Content and construct validity of the Diagnostic Criteria for Temporomandibular Disorders Axis I for children

Abstract

Objective To perform the content and construct validation of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I, for children 7‐11 years old. Materials and Methods A Delphi process was used to perform the content validity of the DC/TMD Axis I. One hundred eighty‐nine 7‐ to 11‐year‐old children were assessed with the adapted instrument. Confirmatory factor analysis (CFA) was used to investigate construct validity of the DC/TMD for children. A baseline one‐factor model was compared against a two‐factor (Model 2) and a seven‐factor (Model 3) models based on the original DC/TMD. Root mean squared error of approximation (RMSEA), comparative fit index (CFI), chi‐square, change in chi‐square and Cronbach's α were used to analyse the data. All analyses were performed in STATA© version 13.0. Results Items of the DC/TMD were reduced, “history time” was changed to 2 weeks, pain intensity was assessed through a face scale, and language was adapted to be better understood by children. The amount of muscle pressure was maintained as in the original DC/TMD Axis I. The CFA led to a two‐ and a seven‐factor model, with good fit. The internal consistency of Model 2 was .91 and of Model 3, .94. Conclusion The results of this study provide evidence to support a seven‐factor representation of the DC/TMD Axis I for 7‐ to 11‐year‐old children, as well as a two‐factor structure. Such findings will begin to provide researchers with confidence in the properties of this instrument when considering its inclusion in clinical research.

Diagnostic criteria for temporomandibular disorders in children and adolescents: An international Delphi study‐Part 2‐Development of Axis II

“…Having a standardised protocol to assess Axis I and Axis II would improve the quality of the research as well as clinicians' ability to detect children and adolescents at higher risk of developing long‐lasting pain. The need for tools to assess TMD in children has been clear since the publication of at least two previous studies 59,60 . However, both analysed only DC/TMD Axis I, without including any Axis II assessments.…”

“…The need for tools to assess TMD in children has been clear since the publication of at least two previous studies. 59,60 However, both analysed only DC/TMD Axis I, without including any Axis II assessments.…”

Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: An international Delphi study—Part 1‐Development of Axis I

“…Since no agreement was reached, the 30‐day time frame was retained to be tested in future studies. However, it must be considered that a very recent study, published after the end of the Delphi process, tried a 15‐day time frame in the assessment of the Symptom Questionnaire and in the clinical examination of DC/TMD Axis I and found better accuracy compared to the 30‐day time frame in children between 7 and 11 years 18 . Future studies comparing the 30‐day time frame and the 15‐day time frame should be conducted on this population to further support this hypothesis; in addition, the role of parent information should be considered.…”

“…Adaptation and assessment of content and construct validity of the Spanish translation of the DC/TMD Axis I were performed in 7-to 11-year-old children in Colombia, finding high internal consistency (.72 ≤ Cronbach's alpha ≤ .94). 18 In the development or adaptation of diagnostic systems for which high-quality evidence is not yet available, relying on experience of international experts in the field to achieve consensus on a topic is an effective method moving towards testable hypotheses. 19 One of the methods used for decision-making among experts is the Delphi method.…”

“…Adaptation of the DC/TMD includes (1) a separate language review for both questionnaires and clinical examination, due to the difference in understanding and speaking skills between adults, adolescents and children, 17 and (2) modified protocols for clinical assessment. Adaptation and assessment of content and construct validity of the Spanish translation of the DC/TMD Axis I were performed in 7‐ to 11‐year‐old children in Colombia, finding high internal consistency (.72 ≤ Cronbach's alpha ≤ .94) 18 …”