The Responsiveness and Minimal Important Change of the Western Ontario Shoulder Instability Index and Oxford Shoulder Instability Score Does acupuncture used in nulliparous women reduce time from prelabour rupture of membranes at term to active phase of labour? A randomised controlled trial. Online training course on critical appraisal for nurses: adaptation and assessment Evaluating the teaching of evidence-based medicine. Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial. Evidence-based consumer health information: developing teaching in critical appraisal skills. Teaching critical appraisal during critical care fellowship training: A foundation for evidence-based critical care medicine Critical appraisal and positive outcome bias in case reports published in Brazilian dental journals. Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial Affecting residents' literature reading attitudes, behaviors, and knowledge through a journal club intervention.
• STUDY DESIGN : Prospect i ve cohort study . • BACKGROUND : Patient‐reported outcome measurements ( PROMs ) are widely used to evaluate functional limitations . Considering PROMs for shoulder instability , information is lacking with regard to what constitutes a relevant change from baseline scores . • OBJECTIVES : To evaluate the responsiveness of the Western Ontario Shoulder Instability Index ( WOSI ) and the  Oxford Shoulder Instability Score ( OSIS ) and estimate their minimal important change ( MIC ) . • METHODS : One hundred five consecutive patients with shoulder instability completed 5 PROMs at baseline and at 6‐month follow‐up . The PROMs included the  WOSI and OSIS , the Simple Shoulder Test , the Oxford Shoulder Score , and the Disabilities of the Arm , Shoulder and H and assessment .  Patients also rated their functional change on an anchor question at follow‐up . Responsiveness was evaluated by testing 9 hypotheses regarding predefined correlations between the changes in PROM scores , by calculating the area under the receiver operating characteristic curve and by calculating the st and ardized response mean and effect size statistics . The MIC was determined by identifying the optimal cutoff on the receiver operating characteristic curve . • RESULTS : Seven out of 9 hypotheses ( 78 % ) were confirmed ; as expected , a high correlation ( 0.77 ) was found between change scores of the WOSI and OSIS , whereas the correlations of the change scores of the WOSI and OSIS with those of general shoulder PROMs were slightly lower ( 0.61‐0.75 ) . The area under the curve was 0.83 ( 95 % confidence interval : 0.75 , 0.91 ) for the OSIS and 0.82 ( 95 % confidence interval : 0.74 , 0.90 ) for the WOSI . The MIC was about 6 points for the OSIS and about 14 points for the WOSI . • CONCLUSION : Both the WOSI and OSIS are able to measure change in shoulder function in patients with shoulder instability . The estimated MIC is 6 points for the OSIS ( on a scale from 0 to 48 ) and 14 points for the WOSI ( on a scale from 0 to 100 ) . •KEY WORDS : clinimetrics , functional outcome measures , outcome assessment , BACKGROUND To assess if acupuncture influences the onset of labour and the need for induction after prelabour rupture of membranes ( PROM ) in nulliparous women . Further , to investigate a possible effect of acupuncture on the woman 's wellbeing . METHODS In a r and omised controlled trial ( RCT ) , 106 nulliparous women with PROM were allocated to an acupuncture group ( AG ) or a control group ( CG ) . The outcome measures were time from PROM to onset of active phase of labour , and rate of inductions if labour was absent after 2 days . The women 's self-reported wellbeing was registered on a Visual Analogue Scale ( VAS ) . RESULTS There was no statistically significant difference between the 2 groups regarding time from PROM to active phase ( median times in AG versus CG : 15 versus 20.5 h , p=0.34 ) . Additionally , there was no difference between the 2 groups in the need for induction . We found no significant differences in self-reported wellbeing , but the women receiving acupuncture considered their treatment to be more positive than the controls ( p=0.003 ) . No adverse effects were reported . CONCLUSIONS Acupuncture treatment used in nulliparas after PROM showed no significant effect in reducing time to active labour or in reducing rate of inductions . There was no change in wellbeing as a result of acupuncture , but it was considered positive to receive this kind of treatment while waiting for labour to begin Background Research is an essential activity for improving quality and efficiency in healthcare . The objective of this study was to train nurses from the public Basque Health Service ( Osakidetza ) in critical appraisal , promoting continuous training and the use of research in clinical practice . Methods This was a prospect i ve pre-post test study . The InfoCritique course on critical appraisal was translated and adapted . A sample of 50 nurses and 3 tutors was recruited . Educational strategies and assessment instruments were established for the course . A course website was created that contained contact details of the teaching team and coordinator , as well as a course h and book and videos introducing the course . Assessment comprised the administration of question naires before and after the course , in order to explore the main intervention outcomes : knowledge acquired and self-learning readiness . Satisfaction was also measured at the end of the course . Results Of the 50 health professionals recruited , 3 did not complete the course for personal or work-related reasons . The mean score on the pre-course knowledge question naire was 70.5 out of 100 , with a st and ard deviation of 11.96 . In general , participants ’ performance on the knowledge question naire improved after the course , as reflected in the notable increase of the mean score , to 86.6 , with a st and ard deviation of 10.00 . Further , analyses confirmed statistically significant differences between pre- and post-course results ( p < 0.001 ) . With regard to self-learning readiness , after the course , participants reported a greater readiness and ability for self-directed learning . Lastly , in terms of level of satisfaction with the course , the mean score was 7 out of 10 . Conclusions Participants significantly improved their knowledge score and self-directed learning readiness after the educational intervention , and they were overall satisfied with the course . For the health system and nursing professionals , this type of course has the potential to provide method ological tools for research , promote a research culture , and encourage critical thinking for evidence -based decision making AN INCREASING NUMBER OF MEDICAL SCHOOLS AND residency programs are instituting curricula for teaching the principles and practice of evidence based medicine ( EBM ) . For example , 95 % of US internal medicine residency programs have journal clubs and 37 % of US and Canadian internal medicine residencies have time dedicated for EBM . Curricula based on EBM are increasingly popular in residency programs in other specialties , including family medicine , pediatrics , obstetrics/ gynecology , and surgery . Despite the widespread teaching of EBM , however , most of what is known about the outcomes of evidence -based curricula relies on observational data . Although evaluation of the quality of research evidence is a core competency of EBM , the quantity and quality of the evidence for effectively teaching EBM are poor . Ironically , if one were to develop guidelines for how to teach EBM based on these results , they would be based on the lowest level of evidence . There are several reasons why the quality of the evidence for teaching EBM is so weak . Many of these problems are related to the limitations in educational research in general . First , quantitative research methods may be inadequate to capture the complexity of an educational system . Second , students and residents change frequently , making it difficult to retain a consistent sample . Third , the time allotted for a given intervention may be brief in the context of the overall medical curriculum . Fourth , educational institutions may be hesitant to pay students as research participants or to allocate them to unproved educational interventions . Fifth , because most educational interventions are unique to specific institutions , assessment of their effectiveness is usually limited by small sample sizes . Furthermore , even if such interventions could be instituted across multiple institutions , the problems of st and ardization and cointervention would be particularly challenging . Sixth , perhaps because they are simplest to measure , the most frequently reported outcomes are subjective variables such as satisfaction or self-reported changes in attitudes or knowledge , rather than more important assessment s of objective ly measured clinical skills or improved patient outcomes . Finally , granting agencies do not give priority to educational investigations , making it difficult to undertake definitive multicenter studies . Educators who have struggled to evaluate educational interventions will find these issues all too familiar . With the increasing prevalence of EBM teaching , however , high quality evidence is more important than ever . Assessment of EBM teaching has also presented some unique problems . For instance , we originally defined evidence -based practice in terms of 4 basic competencies : ( 1 ) recognition of a patient problem and construction of a structured clinical question ; ( 2 ) ability to efficiently and effectively search the medical literature to retrieve the best available evidence to answer the clinical question ; ( 3 ) critical appraisal of the evidence ; and ( 4 ) integration of the evidence with all aspects of individual patient decision making to determine the best clinical care for the patient . Although these 4 skills were the most commonly reported curricular objectives in 99 internal medicine residencies that teach EBM , almost all the research on EBM education has focused exclusively on the third item : teaching critical appraisal skills . Examining this literature may yield useful insights into the difficulties of EBM educational research . Since critical appraisal skills involve the ability to differentiate strong from weak research methods , one might expect that this research would be of relatively high quality . In fact , most of these studies are method ologically weak . Using broad criteria to identify any reports of a graduate ( residency ) EBM curricula , Green identified 18 reports published between 1980 and 1997 . Of these , 72 % used a traditional journal club format to teach critical appraisal skills . Only 7 of the 18 studies evaluated the effectiveness of their intervention . Five of these 7 studies compared intervention with control ( only 1 with r and omized design ) ; only 2 of 7 studies used any blinding . Of these 5 controlled studies , 2 used a vali date d outcome measure to evaluate  critical appraisal skills .  Measurement of behavioral change relied on self-report in all 5 studies , and none examined patient outcomes . Most reports did not evaluate their OBJECTIVE To compare the efficacy of neuromuscular electrical stimulation ( NMES ) and transcutaneous nerve stimulation ( TENS ) on  hemiplegic shoulder pain ( HSP ) . DESIGN This is a prospect i ve r and omized controlled trial . SETTING A rehabilitation hospital . PARTICIPANTS Participants ( N=90 ) were r and omized into  NMES  ( n=36 ) , TENS ( n=36 ) , or control groups ( n=18 ) . INTERVENTIONS NMES ( 15Hz , pulse width 200μs ) was applied to supraspinatus and deltoids ( medial and posterior parts ) , whereas TENS ( 100Hz , pulse width 100μs ) was used on the same areas . The surface electrodes were placed near the motor points of the supraspinatus and medial or posterior bundle of deltoids . The 4-week treatment consisted of 20 sessions , each session composed of 1 hour of stimulation per day . Routine rehabilitation program without any stimulation was administered to the control and the NMES/TENS groups . Numerical rating scale ( NRS ) , active/passive range of motion ( AROM/PROM ) of shoulder , upper extremity Fugl-Meyer Assessment ( FMA ) , modified Ashworth scale ( MAS ) , Barthel Index ( BI ) , and stroke-specific quality of life scale ( SSQOLS ) were assessed in a blinded manner at baseline , 2 , 4 , and 8 weeks after treatment , respectively . MAIN OUTCOME MEASURES The primary endpoint was the improvement from baseline in NRS for HSP at 4 weeks . RESULTS NRS scores in NMES , TENS , and control groups had decreased by 2.03 , 1.44 , and 0.61 points , respectively after 4 weeks of treatment , with statistically significant differences among the 3 groups ( P<.001 ) . The efficacy of the NMES group was significantly better than that of the TENS group ( P=.043 ) . Moreover , the efficacy of NMES and TENS groups was superior to that of the control group ( P<.001 , P=.044 , respectively ) . The differences in the therapeutic efficacy on shoulder AROM/PROM , FMA , MAS , BI , and SSQOLS scores were not significant among the 3 groups . CONCLUSIONS TENS and NMES  can effectively improve HSP , the efficacy of NMES being distinctly superior to that of TENS in maintaining long-term analgesia . However , NMES was not more efficacious than the TENS or control group in improving the shoulder joint mobility , upper limb function , spasticity , the ability of daily life activity , and stroke-specific quality of life in HSP patients The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) , patient self-report section . Patients with shoulder dysfunction ( n = 63 ) completed the ASES , The University of Pennsylvania Shoulder Score , and the  Short Form-36  during the initial evaluation , 24 to 72 hours after the initial visit , and after 3 to 4 weeks of physical therapy . The test-retest reliability ( intraclass correlation coefficient[1-way r and om-effects ] , 0.84 ; 95 % CI lower limit , 0.75 ) and internal consistency ( Cronbach alpha , 0.86 ) values were acceptable . The st and ard error of the measure was 6.7 ASES points ( 90 % CI , 11.0 ) . Construct and discriminant validity was demonstrated . Responsiveness was demonstrated with a st and ardized response mean of 1.5 and an effect size of 1.4 . The minimal detectable change was 9.7 ASES points ( 90 % CI , 16 ) , and the minimal clinical ly important difference was 6.4 ASES points . The results indicate that the ASES is a reliable , valid , and responsive outcome tool The journal club is an established teaching modality in many house-staff training programs . To determine if a journal club improves house-staff reading habits , knowledge of epidemiology and biostatistics , and critical appraisal skills , we r and omized 44 medical interns to receive either a journal club or a control seminar series .  A test instrument developed by the Delphi method was administered before and after the interventions ( mean , five journal club sessions ) . By self-report , 86 % of the house staff in the journal club group improved their reading habits vs 0 % in the control group . Knowledge scores increased more in the journal club group than in the control group , and a trend was found toward more knowledge gained as more sessions were attended . Ability to appraise critically a test article increased slightly in each group , but there was no significant difference between the groups . We conclude that a journal club is a powerful motivator of critical house-staff reading behavior and can help teach epidemiology and biostatistics to physicians-in-training OBJECTIVE To help people who give health information to the public develop the skills they need to make sense of evidence about effectiveness . DESIGN Educational approach , preceded by careful planning with representatives of possible participants . SETTING AND STUDY OF PARTICIPANTS : Staff in consumer health information services and members of maternity self-help groups in the UK in summer 1995 . INTERVENTIONS Pairs of half-day workshops introducing participants to r and omised controlled trials and systematic review s and to their critical appraisal . The workshops were run participatively and had at their centre a critical appraisal session in small groups . MAIN OUTCOME MEASURES Attendance at workshops , satisfaction and enjoyment of workshops ; comments at a follow-on event . RESULTS Four pairs of workshops were held ( three for consumer health information services , one for maternity self-help groups ) , 54 people attended a pair of workshops and a further 34 attended individual workshops . The workshops were enjoyed and found to be a good use of time . CONCLUSIONS It is feasible to introduce critical appraisal skills to people whose primary role is to give health information to the public . There is a need for comparative evaluation of different approaches Objective To determine whether  fellowship training in critical care medicine with critical appraisal exercises improves the ability and confidence of fellows to evaluate the medical literature .  Design Prospect i ve , interventional pilot study . Setting Multidisciplinary critical care medicine training program at a large university hospital . InterventionFellows were given three didactic sessions covering study design , analysis , and critical appraisal techniques . During the course of the year , each fellow was required to review one article from the literature and present a critique of this article to the group and faculty ( Journal Club ) . Fellows were guided in the preparation of this presentation by one of the critical care medicine faculty . Finally , a written analysis and critique of the article was performed by each fellow . Measurements and Main Results A test was given to each fellow at the beginning and end of the academic year . This test consisted of two pairs of articles on therapy for acute lung injury . For the pretest , each fellow was assigned , at r and om , one pair of articles . Fellows were given 1 hr to review both articles and to fill out a six-point test to assess their ability and confidence to appraise each article . At the end of the year , each fellow was tested on the opposite pair , the tests were grade d in a blinded fashion and the results of each test were compared . Six fellows completed both pre- and posttests . These paired results were analyzed separately , whereas results for another six fellows were conducted as an unpaired analysis . Mean scores increased both for the paired analysis ( 4.1 ± 0.7 vs. 5.1 ± 0.5;p = .015 ) and for the unpaired analysis ( 4.3 ± 0.6 vs. 5.0 ± 0.5;p = .012 ) . Self-reported confidence in critical appraisal also increased ( 2.5 ± 0.5 vs. 3.9 ± 0.7;p = .004 and 2.6 ± 0.5 vs. 3.9 ± 0.6;p < .001 , respectively ) . Conclusion Critical appraisal exercises used in the training of critical care medicine fellows appear to improve both ability and confidence to appraise relevant medical literature The aim of this study was to carry out a critical appraisal to detect the occurrence of publication bias , specifically positive- outcome bias , in Brazilian dental journals . A convenience sample of twenty-eight dental journals published in Brazil between 1994 and 2003 was selected ( 564 issues containing 5,453 articles ) . Each article was classified according to method ological design ; 1,064 were classified as case reports . A simple r and om sample of 435 articles comprised the final study sample and was su bmi tted to a critical appraisal by previously trained raters . Although a great part of case reports achieve proper structural aspects , most authors did not consider important aspects that could help the decision making process , such as discussion of alternative approaches , limitation of the performed procedures , lack of long-term clinical follow-up , possible variations in treatment outcome , and failure to discuss limitations of study design . In addition , unanimous reports of successful outcomes of clinical interventions strongly suggest that publication of case reports was influenced by positive outcome bias , which may influence readers ' clinical decision making process Background Evidence -Based Medicine ( EBM ) is an important competency for the healthcare professional . Experimental evidence of EBM educational interventions from rigorous research studies is limited . The main objective of this study was to assess EBM learning ( knowledge , attitudes and self-reported skills ) in undergraduate medical students with a r and omized controlled trial . Methods The educational intervention was a  one-semester EBM course in the 5th year of a public medical school in Mexico . The study design was an experimental parallel group r and omized controlled trial for the main outcome measures in the 5th year class ( M5 EBM vs. M5 non-EBM groups ) , and quasi-experimental with static-groups comparisons for the 4th year ( M4 , not yet exposed ) and 6th year ( M6 , exposed 6 months to a year earlier ) groups . EBM attitudes , knowledge and self-reported skills were measured using Taylor ’s question naire and a summative exam which comprised of a 100-item multiple-choice question ( MCQ ) test . Results 289 Medical students were assessed : M5 EBM=48 , M5 non-EBM=47 , M4=87 , and M6=107 . There was a higher reported use of the Cochrane Library and secondary journals in the intervention group ( M5 vs. M5 non-EBM ) . Critical appraisal skills and attitude scores were higher in the intervention group ( M5 ) and in the group of students exposed to EBM instruction during the previous year ( M6 ) . The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group ( p<0.001 , Cohen 's d=0.88 with Taylor 's instrument and 3.54 with the 100-item MCQ test ) . M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups , but lower than the M5 EBM group . Conclusions Formal medical student training in EBM produced higher scores in attitudes , knowledge and self-reported critical appraisal skills compared with a r and omized control group . Data from the concurrent groups add validity evidence to the study , but rigorous follow-up needs to be done to document retention of EBM abilities OBJECTIVE To investigate whether a limited teaching intervention , based on principles of adult education , could change residents ' literature reading attitudes , behaviors , and knowledge . DESIGN The educational intervention supplemented an ongoing bimonthly journal club . The effects on residents were studied prospect ively before and four months following the intervention . SETTING A community hospital internal medicine training program . PARTICIPANTS All 14 residents : six in the first year , and four each in the second and third years of training . INTERVENTION A one-hour seminar incorporating principles of adult education , including the use of multiple teaching modalities . The content was based on the critical literature reading guidelines published by the McMaster group . Reinforcement of learning objectives was achieved by learner participation , written assignments , active feedback , and follow-up in subsequent journal clubs . RESULTS Residents improved their performances on objective testing of critical appraisal knowledge by 60 % ( p = 0.02 ) . They reported improved ability to appraise original research articles critically ( p = 0.01 ) and reported spending more useful time reading . Unaffected were the total time spent reading journals , the reasons for reading them , and the perceived value of journals in " keeping up " with advances in medical knowledge . CONCLUSION Journal clubs are important to residents , and their effectiveness in teaching critical appraisal and promoting reading of the literature may be augmented by applying principles of adult education
The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity .
Dutch users could use either the SDQ or the SST .
In Tamil , Slovene , Spanish and the Danish language s , the evaluated PROMs were not yet of acceptable validity .
None of these PROMs showed strong positive evidence for all measurement properties .
Objective To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures ( PROMs ) focussing on the shoulder , assessing “ activity limitations . ”