Measurement properties of the childhood bladder and bowel dysfunction questionnaire.

OBJECTIVES: The childhood bladder and bowel dysfunction questionnaire (CBBDQ) was previously found feasible, structurally valid, with good internal consistency. The purpose of this study was to evaluate the remaining measurement properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). METHODS: A prospective cohort study among parents of children aged 5-12 years was conducted. Calculated were the area under the curve (AUC) (criterion validity, responsiveness, interpretability) and intra-class correlation coefficients (ICCagreement ) (construct validity and test-retest reliability). RESULTS: One hundred and seventy-two parents were included from March 2019 to April 2021. Correlating the bladder subscales of the CBBDQ with the Vancouver symptom score for dysfunctional elimination (VSSDES) and proxy-reported pediatric incontinence quality of life (p-PinQ) showed convergent validity (ICCsagreement : 0.76 and 0.74). Divergent validity was found when correlating the bowel subscales of the CBBDQ with the VSSDES (ICCagreement : 0.52). Excellent criterion validity (AUC: 0.98); excellent test-retest reliability (ICCagreement : 0.94) and, at 6 months, fair responsiveness (AUC: 0.74) were found. The minimal important change was 4.5, with cut-off value of 11. CONCLUSION: The CBBDQ has been developed according to COSMIN standards. The items were defined using the consensus-based ICCS standards and Rome-III criteria. The measurement properties were identified using enough participants. Although interpretability is not considered a measurement property, interpretability aspects are reported here as they refer to what instrument scores mean. The 18-item-CBBDQ met the measurement properties of validity, reliability, and responsiveness, as defined by COSMIN. The CBBDQ is suitable for self-administration by parents, and completion takes little time.

Factors predicting long-term outcomes following physiotherapy in patients with subacromial pain syndrome: a secondary analysis.

BACKGROUND: Although patients with shoulder complaints are frequently referred to physiotherapy, putative predictive factors for outcomes are still unclear. In this regard, only a limited amount of scientific data for patients with subacromial pain syndrome exist, with inconsistent results. An improved knowledge about the ability of baseline variables to predict outcomes could help patients make informed treatment decisions, prevent them from receiving ineffective treatments, and minimize the risk of developing chronic pain. AIM: The aims of this secondary longitudinal analysis are threefold: First, to investigate baseline differences between patients with and without successful long-term outcomes following physiotherapy. Second, to compare the predictive ability of two sets of putative predictive variables on outcomes, one based on the literature and one based on the data of the original trial. Third, to explore the contribution of short-term follow-up data to predictive models. METHODS: Differences between responders and nonresponders were calculated. The predictive ability of variables defined through literature and of variables based on the Akaike Information Criterion (AIC) from the original trial dataset on the Shoulder Pain and Disability Index and the Patients' Global Impression of Change at the one-year follow-up were analyzed. To test the robustness of the results, different statistical models were used. To investigate the contribution of follow-up data to prediction, short-term data were included in the analyses. RESULTS: A sample of 87 patients with subacromial pain syndrome was analyzed. 77% (n = 67) of these participants were classified as responders. Higher expectations and short-term change scores were positive, and higher fear avoidance beliefs, greater baseline disability and pain levels were negative predictors of long-term outcomes in patients with subacromial pain syndrome. CONCLUSIONS: Although our results are in line with previous research and support the use of clinical factors for prediction, our findings suggest that psychological factors, especially patient expectations and fear avoidance beliefs, also contribute to long-term outcomes and should therefore be considered in the clinical context and further research. However, the hypotheses and recommendations generated from our results need to be confirmed in further studies due to their explorative nature. TRIAL REGISTRATION: The original trial was registered at Current Controlled Trials under the trial registration number ISRCTN86900354 on March 17, 2010.

Experts' perspectives on how to promote implicit and explicit motor learning in children: A mixed-methods study.

BACKGROUND: Little is known about how motor learning strategies (MLSs) can promote implicit and explicit motor learning processes. This study aimed to explore experts' perspectives on therapists' use of MLSs to promote specific learning processes in children with and without developmental coordination disorder (DCD). METHODS: In this mixed-methods study, two consecutive digital questionnaires were used to ascertain the opinions of international experts. Questionnaire 2 explored the findings of Questionnaire 1 in greater depth. In order to reach a certain level of agreement about the classification of MLSs as promoting either (more) implicit or (more) explicit motor learning, 5-point Likert scales were used in addition to open-ended questions. The open-ended questions were analysed with a conventional analysis approach. Open coding was performed by two reviewers independently. Categories and themes were discussed within the research team, taking both questionnaires as one dataset. RESULTS: Twenty-nine experts from nine different countries with different backgrounds in research, education and/or clinical care completed the questionnaires. The results of the Likert scales showed large variation. Two themes emerged from the qualitative analyses: (1) Experts found it difficult to classify MLSs as promoting either implicit or explicit motor learning, and (2) experts stressed the need for clinical decisionmaking when choosing MLSs. CONCLUSIONS: Insufficient insight was gained into how MLSs could promote (more) implicit or (more) explicit motor learning in children in general and in children with DCD specifically. But this study demonstrated the importance of clinical decisionmaking to model and adapt MLSs to child, task and environment, with therapists' knowledge of MLSs being an important prerequisite. Research is needed to better understand the various learning mechanisms of children and how MLSs can be used to manipulate these mechanisms.

Development of a tool to assess environmental factors to support home care - a Delphi study.

BACKGROUND: Living in an adequate environment suited to one's abilities and needs is an essential condition to function in daily life. However, no complete tool currently exists to provide a rapid overview of a person's environment, both material (accommodation and auxiliary means) and social (entourage and available services). Our aim was to develop a tool to identify potentially problematic environmental factors and to determine when an in-depth assessment is necessary. METHODS: Health professionals experienced in home-based treatment participated in a three-round Delphi process. The first round aimed to define which items the tool should contain, the second to collect participants' opinions on a first version of the tool, and the third to collect the participants' opinions on the adapted version of the tool. RESULTS: A total of 29 people participated in the first round, 21 in the second and 18 in the third. The final tool contains 205 items divided into four categories (basic information about the inhabitant and their home, inhabitant's level of independence and autonomy, home, tools and means at the inhabitant's disposition) and two annexes (stairs to access to the home, internal staircase to the dwelling). CONCLUSIONS: A complete tool allowing professionals working in patients' homes to obtain an overview of the environmental factors that could represent obstacles to the independence of the inhabitant, or to the possibility of providing quality care could be developed. This tool is very complete but relatively long. To facilitate its usability, it would be relevant that a digital version to focus on individual relevant categories be elaborated.

Validity and reliability of the 2-minute walk test in individuals with spinal cord injury.

STUDY DESIGN: Multicentre-observational study. OBJECTIVES: The 6-minute walk test (6mWT) is an established assessment of walking function in individuals with spinal cord injury (SCI). However, walking 6 min can be demanding for severely impaired individuals. The 2-minute walk test (2mWT) could be an appropriate alternative that has already been validated in other neurological disorders. The aim of this study was to assess construct validity and test-rest reliability of the 2mWT in individuals with SCI. In addition, the influence of walking performance on sensitivity to change of the 2mWT was assessed. SETTING: Swiss Paraplegic Center Nottwil, Switzerland; Balgrist University Hospital, Zürich, Switzerland. METHODS: Fifty individuals (aged 18-79) with SCI (neurological level of injury: C1-L3, AIS: A-D) were assessed on two test days separated by 1 to 7 days. The first assessment consisted of a 2mWT familiarization, followed by a 2mWT and 10-meter walk test (10MWT) (including the Walking Index for Spinal Cord Injury (WISCI II)) in randomized order. The second assessment consisted of 2mWT and 6mWT in randomized order. Tests were separated by at least 30 min of rest. RESULTS: The interclass correlation coefficient between the 2mWT assessed on the first and second test day was excellent (r = 0.980, p < 0.001). The 2mWT correlated very strongly with the 6mWT (r = 0.992, p < 0.001) and the 10MWT (r = 0.964, p < 0.001), and moderately with the WISCI II (r = 0.571, p < 0.001). Sensitivity to change was slightly affected by walking performance. CONCLUSION: The 2mWT is a valid and reliable alternative to the 6mWT to measure walking function in individuals with SCI. TRIAL REGISTRATION: NCT04555759.

Therapists' Use of Instructions and Feedback in Motor Learning Interventions in Children with Developmental Coordination Disorder: A Video Observation Study.

AIM: This qualitative study explored therapists' use of instructions and feedback when teaching motor tasks to children with developmental coordination disorder (DCD) as a first step in developing practical recommendations. METHODS: A conventional content analysis approach was used to analyze videotaped treatment sessions of physical therapists using a newly developed analysis plan. Inductive coding was used to code purposively selected video segments. The codes were sorted into categories to identify key themes. Analyses were performed independently by two researchers until data saturation was reached. RESULTS: Ten video-taped sessions were analyzed and 61 segments were coded. Three key themes were identified: (1) therapists' intention with the instructions and feedback was to motivate or to provide information; (2) the preferred therapists' teaching style was either direct or indirect; and (3) parameters to shape specific instructions and feedback were the focus of attention, modality, information content, timing and frequency. CONCLUSION: Therapists used numerous instructions and feedback with different information content, often shaped by multiple focuses and/or modalities to motivate children or to provide specific information about task performance. Although therapists adapted instructions and feedback to child and task, future research should explore how characteristics of child and task can guide therapists' clinical decision-making.

Needs, benefits, and issues related to home adaptation: a user-centered case series applying a mixed-methods design.

INTRODUCTION: Home adaptation can be a key contributor to successfully aging at home, allowing older adults to remain in a familiar environment while maintaining their quality of life and well-being despite progressing functional difficulties. Although several theoretical studies on home adaptations exist, the benefits of custom home adaptations remain poorly evaluated. The present study's primary aims were to explore older adults' expectations and needs regarding home adaptations and evaluate the impact of individualized home adaptations on quality of life, fear of falling, independence, and difficulties using adapted rooms. Its secondary aim was to describe the barriers and facilitators of home adaptation. METHOD: The 15 homes in this case series were adapted using an inclusive, interdisciplinary approach. Adaptations' effects were assessed using a parallel mixed-methods design. Quantitative and qualitative data were collected using questionnaires and semi-structured interviews. An architect and a health professional visited each home twice to assess the older adult's expectations and needs, evaluate the home's technical aspects, and co-create an adaptation plan with that study participant. They assessed the older adult's perceived quality of life, fear of falling, independence, and difficulties using the rooms needing adaptations. Inhabitants received two more visits after the adaptations (one or two months and six months later) to assess their benefits. RESULTS: Most homes had their bathroom adapted. Participants reported improved safety, independence, ease of use, positive feelings, and comfort. They also reported lower perceived levels of difficulties during the activities of daily living in the adapted rooms (reductions of 93.4% [SD = 12.7] of bathrooms and 100% of kitchens), an improvement in quality of life of 9.8% (SD = 27.6), and a reduction in fear of falling of 12.5% (SD = 9.7). CONCLUSION: Home adaptations are beneficial to older adults' activities of daily living and improve their quality of life; however, several factors hinder the implementation of those adaptations.

A social network analysis to explore collaborative practice in home care: research protocol.

BACKGROUND: The conceptualization of the home as a care environment and maintaining a high standard of care requires different professionals to collaborate. This study will explore collaborative practice in home care, needs and expectations of the stakeholders involved, and identify their roles and tasks. Secondly, it will investigate possible strategies to improve home care management and, more particularly, optimize collaborative practice in home care. METHODS: The study will be conducted during three distinct consecutive phases, within a multiphase mixed-methods design. Phase 1 will use a quantitative approach in which a social network analysis will be conducted to have an overview of collaborative practice in home care in French-speaking Switzerland. Phases 2 and 3 will be qualitative and focus on three different situations involving different locations (rural and urban) and different home care functioning (home care provided by agencies and home care providing by independent caregivers). In each situation, semi-structured interviews will be conducted with home care recipients and their home caregivers. In phase 2, results of phase 1's network analysis will be discussed, such as roles, needs, and expectations of all stakeholders involved in home care. In phase 3, phase 2's findings will be discussed and strategies to improve home care and to optimize collaborative practice will be explored. DISCUSSION: Over the past years, home care has grown considerably. Therefore, more and more different caregivers are involved in the recipients' homes. Since optimal coordination between these different caregivers is a prerequisite for quality and safe care, it is essential to investigate the existing collaborative practice and how it is functioning. This study will provide knowledge on roles, needs and expectations of different caregivers involved in home care. It will also allow for strategies to optimize collaborative practice and thus ensure comprehensive care for recipients. Finally, it will serve as a basis for future studies that can be conducted to address identified needs.

Development and validation of an alternative ankylosing spondylitis disease activity score when patient global assessment is unavailable.

OBJECTIVE: To develop an alternative Ankylosing Spondylitis Disease Activity Score (ASDAS) to be used in research settings in axial SpA (axSpA) when Patient Global Assessment (PGA) is unavailable in databases. METHODS: Longitudinal data from four axSpA cohorts and two randomized controlled trials were combined. Observations were randomly split in a development (N = 1026) and a validation cohort (N = 1059). Substitutes of PGA by BASDAI total score, single or combined individual BASDAI questions, and a constant value, were established in the development cohort. Conversion factors for each substitute were defined by Generalized Estimating Equations, obtaining seven 'alternative' formulae. Validation was performed in the validation cohort according to the OMERACT filter, taking into consideration: (i) truth (agreement with original-ASDAS in the continuous score, by intraclass correlation coefficient and in disease activity states, by weighted kappa); (ii) discrimination [standardized mean difference of ASDAS scores between high/low disease activity states defined by external anchors, e.g. Patient Acceptable Symptom State; agreement (kappa) in the percentage of patients reaching ASDAS improvement criteria according to alternative vs original formulae]; and (iii) feasibility. RESULTS: Comparing various options, alternative-ASDAS using BASDAI total as PGA replacement proved to be: truthful (intraclass correlation coefficient = 0.98, kappa = 0.90), discriminative [ASDAS scores between Patient Acceptable Symptom State no/yes: standardized mean difference = 1.37 (original-ASDAS standardized mean difference = 1.43); agreement with original-ASDAS in major improvement/clinically important improvement criteria: kappa = 0.93/0.88] and feasible (BASDAI total often available, as questions required for the ASDAS; conversion coefficient ≈ 1). CONCLUSION: Alternative-ASDAS using BASDAI total score as PGA replacement is the most truthful, discriminative and feasible instrument.

Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy.

AIM: To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut-off values for this purpose. METHOD: A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut-off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. RESULTS: Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63-0.91) to 0.95 (95% CI 0.90-1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. INTERPRETATION: HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut-off values for different ages were applied. What this paper adds The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy. HAI cut-off values can guide clinical practice for early identification and diagnosis of unilateral CP.

Test-retest reliability of static and dynamic motor fatigability protocols using grip and pinch strength in typically developing children.

Upper limb motor fatigability is an important debilitating factor for activities of daily living in clinical pediatric populations. However, the reliability of fatigability protocols in these populations is currently unknown. Therefore, the current study investigates test-retest reliability of a static and dynamic motor fatigability protocol for grip and pinch strength in typically developing children (TDC). Eighty-nine TDC (35 boys, 54 girls; mean age 10 years 11 months) used a grip and pinch dynamometer for static (sustained) and dynamic (repeated) contractions during 30s. For static motor fatigability (SFI), mean (Fmean) and SD (Fvar) of force were calculated, and for dynamic motor fatigability, F mean and number of peaks (Npeaks) were calculated. Intraclass correlation coefficients (ICC) were calculated. ICCs of F mean in static and dynamic motor fatigability were high (ICC: 0.94-0.96 and 0.91-0.98). ICCs were moderate to high for F var (ICC: 0.67-0.85). The SFI showed moderate ICCs (ICC: 0.69-0.77). ICCs were moderate to high for N peaks (ICC: 0.78-0.91).Conclusion: The results suggest that static and dynamic motor fatigability in for grip and pinch can be used reliably in TD children aged 6-18 years. What is Known: •Psychometric properties of motor fatigability protocols using grip and pinch in children are lacking. •Motor fatigability in grip and pinch is an important debilitating symptom in multiple neurologic populations. What is New: •Static fatigability can be investigated using a 30-s maximum sustained grip strength protocol in children. •Dynamic fatigability can be investigated using a 30-s maximum repeated grip strength protocol in children.

Reliability and validity of an adapted hip abductor strength measure as a potential new fall risk assessment for older persons: a study protocol.

BACKGROUND: Persons aged ≥ 65 years are currently the world's fastest growing age group. An important complication of age is the increasing risk of falls. Falls have multifactorial etiology and modifiable risk factors open for interventions in prevention and rehabilitation, are of high interest. In this context, strong hip abductors seem to be important to prevent falls. A newly adapted measurement device to measure hip abductor strength (HAS) in a closed chain position was developed. We aim to assess feasibility, intra- and inter-tester reliability and construct and criterion validity of the new measure. METHODS: In two subsequent parts a feasibility, reliability and validity study with an adapted measurement instrument for the assessment of HAS (index test) in a closed chain position in persons aged ≥ 65 years will be conducted. Part I investigates feasibility of the measure in clinical settings as well as reliability of the new HAS test (n = 26). Part II evaluates construct and criterion validity (n = 169). Construct validity will be assessed cross-sectional, criterion validity by comparison with prospectively followed up fall history for 12 months (external criterion) and other functional fall risk assessments (Short Physical Performance Battery, Timed Up and Go test, usual gait speed and hand grip strength). DISCUSSION: Results of feasibility, will give insight in its applicability in daily clinical life and clinimetric properties will show if measurements of HAS in a closed chain position should be encouraged to include in fall risk assessments in older adults.

Validation of the 7-item knee replacement patient education questionnaire (KR-PEQ-7), based on the 16-item knee osteoarthritis patient education questionnaire (KOPEQ).

BACKGROUND: The aim of this study was to investigate the content validity including item reduction, construct validity and internal consistency of the existing 16-item Knee Osteoarthritis Patient Education Questionnaire. Former research had indicated that a reduction of items was necessary. Participants were patients with severe knee osteoarthritis who, prior to undergoing a knee replacement operation, participated routinely in a preoperative educational intervention. METHODS: A mixed method design was used. The first step was directed at the reduction in the number of items on the 16-item Knee Osteoarthritis Patient Education Questionnaire. Based on a priori hypotheses, this was followed by a cross-sectional validation study, performed to compare the resulting 7-item Knee Replacement Patient Education Questionnaire to a patient-testing Interview Protocol that was tailored to the same patient educational material. Additionally, the revised questionnaire was correlated with both the Short Test of Functional Health Literacy and the Mini-Mental State Examination score. RESULTS: A relatively high internal consistency was found for the 7-item Knee Replacement Patient Education Questionnaire, with a Cronbach's alpha of 0.84 (SE: 0.036). Explanatory factor analysis showed no evidence against a one-factor model, with the first and second eigenvalues being 3.8 and 0.31, respectively. Bayesian Estimation of the correlation between the 7-item Knee Replacement Patient Education Questionnaire and the Interview Protocol was 0.78 (mode) (95% HPD 0.58-0.89). CONCLUSIONS: The 7-item Knee Replacement Patient Education Questionnaire shows good psychometric properties and could provide valuable support to health professionals. It can provide valid feedback on how patients waiting for a knee replacement operation experience an applied patient education intervention. Further investigation is needed to assess the applicability of the 7-item Knee Replacement Patient Education Questionnaire to larger samples in different hospitals and countries.

Administration of the German Pediatric Evaluation of Disability Inventory (PEDI-G) Using the Mode of Observation in Children Undergoing Inpatient Rehabilitation: A Reliability and Validity Study.

Aims: To investigate inter-rater reliability, concurrent validity, and feasibility of the German Pediatric Evaluation of Disability Inventory (PEDI-G) using the mode of observation in a Swiss inpatient rehabilitation setting with the Functional Independence Measure for Children (WeeFIM®) as criterion.Methods: Cross-sectional clinimetric study including 36 children and adolescents with median age 10.8 (quartiles 8.7, 13.0) years with neurological/neuro-orthopedic disorders. Data were collected by healthcare professionals through observation. Analyses were performed using intraclass correlation coefficients (ICC2,1), standard error of measurement (SEMAgreement), Bland-Altman plots, Cohen's Kappa κ, percentage agreement, and correlations.Results: Excellent inter-rater reliability (ICCs2,1 ≥ 0.97), small SEMs and acceptable limits of agreement for the Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) were found. No systematic differences between raters existed. Cohen's Kappa for inter-rater agreement of the Modifications Scale (MS) ranged from poor to strong (-0.06 ≤ κ ≤0.85). Excellent concurrent validity for FSS and CAS with the WeeFIM® (ρ ≥ 0.96), and excellent correlations of FSS and CAS with each other (ρ ≥ 0.98) were identified.Conclusion: The German PEDI-G seems to be a reliable and valid, but time-consuming tool when applied in an inpatient setting using observation.

Measuring change in gait performance of children with motor disorders: assessing the Functional Mobility Scale and the Gillette Functional Assessment Questionnaire walking scale.

AIM: To examine the responsiveness and minimal important change (MIC) of two gait performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire walking scale (FAQ), in a paediatric inpatient setting. METHOD: Sixty-four children and adolescents with a motor disorder, including cerebral palsy, traumatic brain injury, or stroke (25 females, 39 males; mean age [SD] 12y 6mo [3y 2mo], range 6-18y 6mo), were recruited. Physiotherapists scored the FMS and FAQ at the start and end of active gait rehabilitation. Change scores were compared with changes in gait capacity tests, the walking item of the Functional Independence Measure for Children, and a global rating scale (GRS) on the physiotherapists' perceived change of the child's functional mobility. The GRS was also used to define the MIC. RESULTS: Change scores of the FMS and FAQ correlated between 0.35 and 0.49 with those of the capacity tests, 0.54 to 0.76 with the Functional Independence Measure for Children walking item change scores, and 0.57 to 0.76 with the GRS. The MIC values for the FMS and FAQ were 0.5 and 1.5 respectively. INTERPRETATION: FMS and FAQ can illustrate change in inpatient gait performance of children and adolescents with motor disorders. An improvement of one level in the FMS and two levels in the FAQ is considered as a clinically meaningful change. WHAT THIS PAPER ADDS: The Functional Mobility Scale (FMS) can detect change in children's inpatient gait performance. The Gillette Functional Assessment Questionnaire walking scale (FAQ) can also detect change in children's inpatient gait performance. A one-level improvement in the FMS is clinically relevant. A two-level improvement in the FAQ is clinically relevant.

MEDICIÓN DEL CAMBIO EN EL DESEMPEÑO DE LA MARCHA EN NIÑOS CON TRASTORNOS MOTORES: EVALUACIÓN DE LA ESCALA DE MOVILIDAD FUNCIONAL Y EL CUESTIONARIO DE EVALUACIÓN FUNCIONAL DE GILLETTE: OBJETIVO: Examinar la sensibilidad y el cambio mínimo significativo de dos mediciones de desempeño de la marcha, la Escala de Movilidad Funcional (FMS) y el Cuestionario de Evaluación Funcional de Gillette (FAQ), en una población de pacientes pediátricos hospitalizados. MÉTODO: Se reclutaron sesenta y cuatro niños y adolescentes con algún trastorno motor, incluyendo parálisis cerebral, lesión cerebral traumática o accidente cerebrovascular (25 mujeres, 39 varones; edad promedio [DE] 12a 6m [3a 2m], rango 6a - 18a 6m). Fisioterapeutas aplicaron las escalas FMS y FAQ al principio y final del proceso de rehabilitación activa de la marcha. Los puntajes de cambio fueron comparados con los cambios en pruebas de capacidad de marcha, el ítem de marcha de la escala WeeFIM (Functional Independence Measure for Children) y una escala global de calificación (EGC) sobre la percepción del fisioterapeuta del cambio en la movilidad funcional del niño. La EGC se utilizó, además, para definir el cambio mínimo significativo. RESULTADOS: Los puntajes de cambio de la FMS y el FAQ tuvieron una correlación de 0,35 a 0,49 con lo de la prueba de capacidad de marcha, 0,54 a 0,76 con el ítem de marcha de la escala WeeFIM, y 0,57 a 0,76 con la EGC. El cambio mínimo significativo para la FMS y el FAQ fueron 0,5 y 1,5, respectivamente. INTERPRETACIÓN: La FMS y el FAQ permiten observar cambios en el desempeño de la marcha de pacientes pediátricos y adolescentes hospitalizados con trastornos motores. Un cambio positivo de un nivel en la FMS y de dos niveles en el FAQ se considera un cambio clínicamente significativo.

MENSURANDO MUDANÇA NO DESEMPENHO DA MARCHA EM CRIANÇAS COM DESORDENS MOTORAS: AVALIANDO A ESCALA DE MOBILIDADE FUNCIONAL A ESCALA DA MARCHA DO QUESTIONÁRIO DE AVALIAÇÃO FUNCIONAL GILLETTE: OBJETIVO: Examinar a responsividade e mínima mudança importante (MMI) de tduas medidas do desempenho da marcha, a Escala de mobilidade funcional (FMS), e a escala da marcha do Questionário de Avaliação Funcional Gillette (FAQ), em uma unidade de internação pediátrica. MÉTODO: Sessenta e quatro crianças e adolescentes com uma desordem motora, incluindo paralisia cerebral, lesão cerebral traumática, ou acidente vascular encefálico (25 do sexo feminino, 39 do sexo masculino; média de idade [DP] 12a 6m [3a 2m], variação 6a-18a 6m), foram recrutadas. Fisioterapeutas pontuaram a FMS e FAQ no início e final da reabilitação ativa da marcha. Mudanças nos escores foram comparadas com mudanças nos testes de capacidade da marcha, no item de marcha da Medida de Independência Funcional para crianças, e uma Escala Global de Pontuação (EGP) sobre as mudanças percebidas pelos fisioterapeutas na mobilidade funcional da criança. A EGP também foi usada para determinar a MMI. RESULTADOS: Os escores de mudança da FMS e FAQ correlacionaram entre 0,35 e 0,49 com os dos testes de capacidade, 0,54 a 0,76 com a mudaça de escores no item de marcha da medida de Independência Funcional para crianças, e 0,57 a 0,76 com a EGP. A MMI para FMS e FAQ foi 0,5 e 1,5, respectivamente. INTERPRETAÇÃO: FMS e FAQ podem ilustrar mudanças no desempenho da marcha em crianças e adolescentes com desordens motoras que se encontram internados. Uma melhora de um nível na FMS e dois níveis na FAQ é considerada mudança clinicamente significativa.

Concurrent Validity of Two Gait Performance Measures in Children with Neuromotor Disorders.

AIMS: To investigate the concurrent validity of two mobility performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire - walking scale (FAQ) in an inpatient pediatric neurorehabilitation setting. METHODS: Cross-sectional data were collected on 71 children (mean age 12.7 years) with neuromotor gait impairments who participated in an inpatient rehabilitation program to evaluate aspects of concurrent validity of the FMS and FAQ. Physiotherapists independently performed ratings. Comparator instruments included the walking item of the Functional Independence Measure for children, 10-m and 6-minute walking tests, and Gross Motor Function Measure-88 dimension E. All tests were completed within 7 days. Spearman correlation coefficients were calculated to test a priori formulated hypotheses regarding the strength and direction of the measures relationships. RESULTS: The children had a broad spectrum of mobility levels, including all levels of FMS and levels 2-10 of FAQ. Spearman correlation coefficients with comparator measures varied between 0.58-0.79 for the FMS and 0.69-0.73 for the FAQ. Hypotheses concerning correlation strengths and directions were met for FMS and FAQ. CONCLUSIONS: The findings demonstrate that the FMS and FAQ are valid to evaluate functional mobility in pediatric inpatient neurorehabilitation.

The course of complaints of arm, neck and/or shoulder: a cohort study in a university population participating in work or study.

BACKGROUND: Not much is known about the characteristics, course and prognosis of complaints of arm, neck and/or shoulder that have not been caused by a trauma or systemic disease (CANS), in a screened population. This study aims to: (1) describe personal and complaint characteristics in a screened population; (2) describe the course during one-year follow-up, in terms of the three different domains of functioning of the International Classification of Functioning, Disability and Health (ICF); and (3) to explore prognostic factors for the different domains of functioning at one-year follow-up. Additionally, this study aims to investigate the manifestation of selection effects (i.e. tertiary selection effects), in order to understand their impact on the interpretation of results. METHODS: A cross-sectional survey was conducted in a university population. Survey respondents who fulfilled eligibility criteria were asked to participate in a longitudinal cohort study. The course of CANS was assessed in terms of the three ICF domains of functioning. Possible prognostic factors across the different components of the ICF were selected to investigate their influence on outcome at one-year follow-up. Non-response analyses were performed to investigate the presence of tertiary selection effects. RESULTS: The results revealed a population with relatively mild complaints at baseline, and a relatively stable course during follow-up. Because of the small change in scores between baseline and follow-up measurements, examination of prognostic factors was not feasible. The results of the non-response analyses revealed some indications for the potential presence of tertiary selection effects, which may imply that the results obtained are a slight overestimation of the true results. CONCLUSION: The results of this study demonstrate mild complaints at baseline and an overall stable course during one-year follow-up. Since selection effects cannot be ruled out, the true course might possibly be somewhat less favourable than our results suggest.

Childhood Bladder and Bowel Dysfunction Questionnaire: Development, Feasibility, and Aspects of Validity and Reliability.

OBJECTIVES: The aim of the study was to develop a questionnaire evaluating the frequency of symptoms over time of concomitant childhood bladder and bowel dysfunctions (CBBDs) in 5- to 12-year-old children and to assess its feasibility and aspects of validity and reliability. METHODS: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) was developed in phases according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) in cooperation with epidemiologists, pediatricians, physiotherapists (phases 1 and 5), and professional translators (phase 5): selection of items (Delphi-method), content validity (pilot), feasibility (interviews), structural validity and internal consistency (field testing), and guideline-based translation (Dutch-English). Participants were parents of children, ages 5 to 12 years (phases 2-4). RESULTS: Parents of 1333 children (mean age 7.8 years [standard deviation 2.1]) were included. Most common were urinary incontinence (35.9%), enuresis (29.7%), and constipation/fecal incontinence (30.1%). Concomitant CBBD was seen in 74.2% of 1229 children. Originally, a 27-item CBBDQ was developed. After the pilot (48 parents) a 23-item version remained for evaluation of feasibility aspects by interviewing 56 parents. Based on 1229 completed questionnaires during field testing, the CBBDQ reduced to 18 items. Cronbach α values were 0.74 and 0.71 for bladder and bowel subscales, respectively. Feasibility and aspects of validity and reliability were satisfactory. A definitive and accepted English version of the CBBDQ is available. CONCLUSIONS: When completed by parents, the 18-item evaluative CBBDQ appears feasible, content, and structurally valid with good internal consistency for the bladder and bowel subscales. The Dutch and English versions will be introduced clinically and subjected to further psychometric evaluation.

Interrater reliability of two gait performance measures in children with neuromotor disorders across two different settings.

AIM: To examine the interrater agreement of the two gait performance measures - the Functional Mobility Scale (FMS) and Gillette Functional Assessment Questionnaire - walking scale (FAQ) - within health professionals and parents in children with neuromotor disorders, measured in an inpatient setting and at home. METHOD: Seventy-one children with a neuromotor diagnosis (44 males, 27 females; median age 12y 11mo [interquartile range 4y-10mo]) were consecutively recruited when starting an inpatient active gait rehabilitation programme. Physiotherapists and nurses independently scored the level of children's gait performance with the FMS and the FAQ, while parents' scores regarding the children's gait performance at home were obtained by interview or telephone call at the same measurement points. RESULTS: Linear weighted kappa coefficients were substantial to almost perfect for all comparisons. Kappa coefficients ranged from 0.62 to 0.85 for the FMS-5, from 0.79 to 0.92 for the FMS-50, from 0.83 to 0.90 for the FMS-500, and from 0.69 to 0.77 for the FAQ. Friedman tests did not reveal significant differences between the different rater groups. INTERPRETATION: The unexpectedly high level of interrater agreement between parents, physiotherapists, and nurses demonstrates that the FMS and FAQ can reliably assess gait performance in an inpatient setting. Inpatient scores correspond well to the children's performance in their usual environment. WHAT THIS PAPER ADDS: The Functional Mobility Scale and Gillette Functional Assessment Questionnaire - walking scale measure gait performance reliably at home and in an inpatient setting. Physiotherapists, nurses, and parents reliably score gait performance. Inpatient gait performance scores correspond well to children's performance at home. Physiotherapists and nurses in an inpatient setting can reliably estimate gait performance at home.