Background: The impact of dizziness on quality of life is often assessed by the Dizziness Handica... more Background: The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured. Methods: Two samples (n = 92 and n = 27) included participants with dizziness of mainly vestibular origin. A cross-sectional design was used to examine the factor structure (exploratory factor analysis), internal consistency (Cronbach's α), concurrent validity (Pearson's product moment correlation r), and discriminate ability (ROC curve analysis). Longitudinal designs were used to examine test-retest reliability (intraclass correlation coefficient (ICC) statistics, smallest detectable difference (SDD)), and responsiveness (Pearson's product moment correlation, ROC curve analysis; area under the ROC curve (AUC), and minimally important change (MIC)). The DHI scores range from 0 to 100. Results: Factor analysis revealed a different factor structure than the original DHI, resulting in dismissal of subscale scores in the DHI-N. Acceptable internal consistency was found for the total scale (α = 0.95). Concurrent correlations between the DHI-N and other related measures were moderate to high, highest with Vertigo Symptom Scale-short form-Norwegian version (r = 0.69), and lowest with preferred gait (r =-0.36). The DHI-N demonstrated excellent ability to discriminate between participants with and without 'disability', AUC being 0.89 and best cutoff point = 29 points. Satisfactory test-retest reliability was demonstrated, and the change for an individual should be ≥ 20 DHI-N points to exceed measurement error (SDD). Correlations between change scores of DHI-N and other self-report measures of functional health and symptoms were high (r = 0.50-0.57). Responsiveness of the DHI-N was excellent, AUC = 0.83, discriminating between self-perceived 'improved' versus 'unchanged' participants. The MIC was identified as 11 DHI-N points. Conclusions: The DHI-N total scale demonstrated satisfactory measurement properties. This is the first study that has addressed and demonstrated responsiveness to important change of the DHI, and provided values of SDD and MIC to help interpret change scores.
Despite enhanced interest in manifestations of pain in adults with intellectual and developmental... more Despite enhanced interest in manifestations of pain in adults with intellectual and developmental disabilities (IDD), the characteristics of pain behavior in this group have seldom been examined. The aim of the present study was to provide a sensitive pain behavior scale for adults with IDD. The participants, 228 adults (mean age, 38.7 years) with different levels of IDD, were videotaped before and during an influenza vaccination and scored using the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R). Observed pain behaviors not captured by the NCCPC-R, was also registered. Sensitivity to pain of all 27 items was examined by Signed Rank test, internal consistency by Cronbach's alpha, and sensitivity to change of the total scale by Standardized Response Mean (SRM). Thirteen items were excluded from the original NCCPC-R scale; 4 new items were added, making a modified scale of 18 items. This scale, named the Non-Communicating Adults Pain Checklist-Revised (NCAPC), was rescored and examined for psychometric properties in a random sample (N = 89). Sensitivity to pain of all items (P < .05) and high internal consistency (alpha = 0.773) were demonstrated. Large sensitivity to pain at all levels of IDD was shown (SRM, 1.20 to 2.07). Better psychometric properties were demonstrated for NCAPC than NCCPC-R in the target population. This article presents initial psychometric properties of a new measure, the NCAPC, evaluating pain behavior in adults with IDD. This measure could help clinicians to better capture pain expressions in this population and contribute to better pain management for this group of patients.
Background. The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed a... more Background. The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed at capturing how people with long-lasting musculoskeletal pain reflect on their own body awareness. Methods based on classical test theory were applied to the development of the instrument and resulted in 4 subscales. However, the scales were not correlated, and construct validity might be questioned. Objective. The primary purpose of this study was to explore the possibility of developing a unidimensional scale from items initially collected for the BARQ using Rasch analysis. A secondary purpose was to investigate the test-retest reliability of a revised version of the BARQ. Design. This was a methodological study. Methods. Rasch and reliability analyses were performed for 3 samples of participants with long-lasting musculoskeletal pain. The first Rasch analysis was carried out on 66 items generated for the original BARQ and scored by 300 participants. The items supported by the first analysis were scored by a new group of 127 participants and analyzed in a second Rasch analysis. For the test-retest reliability analysis, 48 participants scored the revised BARQ items twice within 1 week. Results. The 2-step Rasch analysis resulted in a unidimensional 12-item revised version of the BARQ with a 4-point response scale (scores from 0 to 36). It showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered thresholds. Test-retest reliability was high, with an intraclass correlation coefficient of .83 (95% CI = .71-.89) and a smallest detectable change of 6.3 points. Limitations. The small sample size in the second Rasch analysis was a study limitation. Conclusions. The revised BARQ is a unidimensional and feasible measurement of body awareness, recommended for use in the context of body-mind physical therapy approaches for musculoskeletal conditions.
Material and Methods: Fifty healthy subjects, 25/25 male/female, age 18−65, 5 age brackets were i... more Material and Methods: Fifty healthy subjects, 25/25 male/female, age 18−65, 5 age brackets were included. To quantify the different cervical motions a 3Space Inside Track HP system Polhemus was used. An electromagnetic receiver and transducer measure the range of rotations and translations in respectively the X, Y and Z-axes. The following motions were performed five times active and passive. 1. Rotation 2. Cervical forward flexion 3. Cervical backward flexion 4. Cervical forward flexion/rotation 5. Cervical backward flexion/rotation Results: To test the reliability of this measurement 20 subjects were tested two times (interval one week). The intraclass correlation coefficient (ICC) was good for all movements except active forward flexion. The Range of Motion (active and passive) decreased with increase of age, no effect of gender. No significant differences in the difference score (passive – active) with increase of age. Conclusion: This study demonstrates that a three dimensional motion analysis is a valid and reproducible method to measure active and passive cervical motion which can be used in further pain research as secondary outcome measure.
This study was undertaken to develop a multidimensional instrument in the Norwegian language to m... more This study was undertaken to develop a multidimensional instrument in the Norwegian language to measure pain. The McGill Pain Questionnaire (MPQ) was used as a model, since it is a valid and reliable tool for pain measurement in English speaking countries. A series of steps were taken to develop a Norwegian pain questionnaire: 1) Words descriptive of pain were derived from 95 subjects (patients, students and health personnel). 2) Ten subjects allocated pain words into groups. 3) 36 college students validated the word groupings. 4) 72 patients graded the words contained in each group according to intensity. 5) A test of reliability of group items was performed. The study demonstrated that there are many words in Norwegian to describe pain. The Norwegian pain questionnaire came to contain 106 descriptors of pain placed in 18 groups. We demonstrated the validity of the word groupings and the reliability of group items. The actual value of the Norwegian pain questionnaire as a measuring instrument has not yet been documented.
ABSTRACT Measures of physical performance should address the activity dimension directly and refl... more ABSTRACT Measures of physical performance should address the activity dimension directly and reflect functional problems important to patients with a defined health condition. The Pick-up test was developed for patients with back pain by the first author, and requires the patient to pick up a piece of paper from the floor. Performance is scored by a clinician along a four-point ordinal scale, scores depending on dynamic flexibility and ease of motion. This study is about the development of the Pick-up test and the establishment of reliability, validity and responsiveness to change. Inter-tester reliability was acceptable (=0.74). Test scores discriminated between groups of patients with back pain and other musculoskeletal pain, and reflected perceived difficulty in pick-up as well as dressing tasks among patients with back pain. Test scores were also related to affective pain reports. Baseline test scores did not predict return to work after 1 year. The test was responsive to clinically significant change over time. Evidence was provided that the test can be used as a functional assessment tool, and is suggested for use as an outcome measure. Whether or not the Pick-up test reflects performance of other dynamic physical activities in back pain needs to be examined.
Abilities of the Short‐Form McGill Pain Questionnaire to assess change have scarcely been address... more Abilities of the Short‐Form McGill Pain Questionnaire to assess change have scarcely been addressed in previous studies. The aim of the present study was to examine test–retest reliability, sensitivity to change and responsiveness to clinically important change using a Norwegian version (NSF‐MPQ) in different groups of patients. ICC(1,1) values for test–retest reliability (relative reliability) assessed 1–3 days apart for total, sensory and affective scores were, respectively, 0.75, 0.76 and 0.62 in patients with musculoskeletal pain (n=58), and 0.93, 0.95 and 0.79 in patients with rheumatic pain (n=25). Variability in total scores (absolute reliability) was less in patients with rheumatic pain (within‐subject standard deviation, Sw=2.70) than in patients with musculoskeletal pain (Sw=4.28). Sensitivity to change by standardized response mean (SRM) was mostly large (>0.80) for three patient groups reporting improvement after treatment. More sensitivity to change was demonstrated by the total and sensory scores than by the affective score, and sensitivity of the total score was similarly good to capture improvement as the Visual Analogue Scale (VAS). Indication was provided that mean improvement of groups in NSF‐MPQ total scores should be >5 on the 0–45 scale to demonstrate a clinically important change. Responsiveness to clinically important change by receiver operating characteristic curve analysis was modest, as area under the curve indicating ability to discriminate improved and not improved patients with musculoskeletal pain, was only 0.61. The study indicates mostly satisfactory test–retest reliability and responsiveness values of the NSF‐MPQ, but shows that the measurement properties vary between groups of patients with pain.
The study was undertaken to develop a multidimensional measuring instrument for pain in the Norwe... more The study was undertaken to develop a multidimensional measuring instrument for pain in the Norwegian language. The McGill Pain Questionnaire (MPQ) was used as a model as it is a valid and reliable tool for pain measurement in English speaking countries. A series of steps were taken to develop a Norwegian pain questionnaire: (1) words describing pain were derived from 95 subjects (patients, students and health personnel); (2) 10 subjects allocated pain descriptors into groups; (31 36 college student validated the word groupings; (4) 72 patients graded the words contained in each group according to intensity; and (5) the reliability of group items was tested. The study demonstrated that there are many descriptors of pain in the Norwegian language. The final version of the Norwegian pain questionnaire consisted of 106 pain descriptors divided into 18 groups. Validity of the classifications as well as reliability of the words was demonstrated. The actual value of the Norwegian pain questionnaire as a measuring instrument has not yet been documented.
Physiotherapy Research International, Nov 22, 2021
BackgroundCompensational movement patterns in hip osteoarthritis (HOA) are associated with hip dy... more BackgroundCompensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA.ObjectiveTo examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE).Study DesignA prospective, assessor‐blinded, and block‐randomized controlled trial.MethodsCommunity‐living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self‐reported aspects of function and health.ResultsAt pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty‐one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per‐protocol analysis showed changes in favor of the intervention group for self‐efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included.ConclusionsBBAT was not found to be a more effective treatment modality than self‐initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.
Background: Patients' access to movement experiences is implemented in the evaluation tool Body A... more Background: Patients' access to movement experiences is implemented in the evaluation tool Body Awareness Rating Scale-Movement Quality and Experience, with its two intertwined parts: 1) the physiotherapist's observations of movement quality; and 2) the patient's descriptions of immediate movement experiences. Objective: To study movement experiences and reflections described by patients diagnosed with hip osteoarthritis when guided to explore simple daily-life movements in this particular evaluation context. Design: An explorative qualitative study with open-ended questions following each of the 12 movements integrated into the evaluation. Methods: 35 participants diagnosed with hip osteoarthritis were included; 28 women and 7 men, aged 23-78 years. Their descriptions were audiotaped, transcribed verbatim and analyzed in accordance with qualitative content analysis. Results: The patients described experiences of a dynamic adaptation of movement strategies based on sensations from the moving body. Two interrelated categories of movement awareness were identified: 1) Experienced movement challenges, including three sub-categories; a) Lack of contact, b) Movement changed by symptoms, and c) Compensational movement habits, and 2) Movement components promoting well-being, including three sub-categories; a) Integrating balance, breathing and awareness into movement, b) Small, simple, soft and safe movements, and c) A taste of own movement resources for daily life. Conclusions: The Body Awareness Rating Scale-Movement Quality and Experience provides a platform for patients to become aware of and describe their movement habits and resources in own words, intertwined with the physiotherapist movement observations. Derived descriptions reflect a patient perspective to be implemented in therapy.
INTRODUCTION Delayed achievement of motor milestones may be an early indicator of motor difficult... more INTRODUCTION Delayed achievement of motor milestones may be an early indicator of motor difficulties. Parent-reported questionnaires may serve as an efficient, low-cost screening to identify infants in need of further clinical assessment, and thus be a helpful tool in busy health care centers. PURPOSE To examine the ability of the Ages and Stages Questionnaire, second edition (ASQ-2) to indicate motor difficulties in infants using the Infant Motor Profile (IMP) as the reference standard. METHODS A cross-sectional design was applied to examine the correlation between parent-reported data of the ASQ-2 and data from physiotherapist assessment using IMP. Included were 432 mainly low-risk infants aged 3-12 months from primary care. RESULTS Overall, ASQ-2 gross and fine motor scores did not correlate well with the IMP total or domain scores. The ASQ-2 gross motor cut point (> 2SD below the mean), showed 34.3% sensitivity and 96.7% specificity using the 15th percentile from IMP performance domain as reference standard. The positive predictive value to indicate motor difficulties was 48%. CONCLUSION The motor domains of ASQ-2 have poor ability to identify infants with motor difficulties as indicated by their IMP scores in low-risk infants.
Background: Developing age-appropriate medications remains a challenge in particular for the popu... more Background: Developing age-appropriate medications remains a challenge in particular for the population of infants and toddlers, as they are not able to reliably self-report if they would accept and consequently take an oral medicine. Therefore, it is common to use caregivers as proxies when assessing medicine acceptance. The outcome measures used in this research field differ and most importantly lack validation, implying a persisting gap in knowledge and controversy in the field. The newly developed Caregiver-administered Children's Acceptance Tool (CareCAT) is based on a 5-point nominal scale, with descriptors of medication acceptance behavior. This crosssectional study assessed the measurement properties of the tool with regards to the user's understanding and its intra-and inter-rater reliability. Methods: Participating caregivers were enrolled at a primary healthcare facility where their children (median age 6 months) had been prescribed oral antibiotics. Caregivers, trained observers and the tool developer observed and scored on the CareCAT tool what behavior children exhibited when receiving the medicine (n = 104). The videorecords of this process served as replicate observations (n = 69). After using the tool caregivers were asked to explain their observations and the tool descriptors in their own words. The tool's reliability was assessed by percentage agreement and Cohen's unweighted kappa coefficients of agreement for nominal scales. Results: The study found that caregivers using CareCAT had a satisfactory understanding of the tool's descriptors. Using its dichotomized scores the tool reliably was strong for acceptance behavior (agreement inter-rater 84-88%, kappa 0.66-0.76; intra-rater 87-89%, kappa 0.68-0.72) and completeness of medicine ingestion (agreement inter-rater 82-86%, kappa 0.59-0.67; intra-rater 85-93%, kappa 0.50-0.70). Conclusions: The CareCAT is a low-cost, easy-to-use and reliable instrument, which is relevant to assess acceptance behavior and completeness of medicine ingestion, both of which are of significant importance for developing age-appropriate medications in infants and toddlers.
Disability and Rehabilitation: Assistive Technology, Oct 9, 2017
To explore children's experiences with testing, acquiring and using assistive dev... more To explore children's experiences with testing, acquiring and using assistive devices. Nine children (six boys, three girls, 9-12 years old, with different physical disability and activity experience, participated in semistructured interviews. The interviews were audio-taped, transcribed and analysed using Systematic text condensation. Assistive devices were reported to contribute to cope activities that the children otherwise would not have participated in. Several subjects listed the need for a shielded environment when adapting to new equipment. The children highlighted "independence in activities" and "having the opportunity to participate in activities with family and friends" as important for frequent use. Need for assistance and lack of localizations to perform the activities were listed as reasons for less frequent use. This study reveals that it is useful to map each child's opportunities for independency, appropriate locations for performing the activity and participation with friends, when considering obtaining assistive devices. Implications for Rehabilitation The use of assistive devices gives many children with physical disabilities the opportunity to participate in physical activity. Improving availability to assistive devices for physical activity should be a priority to help facilitate participation. Having opportunities to develop perceptions of competence may be essential for a child's long term participation in physical activity.
Background: The impact of dizziness on quality of life is often assessed by the Dizziness Handica... more Background: The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured. Methods: Two samples (n = 92 and n = 27) included participants with dizziness of mainly vestibular origin. A cross-sectional design was used to examine the factor structure (exploratory factor analysis), internal consistency (Cronbach's α), concurrent validity (Pearson's product moment correlation r), and discriminate ability (ROC curve analysis). Longitudinal designs were used to examine test-retest reliability (intraclass correlation coefficient (ICC) statistics, smallest detectable difference (SDD)), and responsiveness (Pearson's product moment correlation, ROC curve analysis; area under the ROC curve (AUC), and minimally important change (MIC)). The DHI scores range from 0 to 100. Results: Factor analysis revealed a different factor structure than the original DHI, resulting in dismissal of subscale scores in the DHI-N. Acceptable internal consistency was found for the total scale (α = 0.95). Concurrent correlations between the DHI-N and other related measures were moderate to high, highest with Vertigo Symptom Scale-short form-Norwegian version (r = 0.69), and lowest with preferred gait (r =-0.36). The DHI-N demonstrated excellent ability to discriminate between participants with and without 'disability', AUC being 0.89 and best cutoff point = 29 points. Satisfactory test-retest reliability was demonstrated, and the change for an individual should be ≥ 20 DHI-N points to exceed measurement error (SDD). Correlations between change scores of DHI-N and other self-report measures of functional health and symptoms were high (r = 0.50-0.57). Responsiveness of the DHI-N was excellent, AUC = 0.83, discriminating between self-perceived 'improved' versus 'unchanged' participants. The MIC was identified as 11 DHI-N points. Conclusions: The DHI-N total scale demonstrated satisfactory measurement properties. This is the first study that has addressed and demonstrated responsiveness to important change of the DHI, and provided values of SDD and MIC to help interpret change scores.
Despite enhanced interest in manifestations of pain in adults with intellectual and developmental... more Despite enhanced interest in manifestations of pain in adults with intellectual and developmental disabilities (IDD), the characteristics of pain behavior in this group have seldom been examined. The aim of the present study was to provide a sensitive pain behavior scale for adults with IDD. The participants, 228 adults (mean age, 38.7 years) with different levels of IDD, were videotaped before and during an influenza vaccination and scored using the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R). Observed pain behaviors not captured by the NCCPC-R, was also registered. Sensitivity to pain of all 27 items was examined by Signed Rank test, internal consistency by Cronbach's alpha, and sensitivity to change of the total scale by Standardized Response Mean (SRM). Thirteen items were excluded from the original NCCPC-R scale; 4 new items were added, making a modified scale of 18 items. This scale, named the Non-Communicating Adults Pain Checklist-Revised (NCAPC), was rescored and examined for psychometric properties in a random sample (N = 89). Sensitivity to pain of all items (P < .05) and high internal consistency (alpha = 0.773) were demonstrated. Large sensitivity to pain at all levels of IDD was shown (SRM, 1.20 to 2.07). Better psychometric properties were demonstrated for NCAPC than NCCPC-R in the target population. This article presents initial psychometric properties of a new measure, the NCAPC, evaluating pain behavior in adults with IDD. This measure could help clinicians to better capture pain expressions in this population and contribute to better pain management for this group of patients.
Background. The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed a... more Background. The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed at capturing how people with long-lasting musculoskeletal pain reflect on their own body awareness. Methods based on classical test theory were applied to the development of the instrument and resulted in 4 subscales. However, the scales were not correlated, and construct validity might be questioned. Objective. The primary purpose of this study was to explore the possibility of developing a unidimensional scale from items initially collected for the BARQ using Rasch analysis. A secondary purpose was to investigate the test-retest reliability of a revised version of the BARQ. Design. This was a methodological study. Methods. Rasch and reliability analyses were performed for 3 samples of participants with long-lasting musculoskeletal pain. The first Rasch analysis was carried out on 66 items generated for the original BARQ and scored by 300 participants. The items supported by the first analysis were scored by a new group of 127 participants and analyzed in a second Rasch analysis. For the test-retest reliability analysis, 48 participants scored the revised BARQ items twice within 1 week. Results. The 2-step Rasch analysis resulted in a unidimensional 12-item revised version of the BARQ with a 4-point response scale (scores from 0 to 36). It showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered thresholds. Test-retest reliability was high, with an intraclass correlation coefficient of .83 (95% CI = .71-.89) and a smallest detectable change of 6.3 points. Limitations. The small sample size in the second Rasch analysis was a study limitation. Conclusions. The revised BARQ is a unidimensional and feasible measurement of body awareness, recommended for use in the context of body-mind physical therapy approaches for musculoskeletal conditions.
Material and Methods: Fifty healthy subjects, 25/25 male/female, age 18−65, 5 age brackets were i... more Material and Methods: Fifty healthy subjects, 25/25 male/female, age 18−65, 5 age brackets were included. To quantify the different cervical motions a 3Space Inside Track HP system Polhemus was used. An electromagnetic receiver and transducer measure the range of rotations and translations in respectively the X, Y and Z-axes. The following motions were performed five times active and passive. 1. Rotation 2. Cervical forward flexion 3. Cervical backward flexion 4. Cervical forward flexion/rotation 5. Cervical backward flexion/rotation Results: To test the reliability of this measurement 20 subjects were tested two times (interval one week). The intraclass correlation coefficient (ICC) was good for all movements except active forward flexion. The Range of Motion (active and passive) decreased with increase of age, no effect of gender. No significant differences in the difference score (passive – active) with increase of age. Conclusion: This study demonstrates that a three dimensional motion analysis is a valid and reproducible method to measure active and passive cervical motion which can be used in further pain research as secondary outcome measure.
This study was undertaken to develop a multidimensional instrument in the Norwegian language to m... more This study was undertaken to develop a multidimensional instrument in the Norwegian language to measure pain. The McGill Pain Questionnaire (MPQ) was used as a model, since it is a valid and reliable tool for pain measurement in English speaking countries. A series of steps were taken to develop a Norwegian pain questionnaire: 1) Words descriptive of pain were derived from 95 subjects (patients, students and health personnel). 2) Ten subjects allocated pain words into groups. 3) 36 college students validated the word groupings. 4) 72 patients graded the words contained in each group according to intensity. 5) A test of reliability of group items was performed. The study demonstrated that there are many words in Norwegian to describe pain. The Norwegian pain questionnaire came to contain 106 descriptors of pain placed in 18 groups. We demonstrated the validity of the word groupings and the reliability of group items. The actual value of the Norwegian pain questionnaire as a measuring instrument has not yet been documented.
ABSTRACT Measures of physical performance should address the activity dimension directly and refl... more ABSTRACT Measures of physical performance should address the activity dimension directly and reflect functional problems important to patients with a defined health condition. The Pick-up test was developed for patients with back pain by the first author, and requires the patient to pick up a piece of paper from the floor. Performance is scored by a clinician along a four-point ordinal scale, scores depending on dynamic flexibility and ease of motion. This study is about the development of the Pick-up test and the establishment of reliability, validity and responsiveness to change. Inter-tester reliability was acceptable (=0.74). Test scores discriminated between groups of patients with back pain and other musculoskeletal pain, and reflected perceived difficulty in pick-up as well as dressing tasks among patients with back pain. Test scores were also related to affective pain reports. Baseline test scores did not predict return to work after 1 year. The test was responsive to clinically significant change over time. Evidence was provided that the test can be used as a functional assessment tool, and is suggested for use as an outcome measure. Whether or not the Pick-up test reflects performance of other dynamic physical activities in back pain needs to be examined.
Abilities of the Short‐Form McGill Pain Questionnaire to assess change have scarcely been address... more Abilities of the Short‐Form McGill Pain Questionnaire to assess change have scarcely been addressed in previous studies. The aim of the present study was to examine test–retest reliability, sensitivity to change and responsiveness to clinically important change using a Norwegian version (NSF‐MPQ) in different groups of patients. ICC(1,1) values for test–retest reliability (relative reliability) assessed 1–3 days apart for total, sensory and affective scores were, respectively, 0.75, 0.76 and 0.62 in patients with musculoskeletal pain (n=58), and 0.93, 0.95 and 0.79 in patients with rheumatic pain (n=25). Variability in total scores (absolute reliability) was less in patients with rheumatic pain (within‐subject standard deviation, Sw=2.70) than in patients with musculoskeletal pain (Sw=4.28). Sensitivity to change by standardized response mean (SRM) was mostly large (>0.80) for three patient groups reporting improvement after treatment. More sensitivity to change was demonstrated by the total and sensory scores than by the affective score, and sensitivity of the total score was similarly good to capture improvement as the Visual Analogue Scale (VAS). Indication was provided that mean improvement of groups in NSF‐MPQ total scores should be >5 on the 0–45 scale to demonstrate a clinically important change. Responsiveness to clinically important change by receiver operating characteristic curve analysis was modest, as area under the curve indicating ability to discriminate improved and not improved patients with musculoskeletal pain, was only 0.61. The study indicates mostly satisfactory test–retest reliability and responsiveness values of the NSF‐MPQ, but shows that the measurement properties vary between groups of patients with pain.
The study was undertaken to develop a multidimensional measuring instrument for pain in the Norwe... more The study was undertaken to develop a multidimensional measuring instrument for pain in the Norwegian language. The McGill Pain Questionnaire (MPQ) was used as a model as it is a valid and reliable tool for pain measurement in English speaking countries. A series of steps were taken to develop a Norwegian pain questionnaire: (1) words describing pain were derived from 95 subjects (patients, students and health personnel); (2) 10 subjects allocated pain descriptors into groups; (31 36 college student validated the word groupings; (4) 72 patients graded the words contained in each group according to intensity; and (5) the reliability of group items was tested. The study demonstrated that there are many descriptors of pain in the Norwegian language. The final version of the Norwegian pain questionnaire consisted of 106 pain descriptors divided into 18 groups. Validity of the classifications as well as reliability of the words was demonstrated. The actual value of the Norwegian pain questionnaire as a measuring instrument has not yet been documented.
Physiotherapy Research International, Nov 22, 2021
BackgroundCompensational movement patterns in hip osteoarthritis (HOA) are associated with hip dy... more BackgroundCompensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA.ObjectiveTo examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE).Study DesignA prospective, assessor‐blinded, and block‐randomized controlled trial.MethodsCommunity‐living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self‐reported aspects of function and health.ResultsAt pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty‐one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per‐protocol analysis showed changes in favor of the intervention group for self‐efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included.ConclusionsBBAT was not found to be a more effective treatment modality than self‐initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.
Background: Patients' access to movement experiences is implemented in the evaluation tool Body A... more Background: Patients' access to movement experiences is implemented in the evaluation tool Body Awareness Rating Scale-Movement Quality and Experience, with its two intertwined parts: 1) the physiotherapist's observations of movement quality; and 2) the patient's descriptions of immediate movement experiences. Objective: To study movement experiences and reflections described by patients diagnosed with hip osteoarthritis when guided to explore simple daily-life movements in this particular evaluation context. Design: An explorative qualitative study with open-ended questions following each of the 12 movements integrated into the evaluation. Methods: 35 participants diagnosed with hip osteoarthritis were included; 28 women and 7 men, aged 23-78 years. Their descriptions were audiotaped, transcribed verbatim and analyzed in accordance with qualitative content analysis. Results: The patients described experiences of a dynamic adaptation of movement strategies based on sensations from the moving body. Two interrelated categories of movement awareness were identified: 1) Experienced movement challenges, including three sub-categories; a) Lack of contact, b) Movement changed by symptoms, and c) Compensational movement habits, and 2) Movement components promoting well-being, including three sub-categories; a) Integrating balance, breathing and awareness into movement, b) Small, simple, soft and safe movements, and c) A taste of own movement resources for daily life. Conclusions: The Body Awareness Rating Scale-Movement Quality and Experience provides a platform for patients to become aware of and describe their movement habits and resources in own words, intertwined with the physiotherapist movement observations. Derived descriptions reflect a patient perspective to be implemented in therapy.
INTRODUCTION Delayed achievement of motor milestones may be an early indicator of motor difficult... more INTRODUCTION Delayed achievement of motor milestones may be an early indicator of motor difficulties. Parent-reported questionnaires may serve as an efficient, low-cost screening to identify infants in need of further clinical assessment, and thus be a helpful tool in busy health care centers. PURPOSE To examine the ability of the Ages and Stages Questionnaire, second edition (ASQ-2) to indicate motor difficulties in infants using the Infant Motor Profile (IMP) as the reference standard. METHODS A cross-sectional design was applied to examine the correlation between parent-reported data of the ASQ-2 and data from physiotherapist assessment using IMP. Included were 432 mainly low-risk infants aged 3-12 months from primary care. RESULTS Overall, ASQ-2 gross and fine motor scores did not correlate well with the IMP total or domain scores. The ASQ-2 gross motor cut point (> 2SD below the mean), showed 34.3% sensitivity and 96.7% specificity using the 15th percentile from IMP performance domain as reference standard. The positive predictive value to indicate motor difficulties was 48%. CONCLUSION The motor domains of ASQ-2 have poor ability to identify infants with motor difficulties as indicated by their IMP scores in low-risk infants.
Background: Developing age-appropriate medications remains a challenge in particular for the popu... more Background: Developing age-appropriate medications remains a challenge in particular for the population of infants and toddlers, as they are not able to reliably self-report if they would accept and consequently take an oral medicine. Therefore, it is common to use caregivers as proxies when assessing medicine acceptance. The outcome measures used in this research field differ and most importantly lack validation, implying a persisting gap in knowledge and controversy in the field. The newly developed Caregiver-administered Children's Acceptance Tool (CareCAT) is based on a 5-point nominal scale, with descriptors of medication acceptance behavior. This crosssectional study assessed the measurement properties of the tool with regards to the user's understanding and its intra-and inter-rater reliability. Methods: Participating caregivers were enrolled at a primary healthcare facility where their children (median age 6 months) had been prescribed oral antibiotics. Caregivers, trained observers and the tool developer observed and scored on the CareCAT tool what behavior children exhibited when receiving the medicine (n = 104). The videorecords of this process served as replicate observations (n = 69). After using the tool caregivers were asked to explain their observations and the tool descriptors in their own words. The tool's reliability was assessed by percentage agreement and Cohen's unweighted kappa coefficients of agreement for nominal scales. Results: The study found that caregivers using CareCAT had a satisfactory understanding of the tool's descriptors. Using its dichotomized scores the tool reliably was strong for acceptance behavior (agreement inter-rater 84-88%, kappa 0.66-0.76; intra-rater 87-89%, kappa 0.68-0.72) and completeness of medicine ingestion (agreement inter-rater 82-86%, kappa 0.59-0.67; intra-rater 85-93%, kappa 0.50-0.70). Conclusions: The CareCAT is a low-cost, easy-to-use and reliable instrument, which is relevant to assess acceptance behavior and completeness of medicine ingestion, both of which are of significant importance for developing age-appropriate medications in infants and toddlers.
Disability and Rehabilitation: Assistive Technology, Oct 9, 2017
To explore children's experiences with testing, acquiring and using assistive dev... more To explore children's experiences with testing, acquiring and using assistive devices. Nine children (six boys, three girls, 9-12 years old, with different physical disability and activity experience, participated in semistructured interviews. The interviews were audio-taped, transcribed and analysed using Systematic text condensation. Assistive devices were reported to contribute to cope activities that the children otherwise would not have participated in. Several subjects listed the need for a shielded environment when adapting to new equipment. The children highlighted "independence in activities" and "having the opportunity to participate in activities with family and friends" as important for frequent use. Need for assistance and lack of localizations to perform the activities were listed as reasons for less frequent use. This study reveals that it is useful to map each child's opportunities for independency, appropriate locations for performing the activity and participation with friends, when considering obtaining assistive devices. Implications for Rehabilitation The use of assistive devices gives many children with physical disabilities the opportunity to participate in physical activity. Improving availability to assistive devices for physical activity should be a priority to help facilitate participation. Having opportunities to develop perceptions of competence may be essential for a child's long term participation in physical activity.
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