The impact of standardized balance measurement on physical therapist decision-making in acquired brain injury: a survey.

BACKGROUND: The use of balance outcome measures (OM) is proposed to enhance physical therapy services and patient outcomes. OBJECTIVE: Explore current practices of balance OM use and OM's role in United States physical therapists' decision-making with patient's acquired brain injury (ABI). METHODS: Cross-sectional survey utilizing snowball sampling, n = 373. Survey items required ranking agreement with statements on Likert scale. Multinomial logistic regression used to determine the relationship between survey answers and participant characteristics. RESULTS: Ninety-three percent of therapists reported using outcome measures with patients with ABI. Those who reported not using outcome measures with patients with ABI were significantly different on setting, primary patient population, APTA section membership, and ANPT membership. All respondents who primarily treated neurologic diagnoses used outcome measure with clients with ABI, compared to 87% of respondents who worked primarily with orthopedic clients. Comfort, equipment availability, and psychometric properties were the most frequent reasons for choosing a measure. Therapist decision-making was impacted by outcome measures; this frequency was dependent on practice setting, primary patient population, and specialty certifications. CONCLUSIONS: Physical therapists use a low diversity of outcome measures to assess balance. Respondents rated psychometric properties as more important than past published research. This is the first study to demonstrate that outcome measures play a role for most United States PTs in decision-making in all stages of the patient management model including identification of problems, diagnosis, prognosis, intervention selection, termination of services, and discharge planning, as well justifying service delivery.

Keeping it all in balance: a qualitative analysis of the role of balance outcome measurement in physical therapist decision-making and patient outcomes.

PURPOSE: The use of outcome measures (OMs) is a hallmark of contemporary physical therapy in the USA. The effect of OM utilization on patient care decisions and the results of PT services remain poorly understood. The purpose of this study is to explore PTs perceptions about the relationship between balance OMs and decision-making and how that interaction impacts patient outcomes, particularly for patients with acquired brain injury. MATERIALS AND METHODS: This qualitative study used semi-structured phone interviews with an interview guide. Maximum variation sampling was used. Thematic analysis was situated in a priori determined theory-based categories. RESULTS: Twenty-three physical therapists (PTs) from diverse geographic areas and practice settings participated. Therapists expressed diverse views on the impact of OM use on patient outcomes, but the majority perceived that using OMs improved rehabilitation outcomes. The use of OMs was related to the selection of optimal intervention type and intensity and justified continued high-frequency rehabilitation services. OMs were important to therapists' decision-making. CONCLUSIONS: In the present study, PTs reported that they believe the use of validated, clinically useful OMs may improve patient outcomes.Implications For RehabilitationBalance outcome measures are considered an important tool to the optimal management of the profound impact of balance impairments after brain injury.Most physical therapists in this study believe that using balance outcome measures results in better outcomes for patients with brain injury.In this study, physical therapists reported using outcome measures in wide-ranging ways to guide clinical decisions about balance in those with brain injury.

The functional lumbar index: Validation of a novel clinical assessment tool for individuals with low back pain.

STUDY DESIGN: Retrospective Diagnostic Cohort Study. LEVEL OF EVIDENCE: Level 3b. OBJECTIVES: To examine the concurrent and predictive validity of a novel clinical assessment tool, the Functional Lumbar Index (FLI). BACKGROUND: Lumbar surgeries have increased exponentially in the past decade, adding to healthcare costs without improving outcomes. Limitations in clinicians' abilities to identify those individuals who are most likely to benefit from surgery may be enhanced with an effective physical assessment tool. METHODS: The FLI was assessed on 291 individuals (179 conservative and 113 pre-surgical) seeking care for low-back pain (LBP) over a 2.5-year period. The FLI consists of several physical performance tests (PPT) with a novel criterion-based scoring system. Pearson correlations and Poisson regression analysis were used to establish concurrent and predictive validity at alpha = 0.05. RESULTS: The subscale FLI components showed good to excellent inter-rater reliability with intraclass correlation coefficient values as follows: front plank = .993, right side plank = .824, left side plank .861, Sorensen = 0.836, overhead squat = 0.937. A statistically significant, moderate negative correlation was observed between FLI and modified Oswestry Disability Index (r = -0.540, p < .001). Regression analysis showed the FLI as the only significant predictor (p = .004) of failed conservative management for individuals with LBP. An ROC curve showed significant group prediction of the FLI with an AUC of 0.788 (p < .001) and cut-off score of 7.5. CONCLUSION: The FLI is a reliable and valid measure for predicting failed conservative care management in patients with LBP. Clinicians are encouraged to use the FLI as part of their physical assessment when screening individuals with LBP who might need surgical intervention. Further research is needed to determine validity of the FLI in other patient populations. PUBLIC TRIAL REGISTRY: N/A.

Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke.

BACKGROUND AND PURPOSE: A successful chair-rise is an important indicator of functional independence post-stroke. Lower extremity electromyographic analyses provide a basis for muscle activation from which clinical intervention protocols may be derived. Gluteus maximus activation during the chair-rise has not been thoroughly researched in the chronic stroke population. This study investigated the magnitude and onset of gluteus maximus activation during the chair-rise comparing adults post-stroke with healthy controls. METHODS: In this cross-sectional study, adults with chronic stroke (n = 12) and healthy controls (n = 12) completed 4 natural-speed chair-rise trials. Magnitude and onset of bilateral gluteus maximus activation were measured during the movement with secondary comparative data from biceps femoris and vastus lateralis muscles. Kinetic and kinematic measurements were used to quantify chair-rise phases and movement cycle duration. RESULTS: Significant decreases in paretic ( P = 0.002), and nonparetic ( P = 0.001) gluteus maximus magnitudes were noted post-stroke compared with ipsilateral extremities of healthy adults. Significant gluteus maximus onset delays were noted in paretic extremities compared with nonparetic extremities post-stroke ( P = 0.009) that were not apparent in comparative muscles. Similar onset times were noted when comparing the paretic extremity post-stroke to the ipsilateral extremity of healthy controls ( P = 0.714) despite prolonged movement cycle durations in those with chronic stroke ( P = 0.001). No onset delays were evident in the biceps femoris ( P = 0.72) or vastus lateralis ( P = 0.338) muscles. DISCUSSION AND CONCLUSIONS: Despite apparent unilateral muscle weakness post-stroke, bilateral decreases in gluteus maximus activation magnitudes and compounding onset deficits of the paretic extremity were observed during chair-rising. Further research is needed to determine whether interventions maximizing bilateral activation magnitudes and improving temporal activation congruency during chair-rising will carry over to functional gainsVideo Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A387 ).

The effects of a high-intensity exercise bout on landing biomechanics post anterior cruciate ligament reconstruction: a quasi-experimental study.

BACKGROUND: We aimed to examine the effect of a high-intensity exercise bout on landing biomechanics in soccer players who underwent anterior cruciate ligament reconstruction (ACLR) and non-injured soccer players during a soccer-specific landing maneuver. METHODS: Eighteen soccer players who underwent ACLR and 18 normal soccer players were enrolled in this investigation (ACLR group; age, 26.11 ± 3.95 years; body mass index, 23.52 ± 2.69 kg/m2; surgery time, 5 ± 3.30 years: control group; age, 25.83 ± 3.51 years; body mass index, 24.09 ± 3.73 kg/m2, respectively). Participants were evaluated during the landing maneuver before and after carrying out the high-intensity exercise bout using the Wingate test. The intensity of the exercise was defined as a blood lactate accumulation of at least 4 mmol/L. The dependent variables included sagittal-plane kinematics and kinetics of the ankle, knee and hip joints, and electromyography activity of the gastrocnemius, hamstrings, quadriceps, and gluteus maximus. RESULTS: On 2 × 2 analysis of variance, none of the dependent variable showed significant exercise×group interactions. Regardless of group, significant main effects of exercise were found. Post-exercise landing was characterized by increased flexion of hip (p = 0.01), knee (p = 0.001), and ankle joints (p = 0.002); increased extension moments of hip (p = 0.009), knee (p = 0.012), and ankle joints (p = 0.003), as well as decreased quadriceps activity (p = 0.007). CONCLUSION: At 1 year or more post-ACLR, the effect of the high-intensity exercise bout on landing biomechanics is not expected to differ from that experienced by healthy soccer players.

Landing Evaluation in Soccer Players with or without Anterior Cruciate Ligament Reconstruction.

The purpose of this study was to evaluate landing biomechanics in soccer players following ACLR during two landing tasks. Eighteen soccer players with an ACLR and 18 sex-matched healthy control soccer players participated in the study. Planned landing included jumping forward and landing on the force-plates, whereas unplanned landing included jumping forward to head a soccer ball and landing on the force-plates. A significant landing×group interaction was found only for knee flexion angles (p=0.002). Follow-up comparisons showed that the ACL group landed with greater knee flexion during planned landing compared with unplanned landing (p<0.001). Significant main effects of landing were found. The unplanned landing showed reduction in hip flexion (p<0.001), hip extension moments (p<0.013), knee extension moments (p<0.001), and peak pressure (p<0.001). A significant main effect for group for gastrocnemius muscle was found showing that the ACL group landed with reduced gastrocnemius activity (p=0.002). Unplanned landing showed greater injury predisposing factors compared with planned landing. The ACL group showed nearly similar landing biomechanics to the control group during both landing tasks. However, the ACL group used a protective landing strategy by reducing gastrocnemius activity.

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion.

OBJECTIVES: Early physical therapy (PT) with specific stabilization training has been shown to benefit individuals after lumbar spinal surgery but has not been studied in patients after cervical spine surgery. The primary purpose of this study was to compare clinical outcomes between early cervical spine stabilizer (ECS) training and usual care (UC) in patients after anterior cervical discectomy and fusion (ACDF) surgery. The secondary purpose was to determine test-retest reliability of strength and endurance tests of cervical spinal stabilizers in this patient population. METHODS: Forty participants who were scheduled for ACDF surgery were randomized into either the ECS group or the UC group. After surgery, participants received their assigned group intervention during their hospital stay and continued their assigned intervention for 12 weeks. All participants had phone follow-ups twice during the first 6 weeks to address questions or problems. Clinical outcome measures including pain level using the Numeric Pain Rating Scale (NPRS), disability level using the Neck Disability Index (NDI), Craniocervical Flexor Strength (CCF-S), and Craniocervical Flexor Endurance (CCF-E) were collected three times: before surgery and 6 and 12 weeks after surgery. Test-retest reliability was assessed in the first 10 participants. RESULTS: There was no significant interaction between the groups over time for any of the outcome measures. However, all participants made significant improvements in all four outcome measures at 6 and 12 weeks post surgery. The results showed good-to-excellent test-retest reliability for the CCF-S and CCF-E tests. CONCLUSIONS: Both ECS training and UC resulted in the same amount of improvement at 6 and 12 weeks; therefore, both therapy approaches appear to have similar and positive effects on patients in their first 3 months of recovery after ACDF. Both the CCF-S and CCF-E tests can be used reliably to assess the strength and endurance of the cervical spinal stabilizers for patients after ACDF surgery. The study was registered with the ClinicalTrials.gov (NIH, U.S. National Library of Medicine, identifier # NCT01519115) Protocol Registration system.

Immediate Effect of Whole Body Vibration on Sauté Height and Balance in Female Professional Contemporary Dancers A Randomized Controlled Trial.

This randomized controlled trial examined the immediate effect of whole body vibration (WBV) on first position sauté height, and on static and dynamic balance, in 59 female professional contemporary dancers. Following instruction, a warm-up, and a training session, participants received a 75-second randomly assigned WBV intervention under four conditions: static demi-plié (0 Hz), static demi-plié (30 Hz), dynamic demi-plié (0 Hz), and dynamic demi-plié (30 Hz). Before and immediately after intervention, participants performed three sautés on the Just Jump® Mat System, provided dynamic balance data via the Star Excursion Balance Test, and static balance data via the Balance Error Scoring System. A two-way split-plot multivariate approach ANOVA was used to analyze sauté height (α = 0.025). Balance was examined with a 4 x 2 x 2 split-plot MANOVA (α = 0.025). Follow-up two-way split plot multivariate approach ANOVAs were also conducted (α = 0.0125). Dancers from the static first position demi-plié group were found to jump higher than those from the dynamic first position demi-plié group, regardless of WBV frequency (p = 0.001). The 30 Hz frequency resulted in significantly improved static balance (p = 0.001) for both static and dynamic demi-plié. Therefore, the use of WBV is worthy of consideration as a quick method of improving static balance, and use of the static first position demi-plié may be beneficial for improving sauté height.

Assessment of Countermovement Jump Performance in First Position (Sauté) in Healthy Adults.

BACKGROUND:: Prior studies have examined muscle power via the countermovement jump (CMJ). Studies to date have examined neither the reliability nor the construct validity of the ballet first position CMJ (hips in lateral rotation, toes facing away from one another, legs straight) as a measure of power. HYPOTHESES:: There would be (1) good interrater reliability in the visual assessment of the best-quality first position CMJ (κ ≥ 0.60), (2) good test-retest reliability in the height of the first position CMJ of good quality (intraclass correlation coefficient [ICC] ≥ 0.80), and (3) a significant relationship between isokinetic torque of the quadriceps femoris and first position CMJ height ( r ≥ 0.40). STUDY DESIGN:: Correlational study. LEVEL OF EVIDENCE:: Level 3. METHODS:: A convenience sample of 39 healthy young adults who reported moderate activity levels participated in a warm-up and 2 sessions of 6 jumps. Quadriceps femoris isokinetic torque was measured in the first session. RESULTS:: Significant agreement was found within the same day for the best-quality first position CMJ (κ = 0.81), and in the highest, best-quality first position CMJ between days (ICC2,1 = 0.88). The highest, best-quality first position CMJ, when solving for a single trial, was comparable to the average of 2 trials (single trial: ICC2,1 = 0.96 vs average of 2 trials: ICC2,k = 0.98). There was a good relationship between quadriceps femoris isokinetic strength and first position CMJ height (Pearson r = 0.69 and P < 0.001 at 60 deg/s; r = 0.64 and P < 0.001 at 180 deg/s; r = 0.65 and P < 0.001 at 300 deg/s). CONCLUSION:: Visual video movement analysis has good to excellent interrater agreement and test-retest reliability. Selecting the single highest jump of good quality is acceptable. The first position CMJ is a measure of power. CLINICAL RELEVANCE:: Video analysis of the single highest first position CMJ of good quality is an acceptable method of assessing movement quality.

Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility.

PURPOSE: (1) Determine whether ultrasonography can detect differences in diaphragm contractility between body positions. (2) Perform reliability analysis of diaphragm thickness measurements in each test condition. METHODS: We used a repeated-measures experimental design with 45 healthy adults where 3 B-mode ultrasound images were collected at peak-inspiration and end-expiration in supine, sitting, and standing. Mean diaphragm thickening fractions were calculated for each test position. Statistical significance was tested using 1-way repeated-measures analysis of variance with planned comparisons. For reliability analysis, the intraclass correlation coefficient (3, 3) was calculated. RESULTS: Mean diaphragm thickening fraction increased from 60.2% (95% confidence interval [CI] 53.0%, 67.9%) in supine, to 96.5% (95% CI 83.2%, 109.9%) while seated and to 173.8% (95% CI 150.5%, 197.1%) while standing. Body position was a significant factor overall (P < .001), as were comparisons between each individual position (P < .001). Intraobserver reliability was excellent (>0.93) for all body positions tested. CONCLUSIONS: Ultrasound imaging detected positional differences in diaphragm contractility. The effect of gravitational loading on diaphragm length-tension, and body position-mediated changes in intra-abdominal pressure may explain the differences found. Future research should address methodological concerns and apply this method to patients participating in early mobilization programs in the intensive care unit.

A pilot study to determine the effect of one physical therapy session on physical activity levels for individuals with chronic low back pain.

BACKGROUND: A pilot study was conducted to quantify the effect size of changes in physical activity after of one session of physical therapy for individuals with chronic low back pain and to determine factors that predict daily sedentary activity time. METHODS: Fourteen subjects with at least 3 days of physical activity accelerometer data were analyzed before and after one session of physical therapy. Data was analyzed using 1-tailed, paired t-tests with level of significance set at 0.05. Effect sizes were computed using the baseline and post intervention mean differences divided by the baseline and post-intervention differences in the standard deviation. RESULTS: A nonsignificant reduction in steps-per-day and time spent performing sedentary activities, with increases in light and moderate-vigorous physical activity were found (effect size: 0.15-0.33). A nonsignificant decrease in daily sitting and standing time 1 week immediately following the physical therapy session and an increase in daily lying time (p = 0.03) (effect size: 0.23-0.69) were found. CONCLUSION: One physical therapy session resulted in a small physical activity change for individuals with chronic low back pain. Baseline and post intervention levels of pain catastrophisation and perceptions of disability need to be explored in future studies to determine if these are factors that influence levels of physical activity change for these individuals Results are limited by the small sample size, however the ability to increase physical activity in this population may be of clinical relevance. Trial Registration NCT02823756; June 30, 2016: Retrospectively Registered.

Translation and Validation of the Arabic Version of the Fear-Avoidance Beliefs Questionnaire in Patients With Low Back Pain.

STUDY DESIGN: Prospective cohort study of a cross-cultural low back pain (LBP) questionnaire OBJECTIVE.: The objectives of the present study were to translate and cross-culturally adapt the Fear-Avoidance Beliefs Questionnaire (FABQ) to create a version in Arabic and to test its psychometric properties. SUMMARY OF BACKGROUND DATA: The FABQ measures the effects that fear and avoidance beliefs have on work and on physical activity. METHODS: An FABQ cross-culturally adapted for Arabic readers and speakers was created by forward translation, translation synthesis, and backward translation. Forty patients in Riyadh, Saudi Arabia, with LBP evaluated use of the questionnaire, and 70 patients from the same hospital participated in reliability, validity, and sensitivity studies. To determine test-retest reliability of the Arabic FABQ, patients completed it twice within 48 hours without receiving any active treatment between these two sessions. Patients completed the Arabic FABQ (and three other scales) at baseline and 14 days later to determine its validity and sensitivity. RESULTS: Test-retest reliability was good (FABQ-work: intraclass coefficient [ICC] = 0.74; FABQ-physical activity: ICC = 0.90; FABQ overall: ICC = 0.76). Correlations between the FABQ and three other instruments for measuring pain and disability were weak. The strongest correlation was found at the follow-up session with the Arabic Oswestry Questionnaire (r = 0.283; P ≤ 0.05). Sensitivity to change was low. CONCLUSION: The translation and adaptation of the Arabic version of the FABQ was successful. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. The Arabic version of the FABQ shows promise in the assessment of fear-avoidance beliefs among patients with LBP who speak and read Arabic. LEVEL OF EVIDENCE: 3.

Randomized Trial of Lower Extremity Splinting to Manage Neuropathic Pain and Sleep Disturbances in People Living with HIV/AIDS.

BACKGROUND/AIMS: Distal symmetrical peripheral neuropathy (DSPN) and sleep disturbances are among the most common complications reported in people living with the human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLWHA). DSPN-pain is predominantly managed by using systemic agents with little evidence supporting their analgesic efficacy. The purpose of this study is to evaluate the effect of nighttime lower extremity splinting application on DSPN-related pain and sleep disturbances compared to a parallel splint liner application in PLWHA. METHODS: Forty-six PLWHA and DSPN were randomized to nighttime wearing of bilateral lower extremity splints or the liners only. Pain and sleep outcomes were measured at baseline, week 3, and week 6. The pain was measured using the Neuropathic Pain Scale and sleep using the Pittsburgh Sleep Quality Index. RESULTS: Pain and sleep scores improved in both groups over time. The median percentage pain reduction at week 6 was 8% in the liner group and 34% in the splint group. The change in pain scores in the splint group was found to be significant over time, P < .0005. The contrast between the splint and liner groups was underpowered (26%) and was not found to be significant, P > .05. Sleep scores improved 20% from baseline to the end of the study in both groups; all participants were classified as poor sleepers. CONCLUSION: The 6-week use of nighttime splints reduces DSPN-pain possibly by providing peripheral inhibition of external stimuli. Future studies are needed to validate this inhibitory intervention to manage DSPN in PLWHA and other neuropathic conditions.

Pain, sleep disturbances, and functional limitations in people living with HIV/AIDS-associated distal sensory peripheral neuropathy.

BACKGROUND: Pain, sleep, and functional disturbances are a common occurrence in people living with HIV/AIDS-related distal sensory peripheral neuropathy (PLWHA-DSPN) yet lack group classification and quantification. METHODS: A total of 46 PLWHA-DSPN were recruited, as part of a 2-group intervention study, to complete the Neuropathic Pain Scale and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. The participant's performance during a forward reach task and walking distance in 6 minutes was recorded as a measure of function. RESULTS: The pain (60.77 +/- 17.85) and sleep (14.62 +/- 4.28) scores denote marked pain and sleep disturbances, compared to seronegative, age-matched individuals. The ambulation distance was limited (243.99 +/- 141.04 m) and inversely associated with the PSQI-sleep efficiency subscale (rs = -.35, P < .05). The average reaching distances measured (36.07 +/- 7.37 cm) were similar to seronegative, age-matched individuals. Pain, sleep, and functional measures exhibited significant associations. CONCLUSIONS: The data collected suggest that PLWHA-DSPN report moderate-to-severe pain and significant sleep disturbances and exhibit limited ambulation distances.

Pain, sleep disturbances, and functional limitations in people living with HIV/AIDS-associated distal sensory peripheral neuropathy.

BACKGROUND: Pain, sleep, and functional disturbances are a common occurrence in people living with HIV/AIDS-related distal sensory peripheral neuropathy (PLWHA-DSPN) yet lack group classification and quantification. METHODS: A total of 46 PLWHA-DSPN were recruited, as part of a 2-group intervention study, to complete the Neuropathic Pain Scale and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. The participant's performance during a forward reach task and walking distance in 6 minutes was recorded as a measure of function. RESULTS: The pain (60.77 +/- 17.85) and sleep (14.62 +/- 4.28) scores denote marked pain and sleep disturbances, compared to seronegative, age-matched individuals. The ambulation distance was limited (243.99 +/- 141.04 m) and inversely associated with the PSQI-sleep efficiency subscale (rs = -.35, P < .05). The average reaching distances measured (36.07 +/- 7.37 cm) were similar to seronegative, age-matched individuals. Pain, sleep, and functional measures exhibited significant associations. CONCLUSIONS: The data collected suggest that PLWHA-DSPN report moderate-to-severe pain and significant sleep disturbances and exhibit limited ambulation distances.

Multiple sclerosis and fatigue: understanding the patient's needs.

Fatigue is among the most common and debilitating symptoms of multiple sclerosis (MS), affecting approximately 80% of persons who have the disease. Recently, as part of the National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS), a bank of items was developed for measuring self-reported fatigue. This article has two purposes. (1) To assess, from the perspective of individuals living with MS, the relevance of a subset of items from the PROMIS fatigue item bank. (2) To identify additional aspects of fatigue that individuals with MS believe are important for clinicians when asking about their fatigue experience.

Development and validation of a new self-report measure of pain behaviors.

Pain behaviors that are maintained beyond the acute stage after injury can contribute to subsequent psychosocial and physical disability. Critical to the study of pain behaviors is the availability of psychometrically sound pain behavior measures. In this study we developed a self-report measure of pain behaviors, the Pain Behaviors Self Report (PaB-SR). PaB-SR scores were developed using item response theory and evaluated using a rigorous, multiple-witness approach to validity testing. Participants included 661 survey participants with chronic pain and with multiple sclerosis, back pain, or arthritis; 618 survey participants who were significant others of a chronic pain participant; and 86 participants in a videotaped pain behavior observation protocol. Scores on the PaB-SR were found to be measurement invariant with respect to clinical condition. PaB-SR scores, observer reports, and the videotaped protocol yielded distinct, but convergent views of pain behavior, supporting the validity of the new measure. The PaB-SR is expected to be of substantial utility to researchers wishing to explore the relationship between pain behaviors and constructs such as pain intensity, pain interference, and disability.

Validity of an observation method for assessing pain behavior in individuals with multiple sclerosis.

CONTEXT: Pain is a common and complex experience for individuals who live with multiple sclerosis (MS) and it interferes with physical, psychological, and social function. A valid and reliable tool for quantifying observed pain behaviors in MS is critical to understand how pain behaviors contribute to pain-related disability in this clinical population. OBJECTIVES: To evaluate the reliability and validity of a pain behavioral observation protocol in individuals who have MS. METHODS: Community-dwelling volunteers with MS (N=30), back pain (N=5), or arthritis (N=8) were recruited based on clinician referrals, advertisements, fliers, web postings, and participation in previous research. Participants completed the measures of pain severity, pain interference, and self-reported pain behaviors and were videotaped doing typical activities (e.g., walking and sitting). Two coders independently recorded frequencies of pain behaviors by category (e.g., guarding and bracing) and interrater reliability statistics were calculated. Naïve observers reviewed videotapes of individuals with MS and rated their pain. The Spearman's correlations were calculated between pain behavior frequencies and self-reported pain and pain ratings by naïve observers. RESULTS: Interrater reliability estimates indicated the reliability of pain codes in the MS sample. Kappa coefficients ranged from moderate (sighing=0.40) to substantial agreements (guarding=0.83). These values were comparable with those obtained in the combined back pain and arthritis sample. Concurrent validity was supported by correlations with self-reported pain (0.46-0.53) and with self-reports of pain behaviors (0.58). Construct validity was supported by a finding of 0.87 correlation between total pain behaviors observed by coders and mean pain ratings by naïve observers. CONCLUSION: Results support the use of the pain behavior observation protocol for assessing pain behaviors of individuals with MS. Valid assessments of pain behaviors of individuals with MS could lead to creative interventions in the management of chronic pain in this population.

A PROMIS fatigue short form for use by individuals who have multiple sclerosis.

PURPOSE: To derive from the Patient Reported Outcomes Measurement Information System (PROMIS) fatigue item bank, a short form for individuals with multiple sclerosis (MS), the PROMIS-Fatigue(MS). METHODS: A panel of 37 clinicians and 46 individuals with MS ranked the relevance of PROMIS fatigue items to persons with MS. Eight items were selected for the PROMIS-Fatigue(MS) that maximized relevance rankings, content coverage, and item discrimination. The PROMIS-Fatigue(MS) and an existing, 7-item PROMIS fatigue short form (PROMIS-Fatigue(SFv1.0)) were administered to a new sample of 231 individuals with MS. Known groups and content validity were assessed. RESULTS: Scores from the short forms were highly correlated (r = 0.92). Discriminant validity of the PROMIS-Fatigue(MS) scores was supported in known groups comparisons. Scores of neither short form exhibited an advantage in quantitative analyses. The PROMIS-Fatigue(MS) targeted more of the content included in participants' responses to open-ended questions than did the PROMIS-Fatigue(SFv1.0). CONCLUSIONS: The PROMIS-Fatigue(MS) was derived to have content validity in MS samples. The validity of the measure was further supported by the ability of PROMIS-Fatigue(MS) items to discriminate among groups expected to differ in levels of fatigue. We recommend its use in measuring the fatigue of individuals with MS.

Pilot study: does lower extremity night splinting assist in the management of painful peripheral neuropathy in the HIV/AIDS population?

INTRODUCTION: The pain associated with peripheral neuropathy (PN) observed in patients living with HIV/AIDS represents a difficult complication to manage. PARTICIPANTS: A total of 22 participants with a diagnosis of PN were recruited to assess the effects of using night splints on pain and sleep quality. METHODS: For 3 weeks, the participants were instructed to use bilateral night splints and given an exercise regimen for 3 additional weeks. Scores from pain and sleep questionnaires were analyzed using repeated measures analysis of variance (ANOVA). RESULTS: The change in pain scores (F(1.16) = 13.41,η(2) =.456, P = .002) and sleep index scores (z = -2.69, P = .004, 1-tailed) was found to be significant following the use of night splints. No difference was found with the use of the exercises. DISCUSSION: The use of night splints in HIV-infected patients with PN represents an additional tool for managing pain and improving sleep.