Modification and Evaluation of a Velopharyngeal Insufficiency Quality-of-Life Instrument

Objectives: To modify the existing 45-item Velopharyngeal Insufficiency (VPI) Quality-of-Life (QOL) instrument (VPIQL), to assess the modified instrument for reliability, and to provide further validation. Design: Validation convenience sample from a previously conducted pilot study. Setting: Two academic tertiary referral medical centers. Participants: Deidentified data were used from 29 patients with VPI and 29 control patients aged 5 to 17 years and their parents. Main Outcome Measures: Patients and parents completed the VPIQL and a generic pediatric QOL instrument (Pediatric Quality of Life Inventory, Version 4 [PedsQL(4-0)]). Twenty-two items were removed from the VPIQL for ceiling effects, floor effects, and redundancy to produce the modified instrument: the VPI Effects on Life Outcomes instrument (VELO). The VELO was tested for internal consistency (Cronbach alpha), discriminant validity (paired t test with control patients), and concurrent validity (Pearson correlation with the PedsQL(4-0)). These analyses were also completed for the parents. Results: The 45-item VPIQL was reduced to the 23-item VELO, which had excellent internal consistency (Cronbach alpha, .96 for parents and .95 for patients with VPI). The VELO also discriminated well between the patients with VPI and the control patients, with a mean (SD) score that was significantly lower (worse) for patients with VPI (67.6 [23.9]) than for control patients (97.0 [5.2]) (P < .001). The VELO total score was significantly correlated with the PedsQL(4.0) (r = 0.73) among the patients with VPI. Similar results were seen in parent responses. Conclusions: The VELO is a 23-item QOL instrument that was designed to measure and follow QOL in patients with VPI, with less burden than the original VPIQL. The VELO demonstrates internal consistency, discriminant validity, and concurrent validity with the PedsQL(4-0).