Virtual assessment in Physiotherapy: Examining perceptions, constructs, and tool characteristics Xiang Ren Tan, Anthony J Goff, Li Whye Cindy Ng Asia Pacific Scholar, 2024 Introduction: Objective structured clinical examinations have traditionally been used to assess clinical skills. However, these face-to-face clinical assessments were hindered by physical and social restrictions imposed during COVID-19. This created a need to develop novel approaches for reliable assessment of clinical skills. We explored and evaluated a virtual exercise teleconsultation assessment (VETA) to replicate a teleconsultation setting where physiotherapy students were assessed on exercise prescription and coaching skills. Methods: We conducted a cross-sectional mixed-methods study using convenience sampling. A VETA was implemented for 172 physiotherapy students via Zoom to allow synchronous interaction with standardised patients (SPs). 67 students and 9 SPs completed two separate post evaluation surveys on themes relating to administration, support, authenticity, effectiveness, and value of the VETA. Likert-type responses were categorised as positive, neutral, or negative while coded qualitative responses were consolidated into themes by inductive content analysis. Results: 76% of students agreed that the assessment was authentic while 93% felt that the SPs were realistic and believable. Responders also highlighted important challenges including the limited camera viewing angle, time and space constraint, adequacy of equipment and reliability of connectivity. Exploratory factor analysis of responses revealed three latent constructs: (1) clarity of assessment, (2) clinical relevance, and (3) value of assessment. Conclusion: Despite the technical challenges, VETA demonstrated clarity and value as an alternative assessment and showed relevance to future telehealth practice, which is increasingly pervasive in clinical settings. This paper demonstrates a feasible approach for the virtual assessment of clinical competencies. Keywords: Health Sciences Education, Virtual Assessment, Clinical Skills, OSCE, Physiotherapy, Exercise Prescription
Protocol for a systematic review of the associations between inflammatory markers and lung function, muscle force and exercise capacity in people with COPD Nadhirah Mohd Noor, Zawani Mustaffa, Alia Nizam, Mohd Arif Mohd Zim, Li Whye Cindy Ng, Fatim Tahirah Mirza BMJ Open, 2023 IntroductionThe prevalence of chronic obstructive pulmonary disease (COPD) has been on the rise, with acute exacerbation of COPD associated with the highest burden and multiple pulmonary and systemic consequences. People with COPD have been found to have an abnormal response of systemic inflammation. To date, although limited, there are studies that suggest negative associations between inflammatory markers and important clinical outcomes such as exercise capacity and muscle force. This protocol aims to systematically review the evidence for (i) the associations between inflammatory markers and lung function, muscle force and exercise capacity and (ii) the influence of other factors (eg, hospitalisation, exercise programme) on the level of inflammatory markers in people with COPD.Methods and analysisScopus, PubMed, Cochrane, Web of Science and ProQuest will be searched from database inception to February 2023 using PEO search strategy (Population: adults with COPD; Exposure: inflammatory markers; Outcomes: lung function, muscle force and exercise capacity). Four reviewers working in pairs will independently screen articles for eligibility and extract data that fulfilled the inclusion criteria. Depending on the design of the included studies, either Cochrane risk-of-bias version 2 or the Newcastle-Ottawa Scale tools will be used to rate the methodological quality of the included studies. Effect sizes reported in each individual study will be standardised to Cohen’s d and a random effects model will be used to calculate the pooled effect size for the association.Ethics and disseminationEthical approval is unnecessary as this study will only use publicly available data. The findings will be disseminated through publication in peer-reviewed journals and conferences.PROSPERO registration numberCRD42022284446.
Resting metabolic rate in healthy Singaporeans: Performance of the Harris-Benedict equation and a new predictive model Natalie Filipa Mei Xuan Tan, Kwang Wei Tham, Chun Keong Eric Ho, Cindy Li Whye Ng Proceedings of Singapore Healthcare, 2023 Background Prediction equations for resting metabolic rate (RMR) are valuable in managing patients’ weight; however, no accurate equation exists for Singaporeans. Objective To develop and cross-validate a predictive regression equation for RMR in Singaporeans, using indirect calorimetry as the reference method. Methods 104 healthy Singaporeans (34.3 ± 12.2 years) participated, comprising 34 men and 70 women. Anthropometric measurements and demographics information were obtained from participants. RMR was measured via indirect calorimetry (TrueOne 2400 system). Stepwise regression analysis was used to develop the most parsimonious predictive equation. Performance of the equation was evaluated using ordinary least products (OLP) regression and Bland–Altman analysis, whilst internal cross-validation was performed by use of the predicted residual sum of squares (PRESS) method. To compare the new equation with existing ones, the performance of the Harris-Benedict equation was also evaluated. Results The best predictive equation takes the form RMR(kcal) = 918 + 16.5(weight)-135.7(gender) - 1152(Waist-to-height-ratio) +0.014(International Physical Activity Questionnaire Score), where gender = 1 (female) or 0 (male). OLP regression revealed no systematic bias for the new equation. Bland–Altman analysis showed that its total (systematic and random) error was 212 kcal. Internal model validation using the PRESS method revealed minimal reduction in predictive accuracy. In contrast, OLP regression showed a significant pattern of over-prediction by the Harris-Benedict equation (y-intercept = −280 kcal; 95%CI, −100 to −461 kcal). Conclusions Our new equation outperformed the Harris-Benedict equation in accurately predicting RMR in Singaporeans. Comprising easily obtained anthropometric and self-reported measures, we envisage its potential relevance in clinical and epidemiological settings.
Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore – A Multi-Centre Survey Gabriel Wai Mun Ou, Marcus Jun Hui Ng, Cindy Li Whye Ng, Hwee Kuan Ong, Balachandran Jayachandran, Vimal Palanichamy Proceedings of Singapore Healthcare, 2022 Background The roles of physiotherapy in Intensive Care Unit (ICU) have significantly developed from the traditional management of respiratory conditions to early rehabilitation and mobilisation of patients on mechanical ventilation. Surveys of United Kingdom, Australia and regional ICU physiotherapy practice have been published but there are no local data sets. This study aims to report the physiotherapy practices across the adult ICUs of Singapore. Methods Twenty-nine item questionnaire was mailed to 90 physiotherapists working in 15 adult ICUs across restructured and private hospitals in Singapore. Data sets were summarised from the returned questionnaires. This includes identifying common physiotherapy techniques and exercise prescription protocols for both mechanically and non-mechanically ventilated patients in the ICU. Results A total of 63 (70%) questionnaires were returned. The most used physiotherapy interventions were airway secretion clearance, techniques to improve lung ventilation and mobilisation out of bed. Positioning was most used respiratory technique (60/61, 98%). Sitting on the edge of bed is the most preferred physical activity for ICU patients (43/44, 98%). Exercise was routinely prescribed (50/61, 83%) although only a minority (8/50, 16%) have established exercise prescription protocols. For mechanically ventilated patients, active/active assisted exercises were most used (40/44, 91%). 12% of ICU use either Chelsea Critical Care Physical Assessment Tool or the Functional Status Score for the Intensive Care Unit as routine outcome measures. Conclusion Airway clearance was stated as the most used physiotherapy technique. Exercise is routinely prescribed in ICU. Validated outcome measures are only used by few.
Increasing Walking Speed to Achieve a Pre-training Endurance Shuttle Walk Time of 5-10 min May Improve Test Responsiveness in People with Chronic Obstructive Pulmonary Disease Kylie Hill, Yan Ling Chao, Vinicius Cavalheri, L. W. Cindy Ng, Sally L. Wootton, Zoe J. McKeough, Sue C. Jenkins, Peter R. Eastwood, David R. Hillman, Christine Jenkins, Nola Cecins, Lissa M. Spencer, Jennifer A. Alison Journal of Cardiopulmonary Rehabilitation and Prevention, 2021 Participants with chronic obstructive pulmonary disease who report modest symptoms during the 6-min walk test or incremental shuttle walk test achieve a long pre-training endurance shuttle walk test time. In this situation, performing the test at a faster speed to achieve a pretraining test between 5 and10 min may enhance responsiveness. Purpose: The endurance shuttle walk test (ESWT) was used to evaluate ground-based walking training in chronic obstructive pulmonary disease. During pre-training testing, those who walked 5-10 min on the first ESWT with minimal symptoms performed additional ESWTs at increasing speeds until they were at least moderately symptomatic and terminated the test between 5 and 10 min. This report compares participant characteristics and test responsiveness with participants grouped according to whether or not faster walking speeds were selected for the ESWT during pre-training testing. Methods: We conducted a retrospective analysis of data collected in the intervention group during a randomized controlled trial. The intervention was supervised ground-based walking training, performed two to three times/wk, for 8-10 wk. Prior to and immediately following completion of training, participants completed the 6-min walk test (6MWT), incremental shuttle walk test (ISWT), and ESWT. Results: Data were available on 77 participants (70 ± 9 yr, forced expiratory volume in the first second of expiration [FEV1] 43 ± 15 % predicted). For those whom a faster speed was selected during the pre-training ESWTs were characterized by milder dyspnea and leg fatigue on completion of the baseline 6MWT and ISWT (P < .05 for all). On training completion, the change in ESWT was greater in those for whom a faster speed was selected (376 ± 344 sec vs 176 ± 274 sec; P = .017). Conclusions: Participants who report modest symptoms on completion of the pre-training 6MWT or ISWT may achieve a long pre-training ESWT time. In this situation, repeating the pre-training ESWT at a faster walking speed to achieve an exercise time between 5 and 10 min with moderate symptoms may be advantageous.
People with COPD Who Respond to Ground-Based Walking Training Are Characterized by Lower Pre-training Exercise Capacity and Better Lung Function and Have Greater Progression in Walking Training Distance Jian Ping Ho, Jennifer A. Alison, L. W. Cindy Ng, Sally L. Wootton, Zoe J. McKeough, Sue C. Jenkins, Peter R. Eastwood, David R. Hillman, Christine Jenkins, Lissa M. Spencer, Vinicius Cavalheri, Kylie Hill Journal of Cardiopulmonary Rehabilitation and Prevention, 2019 Purpose: To investigate the characteristics that distinguish responders from nonresponders to ground-based walking training (GBWT) in people with chronic obstructive pulmonary disease (COPD). Methods: An analysis was undertaken of data collected during a trial of GBWT in people with COPD. Responders to GBWT were defined in 2 ways: (1) improved time on the endurance shuttle walk test of ≥190 sec (criterion A); or (2) improved ability to walk, perceived by the participant to be at least “moderate” (criterion B). Differences in participant characteristics, pre-training exercise capacity, health-related quality of life, and the improvement in the distance walked during the training program were examined between responders and nonresponders. Results: Of the 95 participants randomized to GBWT (age 69 ± 8 yr, forced expiratory volume in 1 sec [FEV1] % predicted = 43% ± 15%), data were available for analysis on 78 and 73 patients by criterion A and criterion B, respectively. According to criterion A, 32 (41%) participants were responders. The odds of being a responder increased with increasing FEV1 % predicted (OR = 1.2; 95% CI, 1.0-1.5, for every 5% increase) and increased with decreasing pre-training incremental shuttle walk distance (OR = 1.4; 95% CI, 1.0-1.8, for every 50-m decrement). According to criterion B, 42 (58%) participants were responders. There were no differences in characteristics or pre-training measures between the responders and nonresponders. For both criteria, responders demonstrated greater change in the distance walked during the training program (P < .05). Conclusion: Responders to GBWT had lower pre-training exercise capacity, had better lung function, and demonstrated greater change in the distance walked during the training program.
Physical activity patterns and clusters in 1001 patients with COPD Rafael Mesquita, Gabriele Spina, Fabio Pitta, David Donaire-Gonzalez, Brenda M Deering, Mehul S Patel, Katy E Mitchell, Jennifer Alison, Arnoldus JR van Gestel, Stefanie Zogg, Philippe Gagnon, Beatriz Abascal-Bolado, Barbara Vagaggini, Judith Garcia-Aymerich, Sue C Jenkins, Elisabeth APM Romme, Samantha SC Kon, Paul S Albert, Benjamin Waschki, Dinesh Shrikrishna, Sally J Singh, Nicholas S Hopkinson, David Miedinger, Roberto P Benzo, François Maltais, Pierluigi Paggiaro, Zoe J McKeough, Michael I Polkey, Kylie Hill, William D-C Man, Christian F Clarenbach, Nidia A Hernandes, Daniela Savi, Sally Wootton, Karina C Furlanetto, Li W Cindy Ng, Anouk W Vaes, Christine Jenkins, Peter R Eastwood, Diana Jarreta, Anne Kirsten, Dina Brooks, David R Hillman, Thaís Sant’Anna, Kenneth Meijer, Selina Dürr, Erica PA Rutten, Malcolm Kohler, Vanessa S Probst, Ruth Tal-Singer, Esther Garcia Gil, Albertus C den Brinker, Jörg D Leuppi, Peter MA Calverley, Frank WJM Smeenk, Richard W Costello, Marco Gramm, Roger Goldstein, Miriam TJ Groenen, Helgo Magnussen, Emiel FM Wouters, Richard L ZuWallack, Oliver Amft, Henrik Watz, Martijn A Spruit Chronic Respiratory Disease, 2017
