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Global Assessment of Severity of Epilepsy (GASE) Scale in Children with Epilepsy: Construct Validity, Stability, and Responsiveness

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Global Assessment of Severity of Epilepsy (GASE) Scale in Children with Epilepsy: Construct Validity, Stability, and Responsiveness Western University Scholarship@Western Electronic Thesis and Dissertation Repository 12-15-2014 12:00 AM Global Assessment of Severity of Epilepsy (GASE) Scale in Children with Epilepsy: Construct Validity, Stability, and Responsiveness Cindy J. Chan The University of Western Ontario Supervisor Dr. Kathy N. Speechley The University of Western Ontario Graduate Program in Epidemiology and Biostatistics A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Science © Cindy J. Chan 2014 Follow this and additional works at: https://ir.lib.uwo.ca/etd Recommended Citation Chan, Cindy J., "Global Assessment of Severity of Epilepsy (GASE) Scale in Children with Epilepsy: Construct Validity, Stability, and Responsiveness" (2014). Electronic Thesis and Dissertation Repository. 2587. https://ir.lib.uwo.ca/etd/2587 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. GLOBAL ASSESSMENT OF SEVERITY OF EPILEPSY (GASE) SCALE IN CHILDREN WITH EPILEPSY: CONSTRUCT VALIDITY, STABILITY, AND RESPONSIVENESS (Thesis format: Monograph) by Cindy Jauhrur Chan Graduate Program in Epidemiology and Biostatistics A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Cindy Jauhrur Chan 2014 Abstract The Global Assessment of Severity of Epilepsy (GASE) Scale is a single-item, 7-point global rating scale designed for neurologist-report of overall severity of epilepsy in children. Preliminary evidence suggested it may be valid and reliable for research and clinical use. Data from the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES) was analyzed to evaluate validity, stability, and responsiveness of GASE scores. Spearman’s Rho indicated that GASE was moderately correlated with key aspects of epilepsy but weakly correlated with parents’ perceptions of child health. Frequency and intensity of seizures and interference of epilepsy or drugs with daily activities were most strongly correlated with GASE. Intra-class correlation coefficients (ICC) provided modest evidence that GASE could detect stability. Distribution- and anchor-based indices suggested that GASE was responsive to changes in clinical criteria. Results support the construct validity, stability, and responsiveness to change of the GASE Scale in children with epilepsy. Keywords Global Assessment of Severity of Epilepsy (GASE) Scale, children, epilepsy, severity, measurement properties, validity, stability, reliability, responsiveness, sensitivity to change ii Dedication To the children and families affected by epilepsy iii Acknowledgments I would like to express my sincere gratitude to the people who have supported me throughout this project and have made this research possible: My advisor, Dr. Kathy Speechley has been an exceptional teacher and mentor. She has contributed a significant amount of time and expertise for this project and I am thankful for her guidance, encouragement, and patience throughout this programme. The members of my supervisory committee, Dr. Samuel Wiebe and Dr. Guangyong Zou have also contributed greatly to this project. I am thankful for their valuable assistance, especially with methodological and clinical advice. I would also like to thank Dr. Simon Levin for providing additional assistance on the methodology of this thesis. My professors in the Department of Epidemiology and Biostatistics have provided me with the foundation for my education in epidemiology. I am grateful to them for sharing their knowledge and research experience. I would also like to thank Rebecca Waldie and Angela DeCandido for their administrative support. Special thanks to the dedicated study participants, clinicians, nurses, and research team involved with the HERQULES project, especially Jane Terhaerdt and Wenyi Huang. I would especially like to thank my parents and sister for their continuous support of my education. In addition, I would like to thank Teresa Leung for her friendship and support throughout undergraduate and graduate school. Finally, I gratefully acknowledge financial support from the CIHR operating grant (MOP-117493) for HERQULES, Ontario Graduate Scholarship, Western Graduate Research Scholarship, and London Health Research Day. iv Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iii Acknowledgments.............................................................................................................. iv Table of Contents ................................................................................................................ v List of Tables ................................................................................................................... viii List of Figures ................................................................................................................... xii List of Appendices ........................................................................................................... xiii List of Abbreviations ....................................................................................................... xiv CHAPTER 1 ....................................................................................................................... 1 INTRODUCTION .............................................................................................................. 1 1.1 Introduction ............................................................................................................. 1 1.2 Purpose and Rationale............................................................................................. 1 1.3 Thesis Objectives .................................................................................................... 3 1.4 Overview on Epilepsy ............................................................................................. 5 1.4.1 Classification............................................................................................... 6 1.4.2 Prevalence and Incidence .......................................................................... 11 1.4.3 Etiology ..................................................................................................... 11 1.4.4 Clinical Aspects of Childhood Epilepsy ................................................... 12 1.4.5 Prognosis and Treatment........................................................................... 13 1.5 Overview of Thesis ............................................................................................... 15 CHAPTER 2 ..................................................................................................................... 16 LITERATURE REVIEW ................................................................................................. 16 2.1 The Concept and Measurement of Severity .......................................................... 16 v 2.2 Single-item Rating Scales ..................................................................................... 17 2.3 Measurement of Severity of Seizures and the Severity of Epilepsy ..................... 18 2.4 Measures of Severity of Seizures .......................................................................... 19 2.4.1 Veterans Administration Seizure Frequency and Severity Rating Scale (VA) .......................................................................................................... 19 2.4.2 National Hospital (Chalfont) Seizure Severity Scale (NHS3) .................. 20 2.4.3 Liverpool Seizure Severity Scale (LSSS) ................................................. 22 2.4.4 Hague Seizure Severity Scale (HASS) ..................................................... 25 2.4.5 Seizure Severity Questionnaire (SSQ) ...................................................... 27 2.5 Measure of Severity of Epilepsy Syndromes ........................................................ 30 2.5.1 Epilepsy Syndrome Severity Scores- Child (ESSS-C) ............................. 30 2.6 Measure of Severity of Epilepsy ........................................................................... 31 2.6.1 Global Assessment of Severity of Epilepsy Scale (GASE) ...................... 31 2.7 Summary of Measurement Scales ......................................................................... 34 CHAPTER 3 ..................................................................................................................... 37 METHODS ....................................................................................................................... 37 3.1 Assessing the Psychometric Properties of Measurement Scales .......................... 37 3.1.1 Construct Validity ..................................................................................... 37 3.1.2 Stability ..................................................................................................... 38 3.1.3 Responsiveness ......................................................................................... 39 3.2 Data
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