The health-related quality of life (HR-QOL) of children and adolescents is increasingly considered a relevant topic for research. Instruments to assess quality of life in children and adolescents of a generic as well as disease- or condition-specific nature are being developed and applied in epidemiological surveys, clinical studies, quality assurance and health economics. This paper attempts to give an overview on the state of the art of HR-QOL assessment in children as it relates to methodological and conceptual challenges. Instruments available in international or cross-cultural research to assess HR-QOL in generic terms were identified and described according to psychometric data provided and the width of application. In an initial literature search, several challenges in the assessment of child and adolescent HR-QOL were identified, ranging from conceptual and methodological to practical aspects. Seven specific major issues were considered: (i) What are the dimensions of HR-QOL relevant for children and adolescents, and do suitable instruments for their measurement exist? (ii) Can these dimensions be collected in a cross-culturally comparable way? (iii) What advantages and disadvantages do self-rated versus externally evaluated HR-QOL measurements of children and adolescents have? (iv) How can HR-QOL be assessed in an age-appropriate way? (v) What are the advantages and disadvantages of disease-specific and generic data collection? (vi) What advantages and disadvantages do profile and index instruments have? (vii) How can HR-QOL be connected with utility- preference values? In a second literature search we identified nine generic HR-QOL instruments and four utility health state classification systems that complied with the prespecified inclusion criteria. It was concluded that (i) HR-QOL instruments are available to assess the dimensions of the construct relevant to children and adolescents; (ii) provided that an instrument was constructed in an appropriate way, the dimensions of HR-QOL can be measured in an interculturally comparable manner; (iii) the HR-QOL of children and adolescents can and should be ascertained by self-rating; (iv) the measurement instruments used have to consider maturity and cognitive development; (v) only generic quality-of-life instruments allow for an assessment of HR-QOL in both healthy and chronically ill children and adolescents; (vi) the representation of HR-QOL achieved through a singular index value is connected to strict psychometric conditions: the index instrument has to be tailored to these psychometric conditions; (vii) how far utility measures are employable with children and adolescents has to be investigated in further studies. The problem aspects identified indicate the necessity for further research. Nevertheless, instruments for assessing the HR-QOL of children and adolescents can be identified that meet the requirements mentioned above.
BackgroundTelephone interviews have become established as an alternative to traditional mail surveys for collecting epidemiological data in public health research. However, the use of telephone and mail surveys raises the question of to what extent the results of different data collection methods deviate from one another. We therefore set out to study possible differences in using telephone and mail survey methods to measure health-related quality of life and emotional and behavioural problems in children and adolescents.MethodsA total of 1700 German children aged 8-18 years and their parents were interviewed randomly either by telephone or by mail. Health-related Quality of Life (HRQoL) and mental health problems (MHP) were assessed using the KINDL-R Quality of Life instrument and the Strengths and Difficulties Questionnaire (SDQ) children's self-report and parent proxy report versions. Mean Differences ("d" effect size) and differences in Cronbach alpha were examined across modes of administration. Pearson correlation between children's and parents' scores was calculated within a multi-trait-multi-method (MTMM) analysis and compared across survey modes using Fisher-Z transformation.ResultsTelephone and mail survey methods resulted in similar completion rates and similar socio-demographic and socio-economic makeups of the samples. Telephone methods resulted in more positive self- and parent proxy reports of children's HRQoL (SMD ≤ 0.27) and MHP (SMD ≤ 0.32) on many scales. For the phone administered KINDL, lower Cronbach alpha values (self/proxy Total: 0.79/0.84) were observed (mail survey self/proxy Total: 0.84/0.87). KINDL MTMM results were weaker for the phone surveys: mono-trait-multi-method mean r = 0.31 (mail: r = 0.45); multi-trait-mono-method mean (self/parents) r = 0.29/0.36 (mail: r = 0.34/0.40); multi-trait-multi-method mean r = 0.14 (mail: r = 0.21). Weaker MTMM results were also observed for the phone administered SDQ: mono-trait-multi-method mean r = 0.32 (mail: r = 0.40); multi-trait-mono-method mean (self/parents) r = 0.24/0.30 (mail: r = 0.20/0.32); multi-trait-multi-method mean r = 0.14 (mail = 0.14). The SDQ classification into borderline and abnormal for some scales was affected by the method (OR = 0.36-1.55).ConclusionsThe observed differences between phone and mail surveys are small but should be regarded as relevant in certain settings. Therefore, while both methods are valid, some changes are necessary. The weaker reliability and MTMM validity associated with phone methods necessitates improved phone adaptations of paper and pencil questionnaires. The effects of phone versus mail survey modes are partly different across constructs/measures.
Zusammenfassung: Die radiolunäre Arthrodese ist ein probates Operationsverfahren, Instabilität und Schmerzen am rheumatisch veränderten Handgelenk zu behandeln. Zwischen 1988 und 1993 haben wir dieses Operationsverfahren bei 27 Patienten (33 Handgelenke) mit gesicherter chronischer Polyarthritis durchgeführt. 26 Patienten haben ein Follow-up von wenigstens 2 jahren, der durchschnittliche Nachuntersuchungszeitraum beträgt 51 Monate. Die Nachuntersuchungsquote beträgt 97 %. In die Nachuntersuchung gehen ein: Carpaler Höhenindex, ulnarer Translationsindex, Schmerzintensität, Bewegungsumfang, Komplikationsrate und Änderung des Larsen-Stadiums. Die Operationsindikation wurde im Larsen-Stadium 2-3 (2,7 gemittelt) bei ulnarem Translationsindex von 0,31 und carpalern Höhenindex von 0,49 gestellt. Wir haben alle Patienten nach 24 Monaten und, soweit dies möglich war, nach 4 jahren erneut untersucht. Röntgenologisch sind 97% aller Arthrodesen knöchern fest konsolidiert, lediglich eine radiolunäre Arthrodese ist fibrös fest. Nur in einem Drittel der nachuntersuchten Handgelenke hat sich das präoperativ radiologisch festgelegte Larsen-Stadium zum Zeitpunkt der Nachuntersuchung nicht verändert, 2/ 3 der Handgelenke wiesen anläßlich der Nachuntersuchung ein schlechteres Larsen-Stadium auf. Das Larsen-Stadium verschlechterte sich lediglich bei einem Patienten nach zwei jahren, bei einem weiteren Patienten nach 3 jahren, bei allen anderen Patienten 4 jahre und später. Bei den Patienten, die wir 5 jahre und länger überblicken, sind lediglich 2 Patienten in ihrem Larsen-Stadium unverändert. Die Änderung der carpalen Höhe von 0,49 präoperativ auf 0,46 ist statistisch signifikant. Der ulnare Translationsindex liegt präoperativ bei 0,31 und bei der letzten Nachuntersuchung bei 0,36, bei der Nachuntersuchung 2 Jahre postoperativ bei 0,33. Der ulnare Translationsindex verschlechtert sich signifikant. Signifikante Änderungen für die Beweglichkeit zeigen sich für die Flexion, die Radialabduktion sowie die Pro-und Supination. Als Komplikationen haben wir zwei Plattenbrüche zu verzeichnen. Unsere durchschnittliche Nachbeobachtungszeit von 51 Monaten zeigt, daß bei klinischer Beschwerdefreiheit oder -armut radiologische Destruktionen voranschreiten, insbesondere in den Intercarpalgelenken. Die radiolunäre Arthrodese kann das Fortschreiten der grunderkrankungsbedingten Destruktionen nicht aufhalten, jedoch deutlich verlangsamen. Die für die Gesamtfunktion der Hand deletäre Ulnartranslation wird entscheidend positiv beeinflußt.Medium-Term Results of Radiolunate Arthrodesis in Rheumatoid Arthritis Via Mini-T-Plate: Radiolunate arthrodesis (RLA) is a weil known procedure to treat instability and pain of the rheumatoid wrist. We performed this procedure in 27 patients (33 wrist joints) between 1988 and 1993. A follow-up of at least 2 years has been provided for 26 patients; the average follow-up is 51 months. 97% of the operated wrists could be controlled. Carpal height, ulnar translation, pain, range of motion, complications and Larsen index we...
Early experiences with the two-incision approach at the hip joint are reported. We started in July 2002 and until now 272 procedures have been performed. Blood loss (292 ml) and the need for rehabilitation are reduced, the patients will achieve a Harris Hip Score of more than 90 points within 6 or 8 weeks. Complications related to the approach primarily include irritation of the lateral femoral cutaneous nerve. During the learning curve when the initial shaft model was used, shaft fractures or fissures occurred in 4% of the cases. This complication was no longer observed with the ML Taper shaft model now employed (n=102). The development and establishment of minimally invasive approaches constitute a valuable and seminal option for implantation of hip endoprostheses. In the medium term, the time spent in rehabilitation could conceivably be reduced. Conventional approaches still represent the gold standard.
Leit the ma: Te le fo ni sche Ge sund heits sur veys, Teil 2 M. Er hart · R. Wet zel · A. Krü gel · U. Ra vens-Sie be rer Ro bert Koch-In sti tut, Ber linEr fas sung der ge sund heitsbe zo ge nen Le bens qua li tät mit dem deut schen SF-8Ein Ver gleich der te le fo ni schen und po sta li schen Be fra gungs me tho de In epi de mio lo gi schen Stu di en ha ben sich po sta li sche und te le fo ni sche Be fra gungsme tho den be währt. Die Vor-und Nach teile die ser Me tho den sind viel fach be schrieben und für Aspek te der Re spon se, der Öko no mie und der Prak ti ka bi li tät gut belegt [1,2,3]. Deut lich kon tro ver ser dis kutiert wird die Fra ge, in wie weit die ver schiede nen Er he bungs me tho den zu äqui va lenten Be fra gungs er geb nis sen füh ren. Ge genstand der Be trach tung sind da bei die verschie dens ten Aspek te der Da ten qua li tät.Viel fach wird eine un ter schied li che Teilnah me be reit schaft be rich tet. Dies ist insbe son de re vor dem Hin ter grund teil nahme be ding ter Stich pro ben ver zer run gen be deut sam. So fin den sich Be rich te zu unter schied li chem Teil nah me ver hal ten beispiels wei se in Ab hän gig keit vom Al ter [4] und Ge schlecht [5] oder des so zio öko nomi schen Sta tus [6].Ein Vor teil te le fo ni scher Be fra gun gen liegt in der Voll stän dig keit von Da ten sät-zen; dies be züg lich zeich nen sie sich durch äu ßerst ge rin ge Miss in gra ten aus. Dement spre chend fin den sich für te le fo ni sche und po sta li sche Be fra gun gen nur in we nigen Stu di en ver gleich ba re Miss in gra ten [7,8], in der Mehr zahl der Stu di en er weist sich die te le fo ni sche Da te ner he bung der po sta li schen als über le gen [2,4,9].Zent ral bleibt da rü ber hi naus die Frage, wel chen mög li chen Ver zer run gen das Ant wort ver hal ten selbst un ter liegt. Un tersu chun gen zei gen, dass per sön li che Be fragungs me tho den po si ti ve re An ga ben zu Mor bi di tät, In an spruch nah me me di zi nischer Leis tun gen oder so zi al un er wünsch-tem Ver hal ten her vor ru fen kön nen als posta li sche Be fra gun gen [9,10,11]. Die se Beob ach tun gen wer den haupt säch lich auf die grö ße re An ony mi tät po sta li scher Befra gun gen zu rück ge führt. In ei ni gen an deren Stu di en wer den für un ter schied li che Be fra gungs mo di hin ge gen kei ne re le vanten Ver zer run gen im Ant wort ver hal ten fest ge stellt [7,8]. Die se un ein heit li che Befund la ge führt zu der Not wen dig keit, den Ein fluss un ter schied li cher Er he bungs metho den auf ge nau ab ge grenz te The men berei che und ver schie de ne Be fra gungs in strumen te ex pli zit em pi risch zu prü fen. Be sonders viel schich tig stel len sich mög li che Metho den ein flüs se auf kom ple xe Kon struk te wie die ge sund heits be zo ge ne Le bens qua lität (HR QoL) dar. Das Kon zept der ge sundheits be zo ge nen Le bens qua li tät um fasst bei der Be trach tung von Ge sund heit physio lo gi sche, emo tio na le, psy chi sche so wie so zia le Aspek te und hat sich als fes ter Bestand teil der Ge sund he...
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