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Podiatry

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7

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Start date: 1990Subject: search.filters.subject.Juvenile Idiopathic Arthritis

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    Paediatric Rheumatology Fails to Meet Current Benchmarks, a Call for Health Equity for Children Living with Juvenile Idiopathic Arthritis, Using Digital Health Technologies
    (Springer, 2024-03-11) Butler, Sonia; Sculley, Dean; Santos, Derek; Girones, Xavier; Singh-Grewal, Davinder; Coda, Andrea
    Purpose of Review This critical review begins by presenting the history of Juvenile Idiopathic Arthritis (JIA) management. To move the conversation forward in addressing the current shortcomings that exist in the clinical management of children living with JIA, we argue that to date, the advancement of successful treatments for JIA has been historically slow. Factors implicated in this situation include a lack of rigorous research, JIA being considered a rare disease, and JIA’s idiopathic and complex pathophysiology. Recent Findings Despite the well-intended legislative changes to increase paediatric research, and the major advancements seen in molecular medicine over the last 30 years, globally, paediatric rheumatology services are still failing to meet the current benchmarks of best practice. Provoking questions on how the longstanding health care disparities of poor access and delayed treatment for children living with JIA can be improved, to improve healthcare outcomes. Summary Globally, paediatric rheumatology services are failing to meet the current benchmarks of best practice. Raising awareness of the barriers hindering JIA management is the first step in reducing the current health inequalities experienced by children living with JIA. Action must be taken now, to train and well-equip the paediatric rheumatology interdisciplinary workforce. We propose, a resource-efficient way to improve the quality of care provided could be achieved by embedding digital health into clinical practice, to create an integrative care model between the children, general practice and the paediatric rheumatology team. To improve fragmented service delivery and the coordination of interdisciplinary care, across the healthcare system.
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    Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study
    (MDPI, 2024-02-02) Butler, Sonia; Sculley, Dean; Santos, Derek; Gironès, Xavier; Singh-Grewal, Davinder; Coda, Andrea
    Juvenile idiopathic arthritis can be influenced by pain, medication adherence, and physical activity. A new digital health intervention, InteractiveClinics, aims to monitor these modifiable risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smartwatch to record their pain levels and take their medications, using a customised mobile app synchronised to a secure web-based platform. Daily physical activity levels were automatically recorded by wearing a smartwatch. Using a quantitative descriptive research design, feasibility and user adoption were evaluated. The web-based data revealed the following: Pain: mean app usage: 68% (SD 30, range: 28.6% to 100%); pain score: 2.9 out of 10 (SD 1.8, range: 0.3 to 6.2 out of 10). Medication adherence: mean app usage: 20.7% (SD, range: 0% to 71.4%), recording 39% (71/182) of the expected daily and 37.5% (3/8) of the weekly medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), one to six additional medications (mean 3.5, SD 2.4) for 2–6 days. Physical activity: watch wearing behaviour: 69.7% (439/630), recording low levels of moderate-to-vigorous physical activity (mean: 11.8, SD: 13.5 min, range: 0–47 min). To conclude, remote monitoring of real-time data is feasible. However, further research is needed to increase adoption rates among children.
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    Using digital health technologies to monitor pain, medication 2 adherence and physical activity in young people with Juvenile 3 Idiopathic Arthritis: feasibility study
    (MDPI, 2023) Butler, Sonia; Sculley, Dean; Santos, Derek; Girones, Xavier; Singh-Grewal, Davinder; Coda, Andrea
    Juvenile Idiopathic Arthritis can be influenced by pain, medication adherence and physi- 20 cal activity. A new digital health intervention InteractiveClinics, aims to monitor these modifiable 21 risk factors. Twelve children, aged 10 to 18 years, received daily notifications on a smart watch to 22 record their pain level and take their medications, using a customized mobile app, synchronized to 23 a secure web-based platform. Daily physical activity levels were automatically recorded by wearing 24 a smart watch. Using a quantitative descriptive research design, feasibility and user adoption was 25 evaluated. Web-based data revealed: pain mean app usage, 68% (SD 30, range 28.6% to 100%), pain 26 score 2.9 out of ten (SD 1.8, range 0.3 to 6.2 out of 10). Medication adherence; mean app usage 20.7% 27 (SD, range 0% to 71.4%), recording 39% (71/182) of the expected daily, and 37.5% (3/8) of the weekly 28 medications. Pro-re-nata (PRN) medication monitoring: 33.3% (4/12), 1 to 6 additional medications 29 (mean 3.5, SD 2.4) for 2-6 days. Physical activity: watch wearing behaviour 69% (435/630), recording 30 low levels of moderate to vigorous physical activity (mean 11.8, SD 13.5 minutes, range 0 – 47 31 minutes). Concluding, remote monitoring of real-time data is feasible. However, further research is 32 needed to increase adoption rates by children.
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    Effect of customised preformed foot orthoses on gait parameters in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial
    (Elsevier, 2022-04-22) Fellas, Antoni; Singh-Grewal, Davinder; Chaitow, Jeffrey; Santos, Derek; Clapham, Matthew; Coda, Andrea
    Background Children with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA.
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    Effectiveness of eHealth and mHealth interventions supporting children and young people living with juvenile idiopathic arthritis: Systematic review and meta-analysis
    (2022-02-02) Butler, Sonia; Sculley, Dean; Santos, Derek; Fellas, Antoni; Gironès, Xavier; Singh-Grewal, Davinder; Coda, Andrea
    Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good-quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children's and young people's HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I =79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD -0.14, 95% CI -0.43 to 0.15; I =53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I =74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist-children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.