title: Development and application of the Chinese version of the adult strabismus quality of life questionnaire (AS-20): a cross-sectional study.
abstract: BACKGROUND
  Patients with strabismus experience visual dysfunction, self-image disorders, low self-esteem, and social and emotional barriers, which adversely influence their health-related quality of life (HRQoL). Currently no strabismus-specific questionnaire is available in China to identify patients' quality of life and to evaluate the effectiveness of strabismus treatment. The aims of the present study were to validate the Chinese-language version of the Adult Strabismus Quality of Life Questionnaire (AS-20) and to evaluate the impacts of strabismus on the quality of life among Chinese strabismus patients.
  
  
  METHODS
  Two hundred and fifty-five Chinese adults with strabismus, one hundred visually normal adults and one hundred patients with other eye diseases completed the Chinese version of AS-20. Psychometric properties of the Chinese AS-20 were examined by Cronbach's α coefficient, test-retest and split-half reliability, and construct and criterion-related validity. Independent-samples t test and one-way ANOVA analyses were conducted to explore the impact of demographic factors and clinical characteristics on HRQoL in Chinese strabismic adults.
  
  
  RESULTS
  The final AS-20 in Chinese (AS-C) included 18 items and two subscales: psychosocial (12 items) and function (6 items). The Cronbach's α was 0.908 for overall scale, with 0.913 and 0.808 for 'psychosocial' and 'function' subscales respectively, indicating high internal consistency reliability. The mean of the overall AS-C score among strabismus patients was 62.80 ± 18.94, significantly lower than that in visually normal adults (t = -18.693, P < 0.001), and in patients with other eye diseases (t = -5.512, P < 0.001).
  
  
  CONCLUSIONS
  The AS-C is a culturally appropriate tool to evaluate the HRQoL in Chinese strabismus adults. The psychosocial health well-being and overall quality of life in strabismic patients should receive greater emphasis.
authors.forename: Zong-Hua
authors.initials: ZH
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Bian
authors.forename: Hui
authors.initials: H
authors.lastname: Ren
authors.forename: Rosemary
authors.initials: R
authors.lastname: Frey
authors.forename: Ling-Fei
authors.initials: LF
authors.lastname: Tang
authors.affiliation: School of Nursing, Third Military Medical University, Postal address: Gaotanyan Street 30, Shapingba District, Chongqing 400038, China. xywang_tmmu@sina.cn.
authors.forename: Xian-Yuan
authors.initials: XY
authors.lastname: Wang
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D013285:Strabismus / Q000523:psychology* / Q000601:surgery; D011795:Surveys and Questionnaires / Q000592:standards*