Twice-Weekly Outpatient Rehabilitation Intervention for Young Children With Spinal Muscular Atrophy Treated With Genetic-Based Therapies: Protocol for a Feasibility Study

BACKGROUND

Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that causes muscle weakness and is the leading genetic cause of infant mortality worldwide. While no definitive cure exists, the approval of 3 genetic-based therapies in Canada since 2018 has led to significant improvements in muscle function for children with SMA. With that, there are no evidence-based rehabilitation interventions and minimal evidence on the combined effects of genetic-based therapies and rehabilitation.

OBJECTIVE

This protocol describes the methodology to assess the feasibility of a twice-weekly outpatient rehabilitation intervention focusing on gross and fine motor function to inform the methodology and sample size of a definitive clinical trial.

METHODS

We will conduct a single-center nonrandomized pilot and feasibility trial to explore an outpatient rehabilitation intervention for children aged 6 months to 3 years with SMA treated with genetic-based therapies. Participation in the study will occur over a 25-week period, with a baseline assessment visit followed by a 12-week intervention period and a 12-week nonintervention period. The rehabilitation intervention comprises weekly physical and occupational therapy for 11 weeks. Assessments will occur at baseline (week 0), end of intervention or early withdrawal (week 12), and follow-up (week 24). Predetermined feasibility indicators will evaluate study feasibility across process (recruitment rates, eligibility criteria, adherence rates, retention rates, questionnaire suitability, and acceptability), resource (time, implementation, and execution), management (materials and data), and scientific (safety, tolerability, and preliminary efficacy) domains.

RESULTS

This project was funded in March 2022, and data will be collected between March 2023 and December 2023. Data analysis will occur between January 2024 and March 2024, with publication expected in the fall of 2024. The protocol for the feasibility trial will be considered successful if it meets the success criteria set out for the feasibility indicators. Indicators of specific interest include all process indicators, as well as time. Exploratory indicators will be reported. Pragmatically, the results of the feasibility trial will inform changes to the protocol and the start-up of a definitive multisite trial.

CONCLUSIONS

This novel twice-weekly outpatient rehabilitation intervention will be the first step toward filling the need for an evidence-based rehabilitation intervention for children with SMA treated with genetic-based therapies. It is expected that consistent and intensive rehabilitation therapy will augment functional gains being observed in this population. In the future, a definitive trial will measure the efficacy of the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05638750; https://clinicaltrials.gov/study/NCT05638750.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46363.

Obstacle: A Tool to Assess the Home Environment Designed for All

INTRODUCTION

Elderly prefer to live as long as possible independent in their own home. The occupational therapist can play an important role in this, for instance by giving advice regarding home adaptations or the use of assistive technology in order for the person to function more independently. There is need for a tool that allow to screen the home easily and thorough.

AIM

The aim of the study is to develop a screening tool that meets the requirements of occupational therapists to assess the home environment for persons in order to facilitate independent living.

METHODS

The screening tool 'Obstacle' was developed and tested in 3 phases within an iterative way using a user-centred design. Firstly, crucial items based on literature and expertise of researchers and occupational therapists in the field were identified and the Obstacle paper version and manual was developed. Secondly, the tool was adapted and digitalised to be used on a tablet. Thirdly, a mini-version of Obstacle was created, being less time consuming and usable as a signalling tool to determine the need for applying the extensive version. The tool was tested by screening homes of 96 elderly in total. Additionally, opinions of 5 elderly, 5 informal caregivers and 5 professional caregivers were gathered with a focus group.

RESULTS

The digital screening tool Obstacle is developed and includes 13 rooms to be screened with specific items for each room to be scored. Obstacle was judged very useful by occupational therapists.

CONCLUSION

The novelty of this tool is the focus on independent living and the starting point of occupational performance, reduce the risk of falling and facilitating in advising the optimal home adaptations.

Persistent Thrombocytopenia of an Unexplained Cause in a Patient With Metastatic Renal Cell Carcinoma: A Case Report

Thrombocytopenia is a common complication in patients with solid tumors, particularly renal cell carcinoma (RCC), arising from mechanisms such as chemotherapy, direct tumor invasion, and paraneoplastic syndromes. Managing thrombocytopenia in advanced cancer presents significant challenges, often limiting therapeutic options and impacting patient outcomes. This case report describes a 62-year-old man with metastatic RCC complicated by persistent thrombocytopenia, unresponsive to both conventional treatments and novel therapies. Initially treated with palliative intent using Sunitinib, the patient developed complex symptoms including breathlessness, lymphorrhea, petechial rashes, and generalized weakness. Symptom management in a palliative care setting focused on pain relief with morphine and fentanyl, pleural effusion drainage, magnesium sulfate application for lymphorrhea, and occupational therapy for functional support. Additionally, psychological and spiritual care provided holistic support to the patient and his family. This case underscores the challenges of managing refractory thrombocytopenia in metastatic RCC and highlights the importance of individualized care in palliative settings. While therapeutic interventions were limited by the complexity of the disease, improvements in symptom control and emotional well-being demonstrate the value of a multidisciplinary approach in enhancing the patient's quality of life. This report emphasizes the need for further research into effective strategies for managing malignancy-associated thrombocytopenia.