Difference in Physiotherapy Students' Training and Objective Structured Clinical Exam Performance Before and During COVID-19.

Purpose: The Objective Structured Clinical Examination (OSCE) and station examinations, in general, have been widely utilized in health professional programmes to evaluate students' clinical performance prior to advancing to a clinical placement. The COVID-19 pandemic impacted student preparation and implementation of our programme's OSCEs. The impact on changes in student OSCE performance due COVID-19 has not been well studied. This non-concurrent cohort study evaluated the difference before and during COVID-19 pandemic on Year 1 physiotherapy students' performances on an in-person OSCE by estimating the mean difference in cohort OSCE scores and safety occurrences. Methods: Two cohorts of MSc (PT) students were compared: Cohort A (not impacted by COVID-19) and Cohort B (impacted by COVID-19). Cohort scores were summarized as means and 95% CIs. Results: Overall OSCE scores for Cohort A and B were 77.9 and 81.9, respectively (d¯ = 4.0, 95% CI: 2.1, 5.8). Cohort B students were approximately 4 times more likely to demonstrate safety occurrences. Conclusion: The impact of COVID-19 did not adversely affect total OSCE scores; however, it did increase safety infractions.

Objectif: en général, les programmes pour les professionnels de la santé font largement appel à l'examen clinique objectif structuré (ECOS) et aux stations d'examen pour évaluer la performance clinique des étudiants avant leur passage au stage clinique. La pandémie de COVID-19 a nui à la préparation des étudiants et à la mise en œuvre des ECOS du programme de physiothérapie. Les effets sur les changements à la performance des étudiants à l'ECOS découlant de la COVID-19 n'ont pas été bien étudiés. La présente étude de cohorte non concomitante a permis d'évaluer la différence entre la performance des étudiants en première année de physiothérapie à un ECOS en personne avant et pendant la pandémie de COVID-19, d'après la différence moyenne des scores d'ECOS et des occurrences d'infractions aux règles de sécurité au sein des deux cohortes. Méthodologie: deux cohortes d'étudiants à la maîtrise en physiothérapie ont été comparées : la cohorte A (non touchée par la COVID-19) et B (touchée par la COVID-19). Les scores des cohortes ont été résumés sous forme de moyennes et d'IC à 95%. Résultats: les scores globaux de l'ECOS pour la cohorte A et la cohorte B s'élevaient à 77,9 et à 81,9, respectivement (d¯ = 4,0, IC à 95 % : 2,1, 5,8). Les étudiants de la cohorte B étaient environ quatre fois plus susceptibles de démontrer des occurrences d'infraction aux règles de sécurité. Conclusion: la COVID-19 n'a pas nui aux scores totaux de l'ECOS, mais les infractions aux règles de sécurité se sont accrues.

A Systematic Review of Head-to-Head Comparison Studies of the Roland-Morris and Oswestry Measures' Abilities to Assess Change.

PURPOSE: To determine if the sensitivity to change of Roland-Morris Questionnaire (RMQ) and Oswestry Disability Index (ODI) scores differ when applied to patients with low back pain (LBP). A secondary purpose was to critique the methodological rigour of the identified head-to-head comparison studies. METHODS: A systematic review of five online databases was performed to locate head-to-head comparison studies of the RMQ and the ODI that assessed the sensitivity to change of the two measures. Studies were eligible if they met a pre-determined set of inclusion criteria. A newly developed quality criteria form was used to evaluate the methodological rigour of head-to-head comparison studies. RESULTS: Nine articles met the inclusion criteria. Although there was a statistically significant difference in favour of the RMQ for two studies, there was no apparent consistent advantage of one measure over the other. Frequent methodological deficiencies included no formal sample size calculation, no formal between-measure comparison, and no independent reference standard. CONCLUSION: There was no consistent evidence supporting one measure over the other. Many studies displayed methodological deficiencies.

Objectif : Déterminer si la sensibilité au changement des résultats au questionnaire Roland-Morris (Roland-Morris Questionnaire, RMQ) et au questionnaire d'incapacité d'Oswestry (Oswestry Disability Index, ODI) diffèrent lorsqu'on les applique aux patients qui souffrent de lombalgie. Comme objectif secondaire, réaliser une analyse critique de la rigueur méthodologique des études comparatives directes sélectionnées. Méthode : Une revue systématique de cinq bases de données en ligne a été réalisée pour rechercher des études comparatives directes du RMQ et de l'ODI qui évaluaient la sensibilité au changement de ces deux mesures. Les études étaient retenues si elles satisfaisaient à un ensemble de critères d'inclusion préétabli. Un formulaire de critères de qualité nouvellement élaboré a été utilisé pour évaluer la rigueur méthodologique des études comparatives directes. Résultats : Neuf articles satisfaisaient aux critères d'inclusion. Bien que pour deux études, on ait constaté une différence statistique appréciable favorable au RQM, il n'y avait aucun avantage apparent commun pour une mesure plutôt que pour l'autre. Les lacunes méthodologiques fréquentes étaient notamment l'absence de calcul formel de la taille de l'échantillon, l'absence de critère pour la comparaison des mesures et le fait qu'il n'y avait aucune norme de référence indépendante. Conclusion : Il n'y a aucun élément probant commun permettant de privilégier une mesure plutôt qu'une autre. Plusieurs études comportaient des lacunes sur le plan méthodologique.

Measurement properties of performance-specific pain ratings of patients awaiting total joint arthroplasty as a consequence of osteoarthritis.

PURPOSE: To estimate the test-retest reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain sub-scale and performance-specific assessments of pain, as well as the association between these measures for patients awaiting primary total hip or knee arthroplasty as a consequence of osteoarthritis. METHODS: A total of 164 patients awaiting unilateral primary hip or knee arthroplasty completed four performance measures (self-paced walk, timed up and go, stair test, six-minute walk) and the WOMAC. Scores for 22 of these patients provided test-retest reliability data. Estimates of test-retest reliability (Type 2,1 intraclass correlation coefficient [ICC] and standard error of measurement [SEM]) and the association between measures were examined. RESULTS: ICC values for individual performance-specific pain ratings were between 0.70 and 0.86; SEM values were between 0.97 and 1.33 pain points. ICC estimates for the four-item performance pain ratings and the WOMAC pain sub-scale were 0.82 and 0.57 respectively. The correlation between the sum of the pain scores for the four performance measures and the WOMAC pain sub-scale was 0.62. CONCLUSION: Reliability estimates for the performance-specific assessments of pain using the numeric pain rating scale were consistent with values reported for patients with a spectrum of musculoskeletal conditions. The reliability estimate for the WOMAC pain sub-scale was lower than typically reported in the literature. The level of association between the WOMAC pain sub-scale and the various performance-specific pain scales suggests that the scores can be used interchangeably when applied to groups but not for individual patients.

The evaluation of change in pain intensity: a comparison of the P4 and single-item numeric pain rating scales.

STUDY DESIGN: Prospective observation study. OBJECTIVES: To compare the test-retest reliability and longitudinal validity (sensitivity to change) of 2 single-item numeric pain rating scales (NPRSs) with a 4-item pain intensity measure (P4). BACKGROUND: Pain is a frequent outcome measure for patients seen in physical therapy; however, the error associated with efficient pain measures, such as the single-item NPRS, is greater than for self-report measures of functional status. Initial evaluation of the P4 suggests that it is more reliable and sensitive to change than the NPRS. METHODS AND MEASURES: Two single-item NPRSs and the P4 were administered on 3 occasions--initial visit (n = 220), within 72 hours of baseline (n = 213), and 12 days following baseline assessment (n = 183)--to patients with musculoskeletal problems receiving physical therapy. Reliability was assessed using a type 2,1 intraclass correlation coefficient. Longitudinal validity was assessed by correlating the measures' change scores with a retrospective rating of change that included patients' and clinicians' perspectives. RESULTS: The test-retest reliability and longitudinal validity of the P4 were significantly greater (P1<.05) than both single-item NPRSs. Minimal detectable change of the P4 at the 90% confidence level was estimated to be a change of 22% of the scale range (9 points) compared to 27.3% (3 points) and 31.8% (3.5 points) for the 2-day NPRS and 24-hour NPRS, respectively. CONCLUSIONS: The findings of this study suggest the P4 is more adept at assessing change in pain intensity than popular versions of single-item NPRSs.