Measures of Health-Related Quality of Life Outcomes in Pediatric Neurosurgery: Literature Review

Effects of high-quality neurosurgical nursing care on improving clinical nursing quality

BACKGROUND

With continuous advancements in medical technology, neurosurgical nursing is constantly developing and improving to provide higher-quality nursing services.

AIM

To explore the effects of different types of high-quality nursing care on clinical nursing quality and patient satisfaction in neurosurgical nursing.

METHODS

Eighty patients who received neurosurgical treatment in the Affiliated Hospital of Southwest Medical University from June to December 2020 were selected as study participants and categorised into study and control groups. The study group comprised 40 patients who received 4 different types of high-quality nursing care, whereas the control group comprised 40 patients who received conventional nursing care. After a specific period, nursing satisfaction levels and adverse event and complication rates were compared between the two groups.

RESULTS

Satisfaction with high-quality care was higher than that with conventional care, and high-quality health services and regional services showed the highest satisfaction levels, with an average score of 12 on the Glasgow scale. The satisfaction levels of the study and control groups were 75% and 57%, respectively, with a statistically significant difference (t = 7.314, P < 0.05). During the nursing period, the adverse event and complication rates were the highest in patients with level III pathology grade and those who underwent neurosurgery (40.02% and 85.93%, respectively), and the difference was statistically significant.

CONCLUSION

In neurosurgical nursing, employing appropriate high-quality nursing methods can effectively reduce adverse event and complication rates in patients, thereby improving the quality of nursing care and increasing clinical nursing value.

Surgical Intervention is Associated with Improvement in Health-Related Quality of Life Outcomes in Patients with Symptomatic Sacral Tarlov Cysts: Results from a Prospective Longitudinal Cohort Study

OBJECTIVE

The treatment of symptomatic Tarlov cysts remains a controversial topic within neurosurgery. We describe our experience with patients who underwent surgical intervention for sacral Tarlov cysts at a single institution. General and disease-specific outcome measures were used to assess health-related quality of life.

METHODS

Patients who underwent surgical treatment for one or more sacral Tarlov cysts between 2018 and 2021 were included. The Tarlov Cyst Quality of Life (TCQoL), a validated disease-specific measure, was the primary outcome of the study. Secondary outcomes included general outcome measures: 36-Item Short Form Survey, the Oswestry Disability Index, and Visual Analog Scale. Patients were followed at 3, 6, and 12 months postoperatively. Repeated measures analyses were used to assess change from preoperative to 12 months postoperative.

RESULTS

Data were obtained from 144 patients who underwent surgery for sacral Tarlov cysts, average age 52.3 ± 11.3 years, 90.3% female. Patients reported significant mean improvement on the TCQoL over time (preoperative 3.2 ± 0.1; 3-month postoperative 2.1 ± 0.1; 6-month 1.9 ± 0.1; 12-month 1.9 ± 0.1; P < 0.001). Patient age and duration of symptoms were not associated with outcome. A total of 82.3% of patients reported improvement on TCQoL. There was not a significant difference in the proportion of patients reporting improvement on TCQoL by cyst size (small 90.9% vs. large 77.9%; P = 0.066).

CONCLUSIONS

Our longitudinal series demonstrated patient-reported improvement following surgery for symptomatic sacral Tarlov cysts using a validated disease-specific health-related quality of life scale through 12 months after surgery. Patient age and preoperative duration of symptoms were not correlated with outcome.

Disability or Death: A Focused Review of Informed Consent in Pediatric Neurosurgery

The management of pediatric neurosurgical disease often requires families to choose between long-term disability and premature death. This decision-making is codified by informed consent. In practice, decision-making is heavily weighted toward intervening to prevent death, often with less consideration of the realities of long-term disability. We analyze long-term disability in pediatric neurosurgical disease from the perspectives of patients, families, and society. We then present a pragmatic framework and conversational approach for addressing informed consent discussions when the outcome is expected to be death or disability. We performed a focused review of literature regarding informed consent in pediatric neurosurgery by searching PubMed and Google Scholar with search terms including "pediatric neurosurgery," "informed consent," and "disability." The literature was focused on patients with diagnoses including spina bifida, neuro-oncology, trauma, and hydrocephalus. Patient perspective elements were physical/mental disability, lack of autonomy, and role in community/society. The family perspective involves caregiver burden, emotional toll, and financial impact. Societal considerations include the availability of public resources for disabled children, large-scale financial cost, and impacts on global health. Practical conversational steps with patients/caregivers include opening the discussion, information provision and acknowledgement of uncertainty, assessment of understanding and clarifying questions, decision-making, and decision maintenance, all while remaining sensitive to the emotional burden commensurate with these decisions. The "death or disability" paradigm represents a common challenge to informed consent in pediatric neurosurgery. Patient, family, and societal factors that inform surrogate decisions vary and sometimes conflict. Pediatric neurosurgeons must use a comprehensive approach to address the informational and relational needs of caregivers during the informed consent process.

The health-related quality of life in children with arachnoid cysts. Clinical predictors and parent-child perspectives

BACKGROUND

In clinical practice, arachnoid cysts are usually detected by coincidence and are frequently considered as clinically mute. Even though an AC does not usually result in serious symptoms, the diagnosis itself can have a significant impact on the patients and their families, especially in terms of psychological functioning and quality of life.

METHODS

Participants were 22 pairs of children diagnosed with AC and their parents. We analysed patients' medical records and assessed them using the Stanford Binet Intelligence Scale ed. 5th. Additionally, both children and parents filled in the Polish version of the PedsQL™ 4.0 generic core module.

RESULTS

The HRQOL is not related to objective predictors such as radiological predictors and SB 5 results. However, there is a correlation between the HRQOL, and symptoms given in the interview. Secondly, parents assess the HRQOL of their children worse compared to the children's own ratings. Lastly, children with AC assess the HRQOL in a way that is similar to the assessment done by healthy children in the original study describing PedsQL™, whereas parents assess children's HRQOL in a way rather similar to the assessment done by parents of patients.

CONCLUSIONS

The results show the impact of the disease's image and understanding on the HRQOL. Basing on our results we conclude the important role of psychological support for patients with AC. We furthermore conclude that parents of children with AC assess the HRQOL of children worse compared to the children's own ratings.

Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I

OBJECTIVE

The authors' previously published work validated the Chiari Health Index for Pediatrics (CHIP), a new instrument for measuring health-related quality of life (HRQOL) for pediatric Chiari malformation type I (CM-I) patients. In this study, the authors further evaluated the CHIP to assess HRQOL changes over time and correlate changes in HRQOL to changes in symptomatology and radiological factors in CM-I patients who undergo surgical intervention. Strong HRQOL evaluation instruments are currently lacking for pediatric CM-I patients, creating the need for a standardized HRQOL instrument for this patient population. This study serves as the first analysis of the CHIP instrument's effectiveness in measuring short-term HRQOL changes in pediatric CM-I patients and can be a useful tool in future CM-I HRQOL studies.

METHODS

The authors evaluated prospectively collected CHIP scores and clinical factors of surgical intervention in patients younger than 18 years. To be included, patients completed a baseline CHIP captured during the preoperative visit, and at least 1 follow-up CHIP administered postoperatively. CHIP has 2 domains (physical and psychosocial) comprising 4 components, the 3 physical components of pain frequency, pain severity, and nonpain symptoms, and a single psychosocial component. Each CHIP category is scored on a scale, with 0 indicating absent and 1 indicating present, with higher scores indicating better HRQOL. Wilcoxon paired tests, Spearman correlations, and linear regression models were used to evaluate and correlate HRQOL, symptomatology, and radiographic factors.

RESULTS

Sixty-three patients made up the analysis cohort (92% Caucasian, 52% female, mean age 11.8 years, average follow-up time 15.4 months). Dural augmentation was performed in 92% of patients. Of the 63 patients, 48 reported preoperative symptoms and 42 had a preoperative syrinx. From baseline, overall CHIP scores significantly improved over time (from 0.71 to 0.78, p < 0.001). Significant improvement in CHIP scores was seen in patients presenting at baseline with neck/back pain (p = 0.015) and headaches (p < 0.001) and in patients with extremity numbness trending at p = 0.064. Patients with syringomyelia were found to have improvement in CHIP scores over time (0.75 to 0.82, p < 0.001), as well as significant improvement in all 4 components. Additionally, improved CHIP scores were found to be significantly associated with age in patients with cervical (p = 0.009) or thoracic (p = 0.011) syrinxes.

CONCLUSIONS

The study data show that the CHIP is an effective instrument for measuring HRQOL over time. Additionally, the CHIP was found to be significantly correlated to changes in symptomatology, a finding indicating that this instrument is a clinically valuable tool for the management of CM-I.

Measuring Health-Related Quality of Life in Pediatric Neurology

Health-related quality of life (HRQOL) is central to how clinicians and parents make choices about medical care for pediatric neurology patients. To provide parents with the information they need to make these decisions and plan for the future, it is necessary for parents and clinicians to understand how HRQOL is defined and measured in the setting of pediatric neurodevelopmental impairment. We review challenges that exist in measuring HRQOL in pediatric neurology, examine existing measures, and outline key principles to guide selection and interpretation of HRQOL measures in children with neurologic conditions.

Impact of epilepsy surgery on quality of life and burden of caregivers in children and adolescents

OBJECTIVE

The objective of this study was to analyze the impact of pediatric epilepsy surgery on the quality of life (QOL), determining whether patients improve, worsen, or maintain their preoperative patterns, as it relates to the burden of caregivers, as well as evaluating potential related factors, from both the children and caregivers perspectives.

MATERIAL AND METHODS

This is a retrospective study of children and adolescents who underwent epilepsy surgery and were evaluated through clinical data, videoelectroencephalogram (V-EEG), neuroimaging findings, neuropsychological testing, and aspects of QOL. These assessments were performed prior to surgery and after six months and two years of follow-up. Quality of life was assessed with epilepsy-specialized questionnaires, namely Questionnaire health-related quality of life for children with epilepsy (QVCE-50), Autoquestionnaire Qualité de Vie Enfant Image Scale (AUQUEI), Quality of life in epilepsy inventory for adolescents (QOLEI-AD-48); and burden of caregivers with Burden Interview - ZARIT scale. Postoperative changes in QVCE-50 were quantified using measures of the analysis of variance (ANOVA MR) for comparison of the difference between the three times of the scale and domains.

RESULTS

Fifty patients were enrolled. Of these, 27 (54%) were male, with a mean age at surgery of 8.2 years (range: 1-18 years). Thirty-five patients (70%) were Engel I and one was Engel II (2%) at six months of follow-up, whereas 28 (56%) were Engel I and 32 (64%) were Engel I or II at two years of follow-up. Preoperatively, 21 (42%) presented with moderate or severe intellectual disability. Postoperative cognitive evaluations at the two-year follow-up showed 18 (36%) maintained similar deficits. The QVCE-50 showed postoperative improvement in the two-year follow-up period, but not at six months after surgery. Postoperative improvements were associated mainly with better seizure outcome. Autoperception evaluations were limited because of the clinical and cognitive severity of patients. The burden of caregivers was quoted as mild to moderate and remained unchanged postoperatively.

CONCLUSIONS

Children and adolescents with surgically treated epilepsy reach a good seizure outcome, stabilize in intellectual and adaptive functions, and have an increase in QOL, from the caregiver's perspective. Nevertheless, their burden remains unchanged. Seizure outcome is the main factor for improvement in the QOL. The upgrading of structured questionnaires and QOL instruments specific to pediatric epilepsy can be helpful to assess patient- and caregiver-reported surgical outcomes, allowing for better planning of therapeutic approaches.