{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T15:08:22Z","timestamp":1777648102545,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T00:00:00Z","timestamp":1535414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: In pediatric chronic health conditions, health-related quality of life (HRQOL) is a useful indicator of health, development, and well-being. The purpose of the study was to assess the effect of clinical and environmental factors on the HRQOL of children and adolescents with spina bifida (SB). Materials and methods: A cross-sectional study of the sample of 99 children and adolescents with SB aged 5 to 17 years. The questionnaires used in the study were the Spina Bifida Health-Related Quality of Life instrument (HRQOL-SB), and the Participation and Environment Measure for Children and Youth. Medical data were obtained from the medical records and the clinical examination. Results: A multivariate linear regression revealed that the most potent predictors of the HRQOL in children with SB were the community overall environmental supports (\u03b2 = 0.504; p = 0.0001), a number of health conditions (\u03b2 = \u22120.395; p = 0.0001), access to personal transportation (\u03b2 = 0.236; p = 0.023), and supplies (\u03b2 = 0.181; p = 0.031), explaining 80.3% of the variance in the SB-HRQOL scores. The most significant predictors of the HRQOL in adolescents were a number of health conditions (\u03b2 = \u22120.387; p = 0.0001), cognitive demands of activities at home (\u03b2 = 0.345; p = 0.0001), supplies (\u03b2 = 0.267; p = 0.0001), money (\u03b2 = 0.303; p = 0.0001), physical layout at school (\u03b2 = 0.188; p = 0.008), and access to public transportation (\u03b2 = 0.206; p = 0.019), explaining 89.5% of the variance in the SB-HRQOL scores. Conclusions: Both clinical and environmental factors determined the HRQOL of children and adolescents with SB. Environmental supports and resources contributed to HRQOL more than medical problems, especially in adolescents. The number of associated medical problems, reflecting disease severity, was the more potent clinical predictor compared to an individual health problem.<\/jats:p>","DOI":"10.3390\/medicina54040059","type":"journal-article","created":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T12:19:06Z","timestamp":1535458746000},"page":"59","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical and Environmental Predictors of Health-Related Quality of Life in Lithuanian Children and Adolescents with Spina Bifida: A Cross-Sectional Analysis of a Nationally Represented Sample"],"prefix":"10.3390","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0309-7659","authenticated-orcid":false,"given":"Indr\u0117","family":"Bakanien\u0117","sequence":"first","affiliation":[{"name":"Department of Children\u2019s Rehabilitation, Lithuanian University of Health Sciences, LT-4717910 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audron\u0117","family":"Prasauskien\u0117","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Rehabilitation, Lithuanian University of Health Sciences, LT-4717910 Kaunas, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/ddrr.91","article-title":"Optimizing health care for children with spina bifida","volume":"16","author":"Liptak","year":"2010","journal-title":"Dev. Disabil. Res. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/cch.12367","article-title":"Health-related quality of life in children with myelomeningocele: A systematic review of the literature","volume":"42","author":"Bakaniene","year":"2016","journal-title":"Child. Care Health Dev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/j.1469-8749.2009.03321.x","article-title":"Quality of life and participation","volume":"51","author":"Colver","year":"2009","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Megari, K. (2013). Quality of life in chronic disease patients. Health Psychol. Res.","DOI":"10.4081\/hpr.2013.e27"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1007\/s00381-013-2117-5","article-title":"Health-related quality of life in children and adolescents with spinal dysraphism: Results from a Taiwanese sample","volume":"29","author":"Wang","year":"2013","journal-title":"Childs Nerv. Syst."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1023\/A:1026486016212","article-title":"Development of a health-related quality of life instrument for use in children with spina bifida","volume":"6","author":"Parkin","year":"1997","journal-title":"Qual. Life Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1524-4733.2005.04054.x","article-title":"Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation","volume":"8","author":"Wild","year":"2005","journal-title":"Value Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2106\/00004623-197355010-00014","article-title":"Functional ambulation in patients with myelomeningocele","volume":"55","author":"Hoffer","year":"1973","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1191\/0269215505cr865oa","article-title":"Determinants of functional independence and quality of life in children with spina bifida","volume":"19","author":"Schoenmakers","year":"2005","journal-title":"Clin. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.3109\/09638288.2012.748840","article-title":"The effect of the environment on participation of children and youth with disabilities: A scoping review","volume":"35","author":"Anaby","year":"2013","journal-title":"Disabil. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.dhjo.2017.05.005","article-title":"The effect of child, family and environmental factors on the participation of young children with disabilities","volume":"11","author":"Tremblay","year":"2018","journal-title":"Disabil. Health J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/j.1469-8749.2011.04094.x","article-title":"Psychometric evaluation of the Participation and Environment Measure for Children and Youth","volume":"53","author":"Coster","year":"2011","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_14","first-page":"E32","article-title":"The association between urinary continence and quality of life in paediatric patients with spina bifida and tethered cord","volume":"8","author":"Olesen","year":"2013","journal-title":"Paediatr. Child. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/j.1469-8749.2002.tb00818.x","article-title":"Disability and quality of life in spina bifida and hydrocephalus","volume":"44","author":"Kennedy","year":"2002","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/089801010202000307","article-title":"Factors associated with quality of life in adolescents with spina bifida","volume":"20","author":"Sawin","year":"2002","journal-title":"J. Holist. Nurs."},{"key":"ref_17","first-page":"215","article-title":"Is continence status associated with quality of life in young children with Spina Bifida?","volume":"6","author":"Freeman","year":"2013","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s11136-006-0032-x","article-title":"Quality of life and continence in patients with spina bifida","volume":"15","author":"Lemelle","year":"2006","journal-title":"Qual. Life Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1016\/j.juro.2008.03.121","article-title":"Health related quality of life in adolescents with abnormal bladder function: An assessment using the Child Health and Illness Profile-Adolescent Edition","volume":"180","author":"Dodson","year":"2008","journal-title":"J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.pmrj.2013.05.011","article-title":"Shunted Hydrocephalus Has a Significant Impact on Quality of Life in Children with Spina Bifida","volume":"5","author":"Ramachandra","year":"2013","journal-title":"PM&R"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/j.1469-8749.2008.02054.x","article-title":"Self-reported health-related quality of life in children and adolescents with myelomeningocele","volume":"50","author":"Michael","year":"2008","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3171\/2014.10.PEDS1441","article-title":"Assessing health-related quality of life in children with spina bifida","volume":"15","author":"Rocque","year":"2015","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1016\/j.juro.2009.02.060","article-title":"Health Related Quality of Life in Patients with Spina Bifida: A Prospective Assessment Before and After Lower Urinary Tract Reconstruction","volume":"182","author":"MacNeily","year":"2009","journal-title":"J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1097\/01.ju.0000177730.12867.00","article-title":"Lower urinary tract reconstruction for spina bifida\u2014Does it improve health related quality of life?","volume":"74","author":"Macneily","year":"2005","journal-title":"J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1111\/apa.12756","article-title":"Independence does not come with the method\u2014Treatment of neurogenic bowel dysfunction in children with myelomeningocele","volume":"103","author":"Wide","year":"2014","journal-title":"Acta Paediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.pediatrneurol.2011.04.006","article-title":"Quality of life in children and adolescents with cerebral palsy and myelomeningocele","volume":"45","author":"Kulak","year":"2011","journal-title":"Pediatr Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1002\/j.2048-7940.2005.tb00107.x","article-title":"Severity of illness, functional status, and HRQOL in youth with spina bifida","volume":"30","author":"Leger","year":"2005","journal-title":"Rehabil. Nurs."},{"key":"ref_28","first-page":"30","article-title":"Quality of life of children with spina bifida in Kenya is not related to the degree of the spinal defects","volume":"6","author":"Jansen","year":"2011","journal-title":"Trop. Med. Int. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1038\/sj.sc.3101707","article-title":"Assessment of health status in children with spina bifida","volume":"43","author":"Rendeli","year":"2005","journal-title":"Spinal Cord"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1053\/apmr.2002.34599","article-title":"Health-related quality of life and disability in young patients with spina bifida","volume":"83","author":"Padua","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1177\/08830738040190120801","article-title":"Relationship between the Clinical-Neurophysiologic Pattern, Disability, and Quality of Life in Adolescents with Spina Bifida","volume":"19","author":"Padua","year":"2004","journal-title":"J. Child. Neurol."},{"key":"ref_32","first-page":"14","article-title":"Health-related quality of life of children with physical disabilities: A longitudinal study","volume":"30","author":"Law","year":"2014","journal-title":"BMC Pediatr."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/54\/4\/59\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:21:34Z","timestamp":1760196094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/54\/4\/59"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,28]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,9]]}},"alternative-id":["medicina54040059"],"URL":"https:\/\/doi.org\/10.3390\/medicina54040059","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,28]]}}}