Amitesh Narayan | University of California, Los Angeles (original) (raw)
Papers by Amitesh Narayan
Biomedicine, 2022
Introduction and Aim: Children with Cerebral Palsy (CP) have a longer duration and poor quality o... more Introduction and Aim: Children with Cerebral Palsy (CP) have a longer duration and poor quality of reaching movements than the Typically Developing (TD) children. This may be due to the variations in the antagonistic muscular activity. To evaluate the sequence of activity of muscle groups involved in reaching movements, we planned this study. Materials and Methods: We analyzed the order and timing of Biceps Brachii and Triceps Brachii muscle recruitment pattern among children with CP and TD in forward reach task. Thirty-eight children (n=19 CP and n=19 TD) by recording Electromyogram (EMG), after obtaining ethical clearance. Rectified EMG signals determined the onset of muscle activation, and data were analyzed using unpaired Student’s ‘t’-test and Chi-square test. Results: In CP, there was a greater likelihood of Biceps Brachii (flexor) firing prior to Triceps Brachii as compared to TD, for whom the greater probability of Triceps Brachii firing first. (Likelihood ratio (LLR) =2...
Objectives: Medical research in longitudinal motor developmental studies brings collection of lar... more Objectives: Medical research in longitudinal motor developmental studies brings collection of large data base. Therefore need felt to develop an effective raw data entry method in electronic format using existing software i.e. MS Excel. Methods: 42 infants/children were recruited at the time of birth and were followed up to 36 months of age on Peabody Developmental Motor Scales-2nd edition (PDMS-2) instrument. All 42 subjects had been assessed for 9 times during follow ups at various chronological age points. Total numbers of follow up assessments were 378 i.e. 42 (subjects) × 9 (no. of follow up). Total number of data entry cell required for each subject in this study was approximately 2611. Thus total data entry cell in this study became i.e. 42* 2611 = 109662. Results: Through this process, each child‘s raw data digits i.e. >2600 cells, took only 20 to 30 minutes to enter and processed automatically as summary sheet. This process took 21-22 hours for entry of 109662 raw data d...
Background: The Foot Posture Index (FPI) is a validated method for quantifying standing foot post... more Background: The Foot Posture Index (FPI) is a validated method for quantifying standing foot posture, and is used in a variety of clinical and research settings. However, there have been no retrievable normative data available to date for comparison and reference, for Indian children. Aim: This study aimed at investigating normal foot development and establishing normative FPI-6 reference values of typically developing school children in Mangalore and also at finding the association of foot posture with anthropometric parameters. Methods: 240 children of the group of 6 to 11 years of age were evaluated according to the procedure mentioned in The Foot Posture Index (FPI-6) User Guide and Manual. Results: Prevalence of pronated feet was more common in 6-year old children .Age had a significant effect on all six components of FPI-6 scores for both sexes. A significant association was found between FPI-6 and gender in the age group of 9 years. No correlation was found between anthropome...
The National Medical Journal of India, 2021
Background. We sought to establish reference values of the functional independence measure (WeeFI... more Background. We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3–7 years in India using this cross-sectional study. Methods. We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results. There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions. We have provided reference values for WeeFIM in children of India aged 3–7 years (35–84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.
Developmental Medicine & Child Neurology, 2019
AIM To describe the nature and extent of the literature addressing the medical and its re/habilit... more AIM To describe the nature and extent of the literature addressing the medical and its re/habilitative management of cerebral palsy (CP) in India. METHOD Online worldwide scholarly databases, research hosting directories, Indian publishing houses, and grey literature were used to identify papers published between 2005 and 2016. We retrieved 144 English language papers that described the medical and rehabilitative management of Indian children with CP. RESULTS Quantitative, qualitative, and mixed research designs are published by a variety of health care professionals in India. Intervention (45%) and observational studies (30%) predominate. Outcomes were categorized using the World Health Organization's International Classification of Functioning, Disability and Health framework, with body structure and function most reported and activity/participation least reported; 57% described its re/habilitation interventions and 43% were medical interventions. INTERPRETATION There is a substantial body of CP research in India that focuses on interventions to reduce impairments, with minimal attention given to activities and participation, environmental, and personal factors. Twenty-six per cent of studies are published in what appear to be 'predatory journals'. This paper serves as an alert about the presence of 'predatory journals' in medicine that may introduce publication bias, which can distort results reported in those studies individually, or from conclusions drawn in reviews that contain those studies.
Disability and rehabilitation, Jan 26, 2017
To explore parents' perspectives on rehabilitation of their child with cerebral palsy and the... more To explore parents' perspectives on rehabilitation of their child with cerebral palsy and their information needs. Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework. Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the ...
JMIR research protocols, Jan 18, 2017
It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy.... more It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy. As such, there is a need for innovative approaches and tools to motivate these children. We developed the low-cost, computer game-based rehabilitation platform CGR that combines fine manipulation and gross movement exercises with attention and planning game activities appropriate for young children with CP. The objective of this study is to provide evidence of the therapeutic value of CGR to improve upper extremity (UE) motor function for children with CP. This randomized controlled, single-blind, clinical trial with an active control arm will be conducted at 4 sites. Children diagnosed with CP between the ages of 4 and 10 years old with moderate UE impairments and fine motor control abnormalities will be recruited. We will test the difference between experimental and control groups using the Quality of Upper Extremity Skills Test (QUEST) and Peabody Developmental Motor Scales, Second E...
BMC Sports Science, Medicine and Rehabilitation, 2016
Background: Generalized joint hypermobility (GJH), in the absence of symptoms, is a common clinic... more Background: Generalized joint hypermobility (GJH), in the absence of symptoms, is a common clinical finding. The joint instability present due to excessive musculoskeletal flexibility in hypermobile joints impairs the external force production during muscle contraction. However, whether GJH is associated with muscle weakness is unclear. This study evaluated differences in upper and lower limb muscle strengths among asymptomatic young adults with and without GJH. Methods: One hundred six young adults (53 hypermobile, i.e. 25 male (mean age 22 ± 1.8); 28 female (mean age 21 ± 1.8), and 53 non-hypermobile, i.e. 25 male (mean age 19 ± 1.06); 28 female (mean age 20 ± 1.4) were selected using a cutoff ≥ 4 on Beighton and Horan Joint Mobility Index. Isometric strength of elbow and knee extensors was measured using an isokinetic dynamometer. Independent sample t-tests were done to compare the muscle strengths of hypermobile and non-hypermobile participants. One-way ANCOVA was applied to control the effect of height and body mass on muscle strength. Results: Male hypermobile participants had significantly less strength than non-hypermobile males in the right (71.
Critical Reviews in Physical and Rehabilitation Medicine, 2015
Background: Deficient fine motor skills in children with cerebral palsy (CP) limit participation ... more Background: Deficient fine motor skills in children with cerebral palsy (CP) limit participation in daily activities. Objective: Evaluate short-term (3 days) effects of kinesiotaping on fine motor function (Peabody Developmental Motor Scale [PDMS-2]) and active wrist extension range of motion (ROM) in children with CP. Method: Kinesio Tex tape was applied on wrist extensors (lateral epicondyle of humerus to dorsal aspect of metacarpal head) for 3 days on 15 children with CP (male = 60%, n = 9; female = 40%, n = 6) aged 3 to 6 years. Pre and post-outcome measures for fine motor function (PDMS-2) and active wrist extension ROM were recorded. Results: Significant changes (p = 0.024) were found in PDMS-2 fine motor scale quotient scores (pre-tape application [60.92 ± 11.49]; third day pre-tape removal [71.84 ± 16.52] and post-tape removal [72.19 ± 16.22]). AROM of wrist extension changed from pre-tape application (51.90 ± 9.12) to third day pre-tape removal and post-tape removal (55.04 ± 9.60); however, these were not significant (p = 0.641). Conclusion: Kinesio Tex tape may improve fine motor skills in children with CP, and as an adjunct to treatment, may assist in achieving goal-oriented functional activities.
Critical Reviews in Physical and Rehabilitation Medicine, 2012
The objective of this study was to compare differences in knee joint proprioception among asympto... more The objective of this study was to compare differences in knee joint proprioception among asymptomatic working and nonworking women aged 50-55 years who sit for prolonged periods. Working women involved in sedentary jobs and age-matched nonworking women from the community, all homemakers, were included in this study. A total of 113 women were screened, and 76 were included in the study (38 working and 38 nonworking). Joint position sense was measured with a standard goniometer at 45°, 60°, and 80° of knee range of motion from flexion to extension. Absolute error and relative error were recorded and analyzed. The average mean absolute error in the nonworking group was more than the average mean relative error in the working group for both the right and left knee. The nonworking women demonstrated more errors in knee joint position sense compared with working women at all angles of measurements.
Critical Reviews in Physical and Rehabilitation Medicine, 2011
The purpose of this study was to establish normative data for the lateral reach test in the adult... more The purpose of this study was to establish normative data for the lateral reach test in the adult population of the Dakshina Kannada region in India. A normative study was done in a sample of 506 (250 male and 256 female) adult subjects in the age group 20-70 years, recruited from the Dakshina Kannada region of Karnataka State, India. The mean, standard deviation, and standard error for the variables, i.e., age, height, weight, right lateral reach, and left lateral reach, were calculated for the entire population (20-70 years), as well as for 20-45 years and 45-70 years age subgroups, separately. We found that mean lateral reach was 6.88 cm and 6.70 cm toward the right and left side, respectively, for females in the age group of 20-45 years (mean age, 35.20 ± 7.139 years), and 3.61 cm and 3.53 cm toward the right and left side, respectively, in females in the age group of 45-70 years (mean age 57.96 ± 6.581 years). In males of 20-45 years (mean age, 32.01 ± 7.135 years), we found the mean lateral reach was 8.06 cm and 7.76 cm, respectively, toward the right and left sides, whereas it was 3.74 cm and 3.58 cm toward the right and left sides, respectively, in those aged 45-70 years (mean age, 56.70 ± 6.199 years).
Indian Journal of Public Health, 2011
The purpose of this study was to find the applicability of Pediatric Quality Of Life Inventory (P... more The purpose of this study was to find the applicability of Pediatric Quality Of Life Inventory (PedsQL) 4.0 (UK version) on Indian children, adolescents, and teenagers. The methodology was that 360 subjects and their parents were selected under four age groups (i.e., 2–4, 5–7, 8–12, and 13–18 years). The subjects and their parents were provided with the child/teenage report and the parent report of the PedsQL 4.0, respectively. After all the reports were collected, the internal consistency reliability, construct validity, and feasibility were computed for the questionnaire. The results were that the paired correlation between the subject and the parent report showed r values for most of the items under the subcategories to be 0.7, but that for all other subcategories were <0.7, indicating poor internal consistency and reliability. The correlation coefficient values were <0.5 for most of the items, indicating failure to establish the validity. The Pearson’s coefficient for all the items was <0.005, indicating high feasibility. The conclusion is that PedsQL 4.0 Generic Core Scales is not an applicable tool to evaluate the health-related quality of life for the children, adolescents, and teenagers in the context of the Indian population we studied and needs to be examined in other centers for validity.
Biomedicine, 2022
Introduction and Aim: Children with Cerebral Palsy (CP) have a longer duration and poor quality o... more Introduction and Aim: Children with Cerebral Palsy (CP) have a longer duration and poor quality of reaching movements than the Typically Developing (TD) children. This may be due to the variations in the antagonistic muscular activity. To evaluate the sequence of activity of muscle groups involved in reaching movements, we planned this study. Materials and Methods: We analyzed the order and timing of Biceps Brachii and Triceps Brachii muscle recruitment pattern among children with CP and TD in forward reach task. Thirty-eight children (n=19 CP and n=19 TD) by recording Electromyogram (EMG), after obtaining ethical clearance. Rectified EMG signals determined the onset of muscle activation, and data were analyzed using unpaired Student’s ‘t’-test and Chi-square test. Results: In CP, there was a greater likelihood of Biceps Brachii (flexor) firing prior to Triceps Brachii as compared to TD, for whom the greater probability of Triceps Brachii firing first. (Likelihood ratio (LLR) =2...
Objectives: Medical research in longitudinal motor developmental studies brings collection of lar... more Objectives: Medical research in longitudinal motor developmental studies brings collection of large data base. Therefore need felt to develop an effective raw data entry method in electronic format using existing software i.e. MS Excel. Methods: 42 infants/children were recruited at the time of birth and were followed up to 36 months of age on Peabody Developmental Motor Scales-2nd edition (PDMS-2) instrument. All 42 subjects had been assessed for 9 times during follow ups at various chronological age points. Total numbers of follow up assessments were 378 i.e. 42 (subjects) × 9 (no. of follow up). Total number of data entry cell required for each subject in this study was approximately 2611. Thus total data entry cell in this study became i.e. 42* 2611 = 109662. Results: Through this process, each child‘s raw data digits i.e. >2600 cells, took only 20 to 30 minutes to enter and processed automatically as summary sheet. This process took 21-22 hours for entry of 109662 raw data d...
Background: The Foot Posture Index (FPI) is a validated method for quantifying standing foot post... more Background: The Foot Posture Index (FPI) is a validated method for quantifying standing foot posture, and is used in a variety of clinical and research settings. However, there have been no retrievable normative data available to date for comparison and reference, for Indian children. Aim: This study aimed at investigating normal foot development and establishing normative FPI-6 reference values of typically developing school children in Mangalore and also at finding the association of foot posture with anthropometric parameters. Methods: 240 children of the group of 6 to 11 years of age were evaluated according to the procedure mentioned in The Foot Posture Index (FPI-6) User Guide and Manual. Results: Prevalence of pronated feet was more common in 6-year old children .Age had a significant effect on all six components of FPI-6 scores for both sexes. A significant association was found between FPI-6 and gender in the age group of 9 years. No correlation was found between anthropome...
The National Medical Journal of India, 2021
Background. We sought to establish reference values of the functional independence measure (WeeFI... more Background. We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3–7 years in India using this cross-sectional study. Methods. We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results. There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions. We have provided reference values for WeeFIM in children of India aged 3–7 years (35–84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.
Developmental Medicine & Child Neurology, 2019
AIM To describe the nature and extent of the literature addressing the medical and its re/habilit... more AIM To describe the nature and extent of the literature addressing the medical and its re/habilitative management of cerebral palsy (CP) in India. METHOD Online worldwide scholarly databases, research hosting directories, Indian publishing houses, and grey literature were used to identify papers published between 2005 and 2016. We retrieved 144 English language papers that described the medical and rehabilitative management of Indian children with CP. RESULTS Quantitative, qualitative, and mixed research designs are published by a variety of health care professionals in India. Intervention (45%) and observational studies (30%) predominate. Outcomes were categorized using the World Health Organization's International Classification of Functioning, Disability and Health framework, with body structure and function most reported and activity/participation least reported; 57% described its re/habilitation interventions and 43% were medical interventions. INTERPRETATION There is a substantial body of CP research in India that focuses on interventions to reduce impairments, with minimal attention given to activities and participation, environmental, and personal factors. Twenty-six per cent of studies are published in what appear to be 'predatory journals'. This paper serves as an alert about the presence of 'predatory journals' in medicine that may introduce publication bias, which can distort results reported in those studies individually, or from conclusions drawn in reviews that contain those studies.
Disability and rehabilitation, Jan 26, 2017
To explore parents' perspectives on rehabilitation of their child with cerebral palsy and the... more To explore parents' perspectives on rehabilitation of their child with cerebral palsy and their information needs. Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework. Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the ...
JMIR research protocols, Jan 18, 2017
It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy.... more It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy. As such, there is a need for innovative approaches and tools to motivate these children. We developed the low-cost, computer game-based rehabilitation platform CGR that combines fine manipulation and gross movement exercises with attention and planning game activities appropriate for young children with CP. The objective of this study is to provide evidence of the therapeutic value of CGR to improve upper extremity (UE) motor function for children with CP. This randomized controlled, single-blind, clinical trial with an active control arm will be conducted at 4 sites. Children diagnosed with CP between the ages of 4 and 10 years old with moderate UE impairments and fine motor control abnormalities will be recruited. We will test the difference between experimental and control groups using the Quality of Upper Extremity Skills Test (QUEST) and Peabody Developmental Motor Scales, Second E...
BMC Sports Science, Medicine and Rehabilitation, 2016
Background: Generalized joint hypermobility (GJH), in the absence of symptoms, is a common clinic... more Background: Generalized joint hypermobility (GJH), in the absence of symptoms, is a common clinical finding. The joint instability present due to excessive musculoskeletal flexibility in hypermobile joints impairs the external force production during muscle contraction. However, whether GJH is associated with muscle weakness is unclear. This study evaluated differences in upper and lower limb muscle strengths among asymptomatic young adults with and without GJH. Methods: One hundred six young adults (53 hypermobile, i.e. 25 male (mean age 22 ± 1.8); 28 female (mean age 21 ± 1.8), and 53 non-hypermobile, i.e. 25 male (mean age 19 ± 1.06); 28 female (mean age 20 ± 1.4) were selected using a cutoff ≥ 4 on Beighton and Horan Joint Mobility Index. Isometric strength of elbow and knee extensors was measured using an isokinetic dynamometer. Independent sample t-tests were done to compare the muscle strengths of hypermobile and non-hypermobile participants. One-way ANCOVA was applied to control the effect of height and body mass on muscle strength. Results: Male hypermobile participants had significantly less strength than non-hypermobile males in the right (71.
Critical Reviews in Physical and Rehabilitation Medicine, 2015
Background: Deficient fine motor skills in children with cerebral palsy (CP) limit participation ... more Background: Deficient fine motor skills in children with cerebral palsy (CP) limit participation in daily activities. Objective: Evaluate short-term (3 days) effects of kinesiotaping on fine motor function (Peabody Developmental Motor Scale [PDMS-2]) and active wrist extension range of motion (ROM) in children with CP. Method: Kinesio Tex tape was applied on wrist extensors (lateral epicondyle of humerus to dorsal aspect of metacarpal head) for 3 days on 15 children with CP (male = 60%, n = 9; female = 40%, n = 6) aged 3 to 6 years. Pre and post-outcome measures for fine motor function (PDMS-2) and active wrist extension ROM were recorded. Results: Significant changes (p = 0.024) were found in PDMS-2 fine motor scale quotient scores (pre-tape application [60.92 ± 11.49]; third day pre-tape removal [71.84 ± 16.52] and post-tape removal [72.19 ± 16.22]). AROM of wrist extension changed from pre-tape application (51.90 ± 9.12) to third day pre-tape removal and post-tape removal (55.04 ± 9.60); however, these were not significant (p = 0.641). Conclusion: Kinesio Tex tape may improve fine motor skills in children with CP, and as an adjunct to treatment, may assist in achieving goal-oriented functional activities.
Critical Reviews in Physical and Rehabilitation Medicine, 2012
The objective of this study was to compare differences in knee joint proprioception among asympto... more The objective of this study was to compare differences in knee joint proprioception among asymptomatic working and nonworking women aged 50-55 years who sit for prolonged periods. Working women involved in sedentary jobs and age-matched nonworking women from the community, all homemakers, were included in this study. A total of 113 women were screened, and 76 were included in the study (38 working and 38 nonworking). Joint position sense was measured with a standard goniometer at 45°, 60°, and 80° of knee range of motion from flexion to extension. Absolute error and relative error were recorded and analyzed. The average mean absolute error in the nonworking group was more than the average mean relative error in the working group for both the right and left knee. The nonworking women demonstrated more errors in knee joint position sense compared with working women at all angles of measurements.
Critical Reviews in Physical and Rehabilitation Medicine, 2011
The purpose of this study was to establish normative data for the lateral reach test in the adult... more The purpose of this study was to establish normative data for the lateral reach test in the adult population of the Dakshina Kannada region in India. A normative study was done in a sample of 506 (250 male and 256 female) adult subjects in the age group 20-70 years, recruited from the Dakshina Kannada region of Karnataka State, India. The mean, standard deviation, and standard error for the variables, i.e., age, height, weight, right lateral reach, and left lateral reach, were calculated for the entire population (20-70 years), as well as for 20-45 years and 45-70 years age subgroups, separately. We found that mean lateral reach was 6.88 cm and 6.70 cm toward the right and left side, respectively, for females in the age group of 20-45 years (mean age, 35.20 ± 7.139 years), and 3.61 cm and 3.53 cm toward the right and left side, respectively, in females in the age group of 45-70 years (mean age 57.96 ± 6.581 years). In males of 20-45 years (mean age, 32.01 ± 7.135 years), we found the mean lateral reach was 8.06 cm and 7.76 cm, respectively, toward the right and left sides, whereas it was 3.74 cm and 3.58 cm toward the right and left sides, respectively, in those aged 45-70 years (mean age, 56.70 ± 6.199 years).
Indian Journal of Public Health, 2011
The purpose of this study was to find the applicability of Pediatric Quality Of Life Inventory (P... more The purpose of this study was to find the applicability of Pediatric Quality Of Life Inventory (PedsQL) 4.0 (UK version) on Indian children, adolescents, and teenagers. The methodology was that 360 subjects and their parents were selected under four age groups (i.e., 2–4, 5–7, 8–12, and 13–18 years). The subjects and their parents were provided with the child/teenage report and the parent report of the PedsQL 4.0, respectively. After all the reports were collected, the internal consistency reliability, construct validity, and feasibility were computed for the questionnaire. The results were that the paired correlation between the subject and the parent report showed r values for most of the items under the subcategories to be 0.7, but that for all other subcategories were <0.7, indicating poor internal consistency and reliability. The correlation coefficient values were <0.5 for most of the items, indicating failure to establish the validity. The Pearson’s coefficient for all the items was <0.005, indicating high feasibility. The conclusion is that PedsQL 4.0 Generic Core Scales is not an applicable tool to evaluate the health-related quality of life for the children, adolescents, and teenagers in the context of the Indian population we studied and needs to be examined in other centers for validity.