Background
Methods
Validated instruments for QoL and neurobehavioural assessment
Day-to-day life functioning | Sleep symptoms | Recurrent infections | Behaviour and social functioning | Scholastic performance and cognitive functioning | Physical functioning | Emotional functioning | |
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Children’s Quality of Life Questionnaire (CH-QOL) | X | ||||||
PedsQL Measurement Model for Pediatric Quality of Life Inventory (PedsQL) | X | X | X | X | |||
TNO-AZL Preschool children Quality of Life (TAPQOL) | X | X | X | X | |||
Child Health Questionnaire (CHQ) | X | X | X | ||||
Glasgow Children’s Benefit Inventory (GCBI) | X | X | X | X | |||
Short Form (36) Health Survey (SF-36) | X | X | X | ||||
Obstructive Sleep Apnea-18 (OSA-18) | X | X | X | X | |||
Post Tonsillectomy QOL Questionnaire | X | X | X | ||||
14-item Paediatric Throat Disorders Outcome Test (IT-14) | X | X | X | ||||
Brouillette questionnaire | X | X | |||||
EuroQol Visual Analogue Scale | X | X | X | X | X | ||
Wechsler Intelligence Scale for Children (WISC) | X | X | |||||
Raven Progressive Matrices (RPM) | X | ||||||
School Performance Test (SPT) | X | ||||||
Kaufman Assessment Battery for Children (K-ABC) | X |
Generic health related questionnaires
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The Children’s Quality of Life Questionnaire (CH-QOL) is a QoL tool originally designed for the use in healthy children, but later also applied to disease-related contexts; it is made up of 15 scales for a total of 55 items, exploring all the different fields of day-to-day life functioning of the child [16].
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The PedsQL Measurement Model for Pediatric Quality of Life Inventory (PedsQL) is a standardized, generic assessment instrument that provides a modular approach to measure health related QoL in healthy children and adolescents and those with acute and chronic disorders. This instrument consists of 23 items evaluating physical, emotional, social and scholastic functioning, and it integrates both generic core scales and disease-specific modules [17].
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The TNO-AZL Preschool children Quality of Life (TAPQOL) is the first multi-dimensional questionnaire evaluating health related QoL that was specifically designed for preschool children aged 1–5 years. It is a 43 items questionnaire, consisting of 12 multi-item scales that consider physical, social, cognitive, and emotional functioning; each scale contains 3 to 7 items, and the questionnaire is usually designed to refer to the preceding 3 months, although it can be adjusted to take into consideration a longer span of time. Data currently available in literature seem to suggest that this questionnaire is a valid and reliable instrument for the evaluation of parent reported health related QoL in infants and toddlers [18].
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The Child Health Questionnaires (CHQ) are a family of general pediatric QoL surveys that have been designed and normed for children aged 5 to 18 years. There are two available versions of this questionnaire, one that is designed to be directly submitted to children older than 10 years, and the parent form, in which the parent is asked to express his/her opinion on the general QoL and health related QoL of the child. The parent form is available in 2 lengths, a 28 questions version and an extended 50 questions version, and it measures 14 physical and psychosocial aspects of the everyday life of the child [19]. The accuracy of the CHQ 28 questions parent form in assessing the impact of adenotonsillar disease on children’s quality of life has been specifically evaluated in a recent British study with positive results [20].
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The Glasgow Children’s Benefit Inventory (GCBI) comprises 24 questions on the consequences of a specified intervention on various aspects of the day-to-day child life, without reference to any specific symptoms, and it can be apply to children of any age. The questionnaire was proven to be valid and reliable by different studies, and it includes 4 dimensions in the pattern of responses, relating to emotion, physical health, learning, and vitality. Although not restricted to any branch of paediatric medicine, it is eminently suitable for use in the field of paediatric otolaryngology [21].
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The Short Form (36) Health Survey (SF-36) consists in eight scaled scores, which are the weighted sums of each section. The eight sections are: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health. Scores range between 0 and 100, with lower scores corresponding to more significant disability and higher scores to slighter disability [22, 23].
Disease specific health related questionnaires
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The Obstructive Sleep Apnoea-18 (OSA-18) questionnaire consists in 18 questions concerning sleep disturbances, physical symptoms, emotional distress, daytime function, and caregiver concerns. Each question can be scored 1–7 and so the final score ranges from 18 to 126: a score of <60 indicates a minimal impact on the QoL; a score of 60–80 a moderate impact; and a score of >80 a highly negative impact [5, 6]. On the basis of our revision of literature, it is the most used tool for the assessment of QoL in children with adenotonsillar disease [6].
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The Post Tonsillectomy QoL Questionnaire is used to evaluate outcome measures for tonsillar surgery, specifically the frequency of tonsillitis per year, absences from work (or school), doctor visits or need for antibiotic prescriptions, and feelings of well-being (investigating self-consciousness, embarrassment, easy distraction, self-esteem, confidence and self-care, learning, concentration, liveliness, fun with friends and leisure activities, family harmony and overall satisfaction) [24].
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The 14-items Pediatric Throat Disorders Outcome Test (IT-14) was validated by the Clinical Audit and Practice Advisory Group of ENT UK in 2010 and consists in 14 questions specifically aimed at determining the impact of tonsillar disease on everyday activities. It is divided into two sections that cover two complementary and equally significant aspects of tonsillar disease: obstructive respiratory problems (five questions) and oropharyngeal infectious recurrences (nine questions) [25, 26]. Each question is scored 1–5, and the total score is directly proportional to the impact of the disease on disease-specific QoL of the patient [27].
Symptoms questionnaires
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The Brouillette questionnaire is a symptom questionnaire that was created to decrease the need for polysomnography monitoring and to select children candidate to adenotonsillectomy. Brouillette questionnaire investigates the presence of respiratory sleep disorders and the frequency of apnoea and pathological snoring. Each item is scored from 0 to 3 (0 = absence of symptoms, 1 = occasional symptoms, 2 = frequent symptoms, and 3 = constant symptoms), and the overall score is directly proportional to disease severity [24].
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EuroQol Visual Analogue Scale is a questionnaire specifically designed to evaluate obstructive respiratory symptoms and the recurrence of tonsillar infections. The EQ-5D questionnaire is made up of two components: health status description and evaluation. In the description part, health status is measured in terms of five dimensions (5D): mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. In the evaluation part, the respondents evaluate their overall health status using a visual analogue scale [28].
Neurobehavioural comorbidities
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The Wechsler Intelligence Scale for Children (WISC) evaluates global intellectual functioning and it is composed of a Verbal Scale (testing language and expression), and a Performance Scale (testing visuo-spatial and motor skills). The Wechsler Intelligence Scale for Children (WISC) is an individually administered intelligence test for children aged 6 to 16 years. The Fifth Edition (WISC-V; Wechsler, 2014) is the most current version. It generates a Full Scale IQ (formerly known as an intelligence quotient or IQ score) that represents a child’s general intellectual ability. It also provides five primary index scores corresponding to discrete cognitive domains: Verbal Comprehension Index, Visual Spatial Index, Fluid Reasoning Index, Working Memory Index, and Processing Speed Index [29].
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The Raven Progressive Matrices (RPM) consist in a group of tests that are widely used to evaluate patients with neurological impairment and their purpose is to assess the performance in two specific cognitive fields, i.e. the educative ability (the ability to make meaning out of confusion) and the reproductive ability (the ability to absorb and subsequently reproduce an information that has been explicitly reported from one person to another). These tests consist in a series of diagrams or designs with a missing part which should be chosen by the patients among a number of available options [30].
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The School Performance Test (SPT) is a useful tool for the evaluation of cognitive abilities, and more specifically scholastic performance in older children (7 to 12 years). It is a standardized psychometric instrument composed of 3 subtests, focusing respectively on writing of dictated words, arithmetic (oral solution of problems and calculation of written arithmetical operations) and reading (recognition of words apart from the context) [31].
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The Kaufman Assessment Battery for Children (K-ABC) is a clinical instrument designed in 1983 and subsequently revised, that assesses cognitive development in children aged from 2.5 to 12.5 years. This tool is composed of 16 subtests, grouped into a mental processing set and an achievement set, which yield separate global scores; the mental processing set can be furtherly divided into a subset of tests requiring primarily sequential processing of information and a second subset requiring simultaneous processing, with separate global scores for each [32].