Although oral health-related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontics patients. Using the project's Learning Sample (N=5,173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5,146 subjects with sufficiently complete data. The first eigenvalue (27.0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2.6), suggesting the presence of a dominant, higher-order general factor. Follow-up analyses with Horn's parallel analysis revealed a viable second-order, four-factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP.
Background
How dental patients are affected by oral conditions can be described
with the concept of oral health-related quality of life (OHRQoL). This
concept intends to make the patient experience measurable. OHRQoL is
multidimensional and Oral Function, Orofacial
Pain, Orofacial Appearance, and
Psychosocial Impact were suggested as its four
dimensions and consequently four scores are needed for comprehensive OHRQoL
assessment. When only the presence of dimensional impact is measured, a
pattern of affected OHRQoL dimensions would describe in a simple way how
oral conditions’ influence the individual.
Objective
By determining which patterns of impact on OHRQoL dimensions (Oral
Function-Orofacial Pain-Orofacial Appearance-Psychosocial Impact) exist in
prosthodontic patients and general population subjects, we aimed to identify
in which combinations oral conditions’ functional, painful,
aesthetical, and psychosocial impact occurs.
Methods
Data came from the Dimensions of OHRQoL Project with OHIP-49 data
from 6,349 general population subjects and 2,999 prosthodontic patients in
the Learning Sample (N=5,173) and the Validation Sample (N=5,022). We
hypothesized that all 16 patterns of OHRQoL dimensions should occur in these
individuals who suffered mainly from tooth loss, its causes and
consequences. A dimension was considered impaired when at least one item in
the dimension was affected frequently.
Results
The 16 possible patterns of impaired OHRQoL dimensions were found in
patients and general population subjects in both Learning and Validation
Samples.
Conclusions
In a four-dimensional OHRQoL model consisting of Oral Function,
Orofacial Pain, Orofacial Appearance, and Psychosocial
Impact, oral conditions’ impact can occur in any
combination of the OHRQoL dimensions.
Purpose
A desideratum of oral health-related quality of life (OHRQoL)
instruments - such as the Oral Health Impact Profile (OHIP) - is that they
accurately reflect the structure of the measured construct(s). With this
goal in mind, the Dimensions of Oral Health-Related Quality of Life (DOQ)
Project was proposed to investigate the number and nature of OHRQoL
dimensions measured by OHIP. In this report, we describe our aggregate data
set for the factor analyses in the project, which consists of responses to
the 49-item OHIP from general population subjects and prosthodontics
patients from 6 countries, including a large age range of adult subjects and
both genders.
Material and methods
The DOQ Project's aggregate data set combines data from 35 individual
studies conducted in Croatia, Germany, Hungary, Japan, Slovenia, and
Sweden.
Results
The combined data set includes 10,778 OHIPs from 9,348 individuals
(N=6,349 general population subjects, N=2,999 prosthodontic patients). To
elucidate the OHIP latent structure, the aggregated data were split into a
Learning Sample (N=5,173) for exploratory analyses and a Validation Sample
(N=5,022) for confirmatory analyses. Additional data (N=583) were assigned
to a third data set.
Conclusion
The Dimensions of Oral Health-Related Quality of Life Project
contains a large amount of international data and is representative of
populations where OHIP is intended to be used. It is well-suited to assess
the dimensionality of the questionnaire.
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