Herge Whitney M, Samchukov Mikhail, Elerson Emily, Cherkashin Alexander, Hubbard Elizabeth, Podeszwa David
Scottish Rite for Children, Dallas, TX, USA.
J Pediatr Soc North Am. 2024 Mar 30;7:100030. doi: 10.1016/j.jposna.2024.100030. eCollection 2024 May.
The purpose of this paper is to review the role of psychology within the multidisciplinary preparation process for pediatric patients considering limb lengthening and reconstruction (LLR) and establish best practices for a staged preparation workflow. This work is grounded in the collective clinical experience of a well-established LLR team that treats nearly 300 patients considering or undergoing LLR per year.Preparation of pediatric patients and caregivers/families considering LLR is approached as a multidisciplinary process, spearheaded by the orthopaedic surgeon and accompanied by expert nursing, psychology, and physical therapy/occupational therapy support. Treatment planning and preparation occurs in a staged, developmentally appropriate fashion, guided by the individual patient's (and family's) understanding of treatment, goals for treatment, motivation for treatment, physical and emotional readiness for treatment, and demonstrated history of adherence. Particularly for pediatric patients, educational information is provided at an appropriate level, to support the child or adolescent's sense of autonomy and control over their body. Caregiver and family factors must also be considered, including caregiving support, division of responsibilities within the home, and the logistical feasibility of treatment tasks for the family unit. Additionally, connecting pediatric patients and families with peer supports (i.e., patients who have previously undergone the same or similar treatments) is very beneficial from an expectation setting standpoint and allows patients an opportunity to see what it may be like to incorporate LLR activities into their daily lives. With this approach, treatment progress is dependent upon the individual patient's and family's completion of each of these tasks that may take anywhere from weeks to years to complete. While certainly time and labor intensive, this method ensures the appropriateness of a patient and family's comprehension of, motivation for, and capacity to manage treatment expectations.
(1)Treatment preparation for pediatric patients considering LLR includes a staged, multidisciplinary assessment; this includes assessment by the orthopaedic surgeon, team nurse, psychologist, and physical/occupational therapist.(2)Treatment preparation and timing is guided by the individual patient and family's demonstrated interest in, motivation for, and capacity to manage treatment.(3)Inadequate understanding of treatment expectations, lack of motivation for treatment, and inappropriate treatment goals are likely to negatively impact a patient's adherence to treatment tasks, ability to sustain motivation and grit, pain management capability, and overall satisfaction with treatment.
本文旨在回顾心理学在小儿患者肢体延长与重建（LLR）多学科准备过程中的作用，并确立分阶段准备工作流程的最佳实践。这项工作基于一个成熟的LLR团队的集体临床经验，该团队每年治疗近300名考虑或正在接受LLR治疗的患者。
对于考虑进行LLR治疗的小儿患者及其照顾者/家庭的准备工作，是一个多学科过程，由骨科医生牵头，并辅以专业护理、心理学以及物理治疗/职业治疗支持。治疗计划和准备工作以分阶段、适合患者发育阶段的方式进行，以个体患者（及其家庭）对治疗的理解、治疗目标、治疗动机、身体和情感上对治疗的准备情况以及已证明的依从历史为指导。特别是对于小儿患者，会以适当的水平提供教育信息，以支持儿童或青少年对自己身体的自主感和掌控感。照顾者和家庭因素也必须加以考虑，包括照顾支持、家庭内部的责任分工以及家庭单元执行治疗任务的后勤可行性。此外，从设定期望的角度来看，将小儿患者及其家庭与同伴支持（即之前接受过相同或类似治疗的患者）联系起来非常有益，这使患者有机会了解将LLR活动融入日常生活会是什么样。采用这种方法，治疗进展取决于个体患者及其家庭完成这些任务的情况，这些任务可能需要数周甚至数年才能完成。虽然这肯定需要大量时间和人力，但这种方法可确保患者及其家庭对治疗期望的理解、治疗动机以及管理治疗期望的能力是恰当的。
（1）对于考虑进行LLR治疗的小儿患者，治疗准备包括分阶段的多学科评估；这包括骨科医生、团队护士、心理学家以及物理/职业治疗师的评估。（2）治疗准备和时间安排以个体患者及其家庭对治疗表现出的兴趣、动机以及管理治疗的能力为指导。（3）对治疗期望的理解不足、缺乏治疗动机以及不恰当的治疗目标可能会对患者坚持治疗任务的能力、保持动机和毅力的能力、疼痛管理能力以及对治疗的总体满意度产生负面影响。
