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Pediatric Quality of Life Inventory (PEDSQL)
Please visit these websites for more information about the instrument: PedsQL or ePROVIDE
NeuroRehab Core: Pediatric (ages 2-18)
Supplemental - Highly Recommended: Mitochondrial Disease (Mito) and Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months)
Recommendations for use: Indicated for pediatric interventional studies requiring a measure of quality of life.
Supplemental: Cerebral Palsy (CP), Duchenne Muscular Dystrophy (DMD), Friedreich's Ataxia (FA), Headache, Spinal Muscular Atrophy (SMA), Sports Related Concussion (SRC) Acute (time of injury until 72 hours) and Persistent/Chronic (3 months and greater post concussion), Stroke, Acute, Moderate and Mild Traumatic Brain Injury (TBI), and Epidemiology TBI
Exploratory: Myotonic Dystrophy (DM)
Short Description of Instrument
Description: Developed in the US in 1998, the PedsQL 4.0 Measurement Model is a modular approach to measuring health-related quality of life (HRQOL) in healthy children and adolescents and those with acute and chronic health conditions. The PedsQL Measurement Model covers 4 domains: physical (8 items), emotional (5 items), social (5 items), and school (5 items). It provides a total scales score from 23 items, of which 8 are for physical health summary score and 15 are for psychosocial health summary score.
The instrument takes 4 minutes to complete and is translated in multiple international languages including broadcast Spanish. It is usable for parents/guardians of children between the ages of 2 to 18 years (in 4 age groups) and child versions are available for all age groups except the 2-4 years old.
Administration mode:
Interviewer-administered, proxy-rated, self-administered
Data Collection mode:
Paper and pen. Self-administered self-report ages 8 and older. Interviewer-administered self-report ages 5-7. Self-administered proxy report ages 2 and older.
Comments/Special Instructions
The PedsQL covers a wide age range, it has been well used and has reasonable psychometrics. It captures something that the NeuroRehab Infant Pediatrics Subgroup agrees is important for almost all NeuroRehab scientific studies, especially clinical trials.
There is an infant version for children 1-24 months. The infant scales include two age-appropriate versions for ages 1-12 months and 13-24 months and assess parents' perceptions of their infant's generic HRQOL. The 36-item PedsQL™ Infant Scales 1-12 months Version encompasses 5 scales: (1) Physical Functioning (6 items), (2) Physical Symptoms (10 items), (3) Emotional Functioning (12 items), (4) Social Functioning (4 items), and (5) Cognitive Functioning (4 items). The 45-item PedsQL™ Infant Scales 13-24 months Version contains the same 5 scales and the same 36 items as the 1-12 months Version with 9 additional age-appropriate items: (1) Physical Functioning (9 items), (2) Physical Symptoms (10 items), (3) Emotional Functioning (12 items), (4) Social Functioning (5 items), and (5) Cognitive Functioning (9 items). For the infant scales, the total score internal consistency reliability was alpha=.92.
Scoring and Psychometric Properties
Scoring: The generic core contains 23 items encompassing four areas: physical, emotional, social, and school. Participants respond on a Likert scale from 0 to 4. Items are reverse scored and linearly transformed to a 0 to 100 scale, with higher converted scores indicating better HRQOL. The instrument provides four domain scores, two summary scores (physical and psychosocial functioning), and a total HRQOL score.
0-100 scale with scores near 0 representing lower QOL and scores near 100 representing higher QOL. Individual subscale scores can also be calculated for each of the four areas of functioning: physical, emotional, social, and school. To score, items are transferred to a 0-100 scale, i.e., 0=100, 1=75, 2=50, 3=25, 4=0. Scores are then averaged to obtain a final score between 0-100.
Psychometric Properties: Well-standardized and validated, good reliability and sensitivity to change, good correlations with other standardized measures of disease severity in disease-specific modules.
Reliability: For the generic core, over all 23 multi-item scales had internal consistency reliabilities averaging 0.80; The total scale score had alpha=0.88 for child and alpha=0.90 for parent report.
Validity of scales: Distinguishes between healthy children and children with acute and chronic health conditions; distinguishes disease severity within a chronic health condition.
Headache specific data is also supportive of the reliability (internal consistency and test-retest) and validity (criterion related, convergent, known-groups, and responsiveness to intervention) of the PedsQL 4.0 within a pediatric headache sample.
Particular Features: PedsQL Disease-Specific Modules are available for asthma, arthritis, cancer, cardiac disease, and diabetes.
Strengths: PedsQL is short, easy to complete, and is widely used and validated in US. It also has many translations. Lastly, it is a broad measurement of function collected in under 4 minutes.
Weaknesses: Nothing specific noted in publications on the studies listed above, although a reliable mitochondrial disease-specific module does not exist. PedsQL 4.0 has been described as one of the three available general measures of QOL in childhood and adolescence with adequate psychometric properties for application in clinical research (NINDS Headache CDEs). It is an overall quality of life tool that does not focus on either epilepsy or its treatment.
Key Reference:
Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001 Aug;39(8):800-12.
Additional References:
Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003 Nov-Dec;3(6):329-41.
Varni JW, Limbers CA. The pediatric quality of life inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatr Clin North Am. 2009 Aug;56(4):843-63.
Varni JW, Limbers CA. The PedsQL 4.0 Generic Core Scales Young Adult Version: feasibility, reliability and validity in a university student population. J Health Psychol. 2009 May;14(4):611-22.
Varni JW, Limbers CA, Neighbors K, Schulz K, Lieu JE, Heffer RW, Tuzinkiewicz K, Mangione-Smith R, Zimmerman JJ, Alonso EM. The PedsQL™ Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants. Qual Life Res. 2011 Feb;20(1):45-55.
Varni JW, Seid M, Knight TS, Uzark K, Szer IS. The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making. J Behav Med. 2002 Apr;25(2):175-93.
Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care. 1999 Feb;37(2):126-39.
Headache-Specific Reference:
Connelly M, Rapoff MA. Assessing health-related quality of life in children with recurrent headache: reliability and validity of the PedsQLTM 4.0 in a pediatric headache sample. J Pediatr Psychol. 2006 Aug;31(7):698-702.
Mitochondrial Disease-Specific Reference:
Martinelli D, Catteruccia M, Piemonte F, Pastore A, Tozzi G, Dionisi-Vici C, Pontrelli G, Corsetti T, Livadiotti S, Kheifets V, Hinman A, Shrader WD, Thoolen M, Klein MB, Bertini E, Miller G. EPI-743 reverses the progression of the pediatric mitochondrial disease--genetically defined Leigh Syndrome. Mol Genet Metab. 2012 Nov;107(3):383-8.
Stroke-Specific References:
Abecassis IJ, Nerva JD, Barber J, Rockhill J, Ellenbogen RG, Kim LJ, Sekhar LN. Toward a comprehensive assessment of functional outcomes in pediatric patients with brain arteriovenous malformations: the Pediatric Quality of Life Inventory. J Neurosurg Pediatr. 2016 Nov;18(5):611-22.
Friefeld S, Yeboah O, Jones JE, deVeber G. Health-related quality of life and its relationship to neurological outcome in child survivors of stroke. CNS Spectr. 2004 Jun;9(6):465-75.
Ghotra SK, Johnson JA, Qiu W, Newton AS, Rasmussen C, Yager JY. Health-related quality of life and its determinants in paediatric arterial ischaemic stroke survivors. Arch Dis Child. 2018 Oct;103(10):930-6.
Smith SE, Vargas G, Cucchiara AJ, Zelonis SJ, Beslow LA. Hemiparesis and epilepsy are associated with worse reported health status following unilateral stroke in children. Pediatr Neurol. 2015 Apr;52(4):428-34.
Traumatic Brain Injury-Specific References:
McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CN, Slomine BS, Dorsch AM, Berk RA, Christensen JR, Ding R; CHAT Study Group. The Pediatric Quality of Life Inventory: an evaluation of its reliability and validity for children with traumatic brain injury. Arch Phys Med Rehabil. 2005 Oct;86(10):1901-9.
McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CN, Slomine BS, Dorsch AM, Christensen JR, Ding R; Children's Health After Trauma Study Group. Health-related quality of life during the first year after traumatic brain injury. Arch Pediatr Adolesc Med. 2006 Mar;160(3):252-60.
Document last updated March 2024