METHODS: A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored.

RESULTS: PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools.

CONCLUSIONS: KBs positively influenced PTs' self-reported knowledge and self-reported use of the targeted measurement tools. Further research is warranted to investigate whether this is a feasible, cost-effective model that could be used more broadly in a rehabilitation setting to facilitate the uptake of other measurement tools or evidence-based intervention approaches.

METHODS: Data for developing the interRAI Pressure Ulcer Risk Scale (interRAI PURS) were available from 2 Ontario sources: three LTC homes with 257 residents assessed during the same time frame with the MDS and Braden Scale for Predicting Pressure Sore Risk, and eighty-nine Ontario LTC homes with 12,896 residents with baseline/reassessment MDS data (median time 91 days), between 2005-2007. All assessments were done by trained clinical staff, and baseline assessments were restricted to those with no recorded pressure ulcer. MDS baseline/reassessment samples used in further testing included 13,062 patients of Ontario Complex Continuing Care Hospitals (CCC) and 73,183 Ontario long-stay home care (HC) clients.

RESULTS: A data-informed Braden Scale cross-walk scale using MDS items was devised from the 3-facility dataset, and tested in the larger longitudinal LTC homes data for its association with a future new pressure ulcer, giving a c-statistic of 0.676. Informed by this, LTC homes data along with evidence from the clinical literature was used to create an alternate-form 7-item additive scale, the interRAI PURS, with good distributional characteristics and c-statistic of 0.708. Testing of the scale in CCC and HC longitudinal data showed strong association with development of a new pressure ulcer.

CONCLUSIONS: interRAI PURS differentiates risk of developing pressure ulcers among facility-based residents and home care recipients. As an output from an MDS assessment, it eliminates duplicated effort required for separate pressure ulcer risk scoring. Moreover, it can be done manually at the bedside during critical early days in an admission when the full MDS has yet to be completed. It can be calculated with established MDS instruments as well as with the newer interRAI suite instruments designed to follow persons across various care settings (interRAI Long-Term Care Facilities, interRAI Home Care, interRAI Palliative Care).

Methods: Following criterion testing on 5 individuals, 90 healthy volunteers who met the inclusion criteria and consented to participate in the study were tested on the CB&M. The subjects were recruited through quota sampling in three age categories: 30 to 39 years, 40 to 49 years, and 50 to 59 years, with 15 men and 15 women in each age category. The groups were not matched for any anthropometric variables.

Results: Women within the age category of 50 to 59 years had significantly lower scores on the CB&M compared with all other age and gender categories.

Conclusions: The results from this study indicate that although the items on the CB&M were appropriate for the 30- to 59-year age categories, some items still posed a challenge to healthy participants because most were unable to score full points on the CB&M. The normative data from the present study could help clinicians put the CB&M scores of middle-aged patients into context. These data may also be useful in making recommendations regarding the safe integration of patients back into the community following mild stroke.

Methods: Six groups of practising therapists were identified based on expertise status (novice, intermediate, and expert, as determined by a multifaceted assessment battery), and their level of clinical experience (10 years or less, more than 10 years). Scores for these six therapist groups were examined on three variables generally considered to be associated with the development of expertise — motivation, openness to experience (as defined by the critical-thinking dispositions of truth-seeking, open-mindedness, and cognitive maturity), and features of their clinical caseload experience (i.e. breadth of experience as measured by number of different client age groups worked with, the complexity of clients' needs, and experience in delivering services to adolescents, school-age children, preschoolers, and infants).

Results: Low-experience experts ('young stars') had the highest motivation, truth-seeking, and open-mindedness scores of all groups, the highest percentage of clients with complex service needs, and were more likely to work with adolescents.

Conclusions: The major differences between therapists who attain expertise quickly versus those who remain novices after many years of experience appear to be motivation and complexity of work experiences. Implications for supporting the development of expertise in practising therapists are discussed.

METHODS: Two qualitative studies were conducted. Thirteen therapists took part in a study using the critical incident interview technique and 11 therapists took part in a study using the 'think aloud' technique. Therapists were classified as novice, intermediate, or expert in developmental level based on a cluster analysis of data collected using a multifaceted battery of assessment tools. Data were analyzed using a grounded theory approach.

RESULTS: Expert and intermediate therapists differed from novices with respect to content, self-, and procedural knowledge.

CONCLUSION: With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the child's functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.

Methods: A cervical manipulation information sheet (CMIS) was created with five sections: Introduction, Benefits, Risks, Procedures and Effectiveness. The content of the information sheet was generated using the Delphi method, followed by a mail-out survey to a random sample of CMPTs (N = 307) to determine the information sheet's acceptability and clinical utility. The proportion of CMPTs who agreed with the content of the information sheet and the proportion of CMPTs who indicated a willingness to use the sheet clinically were calculated.

Results: The survey response rate was 74 per cent. The proportion (95 per cent confidence interval) of respondents who agreed with the content of the CMIS and approved its clinical acceptability was 0.95 (0.94-0.96) and 0.61 (0.58-0.64), respectively. Written comments from the CMPTs reflected concern about wording in the Risks section.

Conclusions: Our results suggest that CMPTs agreed with the content of the CMIS but not how it was written. Physical therapists should consider the CMIS a proposed guideline for clinician use. Ideally, a patient version should also be created.

Method: Forty-two students enrolled in our newly developed master's degree programme wrote three-page reflective journals on a critical learning incident after each of three selected clinical experiences. The journals were coded and analyzed, and major themes were identified and described. A separate cohort of 44 students participated in focus groups after the same three clinical experiences to check the trustworthiness of the results.

Results: Following the first placement, the main themes coded were emotions, self-confidence, professionalism in the real world, communication, and learning by doing. After the intermediate placement, major themes were idealism versus realism, depth of communication with clients, and breadth of communication with family members and colleagues. Aspects of clinical learning were variable, and self-confidence remained an issue. After the final placement, most students were deeply engaged with their clients and self-confidence had developed to the point of self-efficacy. Tensions increased between the concept of ideal practice and the pragmatics of actual practice, and the concept of self as protégé (rather than as object of the supervisor's evaluation) emerged. The themes were subsequently assembled in a booklet with representative quotations.

Conclusion: These results contribute to foundational knowledge required by PT educators, including clinical instructors, by explicitly describing the professional socialization of PT students.

SUBJECTS AND METHODS: A total of 1,940 motor measurements from 650 children with CP were used to develop percentiles. These observations were taken from a subsample, stratified by age and GMFCS, of those in a longitudinal cohort study reported in 2002. A standard LMS (skewness-median-coefficient of variation) method was used to develop cross-sectional reference percentiles.

RESULTS: Reference curves were created for the GMFM-66 by age and GMFCS level, plotted at the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles. The variability of change in children's percentiles over a 1-year interval also was investigated.

DISCUSSION AND CONCLUSION: The reference percentiles extend the clinical utility of the GMFM-66 and GMFCS by providing for appropriate normative interpretation of GMFM-66 scores within GMFCS levels. When interpreting change in percentiles over time, therapists must carefully consider the large variability in change that is typical among children with CP. The use of percentiles should be supplemented by interpretation of the raw scores to understand change in function as well as relative standing.

SUMMARY OF KEY POINTS: Descriptive instruments measuring the extent of motor impairments or activity limitations can be used to: (1) identify children who might benefit from intervention; and (2) determine the optimal type of intervention and model of service delivery. Evaluative tools that measure activities or participation, but not primary impairments, should be used to determine change over time. Commonly used measures for describing children with DCD and evaluating outcomes are reviewed and discussed in the context of the ICF framework. Intervention approaches are then outlined for children with DCD that are targeted to the levels of activity, participation, and prevention of secondary impairments.

CONCLUSIONS: Outcomes of children with DCD will be optimized with the use of current research evidence and the appropriate ICF level guiding both assessment and intervention.

METHOD: An algorithmic approach was used to identify item sets of the GMFM-66 (GMFM-66-IS) using data from 95 males and 79 females with cerebral palsy (CP; mean age 14y 7mo, SD 1y 8mo, range 12y 7mo to 17y 8mo). The GMFM-66-IS scores were then validated using combined data from three Dutch studies involving 134 males and 92 females with CP (mean age 7y, SD 4y 6mo, range 1y 4mo to 13y 8mo), representing all levels of the Gross Motor Function Classification System.

RESULTS: The final algorithm contains three decision items from the GMFM-66 that determine which one of four item sets to administer. The GMFM-66-IS has excellent agreement with the full GMFM-66 both at a single assessment (intraclass correlation coefficient [ICC]=0.994, 95% confidence intervals [CI] 0.993-0.996) and across repeat assessments (ICC=0.92, 95% CI 0.89-0.95).

INTERPRETATION: The GMFM-66-IS is a promising alternative to the full GMFM-66. Users should be consistent in their choice of measure (GMFM-66 or GMFM-66-IS) on repeat testing and clearly identify which method was used.

METHODS: Data were collected using the Spinal Alignment and Range of Motion Measure (SAROMM), the Gross Motor Function Classification System (GMFCS) and the Activity Scale for Kids (ASK).

RESULTS: Two hundred and twenty-five adolescents (122 males; mean age 14 years 8 months; SD 1 year 8 months) participated. SAROMM scores by GMFCS levels and item scores in various body regions are presented. Correlations between indices of function and SAROMM total score were >0.70 (p<0.001). Males in GMFCS levels I/V obtained higher total SAROMM scores than females. Age was significantly associated with SAROMM scores for GMFCS levels IV/V participants.

CONCLUSIONS: These data provide benchmarks for evaluating impairments in adolescents with CP and support the role of function in contracture development and possibly prevention. Gender and age were factors that modified outcomes.

METHODS:: A sample of 104 girls and 126 boys, mean ages 14.7 (SD = 1.7) and 14.8 (SD = 1.7) years, were asked "Have you experienced physical pain in the past month?"

RESULTS:: Sixty-four percent of girls and 50% of boys reported pain. Pain was most frequent in the feet and ankles, knees, and lower back of girls and boys at Gross Motor Function Classification System levels I to IV. Foot and ankle and knee pain were also frequent at level V. The Spearman rho value between intensity and effect on daily activities was 0.75 (p < 0.01) and 0.82 (p < 0.01) for girls and boys.

CONCLUSIONS:: The high prevalence of pain and its effect on daily activities suggests a need for greater focus on health promotion.