All ETDs from UAB

Advisory Committee Chair

David M Morris

Advisory Committee Members

Cynthia J Brown

Matthew P Ford

Cecilia L Graham

Debbie Ingram

Document Type

Dissertation

Date of Award

2012

Degree Name by School

Doctor of Science in Physical Therapy (DScPT) School of Health Professions

Abstract

Background: Analysis of and intervention for movement dysfunction, especially walking dysfunction, is the central expertise of physical therapists (PTs). PTs are called to establish a diagnosis prior to making patient management decisions yet no valid classification system for walking exists. Objectives: The purpose of this study was to determine if locomotor experts could arrive at consensus on the validity, mutual exclusivity and understandability of diagnostic classifications for bipedal locomotion. Methods: An electronic mail Delphi survey methodology was utilized. Experts were recruited purposefully through research and clinical leaders in the PT profession. Identified experts were then asked for their recommendations in the snowball phase of recruitment. In the first survey, the panelists were asked if any of the 15 original classifications should be added removed, reworded, or merged. In Rounds 2 and 3, following a summary of responses from the previous round, panelists were asked to rate the validity, mutual exclusiveness and understandability of each original and modified classification using a 4 point Likert Scale as well as to comment on them. Constant comparative analysis was used to analyze qualitative data and non-parametric statistics was used for ordinal data (p < 0.05). Consensus was defined as: 1) greater than 75% of participants agree or strongly agree that a classification is valid, mutually exclusive and understandable, 2) no difference between Rounds 2 and 3 responses, 3) Kappa coefficients are > .60 and 4) there is a reduction in the percentage of panelists who comment as well as a convergence of themes between Rounds 1 and 3. Results: A total of 287 participants were invited initially and 58 experts participated in all rounds. Full consensus was reached for 5 of the modified diagnostic classifications and partial consensus for 6. There were no significant differences between Rounds 2 and 3 ratings and there was a decrease in the percentage of panelists who made global comments between Rounds 1 and 3. Other measures of consensus did not reflect full consensus. Conclusions: This study provides initial validation for several bipedal locomotor classifications and provides a model for development of diagnostic classification systems for physical therapist practice.

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