Validation and comparison of the Arabic versions of GOHAI and OHIP-14 in patients with and without denture experience

Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.

OBJECTIVES

To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.

RESULTS

This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132).

CONCLUSION

There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

The Effect of Treatment With Clear Aligners Versus Fixed Appliances on Oral Health-Related Quality of Life in Patients With Severe Crowding: A One-Year Follow-Up Randomized Controlled Clinical Trial

Objective

To compare the level of oral health-related quality of life (OHRQoL) between patients receiving clear aligners or fixed appliances within one year of follow-up using Oral Health Impact Profile 14 (OHIP-14), a validated self-administered questionnaire.

Materials and methods

A single-centered, two-arm parallel-group randomized controlled clinical trial was conducted on 36 adult patients (19 females, 17 males; age range: 18 to 25 years) who had severe crowding and require orthodontic treatment with first premolars extraction. The patients were equally and randomly divided into two groups: The clear aligners (CA) group and the fixed appliances (FA) group. OHRQoL was assessed using the OHIP-14 tool at various times during comprehensive orthodontic therapy: baseline (T0), one week (T1), two weeks (T2), one month (T3), 6 months (T4), and 12 months (T5) after starting the active orthodontic treatment. Mann-Whitney U test or Friedman test were used to detect significant differences. The level of significance was set at 5%. 

Results

All of the selected patients entered the statistical analysis stage. There were no significant differences between the CA and FA groups for the psychological discomfort, psychological disability, social disability, and handicap (P˃0.05) at almost all assessment times. For the functional limitation, physical pain, physical disability, and the overall score, there were significant differences between the studied groups (P˂0.05), with the FA group having higher mean scores than the CA group in all of the assessment times.

Conclusion

Patients' treatment with clear aligners has less impact on OHRQoL than those treated using conventional fixed appliances during the first year of treatment.

Patient-reported outcome measures in Arabic-speaking populations: a systematic review

PURPOSE

This research aimed, first, to identify, summarize, and synthesize the studies reporting the development, translation, and/or psychometric evaluation of PROMs in Arabic-speaking populations and, second, to evaluate the psychometric properties and the translation process of a sample 26 PROMs.

METHODS

In 2019, PubMed, Web of Science, and SCOPUS were searched for studies reporting the development, translation, or cross-cultural adaptation of patient-reported outcome measures in Arabic-speaking populations, and those including the assessment of one or more psychometric properties as PROMs (including validity, reliability, responsiveness, interpretability) in our target populations were included. The review protocol registration number is CRD42018088991.

RESULTS

The search strategy outlined above yielded a total of 3179 titles in the three databases. Of these, 174 English language studies met the inclusion criteria. One hundred thirty-six PROMs were identified. The methodological quality and translation process of PROMs reported by at least two studies (26 PROM instruments, 63 studies) were examined. Internal consistency, reliability, and construct validity were the most frequently reported psychometric properties. Structural validity, cross-cultural validity, responsiveness, and measurement error were largely unreported. The process of developing at least two independent forward translations and back translation of the instrument into the source language were reported by 32 and 43 studies, respectively.

CONCLUSION

There is a need for further investigation of measurement properties of Arabic PROMs measures before routine use can be recommended in clinical practice.

Bosnian Version of Oral Health of Edentulous Patients (OHIP-EDENT-B&H) Questionnaire: Assessment of Reliability and Validity

Background/Aim: The aim of this study was to assess of the internal coherence of Bosnian translated version of the Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT-B&H), and evaluated the validity of this version.

Material and Methods: OHIP-EDENT-B&H questionnaires were completed by 117 edentulous patients and specialists of prosthodontics in health institutions of central Bosnia.

Results: Test-retesting analysis showed strong correlations, r ranging from 0.46 to 0.58, respecting complete dentures, with Kappa= 0.68, that indicated reliability of the questionnaire. The lowest reliability was obtained for Psychological disability (n= 117, α= 0.636) and the highest was obtained for Social disability (α= 0.859). The reliability of the summary scores for OHIP-EDENT-B&H was good (α= 0.907). Content validity for the test group-retest group did not expose significant differences between the groups tested.

Conclusions: The OHIPEDENT-B&H instrument for verifying of oral-health–related quality of life in edentulous patients demonstrated good reliability and validity in Bosnian patients.

Comparison of psychometric properties of GOHAI, OHIP-14, and OHIP-EDENT as measures of oral health in complete edentulous patients aged 60 years and more

OBJECTIVES

To compare the psychometric properties of three OHRQoL indicators (GOHAI, OHIP-14, and OHIP-EDENT) in a group of complete edentulous subjects and to explore the ability of these instruments to distinguish between individuals with different prosthetic and oral health status.

METHODS

This was a cross-sectional study. Edentulous individuals aged 60 years and more were recruited between January 2019 and February 2020 in a medical and dental care centers. The Lebanese versions of GOHAI, OHIP-14, and OHIP-EDENT were used. External and internal consistencies were assessed using intraclass correlation coefficient (ICC) and Cronbach alpha, respectively. The concurrent validity was evaluated by testing the indicators against a proxy measure of a similar concept. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile, respectively, and multivariate analyses were performed using sociodemographic, clinical, and subjective health parameters as explanatory variables.

RESULTS

Two hundred and two edentulous subjects (age: 72.94 ± 7.378 years) were included. The proportion of subjects with no impact was lower for OHIP-EDENT (7.9%) compared to GOHAI (28.2%) and OHIP-14 (38.6%). Reproducibility was satisfactory for all OHRQoL tools since they were able to reproduce the results consistently in time (ICC > 0.80). The Cronbach alpha values were greater than 0.8 indicating acceptable internal consistency. The concurrent validity of the three tools was acceptable since subjects with lower OHRQoL score were less satisfied with their dentures and reported a higher need for self-rated therapy. Concerning the discriminant validity, OHIP-EDENT was more discriminant than OHIP-14 and GOHAI, since it was more able to identify patients with poor prosthetic issues or using instable denture.

CONCLUSION

The OHIP-EDENT was more effective in identifying edentulous individuals with oral and prosthetic problems. Our results can help decide which dental instrument to use to assess the perception of oral health in edentulous individuals. More prospective studies are required to compare their evaluative properties.

A Danish version of the oral health impact profile-14 (OHIP-14): translation and cross-cultural adaptation

Background

The Oral Health Impact Profile-14 (OHIP-14) questionnaire assesses quality of life related to people’s perception of oral disorders on their well-being. However, a translated and validated Danish version of OHIP-14 is not yet available.

The purpose of this pilot study was to translate and cross-culturally adapt the English version of the OHIP-14 into Danish (OHIP-14-DK). In addition, to assess its content and face validity, internal consistency and test-retest reliability.

Methods

The English version of OHIP-14 was translated into Danish following a standard protocol of cross-cultural adaptation. Stages I-IV: translation phase to generate a pre-final version “OHIP-14-DK”. Stage V: pre-testing phase. A random sample of 22 orthodontic patients (mean age 24.7 years, SD ±14.8; 14 females, 8 males) were selected at the Section of Orthodontics, Aarhus University, Denmark. All patients self-completed the OHIP-14-DK and were then interviewed to assess its content and face validity. Internal consistency was assessed with Cronbach’s alpha coefficients. All patients completed the same questionnaire again at a one-week interval. Test-retest reliability was assessed using Spearman’s correlation coefficient and intra-class correlation coefficient (ICC).

Results

The initial and back translations were very similar: the OHIP-14-DK proved to have a good level of equivalence with no translation errors or deviations. Furthermore, the OHIP-14-DK seemed well-adapted to Danish culture and was understood by individuals down to 12 years of age. Pre-testing demonstrated good face and content validity; interviews had a response rate of 100% and confirmed that each item was understandable without inducing reluctance or hesitation. Thus, responses were related to their corresponding item. Therefore, no final adjustments were required for the pre-tested version. Cronbach’s alpha for the OHIP-14-DK subscales fell in the 0.75–0.84 range, indicating an adequate-to-good internal consistency. Spearman’s correlation coefficient for the OHIP-14-DK total score was 0.77. The ICC for the OHIP-14-DK total score was 0.91.

Conclusions

The OHIP-14-DK seems well adapted to Danish culture, proved to be face and content valid and also showed good internal consistency and excellent reliability. However, its psychometric properties still need to be tested.

Study registration

Not applicable

Assessment of Oral Health-related Quality of Life among Expatriate Working Population, Saudi Arabia: A Cross-sectional Study

Background:

The expatriate workers (foreign workers) come from various countries having different languages, cultures, and tradition to work in Kingdom of Saudi Arabia (KSA); here they adopt to local customs, traditions, and work ethics in this new environment. How they perceive their oral health-related quality of life (OHRQoL) is important for health-care provider for understanding and planning in patient management. The data of expat workers and their OHRQoL in KSA are meager; hence, assessment of OHRQoL among expatriate working population in Al Zulfi, Saudi Arabia was planned.

Materials and Methods:

A cross-sectional study was conducted on adult expat working population of various nationalities who were working in Al Zulfi, KSA. The study sample comprised 600 adult expats. OHRQoL was analyzed by using 14-Item Oral Health Impact Profile (OHIP-14) questionnaire as instrument. Clinical examination for oral health status was carried out using decayed, missing, and filled teeth (DMFT) index and Oral Hygiene Index simplified (OHI-S). Student’s t test and analysis of variance (ANOVA) were used to compare data using Statistical Package for the Social Sciences (SPSS) software program, version 20.0 with significance at P ≤ 0.05.

Results:

The age of the sample population ranged from 19 to 60 years. No significant difference was observed in oral health status among expats of different nationalities. Age and education were significantly related to OHRQoL as well as oral health status. The mean cumulative scores of OHIP-14 showed that expats from different nationalities had statistically significant differences.

Conclusion:

Overall the impact of OHRQoL was less among working expat population in Al Zulfi. Physical pain was the common dimension seen among all nationalities. Psychological discomfort and handicap dimensions of OHIP-14 were significant among the study sample.

Functional oral health-related quality of life impact: A systematic review in populations with tooth loss

Patients perceive the impact of oral disorder in four major areas, the dimensions of oral health-related quality life (OHRQoL) Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. The functional aspect is essential given the need of chewing, biting, speech and swallowing. The objective of this study was to identify OHRQoL information for dental subjects with functional oral health problems. In a systematic review, distinct and clinically relevant groups of dental subject samples, in this study called "population groups," with such functional OHRQoL information based on the Oral Health Impact Profile (OHIP) were identified (PROSPERO registration: CRD42017064033). The search strategy was "Oral Health Impact Profile" or OHIP. Searches were conducted in the PubMed interface of the Medline database, EMBASE, Cochrane, CINAHL and PsyINFO on 8 June 2017 and updated on 14 January 2019. Published OHIP domain data of different versions were recalculated into OHIP-14`s Physical Disability domain score, characterising the subject's Oral Function impact. 3,653 potentially abstracts were screened. We identified 78 publications reporting dimensional information on 154 subject samples with 52 populations. A typical mean functional impact for partially dentate subjects was 1.6 units on a 0 to 8 unit metric, while for edentate subjects, the mean functional impact was 2.6 units. The functional impact score ranged from 0 to 7.9 units with 50% of the patient samples located between 0.8 and 2.6 units. For the first time, we provide normalised and therefore comparable metric information about the functional OHRQoL impact for a substantial number of functional oral conditions.

Validation of a modified version of the Spanish Geriatric Oral Health Assessment Index (GOHAI-SP) for adults and elder people

Background

The Geriatric Oral Health Assessment Index (GOHAI) was developed and validated in 1990 and translated into Spanish in 1999. Since then, the original version has been used in numerous studies, but it has not been re-evaluated in terms of language in the new generations of older adults. The purpose of this study is to confirm the validity of the Spanish version of the Geriatric Oral Health Assessment Index (GOHAI-SP) after three decades to be used as part of an ongoing field trial.

Methods

The GOHAI-SP was pilot tested in a focus group to confirm linguistic comprehension. A version with minor language changes was administered to individuals with metabolic syndrome aged 55–75 years from one health care district in southern Spain as part of an ongoing field trial (PREDIMED-Plus). Clinical evaluation included assessment of dental and periodontal status. The psychometric properties of the GOHAI-SP were evaluated through stability and internal consistency measures, and concurrent and discriminant validity were assessed.

Results

The new version of the GOHAI-SP was administered to 100 individuals. The application time was reduced by 7 min. The alpha value for reliability was 0.87. The item-scale correlation coefficients ranged from 0.54 to 0.75, and the test–re-test correlation for the total score was 0.75. There were inverse correlations between GOHAI-SP scores and the number of lost teeth and the decayed-missing-filled teeth index (p < 0.001).

Conclusions

The GOHAI-SP questionnaire remains a valid and useful tool to assess oral health-related quality of life in primary health care settings. A linguistic update of the questionnaire brought improvements to the instrument application.

Trial registration

The PREDIMED-Plus trial is registered in the ISRCTN registry with reference number ISRCTN89898870. Registration date: 4th July 2014.

What factors contribute to the self-reported oral health status of Arab adolescents? An assessment using a validated Arabic-WHO tool for child oral health (A-OHAT)

BACKGROUND

The current study was performed; to validate the Arabic version of WHO child oral health assessment tool (A-OHAT), to assess the oral health status of Arab school children and finally to identify the important risk factors associated with the poor teeth and gum conditions of school children.

METHODS

A cross-sectional study with two-staged simple random sampling technique was implemented. A-OHAT, a self-assessment tool was subjected to psychometric analyses with the respondents being high school children. The Cronbach's alpha and the Intra class correlation values were computed. Paired t-test was performed to identify the differences between the readings after repeated administration, followed by the analysis for convergent validity. This tested Arabic-WHO Child-OHAT was administered to collect the data. Univariate, bivariate and logistic regression analyses were performed to report on the potential risk factors associated with poor teeth and poor gum conditions of school children.

RESULTS

Psychometric analyses revealed that the Arabic Child Oral Health Assessment Tool (A-OHAT) was reliable and valid. A total of 478 (N) high school children were subjected to the tested tool, of which 66.5% were male and 33.5% were female with a mean age of 16.28 + 1.04 years. 80.3% of school children had poor teeth condition and 36.2% of school children had often experienced toothache. Children had 1.5 times higher odds of having poor teeth condition if they had increased frequency of sweet and candy consumption. It was also seen that increased frequency of sweets and candy consumption by school children had put them at nearly 20% higher risk of having poor gum condition. Finally, children with the habit of using toothbrush had nearly 50% lower chance of having poor gum condition in contrast to the school children who do not use toothbrush.

CONCLUSION

To conclude, the study provides a reliable and valid tool to assess the oral health status of Arab adolescents. Improper oral hygiene habits and diet were identified as the plausible risk factors for poor teeth and gum condition.