Is more always better? Effectiveness of constraint-induced movement therapy in children with high-risk or unilateral cerebral palsy (0-6 years): Systematic review and meta-analysis.

BACKGROUND: While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis. METHODS: This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration's tool. RESULTS: Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents' perception of how effectively children use their affected upper limb. CONCLUSIONS: Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent's perception.

Relationship between Female Sexual Dysfunction and Trunk Stability Post-Stroke: A Cross-Sectional Study.

Background and Objectives: Stroke can lead to a variety of consequences, the severity and nature of which are contingent upon the affected brain region or lesion type. These consequences manifest with distinct clinical presentations and recovery trajectories. This study aims to investigate the potential correlation between feminine sexual dysfunction and trunk stability among stroke survivors. Materials and Methods: Thirty-eight women (stroke group n = 19 and control group n = 19) were recruited. A cross-sectional observational study was designed. Outcome measures were recorded using the Feminine Sexual Function Index, the National Institute of Health Stroke Score, the Newcastle Stroke-specific Quality of Life Measure Beck Depression Index, the Barthel Index, the Urge-urinary Distress Inventory, and the Trunk Impairment Scale. Spearman's correlation was tested between different factors influencing feminine sexual dysfunction and trunk stability. Results: Statistically significant differences were found in sexual function between the stroke group versus the control group (Z = 88; p = 0.007; rb = 0.51). The correlation showed a relationship between feminine sexual dysfunction and trunk stability (p < 0.05). A relationship between quality of life and sexual dysfunction was also found (p < 0.05). There were no statistically significant results for the association between dependency, severity of stroke, time after stroke type of stroke, and sexual dysfunction (p = 0.378). Conclusions: The results of this study support the existence of a correlation between feminine sexual dysfunction and trunk stability, probably due to trunk and pelvic floor muscle synergy. Multidisciplinary teams assessing sexual dysfunction after stroke should include a physical therapist to assess the physical components that may interfere with feminine sexual health post-stroke.

Effectiveness of motor imagery in complex regional pain syndrome: A systematic review with meta-analysis.

OBJECTIVE: The purpose of this study was to determine the effects of motor imagery (MI) on pain intensity and disability in individuals with complex regional pain syndrome (CRPS). METHODS: A systematic search was conducted in various electronic databases to identify all relevant studies: PubMed, CINAHL, WOS, PEDro, CENTRAL, and Scopus. Randomized controlled trials assessing the effects of MI in individuals with CRPS were included. The risk of bias was assessed with the Cochrane Risk of Bias tool, the methodological quality was evaluated using PEDro scale, and the level of evidence was reported according to the GRADE. Between-groups standardized mean differences (SMD) were calculated. RESULTS: Six studies were included. The meta-analysis found moderate-quality evidence that MI improves pain intensity and related disability as immediate (pain: SMD -1.07, 95% CI: -1.53 to -0.60; disability: SMD 1.05, 95% CI: 0.59 to 1.51), short-term (pain: SMD -1.28, 95% CI: -2.14 to -0.42; disability: SMD 1.37; 95% CI: 0.16 to 2.58), and long-term effects (pain: SMD -1.18; 95% CI: -1.89 to -0.46; disability: SMD 1.18; 95% CI: 0.46 to 1.89), as compared with a comparison group. The risk of bias of the trials was relatively low, but the imprecision of the results downgraded the level of evidence. CONCLUSIONS: Moderate-quality evidence suggests a positive effect of MI for improving pain intensity and disability immediately after and at short-term in individuals with CRPS.

Test-Retest Reliability and Criterion Validity of the Spanish Version of Two Motor Imagery Questionnaires in People With Parkinson Disease.

BACKGROUND AND PURPOSE: The Kinesthetic and Visual Imagery Questionnaire (KVIQ) and the Movement Imagery Questionnaire-Revised Second Version (MIQ-RS) are measurement instruments that assess motor imagery vividness. The aim of this study was to examine the validity and reliability of the Spanish KVIQ and MIQ-RS in people with Parkinson disease (PD). METHODS: A longitudinal descriptive study was conducted following the COSMIN standards. Thirty-five people with idiopathic PD were evaluated twice (7-15 days apart) with the Spanish KVIQ and MIQ-RS. Structural validity, internal consistency, test-retest reliability (ICC), standard error of measurement (SEM), smallest detectable change (SDC), and criterion validity of the MIQ-RS and KVIQ long (KVIQ-20), short (KVIQ-10), and extended (KVIQ-34) versions and their subscales (if pertinent) were tested. RESULTS: Factor analysis was satisfactory for the MIQ-RS, KVIQ-20, and KVIQ-10, providing evidence of their 2-dimensional structure. Evidence of the structural validity of the KVIQ-34 was not confirmed and thus was analyzed as an overall score. Revelle's ω > 0.9 showed excellent internal consistency. Test-retest reliability was moderate (ICC = 0.58-0.75) and higher for all visual subscales. SEM and SDC were up to 14.39% and 39.89% of the scores, respectively. Criterion validity between questionnaires and subscales was strong (Spearman's r > 0.7). DISCUSSION AND CONCLUSIONS: The results provide evidence for the validity and reliability of the Spanish MIQ-RS, KVIQ-20, and KVIQ-10 to assess motor imagery vividness in people with PD, whereas the KVIQ-34 should only be interpreted as an overall score. Psychometric, procedural, and practical features of the questionnaires should be considered when applying into clinical practice.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A401).

Dry Needling Versus Trigger Point Injection for Neck Pain Symptoms Associated with Myofascial Trigger Points: A Systematic Review and Meta-Analysis.

OBJECTIVE: To examine the effects of dry needling against trigger point (TrP) injections (wet needling) applied to TrPs associated with neck pain. METHODS: Electronic databases were searched for randomized clinical trials in which dry needling was compared with TrP injections (wet needling) applied to neck muscles and in which outcomes on pain or pain-related disability were collected. Secondary outcomes consisted of pressure pain thresholds, cervical mobility, and psychological factors. The Cochrane Risk of Bias tool, the Physiotherapy Evidence Database score, and the Grading of Recommendations Assessment, Development, and Evaluation approach were used. RESULTS: Six trials were included. TrP injection reduced pain intensity (mean difference [MD ] -2.13, 95% confidence interval [CI] -3.22 to -1.03) with a large effect size (standardized mean difference [SMD] -1.46, 95% CI -2.27 to -0.65) as compared with dry needling. No differences between TrP injection and dry needling were found for pain-related disability (MD 0.9, 95% CI -3.09 to 4.89), pressure pain thresholds (MD 25.78 kPa, 95% CI -6.43 to 57.99 kPa), cervical lateral-flexion (MD 2.02°, 95% CI -0.19° to 4.24°), or depression (SMD -0.22, 95% CI -0.85 to 0.41). The risk of bias was low, but the heterogenicity and imprecision of results downgraded the evidence level. CONCLUSION: Low evidence suggests a superior effect of TrP injection (wet needling) for decreasing pain of cervical muscle TrPs in the short term as compared with dry needling. No significant effects on other outcomes (very low-quality evidence) were observed. LEVEL OF EVIDENCE: Therapy, level 1a.

Validity and reliability of Spanish PROMIS pediatric pain interference short form.

BACKGROUND: The goal of this study was to analyze psychometric properties of the Spanish PROMIS Pediatric Pain Interference short form (PROMIS-PPI) in a sample of Spanish children and adolescents. METHODS: In a hospital pediatric sample it was studied the structure scale (exploratory and confirmatory analysis), construct validity, convergent validity, and reliability (internal consistency). FINDINGS: 163 children and adolescents (mean age 13.3 years; SD 2.01; 39.26% female) with and without chronic pain completed measures pertaining to their pain experience. Psychometric analysis showed the PROMIS-PPI Spanish version maintains the original one-factor model of the scale, excellent internal consistency (Cronbach's α coefficient 0.90 (95% CI 0.88-0.92)), and convergent validity (showed a positive, significant, and moderate magnitude correlation [r from 0.330 to 0.604] with pediatric quality of life, child and parent pain intensity, and showed a low correlation with the number of medical consultations in the last year). DISCUSSION: The Spanish PROMIS-PPI scale is a valid and reliable tool. It is recommended for research and clinical care in pediatric populations. APPLICATION TO PRACTICE: The results provide evidence that the Spanish version of PROMIS-PPI is valid and reliable tool. Health professionals who work with children in risk to develop persistent pain, will have access to short tool with highest evidence, for assess pain interference.

Active Muscle Trigger Points Are Associated with Pain and Related Disability in Patients with Plantar Heel Pain: A Case-Control Study.

OBJECTIVE: Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability. METHODS: A case-control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject's condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0-10), the Foot Function Index, and the Foot Health Status Questionnaire. RESULTS: The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (-0.447 < rs < -0.35456, P < 0.05). CONCLUSIONS: The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.

Effects of Adding Motor Imagery to Early Physical Therapy in Patients with Knee Osteoarthritis who Had Received Total Knee Arthroplasty: A Randomized Clinical Trial.

OBJECTIVE: To investigate the effects of the inclusion of motor imagery (MI) principles into early physical therapy on pain, disability, pressure pain thresholds (PPTs), and range of motion in the early postsurgical phase after total knee arthroplasty (TKA). METHODS: A randomized clinical trial including patients with knee osteoarthritis who have received TKA was conducted. Participants were randomized to receive five treatment sessions of either physical therapy with or without MI principles in an early postsurgical phase after a TKA (five days after surgery). Pain intensity (visual analog scale [VAS], 0-100), pain-related disability (short-form Western Ontario McMaster Universities Osteoarthritis Index [WOMAC], 0-32), pressure pain thresholds (PPTs), and knee range of motion were assessed before and after five daily treatment sessions by an assessor blinded to the subject's condition. RESULTS: Twenty-four participants completed data collection and treatment. The adjusted analysis revealed significant group*time interactions for WOMAC (F = 17.29, P = 0.001, η2 = 0.48) and VAS (F = 14.56, P < 0.001, η2 = 0.45); patients receiving physiotherapy and MI principles experienced greater improvements in pain (Δ -28.0, 95% confidence interval [CI] = -43.0 to -13.0) and pain-related disability (Δ -6.0, 95% CI = -8.3 to -3.7) than those receiving physiotherapy alone. No significant group*time interactions for knee range of motion and PPTs were observed (all, P > 0.30). CONCLUSIONS: The application of MI to early physiotherapy was effective for improving pain and disability, but not range of motion or pressure pain sensitivity, in the early postsurgical phase after TKA in people with knee osteoarthritis.

Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial.

OBJECTIVE: This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs). METHODS: Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico-mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor. RESULTS: The adjusted analyses showed better outcomes (all, P < 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (η 2 P = 0.153), tinnitus severity (η 2 P = 0.233), THI (η 2 P = 0.501), CF-PDI (η 2 P = 0.395), BDI-II (η 2 P = 0.194), PPTs (0.363 < η 2 P < 0.415), and range of motion (η 2 P = 0.350), but similar changes for the SF-12 (P = 0.622, η 2 P = 0.01) as the exercise/education alone group. CONCLUSIONS: This clinical trial found that application of cervico-mandibular manual therapies in combination with exercise and education resulted in better outcomes than application of exercise/education alone in individuals with tinnitus attributed to TMD.

Impact of social and occupational factors over job control.

BACKGROUND: Psychosocial risk factors, among which job control has proved to be a key dimension, can have a negative impact on the health of workers. Various research projects have found a relationship between low levels of free time at work and stress and job satisfaction indicators. OBJECTIVES: to assess to what extent certain social and employment variables influence "job control". METHODS: A descriptive study was carried out on a sample of workers to analyse the influence of certain socio-demographic and work-related variables on job control, by means of an assessment survey on psychosocial risk and the general state of workers' health. The tools used in this study were the COPSOQ-ISTAS 21 version 1.5 psychosocial risk assessment questionnaire and a specific survey on the perceived state of health. RESULTS: Three hundred fourteen workers were asked to participate in the study. One hundred and ninety workers completed the questionnaire and were finally included. For the "job control" variable, 47.4% of workers described their situation as good. The results show that workers with a higher educational level (+78%), who have seniority in the job, have a good understanding of their situation at work (+15%), and are employed as white collars (34%), are more likely to show high job control and, therefore, could be less at risk from psychosocial factors. CONCLUSIONS: There are two parameters influencing "job control": social factors concerning educational level, and work situation factors, including seniority and being a white collar worker.

Ultrasound Evaluation of the Abdominal Wall and Lumbar Multifidus Muscles in Participants Who Practice Pilates: A 1-year Follow-up Case Series.

OBJECTIVE: The purpose of this study was to describe ultrasound (US) changes in muscle thickness produced during automatic activation of the transversus abdominis (TrAb), internal oblique (IO), external oblique (EO), and rectus abdominis (RA), as well as the cross-sectional area (CSA) of the lumbar multifidus (LM), after 1 year of Pilates practice. METHODS: A 1-year follow-up case series study with a convenience sample of 17 participants was performed. Indeed, TrAb, IO, EO, and RA thickness, as well as LM CSA changes during automatic tests were measured by US scanning before and after 1 year of Pilates practice twice per week. Furthermore, quality of life changes using the 36-Item Short Form Health Survey and US measurement comparisons of participants who practiced exercises other than Pilates were described. RESULTS: Statistically significant changes were observed for the RA muscle thickness reduction during the active straight leg raise test (P = .007). Participants who practiced other exercises presented a larger LM CSA and IO thickness, which was statistically significant (P < .05). Statistically significant changes were not observed for the domains of the analyzed 36-Item Short Form Health Survey (P > .05). A direct moderate correlation was observed (r = 0.562, P = .019) between the TrAb thickness before and after a 1-year follow-up. CONCLUSIONS: Long-term Pilates practice may reduce the RA thickness automatic activation during active straight leg raise. Furthermore, LM CSA and IO thickness increases were observed in participants who practice other exercise types in conjunction with Pilates. Despite a moderate positive correlation observed for TrAb thickness, the quality of life did not seem to be modified after long-term Pilates practice.

A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study.

[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol's feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.

Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand.

[Purpose] To examine the intrasession and intersession reliability and the absolute reliability of three functional dynamic tests-forward-lunge, step-up-over and sit-to-stand tests-using computerized dynamic posturography. [Subjects and Methods] An intra-test and test-retest, repeated measure study was designed. Forty-five healthy subjects twice carried out the forward-lunge test, step-up-over test, and sit-to-stand test on two days, one week apart. The intrasession and intersession reliabilities as judged by the intraclass correlation coefficient (ICC) and the minimal detectable change of the three functional tests were calculated. [Results] Excellent to very good intrasession reliability of the forward-lunge test (ICC range of 0.9-0.8) was found. Very good to good intrasession reliability of the step-up-over test (ICC range of 0.9-0.5) was found and very good intrasession reliability of the sit-to-stand test (ICC range of 0.8-0.7) was found. The minimal detectable change at the 95% confidence level of most of the measures was lower than 30%. [Conclusion] The forward-lunge, step-up-over and sit-to-stand tests are reliable measurement tools.

Postural Control and Sensory Processing in Preschool Children with Autistic Spectrum Disorder: A Cross-Sectional Study.

The role of sensory processing in maintaining postural control (PC) among preschool-aged children with autism spectrum disorder (ASD) remains underexplored despite its potential implications for their developmental trajectory. This study aimed to assess the utilization of sensory information for PC maintenance while standing in preschool-aged children with ASD and to examine its correlation with PC during functional tasks using a standardized tool. The cross-sectional study recruited 27 children, aged between 3 and 6 years, diagnosed with ASD. Participation indexes for somatosensory, vestibular, visual, and visual preference were computed during a modified Clinical Test of Sensory Integration and Balance (m-CTSIB), based on sagittal plane body sway analyzed via video with Kinovea® software (version 0.9.4). Additionally, scores from the Pediatric Balance Scale (PBS) were analyzed. Statistical analysis of data derived from lateral malleolus and mastoid process sway using the Friedman test revealed significant differences in the utilization of various sensory systems involved in PC during the m-CTSIB (p < 0.001). There was a pronounced reliance on somatosensory information, coupled with increased instability in the absence or with the variability of visual information. The mean PBS score was 50.44 ± 2.74, exhibiting a significant negative correlation with the vestibular index (p < 0.05). Preschool-aged children with ASD demonstrated challenges in maintaining PC while standing under different sensory conditions, indicating a heightened dependence on somatosensory cues, particularly in the absence or with the variability of visual stimuli. While these challenges were not reflected in PBS scores, they were negatively correlated with the vestibular index.

Imagined Timed Up and Go test (iTUG) in people with Parkinson's Disease: test-retest reliability and validity.

PURPOSE: To determine the test-retest reliability and validity of the Imagined Timed Up and Go Test (iTUG) as a Motor Imagery measure of temporal accuracy in people with Parkinson's Disease (PD). MATERIALS AND METHODS: A descriptive study was conducted following the GRRAS recommendations. Thirty-two people with idiopathic, mild to moderate PD (Hoehn and Yahr I-III), without cognitive impairment (MMSE ≥ 24), were assessed twice (7-15 days apart) with the iTUG. The absolute unadjusted difference in seconds, and the absolute adjusted difference as percentage of estimation error, between real and imagined TUG times, were calculated as outcome measures. Test-retest reliability was assessed using a two-way mixed-effects model of the ICC. Construct validity was tested with the Imagined Box and Blocks Test (iBBT) and convergent validity with clinical characteristics of PD, using the Spearman's rank correlation coefficient. RESULTS: The ICC for the unadjusted and adjusted measures of the iTUG was ICC = 0.61 and ICC = 0.55, respectively. Correlations between iTUG and iBBT were not statistically significant. The iTUG was partially correlated to clinical characteristics of PD. CONCLUSIONS: Test-retest reliability of the iTUG was moderate. Construct validity between iTUG and iBBT was poor, so caution should be taken when using them concurrently to assess imagery's temporal accuracy.

In people with Parkinson's Disease (PD), the absolute unadjusted difference (in seconds) and the absolute adjusted difference (as a percentage of estimation error) of the Imagined Timed Up and Go test (iTUG) were moderately reliable.iTUG and Imagined Box and Blocks Test (iBBT) measures were not statistically correlated. Therefore, temporal accuracy measures of Motor Imagery are highly task-dependant and thus their construct validity is poor.Correlations between the adjusted and unadjusted measures of the iTUG and the majority of clinical variables of PD were not statistically significant. Statistically significant correlations were only found between the unadjusted difference and MDS-UPDRS Part III, Schwab and England, and Berg Balance scales, as well as the adjusted difference and disease duration.

Cross-cultural adaptation and psychometric properties of Spanish Child Pain Anxiety Symptoms Scale.

INTRODUCTION: Pain anxiety is a psychological component that can regulate and modulate the experience of pain in children and adolescents. It can also have an impact on the outcomes of surgical procedures, chronic pain management and psychological interventions. The aim of our study was to translate the Child Pain Anxiety Symptoms Scale (CPASS) into Spanish and assess the psychometric properties of the Spanish version. PATIENTS AND METHODS: First, the CPASS was translated according to international guidelines. Secondly, to assess the psychometric properties of the translated version, we conducted an analysis in a paediatric sample. A total of 160 children, 49.37% female, with a mean age of 14.5 years (SD, 2.3; range, 8-18 years) completed pain catastrophising, health-related quality of life, pain interference and pain intensity scales. We assessed the following psychometric properties: construct validity (exploratory and confirmatory factor analysis), internal consistency, floor and ceiling effects and convergent validity (correlation of CPASS to the other completed questionnaires completed and with objective aspects of the health history). RESULTS: In the exploratory factor analysis, the final 18-item version (having excluded items 18 and 19) of the CPASS was the best fit, with all items included in the hypothetical construct and exhibiting optimal factor loadings. The confirmatory factor analysis showed that the final 18-item, 4-factor model was adequate for the scale structure. We did not detect any floor or ceiling effects in the final version. Lastly, the results confirmed that the Spanish version has good internal consistency (Cronbach  α, 0.88) and an adequate convergent validity. CONCLUSION: The Spanish CPASS exhibits good psychometric proprieties and it can be used to assess pain anxiety in the paediatric population.

Validation of the Spanish version of the Pain Catastrophizing Scale for Children (PCS-C).

INTRODUCTION: Pain catastrophizing is a powerful factor that can affect health care outcomes as well as emotional and physical well-being. The Pain Catastrophizing Scale for Children (PCS-C) is widely used, but it is not validated in Spanish. The aim of the study was to translate the PCS-C to Spanish and assess the validity and reliability of the translated version. PATIENTS AND METHODS: This study was carried out in two phases: (a) instrument translation (via a translation-back-translation process) and (b) psychometric analysis (construct validity: exploratory and confirmatory factor analysis, internal consistency, floor and ceiling effects and convergent validity). It had a cross-sectional design and was conducted on a sample of children aged 8-18 years was selected by convenience in a paediatric hospital. The study followed the STARD checklist. RESULTS: The sample included 150 children and adolescents (mean age, 12.45 years; 63.8% male) and their parents. The exploratory and the confirmatory analysis showed a good adjustment of the model to the original 3-model structure with 13 items. The internal consistency of the scale was excellent (Cronbach α, 0.904), and no floor or ceiling effects were detected. In the convergent validity analysis, the Spanish version of the PCS-C showed a moderate correlation with pain interference (r=0.400) and with health-related quality of life (r=0.217-0.303). CONCLUSIONS: These results show that the Spanish version of the PCS-C is a valid and reliable scale to assess pain catastrophizing in children and adolescents.

Spanish adaptation and validation of the empowerment of parents in the intensive care-neonatology (EMPATHIC-N) questionnaire.

INTRODUCTION: Parental satisfaction is rarely measured in the neonatal intensive care unit due to a lack of specific assessment tools. The Empowerment of Parents in The Intensive Care-Neonatology (EMPATHIC-N) questionnaire is an instrument to assess satisfaction in relation to family-centred care that has been validated in several countries, but not Spain. OBJECTIVES: To perform the translation and cultural adaptation of the EMPATHIC-N to Spanish followed by its validation for the purpose of assessing satisfaction in parents with children admitted to the neonatal intensive care unit. MATERIAL AND METHODS: The questionnaire first underwent forward and backward translation and transcultural adaptation by a panel of experts through a standardized process based on the Delphi method, followed by a pilot study in 8 parents and then a cross-sectional study in the neonatal intensive care unit of a tertiary care hospital to assess the reliability and converging validity of the Spanish version. RESULTS: The study proved the comprehensibility, validity, feasibility, applicability and usefulness of the Spanish version of the EMPATHIC-N in the field of paediatric health after being evaluated by 19 professionals and 60 parents. The content validity was found to be excellent (0.93). The reliability and convergent validity of the Spanish version of the EMPHATIC-N was analysed in a sample of 65 completed questionnaires. The Cronbach α for each domain was greater than 0.7, indicating a high internal consistency. We assessed validity by analysing the correlation of the 5 domains with the with the 4 general satisfaction items. The validity was found to be adequate (rs, 0.4-0.76; P < .01). CONCLUSIONS: The Spanish version of the EMPATHIC-N questionnaire is a comprehensible, useful, valid and reliable instrument to measure satisfaction in the parents of children admitted to neonatal care units.

Differences between Novice and Expert Raters Assessing Trunk Control Using the Trunk Control Measurement Scale Spanish Version (TCMS-S) in Children with Cerebral Palsy.

The Trunk Control Measurement Scale (TCMS) is a valid and reliable tool to assess static and dynamic trunk control in cerebral palsy. However, there is no evidence informing about differences between novice and expert raters. A cross-sectional study was conducted with participants between the ages of 6 and 18 years with a CP diagnosis. The TCMS Spanish version (TCMS-S) was administered in-person by an expert rater, and video recordings were taken for later scoring by the expert and three other raters with varying levels of clinical experience. The intraclass correlation coefficient (ICC) was used to evaluate reliability between raters for the total and subscales of the TCMS-S scores. Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) were also calculated. There was a high level of agreement between expert raters (ICC ≥ 0.93), while novice raters demonstrated good agreement (ICC > 0.72). Additionally, it was observed that novice raters had a slightly higher SEM and MDC than expert raters. The Selective Movement Control subscale exhibited slightly higher SEM and MDC values compared to the TCMS-S total and other subscales, irrespective of the rater's level of expertise. Overall, the study showed that the TCMS-S is a reliable tool for evaluating trunk control in the Spanish pediatric population with cerebral palsy, regardless of the rater's experience level.

Mobile Applications for Resting Tremor Assessment in Parkinson's Disease: A Systematic Review.

(1) Background: Resting tremor is a motor manifestation present in most Parkinson's disease (PD) patients. For its assessment, several scales have been created, but mobile applications could help in objectively assessing resting tremor in PD patients in person and/or remotely in a more ecological scenario. (2) Methods: a systematic review following the PRISMA recommendations was conducted in scientific databases (PubMed, Medline, Science Direct, Academic Search Premier, and Web of Science) and in the main mobile application markets (Google Play, iOS App Store, and Windows Store) to determine the applications available for the assessment of resting tremor in patients with PD using only the measurement components of the phone itself (accelerometers and gyroscopes). (3) Results: 14 articles that used mobile apps to assess resting tremor in PD were included, and 13 apps were identified in the mobile application markets for the same purpose. The risk of bias and of applicability concerns of the articles analyzed was low. Mobile applications found in the app markets met an average of 85.09% of the recommendations for the development of medical mobile applications. (4) Conclusions: the use of mobile applications for the evaluation of resting tremor in PD patients has great potential, but validation studies for this purpose are scarce.