Assessment of Transition Readiness in Adolescents with Rheumatic Diseases: A Cross-Sectional Study

Abstract

Background: Most childhood-onset rheumatic diseases are chronic health conditions, which need long-term care throughout adulthood. A well-organized transition care is challenging and patient assessment of transition skills is needed for transfer preparation to adult care setting. The Transition Readiness Assessment Questionnaire (TRAQ) is used to assess transition skills in chronically ill patients. Currently, limited transition skill assessment data exist in pediatric patients with rheumatic diseases, especially in Asian countries. This study aimed to determine the transition readiness skills in patients with rheumatic diseases and ascertain predictive factors contributing to low transition readiness skills.Methods: This is a cross-sectional study. All patients with rheumatic diseases aged 15-24 years were recruited. The TRAQ was cross-culturally adapted into the Thai language with good internal consistency and reliability. Patients completed the Thai TRAQ at the recent clinic visit and took the re-test at a 2-week interval. Demographic data, baseline characteristics, clinical manifestations, and disease status were collected. Descriptive and logistic regression analyses were performed. Results: A total of 123 patients with a mean age of 17.8 ± 2.2 years were included. Median (IQR) disease duration was 6.76 (6.05) years. The most common rheumatic disease was juvenile idiopathic arthritis (47.15%), followed by systemic lupus erythematosus (36.59%). The mean TRAQ score was 3.90 ± 0.68. Studying for a bachelor's degree (odds ratio [OR] 4.64, 95% confidence interval [CI] 1.68–12.80) and independent clinic visits (OR 4.07, 95% CI 1.35–12.22) were predictors of a higher TRAQ score. Lack of knowledge on health insurance coverage and financial management were two issues causing lower TRAQ scores. Furthermore, patients with inactive disease status (OR 5.60, 95% CI 1.20–26.14) and patients, who had dependent clinic visits (OR 4.13, 95% CI 1.60–10.67), had more opportunities of getting lower TRAQ scores.Conclusions: Patients with a higher level of education had a higher chance of successfully transitioning to adult care, whereas patients, who had inactive disease and dependent clinic visits, had less transition readiness skills. Physicians and parents should educate their children on independent living skills and paying particular attention to two issues: health insurance coverage and financial management.

Transition Readiness Assessment Questionnaire: Skill gaps and psychosocial predictors of transition readiness among adolescents and young adults with chronic medical conditions

“…Second, information on AYAs' socio-economic status, medical complexity or comorbidity and proxy markers of autonomy (e.g. current living situation, pregnancy) was not collected, even though these may influence their level of transition readiness (Anelli et al, 2019;Culen et al, 2019;González et al, 2017;Kittivisuit et al, 2021;Wood et al, 2014). Finally, most subscales of the TRAQ showed low reliability estimates, which is often found in scales with few items (median = 4) (Streiner, 2003), and a number of TRAQ items may not apply to specific clinical populations (e.g.…”

“…Thus far, lower overall transition readiness has been associated with younger age (Anelli et al, 2019;Wood et al, 2014), being male (Chapados et al, 2021;González et al, 2017), cognitive impairment (Sawicki et al, 2009) and lower health literacy beliefs (Prussien et al, 2022). Beyond global scores, few studies identified predictors of transition readiness at the subscale level (Kittivisuit et al, 2021;Wood et al, 2014), and several factors associated with transition readiness have yet to be assessed, such as AYAs' psychosocial functioning (Gutierrez-Colina et al, 2020;Kittivisuit et al, 2021). Identifying AYA transition readiness skills and skill gaps, both in general and at transfer age, could be a valuable means of promoting a successful transition to the adult care system.…”

“…The TRAQ is a condition-neutral, self-administered questionnaire, and its final version consists of 20 items divided into five subscales (Wood et al, 2014). The TRAQ has been translated and validated into several languages (Anelli et al, 2019;Culen et al, 2019;De Cunto et al, 2017;González et al, 2017;Kittivisuit et al, 2021;Kızıler et al, 2018;Perica et al, 2019;Sato et al, 2020), including French (TRAQ-FR) (Chapados et al, 2021).…”