Evidence-based assessment of health-related quality of life and functional impairment in pediatric psychology

Psychometric properties of the Hebrew KIDSCREEN 52, 27 and 10 items: a cross-sectional study of self and parents reports in youth with and without physical disabilities

PURPOSE

The KIDSCREEN health related quality of life (HRQoL) measures have not been validated in Hebrew and are under-studied in youth with physical disabilities. This study evaluated the psychometric properties of the Hebrew KIDSCREEN-52, 27, and 10, in self-report and parent versions, among youth with and without physical disabilities.

METHODS

Youth (ages 10-18) with and without physical disabilities, and their parents, completed the KIDSCREEN questionnaires. Disability-related data were collected using the Pediatric Evaluation of Disability Inventory (PEDI), along with psychological evaluations. Internal consistency was measured with Guttman's Lambada, and parent-child concordance using paired t-tests and intraclass correlation (ICC). Convergent validity was assessed with correlations and known group's and discriminative validity were tested by independent t-tests and receiver operating characteristic curve (ROC), respectively. Confirmatory factor analysis (CFI) was also conducted.

RESULTS

This study involved 566 child-parent dyads of youth without disabilities and 379 with disabilities, with a mean age of 12.42-13.54 years. Guttman's Lambada was acceptable (≥ 0.7) for all KIDSCREEN subscales. No significant differences were found between self- and parent-reports in the non-disability group, but parents scored lower in the disability group. ICC ranged from 0.5-to-0.90. Convergent validity was confirmed by significant associations between PEDI, psychological health and KIDSCREEN scales. Youth without disabilities reported better HRQoL than those with disabilities. The KIDSCREEN's discriminative ability ranged from very high accuracy in the self-reported KIDSCREEN-52 (AUC = 0.85) to moderate accuracy in the proxy-reported KIDSCREEN-10 (AUC = 0.683). The CFI showed overall good model fit.

CONCLUSION

The Hebrew KIDSCREEN scales show reliability and validity but should be interpreted cautiously due to study limitations. Parent reports should only be primary when self-report isn't possible, as youth with disabilities often differ in their HRQoL evaluations. Youth without physical disabilities reported better HRQoL across multiple dimensions, highlighting the importance of evaluating HRQoL in youth with physical disabilities to address their unique needs.

An evaluation of the validity, reliability, and psychometric properties of the Turkish version of the functional disability inventory in children and adolescents with chronic pain

PURPOSE

To investigate the cultural adaption, validity, and reliability of the Functional Disability Inventory (FDI) in Turkish children and adolescents with chronic headache.

MATERIALS AND METHODS

The original version of the FDI was translated to Turkish, back-translated and synthesized. The validity of the Turkish version of the FDI was examined using confirmatory factor analysis, discriminant validity and similar scale validation. Internal consistency and test-retest analyses were performed to determine the FDI reliability on 210 children and adolescents with chronic pain and 101 typically developing children and adolescents, all aged 8 to 18 years.

RESULTS

The Turkish version of the FDI was found to have excellent internal consistency (Cronbach's's α = 0.91) and test-retest reliability (ICC = 0.97). The confirmatory factor analysis identified a two-factor structure of the FDI. Scores on the FDI correlated with similar scales. There were significant differences in average total and average item scores of FDI between the two groups.

CONCLUSION

The results of the current study demonstrated that the FDI has appropriate psychometric qualities and is valid and reliable for application among children and adolescents with chronic pain.

CLINICAL TRIAL NUMBER

NCT05422456.

The Effectiveness of Leg- and Arm-Powered Trike Training Among Children with Impaired Walking Ability-A Pilot Study

Background/Objectives: The GO-TRYKE® Kid (GTK®) is an arm- and leg-powered tricycle which, in addition to promoting strength, endurance, and coordination, aims to reactivate the central pattern generators of the spine for locomotion through cyclical movements. The present study investigated the effects of GTK® training on walking ability, GTK® riding performance, and health-related quality of life in children with walking disabilities. Methods: Nine children trained with the device twice a week for nine weeks. Short- and long-term effects on walking ability were measured using the timed up and go test (TUG) and the two-minute walk test (2MWT). GTK® riding performance and health-related quality of life were compared before and after the intervention period. Results: While no long-term effect on walking was found, a significant short-term effect on functional walking ability was observed (p = 0.009). GTK® riding performance improved significantly over the training period (p = 0.004). There were no significant changes in health-related quality of life. Conclusions: GTK® enables children with walking disabilities to participate in cycling as part of play and sport. Further research is required to investigate its functional and participatory effects, as there is significant potential to improve physical activity and overall well-being in this population.

A validity and reliability study of the Work and Social Adjustment Scale (WSAS) Youth and Parent Forms in the Turkish population

This study assessed the validity and reliability of the Youth and Parent Forms of the Work and Social Adjustment Scale (WSAS) in the Turkish population. The patient group comprised 298 young patients aged 8 to 18 with any anxiety disorder, while 107 healthy young people formed the control group. Participants completed assessments, including the Screen for Child Anxiety-Related Disorders and the Pediatric Quality of Life Inventory (PedsQL), alongside the WSAS, while parents also completed the PedsQL and the WSAS. After 2 weeks, 100 individuals from the patient group were reevaluated for test-retest reliability. Results showed satisfactory validity and reliability, supported by statistical analyses, including Rasch analysis and Cronbach's alpha coefficient. The WSAS demonstrated validity across all evaluations and reliable internal consistency (Cronbach's alpha: parent form = .755, youth form = .750), test-retest reliability (correlation coefficients: parent form = 0.934, youth form = 0.937). Overall, the WSAS proved valid and reliable in the Turkish language.

Exploring the factors influencing the health-related quality of life in patients experiencing adverse drug reactions: a cross-sectional study

BACKGROUND

This study aimed to assess the factors influencing health-related quality of life (HRQoL) in patients experiencing adverse drug reactions (ADRs) at a tertiary care public sector hospital. A cross-sectional study was conducted over a period of 18 months, and included both male and female patients aged 18 years and above. Patients who visited the outpatient and inpatient departments with complaints associated with ADRs were included in this study. HRQoL data were collected using the EuroQol-5 Dimension-5 Level (EQ-5D-5L) questionnaire to assess five dimensions of health on a five-level scale. Descriptive statistics, t-tests, and analysis of variance were used to analyze the data. Multivariate regression analysis was performed to identify the potential determinants of HRQoL.

RESULTS

A total of 316 patients were included in the study among these participants, of which 54% were female, and 65% were from rural areas. The majority (68%) of the patients had moderately severe ADRs, and 63% of the participants had an income < 2.5 lakh Indian rupees (3009 USD). The mean EQ-5D-5L and EuroQoL Visual Analog Scale (EQ VAS) scores of the study participants were 0.714 and 69.73, respectively. The variables ADR severity, income, and age showed a significant difference (p < 0.05) in HRQoL.

CONCLUSION

This study provides insights into HRQoL among patients with ADRs and identifies the determinants of HRQoL. The findings of this study will contribute to improving patient-centered care and optimizing patient outcomes.

Patient Reported Outcomes in Patients with Cleft Lip and/or Palate Help Identify Youth at Risk for Suicidality

OBJECTIVE

To identify associations between scores on the CLEFT-Q and Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime Version in patients with cleft lip and/or palate (CLP).

DESIGN

Prospective.

SETTING

Tertiary care center.

PATIENTS, PARTICIPANTS

Patients ages six and older administered both the CLEFT-Q questionnaire and C-SSRS survey between 2019 and 2024.

INTERVENTIONS

Multidisciplinary care coordination facilitated by the team psychologist.

MAIN OUTCOME MEASURE(S)

Associations among demographics, CLEFT-Q responses, and suicidality.

RESULTS

A total of 305 patients were included, 141 females (46.2%) and 164 males (53.8%). Fifty-one (16.7%) endorsed lifetime incidence of suicidal ideation, four (1.3%) endorsed suicidal behavior, 12 (3.9%) endorsed non-suicidal self-injury (NSSI), and one (0.3%) endorsed self-injurious behavior, intent unknown. Patients endorsing suicidal ideation had lower PROs in 12/13 categories on the CLEFT-Q questionnaire (p < 0.001). Those with suicidal behavior had lower PROs in three health-related quality of life categories (psychological function, p = 0.018; social function, p = 0.005; school function, p = 0.007), but no difference in other domains. A cutoff of ≤70 in the CLEFT-Q psychological function domain identified suicidal ideation with 72.9% sensitivity and 65.9% specificity and suicidal behavior with 100.0% sensitivity and 62.2% specificity.

CONCLUSIONS

Patients with cleft lip and/or palate have increased risks for psychosocial challenges that are often missed by healthcare providers. This study reveals that patient-reported outcomes are worse in those with CLP who endorsed suicidal ideation and behavior. Low PRO responses identify suicidality with moderate sensitivity and specificity. Patients with low scores should be offered safety screenings and psychosocial support, ideally by mental healthcare professionals.

Health-related quality of life in 153 children with neuromuscular disorders in Latin America: is it age, functional dependence or diagnosis?

Neuromuscular diseases impact on children's health related quality of life but there is a lack of studies in Latin America that measured this construct. To respond to this need, this study aimed to explore quality of life and its relationship with age, functional dependence and specific diagnosis in children and adolescents in Latin America. A cross-sectional correlation study was carried out with 133 caregivers on children (2-18 years old) with various neuromuscular disorders. Parents reported on their children's health related quality of life through the PedsQL GCS and the PedsQL NMM. Differences in quality of life were found when comparing children with high functional dependence with those with mild dependence (p = 0.05). No significant differences were found regarding the child diagnosis. Finally, quality of life was highly correlated with the child's age, even when controlling for functional dependence differences between ages. Children and adolescents with neuromuscular show a diminished health related quality of life, not only in physical functioning but in their psychosocial functioning. Health related quality of life may vary according to the child's age and functional dependence.

Health-Related Quality of Life and Mental Health of Parents of Children with Pediatric Abdominal Tumors

BACKGROUND

Abdominal tumors rarely occur in childhood but are associated with great psychological stress for patients and their families. Parents playing a central role in their children's treatment may experience adverse effects on their Health-Related Quality of Life (HRQoL) and mental health due to the children's illness and required treatment. Given the limited knowledge of the psychosocial burden of parents with children suffering from solid abdominal tumors, this study aims to assess their HRQoL and mental health along with the impact of various psychosocial factors.

METHODS

A cross-sectional cohort study was carried out involving 54 parents of children with solid abdominal tumors who had surgery at the University Medical Center Hamburg-Eppendorf in Germany. The results were compared with 46 parents of children undergoing routine surgeries without a prior tumor diagnosis, and with normative values. Data were obtained using standardized questionnaires.

RESULTS

Parents of the index group showed significantly worse HRQoL and limited mental health. Furthermore, they showed significantly higher parental burden in several subscales and less social support in comparison with the control group.

CONCLUSIONS

Considering the lower parental HRQoL and the central role parents play in their children's lives, it is crucial to include prevention and intervention measures for parents as part of a multimodal treatment regime for children with solid pediatric abdominal tumors.

Peer support for people living with hepatitis B virus-A foundation for treatment expansion

Chronic hepatitis B infection (CHB) affects 300 million people worldwide and is being targeted by the United Nations 2030 Sustainable Development Goals (SDGs) and the World Health Organisation (WHO), working towards elimination of hepatitis B virus (HBV) as a public health threat. In this piece, we explore the evidence and potential impact of peer support to enhance and promote interventions for people living with CHB. Peer support workers (PSWs) are those with lived experience of an infection, condition or situation who work to provide support for others, aiming to improve education, prevention, treatment and other clinical interventions and to reduce the physical, psychological and social impacts of disease. Peer support has been shown to be a valuable tool for improving health outcomes for people living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), but to date has not been widely available for communities affected by HBV. HBV disproportionately affects vulnerable and marginalised populations, who could benefit from PSWs to help them navigate complicated systems and provide advocacy, tackle stigma, improve education and representation, and optimise access to treatment and continuity of care. The scale up of peer support must provide structured and supportive career pathways for PSWs, account for social and cultural needs of different communities, adapt to differing healthcare systems and provide flexibility in approaches to care. Investment in peer support for people living with CHB could increase diagnosis, improve retention in care, and support design and roll out of interventions that can contribute to global elimination goals.

The Association Between Autism Symptomatology and Adaptive Functioning Over Six Months: Findings from the Pilot Phase of the PARC Study

PURPOSE

In the context of developmental trajectories, the association between adaptive functioning and core autism symptomatology remains unclear. The current study examines the associations of adaptive behavior with autism symptom sub-domains and with different facets of symptom expression.

METHODS

Participants include 36 children with a recent diagnosis of autism (33 males; mean age = 56.4 months; SD = 9 months). Families were recruited in the context of the Pediatric Autism Research Cohort (PARC) project. Parents filled out questionnaires at two time points, six months apart, regarding their child's autism symptoms and adaptive functioning. The longitudinal relationship between adaptive functioning and autism symptoms was investigated using Mixed Linear Model analyses: one assessing the relationship between general symptom levels and adaptive functioning, and another examining the associations between symptom frequency and impact with adaptive functioning. We conducted Pearson correlation tests at both time points to assess the associations between symptom sub-domains and adaptive functioning.

RESULTS

Findings showed that higher autism symptoms associated with lower adaptive behavior skills, and that this association remained stable over time. Autism impact scores did not significantly relate to adaptive skills, as opposed to frequency scores. Associations between adaptive functioning and autism symptom sub-domains strengthened over time.

CONCLUSION

These findings suggest that adaptive functioning is associated with parent-report autism symptomatology, and that this association changes and, on average, becomes stronger over time. Findings may indicate that frequency and impact of symptoms have differential roles in the development of adaptive skills and are worthy of further exploration.

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.

Assessing uptake of the core outcome set in clinical trials for immune thrombocytopenia: A cross-sectional analysis

INTRODUCTION

Clinical trials (CTs) guide clinical practice, but inconsistent outcome reporting presents challenges. To increase comparability, a core outcome set (COS) was created for primary Immune thrombocytopenia (ITP) in 2009 to standardize outcome measurements. We aimed to evaluate uptake of the primary ITP COS in CT registries.

MATERIALS & METHODS

Our cross-sectional analysis employed a search string on ClinicalTrials.gov and ICTRP for phase III/IV CTs in June 2023. Inclusion criteria consisted of subjects with primary ITP, study was registered five years before COS publication to June 26, 2023, and assessed effectiveness of interventions. Two investigators extracted data in a masked, duplicate manner. Interrupted time series analysis, ANOVAs, and correlation analyses were conducted to assess the main outcome of COS uptake pre/post COS publication.

RESULTS

The search identified 131 eligible trials for data extraction. Altogether, 38.2 % (50/131) followed IWG platelet response guidelines. An alternative platelet count measurement was 50,000 × 109 L, with 46.56 % (61/131) of trials reporting it. The most measured outcome was adverse events (106/131, 80.9 %). Remaining secondary outcomes were measured in <50 % of studies. After COS publication, there was a statistically non-significant 0.03 % (p = 0.50, CI 95 % = [-0.06, 0.13]) 0.03 % (p = 0.50, CI 95 % = [-0.06, 0.13]) increase in the monthly trend of COS-defined outcomes.

CONCLUSION

We found a non-significant increase in uptake of the ITP COS since its publication and highlighted the lack of standardization among endpoints within ITP clinical trials. Our analysis highlights the need for heightened awareness and a COS update that acknowledges the variability in clinical trials.

Ranking of diseases affecting the health-related quality of life of patients in Poland - a cross-sectional study

Introduction

Epidemiology of non-communicable diseases (NCDs) provides scientific evidence indicating the appearance of dysfunction and disability in patients in various aspects and, as a result, a decrease in the quality of life (QoL). The main aim of the research was to prepare a ranking of diseases determining the degree of disease incidence quality of life (HRQoL) of patients in physical and mental dimensions.

Material and methods

The study was carried out in a group of 7,620 patients assigned to 13 groups of disease entities. The quality of life was assessed using the SF-36 questionnaire. The chances of a better QoL were assessed and the groups of diseases determining the individual QoL dimensions were indicated. Multi-stage, stratified random sampling was used in the study to obtain representatives in each diseases entities.

Results

The worst quality of life among the 13 analysed diseases was noted among cancer patients. Patients with ENT (ear, nose, throat) diseases had the highest chance of a better QoL among the studied subjects (Mental Component Summary (MCS)-OR: 27.4; Physical Component Summary (PCS)-OR: 27.9). Diseases such as cancers, diseases of the nervous system and cardiovascular diseases determined the lowest QoL in terms of MCS, PCS and ILQ (Index of Life Quality). Additionally, lower QoL in the MCS dimension was also affected by diabetes, diseases of the digestive and respiratory systems.

Conclusions

Cancer, cardiovascular disease and diseases of the nervous system are the disease entities correlated with poorer quality of life.

Health-Related Quality of Life in Kindergarten Children with Developmental Language Disorder: Child-Mother Agreement

Language disorders are associated with difficulties in various aspects of life, such as academic and social functioning, resulting in impaired health-related quality of life (HRQoL). Most studies use a parent proxy method to assess HRQoL. Since HRQoL refers to the subjective experience of an individual, it is necessary to assess children's perspectives along with their mothers'. The aim of the current study is to explore HRQoL rating agreement between children and their mothers, since the literature on other conditions suggests that discrepancies seem to reflect their different perspectives. Thus, 53 Greek-speaking children diagnosed with DLD attending kindergarten and their mothers completed, respectively, self-report and parent proxy PedsQLTM questionnaires. Mothers reported significantly better HRQoL than their children with developmental language disorder (DLD) in all HRQoL domains (p < 0.001). Poor agreement was revealed after comparing the scores from both responders, both in abstract domains, such as emotional functioning, as well as in more observable ones, such as physical health (ICC ranged from -0.05 to 0.07). Bland-Altman plots also showed poor agreement on HRQoL. Our results expand on the already known, from other conditions, importance of evaluating children's subjective experience of their HRQoL in kindergarten children with DLD. A multi-informant approach is ideal, and clinicians should prioritize children's view about their lives even when they are kindergarten-age. This approach could inform interventions focusing not only on language skills but also on other areas where it is necessary, depending on the child's subjective experience combined with the maternal perspective.

Health-related quality of life in family caregivers of autistic adults

Introduction

Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL.

Methods

N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL.

Results

Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05).

Discussion

Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.

Impact of hospitalization for vaso-occlusive crisis on health-related quality of life in children with sickle cell disease

BACKGROUND

Sickle cell disease (SCD) is characterized by vaso-occlusive crises (VOCs) that impair the health-related quality of life (HRQoL). The aim of this study is to evaluate the impact of hospitalization for VOCs on HRQoL in children with SCD over time.

METHODS

In this longitudinal cohort study, children aged 8-18 years diagnosed with SCD at the Amsterdam UMC were included between 2012 and 2021. HRQoL was annually measured as part of standard care using the Pediatric Quality of Life Inventory. The impact of hospitalization for VOC on HRQoL was evaluated using linear mixed models 3, 6, 9, and 12 months after hospitalization. The effect of frequency of hospitalization for VOC on HRQoL was evaluated over the last 12 months.

RESULTS

In total, 94 children with SCD were included with a median age of 11.8 years (interquartile range [IQR]: 9-14). Thirty-seven patients (39%) had been hospitalized for a VOC. Hospitalization for VOC led to a decrease of 3.2-4.8 points in total HRQoL compared to patients without hospitalization, most pronounced 3 months after hospitalization. Recurrent admission for VOC in the last 12 months was associated with a decrease of 2.3 points in total HRQoL (p = .04). The most affected subscale was physical functioning.

CONCLUSION

The adverse effects of hospitalization for VOC in children with SCD persist up to 12 months after hospitalization. After hospitalization for VOC, extra attention and support for its negative impact on HRQoL are recommended. This study also underlines the importance of systematically measuring HRQoL, allowing clinicians to intervene accordingly.

Receiver operating characteristic curve analysis of the Weiss Functional Impairment Rating Scale-Parent Report for screening children with ADHD: Looking beyond symptoms in ADHD diagnosis

AIM

The current study aimed at examining the ability of the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) to discriminate between children with ADHD and controls in functional impairment and identifying optimal cutoff scores for the WFIRS-P subscales and total scale.

METHODS

Parents of 51 children with ADHD (90.2% male; grades 1-6) and 51 gender/grade matched controls (90.2% male; grades 1-6) completed the WFIRS-P. Receiver operating characteristic (ROC) curve analysis was used to examine the ability of the WFIRS-P to differentiate children with ADHD from controls and to determine optimal cutoff scores of the WFIRS-P.

RESULTS

Area under the curve (AUC) was 0.98 for the WFIRS-P total scale, indicating excellent ability to differentiate children with ADHD from controls. The score of 0.45 with 0.88 for sensitivity and 0.96 for specificity was determined as the optimal cutoff score for the total scale of the WFIRS-P. AUC was 0.73 to 0.97 for the WFIRS-P subscales, suggesting good to excellent ability for discriminating between children with ADHD and controls. Among the subscales, the family subscale score of 0.42 with 0.92 for sensitivity and 0.96 for specificity showed the highest discriminating power. The self-concept and life skills subscales had low sensitivity, suggesting Iranian mothers do not identify problems with self-concept or difficulty with life skills as particularly problematic in ADHD.

CONCLUSIONS

The WFIRS-P is a sensitive and specific measure of the functional impairment associated with ADHD in Iranian children. Our sample was predominantly male, limiting the generalizability of results to females.

Patient and Parent Characteristics Related to Quality of Life and Self-Esteem in Healthy Youth Undergoing Provocative Growth Hormone Testing

OBJECTIVE

To examine how height and youth as well as parenting characteristics associate with quality of life (QoL) and self-esteem among healthy youth undergoing growth evaluation with growth hormone (GH) testing.

STUDY DESIGN

Healthy youth, aged 8-14 years, undergoing provocative GH testing, and a parent completed surveys at or around the time of testing. Surveys collected demographic data; youth and parent reports of youth health-related QoL; youth reports of self-esteem, coping skills, social support, and parental autonomy support; and parent reports of perceived environmental threats and achievement goals for their child. Clinical data were extracted from electronic health records. Univariate models and multivariable linear regressions were used to identify factors associated with QoL and self-esteem.

RESULTS

Sixty youth (mean height z score -2.18 ± 0.61) and their parents participated. On multivariable modeling, youth perceptions of their physical QoL associated with higher grade in school, greater friend and classmate support, and older parent age; youth psychosocial QoL with greater friend and classmate support, and with less disengaged coping; and youth height-related QoL and parental perceptions of youth psychosocial QoL with greater classmate support. Youth self-esteem associated with greater classmate support and taller mid-parental height. Youth height was not associated with QoL or self-esteem outcomes in multivariable regression.

CONCLUSIONS

Perceived social support and coping skills, rather than height, were related to QoL and self-esteem in healthy short youth and may serve as an important potential area for clinical intervention.

The Relationship between Self-Perceived Health and Physical Activity in the Mental Health of Korean Cancer Survivors

The purpose of this study was to investigate the relationship between self-perceived health and physical activity on the mental health of cancer survivors using the 2014, 2016, 2018, 2020 National Health and Nutrition Examination Survey (NHANES) data. The study included 378 participants aged 19 years or older who had been diagnosed with cancer, selected from the participants of the 2014, 2016, 2018, 2020 National Health and Nutrition Examination Survey. Our questions included self-perceived health status, physical activity (aerobic exercise, muscle strengthening exercise, walking and sedentary time), and mental health (depression, stress). The statistical analysis was performed using SAS 9.4 (SAS Institute Inc, Cary, NC, USA), and a complex sample analysis was performed using weights according to the KNHANES raw data usage guidelines from the Korea Centers for Disease Control and Prevention. The results of the data analyses showed that cancer survivors with self-perceived good health showed eight times lower levels of stress and five times lower levels of depression. In addition, the stress of cancer survivors with self-perceived good health was measured as about two times lower during the walking exercise. The depression index was measured as lower in the case of the walking exercise than in the case of the non-walking exercise. In conclusion, to manage depression and stress in cancer survivors, it is recommended to regularly monitor their subjective health condition, encourage positive evaluations of their health, and suggest continued participation in activities such as walking.

Identifying Symptoms of ADHD and Disruptive Behavior Disorders Most Strongly Associated with Functional Impairment in Children: A Symptom-Level Approach

To enhance the understanding of how symptoms of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders such as oppositional defiant disorder (ODD), conduct disorder (CD), including callous-unemotional (CU) traits, differentially relate to functional impairment (FI). Participants were 474 German school-age children (age: M = 8.90, SD = 1.49, 81% male) registered for participation in the ESCAschool trial (ESCAschool: Evidence-based, Stepped Care of ADHD in school-aged children). Clinicians assessed the severity of individual symptoms and five FI domains specifically associated with ADHD symptoms or ODD/CD/CU symptoms using a semi-structured clinical interview. We conducted two multiple linear regression analyses, combined with relative importance analyses, to determine the impact of individual symptoms on global FI associated with ADHD and ODD/CD/CU symptoms. Next, we estimated two networks and identified the strongest associations of ADHD symptoms or ODD/CD/CU symptoms with the five FI domains. Symptoms varied substantially in their associations with global FI. The ADHD symptom Easily Distracted (15%) and ODD symptom Argues with Adults (10%) contributed most strongly to the total explained variance. FI related to academic performance, home life and family members, and psychological strain were most strongly associated with ADHD inattention symptoms, whereas FI related to relationships with adults and relationships with children and recreational activities were most strongly associated with hyperactivity-impulsivity symptoms. By comparison, the ODD/CD/CU symptoms most closely linked to FI domains originated from the ODD and CD dimensions. Our findings contribute to a growing body of literature on the importance of analyzing individual symptoms and highlight that symptom-based approaches can be clinically useful.

Does kidney transplant improve health-related quality of life for youth with chronic kidney disease?

Youth with chronic kidney disease are known to have impaired health-related quality of life (HRQOL), particularly as the disorder increases in severity. Few prospective, longitudinal investigations of HRQOL within the context of pediatric chronic kidney disease exist. In the current issue, Guha et al. provide a longitudinal assessment of HRQOL for a cohort of youth with chronic kidney disease. Their findings suggest that children may experience meaningful improvement in HRQOL when they transition from dialysis to transplant.

The Impact of Chronic Suppurative Otitis Media with and without Cholesteatoma in Patients from Northeastern Romania

Quality of life is a widely used concept that tends to become an important part of clinical management. The present study performs an analysis of the impact of suppurative chronic otitis media with and without cholesteatoma on quality of life, using the COMQ-12 questionnaire. It was applied to a group of 40 healthy people and to 40 patients before surgery, and the answers to the questions were analyzed and correlated with socioeconomic factors. After the confirmation of the diagnosis based on clinical and imaging information, the patients completed the COMQ-12 questionnaire. It was observed that the chronic ear problems had negative impacts of varying degrees on daily and long-term activities. The evaluation and analysis of information can be used in setting therapeutic targets.

Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study

PURPOSE

We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs).

METHODS

This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS).

RESULTS

Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD.

CONCLUSION

This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.

Health-related quality of life of patients with multiple sclerosis: Analysis of ten years of national data

BACKGROUND

Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system. Both the physical and mental burden of MS affect patients' health-related quality of life (HRQoL). However, there is limited research at the national level evaluating the humanistic burden among MS patients.

OBJECTIVES

This study evaluated the HRQoL and functional limitations among MS patients using ten years of national survey data.

METHODS

Guided by the conceptual framework of the Wilson and Cleary model, this study compared HRQoL between adults diagnosed with MS (Clinical Classification Code= "080″) and non-MS adults using the 2006-2015 Medical Expenditure Panel Survey (MEPS) data. The humanistic burden included HRQoL and functional limitations. The HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) based on the Short Form Health Survey (SF-12). The study applied the multivariable Generalized Linear Models (GLM) to estimate the marginal differences in PCS and MCS based on the SF-12. In addition, seeking help for activities of daily living (ADL) and instrumental activities of daily living (IADL) were modeled with multivariable logistic regression.

RESULTS

According to the MEPS, the estimated annual prevalence of MS was 0.52 million (95% Confidence Interval [CI]: 0.42-0.60). MS patients were mainly female (71.90%), middle aged (50-64 years, 40.21%), non-Hispanic whites (78.29%), and enrolled in private insurance plans (68.93%). The average PCS scores in MS and non-MS groups were 35.70 and 49.48, respectively. The average MCS scores were 45.58 and 51.25 for MS and non-MS groups, respectively. In addition, 18.26% of MS patients sought help for ADL, and 27.08% sought help for IADL. After adjusting for individual, biological, and environmental characteristics, the multivariable GLM with Poisson distribution indicated that the marginal difference of PCS score was 11.10 (95% CI: 9.50-12.61) units lower, and the MCS score was 4.89 (95% CI: 3.44-6.30) units lower among MS patients. In addition, MS patients were 17.32 (95% CI: 11.61-25.84) and 14.43 (95% CI: 10.09-20.65) times more likely to request assistance for ADL and IADL, respectively.

CONCLUSIONS

MS was associated with lower physical and mental HRQoL than their non-MS counterparts and MS patients were more likely to request help for ADL and IADL. More work is needed to evaluate the effect of treatment strategies on improving the HRQoL and functional limitations in MS.

Systematic review of reviews on Activities of Daily Living measures for children with developmental disabilities

Background

There seems to be a lack of consensus on the concept and domains of Activities of Daily Living (ADL) measured among children and adolescents with developmental disabilities (DD), despite a significant number of existing measures of ADL and associated constructs, and two prevailing theoretical frameworks (i.e., the cognitive-social-practical framework, and the activity-and-participation framework).

Aims

This systematic review (SR) aims to identify articles that systematically reviewed measures of ADL for children and adolescents aged 7-18 years with DD to evaluate the quality of included articles, and describe the measures and domains identified.

Methods

and Procedures: Searches were conducted in PubMed®, Academic Search Complete® (EBSCOhost), Education Source Search® (EBSCOhost), ERIC® (EBSCOhost), and PsychInfo® (EBSCOhost). 14,931 articles were identified, and two researchers completed title screening, abstract screening, and full-text screening, with disagreements resolved. Out of these 14,931 articles, fourteen were included, which resulted in a total of 163 ADL measures. Out of the 163 ADL measures, forty-eight met the criteria and were included for analysis. PRISMA and COSMIN checklists were used to appraise the methodological quality of the included articles.

Outcomes and results

Results indicated that most of the 14 systematic review articles did not provide information on instrument development and content validity of their included measures. Analysis of the identified 48 measures of ADL and its associated constructs revealed heterogeneity in domains covered, although there were seven domains that were most often included.

Conclusions and implications

Implications in terms of practice, research, and policy are further discussed.

The Reliability of the Thai version of Health-Related Quality of Life Questionnaire: PedsQL 3.0 Cancer Module

Assessing the health-related quality of life (HRQOL) is highly recommended as a standard of care for children with cancer in conjunction with medical treatment. The Pediatric Quality of Life Inventory (PedsQL) Cancer Module is a standard tool designed to assess the HRQOL among pediatric oncology patients. This study aimed to evaluate the reliability and correlation of the PedsQL 3.0 Cancer Module in Thai version between child and parent reports. A cross-sectional study was conducted on 85 Thai children with cancer and their families. Excellent internal consistency of the PedsQL 3.0 Cancer Module of the Thai version was addressed among child and parent reports (0.92 and 0.94, respectively). Overall positive correlations were also found between child and parent reports ( r = 0.61, P < .001). However, the statistically significant differences of HRQOL scores between child and parent reports were determined on procedural anxiety (70.05 ± 26.67 vs 60.03 ± 25.6, P = .003), treatment anxiety (88.15 ± 17.37 vs 76.82 ± 26.7, P = .001), worry (66.67 ± 25.59 vs 55.34 ± 30.37, P = .003) and the total score (74.37 ± 15.7 vs 70.42 ± 17.15, P = .034). This study demonstrated desirable internal reliability with positive correlations between child and parent reports of the PedsQL 3.0 Cancer Module in Thai version, although possible differences between child and parent HRQOL scores should be considered.

Reliability and validity of the Japanese version of the Pediatric Quality of Life Inventory Infant Scales

BACKGROUND

PedsQL Infant Scales (PedsQL-I) are used to assess parent-reported health-related quality of life for children younger than 2 years. We determined the feasibility, reliability, and validity of the Japanese version of the PedsQL-I.

METHODS

A total of 183 participants (parents) with infants aged 1-30 months were recruited from 8 day care centers and one pediatric clinic. Participants completed the PedsQL-I (infants aged 1-18 months), the PedsQL-I and the PedsQL-Toddler version (infants aged 19-30 months), and the Kessler-6 psychological distress scale (all participants). We determined feasibility, internal consistency, test-retest reliability, concurrent validity, convergent and discriminant validity, known-groups validity with regard to acute and chronic illness, and relative and transitional validity with PedsQL-Toddler for the use in infants aged 25-30 months.

RESULTS

All subscales were internally consistent (Cronbach's alpha for 1-12 months: 0.88-0.98 and for 13-24 months: 0.85-0.97); test-retest reliability was acceptable (intra-class correlation coefficients > 0.40); and all scales were concurrently valid with the PedsQL-Toddler version (Pearson's product-moment correlation coefficient for the total score = 0.74). The scales' convergent and discriminant validity were acceptable (scaling success rate > 80%). Validation for known-groups showed that the Physical Health Summary score was sensitive to acute and chronic disease, the Psychosocial Health Summary score was sensitive to neither acute nor chronic disease, and the total score was sensitive to acute disease. Relative validity showed a ratio of 1.74 for the squared t values for the total score.

CONCLUSIONS

The PedsQL-I is suitable for assessing health-related quality of life in infants aged 1-24 months in prospective studies.

Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

Background: Health-related quality of life (HRQoL) is multidimensional and is composed of, at a minimum, self-perceived health status, physical functioning, and psychological well-being. HRQoL measures reflect the extent of disability and dysfunction associated with a chronic disease such as cancer. The objective of this study is to examine factors associated with HRQoL among cancer survivors.

Methods: Data from the 2009 Behavioral Risk Factor Surveillance System survey was used to examine factors associated with HRQoL among participants who reported having ever been diagnosed with cancer. Four questions associated with HRQoL included self-perceived health status, number of bad physical health days, and number of bad mental health days per month. Least square regression and logistic regression models, adjusted for confounding variables, were used for an ordinal and dichotomous [5 (bad) vs. 1–4 (excellent, very good, good, fair)] scale of HRQoL, respectively.

Results: Fifty nine thousand one hundred seventy three participants reported having ever been diagnosed with cancer. Adjusted mean self-perceived health status (5-point scale) among survivors of thyroid, colon, lung, cervical, breast, prostate, and ovarian cancer was 3.83 (0.05), 4.02 (0.04), 4.36 (0.06), 3.77 (0.03), 3.88 (0.03), 3.78 (0.04), and 3.96 (0.05), respectively. After adjusting for confounders, a positive dose-response effect was observed between income range and all three HRQoL measures across all seven cancer sites. Income was consistently and inversely associated with a higher chance for reporting poorer HRQoL [OR: 0.64, 95% CI: 0.57–0.71], [OR: 0.63, 95% CI: 0.48–0.82], [OR: 0.67, 95% CI: 0.56–0.80], [OR: 0.69, 95% CI: 0.56–0.86], [OR: 0.55, 95% CI: 0.49–0.62], [OR:0.55, 95% CI: 0.44–0.69], [OR: 0.75, 95% CI: 0.62–0.91] among those with thyroid, colon, lung, cervical, breast, prostate, and ovarian cancer, respectively.

Discussion: This study found that income range was associated with HRQoL among cancer survivors. It is plausible that financial resources may lessen the overall burden of cancer survivors, which could improve health-related quality of life among cancer survivors.

Health-Related Quality of Life and Undergraduate Nursing Students: A Narrative Review

Background:

Undergraduate nursing students are vulnerable to stressful university learning environments and poor working conditions in clinical rotations. This can result in students leaving nursing programs or abandoning the profession following graduation. As a result, the health-related quality of life of nursing students is an important indicator to monitor student quality of life adequacy. Preventing premature student nurses' departure from the profession is necessary to reduce the nursing shortage.

Objective:

To describe the body of knowledge about the health-related quality of life for undergraduate nursing students during their qualification process.

Methods:

This was a narrative review through a six-database search, including Cochrane, CINAHL, Pubmed, Medline, PsycINFO and Livivio, from between January 1990 and June 2018, with updates in the search followed until November 2019. To assess study quality, the STROBE checklist was used.

Results:

Eight studies were included in a narrative synthesis. All studies were of cross-sectional design, and none included follow-up procedures. Most of the studies recruited participants from nursing courses and only one study recruited students from a national register. Sample sizes ranged from 110 individuals to 4,033 participants in the register-based study. Common health-related dimensions evaluated included stress, social support, mental health, fatigue, quality of life, and drug abuse. Stress, the most commonly studied dimension, was associated with clinical placements, final exams, and non-prescribed drugs. Social support networks were positively associated with coping abilities and self-esteem.

Conclusion:

There is low-quality evidence of the impact of nursing courses upon student health-related dimensions (stress, self-esteem, health-related behaviors). Nurse educators should be aware of these associations and support routine screening of students and their health-related dimensions. Interventions, such as consultation and study redesign, might increase the level of health-related dimensions. Nursing schools should further collaborate to investigate these associations and tailored interventions to positively affect health-related dimensions in nursing students.

Peripheral vestibular system: Age-related vestibular loss and associated deficits

Given the interdependence of multiple factors in age-related vestibular loss (e.g., balance, vision, cognition), it is important to examine the individual contributions of these factors with ARVL. While the relationship between the vestibular and visual systems has been well studied (Bronstein et al., 2015), little is known about the association of the peripheral vestibular system with neurodegenerative disorders (Cronin et al., 2017). Further, emerging research developments implicate the vestibular system as an opportunity for examining brain function beyond balance, and into other areas, such as cognition and psychological functioning. Additionally, the bidirectional impact of psychological functioning is understudied in ARVL. Recognition of ARVL as part of a multifaceted aging process will help guide the development of integrated interventions for patients who remain at risk for decline. In this review, we will discuss a wide variety of characteristics of the peripheral vestibular system and ARVL, how it relates to neurodegenerative diseases, and correlations between ARVL and balance, vision, cognitive, and psychological dysfunction. We also discuss clinical implications as well as future directions for research, with an emphasis on improving care for patients with ARVL.

Gender Dysphoria and Chronic Pain in Youth

Chronic pain in youth with gender dysphoria (GD) is poorly understood. The aim of our study was to review the clinical presentation of 8 youth with GD in a multidisciplinary chronic pain clinic. A single center retrospective chart review was conducted to obtain information on demographics, clinical care, previous diagnoses, and validated clinical measures. We present the trajectory of pain in this population with treatment of GD. Recognition and treatment of GD in youth with pain may improve pain outcomes.

A Moving Target: How We Define Avoidant/Restrictive Food Intake Disorder Can Double Its Prevalence

Objective: The DSM-5 criteria for avoidant/restrictive food intake disorder (ARFID) include ambiguities. Diagnostic criteria that allow for clinical judgment are essential for clinical practice. However, ambiguities can have major implications for treatment access and comparability and generalizability of research studies. The purpose of this study was to determine the degree to which distinct operationalizations of the diagnostic criteria for ARFID contribute to differences in the frequency of individuals who are eligible for the ARFID diagnosis. Methods: Because criteria B, C, and D are rule-outs, we focused on criterion A, identified 19 potential operational definitions, and determined the extent to which these different methods impacted the proportion of individuals who met criteria for ARFID in a sample of children, adolescents, and young adults (n = 80; September 2016-February 2020) enrolled in an avoidant/restrictive eating study. Results: Within each criterion, the proportion of individuals meeting diagnostic criteria differed significantly across the methodologies (all P values < .008). Using the strictest definition of each criterion, 50.0% (n = 40) of participants met criteria for ARFID. In contrast, under the most lenient definition of each criterion, the number nearly doubled, resulting in 97.5% (n = 78) meeting ARFID criteria. Conclusions: Comparison of diagnostic definitions for ARFID among children, adolescents, and young adults confirmed a broad range of statistically distinct proportions within a single sample. Our findings support the need for additional contextual support and consensus among disciplines on operationalization in both research and clinical settings.

Measuring What Matters for Children: A Systematic Review of Frequently Used Pediatric Generic PRO Instruments

OBJECTIVE

To provide an assessment of the quality of the most frequently used self-reported, generic patient-reported outcome measures (PROMs) that measure health-related quality of life (HRQoL) in children against the good research practices recommended by ISPOR task force for the pediatric population.

METHOD

Literature search was conducted on OvidSP database to identify the generic pediatric PROMs used in published clinical studies. The quality of PROMs used in more than ten clinical studies were descriptively evaluated against the ISPOR task force's good research practices.

RESULTS

Six PROMs were evaluated, namely Pediatric Quality-of-Life inventory 4.0 (PedsQL), Child Health Questionnaire (CHQ), KIDSCREEN, KINDL, DISABKIDS and Child Health and Illness Profile (CHIP). All PROMs, except KIDSCREEN, had versions for different age ranges. Domains of physical, social, emotional health and school activities were common across all the instruments, while domains of family activities, parent relations, independence, and self-esteem were not present in all. Children's input was sought during the development process of PROMs. Likert scales were used in all the instruments, supplemented with faces (smileys) in instruments for children under 8 years. KIDSCREEN and DISABKIDS were developed in a European collaboration project considering the cross-cultural impact during development.

CONCLUSION

The comparison of the instruments highlights differences in the versions for different pediatric age groups. None of the PROMs fulfill all the good research practices recommended by the ISPOR task force. Further research is needed to define which age-appropriate domains are important for older children and adolescents.

Patient Report of Hearing in Neurofibromatosis Type 2: Recommendations for Clinical Trials

OBJECTIVE

To systematically evaluate published patient-reported outcome measures for the assessment of hearing function and hearing-related quality of life (QoL) and recommend measures selected by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration (REiNS) as endpoints for clinical trials in neurofibromatosis type 2 (NF2).

METHODS

The REiNS Patient-Reported Outcomes Working Group systematically evaluated published patient-reported outcome measures of (1) hearing function and (2) hearing-related QoL for individuals with hearing loss of various etiologies using previously published REiNS rating procedures. Ten measures of hearing functioning and 11 measures of hearing-related QoL were reviewed. Measures were numerically scored and compared primarily on their participant characteristics (including participant age range and availability of normative data), item content, psychometric properties, and feasibility for use in clinical trials.

RESULTS

The Self-Assessment of Communication and the Self-Assessment of Communication-Adolescent were identified as most useful for adult and pediatric populations with NF2, respectively, for the measurement of both hearing function and hearing-related QoL. Measures were selected for their strengths in participant characteristics, item content, psychometric properties, and feasibility for use in clinical trials.

CONCLUSIONS

REiNS recommends the Self-Assessment of Communication adult and adolescent forms for the assessment of patient-reported hearing function and hearing-related QoL for NF2 clinical trials. Further work is needed to demonstrate the utility of these measures in evaluating pharmacologic or behavioral interventions.

Quality of Life-CI: Development of an Early Childhood Parent-Proxy and Adolescent Version

OBJECTIVES

Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes.

DESIGN

Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use.

RESULTS

Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence).

CONCLUSIONS

The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the "whole" child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.

Associations Between Child Maltreatment and Adolescents' Health-Related Quality of Life and Emotional and Social Problems in Low-Income Families, and the Moderating Role of Social Support

This study aimed to examine the associations between different types of child maltreatment and health-related quality of life (HRQoL) and emotional and social problems in adolescents, and to examine the moderating effect of social support on those associations. A cross-sectional survey was conducted between January and June 2016 in Hong Kong. The sample comprised 351 parent and adolescent dyads from low-income families. The parents reported on child maltreatment (physical abuse, psychological aggression, and neglect), and the adolescents reported on their HRQoL, emotional problems, and social problems. The adolescents' perceived social support was included as a potential moderator. Results of the study show that child physical abuse was strongly associated with emotional and social problems (B = 0.91-1.45, p < .05). Lower overall HRQoL was associated with psychological aggression (B = -3.96, p < .05) and neglect (B = -4.14, p < .05). Physical functioning was affected by psychological aggression (B = -3.16, p < .05), and emotional functioning was affected by neglect (B = -4.82, p < .05). Social functioning was impacted by all three types of maltreatment (B = -9.16 to -5.26, p < .05). This study extends previous literature by showing the varying effects of different types of child maltreatment on children's health in the context of low-income families. The findings of this study also support that peer social support may buffer the effects of child physical abuse on adolescents' emotional and social problems.

The associations between pediatric weight status and cystic fibrosis-related diabetes status and health-related quality of life among children and young adults with cystic fibrosis: A systematic review

BACKGROUND

Cystic fibrosis (CF) is a life-shortening genetic disease, yet life expectancy has recently increased, shifting the focus to disease management and health-related quality of life (HRQoL). Identification of clinical factors, such as weight status and CF-related diabetes (CFRD), that are associated with HRQoL can inform clinicians about the patient's health perception. The goal of this systematic review was two prong: identify the association of pediatric weight status and HRQoL and determine how CFRD status impacts HRQoL.

METHODS

A systematic review of published research was conducted following the methodology in the Cochrane Handbook on Systematic Reviews for Interventional Studies. Results were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Risk of bias was assessed using the National Heart Lung & Blood Institute tool. A meta-analysis was not performed due to variability of the inclusion/exclusion criteria, differences in outcome reporting, and insufficient primary outcome data to pool.

RESULTS

Nine studies met inclusion criteria (n = 6 explored weight status and n = 3 studied CFRD), for a total of 1585 subjects (CFRD cases = 87). Pediatric weight status was positively associated with HRQoL, most commonly the Body Image and Eating Disturbance domains. CFRD was negatively associated with HRQoL, specifically the Treatment Burden and Weight domains.

CONCLUSIONS

Based on the limited data available, improved pediatric weight status appears to increase HRQoL while a CFRD diagnosis appears to decrease HRQoL. More research is needed to fully understand the role of these clinical factors on HRQoL, especially with life expectancy increasing among those with CF.

Fear of relapse in patients suffering from RRMS influence their quality of life

Multiple Sclerosis (MS) is a chronic, potentially debilitating disease that affects millions of patients worldwide. About 85% of patients experience a disease subtype characterised by relapses and remittance (RRMS). While many studies have investigated factors influencing patients'' health-related quality of life (HRQoL) in RRMS, none have taken patients' fear of relapses into account. In this study, we measured the patients' self-reported HRQoL, fear of relapse (FoR), health anxiety (HA), number of relapses, duration of disease, type of medication and perceived level of side effects. Treating neurologists provided an estimate of patients' disease severity. All covariates and demographic (personal and disease-related) characteristics were included in regression modelling of their association with HRQoL. The model showed that HRQoL was most strongly associated with disease severity estimated by neurologists, which was highly correlated with the number of relapses and disease duration. However, upon adjustment for FoR (in the presence of all covariates), this association between disease severity and HRQoL attenuated, and FoR remained the only covariate significantly associated with HRQoL. Notably, our modelling also revealed a significant association between HA and FoR in RRMS patients. This study's findings have important implications for the management of MS in RRMS patients and point to the critical roles of FoR and HA as drivers of HRQoL in RRMS. Given the importance of HRQoL to the patient experience and economically, we argue that a more nuanced understanding is needed of the subjective nature of quality of life and its determinants. Interventions aimed at reducing psychological distress and anxiety should be explored.

Parent-child discrepancies in health-related quality of life of children and adolescents with myalgic encephalomyelitis/chronic fatigue syndrome

PURPOSE

Few studies have examined parent-child discrepancies on self-report measures of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptomatology and health-related quality of life (HRQOL). The aim of this study was to investigate parent-child reporting discrepancies between a pediatric sample of diagnosed patients with ME/CFS and controls to better understand the role of children and adolescent reporting.

METHOD

Data for this study were drawn from a community-based epidemiological study of pediatric ME/CFS in the Chicagoland area. A total of 147 parent-child dyads (75 pairs with ME/CFS and 72 control pairs) completed measures assessing HRQOL and ME/CFS symptomatology. At the individual level, agreement was assessed using intra-class correlation coefficient (ICC) scores. Agreement was measured at the group level by a comparison of means using paired-sample t-tests.

RESULTS

Intra-class correlations revealed varied agreement in both parent-child pairs of children who met at least one case definition of ME/CFS and in parent-child pairs in the control group.

CONCLUSION

The current study provides support for the existence of discrepancies between parent-child reports of ME/CFS symptomatology and HRQOL measures. Limitations and future directions are discussed.

The measurement properties of tests and tools used in cystic fibrosis studies: a systematic review

There is no consensus on how best to measure responses to interventions among children and adults with cystic fibrosis (CF). We have systematically reviewed and summarised the characteristics and measurement properties of tests and tools that have been used to capture outcomes in studies among people with CF, including their reliability, validity and responsiveness. This review is intended to guide researchers when selecting tests or tools for measuring treatment effects in CF trials. A consensus set of these tests and tools could improve consistency in how outcomes are captured and thereby facilitate comparisons and synthesis of evidence across studies.

Pain and QOL in Pediatric Sickle Cell Disease: Buffering by Resilience Processes

OBJECTIVE

Sickle cell disease (SCD) is a group of inherited blood disorders. The central feature of this chronic condition is pain. Several identified risk factors exacerbate the impact of pain on quality of life (QOL) in SCD; however, there are relatively fewer investigations of strengths-based resilience variables that might buffer the influence of pain on living with SCD. The purpose of this study was to examine strength-based resilience processes in youth with SCD and their parents. Grounded in an ecological resilience-risk model, we evaluated whether adolescent and parent protective factors (pain acceptance, mindfulness, and psychological flexibility) moderated the relation between adolescent-reported pain burden and QOL.

METHODS

Ninety-three 12- to 18-year-old adolescents with SCD and their parents participated. Adolescents completed assessments of pain characteristics, pain acceptance, mindfulness, and QOL. Parents completed instruments measuring demographic and disease variables and parent psychological flexibility.

RESULTS

Pain variables were associated with protective factors in predicted directions. Adolescent acceptance and mindfulness were positively correlated with QOL. Parent psychological flexibility and adolescent QOL were not related. After controlling for demographic, pain, and disease variables, moderation analyses indicated that adolescent pain acceptance buffered the relation between SCD pain burden and QOL. Moderation analyses were not significant for adolescent mindfulness or parent psychological flexibility.

CONCLUSIONS

Results suggest that strengths-based factors may play an important role for adolescents' QOL within the context of SCD pain. Interventions that enhance teenagers' ability to accept pain might be particularly useful to improve QOL in adolescents living with SCD pain.

Quality of Life and Awareness of Hypertension Among Hypertensive Patients in Saudi Arabia

Background and aim

Hypertension possesses significant public health challenges for both developing and developed economies. Therefore, it is crucial to evaluate the awareness of hypertension and health-related quality of life (HRQoL) among patients with hypertension. This study aims to evaluate the knowledge of hypertension and HRQoL among hypertensive patients.

Materials and methods

A cross-sectional study using an anonymous questionnaire was conducted over a period of 4 months (November 2020 to February 2021) in Riyadh, Kingdom of Saudi Arabia (KSA). This study included 437 questionnaires submitted by the hypertensive population.

Results

A total of 437 participants were included in this study, with 55.4% being males (n=242). The majority (85.1%) were aware of the normal values of blood pressure. Many participants had no problems with mobility, personal care, usual activities, pain or discomfort, and anxiety or depression. Age groups showed a significant association with mobility and usual activities. The knowledge of hypertension was significantly associated with HRQoL.

Conclusion

This study found that majority of the hypertensive patients were aware of the standard values of blood pressure. HRQoL concerning physical functioning and general health is found to be good based on the EuroQol visual analogue scale (EQ VAS) in the hypertensive population who are aware of their condition. This study reported a weak yet significant association between hypertension-related knowledge and HRQoL scores. Several factors can affect the HRQoL of the hypertensive population including gender, education, occupation, and income status.

Long-term quality of life and work status after high-dose spinal cord stimulation in patients with failed back surgery syndrome: a secondary analysis of real-world data

OBJECTIVE

In recent years, the use of high-dose spinal cord stimulation (HD-SCS) as a treatment option for patients with failed back surgery syndrome (FBSS) has drastically increased. However, to the authors' knowledge a thorough evaluation of health-related quality of life (HRQOL) and work status in these patients has not yet been performed. Moreover, it is unclear whether patients who are treated with HD-SCS can regain the same levels of HRQOL as the general population. Therefore, the aims of this study were to compare the HRQOL of patients who receive HD-SCS to HRQOL values in an age- and sex-adjusted population without FBSS and to evaluate work status in patients who are receiving HD-SCS.

METHODS

HRQOL, measured with the 3-level EQ-5D (EQ-5D-3L), and work status were evaluated in 185 FBSS patients at baseline (i.e., before SCS) and at 1, 3, and 12 months of treatment with HD-SCS. Difference scores in utility values between patients and an age- and sex-adjusted normal population were calculated. One-sample Wilcoxon tests were used to assess the EQ-5D-3L difference scores. Mixed models were used to evaluate the evolution over time in EQ-5D-3L utility scores and EQ-5D visual analog scale (VAS) scores in patients and matched controls. Quality-adjusted life-years (QALYs) were calculated using the area under the curve method.

RESULTS

An overall significant increase in EQ-5D-3L utility scores and EQ-5D VAS scores was found over time in the patient group. Wilcoxon tests indicated that the difference scores in utility values between patients and the normal population were significantly different from zero at all time points. The median incremental QALY after 12 months of HD-SCS was 0.228 (Q1-Q3: 0.005-0.487) in comparison to continued conservative treatment. At 12 months, 13.75% of patients resumed work.

CONCLUSIONS

HD-SCS may lead to significantly increased HRQOL at 12 months in patients with FBSS. Despite the increase, reaching the HRQOL level of matched controls was not achieved. Only a limited number of patients were able to return to work. This finding indicates that specialized programs to enhance return to work may be beneficial for patients undergoing SCS.

Emergent academic skills growth in New Zealand pre-school children undergoing treatment for sleep disordered breathing: a case-control pilot study

OBJECTIVES

The main objective of this study was to explore the feasibility and treatment sensitivity of measures of preschool oral language and emergent literacy and numeracy for assessing developing skills of preschool children with sleep disordered breathing (SDB) in New Zealand following adenotonsillectomy.

METHODS

Eight preschool children aged 3 years 1 month-4 years 5 months were recruited from a surgical waiting list and matched to controls for age (±3 months) and sex. Tasks designed to be sensitive to growth in oral language and emergent literacy and numeracy were reviewed for contextual fit, adapted as necessary for the New Zealand context, and administered before surgery (baseline), three months post-surgery, and at a seven-month follow-up alongside other measures.

RESULTS

Growth in oral language and emergent literacy was greater for case children than matched controls, suggesting that the tasks were sensitive to treatment effects. No such effect was observed for early numeracy tasks. Case children had more symptoms of SDB and behavioral and emotional difficulties than matched controls prior to surgery, and improvements were reported in these domains following surgery.

CONCLUSIONS

Oral language and emergent literacy measures trialled in the present research showed potential for evaluating treatment outcomes in pre-schoolers with SDB, and provided preliminary evidence that early treatment of SDB could have positive effects on learning in these domains.

Physical and psychosocial quality of life in children with overweight and obesity from Sri Lanka

Background

While childhood obesity is rising rapidly in South Asia, there is limited research on quality of life (QoL) of children with overweight and obesity from the region. This study assessed physical and psychosocial QoL in Sri Lankan children attending a specialized obesity clinic, from both children’s and parents’ perspective, and modifiable social factors affecting QoL.

Methods

We performed cross-cultural translation of the Pediatric Quality of Life Inventory (PedsQL™) 4.0 (Child-Self Report and Parent-Proxy forms), and assessed self-reported and parental-perception of physical and psychosocial QoL in 8–12 year-olds with overweight and obesity (n=110), referred for obesity management at a tertiary-care children’s hospital in Sri-Lanka. Body mass index (BMI) and pre-selected social factors affecting QoL were also assessed. Data were analyzed by non-parametric tests (Mann-Whitney U test, Wilcoxon test and Spearman correlation).

Results

The median physical QoL was lower than psychosocial QoL (78.1vs81.7, p=0.032) and physical QoL was inversely correlated with BMI. Parental-perception of children’s physical and psychosocial QoL correlated with child-reported QoL, but was lower. Being bullied (p=0.001) and not getting regular exercise (p=0.031) were associated with lower psychosocial QoL. Both physical and psychosocial QoL were lower in children having difficulties in finding suitable clothes (p< 0.001).

Conclusions

Children with overweight and obesity from Sri Lanka appeared to have greater impairment of physical QoL than psychosocial QoL. Higher BMI, bullying, lack of regular exercise and lack of suitable clothing, negatively affected QoL. Potential strategies to improve QoL include promoting regular exercise, addressing bullying and promoting availability of children’s clothes in larger sizes to fit children with overweight and obesity.

Impact of polycystic ovary syndrome on eating behavior, depression and health related quality of life: A cross-sectional study in Riyadh

Background & objectives

Polycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh.

Materials and methods

This is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25.

Results

Of the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior.

Interpretation & conclusion

In conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

Construct Validity of the Autism Impact Measure (AIM)

The Autism Impact Measure (AIM) was designed to track incremental change in frequency and impact of core ASD symptoms. The current study examined the structural and convergent validity of the AIM in a large sample of children with ASD. The results of a series of exploratory and confirmatory factor analyses yielded a final model with five theoretically and empirically meaningful subdomains: Repetitive Behavior, Atypical Behavior, Communication, Social Reciprocity, and Peer Interaction. The final model showed very good fit both overall and for each of the five factors, indicating excellent structural validity. AIM subdomain scores were significantly correlated with measures of similar constructs across all five domains. The results provide further support for the psychometric properties of the AIM.