Health-related quality of life in patients with paediatric inflammatory bowel disease: IMPACT-III validation in Germany
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Published on: September 20, 2018
Aletta Boerkoel1,2, Maresa Buchholz3, Luisa Tischler4,5
1Institute for Community Medicine, University Medicine Greifswald, Ellernholzstrasse 1/2, DE-17487, Greifswald, Germany. aletta.boerkoel@med.uni-greifswald.de.
Insights
The German IMPACT-III measure is validated for assessing health-related quality of life (HRQoL) in pediatric inflammatory bowel disease (IBD) patients. This study confirms its reliability and validity in a German sample, supporting its use in clinical practice.
Area of Science:
- Pediatric Gastroenterology
- Health Outcomes Research
- Psychometric Validation
Background:
- Health-related quality of life (HRQoL) is crucial for pediatric inflammatory bowel disease (IBD) patients.
- The IMPACT-III is a primary HRQoL measure but lacked validation in German pediatric IBD patients using its 4-domain structure.
- Germany has a high prevalence of pediatric IBD, necessitating local validation of assessment tools.
Purpose of the Study:
- To validate the IMPACT-III, a key patient-reported outcome measure, for assessing HRQoL in German pediatric IBD patients.
- To evaluate the psychometric properties of the IMPACT-III within a German population sample.
- To confirm the appropriateness of the IMPACT-III's 4-domain structure in German pediatric IBD patients.
Main Methods:
- Data collected from 221 pediatric IBD patients via the CEDATA-GPGE registry.
- Psychometric performance assessed through distribution properties, reliability (Cronbach's alpha), and validity (correlations with clinical values, known-groups validity).
- Confirmatory factor analysis was employed to evaluate the proposed 4-domain factor structure.
Main Results:
- The IMPACT-III demonstrated excellent internal consistency (Cronbach's alpha = 0.91) and no ceiling or floor effects.
- Strong correlations were observed between the total score and wellbeing (r=0.90) and social functioning (r=0.80) subscales.
- Younger patients (<14 years) reported significantly better HRQoL than older patients (14-17 years); however, the 4-domain structure was not confirmed.
Conclusions:
- The German version of the IMPACT-III is a reliable and valid instrument for measuring HRQoL in pediatric IBD patients.
- Well-being and social functioning subscales significantly contribute to the total score.
- Further longitudinal research with age-adjusted item phrasing is recommended for nuanced subdomain interpretation.
Background:
Health related quality of life (HRQoL) in paediatric patients with inflammatory bowel disease (IBD) is typically measured using the patient reported outcome measure IMPACT-III. This measure has not yet been validated for German patients using the new 4-domain structure. As Germany has a comparatively high prevalence of paediatric IBD and as the IMPACT-III is the main HRQoL outcome measure in use, a validation in the German population is overdue.
Objective:
To validate the main patient reported outcome measure of health-related quality of life (HRQoL) in paediatric patients with inflammatory bowel disease (IBD) IMPACT-III in a German patient sample.
Methods:
Clinical and HRQoL data was gathered in the CEDATA-GPGE registry. To determine the psychometric performance of the IMPACT-III in a German sample, distribution properties, reliability (Cronbach's alpha) and validity (correlations with clinical values; known-groups validity by age, sex, and self-rated health) were calculated. In addition, a confirmatory factor analysis was performed to determine the appropriateness of the factor structure.
Results:
The IMPACT-III was filled out by 221 patients (Female 46%; Mage=14.05; Morbus Crohn n = 126; Ulcerative Colitis n = 79; unclassified IBD n = 18). The total score ranged from 19.29 to 95.00, without the occurrence of ceiling or floor effects. Internal consistency using Cronbach's alpha was excellent (α = 0.91) for the total scale. The total score correlated strongly with the subscales of wellbeing (r = 0.90) and social functioning (r = 0.80). Concerning validity, the subscale of wellbeing correlated with self-reported health and clinical assessments. Younger patients (< 14) reported a significantly better HRQoL than older patients (14-17). The 4-domain structure of IMPACT-III could not be confirmed through factor analysis.
Conclusions:
The German version of the IMPACT-III is a valid and reliable instrument to measure HRQoL in paediatric patients with IBD. The subscales of well-being and social functioning explain most of the total score. To interpret the subdomains of the IMPACT-III further research in a longitudinal design needs to be done, especially with age-related phrasing of the items.
Trial Registration:
German Clinical Trials Register DRKS00015505. Registered on 22.01.2019 Inclusion of patients 01.03.2019; https://drks.de/search/en/trial/DRKS00015505 .
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