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Parent-reported health outcomes in infants/toddlers: measurement properties and clinical validity of the ITQOL-SF47

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Abstract

Purpose

To derive and evaluate a shorter infant/toddler quality of life questionnaire (ITQOL) for use in clinical care.

Methods

Stepwise regression, factor analysis, and item-scaling principles were used to derive and guide item selection using data from a large general sample in the Netherlands (n = 5,211) and a “wheezing illness” sample (n = 138). Item internal consistency, discriminant validity, and floor and ceiling effects were evaluated using a general Dutch sample (Salland Region n = 410) and two clinical samples: Functional abdominal pain (FAP, n = 81) and Burn (n = 194). Reliabilities were estimated using Cronbach’s alpha. Relative precision (RP), the ability to distinguish between clinical subgroups, was computed by comparing the proportion of variance explained by the short-form scales versus respective full-length scales.

Results

The ITQOL was reduced from 97 to 47 items. Median alpha coefficients were 0.77 Salland sample, 0.76 (FAP), and 0.84 (Burn). Ninety-one to 100 % scaling successes for item discriminant validity were observed for 21 of 24 tests (8 scales, 3 samples). Floor effects were not observed; some ceiling effects were detected. RP estimates in the Salland sample ranged from 2.40 (physical abilities) to 0.58 (temperament and moods). RP estimates in the FAP sample were 0.85 (bodily pain), 1.36 (temperament and moods) and 1.62 (parental-impact emotional) and for Burn, 1.51 (temperament and moods) and 0.59 (general health perceptions).

Conclusion

The ITQOL-SF47 is reliable and valid and exceeds item-level scaling criteria.

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Abbreviations

FAP:

Functional abdominal pain

HRQOL:

Health-related quality of life

ITQOL:

Infant/toddler quality of life questionnaire

ITQOL-SF47:

Infant/toddler quality of life questionnaire short form 47

PRO’s:

Patient-reported outcomes

RP:

Relative precision

References

  1. www.fda/gov/downloads/drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282.pdf. Last accessed 12 June 2011.

  2. European Commission—Enterprise and Industry—Pharmaceuticals—Medicines for Children. The 17th annual conference of the international society for quality of life research, October 27–30, 2010. Panel discussion: Ensuring adequate health assessments for national and international health policy decision-making. London, United Kingdom, http://ec.europa.eu. Last accessed 12 June 2011. www.ema.europa.eu.

  3. Raat, H., Mohangoo, A. D., & Grootenhuis, M. A. (2006). Pediatric health-related quality of life questionnaires in clinical trials. Current opinion in Allergy and Clinical Immunology, 6(3), 180–185.

    Article  PubMed  Google Scholar 

  4. Landgraf, J. M., & Abetz, L. (1994). The Infant/toddler quality of life questionnaire: Conceptual framework, logic, content, and preliminary psychometric results. Final proprietary report to Schering-Plough laboratories and health technology associates. Boston, MA: New England Medical Center.

    Google Scholar 

  5. Williams, D. L., Gelijns, A. C., Moskowitz, A. J., Weinberg, A. D., Ng, J. H., Crawford, E., et al. (2000). Hypoplastic left heart syndrome: Valuing the survival. Journal of Thoracic and Cardiovascular Surgery, 119(4 Pt 1), 720–731.

    Article  PubMed  CAS  Google Scholar 

  6. Klassen, A. F., Landgraf, J. M., Lee, S. K., Barer, M., Raina, P., & Chan, H. W., et al. (2003). Health related quality of life in 3 and 4 year old children and their parents: Preliminary findings about a new questionnaire. Health and Quality of Life Outcomes, 1, 81.

  7. Cole, C. R., Bucuvalas, J. C., Hornung, R. W., Krug, S., Ryckman, F. C., Atherton, H., et al. (2004). Impact of liver transplantation on HRQOL in children less than 5 years old. Pediatric Transplantation, 8(3), 222–227.

    Article  PubMed  Google Scholar 

  8. Oostenbrink, R., Jansingh-Piepers, E. M., Raat, H., Nuijsink, M., Landgraf, J. M., Essink-Bot, M. L., et al. (2006). Health related quality of life of pre-school children with wheezing illness. Pediatric Pulmonology, 41, 993–1000. doi:10.1002/ppul.20486.

    Article  PubMed  CAS  Google Scholar 

  9. van Baar, M. E., Essink-Bot, M. L., Oen, I. M., Dokter, J., Boxma, H., Hinson, M. I., et al. (2006). Reliability and validity of the health outcomes burn questionnaire for infants and children in The Netherlands. Burns, 32(3), 357–365.

    Article  PubMed  Google Scholar 

  10. Raat, H., Landgraf, J. M., Oostenbrink, R., Moll, H. A., & Essink-Bot, M. L. (2007). Reliability and validity of the infant and toddler quality of life questionnaire (ITQOL) in a general population and respiratory disease sample. Quality of Life Research, 16(3), 445–460.

    Article  PubMed  Google Scholar 

  11. Oostenbrink, R., Spong, K., de Goede-Bolder, A., Landgraf, J. M., Raat, H., & Moll, H. A. (2007). Health- related quality of life in a sample of young children with neurofibromatosis type 1: Influence of condition specific determinants. Journal of Pediatrics, 151, 182–186. Published Online: 10.1016/j.jpeds.2007.03.005.

    Google Scholar 

  12. Alonso, E. M., Neighbors, K., Barton, F. B., McDiarmid, S. V., Dunn, S. P., Mazariegos, G. V., Landgraf, J. M., Bucuvalas, J. C., & The Studies of Pediatric Liver Transplant Research Group. (2008). Health related quality of life and family function following pediatric liver transplantation. Liver Transplantation, 14, 460–468. Published Online: March 26 2008. doi:10.1002/lt.21352.

    Google Scholar 

  13. Oostenbrink, R., Jongman, H., Landgraf, J. M., Raat, H., & Moll, H. A. (2010). Functional abdominal complaints in pre-school children: Parental reports of health related quality of life. Quality of Life Research, 19(3), 363–369. doi:10.1007/s11136-009-9583-y. 0962-9343 (print) 1573-2649 (online).

  14. Raat, H., van Rossem, L., Jaddoe, V. W. V., Landgraf, J. M., Feeny, D., Moll, H. A., Hofman, A., & Mackenbach, J. P. (2010). The Generation R study: A candidate gene study and genome wide association studies (GWAS) on health-related quality of life (HRQOL) of mothers and young children. Quality of Life Research, 19(10), 1439–1446. Epub 2010 Oct 28. doi:10.1007/s11136-010-9773-7.

  15. Spuijbroek, A. T., Oostenbrink, R., Landgraf, J. M., Rietveld, E., de Goede-Bolder, A., van Beeck, E. F., van Baar, M., Raat, H., & Moll, H. A. (2011). Health related quality of life profiles for five childhood diseases. Quality of Life Research, 20, 779–786. doi:10.1007/s11136-010-9806-2.

  16. Fekkes, M., Theunissen, N. C. M., Brugman, E., Veen, S., Verrips, E. G. H., Koopman, H. M., et al. (2000). Development and psychometric evaluation of the TAPQOL: A health related quality of life instrument for 1–5-year-old children. Quality of Life Research, 9, 961–972.

    Article  PubMed  CAS  Google Scholar 

  17. Rajmil, L., Abad, S., Sardon, O., Moerea, G., Perez-Yara, E. G., Moreno, A., Detmar, S., Fekkes, M., Herdman, M., & Alonso, J. (2011). Reliability and validity of the Spanish version of the TAPQOL: A health-related quality of life (HRQOL) instrument for 1-to 5-year-old children. International Journal of Nursing Studies, 48(5), 549–556.

    Google Scholar 

  18. Varni, J. W., Limbers, C. A., Neighbors, K., Schulz, K., Lieu, J. E. C., Heffer, R. W., Tuzinkiewicz, K., Mangione-Smith, R., Zimmerman, J. J., & Alonso, E. M. (2011). The PedsQL infant scales: Feasibility, internal consistency reliability and validity in healthy and ill infants. Quality of Life Research, 20, 45–55. doi:10.1007/s11136_010-9730-5.

    Google Scholar 

  19. Saigal, S., Rosenbaum, P., Stoskopf, B., et al. (2005). Development, reliability and validity of a new measure of overall health for pre-school children. Quality of Life Research, 14, 243–257.

    Article  PubMed  CAS  Google Scholar 

  20. Landgraf, J. M., Maunsell, E., Nixon-Speechley, K. N., Bullinger, M., Campbell, S., Abetz, L., et al. (1998). Canadian-French, German and United Kingdom versions of the child health questionnaire (CHQ-PF50): Methodology and preliminary item scaling results. Quality of Life Research, 7(5), 433–445.

    Article  PubMed  CAS  Google Scholar 

  21. World Health Organization. (1948). Constitution of the world health organization. Geneva, Switzerland: WHO Basic Documents.

  22. American Academy of Pediatrics. (1998). Guidelines for health supervision II. Chicago IL.

  23. Caplan, F., & Caplan, T. (1993 and 1995). The first twelve months of life: Your baby’s growth month by month. New York: Putnam Publishing Group.

  24. Caplan, F., & Caplan, T. (1997 and 1980). The second twelve months of life: Your baby’s growth month by month. New York: Bantam NY, Grosset and Dunlap a Subsidiary of Putnam Publishing Group.

  25. Confidential Scoring Rules, Infant Toddler Quality of Life Questionnaire. (2008). Boston, MA: HealthActCHQ.

  26. Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., et al. (2005). Principles of good practice for the translation and cultural adaptation process for patient- reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2), 94–104.

    Article  PubMed  Google Scholar 

  27. Stewart, A. L., & Ware, J. E. (1992). Measuring functioning and well-being the medical outcomes study approach. Durham, NC: Duke University Press.

  28. Ware, J. E., Harris, W. J., Gandek, B., Rogers, B. W., & Reese, P. R. (1997). MAPR for windows version 1.1. Boston, MA: Health Assessment Lab.

  29. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334.

    Article  Google Scholar 

  30. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York, NY: McGraw-Hill.

    Google Scholar 

  31. Landgraf, J. M. (2007). Measuring quality of life in pediatric enuresis: Precision and sensitivity of a new short-form for use in clinical care. Journal of Pediatric Urology, 3(2), 109–117.

    Article  PubMed  Google Scholar 

  32. Buckstein, D. A., McGrath, M. M., Buchner, D. A., Landgraf, J. M., & Goss, T. P. (2000). Evaluation of a short- form for measuring health related quality of life among pediatric wheezing illness patients. The Journal of Allergy and Clinical Immunology, 105, 245–251.

    Article  Google Scholar 

  33. McHorney, C. A., Ware, J. E., Rogers, W., Racek, A. E., & Lu, J. F. R. (1992). The validity and relative precision of MOS short-and-long-form health status scales and Dartmouth COOP Charts. Medical Care, 30, 253–265.

    Article  Google Scholar 

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Acknowledgments

None of the authors received financial compensation for this work nor do they have a conflict of interest to report. Ms. Landgraf is the vice president and chief scientific officer at HealthActCHQ, Inc., which owns the intellectual property rights to the ITQOL.

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Correspondence to Jeanne M. Landgraf.

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Landgraf, J.M., Vogel, I., Oostenbrink, R. et al. Parent-reported health outcomes in infants/toddlers: measurement properties and clinical validity of the ITQOL-SF47. Qual Life Res 22, 635–646 (2013). https://doi.org/10.1007/s11136-012-0177-8

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  • DOI: https://doi.org/10.1007/s11136-012-0177-8

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