Relationships among severity of osteonecrosis, pain, range of motion, and functional mobility in children, adolescents, and young adults with acute lymphoblastic leukemia.
OBJECTIVE
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.


METHODS
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).


CONCLUSIONS
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.
Marchese
Victoria G
VG
Department of Physical Therapy, College of Allied Health Sciences, Health Science Center, University of Tennessee, Memphis, Tenn, USA. marchese@lvc.edu
Connolly
Barbara H
BH
Able
Colleen
C
Booten
April R
AR
Bowen
Patrick
P
Porter
Bethany M
BM
Rai
Shesh N
SN
Hancock
Michael L
ML
Pui
Ching-Hon
CH
Howard
Scott
S
Neel
Mike D
MD
Kaste
Sue C
SC
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D018771:Arthralgia / Q000503:physiopathology*; D053587:Arthrometry, Articular; D002648:Child; D002675:Child, Preschool; D005080:Exercise Test; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006621:Hip Joint / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced / Q000503:physiopathology*; D010147:Pain Measurement; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D016059:Range of Motion, Articular / Q000502:physiology*; D012720:Severity of Illness Index
D000970:Antineoplastic Agents; D005938:Glucocorticoids