Physical Therapy Korea
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Phys. Ther. Korea 2021; 28(2): 146-153
Published online May 20, 2021
https://doi.org/10.12674/ptk.2021.28.2.146
© Korean Research Society of Physical Therapy
Analysis of Concordance Between Parent Proxy and Child Self-report of KIDSCREEN-10 Health-related Quality of Life Questionnaire in an Elementary School-based Wellness Program: A Pilot Focus Group Study
Bongsam Choi 
, MPH, PhD, PT
Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Korea
Correspondence to: Bongsam Choi
E-mail: bchoi@wsu.ac.kr
https://orcid.org/0000-0002-0165-4941
Background: Researchers have previously commenced examining the degree of concordance between parent proxy and child self-reports on health-related quality of life (HRQOL) of many disease and impairment populations.
Objects: To explore the differences between parent proxy and child self-reports on the HRQOL using Korean version of KIDSCREEN-10 questionnaires for applying to elementary school children and their parents who participated for a school-based wellness program.
Methods: The focus groups were recruited for a school-based wellness program by implementing the following wellness services: 1) referring to a screening session for detecting potential posture-related musculoskeletal problems and 2) recommending home exercise programs. Before a primary field testing for the program, two focus groups were formed with a group of 9 parents and their 9 elementary school children aged 8–10 years of age. The parent proxy and child self-report versions of KIDSCREEN-10 questionnaires were administered to both groups after completion of the wellness program. Item level Rasch rating scale analysis was applied to compute logit scales of KIDSCREEN-10 questionnaire. Intraclass correlation coefficients (ICCs) and scatterplot of item difficulty between two reports were analyzed.
Results: For fit statistics of parent proxy report, all items except 4 items (i.e., psychological well-being, mood/emotions, self-perception, parent relation) were found to be acceptable. For fit statistics of child self-report, all items except 3 items (i.e., psychological well-being, autonomy and home life) were acceptable. The relationship between two reports using ICCs were ranging from weak to very strong at p = 0.05 (i.e, ICCs = 0.011 to 0.905). Scatterplot analysis between two reports showed a major disparity on self-perception item at 95% confidence intervals.
Conclusion: Both item level analyses and ICC comparisons provided a disparity between parent proxy and child self-reports of the HRQOL on self-perception item after competing a school-based wellness program. Therapist should consider the item as part of the HRQOL assessment.
Keywords: Proxy, Quality of life, Self report, Treatment outcome
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Original Article
Phys. Ther. Korea 2021; 28(2): 146-153
Published online May 20, 2021 https://doi.org/10.12674/ptk.2021.28.2.146
Copyright © Korean Research Society of Physical Therapy.
Analysis of Concordance Between Parent Proxy and Child Self-report of KIDSCREEN-10 Health-related Quality of Life Questionnaire in an Elementary School-based Wellness Program: A Pilot Focus Group Study
Bongsam Choi , MPH, PhD, PT
Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Korea
Correspondence to:Bongsam Choi
E-mail: bchoi@wsu.ac.kr
https://orcid.org/0000-0002-0165-4941
Abstract
Background: Researchers have previously commenced examining the degree of concordance between parent proxy and child self-reports on health-related quality of life (HRQOL) of many disease and impairment populations.
Objects: To explore the differences between parent proxy and child self-reports on the HRQOL using Korean version of KIDSCREEN-10 questionnaires for applying to elementary school children and their parents who participated for a school-based wellness program.
Methods: The focus groups were recruited for a school-based wellness program by implementing the following wellness services: 1) referring to a screening session for detecting potential posture-related musculoskeletal problems and 2) recommending home exercise programs. Before a primary field testing for the program, two focus groups were formed with a group of 9 parents and their 9 elementary school children aged 8–10 years of age. The parent proxy and child self-report versions of KIDSCREEN-10 questionnaires were administered to both groups after completion of the wellness program. Item level Rasch rating scale analysis was applied to compute logit scales of KIDSCREEN-10 questionnaire. Intraclass correlation coefficients (ICCs) and scatterplot of item difficulty between two reports were analyzed.
Results: For fit statistics of parent proxy report, all items except 4 items (i.e., psychological well-being, mood/emotions, self-perception, parent relation) were found to be acceptable. For fit statistics of child self-report, all items except 3 items (i.e., psychological well-being, autonomy and home life) were acceptable. The relationship between two reports using ICCs were ranging from weak to very strong at p = 0.05 (i.e, ICCs = 0.011 to 0.905). Scatterplot analysis between two reports showed a major disparity on self-perception item at 95% confidence intervals.
Conclusion: Both item level analyses and ICC comparisons provided a disparity between parent proxy and child self-reports of the HRQOL on self-perception item after competing a school-based wellness program. Therapist should consider the item as part of the HRQOL assessment.
Keywords: Proxy, Quality of life, Self report, Treatment outcome
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Table 1 . Item interpretation of KIDSCREEN-10 questionnaire.
Items Interpretation Item 1 Physical well-being The level of the child’s physical activity, energy, and fitness such as ability to get around the home and school Item 2 Psychological well-being The level of the child’s positive emotions and satisfaction with life experienced by the individual such as happiness, joy, and cheerfulness Item 3 Mood/emotions How much the child experiences depressive moods/emotions and stressful feelings such as loneliness, sadness, sufficiency/insufficiency, and resignation Item 4 Self-perception How secure and satisfied the child feels about him/herself as well as appearance reflecting how positively others value him/her Item 5 Autonomy The level of the opportunity given to a child to create social and leisure time referring to the child’s freedom of choice, self-sufficiency, and independence Item 6 Home life This attribute examines whether the atmosphere at home is comfortable or not Item 7 Parent relation This specifies the relationship between the parents and the atmosphere in the child’s home Item 8 Peers/social support This examines the nature of the child’s relationships with other children or peer groups exploring the quality of the interaction between the child and peers Item 9 School environment How secure and satisfied the child’s feeling about the environment the child belonged Item 10 Concentration/learning How secure and satisfied the ability to concentrate for learning
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Table 2 . Fit statistics of the KIDSCREEN questionnaire in descending order of difficulty.
Items Difficulty (logits) Infit MnSqa ZSTD Outfit MnSq ZSTD Concentration/learning (PARENT 10) 1.07 0.51 –1.03 0.75 –0.35 Autonomy (PARENT 5) 0.77 0.63 –0.65 1.05 0.28 Autonomy (CHILD 5) 0.61 2.25 1.95 1.79 1.34 Home life (PARENT 6) 0.61 0.65 –0.59 0.64 –0.56 Home life (CHILD 6) 0.44 2.20 1.88 1.48 0.91 Concentration/learning (CHILD 10) 0.44 1.33 0.74 1.25 0.60 Self-perception (PARENT 4) 0.26 3.76 3.30 5.22 3.87 Peers/social support (PARENT 8) 0.26 0.58 –0.75 0.42 –1.06 School environment (PARENT 9) 0.26 0.28 –1.75 0.29 –1.46 Physical well-being (CHILD 1) 0.06 0.13 –2.50 0.17 –1.87 Psychological well-being (CHILD 2) 0.06 0.27 –1.78 0.26 –1.50 Parent relation (CHILD 7) 0.06 0.81 –0.19 0.84 –0.05 Parent relation (PARENT 7) 0.06 0.38 –1.34 0.38 –1.10 Peers/social support (CHILD 8) –0.40 0.80 –0.14 0.54 –0.51 School environment (CHILD 9) –0.40 0.85 –0.04 0.68 –0.25 Psychological well-being (PARENT 2) –0.40 0.24 –1.63 0.27 –1.19 Physical well-being (PARENT 1) –0.70 0.46 –0.79 0.40 –0.67 Mood/emotions (PARENT 3) –0.70 3.01 2.21 5.93 3.22 Mood/emotions (CHILD 3) –2.35 0.45 –0.33 0.18 –0.45 Self-perception (CHILD 4) –3.63 Minimum measureb MnSq, mean squares; ZSTD, Z score standardized; PARENT, parent proxy report item; CHILD, child self-report item. aStandardized residuals. bFit statistics/ZSTDs are too small to estimate..
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Table 3 . Intra-class correlations (ICC) between scores of parent proxy and child self-reports.
Parent proxy versus child self-report ICC Physical well-being (Item 1) 0.743 (0.209–0.936) Psychological well-being (Item 2) 0.868 (0.523–0.969) Mood/emotions (Item 3) 0.122 (–0.553–0.700) Self-perception (Item 4) 0.011 (–0.632–0.632) Autonomy (Item 5) –0.022 (–0.645–0.619) Home life (Item 6) 0.161 (–0.524–0.720) Parent relation (Item 7) 0.847 (0.464–0.963) Peers/social support (Item 8) 0.905 (0.639–0.978) School environment (Item 9) 0.695 (0.112–0.922) Concentration/learning (Item 10) 0.370 (–0.342–0.812) Values are presented as ICC coefficient (95% confidence intervals). p = 0.05..