Sensory and affective components of pain as recorded with the Pain-O-Meter (POM) among children with acute and chronic pain.

AIM: To explore the usefulness of the Pain-O-Meter sensory and affective words scale (POM-WDS) with regard to whether children aged 6-16 who suffer from chronic and acute pain know the words and what words they chose to describe their pain. METHODS: Sixty-one children participated, mean age 11 y, suffering from acute pain (n=25) and pain associated with juvenile idiopathic arthritis (JIA, n=36). Children rated their pain intensity on the POM-VAS (visual analogue scale, 0-10 cm). Thereafter, children were asked whether each sensory and affective word on the POM-WDS was known to them, and whether each word described their pain experience. RESULTS: Seventeen out of 23 words were known to at least 70% of the sample. The least recognized word was grinding. Children age 6-16 knew fewer words than the adolescents. Age was a significant determinant for whether the children knew the words grinding (odds ratio (OR) 20.08, p<0.01), gnawing (OR 5.92, p < 0.05), unbearable (OR 8.02, p<0.05), and excruciating (OR 20.17, p<0.001). Terrible (OR 33.3, p<0.05), aching (OR 44.5, p<0.05) and sore (OR 5.4, p<0.05) were selected more often by children with acute pain than with JIA. CONCLUSION: Further studies will be required to determine the suitability of using the POM-WDS with children.

Functional index-2: Validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis.

OBJECTIVE: To revise the content of the Functional Index in myositis (FI) and to evaluate measurement properties of a revised FI. METHODS: Previously performed FI (n = 287) were analyzed for internal redundancy and consistency, and ceiling and floor effects. Content was evaluated and a preliminary revised FI was developed. To evaluate the construct validity of the preliminary revised FI, it was compared with isokinetic measurements of muscular strength and endurance, the Myositis Activities Profile, disease impact on general wellbeing, and creatine phosphokinase levels. Minor adjustments were made and the revised FI was investigated for interrater reliability and intrarater reliability over a 1-week period. After this, some minor, additional adjustments were made leading to the final version, FI-2. RESULTS: Five tasks were removed from the original FI due to ceiling effects. Performance pace and number of repetitions were modified for the remaining tasks. A moderate correlation (r(s) = 0.58) was found between the shoulder flexion task of the preliminary revised FI and isokinetic measurements of shoulder flexion endurance. Intraclass correlation coefficient (ICC) for interrater reliability of the revised FI varied from 0.86-0.99 with no systematic differences. ICC for intrarater reliability varied from 0.56-0.99 with systematic differences (P < 0.05) between test and retest in 3 of the tasks. The sit-up task was excluded due to low intrarater reliability resulting in the final 7-item FI-2. There was a good correlation between tasks on the right and left side suggesting that the FI-2 could be performed unilaterally. CONCLUSION: The FI-2 is a valid and reliable outcome measure of impairment for patients with polymyositis or dermatomyositis. It is well tolerated and the unilateral FI-2 requires a maximum of 20 minutes to perform. Further evaluation of sensitivity to change and testing in healthy individuals needs to be conducted.

Variability within and between evaluations of sacroiliac pain with the use of distraction testing.

OBJECTIVE: The objective of this study was to determine whether applied force and time interval of force exposure varied within and between physiotherapists (PTs) when they used sacroiliac (SI) distraction testing to provoke pain among subjects with sacroiliitis. METHODS: Two force plates recording 3 orthogonal forces and time intervals were used during repetitive testing. Eleven subjects with sacroiliitis were examined with the use of distraction testing by each of 3 PTs. Subjects lay on an examination board equipped with one force plate for each SI joint. They indicated provoked pain by pressing a button that gave a mark in the data collection. RESULTS: Applied force and time interval of force exposure varied within and between PTs. Significant differences between PTs were found in the impulse (force x time) for the vertical and lateral force components (P

Physical activity, physical fitness, and general health perception among individuals with rheumatoid arthritis.

OBJECTIVE: To describe self-reported physical activity and physical fitness and to identify correlates of physical activity and general health perception. METHODS: Data on self-reported physical activity, physical fitness, activity performance, and disease activity were collected from a sample of 298 patients with rheumatoid arthritis (RA). RESULTS: Forty-seven percent of our sample reported physical activity behaviors that did not comply with public health recommendations. A majority of the patients had decreased lower-limb muscle function (72%), grip force (94%), joint motion (94%), and functional balance (68%). Correlations between self-reported physical activity and other variables were r(s) = 0.25 or less. Variation in general health perception was explained (total adjusted R(2) = 0.65) by pain and activity performance. CONCLUSION: Our findings indicate that there is a case for recommendations on and support for healthy physical activity behaviors among people with RA.

[Moderate intensive exercise has a positive effect in rheumatoid arthritis]. / Måttligt intensiv träning har positiv effekt vid reumatoid artrit.

Rheumatoid arthritis (RA) often confers disability and increased risk of coronary heart disease and premature death. Decreased body functions and psychological obstacles in the individual with RA, and health care workers' fear of causing short-term and long-term aggravation of the disease, might represent barriers to starting and maintaining physical activity. However, there is now good evidence for the safety and benefit of moderately intensive exercise for individuals with RA. Thus, these people should be recommended, and actively supported in, physical activity.

The juvenile arthritis foot disability index: development and evaluation of measurement properties.

OBJECTIVE: To develop a new juvenile arthritis foot disability index (JAFI) and to test it for validity and reliability. METHODS: Samples of 14 children/adolescents and 30 children/adolescents with juvenile idiopathic arthritis (JIA) and 29 healthy children/adolescents participated. We used a questionnaire derived from the International Classification of Functioning, Disability and Health that included 27 statements divided into the dimensions Impairment, Activity Limitation, and Participation Restriction. Comments on the contents were invited from parents and adolescents. Convergent and divergent construct validity was examined by comparing the 3 JAFI dimensions to joint impairment scores, the Childhood Health Assessment Questionnaire (CHAQ), and self-rated, foot-related participation restriction. Known groups construct validity was assessed by comparing answers from children with JIA to those from healthy children. Test-retest stability was investigated over one week. RESULTS: One item was added after suggestions from 2 participants. A consistent pattern of increasing JAFI scores was found with increasing joint impairment scores, CHAQ scores, and self-rated foot-related participation restriction. Foot-related disability as assessed by JAFI was more pronounced in children with JIA than in healthy controls. One statement showing a floor effect was excluded. No internal redundancy (rs > 0.90) between items was found, and internal consistency within each subscale was satisfactory (rs > 0.50) for all items but one. No systematic differences were found between test and retest, and weighted kappa coefficients for the 3 JAFI dimensions were 0.90, 0.85, and 0.88. CONCLUSION: The JAFI appears to be valid and reliable for assessing foot-related disability among children/adolescents with JIA. Its sensitivity to change remains to be investigated.

Characteristics of physiotherapy sessions from the patient's and therapist's perspective.

PURPOSE: The purpose was to explore, describe and compare the characteristics of physiotherapy sessions with patients after stroke from two perspectives: the patients' and the physiotherapists', in relation to observed behaviour. METHODS: A qualitative, descriptive, comparative approach was used. Nine patients and 10 physiotherapists participated. Data from observations and semi-structured interviews were used. RESULTS: Six themes were identified: setting and attaining goals, focusing on motor activity, finding the optimal training strategy, facilitating active patient involvement, making use of environmental factors and adjusting to the structural reorganization of the rehabilitation services. The physiotherapists and the patients made similar descriptions in some of the themes but differed in some. The physiotherapists expressed what they perceived to be their lack of scientific knowledge, while the patients trusted their physiotherapists' competence. The physiotherapists wanted to take the patients' personal experiences into account in the sessions, which was not obvious to the patients. CONCLUSION: Differences in physiotherapists' and patients' descriptions of characteristics of physiotherapy sessions have to be taken into consideration in the rehabilitation of stroke patients. In order to empower the patient to take a more active part in the rehabilitation process, there is a need to explore how to incorporate the patients' personal experiences and knowledge into the rehabilitation process.

Force and time recording for validating the sacroiliac distraction test.

OBJECTIVE: The present aim was to investigate whether applied force and time interval of force exposure during the sacroiliac distraction test could discriminate subjects with sacroiliitis pain from healthy subjects. DESIGN: The study was a methodological one using force plates sensing three orthogonal forces. BACKGROUND: Studies evaluating the validity of sacroiliac joint tests show conflicting results. To our knowledge, no previous studies have evaluated force recording combined with pain reports. METHODS: Eleven subjects with sacroiliitis and 11 healthy subjects were examined with distraction test once by each of three physiotherapists. The subjects indicated any pain by pressing a button giving a mark in the data collection. RESULTS: The magnitude of the total force vector was significantly smaller (P<0.05) and the time interval was significantly shorter (P<0.05) in the sacroiliitis group, although almost 20 s could elapse before pain was provoked. The sensitivity of the test was 0.55 calculated for all physiotherapists involved, and varied between them, range 0.55-0.82. The specificity was 1.0. CONCLUSIONS: The results support the advantage of force and time recording during the distraction test as a technique for evaluating pain. Further investigation is needed on whether the velocity of force application, the ability to maintain the same pressure and the bilateral distribution of force on the sacroiliac joints influence the sensitivity. RELEVANCE: There is a need for objective evaluation methods in manual tests that are easy to perform. Recording force and its time interval may be a step towards standardising pain-provocation sacroiliac joint tests.

Development of the myositis activities profile--validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis.

OBJECTIVE: To develop a disease-specific questionnaire for assessing limitations in activities of daily life, the Myositis Activities Profile (MAP), and to investigate its validity and reliability. METHODS: Groups of 10, 27, 31, and 17 patients with polymyositis (PM) or dermatomyositis (DM) participated in different parts of the study. In the first draft of the MAP, patients rated their difficulty and experienced importance of selected activities from the International Classification of Impairments, Disabilities, and Handicaps (ICIDH)-2 Beta-2 draft. The 37 highest rated activities formed a second draft of the MAP, which was analyzed for internal redundancy and consistency. For construct validity a third draft was correlated with CPK levels, the Functional Index in myositis (FI), the Arthritis Impact Measurement Scales-2 (AIMS2), the Health Assessment Questionnaire (HAQ), and subjective global disease impact. Test-retest reliability over one week was investigated. RESULTS: There were several expected correlations (rs > 0.50) between subscales of the MAP and corresponding subscales of the AIMS2, and a 31 item MAP correlated moderately with the HAQ (rs = 0.70) and less with the FI (rs = 0.55), subjective global disease impact (rs = 0.43), and CPK levels (rs = 0.17). No systematic differences were found between test and retest, and weighted kappa coefficients ranged from Kw = 0.56 to 0.77. CONCLUSION: The MAP seems to be a valid and reliable method for assessing activity limitations in patients with PM and DM.

[Rehabilitation in temperate climate for persons with pelvospondylitis. Accessed disease activity and general well-being is gradually improving]. / Rehabilitering i varmt klimat för personer med pelvospondylit. Skattad sjukdomsaktivitet och allmän sjukdomspåverkan förbättras varaktigt.

The aim of the study was to investigate the effects on disease activity, range of motion, functional ability, and global wellbeing on persons with Ankylosing Spondylitis (AS) during three weeks' rehabilitation in a tempered climate. Forty-eight persons were evaluated twice prior to the rehabilitation and three times after. The results indicated significant improvements on all variables assessed, which lasted three weeks and, in some cases, three months. Global wellbeing continued to improve during follow-up. The results of our study thus indicate that rehabilitation in a tempered climate might be a useful complement to traditional rehabilitation of persons with AS.