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Nisbet LC, Ellis K, Mihai R, Croft E, Davey MJ, Nixon GM. Improvement in quality of life with continuous positive airway pressure outweighs the treatment burden in children with obstructive sleep apnea. Pediatr Pulmonol 2024; 59:1288-1297. [PMID: 38353401 DOI: 10.1002/ppul.26903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 04/30/2024]
Abstract
INTRODUCTION Continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA) may pose a significant burden on families. We assessed the impact of CPAP for children on quality of life (QOL) and caregiver treatment burden. METHODS Prospective cohort study of children commencing outpatient CPAP in a specialist sleep centre 2020-2022. Questionnaires regarding sleep-related symptoms (PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment), QOL (OSA-18, QI-Disability), caregiver burden (Caregiver Strain Questionnaire) and overall health impact (Glasgow Children's Benefit Inventory) were completed by caregivers at CPAP commencement and 6 weeks later. RESULTS Twenty-six patients completed follow-up (7 female; median age 11.4 year, baseline obstructive apnea hypopnea index 10.3/h; 77% overweight or obese, 73% comorbidity other than obesity). OSA-related QOL (OSA-18) significantly improved at follow-up (p < 0.01), as did child general QOL (p < 0.001), sleep disturbance (p < 0.01) and sleep-related impairment (p < 0.001). Caregivers mostly rated CPAP as beneficial to their child's health but 19% rated CPAP as harmful or having no effect. Caregiver strain reduced at follow-up (p < 0.001) and benefit outweighed inconvenience (p < 0.0001) in 81%. CPAP adherence was correlated with overall health impact (r = 0.67, p < 0.01) but not with caregiver rating of inconvenience. CONCLUSIONS CPAP resulted in improvements in QOL and sleep-related symptoms, and reduced caregiver strain. Perceived benefits outweighed the burden of treatment for most but not all families. CPAP adherence was moderately correlated with family-reported measures of benefit but not related to perceived inconvenience. This study provides reassuring evidence regarding the benefits and impacts of CPAP for children, many of whom already have complex health care needs.
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Affiliation(s)
- Lauren C Nisbet
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Kirsten Ellis
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Rebecca Mihai
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Emma Croft
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Margot J Davey
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Gillian M Nixon
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
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Cruz KLT, Santos ICS, de Jesus Alves de Baptista CR, Mattiello-Sverzut AC. Quality of life assessment instruments in children and adolescents with neuromuscular diseases: a systematic scoping review. Health Qual Life Outcomes 2024; 22:18. [PMID: 38360791 PMCID: PMC10870459 DOI: 10.1186/s12955-024-02232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE (1) To identify instruments used to assess quality of life (QoL) in children and adolescents with neuromuscular diseases; (2) To identify the psychometric properties contained in these instruments. METHODS This is a scoping review in which the electronic databases Embase, Scielo, Scopus, Pubmed and Lilacs were used as well as grey literature. The following terms were used in the search for articles published in the last 10 years: children, adolescents, neuromuscular disease, and quality of life. RESULTS In total, 15 articles were included and evaluated, indicating 7 instruments used to assess QoL (PedsQL™ Inventory 3.0 Neuromuscular Module, the PedsQL™ 4.0, the PedsQL DMD Module, the PedsQL ™ MFS, the SOLE, the KIDSCREEN and the LSI-A). The number of items ranged from 17 to 45. In addition, 6 instruments showed psychometric properties, but only 2 showed good and high quality, either in internal reliability or reproducibility. CONCLUSION Our results were able to map the main QoL assessment instruments of children and adolescents with neuromuscular disease and the most cited instrument was the PedsQL™ Inventory 3.0 Neuromuscular Module. Larger studies that assess psychometric properties and that are validated for most diseases are needed.
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Affiliation(s)
- Karoliny Lisandra Teixeira Cruz
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Av. Miguel Covian, 120, Ribeirão Preto, São Paulo, 14.049-900, Brazil
| | - Isadora Cristina Sousa Santos
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Av. Miguel Covian, 120, Ribeirão Preto, São Paulo, 14.049-900, Brazil
| | | | - Ana Claudia Mattiello-Sverzut
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Av. Miguel Covian, 120, Ribeirão Preto, São Paulo, 14.049-900, Brazil.
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Skoutelis VC, Kanellopoulos AD, Vrettos S, Dimitriadis Z, Dinopoulos A, Papagelopoulos PJ, Kontogeorgakos VA. Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:57-63. [PMID: 37689354 DOI: 10.1016/j.recot.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06±9.05; 95% confidence interval [CI], 7.40-14.71; p<0.001). CONCLUSIONS This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).
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Affiliation(s)
- V C Skoutelis
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, School of Health and Caring Sciences, University of West Attica, Egaleo, Attica, Greece; Department of Physiotherapy, ATTIKON University General Hospital, Chaidari, Attica, Greece.
| | - A D Kanellopoulos
- Department of Orthopaedics, IASO Children's Hospital, Maroussi, Attica, Greece
| | - S Vrettos
- ENA Pediatric Physiotherapy Centre, Chalandri, Attica, Greece
| | - Z Dimitriadis
- Department of Physiotherapy, Health and Quality of Life Research Laboratory, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - A Dinopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; Third Department of Paediatrics, ATTIKON University General Hospital, Chaidari, Attica, Greece
| | - P J Papagelopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; First Department of Orthopaedic Surgery, ATTIKON University General Hospital, Chaidari, Attica, Greece
| | - V A Kontogeorgakos
- Medical School, National and Kapodistrian University of Athens, Athens, Attica, Greece; First Department of Orthopaedic Surgery, ATTIKON University General Hospital, Chaidari, Attica, Greece
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4
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Skoutelis VC, Kanellopoulos AD, Vrettos S, Dimitriadis Z, Dinopoulos A, Papagelopoulos PJ, Kontogeorgakos VA. Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T57-T63. [PMID: 37995817 DOI: 10.1016/j.recot.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06 ± 9.05; 95% confidence interval [CI], 7.40-14.71; p < 0.001). CONCLUSIONS This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).
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Affiliation(s)
- V C Skoutelis
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Departamento de Fisioterapia, Laboratorio de Estudio Neuromuscular y Cardiovascular del Movimiento, Facultad de Ciencias de la Salud y el Cuidado, Universidad de West Attica, Egaleo, Grecia; Departamento de Fisioterapia, Hospital General Universitario Attikon, Chaidari, Grecia.
| | | | - S Vrettos
- Centro de Fisioterapia Pediátrica ENA, Chalandri, Grecia
| | - Z Dimitriadis
- Departamento de Fisioterapia, Laboratorio de Investigación sobre Salud y Calidad de Vida, Facultad de Ciencias de la Salud, Universidad de Tesalia, Lamia, Grecia
| | - A Dinopoulos
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Tercer Departamento de Pediatría, Hospital General Universitario Attikon, Chaidari, Greece
| | - P J Papagelopoulos
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Primer Departamento de Cirugía Ortopédica, Hospital General Universitario Attikon, Chaidari, Grecia
| | - V A Kontogeorgakos
- Facultad de Medicina, Universidad Nacional y Kapodistríaca de Atenas, Atenas, Grecia; Primer Departamento de Cirugía Ortopédica, Hospital General Universitario Attikon, Chaidari, Grecia
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Lemmon ME, Reeve BB. Defining Outcomes that Matter Most to Parents: Challenging and Important Work. J Pediatr 2023; 260:113567. [PMID: 37327861 PMCID: PMC10896428 DOI: 10.1016/j.jpeds.2023.113567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Monica E Lemmon
- Department of Pediatrics, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
| | - Bryce B Reeve
- Department of Pediatrics, Department of Population Health Sciences, Duke Cancer Institute, Duke University School of Medicine, Durham, NC
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Peralta D, Bogetz J, Lemmon ME. Seminars in Fetal & neonatal medicine: Palliative and end of life care in the NICU. Semin Fetal Neonatal Med 2023; 28:101457. [PMID: 37230860 PMCID: PMC10827319 DOI: 10.1016/j.siny.2023.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Dana Peralta
- Duke North Pavilion, 2400 Pratt Street, 8th Floor, DUMC 102509, Durham, NC 27710, USA.
| | - Jori Bogetz
- 1900 Ninth Ave, JMB-6, Seattle, WA 98101, USA.
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Saldaris JM, Jacoby P, Leonard H, Benke TA, Demarest S, Marsh ED, Downs J. Psychometric properties of QI-Disability in CDKL5 Deficiency Disorder: Establishing readiness for clinical trials. Epilepsy Behav 2023; 139:109069. [PMID: 36634535 PMCID: PMC9899310 DOI: 10.1016/j.yebeh.2022.109069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Abstract
CDKL5 Deficiency Disorder (CDD) is a rare genetic disorder with symptoms of epilepsy, developmental impairments, and other comorbidities. Currently, there are no outcome measures for CDD with comprehensive evidence of validation. This study aimed to evaluate the psychometric properties of the Quality of Life Inventory-Disability (QI-Disability) in CDD. Quality of Life Inventory-Disability was administered to 152 parent caregivers registered with the International CDKL5 Disorder Database (ICDD). Confirmatory factor analysis was conducted and the goodness of fit of the factor structure was assessed. Fixed-effects linear regression models examined the responsiveness of QI-Disability to reported changes in child health. A subset of parent caregivers (n = 56) completed QI-Disability, as well as additional health-related questions, on two occasions separated by four weeks to evaluate test-retest reliability. Test-retest reliability was assessed using intra-class correlations (ICCs) calculated from QI-Disability scores. Based upon adjustments for changes in child health, ICCs were recalculated to estimate responsiveness to change. Confirmatory factor analysis, internal consistency, and divergent validity were mostly satisfactory, except divergent validity was not satisfactory for the Social Interactions and Independence domains. The Physical Health, Social Interactions, Leisure, and Total scores responded to changes in the child's Physical health, and the Negative Emotions and Leisure domains responded to changes in the child's behavior. Unadjusted and adjusted ICC values were above 0.8 for the Positive Emotions, Negative Emotions, Social Interactions, Leisure, Independence domains and Total score, and above 0.6 for the Physical Health domain. Findings suggest that QI-Disability is suitable to assess the quality of life of children and adults with CDD and could be of value for upcoming clinical trials.
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Affiliation(s)
- Jacinta M Saldaris
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Tim A Benke
- Children's Hospital Colorado, Pediatric Neurology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Scott Demarest
- Children's Hospital Colorado, Pediatric Neurology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Eric D Marsh
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Allied Health, Curtin University, Perth, Western Australia, Australia.
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Marques FJP, Carvalho ALD, Borigato EVM, Oliveira LFVD, Duarte LMR, Silva AGD, Amarante CLD, Pereira LJDM, Tavares EF, Costa LGDSD, Alcântara CAR, Salinas AN, Pinto FDLDC, Alcântara GCD, Utsch F, Silva CRD, Reis DAD, Bessa WM, Dutra RC, Ventura P, Oliveira TS. Health-related quality of life in children with cerebral palsy associated with congenital Zika infection. Rev Paul Pediatr 2023; 41:e2022016. [PMID: 37042942 PMCID: PMC10088476 DOI: 10.1590/1984-0462/2023/41/2022016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/29/2022] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To describe the health-related quality of life (QOL) in children with cerebral palsy (CP) associated with congenital Zika infection. METHODS Cross-sectional study of a consecutive series of children, followed in a referral multicentric rehabilitation network in Brazil. We invited the caregivers to respond to the Brazilian version of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILDTM) questionnaire. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) 26.0™. We used absolute and relative frequencies for categorical variables and mean and standard deviation for continuous variables. RESULTS The sample consisted of 193 children, at mean age of 50.3±7.6 months. We observed a predominance of children with cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level V (93.7%). Epilepsy (88.4%) was the most common comorbidity. CPCHILDTM mean scores were activities of daily living (ADL)/personal care 43.2±12.6; positioning, transferring and mobility 33.7±16.5; comfort and emotions 84.4±15.2; communication and social interaction (CoSI) 48.2±24.3; health 70.9±17.1; and overall quality of life (OQOL) 72.1±17.1. Total score was 54.8±11.3. CONCLUSIONS Among children with cerebral palsy (CP) related to congenital Zika syndrome, the quality of life (QOL) scores were very similar to other populations with cerebral palsy (CP). The activities of positioning, transferring and mobility had the greatest impact on health-related quality of life (QOL). Rehabilitation strategies and public policies should prioritize aspects related to mobility for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fabiana Utsch
- Rede SARAH de Hospitais de Reabilitação, Belo Horizonte, MG, Brazil
| | | | | | | | | | - Paloma Ventura
- Rede SARAH de Hospitais de Reabilitação, Salvador, BA, Brazil
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Milićević M. Functional and environmental predictors of health-related quality of life of school-age children with cerebral palsy: A cross-sectional study of caregiver perspectives. Child Care Health Dev 2023; 49:62-72. [PMID: 35305043 DOI: 10.1111/cch.13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Caregivers' reports often serve as a decision-making guide in the treatment and rehabilitation of children with cerebral palsy (CP). This study identified predictors of the caregiver-reported health-related quality of life (HRQoL) of school-age children with CP. METHODS A cross-sectional study was conducted using the convenience sample of 108 children with CP (60 males; aged 7-18 years; mean age 12 years 8 months [SD 3 years 5 months]). Caregivers reported their child's HRQoL using KIDSCREEN-27. Standard multiple regression analyses were conducted to test if the child characteristics (gender, age, Gross Motor Function Classification System-Expanded & Revised [GMFCS-E&R], Manual Ability Classification System [MACS], intellectual disability, health problems, communication, social skills, behavioural difficulties); family characteristics (income, type, home adaptation); physical, social and attitudinal barriers; environmental features; and family-centeredness of service delivery significantly predicted HRQoL. RESULTS Fine manual abilities, home adaptation and the magnitude of barriers predicted physical well-being. The child's challenging behaviour, the magnitude of barriers and the barriers related to different policies predicted psychological well-being. The home adaptation level and provision of general information about the child's disability and available types of services predicted HRQoL domain related to interactions and relationships with parents. Children with behavioural difficulties and more severe limitations in communication had less social support from friends and peers. The social skills and intellectual functioning combined with the parental ratings of the child's behaviour, other people's attitudes towards the child and the lack of support predicted HRQoL in the School Environment domain. The magnitude and frequency of barriers were the strongest predictors of general HRQoL. CONCLUSION From the caregivers' perspective, home adaptation, supportive laws and policies and family-centred rehabilitation care that meets the family needs may promote children's HRQoL. Specific interventions addressing modifiable environmental features and continuous support to children in improving their fine motor abilities, communication and social skills and families in managing behavioural difficulties may be relevant for HRQoL of school-age children with CP.
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Affiliation(s)
- Milena Milićević
- Institute of Criminological and Sociological Research, Belgrade, Serbia
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Shields N, Bennell KL, Southby A, Rice LJ, Markovic T, Bigby C, Prendergast L, Watts JJ, Schofield C, Loughnan G, Franklin J, Levitt D, Chikani V, McCallum Z, Blair S, Proietto J, Taylor NF. Progressive resistance training in young people with Prader-Willi syndrome: protocol for a randomised trial (PRESTO). BMJ Open 2022; 12:e060306. [PMID: 36549735 PMCID: PMC9791392 DOI: 10.1136/bmjopen-2021-060306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Preliminary evidence suggests that progressive resistance training may be beneficial for people with Prader-Willi Syndrome (PWS), a rare genetic condition that results in muscle weakness and low muscle tone.To establish whether community-based progressive resistance training is effective in improving the muscle strength of people with PWS; to determine cost-effectiveness; and, to complete a process evaluation assessing intervention fidelity, exploring mechanisms of impact, understanding participant experiences and identifying contextual factors affecting implementation. METHODS AND ANALYSIS A multisite, randomised controlled trial will be completed. Sixty participants with PWS will be randomised to receive either progressive resistance training (experimental) or non-progressive exercise (placebo control). Participants will be aged 13 to 60 years, be able to follow simple instructions in English and have no contraindications to performing progressive resistance training. The experimental group will complete progressive resistance training two times weekly for 24 weeks supervised by an exercise professional at a community gym. The control group will receive all aspects of the intervention except progressive overload. Outcomes will be assessed at week 25 (primary endpoint) and week 52 by a blinded assessor. The primary outcome is muscle strength assessed using one repetition maximum for upper limb and lower limb. Secondary outcomes are muscle mass, functional strength, physical activity, community participation, health-related quality of life and behaviour. Health economic analysis will evaluate cost-effectiveness. Process evaluation will assess safety and intervention fidelity, investigate mechanism of impact, explore participant experiences and identify contextual factors affecting implementation. Data collection commenced in February 2020 and will conclude in September 2023. ETHICS AND DISSEMINATION Ethical approval was obtained from The Royal Children's Hospital Human Research Ethics Committee (HREC/50874/RCHM-2019) under the National Mutual Acceptance initiative. Research governance approvals were obtained from five clinical sites. Results will be disseminated through published manuscripts, conference presentations, public seminars and practical resources for stakeholder groups. TRIAL REGISTRATION NUMBER ACTRN12620000416998; Australian and New Zealand Clinical Trial Registry.
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Affiliation(s)
- Nora Shields
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alesha Southby
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Lauren J Rice
- Westmead Clinical School (Child & Adolescent Health), University of Sydney, Sydney, New South Wales, Australia
| | - Tania Markovic
- Boden Collaboration, University of Sydney, Sydney, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Luke Prendergast
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Cara Schofield
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Georgina Loughnan
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David Levitt
- Department of Paediatric Medicine and Dermatology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Viral Chikani
- Department of Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Zoe McCallum
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan Blair
- Prader-Willi Research Foundation of Australia, Heidelberg, Melbourne, Australia
| | - Joseph Proietto
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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Wolters-Leermakers N, Van den Bogaard KJHM, Prins M. Understanding quality of life in people with complex and multiple communicative disabilities: A narrative overview of the empirical research literature. J Intellect Disabil 2022:17446295221146849. [PMID: 36515674 DOI: 10.1177/17446295221146849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The fundamental characteristics of quality of life (QoL) are considered the same for all people. However, the relative importance of QoL domains may vary for specific populations. No studies have focused on understanding QoL for people with intellectual disabilities with additional communicative disabilities (developmental language disorder or hearing impairment), who experience complex and multiple communicative disabilities (CMCD). This study provides a narrative overview of QoL domains and indicators for this population, highlighting the role of communication. The 16 selected studies proved to be heterogeneous in study design, objective and conceptualization of QoL. The eight domains of QoL by Schalock and Verdugo (2002) are recognized, but few studies specify the importance of communication related to QoL for people with CMCD. The current overview attempts to emphasize not only the indirect role of communication for every QoL domain, but also the importance of acknowledging communication as a prerequisite for QoL in general.
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Leonard H, Whitehouse A, Jacoby P, Benke T, Demarest S, Saldaris J, Wong K, Reddihough D, Williams K, Downs J. Quality of life beyond diagnosis in intellectual disability - Latent profiling. Res Dev Disabil 2022; 129:104322. [PMID: 35939908 PMCID: PMC9792277 DOI: 10.1016/j.ridd.2022.104322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare quality of life (QOL) across diagnoses associated with intellectual disability, construct QOL profiles and evaluate membership by diagnostic group, function and comorbidities. METHOD Primary caregivers of 526 children with intellectual disability (age 5-18 years) and a diagnosis of cerebral palsy, autism spectrum disorder, Down syndrome, CDKL5 deficiency disorder or Rett syndrome completed the Quality of Life Inventory-Disability (QI-Disability) questionnaire. Latent profile analysis of the QI-Disability domain scores was conducted. RESULTS The mean (SD) total QOL score was 67.8 (13.4), ranging from 60.3 (14.6) for CDD to 77.5 (11.7) for Down syndrome. Three classes describing domain scores were identified: Class 1 was characterised by higher domain scores overall but poorer negative emotions scores; Class 2 by average to high scores for most domains but low independence scores; and Class 3 was characterised by low positive emotions, social interaction, and leisure and the outdoors scores, and extremely low independence scores. The majority of individuals with autism spectrum disorder and Down syndrome belonged to Class 1 and the majority with CDKL5 deficiency disorder belonged to Class 3. Those with better functional abilities (verbal communication and independent walking were predominately members of Class 1 and those with frequent seizures were more often members of Class 2 and 3. CONCLUSION The profiles illustrated variation in QOL across a diverse group of children. QOL evaluations illustrate areas where interventions could improve QOL and provide advice to families as to where efforts may be best directed.
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Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, Child Disability, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, CliniKids Autism Research, Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Child Disability, The University of Western Australia, Perth, Western Australia, Australia
| | - Tim Benke
- Children's Hospital Colorado, Paediatric Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott Demarest
- Children's Hospital Colorado, Paediatric Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jacinta Saldaris
- Telethon Kids Institute, Child Disability, The University of Western Australia, Perth, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, Child Disability, The University of Western Australia, Perth, Western Australia, Australia
| | - Dinah Reddihough
- Royal Children's Hospital, Parkville, Victoria, Australia; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Katrina Williams
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Education and Research, Monash University, Melbourne, Victoria, Australia; Developmental Paediatrics, Monash Children's Hospital, Australia
| | - Jenny Downs
- Telethon Kids Institute, Child Disability, The University of Western Australia, Perth, Western Australia, Australia; Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.
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Jacoby P, Whitehouse A, Leonard H, Saldaris J, Demarest S, Benke T, Downs J. Devising a Missing Data Rule for a Quality of Life Questionnaire-A Simulation Study. J Dev Behav Pediatr 2022; 43:e414-e418. [PMID: 35075044 PMCID: PMC9308825 DOI: 10.1097/dbp.0000000000001061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to devise an evidence-based missing data rule for the Quality of Life Inventory-Disability (QI-Disability) questionnaire specifying how many missing items are permissible for domain and total scores to be calculated using simple imputation. We sought a straightforward rule that can be used in both research and clinical monitoring settings. METHOD A simulation study was conducted involving random selection of missing items from a complete data set of questionnaire responses. This comprised 520 children with intellectual disability from 5 diagnostic groups. We applied a simple imputation scheme, and the simulated distribution of errors induced by imputation was compared with the previously estimated standard error of measurement (SEM) for each domain. RESULTS Using a stringent criterion, which requires that the 95th percentile of absolute error be less than the SEM, 1 missing item should be permitted for 2 of the 6 QI-Disability subdomain scores to be calculated and 1 missing item per domain for the total score to be calculated. Other, less stringent criteria would allow up to 2 missing items per domain. CONCLUSION Empirical evidence about the impact of imputing missing questionnaire responses can be gathered using simulation methods applied to a complete data set. We recommend that such evidence be used in devising a rule that specifies how many items can be imputed for a valid score to be calculated.
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Affiliation(s)
- Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta Saldaris
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Scott Demarest
- Children’s Hospital Colorado, Paediatric Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Tim Benke
- Children’s Hospital Colorado, Paediatric Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Abstract
BACKGROUND AND OBJECTIVES Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.
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Affiliation(s)
- Nathaniel D. Bayer
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Rochester and Golisano Children’s Hospital, Rochester, New York,Address correspondence to Nathaniel D. Bayer, MD, Division of Pediatric Hospital Medicine, Golisano Children’s Hospital and Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Box 667, Rochester, NY 14642. E-mail:
| | | | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, College of Medicine University of Cincinnati, Cincinnati, Ohio
| | - Jay G. Berry
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
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Reddihough D, Leonard H, Jacoby P, Kim R, Epstein A, Murphy N, Reid S, Whitehouse A, Williams K, Downs J. Comorbidities and quality of life in children with intellectual disability. Child Care Health Dev 2021; 47:654-666. [PMID: 33885172 DOI: 10.1111/cch.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many children with intellectual disability live with medical comorbidities. This study examined the impacts of comorbidities on quality of life (QOL) of children with intellectual disabilities and whether impacts varied with caregiver perceptions that medical needs had been met. METHODS Primary caregivers of 447 children (aged 5-19 years) with an intellectual disability reported on their child's medical comorbidities and the extent to which they perceived their child's medical needs had been met in a cross-sectional observational study. The Quality of Life Inventory-Disability was used to measure QOL on a 100-point scale. Linear regression models including interaction terms were used to evaluate their associations. RESULTS Parent-reported recurrent child pain (-4.97, 95% CI -8.21, -1.72), night-time sleep disturbances (-4.98, 95% CI -7.23, -2.73), daytime somnolence (-8.71, 95% CI -11.30, -2.73), seizures that occurred at least weekly (-7.59, 95% CI -13.50, -1.68) and conservatively managed severe scoliosis (-7.39, 95% CI -12.97, -1.81) were negatively associated with child QOL. Despite the majority of parents (~70%) perceiving that their child's medical needs had been met to a great extent, this did not significantly moderate the association between any comorbidities and QOL. CONCLUSIONS Comorbidities were common and had marked associations with QOL. Evaluation and management of pain and sleep disturbance continue to be high priorities in improving QOL of young people with intellectual disabilities. Further research on the optimal methods of managing these comorbidities is warranted.
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Affiliation(s)
- Dinah Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachel Kim
- Department of Sociology, Princeton University, Princeton, New Jersey, USA
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Nada Murphy
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Sue Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Katrina Williams
- Paediatric Education and Research, Monash University, Melbourne, Victoria, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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16
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Whitehouse AJO, Jacoby P, Reddihough D, Leonard H, Williams K, Downs J. The effect of functioning on Quality of Life Inventory-Disability measured quality of life is not mediated or moderated by parental psychological distress. Qual Life Res 2021. [PMID: 33939076 DOI: 10.1007/s11136-021-02855-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The measurement of quality of life (QOL) in children with intellectual disability often relies upon proxy report via caregivers. The current study investigated whether caregiver psychological distress mediates or moderates the effects of impairment on their ratings of QOL in children with intellectual disability. METHODS Caregivers of 447 children with an intellectual disability reported their child's day-to-day functioning, their own psychological distress using the Kessler Psychological Distress Scale, and the Quality of Life Inventory-Disability (QI-Disability), a measure of QOL for proxy report of a child's observable behaviours that indicate quality of life. Linear regression was used to assess the effects of the child's functional abilities on their QI-Disability score and causal mediation analysis to estimate the extent to which these effects were mediated by caregivers' psychological distress. RESULTS A minority of caregivers (n = 121, 27.1%) reported no psychological distress. Lower day-to-day functional abilities, such as being fully dependent on others to manage their personal needs were associated with lower total QOL scores. There was no significant mediation effect of caregiver psychological distress on the association between child functioning and total QOL scores. Moderation analyses revealed small and largely nonsignificant interaction coefficients, indicating that caregiver psychological distress did not influence the strength of the relationship between child functioning and total QOL scores. CONCLUSION Caregiver psychological distress did not mediate or moderate the relationship between the level of functional abilities and QOL in children with intellectual disability. QI-Disability measured observable child behaviours which may reduce the influence of caregiver factors on the accurate measure of QOL for children with intellectual disability.
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17
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Meert KL, Reeder RW, Maddux AB, Banks R, Berg RA, Newth CJ, Hall MW, Quasney M, Carcillo JA, McQuillen PS, Mourani PM, Chima RS, Holubkov R, Sorenson S, McGalliard J, Dean JM, Zimmerman JJ. Health-Related Quality of Life After Community-Acquired Septic Shock in Children With Preexisting Severe Developmental Disabilities. Pediatr Crit Care Med 2021; 22:e302-e313. [PMID: 33156209 PMCID: PMC8099927 DOI: 10.1097/pcc.0000000000002606] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To serially evaluate health-related quality of life during the first year after community-acquired septic shock in children with preexisting severe developmental disabilities and explore factors associated with health-related quality of life changes in these children. DESIGN Secondary analysis of the Life after Pediatric Sepsis Evaluation investigation. SETTING Twelve academic PICU in the United States. PATIENTS Children greater than or equal to 1 month and less than 18 years old identified by their family caregiver (e.g., parent/guardian) as having severe developmental disability prior to septic shock. INTERVENTIONS Family caregivers completed the Stein-Jessop Functional Status II-R Short Form as a measure of their child's health-related quality of life at baseline (reflecting preadmission status), day 7, and months 1, 3, 6, and 12 following PICU admission. Stein-Jessop Functional Status II-R Short Form scores were linearly transformed to a 0-100 scale, with higher scores indicating better health-related quality of life. MEASUREMENTS AND MAIN RESULTS Of 392 Life after Pediatric Sepsis Evaluation participants, 137 were identified by their caregiver as having a severe developmental disability. Sixteen children (11.6%) with severe disability died during the 12 months following septic shock. Among 121 survivors, Stein-Jessop Functional Status II-R Short Form scores declined from preadmission baseline to day 7 (70.7 ± 16.1 vs 55.6 ± 19.2; p < 0.001). Stein-Jessop Functional Status II-R Short Form scores remained below baseline through month 12 (59.1 ± 21.0, p < 0.001 vs baseline). After adjusting for baseline Stein-Jessop Functional Status II-R Short Form, the caregiver being a single parent/guardian was associated with lower month 3 Stein-Jessop Functional Status II-R Short Form scores (p = 0.041). No other baseline child or caregiver characteristic, or critical illness-related factors were significantly associated with month 3 Stein-Jessop Functional Status II-R Short Form scores. CONCLUSIONS Health-related quality of life among children with severe developmental disability remains, on average, below baseline during the first year following community-acquired septic shock. Children with severe disability and septic shock that are in single parent families are at increased risk. Clinical awareness of the potential for decline in health-related quality of life among disabled children is essential to prevent this adverse outcome from being missed.
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Affiliation(s)
- Kathleen L. Meert
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI
| | - Ron W. Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Aline B. Maddux
- Department of Pediatrics, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Russell Banks
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christopher J. Newth
- Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Mark W. Hall
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Michael Quasney
- Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Patrick S. McQuillen
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Peter M. Mourani
- Department of Pediatrics, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Ranjit S. Chima
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Samuel Sorenson
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Julie McGalliard
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle Research Institute, Seattle, WA
| | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Jerry J. Zimmerman
- Department of Pediatrics, Seattle Children’s Hospital, Seattle Research Institute, University of Washington School of Medicine, Seattle, WA
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González-valero G, Vidal-conti J, Zurita-ortega F, Palou-sampol P. Active Time in Cooperative Activities, Quality of Life and Body Mass Index in Individuals with Intellectual Disabilities. A Model of Structural Equations. Sustainability 2021; 13:2341. [DOI: 10.3390/su13042341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Current research shows that individuals with intellectual disabilities do not engage in enough physical activity to acquire health benefits. However, cooperative learning has been shown to be an effective tool for inclusion and for improving healthy physical habits. The aim of this study is to contrast an explanatory model which incorporates quality of life, active time in cooperative activities, body mass index and age, as well as to analyze, using multi-group structural equations, the existing associations according to the sex of subjects with intellectual disabilities. The convenience sampling used allowed the collection of data from a total of 156 subjects in Granada (Spain), aged between 18–55 years. In terms of gender, the sample was homogeneous, representing 52.6% (n = 82) for women and 47.4% (n = 74) for men. The active time during the cooperative learning was recorded with the Xiaomi Mi Band 2 activity band, for the quality of life scale (GENCAT) was used, and the body mass index was calculated through its standardized equation. Age was directly associated with body mass index in both sexes. Likewise, age was positively related to the active time of women. Quality of life was directly associated with active time and body mass index was inversely related to active time. This study shows the importance of active time during work and cooperative learning in individuals with intellectual disabilities, as it is associated with an improvement in the quality of life and a reduction in the problems of sedentarism, overweight, and obesity.
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Williams K, Jacoby P, Whitehouse A, Kim R, Epstein A, Murphy N, Reid S, Leonard H, Reddihough D, Downs J. Functioning, participation, and quality of life in children with intellectual disability: an observational study. Dev Med Child Neurol 2021; 63:89-96. [PMID: 32862445 DOI: 10.1111/dmcn.14657] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/19/2022]
Abstract
AIMS To investigate associations between functioning, community participation, and quality of life (QoL) and identify whether participation mediates the effects of functioning on QoL. METHOD The caregivers of 435 children (211 females, 224 males; mean age 12y; SD 3y 11mo; age range 5-18y) with intellectual disability and autism spectrum disorder, cerebral palsy, Down syndrome, or Rett syndrome reported on their child's functioning (dependence for managing personal needs, mobility, communication, eye contact when speaking), frequency of participation, and QoL. Linear regression and mediation analyses were used to evaluate the relationships between child functioning, participation, and QoL. RESULTS Children with greater dependency for managing personal needs and limited eye contact when speaking experienced poorer QoL. Less impaired functioning was associated with more frequent participation, which, in turn, was associated with a 3-point gain in QoL for each additional point in frequency of participation (coefficient=2.67, 95% confidence interval 1.56-3.78). The effect of impaired functioning on QoL was partially mediated by participation in children with greater dependency in managing personal needs and those with mildly impaired communication. INTERPRETATION Greater levels of impairments with poorer functioning, notably a high level of dependence, were associated with poorer QoL. Poorer QoL can be partly explained by less frequent community participation.
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Affiliation(s)
- Katrina Williams
- Paediatric Education and Research, Monash University, Melbourne, Victoria, Australia.,Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachel Kim
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Nada Murphy
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Sue Reid
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Dinah Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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20
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Leonard H, Junaid M, Wong K, Demarest S, Downs J. Exploring quality of life in individuals with a severe developmental and epileptic encephalopathy, CDKL5 Deficiency Disorder. Epilepsy Res 2020; 169:106521. [PMID: 33341033 DOI: 10.1016/j.eplepsyres.2020.106521] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND CDKL5 Deficiency Disorder (CDD) is a rare genetic disorder caused by a mutation in the cyclin-dependent kinase-like 5 (CDKL5) gene. It is now considered to be a developmental and epileptic encephalopathy because of the early onset of seizures in association with severe global delay. Other features include cortical visual impairment, sleep and gastro-intestinal problems. Progress in clinical understanding, especially regarding the spectrum of functional ability, seizure patterns, and other comorbidities was initially slow but accelerated in 2012 with the establishment of the International CDKL5 Database (ICDD). Our aim was to use this data source to investigate quality of life (QOL) and associated factors in this disorder. METHOD A follow-up questionnaire was administered in 2018 to parents of children registered with the ICDD who had a pathogenic CDKL5 variant. QOL was assessed using QI Disability, an instrument, specifically developed to measure total and specific domains of QOL (physical health, positive emotions, negative emotions, social interaction, leisure and the outdoors (leisure) and independence) in children with intellectual disability. Associations with functional abilities, physical health, mental health and family factors were investigated, initially using univariate analyses followed by multivariate analyses for each of these groups with a final composite model which included the important variables identified from previous models. RESULTS Questionnaires were returned by 129/160 families with a child aged >3 years. Functional impairment, including lack of ability to sit, use hands and communicate had the greatest adverse impact on QOL. There were also some relationships with major genotype groupings. Individuals using three or more anti-epileptic medications had poorer QOL than those on one or no medication, particularly in the physical health domain. There was also variation by geographical region with those living in North America typically having the best QOL and those living in middle or lower income countries poorer QOL. CONCLUSION Although lower functional abilities were associated with poorer quality of life further research is needed to understand how environmental supports might mitigate this deficit. Comprehensive care and support for both the child and family have important roles to play in helping families to thrive despite the severity of CDD.
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Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Mohammed Junaid
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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García JC, Díez E, Wojcik DZ, Santamaría M. Communication Support Needs in Adults with Intellectual Disabilities and Its Relation to Quality of Life. Int J Environ Res Public Health 2020; 17:ijerph17207370. [PMID: 33050216 PMCID: PMC7601275 DOI: 10.3390/ijerph17207370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 01/05/2023]
Abstract
Research suggests that individuals with intellectual disabilities (ID) experience difficulties in communication, ranging from intelligibility issues to more severe problems in the use and comprehension of spoken, written or sign language. Despite the negative effects that the inability to communicate have on quality of life (QoL), not much research has explored the relationship between communicative competence and QoL in the adult population with ID. The aim of this study was to describe the global communication profile of a sample of 281 adults with ID recruited from Grupo AMÁS Social Foundation, who differed in their level of communication support needs (CSN). The relationships between communicative competence and CSN with QoL were further examined. The results showed lower QoL indices for those participants characterized by their limited use of discourse and inability to exhibit certain communicative purposes, with the largest differences in the dimensions of self-determination, social inclusion, interpersonal relationships, emotional wellbeing and personal development. Overall, low levels of QoL were found for all participants, with even lower scores for the group identified as having CSN. A multiple regression model revealed that having speech/discourse competence is a powerful predictor of QoL, along with the level of disability and having the communicative competences to express likes and preferences or to establish new relationships. This clear relationship between communication and QoL is an important argument for disability support services when it comes to setting communication supports as a priority and as an important preventive step towards the protection of those at risk of exclusion.
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Affiliation(s)
| | - Emiliano Díez
- Institute for Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain; (D.Z.W.); (M.S.)
- Correspondence:
| | - Dominika Z. Wojcik
- Institute for Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain; (D.Z.W.); (M.S.)
| | - Mónica Santamaría
- Institute for Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain; (D.Z.W.); (M.S.)
- Faculty of Education, Universidad Pontificia de Salamanca, 37002 Salamanca, Spain
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Glasson EJ, Forbes D, Ravikumara M, Nagarajan L, Wilson A, Jacoby P, Wong K, Leonard H, Downs J. Gastrostomy and quality of life in children with intellectual disability: a qualitative study. Arch Dis Child 2020; 105:969-974. [PMID: 32269039 DOI: 10.1136/archdischild-2020-318796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Children with intellectual disability and marked feeding difficulties may undergo gastrostomy insertion to assist with their nutritional and medication needs. Use has increased recently for younger children, and it is intended to provide long-term support. This study explored the perceived value of gastrostomy for the quality of life (QOL) of children with intellectual disabilities and their families. METHODS Twenty-one primary caregivers of children with intellectual disability aged 2-18 years participated in semistructured telephone interviews. Data were analysed using directed content analysis, and data were coded to existing QOL domains relevant to children with intellectual disability and their families. RESULTS Benefits in each of the child and family QOL domains were represented in the interview data. For children, the impacts of gastrostomy for the physical health domain were predominant, supplemented by experiences of value for emotional well-being, social interactions, leisure activities and independence. For families, gastrostomy was integrated into multiple aspects of QOL relating to family interactions, parenting, resources and supports, health and safety, and advocacy support for disability. Shortcomings related to difficulties with equipment and complications. CONCLUSIONS Our comprehensive overview of the value of gastrostomy for children with intellectual disability and their families was classified within a QOL framework. Gastrostomy was mainly supportive over long time periods across many QOL domains. Findings will be of use to patient counselling and education and the development of family support resources.
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Affiliation(s)
- Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - David Forbes
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Lakshmi Nagarajan
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia.,Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Australia, Perth, Western Australia, Australia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia .,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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23
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Jacoby P, Epstein A, Kim R, Murphy N, Leonard H, Williams K, Reddihough D, Whitehouse A, Downs J. Reliability of the Quality of Life Inventory-Disability Measure in Children with Intellectual Disability. J Dev Behav Pediatr 2020; 41:534-9. [PMID: 32412990 DOI: 10.1097/DBP.0000000000000815] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess responsiveness and reproducibility using the estimates of test-retest reliability for the Quality of Life Inventory-Disability (QI-Disability), accounting for changes in child health and parental stress. METHOD Quality of Life Inventory-Disability was administered twice over a 1-month period to a sample of 55 primary caregivers of children (aged 5-19 years) with intellectual disability. Caregivers also reported their child's physical and mental health and completed a 4-item Perceived Stress Scale to assess parental stress. Fixed-effects linear regression models examined responsiveness of QI-Disability to the reported change in child health and parental stress. Reliability was then assessed using intraclass correlations (ICCs) calculated from QI-Disability scores adjusted for changes in child health and parental stress. RESULTS Five of 7 unadjusted ICC values indicated at least moderate agreement (>0.70), and 2 values indicated fair agreement. After accounting for changes in child health and parental stress, adjusted ICC values showed substantial agreement for the total QI-Disability score and 4 domain scores (adjusted ICC ≥ 0.80). Adjusted ICC scores indicated moderate agreement for the Physical Health domain (adjusted ICC = 0.68) and fair agreement for the Positive Emotions domain (adjusted ICC = 0.58). Improvements in a child's physical health rating were associated with higher total, Physical Health, and Positive Emotion domain scores, whereas improvements in mental health were associated with higher total and Negative Emotions domain scores, indicating better quality of life. Changes in parental stress did not have a statistically significant relationship with quality of life. CONCLUSION Satisfactory test-retest reliability was shown. Preliminary evidence indicates that QI-Disability is responsive to changes in child health, but not to differing levels of parental stress.
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Abstract
Health-related quality of life (HRQOL) is central to how clinicians and parents make choices about medical care for pediatric neurology patients. To provide parents with the information they need to make these decisions and plan for the future, it is necessary for parents and clinicians to understand how HRQOL is defined and measured in the setting of pediatric neurodevelopmental impairment. We review challenges that exist in measuring HRQOL in pediatric neurology, examine existing measures, and outline key principles to guide selection and interpretation of HRQOL measures in children with neurologic conditions.
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Affiliation(s)
- Monica E. Lemmon
- Department of Pediatrics, Duke University Medical Center, Durham, NC,Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD,Margolis Center for Health Policy, Duke University, Durham, NC
| | | | - Bryce B. Reeve
- Department of Pediatrics, Duke University Medical Center, Durham, NC,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC,Center for Health Measurement, Duke University School of Medicine, Durham, NC
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25
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Epstein A, Williams K, Reddihough D, Murphy N, Leonard H, Whitehouse A, Jacoby P, Downs J. Content validation of the Quality of Life Inventory-Disability. Child Care Health Dev 2019; 45:654-659. [PMID: 31163096 DOI: 10.1111/cch.12691] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Focus is shifting to better understand the lived experiences of children with intellectual disability in relation to their quality of life (QOL). Yet no available QOL measures are grounded in the domains important for this population. We previously conducted qualitative parent caregiver interviews identifying QOL domains in children with intellectual disability to constitute a new measure of QOL. This study describes the content validity of the Quality of Life Inventory-Disability (QI-Disability), a parent-report measure developed for children with intellectual disability. METHODS AND RESULTS Questionnaire items were extracted from a qualitative dataset of 77 parent caregiver interviews. To establish content validation, a draft of QI-Disability was administered to 16 parent caregivers of children with intellectual disability (Down syndrome, Rett syndrome, cerebral palsy, or autism spectrum disorder). Parents participated in a cognitive interviewing procedure known as the "think-aloud" method. The process of item generation, cognitive debriefing, and refinement of QI-Disability prior to its pilot testing are described. A conceptual framework is presented. CONCLUSIONS Satisfactory content validity is reported, where ongoing consumer feedback shaped the dataset from which the final items were selected. Use of QI-Disability for children with intellectual disability will allow for greater insight into service utility and targeted intervention.
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Affiliation(s)
- Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Dinah Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nada Murphy
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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26
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Soper AK, Cross A, Rosenbaum P, Gorter JW. Exploring the international uptake of the "F-words in childhood disability": A citation analysis. Child Care Health Dev 2019; 45:473-490. [PMID: 31041806 DOI: 10.1111/cch.12680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The "F-words in childhood disability" (function, family, fitness, fun, friends, and future) were introduced in a concept paper in 2012 entitled, "The F-words in childhood disability: I swear this is how we should think!". The "F-words" are grounded in, and aim to operationalize, the World Health Organization's (World Health Organization, 2001) International Classification of Functioning, Disability and Health (ICF) framework. A citation analysis was conducted to explore the extent of research uptake of the "F-words" concepts. METHODS Three databases-Google Scholar, Wiley Online, and Web of Science-were searched from July 2012 to December 2018 for sources that cited the original F-words paper. Dates of publication and countries of first authors were extracted from all cited articles, and a taxonomy was developed to categorize the type of usage. RESULTS The search yielded 157 sources from 26 countries, and the number of citations has continued to increase since the paper's publication. Sources were placed into three categories: cited/referenced (n = 109; i.e., the paper was simply cited), integrated/informed (n = 36; i.e., the F-words were stated within the text), and non-English (n = 12). Of the 36 integrated/informed sources, 34 (94.4%) applied the F-words to the ICF framework and five themes emerged with respect to the use of the F-words: (a) support of a holistic approach to childhood disability, (b) association of the F-words to physical activity and rehabilitation, (c) application and measurement of quality of life, (d) F-words research team-related papers, and (e) "other" category. CONCLUSION This citation analysis shows that the F-words are mainly being used to operationalize the ICF, support a holistic approach to childhood disability, and inform physical activity and rehabilitation-based interventions. These perspectives will play an important role in informing the next steps with respect to moving the F-words into research and practice.
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Affiliation(s)
- Alice Kelen Soper
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Cross
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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27
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Holloway JM, Long TM. The Interdependence of Motor and Social Skill Development: Influence on Participation. Phys Ther 2019; 99:761-770. [PMID: 30801638 PMCID: PMC6702414 DOI: 10.1093/ptj/pzz025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/01/2019] [Indexed: 01/21/2023]
Abstract
Participation is a major outcome area for physical therapists serving young children with disabilities. Contemporary models of disability such as the International Classification of Function, developmental theories such as the system perspective, and evidence-based early childhood practices recognize the interdependence of developmental domains, and suggest that change in 1 area of development influences change in another. Physical therapy provided in naturally occurring activities and routines, considered the preferred service delivery method, promotes participation of young children with disabilities. Research indicates that: (1) children develop skills, become independent, and form relationships through participation; and (2) with developing skills, children can increasingly participate. The purpose of this Perspective article is to synthesize the literature examining the relationship between motor skill development and the social interaction dimension of participation in young children. Current research examining the influence of motor skill development on social interactions in children with autism spectrum disorder will be discussed, exemplifying the interdependence of developmental domains. Implications for physical therapist practice and recommendations for future research are provided.
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Affiliation(s)
| | - Toby M Long
- Georgetown University, Center for Child and Human Development, Washington, District of Columbia
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28
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Strugnell A, Leonard H, Epstein A, Downs J. Using directed-content analysis to identify a framework for understanding quality of life in adults with Rett syndrome. Disabil Rehabil 2019; 42:3800-3807. [PMID: 31074665 DOI: 10.1080/09638288.2019.1610801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Rett syndrome (RTT) is a rare neurodevelopmental disorder mainly affecting females and is caused by a mutation in the MECP2 gene. Recent research identified the domains of quality of life (QOL) important for children with RTT but there has been no investigation of domains important for adults. This qualitative study explored QOL in adults with RTT and compared domains with those previously identified for children.Methods: The sample comprised parents and/or primary caregivers of 20 adults, aged 18-38 years, who were registered with the Australian Rett Syndrome Database. Semi-structured telephone interviews were conducted to investigate aspects of life that were observed to be satisfying or challenging. Data were analyzed using directed content analysis, based on existing QOL domains for children with RTT that related to health and wellbeing, daily activities, and community immersion and services.Results: Each of the domains identified for children with RTT was represented in the adult dataset, with no new domains emerging.Conclusion: This is the first study to identify QOL domains important for adults with RTT. Health and therapy needs are ongoing during adulthood but services may be limited. Findings will guide choice of an appropriate QOL measure for this group.IMPLICATIONS FOR REHABILITATIONKnowing the important domains of quality of life enables clinicians and service providers to systematically review and address key management issues.Despite a high level of dependency and sometimes poor health, parent caregivers perceive potential for strong quality of life in adulthood.Services that maintain functional skills and health throughout the lifespan are valued for their support of quality of life in adults with Rett syndrome.
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Affiliation(s)
- Aleisha Strugnell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
| | - Jenny Downs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
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29
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Tangarorang J, Leonard H, Epstein A, Downs J. A framework for understanding quality of life domains in individuals with the CDKL5 deficiency disorder. Am J Med Genet A 2018; 179:249-256. [DOI: 10.1002/ajmg.a.61012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/12/2018] [Accepted: 11/13/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jodilee Tangarorang
- The University of Notre Dame Australia Fremantle WA Australia
- Telethon Kids Institute, The University of Western Australia Perth WA Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia Perth WA Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia Perth WA Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia Perth WA Australia
- School of Physiotherapy and Exercise Science, Curtin University Perth WA Australia
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30
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Reedman SE, Boyd RN, Trost SG, Elliott C, Sakzewski L. Efficacy of Participation-Focused Therapy on Performance of Physical Activity Participation Goals and Habitual Physical Activity in Children With Cerebral Palsy: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 100:676-686. [PMID: 30543803 DOI: 10.1016/j.apmr.2018.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/09/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the efficacy of a participation-focused therapy (ParticiPAte CP) on leisure-time physical activity goal performance and satisfaction and habitual physical activity (HPA) in children with CP. DESIGN Randomized waitlist-controlled trial. SETTING Home and community. PARTICIPANTS Children classified at Gross Motor Function Classification System (GMFCS) levels I-III were recruited (n=37; 18 males; mean age ± SD, 10.0±1.4y) from a population-based register. INTERVENTIONS Participants were randomized to ParticiPAte CP (an 8-wk goal-directed, individualized, participation-focused therapy delivered by a physical therapist) or waitlist usual care. MAIN OUTCOME MEASURES The primary outcome was Canadian Occupational Performance Measure. Accelerometers were worn for objective measurement of HPA (min/d moderate-to-vigorous physical activity [MVPA], sedentary time). Barriers to participation, community participation, and quality-of-life outcomes were also collected. Data were analyzed by intention-to-treat using generalized estimating equations. RESULTS ParticiPAte CP led to significant improvements in goal performance (mean difference [MD]=3.58; 95% confidence interval [95% CI], 2.19-4.97; P<.001), satisfaction (MD=1.87; 95% CI, 0.37-3.36, P=.014), and barriers to participation (MD=26.39; 95% CI, 6.13-46.67; P=.011) compared with usual care at 8 weeks. There were no between-group differences on minutes per day of MVPA at 8 weeks (MD=1.17; 95% CI, -13.27 to 15.61; P=.874). There was a significant difference in response to intervention between participants who were versus were not meeting HPA guidelines at baseline (MD=15.85; 95% CI, 3.80-27.89; P<.0061). After ParticiPAte CP, low active participants had increased average MVPA by 5.98±12.16 minutes per day. CONCLUSION ParticiPAte CP was effective at increasing perceived performance of leisure-time physical activity goals in children with CP GMFCS I-III by reducing modifiable barriers to participation. This did not translate into change in HPA on average; however, low active children may have a clinically meaningful response.
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Affiliation(s)
- Sarah E Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
| | - Stewart G Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia; Child and Adolescent Health Services, Perth Children's Hospital, Perth, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
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31
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Downs J, Jacoby P, Leonard H, Epstein A, Murphy N, Davis E, Reddihough D, Whitehouse A, Williams K. Psychometric properties of the Quality of Life Inventory-Disability (QI-Disability) measure. Qual Life Res 2019; 28:783-94. [DOI: 10.1007/s11136-018-2057-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
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32
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Nguyen TL, Nguyen HP, Nguyen TK. The effects of bone marrow mononuclear cell transplantation on the quality of life of children with cerebral palsy. Health Qual Life Outcomes 2018; 16:164. [PMID: 30107811 PMCID: PMC6092872 DOI: 10.1186/s12955-018-0992-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/01/2018] [Indexed: 02/08/2023] Open
Abstract
Background Quality of life (QOL) is an important factor in evaluating the effectiveness of treatment in children with cerebral palsy (CP). The aim of this study was to evaluate the effects of autologous bone marrow mononuclear cells (BM MNCs) on the QOL of children with CP. Methods From December 2015 to December 2016, 30 children with CP aged from 2 to 15 years received two intrathecal infusions of BM MNCs, one at baseline and the other 3 months later, at Vinmec International Hospital. The motor function and muscle tone of the patients were evaluated using the Gross Motor Function Measure (GMFM)-88 and Modified Ashworth Score, respectively. Their QOL was assessed at baseline and 6 months after the first BM MNC transplant using the Vietnamese version of the Cerebral Palsy Quality of Life Questionnaire for children (CP QOL-Child)–the parental proxy report, which comprises seven domains. Nineteen mothers (mean age: 32.9±4.9 years) and 11 fathers (mean age: 36.1±6.8 years) were invited to complete the CP QOL-Child assessment before and after the transplantations, Paired t-tests and multivariate regression analyses were used to evaluate the changes in QOL and GMFM scores and to identify the key factors correlated with the QOL score. Results Significant changes were observed in the children’s gross motor function and muscle spasticity, as evidenced by the GMFM-88 total score, scores for each of its domains, the GMFM-66 percentile and the muscle tone (P < 0.001). Six months after the transplantations, the QOL scores of children with CP were markedly increased (P < 0.001) for all the domains, except for the domain of access to services. In the multivariate regression analysis, significant associations were found between higher age of children and higher QOL except for feeling about functioning and pain and impact of disability domains. Gross Motor Function Classification System (GMFCS) level was negatively correlated with the score of pain and impact of disability domain, while the GMFM-88 scores were positively correlated with the QOL in terms of feelings about functioning and family health domain (P < 0.05). Conclusion The QOL of the children with CP was noticeably improved 6 months after BM MNC transplantation and was accompanied by improvements in gross motor function and muscle tone. Trial registration ClinicalTrials.gov Identifier: NCT02574923. Registered on October 14, 2015.
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Affiliation(s)
- Thanh Liem Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, 458 Minh Khai Street, Hanoi, Vietnam.
| | - Hoang Phuong Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, 458 Minh Khai Street, Hanoi, Vietnam
| | - Trung Kien Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, 458 Minh Khai Street, Hanoi, Vietnam
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