Development and Psychometric Properties of A Screening Tool for Assessing Developmental Coordination Disorder in Adults

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder affecting motor coordination. Evidence suggests this disorder persists into adulthood and may be associated with biomechanical dysfunction and pain. We report on the development and initial validation of a questionnaire to assess for DCD in adults. Methods: An initial item pool (13 items) was derived from the American Psychiatric Association criteria and World Health Organisation definition for DCD. An expert panel assessed face and content validity which led to a 9-item Functional Difficulties Questionnaire (FDQ-9) with possible scores ranging from 9-36 (higher scores indicating greater functional difficulties). The FDQ-9 was piloted on individuals recruited from convenience samples. The underlying factor structure and aspects of reliability, validity and accuracy were tested. The Receiver Operating Characteristic Curve was employed to evaluate the diagnostic accuracy of the test using self-reported dyspraxia as the reference standard. Results: Principal Axis Factoring yielded a two factor solution relating to gross and fine motor skills; for conceptual parsimony these were combined. Internal reliability was high (0.81), the mean inter-item correlation was 0.51 and preliminary findings suggested satisfactory construct validity. The Area under the Curve was 0.918 [95% CI 0.84-1.00] indicating a diagnostic test with high accuracy. A cut-off score was established with a sensitivity and specificity of 86% [95% CI 78%-89%] and 81% [95 % CI 73%-89%] respectively. Test-retest reliability was good (ICC 0.96 [95% CI 0.92 to 0.98]. Conclusion: The psychometric properties of the FDQ-9 appear promising. Work is required to conduct further psychometric evaluations on new samples and apply the scale to clinical practice

Facilitating improvements in interprofessional pain management.

Pain is a global phenomenon in which it has been estimated that 20% of adults and 8% of children suffer from at any one time of whom 10% suffer chronic pain [1,2]. Pain is the leading reason for primary care consultations (80%) and musculoskeletal pain is the commonest reason for work absenteeism [3,4]. Pain is complex and there are aspects that require better recognition and understanding in order to improve its treatment and management.</p

Association Between Joint Hypermobility Syndrome and Developmental Coordination Disorder – A Review.

Introduction: The term joint hypermobility syndrome (JHS) was adopted after clinicians became aware of the myriad of symptoms associated with this multisystemic condition. JHS is an inherited disorder of connective tissues affecting the musculoskeletal and visceral systems which may contribute to a reduction in health related physical fitness. Pain associated with JHS may be influenced by hypermobility and biomechanical dysfunction. Biomechanical dysfunction observed in patients with JHS may be as a result of impaired motor control and in particular developmental coordination disorder (DCD). DCD (described in the literature utilising the terms clumsy child syndrome; perceptual motor dysfunction; dyspraxia) is a neurodevelopmental condition characterised by coordination difficulties affecting function. The objective of this review is to examine the association between hypermobility, JHS, motor control impairment and DCD. Methods and data sources: EMBASE, MEDLINE, CINAHL, ASSIA, PsychARTICLES, SPORTDiscus and PsycINFO from 1989 - 2009. Research articles written in English and peer reviewed were included. Results: Five research papers were identified. The studies employed a variety of methodologies and assessment tools for reporting joint hypermobility, JHS, motor delay, motor impairments and DCD. All five studies reported on children between the ages of six months and 12 years. Three out of four studies reported on association between impaired motor development, motor delay and joint hypermobility. There was no consensus as to whether motor delay, impaired motor development and joint hypermobility continued as the child matured. One study ascertained that children with JHS reported similar functional difficulties as children with DCD. Conclusion: There was a paucity of literature relating to an association between joint hypermobility, JHS, impaired motor control, motor delay and DCD in children, there was no literature pertaining to adults. This association requires further exploration if professionals are to understand, nurture and manage those reporting these associated conditions

High Prevalence of Hypermobility and Benign Joint Hypermobility Syndrome (BJHS) in Oman

PURPOSE: To ascertain the prevalence of hypermobility and BJHS in a female patient population with musculoskeletal pain and compare the associated features with a pain free control group. RELEVANCE: Hypermobility is linked with increased musculoskeletal signs and symptoms. The existence of hypermobility with pain may indicate the presence of BJHS, which is a heritable connective tissue disorder synonymous with Ehlers-Danlos type III. Hypermobility is known to be race dependant with Asians and Africans being more hypermobile than Caucasians. The fragility of tissues in those with BJHS makes them more vulnerable to pain associated with soft tissue overuse injuries, traumatic synovitis, sprains and recurrent shoulder dislocations (Grahame 2000; Grahame et al 1981; Finterbush and Pogund 1982) it is also associated with delayed tissue healing, impaired proprioception (Mallik et al 1994; Hall et al 1995) and chronic pain. (Harding and Grahame 1990) PARTICIPANTS: 94 Female Omani patients with musculoskeletal pain attending the rehabilitation department outpatient clinics of the Khoula Hospital aged 18–50 were examined. 90 controls of the same age were recruited from the female Omani hospital staff. METHODS: All patients and controls were examined and questioned by one physiotherapist (CC), who had received training from a rheumatologist (RG) in clinical examination of patients at the hypermobility clinic, University College Hospital, London. Patients and controls were examined using the Beighton score and Brighton Criteria. ANALYSIS: Analysis was by χ2 for number of individuals and t-test for joint mobility scores. (Excel® 2002) RESULTS: 51% of patients were found to be hypermobile as opposed to 30% of controls (p = 0.015). 55.3% of patients had features of BJHS as opposed to 21.1% of controls. (p ≤ 0.0001). Significantly more patients presenting with knee pain had BJHS (p = 0.02). There was a non-significant trend for patients with BJHS to re-attend the out patient clinics (p= 0.06). CONCLUSIONS: This study established that this patient population was significantly more hypermobile than a control population. The incidence of BJHS in patients in this study was higher than that noted amongst female Caucasians, but similar to non Caucasians attending rheumatological clinics in the UK. (Grahame and Hakim 2004). Further epidemiological studies are required in other populations to look at patient re-attendance in musculoskeletal clinics and more specifically for those presenting with back and knee pain. IMPLICATIONS: Better recognition and awareness of hypermobility and BJHS will enable patients to receive treatment programmes, modified to take into account tissue fragility, hypermobile joints, impaired proprioception and chronic pain. KEYWORDS: Hypermobility, Pain, Joints. FUNDING ACKNOWLEDGEMENTS: No funding. Jane Simmonds, UCL supervising team, Professor R. Grahame and Dr. A. Hakim from the Hypermobility clinic UCH, London, Professor H. Holmberg, Khoula Hospital Director, Samia Al Marjeby head of rehabilitation, the staff and patients of Khoula Hospital, Muscat, Oman. CONTACT: [email protected] ETHICS COMMITTEE: Khoula Hospital Ethics committee, Khoula Hospital, Muscat, Oman (12/11/2003

Exploring the multi-factorial manifestations of joint hypermobility syndrome and the impact on quality of life.

Introduction: Performing artistes have entertained audiences for thousands of years. Their repertoires require the integration of a well ‘tuned’ central nervous system and hypermobility. Hypermobility is a common phenomenon that is beneficial for some but not for others. This thesis discusses hypermobility associated with multisystemic symptoms referred to as Joint Hypermobility Syndrome (JHS). It is suggested that the multifactorial manifestations of the condition contribute to deconditioning thus impacting on the physical and mental well being of individuals with JHS. Purpose: To explore the multi-factorial manifestations of JHS including functional difficulties and their impact on quality of life. Methods: A two part study; part one, development of a questionnaire to assess for functional difficulties; part two, a mixed methods approach to explore aspects of JHS. Results: Principal Axis Factoring was employed to explore the structure of the 9-item Functional Difficulties Questionnaire (FDQ-9) to assess functional difficulties reported in childhood and adulthood. Internal consistency was high (0.81), correlations between items were > 0.5 and preliminary findings suggested satisfactory construct validity. Test-retest reliability was good (ICC 0.96 [95% CI 0.92 to 0.98]. Patients with JHS were 3 [95%CI 1.95 – 4.56] times more likely to report functional difficulties both as a child and as an adult than healthy volunteers. Patients with JHS were significantly more likely to report dislocations, autonomic nervous system, gastrointestinal and cardio-respiratory symptoms than healthy volunteers. Chronic widespread pain reported by 86% of patients with JHS was a significant predictor of quality of life using the SF-12. Patients with JHS had significantly lower physical component scores than healthy volunteers (29.2 [SD 10.6] and 54.5 [SD 5.7]) respectively. Conclusions The development of the FDQ-9 contributes to the understanding of the multi-factorial manifestations of JHS and their long term nature. These have important clinical implications as symptoms of JHS appear early in life. Management of this condition requires early recognition and an understanding of the multisystemic nature

Exploring joint hypermobility syndrome, developmental coordination disorder and pain

INTRODUCTION Floppy, clumsy, hypermobile children are increasingly referred to occupational and physical therapy under the label of dyspraxia. Motor impairments associated with the umbrella diagnosis of developmental coordination disorder (DCD) have been reported as persisting into adolescence and adulthood and subsequently affecting functional abilities (Cousins and Smyth 2003). Within this heterogeneous condition the underlying mechanisms causing the motor difficulties remains unclear. Ayers (1985) hypothesised that some individuals might have somatosensory processing issues contributing to their poor motor planning and coordination difficulties. Similarities in functional difficulties have been noted in children with a diagnosis of DCD and joint hypermobility syndrome (JHS) (Kirby and Davies 2006). There is limited understanding of the relationship between the two conditions. JHS is a multisystemic inherited connective tissue disorder, in which hypermobile joints, pain, clumsiness, poor proprioception and dislocations are familiar features (Grahame and Hakim 2006; Adib et al 2005). It has been suggested that adults with JHS show poor movement patterns which contribute to biomechanical dysfunction and continuing pain (Clark et al 2009). Pain and disability reported in adults with JHS often leads to anxiety, depression, work incapacity and social isolation (Grahame and Hakim 2006). The purpose of this study was to explore the association between adults with JHS and DCD and long term pain. METHODOLOGY/ METHODS A mixed methods design influenced by a pragmatic paradigm was utilised. Subjects: 90 patients with JHS (18-65 years) recruited from a hypermobility clinic were compared, using a questionnaire, with 113 healthy volunteers (18-65 years) with no pain recruited from a university. Analysis: Quantitative data were described and examined by regression, odds ratios were calculated. Qualitative data was analysed thematically FINDINGS The percentage of subjects who reported DCD in patients with JHS and healthy volunteers were 56% and 19% respectively. A significant association between patients with JHS and DCD was noted, chi square = 30.11, p < .001. Patients with JHS were 6 times [95% CI 2.9 – 10.3] more likely to report DCD than healthy volunteers. Pain was a significant feature with an average of 9.8 pain sites reported (out of a total of 17). Open ended questions revealed many patients recalling pain starting in early childhood and adolescence. DISCUSSION These results suggest a significant association between patients with JHS and DCD and the reporting of long term pain. Early recognition and understanding of the needs of children with DCD who present with somatosensory impairment, pain modulation and JHS is therefore essential. Sensory integration therapy as part of a comprehensive early intervention program has the potential to mitigate long term problems. A multidisciplinary approach which involves health professionals and teachers is also recommended. CONCLUSION This research may be considered an early step in the identification of an association of DCD and JHS. Further studies are required to explore somatosensory processing issues experienced by those with DCD and JHS as this might be an important underlying mechanism

Does assisted cycling improve function in those with Parkinson’s disease?

Background: Functional decline is a cardinal sign of Parkinson’s disease (PD), a neurodegenerative disease that affects 1% of individuals over the age of 60. Physical symptoms have a detrimental effect on activities of daily living and quality of life. High intensity exercise has enhanced neuroplasticity and reduced the rate of dopaminergic cell loss in animal studies. One form of high intensity exercise is assisted cycling, which has been shown to be effective for those with other neurological disorders. There is no consensus as to the efficacy in those with PD. Objective: To explore the efficacy of assisted cycling in improving motor function in people with PD. Method: A systematic search of PsycINFO, ScienceDirect, SPORTDiscus, CINAHL, arXiv, MEDLINE and Web of Science was conducted, including articles from January 2003 to October 2016. Studies were assessed for quality using a critical appraisal tool. No articles were excluded due to quality. Results: Seven studies were included in this review, with a total sample of 179 participants with a diagnosis of PD. Four studies were randomised control trials, the others included two case control trials, and a single-subject design trial. The level of cycle assistance, length of intervention and sessions varied between studies. All interventions showed improvements in motor function, with a greater effect on those with more advanced PD. Conclusion: There is moderate evidence to show the efficacy of assisted cycling in improving global motor function in individuals with PD. Future research is required to determine optimum assisted cycling interventions in terms of frequency, duration of sessions and length. The long-term effects of assisted cycling should also be explored in future research

Adherence to community based group exercise interventions for older people: A mixed-methods systematic review.

OBJECTIVE: Lifelong physical activity provides some of the best prospects for ageing well. Nevertheless, people tend to become less physically active as they age. This systematic review assessed the views and adherence of participants attending community based exercise programmes of ≥6month's duration. METHOD: Searches were carried out in eight online scientific databases (January 1995-May 2014) to identify relevant primary studies. Studies were assessed for quality and data extracted. Results were synthesised thematically and narratively. Qualitative findings were compared against quantitative studies. RESULTS: A total of 2958 studies were identified and screened against the inclusion/exclusion criteria. Ten studies met the inclusion criteria (five quantitative, three qualitative and two mixed-methods study designs). None were excluded on the basis of quality. Six key themes were identified from the qualitative studies as important for adherence to group exercise programmes: social connectedness, participant perceived benefits, programme design, empowering/energising effects, instructor and individual behaviour. The mean adherence rate of studies with comparable measures was (69.1% SD 14.6). When the views of participants from the qualitative synthesis were juxtaposed against the quantitative studies, programme design was a common feature across all studies. CONCLUSION: Evidence surrounding these programmes is limited both in terms of long-term adherence measures and the views of participants. However, based on limited findings there is some indication that community based group exercise programmes have long-term adherence rates of almost 70%. Incorporating the views of older people into programme designs may provide guidance for innovative interventions leading to sustained adherence

Abstract: Pain poses a significant health burden in those with Joint Hypermobility Syndrome

Background Joint hypermobility Syndrome (JHS) is a complex multisystemic connective tissue disorder. JHS is acknowledged as a common clinical entity in musculoskeletal medicine with a prevalence of between 30%-60% in those presenting with musculoskeletal pain. It is more prevalent in females than males may present in childhood and shares symptom overlap with Ehlers-Danlos Syndrome, Marfan Syndrome and Ostegenesis Imperfecta. Patients with JHS report a variety of symptoms associated with this condition. These symptoms include: chronic pain, dislocations, impaired coordination, autonomic nervous system (ANS) and Gastrointestinal (GI) symptoms. Aims The purpose of this study was to investigate the health burden in those with JHS and to understand which symptoms are considered to be most troublesome. Methods A sample of 89 patients with JHS (mean age 34.6 ± 9.9 years, 82 female), diagnosed by a consultant rheumatologist according to the Brighton Criteria were compared with 113 healthy volunteers (mean age 35.7 ± 12.9, 82 female) with no musculoskeletal pain. Information relating to dislocations, ANS, GI symptoms and impaired coordination was collected by means of a self-report questionnaire. Data relating to the reporting of pain for >3 months was collected on a pain chart and the SF-12 was employed for assessing quality of life. SF-12 data is reported as Physical Component Summary (PCS) scores and Mental Component Summary (MCS) Scores. A difference in either the PCS or MCS scores of 5 points is considered to be a clinically important difference. Numerical data were analysed using independent sample t-tests and regression analysis. Results Patients with JHS reported significantly lower mean PCS scores (M = 29.70 SD 10.63) than healthy volunteers (M = 54.45 SD 5.74), t (127.701) = 19.81, p<0.001 (2-tailed). The mean difference was 24.75 points [95%CI 22.44 - 27.06] - a statistically significant and clinically important difference. Patients with JHS were significantly more likely to report the following than healthy volunteers; subluxations/dislocations, GI and ANS symptoms and impaired coordination. The average number of pain sites reported was 10/17. Regression analysis of the reported symptoms revealed the number of pain sites as the only significant predictor of a lowered PCS score (p< 0.01) in a model explaining 23% of the variance. MCS scores of patients with JHS (M = 41.13 SD 11.60) were significantly lower than those of healthy volunteers (M = 45.64 SD 10.95), t (200) = 2.65, p<0.01. The mean difference was <5 points - this might not be clinically important. Conclusion Patients with JHS in this study reported a statistically significant reduction in both PCS and MCS scores compared with healthy volunteers. The large difference in PCS scores is likely to be clinically important. Although multisystemic symptoms were reported multisite pain was the only symptom which contributed significantly to a lowered PCS score of the SF-12. This study high lights the health and personal burden of those with JHS and the importance of recognising and understanding the contribution of multisite pain in this population

Using Goodwill Impairment To Effect Earnings Management During SFAS No. 142s Year Of Adoption And Later

Prior research (Bens and Heltzer, 2004) shows that the market penalizes firms less for reporting goodwill write-downs below-the-line than it does for presenting them above-the-line.  Only in 2002, the year SFAS No. 142 became effective, did goodwill impairments enjoy below-the-line treatment.  The current research provides evidence that firms “cherry picked” this year to recognize large impairment losses, thus removing much of the burden from future years when these losses otherwise would have been reported above-the-line.  The study also indicates that, even though the number of firms taking goodwill write-offs declined subsequent to 2002, those entities that did so seemed to be taking these discretionary hits because earnings were already depressed in the current year.  As such, the big bath earnings management observed in the year of adoption in previous studies (Jordan and Clark, 2004 and 2005) appears to continue even though these impairment losses no longer receive favorable below-the-line treatment