Department of Hematology Oncology, Gunma Children's Medical Center, Gunma, Japan.
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Phys Ther. 2024 Nov 1;104(11). doi: 10.1093/ptj/pzae142.
The impact of fine motor impairment among adult survivors of childhood acute lymphoblastic leukemia (ALL) on life after treatment is unknown.
This study evaluated prevalence and utilized multivariate logistic regression to identify risk factors for fine motor impairment among survivors of ALL, and associations with educational attainment and social independence. Latent class analysis defined social independence (independent, moderately independent, dependent), using employment, independent living, personal care assistance, routine need assistance, driver's license status, and marital status inputs.
Among 875 survivors who were ≥ 25 years old (age when most adults achieve independence) and ≥ 5 years from diagnosis (mean = 28.97 years), 33.6% had fine motor impairment, with scores at or below the 10th percentile of the scores of community controls (n = 460) on fine motor components of the physical performance test and the grooved peg-board test. Survivors exposed to cranial radiation had more fine motor impairment than those without (45.8% vs 20.2%). Male sex (exposed: odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.65-3.92; unexposed: OR = 3.02, 95% CI = 1.69-5.38) and lower scores on the Wechsler abbreviated scale of intelligence (exposed: OR = 0.46, 95% CI = 0.36-0.58; unexposed: OR = 0.43, 95% CI = 0.31-0.58) were risk factors for neuropathy. A 1-point-higher total neuropathy score was associated with 8% (95% CI = 1%-17%) increased odds of fine motor impairment. Fine motor impairment was associated with less than a college education (less than high school: OR = 2.23, 95% CI = 1.20-4.14; high school diploma/general equivalency diploma: OR = 2.66, 95% CI = 1.65-4.30; vocational education: OR = 2.07, 95% CI = 1.38-3.13) and less social independence (moderately independent: OR = 1.80, 95% CI = 1.15-2.83; dependent: OR = 2.65, 95% CI = 1.25-5.64).
Fine motor impairment in survivors of childhood ALL may interfere with optimal educational attainment and social independence.
Early identification of survivors at risk for fine motor impairment, with timely intervention, may improve long-term outcomes.
儿童期急性淋巴细胞白血病（ALL）成年幸存者的精细运动障碍对治疗后生活的影响尚不清楚。
本研究评估了 ALL 幸存者精细运动障碍的患病率，并利用多变量逻辑回归来确定 ALL 幸存者精细运动障碍的风险因素，并与教育程度和社会独立相关联。潜在类别分析使用就业、独立生活、个人护理援助、日常需要援助、驾驶执照状况和婚姻状况等输入来定义社会独立性（独立、中度独立、依赖）。
在 875 名年龄在 25 岁以上（大多数成年人达到独立的年龄）且诊断后 5 年以上（平均 28.97 岁）的幸存者中，33.6%有精细运动障碍，其精细运动成分的成绩在社区对照组（n=460）的成绩或以下，在身体表现测试和槽钉板测试中处于第 10 个百分位。接受颅辐射的幸存者比未接受辐射的幸存者有更多的精细运动障碍（45.8%比 20.2%）。男性（暴露：比值比[OR]为 2.55，95%置信区间[CI]为 1.65-3.92；未暴露：OR 为 3.02，95% CI 为 1.69-5.38）和智力测验韦氏简明量表得分较低（暴露：OR 为 0.46，95% CI 为 0.36-0.58；未暴露：OR 为 0.43，95% CI 为 0.31-0.58）是神经病变的危险因素。神经病变总评分每增加 1 分，精细运动障碍的几率就会增加 8%（95%CI=1%-17%）。精细运动障碍与低于大学教育程度相关（低于高中：OR=2.23，95%CI=1.20-4.14；高中文凭/普通同等学历证书：OR=2.66，95%CI=1.65-4.30；职业教育：OR=2.07，95%CI=1.38-3.13）和社会独立性较低（中度独立：OR=1.80，95%CI=1.15-2.83；依赖：OR=2.65，95%CI=1.25-5.64）。
儿童期 ALL 幸存者的精细运动障碍可能会干扰最佳教育程度和社会独立。
早期识别有精细运动障碍风险的幸存者，并及时进行干预，可能会改善长期预后。
