Reducing the impact of rheumatic diseases in childhood

Feasibility and Acceptability of Yoga for Adolescents with Juvenile Idiopathic Arthritis

BACKGROUND/OBJECTIVES

Yoga is effective for adults with arthritis but unstudied in adolescents with juvenile idiopathic arthritis (JIA).

METHODS

A pilot study assessed the feasibility and acceptability of an 8-week group yoga intervention for adolescents ages 14-18 with JIA. Each 75-min session included breathing techniques, relaxation, mindfulness, and modified yoga postures, using yoga props and a rope wall. An online video was available for home practice. The outcome measures administered at the baseline and at 8 weeks were physician global assessment with joint count, visual assessment with a joint damage assessment index, the Pediatric Quality of Life Arthritis Module 3.0 (Peds QL), and the visual analog scale for pain.

RESULTS

Thirteen out of 25 participants attended ≥1 class with a mean of 5.7 ± 2.2 classes. Common reasons for non-enrollment included distance, schedule, and lack of interest. The average distance to classes was 29.0 ± 41.7 miles. There was a trend toward improvement for joint count (p = 0.07), global assessment (p = 0.10), and the Pain and Hurt domain of the Peds QL (p = 0.13), but no other outcomes approached significance. Satisfaction data from an anonymous survey (n = 8) were high in all areas.

CONCLUSIONS

Adolescents with JIA who attended yoga reported enjoyment, pain reduction, and interest in continued practice with no adverse events. Future studies should consider stakeholder engagement to reduce barriers and larger sample sizes to test the effectiveness.

Nursing management of children's pain: Current evidence and future directions for research

This critical literature review discusses the research evidence underpinning each of the pain standards in the National Service Framework for Children: Standard for hospital services. Relevant evidence-based reviews and clinical practice guidelines are highlighted, and aspects of children's pain management where the research evidence is particularly strong or weak are identified. Priorities are suggested for nurse-led research aimed at generating new knowledge to improve pain management for children.

The Contribution of Parent and Family Variables to the Well-Being of Youth With Arthritis

Among developed countries, the reported prevalence of juvenile idiopathic arthritis (JIA) varies from 16 to 150 per 100,000. Previous reviews have identified risks faced by children with chronic conditions and indicate a relationship between parent/family characteristics and child adaptation. This analysis provides a mixed-methods synthesis of 29 research reports addressing the intersection of family life and JIA. Data were extracted using a structured template, and effect sizes were calculated for reported relationships between variables. Results were coded using a scheme that differentiated types of family factors. Meta-analysis revealed a moderately strong positive relationship between parent and child psychological functioning, and a medium negative relationship between family conflict and child psychosocial well-being, and parental depression and child physical functioning. Thematic analysis of qualitative results identified parenting challenges related to pain management and regimen demands. Results indicate that interventions to enhance parenting competence and family relationships may improve caregiver and patient outcomes.

Living with Juvenile Idiopathic Arthritis: Children's Experiences of Participating in Home Exercise Programmes

Juvenile idiopathic arthritis (JIA) is used to describe the different subgroups of arthritis in children. JIA is the most common chronic rheumatic condition in children. The long-term consequences are not limited to physical disabilities but also have an impact on the child's social, emotional and cognitive development. Home exercise programmes are a major part of the complex treatment regimen for JIA. Research to date is limited in providing insights into children's perspectives about JIA.

This paper describes a qualitative study undertaken to identify children's perceptions about their participation in home exercise programmes. Using semi-structured interviews, the perspectives of 13 children (aged 8–16 years) about their experiences of living with JIA and specifically about participating in therapist-prescribed exercise programmes were investigated.

Two major themes highlighted the pervasive impact of JIA on the children's lives. First, the children described living with JIA and associated feelings of ‘being different’. Secondly, they discussed their understanding of home exercise programmes and the barriers and facilitators to participation. Key barriers were having better things to do, time required, laziness, boredom, forgetfulness and pain. Facilitators included the incorporation of exercises into everyday routines, making them fun and having rewards. Clinical implications and avenues for future research are also outlined.

Living with Juvenile Idiopathic Arthritis: Parents' Experiences of Treatment Regimens and Home Exercise Programmes

The parents of children with juvenile idiopathic arthritis have been identified as pivotal facilitators of children's involvement in treatment regimens, including home exercise programmes. As such, parents' perspectives regarding the factors that influence participation in their children's treatment regimens, and in particular home exercise programmes, are addressed in this study. In depth, semi-structured interviews were conducted with 16 families. Rigour was ensured through a rich description of participants, peer and member checking, field journals and audit trails.

Four key topics related to the process — the experience of the child's diagnosis, community access and participation, treatment regimens and the impact of these regimens on the parent's roles and relationships — and were addressed. Seven key themes emerged, namely the difficult process of diagnosis, the emotional toll, medications, exercises, life revolves around arthritis, parents' relationship with their child and other family members, and parents and paid work. The implications for clinical practice and future research are discussed.

Illness trajectories in Mexican children with juvenile idiopathic arthritis and their parents

BACKGROUND

We hypothesize that the qualitative approach of socio-cultural aspects in children with juvenile idiopathic arthritis (JIA) and their parents would improve the understanding of their illness.

OBJECTIVE

To explain the phenomenon of experiencing JIA within a specific cultural context.

METHODS

The theoretical position of this research was based on the substantive theories of suffering, explanatory models and illness experience. Its design was that of qualitative field, and its analysis followed the interpretative grounded theory methodology. Data were collected by in-depth interviews and notes; tape recordings were transcribed verbatim, read and imported into the ATLAS/ti 4.2 software. Data conceptualization, categorization and interpretation were based on the constant comparison method.

RESULTS

A total of 16 adults and six children from 10 families were interviewed. 'Pilgrimage' (metaphorically referred by some of the parents) was a major code in the study that reflected the religious reference to the trajectory of pain, faith and hope. For children, pilgrimage was conformed by immediate concepts; for parents, by historical and immediate experiences influenced by JIA subtype. Pilgrimage was consistent with the model of the illness trajectory theory, which conceptually relates to the idea that the course of chronic diseases is variable and modifiable throughout time.

CONCLUSION

The qualitative approach of JIA provides wide and deep information on the perception that children and parents have about the disease. The illness trajectory theory corresponds to pilgrimage, the theoretical model for JIA in this study.

The impact on health-related quality of life from non-steroidal anti-inflammatory drugs, methotrexate, or steroids in treatment for juvenile idiopathic arthritis

OBJECTIVE

To assess and compare the impact of medication treatments on health-related quality of life (HRQOL), family function, and medical status in children with juvenile idiopathic arthritis (JIA).

METHODS

Fifty-seven children diagnosed with JIA were assessed by a pediatric rheumatologist and placed into one of three treatment groups: (1) non-steroidal anti-inflammatory; (2) methotrexate; or (3) steroids via IV methylprednisolone. Questionnaires were administered at baseline and 4-month follow-up. The attending pediatric rheumatologist provided additional medical information.

RESULTS

Data document the impact of JIA on HRQOL, particularly on physical and pain domains. Steroid patients experienced improved HRQOL at follow-up relative to other groups, despite reporting more problems with side effects.

CONCLUSION

These results demonstrate positive benefits of steroids in treating JIA children, despite the greatest incidence of adverse side effects.