Change in Quality of Life with Velopharyngeal Insufficiency Surgery

Abstract

Objective 1) Define the minimal clinically important difference (MCID) of the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument, and 2) test for change in quality of life after VPI surgery. Study Design Prospective observational cohort. Setting VPI clinic at a tertiary pediatric medical center. Subjects and Methods Children with VPI and their parents completed the VELO instrument (higher score is better quality of life) at enrollment and then underwent VPI surgery (Furlow palatoplasty or sphincter pharyngoplasty, n=32), other treatments (obturator or oronasal fistula repair, n=7), or no treatment (n=18). They completed the VELO instrument again and an instrument of global rating of change in quality of life at one year. MCID was anchored to the global change instrument scores corresponding to “a little” or “somewhat” better. Within-group (paired t-test) and between-group (Student’s t-test) changes in VELO were tested for the VPI surgery and no treatment groups. The association between treatment group and VELO change was tested with multivariate linear regression, adjusting for confounders. Results Follow up was obtained on 37/57 (65%) of patients. The mean (SD) VELO change scores corresponding to the MCID anchor was 15 (13). The VELO score improved significantly more in the VPI surgery group (change 22 [15]), p<0.001) than in the no-treatment group (change 9 [12], p=0.04), after adjusting for confounders (p=0.007 between groups). Conclusion VPI surgery using the Furlow palatoplasty or sphincter pharyngoplasty improves VPI specific quality-of-life, and the improvement is clinically important.

Minimal clinically important difference of voice handicap index‐10 in vocal fold paralysis

“…Similar attempts have only recently been undertaken in otolaryngology. To date in our field, the MCID has been described for the Sinonasal Outcome Test‐22 (rhinology), the University of Washington Quality of Life Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Head and Neck‐35 questionnaires (head and neck oncology), the Velopharyngeal Insufficiency Effects on Life Outcomes (pediatric otolaryngology), the Penn Acoustic Neuroma Quality of Life (otology), the EuroQOL 5‐Dimension questionnaire (facial plastics), and the anterior skull base surgery questionnaire (skull base) . Specifically in laryngology, only the Dyspnea Index (DI) thus far has a defined MCID in relation to the population of adolescents with exercise‐induced paradoxical vocal fold motion .…”

“…The small sample size in the subgroups that reported no change or worsening precluded determination of those specific MCID scores, but it is possible that the MCID may be different for improvement as compared to decline in symptoms. It is notable that the range of population size in the studies that define MCID is broad, spanning from as few as approximately 50 patients up to several thousand . A third potential limitation could be recall bias, particularly in relation to the GRCQ .…”

“…[11][12][13][15][16][17][18][19][20][21]23,24,26,27,[30][31][32][33][34][35][36][37] Similar attempts have only recently been undertaken in otolaryngology. To date in our field, the MCID has been described for the Sinonasal Outcome Test-22 (rhinology), 43 44 the Penn Acoustic Neuroma Quality of Life (otology), 25 the EuroQOL 5-Dimension questionnaire (facial plastics), 45 and the anterior skull base surgery questionnaire (skull base). 14 Specifically in laryngology, only the Dyspnea Index (DI) thus far has a defined MCID in relation to the population of adolescents with exercise-induced paradoxical vocal fold motion.…”

“…It is notable that the range of population size in the studies that define MCID is broad, spanning from as few as approximately 50 patients up to several thousand. 11,18,19,22,23,26,37,38,43,44 A third potential limitation could be recall bias, particularly in relation to the GRCQ. 46 However, to decrease that risk, the maximum time interval between visits was restricted to 3 months.…”

Validation of the Chinese Velopharyngeal Insufficiency Effects on Life Outcomes Instrument

“…It minimizes the difficulties of completing the questionnaire by decreasing the number of items, which also leads to a better doctor–patient relationship, helps save time and human resources for research, and includes the patients’ health‐related experiences . Furthermore, the VELO instrument is considered to be reliable, valid, and responsive …”