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Correspondence |

Quality of Life and Parental Adjustment in Pediatric Pulmonary HypertensionPediatric Pulmonary Hypertension Methodology: Some Methodologic Considerations FREE TO VIEW

Sundar Gnanavel, MD; Ruby Stella Robert, MBBS
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From the Department of Psychiatry (Dr Gnanavel), AIIMS, Ansari Nagar; and the Department of Physiology and Cardiopulmonary Rehabilitation (Dr Robert), Vallabhbhai Patel Chest Institute.

Correspondence to: Sundar Gnanavel, MD, Department of Psychiatry, AIIMS, Ansari Nagar, New Delhi, New Delhi 110029, India; e-mail: sundar221103@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1439. doi:10.1378/chest.14-0290
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To the Editor:

We commend Mullen et al1 for their recent article in CHEST (February 2014) on quality of life and parental adjustment in pediatric pulmonary hypertension. It is indeed a very valuable research question that the authors have made an attempt to answer. However, we would like to point out a number of methodologic concerns that we fear might limit the validity of the study results.

The small sample size (N = 47) is likely to lower the statistical power of the study design. We are of the opinion that a generic scale like the Pediatric Quality of Life Inventory (PedsQL), Parent Report version, is not ideal for measurement of quality of life of the study population. A more disease-specific instrument such as the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) scale, which was designed specifically for patients with pulmonary arterial hypertension and is primarily a patient report version, would have better suited the study purpose.2

Lack of adjustment for multiple comparisons and lack of generalizability of the single-site study pose further questions as to the validity of the study results. We would also like to point out that the assessment of psychiatric morbidity in children with pediatric pulmonary hypertension and inclusion of psychologic morbidity detected as a factor influencing both patient quality of life and parental stress would have been appropriate, considering the high psychiatric morbidity demonstrated in earlier studies of patients with pulmonary arterial hypertension.3 Not assessing and including the same (psychiatric morbidity in patients) as a confounding variable results in a lacuna that cannot be filled. We would recommend similar studies on a larger scale (preferably multisite) that would take into account the various methodologic challenges to shed more light on this valuable research question.

References

Mullen MP, Andrus J, Labella MH, et al. Quality of life and parental adjustment in pediatric pulmonary hypertension. Chest. 2014;145(2):237-244.
 
McKenna SP, Doughty N, Meads DM, Doward LC, Pepke-Zaba J. The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR): a measure of health-related quality of life and quality of life for patients with pulmonary hypertension. Qual Life Res. 2006;15(1):103-115.
 
Lowe B, Grafe K, Ufer C, et al. Anxiety and depression in patients with pulmonary hypertension. Psychosom Med. 2004;66(6):831-836.
 

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References

Mullen MP, Andrus J, Labella MH, et al. Quality of life and parental adjustment in pediatric pulmonary hypertension. Chest. 2014;145(2):237-244.
 
McKenna SP, Doughty N, Meads DM, Doward LC, Pepke-Zaba J. The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR): a measure of health-related quality of life and quality of life for patients with pulmonary hypertension. Qual Life Res. 2006;15(1):103-115.
 
Lowe B, Grafe K, Ufer C, et al. Anxiety and depression in patients with pulmonary hypertension. Psychosom Med. 2004;66(6):831-836.
 
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