Targeting Coping to Improve Surgical Outcomes in Pediatric Patients With Median Arcuate Ligament Syndrome: Feasibility Study.
Targeting Coping to Improve Surgical Outcomes in Pediatric Patients With Median Arcuate Ligament Syndrome: Feasibility Study.
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DOI：
10.3389/fpsyg.2021.695435
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发表时间：
2021
影响因子：
3.8
通讯作者：
Drossos T
中科院分区：
文献类型：
--
作者：
Stiles-Shields C;Osos S;Heilbrun A;Feldman ECH;Mak GZ;Skelly CL;Drossos T
背景资料：正中弓状韧带综合征（MALS）是一种血管压迫综合征，可导致餐后上腹部疼痛、恶心和体重减轻，可通过手术治疗。虽然大多数患者报告手术干预后生活质量得到改善，但30%的患者仍会出现慢性腹痛。已发现术前诊断的抑郁和/或焦虑显着预测手术后：生活质量，最高的经验，疼痛，焦虑，父母和自我报告的应对策略。因此，增加MALS儿科患者的应对策略可能会影响他们的术后结局。本研究的目的是：（1）实施术前认知行为治疗方案，重点是心理教育和应对策略;（2）确定该人群术前干预的可行性。方法：被诊断为MALS的符合手术干预条件的儿童（<18岁）被邀请参加为期7周的面对面或基于视频的术前认知行为治疗干预。在基线和术后评估精神病合并症;在4个时间点（基线、第4周、第7周和术后）评估患者报告的痛苦、疼痛干扰和强度、健康相关生活质量和健康状况。描述性分析用于表征样品，评估可行性结果（即，流失率），并探索跨时间的基于风险的结果。结果：12名儿童患者（男性年龄= 15.2 ± 1.7; 91.7%为女性）及其父母（91.7%为母亲）参加了研究。在知情同意阶段（68.4% vs.目标≥50%）、治疗开始阶段（92.3% vs. 85%）和治疗完成阶段（84.6% vs. 75%）的参与超过了基于方案完成的可行性指标。在12名参与者中，9名（75%）在基线时符合至少一种共病精神病诊断的标准，9名（75%）在完成干预后选择接受MALS手术。结论：尽管样本经历了慢性疼痛症状，精神病诊断的高患病率和国际流行病，但干预措施的实施是可行的，这表明进一步评估干预措施的有效性是有益的。未来的研究应包括利益相关者在设计，部署和评估的试点疗效试验的术前认知行为治疗的儿童MALS患者的输入。
Background: Median arcuate ligament syndrome (MALS) is a vascular compression syndrome leading to postprandial epigastric pain, nausea, and weight loss; it can be treated surgically. While most patients report improved quality of life following surgical intervention, 30% continue to experience chronic abdominal pain. Pre-surgical diagnoses of depression and/or anxiety have been found to significantly predict post-surgical: quality of life, highest experience of pain, anxiety, and parent- and self-reported coping strategies. As such, increasing the coping strategies of pediatric patients with MALS may impact their post-surgical outcomes. The purpose of the current study was to: (1) implement a pre-operative cognitive behavioral therapy protocol with a focus on psychoeducation and coping strategies; and (2) determine feasibility of a pre-surgical intervention for this population. Method: Children (<18 years of age) with a diagnosis of MALS who were eligible for surgical intervention were invited to participate in a 7-week in-person or video-based pre-surgical cognitive behavioral therapy intervention. Psychiatric comorbidities were assessed at baseline and post-surgery; patient-reported distress, pain interference and intensity, health-related quality of life, and health status were assessed at four time points (baseline, week 4, week 7, and post-surgery). Descriptive analyses were used to characterize the sample, assess feasibility outcomes (i.e., attrition rates), and explore symptom-based outcomes across time. Results: Twelve pediatric patients (M age = 15.2 ± 1.7; 91.7% female) and their parents (91.7% mothers) participated. Feasibility metrics based on protocol completion were exceeded for engagement at the stages of consent (68.4% vs. goal of ≥50%), treatment initiation (92.3% vs. 85%), and treatment completion (84.6% vs. 75%). Out of the 12 participants, nine (75%) met criteria for at least one comorbid psychiatric diagnosis at baseline and nine (75%) elected to undergo MALS surgery after completing the intervention. Conclusion: The intervention implementation was feasible, despite chronic pain symptoms experienced by the sample, a high prevalence of psychiatric diagnoses, and an international pandemic, suggesting that it would be beneficial to further evaluate the efficacy of the intervention. Future research should include stakeholder input in the design, deployment, and evaluation of a pilot efficacy trial of pre-surgical cognitive behavioral therapy for pediatric patients with MALS.
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