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Frye WS, Milojevic D. The Role of Psychology in Pediatric Rheumatic Diseases. Rheum Dis Clin North Am 2024; 50:535-544. [PMID: 38942583 DOI: 10.1016/j.rdc.2024.05.001] [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] [Indexed: 06/30/2024]
Abstract
Pediatric rheumatic diseases (PRDs) are a heterogeneous group of diseases that can have a chronic unpredictable disease course that can negatively affect mood, functioning, and quality of life. Given the range of difficulties faced in managing PRDs, as well as the psychosocial issues youth with these diseases experience, pediatric psychologists can be well suited to address concerns that arise in care for youth with PRDs including adherence, cognitive assessment, pain management, functional disability, and mood. Potential ways that pediatric psychologists can address these concerns and be embedded within an interdisciplinary treatment plan for youth with PRDs are described.
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Affiliation(s)
- William S Frye
- Department of Psychology, Johns Hopkins All Children's Hospital, 880 6th Street South, Suite 460, St Petersburg, FL 33701, USA.
| | - Diana Milojevic
- Department of Medicine, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 502, Street, St Petersburg, FL 33701, USA
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Dawoud A, Blitz J, Moonaz S, Grout L. Feasibility and Acceptability of Yoga for Adolescents with Juvenile Idiopathic Arthritis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:812. [PMID: 39062261 PMCID: PMC11276325 DOI: 10.3390/children11070812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/05/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND/OBJECTIVES Yoga is effective for adults with arthritis but unstudied in adolescents with juvenile idiopathic arthritis (JIA). METHODS A pilot study assessed the feasibility and acceptability of an 8-week group yoga intervention for adolescents ages 14-18 with JIA. Each 75-min session included breathing techniques, relaxation, mindfulness, and modified yoga postures, using yoga props and a rope wall. An online video was available for home practice. The outcome measures administered at the baseline and at 8 weeks were physician global assessment with joint count, visual assessment with a joint damage assessment index, the Pediatric Quality of Life Arthritis Module 3.0 (Peds QL), and the visual analog scale for pain. RESULTS Thirteen out of 25 participants attended ≥1 class with a mean of 5.7 ± 2.2 classes. Common reasons for non-enrollment included distance, schedule, and lack of interest. The average distance to classes was 29.0 ± 41.7 miles. There was a trend toward improvement for joint count (p = 0.07), global assessment (p = 0.10), and the Pain and Hurt domain of the Peds QL (p = 0.13), but no other outcomes approached significance. Satisfaction data from an anonymous survey (n = 8) were high in all areas. CONCLUSIONS Adolescents with JIA who attended yoga reported enjoyment, pain reduction, and interest in continued practice with no adverse events. Future studies should consider stakeholder engagement to reduce barriers and larger sample sizes to test the effectiveness.
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Affiliation(s)
- Adina Dawoud
- Division of Pediatric Rehabilitation Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA (J.B.)
| | - Jill Blitz
- Division of Pediatric Rehabilitation Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA (J.B.)
| | - Steffany Moonaz
- Department of Clinical and Health Sciences Research, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Leah Grout
- Department of Clinical and Health Sciences Research, Southern California University of Health Sciences, Whittier, CA 90604, USA
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Hu X, Ren J, Wang P, Chen W, Shen W, Li Y, Xiao T, Dai Y, Sang Y. Adherence to exercise therapy among children and adolescents with Juvenile idiopathic arthritis: a scoping review. Disabil Rehabil 2024; 46:1502-1514. [PMID: 37125688 DOI: 10.1080/09638288.2023.2200261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To identify parameters and measurement methods of exercise therapy adherence, as well as barriers and facilitators affecting adherence among children and adolescents with juvenile idiopathic arthritis (JIA). METHODS Studies were eligible for inclusion if patients were 0-18 years of age, had JIA, and the focus of the research was on exercise therapy patterns, measurement/parameters of exercise adherence, and barriers/facilitators for exercise adherence. Two reviewers independently identified and categorized the barriers and facilitators to exercise therapy adherence using the International Classification of Functioning, Disability, and Health (ICF). RESULTS Twenty articles were included in this review. Among patients with JIA, 29%-99% adhered to exercise therapy. The most commonly measured parameters of adherence were session completion and behavior component, with a self-report log serving as the most common means of assessment. Time pressure, symptoms related to JIA, lack of enjoyment, and insufficient motivation were the main barriers. Facilitators were commonly identified as adequate motivation, effective symptoms management, and social support. CONCLUSIONS Future interventions should consider the identified factors to promote exercise engagement in children and adolescents with JIA. Strategies for promoting exercise adherence in children and adolescents with JIA is needed.
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Affiliation(s)
- Xinmiao Hu
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Ren
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Wang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjian Chen
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Shen
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Li
- Department of Critical Care Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tiantian Xiao
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Dai
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Sang
- Department of Nursing, Department of Computer Technology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Ozdemir BC, Savci S, Tanriverdi A, Ozcan Kahraman B, Isguder R, Makay B, Unsal E. Determinants of physical activity level in children and adolescents with juvenile idiopathic arthritis. Z Rheumatol 2024; 83:71-77. [PMID: 37010629 DOI: 10.1007/s00393-023-01340-7] [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] [Accepted: 02/05/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE One of the most frequently discussed physical parameters in juvenile idiopathic arthritis (JIA) is physical activity level. There is limited evidence about determinants of physical activity level in JIA. In this study, we aimed to investigate the determinants of physical activity level in children and adolescents with JIA. MATERIALS AND METHODS Thirty-two JIA patients and 18 age- and sex-matched healthy individuals were included in the study. The age range was 8-18 years. Sociodemographic and clinical data of the participants were recorded. In both groups, anthropometry, fatigue, pain, knee extension muscle strength, gait variables, functional exercise capacity assessed by six-minute walk test (6MWT), and arterial stiffness were evaluated. Physical activity level was assessed by an accelerometer. RESULTS The disease activity level of the patients was low. Pain and fatigue scores were significantly higher in the JIA group compared to healthy controls (p < 0.05). Walking speed, physical activity level, time spent in low-intensity physical activity, time spent in moderate-to-vigorous-intensity physical activity, and 6MWT distance were significantly lower than in healthy controls (p < 0.05). Quadriceps muscle strength and arterial stiffness assessment results were similar in both groups (p > 0.05). In the JIA group, there was a positive correlation between physical activity and age, height, fat-free body mass, quadriceps muscle strength, and 6MWT distance (p < 0.05). Also, there was a negative correlation between physical activity and pain, fatigue, and cadence. Physical activity level was independently associated with 6MWT distance (42.9% of the variability). CONCLUSION In mildly affected JIA patients, gait speed, functional exercise capacity, and physical activity level are affected. Functional exercise capacity is a determinant of physical activity level in JIA.
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Affiliation(s)
- Berk Can Ozdemir
- Health Science Institute, Dokuz Eylul University, Izmir, Turkey.
| | - Sema Savci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Aylin Tanriverdi
- Health Science Institute, Dokuz Eylul University, Izmir, Turkey
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Buse Ozcan Kahraman
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Rana Isguder
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Balahan Makay
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Erbil Unsal
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Junghans-Rutelonis A, Sim L, Harbeck-Weber C, Dresher E, Timm W, Weiss KE. Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study. FRONTIERS IN PAIN RESEARCH 2024; 4:1325270. [PMID: 38333189 PMCID: PMC10850299 DOI: 10.3389/fpain.2023.1325270] [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: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase. Methods Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program. Results Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated. Conclusions Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.
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Affiliation(s)
- Ashley Junghans-Rutelonis
- AJR & Co Consulting and Mental Health, St. Paul, MN, United States
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Leslie Sim
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Cynthia Harbeck-Weber
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Emily Dresher
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Wendy Timm
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Karen E. Weiss
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
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Gudjonsdottir B, Oskarsdottir SA, Kristjansdottir A, Gudmundsdottir JA, Kamban SW, Licina ZA, Gudmundsdottir DB. Impact of Musculoskeletal Pain on Functioning and Disability in Children with Juvenile Idiopathic Arthritis in Iceland. Phys Occup Ther Pediatr 2024; 44:554-571. [PMID: 38178574 DOI: 10.1080/01942638.2023.2299028] [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: 08/03/2022] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
AIMS 1) to map questions of pain from a survey to the International Classification of Functioning, Disability and Health (ICF) 2) to compare the impact of musculoskeletal pain on functioning based on the different components of the ICF in children with juvenile idiopathic arthritis (JIA) and age-matched peers. METHOD A cross-sectional case-control survey. A total of 28 children with JIA and 36 age-matched children participated. The survey included questions on the child's sex and age, about pain experienced, number of painful body areas, pain frequency and three short forms of Patient-Reported Outcome Measurement Information System (PROMIS) pain questionnaires. Sixteen children with JIA (57%) and 10 peers (28%) reported pain during past seven days. Their responses were used in the description of impact of pain. RESULTS After the mapping of the questions to ICF, a comparison between the two groups indicated that a higher number of children with JIA described effects of pain on mental function, mobility, general tasks and demands, than their peers. More children with JIA expressed to others that they had pain, non-verbally and verbally. CONCLUSION The findings provide important information about the impacts of pain on daily life in children with JIA and about their intervention needs.
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Affiliation(s)
- Bjorg Gudjonsdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Audur Kristjansdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Solrun W Kamban
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
| | - Zinajda Alomerovic Licina
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
| | - Drifa Bjork Gudmundsdottir
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
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Jeong HJ, Engel JM, Wilwert O, Muriello M, Basel D, Slavens BA. Pain Characteristics and Symptom Management in Children with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder. Phys Occup Ther Pediatr 2023; 43:630-643. [PMID: 36647261 DOI: 10.1080/01942638.2022.2163601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
AIMS This study aims to investigate pediatric hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) pain features and management strategies. METHODS This is a mixed-methods, cross-sectional study design using patient-reported outcomes in 21 children diagnosed with hEDS/HSD. Children who reported bothersome pain were interviewed for pain features. The Child Activity Limitation Interview-21, the Brief Pain Inventory pain interference items, and the Functional Disability Inventory were used to investigate pain interference. To evaluate psychological symptoms regarding pain, the pediatric version of the Survey of Pain Attitude and the child version of the Pain Catastrophizing Scale were used. RESULTS Nineteen children had bothersome pain and of them, eight children reported constant pain. The most frequently reported regions of pain were at the ankle (mild pain) and the back (moderate-to-severe pain). Children reported mild-to-moderate pain interference and believed medications were beneficial for their pain management. Nineteen children sought treatment and of those 16 children used to exercise and acetaminophen and 13 visited physicians as a means of treatment. Parents were overall satisfied with their child's treatment (13 out of 19). CONCLUSIONS Sufficient awareness of pain-related symptoms and understanding of the treatment strategies in early childhood is needed to prevent deleterious consequences in adulthood.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Joyce M Engel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Olivia Wilwert
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Boeker LS, Kuemmerle-Deschner JB, Saur SJ, Klotsche J, Erbis G, Hansmann S. Health-related quality of life, continuity of care and patient satisfaction: long-term outcomes of former patients of the Tuebingen Transition Program (TTP) - a retrospective cohort study. Pediatr Rheumatol Online J 2022; 20:121. [PMID: 36575486 PMCID: PMC9794404 DOI: 10.1186/s12969-022-00776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/26/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A significant number of patients in pediatric rheumatology suffer from ongoing disease activity into adulthood and thus need to be transferred into adult care. Transition as a structured individual process of preparation and patient empowerment can reduce risks of adverse long-term outcomes. The aim of this study was to measure long-term transition outcomes such as health-related quality of life (HR-QoL), patient satisfaction, and continuity of care in former patients of the interdisciplinary Tuebingen Transition Program (TTP). METHODS In an iterative team process, a standardized questionnaire was developed including the EQ-5D-5L to measure HR-QoL, visual analogue scales to measure various items of patient satisfaction, further questions on continuity of care and physical activity and physician global assessment (PGA) to determine disease activity. HR-QoL and physical activity were compared to data from the average German population. Data was analyzed descriptively, and a logistic regression analysis was performed to identify possible predictive factors for negative outcomes. RESULTS Response rate was 28.8% (85/295), 70.6% were female and median age was 24.1 years. 70.6% were diagnosed with juvenile idiopathic arthritis (JIA). Overall, HR-QoL was high (79.8 on the EQ VAS), yet lower than in the average population. The study cohort was more physically active than the respective average age groups. Mean patient satisfaction with pediatric care (8.4; standard deviation (SD) 1.7) and with the transition program (7.9; SD 2.6) was higher than with adult care (7.7; SD 2.2). 76.5% of participants received regular rheumatologic care after transfer. After excluding all participants in remission, the drop-out rate was 4.7%. A low PGA at the time of transfer was associated with higher HR-QoL and patient satisfaction after transfer. CONCLUSIONS HR-QoL of adult patients after successful transfer to adult rheumatology is reduced compared to the general population but physical activity and achievement of clinical remission could help to prevent negative long-term outcomes. Patient satisfaction and self-management of TTP patients were generally high, whereas youth-specific issues and their impact on the disease mandate greater attention. Treatment discontinuation rates were low and mostly due to remission. Further studies should focus on the identification of early predictors of long-term outcome to improve the process and outcome of transition.
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Affiliation(s)
- Luca Samuel Boeker
- grid.411544.10000 0001 0196 8249Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany
| | - Jasmin Beate Kuemmerle-Deschner
- grid.411544.10000 0001 0196 8249Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany
| | - Sebastian Jonas Saur
- grid.411544.10000 0001 0196 8249Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), University Hospital Tuebingen, Tuebingen, Germany
| | - Jens Klotsche
- grid.418217.90000 0000 9323 8675Programme area Epidemiology and Health Care Research, German Rheumatism Research Center Berlin and Leibniz Institute, Berlin, Germany
| | - Gabriele Erbis
- grid.411544.10000 0001 0196 8249Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Hansmann
- Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany.
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Frye WS, Milojevic D. The Role of Psychology in Pediatric Rheumatic Diseases. Pediatr Clin North Am 2022; 69:965-974. [PMID: 36207106 DOI: 10.1016/j.pcl.2022.05.009] [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] [Indexed: 11/05/2022]
Abstract
Pediatric rheumatic diseases (PRDs) are a heterogeneous group of diseases that can have a chronic unpredictable disease course that can negatively affect mood, functioning, and quality of life. Given the range of difficulties faced in managing PRDs, as well as the psychosocial issues youth with these diseases experience, pediatric psychologists can be well suited to address concerns that arise in care for youth with PRDs including adherence, cognitive assessment, pain management, functional disability, and mood. Potential ways that pediatric psychologists can address these concerns and be embedded within an interdisciplinary treatment plan for youth with PRDs are described.
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Affiliation(s)
- William S Frye
- Department of Psychology, Johns Hopkins All Children's Hospital, 880 6th Street South, Suite 460, St Petersburg, FL 33701, USA.
| | - Diana Milojevic
- Department of Medicine, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 502, Street, St Petersburg, FL 33701, USA
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Azab AR, Kamel FH, Basha MA, Alrawaili SM, Aloraini GS, Hassan SM, Ewais NF, Elnaggar RK. Impact of Clinical Pilates Exercise on Pain, Cardiorespiratory Fitness, Functional Ability, and Quality of Life in Children with Polyarticular Juvenile Idiopathic Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137793. [PMID: 35805451 PMCID: PMC9265800 DOI: 10.3390/ijerph19137793] [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: 05/24/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
Objective: This study intended to examine the effects of Pilates exercise on pain, cardiorespiratory fitness, functional ability, and quality of life in children with polyarticular juvenile idiopathic arthritis. Methods: Forty children with polyarticular JIA aged 10−14 years old were randomly allocated into two groups: the control group (n = 20) received conventional physical therapy (CPT), and the experimental group (n = 20) received clinical Pilates exercises combined with CPT. Patients in both groups received their program three times/week for 3 months. Pain, cardiorespiratory fitness, functional ability, and quality of life were assessed through the visual analogue scale, cardiopulmonary exercise test, 6 min walk test, and PedsQL scale, respectively, just before and after treatment. Results: Pain (p = 0.001), cardiorespiratory markers (all p < 0.05), functional ability (p = 0.002), and overall quality of life (p = 0.007) improved significantly in the experimental groups compared to the control group. Conclusion: Incorporating Pilates exercises into CPT is likely more effective for decreasing pain intensity, improving cardiorespiratory fitness, augmenting functional ability, and promoting quality of life in children with JIA than CPT alone.
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Affiliation(s)
- Alshimaa R. Azab
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Correspondence:
| | - FatmaAlzahraa H. Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
| | - Maged A. Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
- Department of Physical Therapy, ElSahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo 11697, Egypt
| | - Saud M. Alrawaili
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
| | - Ghfren S. Aloraini
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam University, Al-Kharj 11942, Saudi Arabia;
| | - Sahar M. Hassan
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
- Department of Physical Therapy, Cairo University Hospitals, Cairo University, Cairo 4240310, Egypt
| | - Najlaa F. Ewais
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
| | - Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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Lassoued Ferjani H, Maatallah K, Miri S, Triki W, Nessib DB, Kaffel D, Hamdi W. Enthesitis-related arthritis: monitoring and specific tools. J Pediatr (Rio J) 2022; 98:223-229. [PMID: 34597529 PMCID: PMC9432174 DOI: 10.1016/j.jped.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES In this article, the authors aimed to review the different tools used in the monitoring of enthesitis-related arthritis. SOURCES The authors performed a literature review on PubMed, Google Scholar, and Scopus databases. The dataset included the original research and the reviews including patients with enthesitis-related arthritis or juvenile spondylarthritis up to October 2020. SUMMARY OF FINDING Enthesitis-related arthritis is a category of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis, peripheral arthritis, as well as axial involvement. The only validated tool for disease activity measurement in juvenile idiopathic arthritis is the Disease Activity Score: It has proven its reliability and sensitivity. Nevertheless, due to an absence of validated evaluation tools, the extent of functional impairment, as well as the children and parents' perception of the disease, could not be objectively perceived. Despite the great progress in the field of imaging modalities, the role they play in the evaluation of disease activity is still controversial. This is partially due to the lack of validated scoring systems. CONCLUSIONS Further work is still required to standardize the monitoring strategy and validate the outcome measures in enthesitis-related arthritis.
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Affiliation(s)
- Hanène Lassoued Ferjani
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia.
| | - Kaouther Maatallah
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Sirine Miri
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia
| | - Wafa Triki
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Dorra Ben Nessib
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Dhia Kaffel
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Wafa Hamdi
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
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12
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Heale LD, Houghton KM, Rezaei E, Baxter-Jones ADG, Tupper SM, Muhajarine N, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Ellsworth J, Guzman J, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Clinical and psychosocial stress factors are associated with decline in physical activity over time in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:97. [PMID: 34187498 PMCID: PMC8243495 DOI: 10.1186/s12969-021-00584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Physical activity (PA) patterns in children with juvenile idiopathic arthritis (JIA) over time are not well described. The aim of this study was to describe associations of physical activity (PA) with disease activity, function, pain, and psychosocial stress in the 2 years following diagnosis in an inception cohort of children with juvenile idiopathic arthritis (JIA). METHODS In 82 children with newly diagnosed JIA, PA levels, prospectively determined at enrollment, 12 and 24 months using the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) raw scores, were evaluated in relation to disease activity as reflected by arthritis activity (Juvenile Arthritis Disease Activity Score (JADAS-71)), function, pain, and psychosocial stresses using a linear mixed model approach. Results in the JIA cohort were compared to normative Pediatric Bone Mineral Accrual Study data derived from healthy children using z-scores. RESULTS At enrollment, PA z-score levels of study participants were lower than those in the normative population (median z-score - 0.356; p = 0.005). At enrollment, PA raw scores were negatively associated with the psychosocial domain of the Juvenile Arthritis Quality of Life Questionnaire (r = - 0.251; p = 0.023). There was a significant decline in PAQ-C/A raw scores from baseline (median and IQR: 2.6, 1.4-3.1) to 24 months (median and IQR: 2.1, 1.4-2.7; p = 0.003). The linear mixed-effect model showed that PAQ-C/A raw scores in children with JIA decreased as age, disease duration, and ESR increased. The PAQ-C/A raw scores of the participants was also negatively influenced by an increase in disease activity as measured by the JADAS-71 (p < 0.001). CONCLUSION Canadian children with newly diagnosed JIA have lower PA levels than healthy children. The decline in PA levels over time was associated with disease activity and higher disease-specific psychosocial stress.
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Affiliation(s)
- Liane D. Heale
- grid.422356.40000 0004 0634 5667McMaster Children’s Hospital and McMaster University, Hamilton, Canada
| | - Kristin M. Houghton
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Elham Rezaei
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Susan M. Tupper
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Nazeem Muhajarine
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Susanne M. Benseler
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gilles Boire
- grid.86715.3d0000 0000 9064 6198Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie– Centre Hospitalier Universitaire de Santé (CIUSSS de l’Estrie-CHUS) and University of Sherbrooke, Sherbrooke, Canada
| | - David A. Cabral
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Sarah Campillo
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Gaëlle Chédeville
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Anne-Laure Chetaille
- grid.411081.d0000 0000 9471 1794le Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - Paul Dancey
- grid.477424.60000 0004 0640 6407Janeway Children’s Health and Rehabilitation Centre and Memorial University, St. John’s, Canada
| | - Ciaran Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Karen Watanabe Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Janet Ellsworth
- grid.416656.60000 0004 0633 3703Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | - Jaime Guzman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Adam M. Huber
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Roman Jurencak
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Bianca Lang
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ronald M. Laxer
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Kiem G. Oen
- grid.413983.4The Children’s Hospital of Winnipeg and University of Manitoba, Winnipeg, Canada
| | - Ross E. Petty
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Suzanne E. Ramsey
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Johannes Roth
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rayfel Schneider
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rosie Scuccimarri
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Lynn Spiegel
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Elizabeth Stringer
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Shirley M. L. Tse
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lori B. Tucker
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Stuart E. Turvey
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Rae S. M. Yeung
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Alan M. Rosenberg
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
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McErlane F, Davies EH, Ollivier C, Mayhew A, Anyanwu O, Harbottle V, Donald A. Wearable Technologies for Children with Chronic Illnesses: An Exploratory Approach. Ther Innov Regul Sci 2021; 55:799-806. [PMID: 33844190 DOI: 10.1007/s43441-021-00278-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the utility of wearable technologies in physical activity assessment in three paediatric diseases, namely, Niemann-Pick C (NP-C), Juvenile Idiopathic Arthritis (JIA) and Duchenne Muscular Dystrophy (DMD). DESIGN Exploratory study SETTING AND PATIENTS: Thirty children were recruited across three UK hospitals (Royal Manchester's Children Hospital, Great Ormond Street Children's Hospital, and the Great North Children's Hospital). Ten were diagnosed with NP-C, eight with DMD and twelve with JIA. INTERVENTION All participants completed the 6-min walk test (6MWT) at enrolment. Patients were provided with disease-specific smartphone apps paired with a wearable device via Bluetooth. Ambulation was recorded in 30-min epochs measuring average daily maximum (ADM), average daily steps (ADS) and average daily steps per 30-min epoch (ASE). RESULTS Median 6MWT results were 450 m, 325 m and 434.5 m for the NP-C, DMD and JIA cohorts, respectively. Wearable data capture was feasible in all three disease cohorts, although complete data capture was not sustained. A statistically significant between-cohort difference was identified for ADM, ADS and ASE. Statistically significant differences were found between DMD/JIA for ADM; NP-C/DMD for ADS and DMD/JIA for ASE. DISCUSSION Wearable sensor technologies have the potential to provide additional information for our understanding of ambulation in chronic paediatric disease. The wearable devices were easy to use and popular with patients although key features need to be addressed to appropriately meet study objectives. As the technology continues to evolve at a rapid pace, opportunities to implement child friendly solutions are already available.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine (Rheumatology), Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Anna Mayhew
- The John Walton Muscular Dystrophy Research Centre at Newcastle, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Victoria Harbottle
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Aimee Donald
- Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester, UK
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14
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Bourdier P, Birat A, Rochette E, Doré É, Courteix D, Dutheil F, Pereira B, Ratel S, Merlin E, Duché P. Muscle function and architecture in children with juvenile idiopathic arthritis. Acta Paediatr 2021; 110:280-287. [PMID: 32420673 DOI: 10.1111/apa.15335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
AIM To assess muscle function and functional abilities in children with juvenile idiopathic arthritis (JIA). METHODS Fourteen children with JIA and 14 healthy controls matched for age and sex were included. Muscle characteristics, both structural (thickness, cross-sectional area (CSA) and fascicle angle) and qualitative (intermuscular adipose tissue; IMAT), were assessed in thigh muscles using ultrasound and peripheral quantitative computed tomography (pQCT). Muscle function and functional abilities were determined from the assessment of maximal voluntary isometric contraction (MVIC) knee extensors force and vertical jump performance. RESULTS No significant difference in MVIC force was observed between the two groups. However, squat jump height was significantly reduced in children with JIA (18.3 ± 5.4 vs 24.3 ± 7.9 cm, P < .05). No differences in structural parameters were observed, but IMAT/CSA (0.22 ± 0.02 vs 0.25 ± 0.03; P = .01) was significantly lower in children with JIA than in healthy children. CONCLUSION Knee extensor muscle architecture and force were comparable between children with and without JIA, but functional abilities (vertical jump performance) were poorer in JIA. The lower IMAT area in JIA could result from a lower physical activity level compared with healthy children.
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Affiliation(s)
- Pierre Bourdier
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Anthony Birat
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Emmanuelle Rochette
- INSERM, CIC 1405, Unité CRECHE, CHU Clermont‐Ferrand Université Clermont Auvergne Clermont‐Ferrand France
- CHU Clermont‐Ferrand Clermont‐Ferrand France
- Laboratoire IAPS Université de Toulon Toulon France
| | - Éric Doré
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Daniel Courteix
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Frédéric Dutheil
- CNRS Laboratoire de Psychologie Sociale et Cognitive (LaPSCo) UCA‐CNRS 6024, CHU Université Clermont Auvergne Clermont–Ferrand France
- Faculty of Health School of Exercise Science Australian Catholic University Melbourne Vic. Australia
| | | | - Sébastien Ratel
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
| | - Etienne Merlin
- INSERM, CIC 1405, Unité CRECHE, CHU Clermont‐Ferrand Université Clermont Auvergne Clermont‐Ferrand France
- CHU Clermont‐Ferrand Clermont‐Ferrand France
- INRA, UMR 1019 UNH, ECREIN Université Clermont Auvergne Clermont‐Ferrand France
| | - Pascale Duché
- Laboratoire AME2P Université Clermont Auvergne Clermont‐Ferrand France
- Laboratoire IAPS Université de Toulon Toulon France
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15
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Physical activity assessment in children and adolescents with juvenile idiopathic arthritis compared with controls. Arch Pediatr 2020; 28:47-52. [PMID: 33250332 DOI: 10.1016/j.arcped.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/13/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We aimed to assess physical activity (PA) in children with juvenile idiopathic arthritis (JIA) compared with healthy peers and to determine factors influencing PA level. METHODS This was a cross-sectional study of the measured level of PA in children with JIA, compared with age- and gender-matched healthy schoolchildren. PA was estimated using a physical activity questionnaire for children and for adolescents (cPAQ/aPAQ). Disease activity was evaluated with the Juvenile Arthritis Disease Activity Score (JADAS). Functional ability was assessed with the Childhood Health Assessment Questionnaire (CHAQ). RESULTS A total of 55 children with JIA and 55 healthy control schoolchildren were included. Children with JIA had significantly lower levels of PA compared with their healthy peers as assessed with the cPAQ/aPAQ (P=0.0121). In total, 76% of the JIA group spent the day sleeping and sitting, which was significantly higher compared with the reference group (P=0.001 and P=0.055, respectively). Low PA level was associated with systemic JIA (P=0.002, OR=2.123), polyarticular JIA with positive rheumatoid factor (P=0.001, OR=2.014), JADAS-27≥6 (P=0.001, OR=2.524), patients undergoing treatment (P=0.001, OR=1.271), and higher CHAQ (P=0.002, OR=2.461). CONCLUSION Children with JIA were less physically active than their healthy peers and less active than recommended for general health.
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16
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Hanns L, Radziszewska A, Suffield L, Josephs F, Chaplin H, Peckham H, Sen D, Christie D, Carvalho LA, Ioannou Y. Association of Anxiety With Pain and Disability but Not With Increased Measures of Inflammation in Adolescent Patients With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 72:1266-1274. [PMID: 31199593 PMCID: PMC7496487 DOI: 10.1002/acr.24006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
Objective To explore whether anxiety and depression are associated with clinical measures of disease for adolescent patients with juvenile idiopathic arthritis (JIA) and whether anxiety and depression are associated with increased peripheral proinflammatory cytokine levels in adolescent patients with JIA and in healthy adolescent controls. Methods A total of 136 patients with JIA and 88 healthy controls ages 13–18 years completed questionnaires on anxiety and depressive symptoms. For patients with JIA, pain, disability, physician global assessment (using a visual analog scale [VAS]), and number of joints with active inflammation (active joint count) were recorded. In a subsample, we assessed lipopolysaccharide‐stimulated interleukin 6 (IL‐6) production from peripheral blood mononuclear cells, serum IL‐6, cortisol, and C‐reactive protein levels. Data were analyzed by linear regression analysis. Results Levels of anxiety and depressive symptoms in patients with JIA were not significantly different than those in healthy controls. For patients with JIA, anxiety was significantly associated with disability (β = 0.009, P = 0.002), pain (β = 0.029, P = 0.011), and physician global assessment VAS (β = 0.019, P = 0.012), but not with active joint count (β = 0.014, P = 0.120). Anxiety was not associated with any laboratory measures of inflammation for JIA patients. These relationships were also true for depressive symptoms. For healthy controls, there was a trend toward an association of anxiety (but not depressive symptoms) with stimulated IL‐6 (β = 0.004, P = 0.052). Conclusion Adolescent patients with JIA experience equivalent levels of anxiety and depressive symptoms as healthy adolescents. For adolescent patients with JIA, anxiety and depressive symptoms are associated with pain, disability, and physician global assessment VAS, but not with inflammation.
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17
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Bourdier P, Saidi O, Rochette E, Ratel S, Merlin E, Pereira B, Duché P. Physical activity and sedentary levels in children with juvenile idiopathic arthritis and inflammatory bowel disease. A systematic review and meta-analysis. Pediatr Res 2019; 86:149-156. [PMID: 31029060 DOI: 10.1038/s41390-019-0409-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical activity (PA) is essential for children throughout their growth and maturation. It improves physiological and psychological health and limits the risk of developing metabolic disorders. However, some chronic physiological and metabolic diseases may lead to decreased PA. The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). METHODS A literature review and a meta-analysis were carried out with original studies from a Medline database search. Only high-quality studies (STROBE checklist) written in English comparing PA level or sedentary behavior (SB) between children with the disorders and their healthy peers were considered. The aim was to examine PA and SB in children with JIA or IBD compared to their healthy peers. RESULTS The literature review and meta-analysis identified decreased PA and increased time spent in SB in these populations, which may exacerbate both their lower physical fitness and the symptoms of their health disorders. CONCLUSION Results nevertheless show discrepancies due to the different materials and methods used and the variables measured. Further studies are needed to establish a gold standard method for assessing PA level in these populations.
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Affiliation(s)
- Pierre Bourdier
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Oussama Saidi
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- CRNH-Auvergne, 63000, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université de Toulon, Laboratoire IAPS, 83041, Toulon, France
| | - Sébastien Ratel
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Etienne Merlin
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation de la Recherche Clinique et Innovations, 63000, Clermont-Ferrand, France
| | - Pascale Duché
- Université de Toulon, Laboratoire IAPS, 83041, Toulon, France.
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18
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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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19
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Rebane K, Orenius T, Ristolainen L, Relas H, Kautiainen H, Luosujärvi R, Säilä H, Aalto K. Pain interference and associated factors in young adults with juvenile idiopathic arthritis. Scand J Rheumatol 2019; 48:408-414. [DOI: 10.1080/03009742.2019.1596308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- K Rebane
- Children’s Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - T Orenius
- Orton Orthopaedic Hospital, Orton, Helsinki, Finland
| | | | - H Relas
- Department of Medicine, Division of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - R Luosujärvi
- Department of Medicine, Division of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Säilä
- Research Institute Orton, Orton, Helsinki, Finland
| | - K Aalto
- Children’s Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Flodén A, Broström EW, von Heideken J, Rostlund S, Nilsson R, Löwing K, Iversen MD. A qualitative study examining the validity and comprehensibility of physical activity items: developed and tested in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:16. [PMID: 31023371 PMCID: PMC6482510 DOI: 10.1186/s12969-019-0317-6] [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] [Received: 09/19/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not all physical activity (PA) questionnaires (PAQ) gather information regarding PA intensity, duration, and modes and only a few were developed specifically for children. We assessed children's comprehensibility of items derived from two published PAQs used in children along with three items designed to ascertain PA intensity in order to assess comprehensibility of items and identify response errors. We modified items to create a new PAQ for children (ASCeND). We hypothesized that children would have comprehension difficulties with some original PAQ items and that ASCeND would be easier to comprehend, and would improve recall and reporting of PA. METHODS For this qualitative study, we recruited 30 Swedish children [ages 10-16 years; mean age = 13.0 (SD = 1.8)]; median disease activity score = 4.5 (IQR 2.2-9.0); median disease duration = 5.0 (IQR 2.6-10.8) with juvenile idiopathic arthritis (JIA) from a children's hospital-based rheumatology clinic. We conducted cognitive interviews to identify children's comprehension of PAQ items. Interviews were audiotaped, transcribed, and independently analyzed. In phase one, 10 children were interviewed and items modified based on feedback. In phase two, an additional 20 children were interviewed to gather more feedback and further refine the modified items, to create the ASCeND. RESULTS The median interview time was 41 min (IQR 36-56). In phase one, 219 comments were generated regarding directions for recording PA duration, and transportation use, walking, dancing, weight-bearing exercise and cardio fitness. Based on feedback we modified the survey layout, clarified directions and collapsed or defined items to reduce redundancy. In phase two, 95 comments were generated. Most comments related to aerobic fitness and strenuous PA. Children had difficulty recalling total walking and other activities per day. Children used the weather on a particular day, sports practice, or gym schedules to recall time performing activities. The most comments regarding comprehension were generated about the 3-item PA intensity survey, suggesting children had problems responding to intensity items. CONCLUSIONS The newer layout facilitated recall of directions or efficiency in answering items. The 3-item intensity survey was difficult to answer. Sports-specific items helped children more accurately recall the amount of daily PA. The ASCeND appeared to be easy to answer and to comprehend.
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Affiliation(s)
- August Flodén
- Department of Physical Therapy, Stockholm South General Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Eva W. Broström
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Heideken
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Rostlund
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Rikard Nilsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Löwing
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Maura D. Iversen
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Section of Clinical Sciences, Department of Medicine, Brigham & Women’s Hospital, Boston, MA USA
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue 120 E Beharkis Health Sciences Building, Boston, MA 02115 USA
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Milatz F, Klotsche J, Niewerth M, Geisemeyer N, Trauzeddel R, Weißbarth-Riedel E, Kallinich T, Peitz J, Hartmann M, Minden K. Participation in school sports among children and adolescents with juvenile idiopathic arthritis in the German National Paediatric Rheumatologic Database, 2000-2015: results from a prospective observational cohort study. Pediatr Rheumatol Online J 2019; 17:6. [PMID: 30744659 PMCID: PMC6371582 DOI: 10.1186/s12969-019-0306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Regular school sports can help adolescents achieve the recommended amount of daily physical activity and provide knowledge, attitudes and behavioral skills that are needed in order to adopt and maintain a physically active lifestyle. Furthermore, it reaches all children including those that are at risk for engaging in more sedentary types of behavior. Since adolescents with juvenile idiopathic arthritis (JIA) are less involved in physical and social activities than their healthy peers, the objectives were to (1) estimate the prevalence of participation in school sports among patients with JIA; (2) determine the correlates associated with school sports absenteeism; and (3) investigate whether attendance in school sports has changed in the era of biologics. METHODS Data from schoolchildren with JIA recorded in the German National Paediatric Rheumatologic Database (NPRD) in the years 2000 to 2015 were considered for the analyses. Data from the year 2015 were inspected to analyze correlates of school sports absenteeism. Whether school sports participation had changed between 2000 and 2015 was determined using linear mixed models. RESULTS During the 15-year period, the participation rates in school sports were determined in 23,016 patients. The proportion of patients who participated in school sports almost always steadily increased from 31% in 2000 to 64% in 2015 (β = 0.017, 95% confidence interval (CI) 0.015, 0.020), whereas the exemption rate simultaneously decreased from 44% in 2000 to 16% in 2015 [β = - 0.009, 95% CI -0.011, - 0.007]. In 2015, the data from 5879 patients (mean age 13.1 ± 3.3 years, female 65%, disease duration 5.9 ± 4.0 years, persistent oligoarthritis 37%) were available for evaluation. Full exemption from school sports (in 16.1% of cases) was associated with functional limitations, disease activity and any use of DMARDs, intra-articular glucocorticoid injections or physiotherapy. CONCLUSIONS School sports attendance among children and adolescents with JIA has increased significantly over the past 15 years. Possible explanations include improved functional ability probably due to better treatment options. The integration of patients with child acceptable symptom states who have previously been fully exempted from school sports needs to be addressed in the future.
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Affiliation(s)
- Florian Milatz
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117, Berlin, Germany.
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Martina Niewerth
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Nils Geisemeyer
- Epidemiology Unit, German Rheumatism Research Centre Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Ralf Trauzeddel
- 0000 0000 8778 9382grid.491869.bDepartment of Paediatric Rheumatology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Elisabeth Weißbarth-Riedel
- 0000 0001 2180 3484grid.13648.38Paediatric Rheumatology Clinics, University Hospital Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Tilmann Kallinich
- 0000 0001 2218 4662grid.6363.0Department of Pediatrics, Division of Pneumonology and Immunology with intensive Medicine, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Joachim Peitz
- Paediatric Rheumatology Centre, Asklepios Clinic, Sankt Augustin, Arnold-Janssen-Straße 29, 53757 Sankt Augustin, Germany
| | - Matthias Hartmann
- German Centre for Paediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
| | - Kirsten Minden
- 0000 0001 2218 4662grid.6363.0Epidemiology Unit, German Rheumatism Research Centre Berlin and Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Chariteplatz 1, 10117 Berlin, Germany
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22
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Heale LD, Dover S, Goh YI, Maksymiuk VA, Wells GD, Feldman BM. A wearable activity tracker intervention for promoting physical activity in adolescents with juvenile idiopathic arthritis: a pilot study. Pediatr Rheumatol Online J 2018; 16:66. [PMID: 30348203 PMCID: PMC6198499 DOI: 10.1186/s12969-018-0282-5] [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: 06/04/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Children and adolescents with juvenile idiopathic arthritis (JIA) are less physically active than their healthy peers and are at high risk of missing out on the general health benefits of physical activity. Wearable activity trackers are a promising option for intervening in this population with potential advantages over traditional exercise prescriptions. The objectives of this study were to: (1) determine the feasibility of a wearable activity tracker intervention in adolescents with JIA; and (2) estimate the variability in response to a wearable activity tracker intervention on the physical activity levels of adolescents with JIA. METHODS Participants aged 12-18 years with JIA were recruited during their routine rheumatology clinic visits at a tertiary care hospital. Participants completed the 3-Day Physical Activity Recall self-reported questionnaire at baseline, 1 week and 5 week follow-up. At the 1 week follow up, participants were instructed to start wearing an activity tracker for 28 consecutive days. Participants completed a feasibility questionnaire at their end of study visit. Participant demographics, adherence rates and feasibility outcomes were summarized using descriptive statistics. The effect of wearing a tracker on moderate-to-vigorous physical activity (MVPA) and total metabolic equivalents (METs) per day were analyzed using a paired t-test. RESULTS Twenty-eight participants (74% female; median age 15.1, range 12.8-18.6) were included in the analysis. All of the participants were able to synchronize the activity tracker to a supported device, use the activity tracker correctly and complete the study measurements. On average, participants had activity logged on their smartphone application for 72% of the intervention period. The standard deviation of the change in mean METs/day was 12.148 and for mean MVPA blocks/day was 3.143 over the study period. CONCLUSION Wrist worn activity tracking is a feasible intervention for adolescent patients with JIA. More research is needed to examine the effect of activity tracking on physical activity levels. TRIAL REGISTRATION Not an applicable clinical device trial as per the criteria listed on ClinicalTrials.gov as the primary objective is feasibility.
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Affiliation(s)
- Liane D. Heale
- 0000 0004 0473 9646grid.42327.30Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Saunya Dover
- 0000 0004 0473 9646grid.42327.30Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON M5G 0A4 Canada
| | - Y. Ingrid Goh
- 0000 0004 0473 9646grid.42327.30Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada ,0000 0004 0473 9646grid.42327.30Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay St, Toronto, ON M5G 0A4 Canada
| | - Victoria A. Maksymiuk
- 0000 0004 0473 9646grid.42327.30Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Greg D. Wells
- 0000 0004 0473 9646grid.42327.30Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Brian M. Feldman
- 0000 0004 0473 9646grid.42327.30Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada ,0000 0001 2157 2938grid.17063.33Department of Pediatrics and the Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7 Canada
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23
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Risum K, Hansen BH, Selvaag AM, Molberg Ø, Dagfinrud H, Sanner H. Physical activity in patients with oligo- and polyarticular juvenile idiopathic arthritis diagnosed in the era of biologics: a controlled cross-sectional study. Pediatr Rheumatol Online J 2018; 16:64. [PMID: 30333025 PMCID: PMC6192283 DOI: 10.1186/s12969-018-0281-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/01/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Knowledge about objectively measured levels of physical activity (PA) and PA participation (included facilitators and barriers for PA) in patients with juvenile idiopathic arthritis (JIA) diagnosed in the era of biologics is limited. We aimed to compare objectively measured PA in patients with oligo- and polyarticular JIA diagnosed in the biologic era with controls and to examine associations between PA and disease variables; furthermore, to explore participation in PA, physical education (PE) and facilitators and barriers for PA participation in patients and controls. METHODS The study cohort included 60 patients (30 persistent oligo JIA/30 poly-articular disease) and 60 age- and sex-matched controls. Age range was 10-16 years and 83% were female. PA was measured with accelerometry for seven consecutive days. Disease activity, current treatment, disease duration, functional ability, pain and fatigue were assessed. Structured interviews were applied to explore participation in PA and PE, and PA facilitators and barriers. RESULTS Patients spent less time in daily vigorous PA than controls, (mean(SE) 21(2) min vs. 26(2) min, p = 0.02), while counts per minute (cpm), steps daily, sedentary time and light and moderate PA did not differ. No differences were found between JIA subgroups. The use of biologic medication was associated with higher cpm and lower sedentary time. Most patients and controls participated in organized or unorganized PA and PE, and enjoyment was the most reported facilitator for PA participation. More patients than controls reported pain as a PA barrier. CONCLUSION The PA levels and participation in patients with oligo- and polyarticular JIA are mostly comparable to controls, but patients still need to be encouraged to increase vigorous PA. Enjoyment is the most important facilitator for PA participation in patients with JIA.
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Affiliation(s)
- Kristine Risum
- Section for Orthopaedic Rehabilitation, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,Department of Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Bjørge Herman Hansen
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Anne Marit Selvaag
- 0000 0004 0389 8485grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Øyvind Molberg
- 0000 0004 0389 8485grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Dagfinrud
- 0000 0004 1936 8921grid.5510.1Department of Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway ,0000 0004 0512 8628grid.413684.cNational Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Helga Sanner
- 0000 0004 0389 8485grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway ,0000 0004 0389 8485grid.55325.34Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Rikshospitalet, Oslo, Norway ,Bjørknes University College, Oslo, Norway
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24
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Riquelme I, do Rosário RS, Vehmaskoski K, Natunen P, Montoya P. Influence of chronic pain in physical activity of children with cerebral palsy. NeuroRehabilitation 2018; 43:113-123. [DOI: 10.3233/nre-172409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Inmaculada Riquelme
- University Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | | | - Kari Vehmaskoski
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
| | - Pekka Natunen
- JAMK University of Applied Sciences, School of Health and Social Studies, Jyväskylä, Finland
| | - Pedro Montoya
- University Institute of Health Sciences Research (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain
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25
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Hanns L, Cordingley L, Galloway J, Norton S, Carvalho LA, Christie D, Sen D, Carrasco R, Rashid A, Foster H, Baildam E, Chieng A, Davidson J, Wedderburn LR, Hyrich K, Thomson W, Ioannou Y. Depressive symptoms, pain and disability for adolescent patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study. Rheumatology (Oxford) 2018; 57:1381-1389. [PMID: 29697850 PMCID: PMC6055569 DOI: 10.1093/rheumatology/key088] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/03/2022] Open
Abstract
Objectives To determine if depressive symptoms assessed near diagnosis associate with future measures of pain, disability and disease for adolescent patients diagnosed with JIA. Methods Data were analysed from JIA patients aged 11–16 years recruited to the Childhood Arthritis Prospective Study, a UK-based inception cohort of childhood-onset arthritis. Depressive symptoms (using the Mood and Feelings Questionnaire; MFQ), active and limited joint count, disability score (Childhood Health Assessment Questionnaire), pain visual analogue scale and patient’s general evaluation visual analogue scale were collected. Associations between baseline measures (first visit to paediatric rheumatologist) were analysed using multiple linear regression. Linear mixed-effect models for change in the clinical measures of disease over 48 months were estimated including MFQ as an explanatory variable. Results Data from 102 patients were analysed. At baseline, median (IQR) age was 13.2 years (11.9–14.2 years) and 14.7% scored over the MFQ cut-off for major depressive disorder. At baseline, depressive symptoms significantly associated with all clinical measures of disease (P ⩽ 0.01). High baseline depressive symptoms scores predicted worse pain (P ⩽ 0.005) and disability (P ⩽ 0.001) 12 months later but not active and limited joint counts. Conclusions Adolescent patients with JIA and depressive symptoms had more active joints, pain and disability at the time of their first specialist appointment. The associations between baseline depression and both pain and disability continued for at least one year, however, this was not the case for active joint count.
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Affiliation(s)
- Laura Hanns
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Lis Cordingley
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - James Galloway
- Department of Academic Rheumatology, Faculty of Life Sciences & Medicine, London, UK
| | - Sam Norton
- Department of Academic Rheumatology, Faculty of Life Sciences & Medicine, London, UK.,Psychology Department, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Livia A Carvalho
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Deborah Christie
- Child and Adolescent Psychological Services, University College London Hospital NHS Foundation Trust, London, UK
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Amir Rashid
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Helen Foster
- Paediatric Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Baildam
- Department of Rheumatology, Alder Hey Children's Foundation NHS Trust Liverpool, Liverpool, UK
| | - Alice Chieng
- Department of Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Joyce Davidson
- Department of Rheumatology, Royal Hospital for Children, Glasgow, UK.,Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK.,UCL GOS Institute of Child Health, University College London, London, UK
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Wendy Thomson
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
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Stephens S, Beyene J, Tremblay MS, Faulkner G, Pullnayegum E, Feldman BM. Strategies for Dealing with Missing Accelerometer Data. Rheum Dis Clin North Am 2018; 44:317-326. [PMID: 29622298 DOI: 10.1016/j.rdc.2018.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Missing data is a universal research problem that can affect studies examining the relationship between physical activity measured with accelerometers and health outcomes. Statistical techniques are available to deal with missing data; however, available techniques have not been synthesized. A scoping review was conducted to summarize the advantages and disadvantages of identified methods of dealing with missing data from accelerometers. Missing data poses a threat to the validity and interpretation of trials using physical activity data from accelerometry. Imputation using multiple imputation techniques is recommended to deal with missing data and improve the validity and interpretation of studies using accelerometry.
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Affiliation(s)
- Samantha Stephens
- Neurosciences and Mental Health, Pediatric M.S., Neuroinflammatory Disorders Program, Center for Brain and Mental Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Room 8.9830, Toronto, Ontario M5G 0A4, Canada.
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, 208 Michael G. DeGroote Centre for Learning, McMaster University, 1280 Main Street W., Hamilton, Ontario L8S 4K1, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Guy Faulkner
- Canadian Institutes of Health Research, Public Health Agency of Canada, Applied Public Health, University of British Columbia, D. H. Copp Building, Room 4606 2146 Health Sciences Mall, Vancouver, BC V6T1Z3, Canada
| | - Eleanor Pullnayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Public Health Sciences, The University of Toronto, Toronto, Ontario, Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Department of Pediatrics, Institute of Health Policy Management and Evaluation, The Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
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Armbrust W, Bos GJFJ, Wulffraat NM, van Brussel M, Cappon J, Dijkstra PU, Geertzen JHB, Legger GE, van Rossum MAJ, Sauer PJJ, Lelieveld OTHM. Internet Program for Physical Activity and Exercise Capacity in Children With Juvenile Idiopathic Arthritis: A Multicenter Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 69:1040-1049. [DOI: 10.1002/acr.23100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 08/10/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Wineke Armbrust
- University of Groningen, University Medical Center Groningen, and Beatrix Children's Hospital; Groningen The Netherlands
| | - G. J. F. Joyce Bos
- University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - Nico M. Wulffraat
- University Medical Center Utrecht and Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Marco van Brussel
- University Medical Center Utrecht and Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Jeannette Cappon
- Reade, Center for Rehabilitation and Rheumatology, Dr. Jan van Breemenstraat; Amsterdam The Netherlands
| | - Pieter U. Dijkstra
- University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - Jan H. B. Geertzen
- University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - G. Elizabeth Legger
- University of Groningen, University Medical Center Groningen, and Beatrix Children's Hospital; Groningen The Netherlands
| | - Marion A. J. van Rossum
- Reade, Center for Rehabilitation and Rheumatology, Dr. Jan van Breemenstraat; Amsterdam The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, and Beatrix Children's Hospital; Groningen The Netherlands
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Race DL, Sims-Gould J, Tucker LB, Duffy CM, Feldman DE, Gibbon M, Houghton KM, Stinson JN, Stringer E, Tse SM, McKay HA. 'It might hurt, but you have to push through the pain': Perspectives on physical activity from children with juvenile idiopathic arthritis and their parents. J Child Health Care 2016; 20:428-436. [PMID: 26907570 DOI: 10.1177/1367493516632616] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Our primary objective was to gather perspectives of children diagnosed with juvenile idiopathic arthritis (JIA) and their parents as they relate to physical activity (PA) participation. To do so, we conducted a study on 23 children diagnosed with JIA and their parents ( N = 29). We used convenience sampling to recruit participants and qualitative method- logies (one-on-one semi-structured interviews). We adopted a five-step framework analysis to categorize data into themes. Children and their parents described factors that act to facilitate or hinder PA participation. Pain was the most commonly highlighted PA barrier described by children and their parents. However, children who were newly diagnosed with JIA and their parents were more likely to highlight pain as a barrier than were child/parent dyads where children had been previously diagnosed.
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Affiliation(s)
| | | | - Lori B Tucker
- 2 British Columbia Children's Hospital, Vancouver, Canada
| | - Ciaran M Duffy
- 3 University of Ottawa, Ottawa, Canada
- 4 Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Michele Gibbon
- 4 Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristin M Houghton
- 1 University of British Columbia, Vancouver, Canada
- 2 British Columbia Children's Hospital, Vancouver, Canada
| | - Jennifer N Stinson
- 6 The Hospital for Sick Children, Toronto, Canada
- 7 University of Toronto, Toronto, Canada
| | | | - Shirley Ml Tse
- 6 The Hospital for Sick Children, Toronto, Canada
- 7 University of Toronto, Toronto, Canada
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29
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Bos GJFJ, Lelieveld OTHM, Armbrust W, Sauer PJJ, Geertzen JHB, Dijkstra PU. Physical activity in children with Juvenile Idiopathic Arthritis compared to controls. Pediatr Rheumatol Online J 2016; 14:42. [PMID: 27387754 PMCID: PMC4936199 DOI: 10.1186/s12969-016-0102-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/30/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To compare physical activity (PA) in children with juvenile idiopathic arthritis (JIA) with controls and to analyse the effect of disease specific factors on PA in children with JIA treated according to current treatment regimes. METHODS PA was measured with a 7-day activity diary and expressed as physical activity level (PAL). Moderate to vigorous physical activity (MVPA) (hours/day) and sedentary time (hours/day) was determined. In children with JIA, medication, the number of swollen and/or painful joints, disease activity, functional ability, pain and well-being was determined. Multivariate regression analysis was performed to analyze differences in PA between JIA and controls, adjusted for influences of age, gender, season, Body Mass Index (BMI) and to analyze predictors of PA in JIA patients. RESULTS Seventy-six children with JIA (26 boys and 50 girls, mean ± SD age 10.0 ± 1.4 years) and 131 controls (49 boys and 82 girls, mean ± SD age 10.4 ± 1.2 years) participated in this study. Children with JIA had a significantly lower PAL (0.10, p = 0.01) corrected for age, BMI, gender and season. They spent less time in MVPA (0.41 h/day, p = 0.06) and had a significantly higher mean time spent in sedentary activities (0.59 h/day, p 0.02) compared to controls. The activity level of children with JIA was related to age, gender, season, feeling of well-being and pain. CONCLUSION Children with JIA have a lower PAL, spent less time in MVPA and spent more time on sedentary activities compared to controls despite current medical treatment and PA encouragement. TRIAL REGISTRATION Data of the children with JIA are from the Rheumates@work study ISRCTN92733069 .
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Affiliation(s)
- G. J. F. Joyce Bos
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Otto T. H. M. Lelieveld
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Wineke Armbrust
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Pieter U. Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands ,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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Nørgaard M, Lomholt JJ, Thastum M, Herlin M, Twilt M, Herlin T. Accelerometer-assessed daily physical activity in relation to pain cognition in juvenile idiopathic arthritis. Scand J Rheumatol 2016; 46:22-26. [DOI: 10.3109/03009742.2016.1160146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Nørgaard
- Department of Physiotherapy, Unit of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - JJ Lomholt
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M Herlin
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - M Twilt
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Herlin
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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Esbjörnsson AC, Iversen MD, André M, Hagelberg S, Schwartz MH, Broström EW. Effect of Intraarticular Corticosteroid Foot Injections on Walking Function in Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2016; 67:1693-701. [PMID: 26017638 DOI: 10.1002/acr.22624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/23/2015] [Accepted: 05/19/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate gait dynamics and self-reported foot-related disability before and after treatment with intraarticular corticosteroid injections (IACI) in children with juvenile idiopathic arthritis (JIA) and foot involvement, and determined whether children with polyarticular and oligoarticular disease responded similarly to IACI treatment. METHODS Forty-three children (35 girls and 8 boys) with JIA were consecutively recruited (mean ± SD age 11.1 ± 4.2 years, mean disease duration 4.5 ± 3.6 years). Sixty-five percent were diagnosed with polyarthritis. All children received IACI treatment for ankle and/or foot joint synovitis. Fifty-eight percent received additional injections in the knee and/or hip joint. Forty healthy children, matched by age and sex, comprised the control group. Gait dynamics and foot-related disability were assessed before IACI treatment and at 3 weeks and 3 months following the injections. RESULTS Foot-related disability and inflammatory joint symptoms improved following treatment. Gait dynamics were compromised before treatment and did not improve following treatment (mean ± SD nondimensional walking speed 0.49 ± 0.05 in the control group; 0.44 ± 0.07 in the JIA group pretreatment; 0.43 ± 0.10 in the JIA group 3 weeks following treatment; and 0.43 ± 0.07 in the JIA group 3 months following treatment) (P = 0.001 in controls versus pretreatment JIA group, P = 0.45 JIA over time). Mean ± SD ankle power was 3.81 ± 0.67 in the control group; 3.01 ± 1.19 in the JIA group pretreatment; 3.19 ± 1.30 in the JIA group 3 weeks after treatment; and 3.22 ± 1.03 in the JIA group 3 months after treatment (P < 0.001 in controls versus pretreatment JIA group, P = 0.51 JIA over time). The ankle power to hip power ratio was reduced (P = 0.01 in controls versus pretreatment JIA group), indicating a power shift from the ankles to the hips, which was more prominent in children with polyarthritis. CONCLUSION As a result of IACI treatment, improvements were found in self-reported foot-related disability and inflammatory joint symptoms, but gait dynamics were unchanged. Children with polyarticular disease and those with greater self-reported walking difficulties prior to IACI treatment demonstrated worse outcomes, and children in these groups should be monitored carefully after treatment.
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Affiliation(s)
| | - Maura D Iversen
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, and Brigham and Women's Hospital, Harvard Medical School, and Northeastern University, Boston, Massachusetts
| | - Marie André
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Hagelberg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare and the University of Minnesota, St. Paul
| | - Eva W Broström
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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32
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Condon C, Morgan M, Ward S, MacDermott E, Killeen O. Physical activity levels of children with juvenile idiopathic arthritis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.3109/21679169.2015.1102967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nørgaard M, Twilt M, Andersen LB, Herlin T. Accelerometry-based monitoring of daily physical activity in children with juvenile idiopathic arthritis. Scand J Rheumatol 2015; 45:179-87. [DOI: 10.3109/03009742.2015.1057862] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Nørgaard
- Department of Physiotherapy, Aarhus University Hospital, Aarhus, Denmark
| | - M Twilt
- Paediatric Rheumatology Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - LB Andersen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - T Herlin
- Paediatric Rheumatology Clinic, Aarhus University Hospital, Aarhus, Denmark
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Taxter AJ, Wileyto EP, Behrens EM, Weiss PF. Patient-reported Outcomes across Categories of Juvenile Idiopathic Arthritis. J Rheumatol 2015; 42:1914-21. [PMID: 26329337 DOI: 10.3899/jrheum.150092] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although there is increasing reliance on patient-reported outcomes (PRO) for disease management, there is little known about the differences in PRO across juvenile idiopathic arthritis (JIA) categories. The purpose of our study was to assess PRO across JIA categories, including pain, quality of life, and physical function, and to determine clinical factors associated with differences in these measures across categories. METHODS This was a longitudinal cohort study of patients with JIA at a tertiary care pediatric rheumatology clinic. Subjects, PRO, and clinical variables were identified by querying the electronic medical record. Mixed-effects regression assessed pain, quality of life, and function. RESULTS Subjects with enthesitis-related arthritis (ERA) and undifferentiated JIA had significantly more pain, poorer quality of life, and poorer physical function. The ERA and undifferentiated JIA categories, physician's global disease activity assessment, female sex, and nonsteroidal antiinflammatory drug use were significantly associated with more pain, poorer quality of life, and poorer function. In models limited to ERA, female sex and tender enthesis count were significant predictors of decreased function. CONCLUSION ERA and undifferentiated JIA categories had poorer PRO than other JIA categories. Further work is needed to address ways to improve PRO in children with JIA, with a special focus on children with ERA and undifferentiated JIA.
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Affiliation(s)
- Alysha J Taxter
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - E Paul Wileyto
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Edward M Behrens
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Pamela F Weiss
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia.
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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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Abstract
Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-term impacts of pain and injury change during postnatal development. Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.
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