Construct Validity and Responsiveness of Performance-based Tests in Individuals With Knee Osteoarthritis.

OBJECTIVES: To assess the construct validity and responsiveness of 3 performance-based tests in individuals with knee osteoarthritis (KOA). DESIGN: This study has a prospective cohort design. SETTING: Assessments were administered at the Federal University of São Carlos (Brazil) by 3 different raters. PARTICIPANTS: A total of 107 participants with KOA were aged ≥40 years (N=107). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: This study assessed the construct validity and responsiveness of 3 performance-based tests: 40-meter fast-paced walk test (40-m FPWT), 11-step stair climb test (11-step SCT), and 30-second chair stand test (30-s CST). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), sedentary behavior (activPAL), and numeric pain rating scale (NPRS) were used as comparator instruments. Measurements were obtained at baseline and after 6 months. The construct validity and responsiveness were calculated using Spearman correlation coefficient within predefined hypotheses based on a panel comprising 5 experts in the field of outcome measurement in KOA. RESULTS: The three performance-based tests showed excellent (ICC>0.9) reliability (intra and inter); however, only the 40-m FPWT and 11-step SCT were considered valid and responsive because both confirmed >75% of the priori hypotheses. The 30-s CST was not considered valid or responsive because it has not confirmed ≥75% of the priori hypotheses. CONCLUSION: The 3 performance-based tests are reliable for intra and inter assessments. The 40-m FPWT and 11-step SCT are both valid and responsive for measuring physical function in patients with KOA. The 30-s CST was not considered valid or responsive. Therefore, 40-m FPWT and 11-step SCT can detect changes over time and are indicated for functional assessment in clinical practice.

Measurement properties of performance-based measures to assess physical function in knee osteoarthritis: A systematic review.

OBJECTIVE: To systematically review the measurement properties of performance-based measures to assess physical function in people with knee osteoarthritis. DATA SOURCES: PubMed, Web of Science, Embase, Scopus, CINAHL, and PsycINFO were searched in May 2022. METHODS: This study was conducted in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Clinical trials on the psychometric properties of performance-based tools for measuring physical function in people with knee osteoarthritis were included. Two reviewers independently rated measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). "Best evidence synthesis" was made using COnsensus-based Standards for the selection of health Measurement INstruments outcomes and the quality of findings. RESULTS: Thirty-six out of 3425 publications were eligible for inclusion. Thirty-two performance-based measures were evaluated including 26 single-activity measures and 6 multi-activity measures. Measurement properties evaluated included internal consistency (2 measures), reliability (23 measures), measurement error (20 measures), hypotheses testing for construct validity (22 measures), and responsiveness (23 measures). On balance of the limited evidence, the walk 40 m fast-paced test and 6-minute walking test were the best rated walking tests. The 30-second chair stand test and timed up and go test were the best rated sit-to-stand tests. The Performance Tests Measures and Physical Activity Restrictions may be the suitable multi-activity measures for knee osteoarthritis. CONCLUSIONS: Further good quality research investigating the measurement properties, and in particular, the measurement error of performance-based measures in patients with knee osteoarthritis is needed.

The association between walking speed from short- and standard-distance tests with the risk of all-cause mortality among adults with radiographic knee osteoarthritis: data from three large United States cohort studies.

OBJECTIVE: Adults with radiographic knee OA (rKOA) are at increased risk of mortality and walking difficulty may modify this relation. Little is known about specific aspects of walking difficulty that increase mortality risk. We investigated the association of walking speed (objective measure of walking difficulty) with mortality and examined the threshold that best discriminated this risk in adults with rKOA. METHODS: Participants with rKOA from the Johnston County Osteoarthritis Project (JoCoOA, longitudinal population-based cohort), Osteoarthritis Initiative and Multicenter Osteoarthritis Study (OAI and MOST, cohorts of individuals with or at high risk of knee OA) were included. Baseline speed was measured via 2.4-meter (m) walk test (short-distance) in JoCoOA and 20-m walk test (standard-distance) in OAI and MOST. To examine the association of walking speed with mortality risk over 9 years, hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox regression models adjusted for potential confounders. A Maximal Likelihood Ratio Chi-square Approach was utilized to identify an optimal threshold of walking speed predictive of mortality. RESULTS: Deaths after 9 years of follow-up occurred in 23.3% (290/1244) of JoCoOA and 5.9% (249/4215) of OAI + MOST. Walking 0.2 m/s slower during short- and standard-distance walk tests was associated with 23% (aHR [95%CI]; 1.23 [1.10, 1.39]) and 25% (1.25 [1.09, 1.43]) higher mortality risk, respectively. Walking <0.5 m/s on short-distance and <1.2 m/s standard-distance walk tests, best discriminated those with and without mortality risk. CONCLUSION: Slower walking speed measured via short- and standard-distance walk tests was associated with increased mortality risk in adults with rKOA.

One-minute stair climbing, 50-foot walk, and timed up-and-go were responsive measures for patients with chronic low back pain undergoing lumbar fusion surgery.

BACKGROUND: Physical capacity tasks are useful tools to assess functioning in patients with low back pain (LBP), but evidence is scarce regarding the responsiveness (ability to detect change over time) and minimal important change (MIC). The aim was to investigate the responsiveness and MIC of 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go in patients with chronic LBP undergoing lumbar fusion surgery. METHODS: In this clinimetric study, 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes were included. All patients performed the physical capacity tasks 5-min walk, 1-min stair climbing, 50-ft walk, and timed up-and-go 8-12 weeks before and six months after surgery. Responsiveness was evaluated by testing five a priori responsiveness hypotheses. The hypotheses concerned the area under the receiver operating characteristics (ROC) curve and correlations (Spearman's rho) between the change scores of the physical capacity tasks, the Oswestry Disability Index 2.0 (ODI), and back pain intensity measured with visual analog scale (VAS). At least 80% of the hypotheses would have to be confirmed for adequate responsiveness. Absolute and relative MICs for improvement were determined by the optimal cut-off point of the ROC curve based on the classification of improved and unchanged patients according to construct-specific global perceived effect (GPE) scales. RESULTS: One-minute stair climbing, 50-ft walk and timed up-and-go displayed adequate responsiveness (≥ 80% of hypotheses confirmed), while 5-min walk did not (40% of hypotheses confirmed). The absolute MICs for improvement were 45.5 m for 5-min walk, 20.0 steps for 1-min stair climbing, - 0.6 s for 50-ft walk, and - 1.3 s for timed up-and-go. CONCLUSIONS: The results of responsiveness for 1-min stair climbing, 50-ft walk, and timed up-and-go implies that these have the ability to detect changes in physical capacity over time in patients with chronic LBP who have undergone lumbar fusion surgery.

The OARSI core set of performance-based measures for knee osteoarthritis is reliable but not valid and responsive.

PURPOSE: The Osteoarthritis Research Society International has identified a core set of performance-based tests of physical function for use in people with knee osteoarthritis (OA). The core set consists of the 30-second chair stand test (30-s CST), 4 × 10 m fast-paced walk test (40 m FPWT) and a stair climb test. The aim of this study was to evaluate the reliability, validity and responsiveness of these performance-based measures to assess the ability to measure physical function in knee OA patients. METHODS: A prospective cohort study of 85 knee OA patients indicated for total knee arthroplasty (TKA) was performed. Construct validity and responsiveness were assessed by testing of predefined hypotheses. A subgroup (n = 30) underwent test-retest measurements for reliability analysis. The Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form, pain during activity score and knee extensor strength were used as comparator instruments. Measurements were obtained at baseline and 12 months after TKA. RESULTS: Appropriate test-retest reliability was found for all three tests. Intraclass correlation coefficient (ICC) for the 30-s CST was 0.90 (95% CI 0.68; 0.96), 40 m FPWT 0.93 (0.85; 0.96) and for the 10-step stair climb test (10-step SCT) 0.94 (0.89; 0.97). Adequate construct validity could not be confirmed for the three tests. For the 30-s CST, 42% of the predefined hypotheses were confirmed; for the 40 m FPWT, 27% and for the 10-step SCT 36% were confirmed. The 40 m FPWT was found to be responsive with 75% of predefined hypothesis confirmed, whereas the responsiveness for the other tests could not be confirmed. For the 30 s CST and 10-step SCT, only 50% of hypotheses were confirmed. CONCLUSIONS: The three performance-based tests had good reliability, but poor construct validity and responsiveness in the assessment of function for the domains sit-to-stand movement, walking short distances and stair negotiation. The findings of the present study do not justify their use for clinical practice. LEVEL OF EVIDENCE: Level 1. Diagnostic study.

Impact of treatment strategy and physical performance on future knee-related self-efficacy in individuals with ACL injury.

BACKGROUND: In people with anterior cruciate ligament (ACL) injury, high self-efficacy facilitates recovery, indicated by improved muscle function, reduced knee symptoms and increased physical activity. Impact of treatment on future self-efficacy is however not well investigated. The aims of the study were to 1) investigate knee-related self-efficacy 6 years after acute ACL injury in patients treated with exercise therapy alone or in combination with either early or the option of delayed ACL reconstruction (ACLR), and 2) to investigate associations between single-leg physical performance at various time points after ACL injury and knee self-efficacy at 6 years after injury. METHODS: Participants (n = 121) originated from the KANON-study (ISRCTN84752559), a treatment RCT including active adults with acute ACL injury treated with structured exercise therapy combined with early or the option of delayed ACLR. In this ancillary study, participants with knee self-efficacy data at 6 years (n = 89) were analyzed as treated; exercise therapy alone (n = 20), exercise therapy plus early ACLR (n = 46), and exercise therapy plus delayed ACLR (n = 23). The participants performed physical performance tests (hop, strength and balance) at the end the of exercise therapy (mean 10 (SD 6) months), and at 5 years, and rated their knee self-efficacy using Knee Self-Efficacy Scale (K-SES) questionnaire (0 to 10, worst to best) at 6 years. RESULTS: Median K-SES score for the total group (n = 89) was 7.8 (IQR 5.9-9.0). There were no differences between treatment groups in K-SES scores at 6 years nor in physical performance at any time point (p ≥ 0.097). Worse knee flexion strength LSI (rsp = 0.341, p = 0.042) at the end of the exercise therapy, and worse LSI for single-leg hop test (rsp = 0.310, p = 0.005) at the end of the exercise therapy and at 5 years, correlated moderately with worse knee-related self-efficacy at 6 years. Low associations were observed between the remaining physical performance tests and K-SES scores (rsp ≤ 0.265, p ≥ 0.045). CONCLUSION: Knee-related self-efficacy at 6 years after ACL injury did not differ between those treated with ACLR, performed early or as a delayed procedure, or exercise therapy alone. Good physical performance at the end of the exercise therapy, and at 5 years, appears to have a positive, yet small, impact on future knee-related self-efficacy.

Protein-Energy Malnutrition Causes Deficits in Motor Function in Adult Male Rats.

BACKGROUND: Adult protein-energy malnutrition (PEM) often occurs in combination with neurological disorders affecting hand use and walking ability. The independent effects of PEM on motor function are not well characterized and may be obscured by these comorbidities. OBJECTIVE: Our goal was to undertake a comprehensive evaluation of sensorimotor function with the onset and progression of PEM in an adult male rat model. METHODS: In Expt. 1 and Expt. 2, male Sprague-Dawley rats (14-15 wk old) were assigned ad libitum access for 4 wk to normal-protein (NP) or low-protein (LP) diets containing 12.5% and 0.5% protein, respectively. Expt. 1 assessed muscle strength, balance, and skilled walking ability on days 2, 8, and 27 by bar-holding, cylinder, and horizontal ladder walking tasks, respectively. In addition to food intake and body weight, nutritional status was determined on days 3, 9, and 28 by serum acute-phase reactant and corticosterone concentrations and liver lipids. Expt. 2 addressed the effect of an LP diet on hindlimb muscle size. RESULTS: PEM evolved over time in rats consuming the LP diet. Total food intake decreased by 24% compared with the NP group. On day 28, body weight and serum albumin decreased by 31% and 26%, respectively, and serum α2-macroglobulin increased by 445% (P < 0.05) in the LP group compared with the NP group. Forelimb dysfunction (173% increase in adaptive flexed-arm-hang score) developed on day 2 in rats fed the LP diet (P < 0.001), whereas abnormal walking (34% decreased incidence of correct hindlimb placement) developed by day 27 (P < 0.05). Relative to the NP diet, the LP diet reduced the cross-sectional area of gastrocnemius medialis (P < 0.05). CONCLUSIONS: PEM in adult male rats causes a variety of sensorimotor abnormalities that develop at different stages of malnutrition. This model can be used in combination with disease models of sensorimotor deficits to examine the interactions between nutritional status, other treatments, and disease progression.

Development and validation of a new performance-based measurement of instrumental activities of daily living in Taiwan.

BACKGROUND: The performance-based instrumental activities of daily living (IADL) measurement is thought to improve the validity and reliability of conventional tools that rely on proxy reports. The aims of this study were to develop and validate a performance-based measurement of IADL for use in elderly patients with cognitive impairment in Taiwan and other Chinese-speaking communities. METHODS: Referring to current versions of performance-based IADL, we developed the new Taiwan Performance-Based IADL (TPIADL) measurement to minimize literacy dependency and render it compatible with local culture. Participants performed tasks, including finding a telephone number, calculating the correct amount of change, reading the ingredients on a tin of food, finding food items on a shelf, and reading instructions on a medicine container. The internal consistency and convergent and criteria validity of the TPIADL were examined. RESULTS: Altogether, 117 elderly subjects were invited to participate in this study, including 39 patients with dementia due to Alzheimer's disease, 29 with amnestic mild cognitive impairment, and 49 without cognitive impairment. The internal consistency of the TPIADL was 0.82. The TPIADL scores were significantly correlated with the Lawton Instrumental Activities of Daily Living Scale (r = 0.76, P < 0.001). The area under the relative operating characteristic curve was 0.90 (95% confidence interval = 0.84-0.97) to differentiate dementia due to Alzheimer's disease and others. The optimal cut-off point for the TPIADL was 6/7, which gives a sensitivity of 84.6% and a specificity of 75.6%. CONCLUSIONS: The TPIADL is a validated instrument for the measurement of IADL in elderly subjects. It might replace conventional assessment as a valid and easily administered measurement.

Comparison of self-report and performance-based measures of everyday functioning in individuals with schizophrenia: implications for measure selection.

INTRODUCTION: Both self-report and performance-based measures are often used in assessment of everyday functioning for individuals with schizophrenia. However, there is little evidence of overlap between them, and there are no established standards for which measures might be most appropriate. In order to better understand differences among these types of measures, we examined relationships between a self-report and two performance-based measures of everyday functioning. We also examined their patterns of interrelationships to neurocognition and psychiatric symptoms. METHODS: Participants were 71 outpatients with schizophrenia spectrum disorder. Measures of everyday functioning (Independent Living Skill Survey-Self Report (ILSS-SR); University of California San Diego Performance-based Skills Assessment; and Medication Management Ability Assessment), cognition and psychiatric symptoms were administered. Correlation analyses were conducted to examine the relationships among the functioning measures, and their relationships to cognition and symptoms. Regression analyses further examined the unique contributions of neurocognitive and symptom variables to functional measures. RESULTS: Consistent with the literature, the two performance-based measures were related to each other, but not to the self-report measure. Whereas the performance-based measures were related to neurocognition but not to the psychiatric symptoms, the opposite pattern was observed for the self-report measure. CONCLUSIONS: The pattern of interrelationships among these self-report and performance-based measures suggests that they tap different aspects of everyday functioning. This has important implications for measure selection, particularly for evaluating intervention outcomes. When targeting symptoms, a self-report measure like the ILSS-SR may be more appropriate, whereas a performance-based measure may be more sensitive to functional changes subsequent to treatments targeting cognition.

Determination of Relationships between Symmetry-Based, Performance-Based, and Functional Outcome Measures in Patients Undergoing Total Hip Arthroplasty.

Due to the high heterogeneity in outcome measures after total hip arthroplasty (THA), the prospective observational study investigated the relationships between symmetry-based (SBMs), performance-based (PBMs), and functional outcome measures in THA patients to determine necessary or redundant categories of tests. The study material consisted of 24 patients with end-stage hip osteoarthritis scheduled for THA. The patients were examined one day before surgery and consecutively on the 4th day, 9th day, and 10th week postoperatively using the SBMs (weight-bearing chair-rising test, measurements of the maximal isometric torque of the quadriceps muscle); the PBMs (10-m walk, timed up-and-go, and stair-climbing tests); and the functional outcome measure (Harris Hip Score). The results obtained in a given category of tests at different time points were compared, and the correlations between the tests were determined. The reliability of the outcome measures was determined. The results of tests in the studied categories statistically significantly (p < 0.05) improved at the 10th week postoperatively compared to preoperative results. No strong correlations were revealed between the three studied types of outcome measures in THA patients. Therefore, none of them can be considered redundant. It also means that the relevance of symmetry for a core measurement set to describe the domain function in THA patients must be further clarified.

Reliability and validity of the two-minute step test in patients with total knee arthroplasty.

PURPOSE: To investigate the test-retest reliability and concurrent validity of 2MST for assessing the physical performance of patients with total knee arthroplasty (TKA). MATERIALS AND METHODS: Fifty-one patients with TKA, aged more than 18 years, of both sexes, and underwent a primary TKA at least six months ago, were included in this study. The intraclass correlation coefficient (ICC) and 95% confidence interval (CI), standard error of measurement (SEM), and minimum detectable change at the 95% confidence level (MDC95) were used to determine the reliability of 2MST. In the validity, the correlations of the 2MST between the six-minute walk test (6MWT) and the two-minute walk test (2MWT) were assessed. RESULTS: The reliability of 2MST was excellent (ICC = 0.97, SEM = 2.76, MDC95 = 7.6). There was a moderate correlation between 2MST and 6MWT (r = 0.586; p = 0.000), as well as between 2MST and 2MWT (r = 0.633; p = 0.000). CONCLUSIONS: 2MST proved to be a reliable and valid physical performance test in patients with TKA. 2MST can be used to evaluate the physical performance of TKA patients.ClinicalTrials.gov Identifier: NCT05064943Implications for RehabilitationThe two-minute step test (2MST) is a reliable and valid test for the assessing the physical performance of patients with total knee arthroplasty (TKA).2MST is an easy-to-administer, low-cost, and quick performance-based test that can be used routinely in any clinical setting to evaluate functional recovery after TKA.The changes of 8 or more steps for 2MST over time may represent a true change in the rehabilitation of patients with TKA.

Thirty second chair stand test: Test-retest reliability, agreement and minimum detectable change in people with early-stage knee osteoarthritis.

BACKGROUND AND PURPOSE: To determine intra-session test-retest reliability, agreement and minimum detectable change (MDC) of the 30 CST across three tests in people with knee osteoarthritis (OA). METHODS: A test-retest reliability study was performed with 93 people with mild radiological knee OA. Participants were asked to complete three attempts of the 30 CST 1-2 min apart according to a standardised protocol. Participants completed three attempts on two occasions: baseline and 6 months later. Change between tests within each session was assessed with ANOVA's and post-hoc t-tests. Reliability was assessed with intra-class correlation coefficients (ICC[2,1] ). Measurement error was expressed as MDC for an individual (MDCind ) and a group (MDCgroup ). Floor effects were considered present if more than 15% of participants scored zero for a test. RESULTS: Scores increased by 0.5 and 0.8 stands between the first and second test (p < 0.05) at the baseline and 6-month assessments respectively, and then stabilised between the second the third tests at the baseline assessment (p > 0.05) or decreased (0.3 stands) at the 6-month assessment (p < 0.05). Scores demonstrated excellent reliability (ICCs >0.9). MDCind was approximately 2.5 stands and MDCgroup was 0.3-0.4 stands. No floor effects were apparent. DISCUSSION: The 30CST demonstrated a practice effect between the first and second tests, which was no longer apparent by the third test. Despite this, scores demonstrated excellent intra-session reliability. MDC estimates provide clinicians and researchers with the smallest change that can be detected by the instrument beyond measurement error for individuals and groups in community-dwelling adults with knee OA.

Assessment of 'Cool' and 'Hot' Executive Skills in Children with ADHD: The Role of Performance Measures and Behavioral Ratings.

Executive dysfunction is an underlying characteristic of Attention Deficit/Hyperactivity Disorder (ADHD). Therefore, this study explored which measures of executive functions (EF) may lead to a better diagnostic prediction and evaluated whether participants were adequately assigned to the ADHD group based on the identified predictors. Seventeen 6- to 10-year-old children with ADHD were matched with 17 typically developing peers (TD) by age, gender, and non-verbal intelligence. Performance-based measures and behavior ratings of 'cool' and 'hot' EF were used. As expected, there was a significant group effect on the linear combination of measures, indicating that children with ADHD showed significant difficulties with EF compared to the TD group. In fact, significant differences were found in measures of short-term and working memory, planning, delay aversion, and EF-related behaviors, as reported by parents and teachers. However, the discriminant function analysis only revealed three significant predictors: the General Executive Composite of the Behavior Rating Inventory of Executive Function (Parent and Teacher Forms) and the Delay of Gratification Task, with 97.1% correct classifications. These findings highlight the importance and contribution of both behavioral ratings and 'hot' measures of EF for the characterization of ADHD in children.

The right pick: Does a self-assessment measurement tool correctly identify health care consumers with inadequate health literacy?

OBJECTIVES: The aim of this study was to investigate whether a self-report measurement instrument (the Brief Health Literacy Screen, BHLS) correctly identifies healthcare consumers with inadequate health literacy. The yardstick for assessing the tool was the Newest Vital Sign (NVS). METHODS: The study used baseline data from the Västerbotten Intervention Programme - VIsualiZation of Asymptomatic Atherosclerotic disease for Optimum Cardiovascular Prevention (VIPVIZA), a randomized controlled trial that is nested within the Västerbotten Intervention Program (VIP) in Sweden. Our analyses were computed on a subsample of 460 persons who underwent the measure of both health literacy scales. ROC analysis was used for the crucial computations. RESULTS: The potential of the BHLS to identify healthcare consumers with inadequate health literacy remained unsatisfying for the complete sample, but reached an acceptable level for women and persons with only basic education. CONCLUSIONS: The relationship is somewhat weaker than in comparable research in various other European countries. The differences might partly have been caused by the use of self-perception questions. Self-delusions, invariably a part of self-perception, may have affected the respective measure. PRACTICE IMPLICATIONS: Caution is advised when patients' health literacy is assessed by only a few questions for self-report.

Multimethod Assessment of Attention, Executive Functions, and Motor Skills in Children With and Without ADHD: Children's Performance and Parents' Perceptions.

Objective: We examined whether children with attention-deficit/hyperactivity disorder (ADHD) differ from children without ADHD in attention, executive functions, and motor skills and whether measures of parents' perceptions and children's performance reveal comparable results. Method: About 52 children with ADHD and 52 children without ADHD aged 6 to 13 years completed performance-based measures of attention, executive functions, and motor skills. Parents completed questionnaires to rate their children's skills. Results: Parent questionnaires but not performance-based measures revealed higher inattention and lower executive function skills in children with ADHD compared to controls. For motor skills, both measurement methods revealed lower mean values and a higher number of children showing an impairment in the ADHD group. Parent-reported difficulties but not performance-based measures were related to the presence of an ADHD diagnosis. Conclusion: Our findings suggest that considering both parent questionnaires and performance-based measures will lead to a comprehensive picture of a child's strengths and difficulties.

Confirmatory Factor Analysis of the BRIEF-2 Parent and Teacher Form: Relationship to Performance-Based Measures of Executive Functions and Academic Achievement.

We conducted two empirical studies to (1) explore the dimensionality of the Behavior Rating Inventory of Executive Function-2 (BRIEF-2) parent and teacher forms, (2) examine the association between the parent and teacher reports, and (3) analyze the relationship between the BRIEF-2 ratings and performance-based measures of executive functions (EFs) (including working memory, inhibition, and shifting tasks) and academic achievement in children. In Study 1 (n = 212 parents; n = 111 teachers), confirmatory factor analysis (CFA) showed that a three-factor solution that included the indices of (1) behavior regulation, (2) emotion regulation, and (3) cognitive regulation best fit the data. In Study 2 (n = 275 8- to 12-year-old Spanish-speaking children), selective and low correlations were found between performance- and rater-based measures of EFs. In addition, low to moderate correlations were found between parent and teacher reports. However, the three indices of both forms of the BRIEF-2 were associated with the diverse academic domains analyzed, although differences emerged depending on the informant (teacher vs. parent). Our results support the hypothesis that the two EF measures document different underlying processes. The clinical and educational implications of considering both perspectives in the assessment of EFs in children with typical development and in children with neurodevelopmental disorders are discussed.

Concordance of teacher-rated and performance-based measures of executive functioning in preschoolers.

The most common method used to evaluate child behavior and functioning is rating scales completed by parents and/or teachers. Given that executive functioning (EF) plays a fundamental role in the developing child's cognitive, behavioral, and social-emotional development, it would be ideal if ratings of EF and performance-based EF measures assess the same construct. However, most studies report a small to negligible association between performance-based measures and ratings of EF. There are few studies investigating this association for preschoolers, and most only include parent ratings. Teachers may be more reliable reporters of EF behaviors due to the higher demand for EF skills in the preschool setting than at home and because teachers may have a better sense of what behaviors are normative. In this study, we reviewed the associations between three EF rating scales completed by teachers on 243 preschool children. Results showed small to moderate correlations with EF measures of inhibition and cognitive flexibility/switching for all three scales, with the strongest associations observed between Child Behavior Rating Scale (CBRS) Behavioral Regulation subscale and child EF measures. Exploratory multivariate path analyses showed that, after controlling for age, sex, and socioeconomic status (SES), Behavioral Regulation significantly predicted performance-based measures of EF and accounted for incrementally more variance in the models. We conclude that in ideal situations, it is best to measure EF using both rating scales and performance-based measures of EF. The CBRS seems to be a sensitive measure of EF in preschoolers and may be a helpful brief screening tool for use with teachers.

The Childhood Executive Functioning Inventory (CHEXI): Factor structure, measurement invariance, and correlates in US preschoolers.

This study tests the factor structure, measurement invariance, and correlates of the Childhood Executive Functioning Inventory (CHEXI) with a large and diverse sample of 3- to 5-year-olds (n = 844). Consistent with previous studies, a two-factor model that distinguishes working memory from inhibition provides the best fit to the observed data. This two-factor model has been shown to demonstrate strong measurement invariance for different subgroups of children (boys vs. girls, high vs. low income). Whereas boys tend to have greater working memory and inhibition difficulties (Cohen's d = 0.15 and 0.20, respectively), children from low-income households tend to have more working memory problems than their peers from high-income households (Cohen's d = 0.25). Finally, correlations between CHEXI scores, examiner reports of child behavior, and child performance on a battery of executive function (EF) tasks were investigated. CHEXI scores were found to be more consistently related to examiner reports of child behavior than child performance on EF tasks. Tthe strengths and weaknesses of the CHEXI as a questionnaire measure of EF are discussed, and directions for future research are suggested.

Agreement between test procedures for the single-leg hop for distance and the single-leg mini squat as measures of lower extremity function.

BACKGROUND: Different test procedures are often used within performance-based measures, causing uncertainty as to whether results can be compared between studies. Thus, the aim of this study was to assess agreement between different test procedures for the single-leg hop for distance (SLHD) and the single-leg mini squat (SLMS), respectively, two commonly used tasks for assessing deficiency in lower extremity muscle function. METHODS: Twenty-three participants (20-42 years) with lower extremity injury performed the SLHD with arms free and with arms behind back, and the Limb Symmetry Index (LSI; injured leg divided by uninjured and multiplied by 100) was calculated. Another group of 28 participants (mean 18-38 years) performed five SLMSs at a pre-defined speed and maximum number of SLMSs during 30 seconds, and were visually observed and scored as either having a knee-over-foot or a knee-medial-to-foot position (KMFP). RESULTS: No systematic difference between test procedures for the LSI of the SLHD was noted (p=0.736), Cohen's kappa = 0.42. The Bland & Altman plot showed wide limits of agreement between test procedures, with particularly poor agreement for participants with abnormal LSI (<90%). Ten participants were scored as having a KMFP during five SLMSs at a predefined speed, while five had a KMFP during maximum number of SLMSs during 30 seconds (p=0.063, Cohen's kappa = 0.56). CONCLUSIONS: The moderate agreement between the two test procedures for the SLHD and the SLMS, respectively, indicate that results from these different test procedures should not be compared across studies. SLHD with arms behind back, and five SLMSs at a pre-defined speed, respectively, were the most sensitive procedures to detect individuals with poor functional performance.

Measurement properties of visual rating of postural orientation errors of the lower extremity - A systematic review and meta-analysis.

OBJECTIVES: To systematically review measurement properties of visual assessment and rating of Postural Orientation Errors (POEs) in participants with or without lower extremity musculoskeletal disorders. METHODS: A systematic review according to the PRISMA guidelines was conducted. The search was performed in Medline (Pubmed), CINAHL and EMBASE (OVID) databases until August 2016. Studies reporting measurement properties for visual rating of postural orientation during the performance of weight-bearing functional tasks were included. No limits were placed on participant age, sex or whether they had a musculoskeletal disorder affecting the lower extremity. RESULTS: Twenty-eight articles were included, 5 of which included populations with a musculoskeletal disorder. Visual rating of the knee-medial-to-foot position (KMFP) was reliable within and between raters, and meta-analyses showed that this POE was valid against 2D and 3D kinematics in asymptomatic populations. Other segment-specific POEs showed either poor to moderate reliability or there were too few studies to permit synthesis. Intra-rater reliability was at least moderate for POEs within a task whereas inter-rater reliability was at most moderate. CONCLUSIONS: Visual rating of KMFP appears to be valid and reliable in asymptomatic adult populations. Measurement properties remain to be determined for POEs other than KMPF.