.83-8.31), self-efficacy (OR 0.71, 95% CI 0.58-0.86), and increasing age (OR 1.04 per year, 95% CI 1.00-1.08) were associated with presenteeism. CONCLUSION: Psychological, sociodemographic, and disease-related factors were all found to be related to work status. These factors should be taken into account when considering early treatment and management. Depression, in particular, appears to be associated with employment, absenteeism, and presenteeism, and should therefore be prioritized in clinical practice.

What the literature tells us about listeners' reactions to stuttering: implications for the clinical management of stuttering.

It is known that listeners harbor negative stereotypes toward people who stutter but there are a host of other findings in the literature that provide a broader perspective about how listeners react to stuttering. The focus of this article is a discussion of four areas of research related to listener reactions to stuttering: (1) how stuttering impacts listeners' reactions to mild, moderate, and severe stuttering; (2) how stuttering interferes with listener recall and comprehension of story information; (3) how children react to stuttering; and (4) how listeners react to strategies plus use in stuttering therapy programs. Studies associated with these four areas of research are summarized and discussed. Clinical implications that emerge from these studies are described to assist clinicians in the treatment of children and adults who stutter.

Influence of text type, topic familiarity, and stuttering frequency on listener recall, comprehension, and mental effort.

PURPOSE: To determine how text type, topic familiarity, and stuttering frequency influence listener recall, comprehension, and perceived mental effort. METHOD: Sixty adults listened to familiar and unfamiliar narrative and expository texts produced with 0%, 5%, 10%, and 15% stuttering. Participants listened to 4 experimental text samples at only 1 stuttering frequency. After hearing the text samples, each listener performed a free recall task, answered cued recall questions, answered story comprehension questions, and rated their perceived mental effort. RESULTS: Free and cued recall as well as story comprehension scores were higher for narrative than for expository texts. Free and cued recall scores were better for familiar than for unfamiliar stories, although topic familiarity did not affect story comprehension scores. Samples with all levels of stuttering resulted in higher mental effort ratings for both text types and topic familiarities. CONCLUSIONS: Stuttering has a greater influence on listener recall and comprehension for narrative than for expository texts. Topic familiarity affects free and cued recall but has no influence on story comprehension. Regardless of the amount of stuttering, mental effort was high for both text types and levels of familiarity.

Middle school students' perceptions of a peer who stutters.

UNLABELLED: Little is known about how middle school students perceive a similar-aged peer who stutters. Therefore, the purpose of this study was to examine the influence of stuttering frequency, Likert statement type (affective, behavioral, cognitive), and the gender of the listener on middle school students' perceptions of a peer who stutters. Sixty-four middle school students (10-14 years) individually viewed a video sample of a teen telling a joke at one of four stuttering frequencies (<1%, 5%, 10%, 14%). After the students viewed one of the video samples, they were asked to rate 11 Likert statements that reflected their affective, behavioral, and cognitive perceptions of a peer who stuttered. The results revealed an interaction between stuttering frequency and Likert statement type. Ratings of behavioral statements (speech production characteristics) were significantly more positive for the sample containing <1% stuttering than 10% and 14% stuttering. Ratings for cognitive statements (thought and beliefs) were significantly more positive for the sample containing <1% stuttering than 10% and 14% stuttering. The stuttering frequency of the peer did not significantly influence how students rated affective statements (feelings and emotions). It was also found that male and female middle school students did not significantly differ in their perceptions of a male peer who stutters. Clinical implications are discussed relative to peer teasing, friendship, listener comfort, and social acceptance within a middle school setting for a student who stutters. Future research directions are also discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) summarize how middle school students perceive stuttering; (2) explain how the frequency of stuttering influences middle school students' perceptions of a peer who stutters; and (3) provide clinical implications of the data from this study.

Stature loss and recovery following a period of loading: effect of time of day and presence or absence of low back pain.

BACKGROUND: Stature reductions in asymptomatic individuals, caused by a set load, are lower later in the day when stature is in the trough of diurnal variation; hence most stature reduction investigations are conducted in the morning. Recent evidence suggests that it is not the reductions in stature, but the recovery of stature, that is of greatest importance. The aim of this investigation was to establish whether stature recovery is also affected by time of day and to determine if any differences exist between a chronic low back pain and asymptomatic group. METHODS: Eleven chronic low back pain participants (age=32.8 SD 7.9 yrs, mass=74.4 SD 14.2 kg and height=1.73 SD 0.07 m) and 11 asymptomatic participants (age=31.0 SD 6.3 yrs, body mass=72.6 SD 11.5 kg and height=1.76 SD 0.09 m) underwent two 20 min loaded walking tasks (10% body mass), one in the morning (09:00) and one in the afternoon (14:00), followed by a 20 min unloaded recovery period. Measurements of stature were obtained throughout. FINDINGS: The asymptomatic group experienced significantly less stature reduction (P=0.05; ES=1.1) and greater stature recovery (P=0.02; ES=0.9) in the afternoon compared to the morning. The chronic low back pain group experienced a similar pattern to the asymptomatic group, however no significant difference between sessions for changes in stature was evident P=0.07. INTERPRETATION: Further investigations of stature recovery should be restricted to the morning when comparing individuals with and without chronic low back pain, as time of day appeared to have effect on stature recovery, particularly in the asymptomatic group. Time dependent differences in stature change between these two populations warrants further investigation.

Listeners' identification and discrimination of digitally manipulated sounds as prolongations.

The present study had two main purposes. One was to examine if listeners perceive gradually increasing durations of a voiceless fricative categorically ("fluent" versus "stuttered") or continuously (gradient perception from fluent to stuttered). The second purpose was to investigate whether there are gender differences in how listeners perceive various duration of sounds as "prolongations." Forty-four listeners were instructed to rate the duration of the // in the word "shape" produced by a normally fluent speaker. The target word was embedded in the middle of an experimental phrase and the initial // sound was digitally manipulated to create a range of fluent to stuttered sounds. This was accomplished by creating 20 ms stepwise increments for sounds ranging from 120 to 500 ms in duration. Listeners were instructed to give a rating of 1 for a fluent word and a rating of 100 for a stuttered word. The results showed listeners perceived the range of sounds continuously. Also, there was a significant gender difference in that males rated fluent sounds higher than females but female listeners rated stuttered sounds higher than males. The implications of these results are discussed.

The effects of self-disclosure and non self-disclosure of stuttering on listeners' perceptions of a person who stutters.

UNLABELLED: The aim of this study was to examine listener perceptions of an adult male person who stutters (PWS) who did or did not disclose his stuttering. Ninety adults who do not stutter individually viewed one of three videotaped monologues produced by a male speaker with severe stuttering. In one monologue, 30 listeners heard the speaker disclose stuttering at the beginning and in another monologue, 30 listeners heard the speaker disclose stuttering at the end. A third group of 30 listeners viewed a monologue where no disclosure of stuttering occurred. After listeners viewed a monologue, they were asked to rate a set of six Likert scale statements and answer three open-ended questions. The results showed that only one of six Likert statements was significantly different across the three conditions. The only statement that was different was that the speaker was perceived to be significantly more friendly when disclosing stuttering at the end of the monologue than when not disclosing stuttering. There were no significant differences between the percentage of positive and negative comments made by listeners across the three conditions. Listeners' comments to each open-ended question showed they were comfortable listening to stuttering with or without disclosure and slightly more than half of the listeners believed their perceptions of the speaker did not change when he disclosed stuttering. The results also showed that the speaker who disclosed stuttering at the beginning of the monologue received significantly more positive listener comments than when he disclosed stuttering at the end of the monologue. Results are discussed relative to comparisons with the study, the clinical relevance of acknowledging stuttering as a component of treatment, and future research on the self-disclosure of stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how different groups of listeners perceive and respond to two conditions of self-disclosure of stuttering and one condition involving non self-disclosure of stuttering; (2) summarize the range of listener responses to and benefits of self-disclosure of stuttering; and (3) describe the value of self-disclosure of stuttering for the listener and the speaker.

Repeatability of stature measurements in individuals with and without chronic low-back pain.

Measurements of reduction in stature have been used to compare spinal loading in chronic low-back pain (CLBP) and asymptomatic populations. Whether there are any differences in the repeatability of stature measurements, between those with and without CLBP, is not known. This investigation aimed to determine the repeatability of stature measurements in those with (n = 12) and without (n = 12) CLBP, and to establish if the ability to produce repeatable measurements is retained after a specific timeframe. Stature measurements were taken on two separate sessions that were 2 weeks apart, using a stadiometer accurate to 0.01 mm. All participants attained a mean SD of < or = 0.5 mm by the third measurement set taken on the first session of testing and no significant difference in mean SD was found between those with (0.37 mm) and without (0.40 mm) CLBP (p > 0.05). Intraclass correlation coefficients (ICC) demonstrated good levels of repeatability for all stature measurements obtained from the participants and the values for Standard error of the measurement (SEM) improved as the mean SD decreased with each measurement set. Investigators should have confidence in the ability of those with and without CLBP to produce equally repeatable stature measurements with appropriate prior practice. The second session of testing demonstrated that both groups had retained the ability to achieve the desired level of repeatability (SD < or = 0.5 mm) 2 weeks later without further practice.