Enhancing pediatric pain management in Turkey: A modified Delphi study on culturally adapted pain neuroscience education for chronic pain in children.

BACKGROUND: Pain Neuroscience Education (PNE) is a commonly used technique applied by physical therapists in the rehabilitation of chronic pain. OBJECTIVE: The aim of this study was to culturally adapt an existing PNE for children with chronic pain (PNE4Kids) to Turkish children with chronic pain (PNE4Kids-Turkish). METHODS: A three-round modified Delphi-study was conducted between September 2023 and February 2024. Experts completed questionnaire with 5 items to elicit demographic data and 16 closed and 7 open-ended questions to assess relevance of information, feasibility of stories, visual information, and clarity of message in the 4 main areas of 'normal pain biology', 'pain modulation', 'chronic pain, adaptations, central sensitization', and 'the application and implications of PNE4Kids. MAXQDA software was used for qualitative analysis of open-ended questions. A total of 38 experts (mean age: 36.6 ± 9.05 years, 6 male, 32 female) were recruited for this study. RESULTS: The results of the first round indicated that 84-100 % of Delphi experts strongly agreed or agreed on the relevance of information, feasibility of stories, visual information, and clarity of message in respect of the 4 main areas. During second and third round, an acceptable degree of agreement with clinical usefulness of PNE4Kids-Turkish materials was obtained. CONCLUSIONS: PNE4Kids was culturally adapted for Turkish children suffering from chronic pain. The findings of this study mainly highlight the viewpoints of the experts. IMPLICATION TO PRACTICE: This is the first study to have developed and culturally adapted the PNE4Kids for Turkish children with chronic pain. The PNE4Kids-Turkish is crucial, valuable, helpful, and understandable for Turkish children with chronic pain. In addition, the PNE4Kids-Turkish has the potential to close the gap in research and clinical areas for Turkish children with chronic pain.

Community Participation, Supports and Barriers of Adolescents with and without Attention Deficit Hyperactivity Disorder.

AIM: To compare participation patterns, environmental supports, and barriers to community activities in adolescents with and without attention deficit hyperactivity disorder (ADHD) in Turkey. METHODS: Participants were 94 adolescents with ADHD and 109 adolescents without ADHD ages 13-17 years (mean age 14.6, S.D 1.49 years) Participation frequency, involvement rate, mothers who desired change, and environmental supports and barriers in a community setting were assessed with the Participation and Environment Measure for Children and Youth (PEM-CY). RESULTS: Adolescents with ADHD participated 20.3% less frequently in socializing with peers in the community than adolescents without ADHD. With moderate to large effect sizes, the mean involvement rate in four community activities, including neighborhood outings, community events, socializing with peers in the community, and religious activities, was significantly lower for adolescents with ADHD than for adolescents without ADHD. CONCLUSION: Adolescents with ADHD participate less frequently and are less involved in socializing with peers in the community. Almost half of all ADHD adolescents never participate in community events. It was seen that cognitive difficulties, sensory qualities, and safety may prevent adolescents with ADHD from socializing with peers in the community.

Investigation of the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis: a randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis and to compare with patient education. METHODS: A total of 46 individuals with systemic sclerosis (55.52±11.54 years) were included. Individuals were randomly assigned into intervention (n=23) and control (n=23) groups. Dynamometer, goniometer, Canadian Occupational Performance Measurement, Disabilities of the Arm, Shoulder, and Hand, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index were used for evaluation. RESULTS: Post-treatment, in terms of delta (Δ) values, hand grip and pinch strengths (p: 0.000-0.016), active (p: 0.000-0.032) and passive (p: 0.000-0.043) total range of motions, Canadian Occupational Performance Measurement performance and satisfaction, Disabilities of the Arm, Shoulder, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index (p: 0.000) were in favor of the intervention group. CONCLUSION: Upper extremity home exercises increase grip strength, range of motion, activity performance, and functionality in patients with systemic sclerosis. We recommend that rehabilitation programs include not only hand exercises but also upper extremity exercises.

Investigation of the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis: a randomized controlled trial

SUMMARY OBJECTIVE: This study aimed to investigate the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis and to compare with patient education. METHODS: A total of 46 individuals with systemic sclerosis (55.52±11.54 years) were included. Individuals were randomly assigned into intervention (n=23) and control (n=23) groups. Dynamometer, goniometer, Canadian Occupational Performance Measurement, Disabilities of the Arm, Shoulder, and Hand, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index were used for evaluation. RESULTS: Post-treatment, in terms of delta (Δ) values, hand grip and pinch strengths (p: 0.000-0.016), active (p: 0.000-0.032) and passive (p: 0.000-0.043) total range of motions, Canadian Occupational Performance Measurement performance and satisfaction, Disabilities of the Arm, Shoulder, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index (p: 0.000) were in favor of the intervention group. CONCLUSION: Upper extremity home exercises increase grip strength, range of motion, activity performance, and functionality in patients with systemic sclerosis. We recommend that rehabilitation programs include not only hand exercises but also upper extremity exercises.

How cognitive and behavioural body-functions of children with ADHD are linked to their participation and environmental supports?

BACKGROUND: Children with chronic conditions face participation restrictions and exclusions. AIMS: To investigate how cognitive and behavioural body-functions are associated with 1) participation patterns and 2) environmental factors among children with attention deficit hyperactivity disorder (ADHD). METHODS AND PROCEDURES: The study included 83 children with ADHD. Cognitive and behavioural body-functions were assessed with Conners' Parent Rating Scale-Revised Long-Version. The participation patterns of children were assessed with Participation and Environment Measure for Children and Youth (PEM-CY). Multiple regression analyses were used to examine the relationships between cognitive and behavioural body-functions and (1) participation patterns at home, school and community settings, and (2) environmental supports and barriers. OUTCOME AND RESULTS: In home setting, inattention and ADHD index which determine ADHD children from typically developing peers, were the strongest factors, explaining 24.9 % of variance in activities that mothers wanted to change. In school setting, presence/level of oppositional behaviours had the strongest effect on environmental barriers, with variation of 29.8 %. In community setting, the strongest factor explaining environmental helpfulness was anxious/shy behaviours (16.1 %). CONCLUSIONS AND IMPLICATIONS: When seeking to improve participation of children with ADHD both the cognitive and behavioural demands of chosen activities should be modified while creating environments that supports these challenges.

Investigation of the relationship between sexual and pelvic floor dysfunction in female patients with fibromyalgia syndrome.

The aim of the study was to examine the relationship between pelvic floor functions and sexual functions in women with fibromyalgia. The study included 204 women with fibromyalgia, mean aged 43.43 ± 8.61 years. All patients who met the inclusion criteria and applied to the rheumatology outpatient clinic were included in the study. The study was conducted between September 2020 and June 2022. The Female Sexual Function Scale (FSFI) was used to evaluate sexual function, Pelvic Floor Distress Scale-20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Incontinence Sexual Function Assessment (PSIQ-12) were used to evaluate pelvic floor problems. The relationship between sexual dysfunction and other parameters was analyzed using Spearman correlation analysis. There was a weak negative correlation between many sub-parameters of FSFI and scores of PFDI-20, PFIQ-7, PSIQ-12 (r:-0.165--0.377 p: 0.02-0.00). According to the results of this study, sexual dysfunction was negatively affected by pelvic floor dysfunction and symptoms related to bladder, bowel, and pelvic organs in women with fibromyalgia. These results may suggest that sexual function and pelvic floor problems in women with fibromyalgia should be considered together and an approach should be planned for such problems in treatment programs.

Investigation of the effects of pelvic floor training on pain, sexual dysfunction, and quality of life in female patients with primary Sjögren syndrome.

AIM: To investigate the effects of pelvic floor training on pain, sexual dysfunction and quality of life in female patients with primary Sjögren syndrome (pSS) and determine whether pelvic floor training was superior to an education program. METHODS: Forty-six pSS patients (all women) with an average age of 47.78 ± 9.18 years were included in the study. Patients were divided into two groups as a pelvic floor training group and control group for 8 weeks. Visual Analog Scale (VAS), Pelvic Pain Impact Questionnaire (PPIQ), Female Sexual Function Scale (FSFI), Health Assessment Questionnaire (HAQ), Pelvic Floor Disability Index-20 (PFDI-20), and Pelvic Floor Impact Questionnaire (PFIQ-7) were used to evaluate the outcomes. All evaluations were performed at baseline and at the end of the 8th week. RESULTS: When the groups were compared before training, there was no significant difference (p > .05). In post-training comparisons, there were significant differences in VAS, PPIQ, FSFI, PFIQ-7, and PFDI-20 in the pelvic floor training group (p values between .02 and .00), and in FSFI-lubrication, PFIQ-7, and PFDI-20 (p values between .00 and .03) in the control group. According to Δ values, the pelvic floor training group was found to be superior in terms of FSFI orgasm, pain, and lubrication scores (p = .00) and all sub-parameters of PFDI-20 (p = .00). CONCLUSION: Pelvic floor training has a positive effect on the sexual dysfunction and discomfort caused by pelvic symptoms in patients with pSS. Pelvic floor training should be included in rehabilitation programs to improve sexual function and pelvic floor dysfunctions for patients with pSS.

The long-term impact of the COVID-19 pandemic on children with ADHD in terms of participation, support, and barriers at home.

PURPOSE: The purpose of this study was to compare the long-term impact of the COVID-19 pandemic on participation, support, and barriers at home in children with attention deficit hyperactivity disorder (ADHD) and without ADHD. DESIGN AND METHODS: This study included a total of 227 participants with a mean age of 11.93 ± 2.96 years, comprising 116 children and adolescents with ADHD and 111 without ADHD. The parents or primary caregivers of all the children completed the Participation and Environment Measure for Children and Youth (PEM-CY), which was used to assess participation and environmental factors in the home. The Student's t-test was used to compare numeric data and Chi-square test to categorical data between children and adolescents with ADHD and those without ADHD in all three settings. RESULTS: The children with ADHD were determined to play computer and video games significantly more than children without ADHD (p < 0.001). The mean frequency of participation in arts, crafts, music, hobbies (p < 0.001), school preparation (<0.0001), and homework (<0.003) was significantly higher in children without ADHD. A moderate effect size (ϕ = 0.42) was determined in respect of cognitive demands making it more difficult for children with ADHD to participate in home activities than children without ADHD. CONCLUSIONS: Children with ADHD were negatively affected in terms of participating in home activities than their typically developing peers. In addition, cognitive demands prevented their participation and involvement in the home environment while cognitive demands were a support for non-ADHD children. PRACTICAL IMPLICATIONS: A highlight of this research was the comprehensive investigation of the long-term effect of the COVID-19 pandemic on participation in all activities at home, in addition to the support and barriers in the home environment for children with ADHD compared to typically developing peers.

The effects of power exercises on body structure and function, activity and participation in children with cerebral palsy: an ICF-based systematic review.

PURPOSE: To systematically review the literature for evidence of effectiveness of power exercises on physical, physiological, and functional outcomes in children and adolescents with cerebral palsy (CP). MATERIALS AND METHODS: Methodological quality and evidence synthesis were assessed with using the Cochrane Risk of Bias (RoB) Tools and Modified Bakker Scale. Using the International Classification of Functioning (ICF), outcome measures for muscle agriculture, gait, balance, motor function, aerobic/anaerobic fitness, daily living, mobility, and school participation were categorised. RESULTS: The overall RoB of four randomised clinical trials was low, one had some concerns and two were rated as high. Moderate evidence was found that power exercises increased walking speed, activities of daily living, muscle strength, and enhanced gross motor function more than a routine physical therapy program. CONCLUSIONS: The lack of stronger evidence for power training interventions to improve muscle architecture, muscle function, walking capacity, and mobility in children with CP might be explained by the differences in training protocols and degree to which these meet the physiological definition of power, different methods of measuring power, limited durations of training, and the relative effectiveness of control interventions. Future studies should include a stronger focus on child and family-centred participation goals.Implications For RehabilitationPower training can improve gross motor function, walking speed, muscle strength, and activities of daily living more than routine physical therapy.Results comparing power training versus traditional strength training were less pronounced likely because both are intensive and may have positive effects.More research is needed to investigate effects of power training on participation.

Investigation of the validity and reliability of the L test in children with cerebral palsy.

Background: The L test is a modified version of the Timed Up and Go Test (TUG), with a walking path that is L-shaped. The L test is a more comprehensive test since it includes a longer walking path than TUG and turning in both directions.Objective: This study aimed to examine the reliability and validity of the L test, and the minimal detectable change (MDC) in children with cerebral palsy (CP).Methods: The study included 80 children with CP at levels 1 and 2 according to the Gross Motor Function Classification System (GMFCS). The Intraclass Correlation Coefficient (ICC) was used to assess the reliability of the L test according to GMFCS level. MDC estimates were calculated using baseline data. The correlations of the L test with TUG and the Timed up and Down Stairs Test (TUDS) were assessed for convergent validity.Results: Intra-rater (ICC 0.903-0.985 for level 1-2) and inter-rater (ICC 0.806-0.937 for level 1-2) reliability of the L test were determined to be excellent. A moderate correlation was found between the L test and TUG (r: 0.691) and TUDS (r: 0.546) for level 1; a moderate correlation was found between the L test and TUG (r: 0.625) and a high correlation was found between the L test and TUDS (r: 0.734) for level 2. The MDC values in terms of intra-rater were 1.44-2.21 s for level 1-2, and 1.30-1.57 s for level 2 in terms of inter-rater, respectively.Conclusion: The results of this study showed that the L test is a valid and reliable method in the assessment of functional mobility in children with CP.

Effects of individual progressive single- and dual-task training on gait and cognition among older healthy adults: a randomized-controlled comparison study.

PURPOSE: Dual-task training has beneficial effects on older individuals for gait and cognition. This study was aimed to make a comparison between the effects of individual progressive single- and dual-task training on gait and cognition among healthy older individuals. METHODS: A total of 32 participants were divided randomly into two groups as the single-task group (n = 16, 64.6 ± 3.3 years, 7 males and 9 females) and dual-task group (n = 16, 65.6 ± 2.6 years, 8 males and 8 females). The 10-m walk test with the LEGSys device was used to assess spatio-temporal gait parameters. The cognitive parameters were evaluated using the Standardized Mini-Mental State Exam and Stroop Test. An individual progressive 60 min single- and dual-task training programs were applied twice per week for a period of 6 weeks. RESULTS: There were significant differences for both gait and cognition variables in the dual-task training group (p < 0.05), according to the comparison of pre- and post-treatment results. In the single-task training group, there were significant differences only in gait parameters with single-task conditions (p < 0.05). The comparisons of the delta values between the groups indicated that the dual-task training group was better compared to the single-task training group in gait speed, cadence, and many cognitive variables (p < 0.05). CONCLUSION: Individual progressive dual-task training is an effective and useful method that improves gait performance and cognitive skills among older individuals. TRIAL REGISTRATION NUMBER AND DATE: NCT03777111, 12/13/2018.

Investigation of the relationship between the pelvic floor and sexual dysfunction in women with Sjögren's syndrome.

BACKGROUND AND AIM: Women with Sjögren's syndrome (SS) may have sexual dysfunctions due to vaginal dryness and may also have pelvic floor problems. The aim of this study was to examine the pelvic floor distress of women with SS with a self-reported questionnaire, to compare this group with healthy individuals, and to examine the relationship between pelvic floor problems and sexual dysfunction. METHODS: The study included 94 women with SS, aged 47.26 ± 7.56 years, and 94 age-matched healthy women, aged 48.15 ± 8.73 years. The Pelvic Floor Disease Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Female Sexual Function Scale (FSFI) were used for assessment. RESULTS: The PFDI-20, PFIQ-7, and FSFI scores of the healthy control group were found to be statistically significantly better than those of the primary SS group (Z = -2.69 to -8.03, P = .00). A moderate-high correlation was found between the total and sub-parameters of PFDI-20 and disease duration, the total and sub-parameters of the PFIQ-7 and the pain sub-parameter and total score of the FSFI (r = -0.66 to 0.78, P = .00-.04). CONCLUSION: According to the study results, as the disease duration increases, the distress increases and this distress has a negative effect on the health-related quality of life of these women. Pelvic floor distress was associated with poor sexual function and pain. From these results, it can be recommended that the methods of pharmacology, education, exercise, relaxation, lifestyle change, and so on for pelvic floor dysfunction and pain in women with SS should be applied together with a multidisciplinary approach.

Investigation of the effectiveness of Tai Chi exercise program in patients with scleroderma: A randomized controlled study.

BACKGROUND: and Purpose: There were studies showing the positive effects of Tai Chi on sleep, fatigue, endurance, balance, anxiety and depression in rheumatologic diseases. The aim of this study was to investigate the effects of Tai Chi exercise program on trunk endurance, balance, sleep, fatigue, anxiety and depression in patients with systemic sclerosis (SSc). MATERIALS AND METHODS: 28 patients were randomly divided into two groups as Tai Chi (n:14, 53.35 ± 10.86 years) and home exercise group (n:14, 52.64 ± 9.45 years). Trunk Lateral Endurance Test, Berg Balance Scale, Pittsburg Sleep Quality Index, Fatigue Severity Scale and Fatigue Impact Scale, Hospital Anxiety and Depression Scale was used for assesment. All evaluations were performed at baseline and at the end of the 10th week. RESULTS: After training, a statistically significant difference was observed in all parameters in Tai Chi group (p:0.00); there was a significant difference in trunk endurance and sleep quality in the home exercise group (p:0.00-0.03) compared to pre-training. When the delta values between groups were compared, Tai Chi group was superior to home exercise group in all parameters except trunk endurance (p:0.00-0.01). No side effects were observed during the exercises. CONCLUSION: As a result of our study; Tai Chi has a possitive effect on endurance, balance, sleep quality, fatique, anxiety and depression in patients with SSc. Tai Chi should be included in rehabilitation programs as a safe alternative type of exercise to improve trunk endurance, balance, sleep quality and reduce fatigue, anxiety and depression in patients with SSc.

The effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss.

Background: The aim of the study was to examine the effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss.Methods: The study included 39 children, aged 10-14 years, with congenital sensorineural hearing loss. The participants were divided into three groups as the Tai Chi group, conventional exercise group, and control group. The Tai Chi group and the conventional exercise group received a 1-h exercise program twice a week for 10 weeks. The balance function of the children was assessed using the Pediatric Balance Scale, the balance subtest of Bruininks-Oseretsky Test 2-Short Form, and the Functional Reach Test. The Timed Up and Go Test and the Timed Up and Down Stairs Test were used to assess functional mobility. The Wilcoxon rank, Kruskal-Wallis. and Mann-Whitney U-tests were used for statistical analyses.Results: When the pre-training values of the groups were compared, with the exception of the Timed Up and Go test, there was no statistically significant difference with respect to demographic data, balance, and functional mobility parameters (p > 0.05). After training, the overall balance and functional mobility tests improved compared to pre-training values in both the Tai Chi and conventional exercise groups (p < 0.05). When the post-training values were compared between the groups, with the exception of the Functional Reach Test and the Timed Up and Down Stairs Test, the results of both exercise groups were superior to those of the control group (p < 0.05).Conclusions: The results of this study indicate that Tai Chi and conventional exercise programs have positive effects on balance and functional mobility in children with congenital sensorineural hearing loss. However, no superiority of Tai Chi or the conventional exercise programs was determined over the other. Both Tai Chi and conventional exercise programs could be used to improve balance and functional mobility in children with congenital sensorineural hearing loss.Implications for rehabilitationTai Chi and conventional exercises are effective on balance in children with congenital sensorineural hearing loss.Tai Chi and conventional exercises are effective on functional mobility in children with congenital sensorineural hearing loss.Tai Chi may be added to the rehabilitation program for children with congenital sensorineural hearing loss.

Validity and reliability of the unsupported upper-limb exercise test in individuals with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease which affects the performance of the upper extremities. There is no method to evaluate the specific upper extremity endurance of individuals with this disease. The unsupported upper-limb exercise test (UULEX) is a performance test that evaluates upper extremity performance (functionality and endurance). AIM: The aim of this study was to examine the reliability and validity of UULEX and the minimal detectable change (MDC) in individuals with RA. METHODS AND MATERIALS: The study included 71 patients (15 male, 56 female) with a mean age of 52.15 ± 10.11 years. The intraclass correlation coefficient (ICC) was used to assess the reliability of UULEX. MDC estimates were calculated using baseline data. Correlations of UULEX with the Disability of Arm, Shoulder and Hand Questionnaire (DASH), Health Assessment Questionnaire (HAQ), 30-second push-up test and 6 pegboard ring test (6PBRT) were assessed for concurrent validity. RESULTS: The level, weight and duration scores of the UULEX test were found to be excellent for intra-rater reliability (ICC = 0.922, 0.960, 0.958). Intra-rater MDC values were determined to be 0.35, 2.04, and 0.80 seconds, respectively. Moderate-excellent correlations were found between UULEX and DASH, HAQ, 30-second push-up test and 6PBRT (P < .05). CONCLUSION: The results of this study showed that UULEX test is a valid and reliable method for the assessment of upper extremity performance in individuals with RA.