Reliability of Selected Health-Related Fitness Tests for Children With Developmental Coordination Disorder.

Aim: To quantify test-retest reliability and minimal detectable change for 90 and 95% confidence levels (90MDC, 95MDC) for health-related fitness tests in children with developmental coordination disorder (DCD). Methods: Lower limb muscle strength [hand-held dynamometry (HHD), unilateral heel rise test (UHRT), standing broad jump (SBJ)], muscle endurance [Muscle Power Sprint Test (MPST)] and cardiorespiratory endurance [20-metre Shuttle Run Test (20mSRT)] were evaluated twice (2-7 day interval) in 31 children with DCD (20 males, 9.4 years old ± 2.0). Results: Test-retest reliability was reported as intraclass correlation coefficient (ICC) (2, 1) 95% confidence interval lower bounds. Values were excellent for MPST (peak and mean power: 0.93, 0.95), good for HHD (0.81-0.88), SBJ (0.82), and the 20mSRT (0.87) and moderate for UHRT (0.74). For HHD, the 90MDC and 95MDC were the largest for hip extensors (14.47, 12.14 Nm) and the smallest for ankle dorsiflexors (1.55, 1.30 Nm). For UHRT, SBJ, MPST and the 20mSRT, these MDC values were 11.90, 9.98 repetitions; 25.49, 21.38 cm; 4.70, 3.94 W (mean power), and 6.45, 5.42 W (peak power) and 0.87, 0.73 (number of stages), respectively. Conclusion: These tests yield reliable test-retest results that can be used to evaluate fitness changes in this group.

Systematic review of the psychometric properties of cultural adaptations and translations of the Children's Assessment of Participation and Enjoyment (CAPE).

BACKGROUND: The Children's Assessment of Participation and Enjoyment (CAPE) is the most widely used questionnaire for the assessment of children participation. While several cultural adaptations and translations exist, the quality of the methods used to produce them, as well as their psychometric properties, remains unclear. The aim of this systematic review was to evaluate the different translated and/or culturally adapted versions of the CAPE for children and youth with and without disabilities. METHOD: A search was performed in five electronic databases CINAHL (EBSCO), MEDLINE (OVID), EMBASE (ELSEVIER), PSYCINFO (OVID), and WEB OF SCIENCE Core Collection (CLARIVATE), for articles available in French or English with the last update in July 2022. All studies related to a cultural adaptation and/or translation of the CAPE were retained and evaluated based on established guidelines for cross-cultural adaptations and measurement properties. The extraction was done independently by two authors. A critical appraisal of translation and psychometric properties methods was performed. Critical appraisal of the articles was done using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. RESULTS: The search identified 642 studies (321 duplicates removed), 16 of which underwent full-text review. Nine studies met all inclusion criteria and underwent analysis. According to the recommended steps for cross-cultural adaptations, one study performed 100% of the steps and two others performed 80%. None of the studies met all the recommendations for the evaluation of psychometric properties. A full evaluation of reliability and internal consistency were reported by 74% of studies. None of the studies reported a full evaluation of responsiveness, agreement and/or construct validity. CONCLUSIONS: This review demonstrated limitations in the robustness of the methods used to develop and evaluate translated and culturally adapted versions of CAPE. To ensure valid and reliable results when conducting future research using the CAPE, it is recommended to fully evaluate the psychometric properties of the existing versions and to produce other translated and culturally adapted versions of the questionnaire.

Growth and muscle strength development in children with developmental coordination disorder.

AIM: To assess effects of growth on lower limb maximal isometric muscle strength (MIMS) development in children with developmental coordination disorder (DCD). METHOD: This observational study used hand-held dynamometry to evaluate MIMS (hip abductors, flexors, extensors; knee flexors and extensors; ankle dorsiflexors) in children with DCD (n=33, 12 females, 21 males, 6-12y, mean [SD] age 9y [2y]). Regression analysis compared changes in MIMS for similar changes in growth (height or body mass) for children with DCD and typically developing children (pre-existing database, n=183), controlling for age and sex. RESULTS: For the same height gain, the gain in muscle strength was 37.3% to 69.2% less in children with DCD compared with typically developing children, with significantly lower slopes (p-value between <0.001-0.042) in all muscle groups tested except knee extensors and ankle dorsiflexors in females. Strength gains related to body mass gains were not different for children with DCD compared to typically developing children. INTERPRETATION: Even when growing at a similar rate, children with DCD do not develop muscle strength gains at the same rate as their typically developing peers. WHAT THIS PAPER ADDS: Strength gains with growth (height) may be reduced in children with developmental coordination disorder.

Participation in leisure activities in adolescents with congenital heart defects.

AIM: To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation. METHOD: Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed. RESULTS: Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05). INTERPRETATION: Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered. WHAT THIS PAPER ADDS: Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Participación en actividades recreativas en adolescentes con cardiopatías congénitas OBJETIVO: Describir la participación en el tiempo libre en adolescentes con defectos cardíacos congénitos (CHD) e identificar los factores asociados con la intensidad de la participación. MÉTODO: Ochenta adolescentes con CHD fueron reclutados (39 varones, 41 mujeres; edad media [DE] 15 años 8 meses [1 año 8 meses] rango 11 año 5 meses- 19 año 11 meses) de los cuales 78 completaron la medida de resultado de la Evaluación de la Participación y el Disfrute de los Niños (Children's Assessment of Participation and Enjoyment [CAPE]) del ocio participación. La medida tiene cinco subescalas: recreación, actividad física, social, basada en habilidades y mejoría personal. Se examinaron las asociaciones entre el CAPE y la edad, el sexo y el desarrollo. Se evaluó la capacidad motora con la Batería de Evaluación de Movimiento para Niños (Movement Assessment Battery for Children, Segunda edición), la cognición (Leiter International Performance Scale-Revised), el comportamiento con el Cuestionario de Fortalezas y Dificultades (Strengths and Difficulties Questionnaire) y la motivación usando el cuestionario Dimensiones del Dominio (Dimensions of Mastery Questionnaire). RESULTADOS: Los participantes exhibieron problemas en el desarrollo motor (43.5%), conducta (23.7%) y en el desarrollo cognitivo (29.9%). La participación más intensa fue en los tipos de actividad social (media [DE] 3.3 [0.99]) y recreativa (2.9 [0.80]) en el CAPE. El sexo masculino (p <0.05) y la edad más joven se asociaron con una mayor actividad física (<15 años: 1.87; ≥15 años: 1.31, p <0.05). Una mayor participación en actividades sociales se relacionó con una mejor cognición (r = 0.28, p <0.05), una función motora más alta (r = 0.30-0.36, p <0.01) y menos dificultades en el comportamiento (r = -0.32 a -0.47, p < 0,01). La capacidad cognitiva (r = 0.27, p <0.05), la destreza manual y la habilidad para apuntar y atajar (r = 0.27-0.33, p <0.05) y los problemas de comportamiento (r = 0.38-0.49, p = 0.001) se correlacionaron con la participación en la actividad física. La capacidad de persistir en las tareas, un aspecto de la motivación se correlacionó con la participación física (r = 0.45, p <0.001) y la actividad social (r = 0.28, p <0.05). INTERPRETACIÓN: Los problemas de desarrollo en los adolescentes con CHD están asociados con una disminución de la participación física y social, lo que los pone a riesgo de una pobre salud física y mental. Deben buscarse estrategias para la promoción de la salud de esta población.

Participação em atividades de lazer em adolescentes com defeitos cardíacos congênitos OBJETIVO: Descrever a participação em lazer de adolescentes com defeitos cardíacos congênitos (DCC) e identificar fatores associados com a intensidade de participação. MÉTODO: Oitenta adolescentes com DCC foram recrutados (39 do sexo masculino, 41 do sexo feminino; média de idade [DP] 15a 8m [1a 8m] variação 11a 5m-19a 11m), dos quais 78 completaram a medida de participação em lazer Avaliação da participação e diversão das crianças (APDC). A medida tem cinco subescalas: recreacional, ativa-física, social, baseada em habilidades, e auto-aprimoramento. Associações entre a APDC e idade, sexo e desenvolvimento foram examinadas. A capacidade motora (Bateria de avaliação do movimento para crianças, segunda edição), cognição (Escala internacional de desempenho de Leiter- Revisada), comportamento (Questionário de capacidades e dificuldades), e motivação (Questionário de Dimensões do Domínio) foram avaliados. RESULTADOS: Os participantes exibiram comprometimento do desenvolvimento motor (43,5%), comportamental (23,7%), e cognitivo (29,9%). A participação mais intensa segundo a APDC foi nos tipos social (média [DP] 3,3 [0,99]) e recreacional (2.9 [0,80]). O sexo masculino (p<0,05) e menor idade foram associados com maior nível de atividade física (<15a: 1,87; ≥15a: 1,31, p<0,05). Um maior engajamento em atividades sociais foi relacionado com uma melhor cognição (r=0,28, p<0,05), maior função motora (r=0,30-0,36, p<0,01), e menos dificuldades comportamentais (r=-0,32 a -0,47, p<0,01). A capacidade cognitiva (r=0,27, p<0,05), destreza e mirar/apreender (r=0,27-0,33, p<0,05), e problemas comportamentais (r=0,38-0,49, p=0,001) foram correlacionadas com a participação em atividades físicas. A persistência nas tarefas, um aspecto da motivação, se correlacionou com o envolvimento em atividades físicas (r=0,45, p<0,001) e sociais (r=0,28, p<0,05). INTERPRETAÇÃO: Alterações persistentes do desenvolvimento de adolescentes com DCC são associadas com engajamento ativo-físico e social reduzidos, o que os coloca em risco para sua saúde física e mental. Estratégias de promoção de saúde deveriam ser consideradas.

A Comparison of Developmental Outcomes of Adolescent Neonatal Intensive Care Unit Survivors Born with a Congenital Heart Defect or Born Preterm.

OBJECTIVE: To compare cognitive, motor, behavioral, and functional outcomes of adolescents born with a congenital heart defect (CHD) and adolescents born preterm. STUDY DESIGN: Adolescents (11-19 years old) born with a CHD requiring open-heart surgery during infancy (n = 80) or born preterm ≤29 weeks of gestational age (n = 128) between 1991 and 1999 underwent a cross-sectional evaluation of cognitive (Leiter International Performance Scale-Revised), motor (Movement Assessment Battery for Children-II), behavioral (Strengths and Difficulties Questionnaire), and functional (Vineland Adaptive Behavior Scale-II) outcomes. Independent samples t tests and Pearson χ2 or Fisher exact tests were used to compare mean scores and proportions of impairment, respectively, between groups. RESULTS: Adolescents born with a CHD and adolescents born preterm had similar cognitive, motor, behavioral, and functional outcomes. Cognitive deficits were detected in 14.3% of adolescents born with a CHD and 11.8% of adolescents born preterm. Motor difficulties were detected in 43.5% of adolescents born with a CHD and 50% of adolescents born preterm. Behavioral problems were found in 23.7% of adolescents in the CHD group and 22.9% in the preterm group. Functional limitations were detected in 12% of adolescents born with a CHD and 7.3% of adolescents born preterm. CONCLUSIONS: Adolescents born with a CHD or born preterm have similar profiles of developmental deficits. These findings highlight the importance of providing long-term surveillance to both populations and guide the provision of appropriate educational and rehabilitation services to better ameliorate long-term developmental difficulties.

Reliability of Inclinometer-Derived Passive Range of Motion Measures in Youth with Cerebral Palsy.

Aims: This study evaluated, for youth with cerebral palsy (CP), the reliability of passive range of motion (PROM) measures taken with an inclinometer, a device that may be simpler to use than a goniometer. Methods: The PROM for elbow and wrist extension, ankle dorsal flexion (knee flexed 90° and fully extended), and the knee popliteal angle of 30 youth with CP (18 boys, 12 girls, 7.0 ± 3.8 years old, classified in Gross Motor Function Classification levels I-V) was measured using an inclinometer. Two physical therapists took the measures during two different sessions, a maximum of 1 week apart. Results: Good mean intra-rater inter-session, inter-rater intra-session, and inter-rater inter-session reliability (ICC = 0.75-0.89), was found for the elbow, ankle, and knee sites. Absolute reliability for these sites and conditions was 7-14° (90% confident) and 10-16° (95% confident). Reliability values for wrist extension were comparable, albeit slight lower. Conclusions: Similar to published values for goniometry, inclinometery yields reliable upper and lower limb PROM measures from ambulatory and non-ambulatory youth with CP whether measures are carried out by different evaluators within or across sessions or whether measures are performed by the same evaluator across sessions.

Educational and rehabilitation service utilization in adolescents born preterm or with a congenital heart defect and at high risk for disability.

AIM: This historical cohort study describes the use of educational and rehabilitation services in adolescents born preterm or with a congenital heart defect (CHD). METHOD: Parents of 76 young people (mean age 15y 8mo [SD 1y 8mo]) with CHD and 125 born ≤29 weeks gestational age (mean age 16y [SD 2y 5mo]) completed a demographics questionnaire including educational and rehabilitation resource utilization within the previous 6 months. Rehabilitation services included occupational therapy, physical therapy, speech language pathology, psychology. Developmental (Leiter Brief IQ, Movement-ABC, Strengths and Difficulties Questionnaire) and functional (Vineland) status of the young people was assessed. Pearson χ2 tests were used to perform simple pairwise comparisons of categorical outcomes across the two groups (CHD, preterm). Univariate logistic regression was used to examine predictors of service utilization. RESULTS: Developmental profiles of the two groups (CHD/preterm) were similar (29.9%/30% IQ<80; 43.5%/50.0% motor difficulties; 23.7%/22.9% behavior problems). One-third received educational supports or attended segregated schools. Only 16% (preterm) and 26.7% (CHD) were receiving rehabilitation services. Services were provided predominantly in the school setting, typically weekly. Few received occupational therapy or physical therapy (1.3-7.6%) despite functional limitations. Leiter Brief IQ<70 was associated with receiving educational supports (CHD: OR 5.53, 95% CI 1.29-23.68; preterm: OR 14.63, 3.10-69.08) and rehabilitation services (CHD: OR 4.46, 1.06-18.88; preterm: OR 5.11, 1.41-18.49). Young people with motor deficits were more likely to require educational (CHD: OR 5.72, 1.99-16.42; preterm: OR 3.11, 1.43-6.77) and rehabilitation services (preterm: OR 3.97, 1.21-13.03). INTERPRETATION: Although young people with impairments were more likely to receive educational and rehabilitation services, many may not be adequately supported, particularly by rehabilitation specialists. Rehabilitation services at this important transition phase could be beneficial in optimizing adaptive functioning in the home, school, and community.

Factors Associated With Moderate to Vigorous Physical Activity in Adolescents Born Preterm.

PURPOSE: Little is known about the physical activity of adolescents born prematurely. This study aimed to: 1) describe relationships between moderate to vigorous physical activity (MVPA) in adolescents born prematurely and various factors and, 2) compare their MVPA level to guidelines. METHOD: A secondary analysis was performed using data from 64 adolescents (16.1 ± 2.5 years old, born £29 weeks gestation; 57.8% girls). Time spent in MVPA was based on accelerometry data. Sociodemographic, prematurity and comorbidity variables were based on questionnaire data or, for movement difficulty, from the results of the Movement Assessment Battery for Children-Second Edition. RESULTS: Multiple regression analysis showed that participants who were older (b = -4.52, p < .001), female (b = 14.18, p = .014), with movement difficulty (b = 18.64, p = .014), with health problems (b = 11.78, p = .036) and without hyperactive behavior (trend, b = 2.04, p = .099) spent less time in MVPA. Together these variables explained 44.4% of the variance in MVPA. Most participants (79.7%) did not meet Canadian MVPA guidelines. CONCLUSION: Study results suggest that physical activity interventions should especially target adolescents born prematurely who are older, female, with health problems, and with marked movement difficulties.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis.

OBJECTIVE: To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA). DATA SOURCES: An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov. STUDY SELECTION: The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis. DATA EXTRACTION: Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations. DATA SYNTHESIS: All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+). CONCLUSIONS: The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.

Acute Physical Exercise Affects Cognitive Functioning in Children With Cerebral Palsy.

Little is known about the effects of acute exercise on the cognitive functioning of children with cerebral palsy (CP). Selected cognitive functions were thus measured using a pediatric version of the Stroop test before and after maximal, locomotor based aerobic exercise in 16 independently ambulatory children (8 children with CP), 6-15 years old. Intense exercise had: 1) a significant, large, positive effect on reaction time (RT) for the CP group (preexercise: 892 ± 56.5 ms vs. postexercise: 798 ± 45.6 ms, p < .002, d = 1.87) with a trend for a similar but smaller response for the typically developing (TD) group (preexercise: 855 ± 56.5 ms vs. postexercise: 822 ± 45.6 ms, p < .08, d = 0.59), and 2) a significant, medium, negative effect on the interference effect for the CP group (preexercise: 4.5 ± 2.5%RT vs. postexercise: 13 ± 2.9%RT, p < .04, d = 0.77) with no significant effect for the TD group (preexercise: 7.2 ± 2.5%RT vs. postexercise: 6.9 ± 2.9%RT, p > .4, d = 0.03). Response accuracy was high in both groups pre- and postexercise (>96%). In conclusion, intense exercise impacts cognitive functioning in children with CP, both by increasing processing speed and decreasing executive function.

The Effects of Acute Intense Physical Exercise on Postural Stability in Children With Cerebral Palsy.

This study evaluated the effects of intense physical exercise on postural stability of children with cerebral palsy (CP). Center of pressure (CoP) was measured in 9 typically developing (TD) children and 8 with CP before and after a maximal aerobic shuttle-run test (SRT) using a single force plate. Anteroposterior and mediolateral sway velocities, sway area, and sway regularity were calculated from the CoP data and compared between pre- and postexercise levels and between groups. Children with CP demonstrated significantly higher pre-SRT CoP velocities than TD children in the sagittal (18.6 ± 7.6 vs. 6.75 1.78 m/s) and frontal planes (15.4 ± 5.3 vs. 8.04 ± 1.51 m/s). Post-SRT, CoP velocities significantly increased for children with CP in the sagittal plane (27.0 ± 1.2 m/s), with near-significant increases in the frontal plane (25.0 ± 1.5m/s). Similarly, children with CP evidenced larger sway areas than the TD children both pre- and postexercise. The diminished postural stability in children with CP after short but intense physical exercise may have important implications including increased risk of falls and injury.

Hand-Held Dynamometry Isometric Torque Reference Values for Children and Adolescents.

PURPOSE: To establish hand-held dynamometry (HHD) maximal isometric muscle torque (MIT) reference values for children and adolescents who are developing typically. METHODS: The MIT of 10 upper and lower limb muscle groups was assessed in 351 Caucasian youth (4 years 2 months to 17 years) using a standardized HHD protocol, previously shown to be feasible, valid, and reliable. RESULTS: The mean MIT and 95% confidence interval of the mean for all muscle groups, for each of the 14 age groups (1 year age span for each group), and for each sex, were reported in both absolute (Nm) and normalized (Nm/kg) values. CONCLUSION: These HHD reference values may be helpful in the identification of muscle strength impairments in several pediatric populations, especially when bilateral impairments are present.

Translation, cross-cultural adaptation and validation of the French version of the Knee Outcome Survey-Activities of Daily Living Scale.

PURPOSE: The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) is a joint-specific questionnaire measuring functional limitation experienced by individuals with knee disorders. The original English version of the KOS-ADLS has been shown to be highly reliable and responsive to change. The purpose of this study was to perform a translation and cross-cultural adaptation of the original version of the KOS-ADLS questionnaire into French and to validate this French version of the questionnaire. METHOD: In accordance with standard procedure, the original version of the KOS-ADLS was translated and cross-culturally adapted into French. Once the final French version of the KOS-ADLS was developed, it was subjected to further psychometric evaluation with 76 individuals with knee disorders. Each participant completed the KOS-ADLS on three occasions: at baseline, two days later to evaluate test-retest reliability, and four weeks later to evaluate responsiveness. Symptoms and function-oriented construct questions were also completed to evaluate construct-convergent and known-group validity. RESULTS: The cross-cultural adaptation procedure revealed no major problems with content or language. The French version of the KOS-ADLS showed excellent test-retest reliability with low measurement error (intraclass correlation coefficient = 0.92, minimal detectable change = 8.3), as well as high responsiveness (standardized response mean = 1.41; clinically important difference = 13.6). Further, it discriminates between different levels of self-rated or clinician-rated knee function. CONCLUSIONS: The French version of the KOS-ADLS is a reliable, valid and responsive questionnaire for the assessment of functional limitation in individuals with musculoskeletal knee disorders.

Maximal cardiorespiratory fitness testing in individuals with chronic stroke with cognitive impairment: practice test effects and test-retest reliability.

OBJECTIVES: To evaluate, for individuals with chronic stroke with cognitive impairment, (1) the effects of a practice test on peak cardiorespiratory fitness test results; (2) cardiorespiratory fitness test-retest reliability; and (3) the relationship between individual practice test effects and cognitive impairment. DESIGN: Cross-sectional. SETTING: Rehabilitation center. PARTICIPANTS: A convenience sample of 21 persons (men [n=12] and women [n=9]; age range, 48-81y; 44.9±36.2mo poststroke) with cognitive impairments who had sufficient lower limb function to perform the test. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Peak oxygen consumption (Vo(2)peak, ml·kg(-1)·min(-1)). RESULTS: Test-retest reliability of Vo(2)peak was excellent (intraclass correlation coefficient model 2,1 [ICC2,1]=.94; 95% confidence interval [CI], .86-.98). A paired t test showed that there was no significant difference for the group for Vo(2)peak obtained from 2 symptom-limited cardiorespiratory fitness tests performed 1 week apart on a semirecumbent cycle ergometer (test 2-test 1 difference, -.32ml·kg(-1)·min(-1); 95% CI, -.69 to 1.33ml·kg(-1)·min(-1); P=.512). Individual test-retest differences in Vo(2)peak were, however, positively related to general cognitive function as measured by the Mini-Mental State Examination (ρ=.485; P<.026). CONCLUSIONS: Vo(2)peak can be reliably measured in this group without a practice test. General cognitive function, however, may influence the effect of a practice test in that those with lower general cognitive function appear to respond differently to a practice test than those with higher cognitive function.

Anaerobic performance in children with cerebral palsy compared to children with typical development.

PURPOSE: Using a locomotor-based field test of anaerobic performance, this study compared the anaerobic performance of children with spastic cerebral palsy (CP) who walk without support with that of peers who are typically developing. METHODS: The Muscle Power Sprint Test was performed by 159 children with CP (102 boys, mean age 9.7 ± 1.5 years; and 57 girls, mean age 9.5 ± 1.6 years) classified at Gross Motor Function Classification System level I (n = 115) or level II (n = 44) and 376 children with typical development (175 boys, mean age 8.9 ± 1.8 years; and 201 girls, mean age 9.0 ± 1.7 years). RESULTS: The anaerobic performance of the children with CP was lower than that of peers with typical development. CONCLUSIONS: The difference between the 2 groups increased with height, especially for the children with CP classified at Gross Motor Function Classification System level II. Children with CP appear to have impaired anaerobic performance.

A proposal for a universal physical therapy diagnostic concept.

BACKGROUND: In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used. OBJECTIVE: To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context. METHODS: The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized. RESULTS: Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures. CONCLUSIONS: The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice.

Rehabilitation interventions to modify endocrine-metabolic disease risk in individuals with chronic spinal cord injury living in the community (RIISC): A systematic search and review of prospective cohort and case-control studies.

CONTEXT: Endocrine-metabolic disease (EMD) is associated with functional disability, social isolation, hospitalization and even death in individuals living with a chronic spinal cord injury (SCI). There is currently very low-quality evidence that rehabilitation interventions can reduce EMD risk during chronic SCI. Non-randomized trials and alternative study designs are excluded from traditional knowledge synthesis. OBJECTIVE: To characterize evidence from level 3-4 studies evaluating rehabilitation interventions for their effectiveness to improve EMD risk in community-dwelling adults with chronic SCI. METHODS: Systematic searches of MEDLINE PubMed, EMBASE Ovid, CINAHL, Cochrane Database of Systematic Reviews, and PsychInfo were completed. All longitudinal trials, prospective cohort, case-control studies, and case series evaluating the effectiveness of rehabilitation/therapeutic interventions to modify/associate with EMD outcomes in adults with chronic SCI were eligible. Two authors independently selected studies and abstracted data. Mean changes from baseline were reported for EMD outcomes. The Downs and Black Checklist was used to rate evidence quality. RESULTS: Of 489 articles identified, 44 articles (N = 842) were eligible for inclusion. Individual studies reported statistically significant effects of electrical stimulation-assisted training on lower-extremity bone outcomes, and the combined effects of exercise and dietary interventions to improve body composition and cardiometabolic biomarkers (lipid profiles, glucose regulation). In contrast, there were also reports of no clinically important changes in EMD outcomes, suggesting lower quality evidence (study bias, inconsistent findings). CONCLUSION: Longitudinal multicentre pragmatic studies involving longer-term exercise and dietary intervention and follow-up periods are needed to fully understand the impact of these rehabilitation approaches to mitigate EMD risk. Our broad evaluation of prospective cohort and case-control studies provides new perspectives on alternative study designs, a multi-impairment paradigm approach of studying EMD outcomes, and knowledge gaps related to SCI rehabilitation.

A Clinical Practice Guide to Enhance Physical Activity Participation for Children with Developmental Coordination Disorder in Canada.

Purpose: This clinical practice guide (CPG) aims to provide evidence-based recommendations for promoting and enhancing the participation and integration of children with developmental coordination disorder (DCD) into physical activities that take place in the home, school, community, or rehabilitation clinic contexts. Methods: A panel of key stakeholders relevant to these contexts (parents, instructors, rehabilitation professionals) developed evidence-based recommendations using a consensus methodology after reviewing results from a recent systematic review of relevant literature. The quality of the evidence on which the recommendations were based was evaluated (2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence scale) as was the strength of the final CPG recommendations (American Society of Plastic Surgeons Grade Recommendation Scale). Results: Recommendations (n = 50; 36% supported by robust, empirically derived evidence) for the different stakeholder groups fell into three categories: 1) Choose an appropriate activity for your child, 2) Harmonize the activity with the child's interests and abilities, and 3) Help the child learn new movements prior to the activity. Conclusions: This comprehensive CPG provides concrete recommendations, based on the currently available evidence, that can be used by stakeholders to address the physical activity participation and integration needs of children with DCD in a variety of contexts.

Objectif: ces directives cliniques visent à fournir des recommandations basées sur les données probantes pour promouvoir et améliorer la participation et l'intégration des enfants ayant un trouble développemental de la coordination (TDC) à des activités physiques qui se déroulent à la maison, à l'école, dans la communauté ou dans des cliniques de réadaptation. Méthodologie: un groupe d'intervenants clés dans ces contextes (parents, entraineurs, professionnels de la réadaptation) a préparé des recommandations fondées sur des données probantes au moyen d'une méthodologie de consensus, après avoir révisé les résultats d'une récente analyse systématique de publications pertinentes. La qualité des données probantes sur laquelle reposent les recommandations a été évaluée (échelle de qualité des preuves de l'Oxford Centre for Evidence-Based Medicine de 2011) de même que les catégories des recommandations définitives tirées des directives (échelle des catégories de recommandations de l'American Society of Plastic Surgeons). Résultats: les recommandations (n = 50; 36 % soutenues par des données probantes empiriques vigoureuses) des divers groupes d'intervenants se déclinaient en trois catégories : 1) choisir une activité appropriée pour l'enfant, 2) harmoniser l'activité selon les intérêts et les capacités de l'enfant, 3) aider l'enfant à s'approprier de nouveaux mouvements pour aller vers l'activité. Conclusions: ces directives cliniques complètes fournissent des recommandations concrètes d'après les données probantes disponibles, que peuvent utiliser les intervenants pour aborder la participation à l'activité physique et les besoins d'intégration des enfants ayant un TDC dans divers contextes.

Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team.

PURPOSE: The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS: An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS: EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS: RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Living with a spinal cord injury or disease (SCI/D) increases endocrine metabolic disease (EMD) risk.EMD-related outcomes include fracture; type II diabetes; and cardiovascular disease (myocardial infarction, sudden cardiac death and stroke), directly contributing to higher morbidity and mortality.Single-disease paradigms are not the ideal strategy to address multimorbidity contexts experienced in SCI/D.Practice-based research could be an alternative/adjunct to randomized control trials at generating evidence on current and emerging rehabilitation approaches.

Relationships between lower limb muscle strength and locomotor capacity in children and adolescents with cerebral palsy who walk independently.

This study aimed to quantify relationships between lower limb muscle strength and locomotor capacity for children and adolescents with cerebral palsy (CP) to identify key muscle groups for strength training. Fifty 6- to 16-year-olds with CP (Gross Motor Function Classification System level I or II) participated. Isometric muscle strength of hip flexor and abductor, knee flexor and extensor, and ankle dorsiflexor muscles was measured using hand-held dynamometry. Ankle plantar flexor concentric muscle strength was assessed as the maximal number of unilateral heel rises. Locomotor capacity was evaluated by the 6-min walk test (6MWT), 10-meter Shuttle Run Test (10mSRT), and Timed Up and Down Stairs Test (TUDS). With control for age, sex, and height, hip flexor and ankle plantar flexor strength explained 47.8% of the variance in the 6MWT and 32.9% of variance in the TUDS and hip abductor isometric strength explained 43.5% of the variance in the 10mSRT. Avenues for future research include randomized controlled trials that specifically target hip flexor muscles, as this has not previously been done, and determining factors other than strength that are likely related to locomotor capacity of children and adolescents with CP.