Development of a post-offer screening tool for patient support services.

OBJECTIVES: The purpose of our project was to develop a post-offer screening tool that demonstrates interrater reliability, predictive validity, and face validity and that accurately represents the physical demands of the patient support services (lifting team) job at our health care facility. METHODS: The screening tool, which consists of 11 static and dynamic tasks, was developed, using the 13 incumbent staff members of the patient support services department, to determine whether the criteria established for each task matched the physical abilities of at least 80% of the total group tested. Test-retest design was used for this study. Intraclass correlation coefficients and the Kappa statistic were used to calculate interrater reliability. Face validity was determined through the Job Similarity Questionnaire completed by all subjects. RESULTS: Subjects did not meet criteria established for the static knee pull and the knuckle-to-elbow lift tasks, resulting in modification of these two criteria. Interrater reliability ranged from .22 for the maximum static pull wall task to .94 for the left-hand grip strength task. Face validity ranged from 53.9% to 92.4%. CONCLUSION: Although face validity of the Job Similarity Questionnaire represented a wide range, we believe that the results were homogeneous enough to continue with the screening tool unchanged, except for lowering the expected outcome on two tasks. Interrater reliability was established for 75% of the tasks. The lack of variation of data for the other 25% prevented statistical analysis of those tasks but confirmed that all members met the physical criteria.

Wrist position and extensor tendon amplitude following repair.

After primary repair of severed extensor tendons, various methods are used to limit tendon adhesions and avoid rupture. Early passive digital motion with wrist extension (a "reverse Kleinert" protocol) has been advocated. However, there are no data to support an optimum wrist position or to indicate how much finger motion may safely be permitted. In this study we used eight fresh cadaver limbs to measure extensor tendon gliding in Verdan's zones 3 to 8 when active grip and passive extension were simulated at different wrist positions. We found that if the wrist is extended more than 21 degrees, the extensor tendon glides with little or no tension in zones 5 and 6 throughout full simulated grip to full passive extension, permitting "passive motion" exercises to minimize tendon adhesions without risking rupture. In addition, we found that up to 6.4 mm of tendon can be debrided safely and full grip can still be permitted postoperatively if the wrist is splinted at 45 degrees extension.

Fieldwork performance and academic grades.

The literature examining the relationship between occupational therapy academic course work and fieldwork performance was reviewed. Responding to a recent suggestion calling for a reexamination of this relationship with a sample of significantly larger size, we initiated the present study. The results are similar to earlier studies, with little or no correlation found in most analyses. Further investigation of the results provides strong evidence supporting the conclusion that correlation analysis is inappropriate for this investigation; thus, it would be incorrect to assume that there is little or no relationship between occupational therapy academic course work and fieldwork performance. Suggestions of ways to study the relationship between course work and fieldwork are presented.