Family management adjustment and quality of life in adolescents with chronic kidney diseases: The mediating role of transition readiness

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Family management adjustment (FMA) and transition readiness (TR) have been identified as important protective factors for QoL among adolescents. However, the mechanisms linking FMA to QoL in adolescents with CKD remain unclear, particularly regarding the potential role of TR. This study aimed to explore the association between FMA and QoL in adolescents with CKD and verify the mediating effect of TR in this relationship. A total of 354 adolescents with CKD aged 10–18 and their parents were recruited for the study. The FMA and sociodemographicdata were reported by the parents, while the adolescents self-reported their TR and QoL. Bivariate correlations, hierarchical regressions, and mediation analysis were the statistical analyses performed. The results showed that FMA, TR, and QoL were significantly positively correlated. Mediation analysis confirmed that TR partially mediated the relationship between FMA and QoL. Conclusion : This study demonstrates that FMA enhances QoL in adolescents with CKD both directly and indirectly through improving TR. These findings highlight the importance of supporting FMA and fostering TR in clinical practice to optimize QoL in this vulnerable population. Chronic kidney disease Adolescents Family management adjustment Transition readiness Quality of life Figures Figure 1 What is Known Previous studies have separately confirmed that both FMA and TR positively influence QoL in children and adolescents with CKD; however, no studies have explored the underlying mechanisms linking these variables and the mediating role of TR. What is New: This study reveals that FMA exerts an indirect impact on the QoL of Chinese adolescents with CKD, with TR serving as a partial mediator in this pathway. Furthermore, the study indicates that FMA and TR act as protective factors for the QoL in adolescents with CKD. Introduction Chronic kidney disease (CKD) is defined as renal structural or functional abnormalities that persist for ≥3 months, with or without a decrease in the glomerular filtration rate (GFR), or a GFR<60 mL/min/1.73 m² that persists for ≥3 months [1, 2]. CKD in children and adolescents has emerged as a critical public health problem worldwide [3]. Due to the improvement in the early diagnosis rate and the increasing burden of chronic complications such as diabetes and hypertension among young people, its prevalence has continued to rise [4-6]. Epidemiological data show that the prevalence of pediatric CKD ranges from 14.9 to 118.8 cases per million children, while the prevalence of end-stage renal disease (ESRD) in this population is 4.9 to 38.7 cases per million children [7]. Notably， long-term studies have demonstrated that once CKD progresses to ESRD in children, the mortality rate increases significantly [8]. CKD is a chronic progressive disease characterized by a long course, difficulty in being cured, and a high recurrence rate, which brings about significant effects on both patients and their families [9, 10]. Beyond its physiological impact, including the increased risk of cardiovascular complications as well as the potential need for dialysis or kidney transplantation in advanced stages, pediatric CKD leads to psychological problems such as loneliness and feelings of inferiority in children, thereby reducing their quality of life (QoL) [11, 12]. Therefore, a comprehensive strategy is required to alleviate the multidimensional damage that CKD causes in children and adolescents. In the management of childhood CKD, parents usually take on the majority of caregiving responsibilities, such as acquiring knowledge regarding the disease, monitoring the child’s behaviors, and providing home-based care [13]. Especially in the Chinese family context, parental caregiving is quite important, due to the strong cultural belief that parents bear the primary responsibility for all aspects of their child’s life, including health problems [9]. Consequently, parents' adjustment to disease management is an essential target for clinical interventions aiming to support families of children with CKD [14]. Family management adjustment (FMA), as a critical protective factor for chronically ill children, is defined as the degree to which families effectively accomplish the tasks associated with the growth and development of children with chronic illnesses [15]. Previous studies in pediatric CKD have shown that families with poor adjustment to disease management are exposed to unpleasant consequences, including mental health problems, marital conflict, and negative effects on the QoL of children [16]. Moreover, interventions targeting family management have been proven to be effective in improving the well-being of children [17]. Nevertheless, few studies have focused on a deeper understanding of the impact of FMA on the QoL of adolescents with CKD. The transition from pediatric to adult healthcare is a necessary stage for adolescents who are living with CKD, and insufficient health services during the transition period can lead to poor individual and family functioning [18]. Transition readiness (TR), referring to the readiness of children with chronic diseases to enter adult healthcare, is the core prerequisite for a successful healthcare transition [15]. With advances in pediatric CKD care, comprehensive transition support to improve the outcomes of adolescents with CKD is well recognized by many medical associations, as this period often introduces heightened disease management challenges [19]. Research has reported that TR is closely related to QoL in adolescents with CKD, and adolescents with sufficient TR have better QoL compared to those with insufficient readiness [20]. In addition, a previous study reported that TR plays a mediating role in mitigating the impact of FMA on the QoL of children with chronic health conditions [21]. Given these associations, we hypothesize that TR might act as a mediator in the association between FMA and QoL. To our knowledge, although previous studies have confirmed separately that both FMA and TR positively influence QoL in children and adolescents with CKD, research that comprehensively examines these variables is lacking. Besides, the potential mediating role of TR in the relationship between FMA and QoL has not been verified. This research gap prevents a comprehensive understanding of the potential mechanisms through which FMA and TR jointly affect the QoL of adolescents with CKD, highlighting the need for further investigation to address this uncertainty. Based on the existing literature, this study aimed to explore the relationships among FMA, TR, and QoL in adolescents with CKD, and to test whether TR acts as a mediating factor in this relationship. By clarifying these pathways, this study gained a more comprehensive understanding of the factors affecting the QoL of adolescents with CKD, and thus provided information for developing targeted interventions supporting FMA and fostering TR to improve long-term outcomes for affected adolescents. Materials and methods Participants and procedures This cross-sectional study was conducted at the Children's Hospital of Soochow University in Suzhou, China, between January 2024 and June 2025. Adolescents with CKD aged 10–18 years and their parents were recruited for the study. The exclusion criteria were: (1) Adolescents with severe comorbidities (e.g., cardiovascular disease, intellectual disability, and psychiatric disorders); and (2) incomplete data on key variables. Of the 370 eligible parent-child pairs who agreed to participate in the study, 354 (95.7%) ultimately returned valid questionnaires. Eligible hospitalized adolescents and their parents were initially identified with the support of clinical nurses. After explaining the purpose of the study, written informed consent for participation was obtained from the parents and adolescents. Data were collected from both the parents and adolescents. Each adolescent received a gift of ¥20 after they had completed the questionnaires. Ethical approval for this study was acquired from the Medical Ethics Committee of the Children's Hospital of Soochow University. Measures Sociodemographic and clinical data The parents completed a structured questionnaire to collect the sociodemographic and clinical information, including their children’s age, sex, disease duration, number of medicines used, family income, family location, number of children in the household, and the parental education level and employment status. Family Management Adjustment The FMA was assessed using the Chinese Family Management Measure (FaMM), which was a validated caregiver-reported tool designed to evaluate family adaptation to a child’s chronic illness [22]. In this study, three subscales, namely, the child’s daily life, management ability, and parental mutuality, comprising 25 items, were adopted to investigate the FMA. Each item is scored using a five-point Likert scale ranging from 1 to 5 (1 = absolutely disagree; 2 = moderately disagree; 3 = uncertain; 4 = moderately agree; 5 = absolutely agree). Higher scores on each subscale indicate better adjustment of family management for adolescents with CKD. The Cronbach's α coefficient of the total scale in this study was 0.79. Transition Readiness The Chinese STARx Questionnaire was used to measure the adolescents’ TR. The self-administered STARx Questionnaire has been used to measure self-management and health care transition readiness skills in Chinese adolescents and young adults with various chronic health conditions [23]. This questionnaire comprises 13 items divided into three dimensions: self-management, disease knowledge, and provider communication. Each item is rated on a five-point Likert scale ranging from 1 to 5 (1 = never, nothing, or very hard; 5 = always, a lot, or very easy). A total TR score is computed by summing all items, with higher scores indicating better transition readiness. In this study, the questionnaire reflected high internal consistency (α = 0.88). Quality of Life QoL was reported by adolescents using the Chinese version of the PedsQL TM 4.0 [24]. The Chinese version of this tool has been validated in pediatric CKD populations [20]. This scale includes 23 items across 4 dimensions: physical functioning, emotional functioning, social functioning, and school functioning. Each item is rated on a 5-point Likert scale ranging from 0 to 4 (0 = never; 1 = almost never; 2 = sometimes; 3 = often; 4 = always). The scores are linearly transformed to a 0-100 scale (0 = 100; 1 = 75; 2 = 50; 3 = 25; 4 = 0) by standardizing raw scores. A total QoL score was derived from the mean of all item scores, with higher scores indicating better QoL. Cronbach’s α was 0.93, indicating excellent internal consistency. Statistical Analysis Data analyses were performed using SPSS 26.0. Descriptive statistics were conducted to analyze the general information and main variables of the participants. Continuous variables were presented as means and standard deviation (SD), and categorical variables were described as frequencies and percentage values. Student’s t-test and Spearman correlation analysis were employed to assess the strength of the association between the general characteristics and QoL, and to identify which variables should serve as covariates. The correlations among FMA, TR, and QoL were assessed using Pearson correlation analyses. Hierarchical regression analyses were used to explore the effects of FMA and TR on QoL. The general characteristics that exerted a statistically significant effect on QoL were incorporated into Model 1 to control their influence on QoL. Model 2 was then developed based on Model 1, with the addition of FMA. Model 3 was built by adding TR to Model 2. Furthermore, the PROCESS macro (Version 4.1) was used for mediation analysis. In our study, a mediation model was established, in which FMA was designated as the independent variable, QoL as the dependent variable, and TR as the mediator. To control for other factors that may interfere with the results and enhance test efficiency, general characteristics exerting a significant effect on QoL were incorporated into the covariate module. A 95% confidence interval (CI) was examined with 5,000 bootstrapping resamples. The mediating effect of TR was considered statistically significant if the CI of the indirect effect did not include zero. A two-tailed significance level of p < 0.05 was applied to all analyses. Results Sample Characteristics The sample included a total of 354 adolescents with CKD, with a mean age of 12.62 ± 2.00 years; 52.8% were male. More than half (57.3%) of the adolescents lived in urban areas. Approximately two-thirds (65.8%) of the adolescents resided in households with more than one child. Regarding CKD-related information, the mean disease duration was 21.31 ± 31.68 months, and the mean number of medicines used was 4.15±2.45. The detailed characteristics are presented in Table 1. Correlations analyses As displayed in Table 2, the correlation analyses indicated that the FMA correlated positively and significantly with TR (0.398, p < 0.01) and total QoL (0.377, p < 0.01) of adolescents with CKD. Moreover, there were significantly positive relationships between the TR and QoL (0.556, p < 0.01). The mean (SD) scores of FMA, TR, and QoL were 92.55 (10.60), 35.66 (9.61), and 57.20 (14.40), respectively. Hierarchical regression analyses Table 3 presents the results of the hierarchical regression analyses. The analyses revealed the following: - Compared with Model 1 (adjusted R 2 = 0.160, p < 0.001), Model 2 (adjusted R 2 = 0.260, p < 0.001) showed that introducing FMA into the model contributes significantly to the model ( β = 0.323, p < 0.001), increasing the variance by 10.0%. - Compared with Model 2, Model 3 (adjusted R 2 =0.423, p < 0.001) showed that when TR were included, the variance of QoL increased by 16.3%. The TR was a significant predictor for QoL ( β = 0.451, p < 0.001), while the effect of FMA on QoL was reduced but still significant ( β = 0.152, p < 0.001). Mediation analysis The results of the mediation effect are shown in Table 4. After incorporating sex, age, and number of medicines used among adolescents as covariates, the total effect (path c) of FMA on QoL was measured as 0.439 ( p < 0.001, 95% CI [0.314 to 0.563]). The coefficients of paths a ( β = 0.343， p < 0.001, 95% CI [0.256 to 0.429]) and b ( β = 0.676, p < 0.001, 95% CI [0.543 to 0.809]) suggested that the direct effects of FMA on TR and TR on QoL were obviously significant. Additionally, the indirect effect (a*b) between FMA and QoL viaTR was measured as 0.232 (95% CI [0.157 to 0.317]). The direct effect (c’) of FMA on QoL was measured as 0.207 ( p =0.001, 95% CI [0.088 to 0.326]), indicating that TR partially mediated the relationship between FMA and QoL in youth with chronic kidney diseases. Fig. 1 shows a simple mediating model. Discussion This study explored the relationships between FMA, TR, and QoL in adolescents with CKD. To our knowledge, it is the first study to explore the possible mediating role of TR in a Chinese sample of adolescents with CKD. The results demonstrated significant correlations among FMA, TR, and QoL. We also found that TR mediated the relationship between FMA and QoL. The FMA of adolescents with CKD in this study was at a lower-middle level, which aligned with the findings reported by Sutthisompohn and Kusol [25]. The TR score of adolescents with CKD in this study was significantly lower than that observed in Huang et al.’s research [23]. The divergence may be explained by the different age distributions of participants. In the study by Huang et al. [23], the participants were aged 10 to 25 years. Previous studies have indicated that older children tend to have higher TR [26, 27]. As proposed by Elorza et al. [28], the results of our study further confirm that the QoL of adolescents with CKD needs to be improved through targeted interventions. Given this persistent challenge, QoL should continue to be recognized as a core priority in clinical practice for healthcare professionals working with adolescents with CKD [29]. Consistent with previous research on chronic conditions [28, 30], this study found a significant positive correlation between FMA and QoL in adolescents with CKD. Adolescents with CKD face ongoing challenges such as complex treatment regimens, dietary restrictions, and frequent medical visits [31]. These burdens can be mitigated through effective FMA by empowering parents to better manage the disease [9]. Families that adapt well to the disease can provide more precise support, including assisting with medication adherence, coordinating medical appointments, and creating a supportive home environment [32]. These actions directly alleviate the physical and psychological stress on adolescents, thus improving their overall QoL [33, 34]. This result reinforces the notion that the family is a crucial support system for adolescents with CKD, and its adaptability has a significant impact on the well-being of adolescents [17]. Healthcare providers should assess FMA in parents of adolescents with CKD and deliver targeted interventions, such as family-centered care, to enhance family management strategies in order to improve the QoL of adolescents. Concerning the relationships identified between TR and FMA, as well as QoL, this study reported that after controlling for demographic variables, TR partially mediated the relationship between FMA and QoL. The findings reveal that a higher TR is related to both stronger FMA and better outcomes in QoL in adolescents with CKD, consistent with those found in other non-CKD clinical youth populations [15, 21]. It is widely recognized that as adolescents transition from pediatric to adult healthcare, families should gradually transfer disease management responsibilities to them while providing ongoing guidance and encouragement [35]. Families that adjust their management strategies appropriately can foster this transition [36]. Through this process, adolescents can build confidence and skills in self-management that are needed to develop higher TR, which in turn enables them to better cope with the disease and maintain a higher QoL [15]. This finding is particularly meaningful for families of adolescents with CKD because it extends existing research by clarifying the mechanism linking family factors to QoL, indicating that TR is an important intermediate variable that cannot be ignored. Hence, the improvement of QoL in adolescents with CKD must be approached by simultaneously enhancing both parents’ FMA and the adolescents’ TR. There are several limitations to this study that should be noted. First, the cross-sectional design could not precisely assess the causal relationships between the variables. Future longitudinal studies are needed to clarify the direction of these associations and examine the effectiveness of family-centered TR interventions in a randomized controlled trial. Second, the sample was recruited only from one hospital, which limits its representativeness of adolescents with CKD. Further research with larger and multi-center samples is required to verify the generalizability of the findings. Finally, other potential variables, such as family function, parenting style, and self-efficacy, that may be related to QoL were not included in this study. Future studies should explore more variables to develop a more comprehensive understanding of the factors influencing QoL in adolescents with CKD. Conclusion This study illustrates that FMA and TR are important influencing factors of QoL in adolescents with CKD, with TR mediating the relationship between FMA and QoL. Our findings highlight the importance of designing interventions to support FMA and foster TR in optimizing QoL in this vulnerable population. By integrating family-centered care and transition skills training into routine clinical practice, clinicians can help adolescents with CKD lead more fulfilling and healthier lives. Abbreviations CKD Chronic kidney disease GFR Glomerular filtration rate ESRD End-stage renal disease QoL Quality of life FMA Family management adjustment TR Transition readiness FaMM Family Management Measure References Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024) KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 105(4S):S117-S314. https://doi.org/10.1016/j.kint.2023.10.018 Expert Group on Kidney Clinical Quality Control Center in Shanghai (2022) Guidelines for early screening, diagnosis, prevention and treatment of chronic kidney disease (2022 Edition). Chin J Nephrol 38(5):453-464. 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Adv Chronic Kidney Dis 28(6):570-576. https://doi.org/10.1053/j.ackd.2021.10.002 Tables Table 1 Demographic and clinical information of the sample Variables n (%)/ M ± SD Age 12.62±2.00 Sex Male 187 (52.8) Female 167 (47.2) Number of children in the household One-child 121 (34.2) Multiple-child 233 (65.8) Family location Rural area 151 (42.7) Urban area 203 (57.3) Family income ≤ ￥5000 83 (23.4) ￥5001-10000 218 (61.6.1) >￥10000 53 (15.0) Paternal education Junior high school and below 172 (48.6) High school 96 (27.1) University degree and above 86 (24.3) Maternal education Junior high school and below 194 (54.8) High school 79 (22.3) University degree and above 81 (22.9) Paternal employment status Employed 342 (96.6) Unemployed 12 (3.4) Maternal employment status Employed 243 (68.6) Unemployed 111 (31.4) CKD duration (months) 21.31±31.68 Number of medicines used 4.15±2.45 M median, SD standard deviation, CKD chronic kidney disease Table 2 Correlations among family management adjustment, transition readiness, and quality of life. Variables M±SD 1 2 3 4 5 6 7 8 9 10 11 12 13 1. Child’s daily life 17.11±3.96 - 2. Management ability 42.03±5.61 0.323 ** - 3. Parental mutuality 33.40±4.79 0.247 ** 0.344 ** - 4. Total FMA 92.55±10.60 0.656 ** 0.806 ** 0.727 ** - 5. Self-management 12.38±4.13 0.187 ** 0.253 ** 0.276 ** 0.328 ** - 6. Disease knowledge 8.95±3.69 0.186 ** 0.178 ** 0.278 ** 0.290 ** 0.542 ** - 7. Provider communication 14.36±4.27 0.287 ** 0.237 ** 0.192 ** 0.320 ** 0.434 ** 0.369 ** - 8. Total TR 35.66±9.61 0.282 ** 0.284 ** 0.315 ** 0.398 ** 0.827 ** 0.780 ** 0.771 ** - 9. Physical functioning 59.98±16.13 0.332 ** 0.109 * 0.307 ** 0.321 ** 0.267 ** 0.403 ** 0.489 ** 0.492 ** - 10. Emotional functioning 56.34±17.05 0.283 ** 0.164 ** 0.276 ** 0.317 ** 0.201 ** 0.311 ** 0.369 ** 0.373 ** 0.584 ** - 11. Social functioning 62.33±17.25 0.312 ** 0.213 ** 0.180 ** 0.311 ** 0.244 ** 0.361 ** 0.438 ** 0.442 ** 0.581 ** 0.527 ** - 12. School functioning 50.14±19.33 0.372 ** 0.158 ** 0.170 ** 0.300 ** 0.311 ** 0.399 ** 0.525 ** 0.524 ** 0.603 ** 0.557 ** 0.600 ** - 13. Total QoL 57.20±14.40 0.395 ** 0.196 ** 0.279 ** 0.377 ** 0.312 ** 0.447 ** 0.553 ** 0.556 ** 0.829 ** 0.804 ** 0.819 ** 0.849 ** - * p < .05, ** p < .01, FMA family management adjustment, TR transition readiness, QoL quality of life Table 3 Hierarchical Regression Models Predicting the QoL Predictors Model 1 Model 2 Model 3 β t p β t p β t p Age 0.091 1.848 0.066 0.106 2.293 0.022 0.088 2.153 0.032 Sex 0.195 3.963 <0.001 0.165 3.555 <0.001 0.075 1.791 0.074 Number of medicines used -0.307 -6.180 <0.001 -0.262 -5.553 <0.001 -0.264 -6.343 <0.001 FMA - - - 0.323 6.932 <0.001 0.152 3.423 <0.001 TR - - - - - - 0.451 9.984 <0.001 F 23.490 32.001 52.775 p <0.001 <0.001 <0.001 Adjusted R 2 0.160 0.260 0.423 QoL quality of life, FMA family management adjustment, TR transition readiness Table 4 Mediation of TR between FMA and QoL (n = 354). Effect Coefficient SE t p 95%CI LLCI ULCI a: Effect of FMA on TR 0.343 0.044 7.757 <0.001 0.256 0.429 b: Effect of TR on QoL after adjustment for FMA 0.676 0.068 9.984 <0.001 0.543 0.809 c: Total effect of FMA on QoL 0.439 0.063 6.932 <0.001 0.314 0.563 c’: Direct effects of FMA on QoL after adjustment for TR 0.207 0.062 3.423 0.001 0.088 0.326 a*b: Indirect effect of TR in the relationship between FMA and QoL 0.232 0.041 0.157 0.317 FMA family management adjustment, TR transition readiness, QoL quality of life, SE standard error, CI confidence interval, LLCI lower level of confidence interval, ULCI upper level of confidence interval Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":23595,"visible":true,"origin":"","legend":"\u003cp\u003eMediating effect of transition readiness (TR) between family management adjustment (FMA) and Quality of life (QoL). \u003cem\u003en\u003c/em\u003e=354. (\u003cstrong\u003ea\u003c/strong\u003e) effect of the FMA and the TR; (\u003cstrong\u003eb\u003c/strong\u003e) correlation of the TR on the QoL, controlling for the FMA; (\u003cstrong\u003ec\u003c/strong\u003e) the total effect of the FMA on the QoL, not controlling for the mediator; (c′) the effect of the FMA on the QoL, controlling for the TR\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8205356/v1/e7e74b416568ea54d9fc37e9.png"},{"id":101045142,"identity":"0caec4f9-8b07-4297-b6b9-c42f7e269f20","added_by":"auto","created_at":"2026-01-24 13:39:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":810967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8205356/v1/f9f53936-485a-4e2d-aedd-5b01a433c3d0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Family management adjustment and quality of life in adolescents with chronic kidney diseases: The mediating role of transition readiness","fulltext":[{"header":"What is Known","content":"\u003cp\u003ePrevious studies have separately confirmed that both FMA and TR positively influence QoL in children and adolescents with CKD; however, no studies have explored the underlying mechanisms linking these variables and the mediating role of TR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is New:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reveals that FMA exerts an indirect impact on the QoL of Chinese adolescents with CKD, with TR serving as a partial mediator in this pathway. Furthermore, the study indicates that FMA and TR act as protective factors for the QoL in adolescents with CKD.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) is defined as renal structural or functional abnormalities that persist for ≥3 months, with or without a decrease in the glomerular filtration rate (GFR), or a GFR\u0026lt;60 mL/min/1.73 m² that persists for ≥3 months\u0026nbsp;[1, 2]. CKD in children and adolescents has emerged as a critical public health problem worldwide [3]. Due to the improvement in the early diagnosis rate and the increasing burden of chronic complications such as diabetes and hypertension among young people, its prevalence has continued to rise [4-6]. Epidemiological data show that the prevalence of pediatric CKD ranges from 14.9 to 118.8 cases per million children, while the prevalence of end-stage renal disease (ESRD) in this population is 4.9 to 38.7 cases per million children [7]. Notably， long-term studies have demonstrated that once CKD progresses to ESRD in children, the mortality rate increases significantly [8].\u003c/p\u003e\n\u003cp\u003eCKD is a chronic progressive disease characterized by a long course, difficulty in being cured, and a high recurrence rate, which brings about significant effects on both patients and their families [9, 10]. Beyond its physiological impact, including the increased risk of cardiovascular complications as well as the potential need for dialysis or kidney transplantation in advanced stages, pediatric CKD leads to psychological problems such as loneliness and feelings of inferiority in children, thereby reducing their quality of life (QoL) [11, 12]. Therefore, a comprehensive strategy is required to alleviate the multidimensional damage that CKD causes in children and adolescents.\u003c/p\u003e\n\u003cp\u003eIn the\u0026nbsp;management of childhood CKD, parents usually take on the majority of caregiving responsibilities, such as acquiring knowledge regarding the disease, monitoring the child’s behaviors, and providing home-based care\u0026nbsp;[13]. Especially in the Chinese family context, parental caregiving is quite important, due to the strong\u0026nbsp;cultural belief that parents bear the primary responsibility for all aspects of their child’s life, including health problems\u0026nbsp;[9]. Consequently, parents' adjustment to disease management is an essential target for clinical interventions aiming to support families of children with CKD\u0026nbsp;[14]. Family management adjustment (FMA), as a critical protective factor for chronically ill children, is defined as\u0026nbsp;the degree to which families effectively accomplish the tasks associated with the growth and development of children with chronic illnesses [15]. Previous studies in pediatric CKD have shown that families with poor adjustment to disease management are exposed to unpleasant consequences, including mental health problems, marital conflict, and negative effects on the QoL of children\u0026nbsp;[16]. Moreover, interventions targeting family management have been proven to be effective in improving the well-being of children [17]. Nevertheless, few studies have focused on a deeper understanding of the impact of FMA on the QoL of adolescents with CKD.\u003c/p\u003e\n\u003cp\u003eThe transition from pediatric to adult healthcare is a necessary stage for adolescents who are living with CKD, and insufficient health services during the transition period can lead to\u0026nbsp;poor individual and family functioning\u0026nbsp;[18]. Transition readiness (TR), referring to the readiness of children with chronic diseases to enter adult healthcare, is the core prerequisite for a successful healthcare transition\u0026nbsp;[15].\u0026nbsp;With advances in pediatric CKD care, comprehensive transition support to improve the outcomes of adolescents with CKD is well recognized by many medical associations, as this period often introduces heightened disease management challenges [19]. Research has reported that TR is closely related to QoL in adolescents with CKD, and adolescents with sufficient TR have better QoL compared to those with insufficient readiness [20]. In addition, a previous study reported that TR plays a mediating role in mitigating the impact of FMA on the QoL of children with chronic health conditions\u0026nbsp;[21].\u0026nbsp;Given these associations,\u0026nbsp;we hypothesize that TR might act as a mediator in the association between FMA and QoL.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo our knowledge, although previous studies have confirmed separately that both FMA and TR positively influence QoL in children and adolescents with CKD, research that comprehensively examines these variables is lacking. Besides, the potential mediating role of TR in the relationship between FMA and QoL has not been verified. This research gap prevents a comprehensive understanding of the potential mechanisms through which FMA and TR jointly affect the QoL of adolescents with CKD, highlighting the need for further investigation to address this uncertainty.\u003c/p\u003e\n\u003cp\u003eBased on the existing literature, this study aimed to explore the relationships among FMA, TR, and QoL in adolescents with CKD, and to test whether TR acts as a mediating factor in this relationship. By clarifying these pathways, this study gained a more comprehensive understanding of the factors affecting the QoL of adolescents with CKD, and thus provided information for developing targeted interventions supporting FMA and fostering TR to improve long-term outcomes for affected adolescents.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted at the Children\u0026apos;s Hospital of Soochow University in Suzhou, China, between January 2024 and June 2025. Adolescents with CKD aged 10\u0026ndash;18 years and their parents were recruited for the study. The exclusion criteria were: (1) Adolescents with severe comorbidities (e.g., cardiovascular disease, intellectual disability, and psychiatric disorders); and (2) incomplete data on key variables. Of the 370 eligible parent-child pairs who agreed to participate in the study, 354 (95.7%) ultimately returned valid questionnaires.\u003c/p\u003e\n\u003cp\u003eEligible hospitalized adolescents and their parents were initially identified with the support of clinical nurses. After explaining the purpose of the study, written informed consent for participation was obtained from the parents and adolescents. Data were collected from both the parents and adolescents. Each adolescent received a gift of \u0026yen;20 after they had completed the questionnaires. Ethical approval for this study was acquired from the Medical Ethics Committee of the Children\u0026apos;s Hospital of Soochow University.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSociodemographic and clinical data\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe parents completed a structured questionnaire to collect the sociodemographic and clinical information, including their children\u0026rsquo;s age, sex, disease duration, number of medicines used, family income, family location, number of children in the household, and the parental education level and employment status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFamily Management Adjustment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FMA was assessed using the Chinese Family Management Measure (FaMM), which was a validated caregiver-reported tool designed to evaluate family adaptation to a child\u0026rsquo;s chronic illness\u0026nbsp;[22]. In this study, three subscales, namely, the child\u0026rsquo;s daily life, management ability, and parental mutuality, comprising 25 items, were adopted to investigate the FMA. Each item is scored using a five-point Likert scale\u0026nbsp;ranging from 1 to 5 (1 =\u0026nbsp;absolutely disagree; 2 =\u0026nbsp;moderately disagree; 3 =\u0026nbsp;uncertain; 4 =\u0026nbsp;moderately agree; 5 =\u0026nbsp;absolutely agree).\u0026nbsp;Higher scores on each subscale indicate better adjustment of family management for adolescents with CKD. The Cronbach\u0026apos;s \u0026alpha; coefficient of\u0026nbsp;the total scale in this study was\u0026nbsp;0.79.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTransition Readiness\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Chinese STARx Questionnaire was used to measure the adolescents\u0026rsquo; TR. The self-administered STARx Questionnaire has been used to measure self-management and health care transition readiness skills in Chinese adolescents and young adults with various chronic health conditions [23].\u0026nbsp;This questionnaire comprises 13 items divided into three dimensions: self-management, disease knowledge, and provider communication. Each item is rated on a five-point Likert scale ranging from 1 to 5 (1 = never, nothing, or very hard; 5 = always, a lot, or very easy). A total TR score is computed by summing all items, with higher scores indicating better transition readiness. In this study, the questionnaire reflected high internal consistency (\u0026alpha; = 0.88).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuality of Life\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQoL was reported by adolescents using the Chinese version of the PedsQL\u003csup\u003eTM\u0026nbsp;\u003c/sup\u003e4.0\u0026nbsp;[24]. The Chinese version of this tool has been validated in pediatric CKD populations\u0026nbsp;[20]. This scale includes 23 items across 4\u0026nbsp;dimensions: physical functioning, emotional functioning, social functioning, and school functioning. Each item is rated on a 5-point Likert scale\u0026nbsp;ranging from 0 to 4\u0026nbsp;(0 = never; 1 = almost never; 2 = sometimes; 3 = often; 4 = always). The scores are linearly transformed to a 0-100 scale (0 = 100; 1 = 75; 2 = 50; 3 = 25; 4 = 0) by standardizing raw scores. A total QoL score was derived from the mean of all item scores, with higher scores indicating better QoL. Cronbach\u0026rsquo;s \u0026alpha; was 0.93, indicating excellent internal consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analyses were performed using SPSS 26.0. Descriptive statistics were conducted to analyze the general information and main variables of the participants. Continuous variables were presented as means and standard deviation (SD), and categorical variables were described as frequencies and percentage values. Student\u0026rsquo;s t-test and Spearman correlation analysis were employed to assess the strength of the association between the general characteristics and QoL, and to identify which variables\u0026nbsp;should serve as covariates. The correlations among FMA, TR, and QoL were assessed using Pearson correlation analyses. Hierarchical regression analyses were used to explore the effects of FMA and TR on QoL. The general characteristics\u0026nbsp;that exerted a statistically significant effect on QoL were incorporated into Model 1 to control their\u0026nbsp;influence\u0026nbsp;on\u0026nbsp;QoL. Model 2 was then developed based on Model 1, with the addition of FMA. Model 3 was built by adding TR to Model 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, the PROCESS macro\u0026nbsp;(Version 4.1) was used for mediation analysis. In our study, a mediation model was established, in which FMA was designated as the independent variable, QoL as the dependent variable, and TR as the mediator.\u0026nbsp;To control for other factors that may interfere with the results and enhance test efficiency, general characteristics exerting a significant effect on QoL were incorporated into the covariate module. A 95%\u0026nbsp;confidence interval (CI) was examined with 5,000 bootstrapping resamples. The mediating effect of TR was considered statistically significant if the CI of the indirect effect did not include zero. A two-tailed significance level of \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was applied to all analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSample Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample included a total of 354 adolescents with CKD, with a mean age of 12.62 ± 2.00 years; 52.8% were male. More than half (57.3%)\u0026nbsp;of the adolescents lived in urban areas. Approximately two-thirds (65.8%) of the adolescents\u0026nbsp;resided in households with more than one child.\u0026nbsp;Regarding CKD-related information, the mean disease duration was\u0026nbsp;21.31 ± 31.68\u0026nbsp;months, and the mean number of medicines used was 4.15±2.45. The\u0026nbsp;detailed characteristics are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs displayed in Table 2, the correlation analyses indicated that the FMA correlated positively and significantly with TR (0.398,\u0026nbsp;\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01)\u0026nbsp;and total QoL (0.377,\u0026nbsp;\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01)\u0026nbsp;of adolescents with CKD. Moreover,\u0026nbsp;there were\u0026nbsp;significantly positive relationships between the\u0026nbsp;TR\u0026nbsp;and QoL (0.556,\u0026nbsp;\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01).\u0026nbsp;The mean (SD) scores of\u0026nbsp;FMA,\u0026nbsp;TR,\u0026nbsp;and\u0026nbsp;QoL\u0026nbsp;were 92.55 (10.60), 35.66 (9.61), and 57.20 (14.40), respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHierarchical regression analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents the results of the hierarchical regression analyses. The analyses revealed the following:\u003c/p\u003e\n\u003cp\u003e- Compared with Model 1 (adjusted\u0026nbsp;\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e= 0.160,\u0026nbsp;\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), Model 2 (adjusted\u0026nbsp;\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 0.260,\u0026nbsp;\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) showed that introducing FMA into the model contributes significantly to the model (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.323, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), increasing the variance by 10.0%.\u003c/p\u003e\n\u003cp\u003e- Compared with Model 2, Model 3 (adjusted\u0026nbsp;\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e =0.423,\u0026nbsp;\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001) showed that when TR were included, the variance of QoL increased by 16.3%. The TR\u0026nbsp;was a significant predictor for QoL (\u003cem\u003eβ\u003c/em\u003e = 0.451, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), while the effect of FMA on QoL was reduced but still significant (\u003cem\u003eβ\u003c/em\u003e = 0.152, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediation analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the mediation effect are shown in Table 4. After\u0026nbsp;incorporating sex, age, and number of medicines used among adolescents as covariates,\u0026nbsp;the total effect (path c) of FMA on QoL was measured as 0.439 (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001, 95% CI [0.314 to 0.563]). The coefficients of paths a (\u003cem\u003eβ =\u0026nbsp;\u003c/em\u003e0.343，\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001, 95% CI [0.256\u0026nbsp;to\u0026nbsp;0.429]) and b (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.676, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001, 95% CI [0.543 to\u0026nbsp;0.809]) suggested that the direct effects of FMA on TR and TR on QoL were obviously significant. Additionally, the indirect effect (a*b) between FMA and QoL viaTR was measured as 0.232 (95% CI [0.157 to 0.317]). The direct effect (c’) of FMA on QoL was measured as 0.207 (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e=0.001, 95% CI [0.088 to 0.326]), indicating that TR partially mediated the relationship between FMA and QoL in youth with chronic kidney diseases.\u0026nbsp;Fig. 1 shows\u0026nbsp;a simple mediating model.\u003c/p\u003e\n\n\n\n\n\n\n"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the relationships between FMA, TR, and\u0026nbsp;QoL\u0026nbsp;in adolescents with CKD. To our knowledge, it is the first study to explore the possible mediating role of TR in a Chinese sample of adolescents with CKD.\u0026nbsp;The results demonstrated significant correlations among FMA, TR, and QoL. We also found that TR mediated the relationship between FMA and QoL.\u003c/p\u003e\u003cp\u003eThe FMA of adolescents with CKD in this study was at a lower-middle level, which aligned with the findings reported by Sutthisompohn and Kusol\u0026nbsp;[25]. The TR score of adolescents with CKD in this study was significantly lower than that observed in\u0026nbsp;Huang et al.’s research [23]. The\u0026nbsp;divergence\u0026nbsp;may be explained by the different age\u0026nbsp;distributions\u0026nbsp;of participants. In the study by Huang et al.\u0026nbsp;[23], the participants were aged 10 to 25 years. Previous studies have\u0026nbsp;indicated that \u003cstrong\u003eolder children\u003c/strong\u003e tend to have higher TR\u0026nbsp;[26, 27]. As proposed by Elorza et al. [28], the results of our study further confirm that the QoL of adolescents with CKD needs to be improved through targeted interventions. Given this persistent challenge, QoL should continue to be recognized as a core priority in clinical practice for healthcare professionals working with adolescents with CKD [29].\u003c/p\u003e\u003cp\u003eConsistent with previous research on chronic conditions\u0026nbsp;[28, 30], this study found a significant positive correlation between FMA and QoL in adolescents with CKD. Adolescents with CKD face ongoing challenges such as complex treatment regimens, dietary restrictions, and frequent medical visits\u0026nbsp;[31].\u0026nbsp;\u003cstrong\u003eThese burdens can be mitigated through effective FMA by\u0026nbsp;\u003c/strong\u003eempowering parents to better manage the disease\u0026nbsp;[9].\u0026nbsp;\u003c/p\u003e\u003cp\u003eFamilies that adapt well to the disease can provide more precise support, including assisting with medication adherence, coordinating medical appointments, and creating a supportive home environment\u0026nbsp;[32]. These actions directly alleviate the physical and psychological stress on adolescents, thus improving their overall QoL\u0026nbsp;[33, 34]. This result reinforces the notion that the family is a\u0026nbsp;crucial\u0026nbsp;support system for adolescents with CKD, and its adaptability has a significant impact on the well-being of adolescents\u0026nbsp;[17]. Healthcare providers should assess FMA in parents of adolescents with CKD and deliver targeted interventions, such as family-centered care, to enhance family management strategies in order to improve the QoL of adolescents.\u003c/p\u003e\u003cp\u003eConcerning the relationships identified between TR and FMA, as well as QoL, this study reported that after controlling for\u0026nbsp;demographic\u0026nbsp;variables, TR partially mediated the relationship between FMA and QoL.\u0026nbsp;The findings reveal that a higher TR is related to both stronger FMA and better outcomes in QoL in adolescents with CKD, consistent with those found in other non-CKD clinical youth populations\u0026nbsp;[15, 21].\u0026nbsp;It is widely recognized that\u0026nbsp;as adolescents transition from pediatric to adult healthcare, families should gradually transfer disease management\u0026nbsp;responsibilities\u0026nbsp;to them while providing\u0026nbsp;ongoing\u0026nbsp;guidance and encouragement\u0026nbsp;[35]. Families that adjust their management strategies appropriately can foster this transition\u0026nbsp;[36]. Through this process, adolescents can build confidence and skills in self-management that are needed to develop higher TR, which in turn enables them to better cope with the disease and maintain a higher QoL\u0026nbsp;[15].\u0026nbsp;This finding is particularly meaningful for families of adolescents with CKD because it extends existing research by\u0026nbsp;clarifying\u0026nbsp;the mechanism linking family factors to QoL, indicating that TR is an important intermediate variable that cannot be ignored.\u0026nbsp;Hence, the improvement of QoL in adolescents with CKD must be approached by simultaneously enhancing both parents’ FMA and the adolescents’ TR.\u003c/p\u003e\u003cp\u003eThere are several limitations to this study that should be noted. First, the cross-sectional design could not precisely assess the causal relationships between the variables. Future longitudinal studies are needed to clarify the direction of these associations and examine the effectiveness of family-centered TR interventions in a randomized controlled trial. Second, the sample was recruited only from one hospital, which limits its representativeness of adolescents with CKD. Further research with larger and multi-center samples is required to verify the generalizability of the findings. Finally, other potential variables, such as family function, parenting style, and self-efficacy, that may be related to QoL were not included in this study. Future studies should explore more variables to develop a more comprehensive understanding of the factors influencing QoL in adolescents with CKD.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study illustrates that FMA and TR are important influencing factors of QoL in adolescents with CKD, with TR mediating the relationship between FMA and QoL. Our findings highlight the importance of designing interventions to support FMA and foster TR in optimizing QoL in this vulnerable population. By integrating family-centered care and transition skills training into routine clinical practice, clinicians can help adolescents with CKD lead more fulfilling and healthier lives.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCKD\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Chronic kidney disease\u003c/p\u003e\n\u003cp\u003eGFR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Glomerular filtration rate\u003c/p\u003e\n\u003cp\u003eESRD\u0026nbsp; \u0026nbsp;\u0026nbsp;End-stage renal disease\u003c/p\u003e\n\u003cp\u003eQoL\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Quality of life\u003c/p\u003e\n\u003cp\u003eFMA\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Family management adjustment\u003c/p\u003e\n\u003cp\u003eTR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Transition readiness\u003c/p\u003e\n\u003cp\u003eFaMM \u0026nbsp; Family Management Measure\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024) KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. 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Adv Chronic Kidney Dis 28(6):570-576. https://doi.org/10.1053/j.ackd.2021.10.002\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"368\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eDemographic and clinical information of the sample\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e(%)/\u003cem\u003eM\u003c/em\u003e\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12.62\u0026plusmn;2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Male\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e187 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Female\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e167 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eNumber of children in the household\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; One-child\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e121 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Multiple-child\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e233 (65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eFamily location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Rural area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e151 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Urban area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e203 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eFamily income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le; ￥5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e83 (23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; ￥5001-10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e218 (61.6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt;￥10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003ePaternal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Junior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e172 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e96 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; University degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e86 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eMaternal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Junior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e194 (54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e79 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; University degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e81 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003ePaternal employment status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e342 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eMaternal\u0026nbsp;employment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e243 (68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026nbsp; Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e111 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eCKD duration (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21.31\u0026plusmn;31.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eNumber of medicines used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.15\u0026plusmn;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e median, \u003cem\u003eSD\u003c/em\u003e standard deviation, CKD chronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"859\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"15\" valign=\"top\" style=\"width: 859px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eCorrelations among family management adjustment, transition readiness, and quality of life.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e1. Child\u0026rsquo;s daily life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e17.11\u0026plusmn;3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e2. Management ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e42.03\u0026plusmn;5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.323\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e3. Parental mutuality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e33.40\u0026plusmn;4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.247\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.344\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e4. Total FMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e92.55\u0026plusmn;10.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.656\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.806\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.727\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e5. Self-management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12.38\u0026plusmn;4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.187\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.253\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.276\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.328\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e6. Disease knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;8.95\u0026plusmn;3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.186\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.178\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.278\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.290\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.542\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e7. Provider communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14.36\u0026plusmn;4.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.287\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.237\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.192\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.320\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.434\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.369\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e8. Total TR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.66\u0026plusmn;9.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.282\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.284\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.315\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.398\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.827\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.780\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.771\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e9. Physical functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e59.98\u0026plusmn;16.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.332\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.109\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.307\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.321\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.267\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.403\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.489\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.492\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e10. Emotional functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e56.34\u0026plusmn;17.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.283\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.164\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.276\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.317\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.201\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.311\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.369\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.373\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.584\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e11. Social functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e62.33\u0026plusmn;17.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.312\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.213\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.180\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.311\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.244\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.361\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.438\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.442\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.581\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.527\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e12. School functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e50.14\u0026plusmn;19.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.372\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.158\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.170\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.300\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.311\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.399\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.525\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.524\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.603\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.557\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.600\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e13. Total QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e57.20\u0026plusmn;14.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.395\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.196\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.279\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.377\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.312\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.447\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.553\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.556\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.829\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.804\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.819\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.849\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"15\" valign=\"top\" style=\"width: 859px;\"\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; .05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; .01, FMA family management adjustment, TR transition readiness, QoL quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"670\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" valign=\"top\" style=\"width: 670px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eHierarchical Regression Models Predicting the QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003ePredictors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e2.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e3.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eNumber of medicines used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e-6.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e-0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e-6.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e6.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e3.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eTR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e9.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e23.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e32.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e52.775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eAdjusted \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" valign=\"top\" style=\"width: 670px;\"\u003e\n \u003cp\u003eQoL quality of life, FMA family management adjustment, TR transition readiness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"620\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 620px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eMediation of TR between FMA and QoL (n = 354).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eEffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003ea: Effect of FMA on TR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003eb: Effect of TR on QoL after adjustment for FMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e9.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003ec: Total effect of FMA on QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003ec\u0026rsquo;: Direct effects of FMA on QoL after adjustment for TR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 297px;\"\u003e\n \u003cp\u003ea*b: Indirect effect of TR in the relationship between FMA and\u0026nbsp;QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 620px;\"\u003e\n \u003cp\u003eFMA family management adjustment, TR transition readiness, QoL quality of life, \u003cem\u003eSE\u003c/em\u003e standard error, CI confidence interval, LLCI lower level of confidence interval, ULCI upper level of confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic kidney disease, Adolescents, Family management adjustment, Transition readiness, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-8205356/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8205356/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe long-term management of chronic kidney disease (CKD) in adolescents places a heavy burden on their families; it also adversely affects adolescents' quality of life (QoL). Family management adjustment (FMA) and transition readiness (TR) have been identified as important protective factors for QoL among adolescents. However, the mechanisms linking FMA to QoL in adolescents with CKD remain unclear, particularly regarding the potential role of TR. This study aimed to explore the association between FMA and QoL in adolescents with CKD and verify the mediating effect of TR in this relationship. A total of 354 adolescents with CKD aged 10–18 and their parents were recruited for the study. The FMA and sociodemographicdata were reported by the parents, while the adolescents self-reported their TR and QoL. Bivariate correlations, hierarchical regressions, and mediation analysis were the statistical analyses performed. The results showed that FMA, TR, and QoL were significantly positively correlated. Mediation analysis confirmed that TR partially mediated the relationship between FMA and QoL.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusion\u003c/em\u003e: This study demonstrates that FMA enhances QoL in adolescents with CKD both directly and indirectly through improving TR. These findings highlight the importance of supporting FMA and fostering TR in clinical practice to optimize QoL in this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Family management adjustment and quality of life in adolescents with chronic kidney diseases: The mediating role of transition readiness","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-05 10:01:48","doi":"10.21203/rs.3.rs-8205356/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d49f22d5-7828-4173-8229-29a7539c4600","owner":[],"postedDate":"December 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-24T13:39:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-05 10:01:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8205356","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8205356","identity":"rs-8205356","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}