The Cleft Lip Education with Augmented Reality (CLEAR) VR Phase 2 Trial: A Pilot Randomized Crossover Trial of a Novel Patient Information Leaflet

Background The Cleft Lip Education with Augmented Reality (CLEAR) project centers around the use of augmented reality (AR) in patient leaflets, as a visual means to overcome the “health literacy” gap. This trial followed Virtual Reality (VR CORE) guidelines for VR Phase 2 (Pilot) trials. Methods Participants included families of children treated for Cleft Lip and Palate at the Royal Hospital for Children, Glasgow. Interventions were AR leaflet or Traditional Leaflet. Objectives were to calculate sample sizes, assess outcome instruments, trial design, and acceptability to patients. Primary outcome measure was Mental Effort Rating Scale, and secondary outcomes were Patient Satisfaction (Visual Analogue Scale), Usefulness Scale for Patient Information Material (USE) scale, and Instructional Materials Motivation Survey (IMMS). Randomization was by block randomization. The trial was single blinded with assessors blinded to group assignment. Results 12 Participants were randomized, with crossover design permitting analysis of 12 per group. Primary outcome with Mental Effort Rating Scale indicated higher mental effort with Traditional compared to AR Leaflet (4.75 vs 2.00, P = .0003). Secondary outcomes for Satisfaction were Traditional 54.50 versus AR 93.50 ( P = .0001); USE scale 49.42 versus 74.08 ( P = .0011); and IMMS 112.50 versus 161.75 ( P = .0003). Subjective interviews noted overwhelmingly positive patient comments regarding the AR leaflet. Outcome instruments and trial design were acceptable to participants. No harms were recorded. Conclusions The CLEAR pilot trial provides early evidence of clinical efficacy of AR leaflets in patient education. It is hoped that this will provide a future paradigm shift in the way patient education is delivered.

FATIGUE IN CHILDREN WITH PRONATED FEET AFTER AEROBIC EXERCISES

Background: Sports have a strong influence on current society. Foot posture has been postulated as a risk factor for overuse injuries; however, the link between foot posture and injuries is unclear. This study aimed at checking whether children with pronated feet become more fatigued after participating in sports tests than those with normal feet.Methods: One-hundred five children between 10 and 12 years old (10.46 {plus minus} 0.78) participated in the sports tests. These tests were aerobic-type resistance exercises with six stations at which each child remained for 30 sec. The posture of the foot was evaluated via the foot posture index (FPI) and the plantar footprint via the arch index and Clarke's angle before and after aerobic-type resistance exercises. The perceived tiredness was evaluated with the Pictorial Children´s Effort Rating Table (PCERT) questionnaire and whether or not there was pain during or after physical activity.Results: The variables used to measure the foot posture and the plantar arch changed more in the group of children with pronated feet, suggesting that the feet undergo pronation more after physical exercise. The neutral feet group obtained an average score of 5.46 {plus minus} 1.89 on the PCERT, while the pronated feet group obtained a score of 7.60 {plus minus} 1.92. Conclusions: The children with pronated feet showed more fatigue and foot pain during and/or after physical exercise than those with neutral feet. The type of foot could be responsible for the lack of enthusiasm of children toward undertaking healthy activities, and this problem might be solved via appropriate orthopedic treatment.

Feasibility study of perceived exertion and heart rate of children with ASD during swimming

This study explored the feasibility of manual heart rate and the Pictorial Children’s Effort Rating Table (PCERT) to measure moderate to vigorous physical activity (MVPA) in children with autism spectrum disorder (ASD). Sixteen children with ASD participated in weekly, 30-minute Sensory Enhanced Aquatics swimming lessons. Swim instructors measured heart rate, and swimmers rated their physical activity levels using the PCERT. Results showed swimmers’ heart rate and perceived exertion significantly increased from the beginning to the end of lessons. However, both measures were difficult to implement, indicating they may not be feasible for this population. Future research should investigate alternative objective measures to quantify MVPA with the ASD population with use of devices such as the Garmin Swim, Fit Bit, or Actigraph.

I judge you by your profit: Judgments of effort exerted by self and others are influenced by received rewards

Effort constitutes a major part of cost-benefit calculations underlying decision making. Therefore, estimating the effort someone has spent on a task is a core dimension for evaluating own and others’ actions. It has been previously shown that self-judgments of effort are influenced by the magnitude of obtained rewards. It is unclear, however, whether the influence of reward on effort estimations is limited to self-judgments or whether reward incorporation represents a general computational principle when judging effort. Here we show that people also integrate reward magnitude when judging the effort exerted by others. Participants (N=48) performed an effortful sensorimotor task interleaved with a partner, while rating either their own or the other person’s effort. After each trial but before the effort rating, both participants were informed about the obtained reward. We found that higher rewards led to higher estimations of exerted effort, in self-as well as other-judgments, and this effect was more pronounced for other-judgments. In both types of judgment, computational modelling revealed that reward information and the perceived level of exertion were combined in a Bayes optimal manner to form effort estimates. Remarkably, the extent to which rewards influenced effort judgments was positively correlated with conservative world-views, indicating that the basic computations underlying this behavioural phenomenon might be related to more general beliefs about the association between effort and reward in the society. The integration of reward information into retrospective effort judgments underscores the convergence of multiple information sources that supports adaptive learning and decision making in social contexts.

The B'Active programme for overweight primary school children in Glasgow: determining the prevalence of overweight and obesity and piloting an activity intervention

The aim of this study was to determine the prevalence of overweight and obesity in primary school children in Glasgow and to evaluate a pilot activity programme for overweight and obese children. BMI was measured in 1548 children. Overweight, obesity and severe obesity were defined as BMI ≥ 85th, 95th and 98th centile, respectively. Overweight and obese children were then invited to participate in a 10-week school-based activity programme. The programme was evaluated by recording weekly attendance, intensity (using the Children's Effort Rating Scale) and enjoyment (scale 1–10). Focus groups were used to explore the experiences and views of the children, teachers, coaches and parents. Of the 1548 children, 31·4 % were overweight, 19·1 % were obese and 12·4 % were severely obese; 38 % of those invited attended the activity programme. Weekly programme attendance was 83 % (range 56–99 %). Mean enjoyment rating (scale 1–10) was 8 for boys and 9 for girls. The intensity of activity sessions were rated ‘very easy’ by boys and ‘just feeling a strain’ by girls. Common themes emerging from the focus groups related to perceived positive and negative aspects of the programme (fun, concerns about stigmatising children); physical and psychological outcomes (fitter, more confident); and future recommendations (involve parents). In summary, the prevalence of overweight and obesity was high. The activity programme was successful in terms of attendance and enjoyment, and overall views of the initiative were positive and there was compelling support for its continuation.

An Assessment of the Validity and Reliability of Two Perceived Exertion Rating Scales among Hong Kong Children

This study evaluated the validity and reliability of the Chinese-translated (Cantonese) versions of the Borg 6–20 Rating of Perceived Exertion (RPE) scale and the Children's Effort Rating Table (CERT) during continuous incremental cycle ergometry with 10- to 11-yr.-old Hong Kong school children. A total of 69 children were randomly assigned, with the restriction of groups being approximately equal, to two groups using the two scales, CERT ( n = 35) and RPE ( n = 34). Both groups performed two trials of identical incremental continuous cycling exercise (Trials 1 and 2) 1 wk. apart for the reliability test. Objective measures of exercise intensity (heart rate, absolute power output, and relative oxygen consumption) and the two subjective measures of effort were obtained during the exercise. For both groups, significant Pearson correlations were found for perceived effort ratings correlated with heart rate ( rs ≥ .69), power output ( rs ≥ .75), and oxygen consumption ( rs ≥ .69). In addition, correlations for CERT were consistently higher than those for RPE. High test-retest intraclass correlations were found for both the effort ( R = .96) and perceived exertion ( R = 89) groups, indicating that the scales were reliable. In conclusion, the CERT and RPE scales, when translated into Cantonese, are valid and reliable measures of exercise intensity during controlled exercise by children. The Effort rating may be better than the Perceived Exertion scale as a measure of perceived exertion that can be more validly and reliably used with Hong Kong children.

Reliability of Effort Perception for Regulating Exercise Intensity in Children Using the Cart and Load Effort Rating (CALER) Scale

The purpose of this study was to assess whether young children could reliability regulate exercise intensity production after several practice trials, without reference to objective feedback measures. The study used a new 10-point scale (Cart and Load Effort Rating [CALER] Scale), which depicts a child on a bicycle, at various stages of exertion, towing a cart in which the load increases progressively. After warm-up, 20 children, aged 7–10 years, performed an intermittent, effort production protocol at CALER 2, 5, and 8 on a cycle ergometer. This was repeated on three further occasions in the next 4 weeks. An increase in PO across trials (44, 65, and 79 W at CALER 2, 5, and 8, respectively) confirmed that the children understood the scale. A Bland and Altman limits of agreement (LoA) analysis and an intraclass correlation analysis (ICC) between trials (T) indicated that reliability improved with practice. Intertrial comparisons of overall reliability from T1 to T2 and from T3 to T4 ranged from 0.76 to 0.97 and an improvement in the overall bias ± 95% limits of agreement from −12 ± 19 W to 0 ± 10 W. This study is the first to apply more than two repeated effort production trials in young children and provides strong evidence that practice improves the reliability of effort perception in children. The data also provide preliminary evidence for the validity of the CALER Scale in children aged 7–10 years.

The Self-Regulation and Perception of Exercise Intensity in Children in a Field Setting

This study examined whether elementary school children (n = 104, M = 59, F = 45) could learn to self-reguiate exercise intensity and provide consistent and accurate perceptual estimates of sell-regulated exercise in the field setting of a physical education class. Five training sessions involving heart rate monitoring (HRM), introduction to the Children’s Effort Rating Table (CERT), and feedback from the researcher preceded two testing sessions (Trial 1 [Tl] and Trial 2 [T2]). Sixty-two percent of the subjects were able to set their intensity within the HR range for Tl, but only 40% did so for both trials. Validity coefficients between HR and CERT were low (r = –.10 to –.18) and intraclass reliability for CERT was only moderate (Tl, R = .67; T2, R = .56). The data indicate that elementary school children could neither consistently self-regulate exercise intensity nor provide valid or reliable CERT estimation responses for self-determined activity.