J. H. F. Oosterhoff, R. Bexkens, L. S. Oh, Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Boston, MA, USA A. M. Vranceanu, Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
Clin Orthop Relat Res. 2018 Apr;476(4):767-775. doi: 10.1007/s11999.0000000000000071.
Although a parent's perception of his or her child's physical and emotional functioning may influence the course of the child's medical care, including access to care and decisions regarding treatment options, no studies have investigated whether the perceptions of a parent are concordant with that of an adolescent diagnosed with a sports-related orthopaedic injury. Identifying and understanding the potential discordance in coping and emotional distress within the athlete adolescent-parent dyads are important, because this discordance may have negative effects on adolescents' well-being.
QUESTIONS/PURPOSES: The purposes of this study were (1) to compare adolescent and parent proxy ratings of psychologic symptoms (depression and anxiety), coping skills (catastrophic thinking about pain and pain self-efficacy), and upper extremity physical function and mobility in a population of adolescent-parent dyads in which the adolescent had a sport-related injury; and (2) to compare scores of adolescents and parent proxies with normative scores when such are available.
We enrolled 54 dyads (eg, pairs) of adolescent patients (mean age 16 years; SD = 1.6) presenting to a sports medicine practice with sports-related injuries as well as their accompanying parent(s). We used Patient-reported Outcomes Measurement Information System questionnaires to measure adolescents' depression, anxiety, upper extremity physical function, and mobility. We used the Pain Catastrophizing Scale short form to assess adolescents' catastrophic thinking about pain and the Pain Self-efficacy Scale short form to measure adolescents' pain self-efficacy. The accompanying parent, 69% mothers (37 of 54) and 31% fathers (17 of 54), completed parent proxy versions of each questionnaire.
Parents reported that their children had worse scores (47 ± 9) on depression than what the children themselves reported (43 ± 9; mean difference 4.0; 95% confidence interval [CI], -7.0 to 0.91; p = 0.011; medium effect size -0.47). Also, parents reported that their children engaged in catastrophic thinking about pain to a lesser degree (8 ± 5) than what the children themselves reported (13 ± 4; mean difference 4.5; 95% CI, 2.7-6.4; p < 0.001; large effect size 1.2). Because scores on depression and catastrophic thinking were comparable to the general population, and minimal clinically important difference scores are not available for these measures, it is unclear whether the relatively small observed differences between parents' and adolescents' ratings are clinically meaningful. Parents and children were concordant on their reports of the child's upper extremity physical function (patient perception 47 ± 10, parent proxy 47 ± 8, mean difference -0.43, p = 0.70), mobility (patient perception 43 ± 9, parent proxy 44 ± 9, mean difference -0.59, p = 0.64), anxiety (patient perception 43 ± 10, parent proxy 46 ± 8, mean difference -2.1, p = 0.21), and pain self-efficacy (patient perception 16 ± 5, parent proxy 15 ± 5, mean difference 0.70, p = 0.35).
Parents rated their children as more depressed and engaging in less catastrophic thinking about pain than the adolescents rated themselves. Although these differences are statistically significant, they are of a small magnitude making it unclear as to how clinically important they are in practice. We recommend that providers keep in mind that parents may overestimate depressive symptoms and underestimate the catastrophic thinking about pain in their children, probe for these potential differences, and consider how they might impact medical care.
Level I, prognostic study.
尽管父母对子女身体和情绪功能的感知可能会影响子女的医疗护理过程，包括获得医疗护理的机会和治疗方案的选择，但尚无研究调查父母的感知是否与运动相关的骨科损伤的青少年一致。确定并理解运动员青少年-父母对子代中应对和情绪困扰的潜在差异很重要，因为这种差异可能对青少年的健康产生负面影响。
问题/目的：本研究的目的是：(1)比较运动相关损伤青少年-父母对子代中青少年和父母代理人对心理症状（抑郁和焦虑）、应对技能（对疼痛的灾难性思维和疼痛自我效能）和上肢功能和活动能力的心理症状的代理评分；(2)比较青少年和父母代理人的评分与可获得的正常评分。
我们招募了 54 对（例如，对子）青少年患者（平均年龄 16 岁；SD=1.6）及其陪同的父母（陪同父母），他们因运动相关损伤而就诊于运动医学诊所。我们使用患者报告的结果测量信息系统问卷来测量青少年的抑郁、焦虑、上肢功能和活动能力。我们使用疼痛灾难化量表短表评估青少年对疼痛的灾难性思维，使用疼痛自我效能量表短表评估青少年的疼痛自我效能。陪同父母（69%的母亲（37/54）和 31%的父亲（17/54））完成了每个问卷的父母代理人版本。
父母报告说，他们的孩子在抑郁方面的得分（47±9）比孩子自己报告的（43±9；平均差异 4.0；95%置信区间[CI]，-7.0 至 0.91；p=0.011；中等效应大小-0.47）更差。此外，父母报告说，他们的孩子对疼痛的灾难性思维程度较轻（8±5），而孩子自己报告的（13±4；平均差异 4.5；95%CI，2.7-6.4；p<0.001；大效应大小 1.2）。由于抑郁和灾难性思维的得分与一般人群相当，且这些测量方法的最小临床重要差异得分不可用，因此尚不清楚父母和青少年的评分之间观察到的相对较小差异在临床上是否有意义。父母和孩子在报告孩子的上肢功能（患者感知 47±10，父母代理 47±8，平均差异-0.43，p=0.70）、活动能力（患者感知 43±9，父母代理 44±9，平均差异-0.59，p=0.64）、焦虑（患者感知 43±10，父母代理 46±8，平均差异-2.1，p=0.21）和疼痛自我效能（患者感知 16±5，父母代理 15±5，平均差异 0.70，p=0.35）方面是一致的。
父母对孩子的抑郁程度和对疼痛的灾难性思维程度的评价高于青少年对自己的评价。尽管这些差异具有统计学意义，但它们的幅度较小，尚不清楚在实践中它们在临床上有多重要。我们建议提供者记住，父母可能会高估孩子的抑郁症状和低估孩子对疼痛的灾难性思维，探查这些潜在的差异，并考虑它们可能对医疗护理的影响。
一级，预后研究。
