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Domingo S, Alamá P, Ruiz N, Lázaro G, Morell M, Pellicer A. Transobturator tape procedure outcome: a clinical and quality of life analysis of a 1-year follow-up. Int Urogynecol J 2006; 18:895-900. [PMID: 17136483 DOI: 10.1007/s00192-006-0263-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 11/01/2006] [Indexed: 10/23/2022]
Abstract
To report the results obtained with the transobturator sub-urethral tape (TOT) for the surgical treatment of stress urinary incontinence (SUI) after 1 year follow-up. Ninety-three patients diagnosed with SUI or mixed urinary incontinence (MUI) underwent a TOT procedure associated to prolapse surgery, if necessary. Pre-operative quality of life (QoL) was assessed with the Urogenital Distress Inventory Short Form (UDI-6)/Incontinence Impact Questionnaire Short Form (IIQ-7) questionnaires. Surgical and early complications were monitored. A stress test and an urodynamic test if urge incontinence de novo appeared were performed at 1 year follow-up. UDI-6/IIQ-7 questionnaires and SUI symptoms were recorded. Patients' characteristics, pre-operative quality of life and urodynamic evaluation were similar in the TOT and in the pelvic floor surgery group. From the sample, 15% had post-operative retention and 10% had vaginal erosion. The global rate of objective cure was 97% in both groups. The scores of the QoL questionnaires were worse by 9% and 10% with the procedure, respectively. Patients with urodynamic (MUI) or persistence of SUI symptoms (10%) did not reach a significant improvement, although patients with urge incontinence de novo (10%) did. The TOT procedure is safe and effective. Results showed that the association to pelvic floor surgical techniques did not diminish 1 year later. The stress test outcome assessment can overestimate the results, compared to the QoL assessment. In our report, the MUI did not improve with this surgical approach. Our results highlight the necessary employment of both the objective testing and the patient's opinion of her symptoms during daily life.
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Affiliation(s)
- S Domingo
- Department of Obstetrics and Gynaecology, Hospital Universitario Dr. Peset, Avda. Gaspar Aguilar, 90-46017, Valencia, Spain.
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202
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Dawson J, Coffey J, Doll H, Lavis G, Cooke P, Herron M, Jenkinson C. A patient-based questionnaire to assess outcomes of foot surgery: Validation in the context of surgery for hallux valgus. Qual Life Res 2006; 15:1211-22. [PMID: 17001437 DOI: 10.1007/s11136-006-0061-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. METHODS We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. CONCLUSIONS The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.
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Affiliation(s)
- Jill Dawson
- Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, UK.
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203
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Sargent S, Wainwright SP. Quality of life following emergency liver transplantation for acute liver failure. Nurs Crit Care 2006; 11:168-76. [PMID: 16869523 DOI: 10.1111/j.1362-1017.2006.00169.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Liver transplantation is an accepted and successful therapy for both acute and chronic liver diseases (CLDs), with good survival outcomes. Whilst the study of health-related quality of life (HRQoL) post transplantation for CLDs have been well documented, there is little data measuring HRQoL following liver transplantation for acute liver failure (ALF) patients. PATIENTS AND METHODS Data were collected using between-method triangulation; however, only the quantitative element of the study is reported here. Measuring eight health domains, we distributed the short form 36 (SF-36) questionnaire by post to 96 acute and chronic transplant recipients. Differences between the groups were measured using both parametric and non-parametric t-tests. RESULTS Overall, the patients showed a satisfactory HRQoL; there were no differences between either acute or chronic transplant groups in seven of the eight domains of quality of life. Among the patients transplanted for ALF, there were no differences in HRQoL between patients transplanted for paracetamol hepatotoxicity compared with other indications, and no variations in HRQoL related to recipient gender, employment or length of survival post transplantation. When compared with the UK SF-36 normal values to the ALF transplant recipients, there was a significantly lower physical functioning and role emotional scores. CONCLUSION Regardless of aetiology, most of recipients transplanted for ALF have a HRQoL comparable with chronic transplant recipients.
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Affiliation(s)
- Suzanne Sargent
- Institute of Liver Studies, Kings College Hospital, London, UK.
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204
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Thrall G, Lane D, Carroll D, Lip GYH. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med 2006; 119:448.e1-19. [PMID: 16651058 DOI: 10.1016/j.amjmed.2005.10.057] [Citation(s) in RCA: 406] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2005] [Revised: 10/30/2005] [Accepted: 10/31/2005] [Indexed: 11/18/2022]
Abstract
The impact of atrial fibrillation (AF) on patients' quality of life (QoL) has yet to be fully elucidated in a systematic manner. This article examines QoL in "general" patients with AF as well as the effects that rate and/or rhythm-control interventions have on QoL. Patients with AF have significantly poorer QoL compared with healthy controls, the general population, and other patients with coronary heart disease. Studies examining rate or rhythm-control strategies alone demonstrate improved QoL after intervention. Three of the four large randomized control trials (STAF, PIAF, RACE) comparing rate versus rhythm control demonstrated a greater improvement in QoL in patients receiving rate control. However, the AFFIRM trial revealed a similar improvement in QoL for both rate and rhythm-control groups. The data, although frequently compromised by various methodologic weaknesses, suggest that patients with AF have impaired QoL, and that QoL can be significantly improved through rate or rhythm-control strategies.
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Affiliation(s)
- Graham Thrall
- Cardiovascular Psychophysiology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom
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205
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Bramlett RE, Bothe AK, Franic DM. Using preference-based measures to assess quality of life in stuttering. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2006; 49:381-94. [PMID: 16671851 DOI: 10.1044/1092-4388(2006/030)] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 08/05/2005] [Indexed: 05/09/2023]
Abstract
PURPOSE The purpose of this study was to determine whether standard pharmaco-economic preference methods can be used to assess perceived quality of life in stuttering. METHOD Seventy-five nonstuttering adults completed a standardized face-to-face interview that included a rating scale, standard gamble, and time trade-off preference measures for 4 health states (your health and mild, moderate, and severe stuttering) in the context of 2 anchor states (perfect health and death). RESULTS Results showed mean utility values between .443 for severe stuttering estimated using the rating scale technique and .982 for respondents' own current health estimated using a standard gamble technique. A two-way repeated measures analysis of variance and post hoc tests showed significant effects for method, health state, and the interaction. CONCLUSIONS These results confirm that utility estimates can differentiate between stuttering severity levels and that utility scores for stuttering conform to the known properties of data obtained using these standard measurement techniques. These techniques, therefore, can and should be further investigated as potential contributors to complete measurement protocols for the study and treatment of stuttering.
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Affiliation(s)
- Robin E Bramlett
- Department of Communication Sciences and Disorders, University of Georgia, Athens 30602-7153, USA.
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206
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Wood GCA, McLauchlan GJ. Outcome assessment in the elderly after total hip arthroplasty. J Arthroplasty 2006; 21:398-404. [PMID: 16627149 DOI: 10.1016/j.arth.2004.12.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Revised: 09/21/2004] [Accepted: 12/16/2004] [Indexed: 02/01/2023] Open
Abstract
An analysis of the Short-Form 36 (SF-36) and Oxford Hip questionnaires, were used to assess 2 randomized groups, by either mail or interview, at a minimum 10-year follow up after total hip arthroplasty. Ninety-nine patients (median age 77 years) were reviewed at a median 11 years after total hip arthroplasty. There was a 91% response rate to participation in the study. There was no significant difference between the groups for missing values. The mode of administration did not affect the mean Oxford scores (P > .1), but significant differences were noted in SF-36 health scales Role Emotional and Role Physical (P = .01). Analysis of other demographic variables revealed unexpectedly that comorbidity affected the Pain score in the Oxford questionnaire (P = .002) and that age had no effect on scores obtained in either questionnaire (P > .05). The uses of both general health and disease-specific questionnaires complement each other in the assessment of such groups. The SF-36 and Oxford questionnaires give a more accurate reflection of health status when self-completed while accepting higher missing values in an elderly population.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/surgery
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/rehabilitation
- Comorbidity
- Female
- Humans
- Male
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Outcome Assessment, Health Care
- Sickness Impact Profile
- Surveys and Questionnaires
- Treatment Outcome
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Affiliation(s)
- G C A Wood
- Department of Orthopaedics, Trafford General Hospital, Manchester, England
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207
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Abstract
UNLABELLED Define the objective of the questionnaire: Discrimination: do you want a questionnaire to enable you to describe the quality of life of patients or to compare the quality of life between groups of patients, for example, to determine who has improved and who has gotten worse? ASSESSMENT do you want a questionnaire to help you measure changes over time (improvement or aggravation) in your patients? Determine the properties of instruments necessary for this objective: If the objective is discrimination, analyze: construct validity, reliability. If the objective is assessment, analyze construct validity, sensitivity to changes. Choose the general category of questionnaire: generic questionnaire, specific questionnaire.
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208
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Bonaros N, Schachner T, Ohlinger A, Friedrich G, Laufer G, Bonatti J. Assessment of Health-Related Quality of Life after Coronary Revascularization. Heart Surg Forum 2005; 8:E380-5. [PMID: 16174598 DOI: 10.1532/hsf98.20051139] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of patient-oriented outcomes, in particular health-related quality if life (HRQOL), to evaluate coronary revascularization is continuously increasing. Current data underline that patients undergoing conventional CABG show a tremendous improvement of HRQOL status as early as 3 months postoperatively. There seems to be no clear benefit concerning HRQOL for off-pump coronary surgery versus conventional CABG. The benefits of minimal invasive CABG via mini-thoracotomy are compromised by increased incidence of pain during the immediate postoperative period. Totally endoscopic approaches seem to be more effective with regard to pain reduction and resume of every day activities. Compared to catheter-based interventions there is evidence that conventional CABG offers significant advantages over PCI. The influence of drug-eluting stents and newer surgical techniques on HRQOL remains to be determined. Inclusion of HRQOL data in CABG and PCI databases can play a central role in order to identify patient groups who benefit the most from each revascularization strategy.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
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209
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Abstract
OBJECTIVE Ocular diseases markedly impair daily function. In Graves' orbitopathy (GO), an associated psychosocial burden is present due to disfiguring proptosis and/or diplopia, signs with significant impact on functional status and well-being. We have therefore surveyed and assessed the psychosocial morbidity of GO. DESIGN A prospective controlled study on subjects with GO using internationally validated, self-reporting questionnaires. PATIENTS One hundred and two consecutive patients with varying degrees of severity and activity of GO. Measurements Emotional distress, coping styles and quality of life (QoL) were assessed by the Hospital Anxiety and Depression Scale, by a German adaptation of the Ways-of-Coping Checklist, and with the 36-item Short Form, respectively. Stressful events in the 6 months preceding diagnosis were registered with the Life Experience Survey. QoL findings were compared to German reference values, as well as to 102 age- and gender-matched patients, each with type 1 diabetes (insulin-dependent diabetes mellitus, IDDM) and inflammatory bowel disease (IBD), respectively. RESULTS Compared to the German reference population, all QoL scales were at a lower rate and were especially decreased in subjects with active and/or severe GO, orbital pain, diplopia and stressful life events. Compared to diabetics, psychosocial scales were considerably reduced in GO (z = -1 vs. 0.1, P < 0.001) and higher scores for depressive coping (2.32 vs. 1.71, P < 0.001) and trivializing (2.37 vs. 1.97, P < 0.006) were noted. In GO, depressive coping and trivializing were negatively correlated with the mental (r = -0.603 and r =-0.411, both P < 0.001) and physical (r = -0.487 and r = -0.354, both P < 0.001) components of QoL. Depressive coping also positively correlated with anxiety (r = 0.636) and depression (r = 0.590), respectively, both P < 0.001. Emotional distress noted in 46 subjects, mostly with active and severe GO, was associated with poor QoL. Anxiety and depression were present in 41 and 24 GO patients, respectively. The number of stressful events positively correlated with the scores of anxiety (r = 0.3335) and depression (r = 0.3178), both P = 0.001. Foremost emotional distress, but also diplopia, stressful events and depressive coping had a major impact on QoL (proportion of variance explained = 13.1%, P < 0.001, multiple regression analysis). More than 75% of the psychosocial impairment in GO (R2= 0.76, P < 0.001) was associated with seven variables only (e.g. depression and anxiety). Six months prior to GO onset, 74 patients experienced a mean of 4 (range 0-13) stressful life events. Subjects with optic neuropathy had more stressful events than those without nerve involvement (5.1 vs. 2.7, P = 0.0425). CONCLUSIONS Psychosocial morbidity is present in severe and/or active GO, which negatively affects QoL. The patients are not only physically ill, they also exhibit emotional distress. Accompanying psychosomatic treatment is indicated among about half of all GO patients.
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Affiliation(s)
- G J Kahaly
- Department of Medicine I, Gutenberg University, Mainz, Germany.
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210
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Doll HA, Petersen SE, Stewart-Brown SL. Eating disorders and emotional and physical well-being: associations between student self-reports of eating disorders and quality of life as measured by the SF-36. Qual Life Res 2005; 14:705-17. [PMID: 16022064 DOI: 10.1007/s11136-004-0792-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess health-related quality of life (HRQoL) in subjects with eating disorders in terms of eating disorder type and in relation to self-reports of longstanding illness, depression and self-harming behaviours. METHOD Data on eating disorder history, SF-36 health status, longstanding illness, and self-reported frequencies of depression, self-harming behaviour, and suicidal thoughts or acts were collected during 1996 as part of a UK postal survey of students' health. Completed questionnaires were returned by 1439 of 3750 students (response rate 42%). RESULTS Eighty-three respondents (5.8%; 8.9% of females) reported a probable eating disorder history: 54 (3.8%) bulimia nervosa, 22 (1.6%) binge eating disorder, and 7 (0.5%) anorexia nervosa. Eating disorder subjects reported more impairment in SF-36 emotional than physical well-being, with significantly lower mental (p < 0.001) but not physical (p = 0.21) component summary scores. This was most evident in bulimia nervosa and binge eating disorder subjects. Anorexia nervosa subjects reported fewer SF-36 emotional limitations although they were significantly more likely to report depression, self-harming behaviour, and suicidal ideation. DISCUSSION An eating disorder history is accompanied by HRQoL impairment primarily in emotional well-being. Anorexia nervosa subjects perceive fewer limitations than subjects with other eating disorders. While this is consistent with previous reports of better SF-36 emotional well-being in those with restrictive eating behaviours, it may also suggest that the SF-36 is insensitive to emotional distress in anorexia nervosa.
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Affiliation(s)
- Helen A Doll
- Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom.
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211
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Whitehouse SL, Blom AW, Taylor AH, Pattison GTR, Bannister GC. The Oxford Knee Score; problems and pitfalls. Knee 2005; 12:287-91. [PMID: 15993604 DOI: 10.1016/j.knee.2004.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Revised: 09/20/2004] [Accepted: 11/16/2004] [Indexed: 02/02/2023]
Abstract
The Oxford Knee Score is a self-completed patient based outcome score. We audited the outcome of total knee arthroplasty at our unit using the Oxford Knee Score. The hypothesis of this study is that the OKS can be easily and accurately completed by unassisted patients. Of 856 patients who had undergone total knee arthroplasty and were given questionnaires, 769 (90%) responded. 624 (81%) of the respondents managed to complete the questionnaire. A number of the 12 items composing the questionnaire posed problems for the patients and a number of items were left blank. Item 4 (concerning walking time) was omitted in 82 (13%) of the 624 completed questionnaires. Calculation of Cronbach's alpha for internal consistency suggests that there are redundancies within the Score. Limitations in some of the items of the scale suggest the need for reconsideration and reformulation of questions and response categories. This study suggests that where detailed assessment of outcome is required, such as for outcome studies or controlled trials, the Oxford Knee Score, in its present form, is not ideal for use as a postal questionnaire.
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Affiliation(s)
- Sarah L Whitehouse
- Avon Orthopaedic Centre, Southmead Hospital, 23 Old Sneed Ave., Stoke Bishop, Bristol BS9 1SD, United Kingdom
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212
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Okuda M, Ohkubo K, Goto M, Okamoto H, Konno A, Baba K, Ogino S, Enomoto M, Imai T, So N, Ishikawa Y, Takenaka Y, Manndai T, Crawford B. Comparative study of two Japanese rhinoconjunctivitis quality-of-life questionnaires. Acta Otolaryngol 2005; 125:736-44. [PMID: 16012036 DOI: 10.1080/00016480510026944] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSION Two questionnaires were used to assess quality of life (QOL) in allergic rhinitis: the Japanese translation of the Rhino-conjunctivitis Quality of Life Questionnaire (RQLQJ) and an original Japanese QOL questionnaire (JRQLQ). Either questionnaire may be used to assess QOL depending on differences in target domains. OBJECTIVES Although pollinosis is a common disease which has a major impact on patient QOL, no internationally standardized questionnaire has been available in Japan until now. The aim of this study was to compare two currently available QOL questionnaires for allergic rhinitis in Japan-the RQLQJ and JRQLQ-in terms of their appropriateness for clinical use and their psychometric properties. MATERIAL AND METHODS A multicenter, inter-group, cross-sectional study was conducted in 187 adult symptomatic patients with Japanese cedar pollinosis in 2003. Patient scores on the two questionnaires were compared in terms of both overall and comparable domains. We also examined the acceptability, construct and reliability of both questionnaires. RESULTS The questionnaires were highly correlated in terms of both overall and comparable domain scores. In addition, both questionnaires had equal and satisfactory psychometric validity, demonstrating that they are both useful tools for assessing QOL in rhinitis. However, when compared with each other, the JRQLQ focuses mainly on activities of daily life and is simpler, while the RQLQJ focuses mainly on rhinitis-related health and is more responsive.
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Affiliation(s)
- M Okuda
- Nippon Medical School, Tokyo, Japan.
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213
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Heffernan C, Jenkinson C. Measuring outcomes for neurological disorders: a review of disease-specific health status instruments for three degenerative neurological conditions. Chronic Illn 2005; 1:131-42. [PMID: 17136919 DOI: 10.1177/17423953050010021001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health-related quality-of-life measures have been increasingly used in research into neurological disorders in recent years. The aim of this paper is to provide an objective appraisal of the evidence in regard to disease-specific quality-of-life measures used in research on health interventions for three degenerative neurological disorders: multiple sclerosis, motor neurone disease/amyotrophic lateral sclerosis and Parkinson's disease. A comprehensive search strategy was developed to include nine relevant electronic databases. Only studies pertaining to patient-based outcome measurements in multiple sclerosis, motor neurone disease and Parkinson's disease were included. We identified 76 eligible studies. As studies consisted of descriptive and cross-sectional survey study designs, results were reported qualitatively rather than in the form of a meta-analysis. Four disease-specific measures were found for Parkinson's disease, 11 for multiple sclerosis and one for motor neurone disease. We conclude that health-related quality-of-life measures are useful in assessing the impact of treatments and interventions for neurological disorders. However, further research is needed on the development of instruments using psychometric methods and on the validation, utilization and responsiveness of instruments to change.
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Affiliation(s)
- Catherine Heffernan
- Health Services Research Unit, Department of Public Health, University of Oxford, Old Road Campus, Headington, OX3 7LF, UK
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214
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Lips P, van Schoor NM. Quality of life in patients with osteoporosis. Osteoporos Int 2005; 16:447-55. [PMID: 15609073 DOI: 10.1007/s00198-004-1762-7] [Citation(s) in RCA: 246] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 09/09/2004] [Indexed: 01/22/2023]
Abstract
Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)-independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.
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Affiliation(s)
- Paul Lips
- Department of Endocrinology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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215
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Solari A. Role of health-related quality of life measures in the routine care of people with multiple sclerosis. Health Qual Life Outcomes 2005; 3:16. [PMID: 15777478 PMCID: PMC555749 DOI: 10.1186/1477-7525-3-16] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 03/18/2005] [Indexed: 11/10/2022] Open
Abstract
Health-related quality of life instruments are expected to be of particular value in routine care of people with multiple sclerosis (MS), where they may facilitate the detection of disease aspects that would otherwise go unrecognised, help clinicians appreciate patient priorities particularly in terms of treatment goals, facilitate physician-patient communication, and promote shared decision-making. However, it appears that these instruments are little used routine clinical approaches to people with MS. To address this issue, I performed a bibliographic search of studies that evaluated the efficacy of generic or disease-specific health-related quality of life (HRQOL) instruments in MS clinical practice from clinicians' or patients' perspectives. I found only one cross-sectional study, which compared preferences for three instruments, and assessed acceptability in people with MS. Reasons for lack of transfer of HRQOL measurements to clinical practice may be cultural, methodological, or practical. With regard to MS, the proliferation of instruments seems to constitute a barrier, with no particular instrument having gained wide popularity or consensus. Other barriers are lack of resources for the administration, collection and storage of the data, and inability of clinicians to score, interpret, and use HRQOL instrument to guide clinical care. It is therefore important to refine existing tools, extending clinical validation to wider contexts and cultures. More studies assessing acceptability and clinicians' and patients' preferences for different instruments are also required.
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Affiliation(s)
- Alessandra Solari
- Epidemiology Unit, National Neurological Institute C, Besta, Via Celoria 11, 20133 Milan, Italy.
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216
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Resnick B, Orwig D, Wehren L, Hawkes W, Hebel R, Zimmerman S, Magaziner J. Health-Related Quality of Life: Is It a Good Indicator of Function Post THR? Rehabil Nurs 2005; 30:46-54, 67. [PMID: 15789696 DOI: 10.1002/j.2048-7940.2005.tb00359.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to explore the impact of health-related quality of life (HRQOL) measured with the Short Form Health Survey (SF-36) on Functional Recovery Status (physical and psychosocial recovery status) at base-line, 2 months, 6 months, and 12 months following total hip replacement (THR). A secondary analysis was performed using data gathered from a sample of 271 older adults post THR. Four empirically based hypothesized models were tested. None of the models fit the data, with each having significant chi2 values and chi2 /df ratios greater than 3. Different dimensions of HRQOL at baseline, 2, 6, and 12 months were related to physical recovery status, and none of the 8 dimensions of the SF-36 was significantly related to psychosocial recovery status. Overall, the results of this study do not support the hypothesis that HRQOL, as measured by the SF-36, comprehensively explains functional recovery status following THR. Clinically, these findings may be applicable to individuals at risk for poor recovery. They also may prompt practitioners to consider alternative factors that influence psychosocial recovery.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street Baltimore, MD 21201, USA.
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217
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Bjelic-Radisic V, Dorfer M, Tamussino K, Greimel E. Psychometric properties and validation of the German-language King's Health Questionnaire in women with stress urinary incontinence. Neurourol Urodyn 2005; 24:63-8. [PMID: 15578627 DOI: 10.1002/nau.20092] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS The purpose of this study was to evaluate the psychometric properties of and validate the German-language version of the King's Health Questionnaire (KHQ) in women with stress urinary incontinence (SUI). METHODS A total of 145 women treated for stress incontinence with surgery or physiotherapy completed the the KHQ and the SF-36 before and after treatment. Psychometric analyses of the quality of life (QoL) instruments determined the reliability (Cronbach's alpha), internal and external validity, and responsiveness of the KHQ subscales. RESULTS The KHQ showed good internal consistency, content validity, and criterion validity as measured by correlation with scores on the SF-36. Cronbach's alpha coefficient ranged from 0.76 to 0.86, indicating a high internal consistency of the subscales. Concerning criterion validity, correlations between the KHQ subscales and the SF-36 were low to moderate. The highest correlation was found between the general health perception subscales of both questionnaires. CONCLUSIONS The results indicate good psychometric properties for the German-language KHQ.
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Affiliation(s)
- Vesna Bjelic-Radisic
- Department of Obstetrics & Gynecology, Medical University of Graz, Graz, Austria.
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218
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Abstract
Quality of life is an existential concept with multiple definitions. Clinicians and researchers are concerned with the more specific concept of health-related quality of life (HRQL), which considers the impact of impairments, functional states, perceptions, and social opportunities on overall quality of life. The unique nature of the issues related to living with HIV requires that the HRQL instruments used to evaluate HIV-infected patients include dimensions such as sexual function, stigma, and body image. HIV-specific instruments with established validity and reliability that have provided useful information in clinical trials include the Medical Outcomes Study-HIV Health Survey, HIV/AIDS--Targeted Quality of Life instrument, Functional Assessment of HIV Infection, AIDS Health Assessment Questionnaire, HIV Overview of Problems--Evaluation Systems, and Multidimensional Quality of Life Questionnaire for HIV/AIDS. As treatment advances, maximizing HRQL will become an increasingly important goal for clinicians involved in the care of HIV-infected individuals.
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de Korte J, Van Onselen J, Kownacki S, Sprangers MAG, Bos JD. Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme. J Eur Acad Dermatol Venereol 2005; 19:35-41. [PMID: 15649189 DOI: 10.1111/j.1468-3083.2004.01107.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with psoriasis have to cope with their disease for many years or even throughout their entire life. To provide optimal care, a disease management programme was developed. This programme consisted of disease education, disease management training, and psychological support, together with topical treatment. OBJECTIVE To test a disease management programme in dermatological practice, to assess patients' satisfaction with this programme, and adherence to topical treatment. Additionally, disease severity and quality of life were assessed. METHODS An initial clinical investigation was conducted in 10 European treatment centres. A total of 330 patients were included. Patient satisfaction, adherence, disease severity and quality of life were measured with study-specific and standardized self-report questionnaires. RESULTS Patients reported a high degree of satisfaction with the programme, and a high degree of adherence to topical treatment. Disease severity and quality of life significantly improved. The programme was well received by the participating professionals. CONCLUSIONS The disease management programme was found to be a useful tool in the management of psoriasis, providing patients with relief from the burden of psoriasis in everyday life. A full-scale evaluation is recommended.
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Affiliation(s)
- J de Korte
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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220
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Watson L, Story I, Dalziel R, Hoy G, Shimmin A, Woods D. A new clinical outcome measure of glenohumeral joint instability: the MISS questionnaire. J Shoulder Elbow Surg 2005; 14:22-30. [PMID: 15723010 DOI: 10.1016/j.jse.2004.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Many standard shoulder outcome measures do not adequately cover the range of problems and issues specifically encountered in glenohumeral joint instability and have been shown not to be sensitive enough to detect clinical change with intervention adequately. The purpose of this report is to present a prospective evaluation of a new self-administered patient questionnaire specifically designed to assess glenohumeral joint instability. The evaluation involved test-retest reliability and comparison with the Shoulder Rating Questionnaire (SRQ). Sixty-four patients with confirmed glenohumeral joint instability were assessed with both the Melbourne Instability Shoulder Scale (MISS) and SRQ 12 preoperatively and at 6 months after shoulder reconstructive surgery. Twenty-two patients were recruited into a reliability study of the MISS questionnaire. The test-retest reliability of the MISS was found to be 0.98 (interclass correlation coefficient, mixed-model analysis of variance, absolute agreement). Assessment of agreement between the MISS and SRQ questionnaires indicated very poor pretest agreement (0.33) and moderate agreement at 6 months (0.66). The differences between the MISS and SRQ were statistically significant both before surgery (paired t = 13.2, degrees of freedom [ df ] = 63, P < .001) and at 6 months' follow-up (paired t = 7.9, df = 63, P = .001). Change in the questionnaire scores measured from surgery to 6 months' follow-up was significantly greater in the MISS (mean, 30; SD, 19.1; median, 30.8) than in the SRQ (mean, 16.6; SD, 12.8; median, 14.3) (Wilcoxon test: z = -5.8, P = .0001). The results of this study show that the MISS questionnaire is a reliable outcome questionnaire and has a greater range to detect changes in shoulder instability than more global outcome questionnaires such as the SRQ. The higher scores encountered on the SRQ may mean that it underestimates the severity of a patient's instability problem.
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Affiliation(s)
- Lyn Watson
- LifeCare Prahran Sports Medicine, Prahran, Australia
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221
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Mayo NE, Poissant L, Ahmed S, Finch L, Higgins J, Salbach NM, Soicher J, Jaglal S. Incorporating the International Classification of Functioning, Disability, and Health (ICF) into an electronic health record to create indicators of function: proof of concept using the SF-12. J Am Med Inform Assoc 2004; 11:514-22. [PMID: 15298994 PMCID: PMC524632 DOI: 10.1197/jamia.m1462] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Accepted: 06/21/2004] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The purpose of this proof-of-concept study was to assess the feasibility of using a generic health measure to create coded functional status indicators and compare the characterization of a stroke population using coded functional indicators and using health-related quality-of-life summary measures alone. DESIGN Multiple raters assigned International Classification of Functioning, Disability, and Health (ICF) codes to the items of the 12-Item Short Form Health Survey (SF-12). Data for comparing the information from the SF-12 and from ICF codes were derived from the Montreal Stroke Cohort Study that was set up to examine the long-term impact of stroke. Available for analysis were data from 604 persons with stroke, average age 69 years, and 488 controls, average age 62 years. MEASUREMENT The SF-12 provides two summary scores, one for physical health and one for mental health. Domains of the ICF are coded to three digits, before the decimal; specific categorizations of impairments, activity limitations, and participation restrictions are coded to four digits before the decimal. RESULTS Persons with stroke scored, on average, approximately 10 points lower than controls on physical and mental health. The ICF coding indicated that this was attributed, not surprisingly, to greater difficulty in doing moderate activities including housework, climbing stairs, and working and was not attributed to differences in pain. Differences in mental health were attributed most strongly to greater fatigue (impairment in energy), but all areas of mental health were affected to some degree. CONCLUSION The ICF coding provided enhanced functional status information in a format compatible with the structure of administrative health databases.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada.
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222
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Miehsler W, Weichselberger M, Offerlbauer-Ernst A, Dejaco C, Reinisch W, Vogelsang H, Machold K, Stamm T, Gangl A, Moser G. Assessing the demand for psychological care in chronic diseases: development and validation of a questionnaire based on the example of inflammatory bowel disease. Inflamm Bowel Dis 2004; 10:637-45. [PMID: 15472527 DOI: 10.1097/00054725-200409000-00021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND This study was designed to develop and validate the ADAPT (Assessment of the Demand for Additional Psychological Treatment), a questionnaire assessing the demand for disease-oriented counseling (DOC), integrated psychosomatic care (IPC), and psychotherapy (PT) in chronically ill patients on the example of inflammatory bowel diseases (IBDs). METHODS After its development, the ADAPT was distributed to 39 IBD patients along with the Hospital Anxiety and Depression scale (HAD), the Rating Form of IBD Patient Concerns (RFIPC), and a questionnaire on social support (SOZU-K22). For construct validity, 19 hypotheses were made on how DOC, IPC, and PT should correlate with HAD, RFIPC, SOZU-K22, and disease-related variables. To analyze interindividual responsiveness, patients were classified according to their bio-psycho-social state, and DOC, IPC, and PT scores were compared between these classes. The test-retest method with a 4-week time lapse was used to analyze reliability and intraindividual responsiveness. DOC, IPC, and PT scores between baseline and follow-up were compared separately for patients classified as "stable" or "changed" according to changes in HAD and disease activity. RESULTS Observed correlations were largely in agreement with the 19 hypotheses. DOC, IPC, and PT achieved significantly different scores between different patients. After 4 weeks, DOC, IPC, and PT revealed stable scores in patients with "stable" HAD and revealed significantly different scores in patients with "changed" HAD. Changed disease activity was not associated with significant changes of the ADAPT. CONCLUSIONS The ADAPT is the first questionnaire to assess subjective demand for additional psychological care in chronically ill patients. The first application of the ADAPT to 39 IBD patients suggests its validity, reliability, and responsiveness.
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Affiliation(s)
- Wolfgang Miehsler
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, University of Vienna, Austria.
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Fernández-López JA, Fernández Fidalgo M, Cieza A, Ravens-Sieberer U. [Measuring health-related quality of life in children and adolescents: preliminary validation and reliability of the Spanish version of the KINDL questionnaire]. Aten Primaria 2004; 33:434-42. [PMID: 15151790 PMCID: PMC7681901 DOI: 10.1016/s0212-6567(04)79429-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To obtain a first Spanish version of the KINDL questionnaire idiomatic and culturally equivalent to the German original version, and then to evaluate its psychometric properties in a sample of healthy children/adolescents 8-16 years old, and their parents. DESIGN Cross-sectional study. SETTING 2 public schools of Asturias of similar sociodemographic conditions. PARTICIPANTS 243 children 8-16 year-old, and 153 parents were investigated. MAIN MEASUREMENTS HRQoL evaluated through the generic questionnaire KINDL. An external assessment through the parents was made as well. The psychometric properties of the Spanish version of the questionnaire were investigated and results on HRQoL are presented for different ages and gender in the Spanish sample. RESULTS 6 items (6/24) needed successive translations and conceptual discussion during the phase of idiomatic adaptation. The factorial analysis confirmed the validity of construction of the instrument for most scales. The internal consistency, measured by alpha Cronbach coefficent, was good for the total of the questionnaire (>0.70) and acceptable in most of the scales (>0.50). Only the school scale for adolescents shows very poor reliability. Females and children with higher age scored lower in most of the investigated dimensions (P<.01). CONCLUSIONS The first Spanish version of the Kindl showed acceptable reliability and validity. In spite of the punctual inadequacies found in this first step of the investigation, the results constitute an important starting point to work further on the KINDL as an HRQoL instrument--in Spanish language--to measure subjective well-being in children.
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Affiliation(s)
- J A Fernández-López
- Centro de Salud de Riosa, Servicio de Salud del Principado de Asturias, Travesía Santa Bárbara, s/n 33160 La Ará-Riosa, Asturias, Spain.
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224
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Quelles échelles de qualité de vie pour les patients atteints d’EPPR. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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225
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Gil Z, Abergel A, Spektor S, Shabtai E, Khafif A, Fliss DM. Development of a cancer-specific anterior skull base quality-of-life questionnaire. J Neurosurg 2004; 100:813-9. [PMID: 15137599 DOI: 10.3171/jns.2004.100.5.0813] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to develop a disease-specific, multidimensional quality of life (QOL) assessment instrument for patients undergoing surgical extirpation of anterior skull base tumors. METHODS This investigation included 35 patients who had been surgically treated for more than 3 months before the study was begun. Relevant QOL questions were generated from a review of the literature and interviews with health professionals, patients, and their caregivers. The initial multidimensional, 80-item questionnaire was reduced to a 35-item questionnaire by using standard psychometric criteria. Six relevant domains were identified using factor analysis: performance, physical function, vitality, pain, specific symptoms, and influence on emotions. The internal consistency of the instrument had a correlation coefficient of 0.8 and a reliability coefficient (test-retest reliability) of 0.9. The validity of the construct was assessed by testing whether the clinical variable of the patient influenced his QOL domain score as hypothesized. Patients older than 60 years of age had significantly poorer scores in the domains of performance and physical function than younger patients. Patients with malignant tumors had significantly poorer scores in the domains of specific symptoms, influence on emotions, physical function, and performance compared with patients with benign tumors. Radiotherapy was associated with poorer scores in the domains of specific symptoms and influence on emotions. Comorbidity was associated with poor physical function scores. Using the final questionnaire, we prospectively evaluated the QOL of 12 additional patients before they underwent surgery and again between 5 and 6 months postoperatively to test the utility and validity of the instrument further. Again, significantly poorer QOL scores were recorded for patients with malignancy. CONCLUSIONS The proposed questionnaire appears to be sufficiently reliable and valid in estimating a patient's QOL after extirpation of anterior skull base tumors. The instrument can be used in face-to-face interviews and via electronic or regular mail.
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Affiliation(s)
- Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Mathus-Vliegen EM, de Weerd S, de Wit LT. Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss. Surgery 2004; 135:489-97. [PMID: 15118585 DOI: 10.1016/j.surg.2004.01.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Physical, emotional, and social functioning are impaired in obesity. It is unknown whether and, if so, to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels. Our objective was to compare the health-related quality-of-life (HRQL) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric banding. METHODS An HRQL questionnaire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy, normal-weight subjects, matched for age, gender, education, and vocational training. In addition to weight loss and health gain, the influences of achieved weight loss goals, satisfaction with outcome and operative approach (laparoscopy/laparotomy) were assessed. RESULTS Quality-of-life was significantly impaired in obese subjects. With a substantial weight loss of 35 kg and 42% loss of excessive weight, and correction of disturbed metabolic parameters, they significantly improved in general well-being, health distress, and perceived attractiveness, approaching halfway the values of a normal-weight reference group. Improvement in values for depression and self-regard lagged behind. In physical activity, they bypassed the reference group. Days of sick leave decreased to the level of the reference group. Improvements in HRQL paralleled the rate of weight loss. Personal satisfaction and surgical approach were of minor influence. CONCLUSIONS The obese subjects' impaired physical and social functioning improved considerably, catching up midway to normal-weight reference values after weight loss. Psychologic amelioration lagged behind. Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies.
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Affiliation(s)
- Elisabeth M Mathus-Vliegen
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Erasmus University of Rotterdam, and Onze Lieve Vrouwe Gasthuis, Amsterdam and Rotterdam, The Netherlands
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227
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Abstract
Health related quality of life (HRQoL) is determined by both disease and non-disease related factors. Several studies have reported significant HRQoL impairment in GORD patients compared with the general population. Disease severity correlates strongly with HRQoL. Non-disease features, such as the presence of anxiety and comorbid conditions, also negatively impact on HRQoL. Combining a generic and disease specific instrument may avoid missing unexpected outcomes and ensure recognition of all clinically important changes. Full validation of assessment tools is critical. Long term, as well as short term, evaluation is important and is critical when undertaking comparative pharmacoeconomic evaluations.
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Affiliation(s)
- E J Irvine
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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228
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Joshi K, Kumar R, Avasthi A. Morbidity profile and its relationship with disability and psychological distress among elderly people in Northern India. Int J Epidemiol 2004; 32:978-87. [PMID: 14681260 DOI: 10.1093/ije/dyg204] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Morbidity among elderly people has an important influence on their physical functioning and psychological well-being. Evaluation of the morbidity profile and its determinants, which have implications for elderly people, are not available. The objective of this study is to assess morbidity, co-morbidity, and patterns of treatment seeking, and to determine relationship of morbidity with disability, psychological distress, and socio-demographic variables among the elderly population in northern India. METHODS A cross-sectional survey of 200 subjects over 60 years old (100 each from the urban population of Chandigarh City and the rural population of Haryana State of India) was carried out using a cluster sampling technique. The study period was July 1999-April 2000. Various socio-demographic characteristics were recorded at baseline. A clinical diagnosis was made by a physician based on reported illness, clinical examination, and cross-checking of medical records and medications held by the subjects. Psychological distress and disability was assessed using the PGI-Health Questionnaire-N-1 and the Rapid Disability Rating Scale-2, respectively. ANOVA, Kruskal-Wallis H test, correlation coefficient, and multivariate analysis were used to assess the relationship and association of morbidity with other variables. RESULTS Of the total sample, 88.9% reported illness based on their perception, and of these 43.5% were seeking treatment and actually taking medicines, and 42.5% were diagnosed as having 4-6 morbidities. The mean number of morbidities among elderly people was 6.1 (SD 2.9). A total of 87.5% had minimal to severe disabilities and 66% of elderly people were distressed physically, psychologically, or both. The most prevalent morbidity was anaemia, followed by dental problems, hypertension, chronic obstructive airway disease (COAD), cataract, and osteoarthritis. Morbidities like asthma, COAD, hypertension, osteoarthritis, gastrointestinal disorders, anaemia, and eye and neurological problems were significantly associated with disability and distress. Higher number of morbidities was associated with greater disability and distress. In univariate analysis, socio-demographic variables like age, locality, caste, education, occupation, and income were important determinants of morbidity. Multivariate analysis was undertaken to find out the independent relationship of socio-demographic variables with morbidity. Morbidity was significantly associated with age (b value 0.06, 95% CI: 0.01, 0.12), sex (b value 1.03, 95% CI: 0.02, 2.05), and occupation (b value 0.20, 95% CI: 0.07, 0.33). CONCLUSIONS A high mean number of morbidities (6.1, SD 2.9) was observed. Elderly subjects with higher morbidity had increasing disability and distress. Age, sex, and occupation were important determinants of morbidity. Assessment of the morbidity profile and its determinants will help in the application of interventions, both medical and social, to improve the health status and thus the quality of life of the elderly in Northern India.
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Affiliation(s)
- Kamlesh Joshi
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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229
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Pager CK, McCluskey PJ. Surgeons' perceptions of their patients' priorities. J Cataract Refract Surg 2004; 30:591-7. [PMID: 15050254 DOI: 10.1016/s0886-3350(03)00671-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2003] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare cataract surgeons' predictions of patient responses to patients' actual responses on 13 factors that are important to patients about to have cataract surgery and are likely to affect their satisfaction. SETTING Day-stay cataract surgery units at a large private hospital and a large public hospital. METHOD Patients (private and public) were asked to rate the importance of 13 factors regarding their cataract treatment. All cataract surgeons who regularly treated cataract patients in a large metropolitan city were randomized to a public or private group and sent the same 13 factors. The surgeons were asked to rate how important each factor is to their public or private patients, as appropriate. RESULTS Eighty-one patients and 77 doctors responded to the survey. Overall, doctors predicted that all items would be more important to private patients than to public patients, even though no significant difference existed between the patient groups. Doctors correctly identified public patients' priorities but underestimated the magnitude of overall importance. In contrast, doctors recognized the magnitude of overall importance to private patients but misjudged many priorities. Doctors underestimated the importance to patients of nonsurgical characteristics such as seeing the same doctor, having a pleasant location for appointments, and waiting time for surgery. CONCLUSIONS This study demonstrates significant discordance between patients' priorities when having cataract surgery and their doctors' perception of those priorities. These differences could be explained by doctors' stereotypes of public patients and insufficient appreciation of the nonmedical aspects of patient care.
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Affiliation(s)
- Chet K Pager
- Department of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia
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de Korte J, Sprangers MA, Mombers FM, Bos JD. Quality of life in patients with psoriasis: a systematic literature review. J Investig Dermatol Symp Proc 2004; 9:140-7. [PMID: 15083781 DOI: 10.1046/j.1087-0024.2003.09110.x] [Citation(s) in RCA: 268] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Data on physical, psychological, and social functioning of patients with psoriasis have been presented in many studies. The introduction of quality-of-life questionnaires has made it possible to systematically compare these data across studies. The aim of this study was to present an overview of quality-of-life data and to describe the relationship between demographic and clinical variables and quality of life in patients with psoriasis. Computerized bibliographic databases were screened for publications from January 1966 to April 2000. Predefined selection criteria were used to identify quality-of-life studies in psoriasis. Two investigators independently assessed and, subsequently, agreed on inclusion. Data were extracted on the objectives, methods, sample characteristics, and results of the studies. A total of 118 publications were found. Seventeen studies met the inclusion criteria. Patients with psoriasis reported physical discomfort, impaired emotional functioning, a negative body and self-image, and limitations in daily activities, social contacts and (skin-exposing) activities, and work. More severe psoriasis was associated with lower levels of quality of life. There was a tendency that higher age was associated with slightly lower levels of physical functioning and slightly higher levels of psychological functioning and overall quality of life. Sex and quality of life were found to be unrelated.
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Affiliation(s)
- John de Korte
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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231
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Erickson SR, Williams BC, Gruppen LD. Relationship Between Symptoms and Health-Related Quality of Life in Patients Treated for Hypertension. Pharmacotherapy 2004; 24:344-50. [PMID: 15040647 DOI: 10.1592/phco.24.4.344.33177] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To determine the relationship between symptoms and health-related quality of life (HRQOL) in patients receiving drug therapy for hypertension. DESIGN Cross-sectional survey. SETTING Outpatient general medicine and university-based hypertension clinics. PATIENTS All patients prescribed one or more antihypertensive drugs seen during a 6-month period in the clinics. INTERVENTION Data were obtained from a mailed questionnaire and medical records. MEASUREMENTS AND MAIN RESULTS Symptoms were measured by a symptom count and total symptom distress. Two scores derived from the Short Form-36 (SF-36)--the Physical Component Summary (PCS) and the Mental Component Summary (MCS)--were used to assess HRQOL. Responses were received from 125 of 220 patients (56.8%). Mean +/- SD values were 8.8 +/- 7.8 for symptom count, 31.6 +/- 46.2 for total symptom distress, 48.7 +/- 9.3 for PCS, and 51.6 +/- 10.1 for MCS. Higher symptom counts and symptom distress scores were strongly associated with lower HRQOL scores in multivariate models, with standardized coefficients from -0.62 to -0.41. These were greater in magnitude than any other predictor, including demographic information (age, sex, race, education level, income), disease variables (blood pressure, years of hypertension), and drug treatment (number of antihypertensive drugs and duration of regimen). Model-adjusted R2 values were 0.22-0.41. CONCLUSION Symptoms have a greater impact on HRQOL than patient characteristics, blood pressure, or drug-related factors. Among patients receiving drug therapy for hypertension, detailed review of symptoms may yield important information for assessing and improving HRQOL.
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Affiliation(s)
- Steven R Erickson
- Department of Clinical Sciences, College of Pharmacy, University of Michigan, Ann Arbor 48109-1065, USA.
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232
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Boini S, Briançon S, Guillemin F, Galan P, Hercberg S. Impact of cancer occurrence on health-related quality of life: a longitudinal pre-post assessment. Health Qual Life Outcomes 2004; 2:4. [PMID: 14715085 PMCID: PMC317475 DOI: 10.1186/1477-7525-2-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 01/09/2004] [Indexed: 11/17/2022] Open
Abstract
Background Investigations focusing and implementing on the impact of cancer on health-related quality of life (HRQoL) by the way of a mean comparison between cancer patients and subjects from the general population, are scarce and usually cross-sectional. Longitudinal application of HRQoL instruments to a general, initially healthy population allows for change to be assessed as an event occurs, rather than afterwards. The objective of the present study was to investigate the impact of new cancer on HRQoL. Methods The 36-item Short Form (SF-36) and 12-item General Health Questionnaire (GHQ-12) were applied to the French SU.VI.MAX cohort in 1996 and 1998. A controlled longitudinal study was used to determine the impact on HRQoL of newly diagnosed cancer: 84 patients with cancer that occurred between the 2 HRQoL measures were compared with 420 age- and sex-matched cancer-free controls. Results Initial HRQoL level was similar in the two groups. A new cancer had a particularly marked effect on the SF-36 Physical functioning, Role-physical and General health dimensions (more than 6.6-point difference in change in HRQoL evolution on a 0–100 scale). The Bodily pain and Vitality dimensions were less severely affected (difference in change varying from 4.4 to 6.3 points), and there was no effect on either the GHQ-12 score or the SF-36 Mental health, Role-emotional and Social functioning dimensions. Conclusions The negative impact of cancer on the lives of patients was assessed in terms of HRQoL. The aspects most likely to be affected were those with a physical component, and general health perceptions. These results can thus help quantify the impact of a new cancer on HRQoL evolution and potentially facilitate early intervention by identifying the most affected HRQoL domains.
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Affiliation(s)
- Stéphanie Boini
- EA 3444 – Ecole de Santé Publique, Faculté de médecine, Université Henry Poincaré de Nancy, 9 avenue de la forêt de Haye, BP 184, 54500 Vandoeuvre Les Nancy, France
- Centre d'Epidémiologie Clinique – INSERM, Hôpital Marin, 92 avenue du Maréchal de Lattre de Tassigny, C.O. n° 35, 54035 Nancy Cedex, France
| | - Serge Briançon
- EA 3444 – Ecole de Santé Publique, Faculté de médecine, Université Henry Poincaré de Nancy, 9 avenue de la forêt de Haye, BP 184, 54500 Vandoeuvre Les Nancy, France
- Centre d'Epidémiologie Clinique – INSERM, Hôpital Marin, 92 avenue du Maréchal de Lattre de Tassigny, C.O. n° 35, 54035 Nancy Cedex, France
| | - Francis Guillemin
- EA 3444 – Ecole de Santé Publique, Faculté de médecine, Université Henry Poincaré de Nancy, 9 avenue de la forêt de Haye, BP 184, 54500 Vandoeuvre Les Nancy, France
- Centre d'Epidémiologie Clinique – INSERM, Hôpital Marin, 92 avenue du Maréchal de Lattre de Tassigny, C.O. n° 35, 54035 Nancy Cedex, France
| | - Pilar Galan
- Unité 557 – Unité Mixte de Recherche Inserm/Inra/Cnam, 5 rue Vertbois, 75003 Paris, France
| | - Serge Hercberg
- Unité 557 – Unité Mixte de Recherche Inserm/Inra/Cnam, 5 rue Vertbois, 75003 Paris, France
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Vermeersch DA, Whipple JL, Lambert MJ, Hawkins EJ, Burchfield CM, Okiishi JC. Outcome Questionnaire: Is It Sensitive to Changes in Counseling Center Clients? J Couns Psychol 2004. [DOI: 10.1037/0022-0167.51.1.38] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yoshida H, Suzuki T, Kim H, Yukawa H, Watanabe S, Kumagai S, Shinkai S, Ishizaki T. Effects of osteoporotic fractures on quality of life-related variables in the community elderly in Japan: An 8-year follow-up study in TMIG-LISA. Geriatr Gerontol Int 2003. [DOI: 10.1111/j.1444-0594.2003.00096.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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236
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Allen PF. Assessment of oral health related quality of life. Health Qual Life Outcomes 2003; 1:40. [PMID: 14514355 PMCID: PMC201012 DOI: 10.1186/1477-7525-1-40] [Citation(s) in RCA: 318] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2003] [Accepted: 09/08/2003] [Indexed: 11/24/2022] Open
Abstract
In Dentistry, as in other branches of Medicine, it has been recognised that objective measures of disease provide little insight into the impact of oral disorders on daily living and quality of life. A significant body of development work has been undertaken to provide health status measures for use as outcome measures in dentistry. In descriptive population studies, poor oral health related quality of life is associated with tooth loss. There is a less extensive literature of longitudinal clinical trials, and measurement of change and interpretation of change scores continues to pose a challenge. This paper reviews the literature regarding the development and use of these oral health related QoL measures and includes an appraisal of future research needs in this area.
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Affiliation(s)
- P Finbarr Allen
- Department of Restorative Dentistry, University Dental School & Hospital, Wilton, Cork, Ireland.
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237
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Matibag GC, Nakazawa H, Giamundo P, Tamashiro H. Trends and current issues in adult fecal incontinence (FI): Towards enhancing the quality of life for FI patients. Environ Health Prev Med 2003; 8:107-17. [PMID: 21432098 PMCID: PMC2723386 DOI: 10.1007/bf02897914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2003] [Accepted: 07/24/2003] [Indexed: 12/14/2022] Open
Abstract
Our goals are to review the literature on the definition and epidemiology of fecal incontinence (FI), the risk factors involved, available treatment options, and measurement of the quality of life (QOL) of patients with this condition. Articles included for review were searched following the guidelines set by Cochrane Reviewers' Handbook. FI was defined variously depending upon the duration, type, and amount of leakage. About 17 published papers were reviewed on the prevalence of FI that ranged from 1.4% to 50%. Potential risk factors included perianal injury/surgery, and fair/poor general health. QOL assessment using various grading scales provided an objective method of evaluating patients before and after treatment. Management included medical, physiotherapy, and surgical options. Through the range of various references, a clear definition of FI should be specified, which reflects its epidemiology in the various studies. These differences in definition would significantly affect its prevalence. Many risk factors have been sited but further epidemiological studies are necessary to elucidate FI. Understanding the etiology of the disease is an important initial step to provide adequate treatment of FI. QOL assessment provides objective and subjective method in the analysis of effectiveness of therapy.
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Affiliation(s)
- Gino C. Matibag
- Department of Health for Senior Citizens, Division of Preventive Medicine, Social Medicine Cluster, Hokkaido University Graduate School of Medicine, Kita 15 Jo Nishi 7 Chome, Kita-ku, 060-8638 Sapporo, Japan
| | - Hiroshi Nakazawa
- Department of Health for Senior Citizens, Division of Preventive Medicine, Social Medicine Cluster, Hokkaido University Graduate School of Medicine, Kita 15 Jo Nishi 7 Chome, Kita-ku, 060-8638 Sapporo, Japan
| | - Paolo Giamundo
- Department of Surgery, Hospital S. Spirito, Via Vittorio Emanuele 2, Bra (CN), Italy
| | - Hiko Tamashiro
- Department of Health for Senior Citizens, Division of Preventive Medicine, Social Medicine Cluster, Hokkaido University Graduate School of Medicine, Kita 15 Jo Nishi 7 Chome, Kita-ku, 060-8638 Sapporo, Japan
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238
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Evaluation of outcomes in community-acquired pneumonia: a guide for patients, physicians, and policy-makers. THE LANCET. INFECTIOUS DISEASES 2003; 3:476-88. [PMID: 12901890 DOI: 10.1016/s1473-3099(03)00721-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Community-acquired pneumonia (CAP) is a key target for research and quality improvement in acute medicine. However, many of the outcome measures used in prognostic and antibiotic studies are not validated and do not capture features of outcome that are important to patients. Substitutes for traditional outcome measures include a recently validated patient-based symptom questionnaire (the CAP-Sym) and process-of-care measures. The interpretation of outcomes also depends on the quality of the study design and methods used. This paper discusses the advantages and disadvantages of outcome, process-of-care, and economic measures in CAP and the interpretation of these measures in randomised and observational studies. A core set of measures for use in clinical CAP research and performance measurement is proposed.
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239
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Terwee CB, Dekker FW, Wiersinga WM, Prummel MF, Bossuyt PMM. On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Qual Life Res 2003; 12:349-62. [PMID: 12797708 DOI: 10.1023/a:1023499322593] [Citation(s) in RCA: 458] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A lack of clarity exists about the definition and adequate approach for evaluating responsiveness. An overview is presented of different categories of definitions and methods used for calculating responsiveness identified through a literature search. Twenty-five definitions and 31 measures were found. When applied to a general and a disease-specific quality of life questionnaire large variation in results was observed, partly explained by different goals of existing methods. Four major issues are considered to claim the usefulness of an evaluative health-related quality of life (HRQL) instrument. Their relation with responsiveness is discussed. The confusion about responsiveness arises mostly from a lack of distinction between cross-sectional and longitudinal validity and from a lack of distinction between responsiveness defined as the effect of treatment and responsiveness defined as the correlation of changes in the instrument with changes in other measures. All measures of what is currently called responsiveness can be looked at as measures of longitudinal validity or as measures of treatment effect. The latter ones tell us little about how well the instrument serves its purpose and are only of use in interpreting score changes. We therefore argue that the concept of responsiveness can be rejected as a separate measurement property of an evaluative instrument.
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Affiliation(s)
- C B Terwee
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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240
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Goins RT, Spencer SM, Krummel DA. Effect of obesity on health-related quality of life among Appalachian elderly. South Med J 2003; 96:552-7. [PMID: 12938781 DOI: 10.1097/01.smj.0000056663.21073.af] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a paucity of research on health behaviors, health status, and overall health-related quality of life among Appalachian elderly. Identifying factors among older adults that place them at risk for low health-related quality of life is important for targeting unmet health needs and guiding community efforts to help improve population health. METHODS For this study, we examined the relationship between obesity and health-related quality of life among Appalachians aged 65 years or older using the 2000 Behavioral Risk Factor Surveillance Survey data. RESULTS Our results showed that obese elderly Appalachians report poorer self-rated health and more days of poor physical health compared with their nonobese counterparts. CONCLUSION The goals put forward in Healthy People 2010 include the reduction of obesity and enhancement of quality of life. If such health disparities are to be eliminated and quality of life enhanced, a sustained effort to identify their determinants among Appalachian elderly is needed.
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Affiliation(s)
- R Turner Goins
- Center on Aging and Department of Community Medicine, West Virginia University, Morgantown, WV 26506, USA.
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241
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Taylor A, Butt W, Ciardulli M. The functional outcome and quality of life of children after admission to an intensive care unit. Intensive Care Med 2003; 29:795-800. [PMID: 12595983 DOI: 10.1007/s00134-003-1690-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Accepted: 01/22/2003] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the long-term outcome of children following admission to a paediatric intensive care unit. DESIGN Prospective, long-term follow-up study. SETTING Sixteen-bed multi-disciplinary paediatric intensive care unit in a free-standing, university, tertiary, teaching hospital. PATIENTS All children consecutively admitted to the paediatric intensive care unit from 1(st) January, 1995, to 31(st) December, 1995. INTERVENTIONS Outcome was evaluated, by telephone interview, at a median of 3.5 years (range 2.3-6 years) after admission to the intensive care unit using a modification of the Glasgow Outcome Score (GOS) to assess functional outcome and the Health State Utility Index (Mark 1) to assess quality of life. MEASUREMENTS AND MAIN RESULTS Of the children admitted to the intensive care unit, 83.8% were alive at the time of follow-up. While 10.3% of the survivors had an unfavourable outcome and were likely to live dependent on care, 89.7% had a favourable outcome and were likely to lead an independent existence. Although 16.4% had an unfavourable quality of life, 83.6% of the children survived with a favourable quality of life. At the time of follow-up, 16.2% of the children were dead: 49% died in the intensive care unit, 5% died in hospital and 46% died after discharge from hospital. CONCLUSIONS The majority of children admitted to a paediatric intensive care unit survive with an excellent functional outcome and quality of life. Long-term outcome assessment provides a basis for observing trends in outcome over time within the same institution.
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Affiliation(s)
- Anna Taylor
- Intensive Care Unit, Royal Children's Hospital, Flemington Road, Victoria 3052, Parkville, Australia
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242
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Liow RYL, Walker K, Wajid MA, Bedi G, Lennox CME. Functional rating for knee arthroplasty: comparison of three scoring systems. Orthopedics 2003; 26:143-9. [PMID: 12597217 DOI: 10.3928/0147-7447-20030201-15] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study evaluated the reliability of three rating systems for total knee arthroplasty. Twenty-nine patients were assessed by six observers with the American Knee Society Score, the British Orthopaedic Association Score, and the Oxford 12-item questionnaire. The inter- and intraobserver variations were calculated for the American Knee Society Score and the British Orthopaedic Association Score, as was the reproducibility of the Oxford 12-item questionnaire. Components of the scores were evaluated for agreement using Kappa statistics. The British Orthopaedic Association Score had smaller interobserver variation compared to the American Knee Society Score, and the greatest reproducibility of the three systems. This was attributed to the equal weighting of its component variables. The Oxford 12-item questionnaire, a self-administered questionnaire that eliminates interobserver error, emerged as the most reliable system. Observer experience affected the reliability of the American Knee Society Score and the British Orthopaedic Association Score. Subjective variables were more reliable and reproducible than the objective components.
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Affiliation(s)
- Raymond Y L Liow
- Department of Trauma and Orthopedics, Hartlepool General Hospital, Hartlepool, Cleveland, United Kingdom
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243
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Bijkerk CJ, de Wit NJ, Muris JWM, Jones RH, Knottnerus JA, Hoes AW. Outcome measures in irritable bowel syndrome: comparison of psychometric and methodological characteristics. Am J Gastroenterol 2003; 98:122-7. [PMID: 12526947 DOI: 10.1111/j.1572-0241.2003.07158.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although there is growing interest in irritable bowel syndrome (IBS) research, there is as yet no consensus regarding the preferred outcome measure. We aimed to evaluate and to compare the validity and appropriateness of available IBS outcome measures. METHODS IBS symptom and IBS health-related quality of life (HRQOL) scales were identified through a literature search. In a panel evaluation, six reviewers independently rated the scales according to predetermined psychometric and methodological validation criteria. RESULTS Five IBS symptom scales and five IBS HRQOL instruments were identified. Two of the symptom scales were rated as good. The Adequate Relief question scored best. This scale demonstrates responsiveness as well as face and construct validity, and its score was considered easy to interpret and appropriate for use. According to the reviewers, the IBS Severity Scoring System performed well with regard to psychometric capacities, but its practical utility was considered debatable. The properties of the other three symptom scales were suboptimal. The practical utility of the five IBS-specific HRQOL scales was considered poor. However, the reviewers agreed that, at present, the IBS Quality of Life measurement (Patrick et al.) is the best choice, because it has been the most extensively validated and shows appropriate psychometric quality. CONCLUSIONS The Adequate Relief question is the measure of first choice when assessing global symptomatology as an outcome in IBS studies. For a more detailed IBS symptom assessment, the IBS Severity Scoring System is preferable. Finally, the IBS Quality of Life measurement scale can be used to establish changes in health-related quality of life.
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Affiliation(s)
- C J Bijkerk
- Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, Utrecht, The Netherlands
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244
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Crealey GE, Sturgess IK, McElnay JC, Hughes CM. Pharmaceutical care programmes for the elderly: economic issues. PHARMACOECONOMICS 2003; 21:455-465. [PMID: 12696986 DOI: 10.2165/00019053-200321070-00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Pharmaceutical care is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. It describes the process through which a pharmacist collaborates with a patient and with healthcare professionals in designing, implementing and monitoring a therapeutic plan that will produce specific, desirable therapeutic outcomes for the patient. The elderly are a patient population who could particularly benefit from pharmaceutical care provision as they are at greater risk of experiencing significant drug-related problems such as inappropriate prescribing, noncompliance with prescribed medication and adverse drug reactions/interactions leading to a decrease in health-related quality of life. The extent of economic benefit of pharmaceutical care reported in the literature is variable and its generalisability is suspect due to the lack of trials which have utilised a robust research design. The few studies which have undertaken a rigourous economic evaluation have used a range of data collection methods that is reflective of the difficulty of capturing essential data. Furthermore, even in well-designed studies, the generalisability of economic evaluations to other countries is questionable because of unique national data collection systems and an inability to pool international data because of disparities between different healthcare systems. The use of a suitable measure for health-related quality of life is also problematic in a very diverse and heterogeneous population such as the elderly and, therefore, adds to the difficulties of inclusion of such measures in economic analyses of pharmaceutical care programmes. A more standardised approach to data collection is required to facilitate economic analyses as an essential element in the evaluation of any pharmaceutical care programme for the elderly. Suggestions on such approaches, together with a critical appraisal of studies performed to date, are the focus of this review.
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Affiliation(s)
- Grainne E Crealey
- Clinical and Practice Research Group, The School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
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Gilbody SM, House AO, Sheldon TA. Outcome measures and needs assessment tools for schizophrenia and related disorders. Cochrane Database Syst Rev 2003; 2003:CD003081. [PMID: 12535453 PMCID: PMC7017098 DOI: 10.1002/14651858.cd003081] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There has been a recent trend to encourage routine outcome measurement and needs assessment as an aid to decision making in clinical practice and patient care. Standardised instruments have been developed which measure clinical symptoms of disorders such as schizophrenia, wider health related quality of life and patients' needs. Such measures might usefully be applied to aid the recognition of psychosocial problems and to monitor the course of patients' progress over time in terms of disease severity and associated deficits in health related quality of life. They might also be used to help clinicians to make decisions about treatment and to assess subsequent therapeutic impact. Such an approach is not, however, without cost and the actual benefit of the adoption of routine outcome and needs assessment in the day-to-day care of those with schizophrenia remains unclear. OBJECTIVES To establish the value of the routine administration of outcome measures and needs assessment tools and the feedback they provide in improving the management and outcome of patients with schizophrenia and related disorders. SEARCH STRATEGY The reviewers undertook electronic searches of the British Nursing Index (1994 to Sept 1999), the Cochrane Library (Issue 2, 2002), the Cochrane Schizophrenia Group Trials Register (2002), EMBASE (1980-2002), MEDLINE (1966-2002), and PsycLIT (1887-2002), together with hand searches of key journals. References of all identified studies were searched for further trials, and the reviewers contacted authors of trials. SELECTION CRITERIA Randomised controlled trials comparing the feedback of routine standardised outcome measurement and needs assessment, to routine care for those with schizophrenia. DATA COLLECTION AND ANALYSIS Reviewers evaluated data independently. Studies which randomised clinicians or clinical teams (rather than individual patients) were considered to be the most robust. However only those which took account of potential clustering effects were considered further. Where possible and appropriate, risk ratios (RR) and their 95% confidence intervals (CI) were calculated. For continuous data Weighted Mean Differences (WMD) were calculated. Data were inspected for heterogeneity. MAIN RESULTS No randomised data were found which addressed the specified objectives. One unpublished and one ongoing trial was identified. REVIEWER'S CONCLUSIONS The routine use of outcomes measures and needs assessment tools is, as yet, unsupported by high quality evidence of clinical and cost effectiveness. Clinicians, patients and policy makers alike may wish to see randomised evidence before this strategy is routinely adopted.
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Affiliation(s)
- S M Gilbody
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds, UK, LS2 9LT.
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Chassany O, Sagnier P, Marquis P, Fullerton S, Aaronson N. Patient-Reported Outcomes: The Example of Health-Related Quality of Life—a European Guidance Document for the Improved Integration of Health-Related Quality of Life Assessment in the Drug Regulatory Process. ACTA ACUST UNITED AC 2002. [DOI: 10.1177/009286150203600127] [Citation(s) in RCA: 265] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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247
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Capelli G, De Vincenzo RI, Addamo A, Bartolozzi F, Braggio N, Scambia G. Which dimensions of health-related quality of life are altered in patients attending the different gynecologic oncology health care settings? Cancer 2002; 95:2500-7. [PMID: 12467063 DOI: 10.1002/cncr.10993] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND We evaluated the feasibility of measuring health-related quality of life (HRQOL) in a gynecologic oncology clinic by using an instrument that is nonspecific for cancer patients. Our aim was to study whether the HRQOL perception of cancer patients differed from general population norms for the same age and gender and if it varied across cancer type, cancer status, age, health care setting, and reason for the encounter. METHODS Participants in this study included 115 women between the ages of 21 and 83 years who were referred to a university hospital for ovarian, endometrial, and cervical carcinoma. They completed the SF-36 questionnaire. Mean results for the entire sample, for different disease status (primary vs. progressive/recurrent disease), and reason for encounter (surgery, preoperative, postoperative, palliative chemotherapy, and follow-up) were compared with age-specific expected mean values for each SF-36 scale, based on published Italian reference values for the healthy population. RESULTS Patients' attitude to the questionnaire was generally good. Mean values on the SF-36 scales varied. Role (Physical and Emotional) scales showed the highest differences from the expected age-specific values in all situations. Patients with primary disease showed little or no differences for the other six scales from the expected values, whereas a significant 10-point mean decrease in every SF-36 scale was recorded for patients with progressive/recurrent disease. A biologic interaction among cervical carcinoma, age, and disease status was found in multivariate models, showing worst scores for patients with progressive/recurrent cervical carcinoma on almost all scales. CONCLUSIONS Administration of generic HRQOL questionnaires in specialist health care delivery settings is feasible and well accepted and may help physicians and nurses to look beyond "what's wrong" in their patients.
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Dawson J, Hill G, Fitzpatrick R, Carr A. Comparison of clinical and patient-based measures to assess medium-term outcomes following shoulder surgery for disorders of the rotator cuff. ARTHRITIS AND RHEUMATISM 2002; 47:513-9. [PMID: 12382300 DOI: 10.1002/art.10659] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare different assessments following shoulder surgery for impingement syndrome with or without rotator cuff tear or repair. METHODS A prospective study of 93 patients was conducted. Standard assessments were performed before, at 6 months, and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score (OSS), the Medical Outcomes Study Short Form-36 (SF-36) questionnaire, and a surgeon-assessed Constant Shoulder Score. Patients were categorized according to the surgery received in relation to the presence of cuff tears: full repair, partial repair, cuff tear/no repair, no tear/no repair. RESULTS Most patients (57%) received subacromial decompression for impingement with no cuff tear. This group had the fewest pre- and postoperative symptoms. The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessments compared with other groups. Patient-based measures were more stable over time than the Constant. CONCLUSION The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years.
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Affiliation(s)
- Jill Dawson
- School of Health Care, Oxford Brookes University, Oxford, UK.
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McGee MA, Howie DW, Ryan P, Moss JR, Holubowycz OT. Comparison of patient and doctor responses to a total hip arthroplasty clinical evaluation questionnaire. J Bone Joint Surg Am 2002; 84:1745-52. [PMID: 12377903 DOI: 10.2106/00004623-200210000-00002] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgeons traditionally undertake a prospective evaluation of patients undergoing total hip arthroplasty in order to determine outcomes. The validity of doctor-derived data is questionable because of the potential for interobserver error, reporting bias, and differences between the perceptions of doctors and patients. Also, the use of doctor-derived data necessitates the use of costly outpatient services. Consequently, there are likely to be benefits associated with the use of patient-derived clinical evaluation data. However, few studies have focused on whether data obtained from the patient and doctor differ. METHODS The agreement between patient and doctor responses on a sixteen-item total hip arthroplasty clinical evaluation questionnaire completed at more than 2900 clinical assessments was determined. Data from repeated assessments performed preoperatively and postoperatively enabled stratified analyses that were used to examine reasons for disagreement and factors influencing agreement. Agreement was measured with use of the kappa coefficient. RESULTS For twelve of the sixteen items, the patient responses had acceptable agreement with the doctor responses. Some important differences between patient-derived and doctor-derived data were found. If the patient had other joint or health problems, had a revision total hip arthroplasty, or reported mild or moderate pain, there was a greater chance of reduced agreement on the pain items. Younger patients demonstrated better agreement with doctors than older patients did. CONCLUSIONS Patients' perceptions of symptoms and outcomes after total hip arthroplasty are relatively similar to those of their doctor. There is minimum risk of misinterpreting outcomes data by replacing doctor-completed questionnaires with patient-completed questionnaires in uncomplicated total hip arthroplasty cases. For patients with comorbid joint problems or other health problems, and for those reporting substantial pain, direct physician involvement in the evaluation of pain is recommended. The selective use of patient-completed questionnaires has the potential to substantially reduce the costs of outcomes evaluation programs by minimizing doctor input. Pending revision of some of the items, the use of this patient-completed questionnaire is advocated.
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