Effect of cognitive apprenticeship on student-clinician reliability and concurrent validity in rating quality of movement of osteoarthritic subjects
Poulsen, Daniel Roger
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Background of Problem: There are no functional measures of movement quality that can be utilized in the clinical setting to assess the osteoarthritic patient population which have displayed adequate reliability or validity. Previous research shows that the visual observational assessment (VOA) tool is the best method of qualitative measure. However, the VOA tool has only moderate reliability and no evidence exists on the validity of measures through VOA. Purpose: Determine if applying a standard method of education, Cognitive Apprenticeship (CA), would significantly improve inter-rater & intra-rater reliability and concurrent validity of student physical therapist measures of movement quality in patients diagnosed with osteoarthritis to statistically and clinically significant levels. Research Design: A two group pretest-posttest control group design was used to compare the intra- and inter-rater reliability and concurrent validity of visual observational assessments (VOA) obtained from student physical therapists (SPT) who underwent the CA educational intervention to SPTâ€™s who did not. A 2x2 mixed design ANOVA was used to examine differences between groups and within groups. Results: No significant difference was found between any group or time for inter-tester reliability. For intra-tester reliability a significant within groups effect was present (F(1/45) = 9.63, p < 0.05, Î·2=0.18, Power=0.86); post hoc t-tests revealed significant improvement in the intervention group (t(23)=3.74, p<0.025, d=0.98, Power=0.95) but, not the control group (t(24)=0.79, pâ‰¥0.025, d=0.19, Power=0.12). For concurrent validity a statistically significant interaction effect was present (F(1/45) = 4.19, p < 0.05, Î·2=0.09, Power=0.52) and a statistically significant within-subjects effect was present (F(1/45) = 31.75, p < 0.05, Î·2=0.41, Power=1.00); post hoc t-tests revealed significant improvement in the intervention group (t(23)=5.82, p<0.025, d=1.39, Power=1.00) but, not the control group (t(24)=2.40, p>0.025, d=0.57, Power=0.63). Conclusions: Cognitive Apprenticeship educational intervention appears to significantly improve intra-tester reliability and concurrent validity to statistically and clinically (â‰¥0.90) significant levels necessary for application of visual observational assessment in clinical decision-making in the osteoarthritic patient population.