title: Change in Quality of Life with Velopharyngeal Insufficiency Surgery.
abstract: OBJECTIVE
  (1) To define the minimal clinically important difference (MCID) of the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument, and (2) to test for the change in quality of life (QOL) after VPI surgery.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  VPI clinic at a tertiary pediatric medical center.
  
  
  METHODS
  Children with VPI and their parents completed the VELO instrument (higher score is better QOL) at enrollment and then underwent VPI surgery (Furlow palatoplasty or sphincter pharyngoplasty, n = 32), other treatments (obturator or oronasal fistula repair, n = 7), or no treatment (n = 18). They completed the VELO instrument again and an instrument of global rating of change in QOL at 1 year. The MCID was anchored to the global change instrument scores corresponding to "a little" or "somewhat" better. Within-group (paired t test) and between-group (Student t test) changes in VELO scores were tested for the VPI surgery and no treatment groups. The association between treatment group and change in VELO scores was tested with multivariate linear regression, adjusting for confounders.
  
  
  RESULTS
  Follow-up was obtained for 37 of 57 (65%) patients. The mean (±standard deviation) change in VELO scores corresponding to the MCID anchor was 15 ± 13. The VELO score improved significantly more in the VPI surgery group (change, 22 ± 15; P < .001) than in the no treatment group (change, 9 ± 12; P = .04), after adjusting for confounders (P = .007 between groups).
  
  
  CONCLUSIONS
  VPI surgery using the Furlow palatoplasty or sphincter pharyngoplasty improves VPI-specific QOL, and the improvement is clinically important.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Skirko
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Weaver
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
authors.affiliation: Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Kinter
authors.affiliation: Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Eblen
authors.affiliation: Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Martina
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA kathleen.sie@seattlechildrens.org.
authors.forename: Kathleen C Y
authors.initials: KC
authors.lastname: Sie
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010614:Pharynx / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000523:psychology* / Q000601:surgery; D055815:Young Adult
keywords: Furlow palatoplasty; minimal clinically important difference; minimal important change; quality of life; responsiveness; sphincter pharyngoplasty; velopharyngeal dysfunction; velopharyngeal insufficiency