title: Patient-important activity and participation outcomes in clinical trials involving children with chronic conditions.
abstract: OBJECTIVE
  Children with chronic conditions experience medical issues over long-term periods of time which can have lasting emotional and social consequences impacting daily life and functioning. Activities and participation outcomes are needed in order to comprehensively assess child-important health in clinical trials. Our objective was to review the extent to which activity and participation outcomes are included in clinical trials of childhood chronic disease and to determine what trial characteristics are associated with their use.
  
  
  METHODS
  A review of a large clinical trial registration database (clinicaltrials.gov) was conducted over the 2010 calendar year. The measures used to assess primary and secondary endpoints were coded according to the ICF classification system. Trial characteristics that might be associated with activity and participation outcome use such as sponsorship type, intervention type, health condition, whether the trial was focused on pediatric patients, phase of trial and sample size were also extracted and explored with univariable and multivariable regressions.
  
  
  RESULTS
  Four hundred and ninety-nine trials met inclusion criteria, 495 of which had complete information about hypothesized predictors. Only 36 out of 495 trials included an activity and participation outcome as part of the trial evaluation process. Both univariable and multivariable regression models showed that non-drug trials and late phase of trial (phase IV) showed the strongest likelihood with whether a trial would include an activity and participation outcome.
  
  
  CONCLUSIONS
  Most registered clinical trials for children with chronic or ongoing medical conditions do not include a comprehensive approach to health outcomes assessment, especially drug trials and early phase trials. Outcome measures in pediatric clinical trials are lagging relative to World Health Organization standards for comprehensive health evaluation.
authors.affiliation: Health and Outcomes Research, Toronto Western Hospital, University Health Network, Toronto, ON, Canada, fayedn@mcmaster.ca.
authors.forename: Nora
authors.initials: N
authors.lastname: Fayed
authors.forename: Olaf Kraus
authors.initials: OK
authors.lastname: de Camargo
authors.forename: Inam
authors.initials: I
authors.lastname: Elahi
authors.forename: Ankita
authors.initials: A
authors.lastname: Dubey
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Fernandes
authors.forename: Amy
authors.initials: A
authors.lastname: Houtrow
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D002648:Child; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D002986:Clinical Trials as Topic; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D063868:Patient Outcome Assessment; D018579:Patient Selection; D010372:Pediatrics; D011788:Quality of Life; D012044:Regression Analysis; D012109:Research Support as Topic; D018434:Sickness Impact Profile; D058992:Social Participation
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