Impact of Legg-Calvé-Perthes Disease on Physical, Mental, and Social Health in Children Aged 6 to 11 Years at Diagnosis-an Assessment Using PROMIS.

Abstract

Children with Legg-Calvé-Perthes disease (LCPD) have lower health-related quality of life compared with their age-matched peers; however, there is a paucity of literature that follows children's outcomes during different stages of the disease. This study analyzed Patient-Reported Outcomes Measurement Information System (PROMIS) t-scores for physical, mental, and social health in children diagnosed with unilateral early-stage LCPD between the ages of 6 and 11 years. All PROMIS t-scores of patients who had completed a minimum of 2 PROMIS surveys over their duration of care were extracted from a multicenter database. PROMIS subdomain t-scores (Mobility, Pain Interference, Fatigue, Depressive Symptoms, Anxiety, Anger, and Peer Relationships) were analyzed using linear mixed-effects regression models. A total of 629 surveys from 145 children (median age 7.4 y, 83% male) were included in analyses. On average, surveys were completed 5.4 times/patient, corresponding to a median follow-up duration of 28.1 months. All physical and mental health domain scores improved over time. Patient-related pain scores were associated with Mobility, Pain Interference, Fatigue, Anxiety, and Depressive Symptoms. Mobility, Pain Interference, and Fatigue scores were better when self-reported and worse when proxy-reported. Peer Relationships t-scores were not associated with any of the factors. The current study provides normative disease-specific data that enables orthopaedic surgeons to track patient wellbeing in LCPD patients, and to counsel families on realistic timelines for recovery in physical and mental health. This study also highlights that the self-reported pain intensity score is a strong predictor of overall physical and mental health. Level II-prognostic.