Measurement properties and feasibility of clinical tests to assess sit-to-stand/stand-to-sit tasks in subjects with neurological disease: a systematic review

Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments

INTRODUCTION

Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.

METHODS AND ANALYSIS

In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05998239; pre-results.

Reliability of the Five Times Sit to Stand Test performed remotely by multiple sclerosis patients

INTRODUCTION

Multiple Sclerosis, known main cause of non-traumatic neurological disability in adults, leads to changes in muscle strength, especially in the lower limbs. Assessing muscle strength in these patients is thus essential and can be achieved by the Five Times Sit to Stand Test (FTSST), commonly performed in person. Due to the COVID-19 pandemic and social distancing measured adopted, Brazilian physiotherapists turned to remote monitoring and assessment, supported by Resolution n° 516/2020, which required proving the reliability of tests. Given this scenario, this study sought to evaluate the intra- and inter-rater reliability of the Five Times Sit to Stand Test performed remotely and synchronously by multiple sclerosis patients.

METHODS

A sample of 33 individuals with relapsing-remitting Multiple Sclerosis (18 women and 15 men, mean age 43.7 ± 13.4 years) were remotely and synchronously by video call. Inter-rater reliability was evaluated by analyzing FTSST execution time, in seconds, timed by two different raters on the same video call. In turn, intra-rater reliability was assessed by analyzing the execution time recorded in two different video calls made by the same rater, within a 24-28-h interval. Descriptive and inferential data analysis were performed using SPSS 20.0 software. Means and standard deviation were calculated for descriptive statistic. Intraclass correlation coefficient (ICC), with a 0.05 significance level, standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for inferential analysis.

RESULTS

Data analysis showed excellent ICC values and low SEM and MDC values regarding inter-rater reliability (ICC: 0.993 (0.986-0.996); p-value: <0.001; SEM: 0.6 s; MDC: 1.6 s) and intra-rater reliability (ICC: 0.962 (0.925-0.981); p-value: <0.001; SEM: 1.4 s; MDC: 3.8 s).

CONCLUSION

Based on these values, FTSST performed remotely and synchronously by relapsing-remitting Multiple Sclerosis patients is reliable and can be used both by different raters, for assessment, or by the same rater, in pre- and post-test situations.

Informing the development of an outcome set and banks of items to measure mobility among individuals with acquired brain injury using natural language processing

BACKGROUND

The sheer number of measures evaluating mobility and inconsistencies in terminology make it challenging to extract potential core domains and items. Automating a portion of the data synthesis would allow us to cover a much larger volume of studies and databases in a smaller fraction of the time compared to the usual process. Thus, the objective of this study was to identify a comprehensive outcome set and develop preliminary banks of items of mobility among individuals with acquired brain injury (ABI) using Natural Language Processing (NLP).

METHODS

An umbrella review of 47 reviews evaluating the content of mobility measures among individuals with ABI was conducted. A search was performed on 5 databases between 2000 and 2020. Two independent reviewers retrieved copies of the measures and extracted mobility domains and items. A pre-trained BERT model (state-of-the-art model for NLP) provided vector representations for each sentence. Using the International Classification of Functioning, Disability, and Health Framework (ICF) ontology as a guide for clustering, a k-means algorithm was used to retrieve clusters of similar sentences from their embeddings. The resulting embedding clusters were evaluated using the Silhouette score and fine-tuned according to expert input.

RESULTS

The study identified 246 mobility measures, including 474 domains and 2109 items. Encoding the clusters using the ICF ontology and expert knowledge helped in regrouping the items in a way that is more closely related to mobility terminology. Our best results identified banks of items that were used to create a 24 comprehensive outcome sets of mobility, including Upper Extremity Mobility, Emotional Function, Balance, Motor Control, Self-care, Social Life and Relationships, Cognition, Walking, Postural Transition, Recreation, and Leisure Activities, Activities of Daily Living, Physical Functioning, Communication, Work/Study, Climbing, Sensory Functions, General Health, Fatigue, Functional Independence, Pain, Alcohol and Drugs Use, Transportation, Sleeping, and Finances.

CONCLUSION

The banks of items of mobility domains represent a first step toward establishing a comprehensive outcome set and a common language of mobility to develop the ontology. It enables researchers and healthcare professionals to begin exposing the content of mobility measures as a way to assess mobility comprehensively.

Scoring the Sit-to-Stand Performance of Parkinson's Patients with a Single Wearable Sensor

Monitoring disease progression in Parkinson's disease is challenging. Postural transfers by sit-to-stand motions are adapted to trace the motor performance of subjects. Wearable sensors such as inertial measurement units allow for monitoring motion performance. We propose quantifying the sit-to-stand performance based on two scores compiling kinematics, dynamics, and energy-related variables. Three groups participated in this research: asymptomatic young participants (n = 33), senior asymptomatic participants (n = 17), and Parkinson's patients (n = 20). An unsupervised classification was performed of the two scores to differentiate the three populations. We found a sensitivity of 0.4 and a specificity of 0.96 to distinguish Parkinson's patients from asymptomatic subjects. In addition, seven Parkinson's patients performed the sit-to-stand task "ON" and "OFF" medication, and we noted the scores improved with the patients' medication states (MDS-UPDRS III scores). Our investigation revealed that Parkinson's patients demonstrate a wide spectrum of mobility variations, and while one inertial measurement unit can quantify the sit-to-stand performance, differentiating between PD patients and healthy adults and distinguishing between "ON" and "OFF" periods in PD patients is still challenging.

Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors

BACKGROUND

Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF.

METHODS

For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models.

RESULTS

The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19).

CONCLUSIONS

This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.

Reliability and validity of sit-to-stand test protocols in patients with coronary artery disease

Background

Sit-To-Stand (STS) tests are reported as feasible alternatives for the assessment of functional fitness but the reliability of these tests in people with coronary artery disease (CAD) has not been reported. This study explored the test-retest reliability, convergent and known-groups validity of the five times, 30-sec and 1-min sit-to-stand test (FTSTS test, 30-s STS test and 1-min STS test respectively) in patients with CAD. The feasibility of applying these tests to distinguish the level of risk for cardiovascular events in CAD patients was also investigated.

Methods

Patients with stable CAD performed a 6MWT and 3 STS tests in random order on the same day. Receiver operating characteristic (ROC) curve analyses were conducted using STS test data to differentiate patients with low or high risk of cardiovascular events based on the risk level determined by distance covered in the 6MWT as &gt; or ≤ 419 m. Thirty patients repeated the 3 STS tests on the following day.

Results

112 subjects with diagnoses of atherosclerosis or post-percutaneous coronary intervention, or post-acute myocardial infarction (post-AMI) participated in the validity analysis. All 3 STS tests demonstrated moderate and significant correlation with the 6MWT (coefficient values r for the FTSTS, 30-s STS and 1-min STS tests were−0.53, 0.57 and 0.55 respectively). Correlations between left ventricular ejection fraction (LVEF) and all STS tests and between 6MWT and LVEF were only weak (r values ranged from 0.27 to 0.31). Subgroup analysis showed participants in the post-AMI group performed worse in all tests compared to non-myocardial infarction (non-MI) group. The area under the curve (AUC) was 0.80 for FTSTS (sensitivity: 75.0%, specificity: 73.8%, optimal cut-off: &gt;11.7 sec), and the AUC, sensitivity, specificity and optimal cut-off for 30-s STS and 1-min STS test were 0.83, 75.0%, 76.2%, ≤ 12 repetitions and 0.80, 71.4%, 73.8%, ≤ 23 repetitions respectively. The intraclass correlation coefficients (ICC) for repeated measurements of the FTSTS, 30-s STS and 1-min STS tests were 0.96, 0.95 and 0.96 respectively, with the minimal detectable change (MDC95) computed to be 1.1 sec 1.8 repetitions and 3.9 repetitions respectively.

Conclusions

All STS tests demonstrated good test-retest reliability, convergent and known-groups validity. STS tests may discriminate low from high levels of risk for a cardiovascular event in patients with CAD.

Assessment Tools to Evaluate Motor Function in People with Dementia: A Systematic Review

Background: In addition to cognitive changes, motor impairments have been observed in patients with dementia and are present early in the disease, even at the preclinical stage. Although it is difficult to assess motor function in this population, it is critical for monitoring disease progression and determining the efficacy of therapeutic interventions. However, the best measurement tools for assessing motor function in dementia patients have yet to be determined. Objective: We aimed to summarize and critically evaluate the measurement tools used to assess motor function indementia. Methods: A systematic review was conducted using the databases CENTRAL, MEDLINE, Embase, and PEDro from their inception to June 2021 to identify all experimental studies conducted in patients with dementia and that included an assessment of motor function. Two reviewers independently screened citations, extracted data, and assessed clinimetric properties. Results: We included 200 studies that assess motor function in dementia patients. Motor function was assessed using a total of 84 different measurement tools. Only nine (12% ) were used in over ten studies. The Timed-Up-and-Go test, 6MWT, Berg Balance Scale, and the Short Physical Performance Battery are all suggested. Conclusion: Currently, a wide variety of measurement instruments are used to assess motor performance in people with dementia, most instruments were not designed for this population and have not been validated for this use. We propose the development of an assessment protocol tailored to the different disease stages. We also recommend that future research continues to develop technological devices that can assist with this task.

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial

OBJECTIVE

To determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke.

MATERIALS AND METHODS

Twenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up.

RESULTS

The primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS.

CONCLUSION

The combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol

Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.

Quality of mobility measures among individuals with acquired brain injury: an umbrella review

Background and objective

While several mobility measures exist, there is large variability across measures in how mobility is conceptualized, the source of information and the measurement properties making it challenging to select relevant mobility measures for individuals with acquired brain injury (ABI). Therefore, the objective was to conduct a comprehensive synthesis of existing evidence on the measurement properties, the interpretability and the feasibility of mobility measures from various sources of information (patients, clinicians, technology) using an umbrella review of published systematic reviews among individuals with ABI.

Methods

Ovid MEDLINE, CINHAL, Cochrane Library and EMBASE electronic databases were searched from 2000 to March 2020. Two independent reviewers appraised the methodological quality of the systematic reviews using the Joanna Briggs Institute critical appraisal checklist. Measurement properties and quality of evidence were applied according to COnsensus-based Standards for the Selection of Health Measurement Instrument (COSMIN) guidelines. Mobility measures were categorized using international standards with the international classification of functioning, disability and health (ICF).

Results

Thirty-five systematic reviews were included covering 147 mobility measures, of which 85% were mapped to the ICF Activity and Participation component. Results showed an acceptable overall "sufficient" rating for reliability, construct validity and responsiveness for 132 (90%), 127 (86%) and 76 (52%) of the measures, respectively; however, among these measures, ≤ 25% of the methods for evaluating these properties were rated as ‘high’ quality of evidence. Also, there was limited information that supports measure feasibility and scoring interpretability.

Conclusions

Future systematic reviews should report measures’ content validity to support the use of the measure in clinical care and research. More evaluations of the minimal important difference and floor and ceiling effects are needed to help guide clinical interpretation.

Registration information

International Prospective Register of Systematic Reviews (PROSPERO); ID: CRD42018100068.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03103-4.

Feasible and clinical relevant outcome measures for adults with mitochondrial disease

There is no consensus on clinical outcome measures that reflect function, activities and participation which are suitable for adults with mitochondrial diseases (MD). The aim of this study was to determine feasible and clinically relevant outcome measures for patients with MD . In 156 adult patients with MD, endurance, balance, strength and mobility tests were evaluated. All tests showed a negative deviation to healthy reference values. Balance tests were feasible and significantly correlated with clinical severity. The Åstrand cycle test was not feasible in 55%, whereas the feasibility of the 6 min walking test is unclear in patients with MD.

The effectiveness of tele-rehabilitation on improvement of daily living activities in children with cerebral palsy: narrative review

Aim

To investigate the effectiveness of tele-rehabilitation for children diagnosed with unilateral cerebral palsy.

Method

The design of this study is a narrative review. An electronic search was conducted for studies that related to tele-rehabilitation using the following databases: CINAHL, PubMed, MEDLINE, OTSeeker, and PEDro. The data extracted were analyzed by evaluating them according to the key results, limitations, suitability of the methods used to the initial hypothesis, interpretation of the results, and impact of the conclusions in the field.

Results

Out of 139 studies, 3 studies met the inclusion criteria. Further, manual searches of the references of included studies identified 2 more relevant studies. The interventions applied in those studies were web-based multi-modal therapy program using Move-it-to-improve-it (Mitii™), home-based hand-arm bimanual intensive therapy (H-HABIT), and lower-extremity functional training (LIFT). The outcomes were executive functions, occupational performance, activity capacity, dexterity, quality of bimanual hand-use, functional goals, gait capacity, and performance.

Conclusion

Tele-rehabilitation is effective in improving the functions of the upper and lower extremities in daily living activities for children with unilateral cerebral palsy (UCP), aged between 2 to 18 years old, classified to levels I and II in GMFCS and levels I, II, and III in MACS. Webcam and good internet connection are essential requirements to conduct tele-rehabilitation. Children need to be contacted weekly via phone or e-mail for further follow-ups. Additionally, tele-rehabilitation may be considered one of the intervention strategies for patients who live in rural areas.

Analysis of 15 different pelvis marker protocols during sit-to-stand

Sit-to-stand (STS) is a common transition movement needed to perform daily tasks. Previously, the kinematics of the STS movement has been investigated using optical motion capture. This method uses cameras and reflective markers on the body to capture movements. During STS, these markers can be difficult to measure due to blocked vision from the chair's arm- and backrest. This can result in poor data quality. The aim of this study was to investigate 15 different marker protocols and compare them in terms of visibility and selected outcome measures: hip flexion mean angle and range of motion (ROM). Fourteen healthy subjects completed five successful trials of STS. Marker protocols consisted of three anterior marker protocols and five posterior marker protocols, combined into a total of 15 marker protocols. For visibility, the traditional pelvis marker protocol proved unsuitable for STS tracking. Marker pins or additional markers anteriorly, and sacrum markers posteriorly, proved to be more suitable alternatives. For hip flexion mean angle and ROM, the estimates had similar tendencies. Hence, marker protocols were not outcome measure specific. Anteriorly, marker pins resulted in similar estimates as the traditional pelvis marker protocol. Posteriorly, sacrum markers estimated a smaller hip flexion angle, compared to the traditional pelvis marker protocol. In conclusion, marker pins can be used instead of regular ASIS markers at anterior pelvis. Posteriorly, sacrum markers can be used instead of PSIS markers.

The clinical correlates of the chair sit to stand performance in people with multiple sclerosis

Objective: This study aimed to evaluate the motor and non-motor factors associated with sit-to-stand performance in people with Multiple Sclerosis (PwMS). Design: Observational cross-sectional study. Subjects: A total of 88 individuals with MS participated in this study. Main Measures: Standing performance was measured using the five-times-sit-to-stand test (FTSTS). The Berg Balance Scale to assess balance, the 10-Meter Walking Test (10-MWT) was used to assess walking speed; the Patient Determined Disease Steps (PDDS) was used to assess disability level. Furthermore, Brief International Cognitive Assessment for MS (BICAMS) was used to assess cognitive status, Hospital Anxiety and Depression scale (HADS) to assess depression and anxiety, and the Modified Fatigue Impact scale (MFIS) to evaluate fatigue. Spearman correlation coefficient was used to determine the relationship between all these variables and the FTSTS. Furthermore, multiple linear regression was conducted to determine predictive factors of the FTSTS. Results: FTSTS score was correlated significantly with BBS, PDDS, BICAMS, 10-MWT and MFIS (r ranged from 0.3 to 0.52; P < .05). However, there was no significant correlation observed between the FTSTS and HADS-depression or HADS-anxiety. Considering the multiple regression analysis, the following factors were significantly predictive of the FTSTS: 10-MWT, MFIS and the BICAMS-z score (R²: 0.433, P < .0001). Conclusion: The study concludes that sit to stand is multifactorial and is potentially associated with walking speed, cognitive function and fatigue. These factors should be considered by healthcare professionals in interpreting the sit-to-stand performance of PwMS and in designing rehabilitation interventions.

Impact of current or past physical activity level on functional capacities and body composition among elderly people: a cross-sectional analysis from the YMCA study

Background

Physical activity (PA) is recognized as important predictor of healthy aging. However, the influence of the type of voluntary PA as well as age or sex in this relationship is unclear. Thus, we assess the association between current and past PA level and physical performances among voluntary active older adults.

Methods

Functional capacities (timed Up and Go, sit-to-stand, alternate step test, unipodal balance, grip strength, knee extension strength, estimated muscle power and VO2 max) as well as body composition (DXA: total and appendicular lean masses (LM; kg), fat mass (FM; %)) were measured. Current and last 5-years PA level (time spent on total, aerobic, resistance and body & mind activities) were assessed using an interview. Multiple regressions, adjusted on age, sex and BMI, were performed to assess the relationship between current or past PA level and physical performances. Sub-group analysis, according to the sex (men/women) or age (< 65 yrs. vs. ≥65 yrs) were performed.

Results

525 subjects (age:61.7 ± 8.1 yrs.; women:68.9%; BMI:26.4 ± 4.8 kg/m²) were enrolled in this study. After adjustment on confounding factors, total current PA level has positive impact on total FM (β = − 2.09, p = 0004) and balance (β = 0.10; p = 0.05). Moreover, current body & mind activities influence total LBM (β = − 0.22, p = 0.02) and balance (β = 0.17; p = 0.001) whereas resistance activities influence total LBM (β = 0.17; p = 0.05), FM (β = − 0.16; p = 0.04) and sit-to-stand capacities (β = − 0.10; p = 0.05). Globally, these results were more pronounced in women than in men and among people aged over 65 years. Past level of PA has low impact on functional capacities and body composition, regardless of sex. Among people < 65 years, there is no relationship between time spent on total PA and functional capacities or body composition. However, a significant correlation was found between past total PA and balance (r=` 0.19; p = 0.01), alternate-step test (r = 0.24; p = 0.02) and VO2max (r = 0.19; p = 0.02) in people aged over 65 years. More precisely, the past time spent on aerobic and resistance activities influence balance (r = 0.16; p = 0.03 and r = 0.15; p = 0.04, respectively) after 65 yrs. old.

Conclusion

Even if physical activity history has little influence on physical aging process, being active is associated with body composition and functional capacities, especially among women aged 65 years and over.

Prevalence and factors associated with poor performance in the 5-chair stand test: findings from the Cognitive Function and Ageing Study II and proposed Newcastle protocol for use in the assessment of sarcopenia

BACKGROUND

Poor performance in the 5-chair stand test (5-CST) indicates reduced lower limb muscle strength. The 5-CST has been recommended for use in the initial assessment of sarcopenia, the accelerated loss of muscle strength and mass. In order to facilitate the use of the 5-CST in sarcopenia assessment, our aims were to (i) describe the prevalence and factors associated with poor performance in the 5-CST, (ii) examine the relationship between the 5-CST and gait speed, and (iii) propose a protocol for using the 5-CST.

METHODS

The population-based study Cognitive Function and Ageing Study II recruited people aged 65 years and over from defined geographical localities in Cambridgeshire, Newcastle, and Nottingham. The study collected data for assessment of functional ability during home visits, including the 5-CST and gait speed. We used multinomial logistic regression to assess the associations between factors including the SARC-F questionnaire and the category of 5-CST performance: fast (<12 s), intermediate (12-15 s), slow (>15 s), or unable, with slow/unable classed as poor performance. We reviewed previous studies on the protocol used to carry out the 5-CST.

RESULTS

A total of 7190 participants aged 65+ from the three diverse localities of Cognitive Function and Ageing Study II were included (54.1% female). The proportion of those with poor performance in the 5-CST increased with age, from 34.3% at age 65-69 to 89.7% at age 90+. Factors independently associated with poor performance included positive responses to the SARC-F questionnaire, physical inactivity, depression, impaired cognition, and multimorbidity (all P < 0.005). Most people with poor performance also had slow gait speed (57.8%) or were unable to complete the gait speed test (18.4%). We found variation in the 5-CST protocol used, for example, timing until a participant stood up for the fifth time or until they sat down afterwards.

CONCLUSIONS

Poor performance in the 5-CST is increasingly common with age and is associated with a cluster of other factors that characterize risk for poor ageing such as physical inactivity, impaired cognition, and multimorbidity. We recommend a low threshold for performing the 5-CST in clinical settings and provide a protocol for its use.

Responsiveness and Minimal Clinically Important Difference of the Five Times Sit-to-Stand Test in Patients with Stroke

This study aimed to analyze the responsiveness of the 5STS test among stroke patients and to estimate the MCIDs (minimal clinically important differences) for different severity levels of community ambulation and stages of recovery. The 5STS and comparator instruments (gait speed and Functional Ambulatory Category (FAC)) were evaluated at baseline. These measures were repeated at 4 (Stage 1) and 8 weeks (Stage 2), together with the Global Rating of Change (GROC). The MCIDs were calculated with two anchor-based methods using the GROC as the external criterion. Responsiveness to change for the 5STS was estimated analyzing the correlation with changes in the two comparator instruments and their capacity to discriminate improvement. For the 5STS test, while the MCIDs of the limited community ambulators were similar in the two stages (around 3 s), those of the household ambulators decreased from 1.9 s to 0.72 s. Spearman’s rho coefficients showed an acceptable correlation between changes in 5STS and changes for both the FAC and gait speed changes in both stages of recovery. Our study revealed that the 5STS is responsive to functional changes in patients with stroke and that their degree of severity and stage of recovery influence the MCID values of the 5STS.

Slow but Steady: Similar Sit-to-Stand Balance at Seat-Off in Older vs. Younger Adults

Many older adults suffer injuries due to falls as the ability to safely move between sitting and standing degrades. Unfortunately, while existing measures describe sit-to-stand (STS) performance, they do not directly measure the conditions for balance. To gain insight into the effect of age on STS balance, we analyzed how far 8 older and 10 young adults strayed from a state of static balance and how well each group maintained dynamic balance. Static balance was evaluated using the position of the center-of-mass (COM) and center-of-pressure (COP), relative to the functional base-of-support (BOS). As the name suggests, static balance applies when the linear and angular velocity of the body is small in magnitude, in the range of that observed during still standing. Dynamic balance control was evaluated using a model-based balance metric, the foot-placement-estimator (FPE), relative to the COP and BOS. We found that the older adults stay closer to being statically balanced than the younger participants. The dynamic balance metrics show that both groups keep the FPE safely within the BOS, though the older adults maintain a larger dynamic balance margin. Both groups exhibit similar levels of variability in these metrics. Thus, the conservative STS performance in older adults is likely to compensate for reduced physical ability or reduced confidence, as their dynamic balance control does not seem affected. The presented analysis of both static and dynamic balance allows us to distinguish between STS performance and balance, and as such can contribute to the identification of those older adults prone to falling, thus ultimately reducing the number of falls during STS transfers.

Application of vocal organ correction combined with language training in the rehabilitation of children with cerebral palsy and language disorder

BACKGROUND

To explore the effect of vocal organ correction combined with language training on the rehabilitation of children with cerebral palsy (CP) and language disorder.

METHODS

A total of 98 children with CP and language disorder were divided into two groups (49 cases in each group) using a random number table: the control group and the test group. The control group was given language training alone, while the test group received vocal organ correction combined with language training. The changes in language function classification, efficacy, and family satisfaction before and after the treatments were compared.

RESULTS

A significant difference was identified in language function classification between the two groups before and after treatment (P<0.05). The language function classification of the two groups was also significantly different after treatment (P<0.05), as was the distribution of clinical efficacy between the two groups (P<0.05). The total effective rate for the test group was 91.84%, which was higher than the 73.47% for the control group (P<0.05). Family satisfaction between the two groups differed significantly (P<0.05), and the total satisfaction rate of families in the test group was 87.76%, which was higher than the 69.39% in the control group (P<0.05).

CONCLUSIONS

Vocal organ correction combined with language training can improve the language function of children with CP and language disorder, has ideal efficacy, and can also enhance family satisfaction during rehabilitation.

The Relationship Between Performance of Sit-To-Stand From a Chair and Getting Down and Up From the Floor in Community-Dwelling Older Adults

BACKGROUND AND PURPOSE

The ability to perform sit-to-stand from a chair and getting down and up from the floor, or the ability to safely perform a floor transfer are important transitional activities for independent living. The sit-to-stand maneuver is frequently performed by community-dwelling older adults and is routinely evaluated as a part of geriatric physical therapy assessment. Conversely, a floor transfer is rarely performed by older adults or addressed by clinicians, even when working with frail patients who live alone and are at high risk for falls. Accordingly, the specific aim of this cross-sectional study was to determine the concurrent, predictive, and discriminant validity of the five times sit-to-stand (5xSTS) test against 3-point floor transfer performance.

METHODS

A total of 46 community-dwelling adults, ages 65-96 years, were recruited using a stratified sampling technique based on self-reported levels of floor transfer ability: independent (n = 16); assisted (n = 15); and dependent (n = 15). Forty-five of the 46 participated in the data collection process. Participants were first assessed for the 5xSTS test and were categorized based on performance as unable to perform (n = 14), poor performance (>13.6 seconds), or good performance (≤13.6 seconds). Participants then performed the 3-point floor transfer test and were classified based on results as independent (n = 18), assisted (n = 10), or dependent (n = 17). Spearman correlations were calculated to assess the concurrent validity for the 5xSTS testing procedure against 3-point floor transfer performance. The Kruskal-Wallis test was used to: 1) determine the discriminant validity of 5xSTS test outcome performance among groups that differ in 3-point floor transfer test performance; and 2) examine the significance level of the socio-demographic data.

RESULTS

Moderate to strong positive correlations were found between the 3-point floor transfer test and the categorical performance outcomes of the 5xSTS test (rho ranged from 0.67 to 0.88, p < .001). A strong negative correlation was found between 5xSTS scores and the 3-point floor transfer test (rho = 0.86, p < .001). There was moderate sensitivity (71%) and strong specificity (93%) for the 5xSTS test to predict floor transfer performance. The outcomes of 5xSTS performance differed significantly among 3-point floor transfer performance outcome groups. Older adults who were unable to perform 5xSTS test were also dependent in floor transfer performance. In contrast, older adults who demonstrated good performance in the 5xSTS test were independent in floor transfer performance (p ≤ 0.012).

CONCLUSION

Floor transfer is a highly important safety maneuver for older adults, although it is rarely performed and assessed. This study documents that the 5xSTS test displays concurrent, predictive, and discriminative validity properties, making it a potentially useful initial screening tool to predict floor transfer ability. Failure to complete the 5xSTS test may also be a reliable indicator of floor transfer performance dependency among community-dwelling older adults.

The Utility of the Sit-to-Stand Test for Inpatients in the Acute Hospital Setting After Lung Transplantation

OBJECTIVE

Measurement of physical function is important to guide physical therapy for patients post-lung transplantation (LTx). The Sit-to-Stand (STS) test has proven utility in chronic disease, but psychometric properties post-LTx are unknown. The study aimed to assess reliability, validity, responsiveness, and feasibility of the 60-second STS post-LTx.

METHODS

This was a measurement study in 62 inpatients post-LTx (31 acute postoperative; 31 medical readmissions). Interrater reliability was assessed with 2 STS tests undertaken by different assessors at baseline. Known group validity was assessed by comparing STS repetitions in postoperative and medical groups. Content validity was assessed using comparisons to knee extensor and grip strength, measured with hand-held dynamometry. Criterion validity was assessed by comparison of STS repetitions and 6-minute walk distance postoperatively. Responsiveness was assessed using effect sizes over inpatient admission.

RESULTS

Median (interquartile range) age was 62 (56-67) years; time post-LTx was 5 (5-7) days postoperative and 696 (244-1849) days for medical readmissions. Interrater reliability was excellent (intraclass correlation coefficient type 2,1 = 0.96), with a mean learning effect of 2 repetitions. Repetitions were greater for medical at baseline (mean 18 vs 8). More STS repetitions were associated with greater knee extensor strength (postoperative r = 0.57; medical r = 0.47) and 6-minute walk distance (postoperative r = 0.68). Effect sizes were 0.94 and 0.09, with a floor effect of 23% and 3% at baseline (postoperative/medical) improving to 10% at discharge. Patients incapable of attempting a STS test were excluded, reducing generalizability to critical care. Physical rehabilitation was not standardized, possibly reducing responsiveness.

CONCLUSIONS

The 60-second STS demonstrated excellent interrater reliability and moderate validity and was responsive to change postoperatively.

IMPACT

The 60-second STS represents a safe, feasible functional performance tool for inpatients post-LTx. Two tests should be completed at each time point.

Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study

Background

Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality.

Methods

A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings.

Results

Ten stroke survivors aged 55–79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (− 4.2) and 5xSST (− 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying − 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES.

Conclusions

ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.

The modified sphygmomanometer test for assessment of muscle strength of community-dwelling older adults in clinical practice: reliability and validity

Purpose: (a) to investigate the test-retest and inter-rater reliabilities and the criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of muscle strength in community-dwelling older adults, (b) to calculate the standard error of measurement (SEM) and the smallest real difference (SRD); (c) to verify whether the number of trials affect the results.Methods: Bilateral strength of lower limbs (LL) and grip muscles were evaluated with the MST and with portable dynamometers in 50 older adults (69.92 ± 5.52 years). Intra-class Correlation Coefficients (ICC) was used to evaluate the inter-rater and test-retest reliabilities and Pearson Correlations was used to investigate the criterion-related validity of the MST. SEM and SRD were also calculated. Analysis of variance was used to investigate whether the number of trials affects the results.Results: Significant correlations with high to very high magnitude were found for all muscle groups evaluated for test-retest and inter-rater reliabilities (0.80 ≤ ICC ≤ 0.99; p < 0.001) and validity (0.80 ≤ r ≤ 0.91; p < 0.001). Moreover, the values provided by different numbers of trials were similar. The SEM (3.66 ≤ SEM ≤ 20.46) and the SRD (10.15 ≤ SRD95% ≤ 56.70) were considered low for all outcome measures.Conclusion: The MST showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength of older adults.Implications for rehabilitationOlder adults often develop sarcopenia and dynapenia that are associated with an increased number of falls and fractures and loss of independence.Portable dynamometer is the standard instrument to evaluate isometric muscle strength, however this instrument is expensive and it is not readily available in the underdeveloped or in developed countries.The Modified Sphygmomanometer Test is an alternative method for the clinical measurement of muscle strength, is portable, has a low-cost and provides an objective measurement.In this study the Modified Sphygmomanometer Test showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength in community-dwelling older adults and a single trial after test familiarization can be used to measure the muscle strength in this population.

Does grip strength predict lower limb global strength in subjects with stroke?

Abstract Introduction: Grip strength is an important clinical measure and has been used for several purposes in different populations, including those to predict the global strength of lower limbs (LL) and upper limbs. However, little is known about the association between grip strength and lower limb (LL) global strength in subjects with stroke. Objective: To investigate the relationship between grip strength and LL global strength in stroke with subjects at both subacute and chronic phases. Method: Measures of grip strength (handgrip dynamometer) and LL global strength (hand-held dynamometer) were obtained in 20 subjects in the subacute phase of the stroke and 18 in the chronic phase. Pearson correlation coefficient was used to investigate the correlation between grip strength and LL global strength (α = 0.05). Results: Subjects in the subacute phase showed a moderate statistically significant correlation between paretic grip strength and global strength of the non-paretic LL (r = 0.50; p < 0.05), but no correlation with the paretic LL was found (p = 0.25). The non-paretic grip strength showed no statistically significant correlation with global strength of the paretic LL (p = 0.93) and of the non-paretic LL (p = 0.64). In chronic subjects, no statistically significant correlation (0.50 ≤ p ≤ 0.97) was observed. Conclusion: Grip strength does not seem to be an adequate indicator to predict LL global strength of subjects with stroke. This conclusion is different from that obtained for other populations.

Five-repetition sit-to-Stand test among patients post-stroke and healthy-matched controls: the use of different chair types and number of trials

Background: In 2018, the American Physical Therapy Association (APTA) published a clinical guideline for adults with neurological conditions, which included recommendations for the Five-Repetition Sit-to-Stand test (5STSt). According to the APTA, a standard-height chair should be used, but there is no recommendation regarding seat depth. In addition, the APTA recommended the use of one trial of the test, based on expert opinion.Objectives: (1) Compare the 5STSt scores of patients post-stroke and healthy-matched controls using two types of chairs (one standardized and one adjusted to the individual's anthropometric characteristics); and (2) Verify whether different numbers of trial affect the 5STSt scores.Methods: Eighteen patients post-stroke and 18 healthy-matched controls performed three trials of the 5STSt for each type of chair. ANOVA was used for analysis (α = 0.05).Results: No significant interaction between groups and chairs was found. Patients post-stroke showed worsened performances in 5STSt when using both chairs compared to the healthy controls (p = .001). In both groups, the 5STSt scores were lower when using a standardized chair than an adjusted chair (p < .003) and different numbers of trials provided similar 5STSt scores (0.44 ≤ p ≤ 0.98).Conclusion: The 5STSt scores were affected by the physical characteristics of the chair, and an adjusted chair should be used. The APTA recommendation for one trial of the 5STSt is supported by the present results.

A new two square agility test for workplace health-reliability, validity and minimal detectable change

[Purpose] One promising strategy for workplace wellness programs is to emphasize functional mobility screening and coaching to promote suitable physical activity and reduce musculoskeletal risks. This study examined intra-rater reliability, test-retest reliability, concurrent validity, known-groups validity and minimal detectable change for a new Two Square Agility Test (TSAT) designed as a functional mobility measure to promote workplace health. [Participants and Methods] Two hundred forty eight non-disabled participants (ages 18-69) were measured for body size, physical activity and 3 trials of the Two Square Agility Test. 78 participants were tested a week later on the Two Square Agility Test and other functional mobility tests. [Results] Intra-rater reliability was excellent (ICC=0.94) and test-retest reliability was good (ICC=0.87). Two Square Agility Test correlated moderately with Timed Up and Go (r=0.63), Five Times Sit to Stand (r=0.62), and Maximum Step Length (r= -0.54), supporting its concurrent validity. Performances for Two Square Agility Test were better in males, younger age, higher physical activity, and non-obese groups. The minimal detectable change at a 95% confidence level (MDC₉₅) was 1.37 s. [Conclusion] Preliminary results supported reliability and validity of Two Square Agility Test as a functional mobility measure to promote workplace health.

Effectiveness of Lower-Extremity Functional Training (LIFT) in Young Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

Background. Children with unilateral spastic cerebral palsy (USCP) have strength, coordination, and balance deficits affecting gross motor skills, such as walking, running, and jumping. However, there is a paucity of evidence for effective treatments for lower-extremity (LE) function in children with USCP. Objective. To determine the effectiveness of LE intensive functional training (LIFT) compared with an attention control group receiving upper-extremity bimanual training (Hand-Arm Bimanual Intensive Therapy [H-HABIT]). Methods. A total of 24 children with USCP were randomized to receive 90 hours of LIFT (5.8 [2.3] years) or an equivalent dosage of H-HABIT (5.1 [2.6] years) delivered 2 h/d, 5 d/wk for 9 weeks. Caregivers were trained to administer the intervention in the home setting. Progress and skill progression were monitored, and supervision was provided via weekly telerehabilitation. The primary outcome was the 1-minute walk test (1MWT). Secondary outcomes included self-selected and fast walking speeds, ABILOCO-kids, 30-s chair rise test, and single-leg stance. Results. LIFT showed greater improvement for the 1MWT ( P = .017) and ABILOCO-kids ( P = .008) compared with controls. The other secondary outcomes were not different between groups. Conclusions. The administration of LE intensive interventions in the home setting by caregivers was shown to be an effective and novel mode of delivery for improving gait capacity and performance. LIFT delivered in the home setting using telerehabilitation for monitoring resulted in improvements in ambulation distance and overall walking ability as compared to an intervention of equal intensity and duration that also controlled for the increased social interaction and attention between caregiver and child.

Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children?

BACKGROUND

Malnutrition is a common complication in children with chronic diseases. Sarcopenia is one component of malnutrition, characterized by reduced skeletal muscle mass (SMM) and muscle function. The presence of sarcopenia is associated with adverse outcomes in children. Although there is growing research interest in sarcopenia, no review has been done on this novel concept in pediatrics. The purpose of this review was to explore current evidence in sarcopenia with and without obesity and to evaluate the knowledge gaps in the assessment of childhood sarcopenia.

METHODS

A total of 12 articles retrieved from PubMed or Web of Science databases were included.

RESULTS

Limited studies have elucidated sarcopenia in pediatrics. Challenges in sarcopenia assessment include heterogeneity in definition and absence of standardized body composition methods used to measure SMM and muscle function tests. There is a lack of age-specific and gender-specific normative data for SMM, particularly in young children and infants. None of the studies incorporated muscle function assessment, causing potential bias and misclassification of sarcopenia. The research in childhood sarcopenia is also hampered by low study quality, limited number of outcomes-based research, and lack of longitudinal data.

CONCLUSION

Consensus needs to be reached in methodological approaches in sarcopenia diagnosis, body composition measurements, and age-appropriate muscle function tests in pediatrics. Careful considerations on growth, neurocognitive status, and factors influencing development in various clinical populations are warranted. Early identification of sarcopenia is crucial to enable targeted treatment and prevention to be carried out across the pediatric clinical populations.

Assessing trunk flexo-extension during sit-to-stand test variant in male and female healthy subjects through inertial sensors

OBJECTIVE

The objective of the present study was to measure trunk flexo-extension during different Sit-To-Stand (STS) tasks and to analyze differences in those variables when STS repetitions are increased, by using an inertial sensor.

METHODS

In this cross-sectional study trunk flexo-extension was obtained through inertial measurements using an inertial sensor placed on the flat part of the sternum with the Y transversally oriented and attached using double-sided adhesive tape. Trunk flexo-extension was expressed along the Y axis (pitch angle) in a sagittal plane, representing antero-posterior motion (degrees, °). Descriptive anthropometric independent variables were also recorded. Subject had to sit and rise from a 43 cm high chair at a speed of 40 bpm in 5, 10 and 15 repetitions of STS variants.

RESULTS

Men showed higher mean mobility (between 41.51° and 43.23°) than women (between 32.16° and 33.31°) in all STS test, although significant was only found for 10-STS and 15-STS (<0.05). Male gender showed stronger Pearson correlation between each test than female gender. In men, correlations were highly significant in all tests (r between 0.891 and 0.939). However, in the case of women, significance varied between each test comparison (r between 0.474 and 0.745). There were no significant differences observed between trunk flexo-extension and STS variants (p = 0.908; F = 0.097).

CONCLUSION

Men showed a wider range of trunk motion and a more consistent pattern than women through STS variants. However, no significant differences were found in mobility between each test. The results provided in this study should be taken into account when performing STS in this population and should be applied only to a healthy population.

What is the optimal chair stand test protocol for older adults? A systematic review

Purpose: To determine the chair stand test protocol that is most suitable for older adults in clinical settings by reviewing the currently available methods.Methods: Five electronic English databases were searched and details of methods used on individuals aged ≥65 years in the included studies were compared, including the instrument used to record time, units of measurement, chair characteristics (seat height, armrests), footwear, permission to use upper extremities and walking aids, pace of performance, total number of chair stands, timing points, total number of recorded and practice tests.Results: A total of 23 eligible studies were identified. The type of instrument to record performance time, characteristics of the chair and footwear were not frequently mentioned. A majority of studies did not permit the use of the upper extremities or walking aids during assessment. The performance of five chair stands at a fast pace recorded in seconds was most common, with the majority of studies recording the initial and end time point in a seated position. The total number of performed tests and practice tests was not specified in a majority of studies.Conclusion: A feasible and safe protocol for the chair stand test is proposed for assessment of older adults.Implications for RehabilitationThe chair stand test may provide valuable information on declines in mobility in older adults.The use of the chair stand test within clinical settings of older adults may provide a measure to identify frail individuals and to determine their level of frailty.Using the proposed protocol for the chair stand test may allow for the comparability of results.

Measurement properties of self-report physical activity assessment tools in stroke: a protocol for a systematic review

INTRODUCTION

Self-report physical activity assessment tools are commonly used for the evaluation of physical activity levels in individuals with stroke. A great variety of these tools have been developed and widely used in recent years, which justify the need to examine their measurement properties and clinical utility. Therefore, the main objectives of this systematic review are to examine the measurement properties and clinical utility of self-report measures of physical activity and discuss the strengths and limitations of the identified tools.

METHODS AND ANALYSIS

A systematic review of studies that investigated the measurement properties and/or clinical utility of self-report physical activity assessment tools in stroke will be conducted. Electronic searches will be performed in five databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) (PubMed), Excerpta Medica Database (EMBASE), Physiotherapy Evidence Database (PEDro), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO), followed by hand searches of the reference lists of the included studies. Two independent reviewers will screen all retrieve titles, abstracts, and full texts, according to the inclusion criteria and will also extract the data. A third reviewer will be referred to solve any disagreement. A descriptive summary of the included studies will contain the design, participants, as well as the characteristics, measurement properties, and clinical utility of the self-report tools. The methodological quality of the studies will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and the clinical utility of the identified tools will be assessed considering predefined criteria. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement.

DISCUSSION

This systematic review will provide an extensive review of the measurement properties and clinical utility of self-report physical activity assessment tools used in individuals with stroke, which would benefit clinicians and researchers.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42016037146.

[Properties of the Measures to Assess Oxaliplatin-induced Peripheral Neuropathy: A Literature Review]

PURPOSE

The purpose of this study is to provide a comprehensive overview of the various measures available for assessment of oxaliplatin-induced peripheral neuropathy (OXLIPN) and to evaluate the measurement properties of each assessment tool.

METHODS

A systematic review was conducted to identify existing measures for OXLIPN found in the databases of PubMed, Cochrane Library, Embase, RISS and KoreaMed. The quality of the 24 identified tools was evaluated based on their properties of measurement including content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor-ceiling effects and interpretability.

RESULTS

Ten (41.7%) of the 24 tools were identified as specific measures for assessing OXLIPN and the most popular type of measures were clinical grading systems by clinicians (58.3%) and only 29.2% of measures were identified as patient reported outcomes. The most frequently used tool was National Cancer Institute-Common Toxicity Criteria (NCI-CTC), but the validity of NCI-CTC has not been reported appropriately. Overall, the Neuropathic Pain Symptom Inventory (NPSI) received the best psychometric scores, and the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-neurotoxicity-12 (FACT/GOG-Ntx-12) followed NPSI.

CONCLUSION

To select appropriate measure, evidences should be accumulated through the clinical use of tools. Therefore, practitioner and researchers are urged to report relevant statistics required for the validation of the currently used measures for assessment of OXLIPN.

Development and Validation of a Novel Motor-Cognitive Assessment Strategy of Compensatory Sit-to-Stand Maneuvers in People With Dementia

BACKGROUND AND PURPOSE

People with dementia show disease-specific sit-to-stand (STS) movement disorders, which relate to deficits of integrating cognitive aspects of motor processes into motor action organization. During STS training in rehabilitation therapy, compensatory STS movement maneuvers are taught aiming to improve patients' STS ability. Previous clinical STS measures do not address these maneuvers or assess cognitive aspects of their motor action organization. The purpose of this study was to develop and validate a motor-cognitive STS assessment instrument for people with dementia (Assessment of Compensatory Sit-to-Stand Maneuvers in People With Dementia, ACSID).

METHODS

The ACSID covers the recall, initiation, and effective performance of compensatory STS movement maneuvers. The inter- and intrarater reliability, concurrent validity, sensitivity to change, and feasibility were investigated by secondary analysis of data of 97 participants from a randomized controlled trial to improve motor-cognitive performances in people with mild to moderate dementia (mean [standard deviation] age: 82.5 [5.9] years, Mini-Mental Status Examination: 21.9 [2.9] points). Concurrent validity of the individual ACSID items was assessed against reference criteria derived from video-motion analysis.

RESULTS

Good to excellent inter- (kappa [κ] = 0.64-0.99; intraclass correlation coefficient [ICC] = 0.74-0.89) and intrarater (κ= 0.77-0.91; ICC = 0.77-0.91), concurrent validity (point-biserial correlation coefficients = |0.56|-|0.84|), and sensitivity to change (standardized response means = 0.61-1.00) were found. Feasibility was excellent with a high completion rate (96.9%), no critical events during assessment, and no floor or ceiling effects.

CONCLUSIONS

The ACSID represents the first observation-based assessment instrument to document motor and cognitive aspects in the execution of a motor key feature in people with dementia, and has been shown to be reliable, valid, feasible, and sensitive to intervention-induced changes.

Absolute and Relative Reliability of the Timed 'Up & Go' Test and '30second Chair-Stand' Test in Hospitalised Patients with Stroke

OBJECTIVE

The timed 'Up & Go' test and '30second Chair-Stand' test are simple clinical outcome measures widely used to assess functional performance. The reliability of both tests in hospitalised stroke patients is unknown. The purpose was to investigate the relative and absolute reliability of both tests in patients admitted to an acute stroke unit.

METHODS

Sixty-two patients (men, n = 41) attended two test sessions separated by a one hours rest. Intraclass correlation coefficients (ICC2,1) were calculated to assess relative reliability. Absolute reliability was expressed as Standard Error of Measurement (with 95% certainty-SEM95) and Smallest Real Difference (SRD) and as percentage of their respective means if heteroscedasticity was observed in Bland Altman plots (SEM95% and SRD%).

RESULTS

ICC values for interrater reliability were 0.97 and 0.99 for the timed 'Up & Go' test and 0.88 and 0.94 for '30second Chair-Stand' test, respectively. ICC values for intrarater reliability were 0.95 and 0.96 for the timed 'Up & Go' test and 0.87 and 0.91 for '30second Chair-Stand' test, respectively. Heteroscedasticity was observed in the timed 'Up & Go' test. Interrater SEM95% ranged from 9.8% to 14.2% with corresponding SRD% of 13.9-20.1%. Intrarater SEM95% ranged from 15.8% to 18.7% with corresponding SRD% of 22.3-26.5%. For '30second Chair-Stand' test interrater SEM95 ranged between 1.5 and 1.9 repetitions with corresponding SRD of 2 and 3 and intrarater SEM95 ranged between 1.8 and 2.0 repetitions with corresponding SRD values of 3.

CONCLUSION

Excellent reliability was observed for the timed 'Up & Go' test and the '30second Chair-Stand' test in hospitalised stroke patients. The thresholds to detect a real change in performance were 18.7% for the timed 'Up & Go' test and 2.0 repetitions for the '30second Chair-Stand' in groups of patients and 26.5% and 3 repetitions in individual patients, respectively.

Study of acceleration of center of mass during sit-to-stand and stand-to-sit in patients with stroke

[Purpose] The purpose of this study was to compare the center of mass during sit-to-stand and stand-to-sit activities in the timed up and go test between healthy subjects and patients with stroke. [Subjects and Methods] Thirty healthy participants and thirty patients with stroke volunteered for this study. Acceleration of the center of mass was measured using a wireless tri-axial accelerometer during sit-to-stand and stand-to-sit activities in the timed up and go test. Accelerometer data were analyzed using BTS G-studio software. [Results] The phase duration was significantly longer and the anterior-posterior, mediolateral, and vertical acceleration ranges were significantly lower during sit-to-stand for patients with stroke than for healthy controls. Further, phase duration and the mediolateral acceleration range during stand-to-sit differed significantly between healthy controls and subjects with stroke. [Conclusions] During training for the sit-to-stand activity, the focus should be all three balance dimensions, but during training for the stand-to-sit activity, the focus should be on improving mediolateral balance and asymmetrical foot positioning should be recommended.

Psychometric viability of measures of functional performance commonly used for people with dementia: a systematic review of measurement properties

BACKGROUND

Confidence in findings can only be drawn from measurement tools that have sound psychometric properties for the population with which they are used. Within a dementia specific population, measures of physical function have been poorly justified in exercise intervention studies, with justification of measures based on validity or reliability studies from dissimilar clinical populations, such as people with bronchitis or healthy older adults without dementia.

OBJECTIVES

To review the reliability and validity of quantitative measures of pre-identified physical function, as commonly used within exercise intervention literature for adults with dementia.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Participants were adults, aged 65 years and older, with a confirmed medical diagnosis of dementia.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

n/a

TYPES OF STUDIES

Desired studies were observational and cross-sectional and that assessed measures from a pre-identified list of measures of physical function.

OUTCOMES

Studies that assessed the psychometric constructs of reliability and validity were targeted. COSMIN taxology was used to define reliability and validity. This included, but were not limited to, Intra-Class Correlations, Kappa, Cronbach's Alpha, Chi Squared, Standard Error of Measurement, Minimal Detectable Change and Limits of Agreement.

SEARCH STRATEGY

Published material was sourced from the following four databases: MEDLINE, EMBASE, CINAHL and ISI Web of Science. Grey literature was searched for using ALOIS, Google Scholar and ProQuest.

METHODOLOGICAL QUALITY

The COSMIN checklist was used to assess methodological quality of included studies. Assessment was completed by two reviewers independently.

DATA EXTRACTION

Reliability and validity data was extracted from included studies using standardized Joanna Briggs Institute data collection forms. Extraction was completed by two reviewers.

DATA SYNTHESIS

A narrative synthesis of measurement properties of the tools used to measure physical function was performed. Quantitative meta-analysis was conducted for Intra-Class Correlation Coefficients only.

RESULTS

With respect to relative reliability, studies reporting assessed measures had intraclass correlation coefficients greater than 0.71, indicating their suitability for use at a group level. However, a consistent finding among studies that included assessment of absolute reliability was that intra individual variation was too large for meaningful measurement of individuals. This was indicated by large Minimal Detectable Change (MDC) scores. Walk Speed has the smallest reported Mimimal Detectable Change score at 0.11m/s. This represented a change of 35% before statistical variation could be eliminated as the cause for this change. All measures had large MDC values. Walk Speed had the smallest MDC values at 0.11m/s, which represented a necessary change of 35%. Only a limited number of studies assessed the validity of measures. This supports the use of these measures in a very narrow selection of circumstances (see Summary of Findings).

CONCLUSIONS

In summary, measures have shown appropriate levels of relative reliability. This supports their use at the group level. However, large levels of intra-individual variation undermine their applicability at the individual level. Limited studies of validity were available to this review, which limits a conclusion on whether measures are valid for people with dementia.

Surface electromyography as a measure of trunk muscle activity in patients with spinal cord injury: a meta-analytic review

CONTEXT

Surface electromyography (SEMG) may be a sensitive marker for distinguishing the activity of trunk muscles, which are critical to functional mobility recovery in patients with spinal cord injury (SCI).

OBJECTIVES

This manuscript presents a systematic review and meta-analysis of the published literature on the effect of SEMG as a measure of trunk muscle activity in patients with SCI.

METHODS

A comprehensive search of the research literature included Pubmed, Medline, CNKI, WANFANG DATA, Web of Science, Elsevier, Wiley-Blackwell, Karger, OVID, and a review of reference lists within found articles. Case-control, cohort, and cross-sectional studies were included in the review.

RESULTS

Eleven studies were included in this meta-analysis. Trunk muscle activities for the sitting condition were greater in patients with SCI than normal subjects. SEMG activity of trunk muscles for the sitting condition and posterior transfer was greater in patients with high level (HL)-SCI compared to those with low level (LL)-SCI. In addition, across studies, the level of trunk muscle activity for various difficulty settings was different for a given SCI group.

CONCLUSION

This systematic review evaluated the value of trunk muscles for patients with SCI. We recommend use of SEMG as an assessment tool for improving the comparability and interpretability of trunk muscle activity of SCI therapeutic strategies.

The quality of systematic reviews of health-related outcome measurement instruments

BACKGROUND

Systematic reviews of outcome measurement instruments are important tools for the selection of instruments for research and clinical practice. Our aim was to assess the quality of systematic reviews of health-related outcome measurement instruments and to determine whether the quality has improved since our previous study in 2007.

METHODS

A systematic literature search was performed in MEDLINE and EMBASE between July 1, 2013, and June 19, 2014. The quality of the reviews was rated using a study-specific checklist.

RESULTS

A total of 102 reviews were included. In many reviews the search strategy was considered not comprehensive; in only 59 % of the reviews a search was performed in EMBASE and in about half of the reviews there was doubt about the comprehensiveness of the search terms used for type of measurement instruments and measurement properties. In 41 % of the reviews, compared to 30 % in our previous study, the methodological quality of the included studies was assessed. In 58 %, compared to 55 %, the quality of the included instruments was assessed. In 42 %, compared to 7 %, a data synthesis was performed in which the results from multiple studies on the same instrument were somehow combined.

CONCLUSION

Despite a clear improvement in the quality of systematic reviews of outcome measurement instruments in comparison with our previous study in 2007, there is still room for improvement with regard to the search strategy, and especially the quality assessment of the included studies and the included instruments, and the data synthesis.