Assessing fatigue in children and adolescents: Psychometric validation of the German version of the PROMIS® Pediatric Short Form v2.0 - Fatigue 10a in school children and pediatric chronic pain patients

[Pediatric inpatient interdisciplinary multimodal pain treatment in Germany]

BACKGROUND

Severely disabling chronic pain affects approximately half a million children in Germany. If there is a lack of response to unimodal treatment, an inpatient interdisciplinary multimodal pain treatment (IMPT) can be considered.

OBJECTIVE

This review article describes the supply situation of pediatric inpatient IMPT in Germany and presents the current evidence on the effectiveness.

MATERIAL AND METHODS

Based on a systematic literature search, studies addressing the effectiveness of pediatric inpatient IMPT in Germany were identified. In addition, further sources were used to extract information on pediatric IMPT treatment centers in Germany in order to describe the treatment approaches, the qualification of personnel and characteristics of patients.

RESULTS

There are four pediatric pain centers in Germany that are specialized in inpatient IMPT for children and adolescents. Treatment duration ranges between 3 and 4 weeks. The multimodal treatment is carried out by a multiprofessional team and is generally available for patients up to 18 years. The majority of patients are female. The effectiveness of pediatric IMPT in Germany was investigated up to 4 years after treatment. Positive effects were shown for pain characteristics and also for the emotional burden. Additional treatment modules can facilitate further optimization of treatment effects.

CONCLUSION

Further research on the effectiveness of IMPT in Germany is important in order to refine and optimize the available treatment programs.

Prospective evaluation of health care services for children and adolescents with post-COVID-19 condition in Bavaria, Germany: study protocol

BACKGROUND

Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite frequently mild courses of the disease. Nevertheless, extensive care for Post-COVID in children and young people is not available yet. A comprehensive care network ("PoCo") for children and adolescents with Post-COVID has been setup as a model project in Bavaria, Germany.

OBJECTIVE

The aim of this study is to evaluate the health care services provided within these network structures of care for children and adolescents with Post-COVID in a pre-post study design.

METHODS

It is envisaged to recruit 160 children and adolescents up to 17 years with Post-COVID who are diagnosed and treated in 16 participating outpatient clinics. Health care utilization, treatment satisfaction, PROs (Patient Reported Outcomes) related to health-related quality of life (primary endpoint), fatigue, post-exertional malaise and mental health will be assessed at different time points (at baseline, after four weeks, three months and six months) using routine data, interviews and self-report questionnaires.

RESULTS

The study is currently in the recruitment process. This will run from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after recruitment is complete. The results will be published.

CONCLUSIONS

The results will contribute to the evaluation of therapeutic services provided for Post-COVID in children and adolescents and avenues for optimizing care may be identified.

CLINICALTRIAL

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/41010.

Exploring listening-related fatigue in children with and without hearing loss using self-report and parent-proxy measures

Children with hearing loss appear to experience greater fatigue than children with normal hearing (CNH). Listening-related fatigue is often associated with an increase in effortful listening or difficulty in listening situations. This has been observed in children with bilateral hearing loss (CBHL) and, more recently, in children with unilateral hearing loss (CUHL). Available tools for measuring fatigue in children include general fatigue questionnaires such as the child self-report and parent-proxy versions of the PedsQL^TM-Multidimensional Fatigue Scale (MFS) and the PROMIS Fatigue Scale. Recently, the Vanderbilt Fatigue Scale (VFS-C: child self-report; VFS-P: parent-proxy report) was introduced with a specific focus on listening-related fatigue. The aims of this study were to compare fatigue levels experienced by CNH, CUHL and CBHL using both generic and listening-specific fatigue measures and compare outcomes from the child self-report and parent-proxy reports. Eighty children aged 6-16 years (32 CNH, 19 CUHL, 29 CBHL), and ninety-nine parents/guardians (39 parents to CNH, 23 parents to CUHL, 37 parents to CBHL), completed the above fatigue questionnaires online. Kruskal-Wallis H tests were performed to compare fatigue levels between the CNH, CUHL and CBHL. To determine the agreement between parent-proxy and child self-report measures, Bland-Altman 95% limits of agreement were performed. All child self-report fatigue measures indicated that CBHL experience greater fatigue than CNH. Only the listening-specific tool (VFS-C) was sufficiently able to show greater fatigue in CUHL than in CNH. Similarly, all parent-proxy measures of fatigue indicated that CBHL experience significantly greater fatigue than CNH. The VFS-P and the PROMIS Fatigue Parent-Proxy also showed greater fatigue in CUHL than in CNH. Agreement between the parent-proxy and child self-report measures were found within the PedsQL-MFS and the PROMIS Fatigue Scale. Our results suggest that CBHL experience greater levels of daily-life fatigue compared to CNH. CUHL also appear to experience more fatigue than CNH, and listening-specific measures of fatigue may be better able to detect this effect. Further research is needed to understand the bases of fatigue in these populations and to clarify whether fatigue experienced by CBHL and CUHL is comparable in nature and degree.