Doctor of Philosophy (PhD) in Physical Therapy
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College of Health Care Sciences - Physical Therapy Department
Publication Date / Copyright Date
Nova Southeastern University
Daniel Joseph Lee. 2020. Development and validation of the Self-Management Assessment for the Residuum and prosThesis (S.M.A.R.T.). Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Health Care Sciences - Physical Therapy Department. (182)
Background: Self-management is the process of preventing complications through meticulous self-care and vigilant self-inspection. Persons with long-term impairments or diseases must follow an effective self-management routine as part of their care regimen to reduce the risk of injury. Assessment of knowledge as it relates to self-management is standard care forpersons with chronic disease and long-term impairments. Identifying knowledge gaps allows for patient-centered educational interventions to be targeted to the person’s area of deficit. Despite the importance of self-management in persons with limb loss, there is currently no valid and reliable way to objectively assess knowledge specific to this population.
Purposes: The purposes of this dissertation study were to develop and validate a reliable knowledge assessment measure and corresponding set of targeted educational interventions that are specific to the lower limb loss population, and to describe theexperiences of prosthetic users as it relates to self-management.
Methods: This dissertation study took place in four phases and utilized mixed methodology. Phase 1 involved a needs assessment of relevant stakeholders through semi-structured interviews. Phase 2 was development of the knowledge assessment measure, face validation, and content validation of that measure. Phase 3 assessed reliability using Kuder-Richardson Formula 20 (KR-20), item difficulty, and structure of the measure based on corrected total-item correlations. Phase 4 evaluated the discriminate construct validity of the measure using known groups.
Results: Four prominent themes relating to self-management were established from the codes of interviewed prosthetic users, supported through triangulation of interviewed prosthetists and physical therapists. The themes were: self-management(1) requires embodiment of responsibility, (2) requires vigilance and self-advocacy, (3) is a process facilitated through education and support, and (4) requires decision-making. Reliability of the drafted 60-item measure was good at KR-20=.72, however alternative forms were found to have superior or similar internal consistency ranging from KR-20=.70-.82. Face validity was high at a mean 4.49±.15/5.0 (90%) for the measure’s readability, usability, perceived utility, and benefit to stakeholders. All versions ofthe measure had discriminate construct validity (p<.05).
Conclusion: The knowledge assessments developed in this dissertation study are both valid and reliable for persons with lower limb loss. For new prosthetic users, a short 14-item version can be used as a quick screen in the clinic to assess self-management knowledge, while sub-modules and the 45-item comprehensive assessment allows for a progressive depth ofexamination. The measures can be utilized in the clinic to identify gaps in self-management related knowledge.
Amputation, Knowledge assessment, Limb loss, Prosthesis, Prosthetics, Self-management