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Hu X, Ren J, Wang P, Chen W, Shen W, Li Y, Xiao T, Dai Y, Sang Y. Adherence to exercise therapy among children and adolescents with Juvenile idiopathic arthritis: a scoping review. Disabil Rehabil 2024; 46:1502-1514. [PMID: 37125688 DOI: 10.1080/09638288.2023.2200261] [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: 08/06/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To identify parameters and measurement methods of exercise therapy adherence, as well as barriers and facilitators affecting adherence among children and adolescents with juvenile idiopathic arthritis (JIA). METHODS Studies were eligible for inclusion if patients were 0-18 years of age, had JIA, and the focus of the research was on exercise therapy patterns, measurement/parameters of exercise adherence, and barriers/facilitators for exercise adherence. Two reviewers independently identified and categorized the barriers and facilitators to exercise therapy adherence using the International Classification of Functioning, Disability, and Health (ICF). RESULTS Twenty articles were included in this review. Among patients with JIA, 29%-99% adhered to exercise therapy. The most commonly measured parameters of adherence were session completion and behavior component, with a self-report log serving as the most common means of assessment. Time pressure, symptoms related to JIA, lack of enjoyment, and insufficient motivation were the main barriers. Facilitators were commonly identified as adequate motivation, effective symptoms management, and social support. CONCLUSIONS Future interventions should consider the identified factors to promote exercise engagement in children and adolescents with JIA. Strategies for promoting exercise adherence in children and adolescents with JIA is needed.
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Affiliation(s)
- Xinmiao Hu
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Ren
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Wang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjian Chen
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Shen
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Li
- Department of Critical Care Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tiantian Xiao
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Dai
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Sang
- Department of Nursing, Department of Computer Technology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Elnaggar RK, Azab AR, Alrawaili SM, Alhowimel AS, Alotaibi MA, Abdrabo MS, Mohamed RR, Abd El-nabie WA. Efficacy of accommodating variable-resistance training on muscle architecture, peak torque, and functional performance in patients with juvenile idiopathic arthritis: A randomized controlled trial. Heliyon 2024; 10:e27693. [PMID: 38500984 PMCID: PMC10945254 DOI: 10.1016/j.heliyon.2024.e27693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose This study sought to find out if a 6-week accommodating variable-resistance (AcVR) training might enhance muscle architecture, peak torque, and functional performance in patients with juvenile idiopathic arthritis (Juv-IA). Methods Fifty-eight patients with polyarticular Juv-IA (aged 12-18 years) were involved in a randomized controlled trial. They were allocated into two groups: the AcVR group (n = 29; underwent AcVR training, and the control group (n = 29; received the usual exercise regimen). Interventions were applied three times a week over six consecutive weeks. Measurements were done at baseline and after the intervention. The primary outcome measures were muscle architecture and peak torque, with functional capacity being the secondary measure. Results Compared to the control group, the AcVR group showed favorable pre-to-post changes in muscle architecture [fascicle length (P = 0.0007, η2p = .18), pennation angle (P = 0.0004, η2p = .20), and muscle thickness (P = 0.001, η2p = .17)]. Further, the AcVR group revealed a greater increase in peak concentric torque of knee extensors at angular speeds of 120°/sec [right side (P = 0.0032, η2p = .08); left side (P = 0.039, η2p = .07)] and 180°/sec [right side (P = 0.01, η2p = .11); left side (P = 0.014, η2p = .10)]. Furthermore, The AcVR group achieved more conducive changes in functional performance [6-min walk test (P = 0.003, η2p = .15), timed up and down stair test (P = 0.009, η2p = .12), and 4 × 10 m shuttle run test (P = 0.036, η2p = .08)]. Conclusion A 6-week AcVR training is potentially effective for improving muscle architectural qualities, enhancing peak muscle torque, and boosting functional performance in patients with Juv-IA without experiencing any detrimental side effects.
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Affiliation(s)
- Ragab K. Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Alshimaa R. Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed S. Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mazyad A. Alotaibi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohamed S. Abdrabo
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Rania R. Mohamed
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walaa A. Abd El-nabie
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Woolnough LU, Lentini L, Bhavsar PH, Thomas MF, Casella ZM, Vincent HK. Child and Caregiver Beliefs of Importance of Physical Function and Quality of Life in Juvenile Idiopathic Arthritis: A Survey Study. Pediatr Phys Ther 2024; 36:88-93. [PMID: 37820355 DOI: 10.1097/pep.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE To evaluate patient-caregiver beliefs of relative importance across 4 domains while living with juvenile idiopathic arthritis (JIA). METHODS This was a cross-sectional, anonymous survey study conducted in an academic medical center. Participants with JIA and caregivers (N = 151) completed a Likert-style survey to rate items by importance of knowledge about 4 domains: medications, physical activity, routine measures, and quality of life. RESULTS Knowledge of medication issues ranked higher than the remaining 3 domains (4.2 ± 0.7 points vs 4.0 ± 0.7, 4.1 ± 0.8, and 4.0 ± 0.9 points, respectively; P = .026; P = .026). Compared with caregivers, participants rated importance lower for all 4 domains. CONCLUSIONS Gait and physical activity and well-being are not uniformly measured as part of routine clinical care and disease tracking in JIA. Both participants and caregivers ranked knowledge of physical activity similarly to routine office measures and quality of life. Inclusion of these measures in routine care could improve people centeredness and inform treatment plans.
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Affiliation(s)
- Leandra U Woolnough
- Departments of Pediatrics (Dr Woolnough and Mr Lentini) and Physical Medicine and Rehabilitation (Dr Vincent), College of Medicine, University of Florida, Gainesville, Florida; Applied Physiology and Kinesiology Program (Mss Bhavsar and Thomas and Mr Casella), University of Florida, Gainesville, Florida
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Rongo R, Michelotti A, Pedersen TK, Resnick CM, Stoustrup P. Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists. Orthod Craniofac Res 2023; 26 Suppl 1:151-163. [PMID: 37226648 DOI: 10.1111/ocr.12676] [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: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.
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Affiliation(s)
- Roberto Rongo
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Thomas Klit Pedersen
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Peter Stoustrup
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
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Elnaggar RK, Elfakharany MS. Aqua-Plyometric Exercises-Induced Changes in Muscle Strength, Bone Mineral Properties, and Physical Fitness in Patients With Juvenile Idiopathic Arthritis: A 12-Week, Randomized Controlled Trial. Pediatr Exerc Sci 2023; 35:198-205. [PMID: 36535274 DOI: 10.1123/pes.2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/08/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine whether a 12-week, lower body-targeted aqua-plyometric (AquaPlyo) exercise program could improve muscle strength, bone mineral properties, and physical fitness in patients with juvenile idiopathic arthritis. METHODS A randomized controlled trial was adopted and included 48 patients with polyarticular juvenile idiopathic arthritis (age: 12-18 y). Patients were assigned to undergo either AquaPlyo exercises (AquaPlyo group, n = 24) or standard exercises (control group, n = 24). The outcome measures were assessed pretreatment and posttreatment and included concentric quadriceps peak torque, bone mineral properties (areal bone mineral density [BMD], volumetric BMD, bone mineral content, and BMD Z score), and physical fitness. RESULTS A significant posttreatment increase in the concentric quadriceps peak torque was detected in the AquaPlyo group compared with the control group (either at an angular velocity of 90°/s [right side: P = .016, left side: P = .025] or 180°/s [right side: P = .007, left side: P = .029]). Besides, a considerably greater improvement in the areal BMD (P = .0006), volumetric BMD (P = .027), bone mineral content (P = .002), and BMD Z score (P = .0004) was observed in the AquaPlyo group. Moreover, a remarkably greater rise in the physical fitness (P < .001) was revealed in the AquaPlyo group. CONCLUSION AquaPlyo training can efficiently enhance muscle strength, improve bone mineral properties, and boost physical fitness in patients with juvenile idiopathic arthritis.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj,Saudi Arabia
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza,Egypt
| | - Mahmoud S Elfakharany
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza,Egypt
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Nascimento Leite M, Kamper SJ, O'Connell NE, Michaleff ZA, Fisher E, Viana Silva P, Williams CM, Yamato TP. Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents. Cochrane Database Syst Rev 2023; 7:CD013527. [PMID: 37439598 PMCID: PMC10339856 DOI: 10.1002/14651858.cd013527.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Chronic pain is a major health and socioeconomic burden, which is prevalent in children and adolescents. Among the most widely used interventions in children and adolescents are physical activity (including exercises) and education about physical activity. OBJECTIVES To evaluate the effectiveness of physical activity, education about physical activity, or both, compared with usual care (including waiting-list, and minimal interventions, such as advice, relaxation classes, or social group meetings) or active medical care in children and adolescents with chronic musculoskeletal pain. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro, and LILACS from the date of their inception to October 2022. We also searched the reference lists of eligible papers, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared physical activity or education about physical activity, or both, with usual care (including waiting-list and minimal interventions) or active medical care, in children and adolescents with chronic musculoskeletal pain. DATA COLLECTION AND ANALYSIS Two review authors independently determined the eligibility of the included studies. Our primary outcomes were pain intensity, disability, and adverse events. Our secondary outcomes were depression, anxiety, fear avoidance, quality of life, physical activity level, and caregiver distress. We extracted data at postintervention assessment, and long-term follow-up. Two review authors independently assessed risk of bias for each study, using the RoB 1. We assessed the overall certainty of the evidence using the GRADE approach. We reported continuous outcomes as mean differences, and determined clinically important differences from the literature, or 10% of the scale. MAIN RESULTS We included four studies (243 participants with juvenile idiopathic arthritis). We judged all included studies to be at unclear risk of selection bias, performance bias, and detection bias, and at high risk of attrition bias. We downgraded the certainty of the evidence for each outcome to very low due to serious or very serious study limitations, inconsistency, and imprecision. Physical activity compared with usual care Physical activity may slightly reduce pain intensity (0 to 100 scale; 0 = no pain) compared with usual care at postintervention (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -0.82 to -0.08; 2 studies, 118 participants; recalculated as a mean difference (MD) -12.19, 95% CI -21.99 to -2.38; I² = 0%; very low-certainty evidence). Physical activity may slightly improve disability (0 to 3 scale; 0 = no disability) compared with usual care at postintervention assessment (MD -0.37, 95% CI -0.56 to -0.19; I² = 0%; 3 studies, 170 participants; very low-certainty evidence). We found no clear evidence of a difference in quality of life (QoL; 0 to 100 scale; lower scores = better QoL) between physical activity and usual care at postintervention assessment (SMD -0.46, 95% CI -1.27 to 0.35; 4 studies, 201 participants; very low-certainty evidence; recalculated as MD -6.30, 95% CI -18.23 to 5.64; I² = 91%). None of the included studies measured adverse events, depression, or anxiety for this comparison. Physical activity compared with active medical care We found no studies that could be analysed in this comparison. Education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. Physical activity and education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. AUTHORS' CONCLUSIONS We are unable to confidently state whether interventions based on physical activity and education about physical activity are more effective than usual care for children and adolescents with chronic musculoskeletal pain. We found very low-certainty evidence that physical activity may reduce pain intensity and improve disability postintervention compared with usual care, for children and adolescents with juvenile idiopathic arthritis. We did not find any studies reporting educational interventions; it remains unknown how these interventions influence the outcomes in children and adolescents with chronic musculoskeletal pain. Treatment decisions should consider the current best evidence, the professional's experience, and the young person's preferences. Further randomised controlled trials in other common chronic musculoskeletal pain conditions, with high methodological quality, large sample size, and long-term follow-up are urgently needed.
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Affiliation(s)
- Mariana Nascimento Leite
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Zoe A Michaleff
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | | | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Naddei R, Alfani R, Bove M, Discepolo V, Mozzillo F, Guarino A, Alessio M. Increased Relapse Rate During COVID-19 Lockdown in an Italian Cohort of Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 75:326-331. [PMID: 34397168 PMCID: PMC8426691 DOI: 10.1002/acr.24768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/25/2021] [Accepted: 08/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Changes of routine disease management associated with COVID-19 lockdown might have potentially affected the clinical course of juvenile idiopathic arthritis (JIA). The aim of our study was to assess the rate of disease flare before and during COVID-19 lockdown to investigate its impact on disease course in children with JIA. METHODS A single-center retrospective study was conducted, including patients presenting with inactive JIA between September 1, 2018 and March 9, 2019 (group A) and between September 1, 2019 and March 9, 2020 (group B). For each patient, demographic and clinical data were collected. The rate of JIA flare from March 10, 2019 to June 30, 2019 for group A and from March 10, 2020 to June 30, 2020 for group B was compared. RESULTS Group A included 126 patients, and group B 124 patients. Statistical analysis did not show significant differences among the 2 cohorts with respect to age, sex, age at JIA onset, JIA subtype, co-occurrence of uveitis, antinuclear antibody positivity, and past or ongoing medications. The rate of disease flare during lockdown at the time of the first COVID-19 pandemic wave was significantly higher in comparison to the previous year (16.9% versus 6.3%; P = 0.009). CONCLUSION Our study showed that COVID-19 lockdown was associated with a higher rate of joint inflammation in children with JIA. This finding has a considerable clinical implication, as restrictive measures may be necessary in order to contain pandemics. Our data highlight the need for rearrangement in the home and health care management of children with JIA during lockdowns.
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Tarakcı E, Kısa EP, Arman N, Albayrak A. Physical activity and exercise in patients with pediatric rheumatic disease: A systematic search and review. Turk Arch Pediatr 2021; 56:179-186. [PMID: 34104906 DOI: 10.5152/turkarchpediatr.2021.21034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 01/20/2023]
Abstract
Childhood rheumatic diseases are a group of diseases that can affect many organs and systems, resulting in pain, joint stiffness, muscle atrophy and weakness. Physical inactivity has been reported in many childhood rheumatic diseases. There are many studies in the literature comparing the effectiveness of exercise programs in children with juvenile idiopathic arthritis. Exercise and physical activity are considered major parts of the treatment of children with rheumatic disease. The aim of this review is to systematically present studies on physical activity and exercise programs in children with rheumatism from the last 5 years. An internet-based search of three databases-PubMed, PEDro and Medline- was conducted to find relevant studies. Two reviewers individually identified studies on the basis of their title, abstract or full text-as necessary-to determine their eligibility. Differences of opinion between the two examiners were resolved by discussion. Scientific studies of children with different rheumatic diagnoses have shown that physical activity and exercise have a significant effect on reducing the symptoms of the disease. However, the duration, frequency, method and evaluation of the exercises are still being discussed in the literature.
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Affiliation(s)
- Ela Tarakcı
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa Faculty of Health Science, Istanbul, Turkey
| | - Eylül Pınar Kısa
- Division of Physiotherapy and Rehabilitation, Biruni University, Faculty of Health Science, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nilay Arman
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa Faculty of Health Science, Istanbul, Turkey
| | - Asya Albayrak
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Yasar E, Kavlak E, Turkucar S, Bayraktar D, Acari C, Unsal E. Yoga versus home exercise program in children with enthesitis related arthritis: A pilot study. Complement Ther Med 2021; 58:102696. [PMID: 33636297 DOI: 10.1016/j.ctim.2021.102696] [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: 08/14/2020] [Revised: 01/11/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim was to compare the effects of yoga and home exercise program on lower extremity functional status, pain, and quality of life in children with enthesitis related arthritis (ERA). METHODS Twenty-one children with ERA were divided into two groups as yoga (n = 11) and home exercise (n = 10). Yoga group performed supervised yoga exercises twice a week for eight weeks. Home exercise group performed video-based exercises for the same period. Pain in rest and activity, lower extremity functional status, and quality of life were evaluated at baseline and following eight weeks. RESULTS The groups were similar at baseline (p > 0.05). All the parameters, except parent reported quality of life, significantly improved in yoga group (p < 0.05), where only stair climb test times significantly improved in home exercise group (p < 0.05). CONCLUSIONS Yoga seems promising for improving lower extremity functional status, pain, and quality of life as an exercise intervention in rehabilitation programs of children with ERA.
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Affiliation(s)
- Ezgi Yasar
- Pamukkale University, Institute of Health Sciences, Department of Physical Therapy and Rehabilitation, Denizli, Turkey.
| | - Erdogan Kavlak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey.
| | - Serkan Turkucar
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Izmir, Turkey.
| | - Deniz Bayraktar
- Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey.
| | - Ceyhun Acari
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Izmir, Turkey.
| | - Erbil Unsal
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Izmir, Turkey.
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Húngaro TGR, Freitas-Lima LC, Gregnani MF, Perilhão MS, Alves-Silva T, Arruda AC, Barrera-Chimal J, Estrela GR, Araújo RC. Physical Exercise Exacerbates Acute Kidney Injury Induced by LPS via Toll-Like Receptor 4. Front Physiol 2020; 11:768. [PMID: 32765291 PMCID: PMC7380174 DOI: 10.3389/fphys.2020.00768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Lipopolysaccharide (LPS) is a systemic response-triggering endotoxin, which has the kidney as one of its first targets, thus causing acute injuries to this organ. Physical exercise is capable of promoting physiological alterations and modulating inflammatory responses in the infectious process through multiple parameters, including the toll-like receptor (TLR)-4 pathway, which is the main LPS signaling in sepsis. Additionally, previous studies have shown that physical exercise can be both a protector factor and an aggravating factor for some kidney diseases. This study aims at analyzing whether physical exercise before the induction of LPS endotoxemia can protect kidneys from acute kidney injury. Methods: C57BL/6J male mice, 12 weeks old, were distributed into four groups: (1) sedentary (control, N = 7); (2) sedentary + LPS (N = 7); (3) trained (N = 7); and (4) trained + LPS (N = 7). In the training groups, the animals exercised 5×/week in a treadmill, 60 min/day, for 4 weeks (60% of max. velocity). Sepsis was induced in the training group by the application of a single dose of LPS (5 mg/kg i.p.). Sedentary animals received LPS on the same day, and the non-LPS groups received a saline solution instead. All animals were euthanized 24 h after the administration of LPS or saline. Results: The groups receiving LPS presented a significant increase in serum urea (p < 0.0001) and creatinine (p < 0.001) concentration and renal gene expression of inflammatory markers, such as tumor necrosis factor alpha and interleukin-6, as well as TLRs. In addition, LPS promoted a decrease in reduced glutathione. Compared to the sedentary + LPS group, trained + LPS showed overexpression of a gene related to kidney injury (NGAL, p < 0.01) and the protein levels of LPS receptor TLR-4 (p < 0.01). Trained + LPS animals showed an expansion of the tubulointerstitial space in the kidney (p < 0.05) and a decrease in the gene expression of hepatic AOAH (p < 0.01), an enzyme involved in LPS clearance. Conclusion: In contrast to our hypothesis, training was unable to mitigate the renal inflammatory response caused by LPS. On the contrary, it seems to enhance injury by accentuating endotoxin-induced TLR-4 signaling. This effect could be partly due to the modulation of a hepatic enzyme that detoxifies LPS.
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Affiliation(s)
- Talita Guerreiro Rodrigues Húngaro
- Laboratório de Genética e Metabolismo do Exercício, Programa de Nefrologia, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Leandro Ceotto Freitas-Lima
- Laboratório de Genética e Metabolismo do Exercício, Programa de Biologia Molecular, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcos Fernandes Gregnani
- Laboratório de Genética e Metabolismo do Exercício, Programa de Biologia Molecular, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauro Sérgio Perilhão
- Laboratório de Genética e Metabolismo do Exercício, Programa de Nefrologia, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thaís Alves-Silva
- Laboratório de Genética e Metabolismo do Exercício, Programa de Biologia Molecular, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriano Cleis Arruda
- Laboratório de Genética e Metabolismo do Exercício, Programa de Nefrologia, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jonatan Barrera-Chimal
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Gabriel Rufino Estrela
- Departamento de Oncologia Clínica e Experimental, Disciplina de Hematologia e Hematoterapia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ronaldo Carvalho Araújo
- Laboratório de Genética e Metabolismo do Exercício, Programa de Nefrologia, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil.,Laboratório de Genética e Metabolismo do Exercício, Programa de Biologia Molecular, Departamento de Biofísica, Universidade Federal de São Paulo, São Paulo, Brazil
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11
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Bourdier P, Saidi O, Rochette E, Ratel S, Merlin E, Pereira B, Duché P. Physical activity and sedentary levels in children with juvenile idiopathic arthritis and inflammatory bowel disease. A systematic review and meta-analysis. Pediatr Res 2019; 86:149-156. [PMID: 31029060 DOI: 10.1038/s41390-019-0409-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical activity (PA) is essential for children throughout their growth and maturation. It improves physiological and psychological health and limits the risk of developing metabolic disorders. However, some chronic physiological and metabolic diseases may lead to decreased PA. The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). METHODS A literature review and a meta-analysis were carried out with original studies from a Medline database search. Only high-quality studies (STROBE checklist) written in English comparing PA level or sedentary behavior (SB) between children with the disorders and their healthy peers were considered. The aim was to examine PA and SB in children with JIA or IBD compared to their healthy peers. RESULTS The literature review and meta-analysis identified decreased PA and increased time spent in SB in these populations, which may exacerbate both their lower physical fitness and the symptoms of their health disorders. CONCLUSION Results nevertheless show discrepancies due to the different materials and methods used and the variables measured. Further studies are needed to establish a gold standard method for assessing PA level in these populations.
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Affiliation(s)
- Pierre Bourdier
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Oussama Saidi
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- CRNH-Auvergne, 63000, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université de Toulon, Laboratoire IAPS, 83041, Toulon, France
| | - Sébastien Ratel
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Etienne Merlin
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation de la Recherche Clinique et Innovations, 63000, Clermont-Ferrand, France
| | - Pascale Duché
- Université de Toulon, Laboratoire IAPS, 83041, Toulon, France.
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12
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Charuvanij S, Chaiyadech C. Health-related quality of life in children with early-stage juvenile idiopathic arthritis. Musculoskeletal Care 2019; 17:215-220. [PMID: 30861290 DOI: 10.1002/msc.1393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease resulting in physical and psychological disability. This study aimed to measure the health-related quality of life (HRQOL) and identify factors influencing the HRQOL. METHODS We conducted a cross-sectional study in Thai children with JIA and their parents between January and December 2015, using the Thai version of the Pediatrics Quality of Life (PedsQL) 4.0 generic core scale. RESULTS Sixty-five children (33 girls and 32 boys) were included. The median age of the children was 9.6 (interquartile range [IQR] 6.4-12.3) years and the median disease duration was 1.1 (IQR 0.2-2.2) years. The physical health subscale had the lowest score, with a median (range) of 78.1 (34.4-100). Twenty-five (45.4%) children were classified as having suboptimal HRQOL. The school functioning subscale had the lowest score, at 60 (25-100) reported by parents. High disease activity and a disease duration <1 year were significantly associated with suboptimal HRQOL reported by parents, with adjusted odds ratios (ORs) of 20.2 (95% confidence interval [CI] 1.4, 291.7) and 5.9 (95% CI 1.2, 33.3), respectively. CONCLUSIONS Almost half of Thai children with JIA had suboptimal HRQOL. The physical health score was the lowest subscale reported by the children. Early, effective management of disease activity could improve the HRQOL in children with JIA.
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Abstract
PURPOSE To examine safety and efficacy of exercise training (ET) for juvenile idiopathic arthritis (JIA) to improve physical fitness, pain, functional capability, and quality of life. METHODS Ovid Medline, PubMed, CINAHL, PEDro, and Web of Science were searched from 1995 to April 2018 to find English-language articles examining effects of ET in JIA, ages 4 to 21 years. Quality of evidence/strength of clinical recommendations were assessed using the Cochrane GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results were reported using the 2009 Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) checklist for health care interventions. RESULTS Nine papers met inclusion criteria. A total of 457 individuals with JIA, ages 4 to 19.9 years, received ET or alternate activity, wait-list, or no intervention. Moderate-quality evidence supports Stott Pilates and underwater knee-resistance exercise. No adverse effects of ET were reported. CONCLUSIONS Moderate-quality evidence exists for ET (30-50 minutes, 2-3 times/week, 12-24 weeks) to decrease pain, improve range of motion, knee strength, functional capability, and quality of life in JIA.
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14
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The effects of 8-week water-running program on exercise capacity in children with juvenile idiopathic arthritis: a controlled trial. Rheumatol Int 2018; 39:59-65. [PMID: 30430201 DOI: 10.1007/s00296-018-4209-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
Exercise capacity has been reported to be lower in children with Juvenile Idiopathic Arthritis (JIA). Therefore, the aim was to investigate the effects of an 8-week water-based exercise program on exercise capacity in children with JIA. Forty-two children with JIA were divided into two groups as: exercise group [n = 21, water-running, moderate-intensity exercise (60-70%), two times/week], and control group (n = 21, no additional treatment other than the prescribed medication). All children were assessed at baseline and post-intervention in terms of physical and disease-related characteristics, pain at rest and in activity (visual analog scale), range of motion (Escola Paulista de Medicina Range of Motion Scale), aerobic exercise capacity (cycle ergometer), and anaerobic exercise capacity (Wingate Test). Anaerobic exercise capacity was found to be improved in the exercise group [baseline: 5.54 W/kg (IQR 25/75: 4.07/6.88 W/kg) vs. post-intervention: 6.0 W/kg (IQR 25/75: 4.8/7.4 W/kg), p = 0.002], while no improvements were observed in the control group [baseline: 5.29 W/kg (IQR 25/75: 4.75/5.85 W/kg) vs. post-intervention: 5.5 watts/kg (IQR 25/75: 5.0/6.1 W/kg), p = 0.076]. The amount of the changes related to anaerobic exercise capacity were higher in the exercise group [exercise group: 0.6 W/kg (IQR 25/75: 0.3/1.3 W/kg) vs. control group: 0.2 W/kg (IQR 25/75: - 0.1/0.5 W/kg), p = 0.024]. No changes were detected related to aerobic exercise capacity in any of the groups (p > 0.05). An 8-week water-running program might be beneficial to improve anaerobic exercise capacity, but it is not enough to improve the aerobic exercise capacity in children with JIA.
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15
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Houghton KM, Macdonald HM, McKay HA, Guzman J, Duffy C, Tucker L. Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:67. [PMID: 30348221 PMCID: PMC6198360 DOI: 10.1186/s12969-018-0283-4] [Citation(s) in RCA: 20] [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: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Arthritis in childhood can be associated with muscle weakness around affected joints, low bone mass and low bone strength. Exercise is recognized as an important part of management of children with juvenile idiopathic arthritis (JIA) but the exercise prescription to best promote bone and muscle health is unknown. We therefore aimed to: 1. assess feasibility and safety of a 6-month home- and group-based exercise program for children with JIA; 2. estimate the effect of program participation on bone mass and strength, muscle function and clinical outcomes and 3. determine if any positive changes in bone and muscle outcomes are maintained 6 months later. METHODS We recruited 24 children with JIA who were part of the Linking Exercise, Physical Activity and Pathophysiology in Childhood Arthritis (LEAP) study to participate in a 6-month home-based exercise program involving jumping and handgrip exercises, resistance training and one group exercise session per month. We assessed lumbar spine bone mass (dual energy X-ray absorptiometry), distal tibia and radius bone microarchitecture and strength (high-resolution peripheral quantitative computed tomography), muscle function (jumping mechanography, dynamometry) and clinical outcomes (joint assessment, function, health-related quality of life) at baseline, 6- and 12-months. Adherence was assessed using weekly activity logs. RESULTS Thirteen children completed the 6-month intervention. Participants reported 9 adverse events and post-exercise pain was rare (0.4%). Fatigue improved, but there were no other sustained improvements in muscle, bone or clinical outcomes. Adherence to the exercise program was low (47%) and decreased over time. CONCLUSION Children with JIA safely participated in a home-based exercise program designed to enhance muscle and bone strength. Fatigue improved, which may in turn facilitate physical activity participation. Prescribed exercise posed adherence challenges and efforts are needed to address facilitators and barriers to participation in and adherence to exercise programs among children with JIA. TRIAL REGISTRATION Data of the children with JIA are from the LEAP study (Canadian Institutes of Health Research (CIHR; GRANT# 107535 ). http://www.leapjia.com/.
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Affiliation(s)
- Kristin M. Houghton
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Heather M. Macdonald
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada
| | - Heather A. McKay
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Orthopaedics, University of British Columbia, Vancouver, BC Canada
| | - Jaime Guzman
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Ciarán Duffy
- 0000 0000 9402 6172grid.414148.cDivision of Rheumatology, Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori Tucker
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
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Legerlotz K. The Effects of Resistance Training on Health of Children and Adolescents With Disabilities. Am J Lifestyle Med 2018; 14:382-396. [PMID: 33281519 DOI: 10.1177/1559827618759640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 11/15/2022] Open
Abstract
Many parents still hesitate to encourage their children to participate in resistance training programs. This is unfortunate since recent research shows that resistance training can positively affect children's health. This narrative review aims to present an overview of the health-associated effects resistance training can provide particularly in children and adolescents with disabilities by describing its effects on muscle strength, physical function, mental health, self-concept, obesity, and injury prevention. To illustrate the variety of possible fields of application, the effects of resistance training in children and adolescents suffering from Charcot-Marie-Tooth disease, cerebral palsy, Down syndrome, Ehlers-Danlos syndrome, joint hypermobility, juvenile idiopathic arthritis, obesity, and spina bifida are discussed. Although randomized controlled trials with a sufficiently large sample size are rare, the research presented in this review indicates that this mode of training might be a potent tool to improve mental and physical health by improving muscle strength, body composition, self-concept or functionality, reducing pain or injury risk, and strengthening bone or tendons even in the most vulnerable groups of children with physical or mental disability. Furthermore, it has to be emphasized that compared with other types of treatment resistance training is considered to be without adverse effects.
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Affiliation(s)
- Kirsten Legerlotz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
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17
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van Dijkhuizen EHP, Egert T, Egert Y, Costello W, Schoemaker C, Fernhout M, Kepic M, Martini A, Scala S, Rotstein-Grein I, Vastert SJ, Wulffraat NM. Patient's experiences with the care for juvenile idiopathic arthritis across Europe. Pediatr Rheumatol Online J 2018; 16:10. [PMID: 29422094 PMCID: PMC5806356 DOI: 10.1186/s12969-018-0226-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To assess the views of juvenile idiopathic arthritis (JIA) patients and their parents on the care and treatment they receive in referral pediatric rheumatology centers throughout Europe. METHODS In a collaboration between physicians and patient associations, a questionnaire was developed, covering various domains of JIA care, including demographics, diagnosis, referrals to various health care professionals, access to pain and fatigue management and support groups, information they received about the disease and awareness of and participation in research. The questionnaire was translated and distributed by parent associations and pediatric rheumatologists in 25 countries, 22 of which were European. After completion the replies were entered on the PRINTO website. Replies could either be entered directly by parents on the website or on paper. In these cases, the replies were scanned and emailed by local hospital staff to Utrecht where they were entered by I.R. in the database. RESULTS The survey was completed by 622 parents in 23 countries. The majority (66.7%) of patients were female, with median age 10-11 years at the completion of the questionnaire. Frequencies of self-reported JIA categories corresponded to literature. Some patients had never been referred to the ophthalmologist (22.8%) or physiotherapist (31.7%). Low rates of referral or access to fatigue (3.5%) or pain management teams (10.0%), age appropriate disease education (11.3%), special rehabilitation (13.7%) and support groups (20.1%) were observed. Many patients indicated they did not have contact details for urgent advice (35.9%) and did not receive information about immunizations (43.2%), research (55.6%) existence of transition of care clinics (89,2%) or financial support (89.7%). While on immunosuppressive drugs, about one half of patients did not receive information about immunizations, travelling, possible infections or how to deal with chickenpox or shingles. CONCLUSIONS Low rates of referral to health care professionals may be due to children whose illness is well managed and who do not need additional support or information. Improvements are needed, especially in the areas of supportive care and information patients receive. It is also important to improve doctor patient communication between visits. Physicians can be instrumental in the setting up of support groups and increasing patients' awareness of existing support. Suggestions are given to convey crucial pieces of information structurally and repeatedly to ensure, among other things, compliance.
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Affiliation(s)
- E. H. Pieter. van Dijkhuizen
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
| | | | - Yona Egert
- Inbar Parent Association, Jerusalem, Israel
| | - Wendy Costello
- iCAN Irish Children’s Arthritis Network, Dublin, Republic of Ireland
| | - Casper Schoemaker
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,Netherlands JIA patient/parent organization, Amsterdam, Netherlands
| | - Marlous Fernhout
- Netherlands JIA patient/parent organization, Amsterdam, Netherlands
| | - Mirjam Kepic
- Slovenian JIA patient organization, Ljubljana, Slovenia
| | - Alberto Martini
- 0000 0004 1760 0109grid.419504.dPaediatric Rheumatology, IRCCS G. Gaslini, Genoa, Italy
| | - Silvia Scala
- 0000 0004 1760 0109grid.419504.dPaediatric Rheumatology, IRCCS G. Gaslini, Genoa, Italy
| | - Ingrid Rotstein-Grein
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,Department of Pediatric Rheumatology, Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Sebastiaan J. Vastert
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
| | - Nico M. Wulffraat
- 0000000090126352grid.7692.aPaediatric Rheumatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
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