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Yildiz-Kabak V, Buran S, Karaca NB, Tufekci O, Aliyev E, Bayindir Y, Atasavun Uysal S, Bilginer Y, Unal E, Ozen S. Examination of Physical Functions, Activity and Participation in Children with Juvenile Idiopathic Arthritis. Phys Occup Ther Pediatr 2024:1-14. [PMID: 38992979 DOI: 10.1080/01942638.2024.2376058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
AIMS To examine physical functions, activity, and participation level, and associated factors with participation in children with juvenile idiopathic arthritis (JIA) across the International Classification of Functioning Disability and Health-Children and Youth. METHODS 49 children (Girl/Boy:28/21) aged between 7 and 18 years (Mean: 13.4 ± 3.3) were included. To evaluate body structure/functioning; pain, fatigue, disease activity, and motor functions were assessed. Childhood Health Assessment Questionnaire and Juvenile Arthritis Biopsychosocial and Clinical Questionnaire were used to determine activity level. Child and Adolescent Scale of Participation was used to assess participation. RESULTS Mild level of pain (2.0 ± 2.3), disease activity (2.0 ± 2.3), and fatigue (4.1 ± 4.0) were recorded. Decrease in motor functions was determined in 75% of children, while 61% of whom had activity-related disability. There was mild to moderate participation restrictions, and participation was significantly associated with age (r = -0.29), pain severity (r = -0.31), disease activity (r = -0.39), motor functions (r = 0.33), and activity level (r = -0.43), (p ˂ 0.05). CONCLUSIONS Majority of children with JIA have deteriorations in physical functions, activity, and participation. Age, pain, disease activity, motor functions and activity level were associated with participation level. Children with JIA should be regularly evaluated multi-directional and they should be referred to rehabilitation programs to increase functionality and participation.
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Affiliation(s)
- Vesile Yildiz-Kabak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sinan Buran
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nur Banu Karaca
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Orkun Tufekci
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Emil Aliyev
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Yagmur Bayindir
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Songul Atasavun Uysal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Edibe Unal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Faculty of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
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de Oliveira RJ, Londe AC, de Souza DP, Marini R, Fernandes PT, Appenzeller S. Physical Activity Influences Health-Related Quality of Life in Adults with Juvenile Idiopathic Arthritis. J Clin Med 2023; 12:jcm12030771. [PMID: 36769423 PMCID: PMC9917453 DOI: 10.3390/jcm12030771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
This cross-sectional study aimed to evaluate the impact of physical activity and physical fitness on the health-related quality of life (HQoL) of adult patients with Juvenile Idiopathic Arthritis (JIA). Fifty-nine JIA patients and sixty healthy individuals participated in this study. All individuals had the following evaluations performed: body composition (electrical bioimpedance), physical fitness (6 min walk test (6MWT)), physical activity level (International Physical Activity Questionnaire (IPAQ)), and HQoL (Quality of Life Questionnaire in relation to Health-Short Form (SF36)). Thirty-nine (66%) JIA patients were considered sedentary compared with 15 (25%) in the control group (p < 0.01). JIA patients had a lower HQoL compared with the control group in all variables studied (p < 0.05). JIA patients who were very physically active had better HQoL conditions in the categories of functional capacity (p = 0.001), limitations by physical aspects (p = 0.003), and emotional aspects (p = 0.002) compared with sedentary patients. JIA patients had more cardiovascular abnormalities and walked shorter distances compared with healthy controls in the 6MWT. In conclusion, we observed that HQoL was reduced in adults with JIA. A high percentage of JIA patients were sedentary with lower physical fitness, but physically active patients had a better HQoL than sedentary patients. The duration of physical activity, rather than intensity, influenced the mental aspects of HQoL.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Ana Carolina Londe
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Débora Pessoa de Souza
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Science, Faculty of Physical Education, University of Campinas (UNICAMP), Campinas 13083-851, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology—School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
- Correspondence: ; Fax: +55-19-3289-1818
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Min M, Hancock DG, Aromataris E, Crotti T, Boros C. Experiences of living with Juvenile Idiopathic Arthritis: a qualitative systematic review. JBI Evid Synth 2021; 20:60-120. [PMID: 34669687 DOI: 10.11124/jbies-21-00139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to investigate the available qualitative evidence to enhance understanding of the experiences of children, young adults, and their carers living with Juvenile Idiopathic Arthritis in any setting. INTRODUCTION Juvenile Idiopathic Arthritis is the most common chronic rheumatic disease in childhood. Despite the availability of effective treatments, persistent pain, growth retardation, physical disability, and psychological problems can occur. This may reduce the quality of life for Juvenile Idiopathic Arthritis patients by negatively affecting their family, educational, and social well-being. Patient-centered management and care for Juvenile Idiopathic Arthritis patients requires increasing attention to their self-reported quality of life and experiences, in addition to clinically measured disease activity. Furthermore, taking care of children with Juvenile Idiopathic Arthritis may have negative impacts on the lives of their carers and families. The experiences of carers have been poorly understood and studied. This review describes experiences and perspectives from patients and carers in order to inform the needs of families throughout their Juvenile Idiopathic Arthritis journey. INCLUSION CRITERIA Studies describing the experiences of patients aged <21 years who have been diagnosed with Juvenile Idiopathic Arthritis according to the International League of Associations for Rheumatology criteria, as well as the experiences of their carers, have been considered. METHODS A comprehensive search using PubMed, CINAHL, Embase, PsycINFO, Web of Science, and Google Scholar, as well as relevant conference proceedings of the American College of Rheumatology (ACR; 2018-2019), the European Pediatric Rheumatology Congress (PReS) 2018, the European League Against Rheumatism (EULAR; 2018-2019), and the Asia Pacific League of Associations for Rheumatology (APLAR; 2018-2019), was undertaken in December 2020 to identify pertinent published and unpublished studies. Studies published in English from 2001 to 2020 were included. The JBI approach to study selection, critical appraisal, data extraction, and data synthesis was used. RESULTS Ten studies were included in this review. A total of 61 findings were extracted and aggregated to form 12 categories. From the 12 categories, five synthesized findings were developed: i) Self-management of Juvenile Idiopathic Arthritis requires pain management, medication management, and the acquisition of knowledge and professional support; ii) A promising relationship with health care professionals but unbalanced access to services; iii) Parental financial burden and their adjustment to maintain family happiness; iv) Patients and parents support the web-based approach to communicate and develop self-management skills and acknowledge the importance of clinical trials; v) Desire to live a normal life without prejudice from school, social settings, and the workplace. CONCLUSIONS This review has provided a comprehensive overview of experiences and perceptions of Juvenile Idiopathic Arthritis patients and their parents. It is important to understand what they need to know and understand about the disease. This review also highlights the importance of appropriate web-based programs, career counseling, infrastructures, and school facilities. Findings in this review can guide future policy and practice in order to improve care for families and children with Juvenile Idiopathic Arthritis. Further research is required to develop management strategies for medication intolerance and evaluate the longitudinal benefits of relevant Juvenile Idiopathic Arthritis programs. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO (CRD42019133165).
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Affiliation(s)
- Ming Min
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia University of Adelaide Discipline of Paediatrics, Women's and Children's Hospital, Adelaide, SA, Australia Women's and Children's Hospital Department of Rheumatology, Adelaide, SA, Australia JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Nesbitt C, Kuntze G, Toomey C, Esau S, Brooks J, Mosher D, Twilt M, Nettel-Aguirre A, Palacios-Derflingher LM, Ronsky J, Benseler S, Emery CA. Secondary consequences of juvenile idiopathic arthritis in children and adolescents with knee involvement: physical activity, adiposity, fitness, and functional performance. Rheumatol Int 2021; 42:319-327. [PMID: 34132889 DOI: 10.1007/s00296-021-04920-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Secondary consequences of juvenile idiopathic arthritis (JIA) may impact long-term health outcomes. This study examined differences in physical activity, cardiorespiratory fitness, adiposity, and functional performance in children and adolescents with JIA compared to their typically developing (TD) peers. METHODS Participants with JIA (n = 32; 10-20 years old) and their TD peers (n = 35) volunteered for assessments of: daily moderate-to-vigorous physical activity (MVPA, body-worn accelerometer); peak oxygen consumption (VO2 Peak, incremental bike test); fat mass index (FMI, dual-energy X-ray absorptiometry); and triple-single-leg-hop (TSLH) distance. Statistical analyses were performed in R using four linear mixed-effect models with Bonferroni adjustment (⍺ = 0.0125). Fixed effects were group, sex, and age. Participant clusters based on sex and age (within 1.5 years) were considered as random effects. RESULTS Participants with JIA displayed lower mean daily MVPA than their TD peers [p = 0.006; β (98.75% CI); -21.2 (-40.4 to -2.9) min]. VO2 Peak [p = 0.019; -1.4 (-2.5 to -0.2) ml/kg/min] decreased with age. Females tended to have lower VO2 Peak [p = 0.045; -6.4 (-13.0 to 0.4) ml/kg/min] and greater adiposity [p = 0.071; 1.4 (-0.1 to 3.0) kg/m2] than males. CONCLUSION The findings support the need for strategies to promote MVPA participation in children and adolescents with JIA. Sex and age should be considered in research on the consequences of JIA.
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Affiliation(s)
- Colleen Nesbitt
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Gregor Kuntze
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Clodagh Toomey
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Shane Esau
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Julia Brooks
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Dianne Mosher
- Division of Rheumatology, University of Calgary, Calgary, AB, Canada
- Richmond Road Diagnostic and Treatment Centre Rheumatology Clinic, Calgary, AB, Canada
| | - Marinka Twilt
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, School of Mathematics and Statistics, University of Wollongong, Wollongong, NSW, Australia
| | - Luz Maria Palacios-Derflingher
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Janet Ronsky
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada
| | - Susanne Benseler
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Departments of Community Health Sciences and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Pritchard L, Verschuren O, Roy M, Kaup C, Rumsey DG. Reproducibility of the Six‐Minute Walk Test in Children and Youth with Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 74:686-690. [DOI: 10.1002/acr.24492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Lesley Pritchard
- Department of Physical Therapy Faculty of Rehabilitation Medicine University of Alberta Canada Edmonton Alberta
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine Utrecht University Utrecht the Netherlands
| | - Michelle Roy
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
| | - Cara Kaup
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
| | - Dax G. Rumsey
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
- Department of Pediatrics Faculty of Medicine and Dentistry University of Alberta Canada Edmonton Alberta
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Min M, Hancock DG, Aromataris E, Crotti T, Boros C. Experiences of living with juvenile idiopathic arthritis: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:2058-2064. [PMID: 32925420 DOI: 10.11124/jbisrir-d-19-00301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this review is to identify, critically appraise and synthesize the available qualitative evidence to understand the experiences of children, young adults and their carers living with juvenile idiopathic arthritis in any setting. INTRODUCTION Juvenile idiopathic arthritis is the most common rheumatic disease in childhood. Despite the availability of effective treatments, the disease still has negative impacts on patients' and carers' lives. Patients' and carers' experiences of living with juvenile idiopathic arthritis have been recognized as important in the measurement of health status and treatment implementation. Addressing these needs will facilitate more effective management and treatment of the disease. This protocol describes a method for a systematic review regarding the perspectives from patients and carers in order to highlight the needs of families throughout their juvenile idiopathic arthritis journey. INCLUSION CRITERIA Studies on the experiences of patients aged <21 years who have been diagnosed with juvenile idiopathic arthritis according to the International League of Associations for Rheumatology criteria, as well as the experiences of their carers, will be considered. Papers included in this review will include, but not be limited to, designs such as phenomenology, grounded theory and ethnography. METHODS A comprehensive search using PubMed, CINAHL, Embase, PsycINFO and Web of Science was undertaken in August 2019. Available studies published in English from 2001 to 2019 will be included. The recommended JBI method for study selection, critical appraisal, data extraction and data synthesis will be used. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO (CRD42019133165).
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Affiliation(s)
- Ming Min
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - David G Hancock
- University of Adelaide Discipline of Paediatrics, Women's and Children's Hospital, Adelaide, Australia
| | - Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Tania Crotti
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Christina Boros
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,University of Adelaide Discipline of Paediatrics, Women's and Children's Hospital, Adelaide, Australia
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Beneitez I, Nieto R, Hernández E, Boixadós M. Adolescents’ social needs living with juvenile idiopathic arthritis and their views about digital resources. Adv Rheumatol 2020; 60:36. [DOI: 10.1186/s42358-020-00138-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Juvenile Idiopathic Arthritis (JIA) and its related symptoms (e.g. pain) have been associated with interference in the daily life of adolescents with JIA including their friendships. There is little research in that sense and in consequence, interventions designed to improve this area. The objectives of this study are 1) to gain knowledge about the needs of adolescents with JIA, particularly focused on their friendships; 2) to explore the potential of the Internet to help them, and 3) to determine what kind of online resource would be the best and what elements it should include.
Methods
To achieve the proposed objectives we designed a qualitative study including two phases: the first one exploratory (semi-structured interviews) and the following, confirmatory (online focus group).
Results
14 adolescents were interviewed and 7 participated in the focus group. They reported some social challenges related to their illness: feeling different, criticized by peers, or not believed. Additionally, they specified some of the coping strategies they used, such as disclosing to others that they have JIA, using communication skills, maintaining activities with friends, trying to minimize pain, and ignoring negative comments. Adolescents considered an online resource useful and mentioned that they would like to find general information and to have the possibility to interact with others. They considered Instagram and WhatsApp as good platforms to implement the online resource.
Conclusions
According to their perceptions, adolescents with JIA can benefit from an online resource which delivers information, strategies and facilitates interaction with others.
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Toupin April K, Stinson J, Cavallo S, Proulx L, Wells GA, Duffy CM, ElHindi T, Longmuir PE, Brosseau L. Yoga and Aerobic Dance for Pain Management in Juvenile Idiopathic Arthritis: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e12823. [PMID: 32442139 PMCID: PMC7381073 DOI: 10.2196/12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is one of the most common types of arthritis among children. According to JIA guidelines for physical activity (PA), structured PA interventions led to improved health outcomes. However, many PA programs, such as yoga and aerobic dance, have not been studied in this population despite being popular among youth. Web-based PA programs could provide patients with accessible and affordable interventions. Objective The primary aims of the proposed pilot randomized controlled trial (RCT) are to examine (1) the feasibility of conducting a full-scale RCT to evaluate the effectiveness of two popular types of PA: a yoga training program and an aerobic dance training program, in female adolescents (aged 13-18 years) with JIA compared with an electronic pamphlet control group; and (2) the acceptability of these interventions. Methods A three-arm prospective randomized open-label study with a parallel group design will be used. A total of 25 female adolescents with JIA who have pain will be randomized in a ratio of 2:2:1 to one of the 3 groups: (1) online yoga training program (group A: n=10); (2) online aerobic dance training program (group B: n=10); and (3) electronic pamphlet control group (group C: n=5). Participants in groups A and B will complete 3 individual 1-hour sessions per week using online exercise videos, as well as a 1-hour virtual group session per week using a videoconferencing platform for 12 weeks. Participants from all groups will have access to an electronic educational pamphlet on PA for arthritis developed by the Arthritis Society. All participants will also take part in weekly online consultations with a research coordinator and discussions on Facebook with participants from their own group. Feasibility (ie, recruitment rate, self-reported adherence to the interventions, dropout rates, and percentage of missing data), acceptability, and usability of Facebook and the videoconferencing platform will be assessed at the end of the program. Pain intensity, participation in general PA, morning stiffness, functional status, fatigue, self-efficacy, patient global assessment, disease activity, and adverse events will be assessed using self-administered electronic surveys at baseline and then weekly until the end of the 12-week program. Results This pilot RCT has been funded by the Arthritis Health Professions Association. This protocol was approved by the Children’s Hospital of Eastern Ontario Research Ethics Board (#17/08X). As of May 11, 2020, recruitment and data collection have not started. Conclusions To our knowledge, this is the first study to evaluate the effectiveness of yoga and aerobic dance as pain management interventions for female adolescents with JIA. The use of online programs to disseminate these 2 PA interventions may facilitate access to alternative methods of pain management. This study can lead to a full-scale RCT. International Registered Report Identifier (IRRID) PRR1-10.2196/12823
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Affiliation(s)
- Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sabrina Cavallo
- École de Réadaptation, Université de Montréal, Montréal, QC, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ciarán M Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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van Markus-Doornbosch F, van der Holst M, de Kloet AJ, Vliet Vlieland TPM, Meesters JJL. Fatigue, Participation and Quality of Life in Adolescents and Young Adults with Acquired Brain Injury in an Outpatient Rehabilitation Cohort. Dev Neurorehabil 2020; 23:328-335. [PMID: 31746261 DOI: 10.1080/17518423.2019.1692948] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To study the association between fatigue and participation and QoL after acquired brain injury (ABI) in adolescents and young adults (AYAs). MATERIALS & METHODS Cross-sectional study with AYAs aged 14-25 years, diagnosed with ABI. The PedsQL™ Multidimensional Fatigue Scale, Child & Adolescent Scale of Participation, and PedsQL™4.0 Generic Core Scales were administered. RESULTS Sixty-four AYAs participated in the study, 47 with traumatic brain injury (TBI). Median age at admission was 17.6 yrs, 0.8 yrs since injury. High levels of fatigue (median 44.4 (IQR 34.7, 59.7)), limited participation (median 82.5 (IQR 68.8, 92.3)), and diminished QoL (median 63.0 (IQR 47.8, 78.3)) were reported. More fatigue was significantly associated with more participation restrictions (β 0.64, 95%CI 0.44, 0.85) and diminished QoL (β 0.87, 95%CI 0.72, 1.02). CONCLUSIONS AYAs with ABI reported high levels of fatigue, limited participation and diminished quality of life with a significant association between fatigue and both participation and QoL. Targeting fatigue in rehabilitation treatment could potentially improve participation and QoL.
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Affiliation(s)
| | - Menno van der Holst
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Arend J de Kloet
- Basalt Rehabilitation , The Hague, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
| | - Thea P M Vliet Vlieland
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Jorit J L Meesters
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
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Hartmann M, Meyer M, Brudy L, Oberhoffer-Fritz R, Böhm R, Hebestreit H, Hansmann S. Bewegung und Sport bei chronischen Erkrankungen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00935-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Kattackal TR, Cavallo S, Brosseau L, Sivakumar A, Del Bel MJ, Dorion M, Ueffing E, Toupin-April K. Assessing the reporting quality of physical activity programs in randomized controlled trials for the management of juvenile idiopathic arthritis using three standardized assessment tools. Pediatr Rheumatol Online J 2020; 18:41. [PMID: 32448277 PMCID: PMC7245815 DOI: 10.1186/s12969-020-00434-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The reporting quality of physical activity (PA) programs in randomized controlled trials (RCTs) for the management of juvenile idiopathic arthritis (JIA) remains unknown. This study aimed to assess and compare the reporting quality of PA programs in RCTs for the management of JIA using three difference standardized assessment tools, and to describe the elements that were similar and different between these tools. METHODS A systematic search was conducted for moderate-to high-quality RCTs of PA programs in JIA, published up until January 2019. Two reviewers independently included 10 RCTs and scored the reporting quality of PA programs using the following tools: Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist. RESULTS Results showed that reporting of PA programs in 10 moderate- to high-quality RCTs for JIA management remains incomplete. The average reporting quality (± standard deviation) for all RCTs combined was moderate for the three standardized assessment tools with 70.8 (±14.3)% for the TIDieR checklist, 53.2 (±20.2)% for the CERT checklist, and 70.0 (±18.9)% for the CONTENT scale. Despite some overlap, the three standardized assessment tools (TIDieR, CERT, CONTENT) included different elements resulting in different scores. All tools assess elements linked to PA programs (provider, location, timing, personalization and adherence), but the CERT checklist includes other essential elements (e.g., additional resources, motivational strategies, adverse events). CONCLUSIONS The lack of complete reporting of PA programs in RCTs for the management of JIA and the variation in scores and assessed elements among standardized assessment tools show the need to improve reporting. Using the most comprehensive standardized tool (i.e., the CERT) and providing accessible supplemental information on PA programs may improve the reporting quality of PA programs in RCTs and help reproduce PA programs in research and clinical practice.
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Affiliation(s)
| | - Sabrina Cavallo
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Aditi Sivakumar
- Children's Hospital of Eastern Ontario Research Institute, room L1147, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Michael J Del Bel
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Dorion
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Ueffing
- Children's Hospital of Eastern Ontario Research Institute, room L1147, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
- Children's Hospital of Eastern Ontario Research Institute, room L1147, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Nørgaard M, Herlin T. Specific Sports Habits, Leisure-Time Physical Activity, and School-Educational Physical Activity in Children With Juvenile Idiopathic Arthritis: Patterns and Barriers. Arthritis Care Res (Hoboken) 2019; 71:271-280. [PMID: 30354015 DOI: 10.1002/acr.23795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/16/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) may cause functional impairment and reduced time engaged in physical activity. The aim of this study was to investigate the habits of patients with JIA regarding participation in club sports, leisure-time physical activity, and school-educational physical activity and relate this to objectively measured physical activity using accelerometry and to compare the findings with those in healthy controls. METHODS Consecutive patients from the Aarhus University Hospital outpatient clinic were included. Clinical characteristics, functional ability, and exploration of specific habits in club sports, leisure-time physical activity, and school-educational physical activity (based on a standardized questionnaire) in patients were recorded and compared with those in healthy controls. The intensity and frequency of physical activity were measured by accelerometer monitoring, using ActiGraph GT1M. RESULTS Sixty-eight patients with JIA and 118 healthy control subjects were included. Despite having low disease activity, children with JIA had significantly lower accelerometry-monitored physical activity levels compared with healthy controls. The distribution of specific club sport activities was the same among patients and controls. However, the proportion of patients spending >3 hours/week participating in club sports was significantly lower than the proportion of controls, whereas no difference in time spent engaging in physical activity during leisure-time was observed. Participation in compulsory school-educational physical activity was equally high in patients and controls, although participation by patients was significantly less consistent than that by controls. Patient reports of time spent with club sport and leisure-time physical activity was significantly related to accelerometry measures, whereas this was not observed for school-educational physical activity. CONCLUSION The results of this study indicate the need for structured guidance for all patients with JIA (including those with minimal disease activity) in both understanding and coping with the consequences of a low level of physical activity.
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Rochette E, Bourdier P, Pereira B, Doré E, Birat A, Ratel S, Echaubard S, Duché P, Merlin E. TNF blockade contributes to restore lipid oxidation during exercise in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:47. [PMID: 31331342 PMCID: PMC6647146 DOI: 10.1186/s12969-019-0354-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) have impaired physical abilities. TNF-α plays a crucial role in this pathogenesis, but it is also involved in the use of lipids and muscle health. Objective of this study was to explore substrate oxidation and impact of TNF blockade on energy metabolism in children with JIA as compared to healthy children. METHODS Fifteen non-TNF-blockaded and 15 TNF-blockaded children with JIA and 15 healthy controls were matched by sex, age, and Tanner stage. Participants completed a submaximal incremental exercise test on ergocycle to determine fat and carbohydrate oxidation rates by indirect calorimetry. RESULTS The maximal fat oxidation rate during exercise was lower in JIA children untreated by TNF blockade (134.3 ± 45.2 mg.min- 1) when compared to the controls (225.3 ± 92.9 mg.min- 1, p = 0.007); but was higher in JIA children under TNF blockade (163.2 ± 59.0 mg.min- 1, p = 0.31) when compared to JIA children untreated by TNF blockade. At the same relative exercise intensities, there was no difference in carbohydrate oxidation rate between three groups. CONCLUSIONS Lipid metabolism during exercise was found to be impaired in children with JIA. However, TNF treatment seems to improve the fat oxidation rate in this population. TRIAL REGISTRATION In ClinicalTrials.gov, reference number NCT02977416 , registered on 30 November 2016.
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Affiliation(s)
- Emmanuelle Rochette
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, F-63000 Clermont-Ferrand, France
- Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, F-63000 Clermont-Ferrand, France
- Université Clermont Auvergne, Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), EA 3533 Clermont-Ferrand, France
- CRNH-Auvergne, F-63000 Clermont-Ferrand, France
- Pédiatrie, CHU Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - Pierre Bourdier
- Université Clermont Auvergne, Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), EA 3533 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation de la Recherche Clinique et Innovations, F-63000 Clermont-Ferrand, France
| | - Eric Doré
- Université Clermont Auvergne, Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), EA 3533 Clermont-Ferrand, France
- CRNH-Auvergne, F-63000 Clermont-Ferrand, France
| | - Anthony Birat
- Université Clermont Auvergne, Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), EA 3533 Clermont-Ferrand, France
| | - Sébastien Ratel
- Université Clermont Auvergne, Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), EA 3533 Clermont-Ferrand, France
| | - Stéphane Echaubard
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, F-63000 Clermont-Ferrand, France
- Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, F-63000 Clermont-Ferrand, France
| | - Pascale Duché
- Université Clermont Auvergne, Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), EA 3533 Clermont-Ferrand, France
- CRNH-Auvergne, F-63000 Clermont-Ferrand, France
- Université de Toulon, Laboratoire IAPS, F-83041 Toulon, France
| | - Etienne Merlin
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, F-63000 Clermont-Ferrand, France
- Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, F-63000 Clermont-Ferrand, France
- Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, F-63000 Clermont-Ferrand, France
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Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatr Rheumatol Online J 2019; 17:44. [PMID: 31307487 PMCID: PMC6631827 DOI: 10.1186/s12969-019-0341-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA). METHODS Consecutive cases of JIA from defined geographical areas of Finland, Sweden and Norway with disease onset in 1997 to 2000 were followed for 8 years in a multi-center cohort study, aimed to be as close to population-based as possible. Clinical characteristics and information on school attendance and participation in physical education (PE) were registered. RESULTS Participation in school and in PE was lowest initially and increased during the disease course. Eight years after disease onset 228/274 (83.2%) of the children reported no school absence due to JIA, while 16.8% reported absence during the last 2 months due to JIA. Full participation in PE was reported by 194/242 (80.2%), partly by 16.9%, and none by 2.9%. Lowest participation in PE was found among children with ERA and the undifferentiated categories. Absence in school and PE was associated with higher disease activity measures at the 8-year visit. School absence > 1 day at baseline predicted use of disease-modifying anti-rheumatic drugs, including biologics (DMARDs) (OR 1.2 (1.1-1.5)), and non-remission off medication (OR 1.4 (1.1-1.7) 8 years after disease onset. CONCLUSION School absence at baseline predicted adverse long-term outcome. In children and adolescents with JIA participation in school activities is mostly high after 8 years of disease. For the minority with low participation, special attention is warranted to promote their full potential of social interaction and improve long-term outcome.
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Abstract
PURPOSE To examine safety and efficacy of exercise training (ET) for juvenile idiopathic arthritis (JIA) to improve physical fitness, pain, functional capability, and quality of life. METHODS Ovid Medline, PubMed, CINAHL, PEDro, and Web of Science were searched from 1995 to April 2018 to find English-language articles examining effects of ET in JIA, ages 4 to 21 years. Quality of evidence/strength of clinical recommendations were assessed using the Cochrane GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results were reported using the 2009 Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) checklist for health care interventions. RESULTS Nine papers met inclusion criteria. A total of 457 individuals with JIA, ages 4 to 19.9 years, received ET or alternate activity, wait-list, or no intervention. Moderate-quality evidence supports Stott Pilates and underwater knee-resistance exercise. No adverse effects of ET were reported. CONCLUSIONS Moderate-quality evidence exists for ET (30-50 minutes, 2-3 times/week, 12-24 weeks) to decrease pain, improve range of motion, knee strength, functional capability, and quality of life in JIA.
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Houghton KM, Macdonald HM, McKay HA, Guzman J, Duffy C, Tucker L. Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:67. [PMID: 30348221 PMCID: PMC6198360 DOI: 10.1186/s12969-018-0283-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Arthritis in childhood can be associated with muscle weakness around affected joints, low bone mass and low bone strength. Exercise is recognized as an important part of management of children with juvenile idiopathic arthritis (JIA) but the exercise prescription to best promote bone and muscle health is unknown. We therefore aimed to: 1. assess feasibility and safety of a 6-month home- and group-based exercise program for children with JIA; 2. estimate the effect of program participation on bone mass and strength, muscle function and clinical outcomes and 3. determine if any positive changes in bone and muscle outcomes are maintained 6 months later. METHODS We recruited 24 children with JIA who were part of the Linking Exercise, Physical Activity and Pathophysiology in Childhood Arthritis (LEAP) study to participate in a 6-month home-based exercise program involving jumping and handgrip exercises, resistance training and one group exercise session per month. We assessed lumbar spine bone mass (dual energy X-ray absorptiometry), distal tibia and radius bone microarchitecture and strength (high-resolution peripheral quantitative computed tomography), muscle function (jumping mechanography, dynamometry) and clinical outcomes (joint assessment, function, health-related quality of life) at baseline, 6- and 12-months. Adherence was assessed using weekly activity logs. RESULTS Thirteen children completed the 6-month intervention. Participants reported 9 adverse events and post-exercise pain was rare (0.4%). Fatigue improved, but there were no other sustained improvements in muscle, bone or clinical outcomes. Adherence to the exercise program was low (47%) and decreased over time. CONCLUSION Children with JIA safely participated in a home-based exercise program designed to enhance muscle and bone strength. Fatigue improved, which may in turn facilitate physical activity participation. Prescribed exercise posed adherence challenges and efforts are needed to address facilitators and barriers to participation in and adherence to exercise programs among children with JIA. TRIAL REGISTRATION Data of the children with JIA are from the LEAP study (Canadian Institutes of Health Research (CIHR; GRANT# 107535 ). http://www.leapjia.com/.
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Affiliation(s)
- Kristin M. Houghton
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Heather M. Macdonald
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada
| | - Heather A. McKay
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Orthopaedics, University of British Columbia, Vancouver, BC Canada
| | - Jaime Guzman
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Ciarán Duffy
- 0000 0000 9402 6172grid.414148.cDivision of Rheumatology, Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori Tucker
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
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Armbrust W, Lelieveld OHTM, Tuinstra J, Wulffraat NM, Bos GJFJ, Cappon J, van Rossum MAJ, Sauer PJJ, Hagedoorn M. Fatigue in patients with Juvenile Idiopathic Arthritis: relationship to perceived health, physical health, self-efficacy, and participation. Pediatr Rheumatol Online J 2016; 14:65. [PMID: 27919265 PMCID: PMC5139083 DOI: 10.1186/s12969-016-0125-1] [Citation(s) in RCA: 38] [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: 08/11/2016] [Accepted: 11/24/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fatigue is common in patients with JIA and affects daily life negatively. We assessed the presence and severity of fatigue in patients with JIA, including factors presumed associated with fatigue (e.g., disease activity, disability, pain, physical activity, exercise capacity, and self-efficacy), and whether fatigue is related to participation in physical education classes, school attendance, and sports frequency. METHODS The current study used baseline data of 80 patients with JIA (age 8-13) who participated in an intervention aimed at promoting physical activity. Primary outcome measurements were fatigue, assessed using the Pediatric-Quality-of-Life-Inventory (PedsQl)-Fatigue-scale and energy level assessed using a VAS scale. Other outcome measurements were disease activity (VAS Physician Global Assessment Scale), disability (Childhood Health Assessment Questionnaire), physical activity (accelerometer), exercise capacity (Bruce treadmill test), self-efficacy (Childhood Arthritis Self-Efficacy Scale), and participation (self-report). RESULTS Sixty percent of patients with JIA suffered from daily low-energy levels; 27% suffered from very low-energy levels more than half the week. Low energy levels were best predicted by disability and low physical activity. Fatigue measured with the PEDsQL was higher compared to the control-population. Disability and low self-efficacy were main predictors of fatigue. Self-efficacy was a predictor of fatigue but did not act as moderator. Fatigue was a predictor for sports frequency but not for school attendance. CONCLUSION Fatigue is a significant problem for JIA patients. Interventions aimed at reducing perceived disability, stimulating physical activity, and enhancing self-efficacy might reduce fatigue and thereby enhance participation. TRIAL REGISTRATION Trial number ISRCTN92733069.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
| | - Otto H. T. M. Lelieveld
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Jolanda Tuinstra
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico M. Wulffraat
- Department of Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - G. J. F. Joyce Bos
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Jeannette Cappon
- Reade, Center for Rehabilitation and Rheumatology, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Marion A. J. van Rossum
- Reade, Center for Rehabilitation and Rheumatology, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Groningen, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Nijhof LN, van de Putte EM, Wulffraat NM, Nijhof SL. Prevalence of Severe Fatigue Among Adolescents With Pediatric Rheumatic Diseases. Arthritis Care Res (Hoboken) 2016; 68:108-14. [PMID: 26314390 DOI: 10.1002/acr.22710] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the prevalence of severe fatigue and fatigue-related limitations among adolescents with juvenile idiopathic arthritis (JIA) and other pediatric rheumatic diseases (PRDs). In addition, we assessed the effect of disease activity and pain on the severity of fatigue. METHODS This cross-sectional study included 175 patients (ages 10-18 years) who visited the pediatric rheumatology and immunology outpatient clinic at Wilhelmina Children's Hospital from April through July 2013. Patients completed validated questionnaires regarding fatigue, physical functioning, and school attendance. Disease activity in JIA patients was measured using the Juvenile Arthritis Disease Activity Score including 27 joints. The results were compared against a healthy control group. RESULTS The prevalence of severe fatigue among patients with PRDs was 25.1%, which was significantly higher than among the healthy control group (P < 0.001). Fatigued patients had significantly lower levels of physical functioning compared to nonfatigued patients (62.1% versus 89.0%, respectively; P < 0.001) and a significantly higher percentage of school absences (21.2% versus 11.6%, respectively; P = 0.005). Among JIA patients, the level of pain was significantly correlated with fatigue. Finally, disease activity was not a predictor for fatigue. CONCLUSION Fatigue is a common problem among teenagers with PRDs, with a higher prevalence among these patients than in the general population. Severe fatigue leads to significant impairments, including increased school absences and decreased physical functioning. Interestingly, fatigue was associated with pain, but not with the disease activity. Therefore, in this patient population, fatigue may be a promising therapeutic target for improving functioning, school attendance, and possibly pain as well.
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Affiliation(s)
- Linde N Nijhof
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Elise M van de Putte
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
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Brosseau L, Maltais DB, Kenny GP, Duffy CM, Stinson J, Cavallo S, Toupin-April K, Feldman DE, Majnemer A, Gagnon IJ, Mathieu MÈ. What we can learn from existing evidence about physical activity for juvenile idiopathic arthritis? Rheumatology (Oxford) 2015; 55:387-8. [PMID: 26604332 DOI: 10.1093/rheumatology/kev389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada,
| | - Désirée B Maltais
- Department of Rehabilitation, Allied Health Science and Physiotherapy, Université Laval, Québec, QC, Canada
| | - Glen P Kenny
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa
| | - Ciarán M Duffy
- Faculty of Medicine, Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Faculty of Nursing, Lawrence S. Bloomberg, University of Toronto and The Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Sabrina Cavallo
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Toupin-April
- Faculty of Medicine, Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Annette Majnemer
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University and
| | - Isabelle J Gagnon
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University and
| | - Marie-Ève Mathieu
- Department of kinesiology, University of Montreal, CEPSUM, Montréal, QC, Canada
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Smith CAM, Toupin-April K, Jutai JW, Duffy CM, Rahman P, Cavallo S, Brosseau L. A Systematic Critical Appraisal of Clinical Practice Guidelines in Juvenile Idiopathic Arthritis Using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument. PLoS One 2015; 10:e0137180. [PMID: 26356098 PMCID: PMC4565560 DOI: 10.1371/journal.pone.0137180] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives The objectives of this review are to: 1) appraise the methodological quality of clinical practice guidelines (CPGs) in juvenile idiopathic arthritis (JIA) providing pharmacological and/or non-pharmacological intervention recommendations, and 2) summarize the recommendations provided by the included CPGs and compare them where possible. Methods A systematic search was performed. Three trained appraisers independently evaluated the methodological quality of the CPGs using a validated and reliable instrument, the Appraisal of Guidelines in Research and Evaluation II. Six domains were considered: 1) score and purpose; 2) stakeholder involvement; 3) rigor of development; 4) clarity of presentation; 5) applicability; and 6) editorial independence. The domains consist of a total of 23 items each scored on a 7-point scale. High quality CPGs were identified if they had a domain score above 60% in rigor of development, and two other domains. Results Of the three included CPGs, the Royal Australian College of General Practitioners (RACGP) and American College of Rheumatology (ACR) CPGs were considered to be of high quality, but the German Society for Pediatric Rheumatology was of lower quality. Domains one to four had high domain scores across the guidelines (mean (standard deviation)): 72.76 (13.80); 66.67 (9.81); 64.67 (7.77); and 87.00 (9.64), respectively. Lower scores were obtained for applicability (14.00 (5.57)) and editorial independence (43.44 (7.02)). Recommendations varied across CPGs due to differences in context, target audience (general practitioners, rheumatologists, and other multidisciplinary healthcare professionals) and patients’ disease presentations. Despite this variability, progression of pharmacological treatment did not conflict between CPGs. Recommendations for non-pharmacological interventions were vague and the interventions considered varied between CPGs. Conclusions Overall, recommendations were based on a paucity of evidence and weak study designs. Further research is needed on interventions in JIA, as well as higher quality CPGs to facilitate implementation of the best evidence-based recommendations in clinical practice.
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Affiliation(s)
- Christine A. M. Smith
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Toupin-April
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey W. Jutai
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ciarán M. Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Prinon Rahman
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sabrina Cavallo
- École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Affiliation(s)
- Kristin M Houghton
- Clinical Associate Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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Juvenile idiopathic arthritis and physical activity: possible inflammatory and immune modulation and tracks for interventions in young populations. Autoimmun Rev 2015; 14:726-34. [PMID: 25936296 DOI: 10.1016/j.autrev.2015.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/12/2015] [Indexed: 12/26/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by persistent joint inflammation that manifests as joint pain and swelling and limited range of joint motion. In healthy subjects, the literature reports that physical activity has an anti-inflammatory effect. In JIA patients, exercise could be used as a therapeutic tool to counteract disease-related inflammation and thereby improve clinical symptoms, although transient flare of pain could be the price to pay. Indeed, in patients with a chronic inflammatory disease, physical activity is prone to exacerbate underlying inflammatory stress. Physical activity improves quality of life and symptoms in JIA patients, but the mechanisms of action remain unclear. This review focuses on the mechanisms underlying exercise-induced immune and hormonal changes. Data on the impact of acute and chronic physical activities on the secretion of hormones and other molecules such as miRNA or peptides involved in the inflammatory process in JIA was compiled and summarized, and the key role of the biological effect of muscle-derived interleukin 6 in the exercise-induced modulation of pro/anti-inflammatory balance is addressed. We also go on to review the effect of training and type of exercise on cytokine response. This review highlights the beneficial effect of physical exercise in children with JIA and potential effect of exercise on the balance between pro- and anti-inflammatory response.
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