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Keywords
- physical activity (5)
- childhood cancer (3)
- Aktivitätserfassung (2)
- Malignant bone tumor (2)
- Physical activity (2)
- Sporttherapie (2)
- Adoleszenz (1)
- Akzelerometer (1)
- Akzelerometrie (1)
- Areal Bone Mineral Density (1)
Background
While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired.
Procedure
The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients’ PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution.
Results
A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed.
Conclusions
Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions.
Die weitreichenden Potenziale individualisierter Bewegungsförderung für krebskranke Kinder und Jugendliche sollten über den gesamten Zeitraum der Akuttherapie, in der Nachsorge und bei der Rückkehr in den Alltag genutzt und als Bestandteil der Normalität aufrechterhalten und gefördert werden. Dieser Artikel stellt beispielhaft für den Standort Münster Ergebnisse und Erfahrungen aus den letzten 5 Jahren sporttherapeutischer und sportpädagogischer Bewegungsförderung im kinderonkologischen Setting dar und liefert konkrete Zahlen über die Bewegungsumfänge, die erreichten Patienten sowie die Möglichkeiten und Grenzen eines derartigen Angebots.
Objectives
Complex midfoot injuries could lead to severe functional impairment of mobility and quality of daily living. Aim of this study was to compare the clinical and functional outcomes of Chopart, Lisfranc fractures and multiple metatarsal shaft fractures.
Design
Retrospective case series.
Setting
Level one trauma center.
Intervention
Open or closed reduction and internal fixation with screws, K-wires, plates, external fixation or combination of different technics.
Main outcome measurements
The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Maryland Foot Score were used to assess pain and functional outcome. 3D gait analysis, pedobarographic analysis and radiologic examinations were performed. The activity level was measured by a step counting accelerometer. All results were compared to an age-matched healthy control group.
Results
24 patients with a median age of 44 years (16–72) were included: 12 patients with multiple metatarsal shaft fractures, 6 patients with Chopart and 6 patients with Lisfranc fractures. The median follow-up was 2.6 years. The pedobarographic analysis reports reduced contact time of the total foot (p = 0.08), the forefoot (p = 0.008) and the hallux (p = 0.015) for the injured foot. A median score of 64 for the SF-36, 64 for the AOFAS Midfoot Score and 73 for the Maryland Foot Score indicated a poor restoration of foot function. Multiple metatarsal shaft fractures presented a significantly lower walking speed (p = 0.03) and cadence (p = 0.04).
Conclusion
The worst results were reported for multiple metatarsal shaft fractures on outcome scores, pedobarography, gait analysis and activity. Metatarsal serial fractures should not be underestimated as well as Chopart and Lisfranc fractures.
Bracing is an established method of conservative treatment for adolescent idiopathic scoliosis and kyphosis. Compliance among adolescents is frequently inadequate due to the discomfort of wearing a brace, cosmetic issues, and fear on the part of patients and parents that bracing may reduce everyday physical activities. The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS) or adolescent kyphosis (AK). Forty-eight consecutive patients (mean age 13.4 ± 2.3 years), consisting of 38 AIS patients (33 girls, 5 boys) and 10 AK patients (6 girls, 4 boys) were included. Once the decision to carry out bracing had been taken and while the patients were waiting for the individual brace to be built, step activity was assessed without braces by means of step activity monitoring (SAM) for seven consecutive days. After 8 weeks of brace wearing, step activity was assessed during regular brace treatment, again for seven consecutive days. In addition, brace-wearing times were simultaneously recorded using temperature probes implanted in the braces to measure compliance. Before and during brace treatment, patients completed the Scoliosis Research Society (SRS-22) questionnaire. The SAM was worn for an average of 12.7 ± 1.5 h/day during the first measurement and 12.3 ± 1.9 h on average during the second measurement. The mean gait cycles (GCs) per day and per hour before treatment were 5,036 ± 1,465 and 395 ± 105, respectively. No significant reduction in step activity was found at the follow-up measurement during bracing, at 4,880 ± 1,529 GCs/day and 403 ± 144 GCs/h. Taking the 23-h recommended time for brace wearing as a basis (100%), patients wore the brace for 72.7 ± 27.6% of the prescribed time, indicating an acceptable level of compliance. Girls showed a higher compliance level (75.6 ± 25.6%) in comparison with boys (56.7 ± 31.9%), although the difference was not significant (P = 0.093). The SRS-22 total score showed no differences between the two measurements (2.57 ± 0.23 vs. 2.56 ± 0.28). Implementing a simultaneous and objective method of assessing step activity and brace-wearing times in everyday life proved to be feasible, and it expands the information available regarding the impact of bracing on patients’ quality of life. The results clearly show that brace treatment does not negatively interfere with daily step activity in AIS and AK patients. This is an important finding that should help reduce patients’ and parents’ worries concerning bracing.
Abstract
Purpose
Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing.
Methods
A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL® questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models.
Results
Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p < 0.05). While leukemia and lymphoma patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p < 0.001) and sustainable effects on HRQoL global scores (6-month follow-up, t = 4.08, p < 0.001; 12-month follow-up, t = 3.13, p < 0.006).
Conclusions
Immediate and sustainable increases in HRQoL indicate that a 4-week rehabilitation program is beneficial for improving psychosocial well-being, while the significant increase in PA levels could be related to general recovery as well. The lack of a control group hampers the evaluation of the rehabilitation program on promoting PA levels in pediatric cancer patients.
Objective
The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer.
Design
Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait.
Results
Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of −0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp2 = 0.082) and increase in single-leg stance time (mean [median] = 1.1 [2.6] sec, respectively; F1,80 = 12.617, P = 0.001, ηp2 = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp2 = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05).
Conclusions
The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer.
The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients. 21 patients were non-randomly allocated either to the exercise group (n=10) or the control group (n=11). DXA of the lumbar spine, the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy (baseline), as well as 6 and 12 months after baseline. Bone mineral content (BMC), bone mineral density (BMD) and height-corrected lumbar spine Z-scores were determined. Group changes after 6 and 12 months were compared by covariance analyses. Additionally, daily physical activities (PA) were assessed by means of accelerometry. After adjusting for initial age, height and weight, mean reductions in lumbar spine and femoral BMC were lower in the exercise group (not significant). Effect sizes during the observational period for lumbar spine and femur BMC were generally small (partial η²=0.03). The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day, per hour and moderate PA (activities above 40 gait cycles per minute). Additional exercises for bone tumor patients are feasible during hospitalization. Though the intervention did not influence BMC, it appeared beneficial regarding PA promotion with respect to volume and intensity.
Objective assessment of brace wear times and physical activities in two patients with scoliosis
(2010)
Conservative treatment of adolescent idiopathic scoliosis consists of therapeutic exercise and the application of braces. The effectiveness of bracing mainly depends on patient compliance, which can be determined by means of temperature sensors. This methodological paper describes the feasibility of objectively determining compliance and daily physical activities before and during conservative scoliosis treatment, being a relevant indicator for quality of life in children and adolescents. One patient with low compliance (61.4±24.9%) reduced her activity level during bracing by 50.1%, whereas another patient with a satisfactory compliance (85.7±19.5%) increased her daily activity level by 33.7% during conservative treatment.
Zur Bestimmung der Messgenauigkeit handelsüblicher Bewegungssensoren wurden ein Akzelerometer und acht Pedometer von Schulkindern und jungen Erwachsenen unter kontrollierten Bedingungen und unter Alltagsbedingungen im Rahmen einer 24-stündigen Aktivitätsmessung getragen. Die präzisesten Ergebnisse unter kontrollierten Bedingungen wurden mit einem piezoelektrischen Pedometer erzielt. Die absoluten Abweichungen (Median) lagen für diesen Schrittzähler bei den Kindern zwischen 0,2 und 1,0%, bei den Erwachsenen zwischen 0,2 und 1,4%. Die absoluten Abweichungen für den Akzelerometer lagen zwischen 0,8 und 3,1% für die Schulkinder sowie zwischen 0,6 und 3,2% für die Erwachsenen. Die Messpräzision stieg unter kontrollierten Bedingungen mit zunehmender Bewegungsgeschwindigkeit an. Besonders bei den Schulkindern wiesen einige Schrittzähler mit Pendelarm-Mechanismus hohe absolute Abweichungen von über 50% auf. Die Unterschiede unter Alltagsbedingungen verdeutlichen, dass Schrittzahlangaben diverser Monitore nicht direkt miteinander verglichen werden können. In jedem Fall sollten Schrittzähler vor ihrem Einsatz in wissenschaftlichen Untersuchungen auf Gütekriterien wie Validität und Reliabilität gestestet werden.
Die Erfassung von Alltagsaktivitäten (activities of daily life, ADL) ist unerlässlich, wenn der Zusammenhang von körperlicher Aktivität und Gesundheit aufgezeigt oder die Effizienz von Interventionen zur Steigerung der körperlichen Aktivität evaluiert werden soll. Derzeit existiert keine Methode, die präzise alle Formen der Alltagsaktivitäten erfassen kann. Diese Übersichtsarbeit beschreibt und vergleicht auf Basis einer umfassenden Literaturrecherche moderne Messverfahren zur Erfassung körperlicher Aktivitäten im Alltag, bei der die Darstellung objektiver Verfahren einen Schwerpunkt bildet.
Subjektive Erhebungsmethoden wie Fragebögen und objektive Aktivitätsmonitore, zu denen Schrittzähler und Akzelerometer zählen, sowie kombinierte Verfahren von Akzelerometrie und Herzfrequenz, sind derzeit die gängigsten Methoden, Alltagsaktivitäten zu erfassen. Daneben existieren weitere Möglichkeiten wie Doubly Labeled Water, Kalorimetrie oder direkte Beobachtungen der Testperson, die als Goldstandard des Activity Assessments angesehen und zur Validierung oben genannter Verfahren genutzt werden können. Obwohl diese Methoden das größte Potential bei der Erfassung körperlicher Aktivitäten hinsichtlich der Messpräzision haben, muss bei der Auswahl der Erhebungsmethode angesichts der Vielzahl an Möglichkeiten auch ihre Anwendbarkeit berücksichtigt werden. Die technischen Entwicklungen insbesondere im Bereich des Aktivitätsmonitorings machen eine ständige Auseinandersetzung mit seinen vielfältigen Möglichkeiten unerlässlich. Diese Übersicht soll für den Anwender eine Hilfestellung bei der Studienkonzipierung darstellen.