key: cord-1038259-0wla2edg authors: Nishizawa, Hitomi; Nakamura, Akinori title: Changes in motor function in Duchenne muscular dystrophy patients after travel restrictions due to COVID‐19 date: 2021-06-22 journal: Muscle Nerve DOI: 10.1002/mus.27348 sha: 738193d6b65ca82881731507c30fd753825f8868 doc_id: 1038259 cord_uid: 0wla2edg INTRODUCTION/AIM: This retrospective study aimed to quantify the changes in motor function in patients with Duchenne muscular dystrophy (DMD) due to the government‐imposed travel restrictions associated with the coronavirus disease 2019 (COVID‐19) pandemic. METHODS: Twelve DMD patients were enrolled in this investigation (mean ± SD age: 9.8 ± 3.6 y). Their physical characteristics and motor function were evaluated approximately 3 mo before, immediately before, and approximately 3 mo after the travel restrictions were decreed. Statistical comparisons were performed of the changes in motor function before and after the travel restrictions. RESULTS: The change in range of motion (ROM) of ankle dorsiflexion was significantly decreased after the travel restrictions. Changes in body mass index and other motor function parameters were not significant. DISCUSSION: An apparent decrease in the amount of physical activity due to travel restrictions in response to COVID‐19 negatively affected ankle dorsiflexion ROM but not other motor functions. A more sedentary lifestyle and lack of regular physical therapy services most likely contributed to this reduction. The use of remote rehabilitation tools with the involvement of physiotherapists may help mitigate such changes and prevent more severe physical decline. August 3 were included. Data were extracted from medical records at three time points: approximately 3 mo before, immediately before, and approximately 3 mo after the government decree of travel restrictions. We retrospectively enrolled 12 ambulatory patients with DMD. Soon Statistical comparisons for each motor function item were made between the amount of change in the period before the travel restrictions and that in the period after the travel restrictions. The latest measurement date before the travel restrictions was April 3, 2020. We regarded the conditions in the 3 mo preceding the travel restrictions as the natural clinical course. The ensuing condition of travel restrictions was considered as the period of reduced physical activity. Immediately following the travel restriction period, we also interviewed parents on how the patients had spent their time. The study and interviews were approved by the institutional ethical review board (no. 4790). Informed consent was obtained from all parents of study participants. All participants who were old enough to understand also assented to the study. BMI was compared immediately before and after the travel restriction period using paired t-tests. Regarding motor function, the amount of change in the 3 mo before the travel restrictions was compared with that in the 3 mo after the travel restrictions by paired t-tests. The Wilcoxon-signed rank test was used for nonparametric data. The significance level was set at P < .05. All statistical analyses were conducted using IBM SPSS version 26 software (IBM Corp., Armonk, NY, USA). The patients ranged in age from three to 14 y (mean ± SD age: 9.8 ± 3.6 y) and included one preschooler, seven elementary school students, and four junior high school students. Eleven of 12 patients received steroid treatment, with one 3-y-old patient not administered steroids according to our therapeutic protocol for DMD. The BMI of patients just before the travel restrictions was comparable to that after the travel restriction period approximately 3 mo later (22.4 ± 4.8 kg/m 2 vs. 22.7 ± 5.1 kg/m 2 , 95% confidence interval À0.81120 to 0.24211; P = .256). The Wilcoxon signed-rank test revealed significant bilateral decreases in the change in ankle joint dorsiflexion ROM after the travel restrictions as compared with the changes before the travel restrictions (Table 1, Figure 1A ). In contrast, the changes in 10 m running time, rising from the floor time, 6-min walking distance, NSAA score, and maximum lower leg circumference were similar before and after the travel restrictions (Table 1, Figure 1 ). The results of interviews showed that more than half had We observed no remarkable changes in the other motor function tests. Although dorsiflexion ROM of the ankle joints has been shown to affect motor function after 1 y, 9 the travel restriction period in this study was only 3 mo. We therefore considered that minimum gross motor function could be maintained in this time frame. With the closures of schools and outpatient treatment facilities due to the COVID-19 pandemic, many medical services were discontinued worldwide. 1 propose home exercises to be done at least as frequently as in outpatient visits. Indeed, online rehabilitation strategies for various diseases have already been used effectively with the spread of COVID-19. [10] [11] [12] The main limitation of this study was the lack of a true DMD control group who did no additional stretching in the travel restriction period. None of the authors have any conflict of interest to disclose. The authors confirm to have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Research data are not shared. 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