An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2021-09, Vol.74 (9), p.2341-2348
• Main Authors: Klassen, Anne F, Rae, Charlene, Bulstrode, Neil W, Berenguer, Beatriz, Cui, Chunxiao, Fisher, David M., Kasrai, Leila, Li, Yiyuan, Lloyd, Mark, Panchapakesan, Vivek, Pusic, Andrea, Reinsch, John, Stewart, Ken, Todd, Anna, Frank, Ryan, Tsangaris, Elena, Wang, Yi, Wong Riff, Karen WY, Zhang, Ruhong, Cano, Stefan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aesthetic surgery; Child; Ear - abnormalities; Ear - surgery; Ear Diseases - psychology; Ear Diseases - surgery; Ear reconstruction; EAR-Q; Esthetics; Female; Humans; Male; Patient Reported Outcome Measures; Patient-reported outcomes; Plastic Surgery Procedures; Psychometrics; Quality of life; Questionnaire; Reproducibility of Results; Young Adult
• ISSN: 1748-6815; 1878-0539; 1878-0539
• DOI: 10.1016/j.bjps.2021.01.014

There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. The EAR-Q can be used in those 8–29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.