An isometric hand tester: quantifying motor function in the hand.

The aim of this study was to develop and assess an isometric hand tester to measure multiple strength parameters of the muscles of the hand. Nineteen men and 22 women took part in a first study and 17 men were tested in a second one. Five different tests were developed: wrist flexion, wrist extension, metacarpophalangeal joint flexion, thumb adduction and proximal and distal interphalangeal joint flexion. Reliability was tested with an intraclass correlation coefficient for single measures. When the results from men and women were analysed separately, all tests except metacarpophalangeal joint flexion and thumb adduction produced intraclass correlation coefficients greater than 0.7. Combining the genders gave intraclass correlation coefficients greater than 0.9 except for metacarpophalangeal joint flexion and thumb adduction. After adjustments, intraclass correlation coefficients for metacarpophalangeal joint flexion and thumb adduction were between 0.70 and 0.83 in the second study. The new isometric hand tests improve the measurement of intrinsic and extrinsic hand muscle strength.

[S3-Check--evaluation and generation of normal values of a test for balance ability and postural stability]. / S3-Check--Evaluierung und Normwerteerhebung eines Tests zur Erfassung der Gleichgewichtsfähigkeit und Körperstabilität.

INTRODUCTION: Balance is very important in daily living, but there are practically no balance evaluation methods which fulfill scientific criteria and are available to the fitness community and other groups. The aims of this paper are to determine if the MFT-S3-Check, a system to measure balance, is scientifically objective, valid and reliable; and to establish norms for the MFT S 3-Check system. METHODS: Reliability was evaluated with 30 subjects in two testing sessions on two different days. Objectivity was determined by having two different test administrators test 10 subjects. Norms were generated from the data of over 5000 subjects (8 - 70 years of age). Validity was checked by comparing norms to data collected from 758 tests performed on ski racers (10 - 18 years of age). RESULTS: The objectivity and reliability tests for the sensor motor and stability indexes produced correlations which were moderate to very high. Norms were created for all age groups (female, male). The ski racers had significantly better values than the norms. DISCUSSION: The MFT S 3-Check fulfills the scientific criteria and is in use in fitness settings and in physiotherapy.

Frontal plane leg alignment and muscular activity during maximum eccentric contractions in individuals with and without patellofemoral pain syndrome.

PURPOSE: The role of frontal plane tibiofemoral alignment in subjects with patellofemoral pain syndrome (PFPS) is controversial and rarely discussed in the literature. As well, little research has been done on the effects of the hamstrings muscles on PFPS. The aim of the current study was to determine whether, in individuals with PFPS, frontal plane tibiofemoral alignment or muscular activity of the index knee's crossing muscles is altered during maximum eccentric leg press exercise. METHODS: This cross-sectional study involved 19 patients with PFPS and 19 control subjects who were matched according to gender, age, and physical activity. During eccentric leg press action, frontal plane tibiofemoral alignment was assessed with a motion analysis system based on skin markers. Simultaneously, surface-electromyography was used to assess the activity levels of the relevant knee crossing muscles. To assess the activity under functional conditions, a leg press with a footplate having variable stability was used for barefoot testing. RESULTS: The PFPS subjects did not have significantly different frontal plane leg alignment compared to controls. On electromyography (EMG), PFPS patients had significantly lower levels of hamstring activity during eccentric leg exercise. The differences between the two groups (%; absolute differences normalized EMG) ranged from 20% (semitendinosus; stable footplate; p=0.017) to 21% (biceps femoris; unstable footplate; p=0.019) and 32% (semitendinosus; unstable footplate; p=0.002). CONCLUSIONS: PFPS is not linked to altered frontal plane leg alignment during eccentric leg pressing. However, PFPS is associated with eccentric under-activation of the hamstrings, which may be a compensatory strategy that maintains patellofemoral joint pressure within bearable levels.

Barriers to learning from reflection: a study of the use of groupwork with post-registration nurses.

There are few studies which describe the use of groups to facilitate reflection and even fewer which evaluate the effectiveness of such groups. Much of the literature discussing the techniques used to facilitate reflection suggests that learners willingly engage in such processes and find them enjoyable. This paper reports on a qualitative study of the use of groups to develop learning through reflection on a part-time post-registration diploma programme for nurses. The findings suggest that there are many barriers to learning which must be overcome before practitioners can use the opportunities to reflect on and learn from their experience. It is also contended that such learning may not necessarily be an enjoyable experience. The findings suggest that previous educational experience and the current culture in which nurses and midwives work, impose tremendous barriers to reflecting on, and learning from, experience. In particular these affect the willingness of learners to expose themselves to the judgement of others and their ability to be open to taking responsibility for their own learning. Other barriers to learning in groups are the effects of other group members, their commitment or resistance to shared learning, the ways in which group members interact with each other and facilitation styles.

An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course.

An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course Small groups were set up purposefully on a part-time post-registration Diploma in Professional Studies in Nursing programme to enable students to reflect on and learn from experience. The use of these groups was qualitatively evaluated by the use of in-depth interviews. Although there were many barriers to such learning, some students made significant developments in their critical thinking ability and underwent perspective transformations that led to changes in attitudes and behaviour. These are identified as an increased professionalism, greater autonomy in decision making, more self-confidence to challenge the status quo and make their own judgements, and a less rule-bound approach to their practice. The processes by which these changes occurred are identified as support and challenge within the groups offered by both the facilitators and other group members.

Ethical considerations in qualitative research with vulnerable groups: exploring lesbians' and gay men's experiences of health care--a personal perspective.

It is rare to find honest accounts of the difficulties and dilemmas encountered when conducting sensitive research with vulnerable research populations. This account explores some of the ethical issues raised by a qualitative interview study with lesbians and gay men about their experiences of nursing care. There is tension between the moral duty to conduct research with vulnerable and stigmatized groups in order to improve care, and the inevitable lack of resources that go with such a venture. This increases the risk of harm during the process of research. The risk of harm to both the researchers and the researched is explored and the need for a support structure for both groups is raised. There is a pressing need to develop further understanding about the ways in which the dissemination of research can potentially harm already vulnerable research populations.

The concerns of lesbians seeking counseling: a review of the literature.

Whilst lesbians are no different in terms of psychological adjustment than heterosexuals, they do seek counseling for a variety of reasons and some of these are unique to their experiences as lesbians. Some of these reasons are related to difficulties in coming out, particularly in young lesbians, and some are to do with relationship problems. In most cases where lesbians seek counseling it is difficult to establish a rapport and therapeutic milieu without disclosure of sexual orientation even if this does not directly relate to the presenting problems. However, empirical evidence suggests that lesbians have difficulty in finding counselors who are not homophobic or heterosexist and who are sensitive to their mental health concerns. The debate about whether or not specialist counseling services should be developed or mainstream services improved will be discussed.

Next of kin.

Who exactly is a patient's 'next of kin' and why do nurses need to know? Does the term include partners--including same sex partners--who are not related by blood or marriage? Drawing on the negative experiences of lesbians and gay men, this article offers guidance on these difficult questions and recommends that admission documents be changed to reflect the patient's wishes.

Methodological issues conducting sensitive research on lesbian and gay men's experience of nursing care.

This paper is a methodological discussion on a qualitative research project which involved interviewing lesbians and gay men about their experiences of nursing care. The research project arose primarily because most of the knowledge available on the subject was based on hearsay and anecdote. It is worthy of note that those who felt there was an issue to be addressed, as well as the bearers of anecdote, were by and large what would be termed 'insiders' in ethnographic research, and zealots with an axe to grind in less academic circles. It is the nature of this "insider' status which is of interest throughout the research process of what was and remains a sensitive research topic. 'Insider' status can reduce many of the problems associated with conducting sensitive research in terms of access, rapport with subjects, ethical concerns, and stigma contagion, but by the same token lays researchers open to the charge of bias thought to be inherent in going native, or rather in this case being native. However, there are some problems associated with 'insider' status as well and this paper offers a discussion of the methodological problems we have encountered in relation to this, as well as more general methodological issues when conducting research considered to be sensitive. Ethical dilemmas also arose during the research when lesbian and gay patients who were currently receiving hospital care contacted the researchers directly because they felt threatened by nursing and medical staff. The paper is an attempt to describe some fairly conscious strategies to use the research team's 'insider' status for methodological reasons and to explain the ethical position we took when we felt compromised.

Ethics: nursing care of gay and lesbian patients.

Work currently being undertaken by the Royal College of Nursing's Lesbian and Gay Nursing Issues Working Party has revealed evidence of prejudice towards, and discrimination against, lesbian and gay patients by members of the nursing and medical professions. In addition, there are instances when the specific nursing needs of this population have not been met due to lack of knowledge on the part of practitioners. Lesbians and gay men who have mental health problems are particularly vulnerable to abuse from homophobic health care workers. Lesbian and gay teenagers are even more vulnerable, and they run the added risk of being labelled mentally ill because of behaviour which is considered socially undesirable. This article discusses the research evidence and highlights the need for further investigation into providing appropriate and acceptable services to these patients.