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Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion.
JAMA Otolaryngol Head Neck Surg. 2014 Sep; 140(9):823-8.JO

Abstract

IMPORTANCE

Paradoxical vocal fold motion (PVFM) affects almost 1 million adolescents in the United States. However, to date, no disease-specific objective measure exists to assess symptom severity and response to treatment in adolescents with exercise-induced PVFM.

OBJECTIVES

To validate the Dyspnea Index (DI) quality-of-life instrument (previously validated for adults with breathing disorders) in children aged 12 to 18 years with exercise-induced PVFM and to determine the minimum significant DI change corresponding to patient-reported or caregiver-reported improvement or worsening of symptoms.

DESIGN, SETTING, AND PARTICIPANTS

A longitudinal study of 56 patients (age range, 12-18 years) diagnosed as having exercise-induced PVFM and their caregivers from February 1, 2013, to September 30, 2013, in an outpatient pediatric otolaryngology office practice.

INTERVENTIONS

The DI was administered to patients and caregivers, with items modified to reflect the perspective of caregivers.

MAIN OUTCOMES AND MEASURES

Appropriate DI change was measured to reflect improvement or worsening of symptoms. Test-retest reliability was accomplished by having a subset of patients and caregivers complete the instrument twice within 2 weeks before therapy. Internal consistency was assessed by calculation of Cronbach α. Discriminant validity and convergent validity were determined by comparing DIs with assessment of global change in symptoms.

RESULTS

The patient and caregiver mean (SD) DI changes were -12.9 (9.6) and -14.7 (9.3), respectively (P < .001 for both). Reliability was established by test-retest analysis with an intraclass correlation coefficient of 0.8 and by calculation of Cronbach α = 0.80, demonstrating internal consistency. Discriminant validity was determined by assessing for a significant DI change when patients globally perceived that a change existed after treatment (P < .001). A DI change of 8 or higher (P < .001) correlated with patient-reported significant change. Convergent validity was demonstrated by evaluating for significant DI change when no change was reported following treatment (P < .001).

CONCLUSIONS AND RELEVANCE

The DI appears to be a valid and reliable instrument to assess quality of life in exercise-induced pediatric PVFM. A DI change of 8 or higher seems significant. This instrument can serve as an objective tool to assess change in exercise-induced pediatric PVFM following speech therapy.

Authors+Show Affiliations

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston2Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

25104182

Citation

De Guzman, Vanessa, et al. "Validation of the Dyspnea Index in Adolescents With Exercise-induced Paradoxical Vocal Fold Motion." JAMA Otolaryngology-- Head & Neck Surgery, vol. 140, no. 9, 2014, pp. 823-8.
De Guzman V, Ballif CL, Maurer R, et al. Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion. JAMA Otolaryngol Head Neck Surg. 2014;140(9):823-8.
De Guzman, V., Ballif, C. L., Maurer, R., Hartnick, C. J., & Raol, N. (2014). Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion. JAMA Otolaryngology-- Head & Neck Surgery, 140(9), 823-8. https://doi.org/10.1001/jamaoto.2014.1405
De Guzman V, et al. Validation of the Dyspnea Index in Adolescents With Exercise-induced Paradoxical Vocal Fold Motion. JAMA Otolaryngol Head Neck Surg. 2014;140(9):823-8. PubMed PMID: 25104182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion. AU - De Guzman,Vanessa, AU - Ballif,Catherine L, AU - Maurer,Rie, AU - Hartnick,Christopher J, AU - Raol,Nikhila, PY - 2014/8/9/entrez PY - 2014/8/12/pubmed PY - 2014/11/18/medline SP - 823 EP - 8 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 140 IS - 9 N2 - IMPORTANCE: Paradoxical vocal fold motion (PVFM) affects almost 1 million adolescents in the United States. However, to date, no disease-specific objective measure exists to assess symptom severity and response to treatment in adolescents with exercise-induced PVFM. OBJECTIVES: To validate the Dyspnea Index (DI) quality-of-life instrument (previously validated for adults with breathing disorders) in children aged 12 to 18 years with exercise-induced PVFM and to determine the minimum significant DI change corresponding to patient-reported or caregiver-reported improvement or worsening of symptoms. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal study of 56 patients (age range, 12-18 years) diagnosed as having exercise-induced PVFM and their caregivers from February 1, 2013, to September 30, 2013, in an outpatient pediatric otolaryngology office practice. INTERVENTIONS: The DI was administered to patients and caregivers, with items modified to reflect the perspective of caregivers. MAIN OUTCOMES AND MEASURES: Appropriate DI change was measured to reflect improvement or worsening of symptoms. Test-retest reliability was accomplished by having a subset of patients and caregivers complete the instrument twice within 2 weeks before therapy. Internal consistency was assessed by calculation of Cronbach α. Discriminant validity and convergent validity were determined by comparing DIs with assessment of global change in symptoms. RESULTS: The patient and caregiver mean (SD) DI changes were -12.9 (9.6) and -14.7 (9.3), respectively (P < .001 for both). Reliability was established by test-retest analysis with an intraclass correlation coefficient of 0.8 and by calculation of Cronbach α = 0.80, demonstrating internal consistency. Discriminant validity was determined by assessing for a significant DI change when patients globally perceived that a change existed after treatment (P < .001). A DI change of 8 or higher (P < .001) correlated with patient-reported significant change. Convergent validity was demonstrated by evaluating for significant DI change when no change was reported following treatment (P < .001). CONCLUSIONS AND RELEVANCE: The DI appears to be a valid and reliable instrument to assess quality of life in exercise-induced pediatric PVFM. A DI change of 8 or higher seems significant. This instrument can serve as an objective tool to assess change in exercise-induced pediatric PVFM following speech therapy. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/25104182/Validation_of_the_dyspnea_index_in_adolescents_with_exercise_induced_paradoxical_vocal_fold_motion_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2014.1405 DB - PRIME DP - Unbound Medicine ER -