Incidence and risk factors of hip joint pain in children with severe cerebral palsy

Purpose.?Pain is a serious complication associated with hip dislocation in cerebral palsy (CP), limiting patient independence and quality of life. This study aimed to determine the frequency of pain in severe CP patients with hip dislocation and to reveal factors associated with the hip pain.

Methods.?Seventy-three consecutive new-intervention CP patients admitted to authors' institution with spastic quadriplegia, mean age 10.8 years (range 4.0–18.0 years) were enrolled: 31 females and 42 males, totally 99 dislocated hips. All patients were assessed level IV or V according to the Gross Motor Function Classification Scale (GMFCS) and had poor communication skills. Pain severity was evaluated according to the Numeric Rating Scale (NRS-11). Data concerning previously applied physiotherapy was collected to divide the patients into subgroups: A – no abduction therapy (n == 24), B – abduction therapy (n == 35) and C – abduction therapy and horse-back riding (n == 13). On the pelvic antero-posterior radiographs head migration percentage was measured to reveal hip dislocation. Femoral head cartilage degenerative lesions were evaluated for size and location in 45 hips undergoing surgical treatment.

Results.?Overall pain prevalence was 56%%. The appearance of pain was associated with the patient age (p == 0.048), previous abduction physiotherapy (p < 0.00001), previous horse-back riding therapy (p < 0.00001) and anterior location of degenerative changes of the femoral head (p == 0.03). Pain intensity was related to the size of the degenerative cartilage lesions (p == 0.004) and to the degree of femoral anteversion (p < 0.0001).

Conclusions.?Extensive abduction exercises, hippotherapy and presence of degenerative cartilage lesions on the anterior part of femoral head may be considered risk factors for hip pain appearance in the dislocated hip of a child with severe spastic CP. Other associated factors are abduction exercise intensity, age, excessive femoral anteversion and size of degenerative cartilage lesions.     

Daily life consequences of hearing loss in the elderly

Purpose.?To assess the daily life consequences of hearing loss in older adults and to explore the influences of hearing loss, subjective assessment of health and general life satisfaction, gender, age and marital status.

Method.?Eighty-four participants, each older than 65 years, were consecutively recruited from a hospital waiting list for outpatient hearing aid fitting. All participants were assessed by pure-tone audiometry. Daily life consequences of hearing loss were measured using the Hearing Disability and Handicap Scale, which assesses perceived activity limitation and participation restriction. Another questionnaire was used to measure self-assessed health and life satisfaction.

Results.?Adjusted linear regression analysis showed that activity limitation was significantly associated with increased hearing loss (p == 0.028) and decreased health (p == 0.009), and participation restriction with lower estimated life satisfaction (p ≤ 0.001). Gender, age and marital status were not determinant factors for perceived activity limitation or participation restriction.

Conclusions.?Daily life consequences of hearing loss, health conditions and general life satisfaction are closely related. These findings indicate that health factors and psychosocial aspects should be emphasised as a natural part of audiological rehabilitation.     

Perceptions of family participation among parents of children with cerebral palsy followed from infancy to toddler hood

Background.?Little is known about the way parents of children with cerebral palsy (CP) perceive their involvement in family and personal life situations, also called ‘family participation’.

Purpose.?To investigate the perception of family participation among parents of preschool children with CP.

Method.?Semi-structured interviews were used to describe how parents (n = 53) of children with CP (aged 18 months) perceive participation with respect to family activities and their personal activities. In addition, using a combined score of family and personal activities, we investigated the changes of parental (n = 36) perceived family participation over time (followed from 18 months onwards until 42 months of age).

Results.?At the child's age of 18 months, a substantial percentage of parents expressed a feeling of being restricted in their family activities (45%) or personal activities (53%). The longitudinal data show that over the 24-month follow-up significant more parents perceived to be restricted in family participation (p = 0.008; Cochran's Q test).

Conclusions.?A child with CP in a family may lead to parents perceiving restrictions in family participation. These restrictions arise early in the life of a child with CP and may become more prominent as the child grows older.     

Are satisfaction with and self-management of personal assistance services associated with the life satisfaction of persons with physical disabilities??

Purpose.?To examine the relationships between satisfaction with and self-management of personal assistance services ((PAS)) and the quality of life ((QoL)) of persons with disabilities. To test the postulate that consumer-directed PAS can fulfil the human need for control and contribute to a satisfactory life.

Method.?A survey compared the perspectives of persons using consumer-directed PAS versus those using agency-directed. A Personal Data Form obtained demographics and PAS characteristics. The Quality of Life Inventory measured life satisfaction. A PAS questionnaire measured perceptions about the management of, desire for control of, and satisfaction with PAS. Data were analysed using SPSS®? 14.

Results.?Significant relationships were found between QoL and satisfaction with PAS ((p < 0.001)) and between perceived control of PAS and satisfaction with PAS ((p < 0.001)). Significant group differences were also found. Consumer-directed participants reported higher satisfaction with their PAS ((p < 0.01)), greater control over services ((p < 0.001)) and greater QoL than agency-directed participants, ((p == 0.001)).

Conclusions.?The relationships found between self-management, PAS satisfaction, and QoL support the value of consumer-directed programmes. Rehabilitation professionals can use this knowledge to develop, implement and research practises that enable self-management.     

Patients' experience post-lumbar fusion regarding back problems,recovery and expectations in terms of the international classification of functioning,disability and health

Purpose.?To describe within the context of the International Classification of Functioning, Disability and Health ((ICF)), patient's experiences post-lumber fusion regarding back problems, recovery and expectations of rehabilitation and to contrast with the content of outcome measures and the ICF low back pain ((LBP)) core sets.

Methods.?The study has a cross-sectional and retrospective design and involves 20 lumbar fusion patients. Using the ICF, qualitative content analysis of semi-structured interviews 3–6 months post-surgery was performed. This was compared with the ICF related content of the Oswestry Disability Index ((ODI)), Medical Outcome Study Short Form 36 ((SF-36)), European Quality of Life Questionnaire ((EQ5D)) and the ICF LBP core sets.

Results.?Patient's experiences were most frequently linked to psychological, sensory, neuromusculoskeletal and movement related body function chapters of the ICF. The most frequently linked categories of activity and participation were mobility, domestic activities, family relationships, work, recreation and leisure. Environmental factors frequently linked were the use of analgesics, walking aids, family support, social security systems, health care systems and labour market employment services.

Conclusions.?This study highlights important ICF related aspects of patient's experiences post-lumber fusion. The use of the comprehensive ICF core sets is recommended in conjunction with ODI, SF-36 and the EQ5D for a broader analysis of patient outcomes post-lumbar fusion.     

Understanding physical factors associated with participation in community ambulation following stroke

Purpose.?This study examined the association between impaired physical function and participation in community ambulation following stroke. We hypothesised that participation would be significantly less following stroke, and that physical impairments would be associated with participation.

Method.?Using a case–control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation (number of trips and walking-related activities (WRA) reported prospectively over a 12-day period). The association of physical impairments (strength, range of motion, sensation, muscle tone, vision, and activity limitations (gait speed and performance on complex walking tasks)) with level of participation was analysed using negative binomial regression and goodness of fit.

Results.?Participants included 30 individuals with and 30 without stroke, average age 68 years, majority were Caucasian women. Average time since stroke was 40 months. Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction (p < 0.001). Usual gait speed, balance, muscle strength and muscle length were impaired (p < 0.001) in stroke vs. controls, and associated with number of trips and WRA (p < 0.05). However, these factors explained less than very little of the variance in participation.

Conclusions.?While individual factors were associated with level of participation, results failed to accurately predict participation in community ambulation following stroke. Other factors, such as depression, cognition and self-efficacy may be stronger determinants of participation.     

Participation of the elderly after vision loss

Purpose.?To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data.

Method.?This cross-sectional study included visually impaired elderly persons (≥55 years; n?=?173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions.

Results.?Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%).

Conclusions.?Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.     

Spirituality and the International Classification of Functioning,Disability and Health: content comparison of questionnaires measuring mindfulness based on the International Classification of Functioning

Purpose.?To identify and compare the concepts contained in questionnaires measuring mindfulness using the International Classification of Functioning (ICF) as external reference.

Method.?Questionnaires which are published in peer-reviewed journals and listed in Pubmed or PsycInfo were included. The questionnaires were analysed and, using a content-analytical approach, the respective items were categorised and linked to the ICF.

Results.?Ten questionnaires were included. Ninety-four per cent (N == 341) of the concepts could be linked to 37 different ICF categories. One hundred and seventy-one (50.1%%) concepts were linked to ICF categories of the component Body Function, 74 (21.7%%) to categories of the component Activity and Participation and none to categories of the component Environmental Factors. In total, 28.2%% of the linked concepts belonged to Personal factors, which are not yet classified in the ICF. The questionnaires exhibited considerable differences regarding content density (i.e. the average number of concepts per item) and content diversity (i.e. the number of ICF categories per concept).

Conclusions.?The ICF provides an useful external reference to identify and compare the concepts contained in mindfulness questionnaires. Also, mindfulness questionnaire concepts suggest potentially useful factors for classification within the ICF.     

Translation and validation of Chinese version of International Knee Documentation Committee Subjective Knee Form

Purpose.?To translate, cross-culturally adapt and validate the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF-C) to Chinese.

Method.?Forward and backward translations were conducted by two bilingual professional translators. Content validity was verified by a panel of a senior orthopaedic surgeon and six physiotherapists. The IKDC-SKF-C was tested on 84 patients. Psychometric testing included internal consistency (Cronbach's α) and test–retest reliability. Convergent validity used Spearman's correlation coefficient (rho) tests by comparing its score with the Chinese version of SF-36.

Results.?The Internal consistency was excellent with Cronbach's α == 0.97. Test-retest reliability was supported with an ICC == 0.87. The IKDC-SKF-C was moderately related to concurrent measures of physical function and bodily pain (r == 0.64, p <0.05).

Conclusion.?The translated Chinese IKDC-SKF is a reliable and valid tool with equal measurement properties and conceptual equivalent to the original version.     

Effectiveness and expectations of intensive training: A comparison between child and youth rehabilitation and conductive education

Objective.?To compare the effectiveness of two intensive training-programmes from a professional and parent perspective. To describe and compare the type of expectations of the two intensive training programmes with the self-reported individualized goals.

Design.?Quasi-experimental with two groups.

Setting and intervention.?Traditional health care and conductive education.

Patients and their parents.?Fifty-four children with cerebral palsy, 3–16 years old.

Methods.?Data included a self-reported individualized goal measure (SRIGM), before and after the ITP. Individualized goals were classified according to the International Classification of Functioning (ICF). Clinical measures (CM) included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory—Functional Skills (PEDI-FS).

Results.?Twenty-eight parents out of 54 perceived a clinically significant improvement on the SRIGM with no significant difference between the training programmes. Most individualized goals were formulated in the domain of Mobility (115 out of 248) and Neuromusculoskeletal and movement-related functions (64 out of 248 goals) of ICF in both training programmes. There was no difference in the proportion of improvement measured with SRIGM compared to the CM, if an improvement in any dimension in GMFM or domain in PEDI FS was counted.

Conclusion.?There were no major differences in outcome and expectations between the training programmes. Parents' expectations were mainly directed towards improvement in prerequisites of motor function and mobility skills. The SRIGM confirmed the outcome on the CM.     

Examining changes in self-perceived quality of life in children and adolescents with physical disability using a longitudinal design

Purpose.?The study aimed to investigate the changes in self-perceived quality of life (QOL) of children and adolescents with physical disability (PD).

Method.?Two hundred students aged 10–18 with PD were recruited from primary and high schools in Taiwan to participate in this longitudinal study. The Student Version of the Comprehensive Quality of Life Scale (COMQOL-S) was used to measure self-perceived QOL, which was recorded at baseline, and 6, 12 and 18 months post-baseline. Statistically, linear mixed models were used to compare the QOL scores among the four time points.

Results.?At the second, third and fourth visit, 192, 151 and 128 participants completed COMQOL-S, respectively. Significant changes over time were found in overall objective and subjective OQL scores (slope == 0.8, p == 0.002 and slope == ?1.3, p < 0.001, respectively). Specifically, significant reductions of the subjective QOL scores over the period of the four visits were observed in five domains, namely, Productivity (slope == ?1.7, p == 0.005), Intimacy (slope == ?1.6, p == 0.004), Safety (slope == ?1.6, p == 0.008), Place in community (slope == ?1.4, p == 0.019) and Emotional wellbeing (slope == ?2.5, p < 0.001). Age was negatively correlated with the change of overall subjective score. Positive correlation was found between the change in mean objective scores and mean subjective scores in the Intimacy and Productivity domains.

Conclusions.?Even though the conditions of material wellbeing and health can be kept steady, the overall QOL of children and adolescents with PD could still decline over time. This might be attributable to the fact that social life becomes more sophisticated when children become older.     

Use of the International Classification of Functioning,Disability and Health to identify preliminary comprehensive and brief core sets for Guillain Barre syndrome

Purpose.?To identify the preliminary comprehensive and brief core sets for Guillain Barre syndrome (GBS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).

Method.?Focus groups and a consensus process were used to identify ICF core sets for GBS. This included: preliminary ICF studies; empirical patient data collection for 77 GBS participants; review of the evidence base and treatment in GBS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.

Results.?The expert consensus selected 99 second level ICF categories (in three rounds) which identify health domains relevant to GBS for multidisciplinary assessment. These domains were consistent with current practice and existing GBS literature. The comprehensive core set includes: 27 (23%%) categories from the component ‘body function’, 7 (12%%) categories from ‘body structures’, 43 (36%%) from ‘activities and participation’ and 22 (29%%) from the component ‘environmental’ factors. The brief set comprised 20 categories, 20%% of categories in the comprehensive core set.

Conclusion.?The core set categories for GBS-related health need to be addressed in multidisciplinary care programs. Future clinical ‘rating’ of this set may facilitate scale development using the ICF in GBS. Further research is needed to confirm the generalisability of this set in clinical settings.     

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in Greek community-dwelling older adults

Purpose.?The cross-cultural adaptation and validation of Falls Efficacy Scale-International (FES-I) in community-dwelling seniors in Greece.

Method.?For cross-cultural adaptation, the back-translation procedure was utilised by four bi-lingual translators. For validation, 89 community-dwellings (50 males, 39 females) aged 61–90 years old (mean: 72.87 ± 6.04) completed four questionnaires adapted into Greek; two instrument specific ones, FES-I and Confidence in Maintaining Balance (CONFbal), and two generic Questionnaires, Short-form Health Survey (SF-36v2) and General Health Questionnaire (GHQ30). Additionally, three functional/balance tests were compared against the FES-I. All questionnaires and measurements were repeated after 7–10 days to explore repeatability.

Results.?Content validity was achieved as all participants found the questionnaire appropriate and comprehensible. Validity of the FES-I yielded moderate to strong correlations with CONFbal (r == 0.694, p<0.01), three SF-36 subscales (r ranging between 0.560 and 6.55, p<0.01), GHQ30 (r == 0.584, p<0.01) and one functional test (r == 0.638, p<0.01 for Timed Up and Go test). FES-I's test–retest reliability (ICC:0.951, SEM: 1.79, SDD:20.44%%, r == 0.950) and internal consistency (Cronbach's α == 0.925) were excellent, and responsiveness across fallers and non-fallers yielded a large effect size (0.89), indicating good discriminant validity.

Conclusions.?The Greek FES-I was valid, reliable, comprehensible and acceptable for the sample tested and may thus, be used in cross-cultural rehabilitation research and practice.     

Important aspects of participation and participation restrictions in people with a mild intellectual disability

Abstract

Purpose: This study explored a possibility to assess the concepts of participation and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) by combining self-ratings of the perceived importance with the actual performance of different everyday activities in people with a mild intellectual disability. Method: Structured interviews regarding 68 items from the ICF activity/participation domain were conducted (n?=?69). The items were ranked by perceived importance, performance and by combined measures. Furthermore, the measures were related to a single question about subjective general well-being. Results: Rankings of performance highlighted about the same items as “important participation”, while rankings of low performance addressed quite different items compared with “important participation restriction”. Significant correlations were found between subjective general well-being and high performance (r?=?0.56), high performance/high importance (important participation) (r?=?0.56), low performance (r?=?–0.56) and low performance/high importance (important participation restriction; r?=?–0.55). Conclusions: The results support the clinical relevance of the ICF and the studied selection of 68 items. Although performance only may sometimes be a relevant aspect, knowledge about the relationship between the perceived importance and the actual performance is essential for clinical interventions and for research aiming to understand specific needs regarding participation.

• Implications for Rehabilitation

• The concepts of participation and participation restriction are highly relevant in people with a mild intellectual disability.

• Self-rated performance might be sufficient to assess participation at a group level.

• In clinical practices, the relationship between the perceived importance and the actual performance of an activity is essential to assess.

     

The ICF and third-party disability: Its application to spouses of older people with hearing impairment

Purpose.?Third-party disability is defined as the disability of family members due to the health condition of their significant other and was identified as a direction for future development by the World Health Organization in 2001. The aim of this article is to identify the International Classification of Functioning, Disability and Health (ICF) domains and categories that describe third-party disability of spouses of older people with hearing impairment.

Method.?Ten spouses of older people with hearing impairment participated in individual semi-structured in-depth interviews. Themes identified by participants were linked according to ICF instructions to deliver a set of ICF category codes relevant to the study of third-party disability in spouses of older people with hearing impairment.

Results.?A total of 18 themes and 50 sub-themes emerged from analysis of the interviews. The majority of these themes were able to be linked to the ICF, with the majority linking to codes in the activities and participation component. A number of contextual factors also emerged in the interviews that impacted on the spouses' third-party disability. Difficulties arose when attempting to link themes to the body function component.

Conclusions.?The ICF appears to be a useful tool in describing the effects of hearing impairment on the significant other; however, further research is necessary to clarify the applicability of some codes to third-party disability, especially the relevance of body functions to third-party disability.     

Hemiarthroplasty for displaced femoral neck fracture: good clinical outcome but uneven distribution of occupational therapy

Purpose.?To assess rehabilitation, type of follow-up visits and outcome after bipolar hemiarthroplasty for femoral neck fracture.

Method.?Two hundred thirty-six consecutive patients with femoral neck fractures treated with hemiarthroplasty were followed for 30 months.

Results.?One hundred sixty-eight (71%%) were women, 175 (74%%) over 80 years old and 53 (22%%) were demented. Of 150 patients with available 3-month data, 7 patients (5%%) had not regained their walking ability. Seventy (47%%) were pain-free and 112 (75%%) were back in their original habitat. A hip-related complication leading to a contact with the orthopaedic department occurred in 20 of all patients (8%%), and 7 (3%%) of these underwent a revision surgery. One hundred eighty-seven patients (79%%) received occupational therapy (OT). Demented patients received OT more seldom (p < 0.001), as did patients aged 90 and older (p == 0.049).

Conclusion.?Due to the low rate of orthopaedic complications, these patients are now referred to their general practitioners, without any further follow-up at the orthopaedic department. Rehabilitation efforts are unevenly distributed. The need of increased rehabilitation efforts for demented or ‘old old’ patients is discussed.     

Barriers,activities and participation: Incorporating ICF into service planning datasets

Purpose.?Guided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF), a measure of activity and participation (MAP) was developed and incorporated into the National Physical and Sensory Disability Database in Ireland. The aims of this article are to investigate and explore the relationship between the barriers, participation restriction and functioning levels experienced by people with disabilities.

Method.?Seven thousand five hundred and sixty-two personal interviews with people meeting specific eligibility criteria for registering onto the database were conducted across four health service executive regions in Ireland.

Results.?Overall, differences in barriers, participation restriction and activity limitations experienced by people with different types of disabilities were found to be significant. Furthermore, low functioning and experience of barriers were indicators of participation restriction.

Conclusions.?This article has shown that elements of the ICF have been successfully operationalised in a service planning tool through the development of the MAP. This provides a more holistic view of disability and will enable the impact of service interventions to be measured over time.     

Multiple health disparities among minority adults with mobility limitations: An application of the ICF framework and codes

Purpose. To examine the interface between mobility limitations and minority status and its effect on multiple health and health-related domains among adults, using the framework of the International Classification of Functioning, Disability and Health (ICF).

Methods. We combined 8 years of data from the 1997 – 2004 US National Health Interview Survey to investigate health disparities among minorities with mobility limitations as defined by the ICF. A total of 79,739 adults surveyed met these criteria.

Results. Adults with both mobility limitations and minority status experienced the greatest disparities (p < 0.001) in worsening health (adjusted odds ratio [AOR] = 8.5), depressive symptoms (AOR = 17.2), diabetes (AOR = 5.5), hypertension (AOR = 3.4), stroke (AOR = 7.2), visual impairment (AOR = 4.6), difficulty with activities of daily living (AOR = 42.7) and instrumental activities of daily living (AOR = 27.7), use of special equipment (AOR = 28.1), obesity (AOR = 3.3), physical inactivity (AOR = 2.7), and low workforce participation (AOR = 0.35).

Conclusions. For most outcome measures, findings supported our hypothesis that persons with both mobility limitations and minority status experience greater health disparities than do adults with minority status or mobility limitations alone.     

Patients' perceptions of the treatment and management of hand osteoarthritis: a focus group enquiry

Purpose.?Osteoarthritis (OA) is the commonest reason for a musculoskeletal consultation in primary care in older adults. There is evidence that appropriate advice and management is sub-optimal. The aim of this study was to explore perceptions and experiences of the treatment and management of hand OA in older adults.

Methods.?Four focus groups were conducted with primary (n == 15) and secondary (n == 14) care participants aged 50–84 years (mean age 64.9 years; 3 males, 14 females) with a clinical diagnosis of hand OA. Data were tape-recorded, transcribed and analysed using thematic analysis and constant comparison method.

Results.?Participants described a lack of help and information with regards to management of their hand OA and also a perceived lack of understanding of the impact of hand OA on the individual. Some received contradictory advice about its management. Beliefs about treatment efficacy were balanced against perceived and actual side-effects and tolerance, and such perceptions appeared to influence the use of alternative therapies.

Conclusions.?The study identified a perceived unmet need in people with hand OA presenting in primary and secondary care. This may be due to the clinical uncertainty of treatment, lack of high-quality randomised controlled trials evaluating therapeutic options, and the limited written information available incorporating the patient experience. The study emphasised the need to understand patient illness and treatment beliefs. A better understanding of illness and treatment beliefs will facilitate the use of evidence-based approaches in the management of hand OA.     

Reliability and validity of Short Form 36 Version 2 to measure health perceptions in a sub-group of individuals with fatigue

Purpose.?To determine the validity and reliability of Short Form 36 Version 2 (SF36v2) in sub-groups of individuals with fatigue.

Method.?Thirty subjects participated in this study, including n == 16 subjects who met case definition criteria for chronic fatigue syndrome (CFS) and n == 14 non-disabled sedentary matched control subjects. SF36v2 and Multidimensional Fatigue Inventory (MFI-20) were administered before two maximal cardiopulmonary exercise tests (CPETs) administered 24?h apart and an open-ended recovery questionnaire was administered 7 days after CPET challenge. The main outcome measures were self-reported time to recover to pre-challenge functional and symptom status, frequency of post-exertional symptoms and SF36v2 sub-scale scores.

Results.?Individuals with CFS demonstrated significantly lower SF36v2 and MFI-20 sub-scale scores prior to CPET. Between-group differences remained significant post-CPET, however, there were no significant group by test interaction effects. Subjects with CFS reported significantly more total symptoms (p < 0.001), as well as reports of fatigue (p < 0.001), neuroendocrine (p < 0.001), immune (p < 0.01), pain (p < 0.01) and sleep disturbance (p < 0.01) symptoms than control subjects as a result of CPET. Many symptom counts demonstrated significant relationships with SF36v2 sub-scale scores (p < 0.05). SF36v2 and MFI-20 sub-scale scores demonstrated significant correlations (p < 0.05). Various SF36v2 sub-scale scores demonstrated significant predictive validity to identify subjects who recovered from CPET challenge within 1 day and 7 days (p < 0.05). Potential floor effects were observed for both questionnaires for individuals with CFS.

Conclusion.?Various sub-scales of SF36v2 demonstrated adequate reliability and validity for clinical and research applications. Adequacy of sensitivity to change of SF36v2 as a result of a fatiguing stressor should be the subject of additional study.