Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study.

OBJECTIVES: To investigate the effect of acute isometric contraction of the pelvic floor muscles (PFM) and transversus abdominis muscle (TrAM) on inter-rectus distance (IRD) from resting values in postpartum women with diastasis rectus abdominis (DRA). DESIGN: Cross sectional experimental study. SETTING: Physiotherapy clinic. PARTICIPANTS: Thirty eight postpartum women presenting with DRA of at least two finger widths. METHODS: Two dimensional ultrasound images of IRD were recorded using a linear probe (5 to 10MHz) at rest, during PFM contraction, during TrAM contraction, and during combined PFM and TrAM contraction. IRD data were normally distributed. MAIN OUTCOME MEASURE: Change in IRD. RESULTS: There was a significant increase in IRD during PFM and TrAM contraction compared with IRD at rest. At 2cm above the umbilicus, mean PFM was 26.9 [standard deviation (SD) 8.8] mm vs rest 25.7 (SD 8.5) mm {mean difference 1.2 [95% confidence interval (CI) 0.7 to 1.7] mm}; and mean TrAM was 28.4 (SD 9.0) mm vs rest 25.7 (SD 8.5) mm [mean difference 2.8 (95% CI 1.9 to 3.6) mm]. Similarly, 2cm below the umbilicus, mean PFM was 22 (SD 8.3) mm vs rest 21 (SD 7.9) mm [mean difference 0.9 (95% CI 0.4 to 1.6) mm]; and mean TrAM was 23.3 (SD 8.7) mm vs rest 21 (SD 7.9) mm [mean difference 2.3 (95% CI 1.5 to 3.1) mm]. Combined TrAM and PFM contraction measured 2cm above the umbilicus caused the greatest increase in IRD: mean PFM+TrAM 29.6 (SD 9.4) mm vs rest 25.7 (SD 8.5) mm [mean difference 3.9 (95% CI 2.8 to 5.0) mm]. CONCLUSION: Both PFM and TrAM contraction, and combined PFM and TrAM contraction increased IRD in postpartum women with DRA.

The MOBID-2 pain scale: reliability and responsiveness to pain in patients with dementia.

BACKGROUND: Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale is a staff-administered pain tool for patients with dementia. This study explores MOBID-2's test-retest reliability, measurement error and responsiveness to change. METHODS: Analyses are based upon data from a cluster randomized trial including 352 patients with advanced dementia from 18 Norwegian nursing homes. Test-retest reliability between baseline and week 2 (n = 163), and weeks 2 and 4 (n = 159) was examined in patients not expected to change (controls), using intraclass correlation coefficient (ICC2.1 ), standard error of measurement (SEM) and smallest detectable change (SDC). Responsiveness was examined by testing six priori-formulated hypotheses about the association between change scores on MOBID-2 and other outcome measures. RESULTS: ICCs of the total MOBID-2 scores were 0.81 (0-2 weeks) and 0.85 (2-4 weeks). SEM and SDC were 1.9 and 3.1 (0-2 weeks) and 1.4 and 2.3 (2-4 weeks), respectively. Five out of six hypotheses were confirmed: MOBID-2 discriminated (p < 0.001) between change in patients with and without a stepwise protocol for treatment of pain (SPTP). Moderate association (r = 0.35) was demonstrated with Cohen-Mansfield Agitation Inventory, and no association with Mini-Mental State Examination, Functional Assessment Staging and Activity of Daily Living. Expected associations between change scores of MOBID-2 and Neuropsychiatric Inventory - Nursing Home version were not confirmed. CONCLUSION: The SEM and SDC in connection with the MOBID-2 pain scale indicate that the instrument is responsive to a decrease in pain after a SPTP. Satisfactory test-retest reliability across test periods was demonstrated. Change scores ≥ 3 on total and subscales are clinically relevant and are beyond measurement error.

Fatigue in multiple sclerosis: associations with health-related quality of life and physical performance.

BACKGROUND AND PURPOSE: fatigue is a common, but still one of the least understood symptoms in multiple sclerosis (MS). We aimed to investigate whether fatigue was associated with demographic-, clinical-, health-related quality of life (HRQoL)- and physical performance variables, and whether change in fatigue after treatment was associated with changes in HRQoL and physical performance. METHODS: sixty patients were included for inpatient physiotherapy. Fifty-six patients completed the study and were available for analysis. Fatigue (Fatigue Severity Scale; FSS), HRQoL (Multiple Sclerosis Impact Scale; MSIS-29) and physical performance (walking ability and balance) were assessed at screening, baseline, after treatment and at follow-up after 3 and 6 months. We analysed possible associations between fatigue and other variables at baseline by regression models, and between change in fatigue versus changes in both HRQoL and physical performance variables after physiotherapy by correlation analysis. RESULTS: fatigue at baseline was associated with HRQoL (explained 21.9% of variance), but not with the physical performance tests. Change in fatigue was correlated with change in HRQoL, but not with changes in physical performance. All measures were improved after treatment (P ≤ 0.001). While improvements in fatigue and HRQoL were lost at follow-up, improvements in physical performance tests were maintained for at least 6 months (P ≤ 0.05). CONCLUSIONS: fatigue was associated with HRQoL at baseline. Improvement in fatigue seemed to be related to other factors than improvement in physical performance. A broader strategy including both physical and psychological dimensions seems to be needed to improve fatigue over the long-term.

The influence of warm versus cold climate on the effect of physiotherapy in multiple sclerosis.

OBJECTIVE: To compare the effect of inpatient physiotherapy in a warm versus cold climate in short- and long-term perspectives. METHODS: Sixty multiple sclerosis (MS) patients with gait problems, without heat intolerance, were included in a randomized cross-over study of 4-week inpatient physiotherapy in warm (Spain) and cold (Norway) climate. The primary outcome, 6-min walk test (6MWT), and secondary physical performance and self-reported measures were scored at screening, baseline, after treatment and at 3 and 6 months of follow-up. Treatment effects were analysed by mixed models. RESULTS: After treatment, the mean walking distance had increased by 70 m in Spain and 49 m in Norway (P = 0.060). Improvement in favour of warm climate was demonstrated at 6 months of follow-up, 43 m (Spain) compared to 20 m (Norway) (P = 0.048). The patients reported less exertion after walking (6MWT) in favour of treatment in Spain at all time points (P < 0.05). No significant differences in change were detected for the other physical performance measures. Most self-reported measures showed more improvement after treatment in Spain, but these improvements were not sustained at follow-up. CONCLUSION: The results indicate that MS patients without heat intolerance have additional benefits from physiotherapy in a warm climate.

The interrater reliability of SAPS II and SAPS 3.

PURPOSE: In this study we evaluated and compared the interrater reliability of SAPS II and SAPS 3 in order to measure the consistency of performance among different raters. METHOD: Ten junior doctors working at two general ICUs were trained in the use of SAPS II and SAPS 3 using a 2.5-h training program. After training they scored 24 cases in both systems. Scores were analyzed using intraclass correlation coefficient (ICC) statistics. In order to identify variables with low reliability, subscores were analyzed using the ICC, and single-variables were compared to a template score using weighted kappa statistics. RESULTS: The ICC (95% CI) of the scores was 0.84 (0.74, 0.91) in SAPS II and 0.80 (0.68, 0.89) in SAPS 3, which is considered adequate for both systems. Mean mortality predictions among the raters had a range of 0.12 in SAPS II and 0.19 in SAPS 3. Administrative data including age had high reliability, whereas variables based on diagnostic information had only moderate reliability. Laboratory data had consistently higher reliability than variables based on the interpretation of charts. CONCLUSION: Both SAPS II and SAPS 3 have adequate interrater reliability, but the standardized mortality ratios are still likely to be influenced by the rater's scoring practice.

Measurement properties of the Non-Communicating Adult Pain Checklist (NCAPC): a pain scale for adults with Intellectual and Developmental Disabilities, scored in a clinical setting.

The 18 items' Non-Communicating Adult Pain Checklist (NCAPC) has been developed from the 27 items Non-Communicating Children Pain Checklist to better capture pain behavior of adults with Intellectual and Developmental Disabilities (IDD). As part of the NCAPC's measurement properties, internal consistency, reliability and sensitivity to pain have been evaluated and found satisfactory, using scores based on video-uptakes. The aim of the article therefore was to examine the instrument's discriminative ability and sensitivity to pain of adults at different levels of IDD when scored within a clinical situation as well as through video-uptakes. Participants were 59 adults at different levels of IDD who were observed for pain behavior, before and during dental hygiene treatment (scored directly) and influenza injection (scored from video-uptakes), using the NCAPC. The results suggest that the NCAPC differentiated between pain and non-pain situations, as well as between pain reaction during two different medical procedures expected to cause more or less pain, and it was found sensitive to pain at all levels of IDD. We conclude that the present findings add to previous findings of measurement properties of the NCAPC, and support that it can be scored directly in a clinical setting.

Psychometric properties of a Norwegian version of Multiple Sclerosis Impact Scale (MSIS-29).

OBJECTIVES: To examine psychometric properties of Multiple Sclerosis Impact Scale (MSIS-29) for use in Norwegian patients with multiple sclerosis. METHODS: Translation was performed according to international guidelines. The questionnaire was answered by 64 patients prior to and at a screening session, and re-answered by 59 patients before and after 4 weeks of physiotherapy. RESULTS: Internal consistency (α) was 0.92 for the physical and 0.85 for the psychological subscales. Reliability by intraclass correlation coefficients were 0.86 for the physical and 0.81 for the psychological subscales, smallest detectable change being 18.4 and 21.1, respectively. The physical but not the psychological subscale demonstrated mostly satisfactory associations with other physical measures. Responsiveness by area under the receiver operating characteristics curve was 0.83 and 0.76, respectively. As hypothesized, effect size was larger for the physical (1.01) than for the psychological (0.76) subscale after treatment. CONCLUSIONS: MSIS-29, Norwegian Version demonstrated satisfactory psychometric properties.

Reliability of the Non-Communicating Adult Pain Checklist (NCAPC), assessed by different groups of health workers.

Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. The Non-Communicating Adults Pain Checklist (NCAPC) was recently developed from the Non-Communicating Children's Pain Checklist (NCCPC) and examined in a group of adults with IDD (N=228) and found to hold satisfactory construct validity, internal consistency and sensitivity to pain. To further explore its basis for clinical use, intra and interrater reliability of the NCAPC was investigated. Data collection was done by videotaping the participants before and during influenza vaccination. Intrarater reliability was evaluated by the first author on a group of 50 randomly selected individuals (mean age 42.5, range 19-72) and was found at 0.94. Interrater reliability was investigated in two stages. In the initial step different groups of health care workers (caregivers, nurses, case managers, and therapists), each including five raters, viewed a sample of 12 adult participants with IDD (3 at each level of IDD mean age was 49 years, range 16-72), that were extracted from the population sample. Interrater reliability of all raters within the groups varied from low to very high (ICC(1,1)=0.40-0.88). Interrater reliability was very high in caregivers. The Physical -and Occupational therapists are one group were considered potential users of the measure. In the second stage 3 participants from each of the groups showing high interrater reliability (caregivers and therapist) evaluated interrater reliability in a randomly selected group of 40 individuals (mean age 41.2, range 15-72). Interrarter reliability for the therapists and caregivers was found at 0.91 and 0.92 correspondingly. The researchers conclude that that the NCAPC have been found to hold high reliability values.

The impact of physical function and pain on work status at 1-year follow-up in patients with back pain.

STUDY DESIGN: A randomized, controlled trial. OBJECTIVE: To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. SUMMARY OF BACKGROUND DATA: Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. METHODS: Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). RESULTS: At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. CONCLUSIONS: Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

The Sock Test for evaluating activity limitation in patients with musculoskeletal pain.

BACKGROUND AND PURPOSE: Assessment within rehabilitation often must reflect patients' perceived functional problems and provide information on whether these problems are caused by impairments of the musculoskeletal system. Such capabilities were examined in a new functional test, the Sock Test, simulating the activity of putting on a sock. SUBJECTS AND METHODS: Intertester reliability was examined in 21 patients. Concurrent validity, responsiveness, and predictive validity were examined in a sample of 337 patients and in subgroups of this sample. RESULTS: Intertester reliability was acceptable. Sock Test scores were related to concurrent reports of activity limitation in dressing activities. Scores also reflected questionnaire-derived reports of problems in a broad range of activities of daily living and pain and were responsive to change over time. Increases in age and body mass index increased the likelihood of Sock Test scores indicating activity limitation. Pretest scores were predictive of perceived difficulties in dressing activities after 1 year. CONCLUSION AND DISCUSSION: Sock Test scores reflect perceived activity limitations and restrictions of the musculoskeletal system.

Different approximations of the McGill Pain Questionnaire in the Norwegian language: a discussion of content validity.

The McGill Pain Questionnaire (MPQ) is a well recognized measuring instrument for pain in English-speaking countries. Several efforts have been made to develop equivalent pain-measuring instruments in other languages. However, the method of translating the English words contained in the MPQ into another language implies that questions about validity may be posed. In Norway three different pain questionnaires have been developed which are inspired by the MPQ. A primary focus for developing the Norwegian Pain Questionnaire (NPQ) was the semantics of pain; the focus of the adapted MPQ was to include commonly used somatosensory Norwegian descriptors of pain in the population of patients with low back pain; the Norwegian McGill Pain Questionnaire (NMPQ) was literally translated into Norwegian to provide a equivalent pain questionnaire to the MPQ for cross-cultural comparisons of pain. Examination of content validity of the adapted MPQ and the translated version of the MPQ is examined by comparing the words in those questionnaires with words collected among Norwegians in the process of developing the NPQ. The findings support the content validity of the adapted MPQ. The NMPQ, however, should be further refined to better fit the semantics of pain in Norway.

[Development of a Norwegian pain questionnaire for pain measurement]. / Utvikling av norsk spørreskjema for smertemåling.

This study was undertaken to develop a multidimensional instrument in the Norwegian language to measure pain. The McGill Pain Questionnaire (MPQ) was used as a model, since it is a valid and reliable tool for pain measurement in English speaking countries. A series of steps were taken to develop a Norwegian pain questionnaire: 1) Words descriptive of pain were derived from 95 subjects (patients, students and health personnel). 2) Ten subjects allocated pain words into groups. 3) 36 college students validated the word groupings. 4) 72 patients graded the words contained in each group according to intensity. 5) A test of reliability of group items was performed. The study demonstrated that there are many words in Norwegian to describe pain. The Norwegian pain questionnaire came to contain 106 descriptors of pain placed in 18 groups. We demonstrated the validity of the word groupings and the reliability of group items. The actual value of the Norwegian pain questionnaire as a measuring instrument has not yet been documented.