The PedsQL™ Oral Health Scale: feasibility, reliability and validity of the Brazilian Portuguese version

Quality of life in children and adolescents with blood coagulation disorders and hemoglobinopathies

The aim of this study was to evaluate the impact of oral conditions and health-related quality of life (HRQoL) on oral health-related quality of life (OHRQoL) in children and adolescents with blood coagulation disorders and hemoglobinopathies (BCDH). The study was cross-sectional and included 61 individuals aged 2 to 18 years with BCDH. Exams for dental caries (dmft/DMFT index), oral hygiene (simplified oral hygiene index - OHI-S), and gingival health (modified gingival index - MGI) were performed. The pediatric quality of life inventory™ (PedsQL™) generic core scale and oral health scale were used to measure HRQoL and OHRQoL. Spearman's correlation coefficient (ρ) and the Mann-Whitney test (α = 0.05) were conducted to assess the relationship between covariates and the PedsQL™ oral health scale. The mean PedsQL™ oral health scale score was 76.66 (SD = 21.36). Worse OHRQoL was correlated with poor oral hygiene (ρ = -0.383; p: 0.004), poor gingival health (ρ = -0.327; p = 0.014), and better HRQoL (ρ = 0.488; p < 0.001). Greater untreated dental caries experience was associated with worse OHRQoL (p = 0.009). Worse oral health status in children and adolescents with BCDH negatively impacts OHRQoL, and OHRQoL and quality of life analyzed from a generic perspective are positively correlated constructs in this population.

Translation, transcultural adaptation, and validation of PedsQL 3.0 Sickle Cell Disease Module into Brazilian Portuguese

INTRODUCTION

Despite the high prevalence of sickle cell disease (SCD) in Brazil, no studies have described the validation of an SCD-specific health-related quality-of-life (HRQoL) instrument in children. We validated PedsQL 3.0 Sickle Cell Disease Module (PedsQL-SCD) for Brazilian Portuguese, and cross-validated it with PedsQL 4.0 Generic Core Scale (PedsQL-GCS) in children with SCD.

METHODS

PedsQL-SCD was translated and culturally adapted using forward and reverse translations. PedsQL-SCD and PedsQL-GCS were tested in children and adolescents with SCD aged 2-18 years and their caregivers. Validity was assessed using the Pearson and intraclass correlation coefficients, and reliability measured with Cronbach's alpha.

RESULTS

PedsQL-SCD was validated in 206 children with SCD (median age 14 years, range: 8-18) and 201 caregivers. Among patients and caregivers, the mean total score for PedsQL-SCD was 65.7 and 64.1, respectively. The mean total score for PedsQL-GCS was 73.1 and 68.9 among patients and caregivers, respectively. The internal consistency for PedsQL-SCD and PedsQL-GCS was good; Cronbach's alpha coefficients ranged from .59-.93 to .64-.83 among patients and from .60-.95 to .65-.85 among caregivers, respectively. Most intercorrelations between PedsQL-SCD and PedsQL-GCS, for patients and caregivers, had medium to large effect sizes (range: .23-.63 and .27-.64, respectively). Pain and pain impact domains of PedsQL-SCD and physical dimension of PedsQL-GCS had the highest cross-correlation (.63 and .6 for patients; .63 and .64 for caregivers, respectively), confirming convergent construct validity.

CONCLUSION

PedsQL-SCD is a valid, culturally appropriate measure to assess HRQoL in children with SCD in Brazil and is well-correlated PedsQL-GCS.

Reliability and validity of cross‑culturally adapted oral health‑related quality‑of‑Life instruments for Brazilian children and adolescents: a systematic review

OBJECTIVE

This systematic review aimed to review the reliability and validity of oral health-related quality of life (OHRQoL) questionnaires for Brazilian children and adolescents. Also, the cross-cultural adaptation was evaluated.

METHODS

This systematic review is registered in PROSPERO (CRD42022300018) and was performed based on the COSMIN guideline. Electronic searches were performed in the PubMed/MEDLINE, Web of Science, Lilacs, BVS (BIREME), Scielo, and Embase databases until March 2023 by two independent reviewers. There was no restriction on time or language. The following studies were included: validation studies and cross-cultural adaptation of OHRQoL instruments into Brazilian Portuguese; studies that evaluated the measurement properties of OHRQoL questionnaires in children and adolescents and that reported at least one of the measurement properties: reliability, internal consistency, error measurement, content validity, construct validity, criterion validity, discriminant validity, and/or convergent validity. The following were excluded: studies of systematic reviews of OHRQoL measures; studies reporting OHRQoL assessment through instruments; construction (development) and validation of a new instrument; questionnaires that had a single item; and validation for Portuguese from Portugal. The cross-cultural adaptation process and psychometrics of the included studies were verified.

RESULTS

6556 articles were identified, and 19 manuscripts were included. All studies were conducted in Brazil, and the age of the participants ranged from 2 to 15.42 years old. Sixteen articles presented the cross-cultural validation steps. Cronbach's alpha of the revised instruments ranged from 0.59 to 0.86.

CONCLUSIONS

It can be concluded that most studies provided information and evidence regarding validity, reliability, translation, and cultural adaptation.

Psychometric assessment of oral health-related quality of life questionnaires cross-culturally adapted for use in Brazilian adults - a systematic review

OBJECTIVE

This study aimed to review the psychometric properties of oral health-related quality of life (OHRQoL) questionnaires for the Brazilian adult population.

METHODS

A systematic review was performed based on the COSMIN guidelines (PROSPERO CRD42022300018). The studies were obtained through electronic searches in the PubMed/MEDLINE, Web of Science, Lilacs, VHL (BIREME), SciELO, and Embase databases.

RESULTS

The search was performed in December 2022. Articles on OHRQoL that reported the cross-cultural adaptation of instruments into Portuguese (Brazil) and evaluated the psychometric properties of measuring instruments in adult patients were included. Those about the development of a novel instrument and participants under 18 years of age were excluded. Information was collected on the country, type of instrument validated, psychometric tests, and adaptation process. The certainty of the evidence was assessed using GRADEpro program. The search returned 6,556 articles, and 14 were considered for this review. However, two studies did not report the cross-cultural adaptation process. Content validity, internal consistency, criterion validity, construct validity, reliability, general discriminant validity, Cronbach's alpha value, and general intraclass correlation coefficient value were confirmed in 12 studies. Cronbach's alpha ranged from 0.69 to 0.96. The certainty of the evidence was considered moderate and low. This study has some limitations, such as the lack of information in some reviewed studies, the unavailability of Brazilian instruments, and absence of longitudinal validation of some instruments.

CONCLUSIONS

In conclusion, there are 14 OHRQoL instruments adapted for Brazilian adults that can be used with caution by researchers and clinicians, since they presented moderate to low certainty of the evidence.

Quality of life in preadolescent orthodontic patients before and after secondary alveolar bone grafting

INTRODUCTION

We evaluated the effects of secondary bone grafting (SBG) on oral health-related and generic health-related quality of life (OHRQOL and HRQOL, respectively) in preadolescent orthodontic patients with alveolar bone defects.

METHODS

We divided 101 orthodontic patients aged 8-10 years into 3 groups: 39 general orthodontic patients, 18 patients with orofacial clefts who did not require SBG, and 44 patients with alveolar defects who required SBG using particulate cancellous bone and marrow obtained from the iliac crest. The participants completed the self-report Child Perceptions Questionnaire (CPQ) and Paediatric Quality of Life Inventory (version 4.0) for OHRQOL and HRQOL, respectively, and their scores were assessed. The quality of life (QOL) of patients who required SBG was examined before, 1 month, and 6 months after SBG. The relationships between OHRQOL or HRQOL and potential patient factors were also evaluated.

RESULTS

Physical HRQOL subscale scores worsened 1 month after SBG, whereas the total OHRQOL and HRQOL scores before and after SBG showed no significant changes. OHRQOL and HRQOL showed no significant differences among the 3 groups before SBG. The presence of oronasal fistula was associated with poorer OHRQOL in patients with cleft lip and/or palate.

CONCLUSIONS

SBG and orthodontic treatment had a relatively small impact on the QOL of the preadolescent children in this study. Understanding the influence of SBG and patient factors on QOL would enable better treatment and care for these patients.

Validity and reliability of the Turkish version of the Child Perceptions Questionnaire 8-10

BACKGROUND

A reliable measurement tool is needed to gain more knowledge about Turkish children's oral health status that affects the quality of life.

AIM

To develop a translated version of CPQ_8-10 into Turkish language and evaluate its reliability, validity, and reproducibility.

DESIGN

The intra-class correlation coefficient (ICC) was used for the test-retest reliability in the 50 children. For the internal consistency, 418 children aged 8-10 years were evaluated using Cronbach's alpha Coefficient. Construct validity and discriminant validity were calculated using Spearman's correlation analysis, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was also employed.

RESULTS

The mean CPQ_8-10 score was 13.3 ± 9.2. The translated Turkish version of CPQ_8-10 showed high test-retest reliability (ICC = 0.90) and internal consistency (Cronbach's alpha = 0.82). A statistically significant correlation was observed between the scores of the CPQ_8-10 and oral health and overall well-being, which revealed good construct validity (r = 0.50; P < .001 and r = 0.47; P < .001, respectively). Seven factors identified from EFA were statistically verified using CFA. Discriminant validity was supported by significant differences between CPQ and OHIS scores (P < .001).

CONCLUSIONS

The translated version of CPQ_8-10 to the Turkish language is reliable, valid, and reproducible for use in the Turkish culture in this age group.

Psychometric validation of the French self and proxy versions of the PedsQL™ 4.0 generic health-related quality of life questionnaire for 8-12 year-old children

BACKGROUND

The Pediatric Quality of Life Inventory Version 4.0 (PedsQL^TM4.0) is a generic health-related quality of life (HRQoL) questionnaire, widely used in pediatric clinical trials but not yet validated in France. We performed the psychometric validation of the self and proxy PedsQL^TM4.0 generic questionnaires for French children aged 8-12 years old.

METHODS

This bicentric cross-sectional study included 123 children and their parents with congenital heart disease (CHD) and 97 controls. The psychometric validation method was based on the consensus-based standards for the selection of health measurement instruments (COSMIN). The reliability was tested using the intraclass correlation coefficient (ICC). To evaluate the validity of this scale, content, face, criterion, and construct validity psychometric proprieties were tested. Acceptability was studied regarding questionnaires' completion and the existence of a floor or a ceiling effect.

RESULTS

Test-retest reliability intra-class correlation coefficients were mainly in good range (0.49-0.66). Face validity was very good among parents (0.85) and children (0.75). Content validity was good (0.70), despite misinterpretation of some items. In construct validity, each subscale had acceptable internal consistency reliability (Cronbach's α > 0.72 in self-reports, > 0.69 in proxy-reports). In the confirmatory factor analysis, the goodness-of-fit statistics rejected the original structure with 4 factors. The exploratory factor analysis revealed an alternative two-factor structure corresponding to physical and psychological dimensions. Convergent validity was supported by moderate (> 0.41) to high correlations (0.57) between PedsQL and Kidscreeen questionnaires for physical, emotion and school dimensions. The ability of the PedsQL to discriminate CHD severity was better with physical, social and total scores for both self-reports and proxy-reports.

CONCLUSIONS

The PedsQL^TM4.0 generic self and proxy HRQoL questionnaires found good psychometric properties, with regard to acceptability, responsiveness, validity, and reliability. This instrument appeared to be easy to use and comprehend within the target population of children aged 8 to 12 years old and their parents.

TRIAL REGISTRATION

This study was approved by the South-Mediterranean-IV Ethics Committee and registered on ClinicalTrials.gov (NCT01202916), https://clinicaltrials.gov/ct2/show/NCT01202916 .

Oral Health-Related Quality Of Life of Pre-School Children: Review and Perspectives for New Instruments

This study aimed to describe different approaches for the evaluation of the Oral health-related quality of life (OHRQoL) of preschool children and to discuss perspectives for future instruments. The OHRQoL is a concept that surpasses an exclusively clinical perception and includes functional, social, emotional, and environmental issues. The measure of OHRQoL represents a holistic approach for researchers and clinicians extending their visions beyond the mouth and understanding the entire context of the patient. Negative impacts of oral conditions on OHRQoL in childhood can reflect on health development, especially in a life stage marked by social and cognitive maturation. Instruments have been developed and cross-culturally adapted to evaluate the impact of oral conditions on the OHRQoL of preschool children and their families. Some features distinguish these instruments and influence their selection, such as: self- or proxy-report; generic- or specific-condition; long- or short-form, and less or more established used in literature. Moreover, theoretical framework, construct validation and availability should also be considered. Nine OHRQoL instruments for preschool children were included in the present literature review. They were created between 2003 and 2017 by developed countries in most cases. The shorter instrument has five items, and the larger has 31 items. Most of them are proxy-reported, generic-condition, and have been relatively well established in the literature. The diversity of instruments indicates the evolution of OHRQoL studies, but there are methodological issues still in need to be improved in future developments or cross-cultural adaptations, according to current psychometric evidence.

Development of patient-reported outcome measures of children's oral health aesthetics

OBJECTIVES

To develop and evaluate the psychometric properties of child- and parent-proxy measures of oral health aesthetics.

METHODS

Items that describe children's perceptions of their oral attractiveness and its impact on social, emotional, and behavioural functioning were developed based on a systematic review of existing measures, clinician feedback (n = 13) and child semi-structured interviews (n = 27). The tools' content validity was assessed in cognitive interviews with 21 children. Items were administered to socio-demographically diverse samples of 998 children aged 8-17 years and 626 parents of children aged 5-17 years. Psychometric methods were used to finalize and calibrate item banks, generate short questionnaire forms, and evaluate the tools' reliability, precision and validity.

RESULTS

The item banks and their short forms provide precise measurement across a wide range of oral health aesthetic states. They measure relevant and meaningful positive and negative experiences using terminology that most children as young as 8 years of age can understand. Known-group comparisons and convergence with existing measures of oral health-related quality of life, global health and body image provide evidence of construct validity. The scores are interpretable relative to the US general population.

CONCLUSIONS

The oral health aesthetic item banks and short forms provide precise and valid assessments of children's satisfaction with their oral appearance. They may be useful for targeting and evaluating paediatric dental and orthodontic care in clinical practice and research settings.

The development, validation, and psychometric properties of the Japanese version of the Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) for school-age children

Background

This study was performed to develop and validate a Japanese version of Child Oral Health Impact Profile-Short Form (COHIP-SF) 19 and to assess its psychometric properties in Japanese school-age children.

Methods

The original English COHIP-SF 19 was translated into Japanese (COHIP-SF 19 JP) using a standard forward and backward translation procedure. The psychometric properties of the COHIP-SF 19 JP were assessed in 379 public school students between 7 and 18 years of age in Fukuoka, Japan. Internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficient, ICC) were the metrics used for evaluation of this questionnaire. The discriminant validly was examined using the Wilcoxon rank sum test to identify significant differences in COHIP-SF 19 JP scores according to the results of dental examinations. The convergent validity was examined using the Spearman correlations to determine the relationships between COHIP-SF 19 JP scores and the self-perceived oral health ratings. Confirmatory factor analyses (CFA) were performed to verify the factor structure of the questionnaire.

Results

The COHIP-SF 19 JP revealed good internal consistency (Cronbach’s alpha, 0.77) and test-retest reliability (ICC, 0.81). Discriminant validity indicated that children with dental caries or malocclusion had significantly lower COHIP-SF 19 JP scores (P <  0.05); convergent validity indicated that the self-perceived oral health rating was significantly correlated with the COHIP-SF 19 JP total score and subscores (rs = 0.352–0.567, P <  0.0001), indicating that the questionnaire had a sufficient construct validity. CFA suggested that the modified four-factor model had better model fit indices than the original three-factor model.

Conclusion

The collected data showed that the COHIP-SF 19 JP possesses sufficient psychometric properties for use in Japanese school-age children.

Adaptation and validation of the PEDSQL™ oral health scale for toddlers in Chilean population

BACKGROUND

The Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale was developed to measure oral health-related quality of life (OHRQoL). The aim of this study was to cross-culturally adapt the parent-reported version for toddlers of PedsQL™ Oral Health Scale into Spanish and to assess the acceptability, reliability and validity of this version in Chilean preschool population.

METHODS

The PedsQL™ Oral Health Scale for toddlers was cross-culturally adapted for the Spanish language using the recommended standards. To assess metric properties, a cross-sectional study was carried out with 301 children aged 2 to 5 years in Carahue, Chile. Chilean versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, and Early Childhood Oral Health Impact Scale (ECOHIS) were completed by the children's parents. Dental caries, malocclusion and dental trauma were examined by trained dentists. The PedsQL™ Oral Health Scale was administrated a second time 14-21 days after. The reliability of the scale was verified by analysis of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). The validity of the construct was assessed by confirmatory factor analysis and known groups method. The convergent validity was assessed by calculating the Spearman's correlation with the ECOHIS questionnaire.

RESULTS

The PedsQL™ Oral Health Scale demonstrated good reliability, with Cronbach's alpha coefficient of 0.79 and ICC of 0.85. A moderate-to-strong correlation was found between the PedsQL™ Oral Health Scale and the ECOHIS questionnaire (- 0.64); the PedsQL™ Oral Health Scale score was lower in children with poor than those with excellent/very good oral health (median 100 vs 85, p < 0.001); it also was lower in children with caries than in those caries-free (median 100 vs 90, p < 0.001). No statistically significant differences were found among groups according to malocclusion and traumatic dental injuries.

CONCLUSIONS

The PedsQL™ Oral Health Scale for toddlers in Spanish showed to be equivalent to the original version, and its psychometric properties were satisfactory for application in a Chilean pre-school population.

Impacto da cárie dentária na qualidade de vida de pré-escolares mensurado pelo questionário PedsQL

Resumo O objetivo do estudo foi avaliar o impacto da cárie dentária na qualidade de vida de pré-escolares. A população foi constituída por pré-escolares com idade de 5 anos, matriculados em instituições públicas e privadas de Teresina, PI, Brasil. Instrumento de qualidade de vida validado para população brasileira (Pediatric Quality of Life Inventory - PedsQL™) foi aplicado para as crianças e responsáveis, além de questionário socioeconômico-demográfico para os responsáveis. No exame dentário o índice ceod foi utilizado para avaliar a experiência de cárie. Das 566 crianças examinadas, 50,2% apresentaram experiência de cárie. Foi observada associação entre experiência de cárie e pior qualidade de vida no domínio de saúde bucal na percepção das crianças (RR= 0,981; IC95% = 0,97-0,99) e dos pais (RR= 0,955; IC95% = 0,94-0,97). De acordo com a percepção das crianças, cárie em dentes posteriores foi associada a pior qualidade de vida no domínio capacidade física (RR= 0,985; IC95% = 0,97-0,99). Concluiu-se que experiência de cárie impactou negativamente na QVRSB (qualidade de vida relacionada à saúde bucal) no domínio saúde bucal da criança de acordo com a percepção das crianças e dos pais. Cárie localizada em molares impactou negativamente na QVRSB no domínio capacidade física segundo a percepção das crianças.

Impact of Developmental enamel defects on quality of life in 5-year-old children

BACKGROUND

Developmental enamel defects (DDE) represent one of the prevalent oral problems in childhood; however, few studies have evaluated its impact on quality of life in the children's own perception.

AIM

To evaluate the DDE impact on quality of life of 5-year-old children.

METHODS

This cross-sectional observational study assessed 566 children aged 5 years old, in Teresina, Piauí, Brazil, according to their self-perceptions. Children answered the Pediatric Quality of Life Inventory^™ Version 4.0 and Oral Health Scale. The dmft index, modified DDE index and Foster and Hamilton criteria were used to diagnose dental caries, DDE and malocclusion, respectively. A single examiner performed the clinical examination. Descriptive analyses and Poisson regression with robust variance were performed.

RESULTS

The prevalence of DDE was 33.7%. For children's self-reports, the presence of DDE had a negative association with oral health-related quality of life (OHRQoL; PR 1.09, 95% CI 1.02-1.15). Enamel hypoplasia had a negative impact on the physical function (PR 1.05; 95% CI 1.01-1.10) and oral health (PR 1.06, 95% CI 1.01-1.11) domains. Diffuse opacity had a negative impact on the social aspect (PR 1.09, 95% CI 1.02-1.18).

CONCLUSIONS

Enamel defects had a negative impact on OHRQoL according to the self-reports of the children.

Health and oral health-related quality of life of children and adolescents with chronic kidney disease: a cross-sectional study

PURPOSE

The aim of this study was to evaluate if health and oral health status of children and adolescents with different stages of CKD are associated with their health-related quality of life (HRQoL), oral health-related quality of life (OHRQoL) and socioeconomic and demographic conditions.

METHODS

One hundred children and adolescents with CKD were age and gender matched to 100 individuals without CKD (mean age ± SD = 13.04 ± 2.57). Oral health was characterised by means of gingival bleeding index (GBI), plaque index (PI), the decayed, missing, and filled teeth (DMFT) index and the developmental enamel defect (DED) index. All children and adolescents answered two Peds QL^® instruments (general and oral health scales).

RESULTS

Comparing the mean scores of HRQoL and OHRQoL between groups, we observed that CKD group demonstrated worse perceptions when compared to non-CKD group. Multiple linear regression analysis with bootstrap estimation of variance (1000 replications) showed association between dental caries experience (p < 0.001), gingival inflammation (p < 0.001) and diagnosis of CKD (p = 0.027) with the OHRQoL and between physical and the emotional domain of HRQoL, when moderate/severe gingival inflammation and hypoplasia were present.

CONCLUSION

The implementation of public policies that contemplate the early dental preventive intervention in CKD children and adolescents should occur aiming to improve their oral health, once oral manifestations can directly affect the aspects of the HRQoL and OHRQoL of these individuals.

Short form development for oral health patient-reported outcome evaluation in children and adolescents

PURPOSE

Children and adolescents are vulnerable to dental problems and oral diseases. This paper presents the development of two multi-item self-report scales for use in assessing oral health status of children and adolescents.

METHODS

Following the Patient-Reported Outcome Measurement Information System framework, survey questions were designed using a newly developed conceptual model. These items were administered to 334 children and adolescents (8-17 years) along with concurrent dental exams. Exploratory and confirmatory factor analyses were conducted and the item response theory graded response model was used to estimate item parameters and oral health status scores and to identify short-form items. The items were selected by high level of information and wide coverage of different domains to assess Child Oral Health Status Index (COHSI) and treatment referral recommendations (RR).

RESULTS

The long form consists of 28 items. The short-form includes 12 items (8 for COHSI and 7 for RR with 3 common items).The intra-class correlations between long form and short-form were 0.90 for COHSI and 0.87 for RR.

CONCLUSION

The short-forms provide a possible solution for the longstanding challenge of oral health evaluation for large populations of children and adolescents. The calibrated long form provides the foundation for computer adaptive test administration. These oral health assessment toolkits can be used for oral health screening, surveillance program, policy planning, and research.

Reliability and validity of the Chinese mandarin version of PedsQL™ 3.0 transplant module

Background

Long-term health-related quality of life (HRQoL) of pediatric patients after hematopoietic stem cell transplantation (HSCT) is increasingly studied worldwide. However, few studies have been performed in China, where no uniform scale is available; the PedsQL™ Cancer Module 3.0 Chinese Mandarin version has been used to evaluate HRQoL of patients after HSCT in China. This study aimed to assess the reliability and validity of the Chinese Mandarin version of PedsQL™ 3.0 Transplant Module.

Methods

Patients between 2 and 18 years old, who underwent HSCT from January 2006 to June 2014, were recruited in Beijing Children’s Hospital affiliated to Capital Medical University, the First Affiliated Hospital of Southern Medical University and Beijing Daopei Hospital. 207 parent reports and 182 child self-reports of the PedsQL™ 3.0 Transplant Module Chinese Mandarin version were assigned, of which 362 were returned.

Results

No missing item response was observed in the returned reports. Cronbach’s alpha coefficient exceeded 0.7 in total scale and every dimension. The intraclass correlation coefficient exceeded 0.8 in all dimensions of child self-reports and parent reports. Spearman’s rank correlation coefficients of items and their respective dimensions were 0.6-0.94 in parent reports, and 0.62-0.93 in child self-reports, while a weak association was found between the items and other dimensions. Exploratory factor analysis indicated a good extraction effect, and construct validity of the scale was >60 %.

Conclusions

The Chinese Mandarin version of PedsQL™ 3.0 Transplant Module has good feasibility, reliability and validity. Its use may help improve the HRQoL of children after HSCT in China.

Rasch analysis of the Persian version of PedsQL(TM) Oral Health Scale: further psychometric evaluation on item validity including differential item functioning

Background: The study aimed to further evaluate the psychometric properties of one recently developed oral health related quality of life (OHRQoL) instrument (PedsQL Oral Health Scale), including student self-report and parent-proxy report. Specifically, we tested the item validity,threshold order, local dependency, and differential item functioning (DIF) across gender and rater.

Methods: This is a cross-sectional study, and study population was recruited in Qazvin, Iran using one-stage sampling with the unit of school. Students and their parents (1529 dyads) separately completed the Persian version of PedsQL Oral Health Scale. The psychometric properties were analyzed using Rasch rating scale model, including item validity, threshold order for response categories, and DIF across gender (boys vs. girls in student self-report) and rater (student self report vs. parent-proxy report).

Results: All items had satisfactory in fit and outfit mean square error. One disordering category (the response of often) was found in parent-proxy report, while all categories were ordered in student self-report. All items were DIF-trivial across gender and rater.

Conclusion: PedsQL Oral Health Scale is a valid instrument to measure OHRQoL. However, our results indicated that the parent-proxy report was inferior to the student self-report, and healthcare providers should primarily use the student self-report.

Quality of life of family caregivers of children with orofacial clefts in Nigeria: a mixed-method study

BACKGROUND

Orofacial clefts (OFCs) are common birth defects that may impose a large burden on the health and psychosocioeconomic well-being of affected individuals and families. This study aims to identify qualitative factors that affect the quality of life (QOL) of family caregivers of children with OFCs.

METHODS

A mixed-method study in which family caregivers of OFCs children were consecutively recruited from cleft clinics over a 3-month period. Quantitative data were analyzed using SPSS version 17 and focus group discussion by framework analysis.

RESULTS

A total of 107 caregivers participated in the entire study, and 24 caregivers participated in the focus group discussions. About 50% of the children had cleft lip and palate (CLP), 28% with cleft lips only (CL) and 23.4% with cleft palate only (CP). Poor access to specific information and lack of empathy of professionals affected the quality of life and delivery of family-centered care.

CONCLUSIONS

To improve the quality of life of family caregivers, individual-focused counseling sessions should be organized for caregivers soon after birth. This will provide an opportunity to discuss the laid out plans for supportive care. It will also be as an avenue to address the arising social issues by health professionals and counselors.