What is QOL in children and adolescents with physical disabilities? A thematic synthesis of pediatric QOL literature

Living with Pompe disease: results from a qualitative interview study with children and adolescents and their caregivers

BACKGROUND

Children and adolescents with Pompe disease (PD) face chronic and progressive myopathy requiring time-intensive enzyme replacement therapy (ERT). Little is known about their perspectives on the disease and its treatment. This study explored their perceptions of disease symptoms and functioning status, and more subjective feelings about the impacts on their lives as part of developing a disease-specific questionnaire.

METHODS

Eleven pediatric patients aged 8-18 years and 26 caregivers from six children's hospitals in Germany, Austria, and Switzerland underwent semi-structured interviews. Data were recorded, transcribed using MAXQDA software, and analyzed using qualitative content analysis. A system of meaningful categories was developed.

RESULTS

Sixteen main categories were derived across four major thematic areas: perceptions of symptoms and limitations, experiences to do with the biopsychosocial impact of PD, treatment experiences, and general emotional well-being/burden. Participants demonstrated broad heterogeneity in symptom perceptions such as muscle weakness, breathing difficulties, pain, and fatigue. Emotional appraisals of limitations were not directly proportional to their severity, and even comparatively minor impairments were often experienced as highly frustrating, particularly for social reasons. The main psychosocial topics were social exclusion vs. inclusion and experiences to do with having a disease. The main finding regarding treatment was that switching ERT from hospital to home was widely viewed as a huge relief, reducing the impact on daily life and the burden of infusions. Emotional well-being ranged from not burdened to very happy in most children and adolescents, including the most severely affected.

CONCLUSION

This study provided qualitative insights into the perceptions and experiences of pediatric PD patients. Interestingly, biopsychosocial burden was not directly related to disease severity, and tailored psychosocial support could improve health-related quality of life. The present findings ensure the content validity of a novel questionnaire to be tested as a screening tool to identify patients in need of such support.

Qualitative inductive analysis of the lives of women with persistent cloaca based on their narratives

PURPOSE

The study aimed to explore and describe the lives of patients with persistent cloaca (PC) from childhood to adulthood.

METHODS

Semistructured interviews were conducted with nine adult patients with PC. Their experiences and thoughts regarding this disease were analyzed qualitatively and inductively.

RESULTS

After classifying the experiences and thoughts of patients with PC, 13 categories were extracted. The following five themes emerged from these categories. (1) Difficulties with excretion and vaginal management because of the disease. (2) The degree of understanding of those around them and society has a huge effect on their way of life. (3) The inferiority of a woman who is not a "normal woman." (4) A "never-ending disease" in which problems continue even after the transition period. (5) Differences in the central point of the narrative depending on the age group.

CONCLUSIONS

In this study, qualitative and inductive analyses of data from semistructured interviews with patients with PC revealed their experiences and thoughts. The results will provide a guide for young patients and the medical professionals who treat them. Accordingly, monitoring their lives until adulthood is necessary.

Health-related quality of life of children and adolescents with one vs. multiple disabilities - Are there differences from the parents' perspective?

BACKGROUND

Multiple disabilities represent separate entities that cannot be reduced to the sum of disabilities or the main disability. This study compared the health-related quality of life (HRQoL) of children and adolescents with multiple disabilities and those with one developmental disability. We further assessed how comorbidities and guardianship type affected HRQoL.

METHOD

On a sample of 190 children and adolescents with developmental disabilities aged 2-18 years (mean age 11.19 years, SD 3.76), we evaluated HRQoL using the PedsQL 4.0 Generic Core Scale (parent proxy-reports).

RESULTS

Participants with multiple disabilities and participants with one developmental disability statistically significantly differed in all domains of HRQoL, except for emotional functioning. Multiple disabilities resulted in a lower HRQoL. Comorbidities like epilepsy diminished participants' HRQoL. Guardianship type did not affect HRQoL.

CONCLUSIONS

Disability complexity affects HRQoL. Since each impairment increases difficulties in daily functioning, all existing disorders need to be considered when planning services for children with disabilities.

'Struggling to participate in everyday life': emerging adults' experiences of living with long-term health challenges

AIM

To gain a deeper understanding of the experiences of participation in the everyday life of emerging adults living with long-term health challenges and how this influences their own quality of life.

METHODS

Using an explorative study design, data were collected through in-depth interviews with a sample of 12 young people aged 18-29 years living with long-term health challenges in Norway.

FINDINGS

The analysis identified one overarching theme of struggling to participate in everyday life, and four subthemes: the notion of being independent but also dependent, experiencing mismatch between needs and support, experiencing deprivation of spontaneity and feeling uncertain about the future. The emerging adults experienced difficulties with participation in key areas of life such as education, employment and leisure activities. Associated symptoms of their diagnosis, limited physical abilities and lack of sufficient support made it hard to participate in everyday life the way they aspired to.

CONCLUSION

The challenges of living with a long-term health challenge as an emerging adult contributed to limitations in participation in different areas of life that was perceived as important for their quality of life.

Perspectives of adolescents with disabilities and their parents regarding autonomous decision-making and self-determination

BACKGROUND

Parents' promotion of autonomous decision-making (PADM) is essential for adolescents with disabilities and constitutes the basis for maturation of self-determination (SD). SD develops based on adolescents' capacities and the opportunities offered to them at home and at school, to make personal decisions regarding their life.

AIM

Examine the associations between the PADM and SD of adolescents with disabilities from their own perspective and that of their parents.

METHOD

Sixty-nine adolescents with disabilities and one of their parents completed a self-report questionnaire including PADM and SD scales.

OUTCOMES

The findings showed associations between parents' and adolescents' reports of PADM, and opportunities for SD at home. PADM was associated with capacities for SD among adolescents. Gender differences were also apparent, with both adolescent girls and their parents reporting higher ratings of SD than adolescent boys.

CONCLUSIONS

Parents who promote autonomous decision-making among their adolescent children with disabilities start a virtuous circle by offering greater opportunities for SD within the home. In turn, these adolescents rate their SD as higher, and communicate this perspective to their parents. Consequently, their parents offer them more opportunities for autonomous decision-making at home, thus enhancing their SD.

Health-related quality of life in children with and without physical-mental multimorbidity

PURPOSE

This study examined health-related quality of life (HRQL) in children across different physical illnesses; estimated parent-child agreement on HRQL reports; compared HRQL between children with and without physical-mental multimorbidity; and tested if multimorbidity was associated with HRQL.

METHODS

Children aged 6-16 years (mean = 11.1; n = 198) with one physical illness and their parents were recruited from a pediatric hospital. Physical illnesses were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10, mental illnesses were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, and HRQL was measured using the KIDSCREEN-27. Children who screened positive for ≥ 1 mental illness were classified as having physical-mental multimorbidity. χ²/t tests compared sample characteristics of children with vs. without multimorbidity; Kruskal-Wallis tests compared KIDSCREEN-27 scores across ICD-10 categories; interclass correlation coefficients estimated parent-child agreement; and multiple regression examined effects of the number of mental illnesses on HRQL.

RESULTS

HRQL was similar across ICD-10 categories. Parent-child agreement was fair to good for all HRQL domains, regardless of multimorbidity status. Parent-reported HRQL was significantly lower for children with multimorbidity compared to norms across all domains, whereas child-reported HRQL was significantly lower for physical well-being, psychological well-being, and school environment. Number of mental illnesses was negatively associated with psychological well-being and school environment in a dose-response manner.

CONCLUSION

Children with physical-mental multimorbidity are vulnerable to experiencing lower HRQL, particularly for psychological well-being and school environment. Longitudinal studies documenting trajectories of HRQL and school-based interventions that target these domains of HRQL for children with multimorbidity are warranted.