Relationships Among Severity of Osteonecrosis, Pain, Range of Motion, and Functional Mobility in Children, Adolescents, and Young Adults With Acute Lymphoblastic Leukemia

Author:

Marchese Victoria G1,Connolly Barbara H2,Able Colleen3,Booten April R4,Bowen Patrick5,Porter Bethany M6,Rai Shesh N7,Hancock Michael L8,Pui Ching-Hon9,Howard Scott10,Neel Mike D11,Kaste Sue C12

Affiliation:

1. VG Marchese, PT, PhD, is a faculty member, Department of Physical Therapy, College of Allied Health Sciences, Health Science Center, University of Tennessee, Memphis, Tenn, and Department of Physical Therapy, Lebanon Valley College, 101 N College Ave, Annville, PA 17003 (USA)

2. BH Connolly, PT, DPT, EdD, FAPTA, is Chair, Department of Physical Therapy, College of Allied Health Sciences, Health Science Center, University of Tennessee

3. C Able, PT, is Staff Physical Therapist, Department of Physical Therapy, Momentum Physical Rehabilitation, Memphis, Tenn

4. AR Booten, PT, is Staff Physical Therapist, Baptist Hospital, Nashville, Tenn

5. P Bowen, PT, is Staff Physical Therapist, White County Community Hospital, Sparta, Tenn

6. BM Porter, PT, is Staff Physical Therapist, Henry County Medical Center, Paris, Tenn

7. SN Rai, PhD, is a faculty member, Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tenn

8. ML Hancock, MS, is a staff member, Department of Biostatistics, St Jude Children's Research Hospital

9. CH Pui, MD, is a faculty member, Division of Hematology-Oncology, St Jude Children's Research Hospital

10. S Howard, MD, is an assistant faculty member and Director of Clinical Trials, International Outreach Program, St Jude Children's Research Hospital, and Associate Professor, College of Medicine, Health Science Center, University of Tennessee

11. MD Neel, MD, is an assistant faculty member, Department of Surgery, Orthopedics, St Jude Children's Research Hospital

12. SC Kaste, DO, is a faculty member, Division of Diagnostic Imaging, St Jude Children's Research Hospital, and Department of Radiology, Health Science Center, University of Tennessee

Abstract

Background and Purpose Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL. Subjects Thirty-three subjects aged 5 to 27 years with ALL and osteonecrosis participated. Methods The extent of osteonecrosis was determined by magnetic resonance imaging (MRI) of the hip and knee according to 2 classification systems, including the Association Research Circulation Osseous (ARCO) and a knee staging scale. Pain, hip and knee ROM, and the Timed Up and Down Stairs (TUDS) Test were used as measures. Results Correlations were observed between ARCO and hip pain (r=.34), between hip flexion ROM and hip pain (r=−.34), and between knee pain and time on the TUDS Test (r=−.35). Discussion and Conclusion Physical therapists should consider that people with ALL may have hip or knee osteonecrosis without clinical symptoms. This notion supports the need for MRI in addition to a comprehensive examination of functional mobility.

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

Reference42 articles.

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3. Osteonecrosis as a complication of treating acute lymphoblastic leukemia in children: a report from the Children's Cancer Group;Mattano;J Clin Oncol,2000

4. Osteonecrosis: an emerging complication of intensive chemotherapy for childhood acute lymphoblastic leukemia;Arico;Hematology,2003

5. MRI of knee osteonecrosis in children with leukemia and lymphoma, part 2: clinical and imaging patterns;Karimova;AJR,2006

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