Mobility Assessment Tool Research Articles

Older Adult Fall Risk Prediction with Deep Learning and Timed Up and Go (TUG) Test Data.

Falls are a major health hazard for older adults; therefore, in the context of an aging population, predicting the risk of a patient suffering falls in the near future is of great impact for health care systems. Currently, the standard prospective fall risk assessment instrument relies on a set of clinical and functional mobility assessment tools, one of them being the Timed Up and Go (TUG) test. Recently, wearable inertial measurement units (IMUs) have been proposed to capture motion data that would allow for the building of estimates of fall risk. The hypothesis of this study is that the data gathered from IMU readings while the patient is performing the TUG test can be used to build a predictive model that would provide an estimate of the probability of suffering a fall in the near future, i.e., assessing prospective fall risk. This study applies deep learning convolutional neural networks (CNN) and recurrent neural networks (RNN) to build such predictive models based on features extracted from IMU data acquired during TUG test realizations. Data were obtained from a cohort of 106 older adults wearing wireless IMU sensors with sampling frequencies of 100 Hz while performing the TUG test. The dependent variable is a binary variable that is true if the patient suffered a fall in the six-month follow-up period. This variable was used as the output variable for the supervised training and validations of the deep learning architectures and competing machine learning approaches. A hold-out validation process using 75 subjects for training and 31 subjects for testing was repeated one hundred times to obtain robust estimations of model performances At each repetition, 5-fold cross-validation was carried out to select the best model over the training subset. Best results were achieved by a bidirectional long short-term memory (BLSTM), obtaining an accuracy of 0.83 and AUC of 0.73 with good sensitivity and specificity values.

A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery.

Perme intensive care unit (ICU) mobility score is a comprehensive mobility assessment tool; however, its usefulness and validity for patients after cardiovascular surgery remain unclear. We investigated the association between the Perme Score and clinical outcomes after cardiovascular surgery. We retrospectively enrolled 249 consecutive patients admitted to the ICU after cardiac and/or major vascular surgery. The Perme Score contains categories on mental status, potential mobility barriers, muscle strength and mobility level and was assessed within 2days after surgery. The outcomes of physical recovery were the number of days until 100-m ambulation achievement and 6-min walk distance (6MWD) at hospital discharge. The endpoint was a composite outcome of all-cause mortality and/or all-cause unplanned readmission. We analyzed the associations of the Perme Score with physical recovery and the incidence of clinical events. After adjusting for clinical confounding factors, a higher Perme Score was an independent factor of earlier achievement of 100-m ambulation (hazard ratio: 1.039, 95% confidence interval [CI]: 1.012-1.066) and higher 6MWD (β: 0.293, P = .001). During the median follow-up period of 1.1years, we observed an incidence rate of 19.4/100 person-years. In the multivariate Poisson regression analysis, a higher Perme Score was significantly and independently associated with lower rates of all-cause death/readmission (incident rate ratio: 0.961, 95% CI: 0.930-0.992). The Perme Score within 2days after cardiovascular surgery was associated with physical recovery during hospitalization and clinical events after discharge. Thus, it may be useful for predicting clinical outcomes.

A - 20 Identifying Concussion in College-Aged Individuals Using a Multimodal Assessment of Vestibular and Oculomotor Function

Abstract Purpose Vestibular and oculomotor assessments are fundamental tools to identify concussions. However, research is unclear on which vestibular and oculomotor assessment or combination of assessments best detect concussions. The purpose of this study was to assess the discriminant ability of the Vestibular/Ocular Motor Screening (VOMS), Balance Error Scoring System (BESS), modified BESS (mBESS), and High-Level Mobility Assessment Tool (HiMAT) to identify college-aged individuals with concussion from controls. Method A prospective study of college-aged individuals (18–30 years) diagnosed with concussion within 5 days of enrollment was conducted. Demographics, injury information, VOMS, BESS/mBESS, and HiMAT were completed at the initial visit. Logistic regressions (LR) and receiver operating characteristic (ROC) analyses of the area-under-the-curve (AUC) determined the ability of the VOMS, BESS/mBESS, and HiMAT to identify concussion from control. A total of 214 participants (mean age = 20.4¬ ± 2.5 years, 52.8% female) were enrolled, with 137 (64.0%) concussions and 77 (36.0%) controls. Results The VOMS total (AUC = 0.93, 95%CI = 0.90–0.97, p < 0.001) and HiMAT total (AUC = 0.79, 95%CI = 0.65–0.93, p < 0.001) significantly identified concussion from control, while the BESS (AUC = 0.58, 95%CI = 0.50–0.67, p = 0.05) and mBESS (AUC = 0.55, 95%CI = 0.47–0.64, p = 0.23) did not. A 2-factor model with combined VOMS and HiMAT totals did not improve identification (AUC = 0.92, 95%CI = 0.85–1.00, p < 0.001). Conclusions The VOMS total score demonstrated outstanding discriminant ability, HiMAT total score demonstrated adequate discriminant ability, and BESS/mBESS total errors demonstrated unacceptable discriminant ability in identifying concussions from controls. Our findings suggest that the VOMS remains a preferred vestibular and oculomotor functioning assessment for identifying concussion. Furthermore, incorporating objective assessments with the VOMS, such as HiMAT, does not improve diagnostic yield.

The association between continuing to play, clinical domains, and recovery outcomes in collegiate athletes following concussion.

Continued play following concussion can lead to worse outcomes and longer recoveries compared with athletes who immediately report. This has been well documented in youth athletes, while less attention has been paid to collegiate athletes despite differences in healthcare access, recovery trajectories, and additional pressures to play. Therefore, the purpose of this study was to determine if continuing to play immediately following a concussion influenced clinical outcomes and recovery time in collegiate athletes. A prospective, repeated-measures design was used to compare clinical outcomes and recovery time between collegiate athletes who continued playing (n = 37) and those immediately removed (n = 56) after a concussion. Assessments were conducted within 5 days of the concussion and at full medical clearance (FMC; ± 3 days) using the Sport Concussion Assessment Tool-5th edition (SCAT5), Vestibular/Ocular Motor Screening assessment, and High-Level Mobility Assessment Tool. Mann-Whitney U-tests determined differences in clinical outcomes between groups. Cox proportional hazards regression models examined the relationship between factors associated with days to symptom resolution and days to FMC, and covariates were selected a priori based on previous literature. Hazard ratios with 95% CIs were reported for each predictor variable. Significant differences were found in SCAT5 concentration composite scores (p = 0.010) and SCAT5 delayed recall composite scores (p = 0.045) at the acute visit and near point of convergence average distance (cm; p = 0.005) at the FMC visit between the group who continued to play and those who were immediately removed. There were no differences between groups in days to symptom resolution (10 vs 7 days, p = 0.05) and days to clearance (13 vs 11.50 days, p = 0.13). The association between groups and days to symptom resolution (χ2[4] = 5.052, p = 0.282), and days to clearance (χ2[4] = 3.624, p = 0.459) were not significant when adjusting for covariates. Collegiate athletes who continued to play following concussion did not exhibit worse clinical outcomes or recovery times compared with athletes who were immediately removed. While the lack of differences found in this study could be supported by prior literature, including improved education, awareness, reporting attitudes, and concussion management at the collegiate level in recent years, the authors believe discrepancies are more likely due to study-specific differences (e.g., sample size, care setting, and timing). Therefore, these findings should not diminish the dangers of continued play and the importance of timely removal after concussion.

Relative Performance of Bedside Mobility Assessment Tool 2.0 (BMAT) Over Others for Acute Care Patient Recovery

Relative Performance of Bedside Mobility Assessment Tool 2.0 (BMAT) Over Others for Acute Care Patient Recovery

Validation of Bedside Mobility Assessment Tool (BMAT) in Acute Orthopaedic Setting

Background and objective Mobility is an integral part of a patients speedy recovery in acute care settings. Mobility assessment can deliver a high standard of care through safe and effective patient mobilization. The physiotherapist evaluates three main areas of functional mobility. These areas can be effectively evaluated using outcome measures with good psychometric properties. Several mobility-related evaluation outcome measures are used by physiotherapists. The existing outcome measures are reliable and valid in few subgroups but have limitations. After reviewing the literature a tool was found in the nursing discipline named the lsquoBedside Mobility Assessment tool BMATrsquo designed to address limitations of existing outcome measures. The purpose of the study was to validate matched components of BMAT against ICU Mobility scale IMS in acute orthopaedic settings using intraclass correlation coefficient between the testers for BMAT and IMS.Methods A total of sixty-four patients were assessed using BMAT and IMS with an interval of two hours by two qualified raters with more than one year of experience in acute settings. Data were recorded in Excel sheet and scores of BMAT and ICU Mobility Scales were analyzed using Intraclass Correlation Coefficient 95 confidence interval on SPSS software version 22.Results There was excellent inter-rater reliability between raters for BMAT at 95 confidence interval ICC0.95 and between Bedside Mobility Assessment Tool BMAT and ICU Mobility Scale ICC0.96. Conclusion Bedside Mobility Assessment Tool BMAT is a valid scale for use in an acute orthopedic setting.

Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury

ObjectivesTo investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DesignMulti-center, cross-sectional study. SettingThree institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). ParticipantsData were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. InterventionsNot applicable. Outcome MeasuresCognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. ResultsIndividuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. ConclusionsCombining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.

Reliability of Sachse’s mobility criteria in individuals of age 18-24 years

Background: The ability to obtain an efficient yet reliable measurement of mobility can be useful for evaluation as well as for documentation. The physiotherapists use different tools to assess each and every joints mobility. In the clinical setting assessing each joint is time consuming. Sachse’s mobility criteria is the mobility assessment tool which assess all major joints of body. It is an easy and quick to perform diagnostic tool. Hence, this study is intended to estimate reliability of Sachse’s mobility criteria in individuals of age 18-24 years as reliability is the prerequisite for validity. Objectives: To estimate the intra-rater and inter-rater reliability of Sachse’s mobility criteria in individuals of age 18-24 years. Methodology: 92 participants were selected according to inclusion and exclusion criteria. Anatomical landmarks were marked by the both the examiners and removed after each assessment. Examiner 1 assessed the participant and after the interval of 30 minutes examiner 2 assessed the same participant. Examiner 1 repeated the assessment after 7 days of 1st assessment to avoid recall bias. Data analysis done and interpretations were made. Results: Sachse’s mobility criteria showed good to excellent intra-rater and inter-rater reliability ICC= 0.904 and 0.853 respectively. Conclusion: Sachse’s mobility criteria showed good to excellent intra-rater and inter-rater reliability in individuals of age 18-24 years. KEY WORDS: Mobility, hypomobility, hypermobility.

Dizziness-Related Disability One Year after a Mild-to-Moderate TBI-A Follow-Up Study.

Persisting dizziness and balance problems after mild-to-moderate traumatic brain injury (mmTBI) may result in considerable disability. The primary aim of this study was to explore the factors associated with dizziness-related disability one year post-injury. Data from 64 participants (mean age 39.4 [SD 13.0] years; 45 [70.3%] women) with mmTBI from a previous randomised controlled trial were analysed using simple and multiple regression analyses (Clinical Trials Registry #NCT01695577). The Dizziness Handicap Inventory one year (12.1, [SD1.6] months) post-injury was the dependent variable. Demographic and injury-related variables, clinical findings, and measures of post-injury symptoms and functioning (Rivermead Post-Concussion Symptoms Questionnaire, RPQ; Vertigo Symptom Scale-short form, VSS-SF; Hospital Anxiety and Depression Scale; Balance Error Scoring System; and High-Level Mobility Assessment Tool, HiMAT) at baseline (3.5 [SD 2.1] months post-injury) were the independent variables. Dizziness-related disability at one year was associated with pre-injury comorbidity, neck pain, higher RPQ, higher VSS-SF, and lower HiMAT scores (adjusted R2 = 0.370, F = 6.52 p < 0.001). In conclusion, the factors associated with dizziness-related disability one year post-injury, such as pre-injury comorbidity, neck pain, increased post-concussion symptom burden, increased dizziness symptom severity, and reduced balance and mobility, should be addressed early in the rehabilitation process to reduce patient burden.

Success in Supporting Early Mobility and Exercise in a Cardiothoracic Intensive Care Unit.

Early mobility contributes to improved patient outcomes and reduced hospital length of stay during acute and intensive care hospitalization. The Bedside Mobility Assessment Tool was implemented in a cardiothoracic intensive care unit during participation in a nationwide evidence-based quality improvement initiative. One outcome included a high level of mobility that was sustained over time. Using the Dynamic Sustainability Framework model, this article describes the key components that contributed to this sustained mobility performance over 4 years.

The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain.

The self-administered neck mobility assessment tool (S-ROM-Neck) is the subjective cervical region range of motion (S-ROM) assessment scale. The study aimed to demonstrate the reliability and validity of the Turkish version of the S-ROM-Neck in patients with chronic neck pain. : A cross-sectional study was conducted with a total of 60 chronic neck pain patients in the Physical Therapy and Rehabilitation Clinic of Pamukkale University Hospital between January and August 2021. The mean age of the individuals was 34.1 ± 9.9 years. Patients were assessed with S-ROM-Neck twice to prove the test-retest reliability. In addition, Visual Analogue Scale (VAS), Neck Disability Index (NDI) and bubble inclinometer measurement were used to analyze the construct validity of S-ROM-Neck. The intraclass correlation coefficients of the S-ROM-Neck were higher than 0.80 (ICC > 80, CI: 0.90-98). The internal consistency of the S-ROM-Neck total score was within the acceptable limits (α = 0.754). Construct validity was high regarding the correlation analysis (r > 0.05, p < 0.01). Turkish S-ROM-Neck is a valid and reliable tool to assess the S-ROM of individuals with chronic neck pain.

Validation of an Arabic translation of the Functional Mobility Assessment (FMA) tool for assistive mobility device users

BackgroundFunctional mobility assessment (FMA) tool is a self-report questionnaire developed to measure users’ satisfaction with assistive mobility devices while performing activities of daily living.PurposeTo validate an Arabic translation of the FMA tool for Arabic-speaking assistive mobility devices users.MethodsA committee of 2 bilingual qualified occupational therapists translated the English version into Arabic which was verified by back translation. The final versions were administered to bilingual assistive mobility devices users. The participants were randomly assigned to answer either the English or Arabic version of the FMA first, followed by answering the FMA in the other language. The scores obtained were tested for agreement using the kappa statistic.ResultsParticipants’ (n=52), 28 were males and 24 were females, average participant age was 39.4 years old and had used an assistive mobility device for 6.4 years. We found a significant moderate agreement between the scores obtained from the two versions (p<0.000). The kappa measurement of agreement was 0.59 (95% confidence interval, 0.48–0.70).ConclusionThe FMA is now available in Arabic, and it is an appropriate measure for use in research and clinical practice to quantify satisfaction with a functional mobility among assistive mobility device users. Further studies should test its psychometric properties.

Construct Validity of the Revised High-Level Mobility Assessment Tool for Children Who Are Developing Typically.

The aim of this project was to evaluate the construct validity of the high-level mobility assessment tool (HiMAT) for children who are developing typically with no underlying condition that may affect mobility. The HiMAT is a revised 8-item measure of high-level mobility. Rasch analysis was used to assess fit to the Rasch model indicating unidimensionality, person separation index local dependency, targeting of items, and differential item functioning. Children with typical development aged 5 to 12years (n = 1091; 554 girls and 537 boys) were recruited from 8 schools. The mean HiMAT score was 22.4/32 (range, 8-32). Data fit the Rasch model, indicating that the HiMAT was a unidimensional scale assessing a single construct (high-level mobility). The person separation index was .86, indicating good reliability. The skip item exhibited differential item functioning by sex. Although items were well targeted, the fit residual mean for persons was 2.40, indicating most found the tasks easy to complete. Unlike in adult populations, 2 items (walk and walk over obstacle) exhibited local dependency >0.2. The HiMAT is a unidimensional targeted performance measure of high-level mobility for children with typical development aged 5 to 12years. Further examination of the relationship between the test items "walk" and "walk over an obstacle" may be required to ensure that scores on these items are truly independent of one another.

Rehabilitation of People With Chronic Spinal Cord Injury Using a Laparoscopically Implanted Neurostimulator: Impact on Mobility and Urinary, Anorectal, and Sexual Functions

ObjectivesThis study aimed to assess the impact of the laparoscopic implantation of neuromodulation electrodes (Possover-LION procedure) on mobility and on sexual, urinary, and anorectal functions of people with chronic spinal cord injury (SCI). Material and MethodsLongitudinal analysis of 30 patients with chronic SCI (21 ASIA impairment scale (AIS) A, eight AIS B, and one AIS C) submitted to the Possover-LION procedure for bilateral neuromodulation of femoral, sciatic, and pudendal nerves. Assessments were performed before the surgical procedure and at 3, 6, and 12 months postoperatively. The primary outcome was evolution in walking, measured by the Walking Index for Spinal Cord Injury score, preoperatively and at 12 months. Secondary outcomes were changes in overall mobility (Mobility Assessment Tool for Evaluation of Rehabilitation score), urinary function and quality of life (Qualiveen questionnaire), and bowel (time for bowel emptying proceedings and Wexner’s Fecal Incontinence Severity Index [FISI]) and sexual functions (International Index of Erectile Function for men and Female Sexual Function Index for women). Surgical time, intraoperative bleeding, and perioperative complications were also recorded. ResultsQualitatively, 18 of 25 (72%) patients with thoracic injury and 3 of 5 (60%) patients with cervical injury managed to establish a walker-assisted gait at one-year follow-up (p < 0.0001). A total of 11 (47.8%) have improved in their urinary incontinence (p < 0.0001), and seven (30.4%) improved their enuresis (p = 0.0156). The FISI improved from a median of 9 points preoperatively to 5.5 at 12 months (p = 0.0056). Of note, 20 of 28 (71.4%) patients reported an improvement on genital sensitivity at 12 months postoperatively (p < 0.0001), but this was not reflected in sexual quality-of-life questionnaires. ConclusionsPatients experienced improved mobility and genital sensitivity and a reduction in the number of urinary and fecal incontinence episodes. By demonstrating reproducible outcomes and safety, this study helps establish the Possover-LION procedure as an addition to the therapeutic armamentarium for the rehabilitation of patients with chronic SCI. Clinical Trial RegistrationThis study was registered at the WHO Clinical Trials Database through the Brazilian Registry of Clinical Trials—REBEC (Universal Tracking Number: U1111-1261-4428).

Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury.

The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). Research laboratory setting. Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. Cross-sectional. The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.

Validity, Responsiveness, and Predictive Ability of the Japanese Version of the Cumulated Ambulation Score in Patients with Hip Fracture.

ABSTRACTObjectives:The aim of the current study was to investigate the validity, the responsiveness, and the predictive ability for discharge to own home of the Japanese version of the Cumulated Ambulation Score (CAS-JP). This was achieved by analyzing the CAS-JP after hip fracture surgery at multiple time points until patient discharge.Methods:Patients who underwent hip fracture surgery were evaluated using CAS-JP, the Barthel Index, and walking ability on postoperative day (POD) 1, 7, and 14 and at discharge. Floor and ceiling effects, responsiveness, and correlations between CAS-JP and other functional outcomes were assessed at each time point. The predictive ability of CAS-JP for discharge to own home was also analyzed using the area under the curve (AUC) of the receiver operating characteristic.Results:A total of 121 patients were included in this study. On POD7, POD14, and at discharge, strong correlations were observed between CAS-JP and the Barthel Index (r=0.81, 0.82, and 0.87, respectively), and between CAS-JP and walking status (r=0.82, 0.81, and 0.76, respectively). CAS-JP had a large effect size (1.64–2.25) and standardized response mean (1.49–1.81). The predictive ability of CAS-JP for discharge to own home, as indicated by the AUCs, were 0.73 (95% CI: 0.62–0.83) on POD7 and 0.74 (95% CI: 0.62–0.86) on POD14.Conclusions:CAS-JP has sufficient validity and responsiveness as a mobility assessment tool in postoperative hip fracture patients. Furthermore, this study showed that early postoperative mobility status evaluation using CAS-JP can sufficiently predict discharge to own home.

Implementing Bedside Mobility Assessment Tool to Improve Patient Outcomes and Staff Communication

Implementing Bedside Mobility Assessment Tool to Improve Patient Outcomes and Staff Communication

Can adults with cerebral palsy perform and benefit from ballistic strength training to improve walking outcomes? A mixed methods feasibility study

BackgroundPower bursts of hips and ankle plantar flexors are prerequisites to walking propulsion. However, these power bursts are reduced during gait for persons with cerebral palsy (CP) and mainly in the ankle plantar flexors. Hence, task specific training, such as ballistic strength training, is suggested to increase muscle power in walking but not investigated in adults with CP. Therefore, the aim was to investigate if adults with CP could perform and benefit from ballistic strength training to improve walking, evaluated through physical measures and self-reported measures and interviews.MethodsIn this mixed methods feasibility study, eight ambulatory adults (aged 24–56) with spastic CP conducted ballistic strength training on a glideboard targeting the ankle plantarflexors two times a week for eight weeks. The feasibility of the training was assessed through objectives described by Orsmond and Cohn. Before and after the intervention, physical measures (6-Minute Walk Test and the eight-item High-level Mobility Assessment Tool) and self-reported measures (Patient Global Impression of Change, Numeric Pain Rating Scale, Fatigue Impact and Severity Self-Assessment, and Walk-12) were collected. After the intervention, semi-structured interviews explored experiences of this training.ResultsThe participants experienced training the ankle plantar flexor as relevant but reported it took about four weeks to coordinate the exercises successfully. Although we observed no changes in the physical performance measures, most participants reported improvements; some felt steadier when standing, walking, and hopping.ConclusionThis study demonstrated that ballistic strength training was feasible and suitable in adults with CP. However, guidance and a long (4 weeks) familiarization time were reported necessary to master the exercises. Most participants reported self-experienced improvements, although no physical performance measures improved. Thus, prolonged intervention may be required for perceived physical improvements to emerge. Also, other outcome measures sensitive to power output remains to be investigated.

Effects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial

ObjectivesTo investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge. DesignA single-blinded, parallel groups, randomized controlled trial. SettingsOutpatient rehabilitation center. ParticipantsThirty-four patients (N=34), aged 31.3±7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups. InterventionsThe Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks. Main Outcome MeasuresThe primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention. ResultsAfter 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05). ConclusionsPatients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.

Pre-treatment depressive symptoms predict physical performance among pediatric pain program participants

A central concern raised by many patients attending a pediatric chronic pain interdisciplinary clinic is physical functioning decline, fatigue, and diminished endurance. However, most studies examining treatment effects of pain programs on physical outcomes have relied on self- and/or parent-reported measures without confirming the results using objective indices, and predictors of objective indices of physical function in this population have rarely been examined. The purpose of the present study was to evaluate changes in objective physical functioning and to investigate psychosocial predictors of physical functioning over time in a sample of pediatric patients who completed an intensive outpatient pain program (IOP). Participants (N=55; Mage=14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain levels (Brief Pain Inventory), anxiety/depressive symptoms (Hospital Anxiety and Depression Scale), pain catastrophizing (Coping Strategies Questionnaire), and kinesiophobia (Tampa Scale for Kinesiophobia). Participants completed the FitKids Treadmill Test (FitKids) assessing physical endurance and the high-level mobility assessment tool (HiMAT) assessing physical ability pre- and post-IOP completion. Paired samples t-tests indicated significant improvement in Total Time to Exhaustion (TTE) on FitKids (p .138). Participation in an IOP led to significant improvement in physical endurance and ability. Depressive symptoms were negatively associated with endurance at baseline but not after program completion. Depressive symptoms may influence pre-treatment objective physical endurance and should be assessed in pediatric chronic pain patients beginning rehabilitation.