Skip to main content

Advertisement

Log in

PedsQL Neurofibromatosis Type 1 Module for children, adolescents and young adults: feasibility, reliability, and validity

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

The objective of the present study was to report on the measurement properties of the Pediatric Quality of Life Inventory (PedsQL) Neurofibromatosis Type 1 Module for pediatric patients ages 5–25 from the perspectives of patients and parents. The 104-item PedsQL NF1 Module and 23-item PedsQL Generic Core Scales were completed in a multi-site national study by 323 patients and 335 parents (343 families). Patients were diagnosed with NF1 using the National Institutes of Health diagnostic criteria. In addition to a Total Scale Score, 18 unidimensional scales were derived measuring skin itch bother, skin sensations, pain, pain impact, pain management, cognitive functioning, speech, fine motor, balance, vision, perceived physical appearance, communication, worry, treatment anxiety, medicines, stomach discomfort, constipation, and diarrhea. The PedsQL NF1 Module Scales evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.98; parent proxy-report α = 0.98), and good to excellent reliability for the 18 individual scales (patient self-report α = 0.71–0.96; parent proxy-report α = 0.73–0.98). Intercorrelations with the Generic Core Scales supported construct validity. Factor analysis supported the unidimensionality of the 18 individual scales. The PedsQL NF1 Module Scales demonstrated acceptable to excellent measurement properties, and may be utilized as standardized metrics to assess NF1-specific symptoms and problems in clinical research and practice in children, adolescents, and young adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

PedsQL:

Pediatric Quality of Life Inventory

HRQOL:

Health-related quality of life

NF1:

Neurofibromatosis type 1

PRO:

Patient-reported outcome

References

  1. Theos A, Korf BR (2006) Pathophysiology of Neurofibromatosis type 1. Ann Intern Med 144:842–849

    Article  Google Scholar 

  2. Friedman JM (1999) Epidemiology of Neurofibromatosis type 1. Am J Med Genet 89:1–6

    Article  CAS  Google Scholar 

  3. Boyd KP, Korf BR, Theos A (2009) Neurofibromatosis type 1. J Am Acad Dermatol 61:1–14

    Article  Google Scholar 

  4. Monroe CL, Dahiya S, Gutmann DH (2017) Dissecting clinical heterogeneity in Neurofibromatosis type 1. Ann Rev Pathol 12:53–74

    Article  CAS  Google Scholar 

  5. Friedman JM (2002) Neurofibromatosis 1: clinical manifestations and diagnostic criteria. J Child Neurol 17:548–554

    Article  CAS  Google Scholar 

  6. Williams VC, Lucas J, Babcock MA, Gutmann DH, Korf B, Maria BL (2009) Neurofibromatosis type 1 revisited. Pediatrics 123:124–133

    Article  Google Scholar 

  7. Tonsgard JH (2006) Clinical manifestations and management of Neurofibromatosis type 1. Semin Pediatr Neurol 13:2–7

    Article  Google Scholar 

  8. Rosser T, Packer RJ (2002) Neurofibromas in children with Neurofibromatosis 1. J Child Neurol 17:585–591

    Article  Google Scholar 

  9. Vranceanu AM, Merker VL, Park ER, Plotkin SR (2015) Quality of life among children and adolescents with Neurofibromatosis 1: a systematic review of the literature. J Neuro-Oncol 122:219–228

    Article  Google Scholar 

  10. Nutakki K, Hingtgen CM, Monahan P, Varni JW, Swigonski NL (2013) Development of the adult PedsQL Neurofibromatosis type 1 module: initial feasibility, reliability and validity. Health Qual Life Outcomes 11:21. https://doi.org/10.1186/1477-7525-11-21

    Article  PubMed  PubMed Central  Google Scholar 

  11. FDA (2009) Guidance for industry: patient-reported outcome measures: Use in medical product development to support labeling claims. Food and Drug Administration, U.S. Department of Health and Human Services, Rockville

    Google Scholar 

  12. Lasch KE, Marquis P, Vigneux M, Abetz L, Arnould B, Bayliss M, Crawford B, Rosa K (2010) PRO development: rigorous qualitative research as the crucial foundation. Qual Life Res 19:1087–1096

    Article  Google Scholar 

  13. Nutakki K, Varni JW, Steinbrenner S, Draucker CB, Swigonski NL (2017) Development of the pediatric quality of life inventory Neurofibromatosis type 1 module items for children, adolescents and young adults: qualitative methods. J Neuro-Oncol 132:135–143

    Article  Google Scholar 

  14. Draucker CB, Nutakki K, Varni JW, Swigonski NL (2017) The health-related quality of life of children, adolescents, and young adults with neurofibromatosis type 1 and their families: analysis of narratives. J Spec Pediatr Nurs 22:e12174. https://doi.org/10.1111/jspn.12174

    Article  Google Scholar 

  15. Fayers PM, Hand DJ (1997) Factor analysis, causal indicators and quality of life. Qual Life Res 6:139–150

    CAS  PubMed  Google Scholar 

  16. Varni JW, Seid M, Kurtin PS (2001) PedsQL™ 4.0: reliability and validity of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales in healthy and patient populations. Med Care 39:800–812

    Article  CAS  Google Scholar 

  17. Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P (2002) The PedsQL™ in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory™ Generic Core Scales, Multidimensional Fatigue Scale, and cancer module. Cancer 94:2090–2106

    Article  Google Scholar 

  18. Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL (2003) The PedsQL™ in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory™ Generic Core Scales and type 1 diabetes module. Diabetes Care 26:631–637

    Article  Google Scholar 

  19. Varni JW, Burwinkle TM, Berrin SJ, Sherman SA, Artavia K, Malcarne VL, Chambers HG (2006) The PedsQL™ in pediatric cerebral palsy: reliability, validity, and sensitivity of the Generic Core Scales and cerebral palsy module. Dev Med Child Neurol 48:442–449

    Article  Google Scholar 

  20. Panepinto JA, Torres S, Bendo CB, McCavit TL, Dinu B, Sherman-Bien S, Bemrich-Stolz C, Varni JW (2013) PedsQL™ sickle cell disease module: feasibility, reliability and validity. Pediatr Blood Cancer 60:1338–1344

    Article  Google Scholar 

  21. Franciosi JP, Hommel KA, Bendo CB, King EC, Collins MH, Eby MD, Marsolo K, Abonia JP, von Tiehl KF, Putnam PE, Greenler AJ, Greenberg AB, Bryson RA, Davis CM, Olive AP, Gupta SK, Erwin EA, Klinnert MD, Spergel JM, Denham JM, Furuta GT, Rothenberg ME, Varni JW (2013) PedsQL™ Eosinophilic Esophagitis Module: feasibility, reliability and validity. J Pediatr Gastroenterol Nutr 57:57–66

    Article  Google Scholar 

  22. Modi AC, Junger KF, Mara C, Kellermann T, Barrett L, Wagner J, Mucci GA, Bailey L, Almane D, Guilfoyle SM, Urso L, Hater B, Hustzi H, Smith G, Herrmann B, Perry MS, Zupanc M, Varni JW (2017) Validation of the PedsQL Epilepsy Module: a pediatric epilepsy-specific health-related quality of life measure. Epilepsia 58:1920–1930

    Article  Google Scholar 

  23. Varni JW, Bendo CB, Denham J, Shulman RJ, Self MM, Neigut DA, Nurko S, Patel AS, Franciosi JP, Saps M, Verga B, Smith A, Yeckes A, Heinz N, Langseder A, Saeed S, Zacur GM, Pohl JF (2014) PedsQL™ Gastrointestinal Symptoms Module: feasibility, reliability, and validity. J Pediatr Gastroenterol Nutr 59:347–355

    Article  Google Scholar 

  24. Varni JW, Limbers CA (2009) The pediatric quality of life inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatr Clin North Am 56:843–863

    Article  Google Scholar 

  25. Varni JW, Thompson KL, Hanson V (1987) The Varni/Thompson Pediatric Pain Questionnaire: I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain 28:27–38

    Article  CAS  Google Scholar 

  26. Fairclough DL (2002) Design and analysis of quality of life studies in clinical trials: interdisciplinary statistics. Chapman & Hall/CRC., New York

    Book  Google Scholar 

  27. McHorney CA, Ware JE, Lu JFR, Sherbourne CD (1994) The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32:40–66

    Article  CAS  Google Scholar 

  28. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  29. Nunnally JC, Bernstein IR (1994) Psychometric theory. McGraw-Hill, New York

    Google Scholar 

  30. McHorney CA, Tarlow AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4:293–307

    Article  CAS  Google Scholar 

  31. Floyd FJ, Widaman KF (1995) Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess 7:286–299

    Article  Google Scholar 

  32. Pedhazur EJ, Schmelkin LP (1991) Measurement, design, and analysis: an integrated approach. Erlbaum, Hillsdale

    Google Scholar 

  33. Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, Hillsdale

    Google Scholar 

  34. McGraw KO, Wong SP (1996) Forming inferences about some intraclass correlation coefficients. Psychol Methods 1:30–46

    Article  Google Scholar 

  35. Bartko JJ (1966) The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19:3–11

    Article  CAS  Google Scholar 

  36. Varni JW, Franciosi JP, Shulman RJ, Saeed S, Nurko S, Neigut DA, Bendo CB, Patel AS, Self MM, Saps M, Zacur GM, Denham J, Dark CV, Pohl JF (2015) PedsQL™ Gastrointestinal Symptoms Scales and Gastrointestinal Worry Scales in pediatric patients with inflammatory bowel disease in comparison to healthy controls. Inflamm Bowel Dis 21:1115–1124

    Article  Google Scholar 

  37. Varni JW, Shulman RJ, Self MM, Nurko S, Saps M, Saeed S, Bendo CB, Patel AS, Dark CV, Zacur GM, Pohl JF (2015) Symptom profiles in patients with irritable bowel syndrome or functional abdominal pain compared to healthy controls. J Pediatr Gastroenterol Nutr 61:323–329

    Article  Google Scholar 

  38. Varni JW, Nurko S, Shulman RJ, Self MM, Saps M, Bendo CB, Dark CV, Pohl JF (2015) Pediatric functional constipation gastrointestinal symptom profile compared to healthy controls. J Pediatr Gastroenterol Nutr 61:424–430

    Article  Google Scholar 

  39. Choi SW, Swartz RJ (2009) Comparison of CAT item selection criteria for polytomous items. Appl Psychol Meas 33:419–440

    Article  Google Scholar 

  40. Eiser C, Varni JW (2013) Health related quality of life and symptom reporting: similarities and differences between children and their parents. Eur J Pediatr 172:1299–1304

    Article  Google Scholar 

  41. Blakeley JO, Plotkin SR (2016) Therapeutic advances for the tumors associated with neurofibromatosis type 1, type 2, and schwannomatosis. Neuro-oncology 18:624–638

    Article  CAS  Google Scholar 

  42. Ater JL, Xia C, M MC, Booth TN, Freyer DR, Packer RJ, Sposto R, Vezina G, Pollack IF (2016) Nonrandomized comparison of neurofibromatosis type 1 and non-neurofibromatosis type 1 children who received carboplatin and vincristine for progressive low-grade glioma:a report from the Children’s oncology group. Cancer 122:1928–1936

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was fully funded by the Neurofibromatosis Therapeutic Acceleration Program (NTAP) at Johns Hopkins University School of Medicine, Baltimore, MD. We would like to thank Ms. Pamela Knight and Ms. Rebecca Harris at the Children’s Tumor Foundation, Dr. Jaishri Blakeley, Ms. Marigo Stathis and Dr. Sharad Verma at the NTAP, Dr. Cynthia Hingtgen and Ms. Rosemary Anderson at the NF Michigan, Ms. Ellynore Florendo and Dr. Linda Randolph at the Children’s Hospital of Los Angeles, Ms. Diana Haberkamp at the NF Midwest, and Ms. Kelly Walsh-Curtis at the NF Network for their help in reaching out to potential participants.

Funding

This study was fully funded by the Neurofibromatosis Therapeutic Acceleration Program (NTAP) at Johns Hopkins University School of Medicine, Baltimore, MD.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kavitha Nutakki.

Ethics declarations

Conflict of interest

Dr. Varni holds the copyright and the trademark for the PedsQL and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the Pediatric Quality of Life Inventory. All other authors have no competing interests.

IRB approval

The Institutional Review Board at Indiana University, Indianapolis, approved this study (Protocol # 1403632840).

Additional information

The PedsQL NF1 Module is available at http://www.pedsql.org.

Appendix

Appendix

See Table 5.

Table 5 PedsQL Neurofibromatosis Type 1 Module scales and items for teen self-report

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nutakki, K., Varni, J.W. & Swigonski, N.L. PedsQL Neurofibromatosis Type 1 Module for children, adolescents and young adults: feasibility, reliability, and validity. J Neurooncol 137, 337–347 (2018). https://doi.org/10.1007/s11060-017-2723-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-017-2723-2

Keywords

Navigation