Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial.

OBJECTIVES: To compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness, balance, and motor skills of children with spastic cerebral palsy (CWSCP). DESIGN: Single-blind, randomized superiority trial. SETTING: General Community and Referral Center. PARTICIPANTS: Thirty CWSCP, aged 6-12 years, with Gross Motor Function Classification System levels I-III were randomly assigned to the SBST and SSST groups (N=30). INTERVENTIONS: The participants were randomized to receive either SBST or SSST for 5 weeks, 3 days a week. OUTCOME MEASURES: The Trunk Control Measurement Scale (TCMS), abdominal muscle thickness, Pediatric Balance Scale (PBS), standing and walking sections of Gross Motor Function Measure (GMFM-88), and mobility section of the Pediatric Evaluation of Disability Inventory (PEDI) were assessed. RESULTS: After 5 weeks of the intervention and 9 weeks of follow-up, the SBST group showed statistically significant improvements in the TCMS, GMFM-88, PEDI, thickness of the internal oblique muscle at rest and contraction, and thickness of the transverse abdominis muscle at rest and contraction compared with the SSST group (P<.0001). Contrarily, the thickness of the external oblique muscle increased statistically significantly in the SSST group compared with the SBST group after 5 weeks of the intervention and 9 weeks of follow-up both at rest (P<.0001 and P=.0001, respectively) and contraction (P=.015 and P=.017, respectively). No statistically significant difference was found between the groups regarding the PBS score after 5 weeks of intervention. CONCLUSION: The SBST could improve the trunk control, balance, and motor skills of CWSCP and increase the thickness of local abdominal muscles. Also, SBST was more effective than SSST for CWSCP.

Factors Affecting Participation of Children with Cerebral Palsy in Meaningful Activities: Systematic Review.

This is a systematic review using PRISMA guidelines to review the factors affecting participation of children with cerebral palsy (CP), the most common childhood motor disability. Inclusion criteria consisted of publications in a peer-reviewed journal between 2000 and 2018, and at I, II, III, and IV levels of AOTA Evidence. After the title, abstract, and a full text screening, 31 articles met eligibility to be included. The studies examined ADLs (12), IADLs (9), play and leisure (19), and social participation (14), but only 3 in rest/sleep, 1 in work, and 8 in education. Gross motor and manual function, CP type, home, and community physical environment, were the most common factors affecting individuals' participation with CP. Results imply occupational therapists must evaluate clients on all factors shown to facilitate or inhibit participation to ensure an adequate intervention plan. However, evaluating every individual case in the occupational therapy process is time-consuming and difficult. Based on this study's findings, we suggest occupational therapists prioritize evaluating motor skills (gross and fine), the most influential of the factors in all areas of participation. Occupational therapists also could advocate for policy around community environmental barrier removal.

Development of social participation classification system for children with cerebral palsy.

Background: Some classification systems have been designed to measure domains of function of children with cerebral palsy (CP), including the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Eating and Drinking Ability Classification System (EDACS), and Communication Function Classification System (CFCS). The purpose of the present study was to develop a Social Participation Classification System for children with cerebral palsy (SPCS) with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) and assess its reliability. Methods: In this cross-sectional analytic study, 274 parents of 6 to 12 year-old children with CP were asked to complete the questionnaires (CPAS-P, MACS, GMFCS, and CFCS) for their child. The expert review consisting of 10 occupational therapists with at least 5 years of experience working with children with CP was asked to rate the level of social participation with a 5-level sequential scale (level 1 the lowest and level 5 the highest level of participation) of these children according to the variables (intelligent quotient [IQ], CP type, walking ability, GMFCS, CFCS, and MACS). Then, these data were analyzed using the polynomial discriminant function. After performing discriminant function, a flowchart model was determined for the level of children's social participation. To calculate the reliability of the model, 53 new samples were collected and their level of social participation was determined based on the flowchart model. The experts were then asked to determine the social participation level of these 53 new samples in the same manner as before, and then to calculate reliability, intraclass correlation coefficient (ICC) and Cronbach alpha. The SPSS Version 22 (SPSS Inc) and discriminant function model analysis was used for statistical analysis. Results: Based on the discriminant function model, the results between the predicted classification and expert review are over 88% consistent. The ICC and Cronbach alpha values were 0.952 and 0.975, respectively, with absolute agreement and multivariate mixed effects. Conclusion: Based on the results of the present study, the SPCS was developed in 5 levels (very low, low, moderate, high, and very high) and to determine it, the GMFCS, MACS, and CFCS scores, CP type, and IQ level should be calculated.

Factors associated with quality of life among mothers of children with cerebral palsy.

AIM: To identify the factors pertaining to the quality of life (QOL) among the mothers of patients with cerebral palsy. METHODS: In this cross-sectional study, 203 mothers of children with cerebral palsy were selected using convenience sampling. The World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF), the Beck Depression Inventory, the Caregiver Difficulties Scale, Fatigue Severity Scale, and a demographic information questionnaire were administered to these caregivers. Hierarchical multiple linear regression analysis was used to detect the factors associated with QOL. RESULTS: Moderate to high significant negative correlations were observed between all WHOQOL-BREF domains and the other measures. The demographic/clinical variables were controlled, and hierarchical multiple linear regression analysis was run. The results indicated that depression, the burden of care, fatigue, and the type of cerebral palsy could significantly predict QOL in these mothers. Furthermore, QOL was lower in the mothers of children with tetraplegia than those of children with other types of disabilities (P < .05). CONCLUSION: QOL of mothers of children with cerebral palsy is negatively impacted by various factors such as burden of care, fatigue, and psychological symptoms. Thus, a holistic approach, including training (carrying, positioning, feeding, and how to manage the self-care of children) and psychological interventions, is required to improve QOL among this population.

Reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version for children with physical disabilities.

INTRODUCTION: Occupational therapy supports individuals to participate in meaningful activities. Participation in activities should be assessed with appropriate tools. The aim of the present study was to establish the reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version (CPAS-P) for children with physical disabilities. METHODS: The participants were 304 parents of 6- to 12-year-old children with physical disabilities. Confirmatory factor analysis (CFA), internal consistency, convergent validity of the CPAS-P with the Vineland Adaptive Behavior Scale (VABS), and test-retest reliability were measured. RESULTS: Confirmatory factor analysis showed acceptable values for all indices of fit, namely goodness of fit index (GFI), adjusted GFI, normal fix index, comparative fit index, incremental fit index (i.e., greater than 0.90), and the value of root mean square error of approximation was 0.07, which was acceptable. High Cronbach's alpha coefficients (above 0.9) were reported for the total score of each scale (diversity = 0.94, frequency = 0.94, with whom = 0.92, enjoyment = 0.95, and parent satisfaction = 0.95). The convergent validity of the CPAS-P with the VABS was moderate to good and the test-retest reliability (ICC) for the total scores ranged from 0.90 to 0.96. CONCLUSION: The CPAS-P had good psychometric properties for parents reporting the activities of their 6- to 12-year-old children with physical disabilities and can be utilized in clinical practice.

Factors affecting social participation of Iranian children with cerebral palsy.

The purpose of this study was to identify the factors affecting the social participation of Iranian children with cerebral palsy (CP). Participants were 274 (male = 62%; female = 38%) children with CP, 6- to 12-years old (mean = 1.64) and their parents. Several standardized measures were used to assess social participation, gather environmental factors, and demographic questionnaires. The results of stepwise linear regression analysis indicated that the type of CP, Manual ability level and cognitive level (IQ) appear to be strong predictors of social participation between personal and environmental factors.

Caregiver Difficulties Scale (CDS): Translation and Psychometric Evaluation Among Iranian Mothers of Cerebral Palsy Children.

The aim of this study was to investigate of psychometric properties of the Caregiver Difficulties Scale (CDS) for Iranian caregivers of children with cerebral palsy (CP). After a forward-backward translation, the Persian version of CDS (P-CDS) was administered to 151 Iranian mothers of CP children. The confirmatory factor analysis (CFA) was applied to measure the factor structure of P-CDS. The reliability was evaluated by examining internal consistency and test-retest method over a 2-week period using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. The construct validity was assessed by measuring the association between the scores of the P-CDS and Caregiver Burden Scale (CBS), World Health Organization Quality of Life (WHOQOL-BREF), the Beck Depression Index (BDI II), and the Fatigue Severity Scale (FSS). The fit indices showed that the original model of CDS was relatively adequate (χ2/df = 2.03, CFI = 0.90, TLI = 0.88 and RMSEA = 0.08). All domains of P-CDS met the minimum reliability standards (Cronbach'salpha and ICC > 0.7). All subscales of P-CDS were positively correlated with the CBS, BDI-II and FSS and negatively correlated with the WHOQOL-BREF. The results showed that P-CDS is a valid and reliable measure for assessing the burden of care in Iranian mothers of CP children.

Effect of cawthorne and cooksey exercises on balance and quality of life of 60 to 80 year- old individuals in Shiraz: A randomized clinical trial.

Background: One of the vulnerable populations of any community are the elderly, who are exposed to poor balance, falls, injuries, reduced quality of life (QoL) and independency, and early death. Considering the importance of balance in independently performing activities of daily living (ADL) and its impact on QoL, in this study, we aimed at investigating the effect of Cawthorne and Cooksey exercises (CCE) on QoL and balance of 60 to 80 year-old individuals in Shiraz, Iran. Methods: This clinical trial study was conducted on forty 80 to 60-year-old individuals of Jahandideghan retirement center in Shiraz (20 in the intervention and 20 in the control groups) in 2014. The intervention group did CCE in three 60- minute sessions a week for 2 months. The balance status of the participants was assessed with Berg balance test, and their QoL was also examined using SF36 Quality of Life Questionnaire before the intervention and at 2 months post intervention. Data were analyzed by independent t test in SPSS software Version 19. Results: The results of the study revealed that the difference was significant in the balance change scores between the 2 groups (p<0.001, effect size = 0.78). Change differences in the QoL scores were significant between the 2 groups as well (p<0.001, effect size = 0.39). Conclusion: CCT improved QoL and balance of 60 to 80 year- old Shirazians, so considering the low cost, easy implementation, and considerable impact of the exercises, CCT could be used to prevent and treat balance disorders of the elderly.

Psychometric Properties of the Iranian-Children Participation Questionnaire (I-CPQ) When Used with Parents of Preschool Children with Cerebral Palsy.

The purpose of the study was to establish the psychometric properties of the Iranian-Children Participation Questionnaire (I-CPQ) among parents (n = 120) of preschool children with cerebral palsy. The mean age of the preschool children was 5.1 years old. The confirmatory factor analysis was conducted in two stages, and the values of all goodness of fit tests reached an acceptable level (greater than 0.9), and achieved an acceptable root mean square error of approximation model fit value of 0.05. The results of convergent validity with the Vineland Adaptive Behavior Scale for all subtests were significant. Internal consistency was acceptable to excellent (α: 0.66-0.85), and test-retest reliability was excellent (ICC: 0.92-0.98). We concluded that the I-CPQ demonstrated good psychometric properties and utility for assessing participation of Iranian preschool children with cerebral palsy.

Factor Structure and Construct Validity of Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P).

The aim of this study was assess the factor structure, reliability and construct validity of the Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P). The participants of this study were 700 parents of children aged 6-12 years. For data analysis, the confirmatory factor analysis, internal consistency, and test-retest reliability were conducted. Convergent validity was calculated by correlation with the Vineland Adaptive Behaviour Scale. The results indicated the CPAS-P has good internal reliability. Overall, Cronbach's alpha for the participation measures ranged between 0.87 and 0.91, indicating good homogeneity, and Spearman correlations for convergent validity was acceptable. The temporal stability of the CPAS-P was supported with Intra-Class Correlations ranging from 0.79 to 0.94. Therefore, the CPAS-P, which evaluates all eight areas of occupation (i.e., activities of daily living, instrumental activities of daily living, play, leisure, social participation, education, work, and sleep/rest) has demonstrated good psychometric properties; and can be used as a reliable and valid measure to assess children's participation at the age of 6-12 years.

Development and validation of Iranian children's participation assessment scale.

BACKGROUND: Participation is mostly cultural and familial based, and there is not any assessment scales for evaluating kids' participation in Iranian context, therefore the purpose of this study was developing children's participation assessment scale for Iranian children. METHODS: Development of this scale occurred in two phases; phase I: planning: following reviewing the literature and adopting and compiling some items of available evaluation tools in the area (such as CAPE, CPQ, CLASS, Life-H) and receiving advice from two expert panels, the preliminary94- item questionnaire was prepared. Phase II: construct: the survey study was carried out on40 children and 21 of their parents to assess the popularity of the activity in Iran; thus, the items of the questionnaire reduced to 92 and after face and content validity, the final version prepared with 71 items. RESULTS: The final 71-item questionnaire was developed in two parent-report and child-report versions. The 71 items based on the literature and expert panels' advice were categorized in 8 areas of occupation according to Occupational Therapy Practice Framework (ADL, IADL, Play, leisure, social participation, education, work, and sleep/rest). CONCLUSION: Iranian children's participation assessment is a useful and culturally relevant tool to measure participation of Iranian children. It can be used in rigorous clinical and population-based research.

Combined effect of botulinum toxin and splinting on motor components and function of people suffering a stroke.

BACKGROUND: Spasticity is one of the problems after a stroke. Due to this increase in muscle tone, patients are confronted with problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of the simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period. METHODS: In this study a comparison was done between three groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about three months and the evaluations were done monthly. Goniometry was the method to measure the range of motion, and Modified Ashworth Scale was used to examine the spasticity and the upper extremity function was scored based on Fugl- Meyer Assessment. Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times. Significance was set at 0.05. RESULTS: All outcome measures were improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during the 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p>0.05). The results also showed that the changes in elbow`s spasticity (p=0.05) and wrist`s spasticity (p=0.007) and upper extremity function (p=0.04) were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin, and the splint was more than other groups. CONCLUSION: In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.

Clinical assessment of ankle plantarflexor spasticity in adult patients after stroke: inter-and intra-rater reliability of the Modified Tardieu Scale.

PRIMARY OBJECTIVE: To evaluate the reliability of the Modified Tardieu Scale (MTS) in the measurement of ankle plantarflexor spasticity in patients after stroke. RESEARCH DESIGN: Inter- and intra-rater reliability study. INTERVENTIONS: Not applicable. METHODS AND PROCEDURES: Adult patients after stroke participated. Patients were tested by two raters for inter-rater reliability. Patients were re-tested by one rater at least 1 week later for intra-rater reliability. The plantarflexors on the hemiparetic side were tested. MAIN OUTCOMES AND RESULTS: The ICCs of inter and intra-rater reliability across all components of MTS were moderate and moderately high (range 0.40-0.71). Inter- and intra-rater reliability for the dynamic component of spasticity (R2-R1) were moderate (ICC = 0.57 and 0.40, respectively). The difference between the two raters for R2 was statistically significant (p = 0.001). CONCLUSIONS: The reliability of the Modified Tardieu Scale in the measurement of ankle plantarflexor spasticity in adult patients after stroke was insufficient for routine use in clinical settings and research.

Factors Affecting the Independence Level of 4-6-Year-Old Children with Cerebral Palsy in Activities of Daily Living.

Objectives: Enhancing the independence of children with cerebral palsy in their daily activities can significantly alleviate caregiver stress and challenges, thereby improving the quality of life for caregivers.. This study aimed to identify the influential factors in the independence level of children with CP in Activities of Daily Living (ADL) (self-care) and Instrumental Activities of Daily Living (IADL) (home participation). Materials & Methods: In this cross-sectional study, 116 children with different types of CP (61 boys and 55 girls) in the 4-6 age range and their parents were non-randomly selected through convenience sampling. The Iranian-Children Participation Questionnaire was used to measure the children's independence level in self-care activities and home participation. Several instruments, along with a demographic questionnaire, were used to assess personal factors, such as the Gross Motor Function Classification System, Manual Ability Classification System, Communication Function Classification System, SPARCLE (for determining children's cognitive level), and Eating and Drinking Ability Classification System. Eventually, the collected data were analyzed using stepwise linear regression.. Results: The results showed that the level of Gross Motor Function Classification System (GMFCS) and Communication Function Classification System (CFCS) and the child's age had the most correlation with the independence level in self-care activities. Moreover, GMFCS, Manual Ability Classification System (MACS), cognitive level, and child's age were most associated with home participation. Conclusion: Personal factors are more effective than environmental factors in determining the independence of children with CP.

The Effect of Occupation-Based Modified Constraint-Induced Movement Therapy on the Participation of Children with Cerebral Palsy: A Single-Blind Randomized Controlled Trial.

Objective: This study investigates the impact of modified constraint-induced movement therapy (m-CIMT), accompanied by occupation-based and activity analysis, on the participation of children with hemiplegia. Materials & Methods: Twenty-three participants were randomly assigned to the intervention and control groups. The intervention group received occupation-based m-CIMT (m-CIMT along with occupation-based and activity analysis), while the control group received m-CIMT without occupation-based and activity analysis. The intervention was conducted one hour per day, three days a week, for four weeks. Results: The primary outcomes revealed no significant differences between groups in promoting the participation of children with hemiplegia in the activities of daily living (ADL). However, scores were higher in the intervention group with a medium to large effect size (Canadian occupational performance measure: F(1,19)=2.14, P=0.160, η2P=0.101, Canadian occupational performance measure-satisfaction: F(1,19)=1.53, P=0.231, η2P=0.075, Goal attainment scaling: F(1,19)=5.55, P=0.029, η2P=0.226). This effect remained during the follow-up period. The secondary outcomes indicated no significant differences between groups in improving the manual ability of the children. However, scores were higher in the intervention group with a medium to large effect size (ABILHAND-Kids: F(1,19)=0.64, P=0.434, η2P=0.033, pediatric motor activity log- how long: F(1,19)=3.53, P=0.076, η2P=0.157, pediatric motor activity log- how well: F(1,19)=2.59, P=0.124, η2P=0.120). This effect was sustainable during the follow-up period. Conclusion: m-CIMT accompanied by occupation-based and activity analysis and the client-centered paradigm substantially enhances the manual ability of children with hemiplegia and their participation in the ADL.

Development and Validation of Occupation Based Practice Measure (OBPM).

Background. Occupation based practice (OBP) is the central core of occupational therapy. Therefore, measuring its usage and influencing factors seems necessary. Purpose. To develop and validate the occupation based practice measure (OBPM). Method. OBPM was developed in two phases: (I) following a qualitative study, a literature review was conducted. The item pool was revised by expert panel; (II) The face, content, construct validity, internal consistency, and test-retest reliability were assessed. Findings. The 142 items derived through the qualitative study were integrated with the 42 items derived from the literature review. The item pool was reduced by expert panel to 78 items and finalized to 37 items through face, content, and construct validity. Cronbach's alpha was greater than 0.70 and intra-class correlation coefficient showed good to excellent reliability. Implications. OBPM is a valid and reliable questionnaire that evaluates the occupational therapists' knowledge, attitudes, interest, usage, and contextual factors influencing the OBP.

Construct Validity and Reliability of the Children Participation Assessment Scale-Child version in Children with Physical Disabilities.

OBJECTIVE: This study was conducted to determine the construct validity and reliability of the Children Participation Assessment Scale in activities outside of School-Child version (CPAS-C) in 6-12-year-old children with physical disabilities (PDs). MATERIALS & METHODS: In this methodological study, participants were 100 children with PDs, recruited from a school for exceptional children with physical-motor disabilities and 100 normally developing children. For assessing the test-retest reliability (ICC), 40 children with PDs completed CPAS-C within a two-week interval, and for assessing the internal consistency (Cronbach's alpha) and construct validity, 100 children with PDs separately completed the Vinland Adaptive Behavioral Scale (VABS) and CPAS-C. RESULT: The majority of participants were children with CP, among whom the highest and lowest ratios were related to diplegia (32%) and dystonia (1%), respectively. The results showed that CPAS-C had acceptable reliability (ICC: 0.6-0.99). Cronbach's α score was between weak to moderate (α = 0.25-0.75). The difference in the score of participation between the two groups (normally developing children and children with physical disabilities) was significant in all areas (P<0.001). CONCLUSION: The CPAS-C had acceptable psychometric properties; it can be used as a valid and reliable tool for assessing the participation of 6-12-year-old children with PDs in school activities.

The Relationship of School Participation with Motor Proficiency and Executive Function in Children with Autism Spectrum Disorder.

OBJECTIVES: Participation in meaningful activities is an important aspect of development in children with developmental disorders such as autism spectrum disorder (ASD). The purpose of this study was to assess the correlation of school participation with motor proficiency and executive function in children with ASD. MATERIALS & METHODS: In this cross-sectional (descriptive-analytic) study, 52 students aged 6 to 12 years old with ASD were selected through the convenience sampling method. The GARS-2 scale was used to confirm ASD diagnosis. Other psychiatric comorbidities such as ADHA were studied by the CSI-4 tool, and students with comorbidities were excluded. Data were collected using SFA, BOTMP-2, and BRIEF questionnaires. It should be noted that in the BRIEF questionnaire, a higher score indicates a more severe disability. RESULTS: Our findings showed that motor proficiency and its components had a significant direct correlation with school participation in children with ASD (P ≤0.001). On the other hand, school participation was inversely and significantly correlated with the behavioral regulation and metacognition monitoring indices of the executive function dimension (P <0.05). CONCLUSION: Based on the findings of this research, the development of motor proficiency and improvements in the behavioral regulation and metacognition monitoring of students with ASD will boost their participation in school activities. Motor proficiency was significantly correlated with school participation in children with ASD. More attention should be paid to perceptual motor interventions and cognitive rehabilitation programs (with a focus on monitoring metacognition and shifting behavioral regulation) to increase the participation of children with ASD in school activities.

Predictors of mental health among parents of children with cerebral palsy during the COVID-19 pandemic in Iran: A web-based cross-sectional study.

BACKGROUND: Caring for children with cerebral palsy (CP) for many aspects of their lives may affect caregiver's psychological health. Emergence of COVID-19 put added pressure on caregivers. AIMS: The aim of this study was to investigate the psychological health of Iranian caregivers of children with CP and associated risks during a lockdown period. METHODS: Using online snowball sampling, 160 caregivers of children with CP participated in this web-based cross-sectional study. The Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-4), Caregiver Difficulties Scale (CDS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was applied to identify risk factors related to caregiver psychological health. OUTCOMES AND RESULTS: Mental health problems were prevalent; (depression = 45.0% and anxiety = 40.6%). Significant correlations were found between CDS and HADS-Anxiety (r = 0.472, P < 0.001), HADS-depression (r = 0.513, P < 0.001), and perceived stress (PSS) related to COVID-19 (r = 0.425, P < 0.001). After controlling for demographic and clinical variables, burden (CDS) was found to significantly predict caregiver anxiety, depression and stress. Furthermore, several demographic characteristics (being married, low educational level and low income) were significantly related to high HADS Anxiety scores. For depression, only having a physical problem was significantly related to HADS among demographic variables. No significant correlations were found between PSS-4 and demographic variables. CONCLUSIONS AND IMPLICATIONS: During COVID-19 outbreak, the mental health of caregivers of children with CP is affected by multiple factors such as burden of care and demographic characteristics. Due to the importance of well-being among caregivers of disabled children, a comprehensive plan including psychological consultation, remote education, or in-person handouts for the self-care or handling of the children and adequate distance support may enable better mental health for these caregivers.

Fatigue in Children with Cancer: Reliability and Validity of the Persian Version of Child, Parent, and Staff Fatigue Scale.

CONTEXT: The fatigue is reported as the most common and annoying symptom in patients with cancer, timely diagnosis, and treatment can significantly influence the treatment and rehabilitation. It is crucial to have an appropriate tool to accurately assess fatigue status. OBJECTIVES: Our purpose was to assess psychometric properties of the Persian versions of fatigue scale by Original Scales from the viewpoint of children with cancer (Child Fatigue Scale [CFS]-24 h), their parents (Parent Fatigue Scale [PFS]-24 h), and staff (Staff Fatigue Scale FSF-24 h). METHODS: Convenience sampling of the participants was conducted 100, including children with cancer within the age range of 7-12 years, their parents, and caregivers in medical staff. Test-retest reliability and internal consistency were evaluated using intraclass correlation (ICC) and Cronbach's alpha coefficient. Dimensionality was determined by factor analysis. The patients' fatigue was also assessed through visual analog scale-fatigue (VAS-F). RESULTS: Test-retest (ICCCFS = 0.71, ICCPSF = 0.82, and ICCSFS = 0.78) was acceptable with a high level of internal consistency (αCFS = 0.80, αPFS = 0.83, and αSFS = 0.84). Factor analysis identified three, five, and two components for the CFS, PFS, and Staff Fatigue Scale (SFS), respectively. There was moderate correlation between CFS and VAS-F. CONCLUSIONS: Results of the current study indicated that CFS in children with cancer, PFS in their parents, and SFS in medical staff were valid and reliable instruments to assess fatigue from the viewpoint of children with cancer along with their parents and medical staff.