Use of an Ecological Momentary Assessment Application to Assess the Effects of Auricular Point Acupressure for Chronic Low Back Pain.

The purpose of this pilot study was to assess the feasibility and usability of an ecological momentary assessment smartphone application. The app collected real-time data on chronic low back pain and time-contingent ecological momentary assessment surveys during a 4-week auricular point acupressure intervention, and on the consistency between recalled and momentary clinical measures. Eighteen participants received auricular point acupressure treatment weekly for 4 weeks. Each participant was provided a smartphone with the ecological momentary assessment application installed, along with instructions for use. The primary outcomes comprised pain intensity, pain interference with daily activity, sleep quality score, and medication usage. System Usability Scale and adherence were also measured. According to the results, the rate of adherence for completion of the random ecological momentary assessment survey was 87%. The usability score for the ecological momentary assessment application was reported as 78. The average recalled pain intensity was higher than the mean momentary pain intensity. Self-reported average pain interference with daily activities showed a similar result. Spearman rank correlation coefficients were greater than +0.70; P < .01 for the associations among recalled and momentary measurements. In conclusion, the study demonstrated promising adherence rates and supported the usability and feasibility of using an ecological momentary assessment application on a smartphone to collect real-time data on chronic lower back pain, which eliminated recall bias.

Mental health of parents having children with physical disabilities.

BACKGROUND: Parents of children with disabilities play an essential role in the successful rehabilitation of their children. However, the high level of care required may affect the mental health of the parents and consequently contribute to an unfavorable rehabilitation outcome in their children. The aims of this study are to investigate the mental health of parents of children with physical disabilities and to elucidate the factors affecting parental mental health. METHOD: This was a cross-sectional study. Ninety-one parents of children with physical disabilities who visited the outpatient rehabilitation clinics of a tertiary hospital were invited to join the study. Data from the parents and children were recorded during face-to-face interviews. Parental- perceived stress was assessed using the simplified Parenting Stress Index (PSI/SF). Parental mental health was evaluated as the main outcome measure using the 12-item version of the Chinese Health Questionnaire (CHQ-12). RESULTS: Forty parents (44%) were categorized as psychiatric cases on the CHQ. Child-related factors that negatively affected parental mental health were poor walking ability (p < 0.05), dependency on others to perform activities of daily life (ADL) (p < 0.01), and younger age (p < 0.05). Parent-related factors that negatively affected parental mental health were low income (p < 0.05), no religious beliefs (p < 0.01), high level of parental distress (p < 0.01), parent-child dysfunctional interaction (p < 0.01), and having difficult child (p < 0.05). The most significant predictor of overall parental mental health in multivariate analysis was found to be parental distress. CONCLUSIONS: Parents of children with physical disabilities were at risk of poor mental health. Perceived parental distress is the most important factor affecting parental mental health. Strategies to reduce parental stress should be developed to prevent deterioration of parental mental health.

Assessment of symptoms reported by 10- to 18-year-old cancer patients in Taiwan.

The purposes of this study were 1) to assess and describe the occurrence, frequency, severity, and distress of symptoms reported by Taiwanese pediatric cancer patients who were between 10 and 18 years of age, and 2) to use statistical analysis to determine whether the multiple dimensions (i.e., frequency, severity, or distress) of the Memorial Symptom Assessment Scale (MSAS) 10-18 alone can provide sufficient useful information for the assessment of symptoms that patients report as distressing. A total of 144 Taiwanese pediatric cancer patients and their mothers participated in this cross-sectional study. The frequency of symptoms for all patients ranged from 52% for "lack of energy" to 10% for "feeling nervous." The most common symptoms (occurrence >40%) were "lack of energy," "lack of appetite," "feeling drowsy," "sweating," "worrying," "nausea," "dry mouth," "pain," and "lack of concentration." Patients in the "on-treatment group" had more distressing symptoms than those in the "off-treatment group." The severity and distress subscales did provide the most information for symptom assessment and were the two best subscales to represent the impact of symptoms on quality of life, fatigue, and internalizing behaviors. The findings of this study suggest that revising the current format of the MSAS 10-18 into three separate instruments (one for each of the subscales) might provide more accurate data for assessments. Such a modification would change the scoring system and provide for more accurate data analysis.

A comparison of emotional/behavioural problems between Taiwanese children with cancer and healthy controls.

AIMS: The purpose of this study was to compare children, diagnosed with cancer, who were attending school, with their healthy peers on emotional and behavioural problems. BACKGROUND: Children who suffer from cancer experience severe side effects from their treatment protocols and from the uncertainty associated with their disease. We were seeking to find out if these children subsequently experienced more emotional and behavioural problems than their healthy peers. METHODS: Parents and teachers of paediatric oncology patients and their healthy schoolmates were recruited. The ratio was one patient to two schoolmates. The Child Behaviour Checklist (CBCL) was used to collect data from the parents and teachers of 23 paediatric cancer patients and 46 healthy controls. Children were matched on enrollment in the same grade and socioeconomic status of their families. Paired-t tests were used to compare the differences between the emotional/behavioural scores of both groups of children. RESULTS: The findings of the study indicated that children with cancer had statistically higher scores on the following items of the CBCL: withdrawn/depressed, somatic complaints, social problems, thought problems, hyperactivity/impulsivity, rule-breaking behaviours and aggressive behaviours. CONCLUSIONS: School children with cancer in Taiwan did have more emotional/behavioural problems than their peers. Findings from this study suggest that Taiwanese paediatric oncology patients who are able to return to school and their families may need more psychosocial care. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals may need to extend their professional services to school settings to decrease long-term emotional and behavioural problems in children with cancer.

Psychological distress: testing hypotheses based on Roy's adaptation model.

This study examined the relationships among social support, parenting stress, coping style, and psychological distress in parents caring for children with cancer. The hypothesis that coping style plays a mediating role between social support and parenting stress, and psychological distress was tested for both mothers and fathers. In total, 246 mothers and 195 fathers of 270 children participated in the study. Structural equation modeling was used to test the hypothesis. The findings indicate that the hypotheses derived from the Roy adaptation model were supported for both mothers and fathers. A longitudinal study is suggested to examine the circular process of stimulus, coping process, and adaptation outcomes.

Construct validity of newly developed quality of life assessment instrument for child and adolescent cancer patients in Taiwan.

The purpose of this study was to test the convergent, discriminant, and clinical validity of the Quality of Life in Childhood Cancer (QOLCC) instrument for measuring the quality of life of Taiwanese children who suffer from cancer. In total, 160 patients were recruited for the study, including 105 male and 55 female. Overall, QOLCC consisted of generic measure and disease-specific domains to assess the Quality of Life (QOL) for children treated for cancer. The QOLCC is a symptom or problem-based questionnaire with the conceptual framework that health-related problems can be solved from both a biomedical perspective (e.g. changing the patient's medical treatment can enhance the QOL) and from a biobehavioral perspective (e.g. problem solving on a daily basis). This QOLCC, which can be administered in 15 min, is the first documented measure of the QOL administered directly to Taiwanese Children. It demonstrates acceptable psychometric properties. Application of the QOLCC to Taiwanese children with cancer produced encouraging results, validation from a larger independent parent population is still necessary.

Psychosocial adjustment among pediatric cancer patients and their parents.

Children with cancer face both physical and psychosocial challenges. However, there is not enough empirical evidence in Taiwan regarding how they and their families cope with their illness. The purpose of the present study was to explore the psychosocial impact of cancer on target children and their families as well as the degree of depression experienced by these children. Twenty-four pediatric cancer patients, aged 8 through 17 years, completed the Chinese version of Children Depression Inventory (CDI). Both these patients and 18 parents completed questionnaires about their psychosocial adjustment since the diagnosis of cancer. The results showed: (i) patients did not perceive significant changes in their psychosocial adjustment, whereas parents indicated significantly lower mood of patients and a slight decrease in the number of friends; (ii) both parents and siblings showed positive adjustment; and (iii) there was neither significant difference on the CDI scores between the pediatric cancer patients and a normative group, nor significant relationships between patients' CDI scores and demographic characteristics of both patients and their parents, parenting attitudes, as well as variables related to the illness. Lastly, the results are discussed in terms of issues of methodology and instruments. Possible direction for further investigations is suggested.