Background The impact of COVID-19 on adolescents with cerebral palsy (CP) and their families is under investigated, particularly in the Southeastern United States. Objective/Hypothesis Examine the impact of COVID-19 on lifestyle activities, general and mental health, and basic needs among a cohort of adolescents with CP in the Southeast U.S. A second purpose was to identify key factors that impacted their lifestyles. Methods Cross-sectional survey of adolescents with CP (ages 10-19 years) who completed a child-modified version of the Coronavirus Disability Survey (COV-DIS). Health and behavior items were associated with the perceived lifestyle impact of COVID-19. Results A total of 101 respondents completed the survey (mean age 14 ± 2 years). Respondents reported minimal-to-no change in general health since the COVID-19 outbreak. Basic needs were met for most families. Nearly all participants (94.1%) reported a mental health concern that resulted from COVID-19: 32.7% felt down or depressed; 47.5% felt little pleasure in doing things; and 64.4% felt isolated. Moreover, 74.3% reported decreased socialization; 51.5% reported reduced exercise participation; 43.6% reported difficulties in obtaining medical care. Most participants (90.1%) were negatively affected by COVID-19 and key associated factors were: reduced interactions with friends and family ( p =0.001), exercise participation ( p =0.016), interest in doing things ( p =0.005), worsened depression ( p =0.015), increased isolation from others and ( p =0.02) at home ( p =0.006), technological communication ( p =0.00), and virus exposure ( p =0.008). Conclusions Study findings highlight problem areas that warrant urgent intervention among adolescents with CP located within the Southeast U.S.

Introduction: Little is known about the factors affecting the intermediate outcomes of the Brostrom-Gould repair as measured by new patient-reported outcome instruments and the impact of patient resilience on postoperative outcomes. This is the first study to investigate the impact of resilience on the outcomes of lateral ligament repair. Methods: Retrospectively, 173 patients undergoing Brostrom-Gould at single institution from January 2013 to June 2020 were identified. Patient characteristics, participation in athletic activities, surgical variables, and complications were recorded. Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference v1.1 (PI), Physical Function v1.2 (PF), and the Foot Ankle Ability Measure (FAAM) were collected. The Brief Resilience Scale was used to quantify resilience. A linear regression model was constructed to evaluate the independent effect of resilience on each PROMIS and FAAM outcome instrument. Variables were included in the regression model based on an a priori significance threshold of P <0.05 in bivariate analysis. Results: Resilience's independent effect on outcome measures was as follows: PROMIS PF (unstandardized β 8.2, 95% confidence interval [CI] 3.9 to 12.6), PROMIS PI (unstandardized β −4.8, 95% CI −7.9 to −1.7), FAAM Activities of Daily Living (unstandardized β 16.6, 95% CI 8.7 to 24.6), and FAAM Sports (unstandardized β 28.4, 95% CI 15.9 to 40.9). Preoperative participation in athletic activities also had a positive independent effect on multiple outcome metrics including PROMIS PF (unstandardized β 9.4, 95% CI 2.8 to 16.0), PROMIS PI (unstandardized β −5.3, 95% CI −10.0 to −0.582), and FAAM Sport scores (unstandardized β 34.4, 95% CI 15.4 to 53.4). Conclusions: Resilience and patient participation in athletic activities are independent predictors of improved postoperative functional outcomes as measured by PROMIS and FAAM instruments at intermediate term follow-up. Resilient patients and athletes reported markedly higher PF and less pain burden postoperatively. Preoperative quantification of resilience could enable improved prognostication of patients undergoing lateral ligament repair of the ankle.

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