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Butler S, Sculley D, Santos D, Girones X, Singh-Grewal D, Coda A. Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study. Healthcare (Basel) 2024; 12:392. [PMID: 38338277 PMCID: PMC10855480 DOI: 10.3390/healthcare12030392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Juvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2-6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0-47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children.
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Affiliation(s)
- Sonia Butler
- School of Bioscience and Pharmacy, University of Newcastle, Ourimbah, NSW 2258, Australia;
| | - Dean Sculley
- School of Bioscience and Pharmacy, University of Newcastle, Ourimbah, NSW 2258, Australia;
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK;
| | - Xavier Girones
- Department of Research, Universities de Catalunya, Generalitat de Catalunya, 08003 Barcelona, Spain;
| | - Davinder Singh-Grewal
- Department of Rheumatology, Sydney Children’s Hospitals Network (Randwick), Randwick, NSW 2031, Australia;
- Department of Rheumatology, Sydney Children’s Hospitals Network (Westmead), Westmead, NSW 2145, Australia
- John Hunter Children’s Hospital, New Lambton Heights, NSW 2305, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Camperdown, NSW 2050, Australia
- School of Women’s and Children’s Health, University of NSW, Sydney, NSW 2052, Australia
| | - Andrea Coda
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia;
- Equity in Health and Wellbeing Research Program, The Hunter Medical Research Institute (HMRI), Newcastle, NSW 2305, Australia
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Manatpreeprem R, Lerkvaleekul B, Vilaiyuk S. Factors associated with medication adherence among children with rheumatic diseases. Front Pharmacol 2023; 14:1149320. [PMID: 37214435 PMCID: PMC10196057 DOI: 10.3389/fphar.2023.1149320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction: Failure to take medications regularly leads to poorer health outcomes. The Pediatric Rheumatology Adherence Questionnaire (PRAQ) is an effective tool for assessing medication adherence in rheumatic patients. Therefore, we aimed to determine the factors associated with poor medication adherence among children with rheumatic diseases. Methods: This was a cross-sectional study. Patients with rheumatic diseases who had taken at least one medication and had been followed up at our pediatric rheumatology clinic were included in the study, together with their caregivers. Patients with poor medication adherence were characterized as those who had taken less than 80% of their prescribed drugs, as determined using the pill count method. The original PRAQ was translated and validated in Thai language and was completed by caregivers and literate patients over age 13 years. Interviewing for additional problems with taking medications was conducted. We performed descriptive and logistic regression analyses. Results: From 210 patients, 52.86% had juvenile idiopathic arthritis (JIA), and 46.19% had connective tissue diseases. The mean patient age was 14.10 ± 4.74 years, with a median (interquartile range) disease duration of 4.33 (2.08-6.98) years. PRAQ scores in the group with poor adherence were significantly higher than scores in the group with good adherence (11.00 ± 3.47 vs. 9.51 ± 3.16, p = 0.004). Enthesitis-related arthritis (ERA) (odds ratio [OR] 9.09, 95% confidence interval [CI] 1.25-66.18; p = 0.029) and polyarticular JIA (OR 6.43, 95% CI 1.30-31.75; p = 0.022) were associated with poor treatment adherence. Disease duration ≥5 years (OR 3.88, 95% CI 1.17-12.87; p = 0.027), active disease (OR 6.49, 95% CI 1.76-23.99; p = 0.005), PRAQ scores ≥12 (OR 6.48, 95% CI 1.76-23.82; p = 0.005), forgetting to take medications (OR 14.18, 95% CI 4.21-47.73; p < 0.001), and unawareness about the importance of the medicines (OR 44.18, 95% CI 11.30-172.73; p < 0.001) were predictors of poor drug adherence. Conclusion: In the present study, poor medication adherence was found in one-fourth of children with rheumatic illnesses, particularly those with ERA, polyarticular JIA, longer disease duration, active disease, and high PRAQ scores. The most frequent reasons for inadequate medication adherence were forgetfulness and unawareness about the importance of disease control and consistency with treatment.
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Kirchner S, Klotsche J, Liedmann I, Niewerth M, Feldman D, Dressler F, Foeldvari I, Foell D, Haas JP, Horneff G, Hospach A, Kallinich T, Kuemmerle-Deschner JB, Moenkemoeller K, Weller-Heinemann F, Windschall D, Minden K, Sengler C. Adherence, helpfulness and barriers to treatment in juvenile idiopathic arthritis - data from a German Inception cohort. Pediatr Rheumatol Online J 2023; 21:31. [PMID: 37046303 PMCID: PMC10091650 DOI: 10.1186/s12969-023-00811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES To develop and evaluate German versions of the Parent Adherence Report Questionnaire (PARQ) and Child Adherence Report Questionnaire (CARQ) and to evaluate adherence in patients with juvenile idiopathic arthritis (JIA). METHODS The PARQ and CARQ were translated into German, cross-culturally adapted and administered to patients (age ≥ 8 years) and their parents enrolled in the Inception Cohort Study of newly diagnosed JIA patients (ICON). The psychometric issues were explored by analyzing their test-retest reliability and construct validity. RESULTS Four hundred eighty-one parents and their children with JIA (n = 465) completed the PARQ and CARQ at the 4-year follow-up. Mean age and disease duration of patients were 10.1 ± 3.7 and 4.7 ± 0.8 years, respectively. The rate of missing values for PARQ/CARQ was generally satisfactory, test-retesting showed sufficient reliability. PARQ/CARQ mean child ability total scores (0-100, 100 = best) for medication were 73.1 ± 23.3/76.5 ± 24.2, for exercise: 85.6 ± 16.5/90.3 ± 15.0, for splints: 72.9 ± 24.2/82.9 ± 16.5. Construct validity was supported by PARQ and CARQ scores for medications, exercise and splints showing a fair to good correlation with the Global Adherence Assessment (GAA) and selected PedsQL scales. Adolescents showed poorer adherence than children. About one third of the parents and children reported medication errors. Perceived helpfulness was highest for medication, and adverse effects were reported the greatest barrier to treatment adherence. CONCLUSIONS The German versions of the PARQ and CARQ appear to have a good reliability and sufficient construct validity. These questionnaires are valuable tools for measuring treatment adherence, identifying potential barriers and evaluating helpfulness of treatments in patients with JIA.
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Affiliation(s)
- Sabine Kirchner
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Ina Liedmann
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Martina Niewerth
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
| | - Debbie Feldman
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
| | - Frank Dressler
- Clinic for Paediatric PneumologyAllergology and Neonatology, Children's Hospital, Medical School Hannover, Hannover, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Paediatric Rheumatology, Hamburg, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Hospital Muenster, Muenster, Germany
| | - Johannes-Peter Haas
- German Centre for Child and Adolescent Rheumatology, Paediatric Rheumatology, Garmisch-Partenkirchen, Germany
| | - Gerd Horneff
- Asklepios Klinik St. Augustin, St. Augustin, Germany
- Department of Paediatric and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anton Hospach
- Olga Hospital, Department of Pediatrics, Stuttgart, Germany
| | - Tilmann Kallinich
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Berlin, Germany
| | - J B Kuemmerle-Deschner
- Division of Pediatric Rheumatology and Autoinflammation Reference Center Tübingen, Department of Pediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Kirsten Moenkemoeller
- Kliniken Köln - Kinderkrankenhaus Amsterdamer Str, Paediatric Rheumatology, Cologne, Germany
| | | | - Daniel Windschall
- Clinic for Paediatric and Adolescent Rheumatology, Northwest German Center for Rheumatology, St. Josef Stift Sendenhorst, Sendenhorst, Germany
- University of Halle-Wittenberg, Halle, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Berlin, Germany
| | - Claudia Sengler
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Epidemiology Unit, Pediatric Rheumatology, Charitéplatz 1, 10117, Berlin, Germany.
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Doumen M, De Cock D, Van Lierde C, Betrains A, Pazmino S, Bertrand D, Westhovens R, Verschueren P. Engagement and attrition with eHealth tools for remote monitoring in chronic arthritis: a systematic review and meta-analysis. RMD Open 2022; 8:rmdopen-2022-002625. [PMID: 36302561 PMCID: PMC9621170 DOI: 10.1136/rmdopen-2022-002625] [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: 07/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Although eHealth tools are potentially useful for remote disease monitoring, barriers include concerns of low engagement and high attrition. We aimed to summarise evidence on patients’ engagement and attrition with eHealth tools for remotely monitoring disease activity/impact in chronic arthritis. Methods A systematic literature search was conducted for original articles and abstracts published before September 2022. Eligible studies reported quantitative measures of patients’ engagement with eHealth instruments used for remote monitoring in chronic arthritis. Engagement rates were pooled using random effects meta-analysis. Results Of 8246 references, 45 studies were included: 23 using smartphone applications, 13 evaluating wearable activity trackers, 7 using personal digital assistants, 6 including web-based platforms and 2 using short message service. Wearable-based studies mostly reported engagement as the proportion of days the tracker was worn (70% pooled across 6 studies). For other eHealth tools, engagement was mostly reported as completion rates for remote patient-reported outcomes (PROs). The pooled completion rate was 80%, although between-study heterogeneity was high (I2 93%) with significant differences between eHealth tools and frequency of PRO-collection. Engagement significantly decreased with longer study duration, but attrition varied across studies (0%–89%). Several predictors of higher engagement were reported. Data on the influence of PRO-reporting frequency were conflicting. Conclusion Generally high patient engagement was reported with eHealth tools for remote monitoring in chronic arthritis. However, we found considerable between-study heterogeneity and a relative lack of real-world data. Future studies should use standardised measures of engagement, preferably assessed in a daily practice setting. Trial registeration number The protocol was registered on PROSPERO (CRD42021267936).
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium,Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Diederik De Cock
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Van Lierde
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Albrecht Betrains
- General Internal Medicine, KU Leuven University Hospitals, Leuven, Belgium
| | - Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Delphine Bertrand
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium,Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium,Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
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Butler S, Sculley D, Santos D, Fellas A, Gironès X, Singh-Grewal D, Coda A. Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e30457. [PMID: 35107431 PMCID: PMC8851322 DOI: 10.2196/30457] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. OBJECTIVE This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. METHODS We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. RESULTS Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good-quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children's and young people's HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I2=79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD -0.14, 95% CI -0.43 to 0.15; I2=53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I2=74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. CONCLUSIONS Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist-children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.
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Affiliation(s)
- Sonia Butler
- School of Bioscience and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Dean Sculley
- School of Bioscience and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Xavier Gironès
- University of Vic-Central University of Catalonia, Manresa, Spain
| | - Davinder Singh-Grewal
- Department of Rheumatology, Sydney Children's Hospitals Network, Randwick and Westmead, Sydney, Australia.,Department of Rheumatology, John Hunter Children's Hospital, Newcastle, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Priority Research Centre Health Behaviour, Hunter Medical Research Institute, Newcastle, Australia
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6
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Lalloo C, Harris LR, Hundert AS, Berard R, Cafazzo J, Connelly M, Feldman BM, Houghton K, Huber A, Laxer RM, Luca N, Schmeling H, Spiegel L, Tucker LB, Pham Q, Davies-Chalmers CC, Stinson JN. The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: a pilot randomized controlled trial. Rheumatology (Oxford) 2021; 60:196-206. [PMID: 32613229 DOI: 10.1093/rheumatology/keaa178] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/14/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and preliminary effectiveness of iCanCope with Pain (iCanCope), a smartphone-based pain self-management program, in adolescents with JIA. iCanCope featured symptom tracking, goal-setting, pain coping skills and social support. METHODS A two-arm pilot randomized controlled trial was used to evaluate the iCanCope app compared with a version with symptom tracking only. Primary (feasibility) outcomes were: participant accrual/attrition rates, success of app deployment, acceptability and adherence. Secondary (preliminary effectiveness) outcomes were: pain intensity, pain-related activity limitations and health-related quality of life. Outcomes were assessed at baseline and 8 weeks. Adherence was defined as the proportion of completed symptom reports: 'low' (≤24%); 'low-moderate' (25-49%); 'high-moderate' (50-75%); or 'high' (76-100%). Linear mixed models were applied for preliminary effectiveness analyses as per intention-to-treat. RESULTS Adolescents (N = 60) were recruited from three paediatric rheumatology centres. Rates of accrual and attrition were 82 and 13%, respectively. Both apps were deployed with high success (over 85%) and were rated as highly acceptable. Adherence was similar for both groups, with most participants demonstrating moderate-to-high adherence. Both groups exhibited a clinically meaningful reduction in pain intensity (≥1 point) that did not statistically differ between groups. There were no significant changes in activity limitations or health-related quality of life. CONCLUSION The iCanCope pilot randomized controlled trial was feasible to implement in a paediatric rheumatology setting. Both apps were deployed successfully, with high acceptability, and were associated with moderate-to-high adherence. Preliminary reductions in pain intensity warrant a future trial to evaluate effectiveness of iCanCope in improving health outcomes in adolescents with JIA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02764346.
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Affiliation(s)
- Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario
| | - Lauren R Harris
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Amos S Hundert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Roberta Berard
- Division of Rheumatology, Children's Hospital London Health Sciences Centre, London, Ontario
| | - Joseph Cafazzo
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark Connelly
- Division of Developmental and Behavioural Health, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario
| | - Kristin Houghton
- Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia
| | - Adam Huber
- Division of Rheumatology, IWK Health Centre, Halifax, Nova Scotia
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario
| | - Nadia Luca
- Section of Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta
| | - Heinrike Schmeling
- Section of Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta
| | - Lynn Spiegel
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario
| | - Lori B Tucker
- Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia
| | - Quynh Pham
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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7
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Tollisen A, Flatø B, Selvaag AM, Aasland A, Ingebrigtsen T, Sagen J, Lerdal A. Treatment Satisfaction With and Adherence to Disease-Modifying Antirheumatic Drugs in Adult Patients With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2019; 73:221-231. [PMID: 31758669 DOI: 10.1002/acr.24113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine medication satisfaction and adherence and their relationships to disease variables and health-related quality of life (HRQoL) in adults with juvenile idiopathic arthritis (JIA). METHODS Patients (n = 96, mean age 25 years, 67% female) completed questionnaires about their health status 19 years after disease onset. Patients receiving biologic disease-modifying antirheumatic drugs (bDMARDs) or methotrexate (MTX) were assessed with the 8-item Morisky Medication Adherence Scale (MMAS-8) and the Treatment Satisfaction Questionnaire for Medication (TSQM), including dimensions of effectiveness, side effects, convenience, and global satisfaction. RESULTS DMARDs were received by 52 patients (54%) (mean age 25 years, 75% female), of which 28 received MTX and 37 received bDMARDs. Patients receiving combination therapy of MTX and bDMARDs (n = 15) reported higher satisfaction with bDMARDs than MTX in the dimensions of side effects and global satisfaction (mean ± SD 92.9 ± 15.5 versus 56.2 ± 30.9, and mean ± SD 67.6 ± 19.8 versus 47.1 ± 21.7; P < 0.001 and P = 0.016, respectively). Patients receiving either bDMARDs (n = 22) or MTX (n = 13) reported higher satisfaction with bDMARDs than MTX for the dimensions of effectiveness and global satisfaction (mean ± SD 78.7 ± 15.4 versus 60.2 ± 19.9, and mean ± SD 73.6 ± 17.7 versus 52.3 ± 23.9; P = 0.004 and P = 0.005, respectively). Nearly one-half of patients (46%) reported low adherence (MMAS-8 score <6) and 25% high adherence (MMAS-8 score = 8). Higher levels of pain, psychological distress, more active joints, and current MTX use were the strongest correlates of lower medication satisfaction. Perceived medication effectiveness and global satisfaction correlated positively with physical and mental HRQoL. CONCLUSION Patients with JIA were more satisfied with bDMARDs than MTX, and 46% reported low adherence. Higher medication satisfaction was associated with better HRQoL.
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Affiliation(s)
- Anita Tollisen
- Oslo University Hospital, Rikshospitalet, Unger-Vetlesens Institute, Lovisenberg Diaconal Hospital, and University of Oslo, Oslo, Norway
| | - Berit Flatø
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | | | | | | | - Joachim Sagen
- Children and Youth Rheumatology Association, Oslo, Norway
| | - Anners Lerdal
- Lovisenberg Diaconal Hospital and University of Oslo, Oslo, Norway
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8
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Brandelli YN, Chambers CT, Tutelman PR, Stinson JN, Huber AM, Wilson JP. Parent Pain Cognitions and Treatment Adherence in Juvenile Idiopathic Arthritis. J Pediatr Psychol 2019; 44:1111-1119. [PMID: 31509198 PMCID: PMC6761964 DOI: 10.1093/jpepsy/jsz067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Given the high levels of pain and low rates of treatment adherence in children with juvenile idiopathic arthritis (JIA) and their families, this study sought to examine the relationship between parent pain cognitions (i.e., pain catastrophizing, fear of pain) and treatment adherence, and how barriers to treatment (e.g., forgetting treatments, children resisting injections) may be implicated in this relationship. METHODS Parents of children under 18 years of age who have been diagnosed with JIA were recruited to complete an online survey. In total, 221 parents (93% mothers) of children aged 2-17 years (M = 11.10, SD = 4.25) took part, completing questions regarding their pain cognitions, perceived barriers to treatment, and their child's arthritis treatment adherence ability. RESULTS Hierarchical regressions demonstrated that both pain cognitions (i.e., pain catastrophizing and fear of pain) were related to a decrease in parent-reported treatment adherence, however, pain catastrophizing was no longer significant when fear of pain was added to the model. The presence of treatment barriers partially mediated the relationship between fear of pain and treatment adherence, above and beyond the alternate model proposed. CONCLUSION These results suggest that parent pain catastrophizing and fears of pain are related to a greater difficulty following treatment plans, possibly in part because of barriers parents experience that preclude adherence. Given these findings, the identification and management of parent pain cognitions is critical to improving treatment adherence and outcomes for children with JIA and their families.
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Affiliation(s)
- Yvonne N Brandelli
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
- Department of Pediatrics, Dalhousie University
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University
- Division of Pediatric Rheumatology, IWK Health Centre
| | - Jennifer P Wilson
- Cassie and Friends: A Society for Children with Juvenile Arthritis and Other Rheumatic Diseases
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9
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Khan S, Mancini J, Hopper C, Rennick JE. Perceptions of Methotrexate Intolerance and Its Impact on Daily Life in School-Age Children with Juvenile Idiopathic Arthritis. J Pediatr Nurs 2019; 48:49-54. [PMID: 31254860 DOI: 10.1016/j.pedn.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Methotrexate (MTX) is a disease modifying anti-rheumatic drug commonly used to treat children with Juvenile Idiopathic Arthritis (JIA). Unfortunately, half of children taking MTX will experience MTX intolerance, which includes distressing gastrointestinal and behavioural symptoms associated with weekly MTX treatment. This qualitative study aimed to explore the perceptions of school-age children with JIA experiencing MTX intolerance, how they managed MTX intolerance, and how it impacted their daily life. DESIGN AND METHODS An interpretive descriptive design was used. Twelve children participated in one individual 30-minute semi-structured interview using a storyboard technique to elicit their perceptions through storytelling. Interview transcripts and observational data collected during the interviews were analyzed using inductive content analysis. RESULTS Children described MTX intolerance as extremely challenging. Three themes emerged from the data: (1) "No kid likes taking MTX". This theme was comprised of two subthemes related to: (a) associative MTX intolerance; namely, "Talking about it sometimes makes me feel sick"; and (b) anticipatory MTX intolerance, "Before [I take it], I have a little stomach ache". Other themes included: (2) The importance of strategies and routines; and (3) Working hard to live with MTX intolerance. CONCLUSIONS This study sheds new light on MTX intolerance as perceived by school-aged children with JIA. Results highlight the importance of providing families and healthcare professionals with the necessary information for early recognition of MTX intolerance and optimizing care through the development of early intervention strategies. PRACTICE IMPLICATIONS Study findings highlight the importance of prioritizing early identification and prevention of MTX intolerance.
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Affiliation(s)
- Sarah Khan
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacqueline Mancini
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Charlene Hopper
- The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Janet E Rennick
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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10
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Silva CA. POOR ADHERENCE TO DRUG TREATMENT IN CHILDREN AND ADOLESCENTS WITH AUTOIMMUNE RHEUMATIC DISEASES. ACTA ACUST UNITED AC 2019; 37:138-139. [PMID: 31241687 PMCID: PMC6651314 DOI: 10.1590/1984-0462/;2019;37;2;00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 12/13/2022]
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11
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Silva VBME, Okamoto KYK, Ozaki LDS, Len CA, Terreri MTDSELRA. EARLY DETECTION OF POOR ADHERENCE TO TREATMENT OF PEDIATRIC RHEUMATIC DISEASES: PEDIATRIC RHEUMATOLOGY ADHERENCE QUESTIONNAIRE - A PILOT STUDY. ACTA ACUST UNITED AC 2019; 37:149-155. [PMID: 30892543 PMCID: PMC6651309 DOI: 10.1590/1984-0462/;2019;37;2;00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/11/2018] [Indexed: 11/21/2022]
Abstract
Objective: To develop a questionnaire that allows the early detection of patients at risk for poor adherence to medical and non-medical treatment in children and adolescents with chronic rheumatic diseases. Methods: The Pediatric Rheumatology Adherence Questionnaire (PRAQ) was applied in recently diagnosed patients within a period of one to four months after confirmation of the rheumatic disease. After six months, the patients’ adherence to the medical and non-medical treatment was assessed. An internal consistency analysis was conducted to eliminate redundant questions in the PRAQ. Results: A total of 33 patients were included in the pilot study. Six months after the PRAQ had been applied, poor global adherence was observed in seven (21.2%) patients and poor adherence to medical treatment in eight (24.2%) patients. No correlation was observed between the PRAQ scores and the percentages of adherence, as well as the stratification for each index, except for a tendency to a correlation between socioeconomic index and poor adherence to medical treatment (p=0.08). A new PRAQ questionnaire with 25 of the 46 original questions was generated as a result of the reliability analysis. Conclusions: The usefulness of this questionnaire in clinical practice should be still evaluated. Due to the importance of a tool for the early detection of rheumatic patients at risk of poor adherence to treatment, the new PRAQ questionnaire should be reviewed and applied in a larger study to better define its validity and reliability.
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Affiliation(s)
| | | | | | - Claudio Arnaldo Len
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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12
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Cai RA, Beste D, Chaplin H, Varakliotis S, Suffield L, Josephs F, Sen D, Wedderburn LR, Ioannou Y, Hailes S, Eleftheriou D. Developing and Evaluating JIApp: Acceptability and Usability of a Smartphone App System to Improve Self-Management in Young People With Juvenile Idiopathic Arthritis. JMIR Mhealth Uhealth 2017; 5:e121. [PMID: 28811270 PMCID: PMC5575419 DOI: 10.2196/mhealth.7229] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/13/2017] [Accepted: 04/14/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Flare-ups in juvenile idiopathic arthritis (JIA) are characterized by joint pain and swelling and often accompanied with fatigue, negative emotions, and reduced participation in activities. To minimize the impact of JIA on the physical and psychosocial development and well-being of young people (YP), it is essential to regularly monitor disease activity and side effects, as well as to support self-management such as adherence to treatment plans and engagement in general health-promoting behaviors. Smartphone technology has the potential to engage YP with their health care through convenient self-monitoring and easy access to information. In addition, having a more accurate summary of self-reported fluctuations in symptoms, behaviors, and psychosocial problems can help both YP and health care professionals (HCPs) better understand the patient's condition, identify barriers to self-management, and assess treatment effectiveness and additional health care needs. No comprehensive smartphone app has yet been developed in collaboration with YP with JIA, their parents, and HCPs involved in their care. OBJECTIVES The objective of this study was to design, develop, and evaluate the acceptability and usability of JIApp, a self-management smartphone app system for YP with JIA and HCPs. METHODS We used a qualitative, user-centered design approach involving YP, parents, and HCPs from the rheumatology team. The study was conducted in three phases: (1) phase I focused on developing consensus on the features, content, and design of the app; (2) phase II was used for further refining and evaluating the app prototype; and (3) phase III focused on usability testing of the app. The interview transcripts were analyzed using qualitative content analysis. RESULTS A total of 29 YP (aged 10-23, median age 17) with JIA, 7 parents, and 21 HCPs were interviewed. Major themes identified as the ones that helped inform app development in phase I were: (1) remote monitoring of symptoms, well-being, and activities; (2) treatment adherence; and (3) education and support. During phase II, three more themes emerged that informed further refinement of the app prototype. These included (4) adapting a reward system to motivate end users for using the app; (5) design of the app interface; and (6) clinical practice integration. The usability testing during phase III demonstrated high rates of overall satisfaction and further affirmed the content validity of the app. CONCLUSIONS We present the development and evaluation of a smartphone app to encourage self-management and engagement with health care for YP with JIA. The app was found to have high levels of acceptability and usability among YP and HCPs and has the potential to improve health care and outcomes for this age group. Future feasibility testing in a prospective study will firmly establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with arthritis.
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Affiliation(s)
- Ran A Cai
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Dominik Beste
- Department of Computer Science, University College London, London, United Kingdom
| | - Hema Chaplin
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Socrates Varakliotis
- Department of Computer Science, University College London, London, United Kingdom
| | - Linda Suffield
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Francesca Josephs
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,University College London Hospitals NHS Foundation Trust, Adolescent Rheumatology, London, United Kingdom
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Infection, Immunity, Inflammation, and Physiological Medicine, London, United Kingdom
| | - Yiannakis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,University College London Hospitals NHS Foundation Trust, Adolescent Rheumatology, London, United Kingdom
| | - Stephen Hailes
- Department of Computer Science, University College London, London, United Kingdom
| | - Despina Eleftheriou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Infection, Immunity, Inflammation, and Physiological Medicine, London, United Kingdom
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13
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Lee WJ, Briars L, Lee TA, Calip GS, Suda KJ, Schumock GT. Use of Tumor Necrosis Factor-Alpha Inhibitors in Children and Young Adults With Juvenile Idiopathic Arthritis or Rheumatoid Arthritis. Pharmacotherapy 2016; 36:1201-1209. [DOI: 10.1002/phar.1856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Leslie Briars
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Katie J. Suda
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center of Innovation for Complex Chronic Healthcare; Hines VA Hospital; Hines Illinois
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
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14
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Burghardt KJ, Thomas ST, Tutag-Lehr V. Off-label use of duloxetine for pediatric neuropathic pain. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.11.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Duloxetine, a serotonin-norepinephrine reuptake inhibitor, has been used successfully for adults for the management of neuropathic pain syndromes. Pediatric data are needed because inadequate neuropathic pain management in children and adolescents results in lower psychosocial functioning, delayed development, and decreased quality of life. We aim to describe a case series on the use of duloxetine for the management of symptoms associated with chronic neuropathic pain syndromes in a pediatric population.
Methods
Data were collected in a naturalistic, consecutive, case report format, from a pediatric pain management clinic for children prescribed duloxetine for analgesia for a variety of neuropathic-type pain conditions. Follow-up data, including self-report of pain, and type and frequency of adverse reactions, were collected to describe the efficacy and safety of duloxetine.
Results
Duloxetine was prescribed for the management of self-reported average pain scores of greater than 5 out of 10 on the Faces Pain Scale–Revised for pain that was resistant to other medications. Each of these patients had comorbid psychiatric diagnoses. Reduction in pain following duloxetine therapy was not universal, and all patients discontinued duloxetine therapy prematurely because of adverse effects.
Conclusion
Further evidence is needed to demonstrate the efficacy and safety of duloxetine for use in pediatric populations with neuropathic components to their pain. Based on our experience, we suggest considering its use only after failure of other agents. The best management of a pediatric patient's pain condition is likely accomplished through a combination of pharmacotherapy and nonpharmacotherapy interventions.
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Affiliation(s)
- K. J. Burghardt
- (Corresponding author) Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan,
| | - S. T. Thomas
- Medical Director, Pediatric Pain Medicine, Anesthesiology Department, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan
| | - V. Tutag-Lehr
- Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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