Testing responsiveness to change for the early childhood oral health impact scale (ECOHIS)

Abstract

The Early Childhood Oral Health Impact Scale (ECOHIS) is a recently developed oral health-related quality of life instrument designed to assess the impact of oral health problems in 0-5-year-old children. It has previously been validated as discriminative instrument. The goal of this study was to investigate the responsiveness to change of the ECOHIS. Data were collected from a convenience sample of 101 parents of 0-5-year-old children attending a hospital dental clinic for dental treatment. The ECOHIS was completed by parents prior to dental treatment and 2 weeks later. Subjects were also asked a global transition judgement concerning change between the second and first completion of the ECOHIS instrument. Responsiveness to change of the ECOHIS was analysed through: (i) a comparison of ECOHIS change scores with a global transition judgment by study subjects; (ii) an assessment of the statistical significance of within-group change in scores over time for groups reporting improvement, stability and deterioration; (iii) an estimation of the ECOHIS's sensitivity; and (iv) an investigation the effect size of the ECOHIS. Of the 101 subjects recruited, 94 had full datasets. Their data were used for the analyses reported in this paper. Pre- and post-treatment distributions of ECOHIS scores were strongly distributed towards no oral health impacts. Among the 94 subjects, 51.1% reported improvement, 42.6% reported no change and 6.4% reported deterioration following treatment, using the global transition judgement. The mean ECOHIS change scores for these three groups were -0/9, +0.7 and +6.5 respectively, although none of the within-group changes were statistically significant. The effect size for those reporting improvement was small (0.15) but for those reporting deterioration was moderate-to-large (0.69). Sensitivity ranged from 0.61-0.79 depending on the size of the cut-off point, with a change of 3 points demonstrating the best sensitivity to false positive ratio (0.79 versus 0.41 respectively). In this sample with low levels of problems, the ECOHIS has demonstrated some limited ability to respond to change. Further work in a larger sample with higher levels of problems is needed to investigate the instrument's ability to respond to change when it has occurred.