Design and Development of a Telerehabilitation Self-Management Program for Persons with Chronic Lower Limb Swelling and Mobility Limitations: Preliminary Evidence
Identifieur interne : 004229 ( Pmc/Curation ); précédent : 004228; suivant : 004230Design and Development of a Telerehabilitation Self-Management Program for Persons with Chronic Lower Limb Swelling and Mobility Limitations: Preliminary Evidence
Auteurs : Becky L. Faett [États-Unis] ; Mary Jo Geyer [États-Unis] ; Leslie A. Hoffman [États-Unis] ; David M. Brienza [États-Unis]Source :
- Nursing Research and Practice [ 2090-1429 ] ; 2012.
Abstract
This paper describes design and development of a self-management program, delivered by telerehabilitation (TR), to address the problem of chronic lower limb swelling in persons with limited mobility. The 18.6 million persons with limited mobility in the USA are at increased risk for chronic lower limb swelling and related secondary complications, including cellulitis and skin ulcers. Over time, chronic swelling often progresses to lymphedema, an incurable condition requiring lifelong care. Without successful self-management, lymphedema and its related complications inevitably worsen. Access and adherence to appropriate treatment are challenging for persons with limited mobility. Program development involved a structured process to establish content validity (videos and manuals), readability, suitability, and selection of a TR platform to deliver the educational program. Our goal was to develop a program that would engage patients in self-management skills. The TR software platform chosen, Versatile and Integrated System for Telerehabilitation (VISYTER) was designed to facilitate face-to-face delivery of an interactive home-based self-management program via the internet in real time. Results demonstrated validity of the educational program and ease of use with TR. Future plans are to evaluate ability of this approach to promote self-management skills, home monitoring, and improved management of persons with lymphedema and limited mobility.
Url:
DOI: 10.1155/2012/608059
PubMed: 23227323
PubMed Central: 3514836
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Design and Development of a Telerehabilitation Self-Management Program for Persons with Chronic Lower Limb Swelling and Mobility Limitations: Preliminary Evidence</title><author><name sortKey="Faett, Becky L" sort="Faett, Becky L" uniqKey="Faett B" first="Becky L." last="Faett">Becky L. Faett</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206</wicri:regionArea></affiliation></author><author><name sortKey="Geyer, Mary Jo" sort="Geyer, Mary Jo" uniqKey="Geyer M" first="Mary Jo" last="Geyer">Mary Jo Geyer</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206</wicri:regionArea></affiliation></author><author><name sortKey="Hoffman, Leslie A" sort="Hoffman, Leslie A" uniqKey="Hoffman L" first="Leslie A." last="Hoffman">Leslie A. Hoffman</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261</wicri:regionArea></affiliation></author><author><name sortKey="Brienza, David M" sort="Brienza, David M" uniqKey="Brienza D" first="David M." last="Brienza">David M. Brienza</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23227323</idno><idno type="pmc">3514836</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514836</idno><idno type="RBID">PMC:3514836</idno><idno type="doi">10.1155/2012/608059</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">004230</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004230</idno><idno type="wicri:Area/Pmc/Curation">004229</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004229</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Design and Development of a Telerehabilitation Self-Management Program for Persons with Chronic Lower Limb Swelling and Mobility Limitations: Preliminary Evidence</title><author><name sortKey="Faett, Becky L" sort="Faett, Becky L" uniqKey="Faett B" first="Becky L." last="Faett">Becky L. Faett</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206</wicri:regionArea></affiliation></author><author><name sortKey="Geyer, Mary Jo" sort="Geyer, Mary Jo" uniqKey="Geyer M" first="Mary Jo" last="Geyer">Mary Jo Geyer</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206</wicri:regionArea></affiliation></author><author><name sortKey="Hoffman, Leslie A" sort="Hoffman, Leslie A" uniqKey="Hoffman L" first="Leslie A." last="Hoffman">Leslie A. Hoffman</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261</wicri:regionArea></affiliation></author><author><name sortKey="Brienza, David M" sort="Brienza, David M" uniqKey="Brienza D" first="David M." last="Brienza">David M. Brienza</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206</wicri:regionArea></affiliation></author></analytic><series><title level="j">Nursing Research and Practice</title><idno type="ISSN">2090-1429</idno><idno type="eISSN">2090-1437</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This paper describes design and development of a self-management program, delivered by telerehabilitation (TR), to address the problem of chronic lower limb swelling in persons with limited mobility. The 18.6 million persons with limited mobility in the USA are at increased risk for chronic lower limb swelling and related secondary complications, including cellulitis and skin ulcers. Over time, chronic swelling often progresses to lymphedema, an incurable condition requiring lifelong care. Without successful self-management, lymphedema and its related complications inevitably worsen. Access and adherence to appropriate treatment are challenging for persons with limited mobility.
Program development involved a structured process to establish content validity (videos and manuals), readability, suitability, and selection of a TR platform to deliver the educational program. Our goal was to develop a program that would engage patients in self-management skills. The TR software platform chosen, Versatile and Integrated System for Telerehabilitation (VISYTER) was designed to facilitate face-to-face delivery of an interactive home-based self-management program via the internet in real time. Results demonstrated validity of the educational program and ease of use with TR. Future plans are to evaluate ability of this approach to promote self-management skills, home monitoring, and improved management of persons with lymphedema and limited mobility.
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Nurs Res Pract</journal-id><journal-id journal-id-type="iso-abbrev">Nurs Res Pract</journal-id><journal-id journal-id-type="publisher-id">NRP</journal-id><journal-title-group><journal-title>Nursing Research and Practice</journal-title></journal-title-group><issn pub-type="ppub">2090-1429</issn><issn pub-type="epub">2090-1437</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23227323</article-id><article-id pub-id-type="pmc">3514836</article-id><article-id pub-id-type="doi">10.1155/2012/608059</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Design and Development of a Telerehabilitation Self-Management Program for Persons with Chronic Lower Limb Swelling and Mobility Limitations: Preliminary Evidence</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Faett</surname><given-names>Becky L.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Geyer</surname><given-names>Mary Jo</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hoffman</surname><given-names>Leslie A.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Brienza</surname><given-names>David M.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 401, 6425 Penn Avenue, Pittsburgh, PA 15206, USA</aff><aff id="I2"><sup>2</sup>Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA</aff><author-notes><corresp id="cor1">*Becky L. Faett: <email>faettb@pitt.edu</email></corresp><fn fn-type="other"><p>Academic Editor: Patricia M. Davidson</p></fn></author-notes><pub-date pub-type="ppub"><year>2012</year></pub-date><pub-date pub-type="epub"><day>27</day><month>11</month><year>2012</year></pub-date><volume>2012</volume><elocation-id>608059</elocation-id><history><date date-type="received"><day>13</day><month>8</month><year>2012</year></date><date date-type="rev-recd"><day>8</day><month>10</month><year>2012</year></date><date date-type="accepted"><day>9</day><month>10</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2012 Becky L. Faett et al.</copyright-statement><copyright-year>2012</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>This paper describes design and development of a self-management program, delivered by telerehabilitation (TR), to address the problem of chronic lower limb swelling in persons with limited mobility. The 18.6 million persons with limited mobility in the USA are at increased risk for chronic lower limb swelling and related secondary complications, including cellulitis and skin ulcers. Over time, chronic swelling often progresses to lymphedema, an incurable condition requiring lifelong care. Without successful self-management, lymphedema and its related complications inevitably worsen. Access and adherence to appropriate treatment are challenging for persons with limited mobility.
Program development involved a structured process to establish content validity (videos and manuals), readability, suitability, and selection of a TR platform to deliver the educational program. Our goal was to develop a program that would engage patients in self-management skills. The TR software platform chosen, Versatile and Integrated System for Telerehabilitation (VISYTER) was designed to facilitate face-to-face delivery of an interactive home-based self-management program via the internet in real time. Results demonstrated validity of the educational program and ease of use with TR. Future plans are to evaluate ability of this approach to promote self-management skills, home monitoring, and improved management of persons with lymphedema and limited mobility.
</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Conceptual schematic of teleconferencing intervention adapted with permission from Schein [<xref rid="B66" ref-type="bibr">64</xref>].</p></caption><graphic xlink:href="NRP2012-608059.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Remote clinician (a). Simulated telerehabilitation session (b). The right panel, top left, shows an image from video camera with remote control capabilities used for assessment; the right panel, top right, shows an image of a face-to-face intervention; the right panel, bottom left, shows an image of what the participant observes from their camera; the right panel, bottom right, shows educational video used for client education.</p></caption><graphic xlink:href="NRP2012-608059.002"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>10 Steps to healthier feet and legs.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Step</th><th align="left" rowspan="1" colspan="1">Goal</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">1<break></break></td><td align="left" rowspan="1" colspan="1">Understand basic pathophysiology of the vascular and lymphatic system, including warning signs of vascular, lymphatic, and neurological damage.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">Demonstrate proper limb hygiene, for example, washing and drying technique and nail care.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">Describe proper use of moisturizers and appropriate application.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">Relate steps during skin inspection for changes such as redness, wounds, skins cracks, blisters, and excessive dryness and increased hardness.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">Describe proper care for minor skin wounds.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">Describe how to select appropriate footwear and clothing.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">7</td><td align="left" rowspan="1" colspan="1">Demonstrate strategies to prevent/minimize swelling, including leg elevation, avoidance of excessive heat, and proper diet.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">Demonstrate appropriate deep breathing and decongestive exercises. </td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">9</td><td align="left" rowspan="1" colspan="1">Demonstrate appropriate application and care of an advanced pneumatic compression device and compression garments.</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">10</td><td align="left" rowspan="1" colspan="1">State signs and symptoms and appropriate action when complications develop, for example, deep venous thrombosis, pulmonary emboli, pulmonary congestion, edema, and/or infection.</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Excerpts from the tool used to evaluate video content.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" colspan="1">Please respond to the following questions by placing a number in the box that matches your level of agreement</th><th align="center" rowspan="1" colspan="1">Strongly agree</th><th align="center" rowspan="1" colspan="1">Agree</th><th align="center" rowspan="1" colspan="1">Neither agree nor disagree</th><th align="center" rowspan="1" colspan="1">Disagree</th><th align="center" rowspan="1" colspan="1">Strongly disagree</th></tr><tr><th align="center" rowspan="1" colspan="1">5</th><th align="center" rowspan="1" colspan="1">4</th><th align="center" rowspan="1" colspan="1">3</th><th align="center" rowspan="1" colspan="1">2</th><th align="center" rowspan="1" colspan="1">1</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Step 1: Know about your feet and legs</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (1) The basic anatomy and physiology are clearly explained</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (2) Anatomy and physiology provide rationale for interventions at basic level</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (3) The warning signs of poor circulation are accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (4) The warning signs for chronic swelling are accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (5) The warning signs for neuropathy are accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (6) Comorbidity is explained as well as the need for differential diagnosis</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" colspan="6" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Step 2: Wash and dry daily</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (1) Rationale for daily washing is clearly explained</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (2) Preparation for washing is accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (3) Washing technique is accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (4) Criteria for helper assistance and performance requirements are clearly explained</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (5) Preparation for drying is accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (6) Drying techniques are accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (7) Precautions are accurate and complete</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> (8) Instructions to wash and dry both affected and unaffected foot and leg in the same manner are clear</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table></table-wrap><table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label><caption><p>Rating of lymphedema therapists for video content validity. Rating scale was 5: strongly agree to 1: strongly disagree.</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" rowspan="1" colspan="1">Video</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">10</td></tr><tr><td align="left" rowspan="1" colspan="1">Mean</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4.19</td><td align="center" rowspan="1" colspan="1">4.8</td><td align="center" rowspan="1" colspan="1">4.5</td><td align="center" rowspan="1" colspan="1">4.6</td><td align="center" rowspan="1" colspan="1">4.55</td><td align="center" rowspan="1" colspan="1">4.48</td><td align="center" rowspan="1" colspan="1">4.38</td><td align="center" rowspan="1" colspan="1">4.34</td><td align="center" rowspan="1" colspan="1">4.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Mode</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">4</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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