Outcome measures in ULCP: the modified 5-Year-Olds'-Index-development and reliability

Tarun K Mittal, Anthony J Ireland, Nikki E Atack, Sam D Leary, Joyce I Russell, Scott A Deacon, Andy R Ness, Jonathan R Sandy

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)


OBJECTIVE: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index?

DESIGN: Retrospective method comparison and development study.

SETTING: School of Oral and Dental Science, University of Bristol.

METHODS: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP.

RESULTS: The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements.

CONCLUSIONS: The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.

Original languageEnglish
Number of pages9
JournalCleft Palate-Craniofacial Journal
Early online date11 May 2018
Publication statusE-pub ahead of print - 11 May 2018


  • 5-Year-Olds’ Index
  • unilateral cleft lip and palate
  • study models
  • outcome measures


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  • NIHR BRC Nutrition

    Ness, A. R.


    Project: Research, Parent

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