Job-related self-efficacy in musculoskeletal disorders - a questionnaire. / Jobbrelatert mestringstro ved muskel- og skjelettplager ­ et spørreskjema.

BACKGROUND: The Return-To-Work Self-Efficacy Scale questionnaire maps self-efficacy upon return to work following acute lower back pain. We wished to translate and validate the questionnaire, as well as to assess the concordance between the translated form and two other forms. MATERIAL AND METHOD: The questionnaire was translated into Norwegian according to recommended guidelines. Employees in the health and care service with musculoskeletal symptoms were recruited for the study. Cross-cultural validity was assessed by principal component analysis and internal consistency by Cronbach's alpha. Conceptual validity was assessed by correlation between the translated form and simultaneous measurements from two questionnaires that focus on closely related characteristics: the Tampa scale for kinesiophobia and the Demand-ControlSupport model. RESULTS: The Norwegian questionnaire is called 'Job-related self-efficacy'. Of a sample of 229 persons, 206 (89.9 %) were included in the analyses. Principal component analysis supported cross-cultural validity through findings of a three-factor structure in accordance with the original questionnaire. Internal consistency was high for all questions in the questionnaire (0.95), as well as for each of the three factors: meet job requirements (0.99), communicate needs to others (0.97) and adapt work duties (0.96), after adjusting for the number of questions. There were low correlations (< 0.40) between Job-Related Self-Efficacy and the Tampa scale for kinesiophobia, and the various factors in the Demand-Control-Support questionnaire, respectively. INTERPRETATION: The 'Job-Related Self-Efficacy' questionnaire has satisfactory cross-cultural validity after it was translated, and satisfactory internal consistency.

Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism.

BACKGROUND: There is a substantive lack of knowledge about comorbidity in patients with frozen shoulder. The aim of this study was to investigate whether subjective health complaints and Neuroticism would predict treatment outcome in patients diagnosed with frozen shoulder as measured by the Shoulder Pain and Disability Index (SPADI) and change in SPADI. METHODS: A total of 105 patients with frozen shoulder were recruited for a randomised controlled trial, where 69 were in the intervention group and received intraarticular corticosteroid injections and 36 patients served as control group. The SPADI was used as the outcome measure after 8 weeks, and change in SPADI from baseline to 8 weeks as a measure of rate of recovery. To examine comorbidities, all participants completed the Subjective Health Complaints (SHC) questionnaire with its five subscales, and the Neuroticism (N) component of the Eysenck Personality Questionnaire Revised. Multiple regression analysis was performed with the baseline comorbidity variables that correlated significantly with SPADI after 8 weeks, and with change in SPADI from baseline to 8 weeks, controlling for the variables intervention, age, gender and duration of pain. RESULTS: In this study, patients with frozen shoulder had little comorbidity as measured with SHC and scored normally with respect to Neuroticism. Only the Pseudoneurology subscale in SHC correlated significantly with SPADI and had significant predictive power (p < 0.001) for the outcome at 8 weeks. The intervention group exhibited significant statistical predictive power (p < 0.001) for the treatment outcome as measured by a change in SPADI from baseline to 8 weeks. Being female also had some predictive significance for change in SPADI (p < 0.005). CONCLUSION: Psychometric parameters as measured by the Pseudoneurology subscale in SHC questionnaire did predict the treatment outcome in frozen shoulder as measured by SPADI at 8 weeks, but not by change in SPADI from baseline to 8 weeks. One may conclude that psychometric parameters may affect symptoms, but do not predict the rate of recovery in frozen shoulder. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT01570985 .

Adhesive capsulitis of the shoulder, treatment with corticosteroid, corticosteroid with distension or treatment-as-usual; a randomised controlled trial in primary care.

BACKGROUND: Optimal management for adhesive shoulder capsulitis (frozen shoulder) is currently unclear. We intended to explore whether treatment by intra-articular injections with corticosteroid and distension is more effective than treating with corticosteroids alone or treatment-as-usual in a primary care setting in Norway. METHODS: In this prospective randomised intention to treat parallel study, 106 patients were block randomised to three groups; 36 (analysed 35) receiving steroid injection and Lidocaine (IS), 34 receiving steroid and additional saline as distension (ISD) and 36 had treatment-as-usual (TAU). Intervention groups received four injections within 8 weeks, assessed on 1st visit, at the 4th and 8th week. Outcomes were Shoulder Pain and Disability Index (SPADI), Numerical pain rating scale (NPRS) and passive range of motion (PROM). Postal assessment was repeated after 1 year for SPADI. Patients in the IS and ISD groups were "blinded" for intervention received and the assessor was "blinded" to group allocation. RESULTS: At baseline there were no differences between groups in outcome measures. There were no statistical significant differences between the intervention groups in SPADI, NPRS and PROM at baseline, at short-term (4-and 8 weeks) or long-term (12 months). There were statistically significant differences (p < 0.01) in change scores at short-term for SPADI when comparing the IS and TAU groups (-20.8; CI-28.9 to -12.7), and the ISD and TAU groups (-21.7; CI-29.4 to -14.0), respectively for NPRS (-2.0; CI-2.8 to -1.1 and -2.2; CI-3.0 to -1.4), and for PROM, but not at long-term for SPADI (p > 0.05). Effect size (ES) at 8 weeks was large between both injection groups and TAU (ES 1.2). At 12 months ES was reduced to 0.3 and 0.4 respectively. Transitory side effects as flushing and after-pain were reported by 14 % in intervention groups. CONCLUSION: This intention to treat RCT in primary care indicates that four injections with corticosteroid with or without distension, given with increasing intervals during 8 weeks, were better than treatment-as-usual in treatment of adhesive shoulder capsulitis. However, in the long run no difference was found between any of the groups, indicating that natural healing takes place independent of treatment or not. TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov/ identifier: NCT01570985.

Identification of gait domains and key gait variables following hip fracture.

BACKGROUND: Restoration of gait is an important goal of rehabilitation after hip fracture. Numerous spatial and temporal gait variables have been reported in the literature, but beyond gait speed, there is little agreement on which gait variables should be reported and which are redundant in describing gait recovery following hip fracture. The aims of this study were to identify distinct domains of gait and key variables representing these domains, and to explore how known predictors of poor outcome after hip fracture were associated with these key variables. METHODS: Spatial and temporal gait variables were collected four months following hip fracture in 249 participants using an electronic walkway (GAITRite®). From the initial set of 31 gait variables, 16 were selected following a systematic procedure. An explorative factor analysis with oblique (oblimin) rotation was performed, using principal component analysis for extraction of factors. Unique domains of gait and the variable best representing these domains were identified. Multiple regression analyses including six predictors; age, gender, fracture type, pain, global cognitive function and grip strength were performed for each of the identified key gait variables. RESULTS: Mean age of participants was 82.6 (SD = 6.0) years, 75 % were women, and mean gait speed was 0.6 (SD = 0.2) m/sec. The factor analysis revealed four distinct gait domains, and the key variables that best represented these domains were double support time, walk ratio, variability of step velocity, and single support asymmetry. Cognitive decline, low grip strength, extra capsular fracture and male gender, but not pain or age, were significant predictors of impaired gait. CONCLUSIONS: This work proposes four key variables to represent gait of older people after hip fracture. These core variables were associated with known predictors of poor outcome after hip fracture and should warrant further assessment to confirm their importance as outcome variables in addition to gait speed.

Peak oxygen uptake and breathing pattern in COPD patients--a four-year longitudinal study.

BACKGROUND: Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limited by exertional dyspnea and reduced exercise capacity. The aims of the study were to examine longitudinal changes in peak oxygen uptake (V̇O2peak), peak minute ventilation (V̇Epeak) and breathing pattern over four years in a group of COPD patients, and to examine potential explanatory variables of change. METHODS: This longitudinal study included 63 COPD patients, aged 44-75 years, with a mean forced expiratory volume in one second (FEV1) at baseline of 51 % of predicted (SD = 14). The patients performed two cardiopulmonary exercise tests (CPETs) on treadmill 4.5 years apart. The relationship between changes in V̇O2peak and V̇Epeak and possible explanatory variables, including dynamic lung volumes and inspiratory capacity (IC), were analysed by multivariate linear regression analysis. The breathing pattern in terms of the relationship between minute ventilation (V̇E) and tidal volume (VT) was described by a quadratic equation, VT = a + b∙V̇E + c∙V̇E (2), for each test. The VTmax was calculated from the individual quadratic relationships, and was the point where the first derivative of the quadratic equation was zero. The mean changes in the curve parameters (CPET2 minus CPET1) and VTmax were analysed by bivariate and multivariate linear regression analyses with age, sex, height, changes in weight, lung function, IC and inspiratory reserve volume as possible explanatory variables. RESULTS: Significant reductions in V̇O2peak (p < 0.001) and V̇Epeak (p < 0.001) were related to a decrease in resting IC and in FEV1. Persistent smoking contributed to the reduction in V̇O2peak. The breathing pattern changed towards a lower VT at a given V̇E and was related to the reduction in FEV1. CONCLUSION: Increasing static hyperinflation and increasing airway obstruction were related to a reduction in exercise capacity. The breathing pattern changed towards more shallow breathing, and was related to increasing airway obstruction.

Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial.

QUESTION: What is the effect of a 12-week abdominal and pelvic floor muscle exercise program during pregnancy on the inter-recti distance (IRD) in women with diastasis recti abdominis immediately after the 12-week intervention period and at follow-up 6 weeks postpartum? DESIGN: An exploratory, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Ninety-six pregnant women aged ≥ 18 years, either primigravida or multigravida, in gestation week 24 with an IRD of ≥ 28 mm measured at rest and/or a protrusion on initial assessment. INTERVENTION: The experimental group participated in a 12-week abdominal and pelvic floor muscle exercise program during pregnancy. The control group received no intervention. OUTCOME MEASURES: Change (mm) in IRD 2 cm above and below the umbilicus at rest from pre-intervention to immediately post-intervention and to 6 weeks follow-up measured with ultrasonography. RESULTS: The IRD increased for both groups from baseline to immediately after the intervention and decreased from after the intervention to the follow-up at 6 weeks postpartum. The IRD was smallest for both groups at the follow-up. At 2 cm above the umbilicus, the intervention effect was 2 mm (95% CI -2 to 7) immediately after the intervention and -1 mm (95% CI -4 to 3) at follow-up. At 2 cm below the umbilicus, the intervention effect was -5 mm (95% CI -10 to 0) immediately after the intervention and 0 mm (95% CI -4 to 4) at follow-up. CONCLUSION: Abdominal and pelvic floor muscle training during pregnancy have a negligible effect on the IRD immediately after 12 weeks of intervention and at 6 weeks post-partum. REGISTRATION: NCT04960800.

Pain pressure threshold algometry in knee osteoarthritis: intra- and inter-rater reliability.

INTRODUCTION: Synovitis and effusion can cause pain sensitization in persons with knee osteoarthritis (KOA). Pain Pressure Threshold (PPT) algometry is a means to quantify somatosensory abnormalities, including inflammatory-mediated pressure hyperalgesia. We investigated the reliability of PPT algometry with three raters. METHODS: Twenty-seven persons (50 knees) with KOA, according to the American College of Rheumatology criteria, were included. The PPT of the most tender spot in the joint line of each knee, identified by palpation, was assessed using a digital pressure algometer with a round 1 cm2 rubber tip. The algometer was applied three times with at least twenty-second intervals by three physiotherapists each in a single session. Two of the physiotherapists had no experience with the procedure prior to the study. We estimated the Intraclass Correlation Coefficient (ICC) model 2.1, 95% within-subject standard deviation (sw), and Minimal Detectable Difference (MDD). RESULTS: The mean PPTs ranged from 39.94 to 41.81 Newton (N), the intra-rater ICC ranged from 0.909 to 0.956, the sw ranged from 6.44 to 10.77 N, and the related MDD ranged from 9.11 to 15.23 N. The three raters achieved an inter-rater ICC of 0.707, an sw of 17.68 N, and an MDD of 25.01 N. The results were homoscedastic. CONCLUSIONS: Our results indicate that PPT algometry is a suitable method for assessment of pain in osteoarthritic knees. After a short session of PPT procedure training, good intra-rater and acceptable inter-rater ICCs were achieved.

Community living after in-hospital specialized rehabilitation in patients with severe disability after stroke: a long-term follow-up after a randomized controlled trial.

PURPOSE: Physical functioning after discharge from specialized rehabilitation is a concern. The purpose of this study was to investigate functioning and health after a long period of community living in participants with severe disability after stroke. MATERIALS AND METHODS: An observational, longitudinal follow-up design was used to investigate 60 participants from a randomized controlled trial. Assessment tools: Short Form 36 health-survey, Functional Ambulation Categories, EU Walking, 10 Meter Walk Test, and questions concerning health and walking ability. RESULTS: Forty-seven participants (78%) responded, mean age 51.2 years. Non-respondents demonstrated poorer function at hospital discharge. At follow-up, median 11.9 months after discharge, all but three respondents lived in their own home, and 85% received physiotherapy. Twenty-nine (64%) perceived their health as good to excellent, while four (9%) reported poor health. Activities requiring substantial strength and endurance were typically restricted. Most participants (83%) were independent walkers, and fewer (a 27% reduction) used a wheelchair. Among independent walkers, mean walking speed improved by 0.14 m/s. Time elapsed since hospital discharge was not found to correlate with change in walking speed. CONCLUSIONS: This study demonstrates maintenance or progress in important aspects of functioning and health in most participants at long-term follow-up, but not in all.Implications for rehabilitationPatients with severe disability after stroke may maintain or improve their physical functioning and health after a long period of community living, when they receive continuous individualized rehabilitation including physiotherapy.Patients who maintain or improve walking ability and walking speed after living for a long time in the community, may still need assistance with daily activities, especially if they require substantial muscle strength and endurance.Expectations to long-term functional outcomes after institutional followed by community rehabilitation for patients after stroke, should be considered in light of functional status at hospital discharge.

Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study.

OBJECTIVE: To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). DESIGN: Experimental longitudinal design. SETTING: Physiotherapy clinic, primary health care. PARTICIPANTS: Thirty-eight pregnant women with DRA ≥ 2.8 cm. INTERVENTIONS: Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. MAIN OUTCOME MEASURES: Change in IRD. RESULTS: There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27-37 was a mean increase of 8 mm (95% CI: 6, 9). CONCLUSION: Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37. CONTRIBUTION OF THE PAPER.

Within-day test-retest reliability of an accelerometer-based method for registration of step time symmetry during stair descent after ACL reconstruction and in healthy subjects.

Background: Symmetry during stair descent can potentially be used as an early functional measure after anterior cruciate ligament reconstruction (ACLR). We have developed a novel application of a single accelerometer-based inertial motion unit (IMU) to identify foot strikes and calculate step times in an ordinary stairway.Purpose: To examine within-day test-retest reliability and measurement error of step time and step time symmetry measured with a body-fixed IMU during stair descent in subjects early after ACLR and in healthy subjects.Methods: Subjects after ACLR were tested twice 6 weeks (N = 15) and twice 3 months (N = 26) postoperatively. Eighteen healthy subjects were tested twice on one occasion. Subjects descended a flight of stairs at preferred speed. Trunk accelerometry data were collected with an inertial motion unit (IMU). Mean step times (MSTs) and limb symmetry index (LSI) of MSTs were calculated. Clinical trials registration number: NCT01279759.Results: Intraclass Correlation Coefficient (ICC (1,1)) for within test-retest reliability varied from 0.87 to 0.96 for MSTs and from 0.58 to 0.87 for LSIs. The 95% confidence interval (CI) for a true value varied from ± 0.02 seconds (s) to ± 0.05 s for MSTs and from ± 4.6 percentage points (pp) to ± 6.6 pp for LSIs.Conclusion: Mean step times measured with a body-fixed IMU during stair descent and limb symmetry indexes calculated from these mean step times are precise and reliable during early post-operative rehabilitation after ACLR and in healthy subjects.

Effect of a specific exercise programme during pregnancy on diastasis recti abdominis: study protocol for a randomised controlled trial.

INTRODUCTION: Diastasis recti abdominis (DRA) is a common condition in pregnant and postpartum women.Evidence for the treatment of DRA is both sparse and weak. As thiscondition occurs during the last two trimesters of pregnancy and there is a paucity of high-quality studies on a pregnant population, we will conduct a randomised trial on the effect ofa specific exercise programme during pregnancy on DRA. METHODS AND ANALYSIS: This is an exploratory, assessor-blinded, randomised parallel group trial carried out in aprimary healthcare setting in a Norwegian city. 100 pregnant women, both primigravida andmultigravida, in gestation week 24 presenting with DRA of ≥28 mm willbe included. Participants will be allocated to either an intervention group or a control groupby block randomisation. The intervention group will participate in a 12-week specific exerciseprogramme. The control group will not participate in any exercise intervention. Data collectionwill take place prior to intervention, postintervention at gestation week 37, and 6 weeks, 6and 12 months postpartum. The primary outcome measure will be change in the inter-rectidistance, measured by two-dimensional ultrasonography. Data will be analysed and presentedin accordance with international Consolidated Standards of Reporting Trials guidelines and analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION: Ethical approval has been obtained by the regional ethical committee (76296), and allprocedures will be performed in adherence to the Helsinki declaration. The study has beenregistered with ClinicalTrials.gov. Results from this study will be presented atscientific conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT04960800; Pre-results.

The Female Menstrual Cycles Effect on Strength and Power Parameters in High-Level Female Team Athletes.

PURPOSE: The female menstrual cycle (MC) is characterized by hormonal fluctuations throughout its different phases. However, research regarding its effect on athletic performance in high level athletes is sparse. The aim of this study was to (i) investigate the female MCs effect on strength and power performance in highly trained female team athletes throughout the MC and (ii) examine whether eumenorrheic participants with natural hormonal fluctuations displayed enhanced performance in the follicular phase (FP) versus the luteal phase (LP), compared to controls using hormonal contraceptives. MATERIALS AND METHODS: A total of 29 athletes (Age 21.2 ± 3.3 years; weight 65.6 ± 8.7 kg; height 170.2 ± 8.0 cm; and fat free mass 52.7 ± 7.1) completed the study after a 6-week testing period (8 eumenorrheic participants and 21 hormonal contraceptive controls). Participants were recruited from the team sports soccer, handball and volleyball. Testing protocol consisted of maximal voluntary isometric grip strength, 20-m sprint, countermovement jump and pneumatic leg-press. Based on self-reported use of hormonal contraceptives, participants were divided into non-hormonal contraceptive group and hormonal contraceptive group, the latter working as a control group. Differences in performance between the FP and LP were investigated. MC phase was confirmed by serum hormonal levels through venous blood samples in the non-hormonal contraceptive group. RESULTS: There were no statistically significant changes for the two different phases of the MC, in terms of physical performance for the whole group. Further, there was no significant difference between groups during the MC for any of the outcome variables, maximal voluntary isometric grip strength F(3.29) = 0.362; 20-m sprint F(3.24) = 0.710; countermovement jump F(3.26) = 2.361; and leg-press F(3.26) = 1.746. CONCLUSION: In high level female team athletes, no difference in performance was observed based on hormonal contraceptive status. This suggests that the MC does not alter acute strength and power performance on a group level in high level team athletes.

The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. PURPOSE: To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. RESULTS: Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. CONCLUSION: ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.

Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy.

BACKGROUND: The effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks. METHODS: A repeated measures design was applied with three baseline and two follow up assessments; immediately and three weeks after intervention. Twenty-two children with hemiplegia (n = 7), diplegia (n = 11), quadriplegia (n = 2) and ataxia (n = 2) participated, age ranging 3-9 y. All levels of Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were represented. Parents and professionals participated in goal setting and training. ANOVA was used to analyse change over repeated measures. RESULTS: A main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. An interaction between time and GMFCS-levels was found, implying that children classified to GMFCS-levels I-II improved more than children classified to levels III-V. There were no main or interaction effects of age or anti-spastic medication. Change scores in the Pediatric Evaluation of Disability Inventory (PEDI) ranged 2.0-6.7, p < 0.01 in the Self-care domain of the Functional Skills dimension, and the Self-care and Mobility domains of the Caregiver Assistance dimension. The children's individual goals were on average attained, Mean Goal Attainment Scaling (GAS) T-score being 51.3. Non-significant improved scores on the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremities Skills Test (QUEST) were demonstrated. Significant improvement in GMPM scores were found in improved items of the GMFM, not in items that maintained the same score. CONCLUSIONS: Basic motor abilities and self-care improved in young children with CP after goal-directed activity-focused physiotherapy with involvement of their local environment, and their need for caregiver assistance in self-care and mobility decreased. The individualized training within a group context during a limited period of time was feasible and well-tolerated. The coherence between acquisition of basic motor abilities and quality of movement should be further examined.

Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting.

BACKGROUND: To assess pain in older persons with severe dementia is a challenge due to reduced self-report capacity. Recently, the development and psychometric property testing of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale was described using video-recording. The purpose of this article was to present the further development of this instrument. In MOBID-2 Pain Scale, the assessment of inferred pain intensity is based on patient's pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID-2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). OBJECTIVE: The aim of this study was to examine psychometric properties of the MOBID-2 Pain Scale, like inter-rater and test-retest reliability, internal consistency, as well as face-, construct- and concurrent validity. SUBJECTS AND SETTING: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID-2 Pain Scale. Characteristics of the patients' pain were also investigated by their physicians (n = 4). RESULTS: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID-2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (kappa = 0.41-0.90 and kappa = 0.46-0.93). Inter-rater and test-retest reliability for pain intensity was very good, ICC (1, 1) ranging 0.80-0.94 and 0.60-0.94. Internal consistency was highly satisfactory; Cronbach's alpha ranging 0.82-0.84. Face-, construct- and concurrent validity was good. Overall pain intensity by MOBID-2 was well correlated with physicians' clinical examination and defined pain variables (rho = 0.41-0.64). CONCLUSION: On the basis of pain behaviours, standardized movements and pain drawings, MOBID-2 Pain Scale was shown to be sufficiently reliable, valid and time-effective for nurses to assess pain in patients with severe dementia.

Spatiotemporal gait parameters for older adults - An interactive model adjusting reference data for gender, age, and body height.

INTRODUCTION: Since it is well documented that spatiotemporal gait parameters are affected by body size, it is of limited clinical value to compare individual scores against reference values without taking body size into consideration. For older adults, reference values have been presented in recent reports, but unfortunately the effect of body size on gait characteristics was not taken into account and neither prediction intervals nor percentile ranks were included. It is the aim of this study to present and assess a model where individual spatiotemporal gait parameter values for older adults can be compared to reference values adjusted for gender, age, and body height. METHODS: Reference gait data were collected from l464 older adults aged 69-80 years with no impairments believed to affect gait, stratified by gender, intermediately adjusted to a common body height using a pendulum model and entered into a simple regression model for each parameter with age as predictor. From the regression coefficients predicted gait parameter values could be back transformed to the individual body height of a new subject. Calculations were done using spreadsheet formulae and equations. RESULTS: A spreadsheet based graphical user interface (GUI) has been developed in Microsoft Excel® where individual spatiotemporal gait data is entered for comparison with reference data taking gender, age and body height into account, and returning predicted point estimates with confidence intervals, prediction intervals, and percentile ranks. SIGNIFICANCE: A GUI solution where individual spatiotemporal gait data is compared to reference data is feasible to researchers and for clinical use. To the best of our knowledge, this is the first model presented for comparison of basic gait parameters between individuals and reference data from older adults where gender, age, and body height are taken into account.

Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake.

Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (kappa = 0.44-0.92, kappa = 0.10-0.76 and kappa = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra- and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.

The effects of integrated single- and dual-task training on automaticity and attention allocation in Parkinson's disease: A secondary analysis from a randomized trial.

OBJECTIVE: People with Parkinson's disease (PwPD) demonstrate impaired automaticity of motor and cognitive tasks, with unclear prioritization strategies when exposed to dual-task situations. However, no randomized trials have investigated the effects of training on automaticity and prioritization strategies in this population. The purpose of this study was to investigate the effects of training on the automaticity of gait and cognitive processing in PwPD and the allocation of attention between gait and a cognitive task. METHOD: One-hundred PwPD were randomized to 10 weeks of challenging gait and balance training (including single and dual-task conditions) or to a control group (care as usual). Outcome measure was the absolute dual-task interference (difference between single- and dual-tasks) for gait and cognitive parameters. Differences between baseline and follow-up were compared between the groups. The Mann-Whitney U test was used to assess potential differences. Significance level was set to p = .05. The direction and magnitude of nonparametric effect sizes were used to investigate attention allocation. RESULTS: No significant between-groups differences were found regarding any gait parameter. The training group significantly improved the dual-task interference of the cognitive task. The direction of between-groups effect sizes indicated that the training group primarily allocated attention to the cognitive task, whereas the control group appeared to prioritize gait. CONCLUSIONS: The results indicate that challenging training can improve automaticity of cognitive processing during walking. This may have a beneficiary effect on the ability to ambulate safely in the community, thereby improving independence and the quality of life in this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Two-year changes in gait variability in community-living older adults.

BACKGROUND: Increases in stride-to-stride fluctuations (gait variability) are common among older adults, but little is known about the natural progression of gait variability with increasing age. RESEARCH QUESTION: Does gait variability change with increasing age in a group of community-living older adults? METHODS: The participants were community-living volunteers between 70-81 years, who were tested with a two-year interval between tests. They walked 6.5 m under four different conditions: At preferred speed, at fast speed, during a dual task condition and on an uneven surface. Trunk accelerations in the anteroposterior (AP), mediolateral (ML) and vertical (V) direction were captured using a body-worn sensor worn at the lower back. Gait variability was estimated using an autocorrelation procedure, where coefficients tending towards 1.0 indicated low variability and 0.0 as high variability. To estimate change, we used an ANOVA-procedure with baseline gait speed as a covariate. RESULTS: At baseline, 85 older adults were tested, and data for 56 of these were available for analysis over a two-year period of time. The average age at inclusion was 75.8 years (SD 3.43) and 60% were women. During preferred speed walking, variability increased in the AP direction (mean difference 0.05, p = .038), during fast speed walking it increased in the V direction (mean difference 0.04, p = .037) and during dual task-walking, it increased in the ML and V directions (mean differences 0.03, p = .032 and 0.09, p = .020 respectively). SIGNIFICANCE: The findings from this study could be helpful for discriminating between normal and pathological progression of gait variability in older adults.

Treadmill walking with body weight support effect of treadmill, harness and body weight support systems.

This study aims to provide new knowledge on the principles of treadmill walking with body weight support (BWS) by qualifying and quantifying the effects on gait in 28 healthy individuals. Gait assessment included measuring trunk movements during different conditions. Walking overground and on a treadmill with and without harness, and on a treadmill with 30% dynamic and static body weight support, was assessed. Gait variables for all conditions were compared at 1.2m/s. On the treadmill, cadence increased, the trunk tilted more forwards, vertical acceleration increased and anteroposterior acceleration became more variable. Wearing a harness resulted in more restricted vertical acceleration. Walking with body weight support restricted acceleration in all directions. It also produced variable interstride trunk acceleration in the anteroposterior and vertical directions, but more consistent interstride trunk acceleration in the mediolateral direction. Static BWS gave larger differences than dynamic BWS.