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Objective. The purposes of this study were to (1) investigate aspects of construct validity of peak force measurements of crate-and-pitcher tasks using the Task-oriented Arm-hAnd Capacity (TAAC), an instrument designed to measure task-oriented arm and hand strength for cross-sectional and evaluation purposes, and (2) compare TAAC measurements with those of comparative measures using COSMIN guidelines. Methods. In this cross-sectional validity study, participants were 105 children (mean age = 12 years 10 months; number of boys = 66) diagnosed with unilateral cerebral palsy (UCP). Ten a priori hypotheses were formulated with peak force of the TAAC as index measure and compared with measures on body functions and structure and activity level of the International Classification of Functioning, Disability and Health for Children and Youth. Strength and direction of the relationship between the TAAC and comparative measures were investigated by calculating Pearson correlation coefficients (r). Results. On body functions and structures level, low-to-moderate positive correlations (0.493-0.687) were found. On activity level, low negative and positive correlations (-0.271 to 0.387) were found. Conclusion. The construct of peak force measurement of the TAAC is in line with the a priori hypotheses with comparators on body function and structures and activity level, indicating a partial overlap of the construct of the TAAC with both International Classification of Functioning levels. The TAAC appears to be valuable, as it measures functional strength that differs from the constructs of the comparators. More research with a larger population and more comparators is needed. Impact. Clinically relevant information is lacking about the use of strength and strength measurement during daily activities in children with UCP. This study shows that the TAAC provides unique information about functional strength in children with UCP., Children with unilateral cerebral palsy (UCP) experience difficulties in performing activities of daily living (ADL) due to upper limb dysfunction. (1) Due to central neurological disorders, children with cerebral palsy [...]

Objective. The objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7-12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD). Methods. A cross-sectional study design was used. Isometric arm strength (wrist fexion, wrist extension with fexed and extended fngers, elbow fexion/extension) was assessed in 72 children (mean age = 9.3 [SD = 1.9] years) with USCP, and isometric grip/pinch strength was assessed in 86 children (mean age = 9.3 [SD = 1.8] years) with USCP. Arm/grip/pinch strength was assessed in 120 children (mean age = 9.5 [SD = 1.7] years) with TD. Arm strength was measured with a hand-held dynamometer, and grip/pinch strength was measured with a calibrated, modifed (digitized) grip dynamometer and a pinch meter. The nonaffected UE of children with USCP was compared with the preferred UE of children with TD because both sides represent the preferred UE. The affected UE was compared with the nonpreferred UE of children with TD, as both sides represent the nonpreferred UE. Results. In all measurements except for grip strength of the preferred UE, children with USCP were weaker than children with TD. Conclusions. In children with USCP, muscle strength weakness exists in both UEs. Impact. When unimanual or bimanual ability limitations are present in children with unilateral cerebral palsy, investigation of the muscle strength of the nonaffected UE should be part of the assessment., Unilateral spastic cerebral palsy (USCP) is characterized by motor impairments lateralized to 1 body side, resulting in an 'affected' body side and a 'nonaffected' body side (1-3) Several studies have [...]

Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain-coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain., Chronic pain (pain that persists beyond normal expected healing times or for >3 months) affects around 20% of the population. (1) The prevalence of chronic pain is higher than any [...]

Background. Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery. Objective. The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease. Design. This study was a randomized controlled trial. Setting. The study took place at 2 private spine clinics and 1 university hospital. Patients. We prospectively enrolled 118 patients scheduled for lumbar fusion surgery. Intervention. The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care. Measurements. The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome. Results. No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ('Group x Time') was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up. Limitations. The participants' preoperative level of disability was lower than normative values, which suggests selection bias. Conclusions. Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective., Globally, low back pain (LBP) causes more disability than any other condition. (1) Although only 0.5% of persons with LBP undergo back surgery, treatment costs afterwards are significant. (1,2) Degenerative [...]

Background. For children with unilateral spastic cerebral palsy (USCP), reduced muscle strength can lead to activity limitations. However, none of the existing measures of upper extremity strength measure strength in the context of functional activities in which strength must be maintained for several seconds. Objective. The objective of this study was to evaluate the psychometric properties of 2 newly developed functional hand and upper extremity muscle-strength tests (Cup-Task and Box-Task) in children aged 7 to 12 years with USCP. Design. A longitudinal study design was used. Methods. A standardized protocol with detailed descriptions of all procedures and measurements was used to determine test-retest reliability, interrater reliability, and criterion validity. Results. A total of 86 children (53 males, 33 females, mean age = 9.3 years) with USCP participated in this study, with a subset performing each measurement. Only the results of children who were able to perform the measurement were included for analysis. Excellent test-retest reliability (intraclass correlation coefficients = 0.887-0.944; 95% confidence intervals = 0.713-0.969) and interrater reliability (intraclass correlation coefficients = 0.896-0.960; 95% confidence intervals = 0.813-0.980) were observed. The Cup-Task Affected-Hand and Box-Task were moderately correlated with maximum isometric grip strength. The Cup-Task Nonaffected-Hand had a low correlation with maximum isometric grip strength. Limitations. Age, sex, and manual ability were not normally distributed, which could have influenced the results. Conclusions. For children with USCP who can perform the tasks, the Cup-Task and Box-Task are reliable and valid instruments for measuring functional upper extremity muscle strength., Impaired performance of upper extremity activities is reported in ~ 50% of children with unilateral spastic cerebral palsy (USCP), and these impairments affect the children's independence and quality of life. [...]

Background. Physical capacity tasks (ie, observer-administered outcome measures that comprise a standardized activity) are useful for assessing functioning in patients with low back pain. Purpose. The purpose of this study was to systematically review the level of evidence for the reliability, validity, and responsiveness of physical capacity tasks. Data Sources. MEDLINE, CINAHL, PsycINFO, Scopus, the Cochrane Library, and relevant reference lists were used as data sources. Study Selection. Two authors independently selected articles addressing the reliability, validity, and responsiveness of physical capacity tasks, and a third author resolved discrepancies. Data Extraction and Quality Assessment. One author performed data extraction, and a second author independently checked the data extraction for accuracy. Two authors independently assessed the methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist, and a third author resolved discrepancies. Data Synthesis and Analysis. Data synthesis was performed by all authors to determine the level of evidence per measurement property per physical capacity task. The 5-repetition sit-to-stand, 5-minute walk, 50-ft (~15.3-m) walk, Progressive Isoinertial Lifting Evaluation, and Timed 'Up & Go' tasks displayed moderate to strong evidence for positive ratings of both reliability and construct validity. The 1-minute stair-climbing, 5-repetition sit-to-stand, shuttle walking, and Timed 'Up & Go' tasks showed limited evidence for positive ratings of responsiveness. Limitations. The COSMIN 4-point checklist was originally developed for patient-reported outcome measures and not physical capacity tasks. Conclusions. The 5-repetition sit-to-stand, 50-ft walk, 5-minute walk, Progressive Isoinertial Luting Evaluation, Timed 'Up & Go,' and 1-minute stair-climbing tasks are promising tests for the measurement of functioning in patients with chronic low back pain. However, more research on the measurement error and responsiveness of these tasks is needed to be able to fully recommend them as outcome measures in research and clinical practice., Research suggests that low back pain (LBP) causes more years lived with disability than any other condition. (1) Many patients with acute LBP recover quickly, but the pain becomes a [...]

Background. In order to make inferences about strength related to development or treatment interventions, it is important to use measurement instruments that have sound clinimetric properties. Purpose. The objective of this review is to systematically evaluate the level of evidence of the clinimetric properties of instruments for measuring upper extremity muscle strength at the 'body functions & structures' level of the International Classification of Functioning, Disability and Health for Children and Youth (ICFCY) for children with cerebral palsy (CP). Data Sources. A systematic search of the PubMed, EMBASE, OTseeker, CINAHL, PEDro, and MEDLINE databases up to November 2012 was performed. Study Selection. Two independent raters identified and examined studies that reported the use of upper extremity strength measurement instruments and methods for children and adolescents with CP aged 0 to 18 years. Data Extraction. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist with 4-point rating scale was used by 2 independent raters to evaluate the methodological quality of the included studies. Best evidence synthesis was performed using COSMIN outcomes and the quality of the clinimetric properties. Data Synthesis. Six different measurement instruments or methods were iden tilled. Test-retest, interrater, and intrarater reliability were investigated. Two testretest reliability studies were rated as 'fair' for the level of evidence. All other studies were rated as 'unknown' for the level of evidence. Limitations. The paucity of literature describing clinimetric properties, especially other than reliability, of upper limb strength measurement instruments for children with CP was a limitation of the study. Conclusions. For measuring grip strength, the Jamar dynamometer is recommended. For other muscle groups, handheld dynamometry is recommended. Manual muscle testing (MMT) can be used in case of limited (below MMT grade 4) wrist strength or for total upper limb muscle strength. Based on lacking information regarding other clinimetric properties, caution is advised regarding interpretation of the results., The term 'cerebral palsy' (CP) describes a group of disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive impairments, that occur in the [...]