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Marino A, Baldassarre P, Ferrigno C, Biuso A, Minutoli M, Baldo F, Costi S, Gattinara MV, Caporali RF, Chighizola CB. Pre-Rheumatology Referral Consultation and Investigation Pattern in Children with Joint Complaints: Focus on Juvenile Idiopathic Arthritis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:600. [PMID: 38790595 PMCID: PMC11120367 DOI: 10.3390/children11050600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
The diagnosis of juvenile idiopathic arthritis (JIA) is often entrusted to the pediatric rheumatologist specialist. Timely referral to a specialized center is crucial. This study aims to assess the consultation and investigation patterns of patients with joint complaints before rheumatology referral. This longitudinal cohort study included patients with joint complaints who were referred to the Pediatric Rheumatology Unit. The cohort included 301 patients (58% female), 50 of them (17%) diagnosed with JIA. Compared to patients with orthopedic conditions or functional diseases, JIA patients had seen more specialists (p < 0.01) and received a quicker diagnosis (p < 0.01). Patients with early JIA diagnosis (within 3 months from symptoms onset) were younger (8.46 vs. 11.5 years old; p = 0.04), more frequently female (78% vs. 47%, p = 0.03), and with higher erythrocyte sedimentation rate (ESR) values (37 vs. 9 mm/h; p = 0.02) than those diagnosed later. Patients with a late diagnosis of JIA had a significantly longer median time between the first healthcare visit and the PR referral (25 vs. 101 days; p < 0.01). The main contributor to diagnostic delay in JIA was the time required for PR referral after the first healthcare consult. Younger age, female sex, and higher ESR values were associated with earlier diagnosis of JIA.
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Affiliation(s)
- Achille Marino
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Paola Baldassarre
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Cristina Ferrigno
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Andrea Biuso
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Martina Minutoli
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Francesco Baldo
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Maurizio Virgilio Gattinara
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Roberto Felice Caporali
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
- Department of Clinical Sciences and Community Health, Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, 20122 Milan, Italy
- Department of Rheumatology and Medical Sciences, ASST G. Pini-CTO, 20122 Milan, Italy
| | - Cecilia Beatrice Chighizola
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
- Department of Clinical Sciences and Community Health, Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, 20122 Milan, Italy
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Lock K, Nethercott S, Hamilton C, Grace F, Hall N, Lowndes L, Musgrave M, Polychronakis T. Development of the Addenbrooke's MSK screening tool (AMST) for children and adolescents with cystic fibrosis. Heliyon 2024; 10:e25403. [PMID: 38384566 PMCID: PMC10878873 DOI: 10.1016/j.heliyon.2024.e25403] [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: 10/10/2023] [Revised: 11/30/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
Background Musculoskeletal (MSK) issues are common in the paediatric population and in people with CF. There is currently no MSK screening tool for children and adolescents with CF. Methods The protocol to develop the pGALS (paediatric Gait, Arms, Legs, Spine) was followed to create this screening tool. Paediatric respiratory and MSK physiotherapists, and paediatric respiratory doctors at a large teaching hospital were involved in the creation of this tool. This was then reviewed by paediatric respiratory doctors and physiotherapists at a second large teaching hospital with amendments added. One year data of this screening tool used on children over 7 was collected and analysed as a secondary outcome of this project. Results There were 81.8 % more positive screens for MSK issues in the newly developed screening tool compared to the year using Manchester MSK screening tool; there were also 6 more referrals all deemed as appropriate by the services referred to. Almost half of the population screened using the developed tool were positive for an MSK issue, this was commonly related to poor posture or correctable kyphosis. Kyphosis, as measured by plumb line, appeared to be associated with negative health outcomes in this population; pectoralis major length was also associated with kyphosis and these negative health outcomes. Conclusion The development of this tool has followed the protocol set out by the PGALs and has shown some promise with interesting initial results. This tool will need further validation before it is used in the wider paediatric CF population.
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Affiliation(s)
- Kieren Lock
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
- University of East Anglia, Colney Lane, Norwich, England, NR4 7UL, UK
| | - Sarah Nethercott
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
| | - Colin Hamilton
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
| | - Faye Grace
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
| | - Nicholas Hall
- University of Hertfordshire, De Havilland Campus, Mosuito Way, Hatfield, AL10 9EU, UK
| | - Laura Lowndes
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
| | - Monica Musgrave
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
| | - Theofilos Polychronakis
- Addenbrooke's Hospital, Cambridge University Hospitals, Hills Road, Cambridge, England, CB2 0QQ, UK
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Yongolo NM, Halliday J, Bunn C, Mtesha B, Kelly C, Krauth SJ, Mwingwa A, Biswaro SM, Siebert S, Kipengele AH, Walker RW, McIntosh E, Mmbaga BT. Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study. Pan Afr Med J 2024; 47:36. [PMID: 38586069 PMCID: PMC10998254 DOI: 10.11604/pamj.2024.47.36.38258] [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: 11/21/2022] [Accepted: 01/11/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population. Methods a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ). Results among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score. Conclusion this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being.
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Affiliation(s)
- Nateiya Mmeta Yongolo
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Liverpool School of Tropical Medicine, Liverpool, England
| | - Jo Halliday
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Bunn
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
| | - Clive Kelly
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stefanie Jennifer Krauth
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Anthon Mwingwa
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
| | | | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | | | - Richard William Walker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma McIntosh
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Mercer V, Smith N, Jandial S, Guglieri M, Jones SA, Foster HE. Beyond pGALS: the need for a multifaceted musculoskeletal decision-making tool ('pGALSplus') in community-based clinical practice. Rheumatol Adv Pract 2024; 8:rkae004. [PMID: 38283055 PMCID: PMC10822673 DOI: 10.1093/rap/rkae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Musculoskeletal (MSK) problems in children are common, and health-care professionals must identify those requiring onward referral. Paediatric gait, arms, legs and spine (pGALS) is an MSK assessment to discern abnormal joints. We aimed to identify MSK assessments to add to pGALS (pGALSplus) to facilitate decision-making in the context of exemplar conditions representing a spectrum of MSK presentations, namely JIA, mucopolysaccharidoses, muscular dystrophy and developmental co-ordination disorder. A literature review identified 35 relevant articles that focused on clinical assessments [including questionnaire(s), physical examination and functional tests] used by health-care professionals in the context of the exemplar conditions. We provide a description of these assessments and the rationale regarding how they, or components of such tools, might be useful within pGALSplus. This process provides a foundation for further work to develop and validate pGALSplus.
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Affiliation(s)
- Vicky Mercer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Children’s Physiotherapy, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharmila Jandial
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, Saint Mary’s Hospital, Manchester, UK
| | - Helen E Foster
- Population Health Institute, Newcastle University, Newcastle upon Tyne, UK
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Hanene LF, Amdouni N, Emna R, Hela S, Kaouther BA, Dorra BN, Dhia K, Kaouther M, Wafa H. Reliability of the tunisian pediatric gait, arms, legs, and spine: toward a valid screening tool for tunisian children with musculoskeletal conditions. Pediatr Rheumatol Online J 2023; 21:133. [PMID: 37919792 PMCID: PMC10621183 DOI: 10.1186/s12969-023-00905-9] [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: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pediatric musculoskeletal disorders account for 10% of first-line consultations in Tunisia. Referral delay and deficiencies in musculoskeletal screening raise a challenge to the early diagnosis and management of rheumatic conditions in children. The pGALS (Pediatric Gait Arms Legs Spine) was developed and translated into many languages to overcome these deficiencies. Our study aimed to adapt and validate pGALS to the Tunisian dialect for school-age children. METHODS Using the Delphi method, we carried out a cross-cultural adaptation of the pGALS to the Tunisian dialect. This consensual version was validated in a cross-sectional study, in two pediatric centers. RESULTS Ninety-two patients were enrolled, 43 females (46.7%) and 49 males (53.3%), mean age was 9.4 ± 2.6 years. The mean test duration was 3.4 ± 2.3 min, and the acceptability and comprehension of the test were good. Six patients had a musculoskeletal complaint, 19 had positive pGALS, and 14 were diagnosed with musculoskeletal disease. The internal consistency score (Cronbach's α) was 0.852. The sensitivity of the test was 92.8%, the specificity was 92.3%, the positive likelihood ratio was 2.16, and the negative likelihood ratio was 0.01. CONCLUSION The pGALS test adapted to the Tunisian dialect is a relevant, quick, and valid tool for screening musculoskeletal abnormalities in school-age children.
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Affiliation(s)
- Lassoued Ferjani Hanene
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia.
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia.
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia.
| | - Narjess Amdouni
- Pediatric out clinics, Tbourba Hospital, Ksar Said, Tunis, Tunisia
| | - Rabhi Emna
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
| | - Sahli Hela
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Rheumatology department, Rabta Hospital, Tunis, Tunisia
| | - Ben Abdelgheni Kaouther
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Rheumatology department, Mongi Slim Hospital, Tunis, Tunisia
| | - Ben Nessib Dorra
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
| | - Kaffel Dhia
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
| | - Maatallah Kaouther
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
| | - Hamdi Wafa
- Rheumatology department, Kassab orthopedics institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Ksar Saïd, Tunisia
- Research Unit UR17SP04, Ksar Said, Tunis, 2010, Tunisia
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Gupta A, Patra P. Approach to Musculoskeletal Pain in Children. Indian J Pediatr 2023:10.1007/s12098-023-04884-3. [PMID: 37863870 DOI: 10.1007/s12098-023-04884-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Abstract
Musculoskeletal (MSK) pain is a common pediatric problem and can occur due to many etiologies. A pediatrician should be clinically equipped to identify the cause of musculoskeletal pain by a meticulous history, a detailed physical examination and judicious use of appropriate investigations. In this review, the authors attempt to delineate the approach and discuss a few common causes of musculoskeletal pain.
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Affiliation(s)
- Anju Gupta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pratap Patra
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, India
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Clairman H, Dover S, Tomlinson G, Beebe D, Cameron B, Laxer RM, Levy D, Narang I, Paetkau S, Schneider R, Spiegel L, Stephens S, Stinson J, Tse S, Weiss S, Whitney K, Feldman BM. Lengthening sleep reduces pain in childhood arthritis: a crossover randomised controlled trial. RMD Open 2023; 9:e003352. [PMID: 37914178 PMCID: PMC10619109 DOI: 10.1136/rmdopen-2023-003352] [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: 05/30/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES Juvenile idiopathic arthritis (JIA) is a common chronic childhood disease and chronic pain is a debilitating feature. A strong link has been shown between poor sleep and pain in JIA. However, the causal direction is unknown. This study's aim was to determine if, in adolescents with JIA, a recommended healthful sleep duration leads to reductions in pain when compared with the restricted sleep (RS) duration that is commonly seen. METHODS Patients with JIA (12-18 years old; pain score of ≥1 on a visual analogue scale) participated in a randomised, crossover sleep manipulation protocol. The 3-week protocol comprised a baseline week (BL), a week with healthy sleep duration (HSD; 9.5 hours in bed/night) and a RS week (RS; 6.5 hours in bed/night). After BL, participants were randomly assigned to either HSD or RS, and then crossed over to the other condition. Pain was self-assessed using the iCanCope with Pain app. We used Bayesian hierarchical models to estimate the effect of sleep duration on pain. RESULTS Participants (n=31; mean age=15.0±1.8 years) averaged 1.4 (95% credible interval (CrI) 1.2-1.6) more hours of sleep per night during HSD relative to RS. Compared with RS, HSD resulted in a favourable effect on pain scores (OR 0.61, 95% CrI 0.39-0.95). CONCLUSION It is possible to have adolescents with childhood arthritis get a healthier sleep duration, and this longer sleep results in reduced pain. These findings complement prior correlational studies and confirm a causal relationship between reduced sleep duration and increased pain. TRIAL REGISTRATION NUMBER NCT04133662.
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Affiliation(s)
- Hayyah Clairman
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - George Tomlinson
- Division of Clinical Decision Making & Health Care, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Dean Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Bonnie Cameron
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah Levy
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Paetkau
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rayfel Schneider
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lynn Spiegel
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Stephens
- Neurosciences & Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Shirley Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelly Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristi Whitney
- Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Kawishe JE, Ngugi A, Luchters S, Foster H, Migowa A. Screening utility and acceptability of the Kiswahili-pGALS (paediatric Gait, Arms, Legs, Spine) at a tertiary referral hospital in Kenya-A diagnostic accuracy study. Pediatr Rheumatol Online J 2023; 21:103. [PMID: 37723485 PMCID: PMC10506249 DOI: 10.1186/s12969-023-00882-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/28/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Paediatric rheumatic diseases cause considerable disease burden to children and their families (Moorthy LN, Peterson MGE, Hassett AL, et al, Pediatric Rheumatology 8:20, 2010). Delayed diagnosis is a significant determinant of severity and mortality attributed to these conditions (Foster HE, Eltringham MS, Kay LJ, et al, Arthritis Care Res 57(6):921-7, 2007). pGALS is a simple clinical tool used to assess joints and identify musculoskeletal (MSK) conditions in school-going children to enable early referral to paediatric rheumatologists. OBJECTIVES This study aimed to translate and determine the diagnostic accuracy and acceptability of a Kiswahili version of the pGALS screening tool among Kiswahili-speaking children. METHODS The pGALS screening questions were translated into Kiswahili according to the World Health Organisation (WHO) standard for translation of a tool. The validity of the Kiswahili PGALS was ascertained and acceptability rated (time taken, discomfort). Using systematic random sampling, we enrolled children aged 5-16 years presenting at the Aga Khan University Hospital's (AKUH) emergency department in Kenya, who spoke Kiswahili and had symptoms suggestive of an MSK condition. Those already under follow-up at the paediatric rheumatology service at AKUH were excluded. MSK assessment was undertaken by two resident doctors using the newly translated Kiswahili-pGALS and findings were compared with a paediatric rheumatologist examination ('gold-standard') on the same day, and who was blinded to the pGALS findings. We analysed demographic details of the participants and determined the diagnostic accuracy by cross tabulation of the index test results by the results of the reference standard. RESULTS One hundred children with a median age of nine years (IQR 7-11) were enrolled. The sensitivity and specificity of the Kiswahili-pGALS screening tool were 76.8% (95%CI 63.6-87.0%) and 40.0% (95%CI 23.9-57.9%), respectively. The diagnostic accuracy was 62.7% (95%CI 52.1-72.1%), area under the ROC was 0.58 (95%CI 0.48-0.68). The median time to perform the Kiswahili-pGALS was 5.0 min (IQR 3.5-6.0 min). Ninety percent of the guardians found the practice of Kiswahili-pGALS to have none, or only some discomfort. CONCLUSIONS The Kiswahili-pGALS's was found to be a useful screening tool to aid early identification of MSK conditions in Kiswahili-speaking settings. However, the low specificity implies that relatively large number of false positives would still need to be reviewed by a rheumatologist if the tool is adapted for use.
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Affiliation(s)
| | - Anthony Ngugi
- Department of Population Health, The Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of International Public Health, Liverpool School of Tropical Medicine (LSTM, Liverpool, UK
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Angela Migowa
- Department of Paediatrics, The Aga Khan University Medical College East Africa, 30270-00100 3rd Parklands Avenue Nairobi, Nairobi, Kenya.
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McNeill K, Reyes N, Choe S, Peterson D, Bryant D, Sonnadara RR. A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education. MEDICAL SCIENCE EDUCATOR 2023; 33:777-790. [PMID: 37501799 PMCID: PMC10368607 DOI: 10.1007/s40670-023-01782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 07/29/2023]
Abstract
Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Natasha Reyes
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Stella Choe
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Ranil R. Sonnadara
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1 Canada
- Compute Ontario, Toronto, ON Canada
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10
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Mahfud M, Jones M, Fader T, Hause E. A virtual pediatric rheumatology teaching initiative for physicians in Somaliland. Pediatr Rheumatol Online J 2023; 21:1. [PMID: 36593494 PMCID: PMC9806882 DOI: 10.1186/s12969-022-00758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Muna Mahfud
- Director Hope Family Medicine, Amoud University, W6WF+C4F, Amoud Valley, 5 Km East of Borama Borama AD, Boorama, Somalia.
| | | | | | - Emily Hause
- Pediatric Rheumatology, Allergy, & Immunology, University of Minnesota, Academic Office Building, 2450 Riverside Ave S AO-10, 55454, Minneapolis, MN, USA.
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11
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Evans AM. Pediatric Flat Feet: A 2020 Guide for Clinicians to Identify the Boomerangs. J Am Podiatr Med Assoc 2022; 112:20-103. [PMID: 33956150 DOI: 10.7547/20-103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The pediatric flatfoot has long occupied a place in the medical literature, with concerns about the significance of its appearance. At the end of the first decade of the 21st century, an article in this journal provoked active debate about the pediatric flatfoot as part of development, and proposed a considered titration of presenting cases in an effort to justify treatment and appreciated the range and expected change in normal foot posture with growth. A decade later, the availability of normative pediatric foot posture data, and the prospective findings to confirm lessening flat feet with age, encourage a structured and considered approach to this frequent primary care presentation. The pragmatic concept of the "boomerang" is built on the research identifying pediatric flat feet likely to be symptomatic, thus requiring intervention, and filtering from those likely to remain asymptomatic. Differential diagnoses are advisedly considered, and gait remains the hallmark outcome. In this contemporary guide, an eight-step strategy has been developed to improve the approach to community pediatric flatfoot concerns. Furthermore, the three boomerang flat feet factors delineating symptomatic from asymptomatic flat feet, and applicable cutoff levels, are availed for practical reference and use. Given the recognized state of overdiagnosis and resulting unnecessary treatment that pervades the 21st century, it is timely for clear 20/20 vision for the presentation of pediatric flatfoot.
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Affiliation(s)
- Angela M Evans
- *La Trobe University, Discipline of Podiatry, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering
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12
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Williams CM, Menz HB, Lazzarini PA, Gordon J, Harrison C. Australian children's foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data. BMJ Open 2022; 12:e062063. [PMID: 35896301 PMCID: PMC9335039 DOI: 10.1136/bmjopen-2022-062063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore children's foot, ankle and leg consultation patterns and management practices in Australian primary care. DESIGN Cross-sectional, retrospective study. SETTING Australia Bettering the Evaluation and Care of Health program dataset. PARTICIPANTS Data were extracted for general practitioners (GPs) and patients <18 years from April 2000 to March 2016 inclusive. MAIN OUTCOME MEASURES Demographic characteristics: sex, GP age groups (ie, <45, 45-54, 55+ years), GP country of training, patient age grouping (0-4, 5-9, 10-14, 15-18 years), postcode, concession card status, indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses and the clinical management actioned by the GP. RESULTS Children's foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229 137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI 5.3 to 6.8) in 2005-2006 to 9.0 (95% CI 7.9 to 10.1) in 2015-2016. Management of children's foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15-18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100 000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping. CONCLUSIONS Children commonly present to GPs for foot, ankle and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.
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Affiliation(s)
- Cylie M Williams
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Julie Gordon
- WHO-CC for Strengthening Rehabilitation Capacity in Health Systems, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Parramatta, New South Wales, Australia
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13
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Palermi S, Annarumma G, Spinelli A, Massa B, Serio A, Vecchiato M, Demeco A, Brugin E, Sirico F, Giada F, Biffi A. Acceptability and Practicality of a Quick Musculoskeletal Examination into Sports Medicine Pre-Participation Evaluation. Pediatr Rep 2022; 14:207-216. [PMID: 35645365 PMCID: PMC9149839 DOI: 10.3390/pediatric14020028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Child musculoskeletal (MSK) diseases are common and, even if often benign, sometimes can lead to significant impairment in the future health of children. Italian pre-participation evaluation (PPE), performed by a sports medicine physician, allows for the screening of a wide range of children every year. Therefore, this study aims to evaluate the feasibility and the acceptability of pGALS (pediatric Gait, Arms, Legs and Spine) screening, a simple pediatric MSK screening examination, when performed as part of a routine PPE. METHODS Consecutive school-aged children attending a sports medicine screening program were assessed with the addition of pGALS to the routine clinical examination. Practicability (time taken) and patient acceptability (discomfort caused) were recorded. RESULTS 654 children (326 male, mean age 8.9 years) were evaluated through pGALS. The average time taken was 4.26 min (range 1.9-7.3 min). Acceptability of pGALS was deemed high: time taken was "adequate" (97% of parents) and caused little or no discomfort (94% of children). Abnormal MSK findings were common. CONCLUSIONS pGALS is a practical and acceptable tool to perform in sports medicine PPE, even if performed by a non-expert in MSK medicine. Although common, abnormal MSK findings need to be interpreted in the global clinical context and assessment.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Giada Annarumma
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Alessandro Spinelli
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35100 Padova, Italy;
| | - Andrea Demeco
- Unit of Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
| | - Erica Brugin
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale Hospital, 30033 Noale, Italy; (E.B.); (F.G.)
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy; (S.P.); (G.A.); (A.S.); (B.M.); (A.S.); (F.S.)
| | - Franco Giada
- Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale Hospital, 30033 Noale, Italy; (E.B.); (F.G.)
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00118 Rome, Italy
- Correspondence:
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14
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Pate JW, Joslin R, Hurtubise K, Anderson DB. Assessing a child or adolescent with low back pain is different to assessing an adult with low back pain. J Paediatr Child Health 2022; 58:566-571. [PMID: 35218582 PMCID: PMC9303678 DOI: 10.1111/jpc.15933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Abstract
In contrast to an assessment of an adult presenting with low back pain (LBP), clinicians should utilise different approaches when assessing children and adolescents presenting with LBP. Children are not 'little adults'. There are some unique pathologies that only occur in this age group: (i) serious pathologies include infection, fracture, child abuse and malignancy; (ii) growth-related pathologies include scoliosis, Scheuermann's disease, pars fracture and spondylolysis; and (iii) rheumatological conditions include juvenile idiopathic arthritis and ankylosing spondylitis. With changes in each child occurring physically, emotionally and socially, a clinician's knowledge of typical developmental milestones is essential to identify regression or delayed development. When listening to a child discuss their pain experience, a flexible structure should be implemented that gives the capacity to actively listen to a child's narrative (and that of their guardian) and to conduct an effective physical examination. This viewpoint also summarises the relationship between potential clinical diagnoses and key elements of a physical examination. Deciding on the type and timing of paediatric-specific physical examination tests requires unique child-centred considerations. Paediatric-specific outcome measures should be used but implemented pragmatically, with consideration regarding the time, complexity and pathology suspected. Systematic and rigorous approaches to both treatment planning and re-assessment are then proposed for the assessment of children and adolescents presenting with LBP.
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Affiliation(s)
- Joshua W Pate
- Graduate School of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Rhiannon Joslin
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUnited Kingdom
| | - Karen Hurtubise
- CanChild Centre for Childhood Disability Research, School of Rehabilitation SciencesMcMaster UniversityHamiltonOntarioCanada
| | - David B Anderson
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUnited Kingdom,Faculty of Medicine and Health, Sydney School of Health SciencesUniversity of SydneySydneyNew South WalesAustralia
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15
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Baronio F, Zucchini S, Zulian F, Salerno M, Parini R, Cattoni A, Deodato F, Gaeta A, Bizzarri C, Gasperini S, Pession A. Proposal of an Algorithm to Early Detect Attenuated Type I Mucopolysaccharidosis (MPS Ia) among Children with Growth Abnormalities. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010097. [PMID: 35056405 PMCID: PMC8780542 DOI: 10.3390/medicina58010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Diagnostic delay is common in attenuated Mucopolysaccharidosis Type I (MPS Ia) due to the rarity of the disease and the variability of clinical presentation. Short stature and impaired growth velocity are frequent findings in MPS Ia, but they rarely raise suspicion as paediatric endocrinologists are generally poorly trained to detect earlier and milder clinical signs of this condition. Materials and Methods: Following a consensus-based methodology, a multidisciplinary panel including paediatric endocrinologists, paediatricians with expertise in metabolic disorders, radiologists, and rheumatologists shared their experience on a possible clinical approach to the diagnosis of MPS Ia in children with short stature or stunted growth. Results: The result was the formation of an algorithm that illustrates how to raise the suspicion of MPS Ia in a patient older than 5 years with short stature and suggestive clinical signs. Conclusion: The proposed algorithm may represent a useful tool to improve the awareness of paediatric endocrinologists and reduce the diagnostic delay for patients with MPS Ia.
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Affiliation(s)
- Federico Baronio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (S.Z.); (A.P.)
- Correspondence: ; Tel.: +39-(0)-51-2144816
| | - Stefano Zucchini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (S.Z.); (A.P.)
| | - Francesco Zulian
- Rheumatology Unit, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy;
| | - Mariacarolina Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Rossella Parini
- Department of Pediatrics, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, 20900 Monza, Italy; (R.P.); (A.C.); (S.G.)
| | - Alessandro Cattoni
- Department of Pediatrics, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, 20900 Monza, Italy; (R.P.); (A.C.); (S.G.)
| | - Federica Deodato
- Division of Metabolic Disease, Bambino Gesù Children’s Hospital IRCSS, 00165 Rome, Italy;
| | - Alberto Gaeta
- Radiology Unit, Pediatric Hospital Giovanni XXIII, 70123 Bari, Italy;
| | - Carla Bizzarri
- Unit of Endocrinology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Serena Gasperini
- Department of Pediatrics, Milano-Bicocca University, Fondazione MBBM, San Gerardo Hospital, 20900 Monza, Italy; (R.P.); (A.C.); (S.G.)
| | - Andrea Pession
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (S.Z.); (A.P.)
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16
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Waqar-Cowles LN, Chuo J, Weiss PF, Gmuca S, LaNoue M, Burnham JM. Evaluation of pediatric rheumatology telehealth satisfaction during the COVID-19 pandemic. Pediatr Rheumatol Online J 2021; 19:170. [PMID: 34886863 PMCID: PMC8655491 DOI: 10.1186/s12969-021-00649-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the Coronavirus disease 2019 pandemic, ambulatory pediatric rheumatology healthcare rapidly transformed to a mainly telehealth model. However, pediatric patient and caregiver satisfaction with broadly deployed telehealth programs remains largely unknown. This study aimed to evaluate patient/caregiver satisfaction with telehealth and identify the factors associated with satisfaction in a generalizable sample of pediatric rheumatology patients. METHODS Patients with an initial telehealth video visit with a rheumatology provider between April and June 2020 were eligible. All patients/caregivers were sent a post-visit survey to assess a modified version of the Telehealth Usability Questionnaire (TUQ) and demographic and clinical characteristics. TUQ total and sub-scale (usefulness, ease of use, effectiveness, satisfaction) scores were calculated and classified as "positive" based on responses of "agree" or "strongly agree" on a 5-point Likert scale. Results were analyzed using standard descriptive statistics and Wilcoxon signed rank testing. The association between demographic and clinical characteristics with TUQ scores was assessed using univariate linear regression. RESULTS 597 patients/caregivers met inclusion criteria, and the survey response rate was 42% (n = 248). Juvenile idiopathic arthritis was the most common diagnosis (33.5%). The majority of patients were diagnosed greater than 6 months previously (72.6%) and were prescribed chronic medications (59.7%). The median total TUQ score was 4 (IQR: 4-5) with positive responses in 81% of items. Of the subscales, usefulness scores were lowest (median: 4, p < 0.001). Telehealth saves time traveling was the highest median item score (median = 5, IQR: 4-5). Within subscales, items that scored significantly lower included convenience, providing for needs, seeing rheumatologist as well as in person, and being an acceptable way to receive rheumatology services (all p < 0.001). There were no significant demographic or clinical features associated with TUQ scores. CONCLUSIONS Our results suggest telehealth is a promising mode of healthcare delivery for pediatric rheumatic diseases but also identifies opportunities for improvement. Innovation and research are needed to design a telehealth system that delivers high quality and safe care that improves healthcare outcomes. Since telehealth is a rapidly emerging form of pediatric rheumatology care, improved engagement and training of patients, caregivers, and providers may help improve the patient experience in the future.
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Affiliation(s)
- Lindsay N. Waqar-Cowles
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA ,grid.265008.90000 0001 2166 5843College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - John Chuo
- grid.239552.a0000 0001 0680 8770Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Pamela F. Weiss
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Sabrina Gmuca
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA
| | - Marianna LaNoue
- grid.152326.10000 0001 2264 7217Center for Research and Scholarly Development, Vanderbilt University School of Nursing, Nashville, TN 37203 USA
| | - Jon M. Burnham
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
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17
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Pooni R, Lee T. The Emerging Telehealth Landscape in Pediatric Rheumatology. Rheum Dis Clin North Am 2021; 48:259-270. [PMID: 34798951 DOI: 10.1016/j.rdc.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article provides an in-depth review of telemedicine and its use in pediatric rheumatology. Historical barriers to the use of telemedicine in pediatric chronic care are described, and recent policy changes that have supported the use of telemedicine are discussed. Future directions and suggestions for the evaluation of telemedicine in pediatric rheumatology care are provided with a special focus on clinical outcomes, its use in research, patient acceptability, and health equity.
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Affiliation(s)
- Rajdeep Pooni
- Division of Allergy, Immunology and Rheumatology, Department of Pediatric Rheumatology, Stanford Children's Health, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA.
| | - Tzielan Lee
- Division of Allergy, Immunology and Rheumatology, Department of Pediatric Rheumatology, Stanford Children's Health, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA
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18
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Pooni R, Ronis T, Lee T. Telemedicine use by pediatric rheumatologists during the COVID-19 pandemic. Pediatr Rheumatol Online J 2021; 19:93. [PMID: 34134709 PMCID: PMC8206874 DOI: 10.1186/s12969-021-00565-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To characterize various aspects of telemedicine use by pediatric rheumatology providers during the recent pandemic including provider acceptability of telehealth practices, clinical reliability, and clinical appropriateness. METHODS An electronic survey was generated and disseminated amongst the Childhood Arthritis and Rheumatology Research Alliance (CARRA) listserv (n = 547). Survey items were analyzed via descriptive statistics by question. RESULTS The survey response rate was 40.8% (n = 223) with the majority of respondents in an attending-level role. We observed that musculoskeletal components of the exam were rated as the most reliable components of a telemedicine exam and 86.5% of survey respondents reported engaging the patient or patient caregiver to help conduct the virtual exam. However, 65.7% of providers reported not being able to elicit the information needed from a telemedicine visit to make a complete clinical assessment. We also noted areas of disagreement regarding areas of patient engagement and confidentiality. We found that approximately one-third (35.8%) of those surveyed felt that their level of burnout was increased due to telemedicine. CONCLUSION In general, providers found exam reliability (specifically around focused musculoskeletal elements) in telemedicine visits but overall felt that they were unable to generate the information needed to generate a complete clinical assessment. Additionally, there were suggestions that patient engagement and confidentiality varied during telemedicine visits when compared to in-person clinical visits. Further qualitative work is needed to fully explore telemedicine use in pediatric rheumatology.
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Affiliation(s)
- Rajdeep Pooni
- Stanford Cildren's Health, Stanford University School of Medicine, Palo Alto, California, USA.
| | - Tova Ronis
- Children's National Hospital, Washington D.C; George Washington School of Medicine & Health Sciences, Washington DC, USA
| | - Tzielan Lee
- Stanford Cildren's Health, Stanford University School of Medicine, Palo Alto, California, USA
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19
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Smith N, Foster HE, Jandial S. A mixed methods evaluation of the Paediatric Musculoskeletal Matters (PMM) online portfolio. Pediatr Rheumatol Online J 2021; 19:85. [PMID: 34108019 PMCID: PMC8188761 DOI: 10.1186/s12969-021-00567-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The PMM Portfolio is comprised of the Paediatric Musculoskeletal Matters (PMM) website, the paediatric Gait, Arms, Legs and Spine (pGALS) app and e-learning modules (ELM). The target audiences are non-specialists in paediatric musculoskeletal medicine. Our study aimed to evaluate impact on learning and clinical practice. METHODS Mixed methods (analytics, online survey, interviews) were used with PMM and ELM registered users and purposive sampling of users using international contacts within paediatrics and paediatric rheumatology. Data was analysed using descriptive statistics and qualitative techniques. A Paired T-Test compared self-rated confidence before and after use of the PMM Portfolio. RESULTS There has been wide reach for all the e-resources; PMM website (662,827 hits, 262,476 users, 214 countries, data 31st July 2020); pGALS app (12,670 downloads, 70 countries, data 31st July 2020); ELM (150 users, 30 countries, data 30th May 2019). There were 164 responses (students, trainees and health care professionals) to the survey from 25 countries. Most responders deemed the PMM Portfolio useful / very useful for their learning with significantly increased self-rated confidence in their clinical examination and reasoning skills following access to the PMM website, p = < 0.01, pGALS app, p = < 0.01 and ELM, p = < 0.01. The most popular PMM website pages related to clinical assessment techniques (especially pGALS). There was high uptake of the pGALS app and pGALS ELM especially from trainees and allied health professionals. Many clinicians reported the PMM Portfolio to be useful when used to teach others. User feedback reported that easy navigation, open access, clinical images and cases were the most valued features. User feedback highlighted need to increase awareness of the e-resources through training programmes. CONCLUSIONS The PMM Portfolio was developed to aid learning for clinicians who are not specialists in paediatric MSK medicine. Our evaluation demonstrates wide international reach and positive feedback on learning. The PMM Portfolio is a highly useful e-resource for paediatric rheumatologists in their teaching of others to raise awareness, facilitate early diagnosis and referral of children with suspected disease. The wide user engagement informed future PMM Portfolio development and the mixed method of evaluation is transferable to other e-resources.
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Affiliation(s)
- Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Population and Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK ,grid.459561.a0000 0004 4904 7256Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
| | - Sharmila Jandial
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK ,grid.459561.a0000 0004 4904 7256Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
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20
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Rustad AM, Nolan BE, Ollech A, Boctor MJ, Paller AS. Incorporating joint pain screening into the pediatric dermatologic examination. Pediatr Dermatol 2021; 38:92-97. [PMID: 33275304 DOI: 10.1111/pde.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Joint manifestations are a feature of many pediatric skin disorders, among them psoriasis, autoimmune and autoinflammatory diseases, hypermobility disorders, and as an adverse effect of certain medications. Identifying joint disease early is important for intervention and prevention of chronic damage. However, pediatric musculoskeletal complaints are common and determining whether symptoms warrant a rheumatology referral for arthritis can be challenging. METHODS Pediatric dermatologists were surveyed for their comfort in screening for joint disease. Through literature review and interviews with three pediatric rheumatologists, key joints involved in disorders with skin manifestations and arthritis were identified and the essential evaluations were determined. RESULTS Of 100 surveyed practicing board-certified pediatric dermatologists, 79% did not feel confident in their ability to perform a joint-focused physical examination, a key step in screening for joint disease. A rapid joint examination technique (R-JET) was developed, along with an accompanying three-question survey and body diagram for patient self-report of symptoms. A video demonstration of the R-JET was created as a teaching tool. CONCLUSIONS Teaching and incorporation of a rapid screening examination for arthritis by pediatric dermatologists has the potential to identify pediatric arthritis earlier, facilitate referral, and reduce the risk of progressive joint disease. These instruments can easily be incorporated into a pediatric dermatology office visit.
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Affiliation(s)
- Andrea M Rustad
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian E Nolan
- Departments of Pediatrics/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ayelet Ollech
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Departments of Pediatrics/Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Boctor
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Departments of Pediatrics/Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Goh YI, Bullock DR, Taylor J, Pooni R, Lee TC, Vora SS, Yildirim-Toruner C, Morgan EM, Pan N, Harris JG, Warmin A, Wiegand K, Burnham JM, Barbar-Smiley F. Exploring Pediatric Tele-Rheumatology Practices During COVID-19: A Survey of the PRCOIN Network. Front Pediatr 2021; 9:642460. [PMID: 33748049 PMCID: PMC7970043 DOI: 10.3389/fped.2021.642460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Healthcare providers were rapidly forced to modify the way they practiced medicine during the coronavirus disease 2019 (COVID-19) pandemic. Many providers transitioned from seeing their patients in person to virtually using telemedicine platforms with limited training and experience using this medium. In pediatric rheumatology, this was further complicated as musculoskeletal exams typically require hands-on assessment of patients. The objective of this study was to examine the adoption of telemedicine into pediatric rheumatology practices, to assess its benefits and challenges, and to gather opinions on its continued use. A survey was sent to the lead representatives of each Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) site to collect data about their center's experience with telemedicine during the COVID-19 pandemic. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed. Responses were received from the majority [19/21 (90%)] of PR-COIN sites. All respondents reported transitioning from in-person to primarily virtual patient visits during the COVID-19 pandemic. All centers reported seeing both new consultations and follow-up patients over telemedicine. Most centers reported using both audio and video conferencing systems to conduct their telemedicine visits. The majority of respondents [13/19 (68%)] indicated that at least 50% of their site's providers consistently used pediatric Gait Arms Legs and Spine (pGALS) to perform active joint count assessments over telemedicine. Over half of the centers [11/19 (58%)] reported collecting patient-reported outcomes (PROs), but the rate of reliably documenting clinical components varied. A few sites [7/19 (37%)] reported performing research-related activity during telemedicine visits. All centers thought that telemedicine visits were able to meet providers' needs and support their continued use when the pandemic ends. Benefits reported with telemedicine visits included convenience and continuity of care for families. Conversely, challenges included limited ability to perform physical exams and varying access to technology. Pediatric rheumatology providers were able to transition to conducting virtual visits during the COVID-19 pandemic. Healthcare providers recognize how telemedicine can enhance their practice, but challenges need to be overcome in order to ensure equitable, sustainable delivery of quality and patient-centered care.
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Affiliation(s)
- Y Ingrid Goh
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Danielle R Bullock
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Janalee Taylor
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rajdeep Pooni
- Division of Allergy, Immunology and Rheumatology, Stanford Children's Health, Palo Alto, CA, United States
| | - Tzielan C Lee
- Division of Allergy, Immunology and Rheumatology, Stanford Children's Health, Palo Alto, CA, United States
| | - Sheetal S Vora
- Division of Pediatric Rheumatology, Atrium Health Levine Children's Hospital, Charlotte, NC, United States
| | - Cagri Yildirim-Toruner
- Department of Rheumatology, Baylor College of Medicine, Houston, TX, United States.,Department of Rheumatology, Texas Children's Hospital, Houston, TX, United States
| | - Esi M Morgan
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nancy Pan
- Division of Pediatric Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Julia G Harris
- Division of Pediatric Rheumatology, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Andrew Warmin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kendra Wiegand
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jon M Burnham
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Fatima Barbar-Smiley
- Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
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22
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Hovde AM, McFarland CA, Garcia GM, Gallagher F, Gewanter H, Klein-Gitelman M, Moorthy LN. Multi-pronged approach to enhance education of children and adolescents with lupus, caregivers, and healthcare providers in New Jersey: Needs assessment, evaluation, and development of educational materials. Lupus 2020; 30:86-95. [PMID: 33210558 DOI: 10.1177/0961203320969975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Childhood Systemic Lupus Erythematosus (cSLE) patients are younger at diagnosis and have a more severe disease course compared to adult onset SLE patients and develop significant complications related to disease and or immunosuppression. Moreover, female and minority populations experience higher rates of cSLE, with African American, Afro-Caribbean, and Hispanic populations being at greatest risk and having poor prognosis. METHODS The Pediatric Alliance for Lupus initiative addressed the dearth in education and resources in a multi-stage process. First, we conducted a need assessment identifying knowledge gaps among healthcare providers (HCPs), and resources needed to care for cSLE patients and their families. Second, we educated HCPs about the diagnosis and treatment of cSLE by Continuing Medical Education (CME) sessions/webinars (presented here). Third, HCPs participated in a Quality Improvement (QI) program on cSLE approved by the American Board of Pediatrics Maintenance of Certification Part 4. Finally, patients and caregivers were educated through the development of appropriate, culturally and linguistically sensitive cSLE resources. PAL disseminated materials among HCPs and the community to improve the awareness of the availability of these materials. RESULTS According to results from the statewide needs assessment (representative of every county throughout NJ), HCPs face significant challenges in providing care to cSLE patients and their families, in part due to the multi-systemic nature of the autoimmune disease. CONCLUSION Based on this need, we developed educational sessions, with pre-post comparison data showing a significant increase in knowledge after HCP education. The 15 different materials developed as part of the endeavor is a major contribution to the cSLE community, HCPs and pediatric rheumatologists. Resources are available in multiple formats (PDF and web pages), and are accessible on the National Resource Center on Lupus, the latest web site of the Lupus Foundation of American that houses materials for SLE patients, their families, schools, HCPs, and the community at large.Improving cSLE knowledge will empower the children and adolescents and families by increasing their self-efficacy; and positively impact key health outcomes (transition readiness and HRQOL) that are not optimally addressed with current medical treatment alone.
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Affiliation(s)
- Aldina M Hovde
- New Jersey Chapter, American Academy of Pediatrics, East Windsor, USA
| | | | | | - Fran Gallagher
- New Jersey Chapter, American Academy of Pediatrics, East Windsor, USA
| | | | - Marisa Klein-Gitelman
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - L Nandini Moorthy
- Rutgers University/Robert Wood Johnson Medical School, New Brunswick, USA
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23
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Shenoi S, Hayward K, Curran ML, Kessler E, Mehta JJ, Riebschleger MP, Foster HE. Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice. Pediatr Rheumatol Online J 2020; 18:85. [PMID: 33129319 PMCID: PMC7602754 DOI: 10.1186/s12969-020-00476-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.
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Affiliation(s)
- Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, Seattle Children's Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Kristen Hayward
- Department of Pediatrics, Division of Rheumatology, Seattle Children’s Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Megan L. Curran
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, Section of Rheumatology, University of Colorado, 13123 E. 16th Ave, B311, Aurora, CO 80045 USA
| | - Elizabeth Kessler
- grid.413656.30000 0004 0450 6121Department of Pediatrics, Section of Rheumatology, Helen DeVos Children’s Hospital, Grand Rapids, MI. 35 Michigan St NE, Grand Rapids, MI 49503 USA
| | - Jay J. Mehta
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia CTRB 10109, Philadelphia, PA 19104 USA
| | - Meredith P. Riebschleger
- grid.214458.e0000000086837370Department of Pediatrics, Division of Rheumatology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Professor Pediatric Rheumatology, Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
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Abstract
This chapter describes the musculoskeletal (MSK) context in children and young people as an important contributor to the global non-communicable disease burden. Through selected MSK conditions, we describe the impact on patients, families and communities and highlight the challenges that need to be addressed. We focus on opportunities for better working together and describe exemplar initiatives to raise awareness, workforce capacity building, models of care and research agendas to have a greater global context.
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25
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Thermal and Visual Imaging to Assist with Juvenile Idiopathic Arthritis Examination of the Knees. TECHNOLOGIES 2020. [DOI: 10.3390/technologies8020030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Juvenile idiopathic arthritis (JIA) causes inflammation of the joints, and it is frequently associated with their pain and stiffness. Its timely diagnosis is important to avoid its progressive damage to the bones and cartilage. Increases in the joint’s temperature and redness could be indicators of active JIA, hence their accurate quantification could assist with diagnosis. Thermal and visual images of the knees in 20 JIA participants (age: mean = 11.2 years, standard deviation = 2.3 years) were studied. The median temperature of knees with active inflammation was 3.198% higher than that of inactive knees. This difference, examined by a Wilcoxon signed-rank test, was statistically significant (p = 0.0078). In six out of the eight participants who had one active inflamed knee, thermal imaging identified the corresponding knee as warmer. In 16 out of 20 participants, the knee identified as warmer by thermal imaging was also identified as having a greater colour change by visual imaging as compared to their respective reference regions. The devised methods could accurately quantify the colour and temperature of the knees. It was concluded that thermal and visual imaging methods can be valuable in examining JIA. Further studies involving a larger number of participants and more detailed explorations would be needed prior to clinical application.
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26
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Rukuni R, Gregson C, Kahari C, Kowo F, McHugh G, Munyati S, Mujuru H, Ward K, Filteau S, Rehman AM, Ferrand R. The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe (IMVASK Study): a protocol for a prospective cohort study. BMJ Open 2020; 10:e031792. [PMID: 32041852 PMCID: PMC7045196 DOI: 10.1136/bmjopen-2019-031792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 12/08/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe. METHODS AND ANALYSIS Children with (n=300) and without HIV (n=300), aged 8-16 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1 year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores <-2) will also be determined. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities.
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Affiliation(s)
- Ruramayi Rukuni
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Celia Gregson
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
- Older Person's Unit, Royal United Hospital NHS Trust, Bath, UK
| | - Cynthia Kahari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Farirayi Kowo
- Department of Radiology, University of Zimbabwe, Harare, Zimbabwe
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kate Ward
- Lifecourse Epidemiology Unit, MRC, Southampton, UK
| | - Suzanne Filteau
- Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea M Rehman
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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27
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Medical education in pediatric rheumatology—unique challenges and opportunities. Clin Rheumatol 2019; 39:643-650. [DOI: 10.1007/s10067-019-04746-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
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28
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A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education. Clin Rheumatol 2019; 39:627-642. [DOI: 10.1007/s10067-019-04544-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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29
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Foster HE, Vojinovic J, Constantin T, Martini A, Dolezalova P, Uziel Y, Smith E, Lamot L, Wouters C, Avcin T, Wulffraat N. Educational initiatives and training for paediatric rheumatology in Europe. Pediatr Rheumatol Online J 2018; 16:77. [PMID: 30526605 PMCID: PMC6286498 DOI: 10.1186/s12969-018-0289-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/30/2018] [Indexed: 01/08/2023] Open
Abstract
The Paediatric Rheumatology European Society (PReS) has over many years, developed a portfolio of educational activities to address increasing educational needs of workforce and support young clinicians to acquire skills to develop new knowledge and deliver clinical care in the future. These educational activities aim to facilitate growth of paediatric rheumatology and ultimately improve the clinical care for children and families. This article describes the current portfolio of PReS educational activities and their relevance to the international paediatric rheumatology community.
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Affiliation(s)
- Helen E. Foster
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jelena Vojinovic
- Faculty of Medicine, Department Pediatric Rheumatology, University of Nis, Nis, Serbia
| | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | | | - Pavla Dolezalova
- Paediatric Rheumatology and Autoinflammatory Diseases Centre, Department of Paediatrics and Adolescent Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yosef Uziel
- Department of Pediatrics, Meir medical center, Tel Aviv University Sackler School of Medicine, Kfar-Saba, Israel
| | - E.M.D Smith
- Department of Women’s & Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Lovro Lamot
- Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Carine Wouters
- University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, Leuven, Belgium
- University Hospitals Leuven, Pediatric Rheumatology, Leuven, Belgium
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nico Wulffraat
- Department of Paediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Gillispie M, Muscal E, Rama J, Falco C, Brown A. Pediatric Rheumatology Curriculum for the Pediatrics Resident: A Case-Based Approach to Learning. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10767. [PMID: 30800967 PMCID: PMC6342410 DOI: 10.15766/mep_2374-8265.10767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/16/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Pediatric rheumatologic disease occurs more frequently than several other chronic pediatric diseases but is often underrecognized. It is estimated that in the US, one in 250 children has some form of juvenile arthritis and 300,000 children have a form of rheumatologic disease. However, there are only approximately 400 practicing pediatric rheumatologists nationwide. METHODS Kern's six-step method was used to develop a pediatric rheumatology curriculum based on respondents' perceived lack of training and comfort with four key areas: workup, musculoskeletal exam, laboratory interpretation, and referral to rheumatology. These cases were developed for second-year pediatric and second- and third-year internal medicine-pediatric residents rotating with the service. The curriculum was composed of four 30-minute case discussions as well as an observed musculoskeletal exam session. RESULTS In 2017, weekly case study sessions reached 34 trainees. Survey results from these trainees are representative of our overall results and reveal that learners felt the content of the cases helped increase comfort with compiling pertinent history and information of symptoms consistent with autoimmune disease, recognizing physical exam findings of autoimmune disease, ordering and interpreting laboratory studies in children with concerns for autoimmune disease, and referring to pediatric rheumatology. DISCUSSION This case-based curriculum exposed residents to presentations of the more common autoimmune diseases encountered in the pediatric population. The curriculum helps fill a gap in pediatric training through increased exposure to this subset of chronic diseases and expands physical examination skills not typically taught in general pediatrics.
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Affiliation(s)
- Miriah Gillispie
- Fellow, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
| | - Eyal Muscal
- Associate Professor, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
- Associate Professor, Department of Neurology, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
| | - Jennifer Rama
- Assistant Professor, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine at Texas Children's Hospital
| | - Carla Falco
- Assistant Professor, Department of Pediatrics, Section of Hospital Medicine, Baylor College of Medicine at Texas Children's Hospital
| | - Amanda Brown
- Assistant Professor, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
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Acceptability and Practicality of the Turkish Translation of Pediatric Gait Arm Legs and Spine in Turkish Children. J Clin Rheumatol 2018; 23:421-424. [PMID: 28926470 DOI: 10.1097/rhu.0000000000000586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The pediatric Gait, Arms, Leg, and Spine (pGALS) is a practical questionnaire for musculoskeletal (MSK) system evaluation in school-age children. OBJECTIVE The aim of this study was to evaluate the acceptability/practicality of pGALS Turkish translation in Turkey (cross-sectional study). METHODS The Turkish translation of pGALS was administered to children (4-18 years) who attended to the Pediatric Emergency Department of Hacettepe University, Ankara, Turkey, and the outpatient clinic of the Physical Therapy and Rehabilitation Department of Marmara University, Istanbul, Turkey, during 1 month in 2016. The demographics, complaints, final diagnoses, and pGALS parameters were noted. The acceptability of pGALS was evaluated using visual analog scale. RESULTS Ninety-five patients (median age, 108 months; male/female, 1.1) were enrolled. Sixteen patients (16.8%) had MSK diagnosis, whereas 79 (83.2%) had non-MSK diagnoses. Musculoskeletal diagnoses were as follows: scoliosis (n = 4), metatarsus adductus (n = 4), soft tissue injury (n = 3), lumber disk herniation (n = 2), muscle spasm (n = 1), Achilles tendinitis (n = 1), and tibia torsion (n = 1). The sensitivity was 64.7%, and specificity was 89.7% for positive response to 1 or more pGALS screening questions to detect abnormal pGALS. The most sensitive question was pain question. The most common abnormal pGALS components were spine and posture. The sensitivity and specificity of pGALS for detecting MSK diagnosis were 93.7% and 97.4%, respectively. The median duration of pGALS examination was 4 minutes. Most patients/parents found the duration acceptable (94.7%/97.9%, respectively) and reported that pGALS caused little/no discomfort (97.9%/96.8%, respectively). CONCLUSION This is the first study showing the Turkish version of pGALS as a valid, acceptable, and practical screening test in Turkey.
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Physical Examination Tools Used to Identify Swollen and Tender Lower Limb Joints in Juvenile Idiopathic Arthritis: A Scoping Review. ARTHRITIS 2018; 2018:3408162. [PMID: 29862076 PMCID: PMC5976945 DOI: 10.1155/2018/3408162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/19/2018] [Accepted: 04/08/2018] [Indexed: 11/18/2022]
Abstract
Background Juvenile idiopathic arthritis (JIA) is the most common form of rheumatic disease in childhood and adolescents, affecting between 16 and 150 per 100,000 young persons below the age of 16. The lower limb is commonly affected in JIA, with joint swelling and tenderness often observed as a result of active synovitis. Objective The objective of this scoping review is to identify the existence of physical examination (PE) tools to identify and record swollen and tender lower limb joints in children with JIA. Methods Two reviewers individually screened the eligibility of titles and abstracts retrieved from the following online databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. Studies that proposed and validated a comprehensive lower limb PE tool were included in this scoping review. Results After removal of duplicates, 1232 citations were retrieved, in which twelve were identified as potentially eligible. No studies met the set criteria for inclusion. Conclusion Further research is needed in developing and validating specific PE tools for clinicians such as podiatrists and other allied health professionals involved in the management of pathological lower limb joints in children diagnosed with JIA. These lower limb PE tools may be useful in conjunction with existing disease activity scores to optimise screening of the lower extremity and monitoring the efficacy of targeted interventions.
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Unal E, Batu ED, Sonmez HE, Arici ZS, Arin G, Karaca NB, Sag E, Demir S, Hakli DA, Ozcadirci A, Oflaz FB, Alpar R, Bilginer Y, Ozen S. A new biopsychosocial and clinical questionnaire to assess juvenile idiopathic arthritis: JAB-Q. Rheumatol Int 2018; 38:1557-1564. [PMID: 29869009 DOI: 10.1007/s00296-018-4075-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To create a new multidimensional questionnaire for the assessment of juvenile idiopathic arthritis (JIA) patients in standard clinical practice and study the validity and reliability of this questionnaire. METHODS The Juvenile Arthritis Biopsychosocial and Clinical Questionnaire (JAB-Q) was created using the Delphi technique and consensus conference following an initial literature search. The questionnaire has three parts including a clinician form, child form and parent form. This is a patient/parent-centered outcome tool, which helps us to evaluate the biopsychosocial aspects of the patient, including disease activity, posture, functional and psychosocial status, fatigue, and performance in school. From January 2015 to January 2018, 6-18 years old children with JIA were enrolled in the study. The previously validated questionnaires were also applied to each participant to validate the JAB-Q: Juvenile Idiopathic Disease Arthritis Score (JADAS) and Childhood Health Assessment Questionnaire (CHAQ), and the Family Impact Questionnaire (FIS). The same questionnaire was re-administered after one week to assess the test-retest reliability in randomly selected 50 children and their parents. RESULTS A group of experts were invited to the Delphi survey. After the Delphi tours, the final form of the questionnaire containing three parts as clinician form, child form and parent form was created. This tool was applied to 310 JIA patients and their parents. The children and parents easily handled the JAB-Q and filled the forms in around 10-15 min. The validity of the clinician, child and parents' forms were assessed by the JADAS, CHAQ, and FIS, respectively. The validity of these three scales were determined as moderate. In addition, the test-retest reliability of the clinician, child and parents' forms were considerably high. CONCLUSION JAB-Q is a valid and reliable multidimensional biopsychosocial outcome tool that can be used routinely in clinical practice of pediatric rheumatology. The main advantage of this tool is incorporation of patients' and parents' perspectives separately while providing a practical and standard setting for the clinician's evaluation. However, further validation of this tool in an independent cohort is needed to improve its applicability.
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Affiliation(s)
- Edibe Unal
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zehra Serap Arici
- Department of Pediatric Rheumatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Gamze Arin
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Nur Banu Karaca
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Erdal Sag
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Duygu Aydin Hakli
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aykut Ozcadirci
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Fatma Birgul Oflaz
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Reha Alpar
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey. .,Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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Confidence amongst Multidisciplinary Professionals in Managing Paediatric Rheumatic Disease in Australia. ARTHRITIS 2018; 2018:7807490. [PMID: 29593902 PMCID: PMC5822930 DOI: 10.1155/2018/7807490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/24/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
Abstract
Objective Interprofessional collaboration is a crucial component of care for children with rheumatic disease. Interprofessional care, when delivered appropriately, prevents disability and improves long-term prognosis in this vulnerable group. Methods The aim of this survey was to explore allied health professionals' and nurses' confidence in treating paediatric rheumatology patients. Results Overall, 117 participants were recruited, 77.9% of participants reported being “not confident at all,” “not confident,” or “neutral” in treating children with rheumatic diseases (RD) despite 65.1% of participants reporting having treated >1 paediatric rheumatology case in the past month. Furthermore, 67.2% of participants felt their undergraduate education in paediatric rheumatology was inadequate. “Journals” or “texts books” were used by 49.3% of participants as their primary source of continuing professional development (CPD) and 39.3% of participants indicated that they did not undertake any CPD related to paediatric rheumatology. Small group and online education were perceived to be potentially of “great benefit” for CPD. Conclusion This paper highlights allied health professionals' and nurses' perceived inadequacy of their undergraduate education in paediatric RD and their low confidence in recognising and treating RD. Undergraduate and postgraduate education opportunities focusing on interprofessional collaboration should be developed to address this workforce deficiency.
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Kenis-Coskun O, Karadag-Saygi E, Bahar-Ozdemir Y, Gokdemir Y, Karadag B, Kayhan O. The involvement of musculoskeletal system and its influence on postural stability in children and young adults with cystic fibrosis. Ital J Pediatr 2017; 43:106. [PMID: 29162121 PMCID: PMC5696729 DOI: 10.1186/s13052-017-0426-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/15/2017] [Indexed: 01/23/2023] Open
Abstract
Background Cystic fibrosis (CF) affects the musculoskeletal system via a multifactorial pathway that includes vitamin D deficiency and involvement of respiratory muscles such as intercostals due to recurrent upper and lower respiratory tract infections. Eventual result is the deterioration of musculoskeletal health and posture in CF patients. Postural stability is directly affected by posture and can be compromised in every musculoskeletal problem. The aim of this study is to evaluate musculoskeletal system and postural stability in patients with CF. Methods Patients with CF over six years of age and age and sex-matched control groups were included in the study. Cobb angle and thoracic kyphosis angles were measured on the spine radiographs. Both patients and control group were examined with pediatric gait, arms, legs and spine scale (pGALS). They also were evaluated with a NeuroCom Balance Master for their postural stability. Results Fifty-one patients with CF and 94 healthy controls participated in the study. In results of the pGALS examination, CF group had significantly more pathological findings than the control group in lower extremity appearance and movement (p = 0.006 and p = 0.01) and spine appearance and movement (p = 0.001 and p = 0.022) domains. The tandem walking speed was significantly higher in controls with a mean of 24.45 ± 7.79 while it was 20.47 ± 6.95 in the CF group (p = 0.03). Various limits of stability parameters also showed significant differences. Medium correlations were found between musculoskeletal examination and postural stability parameters. Conclusion In patients with CF, a systematic but simple musculoskeletal examination can detect pathologies, which are more frequent than the normal population. These pathologies show a medium correlation with the involvement of postural stability.
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Affiliation(s)
- Ozge Kenis-Coskun
- Semsi Denizer Cad Dr Lutfi Kirdar Kartal Research and Training Hospital, Physical Medicine and Rehabilitation Department Istanbul, 34890, Istanbul, Turkey.
| | - Evrim Karadag-Saygi
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department Istanbul, Istanbul, Turkey
| | - Yeliz Bahar-Ozdemir
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department Istanbul, Istanbul, Turkey
| | - Yasemin Gokdemir
- Marmara University Medical Faculty Pediatric Pulmonology Department Istanbul, Istanbul, Turkey
| | - Bulent Karadag
- Marmara University Medical Faculty Pediatric Pulmonology Department Istanbul, Istanbul, Turkey
| | - Onder Kayhan
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department Istanbul, Istanbul, Turkey
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Frid P, Nordal E, Bovis F, Giancane G, Larheim TA, Rygg M, Pires Marafon D, De Angelis D, Palmisani E, Murray KJ, Oliveira S, Simonini G, Corona F, Davidson J, Foster H, Steenks MH, Flato B, Zulian F, Baildam E, Saurenmann RK, Lahdenne P, Ravelli A, Martini A, Pistorio A, Ruperto N. Temporomandibular Joint Involvement in Association With Quality of Life, Disability, and High Disease Activity in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2017; 69:677-686. [PMID: 27564918 DOI: 10.1002/acr.23003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants. METHODS This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression. RESULTS Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration >4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most important determinants for TMJ involvement. CONCLUSION Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.
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Affiliation(s)
- Paula Frid
- University Hospital of North Norway, UiT The Arctic University of Norway, and Public Dental Competence Center of Northern Norway, Tromsø, Norway
| | - Ellen Nordal
- University Hospital of North Norway, and UiT The Arctic University of Norway, Tromsø, Norway
| | - Francesca Bovis
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | | | - Tore A Larheim
- UiT The Arctic University of Norway, Tromsø, and University of Oslo, Oslo, Norway
| | - Marite Rygg
- Norwegian University of Science and Technology and St. Olavs University Hospital, Trondheim, Norway
| | | | - Donato De Angelis
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | - Elena Palmisani
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | - Kevin J Murray
- Princess Margaret Hospital for Children, Perth, Australia
| | - Sheila Oliveira
- Universidade Federal do Rio de Janeiro, and Instituto de Puericultura e Pediatria Martagao Gesteira, Rio de Janeiro, Brazil
| | | | - Fabrizia Corona
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Helen Foster
- Newcastle University, Newcastle Hospitals NHS Foundation Trust, and Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | - Berit Flato
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Eileen Baildam
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Pekka Lahdenne
- Children's Hospital and Helsinki University Central Hospital, Helsinki, Finland
| | - Angelo Ravelli
- Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy
| | - Alberto Martini
- Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy
| | | | - Nicolino Ruperto
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
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Khawaja K, Al-Maini M. Access to pediatric rheumatology care for Juvenile Idiopathic Arthritis in the United Arab Emirates. Pediatr Rheumatol Online J 2017; 15:41. [PMID: 28511684 PMCID: PMC5434612 DOI: 10.1186/s12969-017-0170-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study looks at access to care for Juvenile Idiopathic Arthritis through pediatric rheumatology in the UAE, as an example of multi-ethnic society. METHODS Patients with a diagnosis of Juvenile idiopathic arthritis were identified through the hospital electronic medical records system from January 1st 2011 to December 31st 2014. All residents of the United Arab Emirates hold an Emirates identity card. We divided our patients into two groups: Emirati-Emirates, who are native Emirati children and hold the Emirati nationality, as stated on their Emirates identity card, and who therefore have full, comprehensive access to free medical care; and non-Emirati-Emirates, who represent other nationalities, as stated on their Emirates identity card. The primary objective of this study is to look at access to care for Juvenile idiopathic arthritis through pediatric rheumatology in the two groups. The secondary objective is to look at the effect of having multiple types of healthcare insurance coverage on access to biologics. A retrospective review was carried out. RESULTS Sixty-six patients with JIA identified: 33 Emirates and 33 non-Emirates. For Emirates, the mean time from onset to first appointment with pediatric rheumatologist and diagnosis is 9 months (range: 1-48), and for non-Emirates is 12.4 months (range: 1-96). Among the Emirates, 10 patients are currently on biologic with methotrexate. Among the non-Emirates, 15 are on biologic with methotrexate. Among the Emirates, 12 are currently in remission while on treatment, as are 10 non-Emirates. Regarding disability, one Emirati patient has blindness secondary to noncompliance while under previous treatment. One Non-Emirati developed joint deformities due to periods of noncompliance and no follow up. CONCLUSIONS Delay in presentation to pediatric rheumatology has been identified as an important factor in our population, which is multi-cultural and multi-ethnic. Type of health care insurance cover did not affect number of patients getting biological therapy once patient seen in the pediatric rheumatology service.
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Affiliation(s)
- Khulood Khawaja
- Department of Rheumatology, Allergy and Immunology, Al-Mafraq Hospital, P.O. Box 2951, Abu Dhabi, United Arab Emirates.
| | - Mustafa Al-Maini
- grid.416275.3Department of Rheumatology, Allergy and Immunology, Al-Mafraq Hospital, P.O. Box 2951, Abu Dhabi, United Arab Emirates
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Burden-Teh E, Thomas KS, Rangaraj S, Cranwell J, Murphy R. Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening. Clin Exp Dermatol 2017; 42:153-160. [DOI: 10.1111/ced.13010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/20/2022]
Affiliation(s)
- E. Burden-Teh
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
- Paediatric Dermatology Department; Nottingham Children's Hospital; Nottingham UK
| | - K. S. Thomas
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - S. Rangaraj
- Paediatric and Adolescent Rheumatology Department; Nottingham Children's Hospital; Nottingham UK
| | - J. Cranwell
- Division of Epidemiology and Public Health; University of Nottingham; Nottingham UK
| | - R. Murphy
- Paediatric Dermatology Department; Nottingham Children's Hospital; Nottingham UK
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Burden-Teh E, Thomas KS, Rangaraj S, Murphy R. Interviews with paediatric rheumatologists about psoriasis and psoriatic arthritis in children: how can specialties learn from each other? Br J Dermatol 2016; 177:316-318. [PMID: 27680897 DOI: 10.1111/bjd.15090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E Burden-Teh
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2RD, U.K
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2RD, U.K
| | - S Rangaraj
- Department of Paediatric and Adolescent Rheumatology, Nottingham Children's Hospital, Nottingham, U.K
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, U.K
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Sabui TK, Samanta M, Mondal RK, Banerjee I, Saren A, Hazra A. Survey of musculoskeletal abnormalities in school-going children of hilly and foothill regions of Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine screening method. Int J Rheum Dis 2016; 21:1127-1134. [PMID: 27306925 DOI: 10.1111/1756-185x.12897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the prevalence and pattern of musculosketetal abnormalities in school-going children living in the hilly and foothill regions of the Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine (pGALS) screening tool. METHODS Total of 3608 children, aged 3-12 years were enrolled from 16 schools (5 in the hills) in the eastern Himalayan region. After the three screening questions, the pGALS maneuvers were administered. Subjects were shown a video on pGALS before the actual testing. Those detected to have abnormality were probed in greater detail and referred for treatment as necessary. RESULTS The pGALS examination was completed in 3463 children with a median time of 3 min (range 1.9-5.4 min). The abnormality pattern was in the order: growing pains (38.86%), hypermobility (25.54%), mechanical pains (24.46%) and others (11.14%). Among mechanical pain, back and neck problems occurred with a similar overall frequency of 7.61%. Similar order was observed considering only children from the pains. However, in hill children, the proportion of mechanical problems (32.28%) exceeded proportion of hypermobility (23.62%). Asymptomatic hypermobility was more common than symptomatic hypermobility. Maximum prevalence of hypermobility was in 6-9 year age group. Of the 94 children with hypermobility, 55.32% had some kind of joint pain. CONCLUSIONS Pediatric Gait, Arms, Legs, Spine is an acceptable screening tool for musculoskeletal abnormalities in apparently healthy children. Growing pain is the commonest musculoskeletal complaint while hypermobility is the commonest physical abnormality in school-going children in the Eastern Himalayas. Asymptomatic hypermobility is more common than symptomatic hypermobility.
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Affiliation(s)
- Tapas Kumar Sabui
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | - Moumita Samanta
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | | | - Indira Banerjee
- Department of Pediatric Medicine, North Bengal Medical College and Hospital, Darjeeling, India
| | - Abishek Saren
- Department of Pediatric Medicine, North Bengal Medical College and Hospital, Darjeeling, India
| | - Avijit Hazra
- Department of Pharmacology, IPGME&R and SSKM Hospital, Kolkata, India
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McErlane F, Foster HE, Carrasco R, Baildam EM, Chieng SEA, Davidson JE, Ioannou Y, Wedderburn LR, Thomson W, Hyrich KL. Trends in paediatric rheumatology referral times and disease activity indices over a ten-year period among children and young people with Juvenile Idiopathic Arthritis: results from the childhood arthritis prospective Study. Rheumatology (Oxford) 2016; 55:1225-34. [PMID: 27016664 PMCID: PMC4911538 DOI: 10.1093/rheumatology/kew021] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Indexed: 11/28/2022] Open
Abstract
Objectives. The medical management of JIA has advanced significantly over the past 10 years. It is not known whether these changes have impacted on outcomes. The aim of this analysis was to identify and describe trends in referral times, treatment times and 1-year outcomes over a 10-year period among children with JIA enrolled in the Childhood Arthritis Prospective Study. Methods. The Childhood Arthritis Prospective Study is a prospective inception cohort of children with new-onset inflammatory arthritis. Analysis included all children recruited in 2001–11 with at least 1 year of follow-up, divided into four groups by year of diagnosis. Median referral time, baseline disease pattern (oligoarticular, polyarticular or systemic onset) and time to first definitive treatment were compared between groups. Where possible, clinical juvenile arthritis disease activity score (cJADAS) cut-offs were applied at 1 year. Results. One thousand and sixty-six children were included in the analysis. The median time from symptom onset and referral to first paediatric rheumatology appointment (22.7–24.7 and 3.4–4.7 weeks, respectively) did not vary significantly (∼20% seen within 10 weeks of onset and ∼50% within 4 weeks of referral). For oligoarticular and polyarticular disease, 33.8–47 and 25.4–34.9%, respectively, achieved inactive disease by 1 year, with ∼30% in high disease activity at 1 year. A positive trend towards earlier definitive treatment reached significance in oligoarticular and polyarticular pattern disease. Conclusion. Children with new-onset JIA have a persistent delay in access to paediatric rheumatology care, with one-third in high disease activity at 1 year and no significant improvement over the past 10 years. Contributing factors may include service pressures and poor awareness. Further research is necessary to gain a better understanding and improve important clinical outcomes.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust
| | - Helen E Foster
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester
| | - Eileen M Baildam
- Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | | | - Joyce E Davidson
- Paediatric Rheumatology, Royal Hospital for Children, Glasgow, Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, Division of Medicine, University College London (UCL)
| | - Lucy R Wedderburn
- Infection, Inflammation and Rheumatology Section, and Arthritis Research UK Centre for Adolescent Rheumatology, UCL Institute of Child Health, London
| | - Wendy Thomson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute for Inflammation and Repair Faculty of Medical and Human Sciences, University of Manchester, and
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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de Inocencio Arocena J. Paediatric rheumatology: The importance of anamnesis and physical examination. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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de Inocencio Arocena J. [Paediatric rheumatology: The importance of anamnesis and physical examination]. An Pediatr (Barc) 2016; 84:131-2. [PMID: 26839167 DOI: 10.1016/j.anpedi.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- J de Inocencio Arocena
- Unidad de Reumatología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España.
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Abstract
It is not uncommon in pediatric clinical practice to encounter children with musculoskeletal symptoms. A number of disparate conditions can present with joint complaints in children. In this article, the author describes the clinical approach to a child presenting with joint complaints. A detailed clinical history, including the family history, along with a complete physical examination can provide vital clues to the underlying condition in most cases. A structured screening examination of the musculoskeletal system that has been recently developed (i.e., pGALS) is also discussed. It is also pointed out that the pattern of joint involvement gives us one of the most important clues to the etiology of arthritis. The pediatrician has to be aware of the conditions that can have arthritis as one of the manifestations so as to investigate and treat the child accordingly.
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Smith N, Rapley T, Jandial S, English C, Davies B, Wyllie R, Foster HE. Paediatric musculoskeletal matters (pmm)--collaborative development of an online evidence based interactive learning tool and information resource for education in paediatric musculoskeletal medicine. Pediatr Rheumatol Online J 2016; 14:1. [PMID: 26728031 PMCID: PMC4700751 DOI: 10.1186/s12969-015-0062-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We describe the collaborative development of an evidence based, free online resource namely 'paediatric musculoskeletal matters' (pmm). This resource was developed with the aim of reaching a wide range of health professionals to increase awareness, knowledge and skills within paediatric musculoskeletal medicine, thereby facilitating early diagnosis and referral to specialist care. METHODS Engagement with stakeholder groups (primary care, paediatrics, musculoskeletal specialties and medical students) informed the essential 'core' learning outcomes to derive content of pmm. Representatives from stakeholder groups, social science and web development experts transformed the learning outcomes into a suitable framework. Target audience representatives reviewed the framework and their opinion was gathered using an online survey (n = 74) and focus groups (n = 2). Experts in paediatric musculoskeletal medicine peer reviewed the content and design. RESULTS User preferences informed design with mobile, tablet and web compatible versions to facilitate access, various media and formats to engage users and the content presented in module format (i.e. Clinical assessment, Investigations and management, Limping child, Joint pain by site, Swollen joint(s) and Resources). CONCLUSIONS We propose that our collaborative and evidence-based approach has ensured that pmm is user-friendly, with readily accessible, suitable content, and will help to improve access to paediatric musculoskeletal medicine education. The content is evidence-based with the design and functionality of pmm to facilitate optimal and 'real life' access to information. pmm is targeted at medical students and the primary care environment although messages are transferable to all health care professionals involved in the care of children and young people.
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Affiliation(s)
- Nicola Smith
- Paediatric Rheumatology, Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.
| | - Sharmila Jandial
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
| | - Christine English
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK.
| | - Barbara Davies
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK.
| | - Ruth Wyllie
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
| | - Helen E Foster
- Paediatric Rheumatology, Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK.
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Smith N, Dhanrajani A, Foster H, Khubchandani RP. A survey of knowledge, attitudes, and practices relating to musculoskeletal examination among pediatricians in Maharashtra, India. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jandial S, Stewart J, Foster HE. What do they need to know: achieving consensus on paediatric musculoskeletal content for medical students. BMC MEDICAL EDUCATION 2015; 15:171. [PMID: 26449878 PMCID: PMC4599324 DOI: 10.1186/s12909-015-0449-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/22/2015] [Indexed: 06/02/2023]
Abstract
BACKGROUND Children present commonly with musculoskeletal (MSK) problems, due to a spectrum of causes including potentially life threatening disease, to doctors in varied health care settings. However, doctors involved in the care of children report a lack of confidence in their paediatric musculoskeletal (pMSK) clinical skills and many have little exposure to pMSK teaching. There is no current guidance on the pMSK clinical skills and knowledge required for medical students. The objective of this study was to achieve consensus amongst experts on the learning outcomes for a pMSK curriculum for medical students. METHODS This was a two-phase study. In Phase one, pMSK educational topics and categories were identified from UK medical students and experts (recruited from pMSK medicine, child health, education and primary care) utilising focus groups and interviews. These themes and concepts informed the structure of learning outcomes that were presented to a Delphi panel in Phase two, with the aim of achieving consensus on the final content of the curriculum. RESULTS In Phase 1 participants identified pMSK skills, knowledge and attitudes relevant for medical students. This content was translated into learning outcomes. In Phase 2, the proposed outcomes were submitted to scrutiny by a two-iteration Delphi process with experts in the field. The agreed learning outcomes (n = 45) were either generic to child health or specific to pMSK medicine, and related to history taking and examination, knowledge about normal development, key clinical presentation and conditions, approaches to investigation and referral pathways. DISCUSSION This study has identified evidence and consensu based content for a pMSK curriculum for medical students, derived from key stakeholders and to be integrated into medical student pMSK teaching. CONCLUSION It is envisaged that implementation of this content will equip graduating doctors with relevant and important skills and knowledge to assess children with MSK presentations, and facilitate early diagnosis and referral to specialist care.
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Affiliation(s)
- Sharmila Jandial
- Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle, UK.
| | - Jane Stewart
- School of Medical Education, Newcastle University, Newcastle, UK.
| | - Helen E Foster
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
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Abstract
Joint pains are a common reason for children to present to primary care. The differential diagnosis is large including some diseases that do not primarily affect the musculoskeletal system. Although the cause for many patients will be benign and self-resolving, in rare cases the diagnosis is associated with long-term morbidity and mortality if not detected early and appropriately treated. These include primary and secondary malignancies, septic arthritis, osteomyelitis, inflammatory arthritis, slipped upper femoral epiphysis (SUFE) and non-accidental injury. We highlight the importance of a thorough history and directed yet comprehensive examination. A diagnostic algorithm is provided to direct primary care physicians' clinical assessment and investigation with the evidence base where available. In many cases, tests are not required, but if there is suspicion of malignancy, infection or inflammatory conditions, laboratory tests including full blood count, blood film, erythrocyte sedimentation rate, C-reactive protein and lactate dehydrogenase help to support or exclude the diagnosis. Autoimmune tests, such as antinuclear antibodies and rheumatoid factor, have no diagnostic role in juvenile idiopathic arthritis; therefore, we advise against any form of 'rheumatological/autoimmune disease screen' in primary care. Imaging does have a place in the diagnosis of joint pains in children, with plain radiographs being most appropriate for suspected fractures and SUFE, whilst ultrasound is better for the detection of inflammatory or infective effusions. The appropriate referral of children to paediatric rheumatologists, oncologists, orthopaedic surgeons and the emergency department are discussed.
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Affiliation(s)
- E S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - S L N Clarke
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
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Abernethy K, Jandial S, Hill L, Sánchez ES, Foster H. Acceptability and practicality of a Spanish translation of paediatric Gait Arms Legs and Spine (pGALS) in Peruvian children. Pediatr Rheumatol Online J 2014; 12:48. [PMID: 25873841 PMCID: PMC4395967 DOI: 10.1186/1546-0096-12-48] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The paediatric Gait, Arms, Legs and Spine (pGALS) musculoskeletal examination tool is validated for use in school-aged English Speaking children and shown to be practical and effective in acute paediatric practice in the UK and Malawi. Our aim was to assess the acceptability and practicality of a Spanish translation of pGALS in an acute paediatric setting in Peru. FINDINGS Fifty-three school-aged children presenting to Hospital Regional de Loreto, Peru were recruited to undergo a pGALS examination using a Spanish translation of the instructions. The pGALS examination was completed in 92.5% (49/53), with the time taken (median 4.42 minutes) being acceptable to most parents (98.1%, 52/53). Most children (88.7%, 47/53), found the pGALS examination caused 'little' or 'no additional discomfort'. Using pGALS, significant findings were observed in 18/53 (34%) children; these related to fractures (4/18), hypermobility (4/18), infectious causes (5/18) and soft tissue trauma (5/18). CONCLUSION Using this Spanish translation, pGALS assessment was practical, acceptable and effective in detecting musculoskeletal changes in many children.
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Affiliation(s)
- Katrina Abernethy
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Sharmila Jandial
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle, UK ,Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Lucy Hill
- School of Modern Languages, Newcastle University, Newcastle, UK
| | | | - Helen Foster
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle, UK ,Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
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