Quality of life of children with lower limb deformities: A systematic review of patient-reported outcomes and development of a preliminary conceptual framework

Background: Lower limb deformities have a substantial impact on the quality of life (QOL) of children. This systematic review was conducted to identify as follows: (a) QOL concepts in existing literature specific to pediatric patients with lower limb deformities; (b) parent-reported outcome and patient-reported outcome (PRO) instruments used to measure QOL in pediatric patients with lower limb deformities; and (c) determinants of QOL in pediatric patients with lower limb deformities. Methods: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from the inception to January 2016. Studies were included if they (1) had patients with lower limb deformities; (2) included children 18 years of age or under; and (3) measured QOL using a PRO or parent-reported outcome of instruments. Results: Of the 938 publications identified in the search, 10 studies used a total of 24 PRO or parent-reported outcome instruments to measure 1 or more aspects of QOL of pediatric patients with lower limb deformities. Three overarching health concepts (physical, psychological, and social health) and 15 subconcepts were identified. Five studies looked at determinants of QOL including type of deformity, severity of deformity, complications postsurgery, stage of treatment, and type of treatment. Psychological health was measured in 10 studies, social health in 7 studies, and physical health in 6 studies. The most frequently measured subconcepts were physical function, psychological distress, and social function. Conclusion: Existing parent-reported outcome and PRO instruments measure 3 QOL concepts in children with lower limb deformities. There were no validated PRO instruments specifically designed to measure QOL of children with lower limb deformities. Level of Evidence: This was a systematic review of level III studies