The Pediatric Quality of Life Inventory: An Evaluation of Its Reliability and Validity for Children With Traumatic Brain Injury

doi:10.1016/j.apmr.2005.03.026

Archives of Physical Medicine and Rehabilitation

Volume 86, Issue 10, October 2005, Pages 1901-1909

Presented as a poster at the World Injury Conference, June 7, 2004, Vienna, Austria.

https://doi.org/10.1016/j.apmr.2005.03.026 Get rights and content

Abstract

McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CN, Slomine BS, Dorsch AM, Berk RA, Christensen JR, Ding R, and the CHAT Study Group. The Pediatric Quality of Life Inventory: an evaluation of its reliability and validity for children with traumatic brain injury.

Objectives

To assess the reliability and validity of the Pediatric Quality of Life Inventory, version 4.0 (PedsQL), and to compare it with that of the Behavior Rating Inventory of Executive Function (BRIEF) among children with traumatic brain injury (TBI).

Design

Prospective cohort study that documented the health-related quality of life of 391 children at 3 and 12 months postinjury.

Setting

Four level I pediatric trauma centers.

Participants

Children (age range, 5–15y) hospitalized with a TBI or an extremity fracture.

Interventions

Not applicable.

Main Outcome Measures

Parent-reported PedsQL and BRIEF scale scores.

Results

Both the PedsQL and BRIEF scales showed good internal consistency (PedsQL α range, .74–.93; BRIEF α range, .82–.98) and test-retest reliability (PedsQL r range, .75–.90; BRIEF r range, .82–.92), respectively. Factor analysis revealed that most PedsQL items loaded most highly on their conceptually derived scale. The PedsQL cognitive function scale detected the largest differences among groups of children with varying severities of TBI as well as parents’ assessment of change in cognition postinjury.

Conclusions

Although the reliability of the 2 instruments is comparable, the PedsQL discriminates better among children with TBI. The PedsQL is a promising instrument for measuring the health of children after TBI.

Section snippets

Study Population

Children between the ages of 5 and 15 years who were hospitalized for 1 or more nights at 1 of 4 level I pediatric trauma centers for treatment of a TBI or an extremity fracture were eligible for the Children’s Health After Trauma (CHAT) study. Children with an extremity fracture as well as children with varying severities of a TBI were included in the study to facilitate the validation of the PedsQL and BRIEF scales. We expected there to be differences in the health profiles of children with a

Demographics of the Study Population

At 3 months postinjury, the parents/guardians of 391 (90%) of the 433 enrolled families completed the follow-up interview (median, 97d). Most of the respondents were either the biologic mother (81%) or father (12%). Subjects were more likely to be male (68%), white (70%), with an average age ± standard deviation (SD) of 10.6±3.2 years (table 1). The children were primarily covered by commercial insurance (73%) or medical assistance (26%) at the time of injury. There were no significant

Discussion

The results of our study suggest that the PedsQL is a reliable measure of general health among children who sustain a TBI and/or an extremity fracture. All of the PedsQL and BRIEF scales showed adequate internal consistency reliability for group comparisons. Although most of the BRIEF scales also met the reliability criterion recommended for individual patient scores, only the PedsQL total scale did so. However, all of the PedsQL scales except for physical functioning have fewer items than the

Conclusions

Whereas the reliability of the PedsQL and the BRIEF was comparable, the PedsQL was more sensitive to differences in cognitive function and HRQOL among children hospitalized with different types and severities of TBI. In addition, its brevity and ease of administration make it well-suited for surveillance as well as clinical and survey research. Our results suggest that some of the core PedsQL scales may need refinement to better reflect unique dimensions of HRQOL. For children with cognitive

Acknowledgments

The CHAT Study Group is Melissa McCarthy, ScD, Ellen MacKenzie, PhD, Dennis Durbin, MD, MS, Charles Paidas, MD, Mary Aitken, MD, MPH, Kenneth M. Jaffe, MD, Beth Slomine, PhD, Andrea Dorsch, PhD, James Christensen, MD, Ronald Berk, PhD, Eileen Houseknecht, RN, BSN, Susan Ziegfeld, MSN, CRNP, Vinita Misra Knight, MPH, CSTR, Patricia Korehbandi, Donna Parnell, RN, MNSc, and Pat Klotz, RN, BSN. We thank the dedicated study coordinators who ensured the successful recruitment of all of the injured

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Citation Excerpt :
Impairments in any of these domains can affect day-to-day functioning, individual well-being and overall satisfaction with life; in other words, they can impact a child’s quality of life ([QoL]; Anderson et al., 2010; Fineblit et al., 2016). QoL is a broad ranging construct that includes school performance, physical, emotional, social as well as health outcomes, and thus captures the effects of mTBI on children’s global functioning and well-being (Brown et al., 2016; McCarthy et al., 2005; Varni et al., 2007). A child’s QoL can be negatively impacted if any of the multiple contributing factors such as family environment, cognitive abilities or biological determinants are disrupted (Beauchamp et al., 2019).
Mild traumatic brain injury (mTBI) in early childhood is prevalent, and some children may be at risk for short- and long-term difficulties that could affect quality of life (QoL). Despite growing efforts to understand associations between potential risk factors and outcomes after injury, prognosis is elusive and lacks the inclusion of genetic variables which may convey additional predictive power. This study assessed which factors contribute to pediatric QoL 6 and 18 months post-recruitment in 159 participants (mTBI = 52; orthopedic injury [OI] = 43; typically developing controls [TDC] = 64) aged 18 to 60 months at the time of injury (M = 37.50, SD = 11.69). Family environment, injury characteristics, and child cognitive-behavioral functioning were assessed at 6 months via parent questionnaires and socio-cognitive assessment. QoL was determined using the Pediatric Quality of Life Inventory at both time points. Genetic information (Brain-derived neurotrophic factor [BDNF] genotype) was collected using saliva samples. Hierarchical regression analyses testing biological, family-environmental, injury and cognitive-behavioral factors revealed that the BDNF Val66Met polymorphism was a significant independent predictor of better QoL 6 months post-injury in the mTBI group. Lower parental distress significantly and independently predicted higher QoL 18 months after mTBI, and 6 months post-recruitment in the TDC group. At 18 months, models were non-significant for both control groups. Genetic factors involved in neuroplasticity may play an important role in recovery 6 months after mTBI and contribute to outcome via their interplay with environmental factors. Over time, family factors appear to become the primary determinants of post-mTBI outcome.
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Supported by the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (grant no. R49/CCR319701).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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Original articleThe Pediatric Quality of Life Inventory: An Evaluation of Its Reliability and Validity for Children With Traumatic Brain Injury

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Study Population

Demographics of the Study Population

Discussion

Conclusions

Acknowledgments

Arch Phys Med Rehabil

J Emerg Med

Ambul Pediatr

Arch Clin Neuropsychol

Recovery of intellectual ability after closed head-injury

Dev Med Child Neurol

Neuropsychological outcome of closed head injury in children and adolescents

Childs Brain

Memory and intellectual ability after head injury in children and adolescents

Neurosurgery

Severity of pediatric traumatic brain injury and neurobehavioral outcomea cohort study

Arch Phys Med Rehabil

Prevalence and correlates of depressive symptoms following traumatic brain injuries in children

Child Neuropsychol

Health-related quality of life of children and adolescents after traumatic brain injury

Pediatrics

Social problem-solving skills in children with traumatic brain injurylong-term outcomes and prediction of social competence

Child Neuropsychol

Long-term behavior problems following pediatric traumatic brain injuryprevalence, predictors and correlates

J Pediatr Psychol

Attention deficit hyperactivity disorder in children and adolescents following traumatic brain injury

Dev Neuropsychol

Quality of life and pharmacoeconomics in clinical trials

The CHQ user’s manual

Multiattribute utility function for a comprehensive health status classification systemHealth Utilities Index Mark 2

Med Care

Functional status II(R)A measure of child health status

Med Care

The Functional Independence Measure for Children (WeeFIM)

Clin Pediatr

Pediatric Evaluation and Disability Inventory (PEDI)development, standardization and administration manual

The POSNA Pediatric Musculoskeletal Functional Health Questionnairereport on reliability, validity and sensitivity to change

J Pediatr Orthop

The adolescent child health and illness profile. A population-based measure of health

Med Care

Health statustypes of validity and the index of well-being

Health Serv Res

The PedsQLmeasurement model for the Pediatric Quality of Life Inventory

Med Care

The PedsQL 4.0reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations

Med Care

Original article
The Pediatric Quality of Life Inventory: An Evaluation of Its Reliability and Validity for Children With Traumatic Brain Injury