Author's reply
http://www.100md.com
《美国医学杂志》
1 Department of Pediatrics,Post Graduate Institute of Medical Educationand Research, Chandigarh-160012, India
2 Department of Pediatrics Post Graduate Institute of Medical Education and Research Chandigarh-160012, India
We thank Drs. Gupta and Matoo for their comments on our recently published paper1 and for providing us an opportunity to clarify the methodological and interpretative issues related to the article.
First, we have used a parent-reported proxy measure of quality of life in children with epilepsy, rather than a child-reported measure as suggested by the authors because of our concern that many Indian children may not be able to provide the required information, or due to their young age give unreliable responses. The age range of the sample in the study was 4 to 15 yrs, and it is possible that many children may not have been able to respond to the questionnaire. It is important to recognize that parents are reliable informants of child's health-related quality of life as they take a crucial role in medical decision-making by defining what they believe to be the most appropriate treatment for their children. Since primary care physicians need parental guidance regarding the health status of their children, validity of parent proxy assessment of children's quality of life assume additional significance. Moreover, several authors have emphasized that parent proxy reports are more reliable and, especially in lonitudinal studies, because of normal developmental changes in children's attitudes and cognitive abilities may nullify children's earlier reports of health status.[2],[3] However, both parent and child reported scales are useful and can provide valid information about quality of life of children.[4] Interestingly, the authors themselves acknowledge this in their comments.
Secondly, we have selected four seizure-related variables including age at onset of seizures, frequency of seizures, duration of treatment, and number of antiepileptic drugs received for analysis in the study. These variables were selected on the basis of previous research[5],[6] and also because data on these variables could be quantified and reliably obtained from the caregivers.
Finally, most studies on clinical samples are small sample studies[7],[8] and problems of small sample size are a concern for most studies. We have included variables with non-significant correlations with the predicted variable in the multiple regresion analysis, because some of these variables may sometimes emerge as significant predictors.
In a nutshell, epilepsy is a common childhood neurological disorder with many co-morbid features. It is today increasingly being recognized that, besides aiming at seizure control with minimal adverse effect, the professionals should also attend to the impact that epilepsy has on the well-being and quanlity of life of children.
References
1. Malhi P, Singhi, P. Correlates of quality of life with epilepsy. Indian J Pediatr 2005; 72 : 131-135.
2. Eiser C, Morse R. A review of measures of quality of life for children with chronic illnesses. Arch Dis Child 2001; 84 : 205-211.
3. Le Coq EM, Boecke AJP, Bezemer. Which source should we use to measure quality of life in children with asthma : The children themselves or their parents Comparing the psychometric properties of a child-and a parent-report scale. Qual Life Res 2000; 9 : 625-636.
4. Ronen GM, Streiner DL, Rosenbaum, Canadian Pediatric Epilepsy Network. Health-related quality of life in children with epilepsy: Development and validation of self report and parent proxy measures. Epilepsia 2003; 44 : 598-612.
5. Austin JK, Risinger MW, Beckett LA. Correlates of behaviour problems in children with epilepsy. Epilepsia 1992; 33 : 1115-1122.
6. Austin JK, Smith MS, Risinger MW, McNelis AM. Childhood epilepsy and asthma: comparison of quality of life. Epilepsia 1994; 35 : 608-615.
7. Miller V, Palermo TM, Grewe SD. Quality of life in pediatric epilepsy : Demographic and disease related predictors and comparison with healthy controls. Epilepsy Behavior 2003;4 : 36-42.
8. Sherman EMS, Slick DJ, Connolly, MB, Steinbok P, Camfield C, Eyrl KL, Massey C, Farrell K. Validity of three measures of health related quality of life in children with intractable epilepsia. Epilepsia 2002; 43 : 1230-1238.(Malhi Prahbhjot, Singhi P)
2 Department of Pediatrics Post Graduate Institute of Medical Education and Research Chandigarh-160012, India
We thank Drs. Gupta and Matoo for their comments on our recently published paper1 and for providing us an opportunity to clarify the methodological and interpretative issues related to the article.
First, we have used a parent-reported proxy measure of quality of life in children with epilepsy, rather than a child-reported measure as suggested by the authors because of our concern that many Indian children may not be able to provide the required information, or due to their young age give unreliable responses. The age range of the sample in the study was 4 to 15 yrs, and it is possible that many children may not have been able to respond to the questionnaire. It is important to recognize that parents are reliable informants of child's health-related quality of life as they take a crucial role in medical decision-making by defining what they believe to be the most appropriate treatment for their children. Since primary care physicians need parental guidance regarding the health status of their children, validity of parent proxy assessment of children's quality of life assume additional significance. Moreover, several authors have emphasized that parent proxy reports are more reliable and, especially in lonitudinal studies, because of normal developmental changes in children's attitudes and cognitive abilities may nullify children's earlier reports of health status.[2],[3] However, both parent and child reported scales are useful and can provide valid information about quality of life of children.[4] Interestingly, the authors themselves acknowledge this in their comments.
Secondly, we have selected four seizure-related variables including age at onset of seizures, frequency of seizures, duration of treatment, and number of antiepileptic drugs received for analysis in the study. These variables were selected on the basis of previous research[5],[6] and also because data on these variables could be quantified and reliably obtained from the caregivers.
Finally, most studies on clinical samples are small sample studies[7],[8] and problems of small sample size are a concern for most studies. We have included variables with non-significant correlations with the predicted variable in the multiple regresion analysis, because some of these variables may sometimes emerge as significant predictors.
In a nutshell, epilepsy is a common childhood neurological disorder with many co-morbid features. It is today increasingly being recognized that, besides aiming at seizure control with minimal adverse effect, the professionals should also attend to the impact that epilepsy has on the well-being and quanlity of life of children.
References
1. Malhi P, Singhi, P. Correlates of quality of life with epilepsy. Indian J Pediatr 2005; 72 : 131-135.
2. Eiser C, Morse R. A review of measures of quality of life for children with chronic illnesses. Arch Dis Child 2001; 84 : 205-211.
3. Le Coq EM, Boecke AJP, Bezemer. Which source should we use to measure quality of life in children with asthma : The children themselves or their parents Comparing the psychometric properties of a child-and a parent-report scale. Qual Life Res 2000; 9 : 625-636.
4. Ronen GM, Streiner DL, Rosenbaum, Canadian Pediatric Epilepsy Network. Health-related quality of life in children with epilepsy: Development and validation of self report and parent proxy measures. Epilepsia 2003; 44 : 598-612.
5. Austin JK, Risinger MW, Beckett LA. Correlates of behaviour problems in children with epilepsy. Epilepsia 1992; 33 : 1115-1122.
6. Austin JK, Smith MS, Risinger MW, McNelis AM. Childhood epilepsy and asthma: comparison of quality of life. Epilepsia 1994; 35 : 608-615.
7. Miller V, Palermo TM, Grewe SD. Quality of life in pediatric epilepsy : Demographic and disease related predictors and comparison with healthy controls. Epilepsy Behavior 2003;4 : 36-42.
8. Sherman EMS, Slick DJ, Connolly, MB, Steinbok P, Camfield C, Eyrl KL, Massey C, Farrell K. Validity of three measures of health related quality of life in children with intractable epilepsia. Epilepsia 2002; 43 : 1230-1238.(Malhi Prahbhjot, Singhi P)