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Orlova N, Riga O, Ishchenko T, Onikiienko О, Omelchenko O, Urivaeva M, Alenina I. CHRONIC PAIN AND PHYSICAL THERAPY IN CHILDREN WITH PARALYTIC SYNDROMES: ARE THERE ANY CHANGES DURING LOCKDOWN? WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2262-2269. [PMID: 36378706 DOI: 10.36740/wlek202209215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To evaluate an influence of physical therapy on chronic pain in children with paralytic's syndrome and to maternal emotional status on lockdown time during the COVID-19 pandemic. PATIENTS AND METHODS Materials and methods: Data from 96 children and their mothers (96 persons) were included in the study. On-site services of physical therapists before the pandemic (2018- 2019) were received by 64 children and by 32 children during quarantine measures due to COVID-19 pandemic (2020). The age of the children ranged from 1 to 6 years, the median age was 3 years and 3 months. RESULTS Results: We note that there were more boys with paralytic syndromes. Among the leading paralytic syndromes, the most common was spastic tetraparesis. The frequency of children with level III-V motor disorders prevailed. CONCLUSION Conclusions: The authors consider that physical rehabilitation in children with paralytic syndromes reduces the incidence of moderate chronic pain and improves the emotional state of parents. But, these changes do not occur during the pandemic.
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Affiliation(s)
| | - Olena Riga
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | | | | | | | | | - Inna Alenina
- KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
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Asnani MR, Francis D, Knight-Madden J, Chang-Lopez S, King L, Walker S. Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial. PLoS One 2021; 16:e0252513. [PMID: 34106974 PMCID: PMC8189456 DOI: 10.1371/journal.pone.0252513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD). DESIGN AND METHODS This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach. RESULTS The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD). CONCLUSION This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.
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Affiliation(s)
- Monika R. Asnani
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- * E-mail:
| | - Damian Francis
- School of Health and Human Performance, Georgia College, Milledgeville, Georgia, United States of America
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Chang-Lopez
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Lesley King
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Sil S, Woodward KE, Johnson YL, Dampier C, Cohen LL. Parental Psychosocial Distress in Pediatric Sickle Cell Disease and Chronic Pain. J Pediatr Psychol 2021; 46:557-569. [PMID: 33484135 PMCID: PMC8502425 DOI: 10.1093/jpepsy/jsaa130] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Pediatric sickle cell disease (SCD) management can result in considerable caregiver distress. Parents of youth with chronic SCD pain may face the additional challenge of managing children's chronic pain and chronic illness. This study examined associations between parent psychological distress and child functioning and the moderating role of chronic pain among youth with SCD. METHODS Youth presenting to pediatric outpatient comprehensive SCD clinics and their primary caregivers completed a battery of questionnaires. Parents reported on parenting stress, parent mental and physical health, and family functioning. Children completed measures of pain characteristics, depressive symptoms, catastrophic thinking, functional disability, and quality of life. RESULTS Patients (N = 73, Mage = 14.2 years, 57% female) and their caregivers (Mage = 41.1 years, 88% mothers, 88% Black) participated. Worse parent functioning was associated with worse child pain, functioning, quality of life, and depressive symptoms. Beyond the effects of SCD, chronic SCD pain magnified the negative associations between parenting stress frequency and child quality of life, parent physical health and child quality of life, and parent depressive symptoms and child depressive symptoms. CONCLUSIONS Chronic pain may exacerbate the relations between parent and child functioning beyond the effects of SCD alone. The management of both SCD and chronic pain may present additional challenges for parents that limit their psychosocial functioning. Family-focused interventions to support parents and youth with chronic SCD pain are warranted to optimize health outcomes.
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Affiliation(s)
- Soumitri Sil
- Department of Pediatrics
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Kerri E Woodward
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine
| | - Yelena L Johnson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine
| | - Carlton Dampier
- Department of Pediatrics
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Lindsey L Cohen
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychology, Georgia State University
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Gavrilescu O, Prelipcean CC, Dranga M, Soponaru C, Mihai C. The specialized educational and psychological counseling in inflammatory bowel disease patients - a target or a challenge? TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:760-766. [PMID: 33361038 DOI: 10.5152/tjg.2020.19669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS Stress, in its various forms, plays an important role in the development and evolution of inflammatory bowel disease (IBD). For patients with IBD, the evidence related to the effects of various types of psychological therapies remains inconclusive. This study aimed to evaluate whether cognitive behavioral therapy, in combination with educational counseling, influenced disease activity and quality of life (QoL) among patients with IBD. MATERIALS AND METHODS We conducted a randomized controlled trial with 60 patients diagnosed with IBD. All patients completed the IBD questionnaire-32 (IBDQ-32) and the Big Five Inventory. Group A (experimental group) received specialized educational and psychological counseling (SEPC), and group B (control group) was treated according to the current medical practice. All patients were reassessed after 12 months. RESULTS After the SEPC, there was no improvement in disease activity as estimated by fecal calprotectin levels. However, the QoL of patients in group A was significantly improved. The highest mean difference between the initial and final IBDQ scores was found among patients whose main personality trait was openness to experience (48.58±28.80), and the lowest mean difference between these 2 scores was found among patients whose main personality trait was closedness to experience (3.33±2.97, p=0.009). CONCLUSION Although there was no improvement in disease activity after the SEPC, this therapy improved patients' QoL in terms of both emotional and social functions, especially among patients whose dominant personality trait was openness to experience or neuroticism.
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Affiliation(s)
- Otilia Gavrilescu
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
| | - Cristina Cijevschi Prelipcean
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
| | - Mihaela Dranga
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
| | - Camelia Soponaru
- Alexandru Ioan Cuza University, School of Psychology and Education Sciences, Iasi, Romania
| | - Catalina Mihai
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
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Moore DA, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, Heyman I, Anderson R, Dickens C, Viner R, Bennett S, Logan S, Lockhart F, Thompson Coon J. Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technol Assess 2020; 23:1-164. [PMID: 31122334 DOI: 10.3310/hta23220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). DATA SOURCES For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. REVIEW METHODS The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. RESULTS Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. LIMITATIONS Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. CONCLUSIONS There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Erin Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Child Mental Health Group, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Obi Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Penny Titman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- University College London Institute of Child Health, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Chris Dickens
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Russell Viner
- University College London Institute of Child Health, London, UK
| | - Sophie Bennett
- University College London Institute of Child Health, London, UK
| | - Stuart Logan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Fiona Lockhart
- Biomedical Research Centre Patient & Public Involvement Group, University College London Hospitals, London, UK
| | - Jo Thompson Coon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
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Fiallo‐Scharer R, Palta M, Chewning BA, Rajamanickam V, Wysocki T, Wetterneck TB, Cox ED. Impact of family-centered tailoring of pediatric diabetes self-management resources. Pediatr Diabetes 2019; 20:1016-1024. [PMID: 31355957 PMCID: PMC6827338 DOI: 10.1111/pedi.12899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The American Diabetes Association recommends a family-centered approach that addresses each family's specific type 1 diabetes self-management barriers. OBJECTIVE To assess an intervention that tailored delivery of self-management resources to families' specific self-management barriers. SUBJECTS At two sites, 214 children 8-16 years old with type 1 diabetes and their parent(s) were randomized to receive tailored self-management resources (intervention, n = 106) or usual care (n = 108). METHODS Our intervention (1) identified families' self-management barriers with a validated survey, (2) tailored self-management resources to identified barriers, and (3) delivered the resources as four group sessions coordinated with diabetes visits. Mixed effects models with repeated measures were fit to A1c as well as parent and child QOL during the intervention and 1 year thereafter. RESULTS Participants were 44% youth (8-12 years) and 56% teens (13-16 years). No intervention effect on A1c or QOL was shown, combining data from sites and age groups. Analyzing results by site and age group, post-intervention A1c for teens at one site declined by 0.06 more per month for intervention teens compared to usual care (P < 0.05). In this group, post-intervention A1c declined significantly when baseline A1c was >8.5 (-0.08, P < 0.05), with an even larger decline when baseline A1c was >10 (-0.19, P < 0.05). In addition, for these teens, the significant improvements in A1c resulted from addressing barriers related to motivation to self-manage. Also at this site, mean QOL increased by 0.61 points per month more during the intervention for parents of intervention youth than for usual care youth (P < 0.05). CONCLUSIONS Tailored self-management resources may improve outcomes among specific populations, suggesting the need to consider families' self-management barriers and patient characteristics before implementing self-management resources.
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Affiliation(s)
- Rosanna Fiallo‐Scharer
- Department of PediatricsMedical College of Wisconsin/Children's Hospital of WisconsinMilwaukeeWisconsin
| | - Mari Palta
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin,Department of Biostatistics and Medical InformaticsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| | - Betty A. Chewning
- Sonderegger Research Center, Division of Social and Administrative Sciences in Pharmacy, School of PharmacyUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Victoria Rajamanickam
- Department of Biostatistics and Medical InformaticsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| | - Tim Wysocki
- Center for Health Care Delivery ScienceNemours Children's Health SystemJacksonvilleFlorida
| | - Tosha B. Wetterneck
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
| | - Elizabeth D. Cox
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin,Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsin
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Sengul ZK, Toruner EK. Intervention Protocol: Technology-Based Psychosocial Motivation for Children with Cancer and Their Parents: A Randomized Trial. Asia Pac J Oncol Nurs 2019; 7:55-63. [PMID: 31879685 PMCID: PMC6927163 DOI: 10.4103/apjon.apjon_25_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/09/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: This experimental randomized controlled trial will be to examine the impact of a technology-based psychosocial motivation program on children and families who are being followed up on a diagnosis of cancer. Methods: The research is based on the “Transactional Model of Stress and Coping.” This study will be conducted on children with leukemia, aged 9–18 years, and their parents, who will be followed in the consolidation treatment phase in the hematology wards and outpatient clinic of a university hospital. Data collection will consist of the children's and parents' descriptive characteristic form, the Spielberger State Anxiety Inventory for Parents, the State-Trait Anxiety Inventory for Children, the Pediatric Cancer Coping Scale, the Pediatric Quality of Life Inventory, and process evaluation forms. A 10-week program will be implemented for the children in the intervention group through web-based training, coaching interviews and counseling via video mobile calls, mobile messages and children's stories, progressive muscle relaxation and breathing exercises, and imagination interventions. During the same period, parents will also receive web-based training, coaching sessions, counseling, mobile messages, and progressive muscle relaxation exercises. Results: It is thought that after the intervention the stress level of the child and the family will decrease, the coping skills of the children will improve, and their quality of life will increase. Conclusions: It is thought that the treatment process can be affected positively by providing psychosocial support to children and their families who receive cancer treatment.
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Affiliation(s)
- Zeynep Kisecik Sengul
- Department of Nursing, Health Sciences Faculty, Kirikkale University, Kirikkale, Turkey
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Law E, Fisher E, Eccleston C, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2019; 3:CD009660. [PMID: 30883665 PMCID: PMC6450193 DOI: 10.1002/14651858.cd009660.pub4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015. OBJECTIVES To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018. SELECTION CRITERIA Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list. DATA COLLECTION AND ANALYSIS We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE. MAIN RESULTS We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate. AUTHORS' CONCLUSIONS Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.
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Affiliation(s)
- Emily Law
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Cunningham NR, Fussner LM, Moorman E, Avar Aydin PO, Brunner HI, Kashikar-Zuck S. Development and pilot testing of the treatment and education approach for childhood-onset lupus (TEACH): a cognitive behavioral treatment. Pediatr Rheumatol Online J 2019; 17:9. [PMID: 30777090 PMCID: PMC6380024 DOI: 10.1186/s12969-019-0307-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/30/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To develop and test the feasibility and initial effectiveness of the Treatment and Education Approach for Childhood-onset Lupus (TEACH) protocol, a 6-session cognitive behavioral therapy (CBT) intervention for adolescents and young adults (AYA) with childhood-onset systemic lupus erythematosus (cSLE). METHODS Females with cSLE (n = 14; ages 13-19 years, M = 16.21 years) presenting to a pediatric rheumatology clinic subsequently completed the protocol, which was iteratively modified based on participant/interventionist feedback. Upon intervention completion, participants provided qualitative data on feasibility, acceptability, potential modifications, and perceived effectiveness of the program via a semi-structured interview, which was analyzed for shared themes. Participants also completed measures of fatigue, psychological distress, and pain intensity before and after the intervention. Nonparametric statistics were conducted to examine changes in outcome measures following the intervention. RESULTS During the study, several protocol modifications were employed to better address the unique needs of individuals with cSLE (e.g., separate content for adolescents versus young adults). Results suggest that TEACH is feasible, acceptable, and potentially effective in the management of cSLE symptoms. Following the intervention, there was a statistically significant reduction in fatigue (Z = - 2.81, p < .01) and depressive symptoms (Z = - 2.69, p < .01). Reductions in pain and anxiety symptoms were marginal. CONCLUSIONS TEACH, a tailored CBT protocol for AYA with cSLE, is a feasible and potentially effective intervention for the management of fatigue and depressive symptoms. Future directions include testing the protocol in a larger controlled study.
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Affiliation(s)
- Natoshia R. Cunningham
- University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Division of Behavioral Medicine and Clinical Psychology, MLC 7039, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - Lauren M. Fussner
- Division of Behavioral Medicine and Clinical Psychology, MLC 7039, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - Erin Moorman
- Division of Behavioral Medicine and Clinical Psychology, MLC 7039, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - Pinar O. Avar Aydin
- University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - Hermine I. Brunner
- University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - Susmita Kashikar-Zuck
- University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Division of Behavioral Medicine and Clinical Psychology, MLC 7039, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
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Thabrew H, Stasiak K, Hetrick SE, Donkin L, Huss JH, Highlander A, Wong S, Merry SN. Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev 2018; 12:CD012488. [PMID: 30578633 PMCID: PMC6353208 DOI: 10.1002/14651858.cd012488.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Long-term physical conditions affect 10% to 12% of children and adolescents worldwide. These individuals are at greater risk of developing psychological problems, particularly anxiety and depression, sometimes directly related to their illness or medical care (e.g. health-related anxiety). There is limited evidence regarding the effectiveness of psychological therapies for treating anxiety and depression in this population. Therapies designed for children and adolescents without medical issues may or may not be appropriate for use with those who have long-term physical conditions. OBJECTIVES This review was undertaken to assess the effectiveness and acceptability of psychological therapies in comparison with controls (treatment-as-usual, waiting list, attention placebo, psychological placebo, or non-psychological treatment) for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 27 September 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to May 2016). In addition we searched the Web of Science (Core Collection) (12 October 2018) and conducted a cited reference search for reports of all included trials. We handsearched relevant conference proceedings, reference lists of included articles, and grey literature. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for treating anxiety or depression in children with long-term physical conditions were included. DATA COLLECTION AND ANALYSIS Abstracts and complete articles were independently reviewed by two authors. Discrepancies were addressed by a third author. Odds ratio (OR) was used for comparing dichotomous data and standardised mean differences (SMD) for comparing continuous data. Meta-analysis was undertaken when treatments, participants, and the underlying clinical question were similar. Otherwise, narrative analysis of data was undertaken. MAIN RESULTS Twenty-eight RCTs and one cross-over trial with 1349 participants were included in the review. Most participants were recruited from community settings and hospital clinics in high-income countries. For the primary outcome of treatment efficacy, short-term depression (versus any control), there was low-quality evidence from 16 trials involving 1121 participants suggesting that psychological therapies may be more effective than control therapies (SMD -0.31, 95% CI -0.59 to -0.03; I2 = 79%). For the primary outcome of treatment efficacy, short-term anxiety (versus any control), there was inadequate evidence of moderate-quality from 13 studies involving 578 participants to determine whether psychological therapies were more effective than control conditions (SMD -0.26, CI -0.59 to 0.07, I2 = 72%). Planned sensitivity analyses could not be undertaken for risk of bias due to the small number of trials that rated high for each domain. Additional sensitivity analysis demonstrated that psychological interventions specifically designed to reduce anxiety or depression were more effective than psychological therapies designed to improve other symptoms or general coping. There was some suggestion from subgroup analyses that they type of intervention (Chi² = 14.75, df = 5 (P = 0.01), I² = 66.1%), the severity of depression (Chi² = 23.29, df = 4 (P = 0.0001), I² = 82.8%) and the type of long-term physical condition (Chi² = 10.55, df = 4 (P = 0.03), I² = 62.1%) may have an impact on the overall treatment effect.There was qualitative (reported), but not quantitative evidence confirming the acceptability of selected psychological therapies for anxiety and depression. There was low-quality evidence that psychological therapies were more effective than control conditions in improving quality of life (SMD 1.13, CI 0.44 to 1.82, I2 = 89%) and symptoms of long-term physical conditions (SMD -0.34, CI -0.6 to -0.06, I2 = 70%), but only in the short term. There was inadequate low-quality evidence to determine whether psychological therapies were more effective than control conditions at improving functioning in either the short term or long term. No trials of therapies for addressing health-related anxiety were identified and only two trials reported adverse effects; these were unrelated to psychological therapies. Overall, the evidence was of low to moderate quality, results were heterogeneous, and only one trial had an available protocol. AUTHORS' CONCLUSIONS A limited number of trials of variable quality have been undertaken to assess whether psychological therapies are effective for treating anxiety and depression in children and adolescents with long-term physical conditions. According to the available evidence, therapies specifically designed to treat anxiety or depression (especially those based on principles of cognitive behaviour therapy (CBT)) may be more likely to work in children and adolescents who have mild to moderate levels of symptoms of these disorders, at least in the short term. There is a dearth of therapies specifically designed to treat health-related anxiety in this age group.
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Affiliation(s)
- Hiran Thabrew
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | - Liesje Donkin
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Jessica H Huss
- University of KasselDepartment of PsychologyKasselGermany
| | | | - Stephen Wong
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
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11
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Noser AE, Dai H, Marker AM, Raymond JK, Majidi S, Clements MA, Stanek KR, Patton SR. Parental depression and diabetes-specific distress after the onset of type 1 diabetes in children. Health Psychol 2018; 38:103-112. [PMID: 30570283 DOI: 10.1037/hea0000699] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine trajectories of two types of type 1 diabetes (T1D) specific distress (i.e., daily T1D management and worries about the future and long-term complications) and the moderating role of parental depression in parents of children newly diagnosed with T1D. METHOD A total of 126 families of 5- to 9-year-olds with new-onset T1D enrolled in the study. One-hundred twenty-five families completed study measures at baseline, 102 at 6-month follow-up, and 89 at 12-month follow-up. Parents completed measures of depression and T1D-specific distress concerning daily T1D management and worries about the future and long-term complications at baseline and at 6- and 12-month follow-ups. We used multilevel modeling to examine 12-month trajectories of daily and long-term T1D-specific distress and to examine if parental depression modified these trajectories. RESULTS Results showed a significant reduction in daily T1D-specific distress from baseline to 6-month follow-up and maintenance of daily T1D-specific distress from 6- to 12-month follow-up. The significant interaction of baseline parental depression and time indicated that parents with depressive symptoms had a smaller reduction in daily T1D-specific distress from baseline to 6-month follow-up compared to parents without depressive symptoms. Findings for long-term T1D-specific distress indicated that parents with depressive symptoms reported higher distress across all assessment points, with peak long-term T1D-specific distress for parents with depressive symptoms occurring at 6-month follow-up. CONCLUSION Many parents experienced significant T1D-specific distress for a period of time following their child's initial diagnosis and this distress appears to be exacerbated by parental depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Amy E Noser
- Clinical Child Psychology Program, University of Kansas
| | - Hongying Dai
- Health Services and Outcomes Research, Children's Mercy-Kansas City
| | | | - Jennifer K Raymond
- The Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles
| | - Shideh Majidi
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine
| | - Mark A Clements
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center
| | - Kelly R Stanek
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine
| | - Susana R Patton
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, and Children's Mercy-Kansas City
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12
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev 2018; 8:CD012489. [PMID: 30110718 PMCID: PMC6513202 DOI: 10.1002/14651858.cd012489.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. Access to face-to-face treatment for such problems is often limited, and available interventions usually have not been tested with this population. As technology improves, e-health interventions (delivered via digital means, such as computers and smart phones and ranging from simple text-based programmes through to multimedia and interactive programmes, serious games, virtual reality and biofeedback programmes) offer a potential solution to address the psychological needs of this group of young people. OBJECTIVES To assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDTR to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2017), Web of Science (1900 - 18 August 2016, updated 31 August 2017) and Ovid MEDLINE, Embase, PsycINFO (cross-search 2016 to 18 Aug 2017). We hand-searched relevant conference proceedings, reference lists of included articles, and the grey literature to May 2016. We also searched international trial registries to identify unpublished or ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised trials, and cross-over trials of e-health interventions for treating any type of long-term physical condition in children and adolescents (aged 0 to 18 years), and that measured changes in symptoms or diagnoses of anxiety, depression, or subthreshold depression. We defined long-term physical conditions as those that were more than three-months' duration. We assessed symptoms of anxiety and depression using patient- or clinician-administered validated rating scales based on DSM III, IV or 5 (American Psychological Association 2013), or ICD 9 or 10 criteria (World Health Organization 1992). Formal depressive and anxiety disorders were diagnosed using structured clinical interviews. Attention placebo, treatment as usual, waiting list, psychological placebo, and other non-psychological therapies were eligible comparators. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed titles, abstracts, and full-text articles; discrepancies were resolved through discussion or addressed by a third author. When available, we used odds ratio (OR) to compare dichotomous data and standardised mean differences (SMD) to analyse continuous data, both with 95% confidence intervals (CI). We undertook meta-analysis when treatments, participants, and the underlying clinical question were adequately similar. Otherwise, we undertook a narrative analysis. MAIN RESULTS We included five trials of three interventions (Breathe Easier Online, Web-MAP, and multimodal cognitive behavioural therapy (CBT)), which included 463 participants aged 10 to 18 years. Each trial contributed to at least one meta-analysis. Trials involved children and adolescents with long-term physical conditions, such as chronic headache (migraine, tension headache, and others), chronic pain conditions (abdominal, musculoskeletal, and others), chronic respiratory illness (asthma, cystic fibrosis, and others), and symptoms of anxiety or depression. Participants were recruited from community settings and hospital clinics in high income countries.For the primary outcome of change in depression symptoms versus any control, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.06, 95% CI -0.35 to 0.23; five RCTs, 441 participants). For the primary outcome of change in anxiety symptoms versus any comparator, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.07, 95% CI -0.29 to 0.14; two RCTs, 324 participants). For the primary outcome of treatment acceptability, there was very low-quality evidence that e-health interventions were less acceptable than any comparator (SMD 0.46, 95% CI 0.23 to 0.69; two RCTs, 304 participants).For the secondary outcome of quality of life, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.83, 95% CI -1.53 to -0.12; one RCT, 34 participants). For the secondary outcome of functioning, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.08, 95% CI -0.33 to 0.18; three RCTs, 368 participants). For the secondary outcome of status of long-term physical condition, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD 0.06, 95% CI -0.12 to 0.24; five RCTs, 463 participants).The risk of selection bias was considered low in most trials. However, the risk of bias due to inadequate blinding of participants or outcome assessors was considered unclear or high in all trials. Only one study had a published protocol; two trials had incomplete outcome data. All trials were conducted by the intervention developers, introducing another possible bias. No adverse effects were reported by any authors. AUTHORS' CONCLUSIONS At present, the field of e-health interventions for the treatment of anxiety or depression in children and adolescents with long-term physical conditions is limited to five low quality trials. The very low-quality of the evidence means the effects of e-health interventions are uncertain at this time, especially in children aged under 10 years.Although it is too early to recommend e-health interventions for this clinical population, given their growing number, and the global improvement in access to technology, there appears to be room for the development and evaluation of acceptable and effective technologically-based treatments to suit children and adolescents with long-term physical conditions.
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Affiliation(s)
- Hiran Thabrew
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | - Stephen Wong
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Jessica H Huss
- University of KasselDepartment of PsychologyKasselGermany
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
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13
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Geense WW, van Gaal BG, Knoll JL, Maas NM, Kok G, Cornelissen EA, Nijhuis-van der Sanden MW. Effect and Process Evaluation of e-Powered Parents, a Web-Based Support Program for Parents of Children With a Chronic Kidney Disease: Feasibility Randomized Controlled Trial. J Med Internet Res 2018; 20:e245. [PMID: 30068502 PMCID: PMC6094085 DOI: 10.2196/jmir.9547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Parents of children with chronic kidney disease (CKD) experience high levels of stress in the daily management of their child’s illness. Parents need continuously available support and information, yet online support programs are lacking. e-Powered Parents was developed to fill this gap; it is an online program consisting of (1) medical information, (2) an interactive part, and (3) four training modules (stress management, setting limits, communication, and coping). Prior to a large-scale evaluation, we conducted a feasibility study that consisted of an effect study and a process evaluation. Objective The objectives of our study were to (1) identify the outcome measures that are most likely to capture the potential benefit, (2) evaluate the potential effectiveness and effect size, and (3) evaluate recruitment, reach, the dose received, and context. Methods We conducted a feasibility study with a two-armed, wait-list randomized controlled trial (RCT). Prior to baseline, parents (n=146) were randomly allocated to group 1 or group 2. After completing the baseline questionnaire, parents in group 1 were given access to e-Powered Parents, while those in group 2 received usual care. At the 6-month follow-up (T1), all parents received a questionnaire and parents in group 2 were given access to e-Powered Parents as well. After 1.5 years, through an extra measurement (T2), we evaluated the effect of long-term exposure. Outcomes were the child’s quality of life (Child Vulnerability Scale), parental stress (Pediatric Inventory for Parents) and fatigue (Multidimensional Fatigue Inventory), self-efficacy in communication with health care professionals (Perceived Efficacy in Patient-Physician Interactions, PEPPI-5), and parental perceptions of family management (Family Management Measure). Floor and ceiling effects and percentage of parents showing no change in scores were calculated. We used linear mixed models to evaluate the potential effectiveness and effect sizes using the intention-to-treat and per-protocol analyses. In the process evaluation, we evaluated recruitment, reach, the dose received, and context using a questionnaire sent to the parents, log-in data, and a focus group interview with health care professionals. Results At T1 (n=86) and T2 (n=51), no significant effects were found on any of the five outcomes. The PEPPI-5 showed ceiling effects and high percentages of parents showing no change between the measurement times. The information and interactive part of the intervention were used by 84% (57/68) of the parents in group 1 and 49% (32/65) of the parents in group 2. The information pages were visited most often. Overall, 64% (85/133) of the parents logged in to the training platform and 31% (26/85) actually used the training modules. Conclusions We did not observe any significant effect on any of the outcomes. This could possibly be explained by the minimal use of the intervention and by parents’ heterogeneity. For continued participation, we recommend a tailored intervention and further studies to find out whether and how online programs could be used to support parents in the management of their child’s CKD. Trial Registration Netherlands Trial Registry NTR4808; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4808 (Archived by WebCite at http://www.webcitation.org/719rCicvW)
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Affiliation(s)
- Wytske W Geense
- IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Betsie Gi van Gaal
- IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands.,Institute of Nursing, HAN University of Applied Science, Nijmegen, Netherlands
| | - Jaqueline L Knoll
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nienke M Maas
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerjo Kok
- Department of Work & Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Elisabeth Am Cornelissen
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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14
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Douma M, Scholten L, Maurice-Stam H, Grootenhuis MA. Online cognitive-behavioral based group interventions for adolescents with chronic illness and parents: study protocol of two multicenter randomized controlled trials. BMC Pediatr 2018; 18:235. [PMID: 30021540 PMCID: PMC6052594 DOI: 10.1186/s12887-018-1216-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adolescents with chronic illness (CI) and parents of a child with CI are at risk for psychosocial problems. Psychosocial group interventions may prevent these problems. With the use of cognitive-behavioral therapy, active coping strategies can be learned. Offering an intervention online eliminates logistic barriers (travel time and distance) and improves accessibility for participants. Aim of this study is to examine the effectiveness of two cognitive-behavioral based online group interventions, one for adolescents and one for parents: Op Koers Online. The approach is generic, which makes it easier for patients with rare illnesses to participate. METHODS/DESIGN This study conducts two separate multicenter randomized controlled trials. Participants are adolescents (12 to 18 years of age) with CI and parents of children (0 to 18 years of age) with CI. Participants are randomly allocated to the intervention group or the waitlist control group. Outcomes are measured with standardized questionnaires at baseline, after 8 (adolescents) or 6 (parents) weeks of treatment, and at 6- and 12-month follow-up period. Primary outcomes are psychosocial functioning (emotional and behavioral problems) and disease-related coping skills. Secondary outcomes for adolescents are self-esteem and quality of life. Secondary outcomes for parents are impact of the illness on family functioning, parental distress, social involvement and illness cognitions. The analyses will be performed according to the intention-to-treat principle. Primary and secondary outcomes will be assessed with linear mixed model analyses using SPSS. DISCUSSION These randomized controlled trials evaluate the effectiveness of two online group interventions improving psychosocial functioning in adolescents with CI and parents of children with CI. If proven effective, the intervention will be optimized and implemented in clinical practice. TRIAL REGISTRATION ISRCTN ISRCTN83623452 . Registered 30 November 2017. Retrospectively registered.
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Affiliation(s)
- Miriam Douma
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Linde Scholten
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martha A. Grootenhuis
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Maxima Center for Pediatric Oncology, University Medical Center, Lundlaan 6, Postbus 85090, 3508 AB Utrecht, the Netherlands
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15
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Distelberg B, Tapanes D, Emerson ND, Brown WN, Vaswani D, Williams-Reade J, Anspikian AM, Montgomery S. Prospective Pilot Study of the Mastering Each New Direction Psychosocial Family Systems Program for Pediatric Chronic Illness. FAMILY PROCESS 2018; 57:83-99. [PMID: 28299791 DOI: 10.1111/famp.12288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Psychosocial interventions for pediatric chronic illness (CI) have been shown to support health management. Interventions that include a family systems approach offer potentially stronger and more sustainable improvements. This study explores the biopsychosocial benefits of a novel family systems psychosocial intervention (MEND: Mastering Each New Direction). Forty-five families participated in a 21-session intensive outpatient family systems-based program for pediatric CI. Within this single arm design, families were measured on five domains of Health-Related Quality of Life (HRQL) self-report measures; Stress, Cognitive Functioning, Mental Health, Child HRQL, Family Functioning. Both survey and biological measures (stress: catecholamine) were used in the study. Results from multivariate general linear models showed positive pre-, post-, and 3-month posteffects in all five domains. The program effects ranged from small to moderate (η2 = .07-.64). The largest program effects were seen in the domains of cognitive functioning (η2 = .64) and stress (η2 = .27). Also, between disease groups, differences are noted and future implications for research and clinical practice are discussed. Conclusions suggest that the MEND program may be useful in helping families manage pediatric chronic illnesses. Study results also add to the growing body of literature suggesting that psychosocial interventions for pediatric chronic illness benefit from a family systems level of intervention.
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Affiliation(s)
| | - Daniel Tapanes
- Department of Counseling and Family Sciences, Loma Linda University Health Behavioral Medicine Center, Loma Linda, CA
| | | | - Whitney N Brown
- Department of Psychology, Loma Linda University, Loma Linda, CA
| | - Deepti Vaswani
- Loma Linda University Health Behavioral Medicine Center, Loma Linda, CA
| | | | - Ara M Anspikian
- Loma Linda University Health Behavioral Medicine Center, Loma Linda, CA
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16
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Persistent postsurgical pain in children and young people: prediction, prevention, and management. Pain Rep 2017; 2:e616. [PMID: 29392231 PMCID: PMC5777679 DOI: 10.1097/pr9.0000000000000616] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/03/2022] Open
Abstract
Ensuring optimum preoperative and postoperative pain management should always be a priority in children.
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17
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Ali A, Weiss TR, Dutton A, McKee D, Jones KD, Kashikar-Zuck S, Silverman WK, Shapiro ED. Mindfulness-Based Stress Reduction for Adolescents with Functional Somatic Syndromes: A Pilot Cohort Study. J Pediatr 2017; 183:184-190. [PMID: 28088398 PMCID: PMC5367961 DOI: 10.1016/j.jpeds.2016.12.053] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the feasibility of a mindfulness-based stress reduction (MBSR) program for adolescents with widespread chronic pain and other functional somatic symptoms and to make preliminary assessments of its clinical utility. STUDY DESIGN Three cohorts of subjects completed an 8-week MBSR program. Child- and parent-completed measures were collected at baseline and 8 and 12 weeks later. Measures included the Functional Disability Inventory (FDI), the Fibromyalgia/Symptom Impact Questionnaire-Revised (FIQR/SIQR), the Pediatric Quality of Life Inventory, the Multidimensional Anxiety Scale (MASC2), and the Perceived Stress Scale. Subjects and parents were interviewed following the program to assess feasibility. RESULTS Fifteen of 18 subjects (83%) completed the 8-week program. No adverse events occurred. Compared with baseline scores, significant changes were found in mean scores on the FDI (33% improvement, P = .026), FIQR/SIQR (26% improvement, P = .03), and MASC2 (child: 12% improvement, P = .02; parent report: 17% improvement, P = .03) at 8 weeks. MASC2 scores (child and parent) and Perceived Stress Scale scores were significantly improved at 12 weeks. More time spent doing home practice was associated with better outcomes in the FDI and FIQR/SIQR (44% and 26% improvement, respectively). Qualitative interviews indicated that subjects and parents reported social support as a benefit of the MBSR class, as well as a positive impact of MBSR on activities of daily living, and on pain and anxiety. CONCLUSIONS MBSR is a feasible and acceptable intervention in adolescents with functional somatic syndromes and has preliminary evidence for improving functional disability, symptom impact, and anxiety, with consistency between parent and child measures. TRIAL REGISTRATION ClinicalTrials.gov: NCT02190474.
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Affiliation(s)
- Ather Ali
- Department of Pediatrics; Department of Medicine.
| | | | | | - Douglas McKee
- Department of Economics, Yale University, New Haven, CT
| | - Kim D Jones
- Schools of Nursing and Medicine, Oregon Health & Science University, Portland, OR
| | | | | | - Eugene D Shapiro
- Department of Pediatrics; Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT
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18
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Defenderfer EK, Rybak TM, Davies WH, Berlin KS. Predicting parent health-related quality of life: evaluating conceptual models. Qual Life Res 2017; 26:1405-1415. [PMID: 28229329 DOI: 10.1007/s11136-016-1491-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Parents of children with chronic illnesses are at risk for poor health-related quality of life (HRQoL), with numerous identified risk factors, but the most informative statistical model considering their combined impact is unclear. The authors conceptualized risk for poor HRQoL using a summed model, comprehensive multivariate model, and latent profile analysis (LPA). METHODS Community parents completed an online survey, providing information about demographics, child's chronic illness, family functioning, and parent and child HRQoL. Parents reported that their children had a variety of chronic conditions (e.g., asthma, headaches, attention deficit/hyperactivity disorder, neurofibromatosis). RESULTS The summed model did not account for a significant proportion of variance in parent HRQoL. The comprehensive multivariate model (R 2 = 0.614) and LPA (R 2 = 0.305) both significantly predicted parent HRQoL. The LPA identified two risk profiles for lower HRQoL: parents who reported milder illnesses, but poorer family functioning; and parents who reported greater disease severity, but better family functioning. CONCLUSIONS Comprehensive multivariate models or LPAs best conceptualize patterns of risk for poor parental HRQoL in the community; though the findings in the current community sample may not extend to parents recruited from specialty clinics whose children may have more severe chronic illnesses. Parents of children with mild chronic conditions are still at risk for poor HRQoL, warranting attention from health care providers.
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Affiliation(s)
- Ellen K Defenderfer
- Psychology Department, University of Wisconsin-Milwaukee, 2441 E Hartford Ave., 413, Milwaukee, WI, 53201, USA.
| | - Tiffany M Rybak
- Psychology Department, University of Memphis, Memphis, TN, USA
| | - W Hobart Davies
- Psychology Department, University of Wisconsin-Milwaukee, 2441 E Hartford Ave., 413, Milwaukee, WI, 53201, USA
| | - Kristoffer S Berlin
- Psychology Department, University of Memphis, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
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Calvano C, Groß M, Warschburger P. Do Mothers Benefit from a Child-Focused Cognitive Behavioral Treatment (CBT) for Childhood Functional Abdominal Pain? A Randomized Controlled Pilot Trial. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E13. [PMID: 28212279 PMCID: PMC5332915 DOI: 10.3390/children4020013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
Abstract
While the efficacy of cognitive-behavioral treatment (CBT) approaches for childhood functional abdominal pain (FAP) is well-established for child outcomes, only a few studies have reported on parent-specific outcomes. This randomized controlled pilot trial analyzed effects of a group CBT on maternal variables (i.e., pain-related behavior, worries and self-efficacy, as well as general psychosocial strain). Methods: The sample constituted of 15 mothers in the intervention group (IG) and 14 mothers in the waitlist control group (WLC). Outcome measures were assessed pre-treatment, post-treatment and at three months follow-up. Results: Analyses revealed significant, large changes in maladaptive maternal reactions related to the child's abdominal pain in the IG compared to the WLC-i.e., reduced attention (d = 0.95), medical help-seeking (d = 0.92), worries (d = 1.03), as well as a significant increase in behaviors that encourage the child's self-management (d = 1.03). In addition, maternal self-efficacy in dealing with a child's pain significantly increased in the IG as well (d = 0.92). Treatment effects emerged post-treatment and could be maintained until three months follow-up. There were no effects on general self-efficacy and maternal quality of life. Conclusion: While these results are promising, and underline the efficacy of the CBT approach for both the child and mothers, further studies, including long-term follow-ups, are warranted.
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Affiliation(s)
- Claudia Calvano
- Counseling Psychology, University of Potsdam, Potsdam 14469, Germany.
| | - Martina Groß
- Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung (DCCV e.V.), Berlin 10179, Germany.
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. Psychological therapies for anxiety and depression in children and adolescents with long-term physical conditions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hiran Thabrew
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Karolina Stasiak
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne; 35 Poplar Road Parkville Melbourne Victoria Australia 3054
| | - Stephen Wong
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Jessica H Huss
- University of Kassel; Department of Psychology; Kassel Germany
| | - Sally N Merry
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
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21
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. eHealth interventions for anxiety and depression in children and adolescents with long-term physical conditions. Hippokratia 2017. [DOI: 10.1002/14651858.cd012489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiran Thabrew
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Karolina Stasiak
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne; 35 Poplar Road Parkville Melbourne Victoria Australia 3054
| | - Stephen Wong
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
| | - Jessica H Huss
- University of Kassel; Department of Psychology; Kassel Germany
| | - Sally N Merry
- University of Auckland; Department of Psychological Medicine; Level 12 Support Building Auckland Hospital, Park Road, Grafton Auckland New Zealand
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Effect of Psychotherapy on Health Care Utilization in Children With Inflammatory Bowel Disease and Depression. J Pediatr Gastroenterol Nutr 2016; 63:658-664. [PMID: 27035372 PMCID: PMC5040612 DOI: 10.1097/mpg.0000000000001207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pediatric patients with inflammatory bowel disease (IBD) are at an increased risk of developing depression compared with community controls. Depression often negatively influences illness behaviors such as resource utilization. We sought to investigate the effects of treating depression on utilization of medical resources in depressed pediatric patients with IBD by comparing rates of health care utilization 1 year before and after psychotherapy. METHOD Two hundred seventeen subjects ages 9 to 17 years with IBD and depression received 3 months of psychotherapy for depression as part of a multicenter randomized controlled trial. Of these 217 subjects, 70 had utilization data available 1 year prior and 1 year after receiving 3 months of psychotherapy. Primary outcomes included frequency of hospitalizations, inpatient hospital days, outpatient gastrointestinal visits, and number of emergency room visits, radiological examinations, and endoscopies. Within subject analyses were completed comparing health care utilization 12 months before psychotherapy compared with the 12 months after the conclusion of psychotherapy. RESULTS Fifty-one and 19 patients had CD and UC, respectively. A total of 55.7% of patients had major depression and 44.3% had minor depression. Overall, all study measures of health care utilization were significantly reduced after psychotherapy (P < 0.01)-including gastrointestinal-related (mean values) hospitalization frequency, inpatient days, outpatient visit, emergency room visits, radiological examinations, and endoscopies. CONCLUSIONS Psychotherapy for comorbid depression in pediatric patients with IBD is associated with decreased GI-related health care utilization. The present study highlights the importance of screening for depression in a pediatric population with IBD, and that psychotherapy may be a reasonable adjunctive treatment for pediatric patients with IBD and comorbid depression.
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Magliano L, Politano L. Family context in muscular dystrophies: psychosocial aspects and social integration. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2016; 35:96-99. [PMID: 28344439 PMCID: PMC5343746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Muscular dystrophies (MDs) are degenerative diseases which may led to marked functional impairment and reduced life expectancy. Being caregivers of a loved one with MD may be both a rewarding and a demanding experience that may have relevant impact on the quality of life of the whole family. In this short review we summarize the main findings of the first survey on family context in MD in Italy. The study was carried out on 502 key-relatives of patients suffering from Duchenne, Becker, or Limb-Girdle MD, aged between 4 and 25 years, and attending one of 8 participating Centers, all over 2012. The results revealed that practical difficulties were mainly related to relatives' involvement in helping the patient in moving and in relative's constraints of leisure activities. Furthermore, feelings of loss and perception of patient's condition as having negative effects on the family life were the psychological consequences more frequently complained. However, despite the difficulties, 88% of the key-relatives acknowledged the caregiving as a positive experience. In fact 94% of the respondents stated they could rely on friends in case of own physical illness, and 88% in case of psychological stress. Burden was found higher among relatives of patients with lower functional autonomy and longer duration of illness, and among relatives with lower professional and social support. Conversely, the positive aspects of the caregiving were more frequently acknowledged by those who received higher level of professional help and psychological social support. These results reveal that the caregiving experience has a positive impact on key-relatives quality of life despite the practical demands, and that the support of professionals is essential to help families in identifying the benefits of this experience without denying its difficulties.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Campania University "Luigi Vanvitelli", Caserta, Italy;,Address for correspondence: Lorenza Magliano, Department of Psychology, Campania University "Luigi Vanvitelli", viale Ellittico, 31, 81100 Caserta, Italy. E-mail: ; Luisa Politano, Cardiomiologia e Genetica Medica, Primo Policlinico, piazza Miraglia, 80138 Napoli. E-mail:
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Campania University "Luigi Vanvitelli", Naples, Italy,Address for correspondence: Lorenza Magliano, Department of Psychology, Campania University "Luigi Vanvitelli", viale Ellittico, 31, 81100 Caserta, Italy. E-mail: ; Luisa Politano, Cardiomiologia e Genetica Medica, Primo Policlinico, piazza Miraglia, 80138 Napoli. E-mail:
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Distelberg BJ, Emerson ND, Gavaza P, Tapanes D, Brown WN, Shah H, Williams-Reade J, Montgomery S. A Cost-Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:371-382. [PMID: 27282311 PMCID: PMC4938762 DOI: 10.1111/jmft.12166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs-benefits of a family systems-based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi-prospective study compared the 12-month pre-post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost-benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.
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Martin S, Wolters PL, Toledo-Tamula MA, Schmitt SN, Baldwin A, Starosta A, Gillespie A, Widemann B. Acceptance and commitment therapy in youth with neurofibromatosis type 1 (NF1) and chronic pain and their parents: A pilot study of feasibility and preliminary efficacy. Am J Med Genet A 2016; 170:1462-70. [PMID: 27021207 PMCID: PMC6675568 DOI: 10.1002/ajmg.a.37623] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 02/26/2016] [Indexed: 11/09/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting about 1 in 3,500 individuals. Chronic pain is commonly reported among individuals with NF1 and plexiform neurofibroma tumors (PNs). Acceptance and Commitment Therapy (ACT), an empirically supported method for addressing chronic pain, helps individuals re-focus on valued relationships and activities. This pilot study investigated the feasibility and preliminary efficacy of a brief ACT workshop in the NF1 population. Eligible participants included adolescents and young adults (AYA; 12-21 years) with NF1 and chronic pain that interfered with daily functioning and their parents. Patients and parents completed baseline measures of pain interference, pain intensity, functional disability, pain acceptance, depression, and anxiety. Then, AYA and parents participated separately in a 2-day small-group ACT workshop. A telephone booster session occurred 1 month post-intervention. Three-month post-treatment measures were completed by mail. Ten adolescents (4 males; M age = 16.9 years) and seven parents provided baseline and 3-month data. Mean satisfaction with the study was moderate to high (3.9 for patients and 4.6 for parents on a 1-5 scales). Patients and parents reported significant declines in patients' pain interference at 3 months post-treatment. Patient-reported pain intensity significantly declined from baseline to 3 months. Parents reported marginally greater acceptance of their child's pain. No changes emerged in functional ability or mood. Preliminary findings suggest that a brief ACT group intervention is feasible and may help AYA with NF1 and PNs cope with their chronic pain, although larger randomized studies are needed to confirm treatment efficacy. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
| | - Pamela L. Wolters
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate/CMRP, Leidos Biomedical Research, Inc., National Laboratory for Cancer Research, Frederick County, Frederick, Maryland
| | - Shawn Nelson Schmitt
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
- Ettenhofer Laboratory for Neurocognitive Research, Uniformed Services University of the Health Sciences, Montgomery County, Bethesda, Maryland
| | - Andrea Baldwin
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
| | - Amy Starosta
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
- University at Albany, State University of New York, Albany County, Albany, New York
| | - Andrea Gillespie
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
| | - Brigitte Widemann
- Pediatric Oncology Branch, National Cancer Institute, Montgomery County, Bethesda, Maryland
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Psychological interventions for migraine: a systematic review. J Neurol 2016; 263:2369-2377. [PMID: 27159991 PMCID: PMC5110589 DOI: 10.1007/s00415-016-8126-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/02/2022]
Abstract
Migraine causes major health impairment and disability. Psychological interventions offer an addition to pharmacotherapy but they are not currently recommended by the National Institute of Clinical Excellence (NICE) or available in the National Health Service. We aimed to systematically review evidence on the efficacy of psychological interventions for migraine in adults. A search was done of MEDLINE, psychINFO, http://www.opengrey.eu , the meta-register of controlled trials and bibliographies. Twenty-four papers were included and rated independently by two people using the Yates scale, which has 35 points. Cochrane recommendations are that high quality reports score above the mid-point (18 points). Methods used in 17/24 papers were rated 'high quality'. However, frequently descriptions of key areas such as randomisation methods were omitted. Eighteen studies measured effects of psychological interventions on headache-related outcomes, fifteen reporting significant improvements, ranging 20-67 %. Interventions also produced improvements in psychological outcomes. Few trials measured or reported improvement in disability or quality of life. We conclude that evidence supports the efficacy of psychological interventions in migraine. Over half of the studies were from the USA, which did not provide universal health care at the time of the study, so it is difficult to generalise results to typical populations in receipt of publically funded health services. We agree with the NICE recommendation that high quality pragmatic randomised controlled trials are needed in the UK.
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Gómez-Ramírez O, Gibbon M, Berard R, Jurencak R, Green J, Tucker L, Shiff N, Guzman J. A recurring rollercoaster ride: a qualitative study of the emotional experiences of parents of children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016; 14:13. [PMID: 26961237 PMCID: PMC4784365 DOI: 10.1186/s12969-016-0073-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/02/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the wealth of clinical research carried out in children with juvenile idiopathic arthritis (JIA), little is known about the emotional experiences of their parents. This article describes the predominant emotional experiences reported by parents of children with JIA in two Canadian cities. METHODS Research participants included 15 experienced parents and 8 novice parents (<6 months since children's JIA diagnosis). Their children were 2 to 16 years old with various JIA categories. A qualitative dataset including audio recordings and verbatim transcripts of three focus groups, and written reports of 59 reciprocal interviews (parents interviewing each other) were examined by a multidisciplinary research team following a four-step qualitative analytical process. RESULTS Parents of children with JIA experienced recurrent mixed negative and positive emotions that varied over time. Between disease onset and diagnosis, mounting anxiety, fear and confusion were the predominant emotions. Shortly after diagnosis there were shock, disbelief, and fear, with a sense of having being blindsided by the disease. At times of disease quiescence there was hope and gratitude, but also fatigue and frustration with ongoing treatment and fear of flares. During periods of increasing or ongoing symptoms there was admiration and sympathy for the courageous way children coped with JIA, as well as sorrow and frustration for ongoing pain and limitations. There were at times, frustration and indignation with peers and teachers unable to understand the child's fluctuations in physical activity and schoolwork. Throughout the disease, parents felt an underlying anxiety and powerlessness. CONCLUSIONS Parents of children with JIA described complex emotional journeys akin to the recurring ups and downs of rollercoaster rides, instead of ordered emotional phases ending in resolution. This has implications for healthcare providers who need to be aware of the complexity of these emotional journeys to support parents more effectively, thereby helping improve patient outcomes.
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Affiliation(s)
- Oralia Gómez-Ramírez
- Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, British Columbia V6T 1Z1 Canada
| | - Michele Gibbon
- Division of Rheumatology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8 L1 Canada
| | - Roberta Berard
- Department of Pediatrics, Western University and Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 5 W9 Canada
| | - Roman Jurencak
- Department of Pediatrics, University of Ottawa and Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8 L1 Canada
| | - Jayne Green
- British Columbia Children’s Hospital, Room K4-116, 4480 Oak Street, Vancouver, British Columbia V6H 3V4 Canada
| | - Lori Tucker
- Department of Pediatrics, University of British Columbia and British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4 Canada
| | - Natalie Shiff
- Department of Pediatrics, University of Florida, and Department of Community Health and Epidemiology, University of Saskatchewan, 1600 Archer Road, Gainesville, Florida USA
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada.
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Ringnér A, Björk M, Olsson C, Graneheim UH. Person-centred information to parents in paediatric oncology (the PIFBO study): A study protocol of an ongoing RCT. BMC Nurs 2016; 14:69. [PMID: 26770070 PMCID: PMC4712555 DOI: 10.1186/s12912-015-0120-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents of children with cancer experience a demanding situation and often suffer from psychological problems such as stress. Trying to coping with the complex body of information about their child's disease is one factor that contributes to this stress. The aim of this study is to evaluate an intervention for person-centred information to parents of children with cancer that consists of four sessions with children's nurses trained in the intervention method. METHODS/DESIGN This is a multi-centre RCT with two parallel arms and a 1:1 allocation ratio. The primary outcome is illness-related parental stress. Secondary outcomes are post-traumatic stress symptoms, anxiety, depression, satisfaction with information, expected and received knowledge, and experiences with health care providers. A process evaluation is performed to describe experiences and contextual factors. Data are collected using web questionnaires or paper forms according to the parents' preference, audio recording of the intervention sessions, and qualitative interviews with parents and the intervention nurses. DISCUSSION Few studies have evaluated information interventions for parents of children with cancer using large multi-centre RCTs. This intervention is designed to be performed by regular staff children's nurses, which will facilitate implementation if the intervention proves to be effective. TRIAL REGISTRATION Clinical trials NCT02332226 (December 11, 2014).
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Affiliation(s)
- Anders Ringnér
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden ; Department of Paediatrics, Umeå University Hospital, SE-901 85 Umeå, Sweden
| | - Maria Björk
- CHILD Research Group, Department of Nursing Science, School of Health Sciences, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden ; School of Life Sciences, University of Skövde, Box 408, SE-541 28 Skövde, Sweden
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Ulla Hällgren Graneheim
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden ; Department of Health Sciences, University West, SE-461 86 Trollhättan, Sweden
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Geense WW, van Gaal BG, Knoll JL, Cornelissen EA, Schoonhoven L, Kok G. Online Support Program for Parents of Children With a Chronic Kidney Disease Using Intervention Mapping: A Development and Evaluation Protocol. JMIR Res Protoc 2016; 5:e1. [PMID: 26764218 PMCID: PMC4730104 DOI: 10.2196/resprot.4837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/27/2015] [Accepted: 09/20/2015] [Indexed: 12/26/2022] Open
Abstract
Background The care for children with a chronic kidney disease (CKD) is complex. Parents of these children may experience high levels of stress in managing their child’s disease, potentially leading to negative effects on their child’s health outcomes. Although the experienced problems are well known, adequate (online) support for these parents is lacking. Objective The objective of the study is to describe the systematic development of an online support program for parents of children with CKD, and how this program will be evaluated. Methods Intervention Mapping (IM) was used for the development of the program. After conducting a needs assessment, defining program objectives, searching for theories, and selecting practical applications, the online program e-Powered Parents was developed. e-Powered Parents consist of three parts: (1) an informative part with information about CKD and treatments, (2) an interactive part where parents can communicate with other parents and health care professionals by chat, private messages, and a forum, and (3) a training platform consisting of four modules: Managing stress, Setting limits, Communication, and Coping with emotions. In a feasibility study, the potential effectiveness and effect size of e-Powered Parents will be evaluated using an explorative randomized controlled trial with parents of 120 families. The outcomes will be the child’s quality of life, parental stress and fatigue, self-efficacy in the communication with health care professionals, and family management. A process evaluation will provide insight in parents’ experiences, including their experienced level of support. Results Study results are expected to be published in the summer of 2016. Conclusions Although the development of e-Powered Parents using IM was time-consuming, IM has been a useful protocol. IM provided us with a systematic framework for structuring the development process. The participatory planning group was valuable as well; knowledge, experiences, and visions were shared, ensuring us that parents and health care professionals support the program. Trial Registration Dutch Trial Registration: NTR4808; www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6cfAYHcYb)
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Affiliation(s)
- Wytske W Geense
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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Hajiabolhasani-Nargani Z, Najafi M, Mehrabi T. Effect of mobile parenting skills education on anxiety of the mothers with autistic children. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:572-576. [PMID: 28194195 PMCID: PMC5301062 DOI: 10.4103/1735-9066.197668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The parents of autistic children suffer from anxiety and tension. Unawareness of parenting skills required for autistic children (parenting) doubles their anxiety. Researchers have recently considered research on mobile education, especially mobile text messages. The present study aimed to investigate the effect of mobile parenting skills education on the anxiety of mothers with autistic children. Materials and Methods: This is a clinical trial conducted on 64 mothers of children suffering from autism who had a medical file. The participants were recruited by convenient sampling in selected autism centers in Isfahan, Iran. Then, the participants were randomly assigned into two 32-subject groups of study and control. Spielberger Anxiety Inventory was adopted for the mothers. The book “Parenting skills for the mothers with autistic children” was distributed in the study and control group, and then, the study group underwent a structured mobile text messages education. Sixty text messages were sent daily to the participants in the study group for two months. Data were analyzed by Mann–Whitney, Chi-square, independent t-test, and paired t-test using Statistical Package for the Social Sciences version 16. Results: The obtained results showed a significant decrease in mothers’ anxiety mean score after intervention in the study group compared to control group (P = 0.04). There was also a significant reduction in mothers’ anxiety mean score after intervention, compared to before intervention (P < 0.001). Conclusions: Mobile parenting skills education, especially through text messages, could reduce the level of anxiety among the mothers with autistic children.
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Affiliation(s)
- Zahra Hajiabolhasani-Nargani
- Student Research Centre, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Najafi
- Department of Child and Adolescent Psychiatry, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tayebeh Mehrabi
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Unrevealed Depression Involves Dysfunctional Coping Strategies in Crohn's Disease Patients in Clinical Remission. Gastroenterol Res Pract 2015; 2016:7803262. [PMID: 26823663 PMCID: PMC4707369 DOI: 10.1155/2016/7803262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
Background and Aims. This study investigated the proportion of CD patients in clinical remission with clinical depression, and coping strategies in those with severe depressive disorders. Materials and Methods. One hundred consecutive CD patients in clinical remission were screened for anxiety and depression by using Hospital Anxiety and Depression Scale and patients with depressive symptoms were further investigated by means of Cognitive Behavioural Assessment 2.0 and Beck Depression Inventory (BDI). Afterwards the coping strategies were assessed through the Brief-COPE questionnaire. Results. Twenty-one patients had anxious symptoms and 16 had depressive symptoms with or without anxiety. Seven of these patients (43.8%) showed significant depressive symptoms. Compared to patients without psychiatric disorders, these patients showed significant lower score in “positive reframing” (p: 0.017) and in “planning” (p: 0.046) and higher score in “use of instrumental social support” (p < 0.001), in “denial” scale (p: 0.001), and in “use of emotional social support” (p: 0.003). Conclusions. Depressed CD patients in clinical remission may have dysfunctional coping strategies, meaning that they may not be able to implement functional strategies to manage at best stress related with their disease.
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Jacob ML, Johnco C, Dane BF, Collier A, Storch EA. Psychosocial functioning in Barth syndrome: Assessment of individual and parental adjustment. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2015.1124768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Psychological interventions for parents of children and adolescents with chronic illness. J Paediatr Child Health 2015; 51:1036-8. [PMID: 26428422 DOI: 10.1111/jpc.13002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain. MATERIALS AND METHODS Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. RESULTS Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. DISCUSSION Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.
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Penny KA, Friedman SH, Halstead GM. Psychiatric support for mothers in the Neonatal Intensive Care Unit. J Perinatol 2015; 35:451-7. [PMID: 25501838 DOI: 10.1038/jp.2014.221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study describes mental health treatment and follow-up for mothers of infants in a Neonatal Intensive Care Unit (NICU). STUDY DESIGN Data were collected retrospectively about 204 mothers referred to a Level 3 NICU Psychiatric Consult Liaison Team over 2 years. This included medical, demographic and treatment information about both mother and infant. RESULT Most mothers (69%) were referred within a week of birth, and 100 (49%) of the referred mothers received a psychiatric diagnosis. Psychiatric follow-up was recommended for 13% on leaving the NICU and additional follow-up referrals were made for another 16%. Mothers with more than one initial reason for referral, a past psychiatric history, receiving therapeutic services, receiving a psychiatric diagnosis and receiving pharmacotherapy were all significantly more likely to have follow-up recommended on discharge. CONCLUSION Approximately one-sixth of mothers in the NICU were referred, a large proportion received a psychiatric diagnosis, and over a quarter required follow-up after discharge, indicating the importance of the service.
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Affiliation(s)
- K A Penny
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - S H Friedman
- Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - G M Halstead
- Starship Hospital, Auckland District Health Board, Auckland, New Zealand
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Magliano L, Patalano M, Sagliocchi A, Scutifero M, Zaccaro A, D'angelo MG, Civati F, Brighina E, Vita G, Vita GL, Messina S, Sframeli M, Pane M, Lombardo ME, Scalise R, D'amico A, Colia G, Catteruccia M, Balottin U, Berardinelli A, Chiara Motta M, Angelini C, Gaiani A, Semplicini C, Bello L, Battini R, Astrea G, Politano L. Burden, professional support, and social network in families of children and young adults with muscular dystrophies. Muscle Nerve 2015; 52:13-21. [PMID: 25363165 PMCID: PMC5029774 DOI: 10.1002/mus.24503] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/11/2022]
Abstract
Introduction: This study explores burden and social and professional support in families of young patients with muscular dystrophies (MDs) in Italy. Methods: The study was carried out on 502 key relatives of 4‐ to 25‐year‐old patients suffering from Duchenne, Becker, or Limb‐Girdle MD who were living with at least 1 adult relative. Results: A total of 77.1% of relatives reported feelings of loss, 74.0% had feelings of sadness, and 59.1% had constraints in leisure activities. Burden was higher among relatives of patients with higher disability and who spent more daily hours in caregiving. Practical difficulties were higher among relatives who perceived lower help in patient emergencies and less practical support by their social network. Psychological burden was higher in those relatives who were unemployed, those with poorer support in emergencies, and those with lower social contacts. Conclusions: Caring for patients with MDs may be demanding for relatives even in the early stages of these disorders, especially when social support is poor and the patient's disability increases. Muscle Nerve52: 13–21, 2015
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Melania Patalano
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Alessandra Sagliocchi
- Department of Psychology, Second University of Naples, Viale Ellittico, 31, I-81100 Caserta, Italy
| | - Marianna Scutifero
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
| | - Antonella Zaccaro
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
| | - Maria Grazia D'angelo
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Federica Civati
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Erika Brighina
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Gian Luca Vita
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Sonia Messina
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Maria Sframeli
- Department of Neurosciences, University of Messina, Rome, Italy
| | - Marika Pane
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | | | - Roberta Scalise
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - Adele D'amico
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Giulia Colia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - Umberto Balottin
- Department of Brain and Behavioural Sciences - Child Neuropsychiatry Unit, University of Pavia, Italy
| | | | | | | | | | | | - Luca Bello
- Department of Neurosciences, University of Padova, Italy
| | | | - Guja Astrea
- Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Italy
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Eccleston C, Fisher E, Law E, Bartlett J, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2015; 4:CD009660. [PMID: 25874881 PMCID: PMC4838404 DOI: 10.1002/14651858.cd009660.pub3] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Psychological therapies have been developed for parents of children and adolescents with a chronic illness. Such therapies include interventions directed at the parent only or at parent and child/adolescent, and are designed to improve parent, child, and family outcomes. This is an updated version of the original Cochrane review published in Issue 8, 2012, (Psychological interventions for parents of children and adolescents with chronic illness). OBJECTIVES To evaluate the efficacy of psychological therapies that include parents of children and adolescents with chronic illnesses including painful conditions, cancer, diabetes mellitus, asthma, traumatic brain injury (TBI), inflammatory bowel diseases (IBD), skin diseases, or gynaecological disorders. We also aimed to evaluate the adverse events related to implementation of psychological therapies for this population. Secondly, we aimed to evaluate the risk of bias of included studies and the quality of outcomes using the GRADE assessment. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO for randomised controlled trials (RCTs) of psychological interventions that included parents of children and adolescents with a chronic illness. Databases were searched to July 2014. SELECTION CRITERIA Included studies were RCTs of psychological interventions that delivered treatment to parents of children and adolescents with a chronic illness compared to an active control, waiting list, or treatment as usual control group. DATA COLLECTION AND ANALYSIS Study characteristics and outcomes were extracted from included studies. We analysed data using two categories. First, we analysed data by each individual medical condition collapsing across all treatment classes at two time points. Second, we analysed data by each individual treatment class; cognitive behavioural therapy (CBT), family therapy (FT), problem solving therapy (PST) and multisystemic therapy (MST) collapsing across all medical conditions. For both sets of analyses we looked immediately post-treatment and at the first available follow-up. We assessed treatment effectiveness for two primary outcomes: parent behaviour and parent mental health. Five secondary outcomes were extracted; child behaviour/disability, child mental health, child symptoms, family functioning, and adverse events. Risk of bias and quality of evidence were assessed. MAIN RESULTS Thirteen studies were added in this update, giving a total of 47 RCTs. The total number of participants included in the data analyses was 2985, 804 of whom were added to the analyses in the update. The mean age of the children was 14.6 years. Of the 47 RCTs, the studies focused on the following paediatric conditions: n = 14 painful conditions, n = 13 diabetes, n =10 cancer, n = 5 asthma, n = 4 TBI, and n = 1 atopic eczema. We did not identify any studies treating parents of children with gynaecological disorders or IBD. Risk of bias assessments of included studies were predominantly unclear. Evidence quality, assessed using the GRADE criteria, was judged to be of low or very low quality.Analyses of separate medical conditions, across all treatment types, revealed two beneficial effects of psychological therapies for our primary outcomes. First, psychological therapies led to improved adaptive parenting behaviour in parents of children with cancer post-treatment (standardised mean difference (SMD) -0.20, 95% confidence interval (CI) -0.36 to -0.04, Z = 2.44, p = 0.01). In addition, therapies also improved parent mental health at follow-up in this group (SMD = -0.18, 95% CI -0.32 to -0.04, Z = 2.58, p = 0.01). We did not find any effect of therapies for parent behaviour for parents of children with a painful condition post-treatment or at follow-up, or for parent mental health for parents of children with cancer, diabetes, asthma, or TBI post-treatment. For all other primary outcomes, no analysis could be conducted due to lack of data.Across all medical conditions, three effects were found for the primary outcomes of psychological therapies. PST had a beneficial effect on parent adaptive behaviour (SMD = -0.25, 95% CI -0.39 to -0.11, Z = 3.59, p < 0.01) and parent mental health (SMD= -0.24, 95% CI -0.42 to -0.05, Z = 2.50, p = 0.01) immediately post-treatment and this effect was maintained at follow-up for parent mental health (SMD= -0.19, 95% CI -0.34 to -0.04, Z = 2.55, p = 0.01). The remaining analysis for PST on parent behaviour found no effect. No effects were found for CBT post-treatment or at follow-up for either parent outcome. For FT, only one analysis could be run on parent mental health and no effect was found. Due to lack of data, the remaining analyses of primary outcomes could not be run. For MST, no parent outcomes could be analysed due to lack of data.Secondary outcome analyses are presented in the Results section. Five studies reported that there were no adverse events during the trial. The remaining 42 studies did not report adverse events. AUTHORS' CONCLUSIONS This update includes 13 additional studies, although our conclusions have not changed from the original version. There is little evidence for the efficacy of psychological therapies that include parents on most outcome domains of functioning, for a large number of common chronic illnesses in children. However, psychological therapies are efficacious for some outcomes. CBT that includes parents is beneficial for reducing children's primary symptoms, and PST that includes parents improved parent adaptive behaviour and parent mental health. There is evidence that the beneficial effects can be maintained at follow-up for diabetes-related symptoms in children, and for the mental health of parents of children with cancer and parents who received PST.
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Affiliation(s)
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK
| | - Emily Law
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Jess Bartlett
- Centre for Pain Research, University of Bath, Bath, UK
| | - Tonya M Palermo
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Fidika A, Herle M, Lehmann C, Weiss C, Knaevelsrud C, Goldbeck L. A web-based psychological support program for caregivers of children with cystic fibrosis: a pilot study. Health Qual Life Outcomes 2015; 13:11. [PMID: 25652684 PMCID: PMC4336741 DOI: 10.1186/s12955-015-0211-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/21/2015] [Indexed: 11/18/2022] Open
Abstract
Background Parents caring for a child with Cystic Fibrosis (CF) are at high risk for psychological distress and have limited access to psychological care. Therefore, a web-based psychological support program for severely distressed parents of children with CF (WEP-CARE) was developed and evaluated for its feasibility and efficacy. Methods A clinical expert panel developed WEP-CARE based on principles of cognitive-behavioral therapy. This web-based writing therapy comprises nine sessions, tailored for the specific needs of caregivers. The pilot study was conducted as a single-group intervention with pre-post-follow-up design. Out of 31 participants, 23 parents completed the intervention (21 female; mean age 37 years; SD = 6.2 years, range 25 – 48 years). Psychological symptoms and quality of life were assessed online by self-report measures at pre- and post-treatment and were followed up three months later. Results On average, the caregivers’ symptoms of anxiety decreased statistically significant and clinical relevant about five points from an elevated (M = 11.4; SD =2.6) to a normal level (M = 6.7; SD = 2.6; p < .001) between pre and post treatment. Fear of disease progression (p < .001) and symptoms of depression (p = .02) significantly decreased as well. Quality of life significantly improved (p = .01). The effects were maintained at the 3-months follow-up assessment. Conclusions WEP-CARE is feasible and promising regarding its efficacy to improve parental mental health and quality of life.
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Affiliation(s)
- Astrid Fidika
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Medical Centre, Steinhoevelstr. 1, Ulm, 89075, Germany.
| | - Marion Herle
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Medical Centre, Steinhoevelstr. 1, Ulm, 89075, Germany.
| | - Christine Lehmann
- Department of Paediatric Pulmonology/Immunology, Charité, Humboldt University, Berlin, Germany.
| | - Christa Weiss
- Department of Paediatric Pulmonology/Immunology, Charité, Humboldt University, Berlin, Germany.
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Freie University Berlin, Berlin, Germany.
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Medical Centre, Steinhoevelstr. 1, Ulm, 89075, Germany.
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Han C, Pae CU. Pain and depression: a neurobiological perspective of their relationship. Psychiatry Investig 2015; 12:1-8. [PMID: 25670939 PMCID: PMC4310906 DOI: 10.4306/pi.2015.12.1.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/13/2014] [Accepted: 03/13/2014] [Indexed: 11/25/2022] Open
Abstract
Remarkable progresses have been achieved regarding the understanding of the neurobiological bases of pain and depression. The principal role of neurotransmitters, neuromodulators, and neurohormones has been proposed in the development of pain and depression. With the progression of molecular biology, an intricate interaction among biological factors accountable to the development and management of pain and depression has been also shown in a numerous preclinical and clinical researches. This mini-review will briefly describe the current issues and future research direction for better understanding of the relationship between pain and depression.
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Affiliation(s)
- Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chi-Un Pae
- Department of Psychiatry, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Republic of Korea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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MAGLIANO LORENZA, D'ANGELO MARIAGRAZIA, VITA GIUSEPPE, PANE MARIKA, D'AMICO ADELE, BALOTTIN UMBERTO, ANGELINI CORRADO, BATTINI ROBERTA, POLITANO LUISA. Psychological and practical difficulties among parents and healthy siblings of children with Duchenne vs. Becker muscular dystrophy: an Italian comparative study. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2014; 33:136-43. [PMID: 25873782 PMCID: PMC4369844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study explored the burden in parents and healthy siblings of 4-17 year-old patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies, and whether the burden varied according to clinical aspects and social resources. Data on socio-demographic characteristics, patient's clinical history, parent and healthy children burden, and on parent's social resources were collected using self-reported questionnaires administered to 336 parents of patients with DMD (246) and BMD (90). Parents of patients with DMD reported higher burden than those of patients with BMD, especially concerning feeling of loss (84.3% DMD vs. 57.4% BMD), stigma (44.2% DMD vs. 5.5% BMD) and neglect of hobbies (69.0% DMD vs. 32.5% BMD). Despite the burden, 66% DMD and 62.4% BMD parents stated the caregiving experience had a positive impact on their lives. A minority of parents believed MD has a negative influence on the psychological well-being (31.0% DMD vs. 12.8% BMD), and social life of unaffected children (25.7% vs. 18.4%). In the DMD group, burden correlated with duration of illness and parent age, and burden was higher among parents with lower social contacts and support in emergencies. In DMD, difficulties among healthy children were reported as higher by parents who were older, had higher burden and lower social contacts. In both groups, burden increased in relation to patient disability. These findings underline that the psychological support to be provided to parents of patients with MD, should take into account clinical features of the disease.
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Affiliation(s)
- LORENZA MAGLIANO
- Department of Psychology, Second University of Naples (SUN), Naples, Italy;,Address for correpondence: Lorenza Magliano, Department of Psychology, Second University of Naples, viale Ellittico 31, 81100 Caserta, Italy. E-mail:
| | - MARIA GRAZIA D'ANGELO
- NeuroMuscular Unit, Department of NeuroRehabilitation, IRCCS "E. Medea", Bosisio Parini (LC), Italy
| | - GIUSEPPE VITA
- Department of Neurosciences, University of Messina, Messina, Italy
| | - MARIKA PANE
- Department of Paediatric Neurology, Catholic University, Rome, Italy
| | - ADELE D'AMICO
- Unit of Neuromuscular and Neurodegenerative Diseases, Bambin Gesù Children's Hospital, Rome, Italy
| | - UMBERTO BALOTTIN
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - CORRADO ANGELINI
- Department of Neurosciences, University of Padova, Padua, Italy and IRCSS San Camillo, Lido, Venice, Italy
| | - ROBERTA BATTINI
- Developmental Neuroscience, IRCCS Stella Maris, University of Pisa, Pisa, Italy
| | - LUISA POLITANO
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Second University of Naples (SUN), Naples, Italy
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Luciano JV, D'Amico F, Cerdà-Lafont M, Peñarrubia-María MT, Knapp M, Cuesta-Vargas AI, Serrano-Blanco A, García-Campayo J. Cost-utility of cognitive behavioral therapy versus U.S. Food and Drug Administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomized controlled trial. Arthritis Res Ther 2014; 16:451. [PMID: 25270426 PMCID: PMC4203881 DOI: 10.1186/s13075-014-0451-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/04/2014] [Indexed: 01/27/2023] Open
Abstract
Introduction Cognitive behavioral therapy (CBT) and U.S. Food and Drug Administration (FDA)-recommended pharmacologic treatments (RPTs; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin + duloxetine) and usual care (TAU) groups in the treatment of FM. Methods The economic evaluation was conducted alongside a 6-month, multicenter, randomized, blinded, parallel group, controlled trial. In total, 168 FM patients from 41 general practices in Zaragoza (Spain) were randomized to CBT (n = 57), RPT (n = 56), or TAU (n = 55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed by using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed by using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare use were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed by using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). Results On average, the total costs per patient in the CBT group (1,847€) were significantly lower than those in patients receiving RPT (3,664€) or TAU (3,124€). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case-analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, by using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves, and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per-protocol analysis) indicated that the results were robust. The comparison of RPT with TAU yielded no clear preference for either treatment when using QALYs, although RPT was determined to be more cost-effective than TAU when evaluating EQ-VAS. Conclusions Because of lower costs, CBT is the most cost-effective treatment for adult FM patients. Implementation in routine medical care would require policymakers to develop more-widespread public access to trained and experienced therapists in group-based forms of CBT. Trial registration Current Controlled Trials ISRCTN10804772. Registered 29 September 2008. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0451-y) contains supplementary material, which is available to authorized users.
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Fisher E, Heathcote L, Palermo TM, de C Williams AC, Lau J, Eccleston C. Systematic review and meta-analysis of psychological therapies for children with chronic pain. J Pediatr Psychol 2014; 39:763-82. [PMID: 24602890 PMCID: PMC4148613 DOI: 10.1093/jpepsy/jsu008] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This systematic review and meta-analysis examined the effects of psychological therapies for management of chronic pain in children. METHODS Randomized controlled trials of psychological interventions treating children (<18 years) with chronic pain conditions including headache, abdominal, musculoskeletal, or neuropathic pain were searched for. Pain symptoms, disability, depression, anxiety, and sleep outcomes were extracted. Risk of bias was assessed and quality of the evidence was rated using GRADE. RESULTS 35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately. Sleep outcomes were not reported in any trials. Optimal dose of treatment was explored. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions. CONCLUSIONS Evidence for psychological therapies treating chronic pain is promising. Recommendations for clinical practice and research are presented.
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Affiliation(s)
- Emma Fisher
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Lauren Heathcote
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Tonya M Palermo
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Amanda C de C Williams
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Jennifer Lau
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London
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Palermo TM, Law EF, Essner B, Jessen-Fiddick T, Eccleston C. Adaptation of Problem-Solving Skills Training (PSST) for Parent Caregivers of Youth with Chronic Pain. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2014; 2:212-223. [PMID: 25422795 DOI: 10.1037/cpp0000067] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Research on the experience of parents caring for a child with chronic pain indicates that high levels of parental role stress, feelings of frustration over an inability to help, and psychological distress are common. Moreover, parental distress adversely influences child adjustment to chronic pain. Therefore, intervening with parents of youth with chronic pain may, in turn, result in positive outcomes for children in their ability to engage in positive coping strategies, reduce their own distress, and to function competently in their normal daily lives. Our aim was to adapt an intervention, Problem-Solving Skills Training, previously proven effective in reducing parental distress in other pediatric illness conditions to the population of caregivers of youth with chronic pain. In the first phase, the intervention was adapted based on expert review of the literature and review of parent responses on a measure of pain-related family impact. In the second phase, the intervention was tested in a small group of parents to evaluate feasibility, determined by response to treatment content, ratings of acceptability, and ability to enroll and deliver the treatment visits. This phase included piloting the PSST intervention and all outcome measures at pre-treatment and immediately post-treatment. In an exploratory manner we examined change in parent distress and child physical function and depression from pre- to post-treatment. Findings from this feasibility study suggest that PSST can be implemented with parents of youth with chronic pain, and they find the treatment acceptable.
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Affiliation(s)
| | - Emily F Law
- University of Washington ; Seattle Children's Hospital
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Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. ACTA ACUST UNITED AC 2014; 69:142-52. [PMID: 24547800 DOI: 10.1037/a0035216] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pain that recurs or persists is unfortunately a common experience for children. One of the unique considerations in pediatric chronic pain management is the bidirectional influences of children's pain experiences and parental and family factors. In this review we present a developmental perspective on understanding pediatric chronic pain and disability, highlighting factors relevant from infancy to adolescence, and family and parent influences. Preliminary evidence indicates that developmental processes are influenced and may also shape the pediatric pain experience. Parent emotions, behaviors, and health also play a role in children's pain experiences, where overly protective parent behaviors, increased distress, and history of chronic pain are important parent-level influences. Research on family-level influences has revealed that families of children with chronic pain have poorer family functioning (e.g., more conflict, less cohesion) than families of healthy children. Several important gaps exist in this research, such as in understanding basic developmental processes in children with chronic pain and how they influence children's perception of and responses to pain. Also, there is a lack of longitudinal data on family relationships and individual adjustment to allow for understanding of whether changes occur in parenting over the course of the child's chronic pain experience. Although parent interventions have been successfully incorporated into many cognitive-behavioral treatments for children with chronic pain conditions, little guidance exists for adapting intervention strategies to be developmentally appropriate. Additional research is needed to examine whether parent interventions are effective at different developmental stages and the best way to incorporate developmental goals into treatment.
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Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington
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Haverman L, van Oers HA, Maurice-Stam H, Kuijpers TW, Grootenhuis MA, van Rossum MAJ. Health related quality of life and parental perceptions of child vulnerability among parents of a child with juvenile idiopathic arthritis: results from a web-based survey. Pediatr Rheumatol Online J 2014; 12:34. [PMID: 25120411 PMCID: PMC4130700 DOI: 10.1186/1546-0096-12-34] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A chronic illness, such as Juvenile Idiopathic Arthritis (JIA), has an impact on the whole family, especially on parents caring for the ill child. Therefore the aim of this study is to evaluate parental Health Related Quality of Life (HRQOL) and parental perceptions of child vulnerability (PPCV) and associated variables in parents of a child with JIA. METHODS Parents of all JIA patients (0-18 years) in Amsterdam, the Netherlands, were eligible. HRQOL was measured using the TNO-AZL Questionnaire (TAAQOL) and PPCV using the Child Vulnerability Scale (CVS). The HRQOL of parents of a child with JIA was compared to a norm population, and differences between parents of a child with JIA and active arthritis versus parents of a child with JIA without active arthritis were analyzed (ANOVA). For PPCV, parents of a child with JIA were compared to a norm population, including healthy and chronically ill children (Chi(2), Mann-Whitney U test). Variables associated with PPCV were identified by logistic regression analyses. RESULTS 155 parents (87.5% mothers) completed online questionnaires. JIA parents showed worse HRQOL than parents of healthy children on one out of twelve domains: fine motor HRQOL (p < .001). Parents of children with active arthritis showed worse HRQOL regarding daily activities (p < .05), cognitive functioning (p < .01) and depressive emotions (p < .05) compared to parents of children without active arthritis. Parents of children with JIA perceived their child as more vulnerable than parents of a healthy child (p < .001) and parents of a chronically ill child (p < .001). Parents of children with active arthritis reported higher levels of PPCV (p < .05) than parents of children without active arthritis. A higher degree of functional disability (p < .01) and shorter disease duration (p < .05) were associated with higher levels of PPCV. CONCLUSION The HRQOL of JIA parents was comparable to the HRQOL of parents of a healthy child. JIA parents of a child with active arthritis showed worse HRQOL than parents of a child without active arthritis. Parents perceived their child with JIA as vulnerable.
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Affiliation(s)
- Lotte Haverman
- Psychosocial Department, Academic Medical Center, Emma Children’s A3-241 Hospital, Postbox 22660, Amsterdam 1100 DD, the Netherlands
| | - Hedy A van Oers
- Psychosocial Department, Academic Medical Center, Emma Children’s A3-241 Hospital, Postbox 22660, Amsterdam 1100 DD, the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Academic Medical Center, Emma Children’s A3-241 Hospital, Postbox 22660, Amsterdam 1100 DD, the Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Diseases, Academic Medical Center, Emma Children’s Hospital, Amsterdam, the Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Academic Medical Center, Emma Children’s A3-241 Hospital, Postbox 22660, Amsterdam 1100 DD, the Netherlands
| | - Marion AJ van Rossum
- Department of Pediatric Hematology, Immunology and Infectious Diseases, and Reade (Location Jan van Breemen), Department of Pediatric Rheumatology, Amsterdam, the Netherlands
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Distelberg B, Williams-Reade J, Tapanes D, Montgomery S, Pandit M. Evaluation of a family systems intervention for managing pediatric chronic illness: Mastering Each New Direction (MEND). FAMILY PROCESS 2014; 53:194-213. [PMID: 24635346 PMCID: PMC4486080 DOI: 10.1111/famp.12066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.
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Affiliation(s)
- Brian Distelberg
- Department of Counseling and Family Sciences, Loma Linda University, Loma Linda, CA
| | | | - Daniel Tapanes
- Department of Counseling and Family Sciences, Loma Linda University, Loma Linda, CA
| | | | - Mayuri Pandit
- Behavioral Medical Center, Loma Linda University, Loma Linda, CA
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Law EF, Fisher E, Fales J, Noel M, Eccleston C. Systematic review and meta-analysis of parent and family-based interventions for children and adolescents with chronic medical conditions. J Pediatr Psychol 2014; 39:866-86. [PMID: 24881048 DOI: 10.1093/jpepsy/jsu032] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To quantify the effects of parent- and family-based psychological therapies for youth with common chronic medical conditions on parent and family outcomes (primary aim) and child outcomes (secondary aim). METHODS MEDLINE, EMBASE, and PsycINFO were searched from inception to April 2013. 37 randomized controlled trials were included. Quality of the evidence was evaluated using GRADE criteria. Data were extracted on parent, family, and child outcomes. RESULTS Pooled psychological therapies had a positive effect on parent behavior at posttreatment and follow-up; no significant improvement was observed for other outcome domains. Problem-solving therapy (PST) improved parent mental health and parent behavior at posttreatment and follow-up. There was insufficient evidence to evaluate cognitive-behavioral and systems therapies for many outcome domains. CONCLUSIONS Parent- and family-based psychological therapies can improve parent outcomes, with PST emerging as particularly promising. Future research should incorporate consensus statements for outcomes assessment, multisite recruitment, and active comparator conditions.
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Affiliation(s)
- Emily F Law
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, and Centre for Pain Research, University of Bath Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, and Centre for Pain Research, University of Bath
| | - Emma Fisher
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, and Centre for Pain Research, University of Bath
| | - Jessica Fales
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, and Centre for Pain Research, University of Bath
| | - Melanie Noel
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, and Centre for Pain Research, University of Bath
| | - Christopher Eccleston
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, and Centre for Pain Research, University of Bath
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Lou Q, Chen Y, Guo X, Yuan L, Chen T, Wang C, Shen L, Sun Z, Zhao F, Dai X, Huang J, Yang H. Diabetes Attitude Scale: validation in type-2 diabetes patients in multiple centers in China. PLoS One 2014; 9:e96473. [PMID: 24802805 PMCID: PMC4011833 DOI: 10.1371/journal.pone.0096473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/09/2014] [Indexed: 02/05/2023] Open
Abstract
Objective The aim of the paper is to report the development and psychometric testing of Diabetes Attitude Scale. Method A prospective study was performed. The cultural equivalency and content validity of the Diabetes Attitude Scale were determined by panels of endocrinologists, physiologists, nurses and dieticians. An accurate and usable translation was obtained for each of five subscales examining attitudes on need for special training, the seriousness of type-2 diabetes, the need for controlling the condition, its psychosocial impact and the degree of autonomy given to patients in decision making. The validation was derived from 5961 patients with type-2 diabetes, recruited from 50 centers in 29 provinces throughout China between March 1st and September 30th, 2010. Results The modified Diabetes Attitude Scale showed an acceptable level of internal consistency. The strength of the inter-correlations among the domains of five subscales suggests that the instrument measures related but separate domains of patients' attitudes toward diabetes. Moreover, the test-retest intraclass correlation coefficients were high enough to support the stability of the Chinese version of the third version of the scale. Conclusions The psychometric properties of the Chinese version of Diabetes Attitude Scale demonstrated satisfactory validity and reliability and appeared to effectively evaluate attitudes toward diabetes in patients with type-2 diabetes.
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Affiliation(s)
- Qingqing Lou
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu Province, China
- Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, Zhejiang Province, China
| | - Yufeng Chen
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- * E-mail:
| | - Li Yuan
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tao Chen
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chun Wang
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Li Shen
- Peking University First Hospital, Beijing, China
| | - Zilin Sun
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Fang Zhao
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Xia Dai
- First Affiliated Hospital, Guangxi Medical University, Nanning, Jiangsu Province, China
| | - Jin Huang
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Huiying Yang
- The First Affiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China
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Guilherme AQ, Carvalho BC, Diniz BP, Bianco BF, Andrade TGD, Araújo LA. Abordagem da dermatite atópica na infância pelo Médico de Família e Comunidade. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2014. [DOI: 10.5712/rbmfc9(31)846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Dermatite atópica (DA) é uma inflamação crônica e pruriginosa da pele, que acomete crianças nos primeiros anos de vida. Sua etiologia permanece pouco elucidada, mas sabe-se que ocorre uma disfunção da barreira cutânea que facilita a penetração de alérgenos/irritantes na epiderme, provocando reação inflamatória com predomínio de resposta Th2 em relação a Th1. O diagnóstico é clínico, podendo associar-se com a presença de história familiar e pregressa de atopias, como rinite e asma. A DA manifesta-se por meio de lesões eczematosas, pruriginosas, com presença de eritema, pápulas, vesículas e escamas. Os principais diagnósticos diferenciais são dermatite seborreica, dermatite de contato, psoríase e escabiose. O tratamento baseia-se na educação do paciente e de seus familiares, somado ao controle do prurido com anti-histamínicos e da inflamação com corticoides e inibidores da calcineurina. Devido à alta prevalência e impacto da DA na qualidade de vida de crianças, corrobora-se a importância do diagnóstico precoce e de uma abordagem individualizada.
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Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Stinson JN. A smartphone-based pain management app for adolescents with cancer: establishing system requirements and a pain care algorithm based on literature review, interviews, and consensus. JMIR Res Protoc 2014; 3:e15. [PMID: 24646454 PMCID: PMC3978558 DOI: 10.2196/resprot.3041] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/04/2014] [Accepted: 02/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. OBJECTIVE To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. METHODS A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. RESULTS The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app. These results were used to build a detailed prototype algorithm capable of providing adolescents with pain management support based on their individual pain. Analysis of qualitative interviews with 9 multidisciplinary health care professionals and 10 adolescents resulted in 4 themes that helped to adapt the algorithm and requirements to the needs of adolescents. Specifically, themes were overall endorsement of the system, the need for a clinical expert, the need to individualize the system, and changes to the algorithm to improve potential clinical effectiveness. CONCLUSIONS This study used a phased and user-centered approach to develop a pain management algorithm for adolescents with cancer and the system requirements of an associated app. The smartphone software is currently being created and subsequent work will focus on the usability, feasibility, and effectiveness testing of the app for adolescents with cancer pain.
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