Bamer Alyssa M, McMullen Kara, Wolf Steven E, Stewart Barclay T, Kazis Lewis, Rencken Camerin A, Amtmann Dagmar
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195-4237, USA.
Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
Qual Life Res. 2021 Jul;30(7):2071-2080. doi: 10.1007/s11136-021-02796-3. Epub 2021 Feb 27.
To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between self- and proxy-reports.
Children 8-17 years of age and their caregivers completed PROMIS measures (physical function, depression, peer relationships, pain interference, and anger) between 6 months and 15 years after injury. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen's effect size, and intraclass correlation coefficients (ICC) and by agreement across severity of symptoms based on recommended cutoffs. Ordinary least squares regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences.
Two hundred and seventy four child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on physical function, pain, and anger (all p ≤ 0.01). The effect sizes were small across all domains except physical function. Similarly, ICCs were all of moderate agreement. The percentage of dyads in agreement by severity groups was high with only 5%-9% of pairs discordant. Only higher self-report score was associated (all p < 0.05) with greater differences across all domains in regression analyses.
This study supports the use of pediatric proxy PROMIS depression, physical function, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, assessing proxy-report alone as a surrogate should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.
探讨小儿烧伤幸存者自我报告与照顾者代理报告在多个患者报告结果测量信息系统（PROMIS）领域的一致性，并研究与自我报告和代理报告差异相关的因素。
8至17岁的儿童及其照顾者在受伤后6个月至15年期间完成了PROMIS测量（身体功能、抑郁、同伴关系、疼痛干扰和愤怒）。使用Wilcoxon符号秩检验、Cohen效应量和组内相关系数（ICC）比较自我报告和代理报告得分，并根据推荐的临界值按症状严重程度的一致性进行比较。普通最小二乘回归分析检查了与得分差异相关的儿童因素（自我报告得分、年龄、性别和种族）和代理相关因素（与儿童的关系）。
274对儿童-照顾者完成了PROMIS测量。儿童的平均年龄为13.0（标准差：3）岁。照顾者报告的身体功能、疼痛和愤怒得分明显比儿童差（所有p≤0.01）。除身体功能外，所有领域的效应量都很小。同样，ICC均为中度一致性。按严重程度分组一致的二元组百分比很高，只有5%-9%的对子不一致。在回归分析中，只有较高的自我报告得分与所有领域的更大差异相关（所有p<0.05）。
本研究支持在小儿烧伤患者中使用小儿代理PROMIS抑郁、身体功能、同伴关系、疼痛干扰和愤怒量表。尽管一致性为中度至良好，但仅在自我报告不可能或不实际时，才应考虑将代理报告作为替代指标单独评估。在所有领域，照顾者报告的症状严重程度通常比儿童略差。
