Reliability and validity of Japanese versions of KIDSCREEN-27 and KIDSCREEN-10 questionnaires

The Lower the Physical Function, the Higher the Quality of Life in Japanese Adolescents with Cerebral Palsy

AIMS

To investigate the factors that contribute to subjective quality of life (QOL) in adolescents with cerebral palsy (CP).

METHODS

We evaluated the subjective QOL in 51 adolescents with CP through interviews using the Japanese version of KIDSCREEN-27 (J-KIDSCREEN-27) and compared the scores with those of 60 typically developing adolescents. Correlations of subjective QOL with age, sex, the levels of functions (gross motor, manipulation, and communication), intelligence, the level of activity of daily living (ADL), and the type of educational support were examined. Thereafter, we investigated the predictors of the subjective QOL by multiple regression analysis.

RESULTS

The total QOL scores and individual J-KIDSCREEN-27 domains were not significantly different from those of typically developing adolescents. Sex, manipulation and communication functions, and intelligence had no relationship with subjective QOL. Gross motor function and ADL level negatively correlated with satisfaction with the school environment. Multiple regression analysis revealed that higher age predicts lower psychological well-being, lower gross motor function predicts higher satisfaction with the school environment, and attending schools or classes for special needs predicts higher physical well-being.

CONCLUSIONS

Seeking adequate support for mildly affected adolescents attending regular classes will be the key to further improving subjective QOL in adolescents with CP.

Development of A Japanese Version of the Family Poly-Victimization Screen (FPS-J)

This study developed a Japanese version of the Family Poly-Victimization Screen (FPS-J) and assessed its validity. A cross-sectional study using self-report questionnaires was conducted with parents of children in Tokyo, Japan, from January to February 2022. To test the validity of the FPS-J, we used the Japanese versions of the revised Conflict Tactics Scale Short Form (J-CTS2SF) as the gold standard for intimate partner violence (IPV), the Conflict Tactics Scale Parent-Child (J-CTS-PC) for child abuse (CAN), the Conflict Tactics Scale (J-MCTS) for elder abuse, the K6-J for depression and anxiety, the PCL5-J for post-traumatic stress disorder, and the J-KIDSCREEN for Health-related Quality of Life among children. Data from 483 participants (response rate: 22.6%) were used. The J-CTS2SF and J-CTS-PC scores were significantly higher among the IPV/CAN-victim groups than in the non-victimized groups classified by the FPS-J (p < 0.001). The JMCTS scores did not differ significantly between the victim and non-victim groups (p = 0.44), but the PCL5-J, K6-J, and J-KIDSCREEN-10 scores were either significantly higher or lower among victims of violence than among the non-victim groups (p < 0.05). This study suggests the validity of parts of the FPS-J, especially the IPV against respondents and CAN by respondents.

Validity and Reliability of the Turkish Version of the KIDSCREEN-27 for Individuals With Cerebral Palsy

Our aims in this study were to examine the construct/concurrent validity and internal/test-re-test reliabilities of both the self-report and parent-report questionnaires of a Turkish version of the KIDSCREEN-27 for adolescents with cerebral palsy (CP). We used a convenience sample of 135 children and adolescents with CP aged 8-18 years (65 males, 70 females; M age = 12.39, SD = 3.57) and their parents/caregivers (123 mothers, seven fathers, and five grandmothers). We explored structural construct validity via confirmatory factor analysis (CFA). Concurrent validity was examined via Spearman's correlations between the KIDSCREEN-27 questionnaires and the self-report and primary caregiver report forms of the Cerebral Palsy Quality of Life for Children (CP QOL-Child) and adolescents (CP QOL-Teen). We explored test-retest and internal consistency reliabilities utilizing intraclass correlation coefficients (ICC) and Cronbach's alpha (α), respectively. CFA goodness-of fit indices verified that the predefined model of the KIDSCREEN-27 was a good fit for data from the CP population (X²/df<5, GFI >0.90, AGFI >0.90, RMSEA<0.80). Results showed the subdomains of both KIDSCREEN-27 forms to be significantly correlated with the matched subdomains of the CP QOL-Child and CP QOL-Teen questionnaires (ranges of r = 0.62-0.94). Overall, α and ICC coefficients for all subdomains of both KIDSCREEN-27 versions were acceptable (α and ICC >0.70). Both versions of the KIDSCREEN-27 have satisfactory psychometric properties for use in evaluating health-related quality of life (HRQOL) outcomes in children and adolescents with CP.

Use of KIDSCREEN health-related quality of life instruments in the general population of children and adolescents: a scoping review

PURPOSE

Subjectively assessing health related quality of life (HRQoL) in children and adolescents is increasingly important in the public health field. One valid and widely used generic HRQoL instrument is the KIDSCREEN questionnaire. The aim of this study was to map all studies using KIDSCREEN instruments in the general population of children and adolescents aged 6-18 years.

METHODS

A scoping review was conducted. The search strategy was formulated according to the Preferred Reporting Items for Systematic Reviews and Scoping Reviews guidelines. The databases Cinahl, socINDEX, Medline, Embase, APA Psychinfo, Scopus, and Eric were searched in October 2021.

RESULTS

In total, 1365 papers were eligible for screening, 1031 were excluded and 334 reports were read in full. 252 reports were included. KIDSCREEN studies in the general population was predominantly conducted in Europe (n = 211). Most studies (n = 179) had a cross sectional design, while few experimental studies (n = 24) were found. The three KIDSCREEN versions comprising of 10, 27 and 52 items, were equally distributed between studies. The self-reported version (n = 225) of the KIDSCREEN instrument was more prevalent than the proxy version, while few studies discussed a cut point. Study contexts reflected international trends of public health challenges, commonly including mental- and psychosocial health, physical activity, socioeconomic status, and obesity.

CONCLUSION

KIDSCREEN is widely used in cross sectional studies assessing common public health challenges. Experimental and longitudinal assessments, possibly including relevant cut offs remain mainly unexplored and are recommended for future research.

Impact of respite care on health-related quality of life in children with medical complexity: A parent proxy evaluation

PURPOSE

This study examined the impact of respite care received by children with medical complexity (CMC) on their health-related quality of life (HRQOL). We hypothesized that out-of-home respite care would increase both opportunities to engage in activities and participation with non-family members and help with acquiring autonomy and social skills.

DESIGN AND METHODS

This cross-sectional study of CMC aged between 8 and 18 years living at home used a web-based questionnaire survey that parents living with the target CMC answered for proxy evaluation of CMC's HRQOL (KIDSCREEN-27). We asked 3142 parents to participate in the study through 237 special-needs schools throughout Japan. Path analysis was used to estimate the variation in each aspect of HRQOL with respite care time of in-home care services, day care services, short-stay services, and school time.

RESULTS

We analyzed the responses from 618 parents of CMC. The results showed that respite care by day care services and special-needs schools increased "physical well-being," "psychological well-being," and "peers and social support," which are components of the HRQOL. Furthermore, respite care at schools had an impact on "school environment."

CONCLUSIONS

Respite care provided by special-needs schools and day care services has implications not only in terms of relief for caregivers but also in improving the HRQOL of CMC.

PRACTICE IMPLICATIONS

Nurses can provide respite care that does not require parental accompaniment at school or day care facilities, which can lead to CMC's involvement in fostering autonomy and social skills. (249/250 words).

The KIDSCREEN-27 Quality of Life Measure for Romanian Children Aged 6: Reliability and Validity of the Romanian Version

The KIDSCREEN-27 represents a standardized, worldwide instrument, employed to assess the health-related quality of life in children. The purpose of the present study is to validate the KIDSCREEN-27 questionnaire for 6-year-old preparatory school children and verify its reliability, as well as to perform a comparison regarding the quality of children’s lives living in two cities in Romania: Arad, a provincial city, versus the second most developed city in the country, Cluj-Napoca. A total of 256 children of 6 years of age, who come from families with both parents, with a medium to high socioeconomic status and a good health status, were included in the analysis, using the KIDSCREEN-27 questionnaire at three assessment time points with a re-test period of two weeks. Results indicated that the KIDSCREEN-27 turned out to be suitable for use in 6-year-old Romanian children. Analysis regarding the psychometric properties showed that the Cronbach’s alpha ranged from 0.554 to 0.661 at the end of the study. The Pearson correlation coefficients showed statistically significant differences between the items of each area investigated. In conclusion, there is a growing need to periodically monitor the health status of children to avoid possible problems which may occur.

Validation of the Chinese Version of KIDSCREEN-10 Quality of Life Questionnaire: A Rasch Model Estimation

The KIDSCREEN-10 was deemed as a cross-national instrument for measuring Health-Related Quality of Life (HRQoL). However, no empirical endeavor has explored its reliability and validity in the context of China. This study aims to translate and validate the Chinese version of the KIDSCREEN-10 questionnaire. The KIDSCREEN-10 was translated into Chinese (Mandarin) using a blindly bilingual forward–backward–forward technique. A cross-sectional survey, including 1,830 students aged from 8 to 18 years, was conducted in a county located in Gansu province, China. Psychometric properties were evaluated using the Rasch partial credit model, ANOVA, and the correlation analysis. Results indicated that the KIDSCREEN-10 performed good internal consistency, known-group validity, and concurrent validity, but there were still some deficiencies in psychometrics: first, disordered response categories were found between category 2 (seldom) and category 3 (sometimes); second, item 3 (“Have you felt sad?”), item 4 (“Have you felt lonely?”), and item 5 (“Have enough time for self?”) demonstrated misfit to the Rasch model; third, items 3 and 4 exhibited differential item functioning. After collapsing the disordered response categories and removing the three misfit items, the seven-item questionnaire performed good psychometric properties. However, the seven-item version does not cover the psychological well-being dimension of HRQoL, and that may lead to inappropriate measures of HRQoL. Therefore, this paper suggested to use classical test theory to investigate the psychological properties of the KIDSCREEN-10.

Testing measurement properties of two EQ-5D youth versions and KIDSCREEN-10 in China

OBJECTIVE

To assess measurement properties of the two youth versions of EQ-5D (i.e., 5-level EQ-5D-Y [Y-5L] and 3-level EQ-5D-Y [Y-3L]) and KIDSCREEN-10 in China.

METHODS

Children and adolescents attending schools in Shanghai, China were recruited to self-complete the Y-5L, KIDSCREEN-10, and Y-3L questionnaires. Their feasibility was assessed according to missing responses. Convergent validity of the EQ-5D-Y dimensions, a summated dimension score [SDS], and Visual Analogue Scale (VAS) were assessed by examining their correlations with the KIDSCREEN-10 index score and dimensions. Known-groups validity of SDS, VAS, and KIDSCREEN-10 index score were tested by comparing the scores of pupils with and without two conditions (i.e., overweight and shortsightedness), and the relative efficiency (RE) between them was also evaluated.

RESULTS

A total of 262 pupils (girl: 58.4%; mean age: 12.7 years) were enrolled. Missing responses were low for both the Y-5L (0.3%) and Y-3L (2.4%), and KIDSCREEN-10 (0.3%). The overall ceiling effects were 40.3% for the Y-5L, 44.1% for the Y-3L and 1.1% for the KIDSCREEN-10. The SDS_Y-5L, SDS_Y-3L and VAS were moderately correlated with the KIDSCREEN-10 index score (|r|= 0.425 for SDS_Y-5L, 0.323 for SDS_Y-3L, and 0.435 for VAS; p < 0.01 for all). Similar EQ-5D-Y and KIDSCREEN-10 dimensions showed moderate to strong correlations (|r|> 0.3). Both the SDS_Y-5L and SDS_Y-3L had lower values, and VAS and KIDSCREEN-10 index score had higher values for pupils without shortsightedness compared with those for their counterparts. The difference was statistical significance for the SDS_Y-5L and VAS (P < 0.05 for both), which also had higher RE in the condition.

CONCLUSIONS

The Y-5L, Y-3L, and KIDSCREEN-10 questionnaires are feasible and valid for measuring HRQoL among children/adolescents in China. It also appears that the advantages of Y-5L over Y-3L were modest.

Psychometric analysis of the Brazilian-version Kidscreen-27 questionnaire

Background

The objective of this study was to verify the reliability, discriminatory power and construct validity of the Kidscreen-27 questionnaire in Brazilian adolescents.

Methods

Adolescents that participated of the pilot study (210 adolescents; 52.9% boys; 13.7 years old) and of the baseline (816 participants; 52.7% girls; 13.1 years old) of the Movimente Project in 2016/2017 composed the sample of the present study. This project was carried out in six public schools in the city of Florianópolis, Santa Catarina, Brazil. Test–retest reproducibility was assessed by the intraclass correlation coefficient and Gwet coefficient; internal consistency through McDonald's Omega; Hankins' Delta G coefficient verified the scale's discriminatory power and; confirmatory factor analysis to assess construct validity.

Results

Reproducibility values ranged from 0.71 to 0.78 for the dimensions (ICC), and ranged from 0.60 to 0.83 for the items (Gwet). McDonald's Ômega (0.82–0.91) for internal consistency measures. Discriminatory power ranging from 0.94 for the dimension Social Support and Friends to 0.98 for Psychological Well-Being. The factorial loads were > 0.40, except for item 19 (0.36). The fit quality indicators of the model were adequate (X²[df] = 1022.89 [311], p < 0.001; RMSEA = 0.053 (0.049–0.087); CFI = 0.988; TLI = 0.987), confirming the five-factor structure originally proposed.

Conclusions

The Brazilian-version Kidscreen-27 achieved good levels of reproducibility, internal consistency, discriminatory power and construct validity. Its use is adequate to measure the health-related quality of life of adolescents in the Brazilian context.

Development and Validation of the Japanese Version of Quality of Life Assessment of Spina Bifida in Children (QUALAS-C-J)

BACKGROUND

We previously developed the Japanese version of The Quality of Life Assessment of Spina Bifida in Teenagers, a health-related quality-of-life instrument specific to children aged 13-17 years with spina bifida (SB). The Quality of Life Assessment of Spina Bifida in Children is a version of this questionnaire for children aged 8-12 years. The purpose of this study was to develop a Japanese version of the Quality of Life Assessment of Spina Bifida in Children (QUALAS-C-J) and verify its reliability and validity.

METHODS

Three urologists specializing in SB, 2 nurses, and 1 statistician developed the QUALAS-C-J and conducted a pilot and main survey. Participants included children with SB and non-disabled (ND) children. Participants completed the QUALAS-C-J and the Japanese version of KIDSCREEN-27 (J-KIDSCREEN) without parental help.

RESULTS

Five children with SB participated in the pilot study and provided face and content validity. Sixty-three children with SB and 40 age- and sex-matched ND children participated in the main survey. The intraclass correlation coefficient in the retest was 0.80, and Cronbach's alpha in each domain was 0.73. The validity was verified by factor analysis, convergent / divergent validity, and known-groups validity. Factor analysis converged to the same two-factor structure as the original version. The correlation between QUALAS-C-J and J-KIDSCREEN-27 was weak (r=-0.06-0.30). The scores of both groups for the two domains of the QUALAS-C-J were significantly lower in SB than ND children.

CONCLUSIONS

QUALAS-C-J is easy to answer, suitable for Japanese children with SB, reliable, and valid. It can be a communication tool for children with SB, medical staff, families, communities, and school teachers.

Health-Related Quality of Life in Non-Concussed Children: A Normative Study to Inform Concussion Management

Purpose: There has been a shift to consider pediatric concussion recovery beyond symptom management by considering how health-related quality of life (HRQoL) affects recovery. This study investigated normative ranges of HRQoL in children and explored its relationship with common pediatric concussion variables. Methods: A cross-sectional study of 1,722 non-concussed children 8-12 years old (M = 10.52 ± 1.23 years; 1,335 males, 387 females) was conducted by secondary analysis of clinical baseline concussion data. Demographic information, concussion-like symptoms (PCSI-C), and HRQoL (KIDSCREEN-10 Index) were self-reported. Results: The most reported concussion-like symptoms were common stress symptoms and were significantly negatively correlated with HRQoL. Premorbid histories of attention deficit hyperactivity disorder, mental health challenges, headaches/migraines, and concussion significantly lowered HRQoL. The number of diagnosed concussions and PCSI-C scores were significantly negatively correlated with HRQoL. Conclusions: The normative ranges and model can indicate HRQoL levels to inform clinicians how children may respond to concussion and streamline care beyond traditional assessment models.

Development and validation of the Japanese version of the Quality of Life Assessment of Spina Bifida in Teenagers (QUALAS-T-J)

BACKGROUND

Spina bifida (SB) is the second-most common birth defect in Japan. In recent years, health-related quality of life measurements have been used to assess the psychosocial status of children with SB. The Quality of Life Assessment of Spina Bifida in Teenagers (QUALAS-T) is a self-reported questionnaire for subjects aged 13-17 years with SB. It focuses particularly on factors related to independence, bladder and bowel. The purpose of this study was to develop and validate a Japanese version of QUALAS-T (QUALAS-T-J).

METHODS

Three urologists specialized in SB, two nurses, one statistician, and the author of the original version developed the QUALAS-T-J. Subjects with SB completed the QUALAS-T-J and the Japanese version of KIDSCREEN-27 (J-KIDSCREEN-27) independently from their parents.

RESULTS

A pilot study involving seven adolescents with SB and confirmed face and content validity. Sixty-nine adolescents with SB participated in the main survey. The intraclass correlation coefficient in the retest was 0.77, and Cronbach's alpha in each domain was 0.83 and 0.79. Validity was verified on factor analysis and convergent/divergent validity. Five items converged in the one domain, Bladder and Bowel. The remaining five items converged in the concept of Family and Independence. The correlation between each domain of the QUALAS-T-J and J-KIDSCREEN-27 was low-moderate.

CONCLUSION

The reliability and validity of the QUALAS-T-J were verified in Japanese adolescents with SB. The QUALAS-T-J would be a useful tool for communication between adolescents with SB and medical staff.

Assessing health-related quality of life in Japanese children with a chronic condition: validation of the DISABKIDS chronic generic module

Background

This study examined the reliability and validity of the Japanese versions of the DISABKIDS-37 generic modules, a tool for assessing the health–related quality of life (HRQOL) of children and adolescents with a chronic condition.

Methods

The study was conducted using a sample of 123 children/adolescents with a chronic medical condition, aged 8–18 years, and their parents. Focus interviews were performed to ensure content validity after translation. The classical psychometric tests were used to assess reliability and scale intercorrelations. The factor structure was examined with confirmatory factor analysis (CFA). Convergent validity was assessed by the correlation between the total score and the sub-scales of DISABKIDS-37 as well as the total score of KIDSCREEN-10.

Results

Both the children/adolescent and parent versions of the score showed good to high internal consistency, and the test-retest reliability correlations were r = 0.91 or above. The CFA revealed that the modified models for all domains were better fit than the original 37 item scale model for both self-report and proxy-report. Moderate to high positive correlations were found for the associations within DISABKIDS-37 sub-scales and between the subscales and total score, except for the treatment sub-scale, which correlated weakly with the remaining sub-scales. The total score of the child-reported version of KIDSCREEN-10 correlated significantly and positively with the total score and all the sub-scales of the child-reported version of DISABKIDS-37 except the Treatment sub-scale in adolescents.

Conclusions

The modified models of Japanese version of DISABKIDS generic module were psychometrically robust enough to assess the HRQOL of children with a chronic condition.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0911-1) contains supplementary material, which is available to authorized users.