Concordance between caregiver and child reports of children's oral health-related quality of life

Agreement between adolescents' and their mothers' reports of oral health-related quality of life

The aim of this study was to determine the level of agreement between reports by adolescents and their mothers regarding the impact of oral health on the adolescents' quality of life. The sample consisted of 960 pairs of adolescents aged 11 to 14 years and their mothers. The Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) and the short form of the Child Perceptions Questionnaire (CPQ11-14) were administered. Agreement on the total scale and the subscales was determined through a comparison of mean values. The means of the directional and absolute differences were also determined. Agreement on each item on the group level and in the individual pairs was analyzed using the Intraclass Correlation Coefficient (ICC). The difference between the means and the directional differences were significant for the total score as well as for the functional limitation and social well-being subscales (p < 0.001). The ICC for the total P-CPQ and CPQ11-14 scores was 0.43. The ICC indicated weak agreement on the subscales, ranging from 0.36 to 0.40. Agreement between reports by adolescents and their mothers regarding oral health-related quality of life (OHRQoL) was moderate, indicating that both perspectives should be considered.

Reliability and validity testing for the Child Oral Health Impact Profile-Reduced (COHIP-SF 19)

OBJECTIVES

This study assessed the reliability and validity of the Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) from the validated 34-item COHIP.

METHODS

Participants included 205 pediatric, 107 orthodontic, and 863 patients with craniofacial anomalies (CFAs). Item level evaluations included examining content overlap, distributional properties, and use of the response set. Confirmatory factor analysis identified potential items for deletion. Scale reliability was assessed with Cronbach's alpha. Discriminant validity of the COHIP-SF 19 was evaluated as follows: among pediatric participants, scores were compared with varying amounts of decayed and filled surfaces (DFS) and presence of caries on permanent teeth; for orthodontic patients, scores were correlated with anterior tooth spacing/crowding; and for those with CFA, scores were compared with clinicians' ratings of extent of defect (EOD) for nose and lip and/or speech hypernasality. Convergent validity was assessed by examining the partial Spearman correlation between the COHIP scores and a standard Global Health self-rating. Comparisons between the COHIP and the COHIP-SF 19 were completed across samples.

RESULTS

The reduced questionnaire consists of 19 items: Oral Health (five items), Functional Well-Being (four items), and a combined subscale named Socio-Emotional Well-Being (10 items). Internal reliability is ≥ 0.82 for the three samples. Results demonstrate that the COHIP-SF 19 discriminates within and across treatment groups by EOD and within a community-based pediatric sample. The measure is associated with the Global Health rating (P < 0.05), thereby indicating convergent validity.

CONCLUSIONS

Reliability and validity testing demonstrate that the COHIP-SF 19 is a psychometrically sound instrument to measure oral health-related quality of life across school-aged pediatric populations.

Oral health-related quality of life in children with orofacial clefts

Objectives : To determine the impact of orofacial clefts on the oral health-related quality of life of affected children and whether the oral health-related quality of life of children with orofacial clefts differs among different age groups. To assess whether the responses of children with orofacial clefts differ from the caregivers' perceptions of their child's oral health-related quality of life and compare with data from a control group. Design : Cross-sectional study. Patients/Setting : A total of 75 subjects with cleft lip and/or cleft palate (mean age, 13.0 years) from the Nationwide Children's Hospital Craniofacial Anomalies Clinic, as well as their caregivers, and 75 control subjects (mean age, 13.9 years). Main Outcome Measure : Self-reported oral health-related quality of life measured with the Child Oral Health Impact Profile, a reliable and valid questionnaire designed for use with children and teenagers. Results : Children with orofacial clefts had statistically significant lower quality of life scores than control subjects had for overall oral health-related quality of life, Functional Well-being, and Social Emotional Well-being. There was a statistically significant difference in the interaction of age group and Social-Emotional Well-being between children with orofacial clefts and control children. No statistically significant differences were found between the responses of children with orofacial clefts and their caregivers' reports. Conclusions : Presence of an orofacial cleft significantly decreases overall oral health-related quality of life, Functional Well-being, and Social-Emotional Well-being in children and adolescents. The negative impact of orofacial clefts on Social-Emotional Well-being is greater in 15- to 18-year-olds than in younger age groups. Children with orofacial clefts and their caregivers had very similar evaluations of the child's oral health-related quality of life.

Oral health-related quality of life: what, why, how, and future implications

Despite its relatively recent emergence over the past few decades, oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual's oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization (WHO) as an important segment of the Global Oral Health Program (2003). This paper identifies the what, why, and how of OHRQoL and presents an oral health theoretical model. The relevance of OHRQoL for dental practitioners and patients in community-based dental practices is presented. Implications for health policy and related oral health disparities are also discussed. A supplemental Appendix contains a Medline and ProQuest literature search regarding OHRQoL research from 1990-2010 by discipline and research design (e.g., descriptive, longitudinal, clinical trial, etc.). The search identified 300 articles with a notable surge in OHRQoL research in pediatrics and orthodontics in recent years.

Oral health-related quality of life in Hong Kong preschool children

OBJECTIVES

To assess the impact of early childhood caries (ECC) on the quality of life in a population of preschool children and their families in Hong Kong.

METHODS

A random sample of 1,296 Chinese preschool children participated in the survey and were subjected to an oral examination for their ECC status by 2 trained examiners. The parents were asked to respond to the Early Childhood Oral Health Impact Scale (ECOHIS) and an extra set of questions concerning their sociodemographic background.

RESULTS

The final data analysis included 1,261 children with a mean (±SD) age of 3.9 ± 0.66 years. The prevalence figures for ECC and severe ECC were 19.9 and 15.2%, respectively. Decayed teeth were found in 34.3% of the children while only 5.2% had filled teeth. The mean (±SD) dmft in this group of children was 1.5 ± 2.98. Higher ECOHIS scores were found in parents with lower education or income level, or with children who were born in mainland China (p < 0.05), or with children who had decayed, missing, or filled teeth (p < 0.001). In multiple regression analyses, decayed teeth and filled teeth in primary dentition were the better predictors (p < 0.001) of the ECOHIS score among the various parent and child characteristics collected in this survey.

CONCLUSIONS

The findings of this study showed that parents of young children with dental caries experience perceived that both the children and other family members had poorer quality of life.

Oral health-related quality of life in Dutch children with cleft lip and/or palate

OBJECTIVE

To investigate the oral health-related quality of life (OH-RQoL) of Dutch cleft lip and palate patients. It was hypothesized that (1) there is no difference between cleft patients' and their parents' reports of patients' OH-RQoL; (2) there are no gender differences; (3) there are no differences in OH-RQoL between cleft patients with regard to their symptoms; and (4) there is no difference between patients above and below 12 years of age.

MATERIALS AND METHODS

The sample consisted of 122 patients with clefts (age range, 8-15 years) and their parents. Respondents were recruited from the cleft palate team of Amsterdam. They completed the Child Oral Health-Related Quality of Life questionnaire (COHIP). Items were divided into five different subscales, and scores on all subscales were compared between and within groups.

RESULTS

Patients' and parents' perceptions differed significantly on three of the five subscales. Girls and boys did not differ significantly with regard to their perception of reported OH-RQoL. The cleft lip and cleft lip and alveolus [CL(A)] subgroup scored significantly higher on the functional well-being subscale. The cleft patients aged 12 years and older scored significantly lower on the emotional well-being and oral symptoms subscales when compared with their younger peers.

CONCLUSIONS

Only the second hypothesis was not rejected in this study. This means that parents are not interchangeable with regard to reporting on their children's perceptions related to OH-RQoL, that OH-RQoL changes with age, and that it is important that subgroups are respected when investigating OH-RQoL in cleft patients.

Living with a craniofacial condition: development of the Craniofacial Experiences Questionnaire (CFEQ) for adolescents and their parents

OBJECTIVE

To develop a new instrument (the Craniofacial Experiences Questionnaire, CFEQ) to measure both stressors and positive aspects of living with a craniofacial condition from adolescent and parent perspectives, and to examine its validity and reliability. A secondary aim was to explore experiences reported according to age, gender, and diagnosis.

DESIGN

Self-report and parent report questionnaires (CFEQ, Youth Self Report [YSR], Child Behavior Checklist [CBCL], Behavioral and Emotional Rating Scale [BERS]) were completed by adolescents with congenital craniofacial conditions and their parents.

PARTICIPANTS

Fifty adolescents with craniofacial conditions and 55 of their parents.

RESULTS

Internal reliability of the stressor and positive aspects scales was acceptable (.81 to .92) but was lower for some stressor subscales (.50-.86). Higher stressor scale scores were related to poorer adjustment (CBCL r = .55, YSR r = .37). There were no consistent differences in the stressful or positive experiences of young people with craniofacial conditions according to gender or age. There were no differences in stressors reported according to diagnosis.

CONCLUSIONS

The CFEQ shows promise as a clinical and research tool for investigating the stressors and positive experiences of young people with craniofacial conditions. Consistent with the literature on chronic pediatric conditions, there were few differences in experiences of young people according to diagnosis. Furthermore, the lack of gender or age differences supports the need for clinicians to comprehensively assess the experiences of young people regardless of demographic variables.

Quality of life in children with chronic kidney disease (with child and parent assessments)

Herein the results of a multicenter study from the Turkish Pediatric Kidney Transplantation Study Group are reported. The aims of this study were to compare the quality of life (QoL) scores of Turkish children who are dialysis patients (DP), renal transplant recipients (TR), and age-matched healthy controls and to compare child-self and parent-proxy scores. The Turkish versions of the Kinder Lebensqualität Fragebogen (KINDL(R)) questionnaires were used as a QoL measure. The study group consisted of 211 children and adolescents with chronic kidney disease (CKD) (139 TR and 72 DP aged between 4-18 years; 13.7 +/- 3.5 years) from 11 university hospitals, 129 parents of these patients, 232 age-matched healthy children and adolescents (aged between 4-18 years; 13.1+/-3.5 years) and 156 of their parents. Patients with CKD had lower scores in all subscales except for physical well-being than those in the control group. TR had higher scores in physical well-being, self-esteem, friends' subscales, and total scores than DP. Child-self scores were lower than parent-proxy scores, especially in CKD, DP, and control groups. Concordance between parent-proxy and child-self reports in the TR, DP, CKD, and control groups was only moderate for the majority of subscales (r = 0.41-0.61). It was concluded that parent-proxy scores on the QoL were not equivalent to child-self scores and that evaluating both children's and parents' perspectives were important. Additionally, psychosocial counseling is crucial not only for patients with CKD but also for their parents.

Agreement between mothers and children with malocclusion in rating children's oral health-related quality of life

INTRODUCTION

The aim of this study was to compare the assessment of oral health-related quality of life (OH-QoL) between children with malocclusion and their mothers, by using responses to the child perceptions questionnaire and the parental-caregivers perceptions questionnaire.

METHODS

The study was conducted in 90 children, aged 11 to 14 years, with a malocclusion grade of 4 or 5 according to the index of orthodontic treatement need dental health component. The children and their mothers completed the questionnaires independently.

RESULTS

The mean ratings were similar for total scores (children, 20.4; mothers, 20.1), oral symptoms (children, 5.2; mothers, 4.7), and social well-being (children, 4.3; mothers, 4.8). However, the mothers group had a lower mean score for functional limitations (children, 5.3; mothers, 3.6) and a higher mean score for emotional well-being (children, 5.6; mothers, 7.1). The correlations between children's and mothers' responses ranged from rs = 0.545 for total score and emotional well-being to rs = 0.357 for functional limitations. There were good correlations between their responses to global (rs = 0.466) and life overall (rs = 0.427) questions, but poor correlations between the 2 questions, suggesting that these concepts were considered differently.

CONCLUSIONS

Maternal opinions were similar to those of their children for the overall impact on OH-QoL of malocclusion, but mothers were more dissatisfied with the appearance of their children's teeth and overestimated the emotional impact of malocclusion. It would be useful to develop a specific measure to assess OH-QoL in children with malocclusion.

Perceptions of Dutch orthodontic patients and their parents on oral health-related quality of life

OBJECTIVE

To test the hypotheses that 1) there is no difference between orthodontic patients' and their parents' reports of patients' oral health-related quality of life, and 2) there are no gender differences.

MATERIALS AND METHODS

The sample consisted of 182 orthodontic patients (age range, 8-15) and their parents. Respondents were required to complete the Child Oral Health Impact Profile (COHIP). Items were divided into five different subscales, and scores on all subscales were compared between and within groups. Also, scores on six additional items regarding treatment expectations and global health perception were compared. Two hypotheses were tested: first, that no differences between parents and patients would be detected, and second, that no differences between boys and girls would be found.

RESULTS

The first hypothesis could not be rejected. Only a few minor differences between parents and patients were found. The second hypothesis was rejected. Differences between boys and girls were found on the subscales Emotional Well-Being and Peer Interaction, indicating that girls experience more effects of oral health on their quality of life than do boys.

CONCLUSIONS

Parents' reports on their children's oral health-related qualities of life were in agreement with reports of the orthodontic patients. This suggests that parents are suitable alternatives to their children in surveys measuring oral health-related quality of life.

Critical issues in craniofacial care: quality of life, costs of care, and implications of prenatal diagnosis

Since the 2000 Surgeon General's Report on Oral Health (SGROH), substantial areas of inquiry relative to individuals, especially children and youth, with orofacial clefts and other craniofacial conditions have emerged. These areas include access to and cost of care, stigmatization and quality of life, and social and ethical issues around prenatal diagnosis. This update on the 2000 SGROH examines what we have learned about the cost and ability to access cleft and craniofacial care, prenatal diagnosis, and how quality of life is impacted by these conditions and the burden of care. The development of new research tools to assess quality of life since 2000 will permit further study of the impact of oral and craniofacial conditions on children and families and the effect of treatment on quality of life. Despite a better understanding of the higher use of services and increased costs of care for families of children with craniofacial conditions, major gaps in research must be addressed to assist with program planning and policy development for these groups of children and their families. Further work is also needed to assess the cost-effectiveness of craniofacial team care and to better understand family experience with accessing needed care. Finally, prenatal detection and diagnosis of clefts and craniofacial conditions have advanced dramatically, and the roles of craniofacial professionals and teams have been affected. New understandings of prenatal diagnosis and genomic sciences are redefining genetic counseling, therapy, and future preventive initiatives.

The impact of orofacial clefts on quality of life and healthcare use and costs

Orofacial clefts are common birth defects that may impose a large burden on the health, quality of life, and socioeconomic well-being of affected individuals and families. They also result in significant healthcare use and costs. Understanding the impact of orofacial clefts on these outcomes is important for identifying unmet needs and developing public policies to reduce the burden of orofacial clefts at the individual, family and societal levels. This paper reviews and summarizes the main findings of recent studies that have evaluated the impact of orofacial clefts on these outcomes, with a focus on quality of life, socioeconomic outcomes, long-term health, and healthcare use and costs. Several studies identify an increased burden of orofacial clefts on these outcomes, but some of the findings are inconsistent. A summary of the primary limitations of the studies in this area is presented, along with recommendations and directions for future research.

Changes in quality of life among Norwegian school children: a six-month follow-up study

BACKGROUND

A considerable gap exists in regard to longitudinal research on quality of life (QoL) in community populations of children and adolescents. Changes and stability of QoL have been poorly examined, despite the fact that children and adolescents undergo profound developmental changes. The aims of the study were to investigate short-term changes in student QoL with regard to sex and age in a school-based sample.

METHODS

A representative Norwegian sample of 1,821 school children, aged 8-16 years and their parents were tested at baseline and 6 months later, using the Inventory of Life Quality for Children and Adolescents (ILC) and the Kinder Lebensqualität Fragebogen (KINDL). Student response rate at baseline was 71.2% and attrition over the follow-up period was 4.6%, and 1,336 parents (70%) completed the follow-up. Change scores between baseline and follow-up evaluations were analysed by means of ANCOVA in regard to sex and age effects.

RESULTS

Students in the 8th grade reported a decrease in QoL over the six-month follow-up period as compared to those in the 6th grade with regard to Family and School domains and total QoL on the KINDL. For emotional well-being a significant linear decrease in QoL across grades 6th to 10th was observed. However, student ratings on the Friends and Self-esteem domains did not change significantly by age. Girls reported a higher decrease in their QoL across all grades over the follow-up period than did boys in respect of Self-esteem on the KINDL, and an age-related decrease in total QoL between 6th and 8th grade on the ILC. Parent reports of changes in child QoL were nonsignificant on most of the domains.

CONCLUSION

The observed age and sex-related changes in school children's QoL across the six-month follow-up period should be considered in epidemiological as well as clinical research.

Quality of Life as reported by school children and their parents: a cross-sectional survey

BACKGROUND

Comprehensive evidence exists regarding the discrepancy between children's reports and parents' by proxy reports on emotional and behavioural problems. However, little is yet known about factors influencing the extent to which child self- and parent by proxy reports differ in respect of child Quality of Life (QoL). The aim of the study was to investigate the degree of discrepancy between child and parent by proxy reports as measured by two different QoL instruments.

METHODS

A representative Norwegian sample of 1997 school children aged 8-16 years, and their parents were studied using the Inventory of Life Quality (ILC) and the 'Kinder Lebensqualität Fragebogen' (KINDL). Child and parent reports were compared by t-test, and correlations were calculated by Pearson product moment coefficient. Psychometric aspects were examined in regard to both translated QoL instruments (internal consistency by Cronbach's alpha and test-retest reliability by intraclass correlation coefficients).

RESULTS

Parents evaluated the QoL of their children significantly more positively than did the children. Correlations between mother-child and father-child reports were significant (p < 0.01) and similar but low to moderate (r = 0.32; and r = 0.30, respectively, for the KINDL, and r = 0.30 and r = 0.26, respectively, for the ILC). Mother and father reports correlated moderately highly (r = 0.54 and r = 0.61 for the KINDL and ILC, respectively). No significant differences between correlations of mother-daughter/son and father-daughter/son pairs in regard to reported child QoL were observed on either of the two instruments.

CONCLUSION

In the present general population sample, parents reported higher child QoL than did their children. Concordance between child and parent by proxy report was low to moderate. The level of agreement between mothers and fathers in regard to their child's QoL was moderate. No significant impact of parent and child gender in regard to agreement in ratings of child QoL was found. Both the child and parent versions of the Norwegian translations of the KINDL and ILC can be used in surveys of community populations, but in regard to the self-report of 9-10 years old children, only the KINDL total QoL scale or the ILC are recommended.

Clinical research in pediatric plastic surgery and systematic review of quality-of-life questionnaires

In the first part of this article, examples of different research designs used to study pediatric patients who undergo plastic surgery are described. The remainder of the article discusses the measurement of outcomes in pediatric plastic surgery research, with a particular focus on the assessment of quality of life (QOL). Issues specific to measuring QOL in children are discussed (eg, developmental considerations, use of self- versus proxy report). The results of a systematic literature review to identify and appraise pediatric plastic surgery condition-specific measures of QOL are presented.