Handwriting difficulties in juvenile idiopathic arthritis: a pilot study.
OBJECTIVE
The aim of the present study was to describe handwriting difficulties of primary school children with juvenile idiopathic arthritis (JIA), and to investigate possible correlations with hand function and writing performance.


METHODS
In a cross-sectional approach, 15 children with JIA and reported handwriting difficulties were included together with 15 healthy matched controls. Impairments (signs of arthritis or tenosynovitis, reduced grip force and limited range of motion of the wrist (wrist-ROM)), activity limitations (reduced quality and speed of handwriting, pain during handwriting), and participation restrictions (perceived handwriting difficulties at school) were assessed and analysed.


RESULTS
Although selected by the presence of handwriting difficulties, the majority of the JIA children (73%) had no active arthritis of the writing hand, and only minor hand impairments were found. Overall, the JIA children performed well during the short handwriting test, but the number of letters they wrote per minute decreased significantly during the 5-minute test, compared to the healthy controls. JIA patients had significantly higher pain scores on a 100 mm Visual Analogue Scale, compared to the healthy controls. The actual presence of arthritis, and limitation in grip force and wrist-ROM did not correlate with reported participation restrictions with regard to handwriting at school. The JIA children reported pain during handwriting, and inability to sustain handwriting for a longer period of time.


CONCLUSIONS
The results of this pilot study show that JIA children with handwriting difficulties, experience their restrictions mainly through pain and the inability to sustain handwriting for a longer period of time. No correlations could be found with impairments.
Reade, Centre of Rehabilitation and Rheumatology (formerly Jan van Breemen Instituut), Amsterdam, The Netherlands. h.haberfehlner@vu.nl
Helga
H
Haberfehlner
Bart
B
Visser
Andreas
A
Daffertshofer
Marion Aj
MA
van Rossum
Leo D
LD
Roorda
Marike
M
van der Leeden
Joost
J
Dekker
Agnes F
AF
Hoeksma
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000503:physiopathology* / Q000534:rehabilitation; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D006236:Handwriting; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D010146:Pain / Q000503:physiopathology; D010865:Pilot Projects; D011795:Surveys and Questionnaires