Reliability and validation of a Brazilian version of the Oral Health Impact Profile for assessing edentulous subjects

The aims of this study were to evaluate the reliability and to validate a Brazilian version of Oral Health Impact Profile for assessing edentulous subjects (OHIP-EDENT), an inventory for measuring oral health-related quality of life of edentulous subjects. The sample comprised 65 complete denture wearers (23 men, mean age of 69.1 +/- 10.3 years). The translated OHIP-EDENT was applied on two occasions with a washout period of 3 months. Reliability was assessed by an internal consistency analysis and a test-retest approach. A preliminary validation process was conducted by a qualitative approach/interview. Results of internal consistency showed a Cronbach's alpha of 0.86 or 0.90 for the first or second appointment respectively. Through the test-retest analysis, an intra-class correlation coefficient of 0.57 was found, and individual answers reflected a broad range of agreement. Interviewed volunteers (n = 6) comprehended most questions well. In conclusion, the Brazilian version of OHIP-EDENT is adequate for assessing the oral health-related quality of life for edentulous subjects.     

Exploratory factor analysis of the Brazilian OHIP for edentulous subjects

Summary The use of seven domains for the Oral Health Impact Profile (OHIP)‐EDENT was not supported for its Brazilian version, making data interpretation in clinical settings difficult. Thus, the aim of this study was to assess patients’ responses for the translated OHIP‐EDENT in a group of edentulous subjects and to develop factor scales for application in future studies. Data from 103 conventional and implant‐retained complete denture wearers (36 men, mean age of 69·1 ± 10·3 years) were assessed using the Brazilian version of the OHIP‐EDENT. Oral health‐related quality of life domains were identified by factor analysis using principal component analysis as the extraction method, followed by varimax rotation. Factor analysis identified four factors that accounted for 63% of the 19 items total variance, named masticatory discomfort and disability (four items), psychological discomfort and disability (five items), social disability (five items) and oral pain and discomfort (five items). Four factors/domains of the Brazilian OHIP‐EDENT version represent patient‐important aspects of oral health‐related quality of life.     

Validation of a Hebrew version of the Oral Health Impact Profile 14

OBJECTIVE: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross-sectional study of a general dental practice in Israel. METHODS: The original English version of a short-form oral health impact profile (OHIP-14) was translated into Hebrew using the back-translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected. RESULTS: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP-14 were both 0.88. Cronbach's alpha of the translated OHIP-14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free. CONCLUSIONS: The Hebrew version of OHIP-14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.     

German short forms of the Oral Health Impact Profile

OBJECTIVES: We report the development and psychometric evaluation of short forms of the Oral Health Impact Profile German version (OHIP-G) - an instrument to assess oral health-related quality of life (OHRQoL). METHODS: A five-item short form was developed using best subset regression in 2050 subjects from a national survey. Two 14-item versions were derived from English-language short forms and a 21-item version from previous factor analytic work. A second sample from the general population (n = 163) and a sample of clinical patients with temporomandibular disorders (TMD; n = 175) were used to investigate validity and internal consistency. Test-retest reliability was evaluated in 30 prosthodontic patients before treatment. Responsiveness was assessed in 67 patients treated for their TMD pain. RESULTS: Associations between short form summary scores and self-report of oral health and four oral disorders in the general population and in TMD patients were interpreted as support for convergent/groups validity. The instruments' responsiveness (effect measures of 0.55-0.98), test-retest reliability (intraclass correlation coefficients: 0.72-0.87), and internal consistency (Cronbach's alpha: 0.65-0.92) were sufficient. CONCLUSIONS: Sufficient discriminative and evaluative psychometric properties of short forms of the OHIP-G make the instruments suitable to assess OHRQoL in cross-sectional as well as longitudinal studies.     

Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form

OBJECTIVE: The aim of the study is to evaluate the measurement properties of the Brazilian version of the short form of the Oral Health Impact Profile (OHIP14). METHODS: Data were obtained from a cross-sectional study designed to assess the impact of toothache on quality of life during pregnancy. The sample consisted of 504 postpartum women (mean age 24 years; SD 6.2), most of whom had unsolved dental problems and belonged to low-income families. The questionnaire was administered in the form of interviews by two trained interviewers who also performed clinical examinations. Reliability was assessed in terms of internal consistency and stability. Construct validity was evaluated based on comparison of the total scores among groups according to: self-perceived and normative oral health care needs, self-perceived general and oral health status, presence of carious lesions and tooth loss. It was also hypothesized that the scores of OHIP14 and Oral Impacts on Daily Performances (OIDP) would correlate with each other. RESULTS: Both test-retest stability and internal consistency, as measured by the intra-class correlation coefficient (0.87) and by Cronbach's alpha (0.91), proved to be adequate. Construct validity was confirmed as the correlation between OHIP14 scores with self-perceived general and oral health were in the expected direction, and the differences in scores of the groups formed according to the selected attributes were significant at values of P < or = 0.05 (Mann-Whitney test). Moreover, the correlation coefficient between OIDP and OHIP14 was 0.76 (rs). CONCLUSION: The Brazilian version of OHIP14 has good psychometric properties, which are similar to those of the original instrument.     

The Hungarian version of the Oral Health Impact Profile

Oral health-related quality of life (OHRQoL) is increasingly of interest in dentistry. The current internationally accepted instruments used to measure OHRQoL need to be cross-culturally adapted for use in other cultural environments. It was the aim of the present study to develop a Hungarian version of the Oral Health Impact Profile (OHIP-H) following accepted guidelines. The original English-language version was translated into Hungarian, back-translated into English, and tested for its psychometric properties. Construct validity was tested on 144 prosthodontic patients and 200 randomly selected subjects. A priori hypothesized associations between OHIP summary scores and self-reported oral health and six self-reported oral conditions were investigated. The pattern of the observed associations supported the new instrument's construct validity. Responsiveness tested in 28 oral surgery patients was indicated by a statistically significant mean OHIP score change from 39.2 to 23.0. Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.81-0.90 for OHIP summary scores and subscales in 31 prosthodontic patients. Cronbach's alpha values between 0.71 and 0.96 proved to have high internal consistency. Adequate psychometric properties in typical patient populations make the new instrument suitable for assessment of OHRQoL in Hungary.     

中文版口腔健康影响程度量表（OHIP-49）的研制

目的：中文版口腔健康影响程度量表（OHIP-49）的翻译及验证研究。方法：按国际标准程序,对英文原版口腔健康影响程度量表（OHIP-49）进行翻译、回译及跨文化适应过程,形成中文版OHIP-49。使用该量表和自评口腔健康状况调查表,对随机抽取的患有不同口腔疾病的患者和社区居民进行口腔健康相关生活质量调查,考评量表的信度和效度。结果：发放问卷360分,回收有效量表333份。OHIP-49各维度及量表总得分的内部一致性Cronbach＇sα系数为0.79～0.96,重测系数为0.83～0.97;量表得分与自评口腔健康呈显著正相关（P〈0.001）;量表各维度及总得分在不同自我评价治疗需要的人群中有显著差异。结论：OHIP-49中文版具有良好的信度、效度,适合在中国人群中应用。     

Japanese version of the Oral Health Impact Profile (OHIP-J)

The objective of the study was to develop a Japanese version of the Oral Health Impact Profile (OHIP). The original 49 items were translated using a forward-backward method following accepted cultural adaptation guidelines. A de novo development of Japanese items was conducted to establish content validity. The associations between the OHIP summary score and self-reported oral health (n = 220) and self-reported denture quality (n = 155) were investigated for construct validity. The association between the OHIP summary score and six oral conditions (n = 227) were also tested. The responsiveness of the instrument was established by comparing the score before and after using newly fabricated removable partial dentures (n = 30). The test-retest reliability (n = 37) and internal consistency (n = 251) were also calculated. After the de novo development, five new items were added to the OHIP. The priori hypothesized associations between the OHIP score and oral health conditions were confirmed (P < 0.001). The change in the OHIP scores from 63.6 to 40.6 (P < 0.001) supports the responsiveness of the instrument. Intra-class correlation coefficients of 0.81 and Cronbach's alpha of 0.98 indicate high test-retest reliability and internal consistency of the instrument's summary score. Sufficient discriminative and evaluative psychometric properties of the currently developed Japanese version of the OHIP in typical target populations make the instrument suitable for assessing the oral health-related quality of life in cross-sectional as well as longitudinal studies.     

Derivation and validation of the short version of the Malaysian Oral Health Impact Profile

OBJECTIVES: This paper describes the development of a short version of the Malaysian Oral Health Impact Profile. METHODS: The 45-item OHIP(M) was shortened using a method known as the 'item frequency method'. Here, the two most frequently reported items from each of the seven OHIP(M) subscales were chosen to form the short version, designated as the S-OHIP(M). Field testing was conducted to assess the effect of different modes of administration (mail versus interview) of the short form and to test its measurement properties (reliability and validity). A total of 206 respondents completed the questionnaire. In order to carry out test-retest analysis, a second administration was carried out 15 days after the first administration on a selected subsample. RESULTS: The mail questionnaire had a lower response rate and a higher percentage of missing data than the interview administered questionnaire. However, the mail mode of administration resulted in higher scores than interview. Cronbach's alpha was 0.89 and the ICC was also 0.89. All hypotheses developed to assess validity were confirmed. CONCLUSION: The S-OHIP(M) was found to be valid and reliable and appropriate for use in the cross-sectional studies in Malaysian adult populations.     

Validation of a Chinese version of the Oral Health Impact Profile (OHIP)

OBJECTIVES: To translate the original English version of Oral Health Impact Profile (OHIP) into a Chinese version, to validate the translated instrument for use among the elderly in Hong Kong and to derive a Chinese short-form OHIP. METHODS: The original English version of OHIP was translated into Chinese. Elderly persons aged 60-80 years were interviewed by two trained interviewers and examined clinically by one of two calibrated dentists. Information on subjects' demographic background and oral health conditions were collected. RESULTS: A total of 586 elderly persons were interviewed and clinically examined. Cronbach's alpha of the translated OHIP subscales ranged from 0.69 to 0.84 and the test-retest correlation coefficient ranged from 0.72 to 0.92. Construct validity of the translated Chinese version was supported by the finding that the OHIP-49 and subscale scores increased as the subject's perceived oral health status changed from healthy to unhealthy. Also, those who had a perceived dental treatment need had higher mean OHIP-49 and subscale scores compared to those who did not. The short-form OHIP derived in this study demonstrated comparable validity and reliability with the full version of OHIP. CONCLUSION: The translated Chinese version of OHIP demonstrated good validity and reliability. It is available for use by researchers in oral health-related quality of life studies in Chinese elderly populations. In situations where a Chinese short-form of OHIP is desirable, there are now two validated Chinese versions for researchers to choose.     

General population norms of the Swedish short forms of Oral Health Impact Profile

We reported the development and psychometric evaluation of a Swedish 14‐item and a five‐item short form of the Oral Health Impact Profile. The 14‐item version was derived from the English‐language short form developed by Slade in1997. The five‐item version was derived from the German‐language short form developed by John et al. in 2006. Validity, reliability and normative values for the two short form summary scores were determined in a random sample of the adult Swedish population (response rate: 46%, N = 1366 subjects). Subjects with sufficient OHRQoL information to calculate a summary score (N = 1309) were on average 50·1 ± 17·4 years old, and 54% were women. Short form summary scores correlated highly with the 49‐item OHIP‐S (r ≥ 0·97 for OHIP‐S14, r ≥ 0·92 for OHIP‐S5) and with self‐report of oral health (r ≥ 0·41). Reliability, measured with Cronbach's alpha (0·91 for OHIP‐S14, 0·77 for OHIP‐S5), was sufficient. In the general population, 50% of the subjects had ≥2 OHIP‐S14 score points and 10% had ≥11 points, respectively. Among subjects with their own teeth only and/or fixed dental prostheses and with partial removable dental prostheses, 50% of the population had ≥2 OHIP‐S14 score points, and 10% had ≥11 points. For subjects with complete dentures, the corresponding figures were 3 and 24 points. OHIP‐S5 medians for subjects in the three population groups were 1, 1 and 2 points. Swedish 14‐item and 5‐item short forms of the OHIP have sufficient psychometric properties and provide a detailed overview about impaired OHRQoL in Sweden. The norms will serve as reference values for future studies.     

Confirmatory factor analysis of the Child Oral Health Impact Profile (Korean version)

Empirical support for the factor structure of the Child Oral Health Impact Profile (COHIP) has not been fully established. The purposes of this study were to evaluate the factor structure of the Korean version of the COHIP (COHIP‐K) empirically using confirmatory factor analysis (CFA) based on the theoretical framework and then to assess whether any of the factors in the structure could be grouped into a simpler single second‐order factor. Data were collected through self‐reported COHIP‐K responses from a representative community sample of 2,236 Korean children, 8–15 yr of age. Because a large inter‐factor correlation of 0.92 was estimated in the original five‐factor structure, the two strongly correlated factors were combined into one factor, resulting in a four‐factor structure. The revised four‐factor model showed a reasonable fit with appropriate inter‐factor correlations. Additionally, the second‐order model with four sub‐factors was reasonable with sufficient fit and showed equal fit to the revised four‐factor model. A cross‐validation procedure confirmed the appropriateness of the findings. Our analysis empirically supported a four‐factor structure of COHIP‐K, a summarized second‐order model, and the use of an integrated summary COHIP score.     

Effect of reducing the number of items of the Oral Health Impact Profile on responsiveness, validity and reliability in edentulous populations

Abstract – Background: The 49‐item Oral Health Impact Profile (OHIP) has shown strong responsiveness, reliability and validity. However, the large number of items included may limit its use in clinical trials, clinical practice and surveys. Objective: The main objective of this study is to assess the effect of reducing the number of items in each domain, one at a time, on responsiveness, reliability and validity of the OHIP in edentulous populations. Materials and methods: Data used in this study were obtained from two randomized clinical trials comparing mandibular implant overdentures and conventional dentures among 102 subjects between 35 and 65 years of age, and 60 subjects over the age of 65 years. Participants were edentulous individuals who wished to replace their current prostheses. Subjects in both trials were asked to complete the 49‐item OHIP prior to treatment and at 2 months post‐treatment. Within the study, effect sizes were computed at each stage of item reduction using the impact method. Intraclass correlation coefficients and Pearson's correlation coefficients were also assessed at each stage of item reduction. In addition, receiver‐operating characteristic (ROC) curves were used to indicate the accuracy with which measurement changes corresponded to judgements of important changes in Oral Health Related Quality of Life (OHRQL). Results: The results indicated that, in general, domain responsiveness was not affected by the reduction of the number of items used per domain. However, there was a decrease in reliability, especially within the ‘psychological’ and ‘social’ disabilities and ‘handicap’ domains (35‐ to 65‐year group). In addition, there was a decrease in construct validity of the ‘physical pain’, ‘psychological’ and ‘social disabilities’ domains (35‐ to 65‐year group), as well as on ‘physical pain’, ‘psychological discomfort’, ‘physical’ and ‘psychological’ disabilities in the 65‐year and older group. This occurred primarily, when reducing from two to one item per domain. Among the 35‐ to 65‐year group, there were consistencies in patients’ ratings of the importance of similarly measured changes in oral health. Conclusion: The results indicate that although the 49‐item OHIP responsiveness could be maintained with item reduction, this will lead to compromises in reliability and validity.     

Instrument-order effects: using the Oral Health Impact Profile 49 and the Short Form 12

Whereas it is well known that the ordering of items can influence research outcomes considerably, very little literature addresses instrument-order effects. Therefore, the aim of this study was to evaluate the effect of changing the administrative order of the Short-Form-12 (SF-12) and the Oral Health Impact Profile-49 (OHIP-49). It was hypothesized that if the SF-12 was administered first, the results would show poorer scores on the SF-12 subscales, as responses would not be restrained to only the oral impacts described by the OHIP-49. Using the Mann-Whitney U-test no significant instrument-order effects were found, except for the Psychological discomfort scale of the OHIP-49, where subjects scored higher when receiving the OHIP-49 first. However, the effect size was negligible (-0.08). These results suggest that no instrument-order effects occurred. Nonetheless, more research dealing with different instruments is needed. This study was performed within a dental setting and we recommend that instrument-order effects should be studied outside this domain.     

Feasibility of oral health-related quality of life assessment in prosthodontic patients using abbreviated Oral Health Impact Profile questionnaires

Summary  To report about the feasibility of oral health-related quality of life assessment using two short forms of the Oral Health Impact Profile – OHIP-J14 and OHIP-J5 – in prosthodontic patients. Using the item pool of the Japanese version of the OHIP, two short forms based on a 14-item English-language version and a 5-item German-language questionnaire were derived. To test construct validity, the associations between summary scores of two short versions and self-reported oral health and self-reported denture quality have been investigated. Responsiveness was tested in 30 patients treated for their removable partial denture. Test–retest reliability using a time interval of 2 weeks and internal consistency were also tested. Associations between the two short form summary scores and self-reported oral health and denture quality supported construct validity of the instruments. Acceptable reliability for OHIP-J14 and OHIP-J5 was indicated by intra-class correlation coefficients of 0·73 and 0·75 (test–retest reliability) and CRONBACH'S alpha of 0·94 and 0·81 (internal consistency) respectively. Responsiveness was sufficient for OHIP-J14 and OHIP-J5 indicated by 'medium' effect sizes (0·50 and 0·57 respectively). In addition to sufficient discriminative psychometric properties, the ability to measure change of perceived oral health make OHIP-J14 and OHIP-J5 suitable for outcomes research.     

The mandarin Chinese shortened version of Oral Health Impact Profile for partially edentate patients with implant-supported prostheses

This study was to validate a mandarin Chinese version of Oral Health Impact Profile (OHIP-49) in China and to develop a shortened version of OHIP appropriate for use in partially dentate patients with implant-supported prostheses. The original 49 items of OHIP were translated into mandarin Chinese using a forward-backward method and administered to 580 subjects selected by stratified random sampling. Self-perceived oral health status and treatment need were also collected. Reliability and validity of the Chinese version of OHIP (OHIP-C49) were validated. A shortened version (OHIP-I) was derived from the OHIP-C49 by exploratory factor analysis (EFA) as well as expert-based approach in partially dentate patients (n=102) with implant-supported prostheses. For validation of the new modified shortened version, another independent sample of 97 partially dentate patients completed OHIP-I and their self-perceived oral health status at baseline and at least 3 months after dental implant rehabilitation. Five hundred and thirty-seven effectual questionnaires were reclaimed from the 580 subjects interviewed. Cronbach's alpha ranged from 0.78 to 0.96 and test-retest correlation coefficients ranged from 0.84 to 0.97 for subscale and summary scores. Construct validity was demonstrated by priori hypothesised associations between the OHIP-C49 scores and self-perceived oral health (P<0.001). The reliability and validity of OHIP-I were similar to which of the OHIP-C49, and the responsiveness appeared able to measure the effect of dental implant therapy effectively. The mandarin version of OHIP-49 showed sufficient psychometric properties for Chinese. The modified shortened version (OHIP-I) may be appropriate for the evaluation of implant therapy outcomes in partially dentate Chinese patients.     

The German version of the Oral Health Impact Profile--translation and psychometric properties

The need for cross-culturally adapted oral-health specific health outcome measures is increasingly recognized in Germany. Following accepted cultural adaptation technique guidelines, we report the development of the German version of the Oral Health Impact Profile (OHIP). The original 49 items were translated using a forward-backward method. A de novo development of German items established content validity. A priori hypothesized associations between the OHIP summary score and self-reported oral health and five oral disorders were confirmed in a random sample of the general population (n = 163, age 20-60 yr). These associations were interpreted as support for construct validity. The instrument's responsiveness, as indicated by a mean OHIP summary score change from 45.0 to 28.3, was established in 67 consecutive patients treated for temporomandibular disorder pain (age 19-85 yr; 72% women). Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.63-0.92 for dimensions and summary scores (convenience sample, n = 30, age 18-85 yr; 53% women). Internal consistency was high (Cronbach's alpha > 0.74). Sufficient discriminative and evaluative psychometric properties of the Oral Health Impact Profile German version (OHIP-G) make the instrument suitable for assessment of oral health-related quality of life in cross-sectional as well as longitudinal studies.     

An assessment of sensitivity to change of the Oral Health Impact Profile in a clinical trial

Patient-based assessment of oral health outcomes is of growing interest. Measurement of change following clinical intervention is a key property of a health status measure. To date, most of the research on oral health status measurement has focused on construct and discriminant validity of health status measures. OBJECTIVES: The objective of this study was to assess sensitivity to change of an oral-specific health status measure, the Oral Health Impact Profile (OHIP). METHODS: Study subjects were in three groups, namely, edentulous/edentate subjects who requested and received complete implant stabilised oral prostheses (IG, n=26), edentulous/edentate subjects who requested implants but received conventional dentures (CDG1, n=22), and edentulous subjects who had new conventional complete dentures (CDG2, n=35). Data were collected pre- and post-operatively using the OHIP and a validated denture satisfaction questionnaire. RESULTS: All subjects reported similar low levels of denture satisfaction pre-operatively. Denture problems had a more significant impact on oral health-related quality of life (OHRQL) for implant seekers (IG and CDG1 subjects) than subjects seeking conventional dentures (CDG2). Following treatment, significant improvement in satisfaction with oral prostheses and OHRQL was reported by IG and CDG2 subjects; the level of improvement was more moderate for CDG1 subjects. OHIP change scores were correlated with denture satisfaction change scores. CONCLUSIONS: It was concluded that sensitivity to change of the OHIP was good. This property was not improved by using statement weights.     

Exploratory factor analysis of the Oral Health Impact Profile

Although oral health‐related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Learning Sample (n = 5173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5146 subjects with sufficiently complete data. The first eigenvalue (27·0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2·6), suggesting the presence of a dominant, higher‐order general factor. Follow‐up analyses with Horn's parallel analysis revealed a viable second‐order, four‐factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP.