Effectiveness of Tai Chi for Health Promotion of Older Adults: A Scoping Review of Meta-Analyses.

Background. Tai Chi is a form of exercise that is accessible to people from different socioeconomic backgrounds, making it a potentially valuable activity for health promotion of older adults. Purpose. The objective of this scoping review was to summarize the current knowledge about the effectiveness of Tai Chi for older adults across a range of general health outcomes from published, peer reviewed, unique meta-analyses. Methods. Meta-analyses were retrieved from Medline, Embase, AMED, CINAHL, SPORTDiscus, PsychINFO, Web of Science, PubMed Health, and the Cochrane Library from database inception to late August 2019. Multistage deduplication and screening processes identified eligible full-length meta-analyses. Two people independently appraised 27 meta-analyses based on the GRADE system and organized results into 3 appendices subsequently collated into heterogeneous, statistically significant, and statistically insignificant tables. Results. "High" and "moderate" quality evidence extracted from these meta-analyses demonstrated that practicing Tai Chi can significantly improve balance, cardiorespiratory fitness, cognition, mobility, proprioception, sleep, and strength; reduce the incidence of falls and nonfatal stroke; and decrease stroke risk factors. Conclusions. Health care providers can now recommend Tai Chi with high level of certainty for health promotion of older adults across a range of general health outcomes for improvement of overall well-being.

Effectiveness of Tai Chi for health promotion for adults with health conditions: a scoping review of Meta-analyses.

PURPOSE: To complete a scoping review of meta-analyses summarizing evidence of the effectiveness of Tai Chi for adults with health conditions. MATERIALS AND METHODS: Meta-analyses were retrieved from Medline, Embase, AMED, CINAHL, SPORTDiscus, PsychINFO, Web of Science, PubMed Health and the Cochrane Library from database inception to early September 2018. Multistage deduplication and screening processes identified full-length, unique, peer-reviewed meta-analyses. Two people independently appraised 42 meta-analyses based on the GRADE system and organized results into 3 appendices subsequently collated into heterogeneous, statistically significant, and statistically insignificant tables. RESULTS: "High" and "moderate" quality evidence indicates that Tai Chi can significantly benefit adults with health conditions including cancers, chronic obstructive pulmonary disease, coronary heart disease, depression, heart failure, hypertension, low back pain, osteoarthritis, osteoporosis, Parkinson's Disease and stroke. Outcomes included significant improvements in activities of daily living, balance, exercise capacity, gait, mastery, mental health, mobility, motor function, participation in daily life, physical function, quality of life, range of motion, and strength; with reductions in blood pressure, body mass index, depression, disability, dyspnea, falls, fatigue, pain, stiffness, and waist circumference. CONCLUSIONS: Healthcare providers now have information to advise clients with health conditions on the effectiveness of Tai Chi for overall health promotion. IMPLICATIONS FOR REHABILITATIONTai Chi is a form of safe, enjoyable, light-to-moderate aerobic physical activity for adults that is inexpensive to implement in diverse community settings.Adults with health conditions require physical activity for prevention of secondary impairments and over-all health promotion.This scoping review of meta-analyses elucidates "high" and "moderate" quality evidence of the effectiveness of Tai Chi in improving important outcomes for people with numerous health conditions.This information can be useful for healthcare providers who wish to recommend effective community-based physical activity to clients they are serving.

Advancing the Evidence Base of Pediatric Physical Therapy: "Sincerely, From the Heart".

PURPOSE: To share reflections on themes that have become important to me as a developing pediatric physical therapy researcher contributing to knowledge generation in our field. KEY POINTS: The themes are: select strong mentors, assemble a research team with diverse perspectives and strengths, be family-centered, be rigorous in approaches to study design to match the research question, mentor the next generation, and engage in knowledge translation and exchange. CONCLUSIONS: I encourage everyone to reflect on who has been or could be your mentors or mentees, and on how you can be a part of an effective, family-centered research team, by encouraging a breadth of research designs to answer the many research questions that remain and by assisting in the implementation of knowledge to practice. CLINICAL RELEVANCE: Outcomes for children and families receiving pediatric physical therapy services are enhanced through the use of evidence-based knowledge.

Updating the Comprehensive Professional Behaviours Development Log.

PURPOSE: The Comprehensive Professional Behaviours Development Log (CPBDL) was designed as an explicit self-assessment tool to explore developing professional behaviours in entry-level master's of physical therapy students. The purpose of this project was to update the CPBDL to reflect current terminology and practice, using similar stakeholder involvement and consensus processes to those used in its initial development. METHODS: Nine individuals representing a range of stakeholder groups participated in two separate face-to-face meetings. The meetings followed the nominal group technique (NGT). The ideas derived from the NGT meetings were refined via the Delphi process until 80% consensus was reached. RESULTS: Eight of the original nine key professional behaviours were updated; one was deleted (Lifelong Learning). Many items within individual behaviours were merged or re-ordered. Items deemed to be obsolete were removed and new ideas were either added separately or incorporated into previously-written items. Some items were thought to belong better to different behaviours, so these were moved accordingly. Terminology was updated for items and for behaviour titles. DISCUSSION: The nine stakeholders involved in the updating process were satisfied with the new version of the CPBDL. The update better reflects current practices and can be adapted to settings outside physical therapy.

Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy.

Background: Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels. Objective: The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels. Design: The design was a longitudinal cohort study. Methods: Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB. Results: Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as "developing as expected" for their age and GMFCS levels. Limitations: Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session. Conclusions: When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability.

Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children With Cerebral Palsy.

BACKGROUND: Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making. OBJECTIVE: For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes. DESIGN: This study used a longitudinal cohort design. METHODS: Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure. RESULTS: Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels. LIMITATIONS: Limitations included a convenience sample and varying numbers of participants assessed at each visit. CONCLUSIONS: The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.

Determinants of playfulness of young children with cerebral palsy.

PURPOSE: To identify child, family, and service determinants of playfulness of young children with cerebral palsy. METHODS: Participants were 429 children, 18-60 months. Children were divided into two groups, Gross Motor Function Classification System levels I-II and III-V. Therapists collected data on body functions and gross motor function; parents provided information about children's health conditions and adaptive behavior, family life, and services. One year after the beginning of the study, therapists assessed children's playfulness. Data were analyzed using structural equation modeling. RESULTS: Higher gross motor function was associated with higher playfulness for both groups. Greater impact of health conditions on daily life was associated with lower playfulness for children in levels I-II. More effective adaptive behavior was associated with higher playfulness, and higher parent perception of therapists' family-centeredness was associated with lower playfulness for children in levels III-V. CONCLUSION: Supporting gross motor function, health, and adaptive behavior may foster playfulness.

Longitudinal trajectories and reference centiles for the impact of health conditions on daily activities of children with cerebral palsy.

AIM: First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels. METHOD: A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression. RESULTS: Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed. INTERPRETATION: Longitudinal trajectories of co-occurring health conditions assist with understanding children's prognoses. Centiles assist in understanding a child's experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing 'as expected', 'better than expected' or 'more poorly than expected' in regard to the impact of health conditions on daily activities. WHAT THIS PAPER ADDS: For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level.

TRAYECTORIAS LONGITUDINALES Y CENTILES DE REFERENCIA PARA EL IMPACTO DE LAS CONDICIONES DE SALUD EN LAS ACTIVIDADES DIARIAS DE LOS NIÑOS CON PARÁLISIS CEREBRAL: OBJETIVO: Primero, describir el impacto de las condiciones de salud en las actividades diarias a lo largo del tiempo en niños con parálisis cerebral (PC) y crear centiles de referencia específicos de la edad. Segundo, para determinar la cantidad de cambio típica en un período de 1 año, a través de los niveles del Sistema de Clasificación de la Función Motora Bruta (GMFCS). MÉTODO: Un diseño de cohorte prospectivo, con cinco evaluaciones durante 2 años, involucró a 708 niños con un diagnóstico confirmado de PC que participó en el estudio On Track (396 varones, 312 mujeres; edad media 6 años de edad [SD 2 años 7 meses]; rango 18 meses-12 años a primera evaluación: 32,1% en GMFCS nivel I, 22,7% en GMFCS nivel II, 11,2% en GMFCS nivel III, 18,2% en GMFCS nivel IV, 15,7% en GMFCS nivel V). El impacto de las condiciones de salud en las actividades diarias se evaluó utilizando el Cuestionario de Condiciones de Salud Infantil. Los datos se analizaron utilizando modelos de efectos mixtos y regresión por cuantiles. RESULTADOS: Las trayectorias longitudinales lineales describen el impacto relativamente estable de las condiciones de salud a lo largo del tiempo para cada nivel funcional para niños de 2 años a 12 años, con las puntuaciones más bajas (menor impacto) en el nivel I de GMFCS y las puntuaciones más altas (mayor impacto) en el nivel de GMFCS V. Centiles fueron creados para los niños en cada nivel de GMFCS. Se desarrolló un sistema para interpretar la magnitud del cambio en el tiempo en centiles. INTERPRETACIÓN: Las trayectorias longitudinales de las condiciones de salud concurrentes ayudan a comprender los pronósticos de los niños. Los centiles ayudan a comprender la experiencia de un niño en relación con los niños en niveles similares de GMFCS. Se proporcionan pautas para determinar si los niños progresan "como se espera", "mejor de lo esperado" o "peor de lo esperado" en relación con el impacto de las condiciones de salud en las actividades diarias.

TRAJETÓRIAS LONGITUDINAIS E CENTIS DE REFERÊNCIA PARA O IMPACTO DAS CONDIÇÕES DE SAÚDE NAS ATIVIDADES DIÁRIAS DE CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Primeiro, descrever o impacto das condições de saúde nas atividades diárias ao longo do tempo em crianças com paralisia cerebral (PC) e criar centis de referência idade-específicos. Segundo, determinar a quantidade de mudança típica em um ano, nos diversos níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). MÉTODO: Um desenho prospectivo de coorte, com cinco avaliações em 2 anos, envolveu 708 crianças com diagnóstico confirmado de PC que participavam do Estudo On Track (396 do sexo masculino, 312 do sexo feminino; méida de idade 6a [DP 2a 7m]; variação 18m-12a na primeira avaliação; 32,1% no nível GMFCS I, 22,7% no nível GMFCS II, 11,2% no nível GMFCS III, 18,2% no nível GMFCS IV, 15,7% no nível GMFCS V). O impacto das condições de saúde nas atividades diárias foi avaliado usando o Questionário das condições de saúde da criança. Os dados foram analisados usando modelos de efeitos mistos e regressão quantil. RESULTADOS: Trajetórias lineares longitudinais descrevem o impacto relativamente estável das condições de saúde ao longo do tempo para cada nível funcional para crianças com idades de 2 a 12 anos, com os menores escores (menor impacto) no nível GMFCS I e maiores escores (maior impacto) no nível GMFCS V. Centis foram criados para crianças em cada nível GMFCS. Um sistema para interpretar a magnitude da mudança ao longo do tempo em centis foi criado. INTERPRETAÇÃO: Trajetórias longitudinais de condições de saúde co-ocorrentes ajudam a entender o prognóstico da criança. Os centis ajudam a compreender a experiência da criança com relação a crianças em níveis GMFCS similares. Diretrizes são oferecidas para determinar se crianças estão progredindo "como esperado", "melhor do que o esperado"ou "pior do que o esperado" com relação ao impacto das condições de saúde nas atividades diárias.

Subgrouping children with cerebral palsy from a broader perspective using two methods.

The purpose was to develop two versions of a body function index in cerebral palsy (BFI-CP I and BFI-CP II) using two methods to explore the relationship and differences among them and the Gross Motor Function Classification System (GMFCS) and to explore the differences among subsets of the classifications that do not correspond to the ordinal levels of the GMFCS. Data on various measures from 405 children with CP between 18 months and 5 years of age were extracted from the Move & PLAY Study. The BFI-CP I was developed using a summing technique and the BFI-CP II was developed using cluster analysis. There was a strong correlation between the BFI-CP I and the GMFCS (r = 0.92), between the BFI-CP II and the GMFCS (r = 0.93), and between the BFI-CP I and II (r = 0.92) all (p < 0.001). There was also a significant difference between the BFI-CP I and the GMFCS (χ2 = 670.49, df = 16, p < 0.001) and between the BFI-CP II and the GMFCS (χ2 = 685.57, df = 16, p < 0.001). The findings of this study indicate that the two versions of the BFI-CP could be used as complementary methods in describing children with CP.

Interrelationships of Functional Status and Health Conditions in Children With Cerebral Palsy: A Descriptive Study.

PURPOSE: To examine the relationship among the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) in children with cerebral palsy (CP) and to determine the average number and effect of health conditions. METHODS: Participants were 671 children with CP aged 2 to 12 years from Canada and the United States. Cross-tabulation of functional classifications and averages were computed for the number and impact of health conditions and comparisons among groups. RESULTS: A total of 78 of the 125 possible classification combinations were recorded. Most frequent were GMFCS I, MACS I, CFCS I; GMFCS I, MACS II, CFCS I; and GMFCS II, MACS II, CFCS I. With lower levels of function, the average number and average impact of associated health conditions increased. CONCLUSIONS: The use of functional profiles across classification systems, with data on the associated health conditions, provides a more comprehensive picture of CP than any single classification or measure.

Perspectives on classification of selected childhood neurodisabilities based on a review of literature.

PURPOSE: Classifying children with heterogeneous health conditions is challenging. The purposes of this perspective are to explore the prevailing classifications in children with the three selected neurodisabilities using the underlying framework of ICF/ICF-CY, explore the utility of the identified classifications, and make recommendations aimed at improving classifications. METHODS: A literature search on six databases and Google was conducted. Articles published between the years 2000 and 2013 were included if they provided information on classification of cerebral palsy (CP), and/or developmental coordination disorder (DCD) and/or autism spectrum disorders (ASD). RESULTS: Children with DCD and ASD are classified using combinations of multiple measures. The classifications in CP meet more of the proposed criteria for utility than those in DCD and ASD. CONCLUSION: None of the existing classifications addressed all the criteria. The heterogeneity associated with the selected neurodisabilities poses major challenges. Further work is required to establish improved classifications.

Construction and validation of the fatigue impact and severity self-assessment for youth and young adults with cerebral palsy.

PURPOSE: The Fatigue Impact and Severity Self-Assessment (FISSA) was created to assess the impact, severity, and self-management of fatigue for individuals with cerebral palsy (CP) aged 14-31 years. METHODS: Items were generated from a review of measures and interviews with individuals with CP. Focus groups with health-care professionals were used for item reduction. A mailed survey was conducted (n=163/367) to assess the factor structure, known-groups validity, and test-retest reliability. RESULTS: The final measure contained 31 items in two factors and discriminated between individuals expected to have different levels of fatigue. Individuals with more functional abilities reported less fatigue (p < 0.002) and those with higher pain reported higher fatigue (p < 0.001). The FISSA was shown to have adequate test-retest reliability, intraclass correlation coefficient (ICC)(3,1)=0.74 (95% confidence interval [CI] 0.53-0.87). CONCLUSIONS: The FISSA valid and reliable for individuals with CP. It allows for identification of the activities that may be compromised by fatigue to enhance collaborative goal setting and intervention planning.

Parents' Experiences and Perceptions when Classifying their Children with Cerebral Palsy: Recommendations for Service Providers.

AIMS: This study investigated the experiences and perceptions of parents of children with cerebral palsy (CP) when classifying their children using the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The second aim was to collate parents' recommendations for service providers on how to interact and communicate with families. METHODS: A purposive sample of seven parents participating in the On Track study was recruited. Semi-structured interviews were conducted orally and were audiotaped, transcribed, and coded openly. A descriptive interpretive approach within a pragmatic perspective was used during analysis. RESULTS: Seven themes encompassing parents' experiences and perspectives reflect a process of increased understanding when classifying their children, with perceptions of utility evident throughout this process. Six recommendations for service providers emerged, including making the child a priority and being a dependable resource. CONCLUSIONS: Knowledge of parents' experiences when using the GMFCS, MACS, and CFCS can provide useful insight for service providers collaborating with parents to classify function in children with CP. Using the recommendations from these parents can facilitate family-provider collaboration for goal setting and intervention planning.

Moving from parent "consultant" to parent "collaborator": one pediatric research team's experience.

We share our experiences as academic physical therapists and parents of young people with cerebral palsy working together as a research team, describe and critically review how our working relationship has evolved and propose further enhancements to realize our shared vision. This manuscript is informed by a call for "family-centered research," transcripts of face-to-face meetings held over a period of 11/2 days, the INVOLVE document and our experiences over almost a decade, as well as other related literature. Authentic collaborative research partnerships between academic researchers and parents embodying trust, mutual respect and shared social responsibility take time and effort to develop and sustain. Rehabilitation research is more meaningful and may be more impactful when strong collaborative partnerships between researchers and health service users are in place. Implications for Rehabilitation Involving service users in rehabilitation research is important, but not without challenges. Attaining authentic collaboration requires face-to-face meetings, time, effort, and ongoing open communication. Research processes are superior and outcomes may be improved with service user involvement. Impact of research on rehabilitation practice is anticipated to be more meaningful with service user involvement.

Office of Laboratory Animal Welfare Comments.

In support of the new column in Zebrafish dedicated to initiating conversations about animal care policies and compliance for the zebrafish, the Office of Laboratory Animal Welfare (OLAW) has offered the following clarification and guidance.

Description of Primary and Secondary Impairments in Young Children With Cerebral Palsy.

PURPOSE: We describe primary and secondary impairments in young children with cerebral palsy (CP); report differences in impairments on the basis of Gross Motor Function Classification System (GMFCS), age, and sex; and examine the extent that individual impairments account for the construct of primary and secondary impairments. METHODS: Participants included 429 children with CP (242 [56%] male; 1½ to 5 years) representing all GMFCS levels. Reliable assessors collected primary and secondary impairment data using clinical measures. Analyses included descriptive statistics, comparisons among GMFCS, age, and sex, and factor analysis. RESULTS: Young children with CP present with primary and secondary impairments. Significant differences in impairments occur among some GMFCS levels and age groups but not sex groups. Postural stability contributed most to primary impairments and strength to secondary impairments. CONCLUSION: Young children with CP across GMFCS levels may have already developed secondary impairments that should be addressed within therapy services.

Determinants of participation in family and recreational activities of young children with cerebral palsy.

PURPOSE: To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). METHODS: Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children's health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children's participation. Data from the two groups of children were analysed separately using structural equation modelling. RESULTS: The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children's adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III-V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children's needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. CONCLUSION: Supporting children's adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP. Implications for Rehabilitation Participation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors. Practitioners are encouraged to support children's adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children. Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities. For children with a good prognosis for walking, providing services perceived by parents to meet their children's needs may enhance children's enjoyment of participation.