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Background Context:
A variety of self‐report and physical performance‐based outcome measures are commonly used to assess progress and recovery in the lower leg, ankle, and foot. A requisite attribute of any outcome measure is its ability to detect change in a condition, a construct known as “responsiveness”. There is a lack of consistency in how responsiveness is defined in all outcome measures.
The purpose of this study was to review the currently used recovery outcome measures for lower leg, ankle and foot conditions in order to determine and report recommended responsiveness values.
A systematic literature search that included electronic searches of PubMed, CINAHL and SportDiscus as well extensive cross‐referencing was performed in January, 2013. Studies were included if each involved: 1) a prospective, longitudinal study of any design; 2) any condition associated with the lower leg, ankle or foot; 3) a measure of responsiveness; and 4) was an acceptable type of outcome measure (eg. self‐report, physical performance, or clinician report). The quality of the included articles was assessed by two independent authors using the responsiveness sub‐component of the Consensus‐based Standards for the selection of health Measurement Instruments (COSMIN).
Sixteen different studies met the inclusion criteria for this systematic review. The most commonly used outcome measures were the Foot and Ankle Ability Measure and the Lower Extremity Functional Scale. Responsiveness was calculated in a variety of methods including effect size, standardized response mean, minimal clinically important difference/importance, minimal detectable change, and minimal important change.
Based on the findings of this systematic review there is a lack of consistency for reporting responsiveness among recovery measures used in the lower leg, ankle or foot studies. It is possible that the variability of conditions that involve the lower leg, ankle and foot contribute to the discrepancies found in reporting responsiveness values. Further research must be conducted in order to standardize reporting measures for responsiveness.
Level of evidence:
PMCID: PMC3867077  PMID: 24377070
Ankle; outcome measures; responsiveness
2.  Effects of implementing electronic medical records on primary care billings and payments: a before–after study 
CMAJ Open  2013;1(3):E120-E126.
Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province.
We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before–after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians’ monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42).
Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments.
Implementation of EMRs by primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff.
PMCID: PMC3985899  PMID: 25077111
3.  Cerebral hemodynamics in preterm infants during positional intervention measured with diffuse correlation spectroscopy and transcranial Doppler ultrasound 
Optics express  2009;17(15):12571-12581.
Four very low birth weight, very premature infants were monitored during a 12° postural elevation using diffuse correlation spectroscopy (DCS) to measure microvascular cerebral blood flow (CBF) and transcranial Doppler ultrasound (TCD) to measure macrovascular blood flow velocity in the middle cerebral artery. DCS data correlated significantly with peak systolic, end diastolic, and mean velocities measured by TCD (pA =0.036, 0.036, 0.047). Moreover, population averaged TCD and DCS data yielded no significant hemodynamic response to this postural change (p>0.05). We thus demonstrate feasibility of DCS in this population, we show correlation between absolute measures of blood flow from DCS and blood flow velocity from TCD, and we do not detect significant changes in CBF associated with a small postural change (12°) in these patients.
PMCID: PMC2723781  PMID: 19654660

Results 1-3 (3)