Training novice clinicians improves observation accuracy of the upper extremity after stroke.

OBJECTIVES

To determine whether training influenced the accuracy of observational kinematic assessment (OKA) of hemiplegic upper extremity impairment and to elucidate the contribution of knowledge of results to learning.

DESIGN

Intervention study; before-after testing of OKA accuracy after training, using 2 trained groups (with knowledge of results, KR group; without, NKR group) and 1 control group with a 1-week retention test.

SETTING

Tertiary teaching.

PARTICIPANTS

Fifty-one first-year physical therapy student volunteers acted as observers. They were ranked on pretest accuracy and then randomized into groups. A consecutive sample of 11 stroke patients and 4 nondisabled subjects acted as performers.

INTERVENTIONS: Performers were videotaped with 3 cameras and upper extremity kinematics derived using computer-assisted motion analysis. Training and test videotapes were generated. Training groups received video-based training of path indirectness accuracy on 4 occasions. The OKA accuracy of all observers' judgments of speed, jerkiness, and path indirectness were examined pretest and posttest.

MAIN OUTCOME MEASURE: Accuracy reported as mean absolute error, which was calculated as difference between observers' judgments and criterion kinematic values.

RESULTS

The KR and NKR groups showed reduction in mean absolute error after training of 34.8% and 6.2%, respectively. Improvements were retained after a 1-week no intervention period. Transfer to trained, but not untrained kinematic parameters occurred. The control group did not change.

CONCLUSIONS

OKA accuracy is susceptible to training and knowledge of results aids learning. However, training is task specific.