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Andrade KKS, Soares LA, Macedo CC, Bispo NR, Sousa Junior RR, Oliveira VC, Leite HR, Gaiad TP. Qualidade dos instrumentos que avaliam Atividade e Participação de pessoas com distrofia muscular: uma revisão sistemática de medidas de resultado relatadas pelos pacientes. Dev Med Child Neurol 2022; 64:e5-e14. [PMID: 35941753 DOI: 10.1111/dmcn.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Keysy K S Andrade
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil
| | - Luana A Soares
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil
| | - Caik C Macedo
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil
| | - Nelcilaine R Bispo
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil
| | - Ricardo R Sousa Junior
- Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Vinícius C Oliveira
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil
| | - Hércules R Leite
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil.,Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Thaís P Gaiad
- Departamento de Fisioterapia, Faculdade de Ciências básicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brasil
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Andrade KKS, Soares LA, Macedo CC, Bispo NR, Sousa Junior RR, Oliveira VC, Leite HR, Gaiad TP. Quality of instruments assessing activity and participation of people with muscular dystrophy: A systematic review of participant-reported outcome measures. Dev Med Child Neurol 2022; 64:1453-1461. [PMID: 35862363 DOI: 10.1111/dmcn.15345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 01/31/2023]
Abstract
AIM To identify the standardized assessment scales for people with muscular dystrophy and investigate the quality/level of evidence of their measurement properties. METHOD A systematic review of patient-reported outcome measures was conducted on the MEDLINE, Embase, AMED, DiTA, and PsycINFO databases in August 2020. We included psychometric studies that investigated the validity, reliability, and responsiveness of instruments assessing activity and participation for muscular dystrophy of any type (Duchenne, Becker, limb-girdle, facioscapulohumeral, congenital, and myotonic) or age. Two independent reviewers selected the studies, extracted data, and evaluated the instruments' quality and level of evidence following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 guidelines. RESULTS The searches identified 6675 references; a total of 46 studies with 28 condition-specific or general instruments were included. The measurement properties of most instruments had sufficient (68.8%) or indeterminate (25.7%) results according to COSMIN. The quality of evidence of the measurement properties was moderate (23.8%) or low (22.6%) according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). INTERPRETATION There is a lack of high-quality instruments whose psychometric properties are adequately measured. The highest quality instrument is the Muscular Dystrophy Functional Rating Scale. The Motor Function Measure (general instrument), Duchenne Muscular Dystrophy Upper-limb Patient-reported Outcome Measure, North Star Ambulatory Assessment, and Myotonic Dystrophy Type 1 Activity and Participation Scale for Clinical Use (specific) are also recommended. WHAT THIS PAPER ADDS There are 28 available instruments for activity and participation of people with muscular dystrophy. The evidence quality is moderate or low because of imprecision and indirectness. The Muscular Dystrophy Functional Rating Scale is the highest quality instrument. The Motor Function Measure is the second most recommended instrument. The Duchenne Muscular Dystrophy Upper-limb Patient-reported Outcome Measure, North Star Ambulatory Assessment, and Myotonic Dystrophy Type 1 Activity and Participation Scale for Clinical Use are also recommended.
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Affiliation(s)
- Keysy K S Andrade
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Luana A Soares
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Caik C Macedo
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Nelcilaine R Bispo
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ricardo R Sousa Junior
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vinícius C Oliveira
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Hércules R Leite
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.,School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thaís P Gaiad
- Department of Physical Therapy, Faculty of Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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International Delphi Recommendations for Pediatric Lower Limb Neurological Test Protocols for Muscle Strength, Reflexes, and Tactile Sensitivity. Pediatr Phys Ther 2022; 34:497-506. [PMID: 35943387 DOI: 10.1097/pep.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To gain consensus from physical therapists on pediatric lower limb neurological tests of muscle strength, tactile sensitivity, and reflexes. METHODS A Delphi technique was used for 2 sequential questionnaire rounds to gain consensus from a panel of pediatric physical therapists (n = 28). Physical therapists rated their agreement to items from statements on pediatric lower limb neurological tests, their protocols, and interpretation using a 6-point Likert scale. RESULTS Ninety percent of items gained consensus: 80% on pediatric lower limb neurological tests, 88% on test protocols, and 92% on test interpretation. Fifty-one percent of items had high agreement and high importance. CONCLUSION There is variability in pediatric neurological tests used, their protocols, and interpretation. Identification of items with high agreement and importance is the first step to develop a standardized lower limb neurological assessment for pediatric clients of varying ages and diagnoses.
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Clark R, Baque E, Wells C, Bialocerkowski A. Perceived Barriers, Enablers, and Modifications to Tests Assessing Pediatric Lower Limb Neurological Impairment: An International Delphi Survey. Phys Ther 2021; 101:6067299. [PMID: 33439245 DOI: 10.1093/ptj/pzaa233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/04/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Accurate, clinically meaningful outcome measures that are responsive to change are essential for selecting interventions and assessing their effects. Little guidance exists on the selection and administration of neurological impairment tests in children with a neurological condition. Clinicians therefore frequently modify adult assessments for use in children, yet the literature is inconsistent. This study aims to establish consensus on neurological conditions most likely to require neurological impairment test in pediatrics and the barriers, enablers, and modifications perceived to enhance test reliability. METHODS Over a 2-round modified Delphi study, a panel of experts (n = 24) identified neurological conditions perceived to typically require pediatric neurological testing and the modifications to address barriers/enablers to testing. Experts comprised physical therapists with evidence of advanced training or research in pediatrics. Using a 6-point Likert scale (6 = strongly agree, 5 = agree, 4 = somewhat agree, 3 = somewhat disagree, 2 = disagree, 1 = strongly disagree), experts rated statements from existing literature. Thematic analyses were conducted on responses to open-ended questions. A priori consensus was pre-set at 65% agreement/disagreement. Median, mode, and interquartile ranges estimated perceived importance. Cessation was pre-determined by non-consensus items <10% and panel fatigue. RESULTS Experts reached consensus on 107/112 (96%) items, including identifying 25/26 (96%) neurological conditions they perceived to require routine neurological testing. Experts strongly agreed with high importance that appropriately trained, experienced therapists are less variable when testing children. Communication modifications were perceived as most important. CONCLUSION High levels of consensus support the use of lower limb neurological testing in a range of pediatric neurological conditions. Trained clinicians should document modifications such as visual aid use. Using recommended modifications could encourage consistency among clinicians. IMPACT This is the first study to our knowledge to identify the barriers and enablers to pediatric neurological testing. Barriers and enablers were partially addressed through suggested modifications. Further rigorous examination of these modifications is required to support their use. LAY SUMMARY This study supports that clinicians should adapt their communication for children and young people with neurological problems to include visual aids and equipment demonstration.
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Affiliation(s)
- Ramona Clark
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Emmah Baque
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Cherie Wells
- School of Community Health, Charles Sturt University, New South Wales, Australia
| | - Andrea Bialocerkowski
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
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Sousa Junior RR, Gontijo APB, Santos TRT, Wright FV, Mancini MC. Measurement Properties and Translation to Brazilian-Portuguese of the Challenge for Children and Adolescents with Cerebral Palsy. Phys Occup Ther Pediatr 2021; 41:372-389. [PMID: 33342345 DOI: 10.1080/01942638.2020.1859663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face validity, evaluate the reliability of the total score and score per item, investigate whether the child's gross motor level (classified by the Gross Motor Function Classification System-GMFCS) influences the reliability levels, and estimate responsiveness to change.Methods: The translation followed four stages: translation, synthesis, back-translation, and review. For face validity, ten physical therapists evaluated item relevance. Children and adolescents with cerebral palsy (n = 50, 5-18 years of age) GMFCS I and II were evaluated by two therapists for inter and intra-rater reliability. Thirty of these participants were recruited for the instrument's responsiveness evaluation and reassessed (n = 28) after three months of treatment. Minimal Detectable Change (MDC), and Minimal Clinically Important Difference (MCID) were estimated.Results: The back-translated version was similar to the English version. All test items were considered relevant by the physical therapists. Total score intra and inter-rater reliability were excellent for both GMFCS levels (ICC = 0.94-0.99). Items' intra- and inter- rater reliability varied from low to almost perfect (kw=-0.14-0.94). MDC90 and MDC95 values were 3.90-6.35 and 4.63-7.54, respectively. MCID values were 3.57-4.56.Conclusion: The translated version of the Challenge showed excellent face validity and reliability and was able to document longitudinal change.
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Affiliation(s)
| | | | | | | | - Marisa C Mancini
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Clinimetric properties of lower limb neurological impairment tests for children and young people with a neurological condition: A systematic review. PLoS One 2017; 12:e0180031. [PMID: 28671957 PMCID: PMC5495217 DOI: 10.1371/journal.pone.0180031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Abstract
Background Clinicians and researchers require sound neurological tests to measure changes in neurological impairments necessary for clinical decision-making. Little evidence-based guidance exists for selecting and interpreting an appropriate, paediatric-specific lower limb neurological test aimed at the impairment level. Objective To determine the clinimetric evidence underpinning neurological impairment tests currently used in paediatric rehabilitation to evaluate muscle strength, tactile sensitivity, and deep tendon reflexes of the lower limb in children and young people with a neurological condition. Methods Thirteen databases were systematically searched in two phases, from the date of database inception to 16 February 2017. Lower limb neurological impairment tests were first identified which evaluated muscle strength, tactile sensitivity or deep tendon reflexes in children or young people under 18 years of age with a neurological condition. Papers containing clinimetric evidence of these tests were then identified. The methodological quality of each paper was critically appraised using standardised tools and clinimetric evidence synthesised for each test. Results Thirteen papers were identified, which provided clinimetric evidence on six neurological tests. Muscle strength tests had the greatest volume of clinimetric evidence, however this evidence focused on reliability. Studies were variable in quality with inconsistent results. Clinimetric evidence for tactile sensitivity impairment tests was conflicting and difficult to extrapolate. No clinimetric evidence was found for impairment tests of deep tendon reflexes. Conclusions Limited high-quality clinimetric evidence exists for lower limb neurological impairment tests in children and young people with a neurological condition. Results of currently used neurological tests, therefore, should be interpreted with caution. Robust clinimetric evidence on these tests is required for clinicians and researchers to effectively select and evaluate rehabilitation interventions.
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Kenyon LK, Westman M, Hefferan A, McCrary P, Baker BJ. A home-based body weight supported treadmill training program for children with cerebral palsy: A case series. Physiother Theory Pract 2017; 33:576-585. [PMID: 28557625 DOI: 10.1080/09593985.2017.1325956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Contemporary approaches to the treatment of cerebral palsy (CP) advocate a task-specific approach that emphasizes repetition and practice of specific tasks. Recent studies suggest that body-weight-supported treadmill training (BWSTT) programs may be beneficial in clinical settings. The purposes of this case series were to explore the outcomes and feasibility of a home-based BWSTT program for three children with CP. CASE DESCRIPTION Three children with CP at Gross Motor Function Classification System (GMFCS) Levels III or IV participated in this case series. Examination included the Functional Assessment Questionnaire (FAQ), the 10-meter walk test, the Gross Motor Function Measure (GMFM-66), and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). A harness system was used to conduct the BWSTT program over an 8-12 week period. OUTCOMES All of the families reported enjoying the BWSTT program and found the harness easy to use. Participant 2 increased from a 2 to a 4 on the FAQ, while Participant 3 increased from a 6 to a 7. DISCUSSION Two of the participants demonstrated post-intervention improvements in functional mobility. In addition to mobility outcomes, future research should explore the potential health benefits of a home-based BWSTT program.
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Affiliation(s)
- Lisa K Kenyon
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Marci Westman
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Ashley Hefferan
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Peter McCrary
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
| | - Barbara J Baker
- a Department of Physical Therapy , Grand Valley State University , Grand Rapids , MI , USA
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