Attitudes toward standardized data collection.Physical therapists, along with other health care professionals, have become increasingly involved in determining whether the treatments they provide are effective. The drive to collect evidence is, in part, a response to the current health care climate, which Relman calls the "Era of Assessment and Accountability The traceability of actions performed on a system to a specific system entity (user, process, device). For example, the use of unique user identification and authentication supports accountability; the use of shared user IDs and passwords destroys accountability. ."[1] Relman describes the present era as a natural evolution: The Era of Expansion, between World War II and the 1960s saw an explosion of new technologies; the Era of Cost Containment cost containment, n the features of a dental benefits program or of the administration of the program designed to reduce or eliminate certain charges to the plan. , from the 1960s until recently, was a reaction against costs that had also grown explosively ex·plo·sive adj. 1. Relating to or having the nature of an explosion. 2. Tending to explode. n. 1. A substance, especially a prepared chemical, that explodes or causes explosion. 2. . But cost containment, indiscriminately applied, can compromise quality of care. Consequently, attention has turned toward ensuring that health care dollars are being spent appropriately. Over the years, health care has been assessed in many ways. Donabedian[2] distinguishes between assessments of structure, process, and outcome. Regulation of the quality of health care through structure includes accreditation accreditation, n a process of formal recognition of a school or institution attesting to the required ability and performance in an area of education, training, or practice. of education and rehabilitation programs Noun 1. rehabilitation program - a program for restoring someone to good health program, programme - a system of projects or services intended to meet a public need; "he proposed an elaborate program of public works"; "working mothers rely on the day care and licensure licensure (lī´s  nsh of practitioners, ensuring a structure with adequate resources
to provide appropriate care. Regulation through process is typically
through chart review of items documented, or verification See verify. verification - The process of determining whether or not the products of a given phase in the life-cycle fulfil a set of established requirements. that the proper procedures were followed. Donabedian suggests that judging health care by its effectiveness, or outcome, is more appropriate than judging it by structure or process. Indeed, neither structure nor process ensures a good outcome.[2,3] Outcomes research, assessing the benefit of therapeutic intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. , is therefore essential for health care practitioners to be accountable for the expense of their care. Increased attention has been directed toward outcomes studies using databases of clinical information gathered during routine medical care.[4,5] Physical therapists collect outcome data regularly, during normal evaluations and reevaluations of their patients. These data, however, are typically dispersed dis·perse v. dis·persed, dis·pers·ing, dis·pers·es v.tr. 1. a. To drive off or scatter in different directions: The police dispersed the crowd. b. throughout millions of handwritten notes Handwritten Notes was the first release on Reed's own label. Track listing (All songs by Preston Reed)?
1. the ability of an intervention to produce the desired beneficial effect in expert hands and under ideal circumstances. 2. , or the improvement noted under ideal, controlled conditions. Clinical trials and controlled experimental research provide information about efficacy; effectiveness is typically a fraction of this ideal benefit, the fraction attainable at·tain v. at·tained, at·tain·ing, at·tains v.tr. 1. To gain as an objective; achieve: attain a diploma by hard work. 2. under realistic clinical conditions. Although clinical trials have long been the "gold standard" for scientific study, outcomes databases are becoming increasingly important. Clinical trials can be very expensive and typically provide information within a very narrow scope.[4,7] Once established, outcomes databases can be less expensive and can provide a broad spectrum of data. Use of this wealth of information is a logical step toward validating val·i·date tr.v. val·i·dat·ed, val·i·dat·ing, val·i·dates 1. To declare or make legally valid. 2. To mark with an indication of official sanction. 3. quality of care and increasing accountability. Outcomes databases can provide many types of information. Therapists and third-party payers can use diagnostic outcome data, the kind of data collected at initial evaluation, to predict which patients will benefit from physical therapy. Therapeutic outcome data, on the other hand, such as those collected in discharge To liberate or free; to terminate or extinguish. A discharge is the act or instrument by which a contract or agreement is ended. A mortgage is discharged if it has been carried out to the full extent originally contemplated or terminated prior to total execution. evaluations, track the response to care.[8] Functional-level and quality-of-life measures are particularly important outcome measures,[9] and clinical databases that collect information about both impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. and disability have the capacity to validate To prove something to be sound or logical. Also to certify conformance to a standard. Contrast with "verify," which means to prove something to be correct. For example, data entry validity checking determines whether the data make sense (numbers fall within a range, numeric data the presumed relationship between these different measures.[10] Furthermore, knowledge about the typical progress for patients with specific injuries and complications would allow therapists and insurance companies to predict, more accurately, the cost of rehabilitation rehabilitation: see physical therapy. . Basing insurance benefits on the typical patterns of recovery allows for efficient use of health care dollars without arbitrarily limiting coverage, independent of the patient's condition. Patient satisfaction, another outcome that is becoming increasingly important, may or may not be related to treatment outcome. Donabedian[6] suggests that the patient-practitioner relationship, accessibility, amenities, and patient preferences all contribute to satisfaction. A clinical database combined with patient satisfaction outcomes could enable researchers to study the relationship between patients' perceived per·ceive tr.v. per·ceived, per·ceiv·ing, per·ceives 1. To become aware of directly through any of the senses, especially sight or hearing. 2. To achieve understanding of; apprehend. needs and outcome goals set by therapists. Ongoing clinical outcome data collection also allows health care providers to monitor changes in quality (measured through outcome) due to changes in procedure or in use of limited resources (ie, staff, facilities, and supplies). In particular, outcome databases can be used to monitor consequences of cost-containment measures.[9,11] For example, increased productivity requirements of staff may be counterproductive coun·ter·pro·duc·tive adj. Tending to hinder rather than serve one's purpose: "Violation of the court order would be counterproductive" Philip H. Lee. if patients require more treatments while clinics are reimbursed per patient rather than per visit, as with some capitated insurance plans. Similarly, increased reliance on physical therapist assistants and athletic trainers An athletic trainer is an allied (non-physician) health care provider capable of performing immediate and emergency injury management, injury assessment, and rehabilitation. may save money, but only if patient outcome is not compromised.[12] The cost of expensive equipment also must be weighed against the benefit it provides. The need to determine the benefit of physical therapy has resulted in an increased interest in outcomes assessment research. In the journal Physical Therapy alone, the number of reports identifying "outcome and process assessment" as a key word increased from 7 articles between 1981 and 1991 to 26 articles between 1992 and 1994. Even so, most of these reports have been of controlled clinical trials controlled clinical trial, n a research strategy that calls for two samples: an experimental sample of patients receiving a pharmaceutical, and a second sample of control patients receiving a placebo. , using some measure of impairment as an outcome measure. Kane Kane can refer to: In sports:
Shields et al[14] have provided the only published report of an effort to initiate INITIATE. A right which is incomplete. By the birth of a child, the husband becomes tenant by the curtesy initiate, but his estate is not consummate until the death of the wife. 2 Bouv. Inst. n. 1725. computerized computerized adapted for analysis, storage and retrieval on a computer. computerized axial tomography see computed tomography. physical therapy outcome data collection. That project was aimed at standardizing some of the data collected during routine evaluation and care in an acute care setting. A major part of standardization standardization In industry, the development and application of standards that make it possible to manufacture a large volume of interchangeable parts. Standardization may focus on engineering standards, such as properties of materials, fits and tolerances, and drafting was development of operational definitions of how measurements were to be done. The authors discussed the importance of therapist support and adherence adherence /ad·her·ence/ (ad-her´ens) the act or condition of sticking to something. immune adherence in developing and using such a standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. data collection system. They used a committee of physical therapists, representing each specialty A contract under seal. A specialty is a written document that has been sealed and delivered and is given as security for the payment of a specifically indicated debt. in their hospital, to develop operational definitions and to generate support among fellow therapists for standardized data collection. Farer[15] stated that lack of staff adherence is the most common reason for failure of an outcome database. Although clinical databases may exist, there are no reports of clinical physical therapy database development or use outside a hospital environment. Because outpatient outpatient /out·pa·tient/ (-pa-shent) a patient who comes to the hospital, clinic, or dispensary for diagnosis and/or treatment but does not occupy a bed. out·pa·tient n. clinics provide a large portion of physical therapy services, insurance and managed care providers are likely to demand outcome data from outpatient settings as well.[16] A single physical therapy clinic is unlikely to collect enough data to generate a statistically meaningful database. Consequently, multisite databases need to be developed. Collecting data in a multisite environment generates complications that Shields et al[14] did not face, because that project had mandatory Peremptory; obligatory; required; that which must be subscribed to or obeyed. Mandatory statutes are those that require, as opposed to permit, a particular course of action. participation of all therapists and the researchers were not able to routinely monitor the quality of data collection. A large, widely distributed Adj. 1. widely distributed - growing or occurring in many parts of the world; "a cosmopolitan herb"; "cosmopolitan in distribution" cosmopolitan bionomics, environmental science, ecology - the branch of biology concerned with the relations between organisms aggregate of clinics, however, cannot involve all therapists in the development of data collection procedures, as did Shields et al. Furthermore, adherence to standardized methods cannot be easily monitored. Yet, conclusions based on "outcome" may be spurious spu·ri·ous adj. Similar in appearance or symptoms but unrelated in morphology or pathology; false. spurious simulated; not genuine; false. if different therapists or clinics measure these outcomes differently.[17] For example, determination of whether a patient has the range of motion necessary to perform a given functional activity would depend on how that range of motion was measured and how the functionally needed range of motion was determined. Despite the large number of therapists in the company participating in our study and despite the large volume of patients who could have been included in a voluntary standardized data collection project, voluntary clinician clinician /cli·ni·cian/ (kli-nish´in) an expert clinical physician and teacher. cli·ni·cian n. participation in the standardized data collection project was low. Standardized forms had been used in approximately ap·prox·i·mate adj. 1. Almost exact or correct: the approximate time of the accident. 2. 2% of the eligible evaluations (new patients with knee, ankle ankle /an·kle/ (ang´k'l) 1. the joint between the leg and foot. 2. the region of this joint. 3. tarsus. an·kle n. 1. and foot, shoulder, and elbow Elbow ignorant, blundering constable. [Br. Lit.: Measure for Measure] See : Stupidity injuries) done in the previous year. Data collection had been completed for about 1% of eligible patients. To improve participation in standardized data collection, we believe that facility administrators need to identify and address attitudes that compromise participation. Attitudes tend to be complex and not easily measured by responses to a single question. In our study, factor analysis allowed therapist responses to a multitude MULTITUDE. The meaning of this word is not very certain. By some it is said that to make a multitude there must be ten persons at least, while others contend that the law has not fixed any number. Co. Litt. 257. of questions to be grouped into a few content areas. These content areas were anticipated to be therapist perceptions about the standardized data collection project. The purposes of our study were (1) to determine whether clinicians made efforts to learn standardized measurement methods, (2) to identify groups of statements about standardized data collection that constitute attitude "factors," and (3) to explore the relationships between these attitudes, characteristics of therapists and clinics, and participation in standardized data collection. Method Background The study was conducted in a corporation that was in the process of establishing a clinical outcomes database, with the goal of achieving 100% therapist and patient participation. The data were collected on paper forms, and therapist participation in data collection was voluntary. The forms allowed for collection of patient histories, demographic See demographics. information, clinical (impairment) measurements, and functional (disability) measurements. Standardized evaluation forms, constructed for an orthopedic orthopedic /or·tho·pe·dic/ (-pe´dik) pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopedics. patient population, were provided to all clinics, along with written and videotaped presentations of operational definitions as to how measurements were to be done. Participation in data collection implied Inferred from circumstances; known indirectly. In its legal application, the term implied is used in contrast with express, where the intention regarding the subject matter is explicitly and directly indicated. that the therapist agreed to learn and use the operational definitions, collect patient data at initial evaluation and all subsequent reevaluations onto standardized "data collection tool" (DCT (Discrete Cosine Transform) An algorithm that is widely used for data compression. Similar to Fast Fourier Transform, DCT converts data (pixels, waveforms, etc.) into sets of frequencies. The first frequencies in the set are the most meaningful; the latter, the least. ) forms, record treatment provided at each visit on a "daily treatment" form, record discharge status on a "discharge status" form, and send the completed data set to a central site where the information could be entered into a computer for inclusion in the database. Therapists were not required or requested to complete all of the measurements included on the DCT, but simply to record onto the DCT those measurements that the evaluating therapist felt were appropriate. All therapists were required to attend one in-service in-service In-service training adjective Referring to any form of on-the-job training noun In-service training of an employee , provided by the central administration, on the goals and administrative procedures for the outcomes data collection project. Each clinic received copies of the written and videotaped presentations of operational definitions and copies of the DCTs for each body segment. Videotapes for each of the joints were 15 to 20 minutes in length, and each written operational definition would take 10 to 20 minutes to read. At the time of this study, DCTs and operational definitions were available for evaluation of the knee, foot and ankle, shoulder, and elbow. Study Population The study population consisted of 220 clinicians employed in 71 clinics of one multisite corporation providing physical therapy and occupational therapy. All clinics included in the study had been oriented o·ri·ent n. 1. Orient The countries of Asia, especially of eastern Asia. 2. a. The luster characteristic of a pearl of high quality. b. A pearl having exceptional luster. 3. in the patient data collection process. Questionnaires were distributed to clinic directors, who were asked to have all therapists in their clinic complete the questionnaire questionnaire, n a series of questions used to gather information. questionnaire, n a form usually filled out by patients that provides data concerning their dental and general health. . Some clinic directors may have distributed questionnaires to only full-time full-time adj. Employed for or involving a standard number of hours of working time: a full-time administrative assistant. full physical therapists, whereas other clinic directors may have distributed the questionnaire to any person involved in data collection, including part-time part-time adj. For or during less than the customary or standard time: a part-time job. part physical therapists, occupational therapists occupational therapist A person trained to help people manage daily activities of living–dressing, cooking, etc, and other activities that promote recovery and regaining vocational skills Salary $51K + 4% bonus. See ADL. , physical therapist assistants, or athletic trainers. Responses were received from 102 individuals, generating a 46% response rate. Characteristics of the total population and of the respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. are reported in Table 1. Table 1 shows that the sample of respondents reflected the population as a whole, except that respondents were more likely to be physical therapists, to be employed full time, and to have completed data collection on at least one patient. Table 1. Characteristics of Population Surveyed and of Respondents Completing the Questionnaire as Number of Individuals and Percentage of Total(a)
Total Population Respondents
N % N %
Total 220 100 102 100
Occupation
Physical therapist 156 71 90 88
Occupational therapist 14 6 4 4
Physical therapist assistant 22 10 0 0
Athletic trainer 20 9 3 3
Other 8 4 3 3
No response 2 2
Employment status
Full time 161 73 81 79
Part time 59 27 17 17
No response 4 4
Gender
Female 139 63 64 63
Male 81 37 35 34
No response 3 3
Age (y)
21-30 81 37 31 30
31-40 99 45 49 48
41+ 40 18 17 17
No response 5 5
No. of years of experience
1-5 (*) 23 23
6-10 (*) 32 31
11+ (*) 41 40
No response 6 6
Highest degree
BA, Associate (*) 64 63
Entry-level MS (*) 17 17
MS/POD (*) 19 19
No response 2 1
Participation in data collection
No completed DCT sent in 158 72 47 46
1 or more DCTs sent in 62 28 51 50
No response 4 4
Respondents as Percentage
of Relative Population
Total 46
Occupation
Physical therapist 58
Occupational therapist 29
Physical therapist assistant 0
Athletic trainer 15
Other 38
No response
Employment status
Full time 50
Part time 29
No response
Gender
Female 46
Male 43
No response
Age (y)
21-30 38
31-40 49
41+ 43
No response
No. of years of experience
1-5
6-10
11+
No response
Highest degree
BA, Associate
Entry-level MS
MS/POD
No response
Participation in data collection
No completed DCT sent in 30
1 or more DCTs sent in 82
No response
(a) DCT=data collection tool (standardized form), BA=Bachelor BACHELOR. The first degree taken at the universities in the arts and sciences, as bachelor of arts, & c. It is called, in Latin, Baccalaureus, from bacalus, or bacillus, a staff, because a staff was given, by way of distinction, into the hands of those who had completed their studies. of Arts, MS=Mastet of Science, PhD=Doctor of Philosophy. Asterisk (1) See Asterisk PBX. (2) In programming, the asterisk or "star" symbol (*) means multiplication. For example, 10 * 7 means 10 multiplied by 7. The * is also a key on computer keypads for entering expressions using multiplication. (*) indicates information not available for whole population. Most respondents (76%) characterized char·ac·ter·ize tr.v. character·ized, character·iz·ing, character·iz·es 1. To describe the qualities or peculiarities of: characterized the warden as ruthless. 2. their primary patient population as patients with general orthopedic or sports injuries Sports Injuries Definition Sports injuries result from acute trauma or repetitive stress associated with athletic activities. Sports injuries can affect bones or soft tissue (ligaments, muscles, tendons). , the patient population for whom the DCT and operational definitions were primarily intended. Other respondents described their primary patient population as follows: 4% as patients with chronic pain, 4% as geriatric geriatric /ger·i·at·ric/ (jer?e-at´rik) 1. pertaining to elderly persons or to the aging process. 2. pertaining to geriatrics. ger·i·at·ric adj. 1. clients, 3% as patients participating in work hardening work hardening n. The increase in strength that accompanies plastic deformation of a metal. programs, and 1% as patients with neurologic neurologic /neu·ro·log·ic/ (-loj´ik) pertaining to neurology or to the nervous system. Neurologic Having to do with the nervous system. disorders A
Questionnaire Information about attitudes toward standardized data collection, as well as clinic and personal demographic information, was gathered through a 67-item questionnaire. Thirty-four items were rated on a five-point Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc , 10 items were rated on a three-point Likert scale, 9 were numerical-entry items, and 14 were circle-the-best-answer items. One question was exclusively narrative. Although space for narrative comments was included for several other questions, narrative responses were not used in the data analysis. Questions used for factor analysis were rated on a five-point Likert-type scale ranging from 1 (strongly agree) to 5 (strongly disagree). Responses were anonymous Nameless. See anonymous post and anonymous Web surfing. . A single follow-up follow-up, n the process of monitoring the progress of a patient after a period of active treatment. follow-up subsequent. follow-up plan reminder was issued approximately 1 month after the questionnaires were distributed. Data Analysis Clinician characteristics and effort to study the operational definitions were described as frequency of response. The relationship between studying the operational definitions and having research as a professional goal was tested through a chi-square test chi-square test: see statistics. . To determine whether having research as a professional goal was associated with higher levels of data collection, an analysis of variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality (ANOVA anova see analysis of variance. ANOVA Analysis of variance, see there ) was followed by Tukey's conservative Honestly Significant Difference (HSD HSD Human Services Department HSD High Speed Data HSD Hillsboro School District (Hillsboro, OR) HSD Hybrid Synergy Drive (Toyota/Lexus) HSD High School Diploma HSD Historical Society of Delaware ) procedure.[18] Agreement with the 33 Likert-type statements was factored with principal-axis factor analysis (PAF PAF platelet activating factor. PAF abbr. platelet-aggregating factor PAF platelet activating factor. ), followed by rotation Rotation An active asset management strategy that tactically overweighted and underweighted certain sectors, depending on expected performance. Sometimes called sector rotation. to simple structure.[19] For the purposes of factor analysis, missing values In statistics, missing values are a common occurrence. Several statistical methods have been developed to deal with this problem. Missing values mean that no data value is stored for the variable in the current observation. were replaced by the item mean values in under 10% of cases prior to initial factor extraction extraction /ex·trac·tion/ (eks-trak´shun) 1. the process or act of pulling or drawing out. 2. the preparation of an extract. . Based on a variety of indicators, including magnitude magnitude, in astronomy, measure of the brightness of a star or other celestial object. The stars cataloged by Ptolemy (2d cent. A.D.), all visible with the unaided eye, were ranked on a brightness scale such that the brightest stars were of 1st magnitude and the of PAF eigenvalues eigenvalues statistical term meaning latent root. , magnitude of factor loadings, and total variance explained, the five-factor solution emerged as the cleanest, most interpretable in·ter·pret v. in·ter·pret·ed, in·ter·pret·ing, in·ter·prets v.tr. 1. To explain the meaning of: interpreted the ambassador's remarks. See Synonyms at explain. final factor solution for both rotation strategies. Only statements loading above .45 were included in a factor.[19] To simplify interpretation of the factors, statements with negative loading values were rephrased as negative statements (these statements have been noted in Tab. 2); mathematical analysis Analysis has its beginnings in the rigorous formulation of calculus. It is the branch of mathematics most explicitly concerned with the notion of a limit, whether the limit of a sequence or the limit of a function. was unaffected. Table 2. Factors Identified For Clinician Attitudes Toward Standardized Data Collection (N= 102)(a)
Factor(b)
1
Factor 1 inconvenience of DCTs
I do not have time to document using the DCTs. .81
I do not have time to do DCT measurements. .79
I do not have time to complete the paperwork. .62
I do not use the DCT information to write my
evaluations/reevaluations. .61
Too many measurements are required. .56
I do not find the DCT forms convenient to use.(*) .54
Factor 2: acceptance of operational definitions(c)
The operational definitions are appropriate
for my patient population. -.05
I originally learned and am accustomed to
doing, measurements as specified in the
operational definitions. -.17
The DCTs are appropriate for the patient
population I treat. -.06
I feel comfortable with my understanding
and manual skills in
conducting tests according to the operational
definitions. .02
Research is an important part of my
profession. -.20
Factor 3: automation
DCTs would be easier if I entered information
directly into a computer. -.03
If processing were computerized and automated,
I would do more. -.10
Automatically generated evaluations/
reevaluations would be
helpful. -.12
Factor 4: daily treatment paperwork
I do not have time to fill out treatment form. .20
Inconvenience in getting paperwork together
prevents me from
filling out treatment forms. .34
I do not remember to fill out the
treatment form. -.05
My evaluations/reevaluations are not
better, using the DCT and operational
definitions.(*) .27
Factor 5: training
I understand treatment categories.(*) -.04
I have had adequate training in how
to use the DCTs.-.13.30.12-.14.58
Categories include protocols I use.(*) .05
Treatment categories are meaningful to
my patient population.(*) -.19
I have convenient access to DCT forms. -.10
Eigenvalue 5.19
Percentage of variance explained 15.7
Factor(b)
2
Factor 1 inconvenience of DCTs
I do not have time to document using the DCTs. .05
I do not have time to do DCT measurements. -.11
I do not have time to complete the paperwork. .08
I do not use the DCT information to write my
evaluations/reevaluations. -.24
Too many measurements are required. -.09
I do not find the DCT forms convenient to use.(*) -.14
Factor 2: acceptance of operational definitions(c)
The operational definitions are appropriate
for my patient population. .77
I originally learned and am accustomed to
doing, measurements as specified in the
operational definitions. .71
The DCTs are appropriate for the patient
population I treat. .69
I feel comfortable with my understanding
and manual skills in
conducting tests according to the operational
definitions. .69
Research is an important part of my
profession. .46
Factor 3: automation
DCTs would be easier if I entered information
directly into a computer. .09
If processing were computerized and automated,
I would do more. .02
Automatically generated evaluations/
reevaluations would be
helpful. .07
Factor 4: daily treatment paperwork
I do not have time to fill out treatment form. .04
Inconvenience in getting paperwork together
prevents me from
filling out treatment forms. .08
I do not remember to fill out the
treatment form. -.01
My evaluations/reevaluations are not
better, using the DCT and operational
definitions.(*) .10
Factor 5: training
I understand treatment categories.(*) .15
I have had adequate training in how
to use the DCTs. .30
Categories include protocols I use.(*) -.06
Treatment categories are meaningful to
my patient population.(*) .03
I have convenient access to DCT forms. .11
Eigenvalue 3.03
Percentage of variance explained 9.2
Factor(b)
3
Factor 1 inconvenience of DCTs
I do not have time to document using the DCTs. .08
I do not have time to do DCT measurements. -.20
I do not have time to complete the paperwork. .19
I do not use the DCT information to write my
evaluations/reevaluations. -.01
Too many measurements are required. -.08
I do not find the DCT forms convenient to use.(*) -.09
Factor 2: acceptance of operational definitions(c)
The operational definitions are appropriate
for my patient population. -.00
I originally learned and am accustomed to
doing, measurements as specified in the
operational definitions. .00
The DCTs are appropriate for the patient
population I treat. -.10
I feel comfortable with my understanding
and manual skills in
conducting tests according to the operational
definitions.
Research is an important part of my .20
profession. -.05
Factor 3: automation
DCTs would be easier if I entered information
directly into a computer. .83
If processing were computerized and automated,
I would do more. .76
Automatically generated evaluations/
reevaluations would be
helpful. .71
Factor 4: daily treatment paperwork
I do not have time to fill out treatment form. .14
Inconvenience in getting paperwork together
prevents me from
filling out treatment forms. .17
I do not remember to fill out the
treatment form. .13
My evaluations/reevaluations are not
better, using the DCT and operational
definitions.(*) -.18
Factor 5: training
I understand treatment categories.(*) -.11
I have had adequate training in how
to use the DCTs. .12
Categories include protocols I use.(*) .03
Treatment categories are meaningful to
my patient population.(*) -.29
I have convenient access to DCT forms. .21
Eigenvalue 2.31
Percentage of variance explained 7.0
Factor(b)
4
Factor 1 inconvenience of DCTs
I do not have time to document using the DCTs. .14
I do not have time to do DCT measurements. -.01
I do not have time to complete the paperwork. .24
I do not use the DCT information to write my
evaluations/reevaluations. -.17
Too many measurements are required. .22
I do not find the DCT forms convenient to use.(*) .35
Factor 2: acceptance of operational definitions(c)
The operational definitions are appropriate
for my patient population. .01
I originally learned and am accustomed to
doing, measurements as specified in the
operational definitions. -.08
The DCTs are appropriate for the patient
population I treat. .20
I feel comfortable with my understanding
and manual skills in
conducting tests according to the operational
definitions.
Research is an important part of my
profession. .09
Factor 3: automation
DCTs would be easier if I entered information
directly into a computer. .09
If processing were computerized and automated,
I would do more. .16
Automatically generated evaluations/
reevaluations would be
helpful.
Factor 4: daily treatment paperwork
I do not have time to fill out treatment form. .59
Inconvenience in getting paperwork together
prevents me from
filling out treatment forms. .52
I do not remember to fill out the
treatment form. .51
My evaluations/reevaluations are not
better, using the DCT and operational
definitions.(*) .46
Factor 5: training
I understand treatment categories.(*) .05
I have had adequate training in how
to use the DCTs.
Categories include protocols I use.(*) -.14
Treatment categories are meaningful to
my patient population.(*) .45
I have convenient access to DCT forms. -.21
Eigenvalue 1.62
Percentage of variance explained 4.9
Factor(b)
5
Factor 1 inconvenience of DCTs
I do not have time to document using the DCTs. .06
I do not have time to do DCT measurements. -.11
I do not have time to complete the paperwork. .06
I do not use the DCT information to write my
evaluations/reevaluations. -.33
Too many measurements are required. -.02
I do not find the DCT forms convenient to use.(*) -.10
Factor 2: acceptance of operational definitions(c)
The operational definitions are appropriate
for my patient population. .11
I originally learned and am accustomed to
doing, measurements as specified in the
operational definitions. -.05
The DCTs are appropriate for the patient
population I treat. .21
I feel comfortable with my understanding
and manual skills in
conducting tests according to the operational
definitions.
Research is an important part of my
profession. .03
Factor 3: automation
DCTs would be easier if I entered information
directly into a computer. -.11
If processing were computerized and automated,
I would do more. .08
Automatically generated evaluations/
reevaluations would be
helpful.
Factor 4: daily treatment paperwork
I do not have time to fill out treatment form. -.04
Inconvenience in getting paperwork together
prevents me from
filling out treatment forms. -.05
I do not remember to fill out the
treatment form. .08
My evaluations/reevaluations are not
better, using the DCT and operational
definitions.(*) .01
Factor 5: training
I understand treatment categories.(*) .70
I have had adequate training in how
to use the DCTs.
Categories include protocols I use.(*) .58
Treatment categories are meaningful to
my patient population.(*) .48
I have convenient access to DCT forms. .47
Eigenvalue 1.28
Percentage of variance explained 3.9
(a) Statements with loading on each factor shown in boxes, listed in order of descending descending /des·cend·ing/ (de-send´ing) extending inferiorly. contribution to their primary factor. DCT=data collection tool (standardized evaluation form). Statements marked with asterisk (*) have been rephrased as the negative of the original statement to give all primary factor loadings positive values. (b) these factor numbers refer to the factors identified and given construct names in the body of the table. (c) Operational definitions of how measurements are to be done. Factor scores were subsequently computed for each respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. and reported as standardized z scores, with a mean of zero and a standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. of one. These factor scores were then subjected to further analysis with respect to the independent variables, through an ANOVA or Pearson product-moment correlation coefficients Noun 1. Pearson product-moment correlation coefficient - the most commonly used method of computing a correlation coefficient between variables that are linearly related product-moment correlation coefficient , using factor scores as dependent variables. Significant ANOVA effects were further pursued in follow-up using Tukey's HSD procedure[18] Pearson Pear·son , Lester Bowles 1897-1972. Canadian politician who served as prime minister (1963-1968). He won the 1957 Nobel Peace Prize for his role in the negotiation of a solution to the Suez crisis (1956). correlation coefficients Correlation Coefficient A measure that determines the degree to which two variable's movements are associated. The correlation coefficient is calculated as: were tested for significant difference from zero. Because some apparently continuous data were severely skewed skewed curve of a usually unimodal distribution with one tail drawn out more than the other and the median will lie above or below the mean. skewed Epidemiology adjective Referring to an asymmetrical distribution of a population or of data and contained large gaps between adjacent values, we believe that valid statistical analysis could be done only if the data were transformed into discrete categories In mathematics, especially category theory, a discrete category is a category whose only morphisms are the identity morphisms. It is the simplest kind of category. Specifically a category C is discrete if
see statistics. were done using Lotus lotus: see water lily. lotus Any of several different plants whose flowers have been given symbolic meaning by many cultures. The lotus of the Greeks is Ziziphus lotus (family Rhamnaceae), a shrub native to southern Europe; wine made from its fruit ,[R](*) and all other statistical computations were done using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. [R].[dagger] Results Characteristics Related to Participation Level The Figure shows how many of the four written operational definitions and the four videotaped operational definitions of standardized measurement methods that the respondents reported studying thoroughly. Thirty-six percent of the respondents reported studying none of the standardized methods more than briefly. A total of 66% of the respondents reported thoroughly studying at least one set of operational definitions. Interest in research as a professional goal was unrelated to study of the operational definitions (P=.572 for written operational definitions, P=.970 for videotapes). [Figure ILLUSTRATION OMITTED] Of the 61 individuals who reported having completed at least one evaluation using the standardized DCT forms, 11% reported not having studied any of the operational definitions thoroughly and 2% (one individual) had not studied any of the operational definitions, even briefly. Less than 8% of the respondents reported having clinic in-services to thoroughly review or practice the operational definitions. Fourteen percent of the respondents reported having in-services that briefly reviewed the material, and 73% of the respondents reported no in-services on operational definitions. Sixty percent of the respondents reported having collected evaluation data, using the DCT, on at least one patient. Although 55% of the respondents reported having completed data collection, using the DCT, on at least one patient, only 50% of the respondents reported submitting at least one completed data set (including daily treatment and discharge status forms). The greatest number of completed data sets submitted by any individual therapist was 37. As shown in Table 3, respondents who identified research as a professional goal submitted more data sets than did respondents for whom research was not a goal, an average of 4.9 and 1.9 data sets, respectively (F=4.61, df=88, P=.035). There was no relationship between the number of data sets completed and age, gender, or years of experience. Table 3. Relationship Between Having Research as a Professional Goal and Reported Number of Completed Data Sets Submitted to the Central Data-Entry Site Research as Professional Goal Number of DCT(a) Sent Group N X SD Yes 53 4.87 8.06 No 36 1.86 2.85 Total 89 3.65 6.62 (a) DCT=data collection tool (standardized form). Characteristics of the clinic were also analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. relative to participation level. Of the respondents completing more than six data sets, 72% reported that their clinic had designated an individual to be responsible for collating and mailing the completed data sets. Thirty-nine percent of the respondents who completed one to five data sets and only 18% of the respondents who completed no data sets reported that their clinic had an individual responsible for these tasks. Clinicians rated how busy they perceived their clinic to be; reported business was not related to the number of data sets completed (F=0.786, df=96, P=.537). The reported number of patients seen per day was greatest among those therapists who completed the most data sets (Tab. 4), but overall there was no correlation correlation In statistics, the degree of association between two random variables. The correlation between the graphs of two data sets is the degree to which they resemble each other. between the number of patients seen per day and the number of data sets completed (n= 101, r =.090, P=.382). The reported number of new patient evaluations done per week was not correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. to the number of data sets completed (n=98, r=.094, P=.357). Table 4. Clinician-Reported Patient Treatment and New Evaluation rate: Total for All Respondents and Relative to Number of Data Sets Completed and Submitted(a)
Total (N= 102) 0 (N=51)
X SD X SD
How many patients per day? 12.2 4.5 12.2 4.8
How many evaluations per week? 6.4 3.6 6.9 4.2
1-5 (N=33) 6+ (N=18)
X SD X SD
How many patients per day? 1.9 3.9 13.1 4.4
How many evaluations per week? 5.5 2.8 6.9 2.6
(a) No significant relationship between patients per day or evaluations per week and data sets submitted (P<.05). Identifying Attitudes Toward Standardized Data Collection Factor analysis of the 33 Likert-type statements revealed that there were six factors with eigenvalues above 1. One of the six factors, however, consisted of only 2 statements and was thus poorly defined. Consequently, a five-factor solution was chosen as more meaningful.[19] These five factors included 21 of the 33 statements and accounted for 42.5% of the total variability for the 33 relevant questions. No statements loaded above .45 on more than one factor. Thus, no variable contributed in a meaningful way to more than one factor, which was further evidence that no factors were correlated. The statements, with their loading on each factor, are shown in Table 2. Ten statements did not load on any of these five factors; these statements are listed in Table 5. Table 5. Statements That Did Not Load (>.45) on Any Factor(a) Statements Unrelated to Any Factor The evaluating therapist is the primary treating therapist. The average clinic day is extremely busy. Patient care may need to accommodate research. Reimbursement will eventually require outcomes data. Using DCTs has become easier over time. Important tests are missing and should be added. I forget to use DCTs. Using the DCTs has made evaluations/reevaluations easier. I agree with how measurements are to be done. I find the operational definitions convenient. (a) DCT = data collection tool (standardized evalation form). The first factor included statements revolving around issues of convenience: not having time to document evaluation or reevaluation Noun 1. reevaluation - the evaluation of something a second time (or more) rating, valuation, evaluation - an appraisal of the value of something; "he set a high valuation on friendship" measurements using the standardized forms. Therapists reported not using the data collected to write evaluation reports and finding the forms inconvenient in·con·ven·ient adj. Not convenient, especially: a. Not accessible; hard to reach. b. Not suited to one's comfort, purpose, or needs: inconvenient to have no phone in the kitchen. . This factor was named "inconvenience of DCTs," because these issues hinge on Verb 1. hinge on - be contingent on; "The outcomes rides on the results of the election"; "Your grade will depends on your homework" depend on, depend upon, devolve on, hinge upon, turn on, ride the time demands or inconvenience of using the DCT forms. Note that although factor analysis identifies relationships among statements, it does not indicate whether the factor was positive or negative. That is, factor 1 could be called "inconvenience" or "convenience." The second factor included statements relating to relating to relate prep → concernant relating to relate prep → bezüglich +gen, mit Bezug auf +acc whether the operational definitions and DCTs were appropriate for the patient population and whether the therapist was comfortable with the operational definitions. This factor also included a statement relating to whether the therapist felt research is an important part of the profession. This factor was identified as "acceptance of operational definitions," because the statements addressed issues relating to appropriateness and therapist comfort with the technical aspects of the standardized measurement procedures. The third factor consisted of three statements relating to use of a computer, automation of data collection, and report generation; hence, it was identified as "automation." The fourth factor included statements relating to completion of the daily treatment forms: relevance of the treatment categories to the patient population, time, and remembering to complete the treatment forms. Despite some similarity Similarity is some degree of symmetry in either analogy and resemblance between two or more concepts or objects. The notion of similarity rests either on exact or approximate repetitions of patterns in the compared items. of the factor 4 statements to those of factor 1, "inconvenience of DCTs," these factors were not correlated. This lack of correlation indicates that attitudes toward using DCTs for evaluations and reevaluations were distinct from attitudes toward the daily treatment forms completed for each visit. Factor 4 was identified as "daily treatment paperwork" to indicate that these attitudes revolved re·volve v. re·volved, re·volv·ing, re·volves v.intr. 1. To orbit a central point. 2. To turn on an axis; rotate. See Synonyms at turn. 3. around aspects of the daily treatment forms. Five statements relating to training issues, other than technical training in the operational definitions, comprised factor 5. These statements included understanding of treatment categories, ability to relate these categories to protocols used, and training in how to use the DCTs and was identified as "training." Attitudes toward training in the operational definitions (factor 2) were not correlated to attitudes toward training in the use of DCT and daily treatment forms (factor 5). Relationship of Identified Attitude Factors to Other Variables Attitude factor scores were related to other variables measured in the questionnaire, to further characterize these attitudes and what might contribute to these attitudes. Significant findings are reported in Table 6. Analyses for these findings were based on factor scores reported in Table 7, with negative scores indicating agreement and positive scores indicating disagreement with the statements in that factor. Clinician age or years of experience were not related to any of the identified factors. Male clinicians were more likely than female clinicians to agree with the statements in factor 2, "acceptance of operational definitions" (P=.022). Clinicians who had been with the company for more than 2 years were more likely to agree with the statements in factor 5, "training" (P=.008). Table 6. Summary of Variables Significantly Associated With Factor Scores(a)
Variable Factor df F Ratio P
Gender 2: acceptance of
operational
definitions
Years with company 5: training
Completing daily treatment forms 1: inconvenience
at each visit of DCTs
4: daily treatment
paperwork
Research as professional goal 2: acceptance of
operational
definitions
Watching videotape of knee operational
definitions 5: training
Reading knee operational definitions 5: training
Watching videotape of shoulder operational
definitions 2: acceptance of
operational
definitions
Watching videotape of elbow operational
definitions 2: acceptance of
operational
definitions
Watching videotape of foot/ankle operational
definitions 2: acceptance of
operational
definitions
No. of data sets completed 2: acceptance of
operational
definitions
5: training
No. of data sets submitted 1: inconvenience
of DCTs
2: acceptance of
operational
definitions
5: training
Variable Factor N
Patients treated per day 1: inconvenience
of DCTs 101
2: acceptance of
operational
definitions
Variable df
Gender
Years with company 98
Completing daily treatment forms 97
at each visit
55
Research as professional goal 55
Watching videotape of knee operational 91
definitions
Reading knee operational definitions 94
Watching videotape of shoulder operational 95
definitions
Watching videotape of elbow operational 94
definitions
Watching videotape of foot/ankle operational 91
definitions
No. of data sets completed 95
98
No. of data sets submitted 98
97
97
97
Variable N
Patients treated per day 101
101
Variable F Ratio
Gender 5.43
5.02
Years with company 12.30
Completing daily treatment forms
at each visit 7.75
Research as professional goal 5.23
13.10
Watching videotape of knee operational 10.50
definitions
Reading knee operational definitions
Watching videotape of shoulder operational
definitions 6.48
Watching videotape of elbow operational
definitions 4.26
Watching videotape of foot/ankle operational
definitions 4.43
4.92
No. of data sets completed 5.60
3.46
No. of data sets submitted
6.06
9.39
Correlation
Variable Coefficient
Patients treated per day -.295
-.389
Variable Factor df F Ratio P
Gender .022(b)
.008(b)
Years with company .001(b)
Completing daily treatment forms
at each visit .007(b)
Research as professional goal .025(b)
<.001(b)
Watching videotape of knee operational <.001(b)
definitions
Reading knee operational definitions
Watching videotape of shoulder operational
definitions .002(b)
Watching videotape of elbow operational
definitions .017(b)
Watching videotape of foot/ankle operational
definitions .015(b)
.009(c)
No. of data sets completed .005(c)
.035(c)
No. of data sets submitted
.003(c)
<.001(c)
Variable
Patients treated per day .003(d)
.001(d)
(a) Factors are defined in Table 2. DCT=data collection tool (standardized evaluation tool). (b) Analysis of variance. (c) Analysis of variance with Tukey's Honestly Significant Difference tests. (d) Pearson correlation coefficient. Table 7. Means and Standard Deviations for Factor Scores, by Group of Interest(a)
Factor Score
Variable N
Gender definitions
Male 35
Female 64
Total 99
Years with company
0.1-1.0 44
1.1-2.0 32
2.1+ 22
Total 98
Completing daily treatment
forms at each visit
Daily 24
At data collection 32
Total 56
Completing daily treatment
forms at each visit
Daily 24
At data collection 32
Total 56
Research as professional goal
Yes 55
No 37
Total 92
Watching videotape of knee
operational definitions
Thoroughly 54
Briefly 20
Not at all 22
Total 96
Reading knee operational
definitions
Thoroughly 51
Briefly 30
Not at all 14
Total 95
Watching videotape of shoulder
operational definitions
Thoroughly 31
Briefly 20
Not at all 44
Total 95
Watching videotape of elbow
operational definitions
Thoroughly 18
Briefly 22
Not at all 52
Total 92
Watching videotape of foot/ankle
operational definitions
Thoroughly 31
Briefly 18
Not at all 47
Total 96
No. of data sets completed
0 43
1-5 34
6+ 22
Total 99
No. of data sets completed
0 43
1-5 34
6+ 22
Total 99
No. of data sets submitted
0 47
1-5 33
6+ 18
Total 98
No. of data sets submitted
0 47
1-5 33
6+ 18
Total 98
No. of data sets submitted
0 47
1-5 33
6+ 18
Total 98
Factor Score
X
2:acceptance of operational
Gender definitions definitions
Male -0.289
Female 0.158
Total 0 000
Years with company 5:training
0.1-1.0 0.067
1.1-2.0 0.205
2.1+ -0.505
Total -0.017
Completing daily treatment
forms at each visit 1:Inconvenience of DCTs
Daily 0.559
At data collection -0.281
Total 0.079
Completing daily treatment
forms at each visit 4: daily treatment paperwork
Daily 0.451
At data collection -0.315
Total 0.013
2: acceptance of operational
Research as professional goal definitions
Yes -0.190
No 0.256
Total -0.010
Watching videotape of knee
operational definitions 5:training
Thoroughly -0.330
Briefly -0.002
Not at all 0.672
Total -0.032
Reading knee operational
definitions 5:training
Thoroughly -0.283
Briefly 0.096
Not at all 0.841
Total 0.003
2: acceptance of
Watching videotape of shoulder operational
operational definitions definitions
Thoroughly -0.432
Briefly -0.010
Not at all 0.319
Total 0.005
2: acceptance of
Watching videotape of elbow operational
operational definitions definitions
Thoroughly -0.317
Briefly -0.376
Not at all 0.201
Total -0.038
2: acceptance of
Watching videotape of foot/ankle operational
operational definitions definitions
Thoroughly -0.250
Briefly -0.314
Not at all -0.282
Total -0.002
2: acceptance of
operational
No. of data sets completed definitions
0 0.279
1-5 -0.039
6+ -0.453
Total 0.007
No. of data sets completed 5: training
0 0.322
1-5 -0.116
6+ -0.354
Total 0.021
No. of data sets submitted 1: inconvenience of DCTs
0 -0.116
1-5 -0.127
6+ 0.515
Total -0.004
2: acceptance of operational
No. of data sets submitted definitions
0 0.335
1-5 -0.248
6+ -0.356
Total 0.012
No. of data sets submitted 5: training
0 0.389
1-5 -0.297
6+ -0.339
Total 0.024
Factor Score
SD
Gender
Male 0.827
Female 0.957
Total 0 934
Years with company
0.1-1.0 0.832
1.1-2.0 0.726
2.1+ 1.010
Total 0.876
Completing daily treatment
forms at each visit
Daily 0.940
At data collection 0.844
Total 0.973
Completing daily treatment
forms at each visit
Daily 0.876
At data collection 1.113
Total 1.080
Research as professional goal
Yes 0.935
No 0.889
Total 0.938
Watching videotape of knee
operational definitions
Thoroughly 0.734
Briefly 0.900
Not at all 0.753
Total 0.868
Reading knee operational
definitions
Thoroughly 0.760
Briefly 0.910
Not at all 0.869
Total 0.905
Watching videotape of shoulder
operational definitions
Thoroughly 0.815
Briefly 0.629
Not at all 1.030
Total 0.940
Watching videotape of elbow
operational definitions
Thoroughly 0.687
Briefly 0.614
Not at all 1.050
Total 0.931
2: acceptance of
operational
Watching videotape of foot/ankle
operational definitions
Thoroughly 0.863
Briefly 0.723
Not at all 1.010
Total 0.949
No. of data sets completed
0 0.971
1-5 0.888
6+ 0.738
Total 0.931
No. of data sets completed
0 0.765
1-5 0.897
6+ 0.821
Total 0.862
No. of data sets submitted
0 0.846
1-5 0.974
6+ 1.030
Total 0.949
No. of data sets submitted
0 0.950
1-5 0.917
6+ 0.627
Total 0.934
No. of data sets submitted
0 0.778
1-5 0.828
6+ 0.805
Total 0.866
(a) Factor scores are reported as standardized z scores (X=O, SD=1) relative to the overall average factor score; slight deviations from X=0 and SD=I are the result of missing values for any given group. Because strongly agree" was scored as I and strongly disagree" was scored as 5, negative factor scores indicate greater-than average agreement with the statements included in that factor; positive factor score greater-than-average disagreement. See Table 2 for the statements and loadings for each factor. DCT=data collection tool (standardized evaluation tool). Clinicians who reported viewing the videotape videotape Magnetic tape used to record visual images and sound, or the recording itself. There are two types of videotape recorders, the transverse (or quad) and the helical. demonstrating operational definitions for the knee, and those who reported reading the operational definitions for the knee were more likely to agree with the statements in factor 5, "training" (P [is less than] .001 for each). Viewing the videotapes demonstrating operational definitions for the other joints (shoulder, elbow, and foot and ankle) was associated with increased agreement with the statements in factor 2, "acceptance of operational definitions" (P [is less than] .002 for each body part). Having research as a professional goal was also associated with "acceptance of operational definitions." Clinicians who treated more patients per day were more likely to agree with the statements in factor 1, "inconvenience of DCTs" (r= -.295, P=.003), and also factor 2, "acceptance of operational definitions" (r= -.389, P [is less than] .001). Completing daily treatment forms on the day of treatment, versus at discharge, was related to agreement with factor 1, "inconvenience of DCTs" (P [is less than] .001), and factor 4, "daily treatment paperwork" (P=.007). Respondents were again divided into groups by whether they had completed and submitted no data sets, one to five data sets, or six or more data sets. Clinicians who collected six or more data sets were more likely to agree with the statements in factor 2, "acceptance of operational definitions," and factor 5, "training," than were clinicians who collected no data sets (P=.009 and P=.005, respectively). The relationship between data sets submitted and factors 2 and 5 was even stronger. Clinicians who submitted any data sets were more likely to accept the operational definitions (P=.003) and to report adequate training (P [is less than] .001). Therapists who agreed with the statements in factor 2, "inconvenience of DCTs," did as much data collection (P [is greater than] .050 for Tukey's HSD test) but submitted fewer completed data sets (P=.035). Discussion The goals of our study were to investigate whether therapists made efforts to learn standardized methods, to identify attitudes toward standardized data collection, and to identify characteristics of clinics and clinicians that influence participation in standardized data collection for construction of a clinical database. Even though several authors[14,15] attribute (1) In relational database management, a field within a record. (2) In object technology, a single element of data. See instance attribute and static attribute. failure of clinical databases to the poor adherence of those collecting data, our review of the literature revealed no other studies examining therapist attitudes toward standardized data collection. Backstrom[20] surveyed physical therapists in Colorado Colorado, state, United States Colorado (kŏlərăd`ə, –răd`ō, –rä`dō), state, W central United States, one of the Rocky Mt. states. about their reasons for not participating in research. The reasons cited, in order of importance, were lack of time, lack of knowledge, lack of personnel, lack of administrative support, lack of equipment, and lack of interest. The results of our study are consistent with Backstrom's findings: lack of time is reflected in factor 1, "inconvenience of DCTs." Factor analysis in our study allowed "lack of knowledge" to be broken down into three independent components, as reflected in factor 2 (being uncomfortable with standardized methods) and in factors 4 and 5 (inadequate training in the mechanism for collecting treatment data or in using standardized forms). We found that lack of personnel designated to assist in data management resulted in lower participation in research. Lack of interest in research, as we measured it as not having research as a professional goal, was also associated with lower participation. Learning Standardized Operational Definitions Our results indicate that most therapists (66%) had thoroughly studied the operational definitions for at least one body part (out of four included in this study). Neither the written nor the videotaped version of the operational definitions was preferred. Because willingness to learn standardized methods was independent of professed pro·fess v. pro·fessed, pro·fess·ing, pro·fess·es v.tr. 1. To affirm openly; declare or claim: "a physics major interest in doing research, companies cannot assume that hiring only clinicians who value research will improve the quality of data collected. Indeed, some clinicians voluntarily contributed to the database without studying any of the operational definitions. If participation becomes compulsory Wikipedia does not currently have an encyclopedia article for . You may like to search Wiktionary for "" instead. To begin an article here, feel free to [ edit this page], but please do not create a mere dictionary definition. , or passive (through use of all patient data, such as through computerized patient records to which every therapist contributes), the percentage of therapists who contribute data without adhering ADHERING. Cleaving to, or joining; as, adhering to the enemies of the United States. 2. The constitution of the United States, art. 3, s 3, defines treason against the United States, to consist only in levying war against them or in adhering to their enemies, to standardized methods is likely to be much greater. Both of these issues--therapists not learning standardized methods and therapists learning but not using the standardized methods--can compromise the quality of a database. High-quality clinical data are crucial for meaningful analysis; poor-quality data can confound con·found tr.v. con·found·ed, con·found·ing, con·founds 1. To cause to become confused or perplexed. See Synonyms at puzzle. 2. results more than the complexity of analysis.2' The development of appropriate, widely accepted, and practical operational definitions is fundamental to therapist adherence.[3,9,13,14,21] Our study suggests that comfort with the operational definitions strongly influences participation in standardized data collection. Although reliability studies could be done to measure consistency Consistency can refer to:
(2) In data entry operations, to compare the keystrokes of a second operator with the data entered by the first operator to ensure that the data were typed in accurately. See validate. that proper procedures are used. Even without reliability studies, we believe, a clinical database can be useful for identifying trends that can be studied further with controlled clinical trials. Impediments IMPEDIMENTS, contracts. Legal objections to the making of a contract. Impediments which relate to the person are those of minority, want of reason, coverture, and the like; they are sometimes called disabilities. Vide Incapacity. 2. to Data Collection Participation in standardized data collection--defined here as using the DCT to collect evaluation data, tracking daily treatments, and submitting completed forms to the central data processing data processing or information processing, operations (e.g., handling, merging, sorting, and computing) performed upon data in accordance with strictly defined procedures, such as recording and summarizing the financial transactions of a site--was lower than efforts to study the operational definitions (50% versus 66% among respondents). Participation in data collection was greater among respondents who reported that research was one of their professional goals, even though effort to learn operational definitions was not. Consequently, encouraging research as a professional goal among therapists may increase participation in data collection, but might not affect behaviors leading to collection of high-quality data. Because of the large, multisite environment of our study, ensuring therapist support through involvement of all therapists in design of data collection tools, as done by Shields et al,[14] was not a realistic method for increasing participation. Methods for increasing willingness both to learn standardized methods and to collect standardized data in a large, multisite environment warrant further study. One clinic characteristic was related to participation: designation DESIGNATION, wills. The expression used by a testator, instead of the name of the person or the thing he is desirous to name; for example, a legacy to. the eldest son of such a person, would be a designation of the legatee. Vide 1 Rop. Leg. ch. 2. 2. of an individual responsible for the administrative portion of data collection, in this case, photocopying photocopying, process whereby written or printed matter is directly copied by photographic techniques. Generally, photocopying is practical when just a few copies of an original are needed. When many copies are required, printing processes are more economical. , collating, and mailing data collected. Although computerization com·put·er·ize tr.v. com·put·er·ized, com·put·er·iz·ing, com·put·er·iz·es 1. To furnish with a computer or computer system. 2. To enter, process, or store (information) in a computer or system of computers. may ultimately make some of these tasks unnecessary, clinics may still benefit from having an individual who is responsible for "administration." Management will need to support personnel to assist data administration. Interestingly, reported business of the clinic, number of patients seen per day, and number or evaluations per week were not related to the number of patient data sets collected. This result is surprising, given the fact that the most strongly defined attitude factor was "inconvenience of DCTs" (factor 1). This result may indicate that clinicians did not collect more data because data collection was too inconvenient in a busy clinic. On the other hand, more patients seen per day provides more opportunities to include patients in the clinical database. The number of evaluations per week was greatest for therapists completing either no data sets or six or more data sets. This result may indicate that, among therapists who are willing to use the standardized methods, doing more evaluations provides more patients who are appropriate for the available standardized tools (orthopedic injuries of the foot and ankle, knee, shoulder, and elbow). Ultimately, the standardized tools need to be appropriate for all patients. Attitude Factors Identified Analysis generated five factors, or components of therapist attitudes toward standardized data collection: "inconvenience of DCTs," "acceptance of operational definitions," "automation," "daily treatment paperwork," and "training." Each factor was independent of the others. For example, attitudes about the inconvenience of collecting evaluation data using the DCTs (factor 1) were distinct from attitudes about the inconvenience of collecting the daily treatment data (factor 4). Consequently, streamlining data collection needs to address both evaluation data and treatment data. Understanding the operational definitions (factor 2) was distinct from understanding how to use the forms, both DCT and daily treatment forms (factor 5). When initiating standardized data collection, therefore, training needs to be directed toward both teaching operational definitions and teaching how the administrative aspects of data collection work. If data are to be entered directly into a computer, this second component of training would need to be in how the computer program works. Attitudes toward automation were unrelated to any other items on the questionnaire. Data collection was not computerized at the time of the study, so therapists had no basis for comparison. One of the goals of this study was to identify which attitudes were associated with increased participation, either in learning the operational definitions or in collecting data. Factor 2, "acceptance of operational definitions," was associated with studying the operational definitions. Those clinicians who made an effort to learn the operational definitions were more likely to have an opinion about whether they feel comfortable with the operational definitions. Studying the operational definitions was related to factor 5, "training," for only the knee. The difference between the knee and the other joints may be due to the knee DCT and operational definitions having been available for the longest time. Therapists may have tried to used the DCT forms for a knee evaluation and been frustrated frus·trate tr.v. frus·trat·ed, frus·trat·ing, frus·trates 1. a. To prevent from accomplishing a purpose or fulfilling a desire; thwart: by lack of training in how to use the forms. Such therapists might have not subsequently tried using DCT forms for evaluations of the other joints. "Acceptance of operational definitions" (factor 2) and "training" (factor 5) were also related to number of data sets completed and returned. Apparently, therapists who understand and feel comfortable with the operational definitions are more likely to collect data. Therefore, an administration that encourages study of or in-services on the operational definitions might improve adherence. Operational definitions also should be appropriate to the patient population for therapists to use them. The operational definitions and DCT forms in this study were geared primarily toward a sports/orthopedic patient population; for data collection on a broader base of patients, operational definitions and DCTs need to be expanded for other patient populations. The relationship of number of data sets completed and returned to factor 5, "training," is not surprising. Adequate instruction in how to use the forms increases use of the forms. Training in how the "system" works, therefore, appears to be of paramount Paramount (pâr`əmount'), city (1990 pop. 47,669), Los Angeles co., S Calif.; inc. 1957. Originally a dairy region, it has become highly industrialized since the 1950s. importance in therapist acceptance of any standardized data collection. Interestingly, the statement "Using DCTs has become easier over time" was not included in the "training" factor. Evidently, practice with the forms does not substitute for initial training. The most strongly defined factor, "inconvenience of DCTs," was not related to the number of evaluations done with the DCT forms but was related to the number of data sets submitted. This difference suggests that completing data collection using the DCTs was more inconvenient than simply using the forms for initial patient evaluation. The statement that loaded most strongly on factor 1 was "I do not have time to document using the DCTs," suggesting that streamlining the documentation process--perhaps through automated au·to·mate v. au·to·mat·ed, au·to·mat·ing, au·to·mates v.tr. 1. To convert to automatic operation: automate a factory. 2. report generation--is likely to decrease perceived inconvenience. Surprisingly, this factor was not related to the number of patients treated per day or clinic business. This factor, however, depended on when the daily treatment forms were completed (de, daily versus at discharge). When standardized data collection procedures are planned, therefore, as much attention must be given to streamlining how treatments are tracked as to how evaluation data are collected. The relationship between number of years with the company and factor 5, "training," was most likely a result of the recent rapid growth of the company in which this study was done. One in-service on how the standardized data collection process worked was typically given 3 to 6 months after a clinic had been acquired. Other instructions were provided informally, as questions were asked by clinicians. Training might be more effective if formalized for·mal·ize tr.v. for·mal·ized, for·mal·iz·ing, for·mal·iz·es 1. To give a definite form or shape to. 2. a. To make formal. b. and provided to new clinics sooner, more thoroughly, and more than one time. Because factors 1, 2, and 5 ("inconvenience of DCTs," "acceptance of operational definitions," and "training") were related to participation in data collection, companies attempting to construct a clinical database may want a simple way to predict which clinicians are likely to have these attitudes. These attitudes, however, cannot be predicted by demographic information such as therapist age, years of experience, or gender. The only apparent exception was a relationship between gender and "acceptance of operational definitions." This relationship may have been due to more male therapists in this sample (86% versus 74% of female therapists) working with patients with sports and orthopedic injuries, the population for whom the operational definitions were intended. Use of Factor Analysis Factor analysis was used in the study to broadly define attitudes toward standardized data collection and to relate these attitudes to other characteristics of clinicians and their clinics. Factor analysis is well suited for simplifying a complex set of variables into a few concepts. Furthermore, factor analysis is ideal in exploratory studies, such as ours, for defining concepts to be refined in future research. We consider our response rate of 46% to be excellent for a questionnaire of this nature. Respondents generally reflected the population as a whole, except that respondents were more likely to be full-time physical therapists and to have participated in the data collection project. Being a physical therapist and being employed full time may reflect who chose to complete the questionnaire, or they may reflect selective distribution by clinic directors. The sample size of 102, in our view, was adequate, particularly because the study was intended to be exploratory. Fewer than 100 responses would have made the analysis less reliable, especially with the large number of variables included in this study.[19] An orthogonal At right angles. The term is used to describe electronic signals that appear at 90 degree angles to each other. It is also widely used to describe conditions that are contradictory, or opposite, rather than in parallel or in sync with each other. rotation was justified, as correlations between factors were found to be small when an oblique o·blique adj. Situated in a slanting position; not transverse or longitudinal. oblique slanting; inclined. rotation was done. Furthermore, no variable loaded above .45 on more than one factor. The nature of the five factors did not change with oblique rotation, or with a variety of other exploratory analyses. Implications for Use of Standardized Data Collection Procedures Identification of attitudes impeding im·pede tr.v. im·ped·ed, im·ped·ing, im·pedes To retard or obstruct the progress of. See Synonyms at hinder1. [Latin imped participation in standardized data collection is a step toward constructing a high-quality clinical database. Further studies can focus more specifically on these attitudes, and can more clearly define what contributes to these attitudes. For example, how much of what kind of training results in improved participation? Understanding therapist attitudes toward standardized data collection allows us to address and, hopefully, resolve these issues in the development of large clinical outcome databases. We looked at voluntary participation in data collection; any clinical database with voluntary clinician or patient participation is vulnerable to bias. Clinicians who choose to contribute to the clinical database may have certain characteristics that affect patient outcome. Freedom to choose which patients to include in the database may further bias the data. Therapists may choose "simple" or "good" patients for inclusion, both because "simple" patients are easier to collect data on and because of the natural tendency to pick cases that exemplify ex·em·pli·fy tr.v. ex·em·pli·fied, ex·em·pli·fy·ing, ex·em·pli·fies 1. a. To illustrate by example: exemplify an argument. b. "good" results. Other types of patient selection, neither voluntary nor conscious, can bias the database (eg, the inclusion of only patients who complete their regimen regimen /reg·i·men/ (rej´i-men) a strictly regulated scheme of diet, exercise, or other activity designed to achieve certain ends. reg·i·men n. 1. of physical therapy).[13] To generate an unbiased database, participation and patient inclusion must be comprehensive. One way to achieve this goal would be for all clinicians to collect all patient data directly into a computerized database system, thus mandating participation. Issues of convenience appeared in two of the attitudes identified in this study. If data collection is too time consuming, the loss of productivity may not justify the knowledge gained. Automated report generation from the data entered into a computer could provide a payback Payback The length of time it takes to recover the initial cost of a project, without regard to the time value of money. in efficiency to compensate for additional time to do or enter the measurements. Similarly, automatic billing from data entered about treatments provided could improve efficiency. The Future of Clinical Databases Many authors[1,5,14,21] have suggested that the use of clinical databases can be expected to increase in the future. In 1988, Congress created the Patient Outcome Assessment Research Program to facilitate development of such clinical databases,[7] and this was the goal of a 1994 conference entitled en·ti·tle tr.v. en·ti·tled, en·ti·tling, en·ti·tles 1. To give a name or title to. 2. To furnish with a right or claim to something: "An Agenda for Medical Rehabilitation Outcome Research."[22] Physical therapists need to respond to this demand for outcomes research by developing patient databases. Clinical databases need to be accumulated ac·cu·mu·late v. ac·cu·mu·lat·ed, ac·cu·mu·lat·ing, ac·cu·mu·lates v.tr. To gather or pile up; amass. See Synonyms at gather. v.intr. To mount up; increase. for years before they become useful, requiring patience Patience, poem Patience: see Pearl, The. patience, card game patience: see solitaire. Patience See also Longsuffering. on the part of the administration and diligence Vigilant activity; attentiveness; or care, of which there are infinite shades, from the slightest momentary thought to the most vigilant anxiety. Attentive and persistent in doing a thing; steadily applied; active; sedulous; laborious; unremitting; untiring. on the part of the clinicians and researchers.[23] Once constructed, however, clinical databases have the potential to allow easy and timely access to a considerable amount of data.[4,5,24] Moreover, clinical practice databases reflect effectiveness of care for a broad spectrum of patients, not just the efficacy of ideal treatment conditions for a small population that does not represent the real patients who are in need of care.[4] Although clinical databases are a powerful tool, their use for research must be undertaken carefully. Our study illustrates the difficulty in obtaining therapist adherence to standardized methods. Jette[9] warned that, after data are collected, standardizing clinical judgment and assessment is also fraught fraught adj. 1. Filled with a specified element or elements; charged: an incident fraught with danger; an evening fraught with high drama. 2. with errors. Coding of these diagnoses, such as ICD-9 codes The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain. causal relating to or emanating from cause. relationships can be inferred but not proven. Finally, careful and innovative methods must be used in the analysis, to avoid misinterpretation.[25,26] Our study raises only some of the potential problems with outcomes research. Outcomes must be interpreted Translated from source code into machine code one line at a time. See interpreted language and interpreter. interpreted - interpreter cautiously cau·tious adj. 1. Showing or practicing caution; careful. 2. Tentative or restrained; guarded: felt a cautious optimism that the offer would be accepted. , because the simple coexistence co·ex·ist intr.v. co·ex·ist·ed, co·ex·ist·ing, co·ex·ists 1. To exist together, at the same time, or in the same place. 2. of treatment and outcome does not prove that the measured outcome is a result of the treatment provided.[27] Even if data are collected reliably, consistent differences in treatment procedures among clinics can bias outcomes. Differences in outcome that appear to be related to use of a treatment may actually be due to other characteristics of a clinic or clinician using that treatment, rather than to the procedure itself.[21,28] Such clinic characteristics can include patient population or volume, staffing, equipment, or how a given treatment is provided. Outcome measures must be practical as well as reliable, valid, and responsive.[9,11,27] We contend that outcome measures need to include functional measures of disability as well as more traditional measures of impairment. Such a database could permit study of the relationship between impairment and disability outcomes, as suggested by Jette.[10] Comparing results from clinical databases with results from controlled clinical trials provides information about the relationship between efficacy and effectiveness.[7] Once constructed, a clinical outcome database can be used to monitor differences related to health care policies, including differences in insurance coverage with or without a co-payment co-payment Managed Care That portion of a claim or medical expense that a health plan member must pay out-of-pocket for specific medical services–eg, hospital care, drugs, office visits, etc; the insurer pays the remaining portion , fee for service versus capitation CAPITATION. A poll tax; an imposition which is yearly laid on each person according to his estate and ability. 2. The Constitution of the United States provides that "no capitation, or other direct tax, shall be laid, unless in proportion to the census, or ,[11] staff productivity requirements, and use of skilled versus unskilled health care providers.[12] With the recent move toward cost-containment and managed care, clinical databases can be used to identify at-risk at-risk adj. Being endangered, as from exposure to disease or from a lack of parental or familial guidance and proper health care: efforts to make the vaccine available to at-risk groups of children. patients whose outcome may be seriously compromised with only the minimum care typically provided.[4] Because clinical databases reflect response to care on an almost daily basis, health care policies can be monitored in real time, without the delay that is inevitable with controlled clinical trials.[16] For health care providers such as nurses and physical therapists, outcome data may be essential in determining and demonstrating that we are not a dispensable dis·pen·sa·ble adj. Capable of being dispensed, administered, or distributed. Used of a drug. component of health care.[12] Summary Clinicians, primarily physical therapists, in a multisite private practice setting perceive per·ceive v. 1. To become aware of directly through any of the senses, especially sight or hearing. 2. To achieve understanding of; apprehend. several deterrents to participation in standardized data collection. These issues need to be addressed to generate a large, high-quality clinical outcome database. Adequate training in both the operational definitions and the data collection procedures is crucial for enhancing participation as well as for improving the quality of data. Inconvenience of the data collection, both evaluation and daily treatment data, interferes with participation. A computerized patient documentation system that streamlines data collection and increases clinician efficiency through automated patient reports may increase participation by decreasing inconvenience and paperwork. Acknowledgment acknowledgment, in law, formal declaration or admission by a person who executed an instrument (e.g., a will or a deed) that the instrument is his. The acknowledgment is made before a court, a notary public, or any other authorized person. Special thanks to Bernadette Bernadette could refer to one of the following:
Plymouth, city (1991 pop. 238,583) and district, Devon, SW England, on Plymouth Sound. The three towns that Plymouth has comprised since 1914 are Plymouth, Stonehouse, and Devonport. State College, for her suggestions and help in the statistical design for this study. (*) Lotus Development Corp, 55 Cambridge Cambridge, city, Canada Cambridge (kām`brĭj), city (1991 pop. 92,772), S Ont., Canada, on the Grand River, NW of Hamilton. It was formed in 1973 with the amalgamation of Galt, Hespeler, and Preston, all founded in the early 19th cent. Pkwy, Cambridge, MA 02142. [dagger] SPSS Inc, 444 N Michigan Michigan (mĭsh`ĭgən), upper midwestern state of the United States. It consists of two peninsulas thrusting into the Great Lakes and has borders with Ohio and Indiana (S), Wisconsin (W), and the Canadian province of Ontario (N,E). Ave AVE Avenue AVE Average AVE Alta Velocidad Espanola (train between Madrid and Seville) AVE Alta Velocidad Española (Spanish: High Speed Train) AVE Audio Video Entertainment AVE Advertising Value Equivalent , Chicago Chicago, city, United States Chicago (shĭkä`gō, shĭkô`gō), city (1990 pop. 2,783,726), seat of Cook co., NE Ill., on Lake Michigan; inc. 1837. , IL 60611. References [1] Relman A. Assessment and accountability: the third revolution in medical care. N Engl ENGL English J Med. 1988;319:1220-1222. [2] Donabedian A. Quality assessment and assurance: unity of purpose, diversity of means. Inquiry. 1988;25:173-192. [3] Brook A brook is a small stream. Brook may refer to the following places:
[4] Tierney Tierney is an Irish surname. It is an Anglicized form of Gaelic Ó Tiarnaigh (male), Ní Tiarnaigh (female), also Tighearnaigh/Tighearnach. It is pronounced "tee + er + nee". It originated in Co. WM, McDonald CJ. Practice databases and their uses in clinical research. Stat Med. 1991;10:541-557. [5] Safran SAFRAN (Euronext: SAF) is a French conglomerate company involved in defense, aerospace propulsion and equipment, communication and security. It results of the merger of the propulsion and aerospace equipment group SNECMA and defense conglomerate SAGEM. C. Using routinely collected data for clinical research. Stat Med. 1991;10:559-564. [6] Donabedian A. The seven pillars of quality. Arch Pathol Lab Med. 1990;114:1115-1118. [7] Salive ME, Mayfield Mayfield, city (1990 pop. 9,935), seat of Graves co., SW Ky., in an area of farms and clay deposits; founded 1823. It is an agricultural trade center with a tobacco market. JA, Weissman NW. Patient outcomes research teams and the Agency for Health Care Policy and Research. Health Serv Res. 1990;25:697-708. [8] Williamson Wil·liam·son , Mount A peak, 4,382.9 m (14,370 ft) high, in the Sierra Nevada of east-central California. JW. Evaluating quality of patient care: a strategy relating outcome and process assessment. JAMA JAMA abbr. Journal of the American Medical Association . 1971;218:564-569. [9] Jette AM. Using health-related quality-of-life measures in physical therapy outcomes research. Phys Ther. 1993;73:528-537. [10] Jette AM. Outcomes research: shifting the dominant research paradigm Pronounced "pah-ruh-dime." A model, example or pattern. See paradigm shift. in physical therapy. Phys Ther. 1995;75:965-970. [11] Brook RH, Davies-Avery A, Greenfield S, et al. Uses of outcome information. Med Care. 1977;15(suppl 9):16-24. [12] Bond S, Thomas (language) Thomas - A language compatible with the language Dylan(TM). Thomas is NOT Dylan(TM). The first public release of a translator to Scheme by Matt Birkholz, Jim Miller, and Ron Weiss, written at Digital Equipment Corporation's Cambridge Research Laboratory runs LH. Issues in measuring outcomes of nursing. J Adv Nurs. 1991;16:1492-1502. [13] Kane RL. Looking for Looking for In the context of general equities, this describing a buy interest in which a dealer is asked to offer stock, often involving a capital commitment. Antithesis of in touch with. physical therapy outcomes. Phys Ther. 1994;74:425-429. [14] Shields RK, Leo Leo, in astronomy Leo [Lat.,=the lion], northern constellation lying S of Ursa Major and on the ecliptic (apparent path of the sun through the heavens) between Cancer and Virgo; it is one of the constellations of the zodiac. KC, Miller B, et al. An acute care physical therapy clinical practice database for outcomes research. Phys Ther. 1994;74:463-470. [15] Farer S. Outcome analysis for program service management. In: Furher MJ, ed. Rehabilitation Outcomes: Analysis and Measurement. Baltimore Baltimore, city (1990 pop. 736,014), N central Md., surrounded by but politically independent of Baltimore co., on the Patapsco River estuary, an arm of Chesapeake Bay; inc. 1745. , Md: Paul Paul, 1901–64, king of the Hellenes (1947–64), brother and successor of George II. He married (1938) Princess Frederika of Brunswick. During Paul's reign Greece followed a pro-Western policy, and the Cyprus question was temporarily resolved. H Brookes Brookes is a surname, and may refer to
[16] Ellwood Ellwood can refer to: People
[17] LaStayo PC, Wheeler DL. Reliability of passive wrist flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. and extension goniometric go·ni·om·e·ter n. 1. An optical instrument for measuring crystal angles, as between crystal faces. 2. A radio receiver and directional antenna used as a system to determine the angular direction of incoming radio signals. measurements: a multisite study. Phys Ther. 1994;74:162-176. [18] Kennedy JJ, Bush AJ. An Introduction to the Design and Analysis of Experiments in Behavioral behavioral pertaining to behavior. behavioral disorders see vice. behavioral seizure see psychomotor seizure. Research. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , NY: Lanham; 1985:193-201. [19] Tabachnick BG, Fidell LS. Using Multivariate Statistics Multivariate statistics or multivariate statistical analysis in statistics describes a collection of procedures which involve observation and analysis of more than one statistical variable at a time. Sometimes a distinction is made between univariate (e.g. . New York, NY: Harper & Row; 1983. [20] Backstrom KM. Why isn't is·n't Contraction of is not. isn't is not isn't be there more clinical research? Orthopedic Practice. 1994;6:13-14. [21] Moses LE. Innovative methodologies for research using databases. Stat Med. 1991;10:629-633. [22] Fuhrer füh·rer also fueh·rer n. A leader, especially one exercising the powers of a tyrant. [German, from Middle High German vüerer, from vüeren, to lead, from Old High German MJ. Conference report: an agenda for medical rehabilitation outcomes research. Am J Phys Med Rehabil. 1995;74:243-248. [23] Epstein AM. The outcomes movement: Will it get us where we want to go? N Engl J Med. 1990:323:266-270. [24] Bohren BF, Hadzikadoc M, Hanley For the town or former electoral district located in Saskatchewan, Canada, see and Hanley (electoral district). EN. Extracting knowledge from large medical databases: an automated approach. Comput Biomed Res. 1995;28:191-210. [25] Pryor Pryor is a surname, which can refer to:
[26] Byar DP. Problems with using observational databases to compare treatments. Stat Med. 1991:10:663-666. [27] Keith Keith may refer to: People with the given name Keith:
adj. Relating to concepts or the the formation of concepts. basis of outcome measures. Am J Phys Rehabil. 1995;74:73-80. [28] Poses RM, Smith WR, McClish DK, Anthony M. Controlling for confounding confounding when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies. confounding factor by indication for treatment: Are administrative data equivalent to clinical data? Med Care. 1995:33:36-46. L Russek, PhD, PT, is Research Physical Therapist, Physiotherapy physiotherapy: see physical therapy. Associates, 203 Hospital Dr, Suite 312, Glen Burnie Burn´ie n. 1. A small brook. , MD 21061 (USA) (Irussek@erols.com). Address all correspondence to Dr Russek. M Wooden, PT, OCS OCS - Object Compatibility Standard , is Director of Clinical Research, Physiotherapy Associates, Memphis, Tenn. S Ekedahl is Manager, Research Department, Physiotherapy Associates, Memphis, Tenn. A Bush, PhD, is Associate Professor, Division of Biostatistics biostatistics /bio·sta·tis·tics/ (-stah-tis´tiks) biometry. bi·o·sta·tis·tics n. The science of statistics applied to the analysis of biological or medical data. and Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , Department of Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. , College of Medicine, University of Tennessee The University of Tennessee (UT), sometimes called the University of Tennessee at Knoxville (UT Knoxville or UTK), is the flagship institution of the statewide land-grant University of Tennessee public university system in the American state of Tennessee. , Memphis, Tenn. This study was approved by the Institutional Review Board of Physiotherapy Associates. This work was funded by Physiotherapy Associates, Memphis, Tenn. This article was submitted March 4, 1996, and was accepted January January: see month. 7, 1997. |
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