Liv Inger Strand

The development of a Norwegian pain questionnaire

&NA; The study was undertaken to develop a multidimensional measuring instrument for pain in the Norwegian language. The McGill Pain Questionnaire (MPQ) was used as a model as it is a valid and reliable tool for pain measurement in English speaking countries. A series of steps were taken to develop a Norwegian pain questionnaire: (1) words describing pain were derived from 95 subjects (patients, students and health personnel); (2) 10 subjects allocated pain descriptors into groups; (3) 36 college student validated the word groupings; (4) 72 patients graded the words contained in each group according to intensity; and (5) the reliability of group items was tested. The study demonstrated that there are many descriptors of pain in the Norwegian language. The final version of the Norwegian pain questionnaire consisted of 106 pain descriptors divided into 18 groups. Validity of the classifications as well as reliability of the words was demonstrated. The actual value of the Norwegian pain questionnaire as a measuring instrument has not yet been documented.

Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy.

BackgroundThe effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks.MethodsA repeated measures design was applied with three baseline and two follow up assessments; immediately and three weeks after intervention. Twenty-two children with hemiplegia (n = 7), diplegia (n = 11), quadriplegia (n = 2) and ataxia (n = 2) participated, age ranging 3-9 y. All levels of Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were represented. Parents and professionals participated in goal setting and training. ANOVA was used to analyse change over repeated measures.ResultsA main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. An interaction between time and GMFCS-levels was found, implying that children classified to GMFCS-levels I-II improved more than children classified to levels III-V. There were no main or interaction effects of age or anti-spastic medication. Change scores in the Pediatric Evaluation of Disability Inventory (PEDI) ranged 2.0-6.7, p < 0.01 in the Self-care domain of the Functional Skills dimension, and the Self-care and Mobility domains of the Caregiver Assistance dimension. The childrens individual goals were on average attained, Mean Goal Attainment Scaling (GAS) T-score being 51.3. Non-significant improved scores on the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremities Skills Test (QUEST) were demonstrated. Significant improvement in GMPM scores were found in improved items of the GMFM, not in items that maintained the same score.ConclusionsBasic motor abilities and self-care improved in young children with CP after goal-directed activity-focused physiotherapy with involvement of their local environment, and their need for caregiver assistance in self-care and mobility decreased. The individualized training within a group context during a limited period of time was feasible and well-tolerated. The coherence between acquisition of basic motor abilities and quality of movement should be further examined.

Reliability and validity of the back performance scale: observing activity limitation in patients with back pain.

Study Design. A single group design to examine reliability and validity of the Back Performance Scale. Objectives: To examine intertester reliability, test-retest reliability, and concurrent validity of the Back Performance Scale. Summary of Background Data: The Back Performance Scale is a condition-specific performance measure of activity limitation in patients with back pain. It includes five tests of daily activities requiring mobility of the trunk: sock test, pick-up test, roll-up test, fingertip-to-floor test, and lift test. Discriminative ability and responsiveness to important change have previously been demonstrated. Methods. A total of 41 patients with back pain participated in the study. Two physiotherapists examined test performances concurrently, but independently. The patients filled in three questionnaires, two reflecting perceived disability (Der Funktionsfragenbogen Hannover, Roland-Morris Disability Questionnaire) as well as one for fear avoidance of daily activities and work (Fear Avoidance Belief Questionnaire). One physiotherapist retested the patients after 2 to 3 days. Results. Intertester agreement of the Back Performance Scale sum score was very high (intraclass correlation coefficient 2.1): 0.996. Within-patient standard deviation (sw) on the 16-point Back Performance Scale was very low: 0.25. Test-retest reliability was high (intraclass correlation coefficient = 0.91, sw = 1.3). Intertester agreement of the separate tests was also very high, ranging from κ= 0.90–1.00. Test-retest reliability was moderate to high (κ= 0.55–0.83). A high correlation was demonstrated between the Back Performance Scale and the Der Funktionsfragenbogen Hannover: Spearman rho (ρ) = 0.825, P < 0.01. Correlation between the Back Performance Scale and Roland-Morris Disability Questionnaire was moderate: ρ = 0.454, P < 0.01. No correlation was demonstrated between the Back Performance Scale and the Fear Avoidance Belief Questionnaire. Conclusion. The Back Performance Scale appears to be a reliable and valid outcome measure of activity limitation.

Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake

Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (kappa = 0.44-0.92, kappa = 0.10-0.76 and kappa = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra- and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.

The Impact of Physical Function and Pain on Work Status at 1-year Follow-up in Patients With Back Pain

Study Design. A randomized, controlled trial. Objective. To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. Summary of Background Data. Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. Methods. Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). Results. At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. Conclusions. Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

The MOBID‐2 pain scale: Reliability and responsiveness to pain in patients with dementia

Mobilization‐Observation‐Behavior‐Intensity‐Dementia‐2 (MOBID‐2) pain scale is a staff‐administered pain tool for patients with dementia. This study explores MOBID‐2s test–retest reliability, measurement error and responsiveness to change.

A modified version of the non-communicating children pain checklist-revised, adapted to adults with intellectual and developmental disabilities: sensitivity to pain and internal consistency.

UNLABELLED Despite enhanced interest in manifestations of pain in adults with intellectual and developmental disabilities (IDD), the characteristics of pain behavior in this group have seldom been examined. The aim of the present study was to provide a sensitive pain behavior scale for adults with IDD. The participants, 228 adults (mean age, 38.7 years) with different levels of IDD, were videotaped before and during an influenza vaccination and scored using the Non-Communicating Childrens Pain Checklist-Revised (NCCPC-R). Observed pain behaviors not captured by the NCCPC-R, was also registered. Sensitivity to pain of all 27 items was examined by Signed Rank test, internal consistency by Cronbachs alpha, and sensitivity to change of the total scale by Standardized Response Mean (SRM). Thirteen items were excluded from the original NCCPC-R scale; 4 new items were added, making a modified scale of 18 items. This scale, named the Non-Communicating Adults Pain Checklist-Revised (NCAPC), was rescored and examined for psychometric properties in a random sample (N = 89). Sensitivity to pain of all items (P < .05) and high internal consistency (alpha = 0.773) were demonstrated. Large sensitivity to pain at all levels of IDD was shown (SRM, 1.20 to 2.07). Better psychometric properties were demonstrated for NCAPC than NCCPC-R in the target population. PERSPECTIVE This article presents initial psychometric properties of a new measure, the NCAPC, evaluating pain behavior in adults with IDD. This measure could help clinicians to better capture pain expressions in this population and contribute to better pain management for this group of patients.

Observer reliability of the Gross Motor Performance Measure and the Quality of Upper Extremity Skills Test, based on video recordings.

The aim of this study was to examine observer reliability of the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremity Skills Test (QUEST) based on video clips. The tests were administered to 26 children with cerebral palsy (CP; 14 males, 12 females; range 2–13y, mean 7y 6mo), 24 with spastic CP, and two with dyskinesia. Respectively, five, six, five, four, and six children were classified in Gross Motor Function Classification System Levels I to V; and four, nine, five, five, and three children were classified in Manual Ability Classification System levels I to V. The childrens performances were recorded and edited. Two experienced paediatric physical therapists assessed the children from watching the video clips. Intraobserver and interobserver reliability values of the total scores were mostly high, intraclass correlation coefficient (ICC)1,1 varying from 0.69 to 0.97 with only one coefficient below 0.89. The ICCs of subscores varied from 0.36 to 0.95, finding‘Alignment’and‘Weight shift’in GMPM and‘Protective extension’in QUEST highly reliable. The subscores‘Dissociated movements’in GMPM and QUEST, and‘Grasp’in QUEST were the least reliable, and recommendations are made to increase reliability of these subscores. Video scoring was time consuming, but was found to offer many advantages; the possibility to review performance, to use special trained observers for scoring and less demanding assessment for the children.

Psychometric properties of the Vertigo symptom scale – Short form

BackgroundThe aim of the study was to examine the psychometric properties of the Vertigo symptom scale – short form (VSS-SF), a condition-specific measure of dizziness, following translation of the scale into Norwegian.MethodsA cross-sectional survey design was used to examine the factor structure, internal consistency and discriminative ability (sample I, n = 503). A cross-sectional pre-intervention design was used to examine the construct validity (sample II, n = 36) of the measure and a test-retest design was used to examine reliability (sub-sample of sample II, n = 28).ResultsThe scree plot indicated a two factor structure accounting respectively for 41% and 12% of the variance prior to rotation. The factors were related to vertigo-balance (VSS-V) and autonomic-anxiety (VSS-A). Twelve of the items loaded clearly on either of the two dimensions, while three items cross-loaded. Internal consistency of the VSS-SF was high (alpha = 0.90). Construct validity was indicated by correlation between path length registered by platform posturography and the VSS-V (r = 0.52), but not with the VSS-A. The ability to discriminate between dizzy and not dizzy patients was excellent for the VSS-SF and sub-dimension VSS-V (area under the curve 0.87 and 0.91, respectively), and acceptable for the sub-dimension VSS-A (area under the curve 0.77). High test-retest reliability was demonstrated (ICC VSS-SF: 0.88, VSS-V: 0.90, VSS-A: 0.90) and no systematic change was observed in the scores from test to retest after 2 days.ConclusionUsing a Norwegian translated version of the VSS-SF, this is the first study to provide evidence of the construct validity of this instrument demonstrating a stable two factor structure of the scale, and the identified sub-dimensions of dizziness were related to vertigo-balance and autonomic-anxiety, respectively. Evidence regarding a physical construct underlying the vertigo-balance sub-scale was provided. Satisfactory internal consistency was indicated, and the discriminative ability of the instruments was demonstrated. The instrument showed satisfactory test-retest reliability.

Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial.

Purpose: Treadmill training with body weight support (TTBWS) for relearning walking ability after brain damage is an approach under current investigation. Efficiency of this method beyond traditional training is lacking evidence, especially in patients needing walking assistance after stroke. The objective of this study was to investigate change in walking and transfer abilities, comparing TTBWS with traditional walking training. Methods: A single-blinded, randomized controlled trial was conducted. Sixty patients referred for multi-disciplinary primary rehabilitation were assigned into one of two intervention groups, one received 30 sessions of TTBWS plus traditional training, the other traditional training alone. Daily training was 1 hr. Outcome measures were Functional Ambulation Categories (FAC), Walking, Functional Independence Measure (FIM); shorter transfer and stairs, 10 m and 6-min walk tests. Results: Substantial improvements in walking and transfer were shown within both groups after 5 and 11 weeks of intervention. Overall no statistical significant differences were found between the groups, but 12 of 17 physical measures tended to show improvements in favour of the treadmill approach. Conclusions: Both training strategies provided significant improvements in the tested activities, suggesting that similar outcomes can be obtained in the two modalities by systematic, intensive and goal directed training. Implications for Rehabilitation Treadmill training with body weight support (TTBWS) and traditional gait training were found to be equally effective in improving walking and transfer in patients dependent on walking assistance after stroke. However, most outcome measures showed a tendency of improvement in favour of the treadmill group. Both training modalities were systematic, goal-directed and intensive, and the time used for training was the same. The choice between the two equally effective training alternatives should be based on the patients’ preference, and availability of equipment and resources.