Warner-Czyz Andrea D, Loy Betty, Tobey Emily A, Nakonezny Paul, Roland Peter S
The University of Texas at Dallas, Callier Advanced Hearing Research Center, Dallas, TX 75235, USA.
Int J Pediatr Otorhinolaryngol. 2011 Jan;75(1):95-105. doi: 10.1016/j.ijporl.2010.10.018. Epub 2010 Nov 11.
Examination of health-related quality of life (HRQoL) in children and adolescents who wear a cochlear implant (CI) primarily has depended on parent proxy report of the child's HRQoL rather than child self-report and generic domains rather than CI-specific issues. This study simultaneously assessed self-report ratings on a generic HRQoL instrument and a preliminary CI module in pediatric CI users. The impact of demographic factors (chronologic age, age at CI, and CI experience) on HRQoL also was explored.
This cross-sectional study included 138 children grouped by chronologic age: 4-7, 8-11 and 12-16 years. The KINDL(R) questionnaire for measuring HRQoL in children and adolescents (generic) and a preliminary CI module (specific) were completed as a researcher-administered interview (4-7 years) or self-administered questionnaire (8-16 years) at CI summer camp or home. Scores were transformed to a 100-point scale with 100 representing the most positive response. The impact of chronologic age group on HRQoL ratings was evaluated using Analysis of Variance. Spearman rank-order correlations and point-biserial correlations tested associations between demographic factors and HRQoL scores. Principal factor analysis was used to discover the factor structure and internal consistency of the preliminary CI module.
The youngest group (M=82.8) rated generic HRQoL significantly more positively than older children (8-11 years: M=75.3; 12-16 years: M=70.4). Similar significant results emerged on the overall CI module (4-7 years: M=79.8; 8-11 years: M=77.8; 12-16 years: M=71.3). The youngest group rated CI-specific items on friends and self-image more positively than older groups, but reported greater difficulties hearing teachers at school. The oldest group provided more consistent responses than younger groups on the CI module (Cronbach α=0.72). Generic and CI module scores correlated positively (r=0.19, p=.03) but this association reflects the strong correlation in the oldest group (r=0.49, p=0.0033) and camouflages non-significant results in younger groups.
Chronologic age impacts self-report of HRQoL for pediatric CI users such that younger children rate HRQoL more positively than older children and adolescents on a generic instrument and preliminary CI module. Older children provide more consistent responses on the CI module. Results support the need for further development of a CI-specific self-report HRQoL instrument.
对佩戴人工耳蜗（CI）的儿童和青少年的健康相关生活质量（HRQoL）进行的评估主要依赖于家长对孩子HRQoL的代理报告，而非孩子的自我报告，且评估的是通用领域而非人工耳蜗特有的问题。本研究同时评估了儿科人工耳蜗使用者在通用HRQoL工具和初步人工耳蜗模块上的自我报告评分。还探讨了人口统计学因素（实足年龄、植入人工耳蜗时的年龄和人工耳蜗使用经验）对HRQoL的影响。
这项横断面研究纳入了138名按实足年龄分组的儿童：4 - 7岁、8 - 11岁和12 - 16岁。用于测量儿童和青少年HRQoL的KINDL(R)问卷（通用）和一个初步人工耳蜗模块（特定），在人工耳蜗夏令营或家中通过研究者访谈（4 - 7岁）或自我填写问卷（8 - 16岁）的方式完成。分数转换为100分制，100分代表最积极的回答。使用方差分析评估实足年龄组对HRQoL评分的影响。Spearman等级相关性和点二列相关性检验了人口统计学因素与HRQoL分数之间的关联。主成分因子分析用于发现初步人工耳蜗模块的因子结构和内部一致性。
最年幼组（M = 82.8）对通用HRQoL的评分显著高于年龄较大的儿童（8 - 11岁：M = 75.3；12 - 16岁：M = 70.4）。在整体人工耳蜗模块上也出现了类似显著结果（4 - 7岁：M = 79.8；8 - 11岁：M = 77.8；12 - 16岁：M = 71.3）。最年幼组对人工耳蜗特定项目中关于朋友和自我形象的评分比年龄较大组更积极，但报告在学校听老师讲课有更大困难。年龄最大组在人工耳蜗模块上的回答比年龄较小组更一致（Cronbach α = 0.72）。通用模块和人工耳蜗模块分数呈正相关（r = 0.19，p = 0.03），但这种关联反映了年龄最大组的强相关性（r = 0.49，p = 0.0033），掩盖了年龄较小组的非显著结果。
实足年龄影响儿科人工耳蜗使用者的HRQoL自我报告，即年幼儿童在通用工具和初步人工耳蜗模块上对HRQoL的评分比年龄较大的儿童和青少年更积极。年龄较大的儿童在人工耳蜗模块上提供更一致的回答。结果支持进一步开发人工耳蜗特定的自我报告HRQoL工具的必要性。
