The psychological well-being and self-efficacy of carers of children with disabilities following attendance on a Simple Massage Training and Support Programme: A 12-month comparison study of adherers and non-adherers

Good overall behavioural adjustment in children and adolescents with classic congenital adrenal hyperplasia

PURPOSE

Patients with classic congenital adrenal hyperplasia (CAH) are treated postnatally with life-long glucocorticoid (GC) replacement therapy. Although prolonged exposure to GCs may have a negative impact on behaviour, few studies have studied this issue. We therefore investigated behavioural outcomes in male and female children and adolescents with CAH.

METHODS

An observational study in which Swedish and Italian children and adolescents with CAH identified through neonatal screening for CAH (n = 57, age range 7-17 years) were compared with healthy population controls matched for age and sex (n = 72, age range 7-17 years). Thirteen (eight females) of the fifty-seven children and adolescents with CAH had been treated prenatally with dexamethasone (DEX). Standardised questionnaires for parents and self-report scales for children/adolescents were used to assess behavioural and emotional problems, social anxiety, temperament and scholastic competence.

RESULTS

There were no statistically significant differences between CAH patients (not prenatally treated with DEX) and controls on most of the scales measuring adaptive functioning or behavioural problems. However, children with CAH were rated by their parents to have more social problems than controls (Child Behaviour Checklist, CBCL social problems, p = 0.032). In the small group (n = 13) of prenatally DEX-treated cases parents rated their children/adolescents to have more mood problems compared with non-DEX-treated children/adolescents with CAH (CBCL-withdrawn/depressed, p = 0.019).

CONCLUSION

Children/adolescents with CAH showed good overall adjustment. The clinical significance of the parentally perceived increase in social problems in children/adolescents with CAH requires further investigation. The findings underline the importance of psychological support for children/adolescents with a chronic condition.

Acupressure and Therapeutic Touch in Childhood Cancer to Promote Subjective and Intersubjective Experiences of Well-being During Curative Treatment

Purpose

Acupressure and therapeutic touch may be beneficial for symptom management and increasing general well-being for children undergoing cancer treatment. Acupressure has the benefit of stimulating targeted acupuncture points while providing therapeutic touch. We sought to explore the relationship between acupressure and the experience of well-being among children being treated for cancer who received acupressure.

Methods

In the Acupressure for Children in Treatment for a Childhood Cancer trial, hospitalized children received acupressure using specified acupressure points for symptom control as well as points for general well-being. Acupressure was delivered by professionals and by caregivers, following training by the professional. Qualitative data were collected through semistructured interviews with a purposive sample of professional acupressure providers (n = 3) and primary caregivers (n = 13), combined with participant observation during the acupressure intervention. Data were analyzed using grounded theory methods.

Results

Analysis of provider interview, caregiver interview, and participation observation yielded 3 prominent themes: (1) well-being elicited by acupressure, (2) well-being elicited by touch, and (3) well-being experienced as relational and intersubjective. These themes, taken together, illustrate the intricate ways in which an intervention like acupressure can help alleviate the difficulties of a childhood cancer illness experience by promoting well-being in the child as well as the caregiver. Acupressure brought symptom relief, physical relaxation, and comforting touch to the child, allowing the caregiver to also feel relief and relaxation as caregiver–child experience of well-being are closely intertwined.

Conclusions

Data from the 3 sources provided distinct and overlapping insights suggesting the versatile benefits of acupressure in promoting well-being during childhood cancer treatment. Professional acupressure combined with training of caregivers for childhood cancer may be a relational intervention that facilitates the experience of well-being for both the caregiver and the child.

Massage for children undergoing hematopoietic cell transplantation: a qualitative report

Background. No in-depth qualitative research exists about the effects of therapeutic massage with children hospitalized to undergo hematopoietic cell transplantation (HCT). The objective of this study is to describe parent caregivers' experience of the effects of massage/acupressure for their children undergoing HCT. Methods. We conducted a qualitative analysis of open-ended interviews with 15 parents of children in the intervention arm of a massage/acupressure trial. Children received both practitioner and parent-provided massage/acupressure. Results. Parents reported that their child experienced relief from pain and nausea, relaxation, and greater ease falling asleep. They also reported increased caregiver competence and closeness with their child as a result of learning and performing massage/acupressure. Parents supported a semistandardized massage protocol. Conclusion. Massage/acupressure may support symptom relief and promote relaxation and sleep among pediatric HCT patients if administered with attention to individual patients' needs and hospital routines and may relieve stress among parents, improve caregiver competence, and enhance the sense of connection between parent and child.

Hematopoietic cell transplant and use of massage for improved symptom management: results from a pilot randomized control trial

Background. Pediatric hematopoietic cell transplant (HCT) is a lifesaving treatment that often results in physical and psychological discomfort. An acupressure-massage intervention may improve symptom management in this setting. Methods. This randomized controlled pilot trial compared a combined massage-acupressure intervention to usual care. Children were offered three practitioner-provided sessions per week throughout hospitalization. Parents were trained to provide additional acupressure as needed. Symptoms were assessed using nurses' reports and two questionnaires, the behavioral affective and somatic experiences scale and the Peds quality of life cancer module. Results. We enrolled 23 children, ages 5 to 18. Children receiving the intervention reported fewer days of mucositis (Hedges' g effect size ES = 0.63), lower overall symptom burden (ES = 0.26), feeling less tired and run-down (ES = 0.86), having fewer moderate/severe symptoms of pain, nausea, and fatigue (ES = 0.62), and less pain (ES = 0.42). The intervention group showed trends toward increasing contentness/serenity (ES = +0.50) and decreasing depression (ES = −0.45), but not decreased anxiety (ES = +0.42). Differences were not statistically significant. Discussion. Feasibility of studying massage-acupressure was established in children undergoing HCT. Larger studies are needed to test the efficacy of such interventions in reducing HCT-associated symptoms in children.

Family Caregiver Provided Massage for Rural-Dwelling Chronically Ill Persons

Family caregivers attending to chronically ill family members within the community are vulnerable to psychological and medical health issues. Rural caregivers may be at increased risk because of fewer resources. This pilot study explored whether rural caregivers would learn and provide gentle massage to their chronically ill loved ones, would find study participation burdensome, and would realize benefits from providing the massage. Positive results in each of the three areas suggest that providing caregivers with instruction on gentle massage techniques for their chronically ill loved ones may support and enhance rural caregivers' perceptions of self-efficacy and self-agency and thus possibly decrease caregiver vulnerability. The findings of this study are important in light of increasing numbers of chronically ill persons who rely predominantly on home care by family members within the community.

Psychosocial well-being of parents of children with ataxia who attended the Training and Support Programme: a 12-month follow-up

The aim of this study was to investigate the impact of a Training and Support Programme (TSP) for parents of children with ataxia, 12 months after commencing the programme. The TSP provides instruction in basic massage to parents of children with disability and life limiting conditions. Questionnaires were mailed at 12-month follow-up to 27 parents who had completed a questionnaire at 4-month follow-up. Of the 14 parents who responded, the median age was 46 years (range 37-57 years), 11 were female and 6 were still massaging their children at 12-month follow-up. Eight children were male, median age 14 years (range 8.3-22.0 years). Results revealed trends towards improvements in parental satisfaction with life and improvements in children's sleeping and bowel movements for those who were still massaging their children at 12-month follow-up. Results suggest that it may be useful to offer parents support and encouragement in the year after attending the TSP, if they wish to continue to massage their children.

The effectiveness of the Training and Support Program for parents of children with disabilities: a randomized controlled trial

OBJECTIVE

The Training and Support Program (TSP) was designed to equip parents of children with disabilities with a simple massage skill for use with their children in the home environment. The effectiveness of the TSP was examined in a randomized controlled trial with a wait-list control group.

METHODS

Parents were trained in massage by suitably qualified therapists in eight weekly sessions, each lasting 1 h. The sample comprised 188 parents who were randomized to an intervention group (n=95), who attended the TSP with their children immediately, or a control group (n=93), who were offered the TSP after 4 months of follow-up. Data were collected by self-administered questionnaires at baseline and at 4-month follow-up.

RESULTS

The majority of participants were mothers (88%), with a partner (88%), and White European (82%); 40% worked full-time or part-time, and 34% had health problems (e.g., chronic fatigue, cancer, and arthritis). The TSP demonstrated statistically significant positive effects on parental self-efficacy (PSE) for managing children's psychosocial well-being and depressed mood (0.004 and 0.007). There were trends toward improvement on parental satisfaction with life (P=.053), global health (P=.065), and parental ratings of children's sleeping (P=.074) and mobility (P=.012). Effect sizes were small (0.11-0.23). Levels of anxiety, depression, and perceived stress were all higher than published norms.

CONCLUSION

The TSP is an effective means of improving PSE and depressed mood. Additional means of supporting parents need to be investigated.