The Italian SF-36 Health Survey: translation, validation and norming

Health-related quality of life and productivity impact in haemophilia patients with inhibitors

To measure health-related quality of life (HRQL), its determinants, and its association with patient and caregiver productivity among a sample of haemophilia patients with inhibitors in the United States (US). Data on demographical and clinical characteristics, treatment patterns, HRQL (SF-12v2), and productivity outcomes were reported for 53 patients. Mean SF-12v2 domain and mental (MCS) and physical (PCS) component summary scores were assessed and compared with US norms. Regression analyses explored the association of patient and treatment factors with HRQL and productivity. Patients' mean age was 20.7 years (SD = 18.8), 88.5% were type A, and 39.6% received on-demand therapy as their only mode of treatment. Mean PCS was significantly lower than the US norm (PCS, 39.9, P < 0.01) and mean MCS showed no significant difference (MCS, 49.9, P = ns). On-demand treatment (B = -0.336, P < 0.05) and number of haemorrhages (B = -0.366, P < 0.05) were negatively associated with PCS; and PCS was associated with patients' missed work or school days [incidence rate ratio (IRR) = 0.93, P < 0.001] and perceived impact on daily activities (OR = 0.72, P < 0.05). Younger age (IRR = 0.91, P < 0.01), lower PCS (IRR = 0.94, P < 0.01), more haemorrhages (IRR = 1.05, P < 0.05), and surgery (IRR = 2.74, P < 0.05) were associated with fewer patients' productive days. Physical functioning among inhibitor patients in the US is compromised and is negatively associated with their daily activities and productivity. These data suggest a positive association of prophylactic and immunotolerance therapy with HRQL, specifically physical impairment.

Physical activity and performance in older persons with musculoskeletal impairment: results of a pilot study with 9-month follow-up

BACKGROUND AND AIMS

Physical activity in older adults improves fitness, but few studies have examined the short- and long-term effects on physical performance. This analysis is preliminary to a RCT investigating physical activity effects on performance over time in older persons with musculoskeletal impairment.

METHODS

Fifty sedentary participants, aged 65+, with musculoskeletal impairment and difficulties in complex mobility, but independent in basic activities of daily living (ADLs) were randomly assigned to 3- monthly, twice-a-week, supervised physical exercise (E) or unsupervised regular walking (W), and advised to keep active.

ASSESSMENTS

baseline (T0), discharge (T1), 6 (T2) and 9 (T3) months from baseline.

OUTCOME

Summary of Performance Score (SPS), strength, flexibility; general mental health (GMH), vitality, and self reported disability.

RESULTS

All participants completed follow-ups. At T3, only 12 E and 2 W participants reported exercising regularly. Each outcome, except for GMH, trunk flexibility and basic ADLs, changed over time significantly more in E than in W. After training, E increased SPS (1 point), along with muscle strength, flexibility, vitality, and reduced difficulties in complex mobility. At 9 months, all parameters, except passive hip flexion and shoulder abduction, had reverted to baseline levels. In the same time-frame, W progressively decreased SPS, knee flexion/ extension strength and passive flexion, and increased difficulties in basic and complex mobility.

CONCLUSIONS

In this physically impaired sample, a 3- month exercise program, compared with unsupervised regular walking, was associated with improved performance, fitness and vitality after discharge, and to delayed physical decline in the next 6-month follow-up.

Alexithymia-A disorder of the regulatory mechanism of the emotion elaboration-and quality of life in gynecologic surgery

STUDY OBJECTIVE

Alexithymia is a disorder of the regulatory mechanism of the emotion elaboration. To verify the influence of the personality trait in the evaluation of quality of life (QoL), we analyzed the effect of alexithymia on the outcome of gynecologic surgery. The purpose of this study was to investigate the presence of alexithymia by using the Toronto Alexithymia Scale (TAS)-20, and to examine the relationship between alexithymia and self-reported descriptors of QoL in a gynecologic population.

DESIGN

All patients were evaluated in a semistructured interview in which personal, medical, and social data were collected. They were provided with a set of questionnaires that included both measure of alexithymia (TAS-20) and QoL perception (the Medical Outcomes Study short-form general health survey-36 [SF-36]). The patients were assessed before the surgical procedure and 1 month postoperatively.

SETTING

Campus BioMedico Hospital in Rome, Italy.

PATIENTS

In all, 40 consecutive patients with benign gynecologic pathology were enrolled in the study.

INTERVENTIONS

A total of 20 of the patients underwent laparoscopy (LPS) and 20 underwent laparotomy (LPT).

MEASUREMENTS AND MAIN RESULTS

Patients were separated into 2 groups, with respect to the TAS questionnaire score: the high-level alexithymia (HA) group, with scores above 59, and the low-level alexithymia group, with scores below 59. The HA group represented 61% in patients who underwent LPS and 50% in patients who were submitted to LPT. Patients who underwent LPS showed a slight decrease in the QoL score after the surgical procedure. Patients who underwent LPT showed different QoL scores depending on the high or low TAS level: high-level TAS group showed higher SF-36 domain scores compared with the presurgical scores, whereas low-level TAS group showed lower scores compared with the presurgical scores.

CONCLUSION

Our data show that the subjective QoL tested with SF-36 in patients with gynecologic conditions undergoing surgery is clearly influenced by the level of alexithymia. This influence is clearly detectable when a more invasive surgery is performed. In this case, patients with low-level alexithymia show a worsening of QoL. Contrarily, patients with HA have a better perception of QoL after more invasive surgery.

Health-related quality of life in primary Raynaud phenomenon

OBJECTIVE

To assess health-related quality of life (HRQL) in patients with primary Raynaud phenomenon (RP).

METHODS

The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire and the EQ-5D questionnaire were administered to 81 patients with primary RP who had been referred to a rheumatological department. The scores were compared with data of control subjects.

RESULTS

In the physical dimensions of the SF-36, the subjects who had RP had significantly lower scores (worse HRQL) than controls (47.6 +/- 9.8 vs. 52.2 +/- 9.3, P = 0.021). The physical component score (PCS) was correlated with age (P = 0.003) and the number of comorbidities (P = 0.004). The mental health component score (MCS) was significantly lower in RP subjects than in controls (41.9 +/- 9.4 vs. 46.1 +/- 10.7, P = 0.006). As regards anxiety/depression (of the EQ-5DA/D), considerably more RP patients (77.7%) reported at least some related problems as compared with controls (60.0%) (chi = 7.93; P = 0.005). Fifty-two RP patients (64.2%) and 178 controls (57.8%) described themselves as moderately anxious/depressed, whereas 11 RP patients (13.5%), and 7 controls (2.2%) reported extreme anxiety/depression (P < 0.0001).

CONCLUSIONS

This study shows a reduction of the HRQL in patients with primary RP, compared with control subjects. The psychologic wellbeing represents the most involved area, whereas physical functioning and symptoms are significantly influenced by age and comorbidities. Moreover, these patients are more anxious/depressed (EQ-5DA/D). Longitudinal studies are needed to validate our findings, to explore the causal relationship between primary RP and emotional factors, and to possibly lead to encouraging behavioral therapies.

Gender- and age-related benefit of renal replacement therapy on health-related quality of life

OBJECTIVES

The aim of this study was to compare the health-related quality of life (HRQOL) of end-stage renal disease patients on renal replacement therapy with that of subjects of the same gender and similar age from the general population, in an attempt to determine patient subgroup that benefits more from the treatment.

METHODS

A cross-sectional study involving haemodialysis, peritoneal dialysis and renal transplant patients (n = 874) was conducted with subjects providing socio-demographic and disease-related data, and completing the validated Greek Short Form-36 (SF-36) Health Survey. Patient-specific z-scores were calculated using mean SF-36 scores and SD of age- and gender-matched subgroups from the Greek norms.

RESULTS

Males and younger patients generally reported better HRQOL. However, z-scores in these groups generally showed a larger health deficit, i.e. an increased divergence from the HRQOL of their age- and gender-matched counterparts of the general population, compared with the health deficit observed in female and younger patients.

CONCLUSIONS

Health-related quality of life studies involving disease groups may sometimes be inconclusive if results are not compared with population norms, and particularly with subgroups matched for important demographic variables. Otherwise, as this study has shown, it is possible that important information may remain unrevealed.

The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people

Background

The health-related quality of life (HRQL) is an important indicator of the burden of musculoskeletal disease. The Medical Outcome Study Short-Term 36 (SF-36) is the most used tool that evaluates HRQL as a subjective perception about psychological and physical limitations due to an underlying illness. The purpose of this study was to compare the HRQL scores among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) and a selected sample of health people and determine their relationship with measures of clinical condition.

Methods

799 patients (469 with RA, 164 with AS, 65 with axial PsA and 101 with peripheral PsA) accepted the invitation to participate. 1579 healthy controls were used for the comparison. We calculated scores for the eight SF-36 subscales, the Physical Component Summary (PCS) score, and the Mental Component Summary (MCS) score, according to published algorithms. Disease-related characteristics included disease duration, comorbidity, a measure for disease activity and for radiographic damage. The presence of comorbidity was ascertained through patient's self-reports by the Self-Administered Comorbidity Questionnaire (SCQ). Comparison were performed with respect to sex and age, and s-scores were calculated for comparison with the norm. Multivariate analyses were used to assess the relationship between HRQL and radiographic damage, disease activity, and socio-demographic data.

Results

The four inflammatory rheumatic diseases (IRD), compared to controls, significantly impaired all eight health concepts of the SF-36 (p < 0.0001) in both component PCS and MCS scores (p < 0.0001). Overall, the dimensions typically affected were physical functioning, limitations due to physical function, and bodily pain. The disease with the worst HRQL for those dimensions was RA. The multivariate analyses revealed that the physical component was influenced by a high disease activity and comorbidity. The severity of psoriatic lesions was associated with poor mental functioning in patients with PsA.

Conclusion

Chronic IRD have a clearly detrimental effect on the HRQL in both sex and in age groups, and physical domain is more impaired than mental and social ones.

Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial

OBJECTIVE

The purpose of the study was to compare the long-term safety and efficacy of laparoscopic surgery and laparotomy approaches to early stage endometrial cancer.

STUDY DESIGN

This was a prospective long-term extension study of a randomized controlled study that included 84 patients with clinical stage I endometrial cancer (laparoscopic surgery group, 40 women; laparotomy group, 38 women). Safety and efficacy data were evaluated and analyzed by the intention-to-treat principle.

RESULTS

After a follow-up period of 78 months (interquartile range, 7; range, 19-84 months) and 79 months (interquartile range, 6; range, 22-84 months) for laparoscopic surgery and laparotomy groups, respectively, no difference in the cumulative recurrence rates (8/40 [20.0%] and 7/38 [18.4%]; P = .860) and deaths (7/40 [17.5%] and 6/38 [15.8%] patients; P = .839) was detected between groups. No significant differences in overall (P = .535) and disease-free (P = .512) survival were observed.

CONCLUSION

The laparoscopic surgery approach to early stage endometrial cancer is as safe and effective a procedure as the laparotomy approach.

Is sacral nerve stimulation an effective treatment for chronic idiopathic anal pain?

BACKGROUND

Chronic idiopathic anal pain is a common, benign symptom, the etiology of which remains unclear. Traditional treatments are often ineffective. This study investigated the efficacy of sacral nerve stimulation in treating chronic idiopathic anal pain.

METHODS

Twelve patients (10 women and 2 men; mean age, 61.0 +/- 10.3 years; range, 48-82 years) implanted with a permanent device for sacral nerve stimulation were followed in the Italian Group for Sacral Neuromodulation (GINS) Registry. All patients had frequent chronic anal or perianal pain; 75 percent had previously undergone pelvic surgery. Pharmacologic and rehabilitative therapy had yielded poor results. Changes from baseline to last follow-up examination were evaluated for scores on a visual analog pain scale (0-10) and the Short-Form 36 (SF-36) health status questionnaire. Manometric measurements recorded at last follow-up were compared with preimplantation values.

RESULTS

In one patient, the permanent device was removed because of technical failure. After a mean follow-up of 15 (range, 3-80) months, visual analog pain scores had significantly improved (from 8.2 +/- 1.7 to 2.2 +/- 1.3, P < 0.001). SF-36 physical component scores increased from 26.27 +/- 5.65 to 38.95 +/- 9.08, P < 0.02). Scores on the mental component showed improvement, although not significant. Postimplantation changes in manometric functional data were not significant, but sensitivity thresholds showed a considerable decrease.

CONCLUSIONS

Long-term follow-up data showing improvements in scores on the visual analog pain scale and quality of life questionnaire indicate that, before adopting more aggressive surgical procedures, SNS should be considered for patients with chronic idiopathic anal pain in whom pharmacologic and biofeedback treatments have failed to produce effective results.

Clinical and socio-economic correlates of quality of life and treatment satisfaction in patients with type 2 diabetes

BACKGROUND AND AIM

The aim of the present study was to assess health-related quality of life (HRQOL) and treatment satisfaction in a large, ambulatory based sample of patients with type 2 diabetes. In particular, we evaluated a large array of socio-economic, clinical, and management-related factors, to investigate the extent to which they correlate with physical and psychological well-being, and with treatment satisfaction.

METHODS AND RESULTS

Patients were requested to fill in a questionnaire including the SF-36 Health Survey (SF-36), the WHO-Well Being Questionnaire (WBQ), and the WHO-Diabetes Treatment Satisfaction Questionnaire (DTSQ). The analyses were based on multivariate analyses, adjusted for patient clinical and socio-demographic characteristics. The study involved 2499 patients, enrolled in 203 diabetes outpatient clinics. Female gender and diabetes complications were associated with worse physical and psychological well-being, while socioeconomic variables were mainly related to general well-being. The perceived frequency of hyperglycemic episodes was negatively associated with all the dimensions explored. Treatment satisfaction was inversely related to female gender, insulin treatment, perceived frequency of hyperglycemic episodes and diabetes complications. Blood glucose self-monitoring, and among patients treated with insulin, self-management of insulin doses and the use of pen for insulin injections, were associated with higher levels of satisfaction. Finally, higher levels of satisfaction were associated with a better perception of physical and psychological well-being.

CONCLUSIONS

Health related quality of life and treatment satisfaction are associated with each other and are both affected by a complex interplay between clinical and socio-economic variables. Some negative aspects, mainly associated with insulin treatment and poor perceived metabolic control, can be attenuated by a deeper involvement of the patients in the management of the disease.

Interactive diary for diabetes: A useful and easy-to-use new telemedicine system to support the decision-making process in type 1 diabetes

BACKGROUND

Widespread use of carbohydrate (CHO) counting is limited by its complex educational needs, but a telemedicine system could simplify the patients' training.

METHODS

The Diabetes Interactive Diary (DID) was set up on patients' mobile phones and allowed to record the blood glucose values and quantify the total CHO intake during a meal, by choosing the specific food and the amount ingested from a list of pictures. It also suggested the most appropriate insulin bolus in relation to the patient's CHO/insulin ratio. Data were sent to the physician by Short Message Service (also known as text message). Two pilot studies were carried out to investigate the feasibility and acceptability of the system and its effectiveness in improving metabolic control.

RESULTS

In the first study, 50 patients were involved in a survey with questionnaires administered before and 12 weeks after the start of the DID. The system was considered by almost all the patients as easy to use and very helpful. CHO counting and insulin bolus calculation were ranked as the most useful functions. In the second study, 41 consecutive patients using DID under routine clinical practice conditions were evaluated after a median of 9 months of follow-up. DID was associated with a nonstatistically significant reduction in fasting blood glucose (FBG), postprandial glucose (PPG), and hemoglobin A1c levels. FBG and PPG coefficient of variation (CV) values were significantly reduced: FBG-CV decreased by 6.7% (95% confidence interval -11.9, -1.6; P = 0.02), while PPG-CV decreased by 11.5% (95% confidence interval -19.3, -3.7; P = 0.01). No patients reported serious hypoglycemic episodes requiring medical intervention.

CONCLUSIONS

DID can represent a useful, safe, and easy-to-use tool to help the patient with type 1 diabetes promote dietary freedom. Adjustment of insulin doses according to CHO intake allowed the reduction of glucose variability, increasingly recognized as an important, independent risk factor for cardiovascular events.

Long-term outcome of sacral nerve stimulation for fecal incontinence

PURPOSE

Sacral nerve stimulation is a safe and effective procedure for fecal incontinence. We investigated whether its efficacy is maintained long term.

PATIENTS AND METHODS

Sixty patients with fecal incontinence underwent permanent sacral nerve stimulation. Patients' data were prospectively recorded in the national registry of the Italian Group of sacral nerve stimulation. The severity of fecal incontinence was evaluated by the Wexner score, and data were collected in a bowel function diary. Quality of life was evaluated by the Italian version of the Medical Outcomes Survey Short Form (SF-36) questionnaire.

RESULTS

Fifty-two patients were available for long-term follow-up lasting at least 5 years. Compared with baseline, the Wexner score decreased significantly after definitive implantation (from 15 +/- 4 to 5 +/- 5, P < 0.001). At least 50 percent improvement in continence was achieved in 74 percent of the patients, and at least 70 percent improvement (median value) was achieved in 50 percent. The mean number of solid/liquid incontinence episodes decreased significantly from 0.5 (+/-0.5) to 0.1 (+/-0.3) per day (P = 0.004). Quality of life improved in all domains. The overall mean improvement in SF-36 scores was 39.8 percent. Both mean resting and squeeze anal pressures increased significantly, and maximum volume tolerated decreased significantly.

CONCLUSIONS

Sacral nerve stimulation maintains its efficacy long term, not only in regard to control of symptoms but also regarding quality of life.

Illness perceptions, mood and health-related quality of life in patients with amyotrophic lateral sclerosis

OBJECTIVES

To divide amyotrophic lateral sclerosis (ALS) patients in two clusters according to their illness representation, and to identify, between the two clusters, the differences in functional state, mood, and quality of life.

METHODS

Seventy-four patients with ALS were recruited at our ALS Centre from different Italian regions, having been for multidisciplinary consultations. The patients' functional impairment was evaluated by the ALS Functional Rating Scale as well as the Bulbar Score and Forced Vital Capacity. Psychological Characteristics and quality of life of ALS patients were evaluated by Profile of Mood State, Illness Perception Questionnaire, and 36-item Short Form Health Survey.

RESULTS

Only few of the ALS patients studied showed critical mood ratings. On the whole, the perceived quality of life, mood state, and the dimensions relating to their illness representation seem to be correlated to the functional state and respiratory capacity. The clustering of patients according to their illness representations allowed to highlight that ALS patients can be divided into two groups: adaptors and nonadaptors. The patients of the two groups, adaptors and nonadaptors, differed in respiratory capacity as well as in their mood and health-related quality of life.

CONCLUSIONS

This study supports the Common Sense Model (CSM) of illness representation when considering ALS patients. Their psychological reactions to illness and quality of life depend not only on the severity of the illness but also on the way the illness is represented. Therefore, CSM could become the theoretical framework for psychological interventions in ALS patients.

The Italian Diabetes and Exercise Study (IDES): design and methods for a prospective Italian multicentre trial of intensive lifestyle intervention in people with type 2 diabetes and the metabolic syndrome

BACKGROUND AND AIMS

The IDES is a prospective Italian multicentre randomized controlled trial to evaluate the efficacy of an intensive lifestyle intervention on modifiable cardiovascular disease (CVD) risk factors in a large cohort of people with type 2 diabetes and the metabolic syndrome.

METHODS AND RESULTS

We recruited 606 subjects with type 2 diabetes and waist circumference >94 cm (M) and >80 cm (F), plus >1 other metabolic syndrome trait (IDF criteria) for both sexes, aged 40-75 years, BMI 27-40 kg/m(2), diabetes duration >1 year with a sedentary lifestyle of >6 months. Patients were randomized into two groups: a control group, receiving conventional care including exercise counselling and an intervention group, treated with a mixed (aerobic and resistance) exercise programme (150 min/week) prescribed and supervised for 12 months. Primary outcome is HbA1c reduction. Secondary outcomes include other traditional and non-traditional risk factors and their relationship to exercise volume/intensity and fitness; dosage of glucose, lipid and blood pressure-lowering drugs; global CVD 10-year risk; patient well-being; and costs.

CONCLUSION

This trial verifies whether a prescribed and supervised exercise programme, including both aerobic and resistance training, is more effective than conventional exercise counselling in reducing modifiable CVD risk factors in type 2 diabetic subjects with the metabolic syndrome.

Health-related quality of life in patients with anterior cruciate ligament insufficiency undergoing arthroscopic reconstruction: a practice-based Italian normative group in comorbid-free patients

Background

Health-related quality of life (HRQoL) in anterior cruciate ligament (ACL) insufficiency has not been assessed in comorbid-free patients to date. An observational study was therefore conducted on a practice-based sample to test the hypothesis that SF-36 scoring in patients with chronic ACL insufficiency differs from the age- and gender-matched Italian norm.

Materials and methods

Chronically ACL-insufficient patients with or without meniscal and/or focal chondral lesions were enrolled in the study. Exclusion criteria were acute ACL tear, severe and diffuse chondral lesions, concomitant knee major ligamentous injuries and/or fractures requiring surgery, previous ACL surgery and infectious, neoplastic and inflammatory disease. Knee function was evaluated by International Knee Documentation Committee (IKDC) form, HRQoL with the SF-36 questionnaire, and associated medical comorbidities by a Self-Administered Comorbidity Questionnaire (SCQ).

Results

A total of 316 consecutive patients, 265 males and 51 females (median age 25 years, range 15–52 years) met the inclusion/exclusion criteria. SF-36 norm-based scoring showed that the Physical Functioning, Role Physical, Bodily Pain, and Social Functioning domains were significantly lower than the Italian norm; the Role Emotional domain was also lower than the norm, but the difference was not significant. Conversely, the General Health and Mental Health domains scored significantly higher than the norm; the Vitality domain also exceeded, albeit not significantly, the norm.

Conclusions

The decision-making process leading to ACL reconstruction currently emphasises the evaluation of knee function and patients’ level of activity. The findings in our study, by showing that chronic ACL insufficiency significantly affects HRQoL in otherwise healthy patients, suggest that a multidimensional evaluation including HRQoL in addition to knee function might be integrated into outcome assessment.

Transperineal microwave thermoablation in patients with obstructive benign prostatic hyperplasia: a phase I clinical study with a new mini-choked microwave applicator

PURPOSE

To evaluate the tolerability and safety of a newly designed probe for trans-perineal microwave thermoablation (TPMT) of the prostate in patients with benign prostatic hyperplasia (BPH), and the in vivo microwave effects on prostatic tissue.

PATIENTS AND METHODS

Nine patients with obstructive BPH who were candidates for open prostatectomy were selected for this study. Under local anesthesia and transrectal ultrasound monitoring, all patients underwent a single standardized application of TPMT. The visual analog scale (VAS) and Short Form-36 health survey (SF-36) questionnaire were administered to each patient prior to, during, and 1 month after TPMT in order to evaluate pain and quality of life. Then the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaires were administered to each patient at baseline and 1 month after prostatectomy in order to evaluate sexual and urinary function, respectively. Then all patients were divided into three groups and underwent open prostatectomy 7, 15, and 30 days after TPMT, respectively. The prostatic adenomas were then evaluated by a pathologist.

RESULTS

No adverse events from TPMT treatment were noted. In particular, no patients reported local, pelvic, or abdominal pain during the procedure or subsequent alterations of defecation rhythm, ano-rectal/intestinal problems, or hematuria. No differences in quality of life or in sexual function were reported. The diameters of the lesions obtained with TPMT treatment ranged from 16 to 18.1 mm in all patients. Quasi-spheroid lesions with a well-defined area of complete coagulative necrosis were documented in all removed adenomas 7, 15, and 30 days after TMPT.

CONCLUSIONS

The AMICA-PROBE is a safe, well-tolerated, and repeatable method to treat BPH with microwave thermotherapy. The spheroid lesions obtained demonstrated the maximal control over the radial and longitudinal coagulative effects of the therapy. Phase II studies are needed to further evaluate the efficacy of this new probe.

Pain in multiple sclerosis: a clinical and instrumental approach

BACKGROUND

Pain is a frequent and disabling symptom in multiple sclerosis (MS) patients. In this study we assess the frequency and intensity of pain, as well as its impact on the quality of life and activities of daily living, in a sample of MS patients.

METHODS

One hundred and twenty eight MS patients underwent a neurological examination, a structured interview designed to assess pain, and a Medical Outcome 36-item Short Form Health Survey. Functional status was assessed by means of the Barthel Index (BI) and Rivermead Mobility Index. We also assessed the presence of depression, by means of the Montgomery and Asberg Depression Rating Scale, and fatigue, by means of the Fatigue Severity Scale. An algometer was used to measure thermal and discomfort thresholds in all of the patients and a group of 61 age- and sex-matched healthy subjects.

RESULTS

Pain was present in 61 patients. No differences were found between patients with and those without pain in disease duration, disease form or Expanded Disability Status Scale and its functional systems. Patients with pain had a lower vitality score (p = 0.008), mental health score (p = 0.03) and physical (p < 0.001) and mental composite scores (p = 0.01) than patients without pain. Furthermore, there was a significant difference between patients with and those without pain in the BI (p = 0.04). Both thermal and discomfort thresholds, as assessed by means of the algometer, were statistically lower in MS patients than in controls, whereas no difference was observed between patients with and those without pain. There was a statistically significant improvement in the thermal threshold in patients with pain who were treated pharmacologically when compared with those who were not treated (p = 0.049).

CONCLUSION

The results of this study provide further evidence of the negative impact that the presence of pain has on both the quality of life and activities of daily living in MS patients. The lower thermal and discomfort thresholds observed in our MS patients, compared with controls, may represent a predisposition to develop pain during the course of the disease.

Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication

BACKGROUND

We investigated which factors are significantly associated with long-term quality of life after laparoscopic total fundoplication in the treatment of gastroesophageal reflux disease.

METHODS

Patients (n = 144) were given a standardized frequency-intensity symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication.

RESULTS

At follow-up evaluation (n = 102), patients had a significant reduction in their symptoms score and no deterioration in quality of life. A significant association with postoperative dysphagia for solids and/or liquids was found in the physical component summary score of the Short-Form 36 administered to patients postoperatively (P = .003).

CONCLUSIONS

In this study, laparoscopic total fundoplication was a safe and effective surgical treatment for gastroesophageal reflux disease, generally offering an improved long-term quality of life, with the exception of a minority of patients (6 of 102 patients; 5.8%) who experienced persistent severe dysphagia.

The functional relevance of neurological recovery after lumbar discectomy: a follow-up of more than 20 years

We have studied 180 patients (128 men and 52 women) who had undergone lumbar discectomy at a mean of 25.4 years (20 to 32) after operation. Pre-operatively, most patients (70 patients; 38.9%) had abnormal reflexes and/or muscle weakness in the leg (96 patients; 53.3%). At follow-up 42 patients (60%) with abnormal reflexes pre-operatively had fully recovered and 72 (75%) with pre-operative muscle impairment had normal muscle strength. When we looked at patient-reported outcomes, we found that the Short form-36 summary scores were similar to the aged-matched normative values. No disability or minimum disability on the Oswestry disability index was reported by 136 patients (75.6%), and 162 (90%) were satisfied with their operation. The most important predictors of patients' self-reported positive outcome were male gender and higher educational level. No association was detected between muscle recovery and outcome. Most patients who had undergone lumbar discectomy had long-lasting neurological recovery. If the motor deficit persists after operation, patients can still expect a long-term satisfactory outcome, provided that they have relief from pain immediately after surgery.

The psoriatic arthritis cost evaluation study: a cost-of-illness study on tumour necrosis factor inhibitors in psoriatic arthritis patients with inadequate response to conventional therapy

OBJECTIVE

To evaluate costs, benefits and cost-effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment.

METHODS

A total of 107 patients, from nine Italian rheumatology centres, with different forms of PsA were given anti-TNF treatment, mainly etanercept (87%). Information on resource use, health-related quality of life, disease activity, function and laboratory values were collected at baseline and through out the 12 months of therapy. Cost (expressed in euro 2007) and utility (measured by EuroQol) before and after anti-TNF therapy initiation were compared in order to estimate the incremental cost per quality-adjusted life year (QALY) gained, and cost-effectiveness acceptability curve was calculated.

RESULTS

At the end of 12 months, there was a significant increase in direct cost due to an increase of drug cost caused by TNF inhibitors that was only partially offset by the decrease in indirect cost. In the last 6 months of therapy, the direct cost increased by euro5052, the cost for the National Health System (NHS) by euro5044 and the social cost by euro4638. However, a gain of 0.12 QALY resulted in a cost per QALY gained of euro40 876 for the NHS and of euro37 591 for the society. The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of euro60 000 per QALY gained.

CONCLUSION

Cost-effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.

Measures in chiropractic research: choosing patient-based outcome assessments

OBJECTIVE

Outcome assessment normally used in research can support the therapeutic process by tracking patient symptoms and function and offering a common language to clinicians and researchers. This study's objectives were to (1) identify patient-based outcomes assessments used in published chiropractic studies, (2) describe a framework for identifying appropriate sets of measures, and (3) address the challenges associated with these measures relevant to chiropractic.

METHODS

This literature review identified and evaluated the most commonly used to outcome measures in chiropractic research. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. A search of PubMed and Index to Chiropractic Literature (from inception to June 2006) was performed.

RESULTS

A total of 1166 citations were identified. Of these, 629 were selected as relevant. The most common patient-based outcomes assessments instruments identified were the Oswestry Pain/Disability Index, Visual Analog Scale, and Short Form 36.

CONCLUSIONS

The integration of outcome measures is consistent with current national initiatives to enhance health care quality through performance measurement and can also be used to further the field of chiropractic health care research. Outcome measures are both a research tool and a means by which providers can consistently measure health care quality. Based upon this review, there is a wide range of outcome measures available for use in chiropractic care. Those most commonly cited in the literature are the numeric rating scale, Visual Analog Scale, Oswestry Pain/Disability Index, Roland-Morris Low Back Pain and Disability Questionnaire, and Short Form 36.

Comorbidity-related quality of life in anterior cruciate ligament insufficiency: a cross-sectional study involving 282 candidates for arthroscopic reconstruction

BACKGROUND AND PURPOSE

Comorbidity-adjusted health-related quality of life (HRQoL) in anterior cruciate ligament insufficiency (ACLI) has not been assessed to date. A cross-sectional study was conducted to test the hypothesis that HRQoL in ACLI is comorbidity-related and differs from the Italian norm.

METHODS

282 chronically ACL-insufficient candidates for arthroscopic reconstruction with or without meniscal and/or focal chondral lesions were studied. Knee function was evaluated with IKDC form, HRQoL with SF-36, and associated medical comorbidities with a self-administered questionnaire allowing calculation of a comorbidity index (CI). Patients were stratified according to CI into subgroup A (CI = 0) and subgroup B (CI > 0). The SF-36 profiles in the whole sample and in subgroups A and B were compared with the Italian norm.

RESULTS

Of the 282 patients, 82 had associated comorbidity and 200 did not. Patients with comorbidity were older and had a higher degree of knee laxity than patients without comorbidity. Distinctive SF-36 profiles were obtained after stratification by comorbidity and comparison with the age- and sex-matched norm. The SF-36 profile in subgroup A showed statistically significantly lower scores on the PF, RP, BP, and SF domains while the GH and MH domains were statistically significantly higher than the norm. Subgroup B showed statistically significantly lower scores than the norm for the PF, RP, BP, VT, SF and RE domains.

INTERPRETATION

Comorbidity-related HRQoL in ACL-insufficient candidates for arthroscopic reconstruction showed statistically significant differences from the norm. Comorbid illness acting as confounder should thus be controlled for when reporting SF-36 profiles, in order to avoid selection bias. Our findings may also be used as benchmark data for researchers investigating SF-36 profiles in ACLI.

Inguinal hernioplasty improves the quality of life in patients with cirrhosis

BACKGROUND

The optimal management of symptomatic inguinal hernia (SIH) in cirrhotics is still undefined. Both hernia and cirrhosis impair quality of life (QOL). The aim of this study was to evaluate QOL by a Short Form-36 (SF-36) questionnaire in cirrhotic patients undergoing inguinal hernioplasty.

METHODS

Thirty-two cirrhotic patients undergoing inguinal hernioplasty were evaluated. They were classified according to Child's class and to the absence or presence of refractory ascites. The SF-36 questionnaire was administered the day before and 6 months after surgery. Global analyses of the 8 domains of SF-36 and of 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS), were performed.

RESULTS

Lichtenstein hernioplasty for SIH originated no major complications. All 8 domains of SF-36 and MCS and PCS scores improved remarkably after hernioplasty especially in patients in Child's class C and/or with refractory ascites.

CONCLUSIONS

Inguinal hernioplasty for SIH in patients with cirrhosis is a safe procedure. The improvement of QOL represents a clear cut indication for elective hernia repair.

Health-related quality of life in epilepsy: findings obtained with a new Italian instrument

The aim of the present study was to evaluate the Epi-QoL, a new Italian-specific measure of health-related quality of life (HRQOL) for adults with epilepsy; the clinical variables that affected the HRQOL score were also assessed. The Epi-QoL is a 46-item self-administered questionnaire focusing on six domains: Physical Functioning, Cognitive Functioning, Emotional Well-Being, Social Functioning, Seizure Worry, and Medication Effects. Eight hundred fifteen patients recruited from 24 secondary and tertiary Italian centers for the care of epilepsy were assessed. The results supported the reliability and validity of the Epi-QoL as a measure of HRQOL. The variables that significantly affected HRQOL scores were: geographic area, gender, seizure frequency, prognostic categories, number of medications, comorbidity, presence of cognitive impairment, psychiatric disturbances, and disability. We believe that a new specific questionnaire for the evaluation of HRQOL in Italy can contribute much to the understanding of the influence of epilepsy on patients' lives.

Determinants of quality of life in Marfan syndrome

BACKGROUND

Marfan syndrome (MFS) is a rare, heritable disorder that affects connective tissue. Men and women are equally affected. Clinical manifestations involve multiple sites, especially bones and ligaments and heart and blood vessels.

OBJECTIVE

Authors sought to investigate quality of life (QoL) in MFS patients, assessing positive and negative sociodemographic factors and self-perceived well-being and functional status.

METHOD

Thirty-six patients affected by MFS were interviewed and were administered the SF-36 psychometric questionnaire.

RESULTS

Subjects affected by MFS reported an impaired quality of life in the psychological domain but not in the physical domain, as compared with a healthy population. Being male and older was significantly associated with a poorer perceived mental QoL.

CONCLUSION

The authors found that MFS negatively influences QoL, increases psychological distress, and may be a possible risk for some psychiatric disorders.

Echocardiographic Follow-Up after Implanting 17-mm Regent Mechanical Prostheses

The aim of this study was to evaluate midterm echocardiographic results and changes in quality of life after aortic valve replacement with 17-mm St. Jude Medical Regent mechanical prostheses in patients with aortic valve stenosis. The study population was 34 women and 2 men, aged 31–83 years. Echocardiographic follow-up was 100% complete at 4.1 ± 1.8 years. Hospital mortality was 5.6%. Actuarial 5-year survival was 88.5% ± 0.067%. Postoperative echocardiography showed significant regression of left ventricular mass index and significant reductions of peak gradient, mean gradient and mean effective orifice area index. All survivors were interviewed using the 36-item Short Form Health Survey questionnaire. Scores obtained in 7 of the 8 domains of the test were significantly higher than preoperative values. In our experience, implantation of this prosthesis allowed regression of left ventricular mass index and improved the perceived quality of life.

Health-related quality of life outcomes in disease-free survivors of mid-low rectal cancer after curative surgery

BACKGROUND

The main objective of this study was to investigate health-related quality of life (HRQOL) in terms of symptoms and functional outcomes in disease-free survivors of rectal cancer.

METHODS

Consecutive patients (n = 117) who underwent curative surgery for rectal cancer with a minimum of 2 years' follow-up and whose disease had not recurred were asked to complete the European Organization for Research and Treatment of Cancer QLQ-C30 and its colorectal cancer module (QLQ-CR38). Long-term HRQOL outcomes were compared with reference data from the general population. Relevant clinical data including type of surgery, stage of disease, type of treatment, and early and late complications were collected. Univariate and multivariate regression analyses were performed to investigate associations among covariates.

RESULTS

HRQOL functional aspects were similar with that of an age- and sex-matched general population. Although clinically meaningful better outcomes favoring our patients were found for the global health status/HRQOL and the pain scales, constipation was worse in rectal cancer survivors than the general population. Multivariate analysis found that worse physical functioning was associated with increasing age (P < .001), female sex (P < .01), presence of stoma (P < .05), and occurrence of late major complications (P < .05). Worse body image was associated with the presence of stoma (P < .001) and chemoradiotherapy (P < .05).

CONCLUSION

Overall, patients with rectal cancer recover well in the long run, with HRQOL levels comparable to that of the general population. HRQOL outcomes provide valuable data that may be used to improve information disclosure to patients.

Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patients: Results of the sentinella–GIVOM Italian randomised clinical trial

AIMS

To compare physical morbidity and health-related quality of life (HRQOL) in breast cancer patients who received standard axillary dissection (ALND) or sentinel lymph node biopsy (SLNB), followed by axillary dissection only in the case of sentinel-node positivity, within a randomised clinical trial.

PATIENTS AND METHODS

Patients with early breast cancer < or =3cm and clinically negative axilla were randomly allocated to ALND or SLNB. All patients underwent physical examination every 6 months in order to assess any arm-related symptoms. A subset of patients completed the SF-36 quality of life questionnaire and the Psychological General Well Being Index (PGWBI) before randomisation, at 6 and 12 months after surgery and yearly thereafter. Results of the first 24 months are reported.

RESULTS

Six-hundred and seventy-seven patients were available for analysis: 341 patients randomised to the ALND group and 336 to the SLNB group. Six months after surgery, the SLNB group had significantly less lymph-oedema, movement restrictions, pain and numbness with respect to the ALND group. Lymph-oedema was also significantly reduced at 12 months and numbness remained significantly less frequent in the SLNB arm at all time points. Three-hundred and ten patients participated in the HRQOL assessment. The mean scores of the PGWB questionnaire general index and anxiety domain were significantly better in the SLNB group than in the ALND group but the difference ceased to be significant at 24 months.

CONCLUSIONS

The SLNB is associated with reduced arm morbidity without evidence of a negative impact on psychological well being. While waiting for long-term results of ongoing randomised clinical trials, the SLNB may be proposed for early stage breast cancer patients after adequate information on the expected advantages and the possible risks.

Minimally invasive surgery for colorectal cancer: quality of life, body image, cosmesis, and functional results

BACKGROUND

The aims of this cross-sectional study were to assess the long-term quality of life, the body image, and the cosmetic and functional results in patients who had laparoscopic-assisted for colorectal cancer.

METHODS

Forty-two patients were enrolled in this study: 21 consecutive patients who had undergone laparoscopic-assisted colonic resection and 21 patients who had open colonic resection, selected according to stage, gender, age, cancer site, and type of resection. The patients answered four questionnaires about their quality of life, body image, functional, and cosmetic results. Nonparametric tests were used for statistical analysis.

RESULTS

Postoperative hospital stay was shorter in patients who had laparoscopic-assisted resection. The cosmetic score was significantly better in the laparoscopic-assisted group than in the open group (p < 0.01). In spite of similar overall body image score, patients who had a laparoscopic-assisted resection reported a significantly better satisfaction with their own body (p = 0.05). Quality-of-life and functional results were similar in both groups.

CONCLUSIONS

The cosmetic results and the consequent satisfaction with the body were significantly better after laparoscopic assisted resection compared to equivalent open procedure. These effects seemed to be temporary but they could help patients to accept the burden of surgery.

Validation of the Italian version of the Cystic Fibrosis Quality of Life Questionnaire (CFQoL), a disease specific measure for adults and adolescents with cystic fibrosis

BACKGROUND

Disease specific, health-related quality of life (HRQoL) measurement is important in cystic fibrosis (CF). This work aimed to translate the original English Cystic Fibrosis Quality of Life Questionnaire (CFQoL) into Italian, evaluate the linguistic translation and to psychometrically evaluate the Italian version of the CFQoL.

METHODS

The linguistic translation followed the international guidelines of forward and backward translation. Psychometric evaluation of the Italian CFQoL involved the assessment of construct validity, internal reliability, concurrent validity, known groups validity and test-retest reliability.

RESULTS

The instrument was acceptable to adolescents and adults with CF and demonstrated robust psychometric properties. Principle components analysis indicated that the factorial structure was essentially similar to the original, and the internal reliability of each domain was good (Cronbach alpha coefficients 0.73 to 0.91). Appropriate domains of the CFQoL and SF-36 correlated well indicating good concurrent validity (r=0.68-0.80). Consistent with theoretical expectations some domains were able to discriminate between disease severity groups. Test-retest reliability, assessed by intraclass correlation coefficients, was found to be excellent (ICC 0.83 to 0.98).

CONCLUSIONS

The Italian CFQoL is a valid and reliable measure. Its use in individual patient monitoring and research should complement traditional clinical outcome measures.

The health impact of pemphigus vulgaris and pemphigus foliaceus assessed using the Medical Outcomes Study 36-item short form health survey questionnaire

BACKGROUND

Pemphigus vulgaris and pemphigus foliaceus are rare, potentially life-threatening, autoimmune disorders characterized by antibodies to epidermal adhesion molecules. Clinical characteristics are painful chronic erosions of mucous membranes and of the skin. There are only few published studies on the impact of the disease on the health status (HS) of patients with these conditions.

OBJECTIVES

To assess the impact of disease on the HS of patients with pemphigus.

METHODS

Fifty-eight patients enrolled at the Bullous Skin Diseases Unit of IDI-IRCCS in the period January-June 2006 were assessed for their HS using the Medical Outcomes Study 36-item short form health survey (SF-36) questionnaire and for anxiety and depression using the Institute for Personality and Ability Testing questionnaires.

RESULTS

A compromised HS on both the physical and the psychosocial scales was observed, similar to other chronic dermatological diseases such as psoriasis. Patients with anxiety had severe disease as measured by the Physician's Global Assessment and the degree of mucocutaneous involvement, as well as those with a more recent disease onset. A better HS was observed in patients whose clinical condition was rated as nonsevere, and also in patients with pemphigus foliaceus. In pemphigus vulgaris, antidesmoglein 3 antibody levels directly correlated with clinical severity and with lower SF-36 scores.

CONCLUSIONS

HS evaluated with the SF-36 can be a very useful additional outcome criterion in clinical studies with pemphigus. The management of the disease must take into account its impact on various aspects of life of the patient.

Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections

AIMS

The aim of this case-control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI).

METHODS

Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF-36 Health Survey (SF-36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio.

RESULTS

Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA(1c) were similar. Of control subjects, 90% followed glargine-based MDI regimens and 10% used NPH-based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions (beta = 5.96; P < 0.0001), daily hassles (beta = 3.57; P = 0.01) and fears about hypoglycaemia (beta = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score (beta = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine- or NPH-based MDI regimens.

CONCLUSIONS

This large, non-randomized, case-control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine-based or NPH-based MDI regimens.

UFT as maintenance therapy in patients with advanced colorectal cancer responsive to the FOLFOX4 regimen

BACKGROUND

In advanced colorectal cancer (ACC), FOLFOX4 has been accepted as a standard chemotherapeutic regimen. Due to the neurotoxicity induced by oxaliplatin, which occurs in about 50% of patients during the 6-month FOLFOX4 regimen, and the frequent need for hospitalization, alternative regimens may be required. We aimed to determine whether a 'maintenance' therapy with oral UFT (uracil-tegafur) in patients responding to FOLFOX4 is able to maintain the response and improve the quality of life (QoL) as a result of the outpatient regimen and lower psychological distress.

METHODS

Untreated patients with ACC who did not progress after 6 months of FOLFOX4 received oral UFT until disease progression or unacceptable toxicity. The aim of the study was to maintain the response obtained with the FOLFOX4 regimen for at least 6 months. The secondary objective was to evaluate QoL during the two different treatment regimens utilizing the 36-item Short Form Health Survey (SF-36).

RESULTS

From January 2003 to August 2004, out of the enrolled 30 patients [22 males and 8 females; 2 patients with a complete response (CR), 14 patients with a partial response (PR) and 6 patients in stable disease (SD) after 6 months of FOLFOX4] 22 continued therapy with UFT until progression without significant toxicity; the remaining 8 patients (27%) had progressive disease (PD) during or at the end of FOLFOX4 and were treated with other regimen. After 6 months of UFT, 4 patients (13%) had CR, 6 patients (20%) PR and 4 patients (13%) SD; 16 patients (53%) progressed. Median follow-up was 31 months [interquartile range (IQR): 20-31 months]; 14 patients died of PD. The median time to progression was 13.9 (IQR: 7.7-20.1) months and the median survival time was 31 months (IQR: 20-31 months). Evaluation of QoL demonstrated a trend towards better QoL during UFT treatment.

CONCLUSIONS

These results support the feasibility of maintaining good response and improving QoL (measured by SF-36) with an oral fluoropyrimidine after combination chemotherapy in ACC patients; moreover, since UFT can be used orally, patient compliance is increased and the duration of hospitalization can be decreased.

Health-related quality of life and subjective outcome after shoulder replacement for proximal humeral fractures

Shoulder replacement has increased exponentially in recent decades, and previous studies have documented the effectiveness of this procedure. Pain relief, physical functional level, and health-related quality of life, however, were often not assessed. To our knowledge, no published articles have assessed quality of life in shoulder replacement for fracture. The main purpose of this study was to assess the patient-relevant outcomes in patients who underwent shoulder replacement for proximal humeral fractures. Standardized quality of life and shoulder-specific, self-administered questionnaires were used. On the Medical Outcomes Study Short Form 36 Health Survey, as expected, we observed a lower score in the domain compared with healthy Italian subjects. A surprising finding was that in the General Health and Role-Emotional domains, our sample had a better picture than the healthy one, probably because patients had experienced severe trauma and major surgery previously. These data represent the first step toward the definition of outcome for this procedure. This study does not address the necessity of therapy, but if this were included in future publications, it might provide useful data for therapeutic recommendations.

The questionnaire of family functioning: a preliminary validation of a standardized instrument to evaluate psychoeducational family treatments

The aim of the study was to develop and preliminarily validate a self-completed questionnaire that could help in the assessment of families before and during psycho-educational interventions. The questionnaire was developed according to the cognitive-behavioural psycho-educational model. From an initial 38-item version of the questionnaire, a final shorter 24-item version was derived. The validation study of the final version was conducted on relatives of schizophrenic and schizoaffective patients: 31 for the test-retest reliability study and 92 for the confirmation of the subscales and convergent validity study vs. SF-36 and the questionnaire on Family Problems, PF. The final questionnaire showed good psychometric properties. The three-core dimensions of Problem-Solving, Communication Skills, and Personal Goals were clearly outlined in the items correlation analysis. The association with family burden and health-related quality of life was as expected. The FF provides a promising assessment of the family functioning pattern that is the object of psychoeducational family interventions. Further studies are needed to confirm the validity of the instrument, that could be helpful both in planning and in monitoring psycho-educational interventions and in mental health promotion projects.