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Galetaki D, Szymczuk V, Shi M, Merchant N. Is endocrine surveillance important in the care of Duchenne Muscular Dystrophy? Results from a national survey to patients and families on endocrine complications. eNeurologicalSci 2024; 36:100513. [PMID: 38989274 PMCID: PMC11231648 DOI: 10.1016/j.ensci.2024.100513] [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: 03/15/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024] Open
Abstract
Glucocorticoids are standard of care for patients with Duchenne muscular dystrophy (DMD). Although prolonged exposure is associated with multiple endocrine side effects, current guidelines related to monitoring and management of endocrinopathies are suboptimal. We aim to explore community perceptions of endocrine related complications in patients with DMD, assess current level of understanding, and desire for further education. A 31-item online survey was sent through Parent Project to Muscular Dystrophy (PPMD) to Duchenne Registry members to be completed by patients or their caretakers. Response rate was 55% (n = 75). Steroids were taken by 93%, but only 50% were followed by endocrinology and 21% report never been seen by endocrinology. Bone health was discussed with 87% of patients and 60% were diagnosed with osteoporosis. Delayed puberty was discussed with 41% of patients with 23% receiving testosterone therapy. About half the patients reported a diagnosis of slowed growth. Only 51% of the participants recalled discussing adrenal insufficiency. Obesity was discussed with 59% of participants. Families felt education about steroid-induced endocrinopathies to be very or extremely important and prefer to discuss about this at the beginning of their steroid therapy. This demonstrates significant gaps in education and access to endocrine care in patients with DMD.
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Affiliation(s)
- Despoina Galetaki
- Division of Endocrinology, Children's National Hospital, Washington, DC, USA
| | - Vivian Szymczuk
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Melody Shi
- Division of Endocrinology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nadia Merchant
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States of America
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Giles ML, Ball GDC, Bonder R, Buchholz A, Gorter JW, Morrison KM, Perez A, Walker M, McPherson AC. Exploring the complexities of weight management care for children with spina bifida: a qualitative study with children and parents. Disabil Rehabil 2024; 46:3440-3448. [PMID: 37665663 DOI: 10.1080/09638288.2023.2251878] [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: 04/04/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE 1) To explore how children with spina bifida (SB) and their parents understand bodyweight, health and weight management; and 2) To identify what services and supports children with SB and their families feel are most appropriate to help them manage their health and weight. METHODS The study used interpretive description within a qualitative design. Participants were children with SB (aged 10-18) attending two Canadian SB clinics and their parents. Data were collected through individual interviews and analyzed using inductive thematic analysis. RESULTS Five children and five parents participated in the study. Children and parents had a weight-centric approach to health, which was related to the child's mobility. Weight was considered to be under individual control and mostly through diet. Trusting relationships between healthcare providers, children and families were important to discuss weight in a non-judgemental manner. Children should be involved in setting meaningful and achievable weight management goals. CONCLUSION Greater knowledge of how children with SB and their families understand weight and health offers opportunities for non-judgemental discussions about their needs and wishes. Helping families to place more value on health over weight may reduce feelings of stigma, while allowing children to develop some autonomy over health-related decisions.
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Affiliation(s)
- Madison L Giles
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Annick Buchholz
- Centre for Healthy Active Living, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands. Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- CanChild, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Arnaldo Perez
- Educational Research & Scholarship Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Amy C McPherson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Bever A, Audhya I, Szabo SM, Mickle A, Feeny D, Malone D, Neumann P, Iannaccone S, Gooch K. "You Take This Day by Day, Come What May": A Qualitative Study of the Psychosocial Impacts of Living with Duchenne Muscular Dystrophy. Adv Ther 2024; 41:2460-2476. [PMID: 38709395 PMCID: PMC11133021 DOI: 10.1007/s12325-024-02867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Studies have reported health-related quality-of-life impacts of Duchenne muscular dystrophy (DMD); however, further research is needed to understand how those with DMD experience their condition and how psychosocial impacts evolve over time in response to disease progression. This qualitative study explores the social and emotional implications of key transitions, challenges and adaptations throughout the disease course from the perspective of patients and family caregivers. METHODS Semi-structured interviews were conducted with men and boys with DMD, and/or their caregivers, in the USA. Thematic analysis was used to examine patterns in data collected across the interviews. RESULTS Nineteen participants were included. Three major themes were identified: (1) barriers to participation are multifaceted; (2) an emotional journey shaped by 'inevitable progression;' (3) family provides critical tangible and emotional support. This study illustrates that psychosocial impacts of DMD are shaped by knowledge of the condition's natural history alongside other factors including the extent of social barriers, personal growth and adaptation, and family support. CONCLUSIONS Findings provide insight into the strength and resilience with which individuals and their families respond to daily challenges and major clinical milestones and highlight the relative importance of loss of upper limb function as a transition in DMD affecting health-related quality-of-life.
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Affiliation(s)
- Andrea Bever
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Ivana Audhya
- Sarepta Therapeutics, Inc., 215 First Street, Cambridge, MA, USA
| | - Shelagh M Szabo
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada.
| | - Alexis Mickle
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - David Feeny
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Daniel Malone
- The University of Utah, 201 Presidents Circle, Salt Lake City, UT, 84112, USA
| | - Peter Neumann
- Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
| | - Susan Iannaccone
- The University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Katherine Gooch
- Sarepta Therapeutics, Inc., 215 First Street, Cambridge, MA, USA
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Provvidenza CF, Bonder R, McPherson AC. Putting weight-related conversations into practice: Lessons learned from implementing a knowledge translation casebook in a disability context. Child Care Health Dev 2024; 50:e13257. [PMID: 38587273 DOI: 10.1111/cch.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Due to reported challenges experienced by healthcare providers (HCPs) when having weight-related conversations with children with disabilities and their families, a knowledge translation (KT) casebook was developed, providing key communication principles with supportive resources. Our aim was to explore how the KT casebook could be implemented into a disability context. Study objectives were to develop and integrate needs-based implementation supports to help foster the uptake of the KT casebook communication principles. METHODS A sample of nurses, physicians, occupational therapists and physical therapists were recruited from a Canadian paediatric rehabilitation hospital. Informed by the Theoretical Domains Framework, group interviews were conducted with participants to understand barriers to having weight-related conversations in their context. Implementation strategies were developed to deliver the KT casebook content that addressed these identified barriers, which included an education workshop, simulations, printed materials, and a huddle and email strategy. Participant experiences with the implementation supports were captured through workshop evaluations, pre-post surveys and qualitative interviews. Post-implementation interviews were analysed using descriptive content analysis. RESULTS Ten HCPs implemented the KT casebook principles over 6 months. Participants reported that the workshop provided a clear understanding of the KT casebook content. While HCPs appreciated the breadth of the KT casebook, they found the abbreviated printed educational materials more convenient. Strategies developed to address participants' need for a sense of community and opportunities to learn from each other did not achieve their aim. Increased confidence in integrating the KT casebook principles into practice was not demonstrated, due, in part, to having few opportunities to practice. This was partly because of the increase in competing clinical demands at the onset of the COVID-19 pandemic. CONCLUSIONS Despite positive feedback on the product itself, changes in the organisational and environmental context limited the success of the implementation plan. Monitoring and adapting implementation processes in response to unanticipated changes is critical to the success of implementation efforts.
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Affiliation(s)
- Christine F Provvidenza
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Ee J, Chong PH, Poh YN, Ang R, Yeo ZZ. "I don't know whether I will be alive or not" - An interpretative phenomenological analysis of young adult males with Duchenne Muscular Dystrophy making sense of self and life. Disabil Health J 2024; 17:101578. [PMID: 38182495 DOI: 10.1016/j.dhjo.2023.101578] [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: 08/04/2023] [Revised: 12/11/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND With ventilatory support, boys with Duchenne Muscular Dystrophy (DMD) now live longer. The emerging adulthood offers unanticipated opportunities for identity exploration. Existing literature has raised issues around transitions and implicit obligations within structural and sociological domains; intrinsic challenges are posed, while concurrently engendering possibilities in an uncertain future. OBJECTIVE Reveal lived experience and meaning making among men with advanced DMD living outside the western context. METHODS Secondary data, essentially transcripts of semi-structured interviews with five young men with DMD, age ranging from 23 to 37 years, conducted as part of a larger study were analysed iteratively in depth. Given their underlying vulnerability associated with significant physical dependencies, all respondents were receiving palliative care from the local hospice, and lived with family caregivers at home. RESULTS Three themes encapsulated the essence of their lifeworld at this juncture. Each shared poignant stories of having survived adverse circumstances in the past, learning to live with themselves in the current state of disabilities and disconnection with peers. Yet, moments of yearning surface, to make new friends and find gainful employment like everyone else. Ambivalence notwithstanding, they navigated societal marginalization through digital media, or found meaning in family bonding and existential dimensions. Faced with uncertainty, most embraced the status quo in silent resignation, to minimise disappointment or as pragmatic responses to enduring systemic and personal barriers. CONCLUSIONS Study findings expounded challenges men with advanced DMD grappled that ultimately shaped self-identity. Healthcare professionals could support this group of precarious survivors even better through individualised person-centred care.
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Affiliation(s)
- Jonathan Ee
- HCA Hospice Limited, 705 Serangoon Rd, Block A #03-01 @Kwong Wai Shiu Hospital, Singapore, 328127.
| | - Poh-Heng Chong
- HCA Hospice Limited, 705 Serangoon Rd, Block A #03-01 @Kwong Wai Shiu Hospital, Singapore, 328127
| | - Ya-Nee Poh
- HCA Hospice Limited, 705 Serangoon Rd, Block A #03-01 @Kwong Wai Shiu Hospital, Singapore, 328127
| | - Raymond Ang
- HCA Hospice Limited, 705 Serangoon Rd, Block A #03-01 @Kwong Wai Shiu Hospital, Singapore, 328127
| | - Zhi-Zheng Yeo
- HCA Hospice Limited, 705 Serangoon Rd, Block A #03-01 @Kwong Wai Shiu Hospital, Singapore, 328127
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Aune SD, Schaufel MA, Andersen TM, Hammer S, Magnussen LH. Experiences of individually tailored physical exercise in boys with Duchenne muscular dystrophy: a qualitative study. Physiother Theory Pract 2024:1-10. [PMID: 38420935 DOI: 10.1080/09593985.2024.2323994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Excessive and insufficient physical exercise have both been associated with accelerated muscle function decline in boys with Duchenne Muscular Dystrophy (DMD), and optimal exercise remains unclear. OBJECTIVE This study explored participants' experiences with a one-year training program. METHODS Five semi-structured qualitative individual interviews and one focus group interview were conducted and analyzed using systematic text condensation. RESULTS Participants included boys with DMD who participated in the intervention study (n = 10), their relatives and/or assistants (n = 7). Four main themes emerged: 1) the crucial role of motivation to maintain training routines, 2) benefiting from exercise, but with a need for balancing it, 3) time management challenges, and 4) the training as a social arena and meeting place. The participants emphasized the importance of experiencing progress, basic skills and enjoyable training. Parents were reassured knowing the appropriate exercise intensity and technique. The boys needed flexibility and support to find a balance between exercise and other activities and described benefits from sharing experiences with each other. CONCLUSION Clinical guidelines for physical exercise in DMD should encompass customization of exercise interventions supporting motivational factors, balance and social interaction, and identify competing commitments. Successful training programs may enhance quality of life and functionality for these boys.
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Affiliation(s)
- Siri Dahl Aune
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Margrethe Aase Schaufel
- Regional Centre of Excellence for Palliative Care, Haukeland University Hospital, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tiina Maarit Andersen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
| | - Stian Hammer
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv Heide Magnussen
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
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A comprehensive qualitative framework for health-related quality of life in Duchenne muscular dystrophy. Qual Life Res 2023; 32:225-236. [PMID: 36050623 PMCID: PMC9829595 DOI: 10.1007/s11136-022-03240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Duchenne muscular dystrophy (DMD) is a rare x-linked neuromuscular condition predominantly affecting boys and men. There is a paucity of research qualitatively detailing the lived experience of health-related quality of life (HRQoL) for people with DMD. The aim of this study was to identify a comprehensive framework for better understanding HRQoL in DMD. METHODS Eighteen boys and men (aged 7 to ≥ 40 years) with DMD were recruited from charity Duchenne UK, a DMD support group, and 5 UK National Health Service Trusts. Semi-structured interviews were conducted using a topic guide informed by a review into HRQoL in DMD. Generic, preference-based, patient-reported outcome measures (PROs) were used as prompts. Interviews were audio recorded, transcribed verbatim and analysed using framework analysis. RESULTS Thirty-seven themes were coded, within seven categories. Six categories were conceptualised as components of HRQoL (autonomy, daily activities, feelings and emotions, identity, physical aspects, social relationships) and one considered an input (healthcare, support, and environment). Three additional themes were used to code feedback on the generic PROs (CHU-9D, EQ-5D, HUI). Social relationships received most coverage in the data and was noted as an omission from the PROs. CONCLUSION A 30-item framework for HRQoL in DMD has been developed, which was used as input into a new condition-specific HRQoL PRO and preference-based measure: the DMD-QoL. The data has value in its own right in highlighting the lived experience of HRQoL for people with DMD and as a barometer for assessing the content of HRQoL PROs for use in DMD.
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Handberg C, Werlauff U, Højberg AL. Perspectives on Everyday Life Challenges of Danish Young People With Duchenne Muscular Dystrophy (DMD) on Corticosteroids. Glob Qual Nurs Res 2022; 9:23333936221094858. [PMID: 35493771 PMCID: PMC9052227 DOI: 10.1177/23333936221094858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate perspectives on everyday life challenges of young persons with Duchenne muscular dystrophy in Denmark treated with corticosteroids perceived by young persons and their parents to improve rehabilitation interventions. Nineteen semi-structured interviews were conducted: 10 individual interviews with 10 persons with DMD and six individual interviews with parents (five mothers and one father) and three couple interviews (three mothers and three fathers). The analysis was guided by interpretive description methodology and Antonovsky’s Sense of Coherence theory. The results indicated that persons with Duchenne muscular dystrophy existed in a flux between experiencing greater Sense of Coherence revolving around normality and less Sense of Coherence exposing their vulnerability which unfolded in four opposing themes: (1) bodily ability and disability, (2) content and anxious, (3) sociable and lonely, and (4) independent and dependent. Future rehabilitation should aim at supporting resistance resources promoting bodily ability, being content, sociable, and independent.
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Affiliation(s)
- Charlotte Handberg
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark.,Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ulla Werlauff
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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