Development of reference values for the Functional Mobility Assessment

Mobility, functionality and functional mobility: A review and application for canine veterinary patients

Mobility is an essential aspect of a dog's daily life. It is defined as the ability to move freely and easily and deviations from an animals' normal mobility capabilities are often an indicator of disease, injury or pain. When a dog's mobility is compromised, often functionality (ability to perform activities of daily living [ADL]), is also impeded, which can diminish an animal's quality of life. Given this, it is necessary to understand the extent to which conditions impact a dog's physiological ability to move around their environment to carry out ADL, a concept termed functional mobility. In contrast to human medicine, validated measures of canine functional mobility are currently limited. The aim of this review is to summarise the extent to which canine mobility and functionality are associated with various diseases and how mobility and functional mobility are currently assessed within veterinary medicine. Future work should focus on developing a standardised method of assessing functional mobility in dogs, which can contextualise how a wide range of conditions impact a dog's daily life. However, for a true functional mobility assessment to be developed, a greater understanding of what activities dogs do on a daily basis and movements underpinning these activities must first be established.

Physical capacity in children and adolescents with newly diagnosed cancer: A systematic review and meta-analysis

OBJECTIVE

To review the body of evidence on cardiorespiratory fitness, muscle strength, and physical performance in children with newly diagnosed cancer, five databases (MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science) were searched on December 19, 2022.

METHODS

Thirteen studies, embodying 594 participants within 1 month of cancer diagnosis and 3674 healthy controls were included. Eighteen different outcomes on cardiorespiratory fitness (n = 2), muscle strength (n = 5), physical performance (n = 10), and adverse events (n = 1) were analyzed.

RESULTS

Fifteen out of 17 outcomes on physical capacity showed severe impairments compared with healthy controls. Where possible, random-effects meta-analysis was conducted to synthesize the results. No adverse events were reported related to testing.

CONCLUSION

Children with cancer have impaired cardiorespiratory fitness, muscle strength, and physical performance within the first month after diagnosis. However, the evidence is based on a small number of studies with large clinical heterogeneity, limiting the certainty of evidence.

Quantifying muscle strength, size, and neuromuscular activation in adolescent and young adult survivors of musculoskeletal sarcoma: Identifying correlates and responses to functional strengthening

BACKGROUND

Medical and surgical treatment for musculoskeletal sarcoma (MSS) place survivors at risk for impairments in muscle properties including muscle strength, muscle size, and neuromuscular activation. The purpose of this study was to explore muscle properties, gross motor performance, and quality of life (QoL) and the changes in response to a 6-week functional strengthening intervention (PT-STRONG) in MSS survivors of childhood cancer (CCS).

METHODS

Eight lower extremity MSS CCS (13-23 years old) performed baseline testing and three completed PT-STRONG. Participants completed measurements of knee extension strength using handheld dynamometry, vastus lateralis (VL) and rectus femoris (RF) muscle thickness using ultrasonography at rest, and neuromuscular activation using electromyography during strength testing and a step-up task. Participants also completed gross motor and QoL assessments.

RESULTS

Compared with the non-surgical limb, MSS CCS had lower surgical limb knee extension strength, VL muscle thickness, and RF step-up muscle rate of activation (RoA). Compared with normative values, MSS CCS had decreased bilateral knee extension strength, gross motor performance, and physical QoL. Positive correlations among muscle strength, muscle thickness, and gross motor performance were identified. After PT-STRONG, MSS CCS had improvements in VL muscle thickness, VL and RF RoA duing step-up, gross motor performance, and physical QoL.

CONCLUSIONS

Positive association between larger muscle thickness with greater knee extension strength, and higher knee extension strength with better gross motor performance indicate that comprehensive physical therapy assessment and interventions that identify and target impairments in muscle properties to guide clinical decision making should be considered for MSS CCS into survivorship.

Physical Fitness-Not Physical Activity Levels-Influence Quality of Life in Anorexia Nervosa

Background: Incorporating physical activity (PA) has been a challenge for health care professionals working with anorexia nervosa (AN) patients. This has contributed to partial physical fitness (PFit) recovery that persists after weight restoration. Objective: This cross-sectional study aimed to examine the relationships between PA, sedentary behaviors, PFit, and quality of life (QoL) in a group of adolescents after hospitalization. Methods: QoL, PA, and sedentary behaviors were measured using the Health-Questionnaire Short-Form 36 (SF-36) and accelerometers, while PFit was assessed through cardiorespiratory fitness, body composition (anthropometry), and strength (six repetition maximum) tests in a total of 63 patients. Results: Light-PA (LPA), moderate-PA (MPA), moderate-to-vigorous-PA (MVPA), and relative sedentary time (%ST) did not meet the recommendations (p < 0.001). Only 22% of the patients met MVPA criteria, and ~82% exceeded %ST. SF-36 scores were lower than normative values except the physical component scale. Absolute cardiorespiratory fitness was reduced (p < 0.001) in 84% of the patients, and was positively associated to body weight, body mass index (BMI), circumferences, and muscle areas. Additional positive significant relationships were found between QoL, muscular strength, and body composition, and negative associations between vigorous-to-very vigorous PA and BMI, skinfolds, and percent body fat. Regression analyses revealed lower body strength as an explanatory factor for improved QoL (OR 1.03, 95%CI 1.00−1.07). Conclusions: PFit and QoL scores are poor after hospitalization. LPA, MPA, and MVPA do not meet recommendations. PFit management—with emphasis on improving muscular fitness—may be a valuable strategy for QoL improvement in AN after hospitalization.

Reference values for the Modified Timed Up and Go Test in Saudi children aged 4-12 years old in Riyadh city: cross-sectional study

PURPOSE

The study aimed to report within-session reliability, estimate the reference values for the Modified Timed Up and Go (mTUG) test in typically developing (TD) Saudi children aged 4-12 years old, develop a reference equation for the estimated mTUG, and compare the measured mTUG in the present study with the predicted mTUG obtained from the previous regression equation.

METHODS

In this cross-sectional observational study, anthropometric measurements and mTUG test were investigated in 805 child. The association between the mTUG test and predictive variables was studied.

RESULTS

Average mTUG speed was 4.63 ± 0.68 s. Within-session reliability was excellent with intraclass correlation coefficient of 0.90. The test was significantly and negatively correlated with age, height, and weight (r = -0.66, p = .00), (r = -0.54, p = .01), and (r = -0.33, p = .01) respectively. According to the stepwise regression analysis, age and weight were the predictors and explained 47% of total variance of mTUG scores.

CONCLUSION

This study provided the mTUG reference values that can be used clinically to evaluate functional mobility and dynamic balance in TD Saudi children aged 4-12 years. The mTUG scores can be predicted as a function of age and weight.KEY MESSAGESModified Timed Up and Go test used to assess the functional mobility and dynamic balance for children with or without developmental abnormalities.Availability of reference values according to age is helpful to compare the performance of children at same ages.

Development of stratified normative data and reference equations for the timed up and down stairs test for healthy children 6-14 years of age

OBJECTIVES

To generate normative data on healthy children aged 6-14 years for the timed up and down stairs (TUDS) test, and to provide reference equations.

DESIGN AND SETTING

Cross-sectional study at two primary schools.

PARTICIPANTS

Healthy children 6-14 years of age.

MAIN OUTCOMES MEASURES

Anthropometric data and Minnesota Leisure-Time Physical Activity Questionnaire from children were collected before the start of the TUDS test. Heart rate, blood pressure and perceived exertion were measured at the beginning and at the end of the test. Two trials of the TUDS test were performed with 15-minute of rest on the same day and the better of the two trials was used in the analyses. The reference equations were established using the anthropometric variables as possible predictors of the TUDS test.

RESULTS

Two hundred fifty eight children (125 boys and 133 girls) were assessed. The mean TUDS test score decreased significantly from 6 to 14 years of age in boys and girls alike, with statistically significant differences between the three age range groups. A significant difference was found between girls and boys in TUDS test score. The 56% of the variation in TUDS test score could be explained by age, height, and weight in boys [TUDS_sec score=(9.967-(0.182×Age_years)+(0.025×Weight_kg)-(2.546×Height_m)], while 50% could be explained in girls [TUDS_sec score=10.553-(0.194×Age_years)+(0.019×Weight_kg)-(2.406×Height_m)]. The inclusion of physical level activity increased the variability explained (boys: 59%; girls: 51%).

CONCLUSIONS

TUDS score improved as the age of the children increased, with boys achieving better values than girls within each age group. TUDS test score can be easily predicted from age, height, and weight. The inclusion of the child's physical activity level increased the variance explained by the equation.

Physical Rehabilitation Practices for Children and Adolescents with Cancer in Canada

Purpose: Children and adolescents with cancer who undergo cancer treatment are at high risk of developing adverse effects, many of which may be amenable to physical rehabilitation. We aimed to identify the current clinical physical rehabilitation practice patterns, services, and programmes available for children and adolescents with cancer in Canada. Method: A cross-sectional survey in English and French was conducted. Participants were health care professionals (HCPs) who provided physical rehabilitation services to children and adolescents with cancer in Canada. The survey included questions on the HCPs' practice patterns and the programmes and services they provided. Results: A total of 35 HCPs responded: 27 physical therapists (77%), 6 occupational therapists (17%), 1 exercise professional (3%), and 1 speech-language pathologist (3%). Overall, they reported activity limitations, alterations in motor performance, muscle weakness, peripheral neuropathy, and fatigue as the top priorities for rehabilitation services. HCPs believed that interventions were valuable in reducing the burden of cancer effects; however, issues such as space, resources, and lack of clinical practice guidelines were viewed as barriers to providing services. Conclusions: Paediatric oncology rehabilitation services exist in some regions in Canada. HCPs strongly support the need to develop clinical practice guidelines for paediatric oncology rehabilitation.

Timed Up and Go: Reference Data for Children Who Are School Age

PURPOSE

To collect normative data for the Timed Up and Go (TUG) on a large, diverse sample of urban school children who are typically developing, accounting for age, sex, and body mass index.

METHODS

Physical therapists administered the TUG with natural walking speeds on 1481 children (M = 635, F = 846), ages 5 to 13 years representing 29.60% whites, 24.2% Asian/Pacific Islanders, 19.7% Latino/Hispanics, 16.3% African Americans, 1.40% Native American/Alaskans, and 8.80% other.

RESULTS

Average TUG speeds ranged from 6.20 to 7.12 seconds across all ages, with speeds decreasing from 5 to 9 years and increasing from 9 to 13 years. Differences between 8-, 9-, and 11-year-old males and females and across age groups did not exceed a clinically important threshold. Body mass index was not consistently correlated with TUG speed.

CONCLUSION

This study provides reference data on the TUG. These data should complement clinical observations and additional tests and measures to determine whether a student is functioning slower than age-matched peers.

Timed "Up & Go" test in children and adolescents

OBJECTIVE

To evaluate, by a literature review, the Timed "Up & Go" (TUG) test use and its main methodological aspects in children and adolescents.

DATA SOURCES

The searches were performed in the following databases: PubMed, CINAHL, Web of Science, SciELO and Cochrane Library, from April to July 2012. Studies published from 1990 to 2012 using the terms in Portuguese and English "Timed "Up & Go", "test", "balance", "child", and "adolescent" were selected. The results were divided into categories: general characteristics of the studies, population, test implementation METHODS, interpretation of results and associations with other measurements.

DATA SYNTHESIS

27 studies were analyzed in this review and most of them used the TUG test along with other outcome measures to assess functional mobility or balance. Three studies evaluated the TUG test in significant samples of children and adolescents with typical development, and the most studied specific diagnoses were cerebral palsy and traumatic brain injury. The absence of methodological standardization was noted, but one study proposed adaptations to the pediatric population. In children and adolescents with specific clinical diagnoses, the coefficient of within-session reliability was found to be high in most studies, as well as the intra and inter-examiner reliability, which characterizes the good reproducibility of the test.

CONCLUSIONS

The TUG test was shown to be a good tool to assess functional mobility in the pediatric population, presenting a good reproducibility and correlation with other assessment tools.

Normative values for the Timed 'Up and Go' test in children and adolescents and validation for individuals with Down syndrome

AIM

To determine normative values for the Timed Up and Go (TUG) test in typically developing children and adolescents and to validate its use in individuals with Down syndrome.

METHOD

Participants in this cross-sectional study were South Brazilian schoolchildren aged 3 to 18 years. In phase 1, 459 typically developing individuals (227 males, 232 females; mean age 10 y 8 mo (SD 4 y 4 mo) were included; and in phase 2, 40 individuals with Down syndrome (16 males, 24 females; mean age 10 y 6 mo (SD 4 y 4 mo). Anthropometric measurements, real leg length, TUG test scores, and Gross Motor Function Measure (GMFM) scores were evaluated. The association between the TUG test and possible predictive variables was analyzed.

RESULTS

In phase 1, the mean time to perform the TUG test was 5.61 seconds (SD 1.06). Values were stratified in age groups that served as normative data for both sexes. A multiple linear regression analysis was conducted and the best variables to predict TUG scores were age and weight. The best model obtained presented an R(2) of 0.25 and a standard error of the estimate of 0.92. Excellent intrasession reliability in the three tests performed (intraclass correlation coefficient [ICC] of 0.93, 0.94, and 0.95) and between the sessions (both with an ICC of 0.95) was demonstrated. In phase 2, the test also showed excellent reproducibility (ICC=0.82 between the two tests performed). The performance time was significantly longer (p<0.001) in individuals with Down syndrome compared with sex- age-, and weight-matched typically developing children with a mean difference of -3.53 (95% confidence interval -4.05 to -3.00). Dimension E of the GMFM (Walking, Running and Jumping) showed the highest correlation (r=-0.55, p<0.001) with the test.

INTERPRETATION

This study provides normative values for the TUG test and shows that TUG scores can be predicted as a function of age and weight in typically developing individuals. The test can also be used for assessment of functional mobility in individuals with Down syndrome.

Do childhood cancer survivors with physical performance limitations reach healthy activity levels?

BACKGROUND

The extent to which physical performance limitations affect the ability of childhood cancer survivors to reach healthy activity levels is unknown. Therefore this study aims to describe the effect of different types of limitations on activity levels in survivors.

PROCEDURE

Within the Swiss Childhood Cancer Survivor Study we sent a questionnaire to all survivors (≥16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976-2005 aged <16 years. We measured healthy activity levels using international guidelines and assessed different kinds of performance limitations (visual impairment, weight and endurance problems, cardiorespiratory, musculoskeletal, and neurological problems, pain and fatigue syndromes).

RESULTS

The sample included 1,560 survivors (75% response rate), of whom 209 (13.5%) reported they have performance limitations. Forty-two percent of survivors with limitations reached healthy activity levels, compared to 57% of survivors without limitations. Least active were survivors with vision impairments (25% active), weight and endurance problems (27.3%), cardiorespiratory problems (36.4%), and musculoskeletal problems (43.1%). After adjusting for socio-demographic variables and type of cancer, we found that survivors with limitations were 1.4 (95%CI 1.0-2.0; P = 0.047) times more likely to be inactive.

CONCLUSIONS

Although many survivors with physical performance limitations maintain healthy activity levels, there is room for improvement. Adapted and targeted physical activity counseling for survivors with performance limitations might help them to raise level of activity and pursue a healthy lifestyle.