The Comprehensive Body Examination

Resumé og seks abstracts fra Berit Bunkans doktordisputats fra 2003.

05.02.2004 af Berit Heir Bunkan, fysioterapeut, Universitet i Oslo.

Doktordisputats

"The Comprehensive Body Examination".

Summary

Physiotherapists use comprehensive body examinations for patients with pain in the musculo-skeletal system, and a number of emotionally related disturbances. A central question is: Is it possible to develop reliable and valid measures of the domains body posture, respiration, movements and muscular consistency, and to what extent do measures discriminate between patients and healthy individuals?

Ninety-nine individuals (healthy, patients with pain in the musculo- skeletal system and patients with psychoses) were examined. Data were primarily treated by factor-analyses, analyses of internal consistency, t-tests and ANOVA for differences between groups The results showed 14 sub-scales: 2 for body posture, 5 for respiration, 3 for movements and 4 for muscular consistency. Nine sub-scales discriminated between healthy individuals and patients with psychoses, 4 sub-scales discriminated between healthy individuals and patients with pain syndromes. The findings showed that patients with psychoses have more aberrations than patients with patients with pain syndromes.

The domains body posture and muscular consistency showed that the extremities and shoulders can convey information that is different from the central parts of the body. The back can have too hard muscular consistency, and at the same time the extremities can have too slack. Such findings necessitate different treatment. Two sub-scales: Adaptation of respiration and resistance to passive movements were responsible for 97 % of the variance in the material. The variance within the groups was greater than the variance between the groups, which indicates that the CBE discriminates better between individuals then between the groups.

Both the global score and the domain scores discriminated between healthy individuals and both patient-groups. However, the 14 new sub-scales showed systematic body traits that give better insight into the relationships in the various aspects of the body. This makes a more precise treatment possible than the coarser sum-scores.

Abstract "What are the basic dimensions of body posture"?

"What are the basic dimensions of body posture? An empirical evaluation of the Comprehensive Body Examination". I.

Svein Friis, Berit H. Bunkan, Anne Elisabeth Ljunggren, Oddmar Moen, Stein Oppjordsmoen
Nord J Psychiatry 1998;52:319-326. Oslo. ISSN 0803-9488

There has been a lack of psychometrically sound scales for physiotherapeutic body examinations. The purpose of this paper is to evaluate the psychometric properties of the body posture items of the Comprehensive Body Examination (CBE). Ninety-nine persons were examined: 17 pain syndrome patients, 27 patients with psychoses, 4 patients with non-psychotic mental disorder, and a comparison group consisting of 51 students and staff members. On the basis of a factor analysis 2 posture subscales were made: Peripheral flexion. (PF) with seven items and Spinal flexion (SF) with five items. Chronbach’s alpha was 0.81 for the PF and 0.61 for the SF subscale. The PF subscale proved to discriminate significantly between patient groups and normal controls, even when we controlled for the use of medication. The second subscale did not distinguish significantly among the groups. The results indicate that the 12 posture items of the CBE form 2 subscales with satisfactory psychometric properties.

Key Words: Body posture, Comprehensive Body Examination, Factor analysis, Psychometric properties.

Abstract "What are the basic dimensions of respiration"?

"What are the basic dimensions of respiration?
A psychometric evaluation of The Comprehensive Body Examination. II."

Berit H Bunkan, Stein Opjordsmoen, Oddmar Moen, Anne Elisbath Ljunggren, Svein Friis
Nord J Psychiatry 1999;53:361-369.Oslo. ISSN 0803-9488.

There has been a lack of psychometrically sound scales for physiotherapeutic body examinations. The purpose of this study was to evaluate the psychometric properties of the respiration items of the Comprehensive Body Examination (CBE). Ninety-nine persons were examined: 17 pain syndrome patients (PSP group), 27 psychotic patients (PP group), 4 non-psychotic patients (NPP group), and a comparison group consisting of 51 students and staff (SS group). On the basis of factor analysis five respiration subscales were made: 1) Lac of Changeability (LC) with five items; 2) Movements Supine (MS) with five items; 3) Tension (T) with six items; 4) Movements Upright (MU) with three items and 5) Position of the Thorax (PT) with four items. The subscales were weakly intercorrelated, and showed high internal consistency (Chronbach’s alpha: .71 - .84). The LC subscale proved to distinguish significantly between the SS and both the PSP and the PP group; the MS subscale distinguished between the SS group and the PP group, the T subscale distinguished between the SS group and the PSP group. These three subscales distinguished significantly between patient groups and controls, even when we controlled for use of medication. The MU and PT subscales did not distinguish between groups. The results indicate that the respiration items form five clinically meaningful subscales with satisfactory psychometric properties.

Key Words: Emotions, Psychometric properties. Respiratory movements.

Abstract "What are the Basic Dimensions of Movements"?

"What are the Basic Dimensions of Movements? A Psychometric Evaluation of the Comprehensive Body Examination. III. "

Bunkan BH., Ljunggren A., Moen, Opjordsmoen S., Friis S, M..
The Oslo College, Faculty of Health Science, Edu­­­­cation of Physiotherapy
Nord J Psychiatry 2000,55; 33-40

The movements were examined in accordance with the Comprehensive Body Examination. The study objects were 99 persons: 17 pain syndrome patients (PSP group), 27 psychotic patients (PP group), 4 non-psychotic patients (NPP group), and a comparison group consisting of 51 students and staff members (SS-group). On the basis of factor analysis 3 subscales were made: 1) Resistance to Passive Movements (RPM), with nine items, 2) Assistance to Passive Movements (APM), with six items, and 3) Movement Disturbances (MD), with three items. The internal consistency of the subscales was high (Chronbach’s Alpha, .81 - .96), and the intercorrelation low to moderate. The RPM subscale distinguished significantly between the SS-group and both patient groups; the APM and MD subscales distinguished between the SS-group and the PP-group. The MD subscale also distinguished between patients taking drugs and those who did not, but there was no difference between patients without a medication and the SS- group.

Key Words: Body movements, Emotions, Psychometric properties.

Abstract "What are the basic dimensions of muscular consistency?"

"What are the basic dimensions of muscular consistency? A psychometric evaluation of The Comprehensive Body Examination [CBE]. IV"

Bunkan BH, Opjordsmoen S, Moen O, Ljunggren AE, Friis S.
J of Musculoskeletal Pain. 2003; 11:21-30.

The present study aims at evaluating the psychometric properties of a palpatory examination of skeletal muscles. Methods: Fifty-one nonpatients [NP group], 17 Patients with Pain Syndromes [PSP group], 27 Patients with Psychosis [PP group] and four patients with nonpsychotic mental disorders were examined by palpation. Results: Through factor analyses four sub-scales emerged: 1) Peripheral Slackness [PS], 2) Central Hardness [CH], 3) Peripheral Hardness [PH] and 4) Central Slackness [CS]. The sub-scales showed high internal consistency [Chronbach’s alpha: .72 - .92] and were slightly to moderately inter-correlated. The PS, CH and CS sub-scales discriminated significantly between the NP and PP groups. Compared with males, the females were characterized by more slack and less hard muscular consistency.

No significant differences for any of the subscales emerged when comparing scores for patients with and without medication. Conclusions: The new subscales will be relevant for physiotherapists, physicians and psychologists who want to study the state of muscular consistency in individuals with various mental disorders.

Key Words: Muscular tension, psychiatric disorders, pain, psychometric properties.

Abstract "Interrater reliability of the Comprehensive Body Examination".

"Interrater reliability of the Comprehensive Body Examination".

Bunkan BH, Opjordsmoen S, Moen O, Ljunggren AE, Friis S Physiotherapy Theory and Practice. 2002; 18: 121-129. 

The purpose of this study was to examine the inter-rater reliability of the Comprehensive Body Examination (CBE) sub-scales. These are psychometrically based sub-scales developed to measure the dimensions of body posture, respiration, movements and muscular consistency. Three independent raters examined 25 individuals (23 patients and 2 students). . Seventeen of patients had personality disorders, 3 had been psychotic and 3 were chronic pain patients attending an ordinary physiotherapy clinic. One of the students had bronchial asthma; the other was a refugee with muscular pain. The inter-rater reliability was estimated as intra-class correlations (ICC(1.1). This coefficient was chosen as it is sensitive both to random and systematic variation between raters. The ICC(1.1) for sub-scales ranged from 0.79 to 0.99 (median 0.94) indicating that properly trained raters can obtain very accurate ratings.

Key Words: Body examination, inter-rater reliability.

Abstract "Interrater reliability of the Comprehensive Body Examination".

"Interrater reliability of the Comprehensive Body Examination".

Friis S, Bunkan BH, Ljunggren AE, Opjordsmoen S, Moen O. Advances in Physiotherapy 2002; 4:162-168

In order to get a global perspective of bodily expressions of tensions and feelings in patients, physiotherapists have made comprehensive clinical examinations comprising the following domains: Posture, Respiration, Movements and Mus­cles. However, in reporting the results one mostly has relied on global impressions or used overall global scores.

The purpose of this study was to determine to what extent clearly defined, and psychometrically sound subscales can contribute to a more specific evaluation.

By use of the Comprehensive Body Examination (CBE) we examined 99 individuals and calculated the correlation between global scores, domain scores and subscale scores. Furthermore, we investigated to what extent the scores discriminated among three groups of individuals. The global and domain scores discriminated very well between three groups of individuals. However, some of the subscales were almost as good at discriminating. Three sub-scales were very strongly correlated with the global score. The scores of two of these subscales could explain 95 % of the variance in the global scores. To discriminate between groups of patients, only a few sub-scales are necessary. However, to get the full clinical picture, and to discriminate within diagnostic groups, the full range of subscales seems valuable.

Key words: Movements, muscles, pain, posture, respiration.

Om medforfattere og forfatter

1. Department of Psychiatry, Ullevaal University Hospital, Oslo
2. The Oslo College, Faculty of Health Science, Edu­­­­cation of Physiotherapy
3.  Division for Physical Therapy Science, University of Bergen,
and Research Forum, Ullevaal University Hospital, Oslo
 
Professor Svein Friis, Department of Psychiatry, Ullevål University Hospital, N-0407 Oslo, Norway,
 
Address  for correspondence:
Bunkan BH, The Oslo University  College, Faculty for Health Sciences, Physiotherapy program.  0167 Oslo, Norway Phone: +47 22 45 25 06  Fax: + 47 22 45 25 05. E-mail



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