The objective of this study was to evaluate the impact of short stature on generic health-related quality of life (HRQOL) and cognitive functioning in pediatric patients. Eighty-nine youth, 48 who were initially seen with short stature (SS group) and 41 with a history of short stature being treated with growth hormone (GHT group) and one of their legal guardians participated in the study. HRQOL and cognitive functioning were assessed using the PedsQL™ 4.0 Generic Core Scales and PedsQL™ Cognitive Functioning Scale. Comparisons were made between the study groups and with a previously obtained matched healthy sample. For the GHT group, height Z score was found to be a positive predictor of overall HRQOL while duration of GHT was found to be a predictor of physical functioning. For the SS group, the difference between midparental height Z score and height Z score was found to be a negative predictor of overall HRQOL and cognitive functioning. Comparison with the healthy sample demonstrated significant negative impact on HRQOL for child self-report and on HRQOL and cognitive functioning for parent proxy-report in both study groups. The GHT group had a significantly higher child self-reported Physical Functioning score than the SS group (effect size (ES) = 0.52, p < 0.05). In conclusion, the GHT group had slightly better HRQOL scores than the SS group, but the difference was not statistically significant. Both groups had significantly lower HRQOL and cognitive functioning scores than healthy sample. Predictors of HRQOL and cognitive functioning found in this study lend support to the use of the PedsQL™ 4.0 Generic Score Scales and PedsQL™ Cognitive Functioning Scale in routine assessment of children with short stature in order to identify children at increased risk for impaired HRQOL and cognitive functioning.
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Bartko JJ (1966) The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19:3–11
Brutt AL, Sandberg DE, Chaplin J, Wollmann H, Noeker M, Koltowska-Haggstrom M, Bullinger M (2009) Assessment of health-related quality of life and patient satisfaction in children and adolescents with growth hormone deficiency or idiopathic short stature—part 1: a critical evaluation of available tools. Horm Res 72:65–73
Bullinger M, Koltowska-Haggstrom M, Sandberg D, Chaplin J, Wollmann H, Noeker M, Brutt AL (2009) Health-related quality of life of children and adolescents with growth hormone deficiency or idiopathic short stature—part 2: available results and future directions. Horm Res 72:74–81
Cohen J (1988) Statistical power analysis for behavioral sciences, 2nd edn. Erlbaum, Hillsdale
Cremeens J, Eiser C, Blades M (2006) Factors influencing agreement between child self-report and parent proxy-reports on the pediatric quality of life inventory™ 4.0 (PedsQL™) generic core scales. Health Qual Life Outcomes 4:1–8
Downie AB, Mulligan J, Stratford RJ, Betts PR, Voss LD (1997) Are short normal children at a disadvantage? The Wessex growth study. BMJ 314:97–100
Frindik JP, Morales A, Fowlkes J, Kemp S, Thrailkill K, Lippe B, Dana K (2009) Stimulant medication use and response to growth hormone therapy: an NCGS database analysis. Horm Res 72:160–166
Goldstein SL, Graham N, Warady BA, Seikaly M, McDonald R, Burwinkle TM, Limbers CA, Varni JW (2008) Measuring health-related quality of life in children with ESRD: performance of the generic and ESRD-specific instrument of the Pediatric Quality of Life Inventory (PedsQL). Am J Kidney Dis 51:285–297
Goldstein SL, Rosburg NM, Warady BA, Seikaly M, McDonald R, Limbers C, Varni JW (2009) Pediatric end stage renal disease health-related quality of life differs by modality: a PedsQL ESRD analysis. Pediatr Nephrol 24:1553–1560
Hull KL, Harvey S (2003) Growth hormone therapy and quality of life: possibilities, pitfalls and mechanisms. J Endocrinol 179:311–333
Kranzler JH, Rosenbloom AL, Proctor B, Diamond FB Jr, Watson M (2000) Is short stature a handicap? A comparison of the psychosocial functioning of referred and nonreferred children with normal short stature and children with normal stature. J Pediatr 136:96–102
Lee JM, Appugliese D, Coleman SM, Kaciroti N, Corwyn RF, Bradley RH, Sandberg DE, Lumeng JC (2009) Short stature in a population-based cohort: social, emotional, and behavioral functioning. Pediatrics 124:903–10
Marcus SB, Strople JA, Neighbors K, Weissberg-Benchell J, Nelson SP, Limbers C, Varni JW, Alonso EM (2009) Fatigue and health-related quality of life in pediatric inflammatory bowel disease. Clin Gastroenterol Hepatol 7:554–561
McGraw KO, Wong SP (1996) Forming inferences about some intraclass correlation coefficients. Psychol Meth 1:30–46
Molinari E, Sartori A, Ceccarelli A, Marchi S (2002) Psychological and emotional development, intellectual capabilities, and body image in short normal children. J Endocrinol Investig 25:321–328
Palmer SN, Meeske KA, Katz ER, Burwinkle TM, Varni JW (2007) The PedsQL brain tumor module: initial reliability and validity. Pediatr Blood Cancer 49:287–293
Patrick DL, Deyo RA (1989) Generic and disease-specific measures in assessing health status and quality of life. Med Care 27:S217–S232
Radcliffe DJ, Pliskin JS, Silvers JB, Cuttler L (2004) Growth hormone therapy and quality of life in adults and children. Pharmacoeconomics 22:499–524
Ross JL, Sandberg DE, Rose SR, Leschek EW, Baron J, Chipman JJ, Cassorla FG, Quigley CA, Crowe BJ, Roberts K, Cutler GB Jr (2004) Psychological adaptation in children with idiopathic short stature treated with growth hormone or placebo. J Clin Endocrinol Metab 89:4873–4878
Sandberg DE (2003) Quality of life and self-esteem in children treated for idiopathic short stature. J Pediatr 143:691
SPSS (2009) SPSS 17 for Windows. Chicago
Stabler B (2001) Impact of growth hormone (GH) therapy on quality of life along the lifespan of GH-treated patients. Horm Res 56(Suppl 1):55–58
Theunissen NC, Kamp GA, Koopman HM, Zwinderman KA, Vogels T, Wit JM (2002) Quality of life and self-esteem in children treated for idiopathic short stature. J Pediatr 140:507–515
Ulph F, Betts P, Mulligan J, Stratford RJ (2004) Personality functioning: the influence of stature. Arch Dis Child 89:17–21
Varni JW, Limbers CA (2009) The pediatric quality of life inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatr Clin North Am 56:843–863
Varni JW, Seid M, Rode CA (1999) The PedsQL: measurement model for the pediatric quality of life inventory. Med Care 37:126–139
Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812
Varni JW, Seid M, Smith Knight T, Burwinkle T, Brown J, Szer IS (2002) The PedsQL in pediatric rheumatology: reliability, validity, and responsiveness of the pediatric quality of life inventory generic core scales and rheumatology module. Arthritis Rheum 46:714–725
Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL (2003) The PedsQL in type 1 and type 2 diabetes: reliability and validity of the pediatric quality of life inventory generic core scales and type 1 diabetes module. Diab Care 26:631–637
Varni JW, Burwinkle TM, Seid M, Skarr D (2003) The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 3:329–341
Varni JW, Sherman SA, Burwinkle TM, Dickinson PE, Dixon P (2004) The PedsQL family impact module: preliminary reliability and validity. Health Qual Life Outcomes 2:55
Varni JW, Limbers CA, Burwinkle TM (2007) Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 generic core scales. Health Qual Life Outcomes 5:43
Voss LD, Mulligan J (2000) Bullying in school: are short pupils at risk? Questionnaire study in a cohort. BMJ 320:612–613
Voss LD, Sandberg DE (2004) The psychological burden of short stature: evidence against. Eur J Endocrinol 151(Suppl 1):S29–S33
Wheeler PG, Bresnahan K, Shephard BA, Lau J, Balk EM (2004) Short stature and functional impairment: a systematic review. Arch Pediatr Adolesc Med 158:236–243
Wilson KA, Dowling AJ, Abdolell M, Tannock IF (2001) Perception of quality of life by patients, partners and treating physicians. Qual Life Res 9:1041–1052
World Health Organization (1948) Constitution of the World Health Organization: basic document. Geneva, Switzerland
Appreciation is expressed to our patients and their families who made this study possible, and to the various medical providers who allowed us to enroll their patients in this study. Special thanks to Kyrie Collins RN, Nunilo Rubio MD, Robyn Klenk RN, FNP-C, MSN and Parvin Yazdani MD who assisted with enrolling patients when the primary investigator was not available and William Risser MD, PhD for editorial contributions.
Dr. Varni holds the copyright and the trademark for the PedsQL™ and receives financial compensation from the MAPI Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the Pediatric Quality of Life Inventory™.
Funding was provided through an intradepartmental grant from the University of Texas Health Science Center at Houston.
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Stephen, M.D., Varni, J.W., Limbers, C.A. et al. Health-related quality of life and cognitive functioning in pediatric short stature: comparison of growth-hormone-naïve, growth-hormone-treated, and healthy samples. Eur J Pediatr 170, 351–358 (2011). https://doi.org/10.1007/s00431-010-1299-z
- Quality of life
- Short stature
- Cognitive functioning
- Growth hormone
- Patient-reported outcomes