Quality of life in children and young adults with cardiac conditions.

PURPOSE OF REVIEW: Unequivocal conclusions regarding the quality of life (QOL) of children, adolescents, and young adults with heart disease cannot be drawn because results vary across studies and between patient and parent-proxy reports. This review focuses on the recent studies that help us understand this variability and why subgroups of young cardiac patients do appear at increased risk of impaired QOL. RECENT FINDINGS: The age at which QOL is assessed might contribute to variability in reported QOL outcomes, with the greatest QOL impairment tending to occur with the youngest patients. Adolescents and young adults with heart disease often report positive QOL outcomes. Recent studies have furthered our understanding of the determinants of impaired QOL, including low social support, emotional instability, developmental disabilities, poorer subjective health status, and lower exercise capacity. Certain cardiac treatments, such as transplantation and implantable cardioverter defibrillator implantation, warrant special attention for potential QOL impairment. SUMMARY: Future research should move beyond cross-sectional studies and include longitudinal assessment of QOL. In addition, given the success with extending the lives of young patients with cardiac conditions, it is important that strategies focused on patient and family QOL are also advanced.

Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review.

BACKGROUND: Total knee arthroplasty (TKA) is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. METHODS: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. RESULTS: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant predictor of chronic pain persisting ≥3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates. CONCLUSION: This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery.