Pediatric outcomes research: development of an outcomes instrument for tonsil and adenoid disease

Comparison of two specific quality of life questionnaires in a paediatric population with adenotonsillar disease

INTRODUCTION AND OBJECTIVE

T-14 and TAHSI are validated and reliable specific questionnaires which measure the quality of life in paediatric patients with adenotonsillar disease. The present study aims to compare the adapted and validated versions in Spanish of these two questionnaires (T-14-s and s-TAHSI) in order to assess the preferential use of either of them in our environment.

MATERIAL AND METHODS

A multicentre prospective cross-sectional study was carried out between November 2015 and April 2016, to determine the possible correlation between these two instruments. Subjects aged from 2 to 16 years with indication for adenotonsillar surgery and healthy controls, were consecutively included. Parents or caregivers of these children completed T-14-s and s-TAHSI questionnaires initially, after 2-6 weeks and at 6 months after surgery. T-14-s and s-TAHSI scores of the entire sample were compared globally, patient and control subgroups were compared separately and finally, compared in the group of patients at 6 months from surgery, using Pearson correlation coefficient. The proportion of variability shared between both tests was calculated.

RESULTS

A hundred subjects (50 cases and 50 controls) were studied. The overall correlation presented by both questionnaires was very high (0.97) with a significance level of p < .01. The proportion of shared variability was 94%, very high. The results were maintained when comparing the questionnaires in the subpopulations of cases and controls, as well as the postoperative questionnaires.

CONCLUSION

Quality of life questionnaires for paediatric patients with adenotonsillar pathology, T-14-s and s-TAHSI, showed high correlation and allows the equivalent use of both in our environment.

Quality of life in children with sleep-disordered breathing: evaluation by OSA-18

Sleep-disordered breathing (SDB) is prevalent. There is evidence of their effect on quality of life.

AIM

To assess the quality of life in children with SDB before and after adenoidectomy or adenotonsillectomy.

METHODS

A prospective before and after interventional study, with a component for assessment. A consecutive sample of children referred to adenoidectomy or adenotonsillectomy was recruited from the otolaryngology clinic; guardians answered a specific survey for the evaluation of quality of life in children with SDB, the OSA-18, before and at least 30 days after surgery. Nasofibroscopic and otolaryngological exams and a semi-structured survey on the childs social and clinical profile were done on both appointments.

RESULTS

48 children with a mean age of 5.93 years (SD=2.43) were evaluated. The mean number of schooling years for guardians was 8.29 years (SD=3.14). The most frequent symptoms were: agitated sleep, apnea and snoring. The total mean score of the initial OSA-18 was 82.83 (major impact); following surgery, the total mean score was 34.15. The differences in the total scores and in the domains between the initial OSA-18 and post-surgery scores were all significant (p<0.00).

CONCLUSION

SDB has a relevant impact on quality of life, and patients show dramatic improvements after surgical treatment.

Qualidade de vida em crianças com distúrbios obstrutivos do sono: avaliação pelo OSA-18

Distúrbios obstrutivos do sono (DOS) são prevalentes e existem evidências de afetarem a qualidade de vida das crianças. OBJETIVO: Avaliar a qualidade de vida de crianças com DOS antes e após adenoidectomia ou adenotonsilectomia. MATERIAL E MÉTODOS: Estudo prospectivo de intervenção, tipo antes e após, com componente avaliativo. Foi recrutada uma amostra consecutiva de crianças com indicação de adenoidectomia ou adenotonsilectomia em um ambulatório de otorrinolaringologia e aplicado aos cuidadores um questionário específico para a avaliação da qualidade de vida, o OSA-18, antes da cirurgia e com pelo menos 30 dias após. Foi realizado exame nasofibroscópico, otorrinolaringológico e questionário semi-estruturado sobre o perfil clínico e social da criança, em ambas as consultas. RESULTADOS: Foram avaliadas 48 crianças com média de idade de 5,93 anos (DP=2,43). A média de escolaridade do cuidador foi de 8,29 anos (DP=3,14). Os sintomas mais freqüentes foram: sono agitado, apnéia e ronco. A média de escore total do OSA-18 basal foi de 82,83 (grande impacto) e no pós-operatório, de 34,15. As diferenças nos escores total e dos domínios entre o OSA-18 basal e pós-operatório foram todas significantes (p<0,00). CONCLUSÃO: DOS apresentam impacto relevante na qualidade de vida e melhoram consideravelmente após o tratamento cirúrgico.

Quality of life after surgical treatment of children with obstructive sleep apnea: long-term results

OBJECTIVES

To measure the long-term impact of tonsillectomy and/or adenoidectomy (T&A) on children with obstructive sleep apnea (OSA).

METHODS

A controlled study on 101 OSA children, operated between June 1999 and January 2001. The OSD-6 was used to assess the results. The caregivers of these patients were asked about their subjective impression prior to surgery (first evaluation), 8 days after the procedure (second evaluation), and with a minimum follow-up of 3 years after the operation (third evaluation).

RESULTS

Mean of follow-up was 61.9+/-13.1 months (range, 36-75 months). The total mean survey score showed a highly significant improvement when comparing first evaluation versus second evaluation, first evaluation versus third evaluation, and second evaluation versus third evaluation (p<0.001). In the same way, we found a favourable outcome in the six domains when visits were compared. Only sleep disturbance between second and third evaluation did not show a significant improvement (p>0.05). There were not differences in the postsurgical outcome of quality of life (QOL) according to the remaining factors studied (p>0.05).

CONCLUSIONS

Children with OSA who undergo surgery show a significant long-term improvement in QOL.

Benefit from tonsillectomy in adult patients with chronic tonsillitis

The objective of this study was to determine the benefits of tonsillectomy in adult patients with chronic tonsillitis with special emphasis on the influence of age and gender. Cross-sectional survey analysis of patients at least 1 year after undergoing adult tonsillectomy at a university department. We used the Glasgow Benefit Inventory and a specifically constructed illness inventory (Specific Benefits from Tonsillectomy Inventory). One hundred and nine patients completed the survey. Significant improvements were demonstrated in three out of four GBI scores ['total score' (+16.9), 'general health' (+12.9), 'physical functioning' (+46.6), all P<0.0001] and in all SBTI scores ['symptom change' (+58.3), 'reduced use of resources' (+70.9), 'general benefit' (+52.1), all P<0.0001]. Gender did not play a significant role in benefit evaluation whereby younger patients evaluated the surgery as more beneficial than older patients. Adult patients with chronic tonsillitis definitely benefit significantly from tonsillectomy. Younger adult patients perceived greater surgical benefits than older adult patients. Patient gender did not significantly influence tonsillectomy benefit evaluation.

The impact of recurrent acute otitis media on the quality of life of children and their caregivers

OBJECTIVE

To assess the quality of life of 384 Dutch children aged 1-7 years with recurrent acute otitis media (AOM), and compare it with that of children from four reference populations: (i) children from a general population; (ii) children with mild-to-moderate asthma, (iii) children with mild-to-moderately severe chronic illness, and (iv) US children with persistent or recurrent otitis media.

DESIGN

Survey.

SETTING

A general and an academic hospital (study population of children with recurrent AOM, n = 384); general population (n = 225 and 117); primary care (children with asthma, n = 64); community care (children with chronic illness, n = 82); and a general hospital (children with persistent or recurrent otitis media, n = 169).

PARTICIPANTS

A total of 384 children aged 1-7 years who had experienced at least two episodes of AOM in the preceding year and their caregivers.

MAIN OUTCOME MEASURES

Generic and disease-specific quality of life as judged by the children's caregivers. Age-adjusted total and subscale scores were compared with those of the reference populations.

RESULTS

For all generic questionnaires, children with recurrent AOM had poorer scores than children from the general population. Quality of life of children with four or more episodes of AOM in the preceding year was poorer than that of children with two to three episodes. Children with recurrent AOM scored lower on the health-related questionnaire than children with mild-to-moderately severe chronic illness. Quality of life of the present study population was similar to those of children with asthma and US children with chronic otitis media with effusion or recurrent AOM.

CONCLUSION

Recurrent AOM has a considerable negative impact on the quality of life of children and causes concern to their caregivers. These effects are proportional to the severity of the condition. Professionals involved in the care of children with OM should be aware that OM not only affects physical functioning but also general well-being of the child and its family. These outcomes should therefore be included in the evaluation of the child with otitis media both in the clinical and research setting.

Health-related quality of life in children with otitis media

BACKGROUND

Growing interest in health-related quality of life (HRQoL) in children with otitis media has brought the need to study the currently available HRQoL instruments with respect to their results and their applicability in clinical practice and research of otitis media.

OBJECTIVE

To review existing literature on health-related quality of life research in children with otitis media with respect to: (1) the measured impact of otitis media on HRQoL; and (2) the applicability of HRQoL instruments used in research and clinical practice based on their characteristics and contents.

METHODS

A search was performed in EMBASE (1988-November 2004) and on NLM Gateway (1966-November 2004) for studies assessing health-related quality of life or functional health status by means of disease-specific or generic questionnaires in children aged 0-18 years with chronic or recurrent otitis media with effusion or acute otitis media. The bibliographies of the selected articles were searched manually.

RESULTS

Only 13 of the 141 retrieved articles retrieved fulfilled the criteria for inclusion. In these studies, physical suffering (pain, high fever, etc.), difficulties with hearing or speech, behavioural problems, or emotional distress were reported to be the most important problems experienced by children with otitis media. Almost all instruments applied in these studies measure functional health status instead of health-related quality of life. Data on validity and reliability of these instruments are incomplete.

CONCLUSIONS

Recurrent or chronic otitis media is reported to have a substantial and negative effect on various domains of functional health status and health-related quality of life of children. The OM-6 appears to be the best available instrument to assess functional health status in children with OM in a research setting. However, the lack of true HRQoL instruments as well as incomplete data on their reliability and validity, limit both our current knowledge of HRQoL in OM and the application of current instruments in both research and clinical practice.

Development of a condition-specific measure of quality of life for children with cerebral palsy: empirical thematic data reported by parents and children

BACKGROUND

Although there is increasing recognition that quality of life (QOL) and health-related quality of life (HRQOL) are important outcome variables in clinical trials for children with cerebral palsy, there are substantial limitations in existing measures of QOL. This study identify themes of QOL for children with cerebral palsy and their parents to guide the development of a new condition-specific QOL scale.

METHODS

A qualitative study of parent and child views on QOL composition was conducted, using a grounded theory framework. Families participated in semistructured interviews on QOL until thematic saturation was reached (n = 28 families).

RESULTS

Overall, 13 themes emerged from the interviews: physical health, body pain and discomfort, daily living tasks, participation in regular physical and social activities, emotional well-being and self-esteem, interaction with the community, communication, family health, supportive physical environment, future QOL, provision of, and access to services, financial stability, and social well-being.

CONCLUSIONS

Research with parents and children with cerebral palsy, representative of severity across the disease spectrum and socio-economic status, reinforced and expanded on the traditional themes that have underpinned QOL measurement development. This has implications not only for the development of a new QOL scale for children with cerebral palsy, but also for clinical interventions and community care management.

Evaluation of sleep-disordered breathing in children

OBJECTIVE

We evaluated changes in disease-specific quality of life (QOL) for children with sleep-disordered breathing (SDB).

PATIENTS, DESIGN, AND SETTING

We conducted a cohort study in 69 children (age range, 6 months to 13 years; median age, 6.1 years) from a hospital-based pediatric otolaryngology practice in a metropolitan area. We used the OSA-18, an 18-item QOL survey with known test-retest reliability, internal consistency, and construct validity. Survey domains included sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns.

INTERVENTION

Tonsillectomy or adenoidectomy was performed as part of routine clinical care. The OSA-18 was completed at entry by the child's caregiver and again at least 4 weeks after surgery.

MAIN OUTCOME MEASURES

The validity of the OSA-18 change score was assessed by comparison with multiple external constructs, including a validated measure of longitudinal change (OSD-6 survey). Responsiveness was assessed by the standardized response mean (SRM).

RESULTS

The mean baseline OSA-18 survey score was 3.1 (SD, 0.9) of a maximum 7.0, with higher values indicating poorer QOL. Change scores were available for all children, with a mean interval between preoperative and postoperative surveys of 61 days (range, 42 to 92 days). The mean OSA-18 change score of 1.14 (SD, 0.71) showed significant correlation with tonsil size (r = 0.40), adenoid size (r = 0.31), OSD-6 change scores (r = 0.71), and the direct caregiver estimates of change (r = 0.34). OSA-18 change scores showed large responsiveness to change (SRM 1.44; 95% confidence interval, 1.16 to 69), with the most responsive domains being sleep disturbance, physical suffering, and caregiver concerns. Significant responsiveness was also demonstrated for the domains of daytime problems and emotional distress.

CONCLUSIONS

The OSA-18 is a valid, reliable, and responsive QOL measure that combines the advantages of a discriminative and evaluative survey in a single instrument. The OSA-18 is a useful measure of patient-based outcomes for clinical trials, health services research, and routine clinical care.

Tutorials in clinical research: part V: outcomes research

OBJECTIVES

This is the fifth in a series of sequential "Tutorials in Clinical Research." The objective of the present report is to give the reader a broad overview of the field of outcomes research. This summary is intended to enable the reader to understand outcomes research methodology and to start the design of an outcomes research study.

STUDY DESIGN

Tutorial.

METHODS

The authors developed the report from available materials and refined it to be concise but complete for use by the practicing clinician.

RESULTS

We describe the basic steps of record-based and patient-based outcomes research, including development of a staging system, identification of comorbid conditions, and creation or identification of an outcomes instrument.

CONCLUSION

Outcomes research is a unique methodology that uses patient-based outcomes to assess the effectiveness of medical treatment.