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1.
J Rehabil Med ; 56: jrm40026, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38850055

ABSTRACT

OBJECTIVE: To determine the physical strain of walking and assess its relationship with daily steps and intensity of daily activity in people with neuromuscular diseases. DESIGN: Cross-sectional study. SUBJECTS/PATIENTS: Sixty-one adults with neuromuscular diseases. METHODS: Physical strain of walking, defined as oxygen consumption during comfortable walking relative to peak oxygen uptake. Daily step count and daily time spent in moderate and vigorous physical activity were assessed using accelerometry and heart rate measurements, respectively. Regression analyses assessed the relationships between log daily step count and log daily time spent in moderate and vigorous physical activity, and physical strain of walking. RESULTS: The mean (standard deviation) physical strain of walking was 73 (20)% Log daily step count and physical strain were negatively associated (ß = -0.47). No association was found with log daily time spent in moderate and vigorous physical activity. CONCLUSIONS: The highly increased physical strain of comfortable walking indicates that walking is very demanding for people with neuromuscular diseases and is associated with a reduction in daily step activity. The absence of a relationship between intensity of activities and physical strain indicates that, despite a reduction in daily step activity, strenuous daily activities may still be performed.


Subject(s)
Accelerometry , Activities of Daily Living , Neuromuscular Diseases , Oxygen Consumption , Walking , Humans , Neuromuscular Diseases/rehabilitation , Neuromuscular Diseases/physiopathology , Walking/physiology , Cross-Sectional Studies , Male , Female , Middle Aged , Adult , Oxygen Consumption/physiology , Heart Rate/physiology , Aged , Exercise/physiology
2.
Article in English | MEDLINE | ID: mdl-33683160

ABSTRACT

Introduction: More insight is needed into participation in daily activities and autonomy among patients with amyotrophic lateral sclerosis (ALS). Aims of this study were (1) to describe the course of participation restrictions and autonomy in participation during the first 10 months after diagnosis; (2) to study the influence of the rate of ALS progression on the course of participation. Methods: Secondary analysis of data from the longitudinal multicenter FACTS-2-ALS study. Self-report questionnaires were administered at inclusion (T0; n = 71), at 4 months (T1), 7 months (T2), 10 months (T3) after inclusion. Median duration of follow-up was 10.0 months. Participation restrictions were assessed using the sum of the Mobility Range and Social Behavior subscales of the Sickness Impact profile-68 (SIPSOC). Autonomy in participation was assessed using the Impact on Participation and Autonomy (IPA) Questionnaire. Fast disease progression was defined as an increase of 1.1 points per month or more on the ALS Functional Rating Scale. Results: Patients reported participation restrictions in all subscales while having mild physical limitations. There was a decrease of participation over time (restrictions and autonomy). This decrease was greatest in patients with fast disease progression. Disease progression negatively influenced movement-related participation more than social interaction domains. Rate of disease progression was more strongly related to SIPSOC scores compared to IPA scores. Discussion: Preserving participation may be an important determinant of quality of care for patients with ALS. Rate of progression of the disease should be taken into account as it was found to be significantly associated with the level of participation.


Subject(s)
Amyotrophic Lateral Sclerosis , Amyotrophic Lateral Sclerosis/diagnosis , Disease Progression , Humans , Longitudinal Studies , Self Report , Sickness Impact Profile , Surveys and Questionnaires
3.
J Neurol ; 267(11): 3310-3318, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32577867

ABSTRACT

BACKGROUND: Poor monitoring of respiratory function may lead to late initiation of non-invasive ventilation (NIV) in patients with motor neuron diseases (MND). Monitoring could be improved by remotely assessing hypoventilation symptoms between clinic visits. We aimed to determine which patient-reported hypoventilation symptoms are best for screening reduced respiratory function in patients with MND, and compared them to the respiratory domain of the amyotrophic lateral sclerosis functional rating scale (ALSFRS-R). METHODS: This prospective multi-center study included 100 patients with MND, who were able to perform a supine vital capacity test. Reduced respiratory function was defined as a predicted supine vital capacity ≤ 80%. We developed a 14-item hypoventilation symptom questionnaire (HYSQ) based on guidelines, expert opinion and think-aloud interviews with patients. Symptoms of the HYSQ were related to dyspnea, sleep quality, sleepiness/fatigue and pneumonia. The diagnostic performances of these symptoms and the ALSFRS-R respiratory domain were determined from the receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, specificity, predictive values and accuracy. RESULTS: Dyspnea-related symptoms (dyspnea while eating/talking, while lying flat and during light activity) were combined into the MND Dyspnea Scale (MND-DS). ROC curves showed that the MND-DS had the best diagnostic performance, with the highest AUC = 0.72, sensitivity = 75% and accuracy = 71%. Sleep-quality symptoms, sleepiness/fatigue-related symptoms and the ALSFRS-R respiratory domain showed weak diagnostic performance. CONCLUSION: The diagnostic performance of the MND-DS was better than the respiratory domain of the ALSFRS-R for screening reduced respiratory function in patients with MND, and is, therefore, the preferred method for (remotely) monitoring respiratory function.


Subject(s)
Amyotrophic Lateral Sclerosis , Motor Neuron Disease , Respiratory Insufficiency , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/diagnosis , Dyspnea/diagnosis , Dyspnea/etiology , Humans , Motor Neuron Disease/complications , Motor Neuron Disease/diagnosis , Patient Reported Outcome Measures , Prospective Studies
4.
BMC Neurol ; 20(1): 184, 2020 May 13.
Article in English | MEDLINE | ID: mdl-32404133

ABSTRACT

BACKGROUND: In individuals with neuromuscular diseases (NMD), symptoms of muscle weakness, fatigue and pain may limit physical activity. Inactivity leads to reduced physical fitness, which further complicates daily life functioning. Due to inconclusive evidence regarding exercise in NMD, the optimal training approach and strategies to preserve an active lifestyle remain to be determined. The physical activity programme I'M FINE, consisting of individualized aerobic exercise to improve physical fitness and coaching to preserve an active lifestyle, was therefore developed. The primary objective of this study will be to evaluate the efficacy of the I'M FINE programme in terms of improved physical fitness in individuals with slowly progressive NMD, compared to usual care. METHODS: A multicentre, assessor-blinded, two armed, randomized controlled trial will be conducted in a sample of 90 individuals with slowly progressive NMD. Participants motivated to improve their reduced physical fitness will be randomized (ratio 1:1) to the I'M FINE intervention or usual care. The I'M FINE intervention consists of a six-month physical activity programme, including individualized home-based aerobic exercise to improve physical fitness (i.e. peak oxygen uptake), and motivational interviewing coaching (e.g. goal setting, self-management) to adopt and preserve an active lifestyle. Measurements will be performed at baseline, post-intervention, and at 12- and 18-months follow-up. The primary outcome is peak oxygen uptake (VO2 peak) directly post intervention. Main secondary outcomes are physical capacity, muscle strength, self-efficacy, daily activity, quality of life and markers of metabolic syndrome. The primary analysis compares change in VO2 peak post-intervention between the intervention and usual care group, with analysis of covariance. DISCUSSION: The I'M FINE study will provide evidence regarding the efficacy of a physical activity intervention on the physical fitness and active lifestyle over the short- and long-term in individuals with slowly progressive NMD. These outcomes could potentially improve the (inter)national guidelines for efficacy of aerobic exercise programmes and provide insight in achieving a more active lifestyle in NMD. TRIAL REGISTRATION: (5/11/2018): Netherlands Trial Register NTR7609 (retrospectively registered), https://www.trialregister.nl/trial/7344. However, the Ethics Review Committee of the Amsterdam Medical Center (AMC) approved the study protocol on 7/11/2017. No adjustments were made to the approved study protocol before the first participant enrolment and registration. Registration was done after the second participant enrolment and the information in the register corresponds one on one with the approved study protocol.


Subject(s)
Exercise Therapy/methods , Multicenter Studies as Topic , Neuromuscular Diseases/rehabilitation , Physical Fitness/physiology , Randomized Controlled Trials as Topic , Adult , Female , Humans , Mentoring/methods , Netherlands , Research Design , Treatment Outcome
5.
Neurorehabil Neural Repair ; 33(2): 153-164, 2019 02.
Article in English | MEDLINE | ID: mdl-30744529

ABSTRACT

BACKGROUND: Weakness caused by motor neuron degeneration in amyotrophic lateral sclerosis (ALS) may result in avoidance of physical activity, resulting in deconditioning and reduced health-related quality of life (HRQoL). OBJECTIVE: To study the effectiveness of aerobic exercise therapy (AET) on disease-specific and generic HRQoL in ambulatory patients with ALS. METHODS: We conducted a multicenter, assessor-blinded, randomized controlled trial. Using a biphasic randomization model, ambulatory ALS patients were assigned (1:1) to AET+usual care (UC), or UC. AET consisted of a 16-week aerobic cycling exercise program. Primary outcome measures were the 40-item ALS assessment questionnaire (ALSAQ-40), and the mental component summary (MCS) and physical component summary (PCS) scores of the short-form survey (SF-36), using linear mixed effects models. Per-protocol (PP) analysis was performed for those patients who attended ≥75% of the training sessions; controls were matched (1:1) by propensity score matching. RESULTS: Of 325 screened patients, 57 were randomized: 27 to AET+UC and 30 to UC. No significant mean slope differences between groups were observed for ALSAQ-40 (-1.07; 95% confidence interval [CI] -2.6 to 0.5, P=0.172) nor for SF-36 MCS (0.24; -0.7 to 1.1, P=0.576) or PCS (-0.51; -1.4 to 0.38, P=0.263). There were no adverse events related to the AET. PP-analyses showed significantly less deterioration in ALSAQ-40 (-1.88, -3.8 to 0.0, P=0.046) in AET+UC compared to UC. CONCLUSIONS: AET+UC was not superior to UC alone in preserving HRQoL in ambulatory ALS patient. However, the study was unfortunately underpowered, because only 10 patients completed the protocol. AET+UC may preserve disease-specific HRQoL in slow progressors. CLINICAL TRIAL REGISTRATION NUMBER: Netherlands National Trial Register (NTR): 1616.


Subject(s)
Amyotrophic Lateral Sclerosis/therapy , Exercise Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Quality of Life , Single-Blind Method , Treatment Outcome
6.
Article in English | MEDLINE | ID: mdl-30654658

ABSTRACT

Objectives: To assess psychological distress levels over time in caregivers of patients in the early stage of amyotrophic lateral sclerosis (ALS) and to investigate the association between caregivers' coping styles and psychological distress over time. Methods: Fifty-four caregivers were followed in a RCT of patients in the early stage of ALS. Questionnaires were administered at baseline, 4, 7, and 10 months. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS) and task-, emotion-, and avoidance-oriented coping styles were identified with the short version of the Coping Inventory for Stressful Situations (CISS-21). Analyses were performed using linear mixed models. Results: Caregivers' psychological distress increased by 0.24 points on the HADS per month (p = 0.01). An emotion-oriented coping style was positively associated with psychological distress in caregivers (b = 0.90, p < 0.01), but did not influence the development of psychological distress over time. The avoidance-oriented coping style and the task-oriented coping style were not significantly related to psychological distress. Conclusion: Feelings of distress increase in ALS caregivers during the course of the disease of the patient. Emotion-oriented coping is related to psychological distress; however, emotional coping and distress might represent overlapping constructs. Focusing on one coping style in the care for ALS caregivers may be too simplistic for the complex situations they face, as it ignores the fact that people may require different coping strategies in different situations.


Subject(s)
Amyotrophic Lateral Sclerosis/psychology , Caregivers/psychology , Psychological Distress , Adaptation, Psychological , Aged , Anxiety/psychology , Depression/psychology , Disease Progression , Female , Humans , Linear Models , Longitudinal Studies , Male , Middle Aged , Patients/psychology , Psychiatric Status Rating Scales , Surveys and Questionnaires
7.
Palliat Med ; 32(1): 231-245, 2018 01.
Article in English | MEDLINE | ID: mdl-28671483

ABSTRACT

BACKGROUND: Informal caregivers of patients with amyotrophic lateral sclerosis experience increased levels of caregiver burden as the disease progresses. Insight in the factors related to caregiver burden is needed in order to develop supportive interventions. AIM: To evaluate the evidence on patient and caregiver factors associated with caregiver burden in amyotrophic lateral sclerosis informal caregivers. DESIGN: A systematic review. DATA SOURCES: Four electronic databases were searched up to 2017. Studies that investigated quantitative relations between patient or caregiver factors and caregiver burden were included. The overall quality of evidence for factors was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: A total of 25 articles were included. High quality of evidence was found for the relation between caregiver burden and the factor "behavioral impairments." Moderate quality of evidence was found for the relations between caregiver burden and the factors "feelings of depression" of the caregiver and "physical functioning" of the patient. The remaining rated caregiver factors-"feelings of anxiety," "distress," "social support," "family functioning," and "age"-and patient factors-"bulbar function," "motor function," "respiratory function," "disease duration," "disinhibition," "executive functioning," "cognitive functioning," "feelings of depression," and "age"-showed low to very low quality of evidence for their association with caregiver burden. CONCLUSION: Higher caregiver burden is associated with greater behavioral and physical impairment of the patient and with more depressive feelings of the caregiver. This knowledge enables the identification of caregivers at risk for caregiver burden and guides the development of interventions to diminish caregiver burden.


Subject(s)
Adaptation, Psychological , Amyotrophic Lateral Sclerosis/nursing , Amyotrophic Lateral Sclerosis/psychology , Anxiety/psychology , Caregivers/psychology , Family/psychology , Quality of Life/psychology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
8.
Muscle Nerve ; 56(5): 912-918, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28073181

ABSTRACT

INTRODUCTION: The aim of this study was to assess the prevalence of participation restrictions in ambulatory patients with amyotrophic lateral sclerosis (ALS) and to identify physical and psychological contributory factors. METHODS: In this cross-sectional study, self-reported participation restrictions of 72 ambulatory ALS patients were assessed using the social health status dimension (SIPSOC) of the Sickness Impact Profile (SIP-68). Associations between SIPSOC and physical functioning, psychological factors, and demographic factors were analyzed using hierarchical regression analyses. RESULTS: Ninety-two percent of the patients reported participation restrictions; 54.9% could be explained by physical functioning; psychological factors accounted for 8.1% of the variance. Lung capacity, functional mobility, fatigue, and helplessness were independently associated with participation restrictions. CONCLUSIONS: Ambulatory ALS patients have participation restrictions, which may be influenced if early ALS care is directed toward lung capacity, functional mobility, fatigue, and feelings of helplessness. Muscle Nerve 56: 912-918, 2017.


Subject(s)
Activities of Daily Living , Amyotrophic Lateral Sclerosis/physiopathology , Amyotrophic Lateral Sclerosis/psychology , Quality of Life , Activities of Daily Living/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Amyotrophic Lateral Sclerosis/rehabilitation , Cohort Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Netherlands , Physical Examination , Self Report , Sickness Impact Profile , Statistics, Nonparametric , Surveys and Questionnaires , Vital Capacity/physiology , Young Adult
9.
J Neuromuscul Dis ; 3(4): 539-544, 2016 11 29.
Article in English | MEDLINE | ID: mdl-27911333

ABSTRACT

BACKGROUND: Ambulatory patients with Amyotrophic Lateral Sclerosis (ALS) show a decreased aerobic capacity which may hamper the ability to perform activities of daily living. A standardized measure, however, for assessing aerobic capacity in patients with ALS during the disease course, is lacking. OBJECTIVE: To examine the feasibility of the Åstrand-Ryhming (ÅR) test protocol longitudinally in ambulatory patients with amyotrophic lateral sclerosis (ALS). METHODS: Seven ambulatory male patients with spinal ALS onset were assessed at baseline and at 4, 7 and 10 months' follow-up. Feasibility of the ÅR test protocol was analysed using percentage of: a) completed ÅR tests; b) achieved steady states; and c) predefined heart rates. RESULTS: Test completion decreased from 7/7 at baseline to 10/21 at follow-up due to ALS-related symptoms as fatigue, muscle weakness and cramps. Steady states and predefined heart rates were achieved in 12/17 and 17/17 of the completed tests, respectively. Overall, the feasibility of the ÅR test protocol declines from 5/7 at baseline to 7/21 at follow-up. CONCLUSIONS: The results suggest that changes in aerobic capacity in ambulatory patients with ALS could not be successfully monitored due to a diminished feasibility of the ÅR test protocol.


Subject(s)
Activities of Daily Living , Amyotrophic Lateral Sclerosis/physiopathology , Exercise Test/methods , Exercise Tolerance , Oxygen Consumption , Adult , Aged , Amyotrophic Lateral Sclerosis/diagnosis , Exercise , Feasibility Studies , Humans , Male , Middle Aged
10.
Health Qual Life Outcomes ; 14(1): 107, 2016 Jul 20.
Article in English | MEDLINE | ID: mdl-27439463

ABSTRACT

OBJECTIVE: To systematically identify and appraise evidence on associations between psychological factors (moods, beliefs, personality) and Health-related QoL (HRQoL) and/or global QoL in patients with Amyotrophic Lateral Sclerosis (ALS). METHODS: A systematic review was conducted in several online databases (PsycINFO, EMBASE, PubMed and CINAHL) up to October 2015. Articles were included if they reported associations between psychological factors (moods, beliefs and personality) and HRQoL and/or global QoL in an ALS population. The search was limited to empirical studies, published in English, which provided quantitative data. The methodological quality of the included articles was assessed. RESULTS: In total, 22 studies were included. Mood was investigated in 14 studies, beliefs in 11 studies and personality in one study. Fifteen different psychological factors were extracted and assessed using 24 different measures. Twelve different QoL measures were used in the selected studies, subdivided into seven different HRQoL measures and five different global QoL measures. Higher levels of anxiety and depression appeared to be related to a poorer HRQoL, whereas a higher level of religiosity seemed to be associated with better global QoL. No conclusive associations were found for confusion-bewilderment (mood), spirituality, mindfulness, coping styles, hopelessness, perception of burden, cognitive appraisal (beliefs), neuroticism, extraversion, openness, agreeableness and conscientiousness (personality), due to insufficient or inconsistent evidence. Religiosity and spirituality appeared to become more positively associated over time. CONCLUSIONS: Our results suggest that higher levels of anxiety and depression are related to a poorer HRQoL, whereas higher levels of religiosity appeared to be related to better global QoL. Associations might change during the disease course. This review supports the importance of psychological factors with regard to ALS care. Further research is needed to supplement the available evidence and to investigate how psychological factors can be modified to improve QoL. REVIEW REGISTRATION NUMBER: PROSPERO 2015:CRD42015027303.


Subject(s)
Amyotrophic Lateral Sclerosis/psychology , Quality of Life/psychology , Adaptation, Psychological , Affect , Anxiety , Depression , Humans , Personality , Spirituality
11.
Article in English | MEDLINE | ID: mdl-26087303

ABSTRACT

Our objective was to compare the effects of cognitive behavioural therapy (CBT) and usual care (UC) on quality of life (QoL) in psychologically distressed patients with ALS and their caregivers. We conducted a multicentre randomized controlled trial (RCT). In 16 weeks, patient-carer pairs received five to 10 CBT sessions plus usual care (UC) or UC alone. Outcome measures were SF-36 Mental Component Summary (MCS), ALSAQ-40 Emotional Functioning (EF), Hospital Anxiety and Depression Scale (HADS) and Caregiver Strain Index (CSI). Assessments took place at baseline, four, seven and 10 months. The steering committee decided to stop the trial prematurely and analyse the data due to: 1) slow recruitment (15 patients over 42 months); and 2) the low demand for joint patient-carer CBT sessions. Caregivers, however, expressed an unanticipated demand for individual psychological support. Patients' ALSAQ-40-EF and caregivers' SF-36-MCS were significantly better in CBT than UC (p < 0.05). CSI was significantly lower in the CBT than the UC (p < 0.05). In conclusion, CBT might be beneficial to patients and caregivers. The stringent eligibility criteria limited participation rate and consequently the generalizability of results. Future studies should further examine the impact of CBT interventions for patients with ALS and their caregivers.


Subject(s)
Amyotrophic Lateral Sclerosis , Caregivers/psychology , Cognitive Behavioral Therapy/methods , Quality of Life/psychology , Stress, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/psychology , Amyotrophic Lateral Sclerosis/rehabilitation , Child , Female , Humans , Longitudinal Studies , Male , Middle Aged , Netherlands , Outcome Assessment, Health Care , Retrospective Studies , Stress, Psychological/etiology , Stress, Psychological/nursing , Stress, Psychological/psychology , Young Adult
12.
BMC Neurol ; 11: 70, 2011 Jun 14.
Article in English | MEDLINE | ID: mdl-21672211

ABSTRACT

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurodegenerative disorder affecting motor neurons in the spinal cord, brainstem and motor cortex, leading to muscle weakness. Muscle weakness may result in the avoidance of physical activity, which exacerbates disuse weakness and cardiovascular deconditioning. The impact of the grave prognosis may result in depressive symptoms and hopelessness. Since there is no cure for ALS, optimal treatment is based on symptom management and preservation of quality of life (QoL), provided in a multidisciplinary setting. Two distinctly different therapeutic interventions may be effective to improve or preserve daily functioning and QoL at the highest achievable level: aerobic exercise therapy (AET) to maintain or enhance functional capacity and cognitive behavioural therapy (CBT) to improve coping style and cognitions in patients with ALS. However, evidence to support either approach is still insufficient, and the underlying mechanisms of the approaches remain poorly understood. The primary aim of the FACTS-2-ALS trial is to study the effects of AET and CBT, in addition to usual care, compared to usual care alone, on functioning and QoL in patients with ALS. METHODS/DESIGN: A multicentre, single-blinded, randomized controlled trial with a postponed information model will be conducted. A sample of 120 patients with ALS (1 month post diagnosis) will be recruited from 3 university hospitals and 1 rehabilitation centre. Patients will be randomized to one of three groups i.e. (1) AET + usual care, (2) CBT + usual care, (3) Usual care. AET consists of a 16-week aerobic exercise programme, on 3 days a week. CBT consists of individual psychological support of patients in 5 to 10 sessions over a 16-week period. QoL, functioning and secondary outcome measures will be assessed at baseline, immediately post intervention and at 3- and 6-months follow-up. DISCUSSION: The FACTS-2-ALS study is the first theory-based randomized controlled trial to evaluate the effects, and the maintenance of effects, of AET and CBT on functioning and QoL in patients with ALS. The results of this study are expected to generate new evidence for the effect of multidisciplinary care of persons with ALS. TRIAL REGISTRATION: Dutch Trial Register NTR1616.


Subject(s)
Amyotrophic Lateral Sclerosis/psychology , Amyotrophic Lateral Sclerosis/rehabilitation , Cognitive Behavioral Therapy/methods , Exercise Therapy/methods , Exercise/physiology , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Compliance , Single-Blind Method , Time Factors , Treatment Outcome , Young Adult
13.
Dev Neurorehabil ; 13(4): 258-65, 2010.
Article in English | MEDLINE | ID: mdl-20629592

ABSTRACT

PURPOSE: The purpose of this study was to examine the inter-rater reliability of two tests measuring selective motor control (SMC) of the lower extremities in children with cerebral palsy (CP). METHODS: Two testers independently assessed 21 children (13 boys, eight girls; mean age 6 years 5 months, SD 12 months) with spastic CP (14 unilateral and seven bilateral) using the Boyd and Graham SMC test (with an existing protocol) and the modified Trost SMC test (with a newly developed protocol). Inter-rater reliability was analysed using Cohen's Kappa. RESULTS: For the Boyd and Graham SMC test for ankle dorsiflexion, Kappa was 0.55 (95% CI = 0.36-0.74). For the modified Trost SMC test for ankle dorsiflexion, knee extension, hip abduction and hip flexion, Kappas were 0.65 (0.47-0.84), 0.69 (0.49-0.88), 0.57 (0.37-0.78) and 0.71 (0.51-0.91), respectively. CONCLUSION: The SMC tests showed moderate (Boyd and Graham SMC test) to good (modified Trost SMC test) inter-rater reliability.


Subject(s)
Cerebral Palsy/diagnosis , Cerebral Palsy/physiopathology , Lower Extremity/physiopathology , Movement/physiology , Muscle, Skeletal/physiopathology , Child , Child, Preschool , Female , Humans , Male , Reproducibility of Results , Severity of Illness Index
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