Impact of pediatric epilepsy on the family: a new scale for clinical and research use.
OBJECTIVE
There is no brief, global instrument available that specifically measures the psychosocial impact of pediatric epilepsy on the family. An 11-item scale was created for parents' use to evaluate the influence of epilepsy on the major aspects of their family and child's life. This will be a helpful tool both in the clinical setting and as an outcome measure for research studies.


METHODS
Mothers rated their child's quality of life on a visual analogue scale (1-6) and completed the Impact of Pediatric Epilepsy Scale (IPES), which assesses the impact on academic achievement, participation in activities, health, relationships with family and with peers and siblings, social activities, self-esteem, and the caregiver's hopes for their child's future adapted from the scale developed by Jacoby. External validation was determined by comparison of the IPES with physicians' reports of the characteristics of the child's epilepsy and neurological limitations and parents' ratings on the Family Environment Scale or Parenting Stress Index. In addition, each school-aged child completed the Piers-Harris Children's Self-Concept Scale, Brother-Sister Questionnaire, and Loneliness Scale. Teachers of children completed the Academic Performance Rating Scale. Seven days later, retest reliability of the IPES was evaluated.


RESULTS
Ninety-seven mothers of children aged 2-16 years completed the IPES and the appropriate family and age-related questionnaires. Internal validation on the IPES yielded a Cronbach's a for the scale of 0.92. A significant Pearson's correlation indicated that total scores were consistent over time (r = 0.81). Spearman's correlations for the individual items were also significant, ranging from 0.48 to 0.78. Significant Spearman's correlations also indicated that quality of life was negatively related to impact on each of the 11 items of psychosocial function. Children with IPES scores above the median differed in some psychosocial aspects from those who scored below. Their parents were more stressed, their siblings were more respectful, they had lower self-esteem, and they experienced more emotional problems. Total impact was also significantly related to seizure frequency, total number of medications taken, number of visits to a physician in the previous year, and number of nights spent in hospital for neurological reasons.


CONCLUSIONS
The IPES is an accurate, acceptable, and quick measurement tool that reflects the way in which childhood epilepsy has an impact on the child and on family life. It may be helpful in routine clinical care and may be useful in the research setting to find ways to improve the lives of children with epilepsy.
Camfield
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Department of Pediatrics, IWK Grace Health Center, P.O. Box 3070, Halifax, Nova Scotia, Canada B3J 3G9. Camfield@is.dal.ca
Breau
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Camfield
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D000293:Adolescent; D000367:Age Factors; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004519:Education, Special; D004522:Educational Status; D004827:Epilepsy / Q000453:epidemiology* / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005192:Family Health; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology / Q000523:psychology; D008297:Male; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D009674:Nova Scotia / Q000453:epidemiology; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013663:Teaching / Q000706:statistics & numerical data