The Psychometric Properties of an Arabic version of the PedsQL Multidimensional Fatigue Scale Tested for Children with Cancer

Effectiveness of exergaming in reducing cancer-related fatigue among children with acute lymphoblastic leukemia: a randomized controlled trial

BACKGROUND

Little is known about the effectiveness of the newly emerging technology of exergaming in reducing Cancer Related Fatigue (CRF).

OBJECTIVES

The study's primary aim was to examine the effectiveness of exergaming in reducing CRF; the secondary aims were to improve functional capacity/endurance and promote physical activity (PA) among children with acute lymphoblastic leukemia (ALL).

METHODS

In this Randomized Controlled Trial (RCT), 45 children aged 6-14 years were randomly assigned into group-I, n = 22, and group II, n = 23. Group-I played exergaming of moderate intensity for 60 min, twice a week for three weeks. Group II was given an instructional session regarding the benefits of PA with advice to practice PA for 60 min twice a week. CRF, functional capacity/endurance, and PA were measured using the pediatric quality of life multidimensional fatigue scale (Ped-QLMFS), six-minute walk test (6-MWT), and Godin-Shepard Leisure Time Physical Activity Questionnaire (QSLTPAQ) respectively. All measurements were taken thrice; in the first, third, and fifth weeks of intervention.

RESULTS

Group-I demonstrated a significant reduction of CRF, and a significant increase of functional capacity/endurance compared to group-II over the five weeks study period. The effect of time × intervention interaction was significant. Based on Cohen's guidelines, CRF and functional capacity/endurance had large effect sizes (η² = 0.41, p = .00) and (η² = 0.27, p = .00) respectively.

CONCLUSION

The protocol of exergaming used in this RCT effectively reduces CRF and promotes functional capacity/endurance and PA in children with ALL undergoing chemotherapy. It may provide an alternative treatment modality to decrease the healthcare load.Key messagesCancer-related fatigue (CRF) is described as physical exhaustion, sleep disturbance, emotional distress, and cognitive dysfunction.Exergaming reduces CRF and promotes functional capacity/endurance and physical activity in children with acute lymphoblastic leukemia undergoing chemotherapy.Exergaming may provide an alternative treatment modality to decrease the healthcare load.

Measurement properties of the Arabic version of the pediatric functional assessment of chronic illness therapy-fatigue in children with cancer

BACKGROUND

The pediatric Functional Assessment of Chronic Illness Therapy-Fatigue (PedsFACIT-F) measures fatigue in various clinical settings.

OBJECTIVE

To verify the measurement properties of the Arabic version (PedsFACIT-F-Ar) in patients with cancer.

METHODS

In this cross-sectional validation study, the PedsFACIT-F and the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) were administered to 114 participants (74 boys and 40 girls) aged 8-18. Exploratory factor analysis was used to test the structural validity of PedsFACIT-F-Ar. Its construct validity was investigated using the hypothesis testing method to predict a moderate correlation (rho ⩾ 0.4) with the PedsQL-MFS domains and the total score. Its reliability was also tested.

RESULTS

The PedsFACIT-F-Ar is a two-factor model that explains 67.38% of the total variance. It is significantly correlated with PedsQL-MFS (rho > 0.84). It displayed excellent internal consistency (Cronbach's α= 0.93) and test-retest reliability (ICC2.1= 0.99; 95% CI: 0.96-0.99). Bland-Altman's analysis revealed the absence of a systematic error between the two test sessions. The standard error of measurement, minimal detectable change (MDC95), and MDC% were 0.92, 2.56 points, and 2.88%, respectively, with no floor or ceiling effects.

CONCLUSIONS

The PedsFACIT-F-Ar demonstrated excellent psychometric properties. The findings suggest the clinical usefulness of this scale.

Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.

OBJECTIVES

To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.

RESULTS

This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132).

CONCLUSION

There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

Factor structure, reliability, inter-rater agreement and convergent validity of the parent and child Italian versions of the paediatric quality of life inventory multidimensional fatigue scale for children and adolescents in paediatric inpatients with obesity and their parents

OBJECTIVE

This study aimed to examine the factor structure, reliability, inter-rater agreement and convergent validity of the child and parent Italian versions of the paediatric quality of life inventory multidimensional fatigue scale (PedsQL-MFS) in paediatric inpatients with obesity and one of their parents.

METHODS

100 pairs of children/adolescents (64% female, mean age = 15.34) with obesity and one of their parents completed the PedsQL-MFS and the Child Behaviour Checklist (CBCL) or the Youth Self Report.

RESULTS

Confirmatory Factor Analysis indicated that the three correlated first-order factors model corresponding to the published subscales demonstrated acceptable fit and achieved strict invariance across parent and child informants. Bifactor Analysis supported the multidimensionality and the reliability of the total and subscale scores as multidimensional composites. Parent-child agreement was low with latent means higher for parent reports. PedsQL-MFS total scores were strongly correlated with Somatic Complaints scores on the CBCL, and moderately associated with anxiety, depression, social problems and school problems.

CONCLUSIONS

Total scores of the child and parent Italian versions of the PedsQL-MFS demonstrated good reliability and convergent validity in paediatric inpatients with obesity and their parents, and are complementary rather than interchangeable.

LEVEL OF EVIDENCE

No level of evidence.

Psychometric properties of Pediatric Quality of Life multidimensional fatigue scale in Italian paediatric cancer patients: A multicentre cross-sectional study

OBJECTIVE

The original Pediatric Quality of Life-Multidimensional Fatigue Scale (PedsQL-MFS) developed in 2002 in the English language is a frequently used tool in paediatric oncology. It has been translated into several languages, and the aim of this study was to test the psychometric properties of the Italian version of this scale in paediatric patients with cancer.

METHODS

This was a cross-sectional validation multicentre study.

RESULTS

Acceptability was 100% for patients and 99.2% for parents. Confirmatory factor analysis of the three-factor model of the original scale yielded poor fit indices. A three-factor solution was found through exploratory structural equation modelling, with good fit indices. The internal consistency, evaluated through the Cronbach's alpha coefficient, ranged 0.71-0.92 for the total sample, both in the self-report and in the proxy-report questionnaire.

CONCLUSION

The Italian version of the PedsQL-MFS for children and adolescents with cancer shows adequate psychometric characteristics of both the self- and proxy-report. Further research with larger samples is needed ensuring all age groups are appropriately represented.

Efficacy of aqua-based plyometric exercises in the rehabilitation of patients with juvenile dermatomyositis: A randomized crossover pilot study

BACKGROUND

Patients with juvenile dermatomyositis (JDM) experience muscle weakness, tiredness, and loss of energy, which restrict their abilities in performance of their daily living activities.

OBJECTIVE

To explore the effect of aquatic-based plyometric (Aqua-PLYO) exercises on muscle strength, fatigue, and functional ability in patients with JDM.

METHODS

This was a randomized, single-blind, crossover pilot study that included 16 patients with JDM (age 13.44 ± 2.85 years). They were assigned randomly to receive either the Aqua-PLYO exercises (n = 8) or the standard outpatient care (SoC ; n = 8) first. After a 1-month washout, the treatment was reversed. Lower limb muscle strength, fatigue perception, functional ability, and disease activity were evaluated before and after each treatment period.

RESULTS

Irrespective of the treatment order, the Aqua-PLYO treatment yielded greater improvement in muscle strength (hip flexors and abductors [P < 0.001] or knee flexors [P < 0.001] and extensors [P = 0.0008]), fatigue perception (P < 0.001), functional ability (P = 0.009), and disease activity (P = 0.0001) than the SoC treatment. By using the shortest confidence intervals (100[1-2α]%) of the difference, the average bioequivalence of the Aqua-PLYO and SoC has not been established at P = 0.05, because the upper and lower confidence bounds of all outcomes were not between the acceptance limits. No period or carryover effects were detected in all outcomes.

CONCLUSION

The Aqua-PLYO exercise protocol as implemented in this study is safe, feasible, and well-tolerated in patients with JDM and seemingly useful to help increase muscle strength, reduce fatigue, and enhance functional ability in such a patient population.

Within 5-year off-chemotherapy: How the cardio-respiratory response to exercise is related to energy expenditure, fatigue, and adiposity in children with acute lymphoblastic leukaemia?

OBJECTIVE

To explore the cardio-respiratory response to exercise and examine the relationships among specific measures of cardio-respiratory function, energy expenditure (EE), fatigue and adiposity in children survivors of acute lymphoblastic leukaemia (ALL).

METHODS

Seventy survivors of ALL (13.31 ± 2.60 years) and 34 controls from the siblings (12.71 ± 2.36 years) participated and were assessed for submaximal and maximal exercise capacity, body composition, EE and fatigue.

RESULTS

ALL survivors had significantly lower submaximal (VO₂ ; p = 0.002) and maximal (VO_2peak ; p ˂ 0.001) cardio-respiratory capacity than their controls. At the submaximal exercise test, EE was significantly lower in ALL survivors (p < 0.001), but the heart rate (HR) was significantly higher (p = 0.005). The VO₂ and HR were significantly correlated [r (95%CI) = 0.689 (0.542 to 0.795), p < 0.001]. The VO_2peak negatively associated with adiposity [r (95%CI) = -0.368 (-0.554 to -0.145), p = 0.002]. Fatigue significantly correlated with the VO_2peak [r (95%CI) = 0.581 (0.401 to 0.718), p < 0.001] and adiposity [r (95%CI) = -0.303 (-0.502 to 0.073), p = 0.012].

CONCLUSION

Children survivors of ALL experience low cardio-respiratory fitness within 5-year off-chemotherapy. Associations exist between measures of cardio-respiratory fitness, EE, fatigue and adiposity. However, it has not yet been proven whether these are cause or effect.

Recommendations for the surveillance of cancer-related fatigue in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

PURPOSE

Cancer-related fatigue (CRF) negatively affects the lives of childhood, adolescent, and young adult (CAYA) cancer survivors. We aimed to provide an evidence-based clinical practice guideline (CPG) with internationally harmonized CRF surveillance recommendations for CAYA cancer survivors diagnosed < 30 years.

METHODS

This CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating concordances and discordances of four existing CPGs, we performed systematic literature searches. We screened articles for eligibility, assessed quality, extracted, and summarized the data from included articles. We formulated recommendations based on the evidence and clinical judgment.

RESULTS

Of 3647 articles identified, 70 articles from 14 countries were included. The prevalence of CRF in CAYA cancer survivors ranged from 10-85%. We recommend that healthcare providers are aware of the risk of CRF, implement regular screening with validated measures, and recommend effective interventions to fatigued survivors.

CONCLUSIONS

A considerable proportion of CAYA cancer survivors suffers from CRF even years after the end of treatment.

IMPLICATIONS FOR CANCER SURVIVORS

We recommend that healthcare providers adopt regular screening to detect and treat CRF early and positively influence survivors' health and quality of life.

Differential expression and diagnostic significance of P53, MutS homologs 2, tropomyosin-4 in alpha-fetoprotein-negative hepatocellular carcinoma

BACKGROUND

Current study aimed to explore the value of P53, MutS homologs 2 (MSH2), and tropomyosin-4 (Tm-4) combined with inflammatory factors, life-history traits in the differential diagnosis of alpha-fetoprotein-negative hepatocellular carcinoma (AFP-Negative HCC).

METHODS

A testing cohort including 280 AFP-Negative HCC patients and 300 controls was included. Three external validation cohorts from 3 centers were used to assess the novel logistic regression model including 400 AFP-Negative HCC patients and 400 controls.

RESULTS

Compared with the control group, the levels of P53, MSH2, and Tm-4 protein in si-P53 group, si-MSH2 group, and si-Tm-4 group were significantly reduced (P < .05). The P53, MSH2, Tm-4, neutrophil to lymphocyte ratio (NLR), monocytes to lymphocyte ratio (MLR), hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6) levels, and the smoking, drinking, and occupational exposure to chemicals rates in patients were significantly higher than those in controls (P < .05). ROC analyses showed that the area under curve (AUC) of NLR, MLR, hs-CRP, TNF-α, IL-6, P53, MSH2, Tm-4, drinking, smoking, and occupational exposure to chemicals were 0.798, 0.803, 0.560, 0.644, 0.808, 0.681, 0.830, 0.694, 0.582, 0.581, and 0.567, respectively. A novel logistic regression model was built and has a high value in identifying AFP-Negative HCC with AUC of 0.917, sensitivity of 85.2%, and specificity of 88.3%. In the validation cohorts, this model also showed good diagnostic efficiency (AUC = 0.898 with Dazu Branch cohort, AUC = 0.924 with Jinshan Branch cohort, and AUC = 0.907 with Liangping Branch cohort).

CONCLUSION

Current model has potential significance for the noninvasive diagnosis of AFP-Negative HCC.

Pediatric Sleep Tools: An Updated Literature Review

Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 "tool"-studies (70 tools) have been published aiming at investigating sleep in primarily 6-18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.

Assessment of the Clinical Effects of Aquatic-based Exercises in the Treatment of Children With Juvenile Dermatomyositis: A 2x2 Controlled-Crossover Trial

Objectives

This study aims to compare the effect of aquatic-based exercises (AQBEs) and land-based exercises (LBEs) on muscle strength, fatigue and quality of life (QoL), and skin disease activity in children with juvenile dermatomyositis (JDM).

Patients and methods

The design of the study was an assessor-blinded, controlled 2x2 crossover trial. Fourteen children (4 boys, 10 girls; mean age 11.7±2.2 years; range, 10 to 16 years) were evaluated. AQBEs and LBEs were applied through two treatment sequences as half of the children received AQBEs first while the second half received LBEs first. Isometric muscle strength, fatigue level and QoL (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale [PedsQL-MFS]), and skin disease activity score (DASskin) were measured at four occasions for each treatment sequence.

Results

The AQBEs had significant superiority over LBEs with improved hip flexors' strength (p=0.007) and hip abductors' strength (p=0.001), while both types of treatment had the same effect in increasing strength of shoulder flexors and abductors (p<0.05). AQBEs improved PedsQL-MFS, and DASskin significantly more than LBEs (p<0.001). For all outcome measures, there was no significant difference in the treatment sequence the children received first.

Conclusion

Supervised AQBEs are more effective in improving muscle strength, fatigue and QoL, and skin disease activity than LBEs in children with JDM. Furthermore, the treatment sequence had no significant effect on measured variables.