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Rahman M, Leroux BG, McKinney CM, Kapp-Simon KA, Edwards T, Jones SM, Rosenberg JM, Patrick D, Daniels K, Stueckle L, Heike CL. Observations by Caregivers Using the Infant with Clefts Observation Outcomes Instrument (iCOO): A Comparison of Three Versus Seven-day Daily Diaries. Cleft Palate Craniofac J 2024; 61:1538-1542. [PMID: 37186767 PMCID: PMC10704860 DOI: 10.1177/10556656231175290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Our goal was to compare data collected from 3- and 7-day Infant with Clefts Observation Outcomes (iCOO) diaries. DESIGN Secondary data analysis of an observational longitudinal cohort study. Caregivers completed the daily iCOO for 7 days before cleft lip surgery (T0) and for 7 days after cleft lip repair (T1). We compared 3- and 7-day diaries collected at T0 and 3- and 7-day diaries collected at T1. SETTING United States. PARTICIPANTS Primary caregivers of infants with cleft lip with and without cleft palate (N = 131) planning lip repair and enrolled in original iCOO study. MAIN OUTCOMES MEASURE(S) Mean differences and Pearson correlation coefficients. RESULTS Correlation coefficients were high for global impressions (>0.90) and scaled scores (0.80-0.98). Mean differences were small across iCOO domains at T0. T1 comparisons reflected the same pattern. CONCLUSIONS Three-day diary data is comparable to 7-day diaries for measuring caregiver observations using iCOO across T0 and T1.
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Affiliation(s)
- Muhammad Rahman
- Seattle Children's Hospital, Seattle, WA
- University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | | | | | - Carrie L Heike
- Seattle Children's Hospital, Seattle, WA
- University of Washington, Seattle, WA
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Lindberg NE, Kynø NM, Billaud Feragen K, Pripp AH, Tønseth KA. Early Follow-up of Parents by a Specialized Cleft Nurse After the Birth of an Infant with Cleft lip and/or Palate. Cleft Palate Craniofac J 2024; 61:1369-1382. [PMID: 37151047 PMCID: PMC11308288 DOI: 10.1177/10556656231171750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE To document the impact of early follow-up by specialized cleft nurses (SCNs) to families of infants with cleft lip and/or cleft palate (CL/P). DESIGN Prospective inclusion of a control group, which received standard care alone, followed by an intervention group, which in addition received early SCN follow-up. SETTING The cleft lip and palate team at a University hospital. PARTICIPANTS 70 families (69 mothers and 57 fathers); control group (n = 38); intervention group (n = 32). INTERVENTION SCNs offered a consultation at the maternity ward and follow-ups by phone or face-to-face at one, three, eight weeks and six months after birth. OUTCOME MEASURES Use of Internet-Questionnaire, Quality of discharge teaching scale (QDTS), Post discharge coping difficulty scale (PDCDS), Response on follow-up by health professionals. RESULTS Infants in the intervention group were admitted less frequently to a Neonatal Intensive Care unit (NICU); 21.9% vs 51.4%, P = .012. Parents in the intervention group used internet for cleft-related reasons less frequently (74.6% vs 85.9%), P = .112 and the mothers benefitted less from cleft-related activity on the internet (P = .013). The intervention group reported higher mean score for satisfaction with total cleft care (P = .001). There were no significant group differences regarding mean total score for discharge teaching (P = .315) and coping difficulties (P = .919). CONCLUSION Early follow-up by a SCN with expertise in cleft care is highly valued by parents. Closer cooperation between the cleft team and health professionals at birth hospitals and Child health centers is necessary for optimal follow-up.
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Affiliation(s)
- Nina Ellefsen Lindberg
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina Margrete Kynø
- Department of Nursing and Health Promotion, Acute and Critical illness, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Rosenberg JM, Bellucci CC, Edwards TC, Heike CL, Leroux BG, Jones SM, Stueckle LP, Patrick DL, Albert M, Aspinall CL, Kapp-Simon KA. Caregiver Observations of Infant Well-Being Before and After Cleft Lip Surgery. Cleft Palate Craniofac J 2024; 61:271-283. [PMID: 36112919 PMCID: PMC11037889 DOI: 10.1177/10556656221125371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the sensitivity to change of daily ratings of the comfort (COMF) and behavioral/emotional health (BEH) domains of the Infants with Clefts Observation Outcomes Instrument (iCOO) at 3 time points, and to assess the association of post-surgical interventions on iCOO ratings. DESIGN The COMF and BEH domains were completed by caregivers before (T0), immediately after (T1), and 2-months after (T2) cleft lip (CL) surgery. Analyses included descriptive statistics, correlations, t-tests, and generalized estimating equations. PARTICIPANTS Caregivers (N = 140) of infants with CL with/without cleft palate. MAIN OUTCOME MEASURES The COMF and BEH domain scores of the iCOO: Scale (SCALE), a summary of observable signs; and Global Impression (IMPR), a single item measuring caregivers' overall impression. RESULTS Daily COMF and BEH SCALE and IMPR scores changed significantly during T1 (P's < 0.001) but not T0 or T2. Day 1 and 7 T0 scores were significantly higher than Day 1 and 7 T1 scores (P's <0.001 to <0.012) but similar at T2 (P's > 0.05). After CL surgery, the combined use of immobilizers and nasal stents and the use of multiple feeding methods with treatment for gastroesophageal reflux were associated with lower daily scores in COMF and BEH SCALE and IMPR (P's: 0.040 to <0.001). CONCLUSIONS COMF and BEH iCOO scores were sensitive to daily changes in infant well-being following CL surgery. Future studies should further investigate impact of post-surgical treatments on infant well-being.
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Affiliation(s)
- Janine M Rosenberg
- Craniofacial Center, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | | | - Todd C Edwards
- Health Services, University of Washington, Seattle, Washington, USA
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | | | - Salene M Jones
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura P Stueckle
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Meredith Albert
- Shriners Hospitals for Children, Chicago Cleft/Craniofacial, Chicago, Illinois, USA
| | | | - Kathleen A Kapp-Simon
- Shriners Hospitals for Children, Cleft/Craniofacial Chicago, Illinois and University of Illinois at Chicago, Chicago, Illinois, USA
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Kapp-Simon KA, Albert M, Edwards TC, Jones SM, Crilly Bellucci C, Rosenberg J, Patrick DL, Heike CL. Developmental Risk for Infants with Cleft Lip with or Without Cleft Palate Based on Caregiver-Proxy Reports. Cleft Palate Craniofac J 2024:10556656231225304. [PMID: 38196373 PMCID: PMC11231059 DOI: 10.1177/10556656231225304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVES (1) Assess caregiver-reported development in infants born with cleft lip ± alveolus (CL ± A) and cleft lip and palate (CLP); (2) determine factors associated with increased developmental risk; and (3) determine consistency of developmental risk before and after surgery for cleft lip. DESIGN Prospective, longitudinal assessment of development. Time (T) 1, prior to lip closure; T2, 2 months post lip closure. SETTING Three US craniofacial teams and online parent support groups. PARTICIPANTS 123 total caregivers (96% mothers); 100 at T1, 92 at T2, and 69 at both T1 and T2. MEASURE Ages and Stages Questionnaire-3 (ASQ-3): Communication, Gross Motor, Fine Motor, Problem Solving, Personal Social Domains. RESULTS At T1 47%; at T2 42% passed all 5 Domains; 36% of infants pass all 5 Domains at both T1 and T2. Infants with CLP were at greatest risk on Communication [B = 1.449 (CI = .149-20.079), p = .038; Odds Ratio (OR) = 4.3 (CI = .923-19.650)] and Gross Motor Domains [B = 1.753 (CI = .316-20.605), p = .034; OR = 5.8 (CI = 1.162-28.671)]. Male infants were at greatest risk on Fine Motor [B = 1.542 (CI = .495-20.005), p = .009; OR = 4.7 (CI = 1.278-17.101)] and Problem Solving Domains [B = 1.200 (CI = .118-19.708), p = .044; OR = 3.3 (CI = .896-12.285)]. CONCLUSIONS Based on caregiver report, infants with CL ± A and CLP meet referral criteria at a high rate. Infants with CLP and male infants were at greatest risk. Regular developmental screening is recommended.
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Affiliation(s)
- Kathleen A Kapp-Simon
- Cleft/Craniofacial Center, Shriners Children's, Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Meredith Albert
- Cleft/Craniofacial Center, Shriners Children's, Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Todd C Edwards
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Salene M Jones
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Janine Rosenberg
- Craniofacial Center, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Carrie L Heike
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
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Jones SMW, Edwards TC, Leroux BG, Kapp-Simon KA, Patrick DL, Stueckle LP, Rosenberg JM, Albert M, Bellucci CC, Aspinall CL, Vick K, Heike CL. Exploration of Caregiver Interrater Agreement and Test-Retest Reliability on the Infant Cleft Observer Outcomes (iCOO). Cleft Palate Craniofac J 2022:10556656221089155. [PMID: 35341357 PMCID: PMC9515238 DOI: 10.1177/10556656221089155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caregiver and observer-reported measures are frequently used as outcomes for research on infants and young children who are unable to report on their own health. Our team developed the Infant with Clefts Observation Outcomes Instrument (iCOO) for infants with cleft lip with or without cleft palate. This exploratory study compared test-retest and interrater reliabilities to inform whether differences in caregiver perspective might affect the iCOO. This study is a secondary analysis comparing caregiver interrater agreement to test-retest reliability. Twenty-five pairs of caregivers completed the iCOO before surgery, 1 week later for test-retest reliability, 2 days after surgery, and 2 months after surgery. Reliability was assessed using intraclass correlations (ICCs) and t-tests were used to compare ratings between caregivers. Infants had cleft lip (28%) or cleft lip and palate (72%). Primary caregivers were predominantly mothers (92%) and secondary caregivers were predominantly fathers (80%). Test-retest reliability met psychometric standards for most items on the iCOO (81%-86% of items). Caregiver agreement on the iCOO items was lower than test-retest reliability (33%-46% of items met psychometric standards). Caregivers did not systematically differ in whether they rated infants as healthier or less healthy than the other caregiver (5%-16% of items had statistically significant differences). Caregivers used the measure consistently, but had different experiences and perceptions of their infant's health and functioning. Future studies are needed to explore mechanisms for the differences in test-retest and interrater reliability. Whenever possible, the same caregiver should provide ratings of the infant, including on the iCOO.
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Edwards TC, Heike CL, Kapp-Simon KA, Jones SM, Leroux BG, Stueckle LP, Bellucci CC, Rosenberg JM, Albert M, Aspinall CL, Patrick DL. Infant with Clefts Observation Outcomes Instrument (iCOO): A New Outcome for Infants and Young Children with Orofacial Clefts. Cleft Palate Craniofac J 2021; 59:1233-1245. [PMID: 34514868 DOI: 10.1177/10556656211040307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated the measurement properties for item and domain scores of the Infant with Clefts Observation Outcomes Instrument (iCOO). DESIGN Cross-sectional (before lip surgery) and longitudinal study (preoperative baseline and 2 days and 2 months after lip surgery). SETTING Three academic craniofacial centers and national online advertisements. PARTICIPANTS Primary caregivers with an infant with cleft lip with or without cleft palate (CL ± P) scheduled to undergo primary lip repair. There were 133 primary caregivers at baseline, 115 at 2 days postsurgery, and 112 at 2 months postsurgery. MAIN OUTCOME MEASURE(S) Caregiver observation items (n = 61) and global impression of health and function items (n = 8) across eight health domains. RESULTS Mean age at surgery was 6.0 months (range 2.7-11.8 months). Five of eight iCOO domains have scale scores, with Cronbach's alphas ranging from 0.67 to 0.87. Except for the Facial Skin and Mouth domain, iCOO scales had acceptable intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.84. The internal consistency of the Global Impression items across all domains was 0.90 and had acceptable ICCs (range 0.76-0.91). Sixteen out of 20 (nonscale) items had acceptable ICCs (range 0.66-0.96). As anticipated, iCOO scores 2 days postoperatively were generally lower than baseline and scores 2 months postsurgery were consistent with baseline or higher. The iCOO took approximately 10 min to complete. CONCLUSIONS The iCOO meets measurement standards and may be used for assessing the impact of cleft-related treatments in clinical research and care. More research is needed on its use in various treatment contexts.
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Affiliation(s)
| | - Carrie L Heike
- 7284University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Shriners Hospital for Children, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Laura P Stueckle
- Seattle Children's Research Institute, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
| | - Claudia Crilly Bellucci
- Shriners Hospital for Children, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL, USA
| | - Janine M Rosenberg
- University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - Meredith Albert
- Shriners Hospital for Children, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL, USA
| | - Cassandra L Aspinall
- Seattle Children's Research Institute, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
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7
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Heike CL, Albert M, Aspinall CL, Bautista S, Bellucci CC, Kapp-Simon KA, Mecham S, Patrick DL, Rosenberg J, Siebold B, Stueckle LP, Edwards TC. Development of an Outcome Measure of Observable Signs of Health and Well-Being in Infants With Orofacial Clefts. Cleft Palate Craniofac J 2020; 57:1266-1279. [PMID: 32468839 DOI: 10.1177/1055665620922105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To develop an outcomes instrument that assesses observations that can be reliably reported by caregivers and can be used to assess health of infants with a cleft lip or cleft lip and cleft palate (CL±P) and impacts of treatments. DESIGN Cross-sectional, mixed methods study. SETTING Caregivers and health-care providers were recruited from 3 academic craniofacial centers and national advertisements. Most interviews were conducted by telephone, and surveys were completed online. PARTICIPANTS Caregivers had a child less than 3 years of age with CL±P and spoke either English or Spanish. Health-care providers were members of a cleft team. Caregivers (n = 492) and health-care professionals (n = 75) participated in at least one component of this study. MAIN OUTCOME MEASURE(S) Caregivers and health-care providers participated in tasks related to instrument development: concept elicitation for items within relevant health domains, prioritization of items, and item review. RESULTS We identified 295 observations of infant well-being across 9 health areas. Research staff and specialists evaluated items for clarity, specificity to CL±P, and responsiveness to treatment. Caregivers and health-care providers rated the resulting list of 104 observations and developed the final instrument of 65 items. CONCLUSIONS In this phase of development of the Infant with Clefts Observation Outcomes (iCOO) instrument, items were developed to collect caregiver observations about indicators of children's health and well-being across multiple domains allowing for psychometric testing, sensitivity to changes associated with treatment, and documentation of the effects of treatment.
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Affiliation(s)
- Carrie L Heike
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA.,7284University of Washington, Seattle, WA, USA
| | - Meredith Albert
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | - Cassandra L Aspinall
- 7274Seattle Children's Hospital, Seattle, WA, USA.,7284University of Washington, Seattle, WA, USA
| | - Suzel Bautista
- 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Claudia Crilly Bellucci
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen A Kapp-Simon
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Janine Rosenberg
- 21725University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - Babette Siebold
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA
| | - Laura P Stueckle
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA
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