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PHYSICAL THERAPY AND CHIROPRACTIC USE AMONG CHILDHOOD CANCER SURVIVORSWITH CHRONIC DISEASE: IMPACT ON HEALTH-RELATED QUALITY OF LIFE

Introduction

The use of reh !"#"$ $"o% ser&"'es $o ((ress )us'u#os*e#e$ #+ %euro#o,"' # %( ' r("o& s'u# r # $e effe'$s)o%, 'h"#(hoo( ' %'er sur&"&ors 'ou#( ") ro&e h.s"' # fu%'$"o% %( he #$h-re# $e( /u #"$.-of-#"fe 0HRQL12

We (es'r"!e h.s"' # $her . 0PT1 %( 'h"ro r '$"' u$"#"3 $"o% )o%, 'h"#(hoo( ' %'er sur&"&ors %( $he"r sso'" $"o% 4"$h HRQL2

Methods

The s ) #e "%'#u(e( 56 .e r sur&"&ors fro) $he Ch"#(hoo( C %'er Sur&"&or S$u(. 0N78+9 812 Ques$"o%s((ress"%, use of PT or 'h"ro r '$"' ser&"'es %( HRQL 0Me("' # Ou$'o)es Sur&e. Shor$ For) 0SF-; 85 CI ?2?-9281+ %euro#o,"' # 0OR ;2 > 85 CI?2

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Ph.s"' # $her . ro&"(es reh !"#"$ $"&e ser&"'es $o "%("&"(u #s $o o $")"3e erfor) %'e 4he% s$ru'$ur # or fu%'$"o% # ") "r)e%$s "%$erfere 4"$h )o&e)e%$2 Ser&"'es re ro r" $e for fu%'$"o% # #oss re# $e( $o "% ur.+("se se+ ("suse+ or $he ,"%, ro'ess2 The ,o #s of h.s"' # $her . "%$er&e%$"o%s re $o (e&e#o + res$ore or ) "%$ "% %or) # fu%'$"o%+ $e 'h 'o) e%s $or. s$r $e,"es 4he% %or) # fu%'$"o% ' %%o$ !e res$ore(+ or ( $$he e%&"ro%)e%$ $o ''o))o( $e su!-o $") # fu%'$"o% so $h $ )o&e)e%$ ' % !e $$ "%e( for fu## r$"'" $"o%"% $ s*s esse%$" # for ( "#. #"fe2 PT ser&"'es re u$"#"3e( re,u# r#. $o ) % ,e s$ru'$ur # or fu%'$"o% # #oss re# $e($o 'hro%"' ("se ses $h $ ") '$ $he )us'u#os*e#e$ #+ %euro#o,"' #+ %( ' r("o& s'u# r s.s$e)s2 Ho4e&er+ 4e4ere u% !#e $o "(e%$"f. o$her s$u("es $h $ h &e e )"%e( 'h"#(hoo( ' %'er sur&"&ors use of h.s"' # $her .2

Ch"ro r '$"' )e("'"%e ((resses ("sor(ers of $he )us'u#os*e#e$ # s.s$e)+ 4"$h r$"'u# r e) h s"s o% s "% #he #$h2 I%$er&e%$"o% "s (es",%e( $o 'orre'$ s "% # #",%)e%$ %( $o re#"e&e ressure o% $he %er&ous s.s$e)2Sur&e.s "%("' $e $h $ "%("&"(u #s see* 'h"ro r '$"' ' re for $he $re $)e%$ of )us'u#os*e#e$ # 'o) # "%$s+ 4"$h

re& #e%'e of use "% $he U%"$e( S$ $es %( C % ( r %,"%, fro) ;-? 2 Wh"#e $he Ch"#(hoo( C %'er Sur&"&or S$u(. 0CCSS1 re'e%$#. re or$e( $h $ ?9 of sur&"&ors re or$e( see"%, 'h"ro r '$or 'o) re( $o ? of $he"r s"!#"%,s+ s e'"f"' f '$ors sso'" $e( 4"$h 'h"ro r '$"' use )o%, 'h"#(hoo( ' %'er sur&"&ors h &e %o$

!ee% re or$e(2

We re or$ 'h"#(hoo( ' %'er sur&"&ors use of PT %( 'h"ro r '$"' ser&"'es ! se( o% $he CCSS 'ohor$ $ $he9@@; fo##o4-u /ues$"o%% "re2 The ") '$ of (" ,%os"s+ $re $)e%$+ (e)o,r h"' %( 'hro%"' ("se se'h r '$er"s$"'s o% ser&"'e u$"#"3 $"o% "s e )"%e(2 A(("$"o% ##.+ HRQL )o%, sur&"&ors 4"$h )us'u#os*e#e$ #+%euro#o,"' #+ %( ' r("o& s'u# r 'hro%"' 'o%("$"o%s 4ho re or$e( use of PT or 'h"ro r '$"' ser&"'es 4ere'o) re( $o HRQL )o%, sur&"&ors 4"$h $hese s )e 'o%("$"o%s 4ho ("( %o$ re or$ use of e"$her )o( #"$.2

METHODS

Sample

The Ch"#(hoo( C %'er Sur&"&or S$u(. 0CCSS1 "s % e "(e)"o#o,"' s$u(. of sur&"&ors of 'h"#(hoo( ' %'er2Perso%s (" ,%ose( $ o%e of 9< "%s$"$u$"o%s !e$4ee% ?8B@ %( ?8

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& #"("$. of $he "%s$ru)e%$ )o%, ("ffere%$ ,rou s re or$"%, "## he #$h+ %( $he $es$-re$es$ re#" !"#"$. of $he SF-;< re e 'e##e%$2 R 4 s'ores fro) $he SF-;< 4ere 'o%&er$e( $o T s'ores 0r %,e+ @-?@@1 %( ("'ho$o)"3e( so$h $ s'ore $ or !e#o4 @ 0? s$ %( r( (e&" $"o% SD !e#o4 $he o u# $"o% )e %1 o% r$"'u# r su)) r. or su!s' #e 4 s '# ss"f"e( s oor HRQL ou$'o)e2

Independent Measures

D" ,%os"s %( $re $)e%$ ( $ re#e& %$ $o $he r") r. (" ,%oses 4ere !s$r '$e( fro) )e("' # re'or(s $ ! se#"%e+ %(+ #$hou,h e& #u $e( %( re or$e( "% re&"ous % #.s"s of HRQL "% $h"s 'ohor$ 9B + re"%'#u(e( here s re("'$ors of $he HRQL su)) r. ou$'o)es for 'o) #e$e%ess2 A,e $ $he 9@@; fo##o4-u/ues$"o%% "re+ se + r 'e+ r") r. (" ,%os"s+ sur,"' # ro'e(ures+ 'he)o$her eu$"' ,e%$s+ %( r (" $"o% 4ere'o%s"(ere( s o$e%$" # re("'$ors of PT or 'h"ro r '$"' use2

De)o,r h"' ( $ %( 'hro%"' ("se se s$ $us 4ere o!$ "%e( fro) $he ! se#"%e /ues$"o%% "re2 E(u' $"o% #$$ "%)e%$+ e) #o.)e%$ s$ $us+ %%u # househo#( "%'o)e+ he #$h "%sur %'e+ &"s"$ $o h.s"'" % "% $he

re&"ous $4o .e rs+ 'urre%$ use of "% )e("' $"o%+ ers"s$e%$ ' %'er re# $e( "%+ %( 'hro%"' ("se se s$ $us4ere #so 'o%s"(ere( s o$e%$" # re("'$ors of PT or 'h"ro r '$"' use2 Chro%"' ("se se s$ $us+ s (es'r"!e( re&"ous#.+ 4 s ! se( o% $he N $"o% # C %'er I%s$"$u$e s Co))o% Ter)"%o#o,. Cr"$er" for A(&erse E&e%$s0Vers"o% ;1+ "%$e%(e( for use "% s'or"%, !o$h 'u$e %( 'hro%"' 'o%("$"o%s "% $"e%$s 4"$h ' %'er %(sur&"&ors2 These re: )"#( 0,r (e ?1+ )o(er $e 0,r (e 91+ se&ere 0,r (e ;1+ #"fe-$hre $e%"%, or ("s !#"%, 0,r (e

1+ or f $ # 0,r (e 512 A $o$ # of ?;B he #$h 'o%("$"o%s 4ere s'ore(2 I%("&"(u #s 4"$h ,r (e 5 'o%("$"o%s 4ere%o$ "%'#u(e( "% $hese % #.ses2

Statistical Anal ses

Des'r" $"&e s$ $"s$"'s+ "%'#u("%, fre/ue%'"es %( er'e%$ ,es+ for $he (e)o,r h"' %( $re $)e%$'h r '$er"s$"'s+ s 4e## s PT %( 'h"ro r '$"' use+ of $he e#","!#e r$"'" %$s 4ere ' #'u# $e( %( 'o) re(

!e$4ee% r$"'" %$s %( s"!#"%,s 4"$h 'h"-s/u re s$ $"s$"'s2 The ro or$"o%s of $hose us"%, PT='h"ro r '$"'ser&"'es or !o$h 4ere 'o) re( !e$4ee% s"!#"%,s %( sur&"&ors "% )u#$"& r" !#e re,ress"o% )o(e#s2Ge%er #"3e( es$") $"%, e/u $"o%s 4ere e) #o.e( "% sur&"&or-s"!#"%, % #.ses $o ''ou%$ for o$e%$" #"%$r f )"#. 'orre# $"o%2 The sso'" $"o% !e$4ee% 'hro%"' ("se se s$ $us+ (" ,%os"s or $re $)e%$ %( PT='h"ro r '$"' use+ or !o$h 4 s e& #u $e( )o%, sur&"&ors us"%, se r $e )u#$"& r" !#e #o,"s$"' re,ress"o%)o(e#s2 The sso'" $"o%s !e$4ee% PT='h"ro r '$"' use %( HRQL )o%, $hose 4ho re or$e( r$"'u# r 'hro%"' 'o%("$"o% re#"e( o% SF-;< su)) r. s' #es )e % s'ore 'o) r"so%s "% #"%e r )o(e#s !e$4ee% $hose4ho re or$e( re'e"&"%, ser&"'es %( $hose 4ho ("( %o$2 Mo(e#s 4ere ( us$e( for ,e $ (" ,%os"s+ ,e $fo##o4-u + ,e%(er+ %( r 'e2 A(("$"o% ##.+ $he ("ffere%'es "% ro or$"o%s of $hose 4"$h SF-;< su)) r. s'ores

J @ 4ere 'o) re( us"%, #o,"s$"' re,ress"o% )o(e#s #so ( us$"%, for ,e $ (" ,%os"s+ ,e $ fo##o4-u +,e%(er+ %( r 'e2 A% #.ses 4ere (o%e "% SAS &ers"o% 82? 0C r.+ N2C212

RESU!TS

There 4ere ??+

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Sur&"&ors 4ere s#",h$#. .ou%,er+ )ore #"*e#. $o !e ) #e %( re or$ ,r (e ; or 'hro%"' 'o%("$"o%+ #ess #"*e#.$o h &e ,r (u $e( fro) 'o##e,e+ )ore #"*e#. $o !e u%e) #o.e(+ %( )ore #"*e#. $o h &e househo#( "%'o)e#ess $h % K9@+@@@ er .e r $h % 4ere $he"r s"!#"%,s2 The. 4ere o%#. s#",h$#. #ess #"*e#. $h % s"!#"%,s $o h &ehe #$h "%sur %'e %( o%#. s#",h$#. )ore #"*e#. $o h &e see% h.s"'" % "% $he re&"ous $4o .e rs 0T !#e I12

A s#",h$#. h",her er'e%$ ,e of sur&"&ors re or$e( us"%, 'h"ro r '$"' 0?92 1 $h % PT 0829 1 ser&"'e+ %( #ess$h % ; of sur&"&ors re or$e( us"%, !o$h PT %( 'h"ro r '$"' ser&"'es2 T !#e II (e)o%s$r $es $he ") '$ of 'hro%"' ("se se se&er"$. o% PT or 'h"ro r '$"' ser&"'e u$"#"3 $"o%2 Af$er ( us$"%, for ,e $ (" ,%os"s+ ,e $fo##o4-u + se + r 'e+ he #$h "%sur %'e s$ $us+ &"s"$ $o h.s"'" % "% $he re&"ous $4o .e rs+ 'urre%$ use of "%)e("' $"o% or )us'#e re# %$ %( ers"s$e%$ ' %'er re# $e( "%+ "%("&"(u #s 4"$h ,r (e ; or 'hro%"''o%("$"o% 4ere )ore #"*e#. $h % $hose 4"$h ,r (e 9 or #o4er 'hro%"' 'o%("$"o% $o re or$ PT use2 Fe) #e,e%(er %( 4h"$e r 'e 4ere sso'" $e( 4"$h 'h"ro r '$"' ser&"'e u$"#"3 $"o%2 See"%, h.s"'" % "% $he $4o.e rs r"or $o $he /ues$"o%% "re+ 'urre%$ use of "% )e("' $"o% or )us'#e re# %$+ %( ers"s$e%$ ' %'er re# $e( "% 4ere sso'" $e( 4"$h o!$ "%"%, PT ser&"'es+ 'h"ro r '$"' ser&"'es+ or !o$h2

DISCUSSION

The f"%("%,s fro) $h"s 'ross-se'$"o% #+ (es'r" $"&e s$u(. "%("' $e $h $ s#",h$#. h",her er'e%$ ,e of sur&"&orsre or$e( us"%, 'h"ro r '$"' ser&"'es $h % PT ser&"'es+ %( $hose sur&"&ors 4"$h )us'u#os*e#e$ #+ %euro#o,"' #+or ' r("o& s'u# r 'hro%"' 'o%("$"o%s 4ho re or$e( PT='h"ro r '$"' use #so re or$e( oorer HRQL $h % $hose%o$ us"%, $hose ser&"'es2 The re# $"&e#. #o4 %u)!er of sur&"&ors 082; 1 4ho re or$e( us"%, PT "% $he $4o.e rs r"or $o $he 9@@; fo##o4-u /ues$"o%% "re "s sur r"s"%, 'o%s"(er"%, 'h"#(hoo( ' %'er sur&"&ors"%'re se( r"s* of )us'u#os*e#e$ #+ ' r("o& s'u# r+ %( %euro#o,"' # 'hro%"' 'o%("$"o%s $h $ ' % o$e%$" ##.#")"$ h.s"' # fu%'$"o%2

Gr (e ; or 'hro%"' 'o%("$"o%s 4ere sso'" $e( 4"$h PT !u$ %o$ 4"$h 'h"ro r '$"' ser&"'e u$"#"3 $"o%2 Thesef"%("%,s re 'o%s"s$e%$ 4"$h re&"ous s$u("es "% 4h"'h sur&"&ors 4ho re or$ )ore se&ere # $e effe'$s re )ore#"*e#. $o u$"#"3e he #$h ser&"'es %( $o h &e ,re $er he #$h 'o%'er%s $h % $hose 4"$hou$ )ore se&ere # $e effe'$s2A #o4er re& #e%'e of PT $h % 'h"ro r '$"' use ) . ref#e'$ $he re/u"re)e%$ !. )os$ "%sur %'e # %s "% $heU%"$e( S$ $es $o re")!urse o%#. for PT ser&"'es res'r"!e( !. h.s"'" %+ or+ $he (("$"o% # re/u"re)e%$ for (o'u)e%$e( ") ro&e( fu%'$"o%"%, s 'o%("$"o% for 'o%$"%ue( PT ser&"'es+ e&e% 4he% 'o%("$"o% "s 'hro%"'2I% (("$"o%+ h.s"'" %s ) . !e re#u'$ %$ $o refer sur&"&ors $o PT %( "%surers ) . !e re#u'$ %$ $o . for PT+

!e#"e&"%, $h $ o%#. $hose sur&"&ors 4ho re ' !#e of fu## re'o&er. %( o $") # 'o))u%"$. %( &o' $"o% # ursu"$s 4"## !e%ef"$ fro) $hose ser&"'es2 Che&"##e %( 'o##e ,ues h &e %o$e( $h $ #$hou,h reh !"#"$ $"o% "s r$ of s$ %( r( ' re for $"e%$s 4"$h u#)o% r. %( ' r(" ' ("se se+ PT "s r re#. offere( $o 'h"#(re% 4"$h' %'er %( 'h"#(hoo( ' %'er sur&"&ors2

A''ess $o h.s"' # $her "s$s ) . !e sso'" $e( 4"$h (e're se( PT use2 Ph.s"' # $her "s$s r '$"'e "%hos "$ #s+ '#"%"'s+ %( r"& $e off"'es $h $ h &e s e'" ##. e/u" e( f '"#"$"es %( $hese f '"#"$"es ) . %o$ !e

& "# !#e "% rur # re s of $he 'ou%$r.2 P r$"'" %$s "% $he Ch"#(hoo( C %'er Sur&"&or S$u(. re s' $$ere($hrou,hou$ $he U%"$e( S$ $es %( C % ( + %( $he use of PT h s !ee% sho4% $o & r. !. ,eo,r h"' re 2Pres"("%, "% % ur! % re or res"("%, "% $he Nor$he s$ 'e%sus re,"o% h s !ee% sho4% $o !e os"$"&e#.

sso'" $e( 4"$h use of PT ser&"'es2 Are & r" $"o%s ) . !e "%("' $"&e of h.s"' # $her "s$ su #.> $h"s %o$"o%"s 'o%s"s$e%$ 4"$h %o$her s$u(. "% 4h"'h h.s"' # $her "s$ su #. 0 h.s"' # $her "s$s=?@+@@@ eo #e1 4 s

os"$"&e#. sso'" $e( 4"$h use of PT "% %. se$$"%,2 A (e're se( #o' # & "# !"#"$. of h.s"' # $her "s$s ) .#e ( $o #o%,er 4 "$s %( #ess f#e "!"#"$. "% s'he(u#"%,+ 4h"'h 'ou#( o$e%$" ##. (e're se PT use2

http://hinari-gw.who.int/whalecomwww.ncbi.nlm.nih.gov/whalecom0/pmc/articles/PMC3062253/table/T1/http://hinari-gw.who.int/whalecomwww.ncbi.nlm.nih.gov/whalecom0/pmc/articles/PMC3062253/table/T2/http://hinari-gw.who.int/whalecomwww.ncbi.nlm.nih.gov/whalecom0/pmc/articles/PMC3062253/table/T1/http://hinari-gw.who.int/whalecomwww.ncbi.nlm.nih.gov/whalecom0/pmc/articles/PMC3062253/table/T2/

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A#$hou,h 'h"ro r '$"' )e("'"%e "s "%'re s"%,#. !e"%, u$"#"3e( for )us'u#os*e#e$ # 'o) # "%$s+ "$ "s %o$ r$ of $he #o%,-$er) fo##o4-u '#"%"' # ,u"(e#"%es for 'h"#(hoo( ' %'er sur&"&ors2 The f"%("%, $h $ )ore sur&"&orsre or$e( us"%, 'h"ro r '$or $h % PT "s $herefore sur r"s"%,2 Th"s su,,es$s $h $ 'h"#(hoo( ' %'er sur&"&ors) . !e e #or"%, #$er% $"&es $o )ore $r ("$"o% # $her "es s 4 . $o (e # 4"$h $he"r # $e effe'$s2

More 'h"#(hoo( ' %'er sur&"&ors ) . use 'h"ro r '$"' $h % PT ser&"'es !e' use $he. ) . h &e ,re $er ''ess$o 'h"ro r '$"' ' re2 Ch"ro r '$"' use "s %o$ (e e%(e%$ u o% referr # fro) h.s"'" % or %urse r '$"$"o%er+ %()ore "%sur %'e ro&"(ers re %o4 'o&er"%, 'h"ro r '$"' ser&"'e2 Re'e%$ effor$s !. $he N $"o% # He #$h Ser&"'eCor s %( Ve$er %s A()"%"s$r $"o% $o e%h %'e 'h"ro r '$or & "# !"#"$. "% u%(erser&e( re s ) . #so

''ou%$ for $he ,re $er er'e%$ ,e of 'h"#(hoo( ' %'er sur&"&ors us"%, 'h"ro r '$"' $h % PT2

I% $he rese%$ s$u(.+ !# '* 'h"#(hoo( ' %'er sur&"&ors 4ere B@ #ess #"*e#. $o use 'h"ro r '$"' ser&"'es $h %4ere 4h"$e sur&"&ors2 Th"s f"%("%, "s 'o%s"s$e%$ 4"$h o$her s$u("es 4h"'h re or$e( $h $ 'h"ro r '$"' use "s )ore'o))o% )o%, 4h"$es $h % !# '*s2 These resu#$s re #so 'o%s"s$e%$ 4"$h $hose of rese r'h "% o$her re s of he #$h ' re use !. eo #e 4"$h )us'u#os*e#e$ # 'o%("$"o%s2 Poss"!#e e # % $"o%s for $he ("ffere%'es "%

'h"ro r '$"' use )o%, 4h"$es %( !# '*s ) . "%'#u(e e'o%o)"' ("s r"$"es+ $he # '* of ("&ers"$. )o%,'h"ro r '$ors+ #o' $"o% of 'h"ro r '$ors off"'es+ or 'u#$ur # !e#"efs !ou$ 'h"ro r '$ors2

Sur&"&ors of 'h"#(hoo( o%se$ CNS $u)ors %( sof$ $"ssue s r'o) 4ere )ore #"*e#. $o use PT ser&"'es'o) re( $o #eu*e)" sur&"&ors2 No s e'"f"' (" ,%oses 4ere sso'" $e( 4"$h "%'re se( use of 'h"ro r '$"'ser&"'es2 Th"s ) . ref#e'$ $he f '$ $h $ sur&"&ors of CNS $u)ors re )os$ #"*e#. $o re or$ erfor) %'e#")"$ $"o%s+ ) *"%, referr # for 'o%$"%ue( or (("$"o% # PT ser&"'es )ore o!&"ous2 Sof$ $"ssue s r'o) $"e%$s) . h &e )us'u#os*e#e$ # ro!#e)s or ers"s$e%$ "% re# $e( $o #o' # 'o%$ro# $her . 0sur,er. %( r (" $"o%12These sur&"&ors ) . h &e )u#$" #e (("$"o% # sur,er"es %( "%$er&e%$"o%s re# $e( $o o%,o"%, s "%e or o"%$(efor)"$.+ %e'ess"$ $"%, "%$er)"$$e%$ !u$ 'o%$"%ue( %ee( for reh !"#"$ $"&e ser&"'es2

I% $h"s s$u(.+ $hose sur&"&ors 4ho h ( )us'u#os*e#e$ #+ %euro#o,"' #+ or ' r("o& s'u# r # $e effe'$s %( use(e"$her PT or 'h"ro r '$"' ser&"'es s'ore( #o4er o% $he HRQL Ph.s"' # Co) o%e%$ Su)) r. s'ore $h % $hose4"$h $he s )e 'o%("$"o%s 4ho ("( %o$ use e"$her ser&"'e2 He #$h-re# $e( f '$ors+ su'h s se&er"$. of 'o%("$"o%+%u)!er of s.) $o)s+ %( fu%'$"o% # #")"$ $"o%s+ re sso'" $e( 4"$h re'e"&"%, h.s"' # $her . ser&"'es2Therefore+ $hese f"%("%,s ) . ref#e'$ $he f '$ $h $ $hose sur&"&ors 4"$h )ore se&ere # $e effe'$s re $he )os$#"*e#. $o use e"$her PT or 'h"ro r '$"' ser&"'es %(+ "% $ur%+ !e )ore #"*e#. $o re or$ oorer HRQL 'o) re( $osur&"&ors 4"$h #ess se&ere # $e effe'$s2 S$u("es h &e sho4% $h $ s",%"f"' %$ re("'$ors of PT use "%'#u(e $he

rese%'e of )ore $h % o%e )us'u#os*e#e$ # 'o%("$"o% 0OR792?@+ 85 CI7?2 -92;81+ $ #e s$ so)e ("ff"'u#$.4"$h h.s"' # fu%'$"o% 0OR7?259+ 85 CI7?2;?-?2B

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