Validity and Responsiveness of VELO: A Velopharyngeal Insufficiency Quality of Life Measure

Skirko, Jonathan R.; Weaver, Edward M.; Perkins, Jonathan A.; Kinter, Sara; Eblen, Linda E.; Sie, Kathleen C.Y.

doi:10.1177/0194599813486081

Cited by 61 publications

(40 citation statements)

References 19 publications

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“…While previous studies have identified a change in QOL or functional status with surgery, 2,6 the favorable change in VELO score in the No Treatment group from baseline to 12 months highlights the importance of a control group. Improvement in the No Treatment group was driven by the VELO Situational Difficulty and Caregiver Impact subscales.…”

Section: Discussionmentioning

confidence: 80%

“…2 English-speaking children (ages 3–22 years) were enrolled from January 2010 to February 2012. Exclusion criteria included severe intellectual disability (n=3), VPI surgery within 6-months prior to enrollment (n=2), treatment with maxillo-mandibular advancement procedures (n=4) and incomplete follow up (i.e., not reaching 12 month time point) at the close of the study (n=23).…”

Section: Methodsmentioning

confidence: 99%

“…6 Additionally in a previous short-term case series, we found significant improvements in short-term QOL measured by the VELO. 2 While these studies have provided a foundation for future analyses, neither study utilized a control group. Data from a comparison group provides further evidence that measured changes in QOL are associated with the intervention rather than just temporal trends or natural course of the disorder, and it allows adjustment for confounders.…”

Section: Introductionmentioning

confidence: 99%

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Change in Quality of Life with Velopharyngeal Insufficiency Surgery

Skirko¹,

Weaver²,

Perkins

et al. 2015

Otolaryngol.--head neck surg.

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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.

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Section: Discussionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Change in Quality of Life with Velopharyngeal Insufficiency Surgery

Skirko¹,

Weaver²,

Perkins

et al. 2015

Otolaryngol.--head neck surg.

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“…In the future, these patients will continue to be followed up with an eye toward the longevity of their symptom improvement and what factors may predispose a patient to needing repeated injections. Furthermore, we have begun to use patient quality-of-life surveys, such as the VPI Effects on Life Outcomes instrument, 21 to better understand patient satisfaction and perceptions. In addition, this study did not analyze non–speech-related manifestations of VPI, such as nasal regurgitation and associated dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Injection Pharyngoplasty With a Hyaluronic Acid and Dextranomer Copolymer to Treat Velopharyngeal Insufficiency in Adults

Peck

Baas

Cofer

2017

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo describe the treatment of adult velopharyngeal insufficiency (VPI) with injection of a hyaluronic acid and dextranomer copolymer (Dx/HA).Patients and MethodsThis was a retrospective case series of 25 consecutively treated adults with VPI who underwent Dx/HA injection pharyngoplasty in a multidisciplinary clinic from January 1, 2011, to December 31, 2014. Data recorded included etiology of VPI, perceptual analysis of resonance, nasalance scores, and estimation of velopharyngeal gap characteristics on video nasendoscopy before and after the intervention. Statistical comparisons were made using a 2-tailed Wilcoxon signed rank test and the Kruskal-Wallis test.ResultsPatients had VPI due to a neurologic etiology, due to a benign anatomic etiology, or acquired after treatment for a head and neck malignancy. Injections were performed with local anesthesia, monitored anesthesia care, or general anesthesia. There were statistically significant improvements in speech resonance, nasalance, and velopharyngeal gap size after treatment. Patients with neurologic or benign anatomic etiologies of their VPI had more significant improvement than those with VPI after treatment of malignancy. Nineteen of the 25 patients required only 1 injection to achieve their final result.ConclusionInjection pharyngoplasty with a readily available Dx/HA is an effective treatment for VPI that allows for titration to complete velopharyngeal closure under local anesthesia or light sedation. It is most effective in patients with nonmalignant etiologies of VPI and in those with good lateral wall motion. Complications experienced were postoperative neck pain and occult retropharyngeal fluid collection, highlighting the importance of follow-up.

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“…Otolaryngology, University of Iowa Hospitals and Clinics. During each child's scheduled appointment, a certified speech-language pathologist administered the VPI Effects of Life Outcome (VELO) Survey(Skirko, Weaver, Perkins, Kinter, & Sie, 2012;Skirko, Weaver, Perkins, Kinter, Eblen, & Sie, 2013) to the child and the parent (or in one case, a legal guardian) as part of the Cleft Clinic Protocol.…”

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confidence: 99%

Parent and child perceptions of disordered speech associated with cleft lip and/or palate

Warndahl¹

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Background & Purpose Approximately 50% of children born with cleft lip and/or palate (CL/P) will need speech and language intervention (Lockhart, 2003). Speech difficulties are related to poorer academic performance, higher risk of retention in younger grades, and greater risk of being bullied or having a low self-esteem (Byrd, 1994; Lockhart, 2003). Since parents are the primary decision makers when it comes to treatment for their child, how closely do parents' perceptions of speech, appearance, and emotional consequences match the perception of their child? This study assessed differences in perceptions between parents and children with CL/P regarding speech, the emotional impact of having a cleft, and quality of life. Methods & Description Twenty parent-child dyads were recruited at a University based cleft palate clinic. The children were between 7 and 17 years of age, with a diagnosis of cleft palate, cleft lip and alveolus, submucous cleft only, or cleft lip and palate. During a routine clinic appointment, the child and a parent/legal guardian completed the VPI Effects of Life Outcome (VELO) Survey. Parents and children completed the VELO Survey separately to facilitate open, unbiased responses, especially regarding sensitive issues such as facial appearance and emotional health. Results Overall, parents and their affected children did not view the child's speech significantly differently. A Wilcoxon signed rank test found that the differences between parent and child responses were not significant (p=0.3979). Gender, age, and cleft type were v not found to have statistically significant impact on differences between parent and child scores. The VELO Survey is divided into five main sections. This study identified the subsection relating to speaking in various situations as having a significantly greater parental concern when compared across all VELO subsections. After applying a Bonferroni multiple comparison adjustment to control the type error rate at 0.05 for all five subsections, a statistically significant relationship was found indicating higher parent ratings than their child in this subsection (p=0. 0.0184). Speech-language pathologist ratings showed a statistically significant linear relationship with the child total VELO scores (p=0.0116), and with parent total VELO scores (p=0.0009). This means that a higher score on the VELO by the parent or the child, and a lower SLP rating, both indicate lower severity of impact of the cleft disorder on the child's life. Conclusion While parents, children, and the speech-language pathologist often agreed with each other in their rating how having a cleft affected the child's life, significant differences did exist between some parent-child dyads. These differences have important clinical implications, primarily the importance of including both parents and children in discussions of the impact of the cleft condition and treatment options. vi

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Validity and Responsiveness of VELO: A Velopharyngeal Insufficiency Quality of Life Measure

Cited by 61 publications

References 19 publications

Change in Quality of Life with Velopharyngeal Insufficiency Surgery

Change in Quality of Life with Velopharyngeal Insufficiency Surgery

Injection Pharyngoplasty With a Hyaluronic Acid and Dextranomer Copolymer to Treat Velopharyngeal Insufficiency in Adults

Parent and child perceptions of disordered speech associated with cleft lip and/or palate

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