Abstract Background/Aims Chronic recurrent multifocal osteomyelitis (CRMO), also known as chronic non-infectious osteomyelitis (CNO), is an auto-inflammatory bone disorder. Its incidence is likely underestimated and CNO is regularly seen in the paediatric rheumatology clinic with the highest incidences in 8-10 year olds. Patients present with bone pain commonly in the leg, clavicle, pelvis, back and feet, localised inflammation and functional impairment. Physiotherapy plays a crucial role in addressing pain and restoring function, often using exercise therapy as a core element of management. Patients with spinal lesions or with an elevated fracture risk may need specific exercise guidelines. Current management is largely based on expert opinion and individual centre treatment protocols. The aim of this review was to evaluate the literature on children with CNO specific to exercise therapy to inform evidence-based guidelines. Methods Following the development of the search strategy, a search was conducted in CINAHL, MEDLINE and EMBASE. Full-text articles reporting children (0-18 years) with a diagnosis of CRMO/CNO were included. Articles were included with a date range limited to the previous 10 years that fulfilled the search criteria. Editorials, opinion papers, abstracts, posters and papers not in the English language were excluded. Review articles’ references were hand-searched to identify papers not yet captured. The final search was uploaded into Excel and duplicates removed. Results Of the 701 articles which were screened, 15 articles were included in the literature review. Only one study explored physical activity objectively in children with CNO. Assessing degree of sarcopenia highlighted a potential role for a tailored approach to exercise prescription. Assessment of psychosocial complications, including chronic pain, reduced health-related quality of life and school absenteeism, was also described as an opportunity for earlier targeted exercise counselling. Targeting exercise therapy to patients with radiological or complete remission was considered of particular importance in spinal lesions, but any detail regarding specific mode of exercise intervention was absent. Conclusion This literature review explored the limited literature available to paediatric physiotherapists managing children with CRMO/CNO. Current literature describes opportunities for targeted exercise therapy, including those with sarcopenia and psychosocial complications, such as chronic pain and school absenteeism. However, details are severely lacking. Current management is based on expert opinion and individual centre treatment protocols. Collaboration across centres should be used to develop guidelines in the absence of high-quality research. Recent publication of global classification criteria offers an opportunity to improve research into better drug therapies. It is important that future research also includes a focus on the potential physical and psychosocial complications of CNO whereby exercise therapy and paediatric physiotherapists can play a key role. Disclosure S. Ward: None. S. Tobin: None. N. O’Shea: None.
Ward et al. (Wed,) studied this question.