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Use of the PedsQL in childhood intermittent exotropia: estimates of feasibility, internal consistency reliability and parent–child agreement

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Abstract

Purpose

To evaluate the PedsQLs performance in children with intermittent exotropia (X[T]) in terms of feasibility, internal consistency, floor–ceiling effects and levels of parent–child agreement.

Methods

Children with X(T) aged <12 years were recruited from 26 UK Hospital Eye Clinics/Orthoptic Departments. QOL was assessed using child (n = 166) and proxy (n = 392) versions of the PedsQLv4. Feasibility was assessed by percentage of missing responses; internal consistency by Cronbach’s alpha and agreement by Bland–Altman plots and intraclass correlations. Analyses included age and gender comparisons.

Results

Missing response rates were no higher than 1.8%. Cronbach’s alpha reached ≥0.70 on all but one parent-rated scale and on most child-rated Total, Psychosocial Summary and Social Functioning scales, but was <0.70 on most child-rated Physical, Emotional and School Functioning scales. On parent-rated scales, there were no floor effects; ceiling effects reached 27–56% in parents’ Physical, Social and School Functioning. On child-rated scales, there were 0–1% floor effects and 0–28% ceiling effects. Parent–child agreement was fair to poor and varied by child’s gender.

Conclusions

Proxy-rated PedsQLs demonstrated good internal consistency/feasibility in parents of children with X(T); child-rated reports appeared acceptable, although caution is advised regarding Physical, Emotional and School Functioning scales in younger children. Low–fair agreement between proxy and self-ratings is common in paediatric QOL assessment, reiterating the importance of obtaining both perspectives. We encourage future studies to explore the influence of child’s age and gender, and the relationship of the proxy respondent.

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Abbreviations

IOXT:

Improving outcomes in intermittent exotropia study

PedsQL:

Paediatric quality of life inventory

QOL:

Quality of life

X(T):

Intermittent exotropia

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Acknowledgments

We wish to thank Teresa Smith, orthoptist at the Royal Victoria Infirmary, Newcastle upon Tyne, for her work on the PedsQL training videos; all collaborating orthoptists and ophthalmologists in the 26 participating centres; and the parents and children who agreed to take part in the study. We are grateful to the Guide Dogs Association and the BUPA Foundation for financial support.

Conflict of interest

None of the authors have any conflict of interest.

Author information

Authors and Affiliations

  1. Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK

    Deborah Buck & Michael P. Clarke

  2. Royal Victoria Infirmary Eye Department, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK

    Michael P. Clarke & Christine Powell

  3. Sunderland Eye Infirmary, Sunderland, UK

    Peter Tiffin

  4. Department of Psychology, Durham University, Durham, UK

    Robert F. Drewett

Authors
  1. Deborah Buck
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  2. Michael P. Clarke
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  3. Christine Powell
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  4. Peter Tiffin
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  5. Robert F. Drewett
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Corresponding author

Correspondence to Deborah Buck.

Additional information

This study is conducted On behalf of the Improving Outcomes in Intermittent Exotropia (IOXT) Study Group.

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Buck, D., Clarke, M.P., Powell, C. et al. Use of the PedsQL in childhood intermittent exotropia: estimates of feasibility, internal consistency reliability and parent–child agreement. Qual Life Res 21, 727–736 (2012). https://doi.org/10.1007/s11136-011-9975-7

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  • DOI: https://doi.org/10.1007/s11136-011-9975-7

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