BackgroundPediatric intraspinal epidermoid cysts are rare with potential to cause life-altering outcomes if not addressed. Reports to date describe symptomatic presentations including loss of bladder or bowel function and motor and sensory losses. This case report identifies the diagnostic challenge of an asymptomatic intraspinal epidermoid cyst in the cauda equina region presenting in a 7-year-old male with juvenile idiopathic arthritis (JIA).DiagnosisAn advanced physiotherapist practitioner assessed and diagnosed a previously healthy 7-year-old-male of South Asian descent with JIA based on persistent knee joint effusions. Complicating factors delayed the investigation of abnormal functional movement patterns, spinal and hip rigidity and severe restriction of straight leg raise, all atypical for JIA. Further delaying the diagnosis was the lack of subjective complaints including no pain, no reported functional deficits, and no neurologic symptoms. A spinal MRI investigation 10-months from initial appointment identified intraspinal epidermoid cysts occupying the cauda equina region requiring urgent referral to neurosurgery.DiscussionClinical characteristics and pattern recognition are essential for diagnosing spinal conditions in pediatric populations. Diagnostic challenges present in this case included co-morbidity (JIA), a severe adverse reaction to treatment, a lack of subjective complaints and a very low prevalence of intraspinal epidermoid cysts.Impact StatementsEarly signs of pediatric asymptomatic intraspinal epidermoid cysts included abnormal functional movement patterns, rigidity of spine, severely limited straight leg raise and hip flexion without pain. Advanced physiotherapist practitioners can be integral to pediatric rheumatology teams considering their basic knowledge in musculoskeletal examination and functional mobility assessment when identifying rare spinal conditions that present within the complex context of rheumatic diseases.

Objective: Adolescents with chronic rheumatic disease must increasingly take on more responsibility for disease management from parents as they transition from pediatric to adult care. Yet, there are limited resources to inform and support parents about transition. Here, we evaluate the impact of a Transition Toolkit, geared towards parents and adolescents, on transition readiness, and explore the potential impact of parent–adolescent communication. Methods: A prospective cohort study of youths aged 14–18 years old and their parents was performed. Participant demographics, disease characteristics, transition readiness scores (Transition-Q, max 100), and parent–adolescent communication scores (PACS, max 100) were collected at enrollment (when the Transition Toolkit was shared with adolescents and their parents. Generalized estimating equation (GEE) analyses determined the influence of the Toolkit on transition readiness and explored the role of parent–adolescent communication quality. Subgroup analyses were conducted by sex. Results: A total of 21 patients were included; 19 completed one post-intervention Transition-Q and 16 completed two. Transition-Q scores increased over time and the rate of increase doubled after the Toolkit was shared (β = 7.8, p < 0.05, and β = 15.5, p < 0.05, respectively). Conclusion: Transition readiness improved at each follow-up, the greatest increase was seen after the Toolkit was shared. Parent–adolescent communication quality did not appear to impact changes in transition readiness.

Background/Objectives: Canadian Advanced Physiotherapist Practitioner (APP) roles have existed for over 25 years in pediatric rheumatology. The APP can manage many common pediatric rheumatic conditions most often in Shared-Care Models (SCMs) with pediatric rheumatologists (PRs). The quality of care children receive in an APP SCM compared to traditional care is unknown. The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) tracks quality measures as Key Performance Indicators (KPIs) in juvenile idiopathic arthritis (JIA) care. This study aimed to analyze the frequency of KPIs documented in a pediatric rheumatology APP SCM from a single center and compare to PR-COIN’s performance targets to assess the quality and safety of care. Methods: A retrospective chart review of JIA cases managed in a pediatric rheumatology APP SCM over a 2-year period was conducted. KPIs for disease activity, safety monitoring and access to care were evaluated. Frequency of KPI documentation by the APP were compared to target performance goals (≥40, ≥70 or ≥80% documentation rate depending on KPI) and with PR-COIN data from the Same Center (SC) (three rheumatologists) and PR-COIN (15 centers). Results: Documented KPIs were compared between the APP SCM, SC and PR-COIN registry (138; 140; 11,431 eligible visits, respectively) between June 2022–May 2024. Demographics were similar between groups. Increased percentages of patients with polyarticular rheumatoid factor positive and psoriatic subtypes were seen by APP compared to SC and PR-COIN. Documentation frequency of all disease activity and safety monitoring KPI performance goals were either higher in the APP SCM or comparable to SC and PR-COIN. Conclusions: The pediatric rheumatology APP SCM exceeded PR-COIN performance goals for KPI documentation, establishing a high level of quality and safety of care for children with JIA when managed in this model of care. Next steps include replicating this study in other pediatric rheumatology centers with an APP SCM.

Objective: For youth with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematosus (cSLE), the time leading up to the transfer from pediatric to adult care is an especially vulnerable, yet optimal time to support building healthcare self-management skills. Few studies have explored how readiness for transition changes over time prior to transfer. We aimed to assess transition readiness over time in youth with JIA or cSLE. Methods: Patients aged 14-17 years with JIA or cSLE were recruited from the McMaster Rheumatology Transition Clinic and asked to complete the 14-item Transition-Q (maximum score 100) at each clinic visit to assess transition readiness. Descriptive statistics summarized patient demographics. Generalized estimating equations assessed transition readiness across multiple clinic visits and evaluated the role of sex, age at enrollment, and age at diagnosis. Results: Analyses included 392 clinic visits from 94 participants. The number of clinic visits per participant ranged from 2 to 8, with varying time between visits. More visits (all P < 0.001), female sex (β 4.5, P = 0.03), and older age at baseline (β 3.6, P < 0.001) were significant positive predictors of higher or improved Transition-Q scores, whereas age at diagnosis was not significant ( P = 0.48). There was no significant interaction between sex and number of visits. Conclusion: Our study demonstrated transition readiness increases at each clinic visit, with female sex and older age at enrollment positively predicting higher Transition-Q scores over time; however, longitudinal trajectories did not differ by sex. This suggests that male individuals and younger adolescents may require additional supports to optimize transition readiness.

Purpose: To describe the implementation and reflections of an entry-level physiotherapy student clinical placement with an advanced physiotherapist practitioner (APP) in paediatric rheumatology. Method: A 7-week physiotherapy clinical placement consisting of 2 days/week supervised by an APP and 3 days/week supervised by a traditional physiotherapist was offered to a student in an entry-level Master of Science (MSc) Physiotherapy (PT) programme. Results: Student performance assessments included a learning contract and the Assessment of Clinical Performance tool. Final assessment in the traditional physiotherapy section aligned with expected MSc (PT) benchmarks. Applicable domains of the original Assessment of Clinical Performance (e.g., communication, professionalism) aligned with the advanced practice portion of the placement. Reflections included strengths of providing exposure and increased awareness of the APP role and providing a placement to practise core physiotherapy skills. Challenges included lack of standardization of APP roles contributing to difficulties in establishing delegation and expectations in the placement. Conclusions: Awareness of APP roles is limited, particularly among physiotherapy students. Developing student clinical placements in advanced practice roles may increase awareness while supporting clinical education opportunities in entry-level physiotherapy curricula. This case report offers insight into one APP clinical placement experience with recommendations for developing similar placement models.