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What is a valid cut-off value for evaluating ankle instability from center of pressure measurements?
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
of less than 99 points were included in the analysis (17 males, 33 limbs, mean age = 15.5 ± 0.6 years). None of the participants had any severe injury in their legs. Secondly measure, body sway during one-leg standing without vision was evaluated by tracking the trajectory of the COP as measured by a pressure sensitive foot analysis platform (Win-Pod Medicapteurs© ). Based on the results of previous work, we used Pearson’s correlation coefficients to test the relationships between the participants’ individual K score parameter scores and the following parameters of COP: locus length, area, locus length per area and average direction-specific velocities in the anteroposterior and mediolateral directions. Statistic analysis was Pearson’s correlation coefficient. Results: Locus length was negatively correlated with instability (r = −0.56) and moderately positively correlated with K score for stair climbing (r = 0.51) and activities of daily living (r = 0.51). Area (r = −0.43) and velocity in the mediolateral direction (r = −0.45) were moderately negatively correlated with K score values for instability. Conclusion(s): Our results indicate that not all of the K score parameters reflect body sway as measured by COP trace trajectory. Only K score parameters relating to ankle instability are negatively correlated with body sway. Thus, if there is no apparatus available to measure COP on the sports field, evaluation of the K score parameters relating to ankle instability will provide an indication of the athlete’s chronic ankle instability. Although scores for stair climbing and activities of daily living were positively correlated with locus length. It means that if body sway were increased, stair climbing and activities of daily living will be getting better. It is our opinion that these unexpected results are due to other causes without instability and should not be regarded as indicative of ankle instability. Implications: Although the K score is used to evaluate patients after ankle sprain, the underlying causes influencing each individual parameter score may differ. When we treat patients with chronic ankle disability, we should consider the possibility of functional disabilities other than pain or instability. Keywords: Karlsson ankle function score; Center of pressure; Ankle instability Funding acknowledgements: This study was no funded. Ethics approval: The Ethics Committee of our hospital approved this study. http://dx.doi.org/10.1016/j.physio.2015.03.1518
Research Report Poster Presentation Number: RR-PO-21-19-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 WHAT IS A VALID CUT-OFF VALUE FOR EVALUATING ANKLE INSTABILITY FROM CENTER OF PRESSURE MEASUREMENTS? T. Toyooka 1 , S. Sugiura 1,2 , A. Takata 1 , T. Ishizaki 1 , Y. Omori 1 , Y. Takata 1 , S. Nishikawa 1 1 Nishikawa
Orthopedic Clinic, Sakura, Japan; 2 Chiba University, Bioenvironmental Medicine, Chiba City, Japan
Background: It has been reported that center of pressure (COP) measurements, such as locus length and velocity, can be used to objectively assess chronic ankle instability. However, we do not know which parameters best reflect a patient’s complaint, and thus assessing COP does not necessarily allow us to propose a correct target for a patient with chronic ankle instability. Purpose: The purpose of this study was to choose COP measurements that correlate with the subjective instability of the foot, and to calculate cut-off values derived from receiver operating characteristic (ROC) analysis to define stability using the correlated measurements. Methods: Participants were 28 high school basketball players (28 males, mean age = 15.5 ± 0.6 years). None of the participants had any severe leg injuries. The primary measure was body sway when standing on one leg without vision, and both legs were evaluated by the resulting trajectory of COP trace (Win-Pod Medicapteurs© ). Participants’ locus length, area and average direction-specific velocities in the anteroposterior and mediolateral directions were measured. The secondary measure was the Karlsson ankle function score. We chose the item that best reflected a sense of instability (I score). First, we used Pearson’s correlation coefficient for statistical analysis to examine the validity. Then, the participants were divided into a stable group with full marks on their I score, and an unstable group without full marks. ROC analysis was used to find the optimal cut-off values for each COP measurement. Results: I score and coefficients of correlation with each COP measurement were as follows: locus length (r = −0.46), area (r = −0.33), average direction-specific velocities in the anteroposterior (r = −0.41) and mediolateral directions (r = −0.34). The correlation results show that these parameters are a valid way of reflecting a conscious sense of non-stability. The cut-off values derived using ROC analysis were as follows. Locus length: 623.4, positive prediction value (PPV) = 0.57, negative prediction value (NPV) = 0.79; area: 1539, PPV = 0.53, NPV = 0.85, average direction-specific velocities in the mediolateral: 42.6, PPV = 0.69, NPV = 0.78, and anteroposterior directions: 44.7, PPV: = 0.59, NPV = 0.79.
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Conclusion(s): For patients with chronic ankle instability, there is a high likelihood that these COP measurements will evaluate a patient’s subjective instability objectively. In particular, the average direction-specific velocity in the mediolateral direction has high positive prediction value and reliability. However, this study is limited by its small number of participants. We will derive a more reliable cut-off value by recruiting more participants in future studies. Implications: One popular static balance measurement is the length of time that a patient can stand on one leg, but some patients can stand on one leg for a long time with a great deal of body sway, so this measurement includes not only ankle stability but also muscle strength and endurance. Thus, our study measurements took place over 10 s to analyze ankle instability correctly. When we investigate COP parameters clinically, the subsequent results will show target values for treating ankle instability. Keywords: Ankle instability; Center of pressure; Cut-off value Funding acknowledgements: This study was no funded. Ethics approval: The Ethics Committee of our hospital approved this study. http://dx.doi.org/10.1016/j.physio.2015.03.1519 Research Report Poster Presentation Number: RR-PO-19-08-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 BUILDING UNDERGRADUATE PHYSIOTHERAPY STUDENTS’ CONFIDENCE, COMMUNICATION AND HANDLING COMPETENCE IN PAEDIATRIC PHYSIOTHERAPY V. Travlos, A.-M. Hill University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia Background: Evidence suggests that physiotherapists’ uptake of paediatric practice may be hampered by a lack of confidence to work with the young child. Black et al. (2010) found that confidence in new-graduate paediatric physiotherapists is directly related to competence in communication skills, an essential component of positive outcomes in paediatric practice. There is a need to understand undergraduate physiotherapy students’ perceptions of their confidence to work with the young child to facilitate both their uptake of and development of competence in paediatric practice. Purpose: This study explored physiotherapy students’ perceptions of factors affecting their confidence in paediatric practice and sought to identify teaching strategies that could increase their confidence. Methods: An action research study involving 57 students and their teacher was conducted over a full teaching semester
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of an undergraduate paediatric physiotherapy unit. Data were collected through focus group interviews, surveys, participant observation and the teacher’s reflective journal. Action cycles implemented a variety of practical teaching strategies. A grounded theory approach was used to analyse qualitative data. Results: Students identified factors they perceived to influence their confidence, as well as strategies that could increase their confidence in paediatric practice. Key areas identified were knowledge and skills in communication and handling as well as challenges in how to apply these skills to practice. Videos of experienced clinicians and guided practice with dolls were teaching strategies suggested by students as helpful, but students reflected that appropriate communication and movement facilitation developed naturally when handling a real child and that this two-way response to movement was difficult to learn from an inanimate doll. Students spontaneously reflected that they needed to invest in face-toface time with young children and their families outside of teaching hours to increase their confidence to communicate with and handle children. Conclusion(s): This study found that communication and handling skills are primary factors affecting undergraduate physiotherapy students’ confidence to work with young children. The use of simulation with dolls together with video of experienced clinicians and time with real children was found to be effective in building confidence. Face-to-face time with children and their parents was perceived as most valuable in building communication and handling skills. Implications: Our study suggests teachers need to assist physiotherapy students to engage in and reflect on their personal interactions with children to build their confidence. Reference: Black, L. L., Jensen, G. M., Mostrom, E., Perkins, J., Ritzline, P. D., Hayward, L., & Blackmer, B. (2010). The first year of practice: an investigation of the professional learning and development of promising novice physical therapists. Physical therapy, 90(12), 1758–1773. doi: 10.2522/ptj.20100078. Keywords: Confidence; Communication; Paediatric physiotherapy undergraduate education Funding acknowledgements: Funded through the University of Notre Dame Australia in partial completion of the first author’s Graduate Certificate in University Education. Ethics approval: Approved by the School of Education Research Committee, University of Notre Dame Australia. http://dx.doi.org/10.1016/j.physio.2015.03.1520
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
of less than 99 points were included in the analysis (17 males, 33 limbs, mean age = 15.5 ± 0.6 years). None of the participants had any severe injury in their legs. Secondly measure, body sway during one-leg standing without vision was evaluated by tracking the trajectory of the COP as measured by a pressure sensitive foot analysis platform (Win-Pod Medicapteurs© ). Based on the results of previous work, we used Pearson’s correlation coefficients to test the relationships between the participants’ individual K score parameter scores and the following parameters of COP: locus length, area, locus length per area and average direction-specific velocities in the anteroposterior and mediolateral directions. Statistic analysis was Pearson’s correlation coefficient. Results: Locus length was negatively correlated with instability (r = −0.56) and moderately positively correlated with K score for stair climbing (r = 0.51) and activities of daily living (r = 0.51). Area (r = −0.43) and velocity in the mediolateral direction (r = −0.45) were moderately negatively correlated with K score values for instability. Conclusion(s): Our results indicate that not all of the K score parameters reflect body sway as measured by COP trace trajectory. Only K score parameters relating to ankle instability are negatively correlated with body sway. Thus, if there is no apparatus available to measure COP on the sports field, evaluation of the K score parameters relating to ankle instability will provide an indication of the athlete’s chronic ankle instability. Although scores for stair climbing and activities of daily living were positively correlated with locus length. It means that if body sway were increased, stair climbing and activities of daily living will be getting better. It is our opinion that these unexpected results are due to other causes without instability and should not be regarded as indicative of ankle instability. Implications: Although the K score is used to evaluate patients after ankle sprain, the underlying causes influencing each individual parameter score may differ. When we treat patients with chronic ankle disability, we should consider the possibility of functional disabilities other than pain or instability. Keywords: Karlsson ankle function score; Center of pressure; Ankle instability Funding acknowledgements: This study was no funded. Ethics approval: The Ethics Committee of our hospital approved this study. http://dx.doi.org/10.1016/j.physio.2015.03.1518
Research Report Poster Presentation Number: RR-PO-21-19-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 WHAT IS A VALID CUT-OFF VALUE FOR EVALUATING ANKLE INSTABILITY FROM CENTER OF PRESSURE MEASUREMENTS? T. Toyooka 1 , S. Sugiura 1,2 , A. Takata 1 , T. Ishizaki 1 , Y. Omori 1 , Y. Takata 1 , S. Nishikawa 1 1 Nishikawa
Orthopedic Clinic, Sakura, Japan; 2 Chiba University, Bioenvironmental Medicine, Chiba City, Japan
Background: It has been reported that center of pressure (COP) measurements, such as locus length and velocity, can be used to objectively assess chronic ankle instability. However, we do not know which parameters best reflect a patient’s complaint, and thus assessing COP does not necessarily allow us to propose a correct target for a patient with chronic ankle instability. Purpose: The purpose of this study was to choose COP measurements that correlate with the subjective instability of the foot, and to calculate cut-off values derived from receiver operating characteristic (ROC) analysis to define stability using the correlated measurements. Methods: Participants were 28 high school basketball players (28 males, mean age = 15.5 ± 0.6 years). None of the participants had any severe leg injuries. The primary measure was body sway when standing on one leg without vision, and both legs were evaluated by the resulting trajectory of COP trace (Win-Pod Medicapteurs© ). Participants’ locus length, area and average direction-specific velocities in the anteroposterior and mediolateral directions were measured. The secondary measure was the Karlsson ankle function score. We chose the item that best reflected a sense of instability (I score). First, we used Pearson’s correlation coefficient for statistical analysis to examine the validity. Then, the participants were divided into a stable group with full marks on their I score, and an unstable group without full marks. ROC analysis was used to find the optimal cut-off values for each COP measurement. Results: I score and coefficients of correlation with each COP measurement were as follows: locus length (r = −0.46), area (r = −0.33), average direction-specific velocities in the anteroposterior (r = −0.41) and mediolateral directions (r = −0.34). The correlation results show that these parameters are a valid way of reflecting a conscious sense of non-stability. The cut-off values derived using ROC analysis were as follows. Locus length: 623.4, positive prediction value (PPV) = 0.57, negative prediction value (NPV) = 0.79; area: 1539, PPV = 0.53, NPV = 0.85, average direction-specific velocities in the mediolateral: 42.6, PPV = 0.69, NPV = 0.78, and anteroposterior directions: 44.7, PPV: = 0.59, NPV = 0.79.
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Conclusion(s): For patients with chronic ankle instability, there is a high likelihood that these COP measurements will evaluate a patient’s subjective instability objectively. In particular, the average direction-specific velocity in the mediolateral direction has high positive prediction value and reliability. However, this study is limited by its small number of participants. We will derive a more reliable cut-off value by recruiting more participants in future studies. Implications: One popular static balance measurement is the length of time that a patient can stand on one leg, but some patients can stand on one leg for a long time with a great deal of body sway, so this measurement includes not only ankle stability but also muscle strength and endurance. Thus, our study measurements took place over 10 s to analyze ankle instability correctly. When we investigate COP parameters clinically, the subsequent results will show target values for treating ankle instability. Keywords: Ankle instability; Center of pressure; Cut-off value Funding acknowledgements: This study was no funded. Ethics approval: The Ethics Committee of our hospital approved this study. http://dx.doi.org/10.1016/j.physio.2015.03.1519 Research Report Poster Presentation Number: RR-PO-19-08-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 BUILDING UNDERGRADUATE PHYSIOTHERAPY STUDENTS’ CONFIDENCE, COMMUNICATION AND HANDLING COMPETENCE IN PAEDIATRIC PHYSIOTHERAPY V. Travlos, A.-M. Hill University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia Background: Evidence suggests that physiotherapists’ uptake of paediatric practice may be hampered by a lack of confidence to work with the young child. Black et al. (2010) found that confidence in new-graduate paediatric physiotherapists is directly related to competence in communication skills, an essential component of positive outcomes in paediatric practice. There is a need to understand undergraduate physiotherapy students’ perceptions of their confidence to work with the young child to facilitate both their uptake of and development of competence in paediatric practice. Purpose: This study explored physiotherapy students’ perceptions of factors affecting their confidence in paediatric practice and sought to identify teaching strategies that could increase their confidence. Methods: An action research study involving 57 students and their teacher was conducted over a full teaching semester
eS1531
of an undergraduate paediatric physiotherapy unit. Data were collected through focus group interviews, surveys, participant observation and the teacher’s reflective journal. Action cycles implemented a variety of practical teaching strategies. A grounded theory approach was used to analyse qualitative data. Results: Students identified factors they perceived to influence their confidence, as well as strategies that could increase their confidence in paediatric practice. Key areas identified were knowledge and skills in communication and handling as well as challenges in how to apply these skills to practice. Videos of experienced clinicians and guided practice with dolls were teaching strategies suggested by students as helpful, but students reflected that appropriate communication and movement facilitation developed naturally when handling a real child and that this two-way response to movement was difficult to learn from an inanimate doll. Students spontaneously reflected that they needed to invest in face-toface time with young children and their families outside of teaching hours to increase their confidence to communicate with and handle children. Conclusion(s): This study found that communication and handling skills are primary factors affecting undergraduate physiotherapy students’ confidence to work with young children. The use of simulation with dolls together with video of experienced clinicians and time with real children was found to be effective in building confidence. Face-to-face time with children and their parents was perceived as most valuable in building communication and handling skills. Implications: Our study suggests teachers need to assist physiotherapy students to engage in and reflect on their personal interactions with children to build their confidence. Reference: Black, L. L., Jensen, G. M., Mostrom, E., Perkins, J., Ritzline, P. D., Hayward, L., & Blackmer, B. (2010). The first year of practice: an investigation of the professional learning and development of promising novice physical therapists. Physical therapy, 90(12), 1758–1773. doi: 10.2522/ptj.20100078. Keywords: Confidence; Communication; Paediatric physiotherapy undergraduate education Funding acknowledgements: Funded through the University of Notre Dame Australia in partial completion of the first author’s Graduate Certificate in University Education. Ethics approval: Approved by the School of Education Research Committee, University of Notre Dame Australia. http://dx.doi.org/10.1016/j.physio.2015.03.1520