Parent and Child Report of Pain and Fatigue in JIA: Does Disagreement between Parent and Child Predict Functional Outcomes?

Amy Gaultney,Laura Schanberg,Tracy Spears,Maggie Bromberg,Mark Connelly

doi:10.3390/children4020011

Abstract

While previous research in juvenile idiopathic arthritis (JIA) has identified discrepancy between parent and child perception of disease-related symptoms such as pain, the significance and impact of this disagreement has not been characterized. We examined the extent to which parent-child discordance in JIA symptom ratings are associated with child functional outcomes. Linear regression and mixed effects models were used to test the effects of discrepancy in pain and fatigue ratings on functional outcomes in 65 dyads, consisting of youth with JIA and one parent. Results suggested that children reported increased activity limitations and negative mood when parent and child pain ratings were discrepant, with parent rated child pain much lower. Greater discrepancy in fatigue ratings was also associated with more negative mood, whereas children whose parent rated child fatigue as moderately lower than the child experienced decreased activity limitations relative to dyads who agreed closely on fatigue level. Implications of these results for the quality of life and treatment of children with JIA are discussed.

Highlights

Juvenile idiopathic arthritis (JIA) is a common chronic childhood illness often characterized by episodes of musculoskeletal pain and fatigue, which may contribute to problems with social and physical functioning [1,2]
A longitudinal study by Palermo et al examining parent-child discrepancy in pain reporting found that parents and children with juvenile idiopathic arthritis (JIA) often disagreed on pain and functional disability ratings: the authors suggested a link between increased disagreement on pain ratings and increased child depression, Children 2017, 4, 11; doi:10.3390/children4020011
Our data suggest that parent reports of child pain and fatigue often closely match those of the child, as evidenced by the center clustering in Figures 3 and 4

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is a common chronic childhood illness often characterized by episodes of musculoskeletal pain and fatigue, which may contribute to problems with social and physical functioning [1,2]. Previous work has focused on the agreement between physicians and parents on the child’s global disease severity [4]; there has been limited research on whether discrepancies in ratings of pain and fatigue between parents and children with JIA influence social and physical activity participation and mood. JIA, Garcia-Munitis et al demonstrated moderate to poor agreement on pain intensity ratings between parents and children, but did not identify predictors or outcomes of the reported discrepancy [5]. Given the daily fluctuations in pain and fatigue typical of JIA, discrepancies in parent-child reports may be stable or dynamic over time

Methods

Results

Conclusion