Aim An international Clinical Outcomes Group consisting of clinicians, scientists, patient advocacy groups, and industries identified a need for a scale to measure motor performance of the upper limb. We report the steps leading to the development of the Performance of the Upper Limb (PUL), a tool specifically designed for assessing upper limb function in ambulant and non‐ambulant patients with Duchenne muscular dystrophy (DMD). Method The development of the PUL followed a number of steps, from the systematic review and a preliminary study exploring the suitability of the existing measures, to the application of a pilot version in a multicentric setting, with Rasch analysis of the preliminary results, leading to a revised pro forma. Results The PUL was specifically designed for DMD, with a conceptual framework reflecting the progression of weakness and natural history of functional decline in DMD. Modern psychometric methods were used to create a scale with robust internal reliability, validity, and hierarchical scalability; males with DMD and their families were involved iteratively throughout the process of the clinician‐reported outcome assessment tool development to establish clinical meaningfulness and relevance of individual PUL items to activities of daily living. Interpretation The module was developed using innovative approaches and will be useful for designing clinical trials.

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Abstract:A long-held assumption in golf research is that the driver-ball impact is accurately modelled as a collision between two free bodies, i.e., the clubhead is not attached to the shaft. The purpose of this work was to examine the validity of this assumption using multibody simulation and motion capture technology. Ten elite golfers were recruited to participate in a motion capture experiment to validate a Rayleigh beam model of a flexible club. Using the six degree-of-freedom motion of the grip as an input to the model, the simulated shaft deflections showed good agreement with the experiment. An impact model based on volumetric contact was integrated with the flexible club model and was used to compare the launch conditions of free-body and full-club impacts. Analysis of the launch conditions revealed that the shaft creates a stiffening effect that resists clubhead rotation during contact, corresponding to an increase in ball speed and suppression of the gear-effect relative to free-body impacts. The results demonstrate that shaft dynamics cannot be treated as negligible when evaluating driver impact mechanics.

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