1. 2008;11;655-658Environmental Conditions and Performance Outcomes: A Preliminary Report of Implications for Patient Outcomes
   Randomized Trial
   Donna Holland, PhD, Joseph D. Fortin, DO, and Erin Korreck, MA.

BACKGROUND: Whereas a host of studies have established various forms of experimental bias, few clinical investigations have examined the relationship of the behavior of the observer or examiner to a subject’s physical performance.

OBJECTIVE: To measure the grip strength of volunteers in 2 distinct clinical “environments.”

METHODOLOGY: Twenty subjects were randomized in a crossover design to undergo grip strength testing in positive and negative environments as created by the distinctly different behavioral/communication approaches of the research staff. Each subject underwent 4 consecutive trials in both settings.

RESULTS: A paired t- test was conducted to determine if the contrasting environments impacted the volunteer’s performance. Eight of the 10 subjects demonstrated a significantly stronger grip in the positive environment. One subject’s grip remained essentially unchanged and one subject provided a slightly higher performance in the negative setting.

CONCLUSIONS: The study suggests that clinical environmental conditions influence the physical performance of a grip strength maneuver. Thus, it seems probable that clinical or experimental settings may affect diagnostic test results and/or functional outcome.