A comparative review of generic quality-of-life instruments

Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: A systematic review

BACKGROUND

Since there are no formal definition of health-related quality of life (HRQOL) there may be a lack of coherence and understanding of how to interpret HRQOL-data. The aim of this study is to summarize HRQOL-results that have used the FACT-M questionnaire in patients with melanoma, and specifically to summarize FACT-M between tumor stage.

METHODS

This review was conducted in accordance with the PRISMA guidelines.

INCLUSION CRITERIA

original studies on cutaneous melanoma between 2005 and 2020, written in English, containing "Functional Assessment of Cancer Therapy Melanoma" OR "Functional Assessment of Cancer Therapy M" OR FACT-M OR FACT/M OR FACTM OR "FACT M" OR FACT-melanoma OR "FACT Melanoma" together with FACT-M numbered data and basic patient characteristics, using the databases Scopus, Web of Science, PubMed and PsycINFO.

RESULTS

16 articles describing 14 patient cohorts published 2008-2020 were included. The majority of the studies did not report subscale scores in accordance with FACT-M guidelines. The results did indicate that FACT-M total scores were inversely correlated with AJCC stage. Subscale analysis demonstrated varying degrees of correlation with AJCC stage. The Melanoma Surgery Subscale score was lowest in stage III patients, probably reflecting more advanced surgical procedures in this group of patients.

CONCLUSIONS

Though this review is based on a questionnaire limited to the assessment of melanoma patients, it highlights the universal need for clinical studies to describe their selected HRQOL-questionnaires, its definition of HRQOL and its dimensions, as well as comply with the questionnaire's guidelines when reporting HRQOL-data.

Hand grip strength and health-related quality of life in postmenopausal women: a national population-based study

OBJECTIVE

Muscle strength progressively decreases after menopause. Hand grip strength (HGS) reflects overall muscle strength and may be associated with health-related quality of life (HRQoL). We aimed to assess the association between HGS and HRQoL in postmenopausal women.

METHODS

We used nationally representative data on 6,059 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2014-2018). HGS was determined as the maximum value in kilograms (kg) achieved using either hand. HRQoL was estimated using the European Quality of Life Questionnaire-Five Dimensions (EQ-5D) questionnaire. The prevalence ratios of having moderate/severe problems on the EQ-5D were evaluated with adjustment for covariates using complex survey analysis.

RESULTS

The prevalence of having a problem in at least one of the HRQoL dimensions among postmenopausal women was 43.6%. Compared with participants with the lowest quintile of HGS, women in the highest quintile had a significantly lower prevalence of moderate/severe problems in most dimensions (fully adjusted prevalence ratios [95% confidence intervals]; 0.73 [0.60-0.89], 0.45 [0.28-0.72], 0.52 [0.38-0.71], 0.74 [0.63-0.87], and 0.91 [0.70-1.18] for mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, respectively). The associations between HGS and EQ-5D index were stronger among the participants who were older (65-79 y), had a higher body mass index (≥ 25.0 kg/m2), had low physical activity, had a longer duration since menopause (≥ 10 y), and had a chronic disease.

CONCLUSIONS

Higher HGS was associated with a lower prevalence of moderate/severe problems in each dimension of the EQ-5D in postmenopausal women. These associations were more apparent in individuals who were older, had higher body mass index, or had a chronic disease.

Measuring Health-Related Quality of Life in Vietnamese Patients After Kidney Transplantation

Objectives: To consider that the health-related quality of life (HRQOL) has become an inherent part of the patient outcomes in the care and treatment after kidney transplantation (KT). This study aimed to measure HRQOL among a representative sample size of patients after KT by using both the Short Form 36 (SF-36) and the Kidney Disease Quality of Life 36 (KDQOL-36). Methods and Results: Data of this cross-sectional design were collected in the Organ Transplant Center, Viet Duc University Hospital (Hanoi, Vietnam) from January 2020 to March 2020 and included the patients aged 18 years or over after KT at 6 months, 1 year, and 3 years postoperatively. HRQOL was evaluated through face-to-face interviews by means of the SF-36 and KDQOL-36 measurement tools. According to the SF-36, the overall mean score of HRQOL was 69.13 ± 15.55 and the two domains were the highest scores of "Mental Health" (81.23 ± 14.28) and "General Health" (80.06 ± 14.81). When measuring with the KDQOL-36, the overall mean score was 68.67 ± 13.75 and was the highest in the domain "Symptoms and Problems of Kidney Disease" (87.06 ± 16.00). Both instruments had good reliability for those after KT. The reliability of the SF-36 was high with Cronbach's coefficients α = 0.90. There were positive relationships between the dimensions measured by the KDQOL-36 and SF-36 (correlation coefficient: 0.03-0.69). Similarly, the domains of the SF-36 also had positive correlations with the KDQOL-36 (correlation coefficient: 0.18-0.51). The correlation coefficient between overall HRQOL scores of the SF-36 and KDQOL-36 was 0.62, indicating a strong correlation between the SF-36 and KDQOL-36. Conclusions: There were slight fluctuations in the HRQOL score in domains in the 3-year follow-up stages, suggesting not having clear change. The mean SF-36 score was consistent with the mean KDQOL-36 score. High reliability and strong correlation were found between two instruments of the SF-36 and KDQOL-36. This study provides the reliability and constructs validity in the combination of two sets of the SF-36 and KDQOL-36 scales for the assessment of HRQOL among post-KT patients, thereby assisting physicians and health professionals in the clinical decision-making, assessment of therapeutic efficacy, and understanding of treatment risk.

The Onset of Depression in Middle-Aged Presumed Healthy Slovenian Family Practice Attendees and Its Associations with Genetic Risk Assessment, Quality of Life and Health Status: A Contribution for Family Medicine Practitioners' Early Detection

Despite depression being a major driver of morbidity and mortality, the majority of primary care patients remain undiagnosed, so this study aimed to assess the prevalence of depression and the association with demographic and clinical variables, genetic risk, and quality of life. The participants were presumably healthy model family medicine practice (MFMP) attendees between 30 and 65 years of age and recruited during a preventive check-up in 2019. Each of the 40 pre-selected MFMP pragmatically invited 30 attendees to voluntarily participate. They completed a questionnaire of demographic, clinical, and social determinants, as well as a three-generational family history. The results were analyzed using multivariable modelling to calculate the associations with signs of depression. A modified Scheuner method was used to calculate the level genetic risk level using family history. Of 968 participants, aged 42.8 ± 8.6 years, 627 (64.8%) were women. The prevalence of depression was 4.1%. Signs of depression were negatively associated with health-related quality of life score, in particular in the domains of self-care (p = 0.001) and anxiety/depression (p < 0.001). Depression was also associated with predicted high risk for comorbidities given the family history (p = 0.030). Primary care directed at improving patients’ quality of life should implement more widespread screening for mental health disorders. Family history for disease even beyond depression can be used by physicians as an important primary prevention tool.

A Scoping Review of Quality of Life Questionnaires in Glaucoma Patients

PRECIS

Multiple questionnaires exist to measure glaucoma's impact on quality of life (QoL). Selecting the right questionnaire for the research question is essential, as is patients' acceptability of the questionnaire to enable collection of relevant patient-reported outcomes.

PURPOSE

QoL relating to a disease and its treatment is an important dimension to capture. This scoping review sought to identify the questionnaires most appropriate for capturing the impact of glaucoma on QoL.

METHODS

A literature search of QoL questionnaires used in glaucoma, including patient-reported outcomes measures, was conducted and the identified questionnaires were analyzed using a developed quality criteria assessment.

RESULTS

Forty-one QoL questionnaires were found which were analyzed with the detailed quality criteria assessment leading to a summary score. This identified the top 10 scoring QoL questionnaires rated by a synthesis of the quality criteria grid, considering aspects such as reliability and reproducibility, and the authors' expert clinical opinion. The results were ratified in consultation with an international panel of ophthalmologists (N=49) from the Educational Club of Ocular Surface and Glaucoma representing 23 countries.

CONCLUSIONS

Wide variability among questionnaires used to determine vision related QoL in glaucoma and in the responses elicited was identified. In conclusion, no single existing QoL questionnaire design is suitable for all purposes in glaucoma research, rather we have identified the top 10 from which the questionnaire most appropriate to the study objective may be selected. Development of a new questionnaire that could better distinguish between treatments in terms of vision and treatment-related QoL would be useful that includes the patient perspective of treatment effects as well as meeting requirements of regulatory and health authorities. Future work could involve development of a formal weighting system with which to comprehensively assess the quality of QoL questionnaires used in glaucoma.

Quality of life among older Chinese people living with HIV/AIDS: a cross-sectional study in Hunan

BACKGROUND

There is little research to date in the area of quality of life (QoL) among older Chinese people living with HIV/AIDS (PLWHA). This study aims to explore the QoL and its influential factors among older PLWHA in China.

METHODS

Cross-sectional data of 242 adults with HIV/AIDS aged 50-84 y from Hunan were analyzed to evaluate the associations of demographic characteristics, illness-related factors, HIV-related stigma and social support with QoL. The WHO QOL-HIV BREF questionnaire was used to measure QoL on six domains (physical, psychological, independence, social relationships, environment and spirituality).

RESULTS

A total of 242 older PLWHA completed the survey, of whom 150 (62.0%) were males. Multivariate linear regression analyses identified that females, side effects of highly active antiretroviral therapy, chronic non-communicable diseases and higher levels of perceived negative self-image were negatively associated with QoL, especially in the physical, independence and spirituality domains; whereas higher education or annual income, retired and elevated levels of subjective social support or support availability were positively associated with QoL, especially in the psychological, independence, social relationships and environment domains.

CONCLUSIONS

The study findings suggest that interventions to improve QoL should focus on reducing HIV-related stigma and side effects and on enhancing economic situations and social support.

Quality of Life and Health Status in Middle-aged Presumed Healthy Slovenian Family Practice Attendees

Background

There is a gap in our knowledge of health-related quality of life (HRQoL) in a population presumed healthy, so this study aimed to assess the associations between HRQoL, demographics and clinical variables.

Methods

The participants were attendees, presumed healthy, at 40 pre-selected model family medicine practices (MFMPs), aged between 30 and 65 years and recruited during a preventive check-up in 2019. Each MFMP pragmatically invited 30 attendees to voluntarily participate. The EQ-5D questionnaire was administered as a measure of HRQoL; the independent variables were demographic characteristics, smoking, alcohol consumption, stress perception, physical activity, signs of depression, cardiovascular risk, body mass index, blood pressure values, and blood sugar and lipidogram laboratory test values. Ordinal logistic regression was used to calculate associations between self-assessed quality of life, demographics, and clinical variables, with P<0.05 set as statistically significant.

Results

Of 986 participants, 640 (64.9%) were women and 346 (35.1%) men, aged 42.7±8.6 years. The average values for the EQ-5D-3L were 0.91±0.15. In the multivariate model, a positive association between adequate physical activity (p=0.003), and a negative association between higher age (p<0.001), female gender (p=0.009), signs of depression (p<0.001), stress (p=0.013), and EQ-5D score were identified.

Conclusion

Given that physical activity was shown to be positively associated with HRQoL, it is of the utmost importance for family physicians to motivate their middle-aged patients, especially women and those with signs of depression and excessive stress, to adopt a more rigorously physically active lifestyle.

Evaluation of Quality of Life in Adult Individuals With Cleft Lip and/or Palate

OBJECTIVES

The purpose of the present study was to systematically review literature relating to the quality of life (QoL) in adult individuals with cleft lip and/or palate (CLP) and identify which aspect of QoL adults with CLP find to be the most problematic, in comparison to a general non-cleft population.

DESIGN

Different databases were searched for this review including the Cochrane Central Register of Controlled Trials, Ovid MEDLINE and Embase. Five domains of QoL were identified to evaluate the overall results of these QoL measures. These domains were; physical function, physical pain, psychological implications and self-esteem, self-perception in relation to facial aesthetics, and social function. The studies included underwent critical appraisal and different types of bias were assessed based on the Cochrane handbook for systematic reviews of interventions.

RESULTS

Ten studies were included in this review. The total number of participants was 541. The most common QoL measure for adults with CLP was Short-Form (SF-36). Seven studies out of 10 reported statistically significantly worse scores (P < 0.05) in the psychological implications and self-esteem domains of QoL in adults with CLP, indicating lower QoL in terms of these domains. The least affected QoL domain was physical function. A high heterogeneity was found among the studies, including variation in the QoL measures, types of orofacial clefts, types of treatment and comparison groups.

CONCLUSION

The presence of CLP did seem to negatively affect the QoL for adults with CLP, mainly in terms of psychological implications and self-esteem.

A retrospective review of parents' perceptions of the impact of bilateral cochlear implants on their child's quality of life

OBJECTIVE

To evaluate the impact of simultaneous and sequential bilateral cochlear implantation on deaf children's quality of life (QoL) and to investigate the impact of inter-implant time delay for the sequentially implanted children.

METHODS

All completed questionnaires of the Brief Assessment of Parental Perception (BAPP), which had been routinely filled out by parents at annual review, were analysed for children with at least 12 months of bilateral implant experience. The responses for the simultaneous implanted group were compared to those who received sequential implants. Within the sequential group, the impact of shorter (<7 years) and longer (>7 years) inter-implant delays on QoL were compared.

RESULTS

There were a total of 176 children in the sequential group and 97 in the simultaneous group. Results indicated that most children wore their devices regularly and significant improvements in QoL were reported for all children particularly in communication and learning. QoL scores were higher for the children with simultaneous implants, followed by children with a shorter time delay between implants.

CONCLUSION

Both simultaneous and sequential bilateral cochlear implants significantly improved the functioning and QoL of deaf children.

Role of Self-Stigma in Pathways from HIV-Related Stigma to Quality of Life Among People Living with HIV

This study examined the relationships between perceived public stigma, experienced stigma, and quality of life in people living with HIV (PLHIV), and whether self-stigma mediates these relationships. Cross-sectional data were analyzed from 1704 PLHIV in care at OLVG hospital in the Netherlands. We measured different types of stigma (perceived public stigma, experienced stigma, and self-stigma), and various quality-of-life outcomes (disclosure concerns, depression, anxiety, sexual problems, sleeping difficulties, self-esteem, general health, and social support). Structural equation modeling was used to test the paths from different types of stigma to quality-of-life outcomes. All direct effects of self-stigma on quality-of-life outcomes were significant. The final mediation model showed that the effects of both perceived public and experienced stigma on quality-of-life outcomes were mediated by self-stigma. These findings highlight the importance of addressing self-stigma in PLHIV, and call for (psychosocial) interventions that reduce the harmful effects of HIV-related stigma.

Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial

Lumbar spinal stenosis is the most common reason for spine surgery in older adults, but the effects of prehabilitation on perioperative outcomes among these patients have not been investigated. This study aims to evaluate the effectiveness of a preoperative exercise-based intervention program compared with usual care on the improvement of clinical status, physical capacities and postoperative recovery of patients awaiting surgery for lumbar spinal stenosis. Sixty-eight participants were randomised to receive either a 6-week supervised exercise-based prehabilitation program or hospital usual care. The outcomes included both clinical and physical measures. Data collection occurred at post-intervention, and 6 weeks, 3- and 6-months post-surgery. Significant but small improvements were found in favour of the experimental group at the post-intervention assessment for pain intensity, lumbar spinal stenosis-related disability, lumbar strength in flexion, low back extensor muscles endurance, total ambulation time, and sit to stand performance. A significant difference in favor of the intervention group was found starting at the 3-month postoperative follow-up for low back-related disability. No adverse events were reported. Exercise-based prehabilitation did not improve short-term postoperative recovery in patients with lumbar spinal stenosis.

The relation between EQ-5D and fatigue in a Dutch general population sample: an explorative study

Background

Fatigue negatively influences health-related quality of life. It is questionable whether fatigue is sufficiently covered by the EQ-5D. This study investigated whether fatigue is covered by the existing domains of the EQ-5D.

Methods

A Dutch general population sample completed the EQ-5D (3L and 5L version) and the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), of which the fatigue item was used. Outcomes were compared between participants with and without a chronic health condition. Convergent validity was assessed, and multivariate regression analyses was used to predict the RPQ fatigue item from the EQ-5D-3L and EQ-5D-5L domains separately.

Results

3027 people completed the survey, of whom 52% had ≥ 1 chronic health condition. Fatigue was reported by 48% of the participants. Fatigue was moderately correlated to the EQ-5D domains ‘pain/discomfort’, ‘usual activities’, and ‘anxiety/depression’ for the 3L (r = 0.379–0.426) and 5L version (r = 0.411–0.469). For the 5L, also a moderate correlation with ‘mobility’ (r = 0.335) was observed. The remaining correlations were weak. All EQ-5D-3L and 5L domains except for ‘mobility’ were significantly associated with the RPQ fatigue item (unstandardized Beta = − 0.20–0.67; p < 0.01 to p = 0.04). Comparable outcomes were found for participants with and without ≥ 1 chronic health condition.

Conclusions

The extent to which fatigue is covered by the EQ-5D domains is small to moderate, with the EQ-5D-5L being slightly more sensitive to capture fatigue compared to the EQ-5D-3L. An extra fatigue item for the EQ-5D may add value, as fatigue is not fully captured by the existing domains, both in people with and without a chronic health condition.

A comparative performance analysis of the International Classification of Functioning, Disability and Health and the Item-Perspective Classification framework for classifying the content of patient reported outcome measures

BACKGROUND

Standardized coding of the content presented in patient reported outcome measures can be achieved using classification frameworks, and the resulting data can be used for ascertaining content validity or comparative analyses. The International Classification of Functioning (ICF) is a framework with a detailed conceptual structure that has been successfully utilized for such purposes through established coding procedures. The Item Perspective Classification (IPC) framework is a newly developed relational coding system that classifies the respondent perspective and conceptual domains addressed in items. The purpose of this study was to compare and describe the performance of these two frameworks when used alone, and in conjunction, for the generation of data pertaining to the content of patient reported outcome measures.

METHODS

Six health-related quality of life questionnaires with a total of 159 items were classified by two raters using the Item Perspective Classification framework in conjunction with the International Classification of Functioning. Framework performance indicators included: classification capacity (percent of items amenable to successful classification), coding efficiency (number of codes required to classify items), and content overlap detection (percent of items sharing identical classification codes with at least one other item). Inter-rater reliability of item coding was determined using Krippendorff's alpha.

RESULTS

Classification capacity of the IPC framework was 97%, coding efficiency 26, and content overlap detection was 95%; whereas respective values for the ICF were 68%, 114, and 58%. When used in conjunction values were 63%, 129, and 30%. Krippendorff's alpha exceeded 0.97 for all 3 classification indices.

CONCLUSION

Inter-rater agreement on classification data was excellent. The IPC framework provided a unique classification of the respondent's judgment during item response and classified more items using fewer categories, indicated greater content overlap across items and was able to describe the relationship between multiple concepts presented within the context of a single item. The ICF provided a unique classification of item content relating to aspects of disability and generated more detailed and precise descriptions. A combined approach provided a rich description (detailed codes) with each framework providing complementary information. The benefits of this approach in instrument development and content validation require further investigation.

Evaluating quality of life in frailty: applicability and clinimetric properties of the SarQoL® questionnaire

BACKGROUND

The SarQoL® questionnaire was specifically designed to measure quality of life (QoL) in sarcopenia. Frailty and sarcopenia have areas of overlap, notably weak muscle strength and slow gait speed, which may mean that the SarQoL could provide a measure of QoL in frailty. This study aimed to evaluate the clinimetric properties of the SarQoL questionnaire in physical frailty using the Fried criteria.

METHODS

Analyses were carried out on data from the Sarcopenia and Physical impairment with advancing Age study. Frailty was assessed with the Fried criteria and QoL with the SarQoL, the Short-Form 36-Item, and the EuroQoL 5-Dimension (EQ-5D) questionnaires. We evaluated discriminative power (with the Kruskal-Wallis analysis of variance test), internal consistency (with Cronbach's alpha), construct validity (through hypotheses testing), test-retest reliability (with the intraclass correlation coefficient), measurement error (calculating standard error of measurement and smallest detectable change), and responsiveness (through hypotheses testing and standardized response mean).

RESULTS

In total, 382 participants were included for the validation and 117 for the responsiveness evaluation. They had a median age of 73 (69-79) years, took 5 (3-8) drugs, and had 4 (3-5) co-morbidities. There were more women (n = 223; 58.4%) than men and, in total, 172 (45%) robust, 167 (44%) pre-frail, and 43 (11%) frail participants. Discriminative power was confirmed when significantly lower (P < 0.001) overall SarQoL scores, and thus also worse QoL, were observed between robust [77.1 (64.35-85.90)], pre-frail [62.54 (53.33-69.57)], and frail [49.99 (40.45-56.06)] participants. Six of the SarQoL domains performed likewise, with significantly lower scores according to frailty status with Domain 7 (fears) being the exception. Internal consistency was good (α = 0.866). Convergent (using Short-Form 36-Item and EQ-5D) and divergent construct validity (using EQ-5D) was confirmed. Test-retest reliability was excellent [intraclass correlation coefficient = 0.918 (0.834-0.961)], with a standard error of measurement of 3.88 and a smallest detectable change of 10.76 points. We found moderate responsiveness when five of the nine hypotheses were confirmed, coupled with a large effect size for the overall SarQoL score (corrected standardized response mean of -1.44).

CONCLUSIONS

The SarQoL questionnaire has adequate clinimetric properties for use with frail patients in clinical practice and trials and could provide data that are more appropriate and detailed than the generic questionnaires currently used.

Patient-reported outcome measures in core outcome sets targeted overlapping domains but through different instruments

OBJECTIVE

There is no comprehensive assessment of which patient-reported outcomes (PROs) are recommended in core outcome sets (COS), and how they should be measured. The aims of this study are to review COS that include patient-reported outcomes measures (PROMs), identify their target health domains, main characteristics, and their overlap within and across different disease areas.

STUDY DESIGN AND SETTING

We selected COS studies collected in a publicly available database that included at least one recommended PROM. We gathered information on study setting, disease area, and targeted outcome domains. Full-text of recommended instruments were obtained, and an analysis of their characteristics and content performed. We classified targeted domains according to a predefined 38-item taxonomy.

RESULTS

Overall, we identified 94 COS studies that recommended 323 unique instruments, of which: 87% were included in only one COS; 77% were disease-specific; 1.5% preference-based; and 61% corresponded to a full questionnaire. Most of the instruments covered broad health-related constructs, such as global quality of life (25%), physical functioning (22%), emotional functioning and wellbeing (7%).

CONCLUSION

The wealth of recommended instruments observed even within disease areas does not fit with a vision of systematic, harmonized collection of PROM data in COS within and across disease areas.

Multi-study randomised controlled trial to develop, implement and evaluate bra prescription to reduce breast pain and improve quality of life

BACKGROUND

and Purpose: Breast pain is a common condition presented at breast care clinics and bras are often recommended to reduce symptoms, although criteria and pathways for obtaining appropriate bras are limited. This multi-study, randomised controlled trial (RCT) aimed to establish criteria and performance variables to prescribe bras for breast pain patients, to implement this bra prescription, and evaluate whether, compared to standard care alone, the bra prescription improves breast pain and quality of life (QoL).

MATERIALS AND METHODS

Eighteen breast pain patients from a UK hospital were assigned to standard care or bra prescription groups and completed the study. Bra prescription patients were prescribed a bra to wear every day for eight weeks. Patient Global Impression of Change (PGIC), breast pain intensity, QoL, and adherence were assessed.

RESULTS

Between-groups there were no differences in baseline breast pain or QoL and no differences in PGIC or breast pain following the intervention. Within-groups, improvements in QoL within bra prescription patients were identified.

CONCLUSION

This study developed a framework for bra prescription for breast pain patients and the intervention demonstrated improvements in QoL.

Do postponed dental visits for financial reasons reduce quality of life? Evidence from the Survey of Health, Ageing and Retirement in Europe

Background

There is a lack of studies investigating the impact of postponed dental visits due to financial constraints on quality of life.

Aims

The aim of this study was to identify whether these factors are associated longitudinally.

Methods

Data were derived from waves 5 and 6 of the “Survey of Health Ageing and Retirement in Europe” (SHARE). The analysis focused on Germany (n = 7506). The widely used CASP-12 was used to quantify the quality of life. Postponed dental visits for financial reasons in the preceding 12 months (no, yes) were used as the main explanatory variable. Socioeconomic and health-related covariates were included in regression analysis.

Results

Gender stratified regression analysis showed that quality of life decreased with the presence of postponed dental visits due to financial reasons in men. Furthermore, quality of life decreased with the worsening of self-rated health in both men and women. The outcome measure was not associated with age, marital status, income, and chronic diseases in both sexes.

Discussion

Study findings suggest that postponing dental visits due to financial constraints contributes to a decreased quality of life among older men.

Conclusion

Efforts to avoid these circumstances might help to maintain the quality of life in older men.

Health-related quality of life in rheumatoid arthritis: Systematic review and meta-analysis of EuroQoL (EQ-5D) utility scores from Asia

INTRODUCTION

Region-specific health-related quality of life (HRQoL) scores or utility values are representative and pivotal for economic evaluations as they are influenced by the value judgment of the local population. This study systematically reviewed and pooled EuroQoL-5 Dimension (EQ-5D) utility scores of rheumatoid arthritis (RA) across primary studies from Asia.

METHODS

Studies reporting EQ-5D utility scores among adult RA patients from Asian countries were systematically searched in PubMed-Medline, Scopus and Embase since inception through February 2020. Selected studies were systematically reviewed and study quality assessment was performed. Meta-analysis was performed using a random-effect model with subgroup and meta-regression analysis to explore heterogeneity.

RESULTS

Among 1391 searched articles, 37 studies with 31 983 participants were systematically reviewed and meta-analysis was conducted among 31 studies. The pooled EQ-5D scores and EQ-5D visual analog score were 0.66 (95% CI 0.63-0.69, I²  = 99.65%) and 61.21 (50.73-71.69, I²  = 99.56%) respectively with high heterogeneity. For RA patients with no, low, moderate and high disease activity based on Disease Activity Score (DAS)-28, the pooled EQ-5D scores were 0.78 (0.65-0.90), 0.73 (0.65-0.80), 0.53 (0.32- 0.74), and 0.47 (0.32-0.62), respectively. On meta-regression, age of patients (P < .05) was positively associated and use of glucocorticoids (P < .05) was inversely associated with utility values.

CONCLUSION

Lower EQ-5D scores were associated with severe disease activity, increasing age and female gender among RA patients. The study provides pooled EQ-5D scores for RA patients that are useful inputs for cost-utility studies in Asia.

Psychometric properties of Short Form-36 Health Survey, EuroQol 5-dimensions, and Hospital Anxiety and Depression Scale in patients with chronic pain

Supplemental Digital Content is Available in the Text.

This large-sample item response theory-based evaluation assessed the measurement properties of SF-36, EQ-5D, and hospital anxiety and depression scale for chronic pain patients in clinical settings.

Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of Short Form-36 Health Survey (SF-36),EuroQol 5-dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Finally, questionnaire scores were correlated with each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of 2 independent constructs of physical and mental health. By contrast, although the approach to summarize the health-related quality of life construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into 2 subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated, whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations because questionnaires' properties determine their discriminating ability in patient status assessment.

Psychological Effects of the COVID-19 Pandemic on Hungarian Adults

We aimed to explore psychological effects of the coronavirus pandemic on Hungarian adults in the time of the national quarantine situation in May 2020.We conducted a cross-sectional observational study with the use of an anonymous online questionnaire that consisted of 65 items. The following measuring instruments were used: Perceived Stress Scale (PSS-10); The General Anxiety Disorder Assessment (GAD)-2; The Patient Health Questionnaire (PHQ)-2; European Quality of Life Visual Analogue Scale (EQ-VAS); Self-administered inventory of complaints (Hungarian questionnaire); Shortened (Hungarian) version of the Ways of Coping Questionnaire; 2 open-ended questions to examine the participants’ mood and ways of coping during the pandemic. The data of 431 participants were analyzed, their average age was 47.53 ± 11.66 years, and the percentage of females was 90%. The mean of participants’ scores were the following: 19.34 ± 7.97 for perceived stress, 73.05 ± 21.73 for health status, and 8.68 ± 4.65 for neurotic complaints. Thirty-four and one-tenth percent of participants were depressed, 36.2% were anxious, and they tended to use problem-focused coping strategies more frequently than emotion-focused ones. We found significant correlations between all of the seven examined psychological variables. Our results highlight the importance of stress management in the psychological support of healthy adults in quarantine situation caused by the coronavirus pandemic.

A Meta-Regression Analysis of Utility Weights for Breast Cancer: The Power of Patients' Experience

To summarize utility estimates of breast cancer and to assess the relative impacts of study characteristics on predicting breast cancer utilities. We searched Medline, Embase, RISS, and KoreaMed from January 1996 to April 2019 to find literature reporting utilities for breast cancer. Thirty-five articles were identified, reporting 224 utilities. A hierarchical linear model was used to conduct a meta-regression that included disease stages, assessment methods, respondent type, age of the respondents, and scale bounds as explanatory variables. The utility for early and late-stage breast cancer, as estimated by using the time-tradeoff with the scales anchored by death to perfect health with non-patients, were 0.742 and 0.525, respectively. The severity of breast cancer, assessment method, and respondent type were significant predictors of utilities, but the age of the respondents and bounds of the scale were not. Patients who experienced the health states valued 0.142 higher than did non-patients (P <0.001). Besides the disease stage, the respondent type had the highest impact on breast cancer utility.

Quality of life and mortality in the general population: a systematic review and meta-analysis

BACKGROUND

Quality of life (QoL) is multi-dimensional concept of an individual' general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population.

METHODS

An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed.

RESULTS

Of 4184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four meta-analyses indicated that higher health-related QoL (HRQoL) is associated with lower mortality risk, which was consistent for overall HRQoL (HR 0.633, 95% CI: 0.514 to 0.780), physical function (HR 0.987, 95% CI: 0.982 to 0.992), physical component score (OR 0.950, 95% CI: 0.935 to 0.965), and mental component score (OR 0.980, 95% CI: 0.969 to 0.992).

CONCLUSION

These findings provide evidence that better QoL/HRQoL was associated with lower mortality risk. The utility of these measures in predicting mortality risk indicates that they should be considered further as potential screening tools in general clinical practice, beyond the traditional objective measures such as body mass index and the results of laboratory tests.

A comparison of measurement properties between UK SF-6D and English EQ-5D-5L and Thai EQ-5D-5L value sets in general Thai population

BACKGROUND

Evidence is limited for comparative psychometric properties between EQ-5D-5L and SF-6D. Therefore, this study compared psychometric properties between those instruments using value sets from Thailand, England, and the UK in the general Thai population.

METHODS

A total of 1,200 participants were recruited. The agreement level was evaluated using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Convergent validity with SF-12v2 was assessed by Spearman's rho correlations. Known-group validity compared discriminant activity and sensitivity between groups. Responsiveness was assessed using standardized effect sizes (SES) and standardized response mean (SRM).

RESULTS

Agreement between SF-6D and Thai (ICCs = 0.51) and English (ICCs = 0.52) EQ-5D-5L index scores was good. The physical functioning demonstrated moderate to strong and moderate correlations with Thai (r = 0.50) and English (r = 0.46) EQ-5D-5L index scores, whereas SF-6D index scores strongly correlated with role emotion (r = 0.81). EQ-5D-5L was better than SF-6D at discrimination and sensitivity for gender, age, education level, household income, and number of diseases. The SF-6D was more responsive than the EQ-5D-5L for the worsened group.

CONCLUSION

Both SF-6D and EQ-5D-5L are valid among the general Thai population. Further studies should reinvestigate responsiveness and determine their impacts on economic analyses among patient groups.

Effect of Neural Mobilization on Nerve-Related Neck and Arm Pain: A Randomized Controlled Trial

Purpose: Neural mobilization (NM) is often used to treat nerve-related conditions, and its use is reasonable with nerve-related neck and arm pain (NNAP). The aims of this study were to establish the effect of NM on the pain, function, and quality of life (QOL) of patients with NNAP and to establish whether high catastrophizing and neuropathic pain influence treatment outcomes. Method: A randomized controlled trial compared a usual-care (UC; n = 26) group, who received cervical and thoracic mobilization, exercises, and advice, with an intervention (UCNM; n = 60) group, who received the same treatment but with the addition of NM. Soft tissue mobilization along the tract of the nerve was used as the NM technique. The primary outcomes were pain intensity (rated on the Numerical Pain Rating Scale), function (Patient-Specific Functional Scale), and QOL (EuroQol-5D) at 3 weeks, 6 weeks, 6 months, and 12 months. The secondary outcomes were the presence of neuropathic pain (using the Neuropathic Diagnostic Questionnaire) and catastrophizing (Pain Catastrophising Scale). Results: Both groups improved in terms of pain, function, and QOL over the 12-month period (p < 0.05). No between-groups differences were found at 12 months, but the UCNM group had significantly less pain at 6 months (p = 0.03). Patients who still presented with neuropathic pain (p < 0.001) and high pain catastrophizing (p = 0.02) at 6- and 12-mo follow-ups had more pain. Conclusions: Both groups had similar improvements in function and QOL at 12-month follow-up. The UCNM group had significantly less pain at 6-month follow-up and a lower mean pain rating at 12-month follow-up, although the difference between groups was not significant. Neuropathic pain is common among this population and, where it persisted, patients had more pain and functional limitations at 12-mo follow-up.

Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus

BACKGROUND

The short- and long-term impact of cerebrospinal fluid shunting on quality of life (QoL) in idiopathic normal pressure hydrocephalus (INPH) is poorly understood.

OBJECTIVE

To investigate QoL in shunted INPH patients compared to the population and to investigate which factors influence QoL in INPH.

METHODS

INPH patients consecutively shunted in Sweden during 2008-2010 were scrutinized. Population-based controls were age- and sex-matched to the patients. Included participants were the following: 176 INPH patients and 368 controls. QoL was assessed using the EuroQol 5-dimension 5-level (EQ5D5L) instrument, which measures overall QoL and health status in 5 dimensions. Independency (accommodation and/or need for in-home care) and comorbidities were assessed. Patients were followed up 6-45 mo after surgery (mean follow-up time: 21 mo).

RESULTS

Shunting improved QoL (P < .001) and health status in all dimensions (P < .005). Shunted INPH patients had lower QoL than controls (P < .001). The patients' health status in mobility, self-care, daily activities, and anxiety/depression was worse than the controls both before and after surgery (P < .001). The main predictors of low QoL in INPH were symptoms of depression (P < .001) and severity of gait disturbance (P = .001). Fewer INPH patients than controls lived independently (45% vs 85%, P < .001). Time after shunting had no influence on QoL.

CONCLUSION

QoL remains improved in shunted INPH patients at a mean follow-up time of 21 mo, but the patients do not reach the same QoL as the population. Symptoms of depression and severity of gait disturbance are the strongest predictors of low QoL in INPH.

Effects of stratified medication review in high-risk patients at admission to hospital: a randomised controlled trial

Background:

Patients at high risk of medication errors will potentially benefit most from medication reviews. An algorithm, MERIS, can identify the patients who are at highest risk of medication errors. The aim of this study was to examine the effects of performing stratified medication reviews on patients who according to MERIS were at highest risk of medication errors.

Methods:

A randomised controlled trial was performed at the Acute Admissions Unit, Aarhus University Hospital, Denmark. Patients were included at admission to the hospital and were randomised to control or intervention. The intervention consisted of stratified medication review at admission on patients with a high MERIS score. Clinical pharmacists and clinical pharmacologists performed the medication reviews; the clinical pharmacologists performed the reviews on patients with the highest MERIS score. The primary outcome measure was the number of prescribing errors during the hospitalisation. Secondary outcomes included self-experienced quality of life, health-care utilisation and mortality measured at follow-up 90 days after discharge.

Results:

A total of 375 patients were included, of which medication reviews were performed in 64 patients. The medication reviews addressed 63 prescribing errors in 37 patients and 60 other drug-related problems. No difference in the number of prescribing errors during hospitalisation between the intervention group (n = 165) and control group (n = 153) was found, corresponding to 0.11 prescribing errors per drug (95% confidence interval (CI): 0.08–0.14) versus 0.13 per drug (95% CI: 0.09–0.16), respectively. No differences in secondary outcomes were observed.

Conclusion:

A stratified medication review approach based on the individual patient’s risk of medication errors did not show impact on the chosen outcomes.

Plain language summary

How does a medication review at admission affect patients who are in high risk of medication errors?

Patients are at risk of medication errors at admission to hospital. Medication reviews aim to detect and solve these. Yet, due to limited resources in healthcare, it would be beneficial to detect the patients who are most at risk of medication errors and perform medication reviews on those patients.

In this study we investigated whether an algorithm, MERIS, could detect patients who are at highest risk of medication errors; we also studied whether performing medication reviews on patients at highest risk of medication errors would have an effect on, for example, the number of medication errors during hospitalisation, qualify of life and number of readmissions. We included 375 patients in a Danish acute admission unit and they were divided into control group and intervention group. Patients in the intervention group received a medication review at admission if they were considered at high risk of medication errors, assessed with the aid of MERIS. In summary, 64 patients in the intervention group were most at risk of medication errors and therefore received a medication review.

We conclude in the study that MERIS was useful in identifying relevant patients for medication reviews. Yet, the medication reviews performed at admission did not impact on the chosen outcomes.

The added value of extending the EQ-5D-5L with an itching item for the assessment of health-related quality of life of burn patients: an explorative study

INTRODUCTION

Health-related quality of life (HRQL) is an important outcome in burn care and research. An advantage of a generic HRQL instrument, like the EQ-5D, is that it enables comparison of outcomes with other conditions and the general population. However, the downside is that it does not include burn specific domains, like scar issues or itching. Adding extra items to a generic instrument might overcome this issue. This study explored the potential and added value of extending the EQ-5D-5L with a burn-specific item, using a itching item as an example.

METHODS

The EQ-5D-5L and the Patient and Observer Scar Assessment Scale (POSAS) was completed by adult patients 5-7 years after injury. A separate POSAS itching item was used to study the added value of an itching item for the EQ-5D-5L. The EQ-5D-5L + Itching was created by adding the POSAS itching item to the EQ-5D-5L. Five psychometric properties were compared between EQ-5D-5L and EQ-5D-5L + Itching: distribution (e.g. ceiling), informativity cf. Shannon's indices, convergent validity, dimension dependency, and explanatory power respectively.

RESULTS

A total of 243 patients were included, of whom 49% reported any itching on the POSAS. Adding an itching item to the EQ-5D-5L decreased the ceiling effect, and resulted in increased absolute informativity (H' = 4.76 vs. H' = 3.64) and relative informativity (J' = 0.34 vs. J' = 0.31). The extra itching item decreased the convergent validity (Spearman's rank correlation coefficient = -0.51 vs. -0.59). Mutual dependency of dimensions existed, showing that all other items were dominant over the itching item. Adding the itching item to the standard EQ-5D-5L barely improved explanatory power (49.3% vs. 49.0%).

CONCLUSIONS

PThe present study showed adding a burn-specific item to the EQ-5D-5L is possible and has potential. However, 5 to 7 years after injury, adding an itching item to the EQ-5D-5L provides little additional information; the gain in terms of added value is relatively small. Apart from instances where itching information is specifically needed, a strong case is not present for adding an itching item to the EQ-5D-5L for long-term (>5 yr after burns) HRQL assessment in burn patients. In early time periods after burn, the added value might be greater and we recommend exploring this potential in future studies, ideally on multiple timepoints after burn.

Quality of life of family carers of persons with young-onset compared to late-onset dementia

Objectives: To compare quality of life (QOL) of family carers of persons with young- (YOD) to late-onset dementia (LOD).Methods: This was a cross-sectional comparison of 88 carers of persons with YOD and 100 carers of persons with LOD. The Quality of Life - Alzheimer's Disease questionnaire (QOL-AD) was used to measure QOL of both carers and persons with dementia. Depressive symptoms were measured by the Geriatric Depression Scale (GDS) for carers and the Cornell Scale for Depression in Dementia for persons with dementia. Care burden was measured by the Relatives' Stress Scale. Activities of Daily Living (ADL) of the persons with dementia were assessed using the total score from the Lawton & Brody Instrumental-ADL scale and the Physical Self-Maintenance Scale. Multiple linear regression models with interactions between covariates and group (YOD versus LOD) were estimated.Results: The QOL-AD scores of YOD-carers were significantly poorer compared to LOD-carers (mean difference 2.5 (95% CI 0.7; 4.3), p = 0.006). Poorer QOL of carers was associated with more depressive symptoms (mean QOL-AD change -0.5 (-0.6; -0.3), p < 0.001), but with no difference between the two groups. In contrast to LOD, QOL of carers of people with YOD was also significantly associated with symptom duration (p = 0.002), depressive symptoms of the persons with dementia (p = 0.030), ADL (p = 0.001), and carer burden (p = 0.002).Conclusion: YOD-carers reported significantly poorer QOL compared to LOD-carers. QOL was significantly associated with depressive symptoms in carers of both groups.

Do financial barriers to access to primary health care increase the risk of poor health? Longitudinal evidence from New Zealand

Primary health care policies in New Zealand, as in many countries, have focused on reducing barriers to access. Financial barriers to obtaining timely health care, while not the only important barriers, are amongst the most important, and are amenable to policy reforms. There is little robust empirical evidence about the extent to which cost related barriers are associated with adverse health outcomes. Past evidence is limited to cross-sectional studies of selected groups, selected primary health care services, and to cross-sectional studies that are susceptible to unmeasured confounding bias. Using fixed effects regression modelling and data from 17,363 participants with at least two observations in three waves (2004-05, 2006-07, 2008-09) of the SoFIE-Health panel data, this study examines the impact of financial barriers to access to primary health care (general practitioner and dentist) on health status using a longitudinal national panel study of adult New Zealanders. Self-rated health (SRH), physical health (PCS) and mental health summary scores (MCS) were the health measures. The two exposures were: not seeing 1) the doctor and 2) the dentist because of cost at least once during the preceding 12 months. We also tested for interactions between the exposure (deferral of care) and age, gender, ethnicity and three health outcomes. For all outcomes, after adjusting for time-varying confounders, health deteriorated as the number of waves increased in which a non-visit was reported. Moreover, the effect size for any health deterioration was greater for deferring a dentist visit than for deferring a physician visit. Except gender and age (for MCS and doctor visits), and gender and ethnicity (for SRH and dentist visits) we did not find any evidence of interactions. These results support policy responses focussed on decreasing financial barriers to access. In the New Zealand context this finding is particularly important for dental care.

Health-related quality of life (EQ-5D + C) among people living in artisanal and small-scale gold mining areas in Zimbabwe: a cross-sectional study

Background

In Zimbabwe, an estimated 500,000 people work in the sector of artisanal and small-scale gold mining (ASGM). Two million Zimbabweans are dependent on this sector. Using mercury is common to extract gold from ore. Long term exposure to mercury can cause various adverse health conditions including chronic mercury intoxication. The influence of these adverse health effects on the health-related quality of life (HRQoL) is still unknown. The aim of this study is to assess the HRQoL of people who identify themselves as miners, and to analyze potential influencing factors, such as age, years of working with mercury and health conditions caused by mercury exposure.

Methods

This cross-sectional study assessed the HRQoL using the standardized EQ-5D + C (3 L) questionnaire and collected human specimens (blood, urine) of people living and possibly working in ASGM areas in Zimbabwe. Factors such as age, years of working with mercury and adverse health conditions possibly caused by mercury exposure were analyzed with regards to their influence on the HRQoL.

Results

The 207 participants (82% male, mean age 38 years) reported 40 different health states. Of the study participants 42.5% reported to be in complete good health while 57.5% reported being unwell in different ways. Nine participants (4.3%) were identified with chronic mercury intoxication, whereas 92 participants (33.3%) had mercury levels above the “Alert” threshold in at least one specimen. Having chronic mercury intoxication has a significant negative influence on the HRQoL, when taking into account age, gender and years of working with mercury. Cognitive problems were the most reported in the questionnaire, however, the association between this domain separately and the HRQoL was not verified.

Conclusion

This study shows that adverse health effects caused by chronic exposure to mercury, have a negative influence on the HRQoL among people living in ASGM areas.

Life after surgical resection of a meningioma: a prospective cross-sectional study evaluating health-related quality of life

Background

Few studies have evaluated the health-related quality of life (HRQoL) of patients with meningiomas. Here, we report the largest prospective, longitudinal cross-sectional cohort study of HRQoL in meningiomas to date, in order to identify possible actionable determinants of global HRQoL.

Methods

Adults who had undergone resection of a grade I intracranial meningioma and were in routine follow-up at a single large tertiary center underwent HRQoL assessment using the QLQ-C30 questionnaire administered opportunistically at follow-up visits. Averaged transformed QLQ-C30 scores at 12-month intervals were compared with scores from a normative reference population, with reference to known minimal clinically meaningful difference (CMD) in scores. To evaluate for possible determinants of changes in global HRQoL, global HRQoL scores were correlated (Spearman's Rho) with subdomain and symptom scores and with interval time from surgical resection.

Results

A total of 291 postoperative patients with histologically confirmed and surgically treated grade I meningiomas consented to participation and a total of 455 questionnaires were included for analysis. Patients with meningiomas reported reduced global HRQoL at nearly every 12-month interval with clinically and statistically significant impairments at 12, 48, 108, and 120 months postoperative compared with the normative population (P < 0.05). Meningioma patients at the 12-month interval also reported a reduction of each subdomain of HRQoL assessment (P < 0.05); however, a CMD was only seen in cognitive functioning. Physical, emotional, cognitive, and social subdomains, as well as fatigue and sleep/insomnia, were significantly associated with global HRQoL at the first 12-month interval. Overall, there was no significant correlation between time from surgery and global HRQoL or the subdomain functional or symptom sections of the QLQ-C30.

Conclusions

Meningioma patients report considerable limitations in HRQoL for more than 120 months after surgery, particularly in cognitive, emotional, and social function, as well as suffering significant fatigue and sleep impairment compared with a normative reference population. The majority of these reported functional impairments and symptoms are strongly associated with global HRQoL and thus can be considered determinants of global HRQoL that if treated, have the potential to improve HRQoL for our meningioma patients. This hypothesis requires future study of targeted interventions to determine their efficacy.

Quality of life of Latin-American individuals with type 2 diabetes mellitus: A systematic review

OBJECTIVE

Diabetes mellitus is a serious public health problem that causes a decrease in the patients' quality of life. The present study was aimed to analyze the quality of life of patients with diabetes mellitus in Latin-American population through a systematic review, using the two instruments of greater validity and reliability at international level, SF-36 and WHOQOL.

METHODS

We performed extensive searches in Redalyc, SciELO, PubMed, Scopus and Web of Science databases. To delimit our search, we only included countries that are members of the Latin American Association of Diabetes. We identified 2168 articles, where 35 were considered relevant for this systematic review.

RESULTS

Our results showed that patients that regularly receive guidance and treatment to control the diabetes, showed better quality of life; in contrast, patients with foot ulcers or comorbidities showed the worse quality of life.

CONCLUSION

The current literature analysis suggests that this disease greatly influences in the quality of life of the patients.

Health-related quality of life following minimally invasive totally endoscopic mitral valve surgery

BACKGROUND

To compare the impact of two different types of mitral valve surgery on health-related quality of life, we conducted a retrospective study comparing modified totally endoscopic mitral valve surgery with median sternotomy mitral valve surgery.

METHODS

A total of 163 patients who underwent mitral valve surgery at our institution between January 1, 2019 and December 31, 2019 were enrolled. For these 163 patients, mitral valve surgery was performed using either a modified totally endoscopic approach or median sternotomy approach. We used the numerical rating scale and the Scar Cosmesis Assessment and Rating Scale to measure pain intensity and the aesthetic appearance of the surgical incision and used the MOS 36-item Short-Form Health Survey to assess health-related quality of life.

RESULTS

Seventy-eight patients underwent the modified totally endoscopic mitral valve surgery, and eighty-five patients underwent the median sternotomy mitral valve surgery. The two groups of patients were similar in terms of demographics and echocardiography findings. The number of bioprosthetic valve replacements performed was significantly higher in the totally endoscopic group than in the median sternotomy group (p = 0.04), whereas the subvalvular apparatus was less preserved in only 33 cases in the totally endoscopic group (p = 0.01). The rate of postoperative adverse events was similar between the two groups. The pain was mild and aesthetic appearance was significantly better in the totally endoscopic approach group than in the sternotomy approach group. Significant differences in the scores for the bodily pain and mental health subscales of the MOS 36-item Short-Form Health Survey were found between the two groups.

CONCLUSIONS

Compared with median sternotomy mitral valve surgery, totally endoscopic mitral valve surgery has an equally good treatment effect, improving patient's health-related quality of life with a better cosmetic appearance and a lower pain intensity. Our study suggested that the totally endoscopic approach is superior to the median sternotomy approach in terms of pain intensity, aesthetic appearance and health-related quality of life.

Validation and psychometric properties of the drug users' quality of life scale in Iranian population

INTRODUCTION

Drug dependence and the resultant problems notably decrease the quality of life (QOL). Measuring the QOL in persons who use drugs (PWUD_s) and planning to improve it can be helpful for rehabilitation programs. Given the absence of a standard tool to measure the quality of life of PWUD, the present study is an attempt to validate psychometric and cultural characteristics of non-injection drug users' QOL scale.

METHOD

The study was carried out as a validation and methodological work. The study population consisted of 273 PWUDs in Kermanshah-based drug clinics including outgoing and hospitalized patients. The participants were selected through convenient-quota sampling. After securing the required permission from the copyright owner of the tool, it was forward/backward translated. Face validity and content validity were determined quantitatively and qualitatively. To examine construct validity of the tool, explorative factor analysis and confirmatory factor analysis were used. Internal consistency was measured using Cronbach's alpha and statistical analyses were performed using SPSS (v.25) and LISREL (v.8).

RESULTS

Explorative factor analysis (EFA) and confirmatory factor analysis (CFA) results supported the tool with one factor and 22 items. The R2 index in the model was equal to 0.99, which means that 99% of the variation of dependent variable (total score of QOL) is attributed to independent variable (22 statements). In other words, 99% of the variation of dependent variable is due to the independent variables in the model. The main indices of the model based on CFA all were higher than 0.9, which indicates goodness of fit of the model (χ2/DF = 2.18, CFI, NFI, TLI = 0.93 GF = 0.84, REMSEA = 0.066, R2 = 0.99). The correlative coefficient was significant (p < 0.05). The reliability of the tool based on internal consistency (Cronbach's alpha) for the subscales ranged from 0.84 to 0.85 and equal to 0.84 for the whole tool.

CONCLUSION

The Farsi version of non-injection drug users' QOL scale had acceptable indices and it was applicable to assess QOL in the target population. The tool can be used in different fields of drug addiction.

Quality of life assessment instruments for adults: a systematic review of population-based studies

BACKGROUND

Against a backdrop of population aging and improving survival rates for chronic noncommunicable diseases (CNCD), researchers are placing growing emphasis on health-related quality of life (HRQoL). The aim of this study was to identify the QoL assessment instruments used in population-based studies with adults conducted around the world.

METHODS

A systematic review of original research published in all languages between 2008 and 2018 was conducted. Systematic reviews and meta-analyses were excluded.

RESULTS

Sixty-three articles (38.1% conducted in the Americas) fitted the eligibility criteria. Based on the AHRQ checklist for cross-sectional studies and the Newcastle-Ottawa scale for cohort studies, methodological quality was shown to be fair in the majority of studies (55.6%) and good in 44.4%. The country with the highest number of publications was Brazil (20.6%). Twelve types of generic instruments and 11 specific instruments were identified. The generic instrument SF-36 was the most frequently used measure (33.3% of studies). In-home interviewing was exclusively used by 47.6% of the studies, while 39 studies (61.9%) reported the use of self-administered questionnaires. Over two-thirds of the studies (34.9%) used questionnaires to investigate the association between chronic diseases and/or associated factors.

CONCLUSIONS

It was concluded that the wide range of instruments and modes of questionnaire administration used by the studies may hinder comparisons between population groups with the same characteristics or needs. There is a lack of research on QoL and the factors affecting productive capacity. Studies of QoL in older persons should focus not only on the effects of disease and treatment, but also on the determinants of active aging and actions designed to promote it. Further research is recommended to determine which QoL instruments are best suited for population-based studies.

Evaluation of the usefulness of EQ-5D as a patient-reported outcome measure using the Paretian classification of health change among patients with chronic heart failure

PURPOSE

The aim of this study was to evaluate the usefulness of EQ-5D as a patient-reported outcome measure using different analytical methods. Especially we used the Paretian Classification of Health Change, to see if this gave better information compared to measures that are more traditional. For the evaluation we used data from patients with chronic heart failure (HF).

METHODS

We compared results of EQ-5D at baseline and at 1 year's follow up for HF patients with preserved or reduced ejection fraction (EF), HFpEF (EF > 50%, n = 930) and HFrEF (EF < 40%, n = 3831) using individual patient data from the Swedish Heart Failure Registry. Statistical analysis included EQ-5D index and proportions for all five dimensions of the EQ-5D. In addition, we also used the Paretian classification of Health Change to judge overall improvements (improved in at least one dimension and not worsened in any other dimension) or worsening (vice versa) in EQ-5D profiles.

RESULTS

Mean EQ-5D index showed minor changes at the one-year follow-up, likewise in both groups. The proportions reporting moderate, or severe, problems increased for all five dimensions of the EQ-5D in the HFpEF group. In the HFrEF group this was seen only for three dimensions, with no change for "anxiety/depression" and reduction of problems for "usual activities ". The Paretian classification showed that 24% (n = 200) of the HFpEF group and 34% (n = 1059) of the HFrEF group reported overall improvement while 43% (n = 355) and 39% (n = 1212) respectively reported overall worsening. Multiple logistic regressions showed different patterns of determinants e.g. that treatment in a cardiology clinic only affected overall health outcome in the HFrEF group.

CONCLUSION

The usefulness of EQ-5D is dependent on the analytical method used. While the index showed minor differences between groups, analyses of specific dimensions showed different patterns of change in the two groups with better prognosis for the HFrEF group. The Paretian classification of Health Change could further identify subgroups that showed overall improvements or overall worsening. This method can therefore help to identify needs for more tailored interventions in health services.

Mental health and prolonged exposure to unaffordable housing: a longitudinal analysis

PURPOSE

When housing is insufficient, or poor quality, or unaffordable there are well established health effects. Despite the pervasiveness of housing affordability problems (widely referred to as Housing Affordability Stress-HAS), little quantitative work has analysed long-term mental health effects. We examine the mental health effects of (prolonged and intermittent) patterns of exposure to housing affordability problems.

METHODS

We analysed a large, nationally representative longitudinal population sample of individuals, following them over five-year periods to assess the relative mental health effects of different patterns of exposure to housing affordability problems. To maximise the number of observations and the robustness of findings, we used 15 years (2002-2016) of data, across three pooled exposure windows. Longitudinal regression analysis with Mundlak adjustment was used to estimate the association between prolonged (constant over a 5-year period) and intermittent exposure to HAS, and mental health (as measured using the SF-36 MCS).

RESULTS

We found that, on average, both prolonged and intermittent exposure were associated with lower mental health (Beta = - 1.338 (95% CI - 2.178-0.488) and Beta = - 0.516 (95% CI - 0.868-0.164), respectively). When we additionally adjusted for baseline mental health, thereby accounting for initial mental health status, coefficients were attenuated but remained significant.

CONCLUSIONS

Both prolonged and intermittent exposure to HAS negatively impact mental health, irrespective of baseline mental health. Interventions that target affordable housing would benefit population mental health. Mental health interventions should be designed with people's housing context in mind.

Development and Validation of a Comprehensive Well-Being Scale for People in the University Environment (Pitt Wellness Scale) Using a Crowdsourcing Approach: Cross-Sectional Study

Background

Well-being has multiple domains, and these domains are unique to the population being examined. Therefore, to precisely assess the well-being of a population, a scale specifically designed for that population is needed.

Objective

The goal of this study was to design and validate a comprehensive well-being scale for people in a university environment, including students, faculty, and staff.

Methods

A crowdsourcing approach was used to determine relevant domains for the comprehensive well-being scale in this population and identify specific questions to include in each domain. A web-based questionnaire (Q1) was used to collect opinions from a group of university students, faculty, and staff about the domains and subdomains of the scale. A draft of a new well-being scale (Q2) was created in response to the information collected via Q1, and a second group of study participants was invited to evaluate the relevance and clarity of each statement. A newly created well-being scale (Q3) was then used by a third group of university students, faculty, and staff. A psychometric analysis was performed on the data collected via Q3 to determine the validity and reliability of the well-being scale.

Results

In the first step, a group of 518 university community members (students, faculty, and staff) indicated the domains and subdomains that they desired to have in a comprehensive well-being scale. In the second step, a second group of 167 students, faculty, and staff evaluated the relevance and clarity of the proposed statements in each domain. In the third step, a third group of 546 students, faculty, and staff provided their responses to the new well-being scale (Pitt Wellness Scale). The psychometric analysis indicated that the reliability of the well-being scale was high.

Conclusions

Using a crowdsourcing approach, we successfully created a comprehensive and highly reliable well-being scale for people in the university environment. Our new Pitt Wellness Scale may be used to measure the well-being of people in the university environment.

Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties

AIM

To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection.

METHOD

Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed.

RESULTS

Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations.

INTERPRETATION

Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines.

WHAT THIS PAPER ADDS

Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.

The importance of physical and mental health in explaining health-related academic role impairment among college students

Research consistently documents high rates of mental health problems among college students and strong associations of these problems with academic role impairment. Less is known, though, about prevalence and effects of physical health problems in relation to mental health problems. The current report investigates this by examining associations of summary physical and mental health scores from the widely-used Short-Form 12 (SF-12) Health Survey with self-reported academic role functioning in a self-report survey of 3,855 first-year students from five universities in the northeastern United States (US; mean age 18.5; 53.0% female). The mean SF-12 physical component summary (PCS) score (55.1) was half a standard deviation above the benchmark US adult population mean. The mean SF-12 mental component summary (MCS) score (38.2) was more than a full standard deviation below the US adult population mean. Two-thirds of students (67.1%) reported at least mild and 10.5% severe health-related academic role impairment on a modified version of the Sheehan Disability Scale. Both PCS and MCS scores were significantly and inversely related to these impairment scores, but with nonlinearities and interactions and much stronger associations involving MCS than PCS. Simulation suggests that an intervention that improved the mental health of all students with scores below the MCS median to be at the median would result in a 61.3% reduction in the proportion of students who experienced severe health-related academic role impairment. Although low-cost scalable interventions exist to address student mental health problems, pragmatic trials are needed to evaluate the effectiveness of these interventions in reducing academic role impairment.

Statistical validity and reliability of the Persian version of the Western Ontario Meniscal Evaluation Tool (WOMET) according to the COSMIN checklist

BACKGROUND

The Western Ontario Meniscal Evaluation Tool (WOMET) is the only questionnaire available to assess quality of life in patients with isolated meniscal injuries. The aims of this study were to prepare the Persian version of the WOMET (PWOMET) and validate it in Iranian patients with isolated meniscal tears.

METHODS

In the first stage, the English version of WOMET was translated into Persian. Content validity, and qualitative and quantitative (impact score) face validity were tested by specialists and in a sample of 30 patients. In the second stage, PWOMET was assessed for the evaluation of psychometric properties in 100 patients with isolated meniscal injury and 50 healthy people based on the COSMIN checklist. Construct validity was tested based on structural validity (factor analysis) and hypothesis testing. Correlation with the total scores on the SF-36, IKDC and KOOS were used for concurrent criterion validity. Test-retest reliability and internal consistency were calculated using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. In addition the standard error of measurement (SEM) and smallest detectable change were calculated. Interpretability was investigated as the ceiling and floor effects and minimal important difference.

RESULTS

The PWOMET had acceptable qualitative face validity and content validity. The impact score (quantitative face validity) was more than 1.5 for all items. For construct validity, structural validity (factor analysis) and hypothesis testing ability were confirmed. Correlations between the PWOMET total score and IKDC, SF-36, KOOS scores were 0.61, 0.54 and 0.63, respectively (p < 0.001), thus confirming concurrent criterion validity. The intraclass correlation coefficient, Cronbach's alpha, SEM and smallest detectable change for the PWOMET were 0.73, 0.89, 9.43 and 26.13, respectively. The PWOMET had no ceiling or floor effects, and minimal important difference was 9.07.

CONCLUSION

The PWOMET provides valid and reliable scores for assessment of the quality of life in patients with isolated meniscal injury.

Shoulder Function After Cardioverter-Defibrillator Implantation: 5-Year Follow-up

BACKGROUND

Implantable cardioverter-defibrillator (ICD) represents the main tool for prevention of sudden cardiac death. Different kinds of postimplant complications have been described; however, little is known about shoulder functional impairment and its impact on quality of life.

METHODS

Patients with standard indications for elective prepectoral subcutaneous ICD insertion were enrolled during a 1-year period. The impact of ICD implantation on shoulder motility, pain, general disability, and quality of life was evaluated prospectively at baseline, and after 2 weeks, 3 months, 1 year, and 5 years using the Constant score, the Numeric Pain Rating Scale, the Disabilities of the Arm, Shoulder, and Hand scale, and the Short Form-36 Health Survey questionnaire.

RESULTS

A total of 50 patients underwent insertion of single, dual chamber, or biventricular ICDs. Two weeks after implantation, functional impairment and mild pain were observed in ipsilateral shoulder movements, with a reduction in the Short Form-36 Health Survey score. Shoulder functional impairment improved at the third-month evaluations, with almost normalization at 1-year and 5-year assessments, as well as pain and quality of life.

CONCLUSIONS

Prepectoral subcutaneous ICD implantation may be associated with ipsilateral shoulder functional impairment that regresses partially after 3 months and completely at 1-year and 5-year assessments. The less invasive implantation technique and the relatively small size of modern ICDs, independently from types and volumes, may be relevant to the degree of postimplantation shoulder functional impairment and recovery time. Shoulder function should be assessed at routine checks, especially soon after ICD implantation because of potential functional impairment and subsequent impact on quality of life.

Self-efficacy for managing hypertension and comorbid conditions

BACKGROUND

Self-efficacy is defined an individual’s belief in completing necessary actions to achieve the desired goal. For individuals with hypertension and other chronic conditions, self-efficacy has been an essential factor to predict adherence to treatment behaviors.

AIM

To examine self-efficacy for managing chronic conditions in individuals with hypertension.

METHODS

A total of 1087 individuals with chronic conditions in two groups (hypertension and non-hypertension groups) were selected in this study. The two groups’ self-efficacy for managing chronic conditions were investigated using the five domains of patient reported outcomes measurement information system self-efficacy for managing chronic conditions measures (PROMIS-SE); daily activities, emotions, medication and treatment, social interactions, and symptoms. Also, the relationships between self-efficacy and other health-related outcomes for the hypertension group were examined using structural equation modeling.

RESULTS

Among 1087 participants, 437 reported having hypertension. The hypertension and non-hypertension groups were statistically different in self-efficacy for managing daily activities [F (1, 598) = 5.63, P < 0.05]. Structural equation modeling indicated that for individuals with hypertension, two domains of PROMIS-SE (managing daily activities and emotions) significantly predict global physical health (P < 0.001 and P < 0.01 sequentially), and one domain (managing emotions) significantly predicts mental health (P < 0.001). Hypertension patients’ general quality of life was significantly predicted by global physical health (P < 0.001) and mental health (P < 0.001).

CONCLUSION

The hypertension group reported deficits in self-efficacy in managing daily activities as compared to the non-hypertension group. In this hypertension group, self-efficacy functioned as an indirect predictor of general quality of life, mediated by global physical and mental health.

Developing a Preliminary Conceptual Framework for Guidelines on Inclusion of Patient Reported-Outcome Measures (PROMs) in Clinical Quality Registries

Purpose

Patient-centred and value-based health-care organisations are increasingly recognising the importance of the patient perspective in the measurement and evaluation of health outcomes. This has been primarily implemented using patient-reported outcome measures (PROMs). Clinical quality registries (CQRs) are specifically designed to improve direct clinical care, benchmark health-care provision and inform health service planning and policy. Despite CQRs having incorporated the patient perspective to support the evaluation of health-care provision, no evidence-based guidelines for inclusion of PROMs in CQRs exist. This has led to substantial heterogeneity in capturing and reporting PROMs within this setting. This publication is the first in a series describing the development of evidence-informed guidelines for PROMs inclusion within CQRs in Australia.

Methods

This study consisted of three components: 1) a literature review of existing evidence of guidelines, enablers, barriers, and lessons learnt of PROMs use within the CQRs setting; 2) a survey of Australian CQRs to determine current practices for PROMs use and reporting; and 3) development of a preliminary conceptual framework for PROMs inclusion in CQRs.

Results

Content analysis of the literature review and survey of 66 Australian registries elicited eight categories for the conceptual framework. The framework covers eight components: rationale, setting, ethics, selection of PROMs, administration, data management, statistical methods, feedback, and reporting.

Conclusion

We developed a preliminary conceptual framework, which classified findings, from both the literature and the survey, into broad categories ranging from initial development to outcome dissemination providing the structure for development of guidelines in the next phase of this project, engaging national and international leaders in health-related quality of life research, clinicians, researchers, patient advocates and consumers.

Patient-Reported Outcomes in Adult Idiopathic Inflammatory Myopathies

PURPOSE OF REVIEW

Idiopathic inflammatory myopathies (IIM) have considerable impact on patient symptoms and quality of life. We have reviewed the evolution of patient-centered care and use of patient-reported outcome measures (PROMs) for adults with IIM.

RECENT FINDINGS

Use of PROMs in myositis care and research is limited, although the importance of incorporation into routine practice and trials has become increasingly recognized. Several key domains/measures have been identified including the patient global assessment of disease activity, physical function as measured by the health assessment questionnaire-disability index (HAQ-DI), Short Form Health Survey-36 (SF-36), or the Patient-Reported Outcome Measurement Information System ® (PROMIS®) in adult IIM. Data are limited for these instruments concerning their reliability, content and construct validity, and responsiveness. Incorporation of the patient perspective into clinical care and research may be used to address the unmet/unaddressed needs of the patient living with myositis. Several ongoing projects aim to bring validated PROMs to the IIM community.