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Smith KA, Hudson SM, Betz CL, Chwa JS, Cellura R, Van Speybroeck A. Risk factors for unanticipated hospitalizations in children and youth with spina bifida at an urban children's hospital: A cross-sectional study. Disabil Health J 2023; 16:101373. [PMID: 36156271 DOI: 10.1016/j.dhjo.2022.101373] [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: 04/11/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spina bifida (SB) is a condition resulting from the improper closure of the neural tube and vertebral column during fetal development. While patients' life expectancy and quality of life have improved dramatically due to medical advances, children continue to experience health-related issues that often require hospitalizations. OBJECTIVE The association among sociodemographic and clinical characteristics with potentially preventable hospitalizations (PPH) in children and youth with myelomeningocele type SB was investigated in this cross-sectional study. METHODS Chart reviews and data extraction were conducted on 108 children and youth, ages 1 month to 21 years, admitted for PPH in a regional children's academic medical center between May 2017 and July 2019. Sociodemographic variables included sex, age, type of insurance and ethnicity. Clinical variables included level of lesion, ambulation status, shunt dependency and selected diagnostic categories. Univariate, bivariate, and multivariate analyses were conducted to identify factors associated with PPH. RESULTS Factors associated with PPH included being male, ages 5-18 years, low lumbar level lesions, non-ambulatory, with public insurance, Hispanic and shunt dependent. Most hospitalizations (73%) were for neurologic or urologic conditions. Factors independently associated with PPH were ethnicity for urologic conditions, being ambulatory for metabolic conditions, and age for gastroenterology conditions. CONCLUSION Selected demographic and clinical variables were found to be associated with PPH of children and youth with myelomeningocele-type SB. The most common reasons for PPH were shunt malfunctions and urinary tract infections, consistent with other studies.
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Affiliation(s)
- Kathryn A Smith
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - Sharon M Hudson
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Cecily L Betz
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Jason S Chwa
- University of Southern California, Dornsife College of Letters, Arts and Sciences, 3551 Trousdale Pkwy, Los Angeles, CA 90089, USA
| | - Rhonda Cellura
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA
| | - Alexander Van Speybroeck
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
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Polfuss M, Liu T, Smith K, Murphy PS, Ward E, Thibadeau J, Dosa NP, Wang Y, Sawin KJ. Weight Status of Children Participating in the National Spina Bifida Patient Registry. Pediatrics 2022; 150:e2022057007. [PMID: 36416007 PMCID: PMC11037268 DOI: 10.1542/peds.2022-057007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Describe the distribution of weight status categories and determine factors associated with overweight and obesity (OW/OB) in children and adolescents with spina bifida (SB) using the National Spina Bifida Patient Registry. METHODS Demographic, anthropometric, and clinical data collected from 2009 through 2018 was used to describe the prevalence of OW/OB. The generalized estimating equation model (GEE) identified factors associated with OW/OB among individuals with SB. RESULTS Participants (n = 7215) were aged 2 to 19 years (mean = 11.1; standard error, 0.06) and 51.4% female. The majority were non-Hispanic white (57.2%) followed by Hispanic or Latino (25.1%) and non-Hispanic Black (7.5%). The myelomeningocele (MMC) subgroup accounted for 76.3%. Most (60.2%) were community ambulators. The overall percentage of OW/OB was 45.2%, with 49.2% of MMC and 32.0% of nonmyelomeningocele OW/OB. Following the Centers for Disease Control Obesity Severity Classification System, 19.7% of MMC were in class 1, 6.6% in class 2, and 3.5% in class 3. Univariate analysis of MMC participants demonstrated demographic (age, sex, race/ethnicity, and clinic region) and clinical variables (functional level of lesion, ambulation, and number of shunt surgeries) were associated with OW/OB. The GEE model showed that OW/OB was independently, and significantly, associated with age, sex, race/ethnicity, lesion levels, and geographic location of the clinics. CONCLUSIONS The demographic and clinical factors associated with OW/OB in children and adolescents with SB further our understanding of factors contributing to the higher prevalence of OW/OB in this population and may inform OW/OB prevention and treatment strategies.
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Affiliation(s)
- Michele Polfuss
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Tiebin Liu
- Rare Disorders and Health Outcomes Team, Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Smith
- Department of Pediatrics, Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California, USA
| | - Pamela S. Murphy
- District Medical Group Children’s Rehabilitative Services, Phoenix, Arizona, USA
| | - Elisabeth Ward
- Carter Consulting, Inc, Consultant to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nienke P. Dosa
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Yinding Wang
- McKing Consulting Corporation, Consultant to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen J. Sawin
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Children’s Wisconsin, Milwaukee, Wisconsin, USA
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Petronic Markovic I, Nikolic D, Stahl M, Tederko P, Hdyrya O, Negrini S, Zampolini M, Kiekens C. Evidence-based position paper of the UEMS PRM on the role of Physical and Rehabilitation Medicine (PRM) physician in the management of children and adults with spinal dysraphism. Eur J Phys Rehabil Med 2022; 58:511-519. [PMID: 35575455 PMCID: PMC9980507 DOI: 10.23736/s1973-9087.22.07536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PRM section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.
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Affiliation(s)
- Ivana Petronic Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Minna Stahl
- National Center for Pediatric and Adolescent Pain Management and Research, New Children's Hospital, HUS, Helsinki, Finland
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Oksana Hdyrya
- Department of Rehabilitation and Alternative Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Stefano Negrini
- La Statale University, Milan, Italy.,IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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Improvement of bladder function after bladder augmentation surgery: a report of 26 years of clinical experience. Pediatr Surg Int 2022; 38:941-948. [PMID: 35348841 PMCID: PMC9054860 DOI: 10.1007/s00383-022-05114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION To assess the long-term effect of bladder augmentation surgery in patients with spina bifida and to identify risk factors for severe bladder dysfunction requiring bladder augmentation. METHODS A retrospective analysis was performed on 178 patients with spina bifida, 23 of them underwent bladder augmentation. Surgery outcome was evaluated according to urodynamic assessments at three follow-up time points per patient up to 120 months postoperatively. The results were compared to the preoperative situation and to the non-operated control group. Bladder function was evaluated using the modified Hostility score. To identify risk factors for bladder dysfunction requiring bladder augmentation, characteristics such as type of spina bifida, lesion level and therapy of bladder dysfunction were analyzed. RESULTS A high spinal lesion level is a risk factor for requiring bladder augmentation. In the BA group, significantly more thoracic lesions were found than NBA group, BA: 26.1%, NBA: 8.4% (p = 0.021). With bladder augmentation surgery, the modified Hostility score decreased from a preoperative median value of 4.3 ± 1.4 to 1.6 ± 1.0 at the third postoperative follow-up (FU3 = 61-120 months after surgery). In the reference group, the score of the last urological assessment was 2.0 ± 1.5. The age at which clean intermittent catheterization or anticholinergic medication started had no significant influence on the decision to perform bladder augmentation. DISCUSSION/CONCLUSION Spina bifida patients with bladder augmentation had a significant improvement of the bladder function even at long-term follow-up. A high level of spinal lesion was a predisposing factor for requiring a bladder augmentation.
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Perenc L, Guzik A, Podgórska-Bednarz J, Drużbicki M. Somatic Development Disorders in Children and Adolescents Affected by Syndromes and Diseases Associated with Neurodysfunction and Hydrocephalus Treated/Untreated Surgically. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095712. [PMID: 35565107 PMCID: PMC9105737 DOI: 10.3390/ijerph19095712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Background: This study was conducted to evaluate the co-occurrence of hydrocephalus treated/untreated surgically and congenital nervous system disorders or neurological syndromes with symptoms visible since childhood, and with somatic development disorders, based on significant data obtained during admission to a neurological rehabilitation unit for children and adolescents. Methods: The study applied a retrospective analysis of data collected during hospitalization of 327 children and adolescents, aged 4−18 years, all presenting congenital disorders of the nervous system and/or neurological syndromes associated with at least one neurodysfunction that existed from early childhood. To allow the identification of individuals with somatic development disorders in the group of children and adolescents with hydrocephalus treated/untreated surgically, the adopted criteria considered the z-score values for body height, body weight, head circumference, body mass index, and head circumference index. Results: Treated/untreated hydrocephalus was observed in the study group at the rates of 8% and 0.9%, respectively. Among 239 patients with cerebral palsy, 9 (3.8%) had surgically treated hydrocephalus, 17 (70.8%) of 24 patients with neural tube defects also had hydrocephalus treated with surgery, and 3 (12.5%) of 24 patients with neural tube defects had untreated hydrocephalus. This medical condition was a more frequent comorbidity in subjects with neural tube defects compared with those with cerebral palsy (p < 0.001). Subjects with untreated hydrocephalus most frequently presented macrocephaly (p < 0.001), including absolute macrocephaly (p = 0.001), and with tall stature (p = 0.007). Excessive body mass co-occurred more frequently with surgically untreated hydrocephalus, but the relationship was not statistically significant (p = 0.098). Conclusions: Surgically treated hydrocephalus occurred in patients with cerebral palsy and neural tube defects, and untreated hydrocephalus was present only in patients with neural tube defects. Untreated hydrocephalus negatively changed the course of individual development in the studied group of children, in contrast to surgically treated hydrocephalus.
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Peterson MD, Lin P, Kamdar N, Hurvitz EA, Mahmoudi E. Psychological, Cardiometabolic, and Musculoskeletal Morbidity and Multimorbidity Among Adults With Cerebral Palsy and Spina Bifida: A Retrospective Cross-sectional Study. Am J Phys Med Rehabil 2021; 100:940-945. [PMID: 34001837 PMCID: PMC9642813 DOI: 10.1097/phm.0000000000001787] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individuals living with cerebral palsy or spina bifida are at heightened risk for a number of chronic health conditions, such as secondary comorbidities, that may develop or be influenced by the disability, the presence of impairment, and/or the process of aging. However, very little is known about the prevalence and/or risk of developing secondary comorbidities among individuals living with cerebral palsy or spina bifida throughout adulthood. The objective of this study was to compare the prevalence of psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity among adults with and without cerebral palsy or spina bifida. METHODS Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for cerebral palsy or spina bifida (n = 29,841). Adults without cerebral palsy or spina bifida were also included (n = 5,384,849). Prevalence estimates of common psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity (≥2 conditions) were compared. RESULTS Adults living with cerebral palsy or spina bifida had a higher prevalence of all psychological disorders and psychological multimorbidity (14.6% vs. 5.4%), all cardiometabolic disorders and cardiometabolic multimorbidity (22.4% vs. 15.0%), and all musculoskeletal disorders and musculoskeletal multimorbidity (12.2% vs. 5.4%), as compared with adults without cerebral palsy or spina bifida, and differences were to a clinically meaningful extent. CONCLUSIONS Adults with cerebral palsy or spina bifida have a significantly higher prevalence of common psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity, as compared with adults without cerebral palsy or spina bifida. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of disease onset/progression in these higher risk populations. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) List the main categories of morbidity that present with higher risk in adults with cerebral palsy and spina bifida; (2) Discuss the potential impact of multimorbidity on 'early aging' in adults living with cerebral palsy and spina bifida; and (3) Describe challenges that adults with cerebral palsy and spina bifida have in obtaining appropriate health care to address prevention and treatment of multimorbidity. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan
- Department of Emergency Medicine, Michigan Medicine, University of Michigan
- Department of Surgery, Michigan Medicine, University of Michigan
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, Michigan Medicine, University of Michigan
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Peterson MD, Haapala H, Kamdar N, Lin P, Hurvitz EA. Pain phenotypes among adults living with cerebral palsy and spina bifida. Pain 2021; 162:2532-2538. [PMID: 34534178 PMCID: PMC9665000 DOI: 10.1097/j.pain.0000000000002240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain is the most commonly reported physical symptomology of cerebral palsy (CP) and spina bifida (SB) throughout the lifespan, and yet, pain is perhaps the least understood comorbidity in these populations. The objective of this study was to compare the prevalence and types of pain diagnosed among adults living with and without CP or SB. In this retrospective cohort study, we analyzed data from a nationwide commercial insurance claims database. Beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnosis code for CP or SB (n = 22,648). Adults without CP or SB were also included as controls (n = 931,623). Pain phenotypes (nociceptive, nociplastic, and neuropathic pain) and pain multimorbidity (≥2 conditions) were compared. We found that adults living with CP or SB had a higher prevalence of any pain disorders (55.9% vs 35.2%), nociceptive pain (44.0% vs 26.7%), nociplastic pain (26.1% vs 11.9%), neuropathic pain (9.6% vs 5.6%), and pain multimorbidity (21.1% vs 8.4%), as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Adjusted odds ratios of nociceptive pain (odds ratio [OR]: 2.20; 95% confidence interval [CI]: 2.15-2.24), nociplastic pain (OR: 2.47; 95% CI: 2.41-2.53), neuropathic pain (OR: 2.71; 95% CI: 2.54-2.89), and other pain (OR: 3.92; 95% CI: 3.67-4.19) were significantly higher for adults living with CP or SB. In conclusion, adults with CP or SB have a significantly higher prevalence and odds of common peripheral, central, and neuropathic pain disorders and pain multimorbidity, as compared to adults without CP or SB.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Heidi Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan
- Department of Emergency Medicine, Michigan Medicine, University of Michigan
- Department of Surgery, Michigan Medicine, University of Michigan
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Bendt M, Seiger Å, Hagman G, Hultling C, Franzén E, Forslund EB. Adults with spina bifida: ambulatory performance and cognitive capacity in relation to muscle function. Spinal Cord 2021; 60:122-128. [PMID: 34262127 DOI: 10.1038/s41393-021-00658-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3. SETTING Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden. METHODS A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis. RESULTS In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity. CONCLUSIONS Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.
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Affiliation(s)
- Martina Bendt
- Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden. .,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Åke Seiger
- Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Göran Hagman
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.,Spinalis, Foundation, Stockholm, Sweden.,Sophiahemmet, University College, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem R & D Unit, Stockholm, Sweden
| | - Emelie Butler Forslund
- Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
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Lee SH, Shin HI, Nam TK, Park YS, Kim DK, Kwon JT. Growth profile assessment of young adults with tethered cord syndrome: a retrospective cohort analysis of Korean conscription data. Childs Nerv Syst 2021; 37:1973-1981. [PMID: 33392650 DOI: 10.1007/s00381-020-05026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Tethered cord syndrome (TCS) is characterized by progressive spinal cord degeneration secondary to congenital spinal dysraphism. The associated accompanying physical inactivity and musculoskeletal deformities have raised interest in the growth profile of adult TCS patients. However, few previous studies have investigated the growth profile of adult TCS patients. METHODS We retrospectively reviewed the demographic data and medical records of 20-year-old Korean conscription examinees who were registered between April 2004 and September 2019. In total, 151 examinees with a diagnosis of TCS were enrolled. The height, weight, and body mass index (BMI) of 300 randomly selected examinees were compared to the TCS group. Obesity was defined by the World Health Organization and Asian-Pacific criteria for BMI and compared between the groups. Growth profile differences according to tethering location and musculoskeletal deformities were analyzed in both groups. RESULTS The mean height, weight, and BMI values of the TCS group were lower than those of the control group. The TCS group had a lower proportion of obese and overweight individuals, and a higher proportion of underweight individuals, according to both BMI criteria. The tethering level was not associated with the degree of obesity in the tethered group. The mean height, weight, and BMI were lower in the tethered group regardless of the existence of musculoskeletal deformity. CONCLUSION Enrollees with a history of TCS were smaller than controls of the same age. Monitoring of health behaviors, including nutrition, diet, and exercise, is warranted for TCS patients.
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Affiliation(s)
- Shin Heon Lee
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Hyun Iee Shin
- Department of Rehabilitation Medicine, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea.
| | - Taek-Kyun Nam
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Yong-Sook Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Don-Kyu Kim
- Department of Rehabilitation Medicine, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, 06973, South Korea
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Peterson MD, Lin P, Kamdar N, Mahmoudi E, Marsack-Topolewski CN, Haapala H, Muraszko K. Psychological morbidity among adults with cerebral palsy and spina bifida. Psychol Med 2021; 51:694-701. [PMID: 32713401 PMCID: PMC9650963 DOI: 10.1017/s0033291720001981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Very little is known about the risk of developing psychological morbidities among adults living with cerebral palsy (CP) or spina bifida (SB). The objective of this study was to compare the incidence of and adjusted hazards for psychological morbidities among adults with and without CP or SB. METHODS Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnostic code for CP or SB (n = 15 302). Adults without CP or SB were also included (n = 1 935 480). Incidence estimates of common psychological morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. RESULTS Adults living with CP or SB had a higher 4-year incidence of any psychological morbidity (38.8% v. 24.2%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for any psychological morbidity [hazard ratio (HR): 1.60; 95% CI 1.55-1.65], and all but one psychological disorder (alcohol-related disorders), and ranged from HR: 1.32 (1.23, 1.42) for substance disorders, to HR: 4.12 (3.24, 5.25) for impulse control disorders. CONCLUSIONS Adults with CP or SB have a significantly higher incidence of and risk for common psychological morbidities, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce the risk of disease onset/progression in these higher-risk populations.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan
- Department of Emergency Medicine, Michigan Medicine, University of Michigan
- Department of Surgery, Michigan Medicine, University of Michigan
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, Michigan Medicine, University of Michigan
| | | | - Heidi Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karin Muraszko
- Department of Neurosurgery, Michigan Medicine, University of Michigan
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Ridosh MM, Stiles-Shields C, Stern A, Winning AM, Anderson L, Sawin KJ, Holmbeck GN. The Adolescent/Young Adult Self-Management and Independence Scale (AMIS-II): Expanding evidence for validity and reliability. J Pediatr Rehabil Med 2021; 14:583-596. [PMID: 33935116 PMCID: PMC8788943 DOI: 10.3233/prm-200679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this longitudinal study was to evaluate the internal consistency reliability and construct validity of the Adolescent/Young Adult Self-Management and Independence Scale-II (AMIS-II), an interview-based measure of self-management for youth with chronic health conditions. METHODS A diverse sample of adolescents and young adults (AYA) with spina bifida (SB) (n = 64 AYA; mean 20.88; age range 18-25 years) completed an AMIS-II interview. Six years earlier, parents from 55 families completed questionnaires that assessed children's responsibility for SB-related care (Sharing of Spina Bifida Management Responsibilities) and their ability to perform skills across condition-related tasks (The Spina Bifida Independence Survey). Parents also reported on child's communication skills, adaptive behaviors, and independent management of finances (Adaptive Behavior Assessment System-Second Edition; Scales of Independent Behavior-Revised). Descriptive and correlational analyses were conducted to assess the construct validity and the internal consistency reliability of the AMIS-II. RESULTS The AMIS-II demonstrated excellent internal consistency reliability (AMIS-II total scale α= 0.95; subscales α= 0.90 -0.91). Evidence in support of construct validity was found in associations between the AMIS-II and measures of child responsibility for SB-related care, ability to perform condition-related skills, and adaptive behaviors (r's = 0.378 -0.777; p's < 0.05). CONCLUSION This study provides further evidence of strong reliability and validity for the AMIS-II. Additional research with this measure will facilitate a better understanding of factors related to self-management behaviors in adolescents and young adults with spina bifida.
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Affiliation(s)
- Monique M Ridosh
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Alexa Stern
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Adrien M Winning
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Lara Anderson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA.,Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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12
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Alriksson-Schmidt AI, Ong K, Reeder MR, Thibadeau JK, Feldkamp ML. Site, frequency, and duration of pain in young children with spina bifida. J Pediatr Rehabil Med 2021; 14:571-582. [PMID: 34776433 PMCID: PMC8764594 DOI: 10.3233/prm-190661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To investigate the: (1) percent of children with spina bifida (SB) complaining of pain, (2) frequency, duration, and cause of pain by sex, level of lesion type of SB, and ambulation status, (3) body sites reported to hurt, by variables in objective 2, and (4) associations between physical and mental/emotional health between caregiver and child. METHODS Cross-sectional study of 101 caregivers of children (3 to 6 years old) with SB. Survey data and information from medical records were included. Pearson chi-square, one-way ANOVA, Fisher's exact test, logistic regressions, and bivariate correlations were used. RESULTS Seventy percent reported that their child complained of pain, which did not significantly differ by sex, level of lesion, type of SB, or ambulation status. Most (86%) were reported to have experienced pain for less than 24 hours. The most frequently reported pain site was the head, followed by the abdomen and the lower body. Number of pain sites was moderately correlated with frequency of pain complaints. Correlations between how caregivers reported their own physical/mental/emotional health and how they rated that of their children ranged from weak (r = 0.22) to moderate (r = 0.55). CONCLUSION Almost seven of ten children reportedly complained of pain ranging from at least once a month to everyday. Pain needs to be routinely assessed and treated in this population.
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Affiliation(s)
- Ann I Alriksson-Schmidt
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
| | - Katherine Ong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Reeder
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Marcia L Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
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13
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Peterson MD, Lin P, Kamdar N, Mahmoudi E, Schmidt MM, Haapala HJ, Hurvitz EA. Cardiometabolic Morbidity in Adults With Cerebral Palsy and Spina Bifida. Am J Med 2020; 133:e695-e705. [PMID: 32687812 PMCID: PMC9645295 DOI: 10.1016/j.amjmed.2020.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to compare the incidence of, and adjusted hazards for, cardiometabolic morbidities among adults with and without cerebral palsy or spina bifida. METHODS Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for cerebral palsy or spina bifida (n = 15,302). Adults without cerebral palsy or spina bifida were also included (n = 1,935,480). Incidence estimates of common cardiometabolic morbidities were compared at 4 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios (HRs) for incident cardiometabolic morbidities. RESULTS Adults living with cerebral palsy or spina bifida had a higher 4-year incidence of any cardiometabolic morbidity (41.5% vs 30.6%) as compared to adults without cerebral palsy or spina bifida, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with cerebral palsy or spina bifida had a greater hazard for any cardiometabolic morbidity (HR: 1.52; 95% confidence interval [CI]: 1.47, 1.57), and all but 1 cardiometabolic disorder (nonalcoholic fatty liver disease) and ranged from HR: 1.20 (1.15, 1.25) for hypercholesterolemia to HR: 1.86 (1.74, 1.98) for heart failure. CONCLUSIONS Adults with cerebral palsy or spina bifida have a significantly higher incidence of, and risk for, common cardiometabolic morbidities, as compared to adults without cerebral palsy or spina bifida. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of cardiometabolic disease onset and progression in these higher-risk populations.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation; Institute for Healthcare Policy and Innovation.
| | - Paul Lin
- Institute for Healthcare Policy and Innovation
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation; Department of Obstetrics and Gynecology; Department of Emergency Medicine; Department of Surgery
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation; Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor
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14
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Lundberg Larsen K, Maalen-Johansen IK, Rennie L, Lidal IB. Gait Function in Adults Aged 50 Years and Older With Spina Bifida. Arch Phys Med Rehabil 2020; 102:702-708. [PMID: 33166524 DOI: 10.1016/j.apmr.2020.10.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To study gait function among individuals with spina bifida (SB) aged 50 years or older. DESIGN A cross-sectional study conducted in 2017. SETTING Home-dwelling participants from all regions in Norway. PARTICIPANTS Individuals between the ages of 51 and 76 years (N=26; 16 women) categorized as independent walkers (n=9), walkers with aids (n=10) and nonwalkers (n=7). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Questionnaire, pain assessment, anthropometry, Falls Efficacy Scale International (FES-I), objective gait analysis, 6-minute walk test (6MWT), and timed Up and Go (TUG). RESULTS Walking speed correlated with SB severity (ρ=-.59; P=.008). Individuals who walked slower than 0.81 m/s had a higher body mass index (BMI) than those who walked faster (P=.008). Independent walkers walked slower than healthy age-matched walkers (P=.046); spatiotemporal variables showed that this was owing to shorter steps rather than cadence. The mean TUG was 10.6±2.6 seconds in independent walkers and 20.2±6.5 in walkers with aids (P<.01). The mean 6MWT was 504±126 meters in independent walkers and 316±88 in walkers with aids (P<.01). The mean pain intensity (numeric rating scale) was 4.9±2.2 in independent walkers and 4.2±1.6 in walkers with aids, but the difference was not statistically significant. FES-I was significantly lower among independent walkers (mean, 23.6±3.9) than walkers with aids (mean, 31.4±10.0) (P=.042). CONCLUSIONS Participants commonly experienced an early onset deterioration in gait function, and walking speed was influenced by SB severity and BMI. This highlights the importance of early monitoring and weight management during follow-up for SB.
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Affiliation(s)
| | | | - Linda Rennie
- Sunnaas Rehabilitation Hospital, Research Department, Nesodden, Norway
| | - Ingeborg B Lidal
- TRS Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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15
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Bendt M, Gabrielsson H, Riedel D, Hagman G, Hultling C, Franzén E, Eriksson M, Seiger Å. Adults with spina bifida: A cross-sectional study of health issues and living conditions. Brain Behav 2020; 10:e01736. [PMID: 32633090 PMCID: PMC7428499 DOI: 10.1002/brb3.1736] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To describe health issues and living conditions in a cohort of adults living with Spina bifida. MATERIAL AND METHODS A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used. RESULTS There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function. CONCLUSIONS This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.
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Affiliation(s)
- Martina Bendt
- Rehab Station Stockholm, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Gabrielsson
- Rehab Station Stockholm, Spinalis Outpatient Clinic, Solna, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Göran Hagman
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.,Spinalis Foundation, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem R&D Unit, Stockholm, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Åke Seiger
- Rehab Station Stockholm, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
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16
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Rendeli C, Kuczynska E, Giuliano AC, Chiaretti A, Ausili E. Dietary approach to prevent obesity risk in Spina Bifida patients. Childs Nerv Syst 2020; 36:1515-1520. [PMID: 31863149 DOI: 10.1007/s00381-019-04471-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this prospective, analytic study is to evaluate if dietary approach can improve the body mass index (BMI) in a total of N = 152 patients with SB. METHODS BMI levels were evaluated stratifying patients by gender and age classes. Patients with BMI ≥ 25 have been randomized (1:1) in two groups: the "diet" group that received a dietary program and the "no diet" group that did not receive any program. Patients have been observed at the beginning of the study (T0), and again at the end of the study, 1 year later (T1). The main objective of the study was to evaluate BMI score in SB patients and how it could be influenced by dietary changes. RESULTS A total of 36.8% patients were classified as overweight or obese. Females present a mean BMI level higher than male, and patients older than 20 years old present the highest mean BMI. The "diet" group BMI decreased from 29.7 (± 3.8) to 27.7 (± 3.7) during the year of program. The mean BMI in the "no diet" group decreased from 30.3 (± 4.6) to 29.2 (± 4.7). There was a statistically significant difference in BMI level between groups (p < 0.0005). There was a statistically significant effect of time on BMI levels for the "diet program" group (p = 0.001), and there was NOT a statistically significant effect of time on BMI levels for the "no diet group" (p = 0.053). CONCLUSIONS Spina Bifida population has high risk of obesity which is related to other comorbidities such as diabetes and hypertension for example. Specific dietary program, since pediatric age, correlates with an improvement of quality of life, a reduction of BMI and of risk of related diseases with obesity. This study confirms that the transition to adulthood marks the beginning of the overweight status for many SB patients, but it also demonstrates that, following a dietary program, even disabled patients with limited training capabilities can achieve a BMI reduction.
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Affiliation(s)
- Claudia Rendeli
- Spina Bifida Center-Pediatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 8, 00168, Rome, Italy.
| | - E Kuczynska
- Spina Bifida Center-Pediatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 8, 00168, Rome, Italy
| | - A C Giuliano
- Spina Bifida Center-Pediatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 8, 00168, Rome, Italy
| | - A Chiaretti
- Spina Bifida Center-Pediatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 8, 00168, Rome, Italy
| | - E Ausili
- Spina Bifida Center-Pediatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 8, 00168, Rome, Italy
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17
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Stiles-Shields C, Crowe AN, Driscoll CFB, Ohanian DM, Stern A, Wartman E, Winning AM, Wafford QE, Lattie EG, Holmbeck GN. A Systematic Review of Behavioral Intervention Technologies for Youth With Chronic Health Conditions and Physical and Intellectual Disabilities: Implications for Adolescents and Young Adults With Spina Bifida. J Pediatr Psychol 2020; 44:349-362. [PMID: 30561676 DOI: 10.1093/jpepsy/jsy097] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management. METHOD The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342). RESULTS In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition. CONCLUSIONS Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.
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Affiliation(s)
| | | | | | | | - Alexa Stern
- Psychology Department, Loyola University Chicago
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18
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Stiles-Shields C, Anderson L, Driscoll CFB, Ohanian DM, Starnes M, Stern A, Yunez J, Holmbeck GN. Technology usage and barriers to the use of behavioral intervention technologies in adolescents and young adults with spina bifida. J Pediatr Rehabil Med 2020; 13:675-683. [PMID: 32986627 DOI: 10.3233/prm-190652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The majority of behavioral intervention technologies (BITs) have been designed and targeted towards the general population (i.e., typically-developing individuals); thus, little is known about the use of BITs to aid those with special needs, such as youth with disabilities. The current study assessed adolescents and young adults with spina bifida (AYA-SB) for: 1) their technology usage, and 2) anticipated barriers to using technology to help manage their health. METHODS AYA-SB completed a survey of their media and technology usage. A card sorting task that ranked and grouped anticipated barriers to using a mobile app to manage health was also completed. Ranked means, standard deviations, and the number of times a barrier was discarded were used to interpret sample rankings. RESULTS AYA-SB reported less frequent technology and media use than the general population. However, differences emerged by age, with young adults endorsing higher usage than their younger counterparts. Top concerns focused on usability, accessibility, safety, personal barriers due to lack of engagement, technological functioning, privacy, and efficacy. CONCLUSIONS AYA-SB appear to be selective users of technology. It is therefore critical that the design of BITs address their concerns, specifically aiming to have high usability, accessibility, and engagement.
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Affiliation(s)
- Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center, Chicago, IL, USA
| | - Lara Anderson
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | | | - Diana M Ohanian
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Meredith Starnes
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Alexa Stern
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Jessica Yunez
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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19
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McPherson AC, Chen L, O'Neil J, Vanderbom KA. Nutrition, metabolic syndrome, and obesity: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:637-653. [PMID: 33325412 PMCID: PMC7838992 DOI: 10.3233/prm-200753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Nutritional challenges and a lack of activity can lead to health problems across the lifespan for people with spina bifida. Children and adults with spina bifida are also at greater risk of being classified as overweight or obese compared to their peers without the condition. Therefore, early recognition of nutrition problems, weight management counseling, and timely referrals for evaluation and management of diet and activity can help those with spina bifida and their families achieve a healthy lifestyle. This article details the development of the Nutrition, Metabolic Syndrome and Obesity Guidelines, which are part of the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida. It discusses the identification and management of poor nutrition and prevention of obesity for children, adolescents, and adults with spina bifida and highlights areas requiring further research.
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Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Lorry Chen
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Joseph O'Neil
- Indiana University School of Medicine, Riley Hospital for Children Indiana University Health, Indianapolis, IN, USA
| | - Kerri A Vanderbom
- National Center on Health, Physical Activity and Disability, University of Alabama at Birmingham/Lakeshore Research Collaborative, Birmingham, AL, USA
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20
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Abstract
Spina bifida's (SB) impact on cognitive, physical, and psychosocial functioning places individuals at risk for mental health concerns. This article discusses the SB Mental Health Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida and reviews evidence-based directions with the intention of helping individuals with SB achieve optimal mental health throughout the lifespan. Guidelines address clinical questions pertaining to the psychosocial impact of SB on mental health and adaptation, domains of mental health that are affected in individuals with SB, areas of resilience, common maladaptive behaviors that may impact people with SB, and resources or practices that are helpful in mitigating mental health issues in this population. Gaps in the research and future directions are discussed.
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Affiliation(s)
- Tessa K Kritikos
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Kathryn Smith
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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21
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Stiles-Shields C, Garcia B, Villota K, Wartman E, Winning AM, Holmbeck GN. Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study. JMIR Pediatr Parent 2019; 2:e15153. [PMID: 31603432 PMCID: PMC6813487 DOI: 10.2196/15153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. OBJECTIVE This study aimed to evaluate the usability of a high-quality, publicly available, weight management-focused mobile BIT (smartphone app) for AYA-SBs. METHODS Overall, 28 AYA-SBs attending a Young Men's Christian Association-based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. RESULTS The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. CONCLUSIONS AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs.
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Affiliation(s)
- Colleen Stiles-Shields
- Population Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Brittney Garcia
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Kimberly Villota
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Elicia Wartman
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Adrien M Winning
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
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22
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Lidal IB, Lundberg Larsen K, Hoff M. 50 Years and older - born with spina bifida: participation, health issues and physical function. Disabil Rehabil 2019; 43:241-250. [PMID: 31180731 DOI: 10.1080/09638288.2019.1621953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose: To study physical function perspectives in persons with spina bifida (SB) aged ≥50 years. In relation to this, we also wanted to survey participation perspectives, health issues and health services usage.Methods: We used predefined fixed questions to interview community-dwelling adults with SB in Norway. Physical function assessments included Timed Up and Go, the Six Minute Walk Test, and BMI was calculated. Descriptive statistics were used, and logistic regression was performed to study variables associated with community walking.Results: Eighteen women and twelve men, twenty-four of them without hydrocephalus, participated in the study. Their mean age was 57.5 years (range 51-76). The majority were well-functioning persons, with 53% employed. However, deterioration in ambulation started at a median age of 40 years in >80% of the participants. Higher odds for being a community walker were found for sacral SB, BMI < 30, and/or being more physical active per week. More than 60% of the study sample used antihypertensive medication, and 43% were obese (BMI ≥ 30). Pain was a commonly perceived health problem. About 50% had been through a comprehensive SB-specific health evaluation in adulthood.Conclusion: The striking results on obesity, hypertension, pain and deterioration in ambulatory function in middle-aged and elderly SB cases call for action. Our findings elucidate the importance of prevention and clinical follow-up throughout the lifespan, even in well-functioning SB cases.Implications for rehabilitationWeight-management and interventions to reduce hypertension are issues that need attention in follow-up and as part of secondary rehabilitation in spina bifida.Early deterioration in ambulatory function and pain in spina bifida are target areas for multidisciplinary secondary rehabilitation, and should adequately focus on maintaining or improving "real-life" functioning performance.Neurogenic bowel and fecal incontinence are important in relation to social participation in ageing spina bifida.Rehabilitation programs and research should take the level of cele and hydrocephalus into account.
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Affiliation(s)
- Ingeborg Beate Lidal
- TRS Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | | | - Marie Hoff
- TRS Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Stiles-Shields C, Holmbeck GN. Health behaviors and disordered eating in adolescents and young adults with spina bifida: results from a national survey. Disabil Rehabil 2019; 42:2910-2916. [PMID: 30978107 DOI: 10.1080/09638288.2019.1575483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Youth with disabilities are at higher risk for obesity, disordered eating, and poor body image but are often excluded from research on these domains. The current study is the first to characterize health behaviors, body mass index, and disordered eating cognitions and behaviors in a national sample of adolescent and young adult males and females with spina bifida.Methods: Participants were recruited nationally through the support of a national spina bifida-related organization to complete an anonymous survey assessing health behaviors and disordered eating.Results: Participants were primarily Caucasian, had myelomeningocele, and were between 15-24 years of age. Body mass indices ranged from underweight to Class Three obesity. Health behaviors (e.g., healthy food consumption, physical activity) were often subthreshold compared to Centers for Disease Control recommendations made to the general public. Both male and female respondents endorsed higher purging and restricting behaviors than norms established with typically-developing college aged peers.Conclusions: Findings revealed that there are few sex-based differences. Additionally, the need for thorough assessment of disordered eating behaviors in this population is warranted, including those with a lower body mass index who might be overlooked for assessment of unhealthy attempts to lose or maintain their weight.Implications for rehabilitationAdolescents and young adults with spina bifida are often advised to lose weight without clear guidelines on how to do so, putting them at risk for disordered eating.Professionals should expect variable body mass indices in this population, with some health behaviors falling short of recommendations made for the general public by the Centers for Disease Control.Professionals should fully assess disordered eating behaviors in youth with disabilities, even when at a healthy weight.
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Abstract
BACKGROUND CONTEXT Patients with spina bifida (SB) are at risk for pathological fractures and low bone mineral density (BMD). PURPOSE AND METHODS This article reviews the literature and provides a comprehensive overview of how the characteristics of SB and its associated comorbidities intersect with bone fragility to identify possible pathophysiological mechanisms of fractures and low BMD. RESULTS Bone fragility occurs early in the life of patients with SB as a result of a disturbance that determines changes in bone shape, quantity, and quality, as poor mineralization reduces bone stiffness. Bone fragility in SB occurs due to local and systemic factors and may be considered a state of impaired bone quality of multifactorial aetiology, with complex interacting influences of neurological, metabolic, and endocrinological origins and the presence of smaller bones. Bone fragility should be evaluated globally according to skeletal age and Tanner staging. The phases of the evolution of Charcot joints seem to intercept the evolution of epiphyseal fractures. Charcot arthropathy in SB may be initiated by the occurrence of repetitive trauma and fractures in epiphyseal and subepiphyseal regions, where there is a deficit of bone mineralization and greater bone mass deficits. CONCLUSION Bone fragility in MMC potentially has a multifactorial neuro-endocrinological-metabolic-renal dimension, with smaller bones, lower bone mass, and mineralization deficits affecting bone strength.
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