Health-related quality of life measured using the EQ-5D-5L: South Australian population norms

Quality of Life after Motorcycle Traffic Injuries: A Cohort Study in Northwest of Iran

Objective:

To investigate the quality of life (QOL) of injured motorcyclists and associated factors in a period of three months after the accident.

Methods:

In the present study, we were included 190 injured motorcyclists who admitted to two referral specialized hospitals (Emam Reza and Shohada) in Tabriz, between June 2018 and January 2019. All injured motorcyclists were contacted through the telephone one and 171 of them (90%) three months after their accident to complete an EQ-5D-3L questionnaire. The baseline measurements were gathered by using face to face interviews in the hospitals. The QOL score could vary between 1 and 3. The higher score showed a lower QOL.

Results:

The injured motorcyclist’s QOL score was relatively better in three months after the accident (mean±Standard Deviation (SD): 1.78±0.51) in comparison with their status a month after the accident (2.15±0.65) (p<0.001). The multivariable model showed that individuals with pelvis injuries (Coef: 0.29, (95% CI: 0.16, 0.42), p=0.001) and knee injuries (Coef: 0.26, (95% CI: 0.10, 0.42), p=0.001), experienced a higher QOL score. Also, those whose accident had happened in rainy weather experienced higher QOL score (Coef: 0.33, (95% CI: 0.12, 0.53), p=0.001). The patients who were in an accident with a vehicle were experienced a better QOL than others (Coef: -0.26, (95% CI: -0.43, -0.09), p=0.002).

Conclusion:

The assessment of three-months post-accident showed that the QOL score of the motorcyclists was reduced. It is recommended that the QOL of patients should be improved in hospital discharge victims.

Association of Bone Conduction Devices for Single-Sided Sensorineural Deafness With Quality of Life: A Systematic Review and Meta-analysis

Importance

Although bone conduction devices (BCDs) have been shown to improve audiological outcomes of patients with single-sided sensorineural deafness (SSD), their effects on the patients' quality of life (QOL) are unclear.

Objective

To investigate the association of BCDs on QOL in patients with SSD.

Data Sources

Literature search of databases (Medline, Embase, Cochrane Library, and ClinicalTrials.gov) from January 1, 1978, to June 24, 2021, was performed.

Study Selection

Prospective interventional studies with 10 or more participants with SSD (defined as pure tone average >70 dB hearing loss in the worse hearing ear and ≤30 dB in the better hearing ear) who underwent unilateral BCD implantation and assessment of QOL before and after the intervention using a validated tool were eligible for inclusion. Studies on adults and children were eligible for inclusion. Patients with only conductive, mixed, or bilateral hearing loss were excluded.

Data Extraction and Synthesis

Data were extracted by 2 independent reviewers. Study clinical and demographic characteristics were obtained. Meta-analysis of mean differences in QOL scores before and after the intervention was performed. Study bias was assessed using Joanna Briggs Institute risk of bias tool.

Main Outcomes and Measures

The main study outcome was mean change in QOL scores at 6 months after insertion of BCDs. The 3 QOL instruments used in the studies included the Abbreviated Profile of Hearing Aid Benefit (APHAB), the Health Utilities Index-3 (HUI-3), and the Speech, Spatial and Qualities of Hearing Scale (SSQ). The APHAB and the SSQ are the hearing-related QOL measures, whereas the HUI-3 is a generic QOL measure.

Results

A total of 486 articles were identified, and 11 studies with 203 patients met the inclusion criteria. Only adult studies met inclusion criteria. Ten of 11 studies were nonrandomized cohort studies. The BCDs assessed were heterogeneous. There was a significant statistical and clinically meaningful improvement in the global APHAB scores (mean change, 15.50; 95% CI, 12.63-18.36; I2 = 0) and the SSQ hearing qualities (mean change, 1.19; 95% CI, 0.46-1.92; I2 = 78.4%), speech (mean change, 2.03; 95% CI, 1.68-2.37; I2 = 0), and spatial hearing (mean change, 1.51; 95% CI, 0.57-2.44; I2 = 81.1%) subscales. There was no significant change detected in the mean HUI-3 scores (mean change, 0.03; 95% CI, -0.04 to 0.10; I2 = 0). The risk of bias was assessed to be low to moderate.

Conclusions and Relevance

These findings suggest that adult patients who receive BCDs may experience improvements in hearing-specific QOL measures but not in generic QOL measures. Prospective QOL studies should be considered in this cohort, particularly for children with SSD.

Can Adherence to and Persistence with Inhaled Long-acting Bronchodilators Improve the Quality of Life in Patients with Chronic Obstructive Pulmonary Disease? Results from a German Disease Management Program

BACKGROUND AND OBJECTIVE: Adherence to and persistence with inhaled long-acting bronchodilators (ILAB), is commonly considered to be a relevant driver of perceived health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD), but the topic is rarely studied with real-world data. Using survey and health insurance claims data, this study investigates the effect of adherence to and persistence with ILAB on EQ-5D-5L visual analog scale (VAS) in ILAB users who were enrolled in the German disease management programs (DMP) for COPD.

METHODS

Included ILAB users were aged ≥ 18 years, continuously insured with AOK Bavaria and enrolled in the DMP for COPD. Adherence to ILAB [proportion of days covered (PDC); PDC ≥ 80%], and persistence (days of uninterrupted ILAB therapy) were assessed in the year preceding the study's HRQoL questionnaire. In a cross-sectional design we applied quasi-Poisson models with log link function and subgroup analyses. The robustness of results was analyzed with comprehensive sensitivity analyses.

RESULTS

Patients with PDC ≥ 80% had 2.96% higher VAS scores than patients with lower PDCs. From all analyses, patients with GOLD stage III had the highest effects from PDC ≥ 80% (5.33% increased VAS). Patients without heart failure profited significantly more from PDC ≥ 80% (+ 4.34% vs - 2.88%) and from an additional persistent day (+ 0.01% vs - 0.01%) than patients with heart failure.

CONCLUSIONS

Overall, ILAB users significantly profited from PDC ≥ 80%, but not from continuous PDC or persistent days. In secondary subgroup analyses, patients with GOLD stage III and patients without heart failure particularly profited from PDC ≥ 80%. Only patients without heart failure particularly profited from more persistent days. Because identified effects were small and often not robust, advancing adherence and persistence alone may not improve the German DMP for COPD substantially.

The Determinants of Living with Long-Term Conditions: An International Cross-Sectional Study

It is essential that healthcare and social professionals understand the daily lives of people with chronic diseases, and the variables that influence them. The aim of this study was to identify the determinants influencing the process of living with long-term conditions. To investigate this, an observational, international, cross-sectional study was carried out. A consecutive sample of 1788 Spanish-speaking population living with chronic obstructive pulmonary disease, chronic heart failure and type 2 diabetes mellitus were included. Descriptive statistics and multiple linear regression models were performed. The linear regression models identified that social support (β = 0.39, p < 0.001) and the satisfaction with life (β = 0.37, p < 0.001) were the main determinants in the process of living with a long-term condition (49% of the variance). Age (β = -0.08, p = 0.01) and disease duration (β = 0.07, p = 0.01) were determinants only in the chronic heart failure subgroup, and country was significant in the chronic obstructive pulmonary disease subgroup (β = -0.15, p = 0.002). Satisfaction with life and social support were key determinants influencing the process of living with long-term conditions. As such, those aspects should be included in the design of interventions focused on the achievement of a positive living in people with long-term conditions.

Quality of Life Experienced by Major Lower Extremity Amputees

Lower extremity amputations and diabetic foot-related complications in the Caribbean population have been previously reported. However, there is a lack of evidence that assess the quality of life experienced in such amputees. This study aimed to determine the health-related quality of life (HRQoL) in patients after a major lower limb amputation.

Data collection was performed for all major lower limb amputations undertaken at a tertiary care institution in Trinidad and Tobago, between January 2012 to December 2016. The quality of life for patients who were accessible, alive, and willing to participate was assessed using the EuroQol 5D-5L tool. Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis tests comparing medians across various subgroups.

A total of 134 individuals were still alive and willing to participate in the study. The average EQ-5D-5L index value for the cohort was (0.598), which was significantly lower compared to EQ-5D-5L population norms for Trinidad and Tobago p < 0.05. Statistically significant differences were also seen in median EQ-5D-5L index value for patients who ambulated with a prosthesis (0.787) compared to those who used another device for mobilization (0.656), p < 0.05, and to those patients who did not ambulate (0.195), p < 0.05. A comparable Quality of life was seen between the level of amputation (transtibial versus transfemoral) and gender (males versus females), p-values were 0.21 and 1.0, respectively.

Overall quality of life after major amputation, as well as independent mobilization with a prosthesis, continues to be problematic in the Caribbean population. Factors adversely related to the quality of life post major amputation include increasing age, problems related to mobility, and non-ambulatory patients.

Intra-Anal Imiquimod Cream against Human Papillomavirus Infection in Men Who Have Sex with Men Living with HIV: A Single-Arm, Open-Label Pilot Study

Men who have sex with men (MSM) living with HIV have a high prevalence and incidence of anal high-risk human papillomavirus (hrHPV) and anal cancer. We conducted an open-label, single-arm pilot study to examine the tolerability of imiquimod cream among MSM aged ≥18 years, living with HIV, who tested positive for anal hrHPV at Melbourne Sexual Health Centre between April 2018 and June 2020. We instructed men to apply 6.25 mg imiquimod intra-anally and peri-anally 3 doses per week for 16 weeks (period 1) and then one dose per week for a further 48 weeks (period 2). Twenty-seven MSM enrolled in period 1 and 24 (86%) applied at least 50% of doses. All men reported adverse events (AEs), including 39.5% grade 1, 39.5% grade 2, and 21% grade 3 AEs on at least one occasion. Eighteen MSM (67%) temporarily stopped using imiquimod during period 1, most commonly due to local AEs (n = 11) such as irritation and itching. Eighteen MSM continued in period 2 and all applied at least 50% of doses with no treatment-limiting AEs reported. Imiquimod 3 doses per week caused local AEs in most men and was not well tolerated. In contrast, once-a-week application was well tolerated over 48-weeks with no treatment-limiting AEs.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

New Zealand Population Norms for the EQ-5D-5L Constructed From the Personal Value Sets of Participants in a National Survey

OBJECTIVES

To derive New Zealand (NZ) population norms for the EQ-5D-5L and to examine the association between participants' sociodemographic characteristics and their health-related quality of life.

METHODS

Data from the 2018 NZ EQ-5D-5L valuation study (n = 2468) were used. Each participant's 5-digit profile was converted to a single utility value using their personal value set. The profiles, mean utility values, and mean EuroQol visual analog scale (EQ-VAS) scores were summarized by dimension and disaggregated by age group and gender. Multivariable logistic and Tobit regressions were used to investigate the association between participants' sociodemographic characteristics and the EQ-5D-5L dimensions, utility values, and EQ-VAS scores.

RESULTS

The mean utility value was 0.847 and the mean EQ-VAS score was 74.8. Of the 3125 possible EQ-5D-5L profiles, 25 profiles represented the current health status of the majority of participants (78%). The odds of having problems with anxiety or depression was greatest for people aged 18 to 24 years and decreased with age. People with a long-term disability or chronic illness had greater odds of problems on all dimensions and lower (poorer) utility values and EQ-VAS scores. Age, ethnicity, employment status, long-term disability, and chronic illness were associated with utility.

CONCLUSION

EQ-5D-5L population norms were derived for the NZ population using the personal value sets of 2468 participants. Consistent with other countries' population norms, EQ-5D-5L utility values and EQ-VAS scores were associated with age, employment status, long-term disability, and chronic illness. These norms will support resource allocation decision making and help in understanding the health-related quality of life of the NZ population.

Comparison of EQ-5D-3L and metabolic components between patients with hyperhidrosis and the general population: a propensity score matching analysis

PURPOSE

It is important to understand the characteristics of patients with hyperhidrosis, which are different from the general population, for treating hyperhidrosis. Sympathetic overactivity, which might play an important role in hyperhidrosis, can contribute to metabolic diseases and the decreased quality of life (QoL). We compared the metabolic components and health-related QoL between patients with hyperhidrosis and the general population.

METHODS

We conducted a case-control study and compared the characteristics of the patients (N = 196) with hyperhidrosis and propensity score-matched controls (N = 196) selected from the Korean National Health and Nutrition Examination Survey. Metabolic components and EQ-5D-3L (EQ-5D) index were compared using a two-way mixed analysis of covariance after adjusting for confounders.

RESULTS

Patients with hyperhidrosis had significantly higher waist circumference (estimated mean values ± SD for patients and the control group, 85.5  ±  10.8 cm vs 81.3  ±  10.3 cm, p < 0.001), blood pressure (SBP, 121.1  ±  16.9 vs 111.7  ±  10.3, p < 0.001 AND DBP, 77.5  ±  12.8 vs 73.6  ±  8.6, p < 0.001, respectively), fasting glucose (97.1  ±  11.3 vs 91.5  ±  9.2, p < 0.001), and the number of components of metabolic syndrome (1.4  ±  1.3 vs 1.0  ±  1.2, p = 0.002), and significantly lower estimated glomerular filtration rate (144.3  ±  53.2 vs 158.3  ±  55.7, p = 0.002) and EQ-5D values (estimated mean values (standard error) for patients and the control group, 0.92 (0.01) vs 0.97 (0.01), p < 0.001) compared to the control group after adjustment.

CONCLUSION

The patients with hyperhidrosis had more central obesity and unfavorable metabolic parameters and a lower EQ-5D index compared with the general population, emphasizing clinical importance of hyperhidrosis to be cured in aspect of metabolic components as well as patients' QOL.

Assessment of Utility in Migraine: Mapping the Migraine-Specific Questionnaire to the EQ-5D-5L

INTRODUCTION

There are increasing demands for studies of cost-effectiveness to allocate resources for disease prevention and treatment strategies. The aim of this study is to measure quality of life in migraineurs, based on the Migraine-Specific Questionnaire (MSQ) and EQ-5D-5L, and thereafter map an algorithm to estimate health-state utility values from the MSQ in individuals with migraine.

METHODS

In this cross-sectional study conducted between May and July 2018 in a tertiary headache clinic in Tehran, Iran, migraineurs diagnosed based on International Classification of Headache Disorders (ICHD)-3β were enrolled and were asked to complete the MSQ questionnaire and EQ-5D questionnaire. The Spearman correlation coefficient (ρ) was calculated to measure the correlation between the EQ-5D-5L and MSQ v2.1 domains' score. A P value of <.05 was considered statistically significant. After statistical analysis, several regression models were presented to map the results of the MSQ domains to the utility index, and the preferred model was achieved based on goodness of fit and the model's predictive performance.

RESULTS

The preferred MSQ algorithm had approximately the same prediction errors in all migraineurs, episodic and chronic migraine (root mean square error 0.24, 0.24, and 0.23, respectively). The preferred MSQ model explained a variance of 0.26 (R2) in episodic and 0.38 in chronic migraine in the EQ-5D-5L questionnaire.

CONCLUSION

The preferred MSQ mapping algorithm will be suitable in estimating health state utilities in trials of patients with migraine that contain MSQ scores but lack utility values.

Family doctor contract services and health-related quality of life among patients with chronic diseases in rural China: what is the role of socioeconomic status?

Purpose

Few studies explored the relationship between the family doctor contract services (FDCS) and health-related quality of life (HRQOL) among patients with chronic diseases in rural China. This study aims to explore the relationship between the status of signing on FDCS and HRQOL among patients with chronic diseases and examine whether there are differences in the relationship between different socioeconomic status (SES).

Methods

A total of 1,210 respondents were included in this study. HRQOL was measured by EQ-5D-3L. The contracting status was divided into uncontracted and contracted. Tobit regression and Logistic regression were employed to explore the association between contracting status and HRQOL. The interaction terms were included to explore the differences in the association among different SES.

Results

Contracting with family doctors was associated with HRQOL (coefficient = 0.042; 95%CI 0.008 to 0.075). The association was different among different socioeconomic levels that the contracting status was only associated with HRQOL in sub-high-income (P < 0.01) and highly educated patients (P < 0.05). Compared with uncontracted patients, contracted patients reported higher ED-5D-3L utility value in the sub-high-income group (coefficient = 0.078; 95%CI 0.017 to 0.140) and high educational attainment (coefficient = 0.266; 95%CI 0.119 to 0.413).

Conclusions

This study found a significant association between FDCS and HRQOL among chronic patients in rural Shandong, China. This relationship varied by income levels and educational attainment. The government should take efforts to formulate a variety of measures to encourage chronic patients to contract with family doctors, with special attention to people with low SES.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01530-2.

Health-Related Quality of Life Norm Data of the Peruvian Adolescents: Results Using the EQ-5D-Y

(1) Introduction: There is a growing interest in health-related quality of life (HRQOL) in adolescent population. The EQ-5D-Y is a generic HRQOL instrument that allows adolescents to understand the health status of different levels of physical, mental, and social health. This study was carried out with an adolescent population in Peru. The main objective of this article is to report the normative values of the EQ-5D-Y questionnaire in Peruvian adolescents. (2) Methods: The EQ-5D-Y questionnaire was administered to Peruvian adolescent students. A total of 1229 young people participated in the survey. The EQ-5D-Y score was reflected as a function of sex and age. (3) Results: The mean utility index of the EQ-5D-Y for the total sample was 0.890; this rating was significantly better for males at (0.899) and females at (0.881). The ceiling effect was higher for adolescent males with (47.3) females (40.7). (4) Conclusions: The results of the present study provide evidence that schooled adolescents show a positive perception of HRQOL.

Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial

BACKGROUND

Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions.

METHODS

This implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios.

DISCUSSION

The My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs.

TRIAL REGISTRATION

This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).

Yoga, cognitive-behavioural therapy versus education to improve quality of life and reduce healthcare costs in people with endometriosis: a randomised controlled trial

INTRODUCTION

Endometriosis is a debilitating chronic inflammatory condition highly burdensome to the healthcare system. The present trial will establish the efficacy of (1) yoga and (2) cognitive-behavioural therapy (CBT), above (3) education, on quality of life, biopsychosocial outcomes and cost-effectiveness.

METHODS AND ANALYSIS

This study is a parallel randomised controlled trial. Participants will be randomly allocated to yoga, CBT or education. Participants will be English-speaking adults, have a diagnosis of endometriosis by a qualified physician, with pain for at least 6 months, and access to internet. Participants will attend 8 weekly group CBT sessions of 120 min; or 8 weekly group yoga sessions of 60 min; or receive weekly educational handouts on endometriosis. The primary outcome measure is quality of life. The analysis will include mixed-effects analysis of variance and linear models, cost-utility analysis from a societal and health system perspective and qualitative thematic analysis.

ETHICS AND DISSEMINATION

Enrolment in the study is voluntary and participants can withdraw at any time. Participants will be given the option to discuss the study with their next of kin/treating physician. Findings will be disseminated via publications, conferences and briefs to professional organisations. The University's media team will also be used to further disseminate via lay person articles and media releases.

TRIAL REGISTRATION NUMBER

ACTRN12620000756921p; Pre-results.

Reference data among general population and known-groups validity among hypertensive population of the EQ-5D-5L in Vietnam

Purpose

This study aims to provide EQ-5D-5L population norms among the general population in Vietnam and to test EQ-5D-5L’ construction validity among people living with hypertension there.

Methods

Descriptive statistics of the five dimensions and five levels, EQ-VAS and EQ-5D-5L indexes were categorised into gender and age groups for the EQ-5D-5L population norms. Known-groups testing was set for lower EQ-5D-5L outcomes among people who were aware of their hypertensive status, females, people with more comorbidities, less education, older ages, and higher body mass indexes. Level of confident interval was 95%.

Results

The mean EQ-VAS and EQ-5D-5L indexes were 81.10 (SD: 13.35) and 0.94 (SD: 0.09) among the general population. The EQ-5D-5L outcomes were better among younger people, males, people with more education, employees, and single people. Respondents reported fewer problems with self-care and usual activities and tend to have problems at higher levels across older ages. The known-group testing showed statistically significant results. The mean EQ-VAS and EQ-5D-5L indexes of people in the diagnosed hypertensive group (71.48 and 0.94, respectively) were statistically significantly smaller than they were in the non-hypertensive and undiagnosed hypertensive group (76.65 and 0.97; 76.95 and 0.96 accordingly). Statistically significant associations of lower EQ-5D-5L indexes and EQ-VAS were found among people diagnosed for hypertension, people suffering from an incremental comorbidity, and obese people.

Conclusion

This study has provided EQ-5D-5L population norms for the general population and evidence for known-groups validity of the EQ-5D-5L instrument among hypertensive people in Vietnam.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02959-2.

Development and evaluation of air pollution-linked quality of life (AP-QOL) questionnaire: insight from two different cohorts

In this study, the air pollution-related quality of life (AP-QOL) questionnaire was carried out in two geographically and economically different groups including New Delhi (Megacity) and Hamirpur, Himachal Pradesh (town), and APE scores were linked with respiratory and cardiovascular illness. The APE-Score was developed by AP-QOL questionnaire responses using Delphi technique and further analyzed using principal component analysis (PCA). For reliability of APE-Score and AP-QOL questionnaire, α-Cronbach's test and basic statistics were performed. The linear mixed-effect model and odds ratios were used to evaluate air pollution exposure and health outcomes. Overall, 720 academicians and 276 security guards were invited to participate in the questionnaire. Cronbach's α coefficients ranged from 0.70 to 0.84 indicated significant reliability in the AP-QOL questionnaire conducted in this study. Substantial variation in respiratory symptoms and their medical history were found - 76.9% ([95% confidential interval (CI)]: (- 83.8, - 66.9) (p < 0.05)) and - 28.6% (95% CI: (- 37.8, - 18.0) (p < 0.05)), respectively, with interquartile range (IQR) increase of APE score. The odds ratios (ORs) of respiratory medical history (MH Res.) showed a significant increase from 1.01 to 1.35 for low to high air pollution exposure in the academic group of IIT Delhi. Interestingly, for an academic group of NITH, the ORs for medical history of cardiovascular (MH Card.) showed an increase from 1.08 to 1.13 for low to high APE which was not the case for IIT Delhi academicians.

Japanese Population Norms of EQ-5D-5L and Health Utilities Index Mark 3: Disutility Catalog by Disease and Symptom in Community Settings

OBJECTIVES

This study aimed to establish the Japanese population norms of the EQ-5D-5L and Health Utilities Index Mark 3 (HUI3) and estimate the disutility associated with diseases and symptoms.

METHODS

We performed a door-to-door survey of the general population by random sampling. The planned sample size was 10 000 residents (age ≥16 years) of 334 districts in Japan. In addition to the EQ-5D-5L and HUI3 questionnaires, questions regarding demographic factors and self-reported main diseases and symptoms were asked. The EQ-5D-5L and HUI3 responses were converted to index values on the basis of Japanese value sets. Summary values by age and sex were calculated to obtain Japanese normative values. A multiple linear model was used to examine relationships between these values and diseases and symptoms.

RESULTS

We collected 10 183 responses from 334 districts. The mean EQ-5D-5L index values were 0.821 (male) and 0.774 (female) in the age group of 80 to 89 years, which were lower compared with 0.978 (male) and 0.967 (female) in the age group of 16 to 19 years. Similar trends were observed for the HUI3 values. Age, sex, household income, and education level had a significant influence on the values of both instruments. When measured with the EQ-5D-5L, Parkinson disease, dementia, and stroke were associated with the largest disutility (>0.2), and the disutility for depression was approximately 0.18. In contrast, the HUI3 disutility values for Parkinson disease and dementia were approximately 0.4.

CONCLUSIONS

This study established the Japanese population norms of the EQ-5D-5L and HUI3, which can be used in healthcare decision making and contribute to a more reliable analysis of economic evaluations.

The cost-effectiveness of icosapent ethyl in combination with statin therapy compared with statin alone for cardiovascular risk reduction

AIMS

The aim of this study was to estimate the cost-effectiveness, from the perspective of the Australian public healthcare system, of icosapent ethyl in combination with statin therapy compared with statin alone for the prevention of cardiovascular disease.

METHODS AND RESULTS

A Markov model populated with data from the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial was designed to predict the effectiveness and costs of icosapent ethyl in combination with statins compared with statins alone over a 20-year time horizon. Data inputs for costs and utilities were sourced from published sources. The annual costs of icosapent ethyl were assumed to be AUD1637 (USD2907) per person. All future costs and outcomes were discounted annually by 5%. The main outcome of interest was incremental cost-effectiveness ratios in terms of cost per quality adjusted life year (QALY) gained and per year of life saved (YoLS). Over a 20-year time horizon, compared with statin alone, icosapent ethyl in combination with statin was estimated to cost an additional AUD$13,022 per person, but led to 0.338 YoLS and 0.289 QALYs gained (all discounted). These equated to incremental cost-effectiveness ratios of AUD45,036 per QALY gained and AUD38,480 per YoLS. Sub-analyses for primary and secondary prevention were AUD96,136 and AUD35,935 per QALY gained, respectively. The results were sensitive to time-horizon, age related trends and the acquisition price of icosapent ethyl.

CONCLUSION

Compared with statin alone, icosapent ethyl in combination with statin therapy is likely to be cost-effective in the prevention of cardiovascular disease assuming a willingness-to-pay threshold of AUD50,000 per QALY gained, especially in the secondary preventive setting.

A national survey on COVID-19 second-wave lockdowns on older adults' mental wellbeing, health-seeking behaviours and social outcomes across Australia

Background

The impact of severe second lockdown measures on older adults’ wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians’ quality of life; (ii) compare the impact of second wave lockdowns in Victoria, Australia’s second most populous State, to those in other States and Territories not in lockdown.

Methods

A national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia.

Results

A total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) participated. At time of data collection, Victoria’s second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t_2,827=2.25 p = 0.025). Being female (95 % CI, -0.051–0.020), having lower educational attainment (95 % CI, -0.089–-0.018), receiving government benefits (95 % CI, -0.054–-0.024), having small social networks (95 % CI, 0.006–0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life.

Conclusions

Longer-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02352-1.

Mixed-mode versus paper surveys for patient-reported outcomes after critical illness: A randomised controlled trial

OBJECTIVE

The aim of the study was to determine the response rate to a mixed-mode survey using email compared with that to a paper survey in survivors of critical illness.

DESIGN

This is a prospective randomised controlled trial.

SETTING

The study was conducted at a single-centre quaternary intensive care unit (ICU) in Adelaide, Australia.

PARTICIPANTS

Study participants were patients admitted to the ICU for ≥48 h and discharged from the hospital.

INTERVENTIONS

The participants were randomised to receive a survey by paper (via mail) or via online (via email, or if a non-email user, via a letter with a website address). Patients who did not respond to the initial survey received a reminder paper survey after 14 days. The survey included quality of life (EuroQol-5D-5L), anxiety and depression (Hospital Anxiety and Depression Scale), and post-traumatic symptom (Impact of Event Scale-Revised) assessment.

MAIN OUTCOME MEASURES

Survey response rate, extent of survey completion, clinical outcomes at different time points after discharge, and survey cost analysis were the main outcome measures. Outcomes were stratified based on follow-up time after ICU discharge (3, 6, and 12 months).

RESULTS

A total of 239 patients were randomised. The response rate was similar between the groups (mixed-mode: 78% [92/118 patients] vs. paper: 80% [97/121 patients], p = 0.751) and did not differ between time points of follow-up. Incomplete surveys were more prevalent in the paper group (10% vs 18%). The median EuroQol-5D-5L index value was 0.83 [0.71-0.92]. Depressive symptoms were reported by 25% of patients (46/187), anxiety symptoms were reported by 27% (50/187), and probable post-traumatic stress disorder was reported by 14% (25/184). Patient outcomes did not differ between the groups or time points of follow-up. The cost per reply was AU$ 16.60 (mixed-mode) vs AU$ 19.78 (paper).

CONCLUSION

The response rate of a mixed-mode survey is similar to that of a paper survey and may provide modest cost savings.

Fatigue Predicts Future Reduced Social Participation, not Reduced Physical Function or Quality of Life in People with Systemic Sclerosis

OBJECTIVE

Although fatigue is one of the most problematic symptoms for people with systemic sclerosis, little is known about how fatigue impacts daily life over time. Such information is important when developing fatigue management interventions. This study was conducted to examine 1) if fatigue severity predicted outcomes of worse functioning (social participation, physical function), and quality of life and 2) if level of self-efficacy moderated significant relationships between fatigue and these outcomes.

METHODS

Data were utilized from a clinical trial in which an online self-management intervention was tested (N = 267). Fatigue, social participation, and physical function were assessed by PROMIS measures. Quality of life was assessed by the EuroQol 5-domain instrument (EQ-5D-5L). Linear regressions were performed to examine how baseline fatigue related to functioning and quality of life outcomes 16 weeks later controlling for relevant covariates. PROMIS measures were used to measure self-efficacy in managing symptoms, daily activities, medications and treatments, emotions, and social interactions.

RESULTS

Fatigue at baseline significantly predicted social participation 16 weeks later; but did not predict physical functioning or quality of life. Self-efficacy variables did not moderate the association between fatigue and social participation.

CONCLUSION

Fatigue severity predicted decreased social participation in people with systemic sclerosis. Interventions targeting fatigue should include support to maintain participation of social roles and activities. The level of reported self-efficacy did not vary the strength of the association between fatigue and decline in social participation indicating that there may be other targets to treat fatigue intervention beyond self-management.

TRIAL REGISTRATION

NCT02494401.

Perceptions of injectable opioid agonist treatment (iOAT) among people who regularly use opioids in Australia: findings from a cross-sectional study in three Australian cities

BACKGROUND AND AIMS

Not all people experiencing opioid dependence benefit from oral opioid agonist treatment. The aim of this study was to examine perceptions of (supervised) injectable opioid agonist treatment (iOAT) (described as 'an opioid similar to heroin self-injected at a clinic several times a day') among people who regularly use opioids and determine how common iOAT eligibility criteria accord with interest in iOAT.

DESIGN

Cross-sectional survey SETTING: Sydney, Melbourne and Hobart, Australia PARTICIPANTS: A total of 344 people (63% male) who use opioids regularly and had ever injected opioids, interviewed December 2017-March 2018. The mean age of participants was 41.5 years [standard deviation (SD) = 8.5].

MEASUREMENTS

Primary outcome measures were interest in iOAT, factors associated with interest and the proportion of participants who would be eligible using common criteria from trials and guidelines. We examined willingness to travel for iOAT, medication preferences and perspectives on whom should receive iOAT.

FINDINGS

Overall, 53% of participants (n = 182) believed that iOAT would be a good treatment option for them. Participants who believed that iOAT was a good treatment option for them were more likely to be male [adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) = 1.10-2.82], have used heroin in the past month (aOR = 6.03, 95% CI = 2.86-12.71), currently regularly inject opioids (aOR = 1.84, 95% CI = 1.16-2.91) and have met ICD-10 criteria for opioid dependence (aOR = 3.46, 95% CI = 1.65-7.24). Those interested in iOAT had commenced more treatment episodes (aOR =1.06, 95% CI = 1.00-1.12). Among those interested in iOAT (n = 182), 26% (n = 48) met common eligibility criteria for iOAT.

CONCLUSIONS

Interest in injectable opioid agonist treatment does not appear to be universal among people who regularly use opioids. Among study participants who expressed interest in injectable opioid agonist treatment, most did not meet common eligibility criteria.

Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery

OBJECTIVE

To evaluate the psychometric properties of the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) for use in evaluating outcomes after joint replacement for osteoarthritis.

DESIGN

Patient-reported outcomes data collected by the Australian Orthopaedic Association National Joint Replacement Registry were used for this analysis. HOOS-12 and KOOS-12 domain (pain, function, quality of life) and summary impact data were available. The Oxford Hip Score (OHS), Oxford Knee Score (OKS) and EQ-5D-5L were used as comparators. Instruments were administered pre-operatively and at 6 months post-operatively. Internal consistency reliability, floor and ceiling effects, convergent validity, known groups validity, and responsiveness were evaluated using standard psychometric techniques.

RESULTS

Baseline HOOS-12 and KOOS-12 data were available for 3,023 patients undergoing primary total hip replacement and 4,010 patients undergoing primary total knee replacement. At baseline, high internal consistency was demonstrated for all domains and summary scores (Cronbach's alpha: HOOS-12 = 0.81-0.93; KOOS-12 = 0.82-0.92). Post-operative ceiling effects (>15% of patients scoring the best possible score) were identified for the HOOS-12 pain (46%), function (39%) and quality of life domains (26%) and summary score (17%), and for the KOOS-12 pain (21%) and function domains (18%). The HOOS-12 and KOOS-12 could differentiate between two known groups (lowest/highest OHS or OKS quartiles post-operatively; p < 0.001) and were highly responsive to change (effect sizes for HOOS-12: 2.20-2.83; KOOS-12: 1.82-2.35).

CONCLUSION

The HOOS-12 and KOOS-12 have good psychometric properties for capturing joint replacement outcomes including excellent responsiveness, although ceiling effects may limit monitoring of post-operative improvement.

The Economic Impact on Australian Patients with Neuroendocrine Tumours

BACKGROUND AND OBJECTIVE

Little is known about the economic burden to patients and families with neuroendocrine tumours (NETs) for medical out-of-pocket expenses and employment decisions. This study was performed to determine the extent and factors influencing the financial consequences of living with NETs and their effect on quality of life.

METHODS

We undertook an online cross-sectional survey using a targeted approach and collected Australian Medicare claims data. Validated surveys measured health-related quality of life (EuroQol 5-dimension 5-level [EuroQol-5D-5L]) and financial toxicity (COmprehenSive Financial Toxicity [COST]), supplemented with questions on employment and retirement, insurance and out-of-pocket medical expenses. Generalised linear models were performed to assess determinants of quality of life and out-of-pocket expenses recorded by Medicare.

RESULTS

The survey was answered by 204 patients with a mean age of 59 years who were diagnosed on average 5.2 years ago. Self-reported mean costs were 1698 Australian dollars ($A) (standard deviation [SD] $A2132) over 3 months (median $A877) and were highest for medical tests (mean $A376 [17% of total costs], SD $A722), travel-related expenses (mean $A289 [13%], SD $A559), and specialist visits (mean $A225 [10%], SD $A342) ($A1 = $US0.69). Imaging scans, surgery and travel expenses were the most common cost burdens reported by patients. Having private health insurance was the key determinant of higher out-of-pocket costs. Poorer quality of life was significantly associated with higher financial toxicity, not working due to cancer, nausea/diarrhoea, two or more co-morbidities and younger age.

CONCLUSIONS

Medical expenses are substantial for some patients with NETs. Quality of life is adversely affected for patients experiencing financial toxicity and avoiding early retirement is an important issue for supportive care services.

Comparing the properties of the EQ-5D-5L and EQ-5D-3L in general population in Iran

BACKGROUND

Little information exists on properties of EQ-5D-5L (the 5L hereafter) compared to the EQ-5D-3L (the 3L hereafter) measures in the context of Iran. This study aims to compare the measurement properties of the two versions of the EQ-5D (the 3L vs. the 5L) using data obtained from general population in Iran.

METHODS

A total of 886 adults aged 18 years and above from September to November 2020 participated in this cross-sectional analysis. The required data collected using self-administered and-standard questionnaire and multistage sampling method was used to select the samples. The 3L and 5L measures compared in terms of celling effect, distribution and redistribution pattern, feasibility, convergent validity, know-groups validity and informativity.

RESULTS

From September to November 2020, 886 adults (mean aged = 44.6 years; 55% male and 87.1% married) included in the study. The study indicated that the 5L had lower celling effects compared to the 3L (45% vs. 46%). A better convergent validity and known-groups validity was found for the 5L version compared to the 3L and significantly stronger association found between the 5L measure with both the Visual Analogue Scale and the 5-point health status scale. The 5L index score showed higher relative efficiency (RE) in 9 of 11 condition (mean RE = 1.36). Compared to the 3L, the 5L classification system had higher Shannon index (H') in all dimensions: mobility (0.52 vs. 0.40), self-care (0.23 vs. 0.20), usual activities (0.61 vs. 0.47), pain/discomfort (1.19 vs. 0.89) and anxiety/depression (1.22 vs. 0.47).

CONCLUSION

The study demonstrated that the measurement properties of 5L version in terms of celling effects, convergent validity, known-groups validity, RE and informativity similar or better than the 3L among general population; suggesting the use of 5L in the context of Iran. Hence, we suggested the use of the 5L in economic evaluation, clinical and public health studies in Iran.

The impact of idiopathic pulmonary fibrosis on health state utility values: evidence from Australia

PURPOSE

Idiopathic pulmonary fibrosis (IPF) is a progressive and universally fatal lung disease, characterised by increasing fibrosis of the lung parenchyma. In this study, we aimed to quantify the health state utility values (HSUVs) for Australians with IPF and to identify the factors affecting these HSUVs.

METHODS

Participants of the Australian IPF Registry (AIPFR), with data on EuroQoL five dimension-five level (EQ-5D-5L) profiles were included. Pulmonary function tests (PFTs) were used to assess disease severity using three IPF -based classification systems. Stepwise multivariable linear regression models assessed the relationship between HSUVs and important demographic and clinical parameters.Query RESULTS: A total of 155 participants provided data for the analysis of HSUVs. For our base case, HSUVs ranged from - 0.57 to 1.00. Mean HSUVs for all participants was 0.65 (95% CI 0.61-0.70). In general, HSUVs decreased with increasing disease severity under all disease severity classification systems. Multivariable linear regression demonstrated a negative association between HSUVs, disease severity and having more than 2 comorbidities.

CONCLUSIONS

Our study has shown that EQ-5D-5L has exhibited discriminatory sensitivity for the study population. We have demonstrated that disease severity and having more than two comorbidities was associated with lower HSUVs in Australians with IPF. Our findings support early diagnosis and appropriate evidence-based treatment to slow or prevent IPF progression; and identification and treatment of associated comorbidities to potentially improve health-related quality of life in people with IPF.

Mobilization During Critical Illness: A Higher Level of Mobilization Improves Health Status at 6 Months, a Secondary Analysis of a Prospective Cohort Study

OBJECTIVES

To determine the influence of active mobilization during critical illness on health status in survivors 6 months post ICU admission.

DESIGN

Post hoc secondary analysis of a prospective cohort study conducted between November 2013 and March 2015.

SETTING

Two tertiary hospital ICU's in Victoria, Australia.

PATIENTS

Of 194 eligible patients admitted, mobility data for 186 patients were obtained. Inclusion and exclusion criteria were as per the original trial.

INTERVENTIONS

The dosage of mobilization in ICU was measured by 1) the Intensive Care Mobility Scale where a higher Intensive Care Mobility Scale level was considered a higher intensity of mobilization or 2) the number of active mobilization sessions performed during the ICU stay. The data were extracted from medical records and analyzed against Euro-quality of life-5D-5 Level version answers obtained from phone interviews with survivors 6 months following ICU admission. The primary outcome was change in health status measured by the Euro-quality of life-5D-5 Level utility score, with change in Euro-quality of life-5D-5 Level mobility domain a secondary outcome.

MEASUREMENTS AND MAIN RESULTS

Achieving higher levels of mobilization (as per the Intensive Care Mobility Scale) was independently associated with improved outcomes at 6 months (Euro-quality of life-5D-5 Level utility score unstandardized regression coefficient [β] 0.022 [95% CI, 0.002-0.042]; p = 0.033; Euro-quality of life-5D-5 Level mobility domain β = 0.127 [CI, 0.049-0.205]; p = 0.001). Increasing the number of active mobilization sessions was not found to independently influence health status. Illness severity, total comorbidities, and admission diagnosis also independently influenced health status.

CONCLUSIONS

In critically ill survivors, achieving higher levels of mobilization, but not increasing the number of active mobilization sessions, improved health status 6 months after ICU admission.

Quality of life under the COVID-19 quarantine

BACKGROUND

COVID-19 has spread rapidly throughout the world, causing thousands of illnesses and deaths. To fight this pandemic, almost all governments and health authorities have focused on prevention. In March or April, most countries' officials imposed home quarantine and lockdown measures nationwide.

PURPOSE

This study sought to assess health-related quality of life (HRQoL) and anxiety levels among people in Portugal under mandatory home quarantine due to the COVID-19 pandemic. The results were compared to the general Portuguese population's HRQoL before the COVID-19 outbreak. This research also aimed to understand the factors that can influence the respondents' HRQoL.

METHODS

A sample of Portugal's population quarantined at home (n = 904) filled in an online survey comprising the Generalized Anxiety Disorder 7-item and the EQ-5D-5L and other questions about sociodemographic characteristics, feelings, duties and activities during the quarantine. The sample was weighted to mirror the general population's gender, age and education. Descriptive analyses and correlation coefficients were used to evaluation the respondents' anxiety and HRQoL. Generalised linear models were estimated to identify determinants of HRQoL during the COVID-19 quarantine.

RESULTS

The results show that individuals quarantined at home reported higher anxiety and lower HRQoL levels and that people with more anxiety tended to have a lower HRQoL. Females and elderly individuals experienced the highest levels of anxiety and poorest HRQoL. In addition, HRQoL during the quarantine can be explained by various occupational and attitudinal variables, as well as sociodemographic variables.

CONCLUSION

Individuals' mental health should be taken into consideration during pandemics or other emergency situations. Anxiety and other factors can decrease people's HRQoL, in conjunction with the pandemic's social and economic consequences.

QALYs for COVID-19: A Comparison of US EQ-5D-5L Value Sets

BACKGROUND

In economic evaluations, quality-adjusted life-years (QALYs) can serve as a unit of measurement for disease burden. Obtaining QALY values for COVID-19 presents a challenge owing to the availability of two US EQ-5D-5L value sets and the potentially asymptomatic presentation of the disease. The first value set was completed allowing for the discounting of future health outcomes while the second value set is undiscounted.

OBJECTIVE

The objective of this study was to compare the distribution of QALY values using a national survey and the two published value sets; and to estimate the association between COVID-19 outcomes and QALY losses.

METHODS

Between 9 and 11 November, 2020, 1153 US adults completed the EQ-5D-5L instrument (five items and a visual analog scale) as well as self-reported their demographics, COVID-19 symptoms, and memberships to populations that are at risk of COVID-19 infection. The two US value sets were applied to the EQ-5D-5L responses to produce QALY values. We estimated the mean QALYs by visual analog scale decile and a generalized linear model of COVID-19 outcomes.

RESULTS

The discounted values are higher than the undiscounted values for each visual analog scale decile owing to methodological differences. Persons at increased risk, with a fever in the past day, and with one or more other symptoms have significantly greater QALY losses (p < 0.01). Overall, non-institutionalized individuals at risk of symptomatic clinical COVID-19 equal 0.68 for the 2016 value set (95% confidence interval 0.49-0.87) and 0.10 for the 2017 value set (95% confidence interval - 0.31 to 0.51) QALYs.

CONCLUSIONS

Multiple studies have shown that decision makers discount future health outcomes, which increase QALY values. This study confronts the practical implications of these methodological advances for use in COVID-19 economic evaluations. Health economists will be able to use the QALY values in this study to better evaluate health interventions against COVID-19.

EQ-5D self-reported health in Barbados and Jamaica with EQ-5D-5L population norms for the English-speaking Caribbean

BACKGROUND

The EQ-5D instrument is increasingly used in clinical and resource allocation decision making in developed and developing countries. EQ-5D valuation and population norms studies have been undertaken for Trinidad and Tobago, however no population norms or value sets have been generated for the other Caribbean countries. The aims of this study were to provide population norms for Barbados and Jamaica, and to develop a set of population norms that could be used by the other English-speaking Caribbean countries.

METHODS

The EQ-5D-5L self-reported health questionnaire was included in surveys of representative samples of adults in Barbados and adults in Jamaica in 2013. EQ-5D health states, mean EQ VAS scores and mean EQ-5D-5L index values (using the Trinidad and Tobago value set) were calculated for demographic groups in both countries based on 2347 respondents from Barbados and 1423 from Jamaica. A set of 'Caribbean' norms were developed by combining the Barbados and Jamaica data with norms recently published for Trinidad and Tobago.

RESULTS

Data were obtained for 2347 and 1423 respondents in Barbados and Jamaica respectively. The mean index and EQ VAS values were 0.943 and 81.9 for Barbados, and 0.948 and 87.8 for Jamaica. The health states most commonly observed in the two countries were similar. Generally the demographic patterns of self-reported health were consistent with those found in other studies. Some differences between the countries were observed in the patterns of rates of reporting problems on the EQ-5D dimensions among age-gender groups specifically for anxiety/depression and pain/discomfort CONCLUSION: This study has produced a set of EQ-5D population norms that can be used as base-line values in clinical and clinico-economic analyses for Barbados and Jamaica and for the English-Speaking Caribbean region.

Comparing the EQ-5D-3L anxiety or depression domain to the Hospital Anxiety and Depression Scale to identify anxiety or depression after stroke

Background: Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke.Methods: Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke.Results: Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years; 42% female. Nearly 50% reported problems (43% moderate; 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke.Conclusions: The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against "gold standard" clinical assessment is required for clinical applications.

EQ-5D-5L reference values for the German general elderly population

Background

Reference values are a helpful tool to facilitate comparisons of sampled values against a specified reference population. The aim is to describe the health profile and to provide visual analogue scale (EQ VAS) and utility reference values for the EQ-5D-5L from a normative sample of the general elderly population (65+) in Germany.

Methods

We analysed a sub-set of data from the German EQ-5D-5L valuation study using self-reported information based on EQ-5D-5L. We examined the share of respondents in each severity level per dimension as well as means, standard deviations (SD) and 95% confidence intervals for the index and EQ VAS values stratified by age groups and gender. Age was categorised in four groups (65–69, 70–74, 75–79 and > 79 years) to facilitate a more detailed examination of age-related health-related quality of life (HRQoL).

Results

The average index and EQ VAS scores were 0.84 (SD 0.22) and 73.2 (SD 18.5), respectively. In total, 21.4% reported no problems in all dimensions. With higher age, health problems were reported more frequently, which, in turn, lead to monotonically decreasing index and EQ VAS values. Overall, men reported fewer problems than women and this difference was largest beyond the age of 80.

Conclusion

HRQoL in the oldest old appears to be less stable and differs from the young elderly. However, the conventional age categorisation of earlier population norms studies seems to mask these differences. Hence, the more detailed provision of EQ-5D-5L reference values for the elderly population seems helpful for future German studies.

Future burden of cardiovascular disease in Australia: impact on health and economic outcomes between 2020 and 2029

AIMS

To estimate the health and economic burden of new and established cardiovascular disease from 2020 to 2029 in Australia.

METHODS AND RESULTS

A two-stage multistate dynamic model was developed to predict the burden of the incident and prevalent cardiovascular disease, for Australians 40-90 years old from 2020 to 2029. The model captured morbidity, mortality, years of life lived, quality-adjusted life years, healthcare costs, and productivity losses. Cardiovascular risk for the primary prevention population was derived using Australian demographic data and the Pooled Cohort Equation. Risk for the secondary prevention population was derived from the REACH registry. Input data for costs and utilities were extracted from published sources. All outcomes were annually discounted by 5%. A number of sensitivity analyses were undertaken to test the robustness of the study. Between 2020 and 2029, the model estimates 377 754 fatal and 991 375 non-fatal cardiovascular events. By 2029, 1 061 756 Australians will have prevalent cardiovascular disease (CVD). The population accrued 8 815 271 [95% uncertainty interval (UI) 8 805 083-8 841 432] years of life lived with CVD and 5 876 975 (5 551 484-6 226 045) QALYs. The total healthcare costs of CVD were projected to exceed Australian dollars (AUD) 61.89 (61.79-88.66) billion, and productivity losses will account for AUD 78.75 (49.40-295.25) billion, driving the total cost to surpass AUD 140.65 (123.13-370.23) billion.

CONCLUSION

Cardiovascular disease in Australia has substantial impacts in terms of morbidity, mortality, and lost revenue to the healthcare system and the society. Our modelling provides important information for decision making in relation to the future burden of cardiovascular disease.

Health-related quality of life and its related factors in coronary heart disease patients: results from the Henan Rural Cohort study

The aims were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific scores in patients with coronary heart disease (CHD). A total of 1247 patients with CHD from the Henan Rural Cohort Study (n = 39,259) were included in this study. The Chinese version of the European Quality of Life Five Dimension Five level scale (EQ-5D-5L) and Visual Analogue Scale (VAS) were used to evaluate HRQoL in patients with CHD. Tobit regression, generalized linear models and binary logistic regression were applied to determine the potential factors influencing the EQ-5D utility, as well as each domain, and the VAS. CHD patients had lower per capita monthly actual income, and higher rates of diabetes mellitus, stroke, anxiety and poor sleep quality, which significantly decreased EQ-5D index and VAS scores. In addition, sex, older age, education, not having a spouse, ever drinking alcohol, a high-fat diet, physical activity, hypertension and depression affected the various domain-specific EQ-5D scores in CHD patients. CHD patients in rural areas have a lower HRQoL. Factors associated with the EQ-5D index, including each domain, and the VAS need attention. CHD patients in rural areas need to be managed systematically.

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

PURPOSE

Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L.

METHODS

Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models.

RESULTS

Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health.

CONCLUSIONS

The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.

Poor self-rated oral health associated with poorer general health among Indigenous Australians

Background

Oral diseases negatively impact general health, affecting physical, psychological, social and emotional wellbeing, and ability to give back to community. The relationship between poor oral health, and general health and wellbeing among Indigenous Australians has not been documented. Working in partnership with seven Indigenous communities in South Australia, this study aimed to: 1) quantify self-rated oral health and health-related quality of life and; 2) investigate associations between poor self-rated oral health and general health among Indigenous Australian adults.

Methods

Data was collected from a large convenience sample of Indigenous Australians aged 18+ years from Feb 2018 to Jan 2019. General health-related quality of life, as the main outcome variable, was measured by calculating disutility scores with the five individual EQ-5D dimensions (EuroQol instrument: EQ-5D-5L), then classified as ‘no problem’ and ‘at least one problem’. Self-reported oral health, as the main explanatory, was dichotomised into ‘fair or poor’ and ‘excellent, very good or good’. Multivariable log-Poisson regression models were used to estimate associations between poor self-rated oral health and general health by calculating mean rate ratios (MRR) for disutility scores and prevalence ratios (PR) for individual dimensions, after adjusting for social-demographic characteristics and health-related behaviours.

Results

Data were available for 1011 Indigenous South Australian adults. The prevalence of ‘fair or poor’ self-rated oral health was 33.5%. The mean utility score was 0.82 (95% CI: 0.81–0.83). Compared with those rating their oral health as ‘excellent or very good or good’, those who rated their oral health as ‘fair or poor’ had a mean disutility score that was 1.6 (95% CI: 1.1–2.2) times higher, and the prevalence of at least one problem ranged from 90 to 160% higher for individual EQ-5D dimensions.

Conclusions

Fair or poor self-rated oral health among Indigenous persons in South Australia was associated with poor general health as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility, self-care and anxiety/depression. The findings emphasise the importance of oral health as predictors of general health among Indigenous Australians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10426-3.

Economic burden of moderate to severe burns and its association with health-related quality of life of Nigerian women

Background

Burns cases are frequent in Nigeria hospitals, however, literature on its economic burden and the association with health-related quality of life (HRQOL) of women in Nigeria is scarce. This study determined the burden of hospitalization after burns on women’s economic status and its associated HRQOL.

Methods

This was a three-month cross-sectional study of female patients ≥ 25 years, treated of mixed or full thickness burns in four teaching hospitals in south-east Nigeria, discharged between September–November, 2018. Study instruments were participants’ case notes for socio-demographic and disease history, interviewer-administered questionnaires, namely-economic-burden-of-burns questionnaire and English version of the EuroQol Five-Dimensions-Three-Level Health Questionnaire for Nigeria. Data were collected on second- or third-day post-discharge through home visits or phone calls. This lasted for 13 weeks.

Results

A total of seventy-three female patients with burn were successfully enrolled. Most participants were married, fairly educated, mainly traders or housewives. Thirty-four (46.6%) had subjective estimated family monthly income below NGN 50,000 (low economic status). Participants’ average monthly income reduced drastically after hospitalization. Their average family monthly income was NGN110,439 (USD307), while their average total expenses incurred during hospitalization was NGN691,093 (USD1,920). Almost all (93.2%) had at least one surgical intervention during management. Their average length of hospital stay was 35.4 days; eleven consequently lost their job. Many had moderate to severe economic burden of treatment; only eleven could bear all the treatment expenses independently. Anxiety/depression and pain/discomfort were common problems reported, However, these Euroqol dimensions varied according to their SES, education and occupation. Women in the low economic class were more inclined to poor HRQOL (Mean ± SD VAS = 53.33 ± 17.619) than women in high economic class (Mean ± SD VAS = 76.67 ± 21.794).

Conclusion

Burns places high level of economic burden on women and unfortunately, Nigerian government’s commitment to healthcare of burns patients is low. The long course of hospitalization and economic depletion impact negatively on the women’s HRQOL. Based on these findings, we recommend that government parastatals create special trust fund for burns treatment and the National Health Insurance Scheme be restructured for more accessibility.

Population norms for the EQ-5D-3L in China derived from the 2013 National Health Services Survey

Background

EQ-5D-3L is one of the most commonly used instruments for assessing health-related quality of life and cost-utility analyses, but it is not yet available in China. This study aims to develop population norms for the EQ-5D-3L in China in order to encourage appropriate use and interpretation of the EQ-5D-3L instrument.

Methods

Data were extracted from the 2013 National Health Services Survey on a nationally representative sample of 188 720 participants. The utility index based on the 2018 Chinese preference-based value sets were calculated for the participants with different demographic and socio-economic characteristics. Differences in reported problems and visual analogue scale (VAS) and utility index scores were tested using a logistic, linear and tobit regression model, respectively.

Results

The Chinese respondents were less likely to report problems on the EQ-5D dimensions compared with most populations in other countries. Pain/discomfort was the most commonly reported problem (12.6%). This resulted in a high ceiling effect (84.19%) on the utility index and high mean scores for the utility index (0.985 ± 0.056) and VAS (80.91 ± 13.74) in the Chinese population. Those who were younger, better educated, employed, married, had no illness condition, lived in a more developed region and had a higher income obtained higher scores in both VAS and utility index. The VAS and utility index scores were also associated with gender, residency and lifestyles, but not always in a consistent way. Male and rural residents had a higher VAS score but not in the utility index compared with their female and urban counterparts.

Conclusions

This study provides national population norms for the EQ-5D-3L based on the 2018 Chinese preference-based value sets. The norms can be used as a reference for health evaluation studies. Cautions need to be taken for presenting and interpreting the utility index results given the high ceiling effect of the EQ-5D-3L instrument.

The COVID-19 Sequelae: A Cross-Sectional Evaluation of Post-recovery Symptoms and the Need for Rehabilitation of COVID-19 Survivors

Background  As of January 19, 2021, around two million fatalities and 68 million recoveries from coronavirus disease 2019 (COVID-19) have been reported around the globe. The past pandemics of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) hint toward a risk of occurrence of "Long-COVID" syndrome, i.e., the persistence of post-discharge symptoms among COVID-19 survivors. With the scarcity of literature addressing post-COVID-19 manifestations and little regard for the stigma associated with this disease, survivors' rehabilitation remains widely neglected. The current study aims to assess the prevalence and characteristics of post-COVID-19 manifestations and their effect on the quality of life (QoL) of COVID-19 recovered individuals. We have also analyzed the relationship of time since the recovery of COVID-19 and its severity with the post-discharge symptoms. The stigma affiliated with the infection of SARS coronavirus-2 (SARS-CoV-2) has also been highlighted. Methodology A descriptive, cross-sectional, questionnaire-based study was conducted from September 2020 to December 2020 among 158 COVID-19 recovered patients, whose information was obtained from Dow Diagnostic Laboratory, Ojha Campus, Karachi, Pakistan. The questionnaire consisted of four sections: sociodemographic data, post-COVID-19 manifestations, questions relating to the stigma, and the QoL of the recovered COVID-19 patients. We used the EuroQol five-dimension five-level questionnaire to assess the QoL, while the modified BG Prasad Socioeconomic Classification updated for 2019 was employed to determine the socioeconomic status of the participants. Data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Data were presented in the form of frequencies and percentages. Results An overwhelming majority (94.9%) experienced at least one post-COVID-19 symptom, with fatigue (82.9%) being the most prevalent post-discharge manifestation. We observed a significant correlation of post-COVID-19 symptoms with gender, age, and time since recovery. COVID-19 severity was found to be significantly related to the five dimensions of the QoL. A significant difference in EuroQol Visual Analog Scale health score was observed between the participants with mild, moderate, and severe COVID-19 infection (p < 0.001). Besides, the associated stigma with SARS-CoV-2 infection was found to be more prevalent in the participants belonging to the upper class as compared to the other classes (p < 0.05). Nonetheless, we also observed a significant association of disease severity with post-COVID-19 manifestations and pre-existing comorbidities. Conclusions The long-COVID syndrome is similar to the post-discharge manifestations of the survivors of prior pandemics of SARS and MERS. Multi-disciplinary rehabilitation teams, healthcare workers, and the general population should recognize the need for systematic assessment of their recovery and further rehabilitation.

Health-related quality of life and its predictors among the type 2 diabetes population of Bangladesh: A nation-wide cross-sectional study

AIMS/INTRODUCTION

We aimed to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh.

MATERIALS AND METHODS

This nationwide cross-sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade-off value set. The predictors were determined using multinomial logistic regression analysis.

RESULTS

The mean EQ-5D-5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as "average" HRQoL. Overall, 64% of respondents had a "problem" at least in one of the dimensions of the EQ-5D-5L, and the burden of reported "problems" was higher among women (70%). Among the five dimensions, the highest reported "problem" was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged <30 years) showed a higher burden of anxiety/depression (95%) compared with the rest of the population. The specific predictors of average/good HRQoL (odds ratio >1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years.

CONCLUSIONS

The majority of Bangladesh's type 2 diabetes patients had an "average" HRQoL based on the EQ-5D-5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes.

Developing dimensions for a new preference-based quality of life instrument for older people receiving aged care services in the community

PURPOSE

To identify the salient quality of life characteristics relevant to older people in receipt of community aged care services in order to develop dimensions for a draft descriptive system for a new preference-based quality of life instrument.

METHODS

Forty-one in-depth semi-structured interviews were undertaken with older people (65 years and over) receiving community aged care services across three Australian states to explore quality of life characteristics of importance to them. The data were analysed using framework analysis to extract broader themes which were organised into a conceptual framework. The data were then summarised into a thematic chart to develop a framework matrix which was used to interpret and synthesise the data. Care was taken throughout to retain the language that older people had adopted during the interviews to ensure that appropriate language was used when identifying and developing the quality of life dimensions.

RESULTS

The analysis resulted in the identification of five salient quality of life dimensions: independence, social connections, emotional well-being, mobility, and activities.

CONCLUSION

This research finds that quality of life for older people accessing aged care services goes beyond health-related quality of life and incorporates broader aspects that transcend health. The findings represent the first stage in a multiphase project working in partnership with older people to develop a new preference-based instrument of quality of life for informing quality assessment and economic evaluation in community aged care. In future work, draft items will be developed from these dimensions and tested in face validity interviews before progressing to further psychometric testing.

Changing Behaviour towards Aerobic and Strength Exercise (BASE): Design of a randomised, phase I study determining the safety, feasibility and consumer-evaluation of a remotely-delivered exercise programme in persons with multiple sclerosis

BACKGROUND

Multiple sclerosis is a chronic progressive neurological disease. Evidence attests to the benefits of exercise, guidelines for exercise in multiple sclerosis are available. Remote-delivery of exercise adherence programmes based on the exercise guidelines require urgent testing.

AIMS

The design, and outcomes of Behaviour towards Aerobic and Strength Exercise in MS (BASE-MS), a remotely-delivered exercise training study based principles of behaviour change, will further evaluate the remote-delivery of the current exercise guidelines.

METHODS

BASE is a 4-month clinically relevant randomised controlled trial to explore the delivery of a remotely supervised, guidelines-based exercise programme for persons with multiple sclerosis, underpinned by principles of health behaviour change. Initially, 72 persons with mild to moderate multiple sclerosis will be randomised in a 1:1:1 allocation to receive the BASE programme, or act as controls continuing usual care. On programme completion, exercise participants will be further randomised to an optimised adherence treatment or usual adherence. Our online survey assesses the primary outcome of exercise participation, and secondary outcomes of symptoms, and correlates of behaviour change at baseline, month four, month five and month eleven. Online surveys will capture coach and participant feedback to identify the contexts, mechanisms and outcomes of BASE implementation.

CONCLUSIONS

The research and clinical landscape for MS management must remain in-step with public health and health communication. BASE tests the remote-delivery of the current exercise guidelines for exercise in persons with MS. Safety, feasibility and evaluative outcomes will provide rich data for future remote-delivery of exercise in neurological conditions.

Survivors of Intensive Care With Type 2 Diabetes and the Effect of Shared-Care Follow-Up Clinics: The SWEET-AS Randomized Controlled Pilot Study

BACKGROUND

Follow-up clinics after ICU admission have demonstrated limited benefit. However, existing trials have evaluated heterogeneous cohorts and used physicians who had limited training in outpatient care.

RESEARCH QUESTION

What are the effects of a "shared-care" intensivist-endocrinologist clinic for ICU survivors with type 2 diabetes on process measures and clinical outcomes 6 months after hospital discharge, and is it feasible to conduct a larger trial?

STUDY DESIGN AND METHODS

This was a prospective, randomized, single-center pilot study with blinded outcome assessment. Patients with type 2 diabetes, who required ≥ 5 days of ICU care (mixed medical-surgical ICU) and survived to ICU discharge, were eligible. Participants were randomized to attendance at the shared-care clinic 1 month after hospital discharge or usual care. Six months after hospital discharge, participants were assessed for outcomes including glycated hemoglobin, neuropathy, nephropathy, quality of life, return to employment, frailty, and health-care use. The primary outcome was participant recruitment and retention.

RESULTS

During an 18-month period, 42 of 82 eligible patients (51%) were recruited. Four participants (10%) withdrew before assessment at 6 months and 11 (26%) died. At 6 months, only 18 of 38 participants who did not withdraw (47%) were living independently without support, and 24 (63%) required at least one subsequent hospital admission. In the intervention group (n = 21), 16 (76%) attended the clinic. Point estimates did not indicate that the intervention improved glycated hemoglobin (+5.6 mmol/mol; 95% CI, -6.3 to 17; P = .36) or quality of life (36-Item Short Form Survey physical summary score, 32 [9] vs. 32 [7]; P = 1.0).

INTERPRETATION

Outcomes for ICU survivors with type 2 diabetes are poor. Because of low participation and high mortality, a larger trial of a shared-care follow-up clinic in this cohort, using the present design, does not appear feasible.

TRIAL REGISTRY

Australian New Zealand Clinical Trials Registry (ANZCTR); No.: ACTRN12616000206426; URL: www.anzctr.org.au.

Association of Participation in Disease Management Programs and Health-Related Quality of Life in Korean Population: Results from the Korea National Health and Nutrition Examination Survey IV and V (2007-2012)

BACKGROUND

The high prevalence of chronic diseases has been an ongoing public concern. The psychological factors, including lack of social support and perceived lack of control, were found to be highly associated with an increased risk of the diseases. In fact, the effect of disease management programs (DMP) in patients diagnosed with chronic diseases were assessed in multiple studies to measure health-related quality of life (HR = QoL), which measured in the EuroQol 5-Dimension Questionnaire (EQ-5D) index score, also known as self-perceived health.

METHODS

The study was conducted using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2012 and through descriptive statistics and multiple linear regression to investigate the association of participation in DMP and the EQ-5D index score.

RESULTS

The results revealed that the subjects diagnosed with hypertension were shown to have a lower quality of life to those without the diagnosis (P < .05). Moreover, in the hypertensive Korean population, DMP did not show any statistically significant impact on the EQ-5D index score (P > .05).

CONCLUSION

Our study has assessed the association of DMP and EQ-5D index score in hypertensive patients only although it is still uncertain the effect of DMP on other chronic diseases therefore, further studies should be conducted to investigate the importance of DMP in Korea for the patients with such diseases in improving their quality of life.

Health-related quality of life improves over the duration of home-based rehabilitation services

Background/Aims

Home-based rehabilitation is an alternative to inpatient rehabilitation. There is little research evaluating its effect on health-related quality of life. This study aimed to investigate whether health-related quality of life improves with rehabilitation services provided in the home.

Methods

A prospective, single-arm, observational study was undertaken, involving 121 patients receiving home-based rehabilitation services. A health-related quality of life questionnaire was completed by participants at the start and completion of services (using the 5-Level EuroQol-5 Dimension instrument) and analysed descriptively. Changes in health-related quality of life were compared using paired sample t-tests. Multivariate regression analyses were undertaken to investigate the effects of various factors (eg age, gender, diagnostic category) on the observed changes in health-related quality of life.

Results

Improved health-related quality of life was found: more participants reported ‘no’ or ‘slight’ problems at completion than initially, and there were significant increases in index values (P<0.001) and EuroQol Visual Analogue Scale scores (P<0.001). Admission scores, diagnostic group and duration of home-based rehabilitation services influenced health-related quality of life.

Conclusions

Health-related quality of life improved from start to completion of home-based rehabilitation services. This may reflect natural recovery and/or the effect of the rehabilitation interventions. Health-related quality of life measures, such as the 5-Level EuroQol-5 Dimension instrument, may be useful to evaluate the effect of home-based rehabilitation.

Effect of a patient-centred deprescribing procedure in older multimorbid patients in Swiss primary care - A cluster-randomised clinical trial

Background

Management of patients with polypharmacy is challenging, and evidence for beneficial effects of deprescribing interventions is mixed. This study aimed to investigate whether a patient-centred deprescribing intervention of PCPs results in a reduction of polypharmacy, without increasing the number of adverse disease events and reducing the quality of life, among their older multimorbid patients.

Methods

This is a cluster-randomised clinical study among 46 primary care physicians (PCPs) with a 12 months follow-up. We randomised PCPs into an intervention and a control group. They recruited 128 and 206 patients if ≥60 years and taking ≥five drugs for ≥6 months. The intervention consisted of a 2-h training of PCPs, encouraging the use of a validated deprescribing-algorithm including shared-decision-making, in comparison to usual care. The primary outcome was the mean difference in the number of drugs per patient (dpp) between baseline and after 12 months. Additional outcomes focused on patient safety and quality of life (QoL) measures.

Results

Three hundred thirty-four patients, mean [SD] age of 76.2 [8.5] years participated. The mean difference in the number of dpp between baseline and after 12 months was 0.379 in the intervention group (8.02 and 7.64; p = 0.059) and 0.374 in the control group (8.05 and 7.68; p = 0.065). The between-group comparison showed no significant difference at all time points, except for immediately after the intervention (p = 0.002). There were no significant differences concerning patient safety nor QoL measures.

Conclusion

Our straight-forward and patient-centred deprescribing procedure is effective immediately after the intervention, but not after 6 and 12 months. Further research needs to determine the optimal interval of repeated deprescribing interventions for a sustainable effect on polypharmacy at mid- and long-term. Integrating SDM in the deprescribing process is a key factor for success.

Trial registration

Current Controlled Trials, prospectively registered ISRCTN16560559 Date assigned 31/10/2014.

The Prevention of Polypharmacy in Primary Care Patients Trial (4P-RCT).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01870-8.

Health related QoL in celiac disease patients in Slovenia

BACKGROUND

Measurements of health-related quality of life (HRQoL) among celiac disease patients using a validated questionnaire have been lacking in Slovenia. This study aims to measure HRQoL in celiac disease (CD) patients using EQ-5D internationally validated questionnaire and comparing it to the HRQoL of the general population.

METHODS

In this cross sectional analysis all of the approximately 2000 members of the Slovenian Celiac Society were invited to take part. We used a 3 step approach for recruitment and data collection. HRQoL was evaluated through the EuroQoL EQ-5D-5L instrument (Slovenian version) and analysed using the ordinal logistic regression.

RESULTS

Out of 321 patients who gave their consent, 247 celiac patients were included in the study (77%). 68% of the participants were female and 53% of them lived in an urban setting. Most patients originated from North-East Slovenia, whereas approximately 30% of patients came from other Slovenian regions. The EQ-5D respondents' self-reported health status at the time of the study show that most patients have slight or no problems when living with CD. The duration of the gluten-free diet, academic education and rare (< 1 × year) doctor visits affect EQ-5D in a positive way. On the other hand, higher age and chronic rheumatic disease were negatively associated with EQ-5D also when compared to the general population.

CONCLUSION

This is the first Slovenian study to measure the HRQoL of Slovenian CD patients, using an internationally validated questionnaire. The results of our study show that HRQoL is slightly impaired among Slovenian patients with CD. Clinical characteristics are better determinants of their HRQoL than socio-demographic factors. Greater awareness of the impact of CD on patients' HRQoL would improve the holistic management of CD patients.

Head-to-Head Comparison of the Psychometric Properties of 3 Carer-Related Preference-Based Instruments

OBJECTIVES

To compare the psychometric properties of the Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer), the Carer Experience Scale (CES), and the Care-related Quality of Life (CarerQol) to inform the choice of instrument in future studies.

METHODS

Data were derived from a 2018 online survey of informal carers in Australia. Reliability was assessed via internal consistency (Cronbach alpha, α) and test-retest reliability (intraclass correlation coefficient, ICC) for respondents who self-reported no change in their quality of life as a carer over 2 weeks. Convergent validity was evaluated via predetermined hypotheses about associations (Spearman's rank correlation) with existing, validated measures. Discriminative validity was assessed based on the ability of the carer-related scores to distinguish between different informal care situations (Mann-Whitney U, Kruskal-Wallis one-way analysis of variance).

RESULTS

Data from 500 carers were analyzed. The ASCOT-Carer demonstrated a higher degree of internal consistency, possibly due to a unidimensional structure, and test-retest reliability than the CarerQol and CES (α = 0.87, 0.65, 0.59; ICC, 0.87, 0.67, 0.81, respectively). All 3 instruments exhibited convergent validity and detected statistically significant associations between carer-related scores and different informal care situations, except for the CarerQol-7D and sole carer status.

CONCLUSIONS

The ASCOT-Carer, CarerQol, and CES performed reasonably well psychometrically; the ASCOT-Carer exhibited the best psychometric properties overall in this sample of Australian informal carers. Findings should be used in conjunction with consideration of research goals, carer population, targeted carer-related constructs, and prevailing perspectives on the economic evaluation to inform choice of instrument in future studies.

EQ-5D-5L Bulgarian population norms

OBJECTIVES

The present study aimed to provide normative data for the EQ-5D-5L questionnaire in Bulgaria, based on a nationally representative sample.

METHODS

Random sampling was used. In September 2018, a total of 1005 respondents (aged 18-89 years) completed the self-administered paper-based EQ-5D-5L questionnaire, including a visual analogue scale (EQ VAS). Health state utility index scores were derived using the directly measured Polish value set.

RESULTS

The study sample was representative of the general Bulgarian population in terms of age, sex, geographical region, educational level, social and professional status. Mean EQ-5D-5L and EQ VAS values decreased from 0.986 and 89.7 (age group 18-24 years) to 0.789 and 53.6 (age group ≥ 75 years), respectively. Perfect health (the "11,111" health state) was reported by half of the population (50.1%), more often by men than women (55.8% vs 44.9%). The most frequently reported complaints characterised pain/discomfort dimension (39.1%), followed by anxiety/depression (34.5%). Although the least commonly reported health limitations concerned the self-care dimension, their frequency (13.6%) was the highest among the seventeen identified EQ-5D-5L population norm studies. The mean severity index score for the whole study sample was 6.96. EQ-5D-5L index was higher in respondents from lower age groups and with a higher average income per household member.

CONCLUSIONS

Bulgarian population norms, which were developed for the descriptive part of the EQ-5D-5L and EQ VAS, can be used as reference values. The availability of such normative data should encourage the use of the EQ-5D-5L questionnaire in health-related quality-of-life studies in Bulgaria.

Depression, anxiety and health status across different BMI classes: A representative study in Germany

BACKGROUND

Changes in body mass index (BMI) over the course of one's lifetime are related to the development of mental disorders. In the current study we compared symptoms of depression, generalized anxiety as well as general health status in the four BMI-classes: underweight, normal weight, overweight and obesity. Furthermore, mediator role of general health status on the relationship between BMI and depression and generalized anxiety was analyzed.

METHODS

A representative sample (random-route sampling) of the German population (N = 2350) was investigated in a cross-sectional survey by measuring the three questionnaires PHQ-9, GAD-7 and EQ-5D-5L.

RESULTS

The results showed significant differences between the four BMI-classes in all three questionnaires. Individuals with obesity demonstrated higher values in depression, anxiety and general health compared to the three other BMI-classes. However, there was no U-shaped association between BMI and depression, anxiety and health-related quality of life. Regarding to the mediation analysis, general health status fully mediated the association between BMI, depressive symptoms as well as generalized anxiety symptoms.

LIMITATIONS

The assessment of the three factors depression, anxiety and general health status were measured by questionnaires, but no clinical diagnoses can be provided.

CONCLUSIONS

Evidence supports that individuals with obesity have an increased risk for depression and anxiety as well as lower general health. Further research on potential intervention and strategies in public health policies is needed to be able to target the developing of mental disorders in individuals with obesity. Taking their general health status into account is also of great importance.