Moderate Weightbearing Restrictions Are Associated with Worse Depressive Symptoms and Anxiety in Children Aged 5 to 7 Years with Perthes Disease

Do, Dang-Huy; Valencia, Angel; Jo, Chan-Hee; Kim, Harry K.W.

doi:10.1097/corr.0000000000002010

Cited by 8 publications

(3 citation statements)

References 40 publications

(59 reference statements)

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“…A study of prolonged non-weight-bearing for patients with severe hypoperfusion on MRI found that prolonged non-weight-bearing begun during early Legg-Calvé-Perthes disease decreased femoral head deformity 33 . Weight-bearing restrictions were not found to be associated with a meaningful increase in body mass index 34 , but were associated with increased depression and anxiety, in patients with Legg-Calvé-Perthes disease 35 .…”

Section: Legg-calvé-perthes Diseasementioning

confidence: 76%

What’s New in Pediatric Orthopaedics

Andras

Sanders²,

Goldstein

et al. 2022

Journal of Bone and Joint Surgery

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This pediatric orthopaedic update represents a review of articles predominantly from October 2021 to October 2022. Spine Adolescent Idiopathic ScoliosisAs we strive toward optimal adolescent idiopathic scoliosis treatment that will serve patients well into adulthood, longterm follow-up studies are of particular importance. Lander et al. reported on a series of 134 patients treated with Harrington instrumentation with a minimum 40-year follow-up. Patients with a lowest instrumented vertebra (LIV) at L3 or proximal had a lower likelihood of undergoing additional surgical procedures at 13% compared with patients with an LIV at L4 or distal at 36%, but, aside from this, the groups were similar with regard to health-related quality of life and their scores were not different from normal age-based means 11 . Also encouraging was the report on 115 patients with a 25year follow-up that showed that the serum levels of cobalt and chromium ions were similar in the patients treated with Harrington instrumentation compared with a control group of patients treated with bracing 12 . However, questions with regard to the long-term effect of retained implants continue to generate concern as titanium levels were found to be persistently elevated to 5 times the preoperative level at the 2-year follow-up in a series with more contemporary implants 13 . The impact of this remains unknown but warrants continued study.There remains continued interest in leveraging technology to achieve optimal pedicle screw placement safely and consistently. In a systematic review and meta-analysis by Baldwin et al., screws placed with intraoperative computed tomographic (CT) navigation were determined to be one-third Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H355).

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Section: Legg-calvé-perthes Diseasementioning

confidence: 76%

What’s New in Pediatric Orthopaedics

Andras

Sanders²,

Goldstein

et al. 2022

Journal of Bone and Joint Surgery

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“…29 Our results are supported by similar findings in the literature evaluating PROMIS Anger and Anxiety domains in pediatric patients seen for other orthopaedic conditions. Do et al 30 used PROMIS domains, including Anxiety and Anger, to evaluate psychiatric symptoms in children aged 5-7 years with Legg-Calvé-Perthes disease. Similarly, Matsumoto et al 31 evaluated children (aged 4-18 years) with Perthes disease and found that the PROMIS domains they tested, which included Anger and Anxiety, exhibited both convergent and divergent validity.…”

Section: Discussionmentioning

confidence: 99%

Validation of Patient-Reported Outcome Measurement Information System for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma

May,

Nguyen,

Miller

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: The efficiency and validity of PROMIS surveys were determined for pediatric orthopaedic trauma patients with posttraumatic stress disorder (PTSD) symptoms in a clinic setting. METHODS: Design: Prospective cohort study. Setting: Single-institution, Level I Trauma Center. Patient Selection Criteria: All consecutive children aged 8-18 years undergoing procedures or surgery for orthopaedic trauma. Outcome Measures and Comparisons: The convergent, divergent, and discriminant validity of the PROMIS Anger and Anxiety computerized adaptive tests (CATs) were evaluated and compared to the previously validated Child PTSD Symptom Scale (CPSS). The efficiency in time to completion of the outcome measures was compared between the CPSS and PROMIS surveys. Cutoffs for increased likelihood of PTSD were established for the PROMIS questionnaires. RESULTS: A total of 233 subjects were included in this study (mean age 13.1 years with SD 2.8 years, 71% male). The majority (51%) of injuries were sports-related and most (60%) involved the upper extremity. Of those included, 41 patients had high levels of PTSD symptoms on the CPSS (18%; 95% CI=13.1-23.2%). The CPSS took 182 (IQR 141-228) seconds versus 52 (IQR 36-84) and 52 (IQR 36-70) seconds for PROMIS Anger and Anxiety CATs, respectively. Convergent validity showed patient scores on both PROMIS instruments significantly correlated with CPSS scores (Anger: p<0.001, r=0.51; Anxiety: p<0.001, r=0.41). Neither PROMIS score correlated with UCLA Activity Score (Anger: r=-0.26; Anxiety: r=-0.22), a functional outcome measure, demonstrating divergent validity. Both PROMIS instruments sufficiently discriminated across PTSD risk groups (Anger p<0.001; Anxiety p<0.001). A score of at least 53 on PROMIS Anger or at least 48 on PROMIS Anxiety indicated an increased likelihood of PTSD risk. CONCLUSIONS: PROMIS Anger and Anxiety CATs are efficient and valid for evaluating posttraumatic stress in children following orthopaedic trauma procedures. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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“…11 A wide abduction brace treatment has been shown to produce good outcomes in hips with lateral pillars B and C in a large study by Rich and Schoenecker. 10 However, disadvantages of brace treatment include prolonged duration of treatment, activity restrictions, [11][12][13] and the need for patient adherence over a prolonged period.…”

mentioning

confidence: 99%

Patient Adherence to Wide Abduction Brace Treatment for Legg-Calvé-Perthes Disease

Prasadh

Kim

2023

Journal of Pediatric Orthopaedics

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Background: A wide abduction brace called the A-frame brace is used to contain the deformed femoral head and improve femoral head remodeling in patients with Legg-Calvé-Perthes disease (LCPD). While there is some data showing the efficacy of brace treatment, little is known about patient adherence. The purpose of this study was to measure A-frame brace adherence using temperature sensors and to identify factors that influence adherence. Methods: This is an IRB-approved retrospective study of 61 patients with LCPD treated with an A-frame brace between ages 5 and 11. Brace wear was measured using built-in temperature sensors. Pearson correlation coefficient and multiple regression were used to determine relationships between patient characteristics and brace adherence. Results: Of 61 patients, 80% were male. Mean age at LCPD onset was 5.9±1.8 years and the mean age at initiation of brace treatment was 7.1±1.5 years. Fifty-eight patients (95%) were in the fragmentation or reossification stage at the start of bracing, with 23 patients (38%) having lateral pillar B, 7 (11%) lateral pillar B/C, and 31 (51%) lateral pillar C. Forty-two (69%) patients were treated with a Petrie cast for 6 weeks before the A-frame brace. Mean adherence, defined as the ratio of measured over prescribed brace wear, was 0.69±0.32. Mean adherence improved with age (P<0.05), increasing from 0.57 in patients less than 6 to 0.84 in patients aged 8 to 11. Patients first treated with a Petrie cast had significantly better adherence than those without (0.77 vs. 0.50; P<0.005). Adherence was negatively associated with the amount of prescribed brace wear per day (P<0.005). Adherence did not change significantly between the start and end of treatment and was not significantly associated with sex or attention deficit hyperactivity disorder. Conclusions: A-frame brace adherence was significantly associated with age at treatment, prior Petrie casting, and the amount of daily prescribed brace wear. These findings provide new insight into A-frame brace treatment, which will lead to better patient selection and counseling to optimize adherence. Level of Evidence: III Therapeutic Study.

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Moderate Weightbearing Restrictions Are Associated with Worse Depressive Symptoms and Anxiety in Children Aged 5 to 7 Years with Perthes Disease

Cited by 8 publications

References 40 publications

What’s New in Pediatric Orthopaedics

What’s New in Pediatric Orthopaedics

Validation of Patient-Reported Outcome Measurement Information System for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma

Patient Adherence to Wide Abduction Brace Treatment for Legg-Calvé-Perthes Disease

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