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Validation of an Outcomes Instrument for Tonsil and Adenoid Disease
Michael G. Stewart, MD, MPH;
Ellen M. Friedman, MD;
Marcelle Sulek, MD;
Andrew deJong, MD;
Gregory F. Hulka, MD;
Marilyn H. Bautista, MPH;
Susan E. Anderson, RN
Arch Otolaryngol Head Neck Surg. 2001;127:29-35.
Objective To design and validate a disease-specific health status instrument—the
Tonsil and Adenoid Health Status Instrument—for use in children with
tonsil and adenoid disease.
Design Prospective psychometric and clinimetric instrument validation in 3
stages.
Settings A tertiary academic pediatric specialty hospital and a tertiary academic
hospital, in 2 different cities.
Patients/Other Participants Children with tonsil and adenoid disease presenting for evaluation and
treatment (n = 224).
Intervention/Method Prospective instrument validation. Stage 1 consisted of initial item
testing, reduction, and subscale construction; stage 2, reliability and validity
testing, factor analysis, and final item reduction; and stage 3, responsiveness
analysis.
Main Outcome Measures Test-retest and internal consistency reliability; content, construct,
and criterion validity; orthogonal principal components factor analysis; and
response sensitivity analysis.
Results Factor analysis and item analysis confirmed 6 distinct subscales measuring
different constructs (aspects) of disease-specific health status that are
affected by tonsil and adenoid disease: eating and swallowing, airway and
breathing, infections, health care utilization, cost of care, and behavior.
For each subscale, the Tonsil and Adenoid Health Status Instrument demonstrated
excellent test-retest reliability (r = 0.72-0.88)
and internal consistency reliability (Cronbach  = .73-.87). Content
validity was ensured during the design process. Construct validity was demonstrated
by means of convergent and divergent validity with a global quality-of-life
instrument (the Child Health Questionnaire, version PF28). Criterion validity
was also satisfactory. Finally, the instrument was appropriately sensitive,
with high standardized response means and effect sizes.
Conclusions The Tonsil and Adenoid Health Status Instrument is a valid, reliable,
and sensitive instrument with 6 distinct subscales. This instrument has significant
utility for outcomes research in children with tonsil and adenoid disease.
From the Bobby R. Alford Department of Otorhinolaryngology and Communicative
Sciences, Baylor College of Medicine, Houston, Tex (Drs Stewart, Friedman,
Sulek, and deJong and Ms Bautista), and the Division of Otolaryngology–Head
and Neck Surgery, Department of Surgery, Duke University School of Medicine,
Durham, NC (Dr Hulka and Ms Anderson).
Corresponding author and reprints: Michael G. Stewart, MD, MPH, Baylor
College of Medicine, One Baylor Plaza (NA-102), Houston, TX 77030 (e-mail: mgstew{at}bcm.tmc.edu).
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