Health-Related Quality of Life and Related Factors among Primary Caregivers of Children with Disabilities in Shanghai, China: A Cross-Sectional Study

Quality of life and associated factors among primary caregivers of children and adolescents with neurodevelopmental disorders attending public hospitals in Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND

Neurodevelopmental disorders are a set of disorders that negatively affect the acquisition of skills in a variety of developmental domains, including motor function, learning, socialization, language and cognition. However, there is no information available on the standard of living of Ethiopian primary caregivers of children and adolescents with neurodevelopmental disorders. Therefore, this study aimed to assess the quality of life (QOL) and associated factors among primary caregivers of children and adolescents with neurodevelopmental disorders in Addis Ababa, Ethiopia.

METHODS

A cross-sectional study was conducted during 1-30 May 2022. Systematic random sampling was used to obtain 352 samples. QOL was measured using the WHO Quality of Life Brief. The gathered information was coded, entered into EpiData 4.6.0.2 and analyzed with SPSS version 26. Multiple linear regression analysis was used to identify the correlates of QOL and the strength of the correlation was measured by β coefficient with 95% CI.

RESULTS

The mean score of the overall QOL was 62.61 with a SD of 5.17. The mean (±SD) scores for the physical health, psychological, environmental and social relationship domains of primary caregivers were 57.36±9.98, 66.98±9.39, 66.06±12.91 and 60.02±9.14, respectively. Age was significantly associated with physical domain (β=-0.25, 95% CI -0.43 to -0.07) and with environmental domain (β=-4.57, 95% CI -9.06 to -0.09). Being divorced/widowed was negatively associated with psychological health (β=-2.99, 95% CI -5.82 to -0.17) and social health (β=-0.62, 95% CI -1.33 to -0.10). The presence of medical illness was negatively associated with the physical health domain (β=-4.32, 95% CI -7.64 to -2.91) and the environmental domain (β=-3.11, 95% CI -5.71 to -0.51). Poor social support was negatively associated with psychological health (β=-3.25, 95% CI -5.89 to -0.61) and the social health domain (β=-3.39, 95% CI -11.3 to 4.6), and moderate social support (β=8.62, 95% CI 3.15 to 14.09) was positively associated with physical health. Depression (β=-6.32, 95% CI -11.96 to -0.67) and anxiety (β =-3.07, 95% CI -5.80 to -0.34) were negatively associated with physical health and the psychological health domain, respectively.

CONCLUSIONS

The findings from this study indicate that all dimensions of QOL of primary caregivers of children and adolescents with neurodevelopmental disorders in this study setting were compromised. Being divorced or widowed, lack of formal education, age, average monthly income, poor social support, depression, anxiety and the presence of medical illness were factors associated with QOL in all domains. This requires integrating a bio-psychosocial perspective, a positive mental health strategy and pharmaceutical therapies to enhance QOL for caregivers of children and adolescents with neurodevelopmental disorders.

Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review

BACKGROUND

The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries.

OBJECTIVE

This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries.

METHODS

A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers.

RESULTS

The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies.

CONCLUSIONS

Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.

Influence of motor capacity of the lower extremity and mobility performance on foot plantar pressures in community-dwelling older women

Objectives

To investigate the associations of motor capacity of the lower extremity and mobility performance in daily physical activities with peak foot plantar pressures during walking among older women.

Methods

Using the data collected among 58 community-dwelling older women (68.66 ± 3.85 years), Pearson correlation and multiple linear regression analyses were performed to analyze the associations of motor capacity of the lower extremity (the 30-s chair stand test, the timed one-leg stance with eyes closed, and the Fugl-Meyer assessment of lower extremity), mobility performance in daily physical activities (the average minutes of moderate to vigorous physical activity every day and the metabolic equivalents), and foot plantar pressures (peak force and peak pressure) with the age and body fat percentage as covariates.

Results

(1) The motor capacity of the lower extremity has higher explanatory power for peak foot plantar pressures compared with the mobility performance in daily physical activities. (2) Higher body fat percentage was positively associated with peak force and pressure, while a lower score on the Fugl-Meyer assessment of lower extremity was negatively associated with both of them. (3) The metabolic equivalents were positively associated with the peak force, while the 30-s chair stand test was negatively associated with it.

Conclusions

Mobility performance in daily physical activities can be significant predictors for peak foot plantar pressures among older women. The significant predictor variables include the Fugl-Meyer assessment of lower extremity, the 30-s chair stand test, and metabolic equivalents.

Comparing Physical Activity and Quality of Life of Caregivers of Children With Physical Disabilities and Typically Developing Children

There are conflicting reports of the level of physical activity (PA) and its relationship to quality of life (QoL) among caregivers of children with physical disabilities (CwPD). In this cross-sectional study, we aimed to compare the PA levels and QoL of two groups of caregivers - a CwPD group and caregivers of typically developing children (CwTD). We included 32 family caregivers in the CwPD group (22 women, 10 men; M age = 42.1, SD = 6.2 years) and 32 caregivers in the CwTD group (24 women, 8 men; M age = 42.3, SD = 6.1 years). We assessed PA with the International Physical Activity Scale-Short Form (IPAQ-SF) and self-reported activity diaries, and we assessed QoL with the Short-Form 36 (SF-36) questionnaire. Although the IPAQ scores and sitting times of caregivers in these two groups were not statistically different (p > .05), many parameters of self-reported activity diary data and total energy expenditure were significantly higher in the CwPD than the CwTD group (p < .05, effect size = .53-1.10). The CwPD group reported a lower QoL according to the SF-36 and its sub-scores (p < .05, effect size = .54-.77), and higher PA levels than those in the CwTD group. In the CwPD group, moderate, vigorous, and total PA scores were mildly to moderately associated with the total Qol score, and many of its subscores (r = .36 to .60, p < .05). The lower quality of life observed in CwPD, despite high-intensity physical activity levels, suggested that investigators and care providers should consider QoL in the CwPD group to be multifactorial and that here is a need for caregiver interventions to enhance QoL in this underserved population.

Anxiety, Depression, Quality of Life, and Family Support Among Family Caregivers of Children with Disabilities

Purpose

To investigate the family support, anxiety, depression, health-related quality of life (HRQoL), and their associations among parents and grandparents of children with disabilities.

Methods

This is a cross-sectional study and a total of 327 family caregivers were included. Chi-square test, Mann-Whitney U-test, and two independent t-test were used to identify the intergenerational differences in sociodemographic characteristics, received family support, anxiety, depression, and HRQoL. Eight generalized linear models were developed to examine the associations in both generations.

Results

Parents and grandparents were most in need of rehabilitation and financial support, but both populations received the least amount of financial support. 33.6% and 36.1% of family caregivers had the risk of anxiety and depression and found no significant intergenerational differences. As for HRQoL, intergenerational differences were found in the physical component score, but not found in the mental component score. Among parents, childcare support of respite care and household tasks assistance was negatively associated with their depression (p<0.05), professional support of appropriate surgery for children (p<0.05) and psychological support from professional psychologists (p<0.01) were negatively associated with their anxiety and depression, psychological support from relatives and friends was negatively associated with their depression (p<0.05) whereas was positively associated with their mental HRQoL (p<0.01). As for grandparents, financial support for daily living expenses was negatively associated with depression (p<0.05), and psychological support from families was negatively associated with depression (p<0.05) whereas was positively associated with mental HRQoL (p<0.05). However, no relationship was found between family support and anxiety among grandparents. Notably, no association was found between family support and physical HRQoL among both populations.

Conclusion

Both parents and grandparents had high risks of anxiety, depression and low levels of mental HRQoL. To efficiently improve psychological health, care providers and policymakers may consider intergenerational differences and provide targeted family support.

Chronic fatigue syndrome in caregivers of children with cerebral palsy and affecting factors

OBJECTIVE

In this study, the frequency of chronic fatigue syndrome (CFS), sleep disturbances, and quality of life levels in mothers of children with cerebral palsy (CP) was compared in relation to the functional status of the child.

METHODS

The caregivers were evaluated with the sociodemographic data form, Chalder fatigue scale (ChFS), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index, and Short Form-12, respectively. In addition, the functional status of the child with CP was evaluated with the gross motor function classification system, manual ability classification system (MACS), communication function classification system, and eating and drinking ability classification system.

RESULTS

According to CDC-1994 criteria, 80.4% of the participating mothers have CFS (n=45). While the mean ChFS and FSS scores of housewives were found to be significantly higher than those of full-time workers (p=0.002; p=0.003, respectively), the mean SF-12 MCS was found to be significantly lower (p=0.007). The rate of housewives was found to be significantly higher in those diagnosed with CFS (p<0.001). The relationship between independent variables and dependent variables data sets as a result of canonical correlation analysis was obtained as 0.815. While the variable with the highest effect among the independent variables is the MACS variable, the variable with the highest percentage of explanation for the dependent variables is ChFS.

CONCLUSION

The frequency of CFS is very high in mothers of children with CP, and the most important factors in the presence and severity of CFS are the mother's occupational status and the child's manual skills.

Family health conditions and parental occupational status modify the relationship between pediatric-onset multiple sclerosis and parental health-related quality of life

BACKGROUND

The health-related quality of life (HRQoL) of children with multiple sclerosis (MS) is mediated by the HRQoL of their parents. Understanding factors that modify the relationship between the child's MS diagnosis and parental HRQoL would inform interventions to improve the HRQoL of both parents and children living with MS.

OBJECTIVE

We evaluated whether the association between an MS diagnosis during childhood and parental HRQoL is modified by the presence of a family health condition or low socioeconomic position (SEP).

METHODS

Parents of children with MS or the transient illness, monophasic-acquired demyelinating syndromes (monoADS), were enrolled in a prospective Canadian study. Multivariable models evaluated whether the association between a child's MS diagnosis (vs. monoADS) and parental HRQoL was modified by ⩾1 family health conditions or low SEP.

RESULTS

Two hundred seven parents and their children with MS (n = 65) or monoADS (n = 142) were included. We found a synergistic effect of an MS diagnosis and a family health condition on parental HRQoL. We also found a synergistic effect of having MS and a low SEP on parental HRQoL.

CONCLUSION

Parents of children with MS who have another family health condition or a low SEP are at particularly high risk for low HRQoL.

Association between Participation of Children with Disabilities and the Child, Family, and Environmental Factors in Shanghai, China: A Cross-Sectional Study

Participation is essential to a child's health and well-being, whereas children with disabilities may lack the associated benefits because of physical restrictions. This study aims to examine the association between the participation of children with disabilities and the child, family, and environmental factors. A total of 433 children with disabilities aged 3-18 and their family caregivers were included. Three binary logistic regression models were respectively established to identify the significant factors associated with children's home, school, and community participation. Our main empirical results showed that among 433 children with disabilities, 44.3%, 47.6%, and 58.7% of them never or seldom participated in home, school, and community activities. Child and family factors were found to be dominantly associated with children's participation, and significant factors associated with the home, school, and community participation of children were different, including children's disability type, sleep problems and emotional stability, caregivers' education, mental HRQOL, rehabilitation belief, and number of children in the family. These results highlight that the participation of children with disabilities in mainland China urgently needs to be enhanced, and further research might be focused on validating the causal relationships between participation and significant child and family factors identified in this study.

Double Disadvantage of Carers with a Disability: A Cross-Sectional Study of Care Duration and Perceived Importance for Service Improvement in Hong Kong, China

OBJECTIVES

this study examined (i) the relationships between the care duration of carers and their perceptions of the importance of service improvement by types of service, and (ii) whether carers had a disability that moderated the impacts of care duration on these perceptions.

DESIGN

survey data for cross-sectional analyses.

METHOD

The sample consisted of carers without disability (n = 625) and carers with a disability (n = 77). Hierarchical multiple regression was applied to examine the unique contribution of care duration. The interaction effects of the disability status of the carer was also estimated.

RESULTS

Longer care duration was associated with a greater perception of the importance of service improvement for certain services by carers. The positive relationships between care duration and perception of the importance of caregiver assistances and financial subsidy improvement were stronger for carers with disabilities compared to carers without disability.

CONCLUSIONS

Long-term carers with disabilities face a potential double disadvantage of service improvement needs with more years of caregiving. Policy makers should consider prioritizing caregiver assistances or financial subsidy service improvements for long-term carers who themselves have a disability.

Comparative Analysis of the Quality of Life in Families with Children or Adolescents Having Congenital versus Acquired Neuropathology

AIM

This research aims to determine whether the time of injury (congenital or acquired) affects the quality of life (QOL) in families having a child or adolescent with neurological impairment.

DESIGN

Comparative, cross-sectional study.

MATERIAL AND METHODS

To find out if there are differences in the quality of life domains between these two groups, 66 subjects (31 mothers of patients with congenital disorders and 35 mothers of patients with acquired disorders) completed the PedsQL-Family Impact Module (PedsQL-FIM), the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-BRIEF), and the Cognitive Emotion Regulation Questionnaire (CERQ).

RESULTS

Analyzing the PedsQL-FIM dimensions, we found significant differences between groups in terms of emotional functioning, communication, and worry, which favor the congenital group. There are no statistically significant differences between social functioning, cognitive functioning, and daily activities groups. No significant differences between groups when evaluating the WHOQOL-BRIEF's domains (physical health, psychological health, social relationships, environment) have been found. According to CERQ results, adaptive strategies had higher mean scores in the congenital than in the acquired group. The mean score for maladaptive strategies in the congenital group is higher than that in the acquired one, except for catastrophizing, which is higher for acquired.

CONCLUSION

Our findings show that the mothers of patients with acquired neuropathology have a lower quality of life in the emotional functioning, communication, and worry domains.

Modifiable personal and environmental factors associated with anxiety in family caregivers of children with disabilities: A comparison between parents and grandparents

BACKGROUND

Caregivers of children with disabilities might face high risk of anxiety, but the specific influencing factors may be different between parents and grandparents. This study is to explore the influencing modifiable factors from personal and environmental dimensions, so as to provide practical reference for effectively preventing and alleviating anxiety of this population.

METHODS

A total of 504 primary caregivers were investigated in Shanghai, China, of which 496 parents and grandparents were included in the analysis. Risk of anxiety was measured by the Generalized Anxiety Disorder 7-item (GAD-7) Scale. Descriptive statistics, univariate analysis, and multivariable logistic regression were performed to describe the personal and environmental characteristics of parents and grandparents, risk of anxiety, and identify the significant factors.

RESULTS

35.1% of the total caregivers had the risk of anxiety, parents (35.8%) were slightly more anxious than grandparents (33.1%). Among parents, children's stable emotion (AOR=0.263, 95% CI=0.113, 0.611), higher household income (AOR=0.664; 95% CI=0.519, 0.850), owning a house (AOR=0.326; 95% CI=0.174, 0.610), and better barrier-free construction (AOR=0.400; 95% CI=0.170, 0.941) were associated with lower odds of anxiety. As for grandparents, significant association was merely found in caregiving time (AOR=2.936; 95% CI=1.064, 8.107).

LIMITATIONS

Given the cross-sectional design, we would not infer causal relationships.

CONCLUSIONS

Anxiety among family caregivers of children with disabilities was not encouraging and need to be urgently concerned. To reach optimal efficiency, intergenerational differences should be considered when health care providers and policy makers taking measures to facilitate the mental health of this population.

Impact of Caregiving Burden on Quality of Life of Caregivers of COPD Patients: The Chain Mediating Role of Social Support and Negative Coping Styles

Purpose

Caregivers of COPD patients experience various caregiving burden, which is related to their quality of life. We aimed to explicitly explore whether social support and negative coping styles play the chain mediating roles in the relationship between the caregiving burden of caregivers of COPD patients and their health-related quality of life.

Methods

We conducted a multicenter cross-sectional survey in four hospitals using a convenience sample. Participants who met the inclusion criteria completed five relevant scales, including a sociodemographic scale. One-way ANOVA and Pearson’s method were used to analyze the data accordingly, and chain mediated effect values were estimated by bootstrap method to determine whether the model holds.

Results

Among the 201 caregivers who participated in this study, the mean age was 55.94 years, most of them were female (61.2%), the mean caregiving burden score was 52.39 ± 14.65, and the quality of life score was 37.97 ± 3.55. Among them, age, gender, education, relationship with the patient, and the number of chronic diseases were the main factors affecting the quality of life score of the caregivers. According to Pearson results, there was a negative correlation between quality of life and caregiving burden, and negative coping styles. The model result showed that caregiving burden could directly and negatively predict quality of life, and also predict quality of life through the chain mediation of social support and negative coping styles.

Conclusion

In China, caregivers of patients with COPD experience severe levels of caregiving burden and low quality of life. The combination of adequate perceived social support and lower negative coping can be effective in alleviating caregiving burden and improving their quality of life. Therefore, healthcare professionals should provide targeted guidance to caregivers with the help of social support and interventions that regulate negative coping styles.