PSYCHOMETRIC PROPERTIES OF FUNCTIONAL CAPACITY TESTS IN CHILDREN AND ADOLESCENTS: SYSTEMATIC REVIEW

Upper Extremity Exercise Capacity and Muscle Oxygenation in Patients With Primary Ciliary Dyskinesia

BACKGROUND AND OBJECTIVES

Patients with primary ciliary dyskinesia (PCD) have a reduction in exercise capacity from the early stages. Although there are studies investigating these patients' lower extremity exercise capacity using various methodologies, there needs to be more research on the functional exercise capacity of the upper extremities. This study aimed to compare pulmonary function, upper extremity functional exercise capacity, muscle oxygenation, muscle strength, and physical activity level in children with PCD and controls.

METHODS

Twenty-seven children with PCD and 26 controls were included. Pulmonary function (spirometry), upper extremity functional exercise capacity (6-min pegboard and ring test (6PBRT), muscle oxygenation (Moxy device), deltoid muscle strength (dynamometer), and physical activity level (metabolic holter) were assessed.

RESULTS

Patients' FVC%, FEV1%, FEV1/FVC, PEF%, FEF25%-75%, deltoid muscle strength (%) were statistically decreased compared with controls (p < 0.05). The 6PBRT ring count, deltoid muscle oxygen saturations, and total hemoglobin levels were similar in both groups (p > 0.05).

DISCUSSION

Pulmonary function deteriorates and upper extremity muscle strength decreases in children with PCD. The upper extremity exercise capacity of these patients remains preserved. However, upper extremity resting muscle oxygen saturation is lower in children compared to healthy children. Most patients and healthy children are inactive. The upper extremity exercise capacity possibly declines due to deteriorating pulmonary function as the patients get older, which needs to be investigated routinely. Both upper-lower extremity aerobic exercise training applied consistently and physical activity counseling as part of their pulmonary rehabilitation program should be considered in children with PCD.

The PAY test: a new approach for assessing functional performance in children and adolescents with asthma

OBJECTIVE

To develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth).

METHODS

participants without and with asthma were included in the development and validation phases, respectively. The PAY test includes five activities: transition from sitting to standing, walking 10 m, step climbing, shoulder extension and flexion, and star jumps. Participants underwent the Pediatric Glittre test (TGlittre-P test time), modified shuttle test (MST), and cardiopulmonary exercise test (CPET).

OUTCOMES

PAY test and TGlittre-P test times, oxygen uptake (VO2peak), and distance walked in the MST.

RESULTS

8 healthy volunteers, aged 12 (7 - 15) years old were included in the development phase and 34 participants with asthma, aged 11 (7 -14) years old, in the validation phase. The PAY test elicited greater physiological responses (VO2peak 33.5 ± 6.9 mL/kg) than the TGlittre-P (VO2peak: 27.4 ± 9.0 mL/kg), but lower than the MST (VO2peak: 48.9 ± 14.2 mL/kg) and CPET (VO2peak: 42.0 ± 8.8 mL/kg), p < .05. Moderate correlation between the PAY test time and the TGlittre-P time (r = 0.70, p < .001) and distance walked in the MST (r = -0.72, p < .001). The PAY test time was longer in participants with asthma than in healthy participants (3.1 [3.0 - 3.3] min vs. 2.3 [2.1 - 2.4 min]), p < .001.; and the test was reproducible (ICC 0.78, CI 95% 0.55-0.90, p < .001).

CONCLUSIONS

The PAY test is a valid and reproducible tool for assessing functional performance in children and adolescents with asthma.

Measurement properties of the six-minute pegboard and ring test (6PBRT) in healthy adolescents

OBJECTIVES

To investigate the cardiorespiratory responses to the 6-min pegboard and ring test (6PBRT) and to assess its reproducibility in healthy adolescents.

METHODS

It was a cross-sectional study with 52 healthy adolescents (11-18 years old of both genders). The 6PBRT was performed twice on two different days by the same examiner. Intra-rater reliability, percentage of the minimal difference chance (MDC%) and agreement of the number of moving rings were analyzed. Also, cardiopulmonary parameters were collected before and after tests.

RESULTS

Intraclass correlation coefficient (ICC) for the number of rings moved was 0.87 (95%CI 0.69-0.93). The mean number of moved rings during the second test was higher. The MDC% with a 95 % confidence interval was greater than acceptable values. Bland-Altman analysis did not show agreement between measurements (bias = 30.1); with upper and lower limits of agreement of -67.8 to 127.9, respectively. There was a significant increase in dyspnea, fatigue and HR values at the end of the tests (p < 0.0001). In both tests, participants reached HR equivalent to 48 % of the maximum predicted.

CONCLUSION

Together, the results suggest that the 6PBRT is not a reliable measure for a population of healthy adolescents, which indicates the necessity to perform more than one test. The 6PBRT is suggested to be a submaximal test for this population.

Reliability and validity of physical fitness tests in people with mental disorders: A systematic review and meta-analysis

BACKGROUND

Several tests are available to assess the different components of physical fitness, including cardiorespiratory fitness, muscular strength, and flexibility. However, the reliability and validity of physical fitness tests in people with mental disorders has not been meta-analyzed.

AIMS

To examine the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders.

METHODS

Studies evaluating the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders were searched from major databases until January 20, 2020. Random-effects meta-analyses were performed pooling (1) reliability: test-retest correlations at two-time points, (2) convergent validity between submaximal tests and maximal protocols, or (3) concurrent validity between two submaximal tests. Associations are presented using r values and 95% confidence intervals. Methodological quality was assessed using the Quality Appraisal of Reliability Studies and the Critical Appraisal Tool.

RESULTS

A total of 11 studies (N = 504; 34% females) were included. Reliability of the fitness tests, produced r values ranging from moderate (balance test-EUROFIT; [r = 0.75 (0.60-0.85); p = 0.0001]) to very strong (explosive leg power EUROFIT; [r = 0.96 (0.93-0.97); p = 0.0001]). Convergent validity between the 6-min walk test (6MWT) and submaximal cardiorespiratory tests was moderate (0.57 [0.26-0.77]; p = 0.0001). Concurrent validity between the 2-min walk test and 6MWT (r = 0.86 [0.39-0.97]; p = 0.0004) was strong.

CONCLUSION

The present study demonstrates that physical fitness tests are reliable and valid in people with mental disorders.

Multichannel intraluminal impedance-pH and psychometric properties in gastroesophageal reflux: systematic review

OBJECTIVE

Systematically assess studies that have analyzed the psychometric properties of multichannel intraluminal impedance-pH for the diagnosis of gastroesophageal reflux. Systematically verify studies that have analyzed the psychometric properties of multichannel intraluminal impedance-pH regarding the diagnosis of gastroesophageal reflux disease in pediatric patients.

METHODS

Systematic review considering specific descriptors (children and adolescents, gastroesophageal reflux disease and multichannel intraluminal impedance-pH) and their synonyms. The systematic search was carried out in the MEDLINE/Ovid, Scopus, and Embase databases, considering the period from October 2017 to December 2018. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), which was used for study selection. The psychometric properties described in the studies were: sensitivity, specificity, accuracy, and reproducibility.

RESULTS

Sensitivity was discussed in most studies, with a result of more than 70% in four of them. Specificity was assessed only in conjunction with sensitivity, with values from 23% to 25% in two studies, and it reached 80% in a single study. Accuracy was assessed higher than 76% in one of the selected articles. The methodological quality of the studies demonstrated low risk of bias, and there was no significant concern related to applicability of the studies.

CONCLUSIONS

According to the selected studies, multichannel intraluminal impedance-pH was considered a safe and effective tool, presenting higher sensitivity values than pHmetry regarding the diagnosis of gastroesophageal reflux disease.

REPRODUCIBILITY OF PHYSIOLOGICAL VARIABLES OF THE SIX-MINUTE WALK TEST IN HEALTHY STUDENTS

OBJECTIVE

To verify the reproducibility of the six-minute walk test (6MWT) performance and its physiological variables in healthy students.

METHODS

This is as prospective cross-sectional study. The sample consisted of healthy students aged 6-12 years old from public and private schools in the region of Florianópolis City, Santa Catarina State, (Southern Brazil). The medical state was considered according to the health records and scores on the International Study of Asthma and Allergies in Childhood (ISAAC) and the spirometric values of forced expiratory volume in the first second and forced vital capacity above 80% of what was predicted. Two 6MWTs were conducted with a 30-minute interval between them, following the recommendations from the American Thoracic Society. Physiologic variables were recorded using the portable telemetric gas analyzer K4b2 (Cosmed®, Italy). For analysis, the dyspnea index, the perception of effort and performance variables identified in both 6MWT were considered. Data distribution was verified with the Shapiro-Wilk test and statistical analysis included paired t-test or Wilcoxon test, and intraclass correlation coefficient (ICC). The significance level adopted was 5%.

RESULTS

A total of 22 students with a mean age of 10.2±1.5 years participated in the study. The covered distance and the variation of oxygen consumption reproducibility between the two 6MWTs presented ICC=0.76 and ICC=0.86, respectively. There was also similar behavior of the physiological variables when comparing the two tests (p=0.001), especially the minute volume (MV), the oxygen consumption (VO2), and the carbon dioxide production (VCO2).

CONCLUSIONS

The 6MWT showed reproducible values, both in performance and physiological parameters, in the healthy students analyzed.

Sleep disturbance in children with attention-deficit hyperactivity disorder: A systematic review

The aim of the present systematic review was to compare sleep disorders in children, from 7 to 12 years old, with and without an attention-deficithyperactivity disorder (ADHD) diagnosis. Electronic literature search of PubMed, LILACS, Scopus, Web of Science and Cochrane Library databases was conducted in September 2017. We included cross-sectional observational studies comparing the sleep of children between 7 and 12 years old, with and without an ADHD diagnosis, reported according to the Diagnostic and Statistical Manual of Mental Disorders criteria. The studies with other research designs, those that included adolescents and/or adults in the sample and those who evaluated the sleep of children with ADHD and other associated comorbidities were excluded. A total of 1911 articles were identified. After analyzing, 8 articles were compatible with the theme and included in the review. For sleep evaluation, most of the studies used an objective measure together with another subjective measure. Three out of six studies that used objective measures did not observe any differences between children with and without ADHD diagnosis. Children with ADHD presented more sleep disturbances when compared to children without the diagnosis. These disorders were diverse, yet inconsistent among the surveys. More studies are needed to clarify and for robust results.