| Abstract | Cilj ovog istraživanja bio je ispitati valjanost, pouzdanost i prikladnost Upitnika
roditeljske/starateljske percepcije (P-CPQ) i Ljestvice obiteljskih utjecaja (FIS), a zatim istražiti
odrednice utjecaja oralnog stanja na obitelj te ulogu obitelji u oblikovanju zahtjeva za
liječenjem i uspjehu ortodontske terapije. U dio istraživanja u kojem je ispitivana valjanost
psiholoških instrumenata uključeno je 334 ispitanika, za pouzdanost 26, a prikladnost 46
ispitanika. Za ispitivanje odrednica zahtjeva za liječenjem uključen je 221 par roditelj-dijete,
dok je 88 ispitanika s malokluzijom klase II/1 sudjelovalo u istraživanju odrednica uspjeha
ortodontskog liječenja mobilnim funkcionalnim napravama (twin-blokom i Sanderovim
dvojnim pločama) u razdoblju od godine dana. Djeca uključena u ovo istraživanje bila su u dobi
od 11 do 14 godina, s iznimkom uzorka za ispitivanje prikladnosti i odrednica uspjeha
ortodontske terapije koje je uključilo mlađe adolescente u starosti od 11 do 13 godina. Mlađi
adolescenti samostalno su ispunili Upitnik percepcije djece (CPQ), a njihovi roditelji P-CPQ i
FIS. Procijenjen je objektivni stupanj malokluzije te zahvaćenost denticije karijesom. Rezultati
ove studije pokazali su da su P-CPQ i FIS pogodni za korištenje u hrvatskom kulturalnom
kontekstu – dok se u podlozi P-CPQ nalaze četiri faktora (pouzdanosti α=0,66-0,88), FIS
pokazuje jednofaktorsku strukturu (α=0,81). Slaganje roditelja i djece oko djetetova zahtjeva
za liječenjem postojalo je u 67,4% slučajeva. Utjecaj na obitelj bio je značajniji kod djece s
izraženijim malokluzijama i prisutnim karijesom, što primarno uključuje roditeljske aktivnosti
i emocije (p<0,05). Značajnije odrednice utjecaja na obitelj bile su roditeljska percepcija
djetetovih emocija, oralnih simptoma i društvenih odnosa (p<0,001). Samoprocjena narušenosti
emocionalnog blagostanja adolescenata najznačajnija je odrednica njihova zahtjeva za
liječenjem (p=0,049). Niska ograničenja funkcije djeteta koje primijeti roditelj povećava izgled
za uspjehom terapije 3,3 puta (95% interval pouzdanosti (CI) 1,2-9,0; p=0,020), a isto toliko i
terapijska opcija twin-blokom u odnosu na Sanderove dvojne ploče (95% CI 1,2-8,6; p=0,016).
Zaključno, uloga obitelji u ortodontskom liječenju mlađih adolescenata nije velika. Roditelji
nisu sposobni adekvatno procijeniti djetetov zahtjev za liječenjem i imaju slab utjecaj na taj
zahtjev, no terapija je uspješnija kada roditelj inicijalno navede da primjećuje da dijete ima
manje ograničene oralne funkcije. |
| Abstract (english) | Aim: The aim of this study was to perform the Croatian translation of the Parental-Caregiver
Perception Questionnaire (P-CPQ), Family Impact Scale (FIS) and their short forms, and to
analyze their psychometric properties for the Croatian population. Only valid questionnaires
could then enable the following goals: (1) to define the predictors of family impacts, (2) to
assess the levels of agreement between parents and adolescents about young adolescents'
orthodontic treatment demand, (3) to evaluate to what extent was the treatment demand under
the influence of family and psychosocial impacts as well as oral function and (4) to determine
factors that could be classified as the predictors of treatment success (including the assessment
of the impact of the family on cooperation) during treatment of Class II/1 malocclusion with
removable functional appliances.
Materials and methods: A forward-backward translation of the P-CPQ and FIS was made as
a first step in the testing of psychometric properties of the Croatian instruments, which was then
followed by a validation study of the previously mentioned questionnaires. The sample size that
was obtained to assess the validity and internal reliability of the measures equaled 334
participants (children aged 11-14 years; 53% female and their parents). For the assessment of
test-retest reliability, 26 participants were included in the study, while 46 participated in the
testing of responsiveness of the measures. For the part where the agreement between
adolescents and parents on the orthodontic treatment demand of adolescents was evaluated, and
for the assessment of predictors of orthodontic treatment demand in young adolescents, a
sample size of 221 subjects (dyads of children (11-14 years; 54% female) and their parents)
was used. A sample of 88 participants (aged 11-13; 47% female) who presented with a Class II
division 1 malocclusion with a distal molar relationship, overjet equal or greater than 6
millimeters, and confirmed pubertal growth spurt were included in a randomized controlled
trial meant to evaluate possible predictors of orthodontic treatment success of young
adolescents. Patients were treated with removable functional appliances (50% twin-block, 50%
Sander bite jumping appliance) with built-in maxillary expansion screws. The follow-up period
was 1 year. The CPQ, P-CPQ and FIS were self-administrated to assess emotional well-being
(EW), social well-being (SW), oral symptoms (OS), functional limitations (FL), parental
emotions (PE), family activities (FA), family conflicts (FC), and financial burden (FB).
Participants additionally responded to questions related to self-perceived oral health, well-
being, satisfaction with appearance, treatment need and treatment demand on a five-point
Likert-type scale. Malocclusion severity was assessed using the Index of Orthodontic
Treatment Need Dental Health Component (IOTN DHC), while caries severity was assessed
using the Decayed, Missing, Filled Teeth Index (DMFT). Sex and overjet were also recorded.
Exploratory and confirmatory factor analysis, Pearson correlation, Cronbach alpha coefficient,
inter-item correlation, intraclass correlation coefficient, Cohen's kappa coefficient, MannWhitney, Wilcoxon, Fisher, Kruskal Wallis test, linear and logistic regression and discriminant
analysis were used in the statistical analysis.
Results: Exploratory factor analysis of the P-CPQ initially indicated an eight-factor structure
with interference of all original dimensions. However, when the analysis was fixed to four
factors, it indicated a mixing of the EW and SW subscales as well as the OS and FL subscales.
Additionally, a two-factor model was also evaluated, but overall, the four-factor structure was
found to be more appropriate for the Croatian population than the two-factor structure
explaining 52.5% of variability. Confirmatory factor analysis confirmed the findings of
exploratory factor analysis. The instrument moderately correlated with all dimensions of oral
health related quality of life (OHRQoL) reported by children (r=0.345-0.506; p<0.001). Higher
P-CPQ scores in all subscales were detected in subjects with caries lesions, while only EW and
SW scores differed between participants with low and high malocclusion severity. Internal
consistency of original four factors ranged α=0.66-0.89. All subscales of the overall measure
were stable over time, while the temporal stability results for the 16- and 8-item P-CPQ were
not satisfactory. The questionnaire showed adequate responsiveness to change as a consequence
of Class II/1 treatment with removable functional appliances, mostly in the EW domain. Short
forms of P-CPQ (16 and 8-items) had lower psychometric properties than long form instrument.
On the other hand, the exploratory factor analysis of the FIS with 14 items showed a four-factor
structure of the instrument with mixing of all original dimensions – PE, PA, FC and FB,
accounting for 56% of variance. FIS correlated greatly with parental reporting of impaired EW
and SW of their children (r=0.656-0.694; p<0.001) and the overall P-CPQ (r=0.716-0.736;
p<0.001). Higher family impacts were detected in young adolescents affected with caries
lesions and severe malocclusions, mostly PE and PA (p<0.05). The Cronbach alpha values of
the unidimensional FIS and 8-item short-form FIS were found to be better (α=0.81 and 0.73)
compared to the individual dimensions (α=0.60-0.69). Repeatability of family impact reporting
was good for the summary FIS scale, PA and PE subscales. The questionnaire was responsive
to change that happened as a consequence of Class II/1 treatment, mostly in the PE domain.
According to the linear regression analysis, parental perception of child's emotional state, OS,
and social relationships were significant predictors of family impacts (p<0.001). The agreement
between parents and their children on young adolescents’ orthodontic treatment demand was
weak, concording in 67.4% of cases. The most common reasons why adolescents demanded
orthodontic treatment came from a psychosocial background for both informants. In linear
regression, the adolescent's reporting of an impaired EW and an objective treatment need were
the only significant linear predictors of the orthodontic treatment demand. There were more
patients with successful than unsuccessful result (58% vs. 42%). Low functional limitations of
the child as noted by the parent before starting the treatment increased the odds of the treatment
success 3.3 times (95% CI 1.2-9.0; p=0.020), as did the twin-block appliance compared to the
Sander bite jumping appliance (95 % CI 1.2-8.6; p=0.016).
Conclusion: Among the evaluated questionnaires, the four-factor structure of the P-CPQ
showed the best metric properties, while the one-dimensional FIS instrument had better
properties for orthodontic scenarios compared to other questionnaire forms. Overall, the role of
family in orthodontic treatment of young adolescents was not big. Parents were not able to
properly assess the demand for orthodontic treatment of their children and had little influence
on that request. However, parents did play a role in the treatment success as the treatment was
considered to be more successful in those patients whose parents perceived a low impairment
of oral function, as well as in those treated with the twin block appliance. |
