The Treatment of Postural Orthostatic Tachycardia Syndrome in Adolescents in an Interdisciplinary Treatment Program: Preliminary Outcomes
Main Article Content
Abstract
Importance: Estimates suggest that 1% of all teens struggle with Postural Orthostatic Tachycardia Syndrome. It can be a devastating condition for the adolescents who do not respond to the currently available pharmacologic and non-pharmacologic interventions. Preliminary data suggests that intensive interdisciplinary treatment may provide an effective intervention that can return these youth to normal functioning including full-time attendance at school, as well as reduce orthostatic symptoms, and psychological distress.
Objective: To determine the effectiveness and durability of a 3-week interdisciplinary treatment in adolescents with Postural Orthostatic Tachycardia Syndrome in improving orthostatic symptoms, functioning, and psychological distress.
Design: Patients diagnosed with Postural Tachycardia Syndrome admitted to an interdisciplinary treatment program were assessed at admission, discharge and 3-month follow-up to determine presence and severity of orthostatic symptoms, as well as functional status including return to school, and depression.
Setting: An intensive interdisciplinary treatment program in a tertiary hospital outpatient setting.
Participants: Forty-five adolescents ages 12-18 with confirmed diagnoses of Postural Tachycardia Syndrome referred to a tertiary medical center for interdisciplinary treatment.
Intervention: A 3-week intensive outpatient interdisciplinary rehabilitation program with significant parental involvement based on a cognitive-behavioral model.
Main Outcome and Measure(s): Self-reported orthostatic symptoms were assessed with the Compass 31; level of functioning was assessed with the Functional Disability Index, depressive symptoms were assessed with the Center for Epidemiological Studies-Depression for Children, and self-reported school attendance was assessed.
Results: Significant improvements were observed and maintained at the end of treatment and at 3-month follow-up on measures of orthostatic symptoms, physical functioning, and psychological distress. At admission, 32% of patients had completed high school or were attending school full-time. At 3-month follow-up, 90% were either attending school full-time or had completed their schooling.
Keywords: Postural Orthostatic Tachycardia Syndrome, POTS, interdisciplinary treatment, adolescents.
Article Details
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References
doi: 10.1016/j.jpeds.2016.02.035
2. Raj SR, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting–Part 2. Autonomic Neuroscience. 2021;235:102836.
3. Goldstein DS. The possible association between COVID-19 and postural tachycardia syndrome. Heart rhythm. 2021;18(4):508-509.
4. Kanjwal K, Jamal S, Kichloo A, Grubb BP. New-onset postural orthostatic tachycardia syndrome following coronavirus disease 2019 infection. The Journal of innovations in cardiac rhythm management. 2020; 11(11): 4302.
5. Miglis MG, Prieto T, Shaik R, Muppidi S, Sinn D-I, Jaradeh S. A case report of postural tachycardia syndrome after COVID-19. Clinical Autonomic Research. 2020; 30(5): 449-451.
6. Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ, Fischer PR. Postural orthostatic tachycardia syndrome: a clinical review. Pediatric neurology. Feb 2010; 42(2): 77-85. doi: 10.1016/j.pediatrneurol.2009.07.002
7. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. Apr 2011; 21(2): 69-72.
doi: 10.1007/s10286-011-0119-5
8. Singer W, Sletten DM, Opfer-Gehrking TL, Brands CK, Fischer PR, Low PA. Postural tachycardia in children and adolescents: what is abnormal? J Pediatr. Feb 2012; 160(2):222-6. doi: 10.1016/j.jpeds.2011.08.054
9. Raj SR. The Postural Tachycardia Syndrome (POTS): pathophysiology, diagnosis & management. Indian pacing and electrophysiology journal. Apr 01 2006; 6(2): 84-99.
10. Benrud-Larson LM, Dewar MS, Sandroni P, Rummans TA, Haythornthwaite JA, Low PA. Quality of life in patients with postural tachycardia syndrome. Mayo Clin Proc. Jun 2002; 77(6): 531-7. doi: 10.4065/77.6.531
11. McTate EA, Weiss KE. Psychosocial Dimensions and Functioning in Youth With Postural Orthostatic Tachycardia Syndrome. Clin Pediatr (Phila). Sep 2016; 55(10): 979-82. doi: 10.1177/0009922815616890
12. Kritzberger CJ, Antiel RM, Wallace DP, et al. Functional disability in adolescents with orthostatic intolerance and chronic pain. J Child Neurol. May 2011; 26(5): 593-8.
doi: 10.1177/0883073810390366
13. Benrud-Larson LM, Sandroni P, Haythornthwaite JA, Rummans TA, Low PA. Correlates of functional disability in patients with postural tachycardia syndrome: preliminary cross-sectional findings. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. Nov 2003; 22(6): 643-8.
doi: 10.1037/0278-6133.22.6.643
14. Grubb BP. Postural tachycardia syndrome. Circulation. May 27 2008; 117(21): 2814-7. doi: 10.1161/circulationaha.107.761643
15. Pederson CL, Brook JB. Health-related quality of life and suicide risk in postural tachycardia syndrome. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. Apr 2017; 27(2): 75-81. doi: 10.1007/s10286-017-0399-5
16. Kizilbash SJ, Ahrens SP, Bruce BK, et al. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care. May-Jun 2014; 44(5): 108-33. doi: 10.1016/j.cppeds.2013.12.014
17. Winker R, Barth A, Bidmon D, et al. Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Hypertension. Mar 2005; 45(3): 391-8.
doi: 10.1161/01.HYP.0000156540.25707.af
18. Joyner MJ. Exercise training in Postural Orthostatic Tachycardia syndrome: blocking the urge to block β-receptors? Hypertension. 2011; 58(2): 136-137.
19. Moon J, Kim DY, Byun JI, et al. Orthostatic intolerance symptoms are associated with depression and diminished quality of life in patients with postural tachycardia syndrome. Health Qual Life Outcomes. Oct 12 2016; 14(1): 144. doi: 10.1186/s12955-016-0548-x
20. Bruce BK, Weiss KE, Harrison TE, et al. Interdisciplinary Treatment of Maladaptive Behaviors Associated with Postural Orthostatic Tachycardia Syndrome (POTS): A Case Report. J Clin Psychol Med Settings. Jun 2016; 23(2): 147-59.
doi: 10.1007/s10880-015-9438-3
21. McDonald C, Koshi S, Busner L, Kavi L, Newton JL. Postural tachycardia syndrome is associated with significant symptoms and functional impairment predominantly affecting young women: a UK perspective. BMJ open. Jun 16 2014; 4(6): e004127.
doi: 10.1136/bmjopen-2013-004127
22. Bruce BK, Harrison TE, Bee SM, et al. Improvement in Functioning and Psychological Distress in Adolescents With Postural Orthostatic Tachycardia Syndrome Following Interdisciplinary Treatment. Clin Pediatr (Phila). Mar 15 2016;
doi: 10.1177/0009922816638663
23. Junghans-Rutelonis AN, Craner JR, Ale CM, Harbeck-Weber C, Fischer PR, Weiss KE. Youth with chronic pain and postural orthostatic tachycardia syndrome (POTS): treatment mediators of improvement in functional disability. Journal of clinical psychology in medical settings. 2018; 25(4): 471-484.
24. Bruce BK, Ale CM, Harrison TE, et al. Getting Back to Living: Further Evidence for the Efficacy of an Interdisciplinary Pediatric Pain Treatment Program. The Clinical journal of pain. Aug 31 2016;
doi: 10.1097/AJP.0000000000000433
25. Hechler T, Kanstrup M, Holley AL, et al. Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain. Pediatrics. Jul 2015; 136(1): 115-27. doi: 10.1542/peds.2014-3319
26. Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score. Mayo Clin Proc. Dec 2012;87(12): 1196-201.
doi:10.1016/j.mayocp.2012.10.013
27. Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O'Brien PC, Low PA. The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms. Neurology. Feb 1999;52(3):523-8.
28. Treister R, O'Neil K, Downs HM, Oaklander AL. Validation of the composite autonomic symptom scale 31 (COMPASS-31) in patients with and without small fiber polyneuropathy. European journal of neurology. Jul 2015; 22(7): 1124-30.
doi: 10.1111/ene.12717
29. Robinson-Papp J, Sharma SK, George MC, Simpson DM. Assessment of autonomic symptoms in a medically complex, urban patient population. Clinical autonomic research: official journal of the Clinical Autonomic Research Society. Feb 2017; 27(1):25-29. doi: 10.1007/s10286-016-0384-4
30. Claar RL, Walker LS. Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory. Pain. Mar 2006; 121(1-2): 77-84. doi: 10.1016/j.pain.2005.12.002
31. Kashikar-Zuck S, Flowers SR, Claar RL, et al. Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain. Pain. Jul 2011; 152(7): 1600-7.
doi: 10.1016/j.pain.2011.02.050
32. Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol. Feb 1991;16(1):39-58.
33. Weissman MM, Orvaschel H, Padian N. Children's symptom and social functioning self-report scales. Comparison of mothers' and children's reports. The Journal of nervous and mental disease. Dec 1980; 168(12): 736-40.
34. Roberts RE, Andrews JA, Lewinsohn PM, Hops H. Assessment of depression in adolescents using the Center for Epidemiologic Studies Depression Scale. Peer Reviewed. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990; 2(2): pp.
doi: 10.1037/1040-3590.2.2.122
35. Faulstich ME, Carey MP, Ruggiero L, Enyart P, Gresham F. Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). The American journal of psychiatry. Aug 1986; 143(8): 1024-7.
doi: 10.1176/ajp.143.8.1024
36. Bruce B, Weiss K, Ale CM, Harrison T, Fischer PR. Development of an Interdisciplinary Pediatric Pain Rehabilitation Program: The First 1,0000 Consecutive Patients. Mayo Clin Proc. 2017 In Press;
37. Townsend CO, Bruce BK, Hooten WM, Rome JD. The role of mental health professionals in multidisciplinary pain rehabilitation programs. J Clin Psychol. Nov 2006;62(11):1433-43. doi: 10.1002/jclp.20322
38. Kluck BN, Junghans-Rutelonis AN, Jones AE, Fischer PR, Weiss KE. Adolescent Chronic Fatigue and Orthostatic Intolerance: Relationships Between Parental Attributes and Child Functioning. Clin Pediatr (Phila). Jul 15 2016; doi: 10.1177/0009922816644730