Towards Consensus on Clinical Assessment of Embouchure in Brass Players: A Delphi Study.

AIMS: The objective of this study was to determine the content validity of an assessment instrument for embouchure (the "CODE of Embouchure") which covers the main aspects of the construct of embouchure in brass players. METHODS: The study design followed the Delphi technique. A select panel of 35 international experts gave their opinion via a three-round digital Delphi survey as to whether the instrument as a whole, and its items, adequately measure the construct of embouchure. Criteria for consensus and whether items should go through to the next Delphi round were pre-determined. Data were independently analyzed by two researchers. The CREDES guidelines were used for conducting and reporting of the study. RESULTS: Consensus was reached over 64% and 73% of the closed questions in the first and third rounds, respectively. A second round was necessary to resolve intra- and inter-expert contradicting information. Finally, 5 items were added to the instrument, 3 items were removed, and 23 items were adjusted. Consensus was reached in 63 items (98%). The final multi-item assessment instrument consists of 4 domains and 64 items. CONCLUSIONS: Content validity of most aspects of the "CODE of embouchure" instrument was established.

Variation in occupational exposure associated with musculoskeletal complaints: a cross-sectional study among professional bassists.

BACKGROUND: Variation in occupational exposure is assumed to have a protective effect against the development of musculoskeletal complaints (MSC), but this common assumption is not strongly supported by the literature. Among musicians, who have a high prevalence of MSC, many play more than one type of instrument (multi-instrumentalism) for many hours a day. Since multi-instrumentalism implies greater variation in ergonomic load of specific musculoskeletal areas than mono-instrumentalism, musicians are a suitable study population to test whether the above assumption is true. PURPOSE: To investigate in a sample of professional bass players whether multi-instrumentalists are less likely to have MSC than mono-instrumentalists. METHODS: Participants were 141 professional and professional student double bassists and bass guitarists. Demographic, MSC and exposure characteristics were collected online with self-constructed and existing questionnaires. Logistic regression analysis was used to test the association between multi- versus mono-instrumentalism and MSC, adjusted for confounders. RESULTS: The prevalence of having MSC in the neck, back, right shoulder area and both wrist areas did not differ significantly between the two groups. Further analysis revealed that the likelihood of having MSC in the left shoulder area was higher in multi-instrumentalists compared to mono-instrumentalists (Odds ratio 0.30, 95% CI 0.119-0.753, p = 0.010). CONCLUSION: In this sample of professional bass players, no protective effect of multi-instrumentalism against MSC was found. Multi-instrumentalism was associated with a higher prevalence of MSC in the left shoulder. This result challenges theoretical and clinical assumptions in occupational and pain medicine.

Reliability of an instrument for screening hand profiles: The Practical Hand Evaluation.

STUDY DESIGN: Psychometric study with 2-week interval. INTRODUCTION: Musculoskeletal hand complaints are common among manual workers. Mismatch between anthropometric hand features and tasks can affect the ability to perform hand activities, with an increased risk of complaints. Although screening of these features may improve diagnosis and treatment, no validated screening tool is available. The Practical Hand Evaluation (PHE) screening tool might fill this gap, but its psychometric properties are unknown. PURPOSE OF THE STUDY: To test the reliability of the PHE and to explore the feasibility of item reduction of the PHE. METHODS: Right-hand profiles of 117 healthy volunteers (66 women, 51 men; mean age, 22.8 years) were independently assessed 4 times by 6 couples of researchers using the PHE, twice on day 1 and twice 2-3 weeks later. Intrarater and inter-rater reliability (intraclass correlations), standard error of measurement (SEM), potential confounding factors (gender, joint hyperlaxity, and measurement order) affecting the instrument's reliability (limits of agreement), and collinearity between the PHE items were determined (variation inflation factor analysis and hierarchical clustering of correlation coefficients). RESULTS: The intrarater and inter-rater reliabilities of the PHE were good for 12 of 14 items (86%; r = 0.67-0.90). Absolute SEM varied between 2.01 and 9.23 mm. The percentage of shifts of at least 2 classes in a repeated measurement was <15%. Cluster analysis identified 6 clusters of hand items. DISCUSSION: The reliability for nearly all PHE items is good. Measurement errors were substantial relative to variances in the reference population, but not to gender, joint laxity and order of administration. Clustering into 6 seperated clusters of items was possible. CONCLUSIONS: The PHE fulfills many of the criteria for screening of anthropometrics of the hand. Its reliability is high. The SEM might be improved with future adaptations toward a digital photographic PHE. Reduction to 6 items seems also possible.

Differences in muscle activity and temporal step parameters between Lokomat guided walking and treadmill walking in post-stroke hemiparetic patients and healthy walkers.

BACKGROUND: The Lokomat is a robotic exoskeleton that can be used to train gait function in hemiparetic stroke. To purposefully employ the Lokomat for training, it is important to understand (1) how Lokomat guided walking affects muscle activity following stroke and how these effects differ between patients and healthy walkers, (2) how abnormalities in the muscle activity of patients are modulated through Lokomat guided gait, and (3) how temporal step characteristics of patients were modulated during Lokomat guided walking. METHODS: Ten hemiparetic stroke patients (>3 months post-stroke) and ten healthy age-matched controls walked on the treadmill and in the Lokomat (guidance force 50%, no bodyweight support) at matched speeds (0.56 m/s). Electromyography was used to record the activity of Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius and Tibialis Anterior, bilaterally in patients and of the dominant leg in healthy walkers. Pressure sensors placed in the footwear were used to determine relative durations of the first double support and the single support phases. RESULTS: Overall, Lokomat guided walking was associated with a general lowering of muscle activity compared to treadmill walking, in patients as well as healthy walkers. The nature of these effects differed between groups for specific muscles, in that reductions in patients were larger if muscles were overly active during treadmill walking (unaffected Biceps Femoris and Gluteus Medius, affected Biceps Femoris and Vastus Lateralis), and smaller if activity was already abnormally low (affected Medial Gastrocnemius). Also, Lokomat guided walking was associated with a decrease in asymmetry in the relative duration of the single support phase. CONCLUSIONS: In stroke patients, Lokomat guided walking results in a general reduction of muscle activity, that affects epochs of overactivity and epochs of reduced activity in a similar fashion. These findings should be taken into account when considering the clinical potential of the Lokomat training environment in stroke, and may inform further developments in the design of robotic gait trainers.

Pain and hospital admissions are important factors associated with quality of life in nonambulatory children.

AIM: This was the first study to investigate the factors associated with health-related quality of life (HRQoL) in nonambulatory children with cerebral palsy (CP), based on a HRQoL measure specifically developed for this population. METHODS: The Dutch version of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD-DV) was used to measure HRQoL. It was completed by 66 parents of 47 boys and 19 girls with nonambulatory CP aged between five and 18 years with gross motor function classification system (GMFCS) levels of IV and V. Factors measured were the child's motor and cognitive impairments, comorbidities, pain, parents' education and occupations and family structure. Multiple linear regression analyses were used to determine the significant factors and the relative contribution of these factors to the CPCHILD-DV scores. RESULTS: The most important factors associated with poorer HRQoL scores were pain and hospital admissions in the previous six months. Other factors were as follows: increased GMFCS level, feeding by gastrostomy tube, inability to communicate verbally, cognitive impairment, poor seizure control and higher parents' educational qualifications. CONCLUSION: Pain and hospital admissions were the most important factors that were negatively associated with HRQoL in nonambulatory children with CP between five to 18 years.

Fundamentals of Embouchure in Brass Players: Towards a Definition and Clinical Assessment.

Brass players may experience problems producing an optimal sound (or range of sounds) in their instrument. Assessing and treating dysfunctional embouchure requires knowledge of functional embouchure, but peer-reviewed literature on dysfunctional and functional embouchure is scarce. OBJECTIVE: This study aimed to provide a narrative overview of embouchure based on information from different scientific and clinical fields. This should be regarded as a first step in constructing a reliable, valid, and practical multi-item method to assess embouchure for brass players. METHODS: Literature reviews were conducted concerning: 1) the definition of embouchure, 2) physics and acoustics of embouchure, 3) functioning of embouchure-related structures, and 4) instruments to assess embouchure. Also, embouchure experts (clinicians, scientists, and elite wind players) were consulted for information and discussion. RESULTS: A proposal for a new definition of embouchure, an overview of the relevant physics and acoustics, functions of embouchure-related body structures, and the main methods to measure embouchure in brass playing are presented. CONCLUSION: Peer-reviewed information about the fundamentals of dysfunctional embouchure is scarce and sometimes contradictory. A new definition for embouchure is proposed: embouchure is the process needed to adjust the amount, pressure, and direction of the air flow (generated by the breath support) as it travels through the mouth cavity and between the lips, by the position and/or movements of the tongue, teeth, jaws, cheeks, and lips, to produce a tone in a wind instrument. An integrative overview is presented which can serve as a transparent foundation for the present understanding of functional and dysfunctional embouchure and for developing an evidence-based multi-item assessment instrument.

Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT.

PURPOSE: TREATMENT of patients with chronic low back pain (CLBP) aims to reduce disability, improve functional capacity, and participation. Time contingent prescription of analgesics is a treatment modality in CLBP. The impact of analgesics on functional capacity is unknown. Aim of the study was to explore the effect of analgesics on functioning measured by functional capacity evaluation, and self-reported disability in patients with CLBP. METHODS: Explorative Randomized Placebo-Controlled Clinical Trial was performed in an outpatient pain rehabilitation setting on patients waiting for rehabilitation. Included patients had low back pain lasting >3 months, visual analogue scale worst pain ≥4.0 cm, and age >18 years. Outcome measures before (T0) and after treatment (T1): functional capacity, pain intensity, Roland Morris Disability Questionnaire. T1: global perceived pain relief. Patient characteristics and psychological questionnaires were assessed. Fifty patients were included in this study and were randomly assigned to 2 weeks treatment or placebo. TREATMENT: acetaminophen/tramadol 325 mg/37.5 mg per capsule. Dose: maximum acetaminophen 1,950 mg and tramadol 225 mg per day; treatment and placebo titrated identically. Compliance and side-effects were monitored. TREATMENT effects between groups over time were compared. RESULTS: One patient (treatment group) was lost to follow-up. Forty-nine patients remained in the study. TREATMENT effects in primary outcomes did not differ significantly between groups. A subgroup of 10 (42%) patients (treatment group) reported global pain relief (responders) who reduced self-reported disability (p < 0.05). Responders had significantly lower catastrophizing scores. CONCLUSION: Overall treatment effects were small and non-significant. A subgroup, however, reported improved functioning as a result of treatment. Responders had lower catastrophizing scores.

Life satisfaction in patients with chronic musculoskeletal pain and its predictors.

PURPOSE: To determine the life satisfaction of patients with chronic non-malignant musculoskeletal pain (CMP) compared to the general population (GP) and to identify predictors of life satisfaction. METHODS: Subjects were patients with CMP (n = 1,082) admitted to multidisciplinary rehabilitation and a general population sample (n = 506). Lisat-9 measures satisfaction with life as a whole and eight life domains. Physical, emotional and social functioning and pain intensity were assessed using the SF-36. Ordinal logistic regression was used to analyse differences between patients with CMP and the GP, and predictors of life satisfaction in patients with CMP. RESULTS: Compared to the general population, patients with CMP reported lower satisfaction with 'life as a whole', and with six life domains: self-care, leisure, vocational and financial situation, sex life and contacts with friends. In the CMP group, pain was associated with satisfaction with self-care, vocational situation, partnership, family life and contacts with friends. Marital status, age and mental health were associated with most satisfaction scores. CONCLUSIONS: Compared to the general population, patients with CMP reported lower satisfaction with 'life as a whole' and most life domains. The most consistent predictors of life satisfaction were marital status, mental health, vitality and pain.

Relation between muscle activation pattern and pain: an explorative study in a bassists population.

OBJECTIVE: To explore the muscle activation patterns in relation to pain complaints in bassists studied during a musical task. This study was based on the assumption that pain complaints are caused by increased muscle activation during playing or relaxation and/or faster onset of fatigue of muscles. DESIGN: Cross-sectional study. SETTING: Nonclinical. PARTICIPANTS: Student bass guitarists (N=36) from conservatories in the Netherlands. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Bassists played a standard music piece for 30 minutes. Muscle activation levels and pain were recorded. Pain was registered with a Numeric Rating Scale (NRS 0-10). The muscle activation level of both the trapezius muscles and flexor carpi radialis was measured with sEMG: sEMG as the percentage of the maximal voluntary isometric contraction (%MVC) and the slope of the sEMG (slope of %MVC) were calculated. The %MVC as a function of time and the slope of %MVC were calculated during playing and for rest periods before and after playing. For statistic analysis, the Mann-Whitney U test and a multilevel multiregression analysis were used for comparing the sEMG data of bassists with and without pain. RESULTS: No significant differences in %MVC or the slope of %MVC were between the bassists with and without pain complaints. CONCLUSIONS: The results surprisingly indicate that pain complaints of bassists may not be associated with another muscle activation pattern. It is, therefore, not likely that pain is caused by increased muscle activation during playing and/or relaxation, nor by faster onset of fatigue.

A systematic evaluation of the effect of thumb opponens splints on hand function in children with unilateral spastic cerebral palsy.

OBJECTIVE: To examine the effects of a neoprene thumb opponens splint on hand function during a self-selected activities of daily living task in children with unilateral spastic cerebral palsy with thumb-in-palm position of the affected hand. DESIGN: Systematic evaluation of seven cases using a multiple baseline design across individuals. SETTING: Outpatient clinic. SUBJECTS: Seven children with unilateral cerebral palsy (2-7 years old), Manual Ability Classification System level 2-3 participated in the study. INTERVENTIONS: Neoprene thumb opponens splints (McKie splint) were used. Children were followed for about four months. Baseline period ranged from 4 to 9 weeks, intervention period was two months and duration of follow-up one month. MAIN MEASURES: Hand function was assessed using goal attainment scaling and visual analogue scales. Data was assessed visually. RESULTS: In four children goal attainment scaling and/or visual analogue scale scores increased after introducing the splint. These effects remained when splints were not worn. Two children only benefited from the splint when it was worn. Thumb opponens splints were tolerated well by all children who participated in this study. CONCLUSIONS: Thumb opponens splints may have a positive effect on hand function in children with unilateral spastic cerebral palsy.

Assessing the treatment effects in apraxia of speech: introduction and evaluation of the Modified Diadochokinesis Test.

BACKGROUND: The number of reliable and valid instruments to measure the effects of therapy in apraxia of speech (AoS) is limited. AIMS: To evaluate the newly developed Modified Diadochokinesis Test (MDT), which is a task to assess the effects of rate and rhythm therapies for AoS in a multiple baseline across behaviours design. METHODS: The consistency, accuracy and fluency of speech of 24 adults with AoS and 12 unaffected speakers matched for age, gender and educational level were assessed using the MDT. The reliability and validity of the instrument were considered and outcomes compared with those obtained with existing tests. RESULTS: The results revealed that MDT had a strong internal consistency. Scores were influenced by syllable structure complexity, while distinctive features of articulation had no measurable effect. The test-retest and intra- and inter-rater reliabilities were shown to be adequate, and the discriminant validity was good. For convergent validity different outcomes were found: apart from one correlation, the scores on tests assessing functional communication and AoS correlated significantly with the MDT outcome measures. The spontaneous speech phonology measure of the Aachen Aphasia Test (AAT) correlated significantly with the MDT outcome measures, but no correlations were found for the repetition subtest and the spontaneous speech articulation/prosody measure of the AAT. CONCLUSIONS & IMPLICATIONS: The study shows that the MDT has adequate psychometric properties, implying that it can be used to measure changes in speech motor control during treatment for apraxia of speech. The results demonstrate the validity and utility of the instrument as a supplement to speech tasks in assessing speech improvement aimed at the level of planning and programming of speech.

Effects of asymmetrical support on lower limb muscle activity during Lokomat guided gait in persons with a chronic stroke: an explorative study.

BACKGROUND: The Lokomat, one of the most popular robotic exoskeletons, can take the asymmetry in the gait pattern of unilaterally affected patients into account with its opportunity to provide unequal levels of movement support (or 'guidance') to each of the legs. This asymmetrical guidance may be used to selectively unburden limbs with impaired voluntary control and/or to exploit the interlimb couplings for training purposes. However, there is a need to explore and understand these specific device opportunities more broadly before implementing them in training. AIM: The aim of this study was to explore the effects of (a)symmetrical guidance settings on lower limb muscle activity in persons with post stroke hemiparesis, during Lokomat guided gait. DESIGN: A single group, dependent factorial design. SETTING: Rehabilitation center; a single session of Lokomat guided walking. POPULATION: A group of ten persons with post stroke hemiparesis. METHODS: Participants walked in the Lokomat in eight conditions, consisting of symmetrical and asymmetrical guidance situations, at both 0.28 m/s and 0.56 m/s. During symmetrical conditions, both legs received 30% or 100% guidance, while during asymmetrical conditions one leg received 30% and the other leg 100% guidance. Surface electromyography was bilaterally measured from: Biceps Femoris, Rectus Femoris, Vastus Medialis, Medial Gastrocnemius and Tibialis Anterior. Statistical effects were assessed using Statistical Parametric Mapping. RESULTS: The provision of assymetrical guidance did not affect the level of lower limb muscle activity. In addition, no effect (except for Vastus Medialis in the affected leg during 1.5-2.4% of the gait cycle) of symmetrical guidance on muscle amplitude could be observed. CONCLUSIONS: The results show no evidence that either symmetrical or asymmetrical guidance settings provided by the Lokomat can be used to manipulate activity of lower limb musculature in persons with post stroke hemiparesis. CLINICAL REHABILITATION IMPACT: This study provides insights for the use of specific opportunities provided by the Lokomat for training purposes post stroke.

Quality and usability of clinical assessments of static standing and sitting posture: A systematic review.

BACKGROUND: A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no systematic overview of assessment methods, their clinimetric properties, and usability is available. OBJECTIVE: The objective of this study was to provide such an overview and to interpret the results for clinical practice. METHODS: A systematic literature review was performed according to international guidelines. Two independent reviewers assessed risk of bias, clinimetric values of the assessment methods, and their usability. Quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE). RESULTS: Out of 27,680 records, 41 eligible studies were included. Thirty-two assessment instruments were identified, clustered into five categories. The methodological quality of 27 (66%) of the articles was moderate to good. Reliability was most frequently studied. Little information was found about validity and none about responsiveness. CONCLUSIONS: Based on a moderate level of evidence, a tentative recommendation can be made to use a direct visual observation method with global posture recorded by a trained observer applying a rating scale.

Long-term follow-up of patients with chronic musculoskeletal pain attending interdisciplinary pain rehabilitation: outcomes and predictive factors.

The long-term outcomes of interdisciplinary pain rehabilitation (IPR) in patients with chronic musculoskeletal pain (CMP) and its predictors has been studied to a limited extent. In this historical cohort study, functioning, satisfaction with life domains, and pain were assessed at baseline, discharge, and at 6-15 years follow-up. At follow-up, most patients (77%) rated the effects of the IPR as temporarily or persistently positive. The gains in functioning, satisfaction with life domains, and pain made during IPR remained for 6-15 years after the IPR. Patients who were single, retired, or not in work, and those having higher pain and lower functioning at baseline, had lower functioning at follow-up, while patients with traumatic pain disorders had higher functioning at follow-up. Gains made during IPR, particularly gains in social and mental functioning and in pain predicted functioning at follow-up. Treatments and events between discharge and follow-up also influenced the long-term outcome. In conclusion, on average, outcomes achieved during IPR persisted at long-term follow-up. Predictors of a better long-term outcome were mainly baseline characteristics.

Lokomat guided gait in hemiparetic stroke patients: the effects of training parameters on muscle activity and temporal symmetry.

Purpose: The Lokomat is a commercially available robotic gait trainer, applied for gait rehabilitation in post-stroke hemiparetic patients. Selective and well-dosed clinical use of the Lokomat training parameters, i.e. guidance, speed and bodyweight support, requires a good understanding of how these parameters affect the neuromuscular control of post-stroke hemiparetic gait.Materials and methods: Ten stroke patients (unilateral paresis, 7 females, 64.5 ± 6.4 years, >3months post-stroke, FAC scores 2-4)) walked in the Lokomat under varying parameter settings: 50% or 100% guidance, 0.28 or 0.56m/s, 0% or 50% bodyweight support. Electromyography was recorded bilaterally from Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius, and Tibialis Anterior. Pressure sensors placed under the feet were used to determine the level of temporal gait symmetry.Results: Varying guidance and bodyweight support had little effect on muscle activity, but increasing treadmill speed led to increased activity in both the affected (Biceps Femoris, Medial Gastrocnemius, Tibialis Anterior) and unaffected leg (all muscles). The level of temporal symmetry was unaffected by the parameter settings.Conclusions: The Lokomat training parameters are generally ineffective in shaping short term muscle activity and step symmetry patients with hemiparetic stroke, as speed is the only parameter that significantly affects muscular amplitude.Trial Registration: d.n.a.IMPLICATIONS FOR REHABILITATIONThe Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients.This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking.Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters.Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training.

Amplitude and stride-to-stride variability of muscle activity during Lokomat guided walking and treadmill walking in children with cerebral palsy.

BACKGROUND: The Lokomat is a commercially available exoskeleton for gait training in persons with cerebral palsy (CP). Because active contributions and variability over movement repetitions are determinants of training effectiveness, we studied muscle activity in children with CP, and determined (i) differences between treadmill and Lokomat walking, and (ii) the effects of Lokomat training parameters, on the amplitude and the stride-to-stride variability. METHODS: Ten children with CP (age 13.2 ± 2.9, GMFCS level II(n = 6)/III(n = 4)) walked on a treadmill (±1 km/h; 0% bodyweight support(BWS)), and in the Lokomat (50% and 100% guidance; ±1 km/h and ±2 km/h; 0% and 50% BWS). Activity was recorded from Gluteus Medius (GM), Vastus Lateralis (VL), Biceps Femoris (BF), Medial Gastrocnemius (MG) and Tibialis Anterior (TA) of the most affected side. The averaged amplitude per gait phase, and the second order coefficient of variation was used to determine the active contribution and stride-to-stride variability, respectively. RESULTS: Generally, the amplitude of activity was lower in the Lokomat than on the treadmill. During Lokomat walking, providing guidance and BWS resulted in slightly lower amplitudes whereas increased speed was associated with higher amplitudes. No significant differences in stride-to-stride variability were observed between Lokomat and treadmill walking, and in the Lokomat only speed (MG) and guidance (BF) affected variability. CONCLUSIONS: Lokomat walking reduces muscle activity in children with CP, whereas altering guidance or BWS generally does not affect amplitude. This urges additional measures to encourage active patient contributions, e.g. by increasing speed or through instruction.

Needs, problems and rehabilitation goals of young children with cerebral palsy as formulated in the rehabilitation activities profile for children.

OBJECTIVE: To describe the content of needs, problems and goals of 41 Dutch children with cerebral palsy using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a classification system. To evaluate the adherence of formulations of needs, problems and goals to specifications of the Rehabilitation Activities Profile for Children. METHODS: Raw text data were extracted and organized. Two raters independently weighed the entries' quality against the specifications and linked the extracted content to ICF-CY categories. RESULTS: In 12% of the reports no needs, and in 24% no principal goals, were formulated. Needs mostly pertained to the activities-and-participation domain (65%), whereas problems and goals covered all 3 ICF-CY domains. None of the needs were prioritized and 79% met the quality criterion of description of a problem/desire. Twenty-four percent of the problems were described in the activity-and-participation domain and 83% referred to a treatable problem. Fifty-six percent of the goals were formulated in terms of intended result/effect and 63% as child/parent actions. CONCLUSION: Insight is provided into the content of rehabilitation programmes for children with cerebral palsy. To optimize the quality of the reports, research on reasons for non-adherence to specifications of the Rehabilitation Activities Profile is needed.

Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain.

To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional design was used. A general rehabilitation centre and a university rehabilitation centre was the setting for the study. The study population consisted of patients over 18 years of age, suffering from chronic musculoskeletal pain; 52 patients in the reliability study, 344 patients in the validity study. Main outcome measures were as follows. Reliability study: Spearman's correlation coefficients (rho values) of the test and retest data of the VAS for disability; validity study: rho values of the VAS disability scores with the scores on four domains of the Short-Form Health Survey (SF-36) and VAS pain scores, and with Roland-Morris Disability Questionnaire scores in chronic low back pain patients. Results were as follows: in the reliability study rho values varied from 0.60 to 0.77; and in the validity study rho values of VAS disability scores with SF-36 domain scores varied from 0.16 to 0.51, with Roland-Morris Disability Questionnaire scores from 0.38 to 0.43 and with VAS pain scores from 0.76 to 0.84. The conclusion of the study was that the reliability of the VAS for disability is moderate to good. Because of a weak correlation with other disability instruments and a strong correlation with the VAS for pain, however, its validity is questionable.

Reliability of the Life Satisfaction Questionnaire to assess patients with chronic musculoskeletal pain.

The aim of this study was to determine the reliability of the Life Satisfaction Questionnaire, Dutch version (LSQ-DV), to assess chronic pain patients. The study was designed as test-retest. The setting was the general rehabilitation centre. There were 51 patients over 18 years of age, suffering from chronic nonmalignant musculoskeletal pain. The main outcome measures were weighted kappa of test and retest data on the nine questions of the LSQ-DV, and Spearman correlation coefficient (rho) of the test and retest data on the mean LSQ score. The results were as follows: weighted kappa varied from 0.34 to 0.82: eight of the nine weighted kappa values were moderate to almost perfect whereas one ('family life') was low. The rho value of the mean score was 0.74. The conclusion was that the reliability of the LSQ-DV in patients with chronic nonmalignant pain treated in a rehabilitation setting proved moderate to good for most domains, though low for the 'family life' domain. We recommend using the LSQ-DV in clinical practice and research, although the 'family life' score has to be interpreted with caution.

Test-retest and inter- and intrareliability of the quality of the upper-extremity skills test in preschool-age children with cerebral palsy.

OBJECTIVE: To investigate the test-retest, inter-, and intraobserver reliability of the Quality of Upper Extremity Skills Test (QUEST) in young children with cerebral palsy (CP). DESIGN: For test-retest reliability, a test-retest design was used; for the intra- and interobserver reliability, the videotaped test was scored on 2 occasions by 1 observer and by various observers. SETTING: Groups of preschool-age children in 2 general rehabilitation centers. PARTICIPANTS: Twenty-one children with CP (12 boys, 9 girls) aged 2 to 4.5 years (mean, 39 mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Spearman correlation coefficient. RESULTS: The data indicated that test-retest reliability was strong (rho range, .85-.94). Intraobserver agreement (rho range, .63-.95) and agreement between various observers (rho range, .72-.90) were moderate to strong. CONCLUSIONS: Test-retest and inter- and intraobserver reliability of the QUEST in preschool-age children with CP is good.