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To explore relevant parameters and investigate their test-retest reliability within the scope of the push button task of the Task-oriented Arm-hAnd Capacity (TAAC) measured in children with unilateral Cerebral Palsy (CP). 118 children diagnosed with unilateral CP, aged between 6 and 18 years, participated in this study. Thetest–retest reliability of the force generated during the push button task of the TAAC was investigated using an intraclass correlation (ICC) two-way random model with absolute agreement. The ICCs were calculated across the whole age group and for two separate age subgroups (6–12 and 13–18 years). Test-retest reliability of the parameters "mean peak force of all attempts", "overshoot of force", "number of successful attempts" and "time to complete four successful attempts" were moderate to good (ICC range 0.667–0.865; 0.721–0.908; 0.733–0.817, respectively). The results showed moderate to good test-retest reliability for all parameters. The parameters "mean peak force" and "number of successful attempts" are the most relevant parameters, as these parameters are task-specific and the most functional for clinical practice. Clinical relevant information about the use of task-oriented strength during the performance of daily activity has been added to strength measurements in children with Cerebral Palsy. The Task-oriented Arm-hAnd Capacity instrument is a reliable, objective and simple instrument to measure task-oriented strength during daily activity and is ready for use in a clinical setting. The Task-oriented Arm-hAnd Capacity instrument is both a capacity and performance-based test. The measurement with the push button task showed moderate to good test-retest reliability. [ABSTRACT FROM AUTHOR]

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Purpose: Literature shows promising effects for interdisciplinary biopsychosocial rehabilitation programs in patients with chronic low back pain (CLBP). Not every patient needs an interdisciplinary rehabilitation trajectory provided in a secondary care setting. Patients with moderate complex psychosocial complaints might benefit from biopsychosocial interventions offered in primary care under supervision of a physician in rehabilitation medicine (i.e. biopsychosocial integrated care intervention). This study investigated the feasibility and effectiveness of such intervention in patients with CLBP with moderate complex psychosocial complaints. Methods: mixed-method. Patients (aged 18-65 years, low back pain ≥12 weeks, moderate complex psychosocial complaints) received the intervention (4 individual sessions, 8 group sessions) provided by trained primary care physiotherapists. Physicians in rehabilitation medicine provided one consultation afterwards. Data from patients (n¼18), physicians (n¼4) and physiotherapists (n¼12) were used. Results: Physiotherapists were satisfied with the training. Patient attendance was good for individual sessions, less for groups. Physiotherapists sufficiently delivered the intervention, although recruitment and contextual factors influenced delivery. Patients reported significantly reduced functional disability (Quebec Back Pain Disability Scale) post-treatment (-8.3, 95% CI -13.3 to -2.7) and at 3months follow-up (-7.6, 95% CI -12.9 to -2.2). Conclusions: A biopsychosocial integrated intervention is feasible and potentially effective in patients with CLBP. [ABSTRACT FROM AUTHOR]

To identify and rank opportunities and challenges around adapting supported employment interventions for people with chronic low back pain (LBP). Delegates from an international back and neck research forum were invited to join an expert panel. A modified nominal group technique (NGT) was used with four stages: silent generation, round robin, clarification, and ranking. Ranked items were reported back and ratified by the panel. Nine experienced researchers working in the fields related to LBP and disability joined the panel. Forty-eight items were generated and grouped into 12 categories of opportunities/challenges. Categories ranked most important related respectively to policy and legislation, ensuring operational integration across different systems, funding interventions, and managing attitudes towards work and health, workplace flexibility, availability of "good" work for this client group, dissonance between client and system aims, timing of interventions, and intervention development. An expert panel believes the most important opportunities/challenges around adapting supporting employment interventions for people with chronic LBP are facilitating integration/communication between systems and institutions providing intervention components, optimising research outputs for informing policy needs, and encouraging discussion around funding mechanisms for research and interventions. Addressing these factors may help improve the quality and impact of future interventions. Interaction pathways between health, employment, and social systems need to be improved to effectively deliver intervention components that necessarily span these systems. Research-policy communication needs to be improved by researchers and policy makers, so that research outputs can be consumed by policy makers, and so that researchers recognise the gaps in knowledge needed to underpin policy. Improvements in research-policy communication and coordination would facilitate the delivery of research output at a time when it is likely to make the most impact on policy-making. Discussion and clarification surrounding funding mechanisms for research and interventions may facilitate innovation generally. [ABSTRACT FROM AUTHOR]

The aim of this article is to conceptualise the phenomenon of therapy-related parental stress in parents of children with a physical disability. Three models related to parental stress were reviewed, i.e., general parental stress, burden of caregiving in parents of children with physical disabilities, and experiences of these parents with their child's therapy. The proposed definition of therapy-related parental stress is "the subjective stress and subsequent changes of functioning and health experienced by a parent of a child with a physical disability in response to paramedical therapies (i.e., physical, occupational, and/or speech and language therapy)". A theoretical model is proposed to describe the process of therapy-related parental stress. Available questionnaires will most likely not be valid and responsive to capture the (changes in) stress parents experience related to therapy their child receives. This article provides a first definition of therapy-related parental stress and a theoretical model to visualise the processes with regard to this topic. Empirical testing of the presented components and their coherence is needed to confirm or improve the model. A questionnaire that specifically measures the concept of therapy-related parental stress is needed, along with evaluating therapy-related parental stress in clinical practice and research. It is imperative to recognise paramedical therapies (i.e., physical, occupational, and speech and language therapy) as a potential stressor for parents of children with a physical disability, both in paediatric rehabilitation practice and research. A definition and theoretical model of therapy-related parental stress is proposed and the need for measures to evaluate this phenomenon is argued. The authors provide a starting point for the evidence base of the concept of therapy-related parental stress. [ABSTRACT FROM AUTHOR]

To compare the effectiveness of a biopsychosocial primary care intervention (Back on Track) with primary care physiotherapy as usual in patients with chronic low back pain (CLBP) experiencing low complex psychosocial complaints. A double-blind multicentre pilot-randomised controlled trial. Twenty-five patients (≥18 years) with non-specific CLBP (≥12 weeks) experience low psychosocial complaints and a low to moderate level of disability. The Back on Track intervention (four individual and eight group sessions) versus physiotherapy as usual (maximally 12 individual sessions). Primary outcome: functional disability (Quebec Back Pain Disability Score) at post-treatment and 3 months follow-up. Anxiety, depression, catastrophizing, pain intensity, kinesiophobia, self-efficacy, global perceived effect. Effects were analysed using linear mixed model analysis. No significant differences in functional disability were found between interventions at post-treatment (mean difference 0.10, 95% CI: −12.9 to 13.1) and 3 months follow-up (mean difference −5.4, 95% CI −19.1 to 8.3). Secondary outcomes also showed no significant differences. No differences in effects were found between patients with CLBP experiencing low complex psychosocial complaints who receive the Back on Track intervention compared to patients receiving primary care physiotherapy as usual. Well-powered studies of sufficient methodological quality are needed to detect differences in effects. [ABSTRACT FROM AUTHOR]

Purpose: To investigate test–retest and inter-rater reliability of maximum isometric arm muscle strength measurements using the hand-held dynamometer (HDD) and maximum isometric grip and pinch strength measurements using the Biometrics E-Link Evaluation System in children aged 7–12 years with unilateral spastic cerebral palsy. Materials and methods: All data were obtained using a test–retest study design. The study met the conditions of the COSMIN criteria to achieve good methodological quality. Results: For arm strength measurements, all test–retest reliability intraclass correlation coefficient (ICC) values and all but one inter-rater reliability ICC value indicated excellent reliability. For grip- and pinch strength measurements, all test–retest reliability and inter-rater reliability ICC values showed excellent reliability. The standard error of measurement values ranged from 4.97 to 11.36 N (HDD) and 0.37 to 1.81 kg (E-link). Smallest detectable change values ranged from 13.79 to 31.49 N (HDD) and 1.03 to 5.02 kg (E-link). Conclusions: The HDD and E-link system are usable measurement instruments for cross-sectional muscle strength measurements in children with unilateral spastic cerebral palsy. It is not clear if both instruments are usable to measure changes in muscle strength within an individual, especially if a child with unilateral spastic cerebral palsy has low muscle strength. Caution in the interpretation of changes in muscle strength is therefore necessary. The hand-held dynamometer and E-Link Evaluation System are reliable measurement instruments to measure muscle strength of the arm and hand in children with unilateral spastic cerebral palsy, aged 7–12 years. Cross-sectional measurements; it is possible to measure upper extremity muscle strength in children with unilateral spastic cerebral palsy with the hand-held dynamometer and E-link system. Longitudinal measurements; changes in upper extremity muscle strength within one person should be interpreted with care, especially if a child with unilateral spastic cerebral palsy has low muscle strength. [ABSTRACT FROM AUTHOR]

Purpose: A prehabilitation phase is suggested as the ideal way to prepare patients for optimal outcomes from surgery. Our aim was to describe the lessons we learned from developing PREPARE, an evidence-based prehabilitation programme based on a cognitive behavioural approach designed to improve functional outcomes after lumbar fusion surgery. Methods: We used the Medical Research Council (MRC) framework approach for developing and designing a complex intervention, specifically the two phases; 'Development' and 'Feasibility and Piloting'. Various aspects of treatment fidelity were evaluated during the phase 'Feasibility and Piloting'. As part of the feasibility element, a pilot Single Subject Research Design study was performed. Eleven patients awaiting lumbar fusion surgery participated in the study. We evaluated in particular the use and application of outcome measures. Results: Significant lessons were learned which we used to adjust the prehabilitation programme to better fit a surgical context. The original treatment manual was elaborated on, the outcome measures adjusted, and the content of the intervention altered. Finally, the PREPARE programme was published in the form of a study protocol. Conclusions: There are significant lessons to be learned from testing a study protocol before it is implemented in a large-scale randomised controlled trial (RCT). [ABSTRACT FROM AUTHOR]

Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/adolescents with cerebral palsy (CP). Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed. Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified. Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction. [ABSTRACT FROM AUTHOR]

Aim: To examine reproducibility of the arm-hand strength measured while performing the bimanual crate task and the unimanual pitcher task. Methods: 105 children diagnosed with unilateral Cerebral Palsy, aged between 6 and 18 years, participated in this study. The test–retest reliability of the force generated during bimanual crate task and unimanual pitcher task of the Task-oriented Arm-hAnd Capacity instrument was investigated using intraclass correlation two-way random model with absolute agreement. The intraclass correlations were calculated for two age groups (6–12 and 13–18 years old). Results: The results showed good test–retest reliability for the crate and pitcher task with the non-affected hand for both age groups. The results of the pitcher task for the affected hand showed moderate test–retest reliability for both age groups. Conclusion: The Task-oriented Arm-hAnd Capacity instrument has moderate to good test–retest reliability. It is a simple and objective instrument to assess task-oriented strength in children with unilateral cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the usability and effectiveness of a functional hand orthosis, combined with electrical stimulation adjunct to therapy-as-usual, on functional use of the moderately/severely impaired hand in sub-acute stroke patients. Materials and Methods: Single case experiment (A-B-A′-design) involving eight sub-acute stroke patients. The functional hand orthosis and electrical stimulation were used for six weeks, four days/week, 45′/day. Outcome measures: Action_Research_Arm_Test, Intrinsic_Motivation_Inventory. Results: At group level, patients improved 19.2 points (median value) (interquartile range: [8.8, 29.5] points) on the Action_Research_Arm_Test (p = 0.001). After correcting for spontaneous recovery and/or therapy-as-usual effects Action_Research_Arm_Test scores still improved significantly (median: 17.2 points; interquartile range: [5.1, 29.2] points) (p = 0.002). At individual level, six patients had improved as to arm-hand skill performance at follow-up (p < = 0.010). In one patient, arm-hand skill performance improvement did not attain statistical significance. In another patient, no arm-hand skill performance improvement was observed. Average Intrinsic_Motivation_Inventory sub-scores were between 4.6 and 6.3 (maximum: 7), except for 'perceived pressure/tension' (3.3). Conclusion: Sub-acute stroke patients who display only little/modest improvement on their capacity to perform daily activities, seem to benefit from training with a dynamic arm orthosis in combination with electrical stimulation. Patients' perceived intrinsic motivation and sense of self-regulation was high. Arm-hand training featuring the dynamic hand orthosis in combination with electrical stimulation shows a shift from no dexterity to dexterity. As to the users' experience regarding the dynamic hand orthosis, patients perceive a high-intrinsic motivation and sense of self-regulation. Combining the orthosis with electrical stimulation creates opportunities for a nonfunctional hand towards task-oriented training. [ABSTRACT FROM AUTHOR]

Objective: Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN. Design: Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N = 12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach. Main Outcome Measures: Fears and coping strategies related to PA in persons with PDN. Results: Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described. Conclusion: In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN. [ABSTRACT FROM AUTHOR]

Background: The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) offers an optional performing arts module. The goal was to examine the psychometric properties of this module in musicians. Methods: This study is a secondary analysis of a randomized controlled trial on the effectiveness of a biopsychosocial intervention to prevent or reduce playing-related disability in conservatory students. Baseline data were used to examine internal consistency and discriminative validity of the performing arts module of the DASH questionnaire. Construct validity was analyzed by hypotheses testing. The performing arts module outcomes were compared to scores from the general DASH questionnaire, pain disability index, Short-Form 36, playing-related musculoskeletal disorder (PRMD) intensity, and pain intensity. Results: Questionnaires completed by 130 conservatory students were analyzed, 55% of the population was female. Median age was 20 years (IQR 4). The performing arts module showed good internal consistency (Cronbach’s alpha 0.893). Discriminative validity between students with and without PRMDs was good. Three out of six hypotheses were accepted, indicating moderate construct validity. Conclusions: The performing arts module showed good internal consistency, good discriminative validity and moderate construct validity in a population of conservatory students. Implications for Rehabilitation: Musicians suffer frequently from musculoskeletal disorders, mostly in the upper extremity. The Disabilities of the Arm, Shoulder, and Hand questionnaire is a well-known outcome measure, which also includes a performing arts module. This study is the first to explore psychometric properties of the performing arts module. The performing arts module of the Disabilities of the Arm, Shoulder, and Hand questionnaire showed good internal consistency, good discriminative validity, and moderate construct validity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide an in-depth exploration and understanding of parents’ thoughts, feelings and concerns they experience while reflecting on their actions, challenges and needs in enabling their child’s participation at home, at school and in the community.Method: A naturalistic inquiry with thirteen Dutch parents using interpretative phenomenological analysis.Results: Analysis revealed three super-ordinate themes: “Parents’ experiences and concerns about systems, laws and regulations”, “Parents’ experiences and thoughts about physical and/or social environment” and “Parents’ experiences and feelings of finding and/or enabling an activity”. Parents’ often expressed feelings of disappointment derived from being misunderstood, from dealing with the complexity of systems, from hindrance of participation of their children by the social and the physical environment, and from the lack of leisure activities for their child. It is primarily restrictions in the physical and social environments that urge them to take actions, to experience challenges and think of needs.Conclusions: In-depth exploration and understanding of parents’ articulated matters must be shared and taken seriously by policymakers and service providers. Parents’ knowledge and experiences should be of major relevance to improve paediatric rehabilitation and other services for children with a physical disability.Implications for RehabilitationTo achieve tailored pediatric rehabilitation, involvement and needs of parents in enhancing their child’s participation ought to be acknowledged.Active use of parents’ experiences and knowledge regarding the participation of their child on different levels of decision making may improve daily services in pediatric rehabilitation.Aiming for optimal participation of a child with a physical disability at home, at school and in the community, the focus of pediatric rehabilitation needs to shift towards enabling, social and physical, environments. [ABSTRACT FROM PUBLISHER]

An editorial is presented on how to sustain and improve client centered care in chronic musculoskeletal pain, and start by changing the way policy makers select and judge the large amount of available data, and get rid of the dogma of stepped care. The article discusses that this development definitely does not deserve the reflex of controlling the budget or restricting the availability of proven effective care, but a revaluation of primary and early secondary prevention.

In patients with chronic low back pain (CLBP), a patient's level of physical functioning is evaluated to determine the impact of pain on physical functioning. It appears that in various performance tests the influence of non-physiological factors differs. It is unclear which performance tests are best suited for measurement of maximum capacity or pain-related behaviour. The main aim of the present review is to highlight the influence of psychological factors during different types of performance testing in patients with CLBP. The degree in which pain-related and psychological factors influence test outcome differs between performance tests. A minimum influence of pain intensity and psychological factors is found in (sub)maximal exercise testing in patients who are able to complete the test. The influence of pain intensity and psychological factors is most prominent in holding endurance tasks evaluating the duration a patient can hold a certain weight. In order to decide which assessment tool for physical performance can best be used for the evaluation of physical functioning in patients with CLBP, one should specifically consider the question that has to be answered. In case a patients' physical capacity has to be objectified, another assessment tool seems preferred compared with a situation in which a patient's pain-related behaviour is aimed to be assessed. [ABSTRACT FROM AUTHOR]

In this article the author focuses on chronic musculoskeletal pain's treatment. He states that there needs to be more research related to pain and disability associated with it. He mentions that one can use statistical analyses like randomization testing in single case design (SCD). He highlights that one should work on pain management and physiotherapy.