Stiles-Shields Colleen, Osos Sylwia, Sunnquist Madison L, Mak Grace Zee, Skelly Christopher L, Drossos Tina
Department of Psychiatry and Behavioral Sciences, Section of Community Behavioral Health, Rush University Medical Center.
Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine.
Clin Pract Pediatr Psychol. 2022 Mar;10(1):44-53. doi: 10.1037/cpp0000355. Epub 2021 Mar 1.
Median arcuate ligament syndrome (MALS) is a vascular condition that is treated surgically. MALS is a diagnosis of exclusion and therefore often requires that pediatric patients undergo an exhaustive number of tests and potential experiences with misdiagnosis before receiving an accurate diagnosis and treatment. The purpose of the current mixed-methods study was to assess the pediatric patient- and parent-reported experience of (a) coping with and managing symptoms associated with MALS and (b) the diagnostic, treatment, and recovery process for pediatric MALS.
Nine postsurgical pediatric patients ( age = 20.11 ± 3.59; all <18 at time of surgery) and 6 parents participated in semistructured focus groups and completed self-report questionnaires about their experiences and current functioning.
Four themes emerged: (a) the impact of MALS (physical and psychosocial), (b) uncertainties and feeling misunderstood, (c) extensive medical tests, and (d) mental health impacts, with an additional three themes related to specific querying (i.e., appreciation, recommendations, and interdisciplinary treatment team). With the exception of variable long-term physical impacts, patients and their parents reported fairly consistent experiences, and the content of these themes was consistent with self-reported quantitative data.
The current study highlights the resilience and resources seemingly required for effective diagnosis and intervention for pediatric MALS. The need for increased knowledge about MALS, the inclusion of an interdisciplinary treatment team, and long-term follow-up for pediatric patients with MALS are implicated.
正中弓状韧带综合征(MALS)是一种需手术治疗的血管性疾病。MALS是一种排除性诊断,因此儿科患者在获得准确诊断和治疗之前,往往需要进行大量检查,并可能经历误诊。本混合方法研究的目的是评估儿科患者及其家长报告的以下经历:(a)应对和管理与MALS相关的症状,以及(b)儿科MALS的诊断、治疗和康复过程。
9名儿科术后患者(年龄 = 20.11 ± 3.59;手术时均<18岁)和6名家长参加了半结构化焦点小组,并完成了关于他们的经历和当前功能的自我报告问卷。
出现了四个主题:(a)MALS的影响(身体和心理社会方面),(b)不确定性和被误解的感觉,(c)广泛的医学检查,以及(d)心理健康影响,另外还有三个与特定询问相关的主题(即感激、建议和跨学科治疗团队)。除了长期身体影响各不相同外,患者及其家长报告的经历相当一致,这些主题的内容与自我报告的定量数据一致。
本研究强调了有效诊断和干预儿科MALS似乎所需的适应能力和资源。这涉及到增加对MALS的了解、纳入跨学科治疗团队以及对儿科MALS患者进行长期随访的必要性。