PAEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRE (PAQLQ)
The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) was developed to measure the functional problems (physical, emotional and social) that are most troublesome to children with asthma.
After identifying all the possible problems that children, between the ages of 7 and 17 years, may experience as a result of their asthma, we asked 100 children in this age group to tell us which of these problems they had experienced and to score each positively identified problem according to how troublesome it was. The items that were identified most frequently and scored highest were included in the PAQLQ.
The PAQLQ has 23 questions in 3 domains (symptoms, activity limitation and emotional function). The activity domain contains 3 ‘patient-specific’ questions. Children are asked to think about how they have been during the previous week and to respond to each of the 32 questions on a 7-point scale (7 = not bothered at all -
1 = extremely bothered). The overall PAQLQ score is the mean of all 23 responses and the individual domain scores are the means of the items in those domains.
The measurement properties and validity of the PAQLQ have been evaluated in several studies in different countries. It has strong measurement properties and good validity and a change in score greater than 0.5 on the
7-point scale can be considered clinically important. These studies have shown that children as young as 7 have no difficulties understanding the questions or the response choices and are able to give very accurate responses.
A large number of studies, both in asthma and other paediatric conditions, have shown that parents often have a very poor perception of the problems that their child experiences as a result of their illness. Therefore, it must always be the child who responds to the questions - never the parent or caregiver. In addition, we always ask parents to wait in another room. This prevents the child looking to the parent for guidance and it stops the parent telling the child how to respond or challenging the child’s own response. In addition, some children, for a wide range of reasons, do not want their parent to know about their problems.
All the words used in the PAQLQ are words that children themselves use to describe their problems. Therefore, understanding the questions is never a difficulty. In addition, we have never encountered any problems with children 7 years and older understanding the 7-point response scale. Only the recall time (one week) is sometimes difficult for younger children. The concept of time develops late and it is for this reason that the PAQLQ should not be used in children under 7 years old - very young children can tell you how they are now but do not recall accurately how they have been during the previous 7 days. Full instructions on how to administer the PAQLQ to younger children, including how to explain the response scale and check that the child understands the concept of ‘during the last week’, are included in our implementation manual.
Some 7 year old children with good reading and numeracy skills and an ability to concentrate can complete the PAQLQ on their own. In contrast, some 10 year old children give random responses. Usually, these older children have the ability to understand the questions and responses but they can not be bothered to concentrate (usually young boys who would much prefer to be out playing football!). Therefore, it is wise to use the interviewer-administered version of the PAQLQ in all children under 11 years of age. The self-administered version may be used in adolescents but some clinics and studies prefer to be consistent and use the interviewer-administered version in all children.
- Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in children with asthma. Qual Life Res 1996; 5: 35 -46.
- Guyatt GH, Juniper EF, Feeny DH, Griffith LE. Children and adult perceptions of childhood asthma. Pediatrics 1997; 99: 165-168.
- Juniper EF, Guyatt GH, Feeny DH, Griffith LE, Ferrie PJ. Minimum skills required by children to complete health-related quality of life instruments for asthma: comparison of measurement properties. Eur Respir J 1997; 10: 2285-2294.
English for North America
Paper: Interviewer-administered and self-administered
OBTAINING THE PAQLQ
Paediatric Asthma Quality of Life Questionnaire (PAQLQ) - original | Standardised Paediatric Asthma Quality of Life Questionnaire (PAQLQ(S)) | Mini Paediatric Asthma Quality of Life Questionnaire (MiniPAQLQ) | Paediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ)