Quality of life measures in health care. I: Applications and issues in assessment

Evaluation of quality of life in patients undergoing surgery for benign prostatic hyperplasia

INTRODUCTION

Benign prostatic hyperplasia (BPH) is one of the most common diseases in the world and also one of the most common causes of urinary complaints that occur with increasing age. Thus, BPH should be addressed with surgical procedures. To contribute to the relevant literature, the present study aims to investigate the effects of surgical therapies for BPH on the patients quality of life.

MATERIALS AND METHODS

This study included 120 patients who underwent surgery for BPH at a Training and Research Hospital. The short-form health survey (SF-36) was administered to the patients before the surgery and at three months after the surgery. Eight parameters of the SF-36 and mental (MCS) and physical (PCS) component summary scores were calculated. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis.

RESULTS

When the eight parameters within the SF-36 health questionnaire were examined separately, the findings showed that patients quality of life increased significantly with respect to physical functioning, social functioning, and role limitations because of emotional problems , vitality, bodily pain, general health perceptions, and mental health domains three months after surgery (p < .001). The PCS and MCS significantly increased after surgery (p < .001).

CONCLUSION

The SF-36 questionnaire results showed that a significant improvement in the patients quality of life was observed in patients who underwent surgery for BPH. Our findings suggest that SF-36 could be considered a reliable evaluation test to be used in the patients with BPH after surgery.

Reliability, validity and responsiveness of the German Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery

BACKGROUND

Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopaedic procedures. The intention of this study was to develop and culturally adapt a German version of the Manchester-Oxford Foot Questionnaire (MOXFQ) and to evaluate reliability, validity and responsiveness.

METHODS

According to guidelines forward and backward translation has been performed. The German MOXFQ was investigated in 177 consecutive patients before and 6 months after foot or ankle surgery. All patients completed MOXFQ, Foot and Ankle Outcome Score (FAOS), Short form 36 and numeric scales for pain and disability (NRS). Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed.

RESULTS

The German MOXFQ demonstrated excellent test-retest reliability with ICC values >0.9 Cronbach's alpha (α) values demonstrated strong internal consistency. No floor or ceiling effects were observed. As hypothesized MOXFQ subscales correlated strongly with corresponding FAOS and SF-36 domains. All subscales showed excellent (ES/SRM >0.8) responsiveness between preoperative assessment and postoperative follow-up.

CONCLUSIONS

The German version of the MOXFQ demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in foot and ankle patients.

Spanish Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes: VELO-Spanish

Background:

Quality of life (QOL) assessments are useful tools that measure a patient’s health status and monitor patient-reported outcome measures. This study highlights the process of linguistic validation of a QOL assessment to serve Spanish-speaking families and ultimately help decrease language barriers in the treatment of velopharyngeal insufficiency (VPI).

Methods:

The standardized linguistic validation process included forward and backward translation, reconciliation, and cognitive interviews with patients and families. Preliminary instrument test-retest measurement was assessed. Eligibility for cognitive interviews included families with familiarity of velopharyngeal insufficiency. Exclusion criteria included illiteracy and parent and child respondents who do not speak Spanish. Reliability was tested by intraclass correlation (ICC) on VPI Effects on Life Outcomes (VELO)–Spanish instruments completion on 2 measurements from the medical record.

Results:

The instrument was optimized through a standardized forward and backward translation process. Further problematic language was identified during cognitive interviews with families and their children. In the second interview, only minimal changes were needed. Twenty-one patients (8 males and 13 females) were included. Mean (SD) age was 8.0 (5.3) years (range, 3–21 years). The mean (SD) Velo-Spanish score was 65 (22.1); range 32.7–100. The VELO-Spanish instrument demonstrated excellent test–retest reliability [ICC = 0.91; n = 21 and internal consistency (α = 0.96)].

Conclusions:

The Spanish VELO has been developed and refined for use in Spanish-speaking populations as a VPI-specific QOL instrument. The linguistic validation process including cognitive interviews and initial reliability testing. The instrument may improve the understanding of patient-reported outcomes and potential disparities from linguistic and cultural barriers in VPI treatment

The reliability and validity of the Turkish version of the oxford shoulder instability score

Background: The aim of this study was to adapt the Oxford Shoulder Instability Score to Turkish culture and test its reliability and validity.Methods: This study included 118 patients with shoulder instability. Confirmatory factor analyses, and correlation coefficient between Oxford Shoulder Instability Score and Short Form 36 were calculated in order to test construct validity. Internal consistency was tested using Cronbach's alpha. Pearson correlation were calculated to test reliability. Differential item functioning analysis was performed to detect whether items exhibited differences according to gender.Results: Confirmatory factor analysis indicating the single structure of the Oxford Shoulder Instability Score was confirmed. Cronbach's alpha was calculated as 0.87 for the whole scale. There were positive and strong correlations between the first and follow-up assessments (r = 0.86, p < 0.01). The Turkish version of OSIS showed moderate and significant correlations with domains of the SF-36 in general. Results also showed that there was no item exhibiting differential item functioning analysis in the Turkish version of Oxford Shoulder Instability Score.Conclusion: The Turkish version of the Oxford Shoulder Instability Score is a reliable, valid, reproducible and practical tool. It can be used for patients with shoulder disorders and is recommended for clinical use.Implications for RehabilitationOxford Shoulder Instability Score is a 12-item tool measuring health-related quality of life and shoulder functions.Since the Turkish version of the Oxford Shoulder Instability Score is confirm to be a reliable, valid, and reproducible tool, it can be used in clinics to assess the functional status in patient with shoulder instability.It can be recommended to identify improvements in patients with shoulder problems for research purposes as well.

The impact of an adaptation course on health-related quality of life and functional capacity of patients with inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD) has a substantial impact on patients health-related quality of life (HRQoL). In this study, we examined the impact of adaptation courses on HRQoL, psychological well-being, depression and number of sick-leave days of IBD patients.

METHODS

The study recruited 142 IBD patients attending an adaptation course of 5-12 days. The courses were specially designed for IBD patients and included multidisciplinary information about IBD, peer support, group activities and encouragement for adequate physical exercise. The participants completed the study questionnaire at the beginning and the end of the course and after six and 12 months of follow-up. HRQoL was assessed with the generic 15-dimensional (15D) tool and depression with Beck's Depression Inventory (BDI). Utilization of health care services and work absenteeism was also assessed. Visual analog scales were used for assessing psychological functioning.

RESULTS

15D, BDI scores and scores describing psychological well-being were significantly better at the end of the course when compared to baseline (15D 0.82 vs. 0.84, p < .001; BDI 11.8 vs. 8.5, p < .001). Positive results were maintained during follow up. The percentage of patients receiving peer support rose from 32 to 70% and those with peer support had better HRQoL at the 12-month follow-up (p = .01). No significant change in health care utilization or number of sick-leave days was observed.

CONCLUSION

Adaptation training appears to have a positive impact on the psychological well-being of IBD patients. Peer support appears to be an important factor.

Oral clinical status and oral health-related quality of life: is socioeconomic position a mediator or a moderator?

AIM

To evaluate whether socioeconomic position exerts a mediating and/or moderating effect on the association between oral clinical measures and oral health-related quality of life (OHRQoL) in adolescents.

MATERIALS AND METHODS

The study analysed data on 5,445 adolescents aged 15-19 years from the Brazilian Oral Health Survey (SBBrasil Project). The numbers of decayed and missing teeth, number of sextants with gingivitis and malocclusion were assessed through oral clinical examinations. Participant's age, sex, OHRQoL and socioeconomic position were also collected. Monthly family income was used to indicate the participant's socioeconomic position, and OHRQoL was assessed using the Oral Impacts on Daily Performance. Moderation was tested using Poisson regression models. Structural equation modelling and Sobel's test assessed the mediation effects.

RESULTS

Oral clinical measures, OHRQoL and socioeconomic position were significantly correlated (P < 0.001). The moderator effect of socioeconomic position on the association between all oral clinical measures and OHRQoL was observed. The impact of all oral clinical conditions on adolescents' OHRQoL was lower in the low-family-income groups compared with those with a better income. Socioeconomic position partially mediated the relationship between the four oral clinical measures and OHRQoL. Sobel's test confirmed these findings (P < 0.001).

CONCLUSIONS

The findings suggest the importance of socioeconomic position as a moderator and mediator factor between oral clinical measures and OHRQoL. Disadvantaged adolescents are likely to experience poor OHRQoL due to oral conditions. The reduction of the impact of oral conditions on quality of life in adolescents may be enhanced by addressing social inequalities related to oral health.

Changes in health-related quality of life (EQ-5D) dimensions associated with community-based musculoskeletal physiotherapy: a multi-centre analysis

Purpose

To determine the changes in each of the five dimensions of the EuroQol 5-dimension index associated with community-based physiotherapy.

Methods

Four thousand one hundred and thirty-six patients that received community-based musculoskeletal physiotherapy across five NHS centres completed the EQ-5D on entry into the service and upon discharge. Patients were categorised on symptom location and response to treatment based on their EQ-5D index improving by at least 0.1 (“EQ-5D responders”). For each symptom location, and for responders and non-responders to treatment, the mean (± SD) were calculated for each dimension pre- and post-treatment as well as the size of effect.

Results

The mobility dimension improved (p < 0.05) in all symptom locations for EQ-5D responders (d = 0.26–1.58) and in ankle, knee, hip and lumbar symptoms for EQ-5D non-responders (d = 0.17–0.45). The self-care dimension improved (p < 0.05) in all symptom locations for EQ-5D responders (d = 0.49–1.16). The usual activities dimension improved (p < 0.05) across all symptom locations for EQ-5D responders (d = 1.00–1.75) and EQ-5D non-responders (d = 0.14–0.60). Despite the pain/discomfort dimension improving (p < 0.05) across all symptom locations for both EQ-5D responders (d = 1.07–1.43) and EQ-5D non-responders (d = 0.29–0.66), the anxiety/depression dimension improved (p < 0.05) from higher starting levels in EQ-5D responders (d = 0.76–1.05) with no change seen for EQ-5D non-responders (d = − 0.16 to 0.06).

Conclusions

Clinicians should not assume that a patient presenting with pain but expressing high anxiety/depression is unlikely to respond to treatment, as they may show the best HRQoL outcomes. For patients presenting with pain/discomfort and low levels of anxiety/depression, the EQ-5D index is perhaps not a suitable tool for sole use in patient management and service evaluation.

The burden of chronic rhinosinusitis and its effect on quality of life among patients re-attending an otolaryngology clinic in south western Uganda

BACKGROUND

Worldwide, the burden of chronic rhinosinusitis (CRS) is variable, but not known in Uganda. CRS has significant negative impact on quality of life (QOL) and as such QOL scores should guide adjustments in treatment strategies. However, most of these studies have been done in the west. Our hypothesis was that QOL scores of the majority of CRS patients in low- to- middle income countries are poorer than those among patients without CRS. The aim of this study was to determine the burden of CRS among patients re-attending the Otolaryngology clinic and whether CRS is related to poor QOL.

METHODS

A cross sectional study was conducted at Mbarara Regional Referral Hospital Otolaryngology clinic. One hundred and twenty-six adult re-attendees were consecutively recruited. Data was collected using a structured questionnaire and the Sinonasal Outcome Test 22 (SNOT 22) questionnaire measured QOL.

RESULTS

The proportion of re-attendees with CRS was 39.0% (95% CI 30-48%). Majority of CRS patients had poor quality of life scores compared to non-CRS (88% versus 20% p < 01). The poor quality of life scores on the SNOT 22 were almost solely as a result of the functional, physical and psychological aspects unique to CRS.

CONCLUSIONS

CRS is highly prevalent among re-attendees of an Otolaryngology clinic at a hospital in resource limited settings and has a significant negative impact on the QOL of these patients.

Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons

OBJECTIVE

To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs.

DESIGN

Online survey.

PARTICIPANTS

Surgeons who are members of the AO Foundation.

MEASURES

Participants answered questions regarding demographics, their familiarity with specific and generic PROMs and the use of PROMs in clinical routine. Furthermore, reasons for/against using PROMs, why not used more often, prerequisites to implement PROMs into clinical routine and whether PROMs would be implemented if adequate tools/technologies were available, were solicited. Χ² tests and multivariable logistic regressions were conducted to evaluate the effect of the AO Region, surgeon specialisation, current position, clinical experience, and workplace on the familiarity with disease-specific PROMs, the familiarity with generic PROMs and the current use of PROMs. Exploratory factor analysis was used to identify issues underlying the extent of PROM usage.

RESULTS

1212 surgeons completed the survey (response rate: 6.8%; margin of error: ±2.72%): 54.2% were trauma/orthopaedic surgeons, 16.6% were spine surgeons, 27.9% were craniomaxillofacial surgeons and 16 had no defined specialty. Working in a certain AO Region, surgical specialisation and current workplace were associated with a higher familiarity of disease-specific PROMs and the use of PROMs in daily clinical routine (p≤0.05). Exploratory factor analysis identified four categories important for the use of PROMs and two categories preventing the use of PROMs. In case of the availability of an adequate tool, 66.2% of surgeons would implement PROMs in clinical routine.

CONCLUSIONS

Our survey results provide an understanding of the use of PROMs in clinical routine. There is consensus on the usefulness of PROMs. User-friendly and efficient tools/technologies would be a prerequisite for the daily use of PROMs. Additionally, educational efforts and/or policies might help.

What Do Italian Hospital Physicians Know about Quality of Life Assessment in Oncology?

Aims

To assess the current level of information and use of quality of life assessment instruments by Italian physicians involved in oncologic patient care.

Methods

Specifically trained scientific representatives of a pharmaceutical company interviewed 2237 hospital physicians all over Italy.

Results

A total of 1390 physicians (62.1%) had some knowledge of quality of life assessment tools in oncology, but 364 of them (26.2%) were unable to recall the name of any instruments. The one that was most frequently recalled by the 1026 physicians who knew of the existence of one or more instruments was the Karnofsky Performance Status (KPS) (91%) followed by the Eastern Cooperative Oncology Group performance scale (ECOG) (35.5%) whereas the Quality of Life Index and Visual Analogue Scale were at the very bottom of the list (5.9% and 3.7%, respectively). Physician age and type of department were found to be strong predictors of knowledge of the instruments, which was greater among young physicians and those working in oncological departments. Of the physicians aware of the KPS, 56.6% used it, whereas the percentage of physicians using ECOG was higher (69.5%).

Conclusions

The collected data indicate a poor knowledge of quality of life assessment instruments in Italian physicians. Most physicians tend to use so-called «objective» instruments where the assessment is made by the physician and not by the patient (KPS, ECOG Quality of Life index), are practically unaware of the new generation of «subjective» self-rating instruments. The use of such instruments in particular might provide greater insights into the impact of the disease and related treatments on the quality of life of cancer patients.

Patient-Physician Agreement Using Summary Outcome Determination Scores

OBJECTIVE

To determine whether the Summary Outcome Determination (SOD) score had exhibited a high level of physician-patient agreement in surgical patients.

PATIENTS AND METHODS

The medical records of 320 postoperative patients were reviewed, of whom 164 patients were included in the study. Patients were included if both physician-assigned and patient-assigned SOD scores had been recorded. The SOD is administered as follows: the patient is asked "Compared to before surgery, is your elbow/shoulder better, worse or no different?" If better: "Is it improved, greatly improved, almost normal or normal?" If worse: "Is it worse or profoundly worse, or as bad as dying?" Each category is associated with a numerical value and definition for further clarification. The patient is asked to assign a category and a numerical value after the physician has already done so. These categories and values were evaluated between raters (ie, physician and patient) to assess reliability.

RESULTS

The intraclass correlation coefficient of physician-patient numerical ratings was "excellent" (0.93). The Bland-Altman 95% limits of agreement on the differences between the physician and the patient ranged from -1.3 to 1.3. The physician and patient numerical rankings matched exactly in 118 patients (72%) or differed by a factor of no more than 1 (26%) in 161 (98%) patients.

CONCLUSION

The SOD score can be used as both a surgeon-based and a patient-based outcome score, given the high level of agreement. Given its brevity, ease of understanding, and high interrater reliability, the SOD has the potential to be used across multiple specialties to rate outcomes.

Sample size calculations based on a difference in medians for positively skewed outcomes in health care studies

Background

In healthcare research, outcomes with skewed probability distributions are common. Sample size calculations for such outcomes are typically based on estimates on a transformed scale (e.g. log) which may sometimes be difficult to obtain. In contrast, estimates of median and variance on the untransformed scale are generally easier to pre-specify. The aim of this paper is to describe how to calculate a sample size for a two group comparison of interest based on median and untransformed variance estimates for log-normal outcome data.

Methods

A log-normal distribution for outcome data is assumed and a sample size calculation approach for a two-sample t-test that compares log-transformed outcome data is demonstrated where the change of interest is specified as difference in median values on the untransformed scale. A simulation study is used to compare the method with a non-parametric alternative (Mann-Whitney U test) in a variety of scenarios and the method is applied to a real example in neurosurgery.

Results

The method attained a nominal power value in simulation studies and was favourable in comparison to a Mann-Whitney U test and a two-sample t-test of untransformed outcomes. In addition, the method can be adjusted and used in some situations where the outcome distribution is not strictly log-normal.

Conclusions

We recommend the use of this sample size calculation approach for outcome data that are expected to be positively skewed and where a two group comparison on a log-transformed scale is planned. An advantage of this method over usual calculations based on estimates on the log-transformed scale is that it allows clinical efficacy to be specified as a difference in medians and requires a variance estimate on the untransformed scale. Such estimates are often easier to obtain and more interpretable than those for log-transformed outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-017-0426-1) contains supplementary material, which is available to authorized users.

Health-related quality of life in residents aged 18 years and older with and without disease: findings from the First Provincial Health Services Survey of Hunan, China

OBJECTIVE

Published research has not considered acute diseases and injuries in assessing the impact of varying disease counts on health-related quality of life (HRQoL). We used Chinese value sets of EQ-5D-3L to examine the relationship between the number of diseases individuals had (including chronic diseases, acute diseases and injuries) and their HRQoL.

METHODS

A total of 19 387 individuals aged 18 years and older were included in the study. Using data from the First Provincial Health Services Survey of Hunan, China, HRQoL was assessed with the EQ-5D-3L scale, a standardized instrument developed by the EuroQoL group. The EQ-5D-3L utility score was calculated using the Chinese EQ-5D-3L value set. This survey coded disease using the list of 133 conditions that was defined by the First Provincial Health Services Survey of Hunan, China, based on the 10th International Classification of Diseases. 126 conditions were disease-related and were therefore included in data analysis.

RESULTS

Of 15 245 respondents, urban residents and male constituted 53.0% and 48.2%, respectively. 19.3% of respondents had one disease and 5.0% had at least two diseases. Of the five dimensions of the EQ-5D-3L, the pain/discomfort dimension had the highest proportion of moderate or serious problems among the respondents (14.4%, 95% CI 10.5% to 18.2%). The average Visual Analogue Scale (VAS) score and utility score were 78.0 (95% CI 76.9 to 79.1) and 0.958 (95% CI 0.946 to 0.970), respectively. Residents with 1 and ≥2 diseases had higher proportions of moderate or serious problems in five dimensions of the EQ-5D-3L scale during the previous 2 weeks than those without disease after controlling for location (urban/rural), sex, age, education level and household income, respectively (adjusted ORs: 3.1-3.7 and 4.4-6.6, respectively). The mean of the EQ VAS score was 8.4 and 13.6 points lower in respondents with 1 and ≥2 diseases than in respondents without disease; the corresponding mean score difference was 0.048 and 0.086 in EQ-5D-3L utility score. Disease-specific analyses were not conducted due to the inadequacy of sample size.

CONCLUSIONS

The HRQoL of residents aged 18 years and older declines distinctly as the number of diseases increases. Actions should be taken to improve the HRQoL of residents with multiple diseases in China (including acute diseases, chronic diseases and injuries).

Oral Health and Risk of Arthritis in the Scottish Population: Results from the Scottish Health Survey

Objectives

To investigate the link between self-reported oral health and arthritis in the Scottish population using data from the Scottish Health Survey.

Material and Methods

Data were available from 2008 to 2013 on self-reported arthritis, oral health conditions and oral hygiene habits from the Scottish Health Survey. Arthritis was defined in this survey by self-reported long standing illness, those who reported having arthritis, rheumatism and/or fibrositis. Oral conditions were defined by self-reported bleeding gums, toothache, biting difficulties and/or edentulousness. Oral hygiene habits were defined by self-reported brushing teeth and/or using dental floss on daily basis. Logistic regression was used for statistical analysis adjusted for age, gender, qualification, smoking and body mass index.

Results

Prevalence of self-reported arthritis was 9.3% (95% confidence interval [CI] = 9.03 to 9.57). Those who reported having bleeding gums (adjusted odds ratio [OR] = 1.63; 95% CI = 1.35 to 1.96), toothache (OR = 1.32; 95% CI = 1.16 to 1.5), biting difficulties (OR = 1.95; 95% CI = 1.62 to 2.34), and being edentulous (OR = 1.22; 95% CI = 1.08 to 1.37) had an increased risk of arthritis. Brushing teeth (OR = 1.25; 95% CI = 0.74 to 2.12), and using dental floss (OR = 1.11; 95% CI = 0.89 to 1.39) were not associated with arthritis.

Conclusions

Self-reported oral conditions were associated with increased risk of self-reported arthritis. Oral hygiene habits were not associated with self-reported arthritis. Further investigation is required to assess the causal association between oral hygiene, oral disease and arthritis.

Initial observation of CIN2 does not appear to reduce quality of life in women under 25 years of age

BACKGROUND

Although the patient perspective is implicit in the practice of medicine, research evaluating this remains scarce. In a climate where clinicians and policy-makers constantly strive to achieve more patient-centred models of care, this omission warrants attention.

AIM

To assess health-related quality of life (HrQoL) in women under 25 years of age with cervical intra-epithelial neoplasia grade 2 (CIN2) receiving conservative management (colposcopy follow-up, with treatment if necessary) compared with those receiving immediate excisional treatment with large loop excision of the transformation zone (LLETZ).

METHODS

An observational study evaluating HrQoL was conducted at Christchurch Women's Hospital, New Zealand. Women undergoing conservative management for CIN2 were compared with those undergoing immediate excisional treatment in an age-matched sample. The Short Form Health Survey 12 version 2 (SF-12v2) was used to evaluate HrQoL. Secondary outcomes of anxiety and sexual function were also assessed.

RESULTS

One hundred and four women with CIN2 participated in the study. Of these, 63 (60%) received conservative management and 41 (40%) received immediate excisional treatment with LLETZ. We found no significant difference in HrQoL between the groups in a multivariate regression analysis adjusted for parity, smoking and socioeconomic status. There were also no significant differences in sexual function or anxiety.

CONCLUSION

We found no difference in HrQoL by management strategy. Conservative management of CIN2 in women under 25 is unlikely to have an adverse impact on self-reported HrQoL, anxiety or sexual functioning compared with conventional management.

Change in Visual Function in Uveitis Patients after Treatment: An Experience from Nepal

PURPOSE

To assess the change in visual function in uveitis patients after treatment.

MATERIALS AND METHODS

This one and a half year prospective study was conducted among 180 new uveitis patients. A questionnaire was used to assess the visual function in uveitis cases and analysis of effect size change was also done.

RESULTS

The male to female ratio was 1.3:1. The mean vision at presentation was 0.49 logMAR units, which improved to 0.39 logMAR units and 0.35 logMAR units by the 1st and 4th week but deteriorated to 0.62 logMAR units at the 6th week. Anterior uveitis and posterior uveitis patients had significant improvement (p≤0.001) in all three scales but panuveitis and intermediate uveitis had significant improvement (p<0.05) in two scales. The effect size showed small to large change in all three scales.

CONCLUSIONS

Visual function is adversely affected by uveitis, which can be improved after treatment.

Symptomatic Remission Determines Functional Improvement and Quality of Life in Schizophrenia

INTRODUCTION

Schizophrenia is a chronic illness that negatively affects the quality of life and psychosocial functions. Defined criteria to assess remission in schizophrenia are considered to be useful in the long-term follow-up of patients and in discriminating diagnostic factors. This study investigated the quality of life and functionality in schizophrenia patients in symptomatic remission (R-Sch) and not in remission (Non-R-Sch).

METHODS

Sociodemographic data were collected for 40 R-Sch and 40 Non-R-Sch patients, and the following scales were administered: the Clinical Global Impression-Severity (CGI-S) Scale; Positive and Negative Syndrome Scale (PANSS), World Health Organization Quality of Life Questionnaire-Short Form, Turkish Version (WHOQOL-BREF-TR), Quality of Life Scale for Schizophrenia Patients (QLS), and Global Assessment of Functioning Scale (GAF).

RESULTS

The total and all subscale scores of PANSS and the CGI-S score were significantly lower in the R-Sch group than in the Non-R-Sch group, whereas the GAF scores and all subscales of QLS and WHOQOL-BREF-TR were significantly higher.

CONCLUSION

This study demonstrates that improvement in symptoms in schizophrenia patients improves quality and functionality in all areas of life, suggesting that an improvement in symptoms is the most important determinant of functional recovery in the treatment of schizophrenia.

Defining and Assessing Quality of Life

This article is a literature review, undertaken to have a fuller understanding of what is meant by the term ‘quality of life’ and how it is measured or assessed. The literature review shows that the term Is not clearly defined. It is suggested that occupational therapists each have their own definition and may use the term too narrowly: a satisfactory quality of life means something different to all of us, whether we be occupational therapist or client. This suggests that discussion with a client about his/her Individual quality of life and what this means to him/her is probably more realistic than trying to measure aspects of it.

The reliability and validity of the Turkish version of the Oxford Elbow Score

Background

Objective measures of outcome ensure reliable decisions with regard to treatment planning. Oxford Elbow Score (OES) is one of the common outcome measures used for assessing quality of life of patients with elbow disorders. OES consists of three domains: pain, elbow function and social/psychological. The aim of this study is to test the validity and reliability of the Turkish version of the OES.

Methods

The study’s sample includes 82 patients with elbow problems. The original version of the OES was translated into Turkish using the Isis Outcomes Translation and Linguistic Validation Process. The construct validity of the Turkish version of the OES was tested using a confirmatory factor analysis. For internal consistency, Cronbach’s alpha was calculated. A Pearson correlation and a dependent sample t test were utilised for reproducibility of the OES. For convergent validity, the correlation coefficients were calculated between the domains of the OES and Short Form 36 (SF36). An independent sample t test was calculated to determine if there was a significant difference between the scores of the participants from the upper and lower groups.

Results

Confirmatory factor analysis (CFA) indicates that the three-factor structure of the OES was confirmed. Most of the fit indices are at the expected level, except for a root mean square error of approximation and an adjusted goodness of fit index. Cronbach’s alpha was calculated as 0.91 for the whole scale. The results showed that there are positive and high correlations between the first and follow-up assessments (r = 0.89, p < 0.0001). The Turkish OES version and its dimensions have moderate and significant correlations with domains of SF36 in general. The test results indicated that the mean of each item on three domains of the OES was higher for the upper 27 %, and this difference was significant at the 0.01 level.

Conclusions

The Turkish version of the OES is a reliable, valid, reproducible and practical tool. It can be used for patients with elbow disorders and is recommended for clinician use.

The quality of life - A concept for research and practice

This paper gives an overview of the concept of the quality of life as it is related to research and practice in nursing. The paper begins with an account of the concept's history, tracing attempts to measure quality of life to the post-war social indicators movement. This section also discusses problems with the concept's definition. Quantitative approaches to health-related quality of life are then described, with particular attention being given to issues of reliability and validity. The third section addresses qualitative approaches to the quality of life. The emphasis here is to outline a way of thinking about the quality of life that has the potential to inform practice. The approach described is based on the philosophical notion of eudaemonia, or human flourishing. In summary, this paper gives an overview of quantitative (statistical) and qualitative (philosophical) approaches to the quality of life and applies these to research and practice in nursing and allied disciplines.

The suitability of the GERDyzer instrument in pH-test-proven laryngopharyngeal reflux patients

The use of validated patient-reported outcome (PRO) instruments for the treatment outcome measure of laryngopharyngeal reflux (LPR) is crucial given the lack of objective markers. However, current symptom-based PRO instruments can only partially capture the impact of LPR. The GERD Analyzer (GERDyzer), an existing disease-specific PRO instrument, which measures multidimensional health-related quality of life (HRQL) affected by the illness rather than by any specific symptoms, has been validated in patients with erosive gastroesophageal reflux disease (GERD). Following the U.S. Food and Drug Administration PRO guidance, we cross-culturally adapted the GERDyzer instrument into Chinese, and examined the qualitative and quantitative psychometric properties of the Chinese version GERDyzer in pH-test-proven LPR patients.The GERDyzer comprises 10 dimensions of HRQL, including general well-being, pain/discomfort, physical health, diet, energy, activities, leisure activities, social life, mood, and sleep. To examine the content validity, we recruited 26 pH-test-proven LPR participants to conduct 4 focus group meetings for direct patient input on clinical manifestations and HRQL impacts. We also tested the quantitative psychometric properties, including reliability, validity, and responsiveness in 100 pH-test-proven LPR patients.Saturation of concept elicitation was achieved from the 4 focus groups, and a strong conceptual match was evident between the GERDyzer contents and responses from the focus group participants. Cognitive debriefing assessment showed that the Chinese version GERDyzer was adequate for use by patients as it demonstrated linguistic validation and cultural harmonization. Quantitative psychometric properties showed evidence of high internal consistency (Cronbach α: 0.96), good to excellent test-retest reliability (intraclass correlation coefficient: 0.84-0.98). Confirmatory factor analysis supported a 2-factor structure. Convergent validity was confirmed by moderate correlation assessments referencing the Reflux Symptoms Index and the Reflux Questionnaire. The discriminant validity was supported by the ability to discriminate moderate-to-severe disease from mild disease. The responsiveness was also high in participants with and without typical GERD symptoms (effect sizes 1.20 and 1.21, respectively).In conclusion, the Chinese version GERDyzer instrument is a reliable, valid, and responsive instrument for assessing HRQL in Taiwanese patients with LPR.

Evaluating Health Interventions for Older People

In recent years there has been a growing emphasis on evidencebased medicine and measuring outcomes of health care. The evaluation of health interventions for older people has increasingly relied upon the use of standardized assessment instruments, which are seen as providing detailed, holistic and patient-centred information. This article argues that such an approach has several drawbacks which may have serious implications for the evaluation and provision of health care. Standardized assessment instruments ignore the social dimensions of interviewing, decontextualize scores and contain an implicitly individualistic biomedical ideology of health. These factors undermine the effective evaluation of interventions. This is particularly significant when health care is purchased on the basis of delivering demonstrable gains. Provision for older people may be under threat if methods of evaluating its efficacy are inadequate.

Avoiding pitfalls of correlation coefficients in the assessment of measurement instruments in rehabilitation research

Objective: To provide a practical guide on how to avoid the pitfalls of correlated correlation coefficients when comparing multiple instruments in rehabilitation research.

Design: An observational study comparing a number of instruments measuring quality of life (QoL) compared with an external criterion.

Subjects: Sixty-eight patients admitted to a rheumatology ward for intensive treatment of rheumatoid arthritis.

Methods: Patients completed three new (QoL) instruments and an established instrument before and after intensive treatment for rheumatoid arthritis.

Main outcome measures: Correlation coefficients together with their confidence intervals and a test for the difference between a set of correlated correlation coefficients for the change in the EuroQoL Quality of Life scale (EuroQoL), the World Health Organization Quality Of Life-Abbreviated version (WHOQoL-BREF) and the Quality of Life Profile (QLP) against the Stanford Health Assessment Questionnaire (HAQ).

Results: Although the range of correlation between the new instruments and the external criterion was between -0.37 and -0.59 and suggested that one new instrument was far more responsive than the others,; an omnibus test for an overall difference could find no difference in responsiveness.

Conclusions: It is conceptually simple to use correlation coefficients to assess the properties of multiple instruments measured on the same subjects to find a ‘best’ instrument. However, proper interpretation of results when correlated correlation coefficients are calculated is complex. We recommend analysis includes: (a) that simple plots of the pairs of analysed variables are shown, (b) that simple linear model-fitting statistics, e.g., the R-squared statistic, accompany the plots, (c) that confidence intervals are presented for correlation coefficients, (d) that an omnibus statistical test for the difference between correlated correlation coefficients is presented, and (e) that normal model assumptions are tested.

Adaptation and validation of the short version WHOQOL-HIV in Ethiopia

BACKGROUND

Quality of life of patients is an important element in the evaluation of outcome of health care, social services and clinical trials. The WHOQOL instruments were originally developed for measurement of quality of life across cultures. However, there were concerns raised about the cross-cultural equivalence of the WHOQOL-HIV when used among people with HIV in Ethiopia. Therefore, this study aimed at adapting the WHOQOL-HIV bref for the Ethiopian setting.

METHODS

A step-wise adaptation of the WHOQOL-HIV bref for use in Ethiopia was conducted to produce an Ethiopian version-WHOQOL-HIV-BREF-Eth. Semantic and item equivalence was tested on 20 people with HIV. One hundred people with HIV were interviewed to test for measurement equivalence (known group validity and internal consistency) of the WHOQOL-HIV-BREF-Eth. Confirmatory factor analysis was conducted using data from 348 people with HIV who were recruited from HIV clinics.

RESULTS

In the process of adaptation, new items of relevance to the context were added while seven items were deleted because of problems with acceptability and poor psychometric properties. The Cronbach's α for the final tool with twenty-seven items WHOQOL-HIV-BREF-Eth was 0.93. All six domains discriminated well between symptomatic and asymptomatic people with HIV (p < 0.001). Using confirmatory factor analysis, a second order factor structure with six first order indicator factors demonstrated moderate fit to the data ((χ(2) = 627.75; DF = 259; p < 0.001), CFI = 0.82, TLI = 0.77 and RMSEA = 0.064).

CONCLUSION

The WHOQOL-HIV-BREF-Eth has been shown to be a valid measure of quality of life for use in clinical settings among people with HIV in Ethiopia.

Cross-cultural adaptation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) into Brazilian Portuguese

Introduction

The concept of quality of life is subjective and variable definition, which depends on the individual's perception of their state of health. Quality of life questionnaires are instruments designed to measure quality of life, but most are developed in a language other than Portuguese. Questionnaires can identify the most important symptoms, focus on consultation, and assist in defining the goals of treatment. Some of these have been validated for the Portuguese language, but none in children.

Objective

To validate the translation with cross-cultural adaptation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) into Portuguese.

Methods

Prospective study of children aged 2–12 years with sinonasal symptoms of over 30 days. The study comprised two stages: (I) translation and cross-cultural adaptation of the SN-5 into Portuguese (SN-5p); and (II) validation of the SN5-p. Statistical analysis was performed to assess internal consistency, test-retest reliability, and sensitivity, as well as construct and discriminant validity and standardization.

Results

The SN-5 was translated and adapted into Portuguese (SN-5p) and the author of the original version approved the process. Validation was carried out by administration of the SN-5p to 51 pediatric patients with sinonasal complaints (mean age, 5.8 ± 2.5 years; range, 2–12 years). The questionnaire exhibited adequate construct validity (0.62, p < 0.01), internal consistency (Cronbach's alpha = 0.73), and discriminant validity (p < 0.01), as well as good test–retest reproducibility (Goodman–Kruskal gamma = 0.957, p < 0.001), good correlation with a visual analog scale (r = 0.62, p < 0.01), and sensitivity to change.

Conclusion

This study reports the successful translation and cross-cultural adaptation of the SN-5 instrument into Brazilian Portuguese. The translated version exhibited adequate psychometric properties for assessment of disease-specific quality of life in pediatric patients with sinonasal complaints.

Simple shoulder test and Oxford Shoulder Score: Persian translation and cross-cultural validation

PURPOSE

To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder Score (OSS) into Persian language using a cross-sectional and prospective cohort design.

METHODS

A standard forward and backward translation was followed to culturally adapt the SST and the OSS into Persian language. Psychometric properties of floor and ceiling effects, construct convergent validity, discriminant validity, internal consistency reliability, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), and factor structure were determined.

RESULTS

One hundred patients with shoulder disorders and 50 healthy subjects participated in the study. The PSST and the POSS showed no missing responses. No floor or ceiling effects were observed. Both the PSST and POSS detected differences between patients and healthy subjects supporting their discriminant validity. Construct convergent validity was confirmed by a very good correlation between the PSST and POSS (r = 0.68). There was high internal consistency for both the PSST (α = 0.73) and the POSS (α = 0.91 and 0.92). Test-retest reliability with 1-week interval was excellent (ICCagreement = 0.94 for PSST and 0.90 for POSS). Factor analyses demonstrated a three-factor solution for the PSST (49.7 % of variance) and a two-factor solution for the POSS (61.6 % of variance). The SEM/SDC was satisfactory for PSST (5.5/15.3) and POSS (6.8/18.8).

CONCLUSIONS

The PSST and POSS are valid and reliable outcome measures for assessing functional limitations in Persian-speaking patients with shoulder disorders.

Psychometric Validation of the 14 items ChronIc Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14): Confirmatory Factor Analysis

OBJECTIVES

The study aim was to confirm the factorial structure of the short (14 item) version of the ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-14) using the Vein Consult Program (VCP) results.

METHODS

The international VCP study sought to evaluate the impact of chronic venous disease (CVD) on health care costs and quality of life (QoL). The factorial structure of the CIVIQ-14 was evaluated using two methods: exploratory factor analysis (EFA) to calculate the probabilities of items and dimensions remaining stable and to study the dimensionality of the scale using explained variance criteria, followed by confirmatory factor analysis (CFA) to confirm the original three dimensional structure and investigate alternative models that may have arisen from the dimensionality analysis. We also used the VCP results to evaluate the psychometric properties of the questionnaire and conducted subgroup analyses on countries with validated translations.

RESULTS

A total of 47,149 questionnaires from 17 countries were available in the VCP. EFA revealed both items and dimensions as 100% stable. Dimensionality analysis showed that a two factor approach could be considered. CFA revealed the CIVIQ-14 three dimensional structure to be acceptable while rejecting the two dimensional model. Psychometric analysis confirmed the construct validity, internal consistency, and known groups validity of the CIVIQ-14. The results of subgroup analyses were consistent with those of the primary analysis.

CONCLUSIONS

CFA of VCP data supported the factorial structure of the CIVIQ-14. The analysis corroborates the wide use of CIVIQ-14 as a valid instrument for reporting QoL in CVD patients.

Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports

OBJECTIVES

Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings.

DESIGN

A prospective, observational, longitudinal cohort design.

SETTING

Nursing homes (NHs), assisted living facilities (ALFs), community.

PARTICIPANTS

A total of 470 older adults who were first-time recipients of LTSS.

MEASUREMENT

Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments.

RESULTS

Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001).

CONCLUSIONS

Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.

Psychometric properties of the Albanian version of the Orofacial Esthetic Scale: OES-ALB

Abstract

The aim was to adapt the Orofacial Esthetic Scale (OES) and to test psychometric properties of the Albanian language version in the cultural environment of the Republic of Kosovo.

Methods

The OES questionnaire was translated from the original English version according to the accepted techniques. The reliability (internal consistency), and validity (construct, convergent and discriminative) were tested in 169 subjects, test-retest in 61 dental students (DS), and responsiveness in 51 prosthodontic patients with treatment needs (PPTN).

Results

The corrected item correlation coefficients of OES-ALB ranged from 0.686 to 0.909. The inter-item correlation coefficient ranged between 0.572 and 0.919. The Cronbach’s alpha was 0.961 and IIC 0.758. Test- retest was confirmed by good ICCs and by no significant differences of the OES scores through the period of 14 days without any orofacial changes (p > 0.05). Construct validity was proved by the presence of one-factor composition that assumed 79.079 % of the variance. Convergent validity showed significant correlation between one general question about satisfaction with orofacial esthetics and the OES summary score, as well as between the sum of the 3 OHIP-ALB49 questions related to orofacial aesthetics and the OES summary score. Discriminative validity was confirmed with statistically significant differences between DS, prosthodontic patients without treatment need and PPTN (p < 0.01). Responsiveness was confirmed by a significant increase of OES scores after PPTN patients received new fixed partial or removable dentures (P < 0.001).

Conclusion

The results proved excellent psychometric properties of the OES-ALB questionnaire in the Republic of Kosovo.

Outcome measurement in neurodegenerative disease: attributes, applications & interpretation

There has been a marked shift from clinically assessed to patient assessed outcomes of treatment in neurodegenerative conditions over recent decades. The use of patient-reported outcome measures (PROMs) provides a method with which researchers and clinicians can gain insightful and meaningful data on health status from the patients' perspective. It is imperative that high-quality PROMs are chosen based upon their measurement properties and their suitability for use in the intended clinical or research context. This review aims to give a brief overview of best practice standards for selecting PROMs, current instruments used in exemplar neurodegenerative conditions and their application in clinical trials and routine measurement.

Self-reported health and socio-economic inequalities in England, 1996-2009: Repeated national cross-sectional study

Tackling social inequalities in health has been a priority for recent UK governments. We used repeated national cross-sectional data for 155,311 participants (aged ≥16 years) in the Health Survey of England to examine trends in socio-economic inequalities in self-reported health over a recent period of sustained policy focus by successive UK governments aimed at tackling social inequalities in health. Socio-economic related inequalities in self-reported health were estimated using the Registrar General's occupational classification (1996-2009), and for sensitivity analyses, the National Statistics Socio-Economic Classification (NS-SEC; 2001-2011). Multi-level regression was used to evaluate time trends in General Health Questionnaire (GHQ-12) scores and bad or very bad self-assessed health (SAH), as well as EQ-5D utility scores. The study found that the probability of reporting GHQ-12 scores ≥4 and ≥ 1 was higher in those from lower social classes, and decreased for all social classes between 1997 and 2009. For SAH, the probability of reporting bad or very bad health remained relatively constant for social class I (professional) [0.028 (95%CI: 0.026, 0.029) in 1996 compared to 0.028 (95%CI: 0.024, 0.032) in 2009], but increased in lower social classes, with the greatest increase observed amongst those in social class V (unskilled manual) [0.089 (95%CI: 0.085, 0.093) in 1996 compared to 0.155 (95%CI: 0.141, 0.168) in 2009]. EQ-5D utility scores were lower for those in lower social classes, but remained comparable across survey years. In sensitivity analyses using the NS-SEC, health outcomes improved from 2001 to 2011, with no evidence of widening socio-economic inequalities. Our findings suggest that socio-economic inequalities have persisted, with evidence of widening for some adverse self-reported health outcomes.

Greater Independence in Activities of Daily Living is Associated with Higher Health-Related Quality of Life Scores in Nursing Home Residents with Dementia

Health-related quality of life (HRQL) for nursing home residents is important, however, the concept of quality of life is broad, encompasses many domains and is difficult to assess in people with dementia. Basic activities of daily living (ADL) are measured routinely in nursing homes using the Resident Assessment Instrument-Minimum Data Set Version 2.0 (RAI-MDS) and Functional Independence Measure (FIM) instrument. We examined the relationship between HRQL and ADL to assess the future possibility of ADL dependency level serving as a surrogate measure of HRQL in residents with dementia. To assess ADL, measures derived from the RAI-MDS and FIM data were gathered for 111 residents at the beginning of our study and at 6-month follow-up. Higher scores for independence in ADL were correlated with higher scores for a disease-specific HRQL measure, the Quality of Life-Alzheimer's Disease Scale. Preliminary evidence suggests that FIM-assessed ADL is associated with HRQL for these residents. The associations of the dressing and toileting items with HRQL were particularly strong. This finding suggests the importance of ADL function in HRQL. The RAI-MDS ADL scales should be used with caution to evaluate HRQL.

Self-reported health-related quality of life in kindergarten children: psychometric properties of the Kiddy-KINDL

OBJECTIVES

To assess the psychometric properties of the German self-reported version of the Kiddy-KINDL that measures Health Related Quality of Life (HRQoL) in 3 to 5 year old kindergarten children.

STUDY DESIGN

The population of the study comprised baseline data of a longitudinal study whose main aim is to investigate self-reported health outcomes in young children (N = 317).

METHODS

Missing values, the distribution of data, internal consistency (Cronbach's alpha and Guttman's lambda), and reliability (split half and two weeks test-retest) were analysed. To assess discriminant validity, mean differences were tested splitting the sample regarding socio-emotional competences (VBV 3-6), age and gender. Structural validity was investigated with Confirmatory Factor Analysis (CFA).

RESULTS

Mean HRQoL was 69.79 (SD 16.84). Overall missing values were 8.1%, overall Cronbach's alpha was 0.75 and overall Guttman's lambda was 0.77; for the whole scale Spearman-Brown test for split half reliability resulted in 0.80 and ICC for test-retest in 0.83. Discriminant validity investigation differentiated groups with high and low socio-emotional competence and those children who were 4.5 years or older, compared to the younger ones. Differences between boys and girls were also found. CFA suggested two main dimensions: physical and socio-emotional.

CONCLUSION

This preliminary validation of the Kiddy-KINDL in very young children shows satisfactory psychometric properties. However, results of the Cronbach's alpha, Guttman's lambda and the CFA depicted problems, mainly in the psychological dimension. Due to these we recommend to use the Kiddy-KINDL as an instrument with only two dimensions. Further studies in general population samples are needed.