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Ramos-Mejia R, Isoldi G, Ireland PJ, Rodriguez Celin M, Fano V. Evaluation of functionality-mobility in patients with skeletal dysplasias. Application of the STEMS tool ("everyday symptoms and mobility screening tool for skeletal dysplasias"). Am J Med Genet A 2024; 194:e63538. [PMID: 38214061 DOI: 10.1002/ajmg.a.63538] [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: 11/03/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024]
Abstract
Individuals with differing forms of skeletal dysplasias (SD) frequently report impaired mobility and symptoms. With the objetive to evaluate mobility and associated symptoms in people with SD at an Argentinian pediatric hospital, using an Argentinian version of the Screening Tool for Everyday Mobility and Symptoms (STEMS), a simple questionnaire that allows clinicians to quickly identify the presence of symptoms associated with mobility in people with SD, while considering different environmental settings and the use of assistive devices, an analytical study of a consecutive sample of patients older than 5 years with SD and their affected relatives was carried out.Diagnosis, comorbidities, socioenvironmental, therapeutic, auxological and mobility variables were recorded. The presence and intensity of symptoms was noted through use of both the STEMS and validated scales. Descriptive, association and correlation analyzes were performed. One hundred and nineteen individuals with SD were enrolled in the study and divided into groups: Osteogenesis Imperfecta (OI, n = 55), Achondroplasia (ACH, n = 36) and Other SD resulting in disproportionate short stature (n = 28). Mobility assistive devices were almost exclusively used by individuals with OI. They were more frequently used by individuals with overweight and obesity, more severe form of the disease and in the outdoor settings. Two thirds (66.4%) of the individuals assessed in this study reported pain, 87.4% reported fatigue, and 58.8% reported both pain and fatigue. The intensity of symptoms was similar between groups and correlated with age and auxological variables. The STEMS was clear, easy and quick to use for identifying presence of pain and fatigue in this population group. The STEMS proved to be a simple and useful tool for evaluating functional mobility and associated symptoms in our population of individuals with SD.
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Affiliation(s)
- Rosario Ramos-Mejia
- Growth and Development Department, Hospital Garrahan, Buenos Aires, Argentina
| | - G Isoldi
- Growth and Development Department, Hospital Garrahan, Buenos Aires, Argentina
| | - P J Ireland
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Australia
| | - M Rodriguez Celin
- Shriners Hospital for Children, Chicago, Illinois, USA
- Medical College of Wisconsin Marquette University, Milwaukee, Wisconsin, USA
| | - V Fano
- Growth and Development Department, Hospital Garrahan, Buenos Aires, Argentina
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2
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Onesimo R, Sforza E, Bedeschi MF, Leoni C, Giorgio V, Rigante D, De Rose C, Kuczynska EM, Romeo DM, Palmacci O, Massimi L, Porro M, Gonfiantini MV, Selicorni A, Allegri A, Maghnie M, Zampino G. How pain affect real life of children and adults with achondroplasia: A systematic review. Eur J Med Genet 2023; 66:104850. [PMID: 37758167 DOI: 10.1016/j.ejmg.2023.104850] [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: 06/16/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
The clinical features of achondroplasia can cause acute self-limited pain that can evolve into chronic pain. Pain causes a low quality of life, in terms of physical, emotional, social, and school functioning in both adult and children with achondroplasia. We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement to describe prevalence, assessment tools, causes and management strategies of pain in this rare disease. We found that shoulder and knee pain is typically referred during infancy, while knee pain is generally referred around 5-6 years of age. The prevalence of general pain in adolescence can be as high as 90%. Chronic pain in the achondroplasia population increases with age, with up to 70% of adults reporting general pain and back pain. Recognizing the multiple determinants of acute and chronic pain in patients with achondroplasia may enable physicians to better understand and manage this burden, particularly with the advent of new drugs that may modify some of the striking features of achondroplasia.
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Affiliation(s)
- Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | | | | | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Valentina Giorgio
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica Del Sacro Cuore, Rome, 00168, Italy.
| | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Cristina De Rose
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Eliza Maria Kuczynska
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
| | - Domenico Marco Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168, Rome, Italy; Pediatric Neurology Unit, Università Cattolica Del Sacro Cuore, 00168, Rome, Italy.
| | - Osvaldo Palmacci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Luca Massimi
- Neurochirurgia Pediatrica, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy; Dipartimento di Neuroscienze, Università Cattolica Del Sacro Cuore, Italy.
| | - Matteo Porro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Service, Milan, Italy.
| | | | - Angelo Selicorni
- Department of Paediatrics, Presidio S. Fermo, ASST Lariana, Como, Italy.
| | - Anna Allegri
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS IstitutoGianninaGaslini, 16147, Genoa, Italy.
| | - Mohamad Maghnie
- Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS IstitutoGianninaGaslini, 16147, Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132, Genoa, Italy.
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy.
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Labanca L, Brizola E, Luciani D, Luppi G, Sangiorgi L, Benedetti MG. Clinical-functional features of individuals with Osteogenesis Imperfecta and Ehlers-Danlos syndromes: A scoping review of assessment tools and ICF model. Musculoskelet Sci Pract 2023; 64:102742. [PMID: 36905741 DOI: 10.1016/j.msksp.2023.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Clinical-functional assessment of patients affected by Osteogenesis Imperfecta and Ehlers-Danlos Syndromes is essential for clinical management. However, there is no clear information on disease-specific tools of assessment for clinical practice, thus limiting quantification and management of the diseases-related impairments. OBJECTIVE The present scoping review was aimed at investigating the most common clinical-functional features and assessment tools in individuals with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes, and to provide an updated International Classification of Functioning (ICF) model related to functional impairments for each disease. METHODS The literature revision was conducted on PubMed, Scopus and Embase databases. Articles reporting an ICF model of clinical-functional features and assessment tools for Osteogenesis Imperfecta and Ehlers-Danlos Syndromes individuals were included. RESULTS A total of 27 articles were included, 7 reporting an ICF model, and 20 reporting clinical-functional assessment tools. It was reported that patients with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes show impairments in both Body Function and Structure, and Activities and Participation domains of the ICF. A heterogeneous number of assessment tools was found for both diseases regarding proprioception, pain, endurance to exercise, fatigue, balance and motor coordination, and mobility. CONCLUSION Patients with Osteogenesis Imperfecta and Ehlers-Danlos Syndromes show several impairments and limitations in Body Function and Structure, and Activities and Participation domains of the ICF. Thus, an appropriate and ongoing assessment of the disease-related impairments is necessary to improve clinical practice. Several functional tests and clinical scales can be used to assess the patients despite the heterogeneity of assessment tools found in previous literature.
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Evelise Brizola
- Department of Rare Skeletal Disorders, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Deianira Luciani
- Physical Medicine and Rehabilitation Unit, Single Regional Health Company - Large Area 4, Porto San Giorgio, Italy
| | - Giulia Luppi
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Sangiorgi
- Department of Rare Skeletal Disorders, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Tofts LJ, Armstrong JA, Broley S, Carroll T, Ireland PJ, Koo M, Langdon K, McGregor L, McKenzie F, Mehta D, Savarirayan R, Tate T, Wesley A, Zankl A, Jenner M, Eyles M, Pacey V. Australian guidelines for the management of children with achondroplasia. J Paediatr Child Health 2023; 59:229-241. [PMID: 36628540 PMCID: PMC10107108 DOI: 10.1111/jpc.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/14/2022] [Accepted: 10/23/2022] [Indexed: 01/12/2023]
Abstract
Achondroplasia is the most common form of skeletal dysplasia. In addition to altered growth, children and young people with achondroplasia may experience medical complications, develop and function differently to others and require psychosocial support. International, European and American consensus guidelines have been developed for the management of achondroplasia. The Australian focused guidelines presented here are designed to complement those existing guidelines. They aim to provide core care recommendations for families and clinicians, consolidate key resources for the management of children with achondroplasia, facilitate communication between specialist, local teams and families and support delivery of high-quality care regardless of setting and geographical location. The guidelines include a series of consensus statements, developed using a modified Delphi process. These statements are supported by the best available evidence assessed using the National Health and Medicine Research Council's criteria for Level of Evidence and their Grading of Recommendations Assessment, Development and Evaluation (GRADE). Additionally, age specific guides are presented that focus on the key domains of growth, medical, development, psychosocial and community. The guidelines are intended for use by health professionals and children and young people with achondroplasia and their families living in Australia.
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Affiliation(s)
- Louise J Tofts
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jennifer A Armstrong
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stephanie Broley
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Undiagnosed Diseases Program, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Theresa Carroll
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Penelope J Ireland
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Minna Koo
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Langdon
- Kids Rehab WA, Perth Children's Hospital, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| | - Lesley McGregor
- Paediatric and Reproductive Genetics Unit, Women's and Children's Hospital, Adelaide, Australia
| | - Fiona McKenzie
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Divyesh Mehta
- Curtin University, Perth, Western Australia, Australia.,Child and Adolescent Health Services, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Ravi Savarirayan
- Skeletal Therapies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Tracy Tate
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Alison Wesley
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andreas Zankl
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Genetics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Maree Jenner
- Medical Advisory Board, Short Statured People of Australia, Melbourne, Victoria, Australia
| | - Marta Eyles
- Medical Advisory Board, Short Statured People of Australia, Melbourne, Victoria, Australia
| | - Verity Pacey
- Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Constantinides C, Landis SH, Jarrett J, Quinn J, Ireland PJ. Quality of life, physical functioning, and psychosocial function among patients with achondroplasia : a targeted literature review. Disabil Rehabil 2021; 44:6166-6178. [PMID: 34403286 DOI: 10.1080/09638288.2021.1963853] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Achondroplasia (ACH) is the most common form of skeletal dysplasia, resulting in disproportionate short stature and medical complications. We review the literature on physical functioning, psychosocial function, and quality of life (QoL) in ACH individuals compared to average stature individuals or other short stature conditions. Studies that assess the association between these outcomes and height, limb length/lengthening surgery in ACH patients are also summarized. MATERIALS AND METHODS PubMed/MEDLINE and Embase were searched through April 2021. Study inclusion criteria were: (1) quantitative design; (2) study population consisting solely/mainly of ACH patients; (3) reports of physical functioning, psychosocial functioning, and/or QoL. Included studies were summarized separately for pediatric and adult populations. RESULTS Of 1664 records identified, 23 primary studies (sample size 8-437 participants) were included. Multiple tools were used across studies, including the generic PedsQL and SF-36 and height-specific QoLISSY. CONCLUSIONS The literature demonstrates that ACH patients experience limitations in physical functioning and poorer QoL outcomes compared to average stature people across the life span. This appeared to be at least in part due to disproportionate short stature. Future research to better characterize QoL in ACH patients will assist clinicians to better evaluate the effectiveness of management programs including novel interventions.IMPLICATIONS FOR REHABILITATIONPatients with achondroplasia experience limitations in physical functioning and poorer quality of life throughout their life course when compared to average statured individuals.Psychosocial issues are also heightened in adults with achondroplasia compared to average statured peers but are observed less frequently in children and adolescents with achondroplasia.The overall impact that limb lengthening has on physical functioning and QoL remains unclear, although there is some evidence that greater height or upper limb length may lead to an improvement in these parameters.Rehabilitation professionals should regularly assess physical functioning, psychosocial wellbeing, and quality of life in individuals with achondroplasia using condition-specific tools.
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Affiliation(s)
| | | | | | | | - Penelope J Ireland
- Children's Health Queensland Hospital & Health Service, Brisbane, Australia
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Hoover-Fong J, Cheung MS, Fano V, Hagenas L, Hecht JT, Ireland P, Irving M, Mohnike K, Offiah AC, Okenfuss E, Ozono K, Raggio C, Tofts L, Kelly D, Shediac R, Pan W, Savarirayan R. Lifetime impact of achondroplasia: Current evidence and perspectives on the natural history. Bone 2021; 146:115872. [PMID: 33545406 DOI: 10.1016/j.bone.2021.115872] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/18/2022]
Abstract
Achondroplasia, the most common form of disproportionate short stature, is caused by a variant in the fibroblast growth factor receptor 3 (FGFR3) gene. Advances in drug treatment for achondroplasia have underscored the need to better understand the natural history of this condition. This article provides a critical review and discussion of the natural history of achondroplasia based on current literature evidence and the perspectives of clinicians with extensive knowledge and practical experience in managing individuals with this diagnosis. This review draws evidence from recent and ongoing longitudinal natural history studies, supplemented with relevant cross-sectional studies where longitudinal research is lacking, to summarize the current knowledge on the nature, incidence, chronology, and interrelationships of achondroplasia-related comorbidities across the lifespan. When possible, data related to adults are presented separately from data specific to children and adolescents. Gaps in knowledge regarding clinical care are identified and areas for future research are recommended and discussed.
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Affiliation(s)
- Julie Hoover-Fong
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Moira S Cheung
- Guy's and St. Thomas' NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Virginia Fano
- Department of Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
| | - Lars Hagenas
- Karolinska Institute, Division of Pediatric Endocrinology, Department of Women's and Children's Health, Stockholm, Sweden
| | - Jacqueline T Hecht
- University of Texas, Houston, McGovern Medical School, Department of Pediatrics, Houston, TX, USA
| | - Penny Ireland
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Melita Irving
- Guy's and St. Thomas' NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Klaus Mohnike
- Otto-von-Guericke-University Magdeburg, Department of Pediatrics, Magdeburg, Germany
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Ericka Okenfuss
- Kaiser Permanente - Sacramento Medical Center, Department of Genetics, Sacramento, CA, USA
| | - Keiichi Ozono
- Osaka University Graduate School of Medicine, Department of Pediatrics, Osaka, Japan
| | - Cathleen Raggio
- Hospital for Special Surgery, Pediatric Orthopedic Surgery Service, New York, NY, USA
| | - Louise Tofts
- Kids Rehab, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Dominique Kelly
- BioMarin Pharmaceutical Inc., Global Medical Affairs, Novato, CA, USA
| | - Renée Shediac
- BioMarin Pharmaceutical Inc., Global Medical Affairs, Novato, CA, USA
| | - Wayne Pan
- BioMarin Pharmaceutical Inc., Global Medical Affairs, Novato, CA, USA
| | - Ravi Savarirayan
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
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