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Multicenter Study
. 2025 Jul 5;9(1):82.
doi: 10.1186/s41687-025-00916-y.

Psychometric findings for LIMB-Q kids based on an international study of 800 children and adolescents with lower limb differences

Harpreet Chhina  1   2 , Charlene Rae  3 , David Podeszwa  4 , James A Fernandes  5 , Louise Johnson  6 , Bjoern Vogt  7 , Jan Duedal Rolfing  8 , Alicia Kerrigan  9 , Ashish Ranade  10 , Juergen Messner  11 , Mohan Belthur  12 , Melissa Esparza  12 , Jonathan Wright  13 , David Bade  14 , Sarah McMahon  15 , Christopher Iobst  16 , Sanjeev Sabharwal  17 , Marcel Abouassaly  18 , Anthony Cooper #  19 , Anne F Klassen #  3
Affiliations
Multicenter Study

Psychometric findings for LIMB-Q kids based on an international study of 800 children and adolescents with lower limb differences

Harpreet Chhina et al. J Patient Rep Outcomes. .

Abstract

Background: LIMB-Q Kids is a new patient-reported outcome measure (PROM) for children and adolescents with Lower limb differences (LLDs). This international field test study aimed to evaluate the psychometric properties of LIMB-Q Kids.

Methodology: Patients from pediatric orthopaedic clinics with a diagnosis of LLDs were recruited. Participants completed LIMB-Q Kids and 2 generic quality of life questionnaires, i.e., PROMIS Pediatric Short Form v2.0 - Mobility 8a, and PedsQL. Demographic and clinical data were collected including the LLRS AIM Index, a measure of clinical severity for LLDs. Rasch measurement theory (RMT) analysis was used to examine the psychometric properties of LIMB-Q Kids. Test-retest (TRT) reliability was examined and tests of construct validity were performed.

Results: Participants (N = 800) were recruited from 16 sites in 7 countries. Participants were aged 8 years and older (mean = 13, standard deviation = 3.2, range 8-25 years) and had a broad range of LLDs (e.g., Leg Length Discrepancy, Fibular Hemimelia, Skeletal Dysplasia, Blount's disease, Posteromedial Tibial Bowing, Osteogenesis Imperfecta, Congenital Pseudarthrosis of Tibia, Tibial Hemimelia and Amputations). RMT analysis provided evidence of the reliability and validity of 9 independently functioning scales that measure leg appearance, physical function, symptoms (hip, leg, knee, ankle, and foot), leg-related distress, and social, and psychological function. In addition, TRT reliability based on a sample of 46 participants was high for all 9 scales (Intraclass correlation coefficient ranges from 0.76-0.95). LIMB-Q Kids Physical Function scale correlated strongly with the PROMIS Pediatric Short Form v2.0 - Mobility 8a (Pearson correlation 0.82) and the PedsQL Physical Function total score (Pearson correlation 0.77). As hypothesized, participants with more severe LLDs based on the LLRS AIM index scores reported lower scores on all LIMB-Q Kids scales, indicating more impact on the patients.

Conclusions: This study provided evidence for the validity and reliability of LIMB-Q Kids. This new PROM can be used to inform research, quality improvement efforts, and clinical care. By measuring outcomes that matter most to children and adolescents with LLDs, LIMB-Q Kids can provide information to support evidence-based decisions.

Level of evidence: Level III.

Keywords: Health-related Quality of Life; International study; Limb deformities; Limb differences; Limb reconstruction; Patient-reported outcomes; Psychometrics; Quality of life.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Institutional ethics approval for this study was obtained from the senior author’s institution (H21-02204), and each participating site’s ethics review board. Data transfer agreements were signed with each participating site. Participants provided assent (written or verbal depending on the individual site’s research ethics guidelines) and parents provided written consent for the participation of their children. Consent for publication: N/A. Competing interests: McMaster University and the University of British Columbia hold the copyright of LIMB-Q Kids and its translations. Drs. Cooper, Chhina, and Klassen are co-developers of this PROM and may receive a share of any license revenue associated with its use by ‘for-profit’ organizations. Klassen is an owner of EVENTUM Research which provides consulting services to the pharmaceutical industry. Other coauthors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Mapping of LIMB-Q Kids conceptual framework to scales
Fig. 2
Fig. 2
LIMB-Q kids scale scores decrease with increasing severity based on LLRS AIM index
See this image and copyright information in PMC

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