Problem-Solving Skills Training for Vulnerable Families of Children with Persistent Asthma: Report of a Randomized Trial on Health-Related Quality of Life Outcomes

Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 11/2010; 35(10):1133-43. DOI: 10.1093/jpepsy/jsp133
Source: PubMed


To test the efficacy of problem-solving skill training (PST) in improving health-related quality of life (HRQOL) of children with persistent asthma from predominantly lower socioeconomic status (SES) Spanish-speaking Hispanic families.
Randomized controlled trial comparing standard care waitlist (SC) control, home-visiting asthma education/care coordination (CC), and combined intervention (CC + PST) at baseline, after intervention, and 6-month follow-up. The primary outcome was parent proxy-report child HRQOL (PedsQL).
Participants (n = 252) were 83.3% Hispanic and 56.3% monolingual Spanish speakers, and 72.6% of mothers had not graduated high school. We found a significant (P = 0.05) intervention effect for parent proxy-reported child generic (but not asthma-specific) HRQOL, with CC + PST superior to SC [83.8 vs 79.8; adjusted mean difference of 4.05 points (95% confidence interval 0.63-7.4], but no difference between the CC and SC groups.
In this sample of vulnerable families of children with persistent asthma, a CC + PST intervention was efficacious in improving children's generic HRQOL.

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    • "The PedsQL™ was the most widely applied pediatric health-related quality of life measurement instrument in the MEDLINE database from 1966 to 2006 [31]. The accepted minimal clinically important difference (MCID) is 4.5 points for the PedsQL™ [29,32,33], the value that was applied here. "
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    ABSTRACT: Previous pediatric studies have observed a cross-informant variance in patient self-reported health-related quality of life (HRQoL) versus parent proxy-reported HRQoL. This study assessed in older children and adolescents with a variety of chronic pain conditions: 1) the consistency and agreement between pediatric patients' self-report and their parents' proxy-report of their child's HRQoL; 2) whether this patient-parent agreement is dependent on additional demographic and clinical factors; and 3) the relationship between pediatric patient HRQoL and parental reported HRQoL. The 99 enrolled patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed the PedsQLTM 4.0 and 36-Item Short-Form Health Survey Version 2 (SF-36v2) at the time of their initial appointment in a pediatric chronic pain medicine clinic. Patients' and parents' total, physical, and psychosocial HRQoL scores were analyzed via an intra-class correlation coefficient, Spearman's correlation coefficient, Wilcoxon signed rank test, and Bland-Altman plot. A multivariable linear regression model was used to evaluate the association between clinical and demographic variables and the difference in patient and proxy scores for the Total Scale Score on the PedsQL™. With the exception of the psychosocial health domain, there were no statistically significant differences between pediatric patients' self-report and their parents' proxy-report of their child's HRQoL. However, clinically significant patient-parent variation in pediatric HRQoL was observed. Differences in patient-parent proxy PedsQL™ Total Scale Score Scores were not significantly associated with patient age, gender, race, intensity and duration of patient's pain, household income, parental marital status, and the parent's own HRQoL on the SF-36v2. No significant relationship existed among patients' self-reported HRQoL (PedsQL™), parental proxy-reports of the child's HRQoL, and parents' own self-reported HRQoL on the SF-36v2. We observed clinically significant variation between pediatric chronic pain patients' self-reports and their parents' proxy-reports of their child's HRQoL. While whenever possible the pediatric chronic pain patient's own perspective should be directly solicited, equal attention and merit should be given to the parent's proxy-report of HRQoL. To do otherwise will obviate the opportunity to use any discordance as the basis for a therapeutic discussion about the contributing dynamic with in parent-child dyad.
    Health and Quality of Life Outcomes 07/2012; 10(1):85. DOI:10.1186/1477-7525-10-85 · 2.12 Impact Factor
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    • "Complete outcome data (i.e. sample size, means, standard deviations) were available from the published paper in 13 trials (Barakat 2010; Connelly 2006; Hoekstra-Weebers 1998; Kashikar-Zuck 2005; Kashikar- Zuck 2012; Laffel 2003; Ng 2008; Palermo 2009; Seid 2010; Stehl 2009; Wade 2006; Wade 2006b; Wade 2011). Seven authors provided data in response to our requests (Ambrosino 2008; Askins 2009; Celano 2012; Levy 2010; Niebel 2000; Sahler 2002; Sahler 2005). "
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    ABSTRACT: Psychological therapies have been developed for parents of children and adolescents with a chronic illness. Such therapies include parent only or parent and child/adolescent, and are designed to treat parent behaviour, parent mental health, child behaviour/disability, child mental health, child symptoms and/or family functioning. No comprehensive, meta-analytic reviews have been published in this area. To evaluate the effectiveness of psychological therapies that include coping strategies for parents of children/adolescents with chronic illnesses (painful conditions, cancer, diabetes mellitus, asthma, traumatic brain injury, inflammatory bowel diseases, skin diseases or gynaecological disorders). The therapy will aim to improve parent behaviour, parent mental health, child behaviour/disability, child mental health, child symptoms and family functioning. We searched CENTRAL, MEDLINE, EMBASE and PsycINFO for randomised controlled trials (RCTs) of psychological interventions that included parents of children and adolescents with a chronic illness. The initial search was from inception of these databases to June 2011 and we conducted a follow-up search from June 2011 to March 2012. We identified additional studies from the reference list of retrieved papers and from discussion with investigators. Included studies were RCTs of psychological interventions that delivered treatment to parents of children and adolescents (under 19 years of age) with a chronic illness compared to active control, wait list control or treatment as usual. We excluded studies if the parent component was a coaching intervention, the aim of the intervention was health prevention/promotion, the comparator was a pharmacological treatment, the child/adolescent had an illness not listed above or the study included children with more than one type of chronic illness. Further to this, we excluded studies when the sample size of either comparator group was fewer than 10 at post-treatment. We included 35 RCTs involving a total of 2723 primary trial participants. Two review authors extracted data from 26 studies. We analysed data using two categories. First, we analysed data by each medical condition across all treatment classes at two time points (immediately post-treatment and the first available follow-up). Second, we analysed data by each treatment class (cognitive behavioural therapy (CBT), family therapy (FT), problem solving therapy (PST) and multisystemic therapy (MST)) across all medical conditions at two time points (immediately post-treatment and the first available follow-up). We assessed treatment effectiveness on six possible outcomes: parent behaviour, parent mental health, child behaviour/disability, child mental health, child symptoms and family functioning. Across all treatment types, psychological therapies that included parents significantly improved child symptoms for painful conditions immediately post-treatment. Across all medical conditions, cognitive behavioural therapy (CBT) significantly improved child symptoms and problem solving therapy significantly improved parent behaviour and parent mental health immediately post-treatment. There were no other effects at post-treatment or follow-up. The risk of bias of included studies is described. There is no evidence on the effectiveness of psychological therapies that include parents in most outcome domains of functioning, for a large number of common chronic illnesses in children. There is good evidence for the effectiveness of including parents in psychological therapies that reduce pain in children with painful conditions. There is also good evidence for the effectiveness of CBT that includes parents for improving the primary symptom complaints when available data were included from chronic illness conditions. Finally, there is good evidence for the effectiveness of problem solving therapy delivered to parents on improving parent problem solving skills and parent mental health. All effects are immediately post-treatment. There are no significant findings for any treatment effects in any condition at follow-up.
    Cochrane database of systematic reviews (Online) 02/2012; 8(8):CD009660. DOI:10.1002/14651858.CD009660.pub2 · 6.03 Impact Factor
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    ABSTRACT: Problem-solving is one of the necessities of life in twenty first century. Therefore, Psychologists consider it as a skill that everyone must learn it. The purpose of the present study is to compare the effectiveness of the transac-tional analysis, existential, cognitive, and integrated group therapies on improving problem-solving skills. For this purpose, 65 subjects of the clients who were referring to the Ferdowsi University of Mashhad's Mental Health Centre were selected randomly and subjects placed in 5 groups in random assignment method (13 par-ticipants in each group). The research method is Pre-test/Post-test control group design. To gather the data, Long & Cassidy's problem solving styles questionnaire (1996) was used. In the descriptive level, the data were ana-lyzed using mean and standard deviation, and in the inferential level Analysis of Covariance test (ANCOVA) was used. The results of data analysis were indicative of the fact that after modifying pretest scores, there was a significant difference between group's subjects. The results showed that group therapies were effective on im-proving problem-solving skills and that cognitive and integrated group therapies were more effective on im-proving problem-solving skills comparing to other groups. Regarding the results of the present study, it can be concluded that transactional analysis, existential, cognitive and integrated group therapies were effective on im-proving problem-solving skills of the clients who were referring to the Ferdowsi University of Mashhad's Men-tal Health Centre.
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