Development of a Parent-Proxy Quality-of-Life Chronic Cough-Specific Questionnaire: Clinical Impact vs Psychometric Evaluations

doi:10.1378/chest.07-0888

Chest

Volume 133, Issue 2, February 2008, Pages 386-395

https://doi.org/10.1378/chest.07-0888 Get rights and content

Background

Chronic cough affects at least 7% of children, and the impact of this on families is significant. Although adult cough-specific quality-of-life (QOL) instruments have been shown to be a useful cough outcome measure, no suitable cough-specific QOL for parents of children with chronic cough exists. This article compares two methods of item reduction (clinical impact and psychometric) and reports on the statistical properties of both QOL instruments.

Method

One hundred seventy children (97 boys and 73 girls; median age, 4 years; interquartile range, 3 to 7.25 years) and one of their parents participated. A preliminary 50-item parent cough-specific QOL (PC-QOL) questionnaire was developed from conversations with parents of children with chronic cough (ie, cough for > 3 weeks). Parents also completed generic QOL questionnaires (eg, Pediatric Quality of Life Inventory, version 4.0 [PedsQL4.0] and the 12-item Short Form Health Survey, version 2 [SF-12v2]).

Results

The clinical impact and psychometric method of item reduction resulted in 27-item and 26-item PC-QOL questionnaires, respectively, with approximately 50% of items overlapping. Internal consistency among the final items from both methods was excellent. Some evidence for concurrent and criterion validity of both methods was established as significant correlations were found between subscales of the PC-QOL questionnaire and the scales of the SF-12v2 and PedsQL4.0 scores. The PC-QOL questionnaire derived from both methods was sensitive to change following an intervention.

Conclusion

Chronic cough significantly impacts on the QOL of both parents and children. Although the PC-QOL questionnaires derived from a clinical impact method and from a psychometric method contained different items, both versions were shown to be internally consistent and valid. Further testing is required to compare both final versions to objective and subjective cough measures.

Section snippets

Participants

One hundred seventy children < 18 years of age (97 boys and 73 girls; median age, 4.0 years; interquartile range [IQR], 3.00 to 7.25; 10 children were ≥ 13 years of age) and one of their parents were recruited. All children presented to the Royal Children's Hospital, newly referred with chronic cough (cough for > 3 weeks¹⁹). The exclusion criteria were as follows: presence of previously diagnosed respiratory diseases (eg, cystic fibrosis); classic asthma (recurrent wheeze or dyspnea responsive

Clinical Impact

The 50 QOL items were ranked according to the strength of their impact (Table 1). Based on an arbitrary cutoff at a natural break in impact rating, the 27 highest impact scores were selected. The reduced QOL scale was internally consistent (α = 0.94) with a median impact score of 4.35 (IQR, 3.26 to 5.2). Interitem correlations ranged from Spearman correlation (rs) = 0.12 to 0.87 (median, 0.40).

Psychometric Method

Two separate factor analyses were conducted, one on the 30 frequency items and another on the 20 worry

Discussion

The present study sought to generate a reliable and valid pediatric QOL instrument for parents/caregivers of children with chronic cough. A PC-QOL instrument is a necessary addition to our understanding of the impact of children's cough on caregivers' mental health and subsequent burden. The original 50 items were parent-derived and thus reflected issues of relevance to parents. The two methods of identifying items for the QOL instrument resulted in some overlap with 13 common items. Both had

ACKNOWLEDGMENT

We thank Prof. Varni and the Mapi Research Institute for allowing us to utilize the PedsQL4.0 Inventory without cost.

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This study was supported by the Royal Children's Hospital Foundation. Dr. Chang is supported by a National Health and Medical Research Council, Australia, Practitioner Fellowship.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest

Original ResearchQuality of LifeDevelopment of a Parent-Proxy Quality-of-Life Chronic Cough-Specific Questionnaire: Clinical Impact vs Psychometric Evaluations

Background

Method

Results

Conclusion

Section snippets

Participants

Clinical Impact

Psychometric Method

Discussion

ACKNOWLEDGMENT

Chest

Ann Allergy Asthma Immunol

J Clin Epidemiol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Clin Epidemiol

Chest

Ambul Pediatr

Introduction to the diagnosis and management of cough: ACCP Evidence-Based Clinical Practice Guidelines

Chest

Why patients consult when they cough: a comparison of consulting and non-consulting patients

Br J Gen Pract

Persistent cough: is it asthma?

Arch Dis Child

Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ)

Thorax

Persistent cough in children: overuse of medications

J Paediatr Child Health

Very high dose inhaled corticosteroids: panacea or poison?

Arch Dis Child

Original Research
Quality of Life
Development of a Parent-Proxy Quality-of-Life Chronic Cough-Specific Questionnaire: Clinical Impact vs Psychometric Evaluations