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Klassen AF, Rae C, Bulstrode NW, Berenguer B, Cui C, Fisher DM, Kasrai L, Li Y, Lloyd M, Panchapakesan V, Pusic A, Reinsch J, Stewart K, Todd A, Frank R, Tsangaris E, Wang Y, Wong Riff KW, Zhang R, Cano S. An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions. J Plast Reconstr Aesthet Surg 2021; 74:2341-2348. [PMID: 33637465 DOI: 10.1016/j.bjps.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.
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Affiliation(s)
- Anne F Klassen
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Charlene Rae
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Neil W Bulstrode
- Dept of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Beatriz Berenguer
- Division of Pediatric Plastic Surgery, Hospital General Universitario Gregorio Maranon, Calle de O´Donnell 48, 28009, Madrid, Spain
| | - Chunxiao Cui
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - David M Fisher
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Leila Kasrai
- Department of Surgery, St Joseph's Health Centre, University of Toronto, 30 The Queensway, Toronto, ON M6R 1B5, Canada.
| | - Yiyuan Li
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China
| | - Mark Lloyd
- Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Ln, Birmingham B4 6NH, UK.
| | - Vivek Panchapakesan
- Dept of Surgery, William Osler Health System, 101 Humber College Blvd, Etobicoke, ON M9V 1R8, Canada
| | - Andrea Pusic
- Dept of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
| | - John Reinsch
- Dept of Pediatric Plastic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ken Stewart
- Dept of Plastic Surgery, Royal Hospital for Sick Children 9 Sciennes Rd, Edinburgh EH9 1LF, UK.
| | - Anna Todd
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Ryan Frank
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada.
| | - Elena Tsangaris
- Dept of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Yi Wang
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
| | - Karen Wy Wong Riff
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Ruhong Zhang
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - Stefan Cano
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
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A Single Surgeon's Experience of Starting a New Ear Reconstruction Service in the UK. J Craniofac Surg 2021; 32:1785-1787. [PMID: 33481469 DOI: 10.1097/scs.0000000000007452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Autologous ear reconstruction is known as one of the most difficult types of reconstruction to perform in plastic surgery. Very rarely is a trainee exposed to the level of complexity and variety of cases they will treat as a sole care provider in a tertiary care setting. This is because the learning curve is steep and those few surgeons that already perform ear reconstruction are limited in what technical experience they can offer trainees due to the plethora of factors competing against the surgeon. These include patient expectations, level of experience, length of anesthetic and accountability for results and complications. For this reason, once a plastic surgeon is nominated to provide autologous ear reconstruction, they face the daunting prospect of not only performing what is a very complex surgery with a very steep learning curve but also the judgment of their patients and colleagues. This paper charts the endeavors of the senior author to provide a service over the last 5 years. It will hopefully provide insight and context on setting up a service, dealing with complications, patient and peer expectations, and finally acknowledgment from both alike as experience is gained and excellence is reached.
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Willis J, Zeratkaar D, Ten Hove J, Rosenbaum P, Ronen GM. Engaging the Voices of Children: A Scoping Review of How Children and Adolescents Are Involved in the Development of Quality-of-Life-Related Measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:556-567. [PMID: 33840434 DOI: 10.1016/j.jval.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Patient-reported outcomes are increasingly recommended to guide patient care, develop and evaluate interventions, and modify health systems. However, not enough is known about whether and how children and adolescents, as "experts" in their own health and quality of life (QoL), are being engaged in the development of instruments. Our goals in this review were (1) to identify all QoL-related instruments that have included children and/or adolescents in the development of questionnaire content, including identification of themes and items; and (2) to report how this was done; and (3) to highlight those that used qualitative methods. METHODS MEDLINE and Embase were searched for child- or adolescent-completed QoL-related instruments, supplemented by hand-searching of relevant reviews until 2020. Original development papers were identified and retrieved when possible, from which instrument characteristics and details of qualitative development methods were extracted. RESULTS We identified 445 instruments, of which 88 used qualitative methods for content development. Interviews and focus groups were the most common methods. A variety of play techniques were used to engage the child and adolescent participants. The specific criteria for the inclusion of children and adolescents (age, developmental stage, duration, and nonclinical location) varied considerably. CONCLUSIONS Researchers frequently involve children and adolescents in qualitative methods when developing QoL-related measures; however, there is little information about the methods used. Better reporting of methodology, improved dissemination of methods guidelines, and research into optimal ways of including children and adolescents in the process of instrument development would be useful.
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Affiliation(s)
- Jessica Willis
- Department of Pediatrics, Western University, London, Ontario, Canada.
| | - Dena Zeratkaar
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Julia Ten Hove
- University of Waterloo, Department of Kinesiology, Warerloo, Ontario, Canada.
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Kamran R, Longmire NM, Rae C, Riff KWYW, Forrest CR, O’Hara J, Bulstrode N, Klassen AF. Concepts Important to Patients With Facial Differences: A Qualitative Study Informing a New Module of the FACE-Q for Children and Young Adults. Cleft Palate Craniofac J 2020; 58:1020-1031. [DOI: 10.1177/1055665620969589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient’s perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Justine O’Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Health-Related Quality of Life in Craniofacial Conditions: Concordance Between Child and Parent Reports. Ann Plast Surg 2020; 84:S295-S299. [PMID: 32049755 DOI: 10.1097/sap.0000000000002292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Craniofacial conditions (CFCs) profoundly influence health-related quality of life (HRQoL). In children with CFCs, patient-reported outcome measures have become an integral adjunct to more objective surgical outcome measures. Patient-reported outcome measures are designed to assess HRQoL domains. Few studies have evaluated parent and child agreement about HRQoL in the context of CFCs. The aims of this study were to explore the impact of CFCs on HRQoL domains in children and their parents and to determine whether patient and parent perspectives converge. METHODS The Craniofacial Conditions Quality of Life Scale (CFC-QoL) is a newly developed 5-domain survey available in child self-report and parent report and in English- and Spanish-language versions. The 5 domains are the following: social impact, psychological function, physical function, family impact, and appearance impact. Children with CFCs (ages 7-21 years) and parents of children with CFCs were recruited via the craniofacial care team clinic at a major metropolitan children's hospital. All children and parents completed the CFC-QoL Scale in their preferred language of English or Spanish. Scale internal consistencies were calculated for child patients and parents, for English and Spanish versions. Scores on the 5 domains were compared for children and parents across English versus Spanish versions. RESULTS For children with CFCs (N = 75), the sex was distributed almost equally. Patients were mostly Hispanic (69.3%), and their ages ranged from 7 to 21 years old (M = 13.2, SD = 3.62). The mean values for patient and parent scores were low, suggesting good HRQoL across all 5 domains. Pearson correlation coefficients were computed to explore the interrelationships between patient and parent report for each of the 5 CFC-QoL subscales. For the total sample, patient and parent scores were significantly and moderately positively correlated for all subscales. When analyzed separately based on sex, ethnicity, and diagnostic group, the correlation patterns were not identical to those found for the total sample. When analyzed separately for diagnostic group, there was less consistency in patterns, with patient-parent dyads showing different levels of agreement based on child's diagnostic grouping. CONCLUSIONS Although there is substantial agreement between parents and patients when considered on a group level, there is moderate agreement between patients and parents when considered at the dyadic level, underscoring the importance of measuring and considering both perspectives.
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Development of a New Patient-reported Outcome Measure for Ear Conditions: The EAR-Q. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1842. [PMID: 30324053 PMCID: PMC6181510 DOI: 10.1097/gox.0000000000001842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
Background: Patient-reported outcome measures are widely used to improve health services and patient outcomes. The aim of our study was to describe the development of 2 ear-specific scales designed to measure outcomes important to children and young adults with ear conditions, such as microtia and prominent ears. Methods: We used an interpretive description qualitative approach. Semi-structured qualitative and cognitive interviews were performed with participants with any type of ear condition recruited from plastic surgery clinics in Canada, Australia, United States, and United Kingdom. Participants were interviewed to elicit new concepts. Interviews were audio-recorded, transcribed, and coded using the constant comparison approach. Experts in ear reconstruction were invited to provide input via an online Research Electronic Data Capture survey. Results: Participants included 25 patients aged 8–21 years with prominent ears (n = 9), microtia (n = 14), or another condition that affected ear appearance (n = 2). Analysis of participant qualitative data, followed by cognitive interviews and expert input, led to the development and refinement of an 18-item ear appearance scale (eg, size, shape, look up close, look in photographs) and a 12-item adverse effects scale (eg, itchy, painful, numb). Conclusions: The EAR-Q in currently being field-tested internationally. Once finalized, we anticipate the EAR-Q will be used in clinical practice and research to understand the patient’s perspective of outcomes following ear surgery.
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