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Background Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation. Trial registration Clinical trial registration no ISRCTN 82353628, ISRCTN 69520623 and ISRCTN 58583714. Electronic supplementary material The online version of this article (10.1186/s12984-019-0573-1) contains supplementary material, which is available to authorized users.

PURPOSE: To investigate the effects of high-intensity interval training (HIT) on physical fitness in youth with physical disabilities who 1) are able to run, 2) walk independently but are not able to run, and 3) propel a manual wheelchair. METHODS: A total of 70 children and adolescents were recruited from schools for special education in the Netherlands (mean age 13.4±2.9, range 8-19 years, 56% boys). The sample consisted of 35 runners, 24 walkers, and 9 wheelchair users. They had various physical disabilities; cerebral palsy (41%), spina bifida (8%), other neuromuscular diseases (34%), musculoskeletal (4%), cardiovascular (4%) and metabolic diseases (9%). HIT was performed for eight weeks, twice a week, containing 8-12 interval of 30 seconds all-out exercises followed by active recovery. Anaerobic performance was measured by the Muscle Power Sprint Test, agility with the 10x5 meter sprint test and a shuttle run/ride test (SRT) was performed to determine aerobic performance (shuttles) and VO2peak. RESULTS: Exercise attendance was 85%. Following HIT, anaerobic performance improved in both runners (p=.011) and walkers (p=.020), but not in wheelchair users (p=.463). Both agility and aerobic performance showed a significant training effect in all groups; runners (p=.001; p p=.006) and wheelchair users (p=.024; p=.012). However, no changes were found for VO2peak (ml/kg/min) in any of the subgroups. CONCLUSION: Both anaerobic and aerobic performance improved in all subgroups after HIT, except for anaerobic performance in wheelchair users. No effects were found for VO2peak. For clinical practice, 30 seconds all-out intervals are feasible and safe in youth with physical disabilities. Future research should focus on wheelchair users specifically. To improve VO2peak short-term, we suggest for future research to increase training frequency to three times a week and/or increase time per interval (i.e. training volume).

OBJECTIVE. We investigated whether demographic, disease-related, or personal baseline determinants can predict a positive response to energy conservation management (ECM). METHOD. We conducted a secondary analysis of a single-blind, two-parallel-arms randomized controlled trial that included ambulatory adults with severe MS-related fatigue. Therapy responders and nonresponders were categorized by Checklist Individual Strength fatigue change scores between baseline and end of treatment. Logistic regression analyses were used to assess the determinants of response. RESULTS. Sixty-nine participants were included (ECM group, n = 34; control group, n = 35). In the ECM group, fatigue severity, perception of fatigue, illness cognitions about MS, and social support discrepancies were related to the probability of being a responder. CONCLUSION. The results suggest that people with MS-related fatigue who had a less negative perception of fatigue and who perceived fewer disease benefits and a higher discrepancy in social support had the best response to ECM treatment.

Youth with chronic diseases and/or physical disabilities (CDPD) often show reduced fitness and physical activity (PA) levels and participate less in organized sports compared to healthy peers. The purpose of this study was to examine the associations between participation in sports and health-related fitness and PA in youth with CDPD. A total of 163 participants (mean age 14; range 8-19 years) with CDPD were included in this cross-sectional study, with 81 participating in organized sports and 82 not. Participants were recruited between October 2014 and November 2016 in the Netherlands. Aerobic and anaerobic fitness, agility and muscle strength were assessed in the lab while PA was monitored in daily life using accelerometry during one week. Linear regression analyses were used to assess the associations of sports participation (independent variable) with health-related fitness and PA (dependent variables). Results show that youth with CDPD participating in organized sports two times a week performed better on all outcome measures. They reached a higher peak oxygen uptake (difference of 4.9 ml O2/kg/min, P=0.001) compared to their peers not participating in sports. Also, anaerobic fitness, agility, muscle strength and PA were all positively associated with sports participation. Moreover, the association between sports participation and aerobic fitness was mediated by PA for 31% (P=0.045). In conclusion, participation in sports is associated with both higher levels of PA and health-related fitness in youth with CDPD. Promotion and stimulation of participation in sports seems a good way to promote health-related fitness as well as a healthy active lifestyle in youth with CDPD.

PURPOSE: As self-reported diaries are insufficient to monitor daily physical activity including training accurately, we used the opportunity of the HandbikeBattle 2017 to conduct a pilot study on the usage of a multi-sensor activity tracker with both accelerometer and heartrate outputin persons with spinal cord injury (SCI). The aim of our study was to investigate the feasibility of a low cost and widely used fitness tracker to monitor daily physical activity and handbike training activity in wheelchair-dependent persons with SCI. METHODS: Six persons with SCI of the Utrecht HandBikeBattle team were enrolled in the study. All participated to wear a Fitbit Charge 2® 24 hours a day for at least 2 weeks and were questioned about the usefulness and user-friendliness of this device and data was compared with self-reported physical activity. RESULTS: Five participants wore the device nonstop for 2 weeks and most continued usage for multiple weeks and months. Beside high compliance, we found enthusiasm about the direct feedback and user- friendliness and valid data amongst our participants. Data collected during 3 months on 3 participants and during 8 months on one of them showed the possibility to detect training days and observe interpersonal and intrapersonal variation in daily physical activity level. DISCUSSION AND CONCLUSION: A commercially available multi-sensor wrist device like the Fitbit Charge 2® is a promising instrument to monitor training schedules of wheelchair athletes and daily activity levels among wheelchair-users with SCI. Our study illustrates how innovative measurement methods, commercial dashboard and log data can be used in patients, as they benefit from direct feedback of their training activity and timely intervention.&nbsp

Aims: To (1) describe the child- and context-focused behaviors of physical and occupational therapists, and (2) compare the behaviors of therapists in a standard therapy session with those of therapists trained to deliver child- and context-focused services. Method: Videos of 49 therapy sessions provided by 36 therapists were analyzed using the intervention domains of the Paediatric Rehabilitation Observational measure of Fidelity (PROF) to examine the therapeutic behaviors of physical and occupational therapists with young children with cerebral palsy (CP) (24 to 48 months) in a Dutch rehabilitation setting. The PROF ratings of 18 standard therapy sessions were compared with the ratings of 16 child- and 15 context-focused therapy sessions. Results: Therapists who provided standard therapy demonstrated a mix of child- and context-focused behaviors. PROF ratings indicated fewer child- and context-focused behaviors during standard therapy sessions compared with sessions where therapists were instructed to use either child- or context-focused behaviors. Conclusions: A sample of Dutch physical and occupational therapists of young children with CP demonstrated a mix of child- and context-focused therapy behaviors during standard therapy. Further research is recommended on clinical reasoning and the effect of setting to better understand therapists’ use of child- and context-focused behaviors during therapy sessions.

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Understanding the experiences of parents with their child's intervention might help meet the needs of parents and, subsequently get them engaged in their child's intervention. As parents' early beliefs regarding their child's intervention has consequences for treatment participation, it is important to understand these parental perspectives. The aim of this mixed studies review was to give an overview of the experiences and related factors of parents of young children (0-5 years of age) with cerebral palsy in relation to the physical and/or occupational therapy of their child in a rehabilitation setting. The literature was searched systematically for qualitative and quantitative studies published between January 1990 and July 2011. Inclusion criteria were (1) the study population consisted of parents of children with cerebral palsy, with at least 25% of children under the age of five; (2) children had received physical and/or occupational therapy in a rehabilitation setting; and (3) the experiences of the parents with their child's therapy were addressed. Data were synthesized with the framework synthesis method resulting in a conceptual framework describing the factors that are related to the parents' experiences with their child's interventions. A total of 13 studies (eight qualitative and five quantitative) were included and evaluated. Parents expressed various aspects in context, process and outcomes when asked about their experiences with their child's intervention. They had different needs over time and needed time to build a collaborative relationship with their child's therapists. The proposed framework acknowledges the various aspects in context, process and outcomes that parents reported when asked about their experiences. Knowing this, the importance of the broader context of the child in a family should be acknowledged; realizing the impact that the demands of daily life, supports and resources provided to parents, attitudes in the community and culture have on parental experiences.

Aim: The objective of this study was to assess the validity of a mobility questionnaire (MobQues) that was developed to measure parent-reported mobility limitations in children with cerebral palsy (CP). Method: The parents of 439 children with CP (256 males and 183 females; age range 2-18y; Gross Motor Function Classification System [GMFCS] levels I-IV) completed the mobility questionnaire (MobQues). To assess content validity, we linked all meaningful concepts of the MobQues items to the International Classification of Functioning, Disability and Health (ICF). To assess construct validity, we compared the total scores of the two versions of the MobQues (MobQues47 and MobQues28) according to GMFCS level, and determined Pearson's correlation coefficient (r) with the Gross Motor Function Measure-66 (GMFM-66). Results: Content validity was demonstrated by the fact that 46 of the 47 MobQues items were linked to categories in the 'Mobility' chapter of the ICF. Construct validity was demonstrated by the finding that MobQues scores decreased with increasing GMFCS levels (p

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