Rehabilitation and Therapy Commons^™

Predicting Physical Therapy Student Clinical Reasoning In Practice Using Aligned Assessments In A Curricular Domain, Joy L. Moulton

Doctor of Education (Ed.D)

Clinical reasoning (CR) is a difficult concept to assess and is a leading cause of failure for outpatient clinical experiences for physical therapy (PT) students (Silberman et al., 2018). The purpose of this study was to determine to what degree didactic assessments of CR could predict CR in clinical practice utilizing Miller’s (1990) pyramid as a conceptual framework. Using a retrospective quantitative exploratory observational design, archived data were collected for graduates in the classes of 2022 and 2023 (N = 84) from a hybrid Doctor of Physical Therapy program. Each assessment pertained to the musculoskeletal domain of PT practice and …

Force Plate Methodologies Applied To Injury Profiling And Rehabilitation In Sport: A Scoping Review Protocol, Francisco J. Robles-Palazón, Paul Comfort, Nicholas J. Ripley, Lee Herrington, Christopher Bramah, John J. Mcmahon

Research outputs 2022 to 2026

Musculoskeletal injuries are a common health problem among sporting populations. Such injuries come with a high financial burden to the involved organisations and can have a detrimental impact on the career attainment of injured individuals. Force plates are now a common tool available to sport and exercise science and medicine professionals to enable them to profile injury risk predisposition and modulate the rehabilitation process within sporting environments. This is because contemporary force plate technology is portable and affordable and often comes with software that enables the automatic and immediate feedback of test variables to key stakeholders. However, to our knowledge, …

Remote Ischaemic Conditioning Combined With Bimanual Task Training To Enhance Bimanual Skill Learning And Corticospinal Excitability In Children With Unilateral Cerebral Palsy: A Study Protocol Of A Single Centre, Phase Ii Randomised Controlled Trial, Swati M Surkar, John D Willson, Jessica M Cassidy, Shailesh Kantak, Charity G Patterson

Department of Rehabilitation Medicine Faculty Papers

INTRODUCTION: Children with unilateral cerebral palsy (UCP) have difficulty in bimanual coordination that restricts the child's independence in daily activities. Although several efficacious interventions to improve bimanual coordination exist, these interventions often require higher training doses and have modest effect sizes. Thus, there is a critical need to find an effective priming agent that, when paired with task-specific training, will facilitate neurobiological processes to enhance the magnitude of training effects and subsequently improve functional capabilities of children with UCP. The aim of this study is to determine the effects of a novel priming agent, remote ischaemic conditioning (RIC), combined with …

The Effectiveness Of Temporary Deafferentation For Upper Limb Rehabilitation, Chelsea Erazo Macias, Daniel Salinas, Monica Lozano Garcia, Victoria Cuello, Kelsey Baker

Research Symposium

Background: Temporary deafferentation (TD) is an approach that has been investigated in rehabilitation practices to improve motor function in people with spinal cord injuries. The overall goal of temporary deafferentation is to voluntarily reduce sensory input into the nervous system to improve efferent output. Temporary deafferentation is typically achieved using either topical or injectable anesthetics. Recently, our group sought to optimize a protocol for temporary deafferentation using topical anesthetic cream, and results suggested that temporary deafferentation was achieved 50 minutes after anesthetic cream application. Here, we aimed to determine if our optimized protocol impacted limb electromyography (EMG) after the intervention. …

Effect Of Action Observation Therapy On Pain, Kinesiophobia, Function, And Quality Of Life In Adhesive Capsulitis Patients, Prachita Walankar, Dhruvi Shah

Internet Journal of Allied Health Sciences and Practice

Background: Adhesive capsulitis is a common musculoskeletal health problem. Cortical changes along with maladaptive pain behavior has been reported in literature. There is a need to implement biopsychosocial rehabilitation approaches to achieve successful outcomes. Hence, this study aims to evaluate the effect of action observation therapy (AOT) on pain, kinesiophobia, function and quality of life in adhesive capsulitis patients. Methods: This single-center, prospective study was conducted in a group of 30 persons diagnosed with adhesive capsulitis patients (19 males, 11 females). Patients were randomly assigned into two groups. Patients in one group were given AOT along with conventional exercises, while …

Student Perceptions Of Reading Preparation And Textbook Use In Professional Allied Health Programs, Laura Stimler, Camille Skubik-Peplaski, Melba G. Custer, Shirley P. O'Brien

Internet Journal of Allied Health Sciences and Practice

Purpose: In professional allied health education, textbooks are central to developing course content, student learning and certification exams, but little is known about the graduate student’s perspective. This study was intended to describe current trends in graduate students’ point of view, habits and opinions related to buying and using textbooks and other resources in allied health education. Methods: This was a multi-site collaborative research project. An electronic survey was developed to gather data on student habits and perspectives regarding textbook preferences including digital texts, academic reading, exam preparation, and obtaining course materials. The survey was distributed across four academic institutions. …

The Use Of Dynamic 3d Printed Cervical Spine Models In A Musculoskeletal Physical Therapy Course, Cassandra I. Ciorciari, Dallas A. Rynda, Christina L. Fojas

Internet Journal of Allied Health Sciences and Practice

Purpose: While mass-produced anatomical models are commercially available, many models are inflexible and static, and may not meet the needs of health professions students. Advances in three-dimensional (3D) printing have demonstrated tremendous potential for enhancing student learning. This study uses 3D printed cervical spine models to explore whether use of dynamic, flexible models improve student learning in a cohort of physical therapy students. Methods: 3D printed models of the cervical spine and occiput were printed using a fused deposition modeling 3D printer and polylactic acid filament, and augmented with hook and loop fasteners, foam sheets, and cords to simulate structures …

The Impact Of Experiential Learning In A Pro Bono Ot Clinic On Clinical Reasoning Development, Julie Sandvig, Debra Hanson, Paula Kitzenberg

Internet Journal of Allied Health Sciences and Practice

Abstract

Fieldwork educators have expressed concerns about the readiness of occupational therapy students for clinical reasoning in the practice setting. Experiential learning involving face-to-face personal interactions with clients facilitates the application of theoretical knowledge, and the development of professional skills, competence, and self-confidence. Having the opportunity for extensive hands-on time working with clients, such as is offered in a pro bono clinic structure, may positively impact student clinical reasoning development of occupational therapy students.

Purpose: The purpose of this study was to explore the impact of participation in a student-run occupational therapy pro bono clinic on student perceptions of clinical …

Effect Of Posterior Leaf Spring And Carbon Composite Ankle Foot Orthosis On Gait And Functional Mobility Of Stroke Survivors With Hemiplegia: A Randomized Clinical Trial, Zidikheri B. Msechu, Ahmad Zaheer Qureshi, Tim Drew

Internet Journal of Allied Health Sciences and Practice

Purpose: The study was carried out as a randomized clinical trial to assess the effect of posterior leaf spring ankle foot orthosis (PLS-AFO) and carbon composite ankle foot orthosis (C-AFO) on functional mobility, walking speed and satisfaction among stroke survivors with hemiplegia. Methods: Twenty-seven ambulatory stroke survivors with hemiplegia who had completed a rehabilitation program and were already using an ankle foot orthosis (AFO) were included in the study. Subjects were randomly assigned either PLS-AFO or C-AFO and assessment was done with and without their AFOs. Functional mobility, walking speed, and satisfaction were assessed using the Timed Up and …

Occurrence Of Temporomandibular Disorder In Subjects With Low Back Pain And Spinal Postural Deformities: An Observational Study, Vijay Kage, Aarti Welling, Richa Desai

Internet Journal of Allied Health Sciences and Practice

Purpose: Back pain and temporomandibular disorder (TMD) are two predominant illnesses that affect the human motor system. Literature has stated significant associations between chronic low back pain (CLBP) and TMD. Global postural deviations cause body adaptation and realignment, which may interfere with the function of TMJ. However, the possibility of TMD in subjects with CLBP associated with spinal postural deformities has yet to be completely explored. Method: This was an observational study carried out among 65 people having CLBP with co-presence of any spinal deformities. Forward head posture (FHP) was assessed using the On-Protractor application and thoracic kyphosis and lumbar …

Influence Of Apathy And Grit On Exercise Adherence For Persons With Parkinson’S Disease: A Cohort Study, Erica J. Kiernan, Evan M. Pucillo, Christopher M. Wiedman

Internet Journal of Allied Health Sciences and Practice

Purpose: Parkinson’s disease (PD) is the second most common neurodegenerative disease in the United States. A preponderance of evidence supports exercise and physical activity as an effective intervention to slow the progression of motor symptoms in persons with PD. However, less study has been given to the influence of non-motor symptoms of PD, such as apathy and grit, on adherence to therapeutic exercise programs. The primary aim of this study was to characterize levels of apathy and grit in individuals with PD and explore any relationship to adherence in a community exercise program. Due to the importance of caregiver interaction, …

Training And Instruction Of Learning And Study Strategies Improve Academic Performance In Rehabilitation Students, Evan M. Pucillo, Gabriela Perez

Internet Journal of Allied Health Sciences and Practice

Purpose: Prior study has demonstrated that certain learning strategies can be improved with training and instruction. As a result, downstream academic success may be potentiated. However, it is unclear if instructional intervention can influence academic outcomes among rehabilitation students. The purpose of this study was to compare changes in grade point average (GPA) after exposure to a set of standardized self-paced training modules on the Learning and Study Strategies Inventory (LASSI) in Physical therapy (PT) and Occupational therapy (OT) students. Methods: A causal-comparative design was used, and a multi-center convenience sample collected N=75 entry-level PT and OT students [PT: 41(55%); …

Improving Hand Recovery In Tetraplegia Through The Use Of Meaningful Occupations: A Qualitative Case Series, Amanda C. Glueck, Casey E. Humphrey, Elizabeth Salmon Powell, Cassandra Catherine Ginn, Melba G. Custer, Camille L. Skubik-Peplaski

Internet Journal of Allied Health Sciences and Practice

Purpose: This qualitative descriptive study explored participants’, with chronic spinal cord injury (SCI), experiences with meaningful intensive task specific training (ITST). Methods: Three participants completed 24-ITST upper extremity motor therapy intervention sessions. Qualitative interviews were completed at three time points for a case series: baseline, within 7 days of the completion of the final ITST intervention session, and within one month of the final ITST intervention session for a total of 9 interviews. Results: Three themes were identified including: Quality of Movement Enhances Normal Use of Hands, Empowering Through Education and Motivation to Participate and Enhance Quality of Life. Through …

Exploring Clinical Reasoning In Doctor Of Physical Therapy (Dpt) Students Through Computer-Based Simulation, Denise Romano, Alyson Pasquale

Internet Journal of Allied Health Sciences and Practice

ABSTRACT

Purpose: Clinical reasoning is a critical skill required to be an effective clinician in today’s dynamic and complex healthcare environment. Reflective ability is considered foundational for building clinical reasoning skills. The purpose of this mixed methods study was to explore the clinical reasoning strategies used by Doctor of Physical Therapy (DPT) students during a computer-based simulation and the relationship between the quality of reflection and clinical reasoning strategies used. Methods: Forty-five first (n=15), second (n=23), and third (n=7) year DPT students enrolled in six professional DPT programs in the United States participated in an asynchronous computer-based simulation designed to …

The Ventilatory Management Of Paediatric Central Sleep Apnoea: A Systematic Review, Kane A. Hodge, Anne Jones

Internet Journal of Allied Health Sciences and Practice

Purpose: Paediatric central sleep apnoea (CSA) occurs more frequently in the presence of another medical condition. This systematic review aimed to determine the effectiveness of oxygen therapy and non-invasive ventilation (NIV) for children with CSA and additional underlying comorbidities. Method: A search was undertaken of CINAHL Complete, Emcare, Scopus, MEDLINE, and PubMed with forward and backward citations for studies published between database inception and the 5th of May 2022. Articles of any study design or quality were included, excluding systematic reviews, letters, or study protocols. Articles had to involve only paediatric patients with a diagnosis of CSA with …

Trends In Length Of Stay: Experience From A Tertiary Care Pediatric Rehabilitation Unit In Saudi Arabia., Sami Ullah, Ahmad Zaheer Qureshi, Waqas Sami, Amara Ilyas, Sherif Samir Abdelmaksoud Tantawy, Sarah Samir Abdulakarim Alqatari, Hasan Shacfe, Colleen Ann Wunderlich

Internet Journal of Allied Health Sciences and Practice

Background: Pediatric rehabilitation units offer unique challenges due to complex rehabilitation needs of children based on their age group and diagnosis. Length of stay (LOS) is an indirect measure of hospital cost and efficiency of a clinical service and it is important to determine the factors affecting LOS in hospitalized children undergoing inpatient rehabilitation. Methods: Record of 350 children (males: 222, female: 128) who underwent inpatient pediatric rehabilitation program at King Fahad Medical City, Riyadh Saudi Arabia during 2011 to 2018 were reviewed. Diagnoses were categorized into cerebral palsy, spinal cord injury, traumatic brain injury, non-traumatic brain injury and others. …

Effects Of A Multi-Modal Gait Training Program In An Individual With Chronic Stroke: A Case Study, Anne Boddy, Lindsay A. Perry, Chitralakshmi K. Balasubramanian

Internet Journal of Allied Health Sciences and Practice

Purpose: Multi-modal gait training (MMGT) may improve impairments and functional limitations in individuals’ post-stroke. The purpose of this case study was to investigate effects of MMGT on gait and balance outcomes immediately post-intervention, 30-day short term (ST) and 1-year long term follow-up periods. Method: A 63-year-old patient, eight years post-stroke, participated in a MMGT program that included evidence-based gait interventions: unilateral treadmill training, inclined treadmill training at 8%, and over-ground fast walking. The eight sessions lasted 45-minutes each and consisted of the three interventions lasting 10-minutes each with rest breaks. Results: Self-selected (SS) and fastest comfortable gait speed revealed meaningful …

Low-Rate Tens As An Effective Treatment For Pelvic Pain - A Retrospective Case Report, Michelle Allyn, Ryan Kamieneski

Internet Journal of Allied Health Sciences and Practice

Purpose: Chronic pelvic pain (CPP) affects 27% of the world’s female population. The purpose of this case report was to investigate the use of low-rate transcutaneous electrical nerve stimulation (TENS) for pain relief in a woman with CPP. Few studies have investigated the effects of low-rate TENS on gynecological-related pelvic pain. Methods: A 21-year-old woman presented with a six-month history of pelvic pain and decreased quality of life. Persistent pain led the patient to seek physical therapy treatment. Single-channel low-rate TENS (five hertz frequency, 250 microseconds phase duration) was provided for 30 minutes daily at the maximum tolerated intensity, for …

The Level Of Functionality Of The Affected Upper Limb In Stroke Patients Depends On The Type Of Therapy Used And The Lateralization Of The Subjects' Body - A Randomized Observational Study., Anna Olczak, Marcin Dornowski

Baltic Journal of Health and Physical Activity

Introduction: Impairment of the functions of the upper limb and hand is a major problem in stroke patients. The aim of the study was to evaluate various therapies in terms of their influence on changes in the activity of the affected, dominant, and non-dominant upper limb in patients after ischemic stroke. Material/Methods: This is a randomized, double-blinded study. The research was carried out in a rehabilitation clinic on a group of 60 stroke patients who were randomly assigned to groups differing in the rehabilitation program. The study group had physiotherapy based on the NDT Bobath concept and the control group …

Pedophilia: Understanding The Origins And Problems Within The Criminal Justice System, James K. Mcelhaney

Doctoral Dissertations and Projects

Societal stigma, criminal sanctions, and the mental illness or disorder of pedophilia are explored in this paper because of the considerable research gaps that have accumulated over the past decade. Most of the data acquired regarding individuals with pedophilia have been predominantly from male offenders, with most of the information coming from reports to local law enforcement and the FBI. The outcome of multiple studies shows that neuroimaging, associated brainwaves, and related sexual attraction are significantly different for individuals with pedophiliac tendencies than for others. Studies also reveal that research has been limited to prevention techniques and therapy for nonoffenders …

Exploring First Semester Allied Health Students’ Transition To Graduate School Through The Lens Of Occupational Adaptation, Carly E. Williams, Jessica N. O'Brien, Rebecca E. Dodick, Jillian M. Bell, Jennifer O. Knauth, Lorrie A. George-Paschal, Nancy Krusen, Jacquie Rainey

Innovations in Health Sciences Education Journal

The purpose of the study was to examine experiences of students transitioning into graduate allied health programs within a public university in the United States. Researchers assessed students’ occupational adaptation as well as factors that facilitated and inhibited their transition. Researchers collected data using the Relative Mastery Scale (RMS) (George-Paschal, Krusen, & Fan, 2022) and a researcher-developed transition survey. Participants included 129 students from three allied-health professions. Researchers conducted a mixed ANOVA to explore differences in RMS ratings across three disciplines. There was a statistically significant increase in RMS ratings over time for all disciplines and statistically significant differences between …

The Effect Of A Psychologically Informed Video Series To Treat Adolescents' Patellofemoral Pain: A Randomized Controlled Trial., Mitchell Selhorst, Jessica Hoehn, Laura Schmitt, Jason Benedict, Alicia Fernandez-Fernandez

HPD Articles

OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain (PFP). The secondary aims were to assess pain and psychological beliefs.

DESIGN: A double-blinded randomized controlled trial.

METHODS: Sixty-eight adolescents with PFP were randomly assigned to view brief, psychologically-informed videos (n=34) or control videos (n=34) in addition to usual care physical therapy. The psychologically-informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, three weeks, six weeks (primary endpoint), and three …

The Dosing Of Mobile-Based Just-In-Time Adaptive Self-Management Prompts For Caregivers: Preliminary Findings From A Pilot Microrandomized Study, Jitao Wang, Zhenke Wu, Sung Won Choi, Srijan Sen, Xinghui Yan, Jennifer A Miner, Angelle M Sander, Angela K Lyden, Jonathan P Troost, Noelle E Carlozzi

Faculty, Staff and Students Publications

BACKGROUND: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood.

OBJECTIVE: The primary objective of this study is to evaluate the dose-response …

Non-Native English Speaking Patients: Emergent Themes To Patient Care In Athletic Training, Lacey Bracken, Matthew Kutz

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: When seeking services from healthcare providers language barrier challenges are experienced by patients and clinicians. To purpose of this study was to investigate AT’s experience with Non-native English Speaking (NNES) patient care. Method: Level of agreement to question in four themed areas was measured using The Athletic Trainers Non-Native English Speaking Survey (ATNNESS). Data of agreement were organized by other languages spoken, setting of practice, years of experience, and interaction frequency with NNES patients. Results: The ATNESS yielded satisfactory internal consistency and validity (α = 0.79). Paired sample t-test indicated significant difference in bilingual and monolingual presence of …

Effect Of Depression And Anxiety On Rehabilitation Adherence And Injury Recovery In Collegiate Athletes, Luis Torres, Shala E. Davis, Colleen A. Shotwell, Frederick A. Gardin

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: The noted prevalence of depressive and anxious symptomology both pre-injury and post-injury in collegiate athletes raises concern regarding their ability to maintain appropriate rehabilitation adherence in their recovery from sports injury. The purpose of this study was to further explore the effect of depressive and anxious collegiate athlete symptoms on athletic trainers’ perceptions of rehabilitation adherence and return-to-play. Methods: NCAA Division II and Division III injured collegiate athletes (N = 19, M age = 20.58 ± 1.31) were observed throughout their rehabilitation programs by 5 separate collegiate athletic trainers. Collegiate athlete depressive and anxious symptoms were assessed during preseason …

Successful Closed Reduction And Tooth-To-Tooth Wire-Fixation Of A Mandibular Singular Parasymphysis Fracture In A Male Collegiate Lacrosse Player, Steven Ross Murray, Coryann L. Leadford, Nathaniel Snyder, Robert W. Pettitt, Jeremy R. Hawkins

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

A 19-year-old male collegiate lacrosse player suffered an acute singular parasymphysis fracture of the mandible when he was struck in the facemask of his helmet by a lacrosse ball during practice. The fracture was confirmed via panoramic radiography and treated with a closed reduction under local anesthetic by looping a 26-gauge wire around the two right incisors and the right cuspid. This approach to managing the fracture was taken instead of an open reduction and plate application to be less invasive with the hope of a faster recovery and fewer complications. The fracture healed and aligned properly, and after six …

Reliability And Construct Validity Of The Single-Leg Landing Error Scoring System (Sl-Less) In Physically Active Females, Jennifer E. Earl-Boehm, Madison Mach, Erin Lally, Maegan O'Connor, Hayley Ericksen

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

PURPOSE Single-leg landings are common in sport and often result in injury, however a rubric to evaluate biomechanics during single-leg jump landing (SLL) does not exist. The Single-Leg Landing Error Scoring System (SL-LESS) is a rubric developed to evaluate movement during SLL. The purpose of this study was to 1) determine inter- and intra-rater reliability of the SL-LESS, 2) and determine the content and construct validity of the SL-LESS when evaluating SLL

METHOD 28 healthy females completed SLL on two days while 2D and 3D data were recorded. 3D angles were trunk flexion/lateral-flexion, pelvic tilt/contralateral drop, hip flexion/adduction, and knee …

Leadership And Management Curricula Trends In Athletic Training Education, Stephanie Wise, Matthew R. Kutz

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: Leadership and management skills both are needed by athletic trainers. However, most professional education emphasizes management-related behaviors. The purpose of this study was to differentiate between leadership and management behaviors taught in athletic training programs and explore the pedagogical strategies used in teaching those behaviors. Method: A cross-sectional exploratory design was used to survey Athletic Training Program Directors (PDs). The Leadership and Management Education Assessment Instrument (LMEAI) was developed for this investigation. The LMEAI collected standard demographic characteristics of respondents and used a 5-point Likert scale (1 = extremely important to 5 = not at all important) to assess …

Quality Of Cardiopulmonary Resuscitation Performed Over Hockey Shoulder Pads: A Simulation Study, Jennifer Longo, Katie J. Lyman, Thomas A. Hanson, Adam G. Estabrooks

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: Athletic trainers (ATs) must be prepared to manage cardiac arrest events in all athletes, including those participating in equipment-intensive sports. The goal of this study was to determine if first responders, specifically ATs, were able to perform high-quality cardiopulmonary resuscitation (CPR) over hockey shoulder pads. Methods: A sample of 50 ATs completed a one-minute, compression-only CPR proficiency test on a medium-fidelity manikin (Resusci Anne QCPR). Once deemed proficient, each participant completed CPR according to 2020 AHA guidelines on the manikin fitted with hockey shoulder pads for 8 minutes and 59 seconds. The primary measures of interest were the percentage …

A Bifactor Model Supports Unidimensionality Of The International Knee Documentation Committee Subjective Knee Form In Young Active Patients With Anterior Cruciate Ligament Tears: A Retrospective Analysis Of A Randomized Controlled Trial., Hana Marmura, Paul F Tremblay, Alan M J Getgood, Dianne M Bryant

Health and Rehabilitation Sciences Publications

BACKGROUND: The International Knee Documentation Committee Subjective Knee Form (IKDC) is the most highly recommended patient reported outcome measure for assessing patients with anterior cruciate ligament (ACL) injuries and those undergoing ACL reconstruction (ACLR) surgery. The IKDC was developed as a unidimensional instrument for a variety of knee conditions. Structural validity, which determines how an instrument is scored, has not been definitively confirmed for the IKDC in respondents with ACL injuries, and in fact an alternative two-factor/subscale structure has been proposed in this population. The purpose of this study was to determine the most appropriate structure and scoring system for …