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CareMedEval

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tinely used in clinical practice and
has been tested for both reliability
and validity.29-31 Hall et al29 investi­
gated the concurrent validity of this
method by comparing it with plain
radiographs. They reported a Spear­
man correlation coefficient of .760
between the fingerbreadth palpation
method and plain radiographs. This
study continued this research by comparing ultrasound and finger­
breadth palpation methods.
Method
Participants
The study used a prospective design
and received approval from the
National Health Service (NHS)
Research Ethics Committee, North
Bristol Trust, United Kingdom.
Patients over 50 years of age who
had stroke resulting in one-sided
weakness and who were able to sit
upright were eligible to participate.
Patients with aphasia also were eligi­
ble to participate in the study. Apha­
sia was confirmed if a patient had
difficulty following simple com­
mands, understanding questions
(receptive aphasia), or speaking
(expressive aphasia). Diagnosis or
presence of GHS was not a require­
ment to be able to participate in the
study. Patients with other neurologic
conditions, traumatic brain injury,
brain tumors or other serious comor­
bidities, shoulder pathology, or
recent surgery to the neck, arm, or
shoulder; those who were unavail­
able for testing; and those who were
unable to volunteer due to any rea­
son were excluded.
An a priori power calculation was
performed for assessing the clinical
utility of the ultrasound method as
quantified by the area under the
receiver operating characteristic
(AUROC) curve. To our knowledge,
this is the first study of this topic
using AUROC curve statistics. There­
fore, power calculations were con­
ducted for 2 AUROC curve values.
For standard level of significance (a=.05, /3<.20), a minimum sample
size of n=72 and n = 114 would have
at least 80% power to determine sta­
tistical significance if the true
AUROC was equal to 0.70 and 0.65,
respectively, assuming a 1:1 ratio
between negative and positive cases
in the sample (calculations were per­
formed using MedCalc Software, ver­
sion 11.1, Mariakerke, Belgium).
Therefore, the aim of this study was
to recruit up to 114 patients with
stroke.
Patients were recruited from 4 local
hospital trusts in the southwest of
England and from the community by
accessing the Bristol Area Stroke
Foundation (BASF), a voluntary orga­
nization that operates social clubs in
a number of day centers for patients
with stroke in Bristol. Of the several
BASF social clubs, 6 centers located
in and around the Bristol area were
approached for the recruitment of
patients. Each patient gave informed
written consent to take part, and, for
those who lacked mental capacity,
appropriate procedures were fol­
lowed and involved a family member
signing the personal consultee agree­
ment form in the presence of the
patient.
A p p a ra tu s an d Raters
Prior to commencement of the data
collection process, a portable diag­
nostic ultrasound machine (TITAN
model, L38/10-5 MHz broadband,
Sonosite Ltd, Hitchin, United King­
dom) was tested and calibrated
according to the manufacturer’s
guidelines.
Ultrasound measurements of ACT
distance were undertaken by a phys­
ical therapist (P.K.) at all of the
research sites (hospital and day cen­
ters). The training protocol con­
sisted of a 1-day manufacturer’s
course, supervised training from a
consultant radiologist, pilot work on