Arabic version of the intermittent and constant osteoarthritis pain questionnaire (ICOAP-Ar): translation, cross-cultural adaptation, and measurement properties.

BACKGROUND: Pain is the most incapacitating symptom of knee osteoarthritis (OA), with intermittent and/or continuous nature as described by the patients. Accuracy of pain assessment tools across different cultures is important. This study aimed to translate and culturally adapt the Intermittent and Constant OsteoArthritis Pain (ICOAP) measure into Arabic (ICOAP-Ar) and evaluate its psychometric properties in patients with knee OA. METHODS: The ICOAP was cross-culturally adapted following the recommended guidelines from English. Knee OA patients from outpatient clinics were recruited to assess the structural (confirmatory factor analysis) and construct validity (Spearman's correlation coefficient - rho) to assess the relationship between the ICOAP-Ar and the pain and symptoms subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS), in addition to internal consistency (Cronbach's alpha and the corrected item-total correlation). A week later, test-retest reliability (intraclass correlation coefficient (ICC)) was evaluated. Following four weeks of physical therapy treatment, the ICOAP-Ar responsiveness was evaluated using the receiver operating characteristic curve. RESULTS: Ninety-seven participants were recruited (age = 52.97 ± 9.9). A model with single pain construct showed acceptable fit (Comparative fit index = 0.92). The ICOAP-Ar total and subscales had a strong to moderate negative correlation with the KOOS pain and symptoms domains, respectively. The ICOAP-Ar total and subscales demonstrated satisfactory internal consistency (α = 0.86-0.93). The ICCs were excellent (ICCs = 0.89-0.92) with acceptable corrected item total correlations (rho = 0.53-0.87) for the ICOAP-Ar items. The ICOAP-Ar responsiveness was good with moderate effect size (ES = 0.51-0.65) and large standardized response mean (SRM = 0.86-0.99). A cut-off point of 51.1/100 was determined with moderate accuracy (Area under the curve = 0.81, sensitivity = 85%, specificity = 71%). No floor or ceiling effects were found. CONCLUSIONS: The ICOAP-Ar exhibited good validity, reliability, and responsiveness after physical therapy treatment for knee OA, which renders it reliable for evaluating knee OA pain in clinical and research settings.

Measurement Properties' Evaluation of the Arabic Version of the Patient-Specific Functional Scale in Patients with Multiple Sclerosis.

Purpose: The aim of this study was to assess the reliability and validity of the Arabic version of the patient-specific functional scale (PSFS-Ar) in patients with multiple sclerosis (MS) disorder. Materials and Methods: Reliability and validity were examined in patients with multiple sclerosis using a longitudinal cohort study design. One hundred (N = 100) patients with MS were recruited to examine the PSFS-Ar, test-retest reliability (using the interclass correlation coefficient model 2,1 (ICC2,1)), construct validity (using the hypothesis testing method), and floor-ceiling effect. Results: A total of 100 participants completed the PSFS-Ar (34% male, 66% female). The PSFS-Ar showed an excellent test-retest reliability score (ICC2,1 = 0.87; 95% confidence interval, 0.75-0.93). The SEM of the PSFS-Ar was 0.80, while the MDC95 was 1.87, indicating an acceptable measurement error. The construct validity of the PSFS-Ar was 100% correlated with the predefined hypotheses. As hypothesized, the correlation analysis revealed positive correlations between the PSFS-Ar and the RAND-36 domains of physical functioning (0.5), role limitations due to physical health problems (0.37), energy/fatigue (0.35), and emotional well-being (0.19). There was no floor or ceiling effect in this study. Conclusions: The study results showed that the PSFS-Ar is a self-reported outcome measure that is useful for detecting specific functional difficulties in patients with multiple sclerosis. Patients are able to express and report a variety of functional limitations easily and effectively, as well as to measure their response to physical therapy. The PSFS-Ar is, therefore, recommended for use in Arabic-speaking countries for clinical practice and research for patients with multiple sclerosis.

Effectiveness of exergaming in reducing cancer-related fatigue among children with acute lymphoblastic leukemia: a randomized controlled trial.

BACKGROUND: Little is known about the effectiveness of the newly emerging technology of exergaming in reducing Cancer Related Fatigue (CRF). OBJECTIVES: The study's primary aim was to examine the effectiveness of exergaming in reducing CRF; the secondary aims were to improve functional capacity/endurance and promote physical activity (PA) among children with acute lymphoblastic leukemia (ALL). METHODS: In this Randomized Controlled Trial (RCT), 45 children aged 6-14 years were randomly assigned into group-I, n = 22, and group II, n = 23. Group-I played exergaming of moderate intensity for 60 min, twice a week for three weeks. Group II was given an instructional session regarding the benefits of PA with advice to practice PA for 60 min twice a week. CRF, functional capacity/endurance, and PA were measured using the pediatric quality of life multidimensional fatigue scale (Ped-QLMFS), six-minute walk test (6-MWT), and Godin-Shepard Leisure Time Physical Activity Questionnaire (QSLTPAQ) respectively. All measurements were taken thrice; in the first, third, and fifth weeks of intervention. RESULTS: Group-I demonstrated a significant reduction of CRF, and a significant increase of functional capacity/endurance compared to group-II over the five weeks study period. The effect of time × intervention interaction was significant. Based on Cohen's guidelines, CRF and functional capacity/endurance had large effect sizes (η2 = 0.41, p = .00) and (η2 = 0.27, p = .00) respectively. CONCLUSION: The protocol of exergaming used in this RCT effectively reduces CRF and promotes functional capacity/endurance and PA in children with ALL undergoing chemotherapy. It may provide an alternative treatment modality to decrease the healthcare load.Key messagesCancer-related fatigue (CRF) is described as physical exhaustion, sleep disturbance, emotional distress, and cognitive dysfunction.Exergaming reduces CRF and promotes functional capacity/endurance and physical activity in children with acute lymphoblastic leukemia undergoing chemotherapy.Exergaming may provide an alternative treatment modality to decrease the healthcare load.

Measurement properties of the Arabic version of the pediatric functional assessment of chronic illness therapy-fatigue in children with cancer.

BACKGROUND: The pediatric Functional Assessment of Chronic Illness Therapy-Fatigue (PedsFACIT-F) measures fatigue in various clinical settings. OBJECTIVE: To verify the measurement properties of the Arabic version (PedsFACIT-F-Ar) in patients with cancer. METHODS: In this cross-sectional validation study, the PedsFACIT-F and the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) were administered to 114 participants (74 boys and 40 girls) aged 8-18. Exploratory factor analysis was used to test the structural validity of PedsFACIT-F-Ar. Its construct validity was investigated using the hypothesis testing method to predict a moderate correlation (rho ⩾ 0.4) with the PedsQL-MFS domains and the total score. Its reliability was also tested. RESULTS: The PedsFACIT-F-Ar is a two-factor model that explains 67.38% of the total variance. It is significantly correlated with PedsQL-MFS (rho > 0.84). It displayed excellent internal consistency (Cronbach's α= 0.93) and test-retest reliability (ICC2.1= 0.99; 95% CI: 0.96-0.99). Bland-Altman's analysis revealed the absence of a systematic error between the two test sessions. The standard error of measurement, minimal detectable change (MDC95), and MDC% were 0.92, 2.56 points, and 2.88%, respectively, with no floor or ceiling effects. CONCLUSIONS: The PedsFACIT-F-Ar demonstrated excellent psychometric properties. The findings suggest the clinical usefulness of this scale.

Psychometric properties of the Obstacles and Curb tests and their discriminative ability across functional levels in ambulatory children with spastic cerebral palsy.

The Obstacles and Curb tests are timed walking assessments that have emerged from the Spinal Cord Injury Functional Ambulation Profile and have been modified for children; however, their psychometric properties have not been adequately investigated. The aim of this research was to examine the psychometric properties of the Obstacles and Curb tests for children with cerebral palsy (CP). This cross-sectional study included 68 children aged 6-12 years; there were 34 children with CP and 34 age- and sex-matched typically developing children. Validity was examined by correlation with the 10-m Walk Test (10-MWT), Modified Time Up and Go test (mTUG), and Pediatric Balance Scale (PBS). Differences in the Obstacle and Curb test scores were calculated between children with CP and typically developing children and within different Gross Motor Function Classification System (GMFCS) levels. Children with CP completed the tests twice within a 30-min interval in the same session. The tests showed significant strong to very strong correlations with the 10-MWT, mTUG, and PBS. The within-session reliability was excellent, typically developing children were significantly faster than children with CP with high sensitivity and specificity, and the time differed significantly within the GMFCS level. Thus, the Obstacles and Curb tests can be considered valid, reliable, and sensitive walking tests for ambulatory children with CP.

Psychometric Properties of the Arabic Version of the EPInfant Scale among Typically Developing Children Aged 6-16 Years.

AIMS: The EPInfant scale is a self-assessment for children that measures perceived exertion (PE) during physical exercise. This study aimed to translate the scale into Arabic (EPInfant-Ar) and test its psychometric properties. METHODS: The revised version was tested for face and content validity. Oxygen saturation, heart rate (HR), and ratings of perceived exertion were measured during a 3-minute step test with a sample of 93 children. PE and HR were examined using the Pearson correlation coefficient (r) to assess the concurrent validity. Internal consistency and test-retest reliability were calculated using Cronbach's alpha (α), intraclass correlation coefficient (ICC2,1), and r coefficient. A minimum detectable change with 95% confidence interval (MDC95) and percentage of change (MDC%) was also measured. RESULTS: Content validity showed an excellent level of expert agreement. There was a moderate correlation between PE rated by the scale and HR (r = 0.47, p < .001). The internal consistency and test-retest reliability were acceptable (α = 0.89; ICC2,1= 0.81; 95%Cl: 0.71-0.87, r = 0.81) with low measurement error (MDC95 = 2.66 and MDC% = 61.10%). CONCLUSIONS: The EPInfant-Ar scale was considered valid and reliable for assessing PE after physical exercises in typically developing children aged 6-16 years.

The combined effect of short foot exercises and orthosis in symptomatic flexible flatfoot: a randomized controlled trial.

BACKGROUND: Flatfoot is a musculoskeletal problem associated with dysfunctional active and passive supporting structures of the normal foot curvature. Strengthening of the intrinsic foot muscles or using shoe orthosis are recommend treatment approaches. However, investigating the effect of combining both approaches is still warranted. AIM: To examine the effect of applying short foot exercises (SFE) combined with shoe insole versus shoe insole alone on foot pressure measures, pain, function and navicular drop in individuals with symptomatic flexible flatfoot. DESIGN: Prospective, active control, parallel-group, assessor-blinded, randomized controlled trial and intention-to-treat analysis. SETTING: Outpatient physical therapy clinic of a university teaching hospital. POPULATION: Forty participants with symptomatic flexible flatfoot. METHODS: A six-week treatment protocol of SFE (three sets of 10 repetitions a day) in addition to shoe insole (eight hours a day) (experimental group, N.=20) or shoe insole only (eight hours a day) (control group, N.=20). Clinic visits were made at baseline and every two weeks for monitoring and follow-up. The static and dynamic foot area, force and pressure measures, pain, lower extremity function, and navicular drop were assessed at baseline and postintervention. RESULTS: Forty participants joined the study and 37 (92.5%) completed the six-week intervention period. Foot pressure, pain and function showed a significant interaction (P=0.02 - <0.001) and time (P<0.001) effects with a non-significant group effect in favor of the experimental group. Post-hoc analysis revealed that the experimental group had lesser pain (P=0.002) and better function (P=0.03) than the control group at six weeks. Navicular drop decreased equally in both groups. CONCLUSIONS: Implementation of shoe insole and SFE for six weeks improved pain and function and altered foot pressure distribution greater than shoe insole alone in patients with symptomatic flatfoot. CLINICAL REHABILITATION IMPACT: Wearing shoe insole is an easy, but passive, treatment approach for a flatfoot problem. This study provided evidence regarding the added benefit of SFE. It is recommended that rehabilitation practitioners implement a comprehensive treatment protocol including both shoe insole and SFE for at least six weeks to achieve better results for their flatfoot patients.

Normative reference values for Obstacles Test and Curb Test and their correlation with demographic characteristics: a cross-sectional study in Saudi children.

The Obstacles Test and Curb Test have been used to measure gait speed and functional balance in adults. Recently, they have been modified for use in children but the normative values have not been established. This requires correlating the sex, age, height, weight, and BMI% of children with the test results and developing prediction equations. In this cross-sectional study, the Obstacles Test and Curb Test were administered to a convenience sample of 240 typically developing children aged 6-11 years. The factors associated with the time to complete each test were studied and prediction equations were established. The completion times were 5.27 ± 0.81 s for the Obstacles Test and 2.82 ± 0.45 s for the Curb Test. The Obstacles Test showed a fair negative relationship with height (Pearson's r = -0.41, P < 0.001), age ( r = -0.35, P < 0.001), and weight ( r = -0.32, P < 0.05). The Curb Test also had fair negative correlations with height ( r = -0.42, P < 0.001), age ( r = -0.39, P < 0.001), and weight ( r = -0.31, P < 0.001). Both tests showed poor correlations with the sex [eta ( η ) = 0.15 and 0.12, respectively]. Nonetheless, age and sex emerged as the main predictors of both test scores, accounting for 14% and 17% of the total variance in the Obstacles Test and Curb Test times, respectively. Normative values and prediction equations for both tests in typically developing children may be used for individual comparisons and in clinical research for the evaluation of interventions targeting disabled children.

Normative values and factors affecting Pediatric Reach Tests in Saudi children aged 6-11 years in the eastern province: cross-sectional study.

Background: The Pediatric Reach Tests (PRTs) assess balance while standing-the Functional Reach Test (FRT) and Lateral Reach Test (LRT)-and in a sitting position-the Modified Functional Reach Test (MFRT) and Modified Lateral Reach Test (MLRT). Normative values have not been fully evaluated in Saudi children. The objectives are; to estimate the normative values for PRTs; investigate the correlation between the PRTs and demographic/anthropometric characteristics; and develop predictive equations for the PRTs. Methods: In this cross-sectional study, 251 children aged 6-11 were recruited. The PRTs were measured and correlated with demographic/anthropometric variables. A stepwise regression was conducted to develop the predictive equations for the PRT scores. Results: The mean and standard deviations (in cm) of the PRT scores were as follows: FRT = 20.02 ± 4.31; LRT = 13.42 ± 3.38; MFRT = 21.49 ± 4.70, and MLRT = 14.64 ± 3.66. Several significant correlations were found. Moderate correlations existed between the PRT scores and age, height, upper extremity length, lower extremity length, and foot length; there was a weak correlation with body mass index. Weight was moderately correlated with FRT and MFRT and weakly correlated with LRT and MLRT. The correlation between the base of support and LRT was moderate and was weak with FRT, MFRT, and MLRT. A weak correlation was found between sex and LRT. Age and height were the most predictive of PRT scores. Conclusion: This study provided PRT normative values that can be used as a clinical reference for evaluating balance in typically developing children.

Physical therapists' perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic: Preliminary study.

OBJECTIVE: This preliminary study was conducted to explore physical therapists' (PT) perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic. STUDY DESIGN: An exploratory preliminary study using an internet-based survey followed by focus group sessions. METHODS: A programme of sessions was administered by 12 PTs from the Physical Therapy Department at Prince Sultan Military Medical City. An internet-based survey containing 17 statements was completed by the PTs. RESULTS: With regard to telephone-delivered care, four statements related to patients' privacy, programme convenience, safe patients time and money achieved consensus agreement (≥75% agreed or strongly agreed), there was majority agreement (≥50% of respondents agreed or strongly agreed) with seven of the statements regarding the effectiveness, affordability and safety of the programme, but there was no consensus with regard to the remaining five statements. In addition, most of the participants (84.6%) believed that a telephone consultation should cost 25% or 50% less than a face-to-face session. CONCLUSION: Despite the lack of physical contact with patients, the PTs agreed that telerehabilitation would offer patients an easy method of being prescribed a therapeutic programme, save time and money, and maintain patient privacy. Further, the PTs reported barriers and suggested adaptations for this method of service delivery.

Reference values for the Modified Timed Up and Go Test in Saudi children aged 4-12 years old in Riyadh city: cross-sectional study.

PURPOSE: The study aimed to report within-session reliability, estimate the reference values for the Modified Timed Up and Go (mTUG) test in typically developing (TD) Saudi children aged 4-12 years old, develop a reference equation for the estimated mTUG, and compare the measured mTUG in the present study with the predicted mTUG obtained from the previous regression equation. METHODS: In this cross-sectional observational study, anthropometric measurements and mTUG test were investigated in 805 child. The association between the mTUG test and predictive variables was studied. RESULTS: Average mTUG speed was 4.63 ± 0.68 s. Within-session reliability was excellent with intraclass correlation coefficient of 0.90. The test was significantly and negatively correlated with age, height, and weight (r = -0.66, p = .00), (r = -0.54, p = .01), and (r = -0.33, p = .01) respectively. According to the stepwise regression analysis, age and weight were the predictors and explained 47% of total variance of mTUG scores. CONCLUSION: This study provided the mTUG reference values that can be used clinically to evaluate functional mobility and dynamic balance in TD Saudi children aged 4-12 years. The mTUG scores can be predicted as a function of age and weight.KEY MESSAGESModified Timed Up and Go test used to assess the functional mobility and dynamic balance for children with or without developmental abnormalities.Availability of reference values according to age is helpful to compare the performance of children at same ages.

Reference values and regression equations for predicting the 6-minute walk distance in Saudi adults aged 50-80 years: A cross- sectional study.

BACKGROUND: The 6-minute walk test (6-MWT) is commonly used to measure functional capacity in clinical and research settings. The reference equations for predicting the 6-minute walk distance (6-MWD) in different populations have been established; however, there is a lack of information regarding healthy Saudi individuals over 50 years old. OBJECTIVES: This study aimed to establish the reference values of 6-MWD in a sample of healthy Saudi adults aged 50-80 years, develop regression equations for the established 6-MWD, and compare the measured 6-MWD in the present study with the predicted 6-MWD derived from the previously published regression equations. METHODS: In total, 210 healthy Saudi volunteers aged 50-80 years participated in this cross-sectional study. The 6-MWT was performed according to the American Thoracic Society (ATS) guidelines. Lung function, physical activity, blood pressure, heart rate, oxygen saturation, exertion level of leg fatigue, and sensation of dyspnea were measured. RESULTS: The mean 6-MWD was 396.2 ± 69.4 m. It was significantly correlated with age, sex, height, body mass index (BMI), and physical activity. The predictors of 6-MWD were age and BMI for men, while they were age, BMI, and height for women. They accounted for 25% and 35% of the total variance of 6-MWD for men and women, respectively. The measured 6-MWD was significantly shorter than the predicted 6-MWD. CONCLUSION: Saudi populations have significantly shorter 6-MWDs than those reported in other ethnic groups. The sex-specific equations developed in this study are expected to provide a useful measure of 6-MWT for Saudi adults. However, further investigation is required to validate the application of these equations to individuals living in different regions of Saudi Arabia.

Extracorporeal shockwave therapy for the treatment of chronic wound of lower extremity: current perspective and systematic review.

The purpose of this study was to provide an up-to-date review for the accurate estimation of the efficacy of extracorporeal shock wave therapy (ESWT) on the healing of chronic wounds on the lower extremity (CWLE). A systematic review of 10 databases for clinical trials about ESWT in the management of CWLE published between 2000 and 2016 was performed. A total of 11 studies with 925 patients were found. Expert therapists assessed the methodological qualities of the selected studies using the Physiotherapy Evidence Database (PEDro) scale and categorised each study according to Sackett's levels of evidence. Eight studies were categorised as level II; two studies were categorised as level III and one study was categorised as level V. In conclusion, this review demonstrated mild to moderate evidence to support the use of ESWT as an adjuvant therapy with a standardised wound care programme. However, it is difficult to draw firm conclusions about the efficacy of ESWT. So, future researches with high methodological quality are required to assess the efficacy and cost-effectiveness of this relatively new physical therapy application.

Cross-cultural adaptation, reliability, and validity of the Arabic version of neck disability index in patients with neck pain.

STUDY DESIGN: Translation and psychometric testing. OBJECTIVE: To adapt the neck disability index (NDI) cross-culturally to Arabic language and to investigate the reliability and validity of the Arabic version of NDI in an Arabic-speaking sample with neck pain. SUMMARY OF BACKGROUND DATA: Although largely used, no previous reports exist on the translation process or the testing of the psychometric properties of the Arabic version of the NDI. METHODS: Cross-cultural adaptation of an outcome questionnaire. The English version of the NDI was translated into Arabic (NDI-Ar) and back-translated according to established guidelines. Sixty-five patients with neck pain completed the NDI -Ar twice during a 1-week period, to assess its test-retest reliability. Further psychometric testing was done by assessing internal consistency, construct validity (factor structure), and responsiveness. RESULTS: The internal consistency value (Cronbach α) for the NDI-Ar was 0.89. The test-retest reliability (intraclass correlation coefficient) was excellent at 0.96 (95% confidence interval from 0.93 to 0.97). There was a significant correlation (r = 0.92, P < 0.05) between the scores obtained from the first administration of the NDI-Ar and the second administration. Factor analysis demonstrated a 2-factor structure, explaining 67.58% of total variance. The analysis of responsiveness was calculated with an unpaired t test after 1 week of treatment and demonstrating a statically significant difference between stable and improved patients (P < 0.05). The Spearman correlation coefficient (rS = 0.81; P = 0.000) revealed strong relation between the change in score in the NDI-Ar and global rating of change. No ceiling or floor effects were detected in the NDI-Ar. CONCLUSION: The Arabic version of the NDI has a 2-factor 10-item structure and is a reliable, valid, and responsive tool that can be used to assess neck pain in Arabic-speaking patients with neck pain. Therefore, it can be recommended for clinical and research purposes.

A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema.

PURPOSE: The purpose of this study was to review the effect of low-level laser therapy (LLLT) in the management of breast cancer-related lymphedema (BCRL). METHODS: A systematic review of seven databases for clinical trials for LLLT in the management of BCRL published between 1990 and 2011 was performed. RESULTS: A total of eight studies on 230 patients were found. The methodological qualities of the selected studies were assessed with the Physiotherapy Evidence Database scale, and the studies were categorized according to Sackett's levels of evidence. Five studies were graded at evidence level II. Two studies were graded at evidence level III, and the remaining study was graded at evidence level V. CONCLUSIONS: There is moderate to strong evidence for the effectiveness of LLLT for the management of BCRL from five small studies of acceptable methodological quality. A dose of 1-2 J/cm(2) per point applied to several points covering the fibrotic area can reduce limb volume following BCRL. Further well-designed, large-scale studies are required to determine more precisely how effective LLLT may be in BCRL.