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Weisman A, Chan JM, LaPointe C, Sjoholm K, Steinau K, Artus K, Widhiati S, Bodan R, Wood M, Salas-Alanis JC, Rocha AC, Faitli B, Khuu P. Physiotherapy for epidermolysis bullosa: clinical practice guidelines. Orphanet J Rare Dis 2021; 16:406. [PMID: 34593011 PMCID: PMC8481321 DOI: 10.1186/s13023-021-01997-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
Epidermolysis bullosa (EB) is characterized by skin fragility with blister formation occurring spontaneously or following minor trauma such as gentle pressure or friction. Current physiotherapy practice is based on anecdotal care, clinical expertise and creative problem solving with caregivers and individuals with EB. Evidence based intervention is needed to establish a foundation of knowledge and to guide international practitioners to create and improve standards of care to effectively work with individuals living with EB. This clinical practice guideline (CPG) was created for the purpose of providing evidence based interventions and best clinical practices for the physiotherapy management of individuals with EB. A survey was conducted within the EB community and six outcomes were identified as a priority to address in physiotherapy management, including (1) attaining developmental motor milestones, (2) identifying safe and functional mobility in the natural environment, (3) encouraging ambulation endurance, (4) supporting safe ability to bear weight, (5) improving access to physiotherapy services, and (6) optimizing interaction with the community. A systematic literature review was conducted and articles were critically analyzed by an international panel consisting of thirteen members: healthcare professionals (including physiotherapist, doctors, and occupational therapist), caregivers, and individuals with EB. Recommendations were formulated from evidence and panel consensus. An external panel of twelve were invited to improve the quality and gather feedback on draft manuscript and recommendations. This CPG describes the development of recommendations for physiotherapy management including several best practice interventions. This guideline lays the foundational work for physiotherapist throughout the world to provide high quality services while improving and maintaining functional mobility and independence within the EB community. The CPG outlines limitations in the evidence available and possible future research needed to improve physiotherapy practice.
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Affiliation(s)
- Amy Weisman
- Department of Rehabilitation Services, Stanford Children's Health, 321 Middlefield Road, Menlo Park, CA, 94025, USA.
| | - Jennifer M Chan
- Department of Rehabilitation Services, Stanford Children's Health, 321 Middlefield Road, Menlo Park, CA, 94025, USA
| | - Chantal LaPointe
- Physiotherapy, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Kaye Sjoholm
- Department of Rehabilitation, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kristy Steinau
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kaycie Artus
- Camp Spirit, EB Winter Camp in Colorado, Golden, CO, USA
| | - Suci Widhiati
- Pediatric Dermatology Division, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sebelas Maret - Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Rebecca Bodan
- School of Nursing, California State University Fullerton, Fullerton, CA, USA
| | - Michelle Wood
- Department of Physiotherapy, Great Ormond Street NHS Foundation Trust, London, UK
| | - Julio C Salas-Alanis
- Dermatology Department, Instituto de Dermatologia Jalisco, Guadalajara, Jalisco, Mexico.,DEBRA Mexico, Monterrey , Nuevo Leon, Mexico
| | | | - Beata Faitli
- Department of Physiotherapy, Great Ormond Street NHS Foundation Trust, London, UK
| | - Phuong Khuu
- Department of Rehabilitation Services, Stanford Children's Health, 321 Middlefield Road, Menlo Park, CA, 94025, USA
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Chan JM, Weisman A, King A, Maksomski S, Shotwell C, Bailie C, Weaver H, Bodan R, Guerrero E, Zmazek M, Khuu P. Occupational therapy for epidermolysis bullosa: clinical practice guidelines. Orphanet J Rare Dis 2019; 14:129. [PMID: 31174559 PMCID: PMC6556021 DOI: 10.1186/s13023-019-1059-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this article is to summarize the Dystrophic Epidermolysis Bullosa Research Association (DEBRA) International evidence-based Clinical Practice Guidelines (CPGs) for the provision of occupational therapy (OT) for children and adults living with inherited epidermolysis bullosa (EB). This is a rare genetic disorder characterized by skin fragility leading to blister formation occurring spontaneously or following minor trauma. Current OT practice for persons with EB is based on anecdotal care, clinical expertise and trial and error with collaboration between caregiver and patient. Intervention based on research is needed to establish a foundation of knowledge to guide international practitioners to create and improve standards of care and to be able to work effectively with those living with the rare diagnosis of this condition. This CPG was created by an international panel with expertise working with persons with EB. The panel was made up of 11 members including OT’s, a physiotherapist, a medical doctor, social worker, person with EB and a carer of a person with EB. It describes the development of recommendations for 5 outcomes determined by survey of persons with EB, caregivers, and experienced healthcare professionals. The outcomes include independence in activities of daily living (ADL), independence in instrumental ADL, maximization of hand function (non-surgical), fine motor development and retention, and oral feeding skills. The recommendations are supplemented with additional files that include photos and specific examples to further guide occupational therapists or, in situations where an OT is not available, other members of the healthcare team. As the disorder of EB is rare, evidence-based CPGs are needed to provide a base of knowledge and practice for OTs throughout the world with the goal of providing quality care to patients, while improving their functional independence and quality of life. In addition, this information is valuable as a basis for further research.
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Affiliation(s)
- Jennifer M Chan
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA.
| | - Amy Weisman
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
| | - Alex King
- Phoenix Children's Hospital, Phoenix, USA
| | | | | | | | | | - Rebecca Bodan
- School of Nursing, California State University Fullerton, Fullerton, USA
| | | | | | - Phuong Khuu
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
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Abstract
The hand deformities associated with dystrophic epidermolysis bullosa lead to a mitten-like hand with significant loss of function. The pattern of their development is discussed. Although the digits can be released and divided surgically, the deformity is recurrent. This study provides a review of the literature on the management of the hand in this disease and a discussion of the role of therapy in maintaining hand function.
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Affiliation(s)
- F Mullett
- Great Ormond Street Hospital Trust, London, England
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Mullett FL, Smith PJ. Hand splintage following surgery for dystrophic epidermolysis bullosa. BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:192-3. [PMID: 8387856 DOI: 10.1016/0007-1226(93)90167-a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Patients with Epidermolysis Bullosa, a rare hereditary blistering skin disorder, pose many problems in view of the extreme fragility of their skin. Following surgical division of syndactylised digits hard acrylic splints have traditionally been provided. This paper presents a splint design which is quicker and safer to manufacture, is readily altered and better tolerated by the patient, and has led to improvement in the maintenance of surgical correction.
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Affiliation(s)
- F L Mullett
- Congenital Hand Clinic, Hospital for Sick Children, London, UK
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