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Published on: June 20, 2020
Comparison of quality-of-life instruments in childhood intermittent exotropia
Sarah R Hatt1, David A Leske, Jonathan M Holmes
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
The Intermittent Exotropia Questionnaire (IXTQ) better identifies reduced quality of life in children with intermittent exotropia than the Pediatric Quality of Life Inventory (PedsQL). Parent reports on the IXTQ were more sensitive to the condition than child reports.
Area of Science:
- Ophthalmology
- Pediatric Health
- Quality of Life Research
Background:
- Intermittent exotropia is a common childhood eye condition.
- Health-related quality of life (HRQOL) is an important outcome measure.
- Validated instruments are needed to assess HRQOL in children with intermittent exotropia.
Purpose of the Study:
- To compare the performance of the condition-specific Intermittent Exotropia Questionnaire (IXTQ) and the generic Pediatric Quality of Life Inventory (PedsQL).
- To evaluate the utility of both instruments in assessing HRQOL in children diagnosed with intermittent exotropia.
Main Methods:
- Fifty-one children (5-16 years) with intermittent exotropia completed child and parent versions of the IXTQ and PedsQL.
- HRQOL scores were compared between the intermittent exotropia group and a control group of 47 non-strabismic children.
- Statistical analyses compared proportions of subnormal scores and median scores between groups and instruments.
Main Results:
- Parent-reported IXTQ identified significantly more children with subnormal HRQOL (55%) compared to parent-reported PedsQL (18%).
- Child-reported IXTQ and PedsQL showed similar proportions of subnormal scores (8% vs. 14%).
- Children with intermittent exotropia scored lower on the IXTQ (child and parent reports) and parent-reported PedsQL compared to controls, but not on child-reported PedsQL.
Conclusions:
- The parent-reported IXTQ is more sensitive than the parent-reported PedsQL in detecting reduced HRQOL associated with intermittent exotropia.
- Child-reported measures showed limited detection of HRQOL deficits.
- The IXTQ demonstrates potential utility for clinical evaluation of HRQOL in pediatric intermittent exotropia.
Purpose:
To compare 2 health-related quality-of-life (HRQOL) instruments: the condition-specific Intermittent Exotropia Questionnaire (IXTQ) and the generic Pediatric Quality of Life Inventory (PedsQL) in children with intermittent exotropia.
Methods:
Fifty-one children with intermittent exotropia (median, 7 years; range, 5-16 years) were recruited from outpatient clinics with one of their parents. All children completed age-appropriate Child IXTQ (12 items) and Child PedsQL (23 items). Parents completed parallel Proxy IXTQ and Proxy PedsQL (parent assessment of child's HRQOL). Possible scores ranged from 0 to 100 (worst to best HRQOL). Normal thresholds were defined using the 5th percentile in a control group of 47 normal nonstrabismic children. Proportions scoring below normal on each questionnaire were compared. Median scores in intermittent exotropia and control groups also were compared.
Results:
More scores were subnormal using Proxy IXTQ than Proxy PedsQL (55% vs 18%, p = 0.0004). When Child questionnaires were used, we found that similar proportions scored below normal (IXTQ 8% vs PedsQL 14%, p = 0.3). Median scores were lower for intermittent exotropia children compared with control patients for Child IXTQ (83 vs 92; p = 0.04), Proxy IXTQ (81 vs 98; p < 0.0001), and Proxy PedsQL (p = 0.04) but not for Child PedsQL (p = 0.3).
Conclusions:
The Proxy IXTQ detects reduced HRQOL related to intermittent exotropia more often than the Proxy PedsQL. There were few subnormal scores on Child IXTQ and Child PedsQL. Children with intermittent exotropia scored, on average, lower than control patients on the IXTQ, but most individual scores fell within the normal range. The IXTQ may prove useful for clinical assessment of intermittent exotropia.
