Longitudinal Quality of Life Outcomes in Children Treated With Petrie Casting and Wide-abduction Bracing for Legg-Calve-Perthes Disease.

Abstract

BACKGROUND: Petrie casting (6 wk) followed by wide-abduction bracing and weight-bearing restrictions is an established nonoperative containment treatment for Legg-Calve-Perthes disease (LCPD). Little is known about the quality-of-life impacts of this treatment. Our aim was to determine longitudinal changes to PROMIS Physical, Mental, and Social health measures during Petrie cast, abduction bracing, and weight-bearing restriction treatment. METHODS: This is a retrospective study of prospectively collected PROMIS data from 23 LCPD patients treated with Petrie casting and subsequent abduction bracing and weight-bearing restrictions. Seven PROMIS measures (mobility, pain interference, anxiety, depressive symptoms, fatigue, anger, peer relationships) were collected at pretreatment, cast removal, and subsequent clinic visits. Mean PROMIS scores across different time points were compared using repeated measures ANOVA and multiple pairwise comparisons. RESULTS: Mean age at Petrie casting was 7.3±1.7 years. Mean follow-up duration was 23.5±1.9 months. Mean mobility scores decreased significantly after Petrie casting (P=0.0003) but gradually improved during subsequent visits and reached mildly abnormal levels at 24 months. Mean pain interference scores improved significantly from pretreatment (P=0.018) and reached the normal range by 6 months. Mean scores for anxiety, depressive symptoms, fatigue, anger, and peer relationships measures remained within the normal range throughout the follow-up period. Three out of the 23 patients (13%) had severely abnormal mental or social health scores at multiple follow-up visits. Moderate to strong correlations were observed between pretreatment and follow-up Mental and Social health scores. CONCLUSIONS: Mean mobility score was significantly decreased by Petrie casting, bracing , and weight-bearing restriction treatment. Mean scores for Mental and Social health measures remained within the normal range at every visit during Petrie cast and subsequent abduction bracing and weight-bearing restrictions. Three out of the 23 patients (13%), however, had severely abnormal Mental or Social health scores at multiple follow-up visits. Importantly, moderate to strong correlations between the pretreatment and follow-up visit scores were found, suggesting that the pretreatment PROMIS survey can help identify at-risk patients for severely abnormal Mental and Social health scores during treatment. LEVEL OF EVIDENCE: Level IV-therapeutic study.