Coordination tests in persons with acute central nervous system pathology: assessment of interrater reliability and known-group validity.

BACKGROUND AND PURPOSE: Coordination testing is a standard part of the neurologic examination, yet the psychometric properties of many tests used by practitioners are unknown. This study investigated the interrater reliability and known-group validity of limb coordination tests in participants with acute central nervous system (CNS) pathology. METHODS: Twenty-five participants with CNS pathology completed 20 different limb coordination tests administered at bedside by a physical therapist. Examinations were videotaped and independently rated by a neurologist, a physical therapist, and a student physical therapist using a 5-point ordinal scale. Nine tests were also timed. Results were analyzed for interrater reliability and the degree to which they differed between groups categorized as having or not having coordination deficits. RESULTS: Participants were individuals who had been diagnosed with either a CNS vascular lesion or intracranial tumor. Timed test scores had higher levels of agreement (mean intraclass correlation coefficient [ICC], 0.69-0.97) than ordinal scores (mean κfree 0.56-0.91). Scores from 5 of the 9 timed measures and 8 of the 20 ordinal measures differed between groups. DISCUSSION AND CONCLUSIONS: Eleven tests were scored reliably between raters (κ > 0.60 or ICC > 0.75) and were performed differently between groups with and without coordination deficits (P ≤ 0.05). These tests are recommended for use when examining patients with acute neurologic pathology from a vascular lesion or tumor. They are simple to perform and require only a stopwatch to complete. Future studies should explore the sensitivity and specificity of these tests in disease states and their correlation with functional measures.

Retrospective analysis of the behavioral interview and other preadmission variables to predict licensure examination outcomes in physical therapy.

Evidence supporting the use of personal interviews in admissions decisions for health professions programs is conflicting. This retrospective study was intended to (1) quantify interrater reliability for assessing performance on a particular type of structured interview, the behavioral interview, and (2) examine the ability of multiple preadmission variables, including performance on the behavioral interview, to predict first-time performance on the national physical therapy licensing examination (NPTE). Data from 89 interviewees during the 2006-07 admissions cycle were used to examine inter-rater reliability. Data from 141 students who graduated from 2001 to 2005 were used to examine predictive validity of multiple preadmission variables on NPTE performance, including undergraduate cumulative grade point average (GPA), preprofessional science GPA, performance on the Graduate Record Examination (GRE) (including its analytical, quantitative, and verbal subscales), and performance on the behavioral interview. Inter-rater reliability for assessing interview performance was quantified with an intraclass correlation coefficient (ICC1,1). Receiver operating characteristic (ROC) curves and associated validity indices were used to analyze variables that distinguished graduates who did and did not pass the NPTE on their first attempt (alpha = 0.05). The ICC1,1 for assessing interview performance was 0.749. Performance on the verbal subscale of the GRE (ROC curve area = 0.734, p = 0.007) and behavioral interview (ROC curve area = 0.685, p = 0.034) were statistically significant predictors of NPTE performance. This study provides evidence supporting the contributions of the behavioral interview and verbal subscale of the GRE to predict NPTE performance and assist admissions decisions.

Pre-/postoperative therapy for adult plexus injury.

The rehabilitation of patients who have sustained brachial plexus injuries is essential. Therapy is performed to maintain and increase range of motion, retard the rate of muscle atrophy, and re-educate the muscles once the reconstructive surgeries have been per-formed and reinnervation is verified. This article discusses pre- and postoperative therapy for these injuries.