Frontiers in pediatrics · 2026
Assessing the association of physical distancing to avoid COVID-19 with health-related quality of life in immunocompromised adolescents: results from the cross-sectional observational EAGLE study.
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Williams Paul, Herring Timothy A, Yokota Renata T C, Venkatesan Sudhir, Bergenheim Klas, Severens Johan L, Powell Philip A, Marcus James C, Philpott Stephanie, Bestea Sara, Rohay Jeffrey M, Maia Tiago, Taylor Sylvia, Krol Marieke, Varni James W
Аннотация
OBJECTIVE: We describe physical distancing behaviors to avoid coronavirus disease 2019 (COVID-19) and their associations with health-related quality of life (HRQoL) and related outcomes, among immunocompromised adolescents (aged 13-17 years).
METHODS: EAGLE was a cross-sectional, observational study of immunocompromised adults, adolescents, and children in the United States and United Kingdom. Adolescents and their caregivers were enrolled between February and June 2023 and completed a web-based survey that was designed to capture the following outcomes: physical distancing behaviors in the past 4 weeks, measured using the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19®); HRQoL (Pediatric Quality of Life Inventory™ [PedsQL™] Generic Core Scales); loneliness (Direct Measure of Loneliness [DMOL] scale); health-state utility (EQ-5D-5L); mental health (Hospital Anxiety and Depression Scale; HADS®); and school and activity impairment (Work Productivity and Activity Impairment plus Classroom Impairment Questions: Specific Health Problem questionnaire; WPAI-CIQ:SHP).
RESULTS: Among 405 immunocompromised adolescents, the PDS-C19 mean T-score was 49.1, indicative of moderate physical distancing intensity. Most participants reported moderate (60.1%) or high/very high (16.3%) physical distancing intensity; fewer reported low (10.0%) or very low (13.7%) physical distancing intensity. The PedsQL™ Generic Core Scales mean total score was 58.0 (scale range: 0-100, where higher scores indicate better HRQoL). Most outcomes moderately correlated with PDS-C19 (|r| = 0.4-0.5), with stronger correlations (|r|>0.6) shown for WPAI-CIQ:SHP activity impairment, school presenteeism, and overall school impairment. Linear regression models adjusting for confounders showed similar associations.
CONCLUSIONS: Two years after national lockdowns ended, most immunocompromised adolescents practiced moderate-to-high intensities of physical distancing to avoid COVID-19. Higher intensities of physical distancing were associated with worse HRQoL and greater school and activity impairment, emphasizing the prolonged burden of COVID-19 avoidance in this population.
METHODS: EAGLE was a cross-sectional, observational study of immunocompromised adults, adolescents, and children in the United States and United Kingdom. Adolescents and their caregivers were enrolled between February and June 2023 and completed a web-based survey that was designed to capture the following outcomes: physical distancing behaviors in the past 4 weeks, measured using the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19®); HRQoL (Pediatric Quality of Life Inventory™ [PedsQL™] Generic Core Scales); loneliness (Direct Measure of Loneliness [DMOL] scale); health-state utility (EQ-5D-5L); mental health (Hospital Anxiety and Depression Scale; HADS®); and school and activity impairment (Work Productivity and Activity Impairment plus Classroom Impairment Questions: Specific Health Problem questionnaire; WPAI-CIQ:SHP).
RESULTS: Among 405 immunocompromised adolescents, the PDS-C19 mean T-score was 49.1, indicative of moderate physical distancing intensity. Most participants reported moderate (60.1%) or high/very high (16.3%) physical distancing intensity; fewer reported low (10.0%) or very low (13.7%) physical distancing intensity. The PedsQL™ Generic Core Scales mean total score was 58.0 (scale range: 0-100, where higher scores indicate better HRQoL). Most outcomes moderately correlated with PDS-C19 (|r| = 0.4-0.5), with stronger correlations (|r|>0.6) shown for WPAI-CIQ:SHP activity impairment, school presenteeism, and overall school impairment. Linear regression models adjusting for confounders showed similar associations.
CONCLUSIONS: Two years after national lockdowns ended, most immunocompromised adolescents practiced moderate-to-high intensities of physical distancing to avoid COVID-19. Higher intensities of physical distancing were associated with worse HRQoL and greater school and activity impairment, emphasizing the prolonged burden of COVID-19 avoidance in this population.