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David A Leske, Suzanne M Wernimont, Sarah R Hatt, Eileen E Birch, Jonathan M Holmes; Comparison of rating scales in the development of patient-reported outcome measures for children with eye disorders. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2451.
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© 2017 Association for Research in Vision and Ophthalmology.
As an interim step in developing new patient-reported outcome measures for children with eye disorders, we studied which type of rating scale was easier for children and their parents to use.
We identified three commonly used rating scales for comparison: frequency (never, sometimes, often, always), severity (not at all, a little, some, a lot), and difficulty (not difficult, a little difficult, difficult, very difficult). 10 patient-derived items were formatted for each rating scale, and rating scale testing order was randomized. Questionnaires were administered to children by a trained examiner who read the questions and response options verbatim. Parent (proxy) questionnaires were self-administered. Both child and parent were asked to comment on any problems with, or a preference for, a particular scale. Any delay in answering, confusion about options, or inability to answer was recorded. The pattern of responses was assessed to determine whether the range of options was similarly utilized on each scale.
21 children (aged 5-17 years) with strabismus, amblyopia, or refractive error were recruited, plus one of their parents. Of the first 10 children, 4 (40%) had problems using the difficulty scale, compared with 1 (10%) using frequency, and none using severity. For parents, 2 (20%) had problems using the difficulty scale, 1 (10%) using frequency, and none using severity. The difficulty scale was then modified, replacing the word “difficult” with “hard” and 11 additional children (plus parents) completed all 3 questionnaires. No children had problems using any scale. 4 (36%) parents expressed issues using the difficulty (“hard”) scale and 1 (9%) with frequency. 6 (55%) of 11 children and 6 (55%) of 11 parents preferred using the frequency scale, and 3 (27%) of children and parents preferred severity. For child and parent, the distribution of response options was similar across the 3 scales.
Comparing frequency, difficulty, and severity rating scales, the frequency scale was preferred by most children and parents. In addition, children and parents experienced few problems using the frequency scale. We recommend frequency rating scales when using patient reported outcome measures in pediatric populations.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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