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Hayton T, Gross A, Basson A, Olson K, Ang O, Milne N, Pool J. Psychometric measurement properties of patient-reported and observer-reported outcome measures for spinal mobilisations and manipulation on paediatric subjects with diverse medical conditions: A systematic review. J Man Manip Ther 2024; 32:234-254. [PMID: 38146749 PMCID: PMC11216239 DOI: 10.1080/10669817.2023.2281650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/02/2023] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION Reliable, valid, and responsive outcomes is foundational to address concerns about the risks and benefits of performing spinal manipulation and mobilization in pediatric populations. The aim of this systematic review was to synthesize evidence on measurement properties from cohort/case-control/cross-sectional/randomized studies on patient-reported (SQLI - Scoliosis Quality of Life Index; VAS-Visual Analog Scale; PAQLQ - Pediatric Asthma Quality of Life Questionnaire), observer-reported (Crying Diaries; ATEC - Autism Treatment Evaluation Checklist) and mixed (PedsQL - Pediatric Quality of Life Inventory) outcome measurements identified through a scoping review on manipulation and mobilization for pediatric populations with diverse medical conditions. METHOD AND ANALYSIS Electronic databases, clinicaltrial.gov and Ebsco Open Dissertations were searched up to 21 October 202221 October 2022. Two independent reviewers selected studies, extracted data, and assessed risk of bias. Qualitative synthesis was performed using COSMIN and Cochrane GRADE methodology to establish the certainty of evidence and overall rating: sufficient (+), insufficient (-), inconsistent (±), indeterminate (?). RESULTS Eighteen studies (2 SQLI for scoliosis; 1 VAS - perceived influence of exertion or movement/position on low back problems; 1 PAQLQ for asthma; 1 Crying Diaries for infantile colic; 8 ATEC for autism; 5 PedsQL for cerebral palsy/scoliosis/healthy) with 9653 participants were selected. ATEC and PedsQL had overall sufficient (+) measurement properties with moderate certainty evidence. PAQLQ had indeterminate measurement properties with moderate certainty evidence. Very low certainty of evidence identified measurement properties to be indeterminate (?) for SQLI, Crying Diaries, and VAS- perceived influence of exertion or movement/position on low back problems. CONCLUSION ATEC for autism and PedsQL for asthma may be a suitable clinical outcome assessment (COA); additional validation studies on responsiveness and the minimal important difference are needed. Other COA require further validation.
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Affiliation(s)
- Tricia Hayton
- School of Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Anita Gross
- School of Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Annalie Basson
- Faculty of Health Science, Physiotherapy Department, University of Witwatersrand, Johannesburg, South Africa
| | | | - Oliver Ang
- Integrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
| | - Nikki Milne
- International Organisation of Physical Therapists in Paediatrics, Bond University, Gold Coast, Queensland, Australia
| | - Jan Pool
- Institute of Human Movement Studies, University of Applied Sciences. Utrecht The Netherlands
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Herrington J, Batthish M, Takrouri H, Yarascavitch B, Gross A. Asymptomatic intraspinal epidermoid cyst in a 7-year-old male with juvenile idiopathic arthritis identified by an advanced physiotherapist practitioner: a case report. J Man Manip Ther 2024; 32:343-351. [PMID: 38566497 PMCID: PMC11216243 DOI: 10.1080/10669817.2024.2334103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Pediatric intraspinal epidermoid cysts are rare with potential to cause life-altering outcomes if not addressed. Reports to date describe symptomatic presentations including loss of bladder or bowel function and motor and sensory losses. This case report identifies the diagnostic challenge of an asymptomatic intraspinal epidermoid cyst in the cauda equina region presenting in a 7-year-old male with juvenile idiopathic arthritis (JIA). DIAGNOSIS An advanced physiotherapist practitioner assessed and diagnosed a previously healthy 7-year-old-male of South Asian descent with JIA based on persistent knee joint effusions. Complicating factors delayed the investigation of abnormal functional movement patterns, spinal and hip rigidity and severe restriction of straight leg raise, all atypical for JIA. Further delaying the diagnosis was the lack of subjective complaints including no pain, no reported functional deficits, and no neurologic symptoms. A spinal MRI investigation 10-months from initial appointment identified intraspinal epidermoid cysts occupying the cauda equina region requiring urgent referral to neurosurgery. DISCUSSION Clinical characteristics and pattern recognition are essential for diagnosing spinal conditions in pediatric populations. Diagnostic challenges present in this case included co-morbidity (JIA), a severe adverse reaction to treatment, a lack of subjective complaints and a very low prevalence of intraspinal epidermoid cysts. IMPACT STATEMENTS Early signs of pediatric asymptomatic intraspinal epidermoid cysts included abnormal functional movement patterns, rigidity of spine, severely limited straight leg raise and hip flexion without pain. Advanced physiotherapist practitioners can be integral to pediatric rheumatology teams considering their basic knowledge in musculoskeletal examination and functional mobility assessment when identifying rare spinal conditions that present within the complex context of rheumatic diseases.
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Affiliation(s)
- Julie Herrington
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michelle Batthish
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Pediatrics, Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Heba Takrouri
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Pediatrics, Division of Radiology, McMaster University, Hamilton, ON, Canada
| | - Blake Yarascavitch
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
| | - Anita Gross
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Hov B, Andersen T, Toussaint M, Mikalsen IB, Vollsæter M, Brunborg C, Hovde M, Hovland V. Mechanically assisted cough strategies: user perspectives and cough flows in children with neurodisability. ERJ Open Res 2024; 10:00274-2023. [PMID: 38196892 PMCID: PMC10772903 DOI: 10.1183/23120541.00274-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024] Open
Abstract
Background Mechanical insufflation-exsufflation (MI-E) is used to augment cough in children with neurodisability. We aimed to determine the user comfort and cough flows during three MI-E strategies, and to predict factors associated with improved comfort and cough flows. Methods This multicentre, crossover trial was done at four regional hospitals in Norway. Children with neurodisability using MI-E long term via mask were enrolled. In randomised order, they tested three MI-E setting strategies (in-/exsufflation pressure (cmH2O)/in (In)- versus exsufflation (Ex) time): 1) "A-symmetric" (±50/In=Ex); 2) "B-asymmetric" (+25- +30)/-40, In>Ex); and 3) "C-personalised", as set by their therapist. The primary outcomes were user-reported comfort on a visual analogue scale (VAS) (0=maximum comfort) and peak cough flows (PCF) (L·min-1) measured by a pneumotachograph in the MI-E circuit. Results We recruited 74 children median (IQR) age 8.1 (4.4-13.8) years, range 0.6-17.9, and analysed 218 MI-E sequences. The mean±sd VAS comfort scores were 4.7±2.96, 2.9±2.44 and 3.2±2.46 for strategies A, B and C, respectively (A versus B and C, p<0.001). The mean±sd PCF registered during strategies A, B and C were 203±46.87, 166±46.05 and 171±49.74 L·min-1, respectively (A versus B and C, p<0.001). Using low inspiratory flow predicted improved comfort. Age and unassisted cough flows increased exsufflation flows. Conclusions An asymmetric or personalised MI-E strategy resulted in better comfort scores, but lower PCF than a symmetric approach utilising high pressures. All three strategies generated cough flows above therapeutic thresholds and were rated as slightly to moderately uncomfortable.
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Affiliation(s)
- Brit Hov
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tiina Andersen
- Norwegian Advisory Unit on Long-term Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
- The Faculty of Health and Social Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Michel Toussaint
- Centre de Référence Neuromusculaire, Department of Neurology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Ingvild B. Mikalsen
- Department of Paediatric Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen,Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen,Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mathea Hovde
- Clinic of Rehabilitation, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vegard Hovland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Młyńczyk J, Abramowicz P, Stawicki MK, Konstantynowicz J. Non-disease specific patient-reported outcome measures of health-related quality of life in juvenile idiopathic arthritis: a systematic review of current research and practice. Rheumatol Int 2021; 42:191-203. [PMID: 34971434 PMCID: PMC8719533 DOI: 10.1007/s00296-021-05077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with symptoms negatively impacting health-related quality of life (HRQL). Regarding growing interest in the implementation of the patient-reported outcome measures (PROMs), we aimed to review the non-disease specific PROMs addressing HRQL assessment, potentially useful in the clinical care of JIA and daily practice. A systematic literature search was conducted using MEDLINE/PubMed, Google Scholar, Scopus and Embase databases (1990 to 2021), with a focus on the recent 5-years period. Entry keywords included the terms: “children”, “adolescents”, “JIA”, “chronic diseases”, “HRQL”, “PROMs” and wordings for the specific tools. Several available PROMs intended to measure HRQL, non-specific to JIA, were identified. The presented outcomes differed in psychometric properties, yet all were feasible in assessing HRQL in healthy children and those with chronic diseases. Both EQ-5D-Y and PedsQL have already been tested in JIA, showing relevant reliability, validity, and similar efficiency as disease-specific measurements. For PROMIS® PGH-7 and PGH-7 + 2, such validation and cross-cultural adaptation need to be performed. Considering the future directions in pediatric rheumatology, the large-scale implementation of PROMIS® PGH-7 and PGH-7 + 2 in JIA offers a particularly valuable opportunity. The PROMs reflect the patient perception of the chronic disease and allow to understand child’s opinions. The PROMs may provide an important element of the holistic medical care of patients with JIA and a standardized tool for clinical outcomes, monitoring disease severity and response to treatment.
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Affiliation(s)
- Justyna Młyńczyk
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland
| | - Paweł Abramowicz
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland
| | - Maciej K Stawicki
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, University Children's Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274, Bialystok, Poland.
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