Self-reported Limitations Research Articles

1.124 Harnessing Electronic Health Record Data to Examine the Association Between Adverse Childhood Experiences, Medical Morbidity, and Healthcare Utilization

The Adverse Childhood Experiences (ACEs) questionnaire is a widely used screener for pediatric trauma exposure and general household dysfunction. On a population level, ACEs are cumulative risk factors for a range of mental health and physical conditions. ACEs research has been largely based on self-reported ACEs exposures and health conditions, anthropometric measures, and biomarkers. In contrast, data mined directly from the electronic health record (EHR) allows for more objective analysis and reduces potential harms and limitations of self-report.

Reference Ranges for Gait Speed and Sit-to-Stand Performance in a Cohort of Mobility-Intact Community-Dwelling Older Adults From Singapore.

Slow gait speed and sit-to-stand performance are associated with adverse clinical outcomes in older adults. Identifying older adults with functional performance "below norms" is the first step toward prevention. We aimed to (1) examine the associations of age, body height, and gender with gait speed and sit-to-stand performance and (2) develop subgroup-specific reference ranges in older adults with no self-reported mobility limitations. Cross-sectional study. This study analyzed data from 775 community-dwelling older adults who reported no difficulty walking 100m, climbing stairs, and rising from the chair. Gait speed and sit-to-stand performance were measured by the 10-m gait speed test and 5-times sit-to-stand test, respectively. Bayesian linear regression was used to derive 95% reference ranges for gait speed and sit-to-stand performance, defined by different levels of age, body height, and gender. Overall, 95% reference range was 0.89-1.79m/s for habitual gait speed and 7.4-27.9 stands/30s for sit-to-stand pace. Age had the highest posterior probability (>99%) of a meaningful association with both functional outcomes. Additionally, height was strongly associated with gait speed: a 10-cm increase in height was associated with 0.07m/s (95% credible interval, 0.05-0.10) faster gait speed. For sit-to-stand test, the lower 95% reference range limits tended to be similar across gender and gender-specific height subgroups, owing to the associations of faster sit-to-stand pace with shorter height and male gender. Because extensive tables of reference ranges are impractical, a web-based application (https://sghpt.shinyapps.io/ippts/) is created to provide subgroup-specific reference ranges. In a large sample of mobile-intact older adults, reference ranges for gait speed and sit-to-stand performance differed meaningfully by age. Furthermore, gait speed was stature dependent. Although requiring validation, our findings may be used to define subgroup-specific "below-range" values and to complement existing universal clinical cut points for gait speed and sit-to-stand performance.

Animal foods and mobility limitations in community-dwelling young-old adults: longitudinal analysis of the EpiDoC cohort

BackgroundNutrition and particularly protein play a role in optimally stimulating muscle protein synthesis and maintaining function. Animal foods are excellent sources of high-quality protein. Therefore, we aimed to determine the association between the consumption of animal foods and mobility limitations in young-old adults.MethodsThe analytic sample was composed of 2860 community-dwelling adults aged 50 and over from a nationally representative longitudinal cohort of Portuguese adults who were followed up to 2.7 years. An animal food intake score was derived from the frequency of consumption of meat, fish, and dairy products. Mobility limitations were defined as the difficulty standing up from a chair, walking, and climbing stairs. To determine the association between animal food intake and mobility limitations mixed effects logistic models were fitted.ResultsAssociations between quartiles of animal food intake and mobility limitations (for example, for walking outdoors Quartile 4 v Q1: OR: 0.29; 95%CI: 0.15, 0.56) in unadjusted models were present, but there was no difference in the rate of change of mobility limitations over time in unadjusted models. These associations were no longer present when models were adjusted for sociodemographic, lifestyle and health variables. For example, participants in Q4 of animal food intake were not more or less likely to have difficulty climbing stairs than those in Q1 (OR: 0.95; 95%CI: 0.65, 1.38) nor have a different rate of change over time (OR: 0.86; 95%CI: 0.54, 1.37).ConclusionsNo convincing evidence was found to support an effect of animal foods intake measured at baseline on self-reported mobility limitations over a short period of time.

Validation of the pedHALshort and HALshort in Dutch children and adults with haemophilia.

The Haemophilia Activities List (HAL) and paediatric HAL assess self-reported limitations in various daily activities. To reduce patient burden, shorter versions of the pedHAL (22 items) and HAL (18 items) have been developed. This study aimed to determine the agreement between the pedHAL/HALfull and pedHAL/HALshort and construct validity and internal consistency of the pedHAL/ HALshort in persons with haemophilia (PWH). A cross-sectional secondary analysis of the Hemophilia in the Netherlands-6 national survey was performed. Adult and paediatric PWH completed the original pedHAL/HALfull , from which pedHAL/ HALshort were derived. Score differences between the original and short versions were calculated. Construct validity was studied by testing hypotheses regarding the relationship of the pedHAL/HALshort with the pedHAL/HALfull , Haemophilia & Exercise Project Test-Questionnaire (HEP-Test-Q), Canadian Haemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) and RAND 36-item Health Survey (RAND-36) (convergent/discriminant validity) as well as its ability to discriminate between subgroups (known-group validity). Internal consistency was assessed with Cronbach's α. We included 113 children (median 10y [range 4-17], 53% severe haemophilia) and 691 adults (median 51y [range 18-88], 35% severe). Scores of the pedHAL/HALfull and pedHAL/HALshort were similar with high correlations (>0.9). Construct validity was confirmed for the pedHAL/HALshort . The HALshort was able to discriminate between different disease severities and ages. Cronbach's α of the pedHAL/HALshort was 0.95-0.97. This study confirmed the agreement between the pedHAL/HALfull and the pedHAL/HALshort and the construct validity of the pedHAL/HALshort . The next step is to study construct validity of the pedHAL/HALshort when administered as short forms.

Is maximum grip strength a reliable predictor of hand limitations among older adults?

Grip strength is commonly used to assess hand function among older adults. While shown to be associated with disability, the degree to which grip strength specifically predicts hand limitations is unknown. The primary aim of this study was to evaluate grip strength as a predictor of hand limitations. Using the 2011-14 National Health and Nutrition Examination Survey (NHANES), we classified older adults reporting one or more hand limitations versus those with no limitations. Odds ratios were used to assess the association between grip strength (separated into quartiles) and the likelihood of a hand limitation while controlling for sex, race/ethnicity, education level, income, and pain. Receiver operator characteristic (ROC) curves were used to evaluate the degree to which grip strength discriminates between older adults with and without a hand limitation. We identified 2064 older adults (age ≥ 65), 31% of whom reported a hand-related limitation. Older adults with very low grip strength (weakest quartile) were more likely to report at least one limitation (OR: 6.1, 95% CI: 3.2, 11.8) than those with high grip strength (strongest quartile). However, grip strength had poor to moderate discrimination of hand limitations (ROC area under curves: 0.65-0.81). While self-reported hand limitations were associated with lower grip strength; overall, it is a relatively poor predictor of hand impairments among older adults. Better assessments are needed to adequately evaluate upper extremity impairments to help older adults maintain functional independence.

Biopsychosocial factors associated with chronic low back pain-related activity limitations in Burundi.

BackgroundChronic low back pain (CLBP) is an increasing burden worldwide. The biopsychosocial factors associated with CLBP-related activity limitations have not yet been investigated in Burundi.ObjectiveThe aim of our study was to investigate the biopsychosocial factors that influence the CLBP-related activity limitations in a Burundian sample population.MethodWe carried out a cross-sectional study of 58 adults with nonspecific CLBP from Bujumbura city. Univariate and bivariate analyses were used to investigate the association between biopsychosocial factors and CLBP activity limitations. Sequential multiple regression analyses were subsequently used to predict CLBP activity limitations.ResultsFifty-eight individuals with a mean age of 41.3 ± 10.20, 58.6% of female gender, were recruited. The univariate and bivariate analyses demonstrated that educational level, gender, healthcare coverage, profession, height, pain intensity, depression and physical fitness were significantly associated with CLBP-related activity limitations (p range, < 0.001 to < 0.05). The multivariate regression analysis showed that the significant biopsychosocial factors accounted for 49% of the variance in self-reported activity limitations. Predictors of activity limitations were education level (β = −0.369; p = 0.001), abdominal muscle endurance (β = −0.339; p = 0.002) and depression (β = 0.289; p = 0.011).ConclusionsOur study provides evidence of biopsychosocial factor associations with CLBP-related activity limitations in Burundi. Evidence-based management and prevention of CLBP in Burundi should incorporate a biopsychosocial model.Clinical implicationsBiopsychosocial factors should be regularly evaluated in people with chronic low back pain and efforts to improve the burden of chronic low back pain in Burundi should take these factors into account.

Self-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest

TitleSelf-reported limitations in physical function are common 6 months after out-of-hospital cardiac arrest. BackgroundOut-of-hospital cardiac arrest (OHCA) survivors generally report good health-related quality of life, but physical aspects of health seem more affected than other domains. Limitations in physical function after surviving OHCA have received little attention. AimsTo describe physical function 6 months after OHCA and compare it with a group of ST elevation myocardial infarction (STEMI) controls, matched for country, age, sex and time of the cardiac event. A second aim was to explore variables potentially associated with self-reported limitations in physical function in OHCA survivors. MethodsA cross-sectional sub-study of the Targeted Temperature Management at 33 °C versus 36 °C (TTM) trial with a follow-up 6 months post-event. Physical function was the main outcome assessed with the self-reported Physical Functioning-10 items scale (PF-10). PF-10 is presented as T-scores (0–100), where 50 represents the norm mean. Scores <47 at a group level, or <45 at an individual level indicate limitations in physical function. Results287 OHCA survivors and 119 STEMI controls participated. Self-reported physical function by PF-10 was significantly lower for OHCA survivors compared to STEMI controls (mean 46.0, SD 11.2 vs. 48.8, SD 9.0, p = 0.025). 38% of OHCA survivors compared to 26% of STEMI controls reported limitations in physical function at an individual level (p = 0.022). The most predictive variables for self-reported limitations in physical function in OHCA survivors were older age, female sex, cognitive impairment, and symptoms of anxiety and depression after 6 months. ConclusionSelf-reported limitations in physical function are more common in OHCA survivors compared to STEMI controls. Trial registrationClinicalTrials.gov Identifier: NCT01946932.

Financial social protection and individual out-of-pocket costs of long-term care in the USA and Europe: An observational study.

SummaryBackgroundEmpirical evidence informing policies aiming at ensuring affordability of long-term care (LTC) costs is limited. Combining system-level with individual-level data, we quantify the burden of out-of-pocket costs of LTC services on households in 13 European countries and the USA and explore how social protection systems impact affordability of care.MethodsIn this observational study, we use harmonised data from the Health and Retirement Study (HRS), collected between 2012 and 2016, and from the Survey of Health, Ageing and Retirement in Europe, collected between 2013 and 2017. We assess the severity of LTC needs of older adults (65+) on the basis of self-reported limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We classify countries' social protection systems in terms of affordability and progressivity using information obtained from country officials. We examine variation in individual-level out-of-pocket LTC costs by social protection systems' affordability and progressivity.FindingsOut-of-pocket LTC costs are heterogeneous across countries and increase with individuals' needs. In countries where LTC is more affordable and social protection systems less progressive, older adults incur significantly lower levels of LTC costs. Within Europe, not only are costs lower where systems are characterized by higher affordability and lower progressivity, but they also represent a lower share of households' disposable income.InterpretationOur findings indicate that the social protection systems significantly affect the level of out-of-pocket costs faced and reported by older adults with LTC needs as well as the share of their income that is devoted to pay for care.FundingWe received funding from the National Institute on Aging (grant number R01 AG030153). The OECD programme of work on ageing and long-term care is partly funded by the European Union.

Exploring Health Trends Prior to State Pension Age for The Netherlands up to 2040.

Background: In many Western countries, the state pension age is being raised to stimulate the extension of working lives. It is not yet well understood whether the health of older adults supports this increase. In this study, future health of Dutch adults aged 60 to 68 (i.e., the expected state pension age) is explored up to 2040. Methods: Data are from the Dutch Health Interview Survey 1990–2017 (N ≈ 10,000 yearly) and the Dutch Public Health Monitor 2016 (N = 205,151). Health is operationalized using combined scores of self-reported health and limitations in mobility, hearing or seeing. Categories are: good, moderate and poor health. Based on historical health trends, two scenarios are explored: a stable health trend (neither improving nor declining) and an improving health trend. Results: In 2040, the health distribution among men aged 60–68 is estimated to be 63–71% in good, 17–28% in moderate and 9–12% in poor health. Among women, this is estimated to be 64–69%, 17–24% and 12–14%, respectively. Conclusions: This study’s explorations suggest that a substantial share of people will be in moderate or poor health and, thus, may have difficulty continuing working. Policy aiming at sustainable employability will, therefore, remain important, even in the case of the most favorable scenario.

Living a long life is a multi-step process

There is a strong link between physical activity and health.1 Historically, large-scale epidemiological studies have used self-report surveys to capture physical activity measures (eg, type and intensity). In the past 20–30 years, large cohort studies have increasingly adopted devices, such as pedometers, accelerometers, and consumer-marketed activity trackers, to measure physical activity. Device-based physical activity measures alleviate some limitations of self-reporting by increasing measurement objectivity and accuracy.

Community-dwelling adults with functional limitations are at greater risk for sleep disturbances

ObjectiveTo evaluate whether sleep disturbances vary along a continuum of functional limitations in a large nationally representative sample of US adults. MethodsUsing 2014-2015 National Health Interview Survey data (n = 33,424), we considered associations between each of 5 sleep disturbance measures (duration, trouble falling asleep, trouble staying asleep, use of sleep medications, waking rested) and Functional Limitations Index score, which distinguishes among adults with little-or-no (least-limited), moderate (somewhat-limited), and high functional limitations (most-limited). ResultsSomewhat-limited and most-limited respondents reported significantly worse sleep health for all sleep disturbance measures than people with little-or-no limitations, even controlling for body mass index, psychological distress, and 14 health indicators. ConclusionsPeople with significant self-reported limitations in physical functioning, independent of specific disabilities or disabling condition, report more sleep disturbances. Clinicians may want to evaluate the sleep health of patients with functional limitations.

An exploratory study on the application of screening of activity limitation and safety awareness (SALSA) scale for evaluation of activity limitation among elderly.

Aging poses a significant risk for activity and functional limitations. Problems among aged populations are interrelated, and these problems can lead to other disorders and finally leave a negative impact on the quality of life (QoL) This study used the screening of activity limitation and safety awareness (SALSA) scale to screen and measure activity limitations among the elderly. A community-based descriptive cross-sectional study was conducted among 928 elderly from the three districts of Tamil Nadu, India. The SALSA scale was administered via a door-to-door interview, and data analysis was carried out. Simple random sampling was used to obtain the study subjects in the selected study area. Chi-square tests and binary logistic regression were performed to find the association between selected risk factors. Among the 928 elderly, 53.7% of them were males, 84.9% were between the age of 60 and 69 years, and 31% were 70 years and above. The study found that 66.5% of the elderly have mild activity limitations, 15.7% of them had moderate limitations, 4.8% of them had severe limitations, around 3% of them had extreme limitations, and 10.3% of them had no significant limitations. The binary logistic regression found people of age 65 and above (OR = 3.80), female gender (OR = 2.90), with hypertension (OR = 1.95), vision problem (OR = 1.92), decreased sensation of the foot (OR = 3.41), as the significant independent risk factors for activity limitation among the elderly. The study found self-reported activity limitations among the elderly to be nearly 90%. The SALSA scale may be used as a handy tool to identify the activity limitation in community-based geriatric checkups.

Factors associated with limitations in functional mobility in elderly in the city of São Paulo, Brazil: a comparative analysis of 15 years

The study aimed to analyze the prevalence of self-reported limitation of functional mobility and associated factors from 2000 to 2015 in elderly residing in the city of São Paulo, Brazil. The analyses used data from the four waves (2000, 2006, 2010, and 2015) in the Health, Well-Being, and Aging Study (SABE). Regression models were conducted to analyze the demographic, socioeconomic, behavioral, and health-related characteristics of individuals associated with limitations of mobility in each wave of the study, and multilevel analysis was performed for comparison between the four waves. The results showed an increase in the prevalence of self-reported limitations in mobility, most evident in the year 2006. There was also an association between chronic health conditions such as history of stroke (PR = 1.43; 95%CI: 1.29; 1.58, in 2000), presence of osteoarticular diseases (PR = 1.35; 95%CI: 1.23; 1.49, in 2015), and complaint of "backache" (PR = 1.33; 95%CI: 1.22; 1.45, in 2006), as well as with socioeconomic aspects such as insufficient income (PR = 1.17; 95%CI: 1.07; 1.28, in 2010). In a context of rapid population aging, these results provide relevant information for promoting public policies to prevent the decline in mobility in the elderly.

Self-Reported Physical Limitations Among U.S. Veterans Compared to Non-Veterans: Findings from NHANES

Approximately 43% of males over the age of 65 years are Veterans. Veterans may be at elevated risk for functional declines due to barriers to health care access leading to accelerated loss of independence. This compared the prevalence of functional limitations in Veterans and non-Veterans. Data from two National Health and Examination Survey collection periods, administered 2013-2014 and 2015-2016, were used to compare physical functioning data between male Veterans (N=369) and non-Veterans (N=738) matched 1:2 for sex, race, and BMI. Individuals were considered a Veteran if they self-reported having “served in active duty in the U.S. Armed forces.” Pearson’s chi-square tests were used to assess differences in the prevalence of various self-reported functional limitations between groups. Veterans (mean±SEM: age: 64.5±0.54 years; BMI: 30.0±0.3 kg/m2) were disproportionately affected by self-reported functional limitations caused by long-term physical, mental, or emotional illnesses (8% vs. 3%, p<0.004). Twenty-five % of Veterans reported that these limitations kept them from working compared to 18% of non-Veterans (p<0.003). Veterans (38%) were also more likely to report being limited in the amount of work they could perform compared to non-Veterans (27%) (p<0.01). Additionally, Veterans (20%) were more likely to report the use of special healthcare equipment (i.e. cane, wheelchair) than non-Veterans (12%) (p<0.001). These data suggest that Veterans are at greater risk for functional limitations caused by self-reported long-term physical, mental or emotional illness. Therefore, further research is needed to determine if home- and community-based services could prevent further functional decline, ultimately allowing Veterans to maintain independence.

Reliability of Grip Strength as a Predictor of Hand Limitation Among U.S. Older Adults: How Good is Grip Strength?

Grip strength is commonly used to assess hand function in older adults and is associated with health outcomes including muscle strength, cognition, and mortality. However, the degree to which grip strength predicts an actual hand limitation is unknown. This study evaluated grip strength as a predictor of hand limitations associated with activities of daily living. Using the 2011-14 National Health and Nutrition Examination Survey (NHANES), we selected five self-reported hand-related functional limitations to classify older adults reporting one or more limitations versus those with no limitations. We identified 2,064 older adults (age≥65), 31% of whom reported a hand-related limitation. Odds ratios were used to assess the association between grip strength quartile and the likelihood of a hand limitation while controlling for sex, race/ethnicity, education level, income, and pain. Receiver operator curves were used to evaluate the degree to which grip strength discriminates between those with limitations versus those without. Older adults with very low grip strength (lowest quartile) were more likely to have at least one limitation (OR:6.1, 95% CI:3.2,11.8) than those with high grip strength (highest quartile). However, receiver operator curves suggested grip strength only modestly discriminated hand limitations (area under curve:0.71). While self-reported hand limitations were associated with lower grip strength, it was a relatively poor predictor of hand impairments among older adults. This study suggests grip strength may not predict hand function as well as previously thought. Better assessments are needed to adequately evaluate upper extremity impairments to help older adults maintain functional independence.

Disadvantaged Americans are suffering the brunt of rising pain and physical limitations.

Using data from three national surveys of US adults (one cohort and two cross-sectional studies, covering the period from the mid-1990s to the mid-2010s), we quantify the degree to which disparities by socioeconomic status (SES) in self-reported pain and physical limitations widened and explore whether they widened more in midlife than in later life. Unlike most prior studies that use proxy measures of SES (e.g., education), we use a multidimensional measure of SES that enables us to evaluate changes over time in each outcome for fixed percentiles of the population, thereby avoiding the problem of lagged selection bias. Results across multiple datasets demonstrate that socioeconomic disparities in pain and physical limitations consistently widened since the late 1990s, and if anything, widened even more in midlife than in late life (above 75). For those aged 50-74, the SES disparities in most outcomes widened by more than 50% and in some cases, the SES gap more than doubled. In contrast, the magnitude of SES widening was much smaller above age 75 and, in the vast majority of cases, not significant. Pain prevalence increased at all levels of SES, but disadvantaged Americans suffered the largest increases. Physical function deteriorated for those with low SES, but there was little change and perhaps improvement among the most advantaged Americans. At the 10th percentile of SES, the predicted percentage with a physical limitation at age 50 increased by 6-10 points between the late-1990s and the 2010s, whereas at the 90th percentile of SES, there was no change in two surveys and in the third survey, the corresponding percentage declined from 31% in 1996-99 to 22% in 2016-18. The worst-off Americans are being left behind in a sea of pain and physical infirmity, which may have dire consequences for their quality of life and for society as a whole (e.g., lost productivity, public costs).

Testing Black-White Disparities in Biological Aging Among Older Adults in the United States: Analysis of DNA-Methylation and Blood-Chemistry Methods.

Biological aging is a proposed mechanism through which social determinants drive health disparities. We conducted proof-of-concept testing of 8 DNA-methylation (DNAm) and blood-chemistry quantifications of biological aging as mediators of disparities in healthspan between Black and White participants in the 2016 wave of the Health and Retirement Study (n = 9,005). We quantified biological aging from 4 DNAm "clocks" (Horvath, Hannum, PhenoAge, and GrimAge clock), a DNAm pace-of-aging measure (DunedinPoAm), and 3 blood-chemistry measures (PhenoAge, Klemera-Doubal method biological age, and homeostatic dysregulation). We quantified Black-White disparities in healthspan from cross-sectional and longitudinal data on physical performance tests, self-reported limitations in activities of daily living, and physician-diagnosed chronic diseases, self-rated health, and survival. DNAm and blood-chemistry quantifications of biological aging were moderately correlated (Pearson's r = 0.1-0.4). The GrimAge clock, DunedinPoAm, and all 3 blood-chemistry measures were associated with healthspan characteristics (e.g., mortality effect-size hazard ratios were 1.71-2.32 per standard deviation of biological aging) and showed evidence of more advanced/faster biological aging in Black participants than in White participants (Cohen's d = 0.4-0.5). These measures accounted for 13%-95% of Black-White differences in healthspan-related characteristics. Findings suggest that reducing disparities in biological aging can contribute to building health equity.

Discordance between family report and clinical assessment of suicide attempts: a prospective study from the emergency department

BackgroundDeveloping accurate identification methods for individuals with suicide attempts and providing them with follow-up care and supports can be a vital component of all comprehensive suicide prevention strategies. However, because...

Driver social desirability scale: A Turkish adaptation and examination in the driving context

Self-report data collection methods are widely used techniques to gather information in studies related to road safety. One of the most considerable limitations of self-reports is social desirability bias. One way to overcome the possible detrimental effects of socially desirable responding is to control it by using social desirability scales. With respect to that, the present study aims to adapt the Driver Social Desirability Scale into Turkish, examine its construct validity, and investigate the relationship between social desirability and driving-related measures. A total of 351 drivers between the ages of 19 and 59 completed a questionnaire including a demographic information form, the Driver Behavior Questionnaire (DBQ), the Driver Skill Inventory (DSI), the Two-Dimensional Social Desirability Scale (SDS), and the Driver Social Desirability Scale (DSDS). Factor analysis supported the two-factor structure of the DSDS in the Turkish sample. Social desirability correlated positively with age and driving experience. Female drivers reported higher levels of driver impression management, while male drivers scored higher on self-deception. Driver impression management was associated negatively with violations and perceptual-motor skills and positively with safety skills. Lastly, driver self-deception was positively related to violations, positive driver behaviors, perceptual-motor skills, and safety skills. The study shows that the Turkish version of the DSDS is a reliable and structurally valid instrument with incremental validity compared to the general social desirability measure in predicting driving-related outcomes.

The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10–14-year-old adolescents with patellofemoral pain

ObjectiveTo test 1) if the 45-second Anterior Knee Pain Provocation Test (AKPP-test) could differentiate between adolescents with patellofemoral pain (PFP) and pain-free controls and; 2) whether improvements in the AKPP-test over 12 weeks were associated with improvements in self-reported knee function and pain. DesignProspective cohort. Patients151 with PFP and 50 pain-free controls (age 10–14 years). OutcomesThe AKPP-test was performed at baseline, 4- and 12-week follow-up. Pain and function were collected using Knee Injury and Osteoarthritis Outcome Score (KOOS). ResultsAt baseline, the AKPP-test provoked pain to a median of 5 points (IQR: 3–7) on the 0–10 Numeric Pain Rating Scale in adolescents with PFP, compared to 0 (IQR 0-0) in controls. Higher pain during the AKPP-test was associated with worse KOOS-Sport/Rec (r = −0.33, P < 0.001), worse KOOS-Pain (r = −0.47, P < 0.001), and pain intensity (worst pain last 24 hours) (r = −0.39, P < 0.001) at baseline. Improvements in the AKPP-test over 12 weeks were associated with improvements in KOOS Pain (r = 0.48, P < 0.001) and KOOS Sport/Rec (r = 0.40, P < 0.001). ConclusionsImprovements in the AKPP-test were associated with improvements in self-report knee pain and limitations in sports, suggesting the AKPP-test may be a clinically responsive test of knee pain and sporting function in adolescents with PFP.