Therapeutic recreation programmes for children with epilepsy

Relationship between camp attendance and self-perceptions in children with chronic health conditions: a meta-analysis

OBJECTIVE

A meta-analysis examined the association between camp attendance and changes in self-perceptions in children with chronic health conditions.

METHODS

Studies using quantitative methods to assess changes in self-perceptions while attending camps designed for children with chronic health conditions were included in analyses. A random-effects model was used, and Cohen's d was used to calculate effect sizes at both post-camp and follow-up. Some potential moderators of effects were examined (i.e., type of measure of self-perceptions, children's chronic health condition, camp components).

RESULTS

31 studies were included in the analyses. Children experienced small, but statistically significant, improvements in self-perceptions at both post-camp (d = .25, 95% CI [.16-.34]) and extended follow-up (d = .15, 95% CI [.05-.26]). This relationship was moderated by type of measure of self-perceptions and child health condition.

CONCLUSIONS

Camp attendance is associated with small improvements in self-perceptions for children with some chronic health conditions.

Children's Perspectives of Therapeutic Recreation: Data from the 'Barretstown Studies'

Camps offering therapeutic recreation-based programmes seek to provide a positive experience for children with life-threatening illnesses, and their siblings. While such programmes are undoubtedly motivated by the best of intentions, there are very little data available on children's own experiences in them. This article addresses this by investigating children's experiences in The Barretstown Gang Camp in Ireland. A questionnaire was completed by 449 children from 15 European countries. Feedback was factor analysed to construct an empirical model of how liking for activities in the programme clustered. Eight distinct components were identified.. Results indicated that children's level of liking for some components and whether they felt their friends would like to come to camp were influenced by their age, gender, nationality, level of understanding of explanations in camp and patient/sibling status. Children's descriptions of their camp experience emphasized themes pertaining to fun, activities, scenic surroundings, staff and multiculturalism.

A problem-solving intervention for children with persistent asthma: a pilot of a randomized trial at a pediatric summer camp

BACKGROUND

Pediatric summer camps are emerging as a means to increase social support and improve children's attitudes about their chronic illness. Because of the high rate of camp attendance, it may be feasible to implement interventions within that setting; however, it has yet to be determined what components of camp are beneficial.

OBJECTIVE

The objective of this pilot study was to determine the efficacy of a problem-solving intervention targeting disease management in improving psychosocial functioning of children with persistent asthma, over and above the benefits of participation in a pediatric summer camp.

METHODS

Fifty campers were randomly assigned to receive camp plus a nightly problem-solving intervention activity or camp as usual. Changes in self-reported asthma knowledge and problem-solving skills and self- and parent-reported child self- and social competence health-related quality of life were assessed thrice: before camp, on the last day of camp, and 3-months post-camp.

RESULTS

There were no significant differences between the problem-solving intervention group and the camp as usual group in change across psychosocial variables from before camp to last day of camp or before camp to 3-months post-camp. Increases in asthma knowledge and problem-solving were found 3-months post-camp when groups were combined.

CONCLUSIONS

Although support was found for improvements in disease knowledge and problem-solving skills after camp participation, there were no identified benefits to the problem-solving intervention. Children with asthma who participated in camp were functioning at a high level in terms of knowledge, problem-solving, and social and self-competence, suggesting that interventions may be more effective if targeted to patients with identified problems with disease management.

Children's voices: qualitative data from the ‘Barretstown studies’

This paper describes the experiences of children (7-16 years) affected by life-threatening illness, attending a therapeutic recreation programme. In total, 240 children completed self-report questionnaires prior to the programme, with decreased response rates at follow-up. This paper focuses on children's responses to open-ended questions. The main findings showed that children's expectations focused on the activities and social interactions they were looking forward to, while some were concerned about being away from home. Also two-thirds felt that they had acquired personal and social functioning skills. These findings are discussed in relation to the value of qualitatively accessing children's views and experiences.

Outcomes associated with participation in a therapeutic recreation camping programme for children from 15 European countries: Data from the ‘Barretstown Studies’

In recent years, specialised camping programmes, based largely on the premise of therapeutic recreation, have emerged as a form of intervention for children with chronic illnesses, and their siblings. Although these programmes are proliferating, little systematic evaluation of their outcomes has been undertaken, particularly within a European context. The aim of this research was to investigate the symptom and psychosocial outcomes of The Barretstown Gang Camp therapeutic recreation programme in Ireland, a programme aimed at European children with chronic illnesses and their siblings, in the short and longer term. Measures assessing children's physical, psychological and social functioning, specifically their self-reported physical symptoms, affect, self-esteem and quality of life, were translated into 12 European languages and administered at 3 time periods: 2 weeks before each child participated in the programme (Time 1), 2 weeks after participation (Time 2) and at 6 months following participation (Time 3). Benefits were noted in their experience of physical symptoms, affect pertaining to physiological hyperarousal and quality of life in the short and longer term. Positive changes were also noted in relation to self-esteem as it pertains to global self-worth and physical attractiveness though these were, for the most part, in the longer term only and were preceded by adverse effects in the short term. While some of these positive changes were global, there were group differences based mostly on children's age, and patient/sibling status and to a lesser extent on their nationality. However, no benefits were evident in many aspects of children's functioning, either at a global or a group level, in the short and longer term. These findings clarify previous research and suggest that camping programmes have an important role to play as a complementary intervention in facilitating adjustment to chronic illness.

Epilepsy and athletics

It may seem logical to place restrictions on athletes with epilepsy, but there are no studies to suggest that even contact sports exacerbate seizures, and there is ample evidence that exercise reduces seizure frequency and improves well-being. Thus, sports participation should generally be encouraged for epilepsy patients. The risk-benefit analysis for an individual patient is highly dependent on the athletic activity considered; type of seizure, the likelihood that a seizure will occur during the activity, and comorbid conditions. Water sports (scuba diving, swimming, boating), sports performed at heights (piloting, sky diving, climbing, horseback riding), and motor sports require specific considerations.

Predictors of good compliance in adolescents with epilepsy

The purpose of this paper was to describe the factors that predict compliance in adolescents with epilepsy. Altogether 300 individuals aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (N= 232 ) of the selected adolescents with epilepsy returned the questionnaire. The data were analysed with SPSS software. Using the logistic regression model, the compliance of adolescents with epilepsy was predicted on the basis of support from physician and parents, motivation and the disease not being a threat of social well-being. The most powerful predictor was support from the physician. The likelihood of adolescents supported by their physicians complying with their health regimens was 10.56-fold compared with the adolescents who did not receive support from their physicians. Another powerful predictor was support from parents. The adolescents who received support from their parents complied with the health regimens with a 10.47-fold likelihood compared with adolescents who did not receive support from their parents. Adolescents with good motivation were 9.77 times more likely to comply than adolescents who did not have good motivation. Adolescents who did not feel the disease to be a threat to their social well-being complied with health regimens with an 8.38-fold likelihood compared to those who felt the disease to be a threat to social well-being. The value of the -2Log likelihood was 64.68 and the goodness of fit index was 214.735. The value of Nagelkerke was 0.893, which indicates that the logistic regression model explains 89% of the variance. The model predicts correctly 97% of compliance in adolescents showing good compliance. These values show the logistic regression model to be good and to match well with the data.

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).

Compliance of adolescents with chronic disease

The purpose of this paper is to describe the factors that affect compliance in adolescents with a chronic illness and to compare compliance and factors connected to compliance between adolescents with asthma, epilepsy, rheumatoid arthritis (JRA) and insulin dependent diabetes mellitus (IDDM). The data were collected by questionnaire. Altogether 1200 individuals were selected from the Finnish Social Insurance Institution's register. The response percentage was 88 (n = 1061). One-fifth (23%) of adolescents with chronic disease felt that they had complied fully with health regimens, while 60% placed themselves in the category of satisfactory compliance and the remaining 17% reported poor compliance. In each patient group compliance was promoted by good motivation, a strong sense of normality, a positive attitude towards the disease and treatment, energy and will-power, experience of results, support from the parents, nurses and physicians, and a feeling that the disease was not a threat to social well-being.

Moderators of the effect of preoperative emotional adjustment on postoperative depression after surgery for temporal lobe epilepsy

PURPOSE

Other outcome measures besides seizure control must be considered when assessing the benefit of epilepsy surgery. We investigated the effect of preoperative psychosocial adjustment on postoperative depression in epilepsy patients followed up prospectively for 2 years after temporal lobectomy.

METHODS

The Washington Psychosocial Seizure Inventory (WPSI) evaluated psychosocial functioning; the Centre for Epidemiological Studies Depression Scale (CES-D) measured depression. Both were completed at baseline and follow-up.

RESULTS

Follow-up occurred in 39 temporal lobectomy patients at 2 years after surgery. Greatest improvement in depression scores was limited to patients with good seizure outcomes (seizure free, or marked reduction in seizure frequency), and seizure outcome was a significant predictor of postoperative depression. Despite this, preoperative scores on the emotional adjustment scale of the WPSI were most highly correlated with depression 2 years after surgery. To clarify this relation, moderated hierarchic regression suggested that good preoperative emotional adjustment (WPSI) was generally associated with less depression after surgery. Moreover, poorer preoperative adjustment combined with older age, generalized seizures, the finding of preoperative neurologic deficits, a family history of psychiatric illness, and/or a family history of seizures was related to higher depression scores 2 years after surgery.

CONCLUSIONS

Depression after temporal lobectomy is dependent on a complex interaction of variables and can have a significant effect on indices of postoperative adjustment. The WPSI emotional adjustment scale may help to predict which patients are likely to be chronically depressed after surgery.

Outcome assessment in epilepsy: comparative responsiveness of quality of life and psychosocial instruments

PURPOSE

Few data exist on the ability of instruments to detect within-patient change over time in epilepsy, a property referred to as responsiveness. Our aim was to compare the responsiveness of three instruments [i.e., Epilepsy Surgery Inventory-55 (ESI-55) and Washington Psychosocial Inventory (WPSI), both epilepsy specific, and Symptom Checklist-90-Revised (SCL-90-R), non-epilepsy specific].

METHODS

Instruments were administered at baseline and at 1 year in a prospective cohort of surgically (43) and medically (14) treated patients with temporal lobe epilepsy. Coefficient of Responsiveness and relative efficiency were computed for each scale and for the dimensions of mental health, physical health, and role function.

RESULTS

The ESI-55 contained the most responsive scales, whereas SCL-90-R contained the largest number of scales with moderate responsiveness. The largest number of scales with low responsiveness belonged to the WPSI. Sensitivity to between-treatment differences in change was highest for ESI-55 and SCL-90-R. The most efficient scales in detecting differences between treatment groups in the mental, physical, and role-function dimensions were ESI-55 emotional well-being, ESI-55 health perceptions, and SCL-90-R hostility, respectively.

CONCLUSIONS

Our results support the responsiveness of ESI-55 scales and suggest that SCL-90-R is a responsive tool for the assessment of psychologic function and distress in epilepsy. Comparatively, WPSI is relatively unresponsive to small or medium-size changes.