The overall care for children with cerebral palsy (CP) is challenging to the family which causes significant impacts to their livelihood. There is limited qualitative research that reports the unmet needs of parents with physically disabled children, especially highly dependent CP. The aim of this study was to explore the unmet needs of parents of highly dependent children with CP. A qualitative study using semi-structured face to face interviews was carried out among nine parents of children with CP with gross motor classification function score (GMFCS) levels III, IV, and V. The interviews were tape-recorded and transcribed verbatim. Transcribed data was analysed using thematic analysis method. Several unmet needs were highlighted by the parents; namely the needs in receiving information regarding CP conditions, getting psychological and financial support and explaining the child’s condition to strangers. In addition, parents expressed the need for better support from the social welfare department, as well as in effectively organising family functioning. The findings of this study indicate that there is a need for the healthcare professionals to develop suitable strategies to assist the parents of highly dependent children with CP in fulfilling their specific needs. The role of relevant agencies should be optimised in addressing this area of concern.

Background: Children with physical disabilities (PD) have reduced levels of physical activity (PA) compared to typically developing children, which increases their risk of becoming overweight and obese, which leads to numerous adverse health consequences. This study aimed to determine the differences between groups classified by body mass index (BMI) percentile in terms of PA levels, cardiorespiratory endurance and quality of life (QoL), and also to evaluate the relationship between BMI percentile and PA levels, cardiorespiratory endurance and QoL in children and adolescents with physical disabilities. Methods: A total of 172 children and adolescents with PD aged between 5 and 17 years from Hospital Tunku Azizah were included in this cross-sectional study. The BMI percentile was calculated to determine the weight status. PA levels were assessed with the Physical Activity Questionnaire for Older Children (PAQ-C), cardiorespiratory endurance was measured by the Six-Minute Walk Test (6MWT) and QoL was measured by the Paediatric Quality of Life Inventory version 2.0 (PedsQL 2.0). Results: According to the BMI percentile, 70.3% had a healthy BMI percentile (50th to 84th percentile), 11.6% were overweight (50th to 84th percentile), 11% were underweight (0–49th percentile) and 7.0% were obese (95th percentile and above). Most children reported a healthy weight, and the rates of being overweight and obese were higher in children who could ambulate without aids (6.4% and 3.5%, respectively) compared to those who used walking aids (5.2% and 3.5%, respectively). Significant differences were found in the PAQ-C, 6MWT and PedsQL 2.0 scores between different BMI percentile groups (p < 0.05). There were also significant correlations between the BMI percentile and the PAQ-C (r = 0.209, p < 0.001), 6MWT (r = 0.217, p < 0.001) and PedsQL 2.0 (r = 0.189, p < 0.001). Conclusion: The rate of being overweight and obese is greater among children who ambulate without aids than among those with aids. An increase in the BMI percentile can reduce the QoL in different ways. This study suggests that children with PD who can walk without aids are at a greater risk of being overweight and obese. Hence, the engagement of this population in PA is crucial for their weight management.

Backgrounds: Assessing quality of life (QoL) using a well-developed and validated questionnaire is an essential part of a breast cancer-related lymphedema (BCRL) treatment. However, a QoL questionnaire with the best psychometric properties is so far unknown. The aim of this systematic review is to evaluate the psychometric properties of the questionnaires measuring the QoL of patients with BCRL. Methods: A thorough search was performed to identify published studies in electronic databases such as Medline (via Ovid), EBSCOhost, PubMed, Scopus, and Web of Science, on 8 February 2022, by using search terms as follows: ‘quality of life’; ‘breast cancer’; ‘upper limb’; ‘lymphedema’; ‘questionnaire’; and ‘measurement properties.’ Two reviewers conducted article selection, data extraction, and quality assessment independently. The third reviewer helped solve any possible disagreements between the two reviewers. The COSMIN checklist and manual were used to assess the quality of included studies. Results: A total of nineteen articles with nine questionnaires were included and assessed using the COSMIN Risk of Bias checklist. Most studies only assessed content validity, structural validity, internal consistency, reliability, and construct validity. Lymph-ICF-UL showed the most ‘sufficient’ and ‘high’ quality of evidence ratings for its measurement properties. Conclusion: The most appropriate questionnaire for use based on our assessment is Lymph-ICF-UL.

Virtual reality (VR)-based therapy has demonstrated potential in enhancing upper and lower limb functions, postural control, and balance. Despite its growing use, evidence regarding its impact on physical function and quality of life (QoL) in individuals with cerebral palsy (CP) remains scarce. This study protocol outlines a randomized controlled trial (RCT) designed to evaluate the efficacy of VR-based therapy as an adjunct to conventional therapy on physical function and QoL in adolescents with CP, as well as to explore the perceptions of participants and their caregivers regarding the intervention. This RCT will include 56 adolescents with CP, aged 10-17 years, who will be randomly assigned in a 1:1 ratio to either the intervention group (VR-based therapy) or the control group. Both groups will receive their usual conventional therapy, equated between groups. Additionally, the intervention group will receive VR therapy using the Xbox 360 Kinect, delivered twice weekly in 45- to 60-minute sessions for 12 weeks. Outcome measures will include the Gross Motor Function Measure-88, the 6-Minute Walk Test, handheld dynamometry, and the Paediatric Quality of Life Inventory. Assessments will be conducted at baseline, mid-intervention (week 6), and post-intervention (week 12). Qualitative data will be collected through semi-structured interviews with participants and caregivers after the 12-week program. Statistical analyses will be conducted on an intention-to-treat basis. Repeated measures ANOVA will be used to evaluate changes in physical function and QoL over time at baseline, mid- and post-intervention. The qualitative data from interviews will be analyzed using thematic analysis to identify key themes related to the experiences and perceptions of caregivers and participants.

This study explored the test-retest reliability and construct validity of a two-minute walk test in children and adolescents with CP Gross Motor Function Classification System (GMFCS) levels I, II, and III. Twenty-six participants with CP (age 11.7 ± 3.9 years) were recruited and were assessed twice with the two-minute walk test to determine the test-retest reliability (interval 2 weeks). Minimal detectable changes (MDC95) were calculated. Construct validity was established by comparing the results of the two- and six-minute walk tests during the first assessment. The test-retest reliability was excellent, with intra-class correlation (ICC) = 0.98 for all participants. The (MDC95) for all participants was 12.7 m. The distance covered by children and adolescents with CP in the two-minute walk test had high correlation (r = 0.9, p < 0.01) with distance covered in the six-minute walk test. The two-minute walk test is a valid and reliable outcome measure to assess walking performance in children and adolescents with CP. HIGHLIGHTS The two-minute walk test has excellent reliability and validity among young people with cerebral palsy The minimal detectable change of two-minute walk test among young people with cerebral palsy was 12.7 m The two-minute walk test had high correlation with the six-minute walk test among young people with cerebral palsy

Background: Breast cancer-related lymphedema (BCRL) is the most prevalent comorbidity that occurs following breast cancer treatments and has negative impact on the patients' quality of life (QoL). The Lymphedema Functioning, Disability, and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL) is a valid and reliable instrument in assessing the QoL of patients with BCRL. However, the Bahasa Malaysia (BM) version is not available yet. This study aimed to translate the Lymph-ICF-UL into BM and to evaluate its validity and reliability. Methods and Results: A forward–backward translation was performed based on Sousa's guideline, and then, the face, content, construct validity, internal consistency, and test–retest reliability were tested. Face validity was assessed by five patients, and content validity was evaluated by six experts. Then, construct validity and internal validity were assessed in 107 patients. Finally, test–retest reliability was analyzed in 21 patients. Two items were eliminated following suggestions from the patients and experts. All patients found the scoring system and items clear and relevant. The results showed sufficient content validity index and modified kappa statistics value. Confirmatory factor analysis showed acceptable fit indices. Cronbach's alpha values ranged from 0.67 to 0.95, intraclass correlation coefficient ranged from 0.88 to 0.99, standard error measurement was 2.29–6.15, and the Bland–Altman plot showed an agreement between two test occasions. Conclusion: These results suggested that the Lymph-ICF-UL BM has good validity and reliability in evaluating the QoL of patients with BCRL in Malaysia.