Test and measurement issues

Even with the great variety seen in the clinical practice of physiotherapists (PT) a PT typically meets patients with complaints of pain and/or functional limitations possible arisen in the musculoskeletal system (MSS). The first and most important question for seeing a PT is to decide whether the problem arises from alterations in the body structure or function or not. Thus, a PT needs tools to answer that question. Browsing through PT textbooks shows an almost endless amount of different tests and measurement methods. However, if the PT should be able to answer the question in a useful and correct way, the suggested tests and methods should be valid, reliable and lead to effective advice and/or treatment. If these basic demands are not fulfilled, the patient will be given the wrong functional diagnosis and therefore both a wrong prognosis and/or at best a useless or maybe a harmful and worsening treatment. In order to achieve acceptable validity and reliability, the tests and methods should be quantitative. Unfortunately, this requirement will almost always limit the content of the answer achieved from the test or method, i.e. the test and method excludes important aspects of the patients reality and thereby aspects of the problem important to know. It is important always to consider limitations of the quantitative tests and methods; however, a better but more complex way would be to try to include as much as possible of the complex reality in the tests and methods. In the present issue of Advances in Physiotherapy, Lisbeth Gard and Birgit Rösblad tries to deal with this relevant but difficult task. What they are trying is a very important step in the development of the physiotherapy profession, since we need to be explicit in both our movement analyses and the way we deal with these results. That the method turned out to be not as sensitive as wished for should not be a discouragement, but should simply help the researcher and practitioner to be more specific when this and other methods to assess motor capacity of children are developed. In a reliability study of the selective motor control scale (SMC scale), Kristina Löwing and Eva B. Carlberg pointed out the importance of performing the reliability in the clinical setting, i.e. where the test will be used. Let me add that besides the importance of testing the reliability of a new test, reliability is a property of a measurement, not a test or an instrument. Thus, whoever would like to use the SMC scale should perform a reliability test in their own clinical setting before they implement the test into daily practice. If the reliability then is found to be poor, they need to retest the manual and the procedure again. How difficult can it be? I mean, a push-up or a situp should be rather simple to perform. But with a closer look, as Sofie R. Augustsson and co-workers have shown in the present issue of Advances in Physiotherapy, a sit-up is not simply a sit-up. By a thorough literature analysis and a sharp standardization, the authors found a very good reliability for ways to perform push-ups and sit-ups. Remember, if you want to find the same reliability in your clinic, you need to follow the procedure described in the paper by Augustsson and co-workers. Sometimes, analyses of a test method do not show the promising results anticipated. This, however, may be a more important result than a moderate positive result indicating that the test or questionnaire could be used. By showing that a certain questionnaire and/or test is of no use, the authors have saved clinicians time and efforts. Helena Nordvall and co-workers, in their testing of both a questionnaire and a functional test, have tried to evaluate whether these methods could identify the one in risk of falling short again. But neither a well-founded questionnaire nor apparently relevant functional tests could identify the fallers. Talking about falling, Eva Nordell and co-workers have done a great job in translating and testing a Swedish version of the Fall Efficacy Scale-International (FES-I). They have tested the internal reliability, examined the internal structure and the correlation between FES-I and the Short Form 12. While Nordvall could not identified those who will fall in the near future, Nordell showed that the FES-I seem to be able to identify those who are afraid of falling. When the first question is difficult to achieve, a positive answer to the second is so more important for both clinical practice and research. As mentioned above, we as PTs need to be more precise and explicit in both our movement analyses Advances in Physiotherapy. 2009; 11: 49 50