¿Cuánto de buenos somos haciendo observación?
Os dejo el abstract de uno de los pocos artículos que investiga nuestra capacidad de detectar alteraciones en la postura a través de nuestros ojos.
Merece la pena recordar esto cuándo estamos haciendo la etapa de «Observación y síntomas actuales» en TMO1.
Inter-rater reliability of postural observation after stroke
EK Carr Department of Nursing Studies, FD Kenney Physiotherapy Group, J Wilson-Barnett Department of Nursing
Studies and DJ Newham Physiotherapy Group, King’s College London, London, UK
Objective : To explore the inter-observer reliability of bedside observations of
stroke patients’ posture using two versions of a pictorial tool.
Design : Three projects were conducted. The initial version of the tool was
used in project 1. The modified version was used in projects 2 and 3. In each
project a pair of observers (comprising the main observer and one of five
co-observers with varying degrees of experience in observing posture) used
the tool to make simultaneous observations of 19 aspects of the posture of a
sample of stroke patients. Each patient was observed in one or more of four
positions (seated, supine and lying on the affected and unaffected side). The
degree of inter-observer agreement was sought by calculating kappa values
and percentage agreement.
Setting : Medical wards, care of the elderly wards and a stroke unit.
Subjects : A convenience sample of 57 stroke patients.
Results : Four hundred and forty paired sets of observations were made (200
in project 1, 140 in project 2 and 100 in project 3). The main observer was in
every pair. The co-observers made between 50 and 135 sets of observations
each. When the results from all three projects were amassed, acceptable
percentage agreement (i.e. ≥70%) was obtained for 67% (n = 78) and 73%
(n = 55) of the results collected on aspects of the posture of the affected
upper and lower limbs respectively. In contrast, acceptable percentage
agreement for observations relating to the head, neck and trunk was obtained
for only 34% (n = 50) of the results collected. Uneven distributions in the data
made kappa values difficult to interpret. Inter-observer agreement was not
noticeably higher for pairs in which both observers had prior experience of
observing posture after stroke than for pairs in which one observer was
Conclusions : The tool has potential as a quick and simple means of
collecting information at the bedside about stroke patients’ posture.
Refinements, additional training in using the tool for observers and further
testing are suggested before its wider use is advocated.