Effective teaching of manual skills to physiotherapy students: a randomised clinical trial.

CONTEXT: To date, despite the relevance of manual skills laboratories in physiotherapy education, evidence on the effectiveness of different teaching methods is limited. OBJECTIVES: Peyton's four-step and the 'See one, do one' approaches were compared for their effectiveness in teaching manual skills. METHODS: A cluster randomised controlled trial was performed among final-year, right-handed physiotherapy students, without prior experience in manual therapy or skills laboratories. The manual technique of C1-C2 passive right rotation was taught by different experienced physiotherapist using Peyton's four-step approach (intervention group) and the 'See one, do one' approach (control group). Participants, teachers and assessors were blinded to the aims of the study. Primary outcomes were quality of performance at the end of the skills laboratories, and after 1 week and 1 month. Secondary outcomes were time required to teach, time required to perform the procedure and student satisfaction. RESULTS: A total of 39 students were included in the study (21 in the intervention group and 18 in the control group). Their main characteristics were homogeneous at baseline. The intervention group showed better quality of performance in the short, medium and long terms (F1,111  = 35.91, p < 0.001). Both groups demonstrated decreased quality of performance over time (F2,111  = 12.91, p < 0.001). The intervention group reported significantly greater mean ± standard deviation satisfaction (4.31 ± 1.23) than the control group (4.03 ± 1.31) (p < 0.001). Although there was no significant difference between the two methods in the time required for teaching, the time required by the intervention group to perform the procedure was significantly lower immediately after the skills laboratories and over time (p < 0.001). CONCLUSIONS: Peyton's four-step approach is more effective than the 'See one, do one' approach in skills laboratories aimed at developing physiotherapy student competence in C1-C2 passive mobilisation.

The Effect of Different Attentional Focus Instructions during Finger Movement Tasks in Healthy Subjects: An Exploratory Study.

External focus of attention (EFA) and internal focus of attention (IFA) represent commonly used strategies to instruct subjects during exercise. Several studies showed EFA to be more effective than IFA to improve motor performance and learning. To date the role of these strategies on motor performance during finger movement was less studied. The objective of the study was to investigate motor performance, patient's preference induced by IFA and EFA, and the focus during control condition. Ten healthy right-handed participants performed a finger movement task in control, EFA, and IFA conditions (counterbalanced). Errors, patient's preference, and type of attentional focus spontaneously adopted during the control condition were recorded. EFA determined less error (p < 0.01) compared to control and IFA. Participants preferred EFA against IFA and control condition. In the control group 10% of subjects adopted a purely EFA, 70% of subjects adopted a purely IFA, and 20% of subjects adopted a mixture of the two foci. Our results confirm that EFA is more effective than IFA and control in finger movement task. Due its clinical relevance, the interaction between attention and finger movement should be further investigated.

Intra- and inter-rater reliability of 3D passive intervertebral motion in subjects with nonspecific neck pain assessed by physical therapy students: A pilot study.

BACKGROUND: Passive Intervertebral Movements (PIVMs) are commonly used to assess and treat patients with nonspecific neck pain. Only very few studies have investigated 3D movements until now. OBJECTIVE: This study assessed intra- and inter-rater reliability of three-dimensional (3D) cervical PIVMs performed by physical therapy students in patients with nonspecific neck pain. METHODS: Thirty-one patients, mean age 47.2 ± 7.2 years, were independently evaluated by 2 physical therapy students. The raters (A and B) assessed mobility, end-feel and pain provocation performing bilaterally the 3D cervical segmental side-bending test (3D CSSB) from levels C2-C3 to C6-C7. Percentage agreement (raw, positive and negative), Cohen's kappa (95% CI), prevalence index and bias index were calculated to estimate intra- and inter-reliability. RESULTS: Intra-rater reliability showed kappa values ranging between fair and substantial (k 0.29-0.80) for pain provocation, mobility and end-feel, with percentage agreements between 61%-90%. Inter-rater reliability presented kappa values ranging between fair and substantial (k 0.22-0.62) for pain provocation, mobility and end-feel, with percentage agreements between 61% and 80%. CONCLUSIONS: Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with nonspecific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients.

Trusting beliefs: a functional measurement study

Trust is a fundamental aspect of everyday life. Several authors define trust as the wish to depend on another entity and split the concept of trust into several interconnected components such as trusting beliefs (e.g., benevolence, competence, honesty, and predictability), trusting intentions, trusting behaviors, disposition to trust, and institution-based trust. According to McKnight, Cummings, and Chervany’s (1998) model, beliefs yield behavioral intentions, which in turn are manifested in behavior. In the present research, we applied functional measurement to explain trust-related judgments in terms of information integration among different beliefs. Our results suggest that averaging models could help to describe the observed judgments in terms of beliefs and to comprehend the role and relevance of each belief in a variety of social contexts(AU)

Robot-assisted laparoscopic hysterectomy vs traditional laparoscopic hysterectomy: five metaanalyses.

To assess differences between laparoscopic hysterectomy performed with or without robot-assistance, we performed metaanalyses of 5 key indices strongly associated with societal and hospital costs, patient safety, and intervention quality. The 5 indexes included estimated blood loss (EBL), operative time, number of conversions to laparotomy, hospital length of stay (LOS), and number of postoperative complications. A search of PubMed, Medline, Embase, and Science citation index online databases yielded a total of 605 studies. After a systematic review, we proceeded with meta-analysis of 14 articles for EBL, with a summary effect of -0.61 (95% confidence interval [CI], -42.42 to 46.20); 20 for operative time, with a summary effect of 0.66 (95% CI, -15.72 to 17.04); 17 for LOS, with a summary effect of -0.43 (95% CI, -0.68 to -0.17); 15 for conversion to laparotomy (odds ratio, 0.50; 95% CI, 0.31 to 0.79 with a random model); and 14 for postoperative complications (odds ratio, 0.69; 95% CI, 0.43 to 1.09 with a random model). In conclusion, compared with traditional laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy was associated with shorter LOS and fewer postoperative complications and conversions to laparotomy; there were no differences in EBL and operative time. These results confirm that robot-assisted laparoscopy has less deletorious effect on hospital, society, and patient stress and leads to better intervention quality.