Social Deprivation and Congenital Upper Extremity Differences-An Assessment Using PROMIS
Lindley B Wall1, Melissa Wright1, Julie Samora2
1Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
Insights
Social deprivation negatively impacts children with congenital hand differences, worsening pain, anxiety, and depression. Healthcare must consider environmental factors for better outcomes.
Area of Science:
- Orthopedics
- Pediatric Health
- Socioeconomic Factors
Background:
- Social deprivation, a socioeconomic indicator, adversely affects perceptions of orthopedic conditions and treatment outcomes.
- Congenital hand differences can impact a child's overall well-being and functional abilities.
Purpose of the Study:
- To investigate the correlation between social deprivation and the subjective functional assessment in pediatric patients diagnosed with congenital hand differences.
- To determine if socioeconomic status influences how children perceive their condition and its impact on their lives.
Main Methods:
- Utilized the Congenital Upper Limb Differences (CoULD) registry for patient data.
- Assessed pediatric patients (5+ years) using Patient-Reported Outcomes Measurement Information System (PROMIS) for Pain Interference, Peer Relations, Anxiety, Depression, and Upper Extremity (UE) function.
- Determined social deprivation using the Area Deprivation Index (ADI), correlating PROMIS scores with ADI.
Main Results:
- 375 pediatric patients with congenital UE differences were analyzed (average age 11, 56% female, 55% bilateral).
- Overall PROMIS scores were near normal, but UE function scores were significantly below average.
- Children in the most deprived areas (highest ADI quartile) reported worse Pain Interference, Peer Relations, Anxiety, and Depression compared to those in less deprived areas.
Conclusions:
- While overall psychosocial scores were normal in the cohort, socially deprived children reported more challenges.
- Social deprivation is linked to poorer psychosocial well-being in pediatric patients with congenital hand differences.
- Environmental and societal stressors in deprived areas may increase risks for negative outcomes in these children.
Purpose:
Social deprivation, a measure of socioeconomic status, has been shown to negatively affect perceptions of orthopedic conditions and outcomes of treatment. The objective of this study was to assess whether social deprivation correlates with subjective assessment of function in pediatric patients with congenital hand differences.
Methods:
Patients enrolled in the Congenital Upper Limb Differences (CoULD) registry were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). The PROMIS scores for Pain Interference, Peer Relations, Anxiety, Depression, and Upper Extremity (UE) function were obtained for all patients 5 years and older at initial presentation. Social deprivation was determined by the Area Deprivation Index (ADI); the index ranges from 0 to 100 with higher scores being the most deprived. The PROMIS scores were correlated with the ADI for all patients.
Results:
Three hundred seventy-five pediatric patients with congenital UE differences were evaluated. Average age was 11 years, 56% were female, and 55% had bilateral involvement. Overall, PROMIS scores were within 1 SD of normal for Peer Relations, Pain, Depression, and Anxiety. However, child-reported scores for UE function (39) were more than 1 SD below the national average (50). The mean ADI for the cohort was lower than the national average, indicative of less deprivation, with 14% of patients in the most deprived national quartile. Children in the highest ADI quartile reported PROMIS scores that reflected higher Pain Interference (41 vs 45), lower Peer Relations (55 vs 50), higher Anxiety (44 vs 49), and higher Depression (43 vs 47) than children in the lowest ADI quartile.
Conclusions:
The PROMIS scores were normal for psychosocial measures in children with congenital hand differences when evaluated as an entire cohort. However, child self-reported PROMIS scores for Pain Interference, Peer Relations, Anxiety, and Depression were worse in more socially deprived areas, suggesting more psychosocial challenges in these children.
Clinical Relevance:
Pediatric patients with congenital upper extremity differences in areas of higher social deprivation report lower psychosocial well-being. The care of these individuals must be considered within the context of their environment because they may be more at risk for negative outcomes secondary to environmental and societal stressors.
