To examine the discriminative validity of the Dutch Pediatric Evaluation of Disability Inventory (PEDI) to differentiate functional status between children with and without disabilities.
...Cross-sectional study.
A university children's hospital in the Netherlands.
A clinical sample comprising 197 children with disabilities (infantile encephalopathy, n=40; juvenile idiopathic arthritis, n=20; neurometabolic conditions, n=36; neuromuscular disorders, n=9; skeletal disorders, n=28; spina bifida, n=41; traumatic injury, n=23), and 62 children without disabilities.
Not applicable.
Functional status was measured by using a Dutch version of the PEDI.
Discriminant analysis established the sensitivity and specificity of the PEDI. Correct predictions of group membership (disabled vs nondisabled) were found in both children without disabilities (93.5% correctly predicted) and children with disabling conditions (91.6% correctly predicted).
The discriminative validity of the Dutch PEDI between children with and without disabilities was excellent.
Objective
To examine the anaerobic‐to‐aerobic power ratio in children with juvenile idiopathic arthritis (JIA) compared with healthy peers.
Methods
Sixty‐two patients with JIA (mean ± SD age 11.9 ± ...2.1 years, range 7.2–15.9 years) with varying severity of disease and 50 healthy children (mean ± SD age 12.1 ± 2.1, range 8.4–15.9 years) participated in this study. Anaerobic power was measured using the Wingate Anaerobic Exercise Test. Aerobic power was measured using a cardiopulmonary exercise test. The power ratio was calculated as the ratio between the anaerobic mechanical power and aerobic mechanical power in watts.
Results
Mean ± SD anaerobic‐to‐aerobic power ratio and peak anaerobic‐to‐aerobic ratios in children with JIA were 1.98 ± 0.51 and 3.28 ± 1.15, respectively. Compared with healthy children these differences were not statistically significant (P = 0.52 and P = 0.99, respectively). The differences in these ratios were not statistically significant when corrected for age, height, and body mass. Statistical analyses showed no significant difference between disease‐onset types of JIA for mean anaerobic‐to‐aerobic power ratio and peak anaerobic‐to‐aerobic ratio, respectively. Furthermore, there was no significant difference in the development of the power ratios between children with JIA and healthy controls, or between girls and boys.
Conclusion
This cross‐sectional study suggests that the development of the anaerobic‐to‐aerobic power ratio is not statistically different in children with JIA compared with healthy peers. Exercise training of the anaerobic capacity through interval training, along with aerobic exercise training, seems warranted in the exercise therapy programs of children with JIA.
To analyze the displacement response of juvenile arthritic wrists during grasp in order to diagnose early ligamental laxity and facilitate early splinting.
X-rays of the wrists, made under ...standardized conditions, of 30 children with juvenile chronic arthritis (mean age 10.4 years, range 4.5-16.9) were analyzed after being digitalized. Osseous landmarks were identified, and coordinates were calculated from measured angles and lengths with an accuracy of 0.01'. Lunate and carpal-ulnar distance were obtained according to Youm, and ulnar variance according to Häfner.
Overall, an increase in ulnar-lunate displacement and carpal narrowing and a decrease in ulnar variance were found. However, not all wrists responded to the same extent. Radial displacement of the lunate, though slight, was found in 2 wrists and the amount of ulnar displacement varied substantially (3.1% to 22.5%). The variance in amount of displacement could suggest that juvenile wrists do not respond to increased compressive forces to the same extent.
The changes found are similar to those found in the healthy wrist. Furthermore, our findings suggest that the juvenile wrist acts in accordance with the generally accepted explanation for the development of malalignment in adult wrists. It seems that laxity of ligaments can be diagnosed early by the force grip maneuver during x-ray. It would have a significant impact on the moment of orthotic intervention as well as the design of the orthotic device. Further study along this line seems justified.
Objective
To 1) report the feasibility of an “all‐out” 30‐second cycling exercise test (Wingate Anaerobic Exercise Test WAnT) in juvenile‐onset idiopathic inflammatory myopathy (JIIM) patients, 2) ...describe the anaerobic exercise capacity in juvenile dermatomyositis patients, and 3) determine if the anaerobic exercise capacity could be related to disease duration or disease phase.
Methods
Twenty patients (age 14.13 ± 5.4 years) with JIIM participated in this study. All patients were able to perform the WAnT without adverse events.
Results
Comparison with healthy controls revealed a −29.3 ± 26.58% (P = 0.001) and −27.6 ± 25.7% (P = 0.002) impairment in mean power and peak power on the WAnT, respectively. The WAnT correlated with disease phase and with knee extensor muscle strength.
Conclusion
The WAnT might be a valuable adjunct next to other assessment tools in the followup of JIIM patients.
Background
In both adult rheumatoid arthritis (RA) and juvenile arthritis, the focus has shifted from 'inflammation parameters' to more patient centered disability outcomes. In RA this resulted in ...the development of the Outcome Measures in Arthritis Clinical Trials (OMERACT), and in juvenile arthritis the Pediatric Rheumatology International Trials Organization (PRINTO) core set. This PRINTO‐core set was established using a combination of statistical and consensus formation techniques. This core set contains a number of patient centered disability measures. This review systematically searched the available literature and reports the available evidence of efficacy of MTX, with special focus on patient centered disability measures in Juvenile Idiopathic Arthritis (JIA).
Objectives
To perform a systematic review on the effects of MTX on functional ability, range of motion, quality of life, overall well‐being and pain for patients with JIA.
Search methods
The Cochrane Controlled Trials Register (CCTR) and MEDLINE were searched up to March 2001, using the search strategy sensitive for randomised controlled trials, used by the Cochrane Collaboration.
Selection criteria
Randomized controlled trials and controlled clinical trials comparing MTX against placebo or standard care in patients with Juvenile Idiopathic Arthritis (JIA) were selected.
Data collection and analysis
Two reviewers (TT, JN) determined the studies to be included in this review and extracted the data of patient centered disability measures. The data were pooled using standardized mean differences (SMD) for limited joint range score, number of joints with swelling. The number of joints with pain on motion were evaluated using weighted mean differences (WMD). Physicians global assessment, parents global assessment and withdrawals due to efficacy and side effects were evaluated with pooled odds ratios (OR).
Main results
Only two studies with a total 165 JIA patients under 18 years of age were included in this review. For JIA patients, MTX therapy had small to moderate effects on patient centered disability outcomes. The effect on joint range of motion, number of joints with pain and swelling and physician's and parent's assessment of disease activity showed a relative percentage improvement from 3 to 23% greater with MTX than with placebo.
Authors' conclusions
Current evidence suggests that MTX does have minimal clinically significant effects (>20%) on patient centered disability measures in JIA patients.
Summary
During 1984 and 1985, after their referral to the intermediate care nursery, 51 healthy very low birth weight infants were subjected to a tactile stimulation programme imitating the spatial ...limitation which occurs towards the end of gestation. The sensory motor development of the study group was compared with the development of a control group during initial hospitalization. The study and control group differed significantly in the neonatal period after completion of the programme. The study group showed better auditive responses (P < 0.02), more variations in hand movements (P < 0.01), less hypotony (P < 0.02), more sucking (P < 0.02), and less bradycardia and apnoea (P < 0.01).
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