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Research Reports

Quality of life in pediatric asthma patients and their parents: a meta-analysis on 20 years of research

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Abstract

Introduction: This meta-analytic review was conducted to estimate the magnitude of quality of life (QoL) impairments in children/adolescents with asthma and their parents. Method: A systematic search in four electronic databases revealed 15 quantitative studies published between 1994–2013 that directly compared the QoL of 7- to 18-year-old asthma patients/parents to community/healthy controls. Pooled mean differences (MD) with 95% CI were estimated using the inverse-variance random-effects method. Results: Pediatric asthma patients (n = 1797) presented lower overall QoL (MD = -7.48, CI: -10.67/-4.29), physical functioning (MD = -9.36, CI: -11.85/-6.86), psychological functioning (MD = -5.00, CI: -7.17/-2.82) and social functioning (MD = -3.76, CI: -5.80/-1.72), compared to controls (n = 13,266). For parents (666 cases and 7328 controls), asthma was associated with lower physical functioning (MD = -10.15, CI: -12.21/-8.08). Between-studies heterogeneity was explained by type of informant and selection of controls. Conclusion: The ascertainment of the magnitude of QoL impairments and the most affected QoL dimensions for pediatric asthma patients/parents may contribute to the outlining of realistic goals for multidisciplinary interventions in healthcare settings and evaluate its cost–effectiveness.

Acknowledgements

The authors would like to thank the authors of the articles included in this meta-analysis who kindly supplied additional data upon our request: M Grootenhuis and H Maurice-Stam (Psychosocial Department, Emma Children’s Hospital/Academic Medical Centre, Amsterdam, The Netherlands) and H Moreira (Faculty of Psychology and Education Sciences, University of Coimbra, Portugal).

Financial & competing interests disclosure

This study was supported by the Relationships, Development & Health Research Group of the R&D Unit Cognitive-Behavioral Center for Research and Intervention (PEst-OE/PSI/UI0730/2014) and by a PhD Scholarship from the Portuguese Foundation for Science and Technology (SFRH/BD/69885/2010). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

  • The large amount of papers on quality of life (QoL) of children/adolescents with asthma and/or their parents that were published in the past 20 years illustrates the growing importance of QoL as an essential endpoint in pediatric research and healthcare contexts.

  • Children and adolescents with asthma are at a greater risk for decreased QoL, in general, and physical, psychological and social functioning, in particular, compared to their peers without asthma.

  • A major trend for using self-report QoL measures was observed across studies; however, patient- and parent-reports provide different but complementary data, and thus a multi-informant approach to pediatric QoL assessment is recommended.

  • Over the past two decades, there has been a proliferation of instruments specifically designed for QoL assessment in children and adolescents, resulting in a dissimilar methodological operationalization of the QoL construct and hindering cross-cultural comparisons.

  • Apart from the type of informants and the health status of controls, the severity of the underlying disease and responsiveness to treatments may contribute to explain the high levels of between-studies heterogeneity; however, the different criteria that were used across studies for clustering asthma clinical groups prevented the examination of clinical variables in this meta-analysis.

  • The QoL of parents of children/adolescents with asthma has been understudied; still, the few studies examining their QoL in relation to parents of healthy children consistently indicate QoL impairments in the physical domain.

  • The ascertainment of the magnitude of QoL impairments and the identification of the most affected QoL domains among pediatric asthma patients and their parents may contribute to outline realistic goals for medical treatments and psychosocial interventions and to evaluate its cost–effectiveness.

  • Research can now move from descriptive studies to the examination of risk and resistance factors underpinning the adaptation processes to explain the within-study variability in children/adolescents’ and their parents’ QoL outcomes.

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