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Psychological Resilience in Children With Lower Limb Deformities: A Multicenter Quality of Life Study
Alison L Griffiths1,2,3, Unni G Narayanan4,5, Christopher A Iobst6
1Departments of Physiotherapy.
Background:
Children with lower-limb deformities encounter complex challenges impacting physical function and well-being. The Limb Lengthening and Reconstruction Society AIM (LLRS-AIM) index provides a standardized assessment of deformity complexity, but the relationship between complexity and quality of life remains poorly understood. This study aims to determine the strength of the relationship between lower limb deformity complexity and health-related quality of life in children and adolescents.
Methods:
We conducted a prospective cross-sectional study across 3 international centers over 2 years. Children aged 5 to 18 years with lower limb deformities completed the Pediatric Outcomes Data Collection Instrument (PODCI), while clinicians assessed deformity complexity using the The Limb Lengthening and Reconstruction Society AIM index. Correlations between deformity complexity and quality of life were analyzed, results were compared with published norms, and differences between parent and adolescent reports were examined.
Results:
Among 150 participants, deformity complexity showed strong negative correlations with global quality-of-life scores. The strongest relationships were observed in children with sports and physical activity function ( r =-0.59, P <0.01). Children and adolescents with lower-limb deformities scored significantly lower than the general pediatric population in most PODCI domains. Interestingly, deformity complexity did not correlate with adolescent self-reported happiness levels, and adolescent happiness was similar to that of the general pediatric population, suggesting resilience in psychological adaptation.
Conclusions:
Children and adolescents with lower limb deformities experience significantly reduced quality of life, particularly concerning physical activities and sports participation. More complex deformities are linked to greater functional limitations and lower overall quality of life. While happiness in children with lower limb deformities is affected, adolescent happiness appears to be similar to that of the general pediatric population, which may indicate psychological adaptation and resilience.
Level Of Evidence:
Level II-prospective cohort study.
