Multilinguistic Validation of IMPACT-III Instrument to Assess Quality of Life of Indian Children with Inflammatory Bowel Disease.

OBJECTIVES

To validate the disease-specific quality of life (QoL) instrument for pediatric inflammatory bowel disease (PIBD) patients in three Indian languages (Hindi, Tamil and Bengali). Additionally, also to reveal the significant factors which effect QoL of PIBD patients in India.

METHODS

One hundred and two (102) PIBD patients (mean age 13 ± 2.59 y) across 6 centres were enrolled. Each child completed two questionnaires - the IMPACT-III and Paediatric Quality of Life Inventory Version 4.0 Generic Core Scale (PedsQL™) - in one of the three languages. A uniform clinico-demographic proforma was completed for each recruit to reveal factors which determine QoL. During analysis authors used Cronbach's alpha for internal consistency, principal component analysis for factor analysis, Spearman's correlation between the questionnaires for concurrent validity and ANOVA analysis between IMPACT-III health-related quality of life (HRQoL) scores and disease severity to establish discriminant validity.

RESULTS

A five-domain structure was most suitable: 'Concerns', 'Social acceptance', 'Mental disposition', 'Disease adjustment' & 'Self-confidence', with good internal reliability (Cronbach's α = 0.73-0.94). Concurrent and discriminant validity of the new questionnaire was also statistically significant (p < 0.001). Higher monthly family income led to better QoL scores in the 'Concerns' (p = 0.04) and 'Disease adjustment' (p = 0.03) domains while children with ulcerative colitis (UC) had better 'Social acceptance' scores than children with Crohn's disease (CD) (p = 0.02).

CONCLUSIONS

Modified IMPACT-III questionnaire with a five-domain structure demonstrated good validity and reliability for Indian population. 'Social acceptance' was higher in patients with ulcerative colitis. There is a favourable impact of higher family income on 'Concerns' and 'Disease adjustment' in PIBD.