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Physical Activity and Fatigue in Children With Intestinal Failure on Parenteral Nutrition
Stephanie So1,2,3, Catherine Patterson1,2,3, Zachary Betts3
1Department of Rehabilitation Services.
Insights
Children with intestinal failure (IF) experience reduced physical activity and function, alongside increased fatigue. Medical interventions are crucial to improve their long-term well-being and quality of life.
Area of Science:
- Pediatrics
- Clinical Medicine
- Rehabilitation Science
Background:
- Improved survival rates in children with intestinal failure (IF) necessitate evaluation of long-term functional outcomes.
- Understanding the impact of IF on physical activity (PA), physical function, and fatigue is crucial for pediatric care.
Purpose of the Study:
- To assess physical function, physical activity (PA), and fatigue in children with IF compared to healthy controls.
- To identify clinical factors predicting impairments in physical function, PA, and fatigue in children with IF.
Main Methods:
- A cross-sectional study comparing children with IF on parenteral nutrition (PN) to age- and sex-matched healthy controls (HCs).
- Utilized the Paediatric Quality of Life (PedsQL) Physical Function subscale and Fatigue Scale.
- Measured PA using accelerometers and collected medical data via chart abstraction.
Main Results:
- Children with IF exhibited significantly lower mean daily steps (9709 vs. 13104 in HCs) and poorer physical function and greater fatigue.
- Moderate-to-vigorous PA correlated with gestational age (r=0.642, P=0.010).
- Increased hospitalizations correlated with greater fatigue (r=-0.538, P=0.012) and poorer physical function (r=-0.0650, P=0.0001).
Conclusions:
- Children with IF demonstrate diminished PA levels, reduced physical function, and heightened fatigue compared to their healthy peers.
- Key barriers to PA include fatigue and concerns about medical devices (e.g., "lines").
- Continued development of medical and rehabilitation strategies is essential for optimizing long-term outcomes in children with IF.
Objectives:
With improved survival of children with intestinal failure (IF), it is important to examine the impact on long-term physical function, physical activity (PA), and fatigue and identify clinical factors that may be predictive of impairment.
Methods:
Cross-sectional study in children with IF on parenteral nutrition (PN) compared with healthy age- and sex-matched controls (HCs). Assessments included: Paediatric Quality of Life (PedsQL) Physical Function subscale, PedsQL Multi-Dimensional Fatigue Scale, and PA Perceived Benefits and Barriers scale. PA was measured using an accelerometer. Medical data was collected by chart abstraction.
Results:
Participants included 21 children with IF (14 girls), median age 8.33 (interquartile range [IQR] 6.96-11.04) years and 33 HCs (20 boys), 8.25 (6.67-10.79) years. In those with IF, 13 (62%) were born prematurely with a median of 15 (7.5-24.5) in-patient hospitalizations. There was a significant difference (P = 0.033) in mean steps/day in children with IF (9709 +/- 3975) compared with HCs (13104 +/- 5416), and a correlation between moderate-to-vigorous PA and gestational age (r = 0.642, P = 0.010). Child and parent proxy scores indicate poorer physical function and greater fatigue in the IF group, along with a correlation between greater fatigue (r = -0.538, P = 0.012), poorer physical function (r = -0.0650, P = 0.0001) in children with more hospitalizations. Barriers to PA include "I am tired" and "I am worried about my line."
Conclusions:
Children with IF present with lower levels of PA and physical function and greater fatigue compared with their peers. Ongoing development of medical and rehabilitation intervention strategies is vital to optimize outcomes.
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