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Construct Validity and Interrater Agreement of the Sport Injury Rehabilitation Adherence Scale
Abstract
Context
Adherence to clinic-based rehabilitation might influence outcomes.
Objective
To examine the construct validity and interrater agreement of a measure of adherence to clinic-based rehabilitation.
Design
Repeated-measures in both study 1 and study 2.
Participants
43 student rehabilitation practitioners in study 1 and 12 patients undergoing rehabilitation after anterior cruciate ligament reconstruction in study 2.
Interventions
Participants in study 1 rated the adherence of a simulated videotaped patient exhibiting high, moderate, and low adherence. Two certified athletic trainers rated the adherence of patients at 4 consecutive appointments in study 2.
Main Outcome Measure
The Sport Injury Rehabilitation Adherence Scale.
Results
In study 1, adherence ratings increased in a linear fashion across the 3 levels of adherence, and r WG(J) and rater-agreement-index values ranging from .84 to .95 were obtained. In study 2, the rater-agreement index was .94.
Conclusions
Strong support was found for the construct validity and interrater agreement of the Sport Injury Rehabilitation Adherence Scale.
... Although six studies were adequately sized for evaluative purposes (range 145249) [34], four included fewer than 100 patients [22,40,45,47]. The ages of patients ranged from 13 to 96 years (see Table 1). ...
... Acceptable levels of internal consistency supports application in groups of patients (Cronbach's a range 0.820.8) [46,47]. Poor to high levels of inter-rater (ICC range = 0.570.77; ...
... [39,45]. Evidence in support of known-groups validity is provided following the assessment of standardized vignettes describing three levels of adherence in athletes [40,47]. ...
Objective:
To recommend robust and relevant measures of exercise adherence for application in the musculoskeletal field.
Method:
A systematic review of measures was conducted in two phases. Phase 1 sought to identify all reproducible measures used to assess exercise adherence in a musculoskeletal setting. Phase 2 identified published evidence of measurement and practical properties of identified measures. Eight databases were searched (from inception to February 2016). Study quality was assessed against the Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. Measurement quality was assessed against accepted standards.
Results:
Phase 1: from 8511 records, 326 full-text articles were reviewed; 45 reproducible measures were identified. Phase 2: from 2977 records, 110 full-text articles were assessed for eligibility; 10 articles provided evidence of measurement/practical properties for just seven measures. Six were exercise adherence-specific measures; one was specific to physical activity but applied as a measure of exercise adherence. Evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development or evaluation of any measure.
Conclusion:
The significant methodological and quality issues encountered prevent the clear recommendation of any measure; future applications should be undertaken cautiously until greater clarity of the conceptual underpinning of each measure is provided and acceptable evidence of essential measurement properties is established. Future research should seek to engage collaboratively with relevant stakeholders to ensure that exercise adherence assessment is high quality, relevant and acceptable.
... 12,14 Hence, the identification of techniques that enhance a patient's belief in the efficacy of treatment may provide a basis upon which to design interventions that increase adherence and enhance the rehabilitation process. 15,16 Personal Construct Theory 17 has received little attention in the rehabilitation goal setting literature, 18,19 but does bear some commonalities with other theories. Central to personal construct theory is the notion that individuals continuously attempt to make sense of the world around them. 17 The implication of personal construct theory for rehabilitation practitioners is the requirement to enter the patients' 'world view', and gain their perspective upon treatment provision before meaningful goals can be set. ...
... 28 Adherence to rehabilitation was measured using the Sport Injury Rehabilitation Adherence Scale (SIRAS). 15 This is a three-item scale that measures the practitioner's ratings on (a) the degree to which patients exert themselves, (b) the degree to which patients follow the practitioner's instructions and (c) the degree to which patients are receptive to changes in the rehabilitation programme. The SIRAS employs a 5-point Likert-type scale for each of the three items. ...
... Research has demonstrated high internal consistency (α = 0.82), testretest reliability (ICC = 0.77 over a one-week period), inter-rater reliability, factorial validity and construct validity of the SIRAS. 15,27 The Sports Injury Rehabilitation Beliefs Survey (SIRBS) 12 was used to assess both self-efficacy and treatment efficacy. The SIRBS is a 19-item instrument that contains five subscales. ...
Objective
To examine the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence and treatment outcome in patients undergoing low back pain rehabilitation.
Design
A mixed-model 2 (time) × 3 (group) randomized controlled trial.
Setting
A residential rehabilitation centre for military personnel.
Subjects
UK military personnel volunteers (N = 48); mean age was 32.9 (SD 7.9) with a diagnosis of non-specific low back pain.
Interventions
Subjects were randomly assigned to either a goal setting experimental group (Exp, n = 16), therapist-led exercise therapy group (C1, n = 16) or non-therapist-led exercise therapy group (C2, n = 16). Treatment duration for all groups was three weeks.
Main measures
Self-efficacy, treatment efficacy and treatment outcome were recorded before and after the treatment period. Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale (SIRAS). The Biering-Sørensen test was used as the primary measure of treatment outcome.
Results
ANCOVA results showed that adherence scores were significantly higher in the experimental group (13.70 ± 1.58) compared with C2 (11.74 ± 1.35), (P < 0.025). There was no significant difference for adherence between the experimental group and C1 (P = 0.13). Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 (P < 0.05), whereas no significant difference was found for treatment efficacy. Treatment outcome did not differ significantly between the experimental and two control groups.
Conclusions
The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation.
... Although six studies were adequately sized for evaluative purposes (range 145249) [34], four included fewer than 100 patients [22,40,45,47]. The ages of patients ranged from 13 to 96 years (see Table 1). ...
... Acceptable levels of internal consistency supports application in groups of patients (Cronbach's a range 0.820.8) [46,47]. Poor to high levels of inter-rater (ICC range = 0.570.77; ...
... [39,45]. Evidence in support of known-groups validity is provided following the assessment of standardized vignettes describing three levels of adherence in athletes [40,47]. ...
Executive Summary Background: Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important prerequisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. The aim of this study was to recommend outcome measures of exercise adherence that have clinical and research utility in the musculoskeletal field.
... Therapist-reported rehabilitation compliance was based on the SIRAS, a well-validated scoring instrument for rehabilitation of musculoskeletal injuries with rateragreement index values of up to 0.954 [25]. The SIRAS comprises3 questions concerning rehabilitation intensity, patients' ability to follow instructions and patients' receptivity to change in program. ...
... In addition to self-developed measures, the well-validated SIRAS was also adapted within the questionnaire to lend further credibility to the measurement of rehabilitation compliance. Unlike the author-developed patient-reported rehabilitation compliance measures used in the questionnaire, SIRAS is a well-validated scoring instrument for rehabilitation of musculoskeletal injuries and also has rater-agreement index values of up to 0.95 [25], minimising variability due to subjectivity and improving the score's reproducibility. SIRAS has also been shown to have significant positive correlations with adherence to home-based exercises for rehabilitation specifically in musculoskeletal injuries [33], thereby improving the reliability of reporting of compliance for unsupervised home-based rehabilitation exercises. ...
Introduction:
Proximal humeral fractures (PHFs) are 3rd commonest fragility fractures and cause significant functional impairment. This paper sought to determine impact of rehabilitation compliance on the clinical outcomes for non-surgically managed PHFs, while ascertaining reasons for non-compliance which can be addressed to improve compliance.
Methods:
Prospective cohort study of patients undergoing non-surgical treatment for PHFs from August 2017 to April 2020 in a tertiary trauma centre was performed. Data was collected via questionnaire: patient demographic data, PHF injury details, clinical outcome measures, therapist-reported (Sport Injury Rehabilitation Adherence Scale [SIRAS]) and patient-reported (subjective compliance, frequency of exercise) rehabilitation compliance measures. Data was analysed using multiple linear regression model to account for confounding variables.
Results:
107 participants attended physical therapy follow-up for mean 137.8 days. 6-week SIRAS strongly predicted 3-month Constant score (p = 0.023; 95%CI = 0.265,3.423), OSS (p = 0.038; 95%CI = 0.049,1.634), flexion ROM (p < 0.001; 95%CI = 2.872,8.982), extension ROM (p = 0.035; 95%CI = 0.097,2.614), abduction ROM (p = 0.002;95%CI = 1.995,8.466) and achievement of functional active ROM at 3-months (p = 0.049; 95%CI = 1.001,1.638). Pain was the top reason impairing rehabilitation compliance from therapist (43.9% at 6-weeks and 20.6% at 3-months) and patient-perspective (33.6% at 6-weeks, 24.3% at 3-months). Author-developed patient-reported compliance measures had good correlation with validated SIRAS score (subjective compliance: p < 0.001 frequency of exercise: p = 0.001).
Conclusion:
Rehabilitation compliance predicts short-term clinical outcomes up to 3-months and potentially 1-year outcomes. Pain control should be optimised to maximise rehabilitation compliance and improve PHF outcomes. There is lack of consensus definition for rehabilitation compliance measures; patient-reported measures used have good correlation to existing validated measures and could serve as a steppingstone for further research.
Level of evidence:
II, cohort study.
... At their first physiotherapy appointment, participants were required to complete a questionnaire assessing demographic and injury-related information. At each clinic rehabilitation session (two sessions per week), the physical therapist recorded participants' attendance and completed the Sport Injury Rehabilitation Adherence Scale (SIRAS; Brewer et al., 2002). Alongside this, participants were instructed to monitor their adherence to homebased rehabilitation (one session per week) via a self-report measure. ...
... (Shaw, Williams, & Chipchase, 2005), and has also been reported to have good test-retest reliability over a 1-week period (intraclass correlation coefficient ϭ 0.77; Brewer et al., 2000). In addition, Brewer et al. (2002) demonstrated the construct validity of the SIRAS with a heterogeneous sample of 43 participants. They found a significant linear relationship (p Ͻ .001) between SIRAS scores and observed video footage that depicted minimal, moderate, and maximal clinic-based rehabilitation adherence. ...
Objective: To investigate the relationship between perceived autonomy support, age, and rehabilitation adherence among sports-related injuries. Design: A prospective design measuring adherence over the entire rehabilitation period (8-10 weeks) was employed. Participants: 44 men and 26 women aged between 18 and 55 years took part in this study (M = 32.5 years, SD = 10.2). Method: Adherence was monitored via an observational measure of clinic-based adherence, a self-report measure of home-based adherence, and monitoring of attendance at rehabilitation sessions. Perceived autonomy support of participants was assessed during the last week of their rehabilitation. Results: High autonomy support provided by the physical therapist was related to better clinic-based adherence and attendance but not to home-based adherence. Age was related to all adherence indices and moderated the relationship between perceived autonomy support and clinic-based rehabilitation adherence. Conclusion: Findings indicate the importance of physical therapists providing an autonomous-supportive rehabilitation environment, particularly among older individuals. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... For both measures, a higher score indicates higher adherence or engage-ment. The SIRAS [34,36,37] and the RTES [35] have both demonstrated adequate reliability and validity in rehabilitation contexts. ...
Background:
Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.
Objective:
To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.
Methods:
Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.
Results:
SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.
Conclusion:
In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.
... This means that there is limited information about the details of the rehabilitation received by each patient. The SIRAS was designed and validated for completion by rehabilitation professionals (Brewer, Avondoglio et al., 2002), while in the present study it was completed by patients, for which the scale has not yet been validated. Time between injury and assessment differed between the ACLR and non-ACLR groups, which might impact the responses and entails that the results need to be interpreted with caution. ...
Objectives
To describe and compare patients’ appraisal of the rehabilitation and adherence to the rehabilitation program after acute ACL injury treated with (ACLR) or without (non-ACLR) reconstruction.
Design
Prospective cohort study.
Participants
275 patients (143 females; mean age 25 ± 7 years) with acute ACL injury, of whom 166 patients had ACLR within 24 months.
Main outcome
Adherence to rehabilitation was assessed using the modified Sports Injury Rehabilitation Adherence Scale (SIRAS).
Results
Appraisal of rehabilitation was higher in the post-ACLR group compared to the non-ACLR group at 3 months (91% compared to 70% scored rehabilitation as necessary, p = 0.025) and at 6 months (87% compared to 70% scored it as necessary, p = 0.017). SIRAS score did not differ between 3 and 6 months for the non-ACLR group (median (IQR) 13 (2) vs 13 (2)) or the post-ACLR group (14 (1) vs 14 (2), p > 0.05). The post-ACLR group had a higher SIRAS score than the non-ACLR group at 3 and 6 months (p ≤ 0.001).
Conclusion
Patients treated with ACLR reported valuing their rehabilitation more and rated greater adherence to the rehabilitation programme than non-surgically treated patients. As rehabilitation is essential for good knee function, strategies to improve adherence after non-ACLR treatment should be implemented.
Level of evidence
Prospective cohort study, level II.
... The treating physiotherapist completed the Sport Injury Rehabilitation Adherence Scale 11,12 (Supplemental Appendix 1) at the follow-up at two and six weeks after surgery. The phrase 'since the last appointment' was used instead of 'during today's appointment' as suggested by Brewer et al. 11 The Sport Injury Rehabilitation Adherence Scale has demonstrated good reliability and validity. ...
Objective
Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon.
Design
Prospective multi-centre randomised controlled trial.
Setting
Four hand surgery departments in Sweden.
Subjects
A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52).
Intervention
A smartphone application to facilitate rehabilitation.
Main outcome measures
Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks.
Results
Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8–13.3), 11.8 (CI 11.0–12.8) for the intervention group, and 13.3 (CI 12.6–14.0), 12.8 (CI 12.0–13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9–99.5) compared to the controls 82.9 (CI 76.9–88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction.
Conclusion
The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed.
Level of evidence
I. Randomised controlled trial
... Il successo di un percorso riabilitativo è infatti ampliato enormemente da una corretta aderenza al programma riabilitativo prescritto ed una non corretta aderenza risulta associata a risultati riabilitativi scarsi (valutabili anche da indici oggettivi come la forza), rischio di re-infortunio e ridotta probabilità di rientro in campo (Fisher, Domm e Wuest, 1988). L'aderenza al trattamento ha ricevuto considerevole attenzione: la motivazione intrinseca sembra essere il più importante fattore psicologico ad influenzarla ( Pizzari et al., 2002; Arvinen-Barrow et al., 2014), ma incidono positivamente anche tolleranza al dolore, forza mentale (mental toughtness), percezione di gravità dell'infortunio (Taylor e May, 1996), autoefficacia (Milne, Hall e Forwell, 2005), percezione di supporto sociale (Brewer et al., 2000; Podlog et al., 2014). Negativamente incidono i disturbi dell'umore e la paura di infortunarsi nuovamente (Walker et al., 2014). ...
During last years, the psychological features related to sport injuries have attracted the interest of many researchers and practitioners. Psychological characteristics have been thoroughly investigated both in terms of risk prevention and reduction , and with respect to post-injury phase up to the return to the competition. A systematic review of literature from 1990 to 2015 on the psychological aspects involved in the post-injury was conducted. The dimensions of the acute phase, the rehabilitation phase, and the return to sport phase were analyzed. The most widely used instruments for assessment were presented, and the interventions that sport psychologists can apply with the athletes have been described. Psychological intervention and specific technique were explained in light of the different recovery period. Considering the whole framework and coping with the injury as a multifactorial event has several practical implications and highlights the possibility of integration between multidisciplinary practitioners in order to optimize the athlete's recovery.
Negli ultimi anni gli aspetti psicologici correlati all'in-fortunio sportivo hanno attratto l'interesse di molti ricercatori e professionisti del settore. Le caratteristiche psicologiche sono state oggetto di approfonditi studi sia per quanto riguarda la prevenzione e riduzione del rischio sia rispetto alle fasi post-infortunio fino al rientro in gara. È stata condotta una revisione sistematica della letteratura dal 1990 al 2015 sugli aspetti psicolo-gici coinvolti nel post-infortunio. Sono state analizzate in dettaglio la fase acuta, la fase di riabilitazione e la fase di ritorno allo sport. Sono indicati gli strumenti attualmente più utilizzati per l'assessment e descritti gli interventi che uno psicologo dello sport può attuare con l'atleta. Sono state presentate tecniche psicolo-giche per le diverse fasi di intervento, sottolineando come nei vari momenti siano più utili alcune rispetto ad altre. Considerare il quadro completo e gestire l'infor-tunio come evento multifattoriale ha molteplici risvolti operativi ed evidenzia la possibilità di un'integrazione multidisciplinare tra professionisti al fine di ottimizzare il recupero dell'atleta.
... Las investigaciones desarrolladas por Brewer y sus colaboradores (Brewer, 2003;Brewer et al., 2002;Brewer et al., 2003aBrewer et al., , 2003bBrewer et al., 2004), indican que variables personales como los estados de ánimo, la identificación deportiva y la motivación, y variables situacionales como el apoyo social, son fundamentales en la adherencia del deportista en su recuperación; también sugieren desarrollar proyectos de investigación en los que se estudie como influye el factor edad, o más propiamente una determinada etapa de la vida, marcada por la edad y otras consideraciones deportivas asociadas (estatus, perspectivas, identificación, etc.), en el nivel de adherencia y, por lo tanto, en el pronóstico de la rehabilitación. ...
This study aimed to design and validate an instrument to validly and reliably measure injured athletes' level of adherence to a rehabilitation programme. First, the content was validated through the consensus and agreement of ten expert judges. Second, two physical therapists applied the evaluation instrument to a sample of 32 injured, senior-category federated athletes in various disciplines (test-retest). In relation to injury type, the inclusion criteria for the study were: recent injuries (occurring in the two days preceding the first visit to the health centre), new (not relapses or repeat incidences) and medically diagnosed as moderate or severe. The results showed that the Scale of Adherence to Rehabilitation (EAR) has optimal levels of reliability and validity for recording the level of adherence to prescribed rehabilitation programmes for injured athletes.
... In addition a comparison of participants' SIRAS scores with their clinic attendance revealed a low but significant correlation, which was interpreted by Brewer and colleagues to be indicative of some overlap in the aspects of adherence measured by each. Further support for the SIRAS's ability to measure adherence to the clinic-based component of rehabilitation came from a study undertaken by Brewer et al. (2002) in which it was shown to have high interrater reliability, and construct validity. The SIRAS has successfully discriminated between adherent and nonadherent patients undergoing rehabilitation for low back pain (Kolt and McEvoy, 2003) and following knee surgery (Brewer et al., 2003;Brewer et al., 2000a). ...
... Evaluating aspects of cognitions, emotions, and behavior during sports injury rehabilitation has been the focus of previous sports injury psychological research, and a wide range of outcomes have been used to evaluate aspects, including coping, 58 emotions, 34 mood, 59 locus of control, 60 and adherence to rehabilitation. 61 There has been less focus on the return to sport phase, although increasing research interest has seen the recent development of scales that specifically focus on measuring psychological factors during the return to sport. ...
Address reprint requests to Kate Webster, BSc (Hons), PhD, School of Allied Health, College of Science, Health & Engineering, Health Sciences 3 building, La Trobe University, Kingsbury Dr, Bundoora 3086, Australia.
... Investigaciones más recientes (Abenza, Olmedilla, Ortega y Esparza, 2009), y sobre todo las desarrolladas por Brewer y sus colaboradores (Brewer, 2003;Brewer et al., 2002;Brewer et al., 2003aBrewer et al., , 2003bBrewer et al., 2004), indican que variables personales como los estados de ánimo, la identificación deportiva y la motivación, y variables situacionales como el apoyo social son fundamentales en la adherencia del deportista en su recuperación; también sugieren desarrollar proyectos de investigación en los que se estudie como influye el factor edad, o más propiamente una determinada etapa de la vida, marcada por la edad y otras consideraciones deportivas asociadas (estatus, perspectivas, identificación, etc.) en el nivel de adherencia y, por lo tanto, en el pronóstico de la rehabilitación. ...
The purpose of the present study was to analyze the relation-ship between different mood states (tension, depression, anger, vigor, and fatigue) in injured athletes and the athletes' level of adherence to a rehabilitation program. The sample consisted of five federated athletes of different sports between the ages of 17 and 21 years who suffered from moderate or serious injuries. Both the mood states and the rehabilitation adherence were evaluated continuously for 15 days. The results indicate that tension, depression, and anger progress inversely with regard to the level of adherence throughout the process of recuperation. On the other hand, vigor and fatigue demonstrate a parallel progression, such that when the level of adherence is greater, the vigor and fatigue cited by the athletes is also greater. The influence of mood states, associated with the injury, in the adherence behaviors of the athlete is discussed. It seems that they can slow the athletes' process of recuperation; therefore, it may be beneficial for intervention regarding these psychological aspects during the rehabilitation process.
... Las investigaciones desarrolladas por Brewer y sus colaboradores (Brewer, 2003;Brewer et al., 2002;Brewer et al., 2003aBrewer et al., , 2003bBrewer et al., 2004), indican que variables personales como los estados de ánimo, la identificación deportiva y la motivación, y variables situacionales como el apoyo social, son fundamentales en la adherencia del deportista en su recuperación; también sugieren desarrollar proyectos de investigación en los que se estudie como influye el factor edad, o más propiamente una determinada etapa de la vida, marcada por la edad y otras consideraciones deportivas asociadas (estatus, perspectivas, identificación, etc.), en el nivel de adherencia y, por lo tanto, en el pronóstico de la rehabilitación. ...
... A Cronbach's alpha coefficient of 0.81 and a test-retest reliability (intraclass) coefficient of 0.77 over a one-week period have been documented for the SIRAS [16]. Support for the scale's construct validity and interrater agreement have also been obtained [17,18]. An average SIRAS score across rehabilitation sessions was calculated for all participants. ...
Purpose: A prospective, longitudinal study was conducted to examine Big Five personality characteristics as predictors of adherence to clinic-based rehabilitation activities following anterior cruciate ligament (ACL) reconstruction surgery. Methods: Participants (72 men, 36 women) completed a questionnaire assessing Big Five personality dimensions prior to surgery. For the first 7 weeks after surgery, participants’ rehabilitation session attendance was recorded and rehabilitation professionals rated participants’ adherence during rehabilitation sessions. Results: Results of multiple regression analyses indicated that the 5 personality factors explained 9 percent of the variance in attendance and 16 percent of the variance in adherence ratings, that agreeableness was a significant positive predictor of attendance, and that conscientiousness and openness to experience were significant positive predictors of adherence ratings. Conclusion: As a potential contributor to adherence, personality warrants consideration when implementing rehabilitationprograms after ACL surgery.
... The Sport Injury Rehabilitation Adherence Scale has been demonstrated to be a valid way of quantifying therapeutic exercise adherence. 13 However, all questions on this scale refer to in-clinic exercise sessions and thus are of no use when examining HEP compliance. In a study examining the effect of number of exercises prescribed on the quality of performance, Henry et al 7 developed the Henry-Eckert Performance Assessment Tool (PAT), a 12-point scale in which cueing, alignment, and exercise quality are quantified for each exercise on a scale of 1 to 4. Although this scale has not been validated, it has been found to have good inter-rater reliability in the form of an intraclass correlation coefficient ranging from 0.87 to 0.93 for 3 graders of 2 exercises. ...
Home exercise programs (HEP) are an integral part of any physical therapy treatment plan, but are especially important in theater. The primary aim of this study was to determine if the number of exercises prescribed in a HEP was associated with compliance rate of Service Members (SM) in theater with a secondary aim of determining variables associated with compliance and noncompliance.
Subjects were 155 deployed SM undergoing physical therapy in Iraq and Afghanistan. Clinical evaluation and prescription of a HEP were performed. Pathologic, demographic, and treatment data were obtained. Subjects returned to the clinic 1 week later to demonstrate their HEP. Subjects' performance of each prescribed exercise was rated on a 12-point scale to quantify compliance.
2 variables were found to be significantly associated with rate of compliance. These were the number of exercises prescribed (p = 0.02) and if a subject left the base at least once per week (p = 0.01).
SM prescribed 4 or more exercises had a lower rate of compliance than those prescribed 2 or fewer. SM who left the base at least once per week also had a lower rate of compliance.
Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
... A Cronbach's alpha coefficient of 0.81 and a test-retest reliability (intraclass) coefficient of 0.77 over a one-week period have been documented for the SIRAS [16]. Support for the scale's construct validity and interrater agreement have also been obtained [17,18]. An average SIRAS score across rehabilitation sessions was calculated for all participants. ...
Purpose: A prospective, longitudinal study was conducted to examine Big Five personality characteristics as predictors of adherence to clinic-based rehabilitation activities following anterior cruciate ligament (ACL) reconstruction surgery.
Methods: Participants (72 men, 36 women) completed a questionnaire assessing Big Five personality dimensions prior to surgery. For the first 7 weeks after surgery, participants’ rehabilitation session attendance was recorded and rehabilitation professionals rated participants’ adherence during rehabilitation sessions.
Results: Results of multiple regression analyses indicated that the 5 personality factors explained 9 percent of the variance in attendance and 16 percent of the variance in adherence ratings, that agreeableness was a significant positive predictor of attendance, and that conscientiousness and openness to experience were significant positive predictors of adherence ratings.
Conclusion: As a potential contributor to adherence, personality warrants consideration when implementing rehabilitation programs after ACL surgery.
... In general, some basic considerations with regard to adherence to rehabilitation programmes are; a) sportspeople who do not adhere to the rehabilitation programme have a higher risk of suffering a relapse, 8 b) the levels of adherence tend to wane over the course of long rehabilitation programmes, 16 c) home-based rehabilitation programmes for sportspeople tend towards substantially lower levels of adherence, 17 and d) adherence levels are a significant problem amongst injured sportspeople. 18,19 More recent research, most importantly that carried out by Brewer et al, [20][21][22][23][24] indicates that personal variables such as mood states, sports identity and motivation, and situational variables such as social support, are fundamental to adherence by a sportsperson during their recovery process. The research also suggests that work should be carried out which takes into consideration age, or a specified stage of life relating to age, and other sport-associated considerations (status, perspective, identity, etc.) when looking at adherence level and rehabilitation prognosis. ...
The frequency and, in some cases, the seriousness of ath-letic injuries has increased, alarming distinct types of sports professionals, who believe psychological factors to be rele-vant in research into improved rehabilitation. The objectives of the present study were to assess changes in mood state during the rehabilitation process (from start to finish) as well as the level of adherence by the injured athletes to the rehabilitation program. The study was carried out with five federated athletes, aged from 17 to 21 years, practising dif-ferent sports. The inclusion criteria for the study were re-cent injury (occurring within two days prior to the first health center visit), new injury (no recurrences or reinju-ries) and an injury that was medically diagnosed as moder-ate or serious. To evaluate mood state, the Spanish version of the POMS, which includes the following five dimensions, was used: tension, depression, anger, vigor, and fatigue. To register the adherence index, an evaluation sheet was de-signed, based on the consultation and the professional ex-perience of the medical team collaborating in the study. This sheet evaluated treatment compliance, both in the clinic, as well as individually outside the clinic setting. The results in-dicate that the emotional factors progressed and gradually adopted an ICEBERG profile, a health model by Morgan, in which the dimensions of anger, depression, and fatigue de-creased, vigor increased, and tension maintained high scores. The level of adherence to the rehabilitation program tend-ed to be constant, despite showing a marked decrease at the end of the process. Application of these finding in the professional practice of health workers involved in the re-habilitation process of athletic injuries is suggested. KEY WORDS: Emotional states. Rehabilitation adherence. Athletic injuries. RESUMEN El aumento considerable de la frecuencia y, en algunos casos, de la gravedad de las lesiones ha alertado a los diferentes profesionales del ámbito deportivo, considerando a los fac-tores psicológicos como aspecto relevante en la investiga-ción para la mejor adecuación de propuestas de rehabilita-ción. Los objetivos del presente trabajo son valorar cómo los diferentes factores emocionales evolucionan desde el inicio hasta el final del período de recuperación, y analizar el nivel de adherencia de los deportistas lesionados a su pro-grama de rehabilitación. El estudio se realizó con 5 depor-tistas federados en distintas disciplinas, de edades compren-didas entre los 17 y los 21 años. En relación al tipo de lesión, los criterios de inclusión para el estudio fueron: lesiones recientes (ocurridas en los dos días anteriores a la primera visita al centro sanitario), nuevas (no recaídas o reinciden-tes) y médicamente diagnosticadas como moderadas o gra-ves. Para valorar el estado de ánimo se ha utilizado la ver-sión española del POMS, que incluye 5 dimensiones: tensión, depresión, cólera, vigor y fatiga. Para el registro del índice de adherencia se diseñó una hoja de evaluación partiendo del asesoramiento y la experiencia profesional del equipo mé-dico que colaboró en el estudio; esta hoja permite valorar el cumplimiento del tratamiento, tanto en la clínica como el realizado de forma autónoma por el lesionado fuera de la clínica. Los resultados indican que los factores emocionales evolucionan adoptando gradualmente un perfil ICEBERG (modelo de salud de Morgan), donde las dimensiones cólera, depresión y fatiga muestran una evolución descendente, vi-gor ascendente y tensión de mantenimiento con puntuacio-nes altas. El nivel de adherencia al programa de rehabilita-ción tiende a ser constante, descendiendo notablemente al final del proceso. Se sugiere la aplicabilidad de estos hechos en la práctica profesional del personal sanitario en los pro-cesos de rehabilitación de lesiones deportivas. PALABRAS CLAVE: Estados emocionales. Adherencia a la rehabilitación. Lesiones deportivas.
... For example, the Sport Injury Rehabilitation Adherence Scale is an adherence measure that was developed to assess adherence to an in-clinic exercise regimen in athletic populations. 58 It has been used to assess in-clinic adherence in MSK populations as well, 59 but it has not yet been adapted or validated as a measure to assess adherence to advice in an unsupervised setting. ...
Objective
To identify measures of adherence to non-pharmacological self-management treatments for chronic musculoskeletal (MSK) populations, and report on the measurement properties of identified measures.
Data sources
Five databases were searched for all study types that included a chronic MSK population, an unsupervised intervention and a measure of adherence.
Study selection
Two independent researchers reviewed all titles for inclusion using criteria: adult (>18yrs) participants with a chronic MSK condition; the intervention included an unsupervised self-management component; and it contained a measure of adherence to the unsupervised self-management component.
Data extraction
Descriptive data regarding populations, unsupervised components, measures of unsupervised adherence (items and response options) were collected from each study by one researcher and checked by a second for accuracy.
Data synthesis
No named or referenced adherence measurement tools were found, but a total of 47 ‘self-invented measures’ were identified. No ‘measure’ was used in more than a single study. In terms of methods they could be grouped into: home diaries (n=31); multi-item questionnaires (n=11) and single-item questionnaires (n=7). All measures varied in type of information requested and scoring method. The lack of established tools precluded quality assessment of the measurement properties using COSMIN methodology.
Conclusions
Despite the importance of adherence to self-management interventions, measurement appears to be conducted on an ad hoc basis. It is clear that there is no consistency among adherence measurement tools and that the construct is ill-defined. This study alerts the research community to the gap in measuring adherence to self-care in a rigorous and reproducible manner. Thus, we need to address this gap by using credible methods (e.g. the COSMIN guidelines) to develop and evaluate an appropriate measure of adherence for self-management.
... The SIRAS has been reported to possess adequate levels of test-retest reliability, interrater reliability, internal consistency, 12 construct validity, and interrater agreement. 13 Adherence to home-based exercise was assessed using a self-report (diary) method. Participants were required to record the number of exercise sessions and the number of different exercises prescribed by their physiotherapist and the number of sessions and exercises performed each day. ...
Objective
To investigate the relationship between adherence to rehabilitation and outcome after reconstructive surgery of the anterior cruciate ligament (ACL).
Design
A prospective cohort study with adherence to rehabilitation evaluated over 8 weeks correlated with outcomes at 9 and 12 months postsurgery.
Participants
68 patients who had undergone ACL-reconstructive surgery.
Main Outcome Measures
Adherence was measured to and during appointments and by a self-report diary of home exercise. Outcomes were measured by 6 knee-function scales and 2 hop tests.
Results
There was a significant relationship between home-exercise adherence and many outcomes for participants under 30 years of age ( r s = .33-.44). For participants age 30 and over there was a negative relationship between home-exercise adherence and outcome. There were no significant relationships between adherence to and during physical therapy appointments and outcome after ACL-reconstructive surgery.
Conclusion
Participants under 30 years of age who adhered to their home-exercise regimen had better functional outcome, whereas adherent participants age 30 and over experienced worse outcome with better home-exercise adherence.
... The SIRAS has good internal consistency, ranging between a 5 0.81 and 0.86 (Shaw et al., 2005) and has also been reported to have good test-retest reliability over a 1-week period (ICC 5 0.77; Brewer et al., 2000c). In addition, Brewer et al. (2002) demonstrated the construct validity of the SIRAS with a heterogeneous sample of 43 participants. They found a significant linear relationship (Po0.001) between SIRAS scores and observed video footage that depicted minimal, moderate and maximal clinic rehabilitation adherence. ...
ABSTRACT
This study examined the utility of Maddux’s (1993) revised theory of planned behavior toward the prediction of exercise intentions and adherence. A prospective design was employed whereby 120 private sector health club members completed self report measures pertaining to various components of the revised theory. Adherence was measured prospectively over a sixteen week period by monitoring attendance toward prescribed exercise programs. Path analysis was used to analyze the predictions of the revised theory. Goodness of fit indices suggested an acceptable fit with the data (RMSEA <0.07; CFI > 0.94; SRMSR <0.08). However, self-efficacy was the only theoretical construct to predict intention, with the latter being the only determinant of exercise adherence. Contrary to the revised theory hypotheses, the remaining contribution of the social cognitive variables in predicting exercise intentions and adherence were minimal. The results of the present investigation provide equivocal support for the revised theory; however future research may wish to consider several of the methodological issues discussed.
... Investigaciones más recientes, sobre todo las desarrolladas por Brewer et al [20][21][22][23][24] , indican que variables personales como los estados de ánimo, la identificación deportiva y la motivación, y variables situacionales como el apoyo social, son fundamentales en la adherencia del deportista en su recuperación; también sugieren desarrollar proyectos de investigación en los que se estudie cómo influye el factor edad, o más propiamente una determinada etapa de la vida, marcada por la edad y otras consideraciones deportivas asociadas (estatus, perspectivas, identia p u n t s m e d e s p o r t . 2 0 0 9 ; 1 6 1 : 2 9 -3 7 ficación, etc.) en el nivel de adherencia y, por lo tanto, en el pronóstico de la rehabilitación. ...
... Recerques més recents, sobretot les desenvolupades per Brewer et al [20][21][22][23][24] , indiquen que variables personals com els estats d'ànim, la identificació esportiva i la motivació, i variables situacionals com són el suport social, esdevenen fonamentals en l'adherència de l'esportista en la seva recuperació; també suggereixen que cal desenvolupar projectes d'investigació en què s'estudiï com influeix el factor edat, o més pròpiament una determinada etapa de la vida, marcada per l'edat i altres consideracions esportives associades (estatus, perspectives, identificació, etc.) en el nivell d'adherència i, per tant, en el pronòstic de la rehabilitació. ...
L'augment considerable de la freqüència i, en alguns casos, de la gravetat de les lesions ha alertat els professionals de l'àmbit esportiu, fins a considerar els factors psicològics com un aspecte rellevant en la recerca per a la millor adequació de propostes de rehabilitació. Els objectius d'aquest treball són valorar com els factors emocionals evolucionen des de l'inici fins al final del període de recuperació, i analitzar el nivell d'adherència dels esportistes lesionats al seu programa de rehabilitació. L'estudi es va dur a terme amb cinc esportistes federats en disciplines diferents, d'edats compreses entre els 17 i els 21 anys. En relació amb el tipus de lesió, els criteris d'inclusió en l'estudi van ser: lesions recents (esdevingudes els dos dies anteriors a la primera visita al centre sanitari), noves (no recaigudes o reincidents) i mèdicament diagnosticades com moderades o greus. Per avaluar l'estat d'ànim s'ha utilitzat la versió espanyola del POMS, que inclou cinc dimensions: tensió, depressió, còlera, vigor i fatiga. Per al mesurament de l'índex d'adherència es va idear un full d'avaluació partint de l'assessorament i l'experiència professional de l'equip mèdic que va col·laborar en l'estudi; aquest full permet avaluar el compliment del tractament, tant a la clínica com de manera autònoma pel lesionat fora de la clínica. Els resultats indiquen que els actors emocionals evolucionen i adopten gradualment un perfil ICEBERG (model de salut de Morgan), en què les dimensions còlera, depressió i fatiga mostren una evolució descendent, vigor ascendent i tensió de manteniment amb puntuacions altes. El nivell d'adherència al programa de rehabilitació tendeix a ser constant, però davalla notablement al final del procés. Se suggereix l'aplicabilitat d'aquests fets en la pràctica professional del personal sanitari en els processos de rehabilitació de lesions esportives.
... Due to the subjective nature of compliance, any reliable evaluation needs to be multifaceted [17]. Obtaining more than one measure is recommended and should include both self-report and reasonable objective measures [7,18,19]. ...
Purpose:
This feasibility study sought to determine if compliance and understanding of a home exercise program following a traumatic hand injury is improved when patients are provided with a DVD and a brochure when compared to using brochures only.
Method:
Patients who presented with a traumatic hand injury and commenced on a hand therapy protocol were randomly assigned into two groups. The control group received brochures while the experimental group were provided with exercise instructions on DVD as well as brochures. Compliance was measured through the use of exercise diaries, clinic attendance, a checklist to measure correctness and understanding of exercises and a follow-up survey.
Results:
No significant improvement was found in the mean exercise compliance score (p = 0.344) between the intervention and control groups. From the survey results almost half of all participants reported that pain interfered in their ability to perform their home exercises and a third acknowledged that time limited their ability to perform their exercises.
Conclusion:
Findings demonstrate the multidimensional nature of compliance. The provision of DVD technology, while not shown to cause a statistically significant change in overall compliance, did help improve understanding of exercises; as such DVDs could be utilised as part of a program that facilitates the patient--therapist relationship.
Implications for rehabilitation:
Limited time and level of pain are highlighted as reasons for non compliance with exercise and treatment programs. The use of DVDs can improve understanding and execution of exercises and can be part of a treatment program that facilitates increased patient therapist contact for rural and remote clients.
... Few of these compliance measures have been tested for reliability or validity. The Sports Injury Rehabilitation Adherence Scale (Brewer et al., 2002) uses three items to measure compliance. A five point scale is used to assess the intensity with which exercises are performed, the extent to which patients follow the therapist's advice and the patient's receptiveness to change. ...
Objectives: Home exercise programs are an important component of a hand therapy rehabilitation program. Compliance with the recommended home exercise regime is generally considered essential for good treatment outcomes. The aim of this pilot was to determine the clarity of an innovative hand therapy DVD. This DVD will be utilised in a randomised controlled trial (RCT) examining the usefulness of DVD technology for enhancing treatment compliance for rural and remote hand therapy patients. Methods: A series of seven DVDs of previously utilised home exercise protocols were taped and edited by the researchers. The pilot used a convenience sample of nine consecutive consenting patients who attended the Hand Therapy Service at a regional hospital in North Queensland. Subjects viewed a DVD that related to their clinical diagnosis and then completed a questionnaire on the suitability of the research instrument. Results: There were unanimously positive responses to the DVD from all subjects, with 100% indicating yes to the prompt questions. No negative comments were received. Discussion: The DVDs produced were found to be clear and useful for a group of hand therapy patients characteristically similar to those who will be recruited into the RCT. Resulting compliance with these home exercises will be presented in a subsequent paper resulting from the RCT. Given the poor health outcomes generally associated with patients from rural and remote areas, this endeavour contributes to the ongoing effort to improve service delivery to better address the health needs of rural and remote patients.
... Investigaciones más recientes (Abenza, Olmedilla, Ortega y Esparza, 2009), y sobre todo las desarrolladas por Brewer y sus colaboradores (Brewer, 2003;Brewer et al., 2002;Brewer et al., 2003aBrewer et al., , 2003bBrewer et al., 2004), indican que variables personales como los estados de ánimo, la identificación deportiva y la motivación, y variables situacionales como el apoyo social son fundamentales en la adherencia del deportista en su recuperación; también sugieren desarrollar proyectos de investigación en los que se estudie como influye el factor edad, o más propiamente una determinada etapa de la vida, marcada por la edad y otras consideraciones deportivas asociadas (estatus, perspectivas, identificación, etc.) en el nivel de adherencia y, por lo tanto, en el pronóstico de la rehabilitación. ...
El objetivo del presente estudio es analizar la relación entre diferentes estados de ánimo (tensión, depresión, cólera, vigor y fatiga) y el nivel de adherencia al programa de rehabilitación de los deportistas lesionados. La muestra está formada por 5 deportistas federados en distintas disciplinas, de edades comprendidas entre los 17 y los 21 años, con lesiones moderadas o graves. Tanto los estados de ánimo como la adherencia a la rehabilitación se han evaluado de forma continuada durante 15 días. Los resultados indican que tensión, depresión y cólera muestran una evolución inversa respecto al nivel de adherencia en todos los momentos del proceso de recuperación; por el contrario, tanto vigor, como fatiga muestran una evolución paralela, de manera que cuanto mayor es el nivel de adherencia, mayores son las puntuaciones en vigor y fatiga. Se discute sobre la influencia de los estados de ánimo, asociados a la lesión, en las conductas de adherencia del deportista; parece que pueden frenar su proceso de recuperación, por lo que puede ser beneficioso intervenir sobre estos aspectos psicológicos durante el proceso de rehabilitación.
... The SIRAS has good internal consistency, ranging between a 5 0.81 and 0.86 (Shaw et al., 2005) and has also been reported to have good test-retest reliability over a 1-week period (ICC 5 0.77; Brewer et al., 2000c). In addition, Brewer et al. (2002) demonstrated the construct validity of the SIRAS with a heterogeneous sample of 43 participants. They found a significant linear relationship (Po0.001) between SIRAS scores and observed video footage that depicted minimal, moderate and maximal clinic rehabilitation adherence. ...
The aim of the present study was to examine an adapted integrated psycho-social model to predict sport injury rehabilitation adherence. A longitudinal prospective design was used whereby 70 patients attending private physiotherapy clinics completed a battery of questionnaires both pre- and post-rehabilitation treatment based on the adapted framework. All participants were receiving treatment for tendonitis-related injuries. Adherence was monitored prospectively over the entire rehabilitation program using an observational measure of clinic adherence, a self-report measure of home-based adherence, in addition to monitoring attendance at rehabilitation sessions. In the initial phase of rehabilitation learning goal orientation, attitudes and perceived severity were found to predict rehabilitation intention. Intentions were also found to mediate the relationship between the aforementioned variables and clinic rehabilitation. Self-efficacy and self-motivation were predictors of clinic rehabilitation and attendance but not home rehabilitation. During the maintenance phase of rehabilitation coping ability and social support were predictors regarding all three measures of adherence. Implications for practitioners rehabilitating injured athletes are discussed.
The Sport Injury Rehabilitation Adherence Scale is used to measure patient adherence during rehabilitation sessions in clinical settings. It was designed to measure adherence to rehabilitation tasks for sport injuries and has since been validated in broader physiotherapy settings. The tool is quick and easy to complete, and is available online. We provide a summary of the tool's instructions and scoring, reliability and validity, and a brief commentary.
The monograph presents the author’s biomechanical technology of injury prevention in the climbing. The developed technology contains 3 directions: 1 — theoretical and methodical (creation of bases for understanding by students of mechanisms of formation of movements without risk of injury, formation at students of concept of biomechanically rational movements in general); 2 — analytical (providing students with knowledge about modern means of self-analysis of the level of technical skills); 3 — practical (sportsnen’ mastery of practical means of injury prevention, ie, exercises that will promote the formation of biomechanically rational movements in any sport, and thus prevent injury). The monograph contains an algorithm for identifying the main kinematic parameters of different models of equipment, typical for athletes with different levels of mastery of sports techniques. Based on biomechanical analysis, the main aspects of movement technique on the example of climbing, which affect the level of injuries of athletes. The monograph also presents the principles of application of means for injury prevention. The monograph contains developed and systematized tools to prevent injuries to athletes. The effectiveness of biomechanical technology in the use of neuromuscular training using exercises in a closed kinematic circuit, exercises in eccentric mode in combination with strength exercises for injury prevention and the formation of effective movement techniques for climbing.
Background and purpose:
Adherence to physical therapy (PT) and secondary prevention programs (SPPs) is particularly low for individuals with Parkinson's disease. Preliminary research has linked perceptions of caring climates as well as enhanced tripartite efficacy perceptions to adherence during rehabilitation programs. In light of such preliminary research, the purpose of this study was threefold: (1) to examine relationships between perceptions of a caring climate and the 3 efficacy constructs within the tripartite model, (2) to examine the relationship between the tripartite efficacy constructs and adherence to PT/SPP exercises, and (3) to determine whether tripartite efficacy beliefs mediated the relationship between caring climate perceptions and adherence.
Method:
A total of 77 individuals with Parkinson's disease who were currently or recently enrolled in PT or an SPP were recruited and surveyed about their perceptions of the caring climate of their rehabilitation clinic, their tripartite efficacy perceptions, and their adherence to rehabilitation. Correlations and a multiple mediation analysis were conducted to address the purposes of this study.
Results and discussion:
Results showed significant positive associations between all variables; however, all paths within the proposed mediation model were not significant. Specifically, the c paths linking the tripartite efficacy constructs with adherence were not significant. A follow-up analysis was undertaken to address potential suppression effects within the mediating variables, and this analysis revealed a statistically significant model with relation-inferred self-efficacy (RISE) as a sole mediator of the relationship between caring perceptions and adherence to rehabilitation.
Conclusions:
Several practical implications can be gleaned from the current study. First, practitioners should strive to enhance the caring climate of their clinic by employing techniques reported in previous literature, such as creating a supportive atmosphere, displaying benevolence, and paying attention. In addition, the results suggest that individuals' RISE perceptions, in particular, could be a viable target for enhancing adherence.
Introduction
Patient rehabilitation advice (PRA) is commonly used amongst a variety of health care practitioners to aid and enhance the recovery of their patients. Research has demonstrated a positive relationship between the level of adherence to PRA and recovery from a variety of musculoskeletal conditions,1, 2 and 3 and has shown that non-compliance to home-based exercise programs reduces the probability of successful outcome for therapeutic intervention.2 No previous research has focused on compliance to prescription and methods of prescription used in the osteopathic medicine setting.
Design
Prospective survey study.
Methods
Over a 5 week period, all consenting return patients of Victoria University Osteopathic Medicine Clinic (VUOMC) were surveyed (N = 94) prior to the commencement of their return treatment visit on their adherence to exercises prescribed at the previous treatment using a tool developed by the researchers. Compliance of patients was calculated by comparing the participants' survey markings of prescription, to those recordings of the prescription made by the treating 4th and 5th year student practitioners in the participants' case file.
Results
Sixty-seven percent of return patients were prescribed PRA and 33% were not. Total compliance rate to PRA was 55 (59%) of respondents, with 39 (41%) non-compliant. When combining prescription types into larger categories, Diagrams were used in 15% of cases to instruct PRA compared to Verbal subgroups of 80%. Verbal had a total compliance of 41 (56%) and non-compliance of 32 (44%), compared to the Diagram total compliance of 11 (61%) and non-compliance of 7 (39%).
Conclusions
As exercise has been shown to augment the treatment efficacy and speed of recovery,1, 2 and 3 it is important that osteopaths are informed of the current adherence rate to PRA and all factors that may cause non-compliance to their exercise prescription. The overall compliance rate to PRA at VUOMC is comparable with previous studies,4 and 5 with the use of diagrams being the least utilised but most effective method of prescription in the VUOMC setting. This study provides a basis for understanding exercise implications that are important both to osteopaths and osteopathic patients, in enhancing treatment results in terms of speed and efficacy, as well as potentially reducing treatment costs to both patients and third party payers.
This study examined the relationship between adherence to postoperative physical therapy and outcome after surgical reconstruction of the anterior cruciate ligament (ACL) of the knee in a sample of 72 men and 36 women. Indices of adherence were obtained during the first 6 weeks of postsurgical rehabilitation. Outcome measures were administered before surgery and approximately 6 months after surgery. Results of a canonical correlation analysis indicated a statistically significant association between the adherence variables and the outcome variables (r = 0.56, p
The importance of cultural competency within healthcare is well established in theWest.This mixed-methods study aimed to measure the impact of a cultural competence training programme on the ability of Indian physiotherapy students to engage in culturally competent care practices that improved perceived patient adherence to treatment. Qualitative data from semi-structured interviews conducted online 2 weeks after the training were transcribed and analysed using framework analysis. Quantitative data in the form of pre- and post-training scores on the Sports Injury Rehabilitation and Assessment Scale (SIRAS) were recorded to evaluate the impact of training on therapist’s perception of treatment adherence. Findings revealed significant changes between the pre-training (median9) and post-training (median13) SIRAS scores (Wil- coxon Rank Test p 0.001), with all participants recording a positive change in treatment adherence after attending the training. Qualitative results complemented the quantitative findings. The four main themes consisted of the respondent’s perspective of physiotherapy treatment adherence, culture, the cultural competency training and its positive impact on other parameters. In conclusion, the results of this study justify the need to incorporate cultural competency training within physiotherapy education in order to provide patient-centred care.
Key words: cultural competency training, patient adherence, mixed methods
The purpose of this study was to investigate recreational participants’ experiences of adhering to a sport injury rehabilitation program. Six participants undertaking a rehabilitation program for a tendonitis‐related injury as a result of sport involvement took part in this study. Data were collected using semi‐structured interviews and were thematically analyzed using interpretative phenomenological analysis (Smith & Osborn, 2003). Five themes emerging from the data set were motivation, confidence, coping, social support, and pain. Specifically, a lack of motivation and confidence were perceived to have a negative effect upon home‐based rehabilitation adherence while ineffective coping strategies, over support and pain, appeared to have an adverse influence on rehabilitation adherence in a clinic setting. The use of effective coping strategies and varied types of social support aided rehabilitation adherence. Applied implications and future research directions are discussed.
ObjectiveTo evaluate, through two studies, the factor structure, inter-rater agreement, and test–retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).DesignRepeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).SettingUniversity department (Study 1) and outpatient physiotherapy department (Study 2).ParticipantsSixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.InterventionIn Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.Main outcome measureThe SIRAS.ResultsIn Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test–retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36–0.82) to 0.76 (95% CI 0.55–0.88), respectively.ConclusionThe SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.
La relación entre factores psicológicos y lesiones deportivas ha sido objeto de estudio por los investigadores desde hace años, y aunque se pueden establecer líneas de investigación muy claras, sigue existiendo una gran dispersión de datos, teorías y conceptos. Partiendo de este estado de cosas, se ha considerado la necesidad de definir un modelo global psicológico de lesiones deportivas, que sea comprensivo, multi-conceptual, predictivo y demostrable empírica y/o experimentalmente. En este trabajo se presenta el Modelo Global Psicológico de las Lesiones Deportivas (MGPsLD), con los tres ejes que lo definen: un eje causal, un eje temporal y un eje conceptual. Asimismo, se revisan las variables psicológicas y situacionales del MGPsLD más relevantes aparecidas en la literatura científica; y, finalmente, se determinan las consecuencias metodológicas que se derivan del uso de este modelo. Por último, se discute la necesidad de la validación del modelo, en sus tres ejes, lo que implica el desarrollo de una estrategia global de estudios empíricos.
Rehabilitation programs are considered essential following anterior cruciate ligament reconstruction to maximise the potential outcome of the surgery. Provision of a rehabilitation program, however well intentioned, does not guarantee that patients will adhere to the program. Failure of patients to comply with clinical rehabilitation may limit the effectiveness of the rehabilitation program. Furthermore, failure of subjects to comply with experimental rehabilitation programs may bias results obtained by research studies, limiting the strength of empirical evidence generated. The aim of this paper is to present clinicians and researchers with an overview, particularly with respect to reliability and validity, of a number of adherence measurement instruments that may potentially be administered to patients or subjects following anterior cruciate ligament reconstruction.
The research in this thesis used prospective randomised controlled trials to evaluate two cognitive-behavioural interventions designed to improve adherence to physiotherapy in patients with ankle sprains. In Study 1, a DVD and written intervention grounded in Protection Motivation Theory (PMT: Rogers, 1983) and assessment tools were developed and piloted. In the pilot 31 patients were randomized into one of three treatment conditions (PMT, attention control and non-contact control). Following the intervention patients beliefs toward physiotherapy and injury were assessed. Compared to the two controls, the PMT group had significantly higher scores on severity, vulnerability and response efficacy. No differences were found for self-efficacy or intentions. Both response efficacy and self efficacy were significantly related to intentions. Based on these findings, the self-efficacy component of the PMT DVD was revised. Study 2 (n = 71), an identical three group design, tested the PMT-based intervention’s effect on beliefs, intentions, adherence and functional outcomes. Before physiotherapy, antecedents to adherence (motivation, pain, and subjective norm) and functional outcomes were measured, then the intervention was given, and beliefs and intentions evaluated. Adherence to clinic and home physiotherapy was assessed throughout the treatment programme and functional outcomes again at the end of treatment. Compared to the two controls, the intervention group was significantly higher on all PMT beliefs barring self-efficacy. No significant group differences were found for intentions, adherence and post-physiotherapy functional outcomes. Significant relations occurred between the antecedents, PMT beliefs, intentions, adherence and functional outcomes. The lack of group differences on intention, adherence and functional outcome was attributed to most participants having previously had physiotherapy and antecedent scores that typify highly adherent patients. Study 3 (n = 47) compared a home-based programme steeped in adherence enhancing strategies with its traditional clinic counterpart. Psychological variables (antecedents, locus of control, and anxiety) and functional outcomes were measured before and after the course of physiotherapy, and adherence during. No group differences occurred on either the psychological or functional outcome variables. Compared to the clinic group, the home-based participants required significantly less clinic appointments, had a higher percentage of attendance and a significantly better completion rate. No group differences existed for their adherence to the physiotherapy. Significant relations occurred between psychological variables, adherence, and functional outcomes. Findings suggest home-based physiotherapy is a viable, safe treatment option.
El aumento considerable de la frecuencia y, en algunos casos, de la gravedad de las lesiones ha alertado a los diferentes profesionales del ámbito deportivo, considerando a los factores psicológicos como aspecto relevante en la investigación para la mejor adecuación de propuestas de rehabilitación. Los objetivos del presente trabajo son valorar cómo los diferentes factores emocionales evolucionan desde el inicio hasta el final del período de recuperación, y analizar el nivel de adherencia de los deportistas lesionados a su programa de rehabilitación. El estudio se realizó con 5 deportistas federados en distintas disciplinas, de edades comprendidas entre los 17 y los 21 años. En relación al tipo de lesión, los criterios de inclusión para el estudio fueron: lesiones recientes (ocurridas en los dos días anteriores a la primera visita al centro sanitario), nuevas (no recaídas o reincidentes) y médicamente diagnosticadas como moderadas o graves. Para valorar el estado de ánimo se ha utilizado la versión española del POMS, que incluye 5 dimensiones: tensión, depresión, cólera, vigor y fatiga. Para el registro del índice de adherencia se diseñó una hoja de evaluación partiendo del asesoramiento y la experiencia profesional del equipo médico que colaboró en el estudio; esta hoja permite valorar el cumplimiento del tratamiento, tanto en la clínica como el realizado de forma autónoma por el lesionado fuera de la clínica. Los resultados indican que los factores emocionales evolucionan adoptando gradualmente un perfil ICEBERG (modelo de salud de Morgan), donde las dimensiones cólera, depresión y fatiga muestran una evolución descendente, vigor ascendente y tensión de mantenimiento con puntuaciones altas. El nivel de adherencia al programa de rehabilitación tiende a ser constante, descendiendo notablemente al final del proceso. Se sugiere la aplicabilidad de estos hechos en la práctica profesional del personal sanitario en los procesos de rehabilitación de lesiones deportivas.
Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patient's adherence to the prescribed exercise regime. This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD = 12.3) years; 11/32 (34%) male). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). The average of these three measures formed a multidimensional adherence index (MAI). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities was scored with the Roland-Morris disability scale and back pain intensity with a 0-10 graphic rating scale. Overall, adherence to therapy was very good (average MAI score, 85%; median (IQR), 89 (15)%). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho = 0.36, P = 0.045). Pain intensity and self-rated disability decreased significantly after therapy (each P < 0.01). Adherence to home exercises showed a moderate, positive correlation with the reduction in average pain (Rho = 0.54, P = 0.003) and disability (Rho = 0.38, P = 0.036); higher MAI scores were associated with greater reductions in average pain (Rho = 0.48, P = 0.008) and a (n.s.) tendency for greater reductions in disability (Rho = 0.32, P = 0.07) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes. The benefits of rehabilitation depended to a large extent on the patient's exercise behaviour outside of the formal physiotherapy sessions. Hence, more effort should be invested in finding ways to improve patients' motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the "adherence-outcome" interaction was mediated by improvements in function related to the specific exercises, or by a more "global" effect of the programme, remains to be examined.
Protection motivation theory (PMT) has been used in more than 20 different health-related fields to study intentions and behavior, albeit primarily outside the area of injury rehabilitation. In order to examine and predict patient adherence behavior, this study was carried out to explore the use of PMT as a screening tool in a general sample of people with orthopedic conditions.
New patients who were more than 18 years old and who were prescribed 4 to 8 weeks of physical therapy treatment (n=229) were administered a screening tool (Sports Injury Rehabilitation Beliefs Scale, Positive and Negative Affect Schedule, and a barriers checklist) prior to treatment. Participants' adherence was assessed with several attendance measures and an in-clinic assessment of behavior. Statistical analyses included correlation, chi-square, multiple regression, and discriminant function analyses.
A variety of relationships among affect, barriers, and PMT components were evident. In-clinic behavior and attendance were influenced by affect, whereas dropout status was predicted by affect, severity, self-efficacy, and age.
The screening tool used in this study may assist in identifying patients who are at risk for poor adherence and provide valuable information to enhance provider-patient relationships and foster patient adherence. However, it is recommended that more research be conducted to further understand the impact of variables on patient adherence and that the screening tool be enhanced to increase its predictive ability.
This study investigated adherence to low back pain rehabilitation in the clinical setting. Adherence was assessed in 105 (71 male and 34 female) patients attending private physiotherapy clinics for rehabilitation of low back pain. Three aspects of adherence were measured over the 4-week study period: attendance at clinic-based rehabilitation sessions, adherence to a home exercise component of rehabilitation, and adherence to activities and advice during clinic-based rehabilitation. Rehabilitation outcome was measured using the Patients' Measure of Perceived Rehabilitation (McDonald & Hardy 1990) and the Physiotherapists' Measure of Perceived Rehabilitation (McDonald & Hardy 1990). It was found that patients attended 87.7% of their scheduled physiotherapy rehabilitation appointments and reported completing 71.6% of their prescribed home exercises. In relation to adherence to clinic-based rehabilitation activities (as measured by the Sport Injury Rehabilitation Adherence Scale, Brewer et al. 2000), patients scored an average of 11.6/15. Although no gender differences were found, compensable patients adhered significantly less to clinic-based rehabilitation activities than did their non-compensable counterparts. Further, it was found that higher levels of adherence to clinic-based activities significantly predicted both the patients' and physiotherapists' perception of degree of rehabilitation at the end of the 4-week rehabilitation period. These findings are discussed in relation to rehabilitation strategies for physiotherapists.
The commonly used form of rwg. (J) can display irregular behavior, so four variants of this index were examined. An alternative index, r*wg. J, is recommended. This index is an inverse linear function of the ratio of the average obtained variance to the variance of uniformly distributed random error. r*wg.Jis superficially similar to Cronbach’s α, but careful examination confirms that r*wg.Jis an index of agreement, not reliability. Based on an examination of the small-sample behavior of rwgand r*wg.J, sample sizes of 10 or more raters are recommended.
F. L. Schmidt and J. E. Hunter (1989) critiqued the within-group interrater reliability statistic (
rwg) described by L. R. James et al (1984). S. W. Kozlowski and K. Hattrup (1992) responded to the Schmidt and Hunter critique and argued that
rwg is a suitable index of interrater agreement. This article focuses on the interpretation of
rwg as a measure of agreement among judges' ratings of a single target. A new derivation of
rwg is given that underscores this interpretation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents methods for assessing agreement among the judgments made by a single group of judges on a single variable in regard to a single target. For example, the group of judges could be editorial consultants, members of an assessment center, or members of a team. The single target could be a manuscript, a lower level manager, or a team. The variable on which the target is judged could be overall publishability in the case of the manuscript, managerial potential for the lower level manager, or a team cooperativeness for the team. The methods presented are based on new procedures for estimating interrater reliability. For such situations, these procedures furnish more accurate and interpretable estimates of agreement than estimates provided by procedures commonly used to estimate agreement, consistency, or interrater reliability. The proposed methods include processes for controlling for the spurious influences of response biases (e.g., positive leniency and social desirability) on estimates of interrater reliability. (49 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Indexes of interrater reliability and agreement are reviewed, and suggestions are made regarding their use in counseling psychology research. The distinction between agreement and reliability is clarified, and the relationships between these indexes and the level of measurement and type of replication are discussed. Indexes of interrater reliability appropriate for use with ordinal and interval scales are considered. The intraclass correlation as a measure of interrater reliability is discussed in terms of the treatment of between-raters variance and the appropriateness of reliability estimates based on composite or individual ratings. The advisability of optimal weighting schemes for calculating composite ratings is also considered. Measures of interrater agreement for ordinal and interval scales are described, as are measures of interrater agreement for data at the nominal level of measurement. (54 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery.
Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (
N = 95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, 93 participants reported on their completion of home rehabilitation exercises and cryotherapy, and their rehabilitation practitioners indicated the patients' attendance at, and adherence during, rehabilitation sessions. Rehabilitation outcome measures were taken from 69 participants approximately 6 months postsurgery.
Main Outcome Measures: Knee laxity, functional ability, and subjective symptoms were the primary outcomes assessed.
Results: Self-motivation was significant predictor of home exercise completion; athletic identity and psychological distress were significant predictors of knee laxity; and attendance at rehabilitation sessions and home cryotherapy completion were significant predictors of functional ability. Rehabilitation adherence did not mediate the relationship between psychological factors and rehabilitation outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The repeatability of the the speed/heart rate (S/HR) relationship obtained with the incremental test developed by Conconi et al. (5) was examined by having 75 subjects perform the same running test twice in the course of a few days. From the data obtained, comparisons were made of four variables: 1) speed of deflection, 2) heart rate of deflection, 3) slope, and 4) intercept on the y-axis of the linear portion of the S/HR relationship. Straight-line equations, correlation coefficients (r), and technical errors of measurement (TEM) were obtained by comparing data from the two successive tests. Data analysis suggests that in two successive tests there are some variations in the linear portion of the S/HR relationship. However, the straight lines obtained from the two tests converge at the same deflection point. The problem of assigning a single value to the point of deflection, when determined by means of visual analysis of the S/HR graph, was also examined. For this part of the study, speed and heart rate data previously obtained for 65 subjects were used. The selected tests had been carried out during the course of various studies. The 65 sets of test data were plotted on graph paper and given to six observers for independent evaluation of speed and heart rate of deflection. These observers had different levels of experience in interpreting Conconi test results. The speed and heart rate of deflection values assigned by each observer were compared to the values obtained through mathematical analysis of the tests by computer. Straight-line equations, correlation coefficients (r), and technical errors of measurement (TEM) obtained by comparing visually determined data to those determined through mathematical analysis were calculated for each observer. Only for observers with little experience were some differences found between the observer-assigned and computer-determined results; these differences occurred for both speed and heart rate of deflection. We conclude that visual analysis provides information that is very similar to that obtained through computer analysis. The accuracy of the visually obtained information varies according to the observer's experience.
Contemporary sports medicine literature has begun to address more centrally the idea that treatment adherence is a complex issue. Not only must certified athletic trainers (ATCs) possess knowledge about injuries and subsequent rehabilitation protocols, they also must be able to deliver essential services in a manner that predisposes treatment success. Effective treatment of athletic injuries necessitates consideration of various psychosocial factors shown to enhance rehabilitation adherence. Detailed explanations of several important ATC-athlete interaction patterns and motivational strategies are offered.
The purpose of this study was to examine the inter- and intratester reliability of lower extremity circumference measurements obtained by two testers using the same tape measure and two different tape measures. Twenty-one male high school student-athletes participated in this study. Two testers measured lower extremity circumference at three sites using a standard flexible tape measure and a Lufkin tape measure with a Gulick spring-loaded handle attachment. Measurement sites were medial joint line, 20 cm above medial joint line, and 15 cm below medial joint line. Intraclass correlation coefficients were computed for inter- and intratester comparisons for each measuring device and each measurement site. Results indicated high reliability but a significant difference between the two tape measures. These findings indicate that the reliability of lower extremity circumference measurements is not influenced by tester experience and that the Lufkin tape measure with the Gulick handle attachment is the more accurate of the two tape measures.
Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery. Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (N = 95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, participants (n = 93) reported on their completion of home rehabilitation exercises and cryotherapy, and their rehabilitation practitioners indicated the patients' attendance at, and adherence during, rehabilitation sessions. Rehabilitation outcome measures were taken from participants (n = 69) approximately 6 months postsurgery. Main Outcome Measures: Knee laxity, functional ability, and subjective symptoms were the primary outcomes assessed. Results: Self-motivation was a significant predictor of home exercise completion; athletic identity and psychological distress were significant predictors of knee laxity; and attendance at rehabilitation sessions and home cryotherapy completion were significant predictors of functional ability. Rehabilitation adherence did not mediate the relationship between psychological factors and rehabilitation outcome. Conclusions: The prospective associations obtained among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after ACL reconstruction may inform the development of interventions designed to enhance the rehabilitation of individuals with sport-related orthopedic injuries.
Cognitive appraisal models of adjustment to sport injury hold that cognitive appraisals of the injury determine emotional responses to the injury, which in turn influence behavioral responses (e.g., adherence to rehabilitation). To test this model, recreational and competitive athletes undergoing rehabilitation following knee surgery (N = 31) appraised their ability to cope with their injury and completed a measure of mood disturbance. Adherence to rehabilitation was measured in terms of attendance at rehabilitation sessions and physical therapist/athletic trainer ratings of patient behavior during rehabilitation sessions. As predicted, cognitive appraisal was associated with emotional disturbance. Emotional disturbance was inversely related to one measure of adherence (attendance) but was unrelated to the other measure of adherence (physical therapist/athletic trainer ratings). The results of this study provide support for cognitive appraisal models and suggest that emotional disturbance may be a marker for poor adherence to sport injury rehabilitation regimens.
Under the heading of reliability, most textbooks refer to classical reliability indexes as appropriate measures for determining interrater agreement. It is argued that interrater agreement is a psychometric property that is theoretically different from classical reliability. Interrater agreement indexes measure the degree to which two or more raters agree on the observation of one or more behaviors on one or more subjects and are not theoretically related to classical test theory. A detailed set of formulas is presented to illustrate a set of algebraically equivalent rater agreement indexes that are intended to provide the educational and psychological researcher and practitioner with a practical means of establishing a measure of rater agreement. The formulas are illustrated with a data set. The formulas can be used for dichotomous and continuous data for two or more raters, on one or more subjects, on one or more behaviors. These rater agreement indexes are useful with performance assessments such as observations, porfolios, performance evaluations, essay writing evaluations, authentic assessments, and so on, where multiple facets impact rater agreement.
This study, following on from previous review papers, determined test reliability and validity within a clinical context. The chosen topic was the assessment of intra and inter-tester reliability as well as criterion validity (X-ray) for ‘Tape’ (TP) and ‘Block’ (BK) methods of leg length discrepancy (LLD) estimation. Four different testers using both TP and BK methods on two occasions within the same working day assessed 25 subjects. Two testers were designated as experienced (EX) and two as non-experienced (NEX). Intra-tester reliability was perfect for the BK method but demonstrated a range of variability, as assessed by typical error, for the TP method (range 0·17–0·32cm). One EX tester was more reliable than the other EX and both NEX testers. Inter-tester variability was assessed on the ability of different pairs of testers to categorize any left or right LLD as > or
Schmidt and Hunter (1989) critiqued the within-group interrater reliability statistic (r(wg)) described by James, Demaree, and Wolf(1984). Kozlowski and Hattrup (1992) responded to the Schmidt and Hunter critique and argued that r(wg) is a suitable index of interrater agreement. This article focuses on the interpretation of r(wg) as a measure of agreement among judges' ratings of a single target. A new derivation of r(wg) is given that underscores this interpretation.
Objectives: to examine the psychometric properties of the Sport Injury Rehabilitation Adherence Scale (SIRAS), an instrument designed to assess adherence during clinic-based sport injury rehabilitation sessions. Design: rehabilitation professionals completed the SIRAS for their patients on one occasion in Study 1, two occasions one week apart in Study 2, and multiple (rangeà 6-48) occasions in Study 3. Setting: an orthopedic physical therapy clinic specializing in sports medicine. Participants: one hundred and forty-five general physical therapy patients in Study 1, 31 patients undergoing rehabilitation following knee surgery in Study 2, and 43 patients undergoing rehabilitation following anterior cruciate ligament reconstruction in Study 3. Main outcome measure: the SIRAS. Results: In Study 1, a Cronbach's alpha coefficient of .82 was obtained for the SIRAS, scores on the SIRAS were weakly correlated (rà .21) with attendance at rehabilitation sessions, and the SIRAS items loaded on a single factor in a principal components analysis. In Study 2, a test-retest intraclass correlation coefficient of .77 was obtained for the SIRAS and, in Study 3, a modified interrater intraclass correlation coefficient of .57 was obtained for repeated administrations of the SIRAS across rehabilitation professionals. Conclusions: the results of this study provide preliminary evidence in support of the internal consistency, unidimensionality, discriminant validity, test-retest reliability, and interrater reliability of the SIRAS. # 2000 Harcourt Publishers Ltd
Unlabelled:
The purpose of this study is to provide a statistical analysis of the length of treatment patients experience with one or more of the most common athletic diagnoses seen at a sports medicine clinic. Based on a computerized analysis of 1707 patients the following statistical trends were documented. A hierarchy of the 18 most common diagnoses was established, indicating the importance of injury to the anterior cruciate ligament in the sports medicine clinic setting. Surgical groups required longer treatment times than those patients with nonsurgical diagnoses. Patients who required longer treatment programs could be statistically separated from shorter treatment programs based on their condition (fully active versus improved versus status quo) when released from therapy. Multiple injuries had no effect of increased treatment time when compared to isolated injuries for long-term or short-term diagnoses.
Editors note:
An addendum update from 1984's statistics to 1986 appears in the article as Table 5.J Ortho Sports Phys Ther 1987;9(1):40-46.
The purpose of three related studies was to develop a social dance instrument that had logical validity and generalizable performance ratings. Three social dance experts critiqued the instrument and concluded the items described the characteristics of good social dance performance. Twelve couples from a social dance class were videotaped for 5 min while performing the fox trot. Their performances were evaluated by a different set of coders in each of the three generalizability (G-) studies conducted (Subjects x Coders x Days ANOVA design). Dance performances were held constant across coding occasions so the day facet represents degree of consistency in coding, not stability of subjects' performances. Decision (D-) studies were also conducted for various measurement conditions. Results of the G-studies indicated that coders with several years of experience teaching and evaluating dance had less systematic coder bias and less systematic coder bias for a subset of dancers than coders who had little or no experience evaluating movement of any form. The performance ratings given by novice coders could be generalized for any randomly selected coder evaluating on any given day (G = .79). It was concluded the social dance test was valid and coders could be trained to obtain generalizable performance ratings.
Measurements of the integrity of knee ligaments are used to diagnose injuries as well as to document the state of recovery. Many factors, such as gender and experience of the examiner, are capable of influencing the reliability of such measurements. The purpose of this study was to determine the effects on interrater reliability of measurements obtained using the KT-1000 arthrometer of experience, gender, and leg tested.
Two experienced examiners (1 male, 1 female) and two inexperienced examiners (1 male, 1 female) tested 22 subjects with unilateral anterior cruciate ligament (ACL) pathology.
The leg with an ACL injury and the uninjured leg of each subject were evaluated by all four examiners within one test session using 67-N, 89-N, maximum manual, and active anterior drawer tests.
Greater anterior displacement values were found in the legs with ACL injury than in the uninjured legs. Reliability estimates, as assessed by intraclass correlation coefficients (2,k) and measurement error (SEM), suggest that therapist experience may be a more important factor influencing reliability than gender.
Given the magnitude of the errors obtained for tests routinely conducted in the clinic using the KT-1000 arthrometer, we recommend that repeated measurements should be taken by the same examiners whenever possible. [Ballantyne BT, French AK, Heimsoth SL, et al. Influence of examiner experience and gender on interrater reliability of KT-1000 arthrometer measurements.
The relations of causal attributions for recovery from knee surgery to recovery rate and rehabilitation adherence were examined in a sample of 34 recreational or competitive athletes. Subjects rated their open-ended attributions for recovery on the Revised Causal Dimension Scale (McAuley, Duncan, & Russell, 1992). Subjects who perceived themselves as recovering rapidly made more stable, personally controllable, and externally controllable attributions than subjects who perceived themselves as recovering slowly. Subjects designated by their physical therapist/athletic trainer (PT/AT) as recovering rapidly tended to attribute their rehabilitation progress to more internal and personally controllable factors than subjects identified as recovering slowly. Causal dimension ratings predicted PT/AT rehabilitation adherence ratings, but not attendance at rehabilitation sessions.
Mortality rates and injuries requiring medical treatment associated with sports and exercise are generally low. However, higher injury rates are reported for athletes and members of sports clubs. This study focuses on the sport- and exercise-related injury rate for various age and sex groups in the general population and how sport and exercise injury rates compare with those for other activities. The data presented are based on telephone interviews. Of the participants (N = 6,596), 335 (5.1%) reported having sustained an injury in the previous month; 46% of injuries among males and 14% of those among females were sport or exercise related. The data show a downward trend in sport- and exercise-related injury rates with increasing age. It is concluded that, as a proportion of all injuries sustained, the sport- and exercise-related injury rate is high, particularly among males. Possible future research on sport- and exercise-related injuries is discussed.
To determine the necessity of extensive supervised therapy, we reviewed the records of 39 consecutive patients who underwent arthroscopic anterior cruciate ligament reconstruction using mid-1/3 bone-patellar tendon-bone autograft, followed by a minimal therapy program. This study group was subdivided into a noncompliant group averaging 1.7 visits over 6 months (range, 0 to 5), (subgroup I), and a minimally compliant group averaging 12 visits over 6 months (range, 5 to 24), (subgroup II). Thirty patients who underwent similar surgeries and postoperative protocols, but participated in an extensive supervised outpatient therapy program, served as controls. The control group was fully compliant and averaged 60 visits over 6 months. After 6 months, the minimally compliant study subgroup was equivalent to the fully compliant control group in Lysholm score, patient satisfaction, and return to preoperative activity level. Both of these groups fared better in all of these indices than did the noncompliant subgroup. These results suggest that extensive supervised rehabilitation does not afford a measurable advantage over a minimally supervised program of two visits monthly. Complete noncompliance, however, was associated with suboptimal outcome.
Goniometric measurement of forefoot position relative to the rearfoot is a routine procedure used by rehabilitation specialists. This measurement is also frequently made by visual estimation. The influence of tester experience on the reliability of these two techniques at the forefoot is unknown. The purpose of this investigation was to directly examine the reliability of goniometric and visual estimation of forefoot position measurements when experienced and inexperienced testers perform the evaluation. Two clinicians (> or = 10 years experience) and two physical therapy students were recruited as testers. Ten subjects (20-31 years old), free from pathology, were measured. Each foot was evaluated twice with the goniometer and twice with visual estimation by each tester. Intraclass correlation coefficient (ICC) and coefficients of variation method error were used as estimates of reliability. There was no dramatic difference in the intratester or intertester reliability between experienced and inexperienced testers, regardless of the evaluation used. Estimates of intratester reliability (ICC 2,1), when using the goniometer, ranged from 0.08 to 0.78 for the experienced examiners and from 0.16 to 0.65 for the inexperienced examiners. When using visual estimation, ICC (2,1) values ranged from 0.51 to 0.76 for the experienced examiners and 0.53 to 0.57 for the inexperienced examiners. The estimate of intertester reliability [ICC (2,2)] for the goniometer was 0.38 for the experienced examiners and 0.42 for the inexperienced examiners. When using visual estimation, ICC (2,2) values were 0.81 for the experienced examiners and 0.72 for the inexperienced examiners. Although experience does not appear to influence forefoot position measurements, of the two evaluation techniques, visual estimation may be the more reliable.
Before a measurement technique is used clinically, it must be shown to be both valid and reliable. The purpose of this paper was to investigate a novel technique for measuring the temporal phases of the gait cycle using a stopwatch and slow motion video. Two healthy, young adult subjects walked at a range of self-selected walking speeds on a resistive grid walkway. The subjects were videotaped while traversing the walkway. Using video played back at slow motion and a multimemory stopwatch, two student physical therapists independently analyzed the videotapes on five separate occasions. Regression analysis was used to compare the data obtained by each of the raters with those obtained from the walkway. Measurements by both raters correlated highly with those obtained from the walkway. The results indicated a slight bias between the walkway data and the stopwatch technique, but the confidence intervals suggest that the relative timing of key events differed by less than 1%. This study shows that it is possible to get valid and reliable measures of the relative durations of the temporal gait parameters using slow motion video and a multimemory stopwatch.
Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993.
Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (<15 years of age) and adults (>15 years of age).
Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury.
The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.
Single group repeated measures with multiple raters.
To determine the inter-rater reliability of KT-1000 measurements of novice and experienced raters and to provide error estimates for these raters.
The KT-1000 arthrometer is often used clinically to quantify anterior tibial displacement. Few data have been documented, however, about the relative reliability of KT-1000 measurements obtained by novice compared with experienced users.
Two novice and two experienced KT-1000 users performed measurements on 29 knees of 25 patients after anterior cruciate ligament (ACL) reconstruction or with a diagnosis of ACL deficiency. Measurements were performed at 131 N. Interrater and intertrial reliability coefficients (interclass correlation coefficient; ICC) and the standard error of measurement were calculated for expert and novice raters.
The interrater ICC for novices was 0.65 and the interrate error was +/- 3.52 mm (90% confidence interval [CI]). The interrater ICC for experts was 0.79 and the interrater error was +/- 2.94 mm (90% CI).
These results suggest that experience in using the KT-1000 is related to the interrater error of measurements and that training is an important consideration when using the KT-1000 arthrometer.
Repeated measures of 14 temporal factors of gait obtained with a multimemory stopwatch from a variety of subjects with locomotor impairments.
To estimate the intratester and intertester reliability of 14 temporal factors of gait by using a multimemory stopwatch; to compare novice and expert clinicians at mastery of making these temporal measurements.
Temporal gait measures are useful for describing the effectiveness of treatment interventions in patients with locomotor impairments.
Eleven adult subjects (mean age, 48.4 years; SD, 5.7 years), 10 with locomotor impairments and 1 elderly adult, ambulated along a 6-m walkway 3 times at a self-selected walking speed. The subjects were videotaped from the side as they walked. Four physical therapists independently analyzed the videotapes on 2 occasions; 2 examiners were recent graduates, and 2 others had 23 years of clinical experience. Intraclass correlation coefficients were used to estimate intratester reliability. A component of variance analysis quantified the sources of variation.
Intraclass correlation coefficients for each of the 14 variables varied from 0.88 to 0.98. The major contributor to variance was subject, followed by trial, error, and tester; the tester factor generally contributed less than 1% to the total variance.
Reliable measurements of the temporal aspects of gait can be made by using a multimemory stopwatch and videotape in a clinical setting on patients with various locomotor problems. Our data suggest that measurements obtained by more experienced physical therapists were no more reliable than those made by recent graduates.
The purpose of this investigation was to determine the interrater reliability of peak torque and total work values obtained with isokinetic measures of knee flexion and extension. Eight male and eight female students were evaluated on four occasions by four different examiners (range of isokinetic test experience: 0 to 10 yrs) using a standardized isokinetic measurement protocol. Subjects were randomly assigned to participate in a test sequence determined by a 4 x 4 balanced Latin square. Peak torque and total work values at 60 degrees /sec and 180 degrees /sec were obtained for the concentric measures of knee extension and flexion. The measures of peak torque and total work were corrected for the effects of gravity. Intraclass correlation coefficients and standard error of measurement estimates were used to estimate the interrater reliability for each test condition (test speed x muscle group). Intraclass correlation coefficient values ranged from .90 to .96 for peak torque and .90 to .95 for total work. Standard error of measurement estimates ranged from 8.9 to 13.3 Nm for peak torque and 11.3 to 16.8 Nm for total work. The results of this investigation demonstrate that reliable measures of isokinetic muscle performance of knee extension and flexion may be obtained by four clinicians with varied experience when following a standardized measurement protocol.
Certified athletic trainers (ATCs) in District 2 (n=187) of the National Athletic Trainers' Association (NATA) were asked to complete a questionnaire that assessed the attitudes and judgments of ATCs concerning numerous factors presumed to influence sport injury rehabilitation. Gender and experience differences in ATCs' attitudes and judgments about rehabilitation adherence were examined. Successful and unsuccessful adherence strategies also were reported. The questionnaire consisted of 60 statements that were categorized into seven scales: athletic trainer's influence, environmental influences, athlete's personality, pain tolerance, selfmotivation, goals and incentives, and significant others. There were no significant differences for either gender or experience of ATCs on any of the seven scales. An analysis of questionnaire item responses revealed the following as factors ATCs deemed important to injury rehabilitation: a) good rapport and communication between the ATC and the injured athlete, b) explanation of the injury and rehabilitation regimen, c) convenience and accessibility of the rehabilitation facility, d) rehabilitation sessions planned around the athletes' busy schedules, e) athletes' beliefs that the program is worth pursuing, f) personal supervision and regular monitoring, g) need for injured athletes to see immediate results, and h) support from significant others. ATCs reported education, goal setting, encouragement, monitoring progress, and support systems as successful strategies. Threats and rehabilitation without monitoring were reported as unsuccessful strategies.
Psychological Approaches to Sports Injury Rehabilitation
- J Taylor
- S Taylor
Taylor J, Taylor S. Psychological Approaches to Sports Injury Rehabilitation.
Gaithersburg, Md: Aspen; 1997.
SPSS Base 9.0 for Windows: User's Guide. Chicago, 111: SPSS; 1999. 21 Influence of examiner experience and gender on interrater reliability of KT-1000 arthrometer measurements
- Ballantyne
- French Ak Bt
- Heimsoth
- Sl
- Kachingwe
- Af
- Jb Lee
- Soderberg
- Gl
Statistical Package for Sodal Sciences (SPSS). SPSS Base 9.0 for Windows: User's Guide. Chicago, 111: SPSS; 1999. 21. Ballantyne BT, French AK, Heimsoth SL, Kachingwe AF, Lee JB, Soderberg GL. Influence of examiner experience and gender on interrater reliability of KT-1000 arthrometer measurements. Phys Ther. 1995;75:898-906.
- Dj Caine
- Cg Caine
- Kj Lindner
Caine DJ, Caine CG, Lindner KJ. Epidemiology of Sports Injuries. Champaign, 111:
Human Kinetics, 1996.
- D J Caine
- C G Caine
- K J Lindner
Caine DJ, Caine CG, Lindner KJ. Epidemiology of Sports Injuries. Champaign, 111:
Human Kinetics, 1996.
Athletic trainers' attitudes and judgments of injured athletes' rehabilitation adherence. / At/i/effc Train
- A C Fisher
- S A Muuins
- P A Frye
Fisher AC, MuUins SA, Frye PA. Athletic trainers' attitudes and judgments of
injured athletes' rehabilitation adherence. / At/i/effc Train. 1993;28:43-47.
Measurements of temporal aspects of gait obtained with a mulHmemory stopwatch in persons with gait impairments
- J W Youdas
- A L Atwood
- Harris-Love Mo
- T L Stiller
- K S Egan
- T M Themeau
Youdas JW, Atwood AL, Harris-Love MO, Stiller TL, Egan KS, Themeau TM.
Measurements of temporal aspects of gait obtained with a mulHmemory stopwatch in persons with gait impairments. / Orthop Sports Phys Ther. 2000;30:279-286.