Parent-reported health outcomes in infants/toddlers: measurement properties and clinical validity of the ITQOL-SF47
To derive and evaluate a shorter infant/toddler quality of life questionnaire (ITQOL) for use in clinical care.
Stepwise regression, factor analysis, and item-scaling principles were used to derive and guide item selection using data from a large general sample in the Netherlands (n = 5,211) and a “wheezing illness” sample (n = 138). Item internal consistency, discriminant validity, and floor and ceiling effects were evaluated using a general Dutch sample (Salland Region n = 410) and two clinical samples: Functional abdominal pain (FAP, n = 81) and Burn (n = 194). Reliabilities were estimated using Cronbach’s alpha. Relative precision (RP), the ability to distinguish between clinical subgroups, was computed by comparing the proportion of variance explained by the short-form scales versus respective full-length scales.
The ITQOL was reduced from 97 to 47 items. Median alpha coefficients were 0.77 Salland sample, 0.76 (FAP), and 0.84 (Burn). Ninety-one to 100 % scaling successes for item discriminant validity were observed for 21 of 24 tests (8 scales, 3 samples). Floor effects were not observed; some ceiling effects were detected. RP estimates in the Salland sample ranged from 2.40 (physical abilities) to 0.58 (temperament and moods). RP estimates in the FAP sample were 0.85 (bodily pain), 1.36 (temperament and moods) and 1.62 (parental-impact emotional) and for Burn, 1.51 (temperament and moods) and 0.59 (general health perceptions).
The ITQOL-SF47 is reliable and valid and exceeds item-level scaling criteria.
KeywordsReliability Psychometrics Outcomes Quality of life Questionnaire PRO’s
Functional abdominal pain
Health-related quality of life
Infant/toddler quality of life questionnaire
Infant/toddler quality of life questionnaire short form 47
None of the authors received financial compensation for this work nor do they have a conflict of interest to report. Ms. Landgraf is the vice president and chief scientific officer at HealthActCHQ, Inc., which owns the intellectual property rights to the ITQOL.
- 1.www.fda/gov/downloads/drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282.pdf. Last accessed 12 June 2011.
- 2.European Commission—Enterprise and Industry—Pharmaceuticals—Medicines for Children. The 17th annual conference of the international society for quality of life research, October 27–30, 2010. Panel discussion: Ensuring adequate health assessments for national and international health policy decision-making. London, United Kingdom, http://ec.europa.eu. Last accessed 12 June 2011. www.ema.europa.eu.
- 4.Landgraf, J. M., & Abetz, L. (1994). The Infant/toddler quality of life questionnaire: Conceptual framework, logic, content, and preliminary psychometric results. Final proprietary report to Schering-Plough laboratories and health technology associates. Boston, MA: New England Medical Center.Google Scholar
- 6.Klassen, A. F., Landgraf, J. M., Lee, S. K., Barer, M., Raina, P., & Chan, H. W., et al. (2003). Health related quality of life in 3 and 4 year old children and their parents: Preliminary findings about a new questionnaire. Health and Quality of Life Outcomes, 1, 81.Google Scholar
- 11.Oostenbrink, R., Spong, K., de Goede-Bolder, A., Landgraf, J. M., Raat, H., & Moll, H. A. (2007). Health- related quality of life in a sample of young children with neurofibromatosis type 1: Influence of condition specific determinants. Journal of Pediatrics, 151, 182–186. Published Online: 10.1016/j.jpeds.2007.03.005.Google Scholar
- 12.Alonso, E. M., Neighbors, K., Barton, F. B., McDiarmid, S. V., Dunn, S. P., Mazariegos, G. V., Landgraf, J. M., Bucuvalas, J. C., & The Studies of Pediatric Liver Transplant Research Group. (2008). Health related quality of life and family function following pediatric liver transplantation. Liver Transplantation, 14, 460–468. Published Online: March 26 2008. doi: 10.1002/lt.21352.Google Scholar
- 13.Oostenbrink, R., Jongman, H., Landgraf, J. M., Raat, H., & Moll, H. A. (2010). Functional abdominal complaints in pre-school children: Parental reports of health related quality of life. Quality of Life Research, 19(3), 363–369. doi: 10.1007/s11136-009-9583-y. 0962-9343 (print) 1573-2649 (online).
- 14.Raat, H., van Rossem, L., Jaddoe, V. W. V., Landgraf, J. M., Feeny, D., Moll, H. A., Hofman, A., & Mackenbach, J. P. (2010). The Generation R study: A candidate gene study and genome wide association studies (GWAS) on health-related quality of life (HRQOL) of mothers and young children. Quality of Life Research, 19(10), 1439–1446. Epub 2010 Oct 28. doi: 10.1007/s11136-010-9773-7.
- 15.Spuijbroek, A. T., Oostenbrink, R., Landgraf, J. M., Rietveld, E., de Goede-Bolder, A., van Beeck, E. F., van Baar, M., Raat, H., & Moll, H. A. (2011). Health related quality of life profiles for five childhood diseases. Quality of Life Research, 20, 779–786. doi: 10.1007/s11136-010-9806-2.
- 17.Rajmil, L., Abad, S., Sardon, O., Moerea, G., Perez-Yara, E. G., Moreno, A., Detmar, S., Fekkes, M., Herdman, M., & Alonso, J. (2011). Reliability and validity of the Spanish version of the TAPQOL: A health-related quality of life (HRQOL) instrument for 1-to 5-year-old children. International Journal of Nursing Studies, 48(5), 549–556.Google Scholar
- 18.Varni, J. W., Limbers, C. A., Neighbors, K., Schulz, K., Lieu, J. E. C., Heffer, R. W., Tuzinkiewicz, K., Mangione-Smith, R., Zimmerman, J. J., & Alonso, E. M. (2011). The PedsQL infant scales: Feasibility, internal consistency reliability and validity in healthy and ill infants. Quality of Life Research, 20, 45–55. doi: 10.1007/s11136_010-9730-5.Google Scholar
- 20.Landgraf, J. M., Maunsell, E., Nixon-Speechley, K. N., Bullinger, M., Campbell, S., Abetz, L., et al. (1998). Canadian-French, German and United Kingdom versions of the child health questionnaire (CHQ-PF50): Methodology and preliminary item scaling results. Quality of Life Research, 7(5), 433–445.PubMedCrossRefGoogle Scholar
- 21.World Health Organization. (1948). Constitution of the world health organization. Geneva, Switzerland: WHO Basic Documents.Google Scholar
- 22.American Academy of Pediatrics. (1998). Guidelines for health supervision II. Chicago IL.Google Scholar
- 23.Caplan, F., & Caplan, T. (1993 and 1995). The first twelve months of life: Your baby’s growth month by month. New York: Putnam Publishing Group.Google Scholar
- 24.Caplan, F., & Caplan, T. (1997 and 1980). The second twelve months of life: Your baby’s growth month by month. New York: Bantam NY, Grosset and Dunlap a Subsidiary of Putnam Publishing Group.Google Scholar
- 25.Confidential Scoring Rules, Infant Toddler Quality of Life Questionnaire. (2008). Boston, MA: HealthActCHQ.Google Scholar
- 26.Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., et al. (2005). Principles of good practice for the translation and cultural adaptation process for patient- reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2), 94–104.PubMedCrossRefGoogle Scholar
- 27.Stewart, A. L., & Ware, J. E. (1992). Measuring functioning and well-being the medical outcomes study approach. Durham, NC: Duke University Press.Google Scholar
- 28.Ware, J. E., Harris, W. J., Gandek, B., Rogers, B. W., & Reese, P. R. (1997). MAPR for windows version 1.1. Boston, MA: Health Assessment Lab.Google Scholar
- 30.Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York, NY: McGraw-Hill.Google Scholar