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Development of six PROMIS pediatrics proxy-report item banks

Debra E Irwin1*, Heather E Gross8, Brian D Stucky2, David Thissen2, Esi Morgan DeWitt3, Jin Shei Lai4, Dagmar Amtmann5, Leyla Khastou5, James W Varni6 and Darren A DeWalt7

Author Affiliations

1 Department of Epidemiology, University of North Carolina at Chapel Hill, CB #7295 Chapel Hill, NC, USA 27599

2 Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

3 Department of Pediatrics, Division of Rheumatology, James M. Anderson Center for Health Systems Excellence, Cincinnati children's Hospital and Medical Center, Cincinnati, OH, USA

4 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

5 Center on Outcomes Research in Rehabilitation, University of Washington, Seattle, WA, USA

6 Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas, USA

7 Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

8 Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

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Health and Quality of Life Outcomes 2012, 10:22  doi:10.1186/1477-7525-10-22

Published: 22 February 2012



Pediatric self-report should be considered the standard for measuring patient reported outcomes (PRO) among children. However, circumstances exist when the child is too young, cognitively impaired, or too ill to complete a PRO instrument and a proxy-report is needed. This paper describes the development process including the proxy cognitive interviews and large-field-test survey methods and sample characteristics employed to produce item parameters for the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric proxy-report item banks.


The PROMIS pediatric self-report items were converted into proxy-report items before undergoing cognitive interviews. These items covered six domains (physical function, emotional distress, social peer relationships, fatigue, pain interference, and asthma impact). Caregivers (n = 25) of children ages of 5 and 17 years provided qualitative feedback on proxy-report items to assess any major issues with these items. From May 2008 to March 2009, the large-scale survey enrolled children ages 8-17 years to complete the self-report version and caregivers to complete the proxy-report version of the survey (n = 1548 dyads). Caregivers of children ages 5 to 7 years completed the proxy report survey (n = 432). In addition, caregivers completed other proxy instruments, PedsQL™ 4.0 Generic Core Scales Parent Proxy-Report version, PedsQL™ Asthma Module Parent Proxy-Report version, and KIDSCREEN Parent-Proxy-52.


Item content was well understood by proxies and did not require item revisions but some proxies clearly noted that determining an answer on behalf of their child was difficult for some items. Dyads and caregivers of children ages 5-17 years old were enrolled in the large-scale testing. The majority were female (85%), married (70%), Caucasian (64%) and had at least a high school education (94%). Approximately 50% had children with a chronic health condition, primarily asthma, which was diagnosed or treated within 6 months prior to the

interview. The PROMIS proxy sample scored similar or better on the other proxy instruments compared to normative samples.


The initial calibration data was provided by a diverse set of caregivers of children with a variety of common chronic illnesses and racial/ethnic backgrounds. The PROMIS pediatric proxy-report item banks include physical function (mobility n = 23; upper extremity n = 29), emotional distress (anxiety n = 15; depressive symptoms n = 14; anger n = 5), social peer relationships (n = 15), fatigue (n = 34), pain interference (n = 13), and asthma impact (n = 17).

PROMIS; HRQOL; PRO; Scale development; Parent Proxy; Pediatrics