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Psychometric properties of the Children's Dermatology Life Quality Index in pediatric localized scleroderma
Kaveh Ardalan1,2,3, Galen E Switzer4,5,6,7, Christina K Zigler8,9
1Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
The Children's Dermatology Life Quality Index may underestimate quality of life impacts in pediatric localized scleroderma. Further research is needed to optimize this tool for pediatric localized scleroderma patients.
Area of Science:
- Pediatric Dermatology
- Quality of Life Research
- Psychometrics
Background:
- The Children's Dermatology Life Quality Index (CDLQI) is used to assess quality of life in pediatric localized scleroderma.
- Previous studies suggest only modest impacts on quality of life.
- The CDLQI's psychometric properties have not been validated specifically for localized scleroderma, potentially leading to underestimation of its impact.
Purpose of the Study:
- To assess the psychometric properties of the CDLQI in a cohort of pediatric localized scleroderma patients.
- To evaluate the validity and reliability of the CDLQI for measuring quality of life in this specific population.
Main Methods:
- Analysis of existing CDLQI data from a large pediatric localized scleroderma cohort.
- Evaluation of score distributions, internal consistency (Cronbach's alpha), and construct validity (Spearman's correlations).
- Exploratory factor analysis was used to examine the underlying structure of the CDLQI in this cohort.
Main Results:
- CDLQI scores indicated modest adverse effects on quality of life.
- Internal consistency was adequate (Cronbach's alpha = 0.727), improving with item deletion related to social and treatment burdens.
- CDLQI scores showed moderate association with patient/parent impact assessments but not physician-scored disease severity.
Conclusions:
- The CDLQI may capture functional and psychosocial aspects but likely underestimates the true quality of life impact in pediatric localized scleroderma.
- Items related to friendships, sleep, and treatment burden may have limited relevance or incomplete exploration in this condition.
- Further research is warranted to develop or refine quality of life measures for pediatric localized scleroderma.
Introduction:
The Children's Dermatology Life Quality Index has been used to measure quality of life in studies of pediatric localized scleroderma, which suggested only modest effects on quality of life. However, the Children's Dermatology Life Quality Index psychometric performance has not been examined in localized scleroderma and it was validated in populations lacking localized scleroderma's distinctive clinical features, possibly underestimating the quality of life impact. This study assessed psychometric properties of the Children's Dermatology Life Quality Index in a cohort of pediatric localized scleroderma patients.
Methods:
Existing Children's Dermatology Life Quality Index data from a large pediatric localized scleroderma cohort were analyzed. Children's Dermatology Life Quality Index score distributions were examined and internal consistency was evaluated with Cronbach's alpha for the entire Children's Dermatology Life Quality Index and after deletion of individual items. Construct validity was assessed by calculating Spearman's correlations between Children's Dermatology Life Quality Index scores and disease severity/impact measures. Dimensionality was examined using exploratory factor analysis with sequential item elimination.
Results:
Children's Dermatology Life Quality Index scores suggested modest adverse effects on quality of life. Internal consistency was adequate (Cronbach's alpha = 0.727) but increased after eliminating items regarding friendships, sleep, and treatment burdens. Children's Dermatology Life Quality Index scores were not associated with physician-scored disease severity measures but were moderately associated with patient/parent assessments of disease impact. Exploratory factor analysis yielded a three-factor solution encompassing functional limitations, psychosocial effects, and skin symptoms/treatment burden.
Conclusion:
The Children's Dermatology Life Quality Index may capture functional and psychosocial domains of quality of life in localized scleroderma, but likely underestimates the quality of life impact given that it includes some items with limited relevance in localized scleroderma, incompletely explores skin symptoms and treatment burdens, and demonstrates limited construct validity. Further study to optimize quality of life measurement in pediatric localized scleroderma is warranted.
