Impact of Musculoskeletal Pain on Functioning and Disability in Children with Juvenile Idiopathic Arthritis in Iceland.

AIMS: 1) to map questions of pain from a survey to the International Classification of Functioning, Disability and Health (ICF) 2) to compare the impact of musculoskeletal pain on functioning based on the different components of the ICF in children with juvenile idiopathic arthritis (JIA) and age-matched peers. METHOD: A cross-sectional case-control survey. A total of 28 children with JIA and 36 age-matched children participated. The survey included questions on the child's sex and age, about pain experienced, number of painful body areas, pain frequency and three short forms of Patient-Reported Outcome Measurement Information System (PROMIS) pain questionnaires. Sixteen children with JIA (57%) and 10 peers (28%) reported pain during past seven days. Their responses were used in the description of impact of pain. RESULTS: After the mapping of the questions to ICF, a comparison between the two groups indicated that a higher number of children with JIA described effects of pain on mental function, mobility, general tasks and demands, than their peers. More children with JIA expressed to others that they had pain, non-verbally and verbally. CONCLUSION: The findings provide important information about the impacts of pain on daily life in children with JIA and about their intervention needs.

Mobility devices for children with physical disabilities: use, satisfaction and impact on participation.

INTRODUCTION: Children with physical disabilities commonly use mobility devices. There is a lack of studies on the use and impact of mobility devices on activities and participation. Research is needed on satisfaction with the service delivery process of mobility devices. PURPOSE: To examine the use and impact of mobility devices among children with physical disabilities and the satisfaction with the properties of their mobility devices and related services. MATERIALS AND METHODS: A web-based survey was sent to parents of 6 - 18 years old children with physical disabilities who used mobility devices in Iceland. The use and effectiveness of mobility devices were assessed with a questionnaire designed for this study. The satisfaction was measured with Quebec user evaluation of satisfaction with assistive technology (QUEST) 2.0. RESULTS: The survey was sent to 55 families and 36 replied. Most of the children used mobility devices in social activities. The number of participants who reported positive effects of devices on activities and participation, depended on environmental settings. There was no significant difference in participants' satisfaction between types of mobility devices. Also, there was no significant difference in participants' satisfaction with the properties of the device and the related service (for wheeled walkers p = 0.47, manual wheelchairs p = 0.08, powered wheelchairs p = 1.00). CONCLUSIONS: The results indicate the importance of mobility devices for activities and participation and can guide healthcare workers when providing mobility devices where environmental factors across settings must be kept in mind. Stakeholders should be aware of the value of satisfaction with the devices and related services.Implications for Rehabilitation:Children with physical disabilities use mobility devices across different environmental settings and need to have more than one type of equipment.This study confirms results from earlier research that mobility devices are important for the activities and participation of children with disabilities.It is important to understand how the delivery process of devices is perceived by those who receive them. High satisfaction is an indicator of high quality of service.Environmental factors across settings must be kept in mind in the delivery process of assistive devices.

Musculoskeletal pain and its effect on daily activity and behaviour in Icelandic children and youths with juvenile idiopathic arthritis: a cross-sectional case-control study.

BACKGROUND: Juvenile idiopathic arthritis is characterised by recurring episodes of acute inflammation, with joint swelling in one or more joints, often accompanied by pain. These episodes can now be controlled better than in the past because of a new category of medications. However, despite more stable disease activity, pain may continue to cause problems in the children with juvenile idiopathic arthritis and can reduce their performance of routine physical activities and participation in social or school activities. AIM: To evaluate the prevalence of pain, pain intensity, pain behaviour, and pain interference in Icelandic children with juvenile idiopathic arthritis compared with healthy peers. METHODS: A cross-sectional, case-control study including 8-18 years old children; 28 with juvenile idiopathic arthritis and 36 in a control group. The children answered questions on pain experienced during the last 7 days, painful areas of the body and pain frequency. They completed short form versions of the Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires on pain intensity, pain behaviour, and pain interference. RESULTS: Significantly more children with juvenile idiopathic arthritis had pain compared with the control group (p = 0.02). Children with JIA also had a greater number of painful body areas (p = 0.03), more pain intensity (p = 0.009), and showed more pain behaviour (p = 0.006), and pain interference (p = 0.002). Children with juvenile idiopathic arthritis who had pain, experienced more pain interference (p = 0.023) than their peers who had pain. However, the groups did not differ in terms of pain intensity (p = 0.102) and pain behaviour (p = 0.058). CONCLUSION: The research results indicate that pain experience was different between children with juvenile idiopathic arthritis and the control group. The results suggest that further research of the role of pain management on functional outcomes in children with juvenile idiopathic arthritis is needed.

Digital Entry-Level Education in Physiotherapy: a Commentary to Inform Post-COVID-19 Future Directions.

Currently, the coronavirus disease 2019 (COVID-19) severely influences physiotherapy education which is based mostly on face-to-face teaching. Thus, educators have been compelled to adapt their pedagogical approaches moving to digital education. In this commentary, we debate on digital education highlighting its effectiveness, the users' perspectives, and its weakness in the context of physiotherapy teaching aimed at informing post-COVID-19 future directions in this educational field. Existing evidence on digital education produced before COVID-19 supports its implementation into entry-level physiotherapy education. However, some challenges (e.g. social inequality and evaluation of students) threaten its applicability in post-COVID-19 era, calling educators to take appropriate actions.

[The effect of fampridine on gait in people with Multiple sclerosis (MS)].

INTRODUCTION: Fampridine is a drug for people with Multiple Sclerosis (MS). It is a broad-spectrum voltage-dependent potassium channel blocker that enhances synaptic transmission. The drug has been shown to be able to enhance conduction in demyelinated axons, thereby leading to improved gait in patients with MS. The purpose of this study was to examine the effect of fampridine on gait function in people with MS in the end of a 2 weeks trial drug period and to observe how many patients continued drug therapy. MATERIAL AND METHODS: Data from 41 individuals with MS was collected retrospectively for this study. Measurements were administered by physiotherapists and the results from the Timed 25-Foot Walk (T25FW) and 12-item Multiple Sclerosis Walking Scale (MSWS-12) were obtained from medical records from The National University Hospital of Iceland. RESULTS: The results showed a significant difference in walking speed before and at the end of trial period (p<0.0001). The average improvement in walking speed was 22%. Results also demonstrated a significant difference in MSWS-12 scores before and at the end of treatment (p<0.0001). The average improvement in MSWS-12 was 11.4 points. Eighteen individuals (43.9%) continued treatment after the trial period. CONCLUSION: Fampridine can have a positive effect on impaired gait function in people with MS and can be an important adjunct to treatment.

Attitudes Toward Adoption of Evidence-Based Practice Among Physical Therapists and Social Workers: A Lesson for Interprofessional Continuing Education.

INTRODUCTION: Professionals who embrace evidence-based practice (EBP) continually search for research evidence, appraise, and apply it, while interacting with each client in his/her situation. This dynamic learning process takes a substantial commitment from professionals and requires a positive attitude toward EBP. The main objective of this research was to explore the following: 1) distinct dimensions of attitudes toward adoption of EBP among physical therapists and social workers and 2) the relationship between these dimensions of attitudes and selected background characteristics of the compared professions. METHODS: Cross-sectional web-based surveys were conducted in 2012 and 2013 on a population-based sample from the Icelandic Physical Therapy Association and the Icelandic Association of Social Workers. The participants were 214 physical therapists (76.3% women) and 163 social workers (92.2% women). The Evidence-Based Practice Attitude Scale (EBPAS) and its four subscales were used to survey dimensions of attitudes toward EBP. Scores on the total EBPAS range from zero to five, with a higher score indicating a more positive attitude toward EBPs. Linear regression was used to explore the relationship between the EBPAS scales and selected background variables. RESULTS: The overall response rate was 39%. Both professions generally held positive attitudes toward adoption of EBP, with an average EBPAS total score of 3.06 (SD = 0.46). The professionals' background characteristics were independently related to at least one dimension of attitudes toward EBP. More positive attitudes were associated with being a physical therapist, a woman, in a younger age group, having a graduate degree, working with individual clients, and having at least five same-profession coworkers. DISCUSSION: The results may be useful to design continuing education focusing on EBP. Such inventions should be targeted to professional attitudes, background, and other contextual factors.

Icelandic Physical Therapists' Attitudes Toward Adoption of New Knowledge and Evidence-Based Practice: Cross-Sectional Web-Based Survey.

BACKGROUND: A positive attitude toward evidence-based practice (EBP) has been identified as an important factor in the effectiveness of the dissemination and implementation of EBP in real-world settings. OBJECTIVE: The objectives of this study were: (1) to describe dimensions of Icelandic physical therapists' attitudes toward the adoption of new knowledge and EBP and (2) to explore the association between attitudes and selected personal and environmental factors. DESIGN: This study was a cross-sectional, Web-based survey of the total population of full members of the Icelandic Physiotherapy Association. METHODS: The Evidence-Based Practice Attitude Scale (EBPAS) was used to survey attitudes toward EBP; the total EBPAS and its 4 subscales (requirements, appeal, openness, and divergence) were included. Linear regression was used to explore the association between the EBPAS and selected background variables. RESULTS: The response rate was 39.5% (N=211). The total EBPAS and all of its subscales reflected physical therapists' positive attitudes toward the adoption of new knowledge and EBP. Multivariable analysis revealed that being a woman was associated with more positive attitudes, as measured by the total EBPAS and the requirements, openness, and divergence subscales. Physical therapists with postprofessional education were more positive, as measured by the EBPAS openness subscale, and those working with at least 10 other physical therapists demonstrated more positive attitudes on the total EBPAS and the openness subscale. LIMITATIONS: Because this was a cross-sectional survey, no causal inferences can be made, and there may have been unmeasured confounding factors. Potential nonresponse bias limits generalizability. CONCLUSIONS: The results expand understanding of the phenomenon of attitudes toward EBP. They reveal potentially modifiable dimensions of attitudes and the associated characteristics of physical therapists and their work environments. The findings encourage investigation of the effectiveness of strategies aimed at influencing various dimensions of attitudes toward EBP.

Effects of a dynamic versus a static prone stander on bone mineral density and behavior in four children with severe cerebral palsy.

PURPOSE: In this case series, we examined how two types of prone stander affected bone mineral density and behavioral variables in four children of preschool age with severe cerebral palsy. METHODS: In phase one, four children of preschool age participated in an eight-week standing program, standing for 30 minutes a day, five days a week. Two children stood in a conventional stander, and two stood in a new type of motorized (dynamic) stander that provides intermittent weight bearing. Measurements of bone mineral density before and after the program revealed increases in bone mineral density in both children who used a dynamic stander and one child who used a static stander. In phase two, all four subjects stood in both types of stander during three separate test sessions. RESULTS: Measures of behavioral variables, including behavioral state, reactivity, goal directedness, and attention span, indicated little or no effect of type of stander on behavior. CONCLUSIONS: These results suggest there is potential value in additional research concerning the effects of static and dynamic standers on bone mineral density and behavior in children with cerebral palsy.

A motorized dynamic stander.

PURPOSE: The purpose of this clinical suggestion is to describe a new type of a stander, a dynamic stander. KEY POINTS: The dynamic stander may give children with severe cerebral palsy an opportunity for movement in lower extremities and trunk while they are standing. It may increase their tolerance for standing in a stander for a considerable period of time. In addition, the potential for increased bone mineral density might be greater with a dynamic stander than a conventional stander. The design, development, and initial clinical use of the new type of stander is described. SUMMARY: Some minor problems related to the design of the dynamic stander were noted. Design changes to correct these problems could be easily implemented before the introduction of the stander for more widespread clinical use.