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Background The EQ-5D-Y, an outcome measure of Health Related Quality of Life (HRQoL) in children, was developed by an international task team in 2010. The multinational feasibility, reliability and validity study which followed was undertaken with mainly healthy children. The aim of this study was to investigate the psychometric properties of the EQ-5D-Y when used to assess the HRQoL of children with different health states. Method A sample of 224 children between eight and twelve years were grouped according to their health state. The groups included 52 acutely ill children, 67 children with either a chronic health condition or disability and 105 mostly healthy, mainstream school children as a comparator. They were assessed at baseline, at three months and at six months. An analysis of the psychometric properties was performed to assess the reliability, validity and responsiveness of the EQ-5D-Y in the different groups of children. Cohen’s kappa, the intraclass correlation coefficient, Pearson Chi-square, Kruskal-Wallis ANOVA and effect size of Wilcoxon Signed-rank test were used to determine the reliability, validity and responsiveness of the instrument. Results The EQ-5D-Y dimensions were found to be reliable on test-retest (kappa varying from 0.365 to 0.653), except for the Usual Activities dimension (kappa 0.199). The Visual Analogue Scale (VAS) was also reliable (ICC = 0.77). Post-hoc analysis indicated that dimensions were able to discriminate between acutely ill and healthy children (all differences p  < 0.001). The acutely ill children had the lowest ranked VAS (median 50, range 0–100), indicating worst HRQoL and was the only group significantly different from the other three groups ( p  < 0.001 in all cases). Convergent validity between all similar EQ-5D-Y and PedsQL, WeeFIM and Faces Pain Scale dimensions was only evident in the acutely ill children. As expected the largest treatment effect was also observed in these children (Wilcoxon Signed-rank test for VAS was 0.43). Six of the nine therapists who took part in the study, found the measure quick and easy to apply, used the information in the management of the child and would continue to use it in future. Conclusions The EQ-5D-Y could be used with confidence as an outcome measure for acutely-ill children, but demonstrated poorer psychometric properties in children with no health condition or chronic conditions. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments of children.

Transfer of motor skills is the ultimate goal of motor training in rehabilitation practice. In children with Developmental Coordination Disorder (DCD), very little is known about how skills are transferred from training situations to real life contexts. In this study we examined the influence of two types of practice on transfer of motor skills acquired in a virtual reality (VR) environment. One hundred and eleven children with DCD and their typically developing (TD) peers, aged 6-10 years (M = 8.0 SD = 1.0) were randomly assigned to either variable (n = 56) or repetitive practice (n = 55). Participants in the repetitive practice played the same exergame (ski slalom) twice weekly for 20 minutes, over a period of 5 weeks, while those in the variable group played 10 different games. Motor skills such as balance tasks (hopping), running and agility tasks, ball skills and functional activities were evaluated before and after 5 weeks of training. ANOVA repeated measures indicated that both DCD and TD children demonstrated transfer effects to real life skills with identical and non-identical elements at exactly the same rate, irrespective of the type of practice they were assigned to. Based on these findings, we conclude that motor skills acquired in the VR environment, transfers to real world contexts in similar proportions for both TD and DCD children. The type of practice adopted does not seem to influence children's ability to transfer skills acquired in an exergame to life situations but the number of identical elements does.

Although Developmental Coordination Disorder (DCD) is often characterized as a skill acquisition deficit disorder, few studies have addressed the process of motor learning. This study examined learning of a novel motor task; the Wii Fit ski slalom game. The main objectives were to determine: 1) whether learning occurs over 100 trial runs of the game, 2) if the learning curve is different between children with and without DCD, 3) if learning is different in an easier or harder version of the task, 4) if learning transfers to other balance tasks. 17 children with DCD (6-10 years) and a matched control group of 17 typically developing (TD) children engaged in 20 minutes of gaming, twice a week for five weeks. Each training session comprised of alternating trial runs, with five runs at an easy level and five runs at a difficult level. Wii scores, which combine speed and accuracy per run, were recorded. Standardized balance tasks were used to measure transfer. Significant differences in initial performance were found between groups on the Wii score and balance tasks. Both groups improved their Wii score over the five weeks. Improvement in the easy and in the hard task did not differ between groups. Retention in the time between training sessions was not different between TD and DCD groups either. The DCD group improved significantly on all balance tasks. The findings in this study give a fairly coherent picture of the learning process over a medium time scale (5 weeks) in children novice to active computer games; they learn, retain and there is evidence of transfer to other balance tasks. The rate of motor learning is similar for those with and without DCD. Our results raise a number of questions about motor learning that need to be addressed in future research.

Background Rugby is increasingly gaining popularity among school-aged male junior players in countries hardly known for dominating international rugby, such as Zimbabwe. Given rugby combativeness, participating adolescents should possess qualities or skills commensurate with the physical demands of the sport for effective participation. This study investigated the independent and interactive effects of age category and playing standard on anthropometric, physiological characteristics and rugby-specific game skills among Zimbabwean athletes. Methods Two hundred and eight elite, sub-elite and non-rugby players competing at Under 16 and Under 19 age categories were assessed using the School Clinical Rugby Measure (SCRuM) test battery. Participants underwent height, sitting height, mass, skinfolds, speed, agility, upper-and-lower muscular strength and power, prolonged high-intensity intermittent running ability, tackling, passing and catching assessments in a cross-sectional experimental design. Results Age categories had significant main effect on all SCRuM test items except sum of seven skinfolds ( p  = 0.45, η 2 p = 0.003). Playing standard had significant main effects for all variables except height ( p  = 0.40, η 2 p = 0.01) and sum of seven skinfolds ( p  = 0.11, η 2 p = 0.02). Specifically, upper-and-lower muscular strength and power, prolonged high-intensity intermittent running ability, tackling, passing and catching improved with increasing playing standards. However, two-way analysis of variance only demonstrated significant interactions between the effects of age category and playing standards for vertical jump height (VJ) test, 2-kg medicine ball chest throw (2-kg MBCT) test, Yo-Yo intermittent recovery test level 1 (Yo-Yo IRT L1), and tackling and catching tests. Yo-Yo IRT L1, VJ, tackling and catching tests demonstrated greater discriminative ability among Under 16 s, whereas the 2-kg MBCT test showed better ability in Under 19 s. Conclusion All SCRuM variables except skinfolds improved with age, highlighting relative sensitivity in differentiating older from younger athletes. However, the discriminative ability by playing standards for VJ, 2-kg MBCT, Yo-Yo IRT L1, tackling and catching ability tests was age-dependent. These findings informs on general attribute development in junior rugby players with age and on specific players attributes in need of monitoring for attainment of elite status at U16 or U19 level.

Background This systematic review was conducted with the first objective aimed at providing an overview of the physiological characteristics commonly evaluated in rugby and the corresponding tests used to measure each construct. Secondly, the measurement properties of all identified tests per physiological construct were evaluated with the ultimate purpose of identifying tests with strongest level of evidence per construct. Methods The review was conducted in two stages. In all stages, electronic databases of EBSCOhost, Medline and Scopus were searched for full-text articles. Stage 1 included studies examining physiological characteristics in rugby. Stage 2 included studies evaluating measurement properties of all tests identified in Stage 1 either in rugby or related sports such as Australian Rules football and Soccer. Two independent reviewers screened relevant articles from titles and abstracts for both stages. Results Seventy studies met the inclusion criteria for Stage 1. The studies described 63 tests assessing speed (8), agility/change of direction speed (7), upper-body muscular endurance (8), upper-body muscular power (6), upper-body muscular strength (5), anaerobic endurance (4), maximal aerobic power (4), lower-body muscular power (3), prolonged high-intensity intermittent running ability/endurance (5), lower-body muscular strength (5), repeated high-intensity exercise performance (3), repeated-sprint ability (2), repeated-effort ability (1), maximal aerobic speed (1) and abdominal endurance (1). Stage 2 identified 20 studies describing measurement properties of 21 different tests. Only moderate evidence was found for the reliability of the 30–15 Intermittent Fitness. There was limited evidence found for the reliability and/or validity of 5 m, 10 m, 20 m speed tests, 505 test, modified 505 test, L run test, Sergeant Jump test and bench press repetitions-to-fatigue tests. There was no information from high-quality studies on the measurement properties of all the other tests identified in stage 1. Conclusion A number of physiological characteristics are evaluated in rugby. Each physiological construct has multiple tests for measurement. However, there is paucity of information on measurement properties from high-quality studies for the tests. This raises questions about the usefulness and applicability of these tests in rugby and creates a need for high-quality future studies evaluating measurement properties of these physiological tests. Trial registrations PROSPERO CRD 42015029747 .

ObjectivesDespite growing popularity of adolescent rugby in Zimbabwean schools, little is known about qualities or skills of schoolboy rugby players and how they differ by competitive level. Therefore, the aim of the current study was to identify anthropometric, physiological characteristics and rugby-specific game skills capable of discriminating under-16 (U16) RU players across three proficiency levels.MethodsFollowing development of School Clinical Rugby Measure test battery, elite rugby players (n=41), subelite rugby players (n=30) and non-rugby players (n=29) were enrolled and tested for height, sitting height, body mass, skinfolds, speed, agility, upper and lower muscular strength and power, prolonged high-intensity intermittent running ability, tackling, passing and catching in a cross-sectional study.ResultsElite rugby players displayed significantly better scores for all physiological tests and game skills compared with either subelite or non-rugby players, except for Sit-and-Reach, 20 m speed and L-run tests. However, only vertical jump (VJ) and Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IRT L1) significantly improved with increasing competitive level. In addition, elite rugby players showed significantly better scores for tackling (p<0.001) and catching (p<0.001) compared with subelites. No statistical differences were observed across competitive levels for height (p=0.43), sum of seven skinfolds (p=0.26) and passing (p=0.27).ConclusionSince VJ and Yo-Yo IRT L1 improved with increasing playing standard, these findings possibly highlight physiological attributes important in elite schoolboy rugby in Zimbabwe. Additionally, development and training of tackling and catching skills in U16 schoolboy rugby is important since they are linked to higher playing standard.

Background Scientific focus on rugby has increased over the recent years, providing evidence of the physical or physiological characteristics and game-specific skills needed in the sport. Identification of tests commonly used to measure these characteristics is important for the development of test batteries, which in turn may be used for talent identification and injury prevention programmes. Although there are a number of tests available in the literature to measure physical or physiological variables and game-specific skills, there is limited information available on the psychometric properties of the tests. Therefore, the purpose of this study is to systematically review the literature for tests commonly used in rugby to measure physical or physiological characteristics and rugby-specific skills, documenting evidence of reliability and validity of the identified tests. Methods/design A systematic review will be conducted. Electronic databases such as Scopus, MEDLINE via EBSCOhost and PubMed, Academic Search Premier, CINAHL and Africa-Wide Information via EBSCOhost will be searched for original research articles published in English from January 1, 1995, to December 31, 2015, using a pre-defined search strategy. The principal investigator will select potentially relevant articles from titles and abstracts. To minimise bias, full text of titles and abstracts deemed potentially relevant will be retrieved and reviewed by two independent reviewers based on the inclusion criteria. Data extraction will be conducted by the principal investigator and verified by two independent reviewers. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist will be used to assess the methodological quality of the selected studies. Discussion Choosing an appropriate test to be included in the screening test battery should be based on sound psychometric properties of the test available. This systematic review will provide an overview of the tests commonly used in rugby union and other related high intermittent team sports characterised by skill executions using the hands and legs such as Rugby League and Australian Rules Football. In addition, the review will highlight the psychometric properties of the identified tests. This information is crucial in developing a sport-specific test battery which can be used for talent identification, especially among young adolescent players, and injury prevention programmes. Systematic review registration PROSPERO CRD42015029747

Adequate muscle strength, power, and endurance are important in children's daily activities and sports. Various instruments have been developed for the assessment of muscle function; each measures different aspects. The Functional Strength Measurement (FSM) was developed to measure performance in activities in which strength is required. The study objective was to establish the test-retest reliability and structural and construct validity of the FSM. A cross-sectional descriptive study was conducted. The performance of 474 children with typical development on the FSM was examined. Test-retest reliability (n=47) was calculated with the intraclass correlation coefficient (2.1A) for agreement. Structural validity was examined with exploratory factor analysis, and internal consistency was established with the Cronbach alpha. Construct validity was determined by calculating correlations between FSM scores and scores obtained with a handheld dynamometer (HHD) (n=252) (convergent validity) and between FSM scores and scores on the Movement Assessment Battery for Children-2 (MABC-2) (n=77) (discriminant validity). The test-retest reliability of the FSM total score ranged from .91 to .94. The structural validity revealed one dimension, containing all 8 FSM items. The Cronbach alpha was .74. The convergent validity with the HHD ranged from .42 to .74. The discriminant validity with MABC-2 items revealed correlations that were generally lower than .39, and most of the correlations were not significant. Exploratory factor analysis of a combined data set (FSM, HHD, and MABC-2; n=77) revealed 2 factors: muscle strength/power and muscle endurance with an agility component. Discriminant validity was measured only in children aged 4 to 6 years. The FSM, a norm-referenced test for measuring functional strength in children aged 4 to 10 years, has good test-retest reliability and good construct validity.

Background: Schoolboy rugby is a popular sport which forms the bedrock of rugby development in many African countries, including Zimbabwe. With burgeoning talent identification programmes, the development of multi-dimensional, logically- validated, and reliable test batteries is essential to inform the objective selection of potentially talented young rugby athletes. Objectives: This study sought evidence on the absolute and relative test-retest reliability of the component test items in the newly-assembled SCRuM test battery. Methods: Utilising a pragmatic test-retest experimental design, a sample of 41 Under-19 schoolboy players playing competitive rugby in the elite Super Eight Schools Rugby League in Harare, Zimbabwe, participated in the study. Results: Physiological and game-specific skills tests which showed good to excellent relative reliability and acceptable absolute reliability, included: 20 m and 40 m speed, L-run, Vertical Jump (VJ), 60 s Push-Up, 2 kg Medicine Ball Chest Throw test (2 kg MBCT), Wall Sit Leg Strength test (WSLS), Repeated High Intensity Exercise test (RHIE), One Repetition Maximum Back Squat (1-RM BS) and Bench Press tests (1-RM BP), Yo-Yo Intermittent Recovery Level 1 test (Yo-Yo IRT L1), Tackling Proficiency test, Passing Ability Skill test and Running and Catching Ability skill test. Conclusion: All these tests are reliable and warrant inclusion in the SCRuM test battery for possible profiling of U19 schoolboy rugby players during the ‘in-season’ phase provided there is adequate participant familiarisation and test standardisation. The test-retest ICCs and measurement errors are generalisable to other young athletes in this population, making the tests useful for the evaluation of training and developmental effects of the measured constructs.

Membranous nephropathy leads to end-stage renal disease in more than 20% of patients. Although immunosuppressive therapy benefits some patients, trial evidence for the subset of patients with declining renal function is not available. We aimed to assess whether immunosuppression preserves renal function in patients with idiopathic membranous nephropathy with declining renal function. This randomised controlled trial was undertaken in 37 renal units across the UK. We recruited patients (18–75 years) with biopsy-proven idiopathic membranous nephropathy, a plasma creatinine concentration of less than 300 μmol/L, and at least a 20% decline in excretory renal function measured in the 2 years before study entry, based on at least three measurements over a period of 3 months or longer. Patients were randomly assigned (1:1:1) by a random number table to receive supportive treatment only, supportive treatment plus 6 months of alternating cycles of prednisolone and chlorambucil, or supportive treatment plus 12 months of ciclosporin. The primary outcome was a further 20% decline in renal function from baseline, analysed by intention to treat. The trial is registered as an International Standard Randomised Controlled Trial, number 99959692. We randomly assigned 108 patients, 33 of whom received prednisolone and chlorambucil, 37 ciclosporin, and 38 supportive therapy alone. Two patients (one who received ciclosporin and one who received supportive therapy) were ineligible, so were not included in the intention-to-treat analysis, and 45 patients deviated from protocol before study end, mostly as a result of minor dose adjustments. Follow up was until primary endpoint or for minimum of 3 years if primary endpoint was not reached. Risk of further 20% decline in renal function was significantly lower in the prednisolone and chlorambucil group than in the supportive care group (19 [58%] of 33 patients reached endpoint vs 31 [84%] of 37, hazard ratio [HR] 0·44 [95% CI 0·24–0·78]; p=0·0042); risk did not differ between the ciclosporin (29 [81%] of 36) and supportive treatment only groups (HR 1·17 [0·70–1·95]; p=0·54), but did differ significantly across all three groups (p=0·003). Serious adverse events were frequent in all three groups but were higher in the prednisolone and chlorambucil group than in the supportive care only group (56 events vs 24 events; p=0·048). For the subset of patients with idiopathic membranous nephropathy and deteriorating excretory renal function, 6 months' therapy with prednisolone and chlorambucil is the treatment approach best supported by our evidence. Ciclosporin should be avoided in this subset. Medical Research Council, Novartis, Renal Association, Kidney Research UK.