A critique of the index of the complexity, outcome and need
Ferreira, Dominique Abergail
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The development of a uniform method of epidemiological assessment and grading of malocclusion has been of interest for several decades. Recently, Daniels and Richmond (2000) proposed a new orthodontic index namely the Index of Complexity, Outcome and Need (ICON). Their aim was to develop a single index for assessing treatment inputs and outcomes.The aim of this study was to critique the ICON and to assess to the extent to which each component of the ICON fulfils the ideal requirements of the ideal index as identified in a World Health Organization Report (WHO, 1966). The study was performed in three parts: 1) a gold standard was established to test reliability and validity of the ICON; 2) to assess ease of use and simplicity of the index; 3) and to test the applicability of the index on patients and study casts. The results showed that the ICON identified 25% of the cases as ‘no treatment’, as apposed to the 100% of the gold standard. Validity of the index was shown to be ‘poor’ for complexity (? = 0.2) and degree of improvement (? = 0.34) and ‘excellent’ for outcome. Reliability was high for all the components except for treatment need (? = 0.63). This study concluded that except for complexity and degree of improvement, the index performed well with respects to reliability, validity (of treatment outcome), ease of use and simplicity and applicability to patient and study casts.