Abstract
Background: Children with orthopedic conditions often face social stigmatization, which can impair psychosocial development. Positive peer relationships are critical for emotional resilience, yet little is known about how demographic, diagnostic, and socioeconomic factors influence these relationships.
Purpose: To examine associations between peer relationship quality and age, race, gender, diagnosis, and socioeconomic status among pediatric orthopedic patients.
Methods: A cohort of 3,261 children treated at Shriners Hospital for Children Northern California completed the PROMIS Peer Relationship short form. Demographic and diagnostic data were extracted from medical records; socioeconomic status was estimated using the Area Deprivation Index (ADI). Analyses included descriptive statistics, ANOVA, and multivariable regression models.
Results: A total of 3,261 participants were included (52% female; mean age = 12.8 ± 2.8 years; mean ADI = 43 ± 25). The mean PROMIS PR T-score was 49 ± 11. Children identifying as Black or African American (odds ratio = 0.239, p = 0.002) and those identifying as Other Race (odds ratio = 0.36, p = 0.009) had significantly lower odds of reporting PR scores within the normal range. Thirty-five percent of children with syndromic or cerebral palsy diagnoses reported poor PR scores. Mean PR scores differed significantly across diagnostic groups, with lower scores for children with visible or mobility-related diagnoses such as cerebral palsy, neuroma, or spinal cord injury (mean = 45–47) compared with those with non-visible conditions (mean = 50; p < 0.0001). PR scores decreased 0.14 points for each unit increase in ADI (indicating poorer neighborhood socioeconomic status; p < 0.0001). Regression analyses demonstrated that PR scores fell 0.05 per unit increase in ADI and 4.9 points for visible diagnoses (both p < 0.0001). The interaction between ADI and visible diagnosis revealed a mitigating effect: PR scores increased 0.039 per ADI unit among children with visible conditions (p < 0.0001), suggesting reduced disparity in lower-SES communities.
Conclusions: Race, diagnosis visibility, and socioeconomic status significantly influence peer relationships among children with orthopedic conditions. Interventions should prioritize socially vulnerable groups, particularly those with visible diagnoses and minority racial identities.
Notes
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Sigma Membership
Delta Omicron
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Retrospective
Research Approach
Quantitative Research
Keywords:
Health Equity or Social Determinants of Health, Sustainable Development Goals, Pediatric Orthopedics, Peer Relations, Social Stigma
Recommended Citation
Martens, Sally Ann; Platt, Christine Rae; and Salahshoor, Shima, "Social Well-Being in Pediatric Orthopedics: Predictors from PROMIS Peer Scores" (2026). International Nursing Research Congress (INRC). 183.
https://www.sigmarepository.org/inrc/2026/presentations_2026/183
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-22
Social Well-Being in Pediatric Orthopedics: Predictors from PROMIS Peer Scores
Toronto, Ontario, Canada
Background: Children with orthopedic conditions often face social stigmatization, which can impair psychosocial development. Positive peer relationships are critical for emotional resilience, yet little is known about how demographic, diagnostic, and socioeconomic factors influence these relationships.
Purpose: To examine associations between peer relationship quality and age, race, gender, diagnosis, and socioeconomic status among pediatric orthopedic patients.
Methods: A cohort of 3,261 children treated at Shriners Hospital for Children Northern California completed the PROMIS Peer Relationship short form. Demographic and diagnostic data were extracted from medical records; socioeconomic status was estimated using the Area Deprivation Index (ADI). Analyses included descriptive statistics, ANOVA, and multivariable regression models.
Results: A total of 3,261 participants were included (52% female; mean age = 12.8 ± 2.8 years; mean ADI = 43 ± 25). The mean PROMIS PR T-score was 49 ± 11. Children identifying as Black or African American (odds ratio = 0.239, p = 0.002) and those identifying as Other Race (odds ratio = 0.36, p = 0.009) had significantly lower odds of reporting PR scores within the normal range. Thirty-five percent of children with syndromic or cerebral palsy diagnoses reported poor PR scores. Mean PR scores differed significantly across diagnostic groups, with lower scores for children with visible or mobility-related diagnoses such as cerebral palsy, neuroma, or spinal cord injury (mean = 45–47) compared with those with non-visible conditions (mean = 50; p < 0.0001). PR scores decreased 0.14 points for each unit increase in ADI (indicating poorer neighborhood socioeconomic status; p < 0.0001). Regression analyses demonstrated that PR scores fell 0.05 per unit increase in ADI and 4.9 points for visible diagnoses (both p < 0.0001). The interaction between ADI and visible diagnosis revealed a mitigating effect: PR scores increased 0.039 per ADI unit among children with visible conditions (p < 0.0001), suggesting reduced disparity in lower-SES communities.
Conclusions: Race, diagnosis visibility, and socioeconomic status significantly influence peer relationships among children with orthopedic conditions. Interventions should prioritize socially vulnerable groups, particularly those with visible diagnoses and minority racial identities.
Description
This study highlights significant associations between peer relationship quality, diagnosis visibility, race, and socioeconomic status among children with orthopaedic conditions. Results emphasize the need for targeted psychosocial and community-based interventions to support children most at risk of social exclusion. Future research should explore mechanisms underlying these disparities and evaluate interventions to enhance social inclusion and well-being.