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The Oxford Ankle Foot Questionnaire for children: responsiveness and longitudinal validity

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Abstract

Purpose

To evaluate how scores from the Oxford Ankle Foot Questionnaire change over time and with treatment using both distribution-based and anchor-based approaches.

Methods

Eighty children aged 5–16 and their parent or carer completed questionnaires at orthopaedic or trauma outpatient clinics. They were asked to complete and return a second set of questionnaires again within 2 weeks (retest), and then mailed a third set of questionnaires to complete again after 2 months (follow-up). The follow-up questionnaires included a global rating of change ‘transition’ item.

Results

Child- and parent-reported mean domain scores (Physical, School & Play, and Emotional) were all stable at retest, whereas positive mean changes were observed at follow-up. As we hypothesised, trauma patients had poorer scores than elective patients at baseline, and showed greater improvement at follow-up. For trauma patients, mean changes in per cent scores were large (scores improved between 40 and 56 for the Physical and School & Play domains, and 17 and 21 for Emotional); all effect sizes (ES) were large (>0.8). For elective patients, the mean improvement in per cent scores were more moderate (Physical: child 10, ES = 0.4, parent 11, ES = 0.5; School & Play child 0, ES = 0, parent 9 ES = 0.4; Emotional: child 6, ES = 0.2; parents 8, ES > 0.3). Minimal detectable change (MDC90), an indication of measurement error, ranged from 6 to 8. Half the standard deviation of baseline scores ranged from 11 to 18. Minimal important difference could only be calculated for elective patients (9 child and 13 parent ratings), these ranged from 7 to 17.

Conclusions

The findings support the responsiveness and longitudinal validity of the scales. Changes in domain scores of, or exceeding, the MDC90 (6–8) are likely to be beyond measurement error; further work is required to refine the estimate of change that can be considered important.

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References

  1. Morris, C., Liabo, K., Wright, P., & Fitzpatrick, R. (2007). Development of the Oxford ankle foot questionnaire: Finding out how children are affected by foot and ankle problems. Child: Care, Health and Development, 33(5), 559–568.

    Article  CAS  Google Scholar 

  2. Morris, C., Doll, H., Wainwright, A., Theologis, T., & Fitzpatrick, R. (2008). Development of the Oxford ankle foot questionnaire for children: scaling, reliability and validity. Journal of Bone and Joint Surgery Br, 90B(11), 1451–1456.

    Article  Google Scholar 

  3. Guyatt, G. H., Kirshner, B., & Jaeschke, R. (1992). Measuring health status: What are the necessary measurement properties? Journal of Clinical Epidemiology, 45(12), 1341–1345.

    Article  CAS  PubMed  Google Scholar 

  4. Streiner, D. L., & Norman, G. R. (2008). Health measurement scales: A practical guide to their development and use (4th ed.). Oxford: Oxford University Press.

    Google Scholar 

  5. Cohen, J. (1988). Statistical power analysis for the behavioural sciences. New Jersey: Lawrence Earlbaum.

    Google Scholar 

  6. Haley, S. M., & Fragala-Pinkham, M. A. (2006). Interpreting change scores of tests and measures used in physical therapy. Physical Therapy, 86(5), 735–743.

    PubMed  Google Scholar 

  7. Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status. Ascertaining the minimal clinically important difference. Control Clinical Trials, 10(4), 407–415.

    Article  CAS  Google Scholar 

  8. Norman, G. R., Wyrwich, K. W., & Patrick, D. L. (2007). The mathematical relationship among different forms of responsiveness coefficients. Quality of Life Research, 16(5), 815–822.

    Article  CAS  PubMed  Google Scholar 

  9. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592.

    Article  PubMed  Google Scholar 

  10. Revicki, D. A., Cella, D., Hays, R. D., Sloan, J. A., Lenderking, W. R., & Aaronson, N. K. (2006). Responsiveness and minimal important differences for patient reported outcomes. Health & Quality of Life Outcomes, 27(4), 70.

    Article  Google Scholar 

  11. Ravens-Sieberer, U., & The Kidscreen Group Europe. (2006). The kidscreen questionnaires–handbook. Lengerich: Pabst Science Publishers.

    Google Scholar 

  12. Fitzpatrick, R., Davey, C., Buxton, M. J., & Jones, D. R. (1998). Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment, 2(14), 1–74.

    CAS  PubMed  Google Scholar 

  13. Revicki, D., Hays, R. D., Cella, D., & Sloan, J. (2008). Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. Journal of Clinical Epidemiology, 61(2), 102–109.

    Article  PubMed  Google Scholar 

  14. Eiser, C., & Morse, R. (2001). Can parents rate their child’s health-related quality of life? Results of a systematic review. Quality of Life Research, 10(4), 347–357.

    Article  CAS  PubMed  Google Scholar 

  15. Young, N. L., Williams, J. I., Yoshida, K. K., & Wright, J. G. (2000). Measurement properties of the activities scale for kids. Journal of Clinical Epidemiology, 53(2), 125–137.

    Article  CAS  PubMed  Google Scholar 

  16. Daltroy, L. H., Liang, M. H., Fossel, A. H., & Goldberg, M. J. (1998). The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric outcomes instrument development group. Pediatric Orthopaedic Society of North America. Journal of Pediatric Orthopedics, 18(5), 561–571.

    Article  CAS  PubMed  Google Scholar 

  17. Hays, R. D., Morales, L. S., & Reise, S. P. (2000). Item response theory and health outcomes measurement in the 21st century. Medical Care, 38(9), II28–II42.

    CAS  PubMed  Google Scholar 

  18. Reise, S. P., & Waller, N. G. (2009). Item response theory and clinical measurement. Annu Rev Clin Psychol, 5, 27–48.

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to the children and families who participated, to nurses Bridget Gray and Lisa Fox for helping with recruitment, to Clare Shakeshaft for data entry, and to Andy King for assistance with data management.

Funding

This study was funded by the UK Medical Research Council through a Research Training Fellowship in Health Services Research held by Dr. Morris.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Public Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK

    Christopher Morris, Helen Doll & Ray Fitzpatrick

  2. Nuffield Orthopaedic Centre, Oxford, UK

    Christopher Morris, Andrew Wainwright & Tim Theologis

  3. Nuffield Department of Orthopaedic Surgery, University of Oxford, Oxford, UK

    Neville Davies, Andrew Wainwright, Tim Theologis & Keith Willett

  4. Kadoorie Centre, John Radcliffe Hospital, Oxford, UK

    Neville Davies & Keith Willett

Authors
  1. Christopher Morris
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  2. Helen Doll
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  3. Neville Davies
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  4. Andrew Wainwright
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  5. Tim Theologis
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  6. Keith Willett
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  7. Ray Fitzpatrick
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Corresponding author

Correspondence to Christopher Morris.

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Morris, C., Doll, H., Davies, N. et al. The Oxford Ankle Foot Questionnaire for children: responsiveness and longitudinal validity. Qual Life Res 18, 1367–1376 (2009). https://doi.org/10.1007/s11136-009-9550-7

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  • DOI: https://doi.org/10.1007/s11136-009-9550-7

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