Peds QL scales was firstly studied by varni and his colleagues in San Diego children hospital and health center in 1987, now they include a general core scale and other eight diseases models
. These scales meet the needs proposed by world health organization that Qol should refer to physical, psychological health, social and role functioning, so have been widely used around the world. Moreover, the items selected for the latest version of Peds QL 4.0 general core scale can reflect the universal concern in children and adolescents aged 8 ~ 18 years. The state of California has selected the Peds QL 4.0 general core scale for the health outcomes evaluation of the state’s health insurance program
. In 2004, this scale system was introduced into China after a translation-reverse translation-culture adaptation-pre-experiment procedure
The Qol of children with short stature
This is the first time that Chinese version of Peds QL 4.0 general core scale has been used to evaluate the Qol of short children. So far, Peds QL 4.0 general scale has been translated into 53 languages
[10–12], and widely used in health or chronic disease children
[13, 14]. But we have not found any study on evaluating Qol of short stature children by this scale in China. Recently, more and more Chinese children see doctors because of their height problems. They may have suffered from a series of physical, social and psychological problems
. So an appropriate scale to score their status of Qol was needed.
The Qol of children with short stature was worse than their normal peers, and the statues of their Qol was positively related to their stature. For child self-report, the mean score of total scale in normal group was 87.36 points which is almost no difference from the results of other study
. The normal short group scored 83.50, short stature group 77.77 which was 9.59 points lower than normal group. For parent proxy-report, the scores’differences among these three groups were all statistically significant except the scores of social functioning. This may due to the discrepancy of parents’ and children’s own awareness of their social interaction. Furthermore, as to the two subgroups of short stature group, HtSDS < −3 group scored lower than −3 < HtSDS < −2 group about 5 points in every dimension, which concluded the status of Qol correlated to the stage of disease
[6, 16]. Besides, some studies showed cardiopulmonary function of patients with growth hormone deficiency is abnormal and can influence patients’ physical function
, but this view was not been proved in this study.
The Qol of children with short stature is not as well as normal children but meanly better than children with other chronic diseases. The individual variability in Qol among different patients was huge, the Qol can be normal or badly damaged, so individual assessment is absolutely necessary. In 2005 and 2007, varni and his colleagues explored the Qol of normal children and pediatric patients with ten kinds of chronic diseases (including diabetes, mental illness, heart disease, asthma, obesity, end-stage renal disease, gastrointestinal disease, cancer, rheumatic diseases and cerebral palsy) using Peds QL 4.0 general core scales, normal children gain the highest score 82.7. Among these 10 diseases groups, diabetes scored highest 76.62 and cerebral the lowest 51.28
[15, 18]. In our study, the mean score of short stature group (77.77) was close to the diabetes group and obviously higher than cerebral palsy mentioned above. However, there was also one short children get 44.57 points which even lower than the cerebral palsy group’s mean value. So we stress again the individual assessment.
The reliability and validity of Peds QL 4.0 scales
For both child self- and parent proxy-report, the Cronbach’s α coefficients of physical health, emotional functioning and school functioning were blow 0.7, which suggested lower inter consistencies, the Cronbach’s α coefficients of total scale and other two dimensions were bigger than 0.7. A survey on 3716 school children in Guang Zhou, China, in 2008 showed the total scale’s α coefficients was 0.9 which is close to the result of varni(α = 0.92)
. Another survey on 335 children with cancer in Hong Kong 2012 also showed better reliability, total scale’s α coefficient bigger than 0.9 and all dimensions’ bigger than 0.7
. In our study, total scale’s α coefficient was 0.8. We may need more samples to verify the validity of Peds QL 4.0 general scale on short children.
As to validity, in our study the scores’ correlation coefficients between 74% of items with the dimensions they belong to were bigger than 0.5, suggested a good validity. Other 6 items’ correlation coefficients was blew 0.5, including “It is hard for me to take a bath or shower by myself” which was also mentioned by Chen Yu-ming
, “It is hard for me to do chores around the house”, “I hurt or ache”, “I have trouble sleeping” and “I miss school to go to the doctor or hospital”. The reason for these 6 items were picking out may be the heavy burden of school work, sleeplessness, lack of exercise, less housework of Chinese children.
The necessity of Qol evaluation on children with short stature
For most children with short stature, their physical function are almost normal, their therapy is more likely to be a kind of health intervention. And the biggest challenge of health intervention was to identify those patients whose Qol wound be damaged for a long time, then give them appropriate therapy in order of improve their status of Qol. So, applying standardized scale to screen short children who need be intervened timely should emerge as a necessary procedure in clinical practice. Qol evaluation has been widely used in cancer, chronic diseases and special populations, to provide a comprehensive basis for choices of treatment and interventions, decision-making of health resource allocation. As all we know, the more serious damage in children’s Qol the more urgent need for effective and specific therapy
Qol evaluation should be an important part of all these procedures : assessment of the health damage of short stature in children, decision-making of clinical practice and evaluation of therapy result. In other words, clinic doctors should not pay their attention solely on height of children with short stature, but more on their Qol. This is not only for children with short stature, but for all chronic patients. In the rheumatology clinic sample, when the pediatric rheumatologist examined the completed Peds QL instrument at the point of service and made a clinical intervention decision based on the findings, the subsequent child self-report Peds QL4.0 generic core scales were significantly higher approximately by 10 points
. Except for the field of diseases, Qol scales also should be a necessary tool to screen children with physical and psychological problems in health care