Spoken Communicative Intents Among 3- to 4.5-Year-Old French-Speaking Children: Procedure and Data From the Early Longitudinal Language and Neglect Study.

PURPOSE: This study aimed to (a) provide speech-language pathologists and researchers with a play-based procedure to measure the expression of spoken communicative intents by children aged 3 to 4.5 years and (b) present indicators of these children's capacity to produce these intents in this context. METHOD: A method inspired by TRIAGE (Technique de Recherche d'Informations par Animation d'un Group d'Experts) allowed an advisory group of 16 speech-language pathologists to select and agree on definitions of intents to include in this procedure, among a set of 13 preselected intents based on the scientific literature. A longitudinal design including four measuring times was used to verify the production of these intents by 99 French-speaking children (46 boys; M age = 36.09 months) at 36, 42, 48, and 54 months using the Neighborhood Game, a previously developed elicitation procedure of communicative intents conducted within the context of symbolic play. For each measurement time, the average percentage of children who had produced each intent at least 3 times was calculated with a 95% confidence interval. Nonparametric analysis of variance for longitudinal data was carried out to verify progression with age. RESULTS: A finalized list of eight communicative intents was selected along with their definition and a standardized script to elicit them during symbolic play. The production frequency of most intents showed significant progression between the first and the fourth measurement time. Arguing is the only intent that is still not produced by more than 90% of children at the age of 54 months. CONCLUSIONS: This study led to the development of an assessment procedure, which presents ecological validity and elicits the expression of eight communicative intents among 3- to 4.5-year-olds. This procedure can support the work of speech-language pathologists and researchers. The accompanying indicators of children's capacity to produce these intents at a given age in this kind of context are a notable addition to the knowledge on typical language development. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21844206.

Implementation Determinants of Knowledge Mobilization within a Quebec Municipality to Improve Universal Accessibility.

According to the UN-CRPD, cities must develop action plans about universal accessibility (UA). Operationalization of these plans is complex, and little is known about what municipal employees know about UA. AIM: The aim is to document implementation determinants of UA within a municipal organization in Quebec, Canada. METHODS: An observational cross-sectional study was performed. Employees answered a survey based on the TDF and the DIBQ. Facilitators, barriers, and factors influencing the determinants were identified. RESULTS: A total of 43% of the employees completed the survey. The implementation of UA measures is more facilitated by their beliefs about the impact on citizens, while the external context hinders the proper implementation. It is also influenced by six factors: (1) professional role, (2) capacity, (3) resources, (4) willingness, (5) characteristics, and (6) feedback. DISCUSSION: Results suggest that understanding the consequences, sufficient resources, abilities, and willingness can influence implementation of UA. CONCLUSION: These findings have informed the objectives of the next action plan of the municipal organization and could guide the development of solutions.

Whole-brain morphometry in Canadian soldiers with posttraumatic stress disorder.

Patients with posttraumatic stress disorder (PTSD) display several structural brain differences when compared with healthy individuals. However, findings are particularly inconsistent for soldiers with PTSD. Here, we characterized the brain morphometry of 37 soldiers from the Canadian Armed Forces with adulthood war-related PTSD using structural magnetic resonance imaging. We assessed time since trauma, as well as PTSD, depressive, and anxiety symptoms with the Modified PTSD Symptoms Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively. Whole-brain morphometry was extracted with FreeSurfer and compared with a validated normative database of more than 2700 healthy individuals. Volume and thickness from several regions differed from the norms. Frontal regions were smaller and thinner, particularly the superior and rostral middle frontal gyri. Furthermore, smaller left rostral middle frontal gyrus, left pericalcarine cortex, and right fusiform gyrus were associated with more recent trauma. All subcortical structures were bigger, except the hippocampus. These findings suggest a particular brain morphometric signature of PTSD in soldiers. Smaller and thinner frontal and larger subcortical regions support impaired top-down and/or downregulation of emotional response in PTSD. Finally, the correlation of smaller frontal, temporal, and occipital regions with more recent trauma might inform future therapeutic approaches.

Relationships between cognitive functioning and power wheelchair performance, confidence and life-space mobility among experienced power wheelchair users: An exploratory study.

OBJECTIVES: To explore: (i) relationships between power wheelchair performance, confidence, mobility and the severity of user's cognitive impairment; (ii) relationships between cognitive functioning and power wheelchair performance, confidence and mobility; and (iii) how cognitive scores influence power wheelchair performance, confidence and mobility. DESIGN: Cross-sectional exploratory study. SUBJECTS: Independent power wheelchair users; ≥18 years. OUTCOME MEASURES: Cognitive assessments (Montreal Cognitive Assessment, Motor-Free Visual Perception Test, and Dysexecutive Questionnaire) and power wheelchair driving assessments (Power mobility Indoor Driving Assessment, Wheelchair-Skills-Test-Questionnaire, and Life-Space Assessment). Analyses were completed using multivariate analysis of variance and principal component analysis. RESULTS: There were a total of 30 participants (with a mean (SD) age of 58 (15) years, who had a mean (SD) of 3 (6.2) years of experience of power wheelchair use, (SD) and a mean score of 22 (5 on) the Montreal Cognitive Assessment. There were statistically significant differences in all power wheelchair driving assessments, depending on the severity of cognitive impairment (moderate, p = 0.009; mild, p = <0.001; none, p = 0.009). The first principal component suggested that cognitive functioning, visual perception, and performance explained 69% of the variability in the first principle componenent. The second and third principal components suggested that confidence and the built and social environments also played significant roles in power wheelchair use. CONCLUSION: There are correlations between cognitive functioning and power wheelchair use in experienced users, with the severity of cognitive impairment influencing power wheelchair driving outcomes.

Brain morphometry in adults with gambling disorder.

Little is known regarding the brain substrates of Gambling Disorder, including surface brain morphometry, and whether these are linked to the clinical profile. A better understanding of the brain substrates will likely help determine targets to treat patients. Hence, the aim of this study was two-fold, that is to examine surface-based morphometry in 17 patients with gambling disorder as compared to norms of healthy individuals (2713 and 2790 subjects for cortical and subcortical anatomical scans, respectively) and to assess the clinical relevance of morphometry in patients with Gambling Disorder. This study measured brain volume, surface and thickness in Gambling Disorder. We compared these measures to those of a normative database that controlled for factors such as age and sex. We also tested for correlations with gambling-related behaviors, such as gambling severity and duration, impulsivity, and depressive symptoms (assessed using the South Oaks Gambling Screen, years of gambling, Barratt Impulsiveness Scale, and Beck Depression Inventory, respectively). Patients displayed thinner prefrontal and parietal cortices, greater volume and thickness of the occipital and the entorhinal cortices, and greater volume of subcortical regions as compared to the norms of healthy individuals. There were positive correlations between surface area of occipital regions and depressive symptoms. This work contributes to better characterize the brain substrates of Gambling Disorder, which appear to resemble those of substance use disorders and Internet Gaming Disorder.

Concurrent Transcranial Direct Current Stimulation and Resting-State Functional Magnetic Resonance Imaging in Patients with Gambling Disorder.

Background/Introduction: Transcranial direct current stimulation (tDCS) delivered over the dorsolateral prefrontal cortex (DLPFC) while patients are at rest can decrease craving in patients with substance-related and addictive disorders. Yet, the effects of tDCS on resting-state brain activity remain unknown in this population. This study examined the effects of tDCS on resting-state functional connectivity (rsFC) with concurrent stimulation and functional magnetic resonance imaging in patients with gambling disorder. Methods: This was a randomized, sham-controlled, double-blind, crossover study. The anodal and cathodal electrodes were applied over the right and left DLPFC, respectively. Patients received 30 min of active and sham stimulation on separate days. rsFC was assessed before and during stimulation with seed-based analyses. Results: There was a significant increase of rsFC between the right DLPFC seed and the right superior parietal lobule during active stimulation as compared to during sham stimulation (p = 0.0059, corrected for multiple comparisons). There was also a positive correlation between rsFC change of this frontoparietal network and brain volume of the right DLPFC (p = 0.0042, corrected for multiple comparisons). Discussion: A single session of tDCS targeting the DLPFC strengthened functional connectivity in a frontoparietal circuit, known to be implicated in cognitive control, especially in patients with a greater volume of the region under the anode electrode. Impact statement Transcranial direct current stimulation increased the functional connectivity of a frontoparietal circuit in patients with gambling disorder. These changes were larger in patients with greater volume of the dorsolateral prefrontal cortex. Transcranial direct current stimulation strengthened the connectivity of a brain network known to be associated with cognitive control.

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial.

OBJECTIVES: The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS: We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS: Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION: Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.

Can Technology Abate the Experience of Social Isolation for Those Affected by Dementia?

Background: The widespread social isolation measures recently utilized to mitigate the spread of COVID-19 to older adults may have exuded unexpected consequences. Social isolation among older adults is a risk factor for poor health outcomes. Innovative solutions to balancing public safety and health maintenance for those with dementia and their caregivers are needed. Methods: A sample of N = 82 dementia caregivers participated in a web-based survey to investigate their perceptions on (1) changes in personal mental health due to isolation from their loved one, and (2) the perceived need for use of smart mobile device app use in these situations. Results: The majority of our sample (87%) reported experiencing negative mental health outcomes beyond those experienced in typical situations. Furthermore, over 70% of caregivers were concerned with the care their loved on received during social isolation. Finally, 67% reported perceived need to use SMD apps in these times of social isolation. Conclusion: Our findings provide preliminary insight into troubling consequences occurring when individuals with dementia are socially isolated from their caregivers. An inverse relationship between SMD app use and poor mental health points to the potential for communication technology to lessen the negative impacts of social isolation, when it becomes necessary to public safety.

Impact of neuropathic pain on participation: perspectives from the Canadian SCI community survey.

STUDY DESIGN: Secondary analysis of an observational cohort study. OBJECTIVES: To determine if the perceived overall limitation of neuropathic pain on activities (NP limitation) covaries in 26 specific life activities in people with SCI, taking into account the severity of injury. SETTING: Community-based in Canada. METHODS: Secondary analysis of a cohort (N = 1481) was performed using questionnaires to rate NP frequency and limitation on activities as well as participation in 26 life activities. Relative risks (RR) analyses using Poisson regression were used to examine the data. RESULTS: Most participants (N = 1158; 78%) reported living with NP (from once a year to every day). When NP limitation was described as "not at all" or "very little" (N = 394; 34%), there was no statistically significant RR (p > 0.0019), suggesting no additional risk of not participating "as much as wanted" in any of activities compared to participants with no NP. When NP limitation was described as "to some extent" (N = 411; 35%), a significantly higher risk was observed for 5 of the 26 activities (1.34 < RR < 1.62), and for 23 activities with a large range (1.24 < RR < 3.20) when NP limitation was rated as "to a great extent or more" (N = 353; 31%). CONCLUSION: The variation of RR observed across the 26 activities suggests that the NP limitation may not be general but rather related to specific activity characteristics, which should be taken into account when evaluating NP limitations with a specific focus on the life activities being affected.

Benchmarking length of stay for inpatient stroke rehabilitation without adversely affecting functional outcomes.

OBJECTIVE: To evaluate the effects of introducing the practice of targeting a discharge date for patients admitted to an inpatient stroke rehabilitation unit on process and patient outcomes. DESIGN: Comparison of retrospective (control group n = 69) and prospective (experimental group n = 60) patients. METHODS: Rehabilitation professionals assessed both groups at admission and discharge using a standard-ized assessment toolkit. Benchmarks for length of rehabilitation stay (LoRS) were introduced based on median severity-specific LoRSs in the control group. The multidisciplinary team documented facilitators and obstacles affecting the prediction of patient benchmark attainment. Categorical variables were compared using a χ2 test with exact probabilities. Ordinal and continuous variables were analysed using rank-based non-parametric analysis of variance. Effect sizes were estimated using a relative treatment effect statistic. RESULTS: The mean combined length of stay in acute care and rehabilitation beds for the experimental group (82 days) was shorter (p = 0.0084) than that of the control group (103 days). This 21-day reduction in combined length of stay included a 10-day reduction in the mean time between stroke onset and admission to the stroke rehabilitation unit (p = 0.000014). Improvements in 6 func-tional and sensorimotor outcomes with rehabilitation were of similar magnitude in both groups, while Functional Independence Measure (FIMTM) efficiency improved (p = 0.022). The team was 87% successful in predicting which patients were discharged on the LoRS benchmark. CONCLUSION: Benchmarking the length of stay in rehabilitation resulted in reduced bed occupation and system costs without adversely affecting functional and sensorimotor patient outcomes.

Parental behaviors associated with the level of pragmatic language ability among 42-month-old neglected children.

BACKGROUND: Exposure to neglect can severely compromise children's pragmatic skills (social language use). The disruptions of parent-child interactions that typically occur in context of neglect may compromise several parental behaviors which are known to foster language skills such as pragmatics. OBJECTIVES: 1- Compare the behaviors of neglectful and non-neglectful parents in four domains which are of interest for pragmatic language development, namely, responsive, supportive, affective, and control behaviors, and 2- Identify parental behaviors associated with the levels of pragmatic ability of 42-month-old neglected children. PARTICIPANTS: Study sample consisted of 21 neglected children living in their biological family, recruited in four Youth Centers in the province of Québec (Canada) and 95 non-neglected children recruited in child-care centers. METHOD: Parental behaviors were video recorded in context of free-play with the child at the participants' homes between 2015 and 2017, and subsequently analyzed using the Coding Observations of Parent-Child Interactions (COPI), developed to observe ten parental behaviors associated with early language development. The level of pragmatic ability of children was established using the Language Use Inventory: French, a standardized questionnaire completed with parents of both groups. RESULTS: Parents in situation of neglect scored lower than parents in the control group on eight of the ten behaviors (p < .001). Parental reciprocity was associated with the level of pragmatic ability of 42-month-old neglected children (p = .04). CONCLUSIONS: The results of this exploratory study provide insight on the associations between parental behaviors and the level of pragmatic language skills of children experiencing neglect.

Use of actigraphy to measure real-world physical activities in manual wheelchair users.

INTRODUCTION: The benefits of physical activity for manual wheelchair users are well-known. The purpose of this study was to validate actigraphy to objectively measure physical activity intensity among manual wheelchair users. METHOD: An experimental design was used. Adult manual wheelchair users wore a GT3X actigraph on their non-dominant arm while completing eight physical activities of low (reading), moderate (propelling -- flat) and high (propelling -- steep ramp) intensity. Heart rate and rating of perceived exertion were collected at the end of each physical activity. Distribution of data were examined and used to determine the type of repeated measures (parametric vs. non-parametric). A categorical principal component analysis was performed to determine the amount of variability explained by actigraphy, heart rate and rating of perceived exertion. Activity count cut-points were estimated using bootstrapping methods. RESULTS: Twenty-eight manual wheelchair users completed the study. Actigraphy, heart rate and rating of perceived exertion co-varied as physical activity intensity changed. Activity counts for low-intensity and medium-intensity physical activities were estimated to be 0 to 45 and 45 to 100 activity counts per second, respectively. Activity counts' ranges for high-intensity physical activities were not clear. CONCLUSION: Combining actigraphy and rating of perceived exertion could be an easy and reliable method to measure the intensity of real-world activities. Further research is needed confirm cut-points for physical activity intensity.

Long-Term Effects of a Multimodal Physiotherapy Program on the Severity of Somatosensory Tinnitus and Identification of Clinical Indicators Predicting Favorable Outcomes of the Program.

BACKGROUND: Tinnitus, the perception of sound in the absence of external auditory stimuli, is commonly associated with problems of the auditory system. Head and neck disorders can also be involved in tinnitus emergence. In such cases, the term somatosensory tinnitus is used. Physiotherapy treatments have been identified as a promising avenue in the treatment of somatosensory tinnitus. PURPOSE: The aim of the study was to explore the effect of a physiotherapy program on the intensity and severity of somatosensory tinnitus and to identify the clinical characteristics of the patients who respond well to this treatment. RESEARCH DESIGN: Quasi-experimental pre-post single-group design. STUDY SAMPLE: Thirty-one adults with presumed somatosensory tinnitus. INTERVENTION: All participants received on average ten physiotherapy treatments over six weeks. Treatments included cervical and thoracic mobilizations, as well as muscular strengthening, stretching, postural instruction, and cervical stabilization. DATA COLLECTION AND ANALYSIS: Outcomes were measured at baseline, at the end of the physiotherapy program, and three months later. The primary outcomes were the Tinnitus Handicap Inventory and visual analog scales for loudness and annoyance caused by tinnitus. After the last evaluation, participants were divided into two groups: improved and unimproved participants. Participants were considered improved if they (1) showed significant improvement in at least two of the three primary outcome measures and (2) indicated subjective improvement. Thereafter, the baseline characteristics that correctly identify participants susceptible to improve significantly following treatment were determined (Cohen's effect size d > 0.8). RESULTS: A significant improvement in tinnitus intensity was observed at the end of the program. Of the 31 participants, 14 experienced persistent improvement in the intensity of their tinnitus and were classified as improved. Baseline characteristics strongly associated with tinnitus improvement were no increase in tinnitus when exposed to noise (d = -1.57), no family history of tinnitus (d = -1.16), somatosensory modulation in response to the contraction used to resist pressure applied to the forehead (d = 1.20), and recent onset of tinnitus (d = 1.03). CONCLUSIONS: This exploratory study showed that a multimodal physiotherapy program is effective in decreasing the severity of tinnitus, principally in individuals presenting with somatosensory tinnitus in combination with specific clinical characteristics.

Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review.

OBJECTIVE: To determine the diagnostic validity of high-resolution ultrasound and orthopaedic special tests in diagnosing long head of the biceps tendon pathologies in patients with shoulder pain. DESIGN: Systematic review with meta-analysis tools. DATA SOURCES: MEDLINE, CINAHL and EMBASE. DATA EXTRACTION: Included studies had to report on the diagnostic validity of orthopaedic special tests or high-resolution ultrasound (HRUS) compared with a reference standard for diagnosing long head of the biceps tendon target conditions (superior labrum anterior and posterior lesions, long head of the biceps tendon tendinopathy, dislocation, effusion or rupture). Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: Of the 30 included studies, 8 focused on high-resolution ultrasound and 22 on orthopaedic special tests. High-resolution ultrasound proved highly specific for the diagnosis of long head of the biceps tendon pathologies. Pooled positive (LR+) and negative (LR-) likelihood ratios were 38.00 and 0.24 for dislocation, respectively, and 35.50 and 0.30 for complete rupture, respectively. The accuracy of orthopaedic special tests varied greatly across studies. The only test of value was Yergason's ma-noeuvre in confirming proximal long head of the biceps tendon pathologies except superior labrum anterior and posterior lesion (high specificity): the summary LR+ and LR- were 2.56 and 0.70, respectively. CONCLUSION: High-resolution ultrasound is reliable to confirm suspected long head of the biceps tendon pathologies. There is insufficient evidence to recommend individual orthopaedic special tests.

Characterizing emotional Stroop interference in posttraumatic stress disorder, major depression and anxiety disorders: A systematic review and meta-analysis.

BACKGROUND: Posttraumatic stress disorder is a debilitating psychiatric disorder characterized by symptoms of intrusive re-experiencing of trauma, avoidance and hyper-arousal. Diagnosis and treatment of PTSD is further complicated by concurrently occurring disorders, the most frequent being major depressive disorder and anxiety disorders. Previous research highlights that attentional processing in posttraumatic stress disorder is associated with substantial interference by emotional stimuli, a phenomenon also observed in these concurrently occurring psychiatric disorders. However, the diagnosis-relevance of this interference remains elusive. Here, we investigated the emotional Stroop interference for diagnosis-related stimuli, generally negative stimuli, and generally positive stimuli in posttraumatic stress disorder, major depressive disorder and anxiety disorders. METHODS: We performed a systematic database search in PubMed (Medline), Cochrane Library and PsycINFO on emotional Stroop performance in individuals with a diagnosis of posttraumatic stress disorder, major depressive disorder or anxiety disorders separately. Mean effect sizes, standard errors and confidence intervals were estimated for each clinical group and healthy control group comparison using random effect models. RESULTS: As compared to healthy control group, the posttraumatic stress disorder group displayed greater interference by diagnosis-related stimuli and positive stimuli but not for generally negative stimuli. The major depressive disorder and anxiety disorders groups showed greater interference by diagnosis-related and negative stimuli, but not by positive stimuli. The age and sex had no significant impact on interference. CONCLUSIONS: These findings highlight the importance of diagnosis-relevant information on attentional processing in all three clinical populations, posttraumatic stress disorder, major depressive disorder and anxiety disorders. Further, the impact of generally negative stimuli but not generally positive stimuli in major depressive disorder and anxiety disorders indicate impaired attentional bias for mood-congruent stimuli but not for general stimuli. Finally, it remains to be studied whether the influence of generally positive stimuli in posttraumatic stress disorder indicate that positive stimuli are perceived as PTSD related.

Morphosyntactic Development and Severe Parental Neglect in 4-Year-Old French-Speaking Children: ELLAN study.

Language is the most frequently compromised area of development in English-speaking neglected children, particularly the morphosyntactic component of language. This is very worrisome given its central role in academic success and social participation. No previous study has examined the morphosyntactic skills of French-speaking neglected children, despite the morphological richness of French. This study aimed to fill this gap. Forty-four neglected (mean age = 48.32 months, SD = 0.45) and 92 non-neglected (mean age = 48.07 months, SD = 0.24) French-speaking children participated. Measures of morphosyntactic skills were derived from a sample of spontaneous language collected during standardized semistructured play and analyzed using Systematic Analysis of Language Transcripts software (2012) . Four morphosyntactic indicators were compared using analyses of variance and Kolmogorov-Smirnov tests: the mean length of utterances (MLU), verbal inflections, word-level errors, and omission errors. The results indicate that 25.6% of the neglected children presented clinically significant morphosyntactic difficulties, as evidenced by a significantly shorter MLU (M = 5.60, SD = 1.13; M = 6.90, SD = 1.30), fewer verbal inflections, and more frequent word omission errors compared to their non-neglected peers. The results confirm that French-speaking neglected children present many morphosyntactic difficulties. This study argues for sustained speech-language services for these children.

The Pragmatic Language Skills of Severely Neglected 42-Month-Old Children: Results of the ELLAN Study.

The goals of this study were twofold: (1) to compare the pragmatic language skills (i.e., social communication skills) of 42-month-old neglected children with those of same-aged non-neglected children and (2) to measure the prevalence of pragmatic difficulties among the neglected children. The study sample was composed of 45 neglected and 95 non-neglected 42-month-old French-speaking children. The Language Use Inventory: French (LUI-French) was completed with all parents. This measure, comprised of 159 scored items divided into 10 subscales, was used to assess the children's pragmatic skills. The 10th percentile on the LUI-French (95% confidence interval ) was used to identify children with pragmatic difficulties. The neglected children had lower scores than the non-neglected children on all 10 dimensions of pragmatics evaluated (p < .01), as well as lower LUI-French Total Scores (p < .001). The effect sizes of these differences varied between 0.84 and 2.78. Forty-four percent of the neglected children presented significant pragmatic difficulties compared to 4.2% of their non-neglected peers (p < .001). It can be concluded that exposure to neglect significantly compromises children's pragmatic skills. These results support the need for interventions geared toward neglected children and their families to support the early development of their pragmatic skills.

Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain.

BACKGROUND: Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. METHODS: Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. RESULTS: A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months' work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. CONCLUSION: The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018.