Bachelor in Physiotherapy
Bachelor's Degree
| Status | Complete |
|---|---|
| Part Time | No |
| Years | 1991 - 1995 |
Dr Praveen Kumar's Qualifications (4)
Post Graduate Certificate in Higher Education
Master's Degree
Status Complete Part Time Yes Years 2003 - 2004
MSc in Physiotherapy
Master's Degree
Status Complete Part Time No Years 1998 - 1999
PhD
Doctor of Philosopy
Status Complete Part Time Yes Years 2005 - 2012 Project Title Reliability and Validity of ultrasound measurements of glenohumeral subluxation in people with stroke Project Description Background: Glenohumeral subluxation (GHS) is a common post-stroke complication reported in up to 81% of patients depending on the measurement methods used and the time frames over which it is assessed. The association between GHS and other post-stroke complications such as pain and poor motor recovery is uncertain, however, when present in combination these could have a significant impact on upper limb function. The management of GHS is therefore an important therapeutic goal and various approaches have been used in its prevention and management. Treatment of GHS is, however, hampered by the lack of reliable, objective, real time clinical measurements. Current clinical measurements include the palpation method and plain radiographs. The clinical palpation method lacks the sensitivity to detect early signs and/or minor subluxations. Radiographs are considered to be objective, and have high reliability and validity, but problems relating to cost, time involved, risks inherent to exposure to radiation have ethical and safety implications for the use of radiographs in both research and clinical practice. Ultrasound has also been used for the assessment of GHS in patients with stroke. Using a large, static ultrasound machine Park et al report high intra-rater reliability (ICC = 0.979) of ultrasound measurements of GHS. The aim of this rsearch work was to develop and test the feasibility, reliability, and validity of a new clinical real-time bed-side measurement of glenohumeral subluxation in post-stroke hemiplegia undertaken by physiotherapists and using portable diagnostic ultrasound. Following the development of a study protocol, a series of pilot studies were conducted on healthy people and then on patients with stroke.
Methods: Patients with post-stroke hemiplegia, who gave informed consent, were recruited. Acromion-greater tuberosity (AGT) distance was used for the assessment of GHS. Ultrasonographic measurements of AGT distance on affected and unaffected shoulders were undertaken with patients seated in a standardised position. An intra-rater reliability study was conducted first and measurements were repeated on the same day and within a fortnight to assess both within-day and between-day reliability respectively. Inter-rater reliability involving two raters was conducted on a small sample of stroke patients as part of the validity study. In the larger validity study, ultrasonographic measurements of GHS were compared (concurrent validity) with the fingerbreadth palpation method which was undertaken by clinical physiotherapists working in local hospitals. Agreement between the ultrasound and fingerbreadth methods was tested using the area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, negative and positive predictive values and the likelihood ratios for different values of ultrasound measurements of AGT distance. The discriminant validity was assessed by comparison of AGT distance measurements in stroke-affected and unaffected shoulders. The association between GHS and other clinical outcomes (pain, upper limb motor function) were explored.
Results - Intra-rater reliability-Twenty six patients with a mean age of 71 years (SD ± 10) were recruited. The Intra-class correlation coefficient (ICC) for within-day reliability for the affected shoulder was 0.98 and that for the unaffected shoulder was 0.92. Corresponding values for between-day reliability were 0.94 and 0.79 respectively. The standard error of measurement (SEM) for both unaffected and affected shoulders was less than 0.1cm for both within-day and between-day measurements. Within-day minimum detectable change (MDC) for the unaffected shoulder and the affected shoulder was 0.1cm and 0.2cm respectively. Corresponding MDC values for between-day measurements were 0.3cm and 0.4cm respectively. Inter-rater reliability- Sixteen patients with a mean age of 74±10 years were recruited. Interrater reliability coefficients (ICC) were 0.86 and 0.76 for the affected and unaffected shoulders respectively. For both raters, the SEM for both unaffected and affected shoulders was 0.1cm. Similarly, MDC for both unaffected and affected shoulders was 0.2cm. Validity – One hundred and five patients with a mean age of 74±11 years were recruited. Repeated measures ANOVA showed a significant mean AGT difference between affected and unaffected shoulder measurements (0.4±0.5 cm, p0.2 cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity and specificity of 68% and 62% respectively. Stepwise linear regression analysis showed that three factors were associated with upper limb motor function (adjusted R2 = 0.827, p