Chao-Hsing Yeh

Little is known about the influence of existing muscle tone abnormality on the sitting posture of stroke patients in reclining wheelchairs. To investigate the impact of muscle tone abnormality from hemiplegia on the forward sliding and pressure of stroke patients while sitting in reclining wheelchairs. Experimental study. The Assistive Devices/Technology Center at the Rehabilitation Department of hospital. 14 able-bodied elders and nonambulatory elderly stroke patients with flaccid (N.=12) or spastic hemiplegia (N.=13) participated in this study. Of the 12 patients with flaccid hemiplegia, 8 suffered from left-sided hemiplegia and 4 from right-sided hemiplegia. Of the 13 patients with spastic hemiplegia, 6 suffered from left-sided hemiplegia and 7 from right-sided hemiplegia. We performed 3 reclining cycles in wheelchairs with conventional seats and V-shaped seats for each participant. The sliding along the backrest (BS) plane and the seat (SS) plane, mean sitting pressure (MP), and sacral peak pressure (SPP) of the participants were recorded. The Kruskal-Wallis test was used to compare the difference in BS, SS, MP, and SPP between able-bodied elders and stroke patients. The BS, SS, and SPP during repetitive reclining were generally greatest in flaccid hemiplegic participants, followed by spastic hemiplegic participants, and finally by able-bodied participants. There was no significant difference in MP among three subject groups on both conventional seats and V-shaped seats in most comparisons. Able-bodied participants' buttocks tended to slide forward on conventional seats but backward on V-shaped seats, whereas hemiplegic participants' buttocks slid forward on both seat types. Stroke patients with flaccid hemiplegia are the most vulnerable to sacral sitting and higher sacral pressure in reclining wheelchairs, followed by patients with spastic hemiplegia. There is a difference in the displacement pattern between participants with normal muscle tone and those with abnormal muscle tone during wheelchair positioning. People who have hemiplegia with spasticity do not have incremental forward sliding with repetitive reclining in the same way as those who have a flaccid hemiplegia. The findings are valuable for wheelchair prescription and caregiver education.

The purpose of this study was to describe the experience of cancer-related fatigue in children of different ages in Taiwan. A total of 17 children with different stages of cancer were interviewed. The methods of data collection included interviews, participants' observations, medical chart reviews and the researcher's reflexive journals. Data were progressively analysed by using qualitative data analysis method throughout the process of data collection. The results indicated that children in all age groups used the word 'tiredness' or 'weary' instead of 'fatigue'. Patients in different age groups described the fatigue differently. Younger children (<9 years) reported that fatigue affected their ability to participate in physical activities. Children aged 10-12 years described fatigue as extreme tiredness that affected their daily lives both physically and psychosocially by altering their daily routine and school attendance and performance. Adolescents described fatigue as unrelievable tiredness that differed from normal tiredness and had a great impact on physical and psychosocial aspect, particularly altering their future life plans and self-performance. This study shows that the definition and impact of fatigue differs among children by age group. Defining and understanding the effects of fatigue can help clinicians assess fatigue and implement effective strategies to alleviate it.

Aims.  The aim of this study was to develop and evaluate the psychometric properties of a Chinese version of the Fatigue Scale‐Children (FS‐C‐C).Background.  Cancer‐related fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients during and after their cancer treatment. A reliable and valid instrument to measure fatigue is essential to the successful clinical care of paediatric oncology patients in Taiwan who experience this troubling symptom.Design and methods.  A total of 108 paediatric oncology Taiwanese patients who were aged 7–12 years participated in this cross‐sectional, instrumentation study. The FS‐C was translated into Chinese by using an established translation/back‐translation method. The psychometric testing of the FS‐C‐C included internal consistency, content validity, construct validity, convergent validity, criterion‐related validity and known‐group validity.Results.  The FS‐C‐C achieved an acceptable internal consistency coefficient. Content validity was moderately high (content validity indices ranged from 83–100%). Confirmatory factor analysis supported the three‐factor model as an acceptable model fit (the goodness‐of‐fit index and adjusted goodness‐of‐fit index both were greater than 0·9; normed fit index, 0·89; root‐mean‐square residual, 0·15). Although the results did not support the known‐group hypothesis, the convergent validity, concurrent validity and predictive validity of the FS‐C‐C were supported by significant associations with the PedsQL Multidimensional Fatigue Scale, the Anxious/Depressed subscale of the Child Behaviour Checklist and the generic and disease‐specific scores on the Quality of Life for Children with Cancer instrument, respectively.Conclusion.  Our newly developed FS‐C‐C is a reliable and valid instrument for the measurement of cancer‐related fatigue intensity in Taiwanese children.Relevance to clinical practice.  The FS‐C‐C could provide useful information to guide clinical practice in assessing and managing cancer‐related fatigue in childhood cancer patients in Taiwan.

To derive symptom clusters occurring in a large group of older pediatric patients with cancer in Taiwan and to examine whether each cluster differed based on gender, type of cancer and disease, pain, and functional status. Descriptive, correlational study. Pediatric oncology inpatient unit and outpatient clinics in Taiwan. 144 pediatric patients with cancer, aged 10-18 years. Subjects completed the Memorial Symptom Assessment Scale 10-18, the Play Performance Scale for Children, and a demographic questionnaire. Medical records provided disease and treatment data. Cluster analysis techniques were used to identify the symptoms that clustered together by demographic characteristics, as well as disease, pain, and functional status. Symptom cluster, pain status, and functional status. Five clusters were identified from the statistical analysis. The symptoms that clustered together were somewhat surprising, and some can be explained by cultural differences. Patients with pain reported statistically significant higher distress in all five clusters. Five symptom clusters are identified in older Taiwanese children with cancer. The way and possible rationale of how these symptoms clustered together is discussed. This is the first study that used a statistical procedure to derive symptom clusters experienced by pediatric oncology patients. Knowledge from this study can provide a starting point to investigate the stability of symptom clusters with different states of disease, different populations, and over various periods of time.

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.

Assessment of quality of life (QOL) of children is complex due to the developmental differences in understanding the content being measured. The validity of parent-proxy reports versus children's self-reports remains to be clarified. To examine the agreement on QOL measures between children's self-reports and parent-proxy reports at different points in time, including at baseline and at 6-month follow up, as well as the change in scores between 6-month follow up and baseline. A longitudinal study of QOL assessment of children with cancer for parents and children was conducted. At baseline assessment, 126 children with cancer and at least one of their parents participated (n = 252). Forty boys, 25 girls, and their parents (n = 130) completed the 6-month follow up assessment. Parents tended to report better QOL than did the children at both baseline and 6-month follow up assessments in both the on- and off-treatment groups. Agreement on QOL measure between children and parent proxies varied as a result of the following factors: treatment status (on and off treatment), time (at baseline vs. at 6-month follow up), and changes in score between the time of the baseline assessment and the 6-month follow up. The effects of time, age, gender, and severity of illness had different degrees of significance as predictors on various subscales. The predictors of agreement between patients' reports and parent-proxy reports, including the passage of time (from baseline to 6-month follow up), gender, age, and illness severity, have not been conclusively determined. Further studies are needed to examine patient-proxy agreement during a longer follow up period at more than two points in time and using the same patients through the stages of confirmation of diagnosis, acceptance of diagnosis, treatment, and after treatment.

Assessment of children' Quality of life (QOL) is a special challenge for clinicians and researchers because different cognitive abilities of children at various ages and illness levels are so varied. In addition, statistical strategies reported to evaluate proxy agreement have been inconclusive. The specific aims of this study were to examine agreement between child self‐reports and parent proxy‐reports to evaluate QOL in a sample of pediatric cancer patients. Previously tested QOL instruments (Quality of Life for Children with Cancer, QOLCC) were completed by 141 patients (82 children and 59 adolescents) and 141 of their parents. Three different statistical approaches were employed to evaluate convergence of self‐report and proxy‐report: product‐moment correction coefficient, intraclass correlation (ICC), and comparison of group means. In addition, scatter bias was used to examine the degree of differences across the range of measurement. Our findings indicate that neither Pearson product correlation, ICC or group difference provided enough information to detect the individual differences of measures of QOL. We found that scatter bias should be supplemented to quantify the degree of individual‐level differences. The results suggest that when children who are younger are not able to evaluate QOL assessment due to their developmental limitation or severity of illness, parents can provide valid information about their QOL. However, parent‐proxy of QOL for adolescents provides significantly different information than self‐report and proxy data of QOL for adolescents should be used with caution. Copyright © 2004 John Wiley & Sons, Ltd.