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Wesley A, Bray P, Pacey V, Chan C, Nicholson LL. Hand Impairment and Function in Children and Adolescents With Heritable Disorders of Connective Tissue. Am J Occup Ther 2022; 76:23963. [DOI: 10.5014/ajot.2022.049282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Importance: Heritable disorders of connective tissue (HDCTs) affect hand function and participation in daily activities for children and adolescents.
Objective: To describe hand impairment and function and determine the extent to which hand impairment and function explain the variation in self-reported functional performance.
Design: Cross-sectional observational study.
Setting: Specialist tertiary hospital.
Participants: Children and adolescents ages 8–18 yr with HDCTs (N = 73).
Intervention: None.
Outcomes and Measures: Hand function outcomes included grip strength (digital dynamometer), manipulation and dexterity (Functional Dexterity Test, Nine-Hole Peg Test), and fine motor skills (Bruininks–Oseretsky Test of Motor Proficiency). Upper limb hypermobility was assessed using the Upper Limb Hypermobility Assessment Tool. Hand pain and fatigue were recorded for a timed button test and 3- and 9-min handwriting tasks. Functional performance was measured using the Childhood Health Assessment Questionnaire.
Results: Scores on all hand function measures were below expected norms. Pain and fatigue were significantly worse after the writing tasks (p < .001) but not the button test (p > .40). Secondary students had significantly lower handwriting scores than primary students (p = .03) but similar grip strength z scores (p = .95). Variation in self-reported functional performance was explained by grip strength (6%) and upper limb hypermobility and dexterity (16%).
Conclusions and Relevance: Young people with HDCTs have poor hand function attributable to poor grip strength and hand pain and fatigue. Comprehensive upper limb evaluation and ongoing monitoring throughout the school years are warranted to inform timely intervention.
What This Article Adds: Children and adolescents with heritable disorders of connective tissue have difficulty with hand function that affect their participation in daily activities. The results of this study can help clinicians identify, assess, and monitor daily activities, performance skills, and symptoms of children and adolescents with HDCTs to promote their participation in all aspects of daily life.
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Affiliation(s)
- Alison Wesley
- Alison Wesley, MEd, BSc, GDipOT, is Senior Occupational Therapist, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia, and PhD Candidate, School of Medical Sciences, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia;
| | - Paula Bray
- Paula Bray, PhD, BOT (Hons), is Director of Research, Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia, and Postdoctoral Fellow, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Verity Pacey
- Verity Pacey, PhD, BAppSci (Phty), is Associate Professor, Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Sydney, New South Wales, Australia
| | - Cliffton Chan
- Cliffton Chan, PhD, BPhysio (Hons), is Associate Professor, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia, and Senior Lecturer, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leslie L. Nicholson
- Leslie L. Nicholson, PhD, BAppSc (Phty), is Associate Professor, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Etzweiler D, Albisetti M, Meichtry A, Huber EO. The effect of age on the pressure pain threshold of asymptomatic ankles and knees in young individuals with haemophilia. Haemophilia 2021; 27:683-689. [PMID: 34015164 DOI: 10.1111/hae.14344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite adequate medical treatment, many young adults with haemophilia develop joint alterations-especially in ankles and knees. Undetected over years, subtle structural changes cause subclinical symptoms, before problems become obvious. To objectify these silent pressure pains, the pressure pain threshold (PPT) can be measured by algometry. AIM The aim was to investigate and compare the effect of age on PPTs in asymptomatic ankles and knees between boys and young adults with haemophilia and age-matched controls, in order to gain better knowledge about the alteration of the periarticular structures with increasing age. MATERIAL AND METHODS Nineteen persons with haemophilia (PwH; severe or moderate; 8-30 years) and 19 age-matched controls with 'healthy' ankles and knees were recruited. Asymptomatic joints with a Haemophilia Joint Health Score = 0 were included. The PPT was measured on four periarticular points per joint, and the data were analysed with a linear mixed model. RESULTS The PPT of the control group increased with age, whereas the PPT of the PwH decreased. The difference in age effect per year in kPa between PwH and controls was as follows: β [95%-CI]: -15.41 [-31.63; 0.79]. Although the result was not statistically significant (p = .08), a clear tendency was shown. CONCLUSION The results suggest that subclinical alterations in the periarticular structures of these joints may evolve unnoticed over time. However, further research is warranted to determine whether this observed trend is confirmed in a larger sample and at what age the PPT begins to decrease in PwH compared to controls.
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Affiliation(s)
- Denise Etzweiler
- Division of Haematology, University Children's Hospital Zurich, Zurich, Switzerland.,School of Health Professions, Institute of Physiotherapy, University of Applied Sciences, Winterthur, Switzerland
| | - Manuela Albisetti
- Division of Haematology, University Children's Hospital Zurich, Zurich, Switzerland
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, University of Applied Sciences, Winterthur, Switzerland
| | - Erika O Huber
- School of Health Professions, Institute of Physiotherapy, University of Applied Sciences, Winterthur, Switzerland
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Relationship between School Backpacks and Musculoskeletal Pain in Children 8 to 10 Years of Age: An Observational, Cross-Sectional and Analytical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072487. [PMID: 32260533 PMCID: PMC7177975 DOI: 10.3390/ijerph17072487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 11/26/2022]
Abstract
Back pain in children is a reality and various factors are involved in its etiology. The study’s aim was to analyze the relationship between the use and type of backpack and pain in children. An analytical observational cross-sectional study was conducted among 123 schoolchildren between 8–10 years. Data on the participants’ weight and height and their backpacks were collected, as well as the way of travel to school and their physical activity during the week. The results indicated that all backpacks were large because the backpack’s height is longer than torso length. Participants who studied in a traditional educational system (62.60%) carried backpacks that exceeded 10% of their body weight. Additionally, 31.7% of the students presented pain. There is no significant correlation between the weight or type of backpack and the pressure pain threshold collected from shoulders muscles. Participants who carried backpacks heavier than 10% of their body weight did not have more musculoskeletal pain or a lower pressure pain threshold than the others, although they did report greater fatigue. All these topics should be debated considering the student’s social environment and the backpack’s discomfort to the children, even though no relationship was found between musculoskeletal pain and backpack weight.
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Tang S, Wang X, Wu P, Wu P, Yang J, Du Z, Liu S, Wei F. Platelet-Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta-Analysis of Randomized Controlled Trials. PM R 2020; 12:397-409. [PMID: 31736257 PMCID: PMC7187193 DOI: 10.1002/pmrj.12287] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022]
Abstract
Objective To compare the effectiveness of platelet‐rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis. Type of Study Network meta‐analysis. Literature Survey Randomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library. Methodology Two researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2). Publication bias was evaluated by constructing contour‐enhanced funnel plots. Stata 15 software was applied for pairwise meta‐analysis and network meta‐analysis. To explore the efficacy between different follow‐up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term. Synthesis Twenty RCTs (n = 1271) were included in this network meta‐analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient‐Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short‐term period. For the long‐term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8). Conclusion PRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.
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Affiliation(s)
- Siqi Tang
- The Eight Year Program, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xiaoshuai Wang
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Peihui Wu
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peiqi Wu
- The Five-Year Program, School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jiaming Yang
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Zefeng Du
- The Five-Year Program, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Fuxin Wei
- Department of Orthopedics, Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Balaguier R, Madeleine P, Vuillerme N. Intra-session absolute and relative reliability of pressure pain thresholds in the low back region of vine-workers: ffect of the number of trials. BMC Musculoskelet Disord 2016; 17:350. [PMID: 27538914 PMCID: PMC4990860 DOI: 10.1186/s12891-016-1212-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 08/10/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pressure pain thresholds (PPT) are commonly used to quantify mechanical pain sensitivity of deep structures. Excellent PPT reliability has been previously reported among the low back of healthy subjects. However, there is a lack of studies assessing PPT over the low back of workers exposed to biomechanical risk factors of low back pain. Thus, the purpose of this study was threefold: (1) to evaluate the intra-session absolute and relative reliability as well as minimal detectable change (MDC) values of PPT within 14 locations covering the low back region of vine-workers and (2) to determine the number of trial required to ensure reliable PPT assessments and (3) to assess the effect of modifier factors such as gender, age, body mass index (BMI) and pain intensity on PPT reliability. METHODS Twenty-nine vine-workers voluntarily participated in this study. Twenty-two reported low intensity of low-back pain while seven were pain-free. PPTs were assessed among 14 anatomical locations in the lower back region. Three trials were performed on each location with an interval time of at least one minute. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) for all possible combinations between trials. Bland-Altman plots were also generated to assess potential bias in the dataset. Finally, a repeated measure analysis of variance (RM-ANOVA) with the number of trials used as within subject factor was performed on (1) PPT, (2) ICC and (3) SEM values. RESULTS ICC ranged from 0.86 to 0.99 for all anatomical locations and for all possible combinations between trials. SEM for comparison between trial 1-2, 2-3, 1-3 and, 1-2-3 ranged from respectively, 36.7-77.5, 27.8-77.7, 50-95.2 and, 39.3-80.8 kPa. ICC and SEM remained similar to the ones obtained for the entire population when taking modifier factors in consideration. The visual analysis of Bland-Altman plots suggested small measurement errors for all anatomical locations and for all possible combinations between trials. CONCLUSIONS The assessment of PPTs of the lower back among vine-workers was found to have excellent relative and absolute reliability. Moreover, reliable measurements can be equally achieved when using the mean of three PPT measurement or with the first one.
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Affiliation(s)
- Romain Balaguier
- Université Grenoble-Alpes, EA AGEIS, La Tronche, France.,Physical Activity and Human Performance group - SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Physical Activity and Human Performance group - SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Nicolas Vuillerme
- Université Grenoble-Alpes, EA AGEIS, La Tronche, France.,Physical Activity and Human Performance group - SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Institut Universitaire de France, Paris, France
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Balaguier R, Madeleine P, Vuillerme N. Is One Trial Sufficient to Obtain Excellent Pressure Pain Threshold Reliability in the Low Back of Asymptomatic Individuals? A Test-Retest Study. PLoS One 2016; 11:e0160866. [PMID: 27513474 PMCID: PMC4981327 DOI: 10.1371/journal.pone.0160866] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/26/2016] [Indexed: 02/06/2023] Open
Abstract
The assessment of pressure pain threshold (PPT) provides a quantitative value related to the mechanical sensitivity to pain of deep structures. Although excellent reliability of PPT has been reported in numerous anatomical locations, its absolute and relative reliability in the lower back region remains to be determined. Because of the high prevalence of low back pain in the general population and because low back pain is one of the leading causes of disability in industrialized countries, assessing pressure pain thresholds over the low back is particularly of interest. The purpose of this study study was (1) to evaluate the intra- and inter- absolute and relative reliability of PPT within 14 locations covering the low back region of asymptomatic individuals and (2) to determine the number of trial required to ensure reliable PPT measurements. Fifteen asymptomatic subjects were included in this study. PPTs were assessed among 14 anatomical locations in the low back region over two sessions separated by one hour interval. For the two sessions, three PPT assessments were performed on each location. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for all possible combinations between trials and sessions. Bland-Altman plots were also generated to assess potential bias in the dataset. Relative reliability for both intra- and inter- session was almost perfect with ICC ranged from 0.85 to 0.99. With respect to the intra-session, no statistical difference was reported for ICCs and SEM regardless of the conducted comparisons between trials. Conversely, for inter-session, ICCs and SEM values were significantly larger when two consecutive PPT measurements were used for data analysis. No significant difference was observed for the comparison between two consecutive measurements and three measurements. Excellent relative and absolute reliabilities were reported for both intra- and inter-session. Reliable measurements can be equally achieved when using the mean of two or three consecutive PPT measurements, as usually proposed in the literature, or with only the first one. Although reliability was almost perfect regardless of the conducted comparison between PPT assessments, our results suggest using two consecutive measurements to obtain higher short term absolute reliability.
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Affiliation(s)
- Romain Balaguier
- Univ. Grenoble-Alpes, EA AGEIS, Grenoble, France
- Physical Activity and Human Performance group—SMI, Dept. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Physical Activity and Human Performance group—SMI, Dept. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nicolas Vuillerme
- Univ. Grenoble-Alpes, EA AGEIS, Grenoble, France
- Physical Activity and Human Performance group—SMI, Dept. of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Institut Universitaire de France, Paris, France
- * E-mail:
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Hermesdorf M, Berger K, Baune BT, Wellmann J, Ruscheweyh R, Wersching H. Pain Sensitivity in Patients With Major Depression: Differential Effect of Pain Sensitivity Measures, Somatic Cofactors, and Disease Characteristics. THE JOURNAL OF PAIN 2016; 17:606-16. [DOI: 10.1016/j.jpain.2016.01.474] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022]
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Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil 2014; 6:12. [PMID: 24635909 PMCID: PMC4006635 DOI: 10.1186/2052-1847-6-12] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lateral humeral epicondylitis, or 'tennis elbow', is a common condition with a variety of treatment options. Platelet-rich plasma (PRP) and Autologous Whole Blood (AWB) represent new therapeutic options for chronic tendinopathies including tennis elbow. The aim of the present study was to compare the long term effects of PRP versus autologous whole blood local injection in patients with chronic tennis elbow. METHODS Seventy six patients with chronic lateral humeral epicondylitis with duration of symptoms more than 3 months were included in this study and randomized into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous leukocyte rich PRP (4.8 times of plasma) and group 2 with 2 mL of AWB. Tennis elbow strap, stretching and strengthening exercises were administered for both groups. Pain and functional improvements were assessed using visual analogue scale (VAS), Mayo score (modified Mayo Clinic performance index for the elbow) and pressure pain threshold (PPT) at 0, 4, 8 weeks and 6 and 12 months. RESULTS All pain variables including VAS, PPT and Mayo scores improved significantly in both groups at each follow up intervals compared to baseline. No statistically significant difference was noted between groups regarding pain, functional scores and treatment success rates in all follow up examinations (P >0/05). CONCLUSION PRP and autologous whole blood injections are both effective methods to treat chronic lateral epicondylitis and their efficacy persisted during long term follow up. PRP was not superior to AWB in long term follow up.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Department of Physical Medicine & Rehabilitation, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mansoor Rayegani
- Department of Physical Medicine & Rehabilitation, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanabadi
- Department of Physical Medicine & Rehabilitation, Mashhad University of Medical Sciences, Tehran, Iran
| | - Rosa Rahimi
- Department of Physical Medicine & Rehabilitation, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leyla Sedighipour
- Department of Physical Medicine & Rehabilitation, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khalil Rostami
- Department of Plastic surgery, Shahid Moddares Hospital Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tornøe B, Andersen LL, Skotte JH, Jensen R, Gard G, Skov L, Hallström I. Test-retest repeatability of strength capacity, aerobic power and pericranial tenderness of neck and shoulder muscles in children - relevant for tension-type headache. J Pain Res 2013; 6:643-51. [PMID: 24039446 PMCID: PMC3770627 DOI: 10.2147/jpr.s46344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Frequent or chronic tension-type headache in children is a prevalent and debilitating condition for the child, often leading to medication overuse. To explore the relationship between physical factors and tension-type headache in children, the quality of repeated measures was examined. The aim of the present study was to determine the test-retest repeatability of parameters determining isometric neck and shoulder strength and stability, aerobic power, and pericranial tenderness in children. Methods Twenty-five healthy children, 9 to 18 years of age, participated in test-retest procedures within a 1-week interval. A computerized padded force transducer was used for testing. The tests included the isometric maximal voluntary contraction and force steadiness of neck flexion and extension, and the isometric maximal voluntary contraction and rate of force of the dominant shoulder. Pericranial tenderness was recorded by means of standardized manual palpation, and a submaximal cycle ergometer test predicted maximal oxygen uptake (VO2 max). The measurements were evaluated in steps, using the intraclass correlation coefficient (ICC); changes in the mean between the two test occasions; the levels of agreement, visualized in Bland-Altman Plots; and by quantifying the variability. Results The results showed an acceptable test-retest repeatability of isometric maximal voluntary contraction (ICC 0.90–0.97). The force steadiness measurements revealed a trend of systematic changes in the direction of neck flexion and need further examination in both healthy and ill children. The rate of force development, Total Tenderness Score, and prediction of VO2 max showed repeatability, with ICC 0.80–0.87. Conclusion The measurements of strength capacity, aerobic power, and tenderness provide acceptable repeatability, suitable for research in children.
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Affiliation(s)
- Birte Tornøe
- Department of Health Sciences, Lund University, Scania, Sweden ; Children's Headache Clinic, Department of Pediatrics, University of Copenhagen, Herlev Hospital, Herlev, Denmark ; Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark ; Department of Physiotherapy, Medical Department, University of Copenhagen, Herlev Hospital, Herlev, Denmark
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Wilson AC, Holley AL, Palermo TM. Applications of laboratory pain methodologies in research with children and adolescents: emerging research trends. Pain 2013; 154:1166-1169. [PMID: 23707308 DOI: 10.1016/j.pain.2013.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/27/2013] [Accepted: 04/05/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Anna C Wilson
- Institute on Development and Disability, Division of Psychology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mailstop CDRC, Portland, OR 97239, USA Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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