Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411118EnglishN2019September28HealthcarePsychometric Validation of Hindi Version of 2018 Lake Louise Acute Mountain Sickness Scoring System
English0105Deepak DassEnglish Thinles ChosphelEnglish Harish KumarEnglishBackground: The Lake Louise Score (LLS) – 2018 is a revised 4-item questionnaire used in the diagnosis of Acute Mountain Sickness. However, a validated Hindi translation of LLS-2018 is not available.
Material and Method: Fifty Hindi-speaking volunteers self-reported the translated Hindi version of LLS- 2018 after active ascent to high altitude (11,500 ft). It was then tested for its face validity and internal consistency.
Result: The Cronbach’s alpha was 0.69 and the corrected item score correlation was greater than 0.3.
Conclusion: The simple psychometric properties validate the Hindi version of LLS-2018 for the diagnosis of Acute Mountain Sickness.
EnglishAcute Mountain Sickness, Lake Louise Score, Hindi translation, PsychometricIntroduction:
Acute mountain sickness (AMS) is prevalent in mostly inadequately acclimatized individuals ascending to above 2500 m (8000 ft) altitude1. It is characterized by a combination of nonspecific symptoms, i.e. headache, fatigue, dizziness, loss of appetite and nausea2.
Lake Louise Score (LLS) is the most frequently used self-reporting questionnaire used in the diagnosis of AMS3. It was previously based on five symptoms namely headache, gastrointestinal symptoms, fatigue, dizziness and insomnia4. The symptoms were rated on a scale from 0 to 3 where 0 represents the absence of a symptom and 3 represents a severe symptom5.The LLS Consensus Committee revised his in 2018 (LLS18),wherein sleep disturbance was removed as a symptom for diagnosis6. In the revised system Acute Mountain Sickness is diagnosed if the LLS18score total exceeds 3 points from the four rated symptoms, including atleast one point from headache6. English is the source language of LLS18.
Direct application of English version of self-reporting questionnaires, as this one, without adapting to the cultural context or employing poorly translated versions can adversely affect the diagnostic effectiveness and validity of research data7.
Dellasante et al8 pointed out the importance of language when assessing altitude illness, strongly recommending translations of AMS questionnaires to the target language and psychometric validation of the translation to avoid deviation of meaning during translation.
There are approximately more than three hundred thousand domestic travelers going to Leh, annually9. Even though the demographics are not available, the authors have arbitrarily observed that most of them are from Hindi-speaking regions of India. Every year thousands of worshippers from all over India travel to Shri Amarnath Yatra (12,700 ft); Hemkund Sahib (14,000 ft); Manasarovar, (14,700m)10. Pilgrims traveling to high altitude are a vulnerable group11. There is general lack of awareness about AMS its prevention and usage of LLS as a diagnostic tool among these pilgrims12. A translated version of the LLS in Hindi could be helpful in the early detection of AMS. Early recognition of AMS is key to allowing individuals to seek medical attention before the risks of complications increases13.
Therefore, the aim of this study was to translate a conceptual equivalent of the LLS18 in Hindi (Devangari script), (LLS18H), and conduct a post hoc psychometric validation.
Method:
The LLS18H was translated in Hindi by the authors. Effort was made to create a conceptual equivalent that was colloquial and easy to understand. To confirm linguistic validity the LLS18H was back translated to English by a bilingual scholar from the humanities field who had no knowledge about the LLS18. The back translation was an iteratively process and each version was compared with the original English version to detect any misinterpretation or inaccuracies in the translation. The final version of the LLS18H was put up to an expert panel for evaluation in terms of comprehension and relevance of the scale's items to the concept of interest14. The expert panel consisted of three Hindi-speaking senior scientists experienced in field of high-altitude physiology. After evaluation by the expert panel, the final version of the LLS18H was frozen for validation. [Appendix – 1]
Fifty healthy Indian males volunteered for the study. The mother tongue of the volunteers was Hindi. All the volunteers had their formal education in Hindi medium. The volunteers were non-smokers, and did not have any history of pulmonary disease. The volunteers and had not visited high altitude (HA) areas in the past six months. They air travelled to the location, which is at an altitude of approximately 11,500 ft. The LLS18H was filled by them within 24-48 hours on arrival to HA2.
Since the primary aim was to translate the LLS18 in Hindi and validate the version, two simple psychometric tests; namely face validity and internal consistency were considered to validate the LLS18H14.
Face validity is subjective assessment, defined as experts opinion and feedback from the volunteers to assess the readability, consistency of style and clarity of languageof the questionnaire items15. There no standards with regards to its measurement or quantification of face validity16. Two main facets of the translated version were assessed; comprehensibility andclarity of language. Comprehensibility was assessed by asking; “Were you able to understand the questions? [Yes/No]”, clarity of language was assessed by asking “Were you able to identify the symptoms clearly [Yes/No]”. The expert panel were asked to rate if the language used in the final version of the LLS18H clearly described the symptoms of AMS as ‘‘clearly represented,’’ ‘‘somewhat represented,’’ or ‘‘not represented.’”
These questions were considered to provide adequate information on the general readability, comprehensibilityand possible future review for ambiguity in the language.
The internal consistency of the LLS18H was assessed using Cronbach’s alpha. A robust internal consistency was considered as value above 0.717,18
The internal consistency is defined as the degree to which all items in the scale measures the same concept or construct and hence it is connected to the inter-relatedness of the items within the scale, it is expressed as a number between 0 and 119. Internal consistency is the degree of the association between the items of the questionnaire items, and it can demonstrate the degree to which items are measuring the same condition18.
A total corrected item-score correlation which avoids the inclusion of the item itself in the total was used to assess the internal validity20.
Result:
The mean age of the volunteers was 32.5 years (± 6.3). All the fifty volunteers were assessed with the LLS18H. Upon arrival at 11,500 ft the mean LLS18H score was 3.21 ±2.04. AMS was diagnosed for score of three or more points from the four rated symptoms, including at least one point from headache. 18% was diagnosed with AMS. All of the participants responded affirmatively to the questions with regard to comprehensibility and clarity of language.
The Cronbach’s alpha score was 0.69 in this dataset. The corrected item-total correlation (Spearman Coefficient) was as follows:
Discussion:
General observation: The authors have observed some interviewers’ inability to precisely interpret the symptoms listed in the English version of the LLS when verbally administered. The authors had also noticed a few dissimilar versions of LLS translated in Hindi being used for both diagnostic as well as research purposes. The direct application of the English version of LLS18 or informal translations could conceivably affect the diagnosis of AMS. Further, Southard et al21reported the sophistication of language used in the English version LLS when applied to children and adolescent in Denver, Colorado. To our knowledge there is no validated translation of LLS18 in Hindi.
Discussion of Result: Face validity is a subjective evaluation of the questionnaire in terms of feasibility, readability, clarity of the wording, the possibility of the target audience’s ability to answer the questions22. The experts panel agreed on clarity of language used to represent the symptoms of AMS in the LLS18H. Volunteers reportedly did not face any difficulty in comprehending the questionnaire and there was no ambiguity in identifying the symptoms given in the LLS18H.
Corrected item-total correlation coefficients indicate the correlation of an item with the total scale when that item is removed. Values of over 0.3 show a good level of correlation23. All of the total corrected LLS18H items scored were the above the yardstick level of 0.30 hence supporting the internal reliability of the LLS18H. Headache gave the best item-LLS18H correlation. The fact that the LLS18H was evaluated within 24-48 hours increased the probability of occurrence of the symptom2.
The most common way to test the reliability of a translated questionnaire is to use Cronbach’s alpha coefficient which was estimated to be 0.69, signifying an adequately judicious internal consistency24. The value is similar to earlier studies conducted by Carod-Artal et al 25(Spanish version of LLS) and Macinnis et al26 (Nepali version of LLS), although the later had reported internal consistency in ordinal alpha coefficient. Therefore, the internal consistency of the LLS18H seems acceptable to assess AMS.
Limitation: The limitation of our study is that, due to small sample size the factorial structure to assess the interactions between latent factors could not be done27. The literacy status of the volunteers was not taken into consideration. The sensitivity and specificity of the translated version could not be corroborated with clinical findings.
Conclusion:
LLS18H displayed an acceptable reliability and validity when used by Hindi-speaking volunteers. The study contributes to the usage of a validated instrument to assess the symptoms of AMS in Hindi-speaking population for diagnostic and research purposes.
Englishhttp://ijcrr.com/abstract.php?article_id=2631http://ijcrr.com/article_html.php?did=2631
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411118EnglishN2019September28HealthcareCephalosporins and Metronidazole as Risk Factors for ESBL-Producing Organisms
English0611Scherer JSEnglish Carvalho OFEnglish Silliprandi EMEnglish Dos Santos RPEnglishPrevalence of Extended-spectrum β-lactamase (ESBL)-producing organisms is increasing in healthcare associated (HCA) institutions and community. We conducted a matched case-double control study to assess the risk factors for acquisition of these multi-drug resistant organisms (MDRO), in a cardiac center in Brazil. We studied two hundred and thirty-eight patients (58 cases). Two groups of comparison were included: control Group 1 (N=120), with patients without infection; and control Group 2 (N=70), with patients with infection by non-ESBL producers Klebsiella spp., E. coli or Proteus mirabilis. On multivariate analysis, risk factors for hospital acquisition of ESBL-producing organisms were as follows: previous use of second-generation cephalosporins (OR 5.73; 95% CI 1.30-25.31), fourth-generation cephalosporins (OR 3.62; 95% CI 1.24-10.53) and metronidazole (OR 11.68; 95% CI 1.20-114.00). Previous identification of MDRO (OR 8.98, 95% CI 1.61-50.18), number of days on antibiotic use (OR 1.12; 95% 1.04-1.20) was also independently associated with ESBL-producing organisms. Interestingly, the presence of other MDRO in ward (OR 0.30; 95% CI 0.13-0.71) was associated as a protector factor for ESBL identification. When there was a low consumption of third-generation cephalosporins and quinolones, the second- and fourth-generation cephalosporins and metronidazole were, associated with ESBL-producing bacteria. In addition, adherence to isolation precautions and infection control recommendations can help to prevent ESBL-resistance dissemination.
EnglishESBL, Multidrug resistance, Enterobactereaceae, Infection control
INTRODUCTION
Extended-spectrum β-lactamase (ESBL)-producing organisms pose a great challenge to epidemiologists, infection control practitioners and physicians1,2. The dissemination of these broad spectrum resistant bacteria is difficult to control and the therapeutic options for severe infections are limited1,3,4.
The emergence of ESBL-producers bacteria is increasing in both hospitals and community5. This resistant mechanism is most found in Klebsiella pneumoniae in hospital and Escherichia coli in community as well5,6.
There are several reasons for the increasing prevalence of these organisms in hospitals4,7, such as, the selective pressure of antimicrobials overuse, the use of invasive devices, cross-transmission between patients, hospital cross-infection, and the increase in prevalence of community origin6,8,9,10.
Infection by these organisms is associated with higher mortality rates11,12. Carbapenems use is associated with lower mortality in patients with serious infections8,13. Although other agents may be used in non-severe infected patients, this use must be viewed with caution14,15,16,17
We conduct a case control-study in a cardiac center in Brazil to identify risk factors for ESBL-producing organisms identification.
METHODS
A matched case-double control study was conducted at Instituto de Cardiologia, a 250-bed hospital for cardiology patients in southern Brazil. Instituto de Cardiologia attends adult and pediatric, surgical and clinical cardiology patients. In addition, the hospital has a cardiac transplant service, and three intensive care units (ICUs), which account for 16% of institution’s beds.
Adult (age ≥ 18 years) inpatients were selected from the entire hospital irrespective of unit. Case patients were those with identification of ESBL-producing bacteria at any site, after 48 hours of admission. For this analysis, we included two control groups: Group 1 was composed of patients from hospital units but not with ESBL-producing organisms; and patients with non ESBL-producing composed Group 2 Klebsiella spp., Escherichia coli, or Proteus mirabilis. Controls were matched in terms of age (± 3 years), date of sample identification (± 3 days), gender, and hospital ward.
From January 2008 to December 2009 all ESBL-producing organisms were included (patient cases). Controls were selected in a rate 1:2 (Group 1): 1 (Group 2).
All samples were processed at the microbiology laboratory at Instituto de Cardiologia. Detection of ESBL-producing bacteria was made according to the National Committee for Clinical Laboratory and Standards guidelines18. The susceptibility to antibiotics used agar disc diffusion method tested. For detection ESBL-producing strains, Double-disc synergy test was used. Bacteria considered as multidrug resistant organism (MDRO) were as follows: methicillin resistant Staphylococcus aureus (MRSA), ESBL-producing Escherichia coli, Klebsiella spp., Proteus mirabilis, carbapenems resistant Acinetobacter baumanii and Pseudomonas aeruginosa, vancomycin resistant enterococci (VRE).
We reviewed data from patients’ medical charts. Antibiotic use was measured for 24 months of study period, for the entire hospital. Data from prescribed drugs, such as, carbapenems, fluoroquinolones, cephalosporin’s, piperacillin/tazobactam, vancomycin, ampicillin+sulbactam and oxacillin, metronidazole, clindamycin, sulfametoxazole+trimetoprrim were reviewed. Patient comorbidities, invasive devices use and surgical procedures, ICU admission, previous MDRO identification in the previous 90 days, previous hospital stay during the last year, and other than ESBL-producing MDRO identified in patient ward were also reviewed.
Previous antibiotic use was at least 48h of inpatient use in the current admission. Time-at-risk is defined as the duration of time between admission and the detection of the antibiotic-resistant organism on culture for cases; as the number of days between admission and detection of the susceptible organism on culture, for non-resistant enterobactereacea infected controls; and the time between admission and discharge for non-infected control patients. Antibiotic consumption counted a number of defined daily doses (DDD), expressed as DDD per 100 patient-days. Central venous catheter (CVC), urinary catheterization, and mechanical ventilation were considered as invasive devices.
A descriptive analysis of the variables collected from each patient was performed. The chi-squared test or Fisher’s exact test were used for univariate analysis of selected categorical variables. All odds ratios on univariate analysis were controlled for time at risk exposure. Associations were considered statistically significant when P value was ≤.05. Multivariate analysis, along with 95% confidence intervals (CI) and Odds ratios were calculated using the Logistic regression model. We divided the analysis in three models. The first model included the risk factors other than specific antimicrobials that were statistically significant on univariate analysis; the second model included the antimicrobials with statistical significance on univariate analysis and days on antimicrobial use. The final model included the variables that were statistically significant in the first two models. All analysis was corrected for time at risk. All collected data was stored in Excel® 2000 version and analyzed using SPSS® 18.0 program.
The research and ethics committee of Fundação Universitária de Cardiologia (Brasil) approved the study and waived the need for informed consent because of the nature of the study.
RESULTS
Patient characteristics are shown in Table 1. Through the study period, we included fifty-eight case patients. Most of them infected with Klebsiella spp. (65.5%; N=38). The rest of patients were infected with Proteus spp. (25.9%; N=15) and E. coli (8.6%; N=5). Control
Group 2, were composed by 70 patients with identification of non ESBL-producing Klebsiella spp. (85.7%; N=60), Proteus spp. (10.0%; N=7), and E. coli (4.3%; N=3). One hundred and twenty patients were included in control Group 1.
Most patients were at general ward (55.2%; N=137); 26.6% (N=66) at post-surgical ward; 15.7% (N=39) at ICU; and 2.4% (N=6) were at emergency department. From case patients, most specimens were from urinary tract (39.6%; N=23), respiratory tract (32.8%; N=19), and surgical wound (12.1%; N=7). From control group 2 sites of specimen identification were as follows: respiratory tract (45.7%; N=32), urine (31.4%; N=22), blood culture (10.0%; N=7), and surgical wound (7.1%; N=5).
From January 2008 to December 2009 the mean consumption of antibiotics (in DDD/100 patient-days) were as follows: fourth-generation cephalosporins (5.9), third-generation cephalosporins (0.3), second-generation cephalosporins (2.0), first-generation cephalosporins (4.1), oxacillin (5.7), ampicillin+sulbactam (4.4), piperacillin+tazobactam (2.2), quinolones (2.1), vancomycin (1.4), and carbapenems (0.8).
Table 2 shows the multivariate analysis of statistically significant variables on univariate model, for both control groups.
Antimicrobials, associated with ESBL-producing organism, on univariate analysis of control Group 1, controlled for time at risk, were: piperacillin+tazobactam (OR 3.14, IC 95% 1.33-7.39; PEnglishhttp://ijcrr.com/abstract.php?article_id=2632http://ijcrr.com/article_html.php?did=2632
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411118EnglishN2019September28HealthcareEfficacy of Four Square Step Test and Modified Dynamic Gait Index to Predict the Falls in Parkinson’s Disease: A Comparative Study
English1217Snehal JoshiEnglish Swapnali JoshiEnglishIntroduction: This study evaluated the efficacy of Four square step test (FSST) and modified dynamic gait index (mDGI) in patients with Parkinson’s disease to evaluate balance. In this study 50 individuals with Parkinson’s disease were assessed according to Hoen Yahr scale (grades between 1to 3), were subjected to FSST and mDGI.
Results: FSST and m DGI scores were taken of the same patient. and sensitivity and specificity were also calculated. Both these scales show a highly significant negative correlation with each other (. r= – 0.88, PEnglishSensitivity, Specificity, Balance, Parkinson’s diseaseParkinson’s disease (PD) is a progressive disorder characterized by various motor and non-motor features that can impact on function a variable degree. The four cardinal features of PD that can be under the acronym TRAP: Tremor at rest, rigidity, Akinesia (or bradykinesia) and Postural inability. In addition, flexed posture and freezing (motor blocks) are classic features of parkinsonism, with PD as the most common form.1
The symptoms of PD begin insidiously and worsen gradually. Rest tremor is often the first symptom recognized by the patient. But sometimes it begins with bradykinesia; and in some patients, tremor may never develop. Bradykinesia manifests as slowness, such as slower and smaller handwriting, decreased arm swing and leg stride when walking, decreased facial expression, and decreased amplitude of voice. Rest tremor can be intermittent at the beginning, might be present only in stressful situations; eventually it tends to be present most of the time and got worsens in amplitude with stress or excitement.2 There is a continuous worsening of symptoms over time; and if it remains untreated then those symptoms may lead to disability with severe immobility and falling tendency may increase. The early symptoms and signs of PD that is rest tremor, bradykinesia, and rigidity are related to progressive loss of nigrostriatal dopamine.2 These signs and symptoms result from striatal dopamine deficiency and are usually correctable by levodopa and dopamine agonists. As PD progresses over time, symptoms that do not respond to levodopa develop, such as flexed posture, the freezing phenomenon, and loss of postural reflexes; these are often referred to as non-dopamine-related features of PD. Moreover, bradykinesia that responded to levodopa in the early stage of PD increases as the disease worsens and no longer fully responds to levodopa. It is particularly these intractable motoric symptoms that lead to the disabilities of increasing immobility and balance difficulties. There are also some non-motor symptoms associated with motor symptoms, these include fatigue, depression, anxiety, sleep disturbances, constipation, bladder and other autonomic disturbances (sexual, gastrointestinal), and sensory complaints. Sensory symptoms include pain, numbness, tingling, and burning in the affected limbs; Behavioral and mental alterations are common and include changes in mood, decreased motivation and apathy, slowness in thinking (bradyphrenia), and a declining cognition that can progress to dementia.2
Stages of Parkinson disease according to Hoen Yahr scale3
Hoen and Yahr Scale
1: Only unilateral involvement, usually with minimal or no functional disability
2: Bilateral or midline involvement without impairment of balance
3: Bilateral disease: mild to moderate disability with impaired postural reflexes; physically independent
4: Severely disabling disease; still able to walk or stand unassisted
5: Confinement to bed or wheelchair unless aided
Motor symptoms of Parkinson’s include:
Tremor, bradykinesia, rigidity, postural instability, Hypomimia, dysarthria, dysphagia, sialorrhoea, decreased arm swing, shuffling gait, loss of righting reactions, festination difficulty arising from chair, turning in bed, Micrographia, slow activities of daily living, Glabellar reflex, blepharospasm, dystonia, scoliosis, camptocormia
Balance impairment or postural instability is one of the major problems faced by Parkinson’s patients. This can lead to falls which in turn can lead to serious consequences like death or morbidity. Hence it IS necessary to use an outcome measure which will determine the individuals at the risk of fall
A number of rating scales are used for the evaluation of motor impairment and disability in patients with PD,like UPDRS', modified dynamic gait index ( m DGI), four square step test ( FSST), timed up and go test (TUG), etc.1
Balance is one of the important parts of day to day life. Gait and balance deficits are common in patients with Parkinson disease. Patients with PD are characterized clinically by movement-related symptoms, such as tremor, rigidity, slow movement (bradykinesia), and postural instability. Consequently, they experience difficulties in gait and gait related activities (e.g., turning and climbing stairs) that reduce their quality of life.
To manage and monitor gait and balance deficits, clinicians need to routinely measure these characteristics of patients with PD. Furthermore, to interpret the results of the measurements, clinicians must determine whether change scores in gait and balance deficits represent true changes or are a result of measurement error.
There are so many outcome measures which are used for assessing balance in individuals with Parkinson’s disease like dynamic gait index, berg balance scale, timed up and go test, four square step test, etc. Amongst them modified dynamic gait index is used as gold standard outcome measure to assess balance in Parkinson’s disease individuals as its reliability and validity is very high in Parkinson’s disease.
Recent studies found that four square step test is also valid in individuals with Parkinson’s disease. Four square step test is short, less time consuming, easy test to assess balance. In Parkinson’s disease individuals usually fatigue easily due to posture, age, severity of disease, bradykinesia. Other balance tests are quiet time consuming n lengthy which causes individuals to fatigue in test, so that it is not possible to get effective outcome of those test.
There are very few studies are conducted on four square step test in Parkinson’s disease individuals. There are no studies are performed on comparison of four square step test and modified dynamic gait index in individuals with Parkinson’s disease individuals.
So purpose of this study was to find out correlation between four square step test and modified dynamic gait index and its sensitivity and specificity in individuals with Parkinson’s disease.
Four square step test 4 (FSST):
The Four Square Step Test (4SST), first described by Dite and Temple, is a quick and simple clinical test that requires an individual to rapidly step over obstacles in the forward, backward, and sideways directions. It was hypothesized that the 4SST may be a useful balance screen in people with PD for the following reasons: a) it demands complex anticipatory postural adjustments for gait initiation, known to be impaired in people with PD, b) the requirements for stepping backward and laterally may be particularly challenging for people with PD, and c) the task requires execution of a complex multi-step movement sequence, another area of known difficulty in PD.4
Four square step test versus Modified Dynamic Gait Index in Parkinson’s disease
Modified dynamic gait index (mDGI):
A modified version of the DGI (mDGI) was recently developed by Shumway-Cook and colleagues. The mDGI retains the original 8 tasks but expands the scoring system to evaluate three correlated but unique aspects of walking performance like gait pattern, level of assistance, and time.7
The original 8 tasks of DGI were retained in the mDGI; however, minor modifications were made to facilitate timing and to clarify procedures for several of the tasks. To enable timing, a 6.1-m distance was imposed for all tasks. The change pace task included an acceleration phase (“walk as quickly as you safely can”) but no deceleration phase, as it was difficult to impose both of these task modifications in a distance of 6.1 m. The over obstacle task changed the dimensions of the obstacles and specified the dimensions and placement of the 2 obstacles.
AIM
To compare efficacy of four square step test and modified dynamic gait index in individuals with Parkinson’s disease.
OBJECTIVES
To find out correlation between four square step test and modified dynamic gait index
To find out sensitivity and specificity of four square step test in Parkinson’s patient.
To compare sensitivity and specificity of modified dynamic gait index in Parkinson’s patient.
MATERIALS AND METHODOLOGY
Type of Study: Observational analytical cross sectional study
Study Population: Individuals with Parkinson's disease
INCLUSION CRITERIA:
1. Individuals with parkinsonism disease
2. Individuals who are in between Hoen Yahr grade 1 to 3.
EXCLUSION CRITERIA:
1. Affection in cognition and other perceptual disorders
2. Visual problem
3. Patients having dementia
4. Auditory problems
MATERIALS
Outcome measures: Four square step test (FSST), Modified dynamic gait index (mDGI).
1. Ribbons
2. Measuring tape
3. Stop watch
4. 76cm long, 12cm wide, 5cm thick obstacle
Study settings: Physiotherapy OPD, Patient’s home
Sampling technique: Simple random sampling
Sample size: 50 subjects
METHODOLOGY
The clearance from the ethics committee was taken.
The subjects were screened according to the inclusion, exclusion criteria.
An informed written consent was taken from the subject. The entire procedure was explained to the subject. Before the administration of balance outcome measures, Hoen Yahr scale and history of fall was assessed. Then subjects were asked to perform Four square step test. FSST was assessed twice and best time taken as the score.4 After taking 10 minutes of rest subjects were asked to perform modified dynamic gait index. Data was analyzed using spearman correlation test for correlation. The sensitivity and specificity will be calculated using formula:
RESULTS
Fifty subjects were included in this study after screening for inclusion and exclusion criteria.
For finding cutoff point of Modified dynamic gait index& FSST ROC curve was plotted
Statistical analysis for correlation of Four square step test and Modified dynamic gait index was done using Spearman’s correlation formula.
Sensitivity and specificity of Four square step test and Modified dynamic gait index was done using sensitivity and specificity formula.
Graph I indicate gender distribution in subjects. It showed that around 76% were males and 24% were female
Table III indicates sensitivity and specificity of mDGI and FSST.
mDGI Sensitivity =91.2 % Specificity = 81.2 %
FSST Sensitivity = 94 % Specificity = 84 %
For finding cutoff point of Modified dynamic gait index ROC curve was plotted.
GRAPH II shows cutoff point for mDGI is 56. At this cutoff, maximum sensitivity and specificity can be established.
GRAPH IV shows cutoff point for FSST is 9.68 seconds. At this cutoff maximum sensitivity and specificity can be established
Graph IV indicates highly significant negative correlation between FSST and mDGI. (r=– 0.88, PEnglishhttp://ijcrr.com/abstract.php?article_id=2633http://ijcrr.com/article_html.php?did=2633
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Adriana Galvan et al Pathophysiology of Parkinsonism Clinical Neurophysiology. 2008 July; 119(7): 1459–1474.
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6) Allan H. Ropper, Martin A. Samuels, Joshua P. Klein Adams and Victor's Principles of Neurology 10th edition Ch.4 Abnormalities of Movement and Posture Caused by Disease of the Basal Ganglia
7)Boonstra, Tjitske et al Gait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology Movement disorders: Edited by Marie Vidailhet August 2008 - Volume 21 - Issue 4 - p 461–471
8) B H Wood, et al Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study J Neurol Neurosurg Psychiatry 2002;72:721–725
9) Isao Sugeta, Rpt, Ms et al Ability of the Four-square Step Test to Predict Falls among Community-dwelling Frail Elderly Rigakuryoho Kagaku 2016 31(4): 615–620,.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411118EnglishN2019September28Healthcare
Psychometric Properties of Job Satisfaction Scale for High School Teachers
English1824P. ShankarEnglish K. SubramanyamEnglish
Introduction: Job satisfaction is a worker’s sense of achievement and success in the job. It is generally perceived to be directly linked to productivity as well as to personal well-being. Job satisfaction implies doing a job one enjoys, doing it well and being rewarded for one’s efforts. This study aimed to develop and assess the psychometric properties of a job satisfaction scale tailored specifically for high school teachers. Job satisfaction among educators is a critical factor influencing not only their well-being but also the quality of education provided to students. Despite the importance of measuring job satisfaction, there remains a lack of specific instruments designed to comprehensively evaluate the unique facets of job satisfaction within the high school teaching context.
Aim/Objectives: Psychometric properties of job satisfaction scale for high school teachers and to develop a tool for job satisfaction among high school teachers.
Methodology: Sample of the present study consists of 200 high school teachers in Hyderabad city of Telangana state. Tool used was development of the job satisfaction scale by Dr. P. Shankar and Dr. K. Subramanyam.
Results: Results revealed that all areas of the tool have high reliability with regard to overall job satisfaction. The strength of the tool is identifying appropriate areas to measure Job satisfaction. Eight areas with suitable items in each area were included in this tool. These areas are more suitable to the high school teachers. In measuring job satisfaction of high school teachers it is more useful. The Job satisfaction scale developed in this study is very straight and simple. It is directly measures job satisfaction. It also have good reliability. This tool can be used for others to meet their purpose.
Conclusion: The results offer promising implications for assessing and understanding the factors contributing to teacher job satisfaction, which can ultimately enhance teacher retention and the quality of education in high school settings..
EnglishJob Satisfaction, High School Teachers, Psychometric Properties, Achievement and Success in the Job, Development, Professionhttp://ijcrr.com/abstract.php?article_id=4784http://ijcrr.com/article_html.php?did=4784
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