Related Experiment Video
Updated: Sep 20, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Response-shift bias and parent-reported quality of life in children with otitis media
Angelique A Timmerman1, Lucien J C Anteunis, Cor M G Meesters
1Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Maastricht, The Netherlands. ATI@skno.azm.nl
Insights
The 6-item quality-of-life survey (OM-6) is valid for children with otitis media. Parents may underestimate their child's hearing loss before treatment, indicating a response shift.
Area of Science:
- Pediatric Otolaryngology
- Health-Related Quality of Life Research
- Psychometrics
Background:
- Otitis media significantly impacts children's quality of life.
- Accurate assessment of quality of life is crucial for treatment evaluation.
- The 6-item quality-of-life survey (OM-6) is a tool designed to measure health-related quality of life in children.
Purpose of the Study:
- To validate the 6-item quality-of-life survey (OM-6) in a Dutch pediatric population.
- To investigate response-shift bias in quality-of-life assessments for children with otitis media.
Main Methods:
- The study involved 77 children (12-38 months) with persistent otitis media undergoing tympanostomy tube placement.
- Parents completed the OM-6 pre-surgery and 6 weeks post-surgery, along with a retrospective pre-test at post-surgery.
- Reliability and construct validity of the OM-6 were assessed using test-retest, internal consistency, and correlation analyses.
Main Results:
- The OM-6 demonstrated good test-retest reliability (R>0.8) and satisfactory internal consistency (alpha=.79).
- Construct validity was fair (R=-0.77, P<.01), and prospective quality-of-life changes ranged from moderate to large.
- Response-shift bias was observed at the group level, with significant retrospective changes noted for hearing loss and global quality of life.
Conclusions:
- The OM-6 is a valid instrument for assessing quality of life in Dutch children with otitis media.
- Parents' pre-surgery perceptions may underestimate hearing loss severity and overestimate quality of life, suggesting a response shift.
- Post-treatment realization can lead parents to perceive the pre-treatment condition as worse than initially reported.
Objectives:
To validate the 6-item quality-of-life survey (OM-6) and to investigate response-shift bias regarding children with otitis media.
Setting:
Otorhinolaryngology department of a university hospital that serves the southernmost part of the Netherlands.
Patients:
Seventy-seven children (age range, 12-38 months) experiencing persistent otitis media with effusion and scheduled for placement of tympanostomy tubes.
Survey:
The OM-6 measures health-related quality of life in 6 domains: physical suffering, hearing loss, speech impairment, emotional distress, activity limitations, and caregiver concerns.
Intervention:
Parents completed the OM-6 before surgery (pretest) and 6 weeks after surgery (posttest). At the posttest, parents also completed a retrospective version of the pretest (retrospective pretest).
Results:
For most items, the test-retest reliability was good (R>0.8). The internal consistency of the OM-6 was satisfactory (alpha =.79). The construct validity, determined by correlating the ear-related global quality-of-life measure and the OM-6 summary score, was fair (R = -0.77, P<.01). Prospective change in quality of life on the OM-6 ranged from moderate (standardized response mean >/=0.5) to large (standardized response mean >/=0.8). Response-shift bias was present at the group level (t = -3.3, P<.01). Retrospective change was significant for hearing loss (z = -3.3, P<.05) and ear-related global quality of life (z = -3.6, P<.05).
Conclusions:
The validity of the OM-6 has been proved in a Dutch population. The data suggest that parents underestimate the seriousness of hearing loss and overestimate the quality of life of their child before surgery, indicating a response shift. Treatment results could lead parents to realize that the situation before surgery had been worse than they thought.