Psychische Störungen beim Fibromyalgiesyndrom

Background

Systematic reviews have reported a wide range of prevalence rates for depressive, anxiety and posttraumatic stress disorders (PTSD) in patients with fibromyalgia syndrome (FMS) which have been partially explained by setting differences. No data are currently available on the prevalence of potential mental disorders depending on the medical specialty in Germany.

Material and methods

All consecutive FMS patients of 8 study centres (3 rheumatology/orthopaedic surgery, 3 psychosomatic/pain medicine, 2 physical/integrative medicine) were assessed from February 1 to July 31, 2012 with standardised questionnaires. Patients with FMS diagnosed by a study physician were included. Non-German speaking and mentally retarded patients were excluded. The German version of the Patient Health Questionnaire 4 was used to screen for potential depressive and anxiety disorders. Severe life events were assessed by the trauma list of the Munich Composite International Diagnostic Interview and symptom criteria of PTSD of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using the Posttraumatic Diagnostic Scale.

Results

Of 538 patients, 396 patients (93.9?% women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years, mean duration since FMS diagnosis 4.5 years) were analysed. In all, 65.7?% of patients met the criteria of a potential depressive disorder, 67.9?% of a potential anxiety disorder and 45.5?% of a potential PTSD. Potential depressive disorders were more frequent in the psychosomatic/pain medicine setting than in the rheumatology setting.

Conclusion

Potential mental disorders were frequent in FMS patients regardless of the medical specialty. All FMS patients of all types of clinical settings should be screened for mental disorders.     

Intensität von Gliederschmerzen und Erschöpfung bei Fibromyalgiesyndrom, depressiven Störungen und chronischen Rückenschmerzen

Background

A symptom-based diagnosis of fibromyalgia syndrome (FMS) without tender point examination is needed for primary care. We tested if a symptom-based diagnosis of FMS can be founded on the intensity of the symptoms musculoskeletal pain and fatigue.

Methods

FMS patients from 4 different settings (n=464 members of the German Fibromyalgia Association DFV, n=33 from a private practice of rheumatology, n=36 from a tertiary care pain department, n=162 from medical expertise), patients with depressive disorders from 2 different settings (n=24 from a university department of psychiatry, n=311 from an out-patient university psychosomatic department), patients with chronic back pain from an out-patient training center (n=691) and persons from a representative German population sample (n=1977) were compared using the subscales of the Giessen subjective complaints list GBB 24.

Results

The greatest mean differences between FMS patients and the other samples were found within the subscales“limb pains” and“fatigue”. FMS patients scored higher in the subscales“heart problems” and“dyspepsia”, but both subscales did not contribute to a differentiation of the samples. The rates of reclassification of the subsamples based on the subcales“limb pains” and“fatigue” ranged between 80 and 93%.

Conclusion

High levels of the intensity of chronic widespread musculoskeletal pain and chronic fatigue may form the basis of a symptom-based diagnosis of FMS.     

Behandlung und Krankheitskosten des Fibromyalgiesyndroms in Deutschland

Background

The data available on the types of treatment delivered and healthcare costs of fibromyalgia syndrome (FMS) patients in Germany are currently not representative.

Material and methods

The data from all 6,897,846?insured persons of the German statutory health insurance company Barmer Ersatzkasse (BEK) before the fusion with the Gmünder Ersatzkasse (GEK) were analyzed if more than 2?billing cases with the diagnosis M79.7 were found (FMS cases) in the 8?consecutive quarter years of 2007?C2008. In these cases the types and costs of out-patient treatment as well as the operation and procedure key (OPS) classification of in-patient treatment in cases of any discharge diagnosis of FMS were analyzed.

Results

A diagnosis of FMS was recorded in 14,870?insured persons in out-patient care and in 6130?in-patients from 1^st?January 2008 to 31^st?December 2009. The 1-year prevalence of FMS diagnosis was 19,592 of the patients (0.3%). Non-steroidal agents were prescribed in 48%, weak opioids in 21% and strong opioids in 11% of the out-patients with FMS. Out-patient psychotherapy was conducted in 8% of the FMS cases. In 31% of the cases hospital treatment was carried out of which 14% received multicomponent therapy. The average healthcare costs were 4,331?? per year.

Conclusion

The data of the BEK document high healthcare costs and treatment which is mainly not in line with the recommendations of the German guidelines on the management of FMS.     

Prävalenz und Prädiktoren von Schmerzen in mehreren Körperregionen

Background

There are no data available from representative samples of the general German population on predictors of widespread pain (WP) and fibromyalgia syndrome (FMS).

Methods

A cross-sectional survey of a representative sample of the German general population with persons over 14 years old was conducted based on face-to-face contact using standardised questionnaires. The number of pain sites and the presence of WP and FMS were assessed by the regional pain scale (RPS), somatic symptom intensity was measured by the Patient Health Questionnaire (PHQ-15), depressed mood by PHQ 9 and health-related quality of life (HRQOL) by the Short Form Health Survey (SF-12).

Results

Out of 4064 persons contacted, 2524 (62.1%) completed the study. The prevalence of CWP was 8.6% and of FMS 3.8%. The sex ratio for WP and FMS was 1:1. The variance of the number of pain sites was explained by older age, low social class index, high somatic symptom intensity, low depressed mood in 52.4% (p<0.001). Older age (OR 2.0, 95% CI 1.71; 2.36; <0.001), low social class index (OR 0.64; 95% CI 0.46; 0.91; p=0.01) and potential somatoform syndrome (OR 3.0; 95% CI 1.27; 7.15; p<0.001) predicted WP with a probability 94.4%. Older age (OR 1.39, 95% CI 1.19; 1.62, p <0.001), low social class index (OR 0.61, 95% CI .40, 0.93; p=0.02) and potential somatoform syndrome (OR 19.42; 95% CI 10.31; 36.61; p<0.001) predicted FMS with a probability 97.7%.

Conclusion

WP and FMS are components of a complex of high somatic symptom intensity, low social class index and older age.     

Komorbide depressive Störungen als Mediator der Assoziation von Misshandlungen in Kindheit/Jugend und Fibromyalgiesyndrom

Background

Emotional and physical abuse and neglect in childhood and adolescence [childhood maltreatments (CMs)] are considered to play a role in the etiology of fibromyalgia syndrome (FMS). Whether the association between FMS and CMs can be explained by mediators has not been studied.

Methods

CMs of consecutive FMS patients from three different clinical settings were assessed by the German version of the Childhood Trauma Questionnaire. Clinical setting, gender, age, comorbid depression, and health care use were tested for mediators.

Results

Of 328 patients (86% women, mean age 50 years), 293 were analyzed; 16% of the patients reported severe emotional, 9% severe physical, and 11% severe sexual abuse and 25% severe emotional and 13% severe physical neglect during childhood. The frequency of CMs was not associated with setting, gender, age, and health care use. FMS patients with a comorbid depression more frequently reported physical abuse (p=0.01) and emotional abuse (p=0.001), as well as emotional neglect (p=0.0008) and physical neglect (p=0.001) compared with FMS patients without a comorbid depression.

Discussion

Comorbid depression is a mediator of the association between CMs and FMS.

Conclusion

Prospective population-based studies controlling for depression are necessary to determine the role of CMs in the etiology of FMS.     

Das Fibromyalgiesyndrom

Background

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften”, AWMF; registration number 041/004) was planned starting in March 2011.

Materials and methods

The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy (“Deutsche Interdisziplinären Vereinigung für Schmerztherapie”, DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.

Results and conclusion

The clinical diagnosis of FMS can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with tender point examination), by the modified preliminary diagnostic ACR 2010 criteria or by the diagnostic criteria of the German interdisciplinary guideline (AWMF) on FMS. The English full-text version of this article is available at SpringerLink (under “Supplemental”).     

Validität und Reliabilität klinischer Stabilitätstests bei hochzervikalen Instabilitäten

Background

The aim of this study was to examine the validity and reliability of clinical stability tests for upper cervical instability.

Methods

A search of the literature was performed in the databases PubMed, CINAHL, and the Cochrane Library. The quality of the studies was assessed using the quality appraisal tool for studies of reliability (QAREL) checklist and the diagnostic study appraisal worksheet of the Centre for Evidence-Based Medicine (CEBM). For the analysis of the contents, comparison criteria that describe the validity and reliability of the stability tests were established.

Results

The Sharp-Purser test is especially valid for rheumatoid arthritis in the recognition of upper cervical instabilities. An atlas-dens interval (ADI) >?4 mm is also appropriate for exclusion of upper cervical instabilities. The passive intervertebral movement (PIM) tests also seem to be valid and reliable for the diagnosis of upper cervical instabilities in patients with whiplash injuries. The upper cervical flexion test is the only test that provides reliable results in patients with Down’s syndrome. The clunk test and the anteroposterior laxity test are not suitable for the diagnosis of upper cervical instabilities.

Conclusion

The Sharp-Purser and PIM tests appear to be suitable for the diagnosis of upper cervical instabilities.     

Validity of the diagnosis of a single depressive episode in a case register

Objective

To validate the ICD-10 diagnosis of a single depressive episode as used in daily clinical psychiatric practice and as recorded in the Danish Psychiatric Central Research Register.

Methods

Patients discharged with a diagnosis of a single depressive episode were consecutively sampled from the register and diagnosed according to an interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN).

Results

A total of 75.4% of 399 patients with a register diagnosis of a single depressive episode also got this diagnosis according to the SCAN interview (82.8% for severe type of a single depression, 76.0% for moderate type of a single depression and 65.2% for mild type of a single depression).

Conclusion

The ICD-10 diagnosis of a single depressive episode can be used in daily clinical practice with sufficient precision. The validity of the diagnosis is highest for severe and moderate type of depression and decreases for mild depression.

     

Der deutsche Fibromyalgieverbraucherbericht

Background

Consumer reports provide information on benefits and harms in routine clinical care. We report the first fibromyalgia syndrome (FMS) consumer reports in Europe.

Material and methods

The study was carried out from November 2010 to April 2011. The benefits and harms of pharmacological and non-pharmacological therapies experienced by the patient were assessed in an 11-point Likert scale (0?=?no, 10?=?very high benefit or harm) by a questionnaire. The questionnaire was distributed by the German League against Rheumatism and the German Fibromyalgia Association to their members and to all consecutive FMS patients of nine clinical centers of different levels of care.

Results

A total of 1,661 questionnaires (95% women, mean age 54 years) were analyzed. Self-management strategies (distraction, resting, aerobic exercise), physical therapies (warm and pool therapies), psychological therapies (education, psychotherapy), and inpatient multicomponent therapies were judged to be more efficacious and less harmful than all types of pharmacological therapies.

Conclusion

The German fibromyalgia consumer reports highlight the importance of non-pharmcological therapies in the long-term management of FMS.     

Development and validation of the Short-Form Survivor Unmet Needs Survey (SF-SUNS)

Purpose

The Survivor Unmet Needs Survey (SUNS) is one of the only unmet needs measures that was developed and evaluated utilising a population-based sample of cancer survivors. At 89 items, the current scale is quite burdensome. The current study aimed to develop a valid and reliable short version of this survey.

Methods

A heterogeneous sample of 1,589 cancer survivors, aged 19 years or over at diagnosis, diagnosed with a histologically confirmed cancer in the previous 12 to 60 months, completed the SUNS. Using these data, we employed a combined theoretical and statistical method of reducing the number of items in the SUNS. The shortened survey was examined for construct validity, internal consistency, discriminant validity and floor and ceiling effects.

Results

Fifty-nine items were removed. Construct validity closely reflected the original structure of the SUNS. However, all items from the Emotional health and Relationships domains loaded onto one factor. Cronbach's alpha for the final four domains were 0.85 or above, demonstrating strong internal consistency. Intra-class correlations of the three domains from the original survey (Financial concerns, Information and Access and continuity of care) and shortened survey were high (>0.9). Discriminant validity illustrated the short-form SUNS' ability to discriminate between those who had recently received treatment and those who had not.

Conclusions

This study describes the development and psychometric evaluation of the short-form SUNS (SF-SUNS). Future studies should confirm the test–retest reliability and predictive validity of the SF-SUNS utilising large, independent, population-based samples of cancer survivors.     

Fibromyalgie bei Patienten mit chronischer CCD und CMD

Background

Craniomandibular dysfunction (CMD) and craniocervical dysfunction (CCD) are clearly defined musculoskeletal pain syndromes of the head and neck region and have a multifactorial origin. The aim of this study was to elucidate possible associations between fibromyalgia syndrome (FMS), CMD and CCD.

Patients and methods

In a retrospective study 966 patients with CCD and CMD, in whom FMS had never been diagnosed, were examined with respect to the diagnostic criteria for FMS. In addition to a classical ear, nose and throat (ENT) medical and dental examination, an obligatory manual medicine investigation as well as a dental, clinical and instrumental functional examination for the diagnostics of CMD and CCD were also performed.

Results

The diagnostic criteria of FMS were fulfilled by 708 (69.8?% female and 30.2?% male) of the 966 patients. The average duration of the pain was 108 months. The average pain intensity was 8.6 (scale 1–10). The mean follow-up observational period was 41 months. By therapy with myocentric occlusal splints, which was carried out simultaneously and combined with neuromuscular relaxation measures, a good to very good improvement in bodily complaints could be achieved in 84?% of the previously therapy-resistant CMD-FMS patients and an improvement in mandibular pain in 88?%.

Discussion

The high proportion of patients with CMD/CCD who fulfilled the diagnostic criteria for FMS, emphasizes the complexity of both diseases. It must be assumed that fibromyalgia is a decisive factor in the development of CMD/CCD and vice versa the CMD/CCD can also be partly responsible for the multitude of complaints in FMS. Patients with FMS and CCD/CMD benefit from a simultaneous interdisciplinary treatment for CMD/CCD.

     

Psychische Veränderungen bei Patienten mit komplexem regionalem Schmerzsyndrom (CRPS)

Question

Do comorbid psychological disorders, dysfunctional pain processing, and psychosocial pain coping occur with complex regional pain syndrome (CRPS) and is a connection between clinical and psychological manifestations apparent?

Methods

In addition to securing information on case histories and performing clinical neurological examinations of chronic CRPS patients, the structured clinical interview (SCID), pain perception scale, and the Kiel Pain Inventory were employed.

Results

The structured clinical interview revealed evidence of a depressive episode in 65% of CRPS patients. Pain perception is similar to neuropathic pain syndromes and patient history revealed a slightly increased frequency of anxiety and affective disorders. Depressive syndrome occurred significantly more often in right-sided CRPS; otherwise, there were no significant correlations between medical history, clinical examination, and frequency of psychological disorders. However, CRPS patients with allodynia manifest clinical signs of special psychological distress.

Conclusion

In chronic CRPS depressive syndrome frequently develops and psychological treatment can be recommended.     

The relatives’ perspective on advanced cancer care in Denmark. A cross-sectional survey

Purpose

In order to improve advanced cancer care, evaluations are necessary. An important element of such evaluations is the perspective of the patient’s relatives who have the role of being caregivers as well as co-users of the health care system. The aims were to investigate the scale structure of the FAMCARE scale, to investigate satisfaction with advanced cancer care from the perspective of the relatives of a representative sample of advanced cancer patients, and to investigate whether some sub-groups of relatives were more dissatisfied than others.

Method

From 977 patients treated at 54 different Danish hospital departments, 569 patients provided us with the name and address of their relative. Of these, 544 received the FAMCARE scale that measures the families’ satisfaction with advanced cancer care. For the four FAMCARE sub-scales, internal consistency was analyzed using Cronbach’s alpha; convergent and discriminant validity was analyzed using multitrait-scaling analysis. Associations between the relatives’ dissatisfaction and clinical and sociodemographic variables were investigated in explorative analyses using multiple logistic regressions.

Results

Of the relatives receiving the questionnaire, 467 (86%) responded. The original scale structure of FAMCARE could not be supported in the present sample, and therefore, results are reported at singe-item level. The proportion of dissatisfied relatives ranged from 5% to 28% (median 13%). Highest levels of dissatisfaction were found for time taken to make a diagnosis (28%) and the speed with which symptoms were treated (25%). Younger relatives were more dissatisfied than older relatives. Other sociodemographic and clinical variables had little impact on the relatives’ levels of satisfaction.

Conclusion

The relatives’ level of dissatisfaction with some of the areas included in this survey needs to be taken seriously. Younger relatives were most dissatisfied.     

Das klinische Bild des chronifizierten Schmerzpatienten

Introduction

Patients with chronic headache are seen in an interdisciplinary pain clinic after many years of treatment. Compared with other pain syndromes, the standards for diagnosis and treatment are widely accepted according to the guidelines of the International Headache Society. Nevertheless, many patients continue to suffer. Analysis of their special clinical features may help to clarify what kind of conditions potentially cause chronicity.

Patients and methods

A total of 193 patients were seen in 1992–1993 in our pain clinic. Epidemiological, medical and psychological data were analyzed retrospectively. Classification of headache syndromes and pain behavior was based on the criteria of the International Headache Society, taxonomy of the Multiaxial Pain Classification System for Somatic Dimensions (MASK-S) and “Stages of Chronicity”. Important psychodynamic factors were taken from standardized psychological interviews.

Results

The patients had a mean age of 46 years; 67 % of them were female. Fifty-three percent of the patients suffered from chronic tension headache; a high percentage was suspected to be caused by analgesic intake. Because of their pain behavior, 68 % were classified as being in an advanced chronic stage with a poor prognosis. The most important findings of the psychological diagnosis was that 40 % of patients had a depressive style of conflict solving.

Conclusions

The results are discussed with respect to their relevance in explaining development of chronic pain, as seen in selected headache patients in an interdisciplinary pain clinic.     

Associations of interleukin-6 with vegetative but not affective depressive symptoms in terminally ill cancer patients

Purpose

Previous studies have reported associations of depressive symptoms with pro-inflammatory cytokines, especially with interleukin-6 (IL-6) in noncancer subjects and cancer patients. Meanwhile, symptoms such as tiredness and appetite loss may be vegetative symptoms of depression when associated with other diagnostic criteria of depression. Such vegetative-type symptoms worsen during the last 6 months of life in cancer patients and may not be associated with affective depressive symptoms such as sadness and nervousness. This study explored associations between depressive symptoms and plasma IL-6 in terminally ill cancer patients whose survival period was confirmed to be less than 6 months by follow-up, with attention to differences in vegetative and affective depressive symptoms.

Methods

Data from 112 consecutively recruited terminally ill cancer patients who registered at a palliative care unit without any active anticancer treatment were used. Plasma IL-6 levels were measured using an electrochemiluminescence assay. Depressive symptoms included in the DSM-IV and Cavanaugh criteria were assessed by structured interviews and were categorized into affective symptoms and vegetative symptoms. Affective symptoms were also measured with the depression subscale of the Hospital Anxiety and Depression Scale, which does not include vegetative symptoms.

Results

Vegetative symptoms, such as appetite loss, insomnia, and fatigue, were significantly associated with IL-6 levels. However, neither of the affective symptoms nor their severity was associated with IL-6 levels.

Conclusions

IL-6 was associated with vegetative depressive symptoms in terminally ill cancer patients but not with affective depressive symptoms, suggesting possible differences in the pathophysiological mechanisms between these sets of symptoms.     

Body image, sexual function and depression in Korean patients with breast cancer: modification by 5-HTT polymorphism

Background

Nearly 50% of women with breast cancer show depressive symptoms after diagnosis and treatment. The purpose of this study was to clarify how psychosocial factors (body image, sexuality, and social relationships) and genetic factors (functional polymorphism of the serotonin transporter-linked promoter region) influence depression.

Methods

The participants were categorized by DSM-IV diagnoses; scored according to their depressive symptoms, body image and social and sexual function (BIRS), self-esteem, and quality of life; and genotyped by functional polymorphism of the serotonin transporter promoter.

Results

Patients with depressive symptoms showed low self-esteem, poor body image, relationship problems, and low quality of life. Genotype frequencies did not differ between two groups categorized by the presence or absence of depressive symptoms. However, the patients with the short allele of the 5-HTTLPR had significantly higher HAM-D scores (F?=?7.59, p?=?0.047).

Conclusion

The results suggest that psychosocial factors related to breast cancer treatment such as body image, self-esteem, and interpersonal relationship influence the development of depressive symptoms. The 5-HTTLPR may be associated with the severity of depressive symptoms rather than susceptibility to the development of depressive symptoms.     

Placeboresponder in randomisierten, kontrollierten Medikamentenstudien des Fibromyalgiesyndroms

Background

The superiority of true drug treatment over placebo in reducing symptoms of fibromyalgia syndrome (FMS) is small. Drug placebo treatment of functional somatic syndromes (FSS) such as FMS has been discussed. We determined the magnitude of placebo responders in drug trials with FMS patients to substantiate further research on placebo treatment of FSS.

Material and methods

CENTRAL, MEDLINE, Scopus, and the databases of the U.S. National Institutes of Health and the Pharmaceutical Research and Manufacturers of America were searched for randomized, double-blind, placebo-controlled trials with a parallel design and treatment duration of ???12?weeks in FMS patients from inception to 31?December?2010. The magnitude of placebo responders was assessed by the pooled estimate of patients with a 30% and 50% reduction in pain.

Results

Thirty studies with 3,846?patients on placebo were included. The pooled estimate of a 30% placebo pain reduction was 30.8% (95% confidence interval (CI) 29.4?C32.3%) and of a 50% placebo pain reduction was 18.8% (95% CI 17.5?C20.1%). The pooled estimate of the risk ratio of 30% pain reduction by true drug versus placebo was 1.38 (95% CI 1.27?C1.49). The pooled estimate of the risk ratio of 50% pain reduction by true drug versus placebo response was 1.57 (95% CI 1.36?C1.81).

Conclusion

The magnitude of responders to placebo in drug trials of FMS is substantial. The efficacy, safety, and costs of drugs recommended for FMS therapy and open-label placebo should be compared in large multinational trials sponsored by public institutions. The English full-text version of this article is available at SpringerLink (under ??Supplemental??).     

Usefulness of the Spanish version of the mood disorder questionnaire for screening bipolar disorder in routine clinical practice in outpatients with major depression

Background

According to some studies, almost 40% of depressive patients – half of them previously undetected – are diagnosed of bipolar II disorder when systematically assessed for hypomania. Thus, instruments for bipolar disorder screening are needed. The Mood Disorder Questionnaire (MDQ) is a self-reported questionnaire validated in Spanish in stable patients with a previously known diagnosis. The purpose of this study is to evaluate in the daily clinical practice the usefulness of the Spanish version of the MDQ in depressive patients.

Methods

Patients (n = 87) meeting DSM-IV-TR criteria for a major depressive episode, not previously known as bipolar were included. The affective module of the Structured Clinical Interview (SCID) was used as gold standard.

Results

MDQ screened 24.1% of depressive patients as bipolar, vs. 12.6% according to SCID. For a cut-off point score of 7 positive answers, sensitivity was 72.7% (95% CI = 63.3 – 82.1) and specificity 82.9% (95% CI = 74.9–90.9). Likelihood ratio of positive and negative tests were 4,252 y 0,329 respectively.

Limitations

The small sample size reduced the power of the study to 62%.

Conclusion

Sensitivity and specificity of the MDQ were high for screening bipolar disorder in patients with major depression, and similar to the figures obtained in stable patients. This study confirms that MDQ is a useful instrument in the daily clinical assessment of depressive patients.

     

Social competence in pediatric brain tumor survivors: evaluating the psychometric properties of assessment tools

Purpose

This study was conducted to identify and describe the instruments that have been used to measure social competence in pediatric brain tumor patients and to summarize the psychometric properties of the most common instruments used to measure social competence in pediatric brain tumor patients.

Methods

The following psychometric properties were assessed: (a) construct validity; (b) internal consistency reliability; (c) test retest and inter-rater reliability; and (d) responsiveness. Measures were evaluated based on published criteria for psychometric suitability.

Results

Ten studies met inclusion criteria for the current review. Based on review of these studies, the Social Skills Rating System (SSRS) yielded the most comprehensive data on psychometric properties. Psychometric properties for the SSRS were considered to be adequate in a pediatric brain tumor population. Specifically, the SSRS meets criteria for construct validity, internal consistency and responsiveness. Other commonly used measures included the CBCL/YSR, the PedsQL4.0 and the Revised Class Play each with sufficient psychometric properties.

Conclusions

The SSRS is an appropriate tool to measure social competence in pediatric brain tumor patients. Data for inter-rater reliability and responsiveness in this population is still lacking.