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Cachecho S, Fąfara A, Lacombe F, Bussières A, Dahan-Oliel N. Current rehabilitation practice for the evaluation and treatment of children with arthrogryposis: an international survey. Disabil Rehabil 2024; 46:96-104. [PMID: 36582123 DOI: 10.1080/09638288.2022.2161644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the current practices in rehabilitation for the evaluation and treatment of children with arthrogryposis multiplex congenita (AMC). MATERIALS AND METHODS Rehabilitation practitioners worldwide with at least 2 years of experience with AMC were invited to complete an electronic survey on the evaluations and treatments used with children with AMC within five areas: muscle and joint function, self-care, mobility, pain, participation and psychosocial wellbeing. RESULTS Sixty five participants from nine countries completed the survey. Participants completed the sections applicable to their practice. Number of participants within each area varied between 24 and 53. Over 80% of participants used non-standardized evaluations across areas while <50% used patient-reported or standardized measures. Stretching of upper and lower limbs was reported by >80% across ages and clinical presentation severity. Strengthening reported by >70% was mainly used among children >3 years old with less severe contractures. Other interventions used across areas included orthotics (>70%), positioning (>80%), activity-based training (>80%), assistive devices for self-care (>50%) and mobility (>80%), and energy conservation (>70%). Over 70% of participants were involved in perioperative rehabilitation. CONCLUSION Knowledge of current pediatric rehabilitation practice in AMC, together with empirical evidence, may guide clinical decision-making and identify avenues for future research.
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Affiliation(s)
| | - Alicja Fąfara
- Institue of Physiotherapy, Jagiellonian University, Krakow, Poland
| | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Noemi Dahan-Oliel
- Shriners Hospital for Children, Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Dahan-Oliel N, van Bosse H, Darsaklis VB, Rauch F, Bedard T, Bardai G, James M, Raney E, Freese K, Hyer L, Altiok H, Pellett J, Giampietro P, Hall J, Hamdy RC. Epidemiology, aetiology, interventions and genomics in children with arthrogryposis multiplex congenita: protocol for a multisite registry. BMJ Open 2022; 12:e060591. [PMID: 36307157 PMCID: PMC9621187 DOI: 10.1136/bmjopen-2021-060591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Arthrogryposis multiplex congenita (AMC) is an umbrella term including hundreds of conditions with the common clinical manifestation of multiple congenital contractures. AMC affects 1 in 3000 live births and is caused by lack of movement in utero. To understand the long-term needs of individuals diagnosed with a rare condition, it is essential to know the prevalence, aetiology and functional outcomes in a large sample. The development and implementation of a multicentre registry is critical to gather this data. This registry aims to improve health through genetic and outcomes research, and ultimately identify new therapeutic targets and diagnostics for treating children with AMC. METHODS AND ANALYSIS Participants for the AMC registry will be recruited from seven orthopaedic hospitals in North America. Enrollment occurs in two phases; Part 1 focuses on epidemiology, aetiology and interventions. For this part, retrospective and cross-sectional data will be collected using a combination of patient-reported outcomes and clinical measures. Part 2 focuses on core subset of the study team, including a geneticist and bioinformatician, identifying causative genes and linking the phenotype to genotype via whole genome sequencing to identify genetic variants and correlating these findings with pedigree, photographs and clinical information. Descriptive analyses on the sample of 400 participants and logistic regression models to evaluate relationships between outcomes will be conducted. ETHICS AND DISSEMINATION Ethical approval has been granted from corresponding governing bodies in North America. Dissemination of findings will occur via traditional platforms (conferences, manuscripts) for the scientific community. Other modalities will be employed to ensure that all stakeholders, including youth, families and patient support groups, may be provided with findings derived from the registry. Ensuring the findings are circulated to a maximum amount of interested parties will ensure that the registry can continue to serve as a platform for hypothesis-driven research and further advancement for AMC.
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Affiliation(s)
- Noémi Dahan-Oliel
- Research, Shriners Hospital for Children, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
| | - Harold van Bosse
- Orthopaedic Surgery, Shriners Hospitals for Children Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Frank Rauch
- Research, Shriners Hospital for Children, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
| | - Tanya Bedard
- Clinical Genetics, Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Ghalib Bardai
- Shriners Hospitals for Children Canada, Montreal, Québec, Canada
| | - Michelle James
- Orthopaedic Surgery, Shriners Hospitals for Children Northern California, Sacramento, California, USA
| | - Ellen Raney
- Orthopaedic Surgery, Shriners Hospitals for Children Portland, Portland, Oregon, USA
| | - Krister Freese
- Shriners Hospitals for Children Canada, Montreal, Québec, Canada
| | - Lauren Hyer
- Orthopaedic Surgery, Shriners Hospitals for Children Greenville, Greenville, South Carolina, USA
| | - Haluk Altiok
- Orthopaedic Surgery, Shriners Hospital for Children, Chicago, Illinois, USA
| | - Jonathan Pellett
- Orthopaedic Surgery, Shriners Hospitals for Children Honolulu, Honolulu, Hawaii, USA
| | | | - Judith Hall
- Department of Medical Genetics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Reggie Charles Hamdy
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
- Orthopaedic Surgery, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
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Elfassy C. Advancing research in arthrogryposis: time for common and specific terminology. Dev Med Child Neurol 2022; 64:407. [PMID: 34780674 DOI: 10.1111/dmcn.15110] [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: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Caroline Elfassy
- McGill University, Montreal, Quebec, Canada.,Shriners Hospitals for Children - Canada, Montreal, Quebec, Canada
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Wahlig B, Poppino K, Jo CH, Rathjen K. Arthrogryposis multiplex congenita: a 28-year retrospective study. Dev Med Child Neurol 2022; 64:476-480. [PMID: 34664714 DOI: 10.1111/dmcn.15084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
AIM To identify all patients with arthrogryposis multiplex congenita presenting to a specialized pediatric orthopedic institution over a 28-year period; classify them into three groups (general arthrogryposis not otherwise specified [NOS], amyoplasia, or distal arthrogryposis); report the frequency of various musculoskeletal features; and determine the rate of operative treatment. METHOD Patients with arthrogryposis under the age of 18 years who presented between 1990 and 2017 were included. Patients were placed into one of three groups based on clinical features and family history when available. Age of presentation, joint involvement, and utilization of surgical treatment were recorded. RESULTS There were 417 patients in total (184 females, 233 males); 235 patients (56.4%) had general arthrogryposis NOS, 107 (25.7%) had amyoplasia, and 75 (18.0%) had distal arthrogryposis. Patients with amyoplasia presented at a younger age (median 4mo) than those with general arthrogryposis NOS (median 1y 3mo, p=0.005), and had a lower rate of spine involvement than patients with general arthrogryposis NOS (p=0.004) and distal arthrogryposis (p=0.023). The average number of surgeries across all patients was 1.9 (SD 2.2). INTERPRETATION Pediatric patients with amyoplasia present to orthopedic care earlier and are less likely to have spine involvement than other forms of arthrogryposis. Multiple surgeries are common among all patients with arthrogryposis.
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Affiliation(s)
- Brian Wahlig
- University of Texas Southwestern Medical School, Dallas, TX, USA
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Dahan-Oliel N, Cachecho S, Fąfara A, Lacombe F, Samargian A, Bussières A. Expert guidance for the rehabilitation of children with arthrogryposis: protocol using an integrated knowledge translation approach. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:5. [PMID: 35183264 PMCID: PMC8857823 DOI: 10.1186/s40900-022-00336-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/13/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a group of rare congenital disorders characterized by multiple joint contractures present at birth. Contractures can affect different body areas and impact activities of daily living, mobility and participation. Although early rehabilitation is crucial to promote autonomy and participation in children with AMC, empirical evidence to inform best practice is scarce and clinical expertise hard to develop due to the rarity of AMC. Preliminary research involving stakeholders in AMC (youth with AMC, parents, and clinicians) identified priorities in pediatric rehabilitation. Scoping reviews on these priorities showed a lack of high quality evidence related to rehabilitation in AMC. The objective of this project is to provide rehabilitation expert guidance on the assessment and treatment of children with AMC in the areas of muscle and joint function, pain, mobility and self-care, participation and psychosocial wellbeing. METHODS An integrated knowledge translation approach will be used throughout the project. Current rehabilitation practices in AMC will be identified using a clinician survey. Using the Grading of Recommendations, Assessment, Development and Evaluations framework (GRADE) approach, a panel of interdisciplinary expert clinicians, patient and family representatives, and researchers will develop expert guidance on the assessment and treatment for pediatric AMC rehabilitation based on findings from the scoping reviews and survey results. Consensus on the guidance statements will be sought using a modified Delphi process with a wider panel of international AMC experts, and statements appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Theoretical facilitators and barriers toward implementing clinical guidance into practice will be identified among rehabilitation clinicians and managers to inform the design of dissemination and implementation strategies. DISCUSSION This multi-phase project will provide healthcare users and providers with research-based, expert guidance for the rehabilitation of children with AMC and will contribute to family-centered practice.
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Affiliation(s)
- Noémi Dahan-Oliel
- Shriners Hospital for Children, Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | | | - Alicja Fąfara
- Institute of Physiotherapy, Jagiellonian University, Kraków, Poland
| | | | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Cachecho S, Boruff J, Wong T, Lacombe F, Dahan-Oliel N. Psychosocial wellbeing among children and adults with arthrogryposis: a scoping review. Health Qual Life Outcomes 2021; 19:263. [PMID: 34844631 PMCID: PMC8628374 DOI: 10.1186/s12955-021-01896-5] [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] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a group of congenital conditions characterized by joint contractures in two or more body areas. Management of AMC starts early in life and focuses on improving mobility and function through intensive rehabilitation and surgical interventions. Psychosocial wellbeing is an important determinant of health and the psychosocial experience of individuals with AMC should be considered in the management of this condition. The aim of this scoping review was to explore what is known about the psychosocial wellbeing of children and adults with AMC, to identify the outcome measures used and to explore the factors associated with psychosocial outcomes in this population. METHODS A comprehensive search in four databases was conducted. Articles discussing psychosocial outcomes and outcome measures used with children or adults with AMC were included. Data on the measures used, psychosocial outcomes, and factors associated with psychosocial outcomes, were extracted and analyzed descriptively and synthesized narratively. RESULTS Seventeen articles were included in this scoping review, ten including the pediatric population, six including adults and one article including both children and adults with AMC. The most commonly used outcome measures were the PODCI in the pediatric studies, and the SF-36 in studies on adults. In the pediatric studies, psychosocial outcomes were often secondary, compared to the studies on adults. Results showed that in both children and adults, psychosocial outcomes are comparable with the levels of the general population. Qualitative studies reflected the affective needs of this population and issues with emotional wellbeing. Factors such as fatigue and pain were associated with poorer psychosocial outcomes in adults with an impact on social relationships, intimacy and family planning. CONCLUSION Validated outcome measures, qualitative approaches and longitudinal studies are needed to better understand the psychosocial outcomes in AMC over time. Psychosocial support should be part of the multidisciplinary management of AMC throughout the lifespan.
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Affiliation(s)
- Sarah Cachecho
- Shriners Hospital for Children-Canada, Montreal, Canada.
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Trudy Wong
- Shriners Hospital for Children-Canada, Montreal, Canada
| | - Francis Lacombe
- Orthotist-Prosthetist and Patient Partner, St-Zotique, Canada
| | - Noemi Dahan-Oliel
- Shriners Hospital for Children-Canada, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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